psychiatry The Criteria of mental Health

Classification of mental disorders

1. Introduction in psychiatry Uzhhorod National University Chair of Neurology, Neurosurgery and Psychiatry M.D. Nina Sofilkanych

2. Plan of the lecture

3. Plan of the lecture Object and task of psychiatry, place among other medical disciplines. History of development and modern state of psychiatry. Classifications. Etiology. Psychopathological phenomena, symptoms of abnormal states of mind

4. What is Psychiatry?

5. Psychiatry (from the Greek words "psyche" - the soul, " iatreia " - treatment) is a branch of medicine concerned with the study, diagnosis, treatment and prevention of mental disorders.

6. Difference between psychiatry and psychology? - psychiatrist has attended medical school and is a physician and therefore holds an M.D. - in residency received specialised training in the field of psychiatry - psychiatry tends to focus mainly on the use of medications for treatment

7. A SUZY PRESENTATION 3/5/2015 7

8. VIDEO 1

9. When you speak to God it's called praying ; but when God speaks to you it's called schizophrenia . 2/15/17 8 A SUZY PRESENTATION

10. The criteria of mental health awareness and feeling of continuity, constancy and identity of one's physical and mental self; feeling of constancy and identity of experience in similar circumstances; insight (good judgement ) concerning oneself, one's own mental production and its results; accordance (adequacy) of mental reactions to intensity and frequency of environmental influences,, social circumstances and situations; capacity to self-regulation of one's behaviour in accordance with social norms, rules and laws; capacity to plan one's life activities and to realise these plans; capacity to change one's behaviour depending on the changes of life situations and circumstances.

11. Classification mental disorders (ICD-10) F00-09Organic, including symptomatic, mental disorders F10-19 Mental and behavioural disorders due to psychoactive substance use F20-29 Schizophrenia, schizotypal and delusional disorders F30-39 Mood (affective) disorders F40-48Neurotic,stress-related and somatoform disorders F50-59 Behavioural syndromes associated with physiological disturbances and physical factors F60-69 Disorders of adult personality and behaviour F70-79 Mental retardation F80-89 Disorders of psychological development F90-98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence

12. Classification of mental disorders on the basis of aetiology and pathogenesis 1) endogenous disorders (schizophrenia, bipolar affective disorder and genuine epilepsy) caused by internal mechanisms, the nature of which isn't yet quite clear; these are disorders with he­reditary predisposition. 2) exogenous disorders, caused by ex­ternal reasons: infection, intoxication, head injury, etc.; 3) psychogenous disorders are caused by psychological trauma (posttraumatic stress syndrome) and other psychological factors (adjustment dis­orders, behavioural disorders, neuroses, etc.).

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14. Tasks psychiatry to study the aetiology and pathogenesis of mental disorders; to carry out their classification; to investigate the epidemiology of mental disturbances; to study the symptoms and signs, as well as syndromes and the clinical course of different mental disorders; to develop find practice effective methods of their diagnosing; to work out and use efficient treatment methods; to develop a network of mental health services for the population; to develop a system for the prevention of mental disorders.

15. History of development of psychiatry the first period (pre-scientific), characterised by primitive religious understanding of the mentally ill people's abnormal behaviour; the secend period of ancient antique medicine, a more progressive period, when the first attempts at organising mental health treatment were made; the third period, corresponding to the Middle Ages, was in general a period or regress, when psychiatry returned to its prescientific period (theological scholastics);

16. the fourth period, from the beginning of the XVIII to the beginning of XIX century was the stage of formation of psychiatry part of the medical science; the fifth period was the epoch of E. Krepellin's nosological psychiatry. The creation of a nosological classification of mental disorders was the main outcome of this stage; the sixth period, modern stage of development of psychiatry, formed in the XX century can be called the period of social psychiatry; it is characterised by wide development community, social forms of mental health services; somatological aspects of mental disorders got more attention.

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18. FRAME OF PSYCHIATRY. General psychopathology - studies the basic laws of an etiopathogenesis, clinic, diagnostics, therapy and prophylaxis of alienations. Private psychiatry - studies separate mental diseases. Age psychiatry. Organizational psychiatry. Judicial psychiatry - solves questions of a sanity and capacity for acting. Psychopharmacotherapy - studying of action on mentality of medicinal substances. Social psychiatry.

