Introductory presentation about mental health and mental illnesses for any category of health workers.

1. Mental Health and Mental Illnesses Damber K. Nirola, MD Psychiatrist

2. DEFINITION OF MENTAL HEALTH Mental Health can be defined as a state of well-being in which an individual realizes his own abilities and limits, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his community. Mental health requires a balance between the body, mind, spirit and the environment in which a person lives.

3. DEFINITION OF MENTAL ILLNESS Mental illness is characterized by alterations in thinking, emotions or behaviour associated with personal distress and/or impaired functioning. Like other illnesses, mental illnesses are the result of complex interactions between biological, psychological and social factors. Generally a thought, emotion or behaviour is considered abnormal and is suggestive of mental illness when it occurs without an understandable reason, is exaggerated, lasts for a long time and causes problems for the individual or others.

4. TWO CHARACTERISTICS OF MENTAL ILLNESS: Recurrent changes in one’s thinking, feeling, memory, perceptions and judgment resulting in abnormalities in talk and behaviour. The changes in behaviour and the consequent distress cause disturbances in day-to-day activities, work efficiency, and relationships with others

5. COMMON SYMPTOMS OF MENTAL ILLNESS Changes in bodily function Sleep: The patient may have difficulty sleeping. He may have trouble falling asleep, or staying asleep or may awaken early in the morning. Some depressed people may sleep excessively.

6. Appetite: The patient may have a poor appetite and eat less than usual or he may eat more than usual.. Weight: Usually, the patient will lose weight because of poor appetite. However, some patients may gain weight due to excessive eating or because of side effects of psychotropic drugs.

7. Bowel and bladder functions: Some patients may pass urine more frequently than usual (anxiety) or have loose motions (anxiety). Some others may have constipation (depression or side effect of psychotropic drugs). Sexual desire and activity: Some patients may lose interest in sex. Some may complain of impotence. Some complain of pain during intercourse. Some become hyper-sexual (Mania).

8. Changes in mental functions Appearance: Patients may neglect their personal hygiene and grooming or dress excessively or inappropriately Behaviour: The patient may behave bizarrely or in a manner not consistent with his usual behaviour. He may be restless and wander aimlessly or slow down and withdraw completely. Speech: The patient may talk excessively and irrelevantly or he may utter only a few words or not speak at all.

9. Emotions (feelings):sadness or happiness or emotions inappropriate to the situation. No emotion, labile emotion Perception: The patient’s perception can be disturbed. hallucinations Thinking: The patient’s thinking process can be disturbed. E.g.: delusions, delusions of control, thought broadcasting

10. Changes in cognitive Functioning: Level of Consciousness: Memory: Attention and concentration:

11. Orientation to person, place and time: Intelligence: Insight and judgment:

12. Changes in personal hygiene, social activities and functioning Personal: Patients may neglect their bodily needs and personal hygiene. They may not eat regularly, wash their clothes or comb their hair. They may refuse to bathe or change their clothes. At times, they may even soil their clothes or bed. Social: Patients may behave strangely with family, friends or other people. They may behave inappropriately in social situations. They may become violent or withdraw completely from people. Functioning: Patients may not be able to attend to usual work responsibilities. Assignments may not be submitted or may be poorly executed.

13. CAUSES OF MENTAL ILLNESS Genetic: Physical changes in the brain: changes in brain structure or function, infection, trauma, tumour, uncontrolled seizures or degenerative diseases Physiological changes in brain: chronic alcoholism, nutritional deficiencies and end stage organ failure child birth or menopause

14. Environmental factors: Overcrowding, lack of recreational facilities, lack of social support, and exposure to extreme stressors such as war, terrorism, and manmade or natural disasters Childhood experiences: Lack of parental love, care, and guidance during childhood and traumatic psychological experiences in early life Home atmosphere: Alcohol abuse, frequent quarrels and violence among family members

15. Social factors: Poverty, unemployment, feelings of insecurity, lack of or competition for limited opportunities, frustrations, drug abuse, and alcoholism Individual factors: Diseases like diabetes, cancer, heart diseases and AIDS Chronic illness: diabetes, cancer, heart diseases and AIDS

16. Individual factors: Poor self image, lack of confidence, lack of skills to cope with or resolve conflicts in life, a wide gap between ambition and actual achievement, and guilt can cause mental illness.