Mental Disorders

Mental Health and Wellness: A relative state of being typically related to our ability to cope or
adapt to the challenges of life.

Mental Illness: Disorders that create difficulty coping with ongoing, everyday stresses. Related
to inability to cope with externally imposed stressors.

Causes of Mental Illness:

 Heredity
 Congenital factors
 Accident
 Trauma
 Drug toxicity
 Stress

Classifications of Mental Disorders: These are lose classifications…

 Maladaptive (or personality) disorders
 Phobias
 Anxiety
 Depression
 Addiction

Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DMS-5): A standard
reference used in a clinical setting to diagnose mental disorders. Published by the American
Psychiatric Association.

DSM Categories of Mental Illness: This is a five-axis system to measure different parts of the
overall diagnosis…
 Axis I: Mood and thought disorders often respond to medications and psychotherapy.
 Axis II: Intellectual development disorder and personality disorders that do not typically
respond well to medications and psychotherapy.
 Axis III: Medical conditions that contribute to the psychological condition
 Axis IV: Stressors that contribute to the overall psychological condition
 Axis V: GAF (Global Assessment of Functioning) assigns a number from 0 to 100 that
indicates level of functioning. This provides a reference for how well a person is able to
function in their daily responsibilities given the persons difficulties.
Intellectual Developmental Disorder: A wide range of condition of subnormal intellectual
development as a result of congenital causes, brain injury, or disease. They are characterized by
various cognitive deficiencies, including impaired learning, social, and vocational ability.
Depending on the severity and deficits of the disorder the condition may not be evident until the
child is older.
 Signs and Symptoms: May be few noticeable symptoms during early childhood. As
child grows and enters school, deficits become more obvious and can include
o Delayed development of communication and motor skills
o Difficulty with schoolwork and social relationships.
o Lack of control of emotions
 Etiology:
o Heredity (genetic or chromosomal disorders)
o Early alterations of embryonic development (Down syndrome, toxin exposure)
o Prenatal, perinatal, or postnatal conditions (infections, trauma, poisoning,
hypoxia)
o Trauma that disrupts the supply of oxygen
o Environmental influences
o Anything that interferences with the developmental process
o Anything that compromises the blood supply in the brain and results in
neurological damage.
 Diagnosis: Requires time and observation to examine child’s ability and uses
intelligence tests routinely used to develop intelligence quotient (IQ).
o Stanford-Binet Test: An example of an intelligence. Two standard deviations
below normal is considered an abnormality.
 110-90: Average
 90-70: Below average
 70-50: Mild intellectual disabilities
 50-35: Moderate intellectual disabilities
 35-20: Severe intellectual disabilities
 Below 20: Intellectual disabilities
 Diagnosis Criteria:
o Subaverage intellectual functioning
o Limitations in at least two of the following…
 Communication
 Home living
 Self-care
 Social or interpersonal skills
 Self-direction
 Health and safety
  Treatment:
o No cure or drug therapy is available.
o Underlying causes should be treated.
 Mild to Moderate: Most can function in society with varying degree of
support or supervision.
 Severe to Profound: Live life in an institution and are dependent on others
for daily care.
o Training and therapy to teach important basic task and prevent further delay in
development.

Learning Disorders: Conditions that cause children to learn in a manner that is not typical.
Typically, diagnosed when the child begins school and cause deficits in visual perceptions,
language processing, attention, and memory.
 Signs and Symptoms:
o Difficulty in acquiring a skill in a specific area of learning, such as reading,
writing, and mathematics.
o Low achievement persists despite normal IQ and schooling.
 Etiology: Unknown but there is suspect abnormalities and cognitive processing.
 Diagnosis: A diagnosis is made when the child
o Meets all DSM-5 diagnostic criteria
o Has lower scores (for age) on standardized tests
o Additional tests are needed to rule out inadequate schooling, language barrier,
poor teaching, etc.
o Hearing and vision tests to rule out those disorders
o Rule out other mental disorders
 Treatment:
o Drug therapy for those with hyper-activity
o Instructional techniques
 Prognosis: Depends on the severity and the supports the child has.

