Psychiatry & Psychology

What our psychiatry unit covers

Psychiatry is the medical specialty of mental health — mood, anxiety, thought, memory, attention and the mind’s relationship with the body — and a psychiatrist is a physician first, which shapes everything about how this unit works: assessment that considers the whole person including their physical health and medicines, diagnosis made carefully rather than quickly, and treatment that can draw on medication, psychotherapy and brain-stimulation methods together rather than championing one against the others. At Acıbadem International the psychiatry and psychology unit works across the group’s hospitals, alongside every other specialty in them — because depression complicates heart disease, delirium complicates surgery, and no hospital treats bodies well while ignoring minds.

The work falls into six strands.

• Assessment and second opinions — a thorough psychiatric evaluation, a diagnosis revisited, or a treatment plan reviewed when progress has stalled.
• Mood and anxiety disorders — depression including treatment-resistant depression, bipolar disorder, and the anxiety family.
• Psychosis — early recognition, treatment, and the long-term care schizophrenia deserves.
• Interventional treatments — ketamine-based therapy, TMS and ECT, honestly framed for who they genuinely help.
• Assessment of adult ADHD and autism — structured, evidence-based evaluation rather than a checkbox exercise.
• Psychiatry across life stages and illnesses — older-age psychiatry, perinatal mental health, and the psychiatric side of medical illness.

Honesty about boundaries belongs at the start here more than anywhere. This unit treats adults; children and adolescents are seen within their own specialty. Long-term weekly psychotherapy is a relationship built over months with a therapist near where you live — a visit here can diagnose, plan and begin, but not substitute for it, and we say so. And a psychiatric crisis is not managed by a webpage in any country: psychiatric emergencies are treated in hospital, and everything written in this guide assumes a reader with the time to read it.

Psychiatrist vs psychologist — who does what

Psychiatrist vs psychologist is the most-asked question in all of mental health, and the answer is a division of training, not of rank. A psychiatrist is a medical doctor who specialised in mental health after medical school: they diagnose, prescribe and manage medication, order and interpret physical investigations, and treat the severe end of illness — psychosis, bipolar disorder, complex depression — where medical management is central. A psychologist holds an advanced degree in psychology: assessment with structured psychological testing and, above all, psychotherapy — the talking treatments — are their craft, and in most countries they do not prescribe. Between and around them work psychotherapists and counsellors of varying training, which is why asking about anyone’s actual qualifications is a legitimate, normal question that good clinicians answer without offence.

Which one do you need first?

A useful rule of thumb rather than a law: symptoms that are severe, worsening, or entangled with physical health or existing medicines usually deserve a psychiatrist’s assessment first, because the medical questions need answering before or alongside therapy; milder difficulties with a clear life context often start well with a psychologist. The honest footnote is that the two work best together — much of modern evidence supports combining medication and psychotherapy for moderate-to-severe conditions — and in this unit psychiatrists and psychologists share patients deliberately rather than competing for them.

What does a psychiatrist do?

What does a psychiatrist do in practice? They take a history most of medicine no longer has time for — the story of your symptoms, sleep, energy, appetite, thinking, relationships, work, losses, substances, medical conditions and medicines, and what has already been tried — and they examine mental state the way a cardiologist examines a heart, systematically rather than casually. Then they do the specifically medical work: excluding the physical mimics (thyroid disease, anaemia, medication effects and more masquerade as psychiatric illness often enough that checking is standard), naming the diagnosis with its honest degree of certainty, prescribing and adjusting medication where it is indicated, delivering or arranging the right psychotherapy, and coordinating the interventional options when standard treatment has not been enough. Follow-up is the other half of the job: psychiatric treatment is titrated against a life, not a lab value, and the doctor who adjusts it needs to know the life.

The psychiatric evaluation — what actually happens

A psychiatric evaluation is a structured conversation, usually sixty to ninety minutes for a first assessment, and knowing its shape in advance removes most of the anxiety people bring to it. Expect questions about the present problem and its timeline; about sleep, appetite, energy, concentration and mood through the day; about past episodes and past treatments — what helped, what did not, what was never given a fair trial; about your medical history and every medicine and substance you use, because these change both diagnosis and prescribing; and about family history, since much of psychiatry runs in families. Expect also the questions that surprise people — about safety, about experiences like hearing or seeing things others do not — asked routinely of everyone, because asking routinely is how nothing important is missed.

