LECTURE 6: MENTAL ILLNESS MPH 342 HEALTH & WELLNESS DR SHAI’ DEPARTMENT OF HEALTH SCIENCES

OVERVIEW Nationwide 50 million Americans suffer from a mental illness in a given year Mental Illness is more common than: Cancer, Diabetes, Heart Disease Psychiatric disorders are the number 1 reason for hospital admissions nationwide IT IS TREATABLE

CAUSES Biological Causes Biochemical Disturbances Genetics Infections- can cause brain damage Brain defects or injury Prenatal damage Poor nutrition, exposure to toxins

CAUSES Psychological Causes Severe psychological trauma suffered as a child, such as emotional, physical or sexual abuse An important early loss, such as the loss of a parent Neglect Poor ability to relate to others

CAUSES Environmental Factors Death or divorce A dysfunctional family life Living in poverty Feelings of inadequacy, low self-esteem, anxiety, anger or loneliness Changing jobs or schools Social or cultural expectations (For example, a society that associates beauty with thinness can be a factor in the development of eating disorders.) Substance abuse by the person or the person's parents

STRESS Academic Homesickness Peer relationships Family Identity Work Illness

STIGMIZATION 35% of people with diagnosable disorders seek treatment The single most common barrier to seeking treatment is Shame

TYPES OF MENTAL ILLNESS Mood Disorders Anxiety Disorders Psychotic Disorders Personality Disorders Impulse Control and Addictive Disorders Eating Disorders/Body Image Other ( Adjustment Disorders, Dissocative Disorders, Factitious Disorders, Sexual and Gender Disorders, Somotoform Disorders, Mental Retardation)

ANXIETY DISORDERS Panic Disorder Obsessive Compulsive Disorder Post Traumatic Stress Disorder Social Anxiety Disorder Specific Phobias Generalized Anxiety Disorder

SYMPTOMS OF ANXIETY DISORDERS Feelings of panic, fear and uneasiness Uncontrollable, obsessive thoughts Repeated thoughts or flashbacks of traumatic experiences Nightmares Ritualistic behaviors, such as repeated hand washing Problems sleeping Cold or sweaty hands Shortness of breath Palpitations An inability to be still and calm Dry mouth Numbness or tingling in the hands or feet Nausea Muscle tension

HOW COMMON ARE ANXIETY DISORDERS? Anxiety disorders affect about 19 million adult Americans. Most anxiety disorders begin in childhood, adolescence and early adulthood. They occur slightly more often in women than in men, and occur with equal frequency in Caucasians, blacks and Hispanics.

TREATMENT OF ANXIETY DISORDERS Medication-Medicines used to reduce the symptoms of anxiety disorders include anti-depressants and anxiety- reducing medications. Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people by talking through strategies for understanding and dealing with their disorder. Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of psychotherapy in which the person learns to recognize and change thought patterns and behaviors that lead to troublesome feelings.

TYPES OF DEPRESSION Situational/Adjustment Bereavement Seasonal Clinical Depression Psychotic Depression Bipolar (Manic-Depressive Illness) Dysthymia Post-Partum Depression

SITUATIONAL/ADJUSTMENT Variable mood correlated to circumstances  Minimal change in sleep, appetite, energy  No change in self-attitude  Suicidal thought unlikely  Typically lasts less than one month

SEASONAL Seasonal depression, called seasonal affective disorder (SAD), is a depression that occurs each year at the same time, usually starting in fall or winter and ending in spring or early summer. It is more than just "the winter blues" or "cabin fever." Symptoms of winter SAD may include the seasonal occurrence of: Fatigue Increased need for sleep Decreased levels of energy Weight gain Increase in appetite Difficulty concentrating Increased desire to be alone

DYSTHMIA Dysthymia, sometimes referred to as chronic depression, is a less severe form of depression but the depression symptoms linger for a long period of time, perhaps years. Those who suffer from dysthymia are usually able to function normally, but seem consistently unhappy. Symptoms of dysthymia include: Difficulty sleeping Loss of interest or the ability to enjoy oneself Excessive feelings of guilt or worthlessness Loss of energy or fatigue Difficulty concentrating, thinking or making decisions Changes in appetite Thoughts of death or suicide

