Overview of

Mental Health & Disorders

Dr Bhagwat Rajput

MBBS DNB , Psychiatry

World College Of Medical Sciences

Brief View - Outline

Introduction

Definitions & common term used

Epidemiology - Global burden & National

Etiology

Models & Approaches

Classifications – Purpose & Types

Manifestations of Psychiatric illness

History & Mental status Examinations

Diagnosis & Treatments

Conclusion

Introduction

Mental health : life long process a sense of harmony & balance for the individual, family, friends & community

o Health & Mental health

o Psychiatric disorders – Prevalent & often go untreated

o Global & National burden of mental disorders

o Subject of medicine is human being “Biopsychosocial”

o Consideration aspects - Doctor-patient relationship

o Associated stigma – Patients, caregivers & doctors

Contd…

Psychiatry : Branch of medicine dealing with

mental disorder & Its treatment

Psych : soul or mind ; Iatros : healer

Psychology : Science investigates behaviour,

experience & normal functioning of the mind

Psychotherapy : Treatment of psychological

issues by non-physical means

Organic - Identifiable physical pathology

Functional - Psychological,cause not known

4

Dimensions Of Health

Mental health – Importance��

Mental health – Good health & quality of life

Desirable personality

Emotional & Social development

Moral & Aesthetic Development

Seeking goals of life

Self image & Education

Sleep , Eating & Physical Health

Prevention of mental illness

Mental health – Negative impact

“NO HEALTH WITHOUT MENTAL HEALTH”

Mental Disorder -

WHO ICD 10 - Clinically recognizable set of

symptoms, associated in most case with distress &

with interference in personal functions. Should

exclude culturally/religious sanctioned response to an

event.

India Prevalanc- 20-25% , Anxiety: 12-13% ,

Mood: 5.7-7.5%,Psychosis: 0.2-1.3% ,

Substance use: 7.6-9.7%

Europeans : 28%

Epidemiology

Murray cl,Flaxmon ld ,michaud C et alThe Lancet 2012-380;2063-2066

Global burden

Contd…

Models - Supernatural & Bio-psychosocial

Supernatural Model

Phenomena such as magnetic fields , the moon or the stars

These agents which might be divinities, demons, spirits

Greece ; MIND = SOUL =PSYCHE & considered

separate from the body

Bio-psychosocial

Mental health care - Multiagency task - multidisciplinary

teams of workers - patient/client and their carers.

Program of treatment and support to meet their needs

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Etiology

oDiagnose and understand.

oEarly intervention. & Optimize treatment.

According to nature: a) Biological b) Psychological c) Social

According to the effect: a. Predisposing b. Precipitating c. Perpetuating

Acoording to approch

a. Genetics b. Biochemical studies

c. Endocrinology d. Neuropathology

e. Psychological theories f. Social Science

Contd….

Contd..

Neuro- endo-immuno -crinology:

Contd…

22

Neuropathology – Structural or physiological

Psychological Theories- Learning & Cognitive

Taken from Mash & Wolfe (2005) 23

24

Predisposing factors

Constitution

Illness

Recovery

Precipitating

factors

Perpetuating

factors

Classificatory systems

ICD-10 –

World Health Organization, covers the whole of

medicine

Tenth edition of the - ICD-10

Classification of Mental and Behavioural Disorders.

DSM-IV

American Psychiatric Association

Fourth Edition - (DSMIV)

Multiaxial system

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Categories ICD-10

F 00-09 Organic disorder

F 10-19 Psychoactive substance abuse

F 20-29 Psychotic disorders

F 30-39 Mood disorders

F 40-49 Anxiety disorders

F 50-59 Physiological disorders

F 60-69 Personality disorders

F 70-79 Mental retardation

F 80-89 Developmental Disorders

F 90-99 Behavioral & Emotional - childhood

Contd…

Psychiatric Disorders

Organic Non-Organic

Chronic

Dementia

Korsakoff

Others

Alcohol …

Head Injury

Acute

Delirum

Wernicke’s

Psychoses

Schizophrenia

Mood disorders

Neuroses

Anxiety disorders

Adjustment dis.

Others

Personality dis.

Sleep disorder

Manifestation of Mental Disorders

Contd…

Contd…

The Psychiatric History

Chief complaint & Reason for referral

History of Present Illness

Past History

Medications

Personal History – Birth;Childhood;Educational

Family History – Relationship;Psy illness,

Social History – Marriage; Financial;Hobbies

Premorbid personality & Substance use

Mental Status Examinations

General –

Appearance – Age, Eye contact, Dress and grooming,

Motor – Gait , Freedom of movement,

Speech – Rate,Volume & Defects

oEmotion –

Mood - Euthymic,Angry,Euphoric,Dysphoric,

Affect – Appropriateness,Intensity & Reactivity

o Thought contents –

Preoccupations; Obsessions; Phobia & Beliefs

Contd…

o Cognitive -

Consciousnes , Attention & Orientation

Concentration ,Memory &Intelligence

o Judgments-

The process of Consideration & Formulation

Leading to a Decision & Action

o Insight –

Patient’s capacity to Acknowledge/Appreciate illness

Associated implications & Consequences

Investigations

To detect alteration, Screen organic & drug

Routine investigations – CBC,KFT,LFT,Elecrtolytes, Sugar , HIV & ECG

Electrophysiological tests – EEG & Polysomnography

Neuroimaging tests – CT & MRI

Neuroendocrine tests – TRH,TSH, Melatonin & Prolactine

Genetics tests – Cytogenic work up – MR

Psychological tests – PSE,MMSE,BPRS & SCAN

Treatment of Mental Illness

Contd…

Contd…

Managements

o Decisive Factors -

1.Nature 2.Duration of symptoms 3.Family history

o Phases to treatment - 1.Initial phase 2. Continuations 3. Maintenance o Pharmacological

1. Antipsychotics

2. Antidepressants

3. Mood stabilizing agents

4. Anxiolytics and sedatives

5. Anticonvulsants

o Nonpharmacological -

Imbalance – Neurotransmitter in brains

Speaking

Brain Cell

Listening

Brain Cell

Synapse

Dopamine

Vesicle

Receptor

Site

- Dopamine, Serotonin & Norepinephrine Histamine,GABA & Ach

Antipsychotic Medications

Speaking

Brain Cell

Listening

Brain Cell

Dopamine

Antipsychotic Medication

Blocks Receptor Site

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998

Patr

icia

L.

Scheifle

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Psychotropics – Alternative uses

Nonpharmcological interventions

o Psychotherapies

1.Cognitive behavioral therapy

2.Biofeedback

3.Relaxation techniques

4.Family & Group psychotherapy

Psychoeducation

Skills training

Social, vocational, and educational support

Occupational therapy

ECT & TMS

Deep brain stimulations

Take Home message