Unit 619
Understand mental health problems
Describe the main types of mental ill health according to the psychiatric (DSM/ICD) classification system: mood disorders, personality disorders, anxiety disorders, psychotic disorders, substance-related disorders, eating disorders, cognitive disorders
MOOD DISORDERS

BIPOLAR DISORDER
In bipolar disorder, formerly known as manic-depression, there are swings in mood from elation to depression with no external cause. During the manic phase of this disorder, the patient may show excessive, unwarranted excitement or silliness, carrying jokes too far. They may also show poor judgement and recklessness and may be argumentative. They may speak rapidly, have unrealistic ideas, and jump from subject to subject. They may not be able to sleep or sit still for very long. These symptoms are last for a specific period of time lasting for a few days or even a few months. Hospitalization can often be necessary to keep the person from harming themselves and others.
The other side of the bipolar is the depressive episode. Bipolar depressed patients often sleep more than usual and are lethargic. This contrasts with those with major depression, who usually has trouble sleeping and is agitated. During bipolar depressive episodes, a patient may also show irritability and withdrawal. Manic episodes can occur without depression, but this is very rare.
DEPRESSIVE DISORDERS
A person suffering from major depressive disorder is in a depressed mood for most of the day, nearly every day or has lost interest or pleasure in all, or almost all, activities, for a period of at least two weeks. It is not necessary for the person to report feeling depressed to be diagnosed with major depression the presence of depressed mood can be implied from observing the person’s behaviour. Similarly, they may not complain of a loss of interest or pleasure.
Other features include: significant weight change and appetite disturbance (especially loss of appetite), sleep disturbance, slowed movements and speech, restlessness, decreased feelings of energy, feelings of worthlessness, difficulty in thinking or concentrating, indecisiveness, excessive or inappropriate guilt, thoughts of death and suicide or suicide attempts.

Single Episode
Single episode depression is like major depression only it strikes in one dramatic episode. Recurrent depression is an extended pattern of depressed episodes. Depressed episodes can include any of the features of major depressive disorder.

PERSONALITY DISORDERS

PARANOID PERSONALITY DISORDER
A pervasive distrust and suspiciousness of others such that their motives are interpreted beginning in early adulthood and present in a variety of contexts, as indicated by 4 or more of the following:
1. Suspects, without sufficient basis that others are exploiting, harming, or deceiving him or her
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
4. Reads hidden demeaning or threatening meanings into benign remarks or events
5. Persistently bears grudges, i.e., is unforgiving of insults and injuries
6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counter attack
7. Has recurrent suspicions, without justification, regarding fidelity of spouse.

SCHIZOID PERSONALITY DISORDER
A pervasive pattern of detachment from social relationships and a restricted range of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following:
1. Neither desires nor enjoys close relationships, including being part of a family
2. Almost always chooses solitary activities
3. Has little, if any, interest in having sexual experiences with another person
4. Takes pleasure in few, if any, activities
5. Lacks close friends or confidants other than first-degree relatives
6. Appears indifferent to the praise or criticism of others
7. Shows emotional coldness, detachment, or flattened affectivity.

SCHIZOTYPAL PERSONALITY DISORDER
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, beginning by early adulthood and present in a variety of contexts as indicated by 5 or more:
1. Ideas of reference (excluding delusions of reference)
2. Odd beliefs or magical thinking that influences behaviour and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy or bizarre fantasies or preoccupations
3. Unusual perceptual experiences, including bodily illusions
4. Odd thinking and speech
5. Suspiciousness or paranoid
6. Inappropriate or constricted affect
7. Behaviour or appearance that is odd eccentric or peculiar
8. Lack of close friends or confidants other than first degree relatives
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

ANTISOCIAL PERSONALITY DISORDER
There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by 3 or more of the following:
1. Failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. Impulsivity or failure to plan ahead
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. Reckless disregard for safety of self and others
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations
7. Lack of remorse. As indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
The individual is at least 18 years old
There is evidence of Conduct Disorder with onset before age 15 years
The occurrence is not during Schizophrenia or Manic Episode.

BORDERLINE PERSONALITY
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and a marked impulsiveness beginning by early adulthood and present in a variety of contexts, as indicated by 5 of the following:
1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly & persistently unstable self-image or sense of self
4. Impulsivity in a least 2 areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating (not including # 5 items)
5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
6. Affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety usually lasting a few hours & rarely days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent fights)
9. Ttransient, stress related paranoid ideation or severe dissociative symptoms.

