View source for Psychiatry

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[[Image:American Lady Against The Sky.jpg|thumb|right|200px|The word ''[[wiktionary:psyche|psyche]]'' comes from the [[ancient Greek]] for [[soul]] or [[butterfly]].<ref>[http://www.insects.org/ced4/etymology.html Etymology of Butterfly]</ref> The fluttering elusive insect appears in the [[coat of arms]] of Britain's [[Royal College of Psychiatrists]]<ref>{{Cite journal|last=James|first=F.E.|date=1991|title=Psyche|journal=Psychiatric Bulletin|volume=15|pages=429–431|url=http://pb.rcpsych.org/cgi/reprint/15/7/429.pdf|accessdate=2008-08-04|doi=10.1192/pb.15.7.429|isbn=0881632570|publisher=Analytic Press|location=Hillsdale, NJ}}</ref>]]

'''Psychiatry''' is the [[medicine|medical]] [[specialty (medicine)|specialty]] devoted to the [[biomedical research|study]]  and [[treatment of mental disorders|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.<ref name=Insel>Insel, T.R., Wang, P.S. (2010). Rethinking mental illness. ''JAMA, 303'', 1970-1971.</ref> 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.<ref name="Insel"/>

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 [[neurophysiology|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.<ref name=Kupfer>Kupfer, D.J., Regier, D.A. (2010). Why all of medicine should care about DSM-5. ''JAMA, 303'', 1974-1975.</ref>

[[Treatment of mental disorders|Psychiatric treatment]] applies a variety of modalities, including [[psychopharmacology|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 (journal)|Nature]]'', has dubbed the 10-year period of 2010-2019 to be the “decade for psychiatric disorders,”<ref name=Campbell>Campbell, P. (2010). A decade for psychiatric disorders. ''Nature, 463'', 9.</ref> 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.<ref name="Insel"/> The  ''[[Journal of the American Medical Association]]'' (JAMA) has also devoted its May 19, 2010 issue to the theme of mental health,<ref name=Glass>Glass, R.M. (2010). Mental health vs. mental disorders. ''JAMA, 303'', 1978-1979.</ref> 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 [[psychosis|psychotic]] traits, were considered [[supernatural]] in origin.<ref name=Elkes13>Elkes, A. & Thorpe, J.G. (1967). ''A Summary of Psychiatry''. London: Faber & Faber, p. 13.</ref> This view existed throughout [[ancient Greece]] and [[ancient Rome|Rome]].<ref name=Elkes13/> Early manuals written about mental disorders were created by the Greeks.<ref name=Shorter1>Shorter, E. (1997), p. 1</ref> In the 4th century BC, [[Hippocrates]] theorized that physiological abnormalities may be the root of mental disorders.<ref name=Elkes13/><ref name=Elkes13/> Religious leaders and others returned to using early versions of [[exorcism]]s to treat mental disorders which often utilized cruel, harsh, and barbarous methods.<ref name=Elkes13/>

===Middle Ages===
{{Cite check|section|date=September 2010}}
{{Main|Islamic psychology}}
The first [[psychiatric hospital]]s were built in the [[Islamic Golden Age|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 [[demonic possession|demonological explanations]] for mental illness, [[Islamic medicine|medieval Muslim physicians]] relied mostly on [[clinical psychology|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 [[bathing|bath]]s, drug [[medication]], [[music therapy]] and [[occupational therapy]]. In the 10th century, the [[Persian people|Persian]] physician [[Muhammad ibn Zakarīya Rāzi]] (Rhazes) combined [[psychology|psychological]] methods and [[physiology|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 [[erectile dysfunction|sexual impotence]] (''Nafkhae Malikholia''), [[psychosis]] (''Kutrib''), and [[mania]] (''Dual-Kulb'').<ref name=Syed>Syed (2002), p.7-8</ref>

In the 11th century, another Persian physician, [[Avicenna]], recognized "[[physiological psychology]]" in the treatment of illnesses involving [[emotion]]s, 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.<ref>Syed (2002), p. 7</ref> [[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 (medical)|vertigo]] and [[tremor]].<ref>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.</ref>

