Patient Services by our Psychiatrists
Encino Psychiatrists Karen L. Vause and Ramzi Kiriakos
Encino Psychiatrists
16550 Ventura Blvd.
Suite 212
Encino, CA 91436
Direct Contact Information
Karen Vause, MD (818) 995-0640
Ramzi Kiriakos, MD (818) 881-8208
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Patient Services

Encino Psychiatrists offer the following therapy services:

 

Complete Psychiatric Evaluation

To be able to address a psychiatric issue that a person may have, we have to assess thoroughly what is the diagnosis as precisely and as comprehensively as possible. To start:  a good history of the most important concerns and symptoms that bring you to treatment. Are you unable to function at school, at home or at work? Can you enjoy your leisure time? Is it harder to get along with people than before?

We start by asking about your psychiatric history, your history of school, work and relationships with others, a complete physical history of any existing medical problems and all the medications that you are currently taking. Sometimes we may need to conduct psychological and laboratory testing. We also ask about your history of substance use. A family history is frequently helpful, since the same illnesses can occur in multiple family members. The same illness may manifest itself with different variations. It is important when treating adolescents to involve family members. Even when treating adults, involving significant others will help to define various problems and will help to reach a satisfactory and effective treatment. 

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Individual Therapy

Depending on your individual needs, most of the time best results are obtained by a combination of therapy and various degrees of reliance on medications. In many cases the use of medications is not needed. In other cases the best results for individuals are obtained with a combination of therapy and medications.

Using Supportive Therapy we help you cope and understand a chronic condition. We help you to identify the different treatment or accommodation options with their strengths and weaknesses available to you. We can help you identify your strengths. This will increase your coping skills.

For more information visit Individual Psychotherapy

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Couples Therapy

Many times partners have problems getting along. This could happen to spouses, life partners or to business partners. It can also occur that siblings may wish to get along better. In couples therapy we help the partners to identify the points of difference that cause irritation and difficulties and the positive attributes that cause attraction and satisfaction. The identifications take place by improving communication. The next phase attempts to change what can be changed, to be sensitive to what irritates each other and also to learn to tolerate what cannot be changed. This can help the partners to have a more successful and more gratifying relationship.

For more information visit Couples Therapy

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Family Therapy

Many times in families there are conflicts. Usually this occurs with children living with their parents. Many situations can lead to this. It may be that the parents disagree over the way they treat each other, or to the way they set the rules in the family. Sometimes in a family, one member intimidates the whole family. Frequently if a parent or child is addicted to alcohol or substances this can lead to a lot of problems. Similar problems arise if one member is involved in excessive gambling.

Family therapy is needed with eating disorders, excessive shopping, sexual acting out and physical abuse. These are only examples of family conflicts among many others. It is not possible to address any of those problems without family therapy. Resolution of those conflicts usually can happen in 5 to 10 sessions with the family. The treatment approach in family therapy is similar to couple therapy.

For more information visit Family Therapy

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Cognitive Behavior Therapy (CBT)

Cognitive Behavior Therapy (CBT) is useful in the treatment of anxiety disorders and mood disorders. Cognitive behavior therapy is focused on the here and now and gives you exercises and tools to yourself of your symptoms in a focused approach. The results of CBT are relatively quick and the patient may reach remission in 10 to 16 weeks.

Cognitive Behavior Therapy assumes that the individual has developed patterns of thinking that lead to faulty behaviors and negative emotions. Cognitive Behavioral Therapy focuses on the here and now, attempting to change thinking, behavior and feelings in the present and the future. Less time and effort is spent on identifying childhood experiences that may have contributed to the behavior.

For more information visit Cognitive Behavior Therapy

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Medication Management

Our medication management depends on your individual needs and desires. Many times psychotherapy alone may accomplish the therapeutic goals. In many cases also adding psychotropics may accomplish a higher level of recovery. In some instances, like severe Bipolar Disorder, it is hard to obtain recovery without the use of psychotropics. When we assess psychotropics, we judge the risk benefit ratio, balancing potential side effects with possible therapeutic results. If you have other medical issues for which you are receiving other medications, we try to minimize drug interactions. We are generally inclined to prescribe non habit forming psychotropics. We try to start with a lower dose and increase to a higher dose until the therapeutic effect is obtained. Fortunately we now have a large number of antianxiety medications, antidepressant medications, mood stabilizer medications and hypnotic medications available to treat psychiatric conditions. Many of these medications are very effective and nonhabit forming if used as prescribed. Furthermore, there is a great deal of individual variation in term of response and side effects. Customizing the prescription to the individual patient and condition is imperative. Some mood stabilizers may require regular blood levels determinations via blood testing. Between the two of us we have treated over 10,000 patients in the last 15 years, as consultants to many hospitals. We have extensive experience managing psychotropic medications and their interaction and side effects.

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Duration of Medication Treatment

The duration of treatment depends on the individual. If a crisis that triggers the symptoms, the treatment may be time limited. When symptoms have been present for a long time, the treatment may take much longer. Some conditions require maintenance treatment similar to medical conditions like diabetes, hypertension and arthritis. Some examples are: Schizophrenia, Bipolar Disorder, ADHD and in some cases Obsessive Compulsive Disorder.

