Psychiatry

Not to be confused with Clinical psychology.

Psychiatry is devoted to the study, diagnosis, treatment, and prevention of mental disorders. These include various affective, behavioural, cognitive and perceptual abnormalities.

Initial psychiatric assessment of a person typically begins with a case history and mental status examination. Psychological tests and physical examinations may be conducted, including on occasion the use of neuroimaging or other neurophysiological techniques. Mental disorders are often diagnosed in accordance with criteria listed in diagnostic manuals such as the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, and the International Classification of Diseases (ICD), edited and used by the World Health Organization. The fifth edition of the DSM (DSM-5) was published in 2013, and its development was expected to be of significant interest to many medical fields.[1]

The combined treatment of psychiatric medication and psychotherapy has become the most common mode of psychiatric treatment in current practice,[2] but contemporary practice also includes a wide variety of other modalities, e.g., assertive community treatment, community reinforcement, and supported employment. 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, e.g., with psychologists, nurses, mental health counselors, social workers, radiologists, epidemiologists, or public health specialists.

Etymology

The word psyche comes from the ancient Greek for soul or butterfly.[3] The fluttering insect appears in the coat of arms of Britain's Royal College of Psychiatrists[4]

The term "psychiatry" was first coined by the German physician Johann Christian Reil in 1808 and literally means the 'medical treatment of the soul' (psych- "soul" from Ancient Greek psykhē "soul"; -iatry "medical treatment" from Gk. iātrikos "medical" from iāsthai "to heal"). A medical doctor specializing in psychiatry is a psychiatrist. (For a historical overview, see Timeline of psychiatry.)

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).

Psychiatry refers to a field of medicine focused specifically on the mind, aiming to study, prevent, and treat mental disorders in humans.[5][6][7] 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.[8]

People who specialize in psychiatry often differ from most other mental health professionals and physicians in that they must be familiar with both the social and biological sciences.[6] 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. [9] Psychiatry treats mental disorders, which are conventionally divided into three very general categories: mental illnesses, severe learning disabilities, and personality disorders.[10] 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.[11]

Scope of practice

Disability-adjusted life year for neuropsychiatric conditions per 100,000 inhabitants in 2002.
  no data
  less than 10
  10-20
  20-30
  30-40
  40-50
  50-60
  60-80
  80-100
  100-120
  120-140
  140-150
  more than 150

Though the medical specialty of psychiatry uses research in the field of neuroscience, psychology, medicine, biology, biochemistry, and pharmacology,[12] it has generally been considered a middle ground between neurology and psychology.[13] 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.[13] Psychiatrists also differ from psychologists in that they are physicians and have post-graduate training called residency (usually 4 to 5 years) is in psychiatry; their graduate medical training is identical to all other physicians.[14] Psychiatrists can therefore counsel patients, prescribe medication, order laboratory tests, order neuroimaging, and conduct physical examinations.[15]

Ethics

Like other purveyors of professional ethics, the World Psychiatric Association issues an ethical code to govern the conduct of psychiatrists. The psychiatric code of ethics, first set forth through the Declaration of Hawaii in 1977, has been expanded through a 1983 Vienna update and, in 1996, the broader Madrid Declaration. The code was further revised during the organization's general assembblies in 1999, 2002, 2005, and 2011.[16] The World Psychiatric Association code covers such matters as patient assessment, up-to-date knowledge, the human dignity of incapacitated patients, confidentiality, research ethics, sex selection, euthanasia,[17] organ transplantation, torture,[18][19] the death penalty, media relations, genetics, and ethnic or cultural discrimination.[16]

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 and electroconvulsive therapy. Discredited psychiatrists who operated outside the norms of medical ethics include Harry Bailey, Donald Ewen Cameron, Samuel A. Cartwright, Henry Cotton, and Andrei Snezhnevsky.[20]

Approaches

Psychiatric illnesses can be conceptualised in a number of different ways. The biomedical 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,[21] but have not sufficiently reconciled to settle controversy over either the selection of a psychiatric paradigm or the specification of psychopathology. The notion of a "biopsychosocial model" is often used to underline the multifactorial nature of clinical impairment.[22][23][24] In this notion the word "model" is not used in a strictly scientific way though.[22] Alternatively, a "biocognitive model" acknowledges the physiological basis for the mind's existence, but identifies cognition as an irreducible and independent realm in which disorder may occur.[22][23][24] The biocognitive approach includes a mentalist etiology and provides a natural dualist (i.e. non-spiritual) revision of the biopsychosocial view, reflecting the efforts of Australian psychiatrist Niall McLaren to bring the discipline into scientific maturity in accordance with the paradigmatic standards of philosopher Thomas Kuhn.[22][23][24]

