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Introduction to Psychiatry

Sir Christian Kreipke, PhD, FRSC . Introduction to Psychiatry . A disease manifested in the brain that causes deviation in behavior from a set of socially acceptable norms Distinct from psychological conditions in that a supposed somatic pathotrajectory exists

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Introduction to Psychiatry

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  1. Sir Christian Kreipke, PhD, FRSC Introduction to Psychiatry

  2. A disease manifested in the brain that causes deviation in behavior from a set of socially acceptable norms Distinct from psychological conditions in that a supposed somatic pathotrajectory exists Can be induced by genetic conditions, damage to the brain, or environmental conditions What is a Psychiatric Condition?

  3. Normal Abnormal

  4. Psychiatric Criminal

  5. Most societies have there own set of codes for “normal” and “abnormal” behavior • These closely defined norms may or may not overlap • Examples: • ADHD does not exist in Cuba • Infanticide is culturally acceptable in China • Cannibalism is still practiced in certain tribes of the South Pacific region • Female circumcision • Tattoos • Etc. Medical Anthropological perspective

  6. Schizophrenia (10%) Turret's Syndrome (~1:10,000) Bipolar (~1:5,000) ADHD (~15-20%) Autism (~15%) Depression (~20%) Obsessive Compulsive disorder (~5%) Common Psychiatric Disorders

  7. Characterized by a whole host of conditions • According to the DSM-IV, if the subject exhibits 2 or more of the following they have a probability of schizophrenia: • Auditory/visual hallucinations • Asocial behavior • Aggressive behaviors • Confusion • Negative affect • “split personality disorder” Schizophrenia

  8. Possible biological cause • Abnormal development in striatum, medial temporal lobe, and/or corpus collosum • Hyperdopaminergic and hypoglutamatergic drive to the striatum • More generally, disrupted dopaminergic system Schizophrenia

  9. Treatment: • Haldol (D2 antagonist) • Clorpromazine/clozapine (atypical antipsychotic which binds D3/4 system) • PROBLEM: • Patient’s behavior can be severely altered Schizophrenia

  10. Characterized by multiple personality types (2 or more) and/or by severe shifts in mood (manic-depression) Bipolar

  11. Possible biological cause: • Abnormal development of striatum, corpus collosum, and/or prefrontal cortex • Disrupted glutamatergic drive to the cortex Bipolar

  12. Treatment: • Lithium (mood stabilizer) • Mode of action? UNKNOWN Bipolar

  13. Characterized by lack of ability to focus on single task and/or hyperactivity associated with lack of focus ADHD

  14. Possible biological causes: • Dysfunctional dopaminergic system particularly in the striatum ADHD

  15. Treatment: • Dopaminergic drugs (amphetamine derivatives, psychostimulants) • How do they work? • Deplete the dopamine system quickly. Recovery time squelches dopamine drive and quiets overactive behaviors. Specifically they cause dopaminergic neurons to release dopamine and block reuptake via blocking the DAT ADHD

  16. Characterized by chronic negative affect usually not correlated with a particular event. CAVEAT: clinical depression may be triggered by environmental cue. Emphasis on chronic!!! Depression

  17. Possible biological cause: • Disrupted serotonergic drive to cortex Depression

  18. Treatment: • SSRIs. Selectively prevent serotonin reuptake through the serotonin transporter, thus allowing more to remain in the synaptic cleft. Depression

  19. Characterized by repetitive often self-injurous behaviors OCD

  20. Possible biological cause • Recapitulates that of depression OCD

  21. Treatment: • SSRIs most effective • Cognitive behavioral therapy OCD

  22. Autism, turret’s and a host of other pathological conditions sadly have unknown biological pathotrajectories and hence treatment is often laborious and inconclusive Others

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