chap1.pdf

PSYCHIATRIC FOUNDATIONS The introduction part provides a brief understanding on the definition of psychiatry and the history. This chapter also gives you the various terminologies used in understanding psychiatry. At the end of the chapter, the participants are expe...

PSYCHIATRIC FOUNDATIONS The introduction part provides a brief understanding on the definition of psychiatry and the history. This chapter also gives you the various terminologies used in understanding psychiatry. At the end of the chapter, the participants are expected to: 1. Define terms used in psychiatry 2. Differentiate various psychiatric conditions in terms of sign and symptoms and prognosis and understand implications for patient’s undergoing therapy Before you proceed with the chapter, do the following activity. Share your analysis with classmates on our discussion board 1. What are the terms related to psychiatry that you know? Paul Cresencio R. Liberato  HISTORY OF PSYCHIATRY Johann Christian Reil coined the word psychiatry which is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders. A psychiatrist is a medical doctor (an M.D. or D.O.) who specializes in mental health, including substance use disorders. Psychiatrists are qualified to assess both the mental and physical aspects of psychological problems. People seek psychiatric help for many reasons. The problems can be sudden, such as a panic attack, frightening hallucinations, thoughts of suicide, or hearing "voices." Or they may be more long-term, such as feelings of sadness, hopelessness, or anxiousness that never seem to lift or problems functioning, causing everyday life to feel distorted or out of control Psychiatry got its name as a medical specialty in the early 1800s. For the first century of its existence, the field concerned itself with severely disordered individuals confined to asylums or hospitals. These patients were generally psychotic, severely depressed or manic, or suffered conditions we would now recognize as medical: dementia, brain tumors, seizures, hypothyroidism, etc. As was true of much of medicine at the time, treatment was rudimentary, often harsh, and generally ineffective. Psychiatrists did not treat outpatients, i.e., anyone who functioned even minimally in everyday society. Instead, neurologists treated "nervous" conditions, named for their presumed origin in disordered nerves. In 5th century- Mental disorders were considered supernatural in origin. Religious leaders often turned to versions of exorcism to treat mental disorders. Specialist hospitals were built in Baghdad, Fes, Cairo & Bethlem Royal Hospital in London in medieval Europe to treat mental disorders. These institutions were used only as custodial care and did not provide any type of treatment. Then came the enlightenment age (1620-1780)- attitudes towards the mentally ill began to change. It came to be viewed as a disorder that required compassionate treatment. In early 1800s- advances were made in the diagnosis of mental illness by broadening the category of mental disease. In 20th century- introduced a new psychiatry into the world, with different perspectives of looking at mental disorders. In history, several names made mark in Psychiatry. Sigmund Freud's pioneering work on psychoanalytic theory made him the father of psychoanalysis. He introduced the different terms to describe personalities like; Instincts (eros, thanatos), personality theories (structural, topographical, Ego Defence mechanisms, Psycho-Sexual stages of development. Paul Cresencio R. Liberato  Another name that emerged in Psychiatry was Jean Piaget. A renowned child psychologist and contributed the cognitive stages of development. Others include Johann Weyer who was the Father of modern Psychiatry. COMMON TERMS USED IN PSYCHIATRY Addiction: Dependence on a chemical substance to the extent that a physiological and/or psychological need is established. Withdrawal symptoms are manifested when the substance is removed. Symptoms may include tolerance, withdrawal, and preoccupation with obtaining and using the substance. Narcotics, alcohol, and most sedative drugs may produce addiction. Addictive disorders are not diagnosed when withdrawal results from medication taken as prescribed. Affect: External expression of emotional responsiveness. Affect refers to fluctuating emotional changes, in contrast to more sustained emotion. Some types of affect are: within normal range, constricted, blunted, flat, inappropriate, or labile. Agoraphobia: Anxiety about being in places in which escape might be difficult or embarrassing should a panic attack occur. Fears typically relate to leaving one’s home, being