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| − | + | '''Mental disorder''' or '''mental illness''' are terms used to refer a psychological or physiological pattern that occurs in an individual and is usually associated with distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental disorders has changed over time. Definitions, assessments, and classifications of mental disorders can vary, but guideline criterion listed in the [[ICD]], [[Diagnostic and Statistical Manual of Mental Disorders|DSM]] and other manuals are widely accepted by [[mental health professional]]s. Categories of diagnoses in these schemes may include [[mood disorders]], [[anxiety disorder]]s, [[Psychosis|psychotic]] disorders, [[eating disorder]]s, [[developmental disorders]], [[personality disorder]]s, and many other categories. In many cases there is no single accepted or consistent cause of mental disorders, although they are widely understood in terms of a [[diathesis-stress model]] and [[biopsychosocial]] model. Mental disorders have been found to be common, with over a third of people in most countries reporting sufficient criteria at some point in their life. Mental health services may be based in hospitals or in the community. [[Mental health professionals]] diagnose individuals using different methodologies, often relying on case history and interview. [[Psychotherapy]] and [[psychiatric medication]] are two major treatment options, as well as supportive interventions. Treatment may be involuntary where legislation allows. A number of movements campaign for changes to mental health services and attitudes, including the [[Consumer/Survivor Movement]]. There are widespread problems with [[stigma]] and [[discrimination]]. |
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| − | Symptoms of mental illness greatly vary dependent upon the specific disorder, but may include mild to chronic forms of [[Depression (mood)|depression]], anxiety, [[emotional dysregulation]], difficulties with attention, loss of cognitive abilities, or the presence of [[hallucination]]s or [[delusion]]s. Causes of mental illness also vary, but may result from [[genetics]], [[Physical trauma|trauma]], [[Biology|biological]] factors such as [[infection]]s or [[toxin]]s, or [[neuroplasticity]] resulting from [[psychology|psychological]] or [[anthropology|anthropological]] factors. Mental health professionals diagnose individuals using different methodologies which may or may not include obtaining a medical or psychopathological history of a patient, performing a [[mental status examination]], conducting [[psychological testing]] such as the [[Minnesota Multiphasic Personality Inventory]] or [[intelligence quotient]] tests, obtaining [[neuroimaging|neuroimages]] through [[functional magnetic resonance imaging]] or [[positron emission tomography]] scanning, or other neurophysiologic measurements such as [[electroencephalography]]. Mental health professionals will treat mental disorders differently using one or a combination of [[psychotherapy]], [[psychiatric medication]], [[case management]], or other practices. |
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| ⚫ | A number of mental disturbances, such as [[melancholy]], [[hysteria]] and [[phobia]], were described long ago in [[Ancient Greece]] and [[Ancient Rome|Rome]], while others such as [[schizophrenia]] may not have been recognized.<ref>K. Evans, J. McGrath, R. Milns (2003) [http://www.blackwell-synergy.com/doi/abs/10.1034/j.1600-0447.2003.00053.x?journalCode=acp Searching for schizophrenia in ancient Greek and Roman literature: a systematic review] ''Acta Psychiatrica Scandinavica'' 107 (5), 323–330.</ref> [[Hippocrates]] considered the idea that mental illness may be related to biology.<ref name=Stong>Stong, C. (2005). The Evolution of NeuroPsychiatry. ''Neuropsychiatry Reviews, 6''.</ref> |
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| − | The organization and classification of all facets of mental illness have evolved over time. [[Hippocrates]] considered the idea that mental illness may be related to biology. During the middle ages, and still today, many individuals thought mental illness could only be the result of [[demonic possession]]. [[Paracelsus]] used the word [[lunatic]] to describe those affected by the [[lunar effect]], wherein phases of the moon were thought to affect behavior. From the early study of mental illness through individuals such as [[Philippe Pinel]], [[Sigmund Freud]], and [[Alois Alzheimer]], much has changed in the development and understanding of mental illness and continues to change today. The existence and classifications of mental illness are still challenged by some social critics especially by those adhering to principles stemming from [[anti-psychiatry]]. However, the study, treatment, and research of mental illness and [[human behavior]] in general are widely accepted through academic, science and professional organizations including those active in the field of [[psychology]], the [[Medicine|medical]] specialty of [[psychiatry]], and [[social work]]. |
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| − | ==Definition and terminology== |
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| − | The [[World Health Organization]] (WHO) and national surveys report that there is no single consensus on the definition of mental illness or mental disorder, and that the phrasing used depends on the social, cultural, economic and legal context in different societies or contexts.<ref name="WHORIGHTS">World Health Organization (2005) [http://www.who.int/mental_health/policy/who_rb_mnh_hr_leg_FINAL_11_07_05.pdf WHO Resource Book on Mental Health: Human rights and legislation] ISBN 924156282 (PDF)</ref><ref>Peck, MC. & Scheffler, RM. (2002) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12221306 An analysis of the definitions of mental illness used in state parity laws.] ''Psychiatr Serv.'' Sep;53(9):1089-95.</ref> The WHO's [[ICD]]-10 states that mental disorder is "not an exact term", although is generally used "...to imply the existence of a clinically recognisable set of symptoms or behaviours associated in most cases with distress and with interference with personal functions." (WHO, 1992). The [[American Psychiatric Association]]'s [[DSM]]-IV (original and text revision) characterizes mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual,...is associated with present distress...or disability...or with a significant increased risk of suffering." but that "...no definition adequately specifies precise boundaries for the concept of "mental disorder"...different situations call for different definitions" (APA, 1994 and 2000). There is often a criterion that a condition should not be expected to occur as part of a person's usual culture or religion. Mental illness is typically characterized as involving distress, [[Disability|impaired]] [[Cognition|cognitive]] functioning, [[Abnormality (behavior)|atypical behavior]] and/or [[Adaptive|maladaptive behavior]].<ref name=Gazzaniga>Gazzaniga, M.S., & Heatherton, T.F. (2006). ''Psychological Science''. New York: W.W. Norton & Company, Inc.</ref><ref name=CMPMHMR>Carbon-Monroe-Pike MHMR. (2002, March 05). ''Glossary''. Retrieved April 19, 2007, from http://www.cmpmhmr.cog.pa.us/glossary.htm</ref><ref name=AntiquusMorbus>Antiquus Morbus. (2007, April 18). ''Rudy's List of Archaic Medical Terms''. Retrieved April 19, 2007, from http://www.antiquusmorbus.com/English/EnglishM.htm</ref><ref name=PrincetonDef1>Princeton University. (2006). ''mental illness''. Retrieved April 19, 2007, from http://wordnet.princeton.edu/perl/webwn?s=mental%20illness</ref><ref name=BCBSN>Blue Cross Blue Shield of Nebraska. (Unknown last update). ''Glossary''. Retrieved April 19, 2007, from http://www.bcbsneprovider.com/ProviderLibrary/Glossary/M.asp</ref> The WHO reports that there is intense debate about which conditions should be included under the concept of mental disorder; a broad definition can cover mental illness, mental retardation, personality disorder and substance dependence, but inclusion varies by country and is reported to be a complex and debated issue.<ref name="WHORIGHTS"/> |
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| − | Most international clinical documents avoid the term "mental illness", preferring the term "mental disorder"<ref name="WHORIGHTS"/> However, some use "mental illness" as the main over-arching term to encompass mental disorders.<ref>Office of the Surgeon General and various United States Government agencies (1999) [http://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.html Mental Health: A report of the Surgeon General]</ref> [[Consumer/survivor movement]] organizations tend to oppose use of the term “mental illness” on the grounds that it supports the dominance of a [[medical model]].<ref name="WHORIGHTS"/> The term "serious mental illness" (SMI) is sometimes used to refer to more severe and long-lasting disorder while "[[mental health]] problems" may be used as a broader term, sometimes including to refer only to milder or more transient issues.<ref>US Department of Health and Human Sciences (2007) [http://www.oas.samhsa.gov/MentalHealthHP2010/terminology.htm Mental Health & Mental Disorders: Terminology]</ref><ref>Parabiaghi A, Bonetto C, Ruggeri M, Lasalvia A, Leese M. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16565917 Severe and persistent mental illness: a useful definition for prioritizing community-based mental health service interventions.] ''Soc Psychiatry Psychiatr Epidemiol.'' Jun;41(6):457-63.</ref> Confusion often surrounds the ways and contexts in which these terms are used.<ref>Economic and Social Research Council [http://www.esrcsocietytoday.ac.uk/ESRCInfoCentre/facts/UK/index56.aspx?ComponentId=12917&SourcePageId=18133 Mental Health and Mental Illness in the UK]</ref> An alternative overarching concept is that of "mental disability" or, as preferred by some consumer groups, "psychosocial disability".<ref name="WHORIGHTS"/> The [[International Classification of Functioning, Disability and Health]] (WHO, 2001) defines disability as “an umbrella term for impairments, activity limitations, and participation restrictions” resulting from an interaction between an individual (with a health condition) and contextual factors (environmental and personal barriers or facilitators). Various other legal terms are also used in different countries, such as "mental incapacity" or "unsoundness of mind" or "insanity",<ref name="WHORIGHTS"/> terms with some common usage among the general public include "madness" or "nervous breakdown"<ref name="layconcept">Giosan, C., Glovsky, V., Haslam, N (2001) [http://tps.sagepub.com/cgi/content/abstract/38/3/317 The Lay Concept of ‘Mental Disorder’: A Cross-Cultural Study] Transcultural Psychiatry, Vol. 38, No. 3, 317-332 (2001)</ref> |
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| − | In the scientific and academic literature on the definition of mental disorder, one extreme argues that the definition is entirely a matter of value judgements (including of what is [[normal]]) while another proposes that it is or could be entirely [[Objectivity (science)|objective]] and [[scientific]] (including by reference to statistical norms); other views argue that the concept refers to a "fuzzy [[prototype]]" that can never be precisely defined, or that the definition will always involve a mixture of scientific facts (e.g. that a natural or [[evolved]] function isn't working properly) and value judgements (e.g. that it is harmful or undesired).<ref>Perring, C. (2005) [http://plato.stanford.edu/entries/mental-illness/ Mental Illness] Stanford Encyclopedia of Philosophy</ref> Lay concepts of mental disorder vary considerably across different [[cultures]] and countries, and may refer to different sorts of individual and social problems<ref name="layconcept"/> |
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| − | Mental disorders are commonly classified via a categorical scheme sometimes termed "neo-Kraepelinian" (after the psychiatrist [[Kraepelin]])<ref>Rogler, LH. (1997) [http://links.jstor.org/sici?sici=0022-1465%28199703%2938%3A1%3C9%3AMSOHCI%3E2.0.CO%3B2-K Making Sense of Historical Changes in the Diagnostic and Statistical Manual of Mental Disorders: Five Propositions] ''Journal of Health and Social Behavior'', Vol. 38, No. 1., pp. 9-20.</ref> 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 WHO [[International Classification of Diseases]] (currently ICD-10; section 5 covers mental disorders) and the [[American Psychiatric Association]]'s [[Diagnostic and Statistical Manual of Mental Disorders]] (currently DSM-IV-TR<ref name="DSMIVTR">American Psychiatric Association (2000) ''Diagnostic and Statistical Manual of Mental Disorders, 4th Edition TR'' Washington, DC: American Psychiatric Association.</ref>) as well as other manuals such as the [[Chinese Society of Psychiatry]]'s [[Chinese Classification of Mental Disorders]] (currently CCMD-3) or the [[Latin American Guide for Psychiatric Diagnosis]] (GLDP).<ref>Berganza, CE., Mezzich, JE. & Jorge MR. (2002) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=12145508 Latin American Guide for Psychiatric Diagnosis (GLDP).] ''Psychopathology.'' Mar-Jun;35(2-3):185-90.</ref> |
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| + | Psychiatric theories and treatments for mental illness developed in [[Islamic medicine]] in the [[Middle East]], notably from the 8th century at the [[Baghdad]] Hospital under the physician [[Al-Razi|Rhazes]]. |
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| − | The guideline categories and criteria listed in the [[ICD]] and [[DSM]]], and other manuals, have been widely accepted by many [[mental health professional]]s.<ref name=APAReport>Moser, C., & Kleinplatz, P.J. (2003, May 19). ''DSM-IV-TR and the Paraphilias''. Report to American Psychiatric Association.</ref><ref name=Gazzaniga /><ref name=2002Chen>Chen, Y.F. (2002) Chinese classification of mental disorders (CCMD-3): towards integration in international classification. ''Journal of Psychopathology, 35'', 171-175></ref><ref name=DSMPage>American Psychiatric Association, Division of Research. (Unknown last update). ''Frequently Asked Questions About DSM''. Retrieved April 19, 2007, from http://www.dsmivtr.org/2-1faqs.cfm</ref> The schemes have achieved much widespread acceptance in psychiatry in particular. A survey of 205 psychiatrists, from 66 different countries across all continents, found that ICD-10 was more frequently used and more valued in clincal practice and training, while the DSM-IV was more valued for research, with accessibility to either being limited, and usage by other mental health professionals, policy makers, patients and families less clear<ref>Mezzich, JE. (2002) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12145487 International surveys on the use of ICD-10 and related diagnostic systems.] ''Psychopathology.'' Mar-Jun;35(2-3):72-5.</ref>. A [[primary care]] (e.g. general or family physician) version of the mental disorder section of ICD-10 has been developed (ICD-10-PHC) which has also been used quite extensively internationally.<ref>Jenkins R, Goldberg D, Kiima D, Mayeya J, Mayeya P, Mbatia J, Mussa M, Njenga F, Okonji M, Paton J. (2002) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=12145497 Classification in primary care: experience with current diagnostic systems.] ''Psychopathology.'' Mar-Jun;35(2-3):127-31.</ref> |
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| + | Medieval Europe had focused on [[demonic possession]] as the explanation of aberrant behavior.<ref name=Kroll>Kroll J., & Bachrach, B. (1984). Sin and mental illness in the Middle Ages. ''Psychological Medicine, 14'', 507-514.</ref> [[Paracelsus]] used the word [[lunatic]] to describe behavior thought to be caused by the [[lunar effect]].<ref name=SaludMental>Delgado, J.M., Doherty, A.M.S., Ceballos, R.M., Erkert, H.G. (2000). Moon Cycle Effects on Humans: Myth or Reality? ''Salud Mental, 23'', 33-39.</ref> Many other terms for mental disorder that found their way into everyday use have been traced to initial use in the 16th and 17th centuries. <ref> Dalby JT. (1993) Terms of Madness: Historical Linguistics. ''Comprehensive Psychiatry'' 34,392-395. </ref> Shakespeare and his contemporaries frequently depicted mental disorders in their plays. <ref> Dalby JT. (1997) Elizabethan madness: On London's stage. ''Psychological Reports'' 81, 1331-1343.</ref> Conditions of "[[shell shock]]" came to be recognized in [[war]] veterans. Homosexuality was viewed as a mental illness. From the early study of mental illness through individuals such as [[Philippe Pinel]], [[Sigmund Freud]], and [[Alois Alzheimer]], much has changed in the development and understanding of mental illness and continues to change today. |
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| − | The DSM states that "there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder", but other classification schemes explicitly do not use 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<ref>Maser, JD & Akiskal, HS. et al. (2002) [http://psych.theclinics.com/issues/contents?volume=25&issue=4 Spectrum concepts in major mental disorders] ''Psychiatric Clinics of North America'', Vol. 25, Special issue 4</ref> 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.<ref>Krueger, RF., Watson, D., Barlow, DH. et al. (2005) [http://content.apa.org/journals/abn/114/4 Toward a Dimensionally Based Taxonomy of Psychopathology] ''Journal of Abnormal Psychology'' Vol 114, Issue 4</ref> Another approach may be based directly on the specific complaints reported by an individual.<ref>Bentall, R. (2006) [http://cat.inist.fr/?aModele=afficheN&cpsidt=17441292 Madness explained : Why we must reject the Kraepelinian paradigm and replace it with a 'complaint-orientated' approach to understanding mental illness] ''Medical hypotheses'', vol. 66(2), pp. 220-233</ref> DSM-V planning committees are currently looking at moving towards a dimensional classification of some disorders, including personality disorder.<ref>Widiger TA, Simonsen E, Krueger R, Livesley WJ, Verheul R. (2005) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16175740&dopt=Abstract Personality disorder research agenda for the DSM-V.] ''J Personal Disord.'' Jun;19(3):315-38.</ref> |
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| + | At the start of the 20th century there were only a dozen officially recognized mental health conditions.{{Fact|date=April 2007}}. By 1952 there were 192 and the [[Diagnostic and Statistical Manual of Mental Disorders|Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition]] (DSM-IV) today lists 374. |
