Introduction to psychiatry

The term "psychiatry" was first coined by the German physician Johann Christian Reil
in 1808
literally means the 'medical treatment of the soul’
psych- "soul"
-iatry "medical treatment"

MENTAL ILLNESS
Mental and behavioral disorders are understood as clinically significant conditions
characterized by alterations in thinking, mood (emotions) or behavior associated with
personal distress and / or impaired functioning. (WHO, 2001)

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

ETIOLOGY OF MENTAL ILLNESS
Predisposing Factors
These factors determine an individual's susceptibility to mental illness. They interact
with precipitating factors resulting in mental illness.
These are:
• Genetic make up
• Physical damage to the central nervous system
• Adverse psychosocial influence

Precipitating Factors
These are events that occur shortly before the onset of a disorder and appear to have
induced it.
These are:
 • Physical stress
 • Psychosocial stress
Perpetuating Factors
These factors are responsible for aggravating or prolonging the diseases already
existing in an individual. Psychosocial stress is an example.

Thus etiological factors of mental illness can be:
 • Biological factors
 • Physiological changes
 • Psychological factors
 • Social factors

BIOLOGICAL FACTORS
Heredity
 What one inherits is not the illness or its symptoms, but a predisposition to the illness, which is
determined by genes.
 Studies have shown that three-fourths of mental defectives are mainly due to unfavorable heredity.
Biochemical Factors
 Biochemical abnormalities in the brain are considered to be the cause of some psychological
disorders.
 Disturbance in neurotransmitters in the brain is found to play an important role in the etiology of
certain psychiatric disorders.
Brain Damage
 Any damage to the structure and functioning of the brain can give rise to mental illness. Damage to
the structure of the brain may be due to one of the following causes:
 • Infection:E.g.Neurosyphilis, encephalitis,HIV infection, etc.
 • Injury: Loss of brain tissue due to head injury

 • Intoxication: Damage to brain tissue due to toxins such as alcohol, barbiturates, lead, etc.
 • Vascular: Poor blood supply, bleeding (intracranial hemorrhage, subarachnoid
hemorrhage, subdural hemorrhage)
 • Alteration in brain function: Changes in blood chemistry that interfere with brain
functioning such as disturbance in blood glucose levels, hypoxia, anoxia, and fluid and
electrolyte imbalance
 • Tumors: Brain tumors
 • Vitamin deficiency and malnutrition, in particular deficiency of vitamin Bcomplex
 • Degenerative diseases: Dementia
 • Endocrine disturbances: Hypothyroidism, thyrotoxicosis etc.
 • Physical defects and physical illness: Acute physical illness as well as chronic illnesses with
all their handicapping conditions may result in loss of mental capacities

PHYSIOLOGICAL CHANGES
It has been observed that mental disorders are more likely to occur at certain critical
periods of life namely-puberty, menstruation, pregnancy, delivery, puerperium and
climacteric.
These periods are marked not only by physiological (endocrine) changes, but also by
psychological issues that diminish the adaptive capacity of the individual.
Thus the individual becomes more susceptible to mental illness during this period.

PSYCHOLOGICAL FACTORS
• It is observed that some specific personality types are more prone to develop certain
psychological disorders. For example those who are unsocial and reserved (schizoid)
are vulnerable to schizophrenia when they face adverse situations and psychosocial
stresses.
• Psychological factors like strained interpersonal relationships at home, place of work,
school or college, bereavement, loss of prestige, loss of job, etc.
• Childhood insecurities due to parents with pathological personalities, faulty attitude
of parents (over-strictness,over leniency),abnormal parent-child relationship
(overprotection, rejection, unhealthy comparisons), deprivation of child's essential
psychological and social needs, etc.

• Social and recreational deprivations resulting in boredom, isolation and alienation.
• Marriage problems like forced bachelorhood, disharmony due to physical, emotional,
social, educational or financial incompatibility, childlessness, too many children, etc.
• Sexual difficulties arising out of improper sex education, unhealthy attitudes towards
sexual functions, guilt feelings about masturbation, pre and extra-marital sex relations,
worries about sexual perversions.
• Stress, frustration and seasonal variations are sometimes noted in the occurrence of
mental diseases.

SOCIAL FACTORS
• Poverty, unemployment, injustice, insecurity, migration, urbanization
• Gambling, alcoholism, broken homes, divorce, very big family, religion, traditions.

MISCONCEPTIONS ABOUT MENTAL
ILLNESS
• Mental illness is caused by supernatural power and is the result of a curse or
possession by evil spirit: because of past sins or misdeeds in previous life.
• Mentally ill people show bizarre behavior: exhibiting useless bizarre behavior like
twisting of hands, etc.
• Mentally ill people are dangerous: People who have or had a mental illness are
viewed with suspicion and as dangerous persons.
• Mental illness is something to be ashamed of : This idea arouses an unsympathetic,
cruel attitude towards a mentally ill person. This is the reason why many people hide
mental illness in the family.

