This document discusses the field of psychiatry. It begins by defining psychiatry as the study of the causes, mechanisms, symptoms, prognosis, diagnosis and treatment of mental illnesses. It then discusses the broad scope of conditions studied in psychiatry, from severe psychoses to neuroses and personality disorders. The document also outlines various branches and classifications of psychiatry, diagnostic criteria for mental disorders, and the biological, psychological and social factors that can contribute to psychiatric illnesses.

1. Psychiatry
Li Yan
Xinjiang Production and Construction Corps Mental
Health Center
The Oasis Hospital

2. Preface
 1.The definition and the research scope of
Psychiatry
 2.The classification in Psychiatry and
classification of causes
 3. Diagnostic Criteria of Mental Disorders
 4.Mental state examination

3.  Psychiatry is a section of medicine. It is a
clinical medicine that studies causes,
mechanisms, clinical syndromes or signs ,
prognosis, diagnosis and treatment of
mental illnesses.

4.  In the past,psychiatry was considered as a
 science which study severe psychoses
 such as Schizophrenia,Mood disorders,etc.
 At present,the scope of Psychiatry has been
 broadened,including not only severe
 psychoses,but also Neuroses,Personality
 disorders,Developmental disorders,
 psychosomatic medicine, mental health, etc.

5.  Psychiatry has many branches
 (1) Community psychiatry
 (2) Consultation – liaison psychiatry
 (3) Geriatric psychiatry
 (4) Child psychiatry
 (5) Transcultural psychiatry

6.  (6) Judicial psychiatry
 (7) Biological psychiatry
 (8) Clinical psychiatry

7. & . Mental illness or mental
disease
 Mental illness or mental disease express the
disorders in cognition, affection, will, behavior,
etc.
 (1) The disorders are caused by many factors.
 (2）The social function of patients is weakened.
 Mental Illnesses incline psychosis, mood
disorders, anxiety disorders, mental
retardation, personality disorders, etc.

8.  &.Mental Health
 Mental Health involves in the
prevention and treatment of mental
illnesses and mental hygiene in normal
persons. Its aims are preventing and
reducing mental disorders.

9. 1.Aetiology of Mental Disorder
 The causes of psychiatry are complex.
 In psychiatry, the study of causation is
complicated by two problems.
 (1) The first problem is that causes are
often remote in time from the effects they
produce.

10.  For instance, it is widely believed that
childhood experiences partly determine the
occurrence of neuroses in adult life. It is
difficult to test this idea?
 ① Because the necessary information can
only be gathered either by studying children
and tracing them many years later, which is
difficult.
 ② By asking adults about their childhood
experiences , which is unreliable.

11.  (2)The second problem is that a single cause
may lead to several effects.
 For example deprivation of parental
affection in childhood has been reported to
predispose to antisocial behavior , suicide,
depressive illness and several other
disorders. Conversely, a single effect may
arise from several different causes.

12. 2. The classification of causes
 A single psychiatric disorder may result
from causes. For this reason, a scheme
for classifying causes is required. An
useful approach is to divide causes
chronologically into predisposing,
precipitating and perpetuating.

13. (1) Predisposing factors
 These factors that determine a person’s
vulnerability to causes acting closely to
the time of the illness. Many of them
operating from early life, they include
genetic endowment and environment in
utero, as well as physical, psychological
and social factors in infancy and early
childhood.

14.  There is an important conception: constitution.
Constitution is often used to describe mental
and physical make up of a person at any point
in life. This make-up changes as life goes on,
under the influence of further physical,
psychological and social influences. The
concept of constitution includes the idea that a
person may have a predisposition to develop a
disorder (such as schizophrenia) ever though
the latter never manifests it.

15.  From the standpoint of psychiatric an
etiology, one of the important parts of the
constitution is the personality.
 When the etiology of an individual case is
formulated, the person is always an
essential element.

