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Psychiatry is a field of mental medicine aiming to study, prevent, and treat mental disorders in humans.[6][7][8] 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.[9] People who specialize in psychiatry often differ from most other mental health professionals and physicians in being familiar with both the social and biological sciences.[7] 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.[10] Psychiatry treats mental disorders, which are conventionally divided into three very general categories: mental illnesses, severe learning disabilities, and personality disorders.[11] Whereas the focus of psychiatry has changed little over time, the diagnostic and treatment processes have and continue to evolve. Since the late 20th century the field of psychiatry has become more biological and less conceptually isolated from other medical fields.[12] Scope of practice__ Though the medical specialty of psychiatry utilizes research in the field of neuroscience, psychology, medicine, biology, biochemistry, and pharmacology,[13] it has generally been considered a middle ground between neurology and psychology.[14] 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.[14] Psychiatrists also differ from psychologists in that they are physicians and only their residency training (usually 3 to 4 years) is in psychiatry; their undergraduate medical training is identical to all other physicians.[15] Psychiatrists can therefore counsel patients, prescribe medication, order laboratory tests, order neuroimaging, and conduct physical examinations.[16] Ethics__ Like other purveyors of professional ethics, the World Psychiatric Association issues an ethical code[17] 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,[18] organ transplantation, torture,[19][20] the death penalty, media relations, genetics, and ethnic or cultural discrimination.[21] In establishing such ethical codes, the profession has responded to several controversies about the practice of psychiatry; e.g., lobotomy and electro-convulsive therapy. Among the discredited psychiatrists, who operated outside the norms of medical ethics, include Harry Bailey, Samuel A. Cartwright, Henry Cotton, and Andrei Snezhnevsky.[22] Approaches__ Psychiatric illnesses in many different ways can be conceptualised. 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,[23] 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.[24][25][26] In this notion the word "model" is not used in a strictly scientific way though.[27] 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.[24][25][26] 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.[24][25][26] Subspecialties__ Various subspecialties and/or theoretical approaches exist which are related to the field of psychiatry. They include the following: 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.[28] 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 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.[citation needed] In the United States, psychiatry is one of the specialties which qualify for further education and board-certification in pain medicine, palliative medicine, and sleep medicine. |
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