Psychiatry

Forensic psychiatric evaluations are crucial to many civil and criminal court decisions. Psychiatrists are requested to assess the level of criminal and legal responsibility of defenders in cases of fraud, embezzlement, murder , physical aggression, disputes for child custody, and other crimes and court proceedings. In some countries, when a person decides to write a will, his or her mental sanity has to be established in order to prevent disputes among heirs about the legal validity of the will based on allegations of the author's mental health at the time the document was written. Other roles of forensic psychiatry involve studying the psychiatric risk factors for criminal behavior among the population, to evaluate inmates for probationary release, and to research the neurobiological aspects of psychopathic personalities and the risk they may pose to society.

Psychiatry is the field of medical sciences that studies mental diseases and behavioral disorders associated with biological causes. Congenital (present at birth), hereditary, or acquired psychosis, mania, and schizophrenia can often lead to violent or self-destructive behavior and deviant patterns of social interactions. In contrast to psychiatry, psychology investigates behavioral, emotional, and cognitive disorders. Psychology also studies the unconscious mechanisms underlying life experiences and mental illness. Both psychiatry and psychology study the development of personality from birth to adulthood, and the psychological (emotional and cognitive) and social or interpersonal developmental needs of each phase of life. However, the medical diagnosis and treatment of psychosis and other psychiatric disorders is the exclusive domain of the psychiatrist, whereas the counseling and cognitive re-education of patients suffering from nonpsychotic disorders, such as neurosis, behavioral problems, and emotional traumas, is usually the role of the psychologist.

Neuropsychiatry or the clinical application of the findings of neuroscience to the diagnosis and treatment of psychiatric disorders has yielded a better understanding of the biological bases of violent and criminal behavior associated with some psychopathologies, as well as a number of new effective diagnostic techniques. Since the 1970s, many neuroscience studies have shown that the brain structures and neurochemistry can be modified during infancy and childhood by the repetitive exposure to traumatic experiences or to neglect. Whereas less than 1% of any given population may present hereditary psychosis, these studies have shown that children born with a healthy brain can be neurologically damaged by chronic exposure to maternal neglect, child abuse, or a violent environment, even if the child is not the direct target of the violence. The brain adapts to such situations by undergoing detrimental and often permanent changes in its structures and neurochemical functions that often lead to psychosis and violent behavior, or to self-destructive patterns and other psychiatric pathologies. Such knowledge is leading many psychiatrists to work in the early detection of children at risk in order to prevent further damage through early diagnosis and treatment of abused children. Forensic psychiatry is therefore, crucial to the evaluation of children victimized by domestic or social violence and/or neglect, and for informing courts and social agencies on the therapeutic needs and available treatments in this vulnerable age group.

Forensic psychiatry differs in nature from clinical psychiatric practice because it aims to prove a fact in court, and is subjected to scrutiny and cross-examination by opposing parts. It requires a wide range of specific studies and adequate techniques as well as a special training in order to enable the psychiatrist to act as an expert examiner and witness in court. The psychiatric examiner supplies prosecutors, judges, probation boards, and police investigators with expert diagnosis on the mental state of defenders, convicts, and suspects. Such forensic diagnosis will constitute evidence to be considered by judges and/or by the court.

Expert psychiatric evaluation may be divided in three categories: transversal (or horizontal) evaluation, retrospective evaluation, and prospective evaluation. Transversal evaluations aim to establish whether the defendant is suffering in the present from a psychiatric disorder that would acquit him of civil or criminal responsibility. However, an insanity diagnosis implies in many cases the compulsory reclusion to a psychiatric hospital and treatment. If the psychiatric offender poses serious threat to himself and to other people's lives, he can be committed to a mental institution for life. Transversal evaluations are usually requested by the defense or by the prosecution before the trial or in the initial phases of the trial, and are obligatory by law in many countries. Retrospective evaluations require great expertise and technical preparation from forensic psychiatrists in order to infer the mental condition and legal responsibility of the defender at the time he committed the crime. Prospective evaluations, or risk assessment, consist of evaluations based on the present and past history of a convict, or a defendant to determine future risk of recidivism (repeated criminal behavior). It is usually carried out by a multidisciplinary team when prisoners are being assessed for probation, or by the forensic psychiatrist alone to enable the judge to determine the length of a new sentence in cases of repeated offenses.