16.  The clinicians should be prepared to
spend considerable time in talking to the
patient and to people who know him, in
order to build up a clear picture of his
personality. This assessment usually
helps to explain why the patient responds
to certain stressful events and why he
reacted in a particular way.

17. In the evaluation of person a
life, it is important to acquire
sound clinical skill through
supervised practice.

18. (2) Precipitating factors
 These are events that occur shortly
before the onset of a disorder and appear
to have induced it. They may be physical,
psychological or social. Whether they
produce a disorder at all and what kind
of disorder they produce, depend partly
on constitutional factors in the patient.

19.  Physical precipitating factors, for
example, cerebral tumors or drugs.
Psychological and social precipitants
include personal misfortunes such as
the lost of a job and changes in the
routine of life such as moving home.

20.  Sometimes the same factor can act in
more than one way for example a
head injury can induce psychological
disorder either through physical
changes in the brain or through its
stressful implication to patient.

21. （3）Perpetuating factors
 These factors prolong the course of a
disorder after it has been provoked引发了 .
When planning treatment, it is particularly
important to give attention to these factors.
The original precipitating factors may have
ceased to act by the time the patient is seen,
and the predisposing factors may be well
treatable.

22. 3.Biological, psychological, social
factors and psychiatric illnesses.
 Biological factors included:
 Anatomic and molecular factors those factors
related to gender, age, ethnicity and genetics.
 Psychological factors were related to :
 The individual’s personality·
 Social factors included
 Family, culture, society, environment, religious
and spiritual, economic factors.

23. (1) Genetic factors(Biological factor)
 These are important in several
psychiatric disorders, including
schizophrenia and affective illness, as
evidenced by the following: (see P247)

24.  A higher prevalence among first-degree
relatives than in the general population.
 A higher concordance rate in
monozygotic than in dizygotic twins, even
if the monozygotic twins have been
reared apart寄养 .
 A higher prevalence rate for children of
mentally ill patients who brought up by
healthy adoptive parents.

25.  Some disorders are due to single gene
transmission, such as Huntington’s
chorea and some uncommon causes of
mental retardation (e.g. fragile X
syndrome).

26.  for the majority of psychiatric disorders
in which heredity plays a role, no single
gene has been isolated and it is assumed
that several gene, have influence on the
development of the condition.

27. (2) Family background
 Many patients with psychiatric disorders
report an unhappy childhood and it
seems likely that a traumatic upbringing
predisposes to future psychiatric illness.
Important factors are loss of a parent in
childhood, due to either death or
separation, parental disharmony and
physical, especially sexual, abuse.

28.  (3) Physical illness and chronic ill health.
 Both predispose to psychiatric disorders.
(Why?)
 (4) Stressful life events
 We usually call the stressors. These can
precipitate episodes of illness in
vulnerable people. They usually involve a
sense of loss or threat of loss, and include
death of a close relative, marital
breakdown, redundancy裁员 , retirement
and major financial crisis.

29. (5) Social isolation
 May psychiatrically ill patients are socially
isolated and this often appears to be a
contributory factor in their illness. Particularly
important is lack of a close, confiding
relationship. Social deprivation is associated
with various conditions, such as attempted
suicide, alcoholism and drug dependence.


30. Diagnostic Criteria of Mental
Disorders
 Symptom criteria
 Severity criteria
 Course criteria
 Exclusion criteria

31. Classification in Psychiatry
 ICD-10 (the tenth edition of the International
Statistical Classification of Diseases and Related
Health Problems)
 DSM-IV(the forth edition of the Diagnostic and
Statistical Manual of Mental Disorders)
 CCMD–III(the third edition of Chinese Classification
and Diagnostic Criteria of Mental Disorders)

32. The main categories in ICD-10
F0 Organic, including symptomatic mental disorders
F1 Mental and behavior disorders due to psychoactive
substance use
F2 Schizophrenia, schizotypal and delusional disorders
F3 Mood (affective) disorders
F4 Neurotic, stress-related, and somatoform disorders
F5 Behavioral syndromes associated with physiological
disturbances and physical factors