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| − | Although widely accepted, questions and criticisms have also been widely raised about the schemes advanced by the ICD and DSM, both in terms of the scientific basis and utility<ref name="definepsycho">Helzer, J.E. & Hudziak J.J. (2002) [http://www.appi.org/book.cfm?id=62063 Defining Psychopathology in the 21st Century: DSM-IV and beyond] American Psychiatric Publishing. 1st Edition. ISBN 1585620637</ref> and in terms of social, economic and political factors - including over the inclusion of certain controversial categories, the influence of the pharmaceutical industry,<ref>Cosgrove, L., Krimsky, S., Vijayaraghavan, m., Schneider, L. (2006) [http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=223864&Ausgabe=231734&ArtikelNr=91772 Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry] ''Psychotherapy and Psychosomatics'', Vol. 75, No. 3</ref> or the stigmatizing effect of being categorized or [[Labeling theory|labelled]]. Classification schemes may not apply to all cultures - the DSM is based on predominantly American research studies and has been said to have a decidedly American outlook, meaning that differing disorders or concepts of illness from other cultures (including personalistic rather than naturalistic explanations) may be neglected or misrepresented, while Western cultural phenomena may be taken as universal.<ref>Bhugra, D. & Munro, A. (1997) ''Troublesome Disguises: Underdiagnosed Psychiatric Syndromes'' Blackwell Science Ltd</ref> [[Culture-bound syndromes]] are those hypothesized to be specific to certain cultures (typically taken to mean non-Western or non-mainstream cultures); while some are listed in an appendix of the DSM-IV they are not detailed and there remain open questions about the relationship between Western and Non-Western diagnostic categories and sociocultural factors, which are addressed from different directions by, for example, [[Cross-cultural psychiatry]] or [[anthropology]]. |
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| − | ==Categories/dimensions of disorder== |
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| + | The [[definition]] and [[classification]] of mental disorder is a key issue for the [[mental health professions]] and for users and providers of mental health services. Most international clinical documents use the term "mental disorder" rather than "mental illness". There is no single [[definition]] and the inclusion criteria are said to vary depending on the social, legal and political context. In general, however, a mental disorder has been characterized as a clinically significant behavioral or psychological pattern that occurs in an individual and is usually associated with [[distress]], [[disability]] or increased risk of [[suffering]]. There is often a criterion that a condition should not be expected to occur as part of a person's usual [[culture]] or [[religion]]. The term "serious mental illness" (SMI) is sometimes used to refer to more severe and long-lasting disorder. A broad definition can cover mental disorder, mental retardation, [[personality disorder]] and [[substance dependence]]. The phrase "[[mental health]] problems" may be used to refer only to milder or more transient issues. |
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| + | There are currently two widely established systems that classify mental disorders - Chapter V of the [[International Classification of Diseases]] (ICD-10), produced by the [[World Health Organization]] (WHO), and the [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-IV) produced by the [[American Psychiatric Association]] (APA). Both list categories of disorder and provide standardized criteria for diagnosis. They have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. Other classification schemes may be in use more locally, for example the [[Chinese Classification of Mental Disorders]]. Other manuals may be used by those of alternative theoretical persuasions, for example the [[Psychodynamic Diagnostic Manual]]. |
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| + | Some approaches to classification do not employ distinct categories based on cut-offs separating the abnormal from the normal. They are variously referred to as spectrum, continuum or dimensional systems. There is a significant scientific debate about the relative merits of a categorical or a non-categorical system. There is also significant controversy about the role of science and values in classification schemes, and about the professional, legal and social uses to which they are put. |
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| − | The state of [[anxiety]] or [[fear]] can become disordered, so that it is unusually intense or generalized over a prolonged period of time. Commonly recognized categories of [[anxiety disorder]]s include specific [[Phobia]], [[Generalized anxiety disorder]], [[Social Anxiety Disorder]], [[Panic Disorder]], [[Agoraphobia]], [[Obsessive-Compulsive Disorder]], [[Post-traumatic stress disorder]]. |
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| + | ==Disorders== |
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| − | [[Penis panic]] is a particular sort of anxiety disorder that is diagnosed in some cultures, involving an excessive fear in men of the penis shrinking or drawing back in to the body. |
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| ⚫ | There are many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered.<ref name=Gazzaniga>Gazzaniga, M.S., & Heatherton, T.F. (2006). ''Psychological Science''. New York: W.W. Norton & Company, Inc.</ref><ref name=WebMDTypesIllness>WebMD, Inc. (2005, July 01). ''Mental Health: Types of Mental Illness''. Retrieved April 19, 2007, from http://www.webmd.com/mental-health/mental-health-types-illness</ref><ref name=USDHHS>United States Department of Health & Human Services. (1999). ''[http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec2.html Overview of Mental Illness]''. Retrieved April 19, 2007</ref><ref>NIMH (2005) [http://science-education.nih.gov/supplements/nih5/Mental/guide/info-mental-c.htm Teacher's Guide: Information about Mental Illness and the Brain] Curriculum supplement from The NIH Curriculum Supplements Series</ref> |
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| ⚫ | The state of [[anxiety]] or [[fear]] can become disordered, so that it is unusually intense or generalized over a prolonged period of time. Commonly recognized categories of [[anxiety disorder]]s include specific [[phobia]], [[Generalized anxiety disorder]], [[Social Anxiety Disorder]], [[Panic Disorder]], [[Agoraphobia]], [[Obsessive-Compulsive Disorder]], [[Post-traumatic stress disorder]]. Relatively long lasting [[affective]] states can also become disordered. [[Mood disorder]] involving unusually intense and sustained sadness, melancholia or despair is know as [[Clinical depression]] (or Major depression), and may more generally be described as [[Emotional dysregulation]]. Milder but prolonged depression can be diagnosed as [[dysthymia]]. [[Bipolar disorder]] involves abnormally "high" or pressured mood states, known as [[mania]] or [[hypomania]], alternating with normal or depressed mood. Whether unipolar and bipolar mood phenomena represent distinct categories of disorder, or whether they usually mix and merge together along a dimension or spectrum of mood, is under debate in the scientific literature.<ref>Akiskal, HS. & Benazzi, F. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16488021 The DSM-IV and ICD-10 categories of recurrent (major) depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum.] ''Journal of Affective Disorders'' May;92(1):45-54.</ref> |
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| ⚫ | Patterns of belief, language use and perception can become disordered. [[Psychotic disorder]]s centrally involving this domain include [[Schizophrenia]] and [[Delusional disorder]]. [[Schizoaffective disorder]] is a category used for individuals showing aspects of both schizophrenia and affective disorders. [[Schizotypy]] is a category used for individuals showing some of the traits associated with schizophrenia but without meeting cut-off criteria. |
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| − | ===Belief and perception=== |
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| ⚫ | Patterns of belief, language use and perception can become disordered |
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| ⚫ | The fundamental characteristics of a person that influence his or her cognitions, motivations, and behaviors across situations and time - can be seen as disordered due to being abnormally rigid and maladaptive. Categorical schemes list a number of different [[personality disorder]]s, such as those classed as eccentric (e.g. [[Paranoid personality disorder]], [[Schizoid personality disorder]], [[Schizotypal personality disorder]]), those described as dramatic or emotional ([[Antisocial personality disorder]], [[Borderline personality disorder]], [[Histrionic personality disorder]], [[Narcissistic personality disorder]]) or those seen as fear-related ([[Avoidant personality disorder]], [[Dependent personality disorder]], [[Obsessive-compulsive personality disorder]]). |
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| − | ===Personality=== |
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There may be an emerging consensus that personality disorders, like personality traits in the normal range, incorporate a mixture of more acute dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable.<ref>Lee Anna Clark (2007) [http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.psych.57.102904.190200 Assessment and Diagnosis of Personality Disorder: Perennial Issues and an Emerging Reconceptualization] ''Annual Review of Psychology'' Vol. 58: 227-257</ref> Non-categorical schemes may rate individuals via a profile across different dimensions of personality that are not seen as cut off from normal personality variation, commonly through schemes based on the [[Big Five personality traits]].<ref>Morey LC, Hopwood CJ, Gunderson JG, Skodol AE, Shea MT, Yen S, Stout RL, Zanarini MC, Grilo CM, Sanislow CA, McGlashan TH. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17121690 Comparison of alternative models for personality disorders.] Psychol Med. Nov 23;:1-12</ref> |
There may be an emerging consensus that personality disorders, like personality traits in the normal range, incorporate a mixture of more acute dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable.<ref>Lee Anna Clark (2007) [http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.psych.57.102904.190200 Assessment and Diagnosis of Personality Disorder: Perennial Issues and an Emerging Reconceptualization] ''Annual Review of Psychology'' Vol. 58: 227-257</ref> Non-categorical schemes may rate individuals via a profile across different dimensions of personality that are not seen as cut off from normal personality variation, commonly through schemes based on the [[Big Five personality traits]].<ref>Morey LC, Hopwood CJ, Gunderson JG, Skodol AE, Shea MT, Yen S, Stout RL, Zanarini MC, Grilo CM, Sanislow CA, McGlashan TH. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17121690 Comparison of alternative models for personality disorders.] Psychol Med. Nov 23;:1-12</ref> |
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| + | Other disorders may involve other attributes of human functioning. [[Eating]] practices can be disordered, at least in relatively rich industrialized areas, with either compulsive over-eating or under-eating or binging. Categories of disorder in this area include [[Anorexia nervosa]] and [[Bulimia nervosa]] or [[Binge eating disorder]]. [[Sleep disorder]]s such as [[Insomnia]] also exist and can disrupt normal [[sleep]] patterns. [[Sexual disorder|Sexual]] and gender identity disorders, such as [[Dyspareunia]] or [[Gender identity disorder]] or [[Egodystonic sexual orientation|ego-dystonic homosexuality]]. People who are abnormally unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others, may be classed as having an impulse control disorder, including various kinds of [[Tic disorders]] such as [[Tourette's Syndrome]], and disorders such as [[Kleptomania]] (stealing) or [[Pyromania]] (fire-setting). Substance-use disorders include [[Substance abuse]] disorder. Addictive [[gambling]] may be classed as a disorder. Inability to sufficiently adjust to life circumstances may be classed as an [[Adjustment disorder]]. The category of adjustment disorder is usually reserved for problems beginning within three months of the event or situation and ending within six months after the stressor stops or is eliminated. People who suffer severe disturbances of their self-identity, memory and general awareness of themselves and their surroundings may be classed as having a [[Dissociative identity disorder]], such as [[Depersonalization disorder]] or Dissociative Identify Disorder itself (which has also been called multiple personality disorder, or "split personality".). [[Factitious disorder]]s, such as [[Munchausen syndrome]], also exist where symptoms are experienced and/or reported for personal gain. |
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| − | [[Eating]] practices can be disordered, at least in relatively rich industrialized areas, with either compulsive over-eating or under-eating or binging. Categories of disorder in this area include [[Anorexia nervosa]] and [[Bulimia nervosa]] or [[Binge eating disorder]]. |
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| ⚫ | Disorders appearing to originate in the body, but thought to be mental, are known as somatoform disorders, including [[Somatization disorder]]. There are also disorders of the perception of the body, including [[Body dysmorphic disorder]]. [[Neurasthenia]] is a category involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but not by the DSM-IV.<ref>Gamma A, Angst J, Ajdacic V, Eich D, Rossler W. (2007) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17131216 The spectra of neurasthenia and depression: course, stability and transitions.] ''Eur Arch Psychiatry Clin Neurosci.'' Mar;257(2):120-7.</ref> Memory or cognitive disorders, such as [[amnesia]] or [[Alzheimer's disease]] exist. |
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| − | ===Sleep=== |
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| − | [[Sleep disorder]]s such as [[Insomnia]] |
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| − | ===Sex=== |
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| − | [[Sexual disorder|Sexual]] and gender identity disorders, such as [[Dyspareunia]] or [[Gender identity disorder]] |
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| − | ===Impulse/motor control=== |
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| − | People who are abnormally unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others, may be classed as having an impulse control disorder, including various kinds of [[Tic disorders]] such as [[Tourette's Syndrome]], and disorders such as [[Kleptomania]] (stealing) or [[Pyromania]] (fire-setting). |
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| − | ===Substance use and addictions=== |
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| − | Substance-use disorders include [[Substance abuse]] disorder. Addictive [[gambling]] may be classed as a disorder. |
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| − | ===Adjustment=== |
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| − | Inability to sufficiently adjust to life circumstances may be classed as an [[Adjustment disorder]]. The category of adjustment disorder is usually reserved for problems beginning within three months of the event or situation and ending within six months after the stressor stops or is eliminated. |
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| − | ===Related to the body=== |
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| − | Disorders appearing to originate in the body (or to be non-mental) but thought to be mental, are known as somatoform disorders, including [[Somatization disorder]]. There are also disorders of the perception of the body, including [[Body dysmorphic disorder]]. |
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| ⚫ | [[Neurasthenia]] is a category involving somatic |
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| ⚫ | Some disorders are thought to usually first occur in the context of early childhood development, although they may continue into adulthood. The category of [[Specific developmental disorder]] may be used to refer to circumscribed patterns of disorder in particular learning skills, motor skills, or communication skills. Disorder which appears more generalized may be classed as [[pervasive developmental disorder]]s (PDD) also known as [[autism spectrum disorder]]s (ASD); these include [[autism]], [[Asperger's]], [[Rett syndrome]], [[childhood disintegrative disorder]] and [[PDD-NOS|other types of PDD whose exact diagnosis may not be specified]]. Other disorders mainly or first occurring in childhood include [[Reactive attachment disorder]]; [[Separation Anxiety Disorder]]; [[Oppositional Defiant Disorder]]; [[Attention Deficit Hyperactivity Disorder]]. |
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| − | ===Developmental=== |
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| ⚫ | Some disorders are thought to usually first occur in the context of early childhood development |
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| − | == |
+ | ==Causes== |
| ⚫ | |||
| − | Memory or cognitive disorders, such as [[amnesia]] or [[Alzheimer's disease]] |
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| + | Numerous factors have been linked to the development of mental disorders. In many cases there is no single accepted or consistent cause. A common view is that disorders often result from genetic vulnerabilities combining with environmental stressors ([[Diathesis-stress model]]). An [[wikt:eclectic|eclectic]] or [[Scientific pluralism|pluralistic]] mix of models may be used to explain particular disorders. The primary paradigm of contemporary mainstream Western psychiatry is said to be the [[biopsychosocial]] (BPS) model - incorporating biological, psychological and social factors - although this may not be applied in practice. [[Biopsychiatry]] has tended to follow a [[biomedical]] model, focusing on "organic" or "hardware" pathology of the brain. [[Psychoanalytic]] theories have been popular but are now less so. [[Evolutionary psychology]] may be used as an overall explanatory theory. [[Attachment theory]] is another kind of evolutionary-psychological approach sometimes applied in the context for mental disorders. A distinction is sometimes made between a "medical model" or a "social model" of disorder and related disability. |
