‫بسم هللا الرحمن الرحيم‬

‫‪13-12‬‬ ‫‪Heba Fathy,MD‬‬

 Psychiatry for
Undergraduate
By
Dr.Heba Fathy Abdel Rehem
Assistant professor of Psychiatry
Faculty of Medicine
Cairo University
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 Schizophrenia
 Chronic psychotic disorder that shows
marked disturbance in thought, mood
and behaviour that lead to
impairment of function and
deterioration.
 Symptoms :
 Positive symptoms
 Negative symptoms

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 Types:
 Paranoid
 Disorganized

 Catatonic

 Undifferentiated

 Residual

 Schizoaffective

 Simple

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 Mood Disorder
 Depressive Disorder
 Bipolar Disorder

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 Anxiety Disorder
 Anxiety: feeling of apprehension
caused by anticipation of an ill-
defined threat or danger that is not
realistically based
 Manifestation:
 Physical
 Psychological

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 Classification
 Panic Disorder
 Phobic Disorders
 Agoraphobia
 Social phobia

 Specific Phobia

 Obsessive compulsive Disorder

 Post Traumatic stress disorder
 Generalized anxiety disorder
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 Management
 Pharmacotherapy
 Antidepressant
 Anxiolytics

 B- Blockers

 Psychotherapy

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 Organic Brain Disorders
 Delirium
 Intracranial: concussion, neoplasm,
Infection( Herpes simplex, Syphilis, AIDS)
 Extra cranial: Drugs, DM, organ failure,
Electrolyte imbalance, porphyria
 Dementia

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 Strategies of treatment
 General Guide lines
 Psychotherapy
 Pharmacotherapy
 ECT
 Hospitalization
 Rehabilitation
 Treatment of resistant cases

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 Psychotherapy
 Cognitive therapy
 Behavioural therapy
 Interpersonal therapy
 Psychoanalytic
 Family therapy

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 Pharmacotherapy

 Antipsychotic:typical, atypical.
 Antidepressant: Tricycles, SSRI,
SNRI
 Mood stabilizers.

 Anxiolytics

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 Antipsychotic
 Typical
 Low potency;
 Chloropromazine,25,100, ampoules(Neurazine)
 Thioridazine,30,200(Melleril, thiozine)
 High potency
 Haloperidol (Safinace, 1.5, 5, aqueous)
 Trifluperazine (Stellazil 1, 5)
 Atypical
 Clozapine(Leponex, Clozapex, Clozapine,25,100)
 Risperidone( Risperdal, Apexidone,Zesperone, Psychdal,
Risdal) 1,2,3,4
 Olanzapine(Zyprexa, Olapex,5,10)
 Quitiapine (Seroquel 25,100,200)

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 Side Effect Of Antipsycotics
 Neurological
 Acute dystonic reaction
 Parkinsonian like

 Akasthisia

 Tardive Dyskinesia

 Neuroleptic malignant syndrome

 Non- Neurological

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 Antidepressant
 Old: Tricycle:
 Tofranil(imipramine)10,25
 Tryptizole(amitryptiline)10,25
 Anafranil(Clomipramine)25,75
 New:
 SSRI:
 Fluoxetine( Prozac, Flutin, florosin, philozac, deprepan)
 Serteraline( Lustral, modapex, serto)
 Faverine
 Cipram

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 Antidepressant
 Efexor,75,150XR
 Prothieden, 25,75
 Trittico,50,100
 Tolvon30
 Remerone
 Stablon

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 Anxiolytics
 Diazepam: Neuril, valpam, Valinil
 Bromazepoam: Calmepam,
lexotanil,1.5,3)
 Alprazolam: Xanax, Zolam, Alprax
 Lorazepam: ativan
 Non Bezo:
 Stilnox
 Seista

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 Mood Stabilizer
 Lithium: prianil 400
 Depakine 500 Chrono
 Tegretol, trileptal
 Lamotrigen,25,100

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 ECT
 Mechanism of action : Still uncertain
 It is suggested that ECT similar to
TCA
 ECT may affect the activity of adenyl-
cyclase, phospholipase and Ca++( 2nd
messenger) gene expression
 3rd messenger gene transcription
factors and neurotrophic factors.

