UNIT 1 PSYCHOLOGY

MENTAL ILLNESS ACROSS THE LIFESPAN

AN INTRODUCTION
Mental health includes various states of wellbeing, ranging along a continuum from mentally healthy, through to a short-term mental health problem and further to a potentially serious and prolonged mental illness. At some stage in their life, most people will experience some form of problem with their mental health, just like their physical health. In the majority of situations, the unwanted feelings will subside after a short period of time and the state of mental wellbeing is restored. Occasionally, mental health problems can develop into mental illnesses, lasting for a longer period of time, such as months, years or even for a lifetime.

AN INTRODUCTION
Mental illnesses are not uncommon in Australia, with approximately 45% of the population experiencing some form of mental health issue in their lifetime. This diagnostic rate has steadily increased over the past 20 years, with greater community awareness enabling people to feel more comfortable when seeking help. Some people who experience a mental health issue may only do so on one occasion and fully recover. Whereas, others may experience mental health issues more often throughout their life. In most cases, mental health illnesses can be effectively treated and managed, as long as the appropriate professional support is provided.

WHAT IS MENTAL ILLNESS?

Mental health problem: when the difficulties experienced by a person are mild, temporary and able to be treated within a relatively short period of time. Mental illness: when the difficulties experienced by a person are more serious, likely to persist for a relatively long time and likely to require a longer-term treatment plan. More specifically, mental illness can be defined as a psychological dysfunction experienced by an individual which usually involves distress, impairment with the ability to cope with everyday life, and thoughts, feelings and/or behaviour that are not typical of the person or appropriate within their society or culture.

CHARACTERISTICS OF MENTAL ILLNESS

Psychological dysfunction: refers to a breakdown in cognitive, emotional and/or behavioural functioning during which a persons thoughts, feelings or behaviour differ from those they normally experience in that situation. Distress: is when a person is extremely upset. Impaired functioning: involves the impairment in the ability to cope with everyday life. Atypical: when a person responds in a way that is not normal for them. This is usually shown through their thoughts, feelings and/ or behaviour. NOTE: As each culture or society have its own set of norms or standards about what is considered normal and abnormal behaviour, an individuals behaviour must be interpreted based on their environment and cultural/social beliefs.

CATEGORIES OF MENTAL ILLNESS

Mental illness is a general term that describes a group of psychological illnesses that negatively affect a persons mental health and functioning. Mental illness can be broadly classified into two different categories: psychotic and non-psychotic. A psychotic illness or psychosis involves a loss of touch with reality. Sufferers of a psychotic illness may have difficulty making sense of their thoughts, feelings or what is going on around them. In addition, they may live in a reality that they have created in their own mind. Many people with a psychotic illness may experience: - delusions: false beliefs that do not match reality. - hallucinations: hearing, seeing, smelling, tasting and feeling things that are not actually present. A non-psychotic illness is characterised by staying in touch with reality, despite their dysfunctional thoughts, feelings and behaviour. Sufferers may experience intense and/or prolonged feelings of sadness, anxiety and fear to such an extent that they have difficulty coping with their everyday activities. Examples include Anxiety disorders such as OCD (see picture) and Mood disorders.

INCIDENCE OF MENTAL ILLNESS IN AUSTRALIA

In 2007, the Australian Bureau of Statistics (ABS) conducted a national survey on the mental health and wellbeing of Australians aged 16-85 years old. Below are some key findings - Of the 16 million Australians in that age group, almost half (45%) indicated that they had experienced a mental illness at some stage in their life. - One in five reported that they had experienced a mental illness in the previous 12 months. This was up on the statistics collected in 1997 where one in six people reported experiencing a mental illness in the previous 12 month period. - Males and females experience similar rates of mental illness, however there is a gender difference in the types of mental illnesses experienced. - People in the age group 16-24 reported the highest incidence of mental illness. - The most common illnesses reported by Australians were classified as non-psychotic.

According to the World Health Organisation, this pattern of increasing incidence in mental illness is not only occurring in Australia, bur worldwide.

