What is a mental hospital

Psychiatry: Definition, Treatment & Specialists in Germany

Definition: what is psychiatry?

Psychiatry is a specialist medical discipline that deals with the diagnosis, prevention and treatment of mental illnesses. The special thing about the subject is that it occupies a position between natural science and humanities. She integrates knowledge from the subjects of biochemistry, physiology and genetics on the one hand, with the subjects of psychology, sociology and philosophy on the other. This is of great importance as physical and mental illnesses often overlap or are mutually dependent. It is therefore important to pay attention to such relationships in diagnostics in order not to overlook a possible cause of the disease.

Another special feature of this discipline is that diseases are often recognized late. A psychiatric disorder is often only taken seriously when the patient's subjective level of suffering is very high and everyday life is greatly restricted. This is also related to fear of stigma and social exclusion after diagnosis.

The distinction between "normal" and "pathological" is particularly difficult in this field and requires the greatest possible objectification. Psychiatrists use the ICD diagnosis catalog in order to be able to draw a strict line.

Which diseases are treated in psychiatric clinics?

Based on the ICD-10, the psychiatric disorders are summarized in the following groups:

  • Organic disorders
  • Psychotropic substance disorders: alcohol, drug, drug abuse, and addiction
  • Schizophrenia and Delusional Disorders
  • Affective disorders: depression , bipolar affective disorder
  • Neurotic, stress and somatoform disorders
  • Behavioral problems
  • Personality and behavior disorders
  • Intelligence disorders
  • Developmental Disorders: Autism, Rett Syndrome
  • Behavioral and emotional disorders with onset of childhood: ADHD, tic syndrome, social disorder

Psychiatric treatment

The two major pillars of treatment in this discipline are psychotherapy and pharmacotherapy.

Psychiatric psychotherapy

Psychotherapy is the targeted treatment of mental disorders with disease value. Psychotherapy can also be divided into two categories: psychoanalysis (mainly based on Sigmund Freud) and behavioral therapy.

Psychoanalysis

Psychoanalysis is based on Freud's developmental model, which divides the human psyche into “I”, “superego” and “it”. The “I” is the perceptible controllable entity, while the other two entities cannot be consciously perceived and express instinctual needs. The "superego" is the instance of reason and understanding and represents norms that were taught from outside, e.g. by parents or in school. The opposite pole to this is the “it”, which is the authority of the “life instincts” (love, sexuality, food, recognition) and the “death instincts” (aggression, destruction).

If drives of the “id” are not compatible with the norms of the “superego”, conflicts arise which the “me” has to resolve. The "I" makes use of various so-called defense mechanisms. These include:

  • Projection: The own unbearable desires are ascribed to other people
  • Conversion: The conflict is converted into a physical appearance.
  • Rationalization: Unbearable desires and behaviors are justified by rational reasons.
  • Regression: The conflict leads to temporary withdrawal to an earlier level of personality, e.g. thumb sucking in stressful situations
  • Sublimation: Unbearable desires are transformed into socially accepted achievements. Freud explains the human urge for art and culture by transforming mainly sexual and death instincts.
  • Repression: unwanted contents of consciousness are excluded from the "I", but not deleted.
  • Reaction formation: Unwanted feelings are changed into the opposite behavior.
  • Fixation: stopping at an earlier stage in psychosexual development.

Psychoanalysis is used for diagnosis as well as therapy. First, statements are made about the development, structure and function of the human psyche. The background to this theory is that the permanent use of defense mechanisms leads to the development of so-called neuroses, a quasi no longer fully compensated conflict between “id” and “superego”. The therapist uses the following techniques, among others:

  • Mirroring: The doctor reflects his feelings to the patient
  • Confront: The doctor consciously addresses certain behaviors and expressions
  • Interpret: The doctor creates hypotheses based on the patient's statements

Classical psychoanalysis according to Freud is used for severe psychological and psychosomatic disorders. Defense mechanisms have been reactivated by a current event and it is important to bring the unconscious conflict or the past trauma into consciousness.

In contrast to Freund's psychoanalysis, psychotherapy based on depth psychology focuses on central conflicts. It is used for moderate psychological and psychosomatic disorders. The current illness, situation and social relationships are analyzed and viewed in context.

