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In psychiatry, the entities in the classification are disorders rather than diseases. The term disorder indicates that the symptoms are caused by an abnormality. Functional psychosis is contrast them psychosis due to structural brain disease. Organic and functional disorders are called organic and disorders without such pathology are called functional.
In psychiatry, the entities in the classification are disorders rather than diseases. The term disorder indicates that the symptoms are caused by an abnormality. Functional psychosis is contrast them psychosis due to structural brain disease. Organic and functional disorders are called organic and disorders without such pathology are called functional.
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In psychiatry, the entities in the classification are disorders rather than diseases. The term disorder indicates that the symptoms are caused by an abnormality. Functional psychosis is contrast them psychosis due to structural brain disease. Organic and functional disorders are called organic and disorders without such pathology are called functional.
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Psychiatry Department of psychology The first affiliated hospital of ZZU Huirong guo Introduction Contents: Classification Some commonly used terms Basic classification in psychiatry Etiology of psychiatry
The classification of causes
Classification Inpsychiatry, as in the rest of medicine, classification helps to being order to the great diversity of phenomena met in clinical practice. Its purpose is to identity clinical features that occur together regularly and help to predict outcome and response to treatment Classification is concerned with disorders; patients have to understood as individuals. Classification The basic classification in psychiatry should be known by all doctors It is elaborated in two widely used diagnostic systems: the International Classification of Disease (ICD) produced by the World Health Organization and the Diagnostic and Statistical Manual (DSM) developed by the American Psychiatry Association In China, we have Chinese Classification of Mental Disorder (CCMD) developed by the Chinese Psychiatry Association. Some commonly used terms Illness, disease, and disorder In general medicine, the entities in a classification are known as diseases and the term disease denotes the presence of physical pathology. A distinction is made between disease and illness, a term that denotes a state of subjective distress. Disease and illness usually occur together but not always. Some patients have a disease but not feel ill, for example in the early—‘silent’—stage of a carcinoma. Some patients feel ill but have no disease, they have medically unexplained symptoms In psychiatry, the entities in the classification are disorders rather than diseases. This term is chosen because only a minority of psychiatric conditions have an identified physical pathology so that the term disease, as used in general medicine, is not strictly appropriate. Instead, the causes include biochemical abnormalities and the effects of faulty learning. The term disorder indicates that the symptoms are caused by an abnormality although this is not in the classification have names such as anxiety disorder or depressive disorder Organic and functional Disorders with definite structural pathology are called organic and disorders without such pathology are called functional. The term functional psychosis is contrast them psychosis due to structural brain disease. Also, anxiety and obsessional disorders are sometimes referred to as functional disorders, this distinction is used less often new because modern methods of investigation have revealed previously undiscovered structural changes in some conditions previously thought to be functional Psychosis and neurosis Psychiatric disorders are sometimes grouped into psychoses and neuroses although this grouping is no longer employed in the official systems of classification Psychosis is a collective term for the more severe forms of psychiatric disorder in which hallucinations and delusions may occur and insight is lost. Schizophrenia, manic-depressive disorder, and the dementia are psychoses The term psychosis has been criticized because it groups together conditions that have little in common, and is generally less useful than a specific diagnosis such as schizophrenia. However, some clinicians continue to use the term especially when it is difficult to make a precise diagnosis, for example, to decide whether a patient who has hallucinations and delusions has schizophrenia of mania Used in this way psychosis is a provisional category to be replaced by a more precise one when further evidence has accumulated Neuroses is a collective term for psychiatric disorders in which, irrespective of severity, there are no hallucinations or delusions and no less of insight. The objections to the term neurosis are the same to those for psychosis: it embraces conditions that have little in common, and it is less informative than a more specific diagnosis such as anxiety disorder. Like psychosis, however, neurosis continues to be used in clinical practice as a convenient term for disorders that cannot be assigned to a more precise diagnosis Basic classification in psychiatry The various diagnostic systems contain the same basic categories. The few differences are in nomenclature and in the details of the criteria fore diagnosis. The categories are: Mental disorders—abnormalities of behavior or psychological experience with a recognizable onset after a period of normal functioning. Adjustment disorder and reactions to stress— conditions that are less severe than mental disorders and occur in relation to stressful events or changed circumstances. Personality disorders dispositions to behave in certain abnormal way—present continuously from early adult life. Other disorders—conditions that do not fit into the previous groups; for