Science and Profession (Magill’s Medical Guide, Sixth Edition)
Psychiatrists receive training in biochemistry, community mental health, genetics, neurology, neuropathology, psychopathology, psychopharmacology, and social science. They complete medical school, a four-year residency in psychiatry, and two or more years of specialty residency. Specialty residencies focus on particular treatment methods (such as psychoanalysis) or methods of diagnosis and treatment for particular groups of clients (such as children, adolescents, or elders).
As diagnosticians and treatment providers, psychiatrists must be excellent observers of behavior and be knowledgeable about how nutritional, physical, and situational conditions can be related to mental or emotional problems. An ability to consult with other professionals is also important. Psychiatrists often receive patients from other professionals (general practitioners, psychologists, emergency room staff) and often request diagnostic, legal, case management, and resource advice from other professionals (psychologists, attorneys, social workers). In situations involving abuse, neglect, incompetency, and suicide, such consultation relationships are critical for appropriate referral and treatment.
Given this preparation, psychiatrists are able to diagnose and treat a wide variety of disorders. Some of the most common disorders treated in adult populations include disorders of anxiety (such as phobias, panic attacks, obsessive-compulsive...
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Diagnostic and Treatment Techniques (Magill’s Medical Guide, Sixth Edition)
A well-formulated psychiatric diagnosis facilitates treatment planning for mental and emotional disorders. Psychiatric diagnoses, however, are very complex. They are described in a system with five axes of information in order to give a comprehensive picture of how well a person is functioning in everyday life. Axis I pertains to clinical conditions diagnosed in infancy, childhood, or adolescence, as well as other primary mental problems experienced by adults, including cognitive, substance-related, psychotic, anxiety, mood, eating, sleep, impulse control, factitious, somatoform, dissociative, and adjustment disorders. Axis II summarizes problems related to personality and mental retardation. Axis III describes any general medical conditions that are related to a person’s mental problems and that may also warrant special attention. Axis IV summarizes psychological, social, and environmental problems that may affect the diagnosis, prognosis, or treatment of a person’s mental problems. Axis V is used to give a standardized, overall rating of how well the person has been functioning with his or her disorder.
Once a diagnosis is formulated, a treatment plan is composed. Usually, it involves some combination of medicinal and psychotropic drugs, bibliotherapy, dietary and behavior change recommendations, and psychotherapy for the affected individual and possibly members of his or her family. Treatment...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
The concepts of mental health and illness have been in human cultures since ancient times. As early as 2980 b.c.e., priest-physicians were noted for their treatment of spirit possession involving madness, violence, mutism, and melancholy. In those times, such problems were thought to originate from external, supernatural forces. Later, during the rise of Greco-Roman philosophies in medicine, such states of mind began to be explored more as disturbances of the brain and less as the result of supernatural causes. As such, treatments began to develop greater reliance on methods such as vapors, baths, diets, and emetic and cathartic drugs.
Over time, the field of psychiatry has matured and taken on a major role in medicine. Research into the mind-body relationship has clarified how the mind can influence the healing of medical conditions, as well as how certain medical conditions are rooted in psychological, social, and environmental problems, rather than in a person’s biology alone. Additionally, advances in the development of psychotropic drugs have played a major role in the treatment of disabling conditions long thought to be untreatable, such as schizophrenic and bipolar disorders.
In the future, psychiatry is expected to continue developing a broad variety of specialty areas. New techniques for working with children, adolescents, elders, and individuals with particular medical problems or of a particular...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. Arlington, Va.: Author, 2000. The bible of the psychiatric community, this is a compendium of descriptions of disorders and diagnostic criteria widely embraced by clinicians. Included is an extensive glossary of technical terms, making this volume easy to understand.
Andreasen, Nancy C., and Donald W. Black. Introductory Textbook of Psychiatry. 4th ed. Washington, D.C.: American Psychiatric Press, 2006. Designed for use by medical and other students, this book provides basic information on psychiatry, various psychiatric disorders, treatments, and special topics such as suicide, acquired immunodeficiency syndrome (AIDS), and disorders of childhood and adolescence.
Kring, Ann M., et al. Abnormal Psychology. 11th ed. Hoboken, N.J.: John Wiley & Sons, 2010. This college text addresses the causes of psychopathology and treatments commonly used to treat various disorders. The book is well organized, readable, and interesting. An extensive reference list and a glossary are included.
