A mental disorder , also called mental illness or psychiatric disorder , is a behavioral or mental pattern that causes significant disturbance or impaired personal function. Such features may be persistent, relapse and remission, or occur as one episode. Many disorders have been described, with signs and symptoms that vary greatly between specific disorders. Such disorders can be diagnosed by mental health professionals.
The causes of mental disorders are often unclear. Theory can combine findings from different fields. Mental disorders are usually defined by a combination of how a person behaves, feels, feels, or thinks. It may be related to a particular area or function of the brain, often in a social context. Mental disorders are one aspect of mental health. Cultural and religious beliefs, as well as social norms, must be taken into account when making the diagnosis.
Services are based in psychiatric hospitals or in the community, and assessments are performed by psychiatrists, psychologists, and clinical social workers, using various methods such as psychometric tests but often relying on observations and questions. Treatment is provided by various mental health professionals. Psychotherapy and psychiatric treatment are the two main treatment options. Other treatments include social intervention, peer support, and self-help. In a minority of cases there may be incidental detention or treatment. Prevention programs have been shown to reduce depression.
Common mental disorders include depression, which affects about 400 million, dementia affecting about 35 million, and schizophrenia, which affects about 21 million people globally. Stigma and discrimination can add to the suffering and disability associated with mental disorders, leading to various social movements that seek to increase understanding and challenge social exclusion.
Video Mental disorder
Definitions
The definition and classification of mental disorders is a major problem for researchers and providers and those who may be diagnosed. For a mental state to classify as a disorder, it usually needs to cause dysfunction. Most international clinical documents use the term mental "disturbance," while "illness" is also common. It has been noted that using the term "mental" (ie, of the mind) is not always meant to imply separation from the brain or body.
According to DSM-IV, mental disorders are psychological syndromes or patterns related to distress (eg through painful symptoms), defects (disorders in one or more important areas of functioning), an increased risk of death, or a significant cause. loss of autonomy; but does not include normal responses such as sadness due to the loss of a loved one, and also does not include deviant behavior for political, religious or social reasons that do not arise from dysfunction in the individual.
The DSM-IV precedes the definition by warning, stating that, as in the case of many medical terms, mental disorder has no consistent operational definition covering all situations, noting that different levels of abstraction may be used to medical definitions, including pathology, symptoms, deviations from the normal range, or etiology, and that the same applies to mental disorders, so that sometimes one type of precise definition, and sometimes others, depends on the situation.
In 2013, the American Psychiatric Association (APA) redefines mental disorders in DSM-5 as a "syndrome characterized by a significant clinical disorder in cognition, emotional regulation, or individual behavior that reflects dysfunction in psychological, biological, or developmental processes. the underlying. "
Maps Mental disorder
Classification
There are currently two widely established systems that classify mental disorders:
- ICD-10 Chapter V: Mental and behavioral disorders , since 1949 part of the International Classification of Diseases produced by WHO,
- Diagnostic and Statistical Manual of Mental Disorder (DSM-5) produced by the American Psychiatric Association (APA) since 1952.
Both of these categories are disruptive and provide standardized criteria for diagnosis. They deliberately united their codes in recent revisions so manuals are often widely comparable, although significant differences persist. Other classification schemes may be used in non-western cultures, such as China Mental Disorders Classification , and other manuals may be used by people from alternative theories, such as Psychodynamic Diagnostic Manual Generally , mental disorders are classified separately from neurological disorders, learning disabilities or intellectual disabilities.
In contrast to DSM and ICD, some approaches are not based on identifying different categories of disorders using dichotomous symptom profiles intended to separate abnormal from normal. There is a significant scientific debate about the relative merits of categorical versus non-categorical (or hybrid) schemes, also known as continuum or dimensional models. The spectrum approach can combine elements of both.
In scientific and academic literature on the definition or classification of mental disorders, one extreme argues that it is entirely a matter of value judgment (including what is normal) while others propose that it is or can be wholly objective and scientific (including by reference to statistical norms ). The general hybrid view holds that the concept of mental disorder is objective even if only a "fuzzy prototype" can not be defined precisely, or that the concept always involves a mixture of scientific facts and subjective value judgments. Although the diagnostic category is referred to as 'disorder', they are presented as a medical illness, but are not validated in the same way as most medical diagnoses. Some neurologists argue that classification would only be reliable and valid when based on neurobiological features rather than clinical interviews, while others suggest that different ideological and practical perspectives need to be more integrated.
The DSM and ICD approaches are still under attack both because of the implied causality model and because some researchers believe it is better to target the underlying brain differences that can precede symptoms for years.
Dimension model
The high level of comorbidity between disorders in categorical models such as DSM and ICD has led some to propose dimensional models. Studying the comorbidity between disorders has shown two latent (unobserved) factors or dimensions in the structure of a mental disorder that may allegedly reflect the etiological process. These two dimensions reflect the differences between internalization disorders, such as mood or anxiety symptoms, and externalization disorders such as behavioral symptoms or substance abuse. A single common factor of psychopathology, similar to factor g for intelligence, has been empirically supported. The p factor model supports different internalizations, but also supports the formation of the third dimension of mind disorders such as schizophrenia. Biological evidence also supports the validity of the internalization structure of externalization of mental disorders, with twin studies and adoptions that support inherited factors for externalization and internalization disorders.
Disorders
There are many different categories of mental disorders, and many different aspects of human behavior and personality can become irregular.
Anxiety or fear that disrupts normal functioning can be classified as anxiety disorder. Commonly known categories include specific phobias, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive disorder, and post-traumatic stress disorder.
