Lecture Lecture №1№1Object and task of psychiatry and Object and task of psychiatry and

narcology, their place among narcology, their place among other medical disciplines. History other medical disciplines. History of development and modern state of development and modern state

of psychiatry and narcology. of psychiatry and narcology. Psychonosology and diseases. Psychonosology and diseases.

Principles of therapy, prophylaxis Principles of therapy, prophylaxis and rehabilitation of psychic and rehabilitation of psychic

disordersdisorders Lecturer Savka Svitlana DmytrivnaLecturer Savka Svitlana Dmytrivna

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.

Tasks psychiatryTasks 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 History of development of psychiatrypsychiatry

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.

FRAME OF PSYCHIATRY.FRAME OF PSYCHIATRY. General psychopathology - studies the General psychopathology - studies the

basic laws of an etiopathogenesis, clinic, basic laws of an etiopathogenesis, clinic, diagnostics, therapy and prophylaxis of diagnostics, therapy and prophylaxis of alienations. alienations.

Private psychiatry - studies separate Private psychiatry - studies separate mental diseases. mental diseases.

Age psychiatry. Age psychiatry. Organizational psychiatry. Organizational psychiatry. Judicial psychiatry - solves questions of Judicial psychiatry - solves questions of

a sanity and capacity for acting. a sanity and capacity for acting. Psychopharmacotherapy - studying of Psychopharmacotherapy - studying of

action on mentality of medicinal action on mentality of medicinal substances. substances.

Social psychiatry. Social psychiatry.

Addictology - studies influence of the Addictology - studies influence of the psychotropic substances on a condition of psychotropic substances on a condition of the person.the person.

Trans-cultural psychiatry - is engaged in Trans-cultural psychiatry - is engaged in comparison of a mental pathology in the comparison of a mental pathology in the different countries, cultures. different countries, cultures.

Orthopsychiatry - surveys alienations from Orthopsychiatry - surveys alienations from the point of view of different disciplines. the point of view of different disciplines.

Biological psychiatry. Biological psychiatry. Sexology. Sexology. Suicidology. Suicidology. Military psychiatry - studies posttraumatic Military psychiatry - studies posttraumatic

stressful frustration, psychopathology a stressful frustration, psychopathology a wartime. wartime.

Ecological psychiatry - studies influence of Ecological psychiatry - studies influence of ecological factors on mentality. ecological factors on mentality.

CONTRA-INDICATION FOR CONTRA-INDICATION FOR HOSPITALIZATION IN PSYCHIATRIC HOSPITALIZATION IN PSYCHIATRIC

CLINIC:CLINIC: Mentally healthy man.Mentally healthy man. Persons in a state of simple and, even, heavy Persons in a state of simple and, even, heavy

degree of alcoholic intoxication.degree of alcoholic intoxication. Persons in the state of intoxication.Persons in the state of intoxication. Persons with the affects reactions and Persons with the affects reactions and

antisocial forms conducts, which do not antisocial forms conducts, which do not suffer by the psychical diseases.suffer by the psychical diseases.

Persons with psychopath’s character traits.Persons with psychopath’s character traits. Persons in which found out the neurotic Persons in which found out the neurotic

reactions.reactions. Persons with a mental backwardness (after Persons with a mental backwardness (after

the exception of examination).the exception of examination). Persons with total dementia.Persons with total dementia. Mentally ill with acute somatic pathology Mentally ill with acute somatic pathology

which requires surgical intervention.which requires surgical intervention.

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.

Levels of mental health: Ideal or standard health. Average statistical health. Constitutional health. Accentuation — a variant of mental health

(norm), characterized by increased, emphasized character features and certain personality disharmony, which decreases the level of adjustment.

Pre-illness — appearance of first episodic mild symptoms of disorder, which cause slight dysfunction and social maladjustment.

Basic classification categories:1. Menial retardation: impairment of intellectual

functioning present continuously from early life.2. Personality disorders: dispositions to behave in

certain abnormal ways present continuously from early adult life.

3. Adjustment disorders: disorders that are less severe than mental disorders and occur in relation to stressful events or changed circumstances.

4. Mental disorders: abnormalities of behaviour or psychological experience with a recognisable onset after a period of normal functioning.

5. Other disorders: conditions that do not fit into the first four groups, for example abnormalities of sexual preference and drug dependence.

