Psychiatry 23502 225931727 2008-07-16T02:06:47Z Chupper 645480 violates [[WP:EL]] [[Image:MRI head side.jpg|thumb|right|An [[Magnetic resonance imaging|MRI]] scan of a [[human brain]] and [[head]]. The brain is the most important [[Organ (anatomy)|organ]] studied by [[psychiatrist]]s.<ref name=051997AJP>Andreasen, N.C. (1997). [http://ajp.psychiatryonline.org/cgi/reprint/154/5/591.pdf What is psychiatry?] ''American Journal of Psychiatry, 154'', 591-593.</ref>]] '''Psychiatry''' is a [[Medicine|medical]] [[Specialty (medicine)|specialty]] which exists to [[Biomedical research|study]], [[Prevention (medical)|prevent]], and [[Treatment of mental disorders|treat]] [[mental disorder]]s in [[human]]s. Psychiatric assessment typically involves a [[mental status examination]] and taking a case history, and psychological tests may be administered. Physical examinations may be conducted and occasionally [[Neuroimaging|neuroimages]] or other [[Neurophysiology|neurophysiological]] measurements taken. Diagnostic procedures vary but official criteria are listed in manuals, the most common being the [[ICD]] from the World Health Organisation and the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]] from the [[American Psychiatric Association]]. [[Psychiatric medication]] is a central treatment option, which is largely unique to psychiatry along with rarer procedures such as [[Electroconvulsive therapy]]. [[Psychotherapy]] is also a major treatment option in psychiatry, although it is also the speciality of other [[mental health professions]]. Psychiatric services may be provided on an [[inpatient]] or [[outpatient]] basis. In certain authorized cases this may be done on an involuntary basis. Both the research and clinical application of psychiatry are considered interdisciplinary.<ref name=Pietrini /> Because of this, various subspecialties and theoretical approaches exist. [[Psychiatrist]]s can be considered [[physician]]s who specialize in the doctor-patient relationship<ref name=Shorter326 /> utilizing some of medicine's newest classification schemes, diagnostic tools and treatments.<ref name=Essen /><ref name=Krebs /><ref name=Hampel /> Psychiatry can be said to have originated in the 5th century BC, while the first hospitals for the mentally ill were created in the [[Middle Ages]]. The 18th century saw the development of psychiatry as a recognized field and mental health institutions came to utilize more elaborate, as well as some more humane, treatments. The 19th century saw a massive increase in patient populations. The 20th century saw a rebirth of a biological understanding of mental disorders as well the introduction of disease classifications and psychiatric medications. An [[anti-psychiatry]] movement emerged in the 1960s and a shift led to the [[deinstitutionalization|dismantling of state psychiatric hospitals]] in favor of community treatment. There have been changes in psychiatric diagnoses and treatments and in the balance between the biological and social sciences. Research has continued looking into the origins, classification, and treatment of mental disorders. == Theory and focus == <blockquote class="toccolours" style="text-align:left; width:30%; float:right; padding: 10px 15px 10px 15px; display:table;">"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" <small>([[Psychiatry#cite_note-Guze4-6|Guze, 1992, p.4]]).</small></blockquote> The term psychiatry, coined by [[Johann Christian Reil]] in 1808, comes from the Greek “psyche” (soul or mind) and “iatros" (healer or doctor). It refers to a field of medicine focused specifically on the mind, aiming to [[Biomedical research|study]], [[Prevention (medical)|prevent]], and [[Treatment of mental disorders|treat]] [[mental disorder]]s in [[human]]s.<ref name=Guze4>Guze, S.B. (1992). ''Why Psychiatry Is a Branch of Medicine''. New York: Oxford University Press, p. 4. ISBN 978-0-19-507420-8</ref><ref name=Storrow1>Storrow, H.A. (1969). ''Outline of Clinical Psychiatry''. New York: Appleton-Century-Crofts, p. 1. ISBN 978-0-39-085075-1</ref><ref name=Lyness3>Lyness, J.M. (1997). ''Psychiatric Pearls''. Philadelphia: F.A. Davis Company, p. 3. ISBN 978-0-80-360280-9</ref> 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.<ref name=Gask7>Gask, L. (2004). ''A Short Introduction to Psychiatry''. London: SAGE Publications Ltd., p. 7 ISBN 978-0-7619-7138-2</ref> Those who practice psychiatry are different than most other [[mental health professional]]s and [[physician]]s in that they must be familiar with both the [[Social sciences|social]] and [[Biology|biological sciences]].<ref name=Storrow>Storrow, H.A. (1969). ''Outline of Clinical Psychiatry''. New York:Appleton-Century-Crofts, p 1. ISBN 978-0-39-085075-1</ref> 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.<ref name=Guze131>Guze, S. B. (1992). ''Why Psychiatry is a Branch of Medicine''. New York: Oxford University Press, p 131. ISBN 978-0-19-507420-8.</ref> Psychiatry exists to treat mental disorders which are conventionally divided into three very general categories; [[mental illness]], severe learning disability, and [[personality disorder]].<ref name=Gask113>Gask, L. (2004). ''A Short Introduction to Psychiatry''. London: SAGE Publications Ltd., p. 113 ISBN 978-0-7619-7138-2</ref> 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.<ref name=Gask128>Gask, L. (2004). ''A Short Introduction to Psychiatry''. London: SAGE Publications Ltd., p. 128 ISBN 978-0-7619-7138-2</ref> === Scope of practice === While the medical specialty of psychiatry utilizes research in the field of [[neuroscience]], [[psychology]], [[medicine]], [[biology]], [[biochemistry]], and [[pharmacology]],<ref name=Pietrini>Pietrini, P. (2003). Toward a Biochemistry of Mind? ''American Journal of Psychiatry, 160'', 1907-1908.