Transcript An Introduction to Psychiatry

An Introduction to Psychiatry
Assist Prof
Dr Sirwan K Ali
Department of Psychiatry
Psyche
Definition
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Psychiatry is that branch of medicine
dealing with mental disorder and its
treatment
Psych : soul or mind
Iatros : healer
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
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)
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
Difficulties in Classifications and Diagnosis in
Psychiatry
What is a mental illness, when is a
mental state abnormal?
Psychiatric symptoms and signs are
non specific.
Delusions and hallucinations occur
in different psychiatric disorders.
Depression can be a primary
problem or part of other disorder.
There are no reliable biological
markers.
Psychiatrist can not agree.
Diagnostic systems of psychiatric
disorders
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ICD-10(International Classification
of Diseases)
the World Health Organisation : used
world wide
In USA: Diagnostic and Statistical
Manual of Mental Disorders ( DSM
IV-TR ,2000
DSM :has five axes
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Axis I: Psychiatric disorders
Axis II: Personality disorders / mental
retardation
Axis III: General medical conditions
Axis IV: Social functioning and impact of
symptoms
Axis V: Global Assessment of Functioning
Psychiatric treatment
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In the past, psychiatric patients were
often hospitalized for six months or more,
with some cases involving hospitalization
for many years
Today, most psychiatric patients are
managed as outpatients
Average hospital stay is around 2-3 weeks
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noitazilatipsoh
Inpatient care
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admitted to a hospital, sometimes involuntarily
criteria for involuntary admission vary with
jurisdiction
patients are assessed, monitored, and often given
medication and receive care from a
multidisciplinary team
physicians, nurses, psychologists, occupational
therapists, psychotherapists, social workers, and
other medical professionals
Inpatient care
Inpatient care
Outpatient care
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periodically visit for consultation
Office base
usually 30-60 mins
psychiatric practitioner interviewing
assessment of the patient's condition
provide psychotherapy or review medication
frequency : varies widely, from days to months
depending on the type, severity and stability of
each patient's condition, and on what the clinician
and patient decide would be best
Biomedical treatment
Biomedical treatment
Electroconvulsive therapy
Psychological treatment
Meditation
Psychotherapy
Counselling
Psychiatric rehabilitation
Questions…..
Comments…..
(welcome)
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