Pervasive Developmental Disorders (PDD): Severe impairment in several areas of

development that cause behaviors that interfere with peer relationships and interaction with
others.
 Categories of these in the DSM-5:
o Autism
o Asperger’s
 Autism and Asperger’s are not Classified as Autism Spectrum Disorder
(ASD)
o Rett’s
o Childhood disintegrative disorder (CDD)
o Pervasive Developmental Disorders Not Otherwise Specified (PDD – NOS)
Autism Spectrum Disorder (ASD): Complex PDD that typically appears during the first 3
years of life. Affects thoughts, perception, and attention. It is four times more common in boys
than girls.
 Symptoms: Appear in a wide variety of combinations and no two clients look the same.
o Marked impairment in nonverbal communication
o Absent or delayed verbal communication
o Inability to initiate conversation
o Does not initiate age-appropriate play
o Repetitive motions
o Inflexibility toward change
o Failure to establish normal peer relationships
 Diagnosis: Made when a child display 6 or more of the 12 symptoms listed across 3
areas, social interaction, communication and behavior.
 Functional Impact: Common.
o Difficulty in social interaction
o Difficulty in communication
o Sensory impairments
o Repetitive quality of play activities
o Behaviors
 Treatment:
o Behavioral therapy
o Self-instructed training
o Medications often used…
 Antidepressants
 Antiepileptics
 Stimulants

Retts: This occurs more often in females. In the beginning of life, typically the first 6 to 18
months, a child develops normally, however, the child will soon begin to regress. Regression
occurs first in gross motor skills and then progresses to loss in abilities of speech, reasoning, and
hand use. This does appear to be associated with deficits in X chromosome.

Childhood Disintegrative Disorder (CDD): A rare disorder where the child develops normally,
however, between the ages of 2 and 10, regression in ability to move, bowel and bladder
function, and social and language skills occurs.

Pervasive Developmental Disorders Not Otherwise Specified (PDD-NOS): This is diagnosed

when a child has multiple signs and symptoms of ASD but does not fit all criteria to be formally
diagnosed with ASD.
Attention Deficit Hyperactivity Disorder (ADHD): Persistent inattention with hyperactivity
and impulsivity.
 Three Subtypes:
o Combined type (inattention and hyperactivity): Diagnosed with a person displays
six or more symptoms of inattention and 6 or more symptoms of hyperactivity or
impulsivity, persisting for at least 6 months.
o Predominant inattention: Diagnosed with a person displays six or more
symptoms of inattention and fewer than 6 symptoms of hyperactivity or
impulsivity, persisting for at least 6 months.
o Predominant hyperactivity-impulsivity: Diagnosed with a person displays six or
more symptoms of hyperactivity or impulsivity and fewer than 6 symptoms of
inattention, persisting for at least 6 months.
 Symptoms:
o Attention Deficits: Difficulty sustaining attention and completing tasks
o Hyperactivity: Inability to sit quietly without fidgeting or squirming
o Impulsivity: Impatience and frequent interruptions
o Symptoms usually present before the age of 7 years
o Difficulty sustaining attention and performing age appropriate tasks
o Failure to give close attention at school, makes careless mistakes, and has messy
work
o Inability to sit quietly and are fidgety, and squirmy,
o Inappropriate physical activity, difficulty in play and excessive talking
o These behaviors exaggerated in group situations
 Etiology: Not known but there may be a familial pattern
 Diagnosis
o Clinical observation and evaluation
o Behaviors must last longer than 6 months in at least 2 separate settings
o Behaviors impair the ability to function at age level
 Treatment
o Medication with stimulants
 Methylphenidate (Ritalin)
 Amphetamine (Adderall XR)
o Behavioral therapy/behavior modification
Substance Related Disorders:
Alcohol Abuse: A disorder causing physical and psychological dependence through daily and
excessive use of alcoholic beverages. Excessive use is often associated with anxiety, depression,
insomnia, impotence, and behavior disorders.
 Symptoms
o Social: Family disruption, violence, accidents, etc.
o Physical: Frequent infections, hypertension, gastrointestinal problems, seizures,
alcohol withdrawal problems
o Prolonged use may cause:
 Cirrhosis of liver
 Pancreatitis
 Peripheral neuropathy
 Increased risk of cancer (esophagus, stomach, and parts of GI tract)
 Etiology: There is no single cause.
o Genetic factors
o Depression
o Emotional conflict
o Social factors
o Cultural attitudes
 Treatment:
o Detoxification
o Psychotherapy
o Group therapy and/or 12-step program (AA)
o Antabuse causes violent nausea and vomiting when alcohol is consumed and is
used for those with a high risk of relapse.
o Once re-habilitated avoiding alcohol is key to avoid relapse.

