Psychiatry

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File:American Lady Against The Sky.jpg
The word psyche comes from the ancient Greek for soul or butterfly.[1] The fluttering elusive insect appears in the coat of arms of Britain's Royal College of Psychiatrists[2]

Psychiatry is the medical specialty devoted to the study and treatment of mental disorders—which include various affective, behavioural, cognitive and perceptual disorders. The term was first coined by the German physician Johann Christian Reil 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.

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 and the compilation of a case history. Psychological tests and physical examinations may be conducted, including on occasion the use of neuroimaging or other neurophysiological 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 (DSM), published by the American Psychiatric Association, and the International Classification of Diseases (ICD) edited and used by the World Health Organization. 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 applies a variety of modalities, including medication, psychotherapy and a wide range of other techniques such as transcranial magnetic stimulation. Treatment may be as an inpatient or outpatient, 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, 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 Journal of the American Medical Association (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.

History

Ancient times

Starting in the 5th century BC, mental disorders, especially those with psychotic traits, were considered supernatural in origin.[7] This view existed throughout ancient Greece and Rome.[7] Early manuals written about mental disorders were created by the Greeks.[8] In the 4th century BC, Hippocrates theorized that physiological abnormalities may be the root of mental disorders.[7][7] Religious leaders and others returned to using early versions of exorcisms to treat mental disorders which often utilized cruel, harsh, and barbarous methods.[7]

Middle Ages

Main article: Islamic psychology

The first psychiatric hospitals were built in the medieval Islamic world from the 8th century. The first was built in Baghdad in 705 AD, followed by Fes in the early 8th century, and Cairo in 800 AD. Unlike medieval Christian physicians who relied on demonological explanations for mental illness, medieval Muslim physicians relied mostly on clinical observations. They made significant advances to psychiatry and were the first to provide psychotherapy and moral treatment for mentally ill patients, in addition to other forms of treatment such as baths, drug medication, music therapy and occupational therapy. In the 10th century, the Persian physician Muhammad ibn Zakarīya Rāzi (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.

File:Philippe Pinel.jpg
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]

File:Emil Kraepelin2.gif
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]

File:Acetylcholine.svg
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

File:Neuropsychiatric conditions world map - DALY - WHO2002.svg
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).[77][78] [79]

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;[80] 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.[80]

Research

File:MRI head side.jpg
An MRI scan of the brain: many mental disorders are thought to be associated with neurobiological abnormalities[81]

Psychiatric research is, by its very nature, interdisciplinary. It combines social, biological and psychological perspectives to understand the nature and treatment of mental disorders.[82] Clinical and research psychiatrists study basic and clinical psychiatric topics at research institutions and publish articles in journals.[66][83][84][85] 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.[86]

Clinical application

Diagnostic systems

See also Diagnostic classification and rating scales used in psychiatry

File:Ventral midbrain.png
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.[87][88][89][90][91][92][93] 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.[94] A few psychiatrists are beginning to utilize genetics during the diagnostic process but on the whole this remains a research topic.[95][96][97]

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.[98] 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.[99] It is currently in its fourth revised edition and is also used worldwide.[99] The Chinese Society of Psychiatry has also produced a diagnostic manual, the Chinese Classification of Mental Disorders.[100]

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.[99][101] 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.[102] 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.[103]

Treatment settings

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.

File:NIMH Clinical Center.JPG
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[104][105] and adverse effects of psychiatric drugs have been challenged.[106]

The close relationship between those prescribing psychiatric medication and pharmaceutical companies has become increasingly controversial[107] along with the influence which pharmaceutical companies are exerting on mental health policies.[108][109]

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".[110]
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]

File:Syringe2.jpg
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.[111]

