PSYCHIATRY: Psychological Reactions to Disability

A. General Objectives:
a. To know the development of personality with emphasis on the Filipino personality
b. To know the various psychiatric conditions as a preparation for the management of
psychiatric patients referred to physical therapy and occupational therapy
c. Distinguish between the psychiatric and physical aspects of specific conditions
d. Know the psychological and emotional aspects of significant human life events
e. Know the general principles in integrating the physical and mentally disabled into the
community.

B. Specific, the course aims to:

a. Define the different psychiatric conditions
b. Identify the importance signs and symptoms of each condition
c. Identify the possible causes of each condition
d. Describe the course and prognosis of each condition
e. Identify the management procedures for each condition
f. Identify the psychiatric aspects of specific physical conditions
g. Identify the physical aspects of some psychiatric conditions
h. Discuss the psychodynamics of sexuality, aggression, suicide, death and dying
i. Discuss common reactions of man to illness and hospitalization
j. Demonstrate appropriate treatment approaches towards these events or situations

C. Course Outline
a. The Theoretical Foundations of Psychiatry
i. History of Psychiatry
ii. The Four Schools of Thought in Psychiatry
1. The Psychoanalytic Theory
2. The Social Learning Theory of the Behavioral Approach
3. The Neurobiological Theories and Approaches
4. The Biopsychosocial Approach
b. Child, Adolescent and Adult Development
i. The Psychosexual Stages of Development of Sigmund Freud
ii. The Attachment Theory of John Bowlby
iii. The Stages of Intellectual Development of John Piaget
iv. The Psychosocial Stages of Development of Erik Erikson
c. Brain and Behavior
i. Background in the surface anatomy of the central nervous system
1. The Cerebral Cortex
2. The Limbic System
3. The Brainstem
4. The Spinal Cord
5. The Cranial Nerves
d. Neuropathologic Conditions associated with disruption in the CNS Anatomy
i. Epilepsy
ii. Drive Disorders – rage, eating, pleasure, hunger, sleep
iii. Syndromes of denial, neglect and inattention (Parietal Lobe Syndromes)
iv. Language Disorders
v. The Frontal Lobe Syndromes
vi. Movement Disorders (Brainstem Syndromes)
1. Parkinson’s disease
2. Huntington’s disease
3. Tardive dyskinesia
4. Gilles de la Tourette’s Syndrome
5. Wilson’s disease
e. Adaptive Processes and Mental Mechanism
i. Stress and how it is manifested in the human body and mind
ii. Stressful events throughout the life cycle
iii. Adaptive Mental Mechanisms
1. The Narcissistic Defense Mechanism
2. The immature Defense Mechanism
3. The Neurotic Defense Mechanism
4. The Mature Defense Mechanism
f. The Mental Status Examination Parameters
i. Review of Some Psychiatric Signs and Symptoms
g. The Brain Syndromes due to a General Medical Condition
i. Delirium
ii. Dementia
iii. Amnestic Syndrome
iv. Organic Delusional Syndrome
v. Organic Hallucinosis
vi. Organic Mood Syndrome
vii. Organic Anxiety Syndrome
viii. Organic Personality Syndrome
ix. Substance Use Disorders Drugs and Alcohol
h. The Psychotic Disorders
i. Schizophrenia and Paranoia
ii. Depression and other Mood Disorders
i. The Anxiety Disorders/Personality Disorders
j. Psychological Factors Affecting Physical Condition
i. Cardiovascular System Disorder: CAD, HTN, CHF, Syncope, Arrhythmia
ii. Respiratory System disorder: Bronchial asthma, Hyperventilation Syndrome,
Tuberculosis
iii. Gastrointestinal system disorder: Peptic ulcer, Ulcerative colitis, Obesity,
Anorexia Nervosa
iv. Musculoskeletal system disorder: Rheumatoid Arthritis, Low Back Pain
v. Headaches
vi. Endocrine system disorder: Hyperthyroidism, Diabetes Mellitus, Premenstrual
Syndrome, Menopause, Amenorrhea
vii. Chronic Pain
viii. Immune System Disorders – Infections, Allergies, Organ Transplantation,
Autoimmune diseases (AIDS)
ix. Cancer
x. Skin Disorders
k. The Somatoform Disorders
i. Somatization Disorder
ii. Conversion Disorder
iii. Hypochondriasis
iv. Body Dysmorphic Disorder
v. Pain Disorder
l. Therapeutic Interventions
i. Psychotherapy
ii. Pharmacological Therapy and other Somatic Therapies
iii. Social and Cultural Aspects of Health, Illness and Treatment
iv. Care giving and the True Essence of Helping