</ref> it has generally been considered a middle ground between [[neurology]] and psychology.<ref name=Shorter326>Shorter, E. (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley & Sons, Inc, p. 326. ISBN 978-0-47-124531-5</ref> Unlike other physicians and neurologists, psychiatrists specialize in the [[doctor-patient relationship]] and are trained in the use of psychotherapy and other therepautic communication techniques.<ref name=Shorter326> Psychiatrists also differ from psychologists in that they are physicians and the entirety of [[Medical school|their post-graduate training]] is revolved around the field of medicine.<ref name=Hauser>Hauser, M.J. (Unknown last update). ''Student Information''. Retrieved September 21, 2007, from http://www.psychiatry.com/student.php</ref> Psychiatrists can therefore prescribe medication, order [[Medical laboratory|laboratory test]]s, utilize [[neuroimaging]] in a clinical setting, and conduct [[physical examination]]s.<ref name=NIMHSite>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</ref> === Ethics === Like other [[professional ethics|professions]], 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 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]], research ethics, sex selection, [[euthanasia]],<ref name=Lopez>{{cite journal | doi = 10.1016/j.pnpbp.2006.12.007 | title = 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 |date=2006-12-07 | author=López-Muñoza, Francisco | others= Cecilio Alamoa, Michael Dudleyb, Gabriel Rubioc, Pilar García-Garcíaa, Juan D. Molinad and Ahmed Okasha | publisher = Science Direct |quote=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. | journal = Progress in Neuro-Psychopharmacology and Biological Psychiatry | volume = 31 | pages = 791}}</ref> organ transplantation, [[torture]],<ref name=Gluzman>{{cite journal | author = Gluzman, S.F. | year = 1991 | title = Abuse of psychiatry: analysis of the guilt of medical personnel. | journal = J Med Ethics | volume = 17 | pages = 19–20 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11651120&dopt=Citation | accessdate = 2007-09-30 | quote=Based on the generally accepted definition, we correctly term the utilisation of psychiatry for the punishment of political dissidents as torture.}}</ref><ref name=Debreu>{{cite book | url = http://books.nap.edu/openbook.php?record_id=9733&page=21 | author= Debreu, Gerard | editor= Corillon, Carol | title = Science and Human Rights | chapter = Part 1: Torture, Psychiatric Abuse, and the Ethics of Medicine| accessdate = 2007-10-04 | year=1988|publisher=National Academy of Sciences|quote=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. }}</ref> the [[death penalty]], media relations, genetics, and ethnic or cultural discrimination.<ref>[http://www.wpanet.org/generalinfo/ethic1.html The WPA code of ethics.]</ref> 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: *[[Biological psychiatry]]; an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. *[[Child and adolescent psychiatry]]; a branch of psychiatry that specialises in work with children, teenagers, and their families. *[[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. *[[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 wellbeing. == History == === Ancient times === Starting in the 5th century BC, mental disorders, especially those with [[Psychosis|psychotic]] traits, were considered [[supernatural]] in origin.<ref name=Elkes13>Elkes, A. & Thorpe, J.G. (1967). ''A Summary of Psychiatry''. London: Faber & Faber, p. 13.</ref> This view existed throughout [[ancient Greece]] and [[ancient Rome|Rome]].<ref name=Elkes13 /> Early manuals written about mental disorders were created by the Greeks.<ref name=Shorter1>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 1. ISBN 978-0-47-124531-5</ref> In 4th century BC, [[Hippocrates]] theorized that physiological abnormalities may be the root of mental disorders.<ref name=Elkes13 /> However further explorations of this perspective ceased shortly thereafter following the [[Decline of the Roman Empire|fall of the Roman Empire]].<ref name=Elkes13 /> Religious leaders and others returned to using early versions of [[exorcism]]s to treat mental disorders which often utilized cruel, harsh, and other barbarous methods.<ref name=Elkes13 /> === Middle Ages === {{main|Islamic psychology}} The first [[psychiatric hospital]]s were built in the [[Islamic Golden Age|medieval Islamic world]] from the 8th century. The first was built in [[Baghdad]] in 705, followed by [[Fes]] in the early 8th century, and [[Cairo]] in 800. Unlike medieval Christian physicians who relied on [[demonic possession|demonological explanations]] for mental illness, [[Islamic medicine|medieval Muslim physicians]] relied mostly on [[Clinical psychology|clinical observations]]. They made significant advances to psychiatry and were the first to provide [[psychotherapy]] and [[moral treatment]] for mentally ill patients, in addition to other forms of treatment such as [[bathing|bath]]s, drug [[medication]], [[music therapy]] and [[occupational therapy]]. In the 10th century, the [[Persian people|Persian]] physician [[Muhammad ibn Zakarīya Rāzi]] (Rhazes) combined [[Psychology|psychological]] methods and [[Physiology|physiological]] explanations to provide treatment to mentally ill patients. His contemporary, the [[Arab]] physician Najab ud-din Muhammad, first described a number of mental illnesses such as [[agitated depression]], [[neurosis]], [[priapism]] and [[Erectile dysfunction|sexual impotence]] (''Nafkhae Malikholia''), [[psychosis]] (''Kutrib''), and [[mania]] (''Dual-Kulb'').