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 attempts to put the "whole" of the patient in perspective; it also focuses on self exploration.[25] Behaviorism is a therapeutic school of thought that elects to focus solely on real and observable events, rather than mining the subconscious. Psychoanalysis, on the other hand, concentrates its dealings on early childhood, irrational drives, the subconscious, and conflict between conscious and subconscious streams.[26]

Practitioners

Main article: Psychiatrist

All physicians can diagnose mental disorders and prescribe treatments utilizing principles of psychiatry. Psychiatrists are either: 1) clinicians who specialize in psychiatry and are certified in treating mental illness;[27] 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, psychoanalysis and cognitive behavioral therapy, but it is their training as physicians that differentiates them from other mental health professionals.[27]

As a Career Choice

Psychiatry is not a popular career choice amongst medical students, even though medical school placements are rated favorably.[28] This has resulted in a significant shortage of psychiatrists in the United States and elsewhere.[29] Strategies to rectify this have included the use of short 'taster' placements early in the medical school curriculum [28] and attempts to extend psychiatry services further using telemedicine technologies and other methods.[30]

Subspecialties

The field of psychiatry has many subspecialties (also known as fellowship) that require additional training which are certified by the American Board of Psychiatry and Neurology (ABPN) and require Maintenance of Certification Program (MOC) to continue. The following include:[31]

Further, other specialties that exist include:[32]

Addiction psychiatry; focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. Biological psychiatry; an approach to psychiatry that aims to understand mental disorders in terms of the biological function of the nervous system. Child and adolescent psychiatry; the branch of psychiatry that specializes in work with children, teenagers, and their families. Community psychiatry; an approach that reflects an inclusive public health perspective and is practiced in community mental health services.[33] Cross-cultural psychiatry; 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; the interface between law and psychiatry. Geriatric psychiatry; a branch of psychiatry dealing with the study, prevention, and treatment of mental disorders in humans with old age. Global Mental Health; the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide.[34]--> Liaison psychiatry; the branch of psychiatry that specializes in the interface between other medical specialties and psychiatry. Military psychiatry; covers special aspects of psychiatry and mental disorders within the military context. Neuropsychiatry; branch of medicine dealing with mental disorders attributable to diseases of the nervous system. Social psychiatry; a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental well-being.

In larger healthcare organizations, both public and private, 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, palliative medicine, and sleep medicine.

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.[35] Clinical and research psychiatrists study basic and clinical psychiatric topics at research institutions and publish articles in journals.[12][36][37][38] Under the supervision of institutional review boards, psychiatric clinical researchers look at topics such as neuroimaging, genetics, and psychopharmacology in order to enhance diagnostic validity and reliability, to discover new treatment methods, and to classify new mental disorders.[39]

Clinical application

Diagnostic systems

See also Diagnostic classification and rating scales used in psychiatry Psychiatric diagnoses take place in a wide variety of settings and are performed by many different health professionals. Therefore, the diagnostic procedure may vary greatly based upon these factors. Typically, though, a psychiatric diagnosis utilizes a differential diagnosis procedure where a mental status examination and physical examination is conducted, with pathological, psychopathological or psychosocial histories obtained, and sometimes neuroimages or other neurophysiological measurements are taken, or personality tests or cognitive tests administered.[40][41][42][43][44] 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.[45] A few psychiatrists are beginning to utilize genetics during the diagnostic process but on the whole this remains a research topic.[46][47][48]

Diagnostic manuals

Three main diagnostic manuals used to classify mental health conditions are in use today. The ICD-10 is produced and published by the World Health Organization, includes a section on psychiatric conditions, and is used worldwide.[49] The Diagnostic and Statistical Manual of Mental Disorders, produced and published by the American Psychiatric Association, is primarily focused on mental health conditions and is the main classification tool in the United States.[50] It is currently in its fifth revised edition and is also used worldwide.[50] The Chinese Society of Psychiatry has also produced a diagnostic manual, the Chinese Classification of Mental Disorders.[51]

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.[50][52] 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.[53] 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.[54]

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 and reliability of the diagnostic categories; the reliance on superficial symptoms; the use of artificial dividing lines between categories and from '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.[55][56][57][58] The publication of the DSM, with tightly guarded copyrights, now makes APA over $5 million a year, historically adding up to over $100 million.[59]

Treatment

General considerations

NIMH federal agency patient room for Psychiatric research, Maryland, USA.

Individuals with mental health conditions are commonly referred to as patients but may also be called clients, consumers, or service recipients. They may come under the care of a psychiatric physician or other psychiatric practitioners by various paths, the two most common being self-referral or referral by a primary-care physician. Alternatively, a person may be referred by hospital medical staff, by court order, involuntary commitment, or, in the UK and Australia, by sectioning under a mental health law.

Persons who undergo a psychiatric assessment are evaluated by a psychiatrist 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 psychiatric rating scales. A mental status examination is carried out, and a 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 effects in patients, and some require ongoing therapeutic drug monitoring, for instance full blood counts serum drug levels, renal function, liver function, and/or thyroid function. Electroconvulsive therapy (ECT) is sometimes administered for serious and disabling conditions, such as those unresponsive to medication. The efficacy[60][61] 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.[62]

Mental health issues such as mood disorders and schizophrenia and other psychotic disorders were the most common principle diagnoses for Medicaid super-utilizers in the United States in 2012.[63]

Inpatient treatment

Psychiatric treatments have changed over the past several decades. In the past, psychiatric patients were often hospitalized for six months or more, with some cases involving hospitalization for many years. Today, people receiving psychiatric treatment are more likely to be seen as outpatients. If hospitalization is required, the average hospital stay is around one to two weeks, with only a small number receiving long-term hospitalization.

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.

People may be admitted voluntarily if the treating doctor considers that safety isn't compromised by this less restrictive option. Inpatient psychiatric wards may be secure (for those thought to have a particular risk of violence or self-harm) or unlocked/open. Some wards are mixed-sex whilst same-sex wards are increasingly favored to protect women inpatients. Once in the care of a hospital, people are assessed, monitored, and often given medication and care from a multidisciplinary team, which may include physicians, pharmacists, psychiatric nurse practitioners, psychiatric nurses, clinical psychologists, psychotherapists, psychiatric social workers, occupational therapists and social workers. If a person receiving treatment in a psychiatric hospital is assessed as at particular risk of harming themselves or others, they may be put on constant or intermittent one-to-one supervision, and may be physically restrained or medicated. People on inpatient wards may be allowed leave for periods of time, either accompanied or on their own.[64]

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 crises 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.[65] 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.[66][67][68][69][70][71] 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.[lower-alpha 1] 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.[72]

History

Main article: History of psychiatry

The earliest known texts on mental disorders are from ancient India and include the Ayurvedic text, Charaka Samhita.[73][74] The first hospitals for curing mental illness were established in India during the 3rd century BCE.[75]

The Greeks also created early manuscripts about mental disorders.[76] In the 4th century BCE, Hippocrates theorized that physiological abnormalities may be the root of mental disorders.[77] 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.[78] During the 5th century BCE, mental disorders, especially those with psychotic traits, were considered supernatural in origin,[77] a view which existed throughout ancient Greece and Rome.[77] Religious leaders often turned to versions of exorcism to treat mental disorders often utilizing methods that many consider to be cruel and/or barbaric methods.[77]

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.[79] 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.[79]

Abu Zayd al-Balkhi, known to the west as "Avicenna", 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, and obsession. Al-Balkhi further classified three types of depression: normal depression or sadness (huzn), endogenous depression originating from within the body, and reactive clinical depression originating from outside the body.[80]

Specialist hospitals were built in Baghdad in 705 AD,[81] followed by Fes in the early 8th century, and Cairo in 800 AD. Specialist hospitals such as Bethlem Royal Hospital in London were built in 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.[82]

The beginning of psychiatry as a medical specialty is dated to the middle of the nineteenth century,[76] 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.[83] 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.[84]

During the 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. It was a critique aimed particularly at the Bethlem 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.[85][86]

Dr. Philippe Pinel at the Salpêtrière, 1795 by Tony Robert-Fleury. Pinel ordering the removal of chains from patients at the Paris Asylum for insane women.

The introduction of moral treatment was initiated independently by the French doctor Philippe Pinel and the English Quaker William Tuke.[77] 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.[87]

Although Tuke, Pinel and others had tried to do away with physical restraint, it remained widespread into the 19th century. At the 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 Hanwell Asylum, by then the largest in the country.[88][89]

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 mentally ill people to patients who required treatment. All asylums were required to have written regulations and to have a resident qualified physician.[90] 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 approximately in 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.[91]

At the turn of the century, England and France combined had only a few hundred individuals in asylums.[92] 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.[93] Psychiatrists were pressured by an ever increasing patient population,[93] and asylums again became almost indistinguishable from custodial institutions,[94]

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.[95] 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.[96] Following Sigmund Freud's pioneering work, ideas stemming from psychoanalytic theory also began to take root in psychiatry.[97] The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums.[97]

Otto Loewi's work led to the identification of the first neurotransmitter, acetylcholine.

