Psychiatry
Overview
 
Psychiatry is the medical
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 specialty
Specialty (medicine)
A specialty in medicine is a branch of medical science. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency to become a medical specialist.-History of medical specialization:To...

 devoted to the study
Biomedical research
Biomedical research , in general simply known as medical research, is the basic research, applied research, or translational research conducted to aid and support the body of knowledge in the field of medicine...

 and treatment of mental disorders. These mental disorders include various affective
Affect (psychology)
Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...

, behavioural, cognitive
Cognition
In science, cognition refers to mental processes. These processes include attention, remembering, producing and understanding language, solving problems, and making decisions. Cognition is studied in various disciplines such as psychology, philosophy, linguistics, and computer science...

 and perceptual
Perception
Perception is the process of attaining awareness or understanding of the environment by organizing and interpreting sensory information. All perception involves signals in the nervous system, which in turn result from physical stimulation of the sense organs...

 abnormalities
Abnormality (behavior)
Abnormality, in the vivid sense of something deviating from the normal or differing from the typical , is a subjectively defined behavioral characteristic, assigned to those with rare or dysfunctional conditions...

. The term was first coined by the German physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 Johann Christian Reil
Johann Christian Reil
Johann Christian Reil was a German physician, physiologist, anatomist and psychiatrist. He coined the term psychiatry or, in German, Psychiatrie in 1808....

 in 1808, and literally means the 'medical treatment of the mind' (psych-: mind; from Ancient Greek
Ancient Greek
Ancient Greek is the stage of the Greek language in the periods spanning the times c. 9th–6th centuries BC, , c. 5th–4th centuries BC , and the c. 3rd century BC – 6th century AD of ancient Greece and the ancient world; being predated in the 2nd millennium BC by Mycenaean Greek...

 psykhē: soul; -iatry: medical treatment; from Gk. iātrikos: medical, iāsthai: to heal).
Encyclopedia
Psychiatry is the medical
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 specialty
Specialty (medicine)
A specialty in medicine is a branch of medical science. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency to become a medical specialist.-History of medical specialization:To...

 devoted to the study
Biomedical research
Biomedical research , in general simply known as medical research, is the basic research, applied research, or translational research conducted to aid and support the body of knowledge in the field of medicine...

 and treatment of mental disorders. These mental disorders include various affective
Affect (psychology)
Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...

, behavioural, cognitive
Cognition
In science, cognition refers to mental processes. These processes include attention, remembering, producing and understanding language, solving problems, and making decisions. Cognition is studied in various disciplines such as psychology, philosophy, linguistics, and computer science...

 and perceptual
Perception
Perception is the process of attaining awareness or understanding of the environment by organizing and interpreting sensory information. All perception involves signals in the nervous system, which in turn result from physical stimulation of the sense organs...

 abnormalities
Abnormality (behavior)
Abnormality, in the vivid sense of something deviating from the normal or differing from the typical , is a subjectively defined behavioral characteristic, assigned to those with rare or dysfunctional conditions...

. The term was first coined by the German physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 Johann Christian Reil
Johann Christian Reil
Johann Christian Reil was a German physician, physiologist, anatomist and psychiatrist. He coined the term psychiatry or, in German, Psychiatrie in 1808....

 in 1808, and literally means the 'medical treatment of the mind' (psych-: mind; from Ancient Greek
Ancient Greek
Ancient Greek is the stage of the Greek language in the periods spanning the times c. 9th–6th centuries BC, , c. 5th–4th centuries BC , and the c. 3rd century BC – 6th century AD of ancient Greece and the ancient world; being predated in the 2nd millennium BC by Mycenaean Greek...

 psykhē: soul; -iatry: medical treatment; from Gk. iātrikos: medical, iāsthai: to heal). A medical doctor specializing in psychiatry is a psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...

.
Psychiatric assessment typically starts with a mental status examination
Mental status examination
The mental status examination in the USA or mental state examination in the rest of the world, abbreviated MSE, is an important part of the clinical assessment process in psychiatric practice...

 and the compilation of a case history
Medical history
The medical history or anamnesis of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information , with the aim of obtaining information useful in formulating a diagnosis and providing...

. Psychological tests
Psychological testing
Psychological testing is a field characterized by the use of samples of behavior in order to assess psychological construct, such as cognitive and emotional functioning, about a given individual. The technical term for the science behind psychological testing is psychometrics...

 and physical examinations may be conducted, including on occasion the use of neuroimaging
Neuroimaging
Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain...

 or other neurophysiological
Neurophysiology
Neurophysiology is a part of physiology. Neurophysiology is the study of nervous system function...

 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
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

(DSM), published by the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

, and the International Classification of Diseases (ICD), edited and used by the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

. The fifth edition of the DSM (DSM-5
DSM-5
The next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders , commonly called DSM-5 , is currently in consultation, planning and preparation...

) is scheduled to be published in 2013, and its development is suspected to be of significant interest to many medical fields.

Psychiatric treatment applies a variety of modalities, including psychoactive
Psychoactive drug
A psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior...

 medication, psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

 and a wide range of other techniques such as transcranial magnetic stimulation
Transcranial magnetic stimulation
Transcranial magnetic stimulation is a noninvasive method to cause depolarization or hyperpolarization in the neurons of the brain...

. Treatment may be delivered on an inpatient or outpatient basis, depending on the severity of functional impairment or on other aspects of 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.

Ancient

Although one may trace its germination to the late eighteenth century, the beginning of psychiatry as a medical specialty is dated to the middle of the nineteenth century.Starting in the 5th century BCE, mental disorders, especially those with psychotic
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...

 traits, were considered supernatural
Supernatural
The supernatural or is that which is not subject to the laws of nature, or more figuratively, that which is said to exist above and beyond nature...

 in origin. This view existed throughout ancient Greece
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...

 and Rome
Ancient Rome
Ancient Rome was a thriving civilization that grew on the Italian Peninsula as early as the 8th century BC. Located along the Mediterranean Sea and centered on the city of Rome, it expanded to one of the largest empires in the ancient world....

