Psychiatry

Introduction

Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental,
emotional and behavioral disorders.

A psychiatrist is a medical doctor (an M.D) who specializes in mental health, including substance use
disorders. Psychiatrists are qualified to assess both the mental and physical aspects of psychological
problems.

People seek psychiatric help for many reasons. The problems can be sudden, such as a panic attack,
frightening hallucinations, thoughts of suicide, or hearing "voices." Or they may be more long-term, such
as feelings of sadness, hopelessness, or anxiousness that never seem to lift or problems functioning,
causing everyday life to feel distorted or out of control.

Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and
psychological tests which, combined with discussions with patients, help provide a picture of a patient's
physical and mental state.

Their education and clinical training equip them to understand the complex relationship between
emotional and other medical illnesses and the relationships with genetics and family history, to evaluate
medical and psychological data, to make a diagnosis, and to work with patients to develop treatment
plans.

Mental health conditions that may be diagnosed and treated by a psychiatrist include:

- anxiety and panic attacks

- phobias

- obsessive compulsive disorder (OCD)

- post-traumatic stress disorder (PTSD)

- personality disorders

- schizophrenia
- depression and bipolar disorder

- dementia and Alzheimer's disease

- eating disorders, such as anorexia and bulimia

- sleep disorders, such as insomnia

- addictions, such as drug or alcohol misuse

Components of mental care

1. Acute and short-term care: for severe and common mental disorders (SMD & CMD)

I. Establishing need for treatment: Determining whether the individual requires treatment for their
mental health condition.

ii. Initiating pharmacological treatment: Starting medication to help manage symptoms.

iii. Monitoring for improvement and side effects: Regularly checking to see if the treatment is working
and if there are any unwanted side effects.

iv. Counseling, if required: Providing talk therapy or counseling to support the individual's mental health.

v. Referral, if required: Sending the individual to see a specialist or receive additional services if needed.

2. Emergency Care: for persons having suicidal attempts / ideation, agitated and violent acts

a. For Suicidal Persons:

- Providing reassurance and support

- Offering hope and optimism

- Evaluating the individual's behavior and situation to determine the level of risk they pose to
themselves or others.

- Referral to specialist: Connecting the individual with a mental health specialist who can provide further
evaluation and treatment.

b. Management of Agitated and Violent Individuals

1. Providing safety: Ensuring the safety of the individual, staff, and others in the surrounding area.

2. Emergency sedation: Administering medication, such as Lorazepam or Haloperidol, to help calm the
individual and reduce agitation.

3. Monitoring for side effects: Closely observing the individual for any adverse reactions to the
medication.

4. Referral to specialist: Connecting the individual with a mental health specialist who can provide
further evaluation and treatment.

The referral process involves an initial assessment to determine the severity and complexity of an
individual's mental health needs, followed by appropriate advice, referral to a specialist or facility, and
follow-up care and advice. This process is crucial for individuals with severe mental illnesses, chronic
forms of common mental disorders, substance use disorders, personality disorders, and intellectual
disabilities, ensuring they receive specialized care and support tailored to their needs.

COMMON PRINCIPLES IN ASSESSMENT (HOWTOGOABOUT?)

When communicating with individuals, it's essential to be:

1. Easy to understand( Using simple and clear languagehelps ensure effective communication,
promoting trust and understanding.)

2. Empathic: Showing understanding and compassion

3. Sensitive: Respectful of age, gender, culture, and language differences

To achieve this, be:

1. Warm and approachable

2. Valuing the individual's dignity and worth

3. Avoiding bias and prejudice

4. Respond to the disclosure of private and distressing information (e.g. regarding sexual assault or self-
harm) with sensitivity.

5. Provide information to the persons on their health status in terms that they can understand. 6. Ask
the person for their own understanding of the condition.

Assessment procedures
- Take a medical history, history of the presenting complaint(s), past history and family history, as
relevant.

- Perform a general physical assessment.

- Assess, manage or refer, as appropriate, for any concurrent medical conditions.

- Assess for psychosocial problems, noting the past and ongoing social and relationship issues, living and
financial circumstances, and any other ongoing stressful life events.

