Lecture no.

1
Introduction in psychiatry
Content
Introduction in psychiatry
1. Psychiatry – definition, history, aim and limits
as a medical branch
2. Pathogenesis of the psychiatric disorders
3. Main opinions and tendencies of the
contemporary psychiatry
4. The significance of the epidemiologic
correlations in psychiatric care
5. Social psychiatry and the organization of the
psychiatric care
6. The development of psychiatry in Romania
1. Psychiatry – definition, history, aim and
limits as a medical branch
Definition: Psychiatry is the branch of medicine that
specializes in the treatment of those brain disorders
which primarily cause disturbance of
– Thought
– Behaviour
– Emotion.
• These are often referred to as mental, or psychiatric,
disorders. (Psychiatry, Fourth Edition, Oxford Medical
Publications)
1. Psychiatry – definition, history, aim and
limits as a medical branch
• The term "psychiatry" was first coined by the
German physician Johann Christian Reil in 1808 and
literally means the “medical treatment of the soul”
– psych- "soul" from Ancient Greek psykhē "soul";
– -iatry "medical treatment" from Gk. iātrikos
"medical" from iāsthai "to heal")
– The word psyche comes from the ancient Greek
for soul or butterfly.
– The fluttering insect appears in the coat of arms
of Britain's Royal College of Psychiatrists
1. Psychiatry – definition, history, aim and
limits as a medical branch
• 1550 BCE The Ebers papyrus, one of the most important
medical papyri of ancient Egypt, briefly mentioned clinical
depression;
• 4th century BCE Greek physician Hippocrates theorized that
physiological abnormalities may be the root of mental
disorders.
• 705 CE The first psychiatric hospital was built by Muslims in
Baghdad, followed by Cairo in 800, and Damascus in 1270.
• 1656 King Louis XIV of France founded Pitié-Salpêtrière Hospital
in Paris for prostitutes and the mentally defective.
• 1793 French physician Phillipe Pinel was appointed to Bicêtre
Hospital in south Paris, ordering chains removed from mental
patients, and founding Moral Treatment.
1. Psychiatry – definition, history, aim and
limits as a medical branch
• 1893 German psychiatrist Emil Kraepelin clinically defined
"dementia praecox", later reformulated as Schizophrenia.
• 1895 Sigmund Freud and Josef Breuer of Austria published
Studies on Hysteria, based on the case of Bertha Pappenheim
(known as Anna O.), developing the Talking Cure.
• 1901 German psychiatrist Alois Alzheimer identified the first
case of what later became known as Alzheimer's disease.
• 1905 French psychologists Alfred Binet and Theodore Simon
created the Binet-Simon Scale to assess intellectual ability,
marking the start of standardized psychological testing.
1. Psychiatry – definition, history, aim and
limits as a medical branch
• 1908 The term "Schizophrenia" was coined by Swiss
psychiatrist Paul Eugen Bleuler.
• 1921 Otto Loewi's discovery of the neuromodulatory
properties of acetylcholine; thus identifying it as the first-
known neurotransmitter.
• 1924 German neuropsychiatrist Hans Berger discovered
human Electroencephalography.
• 1938 Italian neurologist Ugo Cerletti and Italian
psychiatrist Dr. Lucio Bini discovered Electroconvulsive
Therapy.
• 1952 The first published clinical trial of chlorpromazine
which is the first antipsychotic.
1. Psychiatry – definition, history, aim and
limits as a medical branch
• 1952 The American Psychiatric Association (APA) published the first
Diagnostic and Statistical Manual of Mental Disorders (DSM).
• 1960 The first benzodiazepine, chlordiazepoxide, under the trade
name Librium was introduced.
• 1967 The term “anti-psychiatry” was coined by psychiatrist David
Cooper
• 1977 The ICD-9 was published by the WHO.
• 1988 Fluoxetine (trade name Prozac), the first selective serotonin
reuptake inhibitor (SSRI) antidepressant was released, quickly
becoming the most prescribed.
