introduction to psychiatry-converted.pptx

introduction to psychiatr

1. Introduction to Psychiatry

2. Introduction Definitions Normal vs abnormal History Famous Personalities Phenomenology Nosology Sub-Specialties

3. Definitions Psychiatry - It is a branch of medicine dealing with mental disorder and its treatment or in other words branch deals with morbid psychological process. ‘ Psych ’- soul or mind ‘ Iatros ’- healer Term was coined by Johann Christian Reil (DNB 2013)

4. Psychiatrist : Medical graduate with post graduate specialization in psychiatry (DPM,MD,DNB). Helping and treating people with emotional difficulties and disturbed interpersonal relationships as a result of their abnormal perceptions, feelings and thoughts.

5. Psychology - It is a science that investigates behavior, experience, and normal functioning of the mind. Psychologist: Non medical therapist with a basic degree in psychology(MA/MSc) and specialization in clinical psychology( Mphil / Phd ). They administer the various Psychological tests in addition to carrying out psychosocial methods of treatment. C/F Psychiatric social worker . Psychotherapy - the treatment of psychological issues by non-physical means, like CBT. Psychoanalysis - a particular sort of psychotherapy, or means of exploring the unconscious mind.

6. Prejudice and stigma: violent, aggressive, irrational, untreatable, unreliable, dependent, chronic. Common man’s concept of psychiatry and its practitioners is fanciful eg most prejudice from movies, taking out thoughts, hypnotism, head shrinkers , treating loonies, crack, nuts. Culture has marked influence; eg Black Magic

7. Normal vs Abnormal: Difficult to determine normal behavior and its range. Eg buddhist ahimsa among cannibal as a cannibal in our midst. Defining by : Social conformity/norm and statistical norms. Abnormal : 1. deviation from social or statistical norm 2. personal misery(anxiety, depression) and mal adjustment 3. personal inefficiency and immaturity preventing individual from fulfilling his expected role in the community.

8. Causes of Abnormality Faulty make up : Heredity, Infection and infestations, Trauma, Metabolic causes, Vascular causes, Degeneration, neoplasms. Faulty environment : family pathology, sibling and peer group rivalry, deprivation and bereavement, Unemployment, Economic instability, marital disharmony, social changes and insecurity, Catastrophic events, childhood traumatic upbringing Faulty Adjustment : faulty learning, poor coping skills, inner conflict, frustrations, prejudices BIO-PSYCHO-SOCIAL MODEL AND DYNAMICS OF BEHAVIOR

9. Scope of psychiatry Data from WHO More than 2/5 th of all disabilities in world are due to mental illness. In 2001 itself schizophrenia worldwide was 45 million, depression alone was among 340 million. Both are responsible for 60 percent of suicide across the globe By 2020 3T became leading morbidity cause: trauma, tumor and tension.

10. Histo r y 5 th century- Mental disorders were considered supernatural in origin. Religious leaders often turned to versions of exorcism to treat mental disorders. Specialist hospitals were built in Baghdad, Fes, Cairo & Bethlem Royal Hospital in London in medieval Europe to treat mental disorders. These institutions were used only as custodial care and did not provide any type of treatment .

11. History Enlightenment age (1620-1780)- attitudes towards the mentally ill began to change. It came to be viewed as a disorder that required compassionate treatment. William Battie - wrote his ‘Treatise on Madness’ on the management of mental disorder, which was a critique aimed at the Bethlem Hospital. Moral treatment - Philippe Pinel & William Tuke . Pinel allowed patients to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms.

12. History In UK, the Lunacy Act 1845 was an important landmark in the treatment of the mentally ill, it explicitly changed the status of mentally ill people. All asylums were required to have written regulations and to have a resident qualified physician . Early 1800s- advances were made in the diagnosis of mental illness by broadening the category of mental disease. 20th century - introduced a new psychiatry into the world, with different perspectives of looking at mental disorders .

13. History Emil Kraepelin- ideas behind biological psychiatry, stating that the different mental disorders are all biological in nature. Sigmund Freud 's pioneering work o f psychoanalytic theory. Psychopharmacology became an integral part of psychiatry starting with Otto Loewi's discovery of the neuromodulatory properties of ACh . The discovery of chlorpromazine's (1952) effectiveness in treating schizophrenia revolutionized the treatment, as did lithium carbonate's (1949) ability to stabilize mood highs and lows in b ipolar .

