MENTAL DISORDERS (see also diseases of the central nervous system)

Table of contents :


  • developmental disorders
  • delirium, dementia, and amnestic disorders
  • substance-related disorders
  • psychoses
  • neuroses
  • factitious disorders
  • sleep disorders
  • impulse control disorders
  • adjustement disorders
  • personality disorders

  • Epidemiology : a national survey of US citizens has found that 6% of them have a debilitating mental illness. More startling, almost 50% of those surveyed were found to have had a mental disorder at some point during their lives; > 25% had had 1 in the year before the interview. Treatment is hard to get, and often not sufficient when available. Only about 33% of those in care receive "minimally adequate treatment", such as the appropriate drugs or a few hours of therapy over a period of several monthsref1, ref2, ref3, ref4. The statistics are nearly impossible to compare with previous studies, thanks to constantly changing definitions of mental illness, but in general things don't seem to have changed much over the past decade. > 9,000 US adults, chosen randomly, were visited in their homes as part of the National Comorbidity Survey, which looks at the incidence of multiple mental disorders. An interview then probed to see whether they had mental difficulties as determined by the latest Diagnostic and Statistical Manual of Mental Disorders. The study also classified the severity of disorders, separating them into severe, moderate or mild conditions. The definition of disorders used by the study was quite broad. A few instances of road rage, for example, might qualify as an intermittent explosive disorder. Such a wide net may not be any use in determining who needs medication or treatment, but the survey does provide some useful information. It reveals, for example, that 50% of those with a mental disorder encountered problems before their 14th birthday. This indicates that watching for signs of mental distress in early years could help to avert larger problems in the future. Progress will be made in finding biological markers that can help distinguish children who are simply shy or have a quick temper from those whose difficulties are likely to degenerate into illness, perhaps through an analysis of genes or brain scans. Meanwhile, the first order of business is to improve the quality of treatment. The prevalence of mental disorders did not change during the decade (29.4% between 1990 and 1992 and 30.5% between 2001 and 2003), but the rate of treatment increased. Among patients with a disorder, 20.3% received treatment between 1990 and 1992 and 32.9% received treatment between 2001 and 2003. Overall, 12.2% of the population 18 to 54 years of age received treatment for emotional disorders between 1990 and 1992 and 20.1% between 2001 and 2003. Only about half those who received treatment had disorders that met diagnostic criteria for a mental disorder. Significant increases in the rate of treatment (49.0% between 1990 and 1992 and 49.9% between 2001 and 2003) were limited to the sectors of general medical services (2.59 times as high in 2001 to 2003 as in 1990 to 1992), psychiatry services (2.17 times as high), and other mental health services (1.59 times as high) and were independent of the severity of the disorder and of the sociodemographic characteristics of the respondents. Despite an increase in the rate of treatment, most patients with a mental disorder did not receive treatment. Continued efforts are needed to obtain data on the effectiveness of treatment in order to increase the use of effective treatmentsref.
    Web resources : Do I Need Therapy online test
     

