Mental disorder
A mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental disorders has changed over time and across cultures. Definitions, assessments, and classifications of mental disorders can vary, but guideline criteria listed in the many cases there is no single accepted or consistent cause of mental disorders, although they are often explained in terms of a diathesis-stress model and biopsychosocial model. Mental disorders have been found to be common, with over a third of people in most countries reporting sufficient criteria at some point in their life. Services for mental disorders may be based in hospitals or in the community. Mental health professionals diagnose individuals using different methodologies, often relying on case history and interview. Psychotherapy and psychiatric medication are two major treatment options, as well as supportive interventions and self-help. Treatment may be involuntary where legislation allows. Several movements campaign for changes to services and attitudes.
Disorders
There are many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered.[1][2][3][4] These categories include anxiety disorders, childhood disorders, eating disorders, mood disorders, cognitive disorders, personality disorders, schizophrenia and other psychotic disorders, and substance-related disorders. Phillip W. Long M.D. (1995-2008). "Disorders". Internet Mental Health. http://www.mentalhealth.com/p20-grp.html.
Situationally inappropriate anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder.[5] Commonly recognized categories of anxiety disorders include specific phobia, Generalized anxiety disorder, Social Anxiety Disorder, Panic Disorder, Agoraphobia, Obsessive-Compulsive Disorder, Post-traumatic stress disorder. Relatively long lasting affective states can also become disordered. Mood disorder involving unusually intense and sustained sadness, melancholia or despair is know as Clinical depression (or Major depression), and may more generally be described as Emotional dysregulation. Milder but prolonged depression can be diagnosed as dysthymia. Bipolar disorder involves abnormally "high" or pressured mood states, known as mania or hypomania, alternating with normal or depressed mood. Whether unipolar and bipolar mood phenomena represent distinct categories of disorder, or whether they usually mix and merge together along a dimension or spectrum of mood, is under debate in the scientific literature.[6]
Patterns of belief, language use and perception can become disordered. Psychotic disorders centrally involving this domain include Schizophrenia, and Delusional disorder. Schizoaffective disorder is a category used for individuals showing aspects of both schizophrenia and affective disorders. Schizotypy is a category used for individuals showing some of the characteristics associated with schizophrenia but without meeting cut-off criteria.
The fundamental characteristics of a person that influence his or her cognitions, motivations, and behaviors across situations and time - can be seen as disordered due to being abnormally rigid and maladaptive. Categorical schemes list a number of different personality disorders, such as those classed as eccentric (e.g. Paranoid personality disorder, Schizoid personality disorder, Schizotypal personality disorder), those described as dramatic or emotional (Antisocial personality disorder, Borderline personality disorder, Histrionic personality disorder, Narcissistic personality disorder) or those seen as fear-related (Avoidant personality disorder, Dependent personality disorder, Obsessive-compulsive personality disorder).
There is an emerging consensus that personality disorders, like personality traits in the normal range, incorporate a mixture of more acute dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable.[7] Non-categorical schemes may rate individuals via a profile across different dimensions of personality that are not seen as cut off from normal personality variation, commonly through schemes based on the Big Five personality traits.[8]
Other disorders may involve other attributes of human functioning. Eating disorders involve disproportionate concern in matters of food and weight.[5] Categories of disorder in this area include Anorexia nervosa, Bulimia nervosa, Exercise bulimia or Binge eating disorder. Sleep disorders such as Insomnia also exist and can disrupt normal sleep patterns. Sexual and gender identity disorders, such as Dyspareunia or Gender identity disorder or ego-dystonic homosexuality. People who are abnormally unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others, may be classed as having an impulse control disorder, including various kinds of Tic disorders such as Tourette's Syndrome, and disorders such as Kleptomania (stealing) or Pyromania (fire-setting). Substance-use disorders include Substance abuse disorder. Addictive gambling may be classed as a disorder. Inability to sufficiently adjust to life circumstances may be classed as an Adjustment disorder. The category of adjustment disorder is usually reserved for problems beginning within three months of the event or situation and ending within six months after the stressor stops or is eliminated. People who suffer severe disturbances of their self-identity, memory and general awareness of themselves and their surroundings may be classed as having a Dissociative identity disorder, such as Depersonalization disorder or Dissociative Identity Disorder itself (which has also been called multiple personality disorder, or "split personality"). Factitious disorders, such as Munchausen syndrome, also exist where symptoms are experienced and/or reported for personal gain.
Disorders appearing to originate in the body, but thought to be mental, are known as somatoform disorders, including Somatization disorder. There are also disorders of the perception of the body, including Body dysmorphic disorder. Neurasthenia is a category involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but not by the DSM-IV.[9] Memory or cognitive disorders, such as amnesia or Alzheimer's disease exist.
Other proposed disorders include: Self-defeating personality disorder, Sadistic personality disorder, Passive-aggressive personality disorder, Premenstrual dysphoric disorder.
