Psychiatry for Medical Students

Psychiatry is one of the major specialties of medicine, and is concerned with the diagnosis and treatment of the psychiatric disorders.

This volume on Psychiatry is currently in the initial stages of development. Initial material has been sourced from Wikipedia.

Further development will be a project of the University of Cape Town's Dept of Psychiatry and Mental Health.

For further information, please contact Dan Stein (dan.stein@curie.uct.ac.za).

Delirium, Dementia, and other Cognitive Disorders

Although most psychiatric disorders are presumed to have an underlying alteration in function, this group are separated off by having a suspected cause in another area of medical specialty. For example, delirium ([1]), is commonly caused by alterations in brain oxygenation and would be better assessed by a physician to determine possible treatable causes. The organic disorders may have an underlying basis that is treatable or untreatable and treatment may or may not improve symptoms. This group includes Delirium, Dementia and other disorders listed below where they are proved to be secondary to a physical cause (e.g. a mood disorder secondary to changed thyroid function). Disorders which are caused by intoxication or withdrawal may also be considered under organic disorders, although we will consider substance use and misuse disorders separately.

Dementia Definition: usually permanent disorder of memory, other cognitive functions and overall level of functioning. Major types of Dementia

Alzheimer's Disease Vascular Dementia Lewy Body Dementia

Psychotic Disorders

The Psychotic Disorders are characterised by alterations in thinking or perception that cause distress or impairment in functioning. These include disorders such as Schizophrenia, Schizoaffective disorder and related disorders. There are clusters of symptoms broadly characterised as positive and negative symptoms.

Schizophrenia

(Citation: Joel Lamoure. Schizophrenia.Getting the Right Drug to the Right Patient. Pharmacy Practice 2007; 23(4) 48-54,63-64)

Schizophrenia is a chronic, severe, and disabling mental illness. It affects men and women with equal frequency. Schizophrenia is usually diagnosed in people aged 17-35 years. The illness appears earlier in men (in the late teens or early twenties) than in women (who are affected in the twenties to early thirties. In Canada the overall incidence is about 0.6 % (1) of the population. People suffering from schizophrenia may have the following symptoms: (2) • Delusions • Hallucinations • Disorganized thoughts and behaviors • Disorganized speech • Catatonic behavior

Schizophrenia Causes (3)

The causes of schizophrenia are not known. However, interplay of genetic, biological, environmental, and psychological factors are thought to be involved in biologic models of schizophrenia, genetic (familial) predisposition, infectious agents, allergies, and disturbances in metabolism have all been investigated. Schizophrenia is known to run in families. Thus, the risk of illness in an identical twin of a person with schizophrenia is 40-50%. A child of a parent suffering from schizophrenia has a 10% chance of developing the illness. (4) The list of neurotransmitters under scrutiny is long, but special attention has been given to dopamine, serotonin, and glutamate. (5,6,7,8) As well, schizophrenia could be a disorder of brain development. It is important for the allied health care team to investigate all reasonable medical causes for any acute change in someone’s mental health or behavior. Sometimes a medical condition that might be treated easily, if diagnosed, is responsible for symptoms that resemble those of schizophrenia. Examples of conditions that may mimic schizophrenia include substance abuse and the initial assessments should include a thorough neurological exam urine and serum screening for alcohol, or other drugs which may be abused. Additionally, such basic lab tests as CBC, serum electrolytes (Especially hyponatremia), glucose, baseline ECG, liver, renal, lipid profile, amylase, BMI and thyroid functions should also be considered. These levels will also provide a baseline for the patient before introduction of antipsychotic therapies and may identify co morbidities and or conditions, which may mimic schizophrenia. (9) Joel Lamoure 15:56, 7 April 2007 (UTC)

References:

1) Addington D (Chair) et al.. Clinical Practice Guidelines Treatment of Schizophrenia. Canadian J of Psychiatry Vol50, Supplement 1 Nov 2005 pg1S-56S

2) Schizophrenia Overview www.emedicine.com

3) Schizophrenia Causes www.emedicine.com

4) VanOs J, McGuffin P. Can the social environment cause schizophrenia? British J of Psychiatry 2003;182 (2): 291-292

5) Carlsson A, Waters N, Carlsson M. Neurotransmitter interactions in schizophrenia-therapeutic implications. Biological Psychiatry 1999; 46 (10) 1388-1395

6) Tandon R. Cholinergic aspects of schizophrenia. British J of psychiatry Suppl. 1999; (37): 7-11

7) Abi-Dargham A, Laurelle M, Aghajanian GK et al. The role of serotonin in the pathophysiology and treatment of schizophrenia. The J of Neuropsychiatry and Clinical Neurosciences. 1997; 9:1-17

8) Goff D, Coyle J. The emerging role of glutamate in the pathophysiology and treatment of schizophrenia. American J of Psychiatry 2001; 158 (9):1367-1377

9) APA Guideline for Treating Adults With Schizophrenia www.medscape.com

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