Psychiatric hospitals were built in [[Middle Ages|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.<ref name=Shorter4>Shorter, E. (1997), p. 4</ref> Founded in the 13th century, [[Bethlem Royal Hospital]] in [[London]] is one of the oldest psychiatric hospitals.<ref name=Shorter4/> By 1547 the City of London acquired the hospital and continued its function until 1948.<ref name=Shorter5>Shorter, E. (1997), p. 5</ref> It is now part of the National Health Service and is an [[NHS Foundation Trust]].
[[Image:Philippe Pinel.jpg|thumb|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.<ref name= Shorter5/> In 1758 English physician [[William Battie]] wrote the ''[[Treatise on Madness]]'' which called for treatments to be utilized in asylums.<ref name=Shorter9>Shorter, E. (1997), p. 9</ref> Thirty years later the new ruling monarch in England, [[George III of the United Kingdom|George III]], was known to be suffering from a mental disorder.<ref name= Elkes13/> Following the King's [[remission (medicine)|remission]] in 1789, mental illness was seen as something which could be treated and cured.<ref name=Elkes13/> By 1792 French physician [[Philippe Pinel]] introduced [[moral treatment|humane treatment]] approaches to those suffering from mental disorders.<ref name=Elkes13/> [[William Tuke]] adopted the methods outlined by Pinel and that same year Tuke opened the [[The Retreat|York Retreat]] in England.<ref name=Elkes13/> That institution became known as a model throughout the world for humane and moral treatment of patients suffering from mental disorders.<ref name=Borthwick>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.</ref> 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.<ref name=Shorter34>Shorter, E. (1997), p. 34</ref> By the late 1890s and early 1900s, this number skyrocketed to the hundreds of thousands.<ref name=Shorter34/> The United States housed 150,000 patients in mental hospitals by 1904.<ref name=Shorter34/> [[German language|German speaking]] countries housed more than 400 public and private sector asylums.<ref name=Shorter34/> These asylums were critical to the evolution of psychiatry as they provided a universal platform of practice throughout the world.<ref name=Shorter34/>

Universities often played a part in the administration of the asylums.<ref name=Shorter35>Shorter, E. (1997), p. 35</ref> Due to the relationship between the universities and asylums, scores of competitive psychiatrists were being molded in Germany.<ref name=Shorter35/> Germany became known as the world leader in psychiatry during the nineteenth century.<ref name=Shorter34/> The country possessed more than 20 separate universities all competing with each other for scientific advancement.<ref name=Shorter34/> 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.<ref name=Shorter34/> Britain, like Germany, also lacked a centralized organization for the administration of asylums.<ref name=Shorter41>Shorter, E. (1997), p. 41</ref> This deficit hindered the diffusion of new ideas in medicine and psychiatry.<ref name=Shorter41/>

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.<ref name=Shorter40>Shorter, E. (1997), p. 40</ref> By 1840, asylums as therapeutic institutions existed throughout Europe and the United States.<ref name=Shorter46>Shorter, E. (1997), p. 46</ref>
[[Image:Emil Kraepelin2.gif|thumb|right|[[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.<ref name=Shorter46/> Psychiatrists and asylums were being pressured by an ever increasing patient population.<ref name=Shorter46/> The average number of patients in asylums in the United States jumped 927%.<ref name= Shorter46/> Numbers were similar in England and Germany.<ref name=Shorter46/> Overcrowding was rampant in France where asylums would commonly take in double their maximum capacity.<ref name=Shorter47>Shorter, E. (1997), p. 47</ref> Increases in asylum populations may have been a result of the transfer of care from families and [[poorhouse]]s, but the specific reasons as to why the increase occurred is still debated today.<ref name=Shorter48>Shorter, E. (1997), p. 48</ref><ref name=Shorter49>Shorter, E. (1997), p. 49</ref> 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<ref name=Rothman>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</ref> and the reputation of psychiatry in the medical world had hit an extreme low.<ref name=Shorter65>Shorter, E. (1997), p. 65</ref>

===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.<ref name=Shorter101>Shorter, E. (1997), p. 101</ref> Kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry.<ref name=Shorter101/> 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.<ref name=Shorter102>Shorter, E. (1997), p. 102</ref><ref name=Shorter103>Shorter, E. (1997), p. 103</ref> Kraepelin began to study and promote the ideas of disease classification for mental disorders, an idea introduced by [[Karl Ludwig Kahlbaum]].<ref name= Shorter103/> 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.<ref name=Shorter114>Shorter, E. (1997), p. 114</ref> Following [[Sigmund Freud]]'s death, ideas stemming from [[psychoanalytic theory]] also began to take root.<ref name=Shorter145>Shorter, E. (1997), p. 145</ref> The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums.<ref name=Shorter145/> By the 1970s the psychoanalytic school of thought had become marginalized within the field.<ref name=Shorter145/>
[[Image:Acetylcholine.svg|right|thumb|[[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]].<ref name=Shorter246/> [[Neuroimaging]] was first utilized as a tool for psychiatry in the 1980s.<ref name=Shorter270>Shorter, E. (1997), p. 270</ref> The discovery of [[chlorpromazine]]'s effectiveness in treating [[schizophrenia]] in 1952 revolutionized treatment of the disease,<ref name="Turner2007">{{Cite journal|author=Turner T. |title= Unlocking psychosis |journal=Brit J Med |year=2007 |volume=334 |issue=suppl |pages=s7 |doi=10.1136/bmj.39034.609074.94 |pmid=17204765}}</ref> as did [[lithium carbonate]]'s ability to stabilize mood highs and lows in [[bipolar disorder]] in 1948.<ref>Cade, JFJ; ''Lithium salts in the treatment of psychotic excitement''. Med J Aust 1949, 36, p349-352</ref> Psychotherapy was still utilized, but as a treatment for psychosocial issues.<ref name=Shorter239>Shorter, E. (1997), p. 239</ref> Genetics were once again thought to play a role in mental illness.<ref name=Shorter246>Shorter, E. (1997), p. 246</ref> Molecular biology opened the door for specific genes contributing to mental disorders to be identified.<ref name= Shorter246/>