33. F6 Disorders of adult personality and behavior
F7 Mental retardation
F8 Disorders of psychological development
F9 Behavioral and emotional disorders with
onset usually occurring in childhood or
adolescence

34. Diagnostic and Statistical
Manual of Mental
Disorders,Fourth Edition
 Disorders Usually First Diagnosed in
 Infancy,Childhood,or Adolescence
 Delirium ,Dementia,and Amnesic and
 Other Cognitive Disorders
 Mental Disorders Due to a General Medical
 Condition Not Elsewhere Classified
 Substance-Related Disorders

35.  Schizophrenia and Other Psychotic
 Disorders
 Mood Disorders
 Anxiety Disorders
 Somatoform Disorders
 Factitious Disorders
 Dissociative Disorders

36.  Sexual and Gender Identity Disorders
 Eating Disorders
 Sleep Disorders
 Impulse-Control Disorders Not Elsewhere
 Classified
 Adjustment Disorders
 Personality Disorders

37. Multiaxial Assessment System
 Diagnostic axes
 Axis I Clinical Disorders
 Other Conditions That May be a
 Focus of Clinical Attention
 Axis II Personality Disorders and
 Mental Retardation
 Axis III General Medical Conditions

38.  Other domains for assessment
 Axis IV Psychosocial and
 Environmental Problems
 Axis V Global Assessment of
 Functioning

39. The diagnostic criteria of
Mental Disorders in CCMD-3
 0 Organic mental disorders
 1 Mental disorders due to psychoactive
 substances or non-addictive substances
 2 Schizophrenia and other psychotic
 disorders
 3 Mood (affective) disorders
 4 Hysteria, Stress-related disorders, Neurosis

40.  5 Physiological disorders related to
 psychological factors
 6 Personality disorders, Habit and impulse
 disorders, Psychosexual disorders
 7 Mental retardation and disorders of
 psychological development with onset
 usually occurring in childhood and
 adolescence
 8 Hyperkinetic, Conduct, and Emotional
 disorders with onset usually occurring in
 childhood and adolescence
 9 Other mental disorders and Psychological
 health conditions

41. 0 Organic mental disorders
 This block comprises a range of mental disorders
due to cerebral or systemic diseases such as
degenerative brain diseases, cerebro-vascular
diseases, intracranial（颅内） infection ,brain damage
or malignancies（恶性肿瘤） of the central nervous
system.Also including symptomatic mental
disorders,which are those organic mental disorders
in which cerebral involvement is secondary to a
systemic extracerebral disease.

42.  I Alzheimer’s disease(early onset ,late
 onset)
 II Vascular disease(acute onset,cortical or
subcortical vascular disease,mixed cortical
and subcortical vascular disease)

43.  III Other brain disease(brain degeneration,such as
Pick’s disease,Huntington’s disease,Parkinson’s
disease,hepatolenticular degeneration（肝豆变性）, etc.
Intracranial infection,such as acute virus
encephalopathy(脑炎) . Postencephalitic syndrome.
Demyelinating encephalopathy（脱髓鞘脑病）,such as
acute disseminated encephalomyelitis and acute
hemorrhagic leucoencephalitis（白质脑炎）,multiple
sclerosis（多发性硬化）. Brain damage such as brain
concussion（脑震荡） and brain contusion（脑挫裂伤）.
 Brain tumor.Epilepsy.)

44.  IV Mental disorders due to physical
disease(physical infection,human
immunodeficiency virus, visceral（内脏的） organ
disease,endocrine disease,nutritional and
metabolic disease,disease of connective tissue
such as systemic lupus erythematosus（系红狼苍）,
chromosomal abnormality, physical factors,
Puerperal（围生期） mental disorder)

45. 1. Mental disorders due to
psychoactive
substances or non-addictive
substances
 Psychoactive substances refer to extraneous
substance that may alter mental activities
and cause dependence. They include
alcohol, opioids , cannabinoids, hypnotics（催
眠药）, anxiolytics,anesthetics,stimulants,
hallucinogens, and tobacco.

