Chapter 11

four of 10 leading causes of disability are mental illnesses

-Depression -Bipolar disorder -Schizophrenia -Obsessive-compulsive disorder

Warning signs of mental illness

-Marked personailty change -Inability to cope with problems/activities -Strange or grandiose ideas -Exessive anxieties -Prolonged depression and apathy -Marked changes in sleeping and/or eating -Thinking about suicide or self-harm -Extreme mood swings -Abuse of Alcohol or drugs -Excessive anger, -hostility, or violent behavior

History of Mental Health Care: World War II

15 million men rejected for service because of mental retardation and mental illness Virtually all psychiatrists were drafted into service New treatments were introduced -Electroconvulsive (shock) therapy (ECT) -Walter Freeman and Lobotomy -Antipsychotic & antidepressive drugs

Mental illness is a major community health issue

20-23% of American adults have a diagnosable mental disorder. ----19-23% have a mental disorder alone ----6% have addictive behaviors alone ----3% have both mental and addictive disorder Only 1/3 of those diagnosable receive necessary treatment

Mental Health Challenges in America today

America has no national mental health program Serious mental illness in people who are homeless -637,000 people are homeless in any given week in the U.S. -More than 2 million adults are homeless each year -2/3 of all people with serious mental illness have been homeless at one time or another -High prevalence of mental health, alcohol, and drug problems in homeless

Mental Illness in children

Approximately 12 million children under the age if 18 have some mental disorder Mental health problems affect 1 in every 5 young people at any given time Less than 1/3 receive mental health services As many as 1 in every 33 children may be depressed; it may be up to 1 in 8 adolescents

Feasibility

Are criteria easy to understand and abuse

Reliability

Are same conclusions consistently reached when criteria are applied across time and providers

Middle ages (500-1500 CE)

Beginnings of the Age of Faith Christ healed by faith, therefore people believed only the grace of God would provide a cure for physical or mental illness Cause of mental illness was demonic possession- treatment involved exorcism

History of mental health care: Moral treatment ERA (early 19th century)

Characterized by more humane treatment Moral in this case means (return to reason" Environment and the comforts of home play a role in the treatment of persons with mental illness Dorothea Dix advocated for those with mental illness; felt state was responsible for their treatment and care Number of state hospitals grew rapidly during last 25 years of 19th century

Early mental Health care in the US

Colonial America -Emphasis on family responsibility v. animal treatment 18th Century -Institutions were built for the insane -Conditions were harsh -Treatments were almost non-existent -Mental Illness viewed as a moral weakness

DSM-5 Classification system

Diagnostic & Statistical Manual of Mental Disorder, 5th edition released in 2013. First published i 1952 by the Americans Psychiatric association with 130 pages and 106 disorders today, 16 major diagnostic classes are based on: Age at onset, Severity, and Symptoms The DSM 5 is a descriptive and does not assess causation

Deinstitutionalization

Discharging of patients form state owned mental hospitals to less restrictive community settings Deinstitutionalaliztion began in 1950s and continued through 1980s Deinstitutionalization was propelled by 4 forces: -Economics -Idealism -Legal considerations -Antipsychotic drugs

Psychosis

Disturbances of perception and thought process -Schizophrenia, Hallucinations, Delusions Positive symptoms (symptoms that are present) include: -Hallucinations- sensory disturbances -Delusions- false beliefs -Disorganized thought and behaviors -Loose or illogical thoughts -Agitation or catatonic behavior Negative symptoms (Symptoms that are absent) include: -Flat or blunted affect -Concrete thoughts -Anhedonia (inability to experience pleasure) -Poor motivation, lack of spontaneity and imitative

Clinical Utility

Do criteria describe problems and help with treatment

Fact:

Each night, as many as 200,000 persons with serious mental illness sleep on the streets or in shelters New asylums: Mental Health Care in Jails & Prisons ---More than ½ of all inmates have mental health problems

