Understanding Mental Disorders

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 ICD is produced by a global health agency with a constitutional public health mission, while the DSM is produced by a single national professional association DSM-IV Codes are the classification found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSM-IV-TR, a manual published by the American Psychiatric Association (APA) that includes all currently recognized mental health disorders.

The DSM-IV codes are used by mental health professionals to describe the features of a given mental disorders and indicate how the disorder can be distinguished from other, similar problems. MOOD DISORDERS Mood disorders are exhibited in terms of a change in personality and episodes of depression, anxiety and agitation. People with mood disorders show an unusual and sudden change in their personalities and go through periods of depression or anger.

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They experience continued feelings of irritability and sadness.

Some are characterized by loss of appetite leading to excessive weight loss. Research has shown that people with mood disorders have a chemical imbalance in their brain. It is also known that mood disorders can run in families in the form of certain genetic traits A disturbance in the psychological state of an individual is termed as a mood disorder. It is characterized by a disturbance in a person's emotional state and manifests itself in different forms.

Mood disturbances may include depression, mania or a combination of these. Mood disorders are classified as depressive disorders and bipolar disorders. Each basic type is further classified into different types of depressions Depressive disorder Current National Institute for Health and Clinical Excellence (NICE) guidance uses the Diagnostic and Statistical Manual Fourth Edition (DSM-IV) classification. To diagnose major depression, this requires at least one of the core symptoms Persistent sadness or low mood nearly every day, or Loss of interests or pleasure in most activities.

Plus some of the following symptoms Fatigue or loss of energy Worthlessness, excessive or inappropriate guilt Recurrent thoughts of death, suicidal thoughts, or actual suicide attempts Diminished ability to think/concentrate or increased indecision Psychomotor agitation or retardation Insomnia/hypersomnia Changes in appetite and/or weight loss Symptoms should have been present persistently for at least 2 weeks and must have caused clinically significant distress and impairment. They should not be due to a physical/organic factor (e.g. substance abuse) or illness (although illness and depression commonly coexist). Severity is based on the extent of symptoms and their functional impact Subthreshold depressive symptoms 5 symptoms. Mild depression - few, if any, symptoms in excess of the 5 required to make the diagnosis with symptoms resulting only in minor functional impairment.

Moderate depression - symptoms or functional impairment are between 'mild' and 'severe'. Severe depression - most symptoms present and the symptoms markedly interfere with normal function. It can occur with or without psychotic symptoms. Bipolar disorder is a mood disorder that manifests itself in the form of alternating periods of depression and mania. Bipolar I is characterized by a history of manic episodes with or without the presence of depressive episodes. Bipolar II is characterized by intermittent episodes of mania and depression. Cyclothymic consists of hypomanic episodes accompanied by milder mood disturbances. Anxiety disorder Fear and stress reactions are essential for human survival. They enable people to pursue important goals and to respond appropriately to danger.

In a healthy individual, the stress response (fight, fright, or flight) is provoked by a genuine threat or challenge and is used as a spur for appropriate action An anxiety disorder, however, involves an excessive or inappropriate state of arousal characterized by feelings of apprehension, uncertainty, or fear., which means to choke or strangle. The anxiety response is often not triggered by a real threat. Nevertheless it can still paralyze the individual into inaction or withdrawal.

An anxiety disorder persists, while an appropriate response to a threat resolves, once the threat is removed The DSM establishes a symptom criteria set for each disorder and establishes certain number of symptoms, from that set, that must be met in order to be diagnosed with an anxiety disorder. Because it is not necessary to have every symptom in the criteria set, people with the same disorder may not necessarily have the exact same set of symptoms. For instance, someone might experience chest pain as their primary symptom of a panic attack, while another person may feel lightheaded. Both of these symptoms are part of the set of symptoms substance-related disorders

Substance abuse is as common as it is costly to society. It is etiologic for many medical illnesses and is frequently comorbid with psychiatric illness. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) defines substance abuse and dependence independent of the substance. Hence,alcohol abuse and dependence is defined by the same criteria as heroin abuse and dependence. This section defines abuse and dependence and provides clinical descriptions of each substance-related disorder. The DSM-IV recognizes the different signs and symptoms associated with various drug addictions.

