Subject and task of psychiatry and

narcology. History of development and

modern state of psychiatry and narcology.
Psychonosology and diseases. Principles
of therapy, prophylaxis and rehabilitation
of psychiatrical disorders. Pathology of
cognitive processes. Disorders of
sensations, perceptions. Disorders of
memory.

Olena Smashna
"A psychiatrist is a fellow who asks you a lot of
expensive questions your wife asks for nothing"
- Joey Adams
 Basic Terms in Psychiatry
Psychiatry studies the causes of mental disorders, gives
their description, predicts their future course and outcome,
looks for prevention of their appearance and presents the
best ways of their treatment
Psychopathology describes symptoms of mental disorders
Special psychiatry is devoted to individual mental diseases
General psychiatry studies psychopathological
phenomena, symptoms of abnormal states of mind:
1. consciousness 5. mood (emotions)
2. perception 6. intelligence
3. thinking 7. motor
4. memory 8. personality
 Psychiatry -
The term psychiatry, coined by Johann Christian Reil in
1808, comes from the Greek psyche (soul or mind)
and iatros" (healer or doctor)
Psychiatry is a medical specialty which exists to study,
prevent, and treat mental disorders in humans.
Psychiatric assessment typically involves a mental
status examination and taking a case history, and
psychological tests may be administered. Physical
examinations may be conducted and occasionally
neuroimages or other neurophysiological
measurements taken.
 Connection with other
specialities -
Those who practice psychiatry are different than most other
mental health professionals and physicians in that they must be
familiar with both the social and biological sciences. The
discipline is interested in the operations of different organs and
body systems as classified by the patient's subjective
experiences and the objective physiology of the patient. While
the focus of psychiatry has changed little throughout time, the
diagnostic and treatment processes have evolved dramatically
and continue to do so. Since the late 20th century, the field of
psychiatry has continued to become more biological and less
conceptually isolated from the field of medicine.
 Ancient times

Starting in the 5th century BC, mental disorders, especially

those with psychotic traits, were considered supernatural in
origin. This view existed throughout ancient Greece and Rome.
Early manuals written about mental disorders were created by
the Greeks. In 4th century BC, Hippocrates theorized that
physiological abnormalities may be the root of mental disorders.
Religious leaders and others returned to using early versions of
exorcisms to treat mental disorders which often utilized cruel,
harsh, and other barbarous methods.
Ancient times
 Middle Ages
The first psychiatric hospitals were built in the medieval Islamic world
from the 8th century. The first was built in Baghdad in 705, followed by
Fes in the early 8th century, and Cairo in 800. Unlike medieval
Christian physicians who relied on demonological explanations for
mental illness, medieval Muslim physicians relied mostly on clinical
observations. They made significant advances to psychiatry and were
the first to provide psychotherapy and moral treatment for mentally ill
patients, in addition to other forms of treatment such as baths, drug
medication, music therapy and occupational therapy. In the 10th
century, the Persian physician Muhammad ibn Zakariya Razi (Rhazes)
combined psychological methods and physiological explanations to
provide treatment to mentally ill patients. His contemporary, the Arab
physician Najab ud-din Muhammad, first described a number of mental
illnesses such as agitated depression, neurosis, and sexual impotence
(Nafkhae Malikholia), psychosis (Kutrib), and mania (Dual-Kulb).
 Middle Ages
In the 11th century, another Persian physician Avicenna
recognized 'physiological psychology' in the treatment of
illnesses involving emotions, and developed a system for
associating changes in the pulse rate with inner feelings, which
is seen as a precursor to the word association test developed by
Carl Jung in the 19th century.Avicenna was also an early
pioneer of neuropsychiatry, and first described a number of
neuropsychiatric conditions such as
hallucination,
insomnia, mania, nightmare, melancholia,
dementia, epilepsy, paralysis, stroke,
vertigo and tremor.
 Middle Ages
Psychiatric hospitals were built in medieval Europe from the
13th century to treat mental disorders but were utilized only as
custodial institutions and did not provide any type of
treatment.Founded in the 13th century, Bethlem Royal Hospital
in London is one of the oldest psychiatric hospitals. By 1547 the
City of London acquired the hospital and continued its function
until 1948.
 Early modern period
In 1656, Louis XIV of France created a public system of
hospitals for those suffering from mental disorders, but as in
England, no real treatment was being applied. Thirty years later
the new ruling monarch in England, George III, was known to
be suffering from a mental disorder. Following the King's
remission in 1789, mental illness was seen as something which
could be treated and cured.
 Early modern period
By 1792 French physician Philippe Pinel introduced humane
treatment approaches to those suffering from mental disorders.
William Tuke adopted the methods outlined by Pinel and that
same year Tuke opened the York Retreat in England. That
institution became known as a model throughout the world for
humane and moral treatment of patients suffering from mental
disorders. It inspired similar institutions in the United States,
most notably the Brattleboro Retreat and the Hartford Retreat
(now the Institute of Living).
 19th century
Universities often played a part in the administration of the
asylums. Due to the relationship between the universities and
asylums, scores of competitive psychiatrists were being molded
in Germany. Germany became known as the world leader in
psychiatry during the nineteenth century. The country
possessed more than 20 separate universities all competing
with each other for scientific advancement. However, because
of Germany's individual states and the lack of national
regulation of asylums, the country had no organized
centralization of asylums or psychiatry.Britain, like Germany,
also lacked a centralized organization for the administration of
asylums. This deficit hindered the diffusion of new ideas in
medicine and psychiatry.

