ANSWER
Psychiatry is a medical specialty that focuses on diagnosing, preventing, and treating mental illnesses. These include various issues concerning mood, behavior, cognition, and perception.
A person’s initial psychiatric assessment usually begins with a case history and a mental status examination. Physical and psychological tests may be administered. Neuroimaging or other neurophysiological techniques are used on occasion. [3] Mental disorders are frequently diagnosed using clinical concepts from diagnostic manuals such as the World Health Organization’s (WHO) edited and used International Classification of Diseases (ICD) and the American Psychiatric Association’s (APA) widely used Diagnostic and Statistical Manual of Mental Disorders (DSM) (APA). In May 2013, the fifth edition of the DSM (DSM-5) was published, which reorganized the more significant categories of various diseases and expanded on the previous edition to include information/insights consistent with current research. [4]
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The most common mode of psychiatric treatment in current practice combines psychiatric medication and psychotherapy. Still, the contemporary method includes many other modalities, such as assertive community treatment, community reinforcement, and supported employment. Depending on the severity of functional impairment or other aspects of the disorder, treatment may be delivered, inpatient or outpatient. A psychiatric hospital may treat an inpatient. Interdisciplinary research in psychiatry is conducted with other professionals such as epidemiologists, nurses, social workers, occupational therapists, and clinical psychologists.
Etymology
The word psyche comes from the ancient Greek for ‘soul’ or ‘butterfly.’
The fluttering insect appears on the coat of arms of the Royal College of Psychiatrists in the United Kingdom.
The term psychiatry was coined in 1808 by the German physician Johann Christian Reil and meant “medical treatment of the soul” (psych- “soul” from Ancient Greek psyche “soul”; -try “medical treatment” from Gk. strikes “medical” from that “to heal”). A psychiatrist is a medical doctor who specializes in psychiatry. (For a historical overview, see Psychiatry Timeline.)
Theory and emphasis
“More than any other branch of medicine, psychiatry forces its practitioners to grapple with the nature of evidence, the validity of introspection, communication problems, and other long-standing philosophical issues” (Guze, 1992, p.4).
Psychiatry is a branch of medicine that focuses on the mind to study, prevent, and treat mental disorders in humans.
It has been described as a bridge between the world from a social perspective and the world from the perspective of mentally ill people. [12]
People specializing in psychiatry must be familiar with the social and biological sciences, which sets them apart from most other mental health professionals and physicians.
[10] The discipline investigates the operations of various organs and body systems as classified by the patient’s subjective experiences and objective physiology. [13] Psychiatry treats mental disorders, traditionally classified into one of three types: mental illnesses, severe learning disabilities, and personality disorders. [14] Although the focus of psychiatry has remained relatively constant over time, the diagnostic and treatment processes have evolved and continue to evolve dramatically. Since the late twentieth century, psychiatry has become more biological and less conceptually isolated from other medical fields. [15]
Practice scope
Additional information: Neurology Interaction with psychiatry
Disability-adjusted life year for neuropsychiatric conditions per 100,000 population in 2002 no less than 10 10-20 20-30 30-40 40-50 50-60 60-80 80-100
100–120 \s 120–140 \s 140–150
greater than 150
Though psychiatry employs neuroscience, psychology, medicine, biology, biochemistry, and pharmacology research,[16] it is generally regarded as a bridge between neurology and psychology.
[17] Because psychiatry and neurology are so closely related, all certification for both specialties and their subspecialties is provided by a single board, the American Board of Psychiatry and Neurology, which is a member board of the American Board of Medical Specialties. [18] Unlike other doctors and neurologists, psychiatrists focus on the doctor-patient relationship and have received varying degrees of training in psychotherapy and other therapeutic communication techniques. [17] Psychiatrists differ from psychologists in that they are physicians with post-graduate training in psychiatry, known as residency (usually 4 to 5 years); the quality and thoroughness of their graduate medical training is the same as that of all other physicians. [19] As a result, psychiatrists can counsel patients, prescribe medication, order laboratory tests, order neuroimaging, and perform physical examinations. [3]
Ethics
Also see: Ethical Issues in Psychiatry (disambiguation)
The World Psychiatric Association publishes an ethical code to govern psychiatrists’ behavior (like other purveyors of professional ethics). The psychiatric code of ethics, first outlined in the Hawaii Declaration in 1977, has since been expanded through a 1983 Vienna update and the broader Madrid Declaration in 1996. The code was revised again during the organization’s general assemblies in 1999, 2002, 2005, and 2011. [20]
The World Psychiatric Association code addresses issues such as confidentiality, the death penalty, ethnic or cultural discrimination, euthanasia, genetics, the human dignity of incapacitated patients, media relations, organ transplantation, patient assessment, research ethics, sex selection, torture,[22][23], and current knowledge.