46.  Inappropriate medical prescription or
repeated self-administration of
psychoactive drugs may cause dependence
syndrome and/or other mental
disorders,such as intoxication,withdrawal
syndrome,psychotic symptoms,affective
disorders,and residual（残留） or delayed-onset
mental disorders.

47. 2. Schizophrenia and other
psychotic disorders
 Schizophrenia comprises a group of psychotic
disorders of unknown specific etiology,often
presented with a gradual onset of abnormalities in
perception,thought,emotion and behavior since
young adulthood. Consciousness is usually
maintained. Intelligence is intact,but in some
cases,there is some degree of cognitive impairment.
The natural course of the disorders is chronic
remitting but sometimes deteriorating.

48. Clinical categories
 Paranoid schizophrenia
 Hebephrenic schizophrenia
 Catatonic schizophrenia
 Simple schizophrenia

49.  Post-schizophrenic depression
 Remitted（缓解期的） schizophrenia
 Residual schizophrenia
 Chronic schizophrenia
 Deteriorated schizophrenia
 Paranoid mental disorders
 Acute and transient psychosis

50.  Schizophrenia-like psychosis
 Traveling psychosis
 Delusional episodes
 Induced(感应性) psychosis
 Schizo-affective psychosis
 Periodic psychosis

51. 3. Mood disorders
 Mood disorders are a group of mental disorders
characterized by obvious and persistent elation
or depression of mood(elated or depressed
mood). The mood disturbance is commonly
associated with cognitive and behavioral
changes. In severe cases,psychotic
symptoms,such as hallucinations and delusions,
may be observed.

52.  There is a tendency for the disorders to
recur,but most recurrent episodes will
eventually remit. In certain cases, an
episode may become chronic and residual
symptoms are observed.

53. Clinical categories
 Manic episode( Hypomania, recurrent
mania, etc)
 Depressive episode
 Bipolar disorder
 Persistent mood disorder (Dysthymia)

54. 4. Hysteria, Stress-related
disorders, Neurosis
 Hysteria: these are a group of mental disorders
with some traits of hysterical personality, usually
onset associated with psychosocial factors. The
main manifestations are dissociative symptoms(a
partial or complete loss of memories and loss of
awareness of personal identity),and conversion
symptoms(the unpleasant affect caused by stresses
and conflicts that the individual can not resolve.
Then ,it is somehow transformed into the
somatizational symptoms).

55.  Hysterical amnesia
 Hysterical fugue(神游)
 Hysterical double or multiple personalities
 Hysterical psychosis
 Hysterical somatic disorders(motor and
sensory symptoms,convulsions)
 Other hysterical symptoms

56. Stress-related disorders
 The factors determining the occurrence,
development, duration and clinical manifestations
of this disorders are: ①life events and life
situations, such as severe superstrong mental
trauma or life events or continuous difficult
situation all may be direct causes; ②social cultural
background; ③personality trait, level of
intelligence, attitude of life and creed; ④excluding
hysteria, neurosis, physiological disorders
associated with psychological factors and
psychotic disorders.

57. Clinical categories
 Acute stress disorders (Acute stress
psychosis or acute reactive （反应）psychosis)
 Post-traumatic stress disorders
 Adjustment disorders

58. Neurosis
 A group of mental disorders with certain factors,
without any demonstrable organic basis, usually
onset after psychosocial factors and last for a long
time. The main manifestation are anxiety,
depression, phobia, obsession-compulsion,
hypochondriasis（疑病症）, somatic symptoms, or
neurasthenic symptoms, which are disproportional
to the patient’s actual situation. The patient has
insight of the illness, but feels affliction (痛苦)and no
significance.

