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HEALTH AND WELLNESS 2/2013
WELLNESS AND ENVIRONMENT
CHAPTER XIV
Katedra i Zakład Zdrowia Publicznego
Uniwersytet Medyczny w Lublinie
Chair and Department of Public Health
Medical University of Lublin
KRZYSZTOF WŁOCH, PIOTR KSIĄŻEK,
EWA WARCHOŁ-SŁAWIŃSKA, MARZENA FURTAK-NICZYPORUK
Some problems of mental health disorders
Wybrane problemy zaburzeń zdrowia publicznego
Mental illness is a disorder characterized by disturbances in a person’s thoughts,
emotions, or behavior. The term mental illness can refer to a wide variety of
disorders, ranging from those that cause mild distress to those that severely impair a
person’s ability to function. Today, mental illness is considered to range from such
ideas as eating disorders to personality disorders [1].
Mental illnesses were reported already 4000-5000 years ago. The reason
scientists believe that mental illness has existed for such a long time is due to
anthropologists finding skulls with holes gashed in them. These skulls look very
similar to those after the process of trepanning performed on them. The process of
trepanning is simply the surgical procedure of creating a hole in the skull. Scientists
believe that this procedure was done in order to let out evil spirits which doctors
believed to be possessed by the mentally ill at that time. The literature of ancient
Greece also contains evidence of the belief that evil spirits or demons controlled the
mentally ill. Not only the Greeks believed in the evil spirit theory, writings from the
early Babylonian, Egyptian, and Chinese civilizations have also shown evidence that
mental illness was believed to be a possession by demons-using beatings, restraint,
and starvation to try to drive out the evil spirits [2].
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These beliefs somewhat cooled down as time continued to move on, but once
again popped up as America started to be formed. In 1692 and 1693 the Salem
witchcraft trials began. At this point in time mental illness was suggested to be
associated with the devil, so those with mental illnesses were thought to be witches.
Those who were thought to be witches were given unfair trials and quick death
penalties. Many innocent people who simply had a mental disorder were burned at
the stake because of the lack of knowledge about this natural disorder. As time
moved on, people saw that the mentally ill were not possessed, but that they were
simply sick. Rather than kill all mentally ill, society decided it would be better to
lock them away in a place that would be safe for them which was away from other
people. One of the first and most notorious institutions was Bethlehem Hospital.
Although Bedlam was founded on high principles it was soon noted as being wild,
crowded, noisy, and filthy. Patients could be found in cold, dark, unsanitary cells
with almost no clothing on in the Bedlam institution.
Another aspect of Mental Illness is that there are many different kinds of them.
Some of the mental disorders mentioned in the book are senility, alcoholism, and
drug abuse. Senility has become a basic epidemic in the United States, with five
percent of people over sixty-five experiencing symptoms of memory loss,
disorientation to time and place, and impaired thinking ability. Senility is not a
disease based on the idea that as age sets in the brain begins to slow down, but
simply that other diseases cause older people more problems in everyday life than it
was thought before. Senility can be preceded by many other disorders including
arteriosclerosis, strokes, Alzheimer’s disease, and severe cases of depression.
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 life. In the
United States 46% qualifies for a mental illness at some point. An ongoing survey
indicates that anxiety disorders are the most common in all but one country,
followed by mood disorders in all but two countries, while substance disorders and
impulse-control disorders were consistently less prevalent. Rates varied according to
regions.
A review of anxiety disorder surveys in different countries found average
lifetime prevalence estimates of 16.6%, with women having higher rates on the
average. A review of mood disorder surveys in different countries found lifetime
rates of 6.7% for major depressive disorder (higher in some studies, and in women)
and 0.8% for Bipolar I disorder.
In the United States the frequency of disorder is: anxiety disorder (28.8%), mood
disorder (20.8%), impulse-control disorder (24.8%) or substance use disorder
(14.6%).
The 2004 cross-Europe study found that approximately one in four people
reported meeting criteria at some point in their life for at least one of the DSM-IV
disorders assessed, which included mood disorders (13.9%), anxiety disorders
(13.6%) or alcohol disorder (5.2%). Approximately one in ten met criteria within a
12-month period. Women and younger people of either gender showed more cases
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Some problems of mental health disorders
of disorder. The 2005 review of surveys in 16 European countries found that 27% of
adult Europeans are affected by at least one mental disorder in a 12 month period.
