An Introduction to Psychiatry

1
An Introduction to Psychiatry

• H.Amini M.D.
• Department of Psychiatry
• TUMS

2
Definition

• Psychiatry is that branch of medicine dealing
  with mental disorder and its treatment
• Psych soul or mind
• Iatros healer

3
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

4
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

5
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

6
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

7
Models of Mental Disorders

• Dogmatism
• Eclectism
• Pleuralism
• Integrationism

8
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

9
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

10
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

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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

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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

13
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

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Psychiatric Interview(general advice)

• Non-verbal communication the interviewers
  non-verbal cues are important in guiding the
  interview
• Finishing the interview

15
The Psychiatric History

• Identifying data name, age, sex, marital
  status, education, occupation, address,
• Present Illness patients description of
  the problem details of the nature of
  the problem present severity of the
  symptoms other relevant problems
  onset and course

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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

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The Psychiatric History

• Personal history mothers pregnancy and
  birth early development childhood
  separation, emotional problems
  schooling and higher education occupations
  sexual relationships

18
The Psychiatric History

• Personal history. menstrual history
  marriage children forensic history
• Past illness past medical history
  past psychiatric history

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The Psychiatric History

• Premorbid personality relationships
  leisure activities prevailing mood
  attitudes, standards habits
• Drugs, alcohol, tobacco