For more information visit Medication Management

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Therapy for Women’s Health Issues

Some of the issues we will address here occur in both genders. They are either more frequent in women and some of them are exclusive to women. It is to be noted that both of us as Psychiatrists are interested and experienced in handling and treating women’s psychological health issues. Some examples are: adjustment to body image changes (which may lead to anorexia, bulimia and obesity), mood changes associated with cyclical hormonal changes (premenstrual syndrome/ PMS), sexually transmitted diseases (STD), pregnancy, and infertility, depression with pregnancy, postpartum depression, lactation issues and caring for the newly born. Adoption, empty nest syndrome, adjustment to malignancy such as breast cancer, uterine cancer and other cancers affecting health, energy and body image. A common problem is insomnia.

Women's health issues require sensitivity and experience in identifying them. Treatment can be with therapy and many times with the help of medications. Women may have general anxiety, depression or obsessive compulsive behavior associated with the life changes and medical conditions listed above. We listen closely to women’s concerns and take their symptoms seriously. We believe treatment is a collaborative effort between doctor and patient.

For more information visit Therapy for Women’s Health Issues

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Caring for Loved Ones with Special Needs

Many times a man or woman is expected to care for a loved one with special needs. The caregiver may be under great stress to provide the care necessary for their loved one. We can help those caregivers by giving the advice, logistic solutions and the psychological support. Sometimes the caregivers may themselves become ill. They may develop anxiety disorders, mood disorders, commonly depression or insomnia. We can assist caregivers with their needs by giving them therapy and medications, if needed. People caring for: mentally challenged children, children with autism, children with severe learning disabilities, ADHD, children with behavioral problems, adults with mental or physical disabilities, or aging family members needing assistance due to mental or physical decline may experience the need for additional support.

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Consultation for Other Professionals

We both welcome referrals for second opinion from other professionals in the field. We also welcome referrals from other therapists who cannot prescribe medication. We can complete a medication evaluation for their patients and provide periodic medication visits, our goal is to collaborate with the referring therapist and provide feedback to coordinate care.

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Consultation for Attorneys

Frequently, accidental physical trauma, chemical trauma, or wrongful termination from employment may be followed by psychological injury. Psychological injury may manifest as Post Traumatic Stress Disorder (PTSD), Major Depression, Anxiety Disorder or many other psychiatric complications. We are experienced in evaluating the psychological injury, assessing the possible complication and projecting possible prognosis. We can also estimate the duration and cost of treatment, as well as the requirement for rehabilitation to obtain recovery. In some cases complete recovery is not possible and we can assess those issues. Consultation requests for Comprehensive Psychiatric Evaluations from attorneys are welcomed.

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Supportive Therapy

This type of treatment and therapy is very helpful in some acute situations. It can also be helpful with more lasting life concerns.

Examples of acute situations where Supportive Therapy would be useful:
  • Starting a new relationship and having difficulties sorting out your feelings about the relationship.
  • Preparing to leave home and start college.
  • Adjusting to a new job.
  • Sudden loss of a loved one.
  • Sudden loss of fortune.

Many people cope with these situations on their own or with the help of a friend or relative. Sometimes outside professional help is needed.

In supportive psychotherapy, the psychiatrist brings objectivity with empathy and concern. Experience and training with these situations can add another dimension to the situation. Each component of the situation is reviewed carefully.  Various factors that cause distress can be evaluated objectively and solutions can be explored with the guidance of the psychiatrist. The advantages and disadvantages of various solutions can be weighed. This will help the individual seeking help to have a sense of control. The process of receiving help brings a sense of relief and resolution.

For more lasting life concerns, supportive therapy can be extremely helpful for individuals:
  • Losing a spouse through divorce or death
  • Caring for children without a partner
  • Sudden diagnosis of a chronic illness that can cause permanent disability or reduction in vitality and energy
  • Adjusting to life threatening illness like cancer

Such conditions require adjustment. Supportive therapy will improve the subjective quality of life and increase the person’s capacity to function and adapt.

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Dynamic Psychotherapy

This form of therapy is used frequently when supportive therapy or cognitive behavior therapy has failed to bring to a resolution the disorder a patient is having.

Dynamic therapy is effective with anxiety disorder, phobic disorders, depression, OCD, and post-traumatic stress disorder.

The premise of dynamic therapy is that unconscious forces can cause the appearance of symptoms and disorders. The unconscious forces are driven by innate instinctive drives or experiential developmental issues that can cause conflicts which manifest themselves in the form of disorders. 

It is conceivable that during early development, the basic needs for acknowledging the child as a separate being have not been satisfying for the child. (faulty mirroring)  This may lead to a low sense of self-esteem and multiple psychological complications and the appearance of different disorders as an adult such as depression, anxiety and obsessive compulsive disorder. Those conflicts can be resolved when optimal empathy is experienced during therapy long enough to heal the damage caused by the faulty mirroring and the empathic failure.

Another example would be if a child during his development had strong innate drives to accomplish and impress his parents and outclass his siblings. This may cause a sense of guilt and a false perception of “being bad”. These feelings may lead to anxiety and depression. Medication management, supportive therapy or cognitive behavioral therapy may not lead to the resolution of the underlying conflicts and the lifting of anxiety and depression. Dynamic therapy may identify the components of the unconscious conflict and may help to bring a resolution of the feelings of guilt, control of the depression and anxiety.

To summarize, not all forms of treatment are best for all patients. In some cases, multiple forms of treatment may be the best solution for the patient, especially in the case of treatment resistant illnesses.

 

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