CFB PSY01 An Introduction To Psychiatry
An introductory overview of psychiatry covering its scope, the biopsychosocial model of mental illness, psychiatric history-taking, mental status examination, and classification systems used in diagnosing mental disorders.
An Introduction to Psychiatry
This lecture (CFB PSY01) is the foundation stone of the psychiatry clerkship. It establishes why psychiatry matters (burden, mortality and inequity), what psychiatric disorders are (definitions and psychopathology), how they are classified (DSM-5-TR, ICD-11, categorical and dimensional approaches), the historical evolution of the field, and the three interacting components of management (biological, psychological and social). Almost every later lecture—psychosis, mood and anxiety disorders, substance use and dementia—builds on these concepts.
Learning Objectives (inferred from lecture structure):
- Appreciate the significance and global burden of mental disorders
- Define mental disorders using DSM-5-TR/ICD-11 concepts
- Understand psychopathology as the foundation of psychiatric assessment
- Know the spectrum and age-of-onset patterns of mental disorders
- Understand classification systems and their limitations
- Recognise the role of biological, psychological, and social management
- Understand stigma and its impact on mental health care
1. Significance & Burden of Mental Disorders
The slide gives a 2019 snapshot: about 1 in 8 people (970 million) were living with a mental disorder. The newer WHO estimate is nearly 1 in 7 people (1.1 billion) in 2021; anxiety and depressive disorders remain the most common. [10]
| Estimate shown on the slide | How to interpret it safely |
|---|---|
| Depression: ~5%; lifetime 15–18% | These are different denominators (current/point versus lifetime prevalence), so do not compare them as if they were the same measure. |
| Anxiety disorders: common; pandemic-associated increase | WHO estimated a large first-year pandemic increase, but prevalence varies by disorder, age, population and survey method. |
| Psychotic disorders including schizophrenia: 2–3% | This is a broad grouping, not the prevalence of schizophrenia alone. WHO estimates schizophrenia affects about 0.29% of people globally. [12] |
| ADHD: 3–5% lifetime; age-standardised ~1% | Again, estimates depend on population and denominator. |
| Dementia: ~10% among people aged ≥70 | An age-specific estimate, not a whole-population prevalence. |
Interpretation rule
Never quote a prevalence number without its condition, population, time frame and denominator. Point, period, lifetime and age-standardised prevalence answer different questions.
The lecture reproduces results from the Global Burden of Disease 2019 analysis: mental disorders ranked seventh among causes of DALYs and second among causes of YLDs in that analysis. Depressive, anxiety and schizophrenia-spectrum disorders were prominent contributors to disability. [1] [17]
High Yield – DALYs Explained
DALYs (Disability-Adjusted Life Years) = Years of Life Lost (YLL, premature death) + Years Lived with Disability (YLD, morbidity). Mental disorders contribute heavily through prolonged disability. The slide's statement that depression was predicted to become the leading global disease burden by 2030 is an older forecast, not a current measured ranking.
| Measure | Depression rank | Anxiety rank | Schizophrenia rank |
|---|---|---|---|
| DALYs (top 25) | 13th | — | — |
| YLDs (top 25) | 2nd | 8th | 20th |
- The lecture quotes an economic cost of about USD 5 trillion in 2019. Treat this as the slide's model-based historical estimate; cost estimates depend strongly on what is counted and which region is studied.
Reading the age-sex burden pyramid on the slide
The stacked horizontal bars plot global mental-disorder DALYs by age and sex in 2019. The widest combined burden lies in adolescence through middle adulthood. Depressive and anxiety disorders make large contributions across many age bands, while the diagnostic composition changes with age. The figure describes the population distribution of burden; it does not show an individual's probability of developing a disorder and should not be used as a diagnostic tool. [17]
The slide summarises population studies in which people with mental disorders had approximately 2–3 times the risk of premature death and substantial loss of life expectancy. These are group averages from particular studies, not a fixed prognosis for an individual. A Hong Kong population cohort likewise demonstrated excess mortality and life-years lost in schizophrenia and other non-affective psychoses. [18]
Excess mortality is not explained by suicide alone. Important, interacting pathways include cardiovascular and metabolic disease, cancer, smoking and substance use, social disadvantage, medication adverse effects, reduced access to preventive and acute care, and diagnostic overshadowing (physical symptoms being misattributed to mental illness).
