Treatment Method Profile: Psychiatry with Dr. Jesalva
Here at A Healing Place – The Estates, we understand the importance of addressing the physical symptoms of chronic pain, but also the co-occuring disorders that impact an individual’s perception of pain and their ability to function. These patients are complex with challenges that are unique to this population. We have found that psychiatry plays a crucial role in helping with these challenges. Every week in Treatment Team Planning meetings we discuss how to psychiatrically stabilize patients so they can get the most out of their stay with us. We sat down with our Psychiatrist, Dr. Ed Jesalva, to learn more about him and his role at A Healing Place – The Estates.
- To get things started, in your own words what role does psychiatry play in treating the unique population?
I think that psychiatry plays a pivotal role in the treatment of patients at AHP. It’s the biomedical part of the bio-psycho-social-spiritual framework, and functions as a stabilizing foundation for treatment of these complex patients. Often times, patients that come to AHP have a lot of difficulty with psychiatric disorders such as, bipolar, major depressive, generalized anxiety, and attention deficit. These disorders make it difficult for them to understand and implement the cognitive-behavioral tools offered while in treatment because their mood, anxiety or focus is impaired.
- What are some clinical areas of expertise in which you specialize?
I would say it is in stabilizing and treating patients with Complex Comorbidities. That means patients suffering with a mood disorder, anxiety disorder, PTSD, and ADD. These are very difficult patients to diagnose let alone stabilize. It is one of the biggest challenges in clinical practice today which I also find the most rewarding to treat.
- How does genomic testing and the use of additional assessment tools influence your treatment planning?
Genomic testing is making treatment easier these days. It enables me to understand which medications a patient can tolerate over several classes of psychotropic medications. It is also reveals which medications to avoid and prevent potential adverse reactions. Genomic testing has shortened the period of finding a medication that can potentially address a patient’s symptoms of depression and anxiety. Patients no longer have to undergo one medication trial after another hoping that they will tolerate and respond to a particular medication.
- What’s your biggest challenge as a psychiatrist working with treatment programs.
That would be diagnosing patients correctly. A good psychiatrist will have the skills necessary to come up with the right diagnoses and implement the correct treatments. In my experience, this is one of the most important components of treatment especially with patients who have complex comorbidities. Another key factor is treating the patient until they are feeling well and are functioning to their expected level. This takes close and careful monitoring and, at most times, relying on the other team members to give you their perspective on how the patient is doing.
- What are some of the most productive ways to utilize a psychiatrist’s skills in treatment planning?
Treatment planning is an opportunity to collaborate and get different perspectives on patients from multiple disciplines. It increases the database of behaviors and creates opportunities to solidify a diagnosis and customize a treatment plan.
Psychiatrists can give as well as receive information. Providing insight into the biological aspect of the patient’s behavior is important and could be considered the foundation of treatment. After all, if the brain is not functioning normally, it would be difficult to learn new behaviors and coping tools. Also, providing staff with target behaviors that are goals of treatment is helpful in measuring the success of medication treatment.
Receiving information from the staff is vitally as important. Behaviors that support the working diagnosis is reaffirming. Other times, behaviors that makes one suspicious of another disorder is very helpful in clarifying a diagnosis. An example is bipolar spectrum disorder. It has a subtle presentation and one has to have a sensitive ear and keen sense of observation in order to diagnose it. Otherwise treatment failures are a common occurrence.
- Please describe to us what exactly the Jesalva Algorithm is?
The Jesalva Algorithm is a method of diagnosing and treating patients with complex comorbidities. It is my own personal way of conceptualizing these challenging patients into a framework that is comprehensive yet addresses the unique needs of each individual patient so that they can return to normal functioning.
The elements I look for in my interview process include:
- The patient has to be motivated to change
- Comorbidity is the rule rather than the exception
- 5 most common disorders in private practice
- Major Depressive Disorders
- Bipolar disorder 2, cyclothymic disorder, bipolar spectrum disorder
- Using the Bipolar Spectrum Disorder Scale (BSDS) to screen
- Anxiety disorders (which are co-morbid with each other)
- Substance use disorders
- Anxiety is the biggest obstacle in achieving optimal
- Treat until the patient is well
- Genomic testing
- How is the Jesalva Algorithm different than other approaches to psychiatry?
I’m sure that my algorithm is not unique with other psychiatrist’s approach. However, I do feel that it takes time and effort to obtain the historical information from a patient so that a clinician can have all of the information necessary to make a diagnosis and treatment decision. This effort takes patience and sometimes intuitiveness on the clinician’s part. It is these attributes that a clinician needs that make the algorithm unique.
Dr. Ed S. Jesalva has been a psychiatrist since 1989. Born in the Philippines, he and his family emigrated to the US when he was a child and he was raised in Arlington Heights, Illinois. He began his education for the medical field with a Bachelor of Science in Chemistry from the University of Illinois. Dr. Jesalva completed his medical degree at the University of Health Sciences Chicago Medical School. With his sights set on becoming a psychiatrist, Dr. Jesalva then moved to California to complete his internship and residency in Psychiatry at Harbor General Hospital/UCLA Medical Center in Torrance, California.
Today, Dr. Jesalva maintains an active outpatient practice, treating adolescents, adults and the elderly who suffer from problems like mood disorders, ADD/ADHD, substance abuse and dementia. Dr. Jesalva is active in community education and frequently lectures on subjects like bipolar disorder, depression and psychopharmacology (managing mental health disorders with medications). In addition, he is an adjunct faculty member at Pepperdine University, teaching therapists and counselors about psychopharmacology. He also acts as a consultant to various local counseling centers, including Community Counseling Group, New Beginning Counseling Center and Conejo Valley Mental Health Professionals Association.
Dr. Jesalva believes that his role is to educate and support patients through a collaborative and multidisciplinary approach. His treatment framework addresses four dimensions: biological, psychological, sociological and spiritual. Dr. Jesalva sees mental disease as a chameleon, that can disable people’s ability to function effectively, destroy relationships or simply be something very subtle but insidious, preventing people from achieving happiness and fulfillment. Mental disease (and it truly is a disease) is often stigmatized, but just as people with diabetes or heart disease need treatment and support, so does someone with an illness of the mind.