CLINICAL DEPRESSION An illness, not a weakness Serious disturbances in work, social, and physical functioning including suicidal thought Not relieved by circumstances May last for months or years untreated Persistent and intense mood change

CLINICAL DEPRESSION WHO AND WHEN 1.5 million young adults in US each year  Fewer than half seek treatment  1 of 4 women and 1 of 10 men develop depression during their lifetime Often begins in early adult years Family history, substance abuse, and stress increase risk

CLINICAL DEPRESSION SIGNS AND SYMPTOMS Extreme sadness, guilt, shame Decreased concentration, poor academic performance or work performance Decreased interest/enjoyment in daily activities Increased irritability, arguments Change in sleep, appetite, energy Social withdrawal Hopelessness, helplessness, suicidal thought

CLINICAL DEPRESSION TREATMENT Anti-Depressant medications (effective,improved safety & tolerability, not habit forming) Psychotherapy (individual, group, cognitive behavioral,self-help) Day treatment, hospitalization Exercise, sleep hygiene, light therapy, ECT

PSYCHOTIC DEPRESSION Roughly 25% of people who are admitted to the hospital for depression suffer from what is called psychotic depression. What Are the Symptoms of Psychotic Depression? Anxiety (fear and nervousness) Agitation Paranoia Insomnia (difficulty falling and staying asleep) Physical immobility Intellectual impairment Psychosis

BIPOLAR DISORDER 2% general population over a lifetime Half of cases begin before age 20 Episodic extremes between states depressed state and excitable, euphoric/irritable, impulsive state Strong family linkage Occurs equally in men and women

SYMPTOMS OF BIPOLAR DISORDER Symptoms of mania ("the highs"): Excessive happiness, hopefulness, and excitement Sudden changes from being joyful to being irritable, angry, and hostile Restlessness Rapid speech and poor concentration Increased energy and less need for sleep High sex drive Tendency to make grand and unattainable plans Tendency to show poor judgment, such as deciding to quit a job Drug and alcohol abuse Increased impulsivity

BIPOLAR DISORDER Some people with bipolar disorder can become psychotic, seeing and hearing things that aren't there and holding false beliefs from which they cannot be swayed. During depressive periods ("the lows”) symptoms include: Sadness Loss of energy Feelings of hopelessness or worthlessness Loss of enjoyment from things that once were pleasurable Difficulty concentrating Uncontrollable crying Difficulty making decisions Irritability Increased need for sleep Insomnia A change in appetite causing weight loss or gain Thoughts of death or suicide Attempting suicide

BIPOLAR DISORDER TREATMENT Mood stabilizer medication Psychotherapy May require emergency hospitalization

FACTS ABOUT SUICIDE 3rd leading cause of death in 15-24 year olds Men 4 times more than women Highest rate in white men over 65 Alcoholism associated with up to half of all suicides Mood disorders account for 60-80% of suicides 50-75% seek help before suicide but 50% have never seen a psychiatrist

RISK FOR SUICIDE History of attempt Males>Females Family history of suicide Native American Mood Disorder or Substance Abuse White>Black

SOCIAL/ENVIRONMENTAL FACTORS CAN INCREASE RISK FOR SUICIDE Humiliating life events Loss History of childhood abuse Interpersonal discord Social isolation

WHAT TO DO? LISTEN FOR: Life isn’t worth living I feel my family would be better off without me. Suicide is the only way out. Take my (something); I don’t need it anymore. Ending the pain is all I care about. Next time, I’ll take enough pills to do it right.

HOW TO HELP Do Don’t Voice concerns Get professional help immediately Tell someone or call the police Don’t Assume the situation will take care of itself Leave the person alone Be sworn to secrecy Act shocked Challenge or dare Argue or debate moral issues

ASKING ABOUT SUICIDE How depressed do you get? Ever so depressed that you think about hurting yourself or taking your own life? What kinds of ideas do you have about suicide? When do you feel most like hurting yourself?

