Monique Mavronicolas – Understanding Mental Health

The objective of this assignment is to demonstrate an understanding of mental illness. The aim of the assignment is to recognise factors that have influence on mental illness as well as demonstrating and understanding of major psychological disorders. The aims will also include an understanding of the range of strategies, treatment models and therapies of psychological disorders.

The World Health organisation defines mental health as: “A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.” On the contrary mental illness is defined by the World Health Organisation as: “Mental disorders comprise a broad range of problems, with different symptoms. However, they are generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others. Examples are schizophrenia, depression, mental retardation and disorders due to drug abuse. Most of these disorders can be successfully treated.”

Both the above definitions places great emphasis on more than one factor influencing our mental health or illness, but fails to distinguish the significance of an individual’s outlook and adaptability. People react differently to various situations due to the many factors that influence their daily lives. A person experiencing various problems at this very moment or in a specific day and could still be in good health as they see opportunity in their future. Others might experience the same issues and might not be able to manage it and therefore might feel they are not in good health. The impacting factors and versatility of humanity makes mental health an intricate phenomenon, associating it with many variant factors such as personality, self-awareness, self-acceptance, adaptability to circumstances and behaviour.

Evidence suggests that the two main factors that play significant parts in the contribution of mental illness is psychological and genetic factors. Evidence suggests that when people suffer extreme psychological trauma such as neglect or abuse, whether physical, mental or emotional, it might contribute to mental illness. This could or might not start from childhood but could also develop later in life. Loss is another a factor that triggers mental illness; the loss of a loved one, especially the loss of a parent or child has a huge impact on our mental, physical and emotional well-being. Other psychological factors may include; not being able to relate to other people and/or coping with live changing situations such as divorce and the birth of a child, all of which have influences on one’s mental and emotional state.

One of many studies regarding genetic influence in the progress of mental health shows the significant influence genes have on mental health. In these studies researchers have found that people with disorders such as ADHD, bipolar disorder, autism and schizophrenia to name a few, had genetic variation within the four identical chromosomal sites which included two genes that regulated the movement of calcium into cells. (https://www.youtube.com/watch?feature=player_embedded&v=8SDKV29NPaE) There is also evidence to suggest that due to the hereditary of our genes, the chances of mental illness is escalated within a family. This however should not be confused with hereditary physical conditions, that as a result of the condition may lead to mental illness, however physical conditions is often triggers that will impact your state of mind and also lead to mental illness. Experts believe that the predispositions of some mental illnesses within families are linked to the abnormalities in some genes, with that said all individuals are unique and respond differently to environmental circumstances. So even though one is susceptible to the inherited gene, it might not develop into a mental illness. As mentioned earlier, there are many triggers that could attribute to a mental illness regardless weather one has the predisposition of the heredity genetics.

Researches have suggested that as for 2002 a person’s genes have the ability to effect the development of mental health disorders in three major ways. Organic causes of some

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disorders may be influenced by our genetic predisposition as well as the irregularities in one’s development before and after birth. Genes may also have an influence on the vulnerability to substance abuse, anxiety and even personality disorders. (Frey 2011).

Apart from psychological and genetic factors, mental illness affects and is affected by demographical factors such as age, gender, class and race to name but a few. Ageing is inevitable but mental illness is not part of normal ageing. Unfortunately due to various lifestyle changes when one gets older, some are affected more than others. Mental illness is complex and not one of the most understood topics, to the point where the elderly will not acknowledge the mere existence of it. The elderly are often hesitant to seek medical and psychiatric help due to their reluctance. This may be due to the fear of being labelled or ashamed of having a mental illness. The fear of something because they don’t understand it including the fear of what would happen to them should they be mentally ill. Then some elderly fear the burden they place on their children and others just believe that mental illness it is part of the aging process.

According to the UK Mental Health Fundamental facts older people are less likely to have a neurotic disorder, other than depression. UK Mental Health Fundamental facts states: “…of the British population, 10.2% of those aged 65-69 and 9.4% of those aged 70-74 have a neurotic disorder, compared with 16.4% of the general population. Depression affects 1 in 5 people over the age of 65 living in the community and 2 in 5 living in care homes…” (NICE 2004)

Various factors could assist in the development in different disorders in elderly. Retiring could be extremely stressful to some as they might not be as financially stable as they need to be, apart from financial stress, when we retire the social part of our lives that were influenced by our work colleges might not continue. There are three distinct mental disorders that shadows the elderly; depression, dementia and Alzheimer’s.

Depression is a common type of disorder in people over the age of 65, this could however affect any one at any age. The elderly are merely more susceptible due to various reasons, including, loss of spouses, retirement, physically not being able to accomplish what they use to and feeling isolated or being lonely. Other factors may also include the neurobiological changes that take place, side effects from medication and mostly the predisposition of genes becomes more and more susceptible with age. Older people often take different medications, some one or two other many more, increasing the risk of confusion. (Mental Capacity Act 2005).

