Chapter 22 Psychiatry

Introduction

• Psychiatry is the medical field focused on diagnosing, treating, and preventing mental illness. It includes both psychological and chemical/structural elements.

• Psychiatrists:

  • Complete medical training (4 years of medical school).

  • Receive an MD (Doctor of Medicine) or OD (Doctor of Osteopathy) degree.

  • Specialized training in psychotherapy (psychological treatment techniques) and psychopharmacology (drug therapy).

  • Complete 3 years of residency, with further specialization through fellowship training.

  • Can specialize in child psychiatry, forensic psychiatry, or psychoanalysis.

• Psychologist:

  • A nonmedical professional trained in psychological testing, psychotherapy, and research.

  • Holds degrees like PhD, PsyD, or EdD.

  • Clinical psychologists treat patients with psychotherapy but cannot prescribe medication or perform electroconvulsive therapy (ECT).

• Other Mental Health Professionals:

  • Licensed Clinical Social Workers (LCSWs), psychiatric nurses, and Licensed Mental Health Clinicians (LMHCs) are involved in treatment.

• Clinical Psychologists use various tests for mental health assessment:

  • IQ tests: Assess intellectual functioning (e.g., Wechsler Adult Intelligence Scale, Stanford-Binet Intelligence Scale).

  • Projective Personality Tests: Use ambiguous stimuli (e.g., Rorschach Inkblot Test, Thematic Apperception Test) to reveal personality and emotions.

  • Graphomotor Projection Tests: Evaluate drawing tasks (e.g., Draw a Person Test, Bender-Gestalt Test) to assess cognitive processing and memory.

  • Minnesota Multiphasic Personality Inventory (MMPI): A test with true/false questions to evaluate personality and psychological health.

Definitions of bolded terms:

• Psychiatry: Medical specialty for treating mental disorders.

• Psychopharmacology: The study of drugs used in treating mental disorders.

• Psychotherapy: Treatment involving psychological techniques.

• Psychoanalysis: A psychotherapeutic method where patients express thoughts freely for interpretation.

• Psychologist: A nonmedical expert in mental health treatment and testing.

• Electroconvulsive Therapy (ECT): A medical procedure using electrical currents to treat severe mental disorders.

• Projective Tests: Tests involving ambiguous stimuli (like inkblots or pictures) to reveal personality and emotions.

• IQ Tests: Tests measuring intellectual ability.

• Bender-Gestalt Test: A test for assessing brain function and developmental delays using drawings.

• Minnesota Multiphasic Personality Inventory (MMPI): A personality and mental health assessment tool based on patient responses.

Psychiatric clinical symptms

• Amnesia: Loss of memory.

• Anxiety: Varying degrees of uneasiness, apprehension, or dread, often accompanied by physical symptoms like palpitations, tightness in the chest, breathlessness, and choking sensations.

• Apathy: Absence of emotions; lack of interest, emotional involvement, or motivation.

• Compulsion: Uncontrollable urge to perform an act repeatedly to reduce anxiety.

• Conversion: Anxiety manifesting as a bodily symptom (like blindness, deafness, or paralysis) without a physical cause.

• Delusion: A fixed, false belief that cannot be altered by logical reasoning or evidence.

• Dissociation: Splitting off uncomfortable thoughts from conscious awareness to avoid distress; extreme cases may lead to multiple personalities.

• Dysphoria: Intense feelings of depression, discontent, and general dissatisfaction with life.

• Euphoria: Intense feelings of well-being, happiness, excitement, and joy.

• Hallucination: False or unreal sensory perception, such as hearing voices when none are present. An illusion is a misperception of an actual sensory stimulus (e.g., hearing voices in rustling leaves).

• Labile: Emotional state that is variable and undergoes rapid changes.

• Mania: Elevated mood state with talkativeness, hyperactivity, euphoria, and racing thoughts.

• Mutism: The inability to speak or having very little ability to speak.

• Obsession: An involuntary, persistent idea or emotion; often indicated by the suffix "-mania" (e.g., pyromania is an obsession with fire).

• Paranoia: Overly suspicious thinking; a fixed delusion that one is being persecuted or unfairly treated.

