Psychological deviations in humans: types, signs and symptoms. Methods for diagnosing mental illness Research of mentally ill

Although many people believe that mental illness is rare, it really isn't. Every year, about 54 million Americans experience a mental health problem or illness. Mental disorders affect 1 in 4 people worldwide at some point in their lives. Many of these diseases can be treated with drugs, psychotherapy, but if left unattended, they can easily spiral out of control. If you think you may be experiencing signs of a mental disorder, seek help from a qualified professional as soon as possible.

Steps

Part 1

The concept of mental illness

Realize that mental illness is not your fault. Society often condemns mental illness and those who suffer from it, and it is easy to believe that the reason for your problem is that you are worthless or do not put in enough effort. It is not true. If you have a mental illness, it is the result of a medical condition, not personal failure or anything else. An experienced primary care physician or mental health professional should never make you feel like you are to blame for your illness. It is not the fault of others, nor you yourself.

Consider possible biological risk factors. There is no single cause of mental illness, but there are many biological factors known to interfere with brain chemistry and contribute to hormonal imbalances.

• genetic predisposition. Some mental illnesses, such as schizophrenia, bipolar disorder, depression, are deeply linked to genetics. If someone in your family has been diagnosed with mental illness, then you may be more likely to develop one, simply due to your genetic make-up.
• Physiological disorder. Injuries, such as severe head trauma, or exposure to viruses, bacteria, or toxins during fetal development, lead to mental illness. Also, illicit drug and/or alcohol abuse can cause or exacerbate mental illness.
• Chronic diseases. Chronic illnesses such as cancer or other long-term illnesses increase the risk of developing mental disorders such as anxiety and depression.

1. Understanding possible environmental risk factors. Some mental illnesses, such as anxiety and depression, are directly related to your personal environment and sense of well-being. Shock and lack of stability can cause or exacerbate mental illness.

   • Difficult life experiences. Extremely emotional and exciting life situations can cause mental illness in a person. They may focus on the moment, such as the loss of a loved one, or linger on, such as a history of sexual or physical abuse. Participation in combat operations or as part of an emergency brigade can also contribute to the development of mental illness.
   • Stress. Stress can exacerbate an existing mental disorder and lead to mental illnesses such as depression or anxiety. Family quarrels, financial difficulties, and problems at work can all be a source of stress.
   • Loneliness. Lack of reliable connections for support, a sufficient number of friends, and a lack of healthy communication contribute to the onset or exacerbation of a mental disorder.

2. How to identify warning signs and symptoms. Some mental illnesses start at birth, but others show up over time or come on quite suddenly. The following are symptoms that may be warning signs of mental illness:

   • Feeling sad or irritable
   • Confusion or disorientation
   • Feeling apathy or lack of interest
   • Increased anxiety and anger/hostility/violence
   • Feelings of fear/paranoia
   • Inability to control emotions
   • Difficulties with concentration
   • Difficulties in taking responsibility
   • Reclusion or social exclusion
   • Sleep problems
   • Illusions and/or hallucinations
   • Strange, grandiloquent or far from reality ideas
   • Alcohol or drug abuse
   • Significant changes in eating habits or sex drive
   • Thoughts or plans of suicide

3. Identify physical warning signs and symptoms. Sometimes physical signs can serve as warning signs of a mental illness. If you have symptoms that do not go away, seek medical attention. Warning symptoms include:

   • Fatigue
   • Back and/or chest pain
   • Cardiopalmus
   • Dry mouth
   • Digestive problems
   • Headache
   • excessive sweating
   • Significant changes in body weight
   • Dizziness
   • Serious sleep disorders

4. Determine how severe your symptoms are. Many of these symptoms appear in response to everyday events and therefore do not necessarily indicate that you are mentally ill. You should have reason to be concerned if they persist and, more importantly, if they negatively impact your day-to-day functioning. Never be afraid to seek medical help.

   Make friends for support. It is important for everyone, especially those who deal with mental illness, to have acquaintances who accept and support them. For starters, it could be friends and family. In addition, there are many support groups. Find a support group in your area or online.

   Consider meditation or cultivating self-awareness. Although meditation is not a substitute for professional help and/or drug treatment, it can help manage the symptoms of certain mental illnesses, especially those associated with addiction and use. narcotic substances or anxiety. Mindfulness and meditation emphasize the importance of acceptance and presence, which helps relieve stress.

   Keep a diary. Keeping a diary of your thoughts and experiences can help you different ways. By writing down negative thoughts or worries, you can stop focusing on them. Keeping track of the causes of certain feelings or symptoms will help your primary psychiatrist provide you with optimal treatment. It also allows you to explore your emotions in a safe way.

5. Maintain a healthy diet and routine physical activity. While diet and exercise cannot prevent mental illness, it can help control your symptoms. In the case of severe mental illness, such as schizophrenia or bipolar disorder, it is especially important to maintain a consistent regimen and get enough sleep.

   • If you suffer from an eating disorder such as anorexia, bulimia, or binge eating, then you may need to be extra careful with your diet and exercise regimen. Consult with a specialist to make sure you are following a healthy diet.

A diagnosis of mental illness cannot be made to a person only because of his disagreement with generally accepted cultural, moral, religious and political values, or for other reasons not related to health.

The principles of diagnosing mental illnesses should be guided by international experience and the use in the work of the approved ICD, which is mandatory in Russia. On the basis of the ICD, the Ministry of Health and Social Development of the Russian Federation developed an adapted version for Russia "Mental and behavioral disorders". There is also a standard for the diagnosis and treatment of mental illness and a guideline "Models for the Diagnosis and Treatment of Mental and Behavioral Disorders" aimed at improving the diagnosis and treatment of mental illness. The procedures described in the documents do not limit the doctor's actions; in each specific case, the psychiatrist has the right to individualize the diagnostic measures and the treatment procedure. The medical and diagnostic standard has the goal of summarizing world experience, and contributes to the growth of the efficiency of medical activity.

Tests for mental disorders as one of the ways to diagnose the disease

Mental health is understood as the coherence and adequate work of a person's mental functions. A mentally healthy person can be considered when all of his cognitive processes are within the normal range.

Under the mental norm is understood the average indicator of the assessment of cognitive functions, characteristic of most people. Mental pathology is considered a deviation from the norm, in which thinking, imagination, intellectual sphere, memory and other processes suffer. According to statistics, every fifth person suffers from a mental illness, a third of them are unaware of their illness.

The most common mental disorders include phobias, panic attacks, depression, alcohol and psychotropic addictions, food cravings and sleep disorders. To diagnose probable psychopathological abnormalities, there are special tests for the detection of mental disorders. These methods determine the propensity of a person to a particular mental illness. Reliable diagnosis is put by a psychiatrist on the basis of anamnesis, pathopsychological observation and screening of probable mental abnormalities.

Diagnosis of mental disorders

In order to diagnose a mental illness, a psychotherapist needs to study the appearance of a person, his behavior, collect an objective history, examine cognitive processes and somato-neurological state. Among the most common tests for mental disorders, a certain specificity of the study is distinguished:

• depressive disorders;
• anxiety levels, fears, panic attacks;
• obsessive states;
• eating disorders.

The following methods are used to assess depression:

• the Zang scale for self-reported depression;
• the Beck Depression Scale.

The Zang scale for self-assessment of depression allows you to determine the severity of depressive conditions and the presence of the depressive syndrome itself. The test consists of 20 statements that must be evaluated from 1 to 4, depending on the conditions encountered. The technique assesses the level of depression from its mild manifestation to severe depressive states. This diagnostic method is quite effective and reliable; many psychiatrists and psychotherapists actively use it to confirm the diagnosis.

The Beck Depression Scale also measures the presence of depressive conditions and symptoms. The questionnaire consists of 21 items, with 4 statements each. The test questions are about describing the symptoms and conditions of depression. Interpretation determines the severity of the depressive state or its complete absence. There is a special teenage version of this technique.

When assessing the level of anxiety, phobias and fears, the following questionnaires are used:

• Zang scale for self-reported anxiety,
• Questionnaire of the structure of actual fears of the individual;
• Spielberger Reactive Anxiety Self-Assessment Scale.

The Zang scale for self-assessment of anxiety allows you to determine the fears and the level of anxiety of the respondent. The test consists of 20 questions, which are divided into two scales - affective and somatic symptoms. Each question-statement must be assigned a level of symptoms encountered, from 1 to 4. The questionnaire reveals the level of anxiety or its absence.

The questionnaire for the structure of actual personality fears, proposed by Y. Shcherbatykh and E. Ivleva, determines the presence of fears and phobias in a person. The methodology consists of 24 questions that need to be assessed according to the severity of a particular symptom. Each question corresponds to a scale with a specific phobia, for example, fear of spiders, darkness, death. If the subject scored more than 8 points on one of the scales, this may indicate that he has a certain phobia.

The Spielberger Reactive Anxiety Self-Assessment Scale identifies patients with neurosis, somatic diseases and anxiety syndromes. The questionnaire consists of 20 judgments that must be assessed from 1 to 4. When interpreting the test results, one should not lose sight of the fact that the level of anxiety increases significantly before an important, significant life situation, for example, when defending a thesis for students.

As a test for identifying such a mental disorder as obsessive neurosis, they use:

• Yale-Brown obsessive-compulsive scale.

This method of diagnosing obsessions consists of 10 questions and two scales. The first scale characterizes the severity of obsessive thoughts, and the second - actions. The Yale-Brown scale is effectively used by psychiatrists to determine the severity of obsessions and compulsions in a patient. In psychiatric clinics, this technique is carried out every week to track the dynamics of the development of the disorder. The results of the questionnaire determine the severity of the obsessive state from subclinical manifestations to severe stages.

When making a diagnosis for eating disorders, use:

In 1979, Canadian scientists developed a test to determine anorexia and bulimia. The methodology consists of 31 questions, 5 of which are optional. The subject answers direct questions, and assigns each a rank from 1 to 3. If the result of the study is more than 20 points, then the patient has a high risk of developing an eating disorder.

Among the methods that determine the tendency to a particular mental illness and psychopathization, there are:

• I-structural test of G. Ammon;
• Character accentuation test;
• Questionnaire for determining the level of neuroticism and psychopathization;
• Rorschach test.

The self-structural test of Günter Ammon is used to identify neurosis, aggressiveness and anxiety, phobias and borderline states. The test includes 220 questions and 18 scales. The questionnaire helps to identify constructive or destructive features and functions.

The character accentuation test is represented by several modifications, the most popular option is the method proposed by A.E. Lichko, a domestic psychiatrist and doctor of medical sciences. Under the accentuation of character is understood - a pronounced trait of character, the extreme limit of the mental norm. The questionnaire consists of 143 questions that determine the type of accentuated personality. This diagnostic technique is not a test for mental disorders, it determines psychopathy and accentuation. In mentally healthy people, accentuations smooth out with age, and in psychopathology they intensify and develop into disorders, for example, the psychoasthenic type of accentuations often manifests itself in schizoid disorder, and the sensitive type in obsessive neurosis.

The questionnaire for determining the level of neuroticism and psychopathization examines the level of aggressiveness, a tendency to neuroses and other mental disorders. The methodology consists of 90 questions and two scales (neuroticization and psychopathology). This test is often used by psychiatrists to confirm the diagnosis of neuroses.

The Rorschach inkblot test is aimed at studying the cognitive sphere, conflicts and personality traits. The technique consists of 10 cards, which depict symmetrical ink blots. The subject must describe what he sees in the pictures, what associations he has, whether the image is moving, etc. The meaning of the test is that a mentally healthy person considers and includes the entire ink spot in the work of the imagination, and a person with a mental deviation operates with parts of the drawing, often illogically and absurdly. A reliable analysis of this technique is carried out by a psychotherapist due to the complexity of interpretation and the diversity of the theoretical foundations of the Rorschach technique.

However, none of the above methods can fully diagnose a mental illness. A reliable diagnosis is made by a psychiatrist on the basis of clinical observations, individual studies, anamnesis and psychodiagnostic methods.

2. General principles for the diagnosis of mental illness. Examination of the mentally ill.

3. The importance of psychiatric knowledge in the general system of physician education at the present stage. General Response Block

There is no single, generally accepted classification of mental illness. Each country, and within countries and individual psychiatric schools, use their own classifications. At the moment, two non-identical classifications of mental disorders have been adopted in the world - this is the Handbook of Diagnostics and Statistics of Mental Disorders (DSM-IV) and the International Classification of Diseases 10th revision (ICD-10), namely its V (F) class - “Mental disorders and conduct disorders”, adopted in the Russian Federation.

Developed by the World Health Organization, ICD-10 as the central classification of diseases for the group of classifications on diseases and health problems, in most countries that have adopted it, is being adapted, which is dictated by the need to preserve the features of the national psychiatric classification. The section on mental disorders contains 11 main sections (F0 - F99), divided into 100 three-digit categories. The disorders are grouped according to major characteristics and descriptive similarity. Throughout the ICD-10, the terms "disease" and "disease" are replaced by the term "disorder", which refers to a clinically defined group of symptoms or behavioral signs that, in most cases, cause suffering and interfere with personal functioning.

Mental disorders are generally classified into psychotic, neurotic, functional and organic.

Psychotic (psychosis) - loss of a sense of reality, accompanied by delusions and hallucinations

Neurotic - there is no loss of a sense of reality, disorders are caused by intrapsychic conflicts or life events and are manifested by obsessions, phobias, compulsiveness.

Functional - structural disturbances and etiological factors are unknown.

organic- are caused by structural (morphological) changes in the brain and are accompanied by cognitive (intellectual) disorders, delirium or dementia.

In a general sense (according to the level of disorder), mental illnesses are divided into psychotic and non-psychotic. The former are characterized by gross disintegration of mental functions, uncriticality, lack of ability to control their actions. According to the etiology, mental illnesses are divided as follows:

endogenous - chromosomal, hereditary, with a hereditary predisposition (multifactorial) - schizophrenia, manic-depressive psychosis

exogenous - due to the influence of an external material factor (intoxication psychosis, encephalitis, etc.)

psychogenic - caused by psychotrauma (psychogeny - reactive psychoses, neuroses)

somatogenic (symptomatic) - caused by non-cerebral somatic suffering (atherosclerosis, diabetes, HIV, hypertension, etc.).

At the same time, it should be noted that the etiology of mental illness quite often remains not fully elucidated, and individual links of pathogenesis remain well studied.

Along the course, mental disorders are divided into continuously ongoing and paroxysmal current. Each form of flow, in turn, is divided into several.