| Disorder | Years of Potential Life Lost (YPLL) |
|---|---|
| Substance-use disorders | 20.1 years (greatest) |
| Eating disorders | 16.6 years |
| Schizophrenia | 15 years |
| Personality disorders | 15 years |
The slide also quotes a pooled life expectancy of 64 years and the YPLL estimates above. Preserve these as lecture-study estimates rather than universal values; effect size varies by diagnosis, country, era and access to care.
Clinical action, not fatalism
Regular physical-health screening, vaccination and prevention, smoking and substance-use support, medication monitoring, prompt investigation of new symptoms, and equitable access to standard medical treatment are core psychiatric care. Do not let a psychiatric diagnosis lower the standard of physical assessment.
WHO now reports that more than 720,000 people die by suicide each year; suicide was the third leading cause of death among 15–29-year-olds in 2021. [11] The slide's figures (> 700,000 and fourth) reflect an earlier data release.
The slide also presents historical pooled estimates of deaths and attempts in depression, bipolar disorder, schizophrenia, substance-use disorders and personality disorders. These correctly signal that risk is elevated across multiple diagnoses, but the wide ranges are not bedside risk calculators and should not be converted into a deterministic probability for one patient.
Important correction: suicide is multifactorial
The older claim that about 90% of people who die by suicide have a mental disorder should not be used as a universal rule. Mental disorders are important risk factors, particularly in high-income settings, but suicide reflects interacting psychological, biological, social, cultural and environmental factors. Acute crises, loss, conflict, violence, chronic pain, substance use and access to lethal means also matter. Use "died by suicide", not "committed suicide" or "suicide completer." [11]
Clinical implication: ask directly about thoughts, intent, plans, means, recent behaviour, previous attempts, acute stressors, substance use, mental state, protective factors and available support. Risk formulation is dynamic and should lead to a proportionate safety plan and follow-up.
The slide reproduces a large meta-analysis showing that many mental disorders first emerge early: approximately half had onset before age 18, and 62.5% before age 25. [13] Early recognition matters, but "early onset" does not mean that later onset is impossible.
Reading the age-of-onset figure
The values below are the median ages displayed in the slide, not diagnostic cut-offs or guaranteed "peak ages."
| Broad disorder group | Median age in slide |
|---|---|
| Neurodevelopmental disorders | 12 |
| Anxiety/fear-related disorders | 17 |
| Feeding/eating disorders | 18 |
| Obsessive-compulsive and related disorders | 19 |
| Personality disorders | 25 |
| Schizophrenia-spectrum disorders | 25 |
| Addictive disorders | 25 |
| PTSD | 30 |
| Mood disorders | 31 |
The lower half of the slide resolves individual diagnoses: separation anxiety (8), autism spectrum disorder (9), ADHD (12), social anxiety disorder (13), anorexia nervosa (17), bulimia nervosa (18), OCD (19), binge-eating disorder (20), cannabis-use disorder (22), schizophrenia (25), panic disorder (26), alcohol-use disorder (27), PTSD and depressive disorders (30), GAD (32), bipolar disorder (33), and acute/transient psychotic disorder (35). [1] [13]
How not to misuse this diagram
These are pooled medians from heterogeneous studies with broad distributions and variable methods. They help identify population patterns (for example, earlier neurodevelopmental and anxiety presentations), but age alone neither establishes nor excludes a diagnosis. Always assess the syndrome, duration, development, substances/medications, physical causes and longitudinal course.
