Diagnostic Classification of mental health disorders and discussion on the symptomatology of major psychiatric illnesses.

1. PRESENTATIONON “DIAGNOSTICS IN PSYCHIATRY”
Dr Bhakti Murkey
Consultant Psychiatrist (MD)

2. An overview…

3.  Like any growing branch of medicine, psychiatry has been
changing.Therefore the rapid changes in classification to
keep up growing research data dealing with epidemiology,
symptomatology, prognostic factors, treatment methods &
new theories for causation of psychiatric disorder.
 At present there are two major classification in psychiatry,
namely ICD 10 (1992) & DSMV (2013).

4.  This isWHO’s classification for all diseases & related health
problems.
 The chapter ‘F’ classifies psychiatric disorder as mental &
behavioral disorders & codes them on an alphanumeric
system from F00 to F99.
The Main Categories in ICD 10:

5. F00 – Dementia in Alzheimer’s disease
F01 – Vascular dementia
F04 – Organic amnestic syndrome
F05 – Delirium
F06 – Other mental disorders due to brain damage & dysfunction &
to physical disease
F07 – Personality & behavioral disorders due to brain disease,
damage & dysfunction

6. F10 – Mental & behavioral disorders due to use of alcohol
F11 - Mental & behavioral disorders due to use of opioids
F12 – Mental & behavioral disorders due to use of cannabinoids
F13 – Mental & behavioral disorders due to use of sedatives &
hypnotics
F14 – Mental & behavioral disorders due to use of cocaine
F16 – Mental & behavioral disorders due to use of hallucinogens

7. F20 – Schizophrenia
F20.0 – Paranoid Schizophrenia
F20.1 – Hebephrenic Schizophrenia
F20.2 – Catatonic Schizophrenia
F20.3 – Undifferentiated Schizophrenia
F20.4 – Post-schizophrenia depression
F20.5 – Residual Schizophrenia
F20.6 – Simple Schizophrenia
F21 – Schizotypal disorder
F22 – Persistent delusional disorder
F23 – Acute &Transient psychotic disorder
F24 – Induced Delusional disorder
F25 – Schizoaffective disorders

8. F30 – Manic episode
F31 – Bipolar affective disorder
F32 – Depressive episode
F33 – Recurrent depressive disorder
F34 – Persistent mood disorder

9. F40 – Phobic anxiety disorders
F41 – Other anxiety disorders
F42 – Obsessive – Compulsive disorder
F43 – Reaction severe stress & adjustment disorders
F44 – Dissociative (Conversion) disorders
F45 – Somatoform disorders

10. F50 – Eating Disorders
F51 – Non-organic sleep disorders
F52 – Sexual dysfunction

11. F60 – Specific personality disorders
F60.0 – Paranoid personality disorders
F60.1 – Schizoid personality disorders
F60.2 – Dissocial personality disorders
F60.3 – Emotionally unstable personality disorder
F60.4 – Histrionic personality disorders
F60.5 – Anankastic personality disorders
F60.6 – Anxious personality disorders
F60.7 – Dependent personality disorders
F61 – Mixed & other personality disorders
F62 – Enduring personality changes, not attributable to brain damage & disease
F63 – Habit & impulse disorders
F64 – Gender identity disorders
F65 – Disorders of sexual preference

12. F70 – Mild Mental Retardation
F71 – Moderate Mental Retardation
F72 – Severe Mental Retardation
F73 – Profound Mental Retardation

13. F80 – Specific developmental disorders of speech & language
F81 – Specific developmental disorders of scholastic skills
F82 – Specific developmental disorders of motor function
F83 – Mixed specific developmental disorders
F84 – Pervasive developmental disorders

14. F90 – Hyperkinetic disorders
F91 – Conduct disorders
F93 – Emotional disorders with onset specific to childhood
F94 – Disorders of social functioning with onset specific to
childhood & adolescence
F95 –Tic Disorders
F98 – Other behavioral & emotional disorders with onset
usually occurring in childhood & adolescence

15. Examining the patient from mental health perspective…

17.  MOST IMPORTANT DIAGNOSTICTOOL
 TO OBTAIN INFORMATIONTO MAKE ACCURATE
DIAGNOSIS
 IT ISTHE RECORD OF PATIENTS LIFE

18.  Chief complaints
 History of Present Illness
 Past History
 Personal History
 Medication History
 Family History
 Social History
 Pre-morbid personality

19.  The Mental Status Exam (MSE) is the psychological
equivalent of a physical exam that describes the mental
state and behaviors of the person being seen.
 It includes both objective observations of the clinician and
subjective descriptions given by the patient.

