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Psychiatry is the
medical specialty A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include children (paediatrics Pediatrics (American and British English differences, also spelled paedi ...
devoted to the diagnosis, prevention, and treatment of
mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing In internal medici ...
s. These include various
maladaptation A maladaptation () is a trait Trait may refer to: * Phenotypic trait in biology, which involve genes and characteristics of organisms * Trait (computer programming), a model for structuring object-oriented programs (a template class in the C++ p ...
s related to mood, behaviour,
cognition Cognition () refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses many aspects of intellectual functions and processes such as: attention, the formation of ...
, and
perception Perception (from the Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Latium. Through the powe ...

perception
s. See
glossary of psychiatry This glossary covers terms found in the psychiatry, psychiatric literature; the word origins are primarily Greek language, Greek, but there are also Latin language, Latin, French language, French, German language, German, and English language, En ...
. Initial psychiatric assessment of a person typically begins with a case history and
mental status examination The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient A patient is any recipient of health care H ...
. Physical examinations and psychological tests may be conducted. On occasion,
neuroimaging Neuroimaging or brain imaging is the use of various techniques to either directly or indirectly Medical imaging, image the neuroanatomy, structure, function, or pharmacology of the nervous system. It is a relatively new discipline within medicine ...
or other
neurophysiological Neurophysiology is the study of nerve cells (neurones) as they receive and transmit information. It is a branch of physiology and neuroscience that focuses on the functioning of the nervous system. The word originates from the Ancient Greek, Greek w ...
techniques are used. Mental disorders are often diagnosed in accordance with clinical concepts listed in diagnostic manuals such as the ''
International Classification of Diseases The International Classification of Diseases (ICD) is a globally used diagnostic Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different academic discipline, disciplines, with variations ...
'' (ICD), edited and used by the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Unit ...
(WHO) and the widely used ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of ...
'' (DSM), published by the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest Psychiatry, psychiatric organization in the world. Its some 38,800 members are main ...
(APA). The fifth edition of the DSM (
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomy (general), taxonomic and diagnostic tool published by the Am ...
) was published in May 2013 which re-organized the larger categories of various diseases and expanded upon the previous edition to include information/insights that are consistent with current research. Combined treatment with
psychiatric medication A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat Mental disorder, mental illnesses. Usually prescribed in ps ...
and
psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase happiness, and ove ...
has become the most common mode of psychiatric treatment in current practice, but contemporary practice also includes a wide variety of other modalities, e.g.,
assertive community treatmentAssertive community treatment (ACT) is an intensive and highly integrated approach for community mental health service delivery. ACT teams serve individuals with the most serious forms of mental illness, predominantly but not exclusively the schizoph ...
, community reinforcement, and
supported employment Supported employment refers to service provisions wherein people with disabilities A disability is a societal imposition on people who have impairments, making it more difficult for people to do certain activities or interact with the world ...
. Treatment may be delivered on an
inpatient A patient is any recipient of health care Health care, health-care, or healthcare is the maintenance or improvement of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, recovery, or cure of disease, illness, injur ...
or
outpatient A patient is any recipient of health care Healthcare is the maintenance or improvement of health Health is a state of physical, mental and social well-being Well-being, also known as ''wellness'', ''prudential value'' or ''quality of l ...
basis, depending on the severity of functional impairment or on other aspects of the disorder in question. An inpatient may be treated in a
psychiatric hospital Psychiatric hospitals, also known as mental health units or behavioral health units, are hospital A hospital is a health care institution providing patient treatment with specialized medical and nursing staff and medical equipment. The best ...
. Research within psychiatry as a whole is conducted on an interdisciplinary basis with other professionals, such as
epidemiologists Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in defined population In biology, a population is a number of all the organisms of the same group ...
,
nurses Nursing is a profession within the health care Healthcare is the maintenance or improvement of health Health is a state of physical, mental and social well-being Well-being, also known as ''wellness'', ''prudential value'' or ''qua ...

nurses
,
social workers Social work is an academic discipline and practice-based profession A Profession is a disciplined group of individuals who adhere to ethical standards and who hold themselves out as, and are accepted by the public as possessing special kno ...
,
occupational therapists Occupational Therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases, and a holistic perspective to promote a person's abi ...
, or clinical
psychologists A psychologist is a professional A professional is a member of a profession or any person who earns a living from a specified professional activity. The term also describes the standards of education and training that prepare members of the ...
.


Etymology

The term ''psychiatry'' was first coined by the German
physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintainin ...

physician
Johann Christian Reil 220px, Reil's tomb on the Reilberg in Halle, Saxony-Anhalt, Halle (Saale), Germany, today Bergzoo Halle Johann Christian Reil (20 February 1759, Rhaude (an urban district of Rhauderfehn) – 22 November 1813, Halle an der Saale) was a German physi ...

Johann Christian Reil
in 1808 and literally means the 'medical treatment of the soul' ('' psych-'' 'soul' from
Ancient Greek Ancient Greek includes the forms of the Greek language Greek ( el, label=Modern Greek Modern Greek (, , or , ''Kiní Neoellinikí Glóssa''), generally referred to by speakers simply as Greek (, ), refers collectively to the diale ...
''psykhē'' 'soul'; '' -iatry'' 'medical treatment' from Gk. ''iātrikos'' 'medical' from ''iāsthai'' 'to heal'). A medical doctor specializing in psychiatry is a
psychiatrist A psychiatrist is a physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is c ...
. (For a historical overview, see Timeline of psychiatry.)