. Early manuals about mental disorders were created by the Greeks. In the 4th century BCE, Hippocrates
Hippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...

 theorized that physiological abnormalities may be the root of mental disorders. Religious leaders often turned to versions of exorcism
Exorcism
Exorcism is the religious practice of evicting demons or other spiritual entities from a person or place which they are believed to have possessed...

 to treat mental disorders often utilizing cruel and barbarous methods.

Middle Ages

Specialist hospitals
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...

 were built in Baghdad
Baghdad
Baghdad is the capital of Iraq, as well as the coterminous Baghdad Governorate. The population of Baghdad in 2011 is approximately 7,216,040...

 in 705 AD, followed by Fes
Fes
Fes or Fez is the second largest city of Morocco, after Casablanca, with a population of approximately 1 million . It is the capital of the Fès-Boulemane region....

 in the early 8th century, and Cairo
Cairo
Cairo , is the capital of Egypt and the largest city in the Arab world and Africa, and the 16th largest metropolitan area in the world. Nicknamed "The City of a Thousand Minarets" for its preponderance of Islamic architecture, Cairo has long been a centre of the region's political and cultural life...

 in 800 AD.

Physicians who wrote on mental disorders and their treatment in the Medieval Islamic period included Muhammad ibn Zakarīya Rāzi (Rhazes), the Arab
Arab
Arab people, also known as Arabs , are a panethnicity primarily living in the Arab world, which is located in Western Asia and North Africa. They are identified as such on one or more of genealogical, linguistic, or cultural grounds, with tribal affiliations, and intra-tribal relationships playing...

 physician Najab ud-din Muhammad, and Abu Ali al-Hussain ibn Abdallah ibn Sina, known in the West as Avicenna
Avicenna
Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā , commonly known as Ibn Sīnā or by his Latinized name Avicenna, was a Persian polymath, who wrote almost 450 treatises on a wide range of subjects, of which around 240 have survived...

.

Specialist hospitals were built in medieval Europe
Middle Ages
The Middle Ages is a periodization of European history from the 5th century to the 15th century. The Middle Ages follows the fall of the Western Roman Empire in 476 and precedes the Early Modern Era. It is the middle period of a three-period division of Western history: Classic, Medieval and Modern...

 from the 13th century to treat mental disorders but were utilized only as custodial institutions and did not provide any type of treatment. Founded in the 13th century, Bethlem Royal Hospital
Bethlem Royal Hospital
The Bethlem Royal Hospital is a psychiatric hospital located in London, United Kingdom and part of the South London and Maudsley NHS Foundation Trust. Although no longer based at its original location, it is recognised as the world's first and oldest institution to specialise in mental illnesses....

 in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...

 is one of the oldest lunatic asylums. By 1547 the City of London acquired the hospital and continued its function until 1948. It is now part of the National Health Service and is an NHS Foundation Trust
NHS Foundation Trust
An NHS foundation trust is part of the National Health Service in England and has gained a degree of independence from the Department of Health and local NHS strategic health authority.Foundation Trusts are represented by the , .-Function:...

.

Early modern period

In 1656, Louis XIV of France
Louis XIV of France
Louis XIV , known as Louis the Great or the Sun King , was a Bourbon monarch who ruled as King of France and Navarre. His reign, from 1643 to his death in 1715, began at the age of four and lasted seventy-two years, three months, and eighteen days...

 created a public system of hospitals for those suffering from mental disorders, but as in England, no real treatment was applied. In 1713 the Bethel Hospital Norwich was opened, the first purpose built asylum in England, founded by Mary Chapman http://www.heritagecity.org/research-centre/social-innovation/the-bethel-hospital.htm/ . In 1758 English physician William Battie
William Battie
William Battie , 1 September 1703–13 June 1776, was an English physician who published in 1758 the first lengthy book on the treatment of mental illness, A Treatise on Madness, and by extending methods of treatment to the poor as well as the affluent, helped raise psychiatry to a respectable...

 wrote his Treatise on Madness which called for treatments to be utilized in asylums. Thirty years later, then ruling monarch in England George III
George III of the United Kingdom
George III was King of Great Britain and King of Ireland from 25 October 1760 until the union of these two countries on 1 January 1801, after which he was King of the United Kingdom of Great Britain and Ireland until his death...

 was known to be suffering from a mental disorder. Following the King's remission in 1789, mental illness was seen as something which could be treated and cured. French medic Philippe Pinel
Philippe Pinel
Philippe Pinel was a French physician who was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy...

 introduced humane treatment
Moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns...

 approaches to those suffering from mental disorders. In 1793, in Parice psychiatric hospital
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...

 “Bisetr”, Pinel released mental patients of chains beginning what has been called the bright epoch of psychiatry. William Tuke
William Tuke
William Tuke was an English businessman, philanthropist and Quaker. He was instrumental in the development of more humane methods in the custody and care of people with mental disorders, an approach that came to be known as moral treatment.-Career:Tuke was born in York to a leading Quaker family...

 adopted the methods outlined by Pinel and that same year Tuke opened the York Retreat
The Retreat
The Retreat, commonly known as the York Retreat, is a place in England for the treatment of people with mental health needs. Located in Lamel Hill in York, it operates as a not for profit charitable organisation....

 in England. Tuke's Retreat became a model throughout the world for humane and moral treatment of patients suffering from mental disorders. The York Retreat inspired similar institutions in the United States, most notably the Brattleboro Retreat
Brattleboro Retreat
The Brattleboro Retreat is a private, not-for-profit mental health and addictions hospital that provides comprehensive inpatient, outpatient, partial hospitalization and intensive outpatient services for children, adolescents and adults....

 and the Hartford Retreat (now the Institute of Living).

19th century

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. The United States housed 150,000 patients in mental hospitals by 1904. German speaking
German language
German is a West Germanic language, related to and classified alongside English and Dutch. With an estimated 90 – 98 million native speakers, German is one of the world's major languages and is the most widely-spoken first language in the European Union....

 countries housed more than 400 public and private sector asylums. These asylums were critical to the evolution of psychiatry as they provided places of practice throughout the world.