59. Clinical categories
 Phobia ( Agoraphobia（场所）, Social phobia, Specific
phobia（单项恐怖）)
 Anxiety disorder ( Panic disorder, Generalized
anxiety disorder)
 Obsessive-compulsive disorder
 Somatoform disorders (Somatization disorder,
Undifferentiated（未分化） somatoform disorders,
Hypochondriasis, Somatoform autonomic
dysfunction, Persistent somatoform pain disorder)
 Neurasthenia神经衰弱症

60. 5 Physiological Disorders related
to psychological factors
 Refer to a group of mental disorders
characterized by the abnormality of
eating, sleeping, and sexual behavior
related to psychosocial factors.

61. Eating disorders
 Anorexia（厌） nervosa
 Bulimia （贪） nervosa
 Psychogenic（神经性） vomiting
 Anorexia nervosa : a type of eating disorder
occurs most commonly in adolescent girls and
young women, characterized by deliberately
eating less and weight loss obviously below
normal standard, which are induced and
sustained by the patient with excessive exercise,
vomiting, or purging（通便）.

62.  Most patients often worry about “fattening”, or
consider themselves to be too fat when they are
obviously thin, despite doctor’s explanation.
 In some patients eating and drinking too much
at one meal is episodic.

63. Nonorganic sleep disorders
 A group of sleep disorders caused by
various kinds nonorganic factors, in this
section including insomnia, hypersomnia,
disorder of sleep-wake rhythm, and
parasomnias（发作性睡眠异常） (sleep walking, night
terrors, and nightmare, etc).

64.  Insomnia
 Hypersomnia
 Disorder of the sleep-wake schedule
 Sleepwalking ( somnambulism)
 Night terrors
 Nightmares
 Other or unspecified nonorganic sleep
disorders

65. Nonorganic sexual dysfunction
 Lack or loss of sexual desire
 Impotence（阳痿）
 Failure of female genital response
 Orgasmic dysfunction（性高潮障碍）
 Premature ejaculation（早泄）
 Vaginismus（阴道痉挛）
 Dyspareunia（性交疼痛）

66. 6. Personality disorders, Habit
and impulse disorders,
Psychosexual disorders
This block comprises a group of disorders that are
characterized by deeply ingrained, enduring and
pervasive behavioral pattern manifested in a wide
range of situations and out of context of a given
cultural and social norm, resulting in marked
impairment in socio-occupational functioning as
well as personal distress. Such patients do not
have intelligent impairment. However, it is
difficult to correct such behavioral pattern.

67.  The onset of the disorder is usually in
adolescence and continues through adulthood. In
some exceptional cases there are attenuations of
the clinical problem with aging. If the
personality deviation is due to physical diseases
or secondary to mental disorders, it should be
coded as a personality change.

68.  Paranoid personality disorder
 Schizoid personality disorder
 Dissocial（反社会） personality disorder
 Impulsive personality disorder
 Hysterical personality disorder
 Anankastic(强迫) personality disorder
 Anxious personality disorder
 Dependent personality disorder

69. Habit and impulse disorders
 This group of disorders comprises a range
of behavior characterized by irrational acts
with underlying excessive impulse. The
behaviors are not socially approved and are
directed for self-gratification. This block
excludes deviant sexual desire or behavior.

70.  Pathological gambling
 Pathological fire-setting (pyromania)
 Pathological stealing (kleptomania)
 Trichotillomania（拔毛症）

71. Psychosexual disorders
 This is a group of disorders characterized by
abnormal psychosexual behavior. The patients
have a strong desire to change their gender, or
reliance on inanimate（无生命的） or non-human
subjects as source of sexual gratification, or
sexual attraction to individuals of homosex or
bisexes. Apart from these, there is no other
mental disturbance. This group of disorders
exclude excessive or lack of sexual desire and
physiological disorders of sexuality.