Theory and focus

Psychiatry refers to a field of medicine focused specifically on the
mind The mind is the set of faculties responsible for mental phenomena A phenomenon (; plural phenomena) is an observable fact or event. The term came into its modern philosophical Philosophy (from , ) is the study of general and fun ...

mind
, aiming to
study Study or studies may refer to: General * Education **Higher education * Clinical trial * Experiment * Observational study * Research * Study skills, abilities and approaches applied to learning Other * Study (art), a drawing or series of drawing ...
, prevent, and treat
mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing In internal medici ...
s in
human Humans (''Homo sapiens'') are the most abundant and widespread species In biology, a species is the basic unit of biological classification, classification and a taxonomic rank of an organism, as well as a unit of biodiversity. A speci ...

human
s.. 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. People who specialize in psychiatry often differ from most other
mental health professional#REDIRECT Mental health professional A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health Mental health, defined by the ...
s and
physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintainin ...

physician
s in that they must be familiar with both the
social Social organisms, including humans, live collectively in interacting populations. This interaction is considered social whether they are aware of it or not, and whether the exchange is voluntary/involuntary. Etymology The word "Social" derives fr ...

social
and
biological sciences Biology is the natural science Natural science is a branch of science Science (from the Latin word ''scientia'', meaning "knowledge") is a systematic enterprise that Scientific method, builds and Taxonomy (general), organizes knowl ...

biological sciences
. The discipline studies the operations of different organs and body systems as classified by the patient's subjective experiences and the objective physiology of the patient. Psychiatry treats mental disorders, which are conventionally divided into three very general categories:
mental illnesses A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitting, or oc ...
, severe learning disabilities, and
personality disorder Personality disorders (PD) are a class of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. ...
s. While the focus of psychiatry has changed little over 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 other medical fields.


Scope of practice

Though the medical specialty of psychiatry uses research in the field of
neuroscience Neuroscience is the scientific study of the nervous system In biology, the classical doctrine of the nervous system determines that it is a Complex system, highly complex part of an animal that coordinates its Behavior, actions and Sens ...

neuroscience
,
psychology Psychology is the scientific Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or something, such as facts A fact is an occurrence in the real world. ...

psychology
,
medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts ( descriptive knowledge), skills (proced ...

medicine
,
biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular interactions, Physiology, physiological mechanisms, Development ...

biology
,
biochemistry Biochemistry or biological chemistry, is the study of chemical process In a scientific Science () is a systematic enterprise that Scientific method, builds and organizes knowledge in the form of Testability, testable explanations and pr ...

biochemistry
, and
pharmacology Pharmacology is a branch of medicine, biology and pharmaceutical sciences concerned with drug or medication action, where a drug may be defined as any artificial, natural, or endogenous (from within the body) molecule which exerts a biochemica ...
, it has generally been considered a middle ground between
neurology Neurology (from el, , "string, nerve" and the suffix , "study of") is a branch of dealing with . Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the and s (and their subdivisions, the ...
and psychology. Because psychiatry and neurology are deeply intertwined medical specialties, all certification for both specialties and for their subspecialties is offered by a single board, the American Board of Psychiatry and Neurology, one of the member boards of the American Board of Medical Specialties. 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. Psychiatrists also differ from psychologists in that they are physicians and have post-graduate training called residency (usually 4 to 5 years) in psychiatry; the quality and thoroughness of their graduate medical training is identical to that of all other physicians. Psychiatrists can therefore counsel patients, prescribe medication, order laboratory tests, order
neuroimaging Neuroimaging or brain imaging is the use of various techniques to either directly or indirectly Medical imaging, image the neuroanatomy, structure, function, or pharmacology of the nervous system. It is a relatively new discipline within medicine ...
, and conduct
physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The pati ...

physical examination
s.


Ethics

The
World Psychiatric Association The World Psychiatric Association is an international umbrella organisation of psychiatric societies. Objectives and goals Originally created to produce world psychiatric congresses, it has evolved to hold regional meetings, to promote professi ...
issues an
ethical code Ethical codes are adopted by organizations to assist members in understanding the difference between right Rights are law, legal, social, or ethics, ethical principles of Liberty, freedom or entitlement; that is, rights are the fundamental nor ...
to govern the conduct of psychiatrists (like other purveyors of
professional ethics Professional ethics encompass the personal and corporate standards of behavior expected by professional A professional is a member of a profession or any person who earns their living from a specified professional activity. The term also descri ...
). 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 the broader Madrid Declaration in 1996. The code was further revised during the organization's general assemblies in 1999, 2002, 2005, and 2011. The World Psychiatric Association code covers such matters as
confidentiality Confidentiality involves a set of rules or a promise usually executed through Non-disclosure agreement, confidentiality agreements that limits access or places restrictions on certain types of information. Legal confidentiality Lawyers are o ...
, the
death penalty Capital punishment, also known as the death penalty, is the state State may refer to: Arts, entertainment, and media Literature * ''State Magazine'', a monthly magazine published by the U.S. Department of State * The State (newspaper), ' ...

death penalty
, ethnic or cultural discrimination,
euthanasia Euthanasia (from el, εὐθανασία 'good death': εὖ, ''eu'' 'well, good' + θάνατος, ''thanatos'' 'death') is the practice of intentionally ending life to relieve pain and suffering. Different countries have different Legality ...

