Psychiatry and Psychology Notes 1-5

Psychiatry

  • Definition: The branch of medicine focused on the diagnosis, treatment, and prevention of mental illness. The term is derived from "psych/o" (mind) and "iatr/o" (treatment).
  • Specialty: Considered a specialty within clinical medicine, similar to surgery, internal medicine, pediatrics, and obstetrics.
  • Psychiatrists:
    • Possess an MD (Medical Doctor) degree.
    • Complete medical school, an internship, and a residency.
    • Undergo extensive training in psychotherapy and psychopharmacology.
    • Complete a 4-year residency, with potential for additional fellowship training to specialize in areas such as:
      • Child psychiatry: Treatment of mental illness in children.
      • Forensic psychiatry: Focuses on the legal aspects of psychiatry, such as assessing an individual's mental competency to stand trial.
      • Psychoanalysis: Requires specialized training in psychoanalytic techniques.

Psychology

  • Definition: The study of the mind. The term is derived from "psych/o" meaning mind and "ology" meaning the study of.
  • Psychologists:
    • Typically hold a Ph.D. (Doctor of Philosophy) in Psychology, obtained after a bachelor's and master's degree.
    • The degree is more academic focused.
  • Limitations:
    • Non-medical professionals restricted in treating mental illness.
    • Primarily involved in research and counseling.
  • Specializations:
    • Clinical psychology: Work in clinical settings like hospitals or outpatient facilities, collaborating with psychiatrists to treat patients.
    • Experimental psychology: Conduct research in various areas of psychology.
    • Social psychology: Study social interaction and behavior.
  • Treatment:
    • Clinical psychologists can use psychotherapy to treat patients.
    • Cannot prescribe medications or perform ECT (Electroconvulsive Therapy).
  • Assessment Tools: Trained in using various tools to assess a patient's mental health and intelligence, such as:
    • Wechsler Adult Intelligence Scale (WAIS)
    • Stanford-Binet Intelligence Scale

Psychological Tests

  • Personality Tests:
    • Rorschach Technique:
      • Utilizes 10 cards with ink blots.
      • Patients describe what they see in the ink blots.
      • The psychologist analyzes patterns in the patient's responses to gain insight into their thoughts and mental state.
    • Thematic Apperception Test (TAT):
      • Involves using pictures as stimuli for creating stories.
      • Patients are asked to tell a story based on the picture, addressing elements like:
        • The setting
        • The actions taking place
        • The dialogue between characters
        • The relationships between characters

Psychiatric Clinical Symptoms

  • Amnesia: Loss of memory.
  • Anxiety: Varying degrees of uneasiness, apprehension, or dread, often accompanied by physical symptoms like palpitations, chest tightness, breathlessness, and choking sensations.
  • Apathy: Absence of emotions; lack of interest, emotional involvement, or motivation.
  • Compulsion: Uncontrollable urge to perform an act repeatedly.
  • Conversion: Anxiety transforming into a bodily symptom. In severe cases, this can manifest as blindness, deafness, or paralysis without a physical basis.
  • Delusion: Fixed false belief that cannot be changed by logical reasoning or evidence. Different from hallucination, where a delusion is a belief that is not true that cannot be changed.
  • Dissociation: Uncomfortable thoughts are split off from conscious awareness to avoid mental distress. In extreme cases, this can lead to multiple personalities.
  • Dysphoria: Intense feelings of depression, discontent, and generalized dissatisfaction with life. (dys- = difficult/bad, phor- = to carry).
  • Euphoria: Intense feelings of well-being, elation, happiness, excitement, and joy. (eu- = good/well, phor- = to carry).
  • Hallucination: False or unreal sensory perception, such as hearing voices when none are present. Can be caused by mental illness or drugs. Different from illusion, which is a misperception of an actual sensory stimulus (e.g., hearing a voice in rustling leaves).
  • Labile: Emotionally variable; undergoing rapid emotional changes (e.g., crying one minute, laughing the next).
  • Mania: Elevated, expansive state with talkativeness, hyperactivity, euphoria, and racing thoughts.
  • Mutism: No, or very little, ability to speak.
  • Obsession: Involuntary, persistent idea or emotion.
    • The suffix -mania indicates a strong obsession with something (e.g., pyromania: obsession with fire).
  • Paranoia: Overly suspicious system of thinking; fixed delusion that one is being harassed, persecuted, or unfairly treated; feeling like a victim.

