1 Mental Health and Illness An Epidemiological Perspective.

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Mental Health and Illness

An Epidemiological Perspective

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Mental Health-Everybody’s Business

• Peter Sims• Professor of Public Health

medicine• University of Papua New

Guinea• <petersims@upng.ac.pg>

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Teaching and Learning Aims

• There is ignorance, superstition, stigma and fear around Mental Illness

• Aetiology, pathogenesis diagnosis and treatment are imperfect.

• There is a different paradigm and a less rigorous epidemiology

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Often sad,sometimes mad,occasionally bad

• The medical model is• insufficient• Diagnosis is largely • clinical and

experiential

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More of an art than a science

• Treatment is pragmatic

• Prevention is about the politics of health

• “populations,people pressures, poverty”

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Mental Health is a worldwide problem

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Mental illness is common 6 in 10 women and 4 in 10 men in Western Europe and North America will have asignificant mental illness during their lifetime

Mental illness can affect any one of us

Mental illness occurs in all societies and cultures

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We are all vulnerable

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A Holistic ApproachBODY

MIND SPIRIT

Arrow of Time

CULTURE

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Intelligence

IQ

IQ = 100

I.Q. = the Mental Age x 100 the Chronological age

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Personality

• Each human being is unique

• We all have different personalities

• My personality reflects genetic inheritance and Environment

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Behaviour

SUPER-EGO

EGO

ID

The Parent

The Adult

The Child

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The Subconscious Mind

The Conscious

The Subconscious

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A Classification• Affective Disorders• Anxiety,depression,mania,obsessional

disorders

• Schizophrenia• Simple,Hebephrenic,Catatonic,paranoid

• Organic states• Delirium,dementia

• Personality Disorder• Abnormal personality,Psychopathy

Substance abuse problemsDrugs, alcohol

Learning disordersSubnormality

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The Classification of Mental Illness:

The Neuroses

Depression, Anxiety, Mania, Obsessions and compulsions(usually the patient retains insight and orientation; they

experience deep distress and may commit suicide)

The Psychoses

Schizophrenia, puerperal psychosis(the patient is disorientated, deluded, and lacking in insight)

The Dementias

Progressive deterioration with loss of recent memory and deterioration of a normal personality,

They may be primary or more commonly secondary to another condition e.g. alcohol, stroke

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Clinical Diagnosis

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The Classification of Mental Illness

Drug Problems

Addictive drugs, (Heroin, Cocaine, Amphetamines,) alcohol and drug related illness-psychosis, delirium and dementia

Personality DisordersA personality and behaviour that is damaging to the individual and/or to society and which is not tolerated by the dominant culture

Mental subnormality/learning disorders:Problems around intelligence and ability to learn on the basis of teaching and experience

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AetiologyInheritance-Genetics/Intra-uterine environment Schizophrenia,Huntington’s

Infections-HIV,Syphilis,CJD

Drug Abuse

Alcohol,Heroin etc

Trauma/head injury Biochemistry/metabolic

Porphyria,Diabetes

Vascular-CVA

Neurological diseases

MS,Brain tumour

Upbringing

Mothering,education,parenting

Nutrition/PCM

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Treatment and Care

Hospital Care

Community Care

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Preventive NetworksChurch,Family, Home, Friends,

Work

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The Mental Health Act

Compulsory Psychiatric Treatment

Criminal responsibility

Power of attorney

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Mental Handicap/learning disability

The mind of a young child in the body of an adult

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Canst thou not minister to a mind diseased,

Pluck from the memory a rooted sorrow,

Raze out the written troubles of the brain,

And with some sweet oblivious antidote

Cleanse the stuff’d bosom of that perilous stuff

Which weighs upon the heart?

Macbeth