CHAPTER 8GENERAL SYMPTOMATOLOGY OF MENTAL ILLNESS PDF

CHAPTER 8GENERAL SYMPTOMATOLOGY OF MENTAL ILLNESSsychological symptom is not a necessary evidence of pathology. SymptomsPare often recognized as abnormal because of their intensity and existence,nonetheless, even when intense and persistent a single symptom does notnecessarily indicate sckness. It i...

CHAPTER 8GENERAL SYMPTOMATOLOGY OF MENTAL ILLNESSsychological symptom is not a necessary evidence of pathology. SymptomsPare often recognized as abnormal because of their intensity and existence,nonetheless, even when intense and persistent a single symptom does notnecessarily indicate sckness. It is the characteristic grouping of symptoms intosyndrome that is important.The following has been identified as signs and symptoms of mental disorder.Disorder of perception: Perception is a personal interpretation ofobservation and could be described in a wide sense to denote imagery whichis described within the mind without the feeling of reality. It could vary inintensityandquality.xIllusions: These are misperception of external stimuli, most likely tooccurwhen the general level of sensory stimulation is reduced. It'is likely to occurwhen the level of consciousness is reduced e.g. in an acute brain syndrome.A common illusion is to misperceive that a shadow is taken to be a man.Itoccurs more often when there is strong affective state e.g. A person who isconfused in a dark lane is more likely to misperceive that she/he saw a manin a dark staircase.Hallucination: This is a perception without stimuli. Mental images arisespontaneously within the brain and are projected to the outside as thoughtreal.The commonest types of hallucination are:Visual-seeing things that others do not seeTactile-feeling things crawling on the skinGustatory-(taste)-they may claim that their food is poisonedOlfactory-(smell)-some patients keep away from fellow humanbeings in the mistaken beliefthat their terrible smell results in othersavoiding them.Audiary sound-Hearing what others aren't hearing.Disorders of thought: This is usually recognized from the patient's speechor writings and can also be inferred from actions of the patients. This termcan be used in a wide sense to denote three separate groups of phenomena.Particular kind of abnormal thought e.g. in delusion which could bepersecutory or grandure or poverty.2)Abnormality of the amount and thespeed of thought e.g very fastspeech,flight of ideas as seen in manic, thought preserve leading toincoherence;kthought block - mental processes are split andfragmented,with a result that thought suddenly stops and mind goesblank. Abmomal belief about the possession of thought e.g. thought broadcast,thought insertion.of associntion resulting in (chess) ight oe e of thinking so tinterview,the therapist may be confused about what has actually been said.Disorder of emotion: The ward mood and affect are used interchangcably-1.uthors reeommend that affect should be used for short term and mood forsustained period.A.Affect may be abnormal in 3ways·a)motor activity is involved.The patient paces the floor continously.·b)althoughsmiling,depression is common.·c.Fluctuation of moodMay be extreme form of total loss of emotion but when the emotionsaidto be "labile"when emotion changes in a rapid abrupt and excessive way.There could also be "continuity of affect e.g.a patient laughing when he is toldthathis beloved motheris to dead.Disorder of memoryMemory is made up of learning, which requires the patient's attention,retention,Retention is impaired in the Korsakow syndrome. The patient cannot retainrecent happenings even though he may recall long past-event clearly,he isnot able to retain six digits forward and 4 backward 791368.Recall-of past memories may be affected by strong emotion,hystericalamnesia,or loss of memoryand fugue may occur in overwhelming anxiety.Deja vu- claiming knowledge of something he or she has no knowledge.Jamas vu-opposite ofdéjà vu(This is a Frenchexpression)Disorder ofconsciousness1.Coma(stupor)common catatonic schizophrenia2.Confusion-(delirium)3.Clouding of consciousness4.Disorientation-inability to locate self in one's environment as to person,place orthing and time.5.Lack of insight-patient does not regard himself asill. Disorder of concentration and attentionThe patient is unable to do "serial 7" test i.e. subtracting 7 serially from 100.Example 100-7=93-7=86etc.Disorder of judgementJudgement is the ability to perceive and distinguish relationship or altematives withpatient gives money away or changes his will,change in living habit may divorce hiswife or husband.Appearance and behaviourFacial appearances,neatness,or unkemptness,speed,movement and tone of speechover talkative,impatient, restless,aggressive and sometime threatening to kill,heand mutism.Talking to selfand there may be fatous smile.Observation,Recording and ReportingGood nursing care consist simply in observing little things which are common to allthe sick ad those which are particular to each sick individual....“Florencenightingale"The nurse's power of observation affords us a good chance to anticipate immediateand future problems of a patient. Therefore, plan and implement care ahead toprevent complications or condition getting worse or out of hand.Definition of observationIt is the ability to detect abnormal from normal.But in nursing observation may bedefined as detecting abnormalities from the patients' health.Examination,test,experiment etc could be used as methods of observation.All the senses are also usedduring this process.Observation and accurate reporting are among the most important functions of apsychiatric nurse. Accurate reports are essential to aid diagnosis. The nurse inreporting must be able to know what is significant and what is not.Developing skillor ability to observe and make useful report is of great asset in psychiatric nursing.Bases of observation1.Appearance2.Facial expression3.Posture4.Personal hygiene5.Speech6.Behaviour patter7.Mood- Physicalactivitics9.Eating habit10.Sleeping habit11.Interest and leisure activities12.Intelligence13.Attitude~14.15.Physical