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ETIOLOGY OF MENTAL

DISORDERS
Dr. Manoe Bernd P. SpKJ.MKes

References
1. Kaplan HI, Sadock BJ.
Synopsis of Psychiatry, Behavioral Sciences /
Clinical Psychiatry, 8th ed. 1998
2. Andreasen NC, Black DW. Introductory
Textbook of Psychiatry, 2nd ed. 1995.
3. Ignacio LL, Tronco AT. Mental Health Care
in Community, 2000.
INSTRUCTIONAL MATERIAL
1. The Basic Needs
2. General System Theory
3. The Human Life Cycle
4. Etiology of Mental Disorders
4.1 The Biological systems
4.2 The Psychological systems
4.3 The Social systems

THE BASIC NEEDS


TRIAD OF NEEDS
.

Physical Needs Psychological Needs

Social Needs
Family
Community
Physical Needs
. Nutrition
Clothing & Shelter
Exercise & Sensory
stimulation
Protection from
bodily harm.

Psychological Needs

Loving, trusting, affectionate


relationship, relation of ones behavior
( by caretakers self control ) to be
assure of ones worth as a person by
other people.
Social Needs

She / he feels that she /


he is an important
member of a group
( family, at work,
organization in the
Multiple role in Society community)

GENERAL SYSTEM THEORY

The Biological System

The Psychological The Social


System System
THE HUMAN LIFE CYCLE
Can be divided into different stages of
development.
Each stage presents a biological,
psychological, and social state.
If a person goes through these stages
successfully and smoothly mentally
healthy & stable.

A disturbance in any of the stages


1. Non-progression from one stage to another
(fixation).
2. A return to a former stage (regression).

A Psychological problem
Mental disorder
THE ETIOLOGY OF MENTAL
DISORDER
Integrated systems approach behavior and
disease ( George Engel )

The Biological Systems


The Psychological Systems
The Social Systems

The Biological Systems

1. The brain
1.1 Anatomical brain Systems
1.2 Neurochemical brain Systems
2. Genetics
3. Endocrine
4. Psychoimmunology
5. Others.
The Brain
1.1 Anatomical brain Systems
The prefrontal, the limbic
the basal ganglia systems
interconnected work interactively

memory, language, attention, (executive function)


emotional function
perceptual function
(motor, visual, auditory, somatosensory systems)

Brain Conditions
Injury Tumor
Lesion Toxin
Infection Atrophy
Bleeding Metabolism
disturbance

Organic Mental Disorder


( Delirium, Dementia )
Mental Retardation
1.2 Neurochemical brain Systems

Neuron consist of :
a cell body surrounded by dendrites

to receive information through synaptic input


from other neurons.
one axon : transfers electrical excitation
from the cell body terminal
neurochemical brain synaps
(neurotransmitter)

4 Key Neurotransmitter Systems

1. Dopamine (DA)
2. Serotonin (5- hydroxytryptamine 5HT)
3. Norepinephrine (NE).
4. Gamma Amino Butyric Acid (GABA).
Dopamine (DA)
Schizophrenia : DA Positive Symptoms
DA some Obsessive Compulsive Disorder
Serotonin (5HT)
5HT ++ Psychotc symptoms
Overactivity of 5HT Impulsive behavior
(Schizophrenia)

Dysregulation of 5HT Obsessive-


Compulsive Disorder
Deficiency of 5HT Depression.
5HT Anxiety
Norepinephrine (NE)
Overactivity of NE neuron Anxiety
NE + + Panic
GABA
Reduced action of GABA Anxiety
Deficiency of GABA Panic
Genetics
Family studies Schizophrenia
Bipolar disorder

Twin studies : has tended to support


familiality potentially the
genetic aspect of
Schizophrenia
Mood disorder
Alcoholism

Adoption studies
Children who were born to parents
with a major mental illness
adopted at birth and reared by
parents without the disorder
The most difficult studies
A Combined genetic and environmental interaction :
Schizophrenia
Affective disorders
3. Endocrine Disorders

Thyroid : Hyperthyroidism confusion,


anxiety,
agitated
depression
Syndroms
Hypothyroidism paranoia,
depression,
hypomania,
hallucination

Parathyroid : parathyroid hormone ++


hypercalemia delirium,
personality changes, apathy.

