MENTAL HEALTH

DISEASE AND
DISORDERS
Chapter 7
Mental health disease and
disorders
• 1 in 4 adults suffer a diagnosable psychiatric disorder in a given year
• This represents 57.5 million people
• Nearly half of those with mental disorder meet the criteria for a
SECOND disorder
• Suicide accounts for 10 deaths per 100,000 people
• As many and 283,000 inmates have a mental illness
 Mental Status Examination
• Set of observations and impression of the • Perceptions
client obtained during a question-and-answer • Hallucinations
examination. • Though content
• Appearance • Delusions
• Gender, ethnicity, height/weight, hygiene, mannerisms • Thought process
• Speech • Patterns
• Speed, volume, clarity, articulation • Level of consciousness
• Motor activity • Person, place, time
• Ability to move, type of movements • Memory
• Manner and approach • Recall, retention
• Interpersonal characteristics • Level of concentration
• Mood • Able to perform basic functions
• Happy, sad, irritable, anxious, hopeless, etc. • Information and intelligence
• Affect • Educational, intellectual ability
• Emotional presentation (blunted, labile, flat, etc.) • Judgment
• Decision-making
Nature V. Nurture
• New research pointing to the increased importance of biological or
genetic causes of mental illness.
• This evidence does not negate the importance of nurture.
• Traumatic events
• Interaction with family, friends, caregivers,
• Continually influenced by other individuals

Depression
• Description
• 19 million individuals. Feelings of
worthlessness, despair, guilt, hopelessness.
Recurrent episodes.
• 3–5% of males, 8–10% of females
• Dysthymia
• Less severe form, long-term or chronic
symptoms
• Postpartum
• 10% of individuals following childbirth.
Symptoms last weeks to months. Loss of
appetite, lack of joy, insomnia, fatigue, loss of
interest in sex, difficulty bonding with baby,
thoughts of harming self or baby.
• Seasonal Affective disorder
• 5% of population. Symptoms include loss of
energy, excessive sleep, craving sweets and
starchy foods, feelings depressed. Symptoms
increase in fall and winter months.
• Etiology
• Biochemical (serotonin), physical,
psychological, and social causes
• Signs/symptoms
• See above and below.
• Diagnostic Procedures
• Must have 5 of the following for at least two weeks.
• Sad, anxious or depressed mood
• Diminished pleasure in most activities
• Wt. loss, or wt. gain
• Insomnia or excessive sleep
• Agitated or reduced psychomotor activity
• Fatigue, loss of energy
• Guilt, worthlessness, hopelessness
• Decreased concentration
• Thoughts of death or suicide
• Persistent physical symptoms that do not respond to treatment.
• Treatment
• Must determine if patient has suicidal ideation
• Exercise, nutritional counseling, light therapy, herbal
remedies
• Psychotherapy (mild to moderate depression)
• Treat first episode of depression for 6-12 months.
• Cognitive-behavioral therapy (CBT): Focuses on changing
patients’ maladaptive thoughts and behaviors
• Drug therapy
• Prognosis
• Good with proper treatment
• Prevention
• Stress management, avoiding drugs and alcohol, regular
exercise and sleep, improved socialization.

Bipolar Disorder
• Description
• Manic-depressive disorder
• Cycling mood changes form severe highs
(mania) to severe lows (depression)
• Bipolar I disorder: At least 1 manic episode with
or with out pervious episodes of depression
• Bipolar II disorder: At least one episode of
depression and at least one episode of
hypomania (a less aggressive form of mania)
• Etiology
• Unknown. Consider biochemical brain activity,
genetic tendencies, and environmental
influences
• Signs/symptoms
• Alternating pattern of emotional highs (mania)
and lows (depression)
• Depression: insomnia, fatigue, sadness,
hopelessness, anxiety, guilt, loss of interest,
irritability, and suicidal thoughts/behavior
• Mania: overactive, talkative, inflated self-esteem,
aggression, agitation, increased sexual desire,
inability of concentration. Unwise or aggressive
decision-making.
