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Mental health

Mental health. Its all in your head - literally. Normality and abnormality. SOCIO-CULTURAL Behaviour that is accepted in a particular society or culture, but not in others HISTORICAL Behaviour that is accepted, however it depends on the period of time SITUATIONAL

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Mental health

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  1. Mental health Its all in your head - literally

  2. Normality and abnormality SOCIO-CULTURAL • Behaviour that is accepted in a particular society or culture, but not in others HISTORICAL • Behaviour that is accepted, however it depends on the period of time SITUATIONAL • Behaviour that is accepted in a particular situation MEDICAL • Abnormal behaviour has a biological cause and can be diagnosed and treated FUNCTIONAL • Normal behaviour is if the individual can function effectively in society

  3. Abnormal? By which measure?

  4. Abnormal? By Which measure?

  5. Abnormal? By which measure?

  6. Normality and abnormality - statistical • Normal Distribution = behaviour in a large group of individuals that is distributed in a particular way • Statistical Average = the majority that demonstrate this behaviour = normal • Statistical Extremity = the minority that demonstrate this behaviour = abnormal

  7. Normality and abnormality - statistical • Normal behaviour = a characteristic that is common in a large group • Disadvantage: Not everyone is normal or average in all ways. It suggests there are distinct dividing lines between normal and abnormal behaviour. • Central Tendency (average) = most results being in the middle • Mean= average of all the individual scores • Average = add up all the scores / how many scores there are • Median = the middle score of the group • Mode= the most common score • Range = spread of scores between the highest and lowest. • Highest number-lowest number • Standard deviation = the average distance each score falls from the mean

  8. The bell or ‘normal’ curve

  9. Normal? Statistically?

  10. Normal? Statistically?

  11. Abnormality – a working definition • Abnormality – pattern of thoughts feelings and behaviours that are deviant, distressing and dysfunctional Serial killer Ted Bundy fits our definition of abnormality

  12. Mental health Vs mental illness • Mental health – capacity to interact with others, cope effectively with problems and stress • Mental health problem- when the difficulties experienced by a person are mild, temporary and able to be treated within a relatively short period of time • Mental illness – psychological dysfunction that usually involves impairment in coping ability with feeling and behaviours that are atypical and inappropriate within their culture • Mental illnesscan 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

  13. The biopsychosocial framework Mental health and wellbeing depends on a combination of biological, social and psychological factors

  14. Systems of classification of mental disorders • Classification – organising items into groups based on their shared characteristics • 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 • 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

  15. Which is best? • Often both are used • Categorical approach used to classify the symptoms • Dimensional approach used to determine the severity of these symptoms

  16. Categorical approaches

  17. Categorical approaches - assumptions • Assumes that mental disorders can be diagnosed from specific symptoms reported by the patient or observed by the professional • Thoughts feelings and behaviours can be categorised – certain categorisation relates to specific disorders • There are distinct sub categories within each disorder • All or nothing – they either have it or they don’t. You cant kind of have schizophrenia • The system must be valid and reliable

  18. The diagnostic and statistical manual of mental disorders iv-r • The system most widely used by mental health professionals throughout the world to identify and classify mental illnesses for the purposes of diagnosis is the Diagnostic and Statistical Manual of Mental Disorders, or the DSM as it is more commonly called • An important feature of the DSM-IV-TR is that it does not suggest causes of specific disorders unless a cause can be definitely established • It simply names the disorders anddescribes them in specific terms

  19. DSM – IV - TR • 365 disorders comprehensively described (one for every day of the year!) • Grouped into 16 categories • Diagnosis matches patient symptoms to the disorder symptoms • Symptoms are considered characteristics of disorders to looking at these enables diagnosis • 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 0f the following 8 • Provides info on the typical course of the disorder

  20. The diagnostic and statistical manual of mental disorders iv-r • Axis I: clinical disorders Symptoms that cause distress or significantly impair social or occupational functioning (such as anxiety disorders, depression) • Axis II:personality disordersandmental retardation Chronic and enduring problems that generally persist throughout life and impair interpersonal or occupational functioning (such as multiple personality disorder) • Axis III: general medical condition Physical disorders that may be relevant to understanding or treating a psychological disorder • Axis IV: psychosocial and environmental problems (such as interpersonal stressors and negative life events) that may affect the diagnosis, treatment and prognosis (prediction of the course of a disease) of psychological disorders • Axis V: global assessment of functioning The individual's overall level of functioning in social, occupational and leisure

  21. ICD – 10 • Diagnosis and classification of mental disorders based on recognised symptoms • Includes detailed description of each disorder listed • Identifies symptoms that indicate the presence of a disorder • The original text covered all of medical practice • Chapter V covered mental disorders • Chapter V now printed as a separate book • Less detailed than the DSM -IV

  22. Strengths / Weaknesses • Allow diagnosis • Help communication • Historically low inter-reliability • Much better now with DSM-IV-R 70% agreement between mental health professionals • Lots of overlap between symptoms can make diagnosis difficult • Stigma and labelling – Rosenham study!

  23. Dimensional approaches

  24. Dimensional approaches • A dimension viewed as a cluster of related psychological/behavioural characteristics that occur together • Quantifies persons symptoms and other characteristics with numerical values • These values are compared with the statistically ‘normal’ expected values for each characteristic • Lower scores equate to lower impairment • Higher scores equate to higher impairment

  25. THE MMPI

  26. Scales on the MMPI • Hs Hypochondriasis Concern with bodily symptoms • D Depression Depressive Symptoms • HyHysteria Awareness of problems and vulnerabilities • Pd Psychopathic Deviate Conflict, struggle, anger, respect for society's rules • MF Masculinity/Femininity Stereotypical masculine or feminine interests/behaviors • Pa Paranoia Level of trust, suspiciousness, sensitivity • Pt Psychasthenia Worry, Anxiety, tension, doubts, obsessiveness • Sc Schizophrenia Odd thinking and social alienation • Ma Hypomania Level of excitability • Si Social Introversion People orientation

  27. MMPI – the t scores • Asking how different is each score is from the mean score • Is the difference big enough to be significant? • Statistical normality is the key here!

  28. Strengths / Weaknesses • Take into account a wider range of factors than categorical approaches • More detailed information on each symptom – quantifying • Reduced stigma as labelling not used instead a profile is created • There is no standard inventory to compare scores to, thus diagnosis is difficult • Time consuming

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