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Basic Concept of Psychiatric Disorders

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Basic Concept of Psychiatric Disorders

  1. 1. Basic Concept of Psychiatric Disorders Prof. Y. K. Sharma Dean cum Principal Rajiv Gandhi Govt Post Graduate Ayurvedic College and Hospital Paprola - Himachal Pradesh
  2. 2. Psychiatric Disorders are Stigma Which Everybody Wants to Shun
  3. 3. Perfect balance of Body, Mind and Soul is absolutely necessary for complete health of individual. Concept of mind in ancient India had been since Pre-vedic Period. It is conceived to be functional element of Atma as is described in Vedas also. Mind is seat of “Rational Thinking” or Manan/Chintan/Vicharan, etc.. It works from its seat in ‘Sirohridya” It has its identity with three Gunas-Satva, Rajas, Tama. Concept of Mana (Mind)
  4. 4. Due to its varied functionality Mana in ancient Vedic literature has different names line Mana, Chitta, Ubhayindriya, Anthakaran, Satav. Mana and Bhuddhi (Intelligence) Mana is regulator of; Dhee-Concentration. Dhriti-Retention Samiriti- Recollection memory These are basic requirements of Learned memory, rational thinking and new ideas: Foundation of functioning of mana is systematic recollection of sequences of events of learned memory for purposeful actions. Synonyms:
  5. 5. Mana is also seat of Diseases like Sharir. It also gets associated with Physical disorders of body called as psychosomatic diseases. The three factors responsible for human ailments i.e. i. Asatmayaindriyaarth samyog. ii. Pragyapradha iii. Parinam. Besides this The other factors like mind related diseases being Genetic, Congenital or Familial is also established. Seat of Disease:
  6. 6. The threefold strategy of management of Sharirik Diseases is also relevant for mind Disorders. This includes: 1. Daivavyapasraya: Application of selected religious practices especially from Hindu or Vedic literature. 2. Sattvavajaya: Psychological practices including Counseling, behaviour therapy, etc. 3. Yuktivyapasaraya: Physiopharmacological methods of management. In addition “Nidanparivarjan” is very important Management of Manas Roga:
  7. 7. Ayurveda highlights Mano-roga patients have three disease factors: 1. Alpasatava- Inadequate mental development leading to proneness. 2. Malapradhushta.:Precipitating etiology. 3. Buddhiniwas hridya pradushti- Disturbed intelligence and psyche Pathogenesis of Psychiatric Ailments and Ayurveda:
  8. 8. 1. Mana-Emotions/Mood. 2. Buddhi – Intelligence/Thought process/Rational thinking/ Judgement/Insight, etc. 3. Sajnajnana – Orientation. 4. Smriti- Memory and memory based functions. 5. Bhakti – Desire/Will. 6. Sila – interests and habits. 7. Cheshta - Psychomotor activities. 8. Aachara –Behavior and conduct. Charak has enumerated Eight features of impaired mental faculty in Unnmada which are relevant to all psychiatric ailments. This includes disturbance of :
  9. 9. Ayurveda considers that all three Sharirik Doshas-Vata , Pitta , Kapha and two Manas Dosha -Raja and Tama when in morbid state are responsible for Manas Roga as such all the three modalities of disease management are equally applicable in management of manasroga also. These are: 1. Daivavyapasraya: Application of selected religious practices especially from Hindu or Vedic literature. 2. Sattvavajaya: Psychological practices including Counseling, behavior therapy, etc. 3. Yuktivapasaraya: Physiopharmacological methods of management. Ayurveda and management of Manas Roga:
  10. 10. Psychiatry also known as Psychological Medicine, is the branch of medicine which deals with the diagnosis, treatment and prevention of mental illnesses. Psychology: Is science which studies the normal aspects of mind and expert of this field is called psychologist. Psychiatry/Psychology
  11. 11. Mind is one of the functions of brain. • Intelligence • Memory • Thinking • Emotions • Orientation • Perception • Behavior • Judgment • Insight • Attention • Etc. are its functions. These are often called as Higher Mental Functions. What is Mind?
