PSYCHIATRY

Introduction

Prof. LUO Xue-rong

 Objectives
After completing this lesson, we should have the ability
to:
 *Describe some concepts of psychiatry and mental
disorders.
 *Explain the etiology of mental disorders.
 *Depict the classification of mental disorders.
 Describe the relationships of psychiatry to medical
practice.

 Demonstrate interest in studying psychiatry

 SOME
Mental health
CONCEPTS
精 神 健 康 creative activities 建设性活动
a state of carry out
mental functions
Triumphantly 成功 harmonious inter-person
地
relationships 人际关系协调

the ability to acclimation

能适应环境
 SOME CONCEPTS
 Mental disorders 精神障碍
a kind of mental problems at-
tributing to diagnosis 有诊断意义

under bio-psycho-social factors

disorders of brain function
cognition, emotion, will and
or behavior
 SOME CONCEPTS
Mental disorders ： denotes a group of disor
ders(attributing to diagnosis) often with charac
teristic symptoms such as
psycho actives deviating norm remarkably,
psychotic symptoms,
social function damaged (psychosis,et al)
feeling psycho agony 痛苦 (neurosis , et a
l).
 SOME CONCEPTS

continuum 连续谱
Health Death
Sub-health Organic dis
Functional dis
Health and disease
is not a opposite 对立 bipolar 两极 st
ate.
 SOME
Psychiatry 精神病学 CONCEPTS
or mental medicine
is a science of study the
etiology 病因 ,
pathology 病理 ,
manifestation 临床表现
prognosis 预后
treatment 治疗
prevention 预防
of mental disorders
 SOME CONCEPTS
clinical medical specialty

Some branch of Psychiatry

•Social or cross-cultural;
•Forensic 司法 ;
•Child 儿童 ;
•Geriatric 老年 ;
brain

•psychopharmacology;
•psycho-pathology
•biological 生物
•others
 SOME CONCEPTS
Mental health is been
paying more attention to

•25%-30% emergency patients are or have mental

disorders, also hospital inpatients.
•10% people are hospitalized because of mental
disorders.
•1/3-1/4 people need psychological consultation.
•More than 15% burden of disease is due to mental
disorders.
 SOME CONCEPTS
Brain and mental activity
The configuration is complex
The configuration is complex
 a hundred billions neurons and even muc
h more glial ( 胶质 ) cells;
 one neuron has more then 1000 links wit
h others;
 one has about 10 thousands billions synap
ses in one’s brain.
 There are countless circuit pathways in o
ur brain
 SOME CONCEPTS
Neuro-chemical
Brain and mental substance
activity
 100+ kinds of neurotransmitters
( 递质 );
 Even more receptors ( 受体 ): ligan
d-gated channel and G protein-link
ed receptors
And the plasticity of brain 脑可朔性
 The Etiology Of Mental Diseases

 Biological factors ( 生物因素 )

 Psychosocial factors ( 心理社会因素 )

 Biological Factors
Inheritance factor （遗传因素） :
abnormal chromosome length, sequences 次序
or translocation 异位， gene mutation 基因突
变 may lead to mental disorders.
Most mental disorders are polygene heredity, wh
ether onset depend on the heritability 遗传度 .

 Infection, somatic disease, intoxication, ect.

 Psychosocial factors
 Stress-related life  Race 种族
event 生活应激事件  Religion 宗教
 Personality 性格  Gender 性别
 Parenting 教养
 Interpersonal relati
onship  Cultural background

 Emotional state
 Social class
 Economy status
 The relationship of the Bio-psycho-
social factors to mental disorders

 Correlation; Risk factor; Consequence and

cause
 Onsets of mental disorders:

Psychosocial factors
p

Biological factors
 The classification of mental disorders

definition
a process of classifying mental
disorders according edited criteria
classification

forming a system, and ascribing

aims

mental disorders to different kinds,

then types.
Significance

favors to communion, treat, prevent

and prognosis prediction.
The rule of classifications
分类原则

 Etiological classification （病因学分类）

 Symptomatic classification （症状学分类）

 The features of Symptomatic
1. To centralize the cases which have the same s
classification
ymptoms without reference to their etiology, and
make a diagnosis according to the same main sym
ptoms or syndrome.

2. The diagnosis only states the disease conditio

n, and then it changes with the main symptom cha
nging in the course of disease.
The
3. Thefeatures of Symptomatic
disease diagnosed according to sim
classification
ilar etiology may be decomposed into seve
ral irrelevant symptomatic diagnosis when
different symptoms appeared.
4. Symptomatic diagnose is favorable to tr
eatment. For example, antidepressants may
be used to treat all kinds of depressive diso
rders with different causes.
 Features of Classification
 The most important etiology classification is
to divide all mental disorders into organic and
functional disorders.
 The most important symptom classification
is to divide all mental disorders into psychotic
disorders and neurosis or mild mental
disorders.
 Mental disorders
Organic 器质性
continuum
Mental disorders

Psychoses 精神病 : major,severe

Functional
功能性 Neuroses 神经症 : mild

personality disorders and MR: organic & functional?

