Psychiatry

1. Psychiatry To treat the disease of mental

2. The history of psychiatry • Philippe Pinel • The founder of psychiatry as a medical discipline • Liberated the insane from their chains

3. The history of psychiatry • Esquirol • The prototype of the psychiatric specialist • Originated the descriptive clinical approach

4. The history of psychiatry • Kraepelin • The founder of contemporary scientific psychiatry，psychopharmacolgy and psychiratric genetics. • His nosological system established around 1900 has remained valid until today.

5. The history of psychiatry • Sigmund Freud • The founder the psychoanalysis • His work influenced the clinical approaches, the humanities and social sciences. • He is considered one of the most prominent thinkers of the first half of the 20th century.

6. The history of psychiatry • Chlorpromazine • Initiated a virtual revolution in psychiatry and psychopharmacology. • The focus of psychiatry began to turn toward brain biological theories.

7. Chapter 1 Symptoms and signs of psychiatric disorder

8. Chapter 1 • Descriptive psychopathology （症状学） • The objective description of symptoms or abnormal states of mind and limited to the description of conscious experiences and observable behavior.

9. Chapter 1 • The use of empathic understanding to explore and clarify the patient's subjective experiences • “feel oneself into the other”

10. Chapter 1 • Disorders of Mood • Disorders of Perception • Disorders of Thinking • Disorders of Memory • Disorders of Consciousness • Disorders of Concentration • Insight

11. Disorders of Mood • Mood is usually characterized as a prevailing and prolonged emotional state that determines a person’s overall perception, feeling, thinking and behaviour for a considerable period of time. • Affect is short-lived and changeable, emerges in immediate reaction to a particular aspect or object.

12. Disorders of Mood • Depression（抑郁） is abnormal when it is out of proportion to the misfortune, or is unduly prolonged. • Lowering self-esteem • Pessimistic or negative thinking • Reduction or loss of the experience of pleasure.

13. Disorders of Mood

14. Disorders of Mood Clinical association • Depressive disorder • Schizophrenia • Anxiety • OCD • Organic disorder

15. Disorders of Mood • Elation（情绪高涨） is an extreme degree of happy mood often coupled with other changes, including increased feelings of self-confidence, well-being, increased activities. • Elation occurs most often in mania and hypomania.

16. Disorders of Mood • Anxiety（焦虑） is abnormal when its severity is out of proportion to the threat of danger or when it outlasts the threat. • The essential anxious feeling including dread, restlessness, narrowing attention, worrying thoughts, increased alertness and irritability.

17. Disorders of Mood • Somatic symptoms means muscle tension, pain and respiration increase. • Autonomic symptoms are increasing of heart rate, sweating, dry mouth, and may be an urge to urinate or defecate.

18. Disorders of Perception • Perception（知觉） is the process of becoming aware of what is presented through the sense organs. • Perception cannot be terminated by an effort of will. • Specific kinds of perceptual disorders are symptoms of severe psychiatric disorders.

19. Disorders of Perception • Illusions（错觉） is based on a percept of a real object or event, which is misinterpreted . • Illusions occur when level of consciousness is reduced, as in delirium.

20. Disorders of Perception • Hallucination（幻觉） is a percept experienced in absence of an external stimulus to the corresponding sense organ. • Hallucination differs from an illusion in not being based on a percept of a real object or event.

21. Disorders of Perception Categories of hallucinations According to complexity: elementary complex According to sensory modality: auditory visual olfactory and gustatory tactile According to special features: second person third person Gedankenlautwerden echo de la pensee

22. Disorders of Perception • Elementary hallucination refers to simple experiences such as whistles, twitters and flash of light. • Complex hallucination refers to complicatedexperiences such as hearing voices and music, or seeing faces and scenes.

23. Disorders of Perception • The most common hallucination is auditory hallucinations（幻听）, usually in the form of voices. • Voices talking to each other about the patient, and voices commenting about the patient‘s ongoing acting or thinking, are considered to be typical to schizophrenia (third-person hallucination，第三人称幻听）. • Voices calling the patient's name or talking without comments to the patient are considered to be non-specific(second-person hallucination）. • Voices which anticipate, speak (Gedankenlautwerden，思维化声) or repeat(echo de la pensee，思维回响) the patient’s thoughts also suggest schizophrenia.

24. Disorders of Perception • Visual hallucinations（幻视） often raise the suspicion of an organic disorder, they also occur in schizophrenia and severe affective disorders. • The content of visual hallucinations is of little significance in diagnosis.

25. Disorders of Perception • Tactile hallucinations（幻触） may be experienced as sensations of being touched, pricked or strangled, which suggest schizophrenia and drug abuse.

26. Disorders of Perception • Hallucinations of smell and taste are often unpleasant, which is also called olfactory and gustatory hallucination. • They are infrequent and may occur in schizophrenia, severe depression, and epilepsy.

27. Disorders of Perception • Reflex hallucination（反射性幻觉） is a rare phenomenon in which a stimulus in one sensory modality results in a hallucination in another.