What an honest evaluation will not do

It will not always end in a diagnosis on day one — some presentations genuinely need a second visit, collateral history from someone who knows you, structured questionnaires or blood tests before a label is fair — and an assessment that ends with “here is what we know, here is what we still need” is being careful, not evasive. It will also not end with a prescription by default: medication is one tool, indicated for some presentations and not others, and a first consultation that ends with a plan rather than a pill is often exactly right.

Depression tests, anxiety tests, bipolar tests — what screening really is

The internet is full of them: a depression test in ten questions, an anxiety test, a bipolar test promising to sort you in minutes — and the honest correction this section exists for is that these are screening questionnaires, not diagnoses. The reputable ones (the PHQ-9 and GAD-7 families and their relatives) are genuinely useful instruments that clinics themselves use — to measure severity, to track change over weeks, to make sure nothing is missed — but they measure symptom load, not cause: grief, thyroid disease, poor sleep, medication effects and half a dozen other things score on the same questions. A high score means “worth assessing properly”, never “you have the disorder”; a low score in someone who feels genuinely unwell means “keep asking”, never “nothing is wrong”. Used that way — as a thermometer rather than a verdict — they are welcome in any consultation here, including the ones you bring with you already filled in.

Why online bipolar tests mislead most often

Bipolar disorder is the diagnosis online tests handle worst, because its defining feature — a sustained episode of elevated or irritable mood with changed energy and behaviour — is a pattern over time, not a feeling in the moment, and questionnaire items about racing thoughts or mood swings capture anxiety, ADHD, personality style and ordinary human variation just as readily. The consequences of a wrong answer run in both directions and both are costly, which is why the pattern is established with a careful history, ideally with someone who has known you across years, before the word is used. The bipolar section carries the honest version.

Depression — and what “treatment-resistant” really means

Depression in the clinical sense is not sadness scaled up: it is a sustained change — weeks, not days — in mood, interest, energy, sleep, appetite, concentration and self-worth that takes the colour out of things that used to matter. It is common, it is treatable, and both halves of that sentence deserve equal weight, because the illness itself whispers that nothing will help, and that whisper is a symptom, not a forecast. First-line treatment is well established: psychotherapy, antidepressant medication, or both together for moderate-to-severe illness, with exercise, sleep repair and alcohol reduction as genuine adjuncts rather than platitudes.

Treatment resistant depression — a stage, not a verdict

Treatment resistant depression is the label used when adequate trials of standard treatments have not brought recovery — and every word of “adequate trial” matters, because the commonest thing an honest re-assessment finds is that previous treatments were never given at the right dose, for the right duration, or with the diagnosis right in the first place: unrecognised bipolar disorder, thyroid disease, sleep apnoea, alcohol and untreated life circumstances are the classic impostors. When resistance is real, the toolkit is genuinely deeper than it was a decade ago — augmentation strategies, the ketamine-based treatments, TMS and ECT described in their own sections — and the honest sequencing of those options against a full treatment history is the classic subject of a psychiatric second opinion.

Anxiety disorders — the treatable family

Anxiety disorders begin where anxiety stops being proportionate and starts running the schedule — panic attacks and the fear of the next one, worry that will not switch off, social fear that shrinks a life, phobias, and the obsessive-compulsive and trauma-related conditions that sit near them. Two honest facts frame treatment. First, anxiety disorders are among the most treatable conditions in psychiatry: structured psychotherapy (CBT above all) has evidence of full recovery for many of them, medication helps substantially, and the combination is often best. Second, the body is a full participant — palpitations, chest tightness, dizziness and breathlessness are anxiety’s vocabulary — which cuts both ways: new physical symptoms deserve proper medical assessment rather than automatic attribution to anxiety, and once assessed, re-testing the same symptom monthly feeds the disorder rather than soothing it. This unit sits inside a general hospital precisely so both halves of that sentence can be done properly.

