PSYCHIATRY

MA. GILDA C. QUIMINALES, PTRP

TOPIC OUTLINE

• DEFINITION OF TERMS • ANXIETY DISORDERS

• STAGES • SOMATOFORM DISORDERS
• DEFENSE MECHANISMS • FACTITIOUS DISORDERS
• BEHAVIORAL PSYCHOLOGY • DISSOCIATIVE DISORDERS
• COGNITIVE DISORDERS • SEXUAL DISORDERS
• PSYCHOTIC DISORDERS • EATING DISODERS
• MOOD DISORDERS • SLEEP DISORDERS
TOPIC OUTLINE

• PERSONALITY DISORDERS
• CHILDHOOD DISORDERS
• PSYCHOPHARMACOLOGY
DEFINITION OF TERMS
DEFINITION OF TERMS

• PSYCHIATRY – Branch of medicine focused on the diagnosis,

treatment, and prevention of mental, emotional and behavioral
disorders
• PSYCHOLOGY – scientific process of knowing the human mind and
its behavior
DEFINITION OF TERMS

• PSYCHOSIS – defined as a major personality disorder which disrupts

one’s emotional and mental aspects of life
• Loss of reality

• NEUROSIS – constant struggle between an individual’s personality

and behavior in a stressful condition, often associated with physical
and mental disturbances
• Intact reality testing
STAGES
PIAGET’S STAGES
(COGNITIVE DEVELOPMENT)

• SENSORIMOTOR • 0-2 y/o

• PREOPERATIONAL • 2-7 y/o
• CONCRETE OPERATIONAL • 7-11 y/o
• FORMAL OPERATIONAL • >11 y/o
ERICKSON STAGES
(PSYCHOSOCIAL
DEVELOPMENT)
FREUD’S PSYCHOSEXUAL
STAGES
KUBLER-ROSS
MODEL
(STAGES OF GRIEF)
FREUD’S PERSONALITY DEVELOPMENT

• ID- primitive and instinctual

part of the mind that contains
sexual and aggressive drives
and hidden memories
• EGO- realistic part that
mediates between the
desires of the id and
superego
• SUPEREGO- operates the
moral conscience
DEFENSE MECHANISMS
(GEORGE VALLIANT’S
CLASSIFICATION)
NARCISSITIC

• DENIAL – ABOLISHING REALITY

• DISTORTION – GROSS RESHAPING REALITY TO SUIT INNER
NEEDS
• PROJECTION – UNACCEPTABLE INNER IMPULSE TO EXTERNAL
OBJECT
NARCISSITIC

• PROJECTION
• NEUROTIC – perceiving others as operating in ways one unconsciously finds
objectionable yourself
• COMPLEMENTARY – assuming that others do, think and feel the same way
you do
• COMPLIMENTARY – assuming that others can do things as well as you do
IMMATURE

• ACTING OUT – impulse gratification

• BLOCKING – inhibition of thinking, tension arises
• INTROJECTION – internalization of traits/qualities of the object
• PASSIVE-AGGRESSIVE – thorough passivity or masochism
IMMATURE

• REGRESSION – reverting to earlier behaviors

• SCHIZOID FANTASY – autistic retreat
• HYPOCHONDRIASIS – exaggeration of illness as evasion/regression
• SOMATIZATION – physical symptoms replaces anxiety
NEUROTIC

• CONTROLLING – regulate the outside to manage the inside

• DISPLACEMENT – shift of cathexis to less distressing object
• EXTERNALIZATION – perception of external words/objects as
elements of own personality
NEUROTIC

• INHIBITION – limiting ego functions

• INTELLECTUALIZATION – excessive use intellect to avoid affective
expression/experience
• RATIONALIZATION – to justify the unacceptable
• ISOLATION – splitting idea from its affect, then repressed
NEUROTIC

• REPRESSION – expelling/withholding an idea

• REACTION FORMATION – transforming unacceptable impulse to
opposite
• DISSOCIATION – modification of identity
• SEXUALIZATION - endowing sexual significance to objects/function
MATURE

• ALTRUISM – service, vicarious gratification

• ANTICIPATION – planning for the future inner discomfort
• ASCETICISM – gratification from renunciation of pleasures
• HUMOR – using comedy to express
• SUBLIMATION – channeling of impulse and altering it to socially
acceptable one
• SUPPRESSION – postponement of attention to minimize discomfort
BEHAVIORAL PSYCHOLOGY
CLASSICAL CONDITIONING