20.  The MSE provides information for diagnosis and assessment
of disorder and response to treatment.
 It provides a snap shot at a point in time
 If another provider sees your patient it allows them to
determine if the patients status has changed without
previously seeing the patient

21.  General Appearance
 Behavior
 Speech
 Mood
 Affect
 Thought process
 Thought content
 Cognition
 Insight/Judgment

22.  Built, posture, dress, grooming, prominent physical
abnormalities
 Level of alertness: Somnolent, alert
 Emotional facial expression
 Attitude toward the examiner: Cooperative, uncooperative

23.  Eye contact: ex. poor, good, piercing
 Psychomotor activity: ex. retardation or agitation i.e.. hand
wringing
 Movements: tremor, abnormal movements i.e.. sterotypes,
gait

24.  Rate: increased/pressured, decreased/monosyllabic, latency
 Rhythm: articulation, prosody, dysarthria, monotone, slurred
 Volume: loud, soft, mute
 Content: fluent, loquacious, paucity, impoverished

25.  The prevalent emotional state the patient tells you they feel
 Often placed in quotes since it is what the patient tells you
 Examples “Fantastic, elated, depressed, anxious, sad, angry,
irritable, good”

26.  The emotional state we observe
 Type: euthymic (normal mood), dysphoric (depressed,
irritable, angry), euphoric (elevated, elated) anxious
 Range: full (normal) vs. restricted, blunted or flat, labile
 Congruency: does it match the mood-(mood congruent vs.
mood incongruent)
 Stability: stable vs. labile

27.  Describes the rate of thoughts, how they flow and are
connected.
 Normal: tight, logical and linear, coherent and goal directed
 Abnormal: associations are not clear, organized, coherent.
Examples include circumstantial, tangential, loose, flight of
ideas, word salad, clanging, thought blocking.

28.  Circumstantial: provide unnecessary detail but eventually
get to the point
 Tangential: Move from thought to thought that relate in
some way but never get to the point
 Loose: Illogical shifting between unrelated topics

29.  Flight of ideas: Quickly moving from one idea to another- see
with mania
 Thought blocking: thoughts are interrupted
 Perseveration: Repetition of words, phrases or ideas
 Word Salad: Randomly spoken words

30.  Refers to the themes that occupy the patients thoughts and
perceptual disturbances
 Examples include preoccupations, illusions, ideas of
reference, hallucinations, derealization, depersonalization,
delusions

31.  Preoccupations: Suicidal or homicidal ideation (SI or HI),
perseverations, obsessions or compulsions
 Illusions: Misinterpretations of environment
 Ideas of Reference (IOR): Misinterpretation of incidents and
events in the outside world having direct personal reference
to the patient

32.  Hallucinations: False sensory perceptions. Can be auditory
(AH), visual (VH), tactile or olfactory
 Derealization: Feelings the outer environment feels unreal
 Depersonalization: Sensation of unreality concerning oneself
or parts of oneself

33.  Delusions: Fixed, false beliefs firmly held in spite of
contradictory evidence
 Control: outside forces are controlling actions
 Erotomanic: a person, usually of higher status, is in love with the
patient
 Grandiose: inflated sense of self-worth, power or wealth
 Somatic: patient has a physical defect
 Reference: unrelated events apply to them
 Persecutory: others are trying to cause harm

34.  Level of consciousness
 Attention and concentration: the ability to focus, sustain and
appropriately shift mental attention
 Memory: immediate, short and long term
 Abstraction: proverb interpretation
 Mini-Mental State Exam

35.  Insight: awareness of one’s own illness and/or situation
 Judgment: the ability to anticipate the consequences of
one’s behavior and make decisions to safeguard your well
being and that of others

37.  The term schizophrenia was given by Eugene Bleuler.
 Splitting of mind.
 Characterized by fundamental distortions of thinking and
perception, and affect that is inappropriate or blunted.
 Clear consciousness and intellectual capacity are usually
maintained
 Certain cognitive deficits may evolve in the course of time.

