Mental illness

What is Normal?• Psychopathology: Scientific study of mental, emotional, and

behavioral disorders.• Subjective Discomfort: Feelings of anxiety, depression, or

emotional distress.• Statistical Abnormality: Having extreme scores on some

dimension, such as intelligence, anxiety, or depression.• Social Nonconformity: Disobeying societal standards for normal

conduct: usually leads to destructive or self-destructive behavior.• Situational Context: Social situation, behavioral setting, or

general circumstance in which an action takes place• Cultural Relativity: Judgments are made relative to the values of

one’s culture• The Medical Model: Mental Illness is treated as a physical

disease.

Diagnosing Mental Illness

• Difficult for even professionals• Case Study

General Risk Factors for Contracting Mental Illness• Social Conditions: Poverty, homelessness,

overcrowding, stressful living conditions.• Family Factors: Parents who are immature,

mentally ill, abusive, or criminal: poor child discipline: severe marital or relationship problems

• Psychological Factors: Low intelligence, stress, learning disorders .

• Biological Factors: Genetic defects or inherited vulnerabilities: poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability

Stereotypes of Psychological Disorders• Psychological Disorders are a sign of

personal weakness.• Psychological disorders are incurable.• People with psychological disorders are

often violent and dangerous.• People with psychological disorder

behave in bizarre ways and are very different from normal people.

Psychodiagnosis: The Classification of DisordersDSM-IV-TR (text revision)

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision

• criteria, descriptions and other information to guide the classification and diagnosis of mental disorders was published in 2000 replacing DSM-IV. It is expected that DSM-V will replace DSM-IV-TR sometime in the future. This revision of the fourth edition of the manual published by the American Psychiatric Association to set forth diagnostic guidelines.

History of the DSM

• DSM-I 1952 (describe 60 disorders)• DSM-II 1968• DSM-III 1980 (Multiaxial system)• DSM-III-R 1988• DSM-IV 1993• DSM- IV-TR 2000 (Over 200 disorders)

Multiaxial System

• Axis I: Major clinical syndrome• Axis II: Personality and developmental dis

orders• Axis III: Physical Disorders and conditions• Axis IV Severity of psychosocial stressors• Axis V Global Assessment of Functioning

(GAF) Scale

A multiaxial evaluationPatient: 58 year old male• Axis I: Major depression, alcohol

dependence• Axis II: Dependent Personality disorder• Axis III: Alcoholic cirrhosis of liver• Axis IV: Severity: 3 (moderate)

Anticipated retirement and change in residence, with loss of contact with friends

• Axis V:GAF 44 Highest in in past year :55

Overview of Mental Disordersin DSM-IV

Disorders of Infancy, Childhood, or AdolescenceMental Retardation, Pervasive Developmental Disorders,Attention-Deficit and Disruptive Behavior Disorders

Delirium, Dementia, and Cognitive DisordersMedical emergencies, Alzheimer’s, Amnesia

Mental Disorders due to a General Medical Condition“Organic”; Hypothyroidism, Infection, Anemia, Cancer

Substance-Related DisordersAbuse vs. Dependence, Intoxication, Withdrawal , Persisting

Schizophrenia and other Psychotic DisordersSchizophrenia subtypes, Delusional Disorder, Psychosis NOS

Overview of Mental Disorders in DSM-IV (cont’d)

Mood Disorders

Major Depression, Bipolar Disorder

Anxiety Disorders

Panic Disorder, Obsessive-Compulsive Disorder, PTSD, Phobias, Generalized Anxiety Disorder

Somatoform Disorders

Conversion Disorder, Hypochondriasis, Pain Disorder

Factitious Disorders

Munchausen’s vs. Malingering

Overview of Mental Disordersin DSM-IV (cont’d)

Dissociative Disorders“Multiple Personality Disorder”, Fugue, Amnesia

Sexual and Gender Identity DisordersDysfunction, Paraphilias, Transvestite vs. “Transsexual”

Eating DisordersAnorexia, Bulimia

Sleep DisordersDyssomnia, Narcolepsy, Parasomnia (Terrors, Sleepwalking)

Impulse-Control DisordersKleptomania, Pyromania, IED, Pathological Gambling

Axis I Major Clinical Syndrome• Disorders usually first evident in infancy , childhood or

adolescence.(ADD, Bulimia and anorexia)• Organic Mental disorder: Temporary or permanent dysfunction of

brain tissue caused by diseases or chemicals.• Psychoactive substance use disorders• Schizophrenic Disorders: (Grossly disorganized behavior,

delusions, and hallucinations)• Delusional disorder:• Mood Disorder• Anxiety disorders• Somatoform disorders• Dissociative disorders• Psychosexual disorder

Back

Axis II: Personality and Developmental Disorders

• Personality Disorders: Disorders are patterns of personality traits that are longstanding, maladaptive,

and inflexible and involve impaired functioning or subjective distress• Specific Developmental disorders :

Autism, Mental retardation, reading, writing and arithmetic disorders

Back

Axis IIIPhysical disorders and conditions• Physical disorders or conditions are

recorded on this axis.• Examples: Diabetes, arthrities, and

hemophilia

Back

Axis IVSeverity of Psychosocial stressors

(back)Code Term Adult Example

1 None No Relevant events

2 Mild Starting or graduating school

3 Moderate Loss of job

4 Severe Divorce

5 Extreme Death of loved one

6 Catastrophic Devastating natural disaster

Axis VGlobal Assessment of Functioning

Scale• 90-Absent or minimal symptoms, good

functioning in all areas• 60 Moderate symptoms or difficulty in social ,

occupational, or school functioning.• 30 Behavior considerably influenced by

delusions or hallucinations, serious impairment in communication or judgment, or inability to function in almost all areas

• 10 Persistent danger of severely hurting self or others

BACK