On the continent, universities often played a part in the administration of the asylums and, because of the relationship between the universities and asylums, scores of psychiatrists were being educated in Germany.. 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. The United Kingdom, unlike Germany, possessed a national body for asylum superintendents - the Medico-Psychological Association - established in 1866 under the Presidency of William A.F. Browne.

In the United States in 1834 Anna Marsh
Anna Marsh
Anna Marsh established the Vermont Asylum of the Insane in 1834.-Biography:Marsh was born and raised in Hinsdale, New Hampshire. She was the widow of physician Perley Marsh....

, a physician's widow, deeded the funds to build her country's first financially-stable private asylum. The Brattleboro Retreat
Brattleboro Retreat
The Brattleboro Retreat is a private, not-for-profit mental health and addictions hospital that provides comprehensive inpatient, outpatient, partial hospitalization and intensive outpatient services for children, adolescents and adults....

 marked the beginning of America's private psychiatric hospitals challenging state institutions for patients, funding, and influence. Although based on England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...

'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. This was the year in which William A.F. Browne achieved his appointment as Superintendent of the Crichton Royal at Dumfries
Dumfries
Dumfries is a market town and former royal burgh within the Dumfries and Galloway council area of Scotland. It is near the mouth of the River Nith into the Solway Firth. Dumfries was the county town of the former county of Dumfriesshire. Dumfries is nicknamed Queen of the South...

 in southern Scotland.
However, the new idea that mental illness could be ameliorated during the mid-nineteenth century were disappointed. Psychiatrists were pressured by an ever increasing patient population. The average number of patients in asylums in the United States jumped 927%. Numbers were similar in England and Germany. Overcrowding was rampant in France where asylums would commonly take in double their maximum capacity. Increases in asylum populations may have been a result of the transfer of care from families and poorhouse
Poorhouse
A poorhouse or workhouse was a government-run facility in the past for the support and housing of dependent or needy persons, typically run by a local government entity such as a county or municipality....

s, but the specific reasons as to why the increase occurred is still debated today. 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 and the reputation of psychiatry in the medical world had hit an extreme low.

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
Emil Kraepelin
Emil Kraepelin was a German psychiatrist. H.J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, as well as of psychopharmacology and psychiatric genetics. Kraepelin believed the chief origin of psychiatric disease to be biological and genetic...

 reflects the convergence of different disciplines in psychiatry. Kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry. 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. Kraepelin began to study and promote the ideas of disease classification for mental disorders, an idea introduced by Karl Ludwig Kahlbaum
Karl Ludwig Kahlbaum
Karl Ludwig Kahlbaum was a German psychiatrist. In 1855 he received his medical doctorate at Berlin, and subsequently worked as a physician at the mental asylum in Wehlau. For a period of time he was also a lecturer at the University of Königsberg , and from 1867 was director of the mental...

. 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. However, Kraepelin was criticized for considering schizophrenia as a biological illness in the absence of any detectable histologic or anatomic abnormalities. While Kraepelin tried to find organic causes of mental illness, he adopted many theses of positivist
Positivism
Positivism is a a view of scientific methods and a philosophical approach, theory, or system based on the view that, in the social as well as natural sciences, sensory experiences and their logical and mathematical treatment are together the exclusive source of all worthwhile information....

 medicine, but he favoured the precision of nosological classification over the indefiniteness of etiological
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....

 causation as his basic mode of psychiatric explanation.

Following Sigmund Freud
Sigmund Freud
Sigmund Freud , born Sigismund Schlomo Freud , was an Austrian neurologist who founded the discipline of psychoanalysis...

's death, ideas stemming from psychoanalytic theory
Psychoanalytic theory
Psychoanalytic theory refers to the definition and dynamics of personality development which underlie and guide psychoanalytic and psychodynamic psychotherapy. First laid out by Sigmund Freud, psychoanalytic theory has undergone many refinements since his work...

 also began to take root. 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 the psychoanalytic school of thought had become marginalized within the field.
Biological psychiatry reemerged during this time. Psychopharmacology
Psychopharmacology
Psychopharmacology is the scientific study of the actions of drugs and their effects on mood, sensation, thinking, and behavior...

 became an integral part of psychiatry starting with Otto Loewi
Otto Loewi
Otto Loewi was a German born pharmacologist whose discovery of acetylcholine helped enhance medical therapy. The discovery earned for him the Nobel Prize in Physiology or Medicine in 1936 which he shared with Sir Henry Dale, whom he met in 1902 when spending some months in Ernest Starling's...

's discovery of the neuromodulatory properties of acetylcholine
Acetylcholine
The chemical compound acetylcholine is a neurotransmitter in both the peripheral nervous system and central nervous system in many organisms including humans...

; thus identifying it as the first-known neurotransmitter. Neuroimaging
Neuroimaging
Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain...

 was first utilized as a tool for psychiatry in the 1980s. The discovery of chlorpromazine
Chlorpromazine
Chlorpromazine is a typical antipsychotic...

's effectiveness in treating schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

 in 1952 revolutionized treatment of the disease, as did lithium carbonate
Lithium carbonate
Lithium carbonate is a chemical compound of lithium, carbon, and oxygen with the formula Li2CO3. This colorless salt is widely used in the processing of metal oxides and has received attention for its use in psychiatry. It is found in nature as the rare mineral zabuyelite.-Properties:Like almost...

's ability to stabilize mood highs and lows in bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

 in 1948. Psychotherapy was still utilized, but as a treatment for psychosocial issues. Genetics were once again thought to play a role in mental illness. Molecular biology opened the door for specific genes contributing to mental disorders to be identified.

Anti-psychiatry and deinstitutionalization

The introduction of psychiatric medication
Psychiatric medication
A psychiatric medication is a licensed psychoactive drug taken to exert an effect on the mental state and used to treat mental disorders. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds, although some are naturally occurring, or at...

s and the use of laboratory
Medical laboratory
A medical laboratory or clinical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease.-Departments:...

 tests altered the doctor-patient relationship
Doctor-patient relationship
The doctor-patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor-patient relationship forms one of the foundations of contemporary medical ethics...

 between psychiatrists and their patients. Psychiatry's shift to the hard sciences had been interpreted as a lack of concern for patients. Anti-psychiatry
Anti-psychiatry
Anti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...

 had become more prevalent in the late twentieth century due to this and publications in the media which conceptualized mental disorders as myths. 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.