An international review of studies on the prevalence of schizophrenia found the
average (median) figure of 0.4% for lifetime prevalence; it was consistently lower in
poorer countries.
Studies of the prevalence of personality disorders (PDs) have been fewer and on
a smaller scale, but one broad Norwegian survey found a five-year prevalence of
almost 1 in 7 (13.4%). The rates for specific disorders ranged from 0.8% to 2.8%,
differing across countries, and by gender, educational level and other factors. The
US survey that incidentally screened for personality disorder found the rate of
14.79%.
Approximately 7% of a preschool pediatric sample were given a psychiatric
diagnosis in one clinical study, and approximately 10% of 1- and 2-year-olds
receiving developmental screening have been assessed as having significant
emotional/behavioral problems based on the parent and pediatrician reports.
While rates of psychological disorders are often the same for men and women,
women tend to have a higher rate of depression. Each year 73 million women are
afflicted with major depression, and suicide is ranked 7th as the cause of death for
women between the ages of 20–59. Depressive disorders account for close to 41.9%
of the disability from neuropsychiatric disorders among women compared to 29.3%
among men.
Common substance-related disorders include alcoholism and drug abuse. In
addition to the effect already given by the abused drug, drug abuse can contribute to
symptoms of other mental disorders such as depression, anxiety, and psychosis.
Most substance-related disorders include alcohol, caffeine, nicotine, cocaine, heroin,
hallucinogens, and sedatives. Alcoholism is regarded as a disease by some who
drink excessively and are generally unable to control how much they drink and
cannot function well physically, socially, or mentally. Babies born to alcoholic
mothers have a death rate eight times that of babies in general. Those that survive
have a very good chance of being mentally retarded.
From my point of view, the best way to prevent mental disorder is using the
following guidelines:
a. Primary (avoid occurrence)
I. Universal prevention (targets general public)
II. Selective prevention (target subgroups of the population with a higher risk)
III. Indicated prevention (targets individuals at high-risk for mental disorders)
b. Secondary (early diagnosis/treatment)
I. Specific treatment
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c. Tertiary
I. Reduce disability
II. Rehabilitation
III. Prevention of relapse
The common mental health disorders: mental health disorder, including generalised anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive
disorder (OCD) and post-traumatic stress disorder (PTSD).
SYMPTOMS AND PRESENTATION
GENERALISED ANXIETY DISORDER
The essential feature of GAD is excessive anxiety and worry (apprehensive
expectation), occurring on more days than not for a period of at least 6 months,
about a number of events or activities. The person with GAD finds it difficult to
control the anxiety and worry, which is often accompanied by restlessness, being
easily fatigued, having difficulty concentrating, irritability, muscle tension and
disturbed sleep.
The focus of the anxiety and worry in GAD is not confined to features of another
disorder, for example having panic attacks (as in panic disorder) or being
embarrassed in public (as in social anxiety disorder). Some people with GAD may
become excessively apprehensive about the outcome of routine activities, in
particular those associated with the health or separation from loved ones. Some
people often anticipate a catastrophic outcome from a mild physical symptom or a
side effect of medication. Demoralisation is said to be a common consequence, with
many individuals becoming discouraged, ashamed and unhappy about the
difficulties of carrying out their normal routines. GAD is often comorbid with
depression and this can make accurate diagnosis problematic.
PANIC DISORDER
People with panic disorder report intermittent apprehension, and panic
attacks(attacks of sudden short-lived anxiety) in relation to particular situations or
spontaneous panic attacks, with no apparent cause. They often take action to avoid
being in particular situations in order to prevent those feelings, which may develop
into agoraphobia
The frequency and severity of panic attacks varies widely. Situational triggers
for panic attacks can be external (for example, a phobic object or situation) or
internal(physiological arousal). A panic attack may be unexpected (spontaneous or
uncued), that is, one that an individual does not immediately associate with a
situational trigger [1, 2].
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Some problems of mental health disorders
The essential feature of agoraphobia is anxiety about being in places or situations
from which escape might be difficult, embarrassing or in which help may not be
available in the event of having a panic attack. This anxiety is said to typically lead
to a pervasive avoidance of a variety of situations that may include: being alone
outside the home or being home alone; being in a crowd of people; travelling by car
or bus; being in a particular place, such as on a bridge or in a lift.