The development of the disease is divided into several stages.

Debut is a manifestation of the first signs.

The initial period is the appearance of non-specific manifestations (general somatic, neurosis-like, emotional disorders).

A detailed clinical picture - the presence of characteristic manifestations. It can begin in the form of a manifest (psychotic manifestations) and non-manifest (non-psychotic manifestations).

Stabilization - "freezing" of symptoms without special fluctuations in intensity.

The outcome is complete recovery, incomplete recovery (with residual, residual symptoms), stabilization of the condition, defect, death.

The examination of the mentally ill is carried out mainly by the clinical method. The main method is the method of conversation and observation. It includes a clinical conversation aimed at identifying anamnestic information about the patient's illness. The anamnesis itself can be objective (what third parties tell) and subjective (what the patient himself tells). The main purpose of the conversation is to identify psychopathological symptoms. In addition to the main method, additional methods are used - a variety of hardware, laboratory and psychological studies. However, they are not decisive, because before the analysis "We take off our hats, but not our heads."

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DIAGNOSTICS OF MENTAL DISORDERS

(Diagnosis is a set of procedures and methods aimed at determining the disease in order to make the correct diagnosis and select the means for treatment, taking into account the prognosis of the disease.

When diagnosing mental disorders, it is important to consider two aspects of the significance of this procedure: medical and legal. Let's look at the medical factor first. For the diagnosis of mental illness, it is necessary to distinguish between the following concepts:

0 normal state;

0 mental illness;

0 mental disorder;

0 personality disorder.

Carrying out diagnostic measures of mental illness begins with the identification of the symptoms of the disease. Further, the symptomatology develops into certain syndromes of the disease. And syndromes, in turn, constitute a nosological form of a mental disorder - a disease. The purpose of accurate diagnosis is the correct development of tactics and strategies for the treatment of the disease, as well as further rehabilitation of the patient.

At the first stage of diagnosis, the main signs of the disease or symptoms are determined. The sign of the disease refers to clinical concepts and is directly related to the psychiatrist's external perception of the person's condition. Separate signs of the disease are distinguished in the patient at the level of sensory cognition by the psychiatrist, taking into account his experience. After determining the main signs of the disease, it is necessary to generalize and classify them, to establish the existing interdependencies. Thus, the symptoms of the disease are subjected to clinical examination. Based on its results, disease syndromes are distinguished, which is the next stage in the diagnosis of mental disorders. The third stage of diagnostics forms the general clinical picture mental illness, reveals the pathogenesis and summarizes the data obtained in the form of a diagnostic hypothesis. The fourth stage is based on the formulated diagnostic hypothesis and is characterized by the clarification of clinical symptoms, the search for causal relationships between various factors of the disease: exogenous, personal, endogenous, psychogenic, etc. Based on the work done, the strategy and tactics of therapeutic treatment are built. At the fifth stage, monitoring of changes in symptoms during the treatment of the disease is carried out. The sixth stage is characterized by clarification of the preliminary diagnosis, determination of the recovery prognosis, development of rehabilitation and preventive measures.

Diagnostic differentiated criteria:

0 history data;

0 age of the patient;

0 type of the debut part of the disease;

0 the rate of development of the debut part of the disease;

0 main clinical manifestations (symptoms, syndromes, their dynamics);

0 type of disease course;

0 specificity of remission and light intervals;

0 indicators of laboratory tests;

0 somato-neurological studies;

0 attitude of a person to the disease.

The next factor in diagnosing mental illness is legal.

Based on the legislation on psychiatric care diagnosis of mental illness is carried out in accordance with the approved international rules. A diagnosis of mental illness cannot be made to a person only because of his disagreement with generally accepted cultural, moral, religious and political values, or for other reasons not related to health.

Diagnosis and therapy of the patient should be carried out by medical methods and medicines approved for use on the basis of regulations of the federal health authority. These medical methods and means of treatment should be used solely for the purpose of diagnosing and improving the health of patients.

The principles of diagnosing mental illnesses should be guided by international experience and the use in the work of the approved ICD, which is mandatory in Russia. On the basis of the ICD, the Ministry of Health and Social Development of the Russian Federation developed an adapted version for Russia "Mental and behavioral disorders". There is also a standard for the diagnosis and treatment of mental illness and a guideline "Models for the Diagnosis and Treatment of Mental and Behavioral Disorders" aimed at improving the diagnosis and treatment of mental illness. The procedures described in the documents do not limit the doctor's actions; in each specific case, the psychiatrist has the right to individualize the diagnostic measures and the treatment procedure. The medical and diagnostic standard has the goal of summarizing world experience, and contributes to the growth of the efficiency of medical activity.

In accordance with the legislation of the Russian Federation, only a psychiatrist has the right to establish a diagnosis of a mental disorder. The preliminary conclusion of another medical specialist cannot serve as a basis for involuntary treatment. In an area where there is no psychiatrist, the diagnosis of the disease is resolved through additional training of a specialist in order to acquire the right of psychiatric activity.

S There are certain methods for diagnosing mental illness:

| YG collection of anamnesis. Information is being collected about the mental and physical state of a person in the present and retrospective plans, data are collected on heredity, features of personality formation, traits and properties of character, interests

and skills and habits. Described past illnesses, head injuries, the use of drugs and alcohol, the presence of facts of immoral behavior. These data can be obtained from investigative and judicial materials, characteristics at the place of work and residence, medical history, etc.;

rZ” collection of information about mental health and the adequacy of human behavior on the basis of witness testimony. These data can be obtained by interviewing witnesses involved in the case under study;

(yg collection of official medical information. It is carried out by requesting psychiatric medical institutions to obtain certificates and extracts from the medical history;

an experimental psychological study includes an examination of the patient by psychologists, which makes it possible to identify violations in certain aspects of the personality and indicate its features;

Its” observation is carried out in stationary conditions by psychiatrists and other medical personnel when they make rounds in the form of a personal conversation with a person. Held around the clock. Attention is drawn to the change in the state of the patient in the mental plane;

Its” examination of the brain consists in conducting analyzes and hardware examination of the functions of the brain (computed tomography, spinal puncture, electroencephalogram, etc.);

1st diagnostics neurological symptoms. A study of neurological reflexes is being carried out. The compliance of tendon reflexes, the absence of pathological reflexes,

paralysis, convulsions, the degree of disorders of the autonomic system;

cZg - diagnosis of somatic symptoms. The absence or presence of these symptoms is determined (impaired metabolic functions, digestion, blood circulation, etc.). It is carried out by laboratory tests and in the form of hardware diagnostics.

Clinical methods for diagnosing mental disorders

The overall goal of psychiatric diagnosis is to identify mental disorders, so special attention is paid to pathological manifestations and their classification. The psychiatrist tends to evaluate each individual as a potential patient, a psychiatric patient. However, in order to have the right to call a person mentally ill and make a definite diagnosis, a doctor must follow a number of steps. Psychiatrists use several diagnostic methods, which complement each other and help to separate norms from pathology. The underlying dilemma of mental health or illness is then brought to the fore. It is often difficult for a non-professional to distinguish a healthy person from a sick person. For example, a depressed person from a slightly melancholic, pensive person; dulling of emotions in schizophrenia from a restrained and balanced character; hypomanic states from liveliness, indefatigability energetic person; decrease in intelligence from stupidity or lack of education; a person with delusions of jealousy from a jealous person.

For a doctor, clinical diagnosis is the main principle; it determines further treatment - therapy. At the same time, one should not rush to establish the pathology, taking into account the whole complex of factors affecting the individual, in particular, the negative impact of the environment, the insufficient development of forms of psychiatric care, and the negative attitude of society towards the mentally ill.

The most important method of psychiatric examination is interview or psychiatric conversation with the patient. Indeed, most of the symptoms of mental disorders can be identified only from the words of the patient. The survey has two goals: firstly, it allows the patient to express his complaints, worries and anxieties to the doctor, allows the doctor to obtain data about the patient's personality, his life circumstances and painful manifestations, and secondly, it is a necessary prerequisite for establishing a diagnosis. A conversation with a patient in medicine is called history taking method.

Anamnesis- information about the medical history (medical history) and the main circumstances of life (anamnesis of life).

When studying the anamnesis of the disease, information is collected about when and what signs of the disease appeared, what events accompanied their occurrence, how the symptoms developed further. When determining the anamnesis of life, questions are asked about biographical events, memories of the parental family, schooling, behavior in childhood and adolescence, as well as the individual's ideas about what his social status is at the moment.

Thus, most of the information comes from the patient himself. This type of information gathering is called subjective history. In the process of questioning, it becomes clear, first of all, how objectively a person perceives what is happening around, how he is oriented in space and time, how much the most important events of his life are stored in his memory. At the same time, direct and indirect questions are asked about painful experiences, for example, about hallucinations, obsessive thoughts, and the critical attitude of a person to the identified painful features is determined - whether he is aware of their pain. In addition, it is always appropriate to find out the presence of suicidal thoughts. Meanwhile, a personal assessment of present and past events that have occurred in the family and professional spheres is essential.

Objective history denotes information received from the patient's relatives and friends, which, in particular, are based on similar questions and are intended to verify, verify the adequacy of the subjective anamnesis and draw up a complete picture of mental disorders.

In foreign psychiatry, the survey can take the form of either a psychiatric interview or intelligence. Interview implies an open, unstructured nature of the conversation, when its course changes depending on the emerging problem areas. This type of questioning is used when there is reason to believe that psychotherapeutic treatment will be needed in the future. For intelligence a more rigid format is characteristic, when the conversation is determined by the focused questions of the psychiatrist. Its goal is the active identification of psychopathological symptoms. In any version, the psychiatric conversation is subject to certain rules regarding the content of its introductory, middle and final phases, however, its through principles are understanding and the most accurate description of the patient's problems.

Another method of psychiatric examination is observation of the patient's behavior. Diagnostic observation supplements the results of the conversation, therefore, at the first contact, it is important to notice the characteristic pattern of actions, movements, facial expressions, gestures, speech of a person. For example, the degree of his excitement or inhibition, the features of the intonation of the voice (monotonous or mournful), as well as the originality of speech (fast, slow, quiet, intermittent) can be assessed. Hallucinations can affect behavior when he looks at something, listens, or delirium, manifested in suspicion, alertness, sudden aggression.

As a result of conversation and observation, an idea is formed about the following functions of a person:

Degrees of orientation in the environment;

Thinking, course and content of thoughts;

Basic mood and affective reactions;

Mnestic functions (memory);

Examination of the patient and associated neurological and somatic examinations are the next method for diagnosing mental disorders. During the examination, bodily injuries and external features of a person are recorded, their connection with painful symptoms is determined. In addition, neurological examination reveals possible manifestations of nervous diseases, which may depend on organic brain lesions. A physical examination is an integral part of every psychiatric report. Its significance is due to the possible connection of mental disorders with somatic diseases.

Additional clinical research methods are neurophysiological and neuroradiological examinations. The most common methods in medical practice for studying brain lesions are electroencephalography, echoencephalography, and computed tomography of the brain, which is especially popular in the search for brain tumors and atrophic processes. However, it should be noted that most mental disorders are not accompanied by damage. nervous system and brain. Although, perhaps today, clinical research methods are not so perfect as to demonstrate problem areas. Nevertheless, the well-known American researcher E. Fuller Torrey, who studies the brains of people with schizophrenia, is convinced that someday medicine will be able to find a universal answer to all questions related to mental illness in the organic structure of the brain.

Thus, the conclusion, which is formed as a result of the examination of the clinical picture of the disease, is based on the data of several methods. Moreover, a psychiatric diagnosis cannot be established on the basis of a single symptom. The whole picture is of decisive importance, since individual psychopathological symptoms are ambiguous and diagnostically non-specific. Psychiatric diagnosis is made in accordance with accepted classifications of mental illness. In Russia, as in many other countries, psychiatrists adhere to the International Classification of Diseases (ICD-10), which contains 10 main sections and includes 458 mental disorders. In the US, another classification is used - the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The peculiarity of the latter is that it is not diseases that are subdivided as integral concepts, but syndromes or individual mental disorders. This is due to the psychiatric paradigm, according to which the entire complex of morbid symptoms can hardly be detected in an individual, rather, more or less persistent syndromic symptoms can be identified in him.

Clinical and psychiatric understanding of the patient's condition includes the following components:

1) the main dates of personal, family life, social status;

2) personal history (early childhood, sexuality, interpersonal relationships and conflicts);

3) family history;

4) social history;

5) medical history;

6) complaints now;

7) somatic and especially neurological condition;

8) data of clinical-psychological and diagnostic testing;

9) data from special somatic studies;

10) psychopathological data;

11) short summary all received data;

12) preliminary diagnosis;

13) hypothetical forecast;

14) treatment plan;

15) subsequent therapy diary;

16) final diagnosis;

17) a generalized record in the form of an epicrisis.

In general, psychiatric examination remains the leading one in determining individual pathology, however, at present, the decision on the final diagnosis is made taking into account the pathopsychological examination and is impossible without psychological diagnostic data.

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Diagnostics

Many mental disorders have similar symptoms, but completely different causes of development. A complete and accurately compiled diagnostic program allows you to make a correct diagnosis, as well as determine what are the causes and mechanisms for the development of a mental disorder.

Diagnosis of mental illness consists of instrumental and laboratory methods studies of the nervous system, clinical and psychological interviews.

What does the diagnosis of mental disorders include?

Biological diagnostic methods

Electroencephalography

This is a record of the bioelectrical activity of different brain structures. An EEG is as important to a psychiatrist or neurologist as an electrocardiogram is to a cardiologist. Like electrocardiography, EEG recording is absolutely safe and has no contraindications. Electroencephalography helps to make an accurate diagnosis of a mental disorder, determine its severity, and choose one or another psychotropic drug. The method of daily monitoring of the bioelectrical activity of the brain is distinguished by high information content. For children, daily monitoring is usually replaced by a 4-hour EEG recording.

Evoked Potentials

A method that allows you to evaluate the reaction of the brain to stimuli and stimuli - signals from the outside world and the internal environment of the patient's body. The evoked potentials help to understand how the brain is involved in the process of information processing and how well the process of this processing goes.

The evoked potentials are classified according to the presented stimuli into cognitive, visual, auditory and visceral:

• Cognitive evoked potentials - a method of integral assessment of the state of memory, attention and thinking of the patient.
• Sympathetic or visceral evoked potentials help assess the state of the autonomic nervous system.
• Auditory and visual evoked potentials are assigned to determine the cause of visual or auditory hallucinations.

