common psychiatric disorders.ppt

mental health, psychiatric disorder,

1. PSYCHOPATHOLOGY
Psy. Vijay Lal Vijayan MSc (Psy),Mphil
M&SP
Consultant Clinical Psychologist ,
Dept of Psychiatry
Pushpagiri Institute Of Medical Sciences
Thiruvalla.

2. Mental Disorder: Concept
•Ingeneral,amentaldisorderhasbeencharacterizedasa
clinicallysignificantbehavioralorpsychologicalpattern
thatoccursinanindividualandisusuallyassociatedwith
distress,disabilityorincreasedriskofsuffering.
•Thesimplestwaytoconceptualizeamental/psychological
disorderisasadisturbanceof
•Cognition (i.e. thought), or
•Conation (i.e., action), or
•Affect (i.e., feeling), or any disequilibrium between
the three.

3. Concepts of Health and Normal Mental Health
•Healthisastateofcompletephysical,mentalandsocialwell-being,andnot
merelyabsenceofdisease(WHO).
•Normalmentalhealth,likenormalhealth,isadifficultconcepttodefine.There
areseveralmodelsforunderstandingwhatis‘normality’.
–MedicalModel(NormalityasHealth):Normalmentalhealthis
conceptualizedasabsenceofpsychiatricdiseaseorpsychopathology.
–SocialModel:Anormalpersonisexpectedtobehaveinasocially
permissivebehaviour.
–StatisticalModel(NormalityasanAverage):Statisticallynormalmental
healthfallswithintwoSDsofthenormaldistributioncurve.
–UtopianModel(NormalityasUtopia):Inthismodel,thefocusindefining
normalityison‘optimalfunctioning’.

4. What is Mental Disorder?
WHO resources:
http://www.who.int/topics/mental_disorders/en/index.html
•The WHO identifies 10 distinct classesof mental disorders
1.Organic mental disorder (egdementia, deleriumand brain
injury)
2.Mental and behavioural disorders due to use of
psychoactive substances (mainly alcohol & other drugs)
3.Schizophrenia and related delusional disorders
4.Mood (affective) disorders: Mania, bipolar disorder
(manic depression)

5. What is Mental Disorder?
WHO definitions, 2008 -http://www.who.int/en/)
1.Neurotic, stress-related and somatoform disorders
(phobias, anxiety, panic, OCD etc)
2.Behavioural disturbance associated with physiological
problems and physical factors (disorders of eating, sleep
and sexual function)
3.Disorders of adult personality & behaviour
4.Mental retardation
5.Behavioural and emotional disorders with onset in
childhood/adolescence (ADHD, CD)

6. Anxiety
Anxietydisordersarecommon
psychiatricillnessescharacterizedbyintense
feelingsoffearworryorapprehensionoften
associatedwithspecificsituations,eventsor
objects.
Theessentialfeatureofanxietyis
generalizedandpersistentworry

7. Clinical features
Restlessness
Inability to concentrate
Relax and fatigue
Autonomic hyperactivity
Hyperarousal and
Motor tension
Motortensionresultsinfrequentheadacheandchronic
musclepaininshoulder,neckandlowerback

8. Types of anxiety disorders include: -
GeneralizedAnxietyDisorder,PanicDisorder,
ObsessiveCompulsiveDisorder,Post–
TraumaticStressDisorder,SocialPhobiaor
SocialAnxietyDisorder,SpecificPhobia

9. Types of Anxiety Disorders
Generalized Anxiety Disorder (GAD)
Social Anxiety Disorder (SAD)
Panic Disorder (PD)
Obsessive Compulsive Disorder (OCD)
Post –Traumatic Stress Disorder (PTSD)
Panic attack, which an extreme form of anxiety
Life time prevalence 3% (OCD)12% (SAD) two
time s greater amount women than among men

10. Dr. P.N. Suresh Kumar
Generalized anxiety disorder
Excessiveworryaboutanumberofeventmostdays
foratleast6monthsofduration.
Physicalandpsychologicalsymptomsleadingto
significantruleoutageneralmedicalconditionor
substanceabuse.
Somaticcomplaintsmuscletension,coldor
clammyhands,drymouth,sweating,nausea,
diarrhea,andurinaryfrequency.

11. Psychologicalsymptomsincludeirritability,
difficultyconcentrating,andsleepdisturbance.
Manifestschronicallywaxingandwaning
symptomsandongoingimpairmentinsocial
function,leadingtothedevelopmentofother
anxiety,depressive,andsubstanceabuse
disorders.

12. Social anxiety disorder (SAD)
Excessivefearofobservationorscrutinyinperformancerelated
situation.
Fearoravoidanceofsocialperformancesituations.
Symptomsasbeingexcessiveorunreasonable;highlydistressing
ordisabling.
Participatinginsmallgroups,eating,drinking,orwritingin
public;talkingtoauthorityfigures;performanceorgivingatalk;
attendingsocialevents;workingwhilebeingobserved;meeting
strangersordating;usingapublicbathroomandbeingthecenter
ofattention

13. Somatic complaints include:-
•Trembling
•Blushing stuttering
•Abdominal distress
Difficulttodifferentiateshyness,differentiatingtwo
conditionsareseverityofavoidance,degreeof
impairmentandcourseofdisease.Socialphobiais
associatedwithmoreavoidanceandgreaterfunctional
impairment,andmorechroniccourse
•Shaking
•Sweating
•Palpitations

14. Panic disorder
Recurrent unexpected panic attacks with persistent concern
about having additional panic attack for at least one month
•Sudden rush of fear
•Apprehensive
•Discomfort usually
pounding heart
Attacks can occur in the most familiar seemingly non-
threatening settings, grocery store, in church or while
driving along a familiar
•Shortness breath
•Choking or suffocating
sensation or other physical
symptoms
Reaching peak of intensity
within 10 minutes

15. Obsessive compulsive disorder
Two phenomenology, obsessive and compulsion
Obsessions include:-
Unwanted thoughts,
Impulses
Images
Attempt to ignore
Suppress
Or neutralize these
thought
Compulsion
Repetitive behavior or
Mental acts that those affected feel
driven to perform.
Compulsionsareaimedatpreventing
orreducingdistressorpreventinga
dreadedevent,notrealistically
connectedtothedreadedeventand
isclearlyexcessive.