3. Psychopathology: The Language of Psychiatry
Psychopathology = the study of abnormal states of mind. [1]
Descriptive psychopathology (phenomenology) = objective description of abnormal states of mind, avoiding preconceived ideas or theories, limited to the description of conscious experiences & observable behaviours. [1]
Think of it this way: In medicine, you learn to describe a heart murmur—its timing, location, character. In psychiatry, psychopathology is how you describe abnormal mental experiences with the same precision. It was systematised by Karl Jaspers in his 1913 General Psychopathology. [1]
| Distinction | Explanation |
|---|---|
| Subjective vs. Objective | Symptoms are reported experiences; signs are observed findings. Behaviour may suggest an experience but does not give direct access to it. |
| Form vs. Content | Form = the type of experience (e.g. a delusion); Content = what the experience is about (e.g. persecutory theme) |
| Primary vs. Secondary | Primary = arising without apparent cause (e.g. primary delusion in schizophrenia); Secondary = understandable in context (e.g. persecutory ideas secondary to auditory hallucinations) |
Types of psychopathology include disturbances of: [1]
| Domain | Examples |
|---|---|
| Mood / emotions | Nature, variation, congruity with thoughts/circumstances |
| Perception | Hallucinations, illusions |
| Thought content | Delusions, obsessions, overvalued ideas |
| Thinking process | Form of thought (e.g. loosening of associations), stream of thought (e.g. flight of ideas, poverty of thought) |
| Motor signs | Catatonia |
| Insight | Awareness of symptoms, illness, need for treatment |
| Cognitive functions & consciousness | Disorientation, memory impairment, clouding of consciousness |
| Experience of self / body image | Depersonalisation, derealisation, distorted body image (e.g. eating disorders), awareness of identity boundaries |
The slide sequence contrasts the communication pathway in physical and psychiatric assessment. [1]
| Diagram | Patient side | Clinician side | Main limitation |
|---|---|---|---|
| Bodily illness | Bodily dysfunction is perceived and communicated as symptoms | History, physical examination and targeted investigation | Tests support or refute hypotheses; they do not replace the history. |
| Mental experience | The mind is both the site of experience and the means by which it is reported | Interview, observation and Mental State Examination (MSE) | A person's report may be shaped by insight, cognition, language, fear, culture or willingness to disclose. |
| Signs and symptoms | Subjective experience is described in words; behaviour can be observed | Clinician characterises both without prematurely inferring cause | Observable behaviour is evidence, not a transparent window into another person's mind. |
The MSE is the psychiatric analogue of a physical examination: a structured, cross-sectional description of appearance/behaviour, speech, mood/affect, thought, perception, cognition, insight and risk at a particular time. It is neither a lie detector nor a complete diagnosis.
Assessment is broader than the MSE
Combine the history and MSE with longitudinal course, functional change, collateral information (with appropriate consent and attention to urgent safety), medication/substance review, physical and neurological examination, and investigations when clinically indicated. There is no routine biomarker that diagnoses a delusion, but tests may be essential to identify delirium, intoxication, neurological disease, endocrine/metabolic disturbance or medication effects.
