Mentally ill

1. Psychiatry for 3th year BSc. Midwifery students
By Takele T.(MSc. In clinical and community mental
health, assist professor )
3/30/2023

2. Learning objectives
At the end of this session the student will able
to:
 discuss about abnormal behavior
 Define mental health
 define mental illness
 identify cause of mental illness
 classify psychiatric disorders using DSM-V
TR
 Understand Psychopathologies
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3. Brainstorming
1. What is abnormal behavior?
2. Who is mentally ill?
3. Is mental illness curable?
4. What do think cause of mental
illness?
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4. Normal vs Abnormal behavior
 Abnormality is being outside the
parameters of what is accepted in our
society.
 Societies are fluid and constantly changing.
 How an individual behaves within a group is
defined by the constraints of the society.
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5. Defining Abnormal Behavior
• Rules and norms govern what are deemed to be normal
parameters.
• When an individual lives within a group, the definition of
normal behavior is usually classified by a consensus of
what is considered to be normal for that group.
• Occasionally, certain groups of people can push the
boundaries but even this has limitations.
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6. Defining Abnormal Behavior
 There is a norm that govern behaviour at
d/t age categories but not written.
 Behavior would be governed by rules of
what is considered age-appropriate behavior
and anyone acting outside these boundaries
would probably be classified as behaving in
an abnormal way.
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7. WHAT IS HEALTH?
 Health is a state of complete physical, mental and
social wellbeing and not merely the absence of
disease or infirmity (WHO, 1948)
 Mental health: is a state of well-being in which an
individual can realize his/her own abilities, interact
positively with others, cope with the stressors of
life and study, work productively and fruitfully,
and contribute to his/her family and community.
(WHO)
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8. Mentally healthy person shows growth and
maturity in three areas:
 Cognitive,
 Emotional, and
Social processes.
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9. A mind is a terrible thing to waste...and there is no health
without mental health!!!
Mental illness: is a state of disturbance in which an
individual
can not realize his/her own abilities,
 interact negatively with others,
can not cope with the stressors of life and study,
not work productively and fruitfully, and
not contribute to his/her family and community.
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10. WHAT IS MENTAL DISORDER?
Mentally ill person acts in ways that deviate from
socially and culturally acceptable manners.
Mental disorders: Is specific diagnosis of a condition
or type of mental illness that is made by a trained mental
health professional after formal psychiatric assessment.
Psychiatry is a branch of medicine that deals with
identification, diagnosis, treatment and prevention of
mental disorders.
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11. Classifying Mental Disorders
 Psychotic Disorder: Severe psychiatric disorder
characterized by hallucinations and delusions, social
withdrawal, and a move away from reality.
 Organic Mental Disorder: Mental or emotional problem
caused by brain pathology (i.e., brain injuries or
diseases).
 Mood Disorder: Disturbances in affect (emotions), like
depression or mania.
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12. Cont’d……………
 Anxiety Disorder: Feelings of fear, apprehension,
anxiety, and distorted behavior that is anxiety related.
 Somatoform Disorder: Physical symptoms that mimic
disease or injury (blindness, anesthesia) for which
there is no identifiable physical cause.
 Dissociative Disorder: Temporary amnesia, multiple
personality, or depersonalization (like being in a dream
world, feeling like a robot, feeling like you are outside
of your body).
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13. CoNt’d……………
 Personality Disorder: Deeply ingrained, unhealthy,
maladaptive personality patterns.
 Sexual and Gender Identity Disorder: Problems with
sexual identity, deviant sexual behavior, or sexual
adjustment.
 Substance Related Disorders: Abuse or dependence
behavior or mood-altering drug, like alcohol or cocaine
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14. General Risk Factors for Contracting Mental Illness
 Social Conditions: Poverty, homelessness, overcrowding,
stressful living conditions.
 Family Factors: Parents who are immature, mentally ill, abusive,
or criminal; poor child discipline; severe marital or relationship
problems.
 Psychological Factors: Low intelligence, stress, learning
disorders.
 Biological Factors: Genetic defects or inherited vulnerabilities;
poor prenatal care, head injuries, exposure to toxins, chronic
physical illness, or disability.
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15. Psychopathology
 The study of abnormal state of mind is called
psychopathology
 Speech
• Muteness:- refers to the absence of speech as in
severe depression, severe schizophrenia or disease of the
brain system (mid brain).
