Introduction to serious mental illness

Introduction

  • Speaker: Dr. Suneetha Siddabattuni, Consultant Child and Adolescent Psychiatrist, Associate Clinical Subdean

Learning Objectives

  • Overview of nomenclature of serious mental illness

  • Knowledge of epidemiology of serious mental illnesses

  • Familiarity with the concept of psychosis

  • Awareness of available psychological, biological, and social treatments for psychosis

  • Reflection on the social, economic, and personal sequelae of serious mental illnesses

Case Study: Patient Presentation

  • Patient: 21-year-old male

    • Brought in by police for bizarre behavior

    • Hiding in shops, refusing to come out

    • Expressed feelings of being followed and threatened

Defining Mental Illness

  • Investigate the aspects and definitions of mental illness

Identifying the Specialist

  • Discussion around determining which specialist is appropriate for mental health treatment

Good Mental Health

  • An overview of common mental disorders

Psychiatric Diagnosis

  • Diagnosis Method:

    • Clinical interview process

    • Importance of history taking and Mental State Examination (MSE)

Components of History Taking

  • Key Areas:

    • Presenting complaint

    • Past psychiatric history

    • Medical history

    • Drug history

    • Family and personal history

    • Forensic history

    • Social history

    • Premorbid personality

Mental State Examination (MSE)

  • Key Observations:

    • Appearance

    • Behavior

    • Speech

    • Mood

    • Perception

    • Thought (form and content)

    • Cognition

    • Insight

Risk Assessment

  • Considerations:

    • Risk to self

    • Risk to others

    • Risk to property

Physical Examination

  • Conduct assessments and investigations as required

Diagnosis and Formulation

  • Formulation Aspects:

    • Biological factors

    • Psychological factors

    • Social factors

    • Identifying predisposing, precipitating, perpetuating, and protective factors

Diagnostic Manuals

  • Manuals Used:

    • ICD-11

    • DSM V

ICD-11 Mental Health Disorders

  • Overview of ICD 11 chapters related to mental, behavioral, and neurodevelopmental disorders

    • Listing of various disorders such as Schizophrenia, Bipolar disorder, etc.

Epidemiology of Psychosis

  • Key Concepts:

    • Prevalence: Measurement of proportion of cases per 1000 persons

    • Lifetime risk estimates

    • Differences in prevalence between countries

  • Incidence:

    • Annual number of new cases per 1000 persons at risk

    • Statistics for schizophrenia in the UK and USA described

Age and Sex Influence

  • Major Findings:

    • Onset can occur at any age

    • Common age of onset: 15-54 years

    • Gender differences observed during the onset ages

    • Discussion on WHO study findings related to sex differences

Inheritance and Genetic Risk

  • Heritability:

    • Identical twins have a 46% risk

    • Risk percentages for various familial relationships

Gene-Environment Interaction

  • Complex polygenic nature of mental illness with environmental contributions

Environmental Risk Factors

  • List of risk factors influencing mental health, e.g., maternal malnutrition, infections during pregnancy, etc.

Understanding Psychosis

  • Introduction to psychosis and relevant concepts related to symptomology

Positive Symptoms of Psychosis

  • Core Symptoms:

    • Delusions and thought interference

    • Disorganized thinking

    • Hallucinations and experiences of control

Negative Symptoms of Psychosis

  • Symptoms: Loss of motivation, social withdrawal, flattening of mood, and poverty of thought/speech

Differential Diagnosis Considerations

  • Key areas of focus in diagnosing psychosis

    • Consideration of brain diseases, metabolic disorders, substance use, mood and personality disorders

Treatments for Psychosis

  • Categories of Treatment:

    • Psychological, biological, and social treatments overview

Hospital Admission Protocols

  • Insight into how and when patients are admitted for assessment and treatment

Aetiological Theories

  • Focus on Neurochemical Factors:

    • Role of dopamine, serotonin, and noradrenaline in psychosis

  • Discussion on antipsychotic medications and their mechanisms

Side Effects of Treatment

  • Overview of complications and adverse effects associated with antipsychotic medications

Bio-Psycho-Social Approach to Treatment

  • Integration of biological, psychological, and social dimensions in patient treatment and care

Non-Pharmacological Treatments

  • Numerous interventions available such as cognitive behavioral therapy, family interventions, and supported living initiatives

Multidisciplinary Team Approach

  • Importance of a comprehensive care approach involving various health professionals

Understanding Social and Economic Sequalae

  • Reviewing implications of severe mental illness on personal and societal levels

Mortality and Morbidity Analysis

  • Summary of findings related to mortality rates in psychiatric patients vs. general population

Barriers to Healthier Lifestyles

  • Identification of personal and service factors that limit healthier lifestyle adoption among patients with severe mental health problems

Conclusions on Patient Well-being

  • Factors influencing good outcomes in patients with severe mental illness

  • Discussion of different outcomes in various countries