<ref name=Syed>Ibrahim B. Syed PhD, "Islamic Medicine: 1000 years ahead of its times", ''Journal of the International Society for the History of Islamic Medicine'', 2002 (2): 2-9 [7-8].</ref> In the 11th century, another Persian physician [[Avicenna]] recognized '[[physiological psychology]]' in the treatment of illnesses involving [[emotion]]s, and developed a system for associating changes in the [[pulse]] rate with inner feelings, which is seen as a percursor to the [[word association]] test developed by [[Carl Jung]] in the 19th century.<ref>Ibrahim B. Syed PhD, "Islamic Medicine: 1000 years ahead of its times", ''Journal of the International Society for the History of Islamic Medicine'', 2002 (2): 2-9 [7].</ref> [[Avicenna]] was also an early pioneer of [[neuropsychiatry]], and first described a number of neuropsychiatric conditions such as [[hallucination]], [[insomnia]], [[mania]], [[nightmare]], [[melancholia]], [[dementia]], [[epilepsy]], [[paralysis]], [[stroke]], [[Vertigo (medical)|vertigo]] and [[tremor]].<ref>S Safavi-Abbasi, LBC Brasiliense, RK Workman (2007), "The fate of medical knowledge and the neurosciences during the time of Genghis Khan and the Mongolian Empire", ''Neurosurgical Focus'' '''23''' (1), E13, p. 3.</ref> Psychiatric hospitals were built in [[Middle Ages|medieval Europe]] from the 13th century to treat mental disorders but were utilized only as custodial institutions and did not provide any type of treatment.<ref name=Shorter4>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 4. ISBN 978-0-47-124531-5</ref> Founded in the 13th century, [[Bethlem Royal Hospital]] in [[London]] is one of the oldest psychiatric hospitals.<ref name=Shorter4 /> By 1547 the City of London acquired the hospital and continued its function until 1948.<ref name=Shorter5>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 5. ISBN 978-0-47-124531-5</ref> [[Image:Philippe Pinel.jpg|thumb|Many consider [[Philippe Pinel]] to be the father of modern psychiatry.]] === Early modern period === 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 being applied.<ref name=Shorter5 /> In 1758 English physician [[William Battie]] wrote the ''[[Treatise on Madness]]'' which called for treatments to be utilized in asylums.<ref name=Shorter9>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 9. ISBN 978-0-47-124531-5</ref> Thirty years later the new ruling monarch in England, [[George III of the United Kingdom|George III]], was known to be suffering from a mental disorder.<ref name=Elkes13 /> Following the King's [[Remission (medicine)|remission]] in 1789, mental illness was seen as something which could be treated and cured.<ref name=Elkes13 /> By 1792 French physician [[Philippe Pinel]] introduced [[Moral treatment|humane treatment]] approaches to those suffering from mental disorders.<ref name=Elkes13 /> [[William Tuke]] adopted the methods outlined by Pinel and that same year Tuke opened the [[The Retreat|York Retreat]] in England.<ref name=Elkes13 /> That institution became known as a model throughout the world for humane and moral treatment of patients suffering from mental disorders.<ref name=Borthwick>Borthwick, A.; Holman, C.; Kennard, D.; McFetridge, M.; Messruther, K.; Wilkes, J. (2001). The relevance of moral treatment to contemporary mental health care. ''Journal of Mental Health, 10'', 427-439.</ref> It inspired similar institutions in the United States, most notably the [[Brattleboro Retreat]] and the Hartford Retreat (now the [[Institute of Living]]). === 19th century === At the turn of the century, England and France combined only had a few hundred individuals in asylums.<ref name=Shorter34>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 34. ISBN 978-0-47-124531-5</ref> By the late 1890s and early 1900s, this number skyrocketed to the hundreds of thousands.<ref name=Shorter34 /> The United States housed 150,000 patients in mental hospitals by 1904.<ref name=Shorter34 /> [[German language|German speaking]] countries housed more than 400 public and private sector asylums.<ref name=Shorter34 /> These asylums were critical to the evolution of psychiatry as they provided a universal platform of practice throughout the world.<ref name=Shorter34 /> Universities often played a part in the administration of the asylums.<ref name=Shorter35>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 35. ISBN 978-0-47-124531-5</ref> Due to the relationship between the universities and asylums, scores of competitive psychiatrists were being molded in Germany.<ref name=Shorter35 /> Germany became known as the world leader in psychiatry during the nineteenth century.<ref name=Shorter34 /> The country possessed more than 20 separate universities all competing with each other for scientific advancement.<ref name=Shorter34 /> 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.<ref name=Shorter34 /> Britain, like Germany, also lacked a centralized organization for the administration of asylums.<ref name=Shorter41>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 41. ISBN 978-0-47-124531-5</ref> This deficit hindered the diffusion of new ideas in medicine and psychiatry.<ref name=Shorter41 /> In 1834, [[Anna Marsh]], a physician's widow, deeded the funds to build the United States' first financially-stable private asylum in 1834. The [[Brattleboro Retreat]] marked the beginning of America's private psychiatric hospitals challenging state institutions for patients, funding, and influence. Although based on [[England]]'s [[York Retreat]], it would be followed by speciality institutions of every treatment philosophy. In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country.