example, abnormalities of sexual preference. Disorders starting in childhood. Mental retardation—impairment of intellectual functioning present continuously from early life. Mentaldisorders are classified further into the main categories shown in the following. Most of these min categories are divided further in ways that are explained in subsequent chapters. Organic psychoses (delirium, dementia, and related disorders) Psychoactive substance use disorders Schizophrenia and paranoid disorders Affective (mood) disorder Neuroses (anxiety and obsessional disorders, somatoform disorders, dissociative disorders) Reactions to stressful experiences Personality disorders and sexual problems Developmental disorders (mental retardation) Disorders starting in childhood (child psychiatry) Etiology of psychiatry Knowledge of the causes of psychiatric disorders is important for two main reasons. First, in everyday clinical work it helps the doctor to evaluate possible causes of an individual patient’s psychiatric disorder. Second, it adds to the general understanding of psychiatric disorders which may contribute to advances in diagnosis, treatment, or prognosis In this section we will only deal with the first of these— the assessment of the causes of disorders in the individual patient. The etiology of specific disorders is considered when these conditions are reviewed in subsequent chapters Remote causes and multiple causes In psychiatry certain events in childhood are associated with psychiatric disorder in adult life. For example, subjects who develop schizophrenia are more likely than controls to have exposed to complications of pregnancy and labor One cause can lead to several effects; for example, lack of parental affection in childhood has been reported to predispose to suicide, anti-social behavior, and depressive disorder Remote causes and multiple causes Conversely a single effect can have several causes, which act singly or in combination; for mental handicap can be caused by any one of several distinct genetic abnormalities, whilst a depressive disorder can be caused by the combined effects of genetic factors and recent stressful events The classification of causes When there are multiple causes it is useful to group them into predisposing, precipitating, and perpetuating factors Predisposing factors determine vulnerability to other causes that act close to the time of the illness. Many predisposing factors act early in life, for example: genetic endowment; the environment in utero; trauma at birth; and social and psychological factors in infancy and childhood Precipitating factors are events that occur shortly before the onset of a disorder and appear to have induced it. They may be physical, psychological, or social. physical precipitating causes diseases such as cerebral tumor, and the effects of drugs taken for treatment or used illegally An example of a psychological cause is bereavement; while moving home is a social cause. Some causes may act in more than one way; for example, a head injury may induce a psychiatric disorder through physical changes in the brain and through psychological effects Perpetuating factors prolong a disorder after it has begun. Sometimes a feature of a disorder makes it self-perpetuating (e.g. some ways of thinking commonly prolong anxiety disorders). Social factors are also important (e.g. overprotective attitudes of relatives) Awareness of perpetuating factors is particularly important in planning treatment because the may be modifiable even when little can be done about predisposing and precipitating factors Predisposing factors Genetic endowment Environment in utter Trauma at birth Social/psychological factors in development Precipitating factors Physical disease; drugs Psychological stresses Social changes Perpetuating factors Intrinsic to the disorder Social circumstances Models in etiology In discussions of etiology the word “model” is often used to mean a way of ordering information. Like a theory, a model seeks to explain certain phenomena and to show the relationship between them. Unlike a theory, it does so in a broad and comprehensive way that cannot be proved wrong by carrying out an experiment. Darwin’s ideas of natural selection are an example of a successful model in the biological sciences. Freudian theory is an example of a model that was widely used in the past in psychiatry Reductionist models seek to understand causation by tracing back to simpler, earlier stages. This kind of model, which is familiar in science, is exemplified in psychiatry by the supposition that schizophrenia is caused by disordered neurotransmission in certain areas of the brain Non-reductionist models seek to understand causation in terms of a wider (rather than a narrower ) set of issues. This kind of model, which is familiar in the social sciences, is exemplified in psychiatry by the supposition that the cause of a patient’s neurosis is an his family, and that his symptoms are only one aspect of a disordered family life The medical model is an approach to research in which psychiatric disorders are investigated in ways that have proved useful in general medicine: for example, by identifying regularly occurring patterns of symptoms (syndromes) and relating them to pathological findings. This model has proved particularly useful in investigating organic psychiatric disorders, and in studying schizophrenia and severe affective disorders. It is less useful, although not without value, in the study of neuroses and personality disorders The behavioral model This term refers to an approach to research in which psychiatric disorders are explained in terms of factors that determine normal behavior; for example drives and reinforcements, attitudes and beliefs, and cultural influences This model has been most useful in investigating neuroses and personality disorders. Behavioral models can be either reductionist (e.g. explanations in terms of conditioning), or non-reductionist (e.g. explanations in terms of social influences) Thank you