1、Handi ZhangPSYCHIATRY2Mental Health Center,Shantou UniversityZhang_Zhang_Outline Roots for psychiatryRoots for psychiatryIntroduction to psychiatryIntroduction to psychiatryBasic definitionsBasic definitionsCommon psychiatric symptoms and signsCommon psychiatric symptoms and signsThe categoriesThe c
2、ategories类别类别 of psychiatric disordersof psychiatric disordersMajor psychiatric disordersMajor psychiatric disorders3Objectives Roots Roots VocabularyVocabularyHaving a general idea about psychiatryHaving a general idea about psychiatry 45psychiatrymentmneanxineurophrenschizmemorynervemindtreatmindU
3、neasy anxiousspiltmindRoots for psychiatryROOTROOTMEANINGMEANINGEXAMPLEEXAMPLEPsych/omindpsychosomaticPsycho-somat-icIatrymedical specialtyPsychiatryPsych-iatrymentmindmentalment-almnememoryamnesiaa-mnes-iaanxiuneasy,anxiousanxietyAnxi-etySchiz/osplitschizophreniaSchizo-phren-iaphrenmindschizophreni
4、a6Psychiatric disorder/mental disorderWith the acting ofWith the acting of the external and the external and internal factors on the braininternal factors on the brainthe function of brain become disturbedthe function of brain become disturbedongoing ongoing 不间断的不间断的patterns of cognition,patterns of
5、 cognition,emotion,and behavior go deviantemotion,and behavior go deviant不正常的不正常的,distressful and/or dysfunctionaldistressful and/or dysfunctionalfor a period of timefor a period of time.78psychiatristpsychologistCommon clinical signs and symptomsNormal mental activity Cognition (Sensation and perce
6、ption,thought/thinking,attention,memory,intelligence,insight,orientation方向)Emotion(mood,affect)Volition意志力 and behaviorConsciousness 9Illusion错觉It is a false perception 曲解曲解due to misinterpretation of the stimuli arising from an object.10HallucinationHallucination幻觉幻觉It is a false It is a false perc
7、eption of perception of something that is not something that is not really there.really there.Hallucination may be Hallucination may be visual,auditory,visual,auditory,tactile,gustatory,or tactile,gustatory,or olfactoryolfactory.Create by the mind.Create by the mind.It is a sign of schizophrenia It
8、is a sign of schizophrenia 精神分裂精神分裂11Auditory hallucinationNon verbal auditory hallucination幻听幻听Verbal auditory hallucinationCommenting 评论评论Ordering命令命令 12DelusionDelusion妄想妄想An abnormality in content An abnormality in content of thought.It is an of thought.It is an irrationally held irrationally he
9、ld a stronga strong belief belief with convictionwith conviction that that cannot be altered by cannot be altered by rationalrational合理的合理的 argument.argument.It is the signs of schizophrenia and bipolar It is the signs of schizophrenia and bipolar disorder.disorder.13DelusionsDelusions妄想妄想 of of per
10、secution/persecutorypersecution/persecutory迫害迫害 delusionsdelusionsDelusions of reference/ideas of Delusions of reference/ideas of referencereference牵连观念牵连观念Delusions of being Delusions of being controlled/delusions of passivitycontrolled/delusions of passivityGrandiose delusionGrandiose delusion夸大妄想
11、夸大妄想 /delusions/delusions of grandeurof grandeur庄严庄严 Delusions of guiltDelusions of guilt14ObsessionObsession强迫症，痴迷强迫症，痴迷unwantedunwanted、uncontrolleduncontrolledIt is a recurrentIt is a recurrent周期性的周期性的 thought that thought that is unpleasant and provokesis unpleasant and provokes煽动煽动 驱使驱使 anxiety
12、 but cannot be got rid of.anxiety but cannot be got rid of.Obsessive thoughtObsessive thoughtObsessive ruminationsObsessive ruminations沉思沉思Obsessive doubtsObsessive doubtsObsessive impulseObsessive impulseObsessive reminiscenceObsessive reminiscence回忆回忆 怀旧怀旧15Compulsion Compulsion 强迫症，强迫症，强制强制The pa
13、tients know that their behaviors are not The patients know that their behaviors are not normal but cannot inhibit it.normal but cannot inhibit it.It is repetitive behaviors or It is repetitive behaviors or mental acts preformed over and mental acts preformed over and over in response to an obsessive
14、 over in response to an obsessive thought and usually leading to thought and usually leading to anxiety.anxiety.Compulsive checkingCompulsive checkingCompulsive washingCompulsive washingCompulsive counting Compulsive counting Compulsive rituals Compulsive rituals 固定程序固定程序Obsessive-compulsive disorde
15、rObsessive-compulsive disorder强迫性精神障强迫性精神障碍碍16Amnesia健忘症健忘症It is a loss of memory.Anterograde顺行性顺行性could not remember could not remember events even after a few seconds or minutes.events even after a few seconds or minutes.Retrograde 逆行性逆行性could not recall pre-could not recall pre-existing memories.