HISTRIONIC PERSONALITY DISORDER
A pervasive pattern of excessive emotionality and attention seeking, beginning in early adulthood and present in a variety of contexts, as indicated in 5 or more of the following:
1. Is uncomfortable in situations in which he/she is not in the centre of attention
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behaviour
3. Displays rapidly shifting and shallow expression of emotions
4. Consistently uses physical appearance to draw attention to self
5. Has a style of speech that is excessively impressionistic and lacking in detail
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion
7. It is suggestible, i.e. easily influenced by others or circumstances
8. Considers relationships to be more intimate than they actually are.

NARCISSISTIC PERSONALITY DISORDER
A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more of the following: 1. Has a grandiose sense of self- importance ( exaggerates achievements, and talents, expects to be recognized as superior ) 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love) 3. Believes he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people or institutions 4. Requires excessive admiration 5. Has a sense of entitlement, i.e., unreasonable expectations of especially favourable treatment or automatic compliance with his/her expectations 6. Is interpersonally exploitive, i.e., takes advantage of others to achieve his or her own ends 7. Lacks empathy: is unwilling to recognize or identify with the feelings of others 8. Is often envious of others or believes that others are envious of him or her 9. Shows arrogant, haughty behaviours or attitudes. AVOIDANT PERSONALITY DISORDER
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following: 1. Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection 2. Is unwilling to get involved with people unless certain of being liked 3. Shows restraint within intimate relationships because of fear of being shamed or ridiculed 4. Is preoccupied with being criticized or rejected in social situations 5. Is inhibited in new interpersonal situations because of feelings of inadequacy 6. Views self as socially inept, personally unappealing, or inferior to others 7. Is usually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

DEPENDENT PERSONALITY DISORDER
A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation, beginning by early adulthood & present in a variety of contexts, as indicated by 5 or more of these: 1. Has difficulty in making everyday decisions without an excessive amount of advice and reassurance from others 2. Needs others to assume responsibility for most major areas of his/her life 3. Has difficulty expressing disagreement with others because of fear of loss of support or approval 4. Has difficulty initiating projects or doing things on his/her own 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself 7. Urgently seeks another relationship as a source of care and support when a close relationship ends 8. Is unrealistically preoccupied with fears of being left to take care of himself

OBSESSIVE-COMPULSSIVE PERSONALITY DISORDER
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, & efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following: 1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost 2. Shows perfectionism that interferes with task completion ( unable to complete a project because his or her own overly strict standards are not met) 3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships 4. Is over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification) 5. Is unable to discard worn-out or worthless objects even when they have no sentimental value 6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things 7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes 8. Shows rigidity and stubbornness.

ANXIETY DISORDERS

GENERALISED ANXIETY DISORDER
Generalised anxiety disorder (GAD) is characterised by anxiety symptoms that are present for much of the time and not restricted to specific situations.
Generalised anxiety often accompanies phobias and is extremely common in people who are depressed. It can also be caused by physical illness, such as an overactive thyroid gland, or result from the emotional response to a serious illness such as a heart attack.
Some 15 per cent of people with GAD have a brother, sister or parent with a similar problem. This may reflect an inherited tendency to the disorder or the effects of the family environment. Two thirds of sufferers are women.

PANIC DISORDER
In panic disorder, repeated panic attacks occur unpredictably and often without obvious causes. The attacks consist of severe anxiety with physical and psychological symptoms.
Physical symptoms can include any of the general symptoms of anxiety described above and often the hyperventilation syndrome.
Psychological symptoms typically include dread (particularly of extreme events such as dying), having a seizure, losing control or 'going mad'.
To the sufferer, the attacks feel as if they are going on for a long time, but actually they tend to last only a few minutes, and at their longest they last around an hour. Panic disorder is common in depression, GAD or agoraphobia.

PHOBIC DISORDERS
A phobia is a fear that is out of proportion to the situation that causes it and cannot be explained away. The person typically avoids the feared situation, since this helps to reduce the anxiety.
Some phobias represent heightened normal anxiety towards situations that people are evolutionarily 'prepared' to fear, e.g. snakes, heights and sharp objects.
In other instances, a phobia may arise by a non-threatening situation being associated with a traumatic experience. Having a car crash in Spain may lead to a phobia of Spain itself, holidays, driving or flying.
Phobias typically occur in specific situations, e.g. a fear of dentists. People experience 'anticipatory anxiety' when thinking of the situation and so attempt to avoid it. They are common in the general population, but are only severe enough to prove disabling in 2 per cent of people.
Simple phobias are phobias that are specific to objects or situations. Specific phobias include:
Animal phobias the start of these phobias is often in childhood, usually before the age of seven years.
Blood and injury phobias: the fear of blood tests or the sight of blood that results in fainting.
Vertigo: a fear of heights.
Agoraphobia: an intense fear of leaving the home, being in crowded spaces, travelling on public transport and being in any place that is difficult to leave. Around 75 per cent of sufferers are women, and it occurs in just under 1 per cent of people. Agoraphobia may follow a life event and be associated with a fear of 'what if it comes back while I am away from home'. It commonly occurs with panic attacks. The person may have a panic attack when outside the home and this reinforces the belief that it is safer to stay inside. Agoraphobia is often associated with depression.

