Basic Terms in Psychiatry

1. Subject and task of psychiatry and narcology. History of development and modern state of psychiatry and narcology. Psychonosology and diseases. Principles of therapy, prophylaxis and rehabilitation of psychiatricaldisorders. Pathology of cognitive processes. Disorders of sensations, perceptions. Disorders of memory.

2. "A psychiatristis a fellowwhoasksyou a lotofexpensivequestionsyourwifeasksfornothing" - JoeyAdams

3. Basic Terms in Psychiatry • Psychiatry studies the causes of mental disorders, gives their description, predicts their future course and outcome, looks for prevention of their appearance and presents the best ways of their treatment • Psychopathology describes symptoms of mental disorders • Special psychiatry is devoted to individual mental diseases • General psychiatry studies psychopathological phenomena, symptoms of abnormal states of mind: 1. consciousness 5. mood (emotions) 2. perception 6. intelligence 3. thinking 7. motor 4. memory 8. personality

4. Psychiatry - • Thetermpsychiatry, coinedbyJohannChristianReilin 1808, comesfromtheGreek “psyche” (soulormind) and “iatros" (healerordoctor) • Psychiatryis a medicalspecialtywhichexiststostudy, prevent, andtreatmentaldisordersinhumans. Psychiatricassessmenttypicallyinvolves a mentalstatusexaminationandtaking a casehistory, andpsychologicaltestsmaybeadministered. Physicalexaminationsmaybeconductedandoccasionallyneuroimagesorotherneurophysiologicalmeasurementstaken.

5. Connection with other specialities - • Thosewhopracticepsychiatryaredifferentthanmostothermentalhealthprofessionalsandphysiciansinthattheymustbefamiliarwithboththesocialandbiologicalsciences. Thedisciplineisinterestedintheoperationsofdifferentorgansandbodysystemsasclassifiedbythepatient'ssubjectiveexperiencesandtheobjectivephysiologyofthepatient. Whilethefocusofpsychiatryhaschangedlittlethroughouttime, thediagnosticandtreatmentprocesseshaveevolveddramaticallyandcontinuetodoso. Sincethelate 20th century, thefieldofpsychiatryhascontinuedtobecomemorebiologicalandlessconceptuallyisolatedfromthefieldofmedicine.

6. Ancient times • Starting in the 5th century BC, mental disorders, especially those with psychotic traits, were considered supernatural in origin. This view existed throughout ancient Greece and Rome. Early manuals written about mental disorders were created by the Greeks. In 4th century BC, Hippocrates theorized that physiological abnormalities may be the root of mental disorders. Religious leaders and others returned to using early versions of exorcisms to treat mental disorders which often utilized cruel, harsh, and other barbarous methods.

7. Ancient times

8. MiddleAges • ThefirstpsychiatrichospitalswerebuiltinthemedievalIslamicworldfromthe 8th century. ThefirstwasbuiltinBaghdadin 705, followedbyFesintheearly 8th century, andCairoin 800. UnlikemedievalChristianphysicianswhoreliedondemonologicalexplanationsformentalillness, medievalMuslimphysiciansreliedmostlyonclinicalobservations. Theymadesignificantadvancestopsychiatryandwerethefirsttoprovidepsychotherapyandmoraltreatmentformentallyillpatients, inadditiontootherformsoftreatmentsuchasbaths, drugmedication, musictherapyandoccupationaltherapy. Inthe 10th century, thePersianphysicianMuhammadibnZakariyaRazi (Rhazes) combinedpsychologicalmethodsandphysiologicalexplanationstoprovidetreatmenttomentallyillpatients. Hiscontemporary, theArabphysicianNajabud-dinMuhammad, firstdescribed a numberofmentalillnessessuchasagitateddepression, neurosis, andsexualimpotence (NafkhaeMalikholia), psychosis (Kutrib), andmania (Dual-Kulb).

9. Middle Ages • In the 11th century, another Persian physician Avicenna recognized 'physiological psychology' in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with inner feelings, which is seen as a precursor to the word association test developed by Carl Jung in the 19th century.Avicenna was also an early pioneer of neuropsychiatry, and first described anumber of neuropsychiatric conditions such as • hallucination, • insomnia, mania, nightmare, melancholia, • dementia, epilepsy, paralysis, stroke, • vertigo and tremor.

10. Middle Ages • Psychiatric hospitals were built in medieval Europe from the 13th century to treat mental disorders but were utilized only as custodial institutions and did not provide any type of treatment.Founded in the 13th century, Bethlem Royal Hospital in London is one of the oldest psychiatric hospitals. By 1547 the City of London acquired the hospital and continued its function until 1948.

11. Early modern period • In 1656, Louis XIV of France created a public system of hospitals for those suffering from mental disorders, but as in England, no real treatment was being applied. Thirty years later the new ruling monarch in England, George III, was known to be suffering from a mental disorder. Following the King's remission in 1789, mental illness was seen as something which could be treated and cured.