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

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Cited texts

  • Gask, L. (2004). A Short Introduction to Psychiatry. London: SAGE Publications Ltd., p. 113 ISBN 978-0-7619-7138-2
  • Guze, S.B. (1992). Why Psychiatry Is a Branch of Medicine. New York: Oxford University Press, p. 4. ISBN 978-0-19-507420-8
  • Leigh, H. (1983). Psychiatry in the practice of medicine. Menlo Park: Addison-Wesley Publishing Company. ISBN 978-0-20-105456-9
  • Lyness, J.M. (1997). Psychiatric Pearls. Philadelphia: F.A. Davis Company, p. 3. ISBN 978-0-80-360280-9
  • Shorter, E. (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley & Sons, Inc. ISBN 978-0-47-124531-5
  • Syed, Ibrahim B. (2002). "Islamic Medicine: 1000 years ahead of its times", Journal of the International Society for the History of Islamic Medicine, (2): 2-9 [7-8].

Further reading

  • Berrios G E, Porter R (1995) The History of Clinical Psychiatry. London, Athlone Press
  • Berrios G E (1996) History of Mental symptoms. The History of Descriptive Psychopathology since the 19th century. Cambridge, Cambridge University Press
  • Ford-Martin, Paula Anne Gale (2002), "Psychosis" Gale Encyclopedia of Medicine, Farmington Hills, Michigan
  • Hirschfeld et al. 2003, "Perceptions and impact of bipolar disorder: how far have we really come?", J. Clin. Psychiatry vol.64(2), p. 161-174.
  • McGorry PD, Mihalopoulos C, Henry L et al. (1995) Spurious precision: procedural validity of diagnostic assessment in psychiatric disorders. American Journal of Psychiatry 152 (2) 220-223
  • MedFriendly.com, Psychologist, Viewed 20 September 2006
  • Moncrieff J, Cohen D. (2005). Rethinking models of psychotropic drug action. Psychotherapy & Psychosomatics, 74, 145-153
  • C. Burke, Psychiatry: a "value-free" science? Linacre Quarterly, vol. 67/1 (February 2000), pp. 59–88. Cormacburke.or.ke
  • National Association of Cognitive-Behavioral Therapists, What is Cognitive-Behavioral Therapy?, Viewed 20 September 2006
  • van Os J, Gilvarry C, Bale R et al. (1999) A comparison of the utility of dimensional and categorical representations of psychosis. Psychological Medicine 29 (3) 595-606
  • Williams, J.B., Gibbon, M., First, M., Spitzer, R., Davies, M., Borus, J., Howes, M., Kane, J., Pope, H., Rounsaville, B., and Wittchen, H. (1992). The structured clinical interview for DSM-III-R (SCID) II: Multi-site test-retest reliability. Archives of General Psychiatry, 49, 630-636.
  • Hiruta, Genshiro. (edited by Dr. Allan Beveridge) "Japanese psychiatry in the Edo period (1600-1868)." History of Psychiatry, Vol. 13, No. 50, 131-151 (2002).

External links


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American Board of Psychiatry and Neurology • American Psychiatric Association • American Neuropsychiatric Association • Royal College of Psychiatrists • Irish College of Psychiatrists • Canadian Psychiatric Association • Royal Australian and New Zealand College of Psychiatrists • Brazilian Association of Psychiatry • Chinese Society of Psychiatry • German Society of Psychiatry, Psychotherapy and Neurology • Hong Kong College of Psychiatrists • Independent Psychiatric Association of Russia • Indian Psychiatric Society • Israeli Psychiatric Association • Italian Psychiatric Society • Korean Neuropsychiatric Association • Japanese Society of Psychiatry & Neurology • Singapore Psychiatric Association • South African Society of Psychiatrists • World Psychiatric Association