Dementia is one of the metal illnesses that affect predominantly the elderly and the reason for this is because the ones that affect the elderly are neurodegenerative diseases, meaning they get worst over time. The best known form of dementia is Alzheimer’s and accounts for two thirds of the diagnosed cases in the elderly in the UK.

There is a couple of evolving mental disorders in childhood that are associated with genetic disorders. Some childhood genetic disorders lends itself to behavioral phenotype with a set of behavioral characteristics that include behavioral problems, cognitive development and social adjustments. Examples of behavioral phenotypes are those associated with Down, Prader-Willi, and Williams syndromes. Children with Down syndrome also have an increased risk of developing early-onset Alzheimer's disease.

Gender is another demographic factor that has indicated a statistical difference in mental health issues. One needs to make a distinction between low-prevalence, high-prevalence and severe mental disorders, as to date, there has been no consistent statistical data regarding gender in all three prevalances. Depression and alcohol dependency (high-prevalence disorders) do however lend themselves to the most robust findings of gender

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differences and have had consistent gender differences statistical rates reported. However beyond these statistical rates of the actual disorder, gender often has huge differences in risk and susceptibility of mental disorders. Studies show that women experienced greater occurrences of hallucinations than men (Lindamer et al. 1999) and were also more likely being hospitalised during manic phase of depression (Hendrick, Altschuler, Gitlin et al. 2000).

Although actual suicides rates in men were higher, a nine country study reported that women had consistently higher rates for parasuicide (Weissman, Bland, Canino et al, 1999).

The multi-country WHO study on Psychological Problems in General Health Care also found that current panic attacks and a diagnosis of panic disorder were frequently associated with the presence of a depressive disorder. Women however predominated in all three disorders- panic attacks, panic disorder and depressive disorder. The combination of these disorders resulted in a long lasting and severe disorder that was linked to a higher rate of suicidality. (Lecrubier & Ustun, 1998). All the studies reported that women were more likely to report their symptoms and illnesses related to mental health, whereas men tended not to report their mental health problem due to various reasons, including stigma.

There are distinct differences in the way cultures may deal with the mental health and mental illness. In order to understand how cultures deal with mental illness and one needs to understand the ‘norm’ within the culture, also understanding that within the culture their will also be differences in other demographics within the culture. Just as they might understand or deal with it, different cultures have different treatment methods. Treatment would therefor vary from culture to culture. Examples of the differences in cultures that impact mental health and illness would include cultures from Asia, India and also

Asian has a significant extended family influence, whereas the oldest male in the family is often the decision maker and spokesperson. The interests and honour of the family are far more important than the individual family members. They don’t always recognise western medicine as it focuses on an assumption that external factors (i.e. bacteria or virus) needs to be treated and that disease is either mental or physical. Within their cultural believe, Eastern medicine assumes that the body is a whole, mental and physical is one and each part of the body is connected. Therefore if an individual’s behaviour reflects on the family, any illness or mental illness may therefor produce shame or guilt. These patients may be reluctant to discuss these things due to the shame or guilt denying them the access to health care available.

Within the Indian culture there is often reluctant to accept any diagnosis of mental or emotional illnesses as this could reduce the chances of other members within the family of getting married. They make use of faith and spiritual healing rituals and believe that meditation and yoga could eliminate certain physical and mental illnesses. The very religious Hindus believe that disease is due to one’s actions in past lives, due to karma.

Religion also has an impact on our mental health, Iulia O. Basu-Zharku wrote “health behaviours (through prescribing a certain diet and/or discouraging the abuse of alcoholic beverages, smoking, etc., religion can protect and promote a healthy lifestyle), social support (people can experience social contact with co-religionists and have a web of social relations that can help and protect whenever the case), psychological states (religious people can experience a better mental health, more positive psychological states, more optimism and faith, which in turn can lead to a better physical state due to less stress) and ‘psi’ influences (supernatural laws that govern ‘energies’ not currently comprehended by science but possibly understandable at some point by science). Because spirituality/religion influence health through these pathways, they act in an indirect way on health (Oman & Thorensen, 2002)” All the health behaviour mentioned above have some influence on mental health.

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Poverty is another demographic factor that influences mental health. Financial problems can be both a cause and a consequence of mental health problems. People with mental health problems are three times as likely to be in debt as the general population and more than twice as likely to have problems managing money. Financial strain could lead to anxiety and depression. Poverty influences life chances significantly and has a huge impact on mental health. Poverty shortens lives; statistics clearly shows that a young boy in Manchester can expect to live seven years less than a boy in Barnet. In the same report they indicated that a girl in Manchester can expect to live six years less than a girl in Kensington, Chelsea and Westminster. Apart from life span, children in poverty are born smaller with birth weights, averaging on 130 grams lower than children from high social classes. Low birth weight is associated with infant death and chronic diseases in later life. Poverty also shapes children's development. Age 0-2 for a child from a poorer family is already more likely to show a lower level of attainment than a child from high social class. Whereas children age 0 -14 from unskilled families are 5 times more likely to die in an accident than children from professional families. Children growing up in poverty are more likely to leave school at 16 with fewer qualifications.

