1. Introduction & Etiology in Psychiatry
Dr. Mohammed Alblowi
SB-Psych
Consultation Liaison Psychiatry – Queen’s University
Neuropsychiatry – University of Western Ontario

2. Huge Thanks to: Ahmad AlHadi, MD
Assistant Professor, Consultant Psychiatry and Psychotherapy Director
College of Medicine, King Saud University
Fahad Alosaimi  MD
Psychiatry & Psychosomatic medicine Consultant Associate professer, College of Medicine, King Saud University
Huge Thanks to:

3. Objectives To describe psychiatry as branch of medicine.
To list the misconceptions about psychiatry.
To know the prevalence of psychiatric disorders in the world in general.
To discuss the etiology of psychiatric disorders.

4. is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
WHO define Health as

5. What is Psychiatry ?
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptation's related to mood, behaviour, cognition, and perceptions
Psychiatrists are qualified to assess and treat both the mental and physical aspects of psychological problems.

6. MISCONCEPTIONS Patients Cuases Treatments: PSYCHIATRISTS
Psychotropic drugs
ECT
Psychotherapy
PSYCHIATRISTS

8. Psychiatric disorders are both common and serious
Lifetime prevalence of mental disorders is 33% in general population & 42% in patients with chronic medical conditions.
In patients with short-term medical or surgical conditions, 30-60% of them presented also with a psychiatric condition.
Patients with schizophrenia or bipolar disorders may die 15 years younger than general populations because of higher medical co-morbidity.
The medical costs are twice higher in depressive patients and they require seven times more frequently the emergency services.

9. Logistics of the PSYCHIATRY COURSE
PEM 462
Logistics of the PSYCHIATRY COURSE

10. Schedule: Day 8:30-9:30 9:30-10:30 10:30-12 1-2:30 pm 2:30-4 pm Sunday
9:30-11
11-12
1-3 pm
3-4 pm
Sunday
17/03/2019
Introduction and etiology of psychiatric disorders
Classification and diagnosis of psychiatric disorders
Psychiatric sign and symptoms (psychopathology)
Schizophrenia Spectrum and other psychotic disorders
Bipolar Disorder
Day
8:30-9:30
9:30-10:30
10:30-12
1-2:30 pm
2:30-4 pm
Sunday
24/03/2019
Depressive Disorder
Anxiety disorder
obsessive compulsive disorder & related disorder
Neurocognitive disorders (delirium and dementias)
Psychosomatic medicine
Wednesday
27/03/2019
Substance-related & addictive disorder-1
Substance-related & addictive disorder-2
Trauma & stress-related disorders
Personality disorders
Eating disorder
Day
8:30-9:30
9:30-10:30
10:30-12
1-2:30 pm
2:30-4 pm
Sunday
31/03/2019
Child Psychiatry-1
Child psychiatry-2
Psychotherapy
Psychopharmacology
Psychiatric emergencies

11. Week 4 &5 (CLINICAL) Group A+B Week 4 Group C+D Week 5 Day 8:30-10
10-12
1-2:30 pm
2:30-4 pm
Sunday
07/04/2019
How to take Psychiatric history
How to do mental state examination
How to interview patient with suicidality and aggressive behavior
How to build rapport (therapeuti c relationship) with patient + video cases +ECT

12. PSYCHIATRY COURSE
Knowledge
Attitude
Skills

13. Knowledge
Phenomenological psychopathology (signs and symptoms) of psychiatric disorders.
Classification and etiology in clinical psychiatry (bio-psycho-social).
Common psychiatric disorders:
Clinical features and course.
Epidemiology and etiology.
Differential diagnosis.
Treatment (bio-psycho-social) and prognosis.
Treatment modalities in psychiatry:
Physical: pharmacotherapy, electroconvulsive therapy
Psychological: behavioral, cognitive, supportive psychotherapy and others.

14. ATTITUDE
Attendance
Interaction
Discipline
Professionalism

15. SKILLS To conduct a full psychiatric interview with:
Proper interview techniques and skills.
Sufficient psychiatric history.
Standard “mental state examination”.
To present a diagnostic formulation for common psychiatric disorders.
To set an outline of a management plan for common psychiatric disorders following the bio- psycho-social approach.
To assess and appropriately refer psychiatric patients in the primary care settings.
To assess and deal competently and safely with psychiatric emergencies.
To assess and dispose properly consultation-liaison cases.

