Etiology in Psychiatry

Khaldoun Marwa, MD / Kimarwa@mcst.edu.sa

Date: 17-Aug-23
Version: 1

Main Topics

Etiology

• Nature
• Nurture

Investigations

• Lab test
• IQ Scales
• Social report

Manifestations & Diagnosis

• Signs, Symptoms & Diagnosis

Management Plan

• Drugs
• Psycho Intervention
• Social Intervention
• Spiritual Support

The Biopsychosocial Model

Biology

• Genes
• Nutrition
• Abuse
• Neglect

Brain/Personality

• Drugs
• Personality

Social Environment

• Trauma
• Stress
• Societal Norms

Etiology in Psychiatry

Causes of Psychiatric Disorder

Key Points in Etiology

1. In Psychiatry, the study of causation is complicated.

   • Causes are often remote in time from the effects that they produce (e.g., childhood experience → adult anxiety disorders).

2. A single cause may lead to several effects.

   • Example: deprivation of parental affection → antisocial behavior, suicide, depression…

3. A single effect may arise from several causes.

   • Example: Depression.

Importance of Understanding Etiology

Vague but important to: 4. Diagnose and understand. 5. Allow early intervention. 6. Optimize treatment.

Classification of Causes

1. According to the effect

   • Predisposing factors
   • Precipitating factors
   • Perpetuating (maintaining) factors

2. According to nature

   • a. Biological
   • b. Psychological
   • c. Social

Detailed Classification of Causes

3. According to the effect:
   • a. Predisposing factors
   • b. Precipitating factors
   • c. Perpetuating (maintaining) factors

Predisposing Factors

• Operating from early life, determining a person’s vulnerability to causes acting close to the time of illness.
  • Examples:
    • Genetic endowment
    • Environment in utero
    • Trauma at birth
    • Social & psychological factors in infancy & early childhood.

Precipitating Factors

• Events that occur shortly before the onset of a disorder and appear to have induced it.
  • Examples:
    • Physical disease
    • Drug
    • Loss of job
    • Changing residency

Perpetuating Factors

• These factors prolong the course of a disorder after it has been provoked.
  • Examples:
    • Intrinsic to the disorder (e.g., avoidance in phobic disorders)
    • Social circumstances:
      Expressed Emotions = over criticizing & over involvement (e.g., marital discords, overprotecting parents).

Classification of Causes According to Nature

4. According to nature
   • a) Biological
   • b) Psychological
   • c) Social

Biopsychosocial Model

Bio-Psycho-Social Theories of Etiology

Etiology: Biological

• GENETIC
• NEUROPATHOLOGICAL
• ENDOCRINOLOGICAL
• PHARMACOLOGICAL
• METABOLIC
• INFLAMMATORY
• AUTOIMMUNE

Etiology: Psychological

a) Psychodynamics

• Provides a comprehensive range of explanation for clinical phenomena.
• The central feature is the concept of the unconscious mind characterized by:
  • a – being dynamic
  • b – being in conflict with the conscious mind.
• Important in the etiology of neurotic disorders.
• Anxiety is the central symptom of all neurosis.
• Defense mechanisms (such as rationalization and projection) are used to reduce anxiety.

Obsolete Psychoanalysis theory of neurosis originates from failure to pass normally through 3 stages of development: oral → anal → genital.

b) Learning theories:

• Experiences in childhood and later life give rise to neurosis.

c) Cognitive theories:

• Symptoms and behavior are produced and maintained by maladaptive ways of thinking.

• Many concepts used by sociologists are relevant to psychiatry.

5. Life events

   • Migration
   • Marital Discord
   • Financial Difficulties
   • Educational Stress
   • Occupational Stress
   • Daily Hassles

6. Family Conflict & Factors

   • a) Lack of social support, criticism, and
   • b) Overprotection within the family.

Effects of Etiological Factors

• Predisposing factors

  • Bio-Psycho-Social

• Constitution

• Precipitating factors

  • Bio-Psycho-Social

• Illness

• Recovery

  • Perpetuating factors
  • Bio-Psycho-Social

Investigation & Psychiatry

• Probing in the Etiology
• Screen for the causes
• BioPsychoSocialSpiritual Approach

The Scale of Islamic Religiosity Attitude, SiRA

• Physical / Biological

  • Gender
  • Physical illness
  • Disability
  • Genetic vulnerability
  • Immune function
  • Neuroplasticity
  • Mental retardation

• Psychological Influences:

  • Thinking distortions
  • Emotional dysregulation
  • Behavioral problems
  • Unconscious conflicts
  • Others

• Spiritual

  • Transcendence
    • Belief System
    • Values
    • Lay healers
    • Parapsychology
    • Extraordinary experiences

• Social

  • Family background
    • Social Support System
    • Cultural traditions
    • Social economics
    • Education

Bio-Psycho-Socio-Spiritual Approach

Investigation plan:

1. Bio: Blood Labs, Drugs & substance level, Imaging & Electric
2. Psych: IQ test, Behavioural analysis & Psychological Scales.
3. Social: Family/ marital dynamics & School/ work report.
4. Spiritual: Belief system exploring (Over Valued Ideations)

Investigate the Causes in Psychiatry

Like other branches of Medicine,
Investigation is usually multifactorial (BioPsychosocialSpiritual)

Biological

1. Genetic studies
2. Neuroimaging
   • MRI, CT, X-ray
   • PIT
3. Endocrine
   • T3, T4, TSH
4. Biochemical
   • a. WBC, RBC, LFT, U&E
   • b. Drug Blood level / Lithium
5. Metabolic
6. Inflammatory/autoimmune

Psychological

7. Thinking distortions
8. Emotional dysregulation
9. Behavioral problems
10. Behavioral analysis
11. Unconscious conflicts

Social

12. Family / Marital factors:
13. Social support, Emotional Expression criticism, and overprotection
14. Work/School social report
15. Life events:

• Migration, unhappy marriage, problems at work, school and financial issues.

Spiritual

16. Belief Systems
17. Religiosity
18. Spectrum