Download Anxiety Disorders - Dubai Medical College

Behavioral Science
By
Dr. Osama Samaneh
For 3rd Year Students
Dubai Medical College
Course Outlines:
This course on behavioral science has two purposes: to
introduce you to psychosocial aspects of medical practice
and to offer you an overview of clinical psychiatry.
The course also increase the knowledge base,
strengthen the skill, and improve capabilities of
participants in the foundation of psychiatry, psychology,
and biopsychology by using the DSM IV.
Topics:
Introduction to behavioral Science
Behavioral Medicine.
Techniques and application
Mental disorders and DSM-IV.
* Adjustment Disorders
* Anxiety Disorders
* Dissociative Disorders
* Eating Disorders
* Impulse-Control Disorders
* Mental Disorders Due to a General Medical Condition
•Neurocognitive Disorders
•Mood Disorders
•Neurodevelopmental Disorders
•Personality disorders
•Psychotic Disorders
•Sexual and Gender Identity Disorders
•Sleep Disorders
•Substance Related Disorders
Research studies in B.S.
T
Thinking
Feeling
F
Acting/
Doing
A
Importance of Psychology
Psychology reference and importance is in the usage
and application of skill, knowledge and understanding
various activities undertaken by humans and how they
are used through daily activities, whether that is within
events, talking to people, education and employment,
relationships and even treating mental health issues.
Psychologists study the mental processes and behavior
of people. It can be applied to various areas of the life of
a human. Everything a person does is connected to the
subject. In its primary form, psychology studies a person
– who and what they are – it looks into why they act and
think the way they do and how someone can improve
himself.
Importance of Psychiatry
psychiatry is an integral part of medicine; that it is a brainbased specialty that encompasses biological,
psychological, social, interpersonal and spiritual
parameters; and that it is most effective when practiced in
an evidence-based manner, involving interdisciplinary
academic collaboration and expertise.
Introducing Psy.
Psychology is the science of mental processes and
behavior.
What is science? (search for facts by using
objective evidence to answer questions).
What are mental processes? (the functioning of the
brain)
What is behavior? (acts of a person alone or in a
group).
THE 3 LEVELS of PSY.
The Brain (Biological factors ..)
The Person (beliefs, desires, & feelings ..)
The Group (social, cultural & environmental…)
Psychiatry
The branch of medicine that deals with the diagnosis,
treatment, and prevention of mental and emotional
disorders.
Psychiatry is about the workings of the brain and how the
brain affects behavior.
Psychiatry is the medical specialty devoted to the study,
diagnosis, treatment, and prevention of mental disorders.
These include various affective, behavioral, cognitive and
perceptual abnormalities.
The term was first coined by the German physician Johann
Christian Reil in 1808, and literally means the 'medical
treatment of the soul' (psych-: soul; from Ancient Greek
psykhē: soul.
Psychologist vs. Psychiatrist
 Psychologist
 5 yrs. B.S. psychology
 2 yrs. Masters in psychology
 4 yrs. PhD psychology
 6 yrs supervised training before individual works alone with
patients
 10 yrs training
 Can’t give medicine
 Psychiatrist
 5 yrs. B.S. Pre Med
 4 yrs. Med School
 3 yrs. Residency – have patient load
 11 yrs. Training
 Can prescribe medicine
A medical doctor specializing in psychiatry is a
psychiatrist.
Psychiatric assessment typically starts with a
mental status examination and the compilation of
a case history.
Psychological tests and physical examinations may
be conducted, including on occasion the use of
neuroimaging / other neurophysiological
techniques.
Mental disorders are diagnosed in accordance with criteria
listed in diagnostic manuals such as the widely used
Diagnostic and Statistical Manual of Mental Disorders
(DSM), published by the American Psychiatric
Association, and the International Classification of
Diseases (ICD), edited and used by the World Health
Organization.
The fifth edition of the DSM (DSM-5) is scheduled to be
published in 2013, and its development is expected to be of
significant interest to many medical fields.[1]
The combined treatment of psychoactive medication and
psychotherapy has become the most common mode of
psychiatric treatment in current practice,[2] but current
practice also includes widely ranging variety of other
modalities.
