Uzzhorod National University

Faculty of medicine
TOPIC 1: Introduction to psychiatry : Object and task
of psychiatry and narcology, their place among other
medical disciplines. History of development and
modern state of psychiatry and narcology.
Psychonosology and diseases.
Principles of therapy, prophylaxis and rehabilitation
of psychic disorders.

Meaning of the word ‘psychiatry’:(from the Greek words "psyche" - the soul,
"iatreia" - treatment) which is a branch of medicine concerned with the study,
diagnosis, treatment and prevention of mental disorders.

-Tasks of psychiatry:

 to study the aetiology and pathogenesis of mental disorders.

 to carry out their classification.
 to investigate the epidemiology of mental disturbances
 to study the symptoms and signs, as well as syndromes and the clinical
course of different mental disorders.
 to develop find practice effective methods of their diagnosing.
 to work out and use efficient treatment methods.
 to develop a network of mental health services for the population.
 to develop a system for the prevention of mental disorders.

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 Psychiatry is an integral part of medicine organically connected with all
its sections. Every doctor in his practical activity will often come across
various psychiatric problems. It is caused by the fact that in cases of all
diseases patients develop some or other mental disorders: from
nonpsychotic
(most frequently) to psychotic, and sometimes defect-organic ones.
Every
doctor is obliged to adequately determine the register of these
disturbances
and devise his tactics in each particular case.
It is expedient to divide all mental disorders into 3 groups depending
upon
the level and depth of the disturbances. These are 3 different registers
of mental disorders: psychotic, nonpsychotic, and defect-organic.
The psychotic state is characterized by presence of at least one of the
following signs: clouding of consciousness, delusions, hallucinations. In
this situation the patient cannot critically assess his diseased state and
does not understand the morbid character of the disturbances.
Nonpsychotic (borderline) mental disorders are mostly characterized by
disorders of emotions and in the effector-volitional sphere. The patients
critically assess their diseased state, understanding that they are ill.

History of development of psychiatry:

1. the first period (pre-scientific): characterized by primitive religious

understanding of the mentally ill people's abnormal behavior.

2. the second period of ancient medicine: a more progressive period,

when the first attempts at organizing mental health treatment were
made.

3. the third period: corresponding to the Middle Ages, was in general a

period or regress, when psychiatry returned to its prescientific period
(theological scholastics).

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 4. the fourth period:from the beginning of the XVIII to the beginning of
XIX century was the stage of formation of psychiatry part of the
medical science;

5. the fifth period was the epoch of E. Krepellin's nosological psychiatry.

The creation of a nosological classification of mental disorders was
the main outcome of this stage;

6. the sixth period, modern stage of development of psychiatry, formed

in the XX century can be called the period of social psychiatry; it is
characterised by wide development community, social forms of
mental health services; somatological aspects of mental disorders got
more attention

Main sections of modern psychiatry

 Pediatric, juvenile and geriatric psychiatry study peculiarities inclinical

manifestations of mental disorders depending upon the age.
 Narcology includes diagnosis, treatment and prevention of
alcoholism,narcomaniae and toxicomaniae.
 Forensic psychiatry works out fundamentals for legal-psychiatricexperts’
examination and prevention of socially dangerous actions. Lately,such a
section as penitentiary psychiatry was separated; it studies peculiarities
of mental disorders in people serving their sentences in places
ofimprisonment.
 Social psychiatry studies the role of social factors in the etiology,
course,treatment and prevention of mental disorders.

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Psychotherapy studies different methods of psychotherapeutic influence on
patients:

 Psychoneurology studies nonpsychotic, mainly neurotic, disturbances.

 Sexual pathology studies prevention and treatment of sexual

disturbances.

 Suicidology studies causes and works out measures for prevention of

suicidal behaviour.

 Military psychiatry studies peculiarities of mental disorders in people

who serve in the armed forces. Close to it is psychiatry of catastrophes
and natural calamities.

Lately, a section of ecological psychiatry was separated; it studies mental

disorders resulting from disturbances in ecology. Scientific notions about
mental diseases reflect the socioeconomic conditions, ideology, philosophy
and natural scientific views of some or another historical period. The history of
psychiatry originates in the depth of centuries. A great physician of the ancient
times Hippocrates laid foundations for the materialistic, natural scientific
understanding of mental diseases .In the period of the Middle Ages, prevailing
was the statement that any disturbances in the psychic activity were not a
disease but resulted from a voluntary communication with the devil. Many
mental patients perished in fires of the Inquisition as guilty of witchcraft and
apostasy. Particularly important for the development of psychiatry were the
reforms carried out in the period of the French Revolution when a legal change
in the 10 status of mental patients took place.

