Classification of Mental Disorders
Contents
• Mood Disorder
• Major Depressive Episode
• Manic Episode
• Hypomanic and Mixed Episodes
• Anxiety Disorders
• Panic Attack
• Types of Anxiety Disorders
• Post-traumatic stress disorder (PTSD)
• Personality Disorders
• AOD and Personality Disorders
• Antisocial Personality Disorder
• Borderline Personality Disorder
• Psychotic Disorders
• Delusions
• Hallucinations
• Symptoms of Psychosis
• Schizophrenia
• Positive Symptoms of Schizophrenia
• Negative Symptoms of Schizophrenia
• Substance-Induced Disorders
• Substance-Induced Psychosis
• Delirium
Introduction
• Individual is not functioning adequately based on either his/her standards or according to significant others in the person’s life.
• Diagnosis of disorder depends of intensity, length of time and how much it’s impacting on the person.
Mood disorders
Anxiety disorders
Personality disorders
Psychotic disorders
Substance-induced disorders
Mood Disorders
• Major depressive episodes
• Manic episodes
• Mixed episodes
• Hypomanic episodes.
Major Depressive Episode
Some symptoms experienced nearly every day for at least 2 weeks:
• Depressed mood or loss of interest or enjoyment in activities
• Reduced interest or pleasure in almost all activities
• Change in weight or appetite
• Difficulty concentrating or sleeping (i.e., sleeping too much or too little)
• Restlessness and agitation
• Slowing down of activity
• Fatigue or reduced energy levels
• Feelings of worthlessness or excessive/inappropriate guilt
• Recurrent thoughts of death, suicidal thoughts, attempts or plans
Manic Episode
Person experiences abnormally elevated, expansive, or irritable mood for at least 1 week characterised by:
• Inflated self-esteem
• Decreased need for sleep
• Increased talkativeness or racing thoughts
• Distractibility
• Agitation or increase in goal directed activity (e.g., at work or socially)
• Excessive involvement in pleasurable activities that have a high potential for negative consequences.
Hypomanic and Mixed Episodes
• Hypomanic same as manic episode but is less severe
• May only last 4 days and does not require the episode to be severe enough to cause impairment in social or occupational functioning
• In mixed episode, person experiences both a manic episode and major depressive episode for at least 1 week
Anxiety Disorders
• Many people feel anxious because they have reason to eg: trouble with law, homelessness
• Many in AOD treatment will experience anxiety as consequence of intoxication, withdrawal, or living without using AOD
• Usually reduces over time with period of abstinence
• Problematic when persistent, or so frequent and intense that prevents person from living his/her life in the way that he/she would like
Panic Attack
• Sweating
• Shaking
• Shortness of breath
• Feeling of choking
• Light headedness
• Heart palpitations, chest pain or tightness
• Numbness or tingling sensations
• Chills or hot flushes
• Nausea and/or vomiting
• Fear of losing control, going crazy or dying
• Feelings of unreality or being detached from oneself
Types of Anxiety Disorders
• Generalised anxiety disorder (GAD)
• Obsessive compulsive disorder (OCD)
• Panic disorder
• Agoraphobia
• Social phobia
• Specific phobia
• Post-traumatic stress disorder (PTSD)
• Acute stress disorder.
Post-Traumatic Stress Disorder (PTSD)
• Can develop after traumatic event
• May experience some of following:
• Intrusions: re-experiencing event as nightmares, or “flashbacks”
• Avoidance: avoiding thoughts, feelings, people, places or activities that remind him/her of the event,
• Hyperarousal: increased startle response, irritability or anger, difficulty sleeping and concentrating
Personality Disorders
• Enduring destructive patterns of thinking, feeling, behaving, and relating to other people across wide range of social and personal situations
• Maladaptive traits are stable and long lasting
• Tend to develop in adolescence or early adulthood and are generally lifelong
• Most common in AOD context ASPD and BPD
AOD and Personality Disorders
• AOD use disorders may cause fluctuating symptoms that mimic symptoms of personality disorders
• Eg: impulsivity, aggressiveness, self-destructiveness, relationship problems, work dysfunction, engaging in illegal activity, dysregulated emotions and behaviour
• Can be difficult to determine whether a person has a personality disorder
Antisocial Personality Disorder
• Failure to conform to social norms with respect to lawful behaviour
• Disregard for the wishes, rights and feelings of others
• Deceptive and manipulative in order to gain personal profit or pleasure; may repeatedly lie or con others
• Reckless disregard for own or other’s safety
• Impulsive behaviour; decisions made on spur of the moment, without forethought, and without consideration of the consequences for self or others
• May lead to sudden change of jobs, residences or relationships
• Irritability and aggression; repeated involvement in physical fights or assaults
• Consistent and extreme irresponsibility
Borderline Personality Disorder
