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Chapter 22 is titled “Psychiatry” in The Language of Medicine textbook. Introduction In the introduction, a few general terms that you want to be familiar with 

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If you look at the term Psychiatry and divide it up, it means treatment of the mind. It is the branch of medicine that deals with the diagnosis, treatment, and prevention of mental illness o It is a specialty of clinical medicine like surgery, internal medicine, pediatrics, and obstetrics. o Psychiatrists are MD’s (Medical Doctor)  They went to medical school, completed internship and a residency  They spend years in training and practicing psychotherapy and psychopharmacology  They complete 4 years of residency and then extra years of fellowship training to specialize in various aspects of psychiatry  For example, child psychiatrists specialize in the treatment of children; forensic psychiatrists specialize in the legal aspects of psychiatry, to determine whether an individual is mentally competent to stand trial  They can focus on psychoanalysis which also requires specialized training in that technique If you look at the term Psychology and divide it up, it means pertaining to the study of the mind o Psychologists have a PhD, so they got a bachelors, masters, then a doctorate in Psychology. It is more of an academic degree  They do have limitations involving treatment of the mind  Most of their work would be in the area of research and counseling  They are non-medical  They can further specialize in clinical psychology where they would work in a clinical setting in a hospital or outpatient treatment facility, where they would work with psychiatrists to try and treat patients  They can work in the area of experimental research where they can do research in the area of psychology, or they can work in the area of social psychology, where they look at social interaction and behavior  A clinical psychologist can use psychotherapy to treat patients, but they cannot prescribe medications like a psychiatrist  They also cannot perform ECT (Electroconvulsive Shock Therapy)  They are trained are using various tools in regards to learning more about a patient’s mental health and intelligence  Two IQ Tests o Wechsler Adult Intelligence Scale (WAIS) o Stanford-Binet Intelligence Scale  Two Personality Tests

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Rorschach Technique uses ink blots. There are 10 cards that contain ink blots and the patient is described to describe what they see in the ink blots. The psychologist is looking for a pattern in the patient’s responses to help determine what is on the patient’s mind. Your textbook has a figure of what the inkblot cards look like Thematic Apperception Test (TAT) uses pictures where the patient would make up stories. The patient is asked to tell a story that the picture illustrates. Your textbook has a figure of what the sample picture card looks like. Where are they? What are they doing? What are they talking about? What is their relationship? What are they drinking?

Psychiatric Clinical Symptoms In regards to psychiatric clinical symptoms, you need to know the following terms:      

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Amnesia is loss of memory Anxiety is varying degrees of uneasiness, apprehension, or dread often accompanied by palpitations, tightness in the chest, breathlessness, and choking sensations Apathy is an absence of emotions; lack of interest, emotional involvement, or motivation Compulsion is the uncontrollable urge to perform an act repeatedly Conversion is when anxiety becomes a bodily symptom; in severe cases a patient may experience things such as blindness, deafness, or paralysis that does not have a physical basis Delusion is a fixed false belief that can’t be changed by logical reasoning or evidence o Keep in mind this is different from a hallucination o For example a delusion would be when someone believes something that is not true, and you can’t change their mind Dissociation is when uncomfortable feelings are separated from their real object. In order to avoid mental distress, the feelings are redirected toward a second object or behavior pattern Dysphoria (dys- means difficult or bad, phor- means to carry, so it is a condition of carrying bad things). It is sadness, hopelessness; depressive mood, or feeling “low” Euphoria (eu- means good or well, so this is to carry good feelings) o It is an exaggerated feeling of well-being “high”, whether chemically or mentally induced Hallucination is a false or unreal sensory perception, as for example, hearing voices when none are present. o Mental illness as well as drugs can cause hallucinations o An illusion is a false perception of an actual sensory stimulus Labile is variable; undergoing rapid emotional change. For example, crying one minute, laughing the next

