PSYCHIATRY

(Redirected from Psychiatric)

'Psychiatry' is a branch of medicine dealing with the prevention, assessment, diagnosis, treatment, and rehabilitation of the mind and mental illness. Its primary goal is the relief of mental suffering associated with symptoms of disorder and improvement of mental well-being. This may be based in hospitals or in the community and patients may be voluntary or involuntary. Psychiatry adopts a medical approach but may take into account biological, psychological, and social/cultural perspectives. Treatment by medication in conjunction with various forms of psychotherapy may be undertaken and has proved most effective in successful treatment. The word 'psychiatry' derives from the Greek for "healer of the spirit" (ψυχ- (spirit) + ιατρος (physician)).
Most psychiatric illnesses cannot currently be cured, although recovery may occur. While some have short time courses and only minor symptoms, many are chronic conditions which can have a significant impact on a patients' quality of life and even life expectancy, and as such may be thought to require long-term or life-long treatment. Effectiveness of treatment for any given condition is also variable from individual to individual.

History

Physicians in Ancient Egypt and Ancient Greece sought to explain and treat mental disturbance, notably melancholy and hysteria, but medieval thought focused on the concept of demonic possession or supernatural spirits. The first hospital wards for people with a mental disturbance opened from the 8th century in the Middle East, notably at the Baghdad Hospital under Rhazes, with the first dedicated asylums opening from the 15th Century in Egypt, Spain, and then the rest of Europe, notoriously at Bedlam in England.
In the 16th century, Johann Weyer argued that some cases of alleged witchcraft were actually psychiatric symptoms, as others had argued before him. Different categories of mental health conditions became systematically considered by physicians in the context of neurology, a term coined in the 17th century from the work of Thomas Willis. In 1758, William Battie gave impetus to the study and treatment of mental disturbance as a medical speciality. From the late 18th Century, the moral treatment movement sought to make asylums more humane and therapeutic as well as custodial, an approach developed partly from the work of physicians, notably Philippe Pinel, who also developed new ways of categorizing mental health conditions.
Psychiatry developed as a clinical and academic profession in the early 19th Century, particularly in Germany. The field sought to systematically apply concepts and tools from general medicine and neurology to the study and treatment of abnormal mental distress and disorder. The term psychiatry was coined in 1808 by Johann Christian Reil, from the Greek “psyche” (soul) and “iatros” (doctor). Official teaching first began in Leipzig in 1811, with the first psychiatric department established in Berlin in 1865. Benjamin Rush pioneered the approach in the United States. The American Psychiatric Association was founded in 1844. Psychiatric nursing developed as a profession.
Early in the 20th Century, neurologist Sigmund Freud developed the field of psychoanalysis and Carl Jung popularized related ideas. Meanwhile Emil Kraepelin developed the foundations of the modern psychiatric classification and diagnosis of mental health conditions. Others who notably developed this approach included Karl Jaspers, Eugen Bleuler, Kurt Schneider and Karl Leonhard. Adolf Meyer was an influential figure in the first half of the twentieth century, combining biological and psychological approaches. ^[1]
Psychiatry was used by some totalitarian regimes as part of a system to enforce political control, for example in Nazi Germany ^[2], the Soviet Union under Psikhushka, and the apartheid system in South Africa ^[3]. For many years during the mid-20th century, Freudian and neo-Freudian thinking dominated psychiatric thinking. Social Psychiatry developed.
From the 1930s, a number of treatment practices came in to widespread use in psychiatry, including inducing seizures (by ECT, insulin or other drugs) or cutting connections between parts of the brain (leucotomy or lobotomy). In the 1950s and 1960s, lithium carbonate, chlorpromazine and other neuroleptics (also termed typical antipsychotics), as well as early antidepressant and anxiolytic medications were discovered, ushering in a new era where psychiatric medication came in to widespread use by psychiatrists and general physicians.
Coming to the fore in the 1960s was the anti-psychiatry movement, which challenged psychiatry's theoretical, clinical and legal legitimacy. Psychiatrists notably associated with critical challenges to mainstream psychiatry included R.D. Laing and Thomas Szasz.
Along with the development of fields such as genetics and tools such as neuroimaging, psychiatry moved away from psychoanalysis back to a focus on physical medicine and neurology^[4] and to search for the causes of mental health conditions within the genome and the neurochemistry of the brain.
Social psychiatry became marginalized relative to biopsychiatry. “Neo-Kraepelinian” categories were codified in diagnostic manuals, notably the ICD and DSM, which became widely adopted. Robert Spitzer was notable in this development. New drugs came in to common use, notably SSRI antidepressants and atypical antipsychotics.
Psychiatry was involved in the development of psychotherapies. Neo-Freudian ideas continued, but there was a trend away from long-term psychoanalysis to more cost-effective or evidence-based approaches, particularly cognitive therapy from the work of Aaron Beck. Other mental health professions, particularly clinical psychology, were becoming more established and competing with or working with psychiatry.
During the last third of the 20th century, the institutional confinement of people diagnosed with symptoms of mental health conditions steadily declined, particularly in more developed countries. Among the reasons for this trend of deinstitutionalization were pressure for more humane care and greater social inclusion, advances in psychopharmacology, increases in public financial assistance for people with disabilities, and the Consumer/Survivor Movement. Developments in community services followed, for example psychiatric rehabilitation and Assertive Community Treatment.
It has been argued that different methods of historical analysis, for example focusing on individual/technical achievements or focusing on social factors and social constructs, can lead to different histories of psychiatry^[5]

