A psychiatrist is a medical doctor who specializes in the diagnosis, treatment and prevention of mental health disorders, including substance use disorders. Psychiatrists are qualified to assess both the mental and physical aspects of psychological disturbance. A psychiatrist has completed medical school (is an M.D. or D.O.) and an additional four or more years of residency training in psychiatry. Medical school and residency training provide at least 15,000 hours of direct, supervised patient care in Psychiatry. This is in addition to the time spent learning in the classroom during medical school.
People seek psychiatric help for many reasons. The problems can be sudden, such as a panic attack, frightening hallucinations, thoughts of suicide, or hearing ‘voices.’ On the other hand, the troubles may be more long-term, such as feelings of sadness and hopelessness or anxious feelings that never seem to lift causing everyday life to feel distorted or out of control.
Diagnosing patients
Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and psychological tests which, combined with interviews/discussions with patients, help provide a picture of a patient’s physical and mental state. Their education and years of clinical training and experience give psychiatrists the expertise needed to understand the complex relationship between emotional and other medical illnesses, to evaluate medical and psychological data, to make a diagnosis, and to work with a patient to develop a treatment plan.
Specific diagnoses are based on criteria established in the Diagnostic and Statistical Manual of Mental Disorders, which contains descriptions, symptoms and other criteria for diagnosing mental disorders.
Treatments
Psychiatrists are experts in the use a variety of treatments, including psychotherapy, medication, and other treatments.
Psychotherapy, sometimes called talk therapy, is a treatment that involves a talking relationship between a therapist and patient. It can be used to treat a broad variety of mental disorders and emotional difficulties. The goal of psychotherapy is to eliminate or control disabling or troubling symptoms so the patient can function better. Depending on the extent of the problem, treatment may take just a few sessions over a week or two or may take many sessions over a period of years. There are many forms of psychotherapy, and it can be done individually, with a family, or in a group. Some mental health conditions require limited but ongoing treatment in order to manage chronic symptoms.
Medications are used by psychiatrists in much the same way that medications are used to treat high blood pressure or diabetes. After medical and psychological evaluations, psychiatrists can prescribe medications to help treat mental disorders. Psychiatric medications can help correct imbalances in brain chemistry that are thought to be involved in some mental disorders. Psychiatrists often use medications in combination with psychotherapy. Patients on long-term medication treatment will need to meet with their psychiatrist periodically in order to monitor the effects of medications.
Other treatments are also sometimes used by psychiatrists. Electroconvulsive therapy (ECT), a medical treatment that involves applying electrical currents to the brain, is used most often to treat severe depression that has not responded to other treatments. Deep brain stimulation, vagus nerve stimulation, and repetitive transcranial magnetic stimulation are a few of the newer therapies being used to treat some mental disorders. Light therapy is used to treat seasonal depression.
Psychiatric Training, Certification
To become a psychiatrist, a person must complete college, then medical school, and then a four-year residency in psychiatry. Medical school and residency training provide at least 15,000 hours of direct, supervised patient care in Psychiatry. This is in addition to the time spent learning in the classroom during medical school. Some psychiatrists also complete additional specialized fellowship training after their four years of general psychiatry training (see below).
There are 3 rigorous written examinations that physicians must pass during medical school and residency in order to obtain a state license to practice medicine. Physicians who specialize in psychiatry spend a large portion of their first year of residency training in a hospital taking care of very sick patients with a wide range of medical illnesses. After this first year of training, the resident psychiatrist spends at least three additional years seeing patients with psychiatric conditions in both the hospital and outpatient clinical settings under direct, intensive supervision from expert psychiatrists. Psychiatric residents learn the diagnosis and treatment of mental health conditions, gaining valuable skills in various forms of psychotherapy and in the use of psychiatric medicines and other treatments.
After completing residency training, psychiatrists take a rigorous written examination given by the American Board of Psychiatry and Neurology to become a “board certified” psychiatrist. They must be re-certified every 10 years.
Psychiatric Specialties
Many psychiatrists continue training beyond the four years to become a psychiatrist. They may study and be certified in
Child and adolescent psychiatry
Geriatric psychiatry
Forensic (legal) psychiatry
Addiction psychiatry
Pain medicine
Psychosomatic (mind and body) medicine
Sleep medicine
Some psychiatrists choose additional training in psychoanalysis at special psychoanalytic institutes or additional training in psychiatric research.
Where do psychiatrists work?
Psychiatrists work in a variety of settings, including private practices, clinics, general and psychiatric hospitals, university medical centers, community agencies, courts and prisons, nursing homes, industry, government, military settings, schools and universities, rehabilitation programs, emergency rooms, hospices, and many other places. About half of the psychiatrists in the U.S. maintain private practices and many psychiatrists work in multiple settings.
What is the Difference Between a Psychiatrist and Psychologist?
A psychiatrist is a medical doctor with 4 years of medical school training and 4 years of residency training that totals over 4,000 hours of classroom learning and 15,000 hours of intensively supervised patient care. A psychiatrist is trained to conduct psychotherapy and prescribe medications and other medical treatments.
A psychologist has a graduate degree (PhD or PsyD) and supervised clinical training in the delivery of psychotherapy to treat mental disorders. Some specialize in psychological testing and evaluation. Psychology is social science, not medical science.