Vous êtes sur la page 1sur 16

Psychiatry

Psychiatry is the medical specialty devoted to the study, diagnosis, treatment,


and prevention of mental disorders. These include various affective, behavioural,
cognitive and perceptual abnormalities. The term "psychiatry" was first coined by
the German physician Johann Christian Reil in 1808 and literally means the
'medical treatment of the soul'

Approaches
Psychiatric illnesses can be conceptualized in a number of different ways. The
biomedical approach examines signs and symptoms and compares them with
diagnostic criteria. Mental illness can be assessed, conversely, through a
narrative which tries to incorporate symptoms into a meaningful life history and
to frame them as responses to external conditions. Both approaches are
important in the field of psychiatry, but have not sufficiently reconciled to settle
controversy over either the selection of a psychiatric paradigm or the
specification of psychopathology. The biocognitive approach includes a mentalist
etiology and provides a natural dualist (i.e. non-spiritual) revision of the
biopsychosocial view.
Medical or biomedical modelAn overall distinction is also commonly made between a "medical model" (also
known as a biomedical or disease model) and a "social model" (also known as an
empowerment or recovery model) of mental disorder and disability, with the
former focusing on hypothesized disease processes and symptoms, and the
latter focusing on hypothesized social constructionism and social contexts.
Biological psychiatry has tended to follow a biomedical model focused on organic
or "hardware" pathology of the brain, where many mental disorders are
conceptualized as disorders of brain circuits likely caused by developmental
processes shaped by a complex interplay of genetics and experience.
Biopsychosocial modelThe primary model of contemporary mainstream Western psychiatry is the
biopsychosocial model (BPS), which merges biological, psychological and social
factors. For instance one view is that genetics accounts for 40% of a persons
susceptibility to mental disorders while psychological and environmental factors
account for the other 60%. It may be commonly neglected or misapplied in
practice due to being too broad or relativistic, however.
The most common view is that disorders tend to result from genetic dispositions
and environmental stressors, combining to cause patterns of distress or
dysfunction or, more sharply, trigger disorders (Diathesis-stress model). A
practical mixture of models may often be used to explain particular issues and
disorder, although there may be difficulty defining boundaries for indistinct
psychiatric syndromes.

Mental Disorders
A mental disorder, also called a mental illness or psychiatric disorder, is a mental
or behavioral pattern or anomaly that causes either suffering or an impaired
ability to function in ordinary life (disability), and which is not developmentally or
socially normative. Mental disorders are generally defined by a combination of
how a person feels, acts, thinks or perceives. This may be associated with
particular regions or functions of the brain or rest of the nervous system, often in
a social context.

ClassificationIn general, mental disorders are classified separately from neurological disorders,
learning disabilities or intellectual disability. In the scientific and academic
literature on the definition or classification of mental disorder, one extreme
argues that it is entirely a matter of value judgments (including of what is
normal) while another proposes that it is or could be entirely objective and
scientific (including by reference to statistical norms).Common hybrid views
argue that the concept of mental disorder is objective even if only a "fuzzy
prototype" that can never be precisely defined, or conversely that the concept
always involves a mixture of scientific facts and subjective value judgments.
Although the diagnostic categories are referred to as 'disorders', they are
presented as medical diseases, but are not validated in the same way as most