Another field of forensic psychiatry involves researching the incidence of crime in the population, and is known as crime epidemiology. One such study sponsored by the National Institute of Mental Health (NIMH) was completed in 2002. An entire generation of boys in the city of Dunedin, New Zealand, was periodically evaluated from birth through physical, psychiatric, neurological, and psychomotor tests. In 2002, the group donated blood for genetic tests, including those who had a record as juvenile offenders in recent years or were serving sentences for violent crimes. It was found that in addition to having been victims of serious abuse or neglect during childhood, a subpopulation among the delinquent group had a genetic mutation that affected the regulation of a chemical messenger in the brain. Although this subgroup represented only 12% of the delinquents, they accounted for 44% of convictions for violent crimes.

The adoption of psychiatric diagnostic guidelines by some countries in the past 20 years, which are regularly updated to include new scientific advances, are essential for modern forensic psychiatry. The process of forensic psychiatric evaluation can be generally described as requiring interviews with the examinee, clinical physical examination, neurological and endocrine tests, neurological and functional diagnostic tests, neuropsychological assessments, and interviews with third parties. Based on the results of these various tests, forensic psychiatrists issue expert reports and prepare evidence for presentation in court. In the United States, a forensic psychiatric diagnosis is based on the Diagnostic and Statistical Manual of Mental Disorders, developed by the American Psychiatric Association. In many other countries the World Health Organization (WHO) guidelines are used, such as the Clinical Descriptions and Diagnostic Guidelines and the Diagnostic Criteria for Research.

Advancements in neuroscience and the establishment of objective criteria for psychiatric diagnostics as well as the clear and detailed description of the etiology (causes) and ethology (progression) of psychopathologies (serious mental disorders) were important to forensic psychiatry, as these advancements rid the profession of the controversial character often attributed to forensic psychiatry in the past. The APA system adopts objective formulations, similar to those used in other medical specialties. Diagnostic techniques introduced or improved in the last two decades, such as functional brain magnetic resonance imaging (fMRI), PET scans, and computer tomography, allow the identification of structural asymmetries and functional abnormalities of the brain associated with some mental illnesses. The same is true for new laboratorial neuroendocrine tests, which give insight into brain chemistry. The advances of neurosciences and the better understanding of brain chemistry gave forensic psychiatry a new scientific status as an objective science, using clear diagnostic parameters and criteria. Therefore, allegations of insanity by defenders can now be proved or disproved on the basis of solid scientific evidence.

see also Brain wave scanners; Criminal profiling; DNA typing systems; Epidemiology; Expert witnesses; Forensic science; Genetic code; Nervous system overview; Psychology; Psychopathic personality.

Psychiatrist

Education and Training: College, medical school, and specialized training

Salary: Median—$180,000 per year

Employment Outlook: Very good

Definition and Nature of the Work

Psychiatrists are physicians who specialize in the prevention, diagnosis, and treatment of mental disorders. They treat patients with mild cases of anxiety as well as those with severe disorders that can cause dangerous and bizarre behavior. Psychiatrists may also diagnose mental retardation and treat alcoholism. They often work with other mental health workers, such as psychologists, psychiatric nurses, and psychiatric social workers.

Psychiatrists talk with patients to learn about their mental health problems. They may also use information provided by patients' families or by other mental health workers. They are trained to recognize the connection between mental and physical disorders, so they may order laboratory or other diagnostic tests.

For treatment, psychiatrists can prescribe drugs and use shock therapy and psychotherapy. In psychotherapy, psychiatrists use their special training to talk with one or more patients to help them understand and cope with their problems.

Psychiatrists may work with patients in private offices or in hospitals or clinics. They may also do research, studying the causes and treatment of mental illness. Some psychiatrists teach in medical schools or in special psychiatric institutes. Others write or edit psychiatric books or journals.

Psychiatrists are often confused with psychologists and psychoanalysts. Psychiatrists are physicians who have advanced training in psychiatry. As physicians, they can prescribe medication. Psychologists have either master's degrees or doctorates in psychology. They are not physicians and cannot prescribe drugs or perform surgery. Psychologists are basically scientists who study the reactions of people to their environment. Psychoanalysts are specially trained to practice long-term therapy that investigates the subconscious or hidden causes of emotional disturbances. Most psychoanalysts are psychiatrists, while those known as lay analysts are not.