euthanasia
, genetics, the
human dignity Dignity is the Rights, right of a person to be valued and respected for their own sake, and to be treated ethically. It is of significance in morality, ethics, law and politics as an extension of the Age of Enlightenment, Enlightenment-era concepts ...

human dignity
of incapacitated patients, media relations, organ transplantation, patient assessment, research ethics, sex selection,
torture Torture is the deliberate infliction of severe pain or suffering Suffering, or pain in a broad sense, may be an experience of unpleasantness and aversion associated with the perception of harm or threat of harm in an individual. Suffering i ...

torture
, and up-to-date knowledge. In establishing such ethical codes, the profession has responded to a number of controversies about the practice of psychiatry, for example, surrounding the use of
lobotomy A lobotomy, or leucotomy, was a form of psychosurgery, a Neurosurgery, neurosurgical treatment of a mental disorder that involves severing connections in the brain's prefrontal cortex. Most of the connections to and from the prefrontal cortex, ...
and
electroconvulsive therapy Electroconvulsive therapy (ECT), formerly known as electroshock therapy, is a psychiatry, psychiatric treatment where seizures in the brain (without muscular convulsions) are electrically induced in patients to provide relief from mental disorder ...
. Discredited psychiatrists who operated outside the norms of
medical ethics Medical ethics is an applied branch of ethics Ethics or moral philosophy is a branch of philosophy Philosophy (from , ) is the study of general and fundamental questions, such as those about Metaphysics, existence, reason, Epistemology, k ...
include
Harry Bailey Harry Richard Bailey (29 October 1922, Picton, New South Wales Picton is a small town in the Macarthur, New South Wales, Macarthur Region of New South Wales, Australia, in the Wollondilly Shire, in south-western Sydney, south-western Sydney. Th ...
,
Donald Ewen Cameron Donald Ewen Cameron ( – ) – known as D. Ewen Cameron or Ewen Cameron – was a Scotland, Scottish-born psychiatrist who served as President of the American Psychiatric Association (1952–1953), Canadian Psychiatric Association (1958–1959), ...
, Samuel A. Cartwright, Henry Cotton, and
Andrei Snezhnevsky Andrei Vladimirovich Snezhnevsky ( rus, Андре́й Влади́мирович Снежне́вский, p=sʲnʲɪˈʐnʲefskʲɪj; , Kostroma – 12 July 1987, Moscow) was a Soviet psychiatrist whose name was lent to the unbridled broadening ...
.


Approaches

Psychiatric illnesses can be conceptualised in a number of different ways. The
biomedical Biomedicine (also referred to as Western medicine, mainstream medicine or conventional medicine)
approach examines signs and symptoms and compares them with diagnostic criteria. Mental illness can be assessed, conversely, through a narrative which tries to incorporate symptoms into a meaningful life history and to frame them as responses to external conditions. Both approaches are important in the field of psychiatry but have not sufficiently reconciled to settle
controversy Controversy is a state of prolonged public dispute or debate, usually concerning a matter of conflicting opinion An opinion is a judgement Judgement (or US spelling judgment) is also known as ''adjudication'' which means the evaluation of ...
over either the selection of a psychiatric
paradigm In science Science () is a systematic enterprise that Scientific method, builds and organizes knowledge in the form of Testability, testable explanations and predictions about the universe."... modern science is a discovery as well as ...
or the specification of
psychopathology Psychopathology is the study of abnormal cognition, behaviour and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era. Biological psychopatholog ...
. The notion of a "
biopsychosocial model The biopsychosocial model is an interdisciplinary model that looks at the interconnection between biology, psychology, and Social, socio-environmental factors. The model specifically examines how these aspects play a role in topics ranging from he ...
" is often used to underline the multifactorial nature of clinical impairment. In this notion the word ''model'' is not used in a strictly scientific way though. Alternatively, a Niall McLaren acknowledges the physiological basis for the mind's existence but identifies
cognition Cognition () refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses many aspects of intellectual functions and processes such as: attention, the formation of ...
as an irreducible and independent realm in which disorder may occur. The biocognitive approach includes a
mentalist Mentalism is a performing art in which its practitioners, known as mentalists, appear to demonstrate highly developed mental or intuitive abilities. Performances may appear to include hypnosis File:Photographic Studies in Hypnosis, Abnorm ...
etiology Etiology (pronounced ; alternatively: aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ε ...
and provides a natural dualist (i.e., non-spiritual) revision of the biopsychosocial view, reflecting the efforts of
Australian Australians, colloquially referred to as "Aussies", are the citizens Citizenship is a relationship between an individual and a state to which the individual owes allegiance and in turn is entitled to its protection. Each state determines ...
psychiatrist Niall McLaren to bring the discipline into scientific maturity in accordance with the paradigmatic standards of
philosopher A philosopher is someone who practices philosophy Philosophy (from , ) is the study of general and fundamental questions, such as those about Metaphysics, existence, reason, Epistemology, knowledge, Ethics, values, Philosophy of mind, mi ...
Thomas Kuhn Thomas Samuel Kuhn (; July 18, 1922 – June 17, 1996) was an American whose 1962 book ' was influential in both academic and popular circles, introducing the term ', which has since become an English-language idiom. Kuhn made several cla ...
. Once a medical professional diagnoses a patient there are numerous ways that they could choose to treat the patient. Often psychiatrists will develop a treatment strategy that incorporates different facets of different approaches into one. Drug prescriptions are very commonly written to be regimented to patients along with any therapy they receive. There are three major pillars of psychotherapy that treatment strategies are most regularly drawn from.
Humanistic psychology Humanistic Psychology is a psychological perspective that arose in the mid-20th century in answer to two theories: Sigmund Freud's psychoanalytic theory and B. F. Skinner's behaviorism. Thus it was referred to as the "third force" in psychology. T ...
attempts to put the "whole" of the patient in perspective; it also focuses on self exploration.
Behaviorism Behaviorism is a systematic approach to understanding the behavior of humans and other animals. It assumes that behavior is either a reflex In biology Biology is the natural science that studies life and living organisms, including thei ...
is a therapeutic school of thought that elects to focus solely on real and observable events, rather than mining the unconscious or ''subconscious''.
Psychoanalysis Psychoanalysis (from Greek language, Greek: + ) is a set of Theory, theories and Therapy, therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a bo ...