Bipolar disorder — pattern over time

Bipolar disorder is defined by episodes: periods of depression alternating with periods of elevated, expansive or irritable mood — mania or its milder form hypomania — with changed energy, sleep need, judgement and behaviour. The diagnosis is a biography, not a blood test, which is why it is made carefully (per the section on what tests can and cannot do) and why it is worth making: treatment differs fundamentally from unipolar depression, and antidepressants given alone to someone with unrecognised bipolar disorder can destabilise rather than help — one of the commonest correctable findings in second-opinion work.

Mood stabilisers and lithium levels

Long-term treatment rests on mood stabilisers, and lithium — the oldest — remains among the best-evidenced medicines in psychiatry, with a genuinely protective effect that newer options have not simply replaced. It is also a medicine with a narrow window, which is why lithium levels are checked on a schedule: blood tests that confirm the dose is in the effective range and protect the kidneys and thyroid over years. The specific numbers belong to the prescriber and the laboratory; what belongs to you is the principle — level checks are not bureaucracy but the thing that makes lithium safe — and the standing rule this platform repeats for every psychiatric medicine: doses change with the prescriber, never unilaterally, because abrupt changes are exactly what destabilises a well-controlled illness.

Psychosis and schizophrenia — early, honest, long-term

Psychosis means losing the shared thread of reality — hallucinations, fixed false beliefs, disorganised thinking — and it is a syndrome with many causes, from primary illnesses like schizophrenia through mood episodes with psychotic features to medical and substance-related states that a physician-led assessment exists to separate. The single most useful fact in this territory: outcomes are consistently better the earlier treatment starts, which is why a first episode of psychosis is treated as a priority everywhere in modern psychiatry, and why worrying early changes deserve assessment rather than watchful silence.

First episode psychosis

First episode psychosis typically emerges in the late teens and twenties, often after a prodrome of withdrawal, slipping function and odd perceptual experiences that families recognise in hindsight. The first assessment is genuinely medical — imaging, blood work and substance history alongside the psychiatric examination, because first presentations can have physical causes — and the first treatment phase is where long-term trajectories are shaped: careful antipsychotic choice at the lowest effective dose, family involvement, and protecting education and work as treatment goals in their own right, not luxuries.

Clozapine — the drug with its own section

Clozapine earns individual mention because it occupies a unique position: for schizophrenia that has not responded to adequate trials of other antipsychotics, it is the single treatment with clearly superior evidence — and it is under-used worldwide because it demands structure: scheduled blood monitoring, especially early on, to catch a rare but serious white-cell side effect, plus attention to a handful of other known risks the prescribing team watches for by protocol. For the right person, taken with its monitoring, it is life-changing far more often than folklore suggests; the decision, the initiation and every adjustment belong to the treating psychiatrist within that monitoring system.

Psychiatric medication — managed honestly

Psychiatric medication works — the evidence for antidepressants, mood stabilisers, antipsychotics and the rest is real — and they are also routinely mismanaged in both directions: prescribed without the follow-up that makes them safe and effective, or feared and abandoned on the internet’s advice. This unit’s approach is neither evangelism nor apology: medication where it is indicated, at adequate dose for adequate time, reviewed against a named goal, and stopped properly when its work is done.

Starting, changing, stopping — and antidepressant withdrawal

Three rules cover most of what goes wrong. Effects take time: most antidepressants need weeks for full effect, and early side effects often fade — judging a medicine in week one wastes the trial. Changes are made with the prescriber: doses are not adjusted, split or stopped unilaterally, because several of these medicines produce genuine discontinuation symptoms when stopped abruptly, and because relapse after sudden stopping is common and avoidable — antidepressant withdrawal is real, manageable, and planned for with a gradual, supervised taper when the time to stop genuinely comes. And combinations are reviewed as a whole: interactions between psychiatric medicines, other prescriptions and substances are a routine part of every consultation here, not an afterthought.