12. Early modern period • By 1792 French physician Philippe Pinel introduced humane treatment approaches to those suffering from mental disorders. William Tuke adopted the methods outlined by Pinel and that same year Tuke opened the York Retreat in England. That institution became known as a model throughout the world for humane and moral treatment of patients suffering from mental disorders. It inspired similar institutions in the United States, most notably the Brattleboro Retreat and the Hartford Retreat (now the Institute of Living).

13. 19th century • Universities often played a part in the administration of the asylums. Due to the relationship between the universities and asylums, scores of competitive psychiatrists were being molded in Germany. Germany became known as the world leader in psychiatry during the nineteenth century. The country possessed more than 20 separate universities all competing with each other for scientific advancement. However, because of Germany's individual states and the lack of national regulation of asylums, the country had no organized centralization of asylums or psychiatry.Britain, like Germany, also lacked a centralized organization for the administration of asylums. This deficit hindered the diffusion of new ideas in medicine and psychiatry.

14. 19th century • IntheUnitedStatesin 1834, AnnaMarsh, a physician'swidow, deededthefundstobuildhercountry'sfirstfinancially-stableprivateasylum. TheBrattleboroRetreatmarkedthebeginningofAmerica'sprivatepsychiatrichospitalschallengingstateinstitutionsforpatients, funding, andinfluence. AlthoughbasedonEngland'sYorkRetreat, itwouldbefollowedbyspecialityinstitutionsofeverytreatmentphilosophy. • In 1838, Franceenacted a lawtoregulateboththeadmissionsintoasylumsandasylumservicesacrossthecountry. By 1840, asylumsastherapeuticinstitutionsexistedthroughoutEuropeandtheUnitedStates.

15. 19th century • However, thenewanddominatingideasthatmentalillnesscouldbe "conquered" duringthemid-nineteenthcenturyallcamecrashingdown. Psychiatristsandasylumswerebeingpressuredbyaneverincreasingpatientpopulation. OvercrowdingwasrampantinFrancewhereasylumswouldcommonlytakeindoubletheirmaximumcapacity. Increasesinasylumpopulationsmayhavebeen a resultofthetransferofcarefromfamiliesandpoorhouses, .

16. 19th century • butthespecificreasonsastowhytheincreaseoccurredisstilldebatedtoday. Nomatterthecause, thepressureonasylumsfromtheincreasewastakingitstollontheasylumsandpsychiatryas a specialty. Asylumswereonceagainturningintocustodialinstitutionsandthereputationofpsychiatryinthemedicalworldhadhitanextremelow.

17. 20th century • The 20th centuryintroduced a newpsychiatryintotheworld. Thedifferentperspectivesoflookingatmentaldisordersbegantobeintroduced. ThecareerofEmilKraepelinsomewhatmodelthishiatusofpsychiatrybetweenthedifferentdisciplines.

18. 20th century • Kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry. Following his acceptance for a professorship of psychiatry, and later his work in a university psychiatric clinic, Kraepelin's interest in pure psychology began to fade and he introduced a plan of a more comprehensive psychiatry.Kraepelin also began to study and promote the ideas of disease classification for mental disorders, an idea introduced by Karl Ludwig Kahlbaum.

19. 20th century • Theinitialideasbehindbiologicalpsychiatry, statingthatthesedifferentdisorderswereallbiologicalinnature, evolvedinto a newideaof "nerves" andpsychiatrybecame a sortofroughneurologyorneuropsychiatry. FollowingSigmundFreud'sdeath, ideasstemmingfrompsychoanalytictheoryalsobegantotakeroot. Thepsychoanalytictheorybecamepopularamongpsychiatristsbecauseitallowedthepatientstobetreatedinprivatepracticesinsteadofasylums. Howevertheprogressofpsychiatrybythe 1970s turnedpsychoanalytictheoryinto a marginalschoolofthoughtwithinthefield.

20. 20th century • ECT was "discovered" whenUgoCerletti, psychiatrist, visited a Romeslaughterhousetoseewhatcouldbelearnedfromthemethodthatwasemployedtobutcherhogs. InCerletti'sownwords, "Assoonasthehogswereclampedbythe [electric] tongs, theyfellunconscious, stiffened, thenafter a fewsecondstheywereshakenbyconvulsions.... Duringthisperiodofunconsciousness (epilepticcoma), thebutcherstabbedandbledtheanimalswithoutdifficulty....