• Diagnostic Procedures
• Look for alternating mania/depression
• Manic episodes are dependent on 1.)
abnormally elevated, expansive, or
irritable mood lasting > 1 week, 2.) Three or
more of the following: inflated self-
esteem, grandiosity, decreased sleep,
talkativeness, racing thoughts,
distractibility, engagement in pleasurable
activities with high risk of harmful
consequences.
• Treatment
• Screen for suicidal, destructive, criminal
thoughts
• Goal: decreased frequency of episodes.
Medication, psychotherapy, and ECT
• Prognosis
• Poor if untreated
• Prevention
• Early treatment prevents unnecessary
complications

Schizophrenia
• Description
• Altered sensory perception with physical and
psychological changes that affect brain
function, behavior, and all five senses.
• Multiple types: Paranoid, disorganized,
catatonic, undifferentiated, residual,
schizoaffective.
• 1% of population M:F 1:1
• Etiology
• Potential theories: Genetic, psychodynamic
neurobiological theory, Diathesis stress theory
• Signs/symptoms
• Two or more, >1 mo
• Psychosis, hallucinations, delusions, disorganized
speech, flat affect, alogia (inability to speak),
attention deficit, and avolition (decreased
motivation)
• Hallmark of psychosis is the inability to
differentiate what comes from within one’s
mind from what comes from without.
• Diagnostic Procedures
• Exam family history, CT, MRE, PET
and/or psychiatric evaluation.
• Treatment
• Antipsychotic medication, counseling,
stress and crisis management.
• Acupuncture, biofeedback, relaxation,
guided imagery , foliate, omega-3
fatty acids.
• Prognosis
• Varies according to treatment success.
• Prevention
• Goal is to prevent significant
progression of the condition.
Prevention is centered on appropriate
treatment.
Anxiety Disorders
• Signs/symptoms
• Description
• Depends on the type. See above
• 40 million adults
• Generalized anxiety (GAD) • Diagnostic Procedures
• Unrealistic worry, > 6 mo
• Collection of the history of illness
• Obsessive-compulsive disorder (OCD)
• Exaggerated fear, repetitive, involuntary and • Treatment
compulsive behavior
• Panic disorder
• Combination of medication,
• Recurrent, intense apprehension, terror, or impending psychotherapy, and cognitive
doom. Greater than 10 minutes of four of the behavioral therapy (CBT)
following:
• Palpations, tachycardia, sweating, trembling, • Deep breathing exercises,
shaking, shortness of breath, chest pain or hypnotherapy, Kava plant
discomfort, nausea, upset stomach, dizziness,
lightheadedness, fear, tingling, chills, hot flash. • Prognosis
• Posttraumatic stress disorder (PTSD)
• Psychological consequences that persist for at least 1
• Good with appropriate treatment
mo after traumatic event
• Prevention
• Phobias
• Persistent and irrational fear. • None.
• Etiology
• Combinations of psychological, biological,
sociopersonal, interpersonal, and environmental
factors
Personality Disorders
• Description
• Diagnostic Procedures
• Pattern of behaviors and experiences that prevent • Deviation in at least two of the following
a person from maintaining healthy relationships • Cognitive
• Pervasive maladaptive personality patterns that
• Affectivity
lead to impaired functioning.
• Etiology • Impulse control
• Neurobiological factors, developmental factors, • Interpersonal functions
sociocultural factors. Possible genetic. • Treatment
• Signs/symptoms
• Moral recognition therapy, dialectical
• Antisocial Personality disorder: 3% of males, 1% females
behavior therapy, medication
• Disregard for rights of others, violating those rights,
lying, seduction and manipulation • Biofeedback, relaxation, guided imagery,
• Borderline personality disorder: acupuncture
• Attention seeking and excessive emotions; Self
destruction, profound mood shifts. Unstable • Prognosis
relationships: Profound love followed quickly by hate
• Depends on severity and success of the
• Narcissistic personality disorder:
treatment plan
• Lack of empathy, need for admiration, and grandiosity
• Avoidant personality disorder: • Prevention
• Pattern of feelings of inadequacy, hypersensitivity to • None
negative criticism, social inhibition.
Substance Abuse and Dependence
• Description
• Addiction: physical and/or psychological
dependence on or need for a potentially
harmful substance
• Tolerance: Increased substance need to
achieve previous affects
• Etiology
• Numerous biological, psychological, and
sociocultural factors may be involved.
• Genetic factors 50–60%
• Signs/symptoms
• Alcohol addiction: Unable to control their
drinking even when it becomes the cause of
serious harm. Medical disorders, marital
difficulties, job loss, traffic accidents, run-ins
with the law.
• Psychoactive drug addiction: needle marks,
scars from skin abscesses, rapid heart rate,
constricted pupil, relaxed or euphoric state.
Hallucinogens, paranoid delusions, blurred
vision, dilated pupils, and tremor.
• Diagnostic Procedures
• CAGE Questionnaire: Have you ever tried to
Cut down? Annoyed by other’s criticism of
your drinking? Felt Guilty about drinking? Do
you have “Eye opener” drinks (drinks first
thing in the morning)?
• Toxicology screens.
• Treatment
• Abstinence, detoxification, rehabilitation,
aftercare. Hospitalization, inpatient treatment
centers, outpatient treatment centers,
support groups.
• Acupuncture, biofeedback, neurofeedback,
herbal medications.
• Prognosis
• Relapse is common, may have a full recovery
with proper treatment.
• Prevention
• Abstinence, support and encouragement for
family and support groups.
Intellectual Disability
• Description • Diagnostic Procedures
• Also called cognitive disability or mental
• Psychological evaluation
retardation. Significantly below-average
intellectual functioning. • Treatment
• Etiology • Team approach to build strengths,
• Exact cause unknown in most cases, possible develop adaptive skills, and improve in
causes include prenatal causes, chromosomal
communication, social, motor, and
abnormalities, and environmental cause.
self-care.
• Signs/symptoms
• Mild intellectual disability: Largest category of • Prognosis
intellectual disability. Sixth grade level of • Depends on degree of disability and
intellect at time of high school graduation. treatment success.
• Moderate intellectual disability: 10%. Second
grade intellect. Difficulty with social and • Prevention
relationship situations, need help with personal • Prenatal screening and genetic
needs and vocational training.
counseling for high-risk families.
• Severe intellectual disability: 3–4% Little to no
communication skills. As adults, live in group
homes or with their families.
• Profound intellectual disability: 1–2%
Neurological disorder accounts for the
intellectual disability. Require a caregiver and
constant supervision.
Autism Spectrum Disorders
• Description
• > 2 million children in the US
• Autism spectrum disorders (ASD) ranges from
severe autism to the more mild for of Asperger
disorder.
• Typically affect children before age 3 and
continue throughout the life span.
• Etiology
• No direct cause. We know there is a genetic
component. Environmental factors, viral
infections, air pollutants, have been connected
to ASD. No connection with vaccines.
• Signs/symptoms
• Usually noted in childhood. Delays in
socialization and communication. Poor eye
contact, inability to play, repetitive behaviors,
seeming hearing impairment, lack of emotional
response, echolalia (mimic word and/or
phrases), inability to regulate emotions,
precocious language, sensory problems,
learning disabilities, intellectual disabilities,
and/or seizures.
• Diagnostic Procedures
• Screening by parents, family, teachers,
and primary care provider. Diagnosis
made by a comprehensive diagnostic
evaluation by a multidisciplinary team of a
psychologist, neurologist, psychiatrist,
speech therapist, and other professionals.
• Treatment
• Educational programs, behavioral
therapies, social and communication
therapies. Medication for some
circumstances. Begin treatment as early
as possible.
• Gluten-free diet, sensory or creative
therapies, music or art therapy.