Other affective (emotional/mood) processes can also become irregular. Mood disorders involving extreme and sustained grief, melancholy, or despair are known as severe depression (also known as unipolar or clinical depression). Lighter but still prolonged depression may be diagnosed as dysthymia. Bipolar disorder (also known as manic depression) involves an abnormal "high" or depressed mood, known as mania or hypomania, alternating with normal mood or depression. The extent to which unipolar and bipolar mood phenomena represent different categories of disorder, or mixed and unified in the dimensions or spectrum of the atmosphere, is subject to some scientific debate.
Patterns of belief, language usage and perception of reality can become disorganized (eg, delusions, mental disorders, hallucinations). Psychotic disorders in this domain include schizophrenia, and delusional disorders. Schizoaffective disorder is a category used for individuals who exhibit aspects of schizophrenia and affective disorder. Schizotypy is a category used for individuals who exhibit some characteristics associated with schizophrenia but without meeting the cutoff criteria.
The personality - the basic characteristics of a person affecting the mind and behavior throughout the situation and time - can be considered irregular if judged to be abnormal and maladaptive. Although treated separately by some, the commonly used categorical scheme includes it as a mental disorder, although on "axis II" is separate in the case of DSM-IV. A number of different personality disorders are listed, including those sometimes classed as "eccentric", such as paranoid, schizoid and schizotypal personality disorders; types described as "dramatic" or "emotional", such as antisocial, limits, histrionic or narcissistic personality disorder; and those who are sometimes classified as fear-related, such as disturbing personality disorders-avoidance, dependence, or obsessive-compulsive. Personality disorders, in general, are defined as appearing in childhood, or at least in adolescence or early adulthood. ICD also has categories to sustain personality changes after a disaster or psychiatric illness. If the inability to adequately adjust to living conditions begins within three months of a particular event or situation, and ends within six months after the stressor has ceased or disappeared, it may even be classified as an adjustment disorder. There is an emerging consensus called "personality disorder," like typical personality traits, actually combining a mixture of acute dysfunctional behavior that can accomplish in a short time, and a more enduring maladaptive temperament. In addition, there is also a non-categorical scheme that assesses all individuals through different personality dimension profiles without cutoffs based on symptoms of normal personality variations, for example through schemes based on dimensional models.
Eating disorders involve disproportionate attention to food and weight. Categories of disorders in this area include anorexia nervosa, bulimia nervosa, sports bulimia, or eating disorders.
Sleep disturbances such as insomnia involve interference with normal sleep patterns, or feelings of tiredness even when sleeping seems normal.
Sexual disorders and gender dysphoria can be diagnosed, including dyspareunia and ego-distonik homosexuality. Various kinds of paraphilia are considered mental disorders (sexual stimulation of objects, situations, or individuals that are considered to be abnormal or harmful to another person or person).
People who are abnormally incapable of withstanding a specific impulse or drive that can harm themselves or others, can be classified as impulse control disorders, and disorders such as kleptomania (stealing) or pyromania (fire settings). Behavioral addictions, such as gambling addiction, can be classified as a nuisance. Obsessive-compulsive disorder can sometimes involve an inability to resist a particular action but is classified separately as a major anxiety disorder.
The use of drugs (legal or illegal, including alcohol), when it persists despite significant problems associated with its use, can be defined as a mental disorder. DSM combines such conditions under the umbrella category of substance use disorders, which include substance dependence and substance abuse. DSM currently does not use general drug addiction, and ICD refers only to "harmful use". The use of irregular substances may be caused by repulsive and recurrent drug use patterns that result in tolerance to the effects and withdrawal symptoms when use is reduced or discontinued.
Persons suffering from a severe disorder of self-identity, general memory and awareness about themselves and their environment can be classified as having dissociative identity disorder, such as depersonalization disorder or Dissociative Identity Disorder itself (also called multiple personality disorder, or "multiple personality"). Memory or other cognitive impairment including amnesia or various types of elderly dementia.
Early developmental disorders of childhood can be diagnosed, for example autism spectrum disorders, rebellious opposition disorders and behavioral disorders, and attention deficit hyperactivity disorder (ADHD), which can continue into adulthood.
Behavioral disorders, if continued into adulthood, may be diagnosed as an antisocial personality disorder (disordered social disorders at ICD). Popular labels such as psychopaths (or sociopaths) do not appear in DSM or ICD but are associated by several people with this diagnosis.
Somatoform disorders can be diagnosed when there are problems that appear to originate from the body that are considered manifestations of mental disorders. This includes somatization disorders and conversion interruptions. There is also disruption of how a person perceives their body, such as a dysmorphic disorder of the body. Neurasthenia is an old diagnosis involving somatic complaints as well as fatigue and low spirits/depression, officially recognized by ICD-10 but no longer by DSM-IV.
Artificial disturbances, such as Munchausen syndrome, are diagnosed where symptoms are considered to be experienced (deliberately produced) and/or reported (falsified) for personal gain.
There is an attempt to introduce a category of relational disorder, where the diagnosis is a relationship rather than on one individual in the relationship. The relationship is possible between children and their parents, between spouses, or others. It already exists, under the category of psychosis, the diagnosis of a shared psychotic disorder in which two or more individuals share a certain fantasy because of their close relationship with each other.
There are a number of unusual psychiatric syndromes, often named after the person who first described them, such as Capgras syndrome, De Clerambault syndrome, Othello syndrome, Ganser syndrome, Cotard delusion, and Ekbom syndrome, and additional disorders such as Couvade. syndrome and Geschwind syndrome.
