Psychiatry is a specialized field of medicine dealing with the diagnosis, prevention, and treatment of mental health illnesses. What makes this discipline unique is its position at the intersection of natural and social sciences. It combines knowledge from fields such as biochemistry, physiology, and genetics with insights from psychology, sociology, and philosophy. This interdisciplinary approach is important because physical and mental illnesses often overlap and influence each other. Therefore, psychiatry combines psychological and biological methods in both clinical practice and research.
Difference between psychiatry and psychology
Many people think psychiatry is about treating mental illnesses with medication, while psychotherapy uses “gentler” methods like talk therapy. But the line between the two is not so clear, as psychiatry also includes the use of psychotherapeutic techniques.
The main difference lies in the professionals themselves: psychiatrists are always medical doctors, meaning they have completed medical school. In Germany, after finishing medical school, aspiring psychiatrists must undergo an additional five years of training that includes clinical psychiatry, psychotherapy, and one year of inpatient neurology.
Because of their medical training, psychiatrists can investigate potential factors linked to psychological symptoms. As doctors, they can also prescribe medications for mental health conditions, known as psychotropic drugs. Psychiatrists can treat patients with medication, psychotherapy, or a combination of both.
Psychiatric treatment methods
The psychiatric treatment methods expanded in the past 3 decades to the point of independent subdisciplines:
Psychopharmacological therapy (pharmacopsychiatry)
involves using medications to treat mental illnesses. This approach now constitutes the largest part of somatic treatments in psychiatry.
Psychotherapy
uses the “talk therapy” for treatment of mental healt disorders. Psychotherapy is based on diverse methods, described in detail in another chapter, with key foundations in depth psychology and learning/behavioral psychology.
Sociotherapy (Social Psychiatry)
focuses on the psychosocial, especially interpersonal, aspects of mental illness that are important for understanding its origins and, more importantly, for treatment and rehabilitation.
Key areas of psychiatry
The areas of psychiatry reflect their therapeutic implementation and consist of:
Psychopathology
The psychopathology studies abnormal behaviors and their influence on the affected individuals. It explores how these pathological symptoms relate to one another, describing and categorising them. Additionally, psychopathology is examining the underlying connections within mental disorders (interpretive psychopathology) and their links to interpersonal processes (dynamic or progressive psychopathology).
Biological-Psychiatric Research
employs methods such as neuroanatomy, neurophysiology and pharmacology, genetics, and others. Chronobiology examines the timing and rhythmic patterns of mental illnesses. Psychophysiology explores the relationship between physiological and psychological processes. This involves studying brain activities (e.g., EEG and neuroimaging methods like CT and MRI scans) and peripheral nervous system’s activities (e.g., autonomic functions like heart rate, blood pressure, skin conductivity, and temperature).
Psychology
relates to the scientific studies of normal and pathological mental processes and their practical applications. For medical professionals, areas like developmental psychology, personality theory, and psychological diagnostics are particularly relevant. Psychology interlinked with psychiatry includes the following sub-diciplines:
Medical psychology
Topics combining psychology and psychiatry are grouped under medical psychology, which includes subjects like psychosocial development, studies on mental health illnesses, and doctor-patient relationships.
Clinical psychology
is a branch of applied psychology and doesn’t refer to clinical settings or treatment in the traditional medical sense. Instead, it focuses on personality diagnostics (e.g., testing methods) and psychological insights to interactions across various life areas, such as counseling (e.g., education, career, family, or addiction counseling). The line between psychological counseling and psychotherapy is not always clearly defined.
Neuropsychology
investigates the connections between brain structure and function on the one hand and mental processes on the other, particularly in individuals with brain injuries. Of great practical significance is psychopharmacology, which studies the influence of medications on mental processes. This field is divided into neuropsychopharmacology, which includes animal experiments and biochemical research, and clinical psychopharmacology, which primarily focuses on applications of psychopharmaka.
Psychiatric Medication: Psychopharmaka
Medications, known as psychopharmaka, play a vital role in treating mental illnesses. These substances influence certain metabolic processes in the brain, suppressing the symptoms an restoring the mental health. Experts call these medication psychoactive or psychotropic drugs.
