REVIEW OF COMMONLY ASSOCIATED MENTAL DISORDERS

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REVIEW OF COMMONLY ASSOCIATED MENTAL DISORDERS
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Addictive behaviour is part of a pattern of
problem behaviours that tend to co-occur and
contribute to each others existence
Psychological Problems
Substance Abuse
Antisocial Behaviour
Problem Gambling
School/Work Problems
Poor Health Practises
Interpersonal Problems
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Similarly, nonaddictive behaviour is part of a
pattern of adaptive behaviours that tend to
co-occur and contribute to each others existence
Good Psychological Health
Responsible Gambling
Prosocial Behaviour
Substance Moderation or Abstinence
Positive School/Work Functioning
Good Health Practises
Good social skills and social support
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• 30 with alcohol abuse/dependence and 50 with
  drug abuse/dependence have a comorbid mental
  health problem
• Similarly, substance abuse is the most common
  comorbid condition among people with major mental
  illness individuals with more than one major
  mental illness have a higher number and severity
  of substance abuse problems
• following conditions have a particularly high
  co-occurrence with substance abuse
• Substance Abuse (having one predisposes to
  others)
• Conduct Disorder/Antisocial Personality
• Depression
• Bipolar Disorder
• Schizophrenia
• Anxiety Disorders (social phobia, panic attacks,
  generalized anxiety)

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MOOD DISORDERS
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MAJOR DEPRESSION

• 2 weeks of either depressed mood or the loss of
  interest or pleasure in most activities
• additional symptoms changes in appetite or
  weight, sleep disturbance, agitation, decreased
  energy, feelings of worthlessness or guilt,
  difficulty concentrating or making decisions,
  recurrent thoughts of death or suicidal ideation
• Any age more common in women
• 4.5 Canadians in 2002 past year prevalence
• Most people have reoccurrences
• 15 of depressed patients commit suicide

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• SUICIDE
• peaks in the spring with a smaller peak in the
  fall
• rates rising, especially in young adults,
  especially attempted suicide (200 attempts to 1
  suicide)
• risk factors male, Aboriginal, living alone
  with no social supports, previous attempts, older
  than 45, accompanying mental disorder,
  hopelessness, severity, having a plan

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BIPOLAR

• Formerly manic depression
• In addition to depression, a distinct period of
  abnormally and persistently elevated or irritable
  mood (at least 1 week) mania
• Typically accompanied by inflated self-esteem or
  grandiosity, decreased sleep, pressure of speech,
  flight of ideas, distractibility, increased
  involvement in activities, increased agitation,
  excessive involvement in pleasurable activities
  with high potential for painful consequences
• Much less common than depression (.8 Canadians
  2002 past year prevalence)
• Any age equally common in men and women
• peak occurrence in summer
• 60-70 of time preceded by or followed by major
  depressive episode
• mixed episode when manic episodes and depression
  occur during the same day
• almost all bipolar disorders are recurrent (90
  will go on to have another episode) interval
  between episodes tends to decrease with each
  episode

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ANXIETY DISORDERS
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OBSESSIVE COMPULSIVE

• chronic obsessions and compulsions where no
  pleasure derived (cf. gambling, drinking,
  compulsive personality) and person recognizes
  them to be unreasonable
• most common obsessions are repeated thoughts
  about contamination, repeated doubts (e.g.
  wondering whether door left unlocked), need for
  symmetry, and aggressive or sexual impulses
• compulsions are repetitive behaviours (hand
  washing, checking) or mental acts (praying,
  counting, repeating words, etc.) that are
  intended to reduce stress
• equal sex ratio
• most develop disorder in adolescence or early
  20s modal age of onset 6-15 for males and 20-29
  for females
• waxing and waning course, exacerbation with stress

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PANIC ATTACKS

• Repeated periods of intense fear and panic
• pounding heart, sweating, trembling, shortness of
  breath/choking, chest pain, abdominal distress,
  dizziness, derealization, fear of losing control
  or dying, chills/hot flushes
• age of onset varies between late adolescence and
  mid 30's
• 1.6 Canadians 2002 past year prevalence
• 2-3 times as common in females
• agoraphobia develops as a result of the panic
  attacks

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GENERALIZED ANXIETY

• Chronic excessive anxiety
• excessive or unrealistic worry about future
  events past behaviour competence in one or more
  areas (e.g. athletic, academic, social)
  psychosomatic complaints marked
  self-consciousness excessive need for
  reassurance marked feelings of tension
• somewhat more common in women
• chronic
• frequently co-occurs with depression, other
  anxiety problems, and alcohol dependence

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POST TRAUMATIC STRESS

• Syndrome experienced by some people following
  exposure to a traumatic event
• intrusive recollections (dreams, flashbacks,
  images)
• avoidance behaviour (amnesia, avoiding reminders)
• persistent increased arousal (e.g., heightened
  startle reflex)
• typically persists for several months to several
  years with gradual diminution