CLASSIFYING MENTAL ILLNESS

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FOURTH EDITION, TEXT REVISION (DSM-IV-TR) - The DSM-IV-TR is a manual first compiled in 1952 by the American Psychiatric Association. - It provides: 1. a system for classifying mental disorders based on recognisable symptoms that are precisely described. 2. information on the typical course of each disorder. 3. information about the age at which people are most likely to develop each disorder. 4. information on the degree of impairment. 5. information on the prevalence of the disorder. 6. information on whether the disorder is likely to affect others in the family. 7. information on the relationship of the disorder to gender, age and culture. - The DSM-IV-TR does not suggest specific causes of disorders unless a cause can be definitely established.

LABELLING SOMEONE WITH A MENTAL ILLNESS

LABELLING: the process of classifying and naming a mental illness, following diagnosis. ADVANTAGE: assists psychologists in identifying and describing a mental health problem, and then prescribing appropriate treatment. DISADVANTAGE: labelling someone in a certain way, particularly as abnormal, can influence the way people think, feel and behave towards them. Also, it influence how people think about themselves. ROSENHAN (1973): a famous study on labelling where people who had never experienced symptoms of any serious mental health disorder presented themselves to various hospitals and told the staff they had been hearing voices. All the pseudopatients (fake patients) were admitted as suffering from schizophrenia. Results: None of the staff identified the patients as pseudopatients, but other patients did. Conclusion: medical staff, including psychologists, could not recognise normal behaviour, and once a person was labelled as having a behaviour, all their subsequent behaviour was interpreted in terms of the disorder.

DISRUPTIONS TO NORMAL DEVELOPMENT

SOME POINTS TO CONSIDER Some mental illnesses are more prevalent in certain lifespan stages than in others, whereas other mental illnesses will occur at any stage of the lifespan. Some mental illnesses have no cure, and once acquired, the symptoms are experienced for the rest of the persons life. Other mental illnesses may be experienced for short or long periods of time. Whether someone will be affected by a mental illness depends on a combination of factors- their genetic make-up, environmental factors and their personal vulnerability. Some specific mental illnesses or disorders that more commonly occur at a particular stage of the lifespan include: - Autism Spectrum Disorder - Attention-Deficit/Hyperactivity Disorder (ADHD) - Eating Disorders - Anxiety Disorders - Schizophrenia - Dementia

AUTISM SPECTRUM DISORDER

AUTISM DEFINITION: a disorder characterised by extreme unresponsiveness to others, poor communication skills and highly repetitive, routine type behaviours. Autism Spectrum Disorder is the term used by contemporary psychologists to highlight the wide range of individual differences experienced in autism. ONSET: It is one of the few mental disorders that begin in infancy, with its symptoms usually very apparent by the age of three. SYMPTOMS: - difficulty interacting with and communicating with others (social interactions) - may find it difficult to form relationships with others - may respond inappropriately in social situations - have a limited range of behaviours, interests and activities - most do not develop strong attachments and often, will not seek comfort when distressed - engage in very little eye contact - difficulty showing affection and find it hard making friends - will rarely engage in imaginative or interactive types of play - no language or very limited language skills, with speech being formal, mechanical and monotone - often display ecolalia where they repeat back what others have said, like an echo - most have a low level of intellectual functioning, but there are those with an exceptional ability in a specific area

AUTISM SPECTRUM DISORDER

ASSESSMENT TOOLS: There is no specific test to diagnose Autism, but Mental health professionals use observations of the child, as well as detailed parents interviews to gain an understanding of the characteristics particular to that childs behaviour. INCIDENCE: 2007 statistics suggest that about one in every 160 children (between the ages 6-12) have an autistic disorder, with significantly higher numbers of males likely to be affected than females. This is equivalent to more than 10,000 Australian children in this age group and 125,000 Australian people of all ages. CAUSE: A specific cause of Autism and Autism Spectrum Disorder is yet to be found. However, it is believed that most have some form of brain dysfunction whereby different parts of the brain dont communicate normally.