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Mania is elation or irritability, associated with distractibility, hyperactivity, talkativeness, injudicious acts, flight of ideas, and racing thoughts Mutism is a non-reactive state with the inability to speak Obsession is an involuntary, persistent idea or emotion; the suffix –mania indicates a strong obsession with something. For example pyromania is an obsession with fire Paranoia is overly suspicious system of thinking; fixed delusion that one is being harassed, persecuted, or unfairly treated. Feeling like the victim

Psychiatric Disorders Regarding Psychiatric Disorders, I will go over the terms you need to know. You need to know the definition of the terms in bold to the right, you do not have to know all the detail unless I list it 

Sigmund Freud did a lot of work in the area of personality and came to understand and determine that the personality of a person is made up of 3 parts: o Id represents unconscious instincts and psychic energy present from birth. It contains basic drives that are operating according to the pleasure principle, and seek immediate gratification regardless of the reality of the situation o Ego is the central coordinating branch of the personality. It is the mediator between the id and the outside world. It is the part of the personality that deals with reality, and it postpones the gratification of a need or drive until a satisfactory object of situation arises. The ego is perceived as being “self” by the individual o Superego is the internalized conscience and moral part of the personality. It encompasses the sense of discipline derived from parental authority and society. This is where you would have guilt feelings that would arise from behavior and thoughts that do not conform to the standards of the superego

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Psychosis is frequently used to describe mental illness o Psychosis would involve significant impairment of reality testing, this would be severe mental illness where you would have symptoms of delusions (false beliefs), hallucinations (false sensory perceptions), and bizarre behavior o Schizophrenic disorders would be examples of psychoses  Patients exhibit a disturbed sense of self, inappropriate affect (emotional reactions), and withdrawal from the external world

*Psychiatric disorders that are discussed in this section are anxiety disorders, bipolar disorders, depressive disorders, dissociative disorders, eating disorders, neurocognitive disorders, neurodevelopmental disorders, schizophrenia spectrum disorders, sexual dysfunctions and gender dysphoria, somatic symptom disorders, and substance-related and addictive disorders. Anxiety Disorders In regards to Anxiety Disorders, you need to know the following terms:

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Anxiety disorders are characterized by the experience of unpleasant tension, distress, troubled feelings, and avoidance behavior o A panic attack is a defined period of intense fear or discomfort in which symptoms develop abruptly and reach a peak within 10 minutes Panic Disorder is a condition characterized by recurrent, unexpected panic attacks and persistent concern about having another panic attack in between episodes Phobic Disorders are characterized by irrational or debilitating fears associated with a specific object or situation o The patient who would have that phobia would go to extreme lengths to avoid that fear Agoraphobia (agora=marketplace) is the fear of being in open, crowded, public places from which escape would be difficult or in which help might not be available, or of going out alone in “unsafe” places o These people limit their normal activities to avoid situations that trigger their anxiety o They may feel comfortable only when at home or in the company of a friend or relative A social phobia (social anxiety disorder) is the fear of situations in which the affected person is open to public scrutiny, which could result in possible embarrassment and humiliation o For example, the fear may focus on speaking in public, using public restrooms, or eating in public Claustrophobia is a fear of closed-in spaces Acrophobia is a fear of heights Zoophobia is a fear of animals Obsessive-Compulsive Disorder (OCD) involves recurrent thoughts (obsessions) and repetitive acts (compulsions) that dominate the patient’s life o The patient experiences anxiety if he or she is prevented from performing special rituals. Post-Traumatic Stress Disorder (PTSD) is the development of symptoms (intense fear, helplessness, insomnia, nightmares, and diminished responsiveness to the external world) following exposure to a traumatic event o Flashbacks, bothersome thoughts, and anxiety often triggered by reminders occur in episodes longer after a life-threatening or major emotional event Generalized Anxiety Disorder (GAD) is characterized by chronic anxiety and exaggerated worry and tension even when there is little or nothing to provoke such feelings

Bipolar Disorders In regards to Bipolar Disorders, you need to know the following terms: 

Bipolar disorders are characterized by one or more manic episodes alternating with depressive episodes o A manic episode is a period during which the predominant mood is excessively elevated or irritable

