Mental disorder An introduction John Crichton Consultant Forensic Psychiatrist

How can Mental Disorder be understood? Disease model Disease model Psychodynamic Psychodynamic Behavioural Behavioural Cognitive Cognitive Social Social

Disease Model Akin to the rest of medicine Akin to the rest of medicine The phenomenological approach The phenomenological approach description of syndrome description of syndrome identification of pathological processes identification of pathological processes natural history of the syndrome natural history of the syndrome treatment treatment

Standard diagnostic manuals

Psychodynamic model Origins with Freud importance of early experience and unconscious processes use of free association in therapy aim for insight and change

Behavioural Model Origins in animal experiments rewarded behaviour reinforced phobias

Cognitive model Automatic thoughts or ways of thinking hopelessness guilt and worthlessness catastrophising

Social Model Means two different things social factors in disease sociology of deviance labelling - Rosenhan antipsychiatry

Dementia Global progressive deterioration of function - memory intellect personality Global progressive deterioration of function - memory intellect personality an organic disorder an organic disorder 5% over 65; 10% over 80 5% over 65; 10% over 80 F:M 2:1 F:M 2:1

Schizophrenia Major mental illness Major mental illness Characterised by psychotic symptoms such as hallucinations and delusions Characterised by psychotic symptoms such as hallucinations and delusions Also negative symptoms Also negative symptoms 1% of the population 1% of the population Controlled by antipsychotic medication Controlled by antipsychotic medication

Manic-Depression Characterised by periods of elated mood and depressed mood with psychotic symptoms Characterised by periods of elated mood and depressed mood with psychotic symptoms 1% of the population 1% of the population Controlled by mood stabilisers Controlled by mood stabilisers

Depression Can be part of manic depression or psychotic depression. Most commonly not characterised by psychosis. Can be part of manic depression or psychotic depression. Most commonly not characterised by psychosis. Low mood, biological symptoms, cognitive symptoms Low mood, biological symptoms, cognitive symptoms Prevalence 5-30% Prevalence 5-30% Twice as common in women Twice as common in women

Personality Disorder An individual’s characteristic way of behaving and feeling in a variety of situations consistently through adulthood. An individual’s characteristic way of behaving and feeling in a variety of situations consistently through adulthood. May at its extremes cause subjective distress and social problems. May at its extremes cause subjective distress and social problems. Various types Various types

Other conditions Eating disorders Eating disorders Substance misuse Substance misuse Learning disability Learning disability ADHD ADHD Autistic spectrum disorder Autistic spectrum disorder Head injury Head injury Gender dysphoria Gender dysphoria PTSD PTSD