Introduction,
Development of Psychiatry
Department of Psychiatry
1st Faculty of Medicine
Charles University, Prague
Head: Prof. MUDr. Jiří Raboch, DrSc.
Teaching: Schedule
Week 1
Week 2
Week 3
MO
TUE
WE
THU
FRI
MO
TUE
WE
THU
FRI
MO
TUE
WE
THU
FRI
8:00-9:30
9:45-12:00
Lecture
Workshop on wards with patients
Lecture
Workshop on wards with patients
Lecture
Workshop on wards with patients
Lecture
Workshop on wards with patients
Lecture
Workshop on wards with patients
Lecture
Workshop on wards with patients
Lecture
Workshop on wards with patients
Psychiatric Hospital Bohnice
Lecture
Workshop on wards with patients
Lecture
Workshop on wards with patients
Lecture
Workshop on wards with patients
Lecture
Workshop on wards with patients
Ward
Lecture
Workshop on wards with patients
Examination
FREE COURSES IN CZECH
• WEDNESDAY 14:00 – 15:30 CLINICAL
SEMINAR, LIBRARY, 2nd. FLOOR
• FIRST WEDNESDAY IN EVERY MONTH –
MEETING OF THE CZECH PSYCHIATRIC
ASSOCIATION – VONDRÁČEK LECTURE
HALL, 9:00 – 17:00
• THURSDAY 12:45 – 15:00, THERAPEUTIC
COMMUNITY, Apolinář, 2nd. FLOOR
• THURSDAY 13:00 – 14:00 SEMINAR FOR
POSTGRADUATE STUDENTS, LIBRARY,
2nd. FLOOR
Study materials
• Basic Psychopathological Terms and
Psychiatric Diagnoses: Raboch J., Pavlovský P.
et al., Karolinum
• Psychiatrie: Raboch, Zvolský a kol., Galén,
Praha 2001, s. 622 (in Czech)
• Psychiatrie-Testy: Raboch a kol., Galén, Praha
1997 (in Czech)
• ANY OTHER ENGLISH TEXTBOOK OF
PSYCHIATRY PUBLISHED AFTER 1995, 400
PAGES AND MORE (e.g. WALDINGER,
ANDREASEN, HALES …)
E-LEARNING
LECTURES, ORAL EXAMINATION QUESTIONS
http://psychiatrie.lf1.cuni.cz/
Department of Psychiatry
http://portal.lf1.cuni.cz/
Educational portal
Course
• 2 absence at maximum
• 2 other absences – free courses
• Written mental status of one patient
(documentary case record)
PSYCHIATRY
MAIN MEDICAL
DISCIPLINE
INFLUENCES – KNOWLEDGE
OF THE MANKIND,
PHILOSOPHY
TWO TRENDS
RESTRICTIVE, PUNISHING ISOLATION
PERMISSIVE,
MEDICINALISATION –
MEDICAL DISEASES
PSYCHIATRY IN
ANCIENT TIMES
• THE OLDEST PSYCHIATRIC
STATUS
– EBERS´S PAPYRUS,
1900 B.C.,
CLINICAL PICTURE
OF
DEPRESSION
• BIBLE, OLD TESTAMENT,
MADNESS
OF THE KING SAUL, MELANCHOLY ASKLEPIOS
• MAGICAL CAUSES OF MENTAL
DISORDERS – ASSYRIANS,
BABYLONIANS, MENTAL DISORDERS –
MARK OF MORAL INSANITY, SIN,
PUNISHMENT
• ANCIENT GREECE – HEALERS, TEMPLE
MEDICINE
HIPPOKRATES
•
•
•
•
•
•
•
460 – 370 B.C.
HYPOTHESIS – 4 BODY JUICES SANGUIS, FLEGMA, CHOLE,
MELANCHOLE
CHARACTER TYPOLOGY
MENTAL DISORDER – BRAIN
FIRST CLASSIFICATION OF
MENTAL
DISORDERS
PARANOIA – MELANCHOLIA –
BLACK
BILE
MANIA – YELLOW BILE
FRENITIS – BLOOD
HYSTERIA
THERAPY – VENIPUNCTURE, EMETICS,
LAXANTIVES, PHYSICAL ACTIVITY,
SWEATING
ROME, A.D.