• Prognosis
• No cure. Early diagnosis and prompt
treatment is the key.
• Prevention
• None
Neuro-immune Dysfunction Syndrome
• Description
• A set of related disorders characterized
by complex interactions between the
nervous system and the immune
system. Such diseases include autism,
attention-deficit hyperactivity
disorder, pervasive developmental
disorder, chronic fatigue syndrome
and other related conditions.
• Etiology
• No single cause for NIDS has been
identified. It appears that genetic
predisposition can play a role, as can
environmental factors including
viruses, illnesses, and prenatal or
neonatal stress.
• The dysregulated immune system can
reduce blood flow to certain areas of the
brain including the temporal lobes, impairing
auditory processing, language, and social
skills. This can produce autistic symptoms.
• Symptoms
Cognitive impairment Language delay
Developmental regression
Inappropriate behaviors
Fine and gross motor abnormalities
Poor muscle tone Fatigue Inability to focus
Low grade fever Frequent ear infections
Food sensitivities Poor eye contact
Obsessive compulsive disorders
• Diagnostic Procedures
• NeuroSPECT imaging measures blood flow
within the brain
 Attention Deficit-Hyperactivity Disorder (ADHD)
• Description • Diagnostic Procedures
• Most common neurobiological disorder • History and physical examination. Ability
in children. tests, achievement test, and a collection of
• Patients show inattentive, impulsive, observation so those closest to the patient.
and hyperactive behavior ah have • Treatment
difficulty with gratification. • Medication, behavior management, social
• Etiology skills development, cognitive therapy.
• Lead poisoning, genetic factors, • Art therapy, children’s games, storytelling,
socioeconomic factors, prenatal and counseling.
perinatal complications all have been • Restrict high sugar foods, avoid food
linked to ADHD. allergies, yoga, exercise.
• Signs/symptoms • Prognosis
• Distractibility, impulsivity, hyperactivity. • The key is early diagnosis and prompt
Symptoms must be excessive, long- treatment. The patient are able to live
term, and occur before age 7, and productive lives with appropriate treatment.
continue > 6 mo. Symptoms must be • Prevention
seen in two to the following areas;
• None
School, home, and social settings.
Anorexia Nervosa
• Description
• Self-imposed starvation and an irrational
fear of gaining weight. 5–10% of the
population around the age of puberty.
F>M, middle class, white.
• Two Types:
• Restrictive: primarily caloric intake, excessive
exercise
• Purging: Use vomiting or laxatives
• Etiology
• Mental health disorder. Influenced by
attitudes in society.
• Signs/symptoms
• Aggressive wt. loss, amenorrhea, alteration
of body image. Loss of >25% of body weight.
Food avoidance, vomiting, excessive
exercise. May see depression and substance
abuse.
• Watch for suicidal ideation
• Diagnostic Procedures
• Interpretation of clinical data.
• Failure to maintain normal body weight (BMI <17.5),
terrified of gaining weight, dysmorphia (seeing
themselves as obese when not), amenorrhea
• Treatment
• Multidisciplinary approach.
• Aggressive medical management, counseling, and
coaching, and individual and family psychotherapy.
Hospitalization may be needed.
• Target: ½-1 lb weight gain per week.
• Hypnotherapy, zinc supplement, well-balanced diet
high in fiber.
• Prognosis
• Varies, depending on the patients willingness to
comply with the treatment program.
• Prevention
• Development of self-esteem, family support,
nutritional education, medical support, positive and
healthy routines.
Bulimia Nervosa
• Description • Diagnostic Procedures
• Repetitive gorging with food followed by self-
• Physical exam, psychological exams,
induced vomiting. May include laxative abuse,
use of diuretics, fasting. lab test including serum electrolytes.
• Behavior occurring twice weekly for three • Treatment
months.
• Similar to anorexia nervosa. Long-
• Fear of being “fat”
term psychotherapy. Nutritional
• Etiology therapy, coaching, and education.
