An Overview of Common Mental Disorders.

Ramkumar G S MDPsychiatry SpecialistCaritas HospitalThallekom, Kottayam.

What are the common mental disorders? What is a mental disorder? Overview of mental disorders.

Definition Characteristics of disorder

What are the common mental disorders?

Epidemiological studies ascertain prevalence.

prevalence rates for psychiatric disorders from 9.5 to 370/1000 populations in India from 16 studies (

Indian J Med Res. 2007 Sep;126(3):183-92. ), Indian J Psychiatry. 2010 Jan;52(Suppl 1) A meta-analysis of 13 psychiatric epidemiological

studies yielded an estimate prevalence rate of 58.2 per thousand population Indian Journal of Psychiatry. 1998 vol. 40 (2) p. 149

The national prevalence rates for 'all mental disorders' arrived at are 70.5 (rural), 73 (urban) and 73 (rural + urban) per 1000 population.(15 studies) Indian Journal of Psychiatry. 2000 vol. 42 (1) p. 14

Mental illness http://www.mayoclinic.org/

Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors.

Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.

A mental illness can make you miserable and can cause problems in your daily life, such as at work or in relationships. In most cases, symptoms can be managed with a combination of medications and counseling (psychotherapy).

Mental disorder DSM 5

"A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.

Mental disorders are usually associated with significant distress in social, occupational, or other important activities.

An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above."

Severe Mental illness…Psychosis Minor mental illness….Neurosis

Indian Journal of Psychiatry. 1998 vol. 40 (2) p. 149

Organic psychosis (0.4), Schizophrenia (2.7), Affective disorders (12.3) contributed a rate of 15.4 for psychoses. (severe

mental illness)

Mental retardation (6.9), epilepsy (4.4), neurotic disorders (20.7), alcohol/drug addiction (6.9) and miscellaneous group (3.9)

Affective disorders (Bipolar and related disorders) Manic depressive disorder. Mania. Distinct period of abnormally and

persistently elevated, expansive or irritable mood…. inflated self esteem, decreased need for sleep, more talkative, flight of ideas, distractibility, increase in goal directed activities, excessive involvement in activities that have a high potential for painful consequences.

Depression

Depressed mood. Diminished interest or pleasure. Significant wt loss. Insomnia/hypersomnia Psychomotor/ agitation or retardation. Fatigue. Felling of worthlessness and inappropriate guilt. Diminished ability to think or concentrate. Recurrent thoughts of death.

Responses to significant loss, Grief etc may have feelings of intense sadness, rumination about loss, insomnia, poor appetite and weight loss which may resemble a depressive episode.

Different types of Biplor disorders.

Schizophrenia Spectrum and other Psychotic Disorders Schizophrenia.Abnormalities in one or more of the five

domains: Delusions, Hallucinations, Disorganised thinking (speech) Grossly disorganised or abnormal motor

behaviour (including catatonia), Negative symptoms.

Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. (Delusion vs a strongly held idea)

Hallucinations are perception-like experiences that occur without an external stimuli.

Delusional disorders

Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre of odd.

Erotomaniac type, grandiose type, jealous type, Persecutory type, Somatic type…

Childhood disorders (Neurodevelopmental disorders) Intellectual disability. Autism spectrum disorder. Specific learning disorder. ADHD. Oppositional Defiant disorder. Conduct disorder.

Intellectual disability (intellectual development disorder) Intellectual and adapt function deficits in

conceptual, social, and practical domains. Clinical assessment with standardized

testing.

Autism spectrum disorder

Deficits in social communication and social interaction

Restricted, Repetitive pattern of behavior, interests, activities.

Attention-Deficit/Hyperactivity disorder

Persistent pattern of inattention and/or hyperactivity-implusivity

Specific Learning disorder (SLD)

Difficulties learning and using academic skills.

School reports and psychoeducational assessment in addition to clinical assessment.

Oppositional defiant disorder.

Angry/irritable mood. Argumentative/defiant behavior. Vindictiveness.

Conduct disorder

Persistent pattern of behavior in which basic rights of others or major age-appropriate societal norms or rules are violated.

Aggression to people or animals. Destruction to property. Deceitfulness or theft. Serious violation of rules.

Late life disorders

Dementia (neurocognitive disorders). Behavioral and psychological symptom of

dementia (BPSD) Delirium.

Neurotic disorders.

Anxiety. Depression. OCD Adjustment disorder. Somatic symptom disorder. Dissociative disorder

Depressive disorders.

Major depressive disorder. Persistent depressive disorder (dysthymia) Premenstrual dysphoric disorder. Depressive disorder due to medical condition.

Anxiety disorders

Share features of excessive fear, anxiety and related behavioral disturbances.

Fear is an emotional response to real or perceived imminent threat.( autonomic arousal of fight or flight, thoughts of immediate danger and escape behavior)

Anxiety is anticipation of future threat. (muscle tension, vigilance in preparation of future danger and cautious or avoidant behavior)

Social phobia. Panic disorder. Generalized anxiety disorder. Specific phobia. Separation anxiety disorder and elective

mutism in children

Genealised Anxiety Disorder

Excessive anxiety and worry (apprehensive expectation)

Difficult to control worry Restlessness or feeling on the edge, Being

easily fatigued, Difficulty concentrating, Irritability, Muscle tension, sleep disturbance.

Cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

Obsessive-Compulsive and Related Disorder. Obsessions are persistent unwanted

thoughts. Compulsions are repetitive behaviors Cleaning , symmetry, forbidden or taboo

thoughts, harm thoughts.

Acute stress disorder. Adjustment disorder. Dissociative disorder. Somatic symptom disorder/ hypocondriasis. Illness anxiety disorder/ health anxiety. Sexual dysfunctions…delayed ejaculation,

premature ejaculation, erectile disorder, Genito-pelvic/penetration disorder

Conversion disorder (Functional Neurological symptom disorder) Symptoms of altered voluntary motor or

sensory function. Incompatibility between the symptom and

recognized neurological or medical conditions.

Psychogenic

Substance Use Disorders.

Cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.

Underlying change in brain circuits.

Symptom cluster in substance use disorders. Impaired control, social impairment, risky use, pharmacological

criteria.

Alcohol use disorder

Alcohol taken in large amounts over longer period. Persistent desire or unsuccessful efforts to cut down or control A great deal of time spent in activities related to alcohol. Craving or strong desire. Failure to fulfill major role obligations Continues use despite harm in social or interpersonal sphere Other activities given up for alcohol related activities. Continued use despite physical or psychological harm Tolerance Withdrawal

Personality disorders. Other conditions that may be a focus of

clinical attention like relational problems, abuse, neglect, Partner violence, educational and occupational problems

Mental healthcare priorities need to be shifted from psychotic disorders to common mental disorders

and from mental hospitals to primary health centers. Increase in invisible mental problems such as

suicidal attempts, aggression and violence, widespread use of substances, increasing marital discord and divorce rates emphasize on the need to prioritize and make a paradigm shift in the strategies to promote and provide appropriate mental health services in the community.

Indian J Psychiatry. 2010 Jan;52(Suppl 1)