• GALEN - ROMAN SCHOOL OF
ECLECTICS
• MENTAL DISORDERS – PRIMARY
DISEASE OF THE BRAIN OR REACTION
OF THE BRAIN TO DISEASES OF OTHER
ORGANS
• FALL OF THE ROMAN EMPIRE – FALL OF
THE HUMANISTIC AND SCIENTIFIC
EDUCATION AND ATTITUDES
• CODEX THEOSIANUS, 438 A.D.,
PUNISHMENT OF MANIACS,
MENTAL DISORDER OUT OF MEDICINE,
SUBJECT OF
RELIGIOUS
LYKANTROPY
EVALUATION
MIDDLE AGES
• ISOLATION OF MENTALLY ILL PEOPLE,
DEMONOLOGY – STIGMATA DIABOLI
• 1487 MALLEUS MALEFICARUM (JAKOB
SPRENGER A HEINRICH KRAEMER)
• SPECIAL MONASTERIES – HOSPITALES
• PRISON
• TORTURE – EXORCISM, WITCH TRIALS
• 18th. CENTURY „FAME PLAGIIS,
VINCULIS COERCENDUS EST INSANUS
RENAISSANCE
16. CENTURY
• RETURN TO HUMANISM, SEPARATION
OF SCIENCE FROM THE CHURCH
• NEW DISCOVERIES IN MEDICINE – W.
HARVEY – BLOOD CIRCULATION
• MIND AND BODY, SOCIAL INFLUENCES
• BEGINNINGS OF CLASSIFICATION IN
PSYCHIATRY
• 1st. PSYCHIATRIC REVOLUTION JOHAN WEYER (1515 – 1588 TREVIR),
PROFESSOR, MEDICAL SCHOOL IN
COLOGNE, DE PRESTIGIIS
DAEMONUM, MENTAL DISORDERS –
MEDICAL CAUSES
ENLIGHTENMENT
17th – 18th CENTURIES
• PIONEERS OF LIBERALISM –
VOLTAIRE, KANT, DIDEROT, SWIFT,
• FRENCH REVOLUTION (1789)
• 2nd. PSYCHIATRIC REVOLUTION –
REAL REFORM OF THE CARE OF
MENTALLY ILL PEOPLE
• WILLIAM TUKE – YORK RETREAT –
MODEL OF HUMANISTIC CARE
• PHILIPPE PINEL – PARIS, BICETRE,
SALPETRIERE, THERAPEUTIC
REGIMEN, ACTIVITY THERAPY,
PSYCHODRAMA
• MODERN PSYCHIATRY – MENTAL
DISORDERS – MEDICAL DISEASES,
PHYSICIANS
MODERN PSYCHIATRY
19th. CENTURY
• 1861 BROCA´S AREAS,
KRAEPELIN – MENTAL
DISORDERS – ABNORMALITIES
OF NEURONAL FUNCTIONS
• CLASSIFICATION –
EINHEITSPSYCHOSE (EUROPE),
IDIOCY (USA)
• E. KRAEPELIN (1856 – 1925) –
DEMENTIA PRAECOX
• E. BLEULER (1857 – 1939) –
SCHIZOPHRENIA
• J. BAILLARGER (1809 – 1890) CYCLOPHRENIA
• W. GRIESINGER (1817 – 1868) ORGANIC PSYCHOSYNDROM
FIRST HALF OF THE
20th. CENTURY
• HUGE PSYCHIATRIC HOSPITALS –
PSYCHOSES
• ORGANIC THEORY OF MENTAL
DISORDERS (WIRCHOV)
• BIOLOGICAL TREATMENTS –
SCHOCK THERAPIES (H.
BOERHAAVE, 1668 –1738), BENEFICIS
MARIS
• 1932 VON MEDUNA – KARDIAZOL
• 1935 M. SAKEL – INZULIN
• 1938 U. CERLETI, L. BINI – ECT
• 1900 S. FREUD – ANALYSIS OF
DREAMS
II. WORLD WAR AND
FASCISM
• 1933 LAW – PREVENTION OF
HERIDITARY DISEASES –
STERILISATION OF 400 000 PEOPLE
• 1939 EUTHANASIA, T4 ACTION, IN
CHILD DEPARTMENTS MURDERED 10
000 OF CHILDREN
• 1939 – 1945 IN GERMANY MURDERED 180
000 PSYCHIATRIC PATIENTS
• FLIGHT OF MANY JEWISH
PSYCHIATRISTS FROM CONTINENTAL
EUROPE (S. FREUD)
„AKTION T4“ – Dr. Karl Brandt
… murdering 70 273
patients saved the German
government, over 10 years,
33 731 040 eggs, a saving of
3 710 414 German marks
and 40 pfennings … also
the savings in vegetables
and other provisions
SECOND HALF OF
THE 20th. CENTURY
• 50ies – PSYCHOANALYSIS,
PSYCHOTROPIC DRUGS
1952 DELAY, DENIKER –
CHLORPROMAZIN
1958 KUHN – IMIPRAMIN
• 60-ies – SOCIAL PSYCHIATRY,