Psychiatric Disorders

Freud's Personality Structure:

• Id: Represents unconscious drives and instincts that seek immediate gratification, governed by the pleasure principle.

• Ego: The rational, reality-testing part of the personality that mediates between the id and the external world.

• Superego: Represents the internalized moral compass, influenced by parental and societal standards, leading to feelings of guilt when violated.

Psychotic Disorders:

• These involve severe impairment of reality testing and may include delusions, hallucinations, and disorganized behavior. Psychosis often leads to withdrawal from reality.

Anxiety Disorders:

• Panic Disorder: Involves recurrent, unexpected panic attacks characterized by physical symptoms like palpitations, chest pain, and feelings of losing control.

• Phobic Disorders: Intense, irrational fear of specific objects or situations, such as agoraphobia (fear of open spaces) or social phobia (fear of public embarrassment).

• Obsessive-Compulsive Disorder (OCD): Marked by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) to alleviate anxiety.

• Post-Traumatic Stress Disorder (PTSD): Develops after experiencing trauma, involving symptoms like flashbacks, nightmares, and heightened anxiety.

• Generalized Anxiety Disorder (GAD): Chronic, excessive worry without clear cause.

Bipolar Disorders:

• Involve mood swings between manic episodes (euphoria, irritability, impulsivity) and depressive episodes (extreme sadness and hopelessness).

• Bipolar I: Manic episodes with possible major depression.

• Bipolar II: Recurrent depression with hypomanic episodes.

• Cyclothymic Disorder: A milder form of bipolar disorder with less severe mood fluctuations.

Depressive Disorders:

• Major Depressive Disorder: Involves persistent feelings of sadness, hopelessness, and other symptoms like appetite changes and sleep disturbances.

• Persistent Depressive Disorder (Dysthymia): A less severe but chronic form of depression lasting at least 2 years.

• Seasonal Affective Disorder (SAD): Depression that occurs seasonally, often in the winter months, with a possible switch to mania in the spring.

Dissociative Disorders:

• These involve disruptions in memory, identity, or perception.

• Dissociative Identity Disorder (DID): Characterized by two or more distinct personalities within one person.

• Dissociative Amnesia: Involves the inability to recall significant personal information, often related to trauma.

• Depersonalization/Derealization Disorder: Involves feelings of detachment from one’s body or surroundings.

Eating Disorders:

• Anorexia Nervosa: Characterized by a refusal to maintain a normal body weight, an intense fear of gaining weight, and a distorted body image. It primarily affects adolescent females, and individuals may also engage in excessive exercise. Amenorrhea (absence of menstruation) is common.

• Bulimia Nervosa: Involves binge eating followed by purging (self-induced vomiting, laxative misuse) to prevent weight gain. People with bulimia maintain a normal or near-normal weight.

Neurocognitive Disorders:

• Delirium: An acute disturbance in cognition, including confusion, disorientation, and changes in behavior. It can be caused by factors like drug use, head trauma, or metabolic disturbances. Delirium typically resolves with treatment.

• Dementia: Progressive loss of cognitive abilities such as memory, reasoning, and judgment. Alzheimer's disease is the most common cause, though other conditions like stroke or brain trauma can also lead to dementia.

Neurodevelopmental Disorders:

• Intellectual Disability Disorders: Deficits in intellectual functioning and the ability to adapt to daily life activities.

• Communication Disorders: Difficulties in language acquisition, such as stuttering or limited vocabulary.

• Autism Spectrum Disorder (ASD): Involves difficulties in social interactions, communication, and repetitive behaviors. High-functioning autism (formerly Asperger syndrome) involves individuals with normal intelligence and language skills but challenges with social interaction.

• Attention-Deficit/Hyperactivity Disorder (ADHD): A pattern of inattention, hyperactivity, and impulsivity that interferes with functioning.

• Specific Learning Disorders: Difficulty with academic skills, such as reading or mathematics.

• Motor Disorders: Include lack of coordination, movement disorders, and tics.

Personality Disorders:

• Cluster A (Odd/Eccentric):

  • Paranoid: Distrust and suspicion of others.