D. Schedule
a. Day: Tuesday
b. Time: 4:00pm to 6:00pm

E. Methods of Evaluation and Grading System

a. Attendance 10%
b. Quizzes/Assignments/Group dynamics 60%
c. Examination 30%
d. Total 100%

F. References
a. Bellish, Karil. Clinical Heatlh Issues Handbook. 1997.
b. Kaplan, Harold I. Comprehensive Textbook of Psychiatry/VI, volume 1. 1995.
c. Kaplan, Harold I. Comprehensive Textbook of Psychiatry/VI, volume 2. 1995.
d. Naidoo, Jennie. Health Promotion: Foundations for Practice. 2000.
e. Sadock, Benjamin James. Synopsis of Psychiatry: Behavioral Sciences/Clinical
Psychiatry, 9th ed. 2003
MODULE 1
(PREPARED BY:
DR. MARIA ELLER ISABEL T. COLLANTES)

DAY 1

The Theoretical Foundations of Psychiatry

1. History of Psychiatry
2. The Four Schools of Thought in Psychiatry
a. The Psychoanalytic Theory
b. The Social Learning Theory of the Behavioral Approach
c. The Neurobiological Theories and Approaches
d. The Biopsychosocial Approach

A. Learning Outcome
At the end of the topic the learner will be able to:
1) Explain the theoretical foundations of psychiatry
2) Differentiate the schools of thought in psychiatry

B. Instructional Flow
a. Pre Activity
i. (Essay) Answer the questions truthfully as possible. This is not graded, however
this will assess on your knowledge on Psychiatry.
1. What are some of the negative things you have heard about people with
mental illness?

______________________________________________________________________________
2. Can you think of any other health conditions or social issues that have
been stigmatized throughout history?

______________________________________________________________________________
3. Identify all the emotions that is at the picture
________________________________________

________________________________________

________________________________________

________________________________________

________________________________________

b. Discussion

Introduction:

Psychiatry is a specialization of medicine. It diagnoses, prevent and treats mental

disorders, including different maladaptation’s s that is related to mood, behaviors,
cognitions and perceptions. In simpler terms it is the study and treatment of mental
illness, emotional disturbance and abnormal behavior, as defined in the Oxford
dictionary.

German physician Johann Christian Reil in the year 1808 was the first to use the
word psychiatry that means medical treatment of the soul. Psychiatry is an Ancient Greek
word divides into psych (psykne) which means soul and iatry (iatrikos) means medical
treatment. A medical doctor who specializes in psychiatry is called a psychiatrist.

History:
As early as 1800s, they are concerned with individuals confined to asylums or
hospitals. Patients are usually psychotic, depressed or manic, or those with medical
condition such as dementia, brain tumors, seizures, hypothyroidism as such. Treatment at
that time was harsh, rudimentary and not effective. They do not really treat outpatients
but rather the neurologists are the ones treating the outpatient or their nervous conditions.

On the 20th century, Sigmund Freud, a neurologist, published theories on

unconscious roots of some less severe disorders, termed psycho-neuroses (Reidbord,
2014). These disorders exhibits symptoms such as paralysis or mutism which at that time
it is not being explained. Freud developed psychoanalysis that treats the neurotic
patients. That term became the first treatment for psychiatric outpatients.

By the late 1950’s and early 1960’s, introduction of new medications that changes
the view of psychiatry Thorazine and other 1st generation antipscyhotics are the best
treatment of choice at that time together with antidepressants as treatment for severely
depressed patients.

