PSIQUIATRÍA
ARTÍCULO
Fuente:
http://es.wikipedia.org
Psiquiatría
La psiquiatría o siquiatría1 (del griegopsiqué, alma, e iatréia, curación) es la rama de la medicina dedicada al estudio de los trastornos mentales con el objetivo de prevenir, evaluar, diagnosticar, tratar y rehabilitar a las personas con trastornos mentales y asegurar la autonomía y la adaptación del individuo a las condiciones de su existencia.2
Índice
[mostrar]
Antecedentes
El estudio objetivo y riguroso de los problemas mentales es relativamente nuevo. Todavía en elsiglo XX los enfermos mentales eran recluidos en asilos donde recibían “tratamientos morales” con el fin de disminuir su “confusión mental” y “restituir la razón”. En el siglo XIX surgió por primera vez el concepto de “enfermedad mental” y la psiquiatría haría su ingreso definitivo a lamedicina. En los años 1930 se introdujeron varias prácticas médicas controvertidas, incluyendo la inducción artificial de convulsiones (por medio de electroshock, insulina y otras drogas) o mediante cercenar porciones del cerebro (lobotomía o leucotomía). Ambos procedimientos se usaron ampliamente en psiquiatría, pero hubo mucha oposición basadas en cuestionamientos morales, efectos nocivos o mal uso. En los años cincuenta nuevas drogas, especialmente el antipsicótico clorpromazina, fueron diseñadas en laboratorios y gradualmente suplantaron a los tratamientos más controvertidos. Aunque inicialmente se aceptaron como un avance, pronto hubo también oposiciones, debido a los efectos adversos observados tales como la disquinesia tardía.
Aplicación en medicina
Como herramienta al servicio del ser humano, la medicina se vale del conocimiento adquirido en su ámbito científico aplicándolo al alivio del sufrimiento mental asociado con los trastornos de la salud mental. La psiquiatría suele adoptar un modelo médico para afrontar los trastornos mentales, pero considera tanto los factores biológicos como psicológicos, socio/culturales y antropológicos. Su objetivo es el estudio de la enfermedad mental, los efectos bioquímicos y ambientales sobre la dinámica del comportamiento y cómo interaccionan con el organismo para enfrentarse al mundo.
La psicoterapia ha demostrado ser eficaz en muchos problemas relacionados con la salud mental. Algunos psiquiatras realizan formación de posgrado en este campo después de completar su especialización.
Según diferentes modelos, su acción puede desarrollarse en un hospital (psiquiatría hospitalaria), en la atención primaria (psiquiatría ambulatoria) o en la comunidad (psiquiatría comunitaria).
Tratamientos
Los tratamientos psiquiátricos suelen dividirse en dos tipos: biológicos y psicoterapéuticos.
- Los biológicos son aquellos que actúan a nivel bioquímico en el cerebro del paciente, como es el caso de los medicamentos y la terapia electroconvulsiva.
- Los psicoterapéuticos son aquellos que se valen de técnicas como la psicoterapia para mejorar la condición del paciente. Sin embargo, la psicoterapia es una aplicación de lapsicología (en particular del área de la psicología clínica), útil en el tratamiento de trastornos de salud mental. Algunos psiquiatras, luego de su postgrado, deciden especializarse en una o más corrientes terapéuticas: las terapias cognitivo-conductuales, la terapia sistémica, la terapia psicodinámica o psicoanalítica, la psicología humanista, laterapia Gestalt. Sin embargo, las universidades y centros de preparación de postgrado han ido reconociendo paulatinamente la necesidad de un estudio disciplinado de la psicoterapia durante los años de formación regular como parte del entrenamiento regular del psiquiatra.
Los fármacospsicotrópicos son el tratamiento biológico más común utilizado en la actualidad, mientras que el tratamiento psicoterapéutico es una de las funciones compartidas con casi todo el equipo multidisciplinario con formación en dicha área. Estos pueden sertrabajadores sociales, psicólogos clínicos, enfermeros, terapeutas ocupacionales.
______________________________________________
Psychiatry
Psychiatry is the medicalspecialty devoted to the study, diagnosis, treatment, and preventionof mental disorders. These include various affective, behavioural, cognitive andperceptualabnormalities.
Psychiatric assessment typically starts with a mental status examination and the compilation of a case history. Psychological tests and physical examinations may be conducted, including on occasion the use of neuroimaging or other neurophysiological techniques. Mental disorders are diagnosed in accordance with criteria listed in diagnostic manuals such as the widely usedDiagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, and the International Classification of Diseases (ICD), edited and used by the World Health Organization. The fifth edition of the DSM (DSM-5) was published in 2013, and its development was expected to be of significant interest to many medical fields.[1]
The combined treatment of psychiatric medication and psychotherapy has become the most common mode of psychiatric treatment in current practice,[2] but current practice also includes widely ranging variety of other modalities. Treatment may be delivered on aninpatient or outpatient basis, depending on the severity of functional impairment or on other aspects of the disorder in question. Research and treatment within psychiatry, as a whole, are conducted on an interdisciplinary basis, sourcing an array of sub-specialties and theoretical approaches.