Different types of new diagnoses of mental disorders are sometimes proposed. Among those controversially considered by the official committee of the diagnostic manual include self-defeating personality disorder, sadistic personality disorder, passive-aggressive personality disorder and premenstrual dysphoric disorder.
Two unofficial recent unofficial proposals are solastalgia by Glenn Albrecht and hubris syndrome by David Owen. The application of the concept of mental illness to the phenomena described by these authors has in turn been criticized by Seamus Mac Suibhne.
Signs and symptoms
Course
The possibilities and outcomes of mental disorders vary and depend on many factors related to the disorder itself, the individual as a whole, and the social environment. Some disorders are temporary, while others may be more chronic in nature.
Even disorders that are often considered the most serious and stubborn have a variety of programs, namely schizophrenia, psychotic disorders, and personality disorders. International long-term schizophrenia studies have found that more than half of individuals recover in terms of symptoms, and about one-fifth to one-third in terms of symptoms and functioning, with some not requiring medication. At the same time, many have experienced serious difficulties and support for many years, although a "late recovery" is still possible. The World Health Organization concludes that long-term research findings merge with others in "freeing patients, nurses and doctors from the chronic paradigm that dominated thought throughout the 20th century."
About half of people initially diagnosed with bipolar disorder achieve syndrome recovery (no longer meet the criteria for diagnosis) within six weeks, and almost all reach within two years, with nearly half recovering their previous occupational status and residence in that period. However, nearly half have new episodes of mania or major depression within the next two years. Functioning has been found to vary, become poor during periods of severe depression or mania but otherwise fair to good, and may excel during the hypomania period in Bipolar II.
Disabled
Some disturbances may be severely limited to their functional effects, while others may involve substantial disability needs and support. The degree of ability or disability can vary over time and across different life domains. Furthermore, further disability has been linked to institutionalization, discrimination and social exclusion and the innate effects of disturbances. Or, the function may be affected by stress due to having to hide conditions at work or school etc., by the detrimental effects of drugs or other substances, or by the mismatch between variations related to disease and the demands of regularity.
It is also a case that, although often characterized by negative terms, some mental or state traits that are labeled as disorders can also involve above-average creativity, incompatibility, struggle-goal, precision, or empathy. In addition, public perceptions of the level of disability associated with mental disorders may change.
However, internationally, people report a disability equal to or greater than a common mental condition rather than a common physical condition, especially in their social roles and personal relationships. The proportion with access to professional help for mental disorders is much lower, however, even among those considered to have very crippling conditions. Disability in this context may or may not involve things like:
- Basic activities of everyday life. Including self-preservation (health care, grooming, dressing, shopping, cooking, etc.) or looking for accommodation (assignments, DIY assignments etc.)
- Interpersonal relationships. Includes communication skills, the ability to form relationships and support them, the ability to leave home or mingle with crowds or certain settings
- Work function. The ability to get a job and keep it, the cognitive and social skills needed for the job, dealing with the culture of the workplace, or learning as a student.
In terms of total disability-adjusted life years (DALY), which is an estimate of how many years of life are lost due to premature death or being in poor health and disability, mental disorder is ranked among the most disabling conditions. Unipolar depressive disorder (also known as Major) is the third leading cause of all disabilities worldwide, any mental or physical condition, accounting for 65.5 million years lost. Total DALY does not necessarily indicate what cripples most individuals because it also depends on how common a condition is; for example, schizophrenia is found to be the most individualized mental disorder that paralyzes the average but is less common. Alcohol abuse is also high on the overall list, responsible for 23.7 million DALYs globally, while other drug use disorders reach 8.4 million. Schizophrenia caused a total loss of 16.8 million DALY, and 14.4 million bipolar disorder. Panic disorder leads to 7 million years lost, obsessive-compulsive disorder 5.1, primary insomnia 3.6, and post-traumatic stress disorder 3.5 million DALY.
The first systematic picture of younger inability in the youth, published in 2011, found that among children aged 10 to 24, nearly half of all disabilities (current and as expected continue) are due to mental and mental conditions neurologic, including substances using disorders and conditions involving self-harm. Second for this is accident accidents (especially traffic collisions) accounting for 12 percent disability, followed by infectious diseases at 10 percent. Interferences associated with most disabilities in high-income countries are unipolar major depression (20%) and alcohol use disorders (11%). In the eastern Mediterranean it is unipolar major depression (12%) and schizophrenia (7%), and in Africa it is unipolar major depression (7%) and bipolar disorder (5%).
Suicide, often associated with some underlying mental disorders, is the leading cause of death among adolescents and adults under 35 years old. There are about 10 to 20 million non-fatal suicide attempts each year around the world.
Risk factors
The main view in 2018 is that biological, psychological, and environmental factors all contribute to the development or development of mental disorders.
Drugs
Mental disorders associated with drug use include: marijuana, alcohol and caffeine, use that seems to increase anxiety. For psychosis and schizophrenia, the use of a number of drugs has been associated with developmental disorders, including marijuana, cocaine, and amphetamines. There is a debate about the relationship between marijuana use and bipolar disorder. Cannabis is also associated with depression.
Personality characters
Risk factors for mental illness are a tendency to high neuroticism or "emotional instability". In anxiety, risk factors can include temperament and attitude (eg pessimism).
Genetics
Although researchers have searched decades for a clear link between genetics and mental disorders to provide better diagnosis and facilitate the development of better care, the work has resulted in almost nothing.
A number of disorders related to family history include depression, and anxiety.