observation-temperature,pulse,respiration,blood pressure.16.Treatment-ifresponding wellValues of observationTo ascertain the signs and symptoms presented on which diagnosis can bemadetreatment including unwanted effect of drugs or change in his environmentasto harm himself or others e.g.aggressive or suicidal behaviourTo access those factors in the patient's personality that can be exploited toaid hisrecoveryBasic principles of observationThe basic princiles must be followed if the best results are to be obtained.Thesignificant if observation is accompanied by knowledge.Normal development and cultural differences in normal behaviourA knwledge of normal behaviour pattern in different cultural groups is essential.educational background and with nationality.It is important to observe to whatextent the patient behaviour deviates from the accepted by his own group.Psychopathology and sympthomatology of mental disordersA nurse should be acquainted with the pattern of abnormal behaviour and theirincidence in various mental disorder. A knowledge of psychology and psychiatricillness may help to detect the earliest manifestations of disorder,when this may betypical and different in cach patient.Participant observationThe nurse should be with the patient for sufficient time to be able to repor on thetotal picture to present.If she knows him intimately he/she can observe minorvariation in behaviour.Observer's effectThe nurse must not disturb the patient by her presence.This means that she must beon the ward so much that her presence is taken for granted and that she is sufficientlythe patient's behaviour ifone joins in allactivities.Objectivityherself to become disturbed or frightened by the patient's behaviour,or shocked orimprovement,since these might lead her to see improvement where there are none.though often desirable,interferes with objective observation.Opportunities for observation1.At night: His attitude to be under observation as well as how deeply andhow long he sleeps should be recorded.2.In the morning:Observation should be made on the grooming habit of thepatient and of his reactiontoo.3.After meal:Much can be learnt from the patient's social and culturalgreat deal of information about the attitude and expectation of the patient.4.Work:Work in a hospital setting can take many forms ranging from thesimplest domestic ward tasks to structured attendance at any industrial oroccupational therapy unit. The attitude displayed by the patient in thiscontext can provide information on his standard perseverance,ability towork alone,and leadership qualities.5.Leisure:A range of recreational activities is provided in all psychiatrichospital and it is most informing to observe the interest or lack of it takinghospital and choice of reading material from the hospital library shouldform a mature bases for observation.6.Visiting:The anticipation with which visiting times are regarded and thereaction of the patient and his visitors while they are together can berevealing t to the observer nurse. It is probably that more can be learnedabout the state of family and interpersonal relationship in the time justbefore and just after relatives and friends have visited them by attempting toprove this at other time of the day.7.Unusual events:The patient's behaviour on being admitted to the hospital,his attitude,staff and other patients to hospital life and hospital rules arepoint of significance.His approach to newly admitted patients,to unusualincidents in the ward, to a chargeof nursing staff,to transfer to anotherward,are all matters of interest.Misconception and Stigmatization in PsychiatryFalse belief about the causes of mental illness caused by Gods violation of taboos.Neglect of vital obligations.Loss of vital substance from the body.133The introduction of foreign and harmful substance into the body possessedby spirit and witchcraft.Some people believe that mental illness cannot be cured. There is also amisconception on the causes of mental illness.Example punishment from God.By certain insects in the brainBroken taboo by heavenly bodies like the moon and stars.The people who take care of the mentally ill are also mad.Stigmatization:In psychiatry it is a mark of shame and disrespec attached topsychiatric patient's parent and psychiatric hospital workers.Negative effect of stigmatization1)People get afraid of getting close to patients2)People avoid interacting with patients3)Look down on patients4)Laugh and vindicate patients5)Patients importance not valued by the society6)Patients not allowed to assume post of responsibility in the society7)Unemployment8)Total neglecta.Familyimplication-Family members may not be married by other members of the community-Political appointment may not be given to suchfamilies-Family members may be exposed to ridicule by the larger society-Economic state of the family will be greatly affected as people will notwant to be involved with them in business transaction.It will lead topsychological trauma on the members of the family.-It will lead to social isolationb.PsychiatrichospitalPeople assume that it is a hospital meant for mad people and so every bodyentering there is mad.-Services provided by the hospital is not patronized-Patient admitted in psychiatric hospital are after abandoned by relativesand friends-Attention to the needs of the institution are not met promptly-In most areas,psychiatric hospitals are resided in very remote areas of thecommunity to keep them away from urban areas.c.Psychiatry health workersThey are being regarded as mental patientsTheir opinions are not valid because it is assumed that they speak likemental patients.Their actions are always misinterpreted134Removal of stigmatization in one soclety1)By improving the physical environment of the psychintric patients2)Calabar,Lagos etc.In that,the public would be able to gain access to thehospital to see things for themselves.3)There should be education of the patient(group psychotherapy).5)There should be psychiatric units in general hospitals as is obtainable ingeneral hospitals in Ogoja and Obubra.6)The public should be educated on the laws of mental illness and