Transcript Organic Disorders

Introduction to psychiatry
Prof. Dr. Elham Khattab Aljammas
18th 0f sept 2013
Objectives:
1. To differentiate between Neurosis & psychosis
2. To experience the skills of history taking in psychiatry
3. To experience the skills of clinical psychiatric examination
4. To detect the factors the make you suspect a psychiatric diagnosis
5..To determine the indications of admission to a psychiatric ward
what is psychiatry
It the science that deals with the phenomenon of mental disorder
regarding their classification, clinical presentation & diagnosis ,
explanation, planning of management , possible etiological factors
& prognosis
Mental Disorder

Mental illness means a state of mind which affects 
thinking, perceiving, emotion or judgment and which
seriously impairs mental function to the extent that
require care or medical treatment in his or her own
interest or in the interest of other people.
Severe dementia means a deterioration of the brain which significantly impairs your
intellectual function and affects thought, comprehension and memory and which
includes severe psychiatric or behavioural symptoms such as physical aggression.
Significant intellectual disability’ means a state of arrested or incomplete
development of the mind which includes significant impairment of intelligence and
social functioning and abnormally aggressive or seriously irresponsible conduct.

Psychiatric services
. Psychiatric hospitals, also known as mental hospitals
Emergency psychiatry 
The crisis stabilization unit is in effect an
emergency room for psychiatry
. Open units. Medium-term, Juvenile wards
. Long-term care facilities,Halfway houses
. Political imprisonment
,

Classififcation
there is two widely used classifications:
1.International classification : ICD use in most countries
2.Diagnostic & statistical manual : DSM used mainly in USA
In both there is a code for every major psychiatric disorders, then
sub-coding for every sub-type.
Psychiatric Disorders
Psychiatric Disorders
Organic
Non-Organic
Acute
Chronic
Others
Psychoses
Neuroses
Others
Delirum
Dementia
Alcohol …
Schizophrenia
Anxiety disorders
Personality dis.
Wernicke’s
Korsakoff
Head Injury
Mood disorders
Adjustment dis.
Sleep disorder
Etc….
Etc….
Dysthymia
Sex disorder
Dissociative dis.
Etc…
Organic
(there is organic damage to CNS)
Functional
(No organic damage but disturbance in the function of CNS)
Organic Disorders
* Acute (Dilirium)
* Subacute ( Dysamnesia)
* Chronic ( Dementia)
Functional Disorders
* Schizophrenia & related disorders
* Affective disorders ( depression , mania ,& bipolar (manic
depressive))
* Neurosis:
- Generalized anxiety disorder
- Phobia & panic disorder
- stress disorder
- Obsessive compulsive disorder
- Somatoform disorder
* Substance abuse
* Personality disorder
Neurosis
A group of mental disorders characterized by :
1.reality testing ( patient still differentiate between
reality &
un-reality i.e no Hallucination nor delusion)
2.Insight still present realize that he is ill & that he needs treatment
Psychosis
A group of mental disorders characterized mainly by:
1.Loss of reality testing ( patient can’t differentiate between reality
& un-reality i.e the presence of hallucination or delusion)
2.Loss of insight i.e patient can’t recognized that he is ill or he
needs treatment
Neurosis
Psychosis
Severity
Features
Minor mental illness
Abnormal in quantity
e.g. anxiety
Major mental illness
Abnormal in quality
e.g. hallucinates
Insight
Preserved
Affected
Treatment
Psychological & drugs
Drugs & ECT
Psychological assessment
We ask about :
Marital status , occupation , place of birth. In more details than
in other branch of medicine.
History of present complaint
Date & circumstance at onset
Reasons for seeking treatment
Ways in which the symptoms started
Specific questions
Sleep pattern
Appt. & weight
Energy
Concentration & level of interest
Libido
Headache, other aches & pain
previous & family history
Mood , especially anxious, depressed or irritable
Previously depressed or irritable
Previous reception of psychoactive drug
Previous nervous trouble
Psychiatric treatment
Suicide attempts
Recent life changes
Moving house
Changing job
Domestic disturbance such as difficult with children or spouse
Engagement, marriage, separation or divorce
Illness in family members or divorce
Any accident
Current social circumstance supportive or not
Personal history
Specific questions mainly:
Premorbid personality
His relation with others
Schooling
Jobs
Hobbies
Attitude towards others, religion, social background,
When to admit a patient to a psychiatric ward?
1.For assessment & then treatment
2.To protect the family & society especially when patient is
dangerous or to protect the patient from his society
3.To protect the patient from himself like in suicidal patients
4.To give relief for the family
5.there is impending relapse of acute illness
Admission to a psychiatric hospital
The rules about admission to psychiatric
hospitals or units are set out in the Mental
Health Act 2001 which has been fully
implemented since 1 November 2006. These
rules apply in the same way to public and
private psychiatric facilities. The Act requires
that psychiatric hospitals and units be
registered as approved psychiatric
centres..a.volutary .b.involuntary admission
Psychiatric unit addmission
Patient present as a danger to self
(Suicidal,elderly,severe depressive illness refusal to
eat or drink ,self neglect ,lonely,)
-Recent (within the past 72 hours) suicide attempt
-the patient has a current suicide plan, specific suicide
intent, or recurring suicidal ideation
-self-mutilative behavior
2. Patient presents as a danger to others .
(psychotic –schizophrenia ,mania
,MDP.Purperal psychosis ,Infanticide)
-Dangerously aggressive behavior
-Threats to kill or seriously injure another
person
- the patient has a current homicide plan,
specific homicidal intent, or recurrent homicidal
3. Patient is gravely disabled and
unable to care for self
- Inability of patient to comply with prescribed
psychiatric and/or medical health regimens .
- Patient has a history of decompensation without 
psychotropic medications and patient refuses to use
these medications as an outpatient
- Patient is at risk of health or life due to non- 
compliance with medical regimens
-. Patient presents with acute onset or acute 
exacerbation of hallucinations, delusions, or illusions
of such magnitude
-that the patient’s well being is threatened. 
nursing

4.. Treatment of the patient’s psychiatric condition requires nursing 
services on an inpatient hospital basis requiring 24-hour nursing
observation under the direction of a psychiatrist. 
services include, but are not limited to 
A. Suicide precautions, unit restrictions, and continuous observation 
and limiting of behavior to protect self or others
B. Active intervention by a psychiatric team to prevent assaultive 
behavior
C. The patient exhibits behaviors that indicate that a therapeutic 
level of medication has not been reached and this necessitates 24hour observation and medication stabilization.
Types of managements:


CRISIS MANAGEMENT 
IN-HOME CRISIS SERVICE 
RESIDENTIAL SERVICES 
PARTIAL HOSPITALIZATION 
DAY PROGRAMS 
MEDICATION MANAGEMENT 
FAMILY SUPPORT SERVICES 
COUNSELING AND HERAPY T 
PSYCHOSOCIAL KILLS TRAINING S
TREATMENT INTEGRATION 
TARGETED CASE MANAGEMENT 
OTHER (SPECIFIY) 


THANK YOU
WHO IS RESPONSIBLE FOR SUCH differences
& WHY?