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Mental Disorders

The individual is not functioning adequately based on either his/her standards or according to significant others in the person’s life.
Diagnosis of the disorder depends on intensity, length of time, and how much it impacts the person.

Mood disorders

Anxiety disorders

Personality disorders

Psychotic disorders

Substance-induced disorders

Mood Disorders

Major depressive episodes
Manic episodes
Mixed episodes
Hypomanic episodes.

Major Depressive Episode

Some symptoms experienced nearly every day for at least 2 weeks:

Depressed mood or loss of interest or enjoyment in activities
Reduced interest or pleasure in almost all activities
Change in weight or appetite
Difficulty concentrating or sleeping (i.e., sleeping too much or too little)
Restlessness and agitation
Slowing down of activity
Fatigue or reduced energy levels
Feelings of worthlessness or excessive/inappropriate guilt
Recurrent thoughts of death, suicidal thoughts, attempts or plans

Manic Episode

A person experiences abnormally elevated, expansive, or irritable mood for at least 1 week characterized by:

Inflated self-esteem
Decreased need for sleep
Increased talkativeness or racing thoughts
Distractibility
Agitation or increase in goal-directed activity (e.g., at work or socially)
Excessive involvement in pleasurable activities that have a high potential for negative consequences.

Hypomanic and Mixed Episodes

Hypomanic same as a manic episode but is less severe
May only last 4 days and does not require the episode to be severe enough to cause impairment in social or occupational functioning
In mixed episodes, a person experiences both a manic episode and a major depressive episode for at least 1 week

Anxiety Disorders

Many people feel anxious because they have reason to eg: trouble with law, homelessness
Many in AOD treatment will experience anxiety as consequence of intoxication, withdrawal, or living without using AOD
Usually reduces over time with period of abstinence
Problematic when persistent, or so frequent and intense that prevents person from living his/her life in the way that he/she would like

Panic Attack

Sweating
Shaking
Shortness of breath
Feeling of choking
Light headedness
Heart palpitations, chest pain or tightness
Numbness or tingling sensations
Chills or hot flushes
Nausea and/or vomiting
Fear of losing control, going crazy or dying
Feelings of unreality or being detached from oneself

Types of Anxiety Disorders

Generalised anxiety disorder (GAD)
Obsessive compulsive disorder (OCD)
Panic disorder
Agoraphobia
Social phobia
Specific phobia
Post-traumatic stress disorder (PTSD)
Acute stress disorder.

Post-Traumatic Stress Disorder (PTSD)

Can develop after traumatic event
May experience some of following:
Intrusions: re-experiencing event as nightmares, or “flashbacks”
Avoidance: avoiding thoughts, feelings, people, places or activities that remind him/her of the event,
Hyperarousal: increased startle response, irritability or anger, difficulty sleeping and concentrating

Personality Disorders

Enduring destructive patterns of thinking, feeling, behaving, and relating to other people across wide range of social and personal situations
Maladaptive traits are stable and long lasting
Tend to develop in adolescence or early adulthood and are generally lifelong
Most common in AOD context ASPD and BPD

AOD and Personality Disorders

AOD use disorders may cause fluctuating symptoms that mimic symptoms of personality disorders
Eg: are impulsivity, aggressiveness, self-destructiveness, relationship problems, work dysfunction, engaging in illegal activity, dysregulated emotions and behavior
Can be challenging to determine whether a person has a personality disorder

Antisocial Personality Disorder

Failure to conform to social norms with respect to lawful behavior
Disregard for the wishes, rights, and feelings of others
Deceptive and manipulative in order to gain personal profit or pleasure; may repeatedly lie or con others
Reckless disregard for own or other’s safety
Impulsive behaviour; decisions made on spur of the moment, without forethought, and without consideration of the consequences for self or others
May lead to sudden change of jobs, residences or relationships
Irritability and aggression; repeated involvement in physical fights or assaults
Consistent and extreme irresponsibility

Borderline Personality Disorder

Persistent patterns of instability in relationships, mood, and self-image
Marked impulsivity, particularly in relation to behaviours that are self-damaging
Extreme efforts to avoid rejection or abandonment
Pattern of unstable and intense relationships
Unstable self-image or sense of self
Impulsivity
Recurrent suicidal behaviour, threats or self-mutilating behaviour
Unstable mood
Chronic feelings of emptiness
Inappropriate, intense anger
Stress-related paranoid thoughts or severe dissociative symptoms