how to treatit.7)There should be orientation of the health workers into the field of psychiatryas is obtainable in Cross River State.8)employed by the government and other bodies as was done in federalpsychiatry hospital Calabar.9)There should be association of discharged psychiatric patients(ADPP)as itis found in USA called American Psychiatric Association.10)There should be involvement of the family and community in themanagement of psychiatric patients,which relatives should also beinvolved.11)There should be an open day ceremony where the community can come intothe hospital to see how the patients are doing.These should be at least onceyearly as it happens in Federal Psychiatry Calabar in 1988.12)There should be mental magazine for the patients to read.13)There should be continued integration in primary health care system.14)The government should encourage community psychiatry as this will bringto the public or the community the knowledge of the causes,the treatmentand prevention of mental illness.The programme has been in federal schoolof psychiatry Nigeria Calabar and patients discovered via this programmeare referred to or advised to go to the federal psychiatric hospital fortreatment.15)All primary and secondary schools should be made to offer a cause inpsychiatry.This would help them know the dangers of taking hard drugs,since this is one of the major causes of mental illness or problem.16)Workshop and seminars should be organized in all tertiary institutions in thecountry.Changing concept of mental illnessChanging concept of mental illness ranges from the pre-modern period of thetheories about causation of mental illness,causation/factors in mental illness andthe theorist and the treatment method that have been used because of the beliefsabout mental illness till date.Pre-historical and throughout history including present preliterate societies andsome religio-cultural groups-people believed that mental illness was caused by supernatural and magical forces, evil spirits,devils,gods,ancestors.Golden age(ancient Greece)offending gods, example epilepsy was believed to be divine. Victims were grantedpriesthood.dedicated to the Gods of healing/medicine aceculopius religion ceremonies bypriest with medical advice from oracles.Hippocrates 460-377BCFather of medicine He believed that mental illness was caused by body eventscauses.He believed in body-harmonious basis for personality. He first attempted toused warm human approach,hadconcern for physical comfort, rest, bath, diet andaestheticenvironment.Plato (427-347BC) philosopherHe had organismic view about the cause of mental illness.He belieyed that mentalillness was caused by conflicts between emotions and reason. Believed thatbehaviour was a product of total psychological process.He utilized reason andteaching to promote good life and happiness as method of treatment.Aristotle(384-322BC)philosopherHe believed that mental illness was caused by injustice and wrong doingexpectation of loss, defeat, rejection, imbalance of pain and pleasure. Heemphasized on the use ofreason as method of treatment.Ancient Rome-asclepiades (1" century BC)physicianHe believed in emotional imbalance to be the cause of mental illness.Hedistinguished between acute and chronic disease process. He had concern forphysical comfort, baths, massage, music therapy, quiet environment,rest,heobjected to beating and imprisonment.Aretaeus(1"century BC)physicianHe believed that mental illness was caused by emotional factors.Brain was affectedeven if there was disease else where.He described hysteria in accurately to becaused by wondering tendencies.He made accurate description of manic depression.He described or classifiedabnormal behaviour based on prognosis. He emphasized more on human approachas way of treatment.1Celsus(AD 14-37)physicianHe believed that mental illness was caused by flow of intelligenceand his methodof treatment was by punishment and hunger.Galen(130-200AD)physicianHe believed that mental illness was caused by brain being directly involved oraffected by other organ disturbances.He emphasized treatment of total person.Hebelieved that one cannot separate mind,body,and environment.Early Christianity St Augustine(354-430AD)human conflicts.Through written selfanalysis,he laid the ground work for modernintrospection and exphorate of inner emotional life as method of treatment.MiddleageDuring this period people believed that mental illness was caused by supernaturalof demon possession, superstition and early Christian theology was used forexplanation.Monks were the only medical practitioners especially in middle ages wheremonasteries were places of refugee for sick and confinement of insane. Theytreated mental illness by sprinkling with holy water, visiting shrines, contacttraditionalist using herbs. Institution in Greek Belgium treated retarded andpsychiatric children with later family placement.Reminder of middle ages - abnormal behaviour equated with sin,personspossessed by devil,mentally ill were regarded asheretic or traitors.Barbaric patientwas used. Persons body considered as unpleasant habitat for demons.Patient wasforced to confess to heresy.Witchcraft trials was organized by church in 1484 bypapal permission followed by witch burning.1.Paracelsus(1493-1541)physicianHe believed that mental illness was caused by stars and planet.He arguedfor rationale approach and more human treatment.2.Renaissance-John Wayer(1515-1576)physician and 1"psychiatristHe believed on rational cause of mental illness rather than superstition anddemons. He believed that mental illness was caused by inner experienceand disturbed interpersonal relationship. He considered a witch to bementally ill and not caused by the devil.Clinical and descriptive work resulted in separation of medical psychologyfrom theology and this resulted in information on psychiatry as a medicalspecialty.He emphasized human medical treatment rather than theological,argued that treatment should meet needs of the people not rules of theinstitution.Theory of custodial care was corrupted into human care in Bethlem Hospital London with result of bedlam.3.He believed