Personality disorder

Personality disorders are included as mental disorders on Axis II of the diagnostic manual of the American Psychiatric Association and in the mental and behavioral disorders section of the ICD manual of the World Health Organization Personality disorders are conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others. Changes in how a person feels and distorted beliefs about other people can lead to odd behavior, which can be distressing and may upset others There are three recognized personality disorder clusters, cluster A odd and eccentric, Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder dramatic and emotional, Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder and anxious and fearful Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder Personality Disorders: Management

PSYCHOTIC DISORDERS

Psychotic disorders are a collection of disorders in which psychosis predominates the symptom complex. Psychosis is defined as a gross impairment in reality testing. Specific psychotic symptoms include delusions, hallucinations, ideas of reference, and disorders of thought Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) classification of the psychotic disorders Schizophrenia, Schizoaffective disorder, Schizophreniform Disorder, Delusional Disorder, Brief Psychotic Disorder, It is important to understand that psychotic disorders are different from mood disorders with psychotic features Patients can present with a severe episode of depression and have delusions or with a manic episode with delusions and hallucinations.

These patients do not have a primary psychotic disorder; rather, their psychosis is secondary to a mood disorder. The diagnoses described below are among the most severely disabling of mental disorders. Disability is due in part to the extreme degree of social and occupational dysfunction associated with these disorders. EATING DISORDERS An eating disorder is a condition defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa and anorexia nervosa are the most common specific forms in the United Kingdom Bulimia nervosa is a disorder characterized by binge eating and purging, and anorexia nervosa is characterized by immoderate food restriction and irrational fear of gaining weight. COGNITIVE DISORDERS In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), which describes 250 disorders and their symptoms, cognitive disorders are classified under a psychological disorder in axis I.

It is described as disorders with a significant impairment of cognition or memory that represents a marked deterioration from a previous level of function The three main areas outlined by the DSM-IV-TR of cognitive disorders are 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 be caused by a preexisting medical condition 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) and amnesia. Amnesia patients have trouble retaining long term memories. Difficulty creating recent term lost 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

Explain the key strengths and limitations of the psychiatric classification system. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is currently the most frequently used way of standardizing and defining psychological disorders. However, the classification systems such as DSM have advantages and disadvantages. The major weakness of DSM is that it judges symptoms superficially and ignores other possible important factors. The major strength of DSM is that it enables categorization of psychological disorders. Strengths of the Diagnostic and Statistical Manual of Mental Disorders include that it provides a well designed standard, and comprehensive diagnostic tool for clinicians and researchers. It allows physicians to look at the complete psychological make-up of a person. DSM due to the way it is designed is applicable in a wide range of contexts and can be utilized by people in various orientations (American Psychiatric Association, 2003).

It categorizes diagnostic information in a systematic manner by grouping individuals. This enables psychiatrists to diagnose extremely disturbed individuals based on similarities of behavior easily and concisely Clinicians and researchers can use the DSM manual easily and effectively. The DSM also hopes to achieve a greater consensus without having to make assumptions about the suspected causes of disorders To do this, recent versions of the DSM have strived to increase their reliability . This was done by formulating new categories, which are more in depth and ask appropriate questions.

DSM-IV has a broad list of categories as well as symptoms that indicate what must and must not be present for the appropriate disorder to be diagnosed 1.3 Explain two alternative frameworks for understanding mental distress Biological and medical frameworks (sometimes referred to as the disease model) view psychological problems as resulting, in the main, from physical causes such as brain defects, hereditary factors or as the results of accidents or injury. Behavioural frameworks are closely aligned to learning theories and have long been associated with early exponents of conditioning theories. Symptoms of mental distress, considered to be learned habits, arise from the interaction between external stressors and the individual's personality.

