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Pathophysiology of Mental Illness
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- 2. DEFINING A PSYCHOLOGICAL DISORDER •DSM-V definition: • Behavioral, cognitive, and emotional dysfunction • Unexpected in cultural context • Personal distress • Substantial impairment in function
- 3. CHARACTERISTICS OF GOOD MENTALHEALTH • Feels good about themselves • Feels comfortable with others • Optimistic • Expresses emotions in a healthy way • Group player • Able to meet demands of life • Uses health skills – stress management, decision making, conflict resolution, and “I” messages • Copes and adapts to change • Assertive • Active listener
- 4. CHARACTERISTICS OF POOR MENTALHEALTH • Does not share feelings • Emotions control behaviors • Pessimistic • Ignores/denies problems • Cannot accept change • Lets stress control life • “You” messages (blaming) • Aggressive and passive • Depressed • Runs from conflict • Close minded • Needs to “run” the group
- 5. WHAT IS AMENTAL ILLNESS? • Patterns of thinking or behavior that cause a person significant emotional pain or prevents normal functioning
- 6. GENERAL CAUSES OF MENTALILLNESS • Inherited traits • Traumatic life experiences • Environmental exposures before birth • Viruses, toxins, alcohol, drugs • Brain chemistry • Hormonal imbalances
- 7. 2000 DSM IVTR • Multiaxial System • Axis I: Major Disorder • Axis II: Personality Disorder and MR • Axis III: General Medical Conditions • Axis IV: Psychosocial and Environmental Problems • Axis V: Global Assessment of Functioning Scale (0 to 100) • Sexual Disorder not otherwise specified
- 9. 2013 DSM V •Combines all mental disorders, including personality disorders and intellectual disability, as well as other medical diagnoses • GAF replaced by World Health Organization Disability Assessment Schedule (WHODAS 2.0) – best current measure of disability for routine clinical use and applicable for any health condition
- 10. ASSESSMENT VS. TESTING •Psychological Assessment • Integrating psychological data for the purpose of making a psychological evaluation • Psychological Test • Device or procedure used to measure variables related to psychology
- 11. PSYCHOLOGICAL ASSESSMENT • ClinicalInterview • Demographic data, psychiatric medical history, family history, reason for visit • Mental Status Exam • Appearance, behavioral disturbances, awareness of surroundings, mood/affect • Behavioral Observations • Informal observations provide information from the natural environment through controlled settings
- 12. PSYCHOLOGICAL TESTING • ProjectiveTests • Rorschach Inkblot or Thematic Apperception Test • Bender Visual Motor Gestalt Test • Evaluates neuropsychological status – visual motor maturity to developmental disorders • MMPI-2 • Personality test • Vineland Adaptive Behavior Scales • Assesses personal and social skills in children
- 13. MENTAL HEALTH DISORDERSOF CHILDREN
- 14. AUTISM SPECTRUM DISORDER •Disorders • Autistic Disorder • Pervasive Developmental Disorder • Asperger’s Disorder • Cause • Unknown • Genetic/environmental factors • Brain structure abnormalities • Large total brain mass • Small frontal cortex • Abnormal cerebellum
- 15. AUTISM SPECTRUM DISORDER •Signs/Symptoms • Lack of social skills • Avoidance of eye contact and physical contact • Aggressive or passive • Resistant to change • Don’t listen • Throw tantrums • Echolalia – meaningless repetition of another person’s spoken words
- 16. AUTISM SPECTRUM DISORDER •Early Indicators • No babbling, pointing, words, or response to name • Loss of language or social skills • Poor eye contact • No social responsiveness • Late Indicators • Impaired ability to make friends, initiate conversation, or play • Inflexible adherence to routines and rituals
- 17. AUTISM SPECTRUM DISORDER •Screening Tests • Childhood Autism Rating Scale (CARS) • Checklist for Autism in Toddlers (CHAT) • Treatment • Intensive behavioral therapy