The evoked potential method is used to diagnose schizophrenia and Alzheimer's disease.

Magnetic resonance imaging (MRI)

Method of visualization of brain structures in different planes. The basic principle of its work is the evaluation of the magnetic resonance of hydrogen nuclei. This method does not require prior preparation, is absolutely painless and safe. A contraindication to MRI is the presence of an artificial pacemaker and metallic foreign bodies. The duration of the study is minutes.

MRI can detect tumors and cysts, changes in the size of the brain, characteristic of some mental illnesses, as well as assess the condition of the brain vessels.

Different mental disorders have their own characteristics of the MRI picture, for example, in schizophrenia, there is an expansion of the left ventricle of the brain and a reduction in size. temporal lobe, with bipolar affective disorder and prolonged depression - expansion of the right ventricle of the brain. Its changes are present in Alzheimer's disease and vascular dementia.

Doppler ultrasound

Used to assess blood flow in the arteries and veins of the head and neck. Ultrasonography is used for the initial detection of blood flow disorders and for the control of circulatory insufficiency and related diseases. Ultrasound examination of the vessels of the head and neck does not require preparation. The method is harmless to the body and is acceptable even during pregnancy. Ultrasound examination takes minutes.

Doppler ultrasound of the vessels of the head and neck is indicated in the following cases:

• dizziness, loss of consciousness, even for seconds, loss of visual fields, weakness of the arms or legs on one side;
• with weakening of pulse waves;
• with asymmetry of pressure and pulse on the hands;
• with chronic arterial hypertension and the possible development of vascular atherosclerosis (increased levels of LDL, triglycerides, hereditary predisposition, diabetes mellitus).

Study of the structure of nocturnal sleep

The study of the structure of nocturnal sleep, or polysomnography, provides an opportunity to assess the state of the brain during sleep, the activity of the cardiovascular system, motor activity during sleep. In addition, polysomnography allows you to choose drugs that improve sleep. Preparation for polysomnography usually begins in the evening (around 20.00), and the procedure itself ends at 7.00. The study is usually well tolerated, since modern electrodes and sensors are made in such a way that they do not affect the quality of sleep at all.

Analyzes

General clinical blood test and biochemical analyzes

Allow to assess the state of metabolism, water-salt balance, energy metabolism. In addition, inflammatory processes, a lack or excess of vitamins and amino acids (relevant for anorexia), the presence of heavy metals in the blood (important for patients living in ecologically disadvantaged areas) are detected.

Hormone analyzes

Help identify diseases endocrine system, which can cause mental disorders, as well as control the side effects of psychotropic drugs.

The concentration of stress axis hormones (corticotropin releasing factor, ACTH, cortisol, DEHA) shows the level and duration of stress, the involvement of the body's mechanisms of dealing with stress. The stress axis hormone ratio predicts the course of anxiety spectrum disorders and depression.

Thyroid hormones and their tropic (concentration-controlling) hormones - thyrotropin releasing factor, TSH, T3, T4 - may be involved in the development of depression.

A decrease in the level of the hormone melatonin, which regulates the sleep-wake rhythm, can lead to the development of affective disorders. Stabilization of melatonin concentration during the treatment of depression indicates a positive prognosis for the treatment of the disease. In addition, melatonin has a positive effect on the immune system.

Measurement of the concentration of the hormone prolactin makes it possible to predict the timing of recovery from psychosis. In addition, control of the concentration of prolactin is necessary when taking certain psychotropic drugs that cause hyperprolactinemia - an increase in the level of prolactin in the blood.

Immune System Research

Immunogram, cytokine and interferon profiles - allow you to identify pathological changes in the immune system, chronic infections and inflammation, as well as autoimmune processes.

Bacteriological and virological studies

The presence of neuroviral infections affecting various structures of the nervous system is detected. The most common neuroinfections include Epstein-Barr, herpes, rubella, streptococcus and staphylococcus viruses.

Neurotest

A blood test that determines the content of autoantibodies to various proteins of the nervous system. The neurotest shows the presence of inflammatory processes in the nervous system, degeneration of the membranes that ensure the rapid transmission of a nerve impulse, changes in the content of neurotransmitter receptors involved in signal transmission in the brain.

Psychological diagnostic methods

Pathopsychological research

Aimed at assessing the perception, memory, attention and thinking of the patient. During the study, the subject is given certain tasks, the performance of which characterizes cognitive functions. In addition, the clinical psychologist can obtain information from the behavior of the subject during the study.

This study has the right to conduct only a clinical (medical) psychologist.

Neuropsychological research

Allows you to identify violations of the state of personality and mental processes at the brain level. This study allows you to localize disorders of mental functions in certain parts of the brain. During the study, general intelligence, attention and concentration, learning and memory, language, volitional functions, perception functions, sensorimotor functions, and psychological emotional status are assessed. The foundations of neuropsychological research were laid by A.R. Luria and his students. The methods are based on the concept of formation and development of higher mental functions by L.S. Vygotsky. Neuropsychological research can also be carried out only by a clinical psychologist.

Other psychological research methods used in the clinic include the study of the type and structure of personality, the determination of sensitivity to various methods of psychotherapy, the diagnosis of the family system and the diagnosis of social and labor adaptation.

Online test for predisposition to mental disorders

Many people are concerned about the issues of maintaining or diagnosing mental health, but not everyone wants to admit it to others. Therefore, the most popular way to find out whether or not you have any mental problems is a clinical test for mental disorders. What can this test tell about, and what did the authors of the test rely on when creating it?

The development of this test was due to the fact that in modern society, mental illness has ceased to be some kind of outlandish disease. Today, a huge number of people suffer from various mental problems. Thus, serious disorders (such as schizophrenia, psychoses or neuroses) are diagnosed or confirmed annually in 5-7 percent of the population. However, mental disorders do not necessarily manifest themselves in the form of mental illnesses, such as psychoses or neuroses. It can also be borderline states, or disturbances in attitude and behavior in the absence of any visible changes in the human nervous system. From 15 to 23% of modern people suffer from such forms of mental disorders. The most common forms of such disorders are depression and various phobias.

The symptoms of a disturbed psyche are very diverse, they largely depend on the cause that caused a particular disorder. However, there are certain physical symptoms that are characteristic of almost all mental illnesses. These symptoms include low mood, a variety of sleep disorders and appetite. These symptoms can be expressed to varying degrees with different types of such deviations in the psyche, but they occur in almost all sick people.

Knowing about this feature of symptoms, psychiatrists have developed a special clinical test to determine a person's predisposition to mental disorders. Now you have an excellent opportunity to learn about the state of your psyche, as well as about the reasons that caused such a state. And besides, you can decide which specialist's advice will be most useful to you. However, do not forget that you should not make hasty conclusions on the basis of a single test. First, go through similar tests, and only if the result matches, be sure to seek help from a psychotherapist to clarify the diagnosis.

All information provided on this site is for reference only and does not constitute a call to action. If you have any symptoms, you should immediately consult a doctor. Do not self-medicate or diagnose.

Do you know what mental disorders are and how they manifest themselves?

Types of mental disorders

1. Topics discussed in the article:
2. What is a mental disorder?
3. What is a psychological disorder?
4. How many people suffer from mental disorders?
5. What is a personality disorder?
6. Mental disorders symptoms.

Mental disorders | Definition, types, treatment and facts

Psychiatric disorder, any illness with significant psychological or behavioral manifestations that is associated with either a painful or distressing symptom or impairment in one or more important areas of functioning.

Mental disorders, in particular their consequences and their treatment, are of greater concern and receive more attention than in the past. Mental disorders have become a more prominent subject of attention for several reasons. They have always been common, but with the eradication or successful treatment of many of the serious physical illnesses that people used to be affected by, mental illness has become a more prominent cause of suffering and explains the higher proportion of those who were disabled by illness. Moreover, the public has come to expect that the medical and psychiatric professions will help him obtain an improved quality of life in his mental and physical functioning. Indeed, both pharmacological and psychotherapeutic treatments were common. The transfer of many psychiatric patients, some still showing noticeable symptoms, from psychiatric hospitals to the community has also raised public awareness of the importance and prevalence of mental illness.

Not simple definition mental disorder that is universally satisfactory. This is partly because mental states or behaviors that are considered abnormal in one culture may be considered normal or acceptable in another, and in either case it is difficult to draw a clear line between healthy and abnormal mental functioning.

A narrow definition of mental illness would insist on the presence of an organic brain disease, both structural and biochemical. An overly broad definition would define mental illness as simply the absence or absence of mental health, that is, a state of mental well-being, balance and resilience in which a person can successfully work and function and in which the individual can confront and learn to cope with the conflicts and stresses that arise in life. . A more generally accepted definition attributes mental disorder to psychological, social, biochemical, or genetic dysfunctions or personality disorders.

Mental disorders can affect every aspect of a person's life, including thinking, feeling, mood and worldview, as well as areas of external activity such as family and family life, sexual activity, work, leisure and management of material affairs. Most mental disorders negatively affect how people feel and reduce their ability to participate in mutually beneficial relationships.

Psychopathology is the systematic study of the significant causes, processes, and symptomatic manifestations of mental disorders. The meticulous research, observation, and research that characterize the discipline of psychopathology are in turn the basis of the practice of psychiatry (i.e., the science and practice of diagnosing and treating mental disorders, as well as combating their prevention). Psychiatry, psychology and related disciplines such as clinical psychology and counseling cover a wide range of methods and approaches to the treatment of mental illness. These include the use of psychoactive drugs to correct biochemical imbalances in the brain or other ways to alleviate depression, anxiety, and other painful emotional conditions.

Another important group of treatment is psychotherapy, which is aimed at treating mental disorders. by psychological means and which includes verbal communication between a patient and a trained person in the context of a therapeutic interpersonal relationship between them. The different modes of psychotherapy vary in emotional experience, cognitive processing, and overt behavior.

This article looks at the types, causes, and treatment of mental disorders. Neurological diseases (see Neurology) with behavioral manifestations are treated for diseases of the nervous system. The prevalence of alcoholism and other alcohol use disorders is discussed with alcohol and drug use. Disorders of sexual functioning and behavior are considered in the sexual behavior of a person. The tests used to assess mental health and functioning are discussed under psychological testing. Various theories of personality structure and dynamics are discussed in Personality, and human emotion and motivation are discussed in Emotion and Motivation.

Types and Causes of Mental Disorders

Classification and epidemiology

Psychiatric classification attempts to bring order to the vast variety of psychiatric symptoms, syndromes, and illnesses that occur in clinical practice. Epidemiology is the measurement of the prevalence or frequency of occurrence of these mental disorders in different human populations.

Classification

Mental disorders are classified.

Diagnosis is the process of identifying a disease by examining its signs and symptoms and taking into account the patient's history. Much of this information is collected by a mental health professional (eg, psychiatrist, psychotherapist, psychologist, social worker, or counselor) during initial interviews with the patient, who describes the main complaints and symptoms and any past, and briefly gives personal history and current situations. The practitioner may apply any of several psychological tests to the patient and may supplement these with physical and neurological examinations.

These data, together with the patient's own observations and the patient's interaction with the practitioner, form the basis for a preliminary diagnostic evaluation. For the practitioner, diagnosis involves finding the most prominent or significant symptoms on the basis of which the patient's disorder can be categorized as the first step in treatment. Diagnosis is just as important in mental health care as it is in treatment.

Classification systems in psychiatry aim to distinguish between groups of patients who share the same or related clinical symptoms in order to provide appropriate therapy and accurately predict recovery prospects for any individual member of that group. Thus, a diagnosis of depression, for example, would cause the practitioner to consider antidepressants in preparation for a course of treatment.

The diagnostic terms of psychiatry were introduced at different stages in the development of the discipline and from very different theoretical positions. Sometimes two words with completely different implications mean almost the same thing, such as praecox dementia and schizophrenia. Sometimes a word like hysteria carries a lot different values depending on the theoretical orientation of the psychiatrist.

Psychiatry is hampered by the fact that the cause of many mental illnesses is unknown, and therefore convenient diagnostic distinctions cannot be made among such illnesses as they can, for example, in infectious medicine, where a specific type of bacterium is a reliable indicator for diagnosing tuberculosis.

But, the greatest difficulties associated with psychiatric disorders with regard to classification and diagnosis is that the same symptoms are often found in patients with different or unrelated disorders, and the patient may show a combination of symptoms appropriately related to several different disorders. Thus, while categories of mental illness are defined according to symptom patterns, course, and outcome, many patients' illnesses are intermediate cases between such categories, and the categories themselves may not necessarily be certain diseases and often poorly defined.

The two most commonly used psychiatric classification systems are the International Statistical Classification of Diseases and Related Health Problems (ICD) by the World Health Organization and the Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association, 10th Edition 1st Edition. , published in 1992, is widely used in Western Europe and other parts of the world for epidemiological and administrative purposes.

Its nomenclature is deliberately conservative in conception so that it can be used by clinicians and mental health systems in different countries. The 11th revision (ICD-11) was scheduled for publication in 2018. The DSM, by contrast, has gone through five changes since its introduction in 1952; the most latest version DSM-5 was introduced in 2013. The DSM differs from the ICD by introducing precisely described criteria for each diagnostic category; its categorizations are based on the detailed description of the symptoms.

DSM is a standard resource in the United States, although it is widely used around the world. His detailed descriptions of diagnostic criteria were helpful in eradicating inconsistencies in early classifications. However, in everyday clinical use there are still some serious problems. Chief among these is the DSM's innovative and controversial rejection of the general categories of psychosis and neurosis in its classification scheme. These terms have been and remain widely used to distinguish between classes of mental disorders, although there are various mental illnesses, such as personality disorders, that cannot be classified as psychoses or neuroses. In addition, a source of criticism has been the use of broad diagnostic criteria and the lack of inclusion of diagnostic criteria based on known biological factors.

psychoses

Psychoses are major mental illnesses characterized by severe symptoms such as delusions, hallucinations, thought disturbances, and deficiencies in judgment and insight. People with psychosis exhibit impairment or disorganization of thought, emotion, and behavior so profoundly that they are often unable to function in daily life and may be incapacitated or disabled. Such people often fail to realize that their subjective perceptions and feelings do not correlate with objective reality, a phenomenon exhibited by people with psychosis who do not know or believe that they are ill despite feeling fear and their apparent confusion. in relation to the outside world. Traditionally, psychoses have been broadly divided into organic and functional psychoses. Organic psychoses were considered the result of a physical defect or damage to the brain. Functional psychoses were not thought to have physical brain disease evident on clinical examination. Many studies show that this distinction between organic and functional may not be accurate. Currently, most psychoses are the result of some structural or biochemical change in the brain.

neuroses

Neuroses or psychoneuroses are less serious disorders in which people may experience negative feelings such as anxiety or depression. Their functioning may be significantly impaired, but the personality remains relatively intact, the ability to recognize and objectively evaluate reality is preserved, and they are basically able to function in everyday life. Unlike people with psychoses, neurotic patients know or can be aware that they are sick, and they usually want to get better and return to normal. Their chances of recovery are better than those of people with psychosis. The symptoms of a neurosis may sometimes resemble the coping mechanisms used by most people in everyday life, but in a neurotic these defensive reactions are inadvertently severe or prolonged in response to external stress. Anxiety disorders, phobic disorder (manifested as unreal fear or fear), conversion disorder (formerly known as hysteria), obsessive-compulsive disorder, and depressive disorders are traditionally classified as neuroses.