• a reflexive or automatic type of learning in which stimulus acquires

the capacity to evoke a response that was originally evoked by
another simulus
OPERANT CONDITIONING

• A process that attempts to modify behavior through the use of

positive and negative reinfocements
COGNITIVE DISORDERS
DELIRIUM

• Altered consciousness and change in cognition over a short period

of time
• M>F, old
• Acute onset, often at night; fluctuating course with lucid intervals;
• Duration: hours to weeks
• Memory deficits: immediate and recent
• Orientation usually impaired
DEMENTIA

• Deterioration of intellectual functions

• Disturbances in higher cortical functions
• Memory impairment: recent and remote.
• Personality changes
• Alertness usually normal.
DEMENTIA

TYPES OF DEMENTIA
• Reversible dementia
• Primary degenerative/Alzheimer’s type
• Senile Alzheimer's type
• Presenile Alzheimer's type

• Multi-infarct dementia
PSYCHOTIC DISORDERS
SCHIZOPHRENIA

• M=F, adolescents to young adults

• Causes: Genetics, brain disease, childhood trauma
• Sx: >/= 6months with 1 month active symptoms
SCHIZOPHRENIA

• Criteria (at least 2 of the positive symptoms and may include

negative symptoms):
• Positive sx: delusion, hallucination, bizarre behavior, thought disorder, paranoia
• Negative sx: flat affect, alogia, avolition, apathy, anhedonia, asociality, attention
SCHIZOPHRENIA

• TYPES OF SCHIZOPHRENIA
• PARANOID – systemized delusion and hallucination
• UNDIFFERENTIATED – psychotic symptoms but criteria of other types does
not fit
SCHIZOPHRENIA

• TYPES OF SCHIZOPHRENIA
• RESIDUAL –milder intensity or absence of complete set of symptoms
• CATATONIC – persistent tone; hyperactivity, rigid posturing, echolalia,
echopraxia
• HEBIPHRENIC – “disorganized”; most severe form
SCHIZOPHRENIA

• Most common symptom: LACK OF INSIGHT

• Most specific symptom: NEOLOGISM
• Most reliable symptom: DELUSION OF CONTROL
SCHIZOPHRENIFORM

• 1 month to <6 months

SCHIZOAFFECTIVE

• Schhizophrenia symptoms + affective disorders symptoms

DELUSIONAL DISORDER

• SX: >1 month, non-bizarre, behavior is within norms

• TYPES:
• Erotomaniac – aka De Clerambault-Kandinsky or Psychose pasionelle; a
person is inlove with the individual
• Grandiose – aka Megalomania; inflated worth/identity/reference
DELUSIONAL DISORDER

• Jealous – aka Zelotypic

• Othello Syndrome – morbid or pathological jealousy

• Persecutory –to self or someone close

• Somatic – physical defect or medical condition
• Mixed
DELUSIONAL DISORDER

• Unspecified
• Capgras syndrome/illusion des sosies/ illusion of doubles – familiar
person is replaced by impostors
• Fregolis phenomenon – diff. people are in fact a single person
• Intermetamorphosis – they can see people change to something else
at will
DELUSIONAL DISORDER

• Cotard phenomenon/Delire de negotiation/nihilistic delusional

disorder - person is already dead
• Reduplicative paramnesia – people exists on a different place at the
same time
• Heautoscopy – aka autoscopic psychosis; person has a double
• Lyncanthropy –werewolf
SHARED PSYCHOTIC DISORDER

• AKA shared paranoid disorder, induced psychotic disorder, folie a

deux, folie impose, double insanity
• Delusion develops in an individual with close relations to an individual
with established delusion
• Other forms: folie a trios/quatre/cinq/famille, folie simultanee
OTHER PSYCHOTIC DISORDER

• Brief psychotic disorder – 1 day to <1 month; symptoms of

schizophrenia
• Postpartum/puerperal psychosis – persecutory to her or her infant
MOOD DISORDERS
MOOD DISORDERS

• Mania – elevated, great excitement, severe impairment of functioning

of >/=1 week
• Hypomania – not as severe as manic; >4 days to <1wk
MOOD DISORDERS

• Major depressive disorder – low mood of at least 2 weeks; suicidal

• TYPES:
• Bipolar I – severe mood episodes from mania to depression
• Bipolar II – hypomania with periods of severe depression
MOOD DISORDERS

