Lecture notes : Psychiatry
Psychiatry can seem disconcertingly different from other specialties, especially if your first experience is on a psychiatric in-patient unit. How do I approach a patient? What am I trying to achieve? Is he or she dangerous? How does psychiatry relate to the rest of medicine?
This chapter is meant to help orientate anyone facing this situation. Like the rest of the book, it is based on three principles:
• Psychiatry is part of medicine.
• Psychiatric knowledge, skills and attitudes are relevant to all doctors.
• Psychiatry should be as effective, pragmatic and evidence-based as every other medical specialty.
What is psychiatry?
‘Psychiatry is … weird doctors in Victorian asylums using bizarre therapies on people who are either un-treatably mad or who are not really ill at all.’ Although remnants of such ill-informed stereotypes persist, the reality of modern psychiatry is very different and rather more mundane! Psychiatry is, in fact, fundamentally similar to the rest of medicine: the treatments used are primarily evidence-based, with success rates comparable with those in other specialties. Psychiatric patients are not a breed apart – psychiatric diagnoses are common in medical patients, and most patients with psychiatric disorders are treated in primary care. And psychiatrists are no stranger than other doctors, probably.
Psychiatric disorders may be defined as illnesses that are conventionally treated with treatments used by psychiatrists, just as surgical conditions are those thought best treated by surgery. The specialty designation does not indicate a profound difference in the illness or type of patient. In fact it can change as new treatments are developed; peptic ulcer moved from being a predominantly surgical to a medical condition once effective drug treatments were developed.
Where is psychiatry going?
Psychiatry is evolving rapidly, and three themes permeate this book:
• Psychiatry, like the rest of medicine, is becoming less hospital based. Most psychiatric problems are seen and treated in primary care, with many others handled in the general hospital. Only a minority are managed by specialist psychiatric services. So psychiatry should be learned and practised in these other settings too.
• Psychiatry is becoming more evidence-based. Diagnostic, prognostic and therapeutic decisions should, of course, be based on the best available evidence. It may come as a surprise to discover that current psychiatric interventions are as evidence-based (and sometimes more so) as in other specialties.
Why study psychiatry?
Studying psychiatry is worthwhile for all trainee doctors, and other health practitioners, because the knowledge, skills and attitudes acquired are applicable to every branch of medicine. Specifically, studying psychiatry will give you:
• A basic knowledge of the common and the ‘classic’ psychiatric disorders.
• A working knowledge of psychiatric problems encountered in all medical settings.
• The ability to effectively assess someone with a ‘psychiatric problem!
• Skills in the assessment of psychological aspects of medical conditions.
• A holistic or ‘biopsychosocial’ perspective from which to understand all illness.
• Psychiatry is a medical specialty. It mostly deals with conditions in which the symptoms and signs predominantly relate to emotions, perception, thinking or memory. It also encompasses learning disability and the psychological aspects of the rest of medicine.
• Knowledge, skills and attitudes learned in psychiatry are relevant and valuable in all medical specialties.
• Be alert to the possibility of psychiatric disorder in all patients, and be able to recognize and elicit the key features.
• The major diagnostic categories are: neurosis, mood disorder, psychosis, organic disorder, substance misuse and personality disorder.