Introduction

Dr. HEM
 Definition
Psychology: the science dealing with the mind and mental
processes, especially in relation to human and animal behavior

Psychiatry: the branch of health science that deals with the

study, treatment and prevention of mental disorders

Psychiatric disorder: clinically significant psychological or

behavioral syndrome that causes significant (subjective)
distress, (objective)disability or loss of freedom and which is
not merely a socially deviant behavior or an expected response
to a stressful life event.
It is a manifestation of behavioral, psychological
and/or biological dysfunction in that person
manifesting as disturbed perception, judgement,
memory, thinking, orientation, intelligence, speech.
 Good health
Health is defined as a state of complete physical, mental and
social well-being and not merely absence of disease or
infirmity.

Components of normal mental health:

1. Reality orientation
2. Self-awareness and self knowledge
3. Self-esteem and self acceptance
4. Ability to exercise voluntary control over their behavior
5. Ability to form affectionate relationships
6. Pursuance of productive and goal directed activities
 Classification
2 systems
1. Diagnostic and Statistical Manual (4th edition) = DSM-IV
2. International Classification of Disease (10th edition)=ICD-10.
 Classification
F0-F9 organic mental disorder
F10-F19 psychoactive substance use
disorder
F20-F29 schizophrenia
F30-F39 mood disorder
F40-F49 neurotic, stress-related and
somatoform disorder
F50-F59 behavioral syndrome
F60-F69 disorder of adult personality
and behavior
F70-F79- mental retardation
F80-F89 disorder of psychological
development
F90-F99 behavioral and emotional
disorder in children and adolescence
Delirium, dementia
acute intoxication, harmful use,
dependence, withdrawal
Mania, depression, bipolar disorder
Anxiety disorder, dissociative disorders,
somatoform disorders, adjustment
disorder
Eating, sleeping, sexual disorder
Personality disorder, habit and impulse
disorder
Speech/language disorder, pervasive
developmental disorder
Hyperkinetic disorder, conduct disorder
 Etiology
Multifactorial cause
1. Biological:
1. Genetic:
2. Neuroendocrine theory
3. CNS lesions, infections
2. Psychological:
1. Stress: childhood trauma, abuse
2. Personality: depressive,
3. Behavior: excessive use – alcohol, eating,
3. Social:
1. Isolation:
2. Stressors: loss of person, property
 Approach
History:
1. Identification data/patient’s particulars
2. Informants: who and relationship with pt, reliability of
history
3. Chief complaints: in chronological order
4. History of presenting illness
5. Past psychiatric and medical history
6. Family history: any psychiatric illness in family, family
tree, current social situation
7. Personal and social history:
1. Perinatal, childhood, educational, puberty, menstrual and obstetric
history, occupational history, sexual and marital history, pre-morbid
personality
2. Alcohol and substance use
 Examination
General examination
Systemic examination
Mental status examination (MSE)
1. General appearance and behavior
1. General appearance, attitude towards examiner,
comprehension, gait and posture, motor activity, social
manner, rapport
2. Speech: rate and quantity, volume and tone, flow and
rhythm
3. Mood and affect:
1. Mood: pervasive feeling over length of time and reflects
total experience of person
2. Affect: outward objective expression of the immediate
emotion at a given time
 Examination
4. Thought: Normal thinking is goal directed flow of ideas,
symbols and associations
1. Stream and form of though: spontaneity, productivity,
content and though block
2. Contents of though:
1. obsessions – recurrent, irrational ideas
2. Phobias – irrational fears
3. Delusion – false, unshakable beliefs; e.g. delusion of
persecution/ grandeur
5. Perception: process of being aware of sensory experience
and being able to recognize it by comparing it with previous
experiences.
3. Hallucination: perception in the absence of an external
stimulation; auditory, visual, olfactory, gustatory, tactile
4. Illusion: distorted perception; perception of snake for
rope
 Examination
6. Cognition: higher mental functions
1. consciousness: intensity of stimulation required
to arouse person
conscious/confused/somnolence/clouding/delirium/
stupor/coma
2. orientation: to time, place and person
3. attention: digit forward and backward test
4. concentration: subtract serial 7 from 100
5. memory: immediate, recent and remote
6. intelligence: ability to think logically, act
rationally and deal effectively with environment
7. abstract thinking:
 Examination
7. Insight: degree of awareness and understanding that
the patient has regarding his illness
is there any illness, what kind of illness, what can be
done, is there any treatment, is there any hope of
recovery???

8. Judgement: ability to assess the situation correctly and

act appropriately
e.g. house on fire, man lying on the road, sealed,
stamped addressed envelop lying on street
 Psychoanalysis
Topographic theory of mind:
Three division of mind
Unconscious mind: governed by primary process thinking
– Contains ideas and affects which are repressed by censor
– Not available for voluntary recall
– Can only reach consciousness through preconscious mind
when censor is relaxed or overpowered
Preconscious mind:
Lies between unconscious and conscious with access to both
Develops during childhood
Censor lies here – maintains repressive barrier

Conscious mind: governed by secondary process thinking and

based on reality principle
All voluntary ideas and thoughts
 Structural theory of mind
The Id:
Original state of mind with which a newborn baby born
Contains basic instincts of survival, sexual drive and aggression
Governed by primary process thinking and based on pleasure
principle
The Ego:
Determined by experience of reality and based on reality principle
Predominantly conscious, some are unconscious
Maintains balance between id and super-ego
The Super-ego:
Unconscious division of mind that develops from ego
Determined by moral standards and influenced by parents, family
members, religion, important peoples - celebrities