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Lecture notes Clinical Sciences 1 (OCS213)
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Lecture notes of 69 pages for the course Clinical Sciences 1 at UWC (Notes from lectures)
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OCS213 - PsychiatryINTRODUCTION TO PSYCHIATRY:
Definition of a mental disorder (DSM-5):
A mental disorder is a syndrome characterized by clinically significant disturbance in an
individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the
psychological, biological, or developmental processes underlying mental functioning.
There is usually significant distress or disability in social or occupational activities.
The diagnosis of a mental disorder should have clinical utility; it should help clinicians to
determine treatment plans and prognosis.
The diagnosis of a mental disorder is not equivalent to a need for treatment.
Until etiological or pathophysiological mechanisms are identified to validate specific disorders,
the most important standard for the disorder criteria will be their clinical utility
The etiology of most mental disorders is unknown.
The pathological physiological mechanisms for most mental disorders are unknown.
Until such factors are identified, it will be difficult to fully validate specific disorders.
In the absence of clear biological markers for mental disorders, it has not been possible to
completely separate normal and pathological symptom expressions contained in diagnostic
criteria.
Therefore, a generic diagnostic criterion is “the disturbance causes clinically significant distress
or impairment . . . .”
There are lab tests for some sleep disorders.
Etiology – causing or contributing factors
Contributing to the disease or conditions
Examples: trauma, genetics, stress
Diagnoses are made on the basis of:
- The clinical interview
- DSM-5 text descriptions (or ICD 10/11)
- DSM-5 Criteria
- Clinician judgment
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,Steps in making a diagnosis:
- Administer cross-cutting assessments and clinical interview
- Apply DSM 5 or ICD 10/11 (classification)
- Determine whether a diagnostic threshold is met
- Consider subtypes and/or specifiers
- Consider contextual information, disorder text, distress, clinician judgment
- Apply codes and develop a treatment plan
NEUROCOGNITIVE DISORDERS:
REVISION of the Mental Status Examination
[ASEPTIC]
1. Appearance and behavior
- Apparent age
- Dress
- Grooming and Hygiene
- Gait
- Psychomotor activity
- Abnormal movements
- Eye contact
- Attitude
2. Speech
- Rate
- Rhythm
- Tone of voice
- Volume
- Accent, Clarity, Quantity
3. Emotion
- Mood
- Affect
- Congruence to mood; appropriateness
- Quality
- Range
- Stability
4. Perception
2
, - Hallucinations
- Illusions
- Depersonalization
- Derealisation
5. Thought Content and Process
- Thought process
- Thought content
- Delusions
- Suicidal ideation
- Homicidal ideation
6. Insight and judgment
7. Cognition
- Level of consciousness
- Orientation in 3 spheres
- Attention / concentration
- Memory
- Intelligence (globally and intellectual functions)
Delirium vs Dementia vs Amnesia
What is Delirium?
- Delirium is characterized by an acute decline in both the level of consciousness and
cognition with particular impairment in attention.
- A life threatening, yet potentially reversible disorder of the central nervous system (cns);
delirium often involves perceptual disturbances, abnormal psychomotor activity, and
sleep cycle impairment.
- Delirium is a medical emergency and requires care by a physician not a psychiatrist
- Causes include: medical conditions such as meningitis, sepsis, electrolyte abnormalities,
substances, withdrawal & medications...
- Treat the cause to treat the delirium, can use sedatives while correcting the underlying
abnormality
Delirium vs. Dementia
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, Epidemiology of Dementia (NCDS):
- 5 - 7% in the elderly
- 1% at 60
- Incidence doubles every 5 years
- 30-40 % by 85 years
- > 35 million people worldwide
- In SA, 250000 with dementia, 25000 have Alzheimer’s
Aetiology:
- Sometimes only definitive at post mortem exam
- In developed countries Alzheimer’s (AD) = 50% of major NCDs,
- South Africa: vascular is more common than AD and HIV assoc. is on the rise
Prognosis:
- Major NCD is progressive and irreversible
- We can make an impact wrt the psycho-social effects
- We can also slow progression by managing comorbidities
- Early diagnosis and intervention is key
Memory:
- Childhood: fast mapping – absorb everything
- Young adulthood: fluid intelligence – memorize easily, integrate info, switch quickly
- +/- 40 years: Crystallized intelligence – integration of info with experience, better
understanding, loss of sharp memory
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