Mental disorder

The terms mental illness, mental disorder and mental health disorder and other synonyms apply to a wide variety of problems, each one of them with different characteristics. In general terms, they manifest as alterations in reasoning processes, behavior, the ability to recognize reality, emotions or the relationship with others, considered abnormal with respect to the reference social group from which the person comes. They do not have a single cause, but are the result of a complex interaction between biological, social and psychological factors. An underlying organic cause can often be identified and treated.

Patient assessments are performed by psychiatric or psychological professionals, using various methods, including psychometric testing, but often rely on personal observation and interview. Traditional treatments have been psychotherapy and psychotropic drugs, being added, since the psychiatric reform processes of the 1970s and 1980s, more comprehensive approaches related to the bio-psycho-social perspective. These treatments include social intervention work, help groups or mutual support (with or without facilitation by professionals in the psychosocial field of psychology, education or social work), self-help or lifestyle changes. In In the 1990s, the so-called recovery model began to be implemented in numerous countries, especially in the Anglo-Saxon sphere and especially in the United Kingdom and the United States.

Scientific evidence from nutritional psychiatry confirms that diet is a risk factor for the development of mental disorders, in all ages and countries. Likewise, it has been shown that both stress and psychological problems or psychiatric causes bad eating habits, affecting the quality of nutrition and causing various general health disorders and worsening mental health, entering into a feedback process.

The most common mental disorders include depression (affecting about 300 million people worldwide), bipolar disorder (about 60 million), dementia (about 50 million), schizophrenia and other psychoses (about 23 million). million) and developmental disorders, including autism.

Social stigma and mentalism (or sane) are forms of discrimination that are increasingly considered as factors that increase the psychological suffering and degree of disability associated with mental disorders. From the social intervention (work and social education, occupational therapy, community health, etc.) and the social movements of the group of affected people try to increase the understanding of these factors to avoid social exclusion and the difficulties that it entails for the recovery processes.

Terminology

Depending on the disease concept used, some authors consider it appropriate to use the term mental disorder in the field of mental health (which is the one used by the two most important psychopathology classification systems currently: the ICD-10 of the World Health Organization and the DSM-V-TR of the American Psychiatric Association), especially in those cases in which the biological etiology is not clearly demonstrated. In addition, The term mental illness is associated with social stigmatization and sanity. For these reasons, the term is out of use and more mental disorder or psychopathology are used. However, the term mental disorder has also been the subject of controversy and criticism along with the diagnostic system itself.

In his Dictionary of Fantastic Psychopathology, José Retik creates fantastic psychopathological entities by inventing their own pathologies. He was not the first to carry out this exercise. In 1995, New York-based psychiatrist Ivan Goldberg came up with the idea of playing a prank. He had read the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the so-called Bible of modern psychiatry, and decided to cheer up with a parody. This was taken seriously and ended up becoming a disorder called "Internet addiction disorder" (IAD, in English). The invention of mental disorders has been a recurring joke channeling criticism that has given rise to texts such as the "Proposition to classify happiness as a psychiatric disorder" by clinical psychologist Richard P. Bentall or the "Etiology and Treatment of Childhood" by psychiatrist Jordan W. Smoller in the satirical and humorous publication Journal of Polymorphous Perversity (Magazine of Polymorphous Perversity).

History

In ancient times, mental disorders were associated with supernatural causes. The most primitive cultures attributed them to demonic possession or natural forces and the most complex cultures to the gods. These primitive thoughts gave rise to the practice of cranial trepanation with the aim of "letting out the demons that caused the diseases". mental" and on which there is evidence dating back more than 5,000 years, to torture or the confinement of the sick.

In the 19th century, asylums were like prisons, since torture was only disguised as a cure, one of the The many cases were in the Charenton psychiatric hospital in Paris, where they applied as treatment, keeping them tied up, immersing them in cold water or beating them. All this to separate the ideas and illusions that these people could harbor.

In 1949, Antonio Egas Moniz received the Nobel Prize in Medicine for "for his discovery of the therapeutic value of lobotomy in certain psychoses", a technique that consists of removing Wholly or partly a fragment of the brain in front. Walter Freeman, an American physician, was the pioneer of transorbital lobotomies, a technique that he performed profusely and was involved in great controversy, until his last intervention in 1967.

At the same time, in 1964 the MK-ULTRA project was carried out, which sought to control the mind and thus erase existing memory and reconstruct thought, some of the experiments carried out were radiation, use of psychotropic drugs, simultaneous injection of barbiturates and amphetamines, and electric shocks to the brain. The only result of this experiment was to leave the people involved with brain damage.

Etiology

The prevalence of mental illness is higher in countries with greater economic inequality.