Education and Training Requirements

Psychiatrists need extensive training after high school. They get bachelor's degrees, followed by four years of medical school. After one-year internships, they must also have three years of psychiatric training as residents in hospitals. Usually after one or two years of residency, psychiatrists must take examinations to be licensed, which is required in all states. They need additional experience before they are eligible to take examinations for certification as psychiatrists.

Getting the Job

Psychiatrists work in institutions or in private practice. Some combine the two types of work. Building a successful private practice can take a while, so many beginning psychiatrists start their careers in established psychiatric offices. Professional associations can provide information about setting up a practice or getting salaried positions.

Advancement Possibilities and Employment Outlook

Psychiatrists usually advance by building their practices. Some specialize in fields such as child, educational, or legal psychiatry. Others become teachers, researchers, or administrators in colleges, hospitals, or other institutions.

Employment of physicians in general is expected to grow faster than average for all occupations through 2014. Expansion of the health-care industry, a growing population, and increasing life spans, as well as higher incomes and educational levels, are spurring the demand. Shortages of psychiatrists exist, especially in rural areas and in public facilities.

Working Conditions

Psychiatrists in private practice work in quiet, peaceful settings so their patients can feel at ease. However, the work can be stressful because of the suffering they see every day. In addition, psychiatrists in private practice must be available to their patients whenever they need help, so their working hours can be irregular. Psychiatrists who work in hospitals and clinics often have more regular hours than private practitioners do because the staff divides the hours they must be on call. To do their work well, psychiatrists must be well balanced, disciplined, and enjoy working with all kinds of people.

Where to Go for More Information

American College of Psychiatrists
122 S. Michigan Ave., Ste. 1360
Chicago, IL 60603
(312) 622-1020
http://www.acpsych.org

American Psychiatric Association
1000 Wilson Blvd., Ste. 1825
Arlington, VA 22209-3901
(703) 907-7300
http://www.psych.org

Earnings and Benefits

Psychiatrists' earnings are similar to those of other physicians. In 2004 psychiatrists who had been in practice more than one year earned a median income of $180,000 per year. Psychiatrists in private practice provided their own benefits. Salaried psychiatrists received paid holidays and vacations, health insurance, and retirement plans.

Psychiatrist

Definition

Description

Resources

Definition

A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders.

Description

Psychiatrists treat patients privately and in hospital settings through a combination of psychotherapy and medication. Their training consists of four years of medical school, followed by three or four years of psychiatric residency. Subspecialities usually involve completion of a fellowship that lasts two or more years following the residency. Psychiatrists may receive certification from the American Board of Psychiatry and Neurology (ABPN), which requires two years of clinical experience beyond residency and the successful completion of a written and an oral test. Unlike a medical license, board certification is not legally required to practice psychiatry.

Psychiatrists may practice general psychiatry or choose a specialty, such as child psychiatry, geriatric psychiatry, treatment of substance abuse, forensic (legal) psychiatry, emergency psychiatry, mental retardation, community psychiatry, or public health. Some focus their research and clinical work primarily on psychoactive medication, in which case they are referred to as psychopharmacologists. Psychiatrists may be called upon to address numerous social issues, including juvenile delinquency, family and marital dysfunction, legal competency in criminal and financial matters, and treatment of mental and emotional problems among prison inmates and in the military.

Psychiatrists treat the biological, psychological, and social components of mental illness simultaneously. They can investigate whether symptoms of mental disorders have physical causes, such as a hormone imbalance or an adverse reaction to medication, or whether psychological symptoms are contributing to physical conditions, such as cardiovascular problems and high blood pressure. Because they are licensed physicians, psychiatrists—unlike psychologists and psychiatric social workers—can prescribe medication; they are also able to admit patients to the hospital. Other mental health professionals who cannot prescribe medication themselves often establish a professional relationship with a psychiatrist.

Psychiatrists may work in private offices, private psychiatric hospitals, community hospitals, state and federal hospitals, or community mental centers. Often, they combine work in several settings. In addition to their clinical work, psychiatrists often engage in related professional activities, including teaching, research, and administration. The American Psychiatric Association, the oldest medical specialty organization in the United States, supports the profession by offering continuing education and research opportunities, keeping members informed about new research and public policy issues, helping to educate the public about mental health issues, and serving as an advocate for people affected by mental illness.

