CATEGORIES OF COMMON MENTAL ILLNESSES:
1.ANXIETY AND PHOBIC DISORDERS
2.DEPRESSION AND BIPOLAR DISORDERS
3.OBSESSIVE-COMPULSIVE DISORDER
4.POST-TRAUMATIC STRESS DISORDER
5.EATING DISORDERS
6.SCHIZOPHRENIA
7.PERSONALITY DISORDER
8.DELIBERATE SELF HARM
1. ANXIETY AND PHOBIC DISORDERS
1.1 GENERALISED ANXIETY DISORDER occurs when an individual feels anxious all the time and when there’s no obvious reason for concern. Anxiety in certain situations is quite normal and the feeling passes. With Generalised Anxiety Disorder, the individual is left debilitated by the anxiety, and normal functioning is severely restricted.
Symptoms
- excessive and uncontrollable anxiety and worry over an extended period.
- restlessness, irritability, and tension.
- fatigue, and difficulty concentrating on work.
- trouble getting to sleep, or frequently wakes up.
- muscle tension, trembling, twitching, headaches, sweating, and hot flushes.
Treatment
Medication can have some effect, but a psychological approach is usually more effective, especially cognitive - behavioural therapy.
1.2 PANIC DISORDER is an anxiety disorder characterised mostly by panic attacks. A panic attack is a frightening experience of feeling totally out of control, and is often accompanied by unpleasant physical symptoms. It can be linked to depression or substance misuse, and can lead to phobias. The disorder usually starts in young adults, with the peak age of onset during the late teens and early twenties. A person with a panic disorder often avoids any activity that may lead to an attack, and because attacks cannot be predicted, the sufferer can eventually end up avoiding so many potential situations, that they cease functioning at any meaningful social level.
Panic attacks are characterised by some or all of the following symptoms:
- Palpitations
- Sweating
- Shaking
- Shortness of breath
- Feelings of choking
- Chest pain
- Nausea
- Dizziness
- Fear of losing control
- Fear of dying
- Numbness or tingling sensations
- Chills or hot flushes
- Feelings of unreality
Treatment
Psychological treatment, especially cognitive therapy, can be very effective. Medication, particularly the newer antidepressants, are effective, and have fewer side effects than previous medication.
1.3 A PHOBIA is a marked and persistent fear that is caused by the presence of an object or a situation. Phobias are irrational in that the fear caused by them is not associated with a real danger. A person who has a phobia is overwhelmed by anxiety and avoids the feared object or situation, as well as people and events associated with the source of fear.
There are three categories of phobias: agoraphobia, specific phobias, and social phobias.
(1) Agoraphobia is a fear of being alone in any place or situation from which the person thinks that escape is impossible or difficult. An extreme example is the person who is afraid to leave their home. Less extreme examples are the person who avoids supermarkets, cinemas, restaurants, or exam halls. Agoraphobia is usually a complication of panic disorder where the patient may associate specific places with having a panic attack, or they fear that if an attack occurs, help will not be available.
(2) Specific phobias are those directed at specific objects or situations, such as dogs or spiders, open spaces, flying, injections, or heights.
(3) Social phobia is the fear of being in a situation where others are watching the individual, with the result being embarrassment or humiliation. This can make socialising, taking part in seminars, interviews, etc. very difficult. It is a very common condition, and the average age of onset is 15 years, and most often begins before the age of 25.
Treatment
Social skills training, relaxation, cognitive therapy and exposure treatment, are all effective. Medication particularly S.S.R.I.s such as paroxetine, are effective in the treatment of social phobias.
2. DEPRESSION AND BIPOLAR DISORDERS
2.1 DEPRESSION is a widely misused self diagnosis. It is more than a temporary feeling of sadness, being fed up, feeling negative about relationships or job prospects, and it is more than the feelings we all get after a bereavement, or a personal disaster. A major depressive disorder often exists without any obvious reason or stressor, or it can be triggered by life events, and it often lasts for long periods and becomes pervasive, affecting every aspect of individual functioning. The individual is left feeling unmotivated, sad, listless, and emotionally drained, and unable to gain pleasure from the usual things such as entertainment, holidays, personal relationships, hobbies, etc. It can interfere with work play, eating, sleeping, and most social interaction. It is the most commonly diagnosed psychiatric disorder, with 5% to 9% of women, and 2% to 3% of men being treated at any one time. 15% of patients with major depression die by suicide.