• Psychosocial factors, family conflict, sexual Interrupting the binge–purge cycle
abuse, cultural overemphasis on physical
and helping the client regain control.
appearance.
• Signs/symptoms • Prognosis
• Normal weight or slightly overweight on • Depends on the motivation of the
diagnosis. High sugar, or junk food diet, dental patient to change.
decay, reflux of gastric secretions, sore throat,
menstrual irregularities. Prone to depression, • Prevention
low tolerance for frustration, anxiety, self- • Avoid predisposing factors.
consciousness, and difficulty expressing
feelings.
Dyspareunia
• Description • Diagnostic Procedures
• Sexual pain disorder. Pain associated with • Collection of thorough sexual history,
sexual intercourse. Occurs in men or women
during, before, or after sexual intercourse.
physical exam, diagnostic test to
detect an underlying anatomical or
• Etiology
pathological causes of the pain.
• Cause may be anatomic or physiologic. May
include lesions of the vagina, retroversion of • Treatment
the uterus, urinary tract infection, lack of • Use of creams, water-soluble
lubrication, scar tissue, or abnormal growths.
lubrication, hygiene, excision of scars,
• May be caused by psychosomatic issues
vaginal stretching, education about
including fear of pain or injury, feelings of
guilt or shame, ignorance of sexual anatomy sexual response and counseling.
and physiology, and fear of pregnancy. • Prognosis
• Signs/symptoms • Good with adequate treatment
• Patient must experience persistent genital
pain that causes interpersonal difficulty and • Prevention
marked distress. May experience mild to • Prompt treatment of the cause.
severe discomfort before, during, or after
intercourse.
 Male Erectile Disorder
• Description
• Inability of the male to achieve or sustain
an erection sufficient to complete sexual
intercourse.
• Etiology
• Psychological (50–60%)or physiological.
• Anxiety, depression, feelings of
inadequacy, and rejection.
• Drug and alcohol abuse, diabetes, surgical
complication, spinal cord or disk injuries,
neurological, endocrine, or urologic
disorders. Age.
• Signs/symptoms
• Inability to achieve and sustain an erection.
Must result in an inability to perform sexual
intercourse 25% of the time.
• Diagnostic Procedures
• Sexual history, physical exam.
Ultrasound, neurological examination.
• Treatment
• Correct the underlying cause.
Counseling, psychotherapy,
medication treatment (Viagra, Cialis,
Levitra), surgical implantation of
penile prosthesis.
• Prognosis
• Variable, depending severity and
response to therapy
• Prevention
• Prompt identification of underlying
causes and treatment.
Female Sexual Arousal Disorder
• Description
• Inability to achieve orgasm. Lack of
desire and arousal.
• Etiology
• Physiological or psychological
• Nerve damage, diabetes mellitus,
multiple sclerosis. Drug reactions, pelvic
infections, vascular disease
• Anxiety, depression, stress, fatigue,
sexual misinformation, inadequate or
ineffective stimulation, traumatic sexual
experiences.
• Signs/symptoms
• Loss of sexual desire, slow sexual
arousal, lack of vaginal lubrication,
inability to achieve orgasm.
• Diagnostic Procedures
• Collection of sexual history. Look for
physiological as well as psychological
sources.
• Treatment
• Correcting the underlying cause.
• Short-term psychotherapy or behavior
modification.
• Prognosis
• Good with prompt treatment
• Prevention
• Early identification and treatment and
Premature Ejaculation
• Description
• Persistent or recurrent onset of
orgasm and expulsion of seminal fluid
before complete erection of the penis.
• Etiology
• Psychological factors include anxiety
or guilt, negative sexual relationships.
• Degenerative neurologic disorders,
urethritis, or prostatitis
• Signs/symptoms
• Ejaculation during foreplay, before
complete erection of the penis.
• Diagnostic Procedures
• Complete sexual history, physical
exam, laboratory tests.
• Treatment
• Sexual therapy including both
partners
• Prognosis
• Excellent with proper response to
treatment
• Prevention
• Avoid the predisposing factors.