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An Introduction to Psychiatry. Assist Prof Dr Sirwan K Ali Department of Psychiatry. Psyche. Definition. 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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An Introduction to Psychiatry Assist Prof Dr Sirwan K Ali Department of Psychiatry
Definition • Psychiatry is that branch of medicine dealing with mental disorder and its treatment • Psych : soul or mind • Iatros : healer
Why Study Psychiatry ? • 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
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
Why Study Psychiatry ?… • 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) • 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) • 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) • 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) • 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) • 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) • Non-verbal communication : * the interviewer’s non-verbal cues are important in guiding the interview • Finishing the interview
The Psychiatric History • 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… • 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… • Personal history: * mother’s pregnancy and birth * early development * childhood separation, emotional problems * schooling and higher education * occupations * sexual relationships
The Psychiatric History… • Personal history…. * menstrual history * marriage * children * forensic history • Past illness: * past medical history * past psychiatric history
The Psychiatric History… • 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 • 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 • 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 • 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 (with only a small number of cases involving long-term hospitalization
Inpatient care • 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
Outpatient care • 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
Psychological treatment Meditation Psychotherapy Counselling
Questions….. Comments….. (welcome)