What is psychiatry?

Science and Profession

Psychiatrists receive training in biochemistry, community mental health, genetics, neurology, neuropathology, psychopathology, psychopharmacology, and social science. They complete medical school, a four-year residency in psychiatry, and two or more years of specialty residency. Specialty residencies focus on particular treatment methods (such as psychoanalysis) or methods of diagnosis and treatment for particular groups of clients (such as children, adolescents, or elders).

As diagnosticians and treatment providers, psychiatrists must be excellent observers of behavior and be knowledgeable about how nutritional, physical, and situational conditions can be related to mental or emotional problems. An ability to consult with other professionals is also important. Psychiatrists often receive patients from other professionals (general practitioners, psychologists, emergency room staff) and often request diagnostic, legal, case management, and resource advice from other professionals (psychologists, attorneys, social workers). In situations involving abuse, neglect, incompetency, and suicide, such consultation relationships are critical for appropriate referral and treatment.

Given this preparation, psychiatrists are able to diagnose and treat a wide variety of disorders. Some of the most common disorders treated in adult populations include disorders of anxiety (such as phobias, panic attacks, obsessive-compulsive behavior, acute and post-traumatic stress) and mood (such as depressive and bipolar problems). Personality, schizophrenic, substance abuse, and dementia-related disorders also are treated frequently by psychiatrists. Such conditions are described in detail in the American Psychiatric Association’s (APA's)
Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (2013).

Diagnostic and Treatment Techniques

A well-formulated psychiatric diagnosis facilitates treatment planning for mental and emotional disorders. Psychiatric diagnoses, however, are very complex. Previously, the APA used a axial system to diagnose psychiatric disorders. Axis I pertained to clinical conditions diagnosed in infancy, childhood, or adolescence; Axis II summarized problems related to personality and intellectual disability; and Axis III described any general medical conditions that are related to a person’s mental problems and that may also warrant special attention. However, in DSM-5 disorders in these categories are grouped into chapters of similar or related disorders. In DSM-IV Axis IV summarized psychological, social, and environmental problems that may affect the diagnosis, prognosis, or treatment of a person’s mental problems. Axis V was used to give a standardized, overall rating of how well the person was functioning with his or her disorder; this axis has been dropped entirely.

Once a diagnosis is formulated, a treatment plan is composed. Usually, it involves some combination of medicinal and psychotropic drugs, bibliotherapy, dietary and behavior change recommendations, and psychotherapy for the affected individual and possibly members of his or her family. Treatment compliance is critical, particularly when psychotropic drugs are involved. As such, psychiatric treatment often involves frequent contacts and an aftercare plan of continued visits with the psychiatrist or a support group able to encourage follow-through on the treatment recommendations.

Perspective and Prospects

The concepts of mental health and illness have been in human cultures since ancient times. As early as 2980 BCE, priest-physicians were noted for their treatment of spirit possession involving madness, violence, mutism, and melancholy. In those times, such problems were thought to originate from external, supernatural forces. Later, during the rise of Greco-Roman philosophies in medicine, such states of mind began to be explored more as disturbances of the brain and less as the result of supernatural causes. As such, treatments began to develop greater reliance on methods such as vapors, baths, diets, and emetic and cathartic drugs.

Over time, the field of psychiatry has matured and taken on a major role in medicine. Research into the mind-body relationship has clarified how the mind can influence the healing of medical conditions, as well as how certain medical conditions are rooted in psychological, social, and environmental problems, rather than in a person’s biology alone. Additionally, advances in the development of psychotropic drugs have played a major role in the treatment of disabling conditions long thought to be untreatable, such as schizophrenic and bipolar disorders.

In the future, psychiatry is expected to continue developing a broad variety of specialty areas. New techniques for working with children, adolescents, elders, and individuals with particular medical problems or of a particular gender or cultural background are developing rapidly. Finally, understanding of the relationship between psychiatric disorders across the life span is likely to increase, as is the need to develop treatments for complex scenarios involving multiple diagnoses.

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington: Author, 2013. Print.

Andreasen, Nancy C., and Donald W. Black. Introductory Textbook of Psychiatry. 5th ed. Washington, DC: Amer. Psychiatric, 2011. Print.

Kring, Ann M., et al. Abnormal Psychology. 12th ed. Hoboken: Wiley, 2012. Print.

Mazure, Carolyn M., ed. Does Stress Cause Psychiatric Illness? Washington, DC: Amer. Psychiatric, 1995. Print.

Muskin, Philip R., Patricia L. Gerbarg, and Richard P. Brown. Complementary and Integrative Therapies for Psychiatric Disorders. Philadelphia: Saunders, 2013. Print.

Preston, John, and James Johnson. Clinical Psychopharmacology Made Ridiculously Simple. 7th ed. Miami: MedMaster, 2012. Print.

Sadock, Benjamin J., and Virginia A. Sadock, eds. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincott, 2009. Print.

Semple, David, and Roger Smyth. Oxford Handbook of Psychiatry. New York: Oxford UP, 2013. Print.

Tomb, David.Psychiatry. 7th ed. Philadelphia: Wolters, 2008. Print.