16、existing memories.17DementiaDementia痴呆痴呆It is a chronic or persistent It is a chronic or persistent disorder of the mental processes disorder of the mental processes characterized by loss of characterized by loss of intellectual abilities,memory intellectual abilities,memory disorders and changes in
17、 disorders and changes in personality,deteriorationpersonality,deterioration恶化恶化 of of personal care,impaired reasoning personal care,impaired reasoning ability,and disorientation.ability,and disorientation.Mental retardationMental retardation智力迟钝智力迟钝It is an abnormal lack of It is an abnormal lack
18、of intelligence as determined by IQ intelligence as determined by IQ testing.testing.18Senile dementia(Senile dementia(AlzheimersAlzheimers disease)disease)老年老年痴呆痴呆 is an example of chronic brain is an example of chronic brain syndrome,in which the brain atrophiessyndrome,in which the brain atrophie
19、s萎缩萎缩,resulting in the loss of memory and resulting in the loss of memory and intellectual functions,altered personality intellectual functions,altered personality and other symptoms.and other symptoms.19http:/ is a state of mind characterized by It is a state of mind characterized by excessive chee
20、rfulness and hyperactivity,excessive cheerfulness and hyperactivity,disorganization of behavior,and elevation of disorganization of behavior,and elevation of mood.mood.CoreCore核心核心 symptom:the elevation of mood(feel symptom:the elevation of mood(feel good even high)good even high)Easily changed,irri
21、tabilityEasily changed,irritability过敏性的过敏性的 易怒的易怒的InflatedInflated膨胀的膨胀的 self-esteemself-esteemIncrease psychomotor activity(rapid thinking Increase psychomotor activity(rapid thinking and speech,distractibilityand speech,distractibility注意力分散注意力分散)Decreased social inhibition with apparent Decreased
22、social inhibition with apparent disregard for potentially harmful disregard for potentially harmful consequences(sexual over-activity,recklessconsequences(sexual over-activity,reckless鲁莽的鲁莽的 spending,dangerous driving,spending,dangerous driving,inappropriate businessinappropriate business)20Depressi
23、onIt is a mental state characterized by excessive sadness.Core symptom:depressed moodLoss of interestAnhedonia Negative,pessimistic thoughts about the self(low self-esteem),the world and the futureGuilt and worthlessness or death or suicide21Apathy 冷漠冷漠It is loss of interest or emotional involvement
24、.22Anxiety Anxiety It is an abnormal and overwhelming sense of It is an abnormal and overwhelming sense of apprehension and fear.apprehension and fear.Involving subjective fear,bodily discomfort Involving subjective fear,bodily discomfort and physical symptomsand physical symptomsPathological anxiet
25、yPathological anxietyPresent in discrete attacks with no external Present in discrete attacks with no external stimulus(panic disorder)stimulus(panic disorder)Present in discrete attacks with feared Present in discrete attacks with feared stimuli(phobias)stimuli(phobias)Present in generalized,persis
26、tent state Present in generalized,persistent state(generalized anxiety disorder)(generalized anxiety disorder)23PhobiaPhobiaIt is an exaggeratedIt is an exaggerated夸张的夸张的,usually,usually unreasonable,fear of someone or something.unreasonable,fear of someone or something.AgoraphobiaAgoraphobiaSocial
27、phobiaSocial phobiaSimple phobia/specific phobiaSimple phobia/specific phobia24Summany 25Illusion Hallucination Delusion Obsession Compulsion Amnesia Dementia Mental retardation Mania Depression Apathy Anxiety Phobia Case study 1An 84-year-old woman is admitted to an acute medical ward.She lives alo
