classification of mental disorders, theories of personaa. deve.

CLASSIFICATION OF MENTAL DISORDERS, REVIEW OF PERSONALITY DEVELOPMENT, DEFENSE MECHANISMS,

1. FLOW OF PRESENTATION

2. CLASSIFICATION OF MENTAL DISORDERS Classification is a process by which complex phenomena are organized into categories, classes or ranks so as to bring together those things that most resemble each other and to separate those that differ.

3. PURPOSES OF CLASSIFICATION Makes generally acceptable diagnosis Provides standardized vocabulary that permits effective communication between psychiatrists, other doctors and professionals Makes generalizations in treatment response, course and prognosis of individual patients Makes framework for research in psychiatry

4. CLASSIFICATION OF MENTAL DISORDERS

5. F40-F49->Neurotic, stress related & somatoform disorders: F50-F59->Behavioral syndrome associated with physiological disturbances & physical factors: F60-F69->Disorders of adult personality & behavior: F70-F79->Mental retardation: F80-F89->Disorders of psychological development: F90-F99->Behavioral & emotional disorders with onset usually occurring in childhood & adolescence: ICD-10 classification ICD 10 (International statistical classification of disease and related health problems) Given by WHO in 1992 Chapter “F” classifies psychiatric disorders as mental and behavioural disorders and codes them on alphanumeric system from F00 to F99.

6. ICD-10 classification F00-F09 -> Organic including symptomatic mental disorder: F10-F19 - >Mental & Behavioral disorders due to psychoactive substance use: F20-F29 - >Schizophrenia, schizotypal &delusional disorders : F30-F39 ->Mood affective disorder:

7. CONTI… F40-F49 ->Neurotic, stress related & somatoform disorders: F50-F59 ->Behavioral syndrome associated with physiological disturbances & physical factors: F60-F69 ->Disorders of adult personality & behavior: F70-F79 ->Mental retardation: F80-F89 ->Disorders of psychological development: F90-F99 ->Behavioral & emotional disorders with onset usually occurring in childhood & adolescence:

8. ICD-10: F00-F09-> Organic including symptomatic mental disorder: F00-dementia in Alzheimer's disease F01-vascular dementia F02-dementia in other diseases F03-unspecified dementia F04-organic amnesic syndrome, not induced by alcohol & other psychoactive substances F05-Delirium F06-Other mental disorders due to brain damage & dysfunction & to physical disease F07-Organic personality disorders F09-unspecified organic /symptomatic mental disorders

9. F10-F19->Mental & Behavioral disorders due to psychoactive substance use: F10-Due to use of alcohol F11-Opioid use F12-Cannabinoids use F13-Sedative & hypnotics F14-Cocaine F15-Stimulants including caffeine F16-Hallucinogens F17-Tubacco F18-Volatile solvents F19-Multiple drug & other psychoactive

10. F20-F29->Schizophrenia, schizotypal &delusional disorders: F20-Schizophrenia F20.0-paranoid Schizophrenia F20.1-hebephrenic Schizophrenia F20.2-catatonic Schizophrenia F20.3-undifferentiated Schizophrenia F20.4-post- Schizophrenia depression F20.5-residual Schizophrenia F20.6-simple Schizophrenia F20.7-other Schizophrenia

11. Conti………………. F21- Schizotypal disorder F22-persistant delusional disorders F23-Acute & transient psychotic disorder F24-Induced delusional disorder F25- Schizoaffective disorders F26-Other non-organic psychotic disorders F29-Unspecified non-organic psychosis

12. F30-F39->Mood affective disorder: F30-Manic episode F31-Bipolar affective disorder F32-Depressive episode F33-Recurrent Depressive disorder F34-Persistant mood (affective ) disorder F38-Other mood (affective) disorder F39-Unspecified mood (affective) disorder

13. F40-F49->Neurotic, stress related & somatoform disorders: F40-Phobic anxiety disorder F41-Other anxiety disorder F42-Obsessive compulsive disorder F43-Reaction to severe stress & adjustment disorders F44-Dissociative /conversion disorders F45-Smatoform disorder F48-Other neurotic disorder

14. F50-F59->Behavioral syndrome associated with physiological disturbances & physical factors: F50-Eating disorder F51-Non-organic sleep disorder F52-Sexual dysfunction & caused by organic disorder or disease F53-Mental & Behavioral factors associated with the puerperium,not elsewhere classified F54-Mental & Behavioral factors associated with disorder or disease classified elsewhere F55-Abuse of non-dependence producing substance F59-Unspecified behavioral syndromes associated with physiological disturbances & physical factors