19. Addictology - studies influence of the psychotropic substances on a condition of the person. Trans-cultural psychiatry - is engaged in comparison of a mental pathology in the different countries, cultures. Orthopsychiatry - surveys alienations from the point of view of different disciplines. Biological psychiatry. Sexology. Suicidology. Military psychiatry - studies posttraumatic stressful frustration, psychopathology a wartime. Ecological psychiatry - studies influence of ecological factors on mentality.

20. Addictology - studies influence of the psychotropic substances on a condition of the person. Trans-cultural psychiatry - is engaged in comparison of a mental pathology in the different countries, cultures. Orthopsychiatry - surveys alienations from the point of view of different disciplines. Biological psychiatry. Sexology. Suicidology. Military psychiatry - studies posttraumatic stressful frustration, psychopathology a wartime. Ecological psychiatry - studies influence of ecological factors on mentality.

21. Classification mental disorders (ICD-10) F00-09Organic, including symptomatic, mental disorders F10-19 Mental and behavioural disorders due to psychoactive substance use F20-29 Schizophrenia, schizotypal and delusional disorders F30-39 Mood (affective) disorders F40-48Neurotic,stress-related and somatoform disorders F50-59 Behavioural syndromes associated with physiological disturbances and physical factors F60-69 Disorders of adult personality and behaviour F70-79 Mental retardation F80-89 Disorders of psychological development F90-98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence

22. Classification of mental disorders on the basis of aetiology and pathogenesis 1) endogenous disorders (schizophrenia, bipolar affective disorder and genuine epilepsy) caused by internal mechanisms, the nature of which isn't yet quite clear; these are disorders with he­reditary predisposition. 2) exogenous disorders, caused by ex­ternal reasons: infection, intoxication, head injury, etc.; 3) psychogenous disorders are caused by psychological trauma (posttraumatic stress syndrome) and other psychological factors (adjustment dis­orders, behavioural disorders, neuroses, etc.).

23. Mental Illness What are the symptoms of Mental Illness ? What do you think causes Mental Illness ?

24. Mental illness can occur when the brain (or part of the brain) is not working well or is working in the wrong way.

25. Thinking When the brain is not working properly , one or more of its 6 functions will be disrupted Perception Emotion Signaling Behavior Physical

26. Symptoms can include Sleep problems Extreme emotional highs and lows Thinking difficulties or problems focusing attention

27. When these symptoms significantly disrupt a person’s life, we say that the person has a mental disorder or a mental illness .

28. So, what are the CAUSES of mental illness??

29. Well, the causes of mental illness are COMPLICATED!! Genetics Environment + → Brain Disorder

30. Basic Terms in Psychiatry Psychiatry studies the causes of mental disorders, gives their description, predicts their future course and outcome, looks for prevention of their appearance and presents the best ways of their treatment Psychopathology describes symptoms of mental disorders Special psychiatry is devoted to individual mental diseases General psychiatry studies psychopathological phenomena, symptoms of abnormal states of mind: 1. consciousness 5. mood (emotions) 2. perception 6. intelligence 3. thinking 7. motor 4. memory 8. personality

31. Disorders of Consciousness Consciousness is awareness of the self and the environment Disorders of consciousness: qualitative quantitative short-term long-term Hypnosis – artificially incited change of consciousness Syncope – short-term unconsciousness

32. Disorders of Consciousness Quantitative changes of consciousness mean reduced vigility (alertness): somnolence sopor coma Qualitative changes of consciousness mean disturbed perception, thinking, affectivity, memory and consequent motor disorders : delirium (confusional state) – characterized by disorientation, distorted perception, enhanced suggestibility, misinterpretations and mood disorders obnubilation (twilight state) – starts and ends abruptly, amnesia is complete; the patient is disordered, his acting is aimless, sometimes aggressive, hard to understood stuporous vigilambulant delirious Ganser sy

33. Disturbances of Perception Perception is a process of becoming aware of what is presented through the sense organs Imagery means an experience within the mind, usually without the sense of reality that is part of reality Pseudoillusions – distorted perception of objects which may occur when the general level of sensory stimulation is reduced Illusions are psychopathological phenomena; they appear mainly in conditions of qualitative disturbances of consciousness (missing insight) Hallucination are percepts without any obvious stimulus to the sense organs; the patient is unable to distinguish it from reality

