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2002 foreign students

Department of psychology
The first affiliated hospital of ZZU
Huirong guo
Some commonly used terms
Basic classification in psychiatry
Etiology of psychiatry

The classification of causes

 Inpsychiatry, as in the rest of medicine,
classification helps to being order to the great
diversity of phenomena met in clinical practice.
Its purpose is to identity clinical features that
occur together regularly and help to predict
outcome and response to treatment
 Classification is concerned with disorders;
patients have to understood as individuals.
 The basic classification in psychiatry should be
known by all doctors
 It is elaborated in two widely used diagnostic
 the International Classification of Disease (ICD)
produced by the World Health Organization
 and the Diagnostic and Statistical Manual (DSM)
developed by the American Psychiatry Association
 In China, we have Chinese Classification of Mental
Disorder (CCMD) developed by the Chinese Psychiatry
Some commonly used terms
 Illness, disease, and disorder
 In general medicine, the entities in a classification are
known as diseases and the term disease denotes the
presence of physical pathology. A distinction is made
between disease and illness, a term that denotes a state
of subjective distress. Disease and illness usually occur
together but not always. Some patients have a disease
but not feel ill, for example in the early—‘silent’—stage
of a carcinoma. Some patients feel ill but have no
disease, they have medically unexplained symptoms
 In psychiatry, the entities in the classification are
disorders rather than diseases. This term is chosen
because only a minority of psychiatric conditions
have an identified physical pathology so that the
term disease, as used in general medicine, is not
strictly appropriate. Instead, the causes include
biochemical abnormalities and the effects of faulty
learning. The term disorder indicates that the
symptoms are caused by an abnormality although
this is not in the classification have names such as
anxiety disorder or depressive disorder
 Organic and functional
 Disorders with definite structural pathology are called
organic and disorders without such pathology are
called functional. The term functional psychosis is
contrast them psychosis due to structural brain disease.
Also, anxiety and obsessional disorders are sometimes
referred to as functional disorders, this distinction is
used less often new because modern methods of
investigation have revealed previously undiscovered
structural changes in some conditions previously
thought to be functional
 Psychosis and neurosis
 Psychiatric disorders are sometimes grouped into
psychoses and neuroses although this grouping is no
longer employed in the official systems of classification
 Psychosis is a collective term for the more severe forms
of psychiatric disorder in which hallucinations and
delusions may occur and insight is lost. Schizophrenia,
manic-depressive disorder, and the dementia are
 The term psychosis has been criticized because it
groups together conditions that have little in common,
and is generally less useful than a specific diagnosis
such as schizophrenia. However, some clinicians
continue to use the term especially when it is difficult to
make a precise diagnosis, for example, to decide
whether a patient who has hallucinations and delusions
has schizophrenia of mania
 Used in this way psychosis is a provisional category to
be replaced by a more precise one when further
evidence has accumulated
 Neuroses is a collective term for psychiatric disorders
in which, irrespective of severity, there are no
hallucinations or delusions and no less of insight. The
objections to the term neurosis are the same to those
for psychosis: it embraces conditions that have little in
common, and it is less informative than a more specific
diagnosis such as anxiety disorder. Like psychosis,
however, neurosis continues to be used in clinical
practice as a convenient term for disorders that cannot
be assigned to a more precise diagnosis
Basic classification in psychiatry
 The various diagnostic systems contain the same basic
categories. The few differences are in nomenclature and
in the details of the criteria fore diagnosis. The
categories are:
 Mental disorders—abnormalities of behavior or
psychological experience with a recognizable onset after
a period of normal functioning.
 Adjustment disorder and reactions to stress—
conditions that are less severe than mental disorders
and occur in relation to stressful events or changed
 Personality disorders dispositions to behave in
certain abnormal way—present continuously from
early adult life.
 Other disorders—conditions that do not fit into the
previous groups; for example, abnormalities of
sexual preference.
 Disorders starting in childhood.
 Mental retardation—impairment of intellectual
functioning present continuously from early life.
 Mentaldisorders are classified further into the
main categories shown in the following. Most of
these min categories are divided further in
ways that are explained in subsequent chapters.
 Organic psychoses (delirium, dementia, and related
 Psychoactive substance use disorders
 Schizophrenia and paranoid disorders
 Affective (mood) disorder
 Neuroses (anxiety and obsessional disorders,
somatoform disorders, dissociative disorders)
 Reactions to stressful experiences
 Personality disorders and sexual problems