Homeless children are up to 75 per cent more likely to have mental health problems, even one year after being rehoused. In 2005/06 there were 7,340 homeless people experiencing mental illness, more than double the number 15 years earlier. The percentage of homeless people judged to be homeless and vulnerable due to mental illness or disability raised from 3.25 per cent in 1991 to 7.8 per cent in 2006. The sad reality is that less than a third of homeless people with mental health problems receive treatment and 128 one in four homeless people will die by suicide. Behavioural problems have been found to be higher among homeless children living in temporary accommodation, and mental health problems are significantly higher among homeless mothers and children.

There is inequality in the diagnostic rates associated mental illness in health. The diagnosis affected by race prejudice is often because of a person's experience in having a “mental illness” which is often affected by race. Due to people associating the assumption of one’s character with the basis of race and cultural influence, the occurrence of racial profiling takes place. Similar assumptions take place in racial mental health due to communication, appearance and previous diagnosis. Afro-Caribbean’s are diagnosed with schizophrenia more than any other racial group, this is often associated due to poverty and racial discrimination. Another stigma that is associated with Afro-Caribbean’s are that of alcohol abuse and drug abuse, but carries no statistical or empirical value. As in racism, if the person who is being psychiatrically discriminated against due to racially motivated questions or even challenges the discrimination and their mistreatment, they are likely to be further discriminated against or punished for their lack of compliance.

Investigating mental ill health on demographic factor is of great knowledge, however, one should include an analysis of how heredity and environmental factors could also influence psychological disorder to get a clearer picture of influences. With many causes to psychological factors there is multifaceted relationships between environmental factors and genetics, with specific risk factors to different disorders. Some risk factors include, poor nutrition, culture, abuse, poverty, war, stress and exposure to toxins. Even though none of these risk factors can contribute to the development of a psychological disorder, but combined with genetics could have an impact. Mental illness is often more identifiable in people who has a genetic history. The genetic risk combined with your life’s environmental factors may trigger the development of psychological disorders. Apart from your current life situation, some psychological disorders could be linked to viruses, toxins, drugs, and alcohol during the time in the womb. Other factors that might also trigger mental illnesses are hormonal imbalances within the brain and other bio brain chemistry. Some physical causes

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such as brain injury (damage to the prefrontal cortex), drug abuse and even birthing trauma could also affect brain chemistry and contribute to mental illness

There are many different strategies that are suggested to individuals with mental illness that could assist in the management of the illness as well as the recovery process. Most strategies will include a healthy diet, avoiding drugs, over consumption of alcohol and exercise, however, when one looks at the individual and their specific needs, a comprehensive strategy will be suggested.

In 2008 a Foresight report suggested that five daily actions was important for one’s well-being and could assist in the prevention of mental ill health. Social connection was at the top of the list, suggesting that we connect with the people around us, which include family, friends, colleagues and neighbours. Whether this is at school, work, and home or even in your local community, these are the cornerstones of your life and one should invest time in developing these relationships. By building the connections the relationships will enrich your everyday life and your support function.

The second action was to stay active and finding a physical activity that is enjoyable and that suits your mobility and fitness. This could include going for a walk, run or cycle, or even going dancing or playing outside with the kids. Exercise releases happy endorphins that makes you feel good and lifts your spirit.

Being attentive and taking notice of your surroundings and emotions was third on the report. Reflecting on one’s experiences and the shared moments, whether it was walking through the park or eating lunch with friends. Remembering the positive things that take place around us every day has a huge input in our well-being. Taking time to enjoy the simple pleasures of life such as sunshine and the beauty of flowers, relaxing and breathing fresh air all contributes to our well-being.

As we grow older we have a need to develop and learning something new or rediscovering an old interest not only increases our confidence but is also fun. And last but not least is giving. When we give, whether it is a smile, a thank you helping a friend or volunteering in our community is incredibly rewarding and creates connections with other people.

The report concluded that even the attempt to incorporate the 5 actions daily, led to happier healthier lives. Apart from the aforementioned strategy, individuals that suffer with mental illnesses could also include specific related strategies to assist them in managing their illness and increasing their mental health.