By establishing such ethical codes, the profession has responded to several controversies surrounding the psychiatric practice, such as the use of lobotomy and electroconvulsive therapy.
Harry Bailey, Donald Ewen Cameron, Samuel A. Cartwright, Henry Cotton, and Andrei Snezhnevsky are the discredited psychiatrists who violated medical ethics.
[24][page required]
Approaches
Psychiatric illnesses can be conceptualized in a variety of ways. The biomedical approach examines and compares signs and symptoms to diagnostic criteria. In contrast, mental illness can be assessed through a narrative that incorporates symptoms into the meaningful life history and frames them as responses to external conditions. Both approaches are important in psychiatry[25]. Still, they need to be sufficiently reconciled to end the debate over the choice of a psychiatric paradigm or the definition of psychopathology. The term “biopsychosocial model” is frequently used to emphasize the multifactorial nature of the clinical impairment. [26] [27][28] However, the term model is not used in a strictly scientific sense in this concept. [26] On the other hand, Niall McLaren acknowledges the physiological basis for the mind’s existence while identifying cognition as a whole and independent realm in which disorder can occur. [26] [27] [28] The biocognitive approach includes a mentalist etiology and 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 per philosopher Thomas Kuhn’s paradigmatic standards. [26][27][28]
Once a medical professional has diagnosed a patient, numerous treatment options are available. Often, psychiatrists will create a treatment strategy combining various approaches. Drug prescriptions are frequently written to be given to patients in conjunction with any therapy they receive. Treatment strategies are most commonly based on three significant pillars of psychotherapy. Humanistic psychology seeks to view the patient as a “whole” and encourage self-discovery. [29] Behaviorism is a therapeutic school of thought that concentrates solely on objective and observable events over mining the unconscious or subconscious. In contrast, psychoanalysis focuses on early childhood, irrational drives, the cold, and the conflict between conscious and cold streams. [30]
Practitioners
Psychiatrist Question book-new. SVG is the main article.
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Using psychiatric principles, any physician can diagnose mental disorders and prescribe treatments. Psychiatrists are doctors who specialize in psychiatry and are licensed to treat mental illnesses. They may treat outpatients, inpatients, or both; they may practice as solo practitioners or as members of groups; they may be self-employed, members of partnerships, or employees of governmental, academic, nonprofit, or for-profit entities; they may treat military personnel as civilians or as members of the military; and they may function as clinicians, researchers, teachers, or some combination of these in any of these settings. Although psychiatrists may receive extensive training in psychotherapy, psychoanalysis, or cognitive behavioral therapy, their training as physicians distinguishes them from other mental health professionals.
In the United States, as a career option.
Despite favorable medical school placements, psychiatry was not a popular career choice among medical students.
[31] As a result, there is a severe shortage of psychiatrists in the United States and elsewhere. [32] Strategies for addressing this shortage have included the use of short “taster” placements early in the medical school curriculum[31] and efforts to expand psychiatry services further through the use of telemedicine technologies and other methods. [33] However, the number of medical students entering psychiatry residencies has recently increased. Several reasons for this increase include the field’s fascinating nature, growing interest in genetic biomarkers involved in psychiatric diagnoses, and newer pharmaceuticals on the market to treat psychiatric illnesses. [34]
Subspecialties
Many psychiatry subspecialties necessitate additional training and certification by the American Board of Psychiatry and Neurology (ABPN). Subspecialties include the following:[35]
Addiction medicine, addiction psychiatry
Brain injury treatment
[36]
[37]
Adolescent and child psychiatry
Neurophysiology in clinical practice
Psychiatry consultation-liaison[38]
Forensic psychology
Geriatric psychiatry is the study of the elderly.
Palliative care and hospice
Sleep medication
[39]
Wikibooks has a book called Psychiatry.
Quotes about Psychiatry can be found on Wikiquote.
Look up psychiatry in the free dictionary Wiktionary.
