Introduction, Development of Psychiatry

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Introduction,Development of Psychiatry

• Department of Psychiatry
• 1st Faculty of Medicine
• Charles University, Prague
• Head Prof. MUDr. Jirí Raboch, DrSc.

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Teaching Schedule
800-930 945-1200
Week 1 MO Lecture Workshop on wards with patients
Week 1 TUE Lecture Workshop on wards with patients
Week 1 WE Lecture Workshop on wards with patients
Week 1 THU Lecture Workshop on wards with patients
Week 1 FRI Lecture Workshop on wards with patients
Week 2 MO Lecture Workshop on wards with patients
Week 2 TUE Lecture Workshop on wards with patients
Week 2 WE Psychiatric Hospital Bohnice Psychiatric Hospital Bohnice
Week 2 THU Lecture Workshop on wards with patients
Week 2 FRI Lecture Workshop on wards with patients
Week 3 MO Lecture Workshop on wards with patients
Week 3 TUE Lecture Workshop on wards with patients
Week 3 WE Ward Ward
Week 3 THU Lecture Workshop on wards with patients
Week 3 FRI Examination Examination
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FREE COURSES IN CZECH

• WEDNESDAY 1400 1530 CLINICAL SEMINAR,
  LIBRARY, 2nd. FLOOR
• FIRST WEDNESDAY IN EVERY MONTH MEETING OF THE
  CZECH PSYCHIATRIC ASSOCIATION VONDRÁCEK LECTURE
  HALL, 900 1700
• THURSDAY 1245 1500, THERAPEUTIC COMMUNITY,
  Apolinár, 2nd. FLOOR
• THURSDAY 1300 1400 SEMINAR FOR POSTGRADUATE
  STUDENTS, LIBRARY, 2nd. FLOOR

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Study materials

• Basic Psychopathological Terms and Psychiatric
  Diagnoses Raboch J., Pavlovský P. et al.,
  Karolinum
• Psychiatrie Raboch, Zvolský a kol., Galén, Praha
  2001, s. 622 (in Czech)
• Psychiatrie-Testy Raboch a kol., Galén, Praha
  1997 (in Czech)
• ANY OTHER ENGLISH TEXTBOOK OF PSYCHIATRY
  PUBLISHED AFTER 1995, 400 PAGES AND MORE (e.g.
  WALDINGER, ANDREASEN, HALES )

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E-LEARNING

• LECTURES, ORAL EXAMINATION QUESTIONS
• http//psychiatrie.lf1.cuni.cz/
• Department of Psychiatry
• http//portal.lf1.cuni.cz/
• Educational portal

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Course

• 2 absence at maximum
• 2 other absences free courses
• Written mental status of one patient (documentary
  case record)

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PSYCHIATRYMAIN MEDICAL DISCIPLINE

• INFLUENCES KNOWLEDGE OF THE MANKIND, PHILOSOPHY
• TWO TRENDS
• RESTRICTIVE, PUNISHING - ISOLATION
• PERMISSIVE, MEDICINALISATION MEDICAL DISEASES

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PSYCHIATRY IN ANCIENT TIMES

• THE OLDEST PSYCHIATRIC STATUS
  EBERSS PAPYRUS, 1900 B.C.,
  CLINICAL PICTURE OF DEPRESSION
• BIBLE, OLD TESTAMENT, MADNESS OF THE
  KING SAUL, MELANCHOLY
• MAGICAL CAUSES OF MENTAL DISORDERS ASSYRIANS,
  BABYLONIANS, MENTAL DISORDERS MARK OF MORAL
  INSANITY, SIN, PUNISHMENT
• ANCIENT GREECE HEALERS, TEMPLE MEDICINE

ASKLEPIOS
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HIPPOKRATES460 370 B.C.

• HYPOTHESIS 4 BODY JUICES - SANGUIS, FLEGMA,
  CHOLE, MELANCHOLE
• CHARACTER TYPOLOGY
• MENTAL DISORDER BRAIN
• FIRST CLASSIFICATION OF MENTAL
  DISORDERS
• PARANOIA MELANCHOLIA BLACK BILE
  MANIA
  YELLOW BILE FRENITIS
  BLOOD
• HYSTERIA
• THERAPY VENIPUNCTURE, EMETICS, LAXANTIVES,
  PHYSICAL ACTIVITY, SWEATING

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ROME, A.D.

