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PREDISPOSING AND PRECIPITATING FACTORS TO MENTAL ILLNESS<br />Hyacinth C. Manood. MD, FPPA<br />
BIOLOGICAL<br />GENETICS<br />	- many major psychiatric disorders have shown to have strong hereditary predispositions.<br...
BIOLOGICAL<br />II.	PSYCHONEUROENDOCRINOLOGY<br />	- refers to the structural and functional relations between hormonal sy...
Addison’s Disease (Adrenal insufficiency)<br />	> apathy, withdrawal, impaired sleep and decreased concentration.<br />	> ...
Insulin – involved in learning and memory<br />	> lower insulin concentration in CSF of patients with Alzheimer’s Disease....
	> anabolic-androgenic steroids – euphoria, increased energy, sexual arousal; irriability, mood swings, violent feelings, ...
Prolactin<br />	> increased PRL – depression, decreased libido, stress intolerance, anxiety, increased irritability;<br />...
Chronic hypotyroidism – fatigue, decreased libido, memory impairment, irritability; suicidal ideation common.<br />GROWTH ...
PSYCHONEUROIMMUNOLOGY<br />	> Stress lowers immune response.<br />	> HIV – depression<br />	> neurosyphilis – neuropsychia...
BIOLOGICAL RHYTMS<br />	* SLEEP<br />	> deprivation leads to breakdown in concentration, motor skills, self-care, attentio...
PSYCHOLOGICAL<br />FREUD<br />STAGES OF PSYCHOSEXUAL DEVELOPMENT<br />ORAL STAGE ( 0 – 1)<br />	- to establish a trusting ...
ANAL STAGE  (1 – 2)<br />	- a period of striving for independence and separation from dependence <br />PATHOLOGICAL:<br />...
PHALLIC STAGE ( 3 – 6)<br />	- castration anxiety; penis envy; <br />	- identification from parental figures<br />	- found...
GENITAL STAGE (11-13 TO young adulthood)<br />	- ultimate separation from dependence on and attachment to parents.<br />	-...
ERIKSON<br />EPIGENETIC PRINCIPLE – development occurs in sequential, clearly defined stages, and that each stage must be ...
EIGHT STAGES OF THE LIFE CYCLE:<br />TRUST VS. MISTRUST (birth – 18 months)<br />	- incorporation<br />	- development of b...
AUTONOMY VS SHAME AND DOUBT (18M – 3)<br />	- terrible two<br />If too much shame and doubt – obsessive personality<br />T...
INDUSTRY  VS  INFERIORITY (5 – 13)<br />	- covers pleasure of production<br />	- learning new skills and takes pride in th...
INTIMACY  VS  ISOLATION (21-40) <br />	- successful formation of stable marriage and family<br />GENERATIVITY  VS  STAGNAT...
SOCIAL FACTORS<br />STRESS<br />	- Stress Diathesis Model of Schizophrenia<br />	- Social Causation hypothesis<br />SOCIAL...
STRESS DIATHESIS MODEL <br />A person may have a specific vulnerability (diathesis) that, when acted on by a stressful inf...
SOCIAL CAUSATION HYPOTHESIS<br />The stresses experienced by members of low socioeconomic group contribute to the developm...
SOCIAL LEARNING THEORY:<br />A person can learn by imitating the behavior of another person, but personal factors are invo...
THANK YOU & GOOD DAY<br />
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Predisposing And Precipitating Factors To Mental Illness

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Predisposing And Precipitating Factors To Mental Illness

  1. 1. PREDISPOSING AND PRECIPITATING FACTORS TO MENTAL ILLNESS<br />Hyacinth C. Manood. MD, FPPA<br />
  2. 2.