• 2013 DSM-5 was published by the American Psychiatric
Association. Among other things, it eliminated the term "gender
identity disorder."
A History of the Madhouse (1h)
https://www.youtube.com/watch?v=oswUssXzFlY
2. Pathogenesis of the psychiatric
disorders
• Biological factors:
– Genetics (heredity): Mental illness occurs from the
interaction of multiple genes and other factors (such as
stress, abuse, or a traumatic event) which can influence, or
trigger, an illness in a person who has an inherited
susceptibility to it.
– Infections: Certain infections have been linked to brain
damage and the development of mental illness or the
worsening of its symptoms (e.g. pediatric autoimmune
neuropsychiatric disorder – PANDA associated with the
Streptococcus bacteria has been linked to the development
of obsessive-compulsive disorder and other mental illnesses
in children.
2. Pathogenesis of the psychiatric
disorders
– Brain defects or injury: Defects in or injury to certain areas of
the brain have also been linked to some mental illnesses.
– Prenatal damage: Some evidence suggests that a disruption
of early fetal brain development or trauma that occurs at the
time of birth (e.g. loss of oxygen to the brain may be a factor
in the development of certain conditions, such as autism.
– Substance abuse : Long-term substance abuse, in particular,
has been linked to anxiety, depression, and paranoia.
– Other factors: Poor nutrition and exposure to toxins, such as
lead, may play a role in the development of mental illnesses.
2. Pathogenesis of the psychiatric
disorders
• Psychological factors:
– Severe psychological trauma suffered as a child,
such as emotional, physical, or sexual abuse
– An important early loss, such as the loss of a
parent
– Neglect
– Poor ability to relate to others

Recommended link:
http://www.webmd.com/mental-health/mental-health-ca
uses-mental-illness?page=2
2. Pathogenesis of the psychiatric
disorders
• Environmental factors:
– Death of the life-partner or divorce
– A dysfunctional family life
– Feelings of inadequacy, low self-esteem, anxiety, anger, or
loneliness
– Changing jobs or schools
– Social or cultural expectations (For example, a society that
associates beauty with thinness can be a factor in the
development of eating disorders.)
– Substance abuse by the person or the person's parents
3. Main opinions and tendencies of the
contemporary psychiatry
• Mental health is defined as a state of well-being in which
every individual realizes his or her own potential, can cope
with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to her or his
community. (WHO – World Health Organization)

• Public perception:
– Attitudes to Mental Illness (2007), based on the responses
of 6000 randomly sampled adults to a short interview:
• Only 65 per cent of respondents thought that people
with mental health problems should have the same
right to a job as those without them.
3. Main opinions and tendencies
of the contemporary psychiatry
• Six out of ten adults agreed with the statement ‘one of the
main causes of mental illness is a lack of self-discipline and
will power’.
• Young people are the most prejudiced.
• Thirty-four per cent of respondents felt that ‘all people with
mental health problems are prone to violence’.
• Two-thirds of people said they were scared of those with
psychiatric illnesses, and would not want to live next door to
one of them.
• Eighty per cent of respondents underestimated the
prevalence of mental health disorders in the UK by at least a
factor of ten.
• Recommended link:
http://www.cchr.org/cchr-reports/the-real-crisis/introductio
n.html
3. Main opinions and tendencies
of the contemporary psychiatry
• Some of the actual polemics and high discussed
topics:
– Psychopharmacology versus psychotherapy;
– DSM/ICD criteria versus “medicalization”;
– Treatment versus prevention;
– Psychiatric rehabilitation;
– Overmedication;
– Psychiatric reform – the reorganization of mental
health care.
– “Blind-therapy” versus exploration.
4. The significance of the epidemiologic
correlations in psychiatric care
• Psychiatric disorders are amongst the most prevalent
causes of ill health in humans:
– one in four adults will suffer from a diagnosable
mental disorder at some time in their life;
– one in five has one in any given year.
