Psychiatry is the medical Medicine is the science and art of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Before scientific medicine, healing arts were practised in accordance with alchemical treatments and ritual practices that developed out of religious and cultural traditions specialty A specialty in medicine is a branch of medical science. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency. Medical practitioners who engage in a medical specialty are known as medical specialists devoted to the study Biomedical research , in general simply known as medical research, is the basic research, applied research, or translational research conducted to aid and support the body of knowledge in the field of medicine. Medical research can be divided into two general categories: the evaluation of new treatments for both safety and efficacy in what are and treatment The treatment of mental disorders includes various forms of psychotherapy, psychiatric medication, and other practices of mental disorders A mental disorder or mental illness is a psychological or behavioral pattern associated with distress or disability that occurs in an individual and is not a part of normal development or culture. The recognition and understanding of mental health conditions has changed over time and across cultures, and there are still variations in the—which include various affective Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect", behavioural Behavior refers to the actions of an organism or system, usually in relation to its environment, which includes the other organisms or systems around as well as the physical environment. It is the response of the organism or system to various stimuli or inputs, whether internal or external, conscious or subconscious, overt or covert, and voluntary, cognitive Cognition is the scientific term for "the process of thought." Usage of the term varies in different disciplines; for example in psychology and cognitive science, it usually refers to an information processing view of an individual's psychological functions. Other interpretations of the meaning of cognition link it to the development of and perceptual In philosophy, psychology, and cognitive science, perception is the process of attaining awareness or understanding of sensory information. The word "perception" comes from the Latin words perceptio, percipio, and means "receiving, collecting, action of taking possession, apprehension with the mind or senses." disorders. The term was first coined by the German physician A physician—also known as doctor of medicine, medical doctor, or simply doctor—practices the ancient profession of medicine, which is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease or injury. This properly requires both a detailed knowledge of the academic disciplines underlying Johann Christian Reil Johann Christian Reil was a German physician, physiologist, anatomist and psychiatrist. He coined the term psychiatry or, in German, Psychiatrie in 1808 in 1808. It literally means the 'medical treatment of the mind' (psych-: mind; -iatry: medical treatment; from Greek iātrikos: medical, iāsthai: to heal). A medical doctor specializing in psychiatry is a psychiatrist A psychiatrist is a physician who specializes in psychiatry and is certified in treating mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy. As part of their evaluation of the patient, psychiatrists are one of the few mental health professionals who may prescribe psychiatric medication, conduct physical.

Mental disorders are currently conceptualized as disorders of brain circuits likely caused by developmental processes shaped by a complex interplay of genetics and experience.[3] In other words, the genetics of mental illness may really be the genetics of brain development, with different outcomes possible, depending on the biological and environmental context.[3]

Psychiatric assessment typically starts with a mental status examination The mental status examination abbreviated MSE, is an important part of the clinical assessment process in psychiatric practice. It is a structured way of observing and describing a patient's current state of mind, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, and the compilation of a case history. Psychological tests and physical examinations may be conducted, including on occasion the use of neuroimaging Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain. It is a relatively new discipline within medicine and neuroscience/psychology or other neurophysiological Neurophysiology is a part of physiology. Neurophysiology is the study of nervous system function. Primarily, it is connected with neurobiology, psychology, neurology, clinical neurophysiology, electrophysiology, biophysical neurophysiology, ethology, neuroanatomy, cognitive science and other brain sciences techniques. Mental disorders are diagnosed in accordance with criteria listed in diagnostic manuals such as the widely used Diagnostic and Statistical Manual of Mental Disorders The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, (DSM), published by the American Psychiatric Association The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international. The association publishes various journals and pamphlets, as well as the Diagnostic and Statistical, and the International Classification of Diseases The International Statistical Classification of Diseases and Related Health Problems provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Under this system, every health condition can be assigned to a unique category and given a (ICD) edited and used by the World Health Organization The World Health Organization is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health Organization, which had been an agency of the. The 5th edition of the DSM (DSM-5) is scheduled to be published in 2013, and is expected to have significant impact on many medical fields. [4]

