Mental Illness

Dr. Ayush PandeyMBBS,PG Diploma

October 25, 2018

January 29, 2024

Mental Illness
Mental Illness

Summary

We all experience moments where our thinking, behaviour and feelings are affected. These may be in response to an event or a person or may be the result of things we did not expect or anticipate. When found in extreme or excessive degrees, these conditions or symptoms qualify as mental disorders based on certain pre-defined criteria. The causes of mental disorders have a wide range and may include traumatic events, childhood traumas, neglect, physical disability due to an accident, loss of a dear one, disturbances in the genetic makeup, brain defects or injuries, developmental defects among others. The treatment of a mental illness depends on its underlying cause and may include counselling, psychotherapy, hypnotherapy, medications, electroconvulsive therapy, surgery and others. Prevention of acquired mental illnesses is possible by having a positive outlook on life, meditation, education of children to be able to handle different events and stress in life, a healthy diet, physical activities and developing hobbies that help in balancing life and work.

Types of mental disorders

Mental disorders may be of several kinds. The most common types of mental disorders include:

Some of the most commonly seen mental illnesses are:

Anxiety

Anxiety is experienced when there is a heightened feeling of tension that is accompanied by elevated blood pressure. Anxiety is also accompanied by an increase in worried thoughts. While a general opinion goes to show that moderate amounts of anxiety only help in building better defences and improve performance levels, anxiety disorders need to be treated medically.

Depression

Depression is a problem that more and more people are experiencing today. It is not just the rates of depression that are alarming, but the fact that it is a problem being experienced by younger people, including children is important.

Depression is often confused with sadness. The two differ not just in terms of intensity but also in what is being experienced. Depression is a brain disorder characterised by a feeling of great sadness, lack of interest in people and things, cluelessness regarding life situations, and persistently low moods.

Schizophrenia

Schizophrenia is characterised by an altered state of mind where things and situations are not perceived in the manner in which they exist. This mental disorder is most commonly seen in responses, relationships, perceptions, and interactions.

Autism

A neurobiological disorder that usually presents quite early in childhood, autism is marked by rigid behaviour patterns, which also tend to be repetitive. Those with autism are found to face challenges in social interactions and have somewhat inadequate communication skills.

Mental retardation

The condition where an individual’s brain has not developed to the desired extent is known as mental retardation. While mental retardation is a term that was conventionally used long ago, the more acceptable way of referring to this condition is Intellectual Disability or ID. An ID can be experienced as one of the four stages – mild, moderate, severe, or profound. While the more severe forms can be noticed at birth, in other forms, it may take longer to ascertain the condition. However, in almost all the cases, ID is detected before the individual has reached adulthood.

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a mental condition that can be found in both adults and children. It is characterised by high levels of impulsivity and hyperactive behaviour, attention deficits, and lack of focus.

While there are several reported cases of ADHD that are worked upon, it is also a condition that goes undiagnosed in several cases because parents do not seek help or because of the lack of attention given to it when it is in very mild forms. Like most other conditions, there are different levels of ADHD. It is usually of three types – predominantly inattentive, predominantly hyperactive-impulsive, and both combined.

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Mental illness symptoms

Symptoms of each type of mental illness vary. These are as follows:

Symptoms of anxiety

There are several forms of anxiety disorders, and each one is different in its own way. There are certain common symptoms that are experienced in anxiety, which include:

  • Constantly worrying about events and life situations including career, finances, and health.
  • Disturbed sleep patterns or insomnia.
  • Unexplainable head, body, or muscle pain.
  • Palpitations i.e., irregular, loud and rapid heartbeats, which can be felt by the person.
  • Nausea and giddiness.​​

Symptoms of depression

There is a lot going through a depressed mind. Some of them may simply be suppressed thoughts that cannot be observed. However, there are some classic symptoms that can help raise alarm bells immediately.

  • Feeling of sadness or emptiness.
  • Either binge eating or starving oneself- causing weight gain or weight loss, respectively.
  • Lack of sleep or excessive sleeping.
  • Constant feeling of fatigue.
  • Aches and pains in the body.
  • Digestive issues.
  • Lack of optimism.
  • Feeling of worthlessness.
  • Feeling of anxiety and guilt.
  • Suicidal thoughts and tendencies.

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Symptoms of schizophrenia

The symptoms of schizophrenia vary from person to person, especially between teens and adults.

  • Teens
    • Hallucinations (experiencing what does not exist).
    • Sleeplessness.
    • Withdrawal from interactions.
    • Lack of drive.
    • Poor academic performance.
  • Adults
    • Delusions (unreal beliefs) and hallucinations.
    • Unclear, irrelevant, and incomplete conversations.
    • Regressive behaviour, bursts of anger or aggression, impulsiveness.
    • Lack of proper care and hygiene.
    • Shying away from making social interactions.

