Bridging the Divide Between Specialties to Treat the Whole Patient

April 3, 2017

NEW YORK CITY—Immune-mediated inflammatory diseases (IMIDs) and mental health conditions have many common elements, and clinicians must work together across specialties to properly treat the whole patient, a pair of speakers said at the Interdisciplinary Autoimmune Summit.

“This dividing business we’ve been doing since we went to medical school, or nursing school, or [physician assistant] school, is incredibly damaging,” Psych Congress co-chair psychiatrist Rakesh Jain, MD, MPH, said. “Divide no more. The differences between our specialties are almost negligible.”

Psychotherapist and Psych Congress Steering Committee member Saundra Jain, MA, PsyD, LPC, said clinicians undergoing training develop a badge of honor and pride about their specialties, no matter what they are.

“I say keep that, hold on to that pride, because we should be proud of our accomplishments.

But when it gets down to where the rubber meets the road, in practice, face-to-face with patients, we need to push that aside because we are all taking care of the same patients,” she said.

Rakesh and Saundra Jain at IASResearch has shown high associations between various psychiatric disorders and IMIDs, including rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, inflammatory bowel disease, and hidradenitis suppurativa, Dr. Rakesh Jain, Clinical Professor, Department of Psychiatry, Texas Tech University School of Medicine, Midland, Texas, explained in his presentation. However, he said, mental health conditions are often not detected or treated by specialists from other fields.

Dr. Rakesh Jain was himself diagnosed with rheumatoid arthritis in 2011. He said he has been treated by 4 rheumatologists and 4 rheumatology nurses, in various types of settings, and taken many different types of medications. Yet none of the doctors or nurses ever asked about his sleep, mood, anxiety, nutritional health, or mental wellness.

“You cannot, you cannot walk away from issues above the neck, because they directly will impact everything you are touching,” Dr. Rakesh Jain told the attendees at the meeting, designed for rheumatologists, dermatologists, immunologists, gastroenterologists, and allied health care professionals. “You have to be interested in the patients’ mental health. It’s not optional.”

He explained the various neurobiological ways in which inflammation overlaps with stress and mental health disorders, and how each condition can affect the other.  For example, abnormalities in T and B lymphocyte cells are seen in both inflammatory disorders and psychiatric disorders

He said there are 3 major threads which tie inflammation, pain, and mental health together—the hypothalamic-pituitary axis, inflammatory cytokines, and the autonomic nervous system— and problems with each can be addressed through nonpharmacological interventions. Such techniques can not only reduce symptoms, but also improve the pathologies involved in IMIDs, he said.

“Nonpharmacological does not mean nonbiological. You can be incredibly biological by being nonpharmacological,” Dr. Rakesh Jain said. “If you have any interest in inflammatory disorders … you must embrace them and embrace them hard. The evidence for that is, I think, quite clear.”