1) Many psychiatric disorders like schizophrenia and bipolar disorder have strong genetic predispositions according to biological factors. Hormonal systems also impact mental health conditions. 2) Freud's psychosexual stages of development and Erikson's stages of psychosocial development describe how psychological factors can influence mental illness if a stage is not successfully resolved. 3) Social and environmental factors like stress, trauma, socioeconomic status, and learning from others also contribute to precipitating mental illnesses according to theories like the stress diathesis model.

1. PREDISPOSING AND PRECIPITATING FACTORS TO MENTAL ILLNESS Hyacinth C. Manood. MD, FPPA

3. BIOLOGICAL GENETICS - many major psychiatric disorders have shown to have strong hereditary predispositions. Examples: Schizophrenia Bipolar Disorder and Major Depressive disorders first degree relatives – 8 – 18x monozygotic twins – 33-90% concordance Tourette’s Disorder – autosomal dominant

4. BIOLOGICAL II. PSYCHONEUROENDOCRINOLOGY - refers to the structural and functional relations between hormonal system and CNS and the behaviors that modulate and arise from it. HYPOTHALAMIC-PITUITARY-ADRENAL Cushing’s Syndrome (inc. cortisol) > 50% mood disturbances > 10% psychosis and suicidal thoughts >cognitive impairments - Decreasing the cortisol level normalizes mood and mental status

5. Addison’s Disease (Adrenal insufficiency) > apathy, withdrawal, impaired sleep and decreased concentration. > replacement of glucocorticoids resolves the above symptoms. Depression > increased cortisol concentration > failure to suppress cortisol in response to dexamethasone > increased adrenal size and sensitivity to ACTH > blunted ACTH response to CRH > increased concentrations of CRH in the brain

6. Insulin – involved in learning and memory > lower insulin concentration in CSF of patients with Alzheimer’s Disease. >depression is frequent in patients with diabetes > antipsychotic effects dysregulate insulin metabolism HYPOTHALAMIC-PITUITARY-GONADAL AXIS Testosterone > associated with increased violence and aggression in animals; > testosterone improves mood and decreases irriability in hypogonadal males

7. > anabolic-androgenic steroids – euphoria, increased energy, sexual arousal; irriability, mood swings, violent feelings, anger and hostility; > DHEA improves well-being and functional status in both depressed and normal individuals. Estrogen and Progesterone > antipsychotic effect changes over menstrual cycles > risk of tardivedyskinesia depends partly on estrogen concentration; > Estrogen administration decreases risks ad severity of Alzheimer’s dementia. > Estrogen has mood-enhancing properties > Premenstrual dysphoric disorder

8. Prolactin > increased PRL – depression, decreased libido, stress intolerance, anxiety, increased irritability; > severity of tardive dyskinesia HYPOTHALAMIC-PITUITARY-THYROID AXIS TRH - neuronal excitability, behavior, neurotransmitter regulation. Hyperthyroidism – fatigue, irritability, insomnia, anxiety, restlessness, weight loss, emotional lability; marked impairment in memory and concentration; delirium and dementia; psychotic feature : paranoia

9. Chronic hypotyroidism – fatigue, decreased libido, memory impairment, irritability; suicidal ideation common. GROWTH HORMONE stressful experiences – decreased GH dec. GH – major depressive disorder and dysthymia ENDOGENOUS OPIOIDS - eating behavior MELATONIN – circadian phase disorders (jetlag) - increases speed of falling asleep OXYTOCIN – sex SUBSTANCE P - memory

10. PSYCHONEUROIMMUNOLOGY > Stress lowers immune response. > HIV – depression > neurosyphilis – neuropsychiatric manifestations > Schizophrenia > Major Depressive Disorder > Alzheimer’s disease > Chronic fatigue syndrome

11. BIOLOGICAL RHYTMS * SLEEP > deprivation leads to breakdown in concentration, motor skills, self-care, attention, judgement, communication; hallucinations and illusions.