19th century
In the United States in 1834, Anna Marsh, a
physician's widow, deeded the funds to build her
country's first financially-stable private asylum. The
Brattleboro Retreat marked the beginning of
America's private psychiatric hospitals challenging
state institutions for patients, funding, and
influence. Although based on England's York
Retreat, it would be followed by speciality
institutions of every treatment philosophy.

In 1838, France enacted a law to regulate both the

admissions into asylums and asylum services across
the country. By 1840, asylums as therapeutic
institutions existed throughout Europe and the
United States.
 19th century
However, the new and dominating ideas that mental illness
could be "conquered" during the mid-nineteenth century all
came crashing down. Psychiatrists and asylums were being
pressured by an ever increasing patient population.
Overcrowding was rampant in France where asylums would
commonly take in double their maximum capacity. Increases in
asylum populations may have been a result of the transfer of
care from families and poorhouses, .
 19th century
but the specific reasons as to why the increase occurred is still
debated today. No matter the cause, the pressure on asylums
from the increase was taking its toll on the asylums and
psychiatry as a specialty. Asylums were once again turning into
custodial institutions and the reputation of psychiatry in the
medical world had hit an extreme low.
 20th century
The 20th century introduced a new psychiatry into the world.
The different perspectives of looking at mental disorders began
to be introduced. The career of Emil Kraepelin somewhat model
this hiatus of psychiatry between the different disciplines.
 20th century
Kraepelin initially was very attracted to psychology and ignored
the ideas of anatomical psychiatry. Following his acceptance for
a professorship of psychiatry, and later his work in a university
psychiatric clinic, Kraepelin's interest in pure psychology began
to fade and he introduced a plan of a more comprehensive
psychiatry.Kraepelin also began to study and promote the ideas
of disease classification for mental disorders, an idea introduced
by Karl Ludwig Kahlbaum.
 20th century