Serotonin syndrome — one plain paragraph

Serotonin syndrome is a rare but serious reaction to excess serotonin activity — usually from combining several serotonergic medicines or adding certain painkillers or supplements to them — producing agitation, tremor, sweating, racing heart, muscle twitching and fever in the severe form. Severe serotonin syndrome is a medical emergency treated in hospital. The practical takeaways are unglamorous: every prescriber you see should know your full medicine list including supplements, and new combinations are checked before they start — precisely the review this unit performs as routine.

Ketamine therapy — promise, limits and the honest frame

Ketamine therapy is the most talked-about development in depression treatment in a generation, and it deserves both halves of an honest description. The promise is real: for some people with depression that has resisted standard treatment, ketamine-based treatment can lift symptoms within days rather than weeks — a speed nothing older offers — and that includes people who had stopped believing anything would work. The limits are equally real: the effect is often temporary and needs a maintenance plan, it does not help everyone, it is an adjunct to comprehensive care rather than a replacement for it, and it is a dissociative anaesthetic with abuse potential, which is why the setting and the team matter as much as the molecule.

Ketamine for depression — how it is actually given

Ketamine for depression is delivered in supervised clinical settings in two main forms: intravenous ketamine infusion sessions with monitoring throughout and a recovery period after, or esketamine (the licensed nasal form, brand name Spravato) given under direct clinical observation on a defined schedule alongside an oral antidepressant. Candidacy is a psychiatric decision — an assessment of diagnosis, treatment history, physical health, blood pressure and substance history comes first — and continuation is decided against measured response, not enthusiasm. What this looks like in practice is closer to a day-unit medical treatment than to the lounge-like “ketamine clinics” that advertise online; where a clinic offers ketamine without psychiatric assessment, monitoring or a plan for what happens after, the honest word for that is a warning sign, whatever country it is in.

TMS treatment (transcranial magnetic stimulation), realistically

TMS treatment — transcranial magnetic stimulation, delivered as repetitive rTMS — uses focused magnetic pulses to stimulate the brain regions involved in mood regulation, without anaesthesia, without memory effects, and without the systemic side effects of medication: you sit in a chair, awake, for sessions of minutes over several weeks, and drive yourself home afterwards. It is an evidence-based option for depression that has not responded to medication, with a realistic framing: a meaningful share of suitable patients respond, a smaller share remit, the commonest side effects are scalp discomfort and headache, and the serious one — seizure — is rare with modern protocols and screened for beforehand. The honest comparison: gentler than ECT and less powerful; slower than ketamine and free of its dissociation; a genuine middle instrument, chosen when its profile fits the person.

ECT treatment (electroconvulsive therapy) — the option nobody wants to need

Electroconvulsive therapy has a reputation set by films made before modern practice, and correcting it plainly matters, because ECT treatment remains the single most effective treatment for severe depression — particularly with psychosis, life-threatening food refusal, or when previous ECT helped — and for some other severe states where speed genuinely matters. Modern ECT is done under brief general anaesthesia with muscle relaxation, in a monitored setting, as a course of short sessions: no one experiences the scene from the films. The honest cost is cognitive: temporary confusion after sessions and, for some, patchy memory loss around the treatment period that usually improves but can persist for events near the course — a real trade-off, weighed openly against what severe untreated illness costs, with consent that treats you as an adult. Units that offer ECT alongside ketamine and TMS can match the instrument to the situation instead of overusing whichever one they own — the machine-park honesty this platform applies everywhere.

Psychotherapy — and how it pairs with everything else

Psychotherapy is treatment, not garnish: for many conditions structured talking therapy has evidence equal to medication, and for some it is superior — with effects that outlast the course in a way tablets alone cannot claim. The evidence-based families matter more than brand names: cognitive-behavioural therapy and its relatives for depression, anxiety and OCD; trauma-focused approaches including EMDR where trauma is central; interpersonal and behavioural-activation approaches for depression; family-based work where the system is part of the picture. Two honest notes complete the picture. Combination usually beats either alone for moderate-to-severe illness — the medication-versus-therapy war is a social-media phenomenon, not a scientific one. And therapy is a course of work over months in a language you think in: what an international visit realistically delivers is assessment, a clear formulation, the start of the right approach and a referral plan for continuing near home — promising more than that would be selling geography, not therapy.

How long does therapy take?