34. Disturbances of Perception Hallucinations: auditory (acousma) visual olfactory gustatory tactile (or deep somatic) extracampine, inadequate intrapsychic (belong rather to disturbances of thinking) hypnagogic and hypnopompic (hypnexagogic) Pseudohallucinations - patient can distinguish them from reality

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36. Multistable perception

37. Multistable perception

38. Multistable perception

39. Multistable perception

40. Multistable perception

41. Mental construction

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43. Disorders of Thinking Thinking Cognitive functions Disorders of thinking: quantitative qualitative

44. Quantitative Disorders of Thinking Quantitative (formal) disorders of thinking : pressure of thought poverty of thought thought blocking flight of ideas perseveration loosening of associations word salad - incoherent thinking neologisms verbigeration

45. Qualitative Disorders of Thinking Quantitative disorders of thought (content thought disorders): Delusions: belief firmly held on inadequate grounds, not affected by rational arguments not a conventional belief Obsessions (obsessive thought) are recurrent persistent thoughts, impulses or images entering the mind despite the person's effort to exclude them. Obsessive phenomena in acting (usual as senseless rituals – cleaning, counting, dressing) are called compulsions .

46. Qualitative Disorders of Thinking Division of delusions: according to onset primary (delusion mood, perception) secondary (systematized) shared (folie a deux) according to theme paranoid (persecutory ) - d. of reference, d. of jealousy, d. of control, d. concerning possession of thought megalomanic (grandiose, expansive) – d. of power, worth, noble origin, supernatural skills and strength, amorous d. depressive (micromanic, melancholic) – d. of guilt and worthlessness, nihilistic d., hypochondriacal d. concerning the possession of thoughts thought insertion thought withdrawal thought broadcasting

47. A SUZY PRESENTATION DELUSION- भ्रम DELUSION IS A FALSE BELIEF IN SOMETHING WHICH IS NOT A FACT, AND THE BELIEF PERSISTS EVEN AFTER ITS FALSITY HAS BEEN CLEARLY DEMONSTRATED. 52 3/5/2015

48. A SUZY PRESENTATION TYPES OF DELUSIONS GRANDEUR OR EXALTATION PERSECUTION(PARANOID) REFERENCE INFLUENCE INFEDILITY SELF-REPROACH NIHILISTIC HYPOCHONDRIAL OTHER TYPES 53 3/5/2015

49. A SUZY PRESENTATION DELUSION OF GRANDEUR OR EXALTATION The person imagines that he is very rich, powerful, while in reality he may be a pauper and may squander away his money or property. It is usually seen in mania, and may be associated with delusion of persecution. This is a pleasant delusion. 54 3/5/2015

50. A SUZY PRESENTATION DELUSION OF GRANDEUR OR EXALTATION 3/5/2015 55

51. A SUZY PRESENTATION DELUSION OF PERSECUTION/PARANOID The person imagines that people are after him and may kill him, poison him(wife, sons or parents) or harm him, or someone is going to rob his property. The person remains suspicious and depressed and may commit some crime. ( He may commit suicide or kill his family members or innocent person thinking him/her to be his enemy.) 56 3/5/2015

52. A SUZY PRESENTATION DELUSION OF PERSECUTION/PARANOID 3/5/2015 57

53. A SUZY PRESENTATION DELUSION OF INFLUENCE/CONTROL The patient complains that his thoughts processes, feelings and actions are being influenced and controlled by some external power, like radio, hypnotism or telepathy. On the basis of this imaginary “command”, he may commit an unlawful act. 58 3/5/2015

54. A SUZY PRESENTATION DELUSION OF INFEDILITY/JEALOUSY-OTHELLO SYNDROME In this, the person thinks that his/her spouse is not loyal to him/ her. Usually, males suffer more from this delusion as compared to females. The person may commit crime in this state. 59 3/5/2015

55. A SUZY PRESENTATION DELUSION OF INFEDILITY/JEALOUSY-OTHELLO SYNDROME 3/5/2015 60

56. A SUZY PRESENTATION DELUSION OF SELF-REPROCH OR SELF-CRITICISM The person criticises himself for some imaginary offence or misdeed committed by him in the past. In serious cases, the person may punish himself by committing suicide. 61 3/5/2015

57. A SUZY PRESENTATION NIHILISTIC DELUSION In this, the person does not believe in his existence or that the world exists. They may commit suicide or kill others. It is commonly seen in depression. 62 3/5/2015

