Psychiatry: A Course of Lectures - V. S. Bitensky 2004

Preface

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Dear Reader,

Odesa State Medical University continues the publication of its new series of educational literature: the "Medical Student's Library."

As we build an independent Ukraine and care for its future, we must strive to preserve and enrich our historical, cultural, and scientific heritage for generations to come. A good book is the finest means to this end. Yet, there are other reasons that have motivated our work.

First, There is a shortage in both quantity and quality of modern textbooks published in the state language. Therefore, our goal was to create a series of textbooks and study guides that incorporate both classical knowledge across various fields of medicine and the latest advancements and extensive expertise of our leading specialists.

Second, in accordance with recent curricula and standard syllabi, A number of new disciplines and courses have been introduced, for which no textbooks previously existed.

Third, we believe that Odesa Medical University, which celebrated its centennial in 2000, is uniquely positioned to create a series of original textbooks and study guides. After all, it serves as the core around which numerous medical schools and academic traditions have formed, led by prominent physicians held in high esteem not only in Ukraine but in many countries worldwide.

We hope this series will make a significant contribution to the advancement of medicine and the training of medical professionals.

Valeriy ZAPOROZHAN, Editor-in-Chief of the Series, Laureate of the State Prize of Ukraine, Academician of the Academy of Medical Sciences of Ukraine

Preface

You are about to begin The Study of a new discipline: psychiatry. It may initially seem somewhat intimidating due to unfamiliar terminology, Abstract concepts and categories, and the lack of clear analogies with other medical subjects you have already mastered—thus precluding the widespread use of analogical thinking or reliance on your accumulated knowledge base. However, do not be discouraged. The challenges you face are identical to those encountered by experienced psychiatrists, reflecting the unique dual nature of psychiatry as a specialty that is, on the one hand, biological, and on the other, humanistically oriented.

From the time psychiatry was recognized as an independent medical discipline to the present day, a fundamental question has remained relevant: do mental disorders develop According to the principles of the general medical paradigm, which presumes a unity of etiological factors, pathogenetic mechanisms, clinical manifestations, and ultimate outcomes within the framework of a single nosological entity? The nosological principle introduced into psychiatry by E. Kraepelin immediately gained an immense following, while also inspiring The Development of an equally powerful concept formulated by K. Bonhoeffer concerning non-specific types of Brain reactions to any pathogenic agent. These theories characterized different aspects of clinical practice and were intended to facilitate the systematization of diverse observational data. The subsequent evolution of psychiatric science was thus envisioned to proceed through a dialectical tension between THE PRINCIPLE OF constancy (uniformity of mental reactions according to Bonhoeffer) and the principle of Variability (etiopathogenetic Specificity of clinical disease manifestations).

However, this proved to be an idealistic notion. In the second half of the 20th century, such a vast multitude of new theories emerged that establishing a "common language" among representatives of different psychiatric schools during scientific discussions became a separate and scarcely achievable task. Consequently, the global psychiatric community decided, in the Tenth Revision of the International Classification of Diseases (ICD-10), to dissect existing nosological entities of psychiatry into elementary operationalized components. These were to be defined so precisely at the descriptive level that proponents of divergent theories could recognize them with equal accuracy. Diagnosis itself was designed to follow an algorithmic "conditional" Structure (if X=Y, proceed to step 2; if X≠Y, proceed to step 3). Yet, it became evident that this operationalized-descriptive, seemingly reliable approach to the systematization of mental disorders presents no fewer complexities than the initial (clinical-theoretical) one. Approximately 750 Clinical Features (Dittmann, Dilling & Freyberger, 1992) comprising the individual criteria for syndromes clearly exceed the discriminatory capacity of a physician tasked with formulating an accurate diagnosis and prescribing appropriate Treatment. To this day, no consensus exists on how to navigate this new predicament...

Such challenges greatly complicate the work of practicing psychiatrists, and one can only imagine the formidable task currently facing students. You must not only master a vast array of entirely unfamiliar psychiatric terms and categories but also learn to navigate an entirely novel coordinate system (anozological and atheoretical) of diagnostic categories and criteria under ICD-10. Therefore, the appearance of this manual—authored by experienced higher-education psychiatry instructors who are professionally fluent in the general medical (nosological) paradigm while fully grasping the diagnostic principles of mental and behavioral disorders embedded in ICD-10—will substantially facilitate the mastery of educational material by future physicians.

Honored Worker of Science and Technology of Ukraine, Doctor of Medical Sciences, Professor V. S. Bitensky