Psychiatric treatment The treatment of mental disorders includes various forms of psychotherapy, psychiatric medication, and other practices applies a variety of modalities, including medication Psychopharmacology is the study of drug-induced changes in mood, sensation, thinking, and behavior, psychotherapy Psychotherapy, or personal counselling with a psychotherapist, is an intentional interpersonal relationship used by trained psychotherapists to aid a client or patient in problems of living and a wide range of other techniques such as transcranial magnetic stimulation Transcranial magnetic stimulation is a noninvasive method to excite the elementary unit of the nervous system; neurons in the brain: weak electric currents are induced in the tissue by rapidly changing magnetic fields (electromagnetic induction). This way, brain activity can be triggered with minimal discomfort, and the functionality of the. Treatment may be as an inpatient A patient is any person who receives medical attention, care, or treatment. The person is most often ill or injured and in need of treatment by a physician or other health care professional, although one who is visiting a physician for a routine check-up may also be viewed as a patient or outpatient A patient is any person who receives medical attention, care, or treatment. The person is most often ill or injured and in need of treatment by a physician or other health care professional, although one who is visiting a physician for a routine check-up may also be viewed as a patient, according to severity of function impairment/the disorder in question. Research and treatment within psychiatry as a whole are conducted on an interdisciplinary basis, sourcing an array of sub-specialties and theoretical approaches.

Philip Campbell, the Editor of the journal Nature Nature is a prominent British scientific journal, first published on 4 November 1869. It is the world's most highly cited interdisciplinary science journal. Most scientific journals are now highly specialized, and Nature is among the few journals that still publish original research articles across a wide range of scientific fields. There are many, has dubbed the 10-year period of 2010-2019 to be the “decade for psychiatric disorders,”[5] referring to the point that research on mental illness has, at long last, reached an inflection point at which insights gained from genetics and neuroscience would transform the understanding of psychiatric illnesses.[3] The esteemed Journal of the American Medical Association JAMA: The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world (JAMA) has also devoted its May 19, 2010 issue to the theme of mental health,[6] testifying to the central importance of mental disorders and mental health in medical practice.

Contents

History

Ancient times

Starting in the 5th century BC, mental disorders, especially those with psychotic Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are described as psychotic traits, were considered supernatural The term supernatural or supranatural pertains to being above or beyond what one holds to be natural. In the case of one who has strong scientific and atheist beliefs, the supernatural is anything unexplainable by natural law or phenomena. While one who holds mystical or heavenly beliefs may have no conception of supernatural phenomena, he or she in origin.[7] This view existed throughout ancient Greece Ancient Greece is the civilization belonging to the period of Greek history lasting from the Archaic period of the 8th to 6th centuries BC to 146 BC and the Roman conquest of Greece after the Battle of Corinth. At the center of this time period is Classical Greece, which flourished during the 5th to 4th centuries BC, at first under Athenian and Rome Ancient Rome was a civilization that grew out of a small agricultural community founded on the Italian Peninsula as early as the 10th century BC. Located along the Mediterranean Sea, it became one of the largest empires in the ancient world.[7] Early manuals written about mental disorders were created by the Greeks.[8] In the 4th century BC, Hippocrates Hippocrates of Cos or Hippokrates of Kos - Greek: Ἱπποκράτης; Hippokrátēs was an ancient Greek physician of the Age of Pericles (Classical Athens), and is considered one of the most outstanding figures in the history of medicine. He is referred to as the Western father of medicine in recognition of his lasting contributions to the theorized that physiological abnormalities may be the root of mental disorders.[7][7] Religious leaders and others returned to using early versions of exorcisms Exorcism is the practice of evicting demons or other spiritual entities from a person or place which they are believed to have possessed by causing the entity to swear an oath. The term became prominent in early Christianity from the early second century onward as the casting out of demons. Nevertheless, the practice is quite ancient and part of to treat mental disorders which often utilized cruel, harsh, and barbarous methods.[7]

Middle Ages

Main article: Islamic psychology Islamic psychology translates the term Ilm-al Nafsiat the science of the Nafs ("self" or "psyche") and refers to the medical and philosophical study of the psyche as it flowered during the Islamic Golden Age (8th–15th centuries)