Psychoanalysis
, on the other hand, concentrates its dealings on early childhood, irrational drives, the unconscious, and conflict between conscious and unconscious streams.


Practitioners

All
physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintainin ...

physician
s can diagnose mental disorders and prescribe treatments utilizing principles of psychiatry.
Psychiatrist A psychiatrist is a physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is c ...
s are trained physicians who specialize in psychiatry and are certified to treat
mental illness A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing In internal medici ...
. They may treat outpatients, inpatients, or both; they may practice as solo practitioners or as members of groups; they may be self-employed, be members of partnerships, or be employees of governmental, academic, nonprofit, or for-profit entities; employees of hospitals; they may treat military personnel as civilians or as members of the military; and in any of these settings they may function as clinicians, researchers, teachers, or some combination of these. Although psychiatrists may also go through significant training to conduct
psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase happiness, and ove ...
,
psychoanalysis Psychoanalysis (from Greek language, Greek: + ) is a set of Theory, theories and Therapy, therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a bo ...

psychoanalysis
or
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (e. ...
, it is their training as physicians that differentiates them from other
mental health professional#REDIRECT Mental health professional A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health Mental health, defined by the ...
s.


As a career choice

Psychiatry was not a popular career choice among medical students, even though medical school placements are rated favorably. This has resulted in a significant shortage of psychiatrists in the United States and elsewhere. Strategies to address this shortfall have included the use of short 'taster' placements early in the medical school curriculum and attempts to extend psychiatry services further using technologies and other methods. Recently, however, there has been an increase in the number of medical students entering into a psychiatry residency. There are several reasons for this surge including the interesting nature of the field, growing interest in genetic biomarkers involved in psychiatric diagnoses, and newer pharmaceuticals on the drug market to treat psychiatric illnesses.


Subspecialties

The field of psychiatry has many subspecialties that require additional training and certification by the
American Board of Psychiatry and Neurology The American Board of Psychiatry and Neurology, Inc. (ABPN) is a not-for-profit corporation that was founded in 1934 following conferences of committees appointed by the American Psychiatric Association, the American Neurological Association, and ...
(ABPN). Such subspecialties include: *
Addiction psychiatry Addiction psychiatry is a medical subspecialty within psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to ...
,
addiction medicine Addiction medicine is a medical subspecialty that deals with the diagnosis, prevention, evaluation, treatment, and Drug rehabilitation, recovery of persons with Substance dependence, addiction, of those with Substance-related disorder, substance- ...
* Brain injury medicine *
Child and adolescent psychiatry Child and adolescent psychiatry (or pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factor ...
*
Clinical neurophysiology Clinical neurophysiology is a medical specialty that studies the central and peripheral nervous systems through the recording of bioelectrical activity, whether spontaneous or stimulated. It encompasses both research regarding the pathophysiology a ...
* Consultation-liaison psychiatry * Forensic psychiatry *
Geriatric psychiatryGeriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a subspecialty of psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental ...
* Hospice and palliative medicine *
Sleep medicine Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and sleep disorder, disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many ...
Additional psychiatry subspecialties, for which the ABPN does not provide formal certification, include: *
Biological psychiatry Biological psychiatry or biopsychiatry is an approach to psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related ...
*
Cognitive Cognition () refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses many aspects of intellectual function Intellectual functioning refers to the "general men ...
diseases, as in various forms of
dementia Dementia manifests as a set of related symptoms, which usually surface when the brain is damaged by injury or disease. The symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or ...
*
Community psychiatry Center for Mental Health Services''(CMHS), also known as community mental health teams (CMHT) in the United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain,Usage is mixe ...
* Cross-cultural psychiatry * Emergency psychiatry * Evolutionary psychiatry *
Global mental healthGlobal mental health is the international perspective on different aspects of mental health Mental health, defined by the World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, s ...
*
Learning disabilities Learning disability, learning disorder, or learning difficulty (British English) is a condition in the brain that causes difficulties comprehending or processing information and can be caused by several different factors. Given the "difficult ...
*
Military psychiatryMilitary psychiatry covers special aspects of psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, beha ...
*
Neurodevelopmental disorder Neurodevelopmental disorders are a group of disorders that affect the development of the nervous system, leading to abnormal brain function which may affect emotion Emotions are biological states associated with all of the nerve systems brou ...
s *
Neuropsychiatry Neuropsychiatry or Organic Psychiatry is a branch of medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patient and managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, tr ...
*
Social psychiatrySocial psychiatry is a branch of psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognit ...
Addiction psychiatry Addiction psychiatry is a medical subspecialty within psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to ...
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 Biological psychiatry or biopsychiatry is an approach to psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related ...
is an approach to psychiatry that aims to understand mental disorders in terms of the biological function of the nervous system.
Child and adolescent psychiatry Child and adolescent psychiatry (or pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factor ...
is the branch of psychiatry that specializes in work with children, teenagers, and their families.
Community psychiatry Center for Mental Health Services''(CMHS), also known as community mental health teams (CMHT) in the United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain,Usage is mixe ...
is an approach that reflects an inclusive
public health Public health has been defined as "the science and art of preventing disease", prolonging life and improving quality of life Quality of life (QOL) is defined by the World Health Organization The World Health Organization (WHO) is a s ...