14. Sigmund Freud Neurologist Contributions- Human nature Instincts (eros, thanatos ) Personality theories (structural, topographical (Q) Ego Defense mechanisms Psycho-Sexual stages of development Father of Psychoanalysis (Q) Books- Interpretation of dreams Died of cancer of jaw & mouth.

15. Anna Freud Daughter of Sigmund Freud Contributions- Ego defence mechanisms Development of modern ego psychology Child psychoanalysis Books- introduction to technique of child analysis, Ego & mechanisms of defence, normality & pathology in childhood.

16. Jean Piaget Renowned child psychologist Contributions- Cognitive stages of development Books- psychology of intelligence, child’s conception of the world, moral judgement of child.

17. Othe r s… Father of modern Psychiatry- Johann Weyer / philippe pinel Coined the term Psychiatry- Johann christian reil (Q) Moral treatment of mentally ill- Philippe pinel (Q)

18. Phenomenology Description of nature of inner life of the patient. Delusion - A false unshakable belief which arises from internal morbid processes. It is easily recognized when it is not keeping with the person’s educational & cultural context. Hallucination - A perception without an object. Illusion - Misinterpretation of stimuli arising from an external object.

19. No s ology Science of classification of diseases . Classification - process of putting things into groups based on ways that they are alike. “Diagnosis and classification are means of viewing the world” (Sartorius,N.1988).

20. Classification in Psychiatry… C l a s si f icatio n i de a ll y m u s t b e base d on etiology , but do we know the aetiology??? U nt i l w e know the c a u s e of the v a r i ous mental illnesses , what to do??? So a Pragmatic/ Practical approach to classification is being followed.

21. Earlier Classifications Initial classification : due to disease of the brain or those with no such basis, i.e. organic & functional . As knowledge of neurobiological processes is increasing, their original meaning is being lost. These categories of classification (i.e. organic versus functional) are becoming absurd now !!!...

22. Organic mental disorders Demonstrable disturbance of brain(primary disturbance or systemic disturbance known to affect brain parenchyma) Classified into acute, sub-acute & chronic. Most common feature is alteration in consciousness . It includes delirium. substance use disorders due to use of alcohol, cannabis, opium etc.., D ementias as well as amnestic disorders.

23. Functional syndromes Refers to those syndromes where there is no apparent or demonstrable of brain parenchyma . Although increasingly it is recognized that some finer variety of brain disease may exist, often at a cellular level. It was customary to divide these functional disorders into neurosis and psychosis .

24. Functional disorders Neurosis Believed to have insight into their illness. Only a part of their personality involved in the disorder. Intact reality testing /awareness . Psychosis Believed to lack insight into their illness. Whole of the personality is distorted. A false environment is constructed out of their distorted subjective experience.

25. Modern classificatory systems 1. ICD -10,11- International Classification of Diseases– Clinical descriptions and diagnostic guidelines 2. DSM-4-TR- Diagnostic and Statistical Manual of Mental Disorders - 4th edition, Text Revision DSM 5- 5 Th edition of the text. 3. Research domain criteria.

26. ICD 11 : Published in 2018 Provides all classification of medical disorders including psychiatry ones Chapter 6 is dedicated for psychiatry

27. DSM-5(Diagnostic and statistical manual of mental disorders)- 2013 Published by American psychiatric society DSM-IV TR had multiaxial system: Axis I: Clinical psychiatry diagnosis Axis II: personality disorders and mental retardation Axis III: medical conditions Axis IV: Psychosocial problems Axis V: Global assessment of functioning

28. DSM-5 this concept was removed Axis I,II,III has been combined IV and V are described separately Research Domain Criteria : the existing classification was criticized for being based on symptoms and not based on neurobiology. National institute of mental health(NIMH), USA has started RDoC which aim to develop experimental classification based on behaviors and neurobiology. (NIMHANS 2019)

29. Sub-Specialties Addiction psychiatry- Evaluation and treatment of individuals with alcohol, drug, or other substance- related disorders. Biological psychiatry- Approach to psychiatry that aims to understand mental disorders in terms of the biological function of the nervous system. Child and adolescent psychiatry- Branch of psychiatry that specializes in work with children, teenagers, and their families. Community psychiatry- An approach that reflects an inclusive public health perspective.

30. Sub-Specialties Forensic psychiatry - Interface between law and psychiatry. Geriatric psychiatry - Branch of psychiatry dealing with the study, prevention, and treatment of mental disorders in old age. Liaison psychiatry - Branch of psychiatry that specializes in the interface between other medical specialties and psychiatry. Military psychiatry - Covers special aspects of psychiatry and mental disorders within the military context.

31. Thank you