Ministry of Health of Ukraine
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Ministry of Health of Ukraine Bukovynian State Medical University “Approved” on the methodical meeting of the Department of neurology, psychiatry and medical psychology nm. S.M.Savenko “____” ___________ 2009 (Report № __). Chief of the Department _______________________ Professor V.M. Pashkovsky Methodical INSTRUCTION for 4-th year students of medical faculty №2 (the speciality “medical affair”) for independent work during preparing to practical class Theme 1: Object and tasks of psychiatry and narcology, history of development. Organization of help for mentally ill patients. Features of structure of mental hospital and dispensary. Examination principles of mentally patients. MODULE 1. GENERAL QUESTIONS OF PSYCHIATRY AND NARCOLOGY. GENERAL PSYCHOPATHOLOGY Topical module 1. General questions of psychiatry and narcology Сhernivtsi, 2009 ^ A narcology is clinical discipline, which studies etiology, pathogenesis, clinic, diagnostics, treatment, prophylaxis and examination of diseases which arose up as a result of the use of alcohol and psychoactive substance.2. Hours: 23. Teaching goal The students must know:
and be able to:
Assimilate practical skills
^ for learning theme 1
^ The mental condition of patient has a big influence on forming of any is under an obligation to direct this influencing in a therapeutic way. Six periods are selected in the development of psychiatry, which were predefined by attitude of society toward mentally ill:
When physicians became interested in insanity, lunacy, and madness, they portrayed mentally ill individuals as having lost their reason, which makes us human beings human. From the 15th and 16th centuries there was an increasing secularism of society and a decreasing power of the Church. There is an important demographic change as well, with increasing urbanism and market economy. There was a growing humanism, with man, not God being the centre of attention and study. In the United States, physicians took initiatives to confine the mad as well. The first American mad-doctor, Benjamin Rush, invented the tranquilizing chair which, as a matter of fact, was quite effective to calm manic patients down. They could be confined in this chair for weeks at a time. Other creative treatment methods developed in the 18th century include the gyrating chair. In France there existed both royal hospitals and those under the auspices of the Catholic Church. These hospitals advocated a form of Moral Treatment. German influence can be seen with the appearance of the concept of Vitalism. Mental illness was also seen as the result of lack of tension in the nervous system. Rousseau, in his advocacy of self-observation and the romantization of nature, had a profound effect on the early psychiatry of France. Thus reform movements developed in Europe, with Chiarugi (1759-1820) in Florence, William Tuke (1732-1822) and his sons and grandsons in England, and Pinel (1745-1826) in Paris. By the late 1800s medicine was established as a discipline and psychiatry was one of its latest specialties. By the early 1800s hospital reforms were occurring in Germany. In the medical schools and hospitals of Germany great strides were being made in neurology and neuropathology through such physicians as Westphal, Kalbaum, Meynert, Wernicke, Kraft-Ebing, and Mobius. Griesinger (1817-1868) had advocated for the combination of neurology and psychiatry. The Vitalistic theories of an earlier Germany gave way to an emphasis on physiology. An increasing localization of brain functions was occurring. New hospitals were being built in Europe. by the 19th century two schools of etiological beliefs existed, the somatic and psychic. The somatic school saw mental illness as having physical causes such as brain lesions or disturbed nerves, whereas, the psychic school understood mental illness as due to emotional stress. Yet these two schools shared a common model of the mind. In the 19th century, through the work of Kraepelin, Bleuler, and Janet, Associationist’s concepts became important in theories of psychopathology. Mental illness was seen as the result of breakdown in the associative functioning of the mind. Inherited vulnerability to associative breakdown (dissociation) was stressed. It is at this point that the modern schools of psychology and psychiatry with their own models of the mind emerge. These are the Functional-Descriptive, Behaviorist (Cognitive-Behaviorist), Psychoanalytic, Interpersonal, and Gestalt/Existentialist/Humanists schools. Whereas Kraepelin focused primarily on the psychosis, Janet (1859-1947) studied the neurosis. Janet, through the study of such phenomena as somnambulism, fugues, contractures, anesthesia, and obsessions emphasized the role of trauma. In his view, trauma results in an emotional reaction, which is repressed, but reappears, through the alteration of consciousness, to repeat the experience of the trauma. Similar to Kraepelin, these states are seen as the result of breakdown of higher psychological functions, such that the smooth and effective functioning of the mind is interrupted. Various experiences, or even whole mental or physical processes, are disassociated from the rest of mental functioning. Nowadays we have the period of intensive development of scientific psychiatry, which|what| is characterized|described| by depolitisation|, openness, common to all mankind values in the grant of mental health care to the patients. Tasks of psychiatry:
Frame of psychiatry.