- 18. ATTENTION DEFICIT HYPERACTIVITY DISORDER •The inability to focus on one thing in all aspects of life • Impairs functioning • Diagnosis must have all three: • Inattention • Hyperactivity • Impulsivity
- 19. TOURETTE’S SYNDROME • Characterizedby tics – involuntary, rapid, repetitive, and stereotyped movements of individual muscle groups
- 20. TOURETTE’S SYNDROME • Classification •Transient Tic Disorder – do not persist for more than one year • Chronic Tic Disorder – duration over many years w/ an unchanging character • Chronic Multiple Tics – several chronic motor tics • Tourette’s – multiform frequency changing motor and phone tics; unknown cause
- 21. BIPOLAR DISEASE • Combinationof euphoria and depression • Signs/Symptoms in Kids • Continuous, rapid-cycling, irritable, mixed symptom state • May co-occur with other disruptive behaviors
- 22. SCHOOL AVOIDANCE • Refusalto go to school on a regular basis, or problems staying in school once there
- 23. OPPOSITIONAL DEFIANT DISORDER (ODD) •Persistent and consistent pattern of defiance, disobedience, and hostility toward authority figures
- 24. CONDUCT DISORDERS • Fighting,bullying, intimidating, physically assaulting, or sexually coercing others • Cruelty to humans and animals • Vandalism, theft, and truancy • Drug and alcohol abuse • Precocious sexual activity
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- 26. DEMENTIA-RELATED DISORDERS • Dementia •Alzheimer’s Disease • Vascular Dementia (TIA) • Mad Cow Disease • Huntington’s Disease
- 27. ANXIETY DISORDERS • GeneralizedAnxiety Disorder • Excessive worry for at least 6 months • Focus of worry will shift between topics • Social Anxiety Disorder • Extreme anxiety about being judged by others or being embarrassed • Causes avoidance behaviors • Specific Phobias • Fear of a specific thing that is at a level which is inappropriate and recognized as irrational
- 28. ANXIETY DISORDERS • Obsessive-CompulsiveDisorder (OCD) • Persistent, recurring thoughts and obsessions • Repetitive, obsessive behaviors • Post-Traumatic Stress Disorder (PTSD) • Follows exposure to a traumatic event • Three characteristic symptoms: reliving the disaster, avoidance behavior, and emotional detachment from other • Panic Disorder • Unexpected Panic Attacks • Situational Panic Attacks • Situationally Pre-Disposed Panic Attacks
- 29. DEPRESSIVE DISORDERS • MajorDepression • Combination of symptoms that interfere with work, sleeping, eating, and social activities • Dysthymia • Less severe form of depression • Chronic, but does not interfere w/everyday life • Bipolar Disorder • Cyclic mood swings with mania and depression
- 30. MA JOR DEPRESSION: SIGNS/SYMPTOMS •Depressed Mood • Diminished Interest • Weight Loss/Gain • Sleep Disturbance • Restlessness • Being Slowed Down • Fatigue • Loss of Energy • Feelings of Worthlessness • Feelings of Excessive Guilt • Difficulty Thinking/Concentrating • Symptoms Occur Every Day • Significant Distress • Significant Impairment • Thoughts of Death
- 31. BIPOLAR DISORDER • ManicEpisodes • Elevated mood • Grandiosity • Decreased need for sleep • Talkativeness • Racing thoughts • Increased goal-directed activity • Marked Impairment • Hospitalization, Psychotic Features • May Alternate w/ Depressive Episodes
- 32. DELUSIONAL DISORDERS • DelusionalParanoid Disorder • Persistent, non-bizarre delusions • No symptoms of other mental disorders • Delusions of being persecuted
- 33. SCHIZOPHRENIA • Characteristic Symptoms •Delusions • Hallucinations • Disorganized speech and behavior • Negative symptoms • Flat affect • Lack of motivation • Social and Occupational Dysfunction • Lasting at least 6 months
- 36. PERSONALITY DISORDERS • Paranoid •Continual mistrust; view everyone as an enemy • Hypersensitive, defensive, and antagonistic • Antisocial • Long-standing pattern of a disregard for other people’s rights • Can only be diagnosed in ages 18 and older • Avoidant • Long-standing and complex pattern of feelings of inadequacy, extreme sensitivity, and social inhibition