Psychotic Disorders

Loss of touch with reality
Feelings, thoughts and perceptions severely altered
Delusions and Hallucinations
May be due to intoxication or withdrawal from substances
If the person experiences psychotic episodes when not intoxicated or withdrawing, possible they may have one of the disorders described

Delusions

Fixed, false beliefs not consistent with cultural context
Involve a misinterpretation of perceptions or experiences
Eg: feel that someone is out to get them, they have special powers, or passages from newspaper have special meaning for them

Hallucinations

Disturbance of sensory perceptions
Auditory (hearing voices or sounds)
Visual (seeing things not present)
Olfactory (smelling things not present)
Tactile (feeling or sensing something)
Gustatory (taste)

Other Symptoms of Psychosis

Disorganised speech
Grossly disorganised behaviour
Catatonic behaviour (eg decreased reactivity)
Affect flattening (reduced range of emotional expressiveness)
Alogia (restricted thought and speech)
Avolition (reduced involvement with activities)

Schizophrenia

Most common and disabling of psychotic disorders
Affects ability to think, feel and act
To be diagnosed symptoms must have been continuing for a period of at least 6 months
Symptoms are grouped within 2 types:

Positive symptoms
Negative symptoms

Positive Symptoms of Schizophrenia

Not as in pleasurable!
Presence of excess or distortion of normal functioning and include hallucinations, delusions, disorganised speech, grossly disorganised behaviour and catatonia

Negative Symptoms of Schizophrenia

Absence of normal functioning including affective flattening, avolition, alogia
Can cause significant impairment in a person’s functioning
Classification of “types” of schizophrenia depending upon the predominance of symptoms displayed (paranoid, disorganised, catatonic, undifferentiated, residual type)

Other Psychotic Disorders

Schizophreniform disorder:equivalent to schizophrenia except its duration limited to less than 6 months
Schizoaffective disorder:symptoms of schizophrenia alongside major depressive, manic or mixed episode
2 types: i) bipolar type (if manic or mixed); ii) depressive type (if major depressive)

Substance-Induced Disorders

Occur as direct consequence of AOD intoxication or withdrawal
Diagnosis requires symptoms only present following intoxication or withdrawal
If symptoms in absence of intoxication or withdrawal, possible they have independent mental health disorder
Symptoms tend to reduce over time with period of abstinence

Examples of Substance Induced Disorders

Alcohol use/withdrawal – symptoms of depression or anxiety
Manic symptoms induced by intoxication with stimulants, steroids, hallucinogens
Psychotic symptoms induced by withdrawal from alcohol, intoxication with amphetamines, cocaine, cannabis, LSD or PCP
Other disorders – substance-induced delirium, amnestic disorder, dementia, sexual dysfunction, sleep disorder

Substance-Induced Psychosis

Difficult to distinguish substance-induced psychosis from other psychotic disorders
Substance-induced psychosis – symptoms appear quickly and last relatively short time, from hours to days until the effects of drug wear off
Psychosis can persist for days, weeks, months or longer
Possible individuals already at risk for developing psychotic disorder triggered by substance use
Visual hallucinations more common in substance withdrawal and intoxication
Stimulant intoxication more commonly associated with tactile hallucinations, person experiences physical sensation interpret as having bugs under skin (“ice bugs” or “cocaine bugs“)
Tactile hallucinations can occur in alcohol withdrawal; auditory and visual hallucinations are more common
Stimulant psychosis sometimes more agitated, energetic, more difficult to calm with sedating or psychiatric medication compared to non-drug induced psychosis
Difference with schizophrenia – lack of negative and cognitive symptoms with return to normal inter-episode functioning during periods of abstinence

Delirium

Disturbance of consciousness and cognition that represents a significant change from the previous level of functioning
Reduced awareness of surroundings, difficulty concentrating, may be difficult to engage him/her in conversation
Changes in cognition include short-term memory impairment, disorientation (in regards to time or place), and language disturbance (eg difficulty finding words, naming objects, writing)

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Pathophysiology Notes