An Introduction to Psychiatry

H.Amini M.D.Department of Psychiatry

TUMS

Definition Psychiatry is that branch of

medicine dealing with mental disorder and its treatment

Psych : soul or mind Iatros : healer

Common confusions within psychiatry Psychology : a science that investigates

behaviour, experience, and normal functioning of the mind

Psychotherapy : the treatment of psychological issues by non-physical means

Psychoanalysis : a particular sort of psychotherapy, or means of exploring the unconscious mind

Why Study Psychiatry ? Psychiatric disorders are prevalent

and often go untreated : * lifetime prevalence in USA :

28% * lifetime prevalence in Iran : 10.5-21% * only 40% receive treatment during lifetimes

* in general practice : 1/6-1/4 of the patients seen have a psychiatric problem

Why Study Psychiatry ?… …. * depression is diagnosed in only 50% of those with depression who present to GPs

* adequate treatment ensues in only about 17% of depressed patients in

primary care settings* half the patients who commit suicide

sought treatment in a primary care setting within 1 month of dying *

two-thirds of patients with undiagnosed depression have six visits or more a year with GPs for somatic complaints

Why Study Psychiatry ?… Global burden of mental disorders Subject of medicine is human

being, a “biopsychosocial” Consideration of the psychological

aspects of the doctor-patient relationship

Models of Mental Disorders Dogmatism Eclectism Pleuralism Integrationism

Biopsychosocial Approach Mental health care is a

multiagency task which may involve multidiciplinary teams of workers developing in conjunction with the patient/client and their carers, a program of treatment and support to meet their needs

Barriers to Dx & Treatment in Primary Care Settings(patient factors)

May present with a somatic complaint Concurrent medical illness often

obscures psychiatric symptoms Denial Stigma & shame The belief that psychiatric illness is

untreatable The belief that drugs are mind-altering

and/or addictive

Barriers to Dx & Treatment in Primary Care Settings(physician factors)

A lack of time Fear of being embarrassed Uncertainty Fear that the patient will have an

illness that is unresponsive to treatment

Prior negative experience Lack of knowledge

Psychiatric Interview(aims) Obtain information Understand the person with the

illness Form a therapeutic relationship Assess the emotions and attitudes of

the patient Provide the patient with information

about the illness, treatment recommendations, and prognosis

Psychiatric Interview(general advice) Putting the patient at ease :

* place : not to be overheard * arrangements for seating * greet the patient by name * introduce yourself with your own

name and your role* explain

Psychiatric Interview…(general advice) Starting the interview :

* begin with a general question * to avoid closed questions and leading questions

Proceeding with the interview :* to keep the patient to

relevant topics, while letting him talk freely

Psychiatric Interview…(general advice) Non-verbal communication :

* the interviewer’s non-verbal cues are important in guiding the interview

Finishing the interview

The Psychiatric History Identifying data: name, age, sex, marital

status, education, occupation, address, … Present Illness: * patient’s description of

the problem* details of the nature of the

problem* present severity of the

symptoms other relevant problems * onset and course

The Psychiatric History… Family history: * parents:

age, occupation, personality,relationship with the patient * sibling:

* social position; atmosphere of the home * Hx of mental disorder or drug abuse

The Psychiatric History… Personal history: * mother’s

pregnancy and birth * early development * childhood separation, emotional problems * schooling and higher education * occupations

* sexual relationships

The Psychiatric History… Personal history….

* menstrual history* marriage* children

* forensic history Past illness:

* past medical history* past psychiatric history

The Psychiatric History… Premorbid personality:

* relationships* leisure

activities * prevailing mood

* attitudes, standards* habits

Drugs, alcohol, tobacco