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Module Content Page Introduction Cognitive Disorders M. A. Al-Sughayir - Manual of Basic Psychiatry / Draft 3 - 2013 Introduction Module Content Page 1- Psychiatry: Definition - Scope (Knowledge - Skills- Attitude). 3-4 Importance of Psychiatry Clerkship & Advice. Introduction 2-Diagnosis and Classification in Psychiatry. 5-6 3- Etiology in Psychiatry. 7-9 4- Psychiatric Assessment (History, MSE, MMSE). 10-16 5- Signs and Symptoms (Psychopathology) in Psychiatry. 17-21 Test-1 22-25 Introduction 27 Delirium 28-30 Cognitive Dementia 31-33 Disorders Amnestic Syndrome 34 ------ Alcohol abuse & Delirium Tremens 35-38 Psychosomatic Abuse of Anxiolytics, sedatives & hypnotics 39 Medicine Abuse of inhalants 40 & Abuse of opioids 41 Somatoform Head injury- Neuropsychiatric aspects 42 Disorder Psychosomatic Medicine & C-L Psychiatry 43-51 Somatoform Disorders 52-54 Test-2 56-59 Objectives , Definition , clinical features , & required clinical skills, & DDx 61 Psychotic Disorders 62 Psychotic Schizophrenia 63-66 Disorders Substance-induced psychosis 67 Personality disorders - cluster A 68 Aggressive / violent patient 69 Antipsychotics 70-73 E C T (Electroconvulsive therapy) 74 Test-3 75 Introduction - Definitions-Episodes vs. Disorders 81 Mood Major Depressive Episode(MDE) & Major Depressive Disorder(MDD) 82-85 Disorders Postpartum Depression - Dysthymic Disorder 86 Antidepressants 87-88 Suicide - Parasuicide 89 -90 Manic-Hypomanic-Mixed Episodes 91 Bipolar I & II 92-93 Mood Stabilizers 94 Personality disorders - cluster B 95-96 Test-4 97 -100 Differential diagnosis of anxiety disorders 103-104 Anxiety Panic disorder. 105 Disorders Agoraphobia - Dependent personality disorder 106 - 107 & Social phobia- Avoidant personality disorder- Specific phobia 108 -109 Psychological Generalized anxiety disorder ( GAD) 110 Treatments Obsessive compulsive disorder ( OCD ) - OCPD 111-112 Acute /post traumatic stress disorders(PTSD) - Adjustment d. & Grief 113-115 Anxiolytic medications 116 Psychological Treatments 117-118 Test-5 119-122 Child Introduction - Assessment - Classification 125 Psychiatry Intellectual Disabilities 126 Pervasive Developmental D. - Attention deficit hyperactivity disorder (ADHD) 127 Other childhood disorders 128 Test-6 130 Appendix A Review: - Exam / Psychiatric Skills 132-153 Appendix B Self-development; Overview 154- 1 M. A. Al-Sughayir - Manual of Basic Psychiatry / Draft 3 - 2013 Introduction Module 2 Module 1 Module 3 PSYCHIATRY Course: 462 Psych Module 6 Module 5 Module 4 2 M. A. Al-Sughayir - Manual of Basic Psychiatry / Draft 3 - 2013 Introduction Psychiatry A medical discipline concerned with the provision of bio-psycho- social assessment and management of mental disorders. Knowledge Attitude Skills Psychiatric Disorders: To adopt a positive attitude. Negative opinion is based on - Psychiatric History. - Classification. unscientific public thinking, - Mental state - Features. media, peers, and past - Etiology. personal negative Examination. experience. It may be a - Epidemiology. - Interview Skills. - Course. defense mechanism. - Treatment. - Eliciting Signs & - Prognosis. Symptoms. Negative attitude Positive attitude Etiology Vague/due to poor adherence to Many aspects have been scientifically religion/always due to supernatural causes. explored & approved >>> good Rx. Diagnosis Subjective / unscientific. Objective criteria & Scales. Medications Deleterious / addictive. Benefit > risk in general. Prognosis Always bad. There are many disorders with good prognosis. Patients Mad / bad / sad / aggressive / not easy to Human beings deserve respect. like / have low faith in Allah. Clinicians Mentally unstable because of patients. Like other clinicians but some may.. !? Psychiatry Unscientific & unappealing. Scientific / Biopsychosocial approach. 3 M. A. Al-Sughayir - Manual of Basic Psychiatry / Draft 3 - 2013 Introduction Importance of Psychiatry Clerkship One of the essential qualities of the clinician is interest in humanity. Training in psychiatry will expand your understanding of the spectrum of human perception, thinking, emotion, and c behavior. This will serve you well in self-awareness, interpersonal relationships, and patients' care. Whatever medical specialty you choose in the future, training in psychiatry will upgrade your clinical skills in: • Putting the patient at ease. • Recognizing the patient's state of mind. • Understanding the patient's suffering. • Expressing empathy for the patient's suffering. • Establishing good rapport with you patient. Before Psychiatry Clerkship Neuroanatomy. Neurophysiology Neurotransmitters It is advisable to review these basics. See Basic Psychiatry chapter 1. Clinical Psychology 4 M. A. Al-Sughayir - Manual of Basic Psychiatry / Draft 3 - 2013 Introduction 2-Diagnosis & Classification in Psychiatry Basic Psychiatry chapter 4 Significance: Making a diagnosis in psychiatry can be difficult 1. To distinguish one diagnosis from another. because of the following: 1. 