People that suffer with psychosis could also try and talk to people they trust about their worries and get support from family and friends. Keeping a diary and identifying what causes their stress and documenting the best ways to deal with it or avoid stressful situations could also benefit them. This could also investigate the ways they could manage stress. This could be done through either alternative or complementary therapies that could include acupuncture, reflexology, hypnotherapy and meditation. Making time to relax, by doing something enjoyable could take their mind off things that cause them to worry. Keep physically well, following a good diet by cutting down on takeaways and fried food and eating of fruit and vegetables every day, and take regular exercise will also help.

Nutrition There is growing evidence that diet plays an important role in specific mental health problems including Attention Deficit Hyperactivity Disorder (ADHD), depression, schizophrenia and Alzheimer’s disease. A balanced mood and feelings of well-being can be protected by a diet that provides adequate amounts of complex carbohydrates, essential fats, amino acids, vitamins and minerals and water.

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Apart from mental health strategies that promote an individual’s well being, there are many protective factors that play a role in the good mental health or the contribution there of. We all experience sadness, unhappiness, stress and grief at some or other time. The only individual difference is how we deal with these factors that cause our mental equilibrium to weaken.

Our mental health is often impacted by the value we put on our sense of self. Self-esteem is the self-worth we experience and influences our daily lives. Just as the notion of being loved and feeling valued, impact our self-esteem, it also allows us to feel secure and enables us to communicate and develop positive relationships. This in turn encourages confidence in oneself, which could lead to more positive attitudes and happier lives. However, poor physical health could affect self-esteem and this often leads to the lack of ability to meet ones goals, which could in turn lead to unhappiness or a mental health disorder.

On the flip side of the coin, just as the above factors influence out positive outlook, the loss of a loved one could have the opposite effect. Coping with changes such as loss could influence our mental health in an instant. People either internalise their feelings or act it out. Some people cope well with managing this but others tend to display problematic behaviour and inappropriate actions which could include anything from verbal abuse to damaging the property of others.

Abuse is one of the greatest risk factors of mental illness whether it is during childhood or adulthood and comes in various forms; verbal, sexual, physical and psychological. Abuse can causes significant knock on effects that could lead to very serious psychological disorders.

There are also social and family factors that could include isolation that would lead to limited social networking or building relationships. Also the lack of support one receives from ones family could also influence ones mental health. The cultural factors that we are raised in could also have an impact (FMG) on one’s mental status.

There are so many factors that could either benefit our mental health in either a positive or negative way and the above is but a mere drop in the bucket.

The next part of the assignments focus will shift to the identification of five different mental illnesses, including the identifiable signs, symptoms, effects, severity, the impact of the illness on life, treatment models and specific ways to reduce the impact of the illness on mental health.

The information provided will be in line with the DMS 5 referring to the clinical classification categories of each disorder. The DMS 5 is a diagnostic and statistical manual that lists mental disorders (DSM) used by clinicians and researchers to diagnose and classify mental disorders. Anorexia Nervosa

Anorexia Nervosa falls under the umbrella eating disorders in the DMS 5 and is one of five disorders in this category. The DMS 5 categorizes it as: “characterized by a person’s refusal to maintain a minimally normal weight for one’s age and height, or failure to make the average weight gain over a period of growth”. A person suffering with AN has a biased view of their body and misconstrues their body image. They have a constant fear of gaining weight and in the process keep losing weight, this behaviour is linked other psychological drivers.

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There are two major types of Anorexia Nervosa; binge-eating/purging type and the restricting type. There is no specific type of person or personality that the disorder affects, however is more common in females and people who have body image lifestyles including adolescents.

The table below indicates the symptoms associated with Anorexia Nervosa.

Behavioural Symptoms

Physical Symptoms

Psychological Symptoms

Family and Developmental Characteristics

Findings on Physical Examination

Weight loss (< 15 % of ideal weight, including growth)

Cold intolerance Perfectionism

Super-normal pre-adolescent development

Vital signs: bradycardia, hypotension

Intense fear of becoming obese/ gaining weight

Dizziness Other-directedness Overachievement Cardiac: arrhythmias,

myopathy, CHF

Preoccupation with food, calories, weight

Hair loss/ lanugo hair Ineffectiveness

Achievement for acceptance in family

Skin: Dry, hair, pasty

Preoccupation with size of particular areas

Muscle wasting, cramping

Deficits in body image/ self-image

“Psychosomatic family”

GI: malabsorption, ulceration

AmenorrhoeaAvoidance of sexuality/ intimacy

Overprotection Renal: diabetes insipidus, failure

Over-activity

Emotional constriction, ascetic, little pleasure

EnmeshmentMusculoskeletal: Osteoporosis, high risk

Eating obsessions/ rituals

Rigidity Extremities: Muscle wasting

Conflict avoidance Labs: Low protein, anaemia

Focus on food/ eating or exercise in family

As the above table indicates the most obvious sign of Anorexia Nervosa is the malnourished appearance. Due to the restriction of food intake, Anorexia Nervosa causes dizziness and a severe lack of energy. Other symptoms that might not be as obvious includes, dry hair and skin with hair loss brittle nails, hypotension and cardiac arrhythmias.