====Anti-psychiatry and deinstitutionalization====
{{Main|Anti-psychiatry}}
{{See also|Political abuse of psychiatry}}
The introduction of [[psychiatric medication]]s and the use of [[medical laboratory|laboratory]] tests altered the [[doctor-patient relationship]] between psychiatrists and their patients.<ref name=Shorter273>Shorter, E. (1997), p. 273</ref> Psychiatry's shift to the [[hard science]]s had been interpreted as a lack of concern for patients.<ref name=Shorter273 /> [[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.<ref name= Shorter274>Shorter, E. (1997), p. 274</ref> 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.<ref name=Shorter277>Shorter, E. (1997), p. 277</ref> 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.<ref>Sunny Y. Lu & Viviana B. Galli, ''The Journal of the American Academy of Psychiatry and the Law''</ref> Historical examples of the abuse of psychiatry took place in [[Nazi Germany]],<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12817666&dopt=Abstract The killing of psychiatric patients in Nazi German...[Isr J Psychiatry Relat Sci. 2003&#93; - PubMed Result<!-- Bot generated title -->]</ref> in the [[Soviet Union]] under [[Psikhushka]], and in the [[apartheid]] system in [[South Africa]].<ref>[http://www.info.gov.za/speeches/1997/06160x76497.htm Mental Health During Apartheid<!-- Bot generated title -->]</ref>

[[Electroconvulsive therapy]] (ECT) was one treatment that the anti-psychiatry movement wanted eliminated.<ref name=Shorter282>Shorter, E. (1997), p. 282</ref> They alleged that ECT damaged the brain and was used as a tool for discipline.<ref name=Shorter282/>  While some believe there is no evidence that ECT damages the brain,<ref name=Weiner>Weiner, R.D. (1984). Does ECT cause brain damage? ''Behavioral and Brain Sciences, 7'', 153.</ref><ref name=Meldrum>Meldrum, B.S. (1986). Neuropathological consequences of chemically and electrically induced seizures. ''Annals of the New York Academy of Sciences, 462'', 18693.</ref><ref name=Dwork>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.</ref> there are some citations that ECT does cause damage.<ref name=Breggin>Peter R. Breggin, M.D., Electroshock: It's Brain Disabling Effects.</ref><ref name=Sammant>Dr. Sidney Sament Clinical Psychiatry News, March 1983, p. 4.</ref> 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".<ref name=Shorter282/> The prevalence of psychiatric medication helped initiate [[deinstitutionalization]],<ref name=Shorter280/> the process of discharging patients from psychiatric hospitals to the community.<ref name=Shorter279>Shorter, E. (1997), p. 279</ref> The pressure from the anti-psychiatry movements and the ideology of community treatment from the medical arena helped sustain deinstitutionalization.<ref name=Shorter280/> Thirty-three years after deinstitutionalization started in the United States, only 19% of the patients in state hospitals remained.<ref name=Shorter280/> [[Mental health professional]]s envisioned a process wherein patients would be discharged into communities where they could participate in a normal life while living in a therapeutic atmosphere.<ref name=Shorter280/> 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, [[President of the United States|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.<ref name=Shorter280>Shorter, E. (1997), p. 280</ref> Later, though, the Community Mental Health Center's focus was diverted to provide psychotherapy sessions for those suffering from acute but mild mental disorders.<ref name=Shorter280/> Ultimately there were no arrangements made for actively and severely mentally ill patients who were being discharged from hospitals.<ref name=Shorter280/> Some of those suffering from mental disorders drifted into homelessness or ended up in prisons and jails.<ref name=Shorter280/><ref name=Slovenko>Slovenko, R. (2003). The transinstitutionalization of the mentally ill. ''Ohio University Law Review, 29'', 641.</ref> Studies found that 33% of the homeless population and 14% of inmates in prisons and jails were already diagnosed with a mental illness.<ref name=Shorter280 /><ref name=Torrey>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</ref>