Co-heriting order between the different pairs of disorders.

It represents the two main pairs of disorders that show greater genetic correlation.

The exact cause of mental disorders is not known, although everything seems to indicate that it is the result of a complex interaction between various biological, social and psychological factors. High scores in neuroticism are predictive for the development of all common mental disorders.

At least a part of the cases of certain psychiatric disorders are secondary to an organic cause, the treatment of which can help to improve symptoms or even to partial or total functional recovery. People subjected to situations of stress, emotional tension or psychological or psychiatric problems neglect their diet and adopt harmful eating habits. This poor diet leads to poor nutrition that causes various general health disorders and also affects mental health, giving feedback to the process.

Poor physical health is a particularly important predictor of poor mental health. Mental health disorders are clearly related to the so-called "diseases of civilization" and they present differences by sex, sharing a multitude of pathophysiological pathways, including alterations of the immune system and oxidative stress. In any medical specialty, from cardiology and dermatology to gastroenterology and rheumatology, mental health is an important variable. However, recent research concludes that nutrition not only directly affects conditions treated in various medical disciplines, but also has the potential to influence (for better or worse) mental disorders.

There is evidence that confirms the involvement of genetic factors in certain psychiatric disorders. Specifically, 134 genes (206 variants) have been identified that are associated with an increased risk of developing major depressive disorder, anxiety disorders, schizophrenia, bipolar disorder, and attention deficit hyperactivity disorder. The most significant advances have occurred in the study of schizophrenia, with 50 genes identified. In contrast, only 3 genes have been found to be involved in anxiety disorders.

Classification

Even though mental disorders have classically been divided into Organic Disorders and Functional Disorders, referring to the degree of physiological or psychological genesis that determines the condition, clinical evidence shows that both spheres are not independent of each other and that in pathology, as in the rest of "normal" mental performance, both factors interact and correlate to generate the broad spectrum of human behavior as we know it. In fact, biological alterations alter the psyche, just as psychological alterations alter or modify biology.

According to the DSM-IV-TR, disorders are a non-exclusive classification by categories, based on criteria with defining features. They admit that there is no definition that adequately specifies the limits of the concept, lacking a consistent operational definition that encompasses all possibilities. A disorder is a behavioral or psychological pattern of clinical significance that, whatever its cause, is an individual manifestation of a behavioral, psychological, or biological dysfunction. This manifestation is considered a symptom when it appears associated with discomfort (for example, pain), with a disability (for example, deterioration in an area of functioning) or with a significantly increased risk of dying or of suffering pain, disability, or loss of freedom.

Other models posit that severe mental disorder is not something definable within some diagnostic category but rather a shift along a continuum between neurosis and psychosis. This position is defended, for example, by the psychiatrist and researcher Jim Van Os. It has also been suggested that the application of a biomedical diagnostic model is too reductionist and causes more problems than it helps in the analysis and treatment of some disorders that have roots and bio-psycho-social needs. Faced with the diagnostic model of biomedical origin, the Division of Clinical Psychology of the British Psychological Society has proposed the Power, Threat and Meaning Framework (PAS Framework).

A very common misconception is to think that the classification of mental disorders classifies people; what it really does is classify the disorders of the people who suffer from them. This bias related to the theory of labeling is one of the factors that receives the most criticism from the psychosocial perspective of the treatment of mental disorders in general and that affects especially serious ones (schizophrenia, bipolar disorder, etc.). The concept that is usually used for this problem is the so-called social stigma of mental disorders, but from the organizations of affected people they speak of saneness or mentalism since it is considered that the concept of social stigma does not indicate the discrimination that occurs within the own health, social or legal institutions in charge of their attention, protection and care. The implications of a psychiatric diagnosis can have serious repercussions on the person and their family and community environment, seriously hindering the process of social inclusion and recovery from their disorder or even aggravating the situation.

There are numerous categories of mental disorders, with greater or lesser severity both in the subjective experience of the individual and in its repercussion within social functioning, thus alluding to another classic classification: Neurotic Disorders and Psychotic Disorders.

• Neurosis has a greater impact on the subject's perception of himself, and on his level of liking, fullness and integration of the self, as well as on his relationships with the nearest social and family environment; however, they do not have the usual symptoms of disconnection with reality and widening of social life, they can work and academically, and according to Freud and psychoanalytic schools this state is the natural condition of psychic life.
• Psychosis, encompassing the most clearly associated manifestation with mental illness, its classic symptoms include hallucinations, delusions and severe affective and relational alteration, these disorders tend to have a fairly pronounced organic factor such as the Depressive and Bipolar Disorders, although schizophrenia are clearly those of greater personal, social and family repercussions given their chronic and degenerative character characterized by the characteristic elements of all psychotic disorders.