Etymology
The word psyche comes from the ancient Greek forsoul or butterfly.[3] The fluttering insect appears in thecoat of arms of Britain’s Royal College of Psychiatrists[4]
The term “psychiatry” was first coined by the German physician Johann Christian Reil in 1808 and literally means the ‘medical treatment of the soul’ (psych- “soul” from Ancient Greekpsykhē “soul”; -iatry “medical treatment” from Gk. iātrikos “medical” from iāsthai “to heal”). A medical doctor specializing in psychiatry is a psychiatrist. (For a historical overview, seeTimeline of psychiatry.)
Theory and focus
“Psychiatry, more than any other branch of medicine, forces its practitioners to wrestle with the nature of evidence, the validity of introspection, problems in communication, and other long-standing philosophical issues” (Guze, 1992, p.4).
Psychiatry refers to a field of medicine focused specifically on the mind, aiming to study,prevent, and treat mental disorders in humans.[5][6][7] It has been described as an intermediary between the world from a social context and the world from the perspective of those who are mentally ill.[8]
People who specialize in psychiatry often differ from most other mental health professionalsand physicians in that they must be familiar with both the social and biological sciences.[6] The discipline studies the operations of different organs and body systems as classified by the patient’s subjective experiences and the objective physiology of the patient.[9] Psychiatry treats mental disorders, which are conventionally divided into three very general categories:mental illnesses, severe learning disabilities, and personality disorders.[10] While the focus of psychiatry has changed little over time, the diagnostic and treatment processes have evolved dramatically and continue to do so. Since the late 20th century the field of psychiatry has continued to become more biological and less conceptually isolated from other medical fields.[11]
Scope of practice
Disability-adjusted life year for neuropsychiatric conditions per 100,000 inhabitants in 2002.
Though the medical specialty of psychiatry utilizes research in the field of neuroscience,psychology, medicine, biology, biochemistry, and pharmacology,[12] it has generally been considered a middle ground between neurology and psychology.[13] Unlike other physicians and neurologists, psychiatrists specialize in the doctor–patient relationship and are trained to varying extents in the use of psychotherapy and other therapeutic communication techniques.[13] Psychiatrists also differ from psychologists in that they are physicians and only their residency training (usually 3 to 4 years) is in psychiatry; their undergraduate medical training is identical to all other physicians.[14] Psychiatrists can therefore counsel patients, prescribe medication, order laboratory tests, order neuroimaging, and conduct physical examinations.[15]
Ethics
Like other purveyors of professional ethics, the World Psychiatric Association issues an ethical code to govern the conduct of psychiatrists. The psychiatric code of ethics, first set forth through the Declaration of Hawaii in 1977, has been expanded through a 1983 Vienna update and, in 1996, the broader Madrid Declaration. The code was further revised during the organization’s general assembblies in 1999, 2002, 2005, and 2011.[16] The World Psychiatric Association code covers such matters as patient assessment, up-to-date knowledge, thehuman dignity of incapacitated patients, confidentiality, research ethics, sex selection,euthanasia,[17] organ transplantation, torture,[18][19] the death penalty, media relations, genetics, and ethnic or cultural discrimination.[16]
In establishing such ethical codes, the profession has responded to a number of controversies about the practice of psychiatry, for example, surrounding the use of lobotomy andelectroconvulsive therapy. Discredited psychiatrists who operated outside the norms ofmedical ethics include Harry Bailey, Donald Ewen Cameron, Samuel A. Cartwright, Henry Cotton, and Andrei Snezhnevsky.[20][page needed]
Approaches
Psychiatric illnesses can be conceptualised in a number of different ways. The biomedicalapproach examines signs and symptoms and compares them with diagnostic criteria. Mental illness can be assessed, conversely, through a narrative which tries to incorporate symptoms into a meaningful life history and to frame them as responses to external conditions. Both approaches are important in the field of psychiatry,[21] but have not sufficiently reconciled to settle controversy over either the selection of a psychiatric paradigm or the specification ofpsychopathology. The notion of a “biopsychosocial model” is often used to underline the multifactorial nature of clinical impairment.[22][23][24] In this notion the word “model” is not used in a strictly scientific way though.[22] Alternatively, a “biocognitive model” acknowledges the physiological basis for the mind’s existence, but identifies cognition as an irreducible and independent realm in which disorder may occur.[22][23][24] The biocognitive approach includes a mentalist etiology and provides a natural dualist (i.e. non-spiritual) revision of the biopsychosocial view, reflecting the efforts of Australian psychiatrist Niall McLaren to bring the discipline into scientific maturity in accordance with the paradigmatic standards ofphilosopher Thomas Kuhn.[22][23][24]
Once a medical professional diagnoses a patient there are numerous ways that they could choose to treat the patient. Often psychiatrists will develop a treatment strategy that incorporates different facets of different approaches into one. Drug prescriptions are very commonly written to be regimented to patients along with any therapy they receive. There are three major pillars of psychotherapy that treatment strategies are most regularly drawn from.Humanistic psychology attempts to put the “whole” of the patient in perspective; it also focuses on self exploration.[25] Behavioralism is a therapeutic school of thought that elects to focus solely on real and observable events, rather than mining the subconscious.Psychoanalysis, on the other hand, concentrates its dealings on early childhood, irrational drives, the subconscious, and conflict between conscious and subconscious streams.[26]
Fuente:
MIGA PRIMERA 