15. F60-F69->Disorders of adult personality & behavior: F60-Specific personality disorder F60.0-paranoid personality disorder F60.1-schizoid personality disorder F60.2-Dissocial personality disorder F60.3-Emotionally unstable personality disorder >.30-Impulsive type >.31-Borderline type F60.4-Histrionic personality disorder F60.5-Anankastic personality disorder F60.6-Anxious(avoidant) personality disorder F60.7-Dependent personality disorder F60.8-Other specific personality disorder

16. Conti………………. F60.9-Unspecified personality disorder F61-Mixed & other personality disorder F62-Enduring personality changes not attributable to brain damage & disease F63-Habit & Impulsive disorders F64-Gender identity disorder F65- Disorders of sexual preference F66-Psychological & behavioral disorders associated with sexual development & orientation F68-Other disorder of adult personality & behavior F69-Unspecified disorder of adult personality & behavior

17. F70-F79->Mental retardation: F70-Mild MR F71-Moderate MR F72-Severe MR F73-Profound MR F78-Other MR F79-Unspecified MR

18. F80-F89->Disorders of psychological development: F80-Specific developmental disorders of speech & language F81-Specific developmental disorders of scholastic skills F82-Specific disorders of motor function F83-Mixed Specific developmental disorder F84-Pervasive Specific developmental disorder F89-Unspecified disorder of psychological

19. F90-F99->Behavioral & emotional disorders with onset usually occurring in childhood & adolescence: F90-Hyperkinetic disorder F91-Conduct disorder F92-Mixed disorders of conduct & emotions F93-Emotional disorders with onset specific to childhood F94-Disorders of social functioning with onset specific to childhood & adolescence F95-Tic disorders F98-Other Behavioral & emotional disorders with onset usually occurring in child & adolescence F99-Unspecified mental disorder

20. DSM V CLASSIFICATION DSM 5 (DIAGNOSITC AND STATISTICAL MANUAL) Published on May 18, 2013. It was introduced to help guide clinical assessment and ensure adequate attention to all mental disorders.

21. DSM V CLASSIFICATION AXIS I : Clinical psychiatric diagnosis AXIS II : Personality disorders & mental retardation AXIS III : General medical conditions AXIS IV : Psychosocial & environmental problems AXIS V : Global assessment of functioning current & in past 1 year

22. INDIAN CLASSIFICATION OF MENTAL DISORDERS Given by Neki (1963), Wig And Singer (1971), Vahia (1961) And Varma (1971) PSYCHOSIS FUNCTIONAL 1.schizophrenia >simple >hebephrenic > catatonic >paranoid AFFECTIVE 1.Mania 2.Depression ORGANIC 1.Acute 2.Chronic

23. CONTI………. NEUROSIS Anxiety neurosis Depressive neurosis Hysterical neurosis Obsessive compulsive neurosis Phobic neurosis

24. CONTI………. SPECIAL DISORDERS CHILDHOOD DISORDERS -conduct & emotional disorders PERSONALITY DISORDERS -sociopath & psychopath SUBSTANCE ABUSE -alcohol abuse & drug abuse PSYCHOPHYSIOLOGICAL DISORDERS -asthma & psoriasis MENTAL RETARDATION- mild , moderate, severe & profound

25. REVIEW OF PERSONALITY DEVELOPMENT

26. DEFINITION Personality refers to deeply ingrained patterns of behaviour, which include the way one relates to, perceives and thinks about the environment and oneself.

27. FACTORS INFLUENCING PERSONALITY

28. THEORIES OF PERSONALITY DEVELOPMENT

29. PSYCHOANALYTIC THEORY – Sigmoid Freud (1961) FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT

30. STAGE AGE MAJOR DEVELOPMENTAL TASK ABNORMALITY   Oral Birth to 18 months Relief from anxiety through oral gratification of needs   Dependent personality traits, schizophrenia, severe mood disorders, and alcohol dependence syndrome and drug dependence behavior.   Anal 18 months to 3 years Learning independence and control, with focus on the excretory function   To obsessive compulsive personality traits and obsessive compulsive disorder. Phallic 3 to 6 years Identification with parent of same gender, development of sexual identity focus on genital organs Sexual deviations, sexual dysfunction and neurotic disorders.   Latency 6 to 12 years Sexuality repressed, focus on relationships with same-gender peers Neurotic disorders. Genital 13 to 20 years Libido reawakened as genital organs mature focus on relationships with members of the opposite gender. Neurotic disorders.