Classification of mental diseases

The classification of mental diseases is based on different principles:

etiological, nosological and syndromological.

By the etiological principle, mental diseases are divided into the following

groups:

1. Exogenous (caused by various pathological influences from outside).

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a. Infectious

b. Traumatic

c. Intoxicating

2. Somatogenies and endocrinopathies (caused by various internal,

including vascular, and endocrine diseases).

3. Psychogenies – connected with various unfavourable psychological

influences.

4. Endogenies – diseases with an insufficiently studied etiology, a great

part in their origination being played by the factor of heredity

(schizophrenia, manic-depressive psychosis, genuine epilepsy).

5. Psychoses of the old age: presenile and senile.

6. Abnormalities in the personality development (oligopsychiae,

psychopathies).

In order to facilitate and broaden international cooperation in the cause of

perfecting the diagnosis of mental diseases, during the last two decades
ourcountry uses the International Classification of Diseases, suggested by the
WHO. At present, the 10th review of this Classification (ICD-10) is used.The
International Classification of Diseases is constructed on two principles –
nosological and syndromological.

F0 Organic, including symptomatic, mental disorders

F00 Dementia in Alzheimer’s disease

F01 Vascular dementia

F02 Dementia in the diseases qualified in other sections (in Pick’s, Creutzfeldt-
Jacob, Gentington’s, Parkinson’s diseases caused by the human
immunodeficiency virus (HIV)

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F04 Organic amnestic syndrome, not caused by alcohol or other psychoactive
substances

F05 Delirium, not caused by alcohol or other psychoactive substances

F06 Other mental disorders resulting from an injury or dysfunction of the

brain, or caused by a physical disease (hallucinosis, catatonic disturbance,
delirious disturbance, affective disturbances, anxious disturbance, dissociative
disturbances, asthenic disturbances)

F07 Disorders of the personality and behaviour caused by a disease, injury and
dysfunction of the brain

F1 Psychic and behavioural disorders caused by taking of psychoactive

substances (alcohol, opioids, cannabioids, sedative or soporific substances,
cocaine, other stimulants, including caffeine, hallucinogens,tobacco, volatile
solvents)

F2 Schizophrenia, schizotypical and delirious disorders

F20 Schizophrenia (paranoid, hebephrenic, catatonic, postschizophrenic

depression, residual, simple)

F21 Schizotypical disorder

F23 Acute and transitory delirious disorders

F24 Induced delirious disorder

F25 Schizoaffective disorders

F3 Affective disorders of mood

F30 Maniacal episode

F31 Bipolar affective disorder

F32 Depressive episode

F33 Recurrent depressive derangement

F34 Chronic (affective) disorders of mood (cyclothymia, dysthymia)

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F4 Neurotic, stress-related and somatoformic disorders

F40 Anxious-phobic disorders (agoraphobia, social phobiae, specific

[isolated] phobiae)

F41 Other anxious disorders (episodic paroxysmal anxiety, generalized

anxious disorder, mixed anxious and depressive disorder)

F42 Obsessive-compulsive disorder (annoying thoughts, obsessive rituals)

F43 Response to severe stress and disorders of adaptation (acute response to

stress, posttraumatic stress disorder, disorders of adaptation)

F44 Dissociative (conversive) disorders (amnesia, fugue, stupor, trances and

states of seizures, disorders of motility, spasms, anaesthesia, Ganser’s
syndrome, disorders of the multiple personality)

F45 Somatoformic disorders (somatized disorder, undifferentiated

somatoformic, hypochondriac disorder, somatoformic vegetative dysfunction
of the heart and cardiovascular system, gastrointestinal tract, respiratory
system, urogenital system, chronic somatoformic pain disorder)

F48 Other neurotic disorders (neurasthenia, the syndrome of

depersonalization and derealization, etc.)

F5 Behavioural syndromes connected with physiological disorders and physical

factors

F50 Disorders in food taking (anorexia nervosa, bulimia nervosa, vomiting

combined with other psychological disturbances)

F51 Sleep disorders of inorganic nature (insomnia, hypersomnia, failure to

keep to the sleep-wakefulness regimen, sleep walking – somnambulism,
horrors during sleep, nightmares)

F52 Sexual dysfunction not caused by any organic disorder or disease (sexual
anhedonia, disturbed orgasm, premature ejaculation, vaginismus, dyspareunia)

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F53 Mental and behavioural disorders connected with childbirth and puerperal
period

F55 Abuse of substances which do not cause addiction (antidepressants,

purgatives, analgetics, antacids, vitamins, steroids and hormones,specific herbs
and folk medicine means, etc.)