The first psychiatric hospitals Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorder were built in the medieval Islamic world The Islamic Golden Age is traditionally dated from the mid-8th to the mid-13th century A.D. although it has been extended by one scholar to at least the 15th century. During this period, artists, engineers, scholars, poets, philosophers, geographers and traders in the Islamic world contributed to agriculture, the arts, economics, industry, law, from the 8th century. The first was built in Baghdad Baghdad is the capital of Iraq and of Baghdad Governorate, with which it is coterminous. Having a municipal population estimated between 7 and 7.5 million, it is the largest city in Iraq and the second largest city in the Arab World (after Cairo, Egypt) in 705 AD, followed by Fes Fes or Fez is the third largest city in Morocco, after Casablanca and Rabat with a population of 946,815 (2004 census). It is the capital of the Fès-Boulemane region in the early 8th century, and Cairo Cairo is the capital of Egypt, and the largest city in Africa, and the Arab World, as well as one of the most densely populated cities in the world. Nicknamed "The City of a Thousand Minarets" for its preponderance of Islamic architecture, Cairo has long been a center of the region's political and cultural life. Even before Cairo was in 800 AD. Unlike medieval Christian physicians who relied on demonological explanations Demonic possession is often the term used to describe the control over a human form by a demon. Descriptions of demonic possessions often include: erased memories or personalities, convulsions, “fits” and fainting as if one were dying. Unlike in channeling or other forms of possession, the subject has no control over the possessing entity and for mental illness, medieval Muslim physicians In the history of medicine, Islamic medicine or Arabic medicine refers to medicine developed in the medieval Islamic civilization and written in Arabic, the lingua franca of the Islamic civilization. Despite these names, a significant number of scientists during this period were not Arab. Some consider the label "Arab-Islamic" as relied mostly on clinical observations Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment and psychotherapy, although clinical. They made significant advances to psychiatry and were the first to provide psychotherapy Psychotherapy, or personal counselling with a psychotherapist, is an intentional interpersonal relationship used by trained psychotherapists to aid a client or patient in problems of living and moral treatment Moral Treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns. The movement is particularly associated with reform and development for mentally ill patients, in addition to other forms of treatment such as baths Bathing is the immersion of the body in a fluid, usually water or an aqueous solution. It may be practised for hygiene, religious or therapeutic purposes or as a recreational activity, drug medication A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease, music therapy Music therapy is both an allied health profession and a field of scientific research which studies correlations between the process of clinical therapy and biomusicology, musical acoustics, music theory, psychoacoustics and comparative musicology. It is an interpersonal process in which a trained music therapist uses music and all of its facets— and occupational therapy Occupational therapy promotes health by enabling people to perform meaningful and purposeful occupations. These include work, leisure, self care, domestic and community activities. Occupational therapists work with individuals, families, groups and communities to facilitate health and well-being through engagement or re-engagement in occupation. In the 10th century, the Persian The Persian people are defined by the use of the Persian language as their mother tongue. However, the term Persian has also a supra-ethnic significance and has been historically referred to a part of Iranian peoples. The origin of the Persian people is traced to the ancient Indo-Iranians , who arrived in parts of Greater Iran circa 2000-1500 BCE physician Muhammad ibn Zakarīya Rāzi Muhammad ibn Zakariyā Rāzī , known as Rhazes or Rasis after medieval Latinists, (August 26, 865, Rayy – 925, Rayy) was a Persian physician, alchemist and chemist, philosopher, and scholar. He is recognised as a polymath, and Biographies of Razi, based on his writings, describe him as “perhaps the greatest clinician of all times.” Numerous (Rhazes) combined psychological methods and physiological explanations to provide treatment to mentally ill patients. His contemporary, the Arab physician Najab ud-din Muhammad, described a number of mental illnesses such as agitated depression, neurosis, priapism and sexual impotence (Nafkhae Malikholia), psychosis (Kutrib), and mania (Dual-Kulb).[9]

In the 11th century, another Persian physician, Avicenna, recognized "physiological psychology" in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with inner feelings, which is seen as a precursor to the word association test developed by Carl Jung in the 19th century.[10] Avicenna was also an early pioneer of neuropsychiatry, and first described a number of neuropsychiatric conditions such as hallucination, insomnia, mania, nightmare, melancholia, dementia, epilepsy, paralysis, stroke, vertigo and tremor.[11]

Psychiatric hospitals were built in medieval Europe from the 13th century to treat mental disorders but were utilized only as custodial institutions and did not provide any type of treatment.[12] Founded in the 13th century, Bethlem Royal Hospital in London is one of the oldest psychiatric hospitals.[12] By 1547 the City of London acquired the hospital and continued its function until 1948.[13] It is now part of the National Health Service and is an NHS Foundation Trust.

Many consider Philippe Pinel to be the father of modern psychiatry.

