Psychiatry: Encyclopedia II - Psychiatry - Practice of psychiatry

Psychiatry - Practice of psychiatry

Psychiatry is one of the clinical medical disciplines which involves the diagnosis, treatment and prevention of mental and behavioral disorders such as clinical depression, schizophrenia and anxiety disorders. In addition to the clinical interview through face-to-face consultation, psychiatrists use information collated from other sources such as other health and social professionals, medical investigations ( e.g.laboratory tests to rule out thyroid dysfunction or anemia, CT brain Scan to rule out a brain tumour ) to diagnose these conditions. Occasionally, other techniques such as psychiatric rating Scales are used for diagnosis.

The field of psychiatry itself can be divided into various subspecialities. These include:

• Child and adolescent psychiatry
• Adult General Psychiatry
• Old Age psychiatry
• Psychiatry of Learning Disability
• Consultation-liaison psychiatry
• Emergency psychiatry
• Addiction and substance abuse psychiatry
• Forensic psychiatry

Practicing psychiatrists may specialise in certain areas of interest such as mood disorders, neuropsychiatry, Eating Disorders, Psychiatric Rehabilitation, Crisis Assessment and Treatment, Early Intervention In Psychosis, Community Psychiatry (Home Treatment and Assertive outreach) and various forms of psychotherapy such as psychodynamic therapy and cognitive behavioral therapy.

Individuals with mental illness, typically referred to as patients (or sometimes clients) may come under the care of a psychiatrist or other psychiatric practitioners through various processes. The two most common methods are self-referral or referral by a primary-care physician. Alternatively, a patient may be referred by hospital medical staff, by court order, involuntary commitment, or, in the UK and Australia, by sectioning under the Mental Health Act. In all circumstances the psychiatrist assesses the patient's mental and somatic (general medical) condition. This usually involves interviewing the patient and/or by obtaining information from relatives, associates, carers, law enforcement personnel, nursing staff or other healthcare professionals. Physical examination is usually performed to establish or exclude other illnesses or identify any signs of self-harm. Blood tests and medical imaging may be also performed and their associated medical specialists consulted.

Mental and behavioral conditions are dealt with by various forms of medication, therapy and counseling. Psychotherapy may be used for many conditions, either exclusively or in combination with medication. Commencing treatment with medication requires the patient to agree to this treatment (although in many countries the law provides overriding circumstances) and that they will follow the dosage prescribed. Many psychiatric medications can produce side-effects in patients and hence often involve ongoing therapeutic drug monitoring, for instance full blood counts or, for patients taking lithium salts, serum levels of lithium. Electroconvulsive therapy (ECT) is sometimes administered for serious and disabling conditions, especially those unresponsive to medication. ECT has drawn criticism from anti-psychiatry groups despite evidence for its efficacy.

Psychiatric patients may be either inpatients and outpatients. Psychiatric outpatients periodically visit their psychiatrist for consultation in his or her office, usually for an appointment lasting thirty to sixty minutes. These consultations normally involve the psychiatrist interviewing the patient to update their assessment of the patient's condition and management of any medication. The psychiatrist may also provide psychotherapy. The frequency with which a psychiatrist sees patients varies widely, from days to months, depending on the type, severity and stability of each patient's condition.

Psychiatric inpatients are patients admitted to a hospital to receive psychiatric care. In some cases this admission is voluntary, and in other cases it is involuntary. In North America, the criteria for involuntary admission varies with jurisdiction. It may be as broad as having a mental disorder and being capable of mental or physical deterioration or as narrow as a patient being considered to be an immediate danger to themselves or others. In the United Kingdom, involuntary admission is limited to this narrow criterion. Some jurisdictions give psychiatrists the sole authority to forcibly admit patients, while others require a trial.

Once in the care of a hospital, patients are monitored, given medication, psychologically tested and, if necessary, prevented from harming themselves or others. Hospitalized patients are increasingly being managed in a multidisciplinary fashion, meaning patients may encounter a variety of nursing staff, occupational therapists, psychotherapists, social workers and other healthcare professionals.

Historically, particularly before the advent of psychiatric medication, hospital stays averaged six months or more, with a significant number of cases involving hospitalization for many years. Today the average hospital stay is around two to three weeks, with only a small number of cases involving long term hospitalization. On being discharged from the hospital, inpatients often become outpatients.

Adapted from the Wikipedia article "Practice of psychiatry", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki