Chapter 18: Mental Health

Overview of Mental Health and Mental Disorders

Mental health is a crucial aspect of overall well-being, as defined by the World Health Organization (WHO). It encompasses emotional, psychological, and social well-being, affecting how individuals think, feel, and act. Mental disorders are abnormal conditions of the brain or mind that impact thoughts, emotions, behaviors, and relationships. The causes of mental disorders are multifactorial, involving genetics, environment, brain chemistry, and psychosocial factors.

• Health: A state of complete physical, mental, and social well-being, not merely the absence of disease.

• Mental health: The ability to realize one’s abilities, cope with normal stresses, work productively, and contribute to the community.

• Mental disorder: An abnormal condition affecting thinking, feeling, behavior, and relationships.

• Contributing factors: Genetics, environment, chemical changes in the brain, drug use, psychological, social, and cultural conditions.

Classification of Mental Illnesses

Mental illnesses are categorized based on severity and impact on daily functioning:

• Any Mental Illness (AMI): Encompasses all recognized mental illnesses, with varying degrees of impact.

• Serious Mental Illness (SMI): A subset of AMI, resulting in significant functional impairment.

Common mental disorders include:

• Anxiety disorders

• Attention-deficit/hyperactivity disorder (ADHD)

• Autism spectrum disorder

• Bipolar disorders

• Depressive disorders

• Feeding and eating disorders

• Obsessive-compulsive disorders

• Schizophrenia

• Trauma and stressor-related disorders

• Adjustment, dissociative, factitious, sexual and gender, somatic symptom, and tic disorders

• Sleep-related problems and some dementias (e.g., Alzheimer disease)

Nearly one in five U.S. adults live with a mental illness. Major depression, bipolar disorder, and schizophrenia are among the top causes of disability in the U.S.

Symptoms of Mental Disorders

Symptoms vary by age group and may include emotional, behavioral, and physical changes.

• Adults: Confused thinking, persistent sadness, mood swings, anxiety, social withdrawal, changes in eating/sleeping, anger, delusions, hallucinations, inability to cope, suicidal thoughts, denial, unexplained physical problems, substance abuse.

• Adolescents: Substance abuse, inability to cope, changes in eating/sleeping, physical complaints, defiance, intense fear of weight gain, persistent negative mood, thoughts of death, anger outbursts.

• Children: Changes in school performance, poor grades, anxiety, hyperactivity, nightmares, disobedience, aggression, temper tantrums.

Diagnosis of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is the standard reference for diagnosing mental disorders in the U.S. It is used by psychiatrists, psychologists, social workers, and insurance companies for classification and coding.

• Psychiatry: Medical specialty focused on mental disorders.

• Psychiatrist: MD with specialized training in psychotherapy and drug therapy; may further specialize.

• Psychoanalyst: Psychiatrist with training in psychoanalysis, focusing on uncovering repressed experiences.

• Psychology: The study of the mind.

• Psychologist: Holds a master's or PhD in psychology; may specialize in clinical, experimental, or social psychology.

• Clinical Psychologist: Patient-oriented, uses psychotherapy, cannot prescribe medication or ECT, trained in psychological testing.

Common psychological tests include:

• Intelligence Quotient (IQ) tests (Stanford-Binet, WAIS-R)

• Rorschach Inkblot Test

• Thematic Apperception Test (TAT)

• Minnesota Multiphasic Personality Inventory-2 (MMPI-2)

Diagnosis is based on reported symptoms and functional impairment, using interviews and assessment tools.

Treatments for Mental Disorders

Treatment approaches include drug therapy, psychotherapy, and electroconvulsive therapy (ECT).

Drug Therapy

• Antianxiety agents: Benzodiazepines, nonbenzodiazepines

• Antidepressant agents: SSRIs, SNRIs, TCAs, MAOIs

• Antimanic agents

• Antipsychotic agents: Typical and atypical

• Stimulants: Used for ADHD

Psychotherapy

Psychotherapy uses psychological techniques to treat mental disorders. It should be performed by trained professionals and may involve various methods:

• Cognitive-behavioral therapy (CBT): Changes thinking patterns and reactions to anxiety-provoking situations; effective for anxiety disorders.

• Family therapy: Involves the family to resolve conflicts.

• Group therapy: Small groups with similar problems meet together.

• Play therapy: Children use toys to express feelings and conflicts.

• Art therapy: Children portray feelings through drawings.

• Hypnosis: Induced state to recall repressed events.

• Psychoanalysis: Reveals and resolves unconscious conflicts.

Electroconvulsive Therapy (ECT)

ECT involves the use of electric shock to produce convulsions, primarily for severe or life-threatening depression when medications are ineffective. The procedure is performed under anesthesia with muscle relaxants, and electrodes are placed on the head to deliver electrical impulses, causing a brief seizure. Typically, three sessions per week are administered for therapeutic benefit.

Selected Mental Disorders and Key Terms

• Panic disorder: Sudden, repeated feelings of terror without warning; symptoms include sweating, chills, weakness, dizziness, tingling, chest pain, and fear of death.

• ADHD: Types include predominantly hyperactive-impulsive, predominantly inattentive, and combined.

• Autism spectrum disorder: Characterized by self-absorption, inaccessibility, and inability to relate to others.

• Major depression: Persistent sadness, loss of interest, and functional impairment; symptoms vary by age group.

• Bipolar disorder: Alternating episodes of depression and mania.

• Obsessive-Compulsive Disorder (OCD): Persistent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) that provide only temporary relief.

• Personality disorders: Rigid and inflexible behavior, poor impulse control, and difficulty relating to others.

• Tourette syndrome: Neurological disorder with repetitive, involuntary movements and vocalizations (tics).

Medical Terminology: Building Your Vocabulary

• Delusion: delus = to cheat; -ion = process

• Hypomania: hypo- = deficient, below; -mania = madness

• Somatic: somat = body; -ic = pertaining to

Drug Highlights

Additional Information

• Depression is not a normal part of aging and is often underdiagnosed in older adults.

• Depression can co-occur with chronic illnesses such as heart disease, stroke, diabetes, cancer, and Parkinson disease.

• Bulimia nervosa and binge-eating disorder are serious eating disorders with distinct features and treatment approaches.

• OCD-related disorders in DSM-5 include excoriation (skin picking), hoarding, substance/medication-induced OCD, and OCD related to another medical condition.