Other Drugs of Abuse (Substance Use Disorders):

 Many types of drugs can modify mood or behavior and possibly harm the body when
abused.
 The main classifications of drugs include:
o Stimulants (amphetamines, ecstasy, cocaine)
o Opiates (heroin)
o Hallucinogens (LSD)
o Volatile substance (inhalants, vapors)
o Cannabanoid (marijuana, hash)
o Steroidal (steroids)
o Tobacco
o Prescription drugs
 Treatment Guidelines:
 o Must meet individual’s needs and be tailored to drug of abuse
o Individual should have a medical, psychological, and social assessment
o Behavior therapy and adequate support crucial for recovery and abstinence
o Many times, the person also have a underlying mental illness that they use
substances to self-medicate for.
Schizophrenia: Psychiatric disturbance resulting in chronic mental dysfunction. It is rarely seen
in children with onset in adolescent and early adult hood.
 Signs and Symptoms: May be positive manifestation or negative manifestation.
o Positive: An excess or distortion of normal function.
 Delusions
 hallucinations
 disorganized speech
 Disorganized or catatonic behavior
o Negative: A loss of normal function
 Affective flattening
 Alogia
 Avolition
o Prodromal signs:
 Withdrawal
 Odd behavior
 Disheveled appearance or decreased ADL functioning
 Loss of interest
o Functional Impact:
 Inability to complete education, have a job, or maintain successful
relationships
 Disheveled appearance and difficulty in completing basic ADLs and
IADLs
 Classifications:
o Paranoid Type: Individual present with anger, hostility, violence, grandiose
delusions and hallucinations
o Disorganized Type: Individual present as blatantly incoherent with delusions that
are not systematically revolved around a certain theme. They have dull,
inappropriate, or exaggerated behavior, odd behavior, and extreme social
dysfunction.
o Catatonic Type: Individual present with excitement or stupor and are rigid in
nature.
o Undifferentiated Type: Individual present with grossly disorganized behavior and
incoherent communications.
o Residual Type: Individual experiences at least one episode but is currently
without symptoms.
 Etiology: Unknown, but it is suspected that genetic factors may play a role.
 Treatment
o Antipsychotic drugs are used in the acute phase
o Long-term multidimensional treatment combines
 Supportive psychotherapy
  Drugs
 Family involvement
o Will not improve without treatment
 Prognosis: Moderate in nature if treatment plan is followed.

Catatonia: Psychomotor immobility and behavioral abnormality that manifest as stupor.

Mood Disorders:
Bipolar Disorder: A major affective disorder with abnormally intense mood swings from a
hyperactive, or manic state, to a depressive syndrome. Often state is often more prevalent than
another. A person can remain in a certain state for days, week, or months before cycling into
another state.
 Symptoms
o During manic episodes:
 Rapid speech
 Frequent changes of topic
 Minimal sleep
 Excessive amount of energy
 Impulsive choices
 Delusions or auditory hallucinations possible
o During depressive episodes:
 Sad or indifferent mood
 Slow thoughts and speech
 Avoid communication
 Loss of interest in life
 Loss of appetite
 Sleep disturbance
 Feelings of guilt
 Threatened or attempted suicide
 Etiology: Unknown
 Treatment:
o Drug therapy
 Lithium carbonate is the drug during an acute phase.
 Depakote and Tegretol may help stabilize manic episodes.
 Antidepressants use with caution because they can trigger mania
o Psychotherapy
 Prognosis: Compliance is key for good prognosis as medication can be effective as long
as they have compliance

Major Depressive Disorder (MDD): A serious mood disorder that is characterized by constant
and deep sadness, despair, and hopelessness. Accompanying symptoms include a loss of interest
in activities that once brought pleasure, sleep irregularity, continuous fatigue. It interferes with
everyday functioning and widely impacts occupational participation and performance.
 Prevalence:
o About 7% of all adults in the United States have had a depressive episode
o Highest among those who are female, between the ages of 18-25 years old, and
biracial
 o Graduate students are 3 times more likely to experience depression and other
mental health disorders

 Symptoms: Are dependent on each person.