Symptoms of autism

There is a very wide range of the autistic spectrum, and the sheer number of observable symptoms in this range is staggering. The most prominent and generalised of these include the ones affecting the following aspects:

  • Communication
    This may sometimes be delayed and not develop for over two years, and children may regress from speaking to babbling. Additionally, children may not be able to add emotion and expression to their communication, do not comprehend sarcasm, do not respond when called, and may not be able to show empathy when communicating.
  • Behaviour
    The most marked behaviour is a repetitive pattern, which may include flapping or rocking. Attachment to odd objects is common. They do not comprehend multiple instructions and have short attention spans. They lack dexterity and can be clumsy in their grasp and movement. They are also extremely sensitive to sounds, light, and touch.
  • Social interaction
    There is a general tendency to be alone and have a limited or minimal social interaction. They are happy left to themselves, often doing the same task for long periods of time. They do not make eye contact to express emotions and will usually respond in one word or a small phrase, if at all.
  • Regression
    Regressing into a child-like state even after a child has shown improvement in symptoms is extremely common.

Symptoms of mental retardation

The symptoms of ID are difficult to generalise since they usually vary depending on the type. Some symptoms are most likely to be observed in all the cases, which include the following:

  • Delayed growth milestones, such as sitting, crawling, standing, and walking.
  • Delayed or unclear speech.
  • Behaviour that is age inappropriate.
  • IQ levels less than 70.
  • Inability to perform regular daily activities and looking after oneself.
  • Memory deficits.
  • The absence of logical reasoning or not being able to predict the result of actions.
  • Impulsiveness and lack of curiosity.
  • Dependency and low self-esteem.
  • Attention deficits, rigidity, and frustration.
  • Passivity and withdrawal from social activities.

Symptoms of attention deficit hyperactivity disorder

Some undifferentiated symptoms of ADHD are as follows:

  • Lack of focus.
  • Poor concentration.
  • High levels of distractibility.
  • Forgetfulness.
  • Inability to complete tasks.
  • Inability to follow instructions.
  • Difficulty experienced in sitting quietly or still for a period of time.
  • Restlessness and fidgety tendencies.
  • Interrupting while others talk.

Mental illness causes

Causes of anxiety

There are certain individuals or personalities who are naturally more likely to develop anxiety disorders. These people are most likely to develop anxiety disorder as a result of

  • Medical ailments, including heart problems, tumours, or thyroid and respiratory problems.
  • Addiction to alcohol and drugs.
  • A family history of anxiety, individuals may have a higher chance of experiencing anxiety-related issues, although no specific genes have been identified that contribute to anxiety.

Causes of depression

It is believed that depression is most likely to be experienced due to a combination of certain factors, including risk factors.

  • Environmental factors, including personal loss, change of place, failure, or other traumatic life events.
  • Social and psychological causes, such as trauma or personality-related issues.
  • Hereditary factors where it runs in the family.
  • Biological factors include a change in neurotransmitter levels.

Causes of schizophrenia

There are no definite indicators or clearly defined causes for schizophrenia. It is believed that a combination of several factors contributes to the occurrence of schizophrenia, and there is a change in the structure of the nervous system and brain. Genetics, complications arising during birth, and brain chemicals are some of the plausible causes of schizophrenia. The continuous use of cannabis has been seen to cause a certain impact.

Causes of autism

A variety of causes have been known to result in autism.

  • Genes
    They have been found to be the most likely causative factor that contributes to the development of autism. Genes not only determine the presence of autism but also contribute to the severity of symptoms, such as Fragile X syndrome. While this altered state of genes may sometimes be inherited from the parent, it could also be independent. Fragile X syndrome is the commonest inherited single-gene cause of autism spectrum disorders. It occurs due to a mutation in the X chromosome leading to delayed speech, long and narrow face, and signs of autism.
  • Environmental Factors
    These include medications prescribed during pregnancy, consumption of alcohol and drugs during pregnancy, adverse effects of pollution and viruses. What is significant is that these factors play a more important role in the cases where genes are predisposed to autism compared to those where they are not.
  • Others
    Some other causes may include problems of the immune system, problems occurring in the brain and the connecting nerve cells, and defects in the energy-producing processes of the body i.e., metabolism.

Causes of mental retardation

The exact causes of ID are difficult to determine precisely, especially in the mild forms. However, there are some common causes that have been found to point towards the prevalence of ID in individuals.