• GALEN - ROMAN SCHOOL OF ECLECTICS
• MENTAL DISORDERS PRIMARY DISEASE OF THE BRAIN
  OR REACTION OF THE BRAIN TO DISEASES OF OTHER
  ORGANS
• FALL OF THE ROMAN EMPIRE FALL OF THE HUMANISTIC
  AND SCIENTIFIC EDUCATION AND ATTITUDES
• CODEX THEOSIANUS, 438 A.D., PUNISHMENT OF
  MANIACS, MENTAL DISORDER OUT OF
  MEDICINE, SUBJECT OF RELIGIOUS
  EVALUATION

LYKANTROPY
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MIDDLE AGES

• ISOLATION OF MENTALLY ILL PEOPLE, DEMONOLOGY
  STIGMATA DIABOLI
• 1487 MALLEUS MALEFICARUM (JAKOB SPRENGER A
  HEINRICH KRAEMER)
• SPECIAL MONASTERIES HOSPITALES
• PRISON
• TORTURE EXORCISM, WITCH TRIALS
• 18th. CENTURY FAME PLAGIIS, VINCULIS COERCENDUS
  EST INSANUS

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RENAISSANCE16. CENTURY

• RETURN TO HUMANISM, SEPARATION OF SCIENCE FROM
  THE CHURCH
• NEW DISCOVERIES IN MEDICINE W. HARVEY
  BLOOD CIRCULATION
• MIND AND BODY, SOCIAL INFLUENCES
• BEGINNINGS OF CLASSIFICATION IN PSYCHIATRY
• 1st. PSYCHIATRIC REVOLUTION - JOHAN WEYER (1515
  1588 TREVIR), PROFESSOR, MEDICAL SCHOOL IN
  COLOGNE, DE PRESTIGIIS DAEMONUM, MENTAL DISORDERS
  MEDICAL CAUSES

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ENLIGHTENMENT17th 18th CENTURIES

• PIONEERS OF LIBERALISM VOLTAIRE, KANT, DIDEROT,
  SWIFT,
• FRENCH REVOLUTION (1789)
• 2nd. PSYCHIATRIC REVOLUTION REAL REFORM OF THE
  CARE OF MENTALLY ILL PEOPLE
• WILLIAM TUKE YORK RETREAT MODEL OF HUMANISTIC
  CARE
• PHILIPPE PINEL PARIS, BICETRE, SALPETRIERE,
  THERAPEUTIC REGIMEN, ACTIVITY THERAPY,
  PSYCHODRAMA
• MODERN PSYCHIATRY MENTAL DISORDERS MEDICAL
  DISEASES, PHYSICIANS

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MODERN PSYCHIATRY19th. CENTURY

• 1861 BROCAS AREAS, KRAEPELIN MENTAL DISORDERS
  ABNORMALITIES OF NEURONAL FUNCTIONS
• CLASSIFICATION EINHEITSPSYCHOSE (EUROPE),
  IDIOCY (USA)
• E. KRAEPELIN (1856 1925) DEMENTIA PRAECOX
• E. BLEULER (1857 1939) SCHIZOPHRENIA
• J. BAILLARGER (1809 1890) - CYCLOPHRENIA
• W. GRIESINGER (1817 1868) - ORGANIC
  PSYCHOSYNDROM

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FIRST HALF OF THE 20th. CENTURY

• HUGE PSYCHIATRIC HOSPITALS PSYCHOSES
• ORGANIC THEORY OF MENTAL DISORDERS (WIRCHOV)
• BIOLOGICAL TREATMENTS SCHOCK THERAPIES (H.
  BOERHAAVE, 1668 1738), BENEFICIS MARIS
• 1932 VON MEDUNA KARDIAZOL
• 1935 M. SAKEL INZULIN
• 1938 U. CERLETI, L. BINI ECT
• 1900 S. FREUD ANALYSIS OF DREAMS

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II. WORLD WAR AND FASCISM

• 1933 LAW PREVENTION OF HERIDITARY DISEASES
  STERILISATION OF 400 000 PEOPLE
• 1939 EUTHANASIA, T4 ACTION, IN CHILD DEPARTMENTS
  MURDERED 10 000 OF CHILDREN
• 1939 1945 IN GERMANY MURDERED 180 000
  PSYCHIATRIC PATIENTS
• FLIGHT OF MANY JEWISH PSYCHIATRISTS FROM
  CONTINENTAL EUROPE (S. FREUD)

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AKTION T4 Dr. Karl Brandt

• murdering 70 273 patients saved the German
  government, over 10 years, 33 731 040 eggs, a
  saving of 3 710 414 German marks and 40 pfennings
  also the savings in vegetables and other
  provisions

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SECOND HALF OF THE 20th. CENTURY