• Mental illness is not curable: People object to have normal relationship with mentally
ill people, or to give them employment even after being cured, or even to accept them
as neighbours.
• Mental illness is contagious: The fear that it is contagious is the main false notion
which leads people to view suspiciously, or object to marital relations with a person
belonging to the household of the mentally ill.
• Mental illness is always hereditary: It is not a rule that children of mentally ill patients
should become mentally ill.

• Marriage can cure mental illness: A mentally ill person can get worse if he gets
married when he is ill, as marriage can become an additional stress. A patient who has
recovered can get married and live a normal life like any other person.
• Mental hospitals are places where only dangerous mentally ill individuals are treated
and restraint is a major form of treatment: People hesitate to take their relatives to
mental hospitals for treatment because of fear.
Further, as ex patient of a mental hospital, he, as well as his family members are often
isolated. Therefore, people seek help from mental hospitals only as a last resort.

PSYCHOSIS VS. NEUROSIS
Psychosis Neurosis
Schizophrenia Anxiety disorders, panic disorders
Manic depression (bipolar) Post traumatic stress
Whole of personality affected Part of personality affected
Lacks insight - Does not recognise
they have problem
Has insight (recognizes they have a
problem)
Loses contact with reality Retains contact with reality
No obvious cause Often begins as a response to a
stressor
Hallucinations and delusions Absent
Not normal behaviour Exaggeration of normal behaviour
Treated mainly by physical
methods
Treated mainly by psychological
methods

CLASSIFICATION OF MENTAL
DISORDERS
At present there are two major classifications in psychiatry, namely, ICD 10 (1992) and
DSM V (1994).
I. ICD 10 (International Statistical Classification of Disease and Related Health
Problems) -1992

Features of Mental Illness
The features of mental illness are classified under four headings
 1. Disturbances in bodily functions
 2. Disturbances in mental functions
 3. Changes in individual and social activities
 4. Somatic complaints

1. DISTURBANCES IN BODILY
FUNCTIONS
Sleep: Disturbed sleep throughout the night, or no sleep at all, or difficulty in falling
asleep, or waking up in the middle of night and failing to fall asleep again  lethargy
and lack of freshness in the morning.
Appetite and food intake: Increased appetite or decreased appetite, weight loss or
weight gain, nausea, vomiting.
Bowel and bladder movement: Diarrhoea or constipation, increased micturition, bed-
wetting.
Sexual desire and activity: Decreased interest in sex, premature ejaculation, impotence
or lack of sexual satisfaction. In some conditions there can be excessive sexual desire
or lack of social inhibitions.

2. DISTURBANCES IN MENTAL
FUNCTIONS

Attention and concentration: Patient may have decreased attention and concentration;
he may get distracted easily, or have selective inattention.
Memory: Patient may lose his memory and start forgetting important matters.
Intelligence and judgment: Patient loses reasoning skills and abilities, may not be able
to perform simple arithmetic, or commits mistakes in routine work.
Level of consciousness : In some mental illnesses due to possible brain damage there
may be changes in the level of consciousness.
Patient fails to identify his relatives. He can be disoriented to time and place. He may
remain confused or become unconscious.
DISTURBANCES IN MENTAL
FUNCTIONS

3. CHANGES IN SOCIAL
ACTIVITIES
Patients may neglect their bodily needs and personal hygiene.
The patient may also lose social sense. They behave in an inappropriate manner in
social situations and embarrass others.
They behave strangely with their family members, friends, colleagues and others. They
may insult, abuse/ assault them.

4. SOMATIC COMPLAINTS
Patient may complain of aches and pains in different parts of the body, fatigue,
weakness, involuntary movements, etc.

MENTAL HEALTH TEAM
The multidisciplinary team includes:
 • A Psychiatrist
 • A Psychiatric nurse
 • A Clinical psychologist
 • A Psychiatric social worker
 • An Occupational therapist or an Activity therapist
 • A Pharmacist and a dietitian
 • A Counselor

ஷாரூக் கான்
நடிகர்
தற்க ொலை கென்ற சொதலையொளர்
தீபிகா படுககான்
நடிகக
ஏஞ்சலினா க ாலி
நடிகக
தி ராக் - ட்வெய்ன் ான்சன்
மல்யுத்த வீரர்
மனிஷா வகாய்ராலா
நடிகக
ஓப்ரா வின்ப்ரீ
அவமரிக்க வதாகுப்பாளர்
J.K.வரௌலிங்
கேரிபாட்டர் பகடப்பாளர்
மார்ட்டின் லூதர் கிங்
சமூக உரிகம தகலெர்
சுகரஷ் வரய்னா
கிரிக்வகட் வீரர்
கமக்ககல் வபல்ப்ஸ்
நீச்சல் வீரர்

Introduction to psychiatry

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