Early modern period

In 1656, Louis XIV of France created a public system of hospitals for those suffering from mental disorders, but as in England, no real treatment was being applied.[13] In 1758 English physician William Battie wrote the Treatise on Madness which called for treatments to be utilized in asylums.[14] Thirty years later the new ruling monarch in England, George III, was known to be suffering from a mental disorder.[7] Following the King's remission in 1789, mental illness was seen as something which could be treated and cured.[7] By 1792 French physician Philippe Pinel introduced humane treatment approaches to those suffering from mental disorders.[7] William Tuke adopted the methods outlined by Pinel and that same year Tuke opened the York Retreat in England.[7] That institution became known as a model throughout the world for humane and moral treatment of patients suffering from mental disorders.[15] It inspired similar institutions in the United States, most notably the Brattleboro Retreat and the Hartford Retreat (now the Institute of Living).

19th century

At the turn of the century, England and France combined only had a few hundred individuals in asylums.[16] By the late 1890s and early 1900s, this number skyrocketed to the hundreds of thousands.[16] The United States housed 150,000 patients in mental hospitals by 1904.[16] German speaking countries housed more than 400 public and private sector asylums.[16] These asylums were critical to the evolution of psychiatry as they provided a universal platform of practice throughout the world.[16]

Universities often played a part in the administration of the asylums.[17] Due to the relationship between the universities and asylums, scores of competitive psychiatrists were being molded in Germany.[17] Germany became known as the world leader in psychiatry during the nineteenth century.[16] The country possessed more than 20 separate universities all competing with each other for scientific advancement.[16] However, because of Germany's individual states and the lack of national regulation of asylums, the country had no organized centralization of asylums or psychiatry.[16] Britain, like Germany, also lacked a centralized organization for the administration of asylums.[18] This deficit hindered the diffusion of new ideas in medicine and psychiatry.[18]

In the United States in 1834 Anna Marsh, a physician's widow, deeded the funds to build her country's first financially-stable private asylum. The Brattleboro Retreat marked the beginning of America's private psychiatric hospitals challenging state institutions for patients, funding, and influence. Although based on England's York Retreat, it would be followed by specialty institutions of every treatment philosophy.

In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country.[19] By 1840, asylums as therapeutic institutions existed throughout Europe and the United States.[20]

Emil Kraepelin studied and promoted ideas of disease classification for mental disorders.

However, the new and dominating ideas that mental illness could be "conquered" during the mid-nineteenth century all came crashing down.[20] Psychiatrists and asylums were being pressured by an ever increasing patient population.[20] The average number of patients in asylums in the United States jumped 927%.[20] Numbers were similar in England and Germany.[20] Overcrowding was rampant in France where asylums would commonly take in double their maximum capacity.[21] Increases in asylum populations may have been a result of the transfer of care from families and poorhouses, but the specific reasons as to why the increase occurred is still debated today.[22][23] No matter the cause, the pressure on asylums from the increase was taking its toll on the asylums and psychiatry as a specialty. Asylums were once again turning into custodial institutions[24] and the reputation of psychiatry in the medical world had hit an extreme low.[25]

20th century

Disease classification and rebirth of biological psychiatry

The 20th century introduced a new psychiatry into the world. Different perspectives of looking at mental disorders began to be introduced. The career of Emil Kraepelin reflects the convergence of different disciplines in psychiatry.[26] Kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry.[26] Following his appointment to a professorship of psychiatry and his work in a university psychiatric clinic, Kraepelin's interest in pure psychology began to fade and he introduced a plan for a more comprehensive psychiatry.[27][28] Kraepelin began to study and promote the ideas of disease classification for mental disorders, an idea introduced by Karl Ludwig Kahlbaum.[28] The initial ideas behind biological psychiatry, stating that the different mental disorders were all biological in nature, evolved into a new concept of "nerves" and psychiatry became a rough approximation of neurology and neuropsychiatry.[29] Following Sigmund Freud's death, ideas stemming from psychoanalytic theory also began to take root.[30] The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums.[30] By the 1970s the psychoanalytic school of thought had become marginalized within the field.[30]

Otto Loewi's work led to the identification of the first neurotransmitter, acetylcholine.