<ref name=Shorter40>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 40. ISBN 978-0-47-124531-5</ref> By 1840, asylums existing as therapeutic institutions existed throughout Europe and the United States.<ref name=Shorter46>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 46. ISBN 978-0-47-124531-5</ref> [[Image:Emil Kraepelin2.gif|thumb|right|[[Emil Kraepelin]] studied and promoted ideas of disease classification for mental disorders.]] However, the new and dominating ideas that mental illness could be "conquered" during the mid-nineteenth century all came crashing down.<ref name=Shorter46 /> Psychiatrists and asylums were being pressured by an ever increasing patient population.<ref name=Shorter46 /> The average number of patients in asylums in the United States jumped 927%.<ref name=Shorter46 /> Numbers were similar in England and Germany.<ref name=Shorter46 /> Overcrowding was rampant in France where asylums would commonly take in double their maximum capacity.<ref name=Shorter47>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 47. ISBN 978-0-47-124531-5</ref> Increases in asylum populations may have been a result of the transfer of care from families and [[poorhouse]]s, but the specific reasons as to why the increase occurred is still debated today.<ref name=Shorter48>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 48. ISBN 978-0-47-124531-5</ref><ref name=Shorter49>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 49. ISBN 978-0-47-124531-5</ref> 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<ref name=Rothman>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</ref> and the reputation of psychiatry in the medical world had hit an extreme low.<ref name=Shorter65>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 65. ISBN 978-0-47-124531-5</ref> === 20th century === ==== Disease classification and rebirth of biological psychiatry ==== The 20th century introduced a new psychiatry into the world. The different perspectives of looking at mental disorders began to be introduced. The career and beginnings of [[Emil Kraepelin]] somewhat model this hiatus of psychiatry between the different disciplines.<ref name=Shorter101>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 101. ISBN 978-0-47-124531-5</ref> Kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry.<ref name=Shorter101 /> Following his acceptance for a professorship of psychiatry, and later his work in a university psychiatric clinic, Kraepelin's insterest in pure psychology began to fade and he introduced a plan of a more comprehensive psychiatry.<ref name=Shorter102>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 102. ISBN 978-0-47-124531-5</ref><ref name=Shorter103>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 103. ISBN 978-0-47-124531-5</ref> Kraepelin also began to study and promote the ideas of disease classification for mental disorders, an idea introduced by [[Karl Ludwig Kahlbaum]].<ref name=Shorter103 /> The initial ideas behind biological psychiatry, stating that these different disorders were all biological in nature, evolved into a new idea of "nerves" and psychiatry became a sort of rough neurology or neuropsychiatry.<ref name=Shorter114>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 1114. ISBN 978-0-47-124531-5</ref> Following [[Sigmund Freud]]'s death, ideas stemming from [[psychoanalytic theory]] also began to take root.<ref name=Shorter145>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 145. ISBN 978-0-47-124531-5</ref> The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of asylums.<ref name=Shorter145 /> However the progress of psychiatry by the 1970s turned psychoanalytic theory into a marginal school of thought within the field.<ref name=Shorter145 /> [[Image:ACh.png|right|thumb|[[Otto Loewi]]'s work led to the identification of the first neurotransmitter, [[acetylcholine]].]] This period of time saw the reemergence of biological psychiatry. [[Psychopharmacology]] became an integral part of psychiatry starting with [[Otto Loewi]]'s discovery of the first neurotransmitter, [[acetylcholine]].<ref name=Shorter246 /> [[Neuroimaging]] was first utilized as a tool for psychiatry in the 1980s.<ref name=Shorter270>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 270. ISBN 978-0-47-124531-5</ref> The discovery of [[chlorpromazine]]'s effectiveness in treating [[schizophrenia]] in 1952 revolutionized treatment of the disease, <ref name="Turner2007">{{cite journal | author=Turner T. | title=Unlocking psychosis | journal=Brit J Med | year=2007 | volume=334 | issue=suppl | pages=s7 | doi=10.1136/bmj.39034.609074.94 | pmid=17204765 }}</ref> as did [[lithium carbonate]]'s ability to stabilize mood highs and lows in [[bipolar disorder]] in 1948.<ref>Cade, JFJ; ''Lithium salts in the treatment of psychotic excitement''. Med J Aust 1949, 36, p349-352</ref> While psychosocial issues were still seen as valid, psychotherapy was seen to be their "cure."<ref name=Shorter239>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 239. ISBN 978-0-47-124531-5</ref> Genetics were once again thought to play a role in mental illness.<ref name=Shorter246>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 246. ISBN 978-0-47-124531-5</ref> Molecular biology opened the door for specific genes contributing mental disorders to be identified.<ref name=Shorter246 /> By 1995 genes contributing to [[schizophrenia]] had been identified on [[Chromosome 6 (human)|chromosome 6]] and those genes contributing to [[bipolar disorder]] on chromosomes [[Chromosome 18 (human)|18]] and [[Chromosome 21 (human)|21]].<ref name=Shorter246 /> ==== Anti-psychiatry and deinstitutionalization ==== {{main|Anti-psychiatry}} The introduction of [[psychiatric medication]]s and the use of [[Medical laboratory|laboratory]] tests altered the [[doctor-patient relationship]] between psychiatrists and their patients.