21. 20th century • "At this point I felt we could venture to experiment on man, and I instructed my assistants to be on the alert for the selection of a suitable subject." • Cerletti's first victim was provided by the local police - a man described by Cerletti as "lucid and well-oriented." After surviving the first blast without losing consciousness, the victim overheard Cerletti discussing a second application with a higher voltage. He begged Cerletti, "Non una seconda! Mortifierel" ("Not another one! It will kill me!") • Ignoring the objections of his assistants, Cerletti increased the voltage and duration and fired again. With the "successful" electrically induced convulsion of his victim, Ugo Cerletti brought about the application of hog-slaughtering skills to humans, creating one of the most brutal techniques of psychiatry.

22. 20th century • Lobotomyis a surgicalpracticewherepartsofthefrontallobesareintentionallydestroyed. Violentcriminalscalmdown, highlydepressedpeopledon'tseemsodepressedanylonger, andmanicsfinallymellowout. Buttheywanderaimlessly, drooluncontrollably, andhaveverylittleleftofwhatever "personality" theyoncehad. Ifthegoaliscalm, quiet, and "nice" people, thenit's a roaringsuccess.

23. Sensation • – the most elementary stage, which reflects separate quality of subject, which is acting in right moment to sensory organs. • Classification : • According to modality: • Interoceptive – give signal about condition of our inner world: warm, cold, hunger, uncomfortability. These sensastions don’t have localisation, outside proection, closely connected with emotional processes. • Exteroceptive – 5 sensation organs: smell, taste, sight, hearing, tactile. • Proprioceptive – information about body position, movement in space, everything which makes body scheme.

24. Sensation • – Anesthesia – absence of 1 or more type of sensation. Analgesia – loss of pain sensation ( at acute psychopathological diseases.) Patients, who commit suicides: they cut their organs – at such moment they don’t feel anything. After some time everything comes back with recreation of psyche. ( At deep depression, progressive paralysis, brain syphillis, convulsive disorders(hysteria), anaestesia dolorosa depresia – absense of sensation). • Hyperesthesia – subjective increasing of sensation. Hyperalgesia – increasing of pain sensastion (depression,espessially light).

25. Sensation • – Optical hyperesthesia – daily light blind a man. • Acustical h-sia – changes of perception threshold. Light sound percept as strong one even to pain. This is sign of exhaustion, asthenic conditions. • Taste, smell – complains on increasing of these sensations. It could be at normal conditions. • Skin sensations – tactile and temperature. Touch to a body is unpleasant. • Paresthesia – distortion sensations.

26. Senestopathy • – psychosomatic sensation. It has such signs: • .Polymorphism of sensations (pain, heartburn, electrisation). • .Sign which differentiates it from general somatic signs – there are complains, but they don’t have any localization, intensity, patients cannot explain them. • It has matter during mask depression diagnostic: sen.-as cardio-vascular, central – neurotic, abdominal, skin- underskin, bone – muscle. • They could be: permanent, episodical, as attack (sen.- crisis). Accompanied with panic, vegetative disorders. They begin with simple sen., after that they become very hard. • Elementary sen.- those, which doesn’t have sensor modality (“my sole is trembling”).Simple sen. – concrete modality – pain, parasthesias.

27. Senesthesia – various disorders of movement, which has subjective character, which are not confirm with objective investigations (“my legs and arms are not listening to me”). • Sinesthesia – appear as a result of action of different sensation organs “colored music”. Smell calls some other sensation. Name of the person- some color etc.

28. PERCEPTION - • - reflection of object in general. • Classification: splitting, illusions, pseudohallucinations, hallucinations, eydetysm, disorder of sensor synthesis, hallucinoids. • Double - loss of capacity of whole object formulation. He percept normally object, but couldn’t join it together. Ex.- tree – it’s separately leaves, trunk etc. At infectious diseases. • Illusions – false perception of real existent object. • Affective ill.- affect of fear, anxious, horror, connected with special emotional condition. • Verbal ill.- words, phrases are percept inplaceofreal. • Pareydolia– opticalillusionswithfantasticcontent. Variousobjectswhichdon’thaveformsareseeninvariouspictures.

29. PERCEPTION - • -

30. PERCEPTION - • - Hallucination – perception without object,which acts on sense organs. • Visual. • Simple – photopsias. Complex – have subject content – zoological, demanomanic, antropomorphic(close people, dead people, body pieces, inner organs), panoramic- ground, atomic explosure).etc • Acustical. • Simple – sounds. • Complex – comment, imperative, stereotypical – during some time they hear same words or phrases.

31. PERCEPTION - • - Smell, taste – whentheydon’ttakefood. • Skin – tactile(touching,pressure, insectsunderskin, hairinthemouth)etc. • Interoceptive, visceral – insideofthebodyanimals, differentobjects. • Kinestetical – feel, likefingersarecompressedin a fist, runsomewhere. • Vestibular – feelingoffalling, lifting. • Symptomoftwin – feelingofbodysplitting. • Hypnogogic – inconditionoffallingasleep. • Hypnopompic –in conditionofgettingup. • Affectogenic h.- inconditionofstrss, affect. • Inductive – theyhavecollectivecharacter. Thereisinductorandthepersontowhominduct. Ifweseparatethemweunderstandwhoisill.