Classification mClassification mental disorders ental disorders (ICD-10)(ICD-10)

F00-09Organic, including symptomatic, mental disordersF00-09Organic, including symptomatic, mental disordersF10-19 Mental and behavioural disorders due to F10-19 Mental and behavioural disorders due to

psychoactive substance usepsychoactive substance useF20-29 Schizophrenia, schizotypal and delusional F20-29 Schizophrenia, schizotypal and delusional

disordersdisordersF30-39 Mood (affective) disordersF30-39 Mood (affective) disordersF40-48Neurotic,stress-related and somatoform disordersF40-48Neurotic,stress-related and somatoform disordersF50-59 Behavioural syndromes associated with F50-59 Behavioural syndromes associated with

physiological disturbances and physical factorsphysiological disturbances and physical factorsF60-69 Disorders of adult personality and behaviourF60-69 Disorders of adult personality and behaviourF70-79 Mental retardationF70-79 Mental retardationF80-89 Disorders of psychological developmentF80-89 Disorders of psychological developmentF90-98 Behavioural and emotional disorders with onset F90-98 Behavioural and emotional disorders with onset

usually occurring in childhood and adolescenceusually occurring in childhood and adolescence

Classification of mental disorders on the Classification of mental disorders on the basis of aetiology and pathogenesisbasis of aetiology and pathogenesis

1) endogenous disorders (schizophrenia, bipolar 1) endogenous disorders (schizophrenia, bipolar affective disorder and genuine epilepsy) caused by affective disorder and genuine epilepsy) caused by internal mechanisms, the nature of which isn't yet internal mechanisms, the nature of which isn't yet quite clear; these are disorders with he reditary quite clear; these are disorders with he reditary predisposition.predisposition.

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

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

The methods of investigation clinical interview and collection of

anamnesis data; physical examination; observation; psychological investigation; additional investigations:

a) neurophysiological investigations

b) X-ray investigations

c) laboratory tests

Psychotropic drugsPsychotropic drugs

Antipsychotics Antipsychotics AntidepressantsAntidepressants Mood stabilizersMood stabilizers AnxiolyticsAnxiolytics HypnoticsHypnotics Cognitive enhancersCognitive enhancers StimulantsStimulants

ANTIPSYCHOTICS ANTIPSYCHOTICS (Neuroleptics, Major (Neuroleptics, Major

Tranquillisers) Tranquillisers) Antipsychotics are used principally Antipsychotics are used principally

in the treatment of psychoses. in the treatment of psychoses. They diminish the agitation, They diminish the agitation, delusions, hallucinations and delusions, hallucinations and thought disorder of these illnesses. thought disorder of these illnesses. The drugs have less effect on the The drugs have less effect on the symptoms of apathy and symptoms of apathy and withdrawal. Treatment response is withdrawal. Treatment response is most dramatic during the first six most dramatic during the first six weeks thereafter it tapers off. weeks thereafter it tapers off.

TYPICAL ANTIPSYCHOTICSTYPICAL ANTIPSYCHOTICS SHORT SHORT ACTING INJECTIBLESACTING INJECTIBLES

GENERIC NAME BRAND NAMEGENERIC NAME BRAND NAME chlorpromazine Largactil chlorpromazine Largactil haloperidol Serenace haloperidol Serenace trifluoperazine Stelazinetrifluoperazine Stelazine LONG ACTING INJECTIBLESLONG ACTING INJECTIBLES GENERIC NAME BRAND NAMEGENERIC NAME BRAND NAME

flupenthixol decanoate Fluanxol flupenthixol decanoate Fluanxol fluphenazine decanoate Modecate fluphenazine decanoate Modecate haloperidol decanoate Haldohaloperidol decanoate Haldo zuclopenthixol decanoate Clopixol Depot zuclopenthixol decanoate Clopixol Depot

ATYPICAL ATYPICAL ANTIPSYCHOTICSANTIPSYCHOTICS

GENERIC NAME BRAND NAME(S)GENERIC NAME BRAND NAME(S) amisulpride Solian amisulpride Solian aripiprazole Abilify aripiprazole Abilify clozapine Clozaril, Clopine clozapine Clozaril, Clopine olanzapine Zyprexa, Zydis (wafers) olanzapine Zyprexa, Zydis (wafers) quetiapine Seroquel quetiapine Seroquel risperidone Risperdal risperidone Risperdal

ANTIPSYCHOTICS – GENERAL ANTIPSYCHOTICS – GENERAL PRECAUTIONSPRECAUTIONS

All antipsychotics are central nervous system All antipsychotics are central nervous system depressants and metabolised in the liver therefore depressants and metabolised in the liver therefore care should be taken when: care should be taken when:

