History of psychiatry. Disorders of sensations and perception. Lyudmyla T. Snovyda
"A psychiatrist is a fellow who asks you a lot of expensive questions your wife asks for nothing" - Joey Adams
Psychiatry - • The term psychiatry, coined by Johann Christian Reil in 1808, comes from the Greek “psyche” (soul or mind) and “iatros" (healer or doctor) • Psychiatry is a medical specialty which exists to study, prevent, and treat mental disorders in humans. Psychiatric assessment typically involves a mental status examination and taking a case history, and psychological tests may be administered. Physical examinations may be conducted and occasionally neuroimages or other neurophysiological measurements taken. Diagnostic procedures vary but official criteria are listed in manuals, the most common being the ICD from the World Health Organization and the DSM from the American Psychiatric Association.
Connection with other specialities - • Those who practice psychiatry are different than most other mental health professionals and physicians in that they must be familiar with both the social and biological sciences. The discipline is interested in the operations of different organs and body systems as classified by the patient's subjective experiences and the objective physiology of the patient. While the focus of psychiatry has changed little throughout time, the diagnostic and treatment processes have evolved dramatically and continue to do so. Since the late 20th century, the field of psychiatry has continued to become more biological and less conceptually isolated from the field of medicine.
Connection with other specialities - • While the medical specialty of psychiatry utilizes research in the field of neuroscience, psychology, medicine, biology, biochemistry, and pharmacology, it has generally been considered a middle ground between neurology and psychology. Unlike other physicians and neurologists, psychiatrists specialize in the doctor-patient relationship and are trained in the use of psychotherapy and other therepautic communication techniques. Psychiatrists can therefore prescribe medication, order laboratory tests, utilize neuroimaging in a clinical setting, and conduct physical examinations.
Ancient times • Starting in the 5th century BC, mental disorders, especially those with psychotic traits, were considered supernatural in origin. This view existed throughout ancient Greece and Rome. Early manuals written about mental disorders were created by the Greeks. In 4th century BC, Hippocrates theorized that physiological abnormalities may be the root of mental disorders. Religious leaders and others returned to using early versions of exorcisms to treat mental disorders which often utilized cruel, harsh, and other barbarous methods.
Middle Ages • The first psychiatric hospitals were built in the medieval Islamic world from the 8th century. The first was built in Baghdad in 705, followed by Fes in the early 8th century, and Cairo in 800. Unlike medieval Christian physicians who relied on demonological explanations for mental illness, medieval Muslim physicians relied mostly on clinical observations. They made significant advances to psychiatry and were the first to provide psychotherapy and moral treatment for mentally ill patients, in addition to other forms of treatment such as baths, drug medication, music therapy and occupational therapy. In the 10th century, the Persian physician Muhammad ibn Zakariya Razi (Rhazes) combined psychological methods and physiological explanations to provide treatment to mentally ill patients. His contemporary, the Arab physician Najab ud-din Muhammad, first described a number of mental illnesses such as agitated depression, neurosis, and sexual impotence (Nafkhae Malikholia), psychosis (Kutrib), and mania (Dual-Kulb).
Middle Ages • In the 11th century, another Persian physician Avicenna recognized 'physiological psychology' in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with inner feelings, which is seen as a precursor to the word association test developed by Carl Jung in the 19th century.Avicenna was also an early pioneer of neuropsychiatry, and first described a • number of neuropsychiatric conditions such as • hallucination, • insomnia, mania, nightmare, melancholia, • dementia, epilepsy, paralysis, stroke, • vertigo and tremor.
Middle Ages • Psychiatric hospitals were built in medieval Europe from the 13th century to treat mental disorders but were utilized only as custodial institutions and did not provide any type of treatment.Founded in the 13th century, Bethlem Royal Hospital in London is one of the oldest psychiatric hospitals. By 1547 the City of London acquired the hospital and continued its function until 1948.