In the year1980, the Diagnostic and Statistical Manual of Mental Disorder (DSM)
which has been published by American Psychiatric Association (APA) is being used as a
diagnostic tool for mental disorders. This tool will describe medical disorders without
association to the causes of the disorder. Hence, it will provide a connection between
biological and psychoanalytic psychiatrists to improve the diagnosis of any mental
disorder. With this development, the psychoanalysis and psychodynamic therapies
became the treatment of choice for nonspecific and unscientific diagnosis while the
pharmaceutical arm will discover drugs that could improve the symptoms of the disorder
until they are no longer classified as DSM.

Pharmaceutical innovation includes a new class of antidepressants called SSRIs or

selective serotonin reuptake inhibitors that are considered to be safer than the other
antidepressants. Prozac or generically it is named as Fluoxetine, an anti - psychotic drug,
approved by the FDA, was released in 1987 and distributed in the year 1988 (Hillhouse
& Porter, 2015).

In the year 1990, the National Institute of Mental Health (NIMH) declared
Decade of Brain, this is to promote awareness on the benefits of brain research. In 1994,
a DSM – IV, a criteria for psychiatric diagnosis have been introduced to elaborate a
psychiatric diagnosis.

Controversy and criticism surrounds the world of psychiatry, it is influenced by

medicine, with use of drugs and primarily the concept of mental illness. Some people
disagree with this label as it is confused as a disorder of the mind with disorder of the
brain and that can be treated with drugs. Anti-psychiatry by introduced by psychiatrist
David Cooper in year 1967 and later by Thomas Szasz. However, it has already been
used in Germany as early as 1904. Anti-psychiatry movement has tried to classify normal
people as deviant, therefore for some, psychiatric treatments are damaging than helpful.
Survivors are referred to as former psychiatric patients. In 1973, Rosenhan experiment
was used to determine the validity of psychiatric diagnosis. There are volunteers who
enter psychiatric hospitals due to hallucinations and acted normally after admitted. They
were diagnosed as psychiatric disorders and treated with antipsychotic drug. This study is
conducted by psychologist David Rosenhan (Gaughwin, 20112). (Wikipedia, 2020)

Four Schools of Thought in Psychiatry:

i. The Psychoanalytic Theory
Psychoanalytic Theory or Psychoanalysis is founded by Sigmund
Freud. This theory emphasized the influence of the unconscious mind on
behavior (Kendra, 2020). This theory is about understanding personality
and personality development of the person. It is a clinical method to test
psychopathology. Hence, it is both an approach to therapy and theory of
personality.

This theory is divided into 3 parts: the Structure of the Psyche that
includes The Topographical Model and The Structural Model, 2nd is the
Theory of Instincts and Libido and lastly the Theory of Psycho Sexual
Development (Sharma, Sangma, & Shadap)

1. Structure of the Psyche or Mind

Explanation of the mind has 2 divisions: first is the Conscious
Subconscious/preconscious and Unconscious known as the
topographical model. Second division has 3 components the Id, Ego
and Superego.

a. The topographical model:

When these three are working together they are responsible
in creating the reality. The conscious mind is being aware of
something and being able to matter with it. Usually these are
what can be recalled as activities of the human mind. The
conscious mind has the ability to direct the focus and to
imagine what is not real. With an important part of the human
mind, the conscious mind will serve as a scanner that will see
an event to trigger a reaction depending on the importance of it
and can store it to either preconscious or subconscious mind
until it will be fully recalled.

The subconscious/preconscious mind is beneath the

conscious mind. It is the storage area of all the memories or
knowledge that has been learned and thus when needed there
will be a quick recall. This is similar to computers RAM or
random access memory.

The unconscious mind is below the preconscious or

subconscious mind. This is where all the past experiences and
memories is stored. It is located deeply into the mind, because
it contains all the negative experiences, trauma, habits and
behavior. It is also the storage of all deep seated emotions.
Therefore there things should permanently stay in this mind.
However, Freud stated that “What we do and how we behave is
always determined by the forces residing in our
unconsciousness and not by the choices of the conscious.”
(Sharma, Sangma, & Shadap). And this mind plays an essential
role in psychoanalysis (Authors, 2018)

b. Structural model of personality:

This will divide the personality into three psychic elements
as Id, Ego and Superego. These elements will work together to
create a complex human behavior.

