Introduction to psychiatry

Prof. Dr. Haroon Rashid ChaudhryDPP (UK), FACHARZT (PSYCH. & NEUROLOGY) FACP (USA) MRCPsych (London)

FRCP (Ireland)

Head of the Department of Psychiatry Fatima Jinnah Medical College Zonal Representative

World Psychiatric Association (WPA)(Western & Central Asia)

Honorary Executive Director Fountain House, Lahore

INTRODUCTION TO PSYCHIATRY

WHAT IS HEALTH?

World Health Organization's Definition

“A state of complete physical, mental, social and spiritual well being and not merely the absence of disease or infirmity”

WHAT IS MENTAL HEALTH?

DIVERSE OPINIONS EXIST

The most acceptable concept now –a – days

A person who is:

Able to to cope/function normally

Meets the responsibilities

Expresses balanced attitude towards

day to day challenges/ problems

MENTAL HEALTH IN THE WORLD

MORE THAN TWO FIFTHS OF THE TOTAL DISABILITIES

ARE DUE TO MENTAL ILLNESSES

(WORLD HEALTH REPORT, 2001)

MENTAL HEALTH IN THE WORLD

EXISTING DATA SUGGESTS:

Schizophrenia (above the age of 18): 45million

Depression: 340millionBoth disorders cause 60% Suicide across the globe.

(Desjarlais R et al 1995 WORLD HEALTH REPORT, 2001)

MENTAL HEALTH IN THE WORLD

Mental Retardation 4.6% (total psychiatric diagnoses)

Alcohol Dependence 140 million

(Nations for Mental Health, WHO, 2001)

MENTAL HEALTH IN THE WORLD

Alzheimer’s disease: 11 million

Epilepsy: 45 million

(Murray L and Lopez A 1996)

DISEASES IN 2020

Ischaemic Heart Disease Depression Road Traffic Accident Cerebrovascular Diseases Chest Diseases

(Murray L. And Lopez A., 1996)

MYTHS Violent Aggressive Irrational Untreatable Unreliable Dependent Chronic

PREJUDICE

Every Patient Deserves a Clinician

And a Healer who is not Prejudiced

AETIOLOGY

Genetics

Biological Factors

Psychological Factors

Social Factors

Bio Psycho Social Model

Psychosocial Factors

GeneticsBiological Factors

GENETICS

Twins Studies

Family Studies

Adoptions Studies

Mode of Inheritance

Molecular Genetics

BIOCHEMICAL

Postmortem Studies

Brain Biochemistry & Imaging

Peripheral Measures

PSYCHOLOGICAL FACTORS

• Parental Deprivation

• Relationship with Parents

• Life Events

• Effect of Physical illness

• High Express Emotion

ANGER

QUARRELS

SPELLS OF CRYING

EMOTIONAL REACTIONSEVERY DAY OCCURANCE IN SOCIETY

SOCIAL FACTORS

• Place of Residence

• Occupation and Social Class

• Culture

• Migration

• Social isolation

National Seminar on Post Earthquake Mental Health Activities

CLASSIFICATIONS

International Classification of Diseases (ICD-10)

The Diagnostic and Statistical Manual (DSM-IV)

ORGANIC MENTAL DISORDERS

Delirium

Dementia

Amnestic Disorders

Personality and Behavioural disorders due to brain disease damage and dysfunction

PSYCHIATRIC DISORDERS

• Psychotic Disorders

• Non Psychotic Disorders

• Personality Disorders

PSYCHIOTIC DISORDERS

• Schizophrenia

• Drug Induced Psychosis

• Schizoaffective

• Postnatal Psychosis

MOOD DISORDERS

• Bipolar Affective Disorder

• Major Depression

• Post Natal Depression

PERSONALITY DISORDERSCLUSTER A

• Paranoid Schizoid, Schizotypal

CLUSTER B

• Antisocial, Border line, histrionic, narcissistic

CLUSTER C

• Avoidant, Dependant, Obsessive Compulsive

ANXIETY DISORDERS

Generalized Anxiety Disorder

Panic Disorder

Phobic Disorders

Obsessive Compulsive Disorder

Post Traumatic Stress Disorder (PTSD)

Hypochondriacal Disorder

Substance Abuse Disorders Intoxication Abuse Dependence Withdrawal Psychotic Disorders Amnestics Disorders Mood Disorders Anxiety Disorders Sexual Dysfunctions Sleep Disorders

CLASSES OF SUBSTANCE ABUSE DRUGS

Alcohol Caffeine Opioids Inhalents Nicotine Cannabis Sedatives / Hypnotics Multiple Drugs Use

PSYCHIATRIC DISORDERS, WITH SOMATIC SYMPTOMS

Stress & Adjustment Disorders Mood Disorders Anxiety Disorders Somatoform Disorders

Dissociative / Conversion DisordersHypochondriacal syndromePsychogenic autononinc dysfunctionPain syndrome

AROUSAL RESPONSE

MALE Erectile impotence

Premature Ejaculation Retarded Ejaculation

FEMALE Lubrication Failure

Anorgasmia

SEXUAL DYSFUCNTIONS

PSYCHOSEXUAL DISORDERS

Gender identity Gender Role

Drive and Responsiveness

Sexual Preferences

Relationshipbehaviour

CHILDHOOD PSYCHIATRIC DISORDERS

• Problems of Preschool Children

• Specific Developmental Disorders

• Pervasive Developmental Disorders

CONTD…..

• Principal Psychiatric Disorders• Hyperkinetic Disorders

• Conduct Disorders

• Juvenile Delinquency

• Anxiety Disorders

• Somatization Disorders

• Depressive Disorders

• School Refusal

• Functional Enuresis • Stammering • Schizophrenia• Gender Identity Disorders• Child Abuse

– Physical – Sexual – Emotional

CONTD…..

SPECIFIC DEVELOPMENTAL DISORDERS

• Specific Reading Disorders

• Mathematical Learning Disorders

• Communication Disorders

CONTD…..

Types Of Mental Retardation

• Mild (IQ 50 - 70)

• Moderate (IQ 35 – 49)

• Severe (IQ 20 - 34)

• Profound (IQ below 20)

PHYSICAL DISORDERS AMONG THE MENTAL RETARDED

• Sensory Disorders

• Motor Disorders

• Epilepsy

• Incontinence

• Schizophrenia

• Mood Disorders

• Emotional Disorders

• Eating Disorders

• Personality Disorders

• Cognitive Psychiatric Disorders

• Behaviour Disorders

PSYCHIATRIC DISORDERS AMONG THE MENTAL RETARDED

EFFECTS OF MENTAL RETARDATION ON THE FAMILY

• Initially Shock

• Depression

• Guilt

• Shame

• Anger

• Inability to cope with practical and financial problems