Transcript An Introduction to Psychiatry

An Introduction to Psychiatry
H.Amini M.D.
Department of Psychiatry
TUMS
Definition
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Psychiatry is that branch of medicine
dealing with mental disorder and its
treatment
Psych : soul or mind
Iatros : healer
Common confusions within
psychiatry
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Psychology : a science that investigates
behaviour, experience, and normal
functioning of the mind
Psychotherapy : the treatment of
psychological issues by non-physical means
Psychoanalysis : a particular sort of
psychotherapy, or means of exploring the
unconscious mind
Why Study Psychiatry ?
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Psychiatric disorders are prevalent and
often go untreated :
* lifetime prevalence in USA : 28%
* lifetime prevalence in Iran : 10.5-21%
* only 40% receive treatment during
lifetimes
* in general practice : 1/6-1/4 of the
patients seen have a psychiatric
problem
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Why
Study
Psychiatry
?…
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* depression is diagnosed in only 50%
of those with depression who
present to GPs
* adequate treatment ensues in only
about 17% of depressed patients in
primary care settings
* half the patients who commit suicide
sought treatment in a primary care
setting within 1 month of dying
* two-thirds of patients with undiagnosed
depression have six visits or more a
year with GPs for somatic
complaints
Why Study Psychiatry ?…
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Global burden of mental disorders
Subject of medicine is human being, a
“biopsychosocial”
Consideration of the psychological
aspects of the doctor-patient
relationship
Models of Mental Disorders
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Dogmatism
Eclectism
Pleuralism
Integrationism
Biopsychosocial Approach
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Mental health care is a multiagency task
which may involve multidiciplinary
teams of workers developing in
conjunction with the patient/client and
their carers, a program of treatment
and support to meet their needs
Barriers to Dx & Treatment in
Primary Care Settings
(patient factors)
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May present with a somatic complaint
Concurrent medical illness often obscures
psychiatric symptoms
Denial
Stigma & shame
The belief that psychiatric illness is
untreatable
The belief that drugs are mind-altering and/or
addictive
Barriers to Dx & Treatment in
Primary Care Settings
(physician factors)
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A lack of time
Fear of being embarrassed
Uncertainty
Fear that the patient will have an illness
that is unresponsive to treatment
Prior negative experience
Lack of knowledge
Psychiatric Interview
(aims)
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Obtain information
Understand the person with the illness
Form a therapeutic relationship
Assess the emotions and attitudes of
the patient
Provide the patient with information
about the illness, treatment
recommendations, and prognosis
Psychiatric Interview
(general advice)
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Putting the patient at ease :
* place : not to be overheard
* arrangements for seating
* greet the patient by name
* introduce yourself with your own
name and your role
* explain
Psychiatric Interview…
(general advice)
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Starting the interview :
* begin with a general question
* to avoid closed questions and leading
questions
Proceeding with the interview :
* to keep the patient to relevant topics,
while letting him talk freely
Psychiatric Interview…
(general advice)
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Non-verbal communication :
* the interviewer’s non-verbal cues
are important in guiding the
interview
Finishing the interview
The Psychiatric History
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Identifying data:
name, age, sex, marital status, education,
occupation, address, …
Present Illness:
* patient’s description of the
problem
* details of the nature of the
problem
* present severity of the symptoms
other relevant problems
* onset and course
The Psychiatric History…
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Family history:
* parents: age, occupation,
personality,relationship with the
patient
* sibling:
* social position; atmosphere of the
home
* Hx of mental disorder or drug
abuse
The Psychiatric History…
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Personal history:
* mother’s pregnancy and birth
* early development
* childhood separation, emotional
problems
* schooling and higher education
* occupations
* sexual relationships
The Psychiatric History…
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Personal history….
* menstrual history
* marriage
* children
* forensic history
Past illness:
* past medical history
* past psychiatric history
The Psychiatric History…
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Premorbid personality:
* relationships
* leisure activities
* prevailing mood
* attitudes, standards
* habits
Drugs, alcohol, tobacco