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af:Psigiatrie ar:طب نفسي az:Psixiatriya bn:মনোরোগবিদ্যা be:Псіхіятрыя be-x-old:Псыхіятрыя bg:Психиатрия ca:Psiquiatria cs:Psychiatrie da:Psykiatri de:Psychiatrie et:Psühhiaatria el:Ψυχιατρική es:Psiquiatría eo:Psikiatrio eu:Psikiatria fa:روان‌پزشکی fr:Psychiatrie ga:Síciatracht gl:Psiquiatría ko:정신의학 hi:मनोरोग विज्ञान hr:Psihijatrija id:Psikiatri ia:Psychiatria it:Psichiatria he:פסיכיאטריה jv:Psikiatri la:Psychiatria lt:Psichiatrija hu:Pszichiátria mk:Психијатрија arz:طب نفسى nl:Psychiatrie ne:मानसिक चिकित्सा ja:精神医学 no:Psykiatri nn:Psykiatri pl:Psychiatria pt:Psiquiatria ro:Psihiatrie ru:Психиатрия si:මනෝ චිකිත්සාව simple:Psychiatry sk:Psychiatria sl:Psihiatrija sr:Психијатрија sh:Psihijatrija fi:Psykiatria sv:Psykiatri tl:Sikiyatriya th:จิตเวชศาสตร์ tr:Psikiyatri uk:Психіатрія ur:طب نفسی yi:פסיכיאטריע