Mazure, Carolyn M., ed. Does Stress Cause Psychiatric Illness? Washington, D.C.: American Psychiatric Press, 1995. Twenty contributors discuss recent empirical data relating stress to psychiatric illness and using new models to differentiate types of stress, account for differential...
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Psychiatry (Encyclopedia of Science)
Psychiatry is the branch of medicine concerned with the study, diagnosis, and treatment of mental illnesses. The word psychiatry comes from two Greek words that mean "mind healing." Those who practice psychiatry are called psychiatrists. In addition to graduating from medical school, these physicians have postgraduate education in the diagnosis and treatment of mental behaviors that are considered abnormal.
Psychiatrists tend to view mental disorders as diseases and can prescribe medicine to treat those disorders. Other medical treatments occasionally used by psychiatrists include surgery (although rarely) and electroshock therapy.
Many, but not all, psychiatrists use psychoanalysis, a system of talking therapy based on the theories of Austrian psychiatrist Sigmund Freud (1856939). Freud believed that mental illness occurs when unpleasant childhood experiences are repressed (blocked out) because they are so painful. Psychoanalysts seek to cure patients by having them recover these repressed thoughts by talking freely until themes or issues related to the troubling conflicts arise, which are then addressed. Psychoanalysis often involves frequent sessions lasting over many years. Many psychiatrists use a number of types of psychotherapy in addition to psychoanalysis and prescription medication to create a treatment plan that fits a patient's needs.
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Psychiatry (World of Forensic Science)
Forensic psychiatric evaluations are crucial to many civil and criminal court decisions. Psychiatrists are requested to assess the level of criminal and legal responsibility of defenders in cases of fraud, embezzlement, murder, physical aggression, disputes for child custody, and other crimes and court proceedings. In some countries, when a person decides to write a will, his or her mental sanity has to be established in order to prevent disputes among heirs about the legal validity of the will based on allegations of the author's mental health at the time the document was written. Other roles of forensic psychiatry involve studying the psychiatric risk factors for criminal behavior among the population, to evaluate inmates for probationary release, and to research the neurobiological aspects of psychopathic personalities and the risk they may pose to society.
Psychiatry is the field of medical sciences that studies mental diseases and behavioral disorders associated with biological causes. Congenital (present at birth), hereditary, or acquired psychosis, mania, and schizophrenia can often lead to violent or self-destructive behavior and deviant patterns of social interactions. In contrast to psychiatry, psychology investigates behavioral, emotional, and cognitive disorders. Psychology also studies the unconscious mechanisms underlying life experiences and mental illness. Both psychiatry and psychology study the development of personality from birth to adulthood, and the psychological (emotional and cognitive) and social or interpersonal developmental needs of each phase of life. However, the medical diagnosis and treatment of psychosis and other psychiatric disorders is the exclusive domain of the psychiatrist, whereas the counseling and cognitive re-education of patients suffering from nonpsychotic disorders, such as neurosis, behavioral problems, and emotional traumas, is usually the role of the psychologist.
Neuropsychiatry or the clinical application of the findings of neuroscience to the diagnosis and treatment of psychiatric disorders has yielded a better understanding of the biological bases of violent and criminal behavior associated with some psychopathologies, as well as a number of new effective diagnostic techniques. Since the 1970s, many neuroscience studies have shown that the brain structures and neurochemistry can be modified during infancy and childhood by the repetitive exposure to traumatic experiences or to neglect. Whereas less than 1% of any given population may present hereditary psychosis, these studies have shown that children born with a healthy brain can be neurologically damaged by chronic exposure to maternal neglect, child abuse, or a violent environment, even if the child is not the direct target of the violence. The brain adapts to such situations by undergoing detrimental and often permanent changes in its structures and neurochemical functions that often lead to psychosis and violent behavior, or to self-destructive patterns and other psychiatric pathologies. Such knowledge is leading many psychiatrists to work in the early detection of children at risk in order to prevent further damage through early diagnosis and treatment of abused children. Forensic psychiatry is therefore, crucial to the evaluation of children victimized by domestic or social violence and/or neglect, and for informing courts and social agencies on the therapeutic needs and available treatments in this vulnerable age group.