By the 1970s, however, the psychoanalytic school of thought became marginalized within the field.[97] Biological psychiatry reemerged during this time. Psychopharmacology became an integral part of psychiatry starting with Otto Loewi's discovery of the neuromodulatory properties of acetylcholine; thus identifying it as the first-known neurotransmitter.[98] Neuroimaging was first utilized as a tool for psychiatry in the 1980s.[99] The discovery of chlorpromazine's effectiveness in treating schizophrenia in 1952 revolutionized treatment of the disorder,[100] as did lithium carbonate's ability to stabilize mood highs and lows in bipolar disorder in 1948.[101] Psychotherapy was still utilized, but as a treatment for psychosocial issues.[102]

In 1963, US president John F. Kennedy introduced legislation delegating the National Institute of Mental Health to administer Community Mental Health Centers for those being discharged from state psychiatric hospitals.[103] Later, though, the Community Mental Health Centers focus shifted to providing psychotherapy for those suffering from acute but less serious mental disorders.[103] 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.[103]

Controversy

Controversy has often surrounded psychiatry, and the term anti-psychiatry was coined by psychiatrist David Cooper in 1967. The anti-psychiatry view is that 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 lobotomy.[104] Some ex-patient groups have become anti-psychiatric, often referring to themselves as "survivors".[104]