38.  The exact etiology and pathogenesis of Schizophrenia is not
known.
 It is accepted that schizophrenia is multifactorial in origin.
 Internal factors - genetic, inborn, biochemical
 External factors - trauma, infection of CNS, stress
 Dopamine hypothesis - Psychotic symptoms are related to
dopaminergic hyperactivity in the brain.

39.  Lifetime prevalence: 0.5 – 1.0%
 DSM-5: 0.3 - 0.7%
 Average age of onset:
 Males: teens to mid-20’s
 Females: early to late 20’s
 Range: Early childhood to 50’s/60’s
 Male slightly > female

40. Social/Occupational Dysfunction
• Work
• Interpersonal relationships
• Self-care
Positive Symptoms
• Delusions
• Hallucinations
• Disorganization
• Catatonia
Negative Symptoms
• Affective flattening
• Anhedonia
• Alogia
• Avolition
• Social withdrawal
Cognitive Deficits
• Attention
• Memory
• Executive functions
(eg, abstraction)
Comorbid
Substance Abuse
Mood Symptoms
• Depression
• Hopelessness
• Suicidality
• Anxiety
• Agitation
Loss of insight
(anosognosia)

41. A. Two (or more) of the following, each present for a significant portion of
time during a 1-month period (or less if successfully treated). At least
one of these must be 1, 2, or 3.
1) Delusions
2) Hallucinations
3) Disorganized speech (freq. derailment or incoherence)
4) Grossly disorganized or catatonic behavior
5) Negative symptoms (i.e., diminished emotional expression or
avolition

42. A.
B. Social/occupational dysfunction
C. Duration: Continuous signs for at least 6 months (psychosis +
prodrome + residual sx)
D. Schizoaffective and psychotic mood disorder have been
excluded
E. Not attributable to substance or general medical condition
F. Not a manifestation of a pervasive developmental disorder

43. F20 Schizophrenia
F20.0 Paranoid schizophrenia
F20.1 Hebephrenic schizophrenia
F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
F20.4 Post-schizophrenic depression
F20.5 Residual schizophrenia
F20.6 Simple schizophrenia
F20.8 Other schizophrenia
F20.9 Schizophrenia, unspecified

44. F21 Schizotypal disorder
F22 Persistent delusional disorders
F22.0 Delusional disorder
F22.8 Other persistent delusional disorders
F22.9 Persistent delusional disorder, unspecified
F23 Acute and transient psychotic disorders
F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia
F23.2 Acute schizophrenia-like psychotic disorder
F23.3 Other acute predominantly delusional psychotic disorders

45. F24 Induced delusional disorder
F25 Schizoaffective disorders
F25.0 Schizoaffective disorder, manic type
F25.1 Schizoaffective disorder, depressive type
F25.2 Schizoaffective disorder, mixed type
F25.8 Other schizoaffective disorders
F25.9 Schizoaffective disorder, unspecified
F28 Other nonorganic psychotic disorders
F29 Unspecified nonorganic psychosis

46.  Paranoid
 Catatonic
 Hebephrenic
 Undifferentiated
 Residual
 Simple

47.  The acute psychotic schizophrenic patients will respond usually to
antipsychotic medication.
 According to current consensus we use in the first line therapy the newer
atypical antipsychotics
conventional
antipsychotics
(classical
neuroleptics)
chlorpromazine, chlorprotixene, clopenthixole,
levopromazine, periciazine, thioridazine
droperidole, flupentixol, fluphenazine, haloperidol,
penfluridol, perphenazine, pimozide,
prochlorperazine, trifluoperazine
atypical
antipsychotics
amisulpiride, clozapine, olanzapine, quetiapine,
risperidone

48.  Psychotherapy is not the treatment of choice for someone
with schizophrenia
 Used as an adjunct to a good medication plan, however ,
psychotherapy can help maintain the individual on their
medication, learn needed social skills, and support the
person’s weekly goals and activities in their community.

49.  This may include:
 Advice, reassurance
 Education
 Modeling
 Limit setting
 Reality testing with the therapist
 Encouragement in setting small goals and reaching them can
often be helpful

50.  Group therapy: can be especially helpful in decreasing social
isolation and increasing reality testing.
 It focuses on real – life plans, problems , and relationship; on
social and work roles and interaction
 Family therapy: encourages the family to convene a family
meeting whenever an issue arises.

51.  A 21 year engineering student is brought to the emergency room by his
room mate for not leaving his dormitory room for 2 weeks.
 The roommate reports that the patient has not left his dormitory room
for 2 weeks and his room is in disarray. He describes the patient as being
“normal” until about 3-4 months ago.
 He states that he noticed that the patient stopped going to social
activities and spent most of his time in his room.
 He also states that the patient sometimes makes odd comments.

52.  He has stopped going to his classes and his grades have been declining.
 He also states that for about a week the patient has stopped eating and
drinks only canned beverages and insists on keeping the shades down on
the windows and has said that he is worried that someone is watching him.
 The patient denies using alcohol or any illicit drugs. His temp is 37° F, pulse
is 92/min, and blood pressure is 140/80 mm Hg.
 On mental status exam he appears distracted and repeated stops
answering your question in mid sentence. He describes hearing two voices
that are telling him to stop eating. He is oriented to place, person and time.

54.  Characterized by disturbances in feelings, thinking, and behaviour that
tend to occur on a continuum, ranging from severe depression to severe
mania (hyperactivity).
 Is the most common psychiatric diagnoses associated with suicide.
 Two Categories:
a. Major Depressive Disorder
b. Bipolar Disorder (Manic-Depressive Illness)

55. International Classification of Diseases (ICD-10)
F30 Manic episode
F31 Bipolar affective disorder
F32 Depressive episode
F33 Recurrent depressive disorder
F34 Persistent mood (affective) disorders
F38 Other mood (affective) disorders
F39 Unspecified mood (affective) disorder

56.  Twice as common in women than men.
 Has 1.5 to 3 times greater incidence in first-degree relatives
than in the general population.
 Its incidence decreases with age in women and increases
with age in men; single and divorced people have the highest
incidence.

57.  Characterized by at least two weeks of a depressed mood or loss of interest
in pleasure and activities
 Also includes at least 4 of the following symptoms of depression:
a. Increase or decrease in appetite
b. Increase or decrease in sleep
c. Psychomotor agitation or retardation
d. Feelings of worthlessness or guilt
e. Fatigue and loss of energy
f. Decreased ability to think and concentrate
g. Recurrent thoughts of suicide
 These symptoms must be present everyday for 2 weeks and result in
significant distress or impair important areas of functioning.
 Referred to as PSYCHOTIC DEPRESSION if combined with delusions and
hallucinations.

58.  Diagnosed when a person’s mood cycles between extremes of mania and
depression.
 Mania – an emotional state characterized by elation, high optimism, increased
energy, and an exaggerated sense of importance and invincibility.
 May last for about 1 week but may be longer for some individuals.
 At least 3 of the following symptoms accompany the manic episode:
a. Inflated self-esteem or grandiosity
b. Decreased need for sleep
c. Pressured speech
d. Flight of ideas
e. Distractibility
f. Increased involvement in goal-directed activity or psychomotor agitation
g. Excessive involvement in pleasure-seeking activities with a high-potential for painful
consequences

59.  HYPOMANIA – a period of abnormally and persistently elevated,
expansive, or irritable mood lasting for days and including 3 or 4 of the
additional symptoms described earlier.
 MIXED EPISODE
 BIPOLAR I DISORDER – one or more manic or mixed episodes usually
accompanied by major depressive episodes.
 BIPOLAR II DISORDER – one or more major depressive episodes
accompanied by at least one hypomanic episode.

60. Onset and Clinical Course
 An untreated episode of depression can last 6 to 24 months before
remitting.
 50% to 60% of people who have one episode of depression will have
another.
 After a second episode, there is 70% chance of recurrence.
Treatment and Prognosis
 Psychopharmacology (TCAs, MAOIs, SSRIs,Atypical Antidepressants)

61.  Psychotherapy
- InterpersonalTherapy: focuses on difficulties in relationships, such as
grief reactions, role disputes, and role transitions.
- BehaviorTherapy: seeks to increase the frequency of the client’s
positively reinforcing interactions with the environment and to decrease
negative interactions.
- CognitiveTherapy: focuses on how the person thinks.

62.  Onset and Clinical Course
- Occurs in the early twenties or in adolescence; or in ages older than 50.
- Manic episodes typically begin suddenly, with rapid escalation of
symptoms over a few days, and last from a few weeks to several
months.
- They tend to be briefer and to end more suddenly than depressive
episodes.

63. Treatment: Psychopharmacology
 Mood stabilizers:
 lithium (0.6—1.2 mEq/L)
 carbamazepine (6—12 mg/L)
 valproate (50—125 mg/L)
 Anticonvulsants:
 gabapentine
 topiramate
 lamotrigine
 Agitated or psychotic patient – co-administration
 antipsychotics of second generation (olanzapine, risperidone)
 benzodiazepines (lorazepam, clonazepam)
 ECT

64. Treatment: Psychotherapy
 Useful in the mildly depressive or normal portion of the bipolar cycle. It is
not useful during acute manic stages because the person’s attention span
is brief and he or she can gain little insight during times of accelerated
psychomotor activity.

65.  A 34 years married housewife studied up to B.A. Having 2 children came
with her husband with
 c/o low mood since 6 months
 loss of interest in daily work since 3 months
 Low energy since 3 months
 Decreased sleep since 2 months
 On MSE her PMA was decreased and her Affect was sad, restricted
 Her thoughts revealed hopelessness and ideas of self harm and guilt

66.  A 24 years old unmarried man, studying B.Com.Was brought to the OPD
by his parents with
 c/o increased talking and big talk since 1 month
 Loss of sleep since 1 month
 Increased religiosity since 2 weeks
 Over-familiarity since 2 weeks
 On MSE his PMA was increased andAffect was elated
 Speech was spontaneous, pressured and loud
 His thoughts revealed flight of ideas and delusion of grandiosity

67. A growing concern...

68. 1. ALCOHOL
2. AMPHETAMINESOR SIMILAR ACTING AGENTS
3. CAFFEINE
4. CANNABIS
5. COCAINE
6. HALLUCINOGENS
7. INHALANTS
8. NICOTINE
9. OPIOIDS
10. PHENCYCLIDINE (PCP)
11. GROUP INCLUDING SEDATIVES , HYPNOTICS , &ANXIOLYTICS.

69.  EPIDEMIOLOGY : -
1)Widely prevalent in Indian society.
2) One of the M/C PSYCHIATRIC DISORDERS observed in India & Western
world.
3) AUDs in US contributes to 20 lac injuries / year including 22,000 deaths /
year.
4) About 2 lac deaths / year are directly related to alcohol abuse.
5) Alcohol abuse can produce serious mental psychological symptoms
including - DEPRESSION ,ANXIETY & PSYCHOSIS.

70.  Social factors
 Religious and cultural factors
 Psychological factors
 Genetic factors - More that 50% of today’s alcoholics are the
children of alcoholics.
 Childhood history – ADHD , CONDUCT DISORDER.

71.  A need for daily use of a large amounts of alcohol for adequate
functioning , regular pattern of heavy drinking limited to weekends and
long periods of sobriety interspersed with binges of heavy alcohol intake
lasting for weeks or months strongly suggest Alcohol dependence.
 TREATMENT OF ALCOHOL DEPENDENCE -
1. Disulfiram – inhibits aldehyde dehydrogenase.
2. Naltrexone – pure opioid antagonist.
3. Acamprosate – affects GLUTAMATE & GABA NT systems.

72.  MEDICAL COMPLICATIONS
 SOCIAL COMPLICATIONS OF ALCOHOL DEPENDENCE
1) Accidents
2) Marital conflicts and divorce
3) Occupational problems , with loss productive man-hours
4) Increased incidence of drug dependence
5) Criminality
6) Financial difficulties

73.  DSM 5 Diagnostic Criteria –
A) Cessation or reduced use of alcohol that has been heavy and prolonged.
B) 2 or more of the following , developing within several hours to a few
days after cessation of or reduction in alcohol use –
 Autonomic hyperactivity (Ex. Sweating , tachycardia).
 Increased hand tremors.
 Insomnia
 Nausea and vomiting
 Transient visual, tactile or auditory hallucinations or illusions.
 Psychomotor agitation.
 Anxiety.
 GTCS.