58. A SUZY PRESENTATION HYPOCHONDRIAL DELUSION The person in this delusion thinks that he is ill always, while medically he may be completely fit. He keeps on visiting doctors. Usually the person gives vague abdominal complaints. 63 3/5/2015

59. A SUZY PRESENTATION DELUSION OF POVERTY The patient is convinced that he is, or will be, bereft of all material possessions. 64 3/5/2015

60. A SUZY PRESENTATION DELUSION OF DOUBLES (DOPPELGANGER) Patient believes that another person has been physically transformed into themselves. 65 3/5/2015

61. A SUZY PRESENTATION DELUSION OF REFERENCE The person believes that everybody is thinking about him only and is being referred by all agencies, media and persons around him in all matters(usually of negative nature) and this may put him in conflict with the world. 66 3/5/2015

62. Disorders of Memory Sensory stores - retains sensory information for 0.5 sec. Short - term memory (working memory) - for verbal and visual information, retained for 15-20 sec., low capacity Long-term memory – wide capacity and more permanent storage declarative (explicit) memory – episodic (for events) or semantic (for language and knowledge) procedural memory – for motor arts priming – unconscious memory conditioning – classic or emotional

63. Disorders of Memory Disorders of memory: Amnesia – inability to recall past events Jamais vu, déja vu Confabulation, amnesic disorientation, Korsakov’s syndrome Pseudologia phantastica Hypomnesia Hypermnesia

64. Disorders of Attention Concentration Capacity Tenacity Irritability Vigility Hypoprosexia (global, selective) Hyperprosexia Paraprosexia

65. Disorders of Mood (Emotions) Normal affect – brief and strong emotional response Normal mood – subjective and for a longer time lasting disposition to appear affects adequate to a surrounding situation and matters discussed Higher emotions : intellectual aesthetic ethic social

66. Disorders of Mood (Emotions) Pathological affect – very strong, abrupt affect with a short change of consciousness on its peak Pathological mood – two poles: manic depressive Phobia – persistent irrational fear and wish to avoid a specific situation, object, activity: agoraphobia claustrophobia social phobias hipsophobia aichmophobia keraunophobia Depersonalization – change of self-awareness, the person feels unreal, unable to feel emotion

67. Disorders of Mood (Emotions) Pathological mood: origin – based on pathological grounds, no psychological cause duration – unusually long-lasting intensity – unusually strong, large changes in intensity impossibility to be changed by psychological means Pathological features of mood: euphoria expansive exaltation explosive mania hypomania depression apathy (anhedonia) blunted, flattened affect emotional lability helpless

68. Intelligence Disorders Intelligence: abstract practical social Intelligence quotient (IQ): IQ = (mental age : calendar age) x 100 Disorders of intellect: mental retardation dementia

69. Motor Disorders quantitative : hypoagility hyperagility agitated behaviour qualitative : mannerisms stereotypies posturing waxy flexibility echopraxia schizophrenic impulse negativism short-circuit behaviour automatism agitation tics abulia compulsions Motor disorders occur frequently in mental disorders of all kinds, especially in catatonic schizophrenia.

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71. Disorders of Volition Disorders of volition : hypobulia abulia hyperbulia

72. Disorders of Personality Personality means a complex of persistent mental and physical traits of a person Disturbances of personality: transformation of personality appersonalization multiple personality (alteration of personality) specific personality disorder deprived personality

73. A SUZY PRESENTATION SOME COMMON PSYCHIATRY TERMS Abreaction:- This is a release phenomenon where old, forgotten things or events are brought into conscious state again. 78 3/5/2015

74. A SUZY PRESENTATION AFFECT It is commonly called mood or feeling. 79 3/5/2015

75. A SUZY PRESENTATION AMNESIA Loss of memory about a person or event is called ‘amnesia’. 80 3/5/2015

76. A SUZY PRESENTATION AMNESIA 3/5/2015 81

77. A SUZY PRESENTATION APHASIA Loss of sensory or motor ability to express by use of speech or writing is called ‘aphasia’. 82 3/5/2015

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79. A SUZY PRESENTATION CONFABULATION Unconscious filling of gaps in memory by imagining experiences or events that have no basis in fact, commonly seen in amnestic syndrome.  Confabulation is considered “honest lying,” but is distinct from lying because there is typically no intent to deceive and the individual is unaware that their information is false.  84 3/5/2015

