Psychiatry: Local and Global

Recommended Prerequisites

Basic knowledge of the prevalence, impact and phenomenology of self-destructive behaviors.

Basic notions of nature-nature relations, genetics and environment.

Basic notions of stigma and disease.

Basic notions of the history of psychiatry in Portugal.

Teaching Methods

Lectures with student’s participation.

PowerPoint presentations, videos and other pedagogical materials.

Learning Outcomes

To identify parasuicidal and suicidal behaviors through History, Sociology and Anthropology. To recognize theoretical contribution of social sciences inside the suicidal phenomenon. To recognize basic clinic elements in order to evaluate and understand the self-destructive behaviors. To recognize a complex interaction between genes and environment.

To learn about the integrative pluralism concept.

 

To understand both variation and social stigma, applied to diseases.

To recognize the subjective experience and the social impact of stigma associated with the disease.

To evaluate the importance and the effects of social stigma in doctor-patient relation.

How to reduce social stigma in a clinic and social perspective.

 

Important facts regarding Portuguese and foreign Psychiatric History.

Critical assessment of the contributions brought about by the anti-psychiatric movement.

Identification of the key players from the alienist movement.

Recognition of Psychiatry as an emerging medical discipline.

 

Global mental health (Professor Vikram Patel)

This course is directed towards the acquisition of concepts related to global social determinants of health and, in particular, mental health. Its objectives convey the importance of stress and experiencing early adversities; underline the impact of poverty, exclusion and social inequities; and contemplate aspects related to the social costs of inequality, influencing social relations, the mental health of the population, medium life expectancy, the chances of providing life-long education, violent behaviors, etc. in different societies. Thus, students are expected to gather the required skills for critically exploring and researching health and disease determinants from a global perspective.

 

Social and cultural psychiatry: past, present, future (Professor Manuel Quartilho)

To define the origins and the historical evolution of social and cultural psychiatry. To identify the main lines of research from the past and present. To explore research hypothesis on contemporary societies.

Work Placement(s)

No

Syllabus

Suicidal behaviors (Professor Carlos Saraiva)

1. Concepts – from sociology to psychiatry. 2. History, philosophy and law. 3. Epidemiology, research and risk factors. 4. Biological and Psychological models. 5. Parasuicide. 6. Psychopathology. 7. Clinical cases. 8. Treatment and prevention.

 

Genetics and Environment: mechanisms of the cultural-biological interface (Professor António Macedo)

Mental diseases are becoming increasingly relevant due to their financial burden on society and the disability and pain they bring to those who suffer from them. Thus, the etiological research of psychiatric and behavioral disorders is raising great interest and undertaking a great development – particularly as regards its biological aspect – in the search of more effective therapeutic alternatives. Since the most relevant psychiatric diseases, namely psychosis and affective disorders, present a high degree of heredity, the investment made in the genetic studies of such pathologies has been significant. However, it is becoming increasingly evident that the final clarification of the phenotypic variation of mental diseases will not result of an exclusive explanation, whether genetic or otherwise. Mental diseases result from complex changes in an equally complex and integrative system. This means the properties of the central nervous system, whether in health or illness, are not entirely deductible by a reducible study of its parts. Explaining mental illnesses requires a full understanding of the integration of multiple levels and processes, including molecular processes (e.g. genetic; biochemical) and specially the mechanisms of interaction between these and environmental factors – which is called integrative pluralism. In this module, we will seek to demonstrate the state of the art of genetics research in psychiatry, while emphasizing interaction mechanisms and the correlation between genetic features and sociocultural factors.

 

Social stigma and mental disease

1. The stigma of mental disease in a historical perspective.

2. The importance of the present fight against stigma in mental health.

3. Strategies to develop anti-stigma actions, mainly concerning schizophrenia.

 

Portuguese Psychiatry History

1. Introduction. Mental diseases history. Institutions history. Psychiatric sciences and its different models. Psycho and socio-dynamic psychiatry. Anti-psychiatry and Psychiatry History.

2. History of Psychiatry in Portugal. From the early years of Psychiatric Assistance in Portugal until the 19^th century. Psychiatry as a medical specialty. Development and institutionalization of psychiatry in Portugal. Main features of psychiatrists. Key players in psychiatrists. Most current trends in psychiatry and psychopathology.

 

Sociology of Migrations

 

1. Main theories of International Migration

1.1. Theories about the creation of migration movements

1.2. Theories about the development and sustainability of migration flows

 

2. Contemporary migration dynamics in Portugal

2.1. Immigration flows and their regulation

2.2. Emigration flows

 

3. Adaptive processes to the host society

3.1. Assimilation, integration and multiculturalism

3.2. Determinants of integration processes

3.3. Integration dimensions and indexes

 

Identity, Communication and Culture (Professor Pio Abreu)

The importance of communication in forging identity;

Non-verbal communication, with particular emphasis on communication with children.

