What happens during psychiatric treatment

Psychiatry, Psychosomatics & Psychotherapy

The medical specialty of "psychiatry" by definition comprises the knowledge, experience and ability to diagnose, treat and prevent as well as rehabilitation of mental and psychosomatic illnesses and disorders - especially using socio- and psychotherapeutic methods. The term is etymologically derived from the Greek for "Psyche" (soul) and "iatrós" (doctor) combined and literally translated means something like "healing of the soul."

Put simply, psychiatry deals with all health disorders and abnormalities that affect a person's psyche, regardless of whether they are of psychological or physical origin. In addition to the psychological and the somatic dimension, the social dimension must also be included, since the individual is in the context of a social environment. Thus the psychological, the somatic and the social level determine the psychiatric understanding of mental illnesses.

In the course of the development of the subject "psychiatry" in Germany, specializations such as gerontopsychiatry and psychotherapy and forensic psychiatry have developed in addition to its own specialist field, child and adolescent psychiatry and psychotherapy and psychosomatics.

The doctor for psychiatry and psychotherapy

A doctor for psychiatry and psychotherapy examines and treats pathological changes and disorders of feelings, thinking, but also moods, drive, memory or experience and behavior. On the one hand, it is about a psychological understanding of human experience and behavior, on the other hand, it is also about a somatic consideration of causal physical illnesses (e.g. of the brain) that can affect psychological experience.

In contrast to the (non-medical) “psychological psychotherapist”, the psychiatrist, as a doctor, can also record possible physical causes of apparently psychological disorders or illnesses as well as the interactions between psychological and physical factors. He can also prescribe medication if necessary and indicated. The psychiatrist can therefore treat a patient with medication or psychotherapy, or usually combine both, one then speaks of integrative psychiatric-psychotherapeutic treatment. Finally, the doctor for psychiatry and psychotherapy can add sociotherapeutic offers as a third pillar of therapy if necessary.

Mental illness

A mental illness is defined as a long-lasting or recurring significant deviation in experience or behavior that affects the areas of thinking, feeling and acting. In addition to the deviation from the norm, both the personal level of suffering for the person concerned and the burden on the environment are further prerequisites for the presence of a mental illness.
Mental illnesses are being diagnosed more and more and are among the most common illnesses. Almost every second person develops a relevant mental disorder at least once in their life. In recent years, the number of sick days and early retirement due to mental illness has risen steadily, with depression and anxiety disorders making up a large part of the diagnoses.

Mental illnesses are usually based on several causes (multifactorial). In addition to genetic factors and physical illnesses, current life events and situations, past stressful events, emotional conflicts and interpersonal tensions can promote the development of a mental disorder. Disturbances of the brain metabolism and changes in the brain substance are often involved in their development.

Treatment of mental illness

In accordance with the complex development (genesis) of mental illnesses and disorders, therapy and rehabilitation are multi-dimensional - in the form of a networked system of outpatient, inpatient, day inpatient and other comprehensive care facilities. Optimal care for patients with mental disorders requires coordination and cooperation with areas such as neurology and similar disciplines, psychosomatic medicine, general medicine, child and adolescent psychiatry and psychotherapy, and clinical psychology. In addition, knowledge of current neurobiological, psychological and social science findings is required.

Mental illnesses are treated with psychotherapy or drugs (pharmacotherapy) or often a combination of both therapy methods. Which procedures are used in individual cases depends on the respective illness or disorder and also on the preferences of the person affected. In the case of moderate and severe illnesses, medication and psychotherapy are usually combined, in the case of milder illnesses, on the other hand, purely psychotherapeutic advice or treatment is carried out.

In the interests of quality assurance in the field of psychiatry and psychotherapy, practice-related guidelines have been drawn up by professional societies for many years. The aim of these is to make knowledge available to all people working in health care in order to be able to diagnose and treat mental illnesses and disorders according to the valid rules of healing.

Psychiatric diagnostic systems

Psychiatric diagnoses are now made on the basis of international agreements - initially without saying anything about the causes of the illnesses. The diagnostic systems classify mental illnesses according to their symptoms, i.e. they only describe their appearance and make no statement about the cause of an illness. The content of the diagnostic systems is a compilation of symptoms decided by experts in order to make diagnoses reproducible and to facilitate healing.

The International Statistical Classification of Diseases, Injuries and Causes of Death (ICD) is the most important diagnostic classification and encryption system recognized worldwide. In Germany, the doctors and medically managed institutions participating in statutory health care are obliged to encode diagnoses according to ICD-10.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification system of the American Psychiatric Association (APA). The DSM-IV is a replacement and / or a supplement for the respective passages in the ICD-10.
With the appearance of the ICD-11 and DSM-5 in the coming years, changes in the classification of mental illnesses are to be expected.

Explanation of terms - psychiatrist, psychologist, psychotherapist

The doctor for psychiatry and psychotherapy
In addition to basic medical training and the completion of the state examination, further training to become a psychiatrist and psychotherapist includes a further five years of training - four years are spent on clinical-psychiatric and psychotherapeutic training, one year on in-patient neurological training. Such further training entitles them to practice psychiatric and psychotherapeutic treatments.

The psychologist
The job title “psychologist” may only be used by people who have completed a university degree in psychology. Psychology is an empirical science in its own right, while psychiatry is a branch of medicine. Psychology describes and explains the experience and behavior of people, their development in the course of life and all relevant internal and external factors and conditions. During the main course, knowledge of mental and physical health and illness as well as the basics of scientific psychotherapy are imparted. After graduation, the psychologist can complete additional training for several years to become a psychological psychotherapist / psychoanalyst and thus obtain state approval (approbation) and call himself a "psychological psychotherapist".

The psychotherapist
A “psychotherapist” can basically be a doctor (“medical psychotherapist”), a psychologist (“psychological psychotherapist”) or a (social) pedagogue who has completed additional training as a psychotherapist in addition to his university studies.

The specialist term "psychotherapy" has been regulated and protected by law since 1999. Doctors and psychologists can undertake further training after completing their studies. The specialists for (children and youth) psychiatry and psychotherapy or the specialist for psychosomatics and psychotherapy acquire the knowledge and experience necessary as a psychotherapist as part of their specialist training after completing their studies. The psychologist acquires this knowledge after completing his diploma in the form of several years of further training. Unlike the doctor, for example, he is not allowed to perform a physical examination or prescribe medication. In contrast to the doctor, however, the psychologist has studied the basics of normal human behavior and thought.