See also

References

  1. ↑ Kupfer DJ, Regier DA (2010). "Why all of medicine should care about DSM-5". JAMA 303 (19): 1974–1975. doi:10.1001/jama.2010.646. PMID 20483976.
  2. ↑ Gabbard GO (2007). "Psychotherapy in psychiatry". International Review of Psychiatry 19 (1): 5–12. doi:10.1080/09540260601080813. PMID 17365154.
  3. ↑ Rabuzzi, Matthew (November 1997). "Butterfly Etymology". Insects.org.
  4. ↑ James, F.E. (1991). "Psyche" (PDF). Psychiatric Bulletin (Hillsdale, NJ: Analytic Press) 15 (7): 429–431. doi:10.1192/pb.15.7.429. ISBN 0-88163-257-0. Retrieved 2008-08-04.
  5. ↑ Guze 1992, p. 4.
  6. 1 2 Storrow, H.A. (1969). Outline of Clinical Psychiatry. New York:Appleton-Century-Crofts, p 1. ISBN 978-0-390-85075-1
  7. ↑ Lyness 1997, p. 3.
  8. ↑ Gask 2004, p. 7.
  9. ↑ Guze 1992, p. 131.
  10. ↑ Gask 2004, p. 113.
  11. ↑ Gask 2004, p. 128.
  12. 1 2 Pietrini P (2003). "Toward a Biochemistry of Mind?". American Journal of Psychiatry 160 (11): 1907–1908. doi:10.1176/appi.ajp.160.11.1907. PMID 14594732.
  13. 1 2 Shorter 1997, p. 326.
  14. ↑ Hauser, Mark J. "Student Information". Psychiatry.com. Archived from the original on 23 October 2010. Retrieved 21 September 2007.
  15. ↑ National Institute of Mental Health. (2006, January 31). Information about Mental Illness and the Brain. Retrieved April 19, 2007, from http://science-education.nih.gov/supplements/nih5/Mental/guide/info-mental-c.htm
  16. 1 2 "Madrid Declaration on Ethical Standards for Psychiatric Practice". World Psychiatric Association. Retrieved 3 November 2014.
  17. ↑ López-Muñoz F, Alamo C, Dudley M, Rubio G, García-García P, Molina JD, Okasha A (2006-12-07). Cecilio Alamoa, Michael Dudleyb, Gabriel Rubioc, Pilar García-Garcíaa, Juan D. Molinad and Ahmed Okasha. "Progress in Neuro-Psychopharmacology and Biological Psychiatry: Psychiatry and political–institutional abuse from the historical perspective: The ethical lessons of the Nuremberg Trial on their 60th anniversary". Progress in Neuro-Psychopharmacology and Biological Psychiatry (Science Direct) 31 (4): 791–806. doi:10.1016/j.pnpbp.2006.12.007. PMID 17223241. These practices, in which racial hygiene constituted one of the fundamental principles and euthanasia programmes were the most obvious consequence, violated the majority of known bioethical principles. Psychiatry played a central role in these programmes, and the mentally ill were the principal victims.
  18. ↑ Gluzman SF (1991). "Abuse of psychiatry: analysis of the guilt of medical personnel". J Med Ethics 17 (Suppl): 19–20. doi:10.1136/jme.17.Suppl.19. PMC 1378165. PMID 1795363. Based on the generally accepted definition, we correctly term the utilisation of psychiatry for the punishment of political dissidents as torture.
  19. ↑ Debreu, Gerard (1988). "Part 1: Torture, Psychiatric Abuse, and the Ethics of Medicine". In Corillon, Carol. Science and Human Rights. National Academy of Sciences. Retrieved 2007-10-04. Over the past two decades the systematic use of torture and psychiatric abuse have been sanctioned or condoned by more than one-third of the nations in the United Nations, about half of mankind.
  20. ↑ Kirk, Stuart A. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers.
  21. ↑ Verhulst J, Tucker G (May 1995). "Medical and narrative approaches in psychiatry". Psychiatr Serv 46 (5): 513–514. PMID 7627683.
  22. 1 2 3 4 McLaren N (February 1998). "A critical review of the biopsychosocial model". The Australian and New Zealand Journal of Psychiatry 32 (1): 86–92; discussion 93–6. doi:10.1046/j.1440-1614.1998.00343.x. PMID 9565189.
  23. 1 2 3 McLaren, Niall (2007). Humanizing Madness. Ann Arbor, MI: Loving Healing Press. ISBN 1-932690-39-5.
  24. 1 2 3 McLaren, Niall (2009). Humanizing Psychiatry. Ann Arbor, MI: Loving Healing Press. ISBN 1-61599-011-9.
  25. ↑ "Humanistic Therapy." CRC Health Group. Web. 29 Mar. 2015. http://www.crchealth.com/types-of-therapy/what-is-humanistic-therapy
  26. ↑ Psychoanalysis | Simply Psychology. (n.d.). Retrieved March 29, 2015, from http://www.simplypsychology.org/psychoanalysis.html
  27. 1 2 About:Psychology. (Unknown last update) Difference Between Psychologists and Psychiatrists. Retrieved March 25, 2007, from http://psychology.about.com/od/psychotherapy/f/psychvspsych.htm
  28. 1 2 http://link.springer.com/article/10.1007%2Fs40596-015-0358-1
  29. ↑ http://www.forbes.com/sites/brucejapsen/2015/09/15/psychiatrist-shortage-worsens-amid-mental-health-crisis/
  30. ↑ Thiele JS, Doarn CR, Shore JH (March 2015). "Locum Tenens and Telepsychiatry: Trends in Psychiatric Care". Telemedicine and e-Health: 150312141436002. doi:10.1089/tmj.2014.0159.
  31. ↑ http://www.abpn.com/become-certified/taking-a-subspecialty-exam/
  32. ↑ The Royal College of Psychiatrists. (2005). Careers info for School leavers. Retrieved March 25, 2007, from http://www.rcpsych.ac.uk/training/careersinpsychiatry/careerbooklet.aspx
  33. ↑ American Association of Community Psychiatrists About AACP Retrieved on Aug-05-2008
  34. ↑ Patel V., Prince M. (2010). "Global mental health - a new global health field comes of age". JAMA 303 (19): 1976–1977. doi:10.1001/jama.2010.616. PMC 3432444. PMID 20483977.
