Introduction to

psychiatry
Complied by= Gedamu D(BScN)

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 Course outline
1. Introduction to psychiatry
2. Sign and symptoms of psychiatric illnesses
3. Psychiatric assessment
4. Psychotic disorder
5. Mood disorders
6. Anxiety disorders
7. Substances related disorders
8. Epilepsy and its psychiatric aspects
9. Cognitive disorders (dementia, delirium. amnesia)
10. Personality disorders
11. Treatment in psychiatry
12. Advanced topic in psychiatry(Eating, sleep, sex, somatoform)
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 Objectives
At the end of this unit; Students will be able to:
• Define common terms in psychiatry
• List the classification of mental illness
• Explain the cause of mental illness
• Describe the epidemiology of mental illness
• Develop appropriate therapeutic communication skill
• Develop a positive attitude towards mental illness

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 What is psychiatry?
Psychiatry:
 is defined as a branch of medicine deals with mental illnesses or psychiatric disorders.

 deals with identification, diagnosis, treatment , prevention and rehabilitation of mental

disorders.

 was first coined by the German physician Johann Christian Reil in 1808.

 literally means the 'medical treatment of the soul'

• psych-: soul; from Ancient Greek psykhē: soul;

• iatry: medical treatment; from Gk. iātrikos: medical: to heal

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 What is mental health?
Mental health is a state of well being in which the
individual:
 realizes his or her own abilities
can cope with normal stresses of life
can work productively and fruitfully
is able to make contribution to his or her community.

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 Characteristics of mentally healthy person

He is not at war with himself, well adjusted, accepts

criticism and is not easily upset.

Searches for an identity, has strong sense of self esteem,

knows himself, his needs, problems and goals (self
actualization).

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 Characteristics of mental health
Mentally healthy person
Accepts self and others
 Coping with stress
Can return to normal functioning if
disturbed
Relationship builder
Sound judgment
 Accepts responsibility
Optimistic
 Recognize limitations
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Mentally ill person
• Feels self inadequacy
• Has poor self concept
• Is unable to cope
• Shows maladaptive behavior
• Non meaningful relationship
• Poor judgment
• Irresponsible
• Pessimistic
• Does not recognize limitation
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 Characteristics cont’d

Mentally healthy person Mentally ill person

Function effectively and
independently
Distinguish reality
Solve problems
Can delay gratification
• Exhibits dependency needs
• Unable to perceive reality
• Avoid problems
• Desire immediate
gratification

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 Characteristics cont’d
 In general mentally healthy person shows growth and
maturity in three areas:
Cognitive
Emotional, and
Social processes

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 What is mental illness?

Mental illness: is a state of disturbance in which an individual:

can not realize his/her own abilities,

interact negatively with others,

can not cope with the stressors of life and study,

Does not work productively and fruitfully, and

Does not contribute to his/her family and community.

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 What is Mental Disorder?
Mental disorder: is a specific diagnosis of a condition
or type of mental illness that is made by a trained
mental health professional after formal psychiatric
assessment.

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 Mental Health In Ethiopia
In 1960s Professor Giel introduced psychiatry into the medical
curriculum of Haile Selassie I University (AAU).
Before 1987 traditional treatment methods are the most widely used
methods.
Most patients visit modern health services as a last resort having tried
and failed all available traditional means.
Modern mental health services in the country started over 60 years
ago.

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 Mental health in Ethiopia cont’d
Only 1% of the PWMI get modern care.
Amanuel Hospital was built for general medical care by Italians (to
date, the only one).
Got converted to mental hospital after Italians got expelled from the
country.
Mainly to lock-up mentally ill offenders.

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 Mental health in Ethiopia cont’d
Patients travel several hundreds of K.Ms. to see psychiatrists.
All psychiatrists who served in the Hospital came from Bulgaria and
Russia.
1972 The first Ethiopian Psychiatrist Dr. Fikre Workneh came from
the US.