SUICIDE PREVENTION Decrease social isolation Identify victimization, rejection, mental illness,and substance abuse Treat depression Reduce hopelessness Skill building around mood regulation Secure or remove firearms Decrease barriers around help seeking

POST TRAUMATIC STRESS Can develop after a person has experienced or witnessed a traumatic or terrifying event in which serious physical harm occurred or was threatened. PTSD is a lasting consequence of traumatic ordeals that cause intense fear, helplessness, or horror, such as a sexual or physical assault, the unexpected death of a loved one, an accident, war, or natural disaster. Families of victims can also develop posttraumatic stress disorder, as can emergency personnel and rescue workers.

SYMPTOMS OF PTSD Symptoms of PTSD most often begin within three months of the event. In some cases, however, they do not begin until years later. The severity and duration of the illness vary. Some people recover within six month, while others suffer much longer. Symptoms of PTSD often are grouped into three main categories, including:re-living, avoiding, and increased arousal

SYMPTOMS OF PTSD Re-living: may include flashbacks, hallucinations and nightmares. They also may feel great distress when certain things remind them of the trauma, such as the anniversary date of the event. Avoiding: may avoid people, places, thoughts or situations that may remind him or her of the trauma. Have feelings of detachment and isolation from family and friends Increased arousal: excessive emotions; problems relating to others, including feeling or showing affection; difficulty falling or staying asleep; irritability; outbursts of anger; difficulty concentrating; and being "jumpy" or easily startled. The person may also suffer physical symptoms, such as increased blood pressure and heart rate, rapid breathing, muscle tension, nausea and diarrhea.

WHO CAN SUFFER FROM PTSD? Victims of trauma related to physical and sexual assault face the greatest risk for PTSD. How Common Is PTSD? About 3.6% of adult Americans -- about 5.2 million people -- suffer from PTSD during the course of a year, and an estimated 7.8 million Americans will experience PTSD at some point in their lives. PTSD can develop at any age, including childhood. Women are more likely to develop PTSD than are men. This may be due to the fact that women are more likely to be victims of domestic violence, abuse and rape.

TREATMENT Treatment for PTSD may involve psychotherapy (a type of counseling), medication or both. Therapy Cognitive-behavior therapy, which involves learning to recognize and change thought patterns that lead to troublesome emotions, feelings and behavior. Psychodynamic therapy focuses on helping the person examine personal values and the emotional conflicts caused by the traumatic event. Family therapy may be useful because the behavior of the person with PTSD can have an affect on other family members. Group therapy may be helpful by allowing the person to share thoughts, fears and feelings with other people who have experienced traumatic events.

OBSESSIVE COMPULSIVE DISORDER Common obsessions include: Fear of dirt or contamination by germs. Fear of causing harm to another. Fear of making a mistake. Fear of being embarrassed or behaving in a socially unacceptable manner. Fear of thinking evil or sinful thoughts. Need for order, symmetry or exactness. Excessive doubt and the need for constant reassurance

TREATMENT Medication Therapy: Various types of psychotherapy, including individual, group and family therapy

PERSONALITY DISORDERS Personality disorders: People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school or social relationships. In addition, the person's patterns of thinking and behavior significantly differ from the expectations of society and are so rigid that they interfere with the person's normal functioning. Examples include antisocial personality disorder, obsessive-compulsive personality disorder and paranoid personality disorder.

PSYCHOTIC DISORDERS Schizophrenia: People with this illness have changes in behavior and other symptoms -- such as delusions and hallucinations -- that last longer than six months, usually with a decline in work, school and social functioning. Schizoaffective disorder: People with this illness have symptoms of schizophrenia, as well as a serious mood or affective disorder, such as severe depression, mania (a disorder marked by periods of excessive energy) or bipolar disorder (a disorder with cyclical periods of depression and mania).

PSYCHOTIC DISORDERS Schizophreniform disorder: People with this illness have symptoms of schizophrenia, but the symptoms last less than six months. Brief psychotic disorder: People with this illness have sudden, short periods of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick -- usually less than a month.