The initial ideas behind biological psychiatry, stating that these

different disorders were all biological in nature, evolved into a
new idea of "nerves" and psychiatry became a sort of rough
neurology or neuropsychiatry. Following Sigmund Freud's death,
ideas stemming from psychoanalytic theory also began to take
root. The psychoanalytic theory became popular among
psychiatrists because it allowed the patients to be treated in
private practices instead of asylums. However the progress of
psychiatry by the 1970s turned psychoanalytic theory into a
marginal school of thought within the field.
 20th century
ECT was "discovered" when Ugo Cerletti, psychiatrist, visited a
Rome slaughterhouse to see what could be learned from the
method that was employed to butcher hogs. In Cerletti's own
words, "As soon as the hogs were clamped by the [electric]
tongs, they fell unconscious, stiffened, then after a few seconds
they were shaken by convulsions.... During this period of
unconsciousness (epileptic coma), the butcher stabbed and bled
the animals without difficulty....
 20th century
"At this point I felt we could venture to experiment on man, and I
instructed my assistants to be on the alert for the selection of a
suitable subject."
Cerletti's first victim was provided by the local police - a man described
by Cerletti as "lucid and well-oriented." After surviving the first blast
without losing consciousness, the victim overheard Cerletti discussing a
second application with a higher voltage. He begged Cerletti, "Non una
seconda! Mortifierel" ("Not another one! It will kill me!")
Ignoring the objections of his assistants, Cerletti increased the voltage
and duration and fired again. With the "successful" electrically induced
convulsion of his victim, Ugo Cerletti brought about the application of
hog-slaughtering skills to humans, creating one of the most brutal
techniques of psychiatry .
 20th century
Lobotomy is a surgical practice where parts of the frontal lobes
are intentionally destroyed. Violent criminals calm down, highly
depressed people don't seem so depressed any longer, and
manics finally mellow out. But they wander aimlessly, drool
uncontrollably, and have very little left of whatever "personality"
they once had. If the goal is calm, quiet, and "nice" people,
then it's a roaring success.
 Sensation
the most elementary stage, which reflects separate quality of
subject, which is acting in right moment to sensory organs.
Classification :
According to modality:
Interoceptive give signal about condition of our inner world:
warm, cold, hunger, uncomfortability. These sensastions dont
have localisation, outside proection, closely connected with
emotional processes.
Exteroceptive 5 sensation organs: smell, taste, sight,
hearing, tactile.
Proprioceptive information about body position, movement
in space, everything which makes body scheme.
 Sensation
Anesthesia absence of 1 or more type of sensation.
Analgesia loss of pain sensation ( at acute
psychopathological diseases.) Patients, who commit
suicides: they cut their organs at such moment they dont
feel anything. After some time everything comes back with
recreation of psyche. ( At deep depression, progressive
paralysis, brain syphillis, convulsive disorders(hysteria),
anaestesia dolorosa depresia absense of sensation ).
Hyperesthesia subjective increasing of sensation.
Hyperalgesia increasing of pain sensastion
(depression,espessially light).
 Sensation
Optical hyperesthesia daily light blind a man.
Acustical h-sia changes of perception threshold. Light sound percept as
strong one even to pain. This is sign of ex haustion, asthenic conditions.
Taste, smell complains on increasing of these sensations. It could be at
normal conditions.
Skin sensations tactile and temperature. Touch to a body is
unpleasant.

Paresthesia distortion sensations.

 Senestopathy
psychosomatic sensation. It has such signs:
.Polymorphism of sensations (pain, heartburn, electrisation ).

.Sign which differentiates it from general somatic signs there

are complains, but they dont have any localization, intensity,

patients cannot explain them.
It has matter during mask depression diagnostic: sen.-as cardio-
vascular, central neurotic, abdominal, skin- underskin, bone muscle.
They could be: permanent, episodical, as attack (sen.- crisis).
Accompanied with panic, vegetative disorders. They begin with simple
sen., after that they become very hard.
Elementary sen.- those, which doesnt have sensor modality (my sole
is trembling).Simple sen. concrete modality pain, parasthesias.
 Senesthesia various disorders of movement,
which has subjective character, which are not
confirm with objective investigations (my legs
and arms are not listening to me).

Sinesthesia appear as a result of action of

different sensation organs colored music. Smell
calls some other sensation. Name of the person-
some color etc.
 PERCEPTION -
- reflection of object in general.
Classification: splitting, illusions, pseudohallucinations, hallucinations,
eydetysm, disorder of sensor synthesis, hallucinoids.

Double - loss of capacity of whole object formulation. He percept

normally object, but couldnt join it together. Ex.- tree its separately
leaves, trunk etc. At infectious diseases.
Illusions false perception of real existent object.
Affective ill.- affect of fear, anxious, horror, connected with special
emotional condition.
Verbal ill.- words, phrases are percept in place of real.
Pareydolia optical illusions with fantastic content. Various objects
which dont have forms are seen in various pictures.
 PERCEPTION -
-
 PERCEPTION -
- Hallucination perception without object,which acts on
sense organs.
Visual.
Simple photopsias. Complex have subject content
zoological, demanomanic, antropomorphic(close people, dead
people, body pieces, inner organs), panoramic- ground, atomic
explosure).etc
Acustical.
Simple sounds.
Complex comment, imperative, stereotypical during some
time they hear same words or phrases.
 PERCEPTION -
- Smell, taste when they dont take food.
Skin tactile(touching,pressure, insects under skin, hair in the
mouth)etc.
Interoceptive, visceral inside of the body animals, different objects.
Kinestetical feel, like fingers are compressed in a fist, run
somewhere.
Vestibular feeling of falling, lifting.
Symptom of twin feeling of body splitting.
Hypnogogic in condition of falling asleep.
Hypnopompic in condition of getting up.
Affectogenic h.- in condition of strss, affect.
Inductive they have collective character. There is inductor and the
person to whom induct. If we separate them we understand who is ill.
 PERCEPTION -
S-m Lippman, s-m Ashaphenburg, s-m Reyhardt.
 PERCEPTION -
PSEUDOHALLUCINATIONS. At first was described by
Candinskyy in 1890.
Pequliarities :
.False objects, which are experience, such as going in

space see by mind, by inner eye, i can see by brain,

hear by inner ear.
.They have obusive character, appear suddenly, agains

patients will. Feeling of self activity accompanied by

someones action.
.They dont have objective reality, dont mix with reality.

