Transcript An Introduction to Psychiatry

An Introduction to Psychiatry
Dr. Rebwar G. Hama
Psychiatrist
School of Medicine
An Introduction to Psychiatry
Dr. Rebwar G. Hama
Psychiatrist
School of Medicine
Definition
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Psychiatry : is that branch of medicine
dealing with mental disorder and its
treatment
Psych : soul or mind
Iatros : healer
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Mental Health
Is a life long process a sense of
harmony and balance for the
individual, family, friends and
community
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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
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Why Study Psychiatry ?
1- 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
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Why Study Psychiatry ?…
2- Global burden of mental disorders
3- Subject of medicine is human being, a
“biopsychosocial”
4- Consideration of the psychological
aspects of the doctor-patient relationship
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Biopsychosocial Approach
Mental health care is a multiagency task
which may involve multidisciplinary teams
of workers developing in conjunction with
the patient/client and their carers, a
program of treatment and support to meet
their needs
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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
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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
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Common terms in psychiatric
classification
Organic and functional:
 Psychiatric conditions are sometimes divided
into organic brain disorders and functional
mental illnesses
 Organic conditions are caused by
identifiable physical pathology affecting the
brain, directly or indirectly, and include, for
example, learning disabilities and the
dementias
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Functional conditions have usually been
attributed to some kind of psychological
stress, although in many cases it would be
more honest to say that their cause is not
known
As knowledge advances, some ‘functional’
conditions are likely to be reclassified as
‘organic’ (as currently may be happening for
schizophrenia), and for this reason the term
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‘organic’ is not used in DSM-IV
Psychosis and neurosis
These terms have largely been removed
from the international classifications but
are still used in clinical practice
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Psychoses (for example,
schizophrenia, bipolar affective
disorder)
Psychoses are characterized by the
following:
 Severe illness
 Symptoms outside normal experience,
such as delusions and hallucinations
 Loss of insight; subjective experience
mistaken for external reality
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Neuroses (for example, anxiety
disorders, most cases of
depression)
In comparison with psychoses, neuroses
may be characterized as follows:
 More common
 Often less severe
 Symptoms possibly understandable as
an exaggeration of the normal response
to stress
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Classification systems
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Classification systems include categorical,
dimensional, and multiaxial types
In the multiaxial type of classification, each
case is rated on several separate categorical
systems, each measuring a different aspect
(for example; psychiatric illness, personality,
intelligence)
The two main classification systems in
international use, ICD and DSM, will now be
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summarized
ICD-10 (World Health Organization)
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The tenth edition of the International
Classification of Disease (ICD-10),
prepared by the World Health
Organization, covers the whole of
medicine, and also includes a Classification
of Mental and Behavioural Disorders. This
is the official classification used in the UK.
It is a descriptive classification
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DSM-IV (American Psychiatric
Association)
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The Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition (DSMIV)
comprises the official classification system
of the American Psychiatric Association,
and has been influential in the UK
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DSM-IV is a multiaxial system
with five axes:
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Axis I: Clinical syndromes
Axis II: Developmental disorders and
personality disorders
Axis III: Physical disorders and conditions
Axis IV: Severity of psychosocial stressors
Axis V: Global assessment of functioning
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Historical conception of
abnormal behaviour
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4000 of years, humans have tried to explain
& control problematic behaviour
Humans have always supposed that certain
agents outside our bodies & environment
influence our behaviour, thinking, &
emotions.
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Supernatural model:
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These agents which might be divinities,
demons, spirits, or other phenomena such
as magnetic fields or the moon or the stars
In addition since ancient Greece, the mind
has often been called the SOUL or the
PSYCHE & considered separate from the
body
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Biological & Psychological
model:
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Although many have thought that the
mind can influence the body &, in turn,
the body can influence the mind, most
philosophers looked for causes of
abnormal behaviour in one or the other
These 3 models (Supernatural, Biological,
& Psychological) are very old but continue
to be used today
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Hippocrates & Galen
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The Greek physician Hippocrates (460-377
B.C.) is considered the father of modern
medicine
The Roman physician Galen (129-198 B.C.)
later adopted the ideas of Hippocrates &
developed them further, creating a powerful
school of thought within the biological
tradition that extended well into the 19th
century
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Hippocrates assumed that normal brain
functioning is related to 4 bodily fluids or
humors:
Blood comes from the heart, Black bile from
the spleen, Phlegm from the brain, &
Yellow bile from the liver
(too much black bile was thought to cause
Melancholia-Depression)
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The
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19
Century
The mentally ill patient should be treated as
physically ill (large hospitals)
(Rest, Diet, proper room Temp. & Ventilation)
 At the end of 19th century, leaders in
psychiatry were alarmed at the increasing
size & impersonality of mental hospitals &
recommended that they be downsized
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Deinstitutionalization
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Community mental health movement was
successful in reducing the population of
mental hospitals
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Development of biological
treatment
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ECT
Brain surgery
Neuroleptics
Benzodiazepines
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