<ref name=Shorter273>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 273. ISBN 978-0-47-124531-5</ref> Psychiatry's shift to the [[hard science]]s had been interpreted as a lack of concern for patients.<ref name=Shorter273 /> [[Anti-psychiatry]] had become more prevalent in the late twentieth century due to this and publications in the media which conceptualized mental disorders as myths.<ref name=Shorter274>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 274. ISBN 978-0-47-124531-5</ref> 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.<ref name=Shorter277>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 277. ISBN 978-0-47-124531-5</ref> Incidents of physical abuse by psychiatrists took place during the reign of some totalitarian regimes as part of a system to enforce political control with some of the abuse even continuing to our present day.<ref>Sunny Y. Lu & Viviana B. Galli, ''The Journal of the American Academy of Psychiatry and the Law''</ref> Historical examples of the abuse of psychiatry took place in [[Nazi Germany]] <ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12817666&dopt=Abstract The killing of psychiatric patients in Nazi German...[Isr J Psychiatry Relat Sci. 2003&#93; - PubMed Result<!-- Bot generated title -->]</ref>, in the [[Soviet Union]] under [[Psikhushka]], and in the [[apartheid]] system in [[South Africa]].<ref>[http://www.info.gov.za/speeches/1997/06160x76497.htm Mental Health During Apartheid<!-- Bot generated title -->]</ref> [[Electroconvulsive therapy]] was one treatment that the anti-psychiatry movement wanted eliminated.<ref name=Shorter282>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 282. ISBN 978-0-47-124531-5</ref> They alleged that electroconvulsive therapy damaged the brain and it was used as a tool for discipline.<ref name=Shorter282 /> While there is no evidence that brain damage was a result of electronconvulsive therapy<ref name=Weiner>Weiner, R.D. (1984). Does ECT cause brain damage? ''Behavioral and Brain Sciences, 7'', 153.</ref><ref name=Meldrum>Meldrum, B.S. (1986). Neuropathological consequences of chemically and electrically induced seizures. ''Annals of the New York Academy of Sciences, 462'', 18693.</ref><ref name=Dwork>Dwork, A.J.; Arango, V.; Underwood, M.; Ilievski, B.; Rosoklija, G.; Sackeim, H.A.; Lisanby, S.H. (2004). Absence of histological lesions in primate models of ECT and magnetic seizure therapy. ''American Journal of Psychiatry, 161'', 576-578.</ref>, there have been isolated incidents where the use of electroconvulsive therapy was threatened to keep the patients "in line."<ref name=Shorter282 /> The prevalence of psychiatric medication helped initiate [[Deinstitutionalisation|deinstitutionalization]],<ref name=Shorter280>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley &; Sons, Inc, p. 280. ISBN 978-0-47-124531-5</ref> the process of discharging patients from psychiatric hospitals to the community.<ref name=Shorter279>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley & Sons, Inc, p. 279. ISBN 978-0-47-124531-5</ref> The pressure from the anti-psychiatry movements and the ideology of community treatment from the medical arena helped sustain deinstitutionalization.<ref name=Shorter280 /> Thirty-three years after deinstitutionalization started in the United States, only 19% of the patients in state hospitals remained.<ref name=Shorter280 /> [[Mental health professional]]s envisioned a process wherein patients would be released into communities where they could participate in a normal life while living in a therapeutic atmosphere.<ref name=Shorter280 /> ==== Transinstitutionalization and the aftermath ==== In 1963, [[President of the United States|United States 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.<ref name=Shorter280>Shorter, E. (1997). ''A History of Psychiatry: From the Era of the Asylum to the Age of Prozac''. New York: John Wiley &; Sons, Inc, p. 280. ISBN 978-0-47-124531-5</ref> Later, though, the Community Mental Health Center's focus was diverted to provide psychotherapy sessions for those suffering from acute and/or mild mental disorders.<ref name=Shorter280 /> Ultimately there were no arrangements made for actively ill patients who were being discharged from hospitals.<ref name=Shorter280 /> Some of those suffering from mental disorders drifted into homelessness or ended up in prisons and jails.<ref name=Shorter280 /><ref name=Slovenko>Slovenko, R. (2003). The transinstitutionalization of the mentally ill. ''Ohio University Law Review, 29'', 641.</ref> Studies found that 33% of the homeless population and 14% of inmates in prisons and jails were already diagnosed with a mental illness.<ref name=Shorter280 /><ref name=Torrey>Torrey, E.F. (1988). ''Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill''. New York: Harper and Row, pp.25-29, 126-128. ISBN 978-0-06-015993-1</ref> In 1972, psychologist [[David Rosenhan]] published the [[Rosenhan experiment]], a study analyzing the validity of psychiatric diagnoses.<ref name=Rosenhan>Rosenhan, D. (1973). [http://www.sciencemag.org/cgi/content/abstract/179/4070/250 On being sane in insane places]. ''Science'' '''179''', 250-258.</ref> 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. Rosenhan's study concluded that individuals with no presence of mental disorders could not be distinguished from those suffering from mental disorders.<ref name=Rosenhan /> While critics such as [[Robert Spitzer (psychiatrist)|Robert Spitzer]] placed doubt on the validity and credibility of the study, they also conceded that the consistency of psychiatric diagnoses needed improvement.