AUTISM SPECTRUM DISORDER

TREATMENT: There is no known cure for Autism Spectrum Disorder, however different strategies can be used to try and treat some of the associated behaviours. One example is called Behaviour Modification. This involves consistently reinforcing the child whenever they behave in an appropriate way until they learn this way of behaving. This form of treatment may also be used as a way of managing or controlling any inappropriate behaviour. Children with an Autism Spectrum Disorder usually need a structured environment both at home and at school. If the Autistic child has severe communication and/or intellectual disabilities, then they may attend a school specifically for autistic children. However, if the language problems and intellectual disabilities are less severe, they are likely to attend a regular school where they may receive additional assistance through an integration program.

ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)

DEFINITION: is a disorder characterised by inattention, hyperactive and impulsive behaviour that is more frequent and severe than in other children of the same age. ONSET: The symptoms of ADHD are sometimes evident in infancy, however they are most commonly shown in childhood (before the age of seven). The symptoms must be present for at least six months before a diagnosis of ADHD is given. SYMPTOMS: Inattention: difficulty concentrating and listening for more than a few minutes. They are also easily distracted and have difficulty sticking to the same task for very long. Hyperactivity: very restless and appear to have excessive energy. They have difficulty keeping still for an extended period of time. Impulsivity: act before thinking through the consequences of their behaviours. They are often unable to control the urge blurt things out or wait their turn in a conversation, activity or game. 75% of children with ADHD will continue to experience their symptoms into adolescence and often adulthood. Hyperactivity is the most likely symptom to decrease with age.

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ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)

INCIDENCE: The exact numbers of children with ADHD are not known as it is believed that there may be many others who have not been diagnosed. It is estimated that about 7% of Australian children have ADHD. Other statistics suggest the incidence to be between 2.3%-20% in school-aged children, with 90% being male and 10% female. CAUSE: The cause of ADHD is unknown, however it is believed that there is some form of neurological basis. This means there is some form of brain difference or change in children with ADHD. Both genetic and environmental factors are thought to play a part in ADHD. TREATMENT: There is currently no cure for ADHD, but the symptoms can be managed in two main ways; medication and various behaviour therapies. Children with ADHD generally attend regular schools, however they may have a special program to help manage their behaviour and they may receive additional support from a teachers aide.

EATING DISORDERS
DEFINITION: An eating disorder is a general term used to describe any disorder involving a severe disturbance in eating behaviour. According to the DSM-IV-TR, a diagnosis of an eating disorder means that the persons eating behaviour is no longer within their control, and it causes a significant change in their psychological, social and physiological functioning. Eating disorders are more common in adolescence than in any other stage of the lifespan. Two most common are: Anorexia Nervosa and Bulimia Nervosa.

ANOREXIA NERVOSA
DEFINITION: is an eating disorder that involves the persistent refusal to maintain body weight at or above a normal level, intense fear of weight gain, a distorted perception of body image, the absence of menstruation (in females) and extreme concern with body shape and weight. SYMPTOMS: Often set themselves a target weight which is usually considerably lower than the appropriate weight prescribed by the medical profession. Lack of food consumption but are generally very focussed on food, constantly talking about it and monitoring their kilojoule intake. Fear of putting on weight. Many anorexics exercise excessively to burn more kilojoules. Very focussed on body shape and weight. Low self-esteem and may consider themselves unattractive. Loss of menstruation in females. According to the DSM-IV-TR, someone cannot be diagnose as anorexic unless they have weigh at least 15% less than the prescribed minimum normal weight for their age and height.

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ANOREXIA NERVOSA
EFFECTS: Starving the body of nutrients can cause a range of medical problems for individuals with anorexia nervosa. These include: Lowered body temperature, causing them to feel unusually cold Reduced bone density, resulting in fragile bones Hair loss from the scalp Growth of fine hair over the body and face Chemical changes that may lead to heart failure or the collapse of circulatory system INCIDENCE: It is estimated that in Australia, approximately 1% of adolescent girls develop anorexia, although some research suggests that this number may be higher. Among adolescent girls, anorexia is the third most common chronic (ongoing) illness after obesity and asthma. Of all adolescents diagnosed with anorexia, one in ten is male and nine in ten and female. Among children, one in four diagnosed with anorexia is male.

