Defining Psychiatry
Psychiatry is the science and practice of diagnosing, treating, and preventing mental, emotional and behavioral disorders.
The term psychiatry is derived from the Greek words psyche, meaning “mind” or “soul,” and iatreia, meaning “healing.” Modern psychiatry was developed due to the efforts of French physician, Philippe Pinel, in the late 1700s. Arguably the most significant contributions to the foundation of psychiatry occurred in the late 19th century; German psychiatrist Emil Kraepelin emphasized a systematic approach to psychiatric diagnosis and classification and Austrian neurologist, Sigmund Freud, founded the theory and practice of psychoanalysis. [1,2]
A psychiatrist is a medical doctor (M.D. or D.O.) specializing in mental health, including substance use disorders. The path to becoming a psychiatrist includes: completion of medical school, passing a written examination for a state license to practice medicine, followed by four years of specialized psychiatry residency.[3] In addition to overall competency to deal with psychiatric disorders, some psychiatrists pursue subspecialty training and associated certification (e.g., addiction psychiatry, forensic psychiatry, geriatric psychiatry, and psychosomatic psychiatry.)[4] Following residency training, a psychiatrist may take a voluntary written and oral examination given by the American Board of Psychiatry and Neurology to become Board Certified in their field; re-certification must occur every 10 years.[5] According to The American Board of Physician Specialties, those who are Board Certified have passed a rigorous process signifying the physician has obtained exemplary knowledge and mastery within their field in their field of medicine.[6]
Qualified to assess both the mental and physical aspects of psychological problems, psychiatrists can order or perform a full range of medical laboratory and psychological tests which, combined with discussions with patients, assess a patient's physical and mental state. This assessment is utilized in forming a diagnosis and subsequent treatment plan.[7] Such plans may include: drug therapy, electroconvulsive therapy, biofeedback and apply different forms of psychotherapy. Most mental and emotional disorders require a pluralistic treatment approach; thus, psychiatrists frequently work as part of a multidisciplinary treatment team with psychologists, social work professionals, occupational therapists, and psychiatric nurses.[8]
Patients on long-term medication treatment will need to meet with their psychiatrist periodically to monitor the effectiveness of the medication and any potential side effects to ensure both specialized and optimized outcomes. Dependent on condition, psychiatrists may utilize any of the following class of medications within a treatment plan:[9]
Antidepressants – used to treat depression, panic disorder, PTSD, anxiety, obsessive-compulsive disorder, borderline personality disorder and eating disorders.
Antipsychotic medications – used to treat psychotic symptoms (delusions and hallucinations), schizophrenia, bipolar disorder.
Sedatives and anxiolytics – used to treat anxiety and insomnia.
Hypnotics – used to induce and maintain sleep.
Mood stabilizers – used to treat bipolar disorder.
Stimulants – used to treat ADHD.
Psychiatrists work in a variety of settings, including private practices, clinics, general and psychiatric hospitals, university medical centers, community agencies, courts and prisons, nursing homes, industry, government, military settings, rehabilitation programs, emergency rooms, hospice programs, among other locations. Roughly half of psychiatrists in the U.S. maintain private practices while others work across multiple settings. There are currently around 45,000 psychiatrists in the U.S.,[10] with the field experiencing rapid growth due to the development of technology that allows measurement and observation of brain function. Neuroimaging techniques, such as magnetic resonance imaging (MRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT), have begun to provide insights about psychopathologic disorders as well as normal development and function,[11] providing psychiatrists with superior grounding in crafting one’s treatment plan.
Q&A
SAS’ Medical Director, Dr. Misty Tu, Discusses the Nuances of Psychiatry
1. To begin, how does someone determine if they should contact a psychiatrist for an appointment, as opposed to a therapist or primary care physician?
