INTRODUCTION TO
PSYCHIATRY
INTRODUCTION TO
PSYCHIATRY
Objectives:
Definition of Psychiatry,
Psychology & relevant dfns
Barriers & Stigma
Prevalence
Classification
Aetiological factors
which deals
with recognition, treatment and
prevention of
mental abnormalities and disorders.
‘Psyche’- Greek word for ‘soul or mind
‘.
‘Iatros’- healer.
Psychology:
A non-medical discipline of science
which deals
with behavior and mental processes
of organism.
The specialty of psychiatry is the most
“human” specialty – devoted to the
understanding of the whole person in
health and illness.
Indeed, it is the only medical specialty
without a veterinary counterpart.
Fields of Psychiatry
Adult Psychiatry
Child and adolescence Psychiatry
Organic and geriatric Psychiatry
Community and social Psychiatry
Forensic Psychiatry
PSYCHIATRIST
is a physician who has post-graduate
degree or extensive post-graduate
training
in psychiatry.
Psychotherapy
is the treatment of psychological issues
by
non- physical means (talk therapy).
PSYCHOTHERAPIST
is a person (medical or non-medical)
who has special skill and training in
psychotherapy.
PSYCHIATRIC NURSING
A specialist nursing training for those
nurses caring for people with mental
health problems.
Mental health care is of Biopsychosocial
model.
It usually involves multidisciplinary team for
developing a comprehensive management
plan in conjunction with the patients and
their
caregivers to meet their needs.
MULTIDISCIPLINARY TEAM
Psychiatrist
Clinical Social
Psychologist Worker
Patient
Occupational Psychiatric
therapist nurse
Barriers for psychiatric
consultation
(Both patient & guardian
factors)
Stigma & shame
Feigning (specially pt with somatic
complaints)
Demonic possession, evil spirit, black
magic or punishment from God (specially
psychotic pt)
The belief that psychiatric illness is
contagious
The belief that psychiatric illness is
untreatable.
The belief that drugs are mind-altering
and/or addictive.
The belief that all psychiatric pts are
insane/mad.
A substantial part of history of psychiatry
has been history of confinement. Our
images of madness is partly derived from
that history.
Mentally ill pts are dangerous/ potentially
violent.
Barriers (physician
factors)
Mental illness is not true illness, compared
with organic illness.
Feigning or malingering.
Lack of time.
It is perceived that psychiatrist has fewer
tests
to do and more time to spend with the
patient.
Fear of being embarrassed.
Barriers (physician factors)
contd-
Fear that the patient will have an illness
that is unresponsive to treatment.
The belief that drugs are mind-altering
and/or addictive.
The term “psycho”, “maniac” etc. are
used to demean someone which
degrade the entire field of mental
health.
Prevalence of psychiatric
Psychiatric
illness
disorders are prevalent and
often go untreated.
In general practice : 1/3-1/4 of the
patients seen have a psychiatric problem.
Hamilton et al 1996, reported rates of
medically unexplained symptoms of 53%,
42%, and 32% in gastroenterology,
neurology, and cardiology respectively.
Prevalence contd-
In different population (in the
U.K. ):
Community- 15-20%
General practice attenders- 30%
General hospital outpatient- 20-30%
General hospital inpatient- 20-40%
Lifetime prevalence:
-in USA : 28%
-in INDIA : 25-66%
Prevalence contd-
National Mental Health Survey in
Bangladesh (2003-2005) showed
Prevalence of psychiatric illness In the
Community 16.05% .
Main disorders are
Psychosis- 1.07% , Neurosis- 8.39%
& Depressive disorder - 4.61% .
CLASSIFICATION
Older classification-
A) Psychosis-
1.Organic-
Delirium & Dementia
2.Functional-
Schizophrenia
Bipolar mood disorder
Older classification contd-
B) Neurosis-
-Generalized anxiety disorder
-Phobic anxiety disorder
-Panic disorder
-Obsessive compulsive
disorder
-Conversion disorder
-Psychosexual dysfunction
NEWER CLASSIFICATION
1) Organic mental disorder
a. Acute-Delirium
b. Chronic-Dementia
2) Substance abuse disorder
* Drug dependence
* Alcohol dependence
3) Schizophrenia & delusional disorder
NEWER CLASSIFICATION
contd-
4) Mood disorder/Affective disorder
*Unipolar depressive disorder
*Bipolar mood disorder
5) Anxiety disorders
*Generalized anxiety
*Phobic anxiety
*Panic disorder
*OCD
NEWER CLASSIFICATION contd-
6) Stress related disorders
*Acute stress disorder
*Post-traumatic stress disorder
*Adjustment disorder
7) Somatoform disorders
*Somatization disorder
*Conversion disorder(hysteria)
*Hypocondriasis
*Pain disorder
*Body dysmorphic disorder
NEWER CLASSIFICATION
contd-
8) Disorders of adult personality & behavior
9) Behavioral syndrome associated with
physiological disturbances
*Eating disorder e.g. anorexia
nervosa
*Sleep disorders
*Psychosexual dysfunction
9)Child & Adolescence disorder
10) Puerperal mental disorders
DIAGNOSTIC HIERARCHY
ORGANIC
DISORDERS
SCHIZOPHRENIA
MOOD DISORDER
NEUROSES
AETIOLOGICAL FACTORS IN
PSYCHIATRIC ILLNESS:
Predisposing factor
– Increased susceptibility to psychiatric
disorder
– Established in utero or in childhood
– Operate throughout patient’s lifetime
– E.g. genetic factors, disturbed family
background
Precipitating factor
– Trigger an episode of illness
– Stressful life events
– E.g. failure, loss of job, broken
relationship
Perpetuating factor
– Delay recovery from illness
– E.g. lack of social support, chronic
physical illness
SERVICE AVAILABLE IN
GOVERNMENT SECTOR:
OPD + Inpatient–old 13 medical colleges,
BSMMU.
Specialized hospitals- *Pabna Mental Hospital
*NIMH, Sher-e-Bangla Nagar,
Dhaka.
OPD –new medical colleges.
Specialized hospitals for substance abuse-
Central drug addiction centre, Tejgaon,
Dhaka.
Psychiatrist
Occupational Social
therapist
Patient Worker
Psychiatric
nurse
INTRODUCTION TO
PSYCHIATRY
Objectives:
Definition of Psychiatry,
Psychology & relevant dfns
Barriers & Stigma
Prevalence
Classification
Aetiological factors
Feigning or malingering
A lack of time
Fear of being
embarrassed
Fear that the patient will
have an illness that is
unresponsive to
treatment
The belief that drugs
are mind-altering and/or
addictive
Uncertainty about
MULTIDISCIPLINARY TEAM with excellent
communication between professionals and
organizations is required for management of psychiatric
disorders.
Psychiatrist
Occupational Social
therapist
Patient Worker
Psychiatric
nurse
• Approximately one third of
neurological outpatients have no
organic pathology (Carson et al, JNNP
2000;68:207-10)
• Hamilton et al 1996, reported rates
of medically unexplained symptoms
of 53%, 42%, and 32% in
gastroenterology, neurology, and
cardiology respectively
