1.introduction Psychiatric & Symptoms

Introduction to Psychiatry
Dr. MUDENGE Charles , MMED (Psych)

Lecturer
School of Medicine and Pharmacy/UR
December, 2019
Definition
 Psychiatry: Psychiatry is the branch of medicine
focused on the diagnosis, treatment and prevention of
mental, emotional and behavioral disorders.
 Psych : soul or mind
 Iatros : healer
(American Psychiatric Association)
Mental Health
Mental health is defined as a state of well-being in which

every individual realizes his or her own potential, can
cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a
contribution to her or his community.
(WHO 2014)
Common confusions within psychiatry
 Psychology : a science that investigates behavior,
experience, and normal functioning of the mind
 Psychotherapy : the treatment of psychological issues
by non-physical means
 Psychoanalysis : a particular sort of psychotherapy,
or means of exploring the unconscious mind
Why Study Psychiatry ?
1- Psychiatric disorders are prevalent and often go

untreated :
 lifetime prevalence in USA : 28%
 lifetime prevalence in Iran : 10.5-21%
 only 40% receive treatment during lifetimes
 In general practice : 1/6-1/4 of the patients seen have
a psychiatric problem
Why Study Psychiatry ?…
 Depression is diagnosed in only 50% of those with

depression who present to General practitioners
 Adequate treatment ensues in only about 17% of
depressed patients in primary care settings
 Half the patients who commit suicide sought
treatment in a primary care setting within 1 month of
dying
 Two-thirds of patients with undiagnosed depression
have six visits or more a year with General
practitioners for somatic complaints
Why Study Psychiatry ?…
2- Global burden of mental disorders
3- Consideration of the psychological aspects of the
doctor-patient relationship
In Rwanda
Rwanda Mental Health Survey ( 2018)
Prevalence
Prevalence of Mental Disorders among Genocide survivors
(MHS,2018)
Bipolar disorder 0.7

Substance use disorder 1.1
Antisocial personality disorder 1.3
Suicidal behavior disorder 1.7
Epilepsy 3.2
Alcohol use disorder 4.0
Social phobia 5.0
Psychotic disorder 6.1
MDD with psychotic features 7.1
Obsessive compulsive disorder 11.6
Panic disorder 26.8
Posttraumatic stress disorder 27.9
Major depressive episode 35.0
0 5 10 15 20 25 30 35 40
Percentage
Utilization of Mental Health Support
94.7
5.3
Used support Did not use support

Barriers to Diagnosis& Treatment in
Primary Care Settings (patient factors)
 May present with a somatic complaint

 Concurrent medical illness often obscures
psychiatric symptoms
 Denial
 Stigma & shame
 The belief that psychiatric illness is untreatable
 The belief that drugs are mind-altering and/or
addictive
Barriers to Diagnosis & Treatment in
Primary Care Settings (physician factors)
 lack of time
 Fear of being embarrassed
 Uncertainty
 Fear that the patient will have an illness that is unresponsive
to treatment
 Prior negative experience
 Lack of knowledge
Common terms in psychiatric classification
Organic and functional:

 Psychiatric conditions are sometimes divided into
organic brain disorders and functional mental
illnesses
 Organic conditions are caused by identifiable physical
pathology affecting the brain, directly or indirectly, and
include, for example, learning disabilities and the
dementias
 Functional conditions have usually been attributed to
some kind of psychological stress, although in many
cases it would be more honest to say that their cause is
not known
 As knowledge advances, some ‘functional’ conditions
are likely to be reclassified as ‘organic’ (as currently
may be happening for schizophrenia), and for this
reason the term ‘organic’ is not used in DSM-5
* DSM-5: Diagnostic and Statistical Manual of Mental Disorder 5th Ed

Psychiatric Symptoms
 A notable change in the mental state of a person
 The development of new onset unusual or bizarre
behaviour
 A diminished level of functioning in one or more of
the following areas:
 Self-care: bathing, dressing, eating
 Family relations - spouse, children, other relatives
 Attendance/performance at work or school
 Doing housework or household tasks
 Social activities, seeing friends
Psychiatric Symptoms cont…
 subjective distress (sadness, fear, irritability)
 Agitation, outbursts of anger, potential for violence,
homicidal thoughts
 Suicidal thoughts or recurrent thoughts of death
 Disturbed sleep and appetite
 Diminished concentration, impairment in complex
thinking, difficulty in learning new tasks
 Emotional numbing or lack of a full range of emotions
 The presence of delusions and hallucinations
 Abnormal behaviour
 Agitation, frightening or unusually impulsive behaviour
 Unkempt appearance and odd ways of relating to others or
odd mannerisms
 Disorganized or strange speech, thoughts or behaviour
 Reporting or responding to hallucinations (e.g. reacting to
false or imagined perceptions)
 Reporting or responding to delusions (e.g. fixed false
beliefs)
 Sad/Anxious States of Mind
 Sad or low mood
 Fatigue/loss of energy/tiredness
 Loss of interest or pleasure
 Guilt or loss of self-confidence
 Loss of sexual desire
 Disturbed appetite (weight loss or gain)
 Feeling tense, anxious, excessively worried, or frightened
 Sad/Anxious States of Mind (cont.)
 Reliving past traumas in thoughts, images, dreams, or acts
 Unexplained somatic symptoms
 Aches and pains
 Tingling, numbness (e.g. pins and needles sensations)
 Shortness of breath (e.g. sense of suffocation)
 Palpitations
 Gastrointestinal distress

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Introduction to Psychiatry

Dr. MUDENGE Charles , MMED (Psych)

Mental health is defined as a state of well-being in which

1- Psychiatric disorders are prevalent and often go

 Depression is diagnosed in only 50% of those with

Bipolar disorder 0.7

Used support Did not use support

 May present with a somatic complaint

Organic and functional:

* DSM-5: Diagnostic and Statistical Manual of Mental Disorder 5th Ed

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