Anti-psychiatry was coined by psychiatrist David Cooper
in 1967.
Dangerous treatments like the Electroconvulsive therapy.
Several books including Divided Self and The Myth of
Mental Illness.
History of Psychiatry
Treatment of emotional and cognitive dysfunction have its origins at
least as far back as the 5th century BC. The first hospices for the
mentally ill appeared in the Middle Ages. The early 19th century saw
the development of psychiatry as a recognized field. Mental health
institutions came to utilize more elaborate and, over the course of
time, more humane treatment methods. The 19th century saw a
huge increase in the number of patients.
The 20th century saw an upsurge of biological understanding of
mental disorders, as well as the introduction of more systematic
disease classification, and the advent of sophisticated psychiatric
medication. An anti-psychiatry movement, hostile to most of the
fundamental assumptions and practices of the discipline, emerged
in the 1960s. A shift in emphasis in several Western societies led to
the dismantling of state psychiatric hospitals in favor of more
community-based treatment.
DSM-IV
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV)
Psychiatric Diagnoses are categorized by the DSM- Better known as
the DSM-IV, the manual is published by the American Psychiatric
Association and covers all mental health disorders for both children
and adults. It also lists known causes of these disorders, statistics in
terms of gender, age at onset, and prognosis as well as some research
concerning the optimal treatment approaches.
Mental Health Professionals use this manual when
working with patients in order to better understand their
illness and potential treatment and to help 3rd party
payers (e.g., insurance) understand the needs of the
patient. The book is typically considered the ‘bible’ for any
professional who makes psychiatric diagnoses in the
United States and many other countries. Much of the
diagnostic information on these pages is gathered from
the DSM IV.
The DSM IV is published by the American Psychiatric
Association.
The DSM-IV uses a five level diagnostic system to classify illnesses
and disorders. When considered together, these 5 levels give the
treatment provider a complete diagnosis that includes factors
influencing your psychiatric condition. This is important for
effective treatment planning.
The five levels of the DSM are called “axes” and are defined as
follows:
Axis I is reserved for clinical disorders and developmental and
learning disorders.
Axis II is for personality disorders or mental retardation.
Axis III is for medical and/or physical conditions or disorders.
Axis IV indicates factors contributing to, or affecting, the current
psychiatric disorder and treatment outcomes.
Axis V is for the GAF or global assessment functioning. This is a 100point scale that the mental health professional uses to describe the
patient’s overall level of performance in usual daily activities and
social, occupational, academic and interpersonal functioning.
Behavioral Medicine
is the interdisciplinary field concerned with the
development and integration of behavioral,
psychosocial, and biomedical science knowledge
and techniques relevant to the understanding of
health and illness, and the application of this
knowledge and these techniques to prevention,
diagnosis, treatment and rehabilitation.
Also it is the study, prevention, and treatment of medical and
psychosomatic disorders and of undesirable behaviors, such as
overeating and substance abuse, by the application of behavior
therapy techniques, such as biofeedback, relaxation training, and
hypnosis.
Mental Health
•1 in 4 people will experience some kind of mental health problem in
the course of a year
•Women are more likely to have been treated for a mental health
problem than men
•About 10% of children have a mental health problem at any one time
•Depression affects 1 in 5 older people living in the community and 2 in
5 living in care homes
•Only one in 10 prisoners has no mental disorder
•Suicide remains the most common cause of death in men under the age of 35
•Mental illness affects people of all ages, educational and income levels,
and cultures.
•Approximately 8% of adults will experience major depression at some
time in their lives.
•Anxiety disorders affect 5% of the household population, causing mild
to severe impairment.
WHO definition of Health
Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.
The correct bibliographic citation for the definition is:
Preamble to the Constitution of the World Health
Organization as adopted by the International Health
Conference, New York, 19-22 June, 1946; signed on 22 July
1946 by the representatives of 61 States (Official Records of
the World Health Organization, no. 2, p. 100) and entered into
force on 7 April 1948.
The Definition has not been amended since 1948
Positive Psy.
Positive psychology is a branch of psychology that
focuses on improving the mental functioning of
human beings above that of normal mental health.
