Mental health and disorder Flashcards
What is mental health?
-Mental health is a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, and is able to make a contribution to his or her community
-Not just the absence of psychological problems
-About half of mental disorders begin before age 14
Worldwide, ~800,000 people die by suicide every year
-Mental disorders increase the risk for physical disorders
-Many health conditions increase the risk for mental disorders
-Stigma prevents many people for seeking mental health care
-There are great inequities in the availability of mental health professional across the world
What is a ‘Mental Disorder’?
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (the DSM-5) is used as the current authoritative listing of mental disorders. It broadly defines mental disorder as:
“clinically significant disturbance in an individual’s cognition, emotion regulation or behaviour…usually associated with significant distress or disability in social, occupational or other important activities”
What is not a Mental Disorder?
The DSM-5 goes on to define what does not constitute a mental disorder:
“an expectable or culturally approved response to a common stressor or loss, such as the death of a love one, is not a mental disorder.”
Categorical vs Dimensional Classification
Categorical
Better clinical and administrative utility - clinicians are often required to make dichotomous decisions.
Easier communication
Dimensional
Closely model lack of sharp boundaries between disorders, between disorders and normality
Have greater capacity to detect change, facilitate monitoring
Can develop treatment-relevant symptom targets- not simply aiming at resolution of disorder (most treatments actually target symptoms, not disorders).
Why Diagnose or Classify Mental Health Issues?
Communication: among clinicians, between science and practice
Clinical: facilitate identification of treatment, and prevention of mental disorders, descriptive of experience, possible etiology and prognosis.
Research: test treatment efficacy and understand etiology
Education: teach psychopathology
Information Management: measure and pay for care
Terminology: Descriptive psychopathology Signs
-objective findings observed by a clinician
Accelerated speech
Poor eye contact
Terminology: Descriptive psychopathology Symptoms
-subjective complaints reported someone experiencing mental health issues.
Low mood
Derealisation
Terminology: Descriptive psychopathology
Syndrome
signs, symptoms and events that occur in a particular pattern and indicate the existence of a disorder
Terminology: Descriptive psychopathology Disorder
A syndrome which can be discriminated from other syndromes;
To be labelled a disorder means there is a distinct course to the syndrome and the age and gender characteristics of the disorder have been described. In some cases prognosis may also be known.
Terminology: Descriptive psychopathology Disease
For a disorder to be labelled a disease, there has to be indications of abnormal physiological processes or structural abnormalities, eg. multi-infarct dementia.
DSM5 Diagnostic Approach
Establish boundary with no mental disorder
Clinical Significance/Cultural Sanction. E.g bereavement vs clinically significant depression
Determine specific primary disorder(s)
Multiple diagnoses possible
Add subtypes/specifiers severity (mild moderate, severe – with or without psychotic features) treatment relevant (poor insight, atypical, etc.) longitudinal course (with/without full inter-episode recovery, seasonal pattern)
Structured Interview
Questions closely mapping onto DSM Diagnostic Criteria.
Screening Section
Detailed assessment sections for each Disorder Category – Individual Disorders
Most widely used: Structured Clinical Interview for DSM Disorders (SCID)
Some other good alternatives, such as the Mini International Neuropsychiatric Interview
Clinical staging model
Model adopted from cancer staging (stages reflecting disease – here disorder – progression).
Based on observations by McGorry and Jackson in schizophrenia.
Focus on identifying those at risk and facilitating early intervention.
Goal of clinical staging model
In most cases, mental disorders develop over time with worsening severity
Staging model aims to define various stages of the development of disorder;
Preventive focus: central goal is to stop emergence of first episode of disorder.
If complete prevention is not possible, then the aim is to prevent progression to later stage, prevent worsening and poor prognosis
Also aims to use more universal interventions that are less costly, less harmful and less intense at earliest stages.
Transdiagnostic model
A move away from notion that each type of mental illness is associated with unique underlying cognitive and potentially neurological factors;
Recognition of shared aetiological and maintenance factors;
May account for high levels of comorbidity between disorders - such as anxiety and depressive disorders
May also provide an explanation why diagnostic specific therapies not effective for all sufferers;
Example - repetitive negative automatic thoughts and anxiety/depression;
Example – perfectionism related to depression, anxiety, eating disorders and some personality disorders.
What mental illness stigma is
the negative or discriminatory attitudes about mental illness
Impacts of stigma about mental illness
Significant barrier to accessing mental health treatment and support, particularly where stigma and social proximity are high.