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ANOREXIA NERVOSA
CAUSE: There is no single cause of anorexia. Instead, it is believed that there are several key factors that put an individual at risk of developing this eating disorder. The risk factors for anorexia can be divided into three main groups: biological factors, psychological factors and socio-cultural factors. BIOLOGICAL FACTORS: Research studies suggest that genes are likely to play a role in determining an individuals susceptibility to anorexia by contributing to abnormalities in hormone levels and an imbalance in brain chemicals. In addition, genes may play a role in the development of certain personality characteristics that predispose an individual to an eating disorder. PSYCHOLOGICAL FACTORS: It is believed that high personal expectations, low self-esteem, a high need for approval from others, perfectionist tendencies, feelings of lack of control, anxiety in social situations, difficulty asserting oneself and feelings of depression are common in sufferers of anorexia. Most anorexics will experience at least some of these symptoms. SOCIO-CULTURAL FACTORS: Socio-cultural factors associated with anorexia include family background, cultural background and images of attractive physical appearance and size promoted in the media.

ANOREXIA NERVOSA
INCIDENCE: Approximately 50% of all people who have anorexia will recover completely. Of the remaining 50%, 20% will continue to have issues with food for the rest of their lives. The other 20% die in the longer term as a consequence of either medical or psychological complications. Therefore, the earlier treatment is started, the better the chance of recovery. TREATMENT: The kind of treatment used depends on the severity of the individuals condition. If the weight loss is extreme and vital organs (such as kidneys, heart and lungs) become impaired, then the situation is potentially lifethreatening, meaning the person is hospitalised and fed intravenously (through a tube) until their body is no longer malnourished. The majority of people with anorexia are treated as outpatients. Their treatment usually involves several health professionals working together to help treat both the physical and psychological aspects of the eating disorder. Cognitive Behaviour Therapy and Family Therapy are two forms of treatment that are regularly used to assist in the treatment and recovery of an anorexic individual. living with anorexia- Isabella Caro

BULIMIA NERVOSA
SUMMARY: Bulimia nervosa involves repeated binge eating. Findings indicate that approximately 5% of Australian women (mostly young women) will be affected by bulimia at some stage in their life. An estimated 95% of sufferers are female and 5% are male. Symptoms include: Ongoing episodes of binge eating (consumption of a large amount of food in a set period of time) A feeling of lack of control over food whilst engaging in the binge eating Self-induced vomiting Use of laxatives or diuretics to try and empty the bowel or bladder Strict dieting or fasting Vigorous exercise to prevent weight gain Consistent overconcern with body weight and shape Unlike anorexics, bulimics usually maintain a normal body weight. However, the regular use of laxatives and diuretics, as well as vomiting, can cause serious physiological effects. For example, the acid produced from vomiting causes tooth decay.

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ANXIETY DISORDERS
Anxiety is a state of arousal associated with feelings of apprehension, worry or uneasiness that something is wrong or something bad is about to happen. Anxiety has 3 basic components: 1. Feelings of tension, apprehension, dread and an expectation of not being able to cope. 2. Behavioural responses such as avoidance of a feared situation 3. Physiological responses including muscle tension, increased heart rate and blood pressure. To some degree, all people experience anxiety. It serves an adaptive purpose and enables us to cope and adapt with new or challenging situations. For example, anxiety may prompt someone to have a medical check up or to study for an upcoming exam. However, it is important that the level of anxiety does not become so high that it starts to impede performance. For example, high anxiety levels may cause inaccurate judgements and difficulty in understanding information.