zh:精神病学
  1. ↑ Etymology of Butterfly
  2. ↑ James, F.E. (1991). "Psyche" (PDF). Psychiatric Bulletin. Hillsdale, NJ: Analytic Press. 15: 429–431. doi:10.1192/pb.15.7.429. ISBN 0881632570. Retrieved 2008-08-04. 
  3. ↑ 3.0 3.1 3.2 Insel, T.R., Wang, P.S. (2010). Rethinking mental illness. JAMA, 303, 1970-1971.
  4. ↑ Kupfer, D.J., Regier, D.A. (2010). Why all of medicine should care about DSM-5. JAMA, 303, 1974-1975.
  5. ↑ Campbell, P. (2010). A decade for psychiatric disorders. Nature, 463, 9.
  6. ↑ Glass, R.M. (2010). Mental health vs. mental disorders. JAMA, 303, 1978-1979.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 Elkes, A. & Thorpe, J.G. (1967). A Summary of Psychiatry. London: Faber & Faber, p. 13.
  8. ↑ Shorter, E. (1997), p. 1
  9. ↑ Syed (2002), p.7-8
  10. ↑ Syed (2002), p. 7
  11. ↑ S Safavi-Abbasi, LBC Brasiliense, RK Workman (2007), "The fate of medical knowledge and the neurosciences during the time of Genghis Khan and the Mongolian Empire", Neurosurgical Focus 23 (1), E13, p. 3.
  12. ↑ 12.0 12.1 Shorter, E. (1997), p. 4
  13. ↑ 13.0 13.1 Shorter, E. (1997), p. 5
  14. ↑ Shorter, E. (1997), p. 9
  15. ↑ Borthwick, A.; Holman, C.; Kennard, D.; McFetridge, M.; Messruther, K.; Wilkes, J. (2001). The relevance of moral treatment to contemporary mental health care. Journal of Mental Health, 10, 427-439.
  16. ↑ 16.0 16.1 16.2 16.3 16.4 16.5 16.6 16.7 Shorter, E. (1997), p. 34
  17. ↑ 17.0 17.1 Shorter, E. (1997), p. 35
  18. ↑ 18.0 18.1 Shorter, E. (1997), p. 41
  19. ↑ Shorter, E. (1997), p. 40
  20. ↑ 20.0 20.1 20.2 20.3 20.4 Shorter, E. (1997), p. 46
  21. ↑ Shorter, E. (1997), p. 47
  22. ↑ Shorter, E. (1997), p. 48
  23. ↑ Shorter, E. (1997), p. 49
  24. ↑ Rothman, D.J. (1990). The Discovery of the Asylum: Social Order and Disorder in the New Republic. Boston: Little Brown, p. 239. ISBN 978-0-316-75745-4
  25. ↑ Shorter, E. (1997), p. 65
  26. ↑ 26.0 26.1 Shorter, E. (1997), p. 101
  27. ↑ Shorter, E. (1997), p. 102
  28. ↑ 28.0 28.1 Shorter, E. (1997), p. 103
  29. ↑ Shorter, E. (1997), p. 114
  30. ↑ 30.0 30.1 30.2 Shorter, E. (1997), p. 145
  31. ↑ 31.0 31.1 31.2 Shorter, E. (1997), p. 246
  32. ↑ Shorter, E. (1997), p. 270
  33. ↑ Turner T. (2007). "Unlocking psychosis". Brit J Med. 334 (suppl): s7. doi:10.1136/bmj.39034.609074.94. PMID 17204765. 
  34. ↑ Cade, JFJ; Lithium salts in the treatment of psychotic excitement. Med J Aust 1949, 36, p349-352
  35. ↑ Shorter, E. (1997), p. 239
  36. ↑ 36.0 36.1 Shorter, E. (1997), p. 273
  37. ↑ Shorter, E. (1997), p. 274
  38. ↑ Shorter, E. (1997), p. 277
  39. ↑ Sunny Y. Lu & Viviana B. Galli, The Journal of the American Academy of Psychiatry and the Law
  40. ↑ The killing of psychiatric patients in Nazi German...[Isr J Psychiatry Relat Sci. 2003] - PubMed Result
  41. ↑ Mental Health During Apartheid
  42. ↑ 42.0 42.1 42.2 Shorter, E. (1997), p. 282
  43. ↑ Weiner, R.D. (1984). Does ECT cause brain damage? Behavioral and Brain Sciences, 7, 153.
  44. ↑ Meldrum, B.S. (1986). Neuropathological consequences of chemically and electrically induced seizures. Annals of the New York Academy of Sciences, 462, 18693.
  45. ↑ Dwork, A.J.; Arango, V.; Underwood, M.; Ilievski, B.; Rosoklija, G.; Sackeim, H.A.; Lisanby, S.H. (2004). Absence of histological lesions in primate models of ECT and magnetic seizure therapy. American Journal of Psychiatry, 161, 576-578.
  46. ↑ Peter R. Breggin, M.D., Electroshock: It's Brain Disabling Effects.
  47. ↑ Dr. Sidney Sament Clinical Psychiatry News, March 1983, p. 4.
  48. ↑ 48.0 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 Shorter, E. (1997), p. 280
  49. ↑ Shorter, E. (1997), p. 279
  50. ↑ Slovenko, R. (2003). The transinstitutionalization of the mentally ill. Ohio University Law Review, 29, 641.
  51. ↑ Torrey, E.F. (1988). Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill. New York: Harper and Row, pp.25-29, 126-128. ISBN 978-0-06-015993-1
  52. ↑ 52.0 52.1 Rosenhan, D. (1973). On being sane in insane places. Science 179, 250-258.