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81. A SUZY PRESENTATION CIRCUMSTANTIALITY When a person is not able to answer properly, in a straight manner, and keeps on giving irrelevant details or wanders off the subject many times in a conversation, the condition is called circumstantiality. 86 3/5/2015

82. A SUZY PRESENTATION CIRCUMSTANTIALITY 3/5/2015 87

83. A SUZY PRESENTATION COMPULSION It is a repetitive behaviour done by an individual in spite of knowing that it is not correct. Examples being, repeatedly washing hands, checking locked premises again and again. 88 3/5/2015

84. A SUZY PRESENTATION COMPULSION 3/5/2015 89

85. A SUZY PRESENTATION DELIRIUM It is an acute reversible mental disorder characterised by confusion and impairment of consciousness, disorientation(most commonly time), emotional lability, hallucination, or illusion and inappropriate, impulsive, irrational or violent behavior. The mental faculty of an individual does not work properly. It may be seen in high grade fevers or due to overwork, mental stress, acute poisoning(dhatura), chronic alcoholics or drug intoxication. 90 3/5/2015

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87. A SUZY PRESENTATION FUGUE STATE The person becomes a wanderer who keeps on moving from place to place in an altered state of mind. He has episodes of amnesia. This stage is seen in depression, schizophrenia and other mental disorders. 92 3/5/2015

88. A SUZY PRESENTATION FUGUE STATE 3/5/2015 93

89. A SUZY PRESENTATION ECHOPRAXIA Repeating the act of another 94 3/5/2015

90. A SUZY PRESENTATION ECHOPRAXIA 3/5/2015 95

91. A SUZY PRESENTATION EMPATHY The degree to which the observer is able to enter into the thoughts and feelings of the patient and establish good contact. 96 3/5/2015

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93. A SUZY PRESENTATION NEGATIVISM Doing just the opposite of what he is asked to do. 98 3/5/2015

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95. A SUZY PRESENTATION NEURASTHENIA A condition arising out of physical or mental exhaustion. 100 3/5/2015

96. A SUZY PRESENTATION NEURASTHENIA 3/5/2015 101

97. A SUZY PRESENTATION PHOBIA IS AN EXCESSIVE IRRATIONAL FEAR OF A PARTICULAR OBJECT OR SITUATION. 102 3/5/2015

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99. A SUZY PRESENTATION PARANOIA Rare psychiatric syndrome marked by the gradual development of a highly elaborate and complex delusional system, generally involving persecutory or grandiose delusions, with few other signs of personality disorientation or thought disorder. 104 3/5/2015

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101. A SUZY PRESENTATION PARASUICIDE It is a conscious often impulsive, manipulative act, undertaken to get rid of an intolerable situation. (attempted suicide or pseudicide) 106 3/5/2015

102. A SUZY PRESENTATION 3/5/2015 107 PARASUICIDE

103. A SUZY PRESENTATION STUPOR Used synonymously with mutism and does not necessarily imply a disturbance of consciousness; in catatonic stupor, patients are ordinarily aware of their surroundings. 108 3/5/2015

104. A SUZY PRESENTATION STUPOR 3/5/2015 109

105. A SUZY PRESENTATION TWILIGHT STATE Disturbed consciousness of short duration with hallucination during which the patient may carry out actions of which he has little or no subsequent memory. 110 3/5/2015

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107. A SUZY PRESENTATION VEGETATIVE SIGNS In depression, denoting characteristic symptoms, such as sleep disturbance(especially early morning awakening), decreased appetite, constipation, weight loss and loss of sexual response. 112 3/5/2015

108. A SUZY PRESENTATION VEGETATIVE SIGNS 3/5/2015 113

109. A SUZY PRESENTATION PSYCHOPATH psychopath is a person who is neither insane nor mentally ill, but fails to conform to the normal standards of behavior. It refers to individuals who have psychopathic personality. They are usually antisocial and have long criminal records. They have no remorse feeling and are not amenable to counseling. Some of them have extra Y chromosome in their chromatin. 114 3/5/2015

110. A SUZY PRESENTATION PSYCHOPATH 3/5/2015 115

111. A SUZY PRESENTATION ONEIROID STATES It is a dream like state which may last for days or weeks. the patient suffers from confusion, amnesia, illusions, hallucination, disorientation agitation and anxiety. 116 3/5/2015