The word “psychosis” is used to describe a group of conditions that affect the mind and to some extent mean that the person loses contact with reality. A person may experience unusual or distressing perceptions e.g. hallucinations and delusions, which may be accompanied by a reduced ability to cope with usual day to day activities and routine. Someone who has these unusual experiences is described as having a psychotic episode. Psychosis can affect anyone including men and women from all walks of life. It is quite common and approximately 4 out of every hundred people will experience a psychotic episode at some time in their lives. Most people make a full recovery from the experience. Neurosis, also known as psychoneurosis or neurotic disorder, is a "catch all" term that refers to any mental imbalance that causes distress, but, unlike a psychosis or personality disorder, does not prevent rational thought or an individual's ability to function in daily life. Contra-indication for hospitalization in psychiatric clinic:
Legislation Psychiatry is an integral part of the health care service, which means that it also comes under the provisions of the Health and Medical Services Act. Supplementary provisions with regard to compulsory mental care are to be found in the Compulsory Mental Care Act (LPT) and the Forensic Mental Care Act (LRV). ^ Compulsory mental care The Compulsory Mental Care Act regulates the care of people suffering from serious mental disturbances and where it is considered that the necessary care cannot be provided on a voluntary basis. This may be the case when a person refuses care and, as a result of his/her mental disturbance, threatens the personal safety or physical or mental health of others. ^ The Forensic Mental Care Act contains provisions on the treatment of people who have committed crimes and are regarded as suffering from a serious mental disturbance. The Act primarily applies to people who are committed to compulsory mental care as a penalty for crime. The Act stipulates inter alia the criteria necessary for compulsory care, the terms for leave and compulsory measures and the conditions to be met before care can be terminated. CONCLUSIONPsychiatry is considered a preparadigmatic science, in that there is no one central paradigm. It is rather considered prescriptional, meaning that it is dominated by oppositional trends, for instance the mind and body or psyche and soma debates. As seen from earliest times there are trends that have continued into present. Modern neuropsychiatry can be traced to the humoral theories of Hippocrates. On the other hand, psychodynamics, as used in contemporary psychiatry, deals with the quality of interpersonal relations, recurrent conflict patterns, and, ultimately, the meaning of actions and experiences. Meaning has both cognitive and affective components. Meaning has sociocultural determination. From earliest times efforts have been found to integrate these ideas, as in the assumed relationship of rational thought to passions, where ration is seen to control emotions and passion. Depending on the historical climate, emphasis has varied. Medieval thought saw all things in relationship to God. Illness, especially mental illness was based on man’s relationship with God. Yet through this time humoral treatments and beliefs remained. Effort was put forth to bring humoral ideas into line with the Christian worldview. With the reappearance of Aristotle in the west and the growing importance of observation and empiricist thought, a deistic model was questioned. This gradually gave way to Empiricist thought and an increasing understanding of biology and anatomy. Mental illness took on syndromal character and was seen as a disorder of the brain. Paradoxically at this same time with the growing rationalism and humanism, witchcraft beliefs became the strongest. Throughout this time the plight of the individual with mental illness, especially if not an elite member of society, had changed little. They were treated with varying degrees of fear, scorn, and torment. Movements toward humane treatment reoccurred through history. Originally coming from the east and Islam, first Church based monastic care occurred. In the 18th century with growing reaction against the absolutist monarchies of Europe, liberalism and centuries, with increasing urbanization, capitalism, and the industrial revolution, greater percentages of the population became marginalized as the poor, the criminal, and the insane. They provided the symbolic focus against which middle class values were organized. The Protestant work ethic became increasingly central to morality. The psychiatric profession played a role in the increasing isolation of the mentally ill through the medicalization of social unrest and the growth of the asylum movement. With all the advances in neurobiology and psychodynamics, one can still question to what degree has the life of the individual with mental illness improved. Continuing stigma and economic factors continue to limit the relief of their suffering. Present efforts to integrate models of the mind hold great promise for increased understanding of behaviour, but to what degree the fundamental causes of mental illness will be addressed by these efforts is unclear. Mental health care is part of health and medical care. The basis of mental health care and social services for the mentally ill is that people with mental illness or a psychiatric disability should have the same rights and obligations as other groups in society. ^
7 Practical training during the tutorial 1. Clinical observation of the behavior of the mentally ill patient. 2. Clinical interview. 3. Acquaintance with a mental hospital. ^ A. Questions for self-control:
Literature
Prepared by assistant S.D.Savka |
