Lecture 19– Introduction to psychiatry

Question 1

psychiatry is based on

Answer 1

body, mind, spirit connection

Question 2

philosophical issues: dualism

Answer 2

• a set of views about the relationship between mind and matter, which begin with the claim that mental phenomena are in some respects non-physical.
• (“the ghost in the machine”)
• Rene Descartes (1641) First to clearly identify the mind with consciousness and self- awareness and to distinguish this from the brain which was the seat of intelligence

Question 3

philosophical issues

Answer 3

Neurosis

• “disorders of sense and motion” due to a “general affection of the nervous system”
• Included a range of conditions (e.g. epilepsy, mania, hysteria, diabetes, etc.), with no identifiable physiological cause (e.g. fever)

Question 4

Medical disease that were psychiatric

Answer 4

Question 5

homosexuality and psychiatrty

Answer 5

was orignally seen as a pathological disease

Question 6

emergent schisms

Answer 6

Overtime neurology and psychiatry were classified as different

Question 7

neurology

Answer 7

disorders of the NS with established aetiologies, demonstratable anatomical pathology and physical symptoms e.g. Parkinsons, stroke, epilepsy, Huntingotns, brain injury

Question 8

psychiatry

Answer 8

disorders of the mood, thought and behaviour with no or only mino physical signs with no visible pathology

Question 9

organic vs function in psychiatry

Question 10

Approaches to mental illness- 1

Answer 10

• Identify chemical imbalances, changes in transmitters and receptors and attempt to correct with drugs (psychopharmacotherapy).
• è Revolutionised psychiatry! Patients (mainly psychotic) in straight jackets or locked up - freed.

Question 11

Approaches to mental illness- 2

Answer 11

• Mental illness results from upbringing and environmental factors
• Seek to understand, work through, find resolutions/adaptations è psychotherapy/social approaches.

Question 12

was the rise of psychiatry..

Answer 12

Question 13

Movement against psychiatry- anti-psychiatry

Answer 13

Some people think antipsychotics are used too much etc

Question 14

Why do we need classification?

Answer 14

• To enable clinicians to communicate with each other about patients
• To understand implications of diagnosis (Sx, prognosis, treatment, etc.)
• To facilitate research
• & to relate research findings to everyday practice

Question 16

Criticisms of Classification:

Answer 16

• Categorisation denies consideration of unique personal difficulties
• Labels deviant behaviour as an illness
• Individuals do not fit neatly into categories (stigma)

Question 17

diagnosis in psychiatry

Answer 17

• – ‘knowing the underlying cause’ of symptoms & signs
  
  • (useful, e.g. for appendicitis è understanding, Rx, etc.)
  • BUT rarely can do in psychiatry (except in organic conditions)
• Lack of clear disease categories in psychiatry , therefore instead of diagnosis or disease we use disorder

Question 18

disorders in psychiatry

Answer 18

• “a clinically recognisable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions. Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder as defined here”
• This means that most psychiatric disorders are
  • Not based on theoretical concepts or aetiology
  • Are based on recongisable clusters of symptoms and behaviours

Question 19

Symptoms

Answer 19

Experienced and reported by the patient

Question 20

Sign

Answer 20

Discovered by doctor during examination

Question 21

diagnostic heiarchy

Answer 21

Organic- we know what’s going on in the brain e.g. Alzheimer’s

Psychotic- delusion and hallucination

Neurotic- anxiety and mood disorders

Question 22

Psychiatric Genetic

Answer 22

• to aid classification
• risk estimation
• to assist in the development of new treatments

Future of Psychiatric Genetics?

• Problems with co-morbidities & classification (!)
• Need new approaches: e.g. candidate gene driven (rather than disorder driven)

Question 23

psychosis (schizoprenia (genetic studies)

Answer 23

• lifetime risk of 1% in the general population
• risk in siblings (& DZ twins) is around 8–10%
• risk increases as more relatives are affected
• monozygotic (MZ) twin pairs have ~45% concordance
• over 50% of MZ co-twins are unaffected, despite being virtually identical genetically, so non-inherited risk factors are also important
• likely that the aetiology is multi-factorial, i.e. many genetic and environmental factors act together to influence risk, and a single risk factor is unlikely to cause the disorder on its own

Question 24

pschiatry future compared to present and past

Answer 24