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| + | Genetic studies have indicated that [[genes]] often play an important role in the development of mental disorders, via developmental pathways interacting with environmental factors. The reliable identification of connections between specific genes and specific categories of disorder has proven more difficult. |
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| − | ===Fabrication=== |
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| + | Environmental events surrounding [[pregnancy]] and [[birth]] have also been implicated. [[Traumatic brain injury]] may increase the risk of developing certain mental disorders. There have been some tentative inconsistent links found to certain viral infections, to [[substance abuse|substance misuse]], and to general physical health. |
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| − | [[Factitious disorder]]s, where symptoms are experienced/reported for personal gain. Includes [[Munchausen syndrome]]. |
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| + | Abnormal functioning of [[neurotransmitter]] systems has been implicated, including serotonin, norepinephrine, dopamine and glutamate systems. Differences have also been found in the size or activity of certain brains regions in some cases. [[Psychological]] mechanisms have also been implicated, such as [[cognitive]] and [[emotional]] processes, [[personality]], [[temperament]] and [[coping]] style. |
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| − | ===Dissociation=== |
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| − | People who suffer severe disturbances of their self-identity, memory and general awareness of themselves and their surroundings may be classed as having a [[Dissociative identity disorder]], such as [[Depersonalization disorder]] or Dissociative Identify Disorder itself (which has also been called multiple personality disorder, or "split personality".). |
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| + | Social influences have been found to be important, including [[abuse]], [[bullying]] and other negative or stressful life experiences. The specific risks and pathways to particular disorders are less clear, however. Aspects of the wider community have also been implicated, including [[employment]] problems, socioeconomic [[inequality]], lack of social cohesion, problems linked to [[Human migration|migration]], and features of particular [[societies]] and [[cultures]]. |
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| − | ==General theories and models== |
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| − | There are a number of [[paradigm]]s (over-arching [[theories]] or [[models]]) seeking to integrate and explain diverse findings on mental disorders. The field is complicated by the fact that many psychiatric disorders could still be classified as [[syndrome]]s, being patterns of symptoms that do not have an accepted or consistent cause. Different disorders may require different explanations and 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 or trigger disorders ([[Diathesis-stress model]]). A practical [[eclectic]] or [[pluralistic]] mixture of models may often be used to explain particular issues and disorders, but the primary paradigm of contemporary mainstream Western psychiatry has been said to be the [[biopsychosocial]] (BPS) model - incorporating or merging together biological, psychological and social factors - although this may be commonly neglected or misapplied in practice due to being too broad or relativistic.<ref name="eclecticism">Seyyed Nassir Ghaemi (2006) [http://www.medscape.com/viewarticle/547497_print Paradigms of Psychiatry: Eclecticism and Its Discontents] ''Curr Opin Psychiatry.'' ;19(6):619-624.</ref> and, in reality, [[biopsychiatry]] has tended to follow a [[biomedical]] model, focusing on "organic" or "hardware" pathology of the brain. [[Psychoanalytic]] theories, focused on unresolved internal and relational conflicts, have been posited as overall explanations of mental disorder, although today most psychoanalytic groups are said to adhere to the biopsychosocial model and to accept an eclectic mix of subtypes of psychoanalysis.<ref name="eclecticism"/> [[Evolutionary psychology]] (or more specifically evolutionary psychopathology or psychiatry) has also been proposed as an overall theory, positing that many mental disorders involve the dysfunctional operation of mental [[modules]] adapted to [[ancestral]] physical or social environments but not necessarily to modern ones.<ref>Baron-Cohen, S. (Ed.) (1997) The Maladapted Mind: Classic Readings in Evolutionary Psychopathology ISBN 9780863774607</ref><ref>Brune, M. (2002) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11980046 Toward an integration of interpersonal and biological processes: evolutionary psychiatry as an empirically testable framework for psychiatric research.] ''Psychiatry.'' 2002 Spring;65(1):48-57.</ref><ref>Nesse, R. (2002) [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1489830 Evolutionary biology: a basic science for psychiatry] World Psychiatry. 2002 February; 1(1): 7–9.</ref> [[Attachment theory]] is another kind of evolutionary-psychological approach sometimes applied in the context for mental disorders, which focuses on the role of early caregiver-child relationships, responses to danger, and the search for a satisfying reproductive relationship in adulthood.<ref>Crittenden (2002) [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525137 Attachment, information processing, and psychiatric disorder] ''World Psychiatry.'' June; 1(2): 72–75.</ref> An overall distinction is also commonly made between a "medical model" (also known as a biomedical or disease model) or a "social model" (also known as an empowerment or recovery model) of mental disorder and [[disability]], with the former focusing on hypothesized disease processes and symptoms, and the latter focusing on hypothesized [[social constructionism]] and social contexts.<ref name="Rogers&Pilgram05"/> |
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| + | Many [[mental health professionals]], particularly psychiatrists, seek to [[diagnose]] individuals by ascertaining their particular mental disorder. Some professionals, for example some [[clinical psychologists]], may avoid diagnosis in favor of other assessment methods such as formulation of a client's difficulties and circumstances.<ref>Kinderman, P. and Lobban, F. (2000) Evolving formulations: Sharing complex information with clients. Behavioural and Cognitive Psychotherapy, 28(3), 307-310.</ref> The majority of mental health problems are actually assessed and treated by family physicians during consultations, who may refer on for more specialist diagnosis in acute or chronic cases. Routine diagnostic practice in mental health services typically involves an interview (which may be referred to as a [[mental status examination]]), where judgements are made of the interviewee's appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of relatives or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. [[Psychological testing]] is sometimes used via paper-and-pen or computerized questionnaires, which may include [[algorithms]] based on ticking off standardized diagnostic criteria, and in relatively rare specialist cases neuroimaging tests may be requested, but these methods are more commonly found in research studies than routine clinical practice.<ref>HealthWise (2004) [http://health.yahoo.com/topic/mentalhealth/symptoms/medicaltest/healthwise/tp16780 Mental Health Assessment.] Yahoo! Health</ref><ref>Davies, T. (1997) [http://www.bmj.com/cgi/content/full/314/7093/1536 ABC of mental health: Mental health assessment] ''British Medical Journal 314:1536</ref> Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.<ref>Kashner TM, Rush AJ, Surís A, Biggs MM, Gajewski VL, Hooker DJ, Shoaf T, Altshuler KZ. (2003) Impact of structured clinical interviews on physicians' practices in community mental health settings. Psychiatr Serv. 2003 May;54(5):712-8. PMID 12719503</ref> It has been found that most clinicians evaluate patients using an unstructured, open-ended approach, with limited training in evidence-based assessment methods, and that inaccurate diagnosis may be common in routine practice.<ref>Shear MK, Greeno C, Kang J, Ludewig D, Frank E, Swartz HA, Hanekamp M. (2000) Diagnosis of nonpsychotic patients in community clinics. ''Am J Psychiatry.'' Apr;157(4):581-7 PMID 10739417</ref> |
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| + | [[Comorbidity]] is very usual with mental disorders, i.e. same person can suffer one or more disorder. The work for fifth version of [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-V) |
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| − | ==Causes and Links== |
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| + | <ref>[http://www.dsm5.org/ DSM-V Prelude Project website]</ref> has raised some questions about dimensional diagnostic criteria compared to categorical diagnostic criteria. Journal of Abnormal Psychology (Vol 114, Issue 4) <ref>[http://content.apa.org/journals/abn/114/4 Journal of Abnormal Psychology - Vol 114, Issue 4]</ref> devoted a whole issue to discuss about categorical and dimensional diagnostic criteria. In short it the argument is that diagnosis of mental disorder can be based on several overlapping dimensions and not categorical and/or two-dimensional classes. One possibility in diagnosis is to have several (>2) dimensions overlapping and that it is harder to describe. In the following picture idea is that multiple dimension lines are crossed with one diagnostic line and the combination of crossing points is basis for a diagnosis. |
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| + | [[Image:Multidimensional diagnosis.JPG]] |
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| − | === Genes === |
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| − | Family-linkage and [[twin studies]] have indicated that genetic factors often play an important role in the development of mental disorders in general, although the reliable identification of specific genetic susceptibility to particular disorders, through [[genetic linkage|linkage]] or [[genetic association|association studies]], has proven difficult.<ref>Insel, TR. & Collins, FS. (2003) [http://ajp.psychiatryonline.org/cgi/content/full/160/4/616 Psychiatry in the Genomics Era] ''Am J Psychiatry'' 160:616-620</ref><ref>Bearden CE, Reus VI, Freimer NB. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15172671 Why genetic investigation of psychiatric disorders is so difficult.] ''Curr Opin Genet Dev.'' Jun;14(3):280-6</ref> This has been reported to be likely due to the complexity of interactions between genes, environmental events, and early development<ref>Kas MJ, Fernandes C, Schalkwyk LC, Collier DA. (2007) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17389901 Genetics of behavioural domains across the neuropsychiatric spectrum; of mice and men.] ''Mol Psychiatry.'' Apr;12(4):324-30.</ref> or to the need for new research strategies.<ref>Burmeister, M. (2006) [http://focus.psychiatryonline.org/cgi/content/abstract/4/3/317 Genetics of Psychiatric Disorders: A Primer] ''Focus'' 4:317</ref> The [[heritability]] of behavioral traits associated with mental disorder may be greater in permissive than in restrictive environments, and susceptability genes probably work through both "within-the-skin" (physiological) pathways and "outside-the-skin" (behavioral and social) pathways.<ref>Kendler KS. (2001) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11695946 Twin studies of psychiatric illness: an update.] ''Arch Gen Psychiatry.'' 2001 Nov;58(11):1005-14.</ref> Investigations increasingly focus on links between genes and endophenotypes - more specific traits (including neurophysiological, biochemical, endocrinological, neuroanatomical, cognitive, or neuropsychological) - rather than disease categories.<ref>Bearden, CE. & Freimer, NB. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16697071 Endophenotypes for psychiatric disorders: ready for primetime?] ''Trends Genet.'' Jun;22(6):306-13.</ref> |
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| − | === Pregnancy and birth === |
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| − | Environmental events surrounding [[pregnancy]] and [[birth]] have been linked to an increased development of mental illness in the [[offspring]]. This includes maternal exposure to serious psychological [[Stress (medicine)|stress]] or [[trauma]], conditions of famine, [[obstetric]] birth complications, infections, and [[gestational]] exposure to [[alcohol]] or [[cocaine]]. Such factors have been hypothesized to affect specific areas of neurodevelopment within the general developmental context and to restrict [[neuroplasticity]].<ref>Fumagalli, F., Molteni, R., Racagni, G., Riva, MA. (2007). [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17350153 Stress during development: Impact on neuroplasticity and relevance to psychopathology.] ''Prog Neurobiol.'' Mar;81(4):197-217.</ref> |
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| − | People with developmental disabilities, such as mental retardation, are more likely to experience mental illness than those in the general community.<ref>[http://www.intellectualdisability.info/mental_phys_health/classification_ac.html Learning about Intellectual Disabilities and Health] URL last accessed on August 24 2006.</ref> |
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| − | === Disease, injury and infection === |
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| − | Higher rates of mood, psychotic, and substance abuse disorders have been found following [[traumatic brain injury]] (TBI). Findings on the relationship between TBI severity and prevalence of subsequent psychiatric disorders have been inconsistent, and occurrence has been linked to prior mental health problems as well as direct neurophysiological effects, in a complex interaction with personality and attitude and social influences.<ref>Fann JR, Burington B, Leonetti A, Jaffe K, Katon WJ, Thompson RS. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14706944 Psychiatric illness following traumatic brain injury in an adult health maintenance organization population.] ''Arch Gen Psychiatry.'' Jan;61(1):53-61.</ref> |
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| − | A number of psychiatric disorders have often been tentatively linked with microbial pathogens, particularly viruses; however while there have been some suggestions of links from animal studies, and some inconsistent evidence for infectious and immune mechanisms (including prenatally) in some human disorders, infectious disease models in psychiatry are reported to have not yet shown significant promise except in isolated cases.<ref>Pearce, B.D. (2003) [http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W84-4B2CCW6-F&_user=10&_coverDate=12%2F31%2F2003&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=bbbde5caf147a5971a3fec9fed3a7f38 Modeling the role of infections in the etiology of mental illness] ''Clinical Neuroscience Research'' Volume 3, Issues 4-5 , December 2003, Pages 271-282</ref> There have been some inconsistent findings of links between infection by the parasite [[Toxoplasma gondii]] and human mental disorders such as schizophrenia, with the direction of causality unclear.<ref>[http://www.pnas.org/cgi/content/abstract/0608310104v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=toxoplasma&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT Behavioral changes induced by Toxoplasma infection of rodents are highly specific to aversion of cat odors]</ref><ref>Thomas HV, Thomas DR, Salmon RL, Lewis G, Smith AP. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15491496 Toxoplasma and coxiella infection and psychiatric morbidity: a retrospective cohort analysis.] ''BMC Psychiatry.'' Oct 18;4:32.</ref><ref>Alvarado-Esquivel C, Alanis-Quinones OP, Arreola-Valenzuela MA, Rodriguez-Briones A, Piedra-Nevarez LJ, Duran-Morales E, Estrada-Martinez S, Martinez-Garcia SA, Liesenfeld O. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=17178002 Seroepidemiology of Toxoplasma gondii infection in psychiatric inpatients in a northern Mexican city.] ''BMC Infect Dis.'' Dec 19;6:178.</ref> A number of diseases of the white matter can cause symptoms of mental disorder.<ref>Walterfang M, Wood SJ, Velakoulis D, Copolov D, Pantelis C. (2005) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16168032 Diseases of white matter and schizophrenia-like psychosis.] ''Aust N Z J Psychiatry.'' Sep;39(9):746-56.</ref> |
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| − | Poorer general health has been found among individuals with severe mental illnesses, thought to be due to direct and indirect factors including diet, substance use, exercise levels, effects of medications, socioeconomic disadvantages, lowered help-seeking or treatment adherence, or poorer healthcare provision.<ref>Phelan, M., Stradins, L., Morrison, S. (2001) [http://www.bmj.com/cgi/content/full/322/7284/443#B8 Physical health of people with severe mental illness] BMJ 322:443-444</ref> Some chronic general medical conditions have been linked to some aspects of mental disorder, such as [[AIDS]]-related psychosis. |
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| − | === Individual traits and functioning === |
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| − | Studies focused on individual mental processes have been conducted at the level of neural or neuropsychological functioning (e.g. through neuroimaging studies) and personality and psychosocial functioning (e.g. through psychometric assessment). |
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| − | Pre-existing characteristics such as personality traits, [[coping]] styles, and [[cognitive]] or [[emotional]] processes, have been linked to the development of mental disorders.{{Fact|date=May 2007}} |