Biological psychiatry reemerged during this time. Psychopharmacology became an integral part of psychiatry starting with Otto Loewi's discovery of the first neurotransmitter, acetylcholine.[31] Neuroimaging was first utilized as a tool for psychiatry in the 1980s.[32] The discovery of chlorpromazine's effectiveness in treating schizophrenia in 1952 revolutionized treatment of the disease,[33] as did lithium carbonate's ability to stabilize mood highs and lows in bipolar disorder in 1948.[34] Psychotherapy was still utilized, but as a treatment for psychosocial issues.[35] Genetics were once again thought to play a role in mental illness.[31] Molecular biology opened the door for specific genes contributing to mental disorders to be identified.[31]

Anti-psychiatry and deinstitutionalization

Main article: Anti-psychiatry See also: Political abuse of psychiatry

The introduction of psychiatric medications and the use of laboratory tests altered the doctor-patient relationship between psychiatrists and their patients.[36] Psychiatry's shift to the hard sciences had been interpreted as a lack of concern for patients.[36] Anti-psychiatry had become more prevalent in the late twentieth century due to this and publications in the media which conceptualized mental disorders as myths.[37] Others in the movement argued that psychiatry was a form of social control and demanded that institutionalized psychiatric care, stemming from Pinel's thereapeutic asylum, be abolished.[38] Incidents of physical abuse by psychiatrists took place during the reign of some totalitarian regimes as part of a system to enforce political control. Some of the abuse even continued to the present day.[39] Historical examples of the abuse of psychiatry took place in Nazi Germany,[40] in the Soviet Union under Psikhushka, and in the apartheid system in South Africa.[41]

Electroconvulsive therapy (ECT) was one treatment that the anti-psychiatry movement wanted eliminated.[42] They alleged that ECT damaged the brain and was used as a tool for discipline.[42] While some believe there is no evidence that ECT damages the brain,[43][44][45] there are some citations that ECT does cause damage.[46][47] Sometimes ECT is used as punishment or as a threat and there have been isolated incidents where the use of ECT was threatened to keep the patients "in line".[42] The prevalence of psychiatric medication helped initiate deinstitutionalization,[48] the process of discharging patients from psychiatric hospitals to the community.[49] The pressure from the anti-psychiatry movements and the ideology of community treatment from the medical arena helped sustain deinstitutionalization.[48] Thirty-three years after deinstitutionalization started in the United States, only 19% of the patients in state hospitals remained.[48] Mental health professionals envisioned a process wherein patients would be discharged into communities where they could participate in a normal life while living in a therapeutic atmosphere.[48] Psychiatrists were criticized, however, for failing to develop community-based support and treatment. Community-based facilities were not available because of the political infighting between in-patient and community-based social services, and an unwillingness by social services to dispense funding to provide adequately for patients to be discharged into community-based facilities.

Transinstitutionalization and the aftermath

In 1963, US president John F. Kennedy introduced legislation delegating the National Institute of Mental Health to administer Community Mental Health Centers for those being discharged from state psychiatric hospitals.[48] Later, though, the Community Mental Health Center's focus was diverted to provide psychotherapy sessions for those suffering from acute but mild mental disorders.[48] Ultimately there were no arrangements made for actively and severely mentally ill patients who were being discharged from hospitals.[48] Some of those suffering from mental disorders drifted into homelessness or ended up in prisons and jails.[48][50] Studies found that 33% of the homeless population and 14% of inmates in prisons and jails were already diagnosed with a mental illness.[48][51]

In 1972, psychologist David Rosenhan published the Rosenhan experiment, a study analyzing the validity of psychiatric diagnoses.[52] The study arranged for eight individuals with no history of psychopathology to attempt admission into psychiatric hospitals. The individuals included a graduate student, psychologists, an artist, a housewife, and two physicians, including one psychiatrist. All eight individuals were admitted with a diagnosis of schizophrenia or bipolar disorder. Psychiatrists then attempted to treat the individuals using psychiatric medication. All eight were discharged within 7 to 52 days. In a later part of the study, psychiatric staff were warned that pseudo-patients might be sent to their institutions, but none were actually sent. Nevertheless, a total of 83 patients out of 193 were believed by at least one staff member to be actors. The study concluded that individuals without mental disorders were indistinguishable from those suffering from mental disorders.[52] Critics such as Robert Spitzer placed doubt on the validity and credibility of the study, but did concede that the consistency of psychiatric diagnoses needed improvement.[53]

Psychiatry, like most medical specialties has a continuing, significant need for research into its diseases, classifications and treatments.[54] Psychiatry adopts biology's fundamental belief that disease and health are different elements of an individual's adaptation to an environment.[55] But psychiatry also recognizes that the environment of the human species is complex and includes physical, cultural, and interpersonal elements.[55] In addition to external factors, the human brain must contain and organize an individual's hopes, fears, desires, fantasies and feelings.[55] Psychiatry's difficult task is to bridge the understanding of these factors so that they can be studied both clinically and physiologically.[55]

Theory and focus

"Psychiatry, more than any other branch of medicine, forces its practitioners to wrestle with the nature of evidence, the validity of introspection, problems in communication, and other long-standing philosophical issues" (Guze, 1992, p.4).