in a crowd, or traveling by car or plane. Agoraphobia usually occurs as part of panic disorder. Alzheimer’s Disease: A degenerative organic mental disease with diffuse brain deterioration and dementia. It is the most common form of dementia, characterized by gradual onset and continuing decline of memory and other cognitive functions. Anxiolytic: A drug having an antianxiety effect and used widely to relieve emotional tension. The most commonly used antianxiety drugs are the benzodiazepines. Comorbidity: The simultaneous appearance of two or more illnesses, such as the co- occurrence of schizophrenia and substance abuse or of alcohol dependence and depression. Compulsion: Repetitive, ritualistic behavior such as handwashing that aims to prevent or reduce stress. The person feels driven to perform such actions, though the behaviors are recognized to be excessive or unreasonable. Delusion: A false belief firmly held despite obvious proof or evidence to the contrary. In addition, the belief is not one ordinarily accepted by other members of the person’s culture or subculture. Delirium: An acute cognitive disorder characterized by impairment in consciousness, attention, and changes in cognition. Dementia: A cognitive disorder characterized by defective memory, language, motor activity, and ability to recognize objects, and problems with abstract thinking and planning. Dependence (Substance): Habituation to, abuse of, and/or addiction to a chemical substance. Largely because of psychological craving, the life of the drug-dependent person revolves around the need for the special effect of one or more chemical agents on mood or state of Paul Cresencio R. Liberato Paul Cresencio R. Liberato consciousness. Dependence includes not only the addiction (which emphasizes physiological dependence), but also drug abuse (where the pathologic craving for drugs seems unrelated to physical dependence). Examples: alcohol, opiates, barbiturates, other hypnotics, sedatives and some antianxiety agents, cocaine, marijuana. Depersonalization/derealization: Feelings of unreality or strangeness concerning either the environment, the self, or both. Diagnosis: The process of determining, through examination and analysis, the nature of a patient’s illness. The purpose of diagnosis is to identify mental disorders and psychological responses to physical illness, and to identify the patient’s personality features and characteristic coping techniques in order to recommend the therapeutic intervention most appropriate for the patient’s needs. Disorientation: Loss of awareness of the position of the self in relation to space, time, or other persons; confusion. Dissociation: The splitting off of clusters of mental content from conscious awareness, often the result of psychic trauma. Distractibility: Inability to maintain attention; shifting from one area or topic to another with minimal provocation. Distractibility may be a manifestation of an underlying medical disease, medication side effect, or a mental disorder such as an anxiety disorder, mania, or schizophrenia. Dual Diagnosis: In mental health settings this term refers to the dual diagnosis of mental illness with substance abuse of alcohol and/or drugs. Comorbidity is the preferred term. Dysthymia: Dysthymia is conceptualized as a chronic disorder, not an episodic disorder with extended asymptomatic periods. Flight of Ideas: A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When severe, speech may be disorganized and incoherent. Sometimes seen in bipolar disorder. Grandiosity: Exaggerated belief or claims of one’s importance or identity, often manifested by delusions of great wealth, power, or fame. Hallucination: A sensory perception that has the compelling sense of reality of a true perception but that occurs in the absence of an external stimulus and is not under voluntary control. May occur in any of the senses — e.g., auditory, gustatory, olfactory, somatic, tactile, visual. Identity: The sense of self and unity of personality over time; one element of identity is gender identity. Paul Cresencio R. Liberato Intoxication (Substance): The acute effects of overdosage with chemical substances that cause maladaptive behavior because of their effects on the central nervous system. Loosening of Associations: A disturbance of thinking in which ideas shift from one subject to another in an unrelated manner. The speaker is unaware of the disturbance. When loosening of associations is severe, speech may be incoherent. Contrast with flight of ideas. Magical Thinking: The erroneous belief that one’s thoughts, words, or actions will cause or prevent a specific outcome in some