1.1 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
The main forms of mental ill health can include clinical depression whereby the main signs and symptoms of this may include:
* An unusually sad mood that does not go away
* Loss of enjoyment and interest in activities that used to be enjoyable
* Lack of energy and tiredness
* Loss of confidence in themselves or poor self-esteem
* Feeling guilt when they are not at fault
* Wishing they were dead
* Difficulty in concentrating or making decisions
* Having difficulty in sleeping or sleeping to much
Bipolar is a specific type of depression this is where a person may have an episode of depression followed by an episode of mania. Mania is the opposite of depression. A person experiencing mania may be:
* overconfident and full of ideas
* be very talkative
* find it difficult in sticking to one subject when they are talking
* be full of ideas
* have less need for sleep
* take risks they normally wouldn’t
Anxiety disorders differ from day to day anxiety as they are more severe, it is long-lasting and it interferes with the persons work or relationships. Some specific types of anxiety disorders can include:
Generalised Anxiety Disorder (GAD)
The main symptom of this is overwhelming anxiety and worry, commonly about things that may go wrong or a persons inability to control a situation, even when there are no signs of trouble. Physical symptoms of GAD include a fast or pounding heart, headaches and inability to relax. Psychological symptoms include excessive worry, feeling on edge, difficulty concentrating and sleep disturbances. After GAD has been present for a while a person may have inability making decisions that would normally be easy and may continually seek reassurance about everyday matters.
A panic attack is where a person has a sudden onset of intense apprehension, fear or terror. The intense fear is inappropriate for the situation they are in and the attacks can begin and develop rapidly. A person experiencing a panic attack will develop several of the following symptoms at the same time:
* increased awareness of heart beat
* trembling or shaking
* feeling of choking, shortness of breath or breathing
* chest pain or discomfort, nausea or abdominal distress
* feeling of unreality or detachment of ones surroundings
* feeling dizzy
* fear of losing control or going crazy
* fear of dying
Someone experiencing phobias may avoid or restrict activities because they have a specific fear. This appears persistant, excessive and unreasonable. Agrophobia involves the avoidance of certain situations because of fear of a panic attack. Social phobia is the fear of any situation whereby public scrutiny may be possible. People may also have specific phobias of certain thing such as spiders etc. these are less disabling than social phobias etc as they involve only a specific situation.
Acute Stress Disorder and PTSD
Acute stress disorder and PTSD may develop after a distressing or catastrophic event. The event may involve actual or threatened death or serious injury or abuse, or possibly after witnessing such an event. In acute stress disorder the symptoms will begin to fade in a month whereby in PTSD the symptoms will continue for longer. Some of the symptoms of Acute Stress Disorder and PTSD may include: * re-experiencing the trauma
* anxiety in situations that bring back memories of the trauma
* avoidance behaviour
* emotional numbing – a person may experience changes in how happiness and/or sadness is experienced and being less able to experience a full range of emotions
* reduced interest in others and how the outside world is experienced
* persistant increased awareness
* Obesessive-Compulsive Disorder (OCD)
OCD can be described as obsessional thoughts and compulsive behaviours accompying the feelings of anxiety. Obsessional thoughts are recurrent thoughts, impulses or images that the person can’t dispel. These thoughts are inappropriate and unwanted and cause increased anxiety in the person. Compulsive disorders are repetitive behaviours or mental activity. It may not be possible to realise that person is engaging in compulsive behaviour as some of the symptoms may be happening internally such as silently repeating words. A person may feel compelled to behave in this way in order to reduce feelings of anxiety.
Eating disorders are often, but not always, associated with low self-esteem. They can also be thought of as a class of anxiety associated with OCD. Some forms of eating disorders can include:
* Anorexia Nervosa
This includes controlling the body weight by restricting the calorie intake. It can be associated with a negative body image, although some people with anorexia report that they do not care about their image but still starve themselves. This is partly due to the way a bodies chemicals react in a starved person. Anorexia also becomes self-perpetuating. When a body has been denied calories for a long time then the ‘heavy after eating feeling’ may persist for longer and can be more unpleasant. This can make an anorexic person physically ill.