How long does therapy take is an answerable question despite the folklore: evidence-based therapies for defined problems typically run as structured courses measured in weeks to a few months, with progress reviewed against goals along the way — and a therapy with no goals, no review points and no expected endpoint deserves the same scrutiny as a medicine prescribed forever without review. Longer work has its legitimate place for longstanding patterns; the point is that duration should be a plan, not a drift.

ADHD and autism assessment in adults

Adult ADHD and adult autism are real, commonly missed, and currently much discussed — and all three facts are true at once, which is exactly why assessment has to be structured rather than impressionistic, in either direction. Many adults, particularly women, genuinely reached adulthood undiagnosed and deserve the explanation and the treatment options a proper diagnosis unlocks; at the same time, attention problems are among the least specific symptoms in psychiatry — depression, anxiety, poor sleep, thyroid disease and modern life all impair concentration — and an assessment worth having must be able to say no as credibly as it says yes.

What a real adult ADHD assessment involves

A credible adult ADHD assessment is more than a questionnaire: a developmental history reaching back to childhood (ADHD does not begin at thirty — evidence of lifelong pattern is part of the diagnosis, often with school reports or a parent’s account), structured symptom instruments, an honest screen for the conditions that mimic or accompany it, and a functional picture of how symptoms actually play out at work and home. When the diagnosis is made, treatment options — medication with its monitoring, and the skills-based approaches that complement it — are laid out with their real trade-offs; when it is not, the assessment should end with what better explains the symptoms, because “not ADHD” is only half an answer.

Autism assessment for adults

Autism assessment for adults follows the same logic with its own instruments: a developmental history, structured diagnostic interviews, and attention to the camouflaging that lets many autistic adults — again, especially women — pass undetected at the cost of exhaustion. An adult diagnosis changes no one’s past but often reorganises it: the point of assessment at this stage of life is explanation, self-understanding, workplace and relationship adjustments, and untangling what belongs to autism from the anxiety and depression that so often travel with it. It is an assessment, honestly delivered — there is no medication for autism itself, and a unit that says so plainly is the kind worth being assessed by.

Geriatric psychiatry (old age psychiatry)

Geriatric psychiatry — old age psychiatry, in the British term — exists because minds age in medical company: depression in later life hides behind physical complaints and gets dismissed as “understandable”, memory concerns raise the dementia question long before anyone says the word, and medicines accumulated across decades do more psychiatric harm in older adults than in anyone else. A geriatric psychiatrist works exactly at those junctions. Three of them recur. Depression versus dementia: late-life depression can impair memory and concentration so convincingly it earns the name pseudodementia — and it is treatable, which makes distinguishing it from true cognitive decline one of the highest-value assessments in this field, done with structured cognitive testing alongside the psychiatric examination and, where needed, the neurology unit’s work-up. Delirium: sudden confusion in an older adult — hours to days, fluctuating, often with a medical trigger — is a medical emergency treated in hospital, and it is routinely mistaken for dementia by frightened families; the distinction is speed of onset, and it matters because delirium’s causes are findable and treatable. And medication burden: the anticholinergic load and sedative stacking that internal medicine’s pages describe apply doubly here, and a medication review is often the single most therapeutic act in an older adult’s psychiatric care — done, as always on this platform, by the prescribers rather than by stopping things at home.

Perinatal mental health — pregnancy, birth and the year after

Perinatal mental health covers pregnancy and the first postpartum year — the period when women are most commonly told their symptoms are “just hormones” and when honest, specific perinatal psychiatry matters most. The spectrum is wide and mostly treatable: antenatal and postpartum depression and anxiety, birth-related trauma, and — rare, serious and treated in hospital — postpartum psychosis, which typically declares itself in the first weeks after delivery with confusion, rapidly shifting mood and beliefs that frighten the family; naming it plainly here is part of honest information, because early treatment protects both mother and baby. Two practical truths shape everything else. Treatment decisions in pregnancy and breastfeeding are individualised risk-balancing — untreated illness carries its own real risks to mother and child, so “stop everything while pregnant” is not the safe default it sounds; those decisions are made with the prescriber and, where relevant, with perinatology and obstetrics at the table. And the exhausted first postpartum year hides physical mimics — the endocrinology unit’s postpartum thyroiditis discussion names the classic one — which is why assessment here stays medical as well as psychological.