medical diagnoses.
*Affective (emotion/mood) processes can become disordered. Mood disorder
involving unusually intense and sustained sadness, melancholia, or despair is
known as major depression (also known as unipolar or clinical depression). Milder
but still prolonged depression can be diagnosed as dysthymia. Bipolar disorder
(also known as manic depression) involves abnormally "high" or pressured mood
states, known as mania or hypomania, alternating with normal or depressed
mood. *Patterns of belief, language use and perception of reality can become
disordered (e.g., delusions, thought disorder, hallucinations). Psychotic
disorders in this domain include schizophrenia, and delusional disorder
*Personalitythe fundamental characteristics of a person that influence
thoughts and behaviors across situations and timemay be considered
disordered if judged to be abnormally rigid and maladaptive. A number of
different personality disorders are listed, including those sometimes classed as
"eccentric", such as paranoid, schizoid and schizotypal personality disorders;
types that have described as "dramatic" or "emotional", such as antisocial,
borderline, histrionic or narcissistic personality disorders; and those sometimes
classed as fear-related, such as anxious-avoidant, dependent, or obsessivecompulsive personality disorders.
*Eating disorders involve unequal concern in matters of food and weight.
Categories of disorder in this area include anorexia nervosa, bulimia nervosa,
exercise bulimia or binge eating disorder.
*Sleep disorders such as insomnia involve disruption to normal sleep patterns,
or a feeling of tiredness despite sleep appearing normal.
*Sexual and gender identity disorders may be diagnosed, including dyspareunia,
gender identity disorder and ego-dystonic homosexuality.
*A range of developmental disorders that initially occur in childhood may be
diagnosed, for example autism spectrum disorders, oppositional defiant disorder
and conduct disorder, and attention deficit hyperactivity disorder (ADHD), which
may continue into adulthood. Conduct disorder, if continuing into adulthood, may
be diagnosed as antisocial personality disorder
*Somatoform disorders may be diagnosed when there are problems that
appear to originate in the body that are thought to be manifestations of a mental
disorder. This includes somatization disorder and conversion disorder. There are
also disorders of how a person perceives their body, such as body dysmorphic
disorder.
*Factitious disorders, such as Munchausen syndrome, are diagnosed where
symptoms are thought to be experienced (deliberately produced) and/or
reported (feigned) for personal gain.

CausesGenetic
Family-linkage and twin studies have indicated that genetic factors often play an

important role in the development of mental disorders. The reliable identification


of specific genetic susceptibility to particular disorders, through linkage or
association studies, has proven difficult. This has been reported to be likely due
to the complexity of interactions between genes, environmental events, and
early development , Schizophrenia, for a long time consensus among scientists
was that certain alleles (forms of genes) were responsible for schizophrenia, but
some research has indicated only multiple, rare mutations thought to alter
neurodevelopmental pathways that can ultimately contribute to schizophrenia;
virtually every rare structural mutation was different in each individual. Research
has shown that many conditions are polygenic meaning there are multiple
defective genes rather than only one that are responsible for a disorder.
Schizophrenia and Alzheimers are both examples of hereditary mental disorders.
Prenatal Damage
Any damage that occurs to a fetus while still in its mothers womb is considered
prenatal damage According to research, certain conditions, such as autism result
from a disruption of early fetal brain progression. Environmental events
surrounding pregnancy and birth have been linked to an increased development
of mental illness in the offspring. This includes maternal exposure to serious
psychological stress or trauma, conditions of famine, obstetric birth
complications, infections, and gestational exposure to alcohol or cocaine.
Preterm birth is associated with almost half of all neurological birth defects.
Infection, Disease and Toxins
A number of psychiatric disorders have often been tentatively linked with
microbial pathogens, particularly viruses; however while there have been some
suggestions of links from animal studies, and some inconsistent evidence for
infectious and immune mechanisms (including prenatally) in some human
disorders, infectious disease models in psychiatry are reported to have not yet
shown significant promise except in isolated cases.
There have been some inconsistent findings of links between infection by the
parasite Toxoplasma gondii and human mental disorders such as schizophrenia,
with the direction of causality unclear. A number of diseases of the white matter
can cause symptoms of mental disorder.
Some chronic general medical conditions have been linked to some aspects of
mental disorder, such as AIDS-related psychosis.
The current research on Lyme's disease caused by a deer tick, and related toxins,
is expanding the link between bacterial infections and mental illness.
Research shows that infections and exposure to toxins such as HIV and
streptococcus cause dementia and OCD respectively. The infections or toxins
trigger a change in the brain chemistry, which can develop into a mental
disorder.
Injury and Brain Defects
Any damage to the brain can cause a mental disorder. The brain is the control
system for the nervous system and the rest of the body. Without it the body
cannot function properly.