F6 Disorders of mature personality and behaviour in adults (paranoid,schizoid,

dissocial, emotionally unstable, hysteric, anancastic, anxious,dependent, etc.)

F62 Chronic personality changes not connected with any injury or disease ofthe
brain (after suffering an accident, after a mental disease, etc.)

F63 Disorders in habits and drives (pathological disposition to games ofchance,

pyromania, kleptomania, trichotillomania, etc.)

F64 Disorders in sex identification (transsexualism, transvestism of thedouble

role, etc.)

F65 Disorders in sex preference (fetishism, fetishistic

transvestism,exhibitionism, voyeurism, pedophilia, sadomasochism, multiple
sex preference disorders, etc.

F66 Psychological and behavioural disorders connected with sexual

development and orientation (disturbance of sexual maturation, egodystonic
sexual orientation by sex, disturbance of sex relations, etc.)

F68 Other disorders of mature personality and behaviour in adults

(exaggeration of physical symptoms for psychological reasons,deliberate
causing or simulation of somatic or psychic symptoms or disability – simulatory
disorder)

F8 Disorders in psychological development

F80 Specific disturbance of speech development (articulation, expressive

speech, receptive speech, aphasia)

F81 Specific disorders in the development of school skills (reading,

spelling,counting)

F82 Specific disorder in the development of motor functions

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F83 General developmental defects (infantile autism, atypical autism, Rett’s
syndrome, hyperactive disturbance, Asperger’s syndrome)

F9 Behavioural and emotional disorders that usually develop in childrenand

juveniles

F90 Hyperkinetic disturbances (disturbance of attention activity,hyperkinetic

behavioural disorder)

F91 Behavioural disorders (limited by family conditions, unsocialized,socialized,

oppositionally provocative, depressive)

F93 Emotional disorders specific for childhood (anxious disturbance owingto

parting, phobic, social anxious disturbance, disturbance of sibling rivalry, etc.)

F94 Disorders of social functioning with the beginning specific for

childhood(elective mutism, reactive disturbance of attachment in
childhood,disinhibited disturbance of attachment in childhood, etc.)

F95 Tic disorders

Organization of psychiatric aid

In Ukraine, the Law on Psychiatric Aid was adopted; it regulates the rights

of mental patients, the rules for giving them aid, as well as clearly determines

indications for hospitalizing patients to psychiatric establishments. The basic

clauses of the Law on Psychiatric Aid proceed from the statement that mental

patients who are citizens of our country enjoy all the rights declared in the

Constitution of Ukraine.

The Law on Psychiatric Aid is based on 10 main principles worked out by

the Mental Health Department of the World Health Organization. These

principles are as follows:

1. Development of mental health and prevention of mental disorders.

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Every person should look after his mental well-being and take measures for
eliminating causes of mental disorders.

2. Availability of the basic psychiatric aid. The psychiatric aid must preserve
dignity of the patient, it must be materially accessible, just, be at an accessible
distance from the patient’s place of living, as well as be given on the voluntary
basis.

3. Assessment of the mental health in compliance with the generally accepted

international principles. This principle includes the following components:

a.the assessment of the mental health should be made solely with the
purposes directly connected with the mental disease or its consequences;

b.the assessment of the mental health consists of: diagnosis, choice of

treatment, determination of competence, determination of presence of a
possibility to cause damage to the patient himself or other people as a result of
the mental disorder.

Realizing this principle, it is necessary:

a.to observe generally accepted international principles;

b.assessing the possibility of causing damage to the patient himself and other
people, to refrain from references to nonclinical criteria, e.g., to political,
economical, racial and religious grounds;

c. every time when carrying on a new procedure of the assessment, to make a

full reassessment, to refrain from using a case history of the mental disorder in
the past as the only basis for the assessment.

4. Provision of the psychiatric aid in the least restrictive form. If it is necessary

to use various measures of restriction, one should periodically revise this
decision (e.g., every 30 minutes in case of a physical restriction and not more
than 4 hours).

5. Self-determination, i.e. receiving of the patient’s consent before using any

type of interference.

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6. The right to receive help in self-determination.

