Professional Documents
Culture Documents
disorder
History. Classification. Prevalence.
Comorbidity. Epidemiology.
Definition
DSM criteria of abnormal behavior: “A behavior
is considered as abnormal if it is statistically rare,
deviates from society's unwritten rules (norms), it is
counter-productive to the individual and affects
individual's mental well-being”
Statistically rare behavior
Statistically rare behavior
Statistically rare behavior
Deviates from the norm
Deviates from the norm
Deviates from the norm
It's counter-productive
It's counter productive
It's counter productive
Affects the mental well-being
Affects the mental well-being
Affects the mental well-being
Disorders usually first diagnosed in infancy, disorders not
childhood, or adolescence
Somatoform disorders elsewhere classified
Delirium, dementia, and amnestic and other
Sleep Disorders
Adjustment disorders
cognitive disorders
Dissociative disorders
Mental disorders due to a general medical
Sexual and gender identity
condition not elsewhere classified disorder
Substance-related disorders
Eating disorders
Schizophrenia and other psychotic disorders
Personality disorders
Example: Major Depressive Episode.
5 or more of these symptoms / 2 weeks:
Statistical Manual
First DSM. Focused
for the use of DSM-III. Use
on diagnosis. Brief DSM-IV-TR.
Institutions for the of field-tested
descriptions of each Text is
Insane. 22 criteria to
disorder. Influenced revised, but
categories, mainly achieve
from psychoanalytic the diagnostic
referred to the reliability. No
thinking criteria are
somatic causes of theories of
not
behavioral disorders aetiology
Criticism of DSM
Use of categories
DSM uses categories, but drugs do not respect the
boundaries of the disorders.
Many disorders are better conceptualized as
dimensional traits.
Different levels of symptoms. More or less severe cases.
“Not Otherwise Specified” category is used very often!
Co-morbidity
A large fraction of patients qualifies for multiple
diagnoses.
Possible explanations:
Mental Disorders and
Neuroscience
Need for integration of Neuroscience into DSM-V
Arbitrary boundaries between mental and neurological disorders.
Overlapping practice patterns between neurology and psychiatry.
Use of neurological techniques in order to treat mental disorders (e.g. deep brain
stimulation)
Both treat higher brain functions (e.g. autism, Alzheimer's disease, ADHD)
Biological basis of many mental disorders (e.g. schizophrenia, bipolar disorder)
Need to build a new dimensional diagnostic system.
Ultimate goal: a diagnostic classification system for mental disorders based not only on
symptomatology but also on aetiology and pathophysiology of the disorders.
How can Neuroscience help?
Neurogenetics
Significant influence of genes
(twin studies/adoption studies etc)
Many studies tried to identify the
role of genetic factors in
development of disorders.
Interaction between multiple
genetic factors that cause a
common symptom in different
mental disorders (e.g. gene
catechol-O-methyltransferase =>
metabolism of neurotransmitters
like dopamine=> schizophrenia-
like symptoms)
New technologies will provide
How can Neuroscience help?
Neuroimaging
Anatomical abnormalities
(e.g. less gray matter in
schizophrenics)
Future diagnostic
classifications
Contribution to experimental
therapies
a. Localization of abnormal
activations
b. Direct therapy in these
brain regions
(e.g. Experimental treatment
of depression with stimulation
How can Neuroscience help?
Example: Phenylketonuria [1 in 15,000 births]
autosomal recessive genetic disorder →
deficiency in the PAH enzyme
Demyalination is caused after the birth
More accurate detection of PKU
Dietary Therapy (low in phenylalanine)
Today: Animal Models
Prevalence of Mental Disorders in
Europe
Prevalence rates of mental disorders in 6 E.U. Countries:
Belgium, France, Germany, Italy, the Netherlands and
Spain
Lifetime Prevalence
Total Males Females
Any Mental Disorder 25,00% 21.8% 28.1%
Any Mood Disorder 14,00% 9.5% 18.2%
Any Anxiety Disorder 13.6% 9.5% 17.5%
Any Alcohol Disorder 5.2% 9.3% 1.4%
Total Males Females
Major Depression 12.8% 8.9% 16.5%
Dysthymia 4.1% 2.6% 5.6%
GAD 2.8% 2.0% 3.6%
Social Phobia 2.4% 1.9% 2.9%
Specific Phobia 7.7% 4.9% 10.3%
PTSD 1.9% 0.9% 2.9%
Agoraphobia 0.9% 0.6% 1.1%
Panic Disorder 2.1% 1.6% 2.5%
Alcohol Abuse 4.1% 7.4% 1.0%
Alcohol Dependence 1.1% 1.8% 0.4%
Declining rates
with
Age age
Group
18-24 13.7%
25-34 11.2%
35-49 9.6%
50-64 9.8%
>65 5.8%