Wikiversity has Psychiatry learning resources.
Psychiatry-related media can be found on Wikimedia Commons.
Other psychiatry subspecialties for which the ABPN does not provide formal certification are as follows:[40]
Medical psychiatry
Cognitive diseases, such as dementia in its various forms
Psychiatry in the community
Psychiatry across cultures
Psychiatry in an emergency
Psychiatry in the evolutionary process
The state of the world’s mental health
Learning disabilities
Military psychiatry
Neurodevelopmental disorders
Neuropsychiatry
Social psychiatry
Addiction psychiatry focuses on evaluating and treating individuals with alcohol, drug, or other substance-related disorders and individuals with a dual diagnosis of substance-related and other psychiatric disorders. Biological psychiatry is an approach to psychiatry that aims to understand mental disorders in terms of the biological function of the nervous system. Child and adolescent psychiatry is the branch of psychiatry that works with children, teenagers, and their families. Community psychiatry is an approach that reflects an inclusive public health perspective and is practiced in community mental health services. [41] Cross-cultural psychiatry is a branch concerned with the cultural and ethnic context of mental disorders and psychiatric services. Emergency psychiatry is the clinical application of psychiatry in emergency settings. Forensic psychiatry generally utilizes medical science, psychiatric knowledge, and assessment methods to help answer legal questions. Geriatric psychiatry is a branch of psychiatry dealing with the study, prevention, and treatment of mental disorders in the elderly. Global mental health is an area of study, research, and practice that prioritizes improving mental health and achieving equity in mental health for all people worldwide [42]. However, some scholars consider it a neo-colonial, culturally insensitive project. [43][44][45] [46] Liaison psychiatry is the branch of psychiatry specializing in the interface between other medical specialties and psychiatry. Military psychiatry covers special aspects of psychiatry and mental disorders within the military context. Neuropsychiatry is a branch of medicine dealing with mental disorders attributable to nervous system diseases. Social psychiatry is a branch that focuses on the interpersonal and cultural context of mental disorders and mental well-being.
In larger healthcare organizations, psychiatrists often serve in senior management roles, responsible for efficiently and effectively delivering mental health services for the organization’s constituents. For example, the Chief of Mental Health Services at most V.A. 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 few specialties which qualify for further education and board certification in pain medicine, palliative medicine, and sleep medicine.
Research
By its very nature, psychiatric research is interdisciplinary, combining social, biological, and psychological perspectives to understand the nature and treatment of mental disorders.
[47] Clinical and research psychiatrists study basic and clinical psychiatric topics at research institutions and publish journal articles. [16] [48][49] [50] Under the supervision of institutional review boards, psychiatric clinical researchers look at topics such as neuroimaging, genetics, and psychopharmacology to enhance diagnostic validity and reliability, discover new treatment methods, and classify new mental disorders. [51] [page required]
Clinical application
Diagnostic systems
See also: Diagnostic classification and rating scales used in psychiatry.
Psychiatric diagnoses take place in a wide variety of settings and are performed by many different health professionals. Therefore, the diagnostic procedure may vary significantly based on these factors. Typically, though, a psychiatric diagnosis utilizes a differential diagnosis procedure where a mental status examination and physical examination are conducted, with pathological, psychopathological, or psychosocial histories obtained, and sometimes neuroimages or other neurophysiological measurements are taken, or personality tests or cognitive tests are administered. [52] [53][54][55][56] In some cases, a brain scan might be used to rule out other medical illnesses, but at this time, relying on brain scans alone cannot accurately diagnose a mental illness or tell the risk of getting a mental illness in the future. [57] Some clinicians are beginning to utilize genetics[58][59][60] and automated speech assessment[61] during the diagnostic process, but on the whole, these remain research topics.
Potential use of MRI/fMRI in diagnosis
In 2018, the American Psychological Association commissioned a review to reach a consensus on whether modern clinical MRI/fMRI can be used to diagnose mental health disorders. The criteria presented by the APA stated that the biomarkers used in diagnosis should:
“have a sensitivity of at least 80% for detecting a particular psychiatric disorder” \s”should have a specificity of at least 80% for distinguishing this disorder from other psychiatric or medical disorders” \s”should be reliable, reproducible, and ideally be noninvasive, simple to perform, and inexpensive” \s”proposed biomarkers should be verified by two independent studies each by a different investigator and different population samples and published in a peer-reviewed journal.”