Electroconvulsive therapy
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...

 (ECT) was one treatment that the anti-psychiatry movement wanted eliminated. They alleged that ECT damaged the brain and was used as a tool for discipline. While some believe there is no evidence that ECT damages the brain, there are some citations that ECT does cause damage. 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". The prevalence of psychiatric medication helped initiate deinstitutionalization, the process of discharging patients from psychiatric hospitals to the community. The pressure from the anti-psychiatry movements and the ideology of community treatment from the medical arena helped sustain deinstitutionalization. Thirty-three years after deinstitutionalization started in the United States, only 19% of the patients in state hospitals remained. Mental health professional
Mental health professional
A mental health professional is a health care practitioner who offers services for the purpose of improving an individual's mental health or to treat mental illness. This broad category includes psychiatrists, clinical psychologists, clinical social workers, psychiatric nurses, mental health...

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. 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.

Political abuse of psychiatry

Psychiatrists around the world have been involved in the suppression of individual rights by states wherein the definitions of mental disease had been expanded to include political disobedience. Nowadays, in many countries, political prisoners are sometimes confined to mental institutions and abused therein. Psychiatry possesses a built-in capacity for abuse which is greater than in other areas of medicine. The diagnosis of mental disease can serve as proxy for the designation of social dissidents, allowing the state to hold persons against their will and to insist upon therapies that work in favour of ideological conformity and in the broader interests of society. In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials. In Nazi Germany
Nazi Germany
Nazi Germany , also known as the Third Reich , but officially called German Reich from 1933 to 1943 and Greater German Reich from 26 June 1943 onward, is the name commonly used to refer to the state of Germany from 1933 to 1945, when it was a totalitarian dictatorship ruled by...

 in the 1940s, the 'duty to care' was violated on an enormous scale: A reported 300,000 individuals were sterilized and 100,000 killed in Germany alone, as were many thousands further afield, mainly in eastern Europe
Eastern Europe
Eastern Europe is the eastern part of Europe. The term has widely disparate geopolitical, geographical, cultural and socioeconomic readings, which makes it highly context-dependent and even volatile, and there are "almost as many definitions of Eastern Europe as there are scholars of the region"...

. From the 1960s up to 1986, political abuse of psychiatry
Political abuse of psychiatry
Political abuse of psychiatry is the purported misuse of psychiatric diagnosis, detention and treatment for the purposes of obstructing the fundamental human rights of certain groups and individuals in a society...

 was reported to be systematic in the Soviet Union
Soviet Union
The Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....

, and to surface on occasion in other Eastern European countries such as Romania
Communist Romania
Communist Romania was the period in Romanian history when that country was a Soviet-aligned communist state in the Eastern Bloc, with the dominant role of Romanian Communist Party enshrined in its successive constitutions...

, Hungary
People's Republic of Hungary
The People's Republic of Hungary or Hungarian People's Republic was the official state name of Hungary from 1949 to 1989 during its Communist period under the guidance of the Soviet Union. The state remained in existence until 1989 when opposition forces consolidated in forcing the regime to...

, Czechoslovakia
Czechoslovak Socialist Republic
The Czechoslovak Socialist Republic was the official name of Czechoslovakia from 1960 until end of 1989 , a Soviet satellite state of the Eastern Bloc....

, and Yugoslavia
Socialist Federal Republic of Yugoslavia
The Socialist Federal Republic of Yugoslavia was the Yugoslav state that existed from the abolition of the Yugoslav monarchy until it was dissolved in 1992 amid the Yugoslav Wars. It was a socialist state and a federation made up of six socialist republics: Bosnia and Herzegovina, Croatia,...

. A "mental health genocide" reminiscent of the Nazi aberrations has been located in the history of South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...

n oppression during the apartheid era. A continued misappropriation of the discipline was subsequently attributed to the People's Republic of China
People's Republic of China
China , officially the People's Republic of China , is the most populous country in the world, with over 1.3 billion citizens. Located in East Asia, the country covers approximately 9.6 million square kilometres...

.

Medicalization of deviance

The concept of medicalization is created by sociologists and used for explaining how medical knowledge is applied to a series of behaviors, over which medicine exerts control, although those behaviors are not self-evidently medical or biological. According to Kittrie, a number of phenomena considered "deviant", such as alcoholism
Alcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...

, drug addiction and mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

, were originally considered as moral, then legal, and now medical problems. As a result of these perceptions, peculiar deviants were subjected to moral, then legal, and now medical modes of social control. Similarly, Conrad and Schneider concluded their review of the medicalization of deviance by supposing that three major paradigms may be identified that have reigned over deviance designations in different historical periods: deviance as sin; deviance as crime; and deviance as sickness. According to Franco Basaglia
Franco Basaglia
Franco Basaglia was an Italian psychiatrist and neurologist, professor who proposed the dismantling of psychiatric hospitals, pioneer of the modern concept of mental health, Italian psychiatry reformer, charismatic leader in Italian psychiatry, figurehead and founder of Democratic...

 and his followers, whose approach pointed out the role of psychiatric institutions in the control and medicalization of deviant behaviors and social problems, psychiatry is used as the provider of scientific support for social control to the existing establishment, and the ensuing standards of deviance and normality brought about repressive views of discrete social groups. As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances.

Transinstitutionalization and the aftermath

In 1963, US president
President of the United States
The President of the United States of America is the head of state and head of government of the United States. The president leads the executive branch of the federal government and is the commander-in-chief of the United States Armed Forces....

 John F. Kennedy
John F. Kennedy
John Fitzgerald "Jack" Kennedy , often referred to by his initials JFK, was the 35th President of the United States, serving from 1961 until his assassination in 1963....

 introduced legislation delegating the National Institute of Mental Health
National Institute of Mental Health
The National Institute of Mental Health is one of 27 institutes and centers that make up the National Institutes of Health...

 to administer Community Mental Health Centers for those being discharged from state psychiatric hospitals. Later, though, the Community Mental Health Center's focus was diverted to provide psychotherapy sessions for those suffering from acute but mild mental disorders. Ultimately there were no arrangements made for actively and severely mentally ill patients who were being discharged from hospitals. Some of those suffering from mental disorders drifted into homelessness or ended up in prisons and jails. Studies found that 33% of the homeless population and 14% of inmates in prisons and jails were already diagnosed with a mental illness.