* Bulimia Nervosa
Bulimia can be described as the eating of lots of food the purging or fasting or lots of exercising. The purging can be in the form of vomiting up the food or by the use of laxatives.
* Binge Eating
This is excessive eating but with no compensating behaviour, this is a relatively new disorder added to the Diagnoses and Statistical Manual of Mental Disorders in 1994.
Psychotic disorders can be described as a mental health disability in which a person experiences changes in thinking, perception, mood and behaviour which can severely disrupt their lives. Some of the main psychotic disorders include schizophrenia, bipolar disorder, psychotic depression, schizo affective disorder and drug induced pychosis. Some common symptoms when a psychotic disorder is developing include depression, anxiety, irritability, suspiciousness, blunted or flat or inappropriate emotion, changes in appetite, changes in thinking, difficulties in concentration or attention, a sense of alteration to ones self or the outside world, odd ideas and unusual perceptual experiences. Some behavioural symptoms can include sleep disturbance, social isolation or withdrawal and/or reduced ability to carry out work and social roles.
Some specific personality disorders include paranoid personality disorder, schizoid personality disorder, dis-social personality disorder, impulsive type emotionally unstable personality disorder and borderline type emotionally unstable personality disorder. Unspecified personality disorders and mixed personality and troublesome personality disorders are also included.
Substance related disorders include mental and behavioural disorders due to use of alcohol, opioid, cannabis, sedatives or hypnotics, cocaine, tobacco, stimulants such as caffeine, multiple drug use and use of other psychoactive substances.
In order for a mild cognitive disorder to be diagnosed then the general criteria of section F06 of the ICD classification system need to be met, as well as cognitive dysfunction for most of the time for at least two weeks. A person with this disorder may have difficulties in new learning, memory, concentration and thinking, as well as various other physical and psychological signs and symptoms.
The International Classification of Diseases (ICD) is an international standard diagnostic classification for all general epidemiological and many health management purposes, published by WHO (World Health Organisation). It is now in its tenth revision.
The ICD includes personality disorders on the same domain as other mental disorders. Unlike the DSM the ICD-10 states that mental disorder is “not an exact term”, although is generally used “…to imply the existence of a clinically recognisable set of symptoms or behaviours associated in most cases with distress and with interference with personal functions.” (WHO, 1992).
The ICD consists of 10 main groups:
: Organic, including symptomatic, mental disorders
: Mental and behavioural disorders due to use of psychoactive substances
: Schizophrenia, schizotypal and delusional disorders
: Mood [affective] disorders
: Neurotic, stress-related and somatoform disorders
: Behavioural syndromes associated with physiological disturbances and physical factors
: Disorders of personality and behaviour in adult persons
: Mental retardation
: Disorders of psychological development
: Behavioural and emotional disorders with onset usually occurring in childhood and adolescence In addition, a group of “unspecified mental disorders”.
The DSM-IV, produced by the American Psychiatric Association, characterizes mental disorder as “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual,…is associated with present distress…or disability…or with a significant increased risk of suffering” but that “…no definition adequately specifies precise boundaries for the concept of ‘mental disorder’…different situations call for different definitions” (APA, 1994 and 2000). The DSM also states that “there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder.”
The DSM consists of five axes (domains) on which disorder can be assessed. The five axes are:
Axis I: Clinical Disorders (all mental disorders except Personality Disorders and Mental Retardation) Axis II: Personality Disorders and Mental Retardation
Axis III: General Medical Conditions (must be connected to a Mental Disorder) Axis IV: Psychosocial and Environmental Problems (for example limited social support network) Axis V: Global Assessment of Functioning (Psychological, social and job-related functions are evaluated on a continuum between mental health and extreme mental disorder)
2 Explain the key strengths and limitations of the psychiatric classification system
The main strength of the DSM is that it is in such wide use and is commonly agreed upon. This allows for a common and universal diagnosis. Through its many revisions, the DSM has stood the test of time. Having a diagnostic companion such as the DSM or ICD allows, theoretically, for two doctors to make the same diagnosis on the same patient – if the symptoms are the same, a more agreeable diagnosis is likely using the DSM. However, some criticise the DSM because it serves as confirmation that sufferers of these conditions are ‘sufferers’ who need ‘treatment’, although some suggest mental illness is often just another way of living
