Introduction Development of Psychiatry Department of Psychiatry 1

Introduction, Development of Psychiatry Department of Psychiatry 1 st Faculty of Medicine Charles University, Prague Head: Prof. MUDr. Jiří Raboch, Dr. Sc.

Teaching: Schedule Week 1 Week 2 Week 3 MO TUE WE THU FRI 8: 00 -9: 30 9: 45 -12: 00 Lecture Workshop on wards with patients Lecture Workshop on wards with patients Psychiatric Hospital Bohnice Lecture Workshop on wards with patients Ward Lecture Workshop on wards with patients Examination

FREE COURSES IN CZECH • WEDNESDAY 14: 00 – 15: 30 CLINICAL SEMINAR, LIBRARY, 2 nd. 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, 2 nd. FLOOR • THURSDAY 13: 00 – 14: 00 SEMINAR FOR POSTGRADUATE STUDENTS, LIBRARY, 2 nd. 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. lf 1. cuni. cz/ Department of Psychiatry http: //portal. lf 1. cuni. cz/ Educational portal

Course • 2 absence at maximum • 2 other absences – free courses • Written mental status of one patient (documentary case record)

PSYCHIATRY MAIN MEDICAL DISCIPLINE INFLUENCES – 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 ASKLEPIOS • MAGICAL CAUSES OF MENTAL DISORDERS – ASSYRIANS, BABYLONIANS, MENTAL DISORDERS – MARK OF MORAL INSANITY, SIN, PUNISHMENT • ANCIENT GREECE – HEALERS, TEMPLE MEDICINE

HIPPOKRATES • • 460 – 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 • 18 th. CENTURY „FAME PLAGIIS, VINCULIS COERCENDUS EST INSANUS

RENAISSANCE 16. 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 • 1 st. PSYCHIATRIC REVOLUTION JOHAN WEYER (1515 – 1588 TREVIR), PROFESSOR, MEDICAL SCHOOL IN COLOGNE, DE PRESTIGIIS DAEMONUM, MENTAL DISORDERS – MEDICAL CAUSES

ENLIGHTENMENT 17 th – 18 th CENTURIES • PIONEERS OF LIBERALISM – VOLTAIRE, KANT, DIDEROT, SWIFT, • FRENCH REVOLUTION (1789) • 2 nd. 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 PSYCHIATRY 19 th. 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 20 th. 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, T 4 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 T 4“ – 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 20 th. CENTURY • 50 ies – 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 - DSMIII, 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 24, 9 disorders Affective 17, 1 disorders Dependencies 26, 6 19, 2 30, 5 12, 7 21, 7 35, 4 17, 9 Non-affective 0, 7 psychoses Total 48, 0 0, 6 0, 8 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 Disability Adjusted Life Years Murray a Lopez, 1997

DALY DEVELOPED COUNTRIES

PSYCHIATRY IN PRAGUE • 1790 – CUSTODIAE MENTE CAPTORUM, GENERAL HOSPITAL • 1822 – TEMPLE OF ST. CATHARINA – OLD HOUSE • 1844 – NEW HOUSE, KARL VON RIEDL

PSYCHIATRIC DEPARTMENT CHARLES UNIVERSITY, PRAHA

CAUSES OF DALY (%) world 1. 2. 3. 4. Respirační infekce Průjmovitá onemocnění Perinatální onemocnění Unipolární deprese 8, 2 7, 2 6, 7 3, 7 5. 6. 7. 8. 9. 10. ICHS Cerebrovaskulární onemocnění Tuberkulóza Zarděnky Dopravní nehody Vrozené vady 3, 4 2, 8 2, 7 2, 5 2, 4 Murray a Lopez, 1997

CAUSES OF DALY (%) developed countries 1. 2. 3. 4. ICHS Unipolární deprese Cerebrovaskulární nemoci Dopravní nehody 9, 9 6, 1 5, 9 4, 4 5. 6. 7. 8. 9. 10. Nadužívání alkoholu Osteoarthritis Nádory trachey, bronchů a plic Demence a další deg. procesy CNS Sebepoškození Vrozené vady 4, 0 2, 9 2, 7 2, 3 2, 2 Murray a Lopez, 1997

CAUSES OF DALY (%) developed countries, age 15 - 44 1. 2. 3. 4. Unipolární deprese Nadužívání alkoholu Dopravní nehody Schizofrenie 12, 3 8, 9 8, 5 5, 0 5. 6. 7. 8. 9. 10. Sebepoškození Bipolární porucha Nadužívání návykových látek Obsedantně kompulzivní porucha Osteoarthritis Následky násilí 4, 2 3, 7 2, 9 2, 7 2, 4 Murray a Lopez, 1997