  53. ↑ Spitzer, R.L.; Lilienfeld, S.O.; Miller, M.B. (2005). Rosenhan revisited: The scientific credibility of Lauren Slater's pseudopatient diagnosis study. Journal of Nervous and Mental Disease, 193, 734-739.
  54. ↑ Lyness, J.M. (1997). Psychiatric Pearls. Philadelphia: F.A. Davis Company. ISBN 978-0-80-360280-9[Full citation needed]
  55. ↑ 55.0 55.1 55.2 55.3 Guze, S. B. (1992), p. 130
  56. ↑ Johann Christian Reil, Dictionary of Eighteenth Century German Philosophers
  57. ↑ British Journal of Psychiatry, Psychiatry’s 200th birthday
  58. ↑ Seminal contributions of Johann Christian Reil
  59. ↑ Guze, S.B. (1992), p. 4
  60. ↑ 60.0 60.1 Storrow, H.A. (1969). Outline of Clinical Psychiatry. New York:Appleton-Century-Crofts, p 1. ISBN 978-0-39-085075-1
  61. ↑ Lyness, J.M. (1997), p. 3
  62. ↑ Gask, L. (2004), p. 7
  63. ↑ Guze, S. B. (1992), p 131
  64. ↑ Gask, L. (2004), p. 113
  65. ↑ Gask, L. (2004), p. 128
  66. ↑ 66.0 66.1 Pietrini, P. (2003). Toward a Biochemistry of Mind? American Journal of Psychiatry, 160, 1907-1908.
  67. ↑ 67.0 67.1 Shorter, E. (1997), p. 326
  68. ↑ Hauser, M.J. (Unknown last update). Student Information. Retrieved September 21, 2007, from http://www.psychiatry.com/student.php
  69. ↑ National Institute of Mental Health. (2006, January 31). Information about Mental Illness and the Brain. Retrieved April 19, 2007, from http://science-education.nih.gov/supplements/nih5/Mental/guide/info-mental-c.htm
  70. ↑ López-Muñoza, Francisco; Alamo, C; Dudley, M; Rubio, G; García-García, P; Molina, JD; Okasha, A (2006-12-07). Cecilio Alamoa, Michael Dudleyb, Gabriel Rubioc, Pilar García-Garcíaa, Juan D. Molinad and Ahmed Okasha. "Progress in Neuro-Psychopharmacology and Biological Psychiatry: Psychiatry and political–institutional abuse from the historical perspective: The ethical lessons of the Nuremberg Trial on their 60th anniversary". Progress in Neuro-Psychopharmacology and Biological Psychiatry. Science Direct. 31 (4): 791. doi:10.1016/j.pnpbp.2006.12.007. PMID 17223241. These practices, in which racial hygiene constituted one of the fundamental principles and euthanasia programmes were the most obvious consequence, violated the majority of known bioethical principles. Psychiatry played a central role in these programmes, and the mentally ill were the principal victims. 
  71. ↑ Gluzman, S.F. (1991). "Abuse of psychiatry: analysis of the guilt of medical personnel". J Med Ethics. 17 (Suppl): 19–20. doi:10.1136/jme.17.Suppl.19. PMID 11651120. Based on the generally accepted definition, we correctly term the utilisation of psychiatry for the punishment of political dissidents as torture. 
  72. ↑ Debreu, Gerard (1988). "Part 1: Torture, Psychiatric Abuse, and the Ethics of Medicine". In Corillon, Carol. Science and Human Rights. National Academy of Sciences. Retrieved 2007-10-04. Over the past two decades the systematic use of torture and psychiatric abuse have been sanctioned or condoned by more than one-third of the nations in the United Nations, about half of mankind. 
  73. ↑ The WPA code of ethics.
  74. ↑ American Association of Community Psychiatrists About AACP Retrieved on Aug-05-2008
  75. ↑ Patel, V., Prince, M. (2010). Global mental health - a new global health field comes of age. JAMA, 303, 1976-1977.
  76. ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
  77. ↑ 77.0 77.1 Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
  78. ↑ McLaren, Niall (2007). Humanizing Madness. Ann Arbor, MI: Loving Healing Press. ISBN 1-932-69039-5. [page needed]
  79. ↑ McLaren, Niall (2009). Humanizing Psychiatry. Ann Arbor, MI: Loving Healing Press. ISBN 1-615-99011-9. [page needed]
  80. ↑ 80.0 80.1 About:Psychology. (Unknown last update) Difference Between Psychologists and Psychiatrists. Retrieved March 25, 2007, from http://psychology.about.com/od/psychotherapy/f/psychvspsych.htm
  81. ↑ Hedges, D.; Burchfield, C. (2006). Mind, Brain, and Drug: An Introduction to Psychopharmacology.. Boston: Pearson Education, p. 64,65. ISBN 978-0-205-35556-3