4. What Are Mental Disorders? – Definition
"A mental disorder is characterised by a clinically significant disturbance in an individual's cognition, emotional regulation, or behaviour. It is usually associated with distress or impairment in important areas of functioning." (WHO) [1]
A mental disorder is: [1]
- A syndrome characterised by clinically significant disturbance in cognition, emotion regulation, or behaviour
- Reflecting a dysfunction in psychological, biological, or developmental processes underlying mental functioning
- Resulting in significant distress (e.g. painful symptom) or disability in important areas of functioning (e.g. occupational, social)
- Must NOT be merely an expected response to common stressors and losses (e.g. grief after losing a loved one)
- Must NOT be a culturally sanctioned response to a particular event (e.g. trance states in religious rituals)
- Socially deviant behaviour and conflicts primarily between individual and society are NOT mental disorders (e.g. political dissidence)
What is not a mental disorder by itself
An expected or culturally accepted response, and socially deviant behaviour or conflict with society, do not by themselves establish a mental disorder. The judgement still depends on syndrome, context, dysfunction, distress/impairment and the relevant criteria. Prolonged grief disorder is included in DSM-5-TR, so "grief is never a diagnosis" is also incorrect. [15]
Eric Kandel: "All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases." [1]
Thomas Insel: "Mental illnesses are no different from heart disease, diabetes, or other chronic illness... the organ of interest is the brain instead of the heart or pancreas." [1]
The lecture presents the perspective that mental disorders are "syndromes of disrupted neural, cognitive, and behavioural systems", aligned with the NIMH Research Domain Criteria (RDoC) research programme. RDoC studies dimensional functional systems across typical-to-atypical ranges; it is a research framework, not a diagnostic guide or a replacement for DSM/ICD clinical diagnosis. [16]
However, the lecture explicitly cautions: "Biological is important, but environmental, behavioural and social factors should not be overlooked." [1] The brain continually rewires itself in response to learning and life events → gene × environment interaction is key. This is the biopsychosocial model in action.
The lecture presents a lifespan framework: [1]
| Life Stage | Common Disorders |
|---|---|
| Child & Adolescent | ADHD, Autism, Learning Disability with behavioural problems, ODD & Conduct disorder |
| Adults | Schizophrenia & other psychoses, Depression & Bipolar disorder, Anxiety & stress-related disorders, Substance & alcohol abuse, Personality disorders |
| Older adulthood | Dementia, mood disorders, psychotic disorders, other late-onset conditions |
This is an onset/recognition pattern, not a set of age silos. Neurodevelopmental conditions persist into adulthood; mood, anxiety, substance-use and psychotic disorders can present across the lifespan; and late-life first presentations require careful consideration of physical, neurological, medication and substance causes. Eating and impulse-control disorders can also occur outside the age band in which they are most often recognised. [1]
6. Classification of Mental Disorders
Categorical approach: Discrete diagnostic categories based on symptom pattern, course, and outcome. [1] [3] Dimensional approach: Disorders exist on spectra/dimensions (e.g. psychosis, mood, negative symptoms, cognition, motor, disorganisation, chronicity). [1]
| Feature | Categorical | Dimensional |
|---|---|---|
| Basis | Distinct diagnoses (present/absent) | Spectrum (severity along dimensions) |
| Advantages | Clinical utility, clear communication, treatment guidelines | Captures overlap and severity across diagnostic boundaries |
| Disadvantages | Arbitrary cut-offs, comorbidity artefacts, poor validity | Complex, less practical in clinical settings |
| Example | Schizophrenia vs. Bipolar disorder (separate boxes) | Both share psychosis dimension but differ on mood, negative symptom dimensions |
The lecture illustrates this with two key diagrams: [1]
- Categorical circles: depression, OCD, acute/transient or brief psychotic disorder, schizophreniform disorder, schizoaffective disorder, schizophrenia, bipolar disorder and delusional disorder are drawn as discrete labels. This makes thresholds communicable but can conceal shared symptoms and boundary cases.
- Dimensional radar chart: psychosis, mood, negative symptoms, cognition, motor features, disorganisation and chronicity form the axes. Different diagnoses trace different profiles, illustrating that domains can cross category boundaries.
Diagram caveat
The radar plot is a conceptual teaching illustration, not a validated scoring instrument. A dimensional profile can complement a categorical diagnosis; it does not by itself determine treatment or prognosis.
The slide shows a traditional hierarchy: organic/substance-induced → psychoses → mood disorders → anxiety disorders. [1]
Use this only as a differential and safety heuristic, not as a ranking in which one diagnosis automatically erases another:
- First assess for delirium, neurological/systemic illness, medication effects, intoxication and withdrawal.
- Characterise the full syndrome, time course and relationship between mood, psychosis, anxiety and substances.
- Record clinically meaningful comorbidity rather than forcing every presentation into a single "highest" box.
A patient with psychosis may still have a mood, anxiety or substance-use disorder that changes risk and management.