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| − | Abnormal levels of [[dopamine]] activity have been implicated in a number of disorders (e.g., reduced in [[ADHD]], increased in Schizophrenia) and has been a major focus of research. The role of dopamine is no longer hypothesized to be as a simple reward signal, but part of the complex encoding of the importance of events in the external world.<ref>Iversen SD, Iversen LL. (2007) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17368565 Dopamine: 50 years in perspective.] ''Trends Neurosci.'' Mar 15</ref> Dysfunction in [[serotonin]] and other [[monoamine]] neurotransmitters such as [[norepinephrine]] and [[dopamine]] has been centrally implicated in [[clinical depression]] as well as [[obsessive compulsive disorder]], [[phobias]], [[posttraumatic stress disorder]], and [[generalized anxiety disorder]], but the limitations of this "monoamine hypothesis" have been highlighted<ref>Hindmarch, I. (2002) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15177084 Beyond the monoamine hypothesis: mechanisms, molecules and methods] ''Eur Psychiatry.'' Jul;17 Suppl 3:294-9.</ref> and studies of depleted levels of [[monoamine]] neurotransmitters have tended to indicate no simple or directly causal relation with mood or major depression, although features of these pathways may form trait vulnerabilities to depression.<ref>Ruhe HG, Mason NS, Schene AH. (2007) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17389902 Mood is indirectly related to serotonin, norepinephrine and dopamine levels in humans: a meta-analysis of monoamine depletion studies.] ''Mol Psychiatry.'' Apr;12(4):331-59.</ref> Dysfunction of the central gamma-aminobutyric ([[GABA]]) system following stress has long been associated with anxiety spectrum disorders and there is now a body of clinical and preclinical literature also indicating an overlapping role in mood disorder.<ref>Kalueff, AV. & Nutt, DJ. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17117412&query_hl=21&itool=pubmed_docsum Role of GABA in anxiety and depression.] ''Depress Anxiety.'' Nov 20</ref> |
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| − | Findings have indicated abnormal functioning of [[brainstem]] structures in disorders such as [[schizophrenia]], related to impairments in maintaining sustained attention.<ref name=2005MirskyDuncan>Mirsky A.F., & Duncan, C.C. (2005). [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16213042 Pathophysiology of mental illness: a view from the fourth ventricle.] ''International Journal of Psychophysiology: 58'', 162.</ref> Some abnormalities in the average size or shape of some regions of the brain have been found in some disorders, reflecting genes and/or experience. Studies of schizophrenia have tended to find enlarged [[Ventricular system|ventricles]] and sometimes reduced volume of the [[cerebrum]] and [[hippocampus]], while studies of (psychotic) [[bipolar disorder]] have sometimes found increased [[amygdala]] volume. Findings differ over whether volumetric abnormalities are risk factors or are only found alongside the course of mental health problems, possibly reflecting neurocognitive or emotional stress processes and/or medication use or substance use.<ref>McDonald C, Marshall N, Sham PC, Bullmore ET, Schulze K, Chapple B, Bramon E, Filbey F, Quraishi S, Walshe M, Murray RM. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16513870 Regional brain morphometry in patients with schizophrenia or bipolar disorder and their unaffected relatives.] ''Am J Psychiatry.'' Mar;163(3):478-87.</ref><ref>Velakoulis D, Wood SJ, Wong MT, McGorry PD, Yung A, Phillips L, Smith D, Brewer W, Proffitt T, Desmond P, Pantelis C. (2006) |
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| − | [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16461856 Hippocampal and amygdala volumes according to psychosis stage and diagnosis: a magnetic resonance imaging study of chronic schizophrenia, first-episode psychosis, and ultra-high-risk individuals.] ''Arch Gen Psychiatry.'' Feb;63(2):139-49.</ref> Some studies have also found reduced hippocampal volumes in [[major depression]], possibly worsening with time depressed.<ref>Colla M, Kronenberg G, Deuschle M, Meichel K, Hagen T, Bohrer M, Heuser I. (2007) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17023001 Hippocampal volume reduction and HPA-system activity in major depression.] ''J Psychiatr Res.'' Oct;41(7):553-60.</ref> |
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| − | === Life events, stresses and relationships === |
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| − | It is reported that there is good evidence on the importance of psychosocial influences on psychopathology in general, although less known about the specific risk and protective mechanisms.<ref name="Rutter2000">Rutter, M. (2000). Psychosocial influences: critiques, findings, and research needs. ''Dev Psychopathol.'' Summer;12(3):375-405.PMID 11014744</ref> Maltreatment in childhood and in adulthood, including [[sexual abuse]], [[physical abuse]], [[emotional abuse]], [[domestic violence]] and [[bullying]], has been linked to the development of mental disorder, through a complex interaction of societal, family, psychological and biological factors.<ref>Spataro J, Mullen PE, Burgess PM, Wells DL, Moss SA. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15123505 Impact of child sexual abuse on mental health: prospective study in males and females.] ''Br J Psychiatry.'' 2004 May;184:416-21.</ref><ref>Maughan, B. & McCarthy, G. (1997) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=9158291 Childhood adversities and psychosocial disorders.] ''Br Med Bull.'' Jan;53(1):156-69.</ref><ref>Teicher MH, Samson JA, Polcari A, McGreenery CE. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16741199& Sticks, stones, and hurtful words: relative effects of various forms of childhood maltreatment.] ''Am J Psychiatry.'' Jun;163(6):993-1000.</ref><ref>Kessler RC, Davis CG, Kendler, KS. (1997) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=9300515 Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey.] ''Psychol Med.'' 1997 Sep;27(5):1101-19.</ref><ref>Pirkola S, Isometsa E, Aro H, Kestila L, Hamalainen J, Veijola J, Kiviruusu O, Lonnqvist J. (2005) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16205853& Childhood adversities as risk factors for adult mental disorders: results from the Health 2000 study.] ''Soc Psychiatry Psychiatr Epidemiol.'' Oct;40(10):769-77.</ref><ref>MacMillan HL, Fleming JE, Streiner DL, Lin E, Boyle MH, Jamieson E, Duku EK, Walsh CA, Wong MY, Beardslee WR. (2001) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11691695& Childhood abuse and lifetime psychopathology in a community sample.] ''Am J Psychiatry.'' Nov;158(11):1878-83.</ref> Negative or stressful life events more generally have been implicated in the development of a range of disorders, including mood and anxiety disorders. The main risks appear to be from a cumulative combination of such experiences over time, although exposure to a single major trauma can sometimes lead to psychopathology, including [[PTSD]]. [[Resilience]] to such experiences varies, and a person may be resistant to some forms of experience but susceptible to others. Features associated with variations in resilience include genetic vulnerability, temperamental characteristics, cognitive set, coping patterns, and other experiences.<ref name="Rutter2000"> |
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| − | Relationship issues have been consistently linked to the development of mental disorders, with continuing debate on the relative importance of the home environment or work/school and peer group. Issues with parenting skills or parental depression or other problems may be a risk factor. Parental divorce appears to increase risk, perhaps only if there is family discord or disorganization, although a warm supportive relationship with one parent may compensate. Details of infant feeding, weaning, toilet training etc do not appear to be importantly linked to psychopathology. Early social privation, or lack of ongoing, harmonious, secure, committed relationships, have been implicated both in childhood (including in institutional care) and also through the lifespan.in social relations and the experience of loneliness, particularly during adolescence, and the development of mental disorder.<ref>Heinrich, LM & Gullone, E. (2006) The clinical significance of loneliness: a literature review. ''Clin Psychol Rev.'' Oct;26(6):695-718. PMID 16952717</ref><ref>Hara Estroff Marano (2003) [http://www.psychologytoday.com/articles/pto-20030821-000001.html The Dangers of Loneliness] ''Psychology Today''</ref> |
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| − | ===Society and culture=== |
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| − | Problems in the wider community or culture - such as poverty, unemployment or underemployment, lack of social cohesion, migration - have been implicated in the development of mental disorder.<ref name="Rogers&Pilgram05"/><ref name="Rutter2000"/> Mental illnesses have been linked to particular social and cultural systems.<ref name=Fee>Fee, D. (2000). [http://books.google.com/books?id=YYyfbJKnbOEC&pg Pathology and the Postmodern: Mental Illness as Discourse and Experience]. London: Sage Publications Ltd.</ref><ref name=AlIssa>Al-Issa, I. (1995). ''Handbook of culture and mental illness''. Connecticut: International Universities Press.</ref><ref name=Krause>Krause, I. (2006). Hidden Points of View in Cross-cultural Psychotherapy and Ethnography. Transcultural Psychiatry, 43, 181-203.</ref><ref name=RichardsBergin>Richards, P.S. & Bergin, A. E. (2000). Handbook of Psychotherapy and Religious Diversity. Washington D.C.: American Psychological Association.</ref><ref name=Littlewood>Littlewood, R. (1997). ''Aliens and Alienists: Ethnic Minorities and Psychiatry''. London: Routledge.</ref> |
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| − | Stresses and strains related to socioeconomic position ([[Socioeconomics|socioeconomic status]] (SES) or [[social class]]) have been linked to the occurrence of major mental disorders, with a lower or more insecure educational, occupational, economic or social position generally linked to more mental disorder.<ref>Muntaner C, Eaton WW, Miech R, O'Campo P. (2004) [http://epirev.oxfordjournals.org/cgi/content/full/26/1/53 Socioeconomic position and major mental disorders.] ''Epidemiol Rev.'' 26:53-62.</ref> There have been mixed findings on the nature of the links and on the extent to which pre-existing personal characteristics influence the links. Both personal resources and community factors have been implicated, as well as interactions between individual-level and regional-level income levels.<ref>V. Lorant1,, D. Deliège1, W. Eaton2, A. Robert3, P. Philippot4 and M. Ansseau (2003) [http://aje.oxfordjournals.org/cgi/content/full/157/2/98#KWF182C19 Socioeconomic Inequalities in Depression: A Meta-Analysis] ''Am J Epidemiol'' 157:98-112.</ref> The causal role of different socioeconomic factors may vary by country.<ref>R Araya1, G Lewis1, G Rojas2 and R Fritsch (2003) [http://jech.bmj.com/cgi/content/full/57/7/501 Education and income: which is more important for mental health?] ''Journal of Epidemiology and Community Health'' 57:501-505</ref> |
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| − | Minority [[ethnic]] groups, including first or second-generation [[immigrants]], have been found to be at greater risk for developing mental disorders, which has been attributed to various kinds of life insecurities and disadvantages, including [[racism]].<ref>Chakraborty, A. & McKenzie, K (2002) [http://bjp.rcpsych.org/cgi/content/full/180/6/475 Does racial discrimination cause mental illness?] ''The British Journal of Psychiatry'' 180: 475-477</ref> |
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| − | Mental health professionals may diagnose individuals using different methodologies which may or may not include obtaining a medical or psychopathological history of a patient, performing a [[mental status examination]], conducting [[psychological testing]] such as the [[Minnesota Multiphasic Personality Inventory]] or [[intelligence quotient]] tests, obtaining [[neuroimaging|neuroimages]] through [[functional magnetic resonance imaging]] or [[positron emission tomography]] scanning, or other neurophysiologic measurements such as [[electroencephalography]].<ref name=NIMH1>National Institute of Mental Health. (2006, January 31). ''Information about Mental Illness and the Brain''. Retrieved April 19, 2007, from http://science-education.nih.gov/supplements/nih5/Mental/guide/info-mental-c.htm</ref><ref name=Hedges>Hedges, D., & Burchfield, C. (2005). ''Mind, Brain, and Drug: An introduction to psychopharmacology''. New York: Allyn & Bacon. |
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| − | </ref><ref name=Ebersole>Ebersole, J.S., & Pedley, T.A. (2003). ''Current practice of clinical electroencephalography''. Pennsylvania: Lippincott Williams & Wilkins.</ref><ref name=HedgesL /> |
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| + | In practical clinical settings it might be problematic to find several disorders in different dimensions and also differentiate the position of specific disorder in its dimensional axis like the picture indicates. |
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== Treatment == |
== Treatment == |
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| − | {{main|Treatment of mental |
+ | {{main|Treatment of mental disorders}} |
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| ⚫ | Mental health services may be based in hospitals, clinics or the community. Often an individual may engage in different treatment modalities. They may be under [[case management]] (sometimes referred to as "service coordination"), use inpatient or [[partial hospitalization|day treatment]], utilize a [[Clubhouse Model of Psychosocial Rehabilitation|psychosocial rehabilitation]] program, and/or take part in an [[Assertive Community Treatment]] program. Individuals may be treated against their will in some cases, especially if assessed to be at high risk to themselves or others. Services in some countries are increasingly based on a [[Recovery model]] that supports an individual's journey to regain a meaningful life. |
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| + | ===Psychotherapy=== |
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| − | Mental health professionals treat mental disorders differently using one or a combination of [[psychotherapy]], [[psychiatric medication]], [[case management]], or other practices.<ref name=Gazzaniga /><ref name=NIMH1 /> 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<ref>{{cite journal| quotes = Music therapy may provide a means of improving mental health among people with schizophrenia, but its effects in acute psychoses have not been explored | last = Crawford | first = Mike J. | authorlink = | coauthors = Talwar, Nakul, ''et al.'' | year = 2006 | month = November | title = Music therapy for in-patients with schizophrenia: Exploratory randomised controlled trial | journal = The British Journal of Psychiatry (2006) | volume = 189 | pages = 405-409 | url = http://bjp.rcpsych.org/cgi/content/abstract/189/5/405}}</ref> |
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| + | {{wikinews|Dr. Joseph Merlino on sexuality, insanity, Freud, fetishes and apathy}} |
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| + | A major option for many mental disorders is [[psychotherapy]]. There are several main types. [[Cognitive behavioral therapy]] (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. [[Psychoanalysis]], addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. [[Systemic therapy]] or [[family therapy]] is sometimes used, addressing a network of signicant others as well as an individual. Some psychotherapies are based on a [[humanistic psychology|humanistic]] approach. There are a number of specific therapies used for particular disorders, which may be offshoots or hybrids of the above types. [[Mental health professionals]] often employ an [[Integrative Psychotherapy|eclectic or integrative approach]]. Much may depend on the [[therapeutic relationship]], and there may be problems with [[trust]], [[confidentiality]] and [[engagement]]. |
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| + | ===Medication=== |
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| ⚫ | Often an individual may engage in different treatment modalities |
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| + | A major option for many mental disorders is [[psychiatric medication]]. There are several main groups. [[Antidepressants]] are used for the treatment of [[clinical depression]] as well as often for anxiety and other disorders. [[Anxiolytics]] are used for [[anxiety disorder]]s and related problems such as insomnia. [[Mood stabilizers]] are used primarily in [[bipolar disorder]], mainly targeting [[mania]] rather than depression. [[Antipsychotics]] are used for [[psychosis|psychotic disorders]], notably for positive symptoms in [[schizophrenia]]. [[Stimulants]] are commonly used, notably for [[ADHD]]. Despite the different conventional names of the drug groups, there can be considerable overlap in the kinds of disorders for which they are actually indicated. There may also be [[off-label use]]. There can be problems with [[adverse effects]] and [[Compliance (medicine)|adherence]]. |
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| − | Mental health services may be based in hospitals, clinics or the community. |
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| + | Electroconvulsive therapy ([[ECT]]) is sometimes used in severe casees when other interventions have failed. [[Psychosurgery]] is no longer generally used. [[Psychoeducation]] may be used to provide people with the information to understand and manage their problems. Creative therapies are sometimes used, including [[music therapy]], [[art therapy]] or [[drama therapy]]. Lifestyle adjustments and supportive measures are often used, including [[peer support]], [[self-help]] and supported [[housing]] or [[employment]]. Some advocate [[dietary supplements]]. Many things have been found to help at least some people. A [[placebo]] effect may play a role in any intervention. |
