psychiatry The Criteria of mental Health

Introduction in psychiatry

Uzhhorod National UniversityChair of Neurology, Neurosurgery and Psychiatry

M.D. Nina Sofilkanych

Plan of the lecture

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

What is Psychiatry?

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.

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

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Module 1.3a What is mental health.mp4

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When you speak to God it's called praying; but when God speaks to you it's called schizophrenia.

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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.

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

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 he reditary predisposition.

2) exogenous disorders, caused by ex ternal reasons: infection, intoxication, head injury, etc.;

3) psychogenous disorders are caused by psychological trauma (posttraumatic stress syndrome) and other psychological factors (adjustment dis orders, behavioural disorders, neuroses, etc.).

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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.

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);

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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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.

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.

Classification mental disorders (ICD-10)

F00-09Organic, including symptomatic, mental disordersF10-19 Mental and behavioural disorders due to

psychoactive substance useF20-29 Schizophrenia, schizotypal and delusional

disordersF30-39 Mood (affective) disordersF40-48Neurotic,stress-related and somatoform disordersF50-59 Behavioural syndromes associated with

physiological disturbances and physical factorsF60-69 Disorders of adult personality and behaviourF70-79 Mental retardationF80-89 Disorders of psychological developmentF90-98 Behavioural and emotional disorders with onset

usually occurring in childhood and adolescence

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 he reditary predisposition.

2) exogenous disorders, caused by ex ternal reasons: infection, intoxication, head injury, etc.;

3) psychogenous disorders are caused by psychological trauma (posttraumatic stress syndrome) and other psychological factors (adjustment dis orders, behavioural disorders, neuroses, etc.).

Mental Illness

What are the symptoms of

Mental Illness?

What do you think causes Mental Illness?

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

wrong way.

Thinking

When the brain is not working properly, one or more of its 6 functions will be disrupted

PerceptionEmotion Signaling

Behavior

Physical

Symptoms can include

Sleep problemsExtreme emotional highs and lows

Thinking difficulties or problems focusing

attention

When these symptoms significantly disrupt a person’s life,

we say that the person has a

mental disorder or a mental illness.

So, what are the

CAUSES of mental illness??

Well, the causes of mental illness are

COMPLICATED!!

Genetics Environment

+ →

Brain Disorder

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. intelligence3. thinking7. motor4. memory 8. personality

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

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

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

Disturbances of PerceptionHallucinations:

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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Multistable perception

Mental construction

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Disorders of Thinking Thinking

Cognitive functions

Disorders of thinking:• quantitative• qualitative

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

Qualitative Disorders of Thinking

Quantitative disorders of thought (content thought disorders):

Delusions: a)belief firmly held on inadequate grounds,b)not affected by rational argumentsc)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.

Qualitative Disorders of Thinking

Division of delusions: according to onset

a)primary (delusion mood, perception)b)secondary (systematized)c)shared (folie a deux)

according to themea)paranoid (persecutory) - d. of reference, d. of jealousy, d. of

control, d. concerning possession of thoughtb)megalomanic (grandiose, expansive) – d. of power, worth,

noble origin, supernatural skills and strength, amorous d.c)depressive (micromanic, melancholic) – d. of guilt and

worthlessness, nihilistic d., hypochondriacal d.d)concerning the possession of thoughts

thought insertion thought withdrawal thought broadcasting

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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.

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TYPES OF DELUSIONS

GRANDEUR OR EXALTATIONPERSECUTION(PARANOID)REFERENCEINFLUENCEINFEDILITYSELF-REPROACHNIHILISTICHYPOCHONDRIALOTHER TYPES

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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.

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DELUSION OF GRANDEUR OR EXALTATION

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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.)

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DELUSION OF PERSECUTION/PARANOID

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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.

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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.

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DELUSION OF INFEDILITY/JEALOUSY-OTHELLO SYNDROME

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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.

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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.

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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.

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DELUSION OF POVERTY

The patient is convinced that he is, or will be, bereft of all material possessions.

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DELUSION OF DOUBLES (DOPPELGANGER)

Patient believes that another person has been physically transformed into themselves.

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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.

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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

Disorders of MemoryDisorders of memory:

Amnesia – inability to recall past events Jamais vu, déja vu Confabulation, amnesic disorientation, Korsakov’s

syndrome Pseudologia phantastica

Hypomnesia Hypermnesia

Disorders of Attention Concentration Capacity Tenacity Irritability Vigility

Hypoprosexia (global, selective) Hyperprosexia Paraprosexia

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

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

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

Intelligence Disorders Intelligence:

• abstract• practical• social

Intelligence quotient (IQ): IQ = (mental age : calendar age) x

100

Disorders of intellect:• mental retardation• dementia

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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Disorders of Volition

Disorders of volition:• hypobulia• abulia• hyperbulia

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

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SOME COMMON PSYCHIATRY TERMS

Abreaction:-This is a release phenomenon where old, forgotten things or events are brought into conscious state again.

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AFFECT

It is commonly called mood or feeling.

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AMNESIA

Loss of memory about a person or event is called ‘amnesia’.

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AMNESIA

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APHASIA

Loss of sensory or motor ability to express by use of speech or writing is called ‘aphasia’.

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CONFABULATIONUnconscious 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.

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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.

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CIRCUMSTANTIALITY

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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.

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COMPULSION

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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.

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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.

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FUGUE STATE

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ECHOPRAXIA

Repeating the act of another

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ECHOPRAXIA

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EMPATHY

The degree to which the observer is able to enter into the thoughts and feelings of the patient and establish good contact.

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EMPATHY

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NEGATIVISM

Doing just the opposite of what he is asked to do.

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NEURASTHENIA

A condition arising out of physical or mental exhaustion.

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NEURASTHENIA

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PHOBIA

IS AN EXCESSIVE IRRATIONAL FEAR OF A PARTICULAR OBJECT OR SITUATION.

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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.

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PARASUICIDE

It is a conscious often impulsive, manipulative act, undertaken to get rid of an intolerable situation. (attempted suicide or pseudicide)

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PARASUICIDE

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STUPOR

Used synonymously with mutism and does not necessarily imply a disturbance of consciousness; in catatonic stupor, patients are ordinarily aware of their surroundings.

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STUPOR

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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.

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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.

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VEGETATIVE SIGNS

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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.

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PSYCHOPATH

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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.

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ONEIROID STATES

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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.

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NEUROSIS PSYCHOSIS

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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.

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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.

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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 drugslike diazepam. Meditation also helps a lot.

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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:

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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.

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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.

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DIFFERENCE BETWEEN NEUROSIS AND PSYCHOSIS

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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

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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.

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SOMNAMBULISM

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.

psychiatry The Criteria of mental Health

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