Psychopharmaka are among the most commonly prescribed drugs, used not only by psychiatrists but also by doctors from various specialties. They are essential for treating mental disorders like depression, anxiety, bipolar disorder or schizophrenia. These medications often make treating such illnesses possible by creating a foundation for use of psychotherapy or sociotherapy. Modern psychopharmaka act quicly and enable outpatient care, helping patients reintegrate into society.
Like all medications, psychopharmaka might have side effects and interactions with other drugs, highlighting the importance of their careful use under strict medical supervision. For each patient, the personal benefits must be weighed against potential side effects.
Psychopharmaka are generally categorized into following groups:
- Antidepressants
- Mood Stabilizers (Prophylactic treatments)
- Antipsychotics (Neuroleptics)
- Anxiolytics / Hypnotics
- Antidementia drugs
- Psychostimulants
Psychiatric treatment
Psychiatric disorders are at the forefront in terms of growth rates for outpatient, daycare, and inpatient treatment cases. They are also responisble for growing number of sick leaves and illness-related early retirements.
The state-of-the-art psychiatric therapy integrates medical, psychological, and social support measures.
Therapy options
Treatment options for mental healt disorders include medication and psychotherapy as the two main pillars of treatment. The focus on either component depends on the type and severity of the illness. Hovewer, there are many disorder-specific therapeutic approaches proven effective in treating certain conditions:
Psychoeducation
Psychoeducation is important therapeutic element in psychiatric treatment, which has become established in recent years. It involves targeted education of patients about their conditions.
Complementary therapies
Additionally, there are many complementary therapeutic methods, such as sociotherapy, occupational therapy and relaxation techniques. The use of thes therapies depends on various factors, such as the type and severity of the illness, its associated impairments, the patient’s personal preferences, and the skills they need to manage the condition.
Founding difficuties
A particular challenge in psychiatric care in Dubai is the funding. Most insurance plans do not cover psychiatric or psychological treatment, creating a significant barrier for patients. Most insurance plans do not cover psychiatric or psychological treatment, creating a significant barrier for patients.
Out-patient psychiatric treatment
Mental illnesses arise from a combination of factors, such as personal history, personality, life experiences, current or past stressors, conflicts, social and financial problems, physical illnesses, and more. During outpatient treatment, patients can identify the connections between these influences and their current situation. This helps them take steps toward personal growth, which they can implement in their lives with the help of a therapist.
Outpatient treatment (from home) is often preferred by most people dealing with depression. In many cases, effective recovery is possible outside a hospital, thanks to the wide range of available resources: care from a doctor or psychologist, medication, self-help groups, and therapeutic techniques like relaxation or mindfulness exercises.
If symptoms of a mental illness start to affect the patient’s daily life (work, family, social interactions, education), a consultation with a specialist is recommended. Outpatient treatment can be applied if patient’s can maintain a daily routine and have a supportive social environment.
Appointments are typically scheduled weekly, biweekly, or three times a week, with frequency reduced as stability improves. The duration of outpatient treatment varies but often spans several months.
Outpatient treatment is the preferred option for most types of mental illnesses. Alternatives like inpatient treatment are only considered if the severity of the illness prevents patients from staying in their usual environment and routine.
Therapy methods used in out-patient treatment
A wide variety of psychotherapeutic methods can be applied depending on your condition. All therapies are based on personal, confidential conversations where you and your therapist define problems, set treatment goals, and choose an appropriate method.
Outpatient psychiatric treatment may also include social work or nursing support, as well as non-verbal therapy methods like body therapy, art therapy, or occupational therapy. Medication may also be part of outpatient care.
Goals of outpatient treatment
Outpatient treatment aims to achieve various objectives, such as:
- Receiving a diagnosis
- Reducing psychological distress
- Clarifying problems
- Changing thought patterns, emotions, and behaviors
- Setting realistic treatment goals
- Optimizing medication if necessary
- Understanding the illness (psychoeducation)
- Improving symptom management
- Increasing self-efficacy
- Enhancing social integration
- Potentially reintegrating into work
By tailoring treatment to your needs, outpatient care offers a structured and effective way to improve mental health and overall well-being.
