Psychiatry

1
Psychiatry

• Chapter 22

2
Introduction

• This chapter is different
• Psychiatry
• Branch of medicine that deals with the diagnosis,
  treatment, and prevention of mental illness
• A specialty of clinical medicine

3
Psychiatrist vs. Psychologist

• Psychiatrist
• Completes same medical training as other
  physicians (4 years of med school)
• Receives an M.D. degree
• Then spend varying number of years studying
  psychotherapy and drug therapy
• May then spend years specializing in various
  aspects of psychiatry
• Child
• Forensic
• Psychoanalysis

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Psychiatrist vs. Psychologist

• Psychologist
• Non-medical person trained in methods of
  psychotherapy, analysis, and research
• Typically completes a masters or doctor of
  philosophy (Ph.D.) in a specific field
• Clinical
• Experimental
• Social
• Clinical psychologist can use various methods of
  psychotherapy to treat patients, but cannot
  prescribe drugs

5
Evaluation Tests

• Used by clinical psychologists to evaluate
  various aspects of a patients mental health and
  intelligence
• Intelligence tests (I.Q.)
• Projective Tests (personality)

6
IQ Tests

• Intelligence Tests
• Wechsler Adult Intelligence Scale (WAIS)
• There are three main types of Wechsler
  intelligence tests
• Wechsler Pre-school and Primary Scale of
  Intelligence (WPPSI) - 3-7 years
• Wechsler Intelligence scale for Children (WISC) -
  7-16 years
• Wechsler Adult Intelligence Scale (WAIS) - 16
  years and over
• Three IQ scores are obtained from the WAIS(R)
  1. Verbal IQ2. Performance IQ3. Full Scale IQ
• Stanford-Binet Intelligence Scale

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Sample Questions

• True or False
• Two ducks and two dogs have a total of fourteen
  legs
• A pie can be cut into more than seven pieces by
  making only four diameter cuts through its center
  
• Two of the following numbers add up to
  thirteen.1, 6, 3, 5, 11

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Sample Questions

• True or False
• The word, "mineral," can be spelled using only
  the letters found in the word, "parliament."
• This sequence of four words, "triangle, glove,
  clock, bicycle," corresponds to this sequence of
  numbers "3, 5, 12, 2.
• 27 minutes before 7 o'clock is 33 minutes past 5
  o'clock

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Sample Questions

• True or False
• The word, "slackers," is spelled by using the
  first letters of the words in the following
  sentence "Silent large anteaters calmly kiss
  each roasted snack."
• If written backwards, the number, "one thousand,
  one hundred twenty-five," would be written "five
  thousand, two hundred eleven."
• Gary has only forty-eight dollars, but he can buy
  a bicycle that costs one hundred twenty dollars,
  (disregarding tax) if he borrows fifty-seven
  dollars from Jane and fifteen dollars from Jill.

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Sample Questions

• Which number should come next in this series?
• 1, 4, 9, 16, 25,
• 36
• Explanation The pattern progressively increases
  3, 5, 7, 9, 11

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Sample Questions

• Which number should come next in this series?
• 3,5,8,13,21,
• 34
• Explanation in order to calculate which number
  comes next each time you should add together the
  last two numbers.
• Thus 3 5 8,  5 8 13,  8 13 21,  13
  21 34.

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Sample Questions
Find the picture that follows logically from one
of the six below.                    
13
Projective Tests

• Tests used to reveal personality structure
• Rorschach technique (inkblots)
• Used to bring out associations
• Patient describes images seen in the blot
• 10 cards in a particular order
• Thematic Apperception Test (TAT)
• Pictures are used as stimuli for making up a
  story
• Minnesota Multiphasic Personality Inventory
  (MMPI)
• Contains true false questions
• Reveals aspects of personality such as
• Sense of duty or responsibility
• Ability to relate to others
• dominance

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Rorschach Technique
15
Rorschach Technique
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Thematic Apperception Test
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TAT
18
Sigmund Freud

• May 6, 1856 September 23, 1939
• Considered by some as father of psychoanalysis
• Some of his research and methods highly
  scrutinized

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Sigmund Freud

• His fundamental idea
• that all humans are endowed with an unconscious
  in which potent sexual and aggressive drives, and
  defenses against them, struggle for supremacy, as
  it were, behind a person's back
• Contended that all neurotic ailments to which
  humans are susceptible is nearly always the work
  of sexual maladjustments, and that erotic desire
  starts not in puberty but in infancy
• Had dramatic evocation of a universal Oedipus
  complex

