Mental HealthIdentification and Diagnosis

Normal? Statistically? Functionally?

Normal? Statistically?

Abnormality – a working definition Abnormality – pattern of thoughts feelings

and behaviours that are deviant, distressing and dysfunctional

Serial killer Ted Bundy who brutally murdered between 30 and 35 women during the 1970’s fits our definition of abnormality

Mental Health

Mental health = capacity to interact with others, cope effectively with problems and stress

Mental Health Problem = temporary and mild condition

Mental Health Illness = more severe and likely to persist for a long time

Mental Illness/Dysfunction

Mental Illness can sometimes be referred to as a psychological dysfunction experienced by an individual and usually involving :

- Emotional distress- Impairment in the ability to cope with

everyday life- Thoughts, feelings and/or behaviour that are

not typical of the person or appropriate within their society and/or culture

Is it common? YES!

Of 18 – 65 year olds almost 45% have experienced a mental illness within their lifetime!

20% had experienced a mental illness within the last 12 months

1 in 5 people at any given time Almost half of us at least once in our life time

Gender Differences Males more at risk of substance abuse

Females more at risk of anxiety disorders

Psychotic Vs non-psychotic Most people do not suffer from psychotic

illnesses A person suffering from psychosis is

experiencing a marked loss of contact with reality

Delusions Halucinations

Non psychotic illnesses are far more common, E.g. Depression, anxiety, substance abuse

Systems of Classification of Mental Disorders

Categorical approaches – organises mental disorders into categories,

each with specific symptoms and characteristics.

Diagnosis involves a comparison of patients symptoms to the listed symptoms within each category

Check your patients list against the lists in the DSM-IV to find a fit – then make diagnosis

You either have a mental illness or you dont1

Systems of Classification of Mental Disorders

Dimensional approaches – classifies symptoms quantitatively Diagnosis involves asking how much of

a characteristic is normal, numerical values are assigned to each characteristic score

Measure all characteristics and the combination of scales that are statistically extreme might point to the type of illness being suffered

Which is best? Often both are used

Categorical approach used to classify the symptoms

Dimensional approach used to determine the severity of these symptoms

DSM IV: Diagnostic & Statistical Manual of Mental Disorders (4th Edition)

Since 1952 – revised many times System for classifying disorders Outlines and describes the symptoms How common the disorder is The degree of impairment How it will develop or progress DOES NOT suggest cause

DSM – IV - TR

365 disorders comprehensively described (one for every day of the year!)

Grouped into 16 categories

Inclusion criteria – symptoms that must be present for diagnosis

Exclusion criteria – symptoms that must not be present

Polythetic criteria – only some symptoms not all need to be present for diagnosis – eg. 3 of 8

Provides info on the typical course of the disorder

DSM IV: AXIS

1. CLINICAL DISORDERS2. PERSONALITY DISORDERS & MENTAL

RETARDATION3. GENERAL MEDICAL CONDITION4. PSYCHOSOCIAL AND ENVIRONMENTAL

PROBLEMS5. GLOBAL ASSESSMENT OF FUNCTIONING

CLINICAL DISORDERS

Condition that emerges in infancy or childhood

Cognitive disorders – dementia, amnesia Substance related Schizophrenia and psychotic disorders Mood disorders – depression, bi-polar Anxiety Disorders Somatoform disorders – psychological not

physical Eating Disorders Sleep Disorders

ANXIETY DISORDERS

Feelings of fear, apprehension, anxiety PHOBIAS OBSESSIVE COMPUSIVE DISORDER (OCD) PANIC DISORDER POST-TRAUMATIC STRESS DISORDER (PSTD)

PHOBIASINTENSE, IRRATIONAL FEAR & AVOIDANCE OF A PARTICULAR OBJECT, ACTIVITY OR SITUATION

OCDPREOCCUPIED WITH CERTAIN DISTRESSING THOUGHTS

THUS COMPELLED TO PERFORM CERTAIN BEHAVIOURS OR RITUALS

- OBSESSION = THOUGH

- COMPULSION = ACT/RITUAL

PSTDOCCURS AFTER EXPERIENCING OR WITNESSING A TRAUMATIC EVENT

REPEATEDLY RELIVING THE TRAUMAATIC EVENT

AVOIDING STIMULI ASSOCIATED WITH THIS EVENT

INSOMNIA, NIGHTMARES, LACK OF CONCENTRATION

POST TRAUMATIC STRESS DISORDER

DISSOCIATIVE DISORDERS

FEELINGS OF DEPERSONALISATION (loss of own identity)

MULTIPLE PERSONALITIES MEMORY LOSS

PSYCHOTIC DISORDERS

HALLUCINATIONS DELUSIONS RETREAT FROM REALITY INABILITY TO CONTROL THOUGHTS AND

ACTIONS

SCHIZOPHRENIA

STRIKING CHANGES IN THINKING, BEHAVIOUR & EMOTION

PSYCHOSIS REFERS TO A LOSS OF CONTACT WITH REALITY

- DELUSIONS

- HALLUCINATIONS

- ALL AGES - BOTH SEXES- GENETIC FACTORS- ENVIRONMENT- DRUG USE

(exacerbates the experience of psychosis & increases the release of dopamine in the brain)

Schizophrenia

DISORGANISED: INCOHERANT AND DISORGANISED BEHAVIOUR BIZARRE THINKING INAPPROPRIATE EMOTIONS

CATATONIC: UNRESPONSIVENESS STUPOR, RIGIDITY PURPOSELESS BEHAVIOUR

Schizophrenia

PARANOID: MOST COMMON DELUSIONS: FALSE BELIEF

DEPRESSIVE: BELIEVE NEGATIVE THOUGHTS ABOUT SELF

SOMATIVE: BELIEVE BODY IS ‘ROTTING AWAY’ DELUSIONS OF GRANDEUR: BELIEVE THEY ARE

SOMEONE IMPORTANT PERSECUTIONS: SOMEONE IS OUT TO GET THEM

HALLUCINATIONS: IMAGINARY SENSATIONS EG. HEARING VOICES ETC

PERSONALITY DISORDERS

DEEPLY INGRAINED

UNHEALTHY PERSONALITY PATTERNS

1. ANTISOCIAL PERSONALITY DISORDER2. SOCIOPATH3. PSYCHOPATH

SOCIOPATHSPSYCHOPATHS

LACK CONSCIENCE OR ABILITY TO FEEL REMORSE

CANNOT EMPATHISE OR SYMPATHISE

SELFISH, MANIPULATIVE, EMOTIONALLY SHALLOW/VOID

FAILURE TO CONFORM

ANTISOCIAL PERSONLAITY DISORDER

OTHER CONDITIONS

SLEEP APNOEA NARCOLEPSY BIPOLAR MAJOR

DEPRESSION S.A.D