1. Introduction to Psychiatry
Sir Christian Kreipke, PhD, FRSC
Introduction to Psychiatry

2. What is a Psychiatric Condition?
A disease manifested in the brain that causes deviation in behavior from a set of socially acceptable norms
Distinct from psychological conditions in that a supposed somatic pathotrajectory exists
Can be induced by genetic conditions, damage to the brain, or environmental conditions

3. Normal
Abnormal

4. Psychiatric
Criminal

5. Medical Anthropological perspective
Most societies have there own set of codes for “normal” and “abnormal” behavior
These closely defined norms may or may not overlap
Examples:
ADHD does not exist in Cuba
Infanticide is culturally acceptable in China
Cannibalism is still practiced in certain tribes of the South Pacific region
Female circumcision
Tattoos
Etc.

6. Common Psychiatric Disorders
Schizophrenia (10%)
Turret's Syndrome (~1:10,000)
Bipolar (~1:5,000)
ADHD (~15-20%)
Autism (~15%)
Depression (~20%)
Obsessive Compulsive disorder (~5%)

7. Schizophrenia Characterized by a whole host of conditions
According to the DSM-IV, if the subject exhibits 2 or more of the following they have a probability of schizophrenia:
Auditory/visual hallucinations
Asocial behavior
Aggressive behaviors
Confusion
Negative affect
“split personality disorder”

8. Schizophrenia Possible biological cause
Abnormal development in striatum, medial temporal lobe, and/or corpus collosum
Hyperdopaminergic and hypoglutamatergic drive to the striatum
More generally, disrupted dopaminergic system

9. Schizophrenia Treatment: Haldol (D2 antagonist)
Clorpromazine/clozapine (atypical antipsychotic which binds D3/4 system)
PROBLEM:
Patient’s behavior can be severely altered

10. Bipolar
Characterized by multiple personality types (2 or more) and/or by severe shifts in mood (manic-depression)

11. Bipolar Possible biological cause:
Abnormal development of striatum, corpus collosum, and/or prefrontal cortex
Disrupted glutamatergic drive to the cortex

12. Bipolar
Treatment:
Lithium (mood stabilizer)
Mode of action? UNKNOWN

13. ADHD
Characterized by lack of ability to focus on single task and/or hyperactivity associated with lack of focus

14. ADHD Possible biological causes:
Dysfunctional dopaminergic system particularly in the striatum

15. ADHD
Treatment:
Dopaminergic drugs (amphetamine derivatives, psychostimulants)
How do they work?
Deplete the dopamine system quickly. Recovery time squelches dopamine drive and quiets overactive behaviors. Specifically they cause dopaminergic neurons to release dopamine and block reuptake via blocking the DAT

16. Depression
Characterized by chronic negative affect usually not correlated with a particular event. CAVEAT: clinical depression may be triggered by environmental cue.
Emphasis on chronic!!!

17. Depression Possible biological cause:
Disrupted serotonergic drive to cortex

18. Depression Treatment:
SSRIs. Selectively prevent serotonin reuptake through the serotonin transporter, thus allowing more to remain in the synaptic cleft.

19. OCD
Characterized by repetitive often self-injurous behaviors

20. OCD
Possible biological cause
Recapitulates that of depression

21. OCD
Treatment:
SSRIs most effective
Cognitive behavioral therapy

22. Others
Autism, turret’s and a host of other pathological conditions sadly have unknown biological pathotrajectories and hence treatment is often laborious and inconclusive