Slides: Day 11 - 20

Week 2 Part 1- What is Mental Illness 

Mental Health: the condition of being sound mentally and emotionally that is characterized by the absence of mental illness and by adequate adjustment especially as reflected in feeling comfortable about oneself, positive feelings about others, and the ability to meet the demands of daily life also : the general condition of one's mental and emotional state From Merriam-Webster 

Mental Health: Mental Health- the psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment ◦Vocabulary.com 

Any Mental Illness •Any mental illness (AMI) is defined as a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment (e.g., individuals with serious mental illness as defined below). Serious Mental Illness •Serious mental illness (SMI) is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to SMI. From National Institute of Health 2021 

Prevalence of Any Mental Illness (AMI) • In 2019, there were an estimated 51.5 million adults aged 18 or older in the United States with AMI. This number represented 20.6% of all U.S. adults. • The prevalence of AMI was higher among females (24.5%) than males (16.3%). • Young adults aged 18-25 years had the highest prevalence of AMI (29.4%) compared to adults aged 26-49 years (25.0%) and aged 50 and older (14.1%). • The prevalence of AMI was highest among the adults reporting two or more races (31.7%), followed by White adults (22.2%). The prevalence of AMI was lowest among Asian adults (14.4%). From National Institute of Health 2021 

Categories from the DSM V Neurodevelopmental Disorders Schizophrenia Spectrum and Other Psychotic Disorders Bipolar and Related Disorders Depressive Disorders Anxiety Disorders Obsessive-Compulsive and Related Disorders Trauma- and Stressor-Related Disorders Dissociative Disorders Somatic Symptom and Related Disorders Feeding and Eating Disorders Elimination Disorders Sleep-Wake Disorders Sexual Dysfunctions Gender Dysphoria Disruptive, Impulse-Control, and Conduct Disorders Substance-Related and Addictive Disorders Neurocognitive Disorders Personality Disorders Paraphilic Disorders Other Mental Disorders and Additional Codes Medication-Induced Movement Disorders and Other Adverse Effects of Medication Other Conditions That May Be a Focus of Clinical Attention 

Neurodevelopmental Disorders Contains Autism Spectrum Disorders 1.8% ADHD 8.8% (11.7 Male/5.7 female) Communication Disorders Specific Learning Disorders Motor Disorders Intellectual Disabilities .2-.5% All percentages of children age 3-17 

Schizophrenia Spectrum and Other Psychotic Disorders Affects .4% of the US population in any given year 

Definition Schizophrenia is a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Although the course of schizophrenia varies among individuals, schizophrenia is typically persistent and can be both severe and disabling. Symptoms of schizophrenia include psychotic symptoms such as hallucinations, delusions, and thought disorder (unusual ways of thinking), as well as reduced expression of emotions, reduced motivation to accomplish goals, difficulty in social relationships, motor impairment, and cognitive impairment. Although symptoms typically start in late adolescence or early adulthood, schizophrenia is often viewed from a developmental perspective. Cognitive impairment and unusual behaviors sometimes appear in childhood, and persistent presence of multiple symptoms represent a later stage of the disorder. This pattern may reflect disruptions in brain development as well as environmental factors such as prenatal or early life stress. This perspective fuels the hope that early interventions will improve the course of schizophrenia which is often severely disabling when left untreated. NIMH 2021 

Bipolar and related disorders 2.8% of the US population last year 4.4% lifetime prevalence Bipolar disorder, sometimes referred to as manic-depressive disorder, is characterized by dramatic shifts in mood, energy, and activity levels that affect a person’s ability to carry out day-to-day tasks. These shifts in mood and energy levels are more severe than the normal ups and downs that are experienced by everyone. From NIMH 2021 

Depressive Disorders Major depression is one of the most common mental disorders in the United States. For some individuals, major depression can result in severe impairments that interfere with or limit one’s ability to carry out major life activities. “A period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities, and had a majority of specified symptoms, such as problems with sleep, eating, energy, concentration, or self-worth.” NIMH 2019 

Anxiety Disorders Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders. NIMH 2021 

Anxiety Disorders During August 2020–February 2021, the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5%, and the percentage of those reporting an unmet mental health care need increased from 9.2% to 11.7%. Increases were largest among adults aged 18–29 years and those with less than a high school education. NIMH 2021 Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic — United States, August 2020– February 2021 Weekly / April 2, 2021 / 70(13);490–494 Anjel Vahratian, PhD1; Stephen J. Blumberg, PhD1; Emily P. Terlizzi, MPH1; Jeannine S. Schiller, MPH1 

Obsessive-Compulsive and related Disorders “Obsessive-Compulsive Disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over.” NIMH 2021 

Trauma and Stressor-Related Disorders Post-traumatic stress disorder (PTSD) can develop after exposure to a potentially traumatic event that is beyond a typical stressor. Events that may lead to PTSD include, but are not limited to, violent personal assaults, natural or human-caused disasters, accidents, combat, and other forms of violence. Exposure to events like these is common. About one half of all U.S. adults will experience at least one traumatic event in their lives, but most do not develop PTSD. People who experience PTSD may have persistent, frightening thoughts and memories of the event(s), experience sleep problems, feel detached or numb, or may be easily startled. In severe forms, PTSD can significantly impair a person's ability to function at work, at home, and socially. NIMH 2021 

According to the Criterion A definition, 82.3% (n = 839) of participants were ‘trauma exposed’. Based on the expanded criterion, 87.7% (n = 895) of participants were ‘trauma exposed’. Using the DSM-5 Criterion A definition of trauma, 12.7% (95% CI = 10.7%, 14.8%) met diagnostic requirements for PTSD (5.0%, 95% CI = 3.7%, 6.3%) or CPTSD (7.7%, 95% CI = 6.1%, 9.4%); using the expanded definition of trauma exposure Hyland, P., Karatzias, T., Shevlin, M., McElroy, E., Ben-Ezra, M., Cloitre, M., & Brewin, C. R. (2021). Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM– 5. Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 133. 