Epidemiology

Epidemiology is a study of the distribution of disease in different populations. Prevalence refers to the number of cases of a condition present at a specific time or during a specific period, while incidence refers to the number of new cases occurring in a specific time period. Epidemiology is also concerned with the social, economic, or other context in which mental illness occurs.

Understanding mental disorders is helped by knowing the speed and frequency with which they occur in different societies and cultures. Looking at the prevalence of mental disorders around the world, you will find many surprising results. Remarkably, for example, the lifetime risk of developing schizophrenia, even across cultures, is about 1 percent.

Gradual historical changes in the prevalence and prevalence of individual disorders have often been described, however it is very difficult to obtain conclusive evidence that such changes actually occurred. On the other hand, prevalence has been seen to increase for several syndromes due to general changes in living conditions over time. For example, dementia inevitably develops in about 20 percent of those over 80 years of age, so with the increase in life expectancy common to developed countries, the number of people with dementia will inevitably increase. There also appears to be some evidence of an increase in the prevalence of mood disorders over the past century.

Several large-scale epidemiological studies have been conducted to determine the incidence and prevalence of mental disorders in the general population. Simple statistics based on those people who are actually in treatment for mental disorders cannot be used in making such a definition, since the number of those who seek treatment is substantially less than the actual number of people with mental disorders, many of whom are not sought after. professional treatment. Moreover, surveys to determine incidence and prevalence depend on their statistical data on the clinical judgment of the observers, which can always be erroneous, since there are no objective tests to assess mental illness. Given such objections, one ambitious study conducted by the National Institute of Mental Health in the United States examined thousands of people in several American localities and produced the following results regarding the prevalence of mental disorders in the general population. It found that about 1 percent of those surveyed had schizophrenia, more than 9 percent had depression, and about 13 percent had phobias or other anxiety disorders.

There is a relatively strong epidemiological association between socioeconomic class and the occurrence of certain types of mental disorders and general patterns of mental health. One study found that the lower the socioeconomic class, the higher the prevalence of psychotic disorders; Schizophrenia was found to be 11 times more common among the lowest of the five classes studied (unskilled workers) than among the upper classes (professionals). (However, anxiety disorders have been found to be more common among the middle class.) Two possible explanations for the increased incidence of schizophrenia among the poor are that people with schizophrenia "drift down" to the lowest socioeconomic class because they are weakened by their disease or , alternatively, that unfavorable sociocultural conditions create circumstances that help to cause illness.

The manifestation of individual psychiatric symptoms is sometimes closely related to specific eras or periods of life. During childhood and adolescence, various psychiatric symptoms characteristic of these periods of life may occur. Anorexia nervosa, several types of schizophrenia, drug abuse, and bipolar disorder often first appear during adolescence or young adulthood. Alcohol dependence and its consequences, paranoid schizophrenia, and recurrent bouts of depression are more common in middle age. Involutional melancholia and presenile dementias usually occur in late middle age, while senile and arteriosclerotic dementias are common in the elderly.

There are also marked sex differences in the prevalence of certain types of mental illness. For example, anorexia nervosa is 20 times more common in girls than boys; men tend to develop schizophrenia at a younger age than women; depression is more common in women than in men; and many sexual deviations occur almost exclusively in men.

Theories of causality

Very often, the etiology or cause of a certain type of mental disorder is unknown or only to a very limited extent understood. To complicate matters, a mental disorder such as schizophrenia can be caused by a combination and interaction of several factors, including a likely genetic predisposition to develop the disease, a postulated biochemical imbalance in the brain, and a group of stressful life events that help hasten the actual onset of the disease. The prevalence of these and other factors likely varies from person to person in schizophrenia. This complex interplay of constitutional, evolutionary, and social factors may influence mood and anxiety disorders.

No theory of causality can explain all mental disorders, or even those of a particular type. Moreover, the same type of disorder may have different causes in different individuals: for example, obsessive-compulsive disorder may have its origin in a biochemical imbalance, in an unconscious emotional conflict, in faulty learning processes, or in a combination of both. The fact that completely different therapeutic approaches can provide equal improvements in different patients with the same type of disorder highlights the complex and ambiguous nature of the causes of mental illness. The main theoretical and research approaches to the causation of mental disorders are discussed below.

Organic and hereditary etiology

Organic explanations for mental illness have usually been genetic, biochemical, neuropathological, or a combination of these.

Genetics

The study of the genetic causes of mental disorders involves both laboratory analysis of the human genome and statistical analysis of the frequency of occurrence of a particular disorder among individuals who share related genes, i.e., family members and especially twins. Family risk studies compare the observed incidence of mental illness in close relatives of a patient with its frequency in the general population. First-degree relatives (parents, siblings) share 50 percent of their genetic material with the patient, and higher than expected disease rates in these relatives indicate a possible genetic factor. In twin studies, the incidence of the disease in both members of pairs of identical (monozygotic) twins is compared with the incidence in both members of a pair of fraternal (dizygotic) twins. The higher agreement for disease among identicals than fraternal ones suggests a genetic component. Additional information about the relative importance of genetic and environmental factors comes from comparing identical twins collected together with separated ones. Adoption studies that compared adopted children whose biological parents had the disease with those whose parents did not can also be useful in separating biological from environmental influences.

Such studies have demonstrated a clear role for genetic factors in the causation of schizophrenia. When a parent is diagnosed with the disorder, that person's children are at least 10 times more likely to develop schizophrenia (about 12% chance of risk) than children in the general population (about 1% chance of risk). If both parents have schizophrenia, there is a 35 to 65 percent chance that their children will develop the disorder. If one member of a pair of fraternal twins develops schizophrenia, there is a 12% chance that the other twin will. If one member of a pair of identical twins has schizophrenia, the other identical twin has at least a 40-50% chance of developing the disorder. Although genetic factors appear to play a less significant role in the causes of other psychotic and personality disorders, studies have demonstrated the likely role of genetic factors in the causes of many mood disorders and some anxiety disorders.

Biochemistry

If the mental illness is caused by a biochemical pathology, examination of the brain at the site where the biochemical imbalance occurs should show neurochemical differences from normal. In practice, this simplistic approach is fraught with practical, methodological and ethical difficulties. The living human brain is not readily available for direct examination, and the dead brain undergoes chemical changes; in addition, evidence of abnormalities in the cerebrospinal fluid, blood, or urine may not be relevant to the question of a suspected biochemical imbalance in the brain. It is difficult to study human mental illness using animal analogs, since most mental disorders either do not occur or are not recognized in animals. Even when biochemical abnormalities are found in individuals with psychiatric disorders, it is difficult to know whether they are the cause or the result of the disease or its treatment, or other consequences. Despite these problems, progress has been made in unraveling the biochemistry of mood disorders, schizophrenia, and some dementias.

Some medications have been shown to have a beneficial effect on mental illness. It is believed that antidepressants, antipsychotics, and antidiagnostics achieve their therapeutic effects by selectively inhibiting or enhancing the amount, action, or disruption of neurotransmitters in the brain. Neurotransmitters are a group of chemical agents that are released by neurons (nerve cells) to stimulate neighboring neurons, allowing impulses to be transmitted from one cell to another throughout the nervous system. Neurotransmitters play a key role in the transmission of nerve impulses across the microscopic gap (synaptic cleft) that exists between neurons. The release of these neurotransmitters is stimulated by the electrical activity of the cell. Norepinephrine, dopamine, acetylcholine, and serotonin are among the major neurotransmitters. Some neurotransmitters excite or activate neurons while others act as inhibitory substances. Abnormally low or high concentrations of neurotransmitters at sites in the brain are thought to alter the synaptic activity of neurons, ultimately leading to the disturbances in mood, emotion, or thought found in various psychiatric disorders.

Neuropathology

In the past, post-mortem brain research has revealed information on which great advances in understanding the etiology of neurological and some mental disorders have been based, leading to the German psychiatrist Wilhelm Griessinger's postulation "All mental illness is a disease of the brain." Applying the principles of pathology to general paresis, one of the most common conditions found in psychiatric hospitals in the late 19th century, led to the discovery that it was a form of neurosyphilis and was caused by infection with the spirochetal bacterium Treponema pallidum. Studying the brains of patients with other forms of dementia has shown useful information about other causes of this syndrome - for example, Alzheimer's disease and arteriosclerosis. Accurate identification of abnormalities in certain areas of the brain has helped to understand some abnormal mental functions such as memory impairments and speech disorders. Recent advances in neuroimaging techniques have expanded the ability to investigate brain disorders in patients with a wide range mental illness, eliminating the need for post-mortem studies.

Psychodynamic etiology

In the first half of the 20th century, theories of the etiology of mental disorders, especially neuroses and personality disorders, were dominated in the United States by Freudian psychoanalysis and post-Freudian derivative theories (see Freud, Sigmund). In Western Europe, the influence of Freud's theory on psychiatric theory declined after World War II.

Theories of personality development

Freudian and other psychodynamic theories view neurotic symptoms as being caused by intrapsychic conflict, i.e., the existence of conflicting motives, urges, impulses, and feelings found in various components of the mind. Central to psychoanalytic theory is the postulated existence of the unconscious, which is that part of the mind whose processes and functions are inaccessible to human conscious awareness or verification. One of the functions of the unconscious is considered to be a repository of traumatic memories, feelings, ideas, desires, and movements that are threatening, disgusting, disturbing, or socially or ethically unacceptable to the individual. These mental contents may at some point be repressed from conscious consciousness, but remain active in the unconscious. This process is a defense mechanism to protect a person from anxiety or other mental pain associated with this content and is known as repression. However, the repressed psychic contents contained in the unconscious retain much of the psychic energy or power that was originally attached to them, and they may continue to significantly affect a person's mental life, although (or because) the person is no longer aware of them.

The natural tendency for repressed movements or feelings, according to this theory, is to achieve conscious awareness so that the person can seek satisfaction, fulfillment, or resolution. But this has been threatened by the release of forbidden impulses or disturbing memories and is considered threatening, and then various defense mechanisms can be activated to alleviate the state of mental conflict. Through reaction formation, forecasting, regression, sublimation, rationalization and other defense mechanisms, a part of the unwanted mental content component may appear in consciousness in a disguised or weakened form, which provides partial help to the individual. Later, perhaps in adulthood, some event or situation in a person's life triggers an abnormal discharge of pent-up emotional energy in the form of neurotic symptoms in a manner mediated by defense mechanisms. Such symptoms may form the basis of neurotic disorders such as conversion and somatoform disorders (see Somatoform Disorders below), anxiety disorders, obsessive-compulsive disorders, and depressive disorders. Because the symptoms represent a compromise in the mind, allowing repressed mental contents to be shed and to continue to deny all conscious knowledge of them, the particular nature and aspects of an individual's symptoms and neurotic problems have an intrinsic meaning that symbolically represents the underlying intrapsychic conflict. Psychoanalysis and other dynamic therapies help the individual achieve a controlled and therapeutic recovery based on conscious awareness of repressed psychic conflicts, as well as an understanding of their impact on past history and present difficulties. These steps are associated with symptom relief and improved mental functioning.

Freudian theory sees childhood as the primary nest of neurotic conflicts. This is because children are relatively helpless and dependent on their parents for love, care, security, and support, and also because their psychosexual, aggressive, and other impulses are not yet integrated into a stable personality structure. The theory states that children do not have the resources to deal with emotional trauma, deprivation, and disappointment; if they escalate into unresolved intrapsychic conflicts that the young person keeps repressed through repression, there is an increased likelihood that insecurity, awkwardness, or guilt will subtly influence the developing personality, thereby affecting the person's interests, relationships, and ability to cope with later ones. stress.

Non-fraud psychodynamics

The focus of psychoanalytic theory on the unconscious mind and its influence on human behavior has led to the proliferation of other related theories of causality, including (but not limited to) the basic psychoanalytic precepts. Most subsequent psychotherapists have emphasized in their theories the causation of early, inadequate psychological development that has been overlooked or underestimated by orthodox psychoanalysis, or they have incorporated ideas drawn from learning theory. The Swiss psychiatrist Carl Jung, for example, focused on the individual's need for spiritual development and concluded that neurotic symptoms could arise from a lack of self-fulfillment in this regard. The Austrian psychiatrist Alfred Adler emphasized the importance of feelings of inferiority and unsatisfactory attempts to compensate for this as important causes of neurosis. Neo-Freudian authorities such as Harry Stack Sullivan, Karen Horney, and Erich Fromm modified Freud's theory, emphasizing social relationships as well as cultural and environmental factors as important in the formation of mental disorders.

Jung, CarlCarl Jung. World History Archive / Ann Ronan Collection / age fotostock

Erich Fromm. Stay at Michigan State University

More modern psychodynamic theories have moved away from the idea of ​​explaining and treating neurosis based on a defect in one psychological system, and have instead adopted a more complex notion of multiple causes, including emotional, psychosexual, social, cultural, and existential ones. A notable trend has been the inclusion of approaches based on learning theories. Such psychotherapies emphasized acquired faulty mental processes and inappropriate behavioral responses that act to maintain neurotic symptoms, thereby directing interest in the patient's existing circumstances and learned responses to those conditions as a causal factor in mental illness. These approaches meant a convergence of psychoanalytic theory and behavioral theory, especially with regard to the views of each theory on the cause of the disease.

