1. An Introduction to Psychiatry Assist Prof Dr Sirwan K Ali Department of Psychiatry

2. Psyche

3. Definition Psychiatry is that branch of medicine dealing with mental disorder and its treatment Psych : soul or mind Iatros : healer

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. 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

8. 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

9. 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

10. 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

11. Psychiatric Interview (general advice)

12. 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

13. Psychiatric Interview … (general advice) Non-verbal communication : * the interviewer ’ s non-verbal cues are important in guiding the interview Finishing the interview

14. 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

15. 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

16. The Psychiatric History … Personal history: * mother ’ s pregnancy and birth * early development * childhood separation, emotional problems * schooling and higher education * occupations * sexual relationships

17. The Psychiatric History … Personal history …. * menstrual history * marriage * children * forensic history Past illness: * past medical history * past psychiatric history

18. The Psychiatric History … Premorbid personality: * relationships * leisure activities * prevailing mood * attitudes, standards * habits Drugs, alcohol, tobacco

19. Difficulties in Classifications and Diagnosis in Psychiatry What is a mental illness, when is a mental state abnormal? Psychiatric symptoms and signs are non specific.

20. Delusions and hallucinations occur in different psychiatric disorders. Depression can be a primary problem or part of other disorder. There are no reliable biological markers. Psychiatrist can not agree.

21. Diagnostic systems of psychiatric disorders ICD-10(International Classification of Diseases)International Classification of Diseases the World Health Organisation : used world wide In USA: Diagnostic and Statistical Manual of Mental Disorders ( DSM IV-TR, 2000Diagnostic and Statistical Manual of Mental Disorders

22. DSM :has five axes Axis I: Psychiatric disorders Axis II: Personality disorders / mental retardation Axis III: General medical conditions Axis IV: Social functioning and impact of symptoms Axis V: Global Assessment of Functioning

23. Psychiatric treatment In the past, psychiatric patients were often hospitalized for six months or more, with some cases involving hospitalization for many yearshospitalized Today, most psychiatric patients are managed as outpatientsoutpatients Average hospital stay is around 2-3 weeks (with only a small number of cases involving long-term hospitalization

24. Inpatient care admitted to a hospital, sometimes involuntarily criteria for involuntary admission vary with jurisdiction patients are assessed, monitored, and often given medication and receive care from a multidisciplinary team physicians, nurses, psychologists, occupational therapists, psychotherapists, social workers, and other medical professionals

25. Inpatient care

27. Outpatient care periodically visit for consultation Office base usually 30-60 mins psychiatric practitioner interviewing assessment of the patient's condition provide psychotherapy or review medication frequency : varies widely, from days to months depending on the type, severity and stability of each patient's condition, and on what the clinician and patient decide would be best

28. Biomedical treatment

29. Biomedical treatment Electroconvulsive therapy

30. Psychological treatment MeditationPsychotherapyCounselling

31. Psychiatric rehabilitation

32. Questions….. Comments….. (welcome) 32