that mental illness was caused by neurotic and unconsciousDescribed psychotic behaviour. He used drama as mode of understandingand cure.4.These were the era of scientific approach to study mental illness,recordedconcerned with classification.Treatment relied on moral permission andkindness ratherthan on coercion.5.emotions,ideas, disease, unconscious and conscious mechanism in thecausation ofmental illness.6.WM Cullen(1712-1790)behaviour.He used cold bath,blood letting,diet and exercise for treatment.7.Anton Mesmer(1734-1815)He believed that mental illness was caused by animal magnetism andpower of suggestion. This was basic for Geter hypnosis (mesmerism)healso emphasized selfawareness.Reform Movement8.Philippe Pinel(1745-1826)He believed that mental illness was caused by hereditary defect or nervoussystem lesion. He believed that mentally ill should have full status asindividual.He documented observations scientifically and classified illnessaccording to observable characteristics. He was more concerned for humancare rather than punishment,he removed chains from male patients andfreed females in French hospitals. He opened asylum doors and devisedspecific treatment for different behaviours.9.Normal treatment John Heinroth(1773-1843)He believed that mental illness was caused by psychological and moralproblems. He also believed that it was caused by unconscious conflictbetween unacceptable impulses and resulting guilt feelings.He believed that hard work,good food,healthy atmosphere,good frame ofmind and firm conduct would resolve problems and help mental illness.William Hone,George Crukshank, V. Chiaugi, John Conolly, AmarianBrigham Cesare Lombroso,Valetine Magnan William Tuke(early 1505)Description of mental illness followed medical model extended to moreconditions.Attempted systematic classification mental illness included mentaldefective paresis criminal and variety of conditions. They protested inhumancondition,fixed scedule,plensant surroundings, diet and no restraints, physicaland mental activities and rallied public support for enlightened legislation.Established mental hospital and emphasized propercare.Benjamin Rush(1745-1813) futher of Amerlean psychintryHe wrote the first systematic book on mental illness in America.He emphasizedthat treatment should be given in hospitals rather than custodial institutions.Dorathea Dox(1802-1887)Herefforts were aimed at building mental hospital.She worked to established crueltreatment.Clifford Beers(Late)(1805-early 1905)gathered support for citizens. Reform group that latter became national associationformental hygiene.10.Pre- Modern Era(Original view) 19"century Emil Kraerelrn 1800sHe believed that mental illness has biological and organic caused. Heclassified all abnormal behavoiour under dementia paravoid(schizophrenas) or manic depressive psychosis. He classified mentalillness on basis of behaviour description as it's still used today.He usedcustodial care because of totalistic beliefabout prognosisWilliam Griesincier(1817- 1868)He believed that the brain caused all psychological disorders.He said thatsymptoms are underlying clinical signs of underlying disease process.He said.behaviour manifestation is considered less important than underlying pathology.He treated mental illness as a disease.11.Psychologic field(Medical model)Jean MIartin Charcot(1825-1893)He believed that hysterical symptoms were caused by psychologicalfactors and related to mental abnormalities.He used hypnosis as a form oftreatment.PiereJanet(1859-1947)He extended charity work on hysteria.He believed that hysteria was dueto splittingoff certain ideas into unconscious that still influence behaviour.He used hypnosis.asa form of treatment.Jean Pierrre Falret(1774-1870)He made early attempt of psychotherapyLeonardo BranchEarly pioneers of mental hygiene movement.139 CHAPTER 9 CAUSES OF MENTAL ILLNESS he main cause of mental illness is unknown but there are two main factorsthat can expose an individual into developing mental illness.These are:T 1)Predisposing factors:These are those inherent factors that can lead one intohaving mental illness. An individual possessing the predisposing factorsneed 40% of precipitating factors to be mentally unstable. A.Predisposing factors are: 1)Hereditary:The individual inherit these traits from the gene of parent andgrand parents. 2)Constitutional factors: This is found in individuals with certain physicalbuilt example the sangion or the asternic built picnic personality B.Precipitating factors:These are factors that can trigger up mental illness,due to the existing predisposing factors.This can be divided intophysical/psychological. Under physical 1.Trauma RTA caused by bad roads and reckless driving. The rate of accidentis high and when this happens,they leave a traumatic scar causing posttraumatic mental illness. 2.Infection:This is found in the 3th stage of syphilis (tertiarystage)and also incases of cerebral malaria which affect the brain cells as well as aids,septiceamia. 3.Circulatory disturbance:Lack of O2 and blood supply (hypoxia) to thebrain,resulting in mal- nourishment or degeneration of the brain cellsleading to mental illness. 4.Endocrine factors:when there is adefect on the endocrine system examplepancreases hormones, high level of Aldosterol which destroyed thefunction of the brain,growth hormones mongolism. 5.Nutritional factors: Mal-nourishment of the body affect the brain cells,thus diminishing the development of the brain cells because they are notproperly nourished, leading to the development of mental illness,exampledementia 6.Chemical poisoning: This is one of the causes of mental illness, examplemushroom,carbon monoxide from bush burning. 7.Intoxicants:example alcohol which affects the brain among drunks andsmokers. I1.PsychologicalfactorsThese include: a.Socio-economic factors-like unemployment non-payment of salaries,low economic income. b.Domestic problems-These are problems at home where couples arebetween parents and children thus causing disharmony at home. Environment factors-poor sanitary conditioncd Emotional factors-loss of loved ones,property,cases of armed robberyand abandoned children in early childhood. Classification of mental disorder The classification of mental illness is based on the following reasons. 