Introduction to psychiatry
Dr. Sami Adil Al-Badri4 oct. 2015
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?
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
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 تذوّقيّة and somatic جسمانية (cocaine bug).
Disorders of thought: it can be disorder of content, or form, or stream تيار of 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 بالقصد, and grandiose العَظَمَة delusions.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).
History:
Basic informationName, 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:
• 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).
• Mood (affective) disorders.
• Anxiety (neurotic) disorders.
• Somatoform, Factitious, and Dissociative disorders.
• Sexual and Identity disorders.
• Eating disorders.
• Sleep disorders.
• Impulse-control disorders.
• Adjustment disorders.