  • Schizoid: Detachment from social relationships and limited emotional expression.

  • Schizotypal: Discomfort in close relationships, odd beliefs, or magical thinking.

• Cluster B (Dramatic/Emotional):

  • Antisocial: Disregard for others' rights and desires.

  • Borderline: Instability in relationships, impulsivity, and identity issues.

  • Histrionic: Attention-seeking, emotionality, and dramatic behavior.

  • Narcissistic: Grandiosity, need for admiration, and lack of empathy.

• Cluster C (Anxious/Fearful):

  • Avoidant: Social inhibition and fear of criticism.

  • Dependent: Excessive need to be cared for, leading to submissive behaviors.

  • Obsessive-Compulsive: Preoccupation with orderliness and perfectionism.

Schizophrenia Spectrum and Psychotic Disorders:

• Delusions: Fixed false beliefs (e.g., persecutory or grandiose delusions).

• Hallucinations: False sensory perceptions, such as hearing voices that aren't present.

• Disorganized Thinking: Incoherent speech or rapid topic changes.

• Abnormal Motor Behavior: Includes behaviors ranging from childlike silliness to agitated, unpredictable actions.

• Negative Symptoms: These include a lack of emotional expression (flat affect) and a lack of motivation to initiate purposeful activities.

Sexual Dysfunctions and Paraphilias:

Sexual Dysfunctions:

• Sexual dysfunctions are conditions that impair a person’s ability to experience sexual pleasure or engage in sexual activities effectively. These can include:

  • Delayed or Premature Ejaculation

  • Orgasmic Disorders

  • Sexual Interest/Arousal Disorders

  • Pelvic Pain Disorders

Paraphilias:

• Paraphilias involve recurrent sexual urges or fantasies directed toward unusual objects, activities, or situations. Examples include:

  • Exhibitionism: Compulsive need to expose oneself to an unsuspecting person.

  • Fetishism: Sexual attraction to non-living objects, such as clothing.

  • Pedophilia: Sexual attraction to prepubescent children (13 or younger).

  • Sexual Masochism: Gaining sexual gratification from being humiliated, beaten, or made to suffer.

  • Sexual Sadism: Deriving sexual pleasure from inflicting pain or humiliation on others.

  • Transvestic Fetishism: Sexual arousal from cross-dressing.

  • Voyeurism: Sexual excitement from watching others undress or engage in sexual activities without their knowledge.

Somatic Symptom Disorders:

These disorders involve the expression of psychological distress as physical symptoms. Common conditions include:

• Somatic Symptom Disorder: The presence of distressing physical symptoms with high anxiety, often without a medical cause.

• Illness Anxiety Disorder: Preoccupation with having a serious illness despite few or no symptoms. The person engages in excessive health-checking behaviors.

• Conversion Disorder: Neurological symptoms, like paralysis or blindness, with no organic cause. These symptoms often stem from unconscious psychological conflicts, allowing the person to avoid emotional distress.

Substance-Related and Addictive Disorders:

These disorders involve dependence on substances that affect the central nervous system (CNS). Key characteristics include psychological dependence (compulsion to continue using) and physiological dependence (withdrawal symptoms when stopping). Notable substances include:

• Alcohol: Intoxication and dependence may lead to slurred speech, impaired coordination, and memory issues. Often co-occurs with other drug use and depression.

• Amphetamines: CNS stimulants (e.g., methamphetamine, Ritalin) cause anger, anxiety, and social isolation. Withdrawal leads to depression.

• Cannabis: Includes marijuana and hashish, causing euphoria, impaired coordination, and memory issues. It may lead to anxiety, paranoia, and a heightened appetite.

• Cocaine: A powerful stimulant that causes euphoria, violence, and elevated heart rate. Long-term use can damage the nasal passages and increase addiction risks.

• Hallucinogens: Drugs like LSD, PCP, and peyote cause hallucinations, mood changes, and difficulty recognizing reality. They may result in irrational behavior.

• Opioids: Drugs like heroin and morphine are powerful painkillers. Symptoms of overdose include slow breathing and possible death.