- 37. PERSONALITY DISORDERS • Borderline •Labile interpersonal relationships characterized by instability, shallow, and impulsive behaviors • Schizoid • Detachment from social relationships • Restricted range of expression of emotion in interpersonal settings • Narcissistic • Pervasive pattern of grandiosity, need for admiration, and lack of empathy
- 38. DISSOCIATIVE IDENTITY DISORDER •Multiple Personality Disorder • Two or more separate identities or traits • Ability to control individual’s behavior and thinking • Create alters to distance themselves from pain and trauma
- 39. SUBSTANCE ABUSE • Addiction •Physical or psychological craving need for higher and higher doses of a substance • Leads to bodily harm, social maladjustment, or economic hardship • Dependence on a substance, habit, or behavior
- 40. ANOREXIA NERVOSA • Irrationalfear of becoming obese results in severe weight loss from self-imposed starvation • Warning Signs • Dramatic weight loss • Anxiety about gaining weight • Denial of hunger • Food rituals • Excessive exercise • Isolation • Frequent comments about being “fat” • Avoids food situations
- 41. GENERAL THERAPIES FORMENTAL HEALTH DISORDERS
- 42. PSYCHOTHERAPY • Therapeutic treatmentof mental illness provided by trained mental health professionals • Explores thoughts, feelings, and behaviors • Seeks to improve an individual’s well- being
- 43. SUPPORT GROUP • Groupmeeting where members guide each other towards the shared goal of recovery • Often comprised of nonprofessionals, but peers that have suffered similar experiences
- 44. HOSPITALIZATION • May benecessary so an individual can be closely monitored, accurately diagnosed, or have medications adjusted when his or her mental illness temporarily worsens
- 45. PHARMACOLOGICAL TREATMENT OF MENTALHEALTH DISORDERS
- 46. ANTI-PSYCHOTICS • Combat psychoticsymptoms • Hallucinations • Delusions • Confused thinking • Altered perceptions • Disorganized speech
- 47. ANTI-PSYCHOTICS • Anti-Psychotic medicationsblock the receptor site of dopamine to prevent dopamine from binding
- 48. ANTIPSYCHOTIC: THORAZINE • Exactmechanism of action unknown • Psychotropic agent that produces sedative and antiemetic activities in the CNS and other organ systems • Weak anticholinergic activity; strong antiadrenergic activity
- 49. ANTI-DEPRESSANTS • Used torelieve symptoms of depression • Sadness • Feelings of failure • Loss of interest in life • Sleep disturbances • Excessive guilt • Loss of Energy/Fatigue • Thoughts of Death • Suicidal Thoughts
- 50. ANTI-DEPRESSANT: LEXAPRO • SelectiveSerotonin Reuptake Inhibitor (SSRI) • Enhances serotonergic activity in the central nervous system as a result of its inhibition of serotonin receptors in CNS neurons
- 51. MOOD STABILIZERS • Usedto treat symptoms of mania • Rapid talking • Decreased need for sleep • Racing thoughts • Distractibility • Irritability • Behavioral excesses • Grandiosity
- 52. MOOD STABILIZERS: LITHIUM •Lithium alters sodium transport in nerve and muscle cells • Results in intraneuronal metabolism of catecholamines • Specific mechanism of action in mania is unknown
- 53. ANTI-ANXIETY • Used totreat symptoms of anxiety • Nervousness • Panic • Shortness of breath • Trembling • Feeling of choking • Heart palpitations • Obsessions and compulsions
- 54. ANTI-ANXIETY: XANAX • Unknownmechanism of action • Benzodiazepine • Binds to various specific receptors in the central nervous system • Exhibits antidepressant properties
- 55. ANTI-PARKINSONIANS • Side EffectsMedications • Used to relieve side effects of anti-psychotics • Stiff muscles • Unsteady gait • tremors • Eyes rolling back • Restless feeling
- 56. ANTI-PARKINSONIANS: COGENTIN • Syntheticdrug • Anticholinergic activity • Utilized in the treatment in parkinsonism
- 57. STIMULANTS • Used totreat symptoms of ADHD • Mainly used in children
- 58. STIMULANTS: ADDERALL • CNSstimulant activity • Amphetamines block the reuptake of norepinephrine and dopamine into the presynaptic neuron, and increase their release into the extraneuronal space • Mechanism of therapeutic activity in ADHD is not known