Mental Illness

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Mental Illness
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Historical Views of Disorders

• Mental disorders have always been with us but
  their treatment has varied
• Hippocrates said mental illness arises in the
  brain.
• Arab physicians established humane asylums
  Moslems believed Allah speaks through the
  mentally ill.
• Middle ages -- demon possession requires
  exorcism, madness was contagious.

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Religious Views

• Medical diseases might affect the body but the
  mind belongs to God.
• Institutions for the mentally ill created.
• Imprisoned but not treated.
• King George III motivated research to study
  mental disorders.
• Eventually asylums became more humane.

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Modern Approaches

• After the 1850s, neuroscientists studied
  structural consequences of strokes, tumors and
  brain trauma.
• By the 1920s-30s, two diseases were eliminated
• Pellagra niacin deficiency
• General paresis (late stage syphillis)
• Hope that more disorders would be organic

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Disease vs Disorder

• Both are malfunctions.
• Disease is a specific set of signs and symptoms
  that are seen together frequently enough to be
  diagnostic.
• Disorder means something is wrong but there is
  less consistency to its features.
• Diseases are disorders but not all disorders are
  diseases.

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Research Approach

• Identify abnormalities of both biology and
  behavior at stages in the progress of a persons
  illness.
• See whether similar correlations exist in other
  patients with the same symptoms.
• Can people be categorized by their symptoms?

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Cellular Dysfunction

• Diseases of the brain arise from cellular
  dysfunction.
• Pathology study of such dysfunctions.
• Organic problems developmental abnormality,
  inherited metabolic problems, infection, allergy,
  tumor, inadequate blood supply, injury, scars
  persisting after recovery.

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Functional Disorders

• No obvious organic pathology.
• Symptoms may be non-physical
• Changes in mood, thinking, social interaction.
• Disruption of normal behavior.
• Failure to find an organic cause does not mean
  none exists.
• Tourettes syndrome once thought to be
  psychological in origin, now organic.

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Diagnostic Tests

• Verbal interview of patient or family.
• Thorough physical exam testing sensory and motor
  systems.
• Additional tests depending upon the findings of
  the physical exam.
• MRI, CAT, angiogram
• Postmortem exam to confirm diagnosis.

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Normal vs Abnormal

• Everyone experiences intrusions of strange
  thoughts, peculiarities and eccentricities, mood
  swings.
• These differ in quality and quantity from the
  mentally ill.
• Many patients are distressed by their own
  behavior or thoughts and feelings.

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Degenerative Diseases

• A disease in which the disease process is
  progressive (becomes more severe).
• Three of the most frequent and devastating
  diseases
• Parkinsons
• Huntingtons
• Alzheimers

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Functional Disorders

• Diagnostic and Statistical Manual, Fourth Edition
  (DSM-IV).
• Mental status exam similar questions asked of
  all patients.
• Results compared at different points in
  treatment.
• Seven areas of functioning
• Diagnostic batteries

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Indicators of Abnormality

• Distress
• Maladaptiveness acts in ways that interfere
  with accomplishing his or her own goals.
• Irrationality inability to communicate with
  others, inappropriate affect.
• Unpredictability erratic behavior
• Unconventionality violations of social norms
• Observer discomfort threatening others

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DSM-IV

• Diagnostic and Statistical Manual, Fourth Edition
  (DSM-IV).
• A standardized way to describe a persons
  problems
• Research, statistical frequencies (epidemiology)
• Insurance purposes
• Communication with other professionals.

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Depression Video
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Mood Disorders (20 in Lifetime)

• Unipolar depression (5 in a year)
• Common cold of psychological problems.
• Can be fatal if untreated, due to suicide
  30,000 deaths per year.
• Bipolar disorder (manic depression) (1-2)
• Mania excessive excitement and elation,
  gradiosity, flight of ideas, distractability.
• Hypomania a milder form of mania that may be
  associated with increased creativity and
  productivity.

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Treatments of Mood Disorders

• ECT (electroconvulsive therapy) current passed
  between electrodes on the scalp triggers seizure.
• Highly effective, temporary memory disruption.
• Psychotherapy talking treatments
• Highly effective, especially combined with drugs
• Drug treatments lithium, antidepressants
  (tricyclics, SSRIs, NE-selective reuptake
  inhibitors, MAO inhibitors), CRH agonists

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Anxiety Disorders (15)

• Panic disorder a feeling of panic that has no
  connection with events (2 of population).
• Agoraphobia (5)
• Phobic disorders irrational fear of a specific
  object, activity or situation.
• Preparedness easier to develop spider phobia
• Obsessive-Compulsive Disorder (OCD) unwanted
  thoughts and behaviors or tics (2).
• Compulsions rituals that reduce anxiety.

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Treatment of Anxiety Disorders

• Psychotherapy addresses the learning component.
• Success rates gt 95.
• Anxiolytic medications
• Benzodiazepine (e.g., valium) increase GABA
  effectiveness resulting in greater inhibition.
• SSRIs (prozac) increase effectiveness of
  serotonin.

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Schizophrenia (1)

• Personality disintegrates and perception is
  distorted, affective symptoms.
• Types
• Catatonic remain motionless and rigid, or
  becomes agitated and hyperactive.
• Paranoid delusions and hallucinations.
• Disorganized incoherent speech, hallucinations,
  delusions, bizarre behavior.
• Undifferentiated anything not classified above.

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Schizophrenic Symptoms

• Positive symptoms
• Delusions
• Hallucinations
• Bizarre behavior.
• Negative symptoms
• Social withdrawal
• Impaired thought processes
• Lack of affect or inappropriate affect
• Positive symptoms controlled by drugs.

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Treatment of Schizophrenia

• Neuroleptic drugs block dopamine receptors and
  prevent positive symptoms.
• Atypical neuroleptics not clear how they work
  reduce negative symptoms.
• PCP produces similar symptoms by reducing NMDA
  receptors (inhibition), so dopamine is not the
  whole story.
• Psychosocial support important treatment.