Id is the only element that is present from birth. This is

entirely unconscious and includes the instinctive and primitive
behavior. Thus, the ego and superego will later be developed
from this behavior. An Id is basically the unorganized part of
the personality and it is a source of our bodily needs, impulses
specifically the sexual and aggressive drives or commonly
known as the libido or the sexual desire. Therefore it is driven
by pleasure principle that will drive for immediate gratification
of all desires, wants and needs. The state of anxiety or tension
is the result if these needs are not immediately satisfied. This
personality is nest sited for infant because their needs should be
satisfied immediately. However as the person gets older this
type of behavior is both disruptive and socially unacceptable.
As to Freud, the Id tries to resolve the tension created by
pleasure principle through the primary process that involves
forming a mental image of the desired object as a way of
satisfying the need.

Ego develops from id and it ensures that impulses of the id

can be shown in the real world as an acceptable act. Ego
functions in all the level of consciousness and it acts in relation
to reality principle meaning it pleases the id but in a realistic
way. The reality principle outweighs the costs and benefits of
the action before any decisions of what actions to be made.
The ego is in constant contact with time, space and physical
reality.

Super ego is the last type of personality to develop.

According to Freud,, the superego starts at around the age of 5.
It holds the moral standards and ideals that are usually acquired
from parents and the society; clearly it is the distinction
between right and wrong. Therefore the superego provides
guidelines in making a judgment. Superego has 2 parts:
conscience and ego ideal. Conscious includes experiences or
events that are bad or negative either by the family or society.
Usually these are not allowed because it will lead to bad
consequences, punishments, a guilty feeling or the remorseful
feeling. The ego ideal is about rules and standards of one’s
supposedly behavior that the ego aspires to. Superego is a
contradiction with id, because it determines between right and
wrong and guilt.

The three components of personality most of the time does

not work together and in harmony, because the ego postpones
the gratification, the id wants it immediately and the superego
battles with both due to the moral code issue.

2. Theory of Instincts and Libido

a. Life and death instinct:
It is believed that the role of instinct is what drives the
human behavior. Instincts are forces that exist behind tensions
and this is because of the needs of the id. Freud noted that
human behaviors are motivated by instincts, in relation to the
neurological representations of physical needs
(members.tripod).This is referred to as sexual instincts, those
that deal with survival, pleasure and reproduction. This is very
important in reproduction of the human species. Instinct
happens because of 3 things: live of individual seeking for
basic necessities such as food and water, the live of species
which mainly is for procreation or having sex. This gave birth
to the word libido from the Latin word “I desire”. In the early
theory, Freud proposed the Eros or the life instincts is opposed
by the forces of ego, but in his later studies the life instincts
were opposed by self-destructive death instinct known as
Thanatos (Kendra, 2020).
The death instinct or THanatos is the goal of life according
to Freud. This is related to impulse of destruction through acts
of aggression, cruelty and suicide. Thanatos is the opposite of
eros and it balances it. It is said that people who have traumatic
experiences will reenact it therefore this will lead to the will to
do negative things such as attempted suicide, alcoholism, drug
abuse and these are all created by the death instinct. However,
when energy is focused on other people it became anger and
violence. In other words the death instinct will lead to a
destruction of one’s self or others.

b. The flow of libido: it is the force of the sexual instincts

directed toward an object – sexual. Libido is said to be related
to ego.

3. Theory of Psycho Sexual Development

Sigmund Freud proposed the behavior and development of a
person are influenced by the interaction between the conscious and
unconscious aspect of the person’s mind Personality are developed
by a series stages, childhood stages which starts with id.. The 3 levels
of consciousness together with components of the personality, they
interact for them to generate a behavior in each stages of development.