• • prescribing them for persons with respiratory or prescribing them for persons with respiratory or cardiac problems; cardiac problems;

• • using with other central nervous system using with other central nervous system depressants including alcohol; depressants including alcohol;

• • driving a car or as reaction times can be slowed. driving a car or as reaction times can be slowed. • • prescribing for persons with liver problems; prescribing for persons with liver problems; • • prescribing with other drugs metabolised in the prescribing with other drugs metabolised in the

liver. liver. Lower doses are usually required in the elderly. Lower doses are usually required in the elderly. They should be used with caution in children and They should be used with caution in children and

adolescents. adolescents. These drugs should not be prescribed for persons These drugs should not be prescribed for persons

with known hypersensitivity to the drugs. with known hypersensitivity to the drugs.

ANTICHOLINERGICS ANTICHOLINERGICS (Side Effect Drugs, (Side Effect Drugs,

Antiparkinsonians)Antiparkinsonians) These drugs are used principally These drugs are used principally

for the treatment of Parkinson’s for the treatment of Parkinson’s Disease. In this context,they are used Disease. In this context,they are used to treat drug-induced parkinsonism to treat drug-induced parkinsonism and other movement disorders and other movement disorders caused by the administration of caused by the administration of antipsychotic medications. They may antipsychotic medications. They may be taken orally or given by injection be taken orally or given by injection as the situation warrants. as the situation warrants.

ANTI-DEPRESSANTSANTI-DEPRESSANTS

These drugs are used to treat These drugs are used to treat major depressive disorder. All major depressive disorder. All anti-depressants can treat anti-depressants can treat depression, however, not all depression, however, not all depression sufferers will respond depression sufferers will respond to treatment. The medicines have to treatment. The medicines have an immediate action in the body an immediate action in the body but the desired improvement in but the desired improvement in mood and depressive symptoms mood and depressive symptoms may take some weeks. may take some weeks.

Classification anti-anti-

depressantsdepressants 1. TRICYCLICS1. TRICYCLICS2. MONOAMINE OXIDASE INHIBITORS 2. MONOAMINE OXIDASE INHIBITORS 3. REVERSIBLE INHIBITOR OF MONOAMINE 3. REVERSIBLE INHIBITOR OF MONOAMINE

OXIDASE OXIDASE 4. SELECTIVE SEROTONIN REUPTAKE INHIBITORS 4. SELECTIVE SEROTONIN REUPTAKE INHIBITORS 5. SELECTIVE SEROTONIN NORADRENALINE 5. SELECTIVE SEROTONIN NORADRENALINE

REUPTAKE INHIBITORREUPTAKE INHIBITOR6. NORADRENERGIC AND SPECIFIC SEROTONIN 6. NORADRENERGIC AND SPECIFIC SEROTONIN

ANTAGONIST ANTAGONIST 7. HETEROCYCLIC 7. HETEROCYCLIC 8. SELECTIVE NORADRENALINE REUPTAKE 8. SELECTIVE NORADRENALINE REUPTAKE

INHIBITORS INHIBITORS

1.TRICYCLICS1.TRICYCLICS antidepressants antidepressants GENERIC NAME BRAND NAME(S)GENERIC NAME BRAND NAME(S) amitriptyline Tryptanol, Endep amitriptyline Tryptanol, Endep clomipramine Anafranil, Placil, ETC clomipramine Anafranil, Placil, ETC dothiepin Prothiaden, Dothep dothiepin Prothiaden, Dothep doxepin Sinequan, Deptran doxepin Sinequan, Deptran imipramine Tofranil, Melipramine imipramine Tofranil, Melipramine nortriptyline Allegron nortriptyline Allegron trimipramine Surmontil trimipramine Surmontil

2. MONOAMINE OXIDASE 2. MONOAMINE OXIDASE INHIBITORSINHIBITORS

These were used in patients These were used in patients resistant to tricyclic treatment and resistant to tricyclic treatment and in phobic anxiety disorders, but are in phobic anxiety disorders, but are now rarely prescribed. now rarely prescribed.