74. CLASSIC SIGNS OF ALCOHOL WITHDRAWAL :
1)Tremors (commonly called shakes or jitters) develops 6 – 8 hours after
cessation of drinking.
2) Psychotic and perceptual symptoms begin in 8 - 12 hours after cessation
of alcohol.
3) Seizures develop in 12 – 24 hours after cessation of alcohol.
4) DT ( delirium tremens) occur anytime during first 72 hours after cessation
of alcohol , although physicians should watch for development of DTs for
1st week of withdrawal.

75.  Benzodiazepines
 Carbamazepine
 Beta blockers and Clonidine

76. 1) Counseling of patient
2) Counseling of family.
3) MEDICATIONS – Disulfiram , Naltrexone and Acamprosate.
4) AA (Alcoholics Anonymous) .

77.  Self help groups.
 Members of AA have help available 24 hours a day , a/w sober peer
group, learnt that it is possible to participate in social functions
without drinking & are given a model of “RECOVERY” by observing
accomplishments of sober members of the group.
 Includes inpatient or outpatient rehabilitation.
 Patients with coexisting Psychiatric disorders may need some
additional education about AA.
 Most studies indicate that participation in AA is a/w improved
outcomes , and incorporation into treatment programs saves the
money.

78. The smaller section of diagnoses

79.  Organic mental disorders
 Neurotic/ stress related and somatoform disorders
 Disorders of eating/ sleep/ sexual function
 Disorders of Adult Personality and behaviour
 Child psychiatric disorders

80. Current problems...

81.  Specific and significant impairment in development of reading skills, not solely
accounted for by mental age, visual acuity problems, or inadequate schooling.
 Reading comprehension skill, reading word recognition, oral reading skill, and
performance of tasks requiring reading may all be affected.
 Unexpected in relation to other cognitive abilities and the provision of effective
classroom instruction.
 Lifetime prevalence of LD is 9.7%
 Affecting at least 90% of all individuals identified as having LD
 Affects more boys than girls (3-4 males to every female)

82.  Early onset disorders
 Delay and deviance in the development of social and communicative skills.
 Unusual sensitivity to the inanimate environment is typical.
 Qualitative abnormalities in reciprocal social interactions and patterns of
communication, and by restricted, stereotyped, repetitive repertoire of
interests and activities.
 Pervasive feature of the individual‘s functioning in all situations
 It includes autistic disorder, Rett's syndrome, childhood disintegrative
disorder, Asperger's syndrome, and pervasive developmental disorder NOS
(atypical autism)

83.  Childhood autism :
 Abnormal functioning in areas of social interaction, communication and
restricted, repetitive behaviour, manifest before the age of 3 years
 Occurs in boys 3-4 times more often than in girls
 It is reasonable to say that approximately 1 in every 800 to 1,000 children
may have autism, with a larger number (1 in 150) exhibiting some
features of the condition
 Studies conducted over the years have found a prevalence rate
progressing with time from 4.5 to 16.8%

84.  Asperger’s Syndrome :
 Is a disorder of qualitative abnormalities of reciprocal social interaction
that typify autism, together with a restricted, stereotyped, repetitive
repertoire of interests and activities
 The disorder differs from autism primarily in that there is no general
delay or retardation in language or in cognitive development
 A recent review suggested a prevalence rate of 1 to 2 in 10,000
 There is little doubt that the condition is more prevalent in males than in
females, with a reported ratio of 9 to 1

85.  Most common childhood behavioral disorder in OPD settings
 Developmentally inappropriate and impairing levels of gross motor
overactivity, inattention and impulsivity.
 Onset before age 7 years
 18-item symptom list of which 6 of 9 inattention or 6 of 9
hyperactive/impulsive symptoms have persisted for at least 6 months to a
degree that is maladaptive and inconsistent with developmental level
 Impairment in two or more settings
 It has a pooled estimate of worldwide prevalence is 5.29%

