mental health-1 for psm and other subjects.

In psm or other subjects we try to know about, what is mental health...

1. Mental Health
COMMUNITY MEDICINE

2. WHAT IS HEALTH?
Health is defined as a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity.


WHAT IS MENTAL HEALTH?

Mental health is thus the balanced development of the individual's personality and
emotional attitudes which enable him to live harmoniously with his fellow men.

By definition, " mental health is a state of well being in which an individual
realizes his or her own abilities, can cope with the normal stress of life, can work
productively and is able to make contribution to his or her community" .

3. PROBLEM STATEMENT
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They are generally characterized by a combination of abnormal
thoughts, perceptions, emotions, behaviour and relationship with others.
The tentative global estimates of the major mental disorders are
depression 300 million, bipolar affective disorders 60 million,
schizophrenia and other psychosis 23 million and dementia 50 million*.
National Mental Health Survey (NMHS) was carried out in the country
to identify the prevalence, pattern, outcome, treatment gap, disabilities
along with the current status of medical health services and facilities.

*year 2018 according to latest edition of PARK book

4. Following are the key findings of the
survey -
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1. NMHS indicates that nearly 150 million Indians aged 13 and
above are likely to be suffering from one or more mental health
problems and are in need of services.
2. More prevalent in urban areas.
3. Proportion of those with a mental health disorder in young and
adolescents was 7.3%
4. Neurosis and stress related disorders affected twice as many
women compared to men.
5. Alcohol use disorder in men was 4.6% amongst the 18 +
population while, illicit substance use disorders was 0.6%
6. Less than 2% had a severe mental illness like psychosis or
bipolar disorder. Nearly 50% had moderate to severe disability.
7. Data indicates that 0.9% are at a high risk of suicide.

5. Characteristics of a
mentally healthy person
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Accept his shortcomings
He has self respect
Able to feel as a part of a group
Able to like and trust others
Able to meet demand of life
Able to think of himself and to take his own decision
Sets reasonable goals
Able to shoulder his daily responsibilities .

6. Warning signals of poor mental health
1.Are you continually unhappy?
2.Are you regularly troubled by insomnia?
3.Are you unable to concentrate ?
4.Do you lose your temper easily ?
5.Are you constantly bitter ?
6.Do you think you are always right?
7.Do you dislike to be with people?
8.Are you always worrying?

7. 9. Are you always afraid without any cause?

10. Do children consistently get on to your
nerves ?

11. Do you have aches and pain without any
cause?

12. Do you have fluctuations of moods with
elation to depression?

13. Are you upset if your routine is disturbed ?

8. TYPES OF MENTAL ILLNESS
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The international classification of diseases (ICD 10) classifies the mental and
behavioural disorders as:
Organic, including symptomatic, mental disorders - e.g., dementia in Alzheimer's
disease, delirium
Mental and behavioural disorders due to psychoactive substance use. e.g.,
harmful use of alcohol, opioid dependent syndrome*
Schizophrenia, schizotypal and delusional disorders - e.g., paranoid schizophrenia,
delusional disorders, acute and transient psychotic disorders.
Mood (affective) disorders - e.g., bipolar affective disorder, depressive episode.
Neurotic, stress related and somatoform disorders - e.g., generalized anxiety
disorders, obsessive compulsive disorders.

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Behavioural syndromes associated with physiological disturbances
and physical factors. eg - eating disorders, non organic sleep
disorders.
Disorders of adult personality and behaviour. eg- paranoid
personality disorder, trans-sexualism.
Mental retardation.
Disorders of psychological development. eg- specific reading
disorders, childhood autism.
Behavioural and emotional disorders with onset usually occurring in
childhood and adolescence. eg- hyperkinetic disorders, conduct
disorders, tic disorders.
Unspecified mental disorder.

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MAJOR ILLNESS ( psychoses )
Schizophrenia
Manic depressive psychosis
Paranoia

MINOR ILLNESS
Neurosis / Psychoneurosis
Personality and Character disorders

11. Causes of mental ill health
1. ORGANIC CONDITIONS : such as cerebral arteriosclerosis,
neoplasms, metabolic diseases, neurological diseases, endocrine
diseases and chronic diseases such as tuberculosis, leprosy, epilepsy
etc.
2. HEREDITY : the child of two schizophrenic parents is 40 times
more likely to develop schizophrenia than is the child of healthy
parents.
3. SOCIAL PATHOLOGICAL CAUSES : worries ,anxiety, emotional
stress, tension, frustration, unhappy marriages, broken homes, poverty,
industrialization, urbanization, changing family structure, population
mobility, economic insecurity, rejection, etc.

12. Environmental factors other than psychological
ones-

1. Toxic substances- carbon disulfide, mercury, manganese, tin, lead compounds
2. Psychotropic drugs
- barbiturates, alcohol.
3. Nutritional factors - deficiency of thiamine, pyridoxine
4. Minerals - deficiency of iodine
5. Infective agents - infectious disease during the prenatal, perinatal and postnatal
periods of life may have adverse effects on brain's development and the integration of
mental functions.
6. Traumatic factors - road and occupational accidents
7. Radiation - Nervous system is most sensitive to radiation during the period of neural
development.