  • psyche : the human faculty for thought, judgment, and emotion; the mental life, including both conscious and unconscious processes; the mind in its totality, as distinguished from the body.
  • situation : the combination of factors with which an individual is confronted. In psychology, the total sum of physical, psychological, and sociocultural factors that act on a person and influence his behavior
  • ego-syntonic : denoting aspects of a person's thoughts, impulses, attitudes, and behavior that are felt to be acceptable and consistent with the rest of their personality.
  • ego-dystonic : denoting aspects of a person's thoughts, impulses, attitudes, and behavior that are felt to be repugnant, distressing, unacceptable, or inconsistent with the rest of their personality.
  • psychiatry : that branch of medicine which deals with the study, treatment, and prevention of mental disorders.
  • psychobiology / biopsychology : a field of study examining the relationship between brain and mind, studying the effect of biological influences, including biochemical, neurological, and pharmacological factors, on psychological functioning or mental processes. Adolf Meyer's school of psychiatric thought, in which the human being is viewed as an integrated unit, incorporating psychological, social, and biological functions, with behavior a function of the total organism.
  • mental disorder : any clinically significant behavioral or psychological syndrome characterized by the presence of distressing symptoms, impairment of functioning, or significantly increased risk of suffering death, pain, disability, or loss of freedom. Mental disorders are assumed to be the manifestation of a behavioral, psychological, or biological dysfunction in the individual. The concept does not include deviant behavior, disturbances that are essentially conflicts between the individual and society, or expected and culturally sanctioned responses to particular events
  • disorders usually diagnosed for the first time in infancy, childhood, or adolescence / developmental disorders : a former classification of chronic disorders of mental development with onset in childhood; such disorders are now classified as ...
  • delirium, dementia, amnestic disorders, and other cognitive disorders
  • mental disorders due to general medical condition-not otherwise classified
  • toxicomanias / drug abuse / chemical substance dependence : a state of periodic or chronic intoxication, detrimental to the individual and to society, produced by the repeated administration of a drug.
  • Drugs of abuse can be classified according to ... Multiple simultaneous variables affecting onset and continuation of drug abuse and addiction
    drug of abuse
    acquired (nonspontaneous) tolerance / assuefaction
    reverse tolerance / sensitization
    dependence (depending on drug of abuse, consumer, and social environment)
    toxic psychoses from dose-dependent
    psychotogens
    acute tolerance
    chronic tolerance
    physical dependence : continued administration of the drug is required to maintain normal function => temporarywithdrawal syndrome when administration is terminated (symptoms tend to be opposite to the original effects produced by the drug before tolerance developed)  => DA in the "shell" of nucleus accumbens => positive reinforcing effect (e.g. conditioned place preference) => psychological dependence : psychic abstinence syndrome
  • crash (hours/days : craving, compulsion, depression, anxiety)
  • withdrawal (weeks: dysphoric syndrome, apathy,..) 
  • extintion (months/years)
  • social substance dependence
     
    amphetamines (neurotoxicity : autooxidation of DA to 6-hydroxyDA or hyperactivity of Glu-ergic circuits => DA-ergic neurons)
    +
    +
    + (hypermotility, stereotypia, psychoses)
    +
  • paranoideal psychosis 
  • chorea-like syndrome 
  • dysautonomic syndrome (anxiety, collapse, seizures) 
  • LSD
    +
    +
    cocaine
    may involve conditioning after long-term exposure, has been linked to paranoid, psychotic manifestations
     dysphoria, depression, sleepiness, fatigue, bradycardia
    +
    +
    heroin
    +
    +
    +
    +
    psilocybin
    +
    cannabinoids seen clinically only in persons who use marijuana on a daily basis and then suddenly stop
    +
    +
    mescaline
    +
    inhalants
    +
    nicotine irritability, impatience, hostility, anxiety, dysphoric or depressed mood, difficulty concentrating, restlessness, bradycardia, hyperphagy or weight gain
    with 10 puffs per cigarette, the one-pack-per-day smoker reinforces the habit 200 times daily
    although > 80% of smokers express a desire to quit, only 35% try to stop each year, and < 5% are successful in unaided attempts to quit
    caffeine / teine fatigue, sedation, headache, nausea and vomiting
    +
    PCP somnolence, tremor, seizures, diarrhea, piloerection, bruxism, and vocalizations schizophrenia
    opioids regular withdrawal : mydriasis, restlessness, irritability, hyperalgesia, sweating, piloerection, tachycardia, nausea and vomiting, gastritis, colic, diarrhea, myalgia, systemic arterial hypertension, dysphoria, yawning, insomnia, anxiety, fever, strabismus, rhinorrhoea, crying, cough ; 
    protracted withdrawal (up to 6 months): anxiety, insomnia, cyclic changes in weight, pupil size, respiratory center sensitivity
    +
    chloral hydrate
    +
    +
    paraldehyde
    +
    +
    glutethimide
    +
    +
    BDZ
    moderate doses : anxiety, paresthesias (photophobia, increased sensitivity to sound), muscle cramps, myloclonic jerks, sleep disturbance, dizziness; high-doses
    seizures, delirium
     
    meprobamate
     
    +
    barbiturates
    +
    +
    ethanol
    tremor, irritability, nausea and vomiting, sleep disturbance, tachycardia, systemic arterial hypertension, sweating, perceptual distortion, seizures (12-48 hrs after last drink); in conjunction with infection, trauma, malnutrition, or electrolyte imbalance => delirium tremens
    +
    SSRI
    +
  •  substance-related disorders : any of the mental disorders associated with excessive use of or exposure to psychoactive substances, including drugs of abuse, medications, and toxins. DSM-IV includes specific disorders for the classes
  • The group is divided into substance use disorders and substance-induced disorders, each of which is specified on the basis of etiology, e.g., alcohol use disorders. Differential diagnosis : Laboratory examinations : Structured Clinical Interview for the Spectrum of Substance Use (SCI-SUBS)
    Web resources :
  • psychotic disorders / psychoses : a mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behavior, usually without apparent awareness on the part of the patient of the incomprehensibility of his behavior (anosognosia); called psychotic disorder in DSM-IV. The term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g., manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic.
  • Pathogenesis : increased activity of mesolimbic tract => alterations in perceptions of time, place, sounds and colors. Symptoms : Therapy :
  • neuroses :  former name for a category of mental disorders characterized by anxiety and avoidance behavior. In general, the term refers to disorders in which the symptoms are distressing to the person (ego-dystonic), reality testing is intact (conscious disorder), behavior does not violate gross social norms, and there is no apparent organic etiology (no fever, no anatomical injuries). Classified in DSM-IV under anxiety disorders, dissociative disorders, mood disorders, sexual disorders, and somatoform disorders.
  • malingering : the willful, deliberate, and fraudulent feigning or exaggeration of the symptoms of illness or injury, done for the purpose of a consciously desired end.
  • factitious disorder : a mental disorder characterized by repeated, intentional simulation of physical or psychological signs and symptoms of illness for no apparent purpose other than obtaining treatment. It differs from malingering in that there is no recognizable motive for feigning illness. It is subtyped on the basis of whether the predominant signs and symptoms are
  • Differential diagnosis :
  • eating disorders : any of several disorders in which abnormal feeding habits are associated with psychological factors. Often the consequences of eating disorders worsen them (e.g. mucositis)

  • Epidemiology : mostly females aged 12-25 years Laboratory examinations : sleep disorders : chronic disorders involving sleep During sleep, noise signals which are associated with danger (i.e. lorry noise) have the potential to trigger stress reactions even if the noise level is low and increases of cortisol in the first half of the night, which increases significantly with increasing traffic load, increases relative risks of asthma, chronic bronchitis and neurodermitisref
    Adolescents and young adults are often excessively sleepy. This excessive sleepiness can have a profound negative effect on school performance, cognitive function, and mood and has been associated with other serious consequences such as increased incidence of automobile crashesref. Sleep research data indicate that adolescents and even young adults under 21 still require 9-10 hours' sleep a night. But since the 1980s, the average sack time for both college and high school students has diminished to 6-7 hours nightly. Youngsters who are aged 9-10 years tend to sleep, on average, for about 10 hours on school nights and usually not more (and many times a lot less!) on weekends. But teenagers typically begin to enjoy sleeping in on the weekends. This trend increases during the high school years. As teens also develop a yen for late-night activities, their sleep debt increases daily. Developmental changes in circadian rhythms, endocrine and neurobehavioral systems, not to mention busier schedules, earlier start times for school, and parental supervision, also contribute to the problem of a teenager's getting less sleep. Regardless of the causes, however, this scenario often proves far more serious than a mere yawn or a brief encounter in slumber land. Current high school start times contribute to sleep deprivation among adolescents. Consistent with a delay in circadian sleep phase, students performed better later in the day than in the early morning. However, exposure to bright light in the morning did not change the sleep/wake cycle or improve daytime performance during weekdays. Both short-term and long-term strategies that address the epidemic of sleep deprivation among adolescents will be necessary to improve health and maximize school performanceref.
    In USA the percentage of people who typically sleep < 6 hours was : 12% in 1998; 13% in 2001; 15% in 2002; 16% in 2005. People who sleep > 10 hours per night have an average BMI = 26.4 kg/mBSA2, while people sleeping 2-4 hours per night have a BMI = 30.1 kg/mBSA2ref
    Therapy : chronotherapy : treatment of certain sleep disorders by capitalizing on the natural phase delay in adults; the bedtime is successively advanced by one to several hours each day until the individual can retire, sleep, and arise at appropriate times.
     
  • impulse control disorders : a group of mental disorders characterized by repeated failure to resist an impulse to perform some act harmful to oneself or to others. The person feels tension or an irresistible urge to perform the act which, even though ego-dystonic, gives pleasure or emotional release upon performance.
  • adjustment disorder : a maladaptive reaction to identifiable stressful life events, such as divorce, loss of job, physical illness, or natural disaster; this diagnosis assumes that the condition will remit when the stress ceases or when the patient adapts to the situation
  • Differential diagnosis :
  • personality disorders : a category of mental disorders characterized by enduring, inflexible, and maladaptive personality traits that deviate markedly from cultural expectations, are self-perpetuating, pervade a broad range of situations, and either generate subjective distress or result in significant impairments in social, occupational, or other functioning. Onset is by adolescence or early adulthood.
  • other factors that influence a medical condition
  • additive codes
  • reaction : the mental and/or emotional state elicited in response to any particular situation.
  • nyctophilia : a preference for darkness or for night.
  • Erickson's 8 psychosexual stages of man
  • complex : a group of interrelated ideas, mainly unconscious, that have a common emotional tone and strongly influence a person's attitudes and behavior
  • conflict : in psychiatry, a psychic struggle, often unconscious, arising from the clash of incompatible or opposing impulses, wishes, drives, or external demands.
  • euphoria : an exaggerated feeling of physical and mental well-being, especially when not justified by external reality. Euphoria may be induced by drugs such as opioids, amphetamines, and alcohol and is also a feature of mania
  • homicide : the taking of the life of one person by another
  • suicide : the taking of one's own life. Only a small minority has a rational base.
  • Epidemiology :
    suicide
    failed suicide
    age mature/advanced < 35
    female-to-male ratio 3:1 1:3
    suicide way violent drugs (> 80%)
    diagnosis major depression 
    alcohol 
    schizophrenia 
    somatic disease
    psychogenous reaction
    personality disorder 
    depressive reaction
    psychogenous reaction 
    alcoholism
    stressors no yes
    premeditation yes no
    aid possibility accidental yes
    aid request no  yes
    aim self-repression manipulatory
    Suicide rates for the elderly > 65 years continue to be the highest for any age group Aetiology : Most frequently used method for committing suicide : Prevention :
  • oedipism [from Oedipus, King of Thebes, who blinded himself after unknowingly killing his father and marrying his mother] : intentional injury of one's own eyes
  • borderline state :a diagnostic term used when it is difficult to determine which of two states are indicated by the presenting symptoms, generally for a state that has some characteristics of psychosis but in which the patient has some contact with reality.
  • Epstein's symptom : a symptom seen in nervous infants, consisting of failure of the upper lid to move downward, giving the child a frightened expression
  • chronotaraxis : disorientation for time; observed as a transient symptom following thalamic or frontal lobe lesions.
  • formal thought disorder : disturbance in the form, rather than the content, of thought; disruption in the flow of ideas or speech; inability to follow the normal semantic or syntactic rules in someone with adequate intelligence and education and the cultural background to do so.
  • asceticism : a way of life or character trait described by the elimination of pleasurable effects associated with experiences and characterized by renunciation, self-denial, withdrawal from society, and sometimes dedication to an unattainable ideal or to eradication of some specific evil.
  • psychataxia : a disordered mental condition marked by confusion and inability to concentrate
  • psycholepsy : a sudden, intense lowering of mood level, usually of short duration, in individuals with unstable psychic tension
  • hallucination : abnormal sensation
  • illusion : a false or misinterpreted sensory impression; a false interpretation of a real sensory image
  • delusion : a false belief that is firmly maintained in spite of incontrovertible and obvious proof or evidence to the contrary and in spite of the fact that other members of the culture do not share the belief.
  • misidentification : failure to identify correctly persons or objects known to the subject, caused by confusion or memory loss.
  • culture-specific syndrome : a form of disturbed behavior highly specific to certain cultural systems and that does not conform to Western nosologic entities; examples are amok, koro, piblokto, falling-out, and windigo.
  • windigo / witigo [Ojibwa a cannibalistic monster of the mythology of Eskimos and certain Native Americans] : a culture-specific syndrome characterized by delusions of being possessed by the windigo, with fears of becoming cannibalistic and agitated depression
  • Kleine-Levin syndrome : episodic periods of excessive sleep and overeating lasting for several weeks, with amnesia for the attacks; it usually occurs in adolescent boys.
  • maternal deprivation syndrome : failure to thrive with severe growth retardation, unresponsiveness to the environment, depression, retarded mental and emotional development, and behavioral problems resulting from loss, absence, or neglect of the mother or other primary caregiver.
  • organic personality syndrome : a term used in a former system of classification, denoting an organic mental syndrome characterized by a marked change in behavior or personality, caused by a specific organic factor and not associated with delirium or dementia. The most common causes are space-occupying lesions of the brain, head trauma, and cerebrovascular disease.
  • social breakdown syndrome : deterioration of social and interpersonal skills, work habits, and behavior seen in chronically hospitalized psychiatric patients; due to the effects of long-term institutionalization rather than the primary illness. Symptoms include excessive passivity, assumption of the chronic sick role, withdrawal, and apathy. Such effects are also seen in long-term inmates of prisons or concentration camps.
  • acathexis : a lack of the emotional charge (cathexis) with which an object or idea would normally be invested; detachment of feelings from thoughts and ideas.
  • taboo [Tongan tabu forbidden, set apart] : any of the negative traditions, objects, or behaviors that are generally regarded as harmful to social welfare and are therefore prohibited
  • mores : the traditions and habits which are generally regarded as conducive to social welfare.
  • psychic determinism : the concept, originated by Freud, that mental events do not occur by chance but have their antecedent mental causes, that even accidents, slips of the tongue, or whims commonly felt to be inexplicable result from unconscious mental processes.
  • stigma : a distinguishing personal trait that is perceived as or actually is physically, socially, or psychologically disadvantageous
  • psychic overtone : the consciousness of a fringe or halo of associated relations that surrounds every image presented to the mind
  • organic drivenness : hyperactivity seen in brain-damaged individuals as a result of injury to and disorganization of cerebellar structures.