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 Indication
1- Major depression: failed medication,
severe, suicidal ideation, psychotic
features, agitated pt, catatonic, prior
improvement
2- Bipolar disorder: not first line only in
exhaustion and failed medication
3- Schizophrenia: acute, catatonia,
suicide, homicide, failed medication

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 Contraindication
 No absolute contraindication
 Recent myocardial infarction
 Recent cerebral hg

 Cerebral aneurysm

 cerebral tumours

 Recent retinal detachment

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 Side effects
 Cognition
 Acute post-ictal confusion

 Antro-grade memory dysfunction

 Retro-grade memory dysfunction

 Headache, muscle aches

 Nausea

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 Hospitalization
 Indications:
 Need for diagnostic procedures

 Risk of suicide or homicide

 Reduced ability to get food and

shelter
 History of rapidly progressing
symptoms
 Lack of support system

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 Rehabilitation
 It emphasizes individual
responsibilities and self reliance
 It address important skills necessary
for survival in community for
independent living

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Case 1:
21 year male, brought to ER by
police sitting in the middle of
busy street
The patient states: The voices
told me to do it and to do bad
things.
Two or three voices talking
about him commenting on his
behaviour
He was dirty, with poor hygiene
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Case 2:
36 years female comes to
emergency with sudden episode of
palpitation, sweating, shortness of
breath and she is going to die.
She is convinced that she is having
a heart attack, she is always
worrying that when to have
another attack

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 Case 3
 27 years old man his friends state
that the patients had not slept for the
past 3 days, he stayed up all night
cleaning, spends a lot of money
buying things that he can not afford,
he speaks too much in a rapid and
loud way, he claims that his mood is
great and he was singing in a loud
voice.
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 Management model
 1- pharmacotherapy: modern drug
with minimal side effect
 2- Psychotherapy
 3- Skill development:
 Social skill training
 Personal self care skills
 Work educational skills
 Vocational training: job placement
 Social support services

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 Emergency
Definition

 Any disturbance in thoughts

,feelings and actions for which
immediate therapeutic intervention
is necessary.
 The number of emergency patients is
on rise due to increase in substance
related disorders, violence, organic
diseases, suicide, homicide, abuse
and rape.
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 Epidemiology

 Male= female
 More in single
 20% suicide, 10% violent.
 Most common diagnosis; mood
disorder, schizophrenia, and alcohol.
 40% require hospitalization
 Mostly during night.

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 It’s all about

1st aid and common lines of

management of psychiatric
emergencies

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 Management
Emergency psychiatric interview; assessing risk, urgency,
complaint of patient, informant, being honest, non threatening

Exclude organisity
The most common causes; anxiety
,depression, psychosis

DD of anxiety with life threatening conditions

Armed violent patient should be disarmed by trained

Law enforcement personnel as they might be very dangerous.

Placing in safe place with forensic consultation

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 Psychiatric Emergency

 Suicide
 Violence
 Organic brain syndrome
 Drug related emergency
 Complication of ECT

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 Suicide
successful attempt to kill one self

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 Epidemiology
 9th overall cause of death in USA ,
12/100.000
 Japan 25/100.000 and in Egypt and
Moslem, catholic countries
10/100.000.
 Male> female.
 Suicide risk increase with age
 Physical illness increase risk of
suicide. (CNS, Endocrinal,Renal
failure, Cancer)
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 Mental Health and suicide

 95% of all people who commit suicide

have diagnosed mental disease.
 Depressive disorders 80%
 Schizophrenia 10%
 Dementia, delirium 5%

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 Psychiatric patients
 Depressive disorder  Alcohol dependence
 15-25% of major  Up to 15%
depression.  Depression
 Rate increase in
 Impulsivity
single, with
psychotic features
and early recovery
 Schizophrenia:  Personality disorder
 Up to 10%  Antisocial
 Single male with  Borderline and
previous attempt histrionic more
 Depression
 Ordering
attempt
hallucination

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 Aetiology
 1- Social Theory( Durkheim’ theory)
 Egoistic
 Altruistic

 Anomic

 2- Dynamic: Freud, Menninger, Beck,

Behavioural
 3- Biological: Genetic, NT

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 Prevention
 It is preventable and should be asked
directly.
 Evaluation by complete history and
examination of mental condition
 Suicide assessment putting in
consideration factors that increase
suicidal risk.

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 Treatment

Hospitalization

Out patient

Drugs psychotherapy

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 Violence & Excitement
 Causes of violence
 Schizophrenia
 Major depression

 Bipolar disorder

 Anxiety (Panic disorder, PTSD)

 Personality disorder (Antisocial, Paranoid)

 Rape, child abuse

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 Management of Violence
 Ensure safety to the patient
and the doctors from the
consequences of uncontrollable
behavior.
 Treatment of the cause.
 Restraints
 Medication:
 Haldol IM 5-10 mg every 30 min
 Chloropromazine 25mg IM
 Benzodiazepine; lorazepam,
diazepam

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Anticonvulsant Heba Fathy,MD
 Drug Related Emergencies
 Acute Dystonia( Dopamine hyperactivity in BG when
CNS level of the drug fall between doses)

 Neuroleptic malignant syndrome

 Lithium intoxication(>1.5 meq/L)
 Anticholinergic overdose, delirium
 Serotonergic syndrome
 Hypertensive crises( Cheese reaction)

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