Verbal communication.

Institutional communication: Social institutions, their symbols and rituals for supporting communication systems.

A selection of socio-communicative systems that organize identity:

1. Linguistic systems; 2. Religious systems and religious or subcultural sects (“beliefs”); 3. Professional systems; 4. Medical systems [the importance of the medical circuit in forging the patient’s identity (or illness behavior)]; 5. Youth subcultures, with special emphasis on music; 6. Local systems (family, neighbors, clubs, social constructions by rumors); 7. Modern media systems (with special emphasis on television and tabloids); 8. The importance of modern media (cellphones, instant messaging, “chats”, internet).

The study of identity and its psychosocial pathologies.

 

Social and cultural psychiatry: past, present, future (Professor Manuel Quartilho)

1. Social Psychiatry

History and definition of Social Psychiatry. The social nature of mental symptoms.

Fundamental social causes of health inequalities.

Social dimensions of clinical practice and theory.

Future: global mental health and public health.

2. Cultural Psychiatry

Concepts of culture.

Comparative psychiatry and colonial background.

Cultural essentialism and ethnocultural diversity.

Contributions made by psychiatric anthropology and psychological anthropology.

Future: globalization, migration and social neuroscience.

 

Global mental health (Professor Vikram Patel)

The concept of “global health”.

Poverty and common mental disturbances in underdevelopment countries.

Basic questions related with global health:

- Contributions made by mental disturbances to disability and mortality.

- Interaction between mental disturbances and other diseases.

Assessment Methods

Continuous
Synthesis work: 100.0%

Bibliography

Carlos Braz Saraiva (1999). Para-Suicídio. Coimbra. Quarteto.

Carlos Braz Saraiva (2006). Estudos sobre o Para-suicídio: O que Leva os Jovens a Espreitar a Morte. Coimbra.

 

Anthony J. (2001): The promise of psychiatric enviromics. British Journal of Psychiatry; 178 (suppl.40), S8-S11.

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Cooper B. (2001): Nature, nurture, and mental disorder: old concepts in the new millennium. British Journal of Psychiatry; 178 (suppl.40), S91-S102.

Dick D. (2011). Gene-Environment Interaction in Psychological Traits and Disorders. Annu. Rev. Clin. Psychol. 7:383–409

Goldberg D. (2001): Vulnerability factors for common mental disorders. British Journal of Psychiatry; 178 (suppl.40), S69-S71.

Kandel E. (1999): A New Intellectual Framework for Psychiatry. Am J Psychiatry ; 155:457–469.

Kendler S., Jaffee S., Romer D. (2008). The dynamic genome and menatl health. The role of genes and environments in youth development. Oxford University Press.

Lewontin R. (1993): The doctrine of DNA – biology as ideology. Penguin Books, London.

MacCabe J., O'Daly O., Murray R., McGuffinP., Wright P. (2006): Beyond Nature and Nurture in Psychiatry: Genes, the Environment, and Their Interplay (European Foundation for Psychiatry at the Maudsley), Informa Healthcare, 2006.

Macedo A., Azevedo M.H. (2001): Os genes que pensam. Editora Quarteto, Coimbra.

Neiderhiser J. (2001): Understanding the roles of genome and envirome: methods in genetic epidemiology. British Journal of Psychiatry; 178 (suppl.40), S12-S17.

Plomin R., DeFries J., McClearn G., Rutter M. (1997): Behavioral Genetics. Third edition, W.H:Freeman and company, New York.

Plomin R., McClearn G. (1993). Nature, Nurture and Psychology. American Psychological Association, Washington.

Rutter M. (2006): Genes and Behavior. Nature-Nurture Interplay Explained. Blackwell Publishing,

Sara R Jaffee, Thomas S Price (2008). Genotype–environment correlations: implications for determining the relationship between environmental exposures and psychiatric illness. PSYCHIATRY 7(12): 496- 499.

Tsuang M., Stone W., Faraone S. (2001): Genes environment and schizophrenia. British Journal of Psychiatry; 178 (suppl.40), S18-S24.

Wilson E. (2004): On human nature. Harvard University Press, Cambridge, Massachusetts.

 

Morgan, G. e Bhugra, D. (2010). Principles of Social Psychiatry. Wiley-Blackwell.

Bhugra, D. e Bhui, K. (2007). Textbook of Cultural Psychiatry. Cambridge University Press.

 

No health without mental health. Lancet

Saxena et al. (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet; 370:878-89

Patel, V. et al. (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. Published online, September 4.

Jacob et al. (2007). Mental health systems in countries: where are we now? Lancet; 370:1061-77

Saraceno, B. (2007). Barriers to improvement of mental health services in low-income and middle-income countries. Published online, September 4

Lancet Global Mental Health Group (2007). Scale up services for mental disorders: a call for action. Published online, September 4.