31. THEORY OF PSYCHOSOCIAL DEVELOPMENT ERICK ERICKSON (1963) STAGES OF DEVELOPMENT IN ERICKSON’S PSYCHOSOCIAL THEORY

32. STAGE AGE MAJOR DEVELOPMENTAL TASK Trust vs. mistrust Infancy (birth to 18 months) To develop a basic trust in the mothering figure and learn to generalize it to others Autonomy vs. shame & doubt Early childhood (18 months to 3years) To gain some self-control and independence within the environment Initiative vs. guilt Late childhood (3 years to 6 years) To develop a sense of purpose and the ability to initiate and direct own activities Industry vs. inferiority School age (6 to 12 years) To achieve as a sense of self-confidence by learning, competing, performing successfully, and receiving recognition from significant others, peers and acquaintances

33. STAGE AGE MAJOR DEVELOPMENTAL TASK Identity vs. role confusion Adolescence (12 to 20 years) To integrate the tasks mastered in the previous stages into a secure sense of self Intimacy vs. isolation Young adulthood (20 to 30 years) To form an intense, lasting relationship or a commitment to another person, cause, institution, or creative effort Generativity vs. stagnation Adulthood (30 to 65 years) To achieve the life goals established for oneself, while also considering the welfare of future generations   Ego integrity vs. despair Old age (65 years-death) To review one’s life and derive meaning from both positive and negative events, while achieving a positive sense of self-worth.

34. COGNITIVE DEVELOPMENT THEORY JEAN PIAGET( 1969) PIAGET’S STAGES OF COGNITIVE DEVELOPMENT

35. STAGE AGE MAJOR DEVELOPMENTAL TASK Sensorimotor Birth-2 years With increased mobility and awareness, development of a sense of self as separate from the external environment the concept of object permanence emerges as the ability to from mental images evolves   Preoperational 2-6 years Learning to express self with language development of understanding of symbolic gestures achievement of object permanence   Concrete operational 6-12 years Learning to apply logic to thinking development of understanding of reversibility and spatiality learning to differentiate and classify increased socialization and application of rules   Formal operational 12-15+ years Learning to think and reason in abstract forms making and testing hypotheses capability of logical thinking and reasoning expand and are refined cognitive maturity achieved  

36. DEFENSE MECHANISMS

37. DEFINITION “The individual has mental capacities or devices for protecting himself against psychological dangers and distress.” -Bhatia and C raig OR An intrapsychic process which provides relief from conflict and anxiety, operates unconsciously. - Ann J Z wemer

38. Characteristics of defence mechanisms Used by almost all individuals in the process of adjustment, exhibited in the everyday behaviour of normal people. The same individual may use varied mechanisms simultaneously, as per his need and its pattern of use depends on one’s own ability. Defence mechanism will be used at all levels of the mind either consciously or unconsciously.

39. CONTI… It reduces anxiety, fear, tension, frustration and emotional distress. The individual will feel secure when adjustment mechanisms are in use. If one uses defence mechanism within limits, it will increase self-satisfaction. Promotes individual functioning and development, satisfies inner motives. Maintains balance and moulds the personality of an individual.

40. CONTI… Defence mechanisms are healthy only when In frequent use Protects self-esteem against psychological dangers Forms acceptable behaviour Able to change positively the external environment Modifies and reaches felt needs

41. CONTI… Defence mechanisms are unhealthy only when Unable to modify abnormal behaviour Away from reality If it interferes with maintenance of self image Develops inferiority feelings, insecurity and lacks self confidence

42. Types of Defense Mechanisms (C2 D3 I3P R4 S2U) Conversion Compensation Denial Displacement Fantasy or Day dreaming Identification Introjections Isolation Projection Regression Rationalization Repression Reaction Formation Suppression Sublimation Undoing

43. CONVERSION/SYMBOLIZATION Emotional tensions will be relieved by changing its intensity into physical symptoms. E.g. a student awakens with a migraine headache the morning of a final examination and feels too ill to take the test

44. Compensation Consciously covering up for a weakness by over emphasizing or making up a desirable trait. Compensation is a process of psychologically counterbalancing perceived weaknesses by emphasizing strength in other areas . Ex . A physically handicapped boy is unable to participate in football, so he compensates by becoming a great scholar.

45. Denial Refusing to acknowledge the existence of a real situation or the feelings associated with it. Many people use denial in their everyday lives to avoid dealing with painful feelings or areas of their life they don’t wish to admit. Ex. Certain individuals do not accept the death of beloved ones. A woman drinks alcohol every day and cannot stop, failing to acknowledge that she has a problem . If denial used excessively, it may lead to severe difficulties related to health and lifestyles

46. Displacement Unconsciously discharging pent-up feelings to a less threatening object. Ex. A client is angry at his doctor, does not express it, but becomes verbally abusive with the nurse . A husband comes home after a bad day at work and yells at his wife

47. Fantasy or Day dreaming Gratifying frustrated desires by imaginary achievement It is a means of tension reduction and helps the individual in deeper part part of imaginative thinking, planning, achievements, wishful thinking and satisfaction.