28. Disorders of Perception • One said he see a snake in the corner, but in fact it was a length of rope. • Illusions

29. Disorders of Perception • One said he hear some people talking with each other about his private affairs just outside of the room, but others in the same room hear nothing. • Auditory hallucination (third-person)

30. Disorders of Perception • A female patient complain that as soon as she saw her neighbor , she would hear voices commenting her dress. • Reflex hallucination

31. Disorders of thoughts • Disorders of thoughts are the most diagnostically significant symptoms in psychiatry. • It contain two aspects: disorder of thoughts content and disorder of the thinking process.

32. Disorders of thoughts • The most important symptom in disorders of thoughts content is delusion（妄想）. • A delusion is a belief that is firmly held on inadequate grounds, it could not be affected by rational argument or evidence to the contrary, and is not a conventional belief that the person might be expected to hold given his educational, cultural and religious background. • In short, a delusion is a false unshakable belief which is out of the patient's background.

33. Disorders of thoughts According to the theme: persecutory delusion of reference grandiose guilty delusions hypochondriacal nihilistic jealousy sexual delusion of control thoughts insertion thoughts withdrawal thoughts broadcasting According to onset: Primary Secondary According to delusional experiences: delusional mood delusional perception delusional memory

34. Disorders of thoughts • A primary delusion（原发性妄想） is one that appears suddenly and with full conviction but without any mental events leading up to it. • Primary delusions are given considerable weight in the diagnosis of schizophrenia. • Primary delusion experiences often start with an idea, but sometimes the first experience could also be delusional mood, delusional perception, or delusional memory.

35. Disorders of thoughts • Delusional mood（妄想心境） is preceding mood that often a feeling of foreboding that some as yet unidentified bad event is about to take place, then the delusion follows, and the delusion appears to explain this feeling of mood.

36. Disorders of thoughts • Delusional perception（妄想知觉） is the attaching of a new significance to a familiar percept without any rational reason • The perception may be normal, however the delusional interpretation is morbid.

37. Disorders of thoughts • Delusional memory（妄想记忆） is a delusional interpretation attached to past event. • The past event actually exists, but the significance attached to it is delusional

38. Disorders of thoughts • Second delusions（继发性妄想） are delusions apparently derived from preceding morbid experience. • Secondary delusions may accumulate until there is a complicated and stable delusional system, which also called systematic delusion.

39. Disorders of thoughts • The most common theme of delusion is persecutory（被害妄想）. • The patient with this symptom believe that some persons or organizations are trying to inflict harm on the patient, damage his reputation, or make him insane. • Persecutory is common in schizophrenia, organic disorders and severe affective disorders.

40. Disorders of thoughts • Delusions of reference（关系妄想） are concerned with the idea that objects, events or people have a personal significance for the patient, but in fact these events or people have nothing to do with the patient. • Delusions of reference also occur in schizophrenia, organic disorders and severe affective disorders.

41. Disorders of thoughts • Grandiose delusions（夸大妄想） are beliefs of exaggerated self-importance. • Such ideas occur particularly in mania as well as schizophrenia.

42. Disorders of thoughts • Guilty delusions（罪恶妄想） are beliefs of sinfulness because of a minor illegal behavior • It often occurs in severe depression

43. Disorders of thoughts • The nihilistic delusions（虚无妄想） are beliefs that something has ceased to exist. • The patient with hypochondriacal（疑病妄想） delusions believe that he is suffering from a severe disease, despite all medical evidence to the contrary. • Delusions of jealousy（嫉妒妄想） are beliefs that his/her partner is unfaithful. • A patient with sexual delusion（钟情妄想） believes that she is loved by a man who is usually inaccessible to her.

44. Disorders of thoughts • A patient with a delusion of control （影响妄想）believes that his actions, movements or thoughts are controlled by an outside agency and not willed by himself. • These are also called passivity phenomena. • This symptom strongly suggests schizophrenia.

45. Disorders of thoughts • Patients with delusions concerning the possession of thoughts lose the normal convictions that thoughts are private and cannot be shared unwillingly, including thoughts insertion, thoughts withdrawal and thoughts broadcasting. • They are strongly associated with schizophrenia.

46. Disorders of thoughts • Thoughts insertion（思维插入） is the delusion that certain thoughts are not the patient’s own but implanted by an outside agency. • Thought withdrawal（思维被窃） is the delusion that thoughts have been taken out of the mind. • Thought broadcasting（思维播散） is the delusion that unspoken thoughts are known to other people through radio, high-tech equipment, or in some other way.

47. Disorders of thoughts • A patient felt guilty and apologized to everyone in the office for her late for work. • Guilty delusion

48. Disorders of thoughts • A patient refused to drink any water at home because he believes his parents will poison him by water. • Persecutory delusion

49. Disorders of thoughts • A patient believed that an article in magazine suggests that he has been under surveillance . • Delusions of reference

50. Disorders of thoughts • A patient believes many people around hear her thoughts through a special electronic instrument. • Thought broadcasting