Mental disorders

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A mental disorder or mental illness refers to one of many mental health conditions characterized by distress, impaired cognitive functioning, atypical behavior, emotional dysregulation, and/or maladaptive behavior. Definitions, assessments, and classifications of mental disorders may vary, however 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 or affective disorders, anxiety disorders, psychotic disorders, eating disorders, developmental disorders, personality disorders, and many other categories.

Symptoms of mental illness greatly vary dependent upon the specific disorder, but may include mild to chronic forms of depression, anxiety, emotional dysregulation, difficulties with attention, loss of cognitive abilities, or the presence of hallucinations or delusions. Causes of mental illness also vary, but may result from genetics, trauma, biological factors such as infections or toxins, or neuroplasticity resulting from psychological or 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 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.

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 medical specialty of psychiatry, and social work.

Definition and terminology

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. 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, impaired cognitive functioning, atypical behavior and/or maladaptive behavior. 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.

Most international clinical documents avoid the term "mental illness", preferring the term "mental disorder" However, some use "mental illness" as the main over-arching term to encompass mental disorders. 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. 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. Confusion often surrounds the ways and contexts in which these terms are used. An alternative overarching concept is that of "mental disability" or, as preferred by some consumer groups, "psychosocial disability". 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", terms with some common usage among the general public include "madness" or "nervous breakdown"

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 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). Lay concepts of mental disorder vary considerably across different cultures and countries, and may refer to different sorts of individual and social problems

Classification schemes

Main article: Classification of mental disorder

Mental disorders are commonly classified via a categorical scheme sometimes termed "neo-Kraepelinian" (after the psychiatrist Kraepelin) 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) 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).

The guideline categories and criteria listed in the ICD and DSM], and other manuals, have been widely accepted by many mental health professionals. 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. 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.

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 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. Another approach may be based directly on the specific complaints reported by an individual. DSM-V planning committees are currently looking at moving towards a dimensional classification of some disorders, including personality disorder.

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 and in terms of social, economic and political factors - including over the inclusion of certain controversial categories, the influence of the pharmaceutical industry, or the stigmatizing effect of being categorized or 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. 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.

Categories/dimensions of disorder

Notable categories of mental disorder, or mental dimensions that can be more or less disordered, include:

Anxiety

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.

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.

Mood

Mood - relatively long-lasting affective states - can 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 (which can result in a diagnosis of Bipolar I) or hypomania (which can result in a diagnosis of Bipolar II), 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.

Belief and perception

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 individals showing some of the traits associated with schizophrenia but without meeting cut-off criteria.

Personality

Personality - 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 or Emotionally Unstable Personality Disorder or Impulsive 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. 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.

Eating

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

Sleep disorders such as Insomnia

Sex

Sexual and gender identity disorders, such as Dyspareunia or Gender identity disorder

Impulse/motor control

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 and addictions

Substance-use disorders include Substance abuse disorder. Addictive gambling may be classed as a disorder.

Adjustment

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.

Related to the body

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.

Neurasthenia is a category involving somatic (bodily) complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but not by the DSM-IV.

Developmental

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), including autism or aspergers (or the autistic spectrum, Rett's Disorder and 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.

Memory

Memory or cognitive disorders, such as amnesia or Alzheimer's disease

Fabrication

Factitious disorders, where symptoms are experienced/reported for personal gain. Includes Munchausen syndrome.

Dissociation

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".).

General theories and models

There are a number of paradigms (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 syndromes, 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. 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. 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. 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. 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.

Causes and Links

Main article: Causes of psychiatric disorder

Genes

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 linkage or association studies, has proven difficult. This has been reported to be likely due to the complexity of interactions between genes, environmental events, and early development or to the need for new research strategies. 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. Investigations increasingly focus on links between genes and endophenotypes - more specific traits (including neurophysiological, biochemical, endocrinological, neuroanatomical, cognitive, or neuropsychological) - rather than disease categories.

Pregnancy and birth

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 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.

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

Disease, injury and infection

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.

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. 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. A number of diseases of the white matter can cause symptoms of mental disorder.

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. Some chronic general medical conditions have been linked to some aspects of mental disorder, such as AIDS-related psychosis.

Individual traits and functioning

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).

Pre-existing characteristics such as personality traits, coping styles, and cognitive or emotional processes, have been linked to the development of mental disorders.^{[How to reference and link to summary or text]}

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. 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 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. 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.

