introduction, development of psychiatry department of psychiatry 1 st faculty of medicine charles...
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Introduction,Development of Psychiatry
Department of Psychiatry1st Faculty of Medicine
Charles University, PragueHead: Prof. MUDr. Jiří Raboch, DrSc.
Teaching: Schedule8:00-9:30 9:45-12:00
Week 1
MO Lecture Workshop on wards with patients
TUE Lecture Workshop on wards with patients
WE Lecture Workshop on wards with patients
THU Lecture Workshop on wards with patients
FRI Lecture Workshop on wards with patients
Week 2
MO Lecture Workshop on wards with patients
TUE Lecture Workshop on wards with patients
WE Psychiatric Hospital Bohnice
THU Lecture Workshop on wards with patients
FRI Lecture Workshop on wards with patients
Week 3
MO Lecture Workshop on wards with patients
TUE Lecture Workshop on wards with patients
WE Ward
THU Lecture Workshop on wards with patients
FRI 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)
PSYCHIATRYMAIN MEDICAL
DISCIPLINEINFLUENCES – 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
• MAGICAL CAUSES OF MENTAL DISORDERS – ASSYRIANS, BABYLONIANS, MENTAL DISORDERS – MARK OF MORAL INSANITY, SIN, PUNISHMENT
• ANCIENT GREECE – HEALERS, TEMPLE MEDICINE
ASKLEPIOS
HIPPOKRATES460 – 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 EVALUATION LYKANTROPY
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
RENAISSANCE16. 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
ENLIGHTENMENT17th – 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 PSYCHIATRY19th. 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 - DSM-III, 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 disorders
24,9 19,2 30,5
Affective disorders
17,1 12,7 21,7
Dependencies 26,6 35,4 17,9
Non-affective psychoses
0,7 0,6 0,8
Total 48,0 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
0
5
10
15
20
25
30
DALY
mark.ec.form.soc.Lat.Am.Chinarest AsiaMediter.subsah.Afr.
Disability Adjusted Life Years Murray a Lopez, 1997
DALY DEVELOPED COUNTRIES
0
5
10
15
20
25
neuropsychiat. 22
CDV 20,4
neoplasmas 13,7
injuries 10,3
% DALY
PSYCHIATRY IN PRAGUE
• 1790 – CUSTODIAE MENTE CAPTORUM, GENERAL HOSPITAL
• 1822 – TEMPLE OF ST. CATHARINA – OLD HOUSE
• 1844 – NEW HOUSE, KARL VON RIEDL
PSYCHIATRIC DEPARTMENTCHARLES UNIVERSITY, PRAHA
CAUSES OF DALY (%)world
1. Respirační infekce 8,2
2. Průjmovitá onemocnění 7,2
3. Perinatální onemocnění 6,7
4. Unipolární deprese 3,7
5. ICHS 3,4
6. Cerebrovaskulární onemocnění 2,8
7. Tuberkulóza 2,8
8. Zarděnky 2,7
9. Dopravní nehody 2,5
10. Vrozené vady 2,4
Murray a Lopez, 1997
CAUSES OF DALY (%)developed countries
1. ICHS 9,9
2. Unipolární deprese 6,1
3. Cerebrovaskulární nemoci 5,9
4. Dopravní nehody 4,4
5. Nadužívání alkoholu 4,0
6. Osteoarthritis 2,9
7. Nádory trachey, bronchů a plic 2,9
8. Demence a další deg. procesy CNS 2,7
9. Sebepoškození 2,3
10. Vrozené vady 2,2
Murray a Lopez, 1997
CAUSES OF DALY (%)developed countries, age 15 - 44
1. Unipolární deprese 12,3
2. Nadužívání alkoholu 8,9
3. Dopravní nehody 8,5
4. Schizofrenie 5,0
5. Sebepoškození 4,2
6. Bipolární porucha 3,7
7. Nadužívání návykových látek 2,9
8. Obsedantně kompulzivní porucha 2,7
9. Osteoarthritis 2,7
10. Následky násilí 2,4
Murray a Lopez, 1997