In 1972, psychologist David Rosenhan
David Rosenhan
David L. Rosenhan is an American psychologist. He is best known for the Rosenhan experiment.Rosenhan received his Bachelor of Arts degree from Yeshiva University...

 published the Rosenhan experiment
Rosenhan experiment
The Rosenhan experiment was a famous experiment into the validity of psychiatric diagnosis conducted by psychologist David Rosenhan in 1973. It was published in the journal Science under the title "On being sane in insane places." The study is considered an important and influential criticism of...

, a study questioning the validity of psychiatric diagnoses. The study arranged for eight individuals with no history of psychopathology to attempt admission into psychiatric hospitals. The individuals included a graduate student, psychologists, an artist, a housewife, and two physicians, including one psychiatrist. All eight individuals were admitted with a diagnosis of schizophrenia or bipolar disorder. Psychiatrists then attempted to treat the individuals using psychiatric medication. All eight were discharged within 7 to 52 days. In a later part of the study, psychiatric staff were warned that pseudo-patients might be sent to their institutions, but none were actually sent. Nevertheless, a total of 83 patients out of 193 were believed by at least one staff member to be actors. The study concluded that individuals without mental disorders were indistinguishable from those suffering from mental disorders. Critics such as Robert Spitzer
Robert Spitzer (psychiatrist)
Robert L. Spitzer was a major architect of the modern classification of mental disorders. He is a retired professor of psychiatry at Columbia University in New York City, United States and was on the research faculty of the Columbia University Center for Psychoanalytic Training and Research. He...

 placed doubt on the validity and credibility of the study, but did concede that the consistency of psychiatric diagnoses needed improvement.

Psychiatry, like most medical specialties has a continuing, significant need for research into its diseases, classifications and treatments. Psychiatry adopts biology's fundamental belief that disease and health are different elements of an individual's adaptation to an environment. But psychiatry also recognizes that the environment of the human species is complex and includes physical, cultural, and interpersonal elements. In addition to external factors, the human brain
Human brain
The human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...

 must contain and organize an individual's hopes, fears, desires, fantasies and feelings. Psychiatry's difficult task is to bridge the understanding of these factors so that they can be studied both clinically and physiologically.

Theory and focus

"Psychiatry, more than any other branch of medicine, forces its practitioners to wrestle with the nature of evidence, the validity of introspection, problems in communication, and other long-standing philosophical issues" (Guze, 1992, p.4).


The term psychiatry (Greek "ψυχιατρική", psychiatrikē), coined by Johann Christian Reil
Johann Christian Reil
Johann Christian Reil was a German physician, physiologist, anatomist and psychiatrist. He coined the term psychiatry or, in German, Psychiatrie in 1808....

 in 1808, comes from the Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...

 "ψυχή" (psychē: "soul or mind") and "ιατρός" (iatros: "healer"). It refers to a field of medicine focused specifically on the mind, aiming to study
Biomedical research
Biomedical research , in general simply known as medical research, is the basic research, applied research, or translational research conducted to aid and support the body of knowledge in the field of medicine...

, prevent, and treat mental disorders in human
Human
Humans are the only living species in the Homo genus...

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.

Those who pees psychiatry are different than most other mental health professional
Mental health professional
A mental health professional is a health care practitioner who offers services for the purpose of improving an individual's mental health or to treat mental illness. This broad category includes psychiatrists, clinical psychologists, clinical social workers, psychiatric nurses, mental health...

s and physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

s in that they must be familiar with both the social
Social sciences
Social science is the field of study concerned with society. "Social science" is commonly used as an umbrella term to refer to a plurality of fields outside of the natural sciences usually exclusive of the administrative or managerial sciences...

 and biological sciences
Biology
Biology is a natural science concerned with the study of life and living organisms, including their structure, function, growth, origin, evolution, distribution, and taxonomy. Biology is a vast subject containing many subdivisions, topics, and disciplines...

. 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. Psychiatry exists to treat mental disorders which are conventionally divided into three very general categories: mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

, severe learning disability, and personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...

. 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.

Scope of practice

While the medical specialty of psychiatry utilizes research in the field of neuroscience
Neuroscience
Neuroscience is the scientific study of the nervous system. Traditionally, neuroscience has been seen as a branch of biology. However, it is currently an interdisciplinary science that collaborates with other fields such as chemistry, computer science, engineering, linguistics, mathematics,...

, psychology
Psychology
Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...

, medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

, biology
Biology
Biology is a natural science concerned with the study of life and living organisms, including their structure, function, growth, origin, evolution, distribution, and taxonomy. Biology is a vast subject containing many subdivisions, topics, and disciplines...

, biochemistry
Biochemistry
Biochemistry, sometimes called biological chemistry, is the study of chemical processes in living organisms, including, but not limited to, living matter. Biochemistry governs all living organisms and living processes...

, and pharmacology
Pharmacology
Pharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...

, it has generally been considered a middle ground between neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...

 and psychology. Unlike other physicians and neurologists, psychiatrists specialize in the doctor-patient relationship
Doctor-patient relationship
The doctor-patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor-patient relationship forms one of the foundations of contemporary medical ethics...

 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 the entirety of their post-graduate training
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...

 is revolved around the field of medicine. Psychiatrists can therefore counsel patients, prescribe medication, order laboratory test
Medical laboratory
A medical laboratory or clinical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease.-Departments:...

s, order neuroimaging
Neuroimaging
Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain...

, and conduct physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...

s.

Ethics

Like other purveyors of professional ethics
Professional ethics
Professional ethics encompass the personal and corporate standards of behaviour expected of professionals.- Professional ethics :Professional people and those working in acknowledged professions exercise specialist knowledge and skill...