Early modern period • In 1656, Louis XIV of France created a public system of hospitals for those suffering from mental disorders, but as in England, no real treatment was being applied. Thirty years later the new ruling monarch in England, George III, was known to be suffering from a mental disorder. Following the King's remission in 1789, mental illness was seen as something which could be treated and cured.
Early modern period • By 1792 French physician Philippe Pinel introduced humane treatment approaches to those suffering from mental disorders. William Tuke adopted the methods outlined by Pinel and that same year Tuke opened the York Retreat in England. That institution became known as a model throughout the world for humane and moral treatment of patients suffering from mental disorders. It inspired similar institutions in the United States, most notably the Brattleboro Retreat and the Hartford Retreat (now the Institute of Living).
19th century • Universities often played a part in the administration of the asylums. Due to the relationship between the universities and asylums, scores of competitive psychiatrists were being molded in Germany. Germany became known as the world leader in psychiatry during the nineteenth century. The country possessed more than 20 separate universities all competing with each other for scientific advancement. However, because of Germany's individual states and the lack of national regulation of asylums, the country had no organized centralization of asylums or psychiatry.Britain, like Germany, also lacked a centralized organization for the administration of asylums. This deficit hindered the diffusion of new ideas in medicine and psychiatry.
19th century • In the United States in 1834, Anna Marsh, a physician's widow, deeded the funds to build her country's first financially-stable private asylum. The Brattleboro Retreat marked the beginning of America's private psychiatric hospitals challenging state institutions for patients, funding, and influence. Although based on England's York Retreat, it would be followed by speciality institutions of every treatment philosophy. • In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country. By 1840, asylums as therapeutic institutions existed throughout Europe and the United States.
19th century • However, the new and dominating ideas that mental illness could be "conquered" during the mid-nineteenth century all came crashing down. Psychiatrists and asylums were being pressured by an ever increasing patient population. Overcrowding was rampant in France where asylums would commonly take in double their maximum capacity. Increases in asylum populations may have been a result of the transfer of care from families and poorhouses, .
19th century • but the specific reasons as to why the increase occurred is still debated today. No matter the cause, the pressure on asylums from the increase was taking its toll on the asylums and psychiatry as a specialty. Asylums were once again turning into custodial institutions and the reputation of psychiatry in the medical world had hit an extreme low.
20th century • The 20th century introduced a new psychiatry into the world. The different perspectives of looking at mental disorders began to be introduced. The career of Emil Kraepelin somewhat model this hiatus of psychiatry between the different disciplines.
20th century • Kraepelin initially was very attracted to psychology and ignored the ideas of anatomical psychiatry. Following his acceptance for a professorship of psychiatry, and later his work in a university psychiatric clinic, Kraepelin's interest in pure psychology began to fade and he introduced a plan of a more comprehensive psychiatry.Kraepelin also began to study and promote the ideas of disease classification for mental disorders, an idea introduced by Karl Ludwig Kahlbaum.
20th century • The initial ideas behind biological psychiatry, stating that these different disorders were all biological in nature, evolved into a new idea of "nerves" and psychiatry became a sort of rough neurology or neuropsychiatry. Following Sigmund Freud's death, ideas stemming from psychoanalytic theory also began to take root. The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of asylums. However the progress of psychiatry by the 1970s turned psychoanalytic theory into a marginal school of thought within the field.
20th century • ECT was "discovered" when Ugo Cerletti, psychiatrist, visited a Rome slaughterhouse to see what could be learned from the method that was employed to butcher hogs. In Cerletti's own words, "As soon as the hogs were clamped by the [electric] tongs, they fell unconscious, stiffened, then after a few seconds they were shaken by convulsions.... During this period of unconsciousness (epileptic coma), the butcher stabbed and bled the animals without difficulty....