• 50ies PSYCHOANALYSIS, PSYCHOTROPIC
  DRUGS
• 1952 DELAY, DENIKER
  CHLORPROMAZIN
• 1958 KUHN IMIPRAMIN
• 60-ies SOCIAL PSYCHIATRY, COMMUNITY
  PSYCHIATRY
• 70-ies EMPIRICAL RESEARCH, HUGE EPIDEMIOLOGICAL
  PROJECTS
• 80-ies BIOLOGICAL PSYCHIATRY, NEUROSCIENCES,
  NEW CLASSIFICATION - DSM-III, ICD-10
• 90-ies COMMUNITY PSYCHIATRY, GLOBAL BURDEN OF
  DISEASE, EXPENDITURE REDUCTION,
  COST-EFFECTIVENESS, QUALITY ASSURANCE

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21. CENTURY

• MENTAL HEALTH
• 2 000 WHO - WORLD HEALTH DAY STOP EXCLUSION,
  DARE TO CARE
• WORLD HEALTH REPORT 2001 NEW UNDERSTANDING,
  NEW HOPE, 10
  RECCOMENDATIONS
• MENTAL HEALTH GLOBAL ACTION PROGRAMME FOR 5 YEARS
• EUROPE HEALTH 21
• 2005 WHO HELSINKI CONFERENCE - MENTAL HEALTH
  ACTION PLAN FOR EUROPE

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LIFE TIME PREVALENCE OF MENTAL DISORDERS
Total Males Females
Anxiety disorders 24,9 19,2 30,5
Affective disorders 17,1 12,7 21,7
Dependencies 26,6 35,4 17,9
Non-affective psychoses 0,7 0,6 0,8
Total 48,0 48,7 47,3
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FIRST OUT-PATIENT EXAMINATION IN A YEAR
DIAGNOSIS 1994 2006 CHANGES ()
ORGANIC BRAIN DISORDER 27 421 50 388 83,8
DEPENDENCIES 31 097 39 301 26,4
SCHIZOPHRENIA 33 805 41 638 23,2
AFECTIVE DISORDER 37 915 93 636 147,0
NEUROTIC DISORDER 103 577 187 665 81,2
DEVELOPMENTAL DISORDER 23 460 21 127 -9,9
TOTAL 307 877 458 500 48,9
ÚZIS 2007
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THE GLOBAL BURDEN OF DISEASECh.J.L.MURRAY,
A.D.LOPEZ, 1997

• HARVARD SCHOOL OF PUBLIC HEALTH
• WORLD HEALTH ORGANISATION
• WORLD BANK

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DALY - Disability Adjusted Life Years DALY
YLL YLD

• YLL - Years of Life Lost
• YLD - Years Lived with Disability

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DALY OF NEUROPSYCHIATRIC DISORDERS IN
VARIOUS PARTS OF THE WORD
Murray a Lopez, 1997
Disability Adjusted Life Years
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DALY DEVELOPED COUNTRIES
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PSYCHIATRY IN PRAGUE

• 1790 CUSTODIAE MENTE CAPTORUM, GENERAL HOSPITAL
• 1822 TEMPLE OF ST. CATHARINA OLD HOUSE
• 1844 NEW HOUSE, KARL VON
  RIEDL

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PSYCHIATRIC DEPARTMENT CHARLES UNIVERSITY, PRAHA
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CAUSES OF DALY ()world
1. Respiracní infekce 8,2
2. Prujmovitá onemocnení 7,2
3. Perinatální onemocnení 6,7
4. Unipolární deprese 3,7
5. ICHS 3,4
6. Cerebrovaskulární onemocnení 2,8
7. Tuberkulóza 2,8
8. Zardenky 2,7
9. Dopravní nehody 2,5
10. Vrozené vady 2,4
Murray a Lopez, 1997
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CAUSES OF DALY ()developed countries
1. ICHS 9,9
2. Unipolární deprese 6,1
3. Cerebrovaskulární nemoci 5,9
4. Dopravní nehody 4,4
5. Nadužívání alkoholu 4,0
6. Osteoarthritis 2,9
7. Nádory trachey, bronchu a plic 2,9
8. Demence a další deg. procesy CNS 2,7
9. Sebepoškození 2,3
10. Vrozené vady 2,2
Murray a Lopez, 1997
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CAUSES OF DALY ()developed countries, age 15 -
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1. Unipolární deprese 12,3
2. Nadužívání alkoholu 8,9
3. Dopravní nehody 8,5
4. Schizofrenie 5,0
5. Sebepoškození 4,2
6. Bipolární porucha 3,7
7. Nadužívání návykových látek 2,9
8. Obsedantne kompulzivní porucha 2,7
9. Osteoarthritis 2,7
10. Následky násilí 2,4
Murray a Lopez, 1997