Mental Illness - Introduction

Mental Illness - Introduction

• 1 in 5 adults and 1 in 7 young people experienced a mental illness in the past 12 months
• In Australia, approximately $11.6 billion was spent on health services in 2020-21, representing 7.3% of the total government health expenditure
• Mental illness has an extensive impact on individuals, families, and the community more broadly

Terminology

• Mental Illness - A health problem that significantly affects how a person feels, thinks, behaves, and interacts with others
• Mental Health Problem - Does not meet the diagnostic criteria for a mental illness, often experienced temporarily as a reaction to life stress, and can progress to mental illness if not managed effectively
• Mental Health Consumer - A person who lives with, or is in the process of recovering from, a mental illness or mental health problem
• Recovery-Oriented Approach - An approach to mental health care that includes principles of self-determination and personalised/individualised care, emphasizing hope, social inclusion, goal-setting, and self-management

Aetiology of Mental Illness

• The aetiology of mental illness is believed to be related to a combination of three factors: biology, psychology, and environment
• Mental illness is associated with personal distress and/or problems functioning in social, work, or family activities

Treatment Provision

• Psychologist - A registered allied health professional who specialises in human behaviour and can assist with managing how an individual thinks, feels, behaves, and reacts
• Psychiatrist - A medical doctor who has completed specialised training in psychiatry, responsible for diagnosing, treating, and preventing mental, emotional, and behavioural disorders

Types of Mental Illness

• Psychotic Disorders (Schizophrenia and Schizoaffective Disorder)
• Mood Disorders (Major Depressive Disorder and Bipolar Disorder)
• Trauma- and Stressor-Related Disorders (PTSD and Acute Stress Disorder)
• Anxiety Disorders (Generalised Anxiety Disorder, Panic Disorder, and Phobias)
• Feeding and Eating Disorders (Anorexia Nervosa and Binge-Eating Disorder)

Psychotic Disorders

• Psychotic disorders are a group of mental illnesses characterised by abnormal thinking and perceptions
• Schizophrenia - A mental illness in which there is an abnormal interpretation of reality, characterised by two or more of the following: delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, or negative symptoms
• Schizoaffective Disorder - The concurrent presence of schizophrenia and a mood disorder

Mood Disorders

• Mood disorders are a group of mental illnesses where a disturbance in a person's emotional state is the main underlying feature
• Major Depressive Disorder (MDD) - Characterised by discrete episodes of at least 2 weeks' duration involving clear-cut changes in affect, cognition, and neurocognitive functions, with inter-episode remissions
• Bipolar Disorder - Characterised by periods of mania followed by periods of depression

Manic Episodes

• Mania is a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy
• Mania is characterised by inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual, racing thoughts, easily distracted by external stimuli, increased goal-directed activity, and excessive involvement in activities that have a high potential for painful consequences

Trauma- and Stressor-Related Disorders

• A form of anxiety that develops after experiencing a traumatic or stressful event
• Associated with intense feelings of fear, horror, anger, sadness, and hopelessness
• Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder are two examples
• Symptoms include flashbacks, intrusive memories and nightmares with physical symptoms, heightened vigilance, irritability, and lack of focus/concentration, avoidance, detachment, and dissociation

Anxiety Disorders

• Anxiety disorders are a group of mental illnesses characterised by feelings of excessive worry and fear
• Can cause physical symptoms such as a fast heart rate, sweating, shakiness, and so on
• There are many anxiety disorders, including Generalised Anxiety Disorder, Social Anxiety Disorder, Separation Anxiety Disorder, Panic Disorder, and Selective Mutism

Feeding and Eating Disorders

• Feeding and eating disorders create a persistent disturbance of eating or eating-related behaviour
• They result in the altered consumption of food
• Can significantly impair physical health or psychosocial functioning
• Anorexia Nervosa - Characterised by restriction of energy intake relative to requirements, leading to a significantly low body weight
• Binge-Eating Disorder - Characterised by eating a very large amount of food in a discrete time window, and by having little to no control of eating behaviour during that episode

Schizophrenia

• Schizophrenia is a severe mental illness that affects how a person thinks, acts, expresses emotions, perceives reality, and relates to others
• Characterised by disruptions in thinking that affect language, perception, and one's sense of self
• Affects about 1% of the Australian population
• Usual onset is at 15-25 years of age
• It affects slightly more males than females### Schizophrenia
• Positive symptoms:
  • Hearing voices, seeing things that aren't there, smelling odors that don't exist, or feeling something touch that is not there
  • Disorganized thinking and speech
  • Disorganized or abnormal motor behavior
• Negative symptoms:
  • Lack of interest in the world
  • Social withdrawal
  • Diminished emotional expression
  • Inability to act spontaneously
  • Reduced sense of purpose
  • Avolition
• Cognitive symptoms:
  • Confusion, difficulty understanding information, and using it to make decisions
  • Difficulty focusing or paying attention to relevant stimuli
  • Poor short- and long-term memory
  • Reduced capacity to use information correctly
  • Inability to recognize one's own cognitive limitations
• Mood symptoms:
  • Loss of motivation
  • Loss of interest or pleasure in things
  • Excessive mood behaviors, including excessive fluctuation in mood
  • Periods of time doing very little followed by periods of time being extremely active
• Pathophysiology:
  • Results in structural brain abnormalities (cerebral atrophy, smaller medial temporal lobes, increased size of the third and lateral ventricles)
  • Results in functional brain abnormalities (abnormalities in neurotransmission due to excess or deficient amounts of dopamine, serotonin, and/or glutamate)
• Management:
  • Goal is to ease symptoms and reduce the risk of relapse
  • Treatments include medications (antipsychotics), psychotherapy, hospitalization, and electroconvulsive therapy

