Mental illness

From Wikipedia, the free encyclopedia

A mental illness or mental disorder, as defined in psychiatry and other mental health professions, is a mental health condition assessed as abnormal or maladaptive and involving significant distress or disability. This can involve cognitive, emotional, behavioral and interpersonal difficulties.

The definition, assessment and classification of mental disorders varies cross-culturally although guideline criteria listed in the ICD or DSM are widely used. Categories of diagnoses in these schemes include mood disorders, anxiety disorders, schizophrenia, eating disorders, and personality disorders.

Alternative terms for mental disorder may include psychological or psychiatric disorder or syndrome, emotional problems, mental health problems, emotional or psychosocial disability, madness, or insanity. Mental illnesses are generally considered to be different from learning disorders and developmental disabilities.

Findings and theories about the causes of mental disorders are debated although there are generally accepted links to genetics, brain structure, neurochemistry and neurofunction, drugs, cognitive biases, emotional problems, trauma, relationships, socioeconomic disadvantage and other psychosocial factors, and cultural issues.

Treatments for mental illness vary, and may include psychoactive medication, psychotherapy and psychosocial interventions. Services may be based in hospitals, clinics or the community. Different clinical and academic professions, including psychiatry, clinical psychology and social work, tend to use differing models, explanations and goals.^[1]

Contents 1 Classification 2 Signs and symptoms 3 Causes 3.1 Neurological 3.1.1 Brain anatomy 3.1.2 Genetics 3.1.3 Bodily or infectious causes 3.2 Psychological 3.2.1 Early development 3.2.2 Personality 3.3 Anthropological 4 Pathophysiology 5 Diagnosis 6 Treatment 7 Prognosis 8 Epidemiology 9 History 10 External factors 10.1 Laws and policies 10.2 Media coverage and cultural references 10.3 Stigma and discrimination 10.4 Movements 10.5 Controversy 11 See also 12 References 12.1 Further reading 12.2 Notes 12.3 External links 12.3.1 Government sites 12.3.2 History and professional specialties 12.3.3 Compiled mental health news and resources

[edit] Classification

Mental disorders are commonly classified via a categorical scheme sometimes termed "neo-Kraepelinian" (after the psychiatrist Kraepelin)^[2] which is intended to be atheoretical with regard to etiology (causation). An individual can be diagnosed if they simply meet a certain minimum number of a mixed set of signs and symptoms (known as "Feigner criteria"), which nearly always include a criterion of clinically significant distress or dysfunction. These diagnostic schemes have been officially codified in the World Health Organization's International Classification of Diseases (currently ICD-10) and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (currently DSM-IV-TR^[3]) as well as other manuals such as the Chinese Society of Psychiatry's Chinese Classification of Mental Disorders (currently CCMD-3).

There are thirteen different groupings in the DSM-IV-TR, some containing a myriad of conditions and others only a few:

DSM Group	Examples	Wikipedia category
Disorders usually first diagnosed in infancy, childhood or adolescence. *Disorders such as autism and epilepsy have also been referred to as developmental disorders and developmental disabilities.	Mental retardation, autism	Category:Childhood psychiatric disorders
Delirium, dementia, and amnesia and other cognitive disorders	Alzheimer's disease	Category:Memory disorders and Category:Cognitive disorders
Mental disorders due to a general medical condition	AIDS-related psychosis	Category:Mental health conditions due to a general medical condition
Substance-related disorders	Alcohol abuse	Category:Substance-related disorders
Schizophrenia and other psychotic disorders	Delusional disorder	Category:Psychosis
Mood disorders	Clinical depression, Bipolar disorder	Category:Mood disorders
Anxiety disorders	General anxiety disorder	Category:Anxiety disorders
Somatoform disorders	Somatization disorder	Category:Somatoform disorders
Factitious disorders	Munchausen syndrome	Category:Factitious disorders
Dissociative disorders	Dissociative identity disorder	Category:Dissociative disorders
Sexual and gender identity disorders	Dyspareunia, Gender identity disorder	Category:Sexual and gender identity disorders
Eating disorders	Anorexia nervosa, Bulimia nervosa	Category:Eating disorders
Sleep disorders	Insomnia	Category:Sleep disorders
Impulse-control disorders not elsewhere classified	Kleptomania	Category:Impulse-control disorder not elsewhere classified
Adjustment disorders	Adjustment disorder	Category:Adjustment disorders
Personality disorders	Narcissistic personality disorder	Category:Personality disorders
Other conditions that may be a focus of clinical attention	Tardive dyskinesia, Child abuse	Category:Other conditions that may be a focus of clinical attention

