An Introduction to Psychiatry

Assist ProfDr Sirwan K Ali

Department of Psychiatry

Psyche

Definition Psychiatry is that branch of

medicine dealing with mental disorder and its treatment

Psych : soul or mind Iatros : healer

Why Study Psychiatry ? Psychiatric disorders are prevalent

and often go untreated : * lifetime prevalence in USA :

28% * lifetime prevalence in Iran : 10.5-21% * only 40% receive treatment during lifetimes

* in general practice : 1/6-1/4 of the patients seen have a psychiatric

problem

Why Study Psychiatry ?… …. * depression is diagnosed in only 50% of those with depression who present to GPs

* adequate treatment ensues in only about 17% of depressed patients in primary care settings

* half the patients who commit suicide sought treatment in a primary care

setting within 1 month of dying * two-thirds of patients with undiagnosed depression have six visits or more a year with GPs for somatic complaints

Why Study Psychiatry ?… Global burden of mental disorders Subject of medicine is human

being, a “biopsychosocial” Consideration of the psychological

aspects of the doctor-patient relationship

Barriers to Dx & Treatment in Primary Care Settings(patient factors)

May present with a somatic complaint Concurrent medical illness often

obscures psychiatric symptoms Denial Stigma & shame The belief that psychiatric illness is

untreatable The belief that drugs are mind-altering

and/or addictive

Barriers to Dx & Treatment in Primary Care Settings(physician factors)

A lack of time Fear of being embarrassed Uncertainty Fear that the patient will have an

illness that is unresponsive to treatment

Prior negative experience Lack of knowledge

Psychiatric Interview(aims) Obtain information Understand the person with the

illness Form a therapeutic relationship Assess the emotions and attitudes of

the patient Provide the patient with information

about the illness, treatment recommendations, and prognosis

Psychiatric Interview(general advice) Putting the patient at ease : *

place : not to be overheard * arrangements for seating * greet the patient by name * introduce yourself with your own

name and your role * explain

Psychiatric Interview(general advice)

Psychiatric Interview…(general advice) Starting the interview :

* begin with a general question * to avoid closed questions and leading questions

Proceeding with the interview :* to keep the patient to

relevant topics, while letting him talk freely

Psychiatric Interview…(general advice) Non-verbal communication :

* the interviewer’s non-verbal cues are important in guiding the interview

Finishing the interview

The Psychiatric History Identifying data:

name, age, sex, marital status, education, occupation, address, …

Present Illness:* patient’s description of the

problem* details of the nature of the

problem* present severity of the symptoms

other relevant problems * onset and course

The Psychiatric History… Family history: * parents:

age, occupation, personality,relationship with the

patient * sibling: * social

position; atmosphere of the home * Hx of mental disorder or drug abuse

The Psychiatric History… Personal history: * mother’s

pregnancy and birth * early development * childhood separation, emotional problems * schooling and higher education * occupations

* sexual relationships

The Psychiatric History… Personal history….

* menstrual history* marriage* children* forensic history

Past illness:* past medical history* past psychiatric history

The Psychiatric History… Premorbid personality:

* relationships* leisure

activities * prevailing mood

* attitudes, standards* habits

Drugs, alcohol, tobacco

Difficulties in Classifications and Diagnosis in Psychiatry

What is a mental illness, when is a mental state abnormal?

Psychiatric symptoms and signs are non specific.

Delusions and hallucinations occur in different psychiatric disorders.

Depression can be a primary problem or part of other disorder.

There are no reliable biological markers.

Psychiatrist can not agree.

Diagnostic systems of psychiatric disorders

ICD-10(International Classification of Diseases)

the World Health Organisation : used world wide

In USA: Diagnostic and Statistical Manual of Mental Disorders ( DSM IV-TR, 2000

DSM :has five axes

Axis I: Psychiatric disorders Axis II: Personality disorders /

mental retardation Axis III: General medical conditions Axis IV: Social functioning and

impact of symptoms Axis V: Global Assessment of

Functioning

Psychiatric treatment

In the past, psychiatric patients were often hospitalized for six months or more, with some cases involving hospitalization for many years

Today, most psychiatric patients are managed as outpatients

Average hospital stay is around 2-3 weeks (with only a small number of cases involving long-term hospitalization

Inpatient care

admitted to a hospital, sometimes involuntarily criteria for involuntary admission vary with

jurisdiction patients are assessed, monitored, and often

given medication and receive care from a multidisciplinary team

physicians, nurses, psychologists, occupational therapists, psychotherapists, social workers, and other medical professionals

Inpatient care

Inpatient care

Outpatient care

periodically visit for consultation Office base usually 30-60 mins psychiatric practitioner interviewing assessment of the patient's condition provide psychotherapy or review medication frequency : varies widely, from days to months depending on the type, severity and stability

of each patient's condition, and on what the clinician and patient decide would be best

Biomedical treatment

Biomedical treatmentElectroconvulsive therapy

Psychological treatment

Meditation Psychotherapy

Counselling

Psychiatric rehabilitation

Questions…..

Comments….. (welcome)

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