The review concluded that although neuroimaging diagnosis may technically be feasible, extensive studies are needed to evaluate specific biomarkers that were unavailable.
[62]
Diagnostic manuals
See also: Diagnostic and Statistical Manual of Mental Disorders.
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 Organization, includes a section on psychiatric disorders, and is used worldwide. [63] The Diagnostic and Statistical Manual of Mental Disorders, produced and published by the American Psychiatric Association (APA), primarily focuses on mental health conditions and is the primary classification tool in the United States. [64] It is currently in its fifth revised edition and is also used worldwide. [64] The Chinese Society of Psychiatry has also produced a diagnostic manual, the Chinese Classification of Mental Disorders. [65]
Diagnostic manuals typically aim to develop replicable and clinically useful categories and criteria to facilitate consensus and agreed-upon standards while being atheoretical regarding etiology.
[64]
[66] However, the categories are based on particular psychiatric theories and data; they are broad and often specified by numerous possible combinations of symptoms. Many of the categories overlap in symptomology or typically occur together. [67] While initially intended only as a guide for experienced clinicians trained in its use, the terminology is now widely used by clinicians, administrators, and insurance companies in many countries. [68]
The DSM has attracted praise for standardizing psychiatric diagnostic categories and criteria. It has also attracted controversy and criticism. Some critics argue that the DSM represents an unscientific system that enshrines the opinions of a few influential psychiatrists. There are ongoing issues concerning the validity and reliability of the diagnostic categories; the reliance on superficial symptoms; the use of artificial dividing lines between classes and from ‘normality’; possible cultural bias; medicalization of human distress, and financial conflicts of interest, including with the practice of psychiatrists and with the pharmaceutical industry; political controversies about the inclusion or exclusion of diagnoses from the manual, in general, or regarding specific issues; and the experience of those who are most directly affected by the manual by being diagnosed, including the consumer/survivor movement. [69] [70][71] [72] The publication of the DSM, with tightly guarded copyrights, now makes APA over $5 million a year, historically adding up to over $100 million. [73]
Treatment
General considerations
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NIMH federal agency patient room for Psychiatric research, Maryland, USA
Individuals receiving psychiatric treatment are commonly referred to as patients but may also be called clients, consumers, 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 countries such as the U.K. and Australia, by sectioning under a mental health law.
A psychiatrist or medical provider evaluates people through a psychiatric assessment of their 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 personnel, emergency medical personnel, and psychiatric rating scales. A mental status examination is carried out, and a physical exam is usually performed to establish or exclude other illnesses contributing to the alleged psychiatric problems. A physical exam may also identify any signs of self-harm; this examination is often performed by someone other than the psychiatrist, mainly if blood tests and medical imaging are performed.
Like most medications, psychiatric medications can cause adverse effects in patients. Some require ongoing therapeutic drug monitoring, for instance, complete blood counts, serum drug levels, renal function, liver function, or thyroid function. Electroconvulsive therapy (ECT) is sometimes administered for severe conditions, such as those unresponsive to medication. The efficacy[74][75] and adverse effects of psychiatric drugs may vary from patient to patient.
Inpatient treatment
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Psychiatric treatments have changed over the past several decades. In the past, psychiatric patients were often hospitalized for six months or more, with some cases involving hospitalization for many years.
Average inpatient, psychiatric treatment stay has decreased significantly since the 1960s, a trend known as deinstitutionalization.
[76][77][78][79] In most countries, people receiving psychiatric treatment are more likely to be seen as outpatients. If hospitalization is required, the average hospital stay is around one to two weeks, with only a small number receiving long-term hospitalization. [80] However, in Japan, psychiatric hospitals keep patients for long periods, sometimes even keeping cal restraints strapped to their beds for months. [81][82]
Psychiatric inpatients are patients admitted to a hospital or clinic for 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 United States 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 or others. Bed availability is often the fundamental determinant of admission decisions to hard-pressed public facilities.