Behavior therapy

According to the behavioral therapy model, human behaviors arise as a result of learning processes, whereby successful behaviors prevail. This principle of trying out and continuing successful behavior is called conditioning. First of all, the doctor prepares an individual behavioral analysis. A detailed interview is conducted for this, which consists of half-open and open questions and does not work through a catalog of questions. The SORKC model according to Kanfer is a widely used instrument for recording the patient. SORKC is an acronym for the areas to be queried:

  • Stimulus: In which situation does the behavior occur?
  • Organism: What is the patient's personality type?
  • Reaction: What is the reaction like on a motor, emotional and physiological level?
  • Contingency: Does the same reaction always have the same consequence in a row?
  • Consequence: What follows the reaction?

Psychiatric pharmacotherapy

Antipsychotics are a group of drugs that are used to treat schizophrenia, mania, delusional states. The term “neuroleptics” is increasingly being replaced by the more appropriate term “antipsychotics”. The typical antipsychotics, e.g. haloperidol, mainly work by blocking a dopamine receptor. The effect of the atypical antipsychotics is mediated by blocking several receptors. Low-potency drugs are mainly sedating and hardly antipsychotic.

Antidepressants are primarily used to treat depression and anxiety and obsessive-compulsive disorders. They are also used to support numerous other psychiatric illnesses. Nowadays, the following drugs are the first choice:

  • selective serotonin reuptake inhibitors (SSRIs)
  • selective serotonin norepinephrine reuptake inhibitors (SSNRIs)
  • Mirtazapine

They increase the level of serotonin and norepinephrine in the brain, which are messenger substances. As a result, they have a mood-enhancing effect. The right drug for the patient is mainly selected according to whether a sedating (e.g. mirtazapine) or activating effect (e.g. SSRI, SSNRI) is desired.

Lithium is an elementary metal and is used as a lithium salt in therapy. The drug has been the first choice in acute therapy and prevention of bipolar affective disorders since the 1960s. The mode of action of the lithium salts is still not fully understood. Lithium also has the effect of reducing suicidal acts, so it is used in treatment-resistant major depression.

Benzodiazepines have a broad therapeutic effect and are used in the context of several clinical pictures. They have an anxiety-relieving, hypnotic, muscle-relaxing and antispasmodic effect. They are mainly used in patients with anxiety and tension states. They are also used for sleep disorders and seizures. The side effects of amnesia and respiratory depression must be taken into account. Benzodiazepines show a strong potential for dependency and are subject to a strict indication guideline.

Which doctors and clinics are specialists in psychiatry?

Anyone who suffers from a mental illness wants the best medical care for themselves. That is why the patient asks himself, where can I find the best psychiatric clinic in Germany? Since this question cannot be answered objectively and a serious doctor would never claim that he is the best doctor, one can only rely on the experience of a doctor.

Patients receive a therapy plan tailored to their individual needs from resident psychiatrists and in psychiatric clinics. An interdisciplinary team of psychiatrists, the psychiatric nursing service, psychologists, social pedagogues, physiotherapists, occupational therapists and music therapists work closely together in clinics.

Outpatient psychiatric therapy

Not every psychiatric illness requires inpatient treatment. That is why resident psychiatrists and psychiatric outpatient clinics are usually the first point of contact for patients. After a diagnostic assessment, further outpatient therapy or referral to a clinic can take place.

Inpatient psychiatric treatment

Inpatient admission should be made if the patient's condition requires 24/7 care. Inpatient treatment offers the opportunity to take distance from a potentially stressful environment and daily worries. After sufficient improvement, a gradual reintegration into everyday life can be tackled.

We help you to find an expert for your illness. All listed doctors and clinics have been checked by us for their outstanding specialization in the field of psychiatry and psychotherapy and await your inquiry or your treatment request.

Where can I find an experienced psychiatrist?

At PRIMO MEDICO you will only find experienced specialists and clinics for psychiatry and psychotherapy in Germany, Austria and Switzerland. We currently have recognized experts in the following cities:

Swell:

  • Karow, Lang-Roth, General and Special Pharmacology and Toxicology 2012, self-published
  • Tonner, Hein, Pharmacotherapy in Anesthesia and Intensive Care Medicine, Springer
  • Falkai et al., S3 guideline for schizopheria, German Society for Psychiatry, Psychotherapy and Neurology (DGPPN)
  • Bandelow et al., Kurzlehrbuch Psychiatrie, Steinkopff