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Associated symptoms include inflated self-esteem, decreased need for sleep, rapid speech with quick changes of topic, distractibility, and excessive involvement in pleasurable activities that have a high or painful consequence o Hypomania describes a mood resembling mania, but lesser intensity Bipolar disorder I is characterized by one or more manic episodes, often alternating with major depressive episodes Bipolar disorder II is characterized by recurrent major depressive episodes alternating with hypomanic episodes Cyclothymic disorder is a mild form of bipolar disorder characterized by at least 2 years of numerous periods with hypomanic symptoms that do not meet criteria for mania and depressive symptoms that do not meet the criteria for a major depressive disorder

Depressive Disorders In regards to Depressive disorders, you need to know the following terms: Depressive Disorders are marked by the occurrence of one or more major depressive episodes without a history of mania or hypomania 

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Major Depressive Disorder involves episodes of severe dysphoria (sadness, hopelessness, worry discouragement) o Other signs and symptoms are appetite disturbances and changes in weight, sleep disorders, fatigue or low energy, feelings of worthlessness, hopelessness, or excessive or inappropriate guilt, difficulty thinking or concentrating, and recurrent thoughts of death or suicide Persistent Depressive Disorder (dysthymia) is a depressive disorder involving depressed mood (feeling sad or “down in the dumps”) that persists over a 2 year period but is not as severe as major depression o No psychotic features (delusions and/or hallucinations) as are sometimes found in major depressive disorder Researchers have noted a relationship between the onset of an episode of depressive disorder and a particular period of the year, and this is called Seasonal Affective Disorder (SAD) o It can occur often in the wintertime o Patients who have long periods of no daylight can develop SAD

Dissociative Disorders In regards to Dissociative Disorders, you need to know the following terms: 

Dissociative Disorder is a condition involving breakdown in memory, identity, or perception. People with dissociative disorder escape reality through amnesia or alternate identities

Eating Disorders In regards to Eating Disorders, you need to know the following terms:

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Eating Disorders are severe disturbances in eating behavior o Anorexia Nervosa is characterized by refusal to maintain a minimal normal body weight  They are so afraid of gaining weight, they just don’t eat. The term anorexia means “lack of appetite” o Bulimia Nervosa is characterized by binge eating (uncontrolled indulgence in food) followed by purging (eliminating food from the body)  The term bulimia means “abnormal increase in hunger”

Neurocognitive Disorders In regards to Neurocognitive Disorders, you need to know the following terms:  

Neurocognitive Disorders are marked by disturbances in cognition (thinking, perception, reasoning and judgement) Delirium and Dementia are their primary feature o Delirium is marked by acute episodes of confused thinking, disorientation, and behavioral changes, such as agitation and fear  It is caused by a variety of conditions including drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances  Delirium tremors (also known as DT’s) is brought on by stopping alcohol consumption suddenly after prolonged periods of heavy alcohol ingestion o Dementia is marked by progressive loss of intellectual abilities such as judgement, memory, and reasoning, as well as changes in personality  It also includes difficulty with language and with simple acts like dressing or brushing the teeth  It may be caused by conditions, some reversible and some progressive, involving damage to the brain  Most common cause is Alzheimer Disease, but there are other causes as well

Neurodevelopmental Disorders In regards to Neurodevelopmental Disorders, you need to know the following terms: 

Neurodevelopmental Disorders are a group of childhood disorders characterized by delays in the development of socialization and communication skills. The following are examples of neurodevelopmental disorders: o Autism spectrum disorders - Autism is usually evident during the first 3 years of life  It is characterized by difficulties in verbal and nonverbal communication and in social play interactions o Asperger Syndrome is often referred to as a less severe type of autism  Children with this frequently have normal language skills and normal intelligence  They usually want to interact with others but don’t know how to do it

Personality Disorders In regards to Personality Disorders, you need to know the following terms:   