1.The etiology of the disorder 2.The clinical manifestation 3.The severity of the symptoms Based on these,mental disorder are grouped into four classes a.mental illness b.mental retardation c.personality disorders d.psychosomatic disorder Mental illness Mental Personality Psychosomatic retardation disorders disorder Mild Psychopathy Asthma Major Minor moderate sociopathy peptic ulcer Psychosis Neurosis severe sexual hypertension profound deviation psychoactive substance abuse Organic Functional Psychosis psychosis Fig.9.1:Classification of mental disorder Mentalillness This is a condition which manifest in abnormal pattern of behavioural thought ofsocicty.Mental illness is of two main types. The major (psychosis) and minorneurosis. victim is so affected that there is lost of contact with reality.It is characterized by: Loss ofinsight Aggressiveness -Destructiveness Neglect of personal hygieneJ nudity and loss of mental function. Itis further classified into: J1.Organic psychosis -It is impairment of function of the central nervoussystem attributed to pathological lack or defect of organic structure. The physical symptoms are as a result of damage done to certain areas of thebrain,while the psychotic symptoms are as a result of the individual'sreaction to stress and trauma of the physical illness. They are distinguished from functional disorders in that they have knownbiologic causes and pathophysiologic mechanisms. Theyinclude: Senile and pre-senile dementia Alcoholic psychosis-including delirium tremens, Korsakov's psychosis,i.e(disorders of memory cause by Alcohol) acute hallucinosis. Psychosis associated with intracranial infection,including central nervoussystem,syphilis,and encephalitis. Psychosis associated with other cerebral conditions, including cerebro-vascular accident,epilepsy,brain trauma and tumour. Psychosis associated with other physical conditions, including endocrine,metabolic,nutritional disorders,systematic infections,intoxication, otherthan alcohol,children. V 2.Toxic psychosis-caused by infection and infestation of the brain substanceby micro-organism or their toxin example cerebral malaria encephalitis andother toxemia. 3.Functional psychosis-Is malfunction of an organ,body,or person,notattributed to physical conditions. It is based upon: Schizophrenia-simple type,Hebephrenic type,catatonic type,paranoidtype,schizoaffective type,childhood type and chronic undifferentiatedtype. 4.Affective-is associated with depression involuntional melancholia and oldage. Treatment Nursing-physical care,emotional care,psychosocial care and spiritual care. Drugs-chlorpromazine,Melleril,Haloperidol,stelazine clozapine,risperidal,modecate,depixol. Antiparkinsonian drugs-artanc,cogentine,akineton Electro-convulsive therapy(ECT). Rehabilitation Occupational therapy Intervention of the medical/social worker with regards to rehabilitation,employment,relatives. Neurosis This is a group of relatively mild or minor forms of mental illness. Neurosis usuallyout of touch with reality. It is characterized with abnormal emotional reaction todisturbingsituations. Patient has insight Maintains contact with reality as the disorder does not affect the wholeperson.It is marked by exaggerated sense of anxiety andtension example aorganic disease is accompanied by certain forms of mental instability. Type of psychoneurosis 1.Anxiety neurosis-state of apprehension and tension 2.Phobic neurosis-fear ordered of a specific objects act or situation which isnot especially dangerous but has come to represent danger. Phobia whichinclude claustrophobia(fear of closed places) and Menophobia (fear ofbeing alone)hydrophobia heamatophobia,demophobia etc 3.Hysterical neurosis-physical symptoms of certain mental disturbanceoccurring in the absence of organic diseases. Obsessive compulsive neurosis-doing things in excess or repeatedly Hypochrondra neurosis-extreme depression anxiety of the mind. Neural stanic neurosis-lack of energy as a result of chronic overwork. 文 Depressive neurosis traumatic neurosis-this arises from unfavourable childhood experiencesthat is,psychological trauma resulting in mal-adjustment reaction in adultlife example armed robbers,cratic parents,neglected or rejected child,infant rape etc. Table 1: Difference between Neurosis and Psychosis Neurosis Psychosis a. Minor form Major form b. Appearance-fair Appearance-rough and dirty C. Mood-fairly affected Mood-changes totally Orientation-very fair Orientation-not intact at all P c. Personality-intact Personality-split,disintegrated and shattered f. Insight-fairly good Insight-no insight,poor indeed and completely impaired g Speech fair Speech-poor h. Thought-intact Thought disordered e.g.blockage in Schizophrenia Mental retardation(mental impairment or mental sub-normality) It is a condition of arrested or incomplete development of the mind existing beforethe ages of 18.This individual cannot functions as wel as those of his age group inmaturation,learning and social adaptation. Typesof mental retardation include: 1)Mild mental retardation:this is regarded as feeble minded.The individual isdull and backward in academic environment. Mental age is between 7 and12 years never exceeds 12 years. Such individual leams slowly andpainfully. 2)Moderate mental retardation-known as imbecile;mental ageis about 3-7years. 