Clinical Psychiatry

Psychiatry

• first coined by Johann Christian Reil in 1808

• From ancient Greek psykhē (soul/butterfly) and
iātrikos (medical) from iāsthai (to heal)
Psychiatry
• Started as specialty in early 1800’s

• “Patients” were severely disordered individuals

confined to asylums or hospitals
– psychotic, severely depressed/manic, demented

• “Nervous” outpatients were treated by neurologists

– Freud developed psychoanalysis (PA) to treat
these "neurotic" (non-hospitalized) patients
Psychoanalysis
• became the first medical treatment for
psychiatric outpatients
• created a split in the field, which continues to
this day, between biological (scientific)
psychiatry and psychoanalytic psychiatry
 Pharmacotherapy vs. Psychotherapy
The Practitioners/ Practice of Psychiatry

• Psychiatrist
• Psychoanalyst (Psychoanalysis)
• Psychotherapist (Psychotherapy)

• Clinical psychologist
• Psychiatric social worker / nurse / aide
The Practitioners of Psychiatry
PSYCHOTHERAPIST
• can be anyone who wants to use this title
(there are no legal or professional criteria
for defining a psychotherapist)
• most are psychiatrists, psychologists, or
psychiatric social workers
• some are psychiatric nurses/aides
The Practitioners of Psychiatry
PSYCHOANALYST
• One with a license to practice psychoanalysis

• According to the American Psychoanalytic Association, 98%

of all bona fide psychoanalysts are MDs

• Psychiatric residency (3 yrs)  5-10 yrs at a

psychoanalytic institute (3 yrs in courses, 5-10 yrs on
the couch, 3-8 yrs conducting 2 psychoanalyses under
supervision)

• only 6% of American psychiatrists practice psychoanalysis

The Practitioners of Psychiatry
PSYCHIATRIST
• Physicians (MDs) w/at least 3 years of formal residency
training
• Only those who finished training may call themselves
psychiatrists
• The only ones who may give drugs and ECT
(electroconvulsive therapy)
• 50% had personal psychotherapy (optional)
Clinical psychiatrists
• Chief experts in caring for the mentally ill

• Distinguish between “mental disorders”* and

“problems in living”

• Deal with “symptoms” (hallucinations, insomnia) and

“issues” (boredom, failed relationships)

*Those with mental disorder have both

 The “new” psychiatrist
• Uses the biopsychosocial approach
– “typically” prescribes medication for the biological
abnormalities
– performs individual psychotherapy (89%) and treats
families and couples (59%) to address psychosocial
problems

– uses the doctor-patient relationship to show that he values

the patient as a person (moral-existential approach)
 The Psychiatric Diagnosis
7 major purposes
1. To determine whether the abnormal state is due
to a mental disorder
2. To guide treatment
3. To predict outcome
4. To illuminate if and how a disorder is inherited
5. To facilitate intraprofessional communication
6. To advance research
7. To uncover mental disorders
 The Psychiatric Diagnosis
• The descriptive tradition
• Started by Emil Kraepelin
– Described the clinical features of thousands of
very disturbed hospitalized patients
– Created psychiatry’s first major diagnostic system
• Divided those without obvious brain damage into 2
groups based on prognosis and age of onset
• Used symptoms and “life course” as bases for diagnosis
 Diagnostic Manuals
• DSM-5 (Diagnostic and Statistical Manual of Mental
Disorders of the American Psychiatric Association or
APA)

• ICD-10 (International Statistical Classification of Diseases

and Related Health Problems) of the World Health Organization (WHO)

• Chinese Classification of Mental Disorders of the

Chinese Society of Psychiatry
 Classification in Psychiatry
DSM
Diagnostic and Statistical Manual of Mental
Disorders (DSM)
• DSM I (1952) and DSM II (1968) – used the
analytic tradition of classification
• DSM III (1980)– return to descriptive tradition
• DSM IV and DSM-IV-TR (2000)
• DSM 5 (2013)
 DSM IV-TR
• Adult psychiatry
• Child and Adolescent Psychiatry
 DSM-5
• Combined adult and child psychiatry in its
classification

• Criticized
– for its medical/biological bias
– for expanding the scope of psychiatric disorders in
ways that shrink the range of normality
– for its definitions which were products of expert
consensus, not experimental data
 Psychiatric Diagnosis
DSM 5
• Diagnostic criteria
A. Typical symptoms/manifestations
B. Duration of symptoms
C. Exclusion of biological causes
1. Substance-induced
2. Another medical condition
D. Exclusion of other mental disorders
 DSM 5
I. Neurodevelopmental Disorders
II. Schizophrenia Spectrum and Other Psychotic
Disorders
III. Bipolar and Related Disorders
IV. Depressive Disorders
V. Anxiety Disorders
VI. Obsessive-Compulsive and Related Disorders
VII.Trauma- and Stressor-related Disorders
VIII.Dissociative Disorders
IX. Somatic symptom and related disorders
X. Feeding and eating disorders
XI. Elimination disorders
XII. Sleep-wake disorders
XIII.Sexual dysfunctions
XIV.Gender dysphoria
XV. Disruptive, impulse-control and Conduct
disorders
XVI. Substance-related and Addictive Disorders
XVII. Neurocognitive Disorders
XVIII Personality disorders
XIX. Paraphilic disorders
XX. Other mental disorders
XXI. Medication-Induced movement disorders and
other adverse effects of medication
XXII. Other conditions that may be a focus of clinical
attention
 DSM-IV-TR
• Delirium, Dementia, and
Amnestic and Other Cognitive
disorders
• Substance-related Disorders
• Schizophrenia
• Other Psychotic Disorders
• Mood Disorders
• Anxiety Disorder
• Adjustment Disorders
DSM 5
• Neurocognitive Disorders
• Substance-related and Addictive
Disorders
• Schizophrenia Spectrum and Other
Psychotic Disorders
• Bipolar and Related Disorders
• Depressive Disorders
• Anxiety Disorders
• Obsessive-Compulsive and Related
Disorders
• Trauma- and Stressor-Related Disorders
OVERVIEW ON MENTAL ILLNESS
 MENTAL ILLNESS
• Mental illness refers to a wide range of mental
health conditions — disorders that affect
mood/affect, thinking/cognition and behavior.

• Marked by
– Presence of signs/symptoms
– Symptoms produce significant distress OR
– Significant effect on social/occupational
functioning
 Etiology
• Mostly unknown
• Genetic factors
• Socio-cultural / environmental factors
• Biological factors (neurotransmitters)
 Mental illness
Risk factors
• Epidemiology
Clinical Manifestations
• Diagnosis
Treatment
Prognosis
THANK YOU