Explain how mental ill health may be indicated through an individual's emotions, thinking and behaviour Signs and symptoms of mental illness can vary, depending on the particular disorder, circumstances and other factors. Mental illness symptoms can affect emotions, thoughts and behaviors. Examples of signs and symptoms include: Feeling sad or down Confused thinking or reduced ability to concentrate Excessive fears or worries Extreme mood changes of highs and lows Withdrawal from friends and activities Significant tiredness, low energy or problems sleeping Detachment from reality (delusions), paranoia or hallucinations Inability to cope with daily problems or stress Extreme feelings of guilt Alcohol or drug abuse Major changes in eating habits Sex drive changes Excessive anger, hostility or violence Suicidal thinking, Sometimes symptoms of a mental health disorder appear as physical problems, such as abdominal pain, back pain, headache, or other unexplained aches and pains, signs and symptoms may indicate a mental illness when they make you miserable and interfere with your ability to function in your daily life. You may have trouble coping with stress, anger or other emotions.

Or you may find it difficult to handle family, work or school responsibilities, or have serious legal or financial problems. With some types of mental illness, though, such as schizophrenia or bipolar disorder, you may not realize the extent of your problems — instead, it may be family members or friends who first become aware that you have a mental illness. CMH302 Unit Summary Know the impact of mental ill health on individuals and others in their social network 2.1Explain how individuals experience discrimination due to misinformation, assumptions and stereotypes about mental ill health Difficulties getting employment because employers think that they might cause trouble or be off work too often or not be able to work to their expectation’s, Neighbours may think they a risk to others or social groups fears that they are dangerous and unpredictable. 2.2a Explain how mental ill health may have an impact on the individual including: psychological and emotional

Evidence from the World Health Organization suggests that nearly half the world's population are affected by mental illness with an impact on their self-esteem, relationships and ability to function in everyday life. An individual's emotional health can also impact physical health and poor mental health can lead to problems such as substance abuse. Maintaining good mental health is crucial to living a long and healthy life. Good mental health can enhance one’s life, while poor mental health can prevent someone from living an enriching life. There is growing evidence that is showing emotional abilities are associated with prosocial behaviors such as stress management and physical health.

It was also concluded in their research that people who lack emotional expression are inclined to anti-social behaviors. These behaviors are a direct reflection of their mental health. Self-destructive acts may take place to suppress emotions. Some of these acts include drug and alcohol abuse, physical fights or vandalism, psychological well-being, or an absence of a mental disorder From the perspective of 'positive psychology' or 'holism', mental health may include an individual's ability to enjoy life, and create a balance between life activities and efforts to achieve psychological resilience. Mental health can also be defined as an expression of emotions, and as signifying a successful adaptation to a range of demands

Practical and financial problems with budgeting due to mental health problems may lead to accumulation of debt as some ill health may cause periods of over spending and find it difficult to control, or not having the skills or confidence to find help in managing their money will result in further unhappiness and anxiety being in debt can bring on a bad episode. If you experience anxiety or depression, you may feel tempted to ignore the problem and hope that it will go away. You may become too afraid to open any official-looking envelopes leading to mental health getting worse.

The impact of using services some people face barriers in accessing services for support, due to issues with transport. This is especially an issue in rural areas. Rethink believes that local commissioners should ensure that such needs are met by providing transport in such areas for people who need it. Similarly, these access issues should be included in Care planning and provided for individuals, we all can be affected by poor mental health at some time during are 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 sufferer's 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 all of the above can lead Social exclusion and this can have long lasting and reverberating effects on certain individuals and groups in society, unfortunately often marking the start of a downward trend into poor health, unemployment, debt and family breakdowns.