People may be admitted voluntarily if the treating doctor considers that this less restrictive option does not compromise safety. For many years, controversy has surrounded the use of involuntary treatment and the term “lack of insight” in describing patients. Internationally, mental health laws vary significantly, but in many cases, involuntary psychiatric treatment is permitted when there is a significant risk to the patient or others due to the patient’s illness. Forced treatment is based on a treating physician’s recommendations without requiring consent from the patient. [83]
Inpatient psychiatric wards may be secure (for those with a particular risk of violence or self-harm) or unlocked/open. Some communities are mixed-sex, while same-sex communities 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, pharmacists, psychiatric nurse practitioners, 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 in physical restraints or medicated. People in inpatient wards may be allowed leave for periods, either accompanied or alone. [84]
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 funding levels, and facilities in developing countries are typically grossly inadequate for the same reason. Even in developed countries, programs in public hospitals vary widely. Some may offer structured activities and therapies from many perspectives, while others may only have the funding for medicating and monitoring patients. This may be problematic because the maximum amount of therapeutic work might not actually occur in the hospital setting. This is why hospitals are increasingly used in limited situations and moments of crisis where patients are a direct threat to themselves or others. Alternatives to psychiatric hospitals that may actively offer more therapeutic approaches include rehabilitation centers or “rehab,” as popularly termed. [citation needed]
Outpatient treatment
Outpatient treatment involves periodic visits to a psychiatrist for consultation in their office or at a community-based outpatient clinic. During initial appointments, a psychiatrist generally conducts a psychiatric assessment or evaluation of the patient. Follow-up appointments then focus on making medication adjustments, reviewing potential medication interactions, considering the impact of other medical disorders on the patient’s mental and emotional functioning, and counseling patients regarding changes they might make to facilitate healing and remission of symptoms. The frequency with which a psychiatrist sees people in treatment varies widely, from once a week to twice a year, depending on the type, severity, and stability of each person’s condition and on what the clinician and patient decide would be best.
Increasingly, psychiatrists are limiting their practices to psychopharmacology (prescribing medications), as opposed to previous practices in which a psychiatrist would provide traditional 50-minute psychotherapy sessions, of which psychopharmacology would be a part. Still, most of the consultation sessions consisted of “talk therapy.” This shift began in the early 1980s and accelerated in the 1990s and 2000s. [85] A significant reason for this change was the advent of managed care insurance plans,[clarification needed] which began to limit reimbursement for psychotherapy sessions provided by psychiatrists. The underlying assumption was that psychopharmacology was at least as effective as psychotherapy and could be delivered more efficiently because less time was required for the appointment. [86] [87][88][89] [90][91] [a] [excessive citations] Because of this shift in practice patterns, psychiatrists often refer patients whom they think would benefit from psychotherapy to other mental health professionals, e.g., clinical social workers and psychologists. [92]
History
Main article: History of psychiatry
Earliest knowledge
The earliest known texts on mental disorders are from ancient India, including the Ayurvedic text Charaka Samhita.
[93]
[94] The first hospitals for curing mental illness were established in India during the 3rd century BCE. [95]
The Greeks also wrote early books on mental illnesses.
[96] Hippocrates proposed that physiological abnormalities could be at the root of mental illnesses. [97] Historians note that Greek philosophers such as Thales, Plato, and Aristotle (particularly in his De Anima treatise) addressed the mind’s workings. Hippocrates, a Greek physician, proposed in the fourth century B.C. that mental disorders had physical rather than supernatural causes. Plato proposed in 387 BCE that mental processes take place in the brain. Hippocrates wrote in the fourth to fifth centuries B.C. Greece, where he visited Democritus and found him in his garden cutting open animals. Democritus explained that he was trying to figure out what caused madness and melancholy. Hippocrates praised him for his work. Democritus was carrying a book about madness and melancholy. [98] During the 5th century BCE, mental disorders, particularly those with psychotic characteristics, were thought to be supernatural in origin,[97] a belief shared by ancient Greece and Rome, as well as Egyptian regions. [99] [page required] Alcmaeon considered the brain to be the “organ of thought,” rather than the heart. He traced the ascending sensory nerves from the body to the brain, hypothesizing that mental activity originated in the CNS and that a malfunction in the brain caused mental illness. He used this knowledge to categorize mental illnesses and treatments. [16] [100] Religious leaders frequently used versions of exorcism to treat mental disorders, often employing methods that many consider cruel or barbaric. Trepanning is one of these methods that has been used throughout history. [97]