Every individual is different, but there are some general things to consider when deciding where to get care. If you are feeling a mild to moderate sensation of discomfort and decreased in function then seeing a therapist first might be a good choice. Primary care physicians have some training in behavioral health and are a good first step for issues of depression and anxiety. If you are having more dramatic mood swings such as “highs and lows” or having any thoughts that don’t seem real, it is probably best to see a psychiatrist.
2. What types of conditions/issues can a psychiatrist treat?
A psychiatrist can treat many conditions such as depression, anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, bipolar disorder, schizophrenia, substance use disorder, and several others. Most psychiatrist specialize in the medication management of these illnesses.
3. People are generally familiar with filling out paperwork prior to seeing a medical care provider, whether it’s a dentist, chiropractor, optometrist or primary care physician. What types of information does a psychiatrist ask in their intake paperwork?
The intake paperwork gives any physician a starting point of general information. When prescribing medications, it is important to understand your medical history, medications that you are on, and allergies. The psychiatrist may also ask you these questions again during the intake to verify the information. Sometimes there will also be questionnaires about your mood or anxiety. This helps the psychiatrists establish a baseline of illness.
4. What can someone expect to happen in their initial (intake) session with a psychiatrist?
The psychiatrist should have gone over the intake paperwork that you filled out. They will get a medical as well as a psychiatric history. They will ask you about different symptoms that you may or may not have had. Gathering a good history can lead to more accurate diagnoses.
5. How often would a person generally have follow-up appointments with their psychiatrist? If someone is prescribed psychiatric medications, would they need to be on them for the rest of their life or is it dependent on the type and severity of condition?
Follow-up sessions should be based on several determining factors including the severity of your current illness, if there are side effects that need to be monitored for, what is the timeline for the medication to have reached maximum benefit at this dose, overall agreement between the patient and psychiatrist.
Psychiatric medications need to be thought of like all other medications. There are certain times when diseases, like high blood pressure, could improve and you no longer need medication. Most individuals will need these medications long-term. This is always something that should be discussed with your psychiatrist with a consideration of your specific condition.
6. Some psychiatric medications have been associated with a stigma; how do you think that has changed over time?
Unfortunately, it is changing very slowly. Sometimes there are cultural challenges, but there is continued stigma about mental illness and psychiatric medications. We need to conceptualize psychiatric illness as we do all other medical illnesses.
7. In addition to psychiatric care, what recommendations would you offer for someone to achieve greater psychological and mental health?
The social determinants of health such as shelter, food access, safety and access to healthcare are all things that can benefit overall health. This is especially true with mental health. Once these issues are not a significant factor, individuals may want to focus on a healthy diet, regular exercise, social supports. We all face challenges in life and our “mental resiliency” is tested during these times. Individuals should understand and focus on what makes them more resilient- such as being able to call a friend or family member when you were feeling badly.
If you suspect you may benefit from the treatment of a psychiatric provider, please reach out to your primary care physician to discuss your concerns and referral options, or request an appointment with a Board Certified psychiatrist in your state.
Contributed by: Jennifer (Ghahari) Smith, Ph.D.
& Misty Tu, M.D.
Editor: Jennifer (Ghahari) Smith, Ph.D.
References
1 “Psychiatry,” Britannica. (accessed 10-8-2021). www.britannica.com/science/psychiatry
2 Miller, N. S., & Katz, J. L. (1989). The neurological legacy of psychoanalysis: Freud as a neurologist. Comprehensive psychiatry, 30(2), 128–134.
3 “What is Psychiatry?” American Psychiatric Association. (accessed 10-6-2021). www.psychiatry.org/patients-families/what-is-psychiatry-menu
4 “Psychiatry,” Britannica.
5 “What is Psychiatry?” American Psychiatric Association.
6 “Physician Certification,” American Board of Physician Specialties (ABPS). (accessed 10-8-2021). www.abpsus.org/physician-board-certified-specialties/
7 “What is Psychiatry?” American Psychiatric Association.
8 “Psychiatry,” Britannica.
9 “What is Psychiatry?” American Psychiatric Association.
10 Ibid.
11 “Psychiatry,” Britannica.