Mental Disorders

Classification of Mental Disorders

Contents

• Mood Disorder

• Major Depressive Episode

• Manic Episode

• Hypomanic and Mixed Episodes

• Anxiety Disorders

• Panic Attack

• Types of Anxiety Disorders

• Post-traumatic stress disorder (PTSD)

• Personality Disorders

• AOD and Personality Disorders

• Antisocial Personality Disorder

• Borderline Personality Disorder

• Psychotic Disorders

• Delusions

• Hallucinations

• Symptoms of Psychosis

• Schizophrenia

• Positive Symptoms of Schizophrenia

• Negative Symptoms of Schizophrenia

• Substance-Induced Disorders

• Substance-Induced Psychosis

• Delirium

Introduction

• Individual is not functioning adequately based on either his/her standards or according to significant others in the person’s life.

• Diagnosis of disorder depends of intensity, length of time and how much it’s impacting on the person.

Mood disorders

Anxiety disorders

Personality disorders

Psychotic disorders

Substance-induced disorders

Mood Disorders

• Major depressive episodes

• Manic episodes

• Mixed episodes

• Hypomanic episodes.

Major Depressive Episode

Some symptoms experienced nearly every day for at least 2 weeks:

• Depressed mood or loss of interest or enjoyment in activities

• Reduced interest or pleasure in almost all activities

• Change in weight or appetite

• Difficulty concentrating or sleeping (i.e., sleeping too much or too little)

• Restlessness and agitation

• Slowing down of activity

• Fatigue or reduced energy levels

• Feelings of worthlessness or excessive/inappropriate guilt

• Recurrent thoughts of death, suicidal thoughts, attempts or plans

Manic Episode

Person experiences abnormally elevated, expansive, or irritable mood for at least 1 week characterised by:

• Inflated self-esteem

• Decreased need for sleep

• Increased talkativeness or racing thoughts

• Distractibility

• Agitation or increase in goal directed activity (e.g., at work or socially)

• Excessive involvement in pleasurable activities that have a high potential for negative consequences.

Hypomanic and Mixed Episodes

• Hypomanic same as manic episode but is less severe

• May only last 4 days and does not require the episode to be severe enough to cause impairment in social or occupational functioning

• In mixed episode, person experiences both a manic episode and major depressive episode for at least 1 week

Anxiety Disorders

• Many people feel anxious because they have reason to eg: trouble with law, homelessness

• Many in AOD treatment will experience anxiety as consequence of intoxication, withdrawal, or living without using AOD

• Usually reduces over time with period of abstinence

• Problematic when persistent, or so frequent and intense that prevents person from living his/her life in the way that he/she would like

Panic Attack

• Sweating

• Shaking

• Shortness of breath

• Feeling of choking

• Light headedness

• Heart palpitations, chest pain or tightness

• Numbness or tingling sensations

• Chills or hot flushes

• Nausea and/or vomiting

• Fear of losing control, going crazy or dying

• Feelings of unreality or being detached from oneself

Types of Anxiety Disorders

• Generalised anxiety disorder (GAD)

• Obsessive compulsive disorder (OCD)

• Panic disorder

• Agoraphobia

• Social phobia

• Specific phobia

• Post-traumatic stress disorder (PTSD)

• Acute stress disorder.

Post-Traumatic Stress Disorder (PTSD)

• Can develop after traumatic event

• May experience some of following:

• Intrusions: re-experiencing event as nightmares, or “flashbacks”

• Avoidance: avoiding thoughts, feelings, people, places or activities that remind him/her of the event,

• Hyperarousal: increased startle response, irritability or anger, difficulty sleeping and concentrating

Personality Disorders

• Enduring destructive patterns of thinking, feeling, behaving, and relating to other people across wide range of social and personal situations

• Maladaptive traits are stable and long lasting

• Tend to develop in adolescence or early adulthood and are generally lifelong

• Most common in AOD context ASPD and BPD

AOD and Personality Disorders

• AOD use disorders may cause fluctuating symptoms that mimic symptoms of personality disorders

• Eg: impulsivity, aggressiveness, self-destructiveness, relationship problems, work dysfunction, engaging in illegal activity,  dysregulated emotions and behaviour

• Can be difficult to determine whether a person has a personality disorder

Antisocial Personality Disorder

• Failure to conform to social norms with respect to lawful behaviour

• Disregard for the wishes, rights and feelings of others

• Deceptive and manipulative in order to gain personal profit or pleasure; may repeatedly lie or con others

• Reckless disregard for own or other’s safety

• Impulsive behaviour; decisions made on spur of the moment, without forethought, and without consideration of the consequences for self or others

• May lead to sudden change of jobs, residences or relationships

• Irritability and aggression; repeated involvement in physical fights or assaults

