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1. Introduction
Mental health professionals provide care for athletes of all abilities, from school team to elite competitor. Sport psychology, which focuses largely on performance enhancement, is an energetic and fairly well-developed specialty. On the other hand, sport psychiatry, with a focus on diagnosis and treatment of psychiatric illness in athletes in addition to performance enhancement, is still developing and evolving. Sport psychologists' and sport psychiatrists' approaches to athlete patients can be very complementary. However, general clinicians are the ones most often treating athletes and because of the still-developing state of knowledge of sport psychiatry, psychiatric care of athletes is often delivered without a full understanding of the diagnostic and therapeutic issues unique to this population. Appropriate diagnosis and treatment of mental illness is critical for the careers of upper level athletes. For recreational participants, it has the ability to impact overall satisfaction with sport and future involvement in physical activity.
The assumption that there is a low prevalence of mental illness in athletes is one reason for the paucity of research in this area. A tendency to idealize athletes leads health care providers to deny the existence or significance of psychiatric symptoms. Athletes themselves have a tendency to minimize apparent signs of weakness. Moreover, athletic behaviours sometimes resemble symptoms of mental disorders (e.g. meticulous attention to diet, relative hyperactivity), thereby confounding recognition of illness. The International Society for Sport Psychiatry, with its core purpose 'to facilitate scientific communication about, and understanding of, disorders of the brain and behaviour associated with sport, and to advance their prevention and treatment', is an organization that has made significant strides in destigmatizing mental illness in athletes and informing healthcare professionals and the public that in fact mental illness does occur in athletes. Nonetheless, stigma and an underdeveloped research base in this field remain problematic because of all the aforementioned issues.
While sport psychiatry is relatively new in the literature, our thorough review reveals important findings. In this paper, we discuss the current state of knowledge of (i) psychiatric diagnoses in athletes; and (ii) the use of psychiatric medications in athletes. Besides medications, sport psychiatrists also use psychotherapy and other treatment modalities, including family assessments and diagnosis[1-3] and participation in team assistance programmes.[4] However, non-medication-based treatments are beyond the...