Introduction to special psychiatry

Introduction to

special psychiatry

What should you know after the 1st semester

basic terminology

e.g. to define the psychosis

disorder vs. disease

in psychiatry: disorder

psychopathology

quantitative vs. quality disorders of consciousness

the difference between hallucination and illusion

hallucinations vs. delusion

catatonic syndrome

patient examination and supportive examination methods

including psychodiagnostics

therapeutic methods

biological, non-biological

etiology, pathogenesis, classification

legislative issues with emphasis on psychiatry

involuntary admissions, treatment without the consent of the patient

Clasiffication

ICD-10

ICD-11 – June 2018

Classifications

from DSM – III (1980)

classifications are to be:

• atheoretical

• descriptive

• operationalized

Increased reliability

although

at the expense of validity

Why are we dealing with the "American"

classification?

it preceded ICD-11 by 5 years

greater impact on research clinical studies needed for registration of new

medicines

terminology from DSM very commonly used worldwide e.g. ADHD, MDD

we will use ICD-10, but we also need to keep in mind a practical, clinical classification based on the presumed or

leading etiology

Clinical classification

„organic“„toxic“(substance induced)

„psychoreactive“

„endogenous“

Main groups of ICD-10

F00 - F09 Organic, including symptomatic, mental disorders

F10 - F19 Mental and behavioural disorders due to

psychoactive substance use

F20 - F29 Schizophrenia, schizotypal and delusional disorders

F30 - F39 Mood (affective) disorders

F40 - F48 Neurotic, stress-related and somatoform disorders

F50 - F59 Behavioural syndromes associated with

physiological disturbances and physical factors

F60 - F69 Disorders of adult personality and behaviour

F70 - F79 Mental retardation

F80 - F89 Disorders of psychological development

F90 - F98 Behavioural end emotional disorders with onset

usually occurring in childhood and adolescence

F99 Unspecified mental disorder

F00 - F09 Organic, including symptomatic,

mental disorders dementias

Dementia in Alzheimer s disease

Vascular dementia

Dementia in other diseases classified elsewhere Dementia in Pick's disease

Dementia in Creutzfeldt-Jakob disease

Dementia in Huntington's disease

Dementia in Parkinson's disease Fronto-temporal dementia

Dementia with Lewy body

Delirium, not induced by alcohol and other psychoactive

Other mental disorders due to brain damage and dysfunction and to physical disease

organic: depression

halucinosis

disturbance of personality

F10 – F19

Mental and behavioural disorders due to psychoactive

substance use

F10.- Mental and behavioural disorders due to use of alcohol

F11.- Mental and behavioural disorders due to use of opioids

F12.- Mental and behavioural disorders due to use of cannabinoids

F13.- Mental and behavioural disorders due to use of sedatives

hypnotics

F14.- Mental and behavioural disorders due to use of cocaine

F15 - Mental and behavioural disorders due to use of other

stimulants, including caffeine

F16: Mental and behavioural disorders due to use of hallucinogens

F17.- Mental and behavioural disorders due to use of tobacco

F18.- Mental and behavioural disorders due to use of volatile

solvents

F19.- Mental and behavioural disorders due to multiple drug use

and use of other psychoactive substances.

F10 – F19

Mental and behavioural disorders due to psychoactive

substance use

F1x.0 Acute intoxication

F1x.1 Harmful use

F1x.2 Dependence syndrome A strong desire (craving) or compulsion for

using the drugs

Problem of controlling amount of drug or to terminate use

Change of tolerance

Withdrawal syndrome

F1x.3 Withdrawal state

F1x.5 Psychotic disorder

F1x.6 Amnesic syndrome

F1x.7 Residual and late-onset psychotic disorder

F20 - F29

Schizophrenia, schizotypal

and delusional disorders

F20 Schizophrenia

F21 Schizotypal disorder

F22 Persistent delusional disorders

F23 Acute and transient psychotic

disorders

F24 Induced delusional disorder

F25 Schizoaffective disorders

F30 - F39

Mood (affective) disorders

F30 Manic episode

F31 Bipolar affective disorder

F32 Depressive episode

F33 Recurrent depressive disorder

F34 Persistent mood [affective] disorders

F38 Other mood [affective) disorders

F39 Unspecified mood [affective) disorder

F40 - F48

Neurotic, stress-related and somatoform disorders

F40 Phobic anxiety disordersF40.1 Social phobias (social anxiety disorder)

F40.2 - Specific (isolated) phobias

F41 Other anxiety disorders

F41.0 Panic disorder [episodic paroxysmal anxiety]

F41.1 Generalized anxiety disorder

F42 Obsessive-compulsive disorder

F43 Reaction to severe stress, and adjustment disorders

F43.0 Acute stress reaction

F43.1 Post-traumatic stress disorder

F43.2 Adjustment disorders

.20 Brief depressive reaction

.21 Prolonged depressive reaction

.22 Mixed anxiety and depressive reaction

.24 With predominant disturbance of conduct

.25 With mixed disturbance of emotions and conduct

F40 - F48

Neurotic, stress-related and somatoform disorders

- cont.

F44 Dissociative [conversion) disorders amnesia, stupor, trance and possession disorders,

convulsions, Ganser's syndrome, multiple personality disorder

F45 Somatoform disorders

F45.2 Hypochondriacal disorder

F48 Other neurotic disorders

F48.0 Neurasthenia

F48.1 Depersonalization - derealization syndrome

F48.8 Other specified neurotic disorders

F48.9 Neurotic disorder, unspecified

F50 - F59

Behavioural syndromes associated with physiological disturbances

and physical factors

F50 Eating disorders

F51 Nonorganic sleep disorders

F52 Sexual dysfunction, not caused by organic disorder or disease

F53 Mental and behavioural disorders associated with the puerperium, not elsewhere classified

F54 Psychological and behavioural factors associated with disorders or diseases classified elsewhere

F55 Abuse of non-dependence-producing substances

F60 - F69

Disorders of adult personality and behaviour

F60 Specific personality disorders

F61 Mixed and other personality disorders

F62 Enduring personality changes, not attributable to brain

damage and disease

F63 Habit and impulse disorders

F64. Gender identity disorders

F65 Disorders of sexual preference

F66 Psychological and behavioural disorders associated with

sexual development and orientation

F70 - FZ9

Mental retardation

F70 Mild mental retardation

F71 Moderate mental retardation

F72 Severe mental retardation

F73 Profound mental retardation

“Child psychiatry”

F80 - F89 Disorders of psychological development

“dys” disorders

F84 Pervasive developmental disorders - child autism

F90 - F98 Behavioural end emotional disorders with

onset usually occurring in childhood and

adolescence

Hyperkinetlc disorder

Conduct disorders

Mixed disorders of conduct and emotions

Epidemiology

Basic overview

schizophrenia ~ 1%

bipolar affective disorder ~ 2-4%

"Unipolar" depression ~ 12%

alcohol dependence ~ 11% (men 20%?) about 25% of psychiatric hospitalizations in our

country

anxiety disorders ~ 30%

dementia up to 65 years 1%, over 85 years 50%

child psychiatry child autism 1% !!!!

ADHD ~ 5%

The end