COMMUNITY
PSYCHIATRY
• 70-ies – EMPIRICAL RESEARCH, HUGE
EPIDEMIOLOGICAL PROJECTS
• 80-ies – BIOLOGICAL PSYCHIATRY,
NEUROSCIENCES, NEW CLASSIFICATION - DSMIII, ICD-10
• 90-ies – COMMUNITY PSYCHIATRY, GLOBAL
BURDEN OF DISEASE, EXPENDITURE
REDUCTION, COST-EFFECTIVENESS, QUALITY
ASSURANCE
21. CENTURY
• MENTAL HEALTH
• 2 000 WHO - WORLD HEALTH DAY „STOP
EXCLUSION, DARE TO CARE“
• WORLD HEALTH REPORT 2001 – „NEW
UNDERSTANDING, NEW HOPE“,
10 RECCOMENDATIONS
• MENTAL HEALTH GLOBAL ACTION
PROGRAMME FOR 5 YEARS
• EUROPE – HEALTH 21
• 2005 WHO HELSINKI CONFERENCE MENTAL HEALTH ACTION PLAN FOR
EUROPE
LIFE TIME PREVALENCE
OF MENTAL DISORDERS
%
Total
Males
Females
Anxiety
24,9
disorders
Affective
17,1
disorders
Dependencies 26,6
19,2
30,5
12,7
21,7
35,4
17,9
Non-affective 0,7
psychoses
Total
48,0
0,6
0,8
48,7
47,3
FIRST OUT-PATIENT
EXAMINATION IN A YEAR
DIAGNOSIS
1994
2006
CHANGES (%)
ORGANIC BRAIN
DISORDER
27 421
50 388
83,8
DEPENDENCIES
31 097
39 301
26,4
SCHIZOPHRENIA
33 805
41 638
23,2
AFECTIVE DISORDER
37 915
93 636
147,0
NEUROTIC DISORDER
103 577
187 665
81,2
DEVELOPMENTAL
DISORDER
23 460
21 127
-9,9
TOTAL
307 877
458 500
48,9
ÚZIS 2007
THE GLOBAL BURDEN
OF DISEASE
Ch.J.L.MURRAY,
A.D.LOPEZ, 1997
HARVARD SCHOOL OF PUBLIC
HEALTH
WORLD HEALTH ORGANISATION
WORLD BANK
DALY - Disability
Adjusted Life Years
DALY = YLL + YLD
YLL - Years of Life Lost
YLD - Years Lived with Disability
DALY
% OF NEUROPSYCHIATRIC
DISORDERS IN VARIOUS PARTS OF
THE WORD
30
25
mark.ec.
form.soc.
Lat.Am.
China
rest Asia
Mediter.
subsah.Afr.
20
15
10
5
0
DALY
Disability Adjusted Life Years
Murray a Lopez, 1997
DALY
DEVELOPED COUNTRIES
25
20
15
10
5
0
neuropsychiat.
CDV
neoplasmas
injuries
% DALY
22
20,4
13,7
10,3
PSYCHIATRY IN PRAGUE
• 1790 – CUSTODIAE MENTE
CAPTORUM, GENERAL HOSPITAL
• 1822 – TEMPLE OF ST. CATHARINA –
OLD HOUSE
• 1844 – NEW HOUSE,
KARL VON RIEDL
PSYCHIATRIC DEPARTMENT
CHARLES UNIVERSITY, PRAHA
CAUSES OF DALY (%)
world
1.
Respirační infekce
8,2
2.
3.
4.
5.
Průjmovitá onemocnění
Perinatální onemocnění
Unipolární deprese
ICHS
7,2
6,7
3,7
3,4
6.
7.
8.
Cerebrovaskulární onemocnění
Tuberkulóza
Zarděnky
2,8
2,8
2,7
9.
10.
Dopravní nehody
Vrozené vady
2,5
2,4
Murray a Lopez, 1997
CAUSES OF DALY (%)
developed countries
1.
ICHS
9,9
2.
3.
4.
5.
Unipolární deprese
Cerebrovaskulární nemoci
Dopravní nehody
Nadužívání alkoholu
6,1
5,9
4,4
4,0
6.
7.
8.
Osteoarthritis
Nádory trachey, bronchů a plic
Demence a další deg. procesy CNS
2,9
2,9
2,7
9.
10.
Sebepoškození
Vrozené vady
2,3
2,2
Murray a Lopez, 1997
CAUSES OF DALY (%)
developed countries, age 15 - 44
1.
Unipolární deprese
12,3
2.
3.
4.
5.
Nadužívání alkoholu
Dopravní nehody
Schizofrenie
Sebepoškození
8,9
8,5
5,0
4,2
6.
7.
8.
Bipolární porucha
Nadužívání návykových látek
Obsedantně kompulzivní porucha
3,7
2,9
2,7
9.
10.
Osteoarthritis
Následky násilí
2,7
2,4
Murray a Lopez, 1997