Introduction and Review

433
Psychiatry Team Introduction & Review

Introduction & Review

Lecture contents:
• Introduction to psychiatry
• Diagnosis and classification in psychiatry
• Etiology in psychiatry
• Review of neuroanatomy and neurophysiology
• Review of neurotransmitters
• Clinical psychology
Manual of Basic Psychiatry

Doctor’s notes
Important
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433 Psychiatry Team Introduction & Review

Introduction to Psychiatry:

Psychiatry is a medical discipline concerned with the provision of bio-‐psychosocial assessment
and management of mental disorders. It links medicine, psychology and sociology together.
Negative attitude Positive attitude

Etiology Vague/due to poor adherence to Many aspects have been scientifically
religion/always due to supernatural causes explored & approved >>> good Rx
Diagnosis Subjective / unscientific. Objective criteria & Scales.
Medications Deleterious / addictive. Benefit > risk in general.
Prognosis Always bad. There are many disorders with good
prognosis.
Patients Mad / bad / sad / aggressive / not easy to Human beings deserve respect.
like / have low faith in Allah.
Clinicians Mentally unstable because of patients. Like other clinicians but some may.. !?

Diagnosis and classification in psychiatry

Significance of diagnosis and classification:
1. To distinguish one diagnosis from another.
2. To enable clinicians to communicate with one another about dx, treatment, and prognosis.
3. To ensure that psychiatric research can be conducted with comparable groups of patients.

Organic classification Functional classification
Psychiatric disorders characterized by neurocognitive No obvious structural brain pathology.
structural brain pathology that can be detected by
clinical assessment or usual tests.
Examples: delirium, dementia, substance-‐induced Examples: schizophrenia, mood disorders,
mental disorders, and medication-‐induced mental anxiety disorders, adjustment disorders.
disorders.
Features Suggestive of Organic Mental Disorders (CNS pathology):
• Disturbed consciousness +/-‐ other cognitive disturbance in: attention, concentration, orientation or
memory.
• Physical illness (e.g. diabetes, hypertension).
• Vital signs disturbances (e.g. fever, high BP).
• Neurological features (e.g. ataxia, dysarthria).

Psychosis vs. Neurosis Classification
Although this classification is no longer used in the official current systems of classification (DSM & ICD), in everyday
clinical practice these terms are still used widely; hence it is of practical value to know this distinction.
Psychoses Neuroses
(Pleural of psychosis) (Pleural of neurosis)
Mental disorders in which the patient lacks insight Generally less severe forms of psychiatry disorders
and is unable to distinguish between subjective in which the patient is able to distinguish between
experience and external reality, as evidenced by subjective experience and external reality. No lack
disturbances in thinking (delusions), perception of insight, delusions or hallucinations.
(hallucinations), or behavior (e.g. violence).
Examples: schizophrenia, severe mood disorders, Examples: dysthymic disorder, anxiety, panic &
and delusional disorders. phobic disorders.
It can be due to an organic cause (organic psychosis)
e.g. delirium, dementia, substance abuse, head
injury.
Features are abnormal in quality (e.g. delusions, Features are abnormal in quantity (e.g. excessive
hallucinations). fear and avoidance).
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DSM-‐5 Classification (May 2013):
Is an evidence-‐based manual useful in accurately and consistently diagnose mental disorders.
In preparation for the release of DSM-‐5, experts from psychiatry, psychology, social work, neuroscience,
pediatrics and other fields have committed years to reviewing scientific research and clinical data,
analyzing the findings of extensive field trials and reviewing thousands of comments from the public.
DSM-‐5 represents the contributions of more than 700 distinguished mental health and medical experts
during an extensive and rigorous 14-‐year development process. http://www.dsm5.org/

Etiology in Psychiatry
The complexity of etiology in psychiatry:
1. Time factor: causes are often remote in time from the effect they produce.
2. Single cause: may lead to several psychological effects e.g. deprivation from parental affection
may lead to depression or conduct disorder in children and adolescents.
3. Single effect: may arise from several causes e.g. depression may be due to accumulation of
several causes like endocrinopathies, psychosocial stresses and side effects of some drugs.
Most psychiatric disorders are multifactorial.