, the World Psychiatric Association
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 professional education and to set ethical, scientific and...

 issues an ethical code
Ethical code
An ethical code is adopted by an organization in an attempt to assist those in the organization called upon to make a decision understand the difference between 'right' and 'wrong' and to apply this understanding to their decision...

 to govern the conduct of psychiatrists. The psychiatric code of ethics, first set forth through the Declaration of Hawaii
Hawaii
Hawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of...

 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
Confidentiality
Confidentiality is an ethical principle associated with several professions . In ethics, and in law and alternative forms of legal resolution such as mediation, some types of communication between a person and one of these professionals are "privileged" and may not be discussed or divulged to...

, research ethics, sex selection, euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....

, organ transplantation, torture
Torture
Torture is the act of inflicting severe pain as a means of punishment, revenge, forcing information or a confession, or simply as an act of cruelty. Throughout history, torture has often been used as a method of political re-education, interrogation, punishment, and coercion...

, the death penalty, media relations, genetics, and ethnic or cultural discrimination. 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
    Addiction psychiatry
    Addiction psychiatry is a subspecialty within psychiatry that focuses on the evaluation, diagnosis, and treatment of people who are suffering from one or more disorders related to addiction...

    ; 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
    Biological psychiatry, or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics and...

    ; 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
    The branch of psychiatry that specializes in the study, diagnosis, treatment, and prevention of psychopathological disorders of children, adolescents, and their families, child and adolescent psychiatry encompasses the clinical investigation of phenomenology, biologic factors, psychosocial factors,...

    ; the branch of psychiatry that specialises in work with children, teenagers, and their families.
  • Community psychiatry; an approach that reflects an inclusive public health
    Public health
    Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...

     perspective and is practiced in community mental health services.
  • Cross-cultural psychiatry
    Cross-cultural psychiatry
    Cross-cultural psychiatry or transcultural psychiatry is a branch of psychiatry concerned with the cultural and ethnic context of mental disorders and psychiatric services...

    ; a branch of psychiatry concerned with the cultural and ethnic context of mental disorder and psychiatric services.
  • Emergency psychiatry; the clinical application of psychiatry in emergency settings.
  • Forensic psychiatry
    Forensic psychiatry
    Forensic psychiatry is a sub-speciality of psychiatry and an auxiliar science of criminology. It encompasses the interface between law and psychiatry...

    ; the interface between law and psychiatry.
  • Geriatric psychiatry
    Geriatric psychiatry
    Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a subspecialty of psychiatry dealing with the study, prevention, and treatment of mental disorders in humans with old age. After a 4 year residency in psychiatry, a psychiatrist can complete a one year...

    ; a branch of psychiatry dealing with the study, prevention, and treatment of mental disorders in humans with old age.

  • Liaison psychiatry
    Liaison psychiatry
    Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry is the branch of psychiatry that specialises in the interface between medicine and psychiatry, usually taking place in a hospital or medical setting...

    ; the branch of psychiatry that specializes in the interface between other medical specialties and psychiatry.
  • Military psychiatry
    Military psychiatry
    Military psychiatry covers special aspects of psychiatry and mental disorders within the military context. The aim of military psychiatry is to keep as many serving personnel as possible fit for duty and to treat those disabled by psychiatric conditions....

    ; covers special aspects of psychiatry and mental disorders within the military context.
  • Neuropsychiatry
    Neuropsychiatry
    Neuropsychiatry is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. It preceded the current disciplines of psychiatry and neurology, in as much as psychiatrists and neurologists had a common training....

    ; branch of medicine dealing with mental disorders attributable to diseases of the nervous system.
  • Social psychiatry
    Social psychiatry
    Social psychiatry is a branch of psychiatry that focuses on the "interpersonal" and cultural context of mental disorder and mental wellbeing. It involves a sometimes disparate set of theories and approaches, with work stretching from epidemiological survey research on the one hand, to an indistinct...

    ; 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
Sleep medicine
Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many questions about sleep-wake functioning. The rapidly evolving field has...

.

Approaches

Psychiatric illnesses can be conceptualised in a number of different ways. The biomedical
Biomedical model
The biomedical model of medicine has been around since the mid-nineteenth century as the predominant model used by physicians in diagnosing diseases.It has four core elements....

 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
Biopsychiatry controversy
The biopsychiatry controversy is a dispute over which viewpoint should predominate and form the scientific basis of psychiatric theory and practice. The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its critics including disparate groups such as the...

 over either the selection of a psychiatric paradigm
Paradigm
The word paradigm has been used in science to describe distinct concepts. It comes from Greek "παράδειγμα" , "pattern, example, sample" from the verb "παραδείκνυμι" , "exhibit, represent, expose" and that from "παρά" , "beside, beyond" + "δείκνυμι" , "to show, to point out".The original Greek...

 or the specification of psychopathology
Psychopathology
Psychopathology is the study of mental illness, mental distress, and abnormal/maladaptive behavior. The term is most commonly used within psychiatry where pathology refers to disease processes...

. The notion of a "biopsychosocial model
Biopsychosocial model
The biopsychosocial model is a general model or approach that posits that biological, psychological , and social factors, all play a significant role in human functioning in the context of disease or illness...

" is often used to underline the multifactorial nature of clinical impairment. Alternatively, a "biocognitive model" acknowledges the physiological basis for the mind's existence, but identifies cognition
Cognition
In science, cognition refers to mental processes. These processes include attention, remembering, producing and understanding language, solving problems, and making decisions. Cognition is studied in various disciplines such as psychology, philosophy, linguistics, and computer science...

 as an irreducible
Antireductionism
Antireductionism is a reaction against reductionism, which instead advocates holism. Although "breaking complex phenomena into parts, is a key method in science," there are those complex phenomena where some resistance to or rebellion against this approach arises, primarily due to the perceived...

 and independent realm in which disorder may occur. The biocognitive approach includes a mentalist
Mentalism (philosophy)
In philosophy of mind, mentalism is the view that the mind and mental states exist as causally efficacious inner states of persons. The view should be distinguished from substance dualism, which is the view that the mind and the body are two distinct kinds of things which nevertheless interact ...

 etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....

 and provides a dualist
Dualism (philosophy of mind)
In philosophy of mind, dualism is a set of views about the relationship between mind and matter, which begins with the claim that mental phenomena are, in some respects, non-physical....

 revision of the biopsychosocial view, reflecting the efforts of psychiatrist Niall McLaren to bring the discipline into scientific maturity in accordance with the paradigmatic standards of philosopher
Philosophy of science
The philosophy of science is concerned with the assumptions, foundations, methods and implications of science. It is also concerned with the use and merit of science and sometimes overlaps metaphysics and epistemology by exploring whether scientific results are actually a study of truth...