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| − | Some approaches are based on a [[psychosocial recovery|recovery model]] of mental disorder, and may focus on challenging [[stigma]] and [[social exclusion]] and creating empowerment and hope<ref>Repper, J. & Perkins, R. (2006) ''Social Inclusion and Recovery: A Model for Mental Health Practice.'' Bailliere Tindall, UK. ISBN 0702026018</ref> |
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| + | {{section-stub}} |
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| + | There is substantial variation over time between disorders, and between individuals. Functional ability may also vary across different domains. There may be [[remission]] of symptoms, but also [[relapse]]. Rates of [[recovery]] vary. A number of individual and social factors have been linked to prognosis. |
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| + | Despite often being characterized in purely negative terms, mental disorders can involve above-average creativity, non-conformity, goal-striving, meticulousness, or empathy.<ref name="Rogers&Pilgram05"/> The public perception of the level of disability associated with mental disorders can change.<ref>Ferney, V. (2003) [http://www.newyorkcityvoices.org/2003janmar/20030318.html The Hierarchy of Mental Illness: Which diagnosis is the least debilitating?] ''New York City Voices'' Jan/March</ref> |
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| − | 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 (medicine)|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.<ref>America's [[Mental Health Survey]], National Mental Health Association, 2001.</ref> Fear of disclosure, rejection by friends, and ultimately discrimination are just a few reasons why people with mental health conditions don't seek help.{{Fact|date=April 2007}} |
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| + | [[WHO]] estimated that about 450 million people worldwide currently suffer from some form of mental or behavioural disorder.<ref>[http://www.who.int/whr/2001/chapter1/en/index.html WHO | The world health report]</ref> One in four people will suffer from mental illness at some time in life, according to a report from the WHO.<ref>[http://www.psychiatrictimes.com/p020101a.html Mental Health Care in the Developing World]</ref><ref>[http://news.bbc.co.uk/2/hi/health/1578755.stm Mental problems 'hit one in four']</ref> |
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| + | {{Main|Prevalence of mental disorders}} |
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| − | Numerous large-scale surveys of the [[prevalence]] of mental disorders in adults in the general population have been carried out since the 1980s based on self-reported symptoms assessed by standardized structured interviews, usually carried out over the phone. Mental disorders have been found to be common, with over a third of people in most countries reporting sufficient criteria at some point in their life.<ref>WHO International Consortium in Psychiatric Epidemiology (2000) [http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862000000400003&lng=&nrm=iso Cross-national comparisons of the prevalences and correlates of mental disorders] ''Bulletin of the World Health Organization'' v.78 n.4</ref> The [[World Health Organization]] is currently undertaking a global survey of 26 countries in all regions of the world, based on [[ICD]] and [[DSM]] criteria.[http://www.hcp.med.harvard.edu/wmh/index.php] The first published figures on the 14 country surveys completed to date, indicate that, of those disorders assessed, anxiety disorders are the most common in all but 1 country (prevalence in the prior 12-month period of 2.4% to 18.2%) and mood disorders next most common in all but 2 countries (12-month prevalence of 0.8% to 9.6%), while substance disorders (0.1%-6.4%) and impulse-control disorders (0.0%-6.8%) were consistently less prevalent. The United States, Colombia, the Netherlands and Ukraine tended to have higher prevalence estimates across most classes of disorder, while Nigeria, Shanghai and Italy were consistently low, and prevalence was lower in Asian countries in general. Cases of disorder were rated as mild (prevalence of 1.8%-9.7%), moderate (prevalence of 0.5%-9.4%) and serious (prevalence of 0.4%-7.7%).<ref>WHO World Mental Health Survey Consortium. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15173149 Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.] ''JAMA.'' Jun 2;291(21):2581-90.</ref> |
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| − | A review that pooled surveys in different countries up to 2004 found overall average prevalence estimates for any anxiety disorder of 10.6% (in the 12 months prior to assessment) and 16.6% (in lifetime prior to assessment), but that rates for individual disorders varied widely. Women had generally higher prevalence rates than men, but the magnitude of the difference varied.<ref>Somers JM, Goldner EM, Waraich P, Hsu L. (2006) [http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2004/february/waraich.asp Prevalence and incidence studies of anxiety disorders: a systematic review of the literature.] ''Can J Psychiatry.'' Feb;51(2):100-13.</ref> A review that pooled surveys of mood disorders in different countries up to 2000 found 12-month prevalence rates of 4.1% for major depressive disorder (MDD), 2% for dysthymic disorder and 0.72% for bipolar 1 disorder. The average lifetime prevalance found was 6.7% for MDD (with a relatively low lifetime prevalence rate in higher-quality studies, compared to the rates typically highlighted of 5%-12% for men and 10%-25% for women), and rates of 3.6% for dysthymia and 0.8% for Bipolar 1.<ref>Waraich P, Goldner EM, Somers JM, Hsu L. (2004) [http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2004/february/waraich.asp Prevalence and incidence studies of mood disorders: a systematic review of the literature.] ''Can J Psychiatry.'' Feb;49(2):124-38.</ref> |
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| − | Previous widely cited large-scale surveys in the United States were the Epidemiological Catchment Area (ECA) survey and subsequent [[National Comorbidity Survey]] (NCS). The NCS was replicated and updated between 2000 and 2003 and indicated that, of those groups of disorders assessed, nearly half of Americans (46.4%) reported meeting criteria at some point in their life for either a DSM-IV anxiety disorder (28.8%), mood disorder (20.8%), impulse-control disorder (24.8%) or substance use disorders (14.6%). Half of all lifetime cases had started by age 14 years and 3/4 by age 24 years.<ref>Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. (2005) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15939837 Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.] ''Arch Gen Psychiatry''. Jun;62(6):593-602.</ref> In the prior 12-month period only, around a quarter (26.2%) met criteria for any disorder - anxiety disorders 18.1%; mood disorders 9.5%; impulse control disorders 8.9%; and substance use disorderes 3.8%. A substantial minority (23%) met criteria for more than two disorders. A minority (22.3%) of cases were classed as serious, 37.3% as moderate and 40.4% as mild.<ref>Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters, EE. (2005) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15939839 Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.] ''Arch Gen Psychiatry.'' Jun;62(6):617-27.</ref><ref>US National Institute of Mental Health (2006) [http://www.nimh.nih.gov/publicat/numbers.cfm The Numbers Count: Mental Disorders in America] Retrieved May 2007</ref> |
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| − | A 2004 cross-European study found that approximately one in four people reported meeting criteria at some point in their life for one of the DSM-IV disorders assessed, which included mood disorders (13.9%), anxiety disorders (13.6%) or alcohol disorder (5.2%). Approximately one in ten met criteria within a 12-month period. Women and younger people of either gender showed more cases of disorder<ref>ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15128384 Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.] ''Acta Psychiatr Scand'' Suppl. (420):21-7.</ref> |
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| − | A 2005 review of prior surveys in 46 countries on the prevalence of schizophrenic disorders, including a prior 10-country WHO survey, found an average (median) figure of 0.4% for lifetime prevalence up to the point of assessment and 0.3% in the 12-month period prior to assessment. A related figure not given in other studies (known as lifetime morbid risk), reported to be an accurate statement of how many people would theoretically develop schizophrenia at any point in life regardless of time of assessment, was found to be “about seven to eight individuals per 1,000.” (0.7/0.8%). The prevalence of schizophrenia was consistently lower in poorer countries than in richer countries (though not the [[incidence]]) but the prevalence did not differ between urban/rural areas or men/women (although incidence did).<ref>Saha S, Chant D, Welham J, McGrath J. (2005) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15916472 A systematic review of the prevalence of schizophrenia.] ''PLoS Med.'' 2005 May;2(5):e141.</ref> |
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| − | Studies of the prevalence of personality disorders (PDs) have been fewer and smaller-scale, but a broader Norwegian survey found a similar overall prevalence of almost 1 in 7 (13.4%), based on meeting personality criteria over the prior five year period. Rates for specific disorders ranged from 0.8% to 2.8%, with rates differing across countries, and by gender, educational level and other factors<ref>Torgersen S, Kringlen E, Cramer V. (2001) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11386989 The prevalence of personality disorders in a community sample.] ''Arch Gen Psychiatry.'' 2001</ref> A US survey that incidentally screened for personality disorder found an overal rate of 14.79%.<ref> Grant BF, Hasin DS, Stinson FS, Dawson DA,Chou SP, Ruan WJ, Pickering RP. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15291684 Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions.] ''J Clin Psychiatry.'' Jul;65(7):948-58.</ref> |
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| − | Approximately 7% of a preschool pediatric sample were given a psychiatric diagnosis in one clinical study, and approximately 10% of 1- and 2-year-olds receiving developmental screening have been assessed as having significant emotional/behavioral problems based on parent and pediatrician reports.<ref>Carter, AS., Briggs-Gowan, MJ. & Davis, NO. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14959805 Assessment of young children's social-emotional development and psychopathology: recent advances and recommendations for practice.] ''J Child Psychol Psychiatry.'' Jan;45(1):109-34.</ref> |
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| − | The understanding and classification of mental illness has changed over time and across cultures. [[Hippocrates]] considered the idea that mental illness may be related to biology.<ref name=Stong>Stong, C. (2005). The Evolution of NeuroPsychiatry. ''Neuropsychiatry Reviews, 6''.</ref><ref name=Hedges /> During the middle ages many individuals thought mental illness could only be the result of [[demonic possession]].<ref name=Kroll>Kroll J., & Bachrach, B. (1984). Sin and mental illness in the Middle Ages. ''Psychological Medicine, 14'', 507-514.</ref> [[Paracelsus]] used the word [[lunatic]] to describe those affected by the [[lunar effect]], wherein phases of the moon were thought to affect behavior.<ref name=SaludMental>Delgado, J.M., Doherty, A.M.S., Ceballos, R.M., Erkert, H.G. (2000). Moon Cycle Effects on Humans: Myth or Reality? ''Salud Mental, 23'', 33-39.</ref> From the early study of mental illness through individuals such as [[Philippe Pinel]], [[Sigmund Freud]], and [[Alois Alzheimer]], much has changed in the development and understanding of mental illness and continues to change today. At the start of the [[20th century]] there were only a dozen recognized mental health conditions.{{Fact|date=April 2007}} By 1952 there were 192, and the [[Diagnostic and Statistical Manual of Mental Disorders|Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition]] (DSM-IV) today lists 374. |
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{{main|Mental health professional}} |
{{main|Mental health professional}} |
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| − | A number of [[professions]] have developed that specialise in mental |
+ | A number of [[professions]] have developed that specialise in the treatment of mental disorders, including the [[Medicine|medical]] speciality of [[psychiatry]] (including psychiatric nursing)<ref name=AJP154Editorial>A, N.C. (1997). What is Psychiatry? ''The American Journal of Psychiatry, 154'', 591-593.</ref><ref name=UM>University of Melbourne. (2005, August 19). ''What is Psychiatry?''. Retrieved April 19, 2007, from http://www.psychiatry.unimelb.edu.au/info/what_is_psych.html</ref><ref name=CPA>California Psychiatric Association. (2007, February 28). ''Frequently Asked Questions About Psychiatry & Psychiatrists''. Retrieved April 19, 2007, from http://www.calpsych.org/publications/cpa/faqs.html</ref>, the division of [[psychology]] known as [[clinical psychology]]<ref>American Psychological Association, Division 12, http://www.apa.org/divisions/div12/aboutcp.html</ref>, [[social work|Social Work]]<ref>Golightley, M. (2004) Social work and Mental Health Learning Matters, UK</ref>, as well as Mental Health Counselors, Marriage and Family Therapists, [[Psychotherapists]], [[Counselors]] and [[Public Health]] professionals. Those with personal experience of using mental health services are also increasingly involved in researching and delivering mental health services and working as mental health professionals.<ref>Goldstrom ID, Campbell J, Rogers JA, et al (2006) [http://www.springerlink.com/content/u132325343qlw4r0/ National estimates for mental health mutual support groups, self-help organizations, and consumer-operated services.] ''Administration and Policy in Mental Health and Mental Health Services Research'', 33:92–102</ref><ref>The Joseph Rowntree Foundation (1998) [http://www.jrf.org.uk/knowledge/findings/socialcare/SCR488.asp The experiences of mental health service users as mental health professionals]</ref><ref>Chamberlin J. (2005) User/consumer involvement in mental health service delivery. ''Epidemiol Psichiatr Soc.'' Jan-Mar;14(1):10-4. PMID 15792289</ref><ref>Terence V. McCann, John Baird, Eileen Clark, Sai Lu (2006) [http://www.blackwell-synergy.com/doi/abs/10.1111/j.1447-0349.2006.00432.x Beliefs about using consumer consultants in inpatient psychiatric units] ''International Journal of Mental Health Nursing'' 15 (4), 258–265.</ref> The different clinical and scientific perspectives draw on diverse fields of research and theory, and different disciplines may favor differing models, explanations and goals.<ref name="Rogers&Pilgram05">Rogers, A. & Pilgram, D. (2005) ''A Sociology of Mental Health and Illness'', Open University Press, 3rd Edition. ISBN 0335215831</ref> |
== Movements == |
== Movements == |
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| + | The [[Consumer/Survivor Movement]] (also known as user/survivor movement) is made up of individuals (and organizations representing them) who are clients of mental health services or who consider themselves "survivors" of mental health services. The movement campaigns for improved mental health services and for more involvement and empowerment within mental health services, policies and wider society.<ref>Everett, B. (1994) [http://www.umaine.edu/JMB/archives/volume15/15_1-2_1994winterspring.html#abstract4 Something is happening: the contemporary consumer and psychiatric survivor movement in historical context.] ''Journal of Mind and Behavior'', 15:55–7</ref><ref>Rissmiller DJ & Rissmiller JH (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=16754765&dopt=Abstract Evolution of the antipsychiatry movement into mental health consumerism. ] ''Psychiatric Services'', Jun;57(6):863-6.</ref><ref>Oaks, D. (2006) [http://psychservices.psychiatryonline.org/cgi/content/full/57/8/1212 The Evolution of the Consumer Movement] ''Psychiatric Services'' 57:1212</ref> [[Patient advocacy]] organizations have expanded with increasing [[deinstitutionalization]] in developed countries, working to challenge the [[stereotypes]], [[stigma]] and exclusion associated with psychiatric conditions. An [[antipsychiatry]] movement fundamentally challenges mainstream psychiatric theory and practice, including the reality or utility of psychiatric diagnoses of mental illnesses.<ref name=AntiPsychCoal>The Antipsychiatry Coalition. (2005, November 26). The Antipsychiatry Coalition. Retrieved April 19, 2007, from www.antipsychiatry.org</ref><ref>Anthony Paul O'Brien, Martin Woods, Christine Palmer (2001) [http://www.blackwell-synergy.com/doi/abs/10.1046/j.1440-0979.2001.00183.x The emancipation of nursing practice: Applying anti-psychiatry to the therapeutic community.] Australian and New Zealand Journal of Mental Health Nursing 10 (1), 3–9.</ref> |
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| − | [[Patient advocacy]] organizations and the [[consumer/survivor movement]], which expanded with increasing [[deinstitutionalization]], have worked to challenge the [[stereotypes]] and [[stigma]] associated with psychiatric conditions. Strengths are highlighted, rather than a focus only on 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. An [[antipsychiatry]] movement fundamentally challenges mainstream psychiatric theory and practice, including the existence or classifications of mental illness<ref name=AntiPsychCoal>The Antipsychiatry Coalition. (2005, November 26). The Antipsychiatry Coalition. Retrieved April 19, 2007, from http://64.233.167.104/search?q=cache:BxiqBa38GUsJ:www.antipsychiatry.org/+Anti-psychiatry&hl=en&ct=clnk&cd=1&gl=us</ref> |
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| + | <ref>Weitz D. (2003) Call me antipsychiatry activist--not "consumer" ''Ethical Hum Sci Serv.'' Spring;5(1):71-2. PMID 15279009</ref> |
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== Laws and policies == |
== Laws and policies == |
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| + | Three quarters of countries around the world have mental |