Differential diagnosis

The first step when faced with a patient with symptoms related to a possible mental disorder is to perform a complete clinical evaluation, to exclude or confirm the presence of an underlying or associated organic cause. There is a wide range of organic disorders that present with psychiatric symptoms or that can simulate a mental disorder. Its identification can be complex and an adequate evaluation of the patient is not always carried out. Sometimes, psychiatric symptoms develop before the appearance of other more characteristic symptoms or signs of the disease, as occurs in certain metabolic disorders, and may even be the only manifestations of the disease in the absence of any other symptoms, as occurs in some cases of celiac disease or non-celiac gluten sensitivity, so that a diagnosis is often not achieved correct or it takes years.

Some of the disorders that frequently present with psychiatric symptoms or can be mistaken for mental illness include:

• Endocrine disorderssuch as hypothyroidism, hyperthyroidism, hyperprolactinemia, premenstrual syndrome, menopause, postpartum psychosis, Addison disease, Cushing syndrome, Hashimoto encephalitis, hypopituitarism or male hypogonadism.
• Systemic, inflammatory and infectious diseases, such as celiac disease and non-Celiac gluten sensitivity (both often without digestive symptoms), systemic erythematous lupus, Sjögren syndrome, rheumatoid arthritis, psoriasis, antiphospholipid syndrome, Behçet disease, PANDES, sarcoidosis, tifoidosis, cycloid mononucleosis
• Gastrointestinal diseases, such as inflammatory bowel disease or Whipple disease.
• Metabolic disorderssuch as hypoglycemia, hyperglycemia, or congenital errors of metabolism.
• Neurological disorders, such as Alzheimer's disease, vascular dementia, Huntington's disease, Parkinson's disease, multiple sclerosis, Wilson's disease, toxic encephalopathies (caused by industrial or pesticide toxic substances), brain tumors, cerebral vascular accidents, chronic cerebral vascular diseases, or hydrocephalus.
• Infectious diseases of the brainsuch as meningitis, encephalitis or neurosyphilis.
• Hepatic failureLike liver encephalopathy.
• Kidney failuresuch as uremia or acute urinary retention.
• Respiratory diseases, such as asthma, pulmonary edema, pulmonary embolism, lung transplantation, chronic obstructive pulmonary disease (COPD), altitude sickness, hypoxemia, or hypercapnia.
• Heart disease, such as heart arrhythmias, heart failure, coronary artery disease, coronary baipás, mitral valve prolapse or heart transplant.
• Hematological diseasessuch as anemia, hypereosinophilic syndrome, thrombocytopenia, polycytemia, leukemia, or sickle cell anemia.
• Electrolytic or fluid disorderssuch as dehydration and insolation, hyponatremia, hypernatremia, hypocalcemia, hypercalcemia, or hypomagnesemia.
• Inadequate StatesB2, B6, B12 or vitamin D, folic acid or cinc, or Wernicke-Korsakoff syndrome.
• Metal poisoningsuch as lead, mercury, aluminum, manganese or copper.

Treatment

The first step in routine care starts with health care. It consists of carrying out a clinical evaluation of the patient, to try to identify and treat a possible associated organic disorder that causes or enhances the psychiatric symptoms, which can achieve the complete recovery of the patient or considerable relief of their symptoms.

The next step uses an integrative and multidisciplinary approach, involving psychiatry, psychology, social education, psychiatric nursing, social work, occupational therapy, and other interventions. Each treatment integrates, depending on the case, the administration of psychotropic drugs as palliative methods for the most pronounced symptoms, as well as a process of psychological intervention to address the origins and manifestations of the disorder and thus generate a more solid state of well-being. effective and permanent in people suffering from a mental disorder.^{[citation required]}

In OECD countries, the proportion of the working-age population that depends on disability and sickness benefits has tended to increase, with negative repercussions for those affected, their families, their employers and the society at large. general.^{[citation needed]} Workplace Disability Management (WPDM) is a comprehensive and cohesive approach, offering a wide variety of practices for employees who are injured or ill. These programs typically comprise multiple components, such as early contact, staff education, and occupational rehabilitation activities.^{[citation needed]}

A systematic review of 13 studies, eight conducted in the United States and five in Canada, evaluated the effectiveness of employment disability management programs in promoting return to work, however, it found no adequate evidence for quantitative synthesis. of the results, so it was not possible to reach a general conclusion about the effectiveness of these programs. It was also not possible to determine if it is some specific components of a program or if it is the set of these components that are driving the effectiveness. Further rigorous research is required, warranting a broader approach.