Forensic psychiatry differs in nature from clinical psychiatric practice because it aims to prove a fact in court, and is subjected to scrutiny and cross-examination by opposing parts. It requires a wide range of specific studies and adequate techniques as well as a special training in order to enable the psychiatrist to act as an expert examiner and witness in court. The psychiatric examiner supplies prosecutors, judges, probation boards, and police investigators with expert diagnosis on the mental state of defenders, convicts, and suspects. Such forensic diagnosis will constitute evidence to be considered by judges and/or by the court.
Expert psychiatric evaluation may be divided in three categories: transversal (or horizontal) evaluation, retrospective evaluation, and prospective evaluation. Transversal evaluations aim to establish whether the defendant is suffering in the present from a psychiatric disorder that would acquit him of civil or criminal responsibility. However, an insanity diagnosis implies in many cases the compulsory reclusion to a psychiatric hospital and treatment. If the psychiatric offender poses serious threat to himself and to other people's lives, he can be committed to a mental institution for life. Transversal evaluations are usually requested by the defense or by the prosecution before the trial or in the initial phases of the trial, and are obligatory by law in many countries. Retrospective evaluations require great expertise and technical preparation from forensic psychiatrists in order to infer the mental condition and legal responsibility of the defender at the time he committed the crime. Prospective evaluations, or risk assessment, consist of evaluations based on the present and past history of a convict, or a defendant to determine future risk of recidivism (repeated criminal behavior). It is usually carried out by a multidisciplinary team when prisoners are being assessed for probation, or by the forensic psychiatrist alone to enable the judge to determine the length of a new sentence in cases of repeated offenses.
Another field of forensic psychiatry involves researching the incidence of crime in the population, and is known as crime epidemiology. One such study sponsored by the National Institute of Mental Health (NIMH) was completed in 2002. An entire generation of boys in the city of Dunedin, New Zealand, was periodically evaluated from birth through physical, psychiatric, neurological, and psychomotor tests. In 2002, the group donated blood for genetic tests, including those who had a record as juvenile offenders in recent years or were serving sentences for violent crimes. It was found that in addition to having been victims of serious abuse or neglect during childhood, a subpopulation among the delinquent group had a genetic mutation that affected the regulation of a chemical messenger in the brain. Although this subgroup represented only 12% of the delinquents, they accounted for 44% of convictions for violent crimes.
The adoption of psychiatric diagnostic guidelines by some countries in the past 20 years, which are regularly updated to include new scientific advances, are essential for modern forensic psychiatry. The process of forensic psychiatric evaluation can be generally described as requiring interviews with the examinee, clinical physical examination, neurological and endocrine tests, neurological and functional diagnostic tests, neuropsychological assessments, and interviews with third parties. Based on the results of these various tests, forensic psychiatrists issue expert reports and prepare evidence for presentation in court. In the United States, a forensic psychiatric diagnosis is based on the Diagnostic and Statistical Manual of Mental Disorders, developed by the American Psychiatric Association. In many other countries the World Health Organization (WHO) guidelines are used, such as the Clinical Descriptions and Diagnostic Guidelines and the Diagnostic Criteria for Research.
Advancements in neuroscience and the establishment of objective criteria for psychiatric diagnostics as well as the clear and detailed description of the etiology (causes) and ethology (progression) of psychopathologies (serious mental disorders) were important to forensic psychiatry, as these advancements rid the profession of the controversial character often attributed to forensic psychiatry in the past. The APA system adopts objective formulations, similar to those used in other medical specialties. Diagnostic techniques introduced or improved in the last two decades, such as functional brain magnetic resonance imaging (fMRI), PET scans, and computer tomography, allow the identification of structural asymmetries and functional abnormalities of the brain associated with some mental illnesses. The same is true for new laboratorial neuroendocrine tests, which give insight into brain chemistry. The advances of neurosciences and the better understanding of brain chemistry gave forensic psychiatry a new scientific status as an objective science, using clear diagnostic parameters and criteria. Therefore, allegations of insanity by defenders can now be proved or disproved on the basis of solid scientific evidence.
SEE ALSO Brain wave scanners; Criminal profiling; DNA typing systems; Epidemiology; Expert witnesses; Forensic science; Genetic code; Nervous system overview; Psychology; Psychopathic personality.