MENTAL HEALTH VS MENTAL ILLNESS

NORMALITY AND ABNORMALITYSOCIO-CULTURAL Behaviour that is accepted in a particular society or culture, but

not in others

HISTORICAL Behaviour that is accepted, however it depends on the period

of time

SITUATIONAL Behaviour that is accepted in a particular situation

MEDICAL Abnormal behaviour has a biological cause and can be

diagnosed and treated

FUNCTIONAL Normal behaviour is if the individual can function effectively in

society

ABNORMAL? BY WHICH MEASURE?

ABNORMAL? BY WHICH MEASURE?

ABNORMAL? BY WHICH MEASURE?

NORMALITY AND ABNORMALITY - STATISTICAL Normal Distribution = behaviour in a large

group of individuals that is distributed in a particular way

Statistical Average = the majority that demonstrate this behaviour = normal

Statistical Extremity = the minority that demonstrate this behaviour = abnormal

NORMALITY AND ABNORMALITY - STATISTICAL

Normal behaviour = a characteristic that is common in a large group

Disadvantage: Not everyone is normal or average in all ways. It suggests there are distinct dividing lines between normal and abnormal behaviour.

Central Tendency (average) = most results being in the middle Mean = average of all the individual scores Average = add up all the scores / how many scores there are Median = the middle score of the group Mode = the most common score Range = spread of scores between the highest and lowest. Highest number-lowest number

Standard deviation = the average distance each score falls from the mean

THE BELL OR ‘NORMAL’ CURVE

NORMAL? STATISTICALLY?

NORMAL? STATISTICALLY?

ABNORMALITY – A WORKING DEFINITION Abnormality – pattern of thoughts feelings

and behaviours that are deviant, distressing and dysfunctional

Serial killer Ted Bundy who brutally murdered between 30 and 35 women during the 1970’s fits our definition of abnormality

MENTAL HEALTH VS MENTAL ILLNESS

Mental health – capacity to interact with others, cope effectively with problems and stress

Mental health problem - when the difficulties experienced by a person are mild, temporary and able to be treated within a relatively short period of time

 Mental illness – psychological dysfunction that usually

involves impairment in coping ability with feeling and behaviours that are atypical and inappropriate within their culture

Mental illness can sometimes be referred to as a psychological dysfunction experienced by an individual and usually involving:

- Emotional distress- Impairment in the ability to cope with everyday life- Thoughts, feelings and/or behaviour that are not typical of the person or

appropriate within their society and/or culture

THE BIOPSYCHOSOCIAL FRAMEWORKMental health and wellbeing depends on a combination of biological, social and psychological factors

SYSTEMS OF CLASSIFICATION OF MENTAL DISORDERS Classification – organising items into groups based on their shared

characteristics

Categorical approaches – organises mental disorders into categories, each with specific symptoms and characteristics.

Diagnosis involves a comparison of patients symptoms to the listed symptoms within each category

Check your patients list against the lists in the DSM-IV to find a fit – then make diagnosis

Dimensional approaches – classifies symptoms quantitatively. The number of symptoms.

Diagnosis involves asking how much of a characteristic is normal, numerical values are assigned to each characteristic score

Measure all characteristics and the combination of scales that are statistically extreme might point to the type of illness being suffered

WHICH IS BEST? Often both are used

Categorical approach used to classify the symptoms

Dimensional approach used to determine the severity of these symptoms

CATEGORICAL APPROACHES

CATEGORICAL APPROACHES - ASSUMPTIONS Assumes that mental disorders can be

diagnosed from specific symptoms reported by the patient or observed by the professional

Thoughts feelings and behaviours can be categorised – certain categorisation relates to specific disorders

There are distinct sub categories within each disorder

All or nothing – they either have it or they don’t. You cant kind of have schizophrenia

The system must be valid and reliable

THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS IV-R

The system most widely used by mental health professionals throughout the world to identify and classify mental illnesses for the purposes of diagnosis is the Diagnostic and Statistical Manual of Mental Disorders, or the DSM as it is more commonly called

An important feature of the DSM-IV-TR is that it does not suggest causes of specific disorders unless a cause can be definitely established

It simply names the disorders and describes them in specific terms

DSM – IV - TR 365 disorders comprehensively described (one for every

day of the year!) Grouped into 16 categories

Diagnosis matches patient symptoms to the disorder symptoms

Symptoms are considered characteristics of disorders to looking at these enables diagnosis

Inclusion criteria – symptoms that must be present for diagnosis

Exclusion criteria – symptoms that must not be present

Polythetic criteria – only some symptoms not all need to be present for diagnosis – eg. 3 0f the following 8

Provides info on the typical course of the disorder

THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS IV-R

Axis I: clinical disorders Symptoms that cause distress or significantly impair social or occupational functioning (such as anxiety disorders, depression)

  Axis II: personality disorders and mental retardation Chronic and

enduring problems that generally persist throughout life and impair interpersonal or occupational functioning (such as multiple personality disorder)

  Axis III: general medical condition Physical disorders that may be relevant

to understanding or treating a psychological disorder  Axis IV: psychosocial and environmental problems (such as

interpersonal stressors and negative life events) that may affect the diagnosis, treatment and prognosis (prediction of the course of a disease) of psychological disorders

  Axis V: global assessment of functioning The individual's overall level of

functioning in social, occupational and leisure

ICD – 10INTERNATIONAL CLASSIFICATION OF DISEASE

Diagnosis and classification of mental disorders based on recognised symptoms

Includes detailed description of each disorder listed

Identifies symptoms that indicate the presence of a disorder

The original text covered all of medical practice Chapter V covered mental disorders

Chapter V now printed as a separate book Less detailed than the DSM -IV

STRENGTHS / WEAKNESSES Allow diagnosis Help communication

Historically low inter-reliability Much better now with DSM-IV-R 70%

agreement between mental health professionals

Lots of overlap between symptoms can make diagnosis difficult

Stigma and labelling – Rosenham study! P431

DIMENSIONAL APPROACHES

DIMENSIONAL APPROACHES A dimension viewed as a cluster of related

psychological/behavioural characteristics that occur together

Quantifies persons symptoms and other characteristics with numerical values

These values are compared with the statistically ‘normal’ expected values for each characteristic

Lower scores equate to lower impairment Higher scores equate to higher impairment

STRENGTHS / WEAKNESSES Take into account a wider range of factors

than categorical approaches More detailed information on each symptom

– quantifying Reduced stigma as labelling not used instead

a profile is created

There is no standard inventory to compare scores to, thus diagnosis is difficult

Time consuming