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| − | {{globalize}} |
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| + | health legislation. Compulsory admission to mental health facilities (also known as [[Involuntary commitment]] or [[sectioning]]), is a controversial topic. From some points of view it can impinge on personal liberty and the right to choose, and carry the risk of abuse for political, social and other reasons; from other points of view, it can potentially prevent harm to self and others, and assist some people in attaining their right to healthcare when unable to decide in their own interests.<ref name="WHORIGHTS">World Health Organization (2005) [http://www.who.int/mental_health/policy/who_rb_mnh_hr_leg_FINAL_11_07_05.pdf WHO Resource Book on Mental Health: Human rights and legislation] ISBN 924156282 (PDF)</ref> |
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| + | All human-rights orientated mental health laws require proof of the presence of a mental disorder as defined by internationally accepted standards, but the type and severity of disorder that counts can vary in different jurisdictions. The two most often utilized grounds for involuntary admission are said to be serious likelihood of immediate or imminent danger to self or others, and the need for treatment. Applications for someone to be involuntarily admitted may usually come from a mental health practitioner, a family member, a close relative, or a guardian. Human-rights-orientated laws usually stipulate that independent medical practitioners or other accredited mental health practitioners must examine the patient separately and that there should be regular, time-bound review by an independent review body.<ref name="WHORIGHTS"/> An individual must be shown to lack the capacity to give or withhold informed consent (i.e. to understand treatment information and its implications). Proxy consent (also known as [[substituted decision-making]]) may be given to a personal representative, a family member or a legally appointed guardian, or patients may have been able to enact an [[advance directive]] as to how they wish to be treated.<ref name="WHORIGHTS"/> The right to [[supported decision-making]] may also be included in legislation.<ref>Manitoba Family Services and Housing. The Vulnerable Persons Living with a Mental Disability Act, 1996</ref> Involuntary treatment laws may be extended to those living in the community, for example [[Community Treatment Order]]s (CTOs) are used in [[New Zealand]], [[Australia]] and 38 states in the [[US]] and are being planned in the [[UK]].<ref>[http://news.independent.co.uk/uk/legal/article2137689.ece The Big Question: Will the new mental health Bill make Britain a safer place?]</ref> |
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| − | 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. This generally applies to inpatient hospital treatment. [[Community Treatment Order]]s (CTOs) are also used in New Zealand, Australia and 38 states in the US and are being planned in the UK.{{Fact|date=April 2007}}. |
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| + | The World Health Organization reports that in many instances national mental health legislation takes away the rights of persons with mental disorders rather than protecting rights, and is often outdated.<ref name="WHORIGHTS"/> In 1991, the [[United Nations]] adopted the [[Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care]], which established minimum human rights standards of practice in the mental health field. In 2006 the UN formally agreed the [[Convention on the Rights of Persons with Disabilities]] to protect and enhance the rights and opportunities of disabled people, including those with psychosocial disabilities<ref>[http://www.un.org/esa/socdev/enable/ ENABLE website] UN section on disability</ref> |
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| − | There is also legislation to protect the rights of those seen as having a mental disorder or disability.{{Fact|date=April 2007}}. |
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| − | The specific relevant legislation in the [[United Kingdom]] is the [[Mental Health Act]], including allowances and procedures for detaining and treating a person with a mental disorder without their consent (known unofficially as "sectioning"). An amended Act is currently being proposed and considered amidst controversy.<ref>Department of Health [http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Mentalhealth/DH_073490 Mental Health Bill]</ref><ref>[http://news.independent.co.uk/uk/legal/article2137689.ece The Big Question: Will the new mental health Bill make Britain a safer place?]</ref> |
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| + | Media coverage of mental illness comprises predominantly negative depictions, for example, of incompetence, violence or criminality, with far less coverage of positive issues such as accomplishments or [[human rights]] issues.<ref>Coverdate, J., Nairn, R. & Claasen, D. (2001) [http://www.blackwell-synergy.com/doi/abs/10.1046/j.1440-1614.2002.00998.x?journalCode=anpquick Depictions of mental illness in print media: a prospective national sample] ''Australian and New Zealand Journal of Psychiatry'', 36 (5), 697–700.</ref><ref>Edney, RD. (2004) [http://www.ontario.cmha.ca/content/about_mental_illness/mass_media.asp Mass Media and Mental Illness: A Literature Review] Canadian Mental Health Association</ref><ref>Diefenbach, D.L. (1998) [http://www3.interscience.wiley.com/cgi-bin/abstract/46099/ABSTRACT?CRETRY=1&SRETRY=0 The portrayal of mental illness on prime-time television] ''Journal of Community Psychology'' Vol 25, Issue 3, Pages 289-302</ref> Such negative depictions, including in children's cartoons, are thought to contribute to [[stigma]] and negative attitudes in the public and in those with mental health problems themselves, although more sensitive or serious cinematic portrayals have increased in prevalence.<ref>Sieff, E. (2003) [http://www.ingentaconnect.com/content/routledg/cjmh/2003/00000012/00000003/art00006 Media frames of mental illnesses: The potential impact of negative frames] ''Journal of Mental Health'', Vol 12(3) pp. 259-269</ref><ref>Wahl, O.F. (2003) [http://abs.sagepub.com/cgi/content/abstract/46/12/1594 News Media Portrayal of Mental Illness: Implications for Public Policy] ''American Behavioral Scientist'' Vol. 46, No. 12, 1594-1600</ref> |
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| − | {{Sectstub}} |
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| + | === General public === |
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| − | ==Violence== |
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| ⚫ | The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill.<ref>Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. (1999) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=10474548 Public conceptions of mental illness: labels, causes, dangerousness, and social distance.] ''Am J Public Health.'' Sep;89(9):1328-33.</ref> Japan has been reported to have more negative attitudes than Australia, although stigma appears common in both countries.<ref>Griffiths KM, Nakane Y, Christensen H, Yoshioka K, Jorm AF, Nakane H. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16716231 Stigma in response to mental disorders: a comparison of Australia and Japan.] ''BMC Psychiatry.'' May 23;6:21.</ref> |
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| − | {{Globalize}} |
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| ⚫ | The public fear of violence due to mental illness is a contentious topic. One US national survey indicated that a far higher percentage of Americans rated individuals described as displaying the characteristics of a mental disorder (for example Schizophrenia or Substance Use Disorder) as "likely to do something violent to others" compared to those described as being 'troubled'.<ref>Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S. (1999) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10474550 The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems.] ''American Journal of Public Health.'' Sep;89(9):1339-45.</ref> Research indicates, on balance, a higher than average number of violent acts by some individuals with certain diagnoses, notably antisocial or psychopathic personality disorders, but conflicting findings about specific symptoms (for example links between psychosis and violence in community settings) - but the mediating factors of such acts are most consistently found to be mainly socio-demographic and socio-economic factors such as being young, [[male]], of lower socio-economic [[status]] and, in particular, substance abuse (including [[alcohol]]).<ref name="Stuart03">Stuart, H. (2003) [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525086 Violence and mental illness: an overview.] '' World Psychiatry. June; 2(2): 121–124</ref><ref>Steadman HJ, Mulvey EP, Monahan J, Robbins PC, Appelbaum PS, Grisso T, Roth LH, Silver E. (1998) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=9596041 Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods.] ''Archives of General Psychiatry.'' May;55(5):393-401.</ref><ref name="Rogers&Pilgram05"/> Findings consistently indicate that it is many times more likely that people diagnosed with a serious mental illness living in the community will be the victim rather than the perpetrator of violence.<ref name="Stuart03"/><ref>Brekke JS, Prindle C, Bae SW, Long JD (2001). Risks for individuals with schizophrenia who are living in the community. Psychiatric Services. Oct;52(10):1358–66. PMID 11585953</ref> 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]]"), including within a family setting,<ref>Solomon, PL., Cavanaugh, MM., Gelles, RJ. (2005) [http://tva.sagepub.com/cgi/content/abstract/6/1/40 Family Violence among Adults with Severe Mental Illness.] ''Trauma, Violence, & Abuse'', Vol. 6, No. 1, 40-54</ref> as well as being an issue in healthcare settings<ref>Chou, KR., Lu, RB., Chang, M. (2001) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11779087 Assaultive behavior by psychiatric in-patients and its related factors.] ''Journal of Nursing Research.'' Dec;9(5):139-51</ref> and the wider community.<ref>B. Lögdberg, L.-L. Nilsson, M. T. Levander, S. Levander (2004) [http://www.blackwell-synergy.com/links/doi/10.1111/j.1600-0047.2004.00322.x/abs/ Schizophrenia, neighbourhood, and crime.] ''Acta Psychiatrica Scandinavica,'' 110(2) Page 92.</ref> |
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| − | Violent acts by individuals seen as mentally ill, and the public fear of such acts, are a contentious topic. In a US national survey a far higher percentage of Americans rated individuals described as displaying the characteristics of a mental disorder (for example Schizophrenia or Substance Use Disorder) as "likely to do something violent to others" compared to those described as being 'troubled'.<ref>Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S. (1999) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10474550 The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems.] ''American Journal of Public Health.'' Sep;89(9):1339-45.</ref> |
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| − | == Media coverage and cultural references == |
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| − | 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.<ref>Coverdate, J., Nairn, R. & Claasen, D. (2001) [http://www.blackwell-synergy.com/doi/abs/10.1046/j.1440-1614.2002.00998.x?journalCode=anpquick Depictions of mental illness in print media: a prospective national sample] ''Australian and New Zealand Journal of Psychiatry'', 36 (5), 697–700.</ref><ref>Edney, RD. (2004) [http://www.ontario.cmha.ca/content/about_mental_illness/mass_media.asp Mass Media and Mental Illness: A Literature Review] Canadian Mental Health Association</ref> |
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| ⚫ | The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill.<ref>Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. (1999) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=10474548 Public conceptions of mental illness: labels, causes, dangerousness, and social distance.] ''Am J Public Health.'' Sep;89(9):1328-33.</ref> Japan has been reported to have more negative attitudes than Australia, although stigma appears common in both countries.<ref>Griffiths KM, Nakane Y, Christensen H, Yoshioka K, Jorm AF, Nakane H. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16716231 Stigma in response to mental disorders: a comparison of Australia and Japan.] ''BMC Psychiatry.'' May 23;6:21.</ref> |
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| + | ===Employment=== |
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| − | Employment discrimination |
+ | [[Employment discrimination]] is reported to play a significant part in the high rate of [[unemployment]] among those with a diagnosis of mental illness<ref>Heather Stuart (2006) [http://www.medscape.com/viewarticle/542517 Mental Illness and Employment Discrimination] ''Current Opinion in Psychiatry'' 19(5):522-526.</ref> Schemes to combat [[stigma]] have been prioritized by global and national psychiatric organizations, but their methods and outcomes have been criticized as counterproductive.<ref>Read, J., Haslam, N., Sayce, L., Davies, E. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17022790 Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach] ''Acta Psychiatr Scand. Nov;114(5):303-18</ref> |
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== See also == |
== See also == |
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* [[Adjustment disorders]] |
* [[Adjustment disorders]] |
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* [[Alexithymia]] |
* [[Alexithymia]] |
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| + | * [[Anti-psychiatry]] |
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* [[Anxiety disorders]] |
* [[Anxiety disorders]] |
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* [[Behavior disorders]] |
* [[Behavior disorders]] |
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* [[Congenital disorders]] |
* [[Congenital disorders]] |
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* [[Consciousness disturbances]] |
* [[Consciousness disturbances]] |
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| − | * [[Defense |
+ | * [[Defense mechanisms]] |
* [[Dementia]] |
* [[Dementia]] |
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* [[Disease course]] |
* [[Disease course]] |
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{{col-break}} |
{{col-break}} |
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* [[Memory disorders]] |
* [[Memory disorders]] |
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| + | * [[Mental disorders and gender]] |
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| + | * [[Mental disorder defence]] |
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* [[Mental health]] |
* [[Mental health]] |
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* [[Mental illness (Attitudes towards)]] |
* [[Mental illness (Attitudes towards)]] |
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* [[Mentally ill offenders]] |
* [[Mentally ill offenders]] |
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| + | * [[Mental retardation]] |
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* [[Neurosis]] |
* [[Neurosis]] |
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* [[Organic brain syndromes]] |
* [[Organic brain syndromes]] |
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* [[Sleep disorders]] |
* [[Sleep disorders]] |
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* [[Structured clinical interview]] |
* [[Structured clinical interview]] |
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| + | * [[Structured Clinical Interview for DSM-IV]] ''(SCID)'' |
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* [[Special needs]] |
* [[Special needs]] |
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* [[Suicide]] |
* [[Suicide]] |
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{{col-end}} |
{{col-end}} |
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| + | ==Spoken Psychology Wiki== |
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| + | {{Spoken Psychology Wiki|Mental_illness.ogg|2005-08-20}} |
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==References== |
==References== |
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[[Category:Disability]] |
[[Category:Disability]] |
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[[Category:Medical ethics]] |
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Revision as of 15:03, 30 December 2007
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Clinical: Approaches · Group therapy · Techniques · Types of problem · Areas of specialism · Taxonomies · Therapeutic issues · Modes of delivery · Model translation project · Personal experiences ·
Mental disorder or mental illness are terms used to refer a psychological or physiological pattern that occurs in an individual and is usually associated with distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental disorders has changed over time. Definitions, assessments, and classifications of mental disorders can vary, but guideline criterion listed in the ICD, DSM and other manuals are widely accepted by mental health professionals. Categories of diagnoses in these schemes may include mood disorders, anxiety disorders, psychotic disorders, eating disorders, developmental disorders, personality disorders, and many other categories. In many cases there is no single accepted or consistent cause of mental disorders, although they are widely understood in terms of a diathesis-stress model and biopsychosocial model. Mental disorders have been found to be common, with over a third of people in most countries reporting sufficient criteria at some point in their life. Mental health services may be based in hospitals or in the community. Mental health professionals diagnose individuals using different methodologies, often relying on case history and interview. Psychotherapy and psychiatric medication are two major treatment options, as well as supportive interventions. Treatment may be involuntary where legislation allows. A number of movements campaign for changes to mental health services and attitudes, including the Consumer/Survivor Movement. There are widespread problems with stigma and discrimination.