 Pressured speech:-rapid, loud & usually excessive
speech seen in classic mania
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16. • Aphasia
 Any disturbance in the comprehension or expression of language
caused by a brain lesion
 Emotion
 MOOD: is the sustained state of once feelings or emotions w/c is
internally experienced.
 Eated Mood:- is characterized by excessive happiness as in mania
 Depressed mood: - refers to unusual and persistent sadness or
unhappiness as in depressive illness.
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17.  Irritable mood: - refers to easily being annoyed as in
mania or depressive illness.
 Labile mood: - is characterized by fluctuation of mood
without warning, say from extreme happiness to anger or
depression and weeping, as in mania.
 AFFECT: is a short term emotional state or feeling tone as
perceived by the clinician during the interview. It is the
outward manifestation of internal feeling.
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18.  Incongruent affect: if emotional externalized feeling tone is
not harmonious with one’s thoughts, actions and
circumstances.
 Blunted affect:-Disturbance of affect manifested by a
severe reduction in the intensity of externalized feeling
tone; one of the fundamental symptoms of schizophrenia.
 Flat affect:-Absence or near absence of any signs of
affective expression.
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19.  Labile affect: excessive, rapid and abrupt change
of emotional feeling tone.
 ANHEDONIA is loss of interest in, and withdrawal
from, all regular and pleasurable activities. Often
associated with depression.
 PERCEPTION: is the process of becoming aware
of what is presented through sense organs.
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20.  Hallucinations: is perception in the absence of an
external stimulus and may occur in all the sensory
modalities.
Types of hallucinations
Auditory hallucination
Visual hallucination
Olfactory hallucination
Tactile hallucination
Gustatory (taste) hallucination
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21. Auditory hallucination is hearing a voice which does
not exist.
Running commentary refers to the experience of the
patient that strange people comment on his/her
every action, thought and feelings.
Example one patient complained that even when he
went to toilet, his/her enemies commented on this
act of opening bowels and laughed at him/her.
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22. Command hallucination: False perception of orders
that a person may feel obliged to obey or unable to
resist.
Visual hallucination: is seeing things which don’t exist.
Tactile hallucination: is sense of touch without existing
stimulus, e.g. insect crawling on the body.
Olfactory hallucination: smelling things which don’t
exist.
Gustatory hallucination: is the experience of strange
taste in the mouth.
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23. Illusion: is the misinterpretation of real
external stimulus.
Derealization: refers to the experience of
the patient that everything in his surrounding
appears to have changed and is strange.
Depersonalization: Sensation of unreality
concerning oneself, or parts of oneself.
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24. THINKING: the ability to process information
in once mind in both content and form.
Disturbance of thinking occur in the following
two forms:
Thought form or process abnormality
Thought content abnormality
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25. Form of thought: refers to how ideas are connected and
related to each other.
The following are the disorders thought form:
 Flight of idea: is the patient thoughts and
conversations move quickly from one topic to
another so that one train of thought is not
completed before another appears.
 Perseveration: is the persistent and
inappropriate repetition of the same thoughts
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26.  Loosening of Association: It appears that the speech
is a lack of clarity and illogical
 Neologism: new words created by the patient
 Pressure of thought :When patients thoughts are rich
in variety and pass quickly through his mind.
 Poverty of thought: When the patient has only few
thoughts and pass slowly through his mind.
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27.  Thought blocking: Sudden interruption of the flow of thoughts
for seconds or minutes in which the patient experiences as his
mind going blank or his mind is empty .
 Circumstantiality: Indirect speech that is delayed in reaching
the point
 Tangentiality: Inability to have goal directed association of
thoughts, he never gets from points to desired goals
 Echolalia: The patient repeats a part or the whole of what have
been said to him
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28. Delusions: is false belief
Types of delusions (Persecutory, Delusions of
reference, Grandiose, Jealous delusion, Delusions
of control)
depersonalization is the change of self-awareness
such that the person feels unreal.
Derealization: Patient describe things in his
surrounding that are artificial and lifeless
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29. Content of thought: refers to the quality of
message being transmitted.
Delusion: is a false belief or conviction that
cannot be changed by rational arguments or
evidence.