72. Clinical categories
 Gender identity disorders (Transsexualism
（易性僻）)
 Disorders of sexual preference (Fetishism
（恋物症）, Exhibitionism（露阴症）, Voyeurism（窥阴症）,
Frotteurism（摩擦症）, Sadomasochism（性施涅与性受捏
症）, Mixed disorders of sexual preference)
 Sexual orientation disorders
(Homosexuality, Bisexuality)

73. 7 Mental retardation and disorders of
psychological development with
onset usually occurring in childhood
and adolescence
 Mental retardation is a condition of arrested
or incomplete development of the mind,
which is characterized by deficits in
intelligence and social adjustment. The
disorders emerges before 18 years old.

74.  Retardation can occur with or without the
presence of other mental or physical
disorders.
 The level of intelligence as shown in
standardized psychometric（心理测验的） test is
defined as below 70, while the scores from
70-85 are defined as borderline intelligence.

75.  Mild mental retardation
 Moderate mental retardation
 Severe mental retardation
 Profound mental retardation

76. Development disorders of
speech and language
 Specific speech articulation （构音）disorder
 Expressive language disorder
 Receptive（感受性） language disorder
 Acquired aphasia（失语） with epilepsy
 Specific development disorders of scholastic skill
(reading, spelling, arithmetic skills)
 Specific development disorder of motor skills
 Mixed specified development disorders
 Pervasive development disorders

77. Pervasive development disorders
 Childhood autism（孤独症）
 Atypical autism （孤独症）
 Rett’s syndrome（Reactive attachment
disorder of childhood）
 Childhood disintegrative disorder (Heller’s
syndrome)(瓦解性)
 Asperger’s syndrome（广泛性发育障碍）

78. 8 Hyperkinetic（多动）, conduct, and
Emotional disorders with onset usually
occurring in childhood and adolescence
 This group of disorders is characterized by a
combination f pervasive manifestation of
over-activity, marked inattention and lack
of perseverance in task performance since
early childhood (usually about 3 years old).
The clinical features should be evident in
more one situation (e.g., home, classroom,
clinic, etc.). It is more common in boys than
in girls.

79.  Hyperkinetic disorders
 Attention deficit and hyperactivity disorder
 Hyperkinetic conduct disorder
 Conduct disorders
 Dissocial conduct disorder
 Oppositional defiant disorder（对立违抗性）

80. Emotional disorders with onset
specific to childhood
 Separation anxiety disorder of childhood
 Phobic anxiety disorder of childhood
 Social anxiety disorder of childhood
 Generalized anxiety with onset specific to
childhood occurring in childhood

81.  Elective autism（选择性缄默症）
 Reactive attachment disorder of childhood
 Tic disorders（抽动障碍）
 Transient tic disorder（短暂性抽动障碍）
 Chronic motor or vocal（发声） tic disorder
 Tourette’s syndrome（发声与多种运动联合抽动障
碍）

82. The mental status
examination
 1. Presentation
 2.Motor behavior and affect
 3.Cognitive status
 4.Thought
 5.Mood

83. Presentation
 Level of consciousness: coma to alert
wakefulness
 General appearance:body habitus, hygiene,
cosmesis, dress
 Attitude

84. Motor behavior and affect
 Motor behavior: akinesia, involuntary
movement,mannerisms（作态）
 Affect: facial expression, gestures, speech
characteristics, pressure, volume,
prosody

85. Cognitive status
 Attention
 Oritentation
 Language
 Memory
 Constructional ability
 Calculations
 Reasoning

86. Thought
 Process: coherence, goal directedness,
logicality
 Content: hallucinations, delusions,
preoccupations, suicidal or homicidal
ideation
 Insight

87. Mood
 Relation to affect and congruence（一致）
with thought content

88. 谢 谢！
Thanks for
attending!