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Psychiatric Disorders

• Freud believed personality is made up of 3 major
  parts
• Id
• Ego
• Superego
• Id
• Represents unconscious instincts and psychic
  energy
• Our basic drives originate here
• Operate according to the pleasure principle
• Seek immediate gratification regardless of
  situation
• Predominate in the thinking of infants
• Manifests in the uncontrolled actions of certain
  mentally ill patients

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Psychiatric Disorders

• Ego
• Central coordinating branch of the personality
• Mediator between id and outside world
• Evaluates and assesses reality of a situation
  (reality testing)
• Postpones the gratification of a need or drive
  until a satisfactory object or situation arises
• This is what we perceive as being self
• Superego
• Internalized conscience and moral part of the
  personality
• Encompasses sense of discipline derived from
  parental authority and society
• Guilt feelings arise from behavior and thoughts
  that do not conform to the standards of the
  superego

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Psychiatric Disorders

• Freud believed certain disorders occurred when
  conflicts existed between two or more of these
  personality aspects
• Psychosis
• Term frequently used to describe mental illness
• Involves significant impairment of reality
  testing
• Symptoms include delusions, hallucinations, and
  bizarre behavior

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TEST
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Clinical Symptoms

• Amnesia
• Anxiety
• Apathy
• Autism
• Compulsion
• Conversion
• Delusion
• Dissociation

• Dysphoia
• Euphoria
• Hallucination
• Labile
• Mania
• Mutism
• Obsession
• Paranoia

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Anxiety Disorders

• Characterized by anxiety
• Unpleasant tension, distress, troubled feelings,
  and avoidance behavior
• Panic attack (disorder)
• Marked by intense fear or discomfort
• Symptoms
• Palpitations
• Sweating
• Trembling
• Dizziness
• Can occur on its own with no symbolic meaning or
  within the context of a particular anxiety
  disorder

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Anxiety Disorders

• Phobic Disorders
• Characterized by irrational or debilitating fears
• Can be associated with an object or situation
• Patient often goes to extreme lengths to avoid
  object of fear
• Feared object is often symbolic of unconscious
  conflict
• Patients attention is diverted from conflict by
  object keeping it unconscious

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Anxiety Disorders

• Agoraphobia
• Fear of being alone or in open, crowded, public
  places where escape would be difficult or help
  might not be available
• People limit normal activities to avoid these
  situations
• Feel comfortable at home or in company of a
  friend or relative
• Panic attacks may occur just in anticipation of
  phobic situation

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Anxiety Disorders

• Social Phobia
• Social Anxiety Disorder
• Fear of situations in which the individual is
  open to public scrutiny which could result in
  embarrassment and humiliation
• Ex.
• Speaking in public
• Using public lavatories
• Eating in public
• Claustrophobia
• Acrophobia
• zoophobia

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Anxiety Disorders

• Obsessive-compulsive Disorder
• Involves recurrent thoughts (obsessions) and
  repetitive acts (compulsions)
• Patient experiences anxiety if prevented from
  performing special rituals
• Often consumes time and interferes with
  individuals social or occupational functioning

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Anxiety Disorders

• Post-traumatic stress disorder
• Development of symptoms following a traumatic
  event
• Intense fear
• Helplessness
• Insomnia
• Nightmares
• Diminished responsiveness to external world

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Delirium and Dementia

• Both disorders of abnormal cognition
• Delirium
• Acute, temporary disturbance of consciousness and
  mental confusion
• Caused by a number of conditions
• SS
• Rambling, irrelevant, or incoherent speech
• Sensory misperceptions
• Disorientation
• Memory impairment

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Delirium and Dementia

• Dementia
• General loss of intellectual abilities
• Impairment in judgment, memory and abstract
  thinking
• Changes in personality
• Normally caused by damage to the brain
• Common causes
• Alzheimer disease
• Parkinson disease
• Huntington disease
• Brain trauma
• tumors

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Dissociative Disorders

• Chronic or sudden disturbances in memory,
  identity, consciousness, or perception or
  environment
• Not caused by direct effects of brain damage or
  drug use
• Dissociative identity disorder
• 2 or more distinct personalities take hold of the
  individuals behavior
• Dissociative amnesia
• Inability to remember important personal
  information

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Schizophrenia

• Withdrawal from reality to an inner world of
  disorganized thinking and conflict
• Delusions
• Hallucinations
• Disorganized thinking