 IThe Classification
nternational of Mental
Statistical Classification of Diseases
and Related Health Problems ( 国际疾病与健康相
Disorders
关问题统计分类） ： ICD-10 （ 1992 ）
 Diagnostic and Statistical Manual of Mental Diso
rders( 精神障碍诊断统计手册， DSM-Ⅳ ， 199
4）
 C hinese C lassification and Diagnosti
c Criteria of M ental D isorders ： CCM
D-3.2001
 CATEGORY IN CCMD-3
CCMD-3 分类（了解）

0.Organic mental disorders;

1. Mental disorders due to psychoactive substances o
r non-addictive substances;
2. Schizophrenia and other psychotic disorders ;
3. Mood (affective)disorders ;
4. Hysteria, stress-related disorders, neurosis;
5. Physiological disorders related to psychological fa
ctors ;
 CATEGORY IN CCMD-3
6. Personality disorders, habit and impulse disorder
s, psychosexual disorders;
7. Mental retardation, and disorders of psychologic
al development with onset usually occurring in c
hildhood and adolescent;
8. Hyperkinetic ,Conduct ,and Emotional disorders
with onset usually occurring in childhood and ad
olescent;
9. Other mental disorders and psychological health
conditions;
 Diagnostic criteria 诊断标准

Inclusive criteria 纳入标准

symptom 症状标准； NO
severity and dysfunction 严重程度标准
；
course criteria 病程标准；
others: special subtype; etiology criteria
NO
Exclusive criteria 排除标准

Diagnoses OK
 Diagnostic criteria
（以精神分裂症为例）

(一 ) 症状标准 ：
至少有下列 2 项，并非继发于意识障碍、
智能障碍、情感高涨或低落，单纯型分裂症另有规
定；
1. 反复出现的言语性幻听；
2. 明显的思维松弛、思维破裂、言语不连贯，或
思维贫乏；
3. 思想被插入、被撤走、被播散、思维中断，或
强制性思维；
………………
(二 ) 严重程度标准 ：
自知力障碍，并有社会功能严重受损或无
法进行有效交谈。
 Diagnostic criteria
( 三 ) 病程标准 ：
1 、 符合症状标准和严重程度标准至少已持续 1 个月，
单纯型另有规定。
2 、若同时符合精神分裂症和心境障碍的症状标准，当
情感症状减轻到不能满足心境障碍的症状标准时，
裂症状需继续满足精神分裂症的症状标准至少 2 周
方可诊断为精神分裂症。
( 四 ) 排除标准 ：
排除器质性精神障碍及精神活性物质和非成瘾物质所
致精神障碍。尚未缓解的精神分裂症病人，若又罹患
本项中前述两类疾病，应并列诊断。
 SOME CONCEPTS
Mental disorders ： denotes a group of
disorders(attributing to diagnosis) often with
characteristic symptoms such as
psycho actives deviating norm remarkably,
psychotic symptoms,
social function damaged (psychosis,et al)
feeling psycho-agony (neurosis , et al).
Bio-psycho-social factors of mental
disorders

 Correlation; Risk factor; Consequence and

cause
 Onsets of mental disorders

Psychosocial factorsp
Biological factors
 Mental disorders
Organic 器质性
continuum
Mental disorders

Psychoses 精神病 : major,severe

Functional
功能性 Neuroses 神经症 : mild

personality dis. and MR.: organic & functional?

 IThe Classification
nternational of Mental
Statistical Classification of Diseases
and Related Health Problems ( 国际疾病与健康相
Disorders
关问题统计分类） ： ICD-10 （ 1992 ）
 Diagnostic and Statistical Manual of Mental Diso
rders( 精神障碍诊断统计手册， DSM-Ⅳ ， 199
4）
 Chinese C lassification and Diagnosti
c C riteria of M ental D isorders ： CCM
D-3.2001
Diagnostic criteria 诊断标准

Inclusive criteria 纳入标准

symptom 症状标准； NO
severity and dysfunction 严重程度标准
；
course criteria 病程标准；
others: special subtype; etiology criteria
NO
Exclusive criteria 排除标准

Diagnoses OK
 The prospect
Biomedicine is leading the development of
psychiatry. Human genome
project ， functional imagery technique and so
on are lighting on studying the mechanisms of
mental disorders
Mental health has been paying more attention to:
the field and forms of psychiatric service are
broaden or multiple: community, polyclinic,
Mental health is basic for both medical specialists
and clients.
Thanks !