Etiological Factors can be classified into biological, psychological, and social factors; Bio-‐Psycho-‐Social approach:

Main causative factors in psychiatry:
A. Genetic: e.g. in schizophrenia, mood disorders, panic disorder and agoraphobia.
B. Neuropathological: e.g. dementias, delirium.
C. Endocrinopathological: e.g. hyperthyroidism, hypothyroidism.
D. Pharmacological: side effects of medications e.g. steroids lead to mood changes.
E. Social: e.g. marital discord, occupational problems, financial difficulties.
F. Psychological: behavioral, cognitive, or psychodynamic problems (subconscious processes that involve
distortion of reality in order to deal with, and resolve the intra-‐psychic conflict (defense mechanism).

Supernatural causal attributions; although many cultures view black magic (sorcery), evil eye, and devil
possession hidden causes of mental diseases it is impossible to subjects such supernatural matters to
empirical research.

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Review of neuroanatomy and neurophysiology

Structure Function
Frontal Lobe • Cognitive and intellectual functions: attention, concentration, registration,
orientation (to time, place, and person) reasoning, understanding, analysis,
comparison, critical thinking, problem-‐ solving, planning and judgment.
• Control of emotion, voluntary movements, and sphincters.
• Speech (motor language).
Temporal Lobe • Retention, comprehension, and recall of information.
• Emotional and sexual activity.
Parietal Lobe • Interpretation of sensations: touch and pressure.
• Appreciation of body parts (spatial orientation).
• Constructional skills: dressing and drawing.
Occipital Lobe Analysis of visual sensations (color, shape, and dimensions).
Cerebellum • Coordination of muscle contractions and motor activity.
• Maintenance of posture and body balance.
Basal Ganglia Subconscious control of tone and movements of the skeletal muscles, such as
swinging the arms while walking.
Midbrain • Control of reflexive head and eye movements.
• Raphe nuclei functions (see serotonin p6).
• Consciousness and arousal (function of the reticular formation which extends
also through pons and medulla).
Pons • Connection of various parts of the brain with each other.
• Cranial nerve functions (5, 6, 7 and 8).
• Locus Cerulus is the most important noradrenergic nucleus in the brain, which
has very high density of noradrenaline neurons, and numerous projections to
other brain regions; especially the cortex and hippocampus. It is essential for the
behavioral and physiological expression of anxiety and fear.
Medulla • Medulla contains vital centers (cardiac, respiratory and vasomotor) and non-‐
vital centers (vomiting, swallowing, sneezing, coughing, and hiccupping).
• Cranial nerves functions (9,10, and 11).
Reticular • Consciousness and alertness.
Formation System • Control of skeletal muscles.
• Control of somatic and visceral sensations.
Thalamus • Sensory relay station: processing tactile, proprioceptive, pain and temperature
information, sending it to sensory cortical areas.
• Integrating a large variety of sensory and motor information, and the relation of
this information to one’s emotional feelings, subjective states, and personality.
• Influencing the level of consciousness and alertness through connections with
the reticular formation and cortical centers.
Hypothalamus Hypothalamus preserves body homeostasis through regulation of:
• Food intake: feeding/hunger center, located in the lateral side of hypothalamus,
which is chronically active and its activity is transiently inhibited by the activity
in the satiety center, located in the ventro-‐medial side, after the ingestion of
food.
• Water intake: (superiolateral part of Hypothalamus).
• Sleep: (suprachiasmatic nucleus: light reduces melatonin in pineal gland
whereas darkness enhances melatonin secretion).
• Temperature: Antirising center in the anterior hypothalamus, mediates the
parasympathetic system to increase body heat loss, thus reducing body
temperature. Antidrop center in the posterior hypothalamus mediates the
sympathetic system to reduce body heat loss.
• Higher control of hormones: Catecholamines-‐vasopressin-‐oxytocin-‐ACTH-‐TSH-‐
FSH-‐LHProlactin and growth hormones.
• Higher control of the autonomic nervous system:
Parasympathetic (by anterior hypothalamus).
Sympathetic (by posterior hypothalamus).
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The Autonomic Nervous System

The sympathetic nervous system The parasympathetic nervous system
• β1 stimulation: acceleration in the heart It aims at restoring energy. It slows the heart rate,
rate and increase in the myocardial constricts the pupils, increases peristalsis of the intestine
contractility. and glandular activities (increasing secretions), opens the
• β2 stimulation: vasodilatation of skeletal sphincters and contracts the bladder wall. The
muscles and coronary artries, parasympathetic neurons also facilitate erection.
bronchodilatation, and relaxation of uterus,
intestines and bladder.
• α receptor stimulation: constriction of the
arterioles of the skin and intestine,
mydriasis, piloerection, sweating,
ejaculation, closure of the sphincters and
reduction of salivary glands secretion.