In-patient (hospital) psychiatric treatment
An inpatient psychiatric stay allows you to leave your usual environment behind and focus fully on yourself and your recovery. It can be a solution when depression cannot be overcome outside a clinical setting or has reached a severe stage.
However, there are specific situations where inpatient treatment is necessary or even indispensable:
1. High Risk of Suicide
This is the most common reason for hospitalization.
The risk of someone acting on suicidal thoughts must be carefully assessed during the first contact with a medical professional. In uncertain cases, family members or friends can contact the treating doctor or emergency services.
This risk may be high at the start of treatment but can also arise during treatment. In such cases, it’s important to try to persuade the person to voluntarily agree to inpatient care. In rare situations, involuntary admission under legal provisions may be unavoidable.
2. Severe Symptoms and Distress
During a depressive episode, some people experience particularly intense symptoms such as:
- Extreme anxiety
- Persistent and overwhelming feelings of guilt
- Severe concentration difficulties
These symptoms may cause significant distress and make it hard for the person to function properly. If the person lives alone or lacks adequate support, inpatient treatment may be indicated. In many cases, simply being removed from their usual environment can bring therapeutic relief.
3. Insufficient Outpatient Care
While outpatient care offers a wide range of treatments, a hospital stay provides the opportunity to engage in these therapies (talk therapy, nonverbal therapy, individual or group therapy) more intensively.
Additionally, a multidisciplinary team of specialists can offer a more comprehensive and holistic view of the patient’s situation. Many patients also benefit from interacting with others in similar circumstances, allowing them to share experiences and feelings.
4. Other Reasons for Inpatient Treatment
Other situations where hospitalization might be necessary include:
- Adjusting or changing medications due to side effects or inadequate response
- Managing patients with complex physical symptoms requiring closer monitoring
Inpatient care can offer unique therapeutic benefits, helping patients receive the support and treatment they need in a safe and structured environment.
Psychotherapy in psychiatric treatment
Psychotherapy, alongside medication (pharmacotherapy), plays a crucial role in treating mental and psychosomatic illnesses. Below is an overview of the most important psychotherapy methods. Cognitive behavioral therapy, with its techniques tailored for various disorders, is undoubtedly one of the most significant approaches today.
Additionally, psychodynamic therapy and person-centered therapy remain relevant in practice. Interpersonal therapy is also an important method for treating depressive disorders.
Behavioral Therapy
Behavioral therapy is effective for many conflicts, mental illnesses, and disorders. It is one of the most widely used and scientifically studied psychotherapy methods today. Based on modern learning theory, it assumes that all behaviors can be learned, maintained, and unlearned. “Behavior” refers not only to observable actions and physical reactions but also to internal feelings, thoughts, motives, and evaluations.
Modern behavioral therapy places emphasis on “cognitions,” meaning thought patterns and mental evaluations, leading to its current name: Cognitive Behavioral Therapy (CBT). Mental disorders are seen as maladaptive behaviors learned in response to external and internal stimuli. The goal is to relearn healthier behaviors or acquire skills that were previously not learned. Patients are encouraged to develop active, positive behavioral patterns.
Behavioral therapy is problem-focused. At the start, the therapist works with the patient to analyze the core issue and understand the underlying behavioral patterns. This includes identifying conditions that trigger or sustain certain reactions. Therapy goals are then clearly defined, treatment principles explained, and a detailed therapy plan established.
A key feature of behavioral therapy is the active involvement of patients, including tasks or “homework” between sessions. The main focus is to empower patients with self-help tools, helping them better manage daily challenges after gaining insight into the causes and development of their problems. Once therapy goals are achieved, treatment typically ends.
Behavioral therapy is used for various disorders, including anxiety disorders, depression, psychosis (e.g., schizophrenia), eating disorders (e.g., anorexia), addictions (e.g., alcohol dependency), obsessive-compulsive disorders, sexual dysfunctions, psychosomatic disorders, and different childhood and adolescent disorders.
Techniques of Cognitive Behavioral Therapy
In recent years, various psychotherapeutic methods based on behavioral therapy have been developed to address the wide range of mental disorders and symptoms, along with their individual manifestations. Depending on the nature of the problem, these techniques can be applied individually or in combination. Behavioral therapy serves as a foundational model that can be adapted to specific patient issues using a modular, multimodal treatment approach.
