What is mental illness defined as?
Abnormalities in thinking/emotion/perception/motivation/motor activity
Visceral dysregulation (involves insomnia, loss of appetite, or loss of libido)
impairment in social and occupational functioning
What are the bio-psycho-social factors that psychiatrists use to understand and treat mental illness?
Biological: Physical factors that can exert an adverse effect on brain development and function.
Psychological: Traumatic life experiences and their impact on brain/personality development
Social: Include past and present social and cultural circumstances
What kind of physical factors can influence mental state and cause mental illness?
What kind of psychological factors can influence mental state and cause mental illness?
Early loss of parents
What kind of social factors can influence mental state and cause mental illness?
Minority ethnic group
How are mental illnesses diagnosed?
Descriptive diagnosis based on presence of symptoms and signs from a cross-sectional and longitudinal perspective.
Diagnosis and classification of mental illness should be based on objectively evident criteria.
What is the difference between a symptom and a sign?
Symptom: Person’s subjective experience of ill health
Sign: Objective evidence of abnormality
What are clinical syndrome?
A similar concurrence of symptoms and signs in different people (eg. Down’s syndrome, schizophrenia)
What kind of diagnosis is a syndrome?
Clinical. Not pathological or aetiological.
Syndromes are only called that until the cause is understood.
Is the genetic component of mental illness large?
No evidence that it is genetically caused. It is expected that its inheritance is nonspecific.
What are epigenetic effects?
Effects that arise from external modifications to DNA that turn genes ‘on’ or ‘off’ which prevents certain genes from being expressed.
Do mental illnesses always involve somatic changes?
Yes, all do to a certain degree
What is the difference between primary and secondary mental illness?
Primary is not caused by underlying physical disease or drug.
Secondary is caused by external factors such as drugs or a primary physical disease.
What is the difference between top-down causation and bottom-up causation of mental illness?
Top-down is reactive to life events; example by traumatic life events causing reactive anxiety, depression, and PTSD.
Bottom up causation: is secondary mental illness; example due to hyperthyroidism causing anxiety.
What are the 4 main categories that must be considered with mental illness?
the 4 Ps
Predisposing factors (genetic, intrauterine, peri-natal, pos-natal, handicaps, medical history, developmental experiences, abuse, drug abuse)
Precipitating factors (Traumatic events)
Perpetuating factors (Continuing stressors; substance abuse, personality, functioning, poor compliance with treatment)
Protective factors (social support, personality, employment, material security, compliance with treatment)
What is DSM - IV?
a 5 axial diagnostic formulation.
What are the 5 axes of DSM - IV?
I - classified disorder
II - Personality traits/disorder
III - Comorbid physical illness
IV - Psychosocial stressors
V - Global assessment of functioning
Is DSM - 5 using the DSM - IV system?
DSM-IV has been omitted but axes I - III are still included
What is the difference between categorical and dimensional illness?
Categorical you either have it or you don’t
Dimensional is in a range
How is pathological anxiety maladaptive?
it impairs social and occupational functioning
It is an inescapable and unpleasant experience
It is associated with unnecessary autsomal arrousal
How does anxiety affect performance?
A little bit of anxiety enhances performance, too much anxiety impairs performance.
What are the 3 groups of personality disorder?
Cluster A (The MAD)
Paranoid, schizoid, and schizotypal personality disorder.
Cluster B (The BAD)
Antisocial, Borderline, Histrionic, Narcissistic
Cluster C (The SAD)
Avoidant, Dependent, Obsessive-Compulsive
What are the positive symptoms of schizophrenia? (More overt symptoms)
Hallucinations [all senses]
Delusions [bizarre, persecutory, control]
Affective changes: Inappropriate (laughing at oneself), incongruous
Abnormalities in movement (catatonia, Parkinson-like)
What are the negative symptoms of schizophrenia?
Anhedonia, poverty of thought, blunt affect, loss of motivation, poor socialization
What is anhedonia?
Incapacity to feel pleasure
Undisputed facts about mental illness:
It is distressing to sufferer.
It results in impairment of social and occupational functioning.
Is associated with an increase in all cause morbidity and mortality
Can reduce life expectancy in serious mental illnesses
Creates large financial burden for society
Causes suffering to relatives and friends of those afflicted
How does mental illness often presented at clinic?
Predominantly as somatic or bodily complaints.
How common are mental illnesses?
Each year approximately 1 in 5 Australians will experience a mental illness.
Mental illnesses are the 3rd leading cause of disability burden in Australia. (estimated 27% of total years lost due to disability.
What is the burden of disease?
Burden of disease refers to total impact of a disease measured by financial cost, mortality, morbidity and other indicators. (number of years lost due to ill-health, disability or early death).
What ages are mental illnesses most common?
Between 16 and late 40s
How much has mental illness cost Australia?
4% of GDP
What is self-stigma of mental illness?
Internalisation of perceived social stigma of the mentally ill.
What other problems are often found with Mental Ilnesses?
Medication effects (myocarditis, cardiomyopathy, arrhythmias, metabolic syndrome, NMS, serotonin sydnrome, malignant neutropenia)
Non-utilisation of health services
Focus on mental illness and neglect of physical health by attending health professionals