20th century • "At this point I felt we could venture to experiment on man, and I instructed my assistants to be on the alert for the selection of a suitable subject." • Cerletti's first victim was provided by the local police - a man described by Cerletti as "lucid and well-oriented." After surviving the first blast without losing consciousness, the victim overheard Cerletti discussing a second application with a higher voltage. He begged Cerletti, "Non una seconda! Mortifierel" ("Not another one! It will kill me!") • Ignoring the objections of his assistants, Cerletti increased the voltage and duration and fired again. With the "successful" electrically induced convulsion of his victim, Ugo Cerletti brought about the application of hog-slaughtering skills to humans, creating one of the most brutal techniques of psychiatry.
20th century • Lobotomy • Lobotomy is a surgical practice where parts of the frontal lobes are intentionally destroyed. Violent criminals calm down, highly depressed people don't seem so depressed any longer, and manics finally mellow out. But they wander aimlessly, drool uncontrollably, and have very little left of whatever "personality" they once had. If the goal is calm, quiet, and "nice" people, then it's a roaring success.
20th century • This period of time saw the reemergence of biological psychiatry. Psychopharmacology became an integral part of psychiatry starting with Otto Loewi's discovery of the first neurotransmitter, acetylcholine. Neuroimaging was first utilized as a tool for psychiatry in the 1980s. The discovery of chlorpromazine's effectiveness in treating schizophrenia in 1952 revolutionized treatment of the disease, as did lithium carbonate's ability to stabilize mood highs and lows in bipolar disorder in 1948. While psychosocial issues were still seen as valid, psychotherapy was seen to be their "cure." Genetics were once again thought to play a role in mental illness. Molecular biology opened the door for specific genes contributing mental disorders to be identified. By 1995 genes contributing to schizophrenia had been identified on chromosome 6 and genes contributing to bipolar disorder on chromosomes 18 and 21
Sensation • – the most elementary stage, which reflects separate quality of subject, which is acting in right moment to sensory organs. • Classification : • According to modality: • Interoceptive – give signal about condition of our inner world: warm, cold, hunger, uncomfortability. These sensastions don’t have localisation, outside proection, closely connected with emotional processes. • Exteroceptive – 5 sensation organs: smell, taste, sight, hearing, tactile. • Proprioceptive – information about body position, movement in space, everything which makes body scheme.
Sensation • – Anesthesia – absence of 1 or more type of sensation. Analgesia – loss of pain sensation ( at acute psychopathological diseases.) Patients, who commit suicides: they cut their organs – at such moment they don’t feel anything. After some time everything comes back with recreation of psyche. ( At deep depression, progressive paralysis, brain syphillis, convulsive disorders(hysteria), anaestesia dolorosa depresia – absense of sensation). • Hyperesthesia – subjective increasing of sensation. Hyperalgesia – increasing of pain sensastion (depression,espessially light).
Sensation • – Optical hyperesthesia – daily light blind a man. • Acustical h-sia – changes of perception threshold. Light sound percept as strong one even to pain. This is sign of exhaustion, asthenic conditions. • Taste, smell – complains on increasing of these sensations. It could be at normal conditions. • Skin sensations – tactile and temperature. Touch to a body is unpleasant. • Paresthesia – distortion sensations.
Senestopathy • – psychosomatic sensation. It has such signs: • .Polymorphism of sensations (pain, heartburn, electrisation). • .Sign which differentiates it from general somatic signs – there are complains, but they don’t have any localization, intensity, patients cannot explain them. • It has matter during mask depression diagnostic: sen.-as cardio-vascular, central – neurotic, abdominal, skin- underskin, bone – muscle. • They could be: permanent, episodical, as attack (sen.- crisis). Accompanied with panic, vegetative disorders. They begin with simple sen., after that they become very hard. • Elementary sen.- those, which doesn’t have sensor modality (“my sole is trembling”).Simple sen. – concrete modality – pain, parasthesias.
Senesthesia – various disorders of movement, which has subjective character, which are not confirm with objective investigations (“my legs and arms are not listening to me”). • Sinesthesia – appear as a result of action of different sensation organs “colored music”. Smell calls some other sensation. Name of the person- some color etc.