  35. ↑ University of Manchester. (Unknown last update). Research in Psychiatry. Retrieved October 13, 2007, from http://www.manchester.ac.uk/research/areas/subareas/?a=s&id=44694
  36. ↑ New York State Psychiatric Institute. (2007, March 15). Psychiatric Research Institute New York State. Retrieved October 13, 2007, from http://nyspi.org/
  37. ↑ Canadian Psychiatric Research Foundation. (2007, July 27). Canadian Psychiatric Research Foundation. Retrieved October 13, 2007, from http://www.cprf.ca/
  38. ↑ Elsevier. (2007, October 08). Journal of Psychiatric Research. Retrieved October 13, 2007, from http://www.elsevier.com/wps/find/journaldescription.cws_home/241/description
  39. ↑ Mitchell, J.E.; Crosby, R.D.; Wonderlich, S.A.; Adson, D.E. (2000). Elements of Clinical Research in Psychiatry. Washington D.C.: American Psychiatric Press. ISBN 978-0-88048-802-0.
  40. ↑ Meyendorf R (1980). "Diagnosis and differential diagnosis in psychiatry and the question of situation referred prognostic diagnosis". Schweizer Archiv Neurol Neurochir Psychiatry für Neurologie, Neurochirurgie et de psychiatrie 126: 121–134.
  41. ↑ Leigh, H (1983), Psychiatry in the practice of medicine, Menlo Park: Addison-Wesley, pp. 15, 17, 67, ISBN 978-0-201-05456-9
  42. ↑ Lyness 1997, p. 10.
  43. ↑ Hampel H, Teipel SJ, Kötter HU, Horwitz B, Pfluger T, Mager T, Möller HJ, Müller-Spahn F (1997). "Structural magnetic resonance imaging in diagnosis and research of Alzheimer's disease". Nervenarzt 68 (5): 365–378. PMID 9280846.
  44. ↑ Townsend B.A., Petrella J.R., Doraiswamy P.M. (2002). "The role of neuroimaging in geriatric psychiatry". Current Opinion in Psychiatry 15 (4): 427–432. doi:10.1097/00001504-200207000-00014.
  45. ↑ NIMH publications (2009) Neuroimaging and Mental Illness
  46. ↑ Krebs MO (2005). "Future contributions on genetics". World Journal of Biological Psychiatry 6: 49–55. doi:10.1080/15622970510030072. PMID 16166024.
  47. ↑ Hensch T, Herold U, Brocke B; Herold, U; Brocke, B (2007). "An electrophysiological endophenotype of hypomanic and hyperthymic personality". Journal of Affective Disorders 101 (1–3): 13–26. doi:10.1016/j.jad.2006.11.018. PMID 17207536.
  48. ↑ Vonk R, van der Schot AC, Kahn RS, Nolen WA, Drexhage HA (2007). "Is autoimmune thyroiditis part of the genetic vulnerability (or an endophenotype) for bipolar disorder?". Biological Psychiatry 62 (2): 135–140. doi:10.1016/j.biopsych.2006.08.041. PMID 17141745.
  49. ↑ World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation. ISBN 978-92-4-154422-1
  50. 1 2 3 American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th Edition). Washington D.C.: American Psychiatric Publishing, Inc. ISBN 978-0-89042-025-6
  51. ↑ Chen YF (2002). "Chinese classification of mental disorders (CCMD-3) towards integration in international classification". Psychopathology 35 (2–3): 171–175. doi:10.1159/000065140. PMID 12145505.
  52. ↑ Essen-Moller E (1971). "On classification of mental disorders". Acta Psychiatrica Scandinavica 37: 119–126.
  53. ↑ Mezzich JE (1979). "Patterns and issues in multiaxial psychiatric diagnosis". Psychological Medicine 9 (1): 125–137. doi:10.1017/S0033291700021632. PMID 370861.
  54. ↑ Guze SB (1970). "The need for toughmindedness in psychiatric thinking". Southern Medical Journal 63 (6): 662–671. doi:10.1097/00007611-197006000-00012. PMID 5446229.
  55. ↑ Dalal PK, Sivakumar T. (2009) Moving towards ICD-11 and DSM-5: Concept and evolution of psychiatric classification. Indian Journal of Psychiatry, Volume 51, Issue 4, Page 310-319.
  56. ↑ Kendell, Robert; Jablensky, Assen (January 2003). "Distinguishing Between the Validity and Utility of Psychiatric Diagnoses". American Journal of Psychiatry 160 (1): 4–12. doi:10.1176/appi.ajp.160.1.4. PMID 12505793.
  57. ↑ Baca-Garcia E, Perez-Rodriguez MM, Basurte-Villamor I, Fernandez del Moral AL, Jimenez-Arriero MA, Gonzalez de Rivera JL, Saiz-Ruiz J, Oquendo MA (March 2007). "Diagnostic stability of psychiatric disorders in clinical practice". The British Journal of Psychiatry 190 (3): 210–6. doi:10.1192/bjp.bp.106.024026. PMID 17329740.
  58. ↑ Pincus HA, Zarin DA, First M (1998). "Clinical Significance" and DSM-IV". Arch Gen Psychiatry 55 (12): 1145; author reply 1147–8. doi:10.1001/archpsyc.55.12.1145. PMID 9862559. (subscription required)
  59. ↑ Greenberg, Gary (January 29, 2012). "The D.S.M.'s Troubled Revision". The New York Times.
  60. ↑ Moncrieff, J; Wessely, S; Hardy, R (2004). "Active placebos versus antidepressants for depression". Cochrane Database Syst Rev (1): CD003012. doi:10.1002/14651858.CD003012.pub2. PMID 14974002.
  61. ↑ Hopper K, Wanderling J (2000). "Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative follow-up project. International Study of Schizophrenia". Schizophrenia Bulletin 26 (4): 835–46. doi:10.1093/oxfordjournals.schbul.a033498. PMID 11087016.
  62. ↑ Unzicker, Rae E.; Wolters, Kate P.; Robinson, Debra (20 January 2000). "From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves". National Council on Disability. Archived from the original on 28 December 2010.
