This document provides an introduction to psychiatry, distinguishing between neurosis and psychosis. Neurosis involves maladaptive psychological symptoms caused by stress rather than organic or psychotic issues, and includes anxiety disorders and depression. Psychosis involves a loss of contact with reality through hallucinations, delusions, and disordered thinking, and can be seen in conditions like schizophrenia, affective disorders, and organic disorders. It also defines key psychiatric terms like hallucination and delusion and describes how they manifest in different conditions. Diagnosis is based on criteria in references like the ICD-10 or DSM-IV. Treatment ideally uses a bio-psycho-social approach targeting biological, psychological, and social factors.

1. An introduction to psychiatry
Diseases in psychiatry (The neuroses - psychosis divide)
Neurosis – maladaptive psychological symptoms NOT due to an organic cause
or psychosis, usually precipitated by stress.
Examples – The anxiety disorders (Generalised anxiety disorders, panic attacks,
obsessive compulsive disorder, post traumatic stress disorder) or affective
disorders i.e. depression.
Psychosis – loss of contact with reality. Consists of hallucinations, delusions
and a formal thought disorder.
Examples
1. Schizophrenia,
2. Affective disorder (depression or mania)
3. Organic disorders – such as alcohol withdrawal. Or such as chronic organic
brain injury (Dementia)
Note – many psychiatric disorders do not fit neatly into neurosis or psychosis.
Personality disorders do not fit into either category. Depression (affective
disorders) can span the neurosis – psychosis divide, and will fit into either
depending on cause and severity of depression.
Useful definitions in psychiatry (with psychosis in mind)
Hallucination – sensation experienced in the absence of a stimulus. Can be
auditory, visual, tactile, olfactory or gustatory.
Pseudo hallucination – the patient knows the stimulus is in their mind, e.g. a
voice heard within the patients mind rather than from over their left shoulder.
• As a rule visual or tactile hallucinations without auditory hallucinations
indicate an organic disorder (such as acute alcohol withdrawal).
• With auditory hallucinations always be mindful of schizophrenia as a
cause, however this is not the only cause. Acute alcohol withdrawal can
also cause auditory hallucinations.
• If a patient describes an auditory hallucination it is important to find out as
much detail about the hallucination as possible.
i. Is it a voice? How many voices are there? Do you recognise
them? Are they talking to you or to each other? What are they
saying? If they are telling the patient to do something what would
happen if they didn’t do what the voice told them to?

2. Hallucinations are different to misinterpretations, illusions and misperceptions.
Delusion – a false fixed unshakeable belief help by a patient out of keeping with
their religious or cultural background resistant to counter argument.
• In schizophrenia a delusion can arise spontaneously fully formed following
an apparently irrelevant event. This is known as delusional perception – ‘I
saw the traffic light go red and I suddenly knew that I have been sent to rid
the world of evil’.
• In depression; nihilistic delusions - an individual believing that they are
dead or that their body is rotting. Persecutory delusions – a belief that one
does not deserve to be alive or that one is intrinsically evil or bad.
• In mania grandiose delusions can occur – e.g. a belief that one is the king
of France.
Major thought disorder - A bizarre or incongruent transition from one thought or
idea to another.
• Mania – Flight of ideas, rapid transition from one thought to another
although the conversation does follow the train of thought.
• Schizophrenia – Loosening of associations, transition from one thought to
another without any apparent link in the conversation (also called knights
move thinking).
Diagnosis in psychiatry
In the UK all possible psychiatric diagnosis are listed in the ICD-10 (International
classification of disease 10th
edition).
This is a full list of psychiatric diagnosis created by the WHO and sets out the
diagnostic criteria for each individual psychiatric diagnosis.
[In America the DSM-IV (Diagnostic and statistical manual of mental disorders 4th
edition) is used].
Always remember when discussing psychiatric cases that any one disease or
condition will have BIOLOGICAL, PSYCHOLOGICAL and SOCIAL causes.
e.g. BIOLOGICAL – physical ill health, drug or alcohol use etc.
PSYCHOLOGICAL – maladaptive ways of thinking about self, history of previous
depression etc.
SOCIAL – poor housing, unemployed, relationship difficulties. etc.
In addition when discussing treatment options always consider a joint
Bio-psycho-social approach.
BIOLOGICAL (medications e.g. antidepressants),
PSYCHOLOGICAL (e.g. offering Cognitive Behavioural Therapy (CBT))
SOCIAL (helping individual apply for benefits, improved housing etc).
Dr Jason Hancock