Adrenal : chronic adrenocortical <<


(addisons disease) apathy,
iritability, depression.
Adrenal : cortisol ++ (Cushings syndrome)
Mood disorder, agitated depression
suicide
Concentration , memory deficit
psychotic reactions
High doses of exogenous
corticosteroids secondary mood
disorder (mania), severe depression.

Nutrition :
Thiamine (B1) deficiency :
beri-beri + apathy, depression, irritability,
nervousness, concentration <<, severe
memory disorders.
Cobalamine (B12) deficiency :
apathy, depression, irritability,
moodiness delirium, hallucinations,
dementia sometimes paranoid
Toxins :
Environmental toxins serious threat to
phycical and mental health
Mercury depressions, irritability,
psychosis
Lead encephalopathy : dizziness,
clumsiness, ataxia, irritability,
restlessness, headache, insomnia
vomiting , visual dis -
turbance, convulsion
coma

The Psychological Systems

1. The Predisposing Factors


2. The Precipitating Factors
1. The Predisposing factors

Factors which caused individual vurnarable


1.1 Low intelegence
1.2 Development or Age
* Mental health problem with age
* Young people are more predisposed
than older people to acute illness

1.3 Personality traits / disorders


* Dependency
* Egocentric
* Introvent
* Paranoid
* Others
2. The Precipitating Factors

General Stress Factors

A stressful life events / situation


(internal or external, acute or chronic)
Psychosocial Stressors

Symptoms / Disorders

Thomas Holmes & Richard Rahe :


Listed 43 life events associated with varying
amounts of disruption and stress in average
peoples live

Social Readjustment Rating Scale


( Kaplan, Sadock p. 860 - 2 )
Social Readjustment Rating Scale, e.g :
Life Event
Death of spouse
Divorce
Marital separation from mate
Death of close family member
Major personal injury or illness
Marriage
Being fired at work
Sexual difficulties

Major change in financial state.


Major change in the number of arguments with
spouse.
Major change in responsibilities at work.
Change in residence
The Social Systems
1. Socioeconomic factors
2. Environmental factors
3. Cultural factors

1. Socioeconomic factors
Peoples socioeconomic status (SES) based on :
income, education, occupation and life style
A positive correlation excists between SES and
mental health

People with high SES have better mental health


Poverty is associated with long-term problem :
poor health, failure, crime, mental disorders
( Kaplan, Sadock : p. 181-2 )
2. Environmental factors
The environment is estimated to contribute to
1/4 of todays health problems.
Environmental risks :

toxic waste, natural disasters, lead, asbestos


and dioxin
75 % of all carcinogens come from the
environment
Mental disorders generally rise among people as
their environments change from the suburban
inner city
( Kaplan, Sadock : p. 182 )

The concept of universals


The wide cultural variations

The implication of culture and its reaction


to diagnosis
( Kaplan, Sadock ; DSM - IV )
The concept of universals

Behaviors are universal within an age or sex


class
The taboo against incest and homocide

The highly variable but always present


institution of marriage, the social construction
of illness and healing
( Kaplan : p. 170 )

The wide cultural variations


* Consept of self, style of communication, coping
mechanisms

* Significant life change


(migration or refugee status )

Affected the integrity of individuals social network


or the Wider system of social support and values
bereavement or separation experiences

Period of adaptation
+
Individual predisposition / vulnerability

Adjustment disorders
( Culture Shock )
( Kaplan, Sadock ; ICD - 10 )

The implication of culture and its relation to


diagnosis :
Diagnosis assessment can be especially
challenging when a clinician from one ethnic
or cultural group uses the DSM IV
classification to evaluate an individual from
a different ethnic or cultural group.

A clinical who is unfamiliar with the


nuances of an individuals culture frame of
reference incorrectly judge
( DSM - IV )

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