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History of Psychiatry by Erick Messias, MD

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Erick Messias

on 16 January 2013

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Transcript of History of Psychiatry by Erick Messias, MD

Erick Messias, MD, PhD History of Psychiatry Hippocrates (circa 400 B.C.E) On the Sacred Disease
…the brain is the cause of this affection, as it is of other very great diseases
Life is short, and Art long Hippocrates (circa 400 B.C.E) On the Sacred Disease

…the brain is the cause of this affection, as it is of other very great diseases

Life is short, and Art long, the crisis fleeting; experience perilous, and decision difficult. Hippocrates (circa 400 B.C.E) The physician must not only be prepared  to do what is right himself, but also to make the patient, the attendants,  and externals cooperate


For extreme diseases, extreme methods of cure Aretaeus, the Cappadocian
(c.150-200 AD) I believe melancholia is the beginning, and as such part of, mania...The development of mania is the result of the aggravation of melancholia, rather than constituting an evolution to a different illness” More explicitly, he wrote: “In most melancholic patients, sadness is converted into happiness; and patients develop what is known as mania.” Classic Age: The Four Humors Melancholic
Moody
Glum Sanguine
Happy
Healthy Phlegmatic
Slow
droopy Choleric
Irritable
Hot tempered Modern Age: The Four Humors * * Add Acetylcholine & Cognitive Deficits of Depression De Praestigiis Daemonum 1563 Open the possibility for doctors, not priests to care for those with mental illness
Dutch-German Dr. Pinel in the courtyard of the Salpet̂riere Pinel’s Nosology
as presented by Esquirol
(1782-1840) Insanity
Melancholy
Monomania
Mania
Dementia
Idiots and Imbeciles
Responsible for the first detailed medical description of a compulsive symptom The Father of American Psychiatry Benjamin Rush
Moral treatment
The Philadelphia Hospital
The therapeutic asylum The
Schools Psychodynamic Descriptive Social
Psych Existential 2002 March (cc) image by jantik on Flickr Emil Kraepelin German
Objective Descriptive Psychiatry
Proposed the dichotomy
Manic-depressive illness
Dementia Praecox
Under Dementia Praecox
Paranoia
Hebephrenia
Catatonia
Observed thousands of patients over many years Eugen Bleuler Swiss
Proposed the name Schizophrenia
He actually proposed “The Group of Schizophrenias”
Famous 4 As
Thought process Sigmund Freud Austrian, German speaking
Never trained in Psychiatry
Neurologist in private practice
Psychoanalysis

3 Phases
Conscious and Unconscious
Id, Ego, Super-Ego
Ich, Es, Uber-Ich
Eros and Thanatos
Love and Death

Lasting impact in anthropology, linguistics, arts, culture
Talk therapy Harry S Sullivan Interpersonal Social Psychiatry
“The most original figure in American psychiatry”
1. Demonstrated the effect of social change on symptoms
From 2 person interaction to family and society
2. Propose to change that social field to help symptoms
Twice psychotic himself
Interested in what the patient meant – without assumptions of meaning or of meaningless!

The other figure here is Adolph Meyer Karl Jaspers Existential Psychiatry
Look from within
Phenomenology
Interested in content – not only process
Subjective experience
Other figures
Binswanger
Minkowski
Current: Irvin Yalom The Evolution of the DSM DSM I 1952
Psychoneurotic disorder
The chief characteristic of these disorders is anxiety which may be directly felt or expressed or which may be unconsciously and automatically controlled by the utilization of various defense mechanisms
Multiple “reactions” – Meyer influence DSM II 1968
Change “reaction” for “neuroses”
Change Conversion reaction for Hysteria
“emotionally charged situations that are symbolic of the underlying conflict”
Heavy on Freud Psychiatric Diagnosis In our view there are only about a dozen diagnostic entities in adult psychiatry that have been sufficiently studied to be useful
Donald Goodwin and Samuel Guze DSM III 1980
Major break
Leaders: Eli Robins, George Winokur, Samuel Guze – “neo-kraepelenians”
John Feighner – published criteria in 1972
Robert Spitzer
The US-UK study DSM IV 1994
Dropped self defeating PD
Keep late luteal phase dysphoric do
As needing more reseach The Case of Homosexuality DSM II – Sexual deviation
DSM III – homodysphilia, dyshomophilia, homosexual conflict disorder, amorous relationship disorder
Settled on Ego-dystonic homosexuality
1974 – dropped by the APA The Case of Homosexuality DSM II – Sexual deviation
DSM III – homodysphilia, dyshomophilia, homosexual conflict disorder, amorous relationship disorder
Settled on Ego-dystonic homosexuality
1974 – dropped by the APA Historical Treatments Historical Treatments Fever Cure and Neurosyphilis Julius von Wagner-Jauregg 1857-
Malaria blood in those with neurosyphilis 1917
Nobel prize 1927 Egas Moniz (1874-1955) Portuguese
Nobel prize for medicine 1949
"for his discovery of the therapeutic value of leucotomy in certain psychoses”
In the US the name most associated with lobotomy was Walter Freeman Manfred Sakel 1900-1957 Austrian
Insulin shock therapy 1927
Seizures and coma improve psychosis
Shock therapies
Insulin - hypolgycemic
Metrazol seizures
ECT
1% mortality – insulin
Von Meduna and Cardiazol 1935
Cerletti and Bini – Italy 1938 How old is psychiatry?
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