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Acute Management of Complications

Individual Psycho-therapy

Nutritional Approaches

Behavioural Approaches

Group Therapy

Family Therapy

Adjunctive Modalities

Acute management of severe malnutrition/ complications critical before any psychotherapy

Cognitive-behavioural as well as insight-oriented

Clarification of distortions about food, weight

Milieu approach: Meal expectations, purge/ exercise prevention, gradual return of control (level system)

Types: support, process, cognitive-behavioural

Active, confronting and supportive techniques

Occupational therapy

Electrolyte/ fluid replacement

Cognitive focus: binge prevention, reframing of body image, problem solving, social skills

Clarification of feelings when eating/ binging

Stress reduction, desensitization (meal outings, meals in controlled social settings with decreasing structure)

More indicated with bulimics, adult patients

Combination of structural, systems, insight approaches

Art Therapy

Protein/ nutrient replacement, Address GI, cardiac, renal, reproductive problems

Focus on self-definition and definition of internal states; support early recognition of feeling states

Emphasis on healthy eating/ nutrition, not weight gain

Food intake/weight contracts

Reduce isolation, sense of uniqueness. Consider Dialectic

Expression of feelings/ needs and negotiation of boundaries

Psychodrama

Suicidality and SIB

Interpretation of maladaptive defences early

Development of comfort with food preparation

Self-monitoring of food intake/ feeling states, binge/ purge episodes

Mutual support and sharing of insights

Conflict resolution/ assertiveness training

Movement therapy

Parenteral re-feeding only in critical state (can create more complications; fine homeostasis)

Manualized therapies: binge eating reduction

Confort with socialization around meals

Conflict resolution, assertiveness, social skills

Promotion of flexibility in problem solving

Recreational Therapy

Gradual weight restoration indicated (physically and psychologically)

Rapidly move to interpersonal expression of conflicts and skills gained

Avoid power-control struggles

Expression of feelings/ needs and negotiation of boundaries

Resolution of past losses, traumas in family

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Treatments will depend on the type of Anorexia Nervosa that the person suffers with, but it’s often fundamental that one’s family (if not part of the psychological issue) is essential to the treatment. Family based treatment (FBT) is a popular treatment method and have better results and recovery figures that individual treatment (Le Grange et al., 2012) especially for those with more severe cases. When the focus of the therapy is shifted towards interfamilial forces at work within a family the success and maintenance of the treatment is higher (Godart et al., 2012).

Cognitive behavioural therapy is also a very popular treatment in Anorexia Nervosa, but unfortunately has a high relapse rate. CBT-E is an Enhanced form of Cognitive behavioural therapy especially designed for treatment of eating disorders and works as a four stage plan treatment plan. The aim of CBT-E is focussing on specific theoretical model of the psychological and behavioural mechanisms that underlie and maintain the eating problems. The therapy itself focusses on setting realistic opportunities and identifies potential setbacks and how the person will respond to the setback. It is individual focussed therapy but includes the therapist as part of the team helping the individual to change the future of their behaviour towards eating with a minimum of 20 weeks in therapy. After therapy CBT-E also has a relapse plan in place as the fourth stage.

The biopsychosocial model would also be considered as a treatment model for anorexics in conjunction with CBT-E and FBT. The biopsychosocial model states that the workings of the body can affect the mind, and the workings of the mind can affect the body. Anorexia Nervosa as the model suggests, has influence from; the biology of the individual (chemical imbalances), behavioural factors (lifestyle, stress, health beliefs) and social conditions (family relationships, social, support).  All three therapies might be extremely successful but takes a long time and could be very costly.

Anorexia Nervosa could have serious effects on one’s physical and psychological well-being. Physical complication may include but is not limited to a hormonal imbalance (females - the absence of menstruation, males – decreased testosterone), heart problems (including mitral valve prolapse), weakening bone and bone loss, sever kidney problems and damage to the brain. Psychological effects may include depression, anxiety, personality and obsessive-compulsive disorders. In addition to these negative effects alcohol and substance misuse often goes hand in hand with the effects Anorexia Nervosa.

Anorexia Nervosa has the highest mortality rate between the eating disorders listed in the DMS 5. With damage and failure to organs, anorexics have a higher risk of premature death (Franko, 2013).