These classification schemes have achieved some widespread acceptance in psychiatry and other fields, although their routine clinical usage is less clear. Issues of validity and utility are criticized and challenged both scientifically^[4] and in terms of social, economic and political controversies, including over the inclusion of certain categories (notably of homosexuality in some form, although it is no longer included as a distinct disorder in the ICD or DSM), the influence of the pharmaceutical industry,^[5] or the stigmatizing effect of being categorized or labelled. There is ongoing debate about the definition of mental illness and the role of science and value judgements.^[6]

Other classification schemes are not based on categories with cut-offs separating the ill from the healthy or the abnormal from the normal (sometimes termed "threshold psychiatry"). Classification may instead be based on broader underlying "spectra", where a spectrum may link together a range of other categorical diagnoses and nonthreshold symptomology in the general population^[7] Or a scheme may be based on a set of continuously-varying dimensions, with each individual having a different profile of low or high scores across the different dimensions.^[8] Another approach may be based directly on the specific complaints reported by an individual.^[9] DSM-V planning committees are currently establishing the research base to move towards a dimensional classification of some disorders, including personality disorder^[10]

What is considered abnormal behavior in one culture, may be considered normal in another. An example of this is Ghost Sickness a preoccupation with death or the deceased in certain Native American cultures.

[edit] Signs and symptoms

Symptoms of mental illness vary greatly between the illness or disorder manifesting itself and may include mild to chronic forms of depression or sadness, loss of cognitive abilities, hallucinations or delusions.

Despite exaggerated portrayals and perceptions of risk, mental disorders do not generally lead to violence, with the major determinants of violence still being socio-demographic and socio-economic factors such as being young, male, and of lower socio-economic status, and substance abuse; in addition the nature of the social interactions leading up to violence acts are often crucial and it is in general far more likely that people with a serious mental illness will be the victim than the perpetrator of violence.^[11] Higher rates of offending after hospital discharge have been found to bes statistically related to the relatively poor and violent neighbourhoods in which ex-patients resided, and to substance misuse.^[12] Violence by or against individuals with mental illness typically occurs in the context of complex social interactions (including in atmosphere of mutually high "expressed emotion") within a family setting,^[13] as well as being an issue in healthcare settings^[14] and the wider community.^[15]

[edit] Causes

Main article: Causes of psychiatric disorder

There have been many theories about the causes of mental disorders. Many psychiatric disorders can actually be classified as syndromes - consistent groups of symptoms that do not have a known or consistent cause. Different disorders are likely to have their own etiology (pattern of causation). A common view is that disorders tend to result from genetic vulnerabilities and environmental stressors combining to cause patterns of dysfunction and suffering (Diathesis-stress model). An "integrative" or biopsychosocial approach is also widely held, whereby genetics, neurodevelopment, psychology, and social factors are all seen as important factors.

[edit] Neurological

A mental health condition may be caused by abnormalities in neurochemistry.^{[citation needed]} There has been a focus on the role of dopamine, norepinephrine, and serotonin systems.

[edit] Brain anatomy

A mental health condition may be due to an abnormality in brain structure^{[citation needed]} Many people diagnosed with schizophrenia have been shown to have enlarged ventricles and reduced grey matter in the brain. On the other hand, many people with schizophrenia have been shown to have perfectly normal vertricles and grey matter. Furthermore, many people with enlarged ventricles and reduced grey matter do not have schizophrenia.^{[citation needed]}

[edit] Genetics

Many studies looking for genetic roots to mental illness, have found statistical links showing that certain mental illnesses seem to run in families. Genetic studies, including adopted twin studies, have shown strong evidence that mental health conditions such as bipolar disorder and schizophrenia can be partially inherited.^{[citation needed]} Some controversy exists^{[citation needed]} over whether this is due to genetics, or simply from being raised by or with someone who is mentally ill, but evidence from studies examining siblings, especially twins, who were raised separately, seems to indicate strong genetic factors.^{[citation needed]} However, such findings are not always replicated.^{[citation needed]}

