1

Mental Health

Introduction

2

What is a mental disorder?Who is mentally ill?

• It is our duty as mental health workers to answer certain questions which are asked by many people such as those who become ill and consult us, colleagues who see patients and have no explanations for their symptoms despite all available methods of examinations and investigations

3

What is a mental disorder?Who is mentally ill? cont’

• Law workers who encounter criminals but can not punish them because they do not intend to commit those offences, funders who would like to fund research and scientific work, and experts who are responsible for planning health services to the country or the region,

4

What is a mental disorder?Who is mentally ill? cont’

• The main question would be what is a mental illness?

• The controversy of what is normal and abnormal

• whether statistical or social .

5

Introduction• Psychiatry: the study of the mental

disorder regarding their etiology, symptomatology, and treatment.

• Mental Health: is a broader term and deals with behavioral sciences, psychosocial issues, prevention and treatment of psychiatric disorders and community health services.

6

Evolution of psychiatry

• Biological wave • Psychiatry as an illness was described at

the nineteenth century. The medical model in which a disease meant tissue destruction or inflammation dominated that era.

7

Evolution of psychiatry cont’

• Psychological wave • The concept of psychological causation of

diseases started at the end of the nineteenth century and early twentieth century. The psychoanalytic theory, behaviourism and many other theories appeard rapidly at that time. The number of experimental and clinical psychologists increased and outnumbered psychiatrists.

8

Evolution of psychiatry cont’

• Psychological wave cont’• psychological disorders were suggested

as a cause of many symptoms that later were called mental disorders. .

9

Evolution of psychiatry cont’

• Social wave • A third and newer approach was to

concentrate on the social approach believing that most of those cases were actually social deviance from “social/moral norms of the dominant group, and that psychiatry mistakes these social/moral norms for medical norms, social disorder for medical disorder” .

10

Evolution of psychiatry cont’

• Social wave cont’• They believe that most of what

psychiatrists label as mental disorders could be explained on social bases.

11

Evolution of psychiatry cont’

• Social wave cont’• The social influence on the causation of mental

disorders became obvious after the second world war and the role of other professions such as Psychologists, social workers and occupational therapists in the process of caring for patients became more important. The concept of Psychosocial factors grew rapidly.

• Interest in community care grew too with the intention to reduce the period and number of admissions to hospitals.

12

Evolution of psychiatry cont’

• The biopsycbosocial model was introduced to indicate the effect of the three approaches at the same time. The result was the establishment of the therapeutic teams and involvement of people from different specialties in the teams.

13

Evolution of psychiatry cont’

• The struggle between supporters of the medical and psychological and social model on the other side strengthened after the 1960s and especially after the closure of most of the mental asylums in Europe and USA.

14

History

• Reil in the early 19th Century coined the term Psychiatry.

• Psychiatry as a medical knowledge was known by the ancient Greek with the birth of medicine as a science.

• Patients were treated in institutions or asylums for about 2000 years by physicians and the patients were called lunatics.

15

History

• Philippe Pinel is known worldwide as the physician who ‘liberated the insane from their chains' in a dramatic initiative he started in 1793 at the height of the French revolution.

• He thought that insanity is a disease and the patient is still a human being despite loosing his sanity.

16

History

• At the Retreat, opened in 1796 near York, William Tuke, decided that physical restraints were largely abolished, and religious and moral values were emphasized in the relations with the patients.

• Esquirol originated the descriptive clinical approach to psychiatry and laid the foundations of the present description of the mental disorders. He emphasized the medical character of psychiatry..

17

History

• The discipline of experimental psychology began at the end of the nineteenth century and expanded in the twentieth century in parallel with social work.

18

History

• Mental hospitals were built and became full of patients with deterioration of care and services due to overcrowding and institutionalization.

• The advent of psychotropic drugs since 1952 resulted in revolution in the field.

• The need for treatment in hospitals decreased and the hospital doors opened for the revolving door policy.

• The patients could be helped at the primary health care level.

19

History

• A new era began in the USA and followed by Europe where the mental hospitals were closed down and community psychiatry grew rapidly.

• The role of social workers and clinical psychologists became more obvious and their numbers has increased dramatically.

20

Classification systems

• The Diagnostic and Statistical Manual of Mental Disorders (DSM) was published by the American Psychiatric Association (APA) in 1952. It is used in the USA and in varying degrees in many countries around the world. There have been many revisions from DSM I to DSM IV text revised in 2000 and the next DSM V is due in the year 2012.

21

Classification systems

• International Classification Of Diseases and related health problems. Was invented by the WHO and it is used in Europe and many other areas around the world. The current edition is 10 and the ICD 11 is due in a couple of years too.

22

Behavioural Sciences

include:

• Neuroanatomy

• Neurophysiology and neurochemistry

• Neuroimaging

• Neurogenetics and Molecular Biology

• Psychoneuroendocrinology and psychoneuroimmunology

23

Team work PsychiatristsClinical psychologistPsychotherapistNurse: ward and communitySocial workerOccupational therapist PhysiotherapistTeacherEducator

24

Assessment in Mental Health

• History • Mental state examination• Physical examination • Psychometry • Laboratory investigations • Provisional diagnosis • Formulation• Treatment

25

Doctor-Patient Relationship

• There must be mutual respect between both parties.

• Rapport: is the spontaneous, conscious feeling of harmonious responsiveness that promotes the development of a constructive therapeutic relationship

• With rapport, patients feel accepted with both their assets and liabilities.

26

Doctor-Patient Relationship

• The perception that the doctor is concerned, caring, and understanding is more superior to technical competence.

• Doctor – Patient Relationship itself becomes part of the therapeutic process.

27

Doctor-Patient Relationship

• Physicians must learn to accept that although they wish to control everything in patient’s care, this wish can never be fully realized.

• In some situations a disease cannot be cured, and death cannot be prevented, no matter how conscientious, competent, or caring the physician is.

28

Doctor-Patient RelationshipSpirituality

• There is some evidence that strong religious beliefs, spiritual yearnings, prayer, and devotional acts have positive influences on a person’s mental and physical health.

• These issues are better attended to by theologians than by physicians; however, doctors need to be aware of spirituality in their patients’ lives and sensitive to their patients’ religious beliefs

• It is the duty of mental health workers to become familiar with the religious and spiritual beliefs of the people they are dealing with to avoid making wrong conclusions.

29

Doctor-Patient Relationship

• Doctors should be able to leave their patients’ problems behind when away from the office or the hospital

• and should not use their patients as substitutes for intimacy or relationships that may be missing in their personal lives.

30

Confidentiality

• The information that we obtain about the patient should be kept in safe places and no one should have access to them other than the mental health workers. The only exception is in the case of Forensic Psychiatry especially when the data are related to the life of others or to national security.

31

References

• Authors: Sadock, Benjamin James; Sadock, Virginia Alcott

• Title: Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition

• Copyright ©2007 Lippincott Williams & Wilkins• New Oxford Textbook of Psychiatry

Oxford University PressMichael G. Gelder, Juan J. Lopez-Ibor and Nancy Andreasen

• Psychiatry, Derek Bolton, Volume 8, Issue 12, pp 463-498 Dec 2009

32

Thank you