Psychiatry inside medical illness — consultation-liaison work

Consultation-liaison psychiatry is the specialty’s hospital-facing half: depression and anxiety complicating cancer, heart disease and transplant; delirium on surgical wards; the psychological load of chronic illness; and the untangling of symptoms that sit between body and mind. It matters to this platform’s readers in one specific way: mental health care here does not live in a building apart — a patient treated for cancer or heart disease in an Acıbadem hospital can have psychiatric assessment and support woven into that admission, and the medical teams can call on it routinely. Depression alongside serious physical illness is not “understandable and therefore untreatable”; it is common, it worsens medical outcomes, and it responds to treatment — which is why asking for this kind of support during medical treatment is normal practice, not an admission of weakness.

Inpatient psychiatry — when hospital is the right setting

Most psychiatric care is outpatient, and inpatient psychiatry exists for the situations where safety, severity or the treatment itself needs a hospital around it: severe depression with inability to eat or care for oneself, mania, psychosis in crisis, medically complicated withdrawal, and treatments like ECT courses that are simpler to deliver admitted. An honest description of a modern psychiatric admission: structured days, daily medical review, medication changes made quickly because response can be watched, family involvement, and discharge planning that starts on day one — closer to any other specialist admission than to the asylum imagery the word still carries. Admission is overwhelmingly voluntary; the narrow legal exceptions that exist everywhere in the world are governed by law and medical necessity, and a unit that explains those rules openly when asked is behaving properly, not ominously.

Crisis, stated plainly

A guide is information, and a mental health crisis is not an information problem. Stated once and plainly, in the same register this platform uses for every emergency: a psychiatric emergency — thoughts of ending one’s life with intent or a plan, psychosis in acute crisis, postpartum psychosis, inability to stay safe — is a medical emergency treated in hospital, immediately, wherever the person is; every Acıbadem hospital’s emergency service receives and stabilises psychiatric emergencies, as do emergency services everywhere. Suicide risk assessment is a core clinical skill practised at every psychiatric evaluation in this unit — asking directly, without euphemism, because decades of evidence show that asking about suicide does not plant the idea, it opens the door to help. That is the whole of what a webpage can responsibly do with this subject: name it without flinching, and hand it to people, not paragraphs.

Online psychiatry and the online psychiatrist — what genuinely works remotely

Online psychiatry works because psychiatry is the most teleconsultation-friendly specialty in medicine — assessment and follow-up are conversation, and the evidence for video-delivered care is solid — which makes an online psychiatrist consultation a genuinely good first step for an international patient: records reviewed, history taken, a provisional formulation and plan made, and an honest answer about whether travelling adds anything. The limits are equally concrete: prescribing across borders is constrained by law in both directions, controlled medicines (stimulants among them) especially so; emergencies cannot be managed by video; and some assessments — the structured ADHD and autism pathways, treatments like TMS, ketamine and ECT — need presence. The workable pattern is hybrid: begin remotely, travel if and when the plan needs it, continue follow-up remotely afterwards with a written handover to a local prescriber.

Coming from abroad for psychiatric care — the practical shape

Psychiatric care travels differently from surgery, and planning around three facts makes an international visit genuinely useful rather than symbolic. First, assessment concentrates well: an evaluation, structured testing, physical work-up and a tumour-board-style treatment plan fit into days — this is the highest-value thing to travel for, especially for second opinions on stalled treatment. Second, some treatments concentrate and some do not: a TMS course runs over weeks and an ECT course needs a stay, ketamine needs supervised sessions with a maintenance plan, while weekly psychotherapy belongs near home — the plan says which is which before flights are booked. Third, continuity is the treatment: every plan made here ends in a written handover — diagnosis, rationale, medication with its monitoring schedule, and the next decision point — for the psychiatrist or family doctor who continues it, because a brilliant plan that lands in no one’s hands at home is a holiday, not healthcare. Interpreters are part of the service; psychiatric care in a language you think in matters, and where a session needs it, it is arranged rather than improvised.