PSYCHOTIC DISORDERS Delusional disorder: People with this illness have delusions involving real-life situations that could be true, such as being followed, being conspired against or having a disease. These delusions persist for at least one month. Shared psychotic disorder: This illness occurs when a person develops delusions in the context of a relationship with another person who already has his or her own delusion(s). Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from some substances, such as alcohol and crack cocaine, that may cause hallucinations, delusions or confused speech.

PSYCHOTIC DISORDERS Psychotic disorder due to a medical condition: Hallucinations, delusions or other symptoms may be the result of another illness that affects brain function, such as a head injury or brain tumor Paraphrenia: This is a type of schizophrenia that starts late in life and occurs in the elderly population.

SYMPTOMS OF A PSYCHOTIC DISORDER Hallucinations and delusions. Hallucinations are unusual sensory experiences or perceptions of things that aren't actually present, such as seeing things that aren't there, hearing voices, smelling odors, having a "funny" taste in your mouth and feeling sensations on your skin even though nothing is touching your body. Delusions are false beliefs that are persistent and organized, and that do not go away after receiving logical or accurate information. For example, a person who is certain his or her food is poisoned, even if it has been proven that the food is fine, is suffering from a delusion.

PSYCHOTIC DISORDERS Other possible symptoms of psychotic illnesses include: Disorganized or incoherent speech Confused thinking Strange, possibly dangerous behavior Slowed or unusual movements Loss of interest in personal hygiene Loss of interest in activities Problems at school or work and with relationships Cold, detached manner with the inability to express emotion Mood swings or other mood symptoms, such as depression or mania

HOW COMMON ARE PSYCHOTIC DISORDERS? About 1% of the population worldwide suffers from psychotic disorders. These disorders most often first appear when a person is in his or her late teens, 20s or 30s. They tend to affect men and women about equally.

TREATMENT Medication Psychotherapy: Various types of psychotherapy, including individual, group and family therapy, may be used to help support the person with a psychotic disorder.

EATING DISORDERS Eating disorders involve extreme emotions, attitudes and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common eating disorders.

IMPULSE CONTROL AND ADDICTION DISORDERS: People with impulse control disorders are unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing) and compulsive gambling are examples of impulse control disorders. Alcohol and drugs are common objects of addictions. Often, people with these disorders become so involved with the objects of their addiction that they begin to ignore responsibilities and relationships.

ADJUSTMENT DISORDER Adjustment disorder occurs when a person develops emotional or behavioral symptoms in response to a stressful event or situation. The stressors may include natural disasters, such as an earthquake or tornado; events or crises, such as a car accident or the diagnosis of a major illness; or interpersonal problems, such as a divorce, death of a loved one, loss of a job or a problem with substance abuse. Adjustment disorder usually begins within three months of the event or situation and ends within six months after the stressor stops or is eliminated.

DISSOCIATIVE DISORDERS People with these disorders suffer severe disturbances or changes in memory, consciousness, identity, and general awareness of themselves and their surroundings. These disorders usually are associated with overwhelming stress, which may be the result of traumatic events, accidents or disasters that may be experienced or witnessed by the individual. Dissociative identity disorder, formerly called multiple personality disorder, or "split personality", and depersonalization disorder are examples of dissociative disorders.

FACTITIOUS DISORDERS Conditions in which physical and/or emotional symptoms are experienced in order to place the individual in the role of a patient or a person in need of help.

SEXUAL AND GENDER DISORDERS Sexual and gender disorders: These include disorders that affect sexual desire, performance and behavior. Sexual dysfunction, gender identity disorder and the paraphilias are examples of sexual and gender disorders.

SOMATOFORM DISORDERS A person with a somatoform disorder, formerly known as psychosomatic disorder, experiences physical symptoms of an illness even though a doctor can find no medical cause for the symptoms.

MENTAL RETARDATION Condition of limited mental ability Low IQ on traditional test of intelligence Difficulty adapting to everyday life Onset of characteristics by age 18 Some causes include Organic retardation Cultural-familial retardation-IQ's 55-70- result from growing up in a below average intellectual environment

REFERENCES http://www.webmd.com/mental-health/mental- health-types-illness A topical approach to Life Span Development, John W Santrock