Psychiatry is a specialty of medicine that focuses on researching, understanding, diagnosing, and treating diseases of the brain and disorders of the mind and behavior. Psychiatrists diagnose and treat a wide range of conditions, from Alzheimer’s disease, anxiety , and autism to mood disorders, Munchausen syndrome , psychosis , and suicidality . As physicians, psychiatrists are trained to recognize the many ways general physiologic processes and pathologies can influence mental functioning—and vice versa.
Practitioners are physicians who typically work in or are affiliated with medical settings. Psychiatry also has a number of fields of subspecialization; addiction psychiatry, child and adolescent psychiatry, forensic psychiatry, geriatric psychiatry, and neuropsychiatry are the best known.
Some psychiatrists devote themselves exclusively to research . Others may be affiliated with medical institutions where they both conduct research and evaluate and treat patients. Others may engage exclusively in patient treatment, in outpatient settings such as independent clinical practice, in a group practice affiliated with other physicians, or in a psychiatric facility. Many clinical psychiatrists have attending privileges in hospitals to accommodate patients needing care and supervision or experiencing a psychiatric emergency.
All psychiatrists begin care with an extensive evaluation of each patient that can provide important clues to the source and nature of the disorder. Psychiatric evaluation includes an interview in which the patient is asked to describe symptoms, personal and family history, medical history, and may include blood and other tests. Psychiatrists pay attention not only to what is said but to the emotional tone of responses, the cognitive factors informing them, and the behavior accompanying them.
Key Takeaways
- Psychiatry affects mental, emotional, and physical wellbeing
- Understanding psychiatry is the first step toward managing it
- Evidence-based approaches can significantly improve outcomes
- Building daily habits is more effective than one-time interventions
Psychiatric Disorders
The criteria for diagnosis of m ental health disorders are laid out in The Diagnostic and Statistical Manual of Mental Disorders , or DSM. Reviewed and modified periodically by experts, in response to new information and understanding of mental dysfunction, the D SM is now in its fifth edition. DSM-5 details more than 20 broad categories of mental disorder :
For each disorder in each category, the DSM specifies the symp toms that characterize the disorder and the frequency with which they must be present to be considered a disorder. After all, everyone gets depressed sometimes, but not everyone experiences relentless mood disturbance that disrupts a person’s life. In almost all categories of disorder, diagnosis can be made only if symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Although the DSM catalogs behavioral symptoms , many of which overlap disorders , the future of psychiatry may rely more on objective criteria for diagnos tic precision , specifically on the biologically based signs of a disorder . For example , neuroimaging procedures and other techniques allow doctors to look directly at the brain , and refinements in imaging technology promise to allow accurate detect ion and diagnos is of mental illness —to determine, for example, which brain cells might be misbehaving and under which conditions . Much research in psychiatry is devoted to the search for biological markers that are indicators of specific pathology and can help clinicians dis tinguish between disorders and apply the most targeted treatment.
The cornerstone of all healing is the physician-patient relationship; this is considered to be the case in all of medicine, but it especially applies in psychiatric disorders. Research demonstrates that a strong , trusting bond between doctor and patient has measurable biologic effects, inducing a state of physiologic calm ; the system is shifted away from the production of stress-related substances that set the body up for defense , invariably at the cost of damage to the brain as well as body tissue. The doctor-patient relationship is the primary conduit of psychotherapy, but it also sets the stage for recovery when biology-based treatments are used.
For many psychiatric conditions, the standard of care is combination therapy—psychotherapy in tandem with medication. The most commonly prescribed classes of psychotropic drugs include:
Antidepressants . Developed to treat depression, antidepressants are also commonly used in the treatment of anxiety disorders, including panic. The most widely prescribed antidepressants are known as selective serotonin uptake inhibitors (SSRIs), and they were originally thought to work by boosting levels of the neurotransmitter serotonin in the brain, but it has never been clear how the change in neurotransmitter levels creates symptom relief. The prototype drug of this group is Prozac.
Frontiers of Research
Differences Between Psychiatrists and Psychologists
Both clinical psychiatrists and clinical psychologists have as their goal the alleviation of mental distress and suffering. And both psychologists and psychiatrists are major participants in research about mental illness and health and in developing new treatments . Both must be licensed in the state where they practice.
But in practice, the tools they have at their disposal differ. W hile both can conduct psychotherapy, psychiatrists are physicians who can prescribe medication. With a health care system set up to favor the dispensing and management of medication for the treatment of disorders—often to the frustration of those practicing medicine in the system—rather than to the dispensing of appropriate care established and delivered through a trusting physician-patient relationship, that becomes a significant clinical difference. Only a small percentage of psychiatrists today conduct psychotherapy. In most mental health settings, therapy is typically administered by a psychologist or other psychotherapist , often in consultation with a psychiatrist administering medication .
Other differences reflect the origins of the two disciplines . Psychology has its origins in philosophy , and psychologists study the development of the mind and the nature of consciousness, the development of emotions and cognition , the development and nature of personality . Traditional psychology training programs offer a Doctor of Philosophy (Ph.D.) degree and have an orientation to research and training in scientific methodology ; a research-based dissertation is a requirement for the degree. Knowledge of psychology is useful to many human endeavors, from education , including animal training, to the design of products to the management of organizations. Psychologists work in many fields besides those related to health care.
Lithium illustrates how drug discovery may evolve from unpredictable scientific factors.
Lithium illustrates how drug discovery may evolve from unpredictable scientific factors.
As psychiatry concedes long-standing criticisms of diagnosis, a deeper question emerges: What now justifies its authority over human suffering?
Frequently Asked Questions
What exactly is psychiatry?
Psychiatry is a specialty of medicine that focuses on researching, understanding, diagnosing, and treating diseases of the brain and disorders of the mind and behavior. Psychiatrists diagnose and treat a wide range of conditions, from Alzheimer’s disease, anxiety , and autism to mood disorders, Munchausen syndrome , psychosis , and suicidality . As physicians, psychiatrists are trained to recogniz
Is psychiatry a serious condition?
Psychiatry exists on a spectrum. While mild forms are a normal part of life, persistent or severe psychiatry can significantly impact daily functioning and quality of life. It's important to seek professional support if psychiatry is interfering with work, relationships, or wellbeing.
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