• TYPES:
• Cyclothymic – alternating episodes of both high and low mood but not as
severe as mania or major depression of at least 2 years
• Dysthymic – phases of mild depression of at least 2 years
MOOD DISORDERS

Others
• Double depression- low energy and self-esteem for 2yrs
• Premenstrual or late luteal phase dysphoric disorder
• Postpartum blues and depression
• Post-psychotic depressive disorder- schizophrenia for a year then
depression
ANXIETY DISORDER
ANXIETY DISORDERS

• Panic disorder – M<F, young adults; panic attacks

• Phobia – M<F, children and young adults; excessive fear
ANXIETY DISORDERS

Obsessive-compulsive disorder – M=F, young adults

• Obsession – recurrent, intrusive thought, self-generated
• Compulsion – recurrent behavior in attempt to reduce anxiety
ANXIETY DISORDERS

• Post-traumatic Stress disorder - >1 month

• Acute Stress disorder - <1 month
• Generalized anxiety control disorders – persistent and excessive
worry about number of different things; >/=6 months
SOMATOFORM DISORDERS
SOMATOFORM DISORDERS

• Somatization disorder– physical symptoms replaces anxiety and

leads to impairment for a long time
• M<F, 30 y/o; combination of pain, GI, sexual and pseudoneurological
dysfunction
SOMATOFORM DISORDERS

• Conversion disorder – a mental condition associated with blindness,

paralysis or other nervous system symptoms that cannot be
explained by medical evaluation
• M<F, adolescent to young adults
SOMATOFORM DISORDERS

• Hypochondriasis – persistent preoccupation to imagined illness; M>F

• Body dysmorphic disorder – imagined defect
• Pain disorder – chronic pain caused by psychological stress
SOMATOFORM DISORDERS

• Undifferentiated
• Autonomic arousal disorder – palpitation, nausea, hyperventilation
• Chronic fatigue syndrome – physical exhaustion
• Neurasthenia – mental exhaustion; emotional disturbance
• Pseudocyesis – phantom pregnancy
FACTITIOUS DISORDERS
FACTITIOUS DISORDERS

• Factitious disorder by proxy – intentional production of illness to a

person under his care
• Malingering – motivated by secondary gain
• Pseudologia fantastica – little factual material and extensive
fantasies
FACTITIOUS DISORDERS

• Impostor – assumes identity of prestigious person

• Ganser syndrome – aka paralogia; giving approximate answers
DISSOCIATIVE DISORDERS
DISSOCIATIVE DISORDERS

• Dissociative amnesia – blocking of certain information usually

associated with a stressful or traumatic event
• Dissociative Fugue – one or more episodes of dissociative amnesia;
sudden travel to a new place, assumption of new identity
• Dissociative identity disorder – aka multiply personality disorder
SEXUALITY AND SEXUAL
DISORDERS
SEXUALITY AND SEXUAL DISORDERS

• SEXUAL PAIN DISORDERS

• DYSPAREUNIA – pain with sexual intercourse
• VAGINISMUS – spasm of vagina
SEXUALITY AND SEXUAL DISORDERS

• Paraphilias – M>F; abnormal expressions of sexuality, objects of

arousal, >/=6 months
• Exhibitionism – exposure of genitals to unsuspecting stranger
• Fetishism – objects
• Frotteurism – rubbing penis to unsuspecting woman
• Paedophilia – attraction to children
SEXUALITY AND SEXUAL DISORDERS

• Paraphilias
• Voyeurism – through ocular observation
• Scatologia – through telephone, computer conversations
• Necrophilia – cadavers
• Masochism – pain infliction to self
• Sadism – pain infliction to others
SEXUALITY AND SEXUAL DISORDERS

• Paraphilias
• Zoophilia – animals
• Partialism/Oralism – parts of the body
• Coprophilia – feces
• Urophilia – urine
• Hypoxyphilia – altered consciousness due to hypoxia
EATING DISORDERS
EATING DISORDERS

• Anorexia Nervosa – adolescent to young adults; fear of gaining

weight
• Types: restricting, binge-eating/purging

• Bullimia nervosa – late adolescent; normal or overweight; binge-

eating
• Types: purging, non-purging
SLEEP DISORDERS
SLEEP DISORDERS

• Insomnia – difficulty in falling asleep

• Adjustment – acute or short-term insomnia; stress; excited
• Behavioral insomnia of childhood – children don’t go to bed on time unless
enforced by parent or guardians
SLEEP DISORDERS