In 1972, psychologist [[David Rosenhan]] published the [[Rosenhan experiment]], a study analyzing the validity of psychiatric diagnoses.<ref name=Rosenhan>Rosenhan, D. (1973). [http://www.sciencemag.org/cgi/content/abstract/179/4070/250 On being sane in insane places]. ''Science'' '''179''', 250-258.</ref> 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 [[Rosenhan experiment#The_non-existent impostor experiment|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.<ref name=Rosenhan/> Critics such as [[Robert Spitzer (psychiatrist)|Robert Spitzer]] placed doubt on the validity and credibility of the study, but did concede that the consistency of psychiatric diagnoses needed improvement.<ref name=Spitzer2005>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.</ref>

Psychiatry, like most medical specialties has a continuing, significant need for research into its diseases, classifications and treatments.<ref name=Lyness16>Lyness, J.M. (1997). ''Psychiatric Pearls''. Philadelphia: F.A. Davis Company. ISBN 978-0-80-360280-9{{Full|date=January 2010}}<!--page no. needed--></ref> Psychiatry adopts biology's fundamental belief that disease and health are different elements of an individual's adaptation to an environment.<ref name=Guze130>Guze, S. B. (1992), p. 130</ref> But psychiatry also recognizes that the environment of the human species is complex and includes physical, cultural, and interpersonal elements.<ref name=Guze130/> In addition to external factors, the [[human brain]] must contain and organize an individual's hopes, fears, desires, fantasies and feelings.<ref name=Guze130/> Psychiatry's difficult task is to bridge the understanding of these factors so that they can be studied both clinically and physiologically.<ref name=Guze130/>

==Theory and focus==
<blockquote class="toccolours" style="text-align:left; width:30%; float:right; padding: 10px 15px 10px 15px; display:table;">"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" <small>([[Psychiatry#cite_note-Guze4-5|Guze, 1992, p.4]]).</small></blockquote>

The term psychiatry (Greek "ψυχιατρική", ''psychiatrikē''), coined by [[Johann Christian Reil]] in 1808, comes from the [[Greek language|Greek]] "ψυχή" (''psychē'': "soul or mind") and "ιατρός" (''iatros'': "healer").<ref>[http://www.manchester.edu/kant/Bio/FullBio/ReilJC.html Johann Christian Reil, ''Dictionary of Eighteenth Century German Philosophers'']</ref><ref>[http://bjp.rcpsych.org/cgi/content/abstract/193/1/1 ''British Journal of Psychiatry'', ''Psychiatry’s 200th birthday'']</ref><ref>[http://www.find-health-articles.com/rec_pub_18091285-the-seminal-contributions-johann-christian-reil-anatomy-physiology.htm''Seminal contributions of Johann Christian Reil'']</ref> It refers to a field of medicine focused specifically on the mind, aiming to [[biomedical research|study]], [[prevention (medical)|prevent]], and [[treatment of mental disorders|treat]] [[mental disorder]]s in [[human]]s.<ref name=Guze4>Guze, S.B. (1992), p. 4</ref><ref name=Storrow1>Storrow, H.A. (1969). ''Outline of Clinical Psychiatry''. New York:Appleton-Century-Crofts, p 1. ISBN 978-0-39-085075-1</ref><ref name=Lyness3>Lyness, J.M. (1997), p. 3</ref> 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.<ref name=Gask7>Gask, L. (2004), p. 7</ref>

Those who practice psychiatry are different than most other [[mental health professional]]s and [[physician]]s in that they must be familiar with both the [[social sciences|social]] and [[biology|biological sciences]].<ref name=Storrow1/> 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.<ref name=Guze131>Guze, S. B. (1992), p 131</ref> Psychiatry exists to treat mental disorders which are conventionally divided into three very general categories: [[mental illness]], severe learning disability, and [[personality disorder]].<ref name=Gask113>Gask, L. (2004), p. 113</ref> 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.<ref name=Gask128>Gask, L. (2004), p. 128</ref>