Higher rates of mood, psychotic, and substance abuse disorders have been
found following traumatic brain injury (TBI). Findings on the relationship between
TBI severity and prevalence of subsequent psychiatric disorders have been
inconsistent, and occurrence has been linked to prior mental health problems as
well as direct neurophysiological effects, in a complex interaction with
personality and attitude and social influences.
Head trauma is classified as either open or closed head injury. In open head
injury the skull is penetrated and brain tissue is destroyed in a localized area.
Closed head injury is more common, the skull is not penetrated but there is an
impact of the brain against the skull which can create permanent structural
damage (e.g. subdural hematoma). With both types, symptoms may disappear
or persist over time. It has been found that typically the longer the length of time
spent unconscious and the length of post-traumatic amnesia the worse the
prognosis for the individual.
The cognitive residual symptoms of head trauma are associated with the type of
injury (either open head injury or closed head injury) and the amount of tissue
destroyed. Symptoms of closed injury head trauma tend to be the experience of
intellectual deficits in abstract reasoning ability, judgement, and memory, and
also marked personality changes. Symptoms of open injury head trauma tend to
be the experience of classic neuropsychological syndromes like aphasia, visualspatial disorders, and types of memory or perceptual disorders.
Brain tumors are classified as either malignant or benign, and as intrinsic
(directly infiltrate the parenchyma of the brain) or extrinsic (grows on the
external surface of the brain and produces symptoms as a result of pressure on
the brain tissue). Progressive cognitive changes associated with brain tumors
may include confusion, poor comprehension, and even dementia. Symptoms
tend to depend on the location of the tumor on the brain. For example, tumors
on the frontal lobe tend to be associated with the symptoms of impairment of
judgment, apathy, and loss of the ability to regulate/modulate behavior.
Some abnormalities in the average size or shape of some regions of the brain
have been found in some disorders, reflecting genes and/or experience. Studies
of schizophrenia have tended to find enlarged ventricles and sometimes reduced
volume of the cerebrum and hippocampus, while studies of (psychotic) bipolar
disorder have sometimes found increased amygdala volume.. Some studies have
also found reduced hippocampal volumes in major depression, possibly
worsening with time depressed.
Neurochemical Imbalances
Chemical imbalances can be viewed as disorders of the brain circuits. If there is
damage to the neurotransmitters in the brain then mental disorders can develop.
Mental disorders possibly associated with chemical imbalances are depression
and schizophrenia. Abnormal levels of dopamine activity have been implicated in
a number of disorders (e.g., reduced in ADHD, increased in schizophrenia),
thought to be part of the complex encoding of the importance of events in the
external world. Dysfunction in serotonin and other monoamine neurotransmitters
such as norepinephrine and dopamine has also been centrally implicated in

mental disorders, including major depression as well as obsessive compulsive


disorder, phobias, posttraumatic stress disorder, and generalized anxiety
disorder
Life experience and Environmental Factors
The term environment is very loosely defined when it comes to mental illness.
Unlike biological and psychological causes, environmental causes are stressors
that individuals deal with in everyday life.
It is reported that ill treatment in childhood and in adulthood, including sexual
abuse, physical abuse, emotional abuse, domestic violence and bullying, has
been linked to the development of mental disorders, through a complex
interaction of societal, family, psychological and biological factors. Negative or
stressful life events more generally have been implicated in the development of
a range of disorders, including mood and anxiety disorders. The main risks
appear to be from a cumulative combination of such experiences over time,
although exposure to a single major trauma can sometimes lead to
psychopathology, including PTSD. Resilience to such experiences varies, and a
person may be resistant to some forms of experience but susceptible to others.
Features associated with variations in resilience include genetic vulnerability,
temperamental characteristics, cognitive set, coping patterns, and other
experiences.
Poor parenting has been found to be a risk factor for depression and anxiety.
Separation or bereavement in families, and childhood trauma, have been found
to be risk factors for psychosis and schizophrenia
Severe psychological trauma such as abuse can wreak havoc on a persons life.
Children are much more susceptible to psychological harm from traumatic events
than that of adults. Once again, the reaction to the trauma will vary based on the
person as well as the individuals age. The impact of these events is influenced
by several factors: the type of event, the length of exposure the individual had to
the event, and the extent to which the individual and their family/friends were
personally affected by the event. Human-caused disasters, such as a tumultuous
childhood have more of an impact in children than that of natural disaster.
Neglect is a type of maltreatment related to the failure to provide needed, ageappropriate care, supervision and protection. It is not to be confused with abuse,
which, in this context, is defined as any action that intentionally harms or injures
another person. Neglect most often happens during childhood by the parents or
caretakers. Oftentimes, parents who are guilty of neglect were also neglected as
children. The long-term effects of neglect are reduced physical, emotional, and
mental health in a child and throughout adulthood.