What to do ……?
Mental disorders are patterns of behavioral or psychological
symptoms that impact multiple areas of life. These disorders create
distress for the person experiencing these symptoms.
Adjustment Disorders
This classification of mental disorders is related to an identifiable
source of stress that causes significant emotional and behavioral
symptoms. The diagnostic criteria listed by the DSM-IV diagnostic
criteria included:
•
(1) Distress that is marked and excessive for what would be
expected from the stressor and
•
(2) Creates significant impairment in school, work or social
environments.
In addition to these requirements, the symptoms must occur within
three months of exposure to the stressor, the symptoms must not
meet the criteria for an Axis I or Axis II disorder, the symptoms must
not be related to bereavement and the symptoms must not last for
longer than six months after exposure to the stressor.
Anxiety Disorders
Anxiety disorders are those that are characterized by excessive and
abnormal fear, worry and anxiety. In one recent survey published in
the Archives of General Psychology1, it was estimated that as many
as 18% of American adults suffer from at least one anxiety disorder.
Types of anxiety disorders include:
•
Generalized anxiety disorder
•
Agoraphobia
•
Social anxiety disorder
•
Phobias
•
Panic disorder
•
Post-traumatic stress disorder
•
Separation anxiety
Anxiety
Anxiety, worry, and stress are all a part of most people's life today. But simply experiencing
anxiety or stress in and of itself does not mean you need to get professional help or you
have an anxiety disorder. In fact, anxiety is a necessary warning signal of a dangerous or
difficult situation. Without anxiety, we would have no way of anticipating difficulties
ahead and preparing for them.
Anxiety becomes a disorder when the symptoms become chronic and interfere with our
daily lives and our ability to function. People suffering from chronic anxiety often report
the following symptoms:
•Muscle tension
•Poor memory
•Fear or confusion
•Constant worry
•Palpitations
•Upset stomach
•Physical weakness
•Sweaty hands
•Inability to relax
•Shortness of breath
•Poor concentration
Treatments
Diazepam/Tricyclic (antidepressants) /Buspirone/
Counseling /Self-Help/ and psychotherapy.
Dissociative Disorders
Dissociative disorders are psychological disorders that involve a
dissociation or interruption in aspects of consciousness, including
identity and memory. Dissociative disorders include:
•
Dissociative disorder (formerly known as multiple
personality disorder
•
Dissociative fugue
•
Dissociative identity disorder
•
Depersonalization/derealization disorder
Eating Disorders
Eating disorders are characterized by obsessive concerns with
weight and disruptive eating patterns that negatively impact
physical and mental health. Types of eating disorders include:
•
Anorexia nervosa
•
Bulimia nervosa
•
Rumination disorder
Factitious Disorders
These psychological disorders are those in which an individual acts
as if he or she has an illness, often be deliberately faking or
exaggerating symptoms or even self-inflicting damage to the body.
Types of factitious disorders include:
•
Munchausen syndrome
•
Munchausen syndrome by proxy
•
Ganser syndrome
Impulse-Control Disorders
Those that involve an inability to control impulses, resulting in
harm to oneself or others. Types of impulse-control disorders
include:
•
Kleptomania (stealing)
•
Pyromania (fire-starting)
•
Trichotillomania (hair-pulling)
•
Pathological gambling
•
Intermittent explosive disorder
•
Dermatillomania (skin-picking)
Mental Disorders Due to a General Medical
Condition
This type of psychological disorder is caused by an
underlying medical condition. Medical conditions can
cause psychological symptoms such as catatonia and
personality changes. Examples of mental disorders due
to a general medical condition include:
•
Psychotic disorder due to epilepsy
•
Depression caused by diabetes
•
AIDS related psychosis
•
Personality changes due to brain damage
Neurocognitive Disorders
These psychological disorders are those that involve cognitive
abilities such as memory, problem solving and perception. Some
anxiety disorder, mood disorders and psychotic disorders are
classified as cognitive disorders. Types of cognitive disorders
include:
•
Alzheimer's disease
•
Delirium
•
Dementia
•
Amnesia
Mood Disorders
Mood disorder is a term given to a group of mental disorders that
are all characterized by changes in mood. Examples of mood
disorders include:
•
Bipolar disorder
•
Major depressive disorder
•
Cyclothymic disorder
Neurodevelopmental Disorders
Developmental disorders, also referred to as childhood disorders,
are those that are typically diagnosed during infancy, childhood, or
adolescence. These psychological disorders include:
•
Intellectual Disability (or Intellectual Developmental
Disorder), formerly referred to as mental retardation
•
Learning disabilities
•
Communication disorders
•
Autism
•
Attention-deficit hyperactivity disorder
•
Conduct disorder
•
Oppositional defiant disorder
Autism Spectrum Disorders
The autism spectrum disorders are more common in children . A
recent study estimated that 3.4 of every 1,000 children 3-10 years
old had autism. Others suggested autism now affects 1 in every 110
children. And that number appears to be only increasing. Autism is
on the rise.