Environment
In schizophrenia and psychosis, risk factors include migration and discrimination, childhood trauma, loss or separation in the family, and drug abuse, and urbanization.
In anxiety, risk factors can be a culprit factor including parental rejection, lack of parental warmth, high hostility, harsh discipline, high negative mother influences, anxious child care, modeling of dysfunctional behavior and drug abuse, and child abuse (emotional, physical and sexual).
Social influence has been found to be important, including harassment, neglect, oppression, social stress, traumatic events and other negative or extraordinary life experiences. For bipolar disorder, stress (such as childhood difficulties) is not a particular cause, but it puts genetically and biologically susceptible individuals at risk for more severe disease. However, the risks and specific pathways for certain disorders are less clear. The broader community aspect has also been involved, including employment issues, socio-economic inequalities, lack of social cohesion, migration-related issues, and specific societal and cultural features.
Model
Mental disorders can arise from a variety of sources, and in many cases there is no single, accepted or consistent cause that is currently defined. A mixture of eclectic or pluralistic models can be used to describe certain disorders. The main paradigm of contemporary Western psychiatry is said to be a biopsychosocial model that combines biological, psychological and social factors, although this may not always be applied in practice.
Biological psychiatry follows a biomedical model in which many mental disorders are conceptualized as a brain circuit disorder that may be caused by a developmental process formed by genetic interaction and complex experience. The common assumption is that disorders may be caused by genetic susceptibility and development, exposed by stress in life (eg in diathetic stress models), although there are various views on what causes differences between individuals. Several types of mental disorders can be seen as major neurodevelopmental disorders.
Evolutionary psychology can be used as a whole explanatory theory, while the attachment theory is another type of evolutionary-psychological approach sometimes applied in the context of mental disorders. Psychoanalytic theories continue to develop together and the cognitive-behavioral and systemic-family approach. Differences are sometimes made between "medical models" or "social models" of disorders and disabilities.
Diagnosis
Psychiatrists seek to provide an individual's medical diagnosis by assessing symptoms, signs and disorders associated with certain types of mental disorders. Other mental health professionals, such as clinical psychologists, may or may not apply the same diagnostic category to their clinical formulation of clients' difficulties and circumstances. The majority of mental health problems, at least initially, are assessed and treated by a family physician (in the general practitioner of the United Kingdom) during consultation, which may refer patients to further specialist diagnosis in acute or chronic cases.
Routine diagnostic practices in mental health services typically involve interviews known as mental status checks, in which evaluations are made of appearance and behavior, self-reported symptoms, mental health history, and current state of life. Other professional views, relatives or other third parties may be considered. Physical examination to check for poor health or effects of other drugs or drugs may be performed. Psychological tests are sometimes used through paper and pen or computer questionnaires, which may include algorithms based on standardized diagnostic criteria, and in rare cases of specialists, neuroimaging tests may be required, but they are more commonly found in research studies than routines. clinical practice.
Time and budget constraints often limit the practice of psychiatrists from conducting a thorough diagnostic evaluation. It has been found that most clinicians evaluate patients using an unstructured and open approach, with limited training in evidence-based assessment methods, and inaccurate diagnosis may be common in routine practice. In addition, comorbidities are very common in psychiatric diagnosis, where the same person meets the criteria for more than one disorder. On the other hand, a person may have several different difficulties, only a few that meet the criteria to be diagnosed. There may be special problems with accurate diagnosis in developing countries.
A more structured approach is increasingly used to measure the level of mental illness.
- HoNOS is the most widely used measure in UK mental health services, used by at least 61 trusts. In HoNOS a score of 0-4 is given for each of 12 factors, based on functional living capacity. Research has supported HoNOS, although some questions have been raised about whether it provides adequate coverage of the range and complexity of mental illness problems, and whether the fact that often only 3 of 12 scales vary over time provides enough subtlety to accurately measure. treatment results.
Criticism
Since the 1980s, Paula Caplan has been concerned about the subjectivity of psychiatric diagnosis, and people are arbitrarily "slapped with psychiatric labels." Caplan says because psychiatric diagnosis is not regulated, doctors do not have to spend much time interviewing patients or seeking a second opinion. Diagnostic and Statistical Manual Mental Disorders may cause a psychiatrist to focus on a narrow list of symptoms, with little consideration of what actually causes a patient problem. Thus, according to Caplan, psychiatric diagnosis and labeling often precludes recovery.
In 2013, psychiatrist Allen Frances wrote a paper entitled "The New Crisis of Trust in Psychiatric Diagnosis", which says that "psychiatric diagnosis... still relies exclusively on subjective judgments that can go wrong rather than objective biological tests." Frances is also concerned about "an unexpected overdiagnosis." For years, psychiatrists have been marginalized (such as Peter Breggin, Thomas Szasz) and outside critics (such as Stuart A. Kirk) have "been accusing psychiatry of engaging in systematic medicalisation of normality." Most recently these concerns come from insiders who have worked and promoted the American Psychiatric Association (eg, Robert Spitzer, Allen Frances). A 2002 editorial in the British Medical Journal warned against inappropriate drugs leading to mongering diseases, where the limits of the definition of the disease were expanded to include personal problems as medical problems or the risk of disease was emphasized to expand market for drugs.