===Scope of practice===
[[Image:Neuropsychiatric conditions world map - DALY - WHO2002.svg|thumb|[[Disability-adjusted life year]] for neuropsychiatric conditions
 per 100,000&nbsp;inhabitants in 2002.<div class="references-small" style="-moz-column-count:3; column-count:3;">
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|less than 10}}
{{legend|#fff200|10-20}}
{{legend|#ffdc00|20-30}}
{{legend|#ffc600|30-40}}
{{legend|#ffb000|40-50}}
{{legend|#ff9a00|50-60}}
{{legend|#ff8400|60-80}}
{{legend|#ff6e00|80-100}}
{{legend|#ff5800|100-120}}
{{legend|#ff4200|120-140}}
{{legend|#ff2c00|140-150}}
{{legend|#cb0000|more than 150}}</div>]]
While the medical specialty of psychiatry utilizes research in the field of [[neuroscience]], [[psychology]], [[medicine]], [[biology]], [[biochemistry]], and [[pharmacology]],<ref name=Pietrini>Pietrini, P. (2003). Toward a Biochemistry of Mind? ''American Journal of Psychiatry, 160'', 1907-1908.</ref> it has generally been considered a middle ground between [[neurology]] and psychology.<ref name=Shorter326>Shorter, E. (1997), p. 326</ref> 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.<ref name=Shorter326/> Psychiatrists also differ from psychologists in that they are physicians and the entirety of [[Medical school|their post-graduate training]] is revolved around the field of medicine.<ref name=Hauser>Hauser, M.J. (Unknown last update). ''Student Information''. Retrieved September 21, 2007, from http://www.psychiatry.com/student.php</ref> Psychiatrists can therefore counsel patients, prescribe medication, order [[medical laboratory|laboratory test]]s, utilize [[neuroimaging]] in a research setting, and conduct [[physical examination]]s.<ref name=NIMHSite>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</ref>

===Ethics===
Like other [[professional ethics|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]],<ref name=Lopez>{{Cite journal|doi=10.1016/j.pnpbp.2006.12.007 |title=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 |date= 2006-12-07 |author=López-Muñoza, Francisco |others=Cecilio Alamoa, Michael Dudleyb, Gabriel Rubioc, Pilar García-Garcíaa, Juan D. Molinad and Ahmed Okasha |publisher=Science Direct |quote=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. |journal=Progress in Neuro-Psychopharmacology and Biological Psychiatry |volume=31 |pages=791 |pmid=17223241 |first2=C |first3=M |first4=G |first5=P |first6=JD |first7=A |issue=4 |last2=Alamo |last3=Dudley |last4=Rubio |last5=García-García |last6=Molina |last7=Okasha}}</ref> organ transplantation, [[torture]],<ref name=Gluzman>{{Cite journal|author=Gluzman, S.F. |year=1991 |title=Abuse of psychiatry: analysis of the guilt of medical personnel |journal=J Med Ethics |volume=17 |pages=19–20 |accessdate=2007-09-30 |quote=Based on the generally accepted definition, we correctly term the utilisation of psychiatry for the punishment of political dissidents as torture. |doi= 10.1136/jme.17.Suppl.19 |pmid=11651120 |issue=Suppl}}</ref><ref name=Debreu>{{Cite book|url=http://books.nap.edu/openbook.php?record_id=9733&page=21 |author=Debreu, Gerard |editor= Corillon, Carol |title=Science and Human Rights |chapter=Part 1: Torture, Psychiatric Abuse, and the Ethics of Medicine |accessdate=2007-10-04 |year=1988 |publisher=National Academy of Sciences |quote=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.}}</ref> the [[death penalty]], media relations, genetics, and ethnic or cultural discrimination.<ref>[http://www.wpanet.org/generalinfo/ethic1.html The WPA code of ethics.]</ref> 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:
*[[Addiction psychiatry]]; focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders.
*[[Biological psychiatry]]; an approach to psychiatry that aims to understand mental disorders in terms of the biological function of the nervous system.
*[[Child and adolescent psychiatry]]; a branch of psychiatry that specialises in work with children, teenagers, and their families.
*[[Community psychiatry]]; an approach that reflects an inclusive [[public health]] perspective and is practiced in [[community mental health services]].<ref>American Association of Community Psychiatrists [http://www.comm.psych.pitt.edu/mission.html About AACP] Retrieved on Aug-05-2008</ref>
*[[Cross-cultural psychiatry]]; a branch of psychiatry concerned with the cultural and ethnic context of mental disorder and psychiatric services.
*[[Eating disorders]]; focuses on [[anorexia nervosa]], [[bulimia nervosa]], [[binge eating disorder]], eating disorders not otherwise specified (EDNOS) and certain feeding disorders such as [[pica (disorder)]].
*[[Emergency psychiatry]]; the clinical application of psychiatry in emergency settings.
*[[Forensic psychiatry]]; the interface between law and psychiatry.
*[[Geriatric psychiatry]]; a branch of psychiatry dealing with the study, prevention, and treatment of mental disorders in humans with old age.
*[[Global Mental Health]]; the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide.<ref name=Patel>Patel, V., Prince, M. (2010). Global mental health - a new global health field comes of age. ''JAMA, 303'', 1976-1977.</ref>
*[[Liaison psychiatry]]; the branch of psychiatry that specializes in the interface between other medical specialties and psychiatry.
*[[Military psychiatry]]; covers special aspects of psychiatry and mental disorders within the military context.
*[[Neuropsychiatry]]; branch of medicine dealing with mental disorders attributable to diseases of the nervous system.
*[[Social psychiatry]]; a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental wellbeing.