public health
perspective and is practiced in
community mental health services Center for Mental Health Services''(CMHS), also known as community mental health teams (CMHT) in the United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain,Usage is mixe ...
. Cross-cultural psychiatry is a branch of psychiatry concerned with the cultural and ethnic context of mental disorder and psychiatric services. Emergency psychiatry is the clinical application of psychiatry in emergency settings. Forensic psychiatry utilizes medical science generally, and psychiatric knowledge and assessment methods in particular, to help answer legal questions.
Geriatric psychiatryGeriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a subspecialty of psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental ...
is a branch of psychiatry dealing with the study, prevention, and treatment of mental disorders in the
elderly Old age refers to ages nearing or surpassing the life expectancy Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, its current age, and other demographic ...
.
Global mental healthGlobal mental health is the international perspective on different aspects of mental health Mental health, defined by the World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, s ...
is an area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide, although some scholars consider it to be a neo-colonial, culturally insensitive project.
Liaison psychiatry Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry is the branch of psychiatry that specialises in the interface between general medicine/pediatrics and psychiatry, usually taking place in a hospital or med ...
is the branch of psychiatry that specializes in the interface between other medical specialties and psychiatry.
Military psychiatryMilitary psychiatry covers special aspects of psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, beha ...
covers special aspects of psychiatry and mental disorders within the military context.
Neuropsychiatry Neuropsychiatry or Organic Psychiatry is a branch of medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patient and managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, tr ...
is a branch of medicine dealing with mental disorders attributable to diseases of the nervous system.
Social psychiatrySocial psychiatry is a branch of psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognit ...
is a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental well-being. In larger healthcare organizations, psychiatrists often serve in senior management roles, where they are responsible for the efficient and effective delivery of mental health services for the organization's constituents. For example, the Chief of Mental Health Services at most VA medical centers is usually a psychiatrist, although psychologists occasionally are selected for the position as well. In the United States, psychiatry is one of the few specialties which qualify for further education and board-certification in
pain medicine Pain management, pain killer, pain medicine, pain control or algiatry, is a branch of medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awarenes ...
,
palliative medicine Palliative care (derived from the Latin root ''palliare, or'' "to cloak") is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex illness. Within the publ ...
, and
sleep medicine Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and sleep disorder, disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many ...
.


Research

Psychiatric research is, by its very nature, interdisciplinary; combining social, biological and psychological perspectives in attempt to understand the nature and treatment of mental disorders. Clinical and research psychiatrists study basic and clinical psychiatric topics at research institutions and publish articles in journals. Under the supervision of
institutional review board An institutional review board (IRB), also known as an independent ethics committee (IEC), ethical review board (ERB), or research ethics board (REB), is a type of committee A committee or commission is a body of one or more persons that is subor ...
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.


Clinical application


Diagnostic systems

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 In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease A disease is a particu ...
procedure where a
mental status examination The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient A patient is any recipient of health care H ...
and physical examination is conducted, with
pathological Pathology is the study of the causesCauses, or causality, is the relationship between one event and another. It may also refer to: * Causes (band), an indie band based in the Netherlands * Causes (company), an online company See also * Cau ...
,
psychopathological Psychopathology is the study of abnormal cognitions, behaviour and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era. It can be broadly separated ...
or
psychosocial The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is u ...
histories obtained, and sometimes neuroimages or other
neurophysiological Neurophysiology is the study of nerve cells (neurones) as they receive and transmit information. It is a branch of physiology and neuroscience that focuses on the functioning of the nervous system. The word originates from the Ancient Greek, Greek w ...
measurements are taken, or
personality test A personality test is a method of assessing human personality construct (psychology), constructs. Most personality assessment instruments (despite being loosely referred to as "personality tests") are in fact introspective (i.e., subjective) self-r ...
s or
cognitive testCognitive tests are assessments of the cognitive capabilities of human Humans (''Homo sapiens'') are the most populous and widespread species of primates, characterized by bipedality, opposable thumbs, hairlessness, and intelligence allowing t ...
s administered. 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. Some clinicians are beginning to utilize
genetics Genetics is a branch of biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular interactions, Physiology, ...

genetics
and
speech Speech is human vocal communication Communication (from Latin Latin (, or , ) is a classical language A classical language is a language A language is a structured system of communication Communication (from Latin ''c ...

speech
during the diagnostic process but on the whole these remain research topics.


Diagnostic manuals

Three main diagnostic manuals used to classify mental health conditions are in use today. The
ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems The International Classification of Diseases (ICD) is a globally used diagnostic Diagnosis is the identification of the nature ...
is produced and published by the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Unit ...
, includes a section on psychiatric conditions, and is used worldwide. The
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of ...
, produced and published by the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest Psychiatry, psychiatric organization in the world. Its some 38,800 members are main ...
(APA), is primarily focused on mental health conditions and is the main classification tool in the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...