1. THE HISTORY TAKING

The history taking is much more elaborate, and includes details of family and personal life and patient's
personality assessment.

Begin with

1. Demographic Information:

- Name

- Age

- Gender

- Education

- Marital status
 - Occupation

- Religion

- Circumstances of referral/reasons for attending the clinic

History of the present illness

1. Patient's Complaints: Record the patient's symptoms and concerns in their own words.

2. Symptom Details: Gather information about:

- Duration: How long the symptoms have been present.

- Nature: The type and characteristics of the symptoms.

- Progression: How the symptoms have changed over time.

- Precipitating, predisposing, and perpetuating factors: What triggered, contributed to, or maintains
the symptoms.

3. Impact on Daily Life: Assess how the symptoms affect:

- Relationships

- Work

- Family

- Daily activities

4. Biological Functions: Inquire about:

- Sleep patterns

- Appetite

5. Treatment History: Document previous treatments, including:

- Medications

- Therapies

- Effectiveness

This comprehensive approach helps healthcare professionals understand the patient's condition,
identify potential causes, and develop an effective treatment plan.
2. Family History

Parent's/ sibling's age, occupations,relationships with the patient

Enquiry into family history of psychiatric illness, suicide, alcohol&drug

abuse,and mental retardation

Personal history

Early life & development

- Accommodation

- Occupation

- Financial status

Occupational history:

- Jobs

- Reasons for change

- Work satisfaction

- Relationships with colleagues

Sexual practices, relationships, marriage

In case of women:

- Menstrual pattern

- Contraception

- Miscarriage / termination of pregnancy

3. Psychiatric History

1. Previous psychiatric contact: Nature and frequency of interactions with mental health services.

2. Treatment and hospitalizations: Details of past psychiatric treatments, including hospitalizations.

Medical History

1. Past surgical history: Previous surgeries or medical procedures.

2. Medical history: Other significant medical conditions or illnesses.

Substance Use

1. Alcohol and drug abuse: Use of prescribed and recreational substances, including patterns of use and
potential addiction.

2. Tobacco consumption: Use of tobacco products.

Forensic History

1. Past forensic history: Any history of involvement with the law, including arrests, convictions, or other
legal issues.

Gathering this information helps healthcare professionals understand a person's overall health and
potential risk factors, informing diagnosis, treatment, and care planning.

MENTAL STATE EXAMINATION

1. Appearance and behaviour

Careful observation of the patient's manner, rapport, eye contact, facial expressions, cleanliness,
clothing, self-care, and movements provides valuable information about their mental state and overall
well-being. This includes assessing their overall demeanor, ability to engage with others, emotional
tone, personal hygiene, attire, and motor activity, which can inform diagnosis, treatment, and care
planning.

2. Mood

Changes in the mood states: depression, elation, euphoria,anxiety and anger

3. Speech

Rate,quantity(increased/decreased)

Pattern:spontaneity,coherence

Abnormalwords(neologisms)

4. Thought

Thought content:

1. Delusions (false beliefs)

2. Preoccupations (persistent thoughts or ideas)

3. Obsessions (intrusive thoughts or urges)

4. Phobias (irrational fears)

5. Suicidal intentions (thoughts or plans of self-harm)

5. Cognitive Assessment

1. Consciousness: Level of awareness and alertness.

2. Orientation: Awareness of:

- Time (date, day, etc.)

- Place (location, surroundings)

- Person (self and others)

3. Concentration and attention: Ability to focus and sustain attention.

4. Memory: Ability to recall and retain information.

5. General fund of knowledge and intelligence: Overall knowledge and cognitive abilities.

6. Social and Personal Judgment

1. Patient's ability to make sound decisions and judgments in social situations.

2. Understanding of potential consequences of their behavior.

Insight

1. Awareness of illness: Recognition of their condition or problem.

2. Understanding of illness: Degree to which they comprehend their illness.

3. Willingness to accept treatment: Motivation to seek and adhere to treatment.

Assessing social and personal judgment and insight helps healthcare professionals:

1. Evaluate patient's decision-making capacity.

2. Inform treatment planning and patient engagement.

3. Identify potential challenges in treatment adherence.