  3. 3. BIOLOGICAL<br />GENETICS<br /> - many major psychiatric disorders have shown to have strong hereditary predispositions.<br />Examples:<br />Schizophrenia<br />Bipolar Disorder and Major Depressive disorders<br />first degree relatives – 8 – 18x<br />monozygotic twins – 33-90% concordance<br />Tourette’s Disorder – autosomal dominant<br />
  4. 4. BIOLOGICAL<br />II. PSYCHONEUROENDOCRINOLOGY<br /> - refers to the structural and functional relations between hormonal system and CNS and the behaviors that modulate and arise from it.<br />HYPOTHALAMIC-PITUITARY-ADRENAL<br />Cushing’s Syndrome (inc. cortisol)<br /> > 50% mood disturbances<br /> > 10% psychosis and suicidal thoughts<br /> >cognitive impairments<br />- Decreasing the cortisol level normalizes mood and mental status<br />
  5. 5. Addison’s Disease (Adrenal insufficiency)<br /> > apathy, withdrawal, impaired sleep and decreased concentration.<br /> > replacement of glucocorticoids resolves the above symptoms.<br />Depression <br /> > increased cortisol concentration<br /> > failure to suppress cortisol in response to dexamethasone<br /> > increased adrenal size and sensitivity to ACTH<br /> > blunted ACTH response to CRH<br /> > increased concentrations of CRH in the brain<br />
  6. 6. Insulin – involved in learning and memory<br /> > lower insulin concentration in CSF of patients with Alzheimer’s Disease.<br /> >depression is frequent in patients with diabetes<br /> > antipsychotic effects dysregulate insulin metabolism<br />HYPOTHALAMIC-PITUITARY-GONADAL AXIS<br />Testosterone<br /> > associated with increased violence and aggression in animals;<br /> > testosterone improves mood and decreases irriability in hypogonadal males<br />
  7. 7. > anabolic-androgenic steroids – euphoria, increased energy, sexual arousal; irriability, mood swings, violent feelings, anger and hostility;<br /> > DHEA improves well-being and functional status in both depressed and normal individuals.<br />Estrogen and Progesterone<br /> > antipsychotic effect changes over menstrual cycles<br /> > risk of tardivedyskinesia depends partly on estrogen concentration;<br /> > Estrogen administration decreases risks ad severity of Alzheimer’s dementia.<br /> > Estrogen has mood-enhancing properties<br /> > Premenstrual dysphoric disorder<br />
  8. 8. Prolactin<br /> > increased PRL – depression, decreased libido, stress intolerance, anxiety, increased irritability;<br /> > severity of tardive dyskinesia<br />HYPOTHALAMIC-PITUITARY-THYROID AXIS<br />TRH - neuronal excitability, behavior, neurotransmitter regulation.<br />Hyperthyroidism – fatigue, irritability, insomnia, anxiety, restlessness, weight loss, emotional lability; marked impairment in memory and concentration; delirium and dementia; psychotic feature : paranoia<br />
  9. 9. Chronic hypotyroidism – fatigue, decreased libido, memory impairment, irritability; suicidal ideation common.<br />GROWTH HORMONE <br /> stressful experiences – decreased GH<br /> dec. GH – major depressive disorder and dysthymia<br />ENDOGENOUS OPIOIDS - eating behavior<br />MELATONIN – circadian phase disorders (jetlag)<br /> - increases speed of falling asleep<br />OXYTOCIN – sex<br />SUBSTANCE P - memory<br />
  10. 10. PSYCHONEUROIMMUNOLOGY<br /> > Stress lowers immune response.<br /> > HIV – depression<br /> > neurosyphilis – neuropsychiatric manifestations<br /> > Schizophrenia<br /> > Major Depressive Disorder<br /> > Alzheimer’s disease<br /> > Chronic fatigue syndrome<br />
  11. 11. BIOLOGICAL RHYTMS<br /> * SLEEP<br /> > deprivation leads to breakdown in concentration, motor skills, self-care, attention, judgement, communication; hallucinations and illusions.<br />
  12. 12. PSYCHOLOGICAL<br />FREUD<br />STAGES OF PSYCHOSEXUAL DEVELOPMENT<br />ORAL STAGE ( 0 – 1)<br /> - to establish a trusting dependence on nursing and sustaining objects;<br /> - to establish comfortable expression and gratification of oral libidinal needs without excessive conflicts or ambivalence from oral sadistic wishes.<br />PATHOLOGICAL: extremes of oral gratification can result in libidinal fixations;<br /> - excessive optimism, narcissism, pessimism, demandingness;<br /> oral traits - envy and jealousy<br />