13. CRUCIAL POINTS IN THE LIFECYCLE
OF HUMAN BEINGS
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Prenatal period
First 5 years of life
School child
Adolescence
Old age

Throughout the life, the needs of man remains the same:
Need for – affection, belonging, independence, achievement,
recognition, sense for personal worth

14. Alcoholism and Drug Dependence
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Definitions-
DRUG-The word drug is defined as any substance that when
taken into living organism may modify one or more of its
functions

Drug abuse is defined as self administration of a drug for non-
medical reasons in quantities and frequencies which may impair
an individual's ability to function effectively which may result in
social, physical or emotional harm

15. •Drug dependence is described as a state, psychic and
sometimes also physical resulting from interaction between a
living organism and a drug characterized by behavioral and
other responses that always include a compulsion to take the
drug on a continuous or periodic basis in order to experience its
psychic effects and sometimes to avoid the discomfort of its
absence.

16. Agent Factors
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ICD 10 recognizes the following as drugs causing mental and behavioural disorders
including dependence-
Alcohol
Opioids
Cannabinoids
Sedatives
Cocaine
Other stimulants including caffeine
Hallucinogens
Tobacco
Volatile solvents
other psychoactive substances

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Anabolic steroids are being abused by people who wish to increase muscle mass for cosmetic reasons
or greater strength
Withdrawal symptoms of steroid dependency include restlessness, fatigue ,depressed mood and
insomnia
Drugs commonly used today are
1. Amphetamines and cocaine-The various brands of amphetamines common names
are-Benzedrine, Dexedrine, Methedrine , etc.
These drugs act on Central nervous system they produce mood ,elevation, relief are feeling of well-being
and increased alertness and a sense of heightened awareness because they give a tremendous boost to
self-confidence and energy while increasing endurance they are called Superman drugs.

Cocaine is derived from the leaves of coca plant it was formally used in medical practices potent local
anaesthetics.
Cocaine is Central nervous system stimulant.
Unlike amphitamines produces no tolerance there is no physical dependence withdrawal symptoms.

18. 2. Barbiturates-They are major ingredients in sleeping pills
The drug abusers generally prefer short-acting barbiturates such as pentobarbitol and
secobarbitol to long acting ones.
The addiction barbiturates is one of the worst forms of suffering it leads to craving or both
physical and psychic dependence
3.Cannabis- There are various forms of cannabis like hashish, charas, marijuana ganja etc.
A marijuana cigarette will produce intoxication within minutes and the effect lasts for 1 to 4
hours .
The oral consumption is a delayed onset of action and prolonged effect lasting for many hours
The most common reaction is the development of dreamy state of altered consciousness.
Relaxation euphoria and an increased tendency to laugh greater awareness of colours and
sounds,interference with perception of both time and space paranoia are common
psychological effects reported by marijuana users.

19. 4.Heroin- morphine, codein, methadone, pethidine, and narcotic analgesics. Addiction
to heroin is perhaps the worst type of addiction because it produces craving with
narcotics generally psychic dependence is strong and tends to develop early.
5.LSD – Lysergic acid diethylamide acid synthesized by Hoffman
LSD alters the normal structuring of perception
The individual perceives the world in a different manner.
There is intensification of colour perception, and auditory acuity, body image distortion,
visual illusions, fantasies, pseudohallucinations are common
Colors are heard and music becomes palpable.
Subjective time is deranged so that second seems to be minutes.
Physical dependence to not developed with LSD and hence there is no addiction
liabilility

20. 6.Alcohol
It can be also classified as a sedative ,tranquilizer, hypnotic or
anaesthetic, depending upon the quantity consumed.
Of all the drugs alcohol is the only drug self intoxication is socially
acceptable.
Alcohol is absorbed from the stomach and small and intestines within
2 to 3 minutes of consumption it can be detected in the blood
The maximum concentration is usually reached about 1 hour after the
consumption the presence of food in the stomach inhibit the
absorption of alcohol because of dilution.
While Alcohol is used traditionally by men its used by women is
traditionally on increase

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According to current concepts alcoholism is considered a
disease and alcohol a disease agent which causes acute and
chronic intoxication like cirrhosis of liver ,toxic psychosis,
gastritis, cardiomyopathy and peripheral neuropathy
Further alcohol is an important etiological factor in suicide,
automobile and other accident and injuries and deaths due to
violence.