The term psychiatry (Greek "ψυχιατρική", psychiatrikē), coined by Johann Christian Reil in 1808, comes from the Greek "ψυχή" (psychē: "soul or mind") and "ιατρός" (iatros: "healer").[56][57][58] It refers to a field of medicine focused specifically on the mind, aiming to study, prevent, and treat mental disorders in humans.[59][60][61] It has been described as an intermediary between the world from a social context and the world from the perspective of those who are mentally ill.[62]

Those who practice psychiatry are different than most other mental health professionals and physicians in that they must be familiar with both the social and biological sciences.[60] The discipline is interested in the operations of different organs and body systems as classified by the patient's subjective experiences and the objective physiology of the patient.[63] Psychiatry exists to treat mental disorders which are conventionally divided into three very general categories: mental illness, severe learning disability, and personality disorder.[64] While the focus of psychiatry has changed little throughout time, the diagnostic and treatment processes have evolved dramatically and continue to do so. Since the late 20th century, the field of psychiatry has continued to become more biological and less conceptually isolated from the field of medicine.[65]

Scope of practice

Disability-adjusted life year for neuropsychiatric conditions per 100,000 inhabitants in 2002. no data less than 10 10-20 20-30 30-40 40-50 50-60 60-80 80-100 100-120 120-140 140-150 more than 150

While the medical specialty of psychiatry utilizes research in the field of neuroscience, psychology, medicine, biology, biochemistry, and pharmacology,[66] it has generally been considered a middle ground between neurology and psychology.[67] Unlike other physicians and neurologists, psychiatrists specialize in the doctor-patient relationship and are trained to varying extents in the use of psychotherapy and other therapeutic communication techniques.[67] Psychiatrists also differ from psychologists in that they are physicians and the entirety of their post-graduate training is revolved around the field of medicine.[68] Psychiatrists can therefore counsel patients, prescribe medication, order laboratory tests, utilize neuroimaging in a research setting, and conduct physical examinations.[69]

Ethics

Like other professions, the World Psychiatric Association issues an ethical code to govern the conduct of psychiatrists. The psychiatric code of ethics, first set forth through the Declaration of Hawaii in 1977, has been expanded through a 1983 Vienna update and, in 1996, the broader Madrid Declaration. The code was further revised in Hamburg, 1999. The World Psychiatric Association code covers such matters as patient assessment, up-to-date knowledge, the human dignity of incapacitated patients, confidentiality, research ethics, sex selection, euthanasia,[70] organ transplantation, torture,[71][72] the death penalty, media relations, genetics, and ethnic or cultural discrimination.[73] In establishing such ethical codes, the profession has responded to a number of controversies about the practice of psychiatry.

Subspecialties

Various subspecialties and/or theoretical approaches exist which are related to the field of psychiatry. They include the following:

In the United States, psychiatry is one of the specialties which qualify for further education and board-certification in pain medicine, palliative medicine, and sleep medicine.

Approaches

Psychiatric illnesses can be approached in a number of different ways. The biomedical approach examines signs and symptoms and compares them with diagnostic criteria. Psychiatric illness can also be assessed through a narrative which tries to understand symptoms as a part of a meaningful life history and as a responses to external conditions. Both approaches are important in the field of psychiatry.[76] A lack of consensus between these often opposing views has contributed in part to the biopsychiatry controversy. It has also played a role in controversies over specific psychiatric illness, such as ADHD and multiple personalities. The biopsychosocial model is often used to understand psychiatric illness. However, the "model's" scientific credentials have been called into question in Dr. Niall McLaren's 1998 paper, A critical review of the Biopsychosocial Model[77] and his books Humanizing Madness and Humanizing Psychiatry. Simply stated, even though it is correct to say that sociology, psychology, and biology are factors in mental illness, simply stating this obvious fact does not make it a model in the scientific sense of the word. Scientific models are meant to be the actualization of a scientific theory and the biopsychosocial model actualizes nothing apart from reiterating a concept which "all practitioners of reasonable sensitivity" should know implicitly (that social and psychological factors matter).[78][79] [80]