PERCEPTION - • - reflection of object in general. • Classification: splitting, illusions, pseudohallucinations, hallucinations, eydetysm, disorder of sensor synthesis, hallucinoids. • Double - loss of capacity of whole object formulation. He percept normally object, but couldn’t join it together. Ex.- tree – it’s separately leaves, trunk etc. At infectious diseases. • Illusions – false perception of real existent object. • Affective ill.- affect of fear, anxious, horror, connected with special emotional condition. • Verbal ill.- words, phrases are percept in place of real. • Pareydolia – optical illusions with fantastic content. Various objects which don’t have forms are seen in various pictures.
PERCEPTION - • -
PERCEPTION - • - Hallucination – perception without object,which acts on sense organs. • Visual. • Simple – photopsias. Complex – have subject content – zoological, demanomanic, antropomorphic(close people, dead people, body pieces, inner organs), panoramic- ground, atomic explosure).etc • Acustical. • Simple – sounds. • Complex – comment, imperative, stereotypical – during some time they hear same words or phrases.
PERCEPTION - • - Smell, taste – when they don’t take food. • Skin – tactile(touching,pressure, insects under skin, hair in the mouth)etc. • Interoceptive, visceral – inside of the body animals, different objects. • Kinestetical – feel, like fingers are compressed in a fist, run somewhere. • Vestibular – feeling of falling, lifting. • Symptom of twin – feeling of body splitting. • Hypnogogic – in condition of falling asleep. • Hypnopompic –in condition of getting up. • Affectogenic h.- in condition of strss, affect. • Inductive – they have collective character. There is inductor and the person to whom induct. If we separate them we understand who is ill.
PERCEPTION - • S-m Lippman, s-m Ashaphenburg, s-m Reyhardt.
PERCEPTION - • PSEUDOHALLUCINATIONS. At first was described by Candinskyy in 1890. • Pequliarities : • .False objects, which are experience, such as going in space ”see by mind, by inner eye, i can see by brain, hear by inner ear”. • .They have obusive character, appear suddenly, agains patients will. Feeling of self activity accompanied by someones action. • .They don’t have objective reality, don’t mix with reality. • .Difference between real and pseudohallucination.
PERCEPTION - • As a rule, at pseudoh. We can see changes in behavior – apsence of signs on outside world. • There are some objective signs: they watching or listening to smth, close ears, nose, touch smth. They hide somewhere, looking for smth, catching smth, run somewhere- real. • In pseudoh. – absence of attention on surrounding.
PERCEPTION - • Hallucinoids – rudimentary display of visual h. Prestage of real h. Patients have some critics to them. It’s not h.-on, but it’s not normal. • Eydetysm(eidetic memory) – Man capacity to hold for a long time some object, pictures. As a rule visual, but could be auditorial and tactile. Phenomenal visual memory.
PERCEPTION - • Depersonalization – is a nonspecific feeling that a person has lost his or her identity, that the self is different or unreal. People may be concerned that body parts do not belong to them. People may have an acute sensation that their body has drastically changed. • Derealization – is the false perception by a person that the environment has changed. For example, everything seems bigger or smaller, or familiar surroundings have become somehow strange and familiar.
PERCEPTION - • DISORDER OF SENSORIAL SYNTHESIS (psychosensorial disorders) – perception disorder of form, size, objects, oneself. On abolition from illusion there is no disorder of identity of subject. • Metamorphosias – perception disorder of form and size. They are bigger – macropsia or smaller – micropsia. • Dysmehalopsia – twisted. • Paliopsia – on abolition of 1 object – there a lot of them. • Disorders of body scheme – autometamorphopsia. Macropsia – increasing (Huliver), micropsia –decreasing (lilliputian). • Disorders of time perception – increasing of time speed(at manic patients), decreasing of time speed(at depressive patients).