<ref name=Spitzer2005>Spitzer, R.L.; Lilienfeld, S.O.; Miller, M.B. (2005). Rosenhan revisited: The scientific credibility of Lauren Slater's pseudopatient diagnosis study. ''Journal of Nervous and Mental Disease, 193'', 734-739.</ref> Psychiatry, like many medical specialties, has a continuing, significant demand for research investigating its related diseases, classifications, origins, and treatments.<ref name=Lyness16>Lyness, J.M. (1997). ''Psychiatric Pearls''. Philadelphia: F.A. Davis Company. ISBN 978-0-80-360280-9</ref> Psychiatry falls into biology's fundamental belief that disease and health are different elements of an individual's adaptation to an environment.<ref name=Guze130>Guze, S. B. (1992). Why Psychiatry is a Branch of Medicine. New York: Oxford University Press, p 130. ISBN 978-0-19-507420-8.</ref> But psychiatry also recognizes that the environment of the human species is complex and includes physical, cultural, and relational elements.<ref name=Guze130 /> In addition to external factors, the [[human brain]] must recognize or organize an individual's hopes, fears, desires, fantasies and feelings.<ref name=Guze130 /> Psychiatry's difficult task is the attempt to envelop the understanding of these factors so that they can be studied both clinically and physiologically.<ref name=Guze130 /> == Industry and academia == === Practitioners === {{main|Psychiatrist}} As with most medical specialties, all [[physician]]s can diagnose mental disorders and prescribe treatments utilizing principles of psychiatry. [[Psychiatrist]]s are physicians who specialize in psychiatry and are certified in treating [[mental illness]] using the biomedical approach to mental disorders.<ref name=AboutPsychologyDiff>About:Psychology. (Unknown last update). ''Difference Between Psychologists and Psychiatrists''. Retrieved [[March 25]], [[2007]], from http://psychology.about.com/od/psychotherapy/f/psychvspsych.htm</ref> Psychiatrists may also go through significant training to conduct [[psychotherapy]], [[psychoanalysis]], and/or [[Cognitive therapy|cognitive behavioral therapy]], but it is their medical training, access to [[Medical laboratory|medical laboratories]], and ability to prescribe medication that differentiates them from other [[mental health professional]]s.<ref name=AboutPsychologyDiff /> === Research === Psychiatric research is, by its very nature, interdisciplinary. From a general perspective it studies and combines social, biological and psychological approaches and how those perspectives cause mental disorders.<ref name=UManchester>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</ref> While practicing psychiatrists and other psychiatric researchers study outcomes from such a wide variety of fields, research institutions and publications exist that are dedicated to the interdisciplinary study of mental disorders within the psychiatric context.<ref name=Pietrini /><ref name=NYSPI>New York State Psychiatric Institute. (2007, March 15). ''Psychiatric Research Institute New York State''. Retrieved October 13, 2007, from http://nyspi.org/</ref><ref name=CPRF>Canadian Psychiatric Research Foundation. (2007, July 27). ''Canadian Psychiatric Research Foundation''. Retrieved October 13, 2007, from http://www.cprf.ca/</ref><ref name=Elsevier>Elsevier. (2007, October 08). ''Journal of Psychiatric Research''. Retrieved October 13, 2007, from http://www.elsevier.com/wps/find/journaldescription.cws_home/241/description</ref> Under the supervision of [[institutional review board]]s, psychiatric researchers looks at a variety of topics such as neuroimaging, genetics, and psychopharmacology, which in turn help enhance diagnostic consistency, discover new treatment methods, and classify new mental disorders.<ref name=Mitchell>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 978-0-88-048802-0.</ref> On the basis of [[Tinbergen's four questions]] a framework of reference or "periodic table" of all fields of anthropological research and humanities can be established. It helps to structure interdisciplinarity in Psychiatry e.g., how [[Neurology]], Psychiatry and [[Psychotherapy]] might be connected with other fields of anthropological research. === Clinical application === ==== Diagnostic systems ==== [[Image:Ventral midbrain.png|thumb|[[Functional magnetic resonance imaging|fMRI]] images such as these may assist in a diagnosis by a psychiatrist.]] Psychiatric diagnoses take place in a wide variety of settings and are performed by many different [[Health care provider|health professional]]s. Therefore, the diagnostic procedure may vary greatly based upon these factors. Typically, though, a psychiatric diagnosis utilizes a [[differential diagnosis]] procedure where mental status examinations and physical examinations are conducted, [[Pathology|pathological]], [[Psychopathology|psychopathological]] and [[psychosocial]] histories obtained, [[Neuroimaging|neuroimages]] or other [[Neurophysiology|neurophysiological]] measurements are taken, and [[personality test]]s or [[cognitive test]]s may be administered.<ref name=Meyendorf>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.</ref><ref name=Leigh15>Leigh, H. (1983). ''Psychiatry in the practice of medicine''. Menlo Park: Addison-Wesley Publishing Company, p. 15. ISBN 978-0-20-105456-9</ref><ref name=Leigh67>Leigh, H. (1983). ''Psychiatry in the practice of medicine''. Menlo Park: Addison-Wesley Publishing Company, p. 67. ISBN 978-0-20-105456-9</ref><ref name=Leigh17>Leigh, H. (1983). ''Psychiatry in the practice of medicine''. Menlo Park: Addison-Wesley Publishing Company, p. 17. ISBN 978-0-20-105456-9</ref><ref name=Lyness10>Lyness, J.M. (1997). ''Psychiatric Pearls''. Philadelphia: F.A. Davis Company, p. 10. ISBN 978-0-80-360280-9</ref><ref name=Hampel>Hampel, H.; Teipel, S.J.; Kotter, H.U.; et al. (1997). Structural magnetic resonance imaging in diagnosis and research of Alzheimer's disease. ''Nervenarzt, 68'', 365-378.