o Emotional symptoms:
 Sadness
 Anxiety
 Despair
 Hopelessness
 Self-blame
 Guilt
 Loss of self-esteem
o Thought Effects:
 Repetitive
 Lack of perspective
 Not grounded in logic or reality
 Possibly suicidal, dependent on severity
o Behavioral:
 Socially withdrawn
 Lack of participation in activities
 Ignoring responsibilities
 Neglected grooming and hygiene
 Substance abuse
o Physical Symptoms:
 Sleep disturbances
 Chronic fatigue
 Appetite disturbances
 Psychomotor retardation
 Etiology:
o Genetic
 Neurological
– Certain brain structures and neurohormone levels that are abnormal
in someone who has depression, but environment can also
influence this
– -Significantly higher cortisol levels in the brain, which has been
hypothesized to damage neural circuits.
 Presence of family history
– If you have a first degree relative with major depression, you have
2-3.5 x the risk of also having depression.
o Environmental
 Acute life stressors
 Chronic stress
 Childhood exposure to adversity
 o Personality
 Perfectionism can cause high stress and cause someone to put unnecessary
pressure on themselves.
 Disposition for more negative emotions, such naturally being more likely
to worry.
 Coping tendencies
 Common Comorbidities:
o Anxiety
o Substance-abuse
o Other mental illnesses
 Diagnosis:
o Questionnaire or a conversation about the presence and duration of symptoms
such as feelings or behavioral patterns.
o Family history is also discussed, as it can give important clues to what is going
on.
o Rule out other conditions that may be causing depression (hormone abnormalities
stemming from the thyroid, or vitamin deficiencies like a lack of iron causing
fatigue).
o For major depressive disorder:
 There needs to be five of these symptoms to be diagnosed: Sadness, loss
of enjoyment in activities, change in appetite, change in sleep, sense of
being run-down, fatigue, feeling of worthlessness or guilt, concentration
problems, or suicidal thoughts.
 In addition to the five symptoms, there needs to be either sadness or a loss
of pleasure in once enjoyed activities felt daily
 These all need to occur for two weeks straight for a diagnosis.
 Treatment:
o Psychotherapy: Helps adjust to a life event, explore relationships, identify
negative beliefs about yourself and circumstances, find better ways to cope, and
encourage healthier behaviors. The act of talking about painful feelings to
someone you trust is therapeutic.
o Medications
o Lifestyle changes
o Electroconvulsive therapy (ECT) and Transcranial magnetic stimulation (TMS)
are possible treatments but not commonly used.
 Pharmacology: Can take patience and a good doctor to find the dosage and kind that is
best for an individual
o SRIs: Prozac, Zoloft, Paxil, Celexa, Lexapro
 Inhibit reuptake of serotonin, which is a neurotransmitter directly involved
in happiness and mood stabilization.
 The simple logic is that this will increase the amount of serotonin in the
brain.
 These have lesser side effects than others, so they are most commonly
prescribed.
o SNRIs: Serotonin-norepinephrine reuptake inhibitors
  Do the same as SRIs also impact norepinephrine.
 Norepinephrine also plays a role in mood stabilization and concentration.
o Tricyclic antidepressants: Tofranil, Norpramin
 Also impact both norepinephrine and serotonin but do so through a
different mechanism.

o Atypical antidepressants: Wellbutrin, Remeron

 Wellbutrin reduces the uptake of dopamine and norepinephrine and can
also be used for quitting smoking.
 Remeron increases noradrenergic and serotonergic neurotransmitters via a
unique mechanism.
o MAOIs (monoamine oxidase inhibitors): Parnate, Nardil
 Will be prescribed when nothing else is working
 Can react with many common foods and can be dangerous.
 Takes ~6 weeks to work, and it’s very important to stay on them
consistently.
o Side effects: Definitely vary but may stop over time
 Weight gain
 Sleep problems
 Nausea
 Drowsiness
 Lack of sexual desire
 Prevention: There’s no specific one way to prevent depression, but it’s important to take
care of one’s self both physically and emotionally.
o Eating healthy, getting enough sleep, exercise
o Finding good coping skills and support systems
o Seeking help as soon as possible (earlier = better)
 Prognosis: Varies depending on the person.
o Those who receive treatment typically have a better diagnosis.
o It is important that the person maintain and follow through with treatment
 Risk of relapse:
o At least 50% of people who have one episode of major depression have a second
o If there is a second episode, there is an 80% chance for a third
o High morbidity and mortality rate due to suicide

Anxiety Disorders: Anxiety moves from the realm of “normal” to “abnormal” when it persists
and prevents the person from leading a normal life. Largest mental health disorder in the us and
may lead to substance use or depression.
 Four classifications of anxiety disorders:
o Generalized anxiety disorder
o Panic disorder
o Phobic disorder
 o Obsessive-compulsive disorder

Generalized Anxiety Disorder: A constant state of anxiety about most things, not situation-
specific
 Symptoms:
o Avoids making decisions or worries about ones that have been made
o Panic attacks
o Physiologic symptoms might include diarrhea, elevated blood pressure, sustained
muscular tension, inability to sleep (nightmares common).

Panic Disorder: Anxiety begins suddenly and unexpectedly, reaching a peak within 10 minutes.
The attack is often accompanied by a sense of impending doom, “going crazy,” losing control, or
dying. Onset is more sudden and severe than generalized anxiety.
 Symptoms:
o Heart pounding and rapid pulse
o Sweating
o Trembling
o Shortness of breath and chest pain
o Nausea
o Dizziness
o Hot flashes
 Diagnosis Criteria: Four panic episodes within a month or one or more attacks followed
by a persistent fear of another attack.