 Thomas Kuhn
Thomas Kuhn
Thomas Samuel Kuhn was an American historian and philosopher of science whose controversial 1962 book The Structure of Scientific Revolutions was deeply influential in both academic and popular circles, introducing the term "paradigm shift," which has since become an English-language staple.Kuhn...

.

Practitioners

All physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

s can diagnose mental disorders and prescribe treatments utilizing principles of psychiatry. Psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...

s are either: 1) clinicians who specialize in psychiatry and are certified in treating mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

; or (2) scientists in the academic field of psychiatry who are qualified as research doctors in this field. Psychiatrists may also go through significant training to conduct psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

, psychoanalysis
Psychoanalysis
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...

 and cognitive behavioral therapy, but it is their training as physicians that differentiates them from other mental health professional
Mental health professional
A mental health professional is a health care practitioner who offers services for the purpose of improving an individual's mental health or to treat mental illness. This broad category includes psychiatrists, clinical psychologists, clinical social workers, psychiatric nurses, mental health...

s.

Research

Psychiatric research is, by its very nature, interdisciplinary. It combines social, biological and psychological perspectives 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
Institutional review board
An institutional review board , also known as an independent ethics committee or ethical review board , is a committee that has been formally designated to approve, monitor, and review biomedical and behavioral research involving humans with the aim to protect the rights and welfare of the...

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.

Diagnostic systems

See also Diagnostic classification and rating scales used in psychiatry
Diagnostic classification and rating scales used in psychiatry
The following diagnostic systems and rating scales are used in psychiatry and clinical psychology.-Diagnostic Criteria:*Diagnostic and Statistical Manual of Mental Disorders *ICD-10 Chapter V: Mental and behavioural disorders...


Psychiatric diagnoses
Psychiatric assessment
A psychiatric assessment, or psychological screening, is a process of way of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for...

 take place in a wide variety of settings and are performed by many different health professional
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....

s. Therefore, the diagnostic procedure may vary greatly based upon these factors. Typically, though, a psychiatric diagnosis utilizes a differential diagnosis
Differential diagnosis
A differential diagnosis is a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible , and may also refer to any of the included candidate alternatives A differential diagnosis (sometimes abbreviated DDx, ddx, DD, D/Dx, or ΔΔ) is a...

 procedure where a mental status examination
Mental status examination
The mental status examination in the USA or mental state examination in the rest of the world, abbreviated MSE, is an important part of the clinical assessment process in psychiatric practice...

 and physical examination is conducted, pathological, psychopathological or psychosocial
Psychosocial
For a concept to be psychosocial means it relates to one's psychological development in, and interaction with, a social environment. The individual needs not be fully aware of this relationship with his or her environment. It was first commonly used by psychologist Erik Erikson in his stages of...

 histories obtained, and sometimes neuroimages
Neuroimaging
Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain...

 or other neurophysiological measurements are taken, or personality test
Personality test
-Overview:There are many different types of personality tests. The most common type, the self-report inventory, involves the administration of many questions, or "items", to test-takers who respond by rating the degree to which each item reflects their behavior...

s or cognitive test
Cognitive test
Cognitive tests are assessments of the cognitive capabilities of humans and animals. Tests administered to humans include various forms of IQ tests; those administered to animals include the mirror test and the T maze test...

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. A few psychiatrists are beginning to utilize genetics
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....

 during the diagnostic process but on the whole this remains a research topic.
Diagnostic manuals

Three main diagnostic manuals used to classify mental health conditions are in use today. The ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...

 is produced and published by the World Health Organisation, includes a section on psychiatric conditions, and is used worldwide. The Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

, produced and published by the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

, is primarily focused on mental health conditions and is the main classification tool in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

. It is currently in its fourth revised edition and is also used worldwide. The Chinese Society of Psychiatry
Chinese Society of Psychiatry
The Chinese Society of Psychiatry is the largest organization for psychiatrists in China. It publishes the Chinese Classification of Mental Disorders...

 has also produced a diagnostic manual, the Chinese Classification of Mental Disorders
Chinese Classification of Mental Disorders
The Chinese Classification of Mental Disorders , published by the Chinese Society of Psychiatry , is a clinical guide used in China for the diagnosis of mental disorders. It is currently on a third version, the CCMD-3, written in Chinese and English...

.

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.

Treatment settings

General considerations

Individuals with mental health conditions are commonly referred to as patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....

s
but may also be called client
Customer
A customer is usually used to refer to a current or potential buyer or user of the products of an individual or organization, called the supplier, seller, or vendor. This is typically through purchasing or renting goods or services...

s
, consumer
Consumer
Consumer is a broad label for any individuals or households that use goods generated within the economy. The concept of a consumer occurs in different contexts, so that the usage and significance of the term may vary.-Economics and marketing:...

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-referral or referral by a primary-care physician. Alternatively, a person may be referred by hospital medical staff, by court order
Court order
A court order is an official proclamation by a judge that defines the legal relationships between the parties to a hearing, a trial, an appeal or other court proceedings. Such ruling requires or authorizes the carrying out of certain steps by one or more parties to a case...

, involuntary commitment
Involuntary commitment
Involuntary commitment or civil commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in a hospital or in the community ....

, or, in the UK and Australia, by sectioning under a mental health law
Mental health law
Mental health law is the area of the law that applies to persons with a diagnosis or possible diagnosis of mental illness, and to those involved in managing or treating such people.-Mental health law in general:...

.
Whatever the circumstance of a person's referral, a psychiatrist first assesses
Psychiatric assessment
A psychiatric assessment, or psychological screening, is a process of way of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for...