The Limbic System
Components: Cingulate gyrus, hippocampus (temporal lobe), amygdala, parahippocampal gyrus,
hypothalamus, anterior nucleus of thalamus, major tracts connecting the system.
Functions:
• Emotional and behavioral responses (anger, fear, etc.). Emotions may be modified by thinking and
judgment (frontal lobe functions). However, limbic circuits have prolonged after-‐discharge following
stimulation. Thus, emotional responses are generally prolonged and outlast the stimuli that initiate
them.
• Sexual feelings and pleasure: norepinephrine is involved in ejaculation (males) and orgasm (females).
• Recent memory.
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The Gate Control Theory of Pain:
In the dorsal horn of the spinal cord, competing signals and neurotransmitters can open or close the gate
on painful perceptions. Substance P is involved in altering the pain threshold. Serotonin in descending
pathways has an inhibitory effect (closing the gate). Endorphin deficiency seems to correlate with the
augmentation of afferent stimuli.
Review of neurotransmitters

1. SEROTONIN (5 Hydroxytryptamine = 5HT):
Serotonin is found in the gastrointestinal tract, platelets, monocytes (5HT1A: enhances activity of natural
killer cells /psychoneuroimmunity), the brain, and the spinal cord.
The major site of serotonergic cell bodies in the brain is the raphe nuclei in the brainstem, from which
fibers project to many brain structures, these include projections to:
o Frontal cortex: regulation of emotional reaction to stress and impulsive behavior ( 5HT 1A).
o Limbic system: anxiety and panic feelings (5HT 2A-‐2C).
o Basal ganglia: movement control and compulsions (5HT2A).
o Hypothalamus: appetite and eating regulation (5HT 3).
o Brainstem chemoreceptor trigger zone: vomiting (5HT 3).
o Brainstem sleep centers: deep sleep (5HT 2A). Ingestion of food rich in tryptophan rapidly
increases brain serotonin synthesis, which accounts for their mild sedative effects.
o Spinal cord: sexual spinal responses, orgasm (5HT 2A).
o Peripheral serotonergic receptors in the intestine regulate intestinal secretions and motility (5HT
3,4 &7).
Serotonin deficiency is found in depression, anxiety, panic disorder, phobias, obsessive compulsive
disorder and bulimia nervosa.
Serotonin is synthesized from L-‐tryptophan and metabolized to an inactive metabolite by MAO-‐A enzyme.

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2. DOPAMINE:
Dopamine is a catecholamine synthesized from tyrosine. There are four major dopaminergic tracts:
1. The mesolimbic dopamine pathway: emotional behavior, reward reinforcement, pleasure feelings
and sex drive. Nucleus accumbens is a dopamenergic nucleus, located in the mesolimbic pathway,
involved in the physiological reward system. Its reinforcing effects are stimulated by caffeine, nicotine,
cocaine and other CNS stimulants. Its stimulation increases sex desire and behavioral response, and
suppresses appetite. Pathological hyperactivity of the mesolimbic pathway accounts for active
psychotic features (hallucinations, delusions, aggression…).
2. The mesocortical dopamine pathway: mental arousal and cognitive functions. Pathological
underactivity of this pathway (mesocortical defect: due to primary dopamine neuron defect, glutamate
excitotoxic overactivity, or serotonergic overactivity) is responsible for most negative features and
cognitive defects seen in some schizophrenic patients.
3. The nigrostriatal tract: low dopamine levels are associated with motor symptoms of Parkinson’s
disease. Antidopaminergic drugs lead to Parkinsonian extrapyramide side effects. Serotonin 2A
receptors on dopamine neurons inhibit dopamine release.
4. The tuberoinfundibular tract: dopamine inhibits prolactin release from the anterior pituitary

Dopamine Receptors:
o D1 receptors may play a role in negative symptoms (D1 antagonist treat negative symptoms).
o D2 receptors blocked by anti-‐psychotic drugs for the treatment of positive psychotic symptoms. D2
agonists are used for the treatment of Parkinson’s disease.
o Other dopamenergic receptors (D3, D4 & D5): it is not clear to what extent these receptors contribute
to the clinical properties of anti-‐psychotic drugs.