Post-Traumatic Stress Disorder (PTSD): The experience of severe signs and symptoms of
extreme distress due to a past event that was traumatic.
 Prevalence:
o 8 out of every 100 women develop PTSD
o 4 out of every 100 men develop PTSD
 Etiology:
o Combat exposure
o Childhood physical abuse
o Sexual violence
o Physical assault
o Being threatened with a weapon
o Other human controlled events
o Natural events
 Signs and Symptoms:
o Go out of their way to avoid reminders
 o Unable to respond to affection
o Irritability
o Insomnia
o Can be delayed onset

 Diagnostic Procedures:
o Intrusive symptoms and thoughts
o Recurrent and distressing recollections
o Avoidance of stimuli
o Hyperarousal in form of heartbeat, dyspnea, and panic
o Children commonly reenact the event, have recurrent nightmares, or often have
patterns of play that are repetitive
o Recurrent nightmares
 Treatment:
o Goal: Restore individuals’ sense of control
o Counseling and Cognitive Behavioral Therapy
o Drug therapy:
 Benzodiazepines: help to normalize sleep patterns
 Anti-anxiety agents: Medicines lower their overall level of anxiety
experienced
 SSRI's: a common depression medication.
 Prevention: There is also no known way to prevent this condition.
 Prognosis: With treatment (therapy and medications) prognosis is good.

Munchausen Syndrome or Factitious Disorder: Occurs when people simulate symptoms of

illness, knowing they are not ill, and they seek medical attention as a way to draw attention to
themselves. Malingering, festering, or the feigning of symptoms for financial or personal gain, is
also a factitious disorder. These individuals often have extensive knowledge of medical terms
and hospital routines.

Munchausen Syndrome by Proxy: A parent projects symptoms to the child (usually a

preschooler), which stimulates an illness in the child and causes the child to present for
treatment. The parent denies any knowledge of the actual cause and relates the symptoms to be
GI, genitourinary, or something else. Purpose is for the parent to draw attention to themselves.

Personality Disorder: A pattern of behavior that deviates from society’s norms and is typically
rooted in a person’s thoughts about him or herself. Often produce chronic, ingrained, and
maladaptive behavior that begin during adolescence.
 Symptoms: Vary based on disorder
o Disordered patterns of relating, thinking, and perceiving
o Impaired social and occupational performance
o Might appear arrogant, shy, or blaming
 o History of longstanding problems in interpersonal relationships
o Occupational difficulties
o Blame others for their problems
 Categories: Ten personality disorders are categorized into three clusters.
o Cluster A:
 Paranoid
 Schizoid
 Schizotypal

o Cluster B:
 Antisocial
 Borderline
 Histrionic
 Narcissistic
o Cluster C:
 Avoidant
 Dependent
 OCPD
 Unspecified Personality Disorder
 Treatment: Depends on symptoms of particular disorders but typically include…
o Psychotherapy
o Drug Therapy (typically anxiety and depression medication)
o Family Therapy
 Prognosis: Very poor overall due to degree that traits are ingrained into individual’s way
of living

Cluster A of Personality Disorders:

 Paranoid Personality Disorder: Person has no trust in others and are suspicious of
others. They think that others intend to hurt or exploit them.
 Schizoid Personality Disorder: Person lacks emotional expression of pleasure or pain
and seems indifferent and socially detached.
 Schizotypal Personality Disorder: Similar to schizoid socially, but can have paranoid
tendencies; superstitious, believing others have magical control

Cluster B of Personality Disorders:

 Antisocial Personality Disorder: The person disregard others, violates others’ rights, are
aggressive and have no remorse.
 Borderline Personality Disorder: Person has unstable relationships and self-image, fears
rejection, are prone to be manipulative and to verbal outbursts
 Histrionic Personality Disorder: Person is overly dramatic, needs to be center of
attention, appears immature and dependent, and seek approval from others
 Narcissistic Personality Disorder: Displays an absorption with self and lacks empathy
for others

Cluster C of Personality Disorders:

 Avoidant Personality Disorder: The person avoids social situations because of fear of
criticism or disapproval, and views them self as inept or inferior
 Dependent Personality Disorder: Person shows a pattern of excessive reliance on others
and often feels reluctant to disagree for fear of losing support
 Obsessive Compulsive Personality Disorder: The person has extreme concern with
orderliness and control