• Mortality associated with mental health disorders is
very variable, depending upon the condition. The
most important area is that of deliberate self-harm
and completed suicide.
• The impact of psychiatric disorders on the economic
success and social coherence of a country is
therefore great.
4. The significance of the epidemiologic
correlations in psychiatric care
• Disability is defined as “a loss of health”, and
is usually used to describe impairments in
activities of daily living caused by physical or
mental disorders.
• The disability-adjusted life year (DALY) is a
measure of the overall burden of a disease,
combining morbidity and mortality into one
number.
DALY (8 min)
https://www.youtube.com/watch?v=cIyDlb6n5aY
4. The significance of the epidemiologic
correlations in psychiatric care
• Next table shows the latest WHO data from
the global burden of disease study, which has
produced a list of the conditions giving rise to
the greatest burden of disability worldwide
(Psychiatry Forth Edition, Oxford Medical
Publications).
4. The significance of the epidemiologic
correlations in psychiatric care
1 Hearing loss
2 Refractive errors
3 Depression
4 Cataracts
5 Unintentional injuries
6 Osteoarthritis
7 Alcohol dependence and problem use
8 Infertility due to unsafe abortion and maternal sepsis
9 Macular degeneration
10 Chronic obstructive pulmonary disease
4. The significance of the epidemiologic
correlations in psychiatric care
11 Ischaemic heart disease
12 Bipolar disorder
13 Asthma
14 Schizophrenia
15 Glaucoma
16 Alzheimer’s and other dementias
17 Panic disorder
18 Cerebrovascular disease
19 Rheumatoid arthritis
20 Drug dependence and problem use
5. Social psychiatry and the organization
of the psychiatric care
• Social psychiatry is a branch of psychiatry that
focuses on the interpersonal and cultural context of
mental disorder and mental wellbeing.
– It combines a medical training and perspective
with fields such as social anthropology, social
psychology, cultural psychiatry, sociology and
other disciplines relating to mental distress and
disorder.
– It can be contrasted with biopsychiatry, with the
latter focused on genetics, brain neurochemistry
and medication.
5. Social psychiatry and the organization
of the psychiatric care
• Social psychiatry has been important in developing the concept
of major "life events" as precipitants of mental ill health,
including for example bereavement, promotion, moving house,
having a child.
• Originally inpatient centers, many therapeutic communities
now operate as day centers.
• Social psychiatrists also work to link concepts such as self-
esteem and self-efficacy to mental health, and in turn to
socioeconomic factors.
• Social psychiatrists often focus on rehabilitation in a social
context, rather than "treatment" per se. A related approach is
community psychiatry.
• Facilitating the social inclusion of people with mental health
problems is a major focus of modern social psychiatry.
Toward a new understanding of
mental illness (13 min)
https://www.youtube.com/watch?v=PeZ-U0pj9LI
6. The development of psychiatry
in Romania
• 17th century – psychiatric care was offered in monasteries
(charity);
– The individuals who were suffering from a mental
illness were attending religious services specially
organized for them;
– This “mild treatment” was totally opposed to the
methods used in Western Europe (culminating with
torture);
– The mentally ill were not punished for their crimes and
remain in the monastery until the resolution of their
disorder.
6. The development of psychiatry
in Romania
• 19th century – first psychiatric settlement in Romania;
– First medical school, founded by Carol Davila
(Bucharest);
– Initially, psychiatry was not an official topic to be
taught, yet – doctor Alexandru Sutu was
voluntarly teaching psychiatry on Sundays;
– First hospice in Iasi (Golia);
– First medical school in Iasi;
6. The development of psychiatry
in Romania
• 20th century – the opening of “Socola” Psychiatric
Hospital;
– Foundation of the “Neurology, Psychiatry,
Psychology and Endocrinology Society”
– Sub-specialties – forensic psychiatry, infantile
psychiatry;
– Important progresses in medical care, research
and education;