GENERIC NAME BRAND NAMEGENERIC NAME BRAND NAME

phenelzine Nardil phenelzine Nardil tranylcypromine Parnale tranylcypromine Parnale

3. REVERSIBLE INHIBITOR OF 3. REVERSIBLE INHIBITOR OF MONOAMINE OXIDASEMONOAMINE OXIDASE A A

Reversible inhibition of the MAO enzyme Reversible inhibition of the MAO enzyme limits the problem of food and drug limits the problem of food and drug interactions. This class of drug is a safer interactions. This class of drug is a safer alternative to MAOIs and no major alternative to MAOIs and no major dietary precautions are needed. RIMAs dietary precautions are needed. RIMAs have fewer interactions, fewer have fewer interactions, fewer cardiovascular effects and greater safety cardiovascular effects and greater safety in overdose. in overdose.

GENERIC NAME BRAND NAME(S) GENERIC NAME BRAND NAME(S) moclobemide Aurorix, Arima moclobemide Aurorix, Arima

4. SELECTIVE SEROTONIN 4. SELECTIVE SEROTONIN REUPTAKE INHIBITORSREUPTAKE INHIBITORS

This class of antidepressant is well tolerated, This class of antidepressant is well tolerated, and relatively safe in overdose. and relatively safe in overdose.

GENERIC NAME BRAND NAME(S) GENERIC NAME BRAND NAME(S) citalopram Cipramil, Celepram, citalopram Cipramil, Celepram,

Talohexal,etc Talohexal,etc Escitalopram Lexapro Escitalopram Lexapro fluoxetine Prozac-20, Lovan, Erocap, fluoxetine Prozac-20, Lovan, Erocap,

Zactin, etc Zactin, etc fluvoxamine Luvox, Faverin, Movox fluvoxamine Luvox, Faverin, Movox paroxetine Aropax, Paxtine, Oxtine, etc paroxetine Aropax, Paxtine, Oxtine, etc sertraline Zoloft,Xydem sertraline Zoloft,Xydem

5. SELECTIVE SEROTONIN NORADRENALINE 5. SELECTIVE SEROTONIN NORADRENALINE REUPTAKE INHIBITORREUPTAKE INHIBITOR

At low doses venlafaxine acts like an At low doses venlafaxine acts like an SSRI.and at higher doses it is a bit more like SSRI.and at higher doses it is a bit more like a tricylic without some of the adverse effects.a tricylic without some of the adverse effects.

GENERIC NAME BRAND NAMEGENERIC NAME BRAND NAME venlafaxine Efexor, Efexor XRvenlafaxine Efexor, Efexor XR

66.. NORADRENERGIC AND SPECIFIC SEROTONIN NORADRENERGIC AND SPECIFIC SEROTONIN ANTAGONISTANTAGONIST

GENERIC NAME BRAND NAME(S)GENERIC NAME BRAND NAME(S) mirtazapine Avanza, Remeron, etc mirtazapine Avanza, Remeron, etc

7. 7. HETEROCYCLIC

GENERIC NAME BRAND NAME(S) mianserin Tolvon, Lumin

8. SELECTIVE NORADRENALINE REUPTAKE INHIBITORS

GENERIC NAME BRAND NAME reboxetine Edronax

MOOD STABILISERSMOOD STABILISERSThis group of drugs effectively treat a This group of drugs effectively treat a

current episode of mania or depression. current episode of mania or depression. They also help prevent future episodes of They also help prevent future episodes of mania and depression when taken mania and depression when taken consistently. consistently.

GENERIC NAME BRAND NAME(S)GENERIC NAME BRAND NAME(S) lithium carbonate Lithicarb, Quilonum lithium carbonate Lithicarb, Quilonum

SR SR carbamazepine Tegretol, Teril carbamazepine Tegretol, Teril sodium valproate Epilim, Valpro sodium valproate Epilim, Valpro lamotrigine Lamictil lamotrigine Lamictil

ANXIOLYTICS ANXIOLYTICS (Antianxiety Drugs)(Antianxiety Drugs)These compounds are effective in relieving These compounds are effective in relieving

the symptoms of anxiety. The main compounds the symptoms of anxiety. The main compounds in this category are the benzodiazepines. in this category are the benzodiazepines.