There are 5 psychosexual stages of Development:

a. Oral stage
From 0-1 year old, the urge is centered in the mouth. It is
primarily about rooting and sucking including biting and
breastfeeding. Successful fulfillment of these needs may lead
to trust and comfort. However, fixation occurs at this stage,
because of the child being dependent to others. This is called
oral fixation, if these persist longer it will lead to drinking,
eating, smoking or nail biting of the child.

b. Anal stage
From 2-3 years old, the center of this stage is the about
controlling the bladder and bowel movement. This is the time
that the child learns to control body needs or the so called toilet
training. A positive experience in toilet training can lead to
competence, creativity and productivity of an individual.
However, a negative one can lead to bad temper, cruelty and
disorderliness on the individual

c. Phallic stage
From 3 to 6 years old, at this stage the primary focus is on
the genitals. The child is beginning to discover the differences
between male and females. The Oedipus complex in boys and
Electra complex in girls were described by Freud. Oedipus
complex in boys is described as feelings of wanting his mother
to replace his father. At this point the child also fears of being
punished by his father, he thinks that penis is the most
important; therefore he develops the castration anxiety. The
child will resolve this problem by imitating, copying or joining
a masculine dad type of behaviors, and it is called
identification. It simply is adapting the values, attitudes and
behaviors of another person. Electra Complex in female is
basically wanting her father and replaces her mother.
However, at this stage the girl is envy of the penis experience
of the boys and wishes to be one of them. This is resolved by
keeping her desire for her father and trying to replace the wish
for a penis for having a baby instead. At this point the girl
blames her mother for such issue and this usually creates
misunderstanding with the mother. However, a girl will repress
her feelings to remove the tension that will identify the mother
to be her role model for a female gender role.
d. Latent stage
From age 6 to puberty, at the stage where the sexual
feelings are inactive, this is the start of intellectual pursuits and
social interactions. In other words, they are developing social
skills, values and relationships to other people outside the
family. This stage is very important because it will lead to self-
confidence of the individual.

e. Genital stage
From puberty to death, this is the stage of maturing the
sexual interests. The individual will start experimenting
sexually; they will have a strong sensation in the genitals and
being attracted to opposite sex and eventually having a
relationship with another person. Sexual instinct is more into
heterosexual pleasure rather than self-pleasure unlike in the
phallic stage. Problems at this stage will lead to frigidity,
impotence and unsatisfactory relationships.

Class interaction: Assessment

Student should answer thee following questions:
1. Do you agree with the Psychosexual stage theory of Sigmund Fresud? Why?
2. Assess yourself, try to analyze details in your life that you have experience these stages. Write it
down. (learner should submit this in a written form. However the answer to this question will be
in outmost confidentiality. Only me as your professor will read it. This is not graded but it will
assess the own personality of the learner.)

Four Schools of Thought in Psychiatry:

ii. The Social Learning Theory of the Behavioral Approach

Social learning theory is developed by psychologist Albert

Bandura. Best known studies include Bobo Doll Studies, Observational
Learning, Social Learning Theory and Self-efficacy.

In this theory, environment plays an important role in learning. It

has different parts: first learn by observing others, second mental state is
an important learning process and lastly learning doesn’t mean there will
be change in behavior (Today). It emphasizes observing and modeling of
behavior, attitudes and emotional reactions of others.

Basic social learning concepts:

1. Observational learning
In the Bobo doll experiment, bandura demonstrate that
children learn and imitate what they see in other people. Bandura
identified 3 basic models of observational learning:

a. A live model that involves actual demonstration or acting

out a behavior
b. A verbal instructional model that give descriptions and
explanation of the behavior
c. A symbolic model that gives real or fictional characters
displaying behavior in books, films, television programs or
online media.

2. Intrinsic reinforcement
It is said that mental states are important to learning. Thus
it is noted that external, environmental reinforcement was not the
only factor in influencing learning and behavior. This is referred to
as intrinsic reinforcement. It is a form of an internal reward such as
pride, satisfaction and sense of accomplishment. The internal
thoughts and cognitions will connect the learning theories to
cognitive developmental theories. Due to this connection Bandura
describe his approach as a social cognitive theory.

