1. Mental illness: mind, body, brain, family and culture
Sid Williams 2019

2. Mental illness: the brain and the body
Today: the brain and the body
But: the mind, the family, the culture – not forgotten.

3. Take home messages
Keep an open mind about brain and body contributions to mental illness
Anxiety, depression, hallucinations, delusions can all be caused directly by brain-based disorders
But always consider psychological, family and cultural issues
If in doubt, discuss, refer, collaborate

4. Mrs Zhenzhen Smith An unusual name Frequent angry outbursts
Seeing ‘Chinesy’ relatives who didn’t speak to her
Good days and bad days
Diagnosis?

5. Dementia with Lewy bodies 1
Vivid visual hallucinations, sometimes illusions
Muddle; memory relatively retained
Easily develop delirium
Fluctuation in function ++
Antipsychotic drugs can  Parkinsonism, falls, delirium

6. Dementia with Lewy bodies 2
Alzheimer drugs can  positive effect
Mild cognitive impairment with Lewy bodies occurs
Often perplexed, depressed, overwhelmed
May have Parkinson’s movement problems

7. Some causes of hallucinations
Delirium
Dementia with Lewy bodies
Stroke
Cortex
Brain stem
Epileptic seizures (focal/partial)
Migraine
Drugs (e.g. propranolol, timoprolol)

8. Some causes of hallucinations/hallucination-like experiences
Sense of presence
Grief
Extreme stress
Doubling:
of oneself (doppelganger, autoscopy, out of body experiences)
of home (partition delusions)

9. Mrs Lucas and the brass plate
82-year-old woman presents with depression + ‘a little vague’
CT some atrophy, some white matter attenuation
CT (left) MRI (right) not Mrs Lucas

10. Mrs Lucas and the brass plate 2
Perfectionist +/-
Daughter Ruth lives with Mrs L.
Mr Lucas died 10 years before
Municipal Councillor, Fred Lucas swimming pool (closed), brass plate

11. Mrs Lucas and the brass plate 3
Arrangement re ownership of home 2yrs before
Renovation, repainting home 5mths before
Painter made new frame for brass plate
Mrs Lucas became very distressed/depressed

12. Hypothesis, Best guess
Mrs Lucas difficulty dealing with/adapting to situation:
wouldn’t anyone?
perfectionism, need for control
White matter changes in the brain
Hickie, I et al. (1995). Subcortical hyperintensities on magnetic resonance imaging: clinical correlates and prognostic significance in patients with severe depression. Biological Psychiatry 37(3):
Hickie, I et al. (1997). Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression – a longitudinal evaluation. Biological Psychiatry 42(5):
The LADIS Study Group. (2011) Cerebrovascular Diseases, 32(6):

13. Mrs Lucas, outcome
With support, antidepressant recovery (more or less)
2 years later significant cognitive problems ‘Vascular Dementia’

14. Some causes of depression (apart from life circumstances)
Strokes
White matter changes
Dementia, Mild Cognitive Impairment
Other brain pathology
Parkinson’s disease
Huntington’s disease
Traumatic brain injury
Epilepsy

15. Some causes of depression
Some drugs
Cortisone and cortisone-like
Beta-blockers
Childbirth
Season
Infections
Cancer

16. Confabulations are not delusions
Confabulation: filling the gaps in memory with imagined events or events from long ago.
Common in:
Alcohol related brain disorders (including Wernicke-Korsakoff)
Alzheimer’s disease
Other dementias
Not delusions, not psychotic, not treat with antipsychotic drugs

17. Anxiety associated with impaired brain function
Catastrophic reaction
Difficulties:
Remembering
Word-finding
Any function
Coping
Delirium

18. All this and more in:
Chapter 13 Anxiety and depression associated with
brain pathology
Chapter 14 False experiences and false beliefs
associated with brain pathology