etiology of mental disorders

ETIOLOGY OF ETIOLOGY OF MENTAL MENTAL

DISORDERSDISORDERS

SONNY T. LISALSONNY T. LISAL

Historical Historical PerspectivePerspective

Perceived CausesPerceived Causeso movements of sun or moonmovements of sun or moono lunacy--full moonlunacy--full moono evil spiritsevil spirits

Ancient TreatmentsAncient Treatmentso exorcism, caged like animals, exorcism, caged like animals,

beaten, burned, castrated, beaten, burned, castrated, mutilated, blood replaced with mutilated, blood replaced with animal’s bloodanimal’s blood

Medical ModelMedical Model concept that diseases have physical concept that diseases have physical

causescauses can be diagnosed, treated, and in most can be diagnosed, treated, and in most

cases, curedcases, cured assumes that these “mental” illnesses assumes that these “mental” illnesses

can be diagnosed on the basis of their can be diagnosed on the basis of their symptoms and cured through therapy, symptoms and cured through therapy, which may include treatment in a which may include treatment in a psychiatric hospitalpsychiatric hospital

1.1. Somatic factors:Somatic factors:• Neuro-anatomyNeuro-anatomy• Neuro-physiologyNeuro-physiology• Neuro-chemistryNeuro-chemistry• Level of development & maturityLevel of development & maturity• Pre & perinatal factorsPre & perinatal factors

2.2. Psychologic factorsPsychologic factors• Child-mother interactionChild-mother interaction• The role of fatherThe role of father• Sibling rivalrySibling rivalry• IntelligenceIntelligence• Interaction within the family, correlation to Interaction within the family, correlation to

occupation, tipe of play & societyoccupation, tipe of play & society• Loss Loss anxiety, depression, self accusation & guilt anxiety, depression, self accusation & guilt• Early concept: self identityEarly concept: self identity• Skill, talents & creativitySkill, talents & creativity• Adaptation pattern & defense mechanismAdaptation pattern & defense mechanism• Level of emotional developmentLevel of emotional development

3.3. Socio-cultural FactorsSocio-cultural Factors• Stability within the familyStability within the family• Nurturing PatternNurturing Pattern• Level of economyLevel of economy• Housing: Urban >< suburb/villageHousing: Urban >< suburb/village• Minority issueMinority issue• Race & Religion influenceRace & Religion influence• Cultural issueCultural issue

Bio-Psycho-Social Bio-Psycho-Social PerspectivePerspective

Assumes that biological, Assumes that biological, sociocultural, and sociocultural, and psychological factors combine psychological factors combine and interact to produce and interact to produce psychological disorderspsychological disorders

Bio-Psycho-Social Bio-Psycho-Social PerspectivePerspective

CLASSIFICTION CLASSIFICTION OF MENTAL OF MENTAL DISORDERSDISORDERS

SONNY T. LISALSONNY T. LISAL

Psychological DisordersPsychological Disorders

a “harmful dysfunction” in which a “harmful dysfunction” in which behavior is judged to be:behavior is judged to be:

atypical--not enough in itselfatypical--not enough in itself disturbing--varies with time and disturbing--varies with time and

cultureculture maladaptive—harmfulmaladaptive—harmful unjustifiable--sometimes there’s unjustifiable--sometimes there’s

a good reasona good reason

Systems of classification for Systems of classification for psychiatric psychiatric

diagnoses have several purposesdiagnoses have several purposes::

1.1. to distinguish one psychiatric to distinguish one psychiatric diagnosis from another, so that diagnosis from another, so that clinicians can offer the most clinicians can offer the most effective treatment effective treatment

2.2. to provide a common language to provide a common language among health care professionals among health care professionals

3.3. to explore the still unknown causes to explore the still unknown causes of many mental disorders of many mental disorders

TTwo most important psychiatric classificationswo most important psychiatric classifications::

1.1. DSM-IVDSM-IV the Diagnostic and Statistical Manual of Mental the Diagnostic and Statistical Manual of Mental

Disorders (DSM) developed by the American Disorders (DSM) developed by the American Psychiatric Association in collaboration with other Psychiatric Association in collaboration with other groups of mental health professionalsgroups of mental health professionals

a widely used system for classifying a widely used system for classifying psychological disorderspsychological disorders

presently distributed as DSM-IV-TR (text presently distributed as DSM-IV-TR (text revision)revision)

In Progress: DSM-V (Issues: Internet addiction)In Progress: DSM-V (Issues: Internet addiction)

2.2. International Classification of Diseases (ICD), International Classification of Diseases (ICD), developed by the World Health Organization developed by the World Health Organization