Both are operational criteria systems → increase diagnostic reliability (but not necessarily improved validity). [1]
| DSM-5-TR (APA) | ICD-11 (WHO) |
|---|---|
| Neurodevelopmental disorders | Neurodevelopmental disorders |
| Schizophrenia spectrum & other psychotic disorders | Schizophrenia or other primary psychotic disorders |
| Bipolar disorder | Mood disorders (bipolar + depressive combined) |
| Depressive disorders | (see above) |
| Anxiety disorders | Anxiety and fear-related disorders |
| OCD and related disorders | OCD and related disorders |
| Trauma- and stress-related disorders | Disorders specifically associated with stress |
| Dissociative disorders | Dissociative disorders |
| Somatic symptom disorders | Disorders of bodily distress and bodily experiences |
| Feeding and eating disorders | Feeding and eating disorders |
| Disruptive, impulse-control and conduct disorders | Disruptive and dissocial disorders / Impulse control disorders |
| Substance use and addictive disorders | Disorders due to substance use and addictive disorders |
| Neurocognitive disorders | Neurocognitive disorders |
| Personality disorders | Personality disorders |
Current terminology and exam wording
The slide says DSM-5, but the current APA manual is DSM-5-TR. ICD-11 is WHO's global standard for health data and clinical documentation; its Clinical Descriptions and Diagnostic Requirements manual was published in 2024, after ICD-11 came into effect for reporting in 2022. [14] [15]
Past paper Q (2021 SAQ Q3): "Name TWO psychiatric classification systems." → DSM and ICD (use the version requested by the question). Reasons to classify include: bringing order to diverse phenomena; identifying clinically similar groups to guide care; helping estimate course/outcome; and providing a common language for clinicians, patients and researchers. [1] [3] [4]
Psychiatric comorbidity is common. [1]
This means patients frequently meet criteria for more than one disorder simultaneously (e.g. depression + anxiety, schizophrenia + substance use). This challenges the categorical approach and supports dimensional thinking.
From senior notes: [3]
- Labelling and stigmatisation (different labels suggest different severities)
- Diagnostic terms can mean different things to different people
- Arbitrary cut-offs between normal and abnormal (e.g. MDD must last ≥2 weeks—why not 13 days?)
- Patients don't fit neatly into categories (hence combined diagnoses like schizoaffective disorder)
- Distracts from understanding individual patients' unique problems
| Psychosis | Neurosis |
|---|---|
| Inability to distinguish subjective experience from reality (hallucinations/delusions) | Retained ability to distinguish subjective from reality |
| More severe, outside range of normal experience | Milder, closer to normal experience |
| Examples: Schizophrenia, mania, delirium | Examples: Anxiety, non-psychotic depression |
This is a historical distinction, not a current diagnostic division. If it appears in older teaching or an exam, use it to explain reality testing while answering in modern syndrome-based terms. [3]
The lecture walks through the evolution of psychiatry. These slides are history of ideas, not a catalogue of current diagnostic criteria. Some traditional "great man" accounts simplify contested history; read them in the social and institutional context of their time.