3. Change in behavior
Learning does not necessarily lead to a change in behavior.

However the observation learning demonstrates that people can

learn new information without demonstrating new behavior. After
understanding the basic concepts, there are steps that are involved in the
observational learning and modeling process.
1. Attention
In order to learn, one should pay attention first. Because anything
that detracts the attention will have a negative effect on learning.
2. Retention
It is the ability to store the information that has been learned.
Retention depends to many factors but the ability to pull up
information later on time and act on it is very significant to
observational learning.
3. Reproduction
Once attention had been gained and have retained the information,
the behavior that has been observed can now be performed. This
behavior will now be repeatedly done to improve the behavior.
4. Motivation
Lastly in order for the observational learning to be successful,
motivation is important to continuously imitate the behavior that has
been modeled. Reinforcement and punishment has an important role in
motivation. A behavior can be rewarded or punish depending on the
action that has been taken.

There are three forms of reinforcement, these are:

1. Direct reinforcement
- Occurs when individual watches a model perform, then
imitates and is reinforced or punished by some individual.
In simpler words, direct reinforcement is directly in
contact with the learner.
2. Vicarious reinforcement
- The observer anticipates receiving a reward for behaving
in a given way because someone else has been rewarded.
This is similar to copying or imitating others to achieve
the same reward with the same action.
3. Self-reinforcement
- The individuals strive to meet personal standard and does
not depend on or care about the reaction of others. In
other words, individual can learn on their own.

Class interaction: assessment

Should answer the question:
1. In our new normal of learning, how can you, as a student, apply the social learning theory in
our current situation?

Four Schools of Thought in Psychiatry:

iii. The Neurobiological Theories and Approaches

Introduced by Karl Lashley, it study the ways in which brain and

nervous system are related to behavior. It can either be a genetic link or
chemical imbalances. Therefore, behavior is understood by biochemical and
neurological causes and can explain physiologically. It is believed that the
behavior is controlled by biological responses in the body such as heart rate,
adrenalin etc. This can be medically treated. \
iv. Biopsychosocial approach\

Biophsychosocial approach was developed by Dr. George Engel

and John Romano. This approach emphasizes on the importance of
human health and illness. It considers biological, psychological
and social factor and their interactions in health, illness and health
care delivery. Natural and social sciences are basic to medical
practice, meaning psychological and social factors are not only a
phenomena but instead there is a scientific meaning in regard to
their biological state. Humanistic qualities are involved in this
scientific method because it diverse the biological, psychological
and social phenomena in relation to human health.

Class interaction: assessment

Activity:
1. Choose one action / behavior and discuss how the action / behaviour can have a
neurobiological approach and biopsychosocial approach.
Example:
Action Neurobiological approach Biopsychosocial approach
Walking ? ?

C. Assessment
Quizzes will be given at the end of the module. It will upload in time for the quiz.

Bibliography
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Gaughwin, P. (20112). On being insane in Medico-Legal Places: The immportance of taking a complete hisotry in
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Hillhouse, T. M., & Porter, J. H. (2015). A brief history of the development of antidepressant drugs: From
monoamines to glutamate. PMC, 1-21.

Kendra, C. (2020, August 17). Very Well Mind. Retrieved September 30, 2020, from
https://www.verywellmind.com/: https://www.verywellmind.com/psychology-schools-of-thought-
2795247#the-psychoanalytic-school-of-thought

members.tripod. (n.d.). members tripod. Retrieved October 3, 2020, from http://members.tripod.com/:

http://members.tripod.com/academic_clarepsy/Psychology%20P.1/Freud%20%26%20Carl.htm

Reidbord, S. M. (2014, October 20). Psychology Today. Retrieved September 29, 2020, from
Psychologytoday.com: https://www.psychologytoday.com/us/blog/sacramento-street-psychiatry/
201410/brief-history-psychiatry

Sharma, A., Sangma, R. N., & Shadap, R. (n.d.). Sigmund Freud’s Psychoanalysis Theory of Personality. Academia,
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Today, P. (n.d.). Psychology Today. Retrieved 4 Octoberr, 2020, from https://www.psychologytoday.com/:

www.psychologytoday.com/intl/basics/social-learning-theory

Wikipedia. (2020, September 28). Wikipedia The Free Encyclopedia. Retrieved September 29, 2020, from
https://en.wikipedia.org/: https://en.wikipedia.org/wiki/Psychiatry#cite_note-Gaughwin-131