Symptoms
- Loss of interest in everyday activities
- Increased irritability
- Lack of motivation
- Absence of pleasure
- Pessimism
- Weight loss
- Loss of appetite
- Profound fatigue
- Difficulty sleeping, and difficulty getting out of bed
- Poor concentration
Treatment
Depression is probably the one condition that responds consistently well to medication. The newer medications have far fewer side effects, and do not have the addictive qualities of drugs used in the past. Cognitive behavioural therapy, and psychotherapy, often in conjunction with medication is effective. Electroconvulsive therapy is still widely used, particularly when the condition is very severe and the two week wait for medication to take effect poses too much of a risk. It is also used when a patient cannot tolerate the side effects of medication, or when a medical condition prevents the use of antidepressants.
2.2 BIPOLAR DISORDER (manic depression) is characterised by periods of depression alternating with high levels of elation, excitability, extreme physical activity, and grandiose ideas. It occurs in 1% to 1.5% of the population, affecting children, adolescents and adults. 25% of patients attempt suicide in the depressive phase. It is probably caused by a major imbalance in the neurochemistry of the brain, and has a possible genetic link. The imbalance can be exacerbated by stressful life events.
Symptoms
- Inflated sense of self-esteem
- Grandiose ideas
- Needs little sleep
- Frantically active and highly focused on work and study
- Spending lots of money
- Sexually active and sexually disinhibited behaviour
- Sudden switch to depressive phase, often without warning
Treatment
Not easy to treat. Long term outcomes rarely include complete recovery, and the recurrence rate can be as high as 50%, even with treatment. Lithium is effective for about 60% of patients, usually combined with anti-psychotic medication.
3. OBSESSIVE-COMPULSIVE DISORDER (O.C.D.)
A condition characterised by intrusive and unwanted thoughts-obsessions, and repetitive behaviour-compulsions. The anxiety created by the obsession is usually relieved through acting out the compulsive behaviour, creating a cycle of behaviour that can totally disrupt everyday functioning. The patient knows that the thoughts are not normal, but cannot control them, and is often too embarrassed to seek help, or may keep it secret and learn to live with it.
The condition is far more than normal worry and anxiety, e.g.
(1) Making sure your hands are washed before eating a meal is normal; washing your hands before eating a sweet is less common but o.k.; washing your hands twenty times a day and never touching food, cutlery, or crockery that others may have touched, for fear of contamination, is O.C.D.
(2) Washing up and checking the kitchen is tidy before you go to work is normal; getting up at 6.00 a.m. every morning so that you can spend two hours rearranging the cups and saucers into an exact order, for fear that something bad will happen if the daily ritual is not observed, is O.C.D.
The lifetime prevalence is about 2.5% for adults and children. The age of onset is between 13 and 15 years in males, and 20 to 25 years in females.
Treatment
Behavioural treatment using real life exposure and response prevention is effective, but many patients find this too frightening, and prefer to take medication, particularly the newer antidepressants, which have about a 50% success rate.
4. POST-TRAUMATIC STRESS DISORDER
Post-traumatic stress disorder is an anxiety disorder, wherein the sufferer relives the traumatic experience, as flashbacks, nightmares, or intrusive thoughts; or finds the trauma dominating their thoughts, behaviour, and actions. Any event that involves actual or threatened physical harm, and leaves the individual feeling frightened and helpless, can trigger the disorder. The event can be natural (flood, earthquake), man-made (train crash, terrorist attack), or personal (physical or sexual assault).
Symptoms
There are three groups of symptoms:
- Re-experiencing phenomena. Intrusive symptoms occur when thoughts about the traumatic event intrude into everyday life and activities. They can include disturbing dreams, flashbacks and intense distress at real or symbolic reminders.
- Avoidance. Symptoms of avoidance are when the victim avoids any remembrance of the trauma, and avoids close emotional ties with anyone connected with the trauma. People who distance themselves to such a degree can’t deal with their grief and anger, and the trauma becomes the defining element in their behaviour and in their lives.
- Increased arousal. Hyperarousal symptoms occur when the sufferer has a physical or psychological reaction to anything that reminds them of the trauma e.g. the war veteran who dives on the floor whenever there is a loud bang. Symptoms include being on edge and irritable, difficulty in concentrating, insomnia, and a constant fear that danger is near.
Treatment
As with other anxiety disorders, exposure therapy is effective, as are anxiety management techniques, and antidepressants.
5. EATING DISORDERS
5.1 ANOREXIA NERVOSA
Anorexia is characterised by such a severe reduction in food intake over a long period that the individual’s health and life are threatened. It is different from dieting, or deliberate starvation, in that the sufferer usually thinks their diet is adequate, and often has a very distorted image of what they look like, i.e. their body weight falls to a level where their ribcage and pelvic bones are visible through their skin, but still they believe they are fat. Anorexia almost exclusively strikes young women in adolescence and early adulthood and is rare in middle age. Women are ten times more likely to be sufferers than men.