History
- Main article: History of mental disorders
A number of mental disturbances, such as melancholy, hysteria and phobia, were described long ago in Ancient Greece and Rome, while others such as schizophrenia may not have been recognized.[1] Hippocrates considered the idea that mental illness may be related to biology.[2]
Psychiatric theories and treatments for mental illness developed in Islamic medicine in the Middle East, notably from the 8th century at the Baghdad Hospital under the physician Rhazes.
Medieval Europe had focused on demonic possession as the explanation of aberrant behavior.[3] Paracelsus used the word lunatic to describe behavior thought to be caused by the lunar effect.[4] Many other terms for mental disorder that found their way into everyday use have been traced to initial use in the 16th and 17th centuries. [5] Shakespeare and his contemporaries frequently depicted mental disorders in their plays. [6] Conditions of "shell shock" came to be recognized in war veterans. Homosexuality was viewed as a mental illness. From the early study of mental illness through individuals such as Philippe Pinel, Sigmund Freud, and Alois Alzheimer, much has changed in the development and understanding of mental illness and continues to change today.
At the start of the 20th century there were only a dozen officially recognized mental health conditions.[How to reference and link to summary or text]. By 1952 there were 192 and the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) today lists 374.
Classification
- Main article: Classification of mental disorders
The definition and classification of mental disorder is a key issue for the mental health professions and for users and providers of mental health services. Most international clinical documents use the term "mental disorder" rather than "mental illness". There is no single definition and the inclusion criteria are said to vary depending on the social, legal and political context. In general, however, a mental disorder has been characterized as a clinically significant behavioral or psychological pattern that occurs in an individual and is usually associated with distress, disability or increased risk of suffering. There is often a criterion that a condition should not be expected to occur as part of a person's usual culture or religion. The term "serious mental illness" (SMI) is sometimes used to refer to more severe and long-lasting disorder. A broad definition can cover mental disorder, mental retardation, personality disorder and substance dependence. The phrase "mental health problems" may be used to refer only to milder or more transient issues.
There are currently two widely established systems that classify mental disorders - Chapter V of the International Classification of Diseases (ICD-10), produced by the World Health Organization (WHO), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) produced by the American Psychiatric Association (APA). Both list categories of disorder and provide standardized criteria for diagnosis. They have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. Other classification schemes may be in use more locally, for example the Chinese Classification of Mental Disorders. Other manuals may be used by those of alternative theoretical persuasions, for example the Psychodynamic Diagnostic Manual.
Some approaches to classification do not employ distinct categories based on cut-offs separating the abnormal from the normal. They are variously referred to as spectrum, continuum or dimensional systems. There is a significant scientific debate about the relative merits of a categorical or a non-categorical system. There is also significant controversy about the role of science and values in classification schemes, and about the professional, legal and social uses to which they are put.
Disorders
| This section needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. This section has been tagged since June 2007. |
There are many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered.[7][8][9][10]
The state of anxiety or fear can become disordered, so that it is unusually intense or generalized over a prolonged period of time. Commonly recognized categories of anxiety disorders include specific phobia, Generalized anxiety disorder, Social Anxiety Disorder, Panic Disorder, Agoraphobia, Obsessive-Compulsive Disorder, Post-traumatic stress disorder. Relatively long lasting affective states can also become disordered. Mood disorder involving unusually intense and sustained sadness, melancholia or despair is know as Clinical depression (or Major depression), and may more generally be described as Emotional dysregulation. Milder but prolonged depression can be diagnosed as dysthymia. Bipolar disorder involves abnormally "high" or pressured mood states, known as mania or hypomania, alternating with normal or depressed mood. Whether unipolar and bipolar mood phenomena represent distinct categories of disorder, or whether they usually mix and merge together along a dimension or spectrum of mood, is under debate in the scientific literature.[11]
Patterns of belief, language use and perception can become disordered. Psychotic disorders centrally involving this domain include Schizophrenia and Delusional disorder. Schizoaffective disorder is a category used for individuals showing aspects of both schizophrenia and affective disorders. Schizotypy is a category used for individuals showing some of the traits associated with schizophrenia but without meeting cut-off criteria.
The fundamental characteristics of a person that influence his or her cognitions, motivations, and behaviors across situations and time - can be seen as disordered due to being abnormally rigid and maladaptive. Categorical schemes list a number of different personality disorders, such as those classed as eccentric (e.g. Paranoid personality disorder, Schizoid personality disorder, Schizotypal personality disorder), those described as dramatic or emotional (Antisocial personality disorder, Borderline personality disorder, Histrionic personality disorder, Narcissistic personality disorder) or those seen as fear-related (Avoidant personality disorder, Dependent personality disorder, Obsessive-compulsive personality disorder).
There may be an emerging consensus that personality disorders, like personality traits in the normal range, incorporate a mixture of more acute dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable.[12] Non-categorical schemes may rate individuals via a profile across different dimensions of personality that are not seen as cut off from normal personality variation, commonly through schemes based on the Big Five personality traits.[13]
Other disorders may involve other attributes of human functioning. Eating practices can be disordered, at least in relatively rich industrialized areas, with either compulsive over-eating or under-eating or binging. Categories of disorder in this area include Anorexia nervosa and Bulimia nervosa or Binge eating disorder. Sleep disorders such as Insomnia also exist and can disrupt normal sleep patterns. Sexual and gender identity disorders, such as Dyspareunia or Gender identity disorder or ego-dystonic homosexuality. People who are abnormally unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others, may be classed as having an impulse control disorder, including various kinds of Tic disorders such as Tourette's Syndrome, and disorders such as Kleptomania (stealing) or Pyromania (fire-setting). Substance-use disorders include Substance abuse disorder. Addictive gambling may be classed as a disorder. Inability to sufficiently adjust to life circumstances may be classed as an Adjustment disorder. The category of adjustment disorder is usually reserved for problems beginning within three months of the event or situation and ending within six months after the stressor stops or is eliminated. People who suffer severe disturbances of their self-identity, memory and general awareness of themselves and their surroundings may be classed as having a Dissociative identity disorder, such as Depersonalization disorder or Dissociative Identify Disorder itself (which has also been called multiple personality disorder, or "split personality".). Factitious disorders, such as Munchausen syndrome, also exist where symptoms are experienced and/or reported for personal gain.
Disorders appearing to originate in the body, but thought to be mental, are known as somatoform disorders, including Somatization disorder. There are also disorders of the perception of the body, including Body dysmorphic disorder. Neurasthenia is a category involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but not by the DSM-IV.[14] Memory or cognitive disorders, such as amnesia or Alzheimer's disease exist.
Some disorders are thought to usually first occur in the context of early childhood development, although they may continue into adulthood. The category of Specific developmental disorder may be used to refer to circumscribed patterns of disorder in particular learning skills, motor skills, or communication skills. Disorder which appears more generalized may be classed as pervasive developmental disorders (PDD) also known as autism spectrum disorders (ASD); these include autism, Asperger's, Rett syndrome, childhood disintegrative disorder and other types of PDD whose exact diagnosis may not be specified. Other disorders mainly or first occurring in childhood include Reactive attachment disorder; Separation Anxiety Disorder; Oppositional Defiant Disorder; Attention Deficit Hyperactivity Disorder.
Causes
- Main article: Causes of mental disorders
Numerous factors have been linked to the development of mental disorders. In many cases there is no single accepted or consistent cause. A common view is that disorders often result from genetic vulnerabilities combining with environmental stressors (Diathesis-stress model). An eclectic or pluralistic mix of models may be used to explain particular disorders. The primary paradigm of contemporary mainstream Western psychiatry is said to be the biopsychosocial (BPS) model - incorporating biological, psychological and social factors - although this may not be applied in practice. Biopsychiatry has tended to follow a biomedical model, focusing on "organic" or "hardware" pathology of the brain. Psychoanalytic theories have been popular but are now less so. Evolutionary psychology may be used as an overall explanatory theory. Attachment theory is another kind of evolutionary-psychological approach sometimes applied in the context for mental disorders. A distinction is sometimes made between a "medical model" or a "social model" of disorder and related disability.
Genetic studies have indicated that genes often play an important role in the development of mental disorders, via developmental pathways interacting with environmental factors. The reliable identification of connections between specific genes and specific categories of disorder has proven more difficult.
Environmental events surrounding pregnancy and birth have also been implicated. Traumatic brain injury may increase the risk of developing certain mental disorders. There have been some tentative inconsistent links found to certain viral infections, to substance misuse, and to general physical health.
Abnormal functioning of neurotransmitter systems has been implicated, including serotonin, norepinephrine, dopamine and glutamate systems. Differences have also been found in the size or activity of certain brains regions in some cases. Psychological mechanisms have also been implicated, such as cognitive and emotional processes, personality, temperament and coping style.
Social influences have been found to be important, including abuse, bullying and other negative or stressful life experiences. The specific risks and pathways to particular disorders are less clear, however. Aspects of the wider community have also been implicated, including employment problems, socioeconomic inequality, lack of social cohesion, problems linked to migration, and features of particular societies and cultures.
Diagnosis
Many mental health professionals, particularly psychiatrists, seek to diagnose individuals by ascertaining their particular mental disorder. Some professionals, for example some clinical psychologists, may avoid diagnosis in favor of other assessment methods such as formulation of a client's difficulties and circumstances.[15] The majority of mental health problems are actually assessed and treated by family physicians during consultations, who may refer on for more specialist diagnosis in acute or chronic cases. Routine diagnostic practice in mental health services typically involves an interview (which may be referred to as a mental status examination), where judgements are made of the interviewee's appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of relatives or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. Psychological testing is sometimes used via paper-and-pen or computerized questionnaires, which may include algorithms based on ticking off standardized diagnostic criteria, and in relatively rare specialist cases neuroimaging tests may be requested, but these methods are more commonly found in research studies than routine clinical practice.[16][17] Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.[18] It has been found that most clinicians evaluate patients using an unstructured, open-ended approach, with limited training in evidence-based assessment methods, and that inaccurate diagnosis may be common in routine practice.[19]
Comorbidity is very usual with mental disorders, i.e. same person can suffer one or more disorder. The work for fifth version of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) [20] has raised some questions about dimensional diagnostic criteria compared to categorical diagnostic criteria. Journal of Abnormal Psychology (Vol 114, Issue 4) [21] devoted a whole issue to discuss about categorical and dimensional diagnostic criteria. In short it the argument is that diagnosis of mental disorder can be based on several overlapping dimensions and not categorical and/or two-dimensional classes. One possibility in diagnosis is to have several (>2) dimensions overlapping and that it is harder to describe. In the following picture idea is that multiple dimension lines are crossed with one diagnostic line and the combination of crossing points is basis for a diagnosis. File:Multidimensional diagnosis.JPG
In practical clinical settings it might be problematic to find several disorders in different dimensions and also differentiate the position of specific disorder in its dimensional axis like the picture indicates.
Treatment
- Main article: Treatment of mental disorders
Mental health services may be based in hospitals, clinics or the community. Often an individual may engage in different treatment modalities. They 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. Individuals may be treated against their will in some cases, especially if assessed to be at high risk to themselves or others. Services in some countries are increasingly based on a Recovery model that supports an individual's journey to regain a meaningful life.
Psychotherapy
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A major option for many mental disorders is psychotherapy. There are several main types. Cognitive behavioral therapy (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. Psychoanalysis, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. Systemic therapy or family therapy is sometimes used, addressing a network of signicant others as well as an individual. Some psychotherapies are based on a humanistic approach. There are a number of specific therapies used for particular disorders, which may be offshoots or hybrids of the above types. Mental health professionals often employ an eclectic or integrative approach. Much may depend on the therapeutic relationship, and there may be problems with trust, confidentiality and engagement.
Medication
A major option for many mental disorders is psychiatric medication. There are several main groups. Antidepressants are used for the treatment of clinical depression as well as often for anxiety and other disorders. Anxiolytics are used for anxiety disorders and related problems such as insomnia. Mood stabilizers are used primarily in bipolar disorder, mainly targeting mania rather than depression. Antipsychotics are used for psychotic disorders, notably for positive symptoms in schizophrenia. Stimulants are commonly used, notably for ADHD. Despite the different conventional names of the drug groups, there can be considerable overlap in the kinds of disorders for which they are actually indicated. There may also be off-label use. There can be problems with adverse effects and adherence.
Other
Electroconvulsive therapy (ECT) is sometimes used in severe casees when other interventions have failed. Psychosurgery is no longer generally used. Psychoeducation may be used to provide people with the information to understand and manage their problems. Creative therapies are sometimes used, including music therapy, art therapy or drama therapy. Lifestyle adjustments and supportive measures are often used, including peer support, self-help and supported housing or employment. Some advocate dietary supplements. Many things have been found to help at least some people. A placebo effect may play a role in any intervention.
Prognosis
There is substantial variation over time between disorders, and between individuals. Functional ability may also vary across different domains. There may be remission of symptoms, but also relapse. Rates of recovery vary. A number of individual and social factors have been linked to prognosis.