  82. ↑ University of Manchester. (Unknown last update). Research in Psychiatry. Retrieved October 13, 2007, from http://www.manchester.ac.uk/research/areas/subareas/?a=s&id=44694
  83. ↑ New York State Psychiatric Institute. (2007, March 15). Psychiatric Research Institute New York State. Retrieved October 13, 2007, from http://nyspi.org/
  84. ↑ Canadian Psychiatric Research Foundation. (2007, July 27). Canadian Psychiatric Research Foundation. Retrieved October 13, 2007, from http://www.cprf.ca/
  85. ↑ Elsevier. (2007, October 08). Journal of Psychiatric Research. Retrieved October 13, 2007, from http://www.elsevier.com/wps/find/journaldescription.cws_home/241/description
  86. ↑ Mitchell, J.E.; Crosby, R.D.; Wonderlich, S.A.; Adson, D.E. (2000). Elements of Clinical Research in Psychiatry. Washington D.C.: American Psychiatric Press. ISBN 978-0-88-048802-0.
  87. ↑ Meyendorf, R. (1980). Diagnosis and differential diagnosis in psychiatry and the question of situation referred prognostic diagnosis. Schweizer Archiv Neurol Neurochir Psychiatry für Neurologie, Neurochirurgie et de psychiatrie, 126, 121-134.
  88. ↑ Leigh, H. (1983), p. 15
  89. ↑ Leigh, H. (1983), p. 67
  90. ↑ Leigh, H. (1983), p. 17
  91. ↑ Lyness, J.M. (1997), p. 10
  92. ↑ Hampel, H.; Teipel, S.J.; Kotter, H.U.; et al. (1997). Structural magnetic resonance imaging in diagnosis and research of Alzheimer's disease. Nervenarzt, 68, 365-378.
  93. ↑ Townsend, B.A.; Petrella, J.R.; Doraiswamy, P.M. (2002). The role of neuroimaging in geriatric psychiatry. Current Opinion in Psychiatry, 15, 427-432.
  94. ↑ NIMH publications (2009) Neuroimaging and Mental Illness
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  97. ↑ Vonk, R.; van der Schot, A.C.; Kahn, R.S.; et al. (2007). Is autoimmune thyroiditis part of the genetic vulnerability (or an endophenotype) for bipolar disorder? Biological Psychiatry, 62, 135-140.
  98. ↑ World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation. ISBN 978-9-24-154422-1
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  100. ↑ Chen, Y.F. (2002) Chinese classification of mental disorders (CCMD-3): towards integration in international classification. Psychopathology, 35, 171-175
  101. ↑ Essen-Moller, E. (1971). On classification of mental disorders. Acta Psychiatrica Scandinavica, 37, 119-126.
  102. ↑ Mezzich, J.E. (1979). Patterns and issues in multiaxial psychiatric diagnosis. Psychological Medicine, 9, 125-137.
  103. ↑ Guze, S.B. (1970) The need for toughmindedness in psychiatric thinking. Southern Medical Journal, 63, 662-671.
  104. ↑ Moncrieff et al. (2003). Active placebos versus antidepressants for depression. Cochrane databases.
  105. ↑ Hopper K, Wanderling J (2000). Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative followup project. International Study of Schizophrenia. Schizophrenia Bulletin, 26 (4), 835–46. PMID 11087016
  106. ↑ Eds. Spiegel D, Lake J. (2006). Complementary And Alternative Treatments in Mental Health Care American Psychiatric Pub, Inc. Quote from p. xxi
  107. ↑ Loren R. Mosher, Richard Gosden and Sharon Beder, 'Drug companies and Schizophrenia: Unbridled Capitalism meets Madness', in Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia edited by John Read, Loren Mosher and Richard Bentall, Brunner-Routledge, New York, 2004, pp. 115-130.
  108. ↑ Richard Gosden and Sharon Beder, 'Pharmaceutical Industry Agenda Setting in Mental Health Policies', Ethical Human Sciences and Services 3(3) Fall/Winter 2001, pp. 147-159
  109. ↑ Thomas Ginsberg. "Donations tie drug firms and nonprofits". The Philadelphia Inquirer 28 May 2006.
  110. ↑ Rae E. Unzicker, Kate P. Wolters, Debra Robinson et al. From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves. National Council on Disability 20 January 2000.
  111. ↑ Treatment Protocol Project (2003). Acute inpatient psychiatric care: A source book. Darlinghurst, Australia: World Health Organisation. ISBN 0-9578073-1-7. OCLC 223935527.  More than one of |author= and |last= specified (help)
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