3. NORADRENALINE (NOREPINEPHRINE):
Noradrenaline is a catecholamine synthesized through hydroxylation of dopamine. The major
concentration of noradrenergic cell bodies in the brain is in the locus Cerulus from which neurons project
to:
o Frontal cortex: regulation of mood (Beta 1 receptors) and regulation of cognitive functions (Alpha-‐2
receptors)
o Limbic system: energy, emotions and psychomotor activity control.
o Cerebellum: regulation of motor movements.
o Cardiovascular centers in the brainstem: blood pressure regulation.
Noradrenergic innervation regulates the heart rate (via Beta 1 receptors in sympathetic neurons) and
controls bladder emptying (via Alpha receptors). Alpha –2 presynaptic noradrenergic autoreceptors (on
adrenergic neurons) and heteroreceptors (on serotonergic neurons) have a negative feedback effect;
inhibiting excessive release of noradrenaline and serotonin respectively.
Noradrenaline at low concentrations has stimulatory effects on immune function but it inhibits effects at
high concentrations.
Noradrenaline is involved in ejaculation in men and orgasm in women.

Noradrenaline – Serotonin Interactions:
There are two types of presynaptic noradrenergic receptors on serotonin neurons that regulate
serotonin release:
o α-‐1 receptors (in the brainstem; a pathway from locus cerulus to raphe nuclei), when stimulated,
these receptors enhance serotonin release.
o α-‐2 heteroreceptors (in the cortex): when stimulated, they turn off serotonin release.

4. ACETYLCHOLINE (ACH):
Acetylcholine is synthesized from choline and acetyl coenzyme A. The major brain center for cholinergic
neurons is the nucleus basalis of Meynert, which projects to cerebral cortex and the limbic system. These
neurons have the principal role in mediating short-‐term memory.
Additional cholinergic neurons are found in:
o The reticular formation: REM –sleep induction.
o Basal ganglia (extrapyramidal tract) and cerebellum: regulation of body posture, muscle tone and
motor movements.
o The autonomic nervous system: parasympathetic (both pre and post synaptic pathways) some
sympathetic pathways (presynaptic/sweet glands).
Acetylcholine is involved in erection. N.B.: nitric oxide (NO), not nitrous oxide (N2O), is also involved in
erection .It is synthesized in the body from l-‐arginine.

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5. GAMA AMINOBUTYRIC ACID (GABA):
GABA is an amino acid neurotransmitter with a very fast inhibitory action. It is found almost exclusively in
the brain, and synthesized from glutamate. GABA suppresses seizure activity, anxiety and mania. There are
three types of GABA receptors A, B&C. The GABA-‐A receptors have binding sites for benzodiazepines and
barbiturates, which increase the affinity of the GABA-‐A receptors for GABA.

6. GLUTAMATE:
Glutamate is an amino acid excitatory neurotransmitter synthesized from deamination of glutamine. Many
sensory organs – including the cochlea, the olfactory bulb, the retina, and thalamocortical fibers– use
glutamate as their principal neurotransmitter. Pyramidal neurons in the cortex are glutamartergic.
Glutamate is involved in the highly organized information flow through the brain. In the hippocampus,
glutamate may be specifically relevant to the pathophysiology of dementing illness (Alzheimer's disease).
Glutamate excitotoxicity is suggested as a possible cause of neuronal degeneration in schizophrenic
patients with negative features. Sigma receptors (1&2): related to glutamate receptors (NMDA) and
involved in enhancement of memory and cognitive functions, when stimulated by fluvoxamine they
improved the negative symptoms in schizophrenic patients.

7. SUBSTANCE – P:
It is an excitatory neurotransmitter associated with mediation of pain perception and thought to play an
important role in the pathogenesis of migraine, cluster headache and chronic pain. Abnormalities affecting
substance P have also been hypothesized for mood disorders, Alzheimer’s dementia and Huntington’s
disease.

8. HISTAMINE:
Histamine is located in the hypothalamus and fibers projecting to cerebral cortex, the limbic system, and
the thalamus.
There are three types of histamine receptors:
H1 receptors regulate appetite and arousal, and have a role in allergic symptoms. When antihistamines
are used for allergic symptoms they exert marked sedative effects and weight gain.
H2 receptors are involved in gastric acid output; when H2 – receptors antagonist are used they heal
gastric and duodenal ulcers.

9. MELATONIN:
Hypnotic hormone produced by the pineal gland stimulated by darkness and inhibited by light
(suprachiasmatic nucleus), involved in regulation of sleep-‐wake 24-‐hour cycle.