Requirements for Measurements

Feasibility Clinical Utility Reliability Validity

PTSD from other wars

Gulf War veterans -Population sample of over 11,000 Gulf War veterans -Current PTSD prevalence = 10% Afghanistan -Army (n=1962) -Current PTSD prevalence = 6-11.5% Iraq -Army (n=894), current PTSD prevalence = 13-18% -Marine (n=815), current PTSD prevalence =12-20%

Mental Disorders

Health conditions characterized by alterations in thinking, mood, or behavior (or some combination) associated with distress and/or impaired functioning

Validity

How accurately do criteria reflect the mental disorders they are designed to describe

History of Mental Health Care: Mental Hygiene Movement

Hygiene in this case means public health Dr. Adolf Meyer felt acute care should be provided in new psychopathic hospitals Clifford Beers had bipolar mood disorder, was repeatedly hospitalized, and founded what is now called the National Mental Health Association

Stigma and Mental Illness

Individuals who have a mental illness are violent and dangerous Individuals who have a mental illness are irresponsible and cant make life decisions People who have a mental illness are childlike and must be taken care of by parents or guardians Mental illness is caused by bad parenting Persons with any mental health challenges are not smart People who have a mental illness should just suck it up and get over it

Diagnostic groups

Miscellaneous psychotic disorders -Brief reactive psychosis Mood disorders -Major depression; bipolar Anxiety disorders -Panic disorders, OCDs, PTSDs Somatoform disorders -Conversion; hypochondriasis, Cyberchondria Dissociative disorders Multiple personality disorders Sleep disorders -Insomnia disorder; dream anxiety disorder Impulse control disorders -Kleptomania; pathological gambling Adjustment disorders -Anxious mood; withdrawal Personality disorders -Avoidant, dependent, obsessive

PTSD in Vietnam Veteans

National Vietnam Veterans Readjustment study -Large, Nationally-representative sample of theatre and era veterans and civilians (n>3000 study participants) -Lifetime prevalence of PTSD ----31% of men and 26% of women -Current prevalence (1986-87) ----15% of men and 8% of women

Anxiety

Perhaps most easily understood mental disorder 3 types of intense fear in response to threat: -Phobias -Panic Attacks -Generalized anxiety Common signs of anxiety include: -Feelings of fear or dread -Trembling, restlessness, and muscle tension -Rapid heart rate -Lightheadedness or dizziness -Perspiration -Cold hands or feet -Shortness of breath

History of mental health care: Ancient Greece and Rome

Plato (400 BC) -Viewed the psyche as a charioteer trying to drive two horses (one noble and the other driven by Animalistic desires) - the charioteer has to balance these impulses Aristotle (384 BC) -Contemplated the role of genetic inheritance -Viewed actions, feelings, and thoughts as a single unit Cicero (110 BC) -assessed the mentally ill via an interview:

Community mental health movement

President Kennedy lobbied for the passage of the Mental Retardation Facilites & community Mental Health Centers (CMHS) act (1963) More than 750 community mental health centers created and deemed eligible for Medicare dollars if core services provided (1966-1989)

Mental Health

Sate of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change. Characteristics: Function under adversity Accept change or adapt to changes around you Maintain control over tension and anxiety Find more satisfaction in giving that receiving Show consideration for others Cure hate and guilt while able to love others

Mental health in America

Scientists estimate that one of every four people is directly affected by mental illness...many more are affected indirectly

Mental Illness

Term that refers collectively to diagnosable mental disorder

Mood Disturbances

Typically sustained sadness or elevated mood -Major depression, mania, or bipolar disorder Symptoms of depression include: -Persistent sadness or despair -Insomnia and decreased appetite -Anhedonia and irritability -Apathy, por motivation, social withdrawal -Feelings of helplessness and suicidal ideation Symptoms of mania include: -Persistently elevated mood -Grandiosity and decreased sleep -Racing thought and distractibility -Poor judgment and impaired impulse control -Rapid or pressured speech

FACT

We have lost more soldiers in suicide than being shot or killed during war.

Accrued Deficits

a child with mental disorder will not perform well in school, is likely to be held back, not reach his goals, not make normal friendships.