Causes include low self-esteem, a need to maintain some control over one’s life, body, perfectionism, a fear of growing up, society’s obsession with weight, poor female role models in the entertainment and fashion industry, and childhood sexual or emotional trauma. As with all eating disorders, there is thought to be some genetic link.
Symptoms
- Body weight that is at least 15% below the normal range
- Amenorrhoea, or absence of menstrual periods
- A distorted body image
- Feelings of low esteem and low self-worth
- A reduction in food intake coupled with denial of any feelings of hunger
- Use of laxatives and diuretics, and excessive exercise
Treatment
Medication appears to have little effect, and most treatment involves counselling, family therapy, group psychotherapy, and education about diet and weight control.
5.2 BULIMIA NERVOSA
Bulimia is characterised by periods of uncontrolled, and usually secretive, binge eating, followed by purging-self induced vomiting, or the use of laxatives or diuretics. Bulimia affects the same group of people as anorexia, i.e. young women. The causes are much the same, but the symptoms are different. Also, because the sufferer often looks quite healthy, it is easier to deny, and can be kept secret. Bulimia is ten times more common than anorexia, and can occur in middle aged women.
Symptoms
- Binge eating
- Purging
- Being very particular about what is eaten, especially avoiding eating in public what is consumed in private (e.g. chocolate or cakes)
- Abnormal attitudes about body shape and weight
- Evidence of food going missing in large quantities
- Dental problems associated with contact with acidic vomit
- Sore throat, mouth sores, irritation of the oesophagus
- Evidence of vomiting or the use of laxatives and diuretics
- Gastrointestinal problems
Treatment
Treatment programmes for bulimia are better established than for anorexia. What appears to be most effective are antidepressants and cognitive behavioural therapy.
6. SCHIZOPHRENIA
Schizophrenia is the most disabling of all the major mental disorders. It affects the individual’s ability to think clearly, distinguish reality from fantasy, react in an emotionally appropriate way, and interact with others. It affects about 1% of the population, with onset for men usually between 18 to 24 years, and for women between 24 and 28 years. This means that the sufferer is less likely to complete higher education or job training and social and interpersonal skills suffer.
Despite much research, there is no clear picture of the causes of schizophrenia, although it is generally accepted that there is some irregularity in brain functioning. There is also good evidence of a genetic link - 1% of the general population; 12% if a parent is schizophrenic; 39% if both parents are diagnosed; and 47% if an identical twin has the disorder. There is also a link to prenatal viral infection and early infancy head injury. However, the predisposed individual may not develop the illness unless other factors trigger it.
Stress factors include unrealistic role expectations, major life events which require considerable adjustment, unhappy personal relationships, inappropriate career choices and triggers such as substance misuse.
Symptoms
- Delusions. Ideas and personal beliefs that are unrelated to reality, e.g. a person believes he is being persecuted by a dead rock singer, or that he has supernatural powers, or he is the reincarnation of someone famous.
- Hallucinations. Hearing and seeing people and things that are not there, and sometimes responding to the hallucinations by obeying commands, or talking to the “voices”.
- Disorganized thinking and speech. Unable to hold a coherent conversation, and appearing to be struggling with a flood of ideas and thoughts.
- Inappropriate emotional expression such as laughing uncontrollably while talking about someone’s death.
- Lacking energy and motivation, flat emotions, poor self-care, and little interest in everyday things.
The general pattern with schizophrenia is that the illness initially presents in the active “florid” form with delusions and hallucinations present. There may then be a period of apparent recovery, and then further episodes at intervals. Each episode seems to take longer to recover from, and causes more damage to the patient’s ability to cope, leaving them eventually with the “negative” symptoms of poor self-care, poor social functioning, and few social and personal contacts. Some patients will be able to control the symptoms by taking medication, while others, even though they are taking medication, will relapse. All medication has side effects, and patients often see little point in taking it when they are feeling well, and so stop and then start to relapse again.
Treatment
Medication is the first line of treatment, combined with education for the patient and carers, and assistance and support with social contacts, accommodation, personal relationships, and occupation. The prognosis is worse with patients who abuse alcohol or drugs, or do not take their medication regularly. Unfortunately, about 15% of sufferers will not respond to medication,
and these will probably spend much of their lives in hospital.