Day to day life could be extremely difficult for those suffering with anorexia, every individual will experience the impact differently. A sufferer of 37 years described her day to day living as follows: “…for me, it basically controlled me to the point it was what I thought about all day and every day, everything I did revolved around my obsession to diet. In the end I drove everyone away from me because I was always so grumpy and exhausted, I never had any energy to do anything, I was always so out of it and couldn’t even focus the only thing I had the energy to do was sleep. I now regret how much time I wasted and I regret making those around me that love me worried constantly it’s one of the hardest things to go through because its unexplainable, it’s like your taken over and your health is just too important to risk, my thoughts are with those suffering” (Kimmie 2011)

The road to recovery for anorexia suffers start with acknowledging that you have a problem and asking for help. Speaking to someone about it and giving them as much information as possible regarding your circumstances and the history of your journey is of vital importance. Understanding that recovery is a long term plan and setting manageable achievable goals is

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important. If the evaluation reveals health problems, they should take top treatment priority. Nothing is more important than your physical well-being As soon as possible treatment needs to start and finding a professional counsellor or nutritionist who specializes in anorexia near you is of vital importance. Making sure one selects a professional that makes one feel comfortable, accepted, and safe, is a big step into reducing the impact of the disorder and the recovery process. Apart from the aforementioned, joining a support group is vital in recovery and impacts mental health positively.

Apart from the above there are various other self-help advice that eating disorder suffers could follow to improve and manage their mental health.

Substance/ Medication-Induced Major or Mild Neurocognitive Disorder

The principle attribute to neurocognitive disorders is the developed cognitive deterioration of one or more cognitive domains. The decline cannot merely be a sense of loss but rather evident to others and tested. They affect ones attention, language, memory and perception to name but a few.

Visible signs of neurocognitive disorders could be anything from loss of memory, significant change in attention, not being able to remember words when trying to explain things to perceptual-motor cognition. Others signs include when the person suffering with the disorder starts requiring assistance in daily activities, including handling or paying bills.

Substance/ Medication-Induced Major Neurocognitive disorder ((previously Substance-Induced Persisting Dementia) is diagnostic name for alcohol or drug induced major neurocognitive disorder. Delirium is a syndrome of changes in attention perception (i.e., vision and hearing), and thinking that is commonly seen in the hospital setting or during an acute illness. Delirium usually starts abruptly, over the course of hours or a few days, and has a fluctuating course. There are many causes of delirium, but the most common are medications. Dementia, on the other hand, is a chronic alteration in thinking that beings more insidiously, sometimes progressing over a course of months or years. It is more common the older you get. However, this does not mean that dementia is simply due to "old age."

Alcohol is predominantly linked to major neurocognitive disorder, affecting recollection of past events, battling with newly acquired information and confabulations. In some instances, suspending alcohol use leads to improvements in cognitive functioning; oftentimes, however, the damage is permanent and irreversible. These disorder is linked to long-lasting effects of alcohol on brain functioning.

Prolonged drinking could increase the frequency of dysphoria, anxiety, and such violence potential. Symptoms of alcohol withdrawal include agitation, anxiety, tremor, malaise, hyper-reflexion (exaggeration of reflexes), mild tachycardia (rapid heartbeat), increasing blood pressure, sweating, insomnia, nausea or vomiting, and perceptual distortions. Even after a few days of no alcohol consumption some will experience continuous mood instability, fatigue, insomnia, reduced sexual interest, and hostility for weeks, also known as protracted withdrawal.

Alcohol-induced deliriums after high-dose drinking are characterized by fluctuating mental status, confusion, and disorientation and are reversible once both alcohol and its withdrawal symptoms are gone, while by definition, alcohol dementias are associated with brain damage and are not entirely reversible even with sobriety.

Apart from alcohol induced deliriums, drug toxicity could also cause neurocognitive induced disorder. Almost any drug can cause delirium, especially in a vulnerable patient. The

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medicine that is known for most causes of dementia is long-acting benzodiazepines. Anticonvulsants is another drug that can cause delirium and dementia.

Because cognitive impairment caused by drugs is so frequently overlooked, it is important that when symptoms of confusion, altered concentration or difficulty thinking occur that the person taking the medication reports the changes to their doctor.

Depression

Depression falls under the umbrella depressive disorders in the DMS 5 and is one of many disorders in this category. The DMS 5 categorizes it as: “state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and sense of well-being” (DMS5). The disorder causes one to feel worthless and/or hopeless, that often causes unhappiness and feelings of despair. There are different types of depression e.g. reactive (neurotic/exogenous); psychotic/endogenous; post-natal depression.

There are various signs and symptoms but most commonly affects ones social, physiological and mental state. Symptoms of our mental state include; poor concentration, impaired memory, slow and impoverished speech, sluggish thought processes, depressed mood, apathy, auditory hallucinations, depersonalisation, suicidal ideas, hopelessness, guilt and poor self-image. Other symptoms that has an impact on our physiological being include; tiredness, sleep disruption, loss of appetite, weight loss, slowness of pace when walking, stooped posture, restlessness/tearfulness and often constipation. The social impact of this disorder makes one avoid others, trends of wanting to stay in bed is popular and one often makes poor company so others in order to avoid.

