Modern psychiatry involves not only the diagnosis and treatment of various mental diseases, neurosis, psychosomatic diseases or mental disorders accompanied by physical diseases, but also the prevention, correction and treatment of adaptation disorders, personality disorders, sexual psychological deviations and various intellectual, ability or moral development obstacles of children. Modern psychiatry involves several branches of natural science, psychological science and social science in theory, and has developed into the stage of combining with social psychological health in practice.
The history of psychiatry
People's understanding of mental phenomena often determines and influences people's attitudes, viewpoints and methods towards mental disorders. The development of psychiatry not only reflects the process of people's understanding of mental disorders and their laws, but also reflects the process of people's correcting and reversing discrimination and prejudice against mental disorders.
The symptoms, diagnosis and treatment methods of mental disorders and people's views on these phenomena are recorded in national cultures and medical classics in different times. However, in the long historical period when science and culture are backward, mental disorder is regarded as an absurd and strange phenomenon, while patients are regarded as haunted by demons and abused or maimed.
The development of material civilization and science and technology has promoted the change of people's attitude towards mental disorders. /kloc-After the French Revolution in the 8th century, Pinel proposed to remove the shackles of patients and treat mental patients with a humanitarian attitude, thus writing an epoch-making page in the history of psychiatric concepts. And brought psychiatry into the threshold of medicine.
Kraepelien summarized the previous observation and research results, determined the diagnosis names of internal mental diseases and brain organic mental diseases such as early-onset dementia and manic depression, and classified mental disorders from the perspective of pathological anatomy, which laid the foundation for future biological psychiatry. Freud founded psychoanalytic theory, which expanded the field of pathological psychology, explored the causes of some mental diseases and sought treatment. Later, Meyer put forward the theory of psychobiology, emphasizing the realistic social environment factors that form personality or mental disorders, thus promoting the development of mental health work and the gradual formation of social psychiatry at that time.
In practice, due to the limitation of the development level of natural science, until the mid-1930s, psychiatry was still in the stage of descriptive discussion and data accumulation, lacking extensive and effective treatment measures, and hospital management was still on alert.
Psychotropic drugs have been widely used in the field of psychiatry since the early 1950s. With the development of psychopharmacology and other brain sciences, it has promoted the rapid progress of contemporary psychiatry. People have summed up many effective measures to treat mental disorders. For example, various psychotropic drugs can control or eliminate the symptoms of mental disorders to a great extent, thus contributing to psychotherapy, occupational and recreational therapy and social therapy.
With the innovation of medical methods, the atmosphere of mental hospitals has been changed, from closed guard management to open management, which has completely lifted the shackles on patients' bodies and is conducive to patients' rehabilitation.
At the same time, the diagnostic technology of mental disorders has also made progress. The application of EEG, brain potential distribution map, brain evoked potential computed tomography and brain magnetic resonance technology is helpful to objectively test some diseases. Many psychological tests, personality tests and intelligence tests are more conducive to the development of psychological diagnosis technology for mental disorders. With the popularization of psychoepidemiology and social psychiatry, people have discussed the causes of mental disorders from a macro perspective, and social treatment and rehabilitation measures have also achieved unprecedented results.
The content of psychiatry
Psychiatry is inextricably linked with clinical disciplines. For example, many nervous system diseases, metabolic diseases, endocrine diseases and visceral diseases may be complicated with mental disorders at different stages and need to be dealt with; People with general physical diseases are also prone to some psychological and emotional problems, which interfere with the diagnosis and treatment of the primary disease and need to be identified and treated.
Many research methods of psychiatry, such as personality test and emotional rating scale, can be applied to the investigation of psychosomatic diseases or to other clinical departments. In addition, mental health consultation and psychotherapy on health and diseases in general hospitals are urgently needed by the masses and should be popularized.
The theoretical research of psychiatry etiology has been extended to many basic fields such as psychology, genetics, physiological psychology, neuropsychoendocrinology, psychopharmacology, neurophysiology, biochemistry and so on. In these different fields, the research results around psychological disorders will promote the progress of related basic medicine.
Genetic research reveals many reasons for mental retardation, such as congenital stupidity caused by chromosome aberration; Other inherited metabolic diseases, such as phenylketonuria, are autosomal recessive inheritance. Phenylpropionic acid hydroxylase is deficient in patients, and phenylpropionic acid cannot be oxidized into tyrosine, which eventually leads to mental retardation. A large number of statistical genetic data show that the expected incidence rate of children with family history of schizophrenia is much higher than that of the general population.