OBSESSIVE-COMPULSIVE DISORDER
OCD is characterised by the presence of either obsessions or compulsions, but
commonly both. An obsession is defined as an unwanted intrusive thought, image or
urge that repeatedly enters the person’s mind. Obsessions are distressing, but are
acknowledged as originating in the person’s mind and not imposed by an external
agency. They are usually regarded by the individual as unreasonable or excessive.
Common obsessions in OCD include contamination from dirt, germs, viruses, body
fluids and so on, fear of harm (for example, that door locks are not safe), excessive
concern with order or symmetry, obsessions with the body or physical symptoms,
religious, sacrilegious or blasphemous thoughts, sexual thoughts (for example, of
being a paedophile or a homosexual), an urge to hoard useless or worn out
possessions, or thoughts of violence or aggression (for example, stabbing one’s
baby).
Compulsions are repetitive behaviours or mental acts that the person feels driven
to perform. A compulsion can either be overt and observable by others, or a covert
mental act that cannot be observed. Covert compulsions are generally more difficult
to resist or monitor than overt ones because they can be performed anywhere
without others knowing and are easier to perform. Common compulsions include
checking (for example, gas taps), cleaning, washing, repeating acts, mental
compulsions (for example, repeating special words or prayers in a set manner),
ordering, symmetry or exactness, hoarding/collecting and counting. The most
frequent presentations are checking and cleaning, and these are the most easily
recognised because they are on a continuum with everyday behaviour. Compulsion
is not in itself pleasurable, which differentiates it from impulsive acts such as
shopping or gambling, which are associated with immediate gratification.
POST-TRAUMATIC STRESS DISORDER
PTSD often develops in response to one or more traumatic events such as deliberate acts of interpersonal violence, severe accidents, disasters or military action.
Those at risk of PTSD include survivors of war and torture, of accidents and
disasters, and of violent crime (for example, physical and sexual assaults, sexual
abuse, bombings and riots), refugees, women who have experienced traumatic
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childbirth, people diagnosed with a life-threatening illness, and members of the
armed forces, police and other emergency personnel.
The most characteristic symptoms of PTSD are re-experiencing ones. People
with PTSD involuntarily re-experience aspects of the traumatic event in a vivid and
distressing way. Symptoms include flashbacks in which the person acts or feels as if
the event is recurring; nightmares; and repetitive and distressing intrusive images or
other sensory impressions from the event. Reminders of the traumatic event arouse
intense distress and/or physiological reactions. As a result, hypervigilance for threat,
exaggerated startle responses, irritability, difficulty in concentrating, sleep problems
and avoidance of trauma reminders are other core symptoms. However, people with
PTSD also have symptoms of emotional numbing. These include inability to have
any feelings, feeling detached from other people, giving up previously significant
activities and amnesia for significant parts of the event [2].
SOCIAL ANXIETY DISORDER
Social anxiety disorder, also referred to as social phobia, is characterised by an
intense fear in social situations that results in considerable distress and in turn, has
impacts on a person’s ability to function effectively in aspects of their daily life.
Central to the disorder is a fear of being judged by others and of being embarrassed
or humiliated. This leads to the avoidance of a number of social situations and often
impacts significantly on educational and vocational performance. The fears can be
triggered by the actual or imagined scrutiny from others. The disorder often begins
in early adolescence, and although an individual may recognise the problem as
outside of normal experience, many do not seek help.
Social anxiety disorder is characterised by a range of physical symptoms
including excessive blushing, sweating, trembling, palpitations and nausea. Panic
attacks are common, as is the development of depressive symptoms as the problem
becomes chronic. Alcohol or drug misuse can develop because people use these
substances in an attempt to cope with the disturbing and disabling symptoms. It is
also often comorbid with other disorders such as depression.
CLASSIFICATION OF MENTAL HEALTH DISORDERS
Classification of mental health disorders can be broken down into four distinct
groups. Affective Disorders that would be related to mental problems such as
anxiety, depression, mania, obsessional disorders. Schizophrenia can be
subcategorized into simple, hebephrenic, catatonic, and paranoid. Some of the
organic states are delirium and dementia. And lastly, disorders that are related to and
cause changes in a person's personality are abnormal personality, psychopathy,
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substance abuse such as drugs and alcohol, and lastly learning disorders of sub
normality [1].
The challenge often faced for diagnostics of mental health disorders is that the
diagnostics is largely clinical and experimental. The challenges about public health,
are to identify risk factors, increase awareness about mental disorders and
effectiveness of treatment, remove the stigma associated with receiving treatment,
eliminate health disparities, and improve access to mental health services for all
persons, particularly among populations that are disproportionately affected.