Prevention
The 2004 WHO report "Prevention of Mental Disorders" states that "Prevention of this disorder is clearly one of the most effective ways to reduce the burden [of disease]." The 2011 European Psychiatric Association (EPA) guideline on the prevention of mental disorders states, "There is ample evidence that psychiatric conditions can be prevented through effective implementation of evidence-based interventions." The 2011 UK Department of Health's report on the economic case for the promotion of mental health and the prevention of mental illness found that "many interventions are excellent for money, low-cost and often self-financing over time, saving on public spending". By 2016, the National Mental Health Institute reaffirms prevention as a research priority area.
Parenting can affect the mental health of children, and evidence suggests that helping parents be more effective with their children can meet mental health needs.
Universal precautions (aimed at populations without increased risks for developing mental disorders, such as school programs or mass media campaigns) require very high numbers of people to show effects (sometimes known as "power" issues). The approaches to overcome this are (1) focus on high incidence groups (eg by targeting groups with high risk factors), (2) using some intervention to achieve greater effects, and thus more statistically valid, (3) using cumulative metadata analysis of many experiments, and (4) running a very large trial.
Management
Treatment and support for mental disorders is provided in psychiatric hospitals, clinics or various diverse community mental health services. A number of professions have evolved that specialize in the treatment of mental disorders. These include psychiatric medical specializations (including psychiatric nursing), a field of psychology known as clinical psychology, and the practical application of sociology known as social work. There are also various psychotherapists (including family therapy), counselors, and public health professionals. In addition, there is a peer support role in which personal experience with similar problems is a major source of expertise. Different clinical and scientific perspectives attract diverse fields of research and theory, and various disciplines may support different models, explanations, and objectives.
In some countries, services are increasingly based on a recovery approach, intended to support individual personal travel to get the kind of life they want, although there may also be 'pessimism of therapy' in some areas.
There are different types of treatments and what works best depending on the disorder and on the individual. Much has been found to help at least some people, and the placebo effect may play a role in any intervention or treatment. In a small number of cases, individuals can be treated against their will, which can cause certain difficulties depending on how it is done and perceived.
Mandatory treatment while in community versus non-compulsory treatment does not appear to make much difference except by perhaps reducing victimization.
Psychotherapy
The main choice for many mental disorders is psychotherapy. There are several main types. Cognitive behavioral therapy (CBT) is widely used and is based on the modification of mindset and behavior associated with certain disorders. Psychoanalysis, dealing with underlying psychological conflict and defense, has become the dominant and still-used school of psychotherapy. Systemic therapy or family therapy is sometimes used, handling significant other people's networks as well as individuals.
Some psychotherapy is based on a humanistic approach. There are a number of specialized therapies that are used for certain disorders, which may be branches or hybrids of the above type. Mental health professionals often use an eclectic or integrative approach. Many depend on therapeutic relationships, and there may be problems with trust, confidentiality, and involvement.
Medication
The main choice for many mental disorders is the treatment of psychiatry and there are several major groups. Antidepressants are used for the treatment of clinical depression, as well as often for anxiety and various other disorders. Anxiolytics (including tranquilizers) are used for anxiety disorders and related problems like insomnia. Mood stabilizers are used primarily in bipolar disorder. Antipsychotics are used for psychotic disorders, especially for positive symptoms in schizophrenia, and also more and more other disorders. Stimulants are commonly used, especially for ADHD.
Despite the different conventional names of the drug group, there may be a lot of overlap in the actual disorder shown, and there may also be drug use without the label. There may be problems with ill effects of drugs and adherence to them, and there are also criticisms of pharmaceutical marketing and professional conflict of interest.
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Electroconvulsive therapy (ECT) is sometimes used in severe cases when other interventions for severe severe depression have failed. Psychosurgery is considered experimental but it is recommended by some neurologists in some rare cases.
Counseling (professional) and co-counseling (among peers) can be used. Psychoeducation programs can provide information to people to understand and manage their problems. Creative therapy is sometimes used, including music therapy, art therapy or drama therapy. Lifestyle adjustments and support measures are often used, including peer support, self-help groups for mental health and supported housing or supported work (including social enterprises). Some recommend dietary supplements.
Reasonable accommodation (adjustment and support) can be applied to help a person cope and succeed in the environment despite the potential disability associated with mental health problems. This could include emotional support animals or specially trained psychiatric service dogs.
Epidemiology
Mental disorders are common. Worldwide, more than one in three people in most countries report sufficient criteria for at least one at some point in their lives. In the United States, 46% are eligible for mental illness at some point. An ongoing survey shows that anxiety disorder is the most common in all but one country, followed by mood disorders in all but two countries, while impaired substance and impulse control disorders are consistently less common. Rates vary by region.
A review of anxiety disorder surveys in different countries found an average lifetime prevalence estimate of 16.6%, with women having a higher average rate. A survey of mood disorders in various countries found a lifetime rate of 6.7% for major depressive disorders (higher in some studies, and in women) and 0.8% for Bipolar I disorder.
In the United States the frequency of interference is: anxiety disorder (28.8%), mood disorder (20.8%), impulse control disorder (24.8%) or substance use disorder (14.6%).
A 2004 cross-European study found that about one in four people reported meeting criteria at some point in their lives for at least one of the assessed DSM-IV disorders, including mood disorders (13.9%), anxiety disorders (13.6 %) or alcohol disorders (5.2%). About one in ten meets the criteria within a 12 month period. Women and young people of both sexes show more cases of disorders. A 2005 survey review of 16 European countries found that 27% of European adults were affected by at least one mental disorder within a 12 month period.
An international review of studies on the prevalence of schizophrenia found median (median) rates of 0.4% for lifetime prevalence; it is consistently lower in poorer countries.