SIDE EFFECTS SIDE EFFECTS Drowsiness Drowsiness Impairment of concentration and reaction Impairment of concentration and reaction

times times Impairment of some memory functions Impairment of some memory functions Muscle incoordination – especially in the Muscle incoordination – especially in the

elderly which can lead to falls elderly which can lead to falls Muscle weakness Muscle weakness Blurred vision Blurred vision

BENZODIAZEPINES BENZODIAZEPINES GENERIC NAME BRAND NAME(S) GENERIC NAME BRAND NAME(S)

alprazolam Xanax, Kalma alprazolam Xanax, Kalma bromazepam Lexotan bromazepam Lexotan clobazam Frisium clobazam Frisium clonazepam Rivotril, Paxam clonazepam Rivotril, Paxam diazepam Antenex, Ducene, diazepam Antenex, Ducene,

Valium Valium lorazepam Ativan lorazepam Ativan oxazepam Alepam, Murelax, oxazepam Alepam, Murelax,

Serepax Serepax

BUSPIRONE BUSPIRONE

Buspirone is a non-benzodiazepine anxiolytic. Buspirone is a non-benzodiazepine anxiolytic. Symptom relief is delayed (unlike the Symptom relief is delayed (unlike the benzodiazepines, which are immediately benzodiazepines, which are immediately relieve symptoms). It is generally well relieve symptoms). It is generally well tolerated. It does not impair alertness, tolerated. It does not impair alertness, attention, memory, reaction time or driving. attention, memory, reaction time or driving.

Its use does not lead to abuse, tolerance or Its use does not lead to abuse, tolerance or withdrawal neither does it influence the effects withdrawal neither does it influence the effects of alcohol or sedative-hypnotics. of alcohol or sedative-hypnotics.

SEDATIVE – HYPNOTIC AGENTS SEDATIVE – HYPNOTIC AGENTS

These agents are used to help in the short–These agents are used to help in the short–term management of insomnia. Generally the term management of insomnia. Generally the medications are prescribed for 2-4 weeks to medications are prescribed for 2-4 weeks to help re-establish normal sleeping patterns. help re-establish normal sleeping patterns. Occasionally, they are prescribed for a longer Occasionally, they are prescribed for a longer period of time. The main agents used are period of time. The main agents used are benzodiazepines. Other non-benzodiazepine benzodiazepines. Other non-benzodiazepine agents have also been used. The agents have also been used. The disadvantages of the hypnotics are similar to disadvantages of the hypnotics are similar to anxiolytics. Tolerance and physical anxiolytics. Tolerance and physical dependence can develop rapidly hence their dependence can develop rapidly hence their indication for short-term intervention in sleep indication for short-term intervention in sleep disturbance. disturbance.

BENZODIAZEPINESBENZODIAZEPINES

GENERIC NAME BRAND NAME(S) GENERIC NAME BRAND NAME(S) flunitrazepam Hypnodorm flunitrazepam Hypnodorm nitrazepam Mogadon, Alodorm nitrazepam Mogadon, Alodorm temazepam Euhypnos, Normison, Temaze, temazepam Euhypnos, Normison, Temaze,

Temtab Temtab triazolam Halcion triazolam Halcion

NON-BENZODIAZEPINESNON-BENZODIAZEPINES

GENERIC NAME BRAND NAME GENERIC NAME BRAND NAME zopiclone Imovane zopiclone Imovane zolpidem Stillnoxzolpidem Stillnox

PSYCHOSTIMULANTS PSYCHOSTIMULANTS

These medicines are used to treat These medicines are used to treat attention deficit disorder, usually in attention deficit disorder, usually in children. They may also be used in children. They may also be used in narcolepsy.narcolepsy.

GENERIC NAME BRAND NAME GENERIC NAME BRAND NAME Atomoxetine Strattera Atomoxetine Strattera Dexamphetamine Dexamphetamine Methylphenidate Ritalin, Attenta Methylphenidate Ritalin, Attenta

Electroconvulsive therapy (ECT)Electroconvulsive therapy (ECT)

Electroconvulsive therapyElectroconvulsive therapy, also known as , also known as electroshock, is a well-established, albeit electroshock, is a well-established, albeit controversial, psychiatric treatment in which controversial, psychiatric treatment in which seizures are electrically induced in anesthetized seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is patients for therapeutic effect. Today, ECT is most often used as a treatment for severe most often used as a treatment for severe major depression which has not responded to major depression which has not responded to other treatment,other treatment, and is also used in the and is also used in the treatment of mania (often in bipolartreatment of mania (often in bipolar disorder),disorder), catatonia andcatatonia and schizophrenia.schizophrenia.

PsychotherapyPsychotherapy

PsychoanalyticPsychoanalytic Cognitive behavioral Cognitive behavioral PsychodynamicPsychodynamic ExistentialExistential HumanisticHumanistic TranspersonalTranspersonal HypnotherapyHypnotherapy Gestalt TherapyGestalt Therapy