1. The Subject and Tasks of Psychiatry.

Mental health and Mental illness- definition and

boundaries.

The subject and task of psychiatry:

- Psychiatry is the medical speciality devoted to the study, diagnosis, treatment and
prevention of mental disorders.
- The term "psychiatry" literally means the 'medical treatment of the soul'
- Initial psychiatric assessment of a person typically begins with a case history and
mental status examination. Physical examinations and psychological tests may be
conducted. On occasion, neuroimaging or other neurophysiological techniques are
used. Mental disorders are often diagnosed in accordance with clinical concepts listed
in diagnostic manuals such as the International Classification of Diseases (ICD).
- The combined treatment of psychiatric medication and psychotherapy has become
the most common mode of psychiatric treatment in current practice

Mental health:
- WHO definition of general health: It is a state of complete physical, mental, social
and spiritual well-being, and not only the absence of disease or infirmity -> the
healthy human:
- is able to cope/function normally
- Meets his/her responsibilities
- Expresses balanced attitude towards problems day to day challenges

- Mental health in particular: Mental health is a level of psychological well-being of

someone who is functioning at a satisfactory level of emotional and behavioural
adjustment. Mental health may include an individual's ability to enjoy life, and to
create a balance between life activities and efforts to achieve psychological resilience
(Die Fähigkeit sich von negativen Erfahrungen zu erholen). Mental health includes
subjective well-being, perceived self-efficacy, autonomy, competence, inter-
generational dependence, and self-actualization of one's intellectual and emotional
potential, among others.

Mental illness:
- A mental disorder is a syndrome characterized by clinically significant
disturbance in an individual’s cognition, emotional regulation, or developmental
processes underlying mental functioning.
Mental disorders are usually associated with significant distress or disability in
social, occupational, or other important activities.
- Signs vs Symptoms:
a) Symptoms: are internal feelings described by the patient and are thus subjective.
If you are having a pain, no one knows unless you tell them. It's the same with
dizziness, numbness, lightheadedness, fatigue, vision disturbances, ringing in your
ears, etc -> symptoms! More examples:
- Hallucinations (perceptions in the absence of stimuli, such as hearing voices when
no one else is present).
- Delusions (beliefs in the absence of evidence, such as, that one is being watched by
aliens)
- Disturbances of mood (sadness/depression, elation/ mania, fear/anxiety)

b) Signs: are visible externally by the psychiatrists and are thus objective. Examples:
- disturbances in behavior (i.e. slowed, rapid or bizarre movements, or inappropriate
crying or laughing)
- disturbances in thought processes (i.e. distractibility or inability to think in a logical
manner).

Causes of mental disorders:

a) Mental disorders, in general, are multifactorial:
- biological, psychological and social factors
b) Biological basis: in the form of an inherited genetic vulnerability/disposition
- For example, Schizophrenia, - if one monozygotic twin develops
schizophrenia, there is at least a 60% chance the co-twin will also develop that
disorder.
c) Stress:
- during childhood- can contribute to anxiety and insecurity in adulthood.
- psychological stress associated with physical and sexual abuse, contributes to
the severe adult disorder called borderline personality disorder.
- post-traumatic stress disorder: healthy adults subjected to horrific trauma,
such as warfare or rape, may develop disabling anxiety, difficulty with thinking
and personality change -> PTSD
d) Social status:
- The loss of status associated with e.g. loss of employment, retirement may
trigger mental disorder.
- In anorexia nervosa (excessive purposeful weight loss) the impact of
social factors is also recognized. The fashion industry, the media and peer
groups all promote thinness, encouraging undue attention body image and
eating.