United States
. It is currently in its fifth revised edition and is also used worldwide. The
Chinese Society of Psychiatry The Chinese Society of Psychiatry (CSP; ) is the largest organization for psychiatrist A psychiatrist is a physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medic ...
has also produced a diagnostic manual, the Chinese Classification of Mental Disorders. 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. However, the categories are nevertheless based on particular psychiatric theories and data; they are broad and often specified by numerous possible combinations of symptoms, and many of the categories overlap in symptomology or typically occur together. While originally intended only as a guide for experienced clinicians trained in its use, the nomenclature is now widely used by clinicians, administrators and insurance companies in many countries. The DSM has attracted praise for standardizing psychiatric diagnostic categories and criteria. It has also attracted controversy and criticism. Some critics argue that the DSM represents an unscientific system that enshrines the opinions of a few powerful psychiatrists. There are ongoing issues concerning the Validity (statistics), validity and Reliability (statistics), reliability of the diagnostic categories; the reliance on superficial symptoms; the use of artificial dividing lines between categories and from 'Normality (behavior), normality'; possible cultural bias; medicalization of human distress and financial conflicts of interest, including with the practice of psychiatrists and with the pharmaceutical industry; political controversies about the inclusion or exclusion of diagnoses from the manual, in general or in regard to specific issues; and the experience of those who are most directly affected by the manual by being diagnosed, including the consumer/survivor movement. The publication of the DSM, with tightly guarded copyrights, now makes APA over $5 million a year, historically adding up to over $100 million.


Treatment


General considerations

Individuals with mental health conditions are commonly referred to as ''patients'' but may also be called ''customer, 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-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. Persons who undergo a psychiatric assessment are evaluated by a
psychiatrist A psychiatrist is a physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is c ...
or a medical provider for their 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 personnel, emergency medical personnel, and List of diagnostic classification and rating scales used in psychiatry, psychiatric rating scales. A
mental status examination The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient A patient is any recipient of health care H ...
is carried out, and a
physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The pati ...

physical examination
is usually performed to establish or exclude other illnesses that may be contributing to the alleged psychiatric problems. A physical examination may also serve to identify any signs of self-harm; this examination is often performed by someone other than the psychiatrist, especially if blood tests and medical imaging are performed. Like most medications, psychiatric medications can cause adverse effect (medicine), adverse effects in patients, and some require ongoing therapeutic drug monitoring, for instance full blood counts blood plasma, serum drug levels, renal function, liver function or thyroid function. Electroconvulsive therapy (ECT) is sometimes administered for serious and disabling conditions, such as those unresponsive to medication. The efficacy and adverse effects of psychiatric drugs may vary from patient to patient. For many years, controversy has surrounded the use of involuntary treatment and use of the term "lack of insight" in describing patients. Mental health laws vary significantly among jurisdictions, but in many cases, involuntary psychiatric treatment is permitted when there is deemed to be a risk to the patient or others due to the patient's illness. Involuntary treatment refers to treatment that occurs based on the treating physician's recommendations without requiring consent from the patient.


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. Average inpatient psychiatric treatment stay has decreased significantly since the 1960s, a trend known as deinstitutionalization. Today in most countries, 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. However, in Japan psychiatric hospitals continue to keep patients for long periods, sometimes even keeping them in physical restraints, strapped to their beds for periods of weeks or months. 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 United States 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 or others. Bed availability is often the real determinant of admission decisions to hard pressed public facilities. People may be admitted voluntarily if the treating doctor considers that safety is not 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, pharmacists, 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 put in physical restraints or medicated. People on inpatient wards may be allowed leave for periods of time, either accompanied or on their own. In many developed countries there has been a massive reduction in psychiatric beds since the mid 20th century, with the growth of community care. Standards of inpatient care remain a challenge in some public and private facilities, due to levels of funding, and facilities in developing countries are typically grossly inadequate for the same reason. Even in developed countries, programs in public hospitals vary widely. Some may offer structured activities and therapies offered from many perspectives while others may only have the funding for medicating and monitoring patients. This may be problematic in that the maximum amount of therapeutic work might not actually take place in the hospital setting. This is why hospitals are increasingly used in limited situations and moments of crisis where patients are a direct threat to themselves or others. Alternatives to psychiatric hospitals that may actively offer more therapeutic approaches include rehabilitation centers or "rehab" as popularly termed.


Outpatient treatment

Outpatient treatment involves periodic visits to a psychiatrist for consultation in his or her office, or at a community-based outpatient clinic. Initial appointments, at which the psychiatrist conducts a psychiatric assessment or evaluation of the patient, are typically 45 to 75 minutes in length. Follow-up appointments are generally shorter in duration, i.e., 15 to 30 minutes, with a focus on making medication adjustments, reviewing potential medication interactions, considering the impact of other medical disorders on the patient's mental and emotional functioning, and counseling patients regarding changes they might make to facilitate healing and remission of symptoms (e.g., exercise, cognitive therapy techniques, sleep hygiene—to name just a few). The frequency with which a psychiatrist sees people in treatment varies widely, from once a week to twice a year, depending on the type, severity and stability of each person's condition, and depending on what the clinician and patient decide would be best. Increasingly, psychiatrists are limiting their practices to psychopharmacology (prescribing medications), as opposed to previous practice in which a psychiatrist would provide traditional 50-minute psychotherapy sessions, of which psychopharmacology would be a part, but most of the consultation sessions consisted of "talk therapy". This shift began in the early 1980s and accelerated in the 1990s and 2000s. A major reason for this change was the advent of managed care insurance plans, which began to limit reimbursement for psychotherapy sessions provided by psychiatrists. The underlying assumption was that psychopharmacology was at least as effective as psychotherapy, and it could be delivered more efficiently because less time is required for the appointment. For example, most psychiatrists schedule three or four follow-up appointments per hour, as opposed to seeing one patient per hour in the traditional psychotherapy model. Because of this shift in practice patterns, psychiatrists often refer patients whom they think would benefit from psychotherapy to other mental health professionals, e.g., clinical social workers and psychologists.