28、ne.According to her neighbour she remained active until a few days ago.He recalls she was in hospital with a chest infection last year,but has never noticed her having any problems with her memory or any abnormal thoughts.She was admitted with confusion,after being found on the floor by paramedics.T
29、he patient tells you she was beaten up by the secret service who took her to a police station.She believes the secret police followed her home due to connections that her dead husband had with a foreign police force.26She is irritable and has at times asked to go home as she believes she is still in
30、 the police station and has spent enough time there.She describes seeing many police officers sitting around drinking tea.Her speech is difficult to follow.27Case study 2A 25-year-old woman lives with her mother.She was referred by her GP after she told him at a routine appointment that she often ha
31、s an overwhelming impulse to jump in front of a train when she is standing at a station.This has alarmed her as she does not want to die.She has never harmed herself and has never wanted to.She has recently lost her job due to consistent poor time-keeping.Although she wakes several hours before she
32、needs to leave the house,she cannot bear to leave until she has washed herself at least five times.28If she touches the floor with her bare feet after her shower she has to start again.If she does not do this the thoughts of being contaminated with dirt become unbearable.She commnets that she knows
33、her thoughts are“not logical”and feels frustrated that she cannot stop her excessive washing.29Diagnosis ICD-10(International Classification of Diseases)DSM-5(Diagnostic and Statistical Manual of Mental Disorders)CCMD-3(Chinese Classification and Diagnostic Criteria of Mental Disorders)30The categor
34、ies of mental disorders in DSM-31Schizophrenia Schizophrenia is a severe mental disorder characterized by withdrawal from reality,delusions,hallucinations,and changes in both behavior and mood.Schizophrenia is mainly divided into simple type,hebephrenic type,catatonic type,paranoid type and undiffer
35、entiated type.Life-time prevalence 1%Onset age 18-25 years for men and 21-30 years for women32Subtypes of schizophreniaSchizophrenia has also been subdivided on the basis of psychopathology,course,and response to treatmentHebephrenic schizophrenia/disorganized schizophreniaParanoid schizophreniaCata
36、tonic schizophreniaSimple schizophreniaUndifferentiated schizophrenia33Paranoid schizophreniaThis type is the most common form of the illness.Is characterized by prominent突出的突出的 paranoid delusion,thought processes and mood are relatively sparedThe patient may appear normal until his abnormal beliefs
37、 are uncovered揭露揭露.34Catatonic schizophreniaThis type is much less frequently now than in previous yearsMotor disturbance is the dominant featureStupor昏迷昏迷(psychomotor inhibition),waxy flexibility蜡样屈曲蜡样屈曲,mutism缄默症缄默症,negativism否定论否定论 and stereotyped陈旧的陈旧的 act or speechAgitated hyperactivity(cataton
38、ic excitment)35Hebephrenic schizophreniaAbout 11%of patients can be diagnosed this typeIs characterized by the absence of systematized delusions and the presence of incoherence and inappropriate affectSilly and childish behavior36Simple schizophreniaAbout 2%of patients can be diagnosed this type.Is