10. ENDOGENOUS OPIOIDS:
Enkephalins, endorphins and dynorphins are involved through their receptors (mu, kappa and delta) in
many mental functions: pain perception (analgesics), learning, memory, mood and dependence.

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Clinical psychology

1. LEARNING THEORIES
Learning is a relatively permanent change in behavior brought about by prior experience. There are three
basic learning theories: I. Classical Conditioning. II. Operant Conditioning. III. Modeling
I. Classical Conditioning
Stage 1: Unconditioned stimulus (e.g. food) > Unconditioned response (e.g. salivation)
Stage 2: Conditioned stimulus (e.g. sound of the bell) + Unconditioned stimulus (food) >
Unconditioned response (salivation).
Stage 3: Conditioned stimulus (sound of the bell) > Conditioned response (salivation).
II. Operant Conditioning Behavior
Which is followed by advantageous consequences, is likely to be repeated, whereas
behavior followed by noxious consequences will become less frequent.
Reinforcement: the process of increasing the frequency of a particular piece of behavior
by presenting a reinforcing stimulus.
Positive reinforcement: enhancement of behavior by a desired reward.
Negative reinforcement: enhancement of behavior by removal of undesirable event.
III. Modeling
Occurs when the behavior of an individual (the observer) is affected by the opportunity
to observe the behavior of another person (the model).

Clinical Uses of Learning Theories:
-‐ Treatment of phobias (systemic desensitization and flooding).
-‐ Treatment of obsessive rituals (exposure and response prevention).
-‐ Relaxation training (for anxiety).
-‐ Aversion therapy (for alcoholism and sexual deviation).

2. COGNITIVE THEORY:
It emphasizes the impact of interpretation of events, expectations, and process of thinking about oneself,
people, the environment, the past, and the future on the mood and behavior. Depression and anxiety
result from, and complicated by, wrong automatic thoughts e.g. “I am bad person”. Correction of
erroneous thoughts with cognitive therapy usually relieves patients from negative emotions.

3. PSYCHOANALYTIC THEORY:
A -‐Topographic model of the mind:
It divides the mind into three regions, and each of which has its own characteristics:
1. The conscious: The part of the mind in which perceptions coming from the mind, the body and from
the outside world are brought into awareness. Its content can be communicated by means of language
or behavior.
2. The unconscious: The part of the mind that contains the instinctual wishes and drives (self
preservative drives and sexual instincts) and represses them; keeping them out of conscious
awareness through resistance to remembering.
3. The preconscious: The part of the mind that comprises those mental processes, contents and events
that are capable of being brought into conscious awareness by deliberate focusing of attention on the
memory.
B -‐ Structural Theory Model (Ego Psychology): It divides the psychological apparatus into the id, the ego
and the super ego.
1. The “id”: It includes the unconscious instinctual wishes and drives, and operates according to the
pleasure principle (it lacks the capacity to delay or modify the instinctual drives).
2. The “ego”: It attempts to achieve and coordinate optimal gratification of instinctual wishes and
drives while maintaining good relations with the demands of the outer world and external reality.
3. The “superego”: It includes internalized moral values, prohibitions and standards; and offers
approval or disapproval. The superego conducts an ongoing scrutiny of the person’s feelings,
thoughts, and behavior. It establishes and maintains the person's moral conscience.

