Psychiatry

What is psychiatry? 

Psychiatry is a specialty of medicine focusing on the diagnosis and treatment of conditions that thought to have primarily psychological manifestations. Psychiatrists often refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM) to determine whether a patient's symptoms match a particular described condition. Some examples of these diagnoses are: Major Depressive Disorder with Anxious Distress, Somatic Symptom Disorder, and Schizotypal Personality Disorder. As implied by the word "disorder," these conditions are necessarily defined by a patient's impairment in the realms of occupational and/or social functioning. These diagnoses help guide treatment recommendations which if followed by the patient are intended to bring her back to a pre-morbid (i.e. before the onset of illness), healthy,  and adaptive mode of interacting with stressors, other individuals, and the environment. 

What are some treatments a psychiatrist might recommend? 

Specific treatments that a psychiatrist may consider to aid in the alleviation of psychological symptoms include psychotherapy (of which there are many approaches and types), pharmaceutical medications, trans-cranial magnetic stimulation/electro-convulsive therapy, or complementary/integrative interventions such as exercise, supplements, and bright light therapy.  

Ultimately, the type of treatment(s) that a patient chooses is a collaboration between her and her physician. There are often other factors unrelated to the research evidence base which become relevant, such as a treatment's availability, marketing bias, time expenditure, cost, and familiarity. These are all practical considerations that a psychiatrist must take into account to ensure that the recommendation makes sense for the patient's personal experience and preferences. 

What would a typical psychiatry appointment with you involve? 

My approach seems simple but is becoming increasingly rare due to the influence of managed care and the medicalization of mental distress. I first orient around your concerns, elicit the information that helps me understand the context of this concern, and then respond thoughtfully to what I hear and observe.  Sometimes this will lead to a recommendation, other times I may ask questions to clarify or highlight elements you may not have considered regarding your symptoms and ask you to return for another visit. You may notice that I de-emphasize the role of medications and you should expect that most visits will include some element of talk therapy. For this reason, most routine psychiatry visits will last somewhere between 30-60 minutes. If this is a initial visit, I may conduct the visit in a more structured fashion in order to get a broad sense of your history and social factors which are relevant to your seeking psychiatric care.  After the initial visit, we will work together to determine the frequency of visits.