INTRODUCTION TO PSYCHIATRY

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What is Psychiatry?

• Psychiatry: is the medical specialty  devoted to the

study, diagnosis, treatment, and prevention of
mental disorders 
• Psychiatric nursing: is the branch of nursing
concerned the prevention and cure of mental
disorders and their sequel.

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 What is psychiatry…

• It was first coined by the German Physician johann

Christian Reil in 1808. 
• literally means the 'medical treatment of the soul'
– psych-: soul; from Ancient Greek psykhē: soul
– iatry: medical treatment; from Gk. iātrikos: medical:
to heal

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 Normality and abnormality

• Based on majority behavior

• Based on ideal behavior
• Absence of pathological behavior such as behavior
causing distress to himself and to the people around
him.

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 Mental health and Mental disorder
• Mental health is an outcome of the influence of emotional, social

and psychological strengths, the events throughout one’s life, the

current pressure and his expectation.

• Mental Health is defined as the successful performance of mental

functions, in terms of

– thought, mood, and behavior

– that results in productive activities

– fulfilling relationships with others

– the ability to adapt to change and to cope with adversity. 5

What is Mental health?
Mental health is ‘a state of well-being in which the
individual:
o realizes his or her own abilities
o can cope with the normal stresses of life
o can work productively and fruitfully
o able to make a contribution to his or her
community (WHO, 2009)

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 Characteristics of a mentally healthy individual

• Mental health is defined as a state of well-being in which an individual

– realizes his own potential

– can cope with normal stresses of life, has the ability to make

adjustment.

– Does not demonstrate any pathological symptomatology.

– can work productively and fruitfully

– Can maintain a meaningful relationship with others

– Is able to make a contribution to his community.

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 Mental health and mental disorder

• Mental illness is
– Is a maladjustment in living

– It interferes with individual’s

• thinking

• appropriate perception of the environment

• social relationship and

• the ability to adapt to changing living conditions or
function optimally.
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 Why concern about Mental illness?

• It affects every body – estimated 1:5 person

• They are a major public health burden- 40% of those
attending General care service.
• Because they are very disabling
• Because societies are rapidly changing
• Because mental illness leads to stigma
• Because mental illness can be treated with simple,
relatively inexpensive methods.
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 Prevalence of Mental disorder

• Common to all countries

• 25% of the world’s population will develop mental
illness at some stage in their lives.
• 450 million people suffer from mental disorder

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 Prevalence…

• Estimates made by WHO in 2002

– 350 million people suffer from depression

– 25 million people suffer from schizophrenia

– 91 million people suffer from alcohol use disorder

– 15 million people suffer from drug use disorder

– 24 million people from Alzheimer and other dementia

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 Prevalence …
• Prevalence of mental disorders in Ethiopia
– Common mental disorders ---- 12 to 17%
– Schizophrenia ---------0.6 to o.7%
– Mood disorders ------- 3.8 to 5%
– Childhood disorders ----12 to 24%
– Substance dependence --- 4%
– Khat abuse -------------------- 22 to 64%
– Suicide attempt -------------- 0.9 to 3.2%
– Completed suicide ----------- 7.7/100,000/year

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 Etiology of Mental disorders
• Unknown or incompletely understood.

• Caused by combination and interaction of several factors.

• Single cause may lead to several effect.

• Complex and ambigious.

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• These factors include

• Biological factors

• Psychological factors

• Social factors

• Spiritual factors

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 Biological factors

Genetic factors: family study, twins study, adoption study

Neuro-developmental study: perinatal infection, hypoxia, Rh
incompatibility, maternal starvation
Functional anatomy: abnormality of certain brain structure may leads
to psychiatric disorder. the system of special interest to psychiatry are
– Prefrontal cortex
– Limbic system
– Basal ganglia

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Neuro-chemistry: dysregulation of neurotransmitters
dopamine, serotonin, nor-epinepherine, GABA etc
– Mental disorders can have a physiological basis and
arise from changes in brain chemistry

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 Psychosocial factors

• Psychological factors: psychologic factors, behavioral and

cognitive factors.

o early childhood experiences of abuse

o psychological trauma

• Social factors: cultural, environmental, and familial influence

• Behavioral factors like drugs, alcohol and substances like khat

are associated with mental illness

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 Predisposing Factors
• Increase susceptibility to psychiatric disorder
• Operate throughout patient’s lifetime
– Genetics:-
E.g. schizophrenia, BPD, dementia
– Age:-
E.g. Adolescence, middle life, old age
– Gender:-
E.g. Alcohol (M>F)
– Physical, psychological and social factor early in life and pre-
morbid personality is important.

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 Precipitating Factors
• are events that precede clinical onset.

• Trigger an episode of illness

• Determine its time of onset

– Environment:- Emotional as well as physical milieu

• Family interactions (engagement, marriage, discord,

separation, death, becoming a parent).

• Other interpersonal relationship(difficulties with

friends or neighbors). 19
• Living circumstances (immigration)

• Financial affairs (inadequate finances)

• Legal affairs (being arrested or sued)

• Occupation – stress related to job.

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• Physical illness
– Personal (pain, discomfort)
– Financial (cost of treatment)
– Emotional (feeling of depression)
– Body image (breast amputation)
– Endocrinal (hyperthyroidism)

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 Perpetuating factors
• are factors that prolong the course of a disorder after it has
been provoked.
• Delay recovery from illness
– Secondary demoralization and withdrawal from social
activities.
– Substance use/abuse
– Lack of social support
– Chronic physical illness
– Demoralization
– Social withdrawal
– Poor social or family support
– Loss of job etc 22
 Management of mental disorder

• Mainly of three types

– Biological- mainly medication, ECT
– Psychological
– social

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Cultural explanations for mental illness in
Ethiopia
– Spirit possession (likift, zar, wuqabi)
– Punishment for sins
– Evil eye
– Bewitched/cursed
– Thinking too much
– Exposure to cold air (berrd)
– Exposure to sun rays (mitch).
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 Misconceptions
•The profession

–Results in mental illness

–Can read the mind

•Patients

–Dangerous & feared

–Are not treatable & can’t work

–Fools, unatrainable, don’t feel pain or suffering don’t remember theirs & others
deed’s

–Can’t possess a property, don’t have equal rights

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Thank you

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