- Teifion Davies
Psychiatry in health care
Psychiatry is a branch of medicine: it deals with those disorders in which mental (emotional or cognitive) or behavioural features are most prominent. The cause, presentation, and course of such disorders are influenced by diverse factors; their symptoms can be bewildering to patients and their relatives; and their management may require social and psychological as well as medical interventions. It is not surprising that this complex situation can lead to misunderstandings of the role of psychiatrists (who are neither social workers nor jailers) and myths about the practice of psychiatry.
The bulk of mild mental disorder has always been managed by family doctors. However, patients referred to psychiatrists are increasingly likely to be managed at home by community mental health services or, if admitted to an acute psychiatric ward, to be discharged after a short stay. Many former long stay patients have been discharged to the community with varying degrees of support and supervision. This series of articles will deal with the principles and practice of managing mental health problems.
There is a myth that psychiatric management cannot proceed without obtaining an extensive history that delves into all aspects of a patient's life. Diagnosis can take only a few minutes, but time must be spent fleshing out the initial impressions, assessing immediate risks, and collecting information about personal and social circumstances that modify symptoms or affect management and long term prognosis.
Accuracy is achieved by close attention to the pattern of evolution of presenting symptoms and examination of a patient's mental state, supplemented by a small number of specific questions. A complete psychiatric assessment requires a detailed personal history, which, if the doctor is not familiar with the patient, may be built up over a series of interviews. The important point is that such detail comes into play only once …