Behavioral etiology

Behavioral theories of the causes of mental disorders, especially neurotic symptoms, are based on learning theory, which in turn is largely based on the study of animal behavior in the laboratory. The most important theories in this field arose from the work of the Russian physiologist Ivan Pavlov and several American psychologists such as Edward L. Thorndike, Clark L. Hull, John B. Watson, Edward C. Tolman, and B. F. Skinner. In the classical Pavlovian model of conditioning, an unconditioned stimulus is followed by an appropriate response; for example, food placed in a dog's mouth is followed by saliva by the dog. If the bell rings before the dog offers food, eventually the dog will only be salified at the sound of the bell, even if no food is offered. Because the bell could not initially salivate the dog (and was therefore a neutral stimulus), but did salivate because it was repeatedly paired with food offerings, it is called a conditioned stimulus. The salivation of a dog at the sound of a bell is called a conditioned response. If the conditioned stimulus (bell) is no longer connected to the unconditioned stimulus (food), the conditioned response gradually disappears (the dog stops saluting at the sound of the bell alone).

Behavioral theories for the causation of mental disorders are largely based on the assumption that the symptoms or symptomatic behaviors found in people with various neuroses (especially phobias and other anxiety disorders) can be seen as learned behaviors that have been shaped into conditioned responses. For example, in the case of phobias, a person who was once exposed to an inherently dangerous situation experiences anxiety even in neutral objects that were simply associated with that situation at the time, but this should not lead to a reasonable occurrence of anxiety. Thus, a child who has had a scary experience with a bird may subsequently develop fear from looking at feathers. A single neutral object is enough to cause anxiety, and the person's subsequent attempts to avoid that object is a scientific behavioral response that is self-reinforcing, in that the person actually provides anxiety reduction by avoiding the dangerous object and thus continuing to avoid it in the future. It is only by confronting the object that one can eventually lose the irrational, association-based fear of it.

Main diagnostic categories

Here are the main categories of mental disorders.

Organic mental disorders

This category includes both psychological and behavioral abnormalities that arise from structural brain diseases, as well as those that arise from brain dysfunction caused by disease outside the brain. These conditions differ from the conditions of other mental illnesses in that they have a definite and identifiable cause, i.e. a disease of the brain. However, the importance of the distinction (between organic and functional) has become less clear as research has shown that brain disorders are associated with many mental illnesses. When possible, treatment is directed at both the symptoms and the underlying physical dysfunction in the brain.

There are several types of psychiatric syndromes that are clearly due to disease of the organic brain, the main of which are dementia and delusions. Dementia is the gradual and progressive loss of intellectual abilities, such as thinking, memory, attention, judgment, and perception, without an accompanying impairment of consciousness. The syndrome may also be marked by the onset of personality changes. Dementia usually appears as a chronic condition that worsens over the long term. Delusion is a diffuse or generalized intellectual impairment that is characterized by a clouded or confused state of consciousness, an inability to pay attention to one's surroundings, difficulty in thinking coherently, a tendency to perceptual disturbances such as hallucinations, and difficulty sleeping. Delirium is usually acute. Amnesia (gross loss of recent memory and sense of time without other intellectual impairment) is another specific psychological disorder associated with organic brain disease.

Steps towards a diagnosis of suspected organic disorders include obtaining complete history the patient's illness followed by a detailed analysis of the patient's mental state with additional tests to perform certain functions as needed. A physical examination is also performed with particular attention to the central nervous system. To determine if a metabolic or other biochemical imbalance is causing the condition, blood and urine tests, liver function tests, thyroid function tests, and other evaluations. X-rays of the chest and skull may be taken, as well as computed tomography (CT) or magnetic resonance imaging (MRI) scans to look for focal or generalized brain disease. Electroencephalography (EEG) can detect localized abnormalities in brain electrical conduction caused by a lesion. Detailed psychological testing may reveal more specific perceptions, memory, or other impairments.

Senile and presenile dementia

In these dementias, there is a progressive intellectual impairment that progresses to lethargy, inactivity, and gross physical deterioration, and eventually to death within a few years. Presenile dementias are arbitrarily defined as those that begin in people under 65 years of age. In the elderly, the most common causes of dementia are Alzheimer's disease and cerebral arteriosclerosis. Dementia from Alzheimer's usually begins in people over 65 and is more common in women than men. It begins with cases of forgetfulness that become more frequent and more severe; memory, personality and mood disorders progress steadily towards physical deterioration and death within a few years. In dementia caused by cerebral arteriosclerosis, areas of the brain are destroyed due to loss of blood supply caused by pieces of blood clots that enter small arteries. The course of the disease is rapid, with periods of deterioration and then periods of slight improvement. Death may be delayed slightly longer than in Alzheimer's dementia, and is often due to coronary heart disease, causing a heart attack or massive cerebral infarction, causing a stroke.

Other causes of dementia include Pick's disease, a rare inherited condition that affects women twice as often as men, usually between the ages of 50 and 60; Huntington's disease hereditary disease, which usually begins around age 40 with involuntary movements and progresses to dementia and death within 15 years; and Creutzfeldt-Jakob disease, a rare brain condition caused by an abnormal form of a protein called a prion. Dementia can also be the result of a head injury, infection such as syphilis or encephalitis - various tumors, toxic conditions such as chronic alcoholism or heavy metal poisoning, metabolic diseases such as liver failure, reduced oxygen to the brain due to anemia or carbon monoxide poisoning and inadequate intake or metabolism of certain vitamins.

Not specific treatment dementia symptoms; the underlying physical cause should be identified and treated whenever possible. The goals of caring for a person with dementia are to alleviate suffering, prevent behavior that could lead to injury, and optimize remaining physical and psychological abilities.

Other organic syndromes

Damage to different areas of the brain can cause specific psychological symptoms. Damage to the frontal lobe of the brain can manifest itself in behavioral disorders such as loss of inhibitions, tactlessness, and excessiveness. Damage to the parietal lobe can lead to speech and language difficulties or spatial perception. Temporal lobe lesions can lead to emotional instability, aggressive behavior, or difficulty learning new information.

Delusions often occur in many other physical conditions, such as intoxication or drug withdrawal, metabolic disorders (such as liver failure or low levels), infections such as pneumonia or meningitis, head trauma, brain tumors, epilepsy, or nutritional or vitamin deficiencies . Clouding or confusion of consciousness and disturbances in thinking, behavior, perception, and mood occur, and disorientation occurs. Treatment is directed at the underlying physical condition.

Abuse related disorders

Substance abuse and substance dependence are two distinct disorders associated with the regular non-medical use of psychoactive drugs. Drug abuse refers to a persistent pattern of use that results in impairment of a person's social or occupational functioning. Subjective addiction implies that a significant part of a person's activity is focused on the use of a particular drug or alcohol. Substance dependence likely leads to tolerance, in which it is necessary to significantly increase the amount of the drug (or other substance addictive) to achieve the same effect. Addiction is also characterized by withdrawal symptoms such as tremors, nausea, and restlessness, any of which may be accompanied by a reduction in the dose of the substance or cessation of drug use. (See chemical dependence.)

Various psychiatric conditions can result from the use of alcohol or other drugs. Mental states caused by alcohol use include intoxication, withdrawal, hallucinations, and amnesia. Similar syndromes may occur after the use of other drugs that affect the central nervous system (see Drug Use). Other drugs that are commonly used for immediate mood changes are barbiturates, opioids (such as heroin), cocaine, amphetamines, hallucinogens such as LSD (lysergic acid diethylamide), marijuana, and tobacco. Treatment is aimed at relieving symptoms and preventing further substance abuse by the patient.

Schizophrenia

The term schizophrenia was coined by the Swiss psychiatrist Eugene Bleuler in 1911 to describe what he considered a group of severe mental illnesses with associated characteristics; it eventually replaced the early term dementia praecox, which the German psychiatrist Emil Kraepelin first used in 1899 to distinguish the disease from what is now called bipolar disorder. People with schizophrenia show a wide range of symptoms; thus, while different experts may agree that a particular individual suffers from the condition, they may disagree on what symptoms are needed for a clinical definition of schizophrenia.

The annual prevalence of schizophrenia - the number of cases, both old and new, reported in one year - is between two and four per 1,000 people. The lifetime risk of developing the disease is seven to nine per 1,000 people. Schizophrenia is the single largest cause of admission to psychiatric hospitals and accounts for an even larger proportion of the resident population of such institutions. It is a severe and often chronic illness that usually presents during adolescence or early adulthood. More severe levels of impairment and disorganization of the personality occur in schizophrenia than in almost any other mental disorder.

Clinical Features

The main clinical features of schizophrenia can be delusions, hallucinations, weakening or incoherence of the person's thought processes and association training, deficits in feeling adequate or normal emotions, and withdrawal from reality. A fallacy is a false or irrational belief that is firmly held despite obvious or objective evidence to the contrary. The delusions of people with schizophrenia may be persecutory, grandiose, religious, sexual, or hypochondriacal in nature, or they may be related to other topics. Delusions of reference, in which a person ascribes a special, irrational, and usually negative meaning to other people, objects, or events, are common to illness. Especially characteristic of schizophrenia are delusions in which the individual believes that his thought processes, body parts, or actions or impulses are controlled or dictated by some external force.

Hallucinations are false sensory perceptions that are experienced without an external stimulus, but nevertheless appear real to the person experiencing them. Auditory hallucinations experienced as "voices" and characteristically audible negative comments about the affected individual in a third person are seen in schizophrenia. Hallucinations of touch, taste, smell, and bodily sensation may also occur. Thought disorders vary in nature but are quite common in schizophrenia. Thinking disorders may consist of weakening associations so that the speaker moves from one idea or topic to another that is not related in an illogical, inappropriate or disorganized way. In its most serious inconsistency of thought, the pronunciation itself spreads, and the speaker's words become garbled or unrecognizable. Speech can also be overly specific and inexpressive; it may be repetitive or, although it may be useless, it may convey little or no real information. Usually individuals with schizophrenia have little or no understanding of their condition and do not realize that they are suffering from a mental illness or that their thinking is disordered.

Among the so-called negative symptoms of schizophrenia is a dulling or flattening of a person's ability to experience (or at least express) emotions, indicating monotony and a peculiar lack of facial expressions. The sense of self (i.e., who he or she is) may be impaired. A person with schizophrenia may be apathetic and may lack the capacity and ability to follow a logical conclusion, may withdraw from society, withdraw from others, or engage in bizarre or nonsensical fantasies. Such symptoms are more characteristic of chronic rather than acute schizophrenia.

Prior to DSM-5, various types of schizophrenia were recognized, as well as intermediate stages between the disease and other conditions. The five main types of schizophrenia recognized by the DSM-IV were the disorganized type, the catatonic type, the paranoid type, the undifferentiated type, and the residual type. Disorganized schizophrenia was characterized by inappropriate emotional reactions, delusions or hallucinations, uncontrollable or inappropriate laughter, and incoherent thought and speech. Catatonic schizophrenia was characterized by striking motor behavior, such as being immobile in an immobile posture for hours or even days, as well as numbness, mutism, or agitation. Paranoid schizophrenia was characterized by having marked delusions of persecution or grandiose nature; some patients were contentious or violent. The undifferentiated type of combined symptoms from the above three categories, and the residual type was marked by the absence of these distinguishing features. Moreover, the residual type, in which the main symptoms subsided, was a less serious diagnosis. However, distinguishing between different types of clinical findings has been limited by the low validity and low reliability of existing diagnostic criteria. The DSM-5 recommended that physicians evaluate patients based on the severity of symptoms.

Course and forecast

The course of schizophrenia is variable. Some people with schizophrenia continue to function reasonably well and are able to live independently, some have recurring episodes of illness with some negative impact on their overall level of function, and some worsen in chronic schizophrenia with severe disability. The prognosis for individuals with schizophrenia has improved due to the development of antipsychotics and the expansion of community support measures.

Between 5 and 10 percent of people with schizophrenia commit suicide. The prognosis for patients with schizophrenia is worse when the onset of the illness is gradual rather than sudden, when the affected individual is very young at the onset, when the individual has been suffering from the illness for a long time, when the individual has blunted feelings or has found an abnormal personality prior to the onset of the illness, and when social factors such as never being married, poor sexual adjustment, poor employment record, or social isolation exist in the history of the individual.

Etiology

A huge amount of research has been done to try to determine the causes of schizophrenia. Family, twin, and adoption studies provide compelling evidence to support an important genetic contribution. Several studies conducted in the early 21st century showed that children born to men over 50 years of age are almost three times more likely to suffer from schizophrenia than children born to younger men. Stressful life events are known to cause or hasten the onset of schizophrenia or cause relapse. Some abnormal neurological signs have been found in individuals with schizophrenia, and it is possible that brain damage, possibly occurring at birth, may be the cause in some cases. Other studies show that schizophrenia is caused by a virus or abnormal activity of genes that regulate the formation of nerve fibers in the brain. Various biochemical abnormalities have also been reported in individuals with schizophrenia. There is evidence, for example, that abnormal coordination of neurotransmitters such as dopamine, glutamate and serotonin may be involved in the development of the disease.

In addition, studies have been conducted to determine whether the parental care used in the families of people with schizophrenia contributes to the development of the disease. There was also a lot of interest in factors such as social class, place of residence, migration and social exclusion. It has not been proven that neither family dynamics nor social disadvantage are causative agents.

Treatment

The most successful treatment approaches combine the use of medications with supportive care. New "atypical" antipsychotics such as clozapine, risperidone, and olanzapine have proven effective in alleviating or eliminating symptoms such as delusions, hallucinations, thought disorders, agitation, and violence. These medications also have fewer side effects than more traditional antipsychotic medications. Long-term maintenance of such drugs also reduces the relapse rate. Meanwhile, psychotherapy can help the affected person release feelings of helplessness and isolation, reinforce healthy or positive tendencies, distinguish psychotic perceptions from reality, and explore any underlying emotional conflicts that may aggravate the condition. Occupational therapy and regular visits from a social worker or psychiatric nurse can be helpful. It is also sometimes helpful to give advice to living relatives of people with schizophrenia. Support groups for people with schizophrenia and their families have become an extremely important resource in dealing with this disorder.

Mood disorders

Mood disturbances include characteristics of depression or mania or both, often in a fluctuating pattern. In their more severe forms, these disorders include bipolar disorder and major depressive disorder.

Major mood disorders

In general, two serious or severe mood disorders are recognized: bipolar disorder and major depression.