Antipsychotic Medications

• First-generation antipsychotics (D2 receptor antagonists):
  • Examples: chlorpromazine, fluphenazine
  • Associated with a higher risk of extrapyramidal symptoms (dystonia, parkinsonism, tardive dyskinesia)
• Second-generation antipsychotics (5-HT2A/D2 receptor antagonists):
  • Examples: olanzapine, clozapine
  • Associated with a lower risk of extrapyramidal symptoms, but a higher risk of metabolic side effects (diabetes, hypertension, hyperlipidaemia)

Major Depressive Disorder (MDD)

• Characterized by:
  • Sad, empty, or irritable moods
  • Accompanied by related changes that significantly affect an individual's capacity to function
  • Affects about 10% of the Australian population
  • Lifetime incidence is slightly higher in females than in males
• Symptoms:
  • Feelings of sadness, tearfulness, emptiness, or hopelessness
  • Loss of interest or pleasure in most or all normal activities
  • Tiredness and lack of energy
  • Sleep disturbances
  • Angry outbursts, irritability, or frustration
  • Changes to appetite
  • Anxiety, agitation, and restlessness
  • Slowed thinking, speaking, or body movements
  • Feelings of worthlessness or guilt
  • Trouble thinking, concentrating, making decisions, and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, or suicide attempts
• Diagnosis:
  • Person must be experiencing five or more symptoms during the same 2-week period
  • At least one symptom must be either depressed mood or loss of interest or pleasure
• Aetiology:
  • Complex mental illness that involves a combination of genetic, environmental, and psychosocial factors
  • Risk factors include abuse, age, chronic disease or illness, conflict, death or loss, gender, family history, major events, stress, and substance misuse
• Management:
  • Range of management strategies available, including pharmacological interventions (SSRIs, SNRIs), exercise interventions, psychotherapy, transcranial magnetic stimulation, and electroconvulsive therapy

Post-Traumatic Stress Disorder (PTSD)

• Characterized by:
  • Intense and disturbing thoughts and feelings
  • Typically caused by an exposure to an actual or threatened death, serious injury, or sexual violence
  • Symptoms usually occur within three months of exposure, but may appear later
  • Symptoms usually persist for months and sometimes years
  • Affects an estimated 12% of the Australian population
  • Women are twice as likely as men to be diagnosed with PTSD
• Behaviors and presentations:
  • Intrusive thoughts (e.g. reliving the event, distressing memories, nightmares)
  • Avoidance (e.g. avoiding thinking or talking about the event, places, activities, or people that remind the individual of the event)
  • Cognitive and mood changes (e.g. memory problems, concentration difficulties, negative thoughts about self and others, hopelessness, emotional numbness, and detachment)
  • Physical and emotional reactions (e.g. easily startled or frightened, feeling tense or 'on edge', self-destructive behavior, sleeping problems, irritability, angry outbursts, aggressive behavior, shame or guilt)
• Diagnosis:
  • Person must experience all of the following symptoms for one month or longer
  • At least one intrusive symptom, at least one avoidance symptom, at least two arousal and reactivity symptoms, and at least two cognition and mood symptoms
  • Symptoms must be serious enough to significantly interfere with daily function, such as work, school, or relationships with friends and family
• Aetiology:
  • No precise explanation for why some people develop PTSD while others do not
  • Multifactorial, like most mental illnesses
  • Personality traits may provide a predisposition to symptoms
  • Individual differences in the regulation of brain chemistry and hormone responses to traumatic and stressful experiences may, in part, explain why some people develop PTSD while others do not
• Risk factors:
  • Exposure to intense or long-lasting trauma or stress
  • Experiencing trauma earlier in life
  • Occupations related to traumatic and stressful events
  • Pre-existing mental illnesses or a family history of mental illness
  • Substance misuse/abuse
  • Limited support systems
  • Family history of PTSD

Exercise and Mental Health

• Evidence for exercise in MDD:
  • Bi-directional relationship between physical health behaviors and psychological well-being
  • MDD is associated with more than a doubling of the risk for mortality and non-fatal CVD events
  • Even sub-clinical elevations in depressive symptoms are associated with a worse prognosis in patients with established CAD
  • Physical activity/exercise is inversely related to MDD development
  • Exercise reduces symptoms in people with MDD
  • Supervised exercise programs are more effective than unsupervised programs
  • Exercise is as effective as an SSRI for the treatment of MDD
  • Resistance training improves MDD symptoms
  • Lifestyle factors can act additively or synergistically with exercise to improve MDD symptoms
• Evidence for exercise in anxiety disorders:
  • Less RCTs have been performed to investigate the effect of exercise on anxiety
  • Research in anxiety has heavily favored aerobic exercise
  • Aerobic exercise has been shown to be effective at reducing symptoms in those with diagnosed anxiety disorders (mostly GAD) and those with raised anxiety (but no diagnosed condition)
  • Higher intensity aerobic exercise has been shown to be more effective than lower intensity aerobic exercise
  • Physiological mechanisms hypothesized to be responsible for the benefits of exercise for anxiety have some overlap with those proposed for MDD