The earlier the disorder is diagnosed, the sooner a child can be
helped through treatment interventions. Pediatricians, family
physicians, daycare providers, teachers, and parents may initially
dismiss signs of autism spectrum disorders.
Autism demonstrate deficits in three primary areas:
1.Social interaction
2.Verbal and nonverbal communication, and
3.Repetitive behaviors or interests .
Indicators of Autism spectrum Disorders
•Does not babble, point, or make meaningful gestures by 1 year of
age
•Does not speak one word by 16 months
•Does not combine two words by 2 years
•Does not respond to name
•Loses language or social skills
•Poor eye contact
•Doesn’t seem to know how to play with toys
•Excessively lines up toys or other objects
•Is attached to one particular toy or object
•Doesn’t smile
•At times seems to be hearing impaired
Personality disorders create a maladaptive pattern of thoughts,
feelings, and behaviors that can cause serious detriments to
relationships and other life areas. Types of personality disorders
include:
•
Antisocial personality disorder
•
Avoidant personality disorder
•
Borderline personality disorder
•
Dependent personality disorder
•
Histrionic personality disorder
•
Narcissistic personality disorder
•
Obsessive-compulsive personality disorder
•
Paranoid personality disorder
•
Schizoid personality disorder
•
Schizotypal personality disorder
Psychotic Disorders
Psychotic disorders are those that involve a loss of contact with
reality. People experiencing psychotic disorders may experience
hallucinations and often display disorganized thinking. Delusional
beliefs are another common characteristic of this class of
psychological disorders. Types of psychotic disorders include:
•
Schizophrenia
•
Delusional disorder
Symptoms
Recent social withdrawal and loss of interest in others.
An unusual drop in functioning, especially at school or work, such as quitting
sports, failing in school/difficulty performing familiar tasks.
Problems with concentration, memory, or logical thought and
speech that are hard to explain.
Heightened sensitivity to sights, sounds, smells or touch; avoidance
of over-stimulating situations.
Loss of initiative or desire to participate in any activity; apathy.
A vague feeling of being disconnected from oneself or one’s
surroundings; a sense of unreality.
Unusual or exaggerated beliefs about personal powers to understand
meanings or influence events; illogical or “magical” thinking typical
of childhood in an adult.
Fear or suspiciousness of others or a strong nervous feeling.
Uncharacteristic, peculiar behavior.
Dramatic sleep and appetite changes or deterioration in personal hygiene.
Rapid or dramatic shifts in feelings or “mood swings.”
Treatment
INVEGA® SUSTENNA® is a long-acting medication given
by injection that you only have to take once a month. It’s
given by injection by a healthcare professional in the arm or
buttocks once monthly after starting doses.
Treatment for schizophrenia may include counseling and
rehabilitation therapy. These programs, along with taking
medication as the doctor prescribed and developing life skills,
may help reduce the risk of relapse.
And others such as Behavioral modifications & Electrical
shocks.