16. Posttraumatic stress disorder (PTSD)
Outside the range of these common experiences
Hurricanes
Floods and other natural disasters
Airplane accidents and car crashes
Rape and assault
Armed combat
Torture
Existence in a death camp
Suchtraumaticeventswouldproducesdistressinalmost
everyoneatanyage.Oftenbeginimmediatelybutmay
emergeafterdays,week,monthsorevenyearsafterthe
events

17. Symptoms
1. Hyper arousal
It is difficult to : -
oConcentrate
oAre easily startled
oOften edgy
oPoor sleep habits
oAgitated
2. Flash back
•Tent to re-experience the event in
painful memories
•Insituationthatresemblethe
originaltraumaassymbolsofit(e.g.
adarkstreetforawomanwhohas
beenraped)
3.Emotionalnumbness
pervasivefeelingofbeingdetached
fromotherperson,fromtheoutside
world,fromotherenjoyable
activities

18. Phobias
Intense,irrationalfearcenteringona
specificsituationorobject.
Phobiasgofarbeyondwhatisnormalor
rational.
Threetypesofphobia
Socialphobia
Simplephobia
Specificphobia(withorwithoutpanicattacks)

19. Social Phobia
Itischaracterizedbypersistentsituationinwhichthe
personisexposedtounfamiliarpeopleortopossible
scrutinybyothers.
Heorshewillactinawaythatwillbehumiliatingor
embarrassing.Recognizesthatfearisunreasonable
Fearofavoidanceshouldnotbebecauseofdirect
physiologicaleffectsofmedicationconditionandother
mentaldisorder.

20. Specific phobia
Itisremarkablefearofanddesiretoavoid
specificsituationorobject.
Don’tvisitcliniciantheyviewtheirfearas
“normal”

21. Common Specific phobia:-
Animal Phobia
Natural environment Phobia(height,
storms, water)
Blood, injection and injury Phobia
Situation Phobia (e.g boat, airplane, elevators)
Other (fear of choking)

22. Pathophysiology of anxiety disorder
•Geneticandnongeneticfactors
•Ifoneidenticaltwinhaspsychiatriccondition,the
riskthattheothertwinwillhavethesamecondition
isapproximately50%.
•Anythingintheenvironmentthatdisturbs
homeostasisisdefinedasastressor

23. Releaseofcorticotrophinreleasingfactor,which,
inturn,
Stimulatesthereleaseofcorticotrophins,
Leadingtoreleaseofthestresshormones
(glucocorticoidsandepinephrine)fromthe
adrenalcortex.
Glucocorticoidstypicallyexertnegativefeedback
tothehypothalamus,decreasingthereleaseof
CRF
Theamygadalaistheprimarymodulatorofthe
responsetofearoranxiety

24. Management
Shouldbetreatedproperly
Comprehensive including both
pharmacotherapyandnonpharmacotherapy

25. Antidepressants
All antidepressants are efficacious for the treatment
Choice depends mostly on their side effect profile
Commonly used antidepressants are:-
Sertraline,
Escitalopram,
Venlaflaxine,
Mirtazapine and
Dethiepin

26. Psychosocial treatment
Non-pharmacological
Psycho education about the illness
Cognitive behavior therapy,
Relaxation techniques
Self-monitoring
Cognitive –behavior therapy combined with
medication has proven to be an effective

27. Self help
•Some person may be able to improve their
symptoms by relaxation techniques,
exercise or talking to their significant
people in support groups
•Meditation
•Yoga
•JPMR

28. COUNSELING
•A professional relationship and activity in
which one person endeavors to help another
to understand and to solve his or her
adjustment problems; the giving of advice,
opinion, and instruction to direct the
judgment or conduct of another.
•Treatment of emotional, behavioral,
personality and psychiatric disorders based
primarily upon verbal and non-verbal
communication

29. Cognitive Behavioral Therapy
•Helps people learn how to identify and
change destructive or disturbing thought
patterns that have a negative influence on
behavior and emotions.
•CBT focuses on changing the automatic
negative thoughts that can contribute to and
worsen emotional difficulties, depression,
and anxiety.

30. Substance Use Disorders
& Addiction
•Addiction is a serious illness
•Health, finance, relationship, careers –all
can ruined
•The abuse of drugs and alcohol is the
leading cause of substance abuse.
•Many effective treatments are available
•The road to recovery begins with
recognition

31. •People often drink alcohol during social
occasions
•The recklessness often resulting from
excessive drinking
•Leading causes of serious injuries and
accidental deaths, preventable birth defects
(fetal alcohol syndrome)
•Liver damage, heart disease, impotence,
infertility and premature aging.

32. Marijuana
•The most widespread and it is the most
widely used illicit drug
1.Short term memory loss
2.Accelerated heartburn
3.Increased BP
4.Lapses in judgment, concentration,
perceptual abnormality

33. •Heroin
•Cocaine
•Hallucinogens (LSD)
•Inhalants
•Sedatives
•Nicotine

34. Treatments
•Motivational Enhancement Therapy
•Counselling
•Family Therapy
•Group Therapy-(Alcohol Anonymous, Al –
Anon)
•Anti-craving medication