SOCIAL PHOBIA
A fear of social interaction with others, talking to people, eating, drinking and speaking in public. In contrast to agoraphobia, men and women are affected equally. Many people have a mixture of both agoraphobia and social phobia. Social phobia is also a common symptom of depression.

OBBSESIVE COMPULSIVE DISORDER
Obsessive-compulsive disorder (OCD) is a relatively rare disorder.
While many people (14 per cent of the general population) have minor obsessional symptoms, OCD itself occurs in between one and three per cent of the population. Men and women are equally affected. It frequently comes on in adolescence, but often people do not go to their GP for help for many years.
An increase in obsessional symptoms can occur in depression, though full-blown OCD is still rare.
The symptoms are somewhat different to other anxiety disorders and include:
Obsessional thoughts that come repeatedly into the person's mind, despite him or her trying to stop them. They are unpleasant and often abhorrent. The thoughts are clearly recognised by the person as being their own. Trying to stop the thoughts causes other anxiety symptoms. obsessional thoughts may include a fear of dirt or germs, doubting that something important has been done (such as locking the door, turning the lights off) or unpleasant and graphic images in the mind of harming others or themselves. People who are suffering from OCD tend not to carry out any of the unpleasant thoughts they are having, though they usually fear they will.
Compulsive acts (obsessional acts) are repetitive actions based on the obsessional thoughts. A person with obsessional thoughts about dirt may spend long periods cleaning the house and washing their hands. These actions are not pleasurable, but they help to reduce the anxiety associated with the obsessional thoughts.
The compulsive actions often have a 'magical quality', e.g. a person must check the door is locked exactly seven times, no more or less. If they are unsure how many times they have checked, they may start all over again. In severe cases, sufferers may spend many hours of the day undertaking these acts so that they have no time for anything else.
Evidence from brain scan studies shows altered brain function in people with OCD – some parts of the brain are underactive, others overactive.
Inherited factors can play a role in the development of the disorder, but otherwise we have few ideas about what are the biological or psychological causes of OCD.

STRESS-RELATED DISORDERS
There are a number of psychological consequences to major stressful events and these often include symptoms of anxiety. There are three types of reactions:
Acute stress reaction starts within minutes (if not immediately) of the stressful event. It also tends to resolve rapidly, once the person is able to get out of the stressful situation. Symptoms are mixed, with the person first appearing dazed and disorientated. In addition, other symptoms of anxiety, anger and withdrawal can occur.
Adjustment reaction starts within one month of the stressful event, and symptoms tend to resolve within six months. They may include depression, anxiety, irritability and a feeling of being unable to cope. Grief for the loss of a loved one can be seen as a combination of an acute stress reaction in the early stages, followed by an adjustment reaction.
Post-traumatic stress disorder (PTSD) tends to come on weeks, or even months, after a stressful event that was of an exceptionally threatening or catastrophic nature, which would cause distress in almost anyone. It can persist for years. Symptoms include flashbacks (vivid memories of the event), nightmares, avoiding anything associated with the stressful event and being on edge. In addition, sufferers often experience generalised anxiety, panic disorder, depression, guilt (of surviving) and blunting of their emotions.

PSYCHOTIC DISORDERS
Schizophrenia: People with this illness have changes in behaviour and other symptoms -- such as delusions and hallucinations -- that last longer than six months, usually with a decline in work, school, and social functioning.

SCHIZOAFFECTIVE DISORDER People with this illness have symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder.

SCHIZOPHREIFORM DISORDER People with this illness have symptoms of schizophrenia, but the symptoms last between one and six months.

BRIEF PSYCHOTIC DISORDER
People with this illness have sudden, short periods of psychotic behaviour, often in response to a very stressful event, such as a death in the family. Recovery is often quick -- usually less than a month.

DELUSIONAL DISORDER People with this illness have delusions involving real-life situations that could be true, such as being followed, being conspired against, or having a disease. These delusions persist for at least one month.

SHARED PSYCHOTIC DISORDER
This illness occurs when a person develops delusions in the context of a relationship with another person who already has his or her own delusion(s).