3)Severe mental retardation-after regarded as idiot because they lackintelligence completely and are unable to do or understand anything.Mentalage is 0-12 years. Profound mental retardation-this is the worst type and is functionless.4) 3.Personality disorder This refers to behaviour that run contrary to accepted standard,norms values of thesociety,and which the individual does not see as-problem. There is persistentdisability of the mind resulting in abnormal aggressiveness and seriousirresponsible conduct. They may be normal intellectually and are legally notpsychiatric.The term “personality" refers to all those attributeslike abilities,beliefs, habits, attitudes,emotional responses, etc.,which distinguish one personfrom another.These attributes describe the uniqueness of character.Because ofvarious factors like heredity,integrity of the nervous system and the child-rearingexperience ofeach individual,no two personalities are alike. In the same vein,thereis no perfect personality. Thereare quite a few classifications of personalitydisorder. Asimple mode of classification recognizes three broad forms. Normalаb Mildly abnormal Definitely with himself and his surroundings(neighbours).Such a person does not experiencehome,atworkor in the nieghbourhood.He respects the rights of others and expectsthat his own rights will be respected. The mildly abnormal has character traits known to his friends and family members.tends to agree too readily with the points of view of others rather than argue to pressover things,i.e. cannot be depended upon to be punctual, otherwise reliable andmates and family members, otherwise the individual passes for normal. Thisprofilecovers most people in the society. long-term abnormality of behaviour or traits,traceable to onset in adolescence orimpairment in social or occupational functions or which cause subjective distress.considered when making the diagnosis of an enduring personality disorder.Thefollowing are some of the types recognized. 1.Borderline personality disorder This is characterized by a pervasive pattern of instability of mood,interpersonal relationships and self- image. 2.Dependent personality disorder This is characterized by inability to take decisions.For example, a marriedhis mother whether an idea brought by his wife to take a bank loan to buy ahabitually unable to make the desirable break with early life dependence,heor she is said to suffer from excessive dependency needs. 3.Hysterical(Histrionic)personality disorder This is characterized by excessive attention-seeking behaviour.Feelings ofinsecurity lead to an excessive need for attention and appreciation. Peoplesuffering this type of disorder are often egoistic, vain and self-centred andemotionally shallow. This group also includes pathological liars who liehabitually(wishful fantasies)and without any otherneed except to gainappreciation. 4.Psychopathy or sociopathy: Lack of morals, chronically anti-social,lacks ethical standards or code of conduet,unatfected by punishment and unable to conform to discipline,make prison asasecond home. This is characterized by a pervasive pattern of being full of oneselr,ofothers)and hypersensitivity to the evaluation of others. Othertypes Inelude:.ereative-inventive but greenness of conduet.inadequate-has poor work reord,umable to settle in a job,pathologicalliar,kleptomanin -aggresslon-emotional instability,no regret for feelings or comfort ofothers indulging in crime. Intelligent·no likeness for work, expensive,well spoken,charming.commit violent and sexualerimes. b.sexual devintion-have sexual behaviour that are not culturally acceptedexample: -homosexuality-mantoman lesblanism-womanto woman- exhibitionlsm-exposure of private part to opposite sex.- nymphomania-excessive demand by woman satyriasis-excessivedemand by man vayeurism-peeping on others pacduophelia-attraction for children fetishism-objectand articles offemale transverstism-wearing cloths of opposite sex. -frottage-by rubbing etc c.Psycho active substance abuse These are alcoholism andsubstance abuse.Alcoholism is a state ofpoisoning and excessive consumption of alcohol over a prolonged periodwhile drug abse is the persistent sporadic,excessive often illegal drug use,which occurs in a way unaeceptable to normal medical practice. 4.Psychosomatic disorder (Psychophysiology)these are physical illness with psychological origintheyinclude: 1.bronchinl asthma 2.pepticulcer 3.migraine 4.colitis etc 5.hypertension(essential) These are disturbed conditions in which emotional strains bring about chronicnervous system example respiratory and circulatory and Gastro Intestinal Tractinfection. Organi Functional Teale Affective Delirium Depression dementta -Schir smiple Drugeg cocaine involutional damage to brain akcohol ingestion. melancholia cells due to ·catatonie Cerebral malaria degeneration of due to lrritant not brain cells -paraneld favourable to brain cels ·undiferentiated due to imbalance of the body shemicaler Types of psychosis Organic Functional schia Mania -Dementia Affective -Traumatic -Toxic Hypomania Fig. 9.2: Types of Psychosis CHAPTER14 DRUG ABUSE Dcause behaviour which adversely affect the person's health,social oroccupational functioning. Itmay also mean using a drug for purposes which the drug is not manufactured for. Drug dependence Drugaddiction Tolerance Emotional or psychological dependence Physical dependence Habituation Drug addiction Thisisthe extreme of total dependence on a particulardrug. Cause of drug addiction 1.Social reasons 2.Personality disorders 3.Environmental factors 4.Chronic illness Socialreasons a.In cases ofalcohol,it might be persons who operate where alcoholis freelyavailablee.g.bar attendant,hotel owners etc. b.Availability of drug often contributes to drug abuse especially doctors,nurses,and other health workers. Personality disorders Those who are ever depending on others to take decision for them can only Environmental factors This includes association with those who are drug users or pushers. Chronic illness Psychiatric illness can lead to people becoming addicted to certain drugs e.g.largactil.Some use drugs to relieve anxietyand pain. Drugs commonly abused Chloroquine-anti-malarial drugs nervous system(CNS)theyare not sensitive. Tranquilizers-these counteract tension and mnxiety without necessarily producing sleepe.g.Librum kola and tea(particularly abused by students) Prevention of smoking,alcoholism,and drug abuse 1.In the home 2.School 3.Health workers 4.Govemment. Home Parents should be educated to advise children against smoking as carly aspossible. Parents should be educated on predisposing factors and advised to givefrom smoking outside the home where they may take to alcoholism,smoking and drug indulgence. Parents should be advised not to