Transcript MPHLECTURE6 - health and wellness

LECTURE 6: MENTAL ILLNESS
MPH 342 HEALTH & WELLNESS
DR SHAI’
DEPARTMENT OF HEALTH SCIENCES
OVERVIEW
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Nationwide 50 million Americans suffer from a
mental illness in a given year
Mental Illness is more common than:
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Cancer, Diabetes, Heart Disease
Psychiatric disorders are the number 1 reason for
hospital admissions nationwide
IT IS TREATABLE
CAUSES
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Biological Causes
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Biochemical Disturbances
Genetics
Infections- can cause brain damage
Brain defects or injury
Prenatal damage
Poor nutrition, exposure to toxins
CAUSES
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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
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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
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STRESS
Academic
 Homesickness
 Peer relationships
 Family
 Identity
 Work
 Illness
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STIGMIZATION
35% of people with diagnosable disorders seek
treatment
 The single most common barrier to seeking
treatment is Shame
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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
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SYMPTOMS OF ANXIETY
DISORDERS
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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
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Medication-Medicines used to reduce the symptoms of
anxiety disorders include anti-depressants and anxietyreducing 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
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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
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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."
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Symptoms of winter SAD may include the seasonal occurrence of:
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Fatigue
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Increased need for sleep
Decreased levels of energy
Weight gain
Increase in appetite
Difficulty concentrating
Increased desire to be alone
DYSTHMIA
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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:
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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
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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
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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
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PSYCHOTIC DEPRESSION
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Roughly 25% of people who are admitted to the hospital for
depression suffer from what is called psychotic depression.
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What Are the Symptoms of Psychotic Depression?
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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
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depressed state and excitable,
 euphoric/irritable, impulsive state
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Strong family linkage
 Occurs equally in men and women
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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
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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:
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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
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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
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History of attempt
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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
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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
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Do
Voice concerns
 Get professional help
immediately
 Tell someone or call the
police
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Don’t
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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?
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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.
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SYMPTOMS OF PTSD
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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
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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?
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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
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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.
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OBSESSIVE COMPULSIVE
DISORDER
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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
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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.
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PSYCHOTIC DISORDERS
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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
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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
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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.
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SYMPTOMS OF A PSYCHOTIC
DISORDER
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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
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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?
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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.
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EATING DISORDERS
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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.
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ADJUSTMENT DISORDER
 Adjustment
disorder occurs when a person
develops emotional or behavioral symptoms
in response to a stressful event or situation.
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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.
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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.
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Dissociative identity disorder, formerly called multiple
personality disorder, or "split personality", and
depersonalization disorder are examples of dissociative
disorders.
FACTITIOUS DISORDERS
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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
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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
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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
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Low IQ on traditional test of intelligence
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Difficulty adapting to everyday life
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Onset of characteristics by age 18
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causes include
Organic retardation
Cultural-familial retardation-IQ's 55-70result from growing up in a below average
intellectual environment
REFERENCES
http://www.webmd.com/mental-health/mentalhealth-types-illness
 A topical approach to Life Span Development,
John W Santrock
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