Overview of Mental Health & Disorders. Dr Bhagwat Rajput MBBS DNB, Psychiatry World College Of Medical Sciences
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1 Overview of Mental Health & Disorders Dr Bhagwat Rajput MBBS DNB, Psychiatry World College Of Medical Sciences
2 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
3 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
4 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
5 Dimensions Of Health
6
7 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
8 Mental health Negative impact
9 NO HEALTH WITHOUT MENTAL HEALTH
10 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 %, Anxiety: 12-13%, Mood: %,Psychosis: %, Substance use: % Europeans : 28%
11 Epidemiology Murray cl,flaxmon ld,michaud C et althe Lancet ;
12 Global burden
13
14 Contd
15 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 15
16
17 Etiology o Diagnose and understand. o Early 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
18 Contd.
19 Contd..
20 Neuro- endo-immuno -crinology:
21 Contd
22 Neuropathology Structural or physiological 22
23 Psychological Theories- Learning & Cognitive Taken from Mash & Wolfe (2005) 23
24 24
25 Predisposing factors Constitution Precipitating factors Illness Perpetuating factors Recovery
26 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 26
27 Categories ICD-10 F Organic disorder F Psychoactive substance abuse F Psychotic disorders F Mood disorders F Anxiety disorders F Physiological disorders F Personality disorders F Mental retardation F Developmental Disorders F Behavioral & Emotional - childhood
28 Contd
29 Psychiatric Disorders Organic Non-Organic Acute Chronic Others Psychoses Neuroses Others Delirum Dementia Alcohol Schizophrenia Anxiety disorders Personality dis. Wernicke s Korsakoff Head Injury Mood disorders Adjustment dis. Sleep disorder
30 Manifestation of Mental Disorders
31 Contd
32
33 Contd
34 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
35 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
36 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
37 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
38 Treatment of Mental Illness
39 Contd
40 Contd
41
42 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 -
43 Imbalance Neurotransmitter in brains Dopamine Synapse Receptor Site Speakin g Brain Vesicle Cell Listening Brain Cell - Dopamine, Serotonin & Norepinephrine Histamine,GABA & Ach
44 Copyright 1998 Patricia L. Scheifler MSW, PIP Antipsychotic Medications Dopamine Speakin g Brain Cell Listening Brain Cell Antipsychotic Medication Blocks Receptor Site
45 Psychotropics Alternative uses
46 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
47 ECT & TMS
48 Deep brain stimulations
49
50 Take Home message
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