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Mental Illness

Mental Illness. Historical Views of Disorders. Mental disorders have always been with us but their treatment has varied: Hippocrates said mental illness arises in the brain. Arab physicians established humane asylums – Moslems believed Allah speaks through the mentally ill.

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Mental Illness

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  1. Mental Illness

  2. Historical Views of Disorders • Mental disorders have always been with us but their treatment has varied: • Hippocrates said mental illness arises in the brain. • Arab physicians established humane asylums – Moslems believed Allah speaks through the mentally ill. • Middle ages -- demon possession requires exorcism, madness was contagious.

  3. Religious Views • Medical diseases might affect the body but the mind belongs to God. • Institutions for the mentally ill created. • Imprisoned but not treated. • King George III motivated research to study mental disorders. • Eventually asylums became more humane.

  4. Modern Approaches • After the 1850’s, neuroscientists studied structural consequences of strokes, tumors and brain trauma. • By the 1920’s-30’s, two diseases were eliminated: • Pellagra – niacin deficiency • General paresis (late stage syphillis) • Hope that more disorders would be organic

  5. Disease vs Disorder • Both are malfunctions. • Disease is a specific set of signs and symptoms that are seen together frequently enough to be diagnostic. • Disorder means something is wrong but there is less consistency to its features. • Diseases are disorders but not all disorders are diseases.

  6. Research Approach • Identify abnormalities of both biology and behavior at stages in the progress of a person’s illness. • See whether similar correlations exist in other patients with the same symptoms. • Can people be categorized by their symptoms?

  7. Cellular Dysfunction • Diseases of the brain arise from cellular dysfunction. • Pathology – study of such dysfunctions. • Organic problems: developmental abnormality, inherited metabolic problems, infection, allergy, tumor, inadequate blood supply, injury, scars persisting after recovery.

  8. Functional Disorders • No obvious organic pathology. • Symptoms may be non-physical: • Changes in mood, thinking, social interaction. • Disruption of normal behavior. • Failure to find an organic cause does not mean none exists. • Tourette’s syndrome – once thought to be psychological in origin, now organic.

  9. Diagnostic Tests • Verbal interview of patient or family. • Thorough physical exam testing sensory and motor systems. • Additional tests depending upon the findings of the physical exam. • MRI, CAT, angiogram • Postmortem exam to confirm diagnosis.

  10. Normal vs Abnormal • Everyone experiences intrusions of strange thoughts, peculiarities and eccentricities, mood swings. • These differ in quality and quantity from the mentally ill. • Many patients are distressed by their own behavior or thoughts and feelings.

  11. Degenerative Diseases • A disease in which the disease process is progressive (becomes more severe). • Three of the most frequent and devastating diseases: • Parkinson’s • Huntington’s • Alzheimer’s

  12. Functional Disorders • Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). • Mental status exam – similar questions asked of all patients. • Results compared at different points in treatment. • Seven areas of functioning • Diagnostic batteries

  13. Indicators of Abnormality • Distress • Maladaptiveness – acts in ways that interfere with accomplishing his or her own goals. • Irrationality – inability to communicate with others, inappropriate affect. • Unpredictability – erratic behavior • Unconventionality – violations of social norms • Observer discomfort – threatening others

  14. DSM-IV • Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). • A standardized way to describe a person’s problems: • Research, statistical frequencies (epidemiology) • Insurance purposes • Communication with other professionals.

  15. Depression Video

  16. Mood Disorders (20% in Lifetime) • Unipolar depression (5% in a year) • “Common cold” of psychological problems. • Can be fatal if untreated, due to suicide – 30,000 deaths per year. • Bipolar disorder (manic depression) (1-2%) • Mania – excessive excitement and elation, gradiosity, flight of ideas, distractability. • Hypomania – a milder form of mania that may be associated with increased creativity and productivity.

  17. Treatments of Mood Disorders • ECT (electroconvulsive therapy) – current passed between electrodes on the scalp triggers seizure. • Highly effective, temporary memory disruption. • Psychotherapy – talking treatments • Highly effective, especially combined with drugs • Drug treatments – lithium, antidepressants (tricyclics, SSRI’s, NE-selective reuptake inhibitors, MAO inhibitors), CRH agonists

  18. Anxiety Disorders (15%) • Panic disorder – a feeling of panic that has no connection with events (2% of population). • Agoraphobia (5%) • Phobic disorders – irrational fear of a specific object, activity or situation. • Preparedness – easier to develop spider phobia • Obsessive-Compulsive Disorder (OCD) – unwanted thoughts and behaviors or tics (2%). • Compulsions – rituals that reduce anxiety.

  19. Treatment of Anxiety Disorders • Psychotherapy – addresses the learning component. • Success rates > 95%. • Anxiolytic medications: • Benzodiazepine (e.g., valium) – increase GABA effectiveness resulting in greater inhibition. • SSRI’s (prozac) – increase effectiveness of serotonin.

  20. Schizophrenia (1%) • Personality disintegrates and perception is distorted, affective symptoms. • Types: • Catatonic – remain motionless and rigid, or becomes agitated and hyperactive. • Paranoid – delusions and hallucinations. • Disorganized – incoherent speech, hallucinations, delusions, bizarre behavior. • Undifferentiated – anything not classified above.

  21. Schizophrenic Symptoms • Positive symptoms: • Delusions • Hallucinations • Bizarre behavior. • Negative symptoms: • Social withdrawal • Impaired thought processes • Lack of affect or inappropriate affect • Positive symptoms controlled by drugs.

  22. Treatment of Schizophrenia • Neuroleptic drugs block dopamine receptors and prevent positive symptoms. • Atypical neuroleptics – not clear how they work – reduce negative symptoms. • PCP produces similar symptoms by reducing NMDA receptors (inhibition), so dopamine is not the whole story. • Psychosocial support important treatment.

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