48. Identification An attempt to increase self worth by acquiring certain attributes and characteristics of an individual one admires Ex. A teenaged boy who required lengthy rehabilitation after an accident decides to become a physical therapist as a result of his experiences.

49. Introjections Integrating the beliefs and values of another individual into one’s own ego structure Children integrate their parents’ value system into the process of conscience formation . Ex. A child says to friend, “Don’t cheat. It’s wrong.”

50. Isolation Separating a thought or memory from the feeling tone or emotion associated with it Without showing any emotion,

51. Projection Unconsciously (or consciously) blaming someone else for one’s difficulties Ex . A student who has cheated in an examination may satisfy herself by saying that others too have cheated. A surgeon whose patient does not respond as well as anticipated may blame the theatre nurse who helped the doctor at the same time of operation.

52. Regression Unconscious return to an earlier and more comfortable developmental level There may be regression to the stage where there was previous fixation E.g. an adult throws a temper tantrum when he does not get his own way Umar pachpan ki , Akal bachpan ki

53. Rationalization Attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors The sour grapes mechanism: Person insist that things we cannot achieve are not worth having. Ex. A student who has failed in an examination may complain that the hostel atmosphere is not favourable and has resulted in his failure The sweet lemon mechanism: In this person overrates what happen to him. Ex. A person who lives in a small house because of limited financial resources , may say that they are much more comfortable.

54. Reaction Formation Replacing unacceptable feelings with their exact opposites Ex . Jane hates nursing. She attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career. A woman who is very angry with her boss and would like to quit her job may instead be overly kind and generous toward her boss and express a desire to keep working there forever.

55. Repression (Unconscious forgetfulness) Involuntarily blocking unpleasant feelings and experiences from one’s awareness  Pushes threatening thoughts back into the unconscious Ex. Forgetting a loved one’s birthday after a fight

56. Suppression The voluntary blocking of unpleasant feelings and experiences from one’s awareness  Ex. Shreya says, “I don’t want to think about that now. I’ll think about that tomorrow.”

57. Sublimation Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive Ex. A woman who is unable to have children may engage herself in working with children. A mother whose son was killed by a drunk driver channels her anger and energy into being the president of the local chapter of Mothers Against Drunk Drivers

58. Undoing Undoing is the attempt to take back an unconscious behavior or thought that is unacceptable or hurtful. By “undoing” the previous action, the person is attempting to counteract the damage done by the original comment, hoping the two will balance one another out . EX. After realizing you just insulted your significant other unintentionally, you might spend then next hour praising their beauty, charm and intellect.

59. MALADAPTIVE BEHAVIOR OF INDIVIDUALS AND GROUPS : STRESS, CRISIS AND DISASTERS

60. ADAPTATION Adaptation affects three important areas: health, psychological well-being and social functioning. A period of stress may compromise any or all of these areas. If a person copes successfully with stress, he returns to a previous level of adaptation. Successful coping results in an improvement in health, well being and social functioning.

61. MALADAPTATION Maladaptation in any one area can negatively affect others. The behaviour is considered to be maladaptive when it is age inappropriate and interferes with adaptive functioning. Factors that influence the adaptive functioning are adequate perceptions of the situation, adequate social support and adequate coping. Adaptive functioning leads to growth, learning and goal achievement. Maladaptive behaviour prevents and interferes with mastery of the environment.

62. STRESS “It can be defined as the normal response of the body and mind to an abnormal situation .” - stuart (2006) Two types of stress: eustress- positive distress- negative STRESSOR A stressor is any person or situation that produces anxiety responses.

63. CRISIS Crisis is a turning point in an individual’s life that produces an overwhelming emotional response. Individuals experience a crisis when confront some life circumstances or stressor that they cannot effectively manage through use of their customary coping skills . DISASTER Disaster is defined by the WHO as a severe disruption, ecological and psychosocial which greatly exceeds the coping capacity of the affected community.

64. Caplan identified the following stages of crisis : The person is exposed to a stressor, experiences anxiety, and tries to cope in a customary fashion. Anxiety increases when customary coping skills are ineffective. The person makes all possible efforts to deal with the stressor, including attempts at new methods of coping When coping attempts fail the person experiences disequilibrium and significant distress.

65. Conti… The most essential element of psychiatric mental health intervention during a crisis or disaster is the – A bility of the nurse to provide emotional support while assessing the individual’s emotional and physical needs and enlisting his or her co-operation .