  12. 12. Conscious Mind: Unconscious Mind: Structure of Mind: The strata of this mind are not within one’s awareness and it constitutes 9/10 of mind. This is important since it influences the mental functions of normal as well as psychologically effected persons. This is strata of mind within one’s awareness and forms only small portion of mind i.e. One tenth of mind structure.
  13. 13. • Does not suffer from disorders of thinking, Emotions, Learning, Intelligence, Memory, Orientation, Perception, Etc. • Well adjusted to self and surrounding. • Experiences sense of Tranquility, Happiness, • Contentment and fulfillment. • Establishes cordial relations with people around. • Performs duty efficiently. • Shoulders family and social responsibilities and obligations satisfactorily. • Should utilize his potential, capacities, and creativity for the welfare of the community and humanity at large. Characteristics of Mentally Healthy Person:
  14. 14. -Disturbed thinking, emotions, intelligence, memory and other Higher Mental Functions. -Disturbed behavior like rowdy, violent, destructive, suicidal, etc. -Anxiety, fears, Irritability, Poverty of concentration, -Diminished work efficiency, unwanted ideas, repetitive meaningless activities. -Somatic symptoms like headache, weakness, anorexia, sleeplessness, palpitation, etc. -Antisocial behavior like criminality, sexual perversions, drug addiction, alcoholism, etc. Recognition of Mentally Ill Person:
  15. 15. No single reason. Multiple factors are incriminated. These include Initiation Factors and Precipitating factors. -Hereditary -Life phase associated like Infancy, Puberty, Pregnancy, Menopause, Senescence, etc. -Trauma. -Infection. -Metabolic and Endocrine disturbances. -Deficiency states. -Drugs and Alcohol. -Physical defects and illnesses. -Strained interpersonal relations at home, work, school, etc. -Bereavement or loss of job or prestige. -Other factors like childhood insecurities, educational problems, social deprivation, sexual difficulties, economic and financial reasons, religious factors, adverse physical environment, natural calamities, etc are other listed factors for psychiatric ailments. Causes of Mental Illnesses:
  16. 16. Detailed History and Observation of activities and Behavior is key to Evaluation of Mental State of Patient. Mental State Examination is based on following observations: -Attitude and Appearance. -Consciousness. -Emotions. -Motor behavior. -Thought process. -Perception. -Memory. -Orientation. -Intelligence. -Insight. Mental State Examination:
  17. 17. Traditionally classified as: Organic Functional. But this classification has now been discarded and current classification is based on: ICD-10 ( International Classification of Diseases-10th Edition) DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) ICD -10 Classification is formulated by W.H.O. Classification:
  18. 18. Includes: Dementias, Delirium, Confusional states secondary to brain disease, systemic disease, endocrinal disorders, trauma, substance abuse, etc. Organic Including Symptomatic Mental Disorders:
  19. 19. Mental and Behavioural Disorders Due to Psychactive Substance Abuse. This includes intoxications, dependence, withdrawl states, Use of Alcohol. Cannabis, Opiates, Cocaine, and other psychoactive drugs are common examples.