Industry and academia

Practitioners

Main article: Psychiatrist

All physicians can diagnose mental disorders and prescribe treatments utilizing principles of psychiatry. Psychiatrists are either: 1) clinicians who specialize in psychiatry and are certified in treating mental illness;[81] or (2) scientists in the academic field of psychiatry and are qualified as research doctors in this field. Psychiatrists may also go through significant training to conduct psychotherapy, psychoanalysis and cognitive behavioral therapy, but it is their training as physicians that differentiates them from other mental health professionals.[81]

Research

An MRI scan of the brain: many mental disorders are thought to be associated with neurobiological abnormalities[82]

Psychiatric research is, by its very nature, interdisciplinary. It combines social, biological and psychological perspectives to understand the nature and treatment of mental disorders.[83] Clinical and research psychiatrists study basic and clinical psychiatric topics at research institutions and publish articles in journals.[66][84][85][86] Under the supervision of institutional review boards, psychiatric clinical researchers look at topics such as neuroimaging, genetics, and psychopharmacology in order to enhance diagnostic validity and reliability, to discover new treatment methods, and to classify new mental disorders.[87]

Clinical application

Diagnostic systems

fMRI images such as these may assist in a diagnosis by ruling out other conditions.

Psychiatric diagnoses take place in a wide variety of settings and are performed by many different health professionals. Therefore, the diagnostic procedure may vary greatly based upon these factors. Typically, though, a psychiatric diagnosis utilizes a differential diagnosis procedure where a mental status examination and physical examination is conducted, pathological, psychopathological or psychosocial histories obtained, and sometimes neuroimages or other neurophysiological measurements are taken, or personality tests or cognitive tests administered.[88][89][90][91][92][93][94] In some cases, a brain scan might be used to rule out other medical illnesses, but at this time relying on brain scans alone cannot accurately diagnose a mental illness or tell the risk of getting a mental illness in the future.[95] A few psychiatrists are beginning to utilize genetics during the diagnostic process but on the whole this remains a research topic.[96][97][98]

Diagnostic manuals

Three main diagnostic manuals used to classify mental health conditions are in use today. The ICD-10 is produced and published by the World Health Organisation, includes a section on psychiatric conditions, and is used worldwide.[99] The Diagnostic and Statistical Manual of Mental Disorders, produced and published by the American Psychiatric Association, is primarily focused on mental health conditions and is the main classification tool in the United States.[100] It is currently in its fourth revised edition and is also used worldwide.[100] The Chinese Society of Psychiatry has also produced a diagnostic manual, the Chinese Classification of Mental Disorders.[101]

The stated intention of diagnostic manuals is typically to develop replicable and clinically useful categories and criteria, to facilitate consensus and agreed upon standards, whilst being atheoretical as regards etiology.[100][102] However, the categories are nevertheless based on particular psychiatric theories and data; they are broad and often specified by numerous possible combinations of symptoms, and many of the categories overlap in symptomology or typically occur together.[103] While originally intended only as a guide for experienced clinicians trained in its use, the nomenclature is now widely used by clinicians, administrators and insurance companies in many countries.[104]

Treatment settings

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General considerations

Individuals with mental health conditions are commonly referred to as patients but may also be called clients, consumers, or service recipients. They may come under the care of a psychiatric physician or other psychiatric practitioners by various paths, the two most common being self-referral or referral by a primary-care physician. Alternatively, a person may be referred by hospital medical staff, by court order, involuntary commitment, or, in the UK and Australia, by sectioning under a mental health law.

A psychiatric patient room in the United States.

Whatever the circumstance of a person's referral, a psychiatrist first assesses the person's mental and physical condition. This usually involves interviewing the person and often obtaining information from other sources such as other health and social care professionals, relatives, associates, law enforcement and emergency medical personnel and psychiatric rating scales. A mental status examination is carried out, and a physical examination is usually performed to establish or exclude other illnesses, such as thyroid dysfunction or brain tumors, or identify any signs of self-harm; this examination may be done by someone other than the psychiatrist, especially if blood tests and medical imaging are performed.

