Introduction,Development of Psychiatry

Department of Psychiatry1st Faculty of Medicine

Charles University, PragueHead: Prof. MUDr. Jiří Raboch, DrSc.

Teaching: Schedule8:00-9:30 9:45-12:00

Week 1

MO Lecture Workshop on wards with patients

TUE Lecture Workshop on wards with patients

WE Lecture Workshop on wards with patients

THU Lecture Workshop on wards with patients

FRI Lecture Workshop on wards with patients

Week 2

MO Lecture Workshop on wards with patients

TUE Lecture Workshop on wards with patients

WE Psychiatric Hospital Bohnice

THU Lecture Workshop on wards with patients

FRI Lecture Workshop on wards with patients

Week 3

MO Lecture Workshop on wards with patients

TUE Lecture Workshop on wards with patients

WE Ward

THU Lecture Workshop on wards with patients

FRI Examination

FREE COURSES IN CZECH• WEDNESDAY 14:00 – 15:30 CLINICAL

SEMINAR, LIBRARY, 2nd. FLOOR• FIRST WEDNESDAY IN EVERY MONTH –

MEETING OF THE CZECH PSYCHIATRIC ASSOCIATION – VONDRÁČEK LECTURE HALL, 9:00 – 17:00

• THURSDAY 12:45 – 15:00, THERAPEUTIC COMMUNITY, Apolinář, 2nd. FLOOR

• THURSDAY 13:00 – 14:00 SEMINAR FOR POSTGRADUATE STUDENTS, LIBRARY, 2nd. FLOOR

Study materials

• Basic Psychopathological Terms and Psychiatric Diagnoses: Raboch J., Pavlovský P. et al., Karolinum

• Psychiatrie: Raboch, Zvolský a kol., Galén, Praha 2001, s. 622 (in Czech)

• Psychiatrie-Testy: Raboch a kol., Galén, Praha 1997 (in Czech)

• ANY OTHER ENGLISH TEXTBOOK OF PSYCHIATRY PUBLISHED AFTER 1995, 400 PAGES AND MORE (e.g. WALDINGER, ANDREASEN, HALES …)

E-LEARNING

LECTURES, ORAL EXAMINATION QUESTIONS

http://psychiatrie.lf1.cuni.cz/

Department of Psychiatry

http://portal.lf1.cuni.cz/

Educational portal

Course

• 2 absence at maximum

• 2 other absences – free courses

• Written mental status of one patient (documentary case record)

PSYCHIATRYMAIN MEDICAL

DISCIPLINEINFLUENCES – KNOWLEDGE OF THE MANKIND, PHILOSOPHY

TWO TRENDS

RESTRICTIVE, PUNISHING - ISOLATION

PERMISSIVE, MEDICINALISATION – MEDICAL DISEASES

PSYCHIATRY IN ANCIENT TIMES• THE OLDEST PSYCHIATRIC

STATUS – EBERS´S PAPYRUS, 1900 B.C., CLINICAL PICTURE OF DEPRESSION

• BIBLE, OLD TESTAMENT, MADNESS OF THE KING SAUL, MELANCHOLY

• MAGICAL CAUSES OF MENTAL DISORDERS – ASSYRIANS, BABYLONIANS, MENTAL DISORDERS – MARK OF MORAL INSANITY, SIN, PUNISHMENT

• ANCIENT GREECE – HEALERS, TEMPLE MEDICINE

ASKLEPIOS

HIPPOKRATES460 – 370 B.C.

• HYPOTHESIS – 4 BODY JUICES - SANGUIS, FLEGMA, CHOLE, MELANCHOLE

• CHARACTER TYPOLOGY• MENTAL DISORDER – BRAIN• FIRST CLASSIFICATION OF

MENTAL DISORDERS• PARANOIA – MELANCHOLIA –

BLACK BILE MANIA – YELLOW BILE

FRENITIS – BLOOD• HYSTERIA• THERAPY – VENIPUNCTURE, EMETICS,

LAXANTIVES, PHYSICAL ACTIVITY, SWEATING

ROME, A.D.• GALEN - ROMAN SCHOOL OF

ECLECTICS• MENTAL DISORDERS – PRIMARY

DISEASE OF THE BRAIN OR REACTION OF THE BRAIN TO DISEASES OF OTHER ORGANS

• FALL OF THE ROMAN EMPIRE – FALL OF THE HUMANISTIC AND SCIENTIFIC EDUCATION AND ATTITUDES

• CODEX THEOSIANUS, 438 A.D., PUNISHMENT OF MANIACS, MENTAL DISORDER OUT OF MEDICINE, SUBJECT OF RELIGIOUS EVALUATION LYKANTROPY

