Defining Mental Disorders. Judy Bass, MPH, PhD Johns Hopkins University

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1 This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site. Copyright 2011, The Johns Hopkins University and Judith Bass. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided AS IS ; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.

2 Defining Mental Disorders Judy Bass, MPH, PhD Johns Hopkins University

3 Class Objectives Be able to Describe the Western model of mental illness Define the different common major mental illnesses among adults and youth Recognize the overlap and interrelationships across many of these disorders 3

4 Section A Defining Mental Health Photo source: morguefile.com. Retrieved from

5 What Is Mental Health? Illness is not absence of health What is considered illness and health is dependent on standards, roles, and expectations Question: To what extent are mental health and mental illness culturally bound? 5

6 Defining Syndrome Syndromes are combinations of signs and symptoms Signs: observable Behavior patterns Relationships/interpersonal Symptoms: reportable Emotions/feelings Cognitions/thoughts 6

7 Defining Syndrome Syndromes are combinations of signs and symptoms Signs: observable Behavior patterns Relationships/interpersonal Symptoms: reportable Emotions/feelings Cognitions/thoughts 7

Conceptualization of Mental Health in West

of Disease: WHO Structured and specific Based

8 Conceptualization of Mental Health in West Syndrome diagnoses DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Rev ICD 10 International Classification of Disease: WHO Structured and specific Based on certain populations Image source: Amazon.com. 8

9 This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site. Copyright 2011, The Johns Hopkins University and Judith Bass. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided AS IS ; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.

10 Section B Disorders of Adulthood Photo source: morguefile.com. Retrieved from

11 Major Domains of Disorders of Adulthood: DSM-IV-TR Mood disorders Anxiety disorders Substance-related disorders Severe mental illness Schizophrenia/schizoaffective/delusional 3

12 Mood Disorders Can consist of depressed moods depression and/or hyper moods mania Depressive disorders Major depressive disorder Dysthymic disorder Manic and combination disorders Bipolor disorder I and II 4

13 Symptoms of Major Depressive Disorder Anhedonia Loss of interest in general Loss of libido/love Psychomotor Slowness in movement Restless in movement Appetite change Loss of appetite/loss of weight Gain of appetite/gain of weight Sleep disturbance Insomnia Wake up early in the morning Sleeping longer than usual Fatigue Tiredness, exhaustion Worthlessness Feeling of inferiority Giving up of hope Loss of self-esteem Sense of being ignored/ forgotten Concentration Inability to concentrate Suicide Meaninglessness of life Suicide attempt 5

14 Anxiety Disorders Generalized anxiety disorder (GAD) Post-traumatic stress disorder (PTSD) Panic disorder Phobias Obsessive-compulsive disorder (OCD) 6

15 Anxiety Disorders Generalized anxiety disorder (GAD) Post-traumatic stress disorder (PTSD) Panic disorder Phobias Obsessive-compulsive disorder (OCD) 7

16 Post-traumatic Stress Disorder Re-experiencing Flashback/vivid memories Nightmares Feeling of trauma happening again Visual re-experiences of trauma Distress at exposure to trigger events Avoidance/numbing Efforts to escape trigger events Force self not to have thoughts or feelings about the trauma Avoidance/numbing (cont.) Experiences disappeared after the trauma Lost interest in everyday life Lost emotional attachment to others Feeling of isolation Feeling the future is worthless Increased arousal symptoms Trouble going to sleep Easily excited Trouble concentrating Experiences of unsubstantiated panic 8

17 Types of Trauma Child abuse Physical Sexual Emotional War Terrorism Victim/witness of violence Domestic Community School Refugee Torture Medical (e.g., transplant) Accidents (e.g., motor vehicle) Traumatic grief Disasters 9

18 Substance Use Disorders Disorders associated with substances that cause Intoxication Dependence Abuse Withdrawal Substances can be legal or illegal Alcohol, nicotine, prescription drugs, illegal drugs 10

19 Substance Disorder Related Problems Maladaptive behavior changes Violence, aggression Risky sexual behaviors Dependence Slurred speech, stupor Culture can be important Chinese culture frowns on solitary drinking Zambia: binge drinking almost exclusively 11

20 Severe Mental Illness Chronic disorders often requiring extensive hospitalization Characterized by psychoses Delusions, hallucinations, disorganized speech and/or behavior Schizophrenia and schizoaffective disorders Severe bipolar disorder with psychotic episodes 12

21 Importance of Function Disturbance causes clinically significant impairment in social, academic, or occupational functioning Photo source: morguefile.com. Retrieved from

22 This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site. Copyright 2011, The Johns Hopkins University and Judith Bass. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided AS IS ; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.

23 Section C Disorders of Childhood Photo source: morguefile.com. Retrieved from

24 Major Disorders of Youth: DSM-IV-TR Oppositional defiant disorder Conduct disorder Separation anxiety disorder Mental retardation/learning disorders Adolescent substance abuse 3

25 Oppositional Defiant Disorder Pattern of negativistic, hostile, and defiant behavior lasting at least six months (need four) Often loses temper Often argues with adults Often actively defies or refuses to comply with adults requests or rules Often deliberately annoys people Often blames others for his/her mistakes or misbehavior Often touchy or easily annoyed by others Often angry and resentful Often spiteful or vindictive 4

26 Conduct Disorder Need three or more in past six months Aggression to people and animals Destruction of property Deceitfulness or theft Serious violations of rules 5

27 Separation Anxiety Disorder Distress when separated from home or major attachment figure Persistent and excessive worry about losing or harm befalling caregiver, or being alone Persistent reluctance or refusal to Attend school Go to sleep Nightmares Somatic complaints 6

28 This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site. Copyright 2011, The Johns Hopkins University and Judith Bass. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided AS IS ; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.

29 Section D Summary and Case Examples

30 Summary Syndromes defined as a constellation of signs and symptoms occurring concurrently within the same individual Western-based psychiatry has a diagnostic structure DSM that defines the syndrome structures and criteria Overlap between syndromes is common (comorbidity) but challenges diagnosis decisions 3

31 Activity Two case examples description of an adult and a child Post your thoughts on which diagnosis might fit these clients, and why 4

Case Example 1: Adult 40-year-old woman who came into a medical clinic Complaints of stomach aches and diarrhea Looking thin, loosing appetite Quiet Keeping

32 Case Example 1: Adult 40-year-old woman who came into a medical clinic Complaints of stomach aches and diarrhea Looking thin, loosing appetite Quiet Keeping to herself Bouts of outrage on her children Says she can t concentrate and often zones out Photo source: morguefile.com. Retrieved from 5

33 Case Example 2: Child 8-year-old child Cries often Stays alone Doesn t listen to parents Refuses to go to school Enuresis Irritable Easily agitated Photo source: morguefile.com. Retrieved from : 6

34 Activity Instructions What type of diagnosis would you first move toward? What additional questions do you have? For the woman? For the child s parents? What more information do you need to start to understand the mental health problem? Post your thoughts in the BBS areas marked Lecture 2. There are separate conversation areas for Case Study 1 and Case Study 2. 7

ATTENTION DEFICIT HYPERACTIVITY DISORDER COMORBIDITIES 23/02/2011. Oppositional Defiant Disorder

ATTENTION DEFICIT HYPERACTIVITY DISORDER COMORBIDITIES The comorbidity of ADHD with other disorders is between 60% and 80% The most commonly comorbid disorder that occur alongside ADHD are: Oppositional