| Figure | Contribution |
|---|---|
| Philippe Pinel | Associated with moral treatment and reform of asylum care. The familiar story that one hero single-handedly "unchained the insane" is an oversimplified historical narrative. [1] |
| Jean-Étienne Dominique Esquirol | Psychiatry as a medical profession; advocated "social and community psychiatry" [1] |
| Wilhelm Griesinger | First biological psychiatry; "patients with mental illness are really individuals with illness of the nerves and brain" [1] |
| Carl Wernicke | Wernicke area; Wernicke encephalopathy; psychosis classification [1] |
| Paul Flechsig | Cerebral localisation [1] |
| Theodor Meynert | Anatomical origins in the brain of mental disorders [1] |
| Karl Ludwig Kahlbaum (& Hecker) | Developed historical syndrome terms including catatonia and hebephrenia and influenced Kraepelin. Several labels on the slide are no longer current diagnostic terms. [1] |
| Emil Kraepelin | Distinguished "dementia praecox" from "manic-depressive insanity" using longitudinal course and outcome. This was highly influential but is not a current diagnosis or a deterministic prognosis. [1] |
| Eugen Bleuler | Proposed a "group of schizophrenias" and distinguished fundamental from accessory symptoms. The later mnemonic "4 As" is historical teaching, not modern DSM/ICD criteria. [1] |
| Sigmund Freud | Developed psychoanalytic models (id, ego, superego, defences) and talking treatment. These are historically influential frameworks, not contemporary diagnostic criteria or evidence for treating every disorder. [1] |
| Karl Jaspers | Systematised descriptive psychopathology (1913) [1] |
| Nathan S. Kline | Pioneer and populariser of clinical psychopharmacology, especially work with reserpine and the MAOI iproniazid. The slide's wording that he developed "the first antipsychotic and antidepressant" is too broad. [19] |
Kraepelin vs. Bleuler: Know the Difference
Kraepelin emphasised course and outcome in distinguishing dementia praecox from manic-depressive illness. Bleuler challenged a uniformly deteriorating outcome and introduced the "group of schizophrenias," emphasising fundamental disturbances over accessory hallucinations and delusions. The familiar 4 As—affect, associations, ambivalence and autism—belong to this historical framework; do not substitute them for current criteria.
8. The Role of a Psychiatrist in Clinical Management
The central image is a three-part biopsychosocial formulation: [1]
- Brain / body: symptoms, cognition, physiology, medication and other somatic treatments
- Reaction to illness: meaning, coping, hope, behaviour, relationships and psychological treatment
- External/social context: family, culture, housing, education/work, discrimination and service access
These are interacting components, not three independent silos. A useful plan links each identified maintaining or protective factor to a treatment and includes the person's goals and preferences.
Psychopharmacology: [1]
| Neurotransmitter System | Drug Class | Indication |
|---|---|---|
| Dopaminergic (D2 blockade) | Antipsychotics | Schizophrenia, psychosis |
| Serotonergic / Noradrenergic | SSRI, SNRI, TCA (antidepressants) | Depression, anxiety |
| Dopamine / Noradrenergic | Stimulants (methylphenidate) | ADHD |
| GABA | Benzodiazepines, hypnotics | Anxiety, insomnia (short-term) |
| Acetylcholine | Cholinesterase inhibitors | Alzheimer's disease |
| Glutamatergic system | Memantine | Moderate-to-severe Alzheimer disease in applicable guidelines/indications |
This table is a teaching simplification of pharmacological targets. Psychiatric disorders are not explained by a single neurotransmitter deficiency, and a drug's receptor action is not the same thing as the full pathophysiology of the disorder.
Other biological and health interventions: [1]
- Exercise, sleep, nutrition and reduction of alcohol/tobacco can support mental and physical health, but "neurogenesis" or "neuroprotection" should not be promised as a proven individual mechanism or used as a substitute for indicated treatment.
- ECT is a somatic treatment performed under general anaesthesia; it does not involve a surgically implanted device and should not be grouped with invasive neurosurgery. It may be considered for severe depression when a rapid response is needed, the person prefers it based on past response, or other treatments have failed, with individualised discussion of anaesthetic and cognitive risks. [20]
- Deep brain stimulation (DBS) is invasive because electrodes are implanted surgically.
- Repetitive TMS is non-invasive and has an established role for selected presentations such as depression; response varies. [21]
- tDCS has greater uncertainty and NICE recommends special governance/consent/audit or research arrangements for depression. [22] The evidence and regulatory status of tDCS and transcranial pulse stimulation (TPS) vary; do not present all stimulation methods as interchangeable established treatments.