Causes
Mental disorders do not have a defined cause. Any disorder can arise from a combination of environmental, biological, and psychological sources. "Causes of Mental Illness". WebMD LLC. 9 February 2009. http://www.webmd.com/anxiety-panic/mental-health-causes-mental-illness. Retrieved 4 October 2009.
Some biological factors include; genetics, infections, prenatal damage, and substance abuse. It is often found that people who have or had a mental disorder within their family, are more susceptible to developing a mental disorder. In some cases, prenatal damage has been the cause for a mental illness. For example, a lack of oxygen to the brain may cause certain conditions. Last but not least, the report of substance abuse has been known to cause to mental illnesses such as; anxiety, depression, and paranoia. "Causes of Mental Illness". WebMD LLC. 9 February 2009. http://www.webmd.com/anxiety-panic/mental-health-causes-mental-illness. Retrieved 4 October 2009.
Psychological and environmental causes are found when the person has experienced a trauma or abuse. Examples of these would be divorce, sexual or physical abuse, and/or witnessing death. "Causes of Mental Illness". WebMD LLC. 9 February 2009. http://www.webmd.com/anxiety-panic/mental-health-causes-mental-illness. Retrieved 4 October 2009.
Diagnosis
Many mental health professionals, particularly psychiatrists, seek to diagnose individuals by ascertaining their particular mental disorder. Some professionals, for example some clinical psychologists, may avoid diagnosis in favor of other assessment methods such as formulation of a client's difficulties and circumstances.[23] The majority of mental health problems are actually assessed and treated by family physicians during consultations, who may refer on for more specialist diagnosis in acute or chronic cases. Routine diagnostic practice in mental health services typically involves an interview (which may be referred to as a mental status examination), where judgments are made of the interviewee's appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of relatives or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. Psychological testing is sometimes used via paper-and-pen or computerized questionnaires, which may include algorithms based on ticking off standardized diagnostic criteria, and in relatively rare specialist cases neuroimaging tests may be requested, but these methods are more commonly found in research studies than routine clinical practice.[24][25] Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.[26] It has been found that most clinicians evaluate patients using an unstructured, open-ended approach, with limited training in evidence-based assessment methods, and that inaccurate diagnosis may be common in routine practice.[27] Mental illness involving hallucinations or delusions (especially schizophrenia) are prone to misdiagnosis in developing countries due to the presence of psychotic symptoms instigated by nutritional deficiencies. Comorbidity is very common in psychiatric diagnosis, i.e. the same person given a diagnosis in more than one category of disorder.
Services and treatments
Treatment and support may be provided in psychiatric hospitals, clinics or any of a diverse range of community mental health services. Often an individual may engage in different treatment modalities. A strong sense of being part of an interdependent society in developing countries makes the community-based treatment model the most effective mode of treatment. A combination of community-based treatment and the use of typical antipsychotic drugs have been found to yield the most positive, cost-effective results. Individuals may be treated against their will in some cases. Services in many countries are increasingly based on a Recovery model that supports an individual's personal journey to regain a meaningful life.
Psychotherapy
A major option for many mental disorders is psychotherapy. There are several main types. Cognitive behavioral therapy (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. Psychoanalysis, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. Systemic therapy or family therapy is sometimes used, addressing a network of significant others as well as an individual. Some psychotherapies are based on a humanistic approach. There are a number of specific therapies used for particular disorders, which may be offshoots or hybrids of the above types. Mental health professionals often employ an eclectic or integrative approach. Much may depend on the therapeutic relationship, and there may be problems with trust, confidentiality and engagement.
Medication
A major option for many mental disorders is psychiatric medication. There are several main groups.
Antidepressants are used for the treatment of clinical depression as well as often for anxiety and other disorders. There are a number of antidepressants beginning with the tricyclics, moving through a wide variety of drugs that modify various facets of the brain chemistry dealing with intercellular communication. Beta-blockers, developed as a heart medication, are also used as an antidepressant.
Anxiolytics are used for anxiety disorders and related problems such as insomnia.
Mood stabilizers are used primarily in bipolar disorder. Lithium carbonate (a salt) and Lamictal (an epileptic drug) are notable for treating both mania and depression. The others, mainly targeting mania rather than depression, are a wide variety of epilepsy medications and antipsychotics.
Antipsychotics are used for psychotic disorders, notably for positive symptoms in schizophrenia. Although there has not been any evidence of the superiority of newer, atypical antipsychotic drugs, they are being prescribed to individuals throughout the world. The prescription of relatively cheaper, older typical antipsychotic drugs is also used.
Stimulants are commonly used, notably for ADHD. Despite the different conventional names of the drug groups, there can be considerable overlap in the kinds of disorders for which they are actually indicated.
There may also be off-label use of medications. There can be problems with adverse effects of medication and adherence.
Recently, the pharmaceutical industry has come into severe criticism for hiding negative results from clinical trials from the public and the USFDA and for promoting medications for unapproved uses by pharmaceutical sales representatives. Prominent psychiatric researchers have also come under fire recently for failing to disclose drug company compensation which poses serious potential conflicts of interest with their research and professional activities.