ANXIETY DISORDERS
Anxiety disorders are the most frequently experienced and diagnosed of all the mental disorders. DEFINITION: Anxiety disorders are characterised by chronic (persistent) feelings of tension, distress, nervousness and apprehension or fear about the future, with a negative effect. SYMPTOMS: - Depends on the type of anxiety disorder, but all interfere with an individuals ability to function normally in everyday life INCIDENCE: Anxiety disorders most commonly occur in adulthood, but can occur at any stage of the lifespan. Overall, about 14.4% of the Australian population (or 2.5 million people) have experienced an anxiety disorder. Furthermore, they occur more in females than males. The DSM-IV-TR identifies five main types of anxiety disorders: 1. Generalised anxiety disorder 2. Panic disorder 3. Phobias 4. Obsessive-Compulsive disorder 5. Post-traumatic stress disorder

ANXIETY DISORDERS
- CAUSES: Some anxiety disorders can be linked to a single event (such as phobias or post-traumatic stress disorder), but this is not always the case. In most cases, psychologists believe there are a number of factors that contribute to influence the onset of an anxiety disorder. These include: * Biological factors- it is believed that brain chemistry or certain genes may cause a predisposition to developing an anxiety disorder. * Psychological factors- including childhood experiences, learning processes and how we interpret specific events can influence the development of an anxiety disorder. * Personality traits- certain personality traits are thought to be common amongst sufferers of anxiety disorders. TREATMENT: The two main forms of treatment for anxiety disorders involve various types of Behaviour Therapy (especially CBT and relaxation) and medication (particularly anti-anxiety).

ANXIETY DISORDERS
TYPES OF ANXIETY DISORDERS: OCD story

TYPE Generalised anxiety disorder Panic disorder

DESCRIPTION The individual worries constantly and excessively about the possibility of everyday, real-life problems occurring. e.g. being late for an appointment The individual has recurring, unexpected attacks of anxiety (panic attacks) in situations when most people would not be afraid. e.g. shopping in a large complex The individual has an excessive, persistent and unreasonable fear of a particular object, activity or situation. e.g. fear of snakes The individual has recurring, unwanted thoughts that produce anxiety, and a need to perform repetitive and rigid actions to reduce their anxiety. These repetitive actions often interfere with their everyday functioning. e.g. constant need to check the doors are locked. The individuals fear and anxiety are linked to a traumatic event and continue to be experienced long after the event. e.g. September 11

Phobia

Obsessive-compulsive disorder

Post-traumatic stress disorder

SCHIZOPHRENIA
DEFINITION: Schizophrenia is a psychotic mental illness characterised by distortions perceptions, bizarre thoughts, disorganised speech, disturbed emotions and a deterioration in coping with everyday life. ONSET: Schizophrenia most commonly occurs in adulthood, however it may first appear in adolescence. The age of onset is often earlier for males than females, but more females are affected between the ages of 25-30.

SCHIZOPHRENIA
- - - - - - - - - - - - - - SYMPTOMS: Significant changes in behaviour Individual becomes more easily stressed and has mood swings Has difficulty telling the difference between reality and fantasy May begin to withdraw from relationships with others Work performance often deteriorates Lack of care for themselves May experience hallucinations (a distorted perception during which the individual sees, hears, feels and/or smells something that is not physically present) Difficulty focussing their attention on external activities or events Bizarre or weird thoughts and confused thinking, often unable to follow a logical line of thinking Delusions may occur (firmly held, but usually false, beliefs which cause significant distress to the individual who experiences it) Some schizophrenics experience delusions of grandeur (they falsely believe that they are someone important or that they have done something significant) Disorganised speech; often illogical, jumbled and disconnected Inappropriate emotional response to situations Difficulty coping with their everyday life

SCHIZOPHRENIA
According to the DSM-IV-TR, for an individual to be diagnosed with schizophrenia, an individual must experience two or more of the symptoms for a period of at least six months. INCIDENCE: Schizophrenia affects about 1% of the Australian population. It is experienced in all cultures and in all levels of society throughout the world. It affects males and females equally. CAUSES: Biological factors: Research has consistently found that biological factors such as heredity (higher likelihood if family history of it), brain chemistry (higher levels of the neurotransmitter dopamine) and brain anatomy (brain size often smaller and structurally different than non-sufferers) seem to influence the onset or development of schizophrenia. Socio-cultural factors: Issues such as stressful life events and/ or a persons drug use can also play a part in the development or onset of schizophrenia. Both may act as triggers of schizophrenia. CURES: There is no cure for schizophrenia, but various kinds of treatment can help manage and control their symptoms. These include medication, hospitalisation, skill development and

social support. The aim of all treatments is to facilitate sufferers of schizophrenia to live as normal a life as possible within the community.

