DIMS Lectures Psychiatry PDF

Here is the complete pdf lecture of psychiatry by Dr. Tahir Malik   

Introduction

Psychiatry is the branch of medicine that focuses on the diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders. It integrates biological, psychological, and social approaches to understand psychiatric conditions.

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1. General Principles of Psychiatry

Mental Status Examination (MSE)

• Appearance & Behavior: Grooming, posture, psychomotor activity.
• Speech: Rate, rhythm, fluency, volume.
• Mood & Affect: Subjective and objective emotional state.
• Thought Process & Content: Coherence, delusions, obsessions.
• Perception: Hallucinations, illusions.
• Cognition: Orientation, memory, attention.
• Insight & Judgment: Understanding of illness and decision-making.

Diagnostic Criteria (DSM-5 & ICD-11)

• Mental disorders are classified based on clinical symptoms and functional impairment.
• Common diagnostic systems:
  • DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition).
  • ICD-11 (International Classification of Diseases, 11th Revision).

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2. Common Psychiatric Disorders

1. Depressive Disorders

• Major Depressive Disorder (MDD):
  • Depressed mood, anhedonia, fatigue, sleep/appetite changes.
  • Treatment: SSRIs (Fluoxetine, Sertraline), CBT.
• Persistent Depressive Disorder (Dysthymia): Chronic low mood for >2 years.
• Postpartum Depression: Depressive symptoms occurring post-delivery.

2. Anxiety Disorders

• Generalized Anxiety Disorder (GAD): Excessive worry for >6 months.
• Panic Disorder: Recurrent panic attacks, fear of dying.
• Social Anxiety Disorder: Fear of social situations.
• Obsessive-Compulsive Disorder (OCD): Intrusive thoughts + compulsive behaviors.
• Treatment: SSRIs, Benzodiazepines (short-term), Cognitive Behavioral Therapy (CBT).

3. Psychotic Disorders

• Schizophrenia:
  • Positive Symptoms: Hallucinations, delusions, disorganized speech.
  • Negative Symptoms: Apathy, flat affect, social withdrawal.
  • Treatment: Antipsychotics (Risperidone, Olanzapine, Clozapine).
• Schizoaffective Disorder: Schizophrenia symptoms + mood disturbances.

4. Bipolar and Related Disorders

• Bipolar I Disorder: At least one manic episode.
• Bipolar II Disorder: Hypomania + major depression.
• Cyclothymic Disorder: Chronic mood fluctuations (mild hypomania and depression).
• Treatment: Mood stabilizers (Lithium, Valproate), Antipsychotics.

5. Personality Disorders

• Cluster A (Odd/Eccentric): Paranoid, Schizoid, Schizotypal.
• Cluster B (Dramatic/Emotional): Borderline, Narcissistic, Antisocial.
• Cluster C (Anxious/Fearful): Avoidant, Dependent, Obsessive-Compulsive Personality Disorder.

6. Substance Use Disorders

• Alcohol Use Disorder: Withdrawal can cause delirium tremens.
• Opioid Use Disorder: Risk of overdose, naloxone used as antidote.
• Cannabis & Stimulant Abuse: Psychiatric symptoms, dependence.
• Treatment: Behavioral therapy, medications (e.g., Naltrexone for alcohol, Methadone for opioids).

7. Neurodevelopmental & Neurocognitive Disorders

• Autism Spectrum Disorder (ASD): Impaired social communication, repetitive behaviors.
• Attention-Deficit/Hyperactivity Disorder (ADHD): Inattention, hyperactivity.
• Dementia (Alzheimer’s, Lewy Body, Vascular): Progressive cognitive decline.
• Delirium: Acute fluctuating confusion (caused by medical illness, drugs).
• Treatment: Supportive care, cognitive enhancers (Donepezil for dementia).

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3. Psychiatric Emergencies

1. Suicide Risk Assessment

• Risk factors: Previous attempts, depression, substance abuse, social isolation.
• Management: Hospitalization if high risk, therapy, antidepressants.

2. Acute Psychosis

• Causes: Schizophrenia, Drug-Induced Psychosis, Delirium.
• Treatment: Antipsychotics, hospitalization if dangerous.

3. Aggression and Violence

• Management: Sedation (Lorazepam, Haloperidol), Restraints if needed.

4. Neuroleptic Malignant Syndrome (NMS)

• Life-threatening reaction to antipsychotics.
• Symptoms: Fever, muscle rigidity, autonomic instability.
• Treatment: Stop antipsychotic, IV fluids, cooling measures.

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4. Psychotherapy & Treatment Approaches

1. Cognitive Behavioral Therapy (CBT)

• Effective for depression, anxiety, OCD.
• Targets negative thought patterns.

2. Psychodynamic Therapy

• Focuses on unconscious conflicts from childhood.

3. Electroconvulsive Therapy (ECT)

• Used in severe depression, treatment-resistant psychosis.

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Case Example : 

1. A 35-year-old male presents with auditory hallucinations, delusions of persecution, and social withdrawal for 1 year. Examination shows disorganized thought process and blunted affect.

2. A 22-year-old female reports recurrent episodes of sudden intense fear, palpitations, sweating, and a feeling of impending doom lasting about 10 minutes. She avoids crowded places due to fear of another episode.

3. A 50-year-old male reports low mood, fatigue, loss of interest in activities, poor sleep, and weight loss for the past 2 months. No history of manic symptoms.

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1. Diagnosis: Schizophrenia

2. Diagnosis: Panic Disorder

3. Diagnosis: Major Depressive Disorder (MDD)

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