L1 - Introduction to mental health disorders

• Greek: Psyche (soul, mind, spirit) + therapeia (healing, treatment)  = healing the mind/soul
• Psychotherapy: A talking therapy that aims to help you deal with emotional problems and mental health disorders.
• Psychotherapy quote: “The informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviours, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable.” (Norcross, 1990, p.218)
• Counselling = short-term, shallower experience, focus on immediate problems.
• Psychotherapy = long-term, ‘deeper’ level of experience.
• Both counselling and psychotherapy are talking therapies - terms are interchangeable in modern society
• Need for therapy is rising

  
• A 2019 BACP public perceptions survey found 33% of respondents reported having had counselling or psychotherapy.
• Improving Access to Psychological Therapies introduced in 2008, and extended with the Five-Year Forward Plan in 2016.
• Mental Health: “Mental health is defined as a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” (World Health Organisation, 2014)
• Dual continuum model

  
• [MHP] ‘A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behaviour…’ (DSM-5)
• [MHP] ‘Mental health problems can affect the way you think, feel and behave.’ 
• [MHP] Estimated 792 million people affected worldwide - 10.7% of the global population (GBD, 2017)
• [MHP] 1 in 6 in the UK identify having a common mental health problem in the previous week (Adult Psychiatric Morbidity Survey, 2016).
• No biological test for any known mental disorder (Hyman, 2010).
• Can use different systems to analyse and classify  reported and observed behaviours.  

  – Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

  – International Statistical Classification of Diseases and Related Health Problems (ICD-10)
• [Heuristics] Deviance - Deviation from the norm, is this statistically less common?
• [Heuristics] Dysfunction - Does the issue interfere in the individuals life in some major way?
• [Heuristics] Distress - How much distress does this cause the individual?
• [Heuristics] Danger - Does this constitute a danger to the self, or to others?
• Prevalence: proportion of the population who have (or had) a specific disorder at/in a given time

  Usually expressed as a percentage (2% or 2 people out of 100), or as number of cases per 10,000 or 100,000 people
• Point prevalence – at a specific point in time

  Period prevalence – at any point in a given time period

  Lifetime prevalence – at some point in life up to the time of assessment
• Incidence: the number of new cases of a disorder arising over a given period (e.g. a month, a year)
• Depression:

  1 yr prevalence 3%

  Female:Male 2:1
• GAD:

  1 yr prevalence 6%

  Female:Male 2:1
• SAD/Phobia:

  1 yr prevalence 7.4%

  Female:Male 3:2
• OCD:

  1 yr prevalence 1-2%

  Female:Male 1:1
• Eating disorders:

  1 yr prevalence 2.5%

  Female:Male 9:1
• Bipolar disorder:

  1 yr prevalence 1-2%

  Female:Male 1:1
• Psychotic disorders:

  1 yr prevalence 1%

  Female:Male 3:4
• Depression: Persistent low mood, loss of interest in activities, irritability, tearfulness, reduced ability to think, disrupted sleep, changes to appetite

  Estimated 4-10% of people will experience depression in their lifetime (McManus et al., 2009)
• Anxiety disorders: Excessive worrying, persists beyond an appropriate period, can cause impairments and distress.

  8.2 million cases of anxiety in the UK in 2013

  Estimated prevalence of 1-7% in Europe (pre-pandemic data!)
• [Anxiety disorders] Can be separated into different subtypes according to triggers

  • Generalised Anxiety Disorder –Excessive or ongoing worry about multiple events; difficulty controlling worry
  • Social Anxiety Disorder –Persistent fear/anxiety about social situation(s); fear of negative evaluation/rejection;
  • Phobias –Persistent fear of specific object/situation
• [OCD]

  Obsessions: Recurrent distressing thoughts E.g. fears of contamination, harm, lack of symmetry, or body image

  Compulsions: Repetitive behaviours aimed to minimise distress E.g. cleaning, checking, repeated acts, mental compulsions

  Intrusive thoughts common in general population, content very similar to obsessions (Rachman & De Silva, 1978)
• Bipolar disorder: A cyclical mood disorder – experiencing

  feelings both of depression and of mania/hypomania

  Nearly 4 million cases in the UK in 2013.
• [Bipolar]

  
  

  Depression:

  Persistent low mood with no clear underlying cause.

  Feelings of worthlessness/guilt.

  Exhaustion and fatigue.

  Physical pain

  
  

  Mania/Hypomania:

  Inflated self-esteem and grandiosity.

  Racing thoughts.

  Psychomotor agitation

  Increased risk-taking.
• [Bipolar] Two types of classification:

  • Bipolar Disorder I: alternating mania and depression
  • Bipolar Disorder II: depressive episodes and hypomania.
• [Bipolar]

  Prevalence of 2% in the US (Grant et al., 2002) and UK (Baker, 2018).

  First episode usually occurs between ages of 20-30.
• Schizophrenia:

  • Experienced by around 220,000 people in England & Wales.
  • Lifetime risk in general population of 1%.
  • Age of onset is early adulthood.
  • Exact nature of schizophrenia is disputed, but is essentially characterised by fundamental distortions of thinking.