History

The earliest known texts on mental disorders are from ancient India and include the Ayurvedic text, Charaka Samhita. The first hospitals for curing mental illness were established in India during the 3rd century BCE. The Greeks also created early manuscripts about mental disorders. In the 4th century BCE, Hippocrates theorized that physiological abnormalities may be the root of mental disorders. In 4th to 5th Century B.C. Greece, Hippocrates wrote that he visited Democritus and found him in his garden cutting open animals. Democritus explained that he was attempting to discover the cause of madness and melancholy. Hippocrates praised his work. Democritus had with him a book on madness and melancholy. During the 5th century BCE, mental disorders, especially those with psychosis, psychotic traits, were considered supernatural in origin, a view which existed throughout ancient Greece and ancient Rome, Rome, as well as Egyptian regions. Religious leaders often turned to versions of exorcism to treat mental disorders often utilizing methods that many consider to be cruel or barbaric methods. Trepanning was one of these methods used throughout history. The Islamic Golden Age fostered early studies in Islamic psychology and psychiatry, with many scholars writing about mental disorders. The Persian physician Muhammad ibn Zakariya al-Razi, also known as "Rhazes", wrote texts about psychiatric conditions in the 9th century. As chief physician of a hospital in Baghdad, he was also the director of one of the first psychiatric wards in the world. Two of his works in particular, ''El-Mansuri'' and ''Al-Hawi'', provide descriptions and treatments for mental illnesses. Abu Zayd al-Balkhi was a Persian polymath during the 9th and 10th centuries and one of the first to classify neurotic disorders. He pioneered cognitive therapy in order to treat each of these classified neurotic disorders. He classified neurosis into four emotional disorders: fear and anxiety, anger and aggression, sadness and Depression (mood), depression, and Fixation (psychology), obsession. Al-Balkhi further classified three types of depression: normal depression or sadness (''huzn''), Endogeny, endogenous depression originating from within the body, and reactive clinical depression originating from outside the body. The first bimaristan was founded in Baghdad in the 9th century, and several others of increasing complexity were created throughout the Arab world in the following centuries. Some of the bimaristans contained wards dedicated to the care of mentally ill patients, most of whom suffered from debilitating illnesses or exhibited violence. Specialist hospitals such as Bethlem Royal Hospital in London were built in Middle Ages, medieval Europe from the 13th century to treat mental disorders, but were used only as custodial institutions and did not provide any type of treatment.. The beginning of psychiatry as a medical specialty is dated to the middle of the nineteenth century, although its germination can be traced to the late eighteenth century. In the late 17th century, privately run asylums for the insane began to proliferate and expand in size. In 1713 the Bethel Hospital Norwich was opened, the first purpose-built asylum in England. 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 applied. During the Age of Enlightenment, Enlightenment attitudes towards the mentally ill began to change. It came to be viewed as a disorder that required compassionate treatment. In 1758 English physician William Battie wrote his ''Treatise on Madness'' on the management of
mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing In internal medici ...
. It was a critique aimed particularly at the Bethlem Royal Hospital, where a conservative regime continued to use barbaric custodial treatment. Battie argued for a tailored management of patients entailing cleanliness, good food, fresh air, and distraction from friends and family. He argued that mental disorder originated from dysfunction of the material brain and body rather than the internal workings of the mind. The introduction of moral treatment was initiated independently by the French doctor Philippe Pinel and the English Quaker William Tuke. In 1792 Pinel became the chief physician at the Bicêtre Hospital. Patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms. Pinel's student and successor, Jean Esquirol (1772–1840), went on to help establish 10 new mental hospitals that operated on the same principles. Although Tuke, Pinel and others had tried to do away with physical restraint, it remained widespread into the 19th century. At the The Lawn, Lincoln, Lincoln Asylum in England, Robert Gardiner Hill, with the support of Edward Parker Charlesworth, pioneered a mode of treatment that suited "all types" of patients, so that mechanical restraints and coercion could be dispensed with—a situation he finally achieved in 1838. In 1839 Sergeant John Adams and Dr. John Conolly were impressed by the work of Hill, and introduced the method into their St Bernard's Hospital, Hanwell, Hanwell Asylum, by then the largest in the country. The modern era of institutionalized provision for the care of the mentally ill, began in the early 19th century with a large state-led effort. In England, the Lunacy Act 1845 was an important landmark in the treatment of the mentally ill, as it explicitly changed the status of mental illness, mentally ill people to patients who required treatment. All asylums were required to have written regulations and to have a resident qualified
physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintainin ...