Bipolar disorder (formerly known as manic-depressive disorder) is characterized by an elevated or euphoric mood, fast-paced thought and fast, loud, or agitated speech, overoptism and heightened enthusiasm and confidence, high self-esteem, increased motor activity, irritability, agitation, and reduced need for sleep. . Depressive mood swings tend to be more frequent and last longer than manic ones, although there are people who only have manic episodes. People with bipolar disorder often also exhibit psychotic symptoms such as delusions, hallucinations, paranoia, or grossly bizarre behavior. These symptoms are usually experienced as discrete episodes of depression and then mania, lasting several weeks or months, with periods of complete normalcy in between. The sequence of depression and mania can vary widely from person to person and within the same person, with the mood anomaly predominating in duration and intensity. Manic people may harm themselves, commit illegal acts, or suffer financial loss due to the poor judgment and risk-taking behavior they exhibit when they are in a manic state.
There are two types of bipolar disorder. The first, commonly known as bipolar 1, has several variations but is characterized primarily by mania, with or without depression. Its most common form involves recurrent episodes of mania and depression, often separated by relatively asymptomatic periods. The second type of bipolar disorder, commonly referred to as bipolar 2 (bipolar II), is characterized primarily by depression often followed by depression often before or immediately after an episode of depression—a condition known as hypomania, which is a milder form of mania that is less likely to interfere with daily activities.

The lifetime risk of developing bipolar disorder is about 1 percent and is about the same for men and women. The onset of the disease often occurs around the age of 30, and the disease persists for a long period. The predisposition to develop bipolar disorder is partly genetically inherited. Antipsychotic drugs are used to treat acute or psychotic mania. Mood-stabilizing agents, such as lithium and several antiepileptic drugs, have been shown to be effective in both treating and preventing recurrent episodes of mania.

Major depressive disorder is characterized by depression without manic symptoms. Episodes of depression in this disorder may or may not be recurrent. In addition, depression can have a number of different characteristics in different people, such as catatonic features, which include unusual motor or vocal behavior, or melancholic features, which include a profound lack of response to pleasure. People with major depression are considered to be at high risk of suicide.

Symptoms of major depressive disorder include a sad or hopeless mood, pessimistic thinking, loss of pleasure and interest in one's usual activities and pastimes, decreased energy and vitality, increased fatigue, slowness of thought and action, changes in appetite, and disturbed sleep. Depression should be distinguished from grief and low mood experienced in response to the death of a loved one or some other unfortunate circumstance. The most dangerous consequence of severe depression is suicide. Depression is a much more common illness than mania, and indeed there are many depressed sufferers who have never experienced mania.
Major depressive disorder can be a single episode, or it can be recurrent. It may also exist with or without melancholia, with or without psychotic features. Melancholia refers to the biological symptoms of depression: early morning awakening, daily mood changes with depression most severe in the morning, loss of appetite and weight, constipation, and loss of interest in love and sex. Melancholia is a specific depressive syndrome that is relatively more responsive to medical treatments such as antidepressants and electroconvulsive therapy (ECT).

It is estimated that women experience depression about twice as often as men. While the incidence of major depression in men increases with age, the peak for women is between 35 and 45 years of age. There is a serious risk of suicide with the disease; of those with major depressive disorder, about one-sixth end up killing themselves. Childhood trauma or deprivation, such as the loss of a parent at a young age, can increase a person's vulnerability to depression later in life, and stressful life events, especially when some type of loss is involved, tend to be powerful. reasons. Both psychosocial and biochemical mechanisms may be causal factors in depression. However, the best-supported hypotheses suggest that the underlying cause is misregulation of the release of one or more neurotransmitters (eg, serotonin, dopamine, and norepinephrine), with neurotransmitter deficiencies leading to depression and excess causing mania. Treatment of major depressive episodes usually requires antidepressants. Electroconvulsive therapy may also be helpful, as can cognitive, behavioral, and interpersonal psychotherapy.

The characteristic symptoms and forms of depression vary by age. Depression can manifest itself at any age, but the most common period of its onset is in youth. Bipolar disorders also tend to appear for the first time at a young age.

Other mood disorders

Less severe forms of mental illness include dysthymia or persistent depressive disorder, chronically depressed mood accompanied by one or more other symptoms of depression, and cyclothymic disorder (also known as cyclothymia) marked by chronic but not severe mood swings.

Dysthymia can occur on its own, but more often appears along with other neurotic symptoms such as anxiety, phobia, and hypochondria. It includes some, but not all, symptoms of depression. Where there are clear external grounds for a person's unhappiness, dysthymic disorder is considered to be present when the depressive mood is disproportionately severe or prolonged, when there is a preoccupation with the precipitation situation, when the depression continues even after the provocation is removed, and when it impairs the person's ability to cope. with specific stress. Although dysthymia tends to be a milder form of depression, it is nonetheless persistent and distressing for the person experiencing it, especially when it interferes with the person's ability to engage in normal social or work activities. In cases of cyclothymic disorder, the predominant mood swings are established during adolescence and continue into adulthood.

At any given time, depressive symptoms may be present in one-sixth of the population. Loss of self-esteem, feelings of helplessness and hopelessness, and loss of cherished possessions are usually associated with minor depression. Psychotherapy is the treatment of choice for both dysthymic disorder and cyclothymic disorder, although antidepressants or mood-stabilizing agents are often helpful. Symptoms must be present for at least two years to be diagnosed with a dysthymic or cyclothymic disorder.

Major depressive disorder and dysthymia are much more common than bipolar disorder and cyclothymic disorder. The former disorders, characterized exclusively by depressive symptoms, are also diagnosed more frequently in women than in men, while the latter tend to be diagnosed approximately equally in women and men. The prevalence of major depression appears to be over 10% for women and 5% for men. The prevalence of dysthymia is about 6 percent in the population in the United States, but it is at least twice as common in women as it is in men. Prevalence rates in old age for bipolar disorder and cyclothymic disorder are approximately 1 percent or less.

Anxiety disorders

Anxiety is defined as a feeling of dread, fear, or apprehension that occurs without a clear or appropriate justification. Thus, it differs from true fear, which is experienced in response to a real threat or danger. Anxiety may arise in response to apparently harmless situations or may be out of proportion to the actual degree of external stress. Anxiety also often arises as a result of subjective emotional conflicts, the nature of which the affected person may not know. Generally, intense, persistent or chronic anxiety that is not justified in response to the stresses of life and that interferes with a person's functioning is considered a manifestation of a mental disorder. Although anxiety is a symptom of many psychiatric disorders (including schizophrenia, obsessive-compulsive disorder, and post-traumatic stress disorder), in anxiety disorders it is the primary and often the only symptom.

Fuseli depicts the feeling of fear and anxiety that a nightmare can bring. Irregular or random nightmares are usually attributed to life stressors and the anxiety that often accompanies them, while recurring and frequent nightmares, commonly referred to as a nightmare disorder or sleep disorder, are thought to be the result of a psychiatric disorder.

The symptoms of anxiety disorders are emotional, cognitive, behavioral and psychophysiological. Anxiety disorder may present in a distinctive set physiological signs, which arise due to hyperactivity of the sympathetic nervous system or due to tension in the skeletal muscles. The patient feels trembling, dry mouth, dilated pupils, shortness of breath, sweating, abdominal pain, tightness in the throat, trembling and dizziness. In addition to actual feelings of fear and apprehension, emotional and cognitive symptoms include irritability, restlessness, poor concentration, and restlessness. Anxiety can also manifest itself in avoidance behavior.

Anxiety disorders are distinguished primarily in terms of how they experience and what type of anxiety they respond with. For example, panic disorder is characterized by the onset of panic attacks, which are short periods of intense anxiety. Panic disorder can occur with agoraphobia, which is the fear of being in certain public places from which it can be difficult to escape.

Specific phobias - unfounded fears about specific stimuli; Common examples are fear of heights and fear of dogs. Social phobia is an unreasonable fear of being in social situations or situations where a person's behavior can be judged, such as in public speaking.

Obsessive-compulsive disorder is characterized by the presence of obsessions, compulsions, or both. obsessive thoughts are persistent unwanted thoughts that lead to disasters. Compulsions are repetitive, rule-bound behaviors that an individual believes should be performed in order to ward off distressing situations. Obsessions and compulsions are often linked; for example, obsessions about infection may be accompanied by compulsive washing.

Post-traumatic stress disorder is characterized by a set of symptoms that are persistently felt after participating, as a participant or bystander, in a highly negative event, usually occurring as a threat to life or well-being. Some of these symptoms include re-holding the event, avoidance of event-related stimuli, emotional numbness, and hyperausality. Finally, generalized anxiety disorder involves a pervasive feeling of unease accompanied by other symptoms of anxiety.

In general, anxiety such as depression is one of the most common psychological problems people experience and seek treatment for. While panic disorders and some phobias such as agoraphobia are more commonly diagnosed in women than men, there is little gender difference for other anxiety disorders. Anxiety disorders tend to appear relatively early in life (i.e., during childhood, adolescence, or at a young age). As with mood disorders, various psychopharmacological and psychotherapeutic therapies can be used to help resolve anxiety disorders.

Somatoform disorders

In somatoform disorders, psychological discomfort is manifested through physical symptoms (combined symptoms of the disease) or other physical problems, but distress can occur in the absence of a medical condition. Even if there is medical condition it may not fully take into account the symptoms. In such cases, there may be positive evidence that the symptoms are caused by psychological factors. The lifetime prevalence of somatoform disorders is relatively low (1 to 5 percent of the population) or has not yet been established. These disorders tend to be lifelong conditions that initially appear during adolescence or adolescence.

Somatization disorder

This type of somatoform disorder, formerly known as Briquette's syndrome (after the French physician Paul Briquet), is characterized by multiple recurrent physical complaints associated with a wide range of bodily functions. Complaints, which usually spread over many years, cannot be fully explained by the person's medical history or current condition and are therefore associated with psychological problems. The person requires medical attention, but no organic cause (i.e., corresponding medical condition) has been found. Symptoms invariably occur in many different body systems—for example, back pain, dizziness, dyspepsia, vision difficulties, and partial paralysis—and may follow health trends among the public.

The condition is relatively common and occurs in about 1 percent of adult women. Men rarely show this disorder. There are no clear etiological factors. Treatment includes disagreeing with the person's tendency to attribute organic causes to symptoms and ensuring that physicians and surgeons do not cooperate with the person in search of excessive diagnostic procedures or surgical remedies for complaints.

Conversion violation

This disorder was previously labeled hysteria. Its symptoms are loss or change in physical functioning, which may include paralysis. Physical symptoms occur in the absence of organic pathology and are thought to occur in place of the underlying emotional conflict. The characteristic motor symptoms of conversion disorder include paralysis of the voluntary muscles of the arm or leg, tremors, tics, and other movement or gait disturbances. Neurological symptoms may be widespread and may not correlate with actual nerve distribution. Blindness, deafness, loss of sensation in the arms or legs, "pins and needles" sensation, and increased sensitivity to pain in the limb may also be present.

Symptoms usually appear suddenly and occur under conditions of extreme psychological stress. The course of the disorder is variable, with recovery often occurring within days, but with symptoms persisting for years or decades in chronic cases that are left untreated.

The causality of conversion disorder is related to fixation (i.e., delayed stages of an individual's early psychosexual development). Freud's theory that threatening or emotionally charged thoughts are repressed from the mind and turned into physical symptoms is still widely held. Thus, the treatment of conversion disorder requires psychological rather than pharmacological methods, in particular the study of the person's underlying emotional conflicts. Conversion disorder can also be seen as a form of "disease behavior"; that is, the person uses the symptoms to gain a psychological advantage in social relationships, whether it be empathy or release from burdensome or stressful obligations and escape from emotionally disturbing or threatening situations. Thus, the symptoms of a conversion disorder may be psychological sense preferred by the person experiencing them.

hypochondriacal syndrome

Hypochondriasis is a preoccupation with physical symptoms or symptoms that a person unrealistically interprets as abnormal, leading to fear or belief that they are seriously ill. There may be fears about the future development of physical or mental symptoms, the belief that actual but minor symptoms have dire consequences, or the experience of normal bodily sensations as threatening symptoms. Even when a thorough physical examination does not find an organic cause for the physical symptoms that an individual is concerned about, the examination still fails to convince the person that there is no serious illness. Symptoms of hypochondria can occur with mental illnesses other than anxiety, such as depression or schizophrenia.

The onset of this disorder may be due to precipitating factors, such as an actual organic disease with physical and psychological consequences, such as a coronary thrombosis in a person that has been previously identified. Hypochondria often begins during the fourth and fifth decades of life, but is also common at other times, such as during pregnancy. The goal of treatment is to provide understanding and support and to reinforce healthy behaviour; antidepressants may be used to relieve depressive symptoms.

Psychogenic pain disorder

In psychogenic pain disorder, the main feature is a constant complaint of pain in the absence of an organic disease and with confirmation of a psychological cause. The pain pattern may not correspond to the known anatomical distribution of the nervous system. Psychogenic pain may occur as part of hypochondria or as a symptom of a depressive disorder. The appropriate treatment depends on the context of the symptom.

Dissociative disorders

Dissociation is said to occur when one or more mental processes (such as memory or personality) separate or dissociate from the rest of the psychological apparatus so that their function is lost, altered, or weakened. Both dissociative identity disorder and depersonalization disorder are more commonly diagnosed in women than in men.

The symptoms of dissociative disorders have often been thought of as the mental counterparts of the physical symptoms of conversion disorders. Since dissociation may be an unconscious mental attempt to protect the individual from threatening impulses or repressed emotions, the transformation into physical symptoms and the dissociation of mental processes can be seen as related defense mechanisms in response to emotional conflict. Dissociative disorders are marked by a sudden, temporary change in a person's consciousness, sense of identity, or motor behavior. There may be apparent loss of memory of previous activities or important personal events, with amnesia for the episode itself after recovery. However, these are rare conditions and it is important to rule out organic causes first.

dissociative amnesia

In dissociative amnesia, there is a sudden loss of memory that may seem complete; a person cannot remember anything about his previous life or even a name. Amnesia may be localized within a short period of time associated with a traumatic event, or it may be selective, affecting the person's recall of some, but not all, events within a certain time frame. In psychogenic fugue, the individual usually leaves home or work and takes on a new personality, cannot remember his former personality, and, upon recovery, cannot remember the events that occurred during the fugue state. In many cases, the disruption lasts only a few hours or days and involves only limited travel. Severe stress is known to cause this disorder.

dissociative identity disorder

Dissociative identity disorder, formerly called multiple personality disorder, is a rare and remarkable condition in which two or more separate and independent personalities develop in the same person. Each of these personalities inhabits the conscious consciousness of a person, to the exclusion of others at a certain time. This disorder often results from childhood trauma and is best treated through psychotherapy that seeks to bring together different personalities into a single, integrated personality.