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 The global burden of mental illness (WHO 2002)

 Mental, neurological and behavioral disorders are common to all

countries and causes immense suffering.

 People with these disorders are often subjected to social isolation, poor

qualities of life and social costs.

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 Global burden cont’d

 Four of the 10 leading causes of disability and premature death.

 25% will develop mental illness at some stages in their lives.

 800,000 people die from suicide each year.

 over ½ of these are young people.

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 Leading causes of years of life lived with disability

1 Unipolar depressive disorders 10.9%

2 Hearing loss, adult onset 4.6%
3 Refractory errors 4.6%
4 Alcohol use disorders 3.7%
5 Cataracts 3.0%
6 Schizophrenia 2.7%
7 Osteoarthritis 2.6%
8 Bipolar affective disorder 2.4%
9 Iron-deficiency anaemia 2.2%
10 Birth asphyxia and birth trauma 2.2%

(Both sexes, all ages)

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 Global burden cont’d
 154 million people suffer from depression.

 25 million people suffer from schizophrenia.

 91 million people suffer from alcohol use disorders and 15 million by

drug use disorders.

 50 million people suffer from Epilepsy (neurological disorder).

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 Global burden cont’d

 24 million people suffer from dementia.

 326 million people suffer from migraine headache.

 61 million people suffer from cerebro-vascular diseases.

 18 million people suffer from neural infections.

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 Burden of mental illness in Ethiopia
Over 13 million people suffer from different kinds of mental illness.
Mental health problem prevalence (%)
Common mental disorders 12-17%
Schizophrenia 0.6-0.7%
Mood disorders 3.8-5%
Child hood disorders 12-24%
Substance dependence 4%
Alcohol use disorders 2.7-7%
Chat abuse 22-64%
Suicide attempt 0.9-3.2%
Completed suicide 7.7/100,000/year
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 Why do we concern about mental illness?

• It affects every body – estimated 1:5 person

• It is a major public health burden- 40% of those attending general care service.

• Because they are very disabling

• Because societies are rapidly changing

• Because mental illness leads to stigma

• Because mental illness can be treated with simple, relatively inexpensive

methods.
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Serious cases receiving no treatment during the last 12 months

80 85%

70 76%

60

50
50%
40

30 35%
20

10

Lower range Upper range

Lower range Upper range

Developed countries Developing countries

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 In your community---

• What are the daily challenges for persons with

mental, neurological and substance use disorders?

• Employment?
• Education?
• Marriage?
• Social life?
• Abuse?
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 Classification Of Mental Disorders/Illness

MODERN CLASSIFICATION

• DSM IV TR/DSM-5 ------APA= USA, África, Etiopia

• ICD -10 ----WHO=Europe, India

N.B. There are more than 300 diagnostic entities of mental disorders

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 Modern Classification
There are over three hundred (365) different
types of mental disorders,
Broadly grouped in to 20 categories; DSM-V

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  Schizophrenia Spectrum and
Other Psychotic Disorders
 Bipolar and Related
Disorders
 Obsessive-Compulsive and
Related Disorders
 Trauma-and Stressor-Related
Disorders
 Disruptive, Impulse-Control,
and Conduct Disorders
 Substance-Related and
Addictive Disorders
 Somatic Symptom and
Related Disorders
 Anxiety Disorders
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 Depressive Disorders
 Dissociative Disorders
 Elimination Disorders
 Sleep-Wake Disorders
 Sexual Dysfunctions
 Gender Dysphoria
 Personality Disorders
 Paraphilic Disorders
 Feeding and Eating Disorders
 Neurocognitive Disorders
 Neurodevelopmental
Disorders
 Other Mental Disorders
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 Misconceptions and public attitude towards
mental illness
• Mental illnesses are caused by Gods as punishment for sin, or by
ghosts, black magic, evil powers and witchcraft.
• Mentally ill patients are different from other people.
• Psychiatric illness is not like physical illness and psychiatric
patients never get better.
• Psychiatric patients should take drugs throughout their life time.
• Psychiatric patients are always violent and dangerous.
• Professionals like psychiatrist, psychiatric nurses who work with
the mentally ill persons are likely to become disturbed themselves.
• Some of these misconceptions are culture based.
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 Cause of mental illness