way that defies commonly understood laws of cause and effect. A conviction that equates thinking with doing. Malingering: Deliberate simulation or exaggeration of an illness or disability in order to avoid an unpleasant situation or to obtain some type of personal gain. Manic Episode: A period of mood disturbance characterized by excessive elation, hyperactivity, agitation, and accelerated thinking and speaking. It is sometimes manifested as flight of ideas, or involvement in pleasurable activities with high potential for painful consequences (e.g., buying sprees, sexual indiscretions). Mania is seen in mood disorders and in certain toxic and drug-induced states. Mental Disorder (Mental Illness): A persistent mental state that leads to significant distress or disability. An illness with biological, psychological, and sociological components, and characterized by symptoms and/or impairment in functioning. Mood: A pervasive and sustained emotion that, in the extreme, markedly colors one’s perception of the world. Common examples of mood include depression, elation, anger, and anxiety. Neuroleptic: A term used for older conventional antipsychotics such as chlorpromazine, which caused notable psychomotor side effects. The newer atypical antipsychotic drugs are less likely to cause these side effects, and neuroleptic is no longer synonymous with the term antipsychotic. Obsession: A persistent, unwanted idea or impulse that cannot be expunged by logic or reasoning. Panic Attack: Discrete periods of sudden onset of intense apprehension, fearfulness, or terror often associated with feelings of impending doom, fear of going crazy or losing control, and physical symptoms such as shortness of breath, palpitations or accelerated heart rate, chest pain or discomfort, and choking. The symptoms reach a crescendo within 10 minutes. Paranoid Ideation: Ideation, of less than delusional proportions, involving suspiciousness or the belief that one is being harassed, persecuted, or unfairly treated. Phobia: A persistent, irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid it. This exposure almost invariably provokes an immediate anxiety response or panic attack even though the fear is recognized as obsessive or unreasonable. Paul Cresencio R. Liberato Psychotic: A term that describes the inability to distinguish reality from fantasy, as well as impaired reality testing, with creation of a new reality. Psychotropic: A term to describe drugs or a drug used to alter abnormal thinking, feelings, or behavior; traditionally divided into classes of antipsychotic, antidepressant, mood stabilizers, and antianxiety (anxiolytic) drugs. Remission: Abatement of an illness (decrease in amount, intensity, or degree). Active symptoms of an illness are in “remission.” Somatization: The tendency to experience and report numerous somatic symptoms, associated with emotional disturbance and/or excessive treatment seeking for physical symptoms. Substance Abuse: Impairment in functioning resulting from a pathological and “compulsive” use of a chemical substance such as alcohol or drugs. Largely because of psychological craving, the life of the substance abusing person can revolve around the need for the specific effect of the “abusing substance.” Syndrome: A configuration of signs and symptoms that occur together and suggest a common underlying pathogenesis, course, familial pattern, or treatment solution. Tic: An intermittent, involuntary, spasmodic movement of a group of muscles, often without a demonstrable external stimulus. A tic may be an expression of an emotional conflict, the result of a neurologic disorder, or an effect of a drug. Tolerance (Substance): The need for markedly increased amounts of a substance to achieve the desired effect that results from repeated use of a drug. People vary widely in the amount of substance they can tolerate independent of their experience with the substance; alcohol tolerance is an example. Withdrawal: The constellation of symptoms that occurs when blood or tissue concentrations of a substance decline in individuals with previous prolonged or heavy use of the substance. Sources: The Language of Mental Health: A Glossary of Psychiatric Terms. NC Shahrokh, RE Hales, KA Phillips, SC Yudofsky. Arlington, VA: American Psychiatric Publishing, Inc., 20011. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed., Washington, DC: American Psychiatric Association, 2013. Paul Cresencio R. Liberato  CLASSIFICATIONS IN PSYCHIATRY Systems of classification for psychiatric diagnoses have several purposes: to distinguish one psychiatric diagnosis from another, so that clinicians can offer the most effective treatment; to provide a common language among health care professionals; and to explore the still unknown causes of many mental disorders. The two most important psychiatric classifications are the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) developed by the American Psychiatric Association in collaboration with other groups of mental health professionals, and the International Classification of Diseases (ICD), developed by the World Health Organization. The DSM-5 lists 22 major categories of mental disorders, comprising more than 150 discrete illnesses. All of the disorders listed in DSM-5 are described in detail in the sections of the book that follow and cover epidemiology, etiology, diagnosis, differential diagnoses, clinical features, and treatment of each disorder. A. Neurodevelopmental Disorders. These disorders are usually first diagnosed in infancy, childhood, or adolescence. B. Schizophrenia Spectrum and Other Psychotic Disorders. The section on schizophrenia and other psychotic disorders includes eight specific disorders (schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, substance/medication induced psychotic disorder, psychotic disorder due to another medical condition, and catatonia) in which psychotic symptoms are prominent features of the clinical picture. The grouping of disorders in DSM-5 under this heading includes schizotypal personality disorder which is not a psychotic disorder; but which sometimes precedes full blown schizophrenia. C. Bipolar and Related Disorders. Bipolar disorder is characterized by severe mood swings between depression and elation and by remission and recurrence. There are four variants: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and bipolar disorder due to substance/medication or another medical condition. D. Depressive Disorder. Depressive disorders are characterized by depression, sadness, irritability, psychomotor retardation and, in severe cases, suicidal ideation. E. Anxiety Disorders. The section on anxiety disorders includes nine specific disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder or social phobia, Paul Cresencio R. Liberato  generalized anxiety disorder, anxiety disorder caused by a general medical condition, and substance-induced anxiety disorder) in which anxious symptoms are a prominent feature of the clinical picture. F. Obsessive-Compulsive and Related Disorders. There are eight categories of disorders listed in this section, all of which have associated obsessions (repeated thoughts) or compulsions (repeated activities). G. Trauma or Stressor-Related Disorder. This group of disorders is caused by exposure to a natural or man-made disaster or to a significant life stressor such as experiencing abuse. There are six conditions that fall under this category in DSM-5 H. Dissociative Disorders. The section on dissociative disorders includes four specific disorders (dissociative amnesia, dissociative fugue, dissociative identity disorder, and depersonalization/derealization disorder) characterized by a disruption in the usually integrated functions of consciousness, memory, identity, or perception. I. Somatic Symptom and Related Disorders (previously called Somatoform Disorders in DSM-IV). This group of disorders is characterized by marked preoccupation with the body and fears of disease or consequences of disease, for example, death. J. Feeding and Eating Disorders. Feeding and eating disorders are characterized by a marked disturbance in eating behavior. K. Elimination Disorders. These are disorders of elimination caused by physiologic or psychological factors. There are two: Encopresis, which is the inability to maintain bowel control, and Enuresis which is the inability to maintain bladder control. L. Sleep–Wake Disorders. Sleep–wake disorders involve disruptions in sleep quality, timing, and amount that result in daytime impairment and distress. They include the following disorders or disorder groups in DSM-5. M. Sexual Dysfunctions. Sexual dysfunctions are divided into 10 disorders that are related to change in sexual desire or performance. N. Gender Dysphoria. Gender dysphoria is characterized by a persistent discomfort with one’s biologic sex and in some cases, the desire to have sex organs of the opposite sex. It is subdivided into Gender Dysphoria in Children and Gender Dysphoria in Adolescents and Adults. Paul Cresencio R. Liberato  O. Substance-Related Disorders. Substance-Induced Disorders. Psychoactive and other substances may cause intoxication and withdrawal syndrome and induce psychiatric disorders including bipolar and related disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunction, delirium, and