Severe Mental Disorders. Etheldreda Nakimuli-Mpungu, MMed (Psych), MBChB Johns Hopkins University

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2 Severe Mental Disorders Etheldreda Nakimuli-Mpungu, MMed (Psych), MBChB Johns Hopkins University

3 Dr. Etheldreda Nakimuli-Mpungu Psychiatrist Uganda Mania (HIV) 3

4 Class Objectives Be able to... Define the primary characteristics of severe mental disorders and how they differ from the common disorders already discussed Recognize the impact of culture on various aspects of presentation and treatment Discuss the place of severe mental disorders in the realm of global mental health issues 4

5 Definitions Mental disorders: behavioral or psychological pattern that causes significant distress and functional impairment Severe mental disorders: chronic affective or non-affective psychoses with extensive hospitalization Psychosis: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior 5

6 Section A Psychotic Disorders Photo by vanessa_hutd. Creative Commons BY-SA. Retrieved from

7 Schizophrenia (SZ) DSM-IV A. Psychotic symptoms B. Poor functioning C. Duration of six months D. Not due to a mood disorder E. Not due to substances or other disease F. Not due to pervasive developmental disorder 7

8 Other Psychotic Disorders I Schizoaffective disorder: mood episodes and psychosis occur together Delusional disorder: at least one month of non-bizarre delusions without other active symptoms of SZ Brief psychotic disorder: psychosis lasts more than one day and remits by one month 8

9 Other Psychotic Disorders II Shared psychotic disorder: delusions in an individual who is influenced by someone else who has a longer-standing delusion with similar content Psychotic disorder due to a general medical condition Substance-induced psychotic disorder Psychotic disorder not otherwise specified 9

10 Schizophrenia: Clinical Presentation Socially unacceptable behaviors Isolation Poor academic achievement Neglect of body hygiene 10

11 Schizophrenia: Clinical Presentation Hallucinations and delusions result in Unusual behaviors Hyperactivity Suspicion refusal of food Aggression 11

12 A Psychiatric Hospital in Uganda Photo by Etheldreda Nakimuli-Mpungu 12

13 Mental Health Unit Photo by Etheldreda Nakimuli-Mpungu 13

14 Associated Symptoms Avolition Anhedonia Alogia Blunt affect Dysphoric mood depression, anxiety, or anger Disturbances in sleep pattern Abnormalities of psychomotor activity Difficulty in concentration, attention, and memory Poor insight 14

15 Laboratory Findings Neuro-imaging studies Enlarged lateral ventricles in the brain 15

16 Prevalence and Incidence Prevalence: 0.5% to 1.5% Incidence: 0.5 to 5.0 per 10,000 Rates vary in different populations 16

17 Place Annual Incidence per 1000 Annual incidence per 1000 Aarhus, Denmark 0.18 Chandigarh, India (rural) 0.42 Chandigarh, India (urban) 0.35 Dublin, Ireland 0.22 Honolulu, Hawaii 0.16 Moscow, Russia 0.28 Nagasaki, Japan 0.21 Nottingham, England 0.22 Source: Eaton and Chen. (2008). 17

18 Etiology The first-degree biological relatives of schizophrenics have a risk for SZ that is about 10 times greater than that of the general population Concordance rates for schizophrenia are higher in monozygotic twins (49%) than in dizygotic twins 25% Adoption studies biological relatives of schizophrenics have a substantially increased risk for SZ, whereas adoptive relatives have no increased risk Stress diathesis model 18

19 Course and Prognosis Heterogeneity as to onset, course, and outcome Considerable chronicity long-term course is mostly stable, not progressive Extended prodrome and insidious onset Outcome: 33% 33% 33%? Negative volatile positive symptoms More benign course in non-modern settings? Sources: Verghese et al. (1989); Srinivasan et al. (2005). 19

20 Acute Admission Wards for SMD Photo by Etheldreda Nakimuli-Mpungu 20

21 A Convalescent Ward Photo by Etheldreda Nakimuli-Mpungu 21

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DSM5: How to Understand It and How to Help Introduction: The DSM5 is a foreign language! Three Questions: I. The first was, What the key assumptions made to determine the organization of the DSM5? A. Mental