Grandiose delusions
Delusions of jealousy (infidelity)
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30.  Persecutory delusions
 Somatic delusion
 Delusion of guilt and worthlessness
 Erotomanic delusion
 Delusion of reference
 Delusion of being controlled
 Thought withdrawal
 Thought broadcasting
 Thought insertion
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31.  Obsessions
 Compulsion
 Phobias
Ambivalence -Coexistence of two opposing
impulses toward the same thing in the same person
at the same time. Seen in schizophrenia, borderline
states, and obsessive-compulsive disorders (OCDs).
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32. Memory: is the ability to remember past
events and general knowledge
 Memory is of three types: Sensory, short
and long memory
 Sensory memory is registered for each of
the senses and its purpose is to facilitate
the rapid processing of incoming stimuli
 Short memory, also called working
memory, allows for the storage of
memories for much longer than the few
seconds available to sensory memory
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33. Site of memory
1. The hippocampus- believed to be the
site where Implicit (procedural)
memory is stored,
2. explicit (declarative) memory is
thought to reside in the limbic system,
the amygdala and the cerebellum
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34. The process of remebering
The process of remembering has four
parts:
o Registration
o retention,
o retrieval and
o recall.
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35. Memory impairment
 For the purposes of discussion we can divide
memory impairments into amnesias (loss of
memory) and paramnesias (distortions of
memory).
The Amnesia
 Amnesia is defied as partial or total inability to
recall past experiences and events
 its origin may be organic or psychogenic.
 Failure to recall may also occur due to normal
memory decay(if the an item is not rehearsed
the memory fades)
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36. Memory Disturbances
Amnesia: partial or total inability to recall past
experiences.
Anterograde amnesia: Loss of memory for
events subsequent to the onset of the amnesia;
common after trauma.
Retrograde amnesia: is loss of memory for
events before the onset of amnesia.
Paramnesia: Disturbance of memory in which
reality and fantasy are confused.
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37. Hyperamnesia: exaggerated degree of
retention and recall.
Confabulation: Unconscious filling of
gaps in memory by imagining
experiences or events that have no
basis in fact.
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38. Disturbances of Motor function
Motor functions: Comprises of movement, posturing and
mannerisms
Tics: are involuntary, regular and repeated movements
involving small groups of muscles. E.g. raising shoulder.
Mannerism: repeated, involuntary movements that appear
to have some functional significance. E.g. saluting(raising
of hand to ahead)
Stereotypes: repeated movements that are irregular (unlike
tics) and without obvious significance (unlike mannerism).
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39. Negativism : patient does the opposite of what is asked
and actively resists efforts to persuade them to comply
Abnormal posturing and positioning: adaptation of
unusual bodily posture continuously for a long time. E.g.
standing on one leg.
Waxy flexibility: Condition in which a person maintains
the body position into which they are placed.
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40. Cataplexy: an attack of muscular flaccidity.
Ecopraxia: pathological imitation of movement of one
person by another even when asked not to do so.
Echolalia: pathological repeating of words or phrases of
one person by another.
Astaxia Abasia - Inability to stand or to walk in a normal
manner, even though normal leg movements can be
performed in a sitting or lying down position. Seen in
conversion disorder.
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41. Akathisia- Subjective feeling of motor
restlessness manifested by a compelling
need to be in constant movement; may be
seen as an extra pyramidal adverse effect of
antipsychotic medication. May be mistaken
for psychotic agitation.
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42. Disturbances of
consciousness
Consciousness – refers to the state of
awareness of the environment and the
disturbance may vary from mild to severe
impairment.
Clouding of consciousness: refers to state
of drowsiness with incomplete reaction to
stimuli, impaired attention, concentration
and memory, and slow muddled thinking
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43. Stupor : a state in which the person is mute, immobile,
and unresponsive, but appears to be conscious because
the eyes are open and follow external objects. If the
patient’s eye was closed, he/she will resist opening them.
Confusion: inability to think clearly. Often occurs in
organic mental disorders.
Inattention: inability to focus on the matter in hand.
Impaired concentration: inability to maintain that focused
attention.
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44. Sleep Disturbances
There are three forms of sleep disturbances:
Failure to fall asleep in early hours of night =Initial
Insomnia
Interrupted sleep, associated with frightening
dreams =middle insomnia
Early morning awakening, at least 2 hours before
the usual time =Terminal. insomnia
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45. Judgment: the ability to make sound
decisions in the interest of self and
others.
Abstract Reasoning : is the ability to
deal with concepts.
Insight: is a correct awareness of one’s
own mental and physical condition.
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