Guide to Psychiatry

The following sections are included:

• Guide to Psychiatry [Singapore Perspective] — (16^th Revision)
• Reviews
• Contents

In medical disease, there are physical and/or mental symptoms and typically a recognised aetiology, demonstrable pathology, and predictable course based on biological or physical factors…

Just as the body (soma) is divided into systems (e.g., central nervous system, cardiovascular system, endocrine system), the mind (psyche) is divided into mental functions, namely cognitive function, emotion, volition or drive, and behavioural expression. These functions are normally inter-related, interactive, integrated, and manifested as the individual’s psychic experience and physical behaviour. It should be emphasised that the division of body and mind is artificial and undesirable…

Psychiatric consultation ranges from problems in living to neurosis, psychosis, and organic brain syndrome. In fact, in liaison psychiatry, it covers virtually the whole of medicine and human activities. Our psychiatric practice is phenomenological in approach. Accurate observation and reliable description of the development and progress of signs and symptoms are therefore of paramount importance. There is no substitute for a complete and detailed longitudinal case history. The stigma of mental illness is universal and dies hard. People often seek psychiatric treatment as a last resort. Patients and their relatives and friends alike are therefore inclined to deny the mental afflictions and attribute them to some cultural beliefs or other plausible explanations. We should distinguish objective facts from subjective understanding or interpretation. As a matter of fact, the more factual information or data is available, the less the need to hypothesise or resort to complex bio-statistics. To achieve this, curiosity, diligence, and thoroughness in interviews are essential. The psychiatrist is his own laboratory, subject to his experience, knowledge, and skill. The development and use of rating scales are akin to laboratory tests for more objective assessments. Only then can we come to a proper diagnostic formulation and carry out appropriate treatment. It is believed that knowing the mechanism of mental disorder may replace phenomenology.

The diagnosis of a mental disorder, in the absence of known aetiology or mechanism, depends on symptom cluster and (arbitrary) duration criteria. This is usually decided by consensus of opinion rather than by nosological concept. There is also the question of whether one takes a longitudinal (historical course) or cross-sectional (episodic) view. Some disorders such as “schizotypal”, “dysthymic”, and “cyclothymic” may be considered “sub-threshold” or “attenuated” forms of major schizophrenic and affective disorders over long periods…

The following sections are included:

• Pharmacotherapy and Psychotherapy
• Evidence-Based Medicine (EBM) and Treatment Algorithm
• Management of Inpatients
• Physical Treatment
  • Pharmacotherapy
  • Electroconvulsive Therapy
  • Transcranial Magnetic Stimulation
  • Deep Brain Stimulation
  • Brain Imaging Studies and Research
• Treatment of Schizophrenia
• Depot Injections
• Adjunct Medication
• Side Effects of Neuroleptics
• Neuroleptic Malignant Syndrome (NMS)
• Anti-Parkinsonism Drug
• Treatment of Affective Disorders
  • Antidepressants
  • Serotonin Syndrome
  • Lithium Therapy
• Treatment of “Neuroses” [Mostly Anxiety Disorders]
  • An Approach
  • Pharmacotherapy
• Psychological Treatment
  • Behaviour Therapy
  • Psychotherapy
• Social Therapy
  • Rehabilitation
  • Facilities
• Outpatient Treatment
  • Other Subspecialist Clinics
  • Treatment of Insomnia
  • Treatment of Impotence and Erectile Dysfunction

The following sections are included:

• • Woodbridge Hospital and the Institute of Mental Health
  • Child and Adolescent Psychiatry
  • Neurodevelopmental Disorders
• ICD-9 (1978)
• ICD-10 (1992)
  • Diagnostic Guidelines
  • Mild Mental Retardation
  • Moderate Mental Retardation
  • Severe Mental Retardation
  • Profound Mental Retardation
• Psychogeriatrics
  • Alcoholism and Treatment
  • Addiction
  • Approach to Management
  • Study Highlights
  • Forensic Psychiatry
  • Psychological Medicine Unit(s)
  • Psychiatric Treatment in Pregnancy or During the Reproductive Period
  • Military Psychiatry
  • Nature of Stigma
• Miscellaneous
  • Certification of Deaths
  • Voluntary Welfare Organisations

Law is concerned with the protection of individuals and properties in society and defines what crime is. As such, what was crime yesterday may not be crime today and what is crime today may not be crime tomorrow, each according to the law of the land…

It seems that there are three major areas of conflict, tension, and stress in modern living. They are not mutually exclusive and in fact overlap and interplay. What is discussed below is with special reference to psychotherapy. Indeed, these conflicts or dilemmas are applicable to other things.

As everything in life is relevant to mental health and psychiatry, mental health and psychiatry are relevant to everyone.

Stress is part of life. In this competitive world, however, some say that it is or should be a way of life. Stress is therefore unavoidable, but it is not always necessary. Very often, it is the result of incompetent, mediocre, selfish, and greedy management or personality problems. A hidden or higher reason for stress to be created is perhaps to toughen people up to ensure survival, but then there will be casualties even before going to war. There are both intrinsic and extrinsic factors involved in stress. The nature of mental health work requires that the psychiatrist should be well informed and interested about life.

The following sections are included:

• Overview of Health Economics Issues
• Training of Future Psychiatrists
• Declaration of Geneva [amended 68^th WMA General Assembly, Chicago, USA in 2017]
• Training Future Consultants
• Science and Art of Medicine (various sources)