4/22 Medical Explorers Notes
Dr. Daniel Mason
Psychiatry
Psychiatry is an outlier in medicine. Disorders are more likely to appear earlier in people’s lives,
unlike other illnesses.
Most people have suffered some degree of psychiatric distress and know people who have
psychiatric disorders.
People studying medicine often experience hypochondria; experiencing symptoms of what they
are studying
What is psychiatry?
 Psych-: soul; from Ancient Greek
 -iatry: medical treatment; from Greek
 What is the difference between medical treatment and religious treatment? And what do
we mean by the soul?
 What are we treating, if not the brain?
Epidemiology
 10th most common cause of death in developed countries is self-inflicted (suicide)
o Suicide is the worst outcome of any psychiatric disease
 Burden of disease can also be measured by the number of people affected and how severe
the illness that is affecting them is
 WHO measures “days lost to illness,” or the severity of disability
 Psychiatric illness seems much more severe when you look at the number of people
affected, how much it affects people’s ability to go to work, school, etc.
o Ranked as severe as terminal stage cancer, revealing that it is as or more severe
than diseases of the body
History
 Psychiatric disorders were thought to be caused by demons or possession, and were
treated by trepination (drilling a hole in the skull to release the demon) or by exorcism
 15th century- asylums started being built, where people with mentally ill family members
could bring them
o People could come and view the mentally ill patients
 Can make guesses as to what psychiatric disorders people have based on paintings
o Grandiosity- thinking very highly of oneself
th
 19 Century- movement to open up the asylums
o No Chains Initiative- movement to get countries to fall in line with adequate
treatment of the mentally ill
 Sigmund Freud- suggested that mental illness could be treated not by locking people up
but by talking (psychoanalysis)
o The unconscious- we have our daily thoughts and emotions that we’re aware of,
but underneath there is an entire world of instincts, emotions, and desires that
we’re unaware of but motivate our daily actions

o The thinking and organizing part of the mind is the Ego. It receives pressure from
the parts of the unconscious which are the Id (the instincts, emotions, desires) and
the Superego (the “parental” function of the brain, more observant and
controlling)
Thorazine- the 1st psychiatric drug about 50 years ago)
o Psychiatric illnesses were mostly treated through talking or other alternative
methods prior to that
o Now, much of psychiatric treatment is very medication-oriented, maybe even too
medication-oriented
Psychiatric Illnesses
 DSM- an attempt to get psychiatrists to speak the same language. Provides a set of
organized symptoms, classifies psychiatric illnesses by symptoms
o Very controversial
o In real life, these disorders have a lot of gradation. It is very difficult to say what
is and isn’t illness
 Depression- most commonly diagnosed of the mental illnesses defined by the DSM
o Major Depressive Disorder
 10%-25% of women
 5%-12% of men
o Defined as more than 2 weeks of 5 or more of:
 Depressed mood
 Anhedonia- inability to feel happy
 Weight loss
 Change in sleep
 Psychomotor changes
 Feelings of guilt or worthlessness
 Low energy
 Poor concentration
 Thoughts of death
o Treatments
 Antidepressants (Prozac, Zanax, Zoloft, etc.)
 SSRI’s- Selective Serotonin Response Inhibitors- increase the
amount of serotonin at neural synapses
 Most medications take 4-6 weeks to start working
 Psychotherapy
 CBT- Cognitive Behavioral Therapy
 Psychodynamic psychotherapy
 Many others
 ECT- Electroconvulsive Therapy. Patients are given anesthesia and a
paralytic agent, then are shocked by electricity, causing the brain to seize.
 TMS
 Bipolar Disorder
o “Manic-Depression”
o Mania
 Inflated self-esteem or grandiosity




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Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Distractability (attention too easily drawn to unimportant or irrelevant
external stimuli)
 Etc.
 Hypomania- not as severe as mania, doesn’t interfere with people’s
lives as much, but same list of symptoms
o Treatments for Bipolar Disorder
 Mood Stabilizers
 Lithium remains perhaps the best treatment for classic bipolar
disorder)
 Antipsychotics
 Sedatives
 Antidepressants
 Psychotherapy
Schizophrenia
o 1% prevalence?
o 2 or more symptoms for > 1 month
 Delusions
 Hallucinations (a larger portion of the population experiences this)usually auditory or visual
 Disorganized speech, which is a manifestation of formal thought disorder
 Grossly disorganized behavior (dressing inappropriately, crying
frequently) or catatonic behavior
 Negative Symptoms: Blunted affect (lack or decline in emotional
response), alogia (lack or decline in speech), or avolition (lack or decline
in motivation)
o Social or occupational dysfunction...
Recommended further reading:
An Unquiet Mind by Kay Redfield Jamison
The Center Cannot Hold- Elyn Saks