An Introduction to Psychiatry H.Amini M.D. Department of Psychiatry TUMS

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

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

Why Study Psychiatry ? Psychiatric disorders are prevalent and often go untreated : * lifetime prevalence in USA : 28% * lifetime prevalence in Iran : % * only 40% receive treatment during lifetimes * in general practice : 1/6-1/4 of the patients seen have a psychiatric problem

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

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

Models of Mental Disorders Dogmatism Eclectism Pleuralism Integrationism

Biopsychosocial Approach Mental health care is a multiagency task which may involve multidiciplinary teams of workers developing in conjunction with the patient/client and their carers, a program of treatment and support to meet their needs

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

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

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

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

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

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

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

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

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

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

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