Psychiatry in professional practice

Main articles: Psychiatrist

Psychiatrists are doctors of medicine or osteopathy and are certified in treating mental illness using the biomedical approach to mental disorders.About:Psychology. (Unknown last update). ''Difference Between Psychologists and Psychiatrists''. Retrieved March 25, 2007, from http://psychology.about.com/od/psychotherapy/f/psychvspsych.htm Psychiatrists may also go through significant training to conduct psychotherapy, psychoanalysis, and/or cognitive behavioral therapy, but it is their medical training and ability to prescribe medications that differentiates them from other mental health professionals.

Treatment overview

In general, 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, most people receiving psychiatric treatment are seen as outpatients. If hospitalization is required, the average hospital stay is around two to three weeks, with only a small number of people receiving long-term hospitalization.
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.

Initial assessment

Whatever the circumstance of a person's referral, a psychiatrist first assesses a 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 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 else other than the psychiatrist, especially if blood tests and medical imaging are performed.
Like all medications, psychiatric medications can have toxic 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. Electroconvulsive therapy (ECT) is sometimes administered for serious and disabling conditions, especially those unresponsive to medication.

Outpatient care

People receiving psychiatric care may do so 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 practice to psychopharmalogy (prescribing medications) with less time devoted to psychotherapy or "talk" therapies, or behavior modification.

Inpatient care

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.
Voluntary commitment is also possible, and in some cases people seeking care are offered this option if a mental health professional feels inpatient care is needed, but is unable or unwilling to seek involuntary commitment. People who are voluntarily committed have more options in ending their commitment, but procedures on leaving the facility vary greatly.
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 patients.
Once in the care of a hospital, people are assessed, monitored, and often given medication and receive care from a multidisciplinary team, which may include physicians, psychiatric nurse practitioners, psychiatric nurses, clinical psychologists, psychotherapists, psychiatric social workers, and other mental health professionals. 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.
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.

Theory and Focus

Mainstream psychiatry is considered a branch of medicine that is, or should aim to be, evidence-based in theory and practice. Psychiatric diagnosis is based on the concept of a distinct boundary between people who are mentally healthy and people who are mentally ill, and between different kinds of mental health conditions that can be medically differentiated, understood and treated. This is commonly done through standardized categories dubbed 'neo-Kraepelian' (Klerman, 1978), based on patterns of so-called 'Feighner criteria' (lists of symptoms with rules on the combinations required for different diagnoses).
Psychiatry is often described as being based within, or dominated by, a biomedical paradigm, although there are different theoretical approaches:

★ Biopsychiatry (or Neuropsychiatry) - focused on genetics, neurochemistry and medication

★ Social psychiatry or Community Psychiatry - focused on the interpersonal or public health context, including psychiatric rehabilitation

★ Cross-cultural psychiatry - focused on the relevance of culture, including ethnicity and globalization.

★ Psychoanalytic psychiatry (or Dynamic Psychiatry) - concerned with applying concepts and methods from psychoanalysis

Diagnostic systems of psychiatric disorders

The Latest Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association.

Two main classifications of mental health conditions are in use today. The ICD-10 (International Classification of Diseases) is produced and published by the World Health Organisation and includes a section on psychiatric conditions, and is used to some extent worldwide. The Diagnostic and Statistical Manual of Mental Disorders (DSM), produced and published by the American Psychiatric Association, is solely focused on mental health conditions and is the main classification tool in the United States. It is currently in its fourth revised edition (''IV-TR'', published 2000) and is also used world-wide, perhaps more so than the ICD-10. The ICD-10 and the DSM are considered roughly on a par with one another, and an explicit concern in the development of the DSM-IV was compatibility with the diagnostic categories and codes of the ICD. The lack of a case example version of the ICD-10 is considered a problem by some. The Chinese Society of Psychiatry has also produced a diagnostic manual, the Chinese Classification of Mental Disorders (CCMD).
The stated intention of diagnostic manuals is typically to develop replicable and clinically useful categories and criteria, to facilitate consensus and agreed standards, whilst being atheoretical as regards etiology. 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. 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.
The 'DSM' has five axes:

★ Axis I: 'Psychiatric disorders'

★ Axis II: 'Personality disorders / mental retardation'

★ Axis III: 'General medical conditions'

★ Axis IV: 'Social functioning and impact of symptoms'

★ Axis V: 'Global Assessment of Functioning (described using a scale from 1 to 100)'
Common axis I disorders between the two systems include substance dependence and abuse (e.g. alcohol dependence); mood disorders (e.g. depression, bipolar disorder); psychotic disorders (e.g. schizophrenia, schizoaffective disorder); and anxiety disorders (e.g. post-traumatic stress disorder, obsessive-compulsive disorder). Axis II disorders include borderline personality disorder, schizotypal personality disorder, avoidant personality disorder and antisocial personality disorder.

Controversy

Anti-psychiatry

Main articles: Anti-psychiatry

There exist movements opposed to the practices of – and, in some cases, the existence of – psychiatry. These movements mostly originated in the 1960s and 1970s. Presently antipsychiatry encompasses a broad range of professional views, including a scholarly journal devoted exclusively to criticism of biopsychiatry, ''Ethical Human Psychology and Psychiatry''^[6], published by ICSPP.

Main criticisms

The efficacy, adverse effects and the widespread and growing use of psychiatric medications has been challenged mainly by social critics. Studies of pharmacogenetic polymorphism indicate that people of various ethnicities have an increased risk of side effects and toxicity.
In addition, the diagnostic reliability (Williams ''et al'', 1992; McGorry ''et al'', 1995; Hirschfeld ''et al'', 2003]), has been challenged, especially when comparing the criteria of the different psychiatric manuals (van Os ''et al'', 1999) .^[7]
The Rosenhan experiment, performed in 1972, questions the validity of psychiatric diagnosis. The first experiment is questionable, but the second part "The non-existent impostor" is not challenged.
Another concern centers on the issue of involuntary commitment, which centers on issues of civil liberties and personal freedoms. In the U.S. someone may be involuntarily detained for psychiatric examination for a period of time (usually 24 to 72 hours depending on the state) if a government official declares the subject to be a danger to himself or others. With the attestation of an examining physician that a patient meets strict criteria of dangerousness to himself or others resulting from symptoms, a judge may extend this commitment. Opposition to involuntary commitment is diverse and includes simple arguments that involuntary commitment is inherently unconstitutional. The laws regarding the involuntary treatment of children vary widely from state to state^[8].

References

Notes

1. Hirshbein, L. (2004) History of Women in Psychiatry. ''Academic Psychiatry'', 28:337-344
2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12817666&dopt=Abstract
3. http://www.info.gov.za/speeches/1997/06160x76497.htm
4. Martin J. B. (2002) The integration of neurology, psychiatry and neuroscience in the 21st century. ''Am. J. of Psychiatry'' 2002; 159:695-704
5. John Berks (2005) Heroes and villains: making sense of the history of psychiatry ''Australasian Psychiatry'' 13(4) pg 408
6. http://www.springerpub.com/journal.aspx?jid=1523-150X
7. http://ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=3060884 Psychiatric side effects attributed to phenylpropanolamine, ''Pharmacopsychiatry'' 1988 Jul; 21(4):171-81
8. http://www.psychlaws.org/LegalResources/Index.htm

External links

★ World Psychiatric Association

★ Culture and Ethnicity, National Mental Health Information Center, SAMHSA

★ American Psychiatric Association

★ The Royal College of Psychiatrists - The UKs governing body

This article provided by Wikipedia. To edit the contents of this article, click here for original source.

psst.. try this: add to faves

	History of Psychiatry
	The Avalanches - Frontier Psychiatrist (Good Quality)
	Psychology vs. Psychiatry
	Psychiatry
	Psychiatry EXPOSED!

	Travelonly - Allan Jenkins
	Time Out for Touring Inc.
	Temptation Resort Spa Cancun
	Temptation Resort Spa Los Cabos
	Marlin Travel - Yonge Street
	Bora Bora Lagoon Resort & Spa
	Destination Greece
	JRD Travel Company
	Travelonly - Dave Corless
	Golf Holidays International

PSYCHIATRY

History

Psychiatry in professional practice

Treatment overview

Initial assessment

Outpatient care

Inpatient care

Theory and Focus

Diagnostic systems of psychiatric disorders

Controversy

Anti-psychiatry

Main criticisms

See also

Related terms

Lists

References

Notes

Further reading

External links

Photo Galleries »

Customer Service

Most Popular

Useful

Find