• Sedatives, Hypnotics, or Anxiolytics: Benzodiazepines (e.g., Valium, Xanax) have calming effects but can lead to dependence. Intoxication leads to confusion and slurred speech.

Therapeutic Modalities

Here’s a summarized version in bullet points:

Psychotherapy

• Cognitive-Behavioral Therapy (CBT): Short-term therapy focusing on changing negative thoughts and behaviors. Effective for depression, anxiety, anger, marital conflicts, and substance abuse.

• Family Therapy: Involves the entire family in treatment to resolve and understand conflicts and issues.

• Group Therapy: Patients with similar issues interact and gain insight from each other. Includes psychodrama, where patients act out roles to express feelings.

• Hypnosis: Uses a trance-like state to recover repressed memories, reduce anxiety, and solve psychological problems.

• Insight-Oriented Psychotherapy: Focuses on understanding underlying conflicts, thoughts, and behavior patterns through face-to-face discussions.

• Play Therapy: A form of therapy for children where they use play to express emotions and conflicts they cannot verbally communicate.

• Psychoanalysis: Long-term therapy focusing on bringing unconscious conflicts to the surface through free association, transference, and dream interpretation.

• Sex Therapy: Helps individuals overcome sexual dysfunctions like frigidity, impotence, and premature ejaculation.

• Supportive Psychotherapy: Provides encouragement, support, and hope during difficult life transitions or events.

Electroconvulsive Therapy (ECT)

• ECT involves applying electrical current to the brain (while the patient is anesthetized) to treat severe depression, especially psychotic depression, and is a life-saving option when a quick response is needed.

Drug Therapy

• Antianxiety and Antipanic Agents: Includes benzodiazepines (e.g., clonazepam) and SSRIs to reduce anxiety, tension, and agitation, especially in panic attacks.

• Antidepressants: Includes SSRIs (e.g., fluoxetine), SNRIs (e.g., venlafaxine), Tricyclics (e.g., amitriptyline), and MAO inhibitors (e.g., phenelzine) to treat depression.

• Anti-OCD Agents: SSRIs and tricyclic antidepressants used to relieve symptoms of obsessive-compulsive disorder.

• Antipsychotics: Atypical (e.g., risperidone) and first-generation (e.g., phenothiazines) drugs used to treat psychosis, including delusions and hallucinations.

• Mood Stabilizers: Lithium (used in bipolar disorder) and anticonvulsants (e.g., valproate) to manage mood swings.

• Hypnotics: Drugs like sedatives and benzodiazepines used to treat insomnia.

• Stimulants: Amphetamines prescribed to treat ADHD, improving focus and managing hyperactivity and impulsivity.

Vocabulary

Here is the information in table format:

Therapy

Terminology

Combining Forms

Suffixes

Phobias

Prefixes

Abbreviations

Review

A

1. physician specializing in treating mental illness
   Answer: psychiatrist

2. nonphysician professionals trained in the treatment of mental illness
   Answer: psychologist

3. therapist who practices psychoanalysis
   Answer: psychoanalyst

4. branch of psychiatry dealing with legal matters
   Answer: forensic psychiatry

5. unconscious part of the personality
   Answer: id

6. conscious, coordinating part of the personality
   Answer: ego

7. conscience or moral part of the personality
   Answer: superego

8. psychological process used to distinguish fact from fantasy
   Answer: reality testing

9. unconscious technique used to resolve or conceal conflicts and anxiety
   Answer: defense mechanism

10. branch of psychology dealing with patient care
    Answer: clinical

B

Here are the fill-in-the-blank answers based on the provided definitions:

1. nonreactive state marked by inability to speak
   Answer: mutism

2. state of excessive excitability; agitation
   Answer: mania

3. loss of memory
   Answer: amnesia

4. uncontrollable urge to perform an act repeatedly
   Answer: compulsion

5. persistent idea, emotion, or urge
   Answer: obsession

6. feelings of apprehension, uneasiness, dread
   Answer: anxiety

7. uncomfortable feelings are separated from their real object and redirected toward a second object or behavior pattern
   Answer: dissociation

8. anxiety becomes a bodily symptom that has no organic basis
   Answer: conversion

9. absence of emotions; lack of motivation or emotional involvement
   Answer: apathy