Findings have indicated abnormal functioning of brainstem structures in disorders such as schizophrenia, related to impairments in maintaining sustained attention. 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 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. Some studies have also found reduced hippocampal volumes in major depression, possibly worsening with time depressed.

Life events, stresses and relationships

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. 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. 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.

Society and culture

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. Mental illnesses have been linked to particular social and cultural systems.

Stresses and strains related to socioeconomic position (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. 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. The causal role of different socioeconomic factors may vary by country.

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.

Diagnosis

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 neuroimages through functional magnetic resonance imaging or positron emission tomography scanning, or other neurophysiologic measurements such as electroencephalography.

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Treatment

Main article: Treatment of mental illness

Mental health professionals treat mental disorders differently using one or a combination of psychotherapy, psychiatric medication, case management, or other practices. 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

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

Mental health services may be based in hospitals, clinics or the community.

Some approaches are based on a recovery model of mental disorder, and may focus on challenging stigma and social exclusion and creating empowerment and hope

Prognosis

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

Prevalence and Incidence

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. 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.[1] 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%).

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. 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.

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. 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.

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

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).

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 A US survey that incidentally screened for personality disorder found an overal rate of 14.79%.

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.

History

Main article: History of mental illness

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

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. During the middle ages 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. At the start of the 20th century there were only a dozen 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.

Mental health professions and fields

Main article: Mental health professional

A number of professions have developed that specialise in mental disorder, including the medical speciality of psychiatry, the division of psychology known as clinical psychology (also related to the scientific field of Abnormal psychology), and clinical or mental health social work, Mental Health Counselors, Marriage and Family Therapists. Psychotherapists, Counselors and Public Health professions may also undertake work in the area of mental illness, drawing on diverse fields of research and theory. Different clinical and academic professions tend to favor differing models, explanations and goals.

Movements

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

Laws and policies

In many countries, individuals diagnosed with mental disorders can be involuntarily detained and treated, if assessed as being non-competent and a risk to themselves or others. This generally applies to inpatient hospital treatment. Community Treatment Orders (CTOs) are also used in New Zealand, Australia and 38 states in the US and are being planned in the UK.^{[How to reference and link to summary or text]}.

The term insanity, sometimes used colloquially as a synonym for mental illness, is used technically as a legal term.

There is also legislation to protect the rights of those seen as having a mental disorder or disability.^{[How to reference and link to summary or text]}.

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.

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Violence

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'.

Research findings indicate, on balance, a higher-than-average number of violent acts by individuals with certain diagnoses. The mediating factors of such acts may be socio-demographic and socio-economic factors such as being young, male, of lower socio-economic status, and mis-using substances (including alcohol). Some findings indicate that it is more likely that people with a serious mental illness will be the victim rather than the perpetrator of violence. In particular, higher rates of offending after hospital discharge have been found to be statistically related to the relatively poor and violent neighbourhoods into which ex-patients are discharged, and to substance misuse. 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, as well as being an issue in healthcare settings and the wider community.

Media coverage and cultural references

See also Mental illness in art and literature.

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

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Stigma and discrimination

The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill. Japan has been reported to have more negative attitudes than Australia, although stigma appears common in both countries.

Employment discrimination can play a part in the high rate of unemployment among those with a diagnosis of mental illness Schemes to combat stigma have been prioritized by global and national psychiatric organizations but their methods and outcomes have been criticized as counterproductive.

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See also

Affective disorders Adjustment disorders Alexithymia Anxiety disorders Behavior disorders Borderline states Brain disorders Chronic mental illness Chronicity (disorders) Comorbidity Congenital disorders Consciousness disturbances Defense mmechanisms Dementia Disease course Dissociative disorders Eating disorders Emotional adjustment Emotional dysregulation Ethnospecific disorders Factitious disorders Homeless mentally ill Impulse control disorders Insanity defence

Memory disorders Mental health Mental illness (Attitudes towards) Mentally ill offenders Neurosis Organic brain syndromes Perceptual disturbances Paraphilias Personality disorders Personality processes Pervasive developmental disorders Predisposition Psychiatric patients Psychiatric symptoms Psychodiagnosis Psychopathology Psychosis Recovery (disorders) Relapse(disorders) Remission (disorders) Research diagnostic criteria Severity (disorders) Sexual function disturbances Schizophrenogenic family Sleep disorders Structured clinical interview Special needs Suicide Susceptibility (disorders) Symptoms Syndromes Thought disturbances Toxic disorders Treatment resistance disorders Work related illnesses

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

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)
• [2] - '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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