SCHIZOPHRENIA
TYPES OF SCHIZOPHRENIA: There are five main types of schizophrenia. Child with Schizophrenia TYPES OF SCHIZOPHRENIA DESCRIPTION Individuals are preoccupied with delusions of persecution, grandeur, or both. These individuals are distrustful and are constantly watchful, as they are convinced that others are plotting against them. Individuals alternate between states of being completely immobile and extremely excited, but one state usually dominates. They may show stupor, negativism, rigidity, excitement and posturing. Individuals are extremely withdrawn and live in private worlds dominated by incoherent speech and grossly disorganised behaviour. Speech may be incoherent and behaviour may be somewhat bizarre. These individuals are schizophrenic, however they do not meet the criteria for other types, or they may meet the criteria for more than one type. Individuals have experienced at least one episode of schizophrenia but obvious symptoms are no longer evident.

PARANOID SCHIZOPHRENIA

CATATONIC SCHIZOPHRENIA DISORGANISED SCHIZOPHRENIA UNDIFFERENTIATED SCHIZOPHRENIA RESIDUAL SCHIZOPHRENIA

DEMENTIA
DEFINITION: Dementia is the progressive deterioration of the functioning of neurons in the brain, resulting in memory impairment, a decline in intellectual ability, poor judgement and sometimes, personality changes. TYPES OF DEMENTIA: There are many different types of dementia, each with different causes and some different symptoms. The most common types are: DESCRIPTION The individual experiences a gradual widespread degeneration of brain neurons. This results in severe deterioration of cognitive abilities, personal skills and behaviour, eventually causing death. The individual experiences brain damage as a result of narrowing of the arteries that supply blood carrying oxygen to the brain. This often occurs after a stroke and the damage that occurs will depend on the area of the brain effected. The individual experiences damage in the front part of the brain initially, with changes to personality and behaviour most common.

TYPE OF DEMENTIA ALZHEIMERS DISEASE

VASCULAR DEMENTIA

PICKS DISEASE

PARKINSONS DISEASE

This occurs due to the loss of the neurotransmitter dopamine in the brain. Progressively, the individual loses control of voluntary movements, and many individuals experience cognitive decline and difficulties in taking care of themselves. Personality changes may also occur.

DEMENTIA
SYMPTOMS: Dementia usually - develops over a number of years, gradually getting worse. In the early stages, individual may - occasionally have problems with - familiar tasks or they may become more forgetful. They can become disoriented and lose track of the day or time May experience difficulty in learning new information or skills - As the illness progresses, cognitive failure becomes more evident and the risks to the persons safety increases. The individual becomes increasingly forgetful Increasing difficulties with speech and may need help with maintaining their personal hygiene Some people experience changes in their personality The last stage of the illness is one of total dependency and loss of almost all activity Memory problems are extreme Often unable to feed themselves, dont recognise family or friends, have difficulty understanding what is said to them, find it hard to walk and may display inappropriate behaviour in public Eventually, the individual dies, either from dementia or an associated cause.

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DEMENTIA
ONSET: Dementia is most common in people over 65 years of age, but it can occur in those in their forties - and fifties. Research suggests the earlier dementia begins, the quicker the deterioration occurs. Therefore, if onset occurs when an individual is very old, the - degeneration of neurons seems to occur at a slower rate. INCIDENCE: As it is difficult to identify people with mild of moderate dementia, there are no totally accurate statistics. However, estimates indicate that about 6.5% of the population aged over 65 years are affected by dementia. In addition, about twice as many females than males have dementia. CAUSES: Biological factors: These include genetic influences and abnormal brain function. Environmental factors: Including viral and bacterial infections such as HIV, AIDS, meningitis and syphilis; drug abuse of various kinds; the ingestion of various toxins (such as smoking) and a diet high in fat. CURE: The type of treatment provided depends on the type of dementia and how far progressed it is. Once this is established, a treatment plan can be established. Currently, there are three main ways used to assist people with dementia: medication, cognitive therapy and behaviour therapy.