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.<ref>{{Cite journal|author=Verhulst J, Tucker G |title=Medical and narrative approaches in psychiatry |journal=Psychiatr Serv |volume=46 |issue=5 |pages=513–514 |year=1995 |month=May |pmid=7627683 |url=http://ps.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=7627683}}</ref> 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 personality controversy|multiple personalities]]. The [[biopsychosocial model]] is often used to understand psychiatric illness. However, the "model's" scientific credentials have been called into question in [[Niall McLaren|Dr. Niall McLaren's]] 1998 paper, ''A critical review of the Biopsychosocial Model''<ref name="McLaren N 1998 86–92; discussion 93–6">{{Cite journal|author=McLaren N |title=A critical review of the biopsychosocial model |journal=The Australian and New Zealand Journal of Psychiatry |volume=32 |issue=1 |pages=86–92; discussion 93–6 |year=1998 |month=February |pmid=9565189 |doi=10.1046/j.1440-1614.1998.00343.x}}</ref> and his books ''[[Niall McLaren#Humanizing Madness (2007)|Humanizing Madness]]'' and ''[[Niall McLaren#Humanizing Psychiatry (2009)|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).<ref name="McLaren N 1998 86–92; discussion 93–6"/><ref>{{Cite book
 | title = Humanizing Madness
 | last = McLaren | first = Niall
 | year = 2007
 | isbn = 1-932-69039-5
 | pages =
 | publisher = Loving Healing Press
 | location = Ann Arbor, MI}}{{Page needed|date=September 2010}}</ref>
<ref>{{Cite book
 | title = Humanizing Psychiatry
 | last = McLaren | first = Niall
 | year = 2009
 | isbn = 1-615-99011-9
 | pages =
 | publisher = Loving Healing Press
 | location = Ann Arbor, MI}}{{Page needed|date=September 2010}}</ref>

==Industry and academia==
===Practitioners===
{{Main|Psychiatrist}}
All [[physician]]s can diagnose mental disorders and prescribe treatments utilizing principles of psychiatry. [[Psychiatrist]]s are either: 1) clinicians who specialize in psychiatry and are certified in treating [[mental illness]];<ref name=AboutPsychologyDiff>About:Psychology. (Unknown last update) ''Difference Between Psychologists and Psychiatrists''.  Retrieved March 25, 2007, from http://psychology.about.com/od/psychotherapy/f/psychvspsych.htm</ref> 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 therapy|cognitive behavioral therapy]], but it is their training as physicians that differentiates them from other [[mental health professional]]s.<ref name=AboutPsychologyDiff/>

===Research===
[[Image:MRI head side.jpg|thumb|right|200px|An [[Magnetic resonance imaging|MRI]] scan of the [[human brain|brain]]: many [[mental disorders]] are thought to be associated with [[Neurobiology|neurobiological]] abnormalities<ref name=Hedges64>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</ref>]]
Psychiatric research is, by its very nature, interdisciplinary. It combines social, biological and psychological perspectives to understand the nature and treatment of mental disorders.<ref name=UManchester>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</ref> Clinical and research psychiatrists study basic and clinical psychiatric topics at research institutions and publish articles in journals.<ref name=Pietrini/><ref name=NYSPI>New York State Psychiatric Institute. (2007, March 15). ''Psychiatric Research Institute New York State''. Retrieved October 13, 2007, from http://nyspi.org/</ref><ref name=CPRF>Canadian Psychiatric Research Foundation. (2007, July 27). ''Canadian Psychiatric Research Foundation''. Retrieved October 13, 2007, from http://www.cprf.ca/</ref><ref name=Elsevier>Elsevier. (2007, October 08). ''Journal of Psychiatric Research''. Retrieved October 13, 2007, from http://www.elsevier.com/wps/find/journaldescription.cws_home/241/description</ref> Under the supervision of [[institutional review board]]s, 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.<ref name=Mitchell >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.</ref>