People with developmental disabilities, such as mental retardation, are more likely to experience mental illness than those in the general community.^[16]

[edit] Bodily or infectious causes

Physical causes of psychiatric illness can include major brain trauma, accidental head injury, metabolic or infectious disturbances of the brain, and drug use, such as alcohol and narcotics. In addition, certain kinds of toxic substances, such as heavy metals, can induce psychiatric disorders.^{[citation needed]} Many illnesses that are not usually classified as mental illnesses can have psychiatric side effects, for example depression associated with strokes or AIDS-related psychosis. There are psychiatric problems that are related to heavy exposure to chemical causes, such as amphetamine psychosis.

A number of psychiatric disorders of unknown etiology have often been tentatively linked with microbial pathogens, particularly viruses; however while there have been some suggestions of links from animal studies, infectious disease models in psychiatry have not yet shown significant promise except in isolated cases.^[17]

[edit] Psychological

Neurocognitive, psychological, and psychosocial findings indicate that cognitive abnormalities, emotional problems or interpersonal problems can cause mental health conditions.^{[citation needed]}

[edit] Early development

Early environmental causes such as stress or upbringing have been implicated in the cause of mental illness.^{[citation needed]}

[edit] Personality

Studies have shown characteristic personality traits in schizophrenia patients 1-2 years before a psychosis but "predisposing" traits are not seen when you look at personality earlier, say 3 - 4 years before first psychosis.^{[citation needed]}

[edit] Anthropological

Social influences, including socioeconomic disadvantage, can cause mental disorders^{[citation needed]}. Cultural factors can also cause mental disorder^{[citation needed]}

[edit] Pathophysiology

No matter the specific underlying cause of mental illness, typically some type of abnormality can be detected in the cognitive processing of the brain which may be evident in certain types of brain scans.^[18]

[edit] Diagnosis

The diagnosis of mental illness can be performed by a licensed mental health professional such as a psychiatrist or clinical psychologist. Resources such as neuroimaging and the Diagnostic and Statistical Manual of Mental Disorders have helped to standardize the detection and criteria of mental illness.^[19]

In routine clinical practice diagnosis is typically made via a relatively brief interview or examination of existing casenotes, but may be made by considering a number of sources and instruments including behavior evaluation, a symptom inventory, condition-specific standardized questionnaires such as the Beck Depression Inventory, or physical examinations.^{[citation needed]}

[edit] Treatment

The major treatment options for mental disorders are psychiatric medication (notably antidepressants, anxiolytics and antipsychotics) and psychotherapy (notably cognitive behavioral therapy and variants, psychodynamic approaches, and systemic/psychosocial interventions). There are also physical treatments used for some disorders, notably ECT. Lifestyle adjustments and supportive measures may also be used. Many things have been found to help at least some people, including listening to music^[20]

Often an individual may engage in different treatment modalities and use various mental health services. These may be under case management (sometimes referred to as "service coordination"), use inpatient or day treatment, utilize a psychosocial rehabilitation program, and/or take part in an Assertive Community Treatment program to help move towards a more productive and independent role in the community.

People with mental health conditions typically seek treatment only when psychiatric symptoms make it very difficult to function, but early treatment - when symptoms are mild or moderate - will generally lead to a better long-term outcome.^{[citation needed]}

[edit] Prognosis

The course of disorders varies, and many can be either mild or severe or anything in between. Symptoms can vary over time, including from severe to complete remission and back. Relapses may be triggered by stress and other factors. With chronic mental health conditions, the chances of the symptoms recurring will be affected by a number of factors. While one in four Americans lives with a mental disorder in any given year, half of people with severe symptoms of a mental health condition received no treatment in the past 12 months.^[21] Fear of disclosure, rejection by friends, and ultimately discrimination are just a few reasons why people with mental health conditions don't seek help.^{[citation needed]}

[edit] Epidemiology

According to the 2003 report of the U.S. President's New Freedom Commission on Mental Health, major mental illness, including clinical depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder, when compared with all other diseases (such as cancer and heart disease), is the most common cause of disability in the United States. Additionally, according to National Alliance for the Mentally Ill (NAMI), 26.2% of North American adults will suffer from a clinically diagnosable mental health condition in a given year, but less than half of them will suffer symptoms severe enough to disrupt their daily functioning (NIMH website). Approximately 9% to 13% of children under the age of 18 experience serious emotional disturbance with substantial functional impairment; 5% to 9% have serious emotional disturbance with extreme functional impairment due to a mental health condition. It is suggested that many of these young people will recover from their conditions before reaching adulthood, and go on to lead normal lives uncomplicated by illness.