86.  Oppositional defiant disorder and conduct disorder are grouped as the
disruptive behavior disorders
 Recurrent pattern of negativistic, defiant, disobedient and hostile behavior
toward authority figures that is clearly more frequent, more intense and
more persistent across the child's development than is typically observed in
individuals of similar age and developmental level and in the absence of more
severe dissocial or aggressive acts that violate the law or the rights of others.
 Characteristically seen in children below the age of 9 or 10 years
 Requires symptoms to be present for at least 6 months and cause impairment
in the child's social, academic or occupational functioning
 Prevalence varies between 4.5 to 15.4% in males and 1.5 to 15.6% in females

87.  Conduct disorder comprises of a repetitive and persistent pattern of
behavior in which the basic rights of others or major age-appropriate
societal norms or rules are repeatedly violated beginning in childhood or
adolescence and is more severe than ordinary childish mischief or
adolescent rebelliousness
 Four main groupings:Aggressive behaviors that cause harm to or
threaten harm to others, nonaggressive property destruction, covert
aggressive behaviors of deceitfulness or theft and rule violations
 Prevalence between 2 and 16% for boys and 1.5 and 15.8% for girls
 For adults older than 18 years the estimated lifetime prevalence of
conduct disorder is 9.5%, including 12% for males and 7.1% for females

88. What we need to know...

89. - How you think, feel, and act in order to face life’s
situations…
- For example, how you handle stress.
- How you look at yourself, your life and the people in your
life…
- For example, how you relate to others.
- How you evaluate your options and make choices…
- For example, how you make decisions.

90.  Thinking is the cognitive component of mental health.
 It’s important to recognize your thoughts.
 It’s important how you respond to your thoughts.
 Thoughts produce feelings in us.

91.  Feeling is the emotional / sensory component of mental
health.
 Thoughts produce feelings.
 It’s important to recognize your feelings.
 For example, “I am angry and upset!”
 It’s important to understand where these feelings are
coming from.
 ie: your thought processes and how you interpret what’s happened.
 It’s important how you respond to your feelings.
 “I feel this way so it’s right to feel this way.”
 Ask yourself questions such as: “Is this a legitimate feeling that is
appropriate for the situation?”

92.  Action is the behavioral component of mental health.
 Thoughts and feelings result in actions.
 Actions can be unhealthy.
– For example, you could pick up the phone and yell at your friend and
damage the relationship.
– For example, you could go out for a smoke or take a drink and hide
away in your room.
 Actions can be healthy.
– For example, you could talk over your thoughts and feelings with your
friend or with someone else who could help.

93.  Since you were a young child, you realized that your
behavior had consequences.
 You touched a hot stove and were burned.
 You disobeyed a rule and were disciplined.
 It’s important to also realize that there are
consequences to the way we think and feel.

94. A few reasons…

95.  It affects your relationships with others:
– Mental health problems lead to new problems with friends, family, law
enforcement or school officials
 It affects how you learn:
– Your attentiveness,
– Your concentration,
– Your classroom conduct,
– Your ability to organize,
– Your ability to communicate.

96. ▪ Mental health problems can lead to other problems such
as:
– Experimenting with drugs or alcohol,
– Being sexually promiscuous,
– Being hostile and aggressive,
– Taking risks in behavior.

97. – Eat healthily.
– Exercise adequately.
– Care for your health daily.
– Take time for yourself regularly.
– Sleep bountifully.
– Manage stress diligently.

98.  Play
▪ Learn to do something new and fun
 Know yourself
▪ Be attuned to your thoughts and feelings.
▪ Keep a journal.
▪ Recognize when “this just doesn’t seem like I usually think or act”.
 Say “no” sometimes. Don’t overbook your schedule or
your life.
▪ Make time for quiet
▪ Turn off the cell phone,TV…

99. – Recognize warning signs in
▪ How you think,
▪ How you feel,
▪ How you act.
– Practice stress management and self care
– Know when and where to get help.
▪ Get help as soon as you suspect you need it.
▪ Get help from a trained counselor or through a medical referral.