16. COURSE REFERENCES
First Aid for the Psychiatry Clerkship, Third Edition,
Introductory Textbook of Psychiatry, latest Edition by Donald W. Black & Nancy C. Andreasen
All lectures' content & handouts distributed throughout the course.
Others:
Textbook of Psychiatry, by Linford Rees, Oxford University Press.
Pocket Handbook of Clinical Psychiatry by Kaplan & Sadock, Williams & Wilkins.
Emergency Psychiatry by Allen Micheal. APA Press.
Clinical Manual to Psychosomatic Medicine: A guide to Consultation- liaison Psychiatry (Concise Guide), By Michael Wise.
Trusted Psychiatry websites including: UpToDate , Medscape psychiatry .. etc.

17. What are the expectations?
To have safe non-psychiatric doctors who can:
Identify (common, treatable or serious) psychiatric co-morbidities.
Treat or follow up mild/stable psychiatric disorders.
Refer the patient to psychiatry service whenever needed.
To recruit some medical students to psychiatry sub -speciality.

18. Course marks 30 marks for mid term 40 marks for final exam
25 marks for video cases
5 marks for attendance

19. COURSE EVALUATION Your evaluation is highly appreciated.
Kindly evaluate both the course & the tutors at the end of the course.
Course organizer will be happy to help you whenever you need.

20. Etiology in Psychiatry
Causes are often remote in time from the effects that they produce e.g. childhood experience  adult anxiety disorders.
a) A single cause may lead to several effects e.g. deprivation of parental affection  antisocial behavior, suicide, depression…
b) A single effect may arise from several causes e.g. M.R. Depression.

21. ETIOLOGY Like other branches of Medicine
ETIOLOGY Like other branches of Medicine ., etiology of primary psychiatric illnesses is usually multifactorial (Bio-Psycho-Social )
BIOLOGICL
PSYCHOLOGICAL
SOCIAL
Genetic
Neuropatholgicl
Endocrinological
Biochemical: the monoamine neurotransmitters.
Metabolic
Inflammatory/ autoimmune
Thinking distortions
Emotional dysregualtion
Behavioral problems
Unconscious conflicts
Others
FAMILY factors:
lack of social support, criticism, and over protection within the family.
Life events : Migration, unhappy marriage, problems of work, school, financial issues.
1. Genetics:
- Family risk studies
- Twin studies
- Adoption studies
- Genetic causes have been studies mainly in moderate to severe mood disorders and schizophrenia.
5. Psychological theories of etiology:
a) Psychoanalysis
- Provides a comprehensive range of explanation for clinical
phenomena.
- The central feature is the concept of unconscious mind which
characterized by:
a – divorce from reality
b – being dynamic
c – being in conflict with the conscious mind.
- It is important in the etiology of neurotic disorders.
- Neurosis originate from failure to pass normally through 3 stages
of development oral  anal  genital.
- Anxiety is the central symptom of all neurosis.
- Defense mechanisms (such as rationalization and projection)
are used to reduce anxiety.
b) Learning theories:
Experiences in childhood and later life give rise to neurosis.
Cognitive:Symptoms and behavior are produced and maintained by maladaptive ways of thinking.

22. EFFECTS OF ETIOLOGICAL FACTORS
Predisposing factors
Constitution
Precipitating factors
Illness
Perpetuating factors
Recovery

23. Etiological factors Biological Psychological Social Protective factors
Perpetuating
Precipitating
Predisposing
Effect
Type
Biological
Psychological
Social

24. Roles of evil eyes, witchcraft and possessions
Islamic concepts
Cultural concepts and practice
The effects of evil eyes, witchcraft and possessions on health in general is proven.
They can be one of the major or minor etiological factors for any type of disease.
The pathophysiology, symptoms and signs are not proven or certain.
The faith healing (Rogiah) is:
One important preventive & treatment modality for all types of diseases but not the only one
Not a diagnostic tool
Some people deny the effects of evil eyes, witchcraft and possessions on health.
Others exaggerate their effects and over blame them.
Some faith healer are ignorant:
Use faith healing as a diagnostic tool
Verbally and physically aggressive with patients
Advice patients against medical management

25. Summary & feedback