• Insomnia – difficulty in falling asleep

• Idiopathic – lifelong sleep disorder
• Insomnia due to drug or substance
• Insomnia due to a medical condition – mental health disorder
SLEEP DISORDERS

• Hypersomnia
• Narcolepsy – inadequate sleep hygiene
• Cataplexy – sudden loss of muscle tone
• Hypnagogic/hypnopompic hallucinations – while falling to/awaken from sleep
• Sleep paralysis
SLEEP DISORDERS

• Breathing related sleep disorders

• Obstructive sleep apnea – old, obese; sx-snoring
• Central alveolar hypoventilation - aka Ondine’s curse; respiratory arrest during
sleep

• Circadian rhythm disorder

SLEEP DISORDERS

• Other dyssomnias:
• Restless leg/Willis-ekbom syndrome/delusional parasitosis- strong urge to
move accompanied by an uncomfortable paresthesia
• Periodic limb movement syndrome/nocturnal myoclonus- limb movement
during sleep
• Kleine-Levin syndrome – recurrent hypersomnia, hyperphagia, hypersexuality
SLEEP DISORDERS

• PARASOMNIAS
• Nightmare – frightening or unpleasant dream
• REM sleep behavior disorder – “acting out”
• Sleep terror – extreme nightmare + act out
• Somnambulism – sleepwalking
• Somniloquy - sleeptalking
• Bruxism – excessive teeth grinding
• Jactacio capitis nocturna – rhythmic movement d/o
CHILDHOOD DISORDERS
CHILDHOOD DISORDERS

• Feeding, eating, elimination disorders

• Pica – persistent eating of substances such of no nutritional value
• Rumination – a deep considered thought about something
• Encopresis - fecal incontinence
• Enuresis – involuntary urination; at night
CHILDHOOD DISORDERS

• Learning disorders
• Mathematics disorder
• Reading disorder
• Disorder of written expression

• Developmental coordination disorder

CHILDHOOD DISORDERS

• Communication disorder
• Expressive/receptive/mixed language disorder
• Phonological disorder –do not use some or all of speech sounds expected for
their age group
CHILDHOOD DISORDERS

• Pervasive developmental disorder

• Childhood disintegrative disorder – Heller’s syndrome; after 2 years,
progressive deterioration; lead to autism
• Asperger’s syndrome – generally very intelligent and language, impaired
behavior and social interaction, repetitive patterns of behavior and interest
CHILDHOOD DISORDERS

• Attention-deficit hyperactivity disorder - >6 months

• s/sx-inattention, hyperactivity, impulsivity

• Disruptive behavior disorder

• Oppositional defiant disorder –angry or irritable mood
• Conduct disorder – basic rights of others or rules are violated
CHILDHOOD DISORDERS

• Other disorders
• Elective/selective mutism
• Reactive attachment disorder - detached
PERSONALITY DISORDER
PERSONALITY DISORDER

• A. Odd, eccentric
• Paranoid – distrust, suspicious
• Schizoid – social withdrawal
• Schizotypal – magical thinking
PERSONALITY DISORDER

• B - Dramatic, emotional, erratic

• Histrionic – emotional, attention seeker
• Antisocial – violates social norms
• Narcissistic – grandiose, self-importance, egomania
• Borderline – unstable mood, affect, behavior, selfimage, object relations
PERSONALITY DISORDER

• C- Anxious, Fearful
• Dependent – submissive, clingy
• Avoidant – sensitive to rejection
• Obsessive-compulsive – order, detailed, control, perfection
PSYCHOPHARMACOLOGY
PSYCHOPHARRMACOLOGY

• Antipsychotics/Neuroleptics
• Chloropromazine
• Haloperidol
• Olanzipine

• Antidepressants
• Tricyclics
• MAO inhibitors
• Serotonin specific reuptake inhibitors
PSYCHOPHARRMACOLOGY

• Antimanic drugs/Mood stabilizers

• Lithium
• Anticonvulssants

• Anxiolytic/Hypnotic drugs
• Benzodiazepines
PSYCHOPHARMACOLOGY

• Depressants
• Alcohol
• Barbiturates
• Opioids

• Stimulants
• Caffeine
• Amphetamines
• Cocaine
THANK YOU!