Mental Illness.pdf

Mental illness • Health condition that changes a person’s thinking, feelings or behaviour and that causes the person distress and difficulty in functioning • Associated with changes in the brain’s structure, chemistry and functioning • Mental and physical illness cannot be considered in isolation 🡪 one can manifest as the other History • Since Hippocrates, conditions such as mania, melancholia and hysteria have been described in medical classifications of disease • Renaissance – mid 18th century 🡪 bodily illness • End 18th century – onwards 🡪 insanity became known as a disease of the mind rather than body • End of 1800s 🡪 mental illness was again being treated as a disease of the brain and interest in psychotherapy develops • Today: Diagnosis of depression/anxiety – somatic symptoms • Tired all the time, sick and run down, headaches, muscle pains, churning gut, sleep problems, loss or change in appetite, significant weight loss or gain. • Increased HR, shortness of breath, nausea, vomiting or stomach ache, muscle tension and pain, sweating or shaking, dizzy, lightheaded or faint, numbness or tingling, hot/cold flushes, difficulty concentrating Note: always consider the possibility of a physical cause for a psychological problem • Anxious patient may have underlying: o Heart failure or other cardiac disorder o Respiratory disease o Hypoglycaemia o Hyper or hypothyroidism o Vitamin B deficiency • Depressed patient presenting with weight disturbance, fatigue, low mood…may be suffering from: o Hypothyroidism o Sleep apnoea o Anaemia 6 Note: always consider the possibility of a psychological cause for a physical problem • Panic attack o Chest pain o Hyperventilate can cause tingling in fingers o Swallowing air can cause distention of abdomen and pain • Common presentations of mental illness: sleep disturbance, headaches, chronic pain, nausea, GIT upsets Physical symptoms of stress – flight or fight response • Perceived threat activates hypothalamus 🡪 activates: o Sympathetic Nervous System (SNS) 🡪 activates nerve pathways and release of hormones from adrenal glands 🡪 causes body to speed up, tense and become alert ▪ Adrenal medulla releases adrenaline and cortisol o Hypothalamic-Pituitary-Adrenal (HPA) axis: • Result: pupils dilate, blood glucose rises, smooth muscle relaxes (e.g. lungs), nonessential systems (e.g. digestion, immune) shut down, HR and BP increase, veins in skin constrict, muscles tense, brain is directed to focus only on the ‘big picture’ • Stuck flight of flight response (physical reaction 🡪 long-term impact) o Increase BP 🡪 heart disease o Stress hormones rise 🡪 anxiety, insomnia, addictions, weight gain o Digestive system slows 🡪 GI problems o Growth and sex hormones fall 🡪 premature aging o Immune system weakens 🡪 infections, cancer o Sticky blood platelets increase 🡪 heart attacks Comorbidity • Physical illness(es) +/- mental illness(es) +/- substance use disorder(s) • Patients with multiple disorders are: more disabled, consume more resources, more difficult to manage 7 • Common among those with mental illness (generally rule rather than exception) • Anxiety is the most common comorbidity with any physical illness • Patients with severe mental illness (SMI) have a shorter lifespan – cardiovascular disease (CVD) is the most common COD • Lifestyle: mental illness 🡪 increased prevalence of modifiable risk factors and risk taking behaviour: o Smoking, alcohol, lack of physical exercise, poor diet, illicit drug use, unprotected sex • Environmental: lower SES, higher unemployment, homelessness/housing issues, relationship issues • Physical health in mentally ill patients is often neglected o Tend to underutilise health services: fear, distrust, impairment, restriction o Health providers themselves fail to encourage screening activities and preventative behaviours focusing instead on managing mental health problems as they are more obvious • Chronic physical illness increases the likelihood of having or developing a mental illness o Physical illness is one of the strongest risk factors for depression 🡪 heart disease, stroke, diabetes mellitus, cancer, rheumatoid arthritis, osteoporosis