There are various treatments for depression and the medical treatment (based on the Medical model) is often anti-depressant medication. The medication will improve some of the symptoms of the disorder but almost never address the underlying causes of depression. However when medical treatment is combined with other therapies such as counselling and cognitive therapy it tends to be more successful.

Other therapeutic treatments could include Therapeutic communities, family therapy, cognitive-behaviour therapy and psychotherapy are treatment approaches used in aiding recovery.

One of the most controversial forms of treatment for severe depression is electro convulsive therapy (ECT) although there are different opinions about the success of ECT in the long term. Just as medication ECT could also have severe negative effects such as memory loss and the process is extremely distressing to the sufferer.

There are different degrees or severities of depression; mild moderate or severe, all of which requires medical assessment. Severe depression could cause extensive amount of anxiety and suffering. The disorder becomes so severe that one is often not able to continue with daily activities such as work, domestic activities and socialising. Severe (or Major) depression usually causes severe enough symptoms for a change to be noticeable by those around us even if we try to mask how we are feeling. Suicide is not only a distinctive aspect of the thought patterns of a severely depressed person but the most important danger to themselves. People with severe depressive episodes may also suffer from delusions, hallucinations or depressive stupor although these are less common.

Depression has a huge impact on one’s daily life, basic things like laundry, dishes and unopened mail are some of the starting points. One tends to stop looking after oneself, including ones diet and basic appearance. Exercise (which is a fundamental part of managing depression) is almost first to disappear from ones daily routine. Drugs and alcohol is often used as a feel better solution. The lack of sleep makes the person even more tired and hopeless for the future. You’ve pretty much stopped eating, or caring what you eat and whether it tastes good. Often suffers stop eating and avoid communication with others.

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The impact of depression on one’s daily life is excessive and often unbearable for the sufferer. But there are ways that those who suffer from depression could reduce the impact of the disorder on their mental health. Early intervention in the lives of those who suffer with depression to promote healthy lifestyle and behaviour change can reduce the health-risk behaviours they practise. The cessation of smoking will improve their mental health by reducing; the risk of physical illness, depressive symptoms and in most cases will allow the reduction of psychiatric medication. Physical activity results in improved subthreshold, mild and moderate depression and improves well-being (NICE 2009); in school-aged children it leads to better cognitive performance (Sibley et al. 2003) and in older people to better mental health outcomes (NICE 2008).

The well-being and spirit of those suffering with depression could be enhanced through a balance between mental and physical activity and a number of other activities such as; lifelong learning, psychological therapies, positive psychology, spirituality and religion, leisure activities, participation in arts, creativity and participation in volunteering activities.

It is vital that professional help and treatment is sought as soon as possible and that treatment is adhered to. As with all major illnesses, during severe depression one need additional support on a daily basis both in managing the symptoms and to provide help with treatment.

Narcissistic Personality Disorder

Narcissistic Personality Disorder falls under the umbrella of personality disorders in the DMS 5. The DMS 5 categorizes it as: “A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts” (DMS 5).

The symptoms of the disorder is indicated by more than 5 of the following; the sufferer has a grandiose sense of self-importance, is often engrossed with unrealities such as unlimited success, power, brilliance, beauty, or ideal love, believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people, have need for unwarranted and disproportionate admiration. Apart from the aforementioned the sufferer often has irrational hopes of particularly favourable treatment and will takes advantage of others to achieve their own agenda. They are often is unwilling to identify with the feelings and needs of others and may believe that others are envious of them. Others often perceive them as arrogant with self-important, conceited behaviours and attitudes.

Narcissists have the capability to justify their problems and often blame someone or something for them. It is not often that they will take any personal responsibility for their actions of issues.

The causes of Narcissistic personality disorder is not well-understood but suggestions are that genes play a significant role with influence from environmental factors. Inherited traits emerged in part due to natural selection for promiscuous sexuality. Some people develop into narcissists because of self-reflection on largely heritable traits. Cultural factors also may bring-about narcissistic qualities as well as media personality profiles.

Treatment is rare as most narcissists not only avoid therapy but believe they don’t require any. I first phase in treatment include the suggestion of empathy and care for others, this will in turn tone down their narcissism. Social groups also have an impact on people that have narcissi behaviour.

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Monique Mavronicolas – Understanding Mental Health

The treatment model best suited for Narcissistic personality disorder is the psychosocial model. The model provides insight into the directions of healthy development across the lifespan and explains culture and its affects towards development. It also considers individual differences and can identify predictable tensions by way of socialization and maturation (Mavronicolas 2015). The impact culture has on development, needs 2 be elaborated in the sense that other factors have an impact too. The model suggests that due to a life stage circumstances a person is negatively affected but not everyone responds the same way and not achieve their full potential will not mean that one will suffer from mental illness. (Mavronicolas 2015)

Psychotherapy may be useful in getting the individual with narcissistic personality disorder to relate to others in a less maladaptive behaviour, this typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder.