.Difference between real and pseudohallucination.

 PERCEPTION -
As a rule, at pseudoh. We can see changes in behavior
apsence of signs on outside world.
There are some objective signs: they watching or listening to
smth, close ears, nose, touch smth. They hide somewhere,
looking for smth, catching smth, run somewhere- real.
In pseudoh. absence of attention on surrounding.
PERCEPTION -
 PERCEPTION -
Hallucinoids rudimentary display of visual
h. Prestage of real h. Patients have some
critics to them. Its not h.-on, but its not
normal.

Eydetysm(eidetic memory) Man capacity to

hold for a long time some object, pictures. As
a rule visual, but could be auditorial and
tactile. Phenomenal visual memory.
 PERCEPTION -
Depersonalization is a nonspecific feeling that a person has
lost his or her identity, that the self is different or unreal. People
may be concerned that body parts do not belong to them.
People may have an acute sensation that their body has
drastically changed.
Derealization is the false perception by a person that the
environment has changed. For example, everything seems
bigger or smaller, or familiar surroundings have become
somehow strange and familiar.
 PERCEPTION -
DISORDER OF SENSORIAL SYNTHESIS (psychosensorial
disorders) perception disorder of form, size, objects,
oneself. On abolition from illusion there is no disorder of
identity of subject.
Metamorphosias perception disorder of form and size. They
are bigger macropsia or smaller micropsia.
Dysmehalopsia twisted.
Paliopsia on abolition of 1 object there a lot of them.
Disorders of body scheme autometamorphopsia. Macropsia
increasing (Huliver), micropsia decreasing (lilliputian).
Disorders of time perception increasing of time speed (at manic
patients), decreasing of time speed(at depressive patients).
PERCEPTION -
 Memory -
is considered by psychologists as kind
of activity, which provides memorizing,
keeping, retention, forgetting. It gives
opportunity to gather the information
and on basis of experience to use it
later.
Basic processes (functions) of
memory:

Memorizing of information (fixing);

Saving or maintenance of
information (RETENSION);

Recreation of information
(reproduction);

Forgetting of information.
 Memory is divided into three
kinds or stages:

sensory memory,
short-term memory,
and long-term
memory
 Disorders of memory:

Quantative disorders:
Hypomnesia decreasing of memory
Hypermnesia increasing of memory
Amnesia loss of memory
Paramnesia memory distortion
 Types of amnesias

Fixative loss of capacity to memorise new or

certain events. Previous events are kept in
memory.
Progressive amnesia gradually decreasing of
memory.
Ribo Law: Memory is suffers from lately acquired
to that, which was acquired before. The most
longer kinesthetic and emotional memory are
kept in storage.
 Types of amnesias
Retrograde loss of memory on events which took place
before psychosis or disorder of consciousness. Could last
on few seconds, minutes, months, years.
Anterograde - loss of memory on the events, which took
place after psychosis or disorder of consciousness.
Retroanterograde before and after psychosis or
disorder of consciousness.
Congrade loss of memory on period of absence of
consciousness.
Total
Fragmentive during delirium.
Retarded after some time of psychosis.
 Types of amnesias
Specific alcoholic - palimpsest special sign for early
alcoholism. Its a loss of memory on some details during
alcohol drinking.
Amnestic disorientation one of the main components
of Korsakoffs psychosis, as result of brain trauma,
atherosclerotic changes, at intoxication, poisoning by CO .
Affectogenic during pathological affect, connected with
stress, psychotrauma.
Amnesias may occur during disorders of consciousness :
obnubilation, somnolence, sopor, coma, during twilight
conditions, pathologial affects, intoxications, vascular
diseases, after traumas, epilepsy, ECT.
Qualitive disorders of memory
(Paramnesias) :

Pseudoreminiscence disorder of events localization in

memory, illusions of memory. Gaps in memory are
completed with events which may be present in life.
Confabulations pathological pictures, with which
amnestic windows are completed with never happen
even in their life.
Cryptomnesias they could not identify source of
information. They could define themselfs as authors of
books, music.
Anecphoria patient is able to reproduct some
information only with prompting.
Ekmnesia events from the past are assimilated as
present.
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