M. A. Al-Sughayir - Manual of Basic Psychiatry / Draft- 4 September 2013 Introduction Module Content Page 1- Psychiatry: Definition - Scope (Knowledge - Skills- Attitude). 3-4 Importance of Psychiatry Clerkship & Advice. Introduction 2- Etiology in Psychiatry. 5-6 3- Diagnosis and Classification in Psychiatry. 7-8 4- Psychiatric Assessment (History, MSE, MMSE). 9-15 5- Signs and Symptoms (Psychopathology) in Psychiatry. 16-20 Test-1 21-24 Introduction 27 Delirium 28-30 Neuro-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 Somatic symptom Head injury- Neuropsychiatric aspects 42 and related Psychosomatic Medicine & C-L Psychiatry 43-51 disorders Somatic symptom and related Disorders 52-55 Test-2 57-60 Objectives , Definition , clinical features , & required clinical skills, & DDx 61 Psychotic Disorders 62 Psychotic Schizophrenia 63-66 Disorders Substance-induced psychosis 68 Personality disorders - cluster A 69 Aggressive / violent patient 70 Antipsychotics 71-74 E C T (Electroconvulsive therapy) 75 Test-3 76-79 Introduction - Definitions-Episodes vs. Disorders 80 Major Depressive Episode(MDE) & Major Depressive Disorder(MDD) 81-85 Depressive & Postpartum Depression - Dysthymic Disorder 86 Mood Antidepressants 87-88 Disorders 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 -101 Differential diagnosis of anxiety disorders 102-104 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 1 M. A. Al-Sughayir - Manual of Basic Psychiatry / Draft- 4 September 2013 Introduction Module 1 Module 6 Module 2 PSYCHIATRY Course: 462 Psych Module 5 Module 4 Module 3 2 M. A. Al-Sughayir - Manual of Basic Psychiatry / Draft- 4 September 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- 4 September 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- 4 September 2013 Introduction 2-Etiology in Psychiatry Basic Psychiatry chapter 5 The Complexity of etiology in Psychiatry 1. Time factor: causes are often remote in time from the effect they produce. 2. Single cause may lead to several psychological effects e.g. deprivation from parental affection may lead to depression or conduct disorder in children and adolescents. 3. Single effect may arise from several causes e.g. depression may be due to accumulation of several causes like endocrinopathies, psychosocial stresses and side effects of some drugs. Most psychiatric disorders are multifactorial. Classification of Causes Etiological Factors can be classified into biological, psychological, and social factors; Bio-Psycho-Social Approach [Engel 1977]: Effect Effect Nature Predisposing Precipitating Aggravating Maintaining N Bio E.g. Genetic E.g. First dose of E.g. Further abuse E.g. Continuation of predisposition e.g. panic cannabis abuse cannabis abuse A disorder T Psycho E.g. Abnormal E.g. Sudden or E.g. Further E.g. Continuation of personally traits with severe psychological stresses such stresses U poor stress adaptation psychological R stress E Social E.g. Parental separation E.g. Marriage E.g. Marital conflict E.g. continuation of marital problems Main causative factors in psychiatry: A. Genetic : e.g. in schizophrenia , mood disorders , panic disorder and agoraphobia. B. Neuropathological: e.g. dementias ,delirium. C. Endocrinopathological: e.g. hyperthyroidism / hypothyroidism. D. Pharmacological: side effects of medications e.g. steroids > mood changes. E. Social: e.g. marital discord /occupational problems/financial difficulties. F. Psychological : behavioral ,cognitive , or psychodynamic problems (subconscious processes that involve distortion of reality in order to deal with, and resolve the intra-psychic conflict (defense mechanism). Supernatural issues; although many cultures view black magic (sorcery), evil eye, and devil possession hidden causes of mental diseases it is impossible to subjects such supernatural matters to empirical research. 5 M. A. Al-Sughayir - Manual of Basic Psychiatry / Draft- 4 September 2013 Introduction ط ٍ ٍ ض ظ ز ٍ Supernatural Causes - - - - - - ؟! Etiology in Psychiatry - Prof. Alsughayir 2007 ط ٍ ٍ ض ظ ز ٍ Supernatural Causes - - - - - - - - - Etiology in Psychiatry - Prof. Alsughayir 2007 فً ٍ ظ ز ض: ٚثانؾ تؼغ انُاس كػ ٙزٔ أصثاب انؼهم انُلضٛح إنٗ انٛؼٍ ٔانضذش يرجاْهٍٛ دٔس انؼٕايم اﻷخشٖ انرٙ هذ ذضثة اﻷيشاع انُلضٛح ْٙٔ كثٛشج ٔيرػُٕح. كانٕساثح نٓا دٔس كثٛش كػ ٙذد يٍ اﻷيشاع ق ﻹ 1 انُلضٛح كانلظاو انؼوهٙ ٔاػطشاتاخ انٕجذاٌ َٕٔتاخ انٓهغ ٔانٕصٕاس انوٓش٘ ٛؿٔش رنك يًا أػٔذرّ دساصاخ ػانًٛح ػهًٛح يرؼذدج ٔكزا انؼـؽٕ اﻻجرًاٛػح ٔانًادٚح ٔانُلضٛح نٓا دٔس كٙ رنك )كشوام انٕانذٍٚ ٔاَلظانًٓا ٔخﻻكاخ اﻷتُاء يغ ضبطت هيئة اﻷمر بالمعروف اٜتاء ٔانخﻻكاخ انزٔجٛح َٔذٕ رنك(. ٔاﻷيشاع انجضذٚح انٕٚؼؼح كزنك صٕاء أثشخ ػهٗ انذياؽ يثاششج )كؤٔساو والنهي عن ال ُمنكر بحي الوسام ٔانرٓاتاخ انذياؽ( أٔ أثشخ ػهٗ تؼغ اﻷؼػاء انذٕٚٛح )كانوهة أٔ انكثذ أٔ انكهٗ أٔ انشئرٛؿٔ )ٍٛش رنك. بمحافظة الطائف راقي نساء ج زقٍ طٍل تشخٍص : انشهٛح دػاء ٔ ذؼشع إنٗ هللا ذؼانٗ أٌ ٚكشق انًشع ، ٔنى ٚجؼهٓا هللا ذؼانٗ ٔصٛهح باكستاني يعمل كإمام مسجد, نهرشخٛض ؽٔشٚوح ﻻخرثاس أصثاب انًشع كًا ٚلؼهّ تؼغ انشهاج انٕٛو يًٍ ذٕصؼٕا كٙ ذُٕٚغ ؽشٚوح انشهٛح ٔاٜٚاخ على الرغم من أنه بمهنة "سائق انًضرخذيح كٛٓا ػهٗ َذٕ ٚشٚذٌٔ يٍ خﻻنّ انٕطٕل إنٗ يؼشكح صثة انًشع )إْٔ ٛػٍ أو يش أو صذش(، ٔنزا كثُش خاص" ويتولى رقية النساء ُ اخرﻻكٓى كًٛا تُٛٓى كٙ انذانح انٕادذج تم إٌ انشاهٙ َلضّ هذ ٚشخض انٕٛو ذشخٛظاً ُٚوؼّ كؿ ٙذِ ثى ُٚوؼّ أخشٖ ٔرنك بداخل مصﻻهن بالمسجد, ُ ﻷجم اػرًادِ ػهٗ ذؤثش انًشٚغ تآٚاخ دٌٔ ٛؿشْا كٙ كم يشج ٔجؼم رنك ٔصٛهح نرشخٛض انًشع كئٌ ذؤثش انًشٚغ ػُذ واستغﻻل ذلك في التحرش بهن , ِ هشاءج آٚاخ انضذش ُش ّخض تؤَّ يضذٕس ٔإٌ ذؤثش ػُذ هشاءج يا ٚرؼهن تانٛؼٍ ُش ّخض تؤَّ يظاب تٛؼٍ ْٔكزا يغ انًش ٔإٌ مدعيا أنه يرقي ويعرف السحر ُ ذؤثش تزنك كهّ ُش ّخض تؤَّ يظاب تانثﻻثح )صذش ٛػٍٔ ٔيش(. ٔصٛؤذٙ يزٚذ تٛاٌ نزنك ػُذ انذذٚث ػٍ انٛؼٍ ٔانضذش والمسحور. ﻻدوا ً. وكانت امرأة شعرت بآﻻم زقٍ م صورة فً أن ص د ن غٍز م ؟: ٚظٍ كثٛش يٍ انُاس أٌ انشهٛح ﻻ ذُلغ إﻻ إرا كاَد يٍ سام يخرض تٓا ٔأٌ فهاتفته وأخبرته بما لديها من انًشٚغ إرا كاٌ را رَٕب ٔيؼاص كﻻ ُٚرلغ تشهٛرّ ػهٗ َلضّ أٔ أٌ نهشهٛح ؽشٚوح يؼوذج يلظهح ﻻذؼشف إﻻ تذساصح خاطح مشكلة صحية, فؤبلغها بؤنها ٍ ُ أٔ خثشج يٛؼُح، ٔنزا كئٌ كثٛشاً يُٓى ٚزْة ٚطهة انشهٛح ػُذ انشهاج ٔهذ ٚضاكش إنٛٓى كٙ تﻻد تٛؼذج ٚٔظٍ أٌ انشهٛح يٍ ْؤﻻء مسحورة, وأن السحر موضوع نٓا شؤٌ يخرهق يٍ دٛث هٕج انرؤثٛش ٔصشػرّ. ًٚٔٓم كثٛش يٍ انُاس اﻻصرشلاء تانوشآٌ يثاششج ٔانشهٛح انششٛػح ػهٗ لها في رحمها, وأنه يجب أن أَلضٓى دٌٔ ٔصؾٛ. ٔانظٕاب أٌ انشهٛح نٛضد يذظٕسج كٙ أَاس دٌٔ ٛؿشْى ٔكهًا هٕ٘ ذؼشع انًشٚغ إنٗ ا÷ ذؼانٗ يتولى تمريخها من أجل استخراج طاس يظُح اﻻصرجاتح ٔهذ هال ا÷ ذؼانٗ: }أَ َّيٍ ُٚ ِجٛ ُة ا ْن ًُ ؼْ َط َّش إِرَا دَ ػَاُِ ََٚٔ ْك ِش ُق ان ُّضٕ َء { ]انًُم: 26[. ذلك السحر من ذلك المكان الحساس, كما طلب منها أن ٌُكتفى