Post on 16-Jul-2018
Overview of
Mental Health & Disorders
Dr Bhagwat Rajput
MBBS DNB , Psychiatry
World College Of Medical Sciences
Brief View - Outline
Introduction
Definitions & common term used
Epidemiology - Global burden & National
Etiology
Models & Approaches
Classifications – Purpose & Types
Manifestations of Psychiatric illness
History & Mental status Examinations
Diagnosis & Treatments
Conclusion
Introduction
Mental health : life long process a sense of harmony & balance for the individual, family, friends & community
o Health & Mental health
o Psychiatric disorders – Prevalent & often go untreated
o Global & National burden of mental disorders
o Subject of medicine is human being “Biopsychosocial”
o Consideration aspects - Doctor-patient relationship
o Associated stigma – Patients, caregivers & doctors
Contd…
Psychiatry : Branch of medicine dealing with
mental disorder & Its treatment
Psych : soul or mind ; Iatros : healer
Psychology : Science investigates behaviour,
experience & normal functioning of the mind
Psychotherapy : Treatment of psychological
issues by non-physical means
Organic - Identifiable physical pathology
Functional - Psychological,cause not known
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Mental health – Importance��
Mental health – Good health & quality of life
Desirable personality
Emotional & Social development
Moral & Aesthetic Development
Seeking goals of life
Self image & Education
Sleep , Eating & Physical Health
Prevention of mental illness
Mental Disorder -
WHO ICD 10 - Clinically recognizable set of
symptoms, associated in most case with distress &
with interference in personal functions. Should
exclude culturally/religious sanctioned response to an
event.
India Prevalanc- 20-25% , Anxiety: 12-13% ,
Mood: 5.7-7.5%,Psychosis: 0.2-1.3% ,
Substance use: 7.6-9.7%
Europeans : 28%
Models - Supernatural & Bio-psychosocial
Supernatural Model
Phenomena such as magnetic fields , the moon or the stars
These agents which might be divinities, demons, spirits
Greece ; MIND = SOUL =PSYCHE & considered
separate from the body
Bio-psychosocial
Mental health care - Multiagency task - multidisciplinary
teams of workers - patient/client and their carers.
Program of treatment and support to meet their needs
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Etiology
oDiagnose and understand.
oEarly intervention. & Optimize treatment.
According to nature: a) Biological b) Psychological c) Social
According to the effect: a. Predisposing b. Precipitating c. Perpetuating
Acoording to approch
a. Genetics b. Biochemical studies
c. Endocrinology d. Neuropathology
e. Psychological theories f. Social Science
Classificatory systems
ICD-10 –
World Health Organization, covers the whole of
medicine
Tenth edition of the - ICD-10
Classification of Mental and Behavioural Disorders.
DSM-IV
American Psychiatric Association
Fourth Edition - (DSMIV)
Multiaxial system
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Categories ICD-10
F 00-09 Organic disorder
F 10-19 Psychoactive substance abuse
F 20-29 Psychotic disorders
F 30-39 Mood disorders
F 40-49 Anxiety disorders
F 50-59 Physiological disorders
F 60-69 Personality disorders
F 70-79 Mental retardation
F 80-89 Developmental Disorders
F 90-99 Behavioral & Emotional - childhood
Psychiatric Disorders
Organic Non-Organic
Chronic
Dementia
Korsakoff
Others
Alcohol …
Head Injury
Acute
Delirum
Wernicke’s
Psychoses
Schizophrenia
Mood disorders
Neuroses
Anxiety disorders
Adjustment dis.
Others
Personality dis.
Sleep disorder
The Psychiatric History
Chief complaint & Reason for referral
History of Present Illness
Past History
Medications
Personal History – Birth;Childhood;Educational
Family History – Relationship;Psy illness,
Social History – Marriage; Financial;Hobbies
Premorbid personality & Substance use
Mental Status Examinations
General –
Appearance – Age, Eye contact, Dress and grooming,
Motor – Gait , Freedom of movement,
Speech – Rate,Volume & Defects
oEmotion –
Mood - Euthymic,Angry,Euphoric,Dysphoric,
Affect – Appropriateness,Intensity & Reactivity
o Thought contents –
Preoccupations; Obsessions; Phobia & Beliefs
Contd…
o Cognitive -
Consciousnes , Attention & Orientation
Concentration ,Memory &Intelligence
o Judgments-
The process of Consideration & Formulation
Leading to a Decision & Action
o Insight –
Patient’s capacity to Acknowledge/Appreciate illness
Associated implications & Consequences
Investigations
To detect alteration, Screen organic & drug
Routine investigations – CBC,KFT,LFT,Elecrtolytes, Sugar , HIV & ECG
Electrophysiological tests – EEG & Polysomnography
Neuroimaging tests – CT & MRI
Neuroendocrine tests – TRH,TSH, Melatonin & Prolactine
Genetics tests – Cytogenic work up – MR
Psychological tests – PSE,MMSE,BPRS & SCAN
Managements
o Decisive Factors -
1.Nature 2.Duration of symptoms 3.Family history
o Phases to treatment - 1.Initial phase 2. Continuations 3. Maintenance o Pharmacological
1. Antipsychotics
2. Antidepressants
3. Mood stabilizing agents
4. Anxiolytics and sedatives
5. Anticonvulsants
o Nonpharmacological -
Imbalance – Neurotransmitter in brains
Speaking
Brain Cell
Listening
Brain Cell
Synapse
Dopamine
Vesicle
Receptor
Site
- Dopamine, Serotonin & Norepinephrine Histamine,GABA & Ach
Antipsychotic Medications
Speaking
Brain Cell
Listening
Brain Cell
Dopamine
Antipsychotic Medication
Blocks Receptor Site
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Nonpharmcological interventions
o Psychotherapies
1.Cognitive behavioral therapy
2.Biofeedback
3.Relaxation techniques
4.Family & Group psychotherapy
Psychoeducation
Skills training
Social, vocational, and educational support
Occupational therapy