MIDDLE AGES

• ISOLATION OF MENTALLY ILL PEOPLE, DEMONOLOGY – STIGMATA DIABOLI

• 1487 MALLEUS MALEFICARUM (JAKOB SPRENGER A HEINRICH KRAEMER)

• SPECIAL MONASTERIES – HOSPITALES• PRISON• TORTURE – EXORCISM, WITCH TRIALS• 18th. CENTURY „FAME PLAGIIS,

VINCULIS COERCENDUS EST INSANUS

RENAISSANCE16. CENTURY

• RETURN TO HUMANISM, SEPARATION OF SCIENCE FROM THE CHURCH

• NEW DISCOVERIES IN MEDICINE – W. HARVEY – BLOOD CIRCULATION

• MIND AND BODY, SOCIAL INFLUENCES

• BEGINNINGS OF CLASSIFICATION IN PSYCHIATRY

• 1st. PSYCHIATRIC REVOLUTION - JOHAN WEYER (1515 – 1588 TREVIR), PROFESSOR, MEDICAL SCHOOL IN COLOGNE, DE PRESTIGIIS DAEMONUM, MENTAL DISORDERS – MEDICAL CAUSES

ENLIGHTENMENT17th – 18th CENTURIES

• PIONEERS OF LIBERALISM – VOLTAIRE, KANT, DIDEROT, SWIFT,

• FRENCH REVOLUTION (1789) • 2nd. PSYCHIATRIC REVOLUTION –

REAL REFORM OF THE CARE OF MENTALLY ILL PEOPLE

• WILLIAM TUKE – YORK RETREAT – MODEL OF HUMANISTIC CARE

• PHILIPPE PINEL – PARIS, BICETRE, SALPETRIERE, THERAPEUTIC REGIMEN, ACTIVITY THERAPY, PSYCHODRAMA

• MODERN PSYCHIATRY – MENTAL DISORDERS – MEDICAL DISEASES, PHYSICIANS

MODERN PSYCHIATRY19th. CENTURY

• 1861 BROCA´S AREAS, KRAEPELIN – MENTAL DISORDERS – ABNORMALITIES OF NEURONAL FUNCTIONS

• CLASSIFICATION – EINHEITSPSYCHOSE (EUROPE), IDIOCY (USA)

• E. KRAEPELIN (1856 – 1925) – DEMENTIA PRAECOX

• E. BLEULER (1857 – 1939) – SCHIZOPHRENIA

• J. BAILLARGER (1809 – 1890) - CYCLOPHRENIA

• W. GRIESINGER (1817 – 1868) - ORGANIC PSYCHOSYNDROM

FIRST HALF OF THE 20th. CENTURY

• HUGE PSYCHIATRIC HOSPITALS – PSYCHOSES

• ORGANIC THEORY OF MENTAL DISORDERS (WIRCHOV)

• BIOLOGICAL TREATMENTS – SCHOCK THERAPIES (H. BOERHAAVE, 1668 –1738), BENEFICIS MARIS

• 1932 VON MEDUNA – KARDIAZOL• 1935 M. SAKEL – INZULIN• 1938 U. CERLETI, L. BINI – ECT

• 1900 S. FREUD – ANALYSIS OF DREAMS

II. WORLD WAR AND FASCISM

• 1933 LAW – PREVENTION OF HERIDITARY DISEASES – STERILISATION OF 400 000 PEOPLE

• 1939 EUTHANASIA, T4 ACTION, IN CHILD DEPARTMENTS MURDERED 10 000 OF CHILDREN

• 1939 – 1945 IN GERMANY MURDERED 180 000 PSYCHIATRIC PATIENTS

• FLIGHT OF MANY JEWISH PSYCHIATRISTS FROM CONTINENTAL EUROPE (S. FREUD)

„AKTION T4“ – Dr. Karl Brandt

… murdering 70 273 patients saved the German government, over 10 years, 33 731 040 eggs, a saving of 3 710 414 German marks and 40 pfennings … also the savings in vegetables and other provisions