A persons self-esteem plays a much larger role in their overall happiness and
quality of life. Poor self-esteem whether it be too high or too low can result in
aggression, violence, self-deprecating behavior, anxiety, and other mental
disorders.
Not fitting in with the masses can result in bullying and other types of emotional

abuse. Bullying can result in depression, feelings of anger, loneliness. Some


clinicians believe that psychological characteristics alone cause mental
disorders. Others speculate that abnormal behavior can be explained by a mix of
social and psychological factors. In many examples, environmental and
psychological triggers complement one another resulting in emotional stress,
which in turn activates a mental illness. Each person is unique in how they will
react to psychological stressors. What may break one person may have little to
no effect on another. Psychological stressors, which can trigger mental illness,
are as follows: emotional, physical or sexual abuse, loss of a significant loved
one, neglect and being unable to relate to others.
The inability to relate to others is also known as emotional detachment.
Emotional detachment makes it difficult for an individual to empathize with
others or to share their own feelings. An emotionally detached person may try to
rationalize or apply logic to a situation to which there is no logical explanation.
These individuals tend to stress the importance of their independence and may
be a bit neurotic. Oftentimes, the inability to relate to others stems from a
traumatic event.
Mental characteristics of individuals, as assessed by both neurological and
psychological studies, have been linked to the development and maintenance of
mental disorders. This includes cognitive or neurocognitive factors, such as the
way a person perceives, thinks or feels about certain things; or an individual's
overall personality, temperament or coping style or the extent of protective
factors or "positive illusions" such as optimism, personal control and a sense of
meaning.

Diagnosis
Psychiatrists seek to provide a medical diagnosis of individuals by an assessment
of symptoms and signs associated with particular types of mental disorder. Other
mental health professionals, such as clinical psychologists, may or may not apply
the same diagnostic categories to their clinical formulation of a client's
difficulties and circumstances. Routine diagnostic practice in mental health
services typically involves an interview known as a mental status examination,
where evaluations are made of appearance and behavior, self-reported
symptoms, mental health history, and current life circumstances. The views of
other professionals, relatives or other third parties may be taken into account. A
physical examination to check for ill health or the effects of medications or other
drugs may be conducted.

Treatments
Psychiatric medication
A psychiatric medication is a licensed psychoactive drug taken to exert an effect

