Summary: Psychiatry

Overview

Psychiatry is the medical specialty for diagnosing and treating psychological disorders. Establishing a diagnosis requires a detailed history and a clinical examination called the Mental Status Examination (MSE).

Mental Status Examination (MSE)

The MSE assesses key areas of mental functioning:

• General appearance and behavior: Patient's appearance and observable behavior.
• Speech: Rate, tone, volume and spontaneity of speech.
• Mood and Affect:
  • Definitions: Affect is immediate emotional state; Mood is sustained emotional state.
  • Quality: dominant emotional state (e.g., euphoric, depressed).
  • Fluctuations: mood variability (e.g., labile, flattened affect).
  • Appropriateness and congruency: fit with context and with thought content.
  • Other disturbances: alexithymia, anhedonia.
  • Neuroanatomy: limbic system with frontal regulation.
• Perception:
  • Illusions: misinterpretation of real stimuli.
  • Hallucinations: perceptions without external stimuli; vivid, external in subjective space, not under voluntary control.
  • Types of hallucinations: auditory, visual, olfactory/tactile, hypnagogic, hypnopompic, reflex (synesthesia), functional.
• Thought (cognition):
  • Stream: speed of thinking (e.g., flight of ideas, inhibition).
  • Form: organization of thought (e.g., derailment, loosening of association, incoherence, circumstantiality, tangentiality, neologisms, word approximations, perseveration).
  • Content: themes of thought including delusions (persecution, reference, grandeur, erotomania, nihilistic, infidelity, guilt); distinctions of bizarre vs nonbizarre delusions.
  • Possession of thought: sense of ownership; includes obsessions and thought alienation (thought insertion, thought withdrawal, thought broadcast).
• Higher mental functions: attention, concentration, memory, judgment, abstract thinking and insight.

Classification of Psychiatric Disorders

Two main systems:

1. ICD-10 (WHO).
2. DSM-5 (APA, 2013).

Common classification contrasts:

• Organic: disorders with demonstrable brain disturbance.
• Functional: disorders without obvious brain pathology (though brain changes may be present).
• Psychoses: impaired reality testing and poor insight, with delusions and hallucinations.
• Neuroses: preserved reality contact and awareness of illness.