Psychiatry Introduction

Li Meixiu (Ellen) JMS University

Chapter 1. Diagnosis & classification in Psychiatry

• Psychiatry : concerned with the origin, diagnosis, prevention & treatment of mental disorders

Psychiatric disorder • a psychological or behavioral pattern that occurs in an individual - distress or disability that is not expected as part of normal development or culture. cognition / conation / affect distress / disability / freedom

Normal mental health • Health • Mental health model: medical / statistical / utopian / subjective social / process / continuum

Normality • • • •

Reality orientation Self-awareness Self –esteem Ability

Classification • ICD-10 1992 mental & behavoir disorders

F00-F99

• DSMIV-TR 2000 Diagnostic & statistical manual of mental disorders ,IV edition ,text revision

Mental & behavior disorders ICD-10 • F00-F09 organic--symptomatic ,mental disorder delirium ,dementia ,organic amnestic syndrome F10-F19 psychoactive substance use acute intoxication , harmful use , dependence syndrome ,psychotic disorders

F20-F29 schizophrenia

/schizotypal&delusional disorders schizophrenia , schizotypal disorder ,persistent delusional disorders ,acute & transient psychotic disorders F31-F39 mood / affective disoders manic episode ,depressive episode ,bipolar affective disorder

neurotic , stress-related & somatoform disorder anxiety disorder , phobic anxiety disorder , obsessive –compulsive disorder,somatoform disorders F50-F59 Behavioral syndromes - physiological disturbances & physical factors eating disorder ,non-organic sleep disorders, sexual dysfunctions F40-F48

Disorder of adult personality & behavior specific personality disorders, enduring personality changes,habit & impulse disorders ,gender identity disorders, sexual preference disorders

F60-F69

F70-F79 Mental retardation

F80-F89 Disorder of psychological development specific developmental disorder of motor function specific developmental disorders of scholastic skill F90-F98 Behavoiral & emotional disorders with onset usually occurring in childhood & adolescence hyperkinetic disorders ,conduct disorders ,tic disorders • F99 Unspecified mental disorder multi-axial classification

Chapter 2 Psychiatric history & examination

Interview technique • • • • • • •

Commuinication disturbance Informants Personal history / premorbid personality Observation Rapport Poor judgement Elicit information

• Identification data aliases,occupation ,residential & office address, social -economic • Informants relationship /ability/ source of referral • Chief complaints predisposing / precipitating F ,perpetuating / relieving F

• History cases / therapy / family / personal

Personal history • Perinatal / childhood / educational / play / • puberty / menstrual & obsteric / occupational /sexual & marital / premorbid personality

premorbid personality • • • • • • • •

Interpersonal relationship Use of leisure time Predominat mood Attitude to self & others Attitude to work & responsibility Religious beliefs & moral attitudes Fantasy life Habits

Examination • Physical • Mental status general speech mood & affect Thought Perception Cognition Insight judgement

General appearance & behavior • • • • • • • •

General appearance Attitude cooperation/ guarded / evasive Comprehension Gait & posture Motor activity Social manner & non-verbal behavior Rapport Hallucinatory behavior

speech • • • •

Rate & quantity mutism Volume & tone Flow & rhythm Mood & affect

Thought • Stream & form tangentiality / circumstantiality / illogical • Content

preoccupation obsession Phobias Delusion

Perception Hallucination Illusions & misinterpretations Depersonalization / derealization Somatic passivity phenomenon others

Cognition (neuropsychiatric)assessment • • • • • • •

Consciousness Orientation Attention Concentration Memory Intelligence Abstract thingking proverb testing / similarities

Others • Investigations • Formulation etiological factors --• Special interviews

Psychiatry

AMTS  What is your age? (1 point)  What is the time to the nearest hour? (1 point)  Give the patient an address, and ask him or her to

repeat it at the end of the test. (1 point) 42 West Street  What is the year? (1 point)