Cognitive techniques, or “working on thought patterns,” have gained significant importance. They help patients realize they can control their problems. Cognitive therapy is based on the idea that conditions like depression, anxiety, and obsessive-compulsive disorders are linked to negative, irrational, and distorted thinking patterns. Patients often generalize, focus narrowly on specific themes, or think in black-and-white terms. Therapy teaches them to observe themselves, identify problems, recognize personal blocks, develop and test alternatives, and ultimately reassess their thinking and behavior patterns—such as distancing themselves, reinterpreting situations positively, or viewing problems as challenges.
Exposure techniques
aim to reduce anxiety by confronting patients with fear-inducing thoughts or situations they tend to avoid. These techniques are particularly used for anxiety disorders, post-traumatic stress disorders, eating disorders, and obsessive-compulsive disorders. Examples include systematic desensitization and flooding.
Systematic desensitization
is based on the idea that fear and relaxation cannot coexist. Patients confront their fears gradually, starting with the least fear-inducing element and progressing to the most, while practicing relaxation techniques like progressive muscle relaxation. Initially, scenarios are imagined, and then they are experienced in reality. This method is mainly used for specific phobias, such as test anxiety, and aims for fear-free experiences from the start.
Flooding
exposes patients immediately to their most fear-inducing stimuli and encourages them to endure the situation until their fear subsides. This helps patients learn that anticipated negative outcomes do not occur and that they can influence their fear and the situation.
Behavioral therapy often uses positive reinforcement to encourage desired behaviors. The idea is that positive consequences increase the likelihood of repeated desired behaviors. Reinforcers can be social (e.g., praise or attention) or material (e.g., tokens). Patients participate in deciding what motivates them. Conversely, negative consequences like punishment reduce unwanted behaviors, according to operant conditioning principles.
Model learning
allows patients to observe and imitate complex behaviors demonstrated by role models. For instance, a therapist might show a patient with obsessive-compulsive disorder how to wash hands or check locked doors in a “normal” manner, enabling the patient to adopt these behaviors.
Developing skills in underdeveloped personal areas complements other treatment methods. Role-playing exercises help patients practice specific behaviors to better handle challenging situations. For instance, a patient with social phobia might engage in social skills training to assert themselves, express their needs, and build confidence. Problem-solving and communication training are also vital components in many cases.
Dialectical Behavioral Therapy (DBT)
Dialectical Behavioral Therapy (DBT) is a specialized form of cognitive behavioral therapy designed primarily to treat the complex symptoms of borderline personality disorder. DBT focuses on emotional regulation issues, viewing borderline symptoms, such as self-harm, as attempts by individuals to reduce intense emotional distress.
The therapy aims to identify the crises that lead to these unsuccessful coping attempts. Previously uncontrolled processes are made predictable for both the patient and therapist. Patients are taught and practice effective coping strategies to manage their often overwhelming emotional states.
DBT also addresses negative self-perception and interpersonal behavior patterns in borderline patients. Depending on the patient’s history and issues, trauma therapy techniques may also be incorporated.
Research has shown DBT to be highly effective in treating borderline personality disorder.
Cognitive Behavioral Analysis System of Psychotherapy (CBASP)
The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is the only psychotherapy method specifically developed for treating chronic depression. This approach combines interpersonal, cognitive, behavioral, and psychodynamic strategies. It is based on the understanding that chronically depressed patients often become unresponsive to feedback and consequences from their environment due to a disconnect in their perception.
The techniques used in CBASP focus primarily on social and interpersonal learning. Patients are encouraged to distinguish between familiar dysfunctional relationship patterns and the behaviors of the therapist or others, helping them change negative interaction patterns. To achieve this, an explicit transference hypothesis is developed. Unlike traditional psychodynamic therapy, this approach openly discusses potential “confusions” early in therapy, guiding patients to consciously differentiate the therapist from influential figures in their past.
Building specific behavioral skills is another key component of CBASP.
Studies have shown CBASP to be as effective as medication. The combination of CBASP with pharmacotherapy proved to be the most successful.