 Developmental disorders (mental retardation)
 Disorders starting in childhood (child psychiatry)
Etiology of psychiatry
 Knowledge of the causes of psychiatric disorders is
important for two main reasons. First, in everyday
clinical work it helps the doctor to evaluate possible
causes of an individual patient’s psychiatric disorder.
Second, it adds to the general understanding of
psychiatric disorders which may contribute to advances
in diagnosis, treatment, or prognosis
 In this section we will only deal with the first of these—
the assessment of the causes of disorders in the
individual patient. The etiology of specific disorders is
considered when these conditions are reviewed in
subsequent chapters
Remote causes and multiple causes
 In psychiatry certain events in childhood are
associated with psychiatric disorder in adult life.
For example, subjects who develop schizophrenia
are more likely than controls to have exposed to
complications of pregnancy and labor
 One cause can lead to several effects; for example,
lack of parental affection in childhood has been
reported to predispose to suicide, anti-social
behavior, and depressive disorder
Remote causes and multiple causes
 Conversely a single effect can have several
causes, which act singly or in combination; for
mental handicap can be caused by any one of
several distinct genetic abnormalities, whilst a
depressive disorder can be caused by the
combined effects of genetic factors and recent
stressful events
The classification of causes
 When there are multiple causes it is useful to group
them into predisposing, precipitating, and
perpetuating factors
 Predisposing factors determine vulnerability to
other causes that act close to the time of the illness.
Many predisposing factors act early in life, for
example: genetic endowment; the environment in
utero; trauma at birth; and social and
psychological factors in infancy and childhood
 Precipitating factors are events that occur shortly
before the onset of a disorder and appear to have
induced it. They may be physical, psychological, or
social. physical precipitating causes diseases such as
cerebral tumor, and the effects of drugs taken for
treatment or used illegally
 An example of a psychological cause is bereavement;
while moving home is a social cause. Some causes
may act in more than one way; for example, a head
injury may induce a psychiatric disorder through
physical changes in the brain and through
psychological effects
 Perpetuating factors prolong a disorder after it has
begun. Sometimes a feature of a disorder makes it
self-perpetuating (e.g. some ways of thinking
commonly prolong anxiety disorders). Social
factors are also important (e.g. overprotective
attitudes of relatives)
 Awareness of perpetuating factors is particularly
important in planning treatment because the may
be modifiable even when little can be done about
predisposing and precipitating factors
Predisposing factors
 Genetic endowment
 Environment in utter
 Trauma at birth
 Social/psychological factors in development
Precipitating factors
 Physical disease; drugs
 Psychological stresses
 Social changes
Perpetuating factors
 Intrinsic to the disorder
 Social circumstances
Models in etiology
 In discussions of etiology the word “model” is often
used to mean a way of ordering information. Like a
theory, a model seeks to explain certain phenomena
and to show the relationship between them.
 Unlike a theory, it does so in a broad and
comprehensive way that cannot be proved wrong by
carrying out an experiment. Darwin’s ideas of natural
selection are an example of a successful model in the
biological sciences. Freudian theory is an example of a
model that was widely used in the past in psychiatry
 Reductionist models seek to understand
causation by tracing back to simpler, earlier
stages. This kind of model, which is familiar in
science, is exemplified in psychiatry by the
supposition that schizophrenia is caused by
disordered neurotransmission in certain areas of
the brain
 Non-reductionist models seek to understand
causation in terms of a wider (rather than a
narrower ) set of issues. This kind of model,
which is familiar in the social sciences, is
exemplified in psychiatry by the supposition that
the cause of a patient’s neurosis is an his family,
and that his symptoms are only one aspect of a
disordered family life
 The medical model is an approach to research
in which psychiatric disorders are investigated
in ways that have proved useful in general
medicine: for example, by identifying regularly
occurring patterns of symptoms (syndromes)
and relating them to pathological findings.
 This model has proved particularly useful in
investigating organic psychiatric disorders, and
in studying schizophrenia and severe affective
disorders. It is less useful, although not without
value, in the study of neuroses and personality
 The behavioral model This term refers to an
approach to research in which psychiatric
disorders are explained in terms of factors that
determine normal behavior; for example drives
and reinforcements, attitudes and beliefs, and
cultural influences
 This model has been most useful in investigating
neuroses and personality disorders. Behavioral
models can be either reductionist (e.g. explanations
in terms of conditioning), or non-reductionist (e.g.
explanations in terms of social influences)
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Thank you

See you next time