Psychological interventions (psychotherapy): [1]
- CBT (Cognitive Behavioural Therapy)
- Motivational interviewing
- Interpersonal therapy
- Adherence therapy
Targets of psychological intervention: [1]
- Hope and a shared, collaborative understanding of difficulties and treatment
- Thinking habit / cognitive distortion
- Mindfulness
- Relationships
- Illness / explanatory models
- Self-stigma
- Enduring personality problems
- Residual positive symptoms
- Dependence / addictive behaviour
Social interventions include: [1]
- Treatment environment (therapeutic relationship, case management, treatment settings)
- Family dynamics (high expressed emotion, parenting style, caregiver burden)
- Social (social support, stigma/discrimination reduction)
- Culture (esp. ethnic minorities)
- Work (job opportunities, rehabilitation, occupational therapy, supported employment)
- Physical/living environment (housing support, supervised settings, halfway houses)
High Expressed Emotion (HEE)
High expressed emotion describes criticism, hostility and emotional over-involvement in a family environment and is associated with relapse in schizophrenia. It is not a blame label for relatives. Family intervention should support communication, problem-solving, knowledge and caregiver needs.
The lecture lists core competencies: [1]
- Empathic dialogue & understanding
- Complex clinical decision and uncertainty handling
- Detective-like observation
- Personalised management
- Neuroscience & psychopharmacotherapy
- Psychotherapeutic skills
- Holistic care
"High level of stigma attached to mental disorders" [1]
Types of Stigma
| Type | Definition |
|---|---|
| Self-stigma | Patients internalise public negative stereotypes against themselves |
| Affiliate stigma | Attribution of negative stereotypes/prejudice/discrimination to family members of patients |
| Public stigma | Negative stereotypes, prejudice & discrimination by society towards patients |
| Institutional / structural stigma | Policies and practices that intentionally or unintentionally restrict care, education, employment, housing or other opportunities |
The final image lists stereotypes applied especially to severe mental disorders: "dangerous," "violent," "unpredictable" and "unable to recover." These are examples of stigma, not clinical facts. Most people with mental health conditions are no more likely to be violent than anyone else; when assessing an individual, formulate risk from current symptoms, behaviour, substance use, history, stressors, victimisation and context rather than a diagnostic label alone. [23]
Recovery is also possible. WHO notes that at least one in three people with schizophrenia can fully recover, while others have episodic or persistent courses; care should be recovery-oriented and preserve agency. [12]
Significant implications: stigma is a major barrier for help-seeking and receipt of optimal treatment. [1]
Clinical relevance of stigma
Stigma can delay help-seeking and produce social exclusion, diagnostic overshadowing and unequal physical healthcare. Use person-first, non-judgemental language; make decisions with rather than about the person; challenge discriminatory policies; support family/carers without blaming them; and include lived-experience contact in anti-stigma work. [24]
12. Connections to Related Lectures
- The MSE is the practical application of psychopathology concepts from this lecture
- MSE domains map directly to the psychopathology categories listed here (mood, perception, thought, insight, cognition, etc.)
- Key point from Seminar 1: "Objectives of psychiatric interview = diagnosis & management"; "MSE is analogous to P/E and usually consistent with HPC" [2]
- Provides detailed elaboration of each psychopathology domain introduced in this lecture
- Framework: conceptual psychopathology → specific symptom descriptions
- Expands on DSM and ICD differences
- Operational criteria and reliability vs. validity in psychiatric diagnosis
- Builds on the "gene × environment interaction" concept introduced here
- Biological, psychological, and social aetiological factors
- 2021 SAQ Q3: Classification systems, reasons for classification, differential diagnoses for low mood and anxiety [4]
- 2020 MCQ Q24: Depression mimicking dementia (pseudodementia) [8]
- 2020 MCQ Q22: Asperger disorder in a child [8]
- 2024 MCQ Q14: Postpartum depression vs. puerperal blues vs. puerperal psychosis [9]
High Yield Summary
- Burden: the slide reports 1 in 8 people in 2019; the current WHO estimate is nearly 1 in 7 in 2021. Always state the denominator and data year.
