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Psychiatrists are asked to deal with a vast array of mental health, substance-related, and social issues, often within the same clinical encounter. Addressing the full set of biopsychosocial concerns can be a daunting task, particularly if the primary—or only—tool in our toolbox is limited to prescribing medications. Although medications and other somatic treatments can be very effective for the syndromes we treat, the sad truth is that many patients respond only partially, or not at all, to medication treatment. Some initial responders experience medication “burnout” and find themselves receiving increasing medication regimens, with increasing side effects, in an attempt to get symptoms under control again. Other patients have difficulty taking their medications as prescribed. Aside from issues with medications, some patients live in such dire social circumstances that the prescriptions we write are little more than bandages on the source of their pain. Significant issues with drugs and alcohol and other addictive behaviors can create chaos and lead to more psychiatric symptoms. Even with more straightforward patients, many do not comply with our suggestions to use sleep hygiene, exercise, socialize, or engage in other behaviors that will improve their health.
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