• Persistent patterns of instability in relationships, mood, and self-image
• Marked impulsivity, particularly in relation to behaviours that are self-damaging
• Extreme efforts to avoid rejection or abandonment
• Pattern of unstable and intense relationships
• Unstable self-image or sense of self
• Impulsivity
• Recurrent suicidal behaviour, threats or self-mutilating behaviour
• Unstable mood
• Chronic feelings of emptiness
• Inappropriate, intense anger
• Stress-related paranoid thoughts or severe dissociative symptoms
Psychotic Disorders
• Loss of touch with reality
• Feelings, thoughts and perceptions severely altered
• Delusions and Hallucinations
• May be due to intoxication or withdrawal from substances
• If the person experiences psychotic episodes when not intoxicated or withdrawing, possible they may have one of the disorders described
Delusions
• Fixed, false beliefs not consistent with cultural context
• Involve a misinterpretation of perceptions or experiences
• Eg: feel that someone is out to get them, they have special powers, or passages from newspaper have special meaning for them
Hallucinations
• Disturbance of sensory perceptions
• Auditory (hearing voices or sounds)
• Visual (seeing things not present)
• Olfactory (smelling things not present)
• Tactile (feeling or sensing something)
• Gustatory (taste)
Other Symptoms of Psychosis
• Disorganised speech
• Grossly disorganised behaviour
• Catatonic behaviour (eg decreased reactivity)
• Affect flattening (reduced range of emotional expressiveness)
• Alogia (restricted thought and speech)
• Avolition (reduced involvement with activities)
Schizophrenia
• Most common and disabling of psychotic disorders
• Affects ability to think, feel and act
• To be diagnosed symptoms must have been continuing for a period of at least 6 months
• Symptoms are grouped within 2 types:
1. Positive symptoms
2. Negative symptoms
Positive Symptoms of Schizophrenia
• Not as in pleasurable!
• Presence of excess or distortion of normal functioning and include hallucinations, delusions, disorganised speech, grossly disorganised behaviour and catatonia
Negative Symptoms of Schizophrenia
• Absence of normal functioning including affective flattening, avolition, alogia
• Can cause significant impairment in a person’s functioning
• Classification of “types” of schizophrenia depending upon the predominance of symptoms displayed (paranoid, disorganised, catatonic, undifferentiated, residual type)
Other Psychotic Disorders
• Schizophreniform disorder: equivalent to schizophrenia except its duration limited to less than 6 months
• Schizoaffective disorder: symptoms of schizophrenia alongside major depressive, manic or mixed episode
• 2 types: i) bipolar type (if manic or mixed); ii) depressive type (if major depressive)
Substance-Induced Disorders
• Occur as direct consequence of AOD intoxication or withdrawal
• Diagnosis requires symptoms only present following intoxication or withdrawal
• If symptoms in absence of intoxication or withdrawal, possible they have independent mental health disorder
• Symptoms tend to reduce over time with period of abstinence
Examples of Substance Induced Disorders
• Alcohol use/withdrawal - symptoms of depression or anxiety
• Manic symptoms induced by intoxication with stimulants, steroids, hallucinogens
• Psychotic symptoms induced by withdrawal from alcohol, intoxication with amphetamines, cocaine, cannabis, LSD or PCP
• Other disorders - substance-induced delirium, amnestic disorder, dementia, sexual dysfunction, sleep disorder
Substance-Induced Psychosis
• Difficult to distinguish substance-induced psychosis from other psychotic disorders
• Substance-induced psychosis - symptoms appear quickly and last relatively short time, from hours to days until the effects of drug wear off
• Psychosis can persist for days, weeks, months or longer
• Possible individuals already at risk for developing psychotic disorder triggered by substance use
• Visual hallucinations more common in substance withdrawal and intoxication
• Stimulant intoxication more commonly associated with tactile hallucinations, person experiences physical sensation interpret as having bugs under skin ("ice bugs" or "cocaine bugs“)
• Tactile hallucinations can occur in alcohol withdrawal; auditory and visual hallucinations are more common
• Stimulant psychosis sometimes more agitated, energetic, more difficult to calm with sedating or psychiatric medication compared to non-drug induced psychosis
• Difference with schizophrenia - lack of negative and cognitive symptoms with return to normal inter-episode functioning during periods of abstinence
Delirium
• Disturbance of consciousness and cognition that represents significant change from previous level of functioning
• Reduced awareness of surroundings, difficulty concentrating, may be difficult to engage him/her in conversation
• Changes in cognition include short-term memory impairment, disorientation (in regards to time or place), and language disturbance (eg difficulty finding words, naming objects, writing)
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