Mental Disorders

Mental Disorders

Mental Disorders

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.

Mood DisordersMajor 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


  • 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


  • 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)


  • 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:
  1. Positive symptoms
  2. 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


  • 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