on the chemical makeup of the brain and nervous system. Thus, these
medications are used to treat mental disorders. Usually prescribed in psychiatric
settings, these medications are typically made of synthetic chemical compounds,
although some are naturally occurring, or at least naturally derived.
There are six main groups of psychiatric medications*Antidepressant; which treat disparate disorders such as clinical depression,
dysthymia, anxiety, eating disorders and borderline personality disorder.
*Stimulants; which treat disorders such as attention deficit hyperactivity
disorder and narcolepsy, and to suppress the appetite.
*Antipsychotics; which treat psychotic disorders such as schizophrenia and
psychotic symptoms occurring in the context of other disorders such as mood
disorders.
*Mood stabilizers; which treat bipolar disorder and schizoaffective disorder.
*Anxiolytics; which treat anxiety disorders.
*Depressants; which are used as hypnotics, sedatives, and anesthetics.
*Psychedelics, which have a broad array of powerful acute effects and are
taken under professional supervision during extended psychotherapy sessions
Electroconvulsive therapy
Electroconvulsive therapy (ECT) is a standard psychiatric treatment in which
seizures are electrically induced in patients to provide relief from psychiatric
illnesses. ECT is usually used as a last line of intervention for major depressive
disorder, schizophrenia, mania and catatonia. A usual course of ECT involves
multiple administrations, typically given two or three times per week until the
patient is no longer suffering symptoms.In western fiction, it is usually depicted
as a painful procedure, but in western countries ECT is administered under
anesthetic with a muscle relaxant. Despite decades of research, the exact
mechanism of action of ECT remains elusive. Critics of ECT suggest that the
therapy induces "a closed-head injury caused by an overwhelming current of
electricity sufficient to cause a grand mal seizure" and that the improvements in
mood seen in patients receiving ECT are resultant from brain damage. Such
claims are rejected as wholly unsubstantiated by the consensus of the scientific
and medical community.
Psychotherapy
Psychotherapy is therapeutic interaction or treatment contracted between a
trained professional and a client, patient, family, couple, or group. Simply,
psychotherapy is a general term for treating mental health problems by talking
with a psychiatrist, psychologist or other mental health provider. During
psychotherapy, one hopes to learn about their condition and moods, feelings,
thoughts and behaviors, how to take control of one's life and respond to
challenging situations with healthy coping skills. The problems addressed are
psychological in nature and can vary in terms of their causes, influences,
triggers, and potential resolutions.
Psychotherapy includes interactive processes between a person or group and a
qualified mental health professional (psychiatrist, psychologist, clinical social
worker, licensed counselor, or other trained practitioner). Its purpose is the

exploration of thoughts, feelings and behavior for the purpose of problem solving
or achieving higher levels of functioning. Psychotherapy aims to increase the
individual's sense of his/her own well-being.

SCHIZOPHRENIA
Schizophrenia is a mental disorder often characterized by abnormal social
behavior and failure to recognize what is real. Common symptoms include false
beliefs, unclear or confused thinking, auditory hallucinations, reduced social
engagement and emotional expression, and inactivity.
Diagnosis is based on observed behavior and the person's reported experiences.
Individuals with schizophrenia may experience hallucinations (most reported are
hearing voices), delusions (often bizarre or persecutory in nature), and
disorganized thinking and speech. The last may range from loss of train of
thought, to sentences only loosely connected in meaning, to speech that is not
understandable known as word salad in severe cases. Social withdrawal,
sloppiness of dress and hygiene, and loss of motivation and judgment are all
common in schizophrenia. There is often an observable pattern of emotional
difficulty, for example lack of responsiveness. Impairment in social cognition is
associated with schizophrenia, as are symptoms of paranoia. Social isolation
commonly occurs. Difficulties in working and long-term memory, attention,
executive functioning, and speed of processing also commonly occur. In one
uncommon subtype, the person may be largely mute, remain motionless in
bizarre postures, or exhibit purposeless agitation, all signs of catatonia. About 30
to 50% of people with schizophrenia fail to accept that they have an illness or
their recommended treatment. Treatment may have some effect on insight.
People with schizophrenia often find facial emotion perception to be difficult.
Schizophrenia is often described in terms of positive and negative (or deficit)
symptoms. Positive symptoms are those that most individuals do not normally
experience but are present in people with schizophrenia. They can include
delusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory
and gustatory hallucinations, typically regarded as manifestations of psychosis.
Hallucinations are also typically related to the content of the delusional theme.
Positive symptoms generally respond well to medication.
Negative symptoms are deficits of normal emotional responses or of other
thought processes, and respond less well to medication. They commonly include
flat expressions or little emotion, poverty of speech, inability to experience
pleasure, lack of desire to form relationships, and lack of motivation. Negative
symptoms appear to contribute more to poor quality of life, functional ability,
and the burden on others than do positive symptoms. People with greater
negative symptoms often have a history of poor adjustment before the onset of
illness, and response to medication is often limited.