22. •We can control alcohol abuse by the following ways
1.Regulating the marketing of alcoholic beverages in particular to
younger people
2.Regulating and restricting the availability of Alcohol
3.Enacting appropriate Drink and drive polices
4.Creating awareness of public health problems caused by harmful
use of alcohol and ensuring support for effective alcohol policies
5.Providing accessible and affordable treatment for people with
alcohol use disorder

23. Tobacco
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Tobacco is in legal use Everywhere In the world-
More people die from tobacco-related diseases other than
cancer such as stroke, myocardial infarction, aortic aneurysm
and peptic ulcer
Young people who take up smoking have been shown to
experience and early onset of cough phlegm production and
shortness of breath and exertion.
It is suggested that 3 factors are associated with young people
smoking peer pressure following the example of siblings and
parents and employment outside the home

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Woman who smoke run even more risks than men for example the
adverse effects of oral contraceptive use are marketing increased in
women's smokers
Osteoporosis is accelerated with tobacco use
Tobacco used is also associated with a higher rate of spontaneous
miscarriages
In pregnancy smoking contributes to perinatal complications such as
bleeding which is dangerous for both mother and fetus especially in
low-income countries where health facilities are inadequate
Intrauterine growth retardation and low birth weight babies are
known outcomes of smoking during pregnancy.

25. PASSIVE
SMOKING
Second hand smoke is
the combination of
smoke emitted from the
burning end of a cigarette
or other tobacco products
and smoke exhaled by
smokers .

26. 8. VOLATILE SOLVENTS: Sniffing of substances such as
glue , petrol , paint thinner , typewriter correction fluid .

These substances are CNS depressants .

There may be initial euphoria , confusion , disorientation ,
delusions, loss of self control.

9.CAFFEINE : One of the most commonly used substance
worldwide .
Tea , cocoa , cola drinks also contribute to an intake of caffeine.
Usually associated with ingestion of over 500mg/dl .

27. HOST FACTORS
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Symptoms of drug addiction :

Loss of interest in sports and daily routine .
Loss of appetite and body weight .
Unsteady gait , clumsy movements , tremors.
Reddening and puffiness of eyes .
Slurring of speech.
Numerous injection marks on the body.

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Nausea , vomiting and body pain.
Sleeplessness , lethargy , profuse sweating
Acute anxiety , depression .
Changing mood , temper .
Depersonalization and emotional
detachment .
Impaired memory and concentration .
Presence of needles , syringes and strange
packets at home.

29. ENVIRONMENTAL FACTORS
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Living away from home
Migration to cities
Relaxed parental control
Early exposure to drugs
Leaving school early
Broken homes ; one parent family
Unemployment

30. MAGNITUDE OF SUBSTANCE ABUSE IN INDIA
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According to national survey conducted between December 2017
and October 2018----
ALCOHOL -- Alcohol is the most common psychoactive substance
used by Indians .
Nationally about 14.6% of population between 10 and 75 years of
age uses alcohol .
It is considerably higher in men (27.3%) than women (1.6%).
CANNABIS –
Cannabis are the next commonly used substance.
The legal form (bhang) was used by 2.2 crore and 1.3 crore persons
used illegal form (ganja and charas).
The highest use of Cannabis was recorded in Uttar Pradesh, Punjab,
Sikkim, Chhattisgarh and Delhi.

31. •OPIOIDS -- About 2.1% population in India which includes opium
or its variance known as doda , heroin or its impure form -
smack or brown sugar and variety of pharmaceutical opioids.

32. PREVENTION
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LEGAL APPROACH --The legal approach is an important approach in the
prevention of drug abuse .
The anti smoking measures suggested are—
(a) Prohibition of the sale of tobacco products to minors .
(b) restriction on the sale of cigarettes from automatic vending machines.
(c) prohibition of smoking in schools another places frequently visited by
young people.
(d) prohibition of smoking in public
(e) prohibition of cigarette advertisement
(f) establishment of mandatory public health education on health
consequences of smoking.
(g) insisting on the placing of mandatory health warning on cigarette
packets.

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EDUCATIONAL APPROACH –
Common approaches have included educational programs for
school children and public information campaigns on electronic
media.
The message should be clear and unambiguous to the intended
audience and come from credible source of information.
The message should also provide specific advice rather than
general and as far as possible the information should be new to
the audience and should be capable of provoking discussion or
reaction.

34. COMMUNITY APPROACH
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There should be a strong emphasis on action at the community
level drug abuse.
Action at community level is also important since communities
often bear the main burden of dealing with the harmful use of
drugs and drug related problems .
A popular approach is provision of alternative activities which
may help to prevent drug abuse e.g. teen centers providing
activities attractive to adolescents .
Such activities include the establishment of groups organization
interested in athletics, sports, music , religion, artistic activities
of various kinds .
NGOs play a crucial role in development of such activities.

35. TREATMENT
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Though drug addiction may be considered as social problem, the first
step in its management is medical care, which includes:
-- identification of drug addicts and their motivation for detoxication
-- detoxication (requires hospitalization)
-- post detoxication counselling and follow up (based on clinic and
home visits)

REHABILITATION
The rehabilitation of former drug user in most cases a long and
difficult process.
Relapses are very frequent.

37. Thank you