Depersonalization

In depersonalization, a person feels or perceives their body or self as unreal, strange, altered in quality, or distant. This state of self-alienation can take the form of feeling as if the person is machine, living in a dream, or not in control of their actions. Separation, or a sense of unreality about objects outside of oneself, often happens at the same time. Depersonalization may occur alone in neurotic individuals, but is more commonly associated with phobic, anxiety, or depressive symptoms. It is most common in young women and may persist for many years. People find the experience of depersonalization very difficult to describe and are often afraid that others will think they are insane. Organic conditions, especially temporal lobe epilepsy, must be ruled out before making a diagnosis of neurosis in depersonalization. As with other neurotic syndromes, many different symptoms are more common than depersonalization itself.

The causes of depersonalization are unclear, and there is no specific treatment for it. When a symptom occurs in the context of another psychiatric condition, treatment is directed at that illness.

Two of the main classifications of eating disorders include not only eating abnormalities but also distortions in body perception. Anorexia nervosa consists of a significant loss of body weight, a refusal to gain weight and a fear of becoming overweight, which is in stark contrast to reality. People with anorexia often become shocking in the eyes of everyone but themselves and show physical symptoms of starvation. Bulimia nervosa is characterized by either impulsive or "drinking" eating (eating a significantly large amount of food for a period of time) alternating with inadequate (and often ineffective) weight loss efforts, such as purging (eg, caused by vomiting or abuse of laxatives, diuretics). or enemas) or fasting. People with bulimia are also preoccupied with body weight and shape, but they do not exhibit the extreme weight loss seen in anorexic patients. Up to 40-60 percent of anorexic patients are also involved in drinking as well as cleaning; however, they still carry considerable weight.

At least half of all people diagnosed with an eating disorder do not meet the full criteria for one of the two main categories described above. The diagnosis of an eating disorder, unless otherwise noted, or EDNOS, is provided to patients with clinically significant eating disorders that meet some, but not all, of the diagnostic criteria for either anorexia nervosa or bulimia nervosa. Such examples include an eating disorder (binge drinking episodes with no compensatory weight loss behavior) and a disorder (eg episodes of self-induced vomiting or laxative abuse that follow normal or below normal amounts of food intake). Patients with anorexia nervosa engage in excessive control over their eating behavior, although they may subjectively report that they lack control over their bodies in regards to weight gain. Those who have bulimia also report losing control when they engage in episodes of drinking, sometimes trying to make up for this at later times. According to the US National Institute of Mental Health, approximately 0.5-3.7 percent of women will be diagnosed with anorexia nervosa during their lifetime. The lifetime prevalence for bulimia nervosa is about 0.6 percent among adult adults. The typical age of onset of anorexia is between 12 and 25 years of age. Both diseases are diagnosed more often in girls than in boys. Prevalence rates for EDNOS are greater than those for concomitant anorexia and bulimia.

Misconceptions about their appearance can also manifest as a body dysmorphic disorder, in which the individual enhances negative aspects a perceived flaw to the extent that the person avoids social attitudes or imposes a compulsive sequence of cosmetic enhancement procedures, such as dermatological treatments and plastic surgery, in an attempt to remove the perceived flaw.

Personality disorders

Personality is the characteristic way in which a person thinks, feels, and behaves; it takes into account the ingrained patterns of behavior of the individual and is the basis for predicting how the individual will act in certain circumstances. Personality encompasses a person's moods, attitudes, and opinions and is most clearly expressed in interactions with other people. A personality disorder is a common, persistent, maladaptive, and inflexible way of thinking, feeling, and behaving that either significantly impairs a person's social or professional functioning or causes distress to the person.

Theories of personality disorder, including their descriptive features, etiology, and development, are as varied as the theories of personality itself. For example, in trait theory (an approach to the study of personality formation), personality disorders are viewed as gross exaggerations of specific traits. Psychoanalytic theorists (Freudian psychologists) explain the genesis of disorders in terms of clearly negative childhood experiences, such as abuse, which significantly alter the course of normal personality development. Still others, in areas such as social learning and sociobiology, focus on inadequate coping and interaction strategies embodied in impairments.

A number of different personality disorders have been identified, some of which are discussed below. It is important to note that the mere presence of a symptom, even if it is in an abnormal degree, is not enough to constitute a disorder; rather, the anomaly must also be of concern to the individual or society. It is also characteristic that personality disorders coexist with other psychological symptoms, including depression, anxiety, and substance use disorders. Because personality traits are, by definition, nearly constant, these disorders are only partially, if at all, treatable. The most effective treatment combines various types of group, behavioral and cognitive psychotherapy. Behavioral manifestations of personality disorders often tend to decrease in intensity in middle and old age.

paranoid personality disorder

Marked by a pervasive suspicion and unjustified distrust of others, this disorder appears when a person misinterprets words and actions as having a special meaning for him or directed against him. Sometimes such people are guarded, secretive, hostile, quarrelsome and litigious, and they are extremely sensitive to the implied criticism of others. The disorder can develop throughout life, sometimes starting in childhood or adolescence. This is more common in men.

Schizoid personality disorder

In this disorder there is a reluctance to interact with others; the individual appears passive, aloof and withdrawn, and there is a marked lack of interpersonal interest and responsiveness. Such a person leads a solitary existence and may appear cold or impassive. Some theorists suggest an underlying fear of tying oneself to others in an intimate relationship. The disorder may appear in childhood or adolescence as a tendency to be alone. Although much discussed in the psychoanalytic literature, it is nevertheless rare.

schizotypal personality disorder

This disorder is characterized by marked oddities or eccentricities of thought, speech, perception, or behavior that may be marked by social withdrawal, illusion of reference (beliefs that things unrelated to the individual are relevant or of personal significance to the individual), paranoid thinking (belief that others intend to harm or offend a person) and magical thinking, as well as bizarre fantasies or delusions of persecutors. Eccentricities alone do not warrant a diagnosis of this (or any) disorder; instead, the characteristic features of schizotypal personality disorder are of such severity that they cause interpersonal disadvantages and significant emotional distress. Some features may even resemble the symptoms of schizophrenia, but unlike schizophrenia, the personality disorder is stable and persistent, developing as early as childhood or adolescence and lasting throughout life, but only rarely develops into schizophrenia.

antisocial personality disorder

Those diagnosed with this disorder usually show a personal history of chronic and ongoing antisocial behavior that violates the rights of others. Jobs are low or non-existent. The disorder is associated with activities such as persistent delinquency, sexual promiscuity or aggressive sexual behavior and drug use. There is evidence of conduct disorder in childhood and antisocial behavior in mid-adolescence. People with this disorder usually have problems with the law and are often deceitful, aggressive, impulsive, irresponsible, and ruthless. As with borderline personality disorder (see below), the features of antisocial personality disorder tend to disappear by middle age, but there remains a high risk of suicide, accidental death, drug or alcohol abuse, and a tendency to interpersonal problems. The disorder is more common in men.

borderline personality disorder

Borderline personality disorder is characterized by unusually unstable mood and self-esteem. Individuals with this disorder may exhibit intense episodes of anger, depression, or anxiety. It is a disorder of personality instability, such as unstable emotionality, unstable interpersonal relationships, an unstable sense of self, and impulsivity. People with this disorder often have "motion videos" in which they experience a desperate fear of rejection and exhibit alternating extremes of positive and negative impact on the other person. They may engage in a variety of reckless behaviors, including sexual risk-taking, substance abuse, suicide, and suicide attempts. They may also exhibit cognitive problems, especially regarding their physical and psychological sense. The disorder, which is more common in women, often appears in early adulthood and tends to disappear by middle age.

Personality disorder

People with this disorder are overly dramatic and intensely expressive, egocentric, highly reactive and excitable. The characteristic behavior seems to be designed to draw attention to itself. Other features of this disorder may include emotional and interpersonal shallowness, as well as socially inappropriate interpersonal behavior. Although the clinical tradition tends to be associated more with women, the disorder occurs in both women and men and tends to take on the characteristics of stereotypical sex roles.

narcissistic personality disorder

A person with this disorder has a grandiose sense of self-importance and a preoccupation with fantasies of success, power, and achievement. An essential characteristic of this disorder is an exaggerated sense of self-importance, which is reflected in a wide variety of situations. Self-esteem surpasses the real achievements of a person. People with this disorder are usually self-centered and often insensitive to other people's perspectives and needs. They are likely to be considered arrogant. The disorder is more common in men, and it manifests itself in early adulthood. Both narcissistic and religious personality disorders are described mainly in terms of general personality characteristics, albeit in an exaggerated form; however, each disturbance is not an exaggerated characterization, but the distress and dysfunction they produce.

avoidance personality disorder

People with this disorder feel personally inadequate and fear that others will judge them that way in social situations. They show extreme sensitivity to rejection and may lead socially withdrawn lives, seeking to avoid social situations for fear that others will be judged negatively. When they participate in social situations, they often find themselves overwhelmed. However, they are not antisocial; they demonstrate a great desire to communicate, but require unusually strong guarantees of uncritical acceptance. Individuals with this disorder are usually described as having an "inferiority complex". Although avoidant personality disorder often appears in childhood or adolescence (first as shyness), it tends to decrease in adulthood.

dependent personality disorder

This disorder is found in people who subordinate their own needs, as well as responsibility for the main areas of their lives, to control others. In other words, people with this disorder feel personally inadequate, and they show this in their unwillingness to take responsibility for themselves, such as in day-to-day decision making and long-term planning. Instead, they turn to others for these things, creating a relationship where others still care about them. Their own relationship behavior is likely to be clinging, despairing, seeking to please, and self-deprecating, and they may exhibit an excessive fear of rejection. This is one of the most common personality disorders. Individuals with this disorder lack self-confidence and may experience extreme discomfort when alone. (Compare codependency.)

Obsessive Compulsive Personality Disorder

A person with this disorder exhibits prominent supernatural, perfectionist traits, expressed in feelings of insecurity, self-doubt, meticulous conscientiousness, indecisiveness, excessive orderliness, and rigid behavior. Man is preoccupied with rules and procedures as an end in itself. Such people tend to be highly concerned with efficiency, are overly committed to work and productivity, and usually lack the ability to express warm or tender emotions. They may also exhibit a high degree of moral rigidity that is not just explained by upbringing. This disorder is more common in men and is in many ways the antithesis of antisocial personality disorder.

The causes of personality disorders are unclear and, in many cases, difficult to study empirically. However, there is a constitutional and therefore hereditary element in the definition of personality characteristics in general and so in the definition of personality disorders. Psychological and environmental factors are also important in causality. For example, many authorities believe that there is a link between child sexual abuse and the development of borderline personality disorder, or between harsh, inconsistent punishment in childhood and the development of antisocial personality disorder. However, it is extremely difficult to establish the validity of these links through a systematic scientific research, and in any case, such environmental factors are not always associated with disturbances.

gender dysphoria

People with gender dysphoria, formerly known as Gender Identity Disorder, experience significant stress and impairment as a result of a sense of inconsistency between their anatomical gender and the gender they ascribe to themselves. The feeling of separation is not in itself considered a disorder. A person with gender dysphoria may assume dress and behavior and engage in activities normally associated with the opposite sex, and may eventually undergo permanent gender relocation through hormone replacement therapy and surgery.

perversions

Paraphilias or sexual deviations are defined as unusual fantasies, urges, or behaviors that are repeated and sexually aroused. These calls must occur for at least six months and cause deprivation in the individual in order to be classified as a paraphilia. In fetishism, inanimate objects (such as shoes) are a person's sexual preference and a means of sexual arousal. In transvestism, repeated wearing of the opposite sex is performed to achieve sexual arousal. In pedophilia, an adult has sexual fantasies or sexual activities with a prepubescent child of the same or opposite sex. In exhibitionism, the repeated exposure of the genitals to an unsuspecting stranger is used to achieve sexual arousal. In voyeurism, watching other people's sexual activity is the preferred means of sexual arousal. In sadomasochism, the individual achieves sexual arousal as the recipient or provider of pain, humiliation, or bondage.

The causes of these conditions are usually unknown. Behavioral, psychodynamic, and pharmacological methods have been used with varying efficacy to treat these disorders.

Disorders usually appear in infancy, childhood, or adolescence

Children usually see a psychiatrist or therapist because of complaints or concerns about their behavior or development expressed by a parent or other adult. Family problems, especially parent-child relationship difficulties, are often an important causative factor in a child's symptomatic behavior. For a child psychiatrist, observation of behavior is especially important because children cannot put their feelings into words. Isolated psychological symptoms are extremely common in children. Boys are affected twice as often as girls.

Attention Deficit Disorders

Children with attention deficit disorders show a degree of inattention and impulsivity that is clearly inappropriate for their stage of development. Gross hyperactivity in children can have many causes, including anxiety, conduct disorder (discussed below), or institutional stress. Learning difficulties and antisocial behavior may occur secondarily. This syndrome is more common in boys than girls.

Conduct violations

These are the most common psychiatric disorders in older children and adolescents, accounting for almost two-thirds of the disorders in people aged 10 or 11 years. Abnormal behavior begins, more serious than the usual childish atrocity; lying, disobedience, aggression, absenteeism, delinquency, and deterioration in work can occur at home or at school. Vandalism, drug and alcohol abuse, and early sexual promiscuity may also occur. The most important reasons are family background; in such cases, broken homes, unstable and rejecting families, childhood institutional care, and poor social environments are often present.

Anxiety disorders

Neurotic or emotional disorders in children are similar to adult conditions, except that they are often less clearly differentiated. AT anxiety disorders childhood, the child is afraid, timid with other children and overly dependent and clinging to parents. There are physical symptoms, sleep disturbance and nightmares. Separation from a parent or home environment is the main cause of this anxiety.

Andrew C.P. Sims Linda Andrews Charles D. Claiborne Stuart K. Yudofsky Editors of Encyclopedia Britannica

Eating Disorders

Anorexia nervosa usually begins in late adolescence and is about 20 times more common in girls than boys. This disorder is characterized by an inability to maintain a normal body weight for a person's age and height; weight loss is at least 15% of ideal body weight. Weight loss is due to strong desire being thin, fear of gaining weight, or disturbances in how the person sees her weight or body shape. Postmenopausal females with anorexia typically experience amenorrhea (i.e., the absence of at least three consecutive menstrual periods). Medical complications of anorexia nervosa can be life-threatening.