Causes
There is no known single cause of schizophrenia. Many diseases, such as heart
disease, result from interplay of genetic, behavioral, and other factors; and this
may be the case for schizophrenia as well. Scientists do not yet understand all of

the factors necessary to produce schizophrenia, but all the tools of modern
biomedical research are being used to search for genes, critical moments in
brain development, and other factors that may lead to the illness.
Estimates of heritability vary because of the difficulty in separating the effects of
genetics and the environment; averages of 0.80 have been given.
The greatest risk for developing schizophrenia is having a first-degree relative
with the disease; more than 40% of monozygotic twins of those with
schizophrenia are also affected. If one parent is affected the risk is about 13%
and if both are affected the risk is nearly 50%.
Developmental neurobiologists funded by the National Institute of Mental Health
(NIMH) have found that schizophrenia may be a developmental disorder resulting
when neurons form inappropriate connections during fetal development. These
errors may lie dormant until puberty, when changes in the brain that occur
normally during this critical stage of maturation interact adversely with the faulty
connections. This research has spurred efforts to identify prenatal factors that
may have some bearing on the apparent developmental abnormality.

Management and medication


The primary treatment of schizophrenia is antipsychotic medications, often in
combination with psychological and social supports. Hospitalization may occur
for severe episodes either voluntarily or (if mental health legislation allows it)
involuntarily. Long-term hospitalization is uncommon since deinstitutionalization
beginning in the 1950s, although it still occurs. Community support services
including drop-in centers, visits by members of a community mental health team,
supported employment and support groups are common. Some evidence
indicates that regular exercise has a positive effect on the physical and mental
health of those with schizophrenia.

AUTISM
Autism is a neurodevelopmental disorder characterized by impaired social
interaction, verbal and non-verbal communication, and by restricted and
repetitive behavior. Autism affects information processing in the brain by altering
how nerve cells and their synapses connect and organize; how this occurs is not
well understood. It is one of three recognized disorders in the autism spectrum
(ASDs), the other two being Asperger syndrome, which lacks delays in cognitive
development and language, and pervasive developmental disorder, not
otherwise specified (commonly abbreviated as PDD-NOS), which is diagnosed
when the full set of criteria for autism or Asperger syndrome are not met.

Causes
Autism has a strong genetic basis, although the genetics of autism are complex
and it is unclear whether ASD is explained more by rare mutations, or by rare

combinations of common genetic variants. In rare cases, autism is strongly


associated with agents that cause birth defects. Controversies surround other
proposed environmental causes, such as heavy metals, pesticides or childhood
vaccines; the vaccine hypotheses are biologically implausible and lack
convincing scientific evidence. The prevalence of autism is about 12 per 1,000
people worldwide, and it occurs about four times more often in boys than girls.
Typically, autism cannot be traced to a Mendelian (single-gene) mutation or to a
single chromosome abnormality, and none of the genetic syndromes associated
with ASDs have been shown to selectively cause ASD. Numerous candidate
genes have been located, with only small effects attributable to any particular
gene. The large number of autistic individuals with unaffected family members
may result from copy number variationsspontaneous deletions or duplications
in genetic material during meiosis. Hence, a substantial fraction of autism cases
may be traceable to genetic causes that are highly heritable but not inherited:
that is, the mutation that causes the autism is not present in the parental
genome. Several lines of evidence point to synaptic dysfunction as a cause of
autism.

Treatment and management


The main goals when treating children with autism are to lessen associated
deficits and family distress, and to increase quality of life and functional
independence. No single treatment is best and treatment is typically tailored to
the child's needs. Families and the educational system are the main resources for
treatment. Many medications are used to treat ASD symptoms that interfere with
integrating a child into home or school when behavioral treatment fails, they are
prescribed psychoactive drugs or anticonvulsants, with the most common drug
classes being antidepressants, stimulants, and antipsychotics.
Treatment is expensive; indirect costs are more so. For someone born in 2000, a

US study estimated an average lifetime cost of $4.05 million (net present value
in 2014 dollars, inflation-adjusted from 2003 estimate), with about 10% medical
care, 30% extra education and other care, and 60% lost economic productivity.

Vous aimerez peut-être aussi