physician
.Wright, David: "Mental Health Timeline", 1999 In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country. In the United States, the erection of state asylums began with the first law for the creation of one in New York, passed in 1842. The Utica State Hospital was opened around 1850. Many state hospitals in the United States were built in the 1850s and 1860s on the Kirkbride Plan, an architectural style meant to have curative effect. At the turn of the century, England and France combined had only a few hundred individuals in asylums. By the late 1890s and early 1900s, this number had risen to the hundreds of thousands. However, the idea that mental illness could be ameliorated through institutionalization ran into difficulties.. Psychiatrists were pressured by an ever-increasing patient population, and asylums again became almost indistinguishable from custodial institutions. In the early 1800s, psychiatry made advances in the diagnosis of mental illness by broadening the category of mental disease to include mood disorders, in addition to disease level delusion or irrationality. The 20th century introduced a new psychiatry into the world, with different perspectives of looking at mental disorders. For Emil Kraepelin, the initial ideas behind biological psychiatry, stating that the different mental disorders are all biological in nature, evolved into a new concept of "nerves", and psychiatry became a rough approximation of neurology and neuropsychiatry. Following Sigmund Freud's pioneering work, ideas stemming from psychoanalytic theory also began to take root in psychiatry.. The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums. By the 1970s, however, the psychoanalytic school of thought became marginalized within the field. Biological psychiatry reemerged during this time. Psychopharmacology and neurochemistry became the integral parts of psychiatry starting with Otto Loewi's discovery of the neuromodulatory properties of acetylcholine; thus identifying it as the first-known neurotransmitter. Subsequently it has been shown that different neurotransmitters have different and multiple functions in regulation of behaviour. In a wide range of studies in neurochemistry using human and animal samples, individual differences in neurotransmitters' production, reuptake, receptors' density and locations were linked to differences in dispositions for specific psychiatric disorders. For example, the discovery of chlorpromazine's effectiveness in treating schizophrenia in 1952 revolutionized treatment of the disorder, as did lithium carbonate's ability to stabilize mood highs and lows in bipolar disorder in 1948. Psychotherapy was still utilized, but as a treatment for psychosocial issues. This proved the idea of neurochemical nature of many psychiatric disorders. Another approach to look for biomarkers of psychiatric disorders is Neuroimaging that was first utilized as a tool for psychiatry in the 1980s. 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.. Later, though, the Community Mental Health Centers focus shifted to providing psychotherapy for those suffering from acute but less serious mental disorders. Ultimately there were no arrangements made for actively following and treating severely mentally ill patients who were being discharged from hospitals, resulting in a large population of chronically homeless people suffering from mental illness.


Controversy and criticism

Controversy has surrounded psychiatry, with scholars producing critiques. It has been argued that psychiatry: is too influenced by ideas from medicine, causing it to misunderstand the nature of mental distress; that its use of drugs is in part due to lobbying by drug companies resulting in distortion of research; that the concept of "mental illness" is often used to label and control those with beliefs and behaviours that the majority of people disagree with; and that it confuses disorders of the mind with disorders of the brain that can be treated with drugs. Critique of psychiatry from within the field comes from the critical psychiatry group in the UK. The term anti-psychiatry, ''anti-psychiatry'' was coined by psychiatrist David Cooper (psychiatrist), David Cooper in 1967 and was later made popular by Thomas Szasz. The word ''Antipsychiatrie'' was already used in Germany in 1904. The basic premise of the anti-psychiatry movement is that psychiatrists attempt to classify "normal" people as "deviant"; psychiatric treatments are ultimately more damaging than helpful to patients; and psychiatry's history involves (what may now be seen as) dangerous treatments, such as the frontal lobectomy (commonly called a
lobotomy A lobotomy, or leucotomy, was a form of psychosurgery, a Neurosurgery, neurosurgical treatment of a mental disorder that involves severing connections in the brain's prefrontal cortex. Most of the connections to and from the prefrontal cortex, ...
). Several former patient groups have been formed often referring to themselves as "Psychiatric survivors movement, survivors". In 1973, the Rosenhan experiment was conducted to determine the validity of psychiatric diagnosis. Volunteers feigned hallucinations to enter psychiatric hospitals, and acted normally afterwards. They were diagnosed with psychiatric disorders and were given antipsychotic drugs. The study was conducted by psychologist David Rosenhan, a Stanford University professor, and published by the journal ''Science'' under the title "On being sane in insane places". However, the neutrality of the project is nowadays often questioned and the project itself is seen by many experts as manipulated. The Church of Scientology is Scientology and psychiatry, critical of psychiatry, whereas others have questioned the veracity of information the Church of Scientology provides to the public.


See also

* Medical psychology * Biopsychiatry controversy *
Child and adolescent psychiatry Child and adolescent psychiatry (or pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factor ...
* Telepsychiatry * Psychiatry Innovation Lab


Notes


References


Citations


Cited texts

* * * *


Further reading

* * * * Gavin Francis, Francis, Gavin, "Changing Psychiatry's Mind" (review of Anne Harrington, ''Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness'', Norton, 366 pp.; and Nathan Filer, ''This Book Will Change Your Mind about Mental Health: A Journey into the Heartland of Psychiatry'', London, Faber and Faber, 248 pp.), ''The New York Review of Books'', vol. LXVIII, no. 1 (14 January 2021), pp. 26–29. "mental disorders are different [from illnesses addressed by other medical specialties].... To treat them as purely physical is to misunderstand their nature." "care [needs to be] based on distress and [cognitive, emotional, and physical] need rather than [on psychiatric] diagnos[is]", which is often uncertain, erratic, and unreplicable. (p. 29.) * * * * * * * * * *


Related articles on Wikipedia

{{Authority control Psychiatry, Mental disorders Neuroscience Branches of psychology