The condition appears to begin with an individual's voluntary control of food intake in response to social pressures such as peer compliance. The disorder is exacerbated by disturbing relationships within the family. It is much more common in developed, affluent societies and in girls of higher socioeconomic class. Treatment includes persuading the person to accept and cooperate with drug therapy, achieve weight gain, and help the person maintain weight with psychological and social therapies.

Bulimia nervosa is characterized by excessive drinking combined with inappropriate methods to stop weight gain, such as self-induced vomiting or the use of laxatives or diuretics.

Other childhood disorders

Stereotypical movement disorders are associated with the exhibition of tics in different patterns. A tic is an involuntary, purposeless movable movement of a group of muscles or the involuntary production of noises or words. Tics can affect the face, head, and neck, or, less commonly, the limbs or trunk. Tourette's syndrome is characterized by multiple tics and involuntary vocalizations, which sometimes include profanity.

Other physical symptoms often listed among childhood psychiatric disorders include stuttering, enuresis (repeated involuntary emptying of urine from the bladder during the day or night), encopresis (repeated emptying of feces into inappropriate places), sleepwalking, and night terrors. These symptoms are not necessarily are evidence of an emotional disturbance or some other mental illness. Behavioral therapies are usually effective.

Other mental disorders

Factor Disorders

Factual disorders are characterized by physical or psychological symptoms that are voluntarily self-induced; they are different from conversion disorder, in which physical symptoms are produced unconsciously. In the case of voluntary disorders, although the person's attempts to create or aggravate the symptoms of the disease are voluntary, such behavior is neurotic in that the person cannot abstain from it, that is, the person's goals, whatever they may be, are involuntarily accepted. In a simulation, by contrast, a person stimulates or exaggerates an illness or disability in order to gain some discernible personal benefit or avoid an unpleasant situation; for example, a prison inmate may fake insanity in order to obtain more comfortable living conditions. It is important to recognize actual disorders as evidence of a psychological disorder.

impulse control disorders

Individuals with these conditions demonstrate an inability to resist desires, impulses, or temptations to commit acts that are harmful to themselves or others. A person experiences a feeling of tension before performing an action and a feeling of release or satisfaction after it is completed. Behavior includes pathological gambling, pathological setting of fires (pyromania), pathological stealing (kleptomania), and repeated hair-pulling (trichotillomania).

Corrective disorders

These are conditions in which there is an inappropriate response to external stress occurring within three months of the stress. The symptoms may be disproportionate to the degree of stress, or they may be maladaptive in the sense that they prevent the individual from adequately coping with normal social or occupational settings. These disorders are often associated with other mood or anxiety disorders.

Many mental disorders have similar symptoms, but completely different causes of development. A complete and accurately compiled diagnostic program allows you to make a correct diagnosis, as well as determine what are the causes and mechanisms for the development of a mental disorder.

Diagnosis of a mental illness consists of instrumental and laboratory methods for studying the nervous system, clinical and psychological interviews.

What does the diagnosis of mental disorders include?

Biological diagnostic methods

E it is a record of the bioelectrical activity of different brain structures. An EEG is as important to a psychiatrist or neurologist as an electrocardiogram is to a cardiologist. Like electrocardiography, EEG recording is absolutely safe and has no contraindications. Electroencephalography helps to make an accurate diagnosis of a mental disorder, determine its severity, and choose one or another psychotropic drug. The method of daily monitoring of the bioelectrical activity of the brain is distinguished by high information content. For children, daily monitoring is usually replaced by a 4-hour EEG recording.

A method that allows you to evaluate the reaction of the brain to stimuli and stimuli - signals from the outside world and the internal environment of the patient's body. The evoked potentials help to understand how the brain is involved in the process of information processing and how well the process of this processing goes.

The evoked potentials are classified according to the presented stimuli into cognitive, visual, auditory and visceral:

• Cognitive evoked potentials - a method of integral assessment of the state of memory, attention and thinking of the patient.
• Sympathetic or visceral evoked potentials help assess the state of the autonomic nervous system.
• Auditory and visual evoked potentials are assigned to determine the cause of visual or auditory hallucinations.

The evoked potential method is used to diagnose schizophrenia and Alzheimer's disease.

Method of visualization of brain structures in different planes. The basic principle of its work is the evaluation of the magnetic resonance of hydrogen nuclei. This method does not require prior preparation, is absolutely painless and safe. A contraindication to MRI is the presence of an artificial pacemaker and metallic foreign bodies. The duration of the study is 20-30 minutes.

MRI can detect tumors and cysts, changes in the size of the brain, characteristic of some mental illnesses, as well as assess the condition of the brain vessels.

Different mental disorders have their own characteristics of the MRI picture, for example, with schizophrenia, there is an expansion of the left ventricle of the brain and a reduction in the size of the temporal lobe, with bipolar affective disorder and prolonged depression - an expansion of the right ventricle of the brain. Its changes are present in Alzheimer's disease and vascular dementia.

Used to assess blood flow in the arteries and veins of the head and neck. Ultrasonography is used for the initial detection of blood flow disorders and for the control of circulatory insufficiency and related diseases. Ultrasound examination of the vessels of the head and neck does not require preparation. The method is harmless to the body and is acceptable even during pregnancy. Ultrasound examination takes 30-45 minutes.

Doppler ultrasound of the vessels of the head and neck is indicated in the following cases:

The study of the structure of nocturnal sleep, or polysomnography, provides an opportunity to assess the state of the brain during sleep, the activity of the cardiovascular system, motor activity during sleep. In addition, polysomnography allows you to choose drugs that improve sleep. Preparation for polysomnography usually begins in the evening (around 20.00), and the procedure itself ends at 7.00. The study is usually well tolerated, since modern electrodes and sensors are made in such a way that they do not affect the quality of sleep at all.

Analyzes

General clinical blood test and biochemical analyzes

Allow to assess the state of metabolism, water-salt balance, energy metabolism. In addition, inflammatory processes, a lack or excess of vitamins and amino acids (relevant for anorexia), the presence of heavy metals in the blood (important for patients living in ecologically disadvantaged areas) are detected.

Hormone analyzes

They help identify diseases of the endocrine system that can cause mental disorders, as well as control the side effects of psychotropic drugs.

The concentration of stress axis hormones (corticotropin releasing factor, ACTH, cortisol, DEHA) shows the level and duration of stress, the involvement of the body's mechanisms of dealing with stress. The stress axis hormone ratio predicts the course of anxiety spectrum disorders and depression.

Thyroid hormones and their tropic (concentration-controlling) hormones - thyrotropin releasing factor, TSH, T3, T4 - may be involved in the development of depression.

A decrease in the level of the hormone melatonin, which regulates the sleep-wake rhythm, can lead to the development of affective disorders. Stabilization of melatonin concentration during the treatment of depression indicates a positive prognosis for the treatment of the disease. In addition, melatonin has a positive effect on the immune system.

Measurement of the concentration of the hormone prolactin makes it possible to predict the timing of recovery from psychosis. In addition, control of the concentration of prolactin is necessary when taking certain psychotropic drugs that cause hyperprolactinemia - an increase in the level of prolactin in the blood.

Immune System Research

Immunogram, cytokine and interferon profiles - allow you to identify pathological changes in the immune system, chronic infections and inflammation, as well as autoimmune processes.

Bacteriological and virological studies

The presence of neuroviral infections affecting various structures of the nervous system is detected. The most common neuroinfections include Epstein-Barr, herpes, rubella, streptococcus and staphylococcus viruses.

Neurotest

A blood test that determines the content of autoantibodies to various proteins of the nervous system. The neurotest shows the presence of inflammatory processes in the nervous system, degeneration of the membranes that ensure the rapid transmission of a nerve impulse, changes in the content of neurotransmitter receptors involved in signal transmission in the brain.

Pathopsychological research

Aimed at assessing the perception, memory, attention and thinking of the patient. During the study, the subject is given certain tasks, the performance of which characterizes cognitive functions. In addition, the clinical psychologist can obtain information from the behavior of the subject during the study.

This study has the right to conduct only.

Neuropsychological research

Allows you to identify violations of the state of personality and mental processes at the brain level. This study allows you to localize disorders of mental functions in certain parts of the brain. During the study, general intelligence, attention and concentration, learning and memory, language, volitional functions, perception functions, sensorimotor functions, and psychological emotional status are assessed. The foundations of neuropsychological research were laid by A.R. Luria and his students. The methods are based on the concept of formation and development of higher mental functions by L.S. Vygotsky. Neuropsychological research can also be carried out only by a clinical psychologist.

Other psychological research methods used in the clinic include the study of the type and structure of personality, the determination of sensitivity to various methods of psychotherapy, the diagnosis of the family system and the diagnosis of social and labor adaptation.

Do you need advice?Do you have any questions?

(Diagnosis is a set of procedures and methods aimed at determining the disease in order to make the correct diagnosis and select the means for treatment, taking into account the prognosis of the disease.
When diagnosing mental disorders, it is important to consider two aspects of the significance of this procedure: medical and legal. Let's look at the medical factor first. For the diagnosis of mental illness, it is necessary to distinguish between the following concepts:
0 normal state;
0 pathology;
0 mental illness;
0 psychosis;
0 mental disorder;
0 neurosis;
0 personality disorder.
Carrying out diagnostic measures of mental illness begins with the identification of the symptoms of the disease. Further, the symptomatology develops into certain syndromes of the disease. And syndromes, in turn, constitute a nosological form of a mental disorder - a disease. The purpose of accurate diagnosis is the correct development of tactics and strategies for the treatment of the disease, as well as further rehabilitation of the patient.
At the first stage of diagnosis, the main signs of the disease or symptoms are determined. The sign of the disease refers to clinical concepts and is directly related to the psychiatrist's external perception of the person's condition. Separate signs of the disease are distinguished in the patient at the level of sensory cognition by the psychiatrist, taking into account his experience. After determining the main signs of the disease, it is necessary to generalize and classify them, to establish the existing interdependencies. Thus, the symptoms of the disease are subjected to clinical examination. Based on its results, disease syndromes are distinguished, which is the next stage in the diagnosis of mental disorders. The third stage of diagnosis forms a general clinical picture of a mental illness, reveals the pathogenesis and summarizes the data obtained in the form of a diagnostic hypothesis. The fourth stage is based on the formulated diagnostic hypothesis and is characterized by the clarification of clinical symptoms, the search for causal relationships between various factors of the disease: exogenous, personal, endogenous, psychogenic, etc. Based on the work done, the strategy and tactics of therapeutic treatment are built. At the fifth stage, monitoring of changes in symptoms during the treatment of the disease is carried out. The sixth stage is characterized by clarification of the preliminary diagnosis, determination of the recovery prognosis, development of rehabilitation and preventive measures.
Diagnostic differentiated criteria:
0 history data;
0 age of the patient;
0 type of the debut part of the disease;
0 the rate of development of the debut part of the disease;
0 main clinical manifestations (symptoms, syndromes, their dynamics);
0 type of disease course;
0 specificity of remission and light intervals;
0 indicators of laboratory tests;
0 somato-neurological studies;
0 attitude of a person to the disease.
The next factor in diagnosing mental illness is legal.
Based on the legislation on psychiatric care, the diagnosis of mental illness is carried out in accordance with approved international rules. A diagnosis of mental illness cannot be made to a person only because of his disagreement with generally accepted cultural, moral, religious and political values, or for other reasons not related to health.
Diagnosis and therapy of the patient must be carried out by medical methods and drugs approved for use on the basis of regulatory acts of the federal health authority. These medical methods and means of treatment should be used solely for the purpose of diagnosing and improving the health of patients. It is forbidden to use these means for the purpose of punishment, intimidation of a person or in the interests of unauthorized persons.
The principles of diagnosing mental illnesses should be guided by international experience and the use in the work of the approved ICD, which is mandatory in Russia. On the basis of the ICD, the Ministry of Health and Social Development of the Russian Federation developed an adapted version for Russia "Mental and behavioral disorders". There is also a standard for the diagnosis and treatment of mental illness and a guideline "Models for the Diagnosis and Treatment of Mental and Behavioral Disorders" aimed at improving the diagnosis and treatment of mental illness. The procedures described in the documents do not limit the doctor's actions; in each specific case, the psychiatrist has the right to individualize the diagnostic measures and the treatment procedure. The medical and diagnostic standard has the goal of summarizing world experience, and contributes to the growth of the efficiency of medical activity.
In accordance with the legislation of the Russian Federation, only a psychiatrist has the right to establish a diagnosis of a mental disorder. The preliminary conclusion of another medical specialist cannot serve as a basis for involuntary treatment. In an area where there is no psychiatrist, the diagnosis of the disease is resolved through additional training of a specialist in order to acquire the right of psychiatric activity.
S There are certain methods for diagnosing mental illness:
| YG collection of anamnesis. Information is being collected about the mental and physical state of a person in the present and retrospective plans, data are collected on heredity, features of personality formation, traits and properties of character, interests
and skills and habits. Past illnesses, head injuries, the use of drugs and alcohol, the presence of facts of immoral behavior are described. These data can be obtained from investigative and judicial materials, characteristics at the place of work and residence, medical history, etc.;
p3 "collection of information about mental health and the adequacy of human behavior based on testimony. These data can be obtained by interviewing witnesses involved in the case under study;
(yg collection of official medical information. It is carried out by requesting psychiatric medical institutions to obtain certificates and extracts from the medical history;
an experimental psychological study includes an examination of the patient by psychologists, which makes it possible to identify violations in certain aspects of the personality and indicate its features;
Its "observation is carried out in stationary conditions by psychiatrists and other medical personnel when they make rounds in the form of a personal conversation with a person. It is carried out around the clock. Attention is drawn to the change in the patient's state in the mental plane;
Its" examination of the brain consists in conducting analyzes and hardware examination of the functions of the brain (computer tomography, spinal puncture, electroencephalogram, etc.);
IgD diagnosis of neurological symptoms. A study of neurological reflexes is being carried out. The compliance of tendon reflexes, the absence of pathological reflexes,
paralysis, convulsions, the degree of disorders of the autonomic system;
cZg - diagnosis of somatic symptoms. The absence or presence of these symptoms is determined (impaired metabolic functions, digestion, blood circulation, etc.). It is carried out by laboratory tests and in the form of hardware diagnostics.

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