Lin Xie conducted an early psychological experiment in the 6th century A.D. in which he asked people to draw a square with one hand and a circle with the other (ostensibly to test people’s susceptibility to distraction). This was allegedly an early psychiatric experiment. [101]
Many scholars wrote about mental disorders during the Islamic Golden Age, which fostered early studies in Islamic psychology and psychiatry. In the ninth century, the Persian physician Muhammad ibn Zakariya al-Razi, also known as “Rhazes,” wrote texts on psychiatric conditions. [102] He was the chief physician of a hospital in Baghdad and the director of one of the world’s first baristas. [102]
The first bipartisan was established in Baghdad in the ninth century, and several others of increasing complexity were found throughout the Arab world in the following centuries. Some baristas had wards dedicated to the treatment of mentally ill patients. [103] Psychiatric hospitals and lunatic asylums were built and expanded throughout Europe during the Middle Ages. Specialist hospitals, such as London’s Bethlem Royal Hospital, were built in medieval Europe to treat mental disorders in the 13th century. Still, they were only used as detention facilities and did not provide any treatment. It is the world’s oldest operating psychiatric hospital. [104]
The Yellow Emperor’s Classic of Internal Medicine, an ancient text, identifies the brain as the nexus of wisdom and sensation, includes yin-yang balance theories of personality, and analyzes mental disorders in terms of physiological and social disequilibrium. The work of Western-educated Fang Yizhi (1611-1671), Liu Zhi (1660-1730), and Wang Qingren advanced Chinese brain scholarship during the Qing Dynasty (1768–1831). Wang Qingren emphasized the brain’s importance as the nervous system’s center, linked mental disorders to brain diseases, and investigated the causes of dreams, insomnia, psychosis, depression, and epilepsy. [101]
Medical specialization
The origins of psychiatry as a medical specialty date to the mid-nineteenth century[96], though its seeds can be traced back to the late eighteenth century. In the late 17th century, privately run insane asylums began to increase and grow. The Bethel Hospital Norwich, England’s first purpose-built asylum, opened in 1713. [105] In 1656, Louis XIV of France established a public system of hospitals for those suffering from mental illnesses, but, as in England, no actual treatment was provided. [106]
Attitudes toward the mentally ill began to shift during the Enlightenment. It became recognized as a disorder that required compassionate care. William Battie, an English physician, published his Treatise on Madness on treating mental disorders in 1758. It was a scathing indictment of the Bethlem Royal Hospital, where a conservative regime used barbaric detention. Battie advocated for patient management, including cleanliness, good food, fresh air, and distraction from friends and family. He contended that mental disorders were caused by malfunctions in the material brain and body rather than by the internal workings of the mind. [107][108]
Tony Robert-1795 Fleury’s painting of Dr. Philippe Pinel at the Salpêtrière. Pinel orders that patients at the Paris Asylum for Insane Women be freed from their chains.
Independently, the French doctor Philippe Pinel and the English Quaker William Tuke pioneered ethical treatment.
[97] Pinel was appointed chief physician at the Bicêtre Hospital in 1792. Patients were allowed to move freely around the hospital grounds, and dark dungeons were eventually replaced with bright, well-ventilated rooms. Jean Esquirol (1772-1840), Pinel’s student and successor, went on to help establish ten new mental hospitals based on the same principles. [109]
Despite the efforts of Tuke, Pinel, and others to abolish physical restraint, it remained widespread into the nineteenth century. At the Lincoln Asylum in England, Robert Gardiner Hill pioneered a mode of treatment that suited “all types” of patients, allowing mechanical restraints and coercion to be avoided—a situation he eventually achieved in 1838. Sergeant John Adams and Dr. John Conolly were impressed by Hill’s work and implemented it at their Hanwell Asylum, the largest in the country, in 1839. [110][111] [page required]
The modern era of institutionalized care for the mentally ill began in the early nineteenth century with a considerable state-led effort. The Lunacy Act of 1845 in England was a watershed moment in treating the mentally ill because it explicitly changed the status of mentally ill people from patients to patients who required treatment. All asylums were required to have written regulations and a qualified physician on staff. [112] [full citation needed] In 1838, France passed legislation to govern both asylum admissions and asylum services throughout the country. The establishment of state asylums in the United States began with the passage of the first law authorizing the establishment of one in New York in 1842. The Utica State Hospital first opened its doors around 1850. Many state hospitals in the United States were built on the Kirkbride Plan, a curative architectural style, in the 1850s and 1860s. [113] [page required]
At the turn of the century, only a few hundred people in asylums in England and France combined.
