Mental Health

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Mental Health
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Mood or Affective Disorders

• Class of disorders involving disturbances of mood
• Include
• Dysthymic disorder
• General depression
• Mania
• Cyclothymic disorder
• Bipolar disorder
• Most common of all disorders
• Depression 10-25 of women 5-12 of men
  (underreported)
• Bipolar disorder about 1 of population

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Affective disorders

• Depression
• Sleep disturbances
• Sad mood
• Low energy
• Suicidal
• Guilt
• Hopelessness
• anhedonia

• Mania
• Decreased need for sleep
• Elation
• Hyperactivity
• Grandiosity
• Distractibility
• Irritability
• psychosis

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Depression

• Several subtypes
• Dysthymia
• Major depression
• Bipolar disorder
• Adjustment disorder
• Grief
• Seasonal affective disorder
• Can be secondary to
• Another medical condition
• Another mental illness

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Scoring

• 0-8 presence of a depressive disorder is
  unlikely
• 9-16
• Presence of depressive disorder is likely
• Recommend a consultation/evaluation with a mental
  health professional
• 17-30
• Presence of depressive disorder is highly likely
• STRONG recommendation for consultation/evaluation
  with a mental health professional

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Mania and hypomania

• Mania
• Little to no sleep
• Pressured speech and thinking
• Markedly increased energy
• Grandiosity
• Irritability
• Impulsivity, spending money, driving too fast,
  hypersexual
• Psychosis break with reality
• Extremely poor judgment

• Hypomania
• Similar to mania, but not as severe
• Can have irritability, decreased sleep, increased
  energy, talking and thinking faster than usual
• Can be pleasurable or productive, but can get out
  of control
• Problems often identified by family/friends,
  minimized by patient

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Bipolar disorder

• Experience periods of BOTH mania and depression
• Show symptoms of both
• Often tend toward one pole
• Several types
• Type I is more manic
• Type II is more depressed (and more common)
• Type III not otherwise specified or NOS
• Type IV cyclothymic disorder

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Causes of mood disorders

• Genetic/biological
• Exogenous depression vs. endogenous depression
• Psychological
• Stress
• Learning
• Cognition attribution style
• In particular LEARNED HELPLESSNESS
• Diathesis stress model- it takes both genetics
  and environment!

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How control?

• Can learn to predict/control mood swings
• Mood stabilizers
• More effective for up than down
• Lithium
• Depakote
• Tegretol
• Antipsychotic medication usually atypicals
• Talk therapy, particularly cognitive-behavioral
  therapies

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Schizophrenia

• NOT multiple personality disorder!

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Schizophrenia

• Severe and chronic disorder characterized by
  disturbances in thinking, perception, emotions
  and behavior
• Psychotic disorder is characterized by a break
  with reality.
• Thought disorder
• a breakdown in the logical structure of thought
  and speech
• Often displayed by loosening of associations

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Symptoms of Schizophrenia

• Positive symptoms
• Hallucinations
• Delusions
• Negative symptoms
• Decreased spontaneity
• Decreased motivation
• Decreased persistence
• Poor hygiene and self care as result
• Cognitive deficits
• Verbal memory deficits
• Executive function deficits

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Common Delusions

• Delusions of grandeur
• Delusions of Persecution
• Somatic delusions
• Delusions of influence
• Delusions of reference
• Delusions of nihilism

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Disturbances of Perception

• Hallucinations perception without any known real
  world stimulus
• Loosening of associations
• Neologisms
• Loss of affect blank or inappropriate emotions

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Other symptoms

• Disturbances of speech
• mutism
• Echolalia
• Social withdrawal
• Diminished motivation

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Progression

• Prodromal stage
• Typical age of onset is late teens or early 20s
• Active stage
• Residual or Refractory phase

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Major subtypes Disorganized or Hebaphrenic

• loosening of associations most important
• delusions and hallucinations
• often sexual, religious
• often hypochondriac themes
• behavior is infantile
• neglect of personal hygiene
• speech incoherent often word salad, neologisms

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Major subtypes Paranoid

• highest level of awareness
• least impairment as far as everyday functioning
• able to conduct most daily living skills
• dominant symptom general suspicion and mistrust
• often delusions of grandeur w/persecution
• if threatened may become dangerous, retaliatory

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Major Subtypes Catatonic

• extreme psychomotor disturbances
• extreme withdrawal, loss of affect
• catatonic stupor
• no movement
• may assume fetal position
• waxy flexibility limbs mold into place
• stupor alternates w/fits of extreme violence
• very dangerous- most dangerous behavioral
  disruption
• SIB
• bizzare motor problems may be diminished w/drugs

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Causes

• Genetics
• Chemical imbalances
• Brain abnormalities
• Psychosocial influences

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Treatment

• Medication alone is NEVER enough
• Problems of persistent, relapsing illness
• Need support in meeting basic needs
• Crisis intervention
• Skill training
• Emotional support
• Support for family/friends

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Drug Treatment

• Antipsychotic medication
• Older/typical
• Thorazine (chlorpromazine)
• Stelazine
• Mellaril
• Serentil
• Newer Atypical antipsychotics
• Clozapine (clozaril)
• Respiridone (Risperidal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)
• Aripiprazole (Ability)

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Side effects of psychotropic medications?

• All medication has side effects
• SSRIs, DASRIs, NESRIs, etc.
• Sexual side effects
• Headache and Nausea
• Weight gain
• Can elicit mania
• Antipsychotics
• All of the above
• Tardive dyskinesia
• Neuroleptic Malignant Syndrome (NMS)
• Alternatives or adjunctives?
• Exercise
• Cognitive behavior therapy
• Interpersonal therapy