Biochemical discussions also put forward some causes related to mental disorders. For example, studies have found that there are changes in central neurotransmitters during the onset of affective psychosis, mainly changes in norepinephrine and serotonin between synapses of neurons. In manic state, norepinephrine increases, while in depressive state, serotonin content is lower than normal.
For example, in some schizophrenic patients, it is also confirmed that there are hypermethylated biogenic amine metabolites at the onset; The activity of monoamine oxidase in platelets of other patients decreased. Psychopharmacology can also provide clues for the pathogenesis of some mental disorders. For example, dependence on amphetamine, a stimulant drug, can lead to amphetamine-induced psychosis similar to schizophrenia.
It is believed that amphetamine, as an agonist of dopamine, enhances the dopaminergic activity between synapses of central neurons and causes mental disorders similar to schizophrenia. However, different kinds of antipsychotic drugs reduce dopaminergic activity and relieve the symptoms of schizophrenia by blocking dopaminergic receptors, which makes people think that dopaminergic hyperactivity may play an important role in the pathogenesis of schizophrenia. Many tricyclic antidepressants indirectly increase the content of amines by blocking the reuptake of monoamine in the presynaptic membrane center, thus playing a therapeutic role. Therefore, it is speculated that there is monoamine metabolism disorder in the pathogenesis of endogenous depression.
Due to the continuous innovation of micromorphology research methods, neuropathology has also made great progress in the study of mental disorders caused by brain organic diseases. For example, finding and studying brown spots in different parts of the brain is helpful to understand the neuropathological features of Alzheimer's disease and distinguish Alzheimer's disease from general aging.
Psychology has always been regarded as one of the important basic disciplines of psychiatry. Both psychology and physiological psychology have influenced the diagnosis, treatment and theoretical discussion of psychiatry. Among them, physiological psychology discusses the neural basis of various psychological abnormalities such as emotion, motivation and memory disorder, which helps to provide a physical and chemical basis for mental abnormalities step by step.
Psychiatry can be divided into many specialties, such as clinical psychiatry, adult psychiatry, child psychiatry, geriatric psychiatry, forensic psychiatry, contact counseling psychiatry, psychoepidemiology, social psychiatry, community psychiatry, occupational psychiatry and so on.
The development of psychiatry is more and more rapid, but the main problem that hinders the development of this discipline is still the etiology and pathogenesis of mental disorders, so the discussion of the etiology is one of the important issues in the future development of psychiatry.
In the discussion of etiology, people have generally attached importance to the new medical model of biology-medicine-psychology-society, and paid full attention to the research direction of combining micro and macro in methodology. In micro-research, we attach importance to the role of genetics and immunology in some mental disorders. In macro-research, we also attach importance to epidemiological investigation in the population to find out the regularity and ecological factors of the disease, thus summarizing the social causes of many mental disorders.
At present, many experts believe that the occurrence, development and prognosis of mental disorders are widely related to individual genetic factors, susceptibility quality, personality characteristics before illness, physical state at the time of illness, mental trauma, environmental inducing factors and social and cultural background. Therefore, we should make full use of the development achievements of natural science and social science, strengthen the comprehensive research of multi-disciplines, accumulate information extensively and achieve results.
The discussion on the pathogenic theory of psychological stimulation factors has now developed to the depth of information theory. It is generally believed that individuals' understanding and evaluation of information and the resulting emotions will have an impact on health. People have carried out research on neurophysiology, psychobiochemistry and psychoendocrinology to clarify the mechanism of mental disorders caused by psychological stimuli.
For example, some mental disorders, such as schizophrenia, have obvious genetic factors, but the mode of action of genetic factors remains to be clarified. In the epidemiological study of mental illness, we must integrate all the related ecological and environmental factors that affect the occurrence, development and outcome of mental illness, and seek the causes and laws from a macro perspective.
The treatment of mental disorders usually adopts comprehensive measures, such as various psychotropic drugs, psychotherapy, occupational therapy, social rehabilitation and so on. From a medical point of view, we take a pragmatic and eclectic attitude towards different therapeutic schools. In the implementation of treatment, a treatment group consisting of psychiatrists, nurses, social workers, therapists and psychologists generally works together.
At present, the community treatment of mental disorders has received extensive attention and attention. Community medical care can prevent, treat and rehabilitate a large number of patients with mental disorders with less manpower and material resources, which shows that the development of contemporary medicine has reached the stage of combining medical care with public health. The practice of community mental health needs public sympathy and support, and also needs to cooperate with social forces to establish medical facilities and carry out established medical goals in a planned way.
Other branches of modern medicine
Introduction to medicine, medical ethics, social medicine, epidemiology, emergency medicine, forensic medicine, biomedical engineering, supernatural medicine, maritime medicine, aerospace medicine, diving medicine, psychiatry.