The New York State Psychiatric Association (NYSPA) Questions and Answers About Psychiatry

A psychiatrist is a medical doctor who specializes in prevention, diagnosis, and treatment of mental and emotional problems. A psychiatrist is a licensed physician trained to understand both the physical and emotional components of illness, and is qualified to order laboratory tests and to prescribe medications as well as to treat psychological problems. These qualifications are important because serious physical diseases, such as hormone problems and high blood pressure, can produce symptoms that resemble those of mental illness. With an understanding of the psychological, physical, and social aspects of health and illness, the psychiatrist is prepared to treat the whole person.

What is a Psychiatrist's Training?

Eight years training beyond college is required: four years in medical school; one year working with hospital patients to further understand and treat medical and surgical problems; then at least three years in intensive psychiatric training to learn the diagnosis and treatment of mental and emotional problems.

What if a Patient is a Child?

A child psychiatrist has special expertise in helping children with emotional disorders, just as a pediatrician has special qualifications to care for the medical problems of children. The psychiatrist has at least two additional years of intensive training in the study of childhood development and evaluation and treatment of children's emotional illnesses. Adolescents are often treated by adult psychiatrists as well as child psychiatrists.

How do I Know if I Need a Psychiatrist?

If you have any of these problems, particularly if they persist, you may wish to arrange for a psychiatric consultation:

Excessive fear of people, places, or events
Sense of hopelessness, despair, or depression; suicidal thoughts
Overwhelming stress or anxiety
Insomnia, nightmares, or other sleep disorder
Alcoholism or drug abuse
Eating problems
Sexual problems
Marital or family problems
Difficulties with memory, concentration, or decision making
Recurrent difficulties in relationships with others; temper outbursts
Difficulty working on the job or at school
Intrusive or uncontrollable thoughts or behaviors
Chronic pain or other physical symptoms not responding to medical treatment

In general, if you feel worried or upset beyond everyday ups and downs for seemingly no reason, you should consider a psychiatrist. Some people are reluctant to do so because they think psychiatrists are trained to deal with a wide range of psychological disturbances, from mild to severe. Others may hesitate to make an appointment because they believe that talking with a sympathetic friend can replace a psychiatric consultation. While friends can help in many situations, they are not trained to evaluate your situation objectively and professionally, or to prescribe treatment.

What Should I Expect on the First Visit?

Like any other medical doctor, your psychiatrist will ask you to describe your symptoms. He or she will ask when they began and how they have affected your life. Your psychiatrist will want to hear about your background and upbringing, about any physical illnesses and about any medications which you have taken. The doctor may want you to have psychological tests, some laboratory tests, or physician evaluation by another physician. After your psychiatric evaluation is completed, the psychiatrists will give an assessment of your problem and make treatment recommendations.

What Happens in Psychiatric Treatment?

A psychiatrist uses treatments for different disorders, like any other physician. For example, the psychiatrist often uses individual psychotherapy, a treatment method in which doctor and patient work together in regularly scheduled meetings to understand and control the patient's emotional distress. In psychotherapy, the psychiatrist is far from being a mind reader. He or she listens carefully; assists in understanding the patient's difficulties; points out harmful patterns in the patient's thinking, feeling, and behavior; and helps guide the patient to find relief from emotional pain. The doctor may also recommend group therapy or family therapy.

Sometimes the psychiatrist may prescribe medication to ease a very depressed mood, to lessen extreme tension, to promote sleep, or to suppress unrealistic ideas.

Some patients with disabling emotional illnesses may need hospitalization lasting from several days to several weeks. Most inpatient psychiatric units provide a supportive environment with friendly and concerned staff who work under the psychiatrist's direction. A variety of inpatient psychiatric facilities are available. Most private psychiatric Hospitals provide acute and long term care. The smaller psychiatric units of many general hospitals usually provide acute care.

Many community mental health centers provide emergency, brief inpatient, and outpatient services. State psychiatric hospitals are a valuable backup resource for the mental health centers and the community at large.

How Long Will Treatment Take?

Some psychiatric problems are treated briefly in three to twelve weeks. Other psychiatric problems may require long term psychotherapy which may involve one or more sessions per week for several months or years. People with emotional illnesses that respond well to medication may require a short outpatient visit every month or so to check for medication side effects and to adjust dosages, as well as for brief talking. Some patients with chronic emotional illness must be maintained on medication for long periods of time with periodic visits to the psychiatrist; just as a person with chronic physical disease, such as diabetes, receives maintenance treatment from other physicians. For example, people who suffer manic-depressive illness can be maintained on medication, and are able to lead full and productive lives.

Some individuals need psychoanalysis, a more intensive treatment method, in which the patient lies on a couch to facilitate the flow of thoughts. This treatment requires three to five sessions per week, and focuses on the patient's thoughts, feelings, and dreams to resolve emotional problems and bring about personality change. It is carried out by psychiatrists who have specialized training in the technique of psychoanalyses.

How Do I Choose a Psychiatrist?

You have several resources when looking for a psychiatrist. Friends who have had psychiatric treatment may recommend the psychiatrist who helped them. Your physician can give you the names of several psychiatrists or you can contact a district branch in your area.

It is very important for you or your referring physician to know about the training and qualifications of any person with whom you consult. A psychiatrist is trained to make a diagnosis, to detect the possible role of physical diseases, to do psychotherapy, to understand how thoughts and feelings interplay and to prescribe medications, if required. The credentials of most psychiatrists are in the Directory of Medical Specialists or in the American Psychiatric Association Biographical Directory which may be reviewed at the reference desks of most public libraries. In addition, your local medical society has a directory which will have the credentials of the psychiatrists in your area.

Will My Insurance Pay for Psychiatric Care?

Most health insurance plans provide some coverage for psychiatric care. However, since plans vary considerably in their coverage, you should check your plan for both outpatient and inpatient coverage. Specifically, you should find out:

If you have a deductible amount which you must pay each year for inpatient or outpatient care;
The dollar limit for inpatient and outpatient care which your insurance will pay each calendar year;
If your insurance limits you to a certain number of inpatient days or outpatient psychiatric visits each year;
Whether you must make copayments for psychiatric care, and how much.

"Questions and Answers About Psychiatry" is a publication of the Psychiatric Society of Westchester, a district branch of the American Psychiatric Association.