10. fixed false belief that cannot be changed by logical reasoning or evidence
    Answer: delusion

11. false or unreal sensory perception
    Answer: hallucination

C

Here are the terms based on the provided definitions:

1. dysphoria
   Feedback: sadness, hopelessness, unpleasant feeling

2. euphoria
   Feedback: exaggerated feeling of well-being (“high”)

3. amnesia
   Feedback: loss of memory

4. paranoia
   Feedback: suspicious system of thinking; fixed delusion that one is being treated unfairly or harassed

5. psychosis
   Feedback: loss of contact with reality; often delusions and hallucinations

6. iatrogenic
   Feedback: pertaining to a disorder caused by a treatment

7. phobia
   Feedback: irrational fear (avoidance) of an object or a situation

8. agoraphobia
   Feedback: fear of leaving one's home or a safe place

9. labile
   Feedback: unstable; undergoing rapid emotional change; fluctuating

10. affect
    Feedback: expression of emotion

D

1. Disturbances of memory and identity that hide the anxiety of unconscious conflicts are dissociative disorders.

2. Troubled feelings, unpleasant tension, distress, and avoidance behavior describe a/an anxiety disorders.

3. Conditions related to regular use of drugs and alcohol are substance-related and addictive disorders.

4. Bulimia and anorexia nervosa are examples of eating disorders.

5. A disorder involving paraphilias is a/an personality disorders.

6. Disorders marked by alternating periods of mania and depression are bipolar disorders.

7. Mental conditions in which physical symptoms cannot be explained by an actual physical disorder or injury are somatic symptom disorders.

8. Lifelong patterns of thought and behavior that are inflexible and cause distress, conflict, and impairment of social functioning are personality disorders.

9. Loss of intellectual abilities with impairment of memory, judgment, and reasoning is dementia.

10. Confusion in thinking with faulty perceptions and irrational behavior is delirium.

F

1. Somatic symptom disorder: Conversion disorder

2. Sexual dysfunction: Pedophilia

3. Anxiety disorder: Phobia

4. Bipolar disorder: Alternating mania and depression

5. Substance-related and addictive disorder: Cocaine abuse

6. Schizophrenia spectrum: Negative symptoms such as flat affect and lack of initiative

7. Dissociative disorder: Fugue and identity disorder

8. Neurocognitive disorder: Delirium and dementia

9. Neurodevelopmental disorder: Autism

I

1. Patients express feelings by acting out roles with other patients: Psychodrama

2. A trance helps patients recover deeply repressed feelings: Hypnosis

3. Long-term and intense exploration of unconscious feelings uses techniques such as transference and free association: Psychoanalysis

4. Toys help a child express conflicts and feelings: Play therapy

5. Conditioning changes actual behavior patterns rather than focusing on subconscious thoughts and feelings: Cognitive behavioral therapy

6. Techniques help patients overcome sexual dysfunctions: Sexual therapy

7. Electrical current is applied to the brain to reverse major depression: Electroconvulsive therapy

8. Agents (chemicals) relieve symptoms of psychiatric disorders: Psychopharmacology

9. Face-to-face discussion of life's problems and associated feelings: Insight-oriented psychotherapy

10. Offering encouragement, support, and hope to patients facing difficult life transitions and events: Supportive psychotherapy

M

1. SSRI; treats anxiety and depression
   Answer: escitalopram (Lexapro)

2. Atypical antipsychotic; treats schizophrenia and bipolar disorder
   Answer: aripiprazole (Abilify)

3. Stimulant; treats attention deficit–hyperactivity disorder
   Answer: methylphenidate (Ritalin, Concerta)

4. Tricyclic antidepressant; treats depression
   Answer: amitriptyline (Elavil)

5. Benzodiazepine; treats anxiety and panic attacks
   Answer: alprazolam (Xanax)

6. Sedative; treats insomnia
   Answer: zolpidem (Ambien)

7. Anticonvulsant that also is used to treat bipolar disorders
   Answer: lamotrigine (Lamictal)

8. First-generation antipsychotic that treats schizophrenia
   Answer: thiothixene (Navane)