[edit] History

Main article: History of mental illness

Many mental disturbances such as melancholy, hysteria and phobia were described in Ancient Greece and Rome, although a systematic review of ancient writings did not find any descriptions matching the current diagnosis of schizophrenia.^[22] Mass delusions and frenzies were recorded in medieval times, and some cases of alleged witchcraft or spiritual or demonic possession came to be attributed to mental illness. Conditions of "shell shock" were recognized in war veterans.

At the start of the 20th century there were only a dozen recognized mental health conditions. By 1952 there were 192 and the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) today lists 374.

[edit] External factors

[edit] Laws and policies

In many countries, individuals diagnosed with mental disorders can be involuntarily detained and treated, if assessed as being non-competent and a risk to themselves or others.

There is also legislation to protect the rights of those seen as having a mental disorder or disability.

[edit] Media coverage and cultural references

See also Mental illness in art and literature.

General media coverage of mental illness has been reported to focus on negative depictions, for example of dangerousness to others and criminality, with less coverage on positive depictions such as human rights themes, leadership or educational accomplishments.^[23][24]

[edit] Stigma and discrimination

The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill.^[25] Employment discrimination plays a part in the high rate of unemployment among those with a diagnosis of mental illness^[26] Schemes to combat stigma have been prioritized by global and national psychiatric organizations but their methods and outcomes have been criticized as counterproductive^[27]

[edit] Movements

Patient advocacy organizations and the consumer/survivor movement have been helpful in changing the stereotypes and stigma associated with psychiatric conditions. Strengths can be seen, as well as weaknesses. Those with symptoms can be encouraged to seek help and treatment and to have hope to continue on the path toward recovery, wellness and a fulfilling and meaningful life.

[edit] Controversy

Until 1989 homosexuality was considered a mental disorder in American psychiatry (see DSM-III). It has been argued that what psychiatry formally considered a disorder or illness was the result of cultural norms or bias and this perception varies over time and place.

Some question whether the concept of 'mental illness' is coherent or appropriate or is used validly in practice. This can include professionals, and this view is often held by some of the anti-psychiatry movement. Some professionals, notably Thomas Szasz, Professor Emeritus of Psychiatry at Syracuse, are profoundly opposed to the practice of applying the label "mental illness." The anti-psychiatry movement often refers to what it considers to be the "myth of mental illness" and some argue against a biological origin for mental health conditions, pointing out that the differences in levels of neurotransmitter, or even in size of brain structures, cannot be taken as indications of illness. Alternatively, some argue that all human experience has a biological origin and so no pattern of behavior can be classified as an illness per se.

There are other branches of the "anti-psychiatry" movement who claim, however, that psychiatry is not biological enough, arguing that symptoms considered diagnostic of severe mental health symptoms, such as hallucinations, delusions and severe depression, are actually commonly seen in physical illnesses that interfere with brain function (see Delirium).

The link between mental and physical illnesses can be controversial, with high rates of physical illnesses such as diabetes, cardiovascular problems and infectious diseases in the severely mentally ill.

Approaches associated with antipsychiatry, the consumer/survivor movement or with family/community members are also advanced. There may be an emphasis on treatment and management and/or on challenging stigma and social exclusion and achieving recovery^[28]

[edit] See also

• Causes of mental health conditions
• Psychopathology
• The Gene Illusion
• Szasz

[edit] References

[edit] Further reading

• Hockenbury, Don and Sandy (2004). Discovering Psychology. Worth Publishers. ISBN 0-7167-5704-4. 
• Roy Porter, Madness. A Brief History, Oxford University Press 2003
• Neurodiversity.com [1]
• Wiencke, Markus (2006) Schizophrenie als Ergebnis von Wechselwirkungen: Georg Simmels Individualitätskonzept in der Klinischen Psychologie. In David Kim (ed.), Georg Simmel in Translation: Interdisciplinary Border-Crossings in Culture and Modernity (pp. 123-155). Cambridge Scholars Press, Cambridge, ISBN 1-84718-060-5
• Dysfunction section of the Neuroscience Book

