A psychiatrist is a medical doctor who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy. Psychiatrists are the only mental health professionals permitted to prescribe psychiatric medication, conduct physical examinations, order and interpret laboratory tests and other clinical investigations, in order to establish a diagnosis. In order to practice in the UK, the psychiatrist must be registered with the UK General Medical Council, and hold a valid license to practice. A consultant will also have completed the required training and examinations to hold membership of the Royal College of Psychiatrists. The College recognizes the following subspecialties of psychiatry:
The problems and consequences of illicit drug use and excessive alcohol use are an apparently universal and persistent source of concern for the media and public. Addictions Psychiatrists work with individuals who have a range of addictions as well as, commonly, mental illness. Particular skills are required to work with people in order to stop or limit use and then, from that position, to maintain their healthier state. Given the likelihood of social problems in this group, Addictions Psychiatrists frequently work alongside courts and probation services as well as social and children’s services.
Child and adolescent psychiatrists specialise in working with children and young people (usually up to the age of 18 years) who have mental health problems. They work as part of a multidisciplinary service that may include other child mental health professionals such as child psychologists, nurses, occupational therapists and others. It also involves liaison with other agencies such as schools and social services. Child and adolescent psychiatrists deal with a wide range of mental health problems, including emotional and psychiatric problems. A large part of a child psychiatrist's work is to identify the problem for the young people and advise about what may help. Child psychiatry highlights developmental aspects given the age range it deals with. It also requires an ability to understand issues from a range of perspectives as it usually involves working with the child/young person’s carers as well as the child or young person.
As eating disorders typically start in adolescence, eating disorder psychiatry can involve working with children and adolescents or with adults with anorexia nervosa, bulimia nervosa or binge eating disorder. Many eating disorder patients have other psychological difficulties or disorders such as anxiety, depression, obsessive-compulsive disorder or personality disorders. Physical complications and disabilities are common.
Forensic psychiatry involves the interface between the law and psychiatry. Forensic psychiatrists have particular expertise in the assessment and management of patients with mental disorders who have been, or have the potential to be, violent. They work in a range of settings including prisons, secure hospitals and the community. There are also specialised services and teams within forensic psychiatry including adolescent forensic psychiatry, forensic learning disability and forensic psychotherapy.
The primary role of a forensic psychiatrist is the treatment of mentally disordered offenders. These are patients who have committed crimes when mentally ill or who become unwell in prison. Such patients can receive a hospital order for treatment in hospital instead of a prison sentence or can be transferred from prison to hospital for treatment. Due to their offending behaviour, these patients need to be treated in a secure environment and low, medium and high secure psychiatric hospitals are available depending upon the nature and extent of the risks.
General Adult Psychiatrists work with mental illness in people of working age, between the ages of 17 (or sometimes 18) and 65 years. A range if disorders are treated, including manifestations of “organic” brain disorders such as Huntington’s Disease, psychoses such as schizophrenia, severe or difficult to treat depressive illness, and personality disorders. The wide range of disorders and problems encountered necessitates close working with other agencies such as social services and the police and clear effective team working within the mental health field. More so than ever, the psychiatrist works as an integral part of the team.
Learning disability Psychiatrists work with learning disabled people. In the UK, a person is said to be learning disabled when his or her general intellectual ability (cognitive, motor, language and social) is felt to be lower than expected for someone of similar age or culture. In addition, the difficulties must originate in childhood. An intelligence quotient (IQ) of 70 which is associated with impairment in adaptive behaviour (an inability to adapt behaviour to the setting in which one lives) demarcates those with a learning disability from the general population. The level of learning disability is further subdivided into mild, moderate, severe and profound mental retardation. The aetiology of learning disability can be hereditary or acquired. In the majority of cases of mild learning disability (the largest sub group) an identifiable cause is not found.
For this group of people, already disadvantaged and stigmatised, the likelihood of mental illness is greater than for the general population and is more likely to be complicated by associated medical problems such as epilepsy, rare genetic conditions or sensory impairment. Add in communication deficits and the diagnostics of mental illness becomes more challenging, whilst arguably more important for appropriate management.
Perinatal psychiatrists work with mental illness following childbirth, which is relatively common. In the postpartum period, women are at increased risk of suffering from affective disorders, and those with pre-existing psychiatric disorders are at increased risk of relapse. There is an additional group of women who present for the first time in the postpartum period with a ‘puerperal’ psychosis.
One of the major challenges in dealing with this group of service users is management of risk of the illness not only to the mother but also to the baby (neglect, poor mother-baby bonding, reckless behaviour). Great care is required when weighing up the benefits of treating a woman’s illness (or medicating to avoid relapse) with pharmacological agents, and the risk of teratogenicity. Additionally, care must be given when prescribing to breast-feeding mothers.
An old age psychiatrist works with people over the age of 65 years. Mental illness in older people is increasingly recognised as a major public health issue in a wide range of contexts. The complexity of interaction between physical, psychiatric and social problems experienced in old age requires close collaboration between a range of agencies including psychiatrists, nurses, physicians, social services, occupational therapy and voluntary agencies.