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PSYCHIATRISTS



Michael J. Wolf, M.D.
620 Newport Center Drive
Newport Beach, CA 92660
(949) 717-6863
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Dr. Wolf completes a thorough assessment for every new patient and then discusses the various treatment options available. His background includes extensive training in both psychotherapy and psychopharmacology.

Specialties
Psychiatry: psychotherapy, psychopharmacology, treatment for depression, anxiety, phobias, relationship problems, women's health issues.

Psychiatry is a medical specialty whose primary goal is to improve people's mental well-being. This is sometimes done by first doing a thorough diagnostic assessment of the person from a biological, psychological, and social/cultural perspective. An illness or problem can then be treated or managed by medication (usually) or various forms of psychotherapy (sometimes). Psychotherapies assist people to gain insight into their problem as well as their relationships with others.

The name derives from the Greek for "healer of the spirit". In the United States, it is practiced by people, termed psychiatrists, holding M.D. or D.O. degrees.

While all clinicians encounter patients with mental illnesses and any of them may treat it, psychiatrists specialize in these areas. They are specifically trained to understand the biological underpinnings of mental illness as well as the contributions of medical illnesses to psychiatric symptoms. Treatment can involve medication, psychotherapy (such as cognitive behavior therapy, interpersonal therapy, and psychodynamic psychotherapy), and psychosocial interventions. The majority of modern treatments involve medication.

Psychiatry is one of the medical disciplines that involve the diagnosis and medication of mental and behavioral disorders such as clinical depression, bipolar disorder, schizophrenia and anxiety disorders.

Most psychiatric illnesses cannot currently be cured. While some have short time courses and only minor symptoms, many are chronic conditions which can have a significant impact on a patients' quality of life and even life expectancy, and as such may require long-term or life-long treatment. Efficacy of medication for any given condition is also variable from patient to patient, with some patients having complete resolution of symptoms and others unfortunately having poor or minimal response to even the strongest measures. The majority of patients will fall somewhere in between.

In general, psychiatric treatments have changed over the past several decades, beginning with the advent of modern psychiatric medications (see History section, below). In the past, psychiatric patients were often hospitalized for six months or more, with some cases involving hospitalization for many years. Today, most psychiatric patients are managed as outpatients. If hospitalization is required, the average hospital stay is around two to three weeks, with only a small number of cases involving long-term hospitalization.

The field of psychiatry itself can be divided into various subspecialties. These include:

Child and adolescent psychiatry
Adult psychiatry
Psychiatry of Old Age (Psychogeriatrics)
Learning disability
Consultation-liaison psychiatry
Emergency psychiatry
Addiction psychiatry
Forensic psychiatry
Practicing psychiatrists may specialize in certain areas of interest such as psychopharmacology, mood disorders, neuropsychiatry, eating disorders, psychiatric rehabilitation, crisis assessment and treatment, early psychosis intervention, community psychiatry (home treatment and outreach) and various forms of psychotherapy such as psychodynamic therapy and cognitive behavioral therapy.

Individuals with mental illness are commonly referred to as patients when seen by physicians but may also be called clients, especially when treated privately by allied healthcare professionals. They may come under the care of a psychiatrist or other psychiatric practitioners by various paths, the two most common being self-referral or referral by a primary-care physician. Alternatively, a patient may be referred by hospital medical staff, by court order, involuntary commitment, or, in the UK and Australia, by sectioning under a mental health law.

Whatever the circumstance of their patient's referral, a psychiatrist first assesses their patient's mental and somatic condition. This usually involves interviewing the patient and often obtaining information collated from other sources such as other health and social care professionals, relatives, associates, law enforcement and emergency medical personnel and psychiatric rating scales. Physical examination is usually performed to establish or exclude other illnesses (e.g. thyroid dysfunction or brain tumors) or identify any signs of self-harm. Blood tests and medical imaging may be also performed. However, a study of the CAT scans of 397 psychiatric patients found no anomaly clinically related to the patients' psychiatric condition and concluded, "the pretest probability of finding a space-occupying lesion or other pertinent abnormality in patients presenting with psychiatric illnesses in this retrospective study appears not to be greater than that of the general population. The outcome of this study could be implemented to develop a clinical pathway for limiting assessment by CT for possible organic pathology in acute psychiatric illness."

Various forms of medication, therapy and counseling deal with mental and behavioral conditions. Psychotherapy may be used for many conditions, either exclusively or in combination with medication. In the United States, only physicians, medical psychologists, nurse practitioners, or physician assistants may prescribe mental health medication. In some countries, mental health medication may only be prescribed by physicians. Commencing treatment with medication requires the patient to agree to this treatment (although in many countries the law provides overriding circumstances) and that they will follow the dosage prescribed. Like all medications, psychiatric medications can produce side-effects in patients and hence often involve ongoing therapeutic drug monitoring, for instance full blood counts or, for patients taking lithium salts, serum levels of lithium. Electroconvulsive therapy (ECT) is sometimes administered for serious and disabling conditions, especially those unresponsive to medication. ECT has drawn criticism from anti-psychiatry groups despite evidence for its efficacy.

Psychiatric patients may be either inpatients or outpatients. Psychiatric outpatients periodically visit their psychiatrist for consultation in his or her office, usually for an appointment lasting thirty to sixty minutes. These consultations normally involve the psychiatrist interviewing the patient to update their assessment of the patient's condition and management of any medication. The psychiatrist may also provide psychotherapy. The frequency with which a psychiatrist sees patients varies widely, from days to months, depending on the type, severity and stability of each patient's condition, and depending on what the psychiatrist and patient decide would be best.

Psychiatric inpatients are patients admitted to a hospital to receive psychiatric care, sometimes involuntarily. In North America, the criteria for involuntary admission vary with jurisdiction. It may be as broad as having a mental disorder and being capable of mental or physical deterioration or as narrow as a patient being considered to be an immediate danger to themselves or others. In the UK, involuntary admission is limited to this narrow criterion.

Once in the care of a hospital, patients are monitored, given medication and tested by a psychologist. If necessary, they are prevented from harming themselves or others. Hospitalized patients are increasingly being managed in a multidisciplinary fashion, meaning patients may encounter a variety of nursing staff, occupational therapists, psychotherapists, social workers and other healthcare professionals.

 

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