  • Exposure to certain forms of medication, alcohol, or drugs during pregnancy.
  • Mercury or lead poisoning.
  • Dietary problems or malnutrition.
  • Injury to the brain.
  • Severe diseases in childhood, including measles, brain fever (encephalitis), or whooping cough.
  • Injury during delivery experienced in premature birth or oxygen deprivation.
  • Disorders that are inherited, including Tay-Sachs disease, a genetic disorder where due to the absence of a specific enzyme, there is an ongoing breakdown of the cells of the spinal cord and brain leading to symptoms.

Causes of ADHD

It is difficult to point out the exact causes of ADHD, and there are only indicators of certain potential causal factors. Although a neurological condition, it has been found that genetics and heredity can play a role in its occurrence.

Reduced quantities of dopamine in the brain is known to cause ADHD. Dopamine, a chemical found in the brain, assists in bodily movements and emotional responses.

Some studies point to a difference in the structure of the brain. It is opined that the volume of grey matter in the brain of those with ADHD is lower than others. Grey matter is responsible for speech, muscular movement control, and self-control.

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Prevention of mental illness

Prevention of anxiety

While anxiety may pose a very unnecessary problem to many of us, it is a very real experience for someone who suffers from it. The key to preventing anxiety lies in identifying triggers and being prepared. Other preventive measures include exercising, meditating, having a balanced diet, resting, and discussing the problem with a professional.

Prevention of depression

While there are no tested methods to prevent depression, a healthy lifestyle and a positive outlook towards life will definitely help. A more structured lifestyle, including adequate exercise, food, rest, stress release and sleep is important. Talking to people, finding support groups for your passions and hobbies, and building self-esteem can also be good ways to avoid depression.

Prevention of schizophrenia

Prevention of schizophrenia that arises due to pregnancy complications can be done by taking good care of the mother and the baby physically, mentally and medically, during pregnancy, at birth and after birth. Since it also has a familial and hereditary cause, special attention and care should be given to children who have first-degree relatives with schizophrenia.

Prevention of autism

Autism can be prevented if the mother stays careful during pregnancy about the medicines that she is taking. All the medicines should only be taken after doctor's consultation, especially those for seizures and epilepsy. Also, drinking alcohol should be avoided during pregnancy and the woman should get herself immunized against diseases like rubella before conceiving. After the birth of the child, regular check-ups should be done for an early diagnosis and treatment of diseases like phenylketonuria and celiac disease.

Prevention of mental retardation

Mental retardation is extremely hard to prevent since there is little scope to predict when it will occur. However, there are cases where children are at higher risk owing to several factors. In such cases, careful screening prior to conception and in pre- and postnatal (after birth) stages must be conducted. Knowing when the cases are high risk and being aware of its likelihood before family planning can help prevent mental retardation in some ways.

Prevention of ADHD

Care during pregnancy is important in preventing ADHD. This includes a healthy diet, proper intake of supplements, abstinence from alcohol and smoking, and exercise. In children as well, it is important to ensure a healthy diet and lifestyle.

Diagnosis of mental illness

Diagnosis of anxiety

A complete physical and psychological examination help understand how much it is ailment related and how much is psychological. A list of criteria known as DSM-5 forms the basis to ascertain whether an individual is suffering from anxiety disorder. There are no blood or imaging tests to diagnose anxiety-related disorders.

Diagnosis of depression

Some individuals may experience prolonged sadness or grief as a result of grave situations experienced. Not every case qualifies as depression. There may be cases of extended bereavement and other complicated cases, which can easily be confused with depression. Depression is a persistent state that has lasted no less than two continuous weeks to make a diagnosis.

A complete physical and psychological evaluation help examine whether it is an actual case of depression and what is causing it. The history of the person is recorded, and the severity is assessed. The Hamilton Depression Rating Scale is among the most popularly used meters to rate depression.

Diagnosis of schizophrenia

The diagnosis of schizophrenia includes various tests.

  • Medical examination to check for the presence of any other ailments or disorders.
  • Tests to ascertain drug and alcohol abuse or for any other conditions, which may be confused with schizophrenia. A range of tests may be conducted depending on the case.
  • Cross reference against the DSM-5 criteria conducted by a doctor.
  • A complete psychiatric assessment that records the history, previous incidents and occurrences, mannerisms, patterns of behaviour, and the likelihood of violent or suicidal tendencies.

Diagnosis of autism

A combination of tests and observations by both a qualified practitioner and parent is necessary to diagnose autism. Diagnostic measures usually include:

  • A checklist for toddlers that must be completed by parents.
  • Diagnostic screeners that can help with a fair degree of certainty to predict autistic patterns.
  • A list of possible associated conditions and manifestations, which can help predict autism. For example- family history of intellectual disability, sibling with an intellectual disability or mental disorder.