- Physical health: premature mortality is a population inequity, not an inevitable outcome. Screen, investigate and treat physical disease to the same standard.
- Suicide: more than 720,000 deaths annually; risk is dynamic and multifactorial. Diagnosis alone is not a risk formulation.
- Age at onset: many disorders begin before 25, but pooled median ages are not diagnostic cut-offs.
- Definition: clinically significant disturbance plus dysfunction and distress/impairment, interpreted in developmental, social and cultural context.
- Assessment: psychopathology and MSE provide precise description; diagnosis also requires history, course, collateral and targeted physical assessment/investigation.
- Classification: DSM-5-TR and ICD-11 remain mainly categorical with dimensional elements. Reliability does not guarantee validity.
- Differential: exclude delirium, medical, medication and substance causes early; do not let a traditional hierarchy erase genuine comorbidity.
- Management: integrate biological/physical, psychological and social interventions around the person's formulation, goals and preferences.
- Stigma: self, affiliate, public and structural stigma obstruct recovery and care. Stereotypes about violence or inability to recover are not clinical facts.
- History: Kraepelin, Bleuler, Freud, Jaspers and Kline shaped ideas and treatments, but their historical constructs are not modern criteria.
Active Recall - Introduction to Psychiatry
[1] Lecture slides: CFB (PSY01) An introduction to Psychiatry.pdf [2] Lecture slides: Seminar 1 - Psychiatric History Taking and Mental State Examination - Dr SE Chua_20250825.pdf [3] Senior notes: Ryan Ho Psychiatry.pdf (Chapter 1.1 Classification in Psychiatry) [4] Past papers: 2021 Fourth Summative SAQ.pdf (Question 3) [5] Lecture slides: Seminar 2 - Psychopathology - Dr Simon SY Lui_1_9_2025.pdf [6] Lecture slides: CFB (PSY02) Classification and Diagnosis of Psychiatric Illness.pdf [7] Lecture slides: CFB (PSY04) Aetiology of Psychiatric Disorders.pdf [8] Past papers: 2020 Fourth Summative Assessment MCQ paper.pdf (Questions 22, 24) [9] Past papers: 2024 Fourth Summative MCQ.pdf (Question 14) [10] World Health Organization. Mental disorders (updated 30 September 2025). [11] World Health Organization. Suicide (updated 25 March 2025). [12] World Health Organization. Schizophrenia (updated 6 October 2025). [13] Solmi M, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry. 2022;27:281–295. [14] World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. 2024. [15] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). [16] National Institute of Mental Health. About RDoC. [17] GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019. Lancet Psychiatry. 2022;9:137–150. [18] Yung NC-L, et al. Excess mortality and life-years lost in people with schizophrenia and other non-affective psychoses: an 11-year population-based cohort study. Schizophrenia Bulletin. 2021;47:474–484. [19] Nathan Kline Institute for Psychiatric Research. Our history. [20] National Institute for Health and Care Excellence. Depression in adults: treatment and management – electroconvulsive therapy. NG222; 2022. [21] National Institute for Health and Care Excellence. Repetitive transcranial magnetic stimulation for depression. HTG396; 2015. [22] National Institute for Health and Care Excellence. Transcranial direct current stimulation (tDCS) for depression. HTG382; 2015. [23] Substance Abuse and Mental Health Services Administration. Get the facts about mental health. [24] World Health Organization Regional Office for Europe. The overwhelming case for ending stigma and discrimination in mental health. 2024.
CFB PSY04 Aetiology Of Psychiatric Disorders
The aetiology of psychiatric disorders encompasses the interplay of genetic, neurobiological, psychological, and sociocultural factors that contribute to the development and manifestation of mental illness.
CFB MED05 Cardiovascular (i) Physical Examination (history Taking)
Cardiovascular history taking is the systematic collection of a patient's symptoms, risk factors, and relevant medical background—including chest pain, dyspnea, palpitations, syncope, and peripheral edema—to guide the clinical assessment of heart and vascular disease.