12. PSYCHOLOGICAL FREUD STAGES OF PSYCHOSEXUAL DEVELOPMENT ORAL STAGE ( 0 – 1) - to establish a trusting dependence on nursing and sustaining objects; - to establish comfortable expression and gratification of oral libidinal needs without excessive conflicts or ambivalence from oral sadistic wishes. PATHOLOGICAL: extremes of oral gratification can result in libidinal fixations; - excessive optimism, narcissism, pessimism, demandingness; oral traits - envy and jealousy

13. ANAL STAGE (1 – 2) - a period of striving for independence and separation from dependence PATHOLOGICAL: Fixation – orderliness, obstinacy, stubbornness, willfulness, frugality, and parsimony If less effective – heightened ambivalence, lack of tidiness, messiness, defiance, rage ad sadomasochistic tendencies. URETHRAL STAGE (2 – 3) - transitional; issues of control and shaming

14. PHALLIC STAGE ( 3 – 6) - castration anxiety; penis envy; - identification from parental figures - foundation for an emerging sense of sexual identity - oedipal conflict resolution - internal source of regulation - superego LATENCY STAGE ( 5-6 TO 11-13) - stage of relative quiescence or inactivity of sexual drive; - homosexual affiliations; sublimation - development of important skills PATHOLIGAL: lack of control leads to failure to sublimate energies in the interests of learning and development of skills.

15. GENITAL STAGE (11-13 TO young adulthood) - ultimate separation from dependence on and attachment to parents. -establishment of mature, nonincestous object relations;

16. ERIKSON EPIGENETIC PRINCIPLE – development occurs in sequential, clearly defined stages, and that each stage must be satisfactorily resolved for development to proceed smoothly. - In relation to Freudian theory, Erikson described a corresponding zone with a specific pattern or mode of behavior.

18. AUTONOMY VS SHAME AND DOUBT (18M – 3) - terrible two If too much shame and doubt – obsessive personality Too rigorous toilet training – stingy, meticulous, selfish Too much shaming – delinquent behavior; impulsive behavior INITIATIVE VS GUILT ( 3 – 5) - active and intrusive - Oedipus complex If excessive guilt – GAD and phobias Punishment or severe prohibitions – sexual inhibitions If oedipal conflict not resolved – conversion disorder; specific phobia

19. INDUSTRY VS INFERIORITY (5 – 13) - covers pleasure of production - learning new skills and takes pride in things made - teachers and other role models are important If unprepared – sense of inferiority or inadequacy Extremes – feelings of inadequacy; compensatory drive for money, power and prestige; work can become the main focus of life IDENTITY VS. ROLE CONFUSION ( 13 – 21) - running away, criminality, overt psychoses Defenses – joining cults, gangs ; identifying with folk heroes - Conduct disorders, Disruptive Behavior disorder, Gender identity disorders, Schizophreniform disorders

20. INTIMACY VS ISOLATION (21-40) - successful formation of stable marriage and family GENERATIVITY VS STAGNATION (40-60) - establishing and guiding the next generation - depression - inc. substance use INTEGRITY VS DESPAIR - acceptance - Psychosomatic illnesses, Hypochondriasis, Depression - suicide rate is highest over age 65

21. SOCIAL FACTORS STRESS - Stress Diathesis Model of Schizophrenia - Social Causation hypothesis SOCIAL STATUS LIFE EVENTS/ TRAUMATIC EVENTS PHYSICAL TRAUMA/PHYSICAL ILLNESS MALNUTRITION POLLUTION CROWDING

22. STRESS DIATHESIS MODEL A person may have a specific vulnerability (diathesis) that, when acted on by a stressful influence, allows the symptoms of schizophrenia to develop. -integrates biological, psychosocial, and environmental factors.

23. SOCIAL CAUSATION HYPOTHESIS The stresses experienced by members of low socioeconomic group contribute to the development of schizophrenia.

24. SOCIAL LEARNING THEORY: A person can learn by imitating the behavior of another person, but personal factors are involved . - relies on role models, identification, and human interactions.

25. THANK YOU & GOOD DAY