A Personality Disorder is an enduring pattern of thinking and behaving contrary to what is culturally acceptable Pervasive and inflexible, it typically first becomes evident in early adulthood and leads to distress or conflict with others Personality Disorders are divided into 3 clusters or categories: o Cluster A  Paranoid – Pattern of distrust and suspiciousness so that motives of others are interpreted as malicious; quick to take offense  Schizoid – Pattern of detachment from social relationships with restricted range of emotions; cold, aloof, and indifferent to the feelings of others o Cluster B  Antisocial – pattern of disregard for, and violation of, the rights of others.  Borderline – pattern of instability and interpersonal relationships and sense of self.  Histrionic –pattern of excessive emotionality and attention seeking.  Narcissistic – pattern of grandiosity, need for admiration, and lack of empathy. o Cluster C  Obsessive-compulsive – pattern of orderliness, perfectionism, and control

Schizophrenia Spectrum and Other Psychotic Disorders In regards to Schizophrenia Spectrum and other Psychotic Disorders, you need to know the following terms:  

Schizophrenia spectrum and other psychotic disorders are chronic psychoses marked by disturbed thinking and disorganized speech Key features that define these disorders are: o Delusions – fixed beliefs that are not easy to change in light of conflicting evidence o Hallucinations – hearing voices or sounds that do not exist but seem real o Disorganized thinking (speech) – person may switch from one topic to another resulting in incoherent speech o Abnormal motor behavior – involuntary movements and mannerisms from childlike “silliness” to unpredictable agitation o Negative symptoms – flatness of affect (diminished emotional expression) and unwillingness to initiate purposeful activities

Sexual Dysfunctions, Paraphilias, and Gender Dysphoria

In regards to Sexual Dysfunctions, Paraphilias, and Gender Dysphoria, you need to know the following terms:  

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Sexual dysfunctions are disturbances in a person’s ability to respond sexually or to experience sexual pleasure Paraphilias are characterized by recurrent, intense, sexual urges, fantasies or behaviors that involve sexual objects, activities, or situations. Some examples of Paraphilias are: o Exhibitionism is the compulsive need to expose one’s body, particularly the genitals, to an unsuspecting stranger o Fetishism is the use of nonliving objects (articles of clothing) as substitutes for a human sexual love object o Pedophilia is sexual urges and fantasies involving sexual activity with a prepubescent child (age 13 or younger) Gender dysphoria is a strong and persistent cross-gender identification manifested in preference for dressing and gender roles typical for the opposite sex

Somatic Symptom Disorders In regards to Somatic Symptom Disorders, you need to know the following terms:  

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In somatic symptom disorders, the patient’s mental conflicts are expressed as physical symptoms These physical symptoms may be abdominal pain, chest pain, nausea, vomiting, diarrhea, palpitations, deafness, blindness, and paralysis and are not adequately explained by a physical or other mental disorder or by injury and are not side effects of medications, drugs, or alcohol Three examples are: o Somatic Symptom Disorder is classified as the presence of one or more somatic symptoms that are distressing or result in significant disruption of daily life o Illness Anxiety Disorder is a preoccupation with having or acquiring a severe illness o Conversion Disorder is a marked by specific neurologic signs or symptoms (numbness, paralysis, or blindness) with no actual, organic basis. These symptoms are the result of anxiety and unconscious inner conflict. The symptom enables the affected person to avoid conflict and get support from the surrounding environment

Substance-Related and Addictive Disorders In regards to Substance-Related and Addictive Disorders, you need to know the following terms: 

Substance-related and addictive disorders are characterized by symptoms and behavioral changes associated with regular use or discontinuation of substances that affect the central nervous system o Psychological dependence is a compulsion to continue taking a drug despite adverse consequences

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Physiologic Dependence is characterized by the onset of withdrawal symptoms when the drug is discontinued abruptly  A significant feature of physiologic dependence is tolerance Tolerance is the declining effect of the drug so that the dose must be increased to give the same effect.  Individuals who get into trouble with overdosing, whether it is prescribed, or not prescribed, they are taking a drug to get a desired effect, and over time that effect is minimized, and they become tolerant, so the drug is increased to get the same effect, and that continuous increasing of the drug causes an overdose You...