[114] This figure had risen to hundreds of thousands by the late 1890s and early 1900s. However, the idea that mental illness could be treated by institutionalization ran into problems. [115] A growing patient population put pressure on psychiatrists, and asylums became almost indistinguishable from custodial institutions. [116]
Psychiatry made advances in diagnosing mental illness in the early 1800s by broadening the category of mental disease to include mood disorders and disease-level delusion or irrationality.
[117] The twentieth century brought new psychiatry into the world, with new ways of looking at mental disorders. The initial ideas behind biological psychiatry, stating that different mental disorders are all biological, evolved into a new concept of “nerves,” and psychiatry became a rough approximation of neurology and neuropsychiatry, according to Emil Kraepelin. [118] Ideas derived from psychoanalytic theory began to take root in psychiatry after Sigmund Freud’s pioneering work. [119] The psychoanalytic theory gained popularity among psychiatrists because it allowed patients to be treated in private practices rather than asylums. [119]
Otto Loewi’s research resulted in the discovery of the first neurotransmitter, acetylcholine.
However, by the 1970s, the psychoanalytic school of thought had become marginalized within the field.
[119] During this time, biological psychiatry reemerged. Beginning with Otto Loewi’s discovery of the neuromodulatory properties of acetylcholine, which identified it as the first-known neurotransmitter, psychopharmacology and neurochemistry became integral parts of psychiatry. As a result, it has been demonstrated that different neurotransmitters have distinct and multifaceted roles in regulating behavior. Individual differences in neurotransmitter production, reuptake, receptor density, and location were linked to differences in dispositions for specific psychiatric disorders in a wide range of neurochemistry studies using human and animal samples. For example, the discovery of chlorpromazine’s effectiveness in treating schizophrenia in 1952 [120], as did lithium carbonate’s ability to stabilize mood highs and lows in bipolar disorder in 1948. [121] Psychotherapy was still used, but only to treat psychosocial issues. [122] This supported the idea that many psychiatric disorders are neurochemical.
[123] Neuroimaging, first used in psychiatry in the 1980s, is another method for looking for biomarkers of psychiatric disorders.
[124]
In 1963, U.S. President John F. Kennedy proposed legislation establishing the National Institute of Mental Health to manage Community Mental Health Centers for people discharged from state psychiatric hospitals.
[125] However, the Community Mental Health Centers’ focus shifted to providing psychotherapy to those suffering from acute but less severe mental disorders. [125] Finally, no plans were made to actively follow and treat severely mentally ill patients discharged from hospitals, resulting in a large population of chronically homeless people with mental illnesses. [125]
Disagreement and criticism
Main article: The Psychiatric Controversy
Since its inception, the institution of psychiatry has been fraught with controversy.
[126]: 47 Scholars from social psychiatry, psychoanalysis, psychotherapy, and critical psychiatry have all written critiques. [126]: 47 It has been argued that psychiatry confuses mental disorders with brain disorders that can be treated with drugs. [126]: 53: 47 that its use of drugs is influenced in part by drug company lobbying, resulting in research distortion;[126]: 51 that the concept of “mental illness” is frequently used to label and control those with beliefs and behaviors that the majority of people disagree with;[126]: 50 that it is too influenced by medical ideas, causing it to misunderstand the nature of mental distress. [126] The critical psychiatry group in the United Kingdom provides psychiatric critique from within the field.
According to Double, the majority of critical psychiatry is anti-reductionist. Rashed contends that new mental health science has progressed beyond this reductionist critique by pursuing integrative and biopsychosocial models for conditions and that much of critical psychiatry now coexists with orthodox psychiatry but that many reviews remain unaddressed[127]: 237.
Anti-psychiatry was coined by psychiatrist David Cooper in 1967 and popularized by Thomas Szasz. Antipsychiatry was first used in Germany in 1904. [128] The basic premise of the anti-psychiatry movement is that psychiatrists attempt to label “normal” people as “deviant,”; that psychiatric treatments are ultimately more harmful than helpful to patients, and that psychiatry’s history includes (what may now be seen as) dangerous treatments, such as psychosurgery, an example of which is frontal lobectomy (commonly called a lobotomy). [129] By the late 1970s, lobotomies had all but vanished.
QUESTION
Mood Disorders “Suicide”