L3 Introduction to Pyschiatry Flashcards
what is psychiatry
“the branch of medicine which is concerned with the understanding, assessment, diagnosis and treatment of the mind”
what may psychiatric disorders involve
emotions, behaviour, perceptions and cognition
what can psychiatric disorders affect
social life, work, and relationships
historical context in psychiatry
- Patients institutionalised in separate facilities → in order to keep them separate from other people.
- Now integrated with general hospitals and primary care.
Examples of co-morbidities between mental and physical illnesses
- Depression and cardiovascular disease (e.g., post-stroke depression).
- Diabetes and schizophrenia.
Hippocrates contributions to psychiatry
- (460–379 BC):
- Humorism (Four humours)
- Black bile - depression
- Yellow bile - mania
- Blood
- Phlegm
Plato’s contributions to psychiatry
(387 BC): Brain is the “seat of mental processes”
historical aspect of psychiatry in ireland
- Pre-1600s:
- Spiritual/religious approaches, Brehon Law altruism.
- Monasteries offered limited care; most lived in destitution or imprisonment.
- Sites like Gleann na nGealt said to offer relief.
- Post-1600s: Reports of people “wandering the roads” because the didn’t have anywhere else to go.
1708
development
St. James’ Gate Workhouse had six cells for the “lunatic poor”
1746
development
Jonathan Swift’s bequest led to St Patrick’s Hospital (first psychiatric hospital) (built in 1757)
1814
development
Richmond Asylum opened with “moral management” principles
1817
development
Robert Peel “Select Committee on the Lunatic Poor in Ireland”
result of Select Committee assessnebt
- Legislation that resulted in building of asylums:
- 1820s: Asylums in Armagh, Belfast, Derry and Limerick
- 1835: Asylums in Ballinasloe, Carlow, Waterford, Maryborough (Portlaoise)
- 1840s and 1850s: Central Mental Hospital (Dublin), Eglinton (Cork), Mullingar, Letterkenny, Castlebar.
how many people were in asylums in 1900
21,000
what problems existed in asylums
overcrowding and infection
examples of early psychiatric treatments
from the 1900s
- insulin therapy (1938)
- convulsive therapy (1939)
- psychosurgery (1946)
- chlorpromazine (1952)
why was there a decline in asylum numbers between the 1900s and 2000s
- challenges and changes made to mental health legislation
- developments in human rights, psychological medicine, and outpatient treatment led to changes in how people were treated
what first psychiatric medications were created in the 1950s
- chlorpromazine - antipsychotic
- imipramine - antidepressant
when were SSRIs introduced
the 1980s
what does SSRI stand for
selective serotonin reuptake inhibitor
examples of SSRIs
- fluoxetine
- sertraline
- escitalopram
what development in mental health policy occured in 1966
Commission of Enquiry on Mental Illness
Commission of Enquiry on Mental Illness
changes to policy
- promoted “radical and widespread changes”
- shift towards community care and family support
- recommended inclusion of the patients’ general practioner
what development to mental health policy occured in 1984
planning for the future
what did planning to the future describe
- admission to hospital was determined a final treatment resource
- community care was underfunded
- day hospitals and child guidance teams were recommended
- highlighted concerns over premature discharges leading to encounters with the criminal justice system
what development in mental health policy occured in 2006
A vision for change
What was a vision for change
- Policy pertaining to mental health assessment, care and treatment
- called for accessible, community-based services
- Closure of all mental hospitals was emphasised
- specifics regarding community mental health teams, per population
What development in mental health policy occured in 2020
“sharing the vision”
what were the general aims of “sharing the vision”
- mental health promotion
- prevention and early intervention
- acute, community and specialist services
- enhanced capacity for primary care services to treat mental health
when was the mental health act enacted
2001
what did the mental health act 2001 say
- governs involuntary detention of people with mental illness to approved centres for inpatient treatment.
- defines the role of he mental health commission as the regulation and promotion of development of service delivery both in approved centres and the community
what percentage of adults with experience mental illness in their lifetime
25%
what is the bio-psycho-social model
- Interdependency between biological, psychological, and social processes.
- Biological processes underlie psycho-social function, and psychological and social processes impact biological function.
what type of care follows the bio-pscho-social framework
multidisciplinary involvement to provide holistic, individualised care
what is mental illness
a series of syndromes consisting of characteristic clusters of symptoms and signs of disordered mental functioning (ie. emotions, thoughts, perceptions and behaviours) resulting in substantial suffering and psychological, social or occupational dysfunction
two examples of standard classification manuals used to classify psychiatric disorders
- Diagnositci and Statistic Manual of Mental Disorders (DSM-V) (2013)
- International Classification of Diseases (ICD-11)
which standard classification manual is used in the US and Canada
DSM-V
which standard classification manual is used in Ireland and europe
ICD-11
two stages of psychiatric assessment
- Elicit psychopathology diagnosis (according to ICD-11/DSM-V)
- Understand the individual patient holistically, identifying their vulnreabilities and protective factors
mental health service provision in hospitals
- in-patient treament
- safe environment
- groups
- 1:1 → psychology, OT, social work, nursing, medicine
- medication
mental health service provision in the community
- GP
- day hospital/services
- community OT, nursing, social work
- community groups
- supported accommodation
MDT members
- consultant psychiatrist
- SHO/registrar
- community psychiatric nurse
- social worker
- OT
- psychologist
- addiction counseller
- dietitican
- pharmacist
- SLT
other disciples involved outside of the MDT
- private psychology
- music/art/drana therapist
- family-based supports
- TUSLA
- addiction services (inpatient rehab & community-based)
- specialist communities (As I Am, Belong To, SHINE)
- service user representatives
stigma
negative stereotypes leading to discrimingation
stereotypes
generalised beliefs about something
prejudice
negative judegements based on stereotypes
discrimination
actions based on these prejudiced judegments and beliefs
public stigma
stigma faced externally from a system, group or individual
impacts of public stigma
life areas such as employment, housing, healthcare and education