[edit] Notes

[edit] External links

[edit] Government sites

• MentalHealthCommission.gov - 'Interim Report of the President's New Freedom Commission on Mental Health' (United States)
• NIMH.NIH.gov - 'Working to improve mental health through biomedical research on mind, brain, and behavior', National Institute of Mental Health (United States)
• NIMHE.org.uk - 'Responsible for supporting the implementation of positive change in mental health and mental health services', National Institute for Mental Health (United Kingdom)
• kc.NIMHE.org.uk - 'Joined up knowledge sharing for mental health service improvement', NIMH (UK)

[edit] History and professional specialties

• OhioU.edu - 'The History of Mental Illness' Ohio University, The Ridges
• Plato.stanford.edu - 'Mental Illness', Stanford Encyclopedia of Philosophy

[edit] Compiled mental health news and resources

• NAMI.org - 'In The News', National Alliance for the Mentally Ill (NAMI California)
• SeeMeScotland.org - Scottish mental health awareness campaign
• The Canadian Mental Health Association
• National Mental Health Consumers' Self-Help Clearinghouse
• National Mental Health Association
• BasicNeeds International Mental Health charity, which shows the international dimension of mental health provision

Mental disorders (alphabetical list)

Edit

Acute stress disorder | Adjustment disorder | Agoraphobia | alcohol and substance abuse | alcohol and substance dependence | Amnesia | Amphetamine Related Disorder | Anxiety disorder | Anorexia nervosa | Antisocial personality disorder | Asperger's syndrome | Attention deficit/hyperactivity disorder | Autism | Avoidant personality disorder | Bereavement | Bibliomania | Binge eating disorder | Bipolar disorder | Body dysmorphic disorder | Borderline personality disorder | Breathing Related Sleep Disorder | Brief psychotic disorder | Bulimia nervosa | Caffine Related Disorder | Cannabis Related Disorder | Childhood disintegrative disorder | Childhood disorder NOS | Circadian rhythm sleep disorder | Cocaine Related Disorders | Conduct disorder | Conversion disorder | Cyclothymia | Delirium | Delusional disorder | Dementia | Dependent personality disorder | Depersonalization disorder | Depression | Disorder of written expression | Dissociative fugue | Dissociative identity disorder | Down syndrome | Drapetomania | Dyspareunia | Dysthymic disorder | Emotional Deprivation | Encopresis | Enuresis | Exhibitionism | Expressive language disorder | Factitious Disorder | Female and male orgasmic disorders | Female sexual arousal disorder | Fetishism | Folie à deux | Frotteurism | Ganser syndrome | Gender identity disorder | Generalized anxiety disorder | General adaptation syndrome | Hallucinogen Related Disorder | Histrionic personality disorder | Hyperactivity disorder | Primary hypersomnia | Hypoactive sexual desire disorder | Hypochondriasis | Hyperkinetic syndrome | Hysteria | Inhalant Related Disorders | Intermittent explosive disorder | Joubert syndrome | Kleptomania | Mania | Male erectile disorder | Munchausen syndrome | Mathematics disorder | Narcissistic personality disorder | Narcolepsy | Nightmares | Obsessive-compulsive disorder | Obsessive-compulsive personality disorder | Oneirophrenia | Oppositional defiant disorder | Pain disorder | Panic attacks | Panic disorder | Paraphilias | Paranoid personality disorder | Parasomnia | Pathological gambling | Pervasive Developmental Disorder | Pica | Postpartum Depression | Post-traumatic stress disorder | Premature ejaculation | Primary insomnia | Psychotic disorder | Pyromania | Reading disorder | Retts disorder | Rumination disorder | Schizoaffective disorder | Schizoid | Schizophrenia | Schizophreniform disorder | Schizotypal personality disorder | Seasonal affective disorder | Separation anxiety disorder | Sexual Masochism and Sadism | Shared psychotic disorder | Sleep disorder | Sleep terror disorder | Sleepwalking disorder | Social phobia | Somatization disorder | Specific phobias | Stereotypic movement disorder | Stuttering | Suicide | Tourette syndrome | Transient tic disorder | Transvestic Fetishism | Trichotillomania | Vaginismus