MENTAL HEALTH

Owondo Thomas
Bwindi Community Hospital

© 2017 Thomas Owondo. All rights reserved. 1

Psychiatry

 Is a the branch of medicine focused on the diagnosis,

treatment and prevention of mental, emotional and
behavioral disorders.
Branches
 Liaison psychiatry, also known as consultative psychiatry or
consultation-liaison psychiatry is the branch of psychiatry that
specializes in the interface between general medicine
and psychiatry, usually taking place in a hospital or medical setting.

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Branches of Psychiatry
 Forensic psychiatry (Legal Psychiatry):Psychiatry in its
legal aspects, including criminology, penology, commitment
of the mentally ill, the psychiatric role in compensation
cases, the problems of releasing information to the court,
of expert testimony. This branch helps to assess whether
one committed crime due to mental illness or intentionally.
 Child and adolescent psychiatry: The branch of
psychiatry that deals with disorders of children and
adolescents.
 Geriatric Psychiatry: The branch of psychiatry that deals
with disorders of old age.

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Mental Health
 Mental health is defined as a state of well-being in which
every individual realizes his or her own potential, can cope
with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to her or his
community.
 The positive dimension of mental health is stressed in WHO's
definition of health as contained in its constitution: "Health is
a state of complete physical, spiritual, mental and social well-
being and not merely the absence of disease or infirmity."

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MENTAL ILLNESS

 Refers to a wide range of mental health conditions or disorders that

affect one’s mood, thinking and behavior.
 Examples of mental illness include depression, anxiety disorders,
schizophrenia, eating disorders addictive behaviors, intellectual
disabilities and disorders due to drug abuse. Most of these disorders
can be successfully treated.
 Many people have mental health concerns from time to time. But a
mental health concern becomes a mental illness when ongoing signs
and symptoms cause frequent stress and affect your ability to function.

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CLASSIFICATION OF MENTAL D/O
 Mental disorders comingle with other mental disorders, e.g:
 A person with a mood disorder might also at times have psychotic
episodes and at other times have serious sleep problems.
 A person with an adjustment disorder might also be very anxious.
 Instead of each classification staying within neat boundaries.
 Much thought and research go into updating the Diagnostic and
Statistical Manual of Mental Disorders (DSM).
 Some disorders are added and some are deleted, so things change.

 Some publications go a safe route and list mental disorders

alphabetically.
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 Classification Challenges

 Even the most dedicated

professional can find it
exhausting!

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Classification of Mental Disorders
 Most of physical conditions are classified on the basis of etiology, e.g.:
viral pneumonia.
Or
On the basis of structural pathology, e.g.: Bronchopneumonia.
Or
Based on symptoms, e.g. migraine.

 Psychiatric disorders are diagnosed based mainly on symptoms.

Few are based on etiology e.g. Alzheimer’s disease.

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Reasons for classification
1. To make generally acceptable diagnosis.
2. To facilitate communication between psychiatrists, other doctors and
professionals.
3. To make generalizations in treatment response, course & prognosis of
individual patients.
4. To make framework for research in psychiatry.

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 Types of Classification

1. Categorical Classification:

- Grouping disorders into separate entities according to

symptom pattern, course and outcome.
- It includes hierarchal categories.
e.g.:Organic mental disorders versus non-organic (functional)
mental disorders.
- Also it includes in-built hierarchy of significance within
the disorders themselves.
e.g.: Psychosis (e.g. Schizophrenia) versus neurosis (e.g.
anxiety disorder) then others (e.g; personality disorders).
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 Psychiatric Disorders

Organic Non-Organic (Functional)

Acute Chronic Others Psychoses Neuroses Others

1. Delirium 1. Dementia 1. Alcohol … 1.Schizophrenia 1. Anxiety disorders 1.Personality dis.
2. OCD & related
2. Wernicke’s 2. Korsakoff 2.Head Injury 2. Mood 2.Sleep disorder
disorder
disorders
3. Dissociative 3.Sex disorder
disorders 4. Childhood
4. Stressor related illnesses
disorder
5. Eating
5. Somatic symptom
disorders 11
© 2017 Thomas Owondo. All rights reserved. d/o
Organic vs. Non-organic (Functional) mental
d/o
a). Organic Mental Disorders (OMD).
 An organic mental disorder (OMD), also known as organic brain
syndrome or chronic organic brain syndrome, is a form of
decreased mental function due to a medical or physical disease or
easily identifiable cause, rather than a psychiatric illness.
 This differs from dementia.
 While mental or behavioral abnormalities related to the
dysfunction can be permanent, treating the disease early may
prevent permanent damage in addition to fully restoring mental
functions.
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Features Suggesting of Organic Mental Illness:

1. Disturbed consciousness.
2. Disturbed cognitive functions:
a. Attention and concentration
b. orientation: time, place & person
c. Memory : immediate, recent and remote
3. Presence of physical illness e.g. DM, HTN
4. Presence of neurological features e.g. Dysarthria (difficulty in
articulating words due to disturbance in the form and function of the
structures that modulate voice into speech) & ataxia (lack of
coordination while moving).
5. Old age onset.