  20. 20. • These are characterized by Disorders of thinking, perception, inappropriate blunted mood. • Patient have delusions, hallucinations and demonstrable thought disorders and all these symptoms occur in clear consciousness. • Schizotypical disorders: Characterized by eccentric behavior and anomalies in thinking and mood. Delusions and hallucinations may be absent. • Delusional Disorders include a variety of disorders with long standing delusional. Schizophrenia, Schizotypical and Delusional Disorders:
  21. 21. This includes change in mood to depression or elation. Persistent and recurrent depressive mood is classified as Major Depressive Illness Depression with lesser intensity and longer duration is classified as Dysthymic Disorder. Mania and Depression are commonly seen as Unipolar or Bipolar Mood Disorders. Mood Disorders
  22. 22. • These consists of disorders associated with • Anxiety • Phobia • Panic • Obsessive Compulsive disorders • Adjustment disorders • Dissociative disorders etc. Neurotic, Stress-Related and Somatoform Disorder:
  23. 23. This includes: Eating Disorders, Non-organic Sleep Disorders, Sexual Dysfunctions not due to any organic disease. Behavior Disorders:
  24. 24. Includes Pathological Gambling Fire setting Kleptomania Gender identity disorder Etc. Disorders of Adult Personality and Behaviour:
  25. 25. This includes: Mental Retardation, Bed wetting, Thumb sucking, etc. Disorders of Childhood and Adolescence:
  26. 26. Psychological Tests to evaluate Intelligence, Adjustment, psychopathology, Personality tests, Projective tests, To evaluate Organic Brain Damage tests to evaluate memory, Problem solving tests like Bender –Gestalt Test, PGI Memory Test, Electrophysiological investigations like EEG, Imaging like CT, MRI, PET are useful. Neuroendocrine tests. Blood,Urine Tests for Substance abuse Special Diagnostic Tests in Psychiatry:
  27. 27. Treatment of psychiatric disorders is based on: 1.Physical therapy. 2.Drug therapy. 3.Psychotherapy and Case work. 4.Other therapies such as Surgical therapy, Behavior therapy. Treatment of psychiatric disorders may be optional as well as mandatory and have legal implications also. Treatment in Psychiatry:
  28. 28. This includes: -Convulsive therapy-ECT. -Insulin Therapy. -Abreactive Therapy like Hypnosis, Psychotherapy and Psychoanalysis. Physical Therapy: Antipsychiotics : • Phenothiazines- Chloropromazine, Trifluperazine, Thioridazine, etc. • Butyropheraphenones-Haloperidol, Trifluperidol, etc. • Serotonin Dopamine antagonists-Resperidon. • Receptor targeted anti-psychotics- Olanzapine, • Sarapgandha was traditionally used for treatment of Psychosis but this has now been discarded. Drug Therapy:
  29. 29. Tricyclics- Imipramine, Amitryptiline, Doxepin, Nortryptilin, etc. MAO inhibitors- Phenelegine, Selegeline, etc. Serotonin uptake inhibitors- Fluoxetine, Paroxetine, Sertraline, Citalopram, Escitalopram, etc. Serotonin norepinephrine uptake inhibitors- Duloxetine, Milnaciparan, etc. Anti-Depressants:
  30. 30. • Lithium. • Valparoate. • Carbamazepine • Lamotrigin. Pharmacology of Anti-anxiety drugs include: • Benzodiazepines, • Low dose antipsychiotics, • MAO inhibitors, • Serotonin uptake inhibitors, • Anti-convulsants, etc. Mood stabilizers:
  31. 31. Individual, Family or Group Psychotherapy. Psychotherapy may be short term also called as Supportive psychotherapy or Long Term called as Analytical Psychotherapy. Educative Psychotherapy e.g. Epileptics and their parents, Relatives of psychotic patients, etc. Psychotherapy and Case Work: Commonly used to treat certain psychological processes and to relieve the patient’s symptoms. It also corrects the psychopathology and modifies personality patterns. It may include:
  32. 32. First choice in neurotic illnesses like anxiety, phobias, hysterias, obsession, etc. Psychosomatic illnesses. Alcoholism, Drug addiction, sexual deviations, personality and character disorders. It is of little help in psychotic ailments. Indications of Psychotherapy:
  33. 33. Surgical therapy: Leucotomy, Lobectomy, but of limited practical utility. Behavior therapy: Recommended for neurotic ailments, addictions, psychopathy, Results are based on conditioning, extinction, reciprocal inhibition and desensitization, etc. Miscellaneous therapy: This includes occupational therapy, work therapy, recreational therapy, music therapy. These are commonly used as adjuvant to other forms of treatment. They help to express conflicts and release tension, aggression, and regain confidence. Hypnosis: Commonly used to manage hysteria, habit disorders like stammering, etc. Other Therapies:
  34. 34. -Psychiatric disorders have same basis of etiopathogenesis as Somatic disorders. -Any age group may be involved. -Early recognition is key to better recovery. -Like somatic illnesses psychiatric illness too have potential to kill the person. -Patients with psychiatric illness should be treated like a somatic illness and no stigma should be attached to such illnesses when the appear in an individual. -Psychiatric diagnosis like psychosis have legal implications and hence such diagnosis should be confirmed by experts of field, Last Word:
  35. 35. THANK YOU

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