neurocognitive disorders. P. Neurocognitive Disorders (previously called Dementia, Delirium, Amnestic and Other Cognitive Disorders in DSM-IV). These are disorders characterized by changes in brain structure and function that result in impaired learning, orientation judgment, memory, and intellectual functions. Q. Personality Disorders. Personality disorders are characterized by deeply engrained, generally lifelong maladaptive patterns of behavior that are usually recognizable at adolescence or earlier. R. Paraphilic Disorders and Paraphilia. In paraphilia, a person’s sexual interests are directed primarily toward objects rather than toward people, toward sexual acts not usually associated with coitus, or toward coitus performed under bizarre circumstances. A paraphilic disorder is acted out sexual behavior that can cause possible harm to another person. Included are: exhibitionism (genital exposure); voyeurism (watching sexual acts); frotteurism (rubbing against another person); pedophilia (sexual attraction toward children); sexual masochism (receiving pain); sexual sadism (inflicting pain); fetishism (arousal from an inanimate object); and transvestism (crossdressing). S. Other Mental Disorders. This is a residual category that includes four disorders that do not meet the full criteria for any of the previously described mental disorders: (1) Other specified mental disorder due to another medical condition, for example, dissociativesymptoms secondary to temporal lobe epilepsy; (2) Unspecified mental disorder due to another medical condition, for example, temporal lobe epilepsy producing unspecified symptoms; (3) Other specified mental disorder in which symptoms are present but subthreshold for a specific mental illness; and (4) Unspecified mental disorder in which symptoms are present but subthreshold for any mental disorder. T. Medication-Induced Movement Disorders and Other Adverse Effects of Medication. Ten disorders are included: (1) Neuroleptic or Other medication-induced parkinsonism presents as rhythmic tremor, rigidity, akinesia, or bradykinesia that is reversible when the causative drug is withdrawn or its dosage reduced; (2) Neuroleptic malignant syndrome presents as muscle rigidity, dystonia, or hyperthermia; (3) Medication- induced acute dystonia consists of slow, sustained contracture of musculature causing postural deviations; (4) Medication-induced acute akathisia presents as motor Paul Cresencio R. Liberato  restlessness with constant movement; (5) Tardive dyskinesia is characterized by involuntary movement of the lips, jaw, tongue, and by other involuntary dyskinetic movements; (6) Tardive dystonia or akathisia is a variant of tardive dyskinesia that involves extrapyramidal syndrome; (7) Medication-induced postural tremor is a fine tremor, usually at rest, that is caused by medication; (8) Other medication-induced movement disorder describes atypical extrapyramidal syndrome from a medication; (9) Antidepressant discontinuation syndrome is a withdrawal syndrome that arises after abrupt cessation of antidepressant drugs, for example, fluoxetine; and (10) Other adverse effect of medication includes changes in blood pressure, diarrhea etc. due to medication. U. Other Conditions That May Be a Focus of Clinical Attention. These are conditions that may interfere with overall functioning but are not severe enough to warrant a psychiatric diagnosis. These conditions are not mental disorders but may aggravate an existing mental disorder. ACTIVITY 1: Answer the short quiz below, this will not be recorded. This is just to test your understanding on the basics of psychiatry. Directions: Select your answers to the following question from the choices given. 1. Which is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders? a. Psychology b. Science c. Psychiatry d. Social Science 2. Who was the Father of modern Psychiatry? a. Sigmund Freud b. Anna Freud c. Jeane Piaget d. Johann Reil Weyer 3. Who specializes in mental health, including substance use disorders? a. Sigmund Freud b. Anna Freud c. Jeane Piaget d. Johann Reil Weyer Paul Cresencio R. Liberato  4. Who introduced cognitive stages of development? a. Sigmund Freud b. Anna Freud c. Jeane Piaget d. Johann Reil Weyer 5. Who pioneered in Psycho-Sexual stages of development? a. Sigmund Freud b. Anna Freud c. Jeane Piaget d. Johann Reil Weyer ACTIVITY 1: 1. Create a 5-sentence synthesis of your understanding of this chapter. Don’t forget to send your written output using your mVLE. It should not exceed 8 MB and in PDF format. 1. A 15-item quiz will be posted for you to complete for 10 minutes, next meeting, on mVLE.