give too much money to their childrensmoking,alcoholism and drug indulgence. Mothers should get them involved in house work for an idle mind,they say-is,the devils workshops. -Children should be advised against having smokers and alcoholics asfriends. -Parents should be advised on problems of adolescence and how to avoid -Parents should exercise somne discipline in the home and not overprotectoroverindulge them. Parents should show good example in the familycircle. School -Teachers should show good example by not smoking -Students who smoke or drink or indulged in drug should be disciplined. -Children should be allowed to choose their subject and do the type of craftthey enjoy. Children should take part in social activities Debating clubs,dramatic clubs etc so that stimulants will not be used whenspeaking in the public in later life. Children should be given lecture hours and should be supervised or guided. of smoking,drug abuse and alcoholism. Health workers They should show good example by not smoking or drinking especiallywhile on duty Hlealth educntion units should make provision monthly for talks and films Social welfare should make provision for motherless babies,victims ofbereavement and disasters. Hospital should publish the names of all patients who die as a result of lungthe number of mad people hospitalized due to complications of drug abuse,smoking and alcoholism. Health workers should launch and promulgate an anti-smoking campaign orleague. Dnig control committees should be set up to detect abusers and sources ofsupply. Government Should prohibit smoking in offices, taxis, parks,hospitals,gatherings andotherpublic place etc. Should advise cigarette dealers be decreased. Federal government should ban the importation of raw materials forcigarette.. Smoking Definition of smoking This is the act of panelling the smoke from tobacco and other herbs into the body. Tobacco is a plant with an unknown origin, but Columbus on his voyages toSpain and Portugal.Thereafter the use of tobacco spread throughout the world. Tobacco is now grown in many parts of the world including Nigeria. There are different names used in describinit. Cigar Weed Grass Wee, Sparker Marijuana Cannabis Igbo Ikong ekpo Stone Ganger..Utaba etc Composition oftobacco smoke(cigarette) About 500 substances have been found in tobacco smoke. Someare: x1. 2. ene rowsthe blood vessels and so deereases blood o o he e eTar Stains and blackens the lungs Conbines with hemoglobin in the blood and reduces its O, or oxyeacarrying capacity. 94. Irritates the lining of the respiratorytract. C5.. poferds oq isn sid oegagents which have been detected in cigarette smoke. Forms oftobacco 1.Snuff 2.Pipe 3.Chewingtobacco 4.Cigarettes Effects of smoking on the body 1.Causes cancer of the lips,mouth, larynx,throat and urinary bladder. 2Itcauses cough-smokers cough 3. 4.Thickens the blood vessels (arteriosclerosis) Leading to hypertension andheart failure 5.Irritates the lining of the stomach causing peptic ulcer 6.Suppresses appetite leading to low resistance to infection 7.leadingto!UD(intra uterine death) 8.Decreases the flow of blood to the breast leading to poor lactation 9.It decreases the flow of blood to the testes leading to scanty spermatozoaandat timesimpotence. 10.Causes mental problems like change in personality and brain damage Stains the nails,teeth and gives a particular or characteristic tobaco smell11.to the clothes and breath. 12.Reduces athletic performance 13.Can leadto fire outbreak or accidents. 二 Adaptlve proeessin symptom formation in or by a personto limit the site or lessen the impact of or localize the effect ofstress. Mhen necessary in responds to interal or external stinuali i or der to onet basispaau Characteristies of adaptation 1) Involuntary unconsciousness or deliberate (conscience)2) 3) Efficient orinefficient4) Slow orrapid5) Creation of temporary or permanent change6) 8)Directly or indirectly related to the stressor Primary (an initial result of stressors) or secondary response to earlierefficient stress reaction General adaptation syndrome 1)Alarm stage-this is instantaneous short term life preserving and totalconsciously perceives a stressor and feels helpless, insecure or biologiallyThere are three psychological stages that occur during the alarm stage 1)Threat appraisal ofthreat 2)Warning(potential degree of harm) 3)Impact-anxiety,fear,anger,quilt,shame begins with appraisal of the threat or potential degree of harm(warning)thisfeelings of response to the meaning of the impact of the threat.Such as anxiety,fear,anger,quilt or shame. Pereeption of'stressor leat,cold,pain,toxin viruses and so onetcHypothalamus stimulated physical and chemical changesAnterior pituitary gland stimulated which increases release ofACTHAdrenal cortex stimulated by ACTH to increase production ofglucocorticoids e.g. hydrocortixone or cortisone andneurolocorticoids c.g.aldesteroneCortacholamines release triggers increase in sympathetic nervoussystem activityStimulation production of epinephrine and norepinephrine by adrenalmedulla and release at adrenergic nerve endingPosterior pituitary release increase ADHFig.14.1:Alarm stagereaction·1In the alarm-stage,the organism mobilizes to meet the threat. This phase is a basicpackage of biological responses that allows a person to fight or fly, no matter whatthe stressor is: Pereeption of'stressor leat,cold,pain,toxin viruses and so onetcHypothalamus stimulated physical and chemical changesAnterior pituitary gland stimulated which increases release ofACTHAdrenal cortex stimulated by ACTH to increase production ofglucocorticoids e.g. hydrocortixone or cortisone andneurolocorticoids c.g.aldesteroneCortacholamines release triggers increase in sympathetic nervoussystem activityStimulation production of epinephrine and norepinephrine by adrenalmedulla and release at adrenergic nerve endingPosterior pituitary release increase ADHFig.14.1:Alarm stagereaction·1In the alarm-stage,the organism mobilizes to meet the threat. This phase is a basicpackage of biological responses that allows a person to fight or fly, no matter whatthe stressor is:trying