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SOCIAL PHOBIA

• Also known as social anxiety avoidant
  personality disorder
• Marked and persistent fear of social or
  performance situations in which embarrassment may
  occur
• Results in repeated avoidance of social
  encounters
• 3 prevalence in adults (CCHS 2002)
• more common in women (3.4 women 2.6 men, CCHS
  2002)
• depression, poor self-concept, poor social skills
• May result in unachievement at school, work or
  socially
• some tendency to persist into adulthood

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SOMATOFORM DISORDERS
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HYPOCHONDRIA

• unrealistic interpretation of physical signs as
  abnormal, leading to preoccupation with the fear
  or belief of having a serious illness
• persists despite medical reassurance
• common, and equal sex ratio
• doctor shopping, frustration with medical system
  and hospitalizations common
• association with anxiety and mood disorders
• usually refusal to see mental health professional
• usually chronic

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SOMATIZATION

• recurrent multiple physical complaints of several
  years duration with no physical cause and a
  plausible psychological origin
• most complain of nausea and abdominal bloating
• unnecessary surgery (especially abdominal
  surgery), numerous physicians and
  hospitalizations
• frequent use of medications may lead to side
  effects and drug use disorders
• More common in women
• 80-90 have additional mental health problems
  (depression, anxiety especially)
• chronic but fluctuating

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THOUGHT DISORDERS
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SCHIZOPHRENIA

• Acute form characterized by auditory
  hallucinations, delusions, and disorganized
  behaviour
• Chronic form characterized by flat mood, lack of
  volition, absence of thought, catatonic motor
  behaviour
• Paranoid (most common), Disorganized, Catatonic
• delusions (persecution, referential, grandiose,
  religious, somatic)
• Called schizoaffective if depression or bipolar
  concurrent
• onset typically late between late teens and early
  30's
• equal sex ratio
• Cocaine or ampetamine overdose mimics
  Schizophrenia

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DELUSIONAL DISORDER

• Nonbizarre delusions of persecution (most
  common) infidelity somatic grandiose
  erotomanic
• equal sex ratio
• usually middle or late adult life
• persecution type most common
• variable course sometimes chronic, sometimes
  remission with relapse, sometimes complete
  remission
• rarely seek treatment
• intellectual and occupational functioning usually
  preserved, whereas often major impairment in
  social and marital functioning

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DEMENTIA

• Multiple cognitive deficits that include problems
  with short-term memory
• Causes significant problems in occupational or
  social functioning
• Alzheimers disease the most common cause

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PERSONALITY DISORDERS
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ANTISOCIAL PERSONALITY

• pervasive pattern of disregard for and violation
  of the rights of others that begins in childhood
  (Conduct Disorder) and continues into adulthood
• lying, cheating, stealing, truancy, resisting
  authority are childhood signs
• adult signs of excessive sexuality, drug use,
  aggressiveness, poor work history, poor
  interpersonal relationships, criminality,
  inability to tolerate boredom, reckless disregard
  for others safety, impulsivity and failure to
  plan ahead
• distinguish from simple criminality (remorse and
  loyalties)
• higher in males, younger ages, and incarcerated
  populations
• chronic

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HISTRIONIC PERSONALITY

• A pervasive pattern of excessive emotionality and
  attention seeking

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BORDERLINE PERSONALITY

• A pervasive pattern of unstable interpersonal
  relationships, self-image, and mood
• marked impulsivity

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Assessment Considerations for People with
Concurrent Mental Health Problems

• Need period of sustained abstinence to assess the
  mental health problem as certain types of
  substance abuse can directly produce mental
  health symptoms (stimulant overdose -gt
  schizophrenia cocaine abstinence -gt depression
  irritability due to drug abuse)
• Need to determine the inter-relationship between
  the mental health problem and the addiction
  (which is causing which?)
• Many clients will be involved with other
  therapists and/or may be on mental health
  medications

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Treatment Considerations for People with
Concurrent Mental Health Problems

• highest rates of suicide, increased violence,
  higher homelessness, higher rates of
  hospitalization, poorer treatment compliance,
  poorer treatment outcome.
• Mental health problems can be treated by an
  addiction counsellor where
• the mental health problem is the result of the
  addiction (e.g., depression, anxiety).
• there are clear psychological, environmental, or
  behavioural issues underlying the mental health
  problem. In this case the problem-solving
  psychotherapeutic approach used to assess and
  treat addictions is the same as would be used for
  a mental health problem.
• However, unless the addiction counsellor has
  specialized training in treating mental health
  problems, he/she should seek consultation from a
  mental health specialist, as there are several
  types of unique treatment specific to certain
  mental health problems.

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Internet resources for more information on mental
health problems

• www.mentalhealth.com