If the patient experiences difficulties in assessing consequences of his decision

(caused by the general level of knowledge, linguistic abilities,disease) he
should be provided with potential assistants (a lawyer, a social

worker).

7. Availability of the reassessment procedure. Each decision must have a

procedure of reassessment realized with the help of an official (a judge),
deputizing persons authorized to take decisions(e.g., a guardian) and people
rendering the aid. This procedure must be opportune (within 3 days after
taking the decision) and the patient must be given an opportunity of personal
presence.

8. The mechanism of automatic periodical revision.

In cases of decisions concerning treatment or hospitalization, with longterm

consequences, it is necessary to have a mechanism of automatic periodical
revision that should be automatic, with a reasonable interval (e.g.,after 6
months), and carried on by a skilled person.

9. Qualification of the people taking a decision.

The people who take a decision concerning the patient must be:

a. competent;

b. informed;

c. independent;

d. impassive.

Ideally, the body taking a decision should consist of at least 3 persons.

10. Respect of law.

The decision must satisfy all the legal rules in force at this particular moment.
The laws must be open, easily understood and in a clear form. The patient
should be informed about his rights. The control over the actual application of
the Law on Mental Health must be exercised by a body which

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does not depend upon the health care authorities. The Ukrainian Law on
Psychiatric Aid is composed with regard for 10 principles of the WHO. It
consists of 10 sections, 33 clauses. The law describes the presumption of
mental health, principles of giving the psychiatric aid, the state guarantees for
providing mental patients with the psychiatric aid and social defence,
determines confidence of the information on the state of mental health, etc.

The scheme of organization of psychiatric aid

I. Out-patient (outside the hospital) aid:
1. A psychiatric (psychoneurological) room of the children’s or general
polyclinic with a district pediatric or general psychiatrist, a psychiatric
room of the central district hospital.
2. A psychoneurological dispensary or a dispensary department of the
mental hospital of the city, region, republic: the general one whose
structure includes pediatric, juvenile psychiatric and logopaedic
rooms, or the pediatric one whose composition may have rooms of
district pediatric psychiatrists and consultants (a logopaedist and
others).
3. A narcological hospitals.
4. Psychoneurological departments at psychoneurological dispensaries,
large somatic hospitals and military hospitals (for treating patients
with acute short-term psychoses, neuroses and reactive states, residual
phenomena of organic lesions of the brain with mental disorders, etc.).
5. Day-time and night-time departments (at mental hospitals or
psychoneurological dispensaries) for completing the cure of
convalescent mental patients and for conducting anti-relapse
supporting courses of treatment for patients followed up at
psychoneurological rooms and dispensaries.
6. Psychoneurological sanatoria (for adults and children).
7. Homes for disabled patients with chronic mental diseases (for adults
and children).
II. In-patient psychiatric aid:
1. City and regional mental hospitals in the system of health services
composed of various typical departments (male and female ones,
narcological, infectious, tuberculosis, forensic medical, etc.),
including children’s and juvenile departments.
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2. Specialized mental hospitals in the system of the Ministry of Internal
Affairs (for compulsory treatment of especially dangerous criminals
who have committed illegal acts).
3. Narcological hospitals.
4. Psychoneurological departments at psychoneurological dispensaries,
large somatic hospitals and military hospitals (for treating patients
with acute short-term psychoses, neuroses and reactive states, residual
phenomena of organic lesions of the brain with mental disorders, etc.).
5. Day-time and night-time departments (at mental hospitals or
psychoneurological dispensaries) for completing the cure of
convalescent mental patients and for conducting anti-relapse
supporting courses of treatment for patients followed up at
psychoneurological rooms and dispensaries.
6. Psychoneurological sanatoria (for adults and children).
7. Homes for disabled patients with chronic mental diseases (for adults
and children).

III. Social-rehabilitative establishments:

1. Medical industrial workshops at mental hospitals and dispensaries.
2. Subsidiary farms at mental hospitals, rehabilitation centres.
3. Sanatorium schools (for children with asthenic states).
4. Schools and groups for children with speech and other disturbances.
5. Boarding schools and schools for mentally retarded children.
In places where a network of pediatric psychiatric establishments is not
sufficiently developed yet, the out-patient aid is usually given at general
psychiatric rooms and dispensaries. A significant part in early revealing
adults and children who need psychiatric follow-up and treatment is
played by family doctors, district therapeutists and pediatricians who by
force of peculiarities in their work are the first to come across various
mental deviations in patients during out-patient, prophylactic and other
examinations.

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