Like all medications, psychiatric medications can cause adverse effects in patients and hence often involve ongoing therapeutic drug monitoring, for instance full blood counts or, for patients taking lithium salts, serum levels of lithium, renal and thyroid function. Electroconvulsive therapy (ECT) is sometimes administered for serious and disabling conditions, especially those unresponsive to medication. The efficacy[105][106] and adverse effects of psychiatric drugs have been challenged.[107]

The close relationship between those prescribing psychiatric medication and pharmaceutical companies has become increasingly controversial[108] along with the influence which pharmaceutical companies are exerting on mental health policies.[109][110]

Also controversial are forced drugging and the "lack of insight" label. According to a report published by the US National Council on Disability,

Involuntary treatment is extremely rare outside the psychiatric system, allowable only in such cases as unconsciousness or the inability to communicate. People with psychiatric disabilities, on the other hand, even when they vigorously protest treatments they do not want, are routinely subjected to them anyway, on the justification that they "lack insight" or are unable to recognize their need for treatment because of their "mental illness". In practice, "lack of insight" becomes disagreement with the treating professional, and people who disagree are labeled "noncompliant" or "uncooperative with treatment".[111]

Inpatient treatment

Psychiatric treatments have changed over the past several decades. In the past, psychiatric patients were often hospitalized for six months or more, with some cases involving hospitalization for many years. Today, people receiving psychiatric treatment are more likely to be seen as outpatients. If hospitalization is required, the average hospital stay is around one to two weeks, with only a small number receiving long-term hospitalization.[citation needed]

Psychiatric inpatients are people admitted to a hospital or clinic to receive psychiatric care. Some are admitted involuntarily, perhaps committed to a secure hospital, or in some jurisdictions to a facility within the prison system. In many countries including the USA and Canada, the criteria for involuntary admission vary with local jurisdiction. They may be as broad as having a mental health condition, or as narrow as being an immediate danger to themselves and/or others. Bed availability is often the real determinant of admission decisions to hard pressed public facilities. European Human Rights legislation restricts detention to medically-certified cases of mental disorder, and adds a right to timely judicial review of detention.[citation needed]

Injections are one of many ways to administer psychiatric medication.

Patients may be admitted voluntarily if the treating doctor considers that safety isn't compromised by this less restrictive option. Inpatient psychiatric wards may be secure (for those thought to have a particular risk of violence or self-harm) or unlocked/open. Some wards are mixed-sex whilst same-sex wards are increasingly favored to protect women inpatients. Once in the care of a hospital, people are assessed, monitored, and often given medication and care from a multidisciplinary team, which may include physicians, psychiatric nurse practitioners, psychiatric nurses, clinical psychologists, psychotherapists, psychiatric social workers, occupational therapists and social workers. If a person receiving treatment in a psychiatric hospital is assessed as at particular risk of harming themselves or others, they may be put on constant or intermittent one-to-one supervision, and may be physically restrained or medicated. People on inpatient wards may be allowed leave for periods of time, either accompanied or on their own.[112]

In many developed countries there has been a massive reduction in psychiatric beds since the mid 20th century, with the growth of community care. Standards of inpatient care remain a challenge in some public and private facilities, due to levels of funding, and facilities in developing countries are typically grossly inadequate for the same reason.[citation needed]

Outpatient treatment

People may receive psychiatric care on an inpatient or outpatient basis. Outpatient treatment involves periodic visits to a clinician for consultation in his or her office, usually for an appointment lasting thirty to sixty minutes. These consultations normally involve the psychiatric practitioner interviewing the person to update their assessment of the person's condition, and to provide psychotherapy or review medication. The frequency with which a psychiatric practitioner sees people in treatment varies widely, from days to months, depending on the type, severity and stability of each person's condition, and depending on what the clinician and client decide would be best. Increasingly, psychiatrists are limiting their practices to psychopharmacology (prescribing medications) with less time devoted to psychotherapy or "talk" therapies, or behavior modification. The role of psychiatrists is changing in community psychiatry, with many assuming more leadership roles, coordinating and supervising teams of allied health professionals and junior doctors in delivery of health services.[citation needed]

See also

References

Notes

  1. ^ Etymology of Butterfly
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How does Psychiatry define older younger relationships?
Q. I am just curious. I m 21 and gay. I ve also never been attracted to anyone under 40. I realize that by society s standards this is quite odd. I have also heard the "daddy issues" deal alot, and that s not really what is going on here. I ve just always been physically and emotionally attracted to older men, be it for the masculinity, maturity, etc... My question is... Does psychiatry view this as a problem or disorder? Or could it be considered just they way I developed mentally? Is it something I should work to change?
Asked by JT - Sat Dec 12 12:22:23 2009 - - 1 Answers - 0 Comments
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Tue Jul 6 14:06:38 2010
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