2. To enable clinicians to communicate with A.Most diagnoses are made at the level of symptoms and signs, which are non-specific. one another about their patients’ symptoms, B.Lack of biological markers. treatment and prognosis. Psychiatric diagnosis has long been criticized as vague. 3. To ensure that psychiatric research can be Classification attempts to avoid these pitfalls using conducted with comparable groups of patients. well-defined criteria. Categories of Psychiatric Disorders (DSM-4) Multiaxial Evaluation: It evaluates patients along several variables and contains 5 axes; Disorders usually first diagnosed in infancy, Axis I: it consists of psychiatric disorders (e.g. schizophrenia). childhood, or adolescence. Axis II: it consists of personality disorders (e.g. paranoid Delirium, dementia and amnesic disorders. personality disorder) & mental retardation if present). Mental disorders due to a general medical Axis III: it lists any current physical disease (e.g. condition. hypothyroidism). Substance – related disorders. Schizophrenia and other Psychotic disorders. Axis IV: it is used to code the psychosocial and Mood disorders. environmental problems that significantly contribute to the development or exacerbation of the current disorder. Anxiety disorders. Somatoform disorders. Axis V: it rates overall level of daily functioning (social, Adjustment disorders. occupational, and psychological) on a scale of 0 to 100; the Other conditions that may be a focus of clinical Global Assessment of Function (GAF) scale. Compare attention. current GAF vs. high GAF during the past year. The Future of Psychiatric Diagnosis; DSM-5. ( Source: http://www.dsm5.org/) The American Psychiatric Association (APA) schedules DSM-5 for release in May 2013. It is in final stages in which reviews of proposed diagnostic criteria and text development are near completion. It will mark one the most anticipated events in the mental health field. The goal in developing DSM-5 is to produce an evidence-based manual that is useful to clinicians in helping them accurately and consistently diagnose mental disorders. In preparation for the release of DSM-5, experts from psychiatry, psychology, social work, neuroscience, pediatrics and other fields have committed much of the last five years to reviewing scientific research and clinical data, analyzing the findings of extensive field trials and reviewing thousand of comments from the public. DSM-5 represents the contributions of more than 700 distinguished mental health and medical experts during an extensive and rigorous 14-year development process. Broad Categories of Psychiatric Disorders: Organic Vs. Non-organic mental disorders. In everyday psychiatric practice the distinction between organic and functional disorders is still commonly used although modern techniques of investigation have revealed underlying neuropathology in some disorders previously considered purely functional (e.g. schizophrenia). Organic Mental Disorders: Structural Non-organic (functional) Mental Disorders: brain pathology can be detectable by No obvious structural brain pathology. E.g. Schizophrenia, mood clinical assessment or usual tests. E.g. disorders, anxiety disorders, adjustment disorders. cognitive disorders (delirium, dementia, & Features Suggestive of Organic Mental Disorders; amnesic syndrome), substance-induced Physical illness (e.g. diabetes, hypertension). Vital signs disturbances mental disorders, medication-induced (e.g. fever, high BP). Neurological features (e.g. ataxia, dysarthria). mental disorders. Disturbed consciousness +/- other cognitive disturbance in: attention, concentration, orientation or memory. 5 M. A. Al-Sughayir - Manual of Basic Psychiatry / Draft 3 - 2013 Introduction Broad Categories of Psychiatric Disorders: Psychoses Vs. Neuroses. Although this classification is no longer used in the official current systems of classification, in everyday clinical practice these terms are still used widely; hence it is of practical value to know this distinction. )العُصاب- Neuroses (pleural of neurosis )الذهان- Psychoses (pleural of psychosis Mental disorders in which the patient lacks insight Generally less severe forms of psychiatry and is unable to distinguish between subjective disorders in which the patient is able to experience and external reality, as evidenced by distinguish between subjective experience and disturbances in thinking (delusions), perception external reality. (hallucinations), or behavior (e.g. violence). No lack of insight, delusions or hallucinations. * * * * * * * * Examples: schizophrenia, severe mood disorders, Examples:
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