How Much Do You Really Know About Psychiatry?

Psychiatry is a medical specialty that focuses on the diagnosis, prevention, and treatment of mental conditions, including mood, behaviour, cognition, and perceptions. Psychiatrists use case histories, mental status examinations, physical examinations, and psychological tests to assess patients. Mental disorders are often diagnosed using the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM). Treatment may involve medication, psychotherapy, or other modalities. Psychiatrists differ from psychologists in that they are physicians who can counsel patients, prescribe medication, and conduct physical examinations. There are many subspecialties of psychiatry, including child and adolescent psychiatry, addiction psychiatry, and global mental health. Psychiatry has been criticized for its reliance on diagnostic manuals, such as the DSM, which can be controversial and subject to cultural bias. There is a shortage of psychiatrists in the US, but there has been an increase in the number of medical students entering psychiatry residencies. Psychiatric research is interdisciplinary and may involve neuroimaging, genetics, and psychopharmacology. Diagnostic manuals used to classify mental health conditions include the ICD-10, the DSM, and the Chinese Classification of Mental Disorders. The DSM has been criticized for its reliance on superficial symptoms, artificial dividing lines between categories, and possible cultural bias.Psychiatric Treatment: From Inpatient to Outpatient

• 100 million people receive psychiatric treatment worldwide.

• Psychiatric patients can be referred by various sources, including self-referral or referral by a primary care physician.

• Psychiatric evaluation includes interviewing the person, obtaining information from other sources, performing a mental status examination, and physical examination.

• Psychiatric medications can cause adverse effects and require ongoing therapeutic drug monitoring.

• Average inpatient psychiatric treatment stay has decreased since the 1960s, and most people receiving psychiatric treatment are seen as outpatients.

• Involuntary admission criteria vary with local jurisdiction, and bed availability is often the real determinant of admission decisions to public facilities.

• People may be admitted voluntarily if the treating doctor considers that safety is not compromised by this less restrictive option.

• Inpatient psychiatric wards may be secure or unlocked, and people may be put on constant or intermittent one-to-one supervision and may be put in physical restraints or medicated.

• Outpatient treatment involves periodic visits to a psychiatrist for consultation, medication adjustments, and counseling patients regarding changes they might make to facilitate healing and remission of symptoms.

• Psychiatrists are limiting their practices to psychopharmacology, and patients who would benefit from psychotherapy are referred to other mental health professionals.

• The modern era of institutionalized provision for the care of the mentally ill began in the early 19th century, and the idea that mental illness could be ameliorated through institutionalization ran into difficulties.

• The 20th century introduced a new psychiatry into the world, with different perspectives of looking at mental disorders, including biological psychiatry and psychoanalytic theory.History and Criticism of Psychiatry

• Psychoanalytic school of thought was popular in the early 20th century.

• By the 1970s, biological psychiatry reemerged as psychopharmacology and neurochemistry became integral parts of psychiatry.

• Neurotransmitters have different functions in the regulation of behavior, and individual differences in neurotransmitters' production, reuptake, receptors' density, and locations were linked to differences in dispositions for specific psychiatric disorders.

• Neuroimaging was first utilized as a tool for psychiatry in the 1980s to look for biomarkers of psychiatric disorders.

• Community Mental Health Centers were established in 1963, but later shifted their focus to psychotherapy for those with acute but less serious mental disorders, resulting in a large population of chronically homeless people with mental illness.

• Psychiatry has attracted controversy since its inception, with critiques from scholars including those from social psychiatry, psychoanalysis, psychotherapy, and critical psychiatry.

• Critiques of psychiatry include confusion of disorders of the mind with disorders of the brain, lobbying by drug companies, and labeling and controlling those with beliefs and behaviors that the majority of people disagree with.

• The term anti-psychiatry was coined by psychiatrist David Cooper in 1967 and was later made popular by Thomas Szasz.

• The anti-psychiatry movement argues that psychiatrists classify "normal" people as "deviant," psychiatric treatments are ultimately more damaging than helpful to patients, and psychiatry's history involves dangerous treatments such as psychosurgery.

• Lobotomies largely disappeared by the late 1970s.