39、characterized by the insidious隐忧的隐忧的 development of odd behavior,social withdrawal,and declining performance at workClear symptoms are absentDifficult to identify reliablyPoor outcome37Undifferentiated schizophreniaThis type is the next most frequent formDelusions and hallucinations of any type are
40、prominent and are accompanied by incoherence and grossly of disorganized behavior.38Mood/affective disordersMood is a sustained持续的持续的 emotional tone情绪情绪基调基调 perceived along a normal continuum of sad to happy.Mood disorders are characterized by abnormal feelings of depression or euphoria精神欢快精神欢快 with
41、 associated psychotic features in some severe cases.39The classification 40Manic episode/mania Depression(unipolar)Dysthymia Bipolar disordersCyclothymia Clinical presentationsManic episode躁狂发作躁狂发作Major depressive episode抑郁发作抑郁发作41Manic episodeThree“high”symptomsEuphoric mood/elationAccelerated thou
42、ght process and speech(flight of ideas)Increase in activity42Major depressive episodeThree“low”symptomsDepressed mood情感低落情感低落(core symptom)Diminished ability to think or concentratePsychomotor retardation精神运动性障碍精神运动性障碍43Neurosis Psychosis Neurosis is a mental illness in which insight is retained but
43、 there is a maladaptive不适应的不适应的 way of behaving or thinking that causes suffering.1,absence of organic causes2,relatively good social function3,considerable insight44NeurosesAnxietyPhobiaObsessive-compulsive disorderSomatoform disorders躯体病样精神障碍躯体病样精神障碍Neurasthenia神经衰弱症神经衰弱症45Anxiety Not attributable
44、引起引起 to real dangerPersist state generalized anxiety disorderUnexpected attack panic disorder46GAD CLINICAL FEATURESPsychological symptoms Physical symptoms Sleep disturbance47Psychological symptomsFree-floating anxietyAnticipatory anxietyWorrying thoughtRestlessnessIrritablePoor concentration48Phys
45、ical symptomsCardiovascular Palpitation,discomfort in chest,pain over the heartRespiratory Constriction in the chest,difficulty inhaling,overbreathingGastrointestinal Dry mouth,difficulty in swallowing,epigastric discomfortNeuromuscular Headache,tremor,tinnitus,dizziness,aching muscles49Sleep distur
46、banceDifficulty falling asleepWaking up in the middle of sleepingEarly morning awakening50Panic disorderPanic disorder is characterized by recurrent episodic severe panic(anxiety)attacks,which occur unpredictably and are not restricted to any particular situation or set of circumstances.51Panic atta
47、cks are discrete periods of intense fear,impending doom or discomfort,accompanied by characteristic symptoms:palpitations,tachycardia,sweating,trembling,breathlessness,feeling of choking,chest pain/discomfort,nausea/abdominal discomfort,dizziness,paraethesias,chills and hot flushes,derealization,dep
48、ersonalization and fear of losing control,“going crazy”or dying.Not in real danger5-20 min,1hWithout impairment of consciousnessAbsence of organic causes52Obsessive-compulsive disorderObsessions ThoughtsruminationsdoubtsImpulseCompulsions CheckingWashingCounting Rituals 53Phobia Provoked by particul
49、ar objects or circumstancesAcute attackAvoidanceClassification AgoraphobiaSocial phobiaSimple phobia54Agoraphobia Common themesCrowdingConfinement Open spacesSocial situationPublic transportationCrowded shopsEmpty streetsCinemas,theatres55Social phobia Common themeBeing observed and open to criticis
50、mCommittees,seminarsSocial gatheringsWriting or performing in front of othersEating or drinking in publicEye to eye56Simple phobiaCommon theme(Inappropriate anxiety)Animals,insectsBloodSharp objectsNatural phenomenon57Hysteria/dissociative(conversion)disorder Hysteria is a psychoneurosis marked by e