SECOND HALF OF THE 20th. CENTURY

• 50ies – PSYCHOANALYSIS, PSYCHOTROPIC DRUGS

1952 DELAY, DENIKER – CHLORPROMAZIN 1958 KUHN – IMIPRAMIN• 60-ies – SOCIAL PSYCHIATRY,

COMMUNITY PSYCHIATRY• 70-ies – EMPIRICAL RESEARCH, HUGE

EPIDEMIOLOGICAL PROJECTS• 80-ies – BIOLOGICAL PSYCHIATRY,

NEUROSCIENCES, NEW CLASSIFICATION - DSM-III, ICD-10

• 90-ies – COMMUNITY PSYCHIATRY, GLOBAL BURDEN OF DISEASE, EXPENDITURE REDUCTION, COST-EFFECTIVENESS, QUALITY ASSURANCE

21. CENTURY

• MENTAL HEALTH• 2 000 WHO - WORLD HEALTH DAY

„STOP EXCLUSION, DARE TO CARE“• WORLD HEALTH REPORT 2001 – „NEW

UNDERSTANDING, NEW HOPE“, 10 RECCOMENDATIONS

• MENTAL HEALTH GLOBAL ACTION PROGRAMME FOR 5 YEARS

• EUROPE – HEALTH 21• 2005 WHO HELSINKI CONFERENCE -

MENTAL HEALTH ACTION PLAN FOR EUROPE

LIFE TIME PREVALENCE OF MENTAL DISORDERS

% Total Males Females

Anxiety disorders

24,9 19,2 30,5

Affective disorders

17,1 12,7 21,7

Dependencies 26,6 35,4 17,9

Non-affective psychoses

0,7 0,6 0,8

Total 48,0 48,7 47,3

FIRST OUT-PATIENT EXAMINATION IN A YEAR

DIAGNOSIS 1994 2006 CHANGES (%)

ORGANIC BRAIN DISORDER

27 421 50 388 83,8

DEPENDENCIES 31 097 39 301 26,4

SCHIZOPHRENIA 33 805 41 638 23,2

AFECTIVE DISORDER 37 915 93 636 147,0

NEUROTIC DISORDER 103 577 187 665 81,2

DEVELOPMENTAL DISORDER

23 460 21 127 -9,9

TOTAL 307 877 458 500 48,9

ÚZIS 2007

THE GLOBAL BURDEN OF DISEASE

Ch.J.L.MURRAY, A.D.LOPEZ, 1997

HARVARD SCHOOL OF PUBLIC HEALTH

WORLD HEALTH ORGANISATION

WORLD BANK

DALY - Disability Adjusted Life Years

DALY = YLL + YLD

YLL - Years of Life Lost

YLD - Years Lived with Disability

DALY % OF NEUROPSYCHIATRIC

DISORDERS IN VARIOUS PARTS OF THE WORD

0

5

10

15

20

25

30

DALY

mark.ec.form.soc.Lat.Am.Chinarest AsiaMediter.subsah.Afr.

Disability Adjusted Life Years Murray a Lopez, 1997

DALY DEVELOPED COUNTRIES

0

5

10

15

20

25

neuropsychiat. 22

CDV 20,4

neoplasmas 13,7

injuries 10,3

% DALY

PSYCHIATRY IN PRAGUE

• 1790 – CUSTODIAE MENTE CAPTORUM, GENERAL HOSPITAL

• 1822 – TEMPLE OF ST. CATHARINA – OLD HOUSE

• 1844 – NEW HOUSE, KARL VON RIEDL

PSYCHIATRIC DEPARTMENTCHARLES UNIVERSITY, PRAHA

CAUSES OF DALY (%)world

1. Respirační infekce 8,2

2. Průjmovitá onemocnění 7,2

3. Perinatální onemocnění 6,7

4. Unipolární deprese 3,7

5. ICHS 3,4

6. Cerebrovaskulární onemocnění 2,8

7. Tuberkulóza 2,8

8. Zarděnky 2,7

9. Dopravní nehody 2,5

10. Vrozené vady 2,4

Murray a Lopez, 1997

CAUSES OF DALY (%)developed countries

1. ICHS 9,9

2. Unipolární deprese 6,1

3. Cerebrovaskulární nemoci 5,9

4. Dopravní nehody 4,4

5. Nadužívání alkoholu 4,0

6. Osteoarthritis 2,9

7. Nádory trachey, bronchů a plic 2,9

8. Demence a další deg. procesy CNS 2,7

9. Sebepoškození 2,3

10. Vrozené vady 2,2

Murray a Lopez, 1997

CAUSES OF DALY (%)developed countries, age 15 - 44

1. Unipolární deprese 12,3

2. Nadužívání alkoholu 8,9

3. Dopravní nehody 8,5

4. Schizofrenie 5,0

5. Sebepoškození 4,2

6. Bipolární porucha 3,7

7. Nadužívání návykových látek 2,9

8. Obsedantně kompulzivní porucha 2,7

9. Osteoarthritis 2,7

10. Následky násilí 2,4

Murray a Lopez, 1997