Internalization of stigma has a negative impact on mental health. For example, reduced self-esteem.
Elements of stigma can impact upon important opportunities across life and psychosocial activities that support recovery.
Levels of Stigma
Taxanomy 4 level model:
- Structural
- public
- personal
- Associate
Structural Stigma
Structural Stigma refers to ingrained stigma manifest at the societal level. Structural Stigma:
is maintained by societal institutions (both government, religious, and private) through policy, law, and prescribed ideologies that restrict opportunities for particular groups.
varies considerably across societies, time, and topics.
applies to mental illness but also extends beyond it to other issues. For example, HIV-AIDS in the 1980’s.
: Public Stigma
Public Stigma refers to stigma exhibited by the public towards those with a mental disorder. Public Stigma:
Manifests in three ways:
Stereotyped attitudes and beliefs. e.g. someone is ‘less than’ – manifest through devaluing language.
Prejudicial emotional responses. e.g. fear.
Discriminatory behaviours. e.g. avoidance of interaction or social exclusion.
Is thought to be particularly harmful, and the driving force behind other aspects of stigma
Self-Stigma
Self-stigma describes how societal and interpersonal stigmatized attitudes, beliefs and behaviour affect individuals. Self-stigma includes:
Direct negative effects and outcomes of stigma. For example: employment or ill-treatment, even within the mental health care system.
Fear or anticipation of stigma, driven by an awareness of public stigma.
Internalization of public stigma
Stigma by Association
Stigma by association is experienced by those associated with someone experiencing a mental disorder. Stigma by association involves aspects of:
Public stigma: expressed negative attitudes and beliefs towards a person associated with someone experiencing a mental disorder
Self-stigma: fear of negative reactions and internalised stigma as regards association with person with a mental disorder.
Mental illness stigma research methods
Often, stigma research involves presentation of vignettes: stories about a person experiencing symptoms of mental disorder.
Vignettes can be written such that they manipulate variables of interest. For example, symptoms, signs or mental disorder labels.
After reading a vignette, participants complete questionnaires. These vignettes assess participants’ stigmatized attitudes and beliefs about the protagonist in vignette.
Attribution Questionnaire
Question revolving 6 Factors Fear/Dangerousness Help/Interact Responsibility Forcing Treatment Empathy Negative Emotion
Effective approaches to stigma reduction
Approaches to stigma reduction that are well-established to be effective include:
Contact: being in contact with someone with mental illness. Positive for both parties and particularly effective for addressing stigma in adulthood.
Education: being educated about mental illness.
This makes sense as familiarity with mental illness is well-established to be associated with decreased stigmatized attitudes and beliefs.
Education-based intervention
Education about mental illness influences stigma reduction by:
Increasing knowledge and understanding. For example, mental disorder, biological contributions, and blame attributions.
Dispelling myth. For example, the violence myth – fear and dangerousness.
Opening societal discourse decreases self-stigma. Observing that it is okay to experience and talk about mental illness. This in turn increases the likelihood of help-seeking, and in turn, recovery.
Definition of Mood, affect and mood disorder
Mood refers to a persons sustained experience of emotion.
Affect refers to the immediate experience and expression of emotion.
Helpful hint: Mood is to affect as climate is to (Melbournian) weather.
Mood disorders (according to DSM-5) involve a depression or elevation of mood as the primary disturbance. Can have other abnormalities (psychosis, anxiety, etc.)
DSM-5 Major Depressive Episode Criteria
Five or more symptoms present for ≥ 2 weeks
Depressed mood
Anhedonia
Decrease or increase in appetite OR significant weight loss or gain
Persistently increased or decreased sleep
Psychomotor agitation or retardation
Fatigue or low energy
Feelings of worthlessness or inappropriate guilt
Decreased concentration or indecisiveness
Recurrent thoughts of death, suicidal ideation, or suicide attempt
DSM-5 Major Depressive Episode Specifiers
Psychotic features (mood congruent or mood incongruent)
Melancholic features
Catatonic features
Postpartum onset
Anxious distress
Seasonal pattern (Seasonal Affective Disorder [SAD] or winter depression)
DSM-5 Major Depressive Disorder Criteria
Presence of a major depressive episode
Episode not better explained by another diagnosis
NO HISTORY of mania, hypomania, or mixed episode (unless substance or medical illness related)