ICD-10/PPDGJ IIIICD-10/PPDGJ III ICD-10 ICD-10 uses alpha-numeric code, 1 uses alpha-numeric code, 1

alphabet and 2 numbers alphabet and 2 numbers 3 3 characterscharacters(A00-Z99)(A00-Z99). For Mental . For Mental Disorders (Disorders (FF.00-F99.00-F99))

Term “Term “Disorder” Disorder” is used for all is used for all classificationclassification,, and not the term and not the term disease disease and illnesand illnesss

DisorderDisorder is used to describe a cluster is used to describe a cluster of sings & symptomsof sings & symptoms or behaviors that or behaviors that could be found clinically with could be found clinically with distressdistress for most of the casesfor most of the cases and could also and could also cause impairment of functioningcause impairment of functioning

TermsTerms impairment: impairment: a loss or an abnormality of a loss or an abnormality of

a structure or functiona structure or function psychological psychological manifestation of mental function manifestation of mental function (memory)(memory)

DDisability: isability: limitation or decrease of limitation or decrease of abilityability to perform normal daily life to perform normal daily life activitiesactivities (bathing, eating, drinking)(bathing, eating, drinking)

handycap: handycap: disadvantage that limit the disadvantage that limit the role of somebody to function normallyrole of somebody to function normally

Dichotomy Dichotomy neurotineuroticc – ps – psychychotioticc is not is not used anymoreused anymore, , instead disorders are instead disorders are grouping according to clinical grouping according to clinical featuresfeatures

Psychotic is a descriptive termPsychotic is a descriptive term,, not not involving psychodynamic formulationinvolving psychodynamic formulation, , point out only hallucinations, point out only hallucinations, delusions, and certain behaviors delusions, and certain behaviors including ecstasy, overactivities, including ecstasy, overactivities, severe motor retardation and catatoniasevere motor retardation and catatonia

All organic origin disorders are All organic origin disorders are grouped into one section (grouped into one section (F00-F09F00-F09)), , and substance related disorders in one and substance related disorders in one section(section(F10-F19F10-F19))

More than one diagnosis can be More than one diagnosis can be concluded, main diagnosis followed by concluded, main diagnosis followed by concomitant diagnosisconcomitant diagnosis

Psychiatric DisordersPsychiatric Disorders

Neurotic Disorder (term seldom Neurotic Disorder (term seldom used now)used now) usually distressing but that allows usually distressing but that allows

one to think rationally and function one to think rationally and function sociallysocially

Psychotic DisorderPsychotic Disorder person loses contact with realityperson loses contact with reality experiences irrational ideas and experiences irrational ideas and

distorted perceptionsdistorted perceptions

Anxiety Anxiety DisordersDisorders

Anxiety DisordersAnxiety Disorders distressing, persistent anxiety or distressing, persistent anxiety or

maladaptive behaviors that reduce maladaptive behaviors that reduce anxietyanxiety

Generalized Anxiety DisorderGeneralized Anxiety Disorder person is tense, apprehensive, and person is tense, apprehensive, and

in a state of autonomic nervous in a state of autonomic nervous system arousalsystem arousal


Panic DisorderPanic Disorder marked by a minutes-long episode marked by a minutes-long episode

of intense dread in which a person of intense dread in which a person experiences terror and experiences terror and accompanying chest pain, accompanying chest pain, choking, or other frightening choking, or other frightening sensationsensation


PhobiaPhobia persistent, irrational fear of a specific persistent, irrational fear of a specific

object or situationobject or situation Obsessive-Compulsive DisorderObsessive-Compulsive Disorder

unwanted repetitive thoughts unwanted repetitive thoughts (obsessions) and/or actions (obsessions) and/or actions (compulsions)(compulsions)


Common and uncommon fearsCommon and uncommon fears


PET Scan of brain PET Scan of brain of person with of person with Obsessive/ Obsessive/ Compulsive Compulsive disorderdisorder

High metabolic High metabolic activity (red) in activity (red) in frontal lobe areas frontal lobe areas involved with involved with directing attentiondirecting attention

Mood DisordersMood Disorders

Mood DisordersMood Disorders characterized by emotional characterized by emotional

extremesextremes Major Depressive Disorder Major Depressive Disorder

a mood disorder in which a person, a mood disorder in which a person, for no apparent reason, experiences for no apparent reason, experiences two or more weeks of depressed two or more weeks of depressed moods, feelings of worthlessness, moods, feelings of worthlessness, and diminished interest or pleasure and diminished interest or pleasure in most activitiesin most activities