Although the exact cause of most mental illnesses is not known, it is

becoming clear through research that many of these conditions are

caused by a combination of:

Biological

psychological and

Social and environmental factors

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 Causes of Mental Illness…
 The bio-psycho-social model is so far the most
plausible approach to the problem

Bio Psycho
MI

Social

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 Causes cont’d
Biological causes:
Genetic make up: family , twins
Substance use
Illness of mothers during pregnancy
Infections
Neuro-chemistry: dysregulation of neurotransmitters (dopamine, serotonin,
norepinephrine, GABA etc.)

• Mental disorders can have a physiological basis and arise from

changes in brain chemistry

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 Causes cont’d
Biological causes…

 Neuro-developmental study: perinatal infection, hypoxia, Rh incompatibility, maternal starvation

 Functional anatomy: abnormality of certain brain structure may leads to psychiatric disorder.

The system of special interest to psychiatry are

• Prefrontal cortex

• Limbic system

• Basal ganglia

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 Causes cont’d
Biological causes…

Vitamin and mineral deficiencies such as Vitamin D, zinc and

certain fatty acids.

Defects in or injury to certain areas of the brain.

Exposure to toxins, such as lead, etc.

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 Causes cont’d
Psychological causes:

• Traumatic and abusive past or current experiences

• Significant life events like bereavement or divorce

• self-destructive thought patterns and perceptions

• Coping skill

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 Causes cont’d
Social causes

• War, disasters

• Child rearing parents

• Housing

• Family stability

• Economic level

• Religion
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 Causes cont’d
The biological, psychological and social causes
categorized in to:
Predisposing factors

Precipitating factors
Perpetuating factors
Protective factors

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 1. Predisposing Factors
• Increase susceptibility to psychiatric disorder
• Are those that render the personality susceptible or vulnerable and are present over a
long period of time.
• Established in utero or in childhood
• Operate throughout patient’s lifetime
• Genetics:-
E.g. schizophrenia, Bipolar disorder, dementia
• Age:-
E.g. Adolescence, middle life, old age
• Gender:-
E.g. Alcohol (M>F)
• Physical, psychological and social factors early in life and pre-morbid personality are
important.
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 2. Precipitating Factors
• are events that precede clinical onset.

• Trigger an episode of illness

• Determine its time of onset

• Environment:- Emotional as well as physical milieu
• Family interactions (engagement, marriage, separation, death, becoming a parent).

• Other interpersonal relationship (difficulties with friends or neighbors).

• Living circumstances (immigration)

• Financial affairs (inadequate finances)

• Legal affairs (being arrested or sued)

• Occupation – stress related to job.

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 Precipitating cont’d
• Physical illness
• Personal (pain, discomfort)

• Financial (cost of treatment)

• Emotional (feeling of depression)

• Body image (breast amputation)

• Endocrinal (hyperthyroidism)

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 3. Perpetuating factors
• Are factors that prolong the course of a disorder after it has been
provoked.

• Delay recovery from illness

• Secondary demoralization and withdrawal from social activities.

• Substance use/abuse

• Chronic physical illness

• Poor social or family support

• Loss of job etc.

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 Who will be more exposed to mental illness?

Single Married
Female Male
High socioeconomic Low socio economic
status status
Strong social support Loose social support

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 Cultural explanations for mental illness in
Ethiopia
• Spirit possession (likift, zar, wuqabi)
• Punishment for sins
• Evil eye
• Thinking too much
• Exposure to cold air (berrd)
• Exposure to sun rays (mitch).
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 CONT…..

GRACIAS!!!.

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