112. A SUZY PRESENTATION ONEIROID STATES 3/5/2015 117

113. A SUZY PRESENTATION NEUROSIS AND PSYCHOSIS Neurosis is when a patient suffers from emotional or intellectual disorders which causes subjective distress, but does not lose touch with reality. Psychosis is characterised by gross impairment in reality-testing(with drawl from reality), as if living in a world of fantasy. 118 3/5/2015

114. A SUZY PRESENTATION NEUROSIS PSYCHOSIS 3/5/2015 119

115. A SUZY PRESENTATION PSYCHOSIS Psychoses are usually of the following two types: 1. Manic-depressive Psychosis: It is expressed in following two phases: (a) Mania phase: In this, the person is very active, full of life, talking too much, mostly irreverent, the mood is elated and he does some action continuously. But he does not have touch with reality. He can commit any crime during this phase. Sleep is very less. Appetite is also less. 120 3/5/2015

116. A SUZY PRESENTATION PSYCHOSIS (b) Depressive phase: It is just the reverse of mania. The person is very sad, mood is depressed. The person sits alone and may speak very little. Touch with reality is not there. He may commit suicide. The motor functions are also quite depressed. A person suffering from manic depressive psychosis may fluctuate between the two phases of mania and depression. It may be possible that the person may be normal between the two phases of mania. This may be lucid interval and the person is completely responsible for his actions. 121 3/5/2015

117. A SUZY PRESENTATION NEUROSIS Neurosis is a minor mental illness. It is of following types: 1 . Anxiety Neurosis: It is a very common variety. The person remains anxious about future events, relationships and individuals. His pulse rate may be high, blood pressure raised, respiratory rate high and he may be sweating. He may be restless, confused and apprehensive. Treatment usually involves counseling and use of anti-anxiety drugs like diazepam. Meditation also helps a lot. 122 3/5/2015

118. A SUZY PRESENTATION NEUROSIS Depression: It is the reverse of anxiety. Here, a person would be aloof, sad and withdrawn. His motor activities would be quite less. He may have a low appetite and may not eat well. However, in chronic cases of depression, the person may keep on eating the whole day, while withdrawn at home and hence may gain weight. The following are the types of depression commonly seen: 123 3/5/2015

119. A SUZY PRESENTATION NEUROSIS Reactive depression: It may be due to some event or situation like the death of spouse or a near one, failure in exam, love, etc. It usually remains there for sometime. Some form of reactive depression is seen in all individuals. Usually, with counseling and use of anti-depressive drugs, most come out of it. 124 3/5/2015

120. A SUZY PRESENTATION NEUROSIS Endogenous depression: It is more serious as its etiology is not known and develops slowly. Early morning awakening, loss of appetite and mood depression are quite common. This depression may be associated with psychosis too, where it carries a bad prognosis. Usually with anti-depressive drugs, most of the individuals recover. 125 3/5/2015

121. A SUZY PRESENTATION DIFFERENCE BETWEEN NEUROSIS AND PSYCHOSIS 126 S.NO FEATURE PSYCHOSIS NEUROSIS 1 Contact with reality lost Preserved 2 Interpersonal behavior Marked disturbance in reality and behavior Preserved 3 Empathy Absent Present 4 Insight Absence of understanding current symptoms Symptoms are recognised as undesirable 5 Organic causative factor Present absent 6 Symptoms Delusions. Illusions and hallucinations Usually physical or psychic symptoms 7 Dealing with reality Capacity is grossly reduced Preserved 8 Examples Dementia, Schizophrenia Anxiety, phobia, depression, conversion disorder 3/5/2015

122. A SUZY PRESENTATION SOMNAMBULISM This is also called ‘sleep walking’. A person may move around while asleep and may commit some crime or theft, and then come back normally. He may not be aware that he has committed a crime. He will not be held responsible if it is proved that he has done this act while asleep. 127 3/5/2015

123. A SUZY PRESENTATION 3/5/2015 128 SOMNAMBULISM

124. CONTRA-INDICATION FOR HOSPITALIZATION IN PSYCHIATRIC CLINIC: Mentally healthy man. Persons in a state of simple and, even, heavy degree of alcoholic intoxication. Persons in the state of intoxication. Persons with the affects reactions and antisocial forms conducts, which do not suffer by the psychical diseases. Persons with psychopath’s character traits. Persons in which found out the neurotic reactions. Persons with a mental backwardness (after the exception of examination). Persons with total dementia. Mentally ill with acute somatic pathology which requires surgical intervention.