3 Explain two alternative frameworks for understanding mental distress.
The parts of the model are made up with:
The functioning of an individual’s body
The individuals biological history – DNA, Bloodline, genetic
The chemical balance and processes of an individuals brain.
This part of the model is made up with:
The cognitive functions and behaviours
Disorders of thinking and reasoning i.e. self control
Perception and Motivation.
The model describes how an individual may interpret things differently when they are experiencing a mental health illness, for example an individual may develop alcohol problems. This could lead to physical problems like liver damage and economic problems, leading to further health problems, which may reduce the likelihood of the individual to work.
4 Explain how mental ill health may be indicated through an individual’s emotions, thinking and behaviour.
Mental illness is any disease of the mind or brain that affects a person’s thoughts, emotions, personality, or behaviour. Symptoms of mental illness may include extreme moods, such as excessive sadness or anxiety, or a decreased ability to think clearly or remember well. Almost everyone experiences mood swings or finds it difficult to think clearly from time to time. A mentally ill person, however, has severe symptoms that damage the person’s ability to function effectively in everyday activities and situations. For example: mood disorder Mood disorders, also known as affective disorders, mainly involve disturbances in the person’s mood. The two chief mood disorders are major depression (extreme sadness) and mania (extreme happiness and over activity).
People with bipolar disorder, also called manic depressive illness, suffer from alternating periods of depression and mania. Mood disorders are usually episodic–that is, the person experiences mood disturbances at relatively brief, distinct periods during the course of the illness. People with mood disorders typically return to normal levels of functioning after treatment. Most people with depression feel sad, hopeless, and worthless. Many also suffer from insomnia and loss of appetite and have trouble concentrating. Some people with depression move and think slowly, but others feel restive. Some feel so hopeless and discouraged that they consider or attempt suicide. About 15 per cent of people who seek treatment for depression commit suicide.
1.1 Explain how individuals experience discrimination due to misinformation, assumptions and stereotypes about mental ill health
There are still attitudes within most societies that view symptoms of psychopathology as threatening and uncomfortable, and these attitudes frequently foster stigma and discrimination towards people with mental health problems. Such reactions are common when people are brave enough to admit they have a mental health problem, and they can often lead on to various forms of exclusion or discrimination – either within social circles or within the workplace. Mental health discrimination can be divided into two distinct types: social stigma is characterized by prejudicial attitudes and discriminating behaviour directed towards individuals with mental health problems as a result of the psychiatric label they have been given.
In contrast, perceived stigma or self-stigma is the internalizing by the mental health sufferer of their perceptions of discrimination and perceived stigma can significantly affect feelings of shame and lead to poorer treatment outcomes Stigma embraces both prejudicial attitudes and discriminating behaviour towards individuals with mental health problems, and the social effects of this include exclusion, poor social support, poorer subjective quality of life, and low self-esteem .
As well as its effect on the quality of daily living, stigma also has a detrimental effect on treatment outcomes, and so hinders efficient and effective recovery from mental health problems. In particular, self-stigma is correlated with poorer vocational outcomes (employment success) and increased social isolation. These factors alone represent significant reasons for attempting to eradicate mental health stigma and ensure that social inclusion is facilitated and recovery can be efficiently achieved.
