Mental Health

Dr. Zeina Adnan Kadhem

Family Medicine Specialist
Health
a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.

Mental health: is a concept that refers to a human individual's

emotional and psychological well-being.
The World Health organization defines mental health as "a state of
well-being in which the individual realizes his or her own abilities, can
cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her community“

Mental illness is a psychological or behavioral pattern generally

associated with subjective distress or disability that occurs in an
individual, and which are not a part of normal development or culture
facts
 World wide, more than one in three people
in most countries report sufficient criteria for at
least one mental disorder at some point in their life

 In the United States 46% qualifies for a mental illness at some point.

 statistics are widely believed to be underestimates, due to poor diagnosis

(especially in countries without affordable access to mental health
services) and low reporting rates.

 treatment gap is estimated to reach about 76-85% for low and middle-
income countries, and still 35-50% for high-income countries.

 Even those who are treated are often treated inefficiently or in an

inhumane way.
Etiology
The etiology of psychiatric disorders is multifactorial, with a
combination of biological, psychological and social causes
 BIOLOGICAL FACTORS
Genetic
Brain structure and function

 PSYCHOLOGICAL AND BEHAVIOURAL FACTORS

Perceived stress and trauma
Personality
Behavior

 SOCIAL AND ENVIRONMENTAL FACTORS

Social isolation
Stressors
classification
two main psychiatric classifications in current use: the American
Psychiatric Association's Diagnostic and Statistical Manual (4th
edition), or DSM-IV, and the WHO International Classification of
Disease (ICD 10)
 Stress-related disorders acute stress disorder
adjustment disorder
post-traumatic stress disorder
 Anxiety disorders generalized anxiety
Phobic anxiety
panic disorder
obsessive-compulsive disorder
 Affective (mood) disorders depressive disorder
mania and bipolar disorder
Schizophrenia and delusional disorders
 
Substance misuse Alcohol
Drugs
 
Organic Acute, e.g. delirium
Chronic, e.g. dementia

Disorders of adult personality

and behavior Personality disorder

Factitious disorder
 
Eating disorders Anorexia nervosa
Bulimia nervosa
 
Somatoform disorders Somatisation disorder
Dissociative (conversion) disorder
Pain disorder
Hypochondriasis
Body dysmorphic disorder
Somatoform autonomic dysfunction

Neurasthenia
Puerperal mental disorders
?How to assess mental disorder
In psychiatry, the following differences are present from other medical
assessment
 There is greater emphasis on the history
 The systematic examination of
the patient's mental state
 The routine interviewing of an informant
( family member or other relative)

Patient interview
is very important in starting a good doctor – patient relationship,
taking good history of the patient illness, past history and background ;
obtaining a good mental health examination; and it enable the doctor to
provide reassurance & advice.
History
identifying data
 chief compliant
 history of the present illness (which is the main part of the
interview because there are no specific elements that will lead to
the diagnosis beside the interview)
 past medical history, past surgical history, allergy
 past psychiatric history ( any psychiatric illness, medication and
response to treatment, and the patient benefit from treatment )
 family history (of psychiatric illness)
 social history (marital state, employment, losing job, birth of
the patient & major childhood events, education of patient,
number & age of patient's children, house state, social habits like
smoking, drinking, and drug abuse)
Mental state examination
 General appearance and behavior

posture, appearance, any unusual features ,level of consciousness,

restlessness or retardation

 Attitude toward the examiner

facial expressions , interested or bored , hostile and defensive ,cooperative?
relaxed ?

 Speech
Speed and fluency ,'Pressure of speech'

 Mood
facial expression, posture and movements,are they anxious? feel sad or
depressed?
Thoughts
The content of thought , the form of thinking may also be abnormal

Abnormal beliefs
delusion ( false believe)

Abnormal perceptions
Illusions are abnormal perceptions of real stimuli. Hallucinations are
sensory perceptions which occur in the absence of external stimuli

Insight (Patients' understanding of illness )

Judgment
Estimate the patient's judgment based on the history or on an imaginary
scenario
 Impulsivity

Estimate the degree of the patient's impulse control. Ask the patient
about doing things without thinking or planning

 Reliability
if the patient seems reliable, unreliable, or if it is difficult to determine.

 Cognitive function
The Mini-Mental State Examination (MMSE) is a useful screening
questionnaire to detect cognitive impairment
MMSE
The total score of 30, a score less than 24 indicates cognitive impairment.
It includes:

 Orientation time & place

 Registration name 3 common objects & ask him to repeat
 Attention spell (world) backwards
 Recall ask him to remember the object he named before
 Language name pencil & watch
repeat words (no ifs, buts, ands)
follow 3 stage order
read & obey( close your eyes)
write sentence
copy design
 Treatment of psychiatric disorders

 SOCIAL INTERVENTIONS
Changing the social circumstances that affect the patient's illness

 BIOLOGICAL TREATMENTS
These aim to modify brain function. Psychotropic drugs are widely used for
various purposes

Psychotropic drugs are classified in

to the following groups:
 Antidepressants: tri-cyclic antidepressants, MAOIs, amine precursors,
noradrenergic re-uptake inhibitors and SSRIs

 Antipsychotic drugs: phenothiazine, butyrophenones, thioxanthenes,

diphenylbutylpiperidines, Substituted benzamides,

dibenzodiazopines, benzisoxazole,
thienobenzodiazopines

 Mood stabilizers: lithium, carbamazipine, sodium valproate.

 Anti anxiety drugs: Benzodiazepines, b- adrenergic antagonists,

buspirone
Electro-convulsive therapy (ECT):
Electro-convulsive therapy (ECT):

Producing a convulsion by the administration of high-voltage, brief

Producing a convulsion by the administration of high-voltage, brief
direct current impulses to the head while the patient is anaesthetised
direct current impulses to the head while the patient is anaesthetised
and paralyzed by muscle relaxants. It is now remarkably safe, has few
and paralyzed by muscle relaxants. It is now remarkably safe, has few
side-effects, and is of proven efficacy for severe depressive illness.
side-effects, and is of proven efficacy for severe depressive illness.
There may be amnesia for events occurring a few hours before ECT
There may be amnesia for events occurring a few hours before ECT
(retrograde) and after it (anterograde), permanent
(retrograde) and after it (anterograde), permanent
anterograde amnesia has been claimed to occur but
anterograde amnesia has been claimed to occur but
is infrequent.
is infrequent.
PSYCHOLOGICAL TREATMENTS
They are based on talking with patients, either
individually or in groups.
 Sometimes discussion is supplemented by
'homework' or tasks to complete between sessions.
 Psychological treatments take a number of forms
based on the duration and frequency of contact, the
specific techniques applied and
their underlying theory.
E.g. cognitive therapy,
behavioral therapy
Thank
you