الهام الجماس

18th 0f sept 2013

Introduction to psychiatry

Prof. Dr. Elham Khattab Aljammas

Objectives:

1. To differentiate between Neurosis & psychosis
2. To experience the skills of history taking in psychiatry
3. To experience the skills of clinical psychiatric examination
4. To detect the factors the make you suspect a psychiatric diagnosis
5..To determine the indications of admission to a psychiatric ward

what is psychiatry

It the science that deals with the phenomenon of mental disorder regarding their classification, clinical presentation & diagnosis , explanation, planning of management , possible etiological factors & prognosis


Mental Disorder

Mental illness means a state of mind which affects thinking, perceiving, emotion or judgment and which seriously impairs mental function to the extent that require care or medical treatment in his or her own interest or in the interest of other people. Severe dementia means a deterioration of the brain which significantly impairs your intellectual function and affects thought, comprehension and memory and which includes severe psychiatric or behavioural symptoms such as physical aggression. Significant intellectual disability’ means a state of arrested or incomplete development of the mind which includes significant impairment of intelligence and social functioning and abnormally aggressive or seriously irresponsible conduct.

Psychiatric services

. Psychiatric hospitals, also known as mental hospitals
Emergency psychiatry
The crisis stabilization unit is in effect an
emergency room for psychiatry
. Open units. Medium-term, Juvenile wards
. Long-term care facilities,Halfway houses
. Political imprisonment

,

Classififcation

there is two widely used classifications:
1.International classification : ICD use in most countries
2.Diagnostic & statistical manual : DSM used mainly in USA
In both there is a code for every major psychiatric disorders, then sub-coding for every sub-type.
Psychiatric Disorders


Psychiatric Disorders
Organic
Non-Organic

Chronic

Dementia
Korsakoff
Others
Alcohol …
Head Injury
Etc….
Acute
Delirum
Wernicke’s

Psychoses

Schizophrenia
Mood disorders
Etc….
Neuroses
Anxiety disorders
Adjustment dis.
Dysthymia
Dissociative dis.


Others
Personality dis.
Sleep disorder
Sex disorder
Etc…

Organic (there is organic damage to CNS)

Functional(No organic damage but disturbance in the function of CNS)

Organic Disorders* Acute (Dilirium)* Subacute ( Dysamnesia)* Chronic ( Dementia)

Functional Disorders* Schizophrenia & related disorders* Affective disorders ( depression , mania ,& bipolar (manic depressive))* Neurosis: - Generalized anxiety disorder - Phobia & panic disorder - stress disorder - Obsessive compulsive disorder - Somatoform disorder* Substance abuse* Personality disorder

Neurosis

A group of mental disorders characterized by :

1.reality testing ( patient still differentiate between reality & un-reality i.e no Hallucination nor delusion)
2.Insight still present realize that he is ill & that he needs treatment


Psychosis

A group of mental disorders characterized mainly by:

1.Loss of reality testing ( patient can’t differentiate between reality & un-reality i.e the presence of hallucination or delusion)
2.Loss of insight i.e patient can’t recognized that he is ill or he needs treatment

• Psychosis

• Neurosis
• Major mental illness
• Abnormal in quality
• e.g. hallucinates
• Affected
• Drugs & ECT
• Minor mental illness
• Abnormal in quantity
• e.g. anxiety
• Preserved
• Psychological & drugs
• Severity
• Features
• Insight
• Treatment


Psychological assessment
We ask about :

Marital status , occupation , place of birth. In more details than in other branch of medicine.
History of present complaint
Date & circumstance at onset
Reasons for seeking treatment
Ways in which the symptoms started

Specific questions

Sleep pattern
Appt. & weight
Energy
Concentration & level of interest
Libido
Headache, other aches & pain
previous & family history
Mood , especially anxious, depressed or irritable
Previously depressed or irritable
Previous reception of psychoactive drug
Previous nervous trouble
Psychiatric treatment
Suicide attempts


Recent life changes
Moving house
Changing job
Domestic disturbance such as difficult with children or spouse
Engagement, marriage, separation or divorce
Illness in family members or divorce
Any accident
Current social circumstance supportive or not

Personal history

Specific questions mainly:
Premorbid personality
His relation with others
Schooling
Jobs
Hobbies
Attitude towards others, religion, social background,

When to admit a patient to a psychiatric ward?

1.For assessment & then treatment
2.To protect the family & society especially when patient is dangerous or to protect the patient from his society
3.To protect the patient from himself like in suicidal patients
4.To give relief for the family
5.there is impending relapse of acute illness


Admission to a psychiatric hospital
The rules about admission to psychiatric hospitals or units are set out in the Mental Health Act 2001 which has been fully implemented since 1 November 2006. These rules apply in the same way to public and private psychiatric facilities. The Act requires that psychiatric hospitals and units be registered as approved psychiatric centres..a.volutary .b.involuntary admission

Psychiatric unit addmission

Patient present as a danger to self
(Suicidal,elderly,severe depressive illness refusal to eat or drink ,self neglect ,lonely,)
-Recent (within the past 72 hours) suicide attempt
-the patient has a current suicide plan, specific suicide intent, or recurring suicidal ideation
-self-mutilative behavior


• 2. Patient presents as a danger to others . (psychotic –schizophrenia ,mania ,MDP.Purperal psychosis ,Infanticide)
• -Dangerously aggressive behavior
• -Threats to kill or seriously injure another person
• - the patient has a current homicide plan, specific homicidal intent, or recurrent homicidal

3. Patient is gravely disabled and unable to care for self

- Inability of patient to comply with prescribed psychiatric and/or medical health regimens .
- Patient has a history of decompensation without psychotropic medications and patient refuses to use these medications as an outpatient
- Patient is at risk of health or life due to non-compliance with medical regimens
-. Patient presents with acute onset or acute exacerbation of hallucinations, delusions, or illusions of such magnitude
-that the patient’s well being is threatened.


nursing

4.. Treatment of the patient’s psychiatric condition requires nursing services on an inpatient hospital basis requiring 24-hour nursing
observation under the direction of a psychiatrist.
services include, but are not limited to
A. Suicide precautions, unit restrictions, and continuous observation and limiting of behavior to protect self or others
B. Active intervention by a psychiatric team to prevent assaultive behavior
C. The patient exhibits behaviors that indicate that a therapeutic level of medication has not been reached and this necessitates 24-hour observation and medication stabilization.

Types of managements:

CRISIS MANAGEMENT
IN-HOME CRISIS SERVICE
RESIDENTIAL SERVICES
PARTIAL HOSPITALIZATION
DAY PROGRAMS
MEDICATION MANAGEMENT
FAMILY SUPPORT SERVICES
COUNSELING AND HERAPY T
PSYCHOSOCIAL KILLS TRAINING S
TREATMENT INTEGRATION
TARGETED CASE MANAGEMENT
OTHER (SPECIFIY)



THANK YOUWHO IS RESPONSIBLE FOR SUCH differences & WHY?