 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
Mental status examination
The mental status examination in the USA or mental state examination in the rest of the world, abbreviated MSE, is an important part of the clinical assessment process in psychiatric practice...

 is carried out, and a physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...

 is usually performed to establish or exclude other illnesses, such as thyroid dysfunction or brain tumors, or identify any signs of self-harm
Self-harm
Self-harm or deliberate self-harm includes self-injury and self-poisoning and is defined as the intentional, direct injuring of body tissue most often done without suicidal intentions. These terms are used in the more recent literature in an attempt to reach a more neutral terminology...

; this examination may be done by someone other than the psychiatrist, especially if blood test
Blood test
A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....

s and medical imaging
Medical imaging
Medical imaging is the technique and process used to create images of the human body for clinical purposes or medical science...

 are performed.

Like all medications, psychiatric medications can cause adverse effects
Adverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...

 in patients and hence often involve ongoing therapeutic drug monitoring
Therapeutic drug monitoring
- Background :Therapeutic drug monitoring is a branch of clinical chemistry and clinical pharmacology that specializes in the measurement of medication concentrations in blood. Its main focus is on drugs with a narrow therapeutic range, i.e. drugs that can easily be under- or overdosed...

, for instance full blood counts or, for patients taking lithium salts, serum
Blood plasma
Blood plasma is the straw-colored liquid component of blood in which the blood cells in whole blood are normally suspended. It makes up about 55% of the total blood volume. It is the intravascular fluid part of extracellular fluid...

 levels of lithium
Lithium
Lithium is a soft, silver-white metal that belongs to the alkali metal group of chemical elements. It is represented by the symbol Li, and it has the atomic number 3. Under standard conditions it is the lightest metal and the least dense solid element. Like all alkali metals, lithium is highly...

, renal and thyroid function. Electroconvulsive therapy
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...

 (ECT) is sometimes administered for serious and disabling conditions, especially those unresponsive to medication. The efficacy and adverse effects of psychiatric drugs have been challenged.

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

Also controversial are forced drugging and the "lack of insight" label. According to a report published by the US National Council on Disability,
Involuntary treatment is extremely rare outside the psychiatric system, allowable only in such cases as unconsciousness or the inability to communicate. People with psychiatric disabilities, on the other hand, even when they vigorously protest treatments they do not want, are routinely subjected to them anyway, on the justification that they "lack insight" or are unable to recognize their need for treatment because of their "mental illness". In practice, "lack of insight" becomes disagreement with the treating professional, and people who disagree are labeled "noncompliant" or "uncooperative with treatment".

Inpatient treatment

Psychiatric treatments
Treatment of mental illness
Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with mental disorders are typically...

 have changed over the past several decades. In the past, psychiatric patients were often hospitalized
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...

 for six months or more, with some cases involving hospitalization for many years. Today, people receiving psychiatric treatment are more likely to be seen as outpatients. If hospitalization is required, the average hospital stay is around one to two weeks, with only a small number receiving long-term hospitalization.

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.

Patients may be admitted voluntarily if the treating doctor considers that safety isn't compromised by this less restrictive option. Inpatient psychiatric wards may be secure (for those thought to have a particular risk of violence or self-harm) or unlocked/open. Some wards are mixed-sex whilst same-sex wards are increasingly favored to protect women inpatients. Once in the care of a hospital, people are assessed
Psychiatric assessment
A psychiatric assessment, or psychological screening, is a process of way of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for...

, monitored, and often given medication and care from a multidisciplinary team, which may include physicians, psychiatric nurse practitioners, psychiatric nurses
Psychiatric and mental health nursing
Psychiatric nursing or mental health nursing is the specialty of nursing that cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression or dementia...

, 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.

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.
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
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

 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 little or no time devoted to psychotherapy or "talk" therapies, or behavior modification. Psychiatrists who serve the lower end of the market, which is dependent on insurance reimbursements, do not receive insurance payments for lengthy psychotherapy sessions which is competitive with that offered for the brief consultations needed for prescribing and monitoring medication. Psychotherapy in such situations is performed by a lower paid psychologist or social worker. 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.

See also

  • Biopsychiatry controversy
    Biopsychiatry controversy
    The biopsychiatry controversy is a dispute over which viewpoint should predominate and form the scientific basis of psychiatric theory and practice. The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its critics including disparate groups such as the...

  • Mental health
    Mental health
    Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...

  • Psychiatric assessment
    Psychiatric assessment
    A psychiatric assessment, or psychological screening, is a process of way of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for...

  • Telepsychiatry
    Telepsychiatry
    Telepsychiatry is the application of Telemedicine to the field of Psychiatry.It has been the most successful of all the telemedicine applications so far, because of its need for only a good videoconferencing facility between the patient and the psychiatrist, especially for follow-up...

  • Anti-psychiatry
    Anti-psychiatry
    Anti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...

  • Bullying in psychiatry

Cited texts

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


Further reading

  • Berrios G E, Porter R (1995) The History of Clinical Psychiatry. London, Athlone Press
  • Berrios G E (1996) History of Mental symptoms. The History of Descriptive Psychopathology since the 19th century. Cambridge, Cambridge University Press
  • Ford-Martin, Paula Anne Gale (2002), "Psychosis" Gale Encyclopedia of Medicine, Farmington Hills, Michigan
  • MedFriendly.com, Psychologist, Viewed 20 September 2006
  • C. Burke, Psychiatry: a "value-free" science? Linacre Quarterly, vol. 67/1 (February 2000), pp. 59–88. http://www.cormacburke.or.ke/node/369
  • National Association of Cognitive-Behavioral Therapists, What is Cognitive-Behavioral Therapy?, Viewed 20 September 2006
  • van Os J, Gilvarry C, Bale R et al. (1999) A comparison of the utility of dimensional and categorical representations of psychosis. Psychological Medicine 29 (3) 595-606
  • Hiruta, Genshiro. (edited by Dr. Allan Beveridge) "Japanese psychiatry in the Edo period (1600-1868)." History of Psychiatry, Vol. 13, No. 50, 131-151 (2002).


External links

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