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
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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
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
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Neuro- endo-immuno -crinology:
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Neuropathology Structural or physiological 22
Psychological Theories- Learning & Cognitive Taken from Mash & Wolfe (2005) 23
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Predisposing factors Constitution Precipitating factors Illness Perpetuating factors Recovery
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
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
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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
Manifestation of Mental Disorders
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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
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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 Dopamine Synapse Receptor Site Speakin g Brain Vesicle Cell Listening Brain Cell - Dopamine, Serotonin & Norepinephrine Histamine,GABA & Ach
Copyright 1998 Patricia L. Scheifler MSW, PIP Antipsychotic Medications Dopamine Speakin g Brain Cell Listening Brain Cell Antipsychotic Medication Blocks Receptor Site
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