  63. ↑ Jiang HJ, Barrett ML, Sheng M (November 2014). "Characteristics of Hospital Stays for Nonelderly Medicaid Super-Utilizers, 2012". HCUP Statistical Brief #184. Rockville, MD: Agency for Healthcare Research and Quality.
  64. ↑ Treatment Protocol Project (2003). Acute inpatient psychiatric care: A source book. Darlinghurst, Australia: World Health Organisation. ISBN 0-9578073-1-7. OCLC 223935527.
  65. ↑ Mojtabai R, Olfson M (Aug 2008). "National trends in psychotherapy by office-based psychiatrists.". Arch Gen Psychiatry 65 (8): 962–70. doi:10.1001/archpsyc.65.8.962. PMID 18678801.
  66. ↑ Clemens NA (Mar 2010). "New parity, same old attitude towards psychotherapy?". J Psychiatr Pract 16 (2): 115–9. doi:10.1097/01.pra.0000369972.10650.5a. PMID 20511735.
  67. ↑ Mellman LA (2006). "How endangered is dynamic psychiatry in residency training?". J Am Acad Psychoanal Dyn Psychiatry 34 (1): 127–33. doi:10.1521/jaap.2006.34.1.127. PMID 16548751.
  68. ↑ Stone AA (Jul 2001). "Psychotherapy in the managed care health market.". J Psychiatr Pract 7 (4): 238–43. PMID 15990529.
  69. ↑ Pasnau RO (Mar 2000). "Can the patient-physician relationship survive in the era of managed care?". J Psychiatr Pract 6 (2): 91–6. doi:10.1097/00131746-200003000-00004. PMID 15990478.
  70. ↑ Mojtabai R, Olfson M (2010). "National trends in psychotropic medication polypharmacy in office-based psychiatry". Arch. Gen. Psychiatry 67 (1): 26–36. doi:10.1001/archgenpsychiatry.2009.175. PMID 20048220.
  71. ↑ Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA (2002). "National trends in the outpatient treatment of depression". JAMA 287 (2): 203–9. doi:10.1001/jama.287.2.203. PMID 11779262.
  72. ↑ Harris, Gardiner (March 5, 2011). "Talk Doesn’t Pay, So Psychiatry Turns to Drug Therapy". The New York Times. Retrieved March 6, 2011.
  73. ↑ Andrew Scull. Cultural Sociology of Mental Illness: An A-to-Z Guide, Volume 1. Sage Publications. p. 386.
  74. ↑ David Levinson, Laura Gaccione (1997). Health and Illness: A Cross-cultural Encyclopedia. ABC-CLIO. p. 42.
  75. ↑ Koenig, Harold G. (2009). Faith and Mental Health: Religious Resources for Healing. Templeton Foundation Press. p. 36. ISBN 978-1-59947-078-8.
  76. 1 2 Shorter 1997, p. 1.
  77. 1 2 3 4 5 Elkes, A. & Thorpe, J.G. (1967). A Summary of Psychiatry. London: Faber & Faber, p. 13.
  78. ↑ Burton, Robert (1881). The Anatomy of Melancholy: What it is with All the Kinds, Causes, Symptoms, Prognostics, and Several Cures of it: in Three Partitions, with Their Several Sections, Members and Subsections Philosophically, Medicinally, Historically Opened and Cut Up. London: Chatto & Windus. pp. 22, 24. OL 3149647W.
  79. 1 2 Wael Mohamed, C.R. (2012). "Arab and Muslim Contributions to Modern Neuroscience". International Brain Research Organization History of Neuroscience.
  80. ↑ Haque Amber (2004). "Psychology from Islamic Perspective: Contributions of Early Muslim Scholars and Challenges to Contemporary Muslim Psychologists". Journal of Religion and Health 43 (4): 357–377 [362]. doi:10.1007/s10943-004-4302-z.
  81. ↑ Peter Verhagen, Herman M. Van Praag, Juan José López-Ibor, Jr., John Cox, Driss Moussaoui. Religion and Psychiatry: Beyond Boundaries. John Wiley & Sons. p. 202.
  82. ↑ Shorter 1997, p. 4.
  83. ↑ "The Bethel Hospital". Norwich HEART.
  84. ↑ Shorter 1997, p. 5.
  85. ↑ Laffey P (2003). "Psychiatric therapy in Georgian Britain". Psychological Medicine 2003 (33): 1285–1297. doi:10.1017/S0033291703008109. PMID 14580082.
  86. ↑ Shorter 1997, p. 9.
  87. ↑ Gerard DL (1998). "Chiarugi and Pinel considered: Soul's brain/person's mind". J Hist Behav Sci 33 (4): 381–403. doi:10.1002/(SICI)1520-6696(199723)33:4<381::AID-JHBS3>3.0.CO;2-S.
  88. ↑ Suzuki A (January 1995). "The politics and ideology of non-restraint: the case of the Hanwell Asylum.". Medical History (183 Euston Road, London NWI 2BE.: Wellcome Institute) 39 (1): 1–17. doi:10.1017/s0025727300059457. PMC 1036935. PMID 7877402.
  89. ↑ Edited by: Bynum, W.F.;Porter, Roy;Shepherd, Michael (1988) The Anatomy of Madness: Essays in the history of psychiatry. Vol.3. The Asylum and its psychiatry. Routledge. London EC4
  90. ↑ Wright, David: "Mental Health Timeline", 1999
  91. ↑ Yanni, Carla (2007). The Architecture of Madness: Insane Asylums in the United States. Minneapolis: Minnesota University Press. ISBN 978-0-8166-4939-6.
  92. ↑ Shorter 1997, p. 34.
  93. 1 2 Shorter 1997, p. 46.
  94. ↑ Rothman, D.J. (1990). The Discovery of the Asylum: Social Order and Disorder in the New Republic. Boston: Little Brown, p. 239. ISBN 978-0-316-75745-4
  95. ↑ Borch-Jacobsen, Mikkel (7 October 2010). "Which came first, the condition or the drug?". London Review of Books 32 (19): 31–33.
  96. ↑ Shorter 1997, p. 114.
  97. 1 2 3 Shorter 1997, p. 145.
  98. ↑ Shorter 1997, p. 246.
  99. ↑ Shorter 1997, p. 270.
  100. ↑ Turner T (2007). "Unlocking psychosis". Brit J Med 334 (suppl): s7. doi:10.1136/bmj.39034.609074.94. PMID 17204765.
  101. ↑ Cade JFJ. "Lithium salts in the treatment of psychotic excitement". Med J Aust 1949 (36): 349–352.
  102. ↑ Shorter 1997, p. 239.
  103. 1 2 3 Shorter 1997, p. 280.
  104. 1 2 Burns, Tom (2006). Psychiatry: A very short introduction. Oxford University Press. ISBN 9780192807274.