32. PERCEPTION - • S-m Lippman, s-m Ashaphenburg, s-m Reyhardt.

33. PERCEPTION - • PSEUDOHALLUCINATIONS. At first was described by Candinskyy in 1890. • Pequliarities : • .False objects, which are experience, such as going in space ”see by mind, by inner eye, i can see by brain, hear by inner ear”. • .They have obusive character, appear suddenly, agains patients will. Feeling of self activity accompanied by someones action. • .They don’t have objective reality, don’t mix with reality. • .Difference between real and pseudohallucination.

34. PERCEPTION - • As a rule, at pseudoh. We can see changes in behavior – apsence of signs on outside world. • There are some objective signs: they watching or listening to smth, close ears, nose, touch smth. They hide somewhere, looking for smth, catching smth, run somewhere- real. • In pseudoh. – absence of attention on surrounding.

35. PERCEPTION -

36. PERCEPTION - • Hallucinoids – rudimentary display of visual h. Prestage of real h. Patients have some critics to them. It’s not h.-on, but it’s not normal. • Eydetysm(eidetic memory) – Man capacity to hold for a long time some object, pictures. As a rule visual, but could be auditorial and tactile. Phenomenal visual memory.

37. PERCEPTION - • Depersonalization – is a nonspecific feeling that a person has lost his or her identity, that the self is different or unreal. People may be concerned that body parts do not belong to them. People may have an acute sensation that their body has drastically changed. • Derealization – is the false perception by a person that the environment has changed. For example, everything seems bigger or smaller, or familiar surroundings have become somehow strange and familiar.

38. PERCEPTION - • DISORDER OF SENSORIAL SYNTHESIS (psychosensorial disorders) – perception disorder of form, size, objects, oneself. On abolition from illusion there is no disorder of identity of subject. • Metamorphosias – perception disorder of form and size. They are bigger – macropsia or smaller – micropsia. • Dysmehalopsia – twisted. • Paliopsia – on abolition of 1 object – there a lot of them. • Disorders of body scheme – autometamorphopsia. Macropsia – increasing (Huliver), micropsia –decreasing (lilliputian). • Disorders of time perception – increasing of time speed(at manic patients), decreasing of time speed(at depressive patients).

39. PERCEPTION -

40. Memory - • is considered by psychologists as kind of activity, which provides memorizing, keeping, retention, forgetting. It gives opportunity to gather the information and on basis of experience to use it later.

41. Basic processes (functions) of memory: • Memorizing of information (fixing); • Saving or maintenance of information (RETENSION); • Recreation of information (reproduction); • Forgetting of information.

43. Memory is divided into three kinds or stages: • sensory memory, • short-term memory, • and long-term memory

45. Disorders of memory: Quantative disorders: • Hypomnesia – decreasing of memory • Hypermnesia – increasing of memory • Amnesia – loss of memory • Paramnesia – memory distortion

46. Types of amnesias • Fixative– loss of capacity to memorise new or certain events. Previous events are kept in memory. • Progressive amnesia – gradually decreasing of memory. Ribo Law:Memory is suffers from lately acquired to that, which was acquired before. The most longer kinesthetic and emotional memory are kept in storage.

47. Types of amnesias • Retrograde– loss of memory on events which took place before psychosis or disorder of consciousness. Could last on few seconds, minutes, months, years. • Anterograde - loss of memory on the events, which took place after psychosis or disorder of consciousness. • Retroanterograde – before and after psychosis or disorder of consciousness. • Congrade – loss of memory on period of absence of consciousness. • Total • Fragmentive – during delirium. • Retarded– after some time of psychosis.

48. Types of amnesias • Specific alcoholic - palimpsest – special sign for early alcoholism. Its a loss of memory on some details during alcohol drinking. • Amnestic disorientation – one of the main components of Korsakoffs psychosis, as result of brain trauma, atherosclerotic changes, at intoxication, poisoning by CO. • Affectogenic– during pathological affect, connected with stress, psychotrauma. • Amnesias may occur during disorders of consciousness : obnubilation, somnolence, sopor, coma, during twilight conditions, pathologial affects, intoxications, vascular diseases, after traumas, epilepsy, ECT.

49. Qualitive disorders of memory (Paramnesias): • Pseudoreminiscence – disorder of events localization in memory, “illusions of memory”. Gaps in memory are completed with events which may be present in life. • Confabulations – pathological pictures, with which “amnestic windows” are completed with never happen even in their life. • Cryptomnesias – they could not identify source of information. They could define themselfs as authors of books, music. • Anecphoria – patient is able to reproduct some information only with prompting. • Ekmnesia – events from the past are assimilated as present.

50. Thank you for your attention!