Medications may also be prescribed to help with specific troubling and debilitating symptoms. In severe cases short term hospitalisation is suggested to those who are quite impulsive or self-destructive, or who have poor reality-testing.

The impact the personality disorder has on one’s life could generate substantial difficulties, and often include one or more of the following; alcohol or drug abuse, depression, anxiety, frequent relationship conflicts with significant others, friends, family members, co-workers, and employees or employers and in severe cases suicidal tendencies.

Sufferers of narcissistic personality disorder will often be defensive about treatment and will often see therapy as a waste of time for everyone involved. In order to reduce the impact the disorder has on one’s mental health the sufferer needs to be committed to recovery and ensure that their lifestyle reinforces the changes suggested. Attending therapy sessions and take any medications as requested will be the first action needed to be taken. Learning relaxation and stress management techniques such as deep breathing exercise, meditation, yoga or tai chi can be very soothing and calming. These in the long run will assist with the need to want more and wanting to be more. Learning about one’s disorder is always a great way to reduce the impact it has on one’s mental health. By understand the risk factors, symptoms and necessity of treatment for narcissistic personality disorder, and education oneself about the condition could assist with triggers and identification of the disorder. This may help identify behaviour and ways of thinking in a different light.

Schizophrenia

Schizophrenia falls under the group of psychotic disorders in the DMS 5 that is characterised by distortion in rational thinking and behaviour. Schizophrenia is the most common form of psychotic disorders and inception is typically between the ages of 15 to 30 years.

Cause of schizophrenia is unknown, however genetics may have a role through the action of definite neuro-transmitters.

The signs and symptoms of schizophrenia often goes unnoticed until the sufferer stars experiencing delusions and/or hallucinations. Other signs and symptoms could include: the belief that thoughts are being controlled or heard by others, self-delusions, social withdrawal, emotional dampening, neologisms and/or word salad and the living in a fantasy into a fantasy world.

The DMS 5 lists various forms of schizophrenia: “including acute, catatonic, childhood, disorganised (hebephrenic) and latent schizophrenia” (DMS 5).

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Monique Mavronicolas – Understanding Mental Health

The treatment for schizophrenia is mostly based on the medical model but could include other therapies. In severe cases preliminary treatment often takes place in a hospital, using anti-psychotic drugs to relieve symptoms immediate symptoms. Once the symptoms are under control, the sufferer will often return into the community with the appropriate support.

Tranquilisers or neuroleptics are psychotic medication to relieve symptoms such as hallucinations and aggressive or agitated behaviour and assist in aid of therapy such as psychotherapy.

Examples of anti-psychotic drugs taken orally include Clozapine (Clozaril), Droperidol (Droleptan), Amisulpiride (Solian), Chlorpromazine (Largactil) and Risperidone (Risperidal). Schizophrenics often require medication to manage their daily lives, however, this is not enough due to the stigma connected to schizophrenia. Support groups and t

With medication, therapy, and a strong support network, many people with schizophrenia are able to control their symptoms, gain greater independence, and lead fulfilling lives.Unfortunately there are immense effects on schizophrenic’s lives due to the disorder. Paranoia and social withdraw often impacts on one’s relationship as one becomes suspicious of friends and family. Other symptoms such as delusions, hallucinations and disorganised thoughts make normal day activities hard and often deters them from bathing eating and running regular errands. People who suffer with schizophrenia often endeavour to get rid of their symptoms by either self-medicating or abusing alcohol or drugs. This creates even more problems physiologically without them realising it. Sufferers that are heavy smokes also complicates their situation as it could interfere with the prescribed medication there are already taking. Schizophrenics falls within a high risk category to commit suicide during psychotic episodes or when they are very depressed. There are a couple of things that schizophrenics can do in to reduce the impact of the disorder on their mental health and physiology. Maintaining good physical and mental health, by preventing illness or accidents and effectively deal with any ailments and long term conditions. Making sure medication is never missed, and doing exercise will decrease anxiety and depression. Including healthy balanced meals will assist with sleep patterns and weight management. Quitting smoking is essential. Stopping smoking has clear physical health benefits but it has also been shown to improve the mental health of people with schizophrenia. A good support system is essential, relapse is always possible and with support easier to get back to management and recovery. There are a magnitude of influences and factors that contribute to influence the understanding of mental illness. Even though the above gave some input on the writers perspective, it was but a mere drop in a very big ocean of mental illnesses and the understanding there of. Improving understanding and care of mental health and illness involves various factors including respect and care and unfortunately the stigma is both a proximate and distal cause of discrimination due to prejudicial attitudes of others (including health care practitioners). Education needs to be the main prerogative in mental health and illness, not just for sufferers, but for everyone else around them.

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