Sexual and Gender Identity Disorders
Sexual disorders are those that impact sexual functioning, while
gender identity disorders are those that involve a discontentment
with the biological sex a person was born with. Examples of sexual
disorders:
•
Erectile dysfunction
•
Sexual pain disorders
•
Paraphilias
Sleep Disorders
Sleep disorders involve an interruption in sleep patterns. These
disorders can have a negative impact on both physical and mental
health. Examples of sleep disorders include:
•
Narcolepsy
•
Sleep terror disorder
•
Sleepwalking disorder
•
Primary insomnia
Somatoform Disorders
Somatoform disorder is a class of psychological disorder that
involves physical symptoms that do not have a physical cause. These
symptoms usually mimic real diseases or injuries. It is important to
note somatoform disorders differ from factitious disorders; people
suffering from somatoform disorders are not faking their symptoms.
•
Conversion disorder
•
Somatization disorder
•
Hypochondriasis
•
Body dysmorphic disorder
•
Pain disorder
Substance Related Disorders
Substance-related disorders are those that involve the use and abuse
of different substance, such as cocaine, methamphetamine, opiates
and alcohol. These disorders can include dependence, abuse,
psychosis, anxiety, intoxication, delirium and withdrawal that
results from the use of various substances. Examples of substancerelated psychological disorders include:
•
Alcohol abuse
•
Caffeine-induced anxiety disorder
•
Cocaine withdrawal
•
Inhalant abuse
#
Item
1
I never seem to have enough time to accomplish my
goals.
I don't understand people who become so impatient
in traffic that they start honking.
I frankly don't care whether I do or do not make it
into the top 10%.
I find it difficult and useless to confide in someone.
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
A driver's license should be more difficult to get in
order to avoid having all those idiots on the road.
It doesn't bother me if I cannot finish what I planned
for the day.
I often choose to spend time with my friends or family, even
though I have something important to do.
I am hardly ever satisfied with my achievements.
I get no particular pleasure out of acquiring things.
It is easy for me to express my feelings.
People who don't know what they want get on my
nerves.
I think that hobbies such as fishing or bowling are
just a waste of time.
When I finish my task, I feel good about myself.
I function best under stress or pressure.
Talking about emotions is a sign of weakness and can
be used by others to get at you.
It doesn't matter whether my family is financially
secure. The important thing is to be together.
If everybody did their job properly, my life would be
Disagree
1
Cannot
say 2
Agree
3
How Outgoing Are You?
#
The Expression Quotient
1.
2.
Loud parties make me feel tired
I enjoy being at social events involving unfamiliar people
3.
4.
5.
I like to sit alone and read
I don't enjoy solitary sports like swimming.
I'd feel uncomfortable making business calls to strangers.
6.
7.
8.
9.
10.
11.
It's easy for people to read my moods.
My friends are somewhat shy.
I try to be the center of group attention.
I dislike dining out in a big group.
I like solitary hobbies like gardening.
I get energized when in a large crowd at an outdoor event.
12.
Chatting with strangers on a train or plane is fun for me.
13.
14.
15.
16.
I don't mind dining alone.
I like socializing in dance clubs.
I'm a party person.
Those who know me would describe ma as very out going.
17.
After getting home, I soon get on the phone to chat with people.
18.
19.
I take vacations alone.
I prefer staying home by myself to being at a noisy party.
20.
21.
22.
I usually share my moods with others.
I like returning to a quiet home.
At parties, I'd rather let others introduce themselves to me than
Disagree
5
4
3
Agree
2
1
Am I At Risk for Developing Depression?
#
The statement
1
Have you been in a depressed mood most of the day, nearly
every day for at least two weeks?
2
Have you lost interest or pleasure in most daily activities, nearly
every day for at least two weeks?
3
Have you experienced a significant weight change (at least five
pounds) either loss or gain recently?
4
Has your appetite changed (increased or decreased) for an
extended period?
5
Have you suffered from insomnia or hypersomnia, nearly every
day for at least two weeks?
6
Have you felt tired or experienced a loss of energy during the
day, nearly every day for at least two weeks?
7
Have you had guilty feelings or feelings of worthlessness nearly
every day for at least two weeks?
8
Have you had difficulty thinking, concentrating, or making
decisions nearly every day ?
9
Have you had any thoughts of death or any thoughts of suicide
without any specific plan?
10
Did the depressed mood begin after someone close to you died
or within four weeks of giving birth?
Yes/no