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Psychiatry is a medical specialty dealing with the prevention, assessment, diagnosis, treatment, and rehabilitation of
the mind and mental illness. Its primary goal is the relief of mental suffering associated with symptoms of disorder and
improvement of mental well-being. This may be based in hospitals or in the community and patients may be voluntary or
involuntary. Psychiatry adopts a medical approach but may take in to account biological, psychological, and social/cultural
perspectives. Treatment by medication in conjunction with various forms of psychotherapy may be undertaken and has proved
most effective in successful treatment. The word 'psychiatry' derives from the Greek for "healer of the spirit" (???-
(spirit) + ?at??? (physician)).
Most psychiatric illnesses cannot currently be cured, although recovery may occur. While some have short time courses
and only minor symptoms, many are chronic conditions which can have a significant impact on a patients' quality of life
and even life expectancy, and as such may be thought to require long-term or life-long treatment. Effectiveness of
treatment for any given condition is also variable from individual to individual.
Psychiatry in professional practice.
Psychiatric nurses and psychiatric social workers are also involved in the professional practice of psychiatry, with the
former having limited prescription rights in some countries and the latter having a legal role in committing people to
psychiatric facilities in some countries. A high proportion of patients presenting to general practice report mental
health problems and family physicians frequently prescribe psychiatric medication and sometimes refer patients for
psychiatric assessment.
Some departments of psychiatry, especially those with academic links, may have the name of "Psychological Medicine,"
which should not be confused with Medical Psychology, Health Psychology or Clinical Psychology. Furthermore, Psychiatry
should not be confused with Psychology as an academic discipline.
As part of their evaluation of the patient, psychiatrists, Physician Assistants, and Nurse Practitioners are the only
mental health professionals who may conduct physical examinations, order and interpret laboratory tests and EEGs, and
may order brain imaging studies such as CT or CAT, MRI, and PET scanning. A medical professional must evaluate the
patient for any medical problems or diseases that may be the cause of the mental health condition, although findings of
relevant brain abnormalities, for example via CT scans, may be uncommon.
Subspecialties
Other psychiatrists and mental health professionals in the field of psychiatry may also specialize in psychopharmacology,
neuropsychiatry, eating disorders, and early psychosis intervention.
Treatment Overview
Individuals with mental health conditions are commonly referred to as patients but may also be called clients. 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 patient 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.
Initial Assessment
Like all medications, psychiatric medications can have toxic effects in patients and hence often involve ongoing therapeutic
drug monitoring, for instance full blood counts or, for patients taking lithium salts, serum levels of lithium.
Electroconvulsive therapy (ECT) is sometimes administered for serious and disabling conditions, especially those
unresponsive to medication.
Outpatient Care
Psychiatric patients may be either inpatients or outpatients. Psychiatric outpatients periodically visit their 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 patient to update their assessment of the patient's
condition, and to provide psychotherapy or review medication. The frequency with which a psychiatric practitioner sees
patients varies widely, from days to months, depending on the type, severity and stability of each patient's condition,
and depending on what the clinician and client decide would be best.
Inpatient Care
Psychiatric inpatients are patients admitted to a hospital or clinic to receive psychiatric care, sometimes involuntarily,
in which case they could be involuntarily committed to a standard, otherwise non-psychiatric prison. In North America,
the criteria for involuntary admission vary with jurisdiction. It may be as broad as having a mental health condition
and being capable of mental or physical deterioration or as narrow as a patient being considered to be an immediate
danger to themselves or others. In the UK, involuntary admission is limited to this narrow criterion. 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 as safer.
Once in the care of a hospital, patients are assessed, monitored, and often given medication and receive care from a
multidisciplinary team, which may include physicians, psychiatric nurses, clinical psychologists, occupational therapists,
psychotherapists, psychiatric social workers, and other mental health professionals. If patients are 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. Inpatients may be allowed leave periods, either accompanied or on their own.
Theory and Focus
Psychiatry is often described as being based within, or dominated by, a biomedical paradigm, although there are different
theoretical approaches:
It is currently in its fourth revised edition (IV-TR, published 2000) and is also used world-wide, perhaps more so than
the ICD-10. The ICD-10 and the DSM are considered roughly on a par with one another, and an explicit concern in the
development of the DSM-IV was compatibility with the diagnostic categories and codes of the ICD. The lack of a case
example version of the ICD-10 is considered a problem by some[citation needed]. The Chinese Society of Psychiatry has
also produced a diagnostic manual, the Chinese Classification of Mental Disorders (CCMD).
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. However, the
categories are nevertheless based on particular psychiatric theories and data, they are are broad and often specified
by numerous possible combinations of symptoms, and many of the categories overlap in symptomology or typically occur
together. 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.
The DSM has five axes:
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