Despite often being characterized in purely negative terms, mental disorders can involve above-average creativity, non-conformity, goal-striving, meticulousness, or empathy.[22] The public perception of the level of disability associated with mental disorders can change.[23]
Prevalence
WHO estimated that about 450 million people worldwide currently suffer from some form of mental or behavioural disorder.[24] One in four people will suffer from mental illness at some time in life, according to a report from the WHO.[25][26]
- Main article: Prevalence of mental disorders
Professions and fields
- Main article: Mental health professional
A number of professions have developed that specialise in the treatment of mental disorders, including the medical speciality of psychiatry (including psychiatric nursing)[27][28][29], the division of psychology known as clinical psychology[30], Social Work[31], as well as Mental Health Counselors, Marriage and Family Therapists, Psychotherapists, Counselors and Public Health professionals. Those with personal experience of using mental health services are also increasingly involved in researching and delivering mental health services and working as mental health professionals.[32][33][34][35] The different clinical and scientific perspectives draw on diverse fields of research and theory, and different disciplines may favor differing models, explanations and goals.[22]
Movements
The Consumer/Survivor Movement (also known as user/survivor movement) is made up of individuals (and organizations representing them) who are clients of mental health services or who consider themselves "survivors" of mental health services. The movement campaigns for improved mental health services and for more involvement and empowerment within mental health services, policies and wider society.[36][37][38] Patient advocacy organizations have expanded with increasing deinstitutionalization in developed countries, working to challenge the stereotypes, stigma and exclusion associated with psychiatric conditions. An antipsychiatry movement fundamentally challenges mainstream psychiatric theory and practice, including the reality or utility of psychiatric diagnoses of mental illnesses.[39][40] [41]
Laws and policies
Three quarters of countries around the world have mental health legislation. Compulsory admission to mental health facilities (also known as Involuntary commitment or sectioning), is a controversial topic. From some points of view it can impinge on personal liberty and the right to choose, and carry the risk of abuse for political, social and other reasons; from other points of view, it can potentially prevent harm to self and others, and assist some people in attaining their right to healthcare when unable to decide in their own interests.[42]
All human-rights orientated mental health laws require proof of the presence of a mental disorder as defined by internationally accepted standards, but the type and severity of disorder that counts can vary in different jurisdictions. The two most often utilized grounds for involuntary admission are said to be serious likelihood of immediate or imminent danger to self or others, and the need for treatment. Applications for someone to be involuntarily admitted may usually come from a mental health practitioner, a family member, a close relative, or a guardian. Human-rights-orientated laws usually stipulate that independent medical practitioners or other accredited mental health practitioners must examine the patient separately and that there should be regular, time-bound review by an independent review body.[42] An individual must be shown to lack the capacity to give or withhold informed consent (i.e. to understand treatment information and its implications). Proxy consent (also known as substituted decision-making) may be given to a personal representative, a family member or a legally appointed guardian, or patients may have been able to enact an advance directive as to how they wish to be treated.[42] The right to supported decision-making may also be included in legislation.[43] Involuntary treatment laws may be extended to those living in the community, for example Community Treatment Orders (CTOs) are used in New Zealand, Australia and 38 states in the US and are being planned in the UK.[44]
The World Health Organization reports that in many instances national mental health legislation takes away the rights of persons with mental disorders rather than protecting rights, and is often outdated.[42] In 1991, the United Nations adopted the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, which established minimum human rights standards of practice in the mental health field. In 2006 the UN formally agreed the Convention on the Rights of Persons with Disabilities to protect and enhance the rights and opportunities of disabled people, including those with psychosocial disabilities[45]
The term insanity, sometimes used colloquially as a synonym for mental illness, is often used technically as a legal term.
Perception and discrimination
Media
- Main article: Mental disorders in art and literature
Media coverage of mental illness comprises predominantly negative depictions, for example, of incompetence, violence or criminality, with far less coverage of positive issues such as accomplishments or human rights issues.[46][47][48] Such negative depictions, including in children's cartoons, are thought to contribute to stigma and negative attitudes in the public and in those with mental health problems themselves, although more sensitive or serious cinematic portrayals have increased in prevalence.[49][50]
General public
The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill.[51] Japan has been reported to have more negative attitudes than Australia, although stigma appears common in both countries.[52]
Violence
The public fear of violence due to mental illness is a contentious topic. One US national survey indicated that a far higher percentage of Americans rated individuals described as displaying the characteristics of a mental disorder (for example Schizophrenia or Substance Use Disorder) as "likely to do something violent to others" compared to those described as being 'troubled'.[53] Research indicates, on balance, a higher than average number of violent acts by some individuals with certain diagnoses, notably antisocial or psychopathic personality disorders, but conflicting findings about specific symptoms (for example links between psychosis and violence in community settings) - but the mediating factors of such acts are most consistently found to be mainly socio-demographic and socio-economic factors such as being young, male, of lower socio-economic status and, in particular, substance abuse (including alcohol).[54][55][22] Findings consistently indicate that it is many times more likely that people diagnosed with a serious mental illness living in the community will be the victim rather than the perpetrator of violence.[54][56] 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"), including within a family setting,[57] as well as being an issue in healthcare settings[58] and the wider community.[59]
Employment
Employment discrimination is reported to play a significant part in the high rate of unemployment among those with a diagnosis of mental illness[60] Schemes to combat stigma have been prioritized by global and national psychiatric organizations, but their methods and outcomes have been criticized as counterproductive.[61]
See also
Spoken Psychology Wiki
References
- ↑ K. Evans, J. McGrath, R. Milns (2003) Searching for schizophrenia in ancient Greek and Roman literature: a systematic review Acta Psychiatrica Scandinavica 107 (5), 323–330.
- ↑ Stong, C. (2005). The Evolution of NeuroPsychiatry. Neuropsychiatry Reviews, 6.
- ↑ Kroll J., & Bachrach, B. (1984). Sin and mental illness in the Middle Ages. Psychological Medicine, 14, 507-514.
- ↑ Delgado, J.M., Doherty, A.M.S., Ceballos, R.M., Erkert, H.G. (2000). Moon Cycle Effects on Humans: Myth or Reality? Salud Mental, 23, 33-39.
- ↑ Dalby JT. (1993) Terms of Madness: Historical Linguistics. Comprehensive Psychiatry 34,392-395.
- ↑ Dalby JT. (1997) Elizabethan madness: On London's stage. Psychological Reports 81, 1331-1343.
- ↑ Gazzaniga, M.S., & Heatherton, T.F. (2006). Psychological Science. New York: W.W. Norton & Company, Inc.
- ↑ WebMD, Inc. (2005, July 01). Mental Health: Types of Mental Illness. Retrieved April 19, 2007, from http://www.webmd.com/mental-health/mental-health-types-illness
- ↑ United States Department of Health & Human Services. (1999). Overview of Mental Illness. Retrieved April 19, 2007
- ↑ NIMH (2005) Teacher's Guide: Information about Mental Illness and the Brain Curriculum supplement from The NIH Curriculum Supplements Series
- ↑ Akiskal, HS. & Benazzi, F. (2006) The DSM-IV and ICD-10 categories of recurrent (major) depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum. Journal of Affective Disorders May;92(1):45-54.
- ↑ Lee Anna Clark (2007) Assessment and Diagnosis of Personality Disorder: Perennial Issues and an Emerging Reconceptualization Annual Review of Psychology Vol. 58: 227-257
- ↑ Morey LC, Hopwood CJ, Gunderson JG, Skodol AE, Shea MT, Yen S, Stout RL, Zanarini MC, Grilo CM, Sanislow CA, McGlashan TH. (2006) Comparison of alternative models for personality disorders. Psychol Med. Nov 23;:1-12
- ↑ Gamma A, Angst J, Ajdacic V, Eich D, Rossler W. (2007) The spectra of neurasthenia and depression: course, stability and transitions. Eur Arch Psychiatry Clin Neurosci. Mar;257(2):120-7.
- ↑ Kinderman, P. and Lobban, F. (2000) Evolving formulations: Sharing complex information with clients. Behavioural and Cognitive Psychotherapy, 28(3), 307-310.
- ↑ HealthWise (2004) Mental Health Assessment. Yahoo! Health
- ↑ Davies, T. (1997) ABC of mental health: Mental health assessment British Medical Journal 314:1536
- ↑ Kashner TM, Rush AJ, Surís A, Biggs MM, Gajewski VL, Hooker DJ, Shoaf T, Altshuler KZ. (2003) Impact of structured clinical interviews on physicians' practices in community mental health settings. Psychiatr Serv. 2003 May;54(5):712-8. PMID 12719503
- ↑ Shear MK, Greeno C, Kang J, Ludewig D, Frank E, Swartz HA, Hanekamp M. (2000) Diagnosis of nonpsychotic patients in community clinics. Am J Psychiatry. Apr;157(4):581-7 PMID 10739417
- ↑ DSM-V Prelude Project website
- ↑ Journal of Abnormal Psychology - Vol 114, Issue 4
- ↑ 22.0 22.1 22.2 Rogers, A. & Pilgram, D. (2005) A Sociology of Mental Health and Illness, Open University Press, 3rd Edition. ISBN 0335215831
- ↑ Ferney, V. (2003) The Hierarchy of Mental Illness: Which diagnosis is the least debilitating? New York City Voices Jan/March
- ↑ WHO | The world health report
- ↑ Mental Health Care in the Developing World
- ↑ Mental problems 'hit one in four'
- ↑ A, N.C. (1997). What is Psychiatry? The American Journal of Psychiatry, 154, 591-593.
- ↑ University of Melbourne. (2005, August 19). What is Psychiatry?. Retrieved April 19, 2007, from http://www.psychiatry.unimelb.edu.au/info/what_is_psych.html
- ↑ California Psychiatric Association. (2007, February 28). Frequently Asked Questions About Psychiatry & Psychiatrists. Retrieved April 19, 2007, from http://www.calpsych.org/publications/cpa/faqs.html
- ↑ American Psychological Association, Division 12, http://www.apa.org/divisions/div12/aboutcp.html
- ↑ Golightley, M. (2004) Social work and Mental Health Learning Matters, UK
- ↑ Goldstrom ID, Campbell J, Rogers JA, et al (2006) National estimates for mental health mutual support groups, self-help organizations, and consumer-operated services. Administration and Policy in Mental Health and Mental Health Services Research, 33:92–102
- ↑ The Joseph Rowntree Foundation (1998) The experiences of mental health service users as mental health professionals
- ↑ Chamberlin J. (2005) User/consumer involvement in mental health service delivery. Epidemiol Psichiatr Soc. Jan-Mar;14(1):10-4. PMID 15792289
- ↑ Terence V. McCann, John Baird, Eileen Clark, Sai Lu (2006) Beliefs about using consumer consultants in inpatient psychiatric units International Journal of Mental Health Nursing 15 (4), 258–265.
- ↑ Everett, B. (1994) Something is happening: the contemporary consumer and psychiatric survivor movement in historical context. Journal of Mind and Behavior, 15:55–7
- ↑ Rissmiller DJ & Rissmiller JH (2006) Evolution of the antipsychiatry movement into mental health consumerism. Psychiatric Services, Jun;57(6):863-6.
- ↑ Oaks, D. (2006) The Evolution of the Consumer Movement Psychiatric Services 57:1212
- ↑ The Antipsychiatry Coalition. (2005, November 26). The Antipsychiatry Coalition. Retrieved April 19, 2007, from www.antipsychiatry.org
- ↑ Anthony Paul O'Brien, Martin Woods, Christine Palmer (2001) The emancipation of nursing practice: Applying anti-psychiatry to the therapeutic community. Australian and New Zealand Journal of Mental Health Nursing 10 (1), 3–9.
- ↑ Weitz D. (2003) Call me antipsychiatry activist--not "consumer" Ethical Hum Sci Serv. Spring;5(1):71-2. PMID 15279009
- ↑ 42.0 42.1 42.2 42.3 World Health Organization (2005) WHO Resource Book on Mental Health: Human rights and legislation ISBN 924156282 (PDF)
- ↑ Manitoba Family Services and Housing. The Vulnerable Persons Living with a Mental Disability Act, 1996
- ↑ The Big Question: Will the new mental health Bill make Britain a safer place?
- ↑ ENABLE website UN section on disability
- ↑ Coverdate, J., Nairn, R. & Claasen, D. (2001) Depictions of mental illness in print media: a prospective national sample Australian and New Zealand Journal of Psychiatry, 36 (5), 697–700.
- ↑ Edney, RD. (2004) Mass Media and Mental Illness: A Literature Review Canadian Mental Health Association
- ↑ Diefenbach, D.L. (1998) The portrayal of mental illness on prime-time television Journal of Community Psychology Vol 25, Issue 3, Pages 289-302
- ↑ Sieff, E. (2003) Media frames of mental illnesses: The potential impact of negative frames Journal of Mental Health, Vol 12(3) pp. 259-269
- ↑ Wahl, O.F. (2003) News Media Portrayal of Mental Illness: Implications for Public Policy American Behavioral Scientist Vol. 46, No. 12, 1594-1600
- ↑ Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. (1999) Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health. Sep;89(9):1328-33.
- ↑ Griffiths KM, Nakane Y, Christensen H, Yoshioka K, Jorm AF, Nakane H. (2006) Stigma in response to mental disorders: a comparison of Australia and Japan. BMC Psychiatry. May 23;6:21.
- ↑ Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S. (1999) The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. American Journal of Public Health. Sep;89(9):1339-45.
- ↑ 54.0 54.1 Stuart, H. (2003) Violence and mental illness: an overview. World Psychiatry. June; 2(2): 121–124
- ↑ Steadman HJ, Mulvey EP, Monahan J, Robbins PC, Appelbaum PS, Grisso T, Roth LH, Silver E. (1998) Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry. May;55(5):393-401.
- ↑ Brekke JS, Prindle C, Bae SW, Long JD (2001). Risks for individuals with schizophrenia who are living in the community. Psychiatric Services. Oct;52(10):1358–66. PMID 11585953
- ↑ Solomon, PL., Cavanaugh, MM., Gelles, RJ. (2005) Family Violence among Adults with Severe Mental Illness. Trauma, Violence, & Abuse, Vol. 6, No. 1, 40-54
- ↑ Chou, KR., Lu, RB., Chang, M. (2001) Assaultive behavior by psychiatric in-patients and its related factors. Journal of Nursing Research. Dec;9(5):139-51
- ↑ B. Lögdberg, L.-L. Nilsson, M. T. Levander, S. Levander (2004) Schizophrenia, neighbourhood, and crime. Acta Psychiatrica Scandinavica, 110(2) Page 92.
- ↑ Heather Stuart (2006) Mental Illness and Employment Discrimination Current Opinion in Psychiatry 19(5):522-526.
- ↑ Read, J., Haslam, N., Sayce, L., Davies, E. (2006) Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach Acta Psychiatr Scand. Nov;114(5):303-18
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
- 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
External links
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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)
- [1] - 'United States National Mental Health Anti-Stigma Campaign'
History and professional specialties
- OhioU.edu - 'The History of Mental Illness' Ohio University, The Ridges
- Plato.stanford.edu - 'Mental Illness', Stanford Encyclopedia of Philosophy
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
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