Here are various types of models of prevention, which happen to be one of the
most important steps in dealing with any issue [2]. Any mental health problems we
discussed earlier such as affective disorders, schizophrenia, organic states, and
personality disorders usually have some sort of a predisposition in a person which
due to genetic factors are more likely to activate these disorders. Such predispositions can be avoided earlier by properly educating people. Majority of the
disorders can be avoided before you present yourself with the circumstances that
provide the right conditions for your disorders to activate; there are three models of
prevention. “Moreover, since most of the preventive and promotional programs cater
to the local culture of the western world, it is not clear whether the strategies
currently in place would be effective across different countries and cultures”.
A good example of primary care would be “Among the most consistent correlates have been age, education, personal contact with PWAs, knowledge about HIV
transmission, and attitudes toward homosexuality. Younger and better-educated
respondents consistently manifest lower levels of AIDS stigma than older
respondents and those with lower levels of education”. In this case education about
the disease and viruses, its consequences and lethality warns people ultimately
driving them being careful in practicing safe sex. This is a fine example of primary
care system that causes disease prevention.
Secondary Health care is early diagnosis and then treatment, if there is any type
of early detecting, where there are specific signs of a particular disorder then one
must visit their doctor right away so that he may be able to get you in touch with the
right people in order to provide help and overcome the problems. Sometimes there
are medications and another time there are therapy sessions that help with secondary
care. However, basically specific treatment would be given in your case. Your
disease would be diagnosed at an early stage using warning signs. Lastly, we can
avert future negative consequences through counseling and treatment [1, 2].
Here is an example of tertiary care “Similarly, uninfected people who personally
know a PWA generally manifest less AIDS stigma than others. Attitudes toward
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PWAs tend to be more favorable and attitudes toward AIDS-related policies less
restrictive to the extent that respondents have more favorable attitudes toward gay
people and are knowledgeable about the lack of risk of HIV transmission through
casual social contact”. How sociable people react to a certain disorder, the stigma
related to it and how well a patient will be able to cope after their secondary care is
what tertiary care is all about. Tertiary care is about reducing disability,
rehabilitation of the patient such as counseling or social support from friends and
family. Lastly, there is the prevention of relapse so that the patient does not delve
back into the issues they once faced, there are organizations such as the Substance
Abuse Mental Health Services Administration (SAMHSA) or the National Institute
of Mental Health (NIMH) that help a patient cope with these issues in order to
overcome and rehabilitate back into society.
Thus we can conclude that throughout history, the stigma attached to epidemic
illnesses and social groups associated with them often hampered treatment and prevention, and inflicted additional suffering on sick individuals and their loved ones.
The sad fact of the matter was that many people live out their natural lives without
ever being diagnosed of their particular psychosis. The discussion about
epidemiology, etiology, symptoms, social and economical impact, and stigma of
specific mental health disorders such as schizophrenia, mood disorders, neurotic
disorders, obsessive-compulsive disorders, post-traumatic stress disorders, eating
disorders, and depression made it clear how the primary, secondary, and tertiary
healthcare systems tackle the issue of mental disorders.
REFERENCES
1. Medawar, Ch.: Power and dependence. Social audit on the safety of medicines.
Social Audit, Ltd, 1992.
2. Nathanson, L. A.: Illness and the faminine role: a theoretical review. Social
Science and Medicine, 1975, 9, 57–62.
ABSTRACT
The aim of the paper is to show the effect of the so called “cultural distance” on
mental health disorder. Organizational and functional model of health care system is
essential for prophylaxis in the case of mental health disorder. 1. Prophylaxis constitutes the basis of medical procedure in mental health disorders in our times. 2. Solution of the social and medical problems is the basis of organizational and functional
development of the primary care system.
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Some problems of mental health disorders
STRESZCZENIE
Celem pracy jest ukazanie wpływu tzw. dystansu kulturowego na rozwój
zaburzeń psychicznych. Organizacyjny i funkcjonalny model opieki zdrowotnej
stanowi istotę profilaktyki w zaburzeniach psychicznych. 1. Profilaktyka w naszych
czasach stanowi podstawę postępowania medycznego w zaburzeniach psychicznych.
2. Rozwiązywanie problemów natury socjomedycznej stanowi podstawę
organizacyjnego i funkcjonalnego rozwoju poz.
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