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    Laboratory examinations :

    Therapy : psychotherapy
    Glossary : In UK 23% of current and recent mental health patients had been in mixed-sex accommodation, despite Government reassurances in 2002 that such wards would be eliminated : those patients in mixed-sex wards had greater concerns about their safety and said it compromised their privacy and dignity. 27% rarely felt safe while in hospital, and only 20% felt they were treated with respect and dignity by staff. 23% had been physically or verbally threatened during their stay in hospital, with 20% reporting a physical assault. And 7% of patients had been harassed or assaulted by staff. > 50% of patients said the hospital surroundings had not helped them recover, and 33% thought they had made their health worse.

    Among elderly people hospitalization of a spouse is associated with an increased risk of death, and the effect of the illness of a spouse varies among diagnoses. Such interpersonal health effects have clinical and policy implications for the care of patients and their families. Overall, 383,480 husbands (74%) and 347,269 wives (67%) were hospitalized at least once, and 252,557 husbands (49%) and 156,004 wives (30%) died. Mortality after the hospitalization of a spouse varied according to the spouse's diagnosis. Among men, 6.4% died within 1 year after a spouse's hospitalization for colon cancer, 6.9% after a spouse's hospitalization for stroke, 7.5% after a spouse's hospitalization for psychiatric disease, and 8.6% after a spouse's hospitalization for dementia. Among women, 3.0% died within 1 year after a spouse's hospitalization for colon cancer, 3.7% after a spouse's hospitalization for stroke, 5.7% after a spouse's hospitalization for psychiatric disease, and 5.0% after a spouse's hospitalization for dementia. After adjustment for measured covariates, the risk of death for men was not significantly higher after a spouse's hospitalization for colon cancer (hazard ratio, 1.02; 95% confidence interval, 0.95 to 1.09) but was higher after hospitalization for stroke (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.09), congestive heart failure (hazard ratio, 1.12; 95% confidence interval, 1.07 to 1.16), hip fracture (hazard ratio, 1.15; 95% confidence interval, 1.11 to 1.18), psychiatric disease (hazard ratio, 1.19; 95% confidence interval, 1.12 to 1.26), or dementia (hazard ratio, 1.22; 95% confidence interval, 1.12 to 1.32). For women, the various risks of death after a spouse's hospitalization were similar. Overall, for men, the risk of death associated with a spouse's hospitalization was 22% of that associated with a spouse's death (95% confidence interval, 17 to 27%); for women, the risk was 16% of that associated with death (95% confidence interval, 8 to 24%)ref.

    Web resources :

    Bibliography :
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