7. PERSONALITY DISORDER
A personality disorder exists when a personality characteristic significantly impedes social, educational, or occupational functioning and distresses the sufferer. Many of the symptoms are present in all of us but these are temporary, and not extreme, and just part of our personality. With a personality disorder, the symptoms are extreme, and significantly disrupt everyday life. Many of the characteristics are also present in other illnesses, e.g. in one study 40% of bulimia sufferers also had a diagnosis of personality disorder. Many sufferers will get through life without engaging in therapy or treatment, and will just be regarded as odd, difficult, antisocial, obsessional, or inadequate, or if they are rich or powerful, they may just be seen as eccentric. They are also as likely to end up in prison. There are three clusters of personality disorders:-Odd, Dramatic, and Anxious.
7.1 ODD
Paranoid, suspecting that others are out to harm them, looking and finding hidden meanings in everything. Schizoid, detached from relationships with others, including family, friends and fellow students. Solitary. Lacking emotion. Schizotypal, eccentric behaviour, odd beliefs, inappropriate emotions, lack of friends.
7.2 DRAMATIC
Histrionic, attention seeking behaviour, melodramatic, odd dress sense to gain attention, sexually inappropriate behaviour. Narcissistic grandiose thinking and behaviour, arrogant, self-focus on being special, needs to be admired. Antisocial disregard for other’s rights, aggressive and impulsive behaviour, failure to conform to social expectations. Borderline lack of stability in social relationships, difficulty controlling anger, impulsivity, recurrent suicidal behaviour, incomplete sense of self.
7.3 ANXIOUS
Feeling inadequate, overacting to criticism, avoiding activities and contacts because of fear of criticism. Dependent personality. Need to be taken care of, inability to assume responsibility for oneself, inability to make decisions. Obsessive-compulsive preoccupied with order and control, inflexible, level of perfectionism that makes achievement almost impossible, hoarding.
Treatment
The symptoms and presentations vary enormously, as do the patient’s understanding of their condition. Some will benefit from individual therapy, or social skills training, but there is very little evidence of effective treatment with medication, except where there is another better understood illness present.
8. DELIBERATE SELF-HARM
Deliberate self-harm includes taking overdoses of medication and drugs; cutting; jumping from high places, or in front of cars and trains; burning with cigarettes; shooting; and drowning. Some people will intend to kill themselves, but many will not. The distinction between suicide and deliberate self-harm is not absolute. Some people who take overdoses with the intention of drawing attention to their problems, and getting help, will die from the effects, while others who take overdoses, intending to kill themselves, will be revived. Three people per thousand self-harm in Britain each year, resulting in 100,000 hospital admissions every year, which is higher than most European countries.
8.1 DRUG OVERDOSES
In the U.K. 90% of self-harm cases admitted to hospital involve a drug overdose. The most commonly used drugs are aspirin and paracetamol. Paracetamol is particularly dangerous in overdose, because it damages the liver, and patients are more likely to die from delayed liver failure than from the paracetamol. 40% of people taking overdoses have taken alcohol in the previous six hours.
8.2 SELF-LACERATION
Self-laceration, or cutting, can be the means of suicide, or an indication of serious suicidal intent, but the majority of cases result in superficial wounds that do not endanger life. Many people who cut themselves do not present to services. Of those who do seek help, the majority are young and female.
Motives or reasons for deliberate self-harm
- To die
- To escape from an unbearable situation, or from unbearable stress or anxiety
- To get psychological relief
- To show other people how unhappy and desperate you are
- To get other people to behave differently towards you
- To punish other people and make them feel guilty
- To get help
What causes people to self-harm?
- Personality problems, low self-esteem, impulsive or aggressive behaviour, unstable moods, and difficulties with interpersonal relationships, are all common factors.
- Problems with drugs and alcohol.
- People who self-harm will typically have experienced a significant increase in stressful life problems in the period before the act.
- There is some evidence that early parental loss through bereavement, or a history of parental neglect or abuse, is more frequent among cases of deliberate self-harm.
- Up to two-thirds of patients seen, have marital, or relationship problems.
- A significant number of men who self-harm, are unemployed.
- A background of poor physical health is common.
- Many people who self-harm will have been treated for depression.
- About half of all people who self-harm will have seen a GP, Psychiatrist, Social Worker, or Psychiatric Nurse, in the previous week.
- Among people who have deliberately self-harmed, the risk of later suicide is much increased.
Treatment
People presenting for treatment need to be fully assessed, to discover the reasons for the self-harm. The triggers can then be addressed, and appropriate help offered. Some people may have a treatable mental illness, but many will require counselling and practical help to deal with their problems.