Defense Mechanism: subconscious mental processes used by a person to deal with distressing situations
or internal conflicts.
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1. Acting out: impulsive behavior in expression of a suppressed desire or conflict to avoid being conscious
of the emotions that accompany it. It occurs mainly in children (e.g., tantrums), adolescents (e.g.,
motiveless assaults), and patients with borderline personality disorder (e.g., destructive behavior,
deliberate self-‐harm).
2. Compensation: covering up for a weakness in the personality by over-‐ emphasizing another desirable
trait. E.g., a person with social anxiety becomes known for his expressive writings.
3. Conversion: symbolic expression of intrapsychic conflict through physical symptoms. E.g., a student in
the exam suddenly develops pseudo-‐siezure. By so doing, two kinds of gains he achieves: 1. Primary gain:
relief of intrapsychic distress. 2. Secondary gain: to be excused from the exam. It occurs mainly in
conversion disorder.
4. Denial: rejection or disapproval of distressing reality (e.g., faults, poor performance, physical illness, loss
of a loved person).
5. Displacement: transfer and discharge of bent-‐up intense emotions (e.g. anger, fear) on objects less
dangerous than those arousing them. E.g., a man harassed by his boss at work, comes home and yells at his
wife.
6. Identification: matching and modeling another person's behavior or attitude. E.g., a patient develops
psychosomatic chest pain after death of a relative of heart attack.
7. Intellectualization: overemphasizing logical analysis of a situation through philosophical discussions to
avoid distressing emotions accompanying it. E.g., a patient told to have cancer appeared self-‐composed
and talked a lot about how cancer is challenging to doctors.
8. Projection: exempting self from one’s own faults, bad motives, or wrong doings by attributing them to
someone else. E.g., someone who dislikes a colleague may attribute to him feelings of anger, and in turn
dislike. In this way, his own feelings of dislike may appear justified and become less distressing.
9. Rationalization: justifying a behavior or attitude with logical, plausible reasons, but these are not the
real reasons. E.g., a student states, “I was able to get grade “A+”, but I was afraid of evil eye, that is why I
left some questions unanswered.”
10. Reaction formation: controlling a distressing feelings by adopting the opposite behavior or attitude to
that which would reflect the true feelings. E.g. a medical student who has been dismissed from medical
college because of poor achievement and wished he continued studying medicine tells his family he hates
medicine.
11. Regression: a return to earlier and more comfortable patterns of thinking and behavior involving less
mature reaction and responsibility. E.g., an adolescent boy whose self-‐esteem has been shattered reverts
to child-‐like "show-‐off" behavior.
12. Splitting: dividing his evaluation of others and situations into two extremes either all good or all bad
rather than considering the full range of their qualities. E.g. a patient with borderline personality disorder
over-‐idealizes some doctors and devalues others.
13. Sublimation: diverting unacceptable drives (particularly sexual and aggressive) into socially acceptable
channels such as creative activities. E.g. turning chronic anger feelings into vigorous sporting activities.
14. Undoing: doing something to counteract unacceptable desires. E.g. a teenager who feels guilty about
masturbation ritually cleans his hands excessively following each occurrence of the act.

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4. INTELLIGENCE TESTING:
Intelligence is the ability to solve environmental problems and to adapt to changes.Two common tests are:
o Stanford -‐ Binet test (age 2 to 18 years).
o Wechsler scales (for children and adults).
Intelligence tests assess intellectual ability; verbal/vocabulary, visual-‐spatial (picture assembly), math skills,
and performance skills.
Intelligence Quotient (IQ) = (mental age/chronological age) x 100
IQ scores: average normal (100 +10), bright normal (120), superior (> 130), dull normal (80-‐90), borderline
(70-‐79), mild mental retardation (50-‐70), moderate mental retardation (35-‐49), severe mental retardation
(20-‐34), and profound mental retardation (< 20).

5. PERSONALITY TESTING:
Personality is the distinctive patterns of thought, emotion, and behavior that define an individual’s
personal style and influence his or her interactions with the environment.
Personality measures
A-‐ There are many personality tests that measure the various traits of normal personality, the most
widely used are the following:
o The five factor model of personality (FFM).
o The Myers-‐Briggs Type Indicator (MBTI).
o The 16 Personality Factor Questionnaire (16 PF).
o The California Psychological Inventory (CPI).
They are helpful in predicting behavior, achievement, and adaptation to stress. They can be used in
many settings like academic, career, and occupational selection.
B-‐ In clinical psychology practice, there are tests used to detect abnormal patterns of personality.

Objective Tests (questions with standardized-‐response format that can be objectively scored).
o Eysenck Personality Inventory (EPI).
o Minnesota Multiphasic Personality Inventory (MMPI-‐2).
Projective Tests (interpretation of ambiguous stimuli with no objective structured-‐ answer format).
o Rorschach test: to identify disordered thoughts and defense mechanisms through interpretation of
inkblots.
o Thematic Apperception Test (TAT): to evaluate motivations and attitude behind behaviors through
creating stories based on pictures of people in various situations.
Several intelligence and personality tests are available in Arabic language, and validated in some Arab
communities.
Clinical psychologists play important roles within the psychiatric team for both patients' assessment (e.g.,
IQ, personality) and treatment (e.g., cognitive-‐behavior therapy).

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433

Psychiatry Team Introduction & Review

Introduction & Review

Manual of Basic Psychiatry

Introduction to Psychiatry:

Negative attitude Positive attitude

Diagnosis and classification in psychiatry

Review of neuroanatomy and neurophysiology

The Autonomic Nervous System

Review of neurotransmitters

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