Transcript Introduction to psychiatry

Introduction to psychiatry
Dr. Sami Adil Al-Badri
4 oct. 2015
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What is disease? What is a patient?
Myths about psychiatry.
History of psychiatry.
Terminology.
History and MSE
Classifications of psychiatric disorders.
What is disease? What is patient?
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Is acne a disease?
Is pregnancy a disease?
Is car accident a disease?
What is the definition of HT in
Davidson’s?
Myths
• One diseases named …
• Jinn possession, witchcraft
• Patient never gets better, dangerous, stupid,
cannot participate in society, should be
confined to asylums
• Psychiatrists abuse patient by electricity, give
them medications that worsen them
History of psychiatry:
• Ancient times. The Babylonians considered
epilepsy as caused by devils.
• 700-1400: Psychiatric units in Baghdad
hospitals and in Mustanseryia University.
• 1900: Freud
• 1930s: neurotransmitters discovered (Nobel
Prize). (ECT).
• 1940s-50s: Lithium, Chlorpromazine,
Benzodiazepines, & Tricyclic antidepressants
(TCAs) were produced and double-blind
studies gave evidence for their efficacy. DSM-I.
• 1960s -70s: the antipsychiatry movement.
Some psychiatrists joined the movement.
Asylums ‫المصحات‬
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• 1980s-90s: new drugs, new psychotherapies
like the Cognitive Behavioral Therapy (CBT)
were discovered and evidence showed their
efficacy. Many asylums were closed and
general hospitals started to have psychiatric
units in it and the mentally ill patients were
encouraged to live in the society and to
participate in life.
Terminology:
• Disorders of perception: illusions and
hallucinations. Illusions are defined as
misperception of misinterpretation of real
external sensory stimuli. If occur in delirium
(=confusion). E.g.: elderly patient, at night, in
the intensive care unit sees the wires attached
to his chest to take ECG as snakes. The
treatment is to reassure the patient and open
the lights at night. Illusion can occur in normal
people.
• Hallucinations are false sensory perception
not associated with real external stimulus.
• Auditory occurs in what disorders?
• Visual hallucinations?
• Olfactory hallucinations?
• Hallucinations can be also gustatory ‫تذوقيّة‬and
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somatic ‫( جسمانية‬cocaine bug).
• Disorders of thought: it can be disorder of
content, or form, or stream ‫ تيار‬of thought.
Disorders of content are: delusions, obsessions,
and overvalued ideas. We can add here also
suicidal thoughts and homicidal thoughts.
• Delusions are false beliefs, based on incorrect
conclusion about external reality, not consistent
with patient's culture. Delusions do not occur in
normal people.
• Bizzare delusion: ====== schizophrenia.
• Paranoid delusions: includes persecutory ‫إضطهادية‬
delusions, delusions of reference ‫تُشير إليه أو تعنيه‬
َ َ‫ الع‬delusions.
‫بالقصد‬, and grandiose ‫ظ َمة‬
• Nihilistic delusion.
• Delusion of infidelity (delusional jealousy).
• Erotomania.
• Delusion of self-accusation ‫إتّهام الذات‬
• Delusions of control.
• There are other types of delusions.
• Obsessions: An idea, image, or impulse which
is recognized by the patient as their own, but
which is experienced as repetitive, intrusive
‫إقتحامية‬, and distressing. It occurs mainly in
obsessive-compulsive disorder, but can also
occur in schizophrenia, depression. It can
occur in a mild degree in normal people.
• Overvalued ideas: A form of abnormal belief.
These are ideas which are reasonable and
understandable in themselves but which come
to unreasonably dominate the patient's life.
Overvalued ideas occur in normal people and
they are mentioned here just to be
differentiated from obsessions and delusions.
• Under the term "Thought Content"
we can also put: suicidal ideas, and
homicidal ideas, as these two ideas
are dangerous and we must ask
about them when the patient seems
to have risk of them: e.g. risk of
suicide in depression, and risk of
homicide in morbid jealousy.
• Disorder of form of thought (also
called Formal Thought Disorders)
appears in the patient's speech and
the most important type is called:
loosening of association, in which
there is a lack of meaningful
connection between sequential
ideas.
• Disorders of stream or speed of thoughts
include mainly what is called as: "Pressure of
thought" which is the subjective experience of
one's thoughts occurring rapidly, each thought
being associated with a wider range of
consequent ideas than normal and with
inability to remain on one idea for any length
of time. Occurs in manic illness. And the
speech is called "pressured (or pressure of
speech)".
Disorders of mood:
• it can be normal or depressed or euphoric.
Depressed in depression and euphoric (or
called elated) in mania. Restricted, or blunted
affect. In severe forms of blunted affect, the
affect is called flat "flat affect". The affect is
also can be described as appropriate, or
inappropriate. Inappropriate.
• Other common signs and symptoms:
• Psychomotor retardation: this is characterized by
slowing of thought and activity. This occurs in
depression and is one of the criteria of it.
• Psychomotor agitation: characterized by a
dysphoric restlessness of speech and motor
behavior. This is also a criterion of depression.
• Stereotypies: repeated, purposeless, and
sometimes bizarre movements. It occurs in
schizophrenia, mental retardation, and in autism.
• Catatonic symptoms: catatonia is defined as an
increase in resting muscle tone to distinguish it from
rigidity. One of the catatonic symptoms is posturing
which is characterised by taking a posture
(sometimes bizarre posture) and maintaining it for
minutes. It occurs in schizophrenia and in
depression. Another catatonic feature is negativism
which is resistance to requests and commands. And
this occurs in chronic schizophrenia. Some catatonic
patients are totally immobile "stupor" and this
occurs in schizophrenia and depression. All catatonic
features respond well to electroconvulsive therapy
(ECT).
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History:
• Basic information
• Name, age, and marital status. Current occupation. Route
of referral.
• Chief complaints
• History of presenting complaints
• Past psychiatric and medical history
• Drug history
• Family history
• Personal history: Birth, Childhood, School, Work, Marriage.
• Forensic Hx.
• Social background information
• Premorbid personality
Mental Status Examination (MSE):
• Appearance: Age. Racial origin. Style of dress.
Level of cleanliness. General physical condition.
• Behaviour: Appropriateness of behaviour. Level of
motor activity. Apparent level of anxiety. Eye
contact. Rapport. Abnormal movement or
posture. Episodes of aggression. Distractibility.
• Speech: Volume, rate, and tone. Quantity and
fluency. Abnormal associations, clang and
punning. Flight of ideas.
• Mood: Subjective and objective assessment of mood.
• Anxiety and panic symptoms. Obsessions and
compulsions.
• Perception: Hallucinations. Depersonalisation and
derealisation.
• Thought Form: formal thought disorder. Content:
delusions, over-valued ideas obsessions, suicidal
intents, and homicidal intents.
• Cognition: Orientation. Level of comprehension.
Short-term memory. Concentration.
• Insight: Does the patient feel his experiences are as
the result of illness? Will he accept medical advice
and treatment?
Classification in psychiatry: the ICD-10 (made by WHO) and
DSM-IV (made in USA) include in a summary:
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Childhood or Adolescent disorders.
Delirium, Dementia, Amnestic, and other cognitive disorders.
Mental disorders due to a general medical condition.
Schizophrenia (including other psychotic disorders and schizotypal
personality disorder).
5. Mood (affective) disorders.
6. Anxiety (neurotic) disorders.
7. Somatoform, Factitious, and Dissociative disorders.
8. Sexual and Identity disorders.
9. Eating disorders.
10. Sleep disorders.
11. Impulse-control disorders.
12. Adjustment disorders.