Psychiatric Disorders

  • Sigmund Freud's Personality Theory:
    • Id: Represents unconscious instincts and psychic energy present from birth. It contains basic drives that operate according to the pleasure principle, seeking immediate gratification regardless of the reality of the situation.
    • Ego: The central coordinating branch of the personality. It mediates between the id and the outside world. It deals with reality, postponing gratification until a satisfactory object or situation arises. The ego is perceived as being "self" by the individual.
    • Superego: The internalized conscience and moral part of the personality. It encompasses the sense of discipline derived from parental authority and society. This is where guilt feelings arise from behavior and thoughts that do not conform to the standards of the superego.
  • Psychosis: Frequently used to describe abnormal conditions that affect the mind, especially where there has been a loss of contact with reality.
    • Psychotic disorders involve significant impairment of reality testing and may include delusions (false beliefs), hallucinations (false sensory perceptions), and bizarre behavior.
    • Patients exhibit a disturbed sense of self, inappropriate affect (emotional reactions), and withdrawal from the external world.
      Psychiatric disorders discussed include anxiety disorders, bipolar disorders, depressive disorders, dissociative disorders, eating disorders, neurocognitive disorders, neurodevelopmental disorders, personality disorders, schizophrenia spectrum and other psychotic disorders, sexual dysfunctions and paraphilias, somatic symptom disorders, and substance-related and addictive disorders.

Anxiety Disorders

  • Anxiety Disorders: Characterized by the experience of unpleasant tension, distress, troubled feelings, and avoidance behavior.
  • Panic Attack: Abrupt surge of intense fear or discomfort that reaches a peak within minutes. Symptoms and clinical signs may include:
    • Palpitations, sweating, trembling
    • Sensations of shortness of breath, feeling of choking
    • Chest pain or discomfort
    • Nausea or abdominal distress
    • Feeling dizzy or faint
    • Feelings of unreality or being detached from oneself
    • Fear of losing control or "going crazy"
    • Fear of dying
    • Numbness or tingling
  • Panic Disorder: Recurrent, unexpected panic attacks and persistent concern about having another panic attack in between episodes.
  • Phobic Disorders: Characterized by irrational or debilitating fears associated with a specific object or situation. Patients go to extreme lengths to avoid the object of their fear.
    • Agoraphobia: (agora-marketplace) Fear of being in open, crowded, public places from which escape would be difficult or in which help might not be available, or of going out alone in "unsafe" places.
      • People with agoraphobia limit their normal activities to avoid situations that trigger their anxiety.
      • They may feel comfortable only when at home or in the company of a friend or relative.
    • Social Phobia (Social Anxiety Disorder): Fear of situations in which the affected person is open to public scrutiny, which could result in possible embarrassment and humiliation.
      • For example, the fear may focus on speaking in public, using public restrooms, or eating in public.
    • Claustrophobia: (claustra/o = barrier) Fear of closed-in spaces.
    • Acrophobia: (acr/o = a high point) Fear of heights.
    • Zoophobia: (zo/o = animals) Fear of animals.
  • Post-Traumatic Stress Disorder (PTSD): Development of symptoms (intense fear, helplessness, insomnia, nightmares, and diminished responsiveness to the external world) following exposure to a traumatic event.
    • Flashbacks, bothersome thoughts, and anxiety often triggered by reminders occur in episodes long after a life-threatening or major emotional event.
  • Generalized Anxiety Disorder (GAD): Chronic anxiety and exaggerated worry and tension, even when there is little or nothing to provoke such feelings.

Bipolar Disorders

  • Bipolar Disorders: (bi- = two; pol/o = extreme) Characterized by one or more manic episodes alternating with depressive episodes.
    • A manic episode is a period during which the predominant mood is excessively elevated (euphoria), expansive, or irritable. Associated symptoms include inflated self-esteem or grandiosity, decreased need for sleep, a nearly continuous flow of rapid speech with quick changes of topic, distractibility, an increase in goal-directed activity, and excessive involvement in pleasurable activities that have a high or painful consequence.
    • Hypomania (hypo- = decrease) describes a mood resembling mania, but of lesser intensity.
  • Bipolar Disorder I: Characterized by one or more manic episodes, often alternating with major depressive episodes.
  • Bipolar Disorder II: Characterized by recurrent major depressive episodes alternating with hypomanic episodes.
  • Cyclothymic Disorder: (cycl/o = cycle; thym/o = mind) Mild form of bipolar disorder characterized by at least 2 years of numerous periods with hypomanic symptoms that do not meet criteria for mania and depressive symptoms that do not meet the criteria for a major depressive disorder.

Depressive Disorders

  • Depressive Disorders: Occurrence of one or more major depressive episodes without a history of mania or hypomania.
  • Major Depressive Disorder: Episodes of severe dysphoria (sadness, hopelessness, worry, discouragement).
    • Other signs and symptoms are appetite disturbances (increase or decrease) and changes in weight; sleep disorders such as insomnia or hypersomnia; fatigue or low energy; feelings of worthlessness, hopelessness, or excessive or inappropriate guilt; difficulty thinking or concentrating; and recurrent thoughts of death or suicide.
  • Persistent Depressive Disorder (Dysthymia): Depressive disorder involving depressed mood (feeling sad or "down in the dumps") that persists over a 2-year period but is not as severe as major depression.
    • No psychotic features (delusions, hallucinations, incoherent thinking) as are sometimes found in major depressive disorder.