Notes

  1. ↑ This article does not enter into that debate or seek to summarize the comparative efficacy literature. It simply explains why managed care insurance companies stopped routinely reimbursing psychiatrists for traditional psychotherapy, without commenting on the validity of that rationale.

Cited texts

  • Gask, L (2004), A Short Introduction to Psychiatry, London: SAGE Publications Ltd., ISBN 978-0-7619-7138-2 
  • Guze, SB (1992), Why Psychiatry Is a Branch of Medicine, New York: Oxford University Press, ISBN 978-0-19-507420-8 
  • Lyness, JM (1997), Psychiatric Pearls, Philadelphia: F.A. Davis Company, ISBN 978-0-8036-0280-9 
  • 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 978-0-471-24531-5 

Further reading

  • Berrios G E, Porter R (1995) The History of Clinical Psychiatry. London, Athlone Press
  • Berrios G E (1996) History of Mental symptoms. The History of Descriptive Psychopathology since the 19th century. Cambridge, Cambridge University Press
  • Ford-Martin, Paula Anne Gale (2002), "Psychosis" Gale Encyclopedia of Medicine, Farmington Hills, Michigan
  • Hirschfeld RM, Lewis L, Vornik LA; et al. (2003). "Perceptions and impact of bipolar disorder: how far have we really come?". J. Clin. Psychiatry 64 (2): 161–174. doi:10.4088/JCP.v64n0209. PMID 12633125. 
  • McGorry PD, Mihalopoulos C, Henry L, Dakis J, Jackson HJ, Flaum M, Harrigan S, McKenzie D, Kulkarni J, Karoly R (1995). "Spurious precision: procedural validity of diagnostic assessment in psychiatric disorders". American Journal of Psychiatry 152 (2): 220–223. doi:10.1176/ajp.152.2.220. PMID 7840355. 
  • Moncrieff J, Cohen D (2005). "Rethinking models of psychotropic drug action". Psychotherapy & Psychosomatics 74 (3): 145–153. doi:10.1159/000083999. 
  • Burke, C. (February 2000). "Psychiatry: a "value-free" science?". Linacre Quarterly 67/1: 59–88. 
  • 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
  • Walker, Evelyn, and Perry Deane Young (1986). A Killing Cure. New York: H. Holt and Co. xiv, 338 p. N.B.: Explanatory subtitle on book's dust cover: One Woman's True Account of Sexual and Drug Abuse and Near Death at the Hands of Her Psychiatrist. Without ISBN
  • Williams JB, Gibbon M, First MB, Spitzer RL, Davies M, Borus J, Howes MJ, Kane J, Pope HG, Rounsaville B (1992). "The structured clinical interview for DSM-III-R (SCID) II: Multi-site test-retest reliability". Archives of General Psychiatry 49 (8): 630–636. doi:10.1001/archpsyc.1992.01820080038006. PMID 1637253. 
  • 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).

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