Dissociative Disorders Dissociative identity disorder (DID) is a rare psychiatric disorder diagnosed in about 1.5% of the global population. This disorder is often misdiagnosed and often requires multiple assessments for an accurate diagnosis. Patients often present with self-injurious behavior and suicide attempts. 

Dissociative Disorders Somatic symptom disorder is characterized by an extreme focus on physical symptoms — such as pain or fatigue — that causes major emotional distress and problems functioning. Found in 5-7% of the US population https://www.mayoclinic.org/diseases-conditions/somatic-symptomdisorder/symptoms-causes/syc-20377776 

Feeding and Eating Disorders Lifetime rate of eating disorders is about 9%. Women suffer from eating disorders 3-5x as often as men. Less than 6% of people with eating disorders are underweight. Eating disorders are the deadliest mental illness outside opioid use. 1.Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74 2.NIMH 2021 

Elimination Disorders Elimination disorders occur when children who are otherwise old enough to eliminate waste appropriately repeatedly void feces or urine in inappropriate places or at inappropriate times. The two disorders that fall under this category are Enuresis and Encopresis. 1.Elimination Disorders: Enuresis - Childhood Mental Disorders and Illnesses (gracepointwellness.org) 

Sexual Dysfunctions Gender Dysphoria 

Sleep-Wake Disorders There are several different types of sleep-wake disorders, of which insomnia is the most common. Other sleep-wake disorders include obstructive sleep apnea, parasomnias, narcolepsy, and restless leg syndrome. 6-10% of people have insomnia disorder www.psychiatry.org/patients-families/sleep-disorders/what-are-sleepdisorders 

Disruptive, Impulse-Control, and Conduct Disorders These are a group of disorders that are linked by varying difficulties in controlling aggressive behaviors, self-control, and impulses. Typically, the resulting behaviors or actions are considered a threat primarily to others’ safety and/or to societal norms. Some examples of these issues include fighting, destroying property, defiance, stealing, lying, and rule breaking. These disorders are: •Oppositional defiant disorder •Intermittent explosive disorder •Conduct disorder •Pyromania •Kleptomania •Other specified disruptive, impulse-control and conduct disorder •Unspecified disruptive, impulse-control, and conduct disorder www.psychiatry.org/patients-families/disruptive-impulse-control-and-conductdisorders/what-are-disruptive-impulse-control-and-conduct-disorders#:~: text=Disruptive%2C%20impulse-control% 20and%20conduct%20disorders%20refer%20to%20a,people% 20to%20behave%20angrily%20or%20aggressively%20toward%20peopl e 

Substance-Related and Addictive Disorders The lifetime rate for alcohol use disorder in teens is approximately 8% in the US. Illicit drug use rate is 2-3%. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J J Am Acad Child Adolesc Psychiatry. 2010 Oct; 49(10):980-9. 

Neurocognitive Disorders Neurocognitive disorders refer to disorder with cognitive decline An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. 2021 Alzheimer's disease facts and figures pubmed.ncbi.nlm.nih.gov/33756057/ 

Personality Disorders Personality Disorders fit into one of three clusters: A Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder B Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder C Antisocial Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder 

Paraphilic Disorders Most people with atypical sexual interests do not have a mental disorder. To be diagnosed with a paraphilic disorder, DSM-5 requires that people with these interests: • feel personal distress about their interest, not merely distress resulting from society’s disapproval; or • have a sexual desire or behavior that involves another person’s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent APA APA_DSM-5-Paraphilic-Disorders (1).pdf 

Other mental disorders and additional codes Medication-induced movement disorders and other adverse effect of medication Other conditions that may be a focus of clinical attention. 

◦This part will include primary information about what to do if someone if struggling with suicidal ideation. 

◦45,797 Suicides in the US in 2020 ◦36,551 Males ◦9,428 Females ◦40,155 Whites ◦5,824 Non-whites 

Attempts: 1,149,475 Attempts in 2020 25:1 ratio of attempts per suicide 3:1 female to male attempt ratio 3.9:1 Male to female suicide ratio 

Groups with higher suicide risk: American Indian/ Alaska Native Whites Veterans People who live in rural areas LGBTQ young people According to the CDC 2021 

Means matter Firearms are used in more than 50% of suicides Suffocation in 29% Poisoning 13% 

Malcolm Gladwell, Town Gas, and Coupling. 

How to talk about suicide with someone who may be suicidal. 

You cannot control the outcome, but you can often make a difference. 3 Stories 

The importance of boundaries 

The importance of forgiveness