</ref><ref name=Townsend>Townsend, B.A.; Petrella, J.R.; Doraiswamy, P.M. (2002). The role of neuroimaging in geriatric psychiatry. ''Current Opinion in Psychiatry, 15'', 427-432.</ref> In addition psychiatrists are beginning to utilize [[genetics]] during the diagnostic process.<ref name=Krebs>Krebs, M.O. (2005). Future contributions on genetics. ''World Journal of Biological Psychiatry, 6'', 49-55</ref> Some endophenotypes being researched may predispose certain individuals to certain conditions.<ref name=Benes>Benes, F.M. (2007). An electrophysiological endophenotype of hypomanic and hyperthymic personality. ''Journal of Affective Disorders, 101'', 13-26.</ref><ref name=Vonk>Vonk, R.; van der Schot, A.C.; Kahn, R.S.; et al. (2007). Is autoimmune thyroiditis part of the genetic vulnerability (or an endophenotype) for bipolar disorder? ''Biological Psychiatry, 62'', 135-140.</ref> ===== 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 Organisation]] and includes a section on psychiatric conditions, and is used worldwide.<ref name=ICD10>World Health Organisation. (1992). ''The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines''. Geneva: World Health Organisation. ISBN 978-9-24-154422-1</ref> The [[Diagnostic and Statistical Manual of Mental Disorders]], produced and published by the [[American Psychiatric Association]], is solely focused on mental health conditions and is the main classification tool in the [[United States]].<ref name=DSM>American Psychiatric Association. (2000). ''Diagnostic and Statistical Manual of Mental Disorders'' (4th Edition). Washington D.C.: American Psychiatric Publishing, Inc. ISBN 978-0-89-042025-6</ref> It is currently in its fourth revised edition and is also used [[Global|worldwide]].<ref name=DSM /> The [[Chinese Society of Psychiatry]] has also produced a diagnostic manual, the [[Chinese Classification of Mental Disorders]].<ref name=Chen>Chen, Y.F. (2002) Chinese classification of mental disorders (CCMD-3): towards integration in international classification. ''Psychopathology, 35'', 171-175</ref> The stated intention of diagnostic manuals is typically to develop replicable and clinically useful categories and criteria, to facilitate consensus and agreed standards, whilst being atheoretical as regards etiology.<ref name=DSM /><ref name=Essen>Essen-Moller, E. (1971). On classification of mental disorders. ''[[Acta Psychiatrica Scandinavica]], 37'', 119-126.</ref> 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.<ref name=Mezzich>Mezzich, J.E. (1979). Patterns and issues in multiaxial psychiatric diagnosis. ''Psychological Medicine, 9'', 125-137.</ref> 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.<ref name=Guze2>Guze, S.B. (1970) The need for toughmindedness in psychiatric thinking. ''Southern Medical Journal, 63'', 662-671.</ref> ==== Treatment settings ==== {{Unreferencedsection|date=October 2007}} {{cleanup-rewrite|2=section}} {{Expand-section|date=October 2007}} =====General considerations===== Individuals with mental health conditions are commonly referred to as ''[[patient]]s'' but may also be called ''[[patient|client]]s'', ''[[consumer]]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]], [[involuntary commitment]], or, in the UK and Australia, by [[sectioning]] under a [[mental health law]]. [[Image:NIMH Clinical Center.JPG|right|thumb|A psychiatric patient room in the United States.]] Whatever the circumstance of a person's referral, a psychiatrist first [[psychiatric assessment|assesses]] a 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]] is carried out, and a [[physical examination]] is usually performed to establish or exclude other illnesses, such as thyroid dysfunction or brain tumors, or identify any signs of [[self-harm]]; this examination may be done by someone else other than the psychiatrist, especially if [[blood test]]s and [[medical imaging]] are performed. Like all medications, psychiatric medications can cause [[Adverse effect (medicine)|adverse effects]] in patients and hence often involve ongoing [[therapeutic drug monitoring]], for instance [[full blood count]]s or, for patients taking [[lithium salt]]s, [[blood plasma|serum]] levels of [[lithium]], renal and thyroid function. [[Electroconvulsive therapy]] (ECT) is sometimes administered for serious and disabling conditions, especially those unresponsive to medication. The efficacity<ref>Hopper K, Wanderling J (2000). Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative followup project. International Study of Schizophrenia. ''Schizophrenia Bulletin'', 26 (4), 835–46. PMID 11087016</ref> and adverse effects of psychiatric drugs has been challenged. The close relationship between those prescribing psychiatric medication and pharmaceutical companies has become increasingly controversial <ref>Loren R. Mosher, Richard Gosden and Sharon Beder, 'Drug companies and Schizophrenia: Unbridled Capitalism meets Madness', in [http://homepage.mac.com/herinst/sbeder/drugcompanies.html Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia] edited by John Read, Loren Mosher and Richard Bentall, Brunner-Routledge, New York, 2004, pp. 115-130.</ref> along with the influence which pharmaceutical companies are exerting on mental health policies.