Diagnosis of mental retardation

There are several people who may be able to aid in the diagnosis of ID. These include the parent, paediatrician, a physical or occupational therapist, or a psychologist. The most common methods of diagnosing ID include screening tests, observation, and meetings with the child and parents.

Diagnosis of ADHD

Doctors and counsellors at school run screening test to help diagnose ADHD. These tests are not only conducted in isolation, but also include close monitoring of the child for about six months, careful watch of patterns, a medical study conducted by doctors to exclude other ailments, and interviews with parents and teachers for information. Those found likely to have ADHD are then referred to specialists.

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Mental illness treatment

Treatment of anxiety

There may be no specific prescribed form of treatment for anxiety since different people respond well to different methods. However, in most cases, a combination of different forms of treatment are used.

  • A thorough medical consultation is necessary to ensure that the condition is not merely physical or caused due to one.
  • Medication is prescribed to help address symptoms. Anxiety-relieving drugs might be necessary in extreme cases.
  • Cognitive behaviour therapy is used to help the patient understand and internalise what he/she is experiencing and find better ways to manage and cope with it.

Treatment of depression

Treating depression involves a three-pronged approach. The main course of treatment includes the following:

  • Antidepressants are used to treat the condition. These are recommended mostly for severe cases and never suggested in the case of children.
  • Psychotherapy focuses on managing interpersonal issues and dealing with problems. In some cases, group therapy may also be advised.
  • Support groups, including peers, friends, colleagues, and family, are ideal in suggesting practical ways to help combat depression, and they help the person cope better with the condition.
  • In some extreme cases and in the cases of psychotic depression, electroconvulsive therapy may be recommended.

Treatment of schizophrenia

Treatment of schizophrenia includes a variety of measures that are taken to address the issue and to ensure sustained improvement. Treatment includes:

  • Medication
    The most commonly prescribed medication is antipsychotic drugs. This helps manage the typical symptoms experienced. The lowest possible dose is preferred in the treatment using antipsychotics.
  • Electroconvulsive and Magnetic Therapy
    It is suggested to address the symptoms in people experiencing hallucinations.
  • Psychosocial Therapy 
    This form of treatment is complex including cognitive behaviour therapy, group therapy, skill-based training for rehabilitation, employment support, and therapy to fight alcohol and substance abuse.

Treatment of autism

The treatment of autism is virtually impossible, and all intervention is aimed at equipping the individual and family to cope with the situation optimally.

  • Behaviour management to encourage the desired behaviour and minimise what is undesired.
  • Cognitive behaviour therapy that focuses on making the individual come to terms with thoughts, feelings, and situations.
  • Occupational therapy to give some sense of independence and reduce dependence on others.
  • Physical therapy to help with general body movements as well as fine motor skills.
  • Speech therapy to help with or improve clarity and articulation of thoughts and feelings.
  • Social skill therapy to encourage them to integrate with their surroundings and form meaningful associations.
  • Nutrition therapy to enable them to improve health and prevent deficiency disorders.
  • Medication may be prescribed in cases where convulsions or depression are noticed.

Treatment of mental retardation

The treatment for ID is a long-drawn-out process, which involves regular counselling. Specially customised programs are prescribed for children with ID to help them through school, and there is a need for a special educator who can not only cater to the child’s individual needs but also enable it to pick up life skills better.

The key criteria for adjustment in the cases of ID include allowing children to actualise the learning experience to the greatest extent possible for them and improving social skills and life skills. To achieve this, a combination of some of the following therapies may be used:

  • Counselling
  • Occupational therapy
  • Behavioural therapy
  • Medication (in very few cases)

Treatment of ADHD

There are various courses of treatment, including alternate and natural therapies. Medication in the form of stimulants and non-stimulants may be prescribed to increase the levels of dopamine in the brain or to increase norepinephrine levels. While the benefits are clear, there may also be some side effects.

Natural remedies include healthy diets, engagement in physical activity, and adherence to a sleep pattern. Activities, such as yoga and meditation have also shown to impact attentiveness and ease depression.

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What is mental illness

Mental disorders may be explained as conditions that impact the way we think and feel, our mood, and consequent behaviour. Mental disorders may either be chronic or infrequent. What typifies a mental disorder is the fact that it begins to impact daily functions and relationships. Genetic and environmental factors also contribute to the occurrence of mental disorders. Some of the most common disorders are discussed in this article.



References

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Medicines for Mental Illness

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