SUBSTANCE-INDUCTED PSYCHOTIC DISORDER This condition is caused by the use of or withdrawal from some substances, such as alcohol and crack cocaine, that may cause hallucinations, delusions, or confused speech.
Psychotic disorder due to a medical condition: Hallucinations, delusions, or other symptoms may be the result of another illness that affects brain function, such as a head injury or brain tumour.

PARAPHRENIA This is a type of schizophrenia that starts late in life and occurs in the elderly population.

SUBSTANCE-RELATEDED DISORDERS

SUBSTANCE DEPENDANT
A pattern of substance use that leads to significant impairment or distress in three (or more) of the following ways:
Tolerance, as defined by either
A need for markedly increased amounts of the substance to achieve the desired effect, or
A markedly diminished effect with continued used of the same amount of the substance
Withdrawal symptoms characteristic for the substance, or increased use to relieve or avoid withdrawal symptoms
The substance is taken in larger amounts or over a longer period than intended
A persistent desire or unsuccessful efforts to cut down or control substance use
Much time is spent in activities to obtain the substance, use the substance, or recover from its effects
Important social, occupational, or recreational activities are given up or reduced
The substance use is continued despite it causing a persistent or recurrent physical or psychological problem (e.g., current cocaine use despite recognition of cocaine-induced depression)

SUBSTANCE ABUSE
A pattern of substance use that leads to significant impairment or distress in one (or more) of the following ways:
A failure to fulfill major role obligations at work, school, or home
Recurrent substance use in situations in which it is physically hazardous
Recurrent substance-related legal problems
Continued substance use despite having persistent or recurrent social or interpersonal problems caused or worsened by the effects of the substance

EATING DISORDERS

ANOREXIA NERVOSA
(AN), characterized by refusal to maintain a healthy body weight, an obsessive fear of gaining weight, and an unrealistic perception of current body weight. However, some patients can suffer from Anorexia nervosa unconsciously. These patients are classified under "atypical eating disorders". Anorexia can cause menstruation to stop, and often leads to bone loss, loss of skin integrity, etc. It greatly stresses the heart, increasing the risk of heart attacks and related heart problems. The risk of death is greatly increased in individuals with this disease.

BULIMIA NERVOSA
(BN), characterized by recurrent binge eating followed by compensatory behaviors such as purging (self-induced vomiting, excessive use of laxatives/diuretics, or excessive exercise). Fasting and over exercise may also use as a method of purging following a binge.

BINGE EATING DISORDER
(BED) or 'compulsive overeating', characterized by binge eating, without compensatory behavior. This type of eating disorder is even more common than Bulimia or anorexia. This disorder does not have a category of people in which it can develop. In fact, this disorder can develop in a range of ages and is unbiased to classes.

COMPLUSIVE OVEREATING (COE) characteristic of binge eating disorder, in which people tend to eat more than necessary resulting in more stress. This is mainly caused by 'binge eating disorder'.

PURGING DISORDER
Characterized by recurrent purging to control weight or shape in the absence of binge eating episodes.

RUMINATION
Characterized by involving the repeated painless regurgitation of food following a meal which is then either re-chewed and re-swallowed, or discarded.

DIABULIMIA
Characterized by the deliberate manipulation of insulin levels by diabetics in an effort to control their weight.

FOOD MAINTAINANCE
Characterized by a set of aberrant eating behaviors of children in foster care.

COGNITIVE DISORDERS

DELIRIUM
Delirium is a disorder that makes situational awareness and processing new information very difficult for those diagnosed. It usually has a high rate of onset ranging from minutes to hours and sometimes days, but it does not last for very long, only a few hours to weeks. Delirium can also be accompanied by a shift in attention, mood swings, violent or unordinary behaviors, and hallucinations. It can also be fatal if it is caused by a preexisting medical condition. Delirium during a hospital stay can result in a longer stay and more risk of complications and long terms stays.

DEMENTIA
Dementia is known as a genetic or trauma induced disorder that erases part or all of the patient’s memory. It is usually associated with but not restricted to the elderly. It is also usually accompanied by another cognitive dysfunction. For non-reversible causes of dementia such as age, the slow decline of memory and cognition is lifelong. It can be diagnosed by screening tests such as the Mini Mental State Examination (MMSE).

AMNESIA
Amnesia patients have trouble retaining long term memories. Difficulty creating recent term loss of memories is called anterograde amnesia and is caused by damage to the hippocampus part of the brain which is a major part of the memory process. Retrograde amnesia is also caused by damage to the hippocampus but the memories that were encoded or in the process of being encoded in long term memory are erased.