2.2 Explain how mental ill health may have an impact on the individual including:
A. psychological and emotional
-person may become paranoid and therefore exclude him or her self
-person may become paranoid and therefore hurt others who she/he fears will try to hurt him/her -person may become isolated and therefore out of touch with other people and reality in general
-person may feel unloved even if it is not true
-person may feel like he/she is a threat to society and therefore attempt suicide
B. practical and financial:
-Person may become disillusional
-person may become irrational
-person’s actions may not make sense to others but to the person; are very practical and rational
-person may believe that everyone else has a conspiracy and that the problem lies with others and not him/her self
-person may refuse treatment and be in denial that a problem even exists Financially:
-person can’t hold a job because he/she can’t organize a work schedule in his/her head and may therefore be late or not show up -person may begin dressing impossible for work and think that what he/she is wearing is suitable for work -person may turn to drugs or alcohol and therefore every dime made at work and/or begging on the streets goes to support his/her drug and alcohol addiction -Person can’t hold a bank account because the person can’t speak to other people and can’t act well in social situations and talking about an account to a bank teller may be an uncomfortable social situation and they just can’t do it without a lot of support and counselling and maybe medication
C. the impact of using services:
Stigma can affect many aspects of people’s lives. Even a brief episode of mental illness can have far-reaching effects on wellbeing, disrupting work, families, relationships and social interactions, impacting on the health and wellbeing not just of patients, but also of their families and friends. This can lead to further psychiatric problems such as anxiety and depression. Stigma can be a barrier to seeking early treatment; often people will not seek professional help until their symptoms have become serious. Others disengage from services or therapeutic interventions or stop taking medication, all of which can cause relapse and hinder recovery.
D. social exclusion:
Millions of individuals will be affected by poor mental health at some time during their lives, and though anyone can experience these problems, there are some people from certain backgrounds and social situations who are at a significantly greater risk. Despite welcome new attitudes in society which are far more accepting of mental health issues, many sufferers’ still find they have to face barriers in society such as employment, health care, family, support and community which those of us in good mental health may take for granted. Social exclusion such as this can have long lasting and reverberating affects on certain individuals and groups in society, unfortunately often marking the start of a downward trend into poor health, unemployment, debt and family breakdowns.
E. positive impacts:
it is a positive sign if a person recognizes that he or she is suffering from a mental illness and seeks treatment and usually in the early stages when he/she begins to feel abnormal. The sooner he/she is helped, the more likely for a positive outcome.
3 Explain how mental ill health may have an impact on those in the individual’s familial, social or work network including:
A. psychological and emotional:
A person may believe that everyone else has a conspiracy and that the problem lies with others and not him/her self. They may also refuse treatment and be in denial that a problem even exists
B. practical and financial:
They can’t hold a job because he/she can’t organize a work schedule in his/her head and may therefore be late or not show up
C. the impact of using services:
Service users also encountered discrimination when accessing services such as GPs. They reported professionals as being dismissive or assuming that physical presentations were “all in the mind” .This can result in reluctance to return for further visits, which can have a detrimental effect on physical health.
D. social exclusion:
Many people with mental health problems experienced discrimination when applying for jobs. This included trying to explain gaps in their CV due to episodes of mental ill health. They not only experienced stigma when applying for jobs, but also found that when returning to work colleagues treated them differently, with some experiencing bullying, ridicule and demotion.
E. positive impacts:
It is a positive sign if a person recognizes that he or she is suffering from a mental illness and seeks treatment and usually in the early stages when he/she begins to feel abnormal. The sooner he/she is helped, the more likely for a positive outcome.
4 Explain the benefits of early intervention in promoting an individual’s mental health and wellbeing.
A they can become very isolated and withdrawn or very hyper and loud. They can have swings in mood from very depressive to very manic. be continually crying or the opposite always taking risks
B they may not be able to concentrate or get confused and also this may cause them to loose their job or have time off sick
C. Often people with mental health illness are unwilling or unable to access services. They may continually not turn up for appointments or become confrontational with people delivering the service. This includes their family who often feel excluded as their friends do not know what to say
D. the general public often do not understand mental illness and shy away or exclude the individual from their activities. The individual often feels excluded and that often makes their condition worse as they have no one to go to for help or feel unable to ask for fear of being rejected.
E Positive impacts. initially are often few and far between but once they access help and support there can be positive impact from support groups or NHH for both the client and their family