  13. 13. ANAL STAGE (1 – 2)<br /> - a period of striving for independence and separation from dependence <br />PATHOLOGICAL:<br />Fixation – orderliness, obstinacy, stubbornness, willfulness, frugality, and parsimony<br />If less effective – heightened ambivalence, lack of tidiness, messiness, defiance, rage ad sadomasochistic tendencies.<br />URETHRAL STAGE (2 – 3)<br /> - transitional; issues of control and shaming<br />
  14. 14. PHALLIC STAGE ( 3 – 6)<br /> - castration anxiety; penis envy; <br /> - identification from parental figures<br /> - foundation for an emerging sense of sexual identity<br /> - oedipal conflict resolution<br /> - internal source of regulation - superego<br />LATENCY STAGE ( 5-6 TO 11-13)<br /> - stage of relative quiescence or inactivity of sexual drive;<br /> - homosexual affiliations; sublimation<br /> - development of important skills<br />PATHOLIGAL: lack of control leads to failure to sublimate energies in the interests of learning and development of skills.<br />
  15. 15. GENITAL STAGE (11-13 TO young adulthood)<br /> - ultimate separation from dependence on and attachment to parents.<br /> -establishment of mature, nonincestous object relations;<br />
  16. 16. ERIKSON<br />EPIGENETIC PRINCIPLE – development occurs in sequential, clearly defined stages, and that each stage must be satisfactorily resolved for development to proceed smoothly.<br /> - In relation to Freudian theory, Erikson described a corresponding zone with a specific pattern or mode of behavior. <br />
  17. 17. EIGHT STAGES OF THE LIFE CYCLE:<br />TRUST VS. MISTRUST (birth – 18 months)<br /> - incorporation<br /> - development of basic trust<br /> - impairment leads to basic mistrust<br />>prolonged separation during infancy<br />hospitalism or anaclitic depression <br /> later life<br />dysthymia, depression, sense of hopelessness<br /><ul><li>Social mistrust Projection</li></ul>Paranoid or delusional disorders, Schizoid PD, Schizophrenia, Substance abuse, thrill-seeking behaviors<br />
  18. 18. AUTONOMY VS SHAME AND DOUBT (18M – 3)<br /> - terrible two<br />If too much shame and doubt – obsessive personality<br />Too rigorous toilet training – stingy, meticulous, selfish<br />Too much shaming – delinquent behavior; impulsive behavior<br />INITIATIVE VS GUILT ( 3 – 5)<br /> - active and intrusive<br /> - Oedipus complex<br />If excessive guilt – GAD and phobias<br />Punishment or severe prohibitions – sexual inhibitions<br />If oedipal conflict not resolved – conversion disorder; specific phobia<br />
  19. 19. INDUSTRY VS INFERIORITY (5 – 13)<br /> - covers pleasure of production<br /> - learning new skills and takes pride in things made<br /> - teachers and other role models are important<br />If unprepared – sense of inferiority or inadequacy<br />Extremes – feelings of inadequacy; compensatory drive for money, power and prestige; work can become the main focus of life<br />IDENTITY VS. ROLE CONFUSION ( 13 – 21)<br /> - running away, criminality, overt psychoses<br />Defenses – joining cults, gangs ; identifying with folk heroes<br /> - Conduct disorders, Disruptive Behavior disorder, Gender identity disorders, Schizophreniform disorders<br />
  20. 20. INTIMACY VS ISOLATION (21-40) <br /> - successful formation of stable marriage and family<br />GENERATIVITY VS STAGNATION (40-60)<br /> - establishing and guiding the next generation<br /> - depression<br /> - inc. substance use<br />INTEGRITY VS DESPAIR<br /> - acceptance<br /> - Psychosomatic illnesses, Hypochondriasis, Depression<br /> - suicide rate is highest over age 65<br />
  21. 21. SOCIAL FACTORS<br />STRESS<br /> - Stress Diathesis Model of Schizophrenia<br /> - Social Causation hypothesis<br />SOCIAL STATUS<br />LIFE EVENTS/ TRAUMATIC EVENTS<br />PHYSICAL TRAUMA/PHYSICAL ILLNESS<br />MALNUTRITION<br />POLLUTION<br />CROWDING<br />
  22. 22. STRESS DIATHESIS MODEL <br />A person may have a specific vulnerability (diathesis) that, when acted on by a stressful influence, allows the symptoms of schizophrenia to develop.<br /> -integrates biological, psychosocial, and environmental factors.<br />
  23. 23. SOCIAL CAUSATION HYPOTHESIS<br />The stresses experienced by members of low socioeconomic group contribute to the development of schizophrenia.<br />
  24. 24. SOCIAL LEARNING THEORY:<br />A person can learn by imitating the behavior of another person, but personal factors are involved<br />.<br /> - relies on role models, identification, and human interactions.<br />
  25. 25. THANK YOU & GOOD DAY<br />

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