Mental illness panorama
Janet Cunningham, MD PhD
Resident of psychiatry
Psychiatric disorders are common!
Lifetime risk is 46%!
15 % of the population will at
some point need professional
psychiatric help.
(USA, NCS, Replication,
Kessler o.a. -05)
Years lived with disability, YLD
WHO, Global burden of disease, 2004 update
It starts early
(USA, NCS, Replication, Kessler o.a. 05)
Anxiety disorders
Median
11 år
Affective disorders
30 år
Substance abuse
20 år
Starts before 14 years old
50%
Starts before 24 years old
75%
Psychology vs. psychiatry
Pathophysiological classification
•Axel I Genotype