Resources

ORGANIZATIONS

The American Board of Psychiatry and Neurology. 500 Lake Cook Road, Suite 335, Deerfield, IL 60015. Telephone: (847) 945-7900; Web site: http://www.abpn.com

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924.

Emily Jane Willingham, PhD

First, Michael

AMERICAN
PSYCHIATRIST

Michael First is known as one of the world's foremost experts in the areas of psychiatric assessment and diagnosis. He is an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons, and an associate attending psychiatrist at Presbyterian Hospital in New York City. His undergraduate degree, earned summa cum laude from Princeton University, was in computer science; his expertise in information technology has resulted in First's creation of a variety of quite popular computer-administered programs utilized for psychiatric interviewing.

First is well known as the text and criteria editor of the psychiatric diagnostic guide for the DSM-IV (Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders ); he was the editor for the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision), as well as the DSM-IV-TR version developed especially for primary care physicians. The DSM is the universally accepted (as a valid and reliable research and diagnostic tool) diagnostic manual for psychiatry, psychology , and the behavioral health (mental health and substance abuse) professions.

First is the primary author of the Structured Clinical Interview for the DSM-IV (SCID). This is a longitudinally studied, highly reliable and valid diagnostic instrument employed by psychiatric, psychological, and behavioral health researchers, by the pharmaceutical industry, by clinicians and educators in many different settings, and by forensic clinicians and researchers as part of their psychodiagnostic and culpability assessments, as well as by those forensic psychologists and psychiatrists who make competency (to stand trial) assessments. The SCID is the most widely used diagnostic assessment tool in psychiatry.

First's forensic science expertise includes diagnostic assessment, differential diagnosis, and psychiatric interviewing. He is particularly noted for observing the subtle diagnostic underpinnings of the various personality disorders. First has published well in excess of thirty peer-reviewed articles on substance dependence, mood disorders, personality disorders, assessment, and psychiatric diagnosis. As a result of First's worldwide reputation as an expert in the fields of psychiatric and psychodiagnostic interviewing and assessment, he has been asked to act as a consultant to the Federal Bureau of Investigation (FBI ) on the classification of violent crime. He serves also as a distinguished member of the professional organization the Forensic Panel, and he provides expert commentary to the journal Forensic Echo.

see also Careers in forensic science; Computer modeling; Criminal responsibility, historical concepts; Mens rea .

Psychiatrist

Definition

A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders.

Description

Psychiatrists treat patients privately and in hospital settings through a combination of psychotherapy and medication. Their training consists of four years of medical school, followed by one year of internship and at least three years of psychiatric residency. Psychiatrists may receive certification from the American Board of Psychiatry and Neurology (ABPN), which requires two years of clinical experience beyond residency and the successful completion of a written and an oral test. Unlike a medical license, board certification is not legally required in order to practice psychiatry.

Psychiatrists may practice general psychiatry or choose a specialty, such as child psychiatry, geriatric psychiatry, treatment of substance abuse, forensic (legal) psychiatry, emergency psychiatry, mental retardation , community psychiatry, or public health. Some focus their research and clinical work primarily on psychoactive medication, in which case they are referred to as psychopharmacologists. Psychiatrists may be called upon to address numerous social issues, including juvenile delinquency, family and marital dysfunction, legal competency in criminal and financial matters, and treatment of mental and emotional problems among prison inmates and in the military.

Psychiatrists treat the biological, psychological, and social components of mental illness simultaneously. They can investigate whether symptoms of mental disorders have physical causes, such as a hormone imbalance or an adverse reaction to medication, or whether psychological symptoms are contributing to physical conditions, such as cardiovascular problems and high blood pressure. Because they are licensed physicians, psychiatrists— unlike psychologists and psychiatric social workers—can prescribe medication; they are also able to admit patients to the hospital. Other mental health professionals who cannot prescribe medication themselves often establish a professional relationship with a psychiatrist.

Psychiatrists may work in private offices, private psychiatric hospitals, community hospitals, state and federal hospitals, or community mental centers. Often, they combine work in several settings. In addition to their clinical work, psychiatrists often engage in related professional activities, including teaching, research, and administration. The American Psychiatric Association, the oldest medical specialty organization in the United States, supports the profession by offering continuing education and research opportunities, keeping members informed about new research and public policy issues, helping to educate the public about mental health issues, and serving as an advocate for people affected by mental illness.