to cross a busy intersection or to escape across rattlesnake.2mstage-stage ofresistanceThis stage of resistance is the body's way of adapting through adrenocoricalresponse to the disequilibrium caused by the stressors of life.In most cases the bodywill eventually adapt to the stressor and return to normal.Effect of adrenocortical responseBecause of adrenocortical responds. Many changes occurs to sustain the body fight for preservation including1)Increased use of body's resources2)Endurance and strength3)Tissue anabolism4)Antibody production5)Hormonal secretion6)Changes in blood sugar levels and blood volume including heomodilation7)HypercloremeaModerate anxiety is felt habitual ego defence are unconsciously usedresponses eventually retum to normal when stressors diminish or when the personhas found adaptation mechanism'that meets emotional needs and physical demands.Stressors that are sudden in onset cause alarm stage physiological reaction alongwith feelings of anxiety but when the person's stress is reduced the person returns tosympathetic nervous functioning (stage of resistance). The adaptive response maybe temporary, weakened but soon recovers unless the stress is of intense magnitude.3"'stage-stage of exhaustionThis occurs when the person is unable to continue to adapt to internal and externalenvironmental demands or when adaptive mechanism are inadequate.Physiological or emotional diseases or deaths result because the body can no longercompensate for or correct homeostatic imbalance.Manifestation of this stage is similar to those of alarming stage except that allreactions first intensify and then diminish in response and shows no ability to returnto an effective level of function frequent or prolong general adaptation syndromeresponse triggers disease which in turn predisposes the person to further emotionalresponse.The stage of exhaustion is also related to the persons low points of biorthymic cycle.Emotionally,the moderate anxiety seen in the stage of resistance becomes severesometimes to the point of panic neurosis or psychosis.Stage ofresistanceCopingAdaptational limitedMultipleResouiceDepletedExhaustion stageFig.14.2:Reaction pattern in chronie stress Psychosomatic disorderDefinition:The psychosomatic disorders are those in which psychic elements aresignificant for initiating chemical,physiological or structural alteration,which inturn create the symptoms responsible for the persons complaints.(psyche-mind,soma-physiological orbody)PathophysiologyThe pathophysiology ofpsychosomatic disorder is related to the fact that emotionalstress finds expression in the vascular structures during and after the period ofdistress (in both alarm and resistant stages). Vasospasms and vasoconstrictor causeischemic effects on the arterial wall and result in local oedema and atrophy, possiblevascular thrombosis, degeneration of tissue necrosis, haermorrhage aneurysimformation and rupture the vasodilatation that follows relief from stress responsepredisposes to aneurysm formation and potential rupture of the vessel,capillarychanges include increased permeability and the passage of proteins and finally,ofred blood cells. In the brain, necrosis is followed by cyst formation.In the stomach where HCL secretion increases other mucous like structures,ulceration,and scarring follow as a result of this processes.Vasospasm with or without thrombosis is an important factor in brain disease andmigraine headache and may be important in number of neurological disordersincluding epilepsy.Repeated ischemic cell damage from vasospasm is also possible factor initiatingautoimmune disease and cancer and in noise induced hearing loss. Intermittenthypomagnessmia may occur in persons under stress since free fatty acid levels inthe plasma are increased by stress which in turn cause deficiency of magnesium inthe blood extracelllular magnesium also decreases causing blood vessels toincrease tone and constriction theresultant vasospasm contributes to ischemia andtissue necrosis, especially in the heart coronary vasculature is especially sensitiveto magnesium deficiency,Disease conditions under psychosomatic disorderPepticulcerUlcerative colitisHypertensionCardiovascular diseaseMigraine headacheDiabetesAsthma and other allergic conditionsEczema and other skin rashesArthritisMuscle and joint conditionsInsomniaPremenstrual tension and menstrual disorders Hypertension can predispose to heart failure-CVAorrenal damageCauses1)Temperament-persons characterized by an event as moody,tensetemperament and irregular living patterns show lower stamina, prematuredisease and death.Thus youthful reactions to stress are linked with futurehealth ordiseases.2)Environmenta.Parental and child rearing behaviour involving severe and frequentphysical punishment which contribute to anger and aggression in the child.b.Emphasis on cultural values and societal changesC.Academic presure on studentd.Professional and managerial occupational levels especially when theperson has had comparatively little education for the position and hasworked very hard to succeed.c.Emphasis on work rather than on home and family to meet emotional needsf.Middle age,women home and jobdemands and responsibilities are heavy.g.Physical stress of employment for both sexes3)Employmenta.Intensejob involvement,expected high level of consciousnessb.Time and speed pressures,work over loadc.Perceived lack of control over the situation,lack of participationin decisionmakingd.Responsibility for people and thingsc.Role ambiguity orrole conflictf.Over promotion and feared inability to performPoor interpersonal relationshipBhWorking alone withouta support systemi.Feeling dissatisfied with subordination or being misunderstood bysuperiorsj.General job dissatisfactionj.ManagementGeneral management approach involves evaluation of relatives'role of:1)Psychological and somatic factors in etiology and considerations of bothaspects in therapy.Emphasis is upon the whole patient:-a.Psychological-psychotherapy-individual and group.b.Hypnosis(by assurance and suggestion)c.Behavioural therapyd.Abreactive techniques2)Symptomatic3)Appropriate nursing care