Positive impacts Positive coping strategies can help an individual to cope with their mental health problems in a constructive or adaptive way. Examples of positive coping strategies include talking about problems, exercising, taking time out and maintaining hobbies also seeking help if possible and learning from experiences as some people can learn how to manage their mental illness with the right help and support and this a positive towards others who are still suffering and think they will never recover Recovery as a concept is about the process of building a meaningful life as defined by the person with a mental health problem themselves.

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 caring for a mentally ill individual often falls on the patient’s immediate family or relatives. Families and caregivers of individuals with psychological disorders find juggling work and and day to day life difficult due to the demands of caring for a mentally ill individual, leading to i. Family members experience significant stress due to the emotional and physical challenges of caring for a mentally ill family member

Practical and financial family and friends may have to give up work due to caring for someone with mental ill health this can put a financial strain on them whilst offering financial assistance to the person with ill health and providing assistance with daily activities providing transportation, helping with housework, cleaning, and money management) and stress associated with care (e.g. concerns about possible violence, embarrassing behaviours, and intra-family conflict family care givers of people with mental illness should be supported to work if they so wish.

The impact of using services Discrimination can also appear in public opinion about how to treat people with mental illness this can lead to family care givers from not feeling confident in using services and improving the quality and accessibility of services for people with poor mental health.

Social exclusion this can be seen as a challenge to those connected to someone with mental ill health as its hard for them to understand what and where may be best for them so family friends should be included and supported too as there is a chance their mental health can be at risk, the work place and family and friends need supporting and fully informing of limits and boundaries to socializing someone with mental ill health their recovery but also having time for themselves, meeting up with support groups or just having time with their friends.

Positive impacts Families may also take on the role of day-to-day care. This often happens with little training or support, or acknowledgment of their own needs and mental health. When families are accepted as partners in care and do receive training and support, there is strong evidence that this leads to better outcomes for everyone involved and have a positive effects on the person with mental ill health, improving neighbourhood environments, developing health and social services which support mental health, anti-bullying strategies at school, workplace health, community safety, childcare and self-help networks.

Reducing structural barriers to mental health by initiatives to reduce discrimination and inequalities and to promote access to education, meaningful employment, housing, services and support for those who are vulnerable.

Explain the benefits of early intervention in promoting an individual's mental health and wellbeing There is increasing evidence that early intervention, prevention and the promotion of better mental health and wellbeing across the whole population is vital for a healthy society. Therefore promoting mental health and wellbeing can have multiple benefits improved health outcomes, life expectancy, productivity and educational and economic outcomes as well reductions in violence and crime.

Discrimination against other people is what we use as a way of keeping ourselves safe - from uncomfortable questions, facing reality, and challenges to ourselves. But it is a belittling and dangerous technique. [ It marginalises other people and in the end, when we discriminate as a society, it causes pain, distress, and long-term damage. It also damages us as a society because it limits our world and impoverishes our understanding. People who have experience of mental illness almost always also have experience of discrimination. They may be denied jobs, accommodation, relationships, social dignity, and of course adequate services. Their families, and the people who work to try to help them may also experience discrimination, because it spreads like a sickness. It is sometimes hard to explain what we mean by discrimination. It is one of those abstract words which cuts us off from the human impact.

But this report starts to give some illustrations of what it means for people. And more importantly, this report begins to examine what causes us to discriminate against others. It looks for parallels and differences in other kinds of discrimination - on the basis of gender, sexuality, age, culture, religion, colour, victimisation, physical disabilities, and size. Sometimes people offer very simplistic solutions to the problem of discrimination. Just change attitudes?. Tighten up the law. Get people to stand up for themselves.

For every complex problem there is a simple solution. And it is wrong. Complex problems usually mean complex solutions. Discrimination is not a tame problem. It is a wicked one. So the solution involves a combination of approaches, as this report explains. We also need to be aware that the problem of discrimination will itself change as we try to change it and so it may need to be re solved time and again. The Mental Health Commission is committed to getting rid of discrimination against people with mental illness. It knows that there is no quick solution, because it involves refusing, as a society, to accept any longer the myths about mental illness.