===Clinical application===
====Diagnostic systems====
''See also [[Diagnostic classification and rating scales used in psychiatry]]''
[[Image:Ventral midbrain.png|thumb|[[Functional magnetic resonance imaging|fMRI]] images such as these may assist in a diagnosis by ruling out other conditions.]]
[[Psychiatric assessment|Psychiatric diagnoses]] take place in a wide variety of settings and are performed by many different [[health care provider|health professional]]s. 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 [[neuroimaging|neuroimages]] or other [[neurophysiological]] measurements are taken, or [[personality test]]s or [[cognitive test]]s administered.<ref name=Meyendorf>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.</ref><ref name=Leigh15>Leigh, H. (1983), p. 15</ref><ref name=Leigh67>Leigh, H. (1983), p. 67</ref><ref name=Leigh17>Leigh, H. (1983), p. 17</ref><ref name=Lyness10>Lyness, J.M. (1997), p. 10</ref><ref name=Hampel>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.</ref><ref name=Townsend>Townsend, B.A.; Petrella, J.R.; Doraiswamy, P.M. (2002). The role of neuroimaging in geriatric psychiatry. ''Current Opinion in Psychiatry, 15'', 427-432.</ref> 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.<ref>[http://www.nimh.nih.gov/health/publications/neuroimaging-and-mental-illness-a-window-into-the-brain/neuroimaging-and-mental-illness-a-window-into-the-brain.shtml NIMH publications (2009) Neuroimaging and Mental Illness]</ref> A few psychiatrists are beginning to utilize [[genetics]] during the diagnostic process but on the whole this remains a research topic.<ref name=Krebs>Krebs, M.O. (2005). Future contributions on genetics. ''World Journal of Biological Psychiatry, 6'', 49-55</ref><ref name=Benes>Benes, F.M. (2007). An electrophysiological endophenotype of hypomanic and hyperthymic personality. ''Journal of Affective Disorders, 101'', 13-26.</ref><ref name=Vonk>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.</ref>

=====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.<ref name=ICD10>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</ref> 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]].<ref name=DSM >American Psychiatric Association. (2000). ''Diagnostic and Statistical Manual of Mental Disorders'' (4th Edition). Washington D.C.: American Psychiatric Publishing, Inc. ISBN 978-0-89-042025-6</ref> It is currently in its fourth revised edition and is also used worldwide.<ref name=DSM/> The [[Chinese Society of Psychiatry]] has also produced a diagnostic manual, the [[Chinese Classification of Mental Disorders]].<ref name=Chen>Chen, Y.F. (2002) Chinese classification of mental disorders (CCMD-3): towards integration in international classification. ''Psychopathology, 35'', 171-175</ref>

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.<ref name=DSM/><ref name=Essen>Essen-Moller, E. (1971). On classification of mental disorders. ''[[Acta Psychiatrica Scandinavica]], 37'', 119-126.</ref> 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.<ref name=Mezzich>Mezzich, J.E. (1979). Patterns and issues in multiaxial psychiatric diagnosis. ''Psychological Medicine, 9'', 125-137.</ref> 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.<ref name=Guze2>Guze, S.B. (1970) The need for toughmindedness in psychiatric thinking. ''Southern Medical Journal, 63'', 662-671.</ref>

====Treatment settings====
{{Cleanup-rewrite|2=section|date=May 2009}}
{{Expand section|date=October 2007}}

=====General considerations=====
Individuals with mental health conditions are commonly referred to as ''[[patient]]s'' but may also be called ''[[customer|client]]s'', ''[[consumer]]s'', 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-[[Wikt:referral|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]].
[[Image:NIMH Clinical Center.JPG|right|thumb|A psychiatric patient room in the United States.]]

Whatever the circumstance of a person's referral, a psychiatrist first [[psychiatric assessment|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 test]]s and [[medical imaging]] are performed.

Like all medications, psychiatric medications can cause [[adverse effect (medicine)|adverse effects]] in patients and hence often involve ongoing [[therapeutic drug monitoring]], for instance [[full blood count]]s or, for patients taking [[lithium salt]]s, [[blood plasma|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<ref>Moncrieff et al. (2003). [http://www.cochrane.org/reviews/en/ab003012.html Active placebos versus antidepressants for depression]. Cochrane databases.</ref><ref>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</ref> and adverse effects of psychiatric drugs have been challenged.<ref name=Spiegel2006>Eds. Spiegel D, Lake J. (2006). ''[http://books.google.com/books?id=tbJx_fYIfegC Complementary And Alternative Treatments in Mental Health Care]'' American Psychiatric Pub, Inc. Quote from p. xxi</ref>

