Overview of

Mental Health & Disorders

Dr Bhagwat Rajput
MBBS DNB , Psychiatry
World College Of Medical Sciences
Brief View - Outline

 Introduction
 Definitions & common term used
 Epidemiology - Global burden & National
 Etiology
 Models & Approaches
 Classifications – Purpose & Types
 Manifestations of Psychiatric illness
 History & Mental status Examinations
 Diagnosis & Treatments
 Conclusion
 Introduction

Mental health : life long process a sense of harmony &

balance for the individual, family, friends & community

o Health & Mental health

o Psychiatric disorders – Prevalent & often go untreated
o Global & National burden of mental disorders
o Subject of medicine is human being “Biopsychosocial”
o Consideration aspects - Doctor-patient relationship
o Associated stigma – Patients, caregivers & doctors
 Contd…

 Psychiatry : Branch of medicine dealing with

mental disorder & Its treatment
 Psych : soul or mind ; Iatros : healer
 Psychology : Science investigates behaviour,
experience & normal functioning of the mind
 Psychotherapy : Treatment of psychological
issues by non-physical means
 Organic - Identifiable physical pathology

 Functional - Psychological,cause not known

4
Dimensions Of Health
 Mental health – Importance

 Mental health – Good health & quality of life

 Desirable personality
 Emotional & Social development
 Moral & Aesthetic Development
 Seeking goals of life
 Self image & Education
 Sleep , Eating & Physical Health
 Prevention of mental illness
Mental health – Negative impact
“NO HEALTH WITHOUT MENTAL HEALTH”
 Mental Disorder -

 WHO ICD 10 - Clinically recognizable set of

symptoms, associated in most case with distress &
with interference in personal functions. Should
exclude culturally/religious sanctioned response to an
event.
 IndiaPrevalanc- 20-25% , Anxiety: 12-13% ,
Mood: 5.7-7.5%,Psychosis: 0.2-1.3% ,
Substance use: 7.6-9.7%
 Europeans : 28%
Epidemiology

Murray cl,Flaxmon ld ,michaud C et alThe Lancet 2012-380;2063-2066

Global burden
Contd…
 Models - Supernatural & Bio-psychosocial

Supernatural Model
Phenomena such as magnetic fields , the moon or the stars

These agents which might be divinities, demons, spirits

Greece ; MIND = SOUL =PSYCHE & considered

separate from the body
Bio-psychosocial
Mental health care - Multiagency task - multidisciplinary
teams of workers - patient/client and their carers.
Program of treatment and support to meet their needs

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 Etiology

o Diagnose and understand.

o Early intervention. & Optimize treatment.
 According to nature:
a) Biological b) Psychological c) Social
 According to the effect: a. Predisposing b. Precipitating
c. Perpetuating
 Acoording to approch
a. Genetics b. Biochemical studies
c. Endocrinology d. Neuropathology
e. Psychological theories f. Social Science
Contd….
Contd..
Neuro- endo-immuno -crinology:
Contd…
Neuropathology – Structural or physiological

22
Psychological Theories- Learning & Cognitive

Taken from Mash & Wolfe (2005) 23

24
 Predisposing factors

Constitution

Precipitating
factors Illness

Perpetuating
factors

Recovery
Classificatory systems

ICD-10 –
World Health Organization, covers the whole of
medicine
Tenth edition of the - ICD-10

Classification of Mental and Behavioural Disorders.

DSM-IV
American Psychiatric Association

Fourth Edition - (DSMIV)

Multiaxial system

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Categories ICD-10

 F 00-09 Organic disorder

 F 10-19 Psychoactive substance abuse
 F 20-29 Psychotic disorders
 F 30-39 Mood disorders
 F 40-49 Anxiety disorders
 F 50-59 Physiological disorders
 F 60-69 Personality disorders
 F 70-79 Mental retardation
 F 80-89 Developmental Disorders
 F 90-99 Behavioral & Emotional - childhood
Contd…
 Psychiatric Disorders

Organic Non-Organic

Acute Chronic Others Psychoses Neuroses Others

Delirum Dementia Alcohol … Schizophrenia Anxiety disorders Personality dis.

Wernicke’s Korsakoff Head Injury Mood disorders Adjustment dis. Sleep disorder
Manifestation of Mental Disorders
Contd…
Contd…
The Psychiatric History
 Chief complaint & Reason for referral
 History of Present Illness
 Past History
 Medications
 Personal History –
Birth;Childhood;Educational
 Family History – Relationship;Psy illness,
 Social History – Marriage;
Financial;Hobbies
 Premorbid personality & Substance use
 Mental Status Examinations

 General –
Appearance – Age, Eye contact, Dress and grooming,
Motor – Gait , Freedom of movement,
Speech – Rate,Volume & Defects
oEmotion –
Mood - Euthymic,Angry,Euphoric,Dysphoric,
Affect – Appropriateness,Intensity & Reactivity
o Thought contents –
Preoccupations; Obsessions; Phobia & Beliefs
 Contd…

o Cognitive -
Consciousnes , Attention & Orientation
Concentration ,Memory &Intelligence

o Judgments-
The process of Consideration & Formulation
Leading to a Decision & Action

o Insight –
Patient’s capacity to Acknowledge/Appreciate illness
Associated implications & Consequences
 Investigations
To detect alteration, Screen organic & drug

Routine investigations – CBC,KFT,LFT,Elecrtolytes,

Sugar , HIV & ECG
Electrophysiological tests – EEG & Polysomnography
Neuroimaging tests – CT & MRI
Neuroendocrine tests – TRH,TSH, Melatonin &
Prolactine
Genetics tests – Cytogenic work up – MR
Psychological tests – PSE,MMSE,BPRS & SCAN
Treatment of Mental Illness
Contd…
Contd…
 Managements
o Decisive Factors -
1.Nature 2.Duration of symptoms 3.Family history
o Phases to treatment -
1.Initial phase 2. Continuations 3. Maintenance

o Pharmacological
1. Antipsychotics
2. Antidepressants
3. Mood stabilizing agents
4. Anxiolytics and sedatives
5. Anticonvulsants
o Nonpharmacological -
 Imbalance – Neurotransmitter in brains
Synapse
Dopamine

Receptor
Site

Speakin Listening
Brain Cell
g
Brain
Vesicle
Cell

- Dopamine, Serotonin & Norepinephrine

Histamine,GABA & Ach
 Copyright © 1998 Patricia L. Scheifler MSW, PIP
Antipsychotic Medications

Dopamine

Speakin Listening
Brain Cell
g
Brain
Cell
Antipsychotic Medication
Blocks Receptor Site
Psychotropics – Alternative uses
 Nonpharmcological interventions

o Psychotherapies
1.Cognitive behavioral therapy
2.Biofeedback
3.Relaxation techniques
4.Family & Group psychotherapy
 Psychoeducation

 Skills training

 Social, vocational, and educational support

 Occupational therapy
ECT & TMS
Deep brain stimulations
Take Home message