Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders.
A psychiatrist is a medical doctor (an M.D. or D.O.) who specializes in mental health, including substance use disorders. Psychiatrists are qualified to assess both the mental and physical aspects of psychological problems.
People seek psychiatric help for many reasons. The problems can be sudden, such as a panic attack, frightening hallucinations, thoughts of suicide, or hearing "voices." Or they may be more long-term, such as feelings of sadness, hopelessness, or anxiousness that never seem to lift or problems functioning, causing everyday life to feel distorted or out of control.
Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and psychological tests which, combined with discussions with patients, help provide a picture of a patient's physical and mental state. Their education and clinical training equip them to understand the complex relationship between emotional and other medical illnesses and the relationships with genetics and family history, to evaluate medical and psychological data, to make a diagnosis, and to work with patients to develop treatment plans.
Specific diagnoses are based on criteria established in APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which contains descriptions, symptoms and other criteria for diagnosing mental disorders.
What Treatments Do Psychiatrists Use?
Psychiatrists use a variety of treatments – including various forms of talk therapy, medications, psychosocial interventions and other treatments (such as electroconvulsive therapy or ECT), depending on the needs of each patient.
Psychotherapy, sometimes called talk therapy, is a treatment that involves a talking relationship between a therapist and patient. It can be used to treat a broad variety of mental disorders and emotional difficulties. The goal of psychotherapy is to eliminate or control disabling or troubling symptoms so the patient can function better. Depending on the extent of the problem, treatment may take just a few sessions over a week or two or may take many sessions over a period of years. Psychotherapy can be done individually, as a couple, with a family, or in a group.
There are many forms of psychotherapy. There are psychotherapies that help patients change behaviors or thought patterns, psychotherapies that help patients explore the effect of past relationships and experiences on present behaviors, and psychotherapies that are tailored to help solve other problems in specific ways. Cognitive behavior therapy is a goal-oriented therapy focusing on problem solving. Psychoanalysis is an intensive form of individual psychotherapy which requires frequent sessions over several years.
Most medications are used by psychiatrists in much the same way that medications are used to treat high blood pressure or diabetes. After completing thorough evaluations, psychiatrists can prescribe medications to help treat mental disorders. While the precise mechanism of action of psychiatric medications is not fully understood, they may change chemical signaling and communication within the brain, which may reduce some symptoms of psychiatric disorders. 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.
Types of Medications
- 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 often prescribe medications in combination with psychotherapy.
Interventional psychiatry describes procedures used when medications and psychotherapy are ineffective in restoring a patient to full health. Electroconvulsive therapy (ECT), a medical treatment that involves applying electrical currents to the brain, is used most often to treat severe depression that has not responded to other treatments. Deep brain stimulation (DBS), vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS), and ketamine treatment are a few of the newer therapies being used to treat some mental health disorders. Psychedelic drugs such as psilocybin are being studied for future treatment potential.
To become a psychiatrist, a person must complete medical school and take a written examination for a state license to practice medicine, and then complete four years of psychiatry residency. In other words, it typically takes 12 years of education after high school to become a general adult psychiatrist, and up to 14 years to become a child and adolescent psychiatrist. The first year of residency training is typically in a hospital working with patients with a wide range of medical illnesses. The psychiatrist-in-training then spends at least three additional years learning the diagnosis and treatment of mental health, including various forms of psychotherapy and the use of psychiatric medications and other treatments. Training takes place in office, hospital, and emergency room settings, and community sites such as primary care.
After completing residency training, most psychiatrists take a voluntary written and oral examination given by the American Board of Psychiatry and Neurology to become a "board certified" psychiatrist. They must be re-certified every 10 years.
Some psychiatrists also complete additional specialized training after their four years of general psychiatry training. They may become certified in the following fellowships which as certified by the Accreditation Council on Graduate Medical Education (ACGME):
- Addiction Psychiatry or Addiction Medicine.
- Child and adolescent Psychiatry.
- Consultation-liaison Psychiatry (patients with complex medical and psychiatric issues).
- Forensic Psychiatry (patients involved in the legal or correctional system).
- Geriatric Psychiatry.
- Hospice and Palliative Medicine (patients with serious illness).
- Pain Medicine.
- Sleep Medicine.
Psychiatrists may also pursue additional training in other areas known as unaccredited fellowships such as:
- Emergency Psychiatry (working with patients in crisis in emergency room settings).
- Public and Community Psychiatry (working with social determinants of health).
- Reproductive psychiatry (pregnant and postpartum women with mental health needs).
Some psychiatrists choose to be trained in 2 or more specialties simultaneously to care for complex patients with both medical and psychiatric issues. Examples include:
- Internal Medicine / Psychiatry.
- Family Medicine / Psychiatry.
- Triple Board Pediatrics / Adult Psychiatry / Child & Adolescent Psychiatry.
Some psychiatrists choose additional training in psychoanalysis or in psychiatric research.
Where Do Psychiatrists Work?
Psychiatrists work in a variety of settings, including private practices, clinics, general and psychiatric hospitals, academic health centers, community agencies, courts and prisons, nursing homes, industry, government, military settings, rehabilitation programs, emergency rooms, hospice programs, and many other places. About half of the psychiatrists in the U.S. maintain private practices and many psychiatrists work in multiple settings. There are about 45,000 psychiatrists in the U.S.
What Is the Difference Between a Psychiatrist and Psychologist?
A psychiatrist is a medical doctor (completed medical school and residency) with special training in psychiatry. A psychiatrist is able to conduct psychotherapy and prescribe medications and other medical treatments.
A psychologist usually has an advanced degree, most commonly in clinical psychology, and often has extensive training in research or clinical practice. Psychologists treat mental disorders with psychotherapy and some specialize in psychological testing and evaluation.
Howard Liu, M.D.
Chair, Department of Psychiatry, University of Nebraska
Chair, APA Council on Communications