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Organic Mental Disorders (OMD).
 An organic cause to brain dysfunction is suspected when there is
no indication of a clearly defined psychiatric or "inorganic" cause,
such as a mood disorder.
 In Uganda organic mental disorders are commonly caused by;
o Physical illness
o Alcohol and substance abuse
o Head injury
o ETC.

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b). Inorganic/ functional mental disorders

 These are mental disorders that impair the normal

function of a bodily process, but where every part of
the body looks completely normal under examination,
dissection or even under a microscope.
 Generally, the mechanism that causes a functional
disorder is unknown, poorly understood, or
occasionally unimportant for treatment purposes.
 The brain or nerves are often believed to be involved.
© 2017 Thomas Owondo. All rights reserved. 15
 Neurosis and Psychosis

Psychosis:
- unsatisfactory term (syndrome)
- refers broadly to severe forms of mental disorders where one loses
touch with reality.
They include disorders such as:
a. organic mental diseases
b. schizophrenia
c. mood/affective disorders

Characteristics:
- greater severity
- lack of insight
- patient’s inability to distinguish between subjective experience and
reality e.g. hallucinations, delusions.
© 2017 Thomas Owondo. All rights reserved. 16
Neurosis:
 unsatisfactory term (syndrome).
 Refers to mental disorders that are generally less severe than psychosis.
Here one doesn’t lose touch with reality.

Characteristics:
- Symptoms are closer to normal experience e.g. anxiety.

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 Psychosis Neurosis

Major mental illness Minor mental illness Severity

Abnormal in quality Abnormal in quantity Features
e.g. hallucinates e.g. anxiety

Affected Preserved Insight

Drugs & ECT Psychological & drugs Treatment

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 2. Dimensional Classification:

- Diagnosing individual patients by giving him scores on separate

dimensions basing on personality traits.
e.g.
 Psychoticism; a personality pattern typified by aggressiveness and
interpersonal hostility. It is defined by Eysenck as a personality type
that is prone to take risks, might engage in anti-social behaviors,
impulsiveness, or non-conformist behavior. High levels of this trait
were believed by Eysenck to be linked to increased vulnerability
to psychosis such as in schizophrenia.
 Neuroticism or emotional stability; a person's ability to remain stable
and balanced. It is a personality trait that includes anxious and nervous
behavior and a frequent feeling of fear or worry.
 Introversion and extroversion; indicate how outgoing and social a
person is.
© 2017 Thomas Owondo. All rights reserved. 19
 3. Multi-axial Approach:

 Applied to schemes of classifications in which two or more separate sets of

information are coded.

e.g. Diagnostic Statistical Manual of mental disorders (DSM),

International Classification of Diseases (ICD).

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The Basic Categories of Classification in Psychiatry:

1. Mental Retardation – impairment of intellectual functioning, present

continuously from early life.
2. Personality Disorders – a pattern of inner feeling experience and
behavior that deviates markedly from the expectations of the
individual’s culture, presents continuously since adolescence or early
adulthood.
3. Mental Disorders – abnormality of behavior or psychological
experience with recognizable onset after a period of normal
functioning.
4. Stress related or adjustment disorders.
5. Other Disorders – e.g. Sexual disorders, drug dependence
6. Learning and developmental disorders.
7. Disorders with onset in childhood or adolescence.

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DSM V TR CLASSIFICATION
 Neurodevelopmental Disorders e.g Autism, Retts disorder, etc.
 Schizophrenia Spectrum and Other Psychotic Disorders
 Bipolar and Related Disorders
 Depressive Disorders
 Anxiety Disorders
 Obsessive-Compulsive and Related Disorders
 Trauma- and Stressor-Related Disorders
 Dissociative Disorders
 Somatic Symptom Disorders

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 Feeding and Eating Disorders
 Elimination Disorders
 Sleep-Wake Disorders
 Sexual Dysfunctions
 Gender Dysphoria
 Disruptive, Impulse Control, and Conduct Disorders
 Substance Use and Addictive Disorders
 Neurocognitive Disorders
 Personality Disorders
 Paraphilias
 Other Disorders

© 2017 Thomas Owondo. All rights reserved. 23