Psychiatry - General Considerations

General Considerations

Individuals with mental health conditions are commonly referred to as patients but may also be called clients, consumers, or service recipients. 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 person 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.

Persons who undergo a psychiatric assessment are evaluated by a psychiatrist for their mental and physical condition. This usually involves interviewing the person and often obtaining information from other sources such as other health and social care professionals, relatives, associates, law enforcement personnel, emergency medical personnel, and psychiatric rating scales. A mental status examination is carried out, and a physical examination is usually performed to establish or exclude other illnesses that may be contributing to the alleged psychiatric problems. A physical examination may also serve to identify any signs of self-harm; this examination is often performed by someone other than the psychiatrist, especially if blood tests and medical imaging are performed.

Like most medications, psychiatric medications can cause adverse effects in patients, and some require ongoing therapeutic drug monitoring, for instance full blood counts or, for patients taking lithium salts, serum levels of lithium, renal function, and thyroid function. Electroconvulsive therapy (ECT) is sometimes administered for serious and disabling conditions, such as those unresponsive to medication. The efficacy and adverse effects of psychiatric drugs may vary from patient to patient. Some groups that oppose psychiatry question the use of many of these drugs.

The close relationship between those prescribing psychiatric medication and pharmaceutical companies is a source of concern for some, particularly anti-psychiatry advocates. Also, such advocates are prone to questioning the influence which pharmaceutical companies are exerting on mental health policies.

For many years, controversy has surrounded the forced drugging and the "lack of insight" label of patients with severe psychiatric symptoms who resist treatment. Involuntary treatment is extremely rare outside the psychiatric system, allowable only in such cases as unconsciousness or the inability to communicate. People with psychiatric disabilities, on the other hand, may be forced to accept treatment even when vigorously protested against by the patient. Frequently those who resist treatment and are forced into it are labeled as having a "lack insight" into the seriousness of their problems and the treatment that their symptoms require. Thus, anti-psychiatry advocates conclude that "lack of insight" is often synonymous with being disagreeable toward the treating professional, and that people who disagree are labeled as noncompliant or uncooperative with necessary treatment.