Studies on the prevalence of personality disorder (PD) have been fewer and smaller scale, but one broad Norwegian survey found a five-year prevalence of almost 1 in 7 (13.4%). Rates for certain disorders range from 0.8% to 2.8%, varying across countries, and by sex, educational level, and other factors. US surveys that were accidentally screened for personality disorder found a 14.79% rate.
Approximately 7% of preschool samples were given a psychiatric diagnosis in one clinical study, and about 10% of children ages 1 and 2 who received developmental screening had been assessed to have significant emotional/behavioral problems based on parent and pediatric reports..
While the level of psychological disturbance is often similar for men and women, women tend to have higher levels of depression. Every year 73 million women are affected by severe depression, and suicide is ranked 7th as the cause of death of women between the ages of 20-59. Depression disorders accounted for nearly 41.9% of disability from neuropsychiatric disorders among women compared with 29.3% among men.
History
Ancient civilizations
Ancient civilizations were described and treated a number of mental disorders. A famous mental illness in ancient Mesopotamia, where illness and mental disorders are believed to be caused by certain gods. Because the hand represents control over a person, mental illness is known as the "hand" of a particular god. One psychological illness known as Q? T I? Tar , which means "Hand of Ishtar". Others are known as "Shamash Hand", "Ghost Hand", and "God's Hand". The explanations of these diseases, however, are so vague that it is usually impossible to determine which diseases relate to them in modern terminology. Mesopotamian doctors kept detailed records of their patient's hallucinations and gave them spiritual meaning. The royal family of Elam is famous for its members often suffering from insanity. The Greeks coined the term for melancholy, hysteria and phobias and developed a theory of humorism. Mental disorders are described, and treatments developed, in Persia, Arabia, and in the medieval Islamic world.
Europe
Medieval
The conception of insanity in the Middle Ages in Christian Europe was a mixture of the divine, cruel, magical and humoral and transcendental. At the beginning of the modern period, some people with mental disorders may have been victims of witch hunts. Although not all magicians and sorcerers who suffer from mental illness, all mentally ill are regarded as magicians or witches. At the turn of the 16th and 17th centuries, mental illness is increasingly recognized in local workplaces, prisons and private madhouses by social justice advocates like Dorothea Dix. Many terms for mental disorders that find their way in daily use first became popular in the 16th and 17th centuries.
18th century
At the end of the seventeenth century and entering the Enlightenment, madness is increasingly seen as an organic physical phenomenon with no connection to the soul or moral responsibility. Asylum care is often rough and treats people like wild animals, but towards the end of the 18th century a movement of moral care gradually evolved. Clear descriptions of some syndromes may rarely occur before the 19th century.
nineteenth century
Industrialization and population growth led to a massive expansion of the number and size of mental hospitals in every Western country in the 19th century. Many different classification schemes and diagnostic terms are developed by different authorities, and psychiatric terms are created (1808), although the medical superintendent is still known as an alienis.
20th Century
The turn of the 20th century saw the development of psychoanalysis, which would then come to the fore, along with the Kraepelin classification scheme. Asylum "inmates" are increasingly referred to as "patients", and hospitals are renamed as hospitals.
Europe and the United States
At the beginning of the 20th century in the United States, a mental hygiene movement was developed, aimed at preventing mental disorders. Clinical psychology and social work are developed as professions. World War I saw a massive increase in conditions that came to be called "shell shock".
World War II saw developments in the US from new psychiatric guides to categorize mental disorders, which together with existing systems to collect census and hospital statistics led to the first Diagnostic and Statistical Manual of Mental Disorders (DSM). The International Classification of Diseases (ICD) also develops a section on mental disorders. The term stress, arising from endocrinologic work in the 1930s, is increasingly applied to mental disorders.
Electroconvulsive therapy, insulin shock therapy, lobotomy, and chlorpromazine "neuroleptic" began to be used in the mid-century. In 1960 there were many challenges to the concept of mental illness itself. These challenges come from psychiatrists such as Thomas Szasz who argue that mental illness is a myth used to disguise moral conflict; from sociologists like Erving Goffman who say that mental illness is just another example of how society labels and controls nonconformists; from behavioral psychologists who challenge the fundamental dependence of psychiatry on unobservable phenomena; and from gay rights activists who criticize APA's list of homosexuality as a mental disorder. A study published in Science by Rosenhan received much publicity and was seen as an assault on the efficacy of psychiatric diagnosis.
Deinstalizationalization is gradually taking place in the West, with isolated psychiatric hospitals closed to support community mental health services. Consumer movement/survivors gain momentum. Other types of psychiatric drugs are being used, such as "psychic energy" (then antidepressants) and lithium. Benzodiazepines were used extensively in the 1970s for anxiety and depression, until the problem of dependency limited their popularity.
Advances in neuroscience, genetics and psychology lead to a new research agenda. Cognitive behavioral therapy and other psychotherapy are developed. DSM and later ICD adopted classifications based on new criteria, and the number of "official" diagnoses saw major expansion. During the 1990s, new SSRI type antidepressants became some of the most commonly prescribed drugs in the world, as did antipsychotics. Also during the 1990s, a recovery approach was developed.
Society and culture
Different societies or cultures, even different individuals within a subculture, may disagree about what is the optimal pathological and pathological biological and psychological function. Research has shown that cultures vary in relative importance placed on, for example, happiness, autonomy, or social relations for pleasure. Likewise, the fact that behavior patterns are valued, accepted, encouraged, or even normatively statistically in a culture does not necessarily mean that it is conducive to optimal psychological functioning.
People in all cultures find some weird or even incomprehensible behavior. But what they feel is strange or incomprehensible is ambiguous and subjective. The differences in this determination can be very controversial. The process in which conditions and difficulties come to be defined and treated as medical conditions and problems, and thus is under the authority of doctors and other health professionals, known as drugs or pathologisation.
Religion
Religious, spiritual, or transpersonal experience and beliefs meet many of the criteria for delusional or psychotic disorders. A belief or experience can sometimes be shown to produce distress or inadequacies to assess mental disorders. There is a connection between religion and schizophrenia, a complex mental disorder characterized by difficulty in recognizing reality, organizing emotional responses, and thinking in a clear and logical way. Those with schizophrenia generally report some kind of religious delusion, and religion itself may be a trigger for schizophrenia.
Movement
Controversy has often surrounded psychiatry, and the term anti-psychiatry was invented by psychiatrist David Cooper in 1967. The anti-psychiatric message is that psychiatric treatment is ultimately more destructive than helping patients, and the history of psychiatry involves what may now be considered harmful treatment. Electroconvulsive therapy is one of them, widely used between the 1930s and 1960s. Lobotomy is another practice that is ultimately considered too invasive and brutal. Diazepam and other sedatives are sometimes too prescribed, leading to an epidemic of dependence. There is also concern about a major increase in prescribing psychiatric drugs for children. Some charismatic psychiatrists come to realize the movement against psychiatry. The most influential is R.D. Laing who wrote a series of best-selling books, including The Divided Self . Thomas Szasz wrote The Myth of Mental Illness . Some groups of former patients have become anti-psychiatric militants, often referring to themselves as "survivors". Giorgio Antonucci has questioned the basis of psychiatry through his work on the demolition of two mental hospitals (in the town of Imola), conducted from 1973 to 1996.
Consumer movement/survivors (also known as the survivors' movement) consist of individuals (and organizations representing them) who are clients of mental health services or who consider themselves survivors of psychiatric intervention. Campaign activists to improve mental health services and for more engagement and empowerment in mental health services, policies and the wider community. Patient advocacy organizations have evolved with increasing deinstitutionalization in developed countries, working to challenge stereotypes, stigma and exceptions related to psychiatric conditions. There is also a parenting movement of people who help and support people with mental health conditions, who may be relatives, and who often work in difficult and time-consuming situations with little recognition and no pay. The anti-psychiatric movement essentially challenges major psychiatric theories and practices, including in some cases that assert that the concept of psychiatry and the diagnosis of 'mental illness' is unreal and useless.
As an alternative, a movement for global mental health has emerged, defined as 'the field of study, research, and practice that places priority on improving mental health and achieving equality in mental health for all people around the world'.
Cultural bias
Current diagnostic guidelines, DSM and to some extent ICD, have been criticized as having a fundamental European-American view. Opponents argue that even when diagnostic criteria are used in different cultures, it does not mean that the underlying construction has validity in that culture, because even a reliable application can only prove consistency, not legitimacy. Advocating for a more culturally sensitive approach, critics such as Carl Bell and Marcello Maviglia argue that cultural and ethnic diversity of individuals is often discounted by researchers and service providers.
Cross-cultural psychiatrist Arthur Kleinman argues that Western bias is ironically illustrated in the introduction of cultural factors to the DSM-IV. Distractions or concepts from non-Western or non-mainstream cultures are described as "culture bound," whereas standard psychiatric diagnoses are not given any cultural qualification, revealing to Kleinman the underlying assumption that Western cultural phenomena are universal. Kleinman's negative view of culturally bound syndrome is largely shared by other cross-cultural criticisms. General responses include both the disappointment of a large number of non-Western documented still-abandoned mental disorders and frustrations that even include often misinterpreted or misinterpreted.
Many mainstream psychiatrists are dissatisfied with the new culture-bound diagnosis, albeit for different reasons. Robert Spitzer, a principal architect of DSM-III, argues that adding a cultural formulation is an attempt to placate cultural critics, and has stated that they have no scientific or supportive reasons. Spitzer also argues that a new culture-bound diagnosis is rarely used, maintaining that the standard diagnosis applies regardless of the culture involved. In general, the main psychiatric opinion remains that if the diagnostic categories are valid, cross-cultural factors are irrelevant or significant only for presentation of certain symptoms.
Clinical conceptions of mental illness also overlap with personal and cultural values ​​in the domain of morality, so much so that sometimes it is argued that separating the two is not possible without fundamentally defining the essence of being a particular person in society. In clinical psychiatry, persistent and impaired disorders show internal disorders requiring treatment; but in other contexts, the same distress and disability can be seen as an indicator of emotional struggle and the need to address social and structural problems. This dichotomy has led some academics and doctors to advocate postmodernist conceptualization of mental stress and well-being.
Such an approach, along with cross-cultural and "cultic" psychology centered on cultural and ethnic-based identity and experience, is very different from the alleged avoidance of a major psychiatric community against any explicit engagement with morals or cultures. In many countries there are attempts to challenge the perceived prejudices against minorities, including the suspicion of institutional racism in psychiatric services. There is also ongoing effort to increase the sensitivity of cross-cultural professionals.
Legal and policy
Three-quarters of countries around the world have mental health legislation. Entry into compulsory mental health facilities (also known as involuntary commitments) is a controversial topic. This may affect personal freedom and the right to vote, and carries the risk of harassment for political, social and other reasons; but it can potentially prevent damage to yourself and others, and help some people in achieving their right to health care when they may not be able to decide for their own interests.
All human rights-oriented mental health laws require evidence of mental disorders as defined by internationally accepted standards, but the type and severity of the imputed disorder may vary across jurisdictions. The two most commonly used reasons for forced entry are said to be serious possibilities of immediate or immediate danger to self or others, and the need for care. Applications for someone who inadvertently confess usually comes from a mental health practitioner, family member, close relative, or guardian. Human rights-oriented legislation usually specifies that an independent medical practitioner or other accredited mental health practitioner should examine the patient separately and that there should be a regular, time-bound review by an independent review board. Individuals should also have private access to independent advocacy.
In order for unintentional treatment to be provided (if required), it must be shown that a person does not have the mental capacity to obtain consent (ie to understand the treatment information and its implications, and therefore can make a choice based on receiving or rejecting information). Legal challenges in some areas have resulted in the highest court decision that a person does not have to agree with the psychiatrist's characterization of the problem as a "disease", or agree with the psychiatric belief in the treatment, but only recognize the issue and information about the option care.
Proxy consent (also known as a substitute or substitute for decision making) may be transferred to a personal representative, family member or legal guardian. In addition, patients may be able to make, when they are considered good, advance instructions that define how they would like to be treated if they are considered to lack future mental capacity. The right to support decision-making, in which a person is assisted to understand and choose treatment options before they can be expressed lack of capacity, may also be included in law. At least there should be joint decision making as far as possible. Unintentional treatment laws are increasingly extended to those living in the community, for example the law of outpatient commitment (known under a different name) is used in New Zealand, Australia, the United Kingdom and most of the United States.
The World Health Organization reports that in many cases, national mental health laws eliminate the rights of people with mental disorders rather than protect the rights, and are often outdated. In 1991, the United Nations adopted the Mental Protection Principles of People with Mental Illness and Improved Mental Health Care, which sets the minimum standard of human rights in the field of mental health. In 2006, the UN formally approved the Convention on the Rights of Persons with Disabilities to protect and enhance the rights and opportunities of persons with disabilities, including those with psychosocial disabilities.
The term madness, sometimes used daily as a synonym for mental illness, is often used technically as a legal term. Defense madness can be used in legal courts (known as defense mental disorders in some countries).
Perception and discrimination
Stigma
The social stigma associated with mental disorders is a widespread problem. The General Surgeon General stated in 1999 that: "A strong and pervasive stigma prevents people from acknowledging their own mental health problems, let alone disclosing them to others." Job discrimination reportedly plays an important part in the high unemployment rate among those diagnosed with mental illness. A study in Australia found that having mental illness was a bigger obstacle to work than a physical disability. The mentally ill are stigmatized in Chinese society and can not legally marry.
Efforts are being made worldwide to eliminate the stigma of mental illness, although the methods and results used are sometimes criticized.
Media and the general public
Media coverage of mental illness consists of negative and degrading depictions, for example, incompetence, violence or crime, with far less coverage of positive issues such as achievement or human rights issues. Such negative depictions, including those in children's cartoons, are thought to contribute to the stigma and negative attitude in society and to those with mental health problems themselves, although more sensitive or serious cinematic depictions have increased in prevalence.
In the United States, the Carter Center has created alliances for journalists in South Africa, the US and Romania, to enable journalists to research and write stories about mental health topics. Former US First Lady Rosalynn Carter embarked on a partnership not only to train journalists in a sensitive and accurate way to discuss mental and mental health, but also to increase the number of stories about these topics in the news media. There is also World Mental Health Day, which in the US and Canada falls in the Week of Mental Illness Awareness.
The general public has been found to have strong stereotypes of danger and a desire for social distance from individuals who are described as mentally ill. A US national survey found that a higher percentage of individual-level individuals were described as displaying the characteristics of mental disorders as "the possibility of doing something cruel to others," compared to the percentage of people judged by people who were described as "problematic".
Recent depictions in the media have included the main characters who successfully lived with and managed mental illness, including in bipolar disorder at Homeland (2011) and post-traumatic stress disorder in Iron Man 3 > (2013)).
Violence
Regardless of public opinion or the media, national research shows that severe mental illness does not independently predict future violent behavior, on average, and not the main cause of violence in society. There is statistical correlation with various factors related to violence (to anyone), such as substance abuse and personal, social and economic factors. A review of 2015 found that in the United States, about 4% of the violence was caused by people diagnosed with mental illness, and a study of 2014 found that 7.5% of crimes committed by mentally ill people were directly related to their mental illness. The majority of people with serious mental illness have never committed violence.
In fact, the findings consistently show that many times more likely that people diagnosed with serious mental illness living in the community will be victims rather than perpetrators of violence. In a study of individuals diagnosed with "severe mental illness" living in inner-city US cities, a quarter were found to have been victims of at least one violent crime for a year, the proportion eleven times higher than the average inner, and higher in each category of crime including violent attacks and theft. People with diagnoses may find it more difficult to secure prosecution, but, in part because of prejudice and are considered less credible.
However, there are specific diagnoses, such as childhood behavioral disorders or adult antisocial personality disorder or psychopathy, defined by, or inherently linked to, problems and violence. There are conflicting findings about the extent to which certain specific symptoms, especially some types of psychosis (hallucinations or delusions) that can occur in disorders such as schizophrenia, delusions or mood disorders, are associated with an increased risk of serious serious violence. The mediating factors of acts of violence, however, are most consistently found primarily socio-demographic and socio-economic factors such as being young, men, low socioeconomic status and, in particular, substance abuse (including alcoholism) that some people may be particularly vulnerable.
High-profile cases have raised concerns that
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