The close relationship between those prescribing psychiatric medication and pharmaceutical companies has become increasingly controversial<ref>Loren R. Mosher, Richard Gosden and Sharon Beder, 'Drug companies and Schizophrenia: Unbridled Capitalism meets Madness', in [http://www.herinst.org/sbeder/corppower/drugcompanies.html 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.</ref> along with the influence which pharmaceutical companies are exerting on mental health policies.<ref>Richard Gosden and Sharon Beder, [http://www.herinst.org/sbeder/corppower/pharm-agenda.html 'Pharmaceutical Industry Agenda Setting in Mental Health Policies'], Ethical Human Sciences and Services 3(3) Fall/Winter 2001, pp. 147-159</ref><ref>Thomas Ginsberg. [http://mindfreedom.org/campaign/media/mf/inquirer-on-drug-firms/ "Donations tie drug firms and nonprofits"]. [[The Philadelphia Inquirer]] 28 May 2006.</ref>

Also controversial are forced drugging and the "lack of insight" label. According to a report published by the US National Council on Disability,
<blockquote>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".<ref>Rae E. Unzicker, Kate P. Wolters, Debra Robinson et al. [http://www.ncd.gov/newsroom/publications/2000/privileges.htm From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves]. [[National Council on Disability]] 20 January 2000.</ref></blockquote>

=====Inpatient treatment=====
[[Treatment of mental illness|Psychiatric treatments]] have changed over the past several decades. In the past, psychiatric patients were often [[psychiatric hospital|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 [[general out-patient clinic|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|date=August 2008}}

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|date=August 2008}}

[[Image:Syringe2.jpg|thumb|[[Injection (medicine)|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 [[psychiatric assessment|assessed]], monitored, and often given medication and care from a multidisciplinary team, which may include physicians, psychiatric nurse practitioners, [[psychiatric and mental health nursing|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.<ref>{{Cite book|last=Treatment Protocol Project |title=Acute inpatient psychiatric care: A source book |publisher=World Health Organisation |location=Darlinghurst, Australia |date=2003 |isbn=0-9578073-1-7 |oclc=223935527 |author=Treatment Protocol Project}}</ref>

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|date=August 2008}}

=====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|date=October 2007}}

==See also==
* [[Biopsychiatry controversy]]
* [[Mental health]]
* [[Psychiatric assessment]]
* [[Telepsychiatry]]
* [[Anti-psychiatry]] - Criticism against psychiatry

==References==
===Notes===
{{Reflist|3}}

===Cited texts===
{{Refbegin}}
* Gask, L. (2004). ''A Short Introduction to Psychiatry''. London: SAGE Publications Ltd., p.&nbsp;113 ISBN 978-0-7619-7138-2
* Guze, S.B. (1992). ''Why Psychiatry Is a Branch of Medicine''. New York: Oxford University Press, p.&nbsp;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.&nbsp;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].
{{Refend}}

===Further reading===
{{Refbegin|2}}
* 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, [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12633125 "Perceptions and impact of bipolar disorder: how far have we really come?"], ''J. Clin. Psychiatry'' vol.64(2), p.&nbsp;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, [http://www.medfriendly.com/psychologist.html ''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.&nbsp;59–88. [http://www.cormacburke.or.ke/node/693 Cormacburke.or.ke]
* National Association of Cognitive-Behavioral Therapists, [http://www.nacbt.org/whatiscbt.htm ''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) "[http://hpy.sagepub.com/cgi/pdf_extract/13/50/131 Japanese psychiatry in the Edo period (1600-1868)]." History of Psychiatry, Vol. 13, No. 50, 131-151 (2002).
{{Refend}}

==External links==
{{wikibooks|Psychiatry}}
{{Wikiquote}}
* [http://www.wpanet.org/ World Psychiatric Association]
* [http://www.psychiatrist.com/ Journal of Clinical Psychiatry]
* [http://www.psych.org American Psychiatric Association]
* [http://www.rcpsych.ac.uk The Royal College of Psychiatrists]
* [http://www.ranzcp.org/ Royal Australian and New Zealand College of Psychiatrists]
* [http://www.wiley.com/bw/journal.asp?ref=1758-5864 Asia-Pacific Psychiatry], official journal of the [http://www.prcp.org/ Pacific Rim College of Psychiatrists.]
* [http://www3.interscience.wiley.com/journal/118501024/home Early Intervention in Psychiatry], official journal of the [http://www.iepa.org.au/Default.aspx [[International Early Psychosis Association]].]
* [http://www3.interscience.wiley.com/journal/118505988/home Psychiatry and Clinical Neurosciences], official journal of the [http://www.jspn.or.jp/ The Japanese Society of Psychiatry and Neurology.]

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{{Medicine}}
{{Psychiatry}}
{{Mental and behavioral disorders}}
{{Neuroscience}}

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[[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]]
[[Category:2Fix]]