• Consistent and extreme irresponsibility

Borderline Personality Disorder

• Persistent patterns of instability in relationships, mood, and self-image

• Marked impulsivity, particularly in relation to behaviours that are self-damaging

• Extreme efforts to avoid rejection or abandonment

• Pattern of unstable and intense relationships

• Unstable self-image or sense of self

• Impulsivity

• Recurrent suicidal behaviour, threats or self-mutilating behaviour

• Unstable mood

• Chronic feelings of emptiness

• Inappropriate, intense anger

• Stress-related paranoid thoughts or severe dissociative symptoms

Psychotic Disorders

• Loss of touch with reality

• Feelings, thoughts and perceptions severely altered

• Delusions and Hallucinations

• May be due to intoxication or withdrawal from substances

• If the person experiences psychotic episodes when not intoxicated or withdrawing, possible they may have one of the disorders described

Delusions

• Fixed, false beliefs not consistent with cultural context

• Involve a misinterpretation of perceptions or experiences

• Eg: feel that someone is out to get them, they have special powers, or passages from newspaper have special meaning for them

Hallucinations

• Disturbance of sensory perceptions

• Auditory (hearing voices or sounds)

• Visual (seeing things not present)

• Olfactory (smelling things not present)

• Tactile (feeling or sensing something)

• Gustatory (taste)

Other Symptoms of Psychosis

• Disorganised speech

• Grossly disorganised behaviour

• Catatonic behaviour (eg decreased reactivity)

• Affect flattening (reduced range of emotional expressiveness)

• Alogia (restricted thought and speech)

• Avolition (reduced involvement with activities)

Schizophrenia

• Most common and disabling of psychotic disorders

• Affects ability to think, feel and act

• To be diagnosed symptoms must have been continuing for a period of at least 6 months

• Symptoms are grouped within 2 types:

1. Positive symptoms

2. Negative symptoms

Positive Symptoms of Schizophrenia

• Not as in pleasurable!

• Presence of excess or distortion of normal functioning and include hallucinations, delusions, disorganised speech, grossly disorganised behaviour and catatonia

Negative Symptoms of Schizophrenia

• Absence of normal functioning including affective flattening, avolition, alogia

• Can cause significant impairment in a person’s functioning

• Classification of “types” of schizophrenia depending upon the predominance of symptoms displayed (paranoid, disorganised, catatonic, undifferentiated, residual type)

Other Psychotic Disorders

• Schizophreniform disorder: equivalent to schizophrenia except its duration limited to less than 6 months

• Schizoaffective disorder: symptoms of schizophrenia alongside major depressive, manic or mixed episode

• 2 types: i) bipolar type (if manic or mixed); ii) depressive type (if major depressive)

Substance-Induced Disorders

• Occur as direct consequence of AOD intoxication or withdrawal

• Diagnosis requires symptoms only present following intoxication or withdrawal

• If symptoms in absence of intoxication or withdrawal, possible they have independent mental health disorder

• Symptoms tend to reduce over time with period of abstinence

Examples of Substance Induced Disorders

• Alcohol use/withdrawal - symptoms of depression or anxiety

• Manic symptoms induced by intoxication with stimulants, steroids, hallucinogens

• Psychotic symptoms induced by withdrawal from alcohol, intoxication with amphetamines, cocaine, cannabis, LSD or PCP

• Other disorders - substance-induced delirium, amnestic disorder, dementia, sexual dysfunction, sleep disorder

Substance-Induced Psychosis

• Difficult to distinguish substance-induced psychosis from other psychotic disorders

• Substance-induced psychosis - symptoms appear quickly and last relatively short time, from hours to days until the effects of drug wear off

• Psychosis can persist for days, weeks, months or longer

• Possible individuals already at risk for developing psychotic disorder triggered by substance use

• Visual hallucinations more common in substance withdrawal and intoxication 

• Stimulant intoxication more commonly associated with tactile hallucinations, person experiences physical sensation interpret as having bugs under skin ("ice bugs" or "cocaine bugs“)

• Tactile hallucinations can occur in alcohol withdrawal; auditory and visual hallucinations are more common

• Stimulant psychosis sometimes more agitated, energetic, more difficult to calm with sedating or psychiatric medication compared to non-drug induced psychosis

• Difference with schizophrenia - lack of negative and cognitive symptoms with return to normal inter-episode functioning during periods of abstinence

Delirium

• Disturbance of consciousness and cognition that represents significant change from previous level of functioning

• Reduced awareness of surroundings, difficulty concentrating, may be difficult to engage him/her in conversation

• Changes in cognition include short-term memory impairment, disorientation (in regards to time or place), and language disturbance (eg difficulty finding words, naming objects, writing)