An Introduction to Psychiatry

1. An Introduction to Psychiatry Dr. Rebwar G. Hama Psychiatrist School of Medicine

2. An Introduction to Psychiatry Dr. Rebwar G. Hama Psychiatrist School of Medicine

3. Definition • Psychiatry : is that branch of medicine dealing with mental disorder and its treatment • Psych : soul or mind • Iatros : healer

4. Mental Health Is a life long process a sense of harmony and balance for the individual, family, friends and community

5. Common confusions within psychiatry • 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

6. 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

7. Why Study Psychiatry ?… • 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

8. 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

9. 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

10. Barriers to Dx & Treatment in Primary Care Settings(patient factors) • 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

11. Barriers to Dx & Treatment in Primary Care Settings(physician factors) • 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

12. 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

13. 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 ‘organic’ is not used in DSM-IV

14. Psychosis and neurosis These terms have largely been removed from the international classifications but are still used in clinical practice

15. 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

16. 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

18. Classification systems • 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 summarized

19. ICD-10 (World Health Organization) • 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

20. DSM-IV (American Psychiatric Association) • 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

21. DSM-IV is a multiaxial system with five axes: • 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

22. Historical conception of abnormal behaviour • 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.

23. Supernatural model: • 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

24. Biological & Psychological model: • 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

25. Hippocrates & Galen • 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

26. 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)

27. The 19th 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

28. Deinstitutionalization • Community mental health movement was successful in reducing the population of mental hospitals

29. Development of biological treatment • ECT • Brain surgery • Neuroleptics • Benzodiazepines