<ref>Richard Gosden and Sharon Beder, [http://homepage.mac.com/herinst/sbeder/pharm-agenda.html 'Pharmaceutical Industry Agenda Setting in Mental Health Policies'], Ethical Human Sciences and Services 3(3) Fall/Winter 2001, pp. 147-159 </ref><ref>Thomas Ginsberg. [http://mindfreedom.org/campaign/media/mf/inquirer-on-drug-firms/ "Donations tie drug firms and nonprofits"]. [[The Philadelphia Inquirer]] 28 May 2006.</ref> Also controversial are forced drugging and the "lack of insight" label. According to a report published by the National Council on Disability, <blockquote>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."<ref>Rae E. Unzicker, Kate P. Wolters, Debra Robinson et al. [http://www.ncd.gov/newsroom/publications/2000/privileges.htm From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves]. [[National Council on Disability]] 20 January 2000.</ref></blockquote> =====Inpatient treatment===== {{Refimprovesect|date=June 2008}} [[Treatment of mental illness|Psychiatric treatments]] have changed over the past several decades. In the past, psychiatric patients were often [[Psychiatric hospital|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 [[General out-patient clinic|outpatients]]. If hospitalization is required, the average hospital stay is around one to two weeks, with only a small number receiving long-term hospitalization. Individuals with mental health problems are commonly referred to as ''[[patient]]s'' but may also be called ''[[patient|client]]s'', ''[[consumer]]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]], [[involuntary commitment]], or, in the UK and Australia, by [[sectioning]] under a [[mental health law]]. Whatever the circumstance of a person's referral, a psychiatrist first assesses a 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]] is carried out, and a [[physical examination]] is usually performed to establish or exclude other illnesses, such as thyroid dysfunction or brain tumors, or identify any signs of [[self-harm]]; this examination may be done by someone else other than the psychiatrist, especially if [[blood test]]s and [[medical imaging]] are performed. 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. [[Image:Syringe2.jpg|thumb|[[Injection (medicine)|Injections]] are one of many ways to administer psychiatric medication.]] 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, psychiatric nurse practitioners, [[Psychiatric and mental health nursing|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. 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 receiving psychiatric care may do so 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 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 practice to psychopharmacology (prescribing medications) with less time devoted to psychotherapy or "talk" therapies, or behavior modification. 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.{{Fact|date=October 2007}} == See also == {{wikibooks|Psychiatry}} {{wikiquote}} * [[Psychiatric hospital]] * [[Psychology]] * [[Medicine]] * [[Mental disorder]] * [[Mental health]] * [[Anti-psychiatry]] === Related topics === {{Medicine}} {{Psychiatry}} == References == === General references === * Ford-Martin, Paula Anne Gale (2002), ''"Psychosis"'' Gale Encyclopedia of Medicine, Farmington Hills, Michigan * Hirschfeld ''et al'' 2003, [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12633125 "Perceptions and impact of bipolar disorder: how far have we really come?"], ''J. Clin. Psychiatry'' vol.64(2), p.161-174. * McGorry PD, Mihalopoulos C, Henry L et al (1995) Spurious precision: procedural validity of diagnostic assessment in psychiatric disorders. ''American Journal of Psychiatry'' 152 (2) 220-223 * MedFriendly.com, [http://www.medfriendly.com/psychologist.html ''Psychologist''], Viewed 20 September, 2006 * Moncrieff J, Cohen D. (2005). Rethinking models of psychotropic drug action. ''Psychotherapy & Psychosomatics'', 74, 145-153 * C. Burke, Psychiatry: a "value-free" science? ''Linacre Quarterly'', vol. 67/1 (Feb. 2000), pp. 59-88. [http://www.cormacburke.or.ke/node/693] * National Association of Cognitive-Behavioral Therapists, [http://www.nacbt.org/whatiscbt.htm ''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 * Williams, J.B., Gibbon, M., First, M., Spitzer, R., Davies, M., Borus, J., Howes, M., Kane, J., Pope, H., Rounsaville, B., and Wittchen, H. (1992). The structured clinical interview for DSM-III-R (SCID) II: Multi-site test-retest reliability. ''Archives of General Psychiatry'', 49, 630-636. === Works cited === {{reflist}} === External links === * [http://www.wpanet.org/ World Psychiatric Association] * [http://www.psych.org American Psychiatric Association] * [http://www.rcpsych.ac.uk The Royal College of Psychiatrists] * [http://www.ranzcp.org/ Royal Australian and New Zealand College of Psychiatrists] <!--Categories--> [[Category:Medical specialties]] [[Category:Mental health]] [[Category:Psychiatry| ]] [[Category:Subjects taught in medical school]] <!--Other languages--> {{Link FA|ro}} [[af:Psigiatrie]] [[ar:طب نفسي]] [[bn:মনোরোগবিদ্যা]] [[bg:Психиатрия]] [[ca:Psiquiatria]] [[cs:Psychiatrie]] [[da:Psykiatri]] [[de:Psychiatrie]] [[et:Psühhiaatria]] [[es:Psiquiatría]] [[eo:Psikiatrio]] [[eu:Psikiatria]] [[fr:Psychiatrie]] [[ga:Síciatracht]] [[gl:Psiquiatría]] [[ko:정신의학]] [[hr:Psihijatrija]] [[id:Psikiatri]] [[ia:Psychiatria]] [[it:Psichiatria]] [[he:פסיכיאטריה]] [[la:Psychiatria]] [[lt:Psichiatrija]] [[hu:Pszichiátria]] [[nl:Psychiatrie]] [[ne:मानसिक चिकित्सा]] [[ja:精神医学]] [[no:Psykiatri]] [[nn:Psykiatri]] [[pl:Psychiatria]] [[pt:Psiquiatria]] [[ro:Psihiatrie]] [[ru:Психиатрия]] [[simple:Psychiatry]] [[sk:Psychiatria]] [[sl:Psihiatrija]] [[sr:Психијатрија]] [[sh:Psihijatrija]] [[fi:Psykiatria]] [[sv:Psykiatri]] [[th:จิตเวชศาสตร์]] [[tr:Psikiyatri]] [[uk:Психіатрія]] [[ur:طب نفسی]] [[yi:פסיכיאטריע]] [[zh:精神病学]]