Mood DisordersMood Disorders Manic EpisodeManic Episode

a mood disorder marked by a a mood disorder marked by a hyperactive, wildly optimistic state, hyperactive, wildly optimistic state, flight of ideasflight of ideas

Bipolar DisorderBipolar Disorder a mood disorder in which the person a mood disorder in which the person

alternates between the hopelessness alternates between the hopelessness and lethargy of depression and the and lethargy of depression and the overexcited state of maniaoverexcited state of mania

formerly called manic-depressive formerly called manic-depressive disorder disorder

Mood Disorders-Mood Disorders-DepressionDepression


Canadian depression rates

Mood Disorders- Mood Disorders- SuicideSuicide

Mood Disorders-Mood Disorders-BipolarBipolar

PET scans show that brain energy PET scans show that brain energy consumption rises and falls with consumption rises and falls with emotional switchesemotional switches

Depressed state Manic state Depressed state


Altering any Altering any one one component of component of the chemistry-the chemistry-cognition-cognition-mood circuit mood circuit can alter the can alter the othersothers


The The vicious vicious cycle of cycle of depressiodepression can be n can be broken at broken at any pointany point

Dissociative Dissociative DisordersDisorders

Dissociative DisordersDissociative Disorders conscious awareness becomes separated conscious awareness becomes separated

(dissociated) from previous memories, (dissociated) from previous memories, thoughts, and feelingsthoughts, and feelings

Dissociative Identity DisorderDissociative Identity Disorder rare dissociative disorder in which a rare dissociative disorder in which a

person exhibits two or more distinct and person exhibits two or more distinct and alternating personalitiesalternating personalities

formerly called multiple personality formerly called multiple personality disorderdisorder

SchizophreniaSchizophrenia

SchizophreniaSchizophrenia literal translation “split mind”literal translation “split mind” a group of severe disorders a group of severe disorders

characterized by:characterized by: disorganized and delusional thinkingdisorganized and delusional thinking disturbed perceptionsdisturbed perceptions inappropriate emotions and actionsinappropriate emotions and actions

SchizophreniaSchizophrenia DelusionsDelusions

false beliefs, often of persecution false beliefs, often of persecution or grandeur, that may accompany or grandeur, that may accompany psychotic disorders, “ bizarre”psychotic disorders, “ bizarre”

HallucinationsHallucinations sensory experiences without sensory experiences without

sensory stimulationsensory stimulation

SchizophreniaSchizophrenia

Personality Personality DisordersDisorders

Personality DisordersPersonality Disorders disorders characterized by disorders characterized by

inflexible and enduring behavior inflexible and enduring behavior patterns that impair social patterns that impair social functioningfunctioning

usually without anxiety, usually without anxiety, depression, or delusionsdepression, or delusions


Antisocial Personality DisorderAntisocial Personality Disorder disorder in which the person disorder in which the person

(usually man) exhibits a lack of (usually man) exhibits a lack of conscience for wrongdoing, even conscience for wrongdoing, even toward friends and family toward friends and family membersmembers

may be aggressive and ruthless or may be aggressive and ruthless or a clever con artista clever con artist


PET scans illustrate reduced activation in PET scans illustrate reduced activation in a murderer’s frontal cortexa murderer’s frontal cortex

Normal Murderer

Rates of Rates of Psychological Psychological

DisordersDisorders

ICD-10ICD-10 F00 – F09F00 – F09

Organic, including symptomatic, mental disordersOrganic, including symptomatic, mental disorders F10 – F11F10 – F11

Mental and behavioral disorders due to psychoactivc substance useMental and behavioral disorders due to psychoactivc substance use F20 – F 29F20 – F 29

Schizophrenia and schizotypal and delusional disordersSchizophrenia and schizotypal and delusional disorders F30 – F 39F30 – F 39

Mood (affective) disordersMood (affective) disorders F40 – F48F40 – F48

Neurotic stress-related and somatoform disordersNeurotic stress-related and somatoform disorders F50 – F59F50 – F59

Behavioral syndromes associated with physiological disturbances Behavioral syndromes associated with physiological disturbances and physical factorsand physical factors

F60 – F69F60 – F69Disorders of adult personality and behaviorDisorders of adult personality and behavior

F70 – F79F70 – F79Mental retardationMental retardation

F80 – F89F80 – F89Disorders of psychological developmentDisorders of psychological development

F90 – F 99F90 – F 99Behavioral and emotional disorders with onset usually occurring in Behavioral and emotional disorders with onset usually occurring in childhood and adolescencechildhood and adolescence

etiology of mental disorders

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