CLASSIFICATION IN PSYCHIATRY 

A. ORGANIC PSYCHIATRIC DISORDERS

• Delirium

• Dementia

• Amnesic disorder

• Organic hallucinosis

• Organic mood disorders

• Organic anxiety disorders

• Organic personality disorders

B. FUNCTIONAL PSYCHIATRIC DISORDERS

• Psychotic disorders

• Scizhhophrenia

• Affective disorders

• Others eg. Paranoid disorders

• Neurotic disorders

• Anxiety disorder

• Phobic disorder

• Obsessive compulsive disorder

• Hysteria

• Hypochondriasis

• Neurotic depression

• Other neurotic & stress related disorders

• Personality disorders e.g. Histerionic personality disorder

• Psychosexual disorders

• Gender identity disorder

• Paraphilias

• Psychosexual dysfunctions

C. DRUG & ALCOHOL USE DISORDERS

• Abuse

• Dependence

• Intoxication

• Withdrawal

D. PSYCHOSOMATIC DISORDERS

• Bronchial asthma

• Hyperventilation

• Peptic ulceration

E. SLEEP DISORDERS

• Dyssomnias

•  Parasomnias

F. CHILD PSYCHIATRIC DISORDERS

• Autism

• Developmental disorders

• MR

• Attention deficit disorder

• Conduct disorder

• Tic disorder

• Enuresis & encopresis

• Speech disorder

Other disorders
PSYCHOSIS
    It is a condition characterized by an impairment of insight and reality with a marked effect on the personality and functioning of the individual.

40%in total

Features:

Biological factors are more important than environmental factors in aetiology

Total disintegration of personality

There are gross disturbance of thinking, emotion & behavior

There is loss of insight and judgment

Therapeutic response is not remarkable

Organic, functional and symptomatic

Organic Psychosis

Result from organic damage of the brain tissue from primary brain disease or the brain may be secondarily involved from various diseases involving liver, kidney, endocrine gland etc.

Aetiology
Head injury, meningitis, encheohalitis,CVA ,Icsol, neurosyphilis, epilepsy, Cerebral malaria, drugs, anoxic state, Endocrine disease, renal disease, hepatic diseases, Senile artriosclerosis, presenile degeneration, avitaminosis

Clinical Features

Amnesia for recent events, while recalling of remote events till the advanced stage

Disorientation of time, person place & self

Loss of judgment

Dementia
Confabulation or story making

Circumstantialities or discussion beyond the present topic

Lack of attention

Loss of emotional control, easily provoked by anger or laughter

Instinctual anomalies

Hypochondriasis

Deterioration of personal care, social bandage & custom
Disorders of concisions of varying degree
Change in personality

INVESTIGATIONS
1.Routinely hepatic, cerebral, renal & endocrine disturbances
2. Psychologically
# . Bender gestalt test — Asked to copy 8
#. Verbal and non verbal intelligence test
#. Memory test by counting the digits

TREATMENT
- Treat the underline cause
Fluid,electrolyte & acid base balance
- Massive vitamin therapy
- Antipsychotic drugs
- ECT & rehabilitation

FUNCTIONAL PSYCHOSIS
Scizophrenia
Dementia precox
A form of mental illness characterized by an abnormal emotional reaction associated with deterioration in personality

AETIOLOGY
No definite
Genetic - 40% if both parents,   50% in monozygotic twins
Intra uterine brain damage
Increased dopamine activity
Dysfunction of limbic system of dominant hemisphere

PREDISPOSING FACTORS
- Hereditary
- In narrow typed physique ( athletes & displastic types)
- In schizoid personality — are unsocial shy & oversensitive
- Parent child relationship — broken homes etc.
- Low socioeconomic classes
- Extrinsic factors — physical illness, pregnancy, child birth, psychic upset etc.
- Endocrine & metabolic disturbances
- Influence of surroundings- poor housing condition, overcrowding etc.

CLINICAL FEATURES
15-35 age Females more
Withdrawal
Thought disorder — flight of ideas, poverty of ideas, meaningless talk
Emotional abnormalities — emotional flattering & incongruity rapid change of emotions
Change in behavior and motor function - awkward, abrupt, violent, repeat things said to him
Disorders of perception -  hallucination than illusion - auditory hallucination TYPES OF SCHIZOPHRENIA
1. SIMPLE
Gradual loss of interest in the surroundings
Withdraw himself from reality, fantasy

2. HEBEPHRENIC
Hallucinations & delusions prominent
Meaningless giggles & self satisfied smile

3. CATATONIC
In adults
Out burst of excitement, depression, stupor
Disturbance of behavior & motor phenomena
Homicidal & suicidal tendencies

4.PARANOID
Females
Late stage
Delusion of persecution
Hypochondriacally delusions
Well preserved personality

5.OTHERS
Schizoaffective — associated symptoms of mania & depression
Pseudo neurotic — features of neurotic illness like hysteria, phobic syndrome etc.
Periodic catatonia — a correlation between onset & metabolic disturbances
Late praphrenia — Females & widows
Delusion of persecution & hallucinations
Oneiroid schizophrenia — acute onset, clouding of consciousness, disorientation
Dream like state & perceptual disturbances.  

PROGNOSIS
15-20 % Complete recovery

FACTORS TO BE CONSIDERED
Onset —a/c good prognosis
Type-Paranoid and Catatonic-good prognosis
Precipitating factor-bad
Age-early-bad
Personality-well adjusted and stable- good
Duration shorter good
Family history positive — bad
Personal relation ship — warm good
Home relation ship warm — good
Mood- disturbed — bad
Treatment prompt — good

TREATMENT
Drugs
Psychological treatment
Reassurance
Moral support
Good patient relation ship
Environmental and social background

PARANOID PSYCHOSIS
Defined as
- Gross impairment of reality thinking
- Marked impairment in personality with impairment in social, interpersonal and occupational functioning
- Marked impairment in judgment and behavior
- Having delusions & hallucinations
Non organic - Schizophrenia & mood disorders
Organic _ paranoid disorders  

PARANOID SCIZOPHRENIA
Is characterized by
Delusions of persecution
Delusions of reference
Delusions of grandeur
Delusions of jealousy
Schneidors first rank symptoms.
Well systematized delusions
Apprehensive , evasive and guarded.
Onset insidious, progressive course, no recovery, remission and relapses.

DIFFERENTIAL DIAGNOSIS
Paranoid disorder
Paranoid personality disorder.

PARANOID DISORDER (DELUSION DISORDER)  
Persistent delusion of persecution, grandeur, jealousy, etc
Absence of significant or persistent hallucination.
Personality disorder only in areas of delusion.
No underlying cause.
Absence of schizophrenic and mood disorders.
Depending on the content of delusions.
1.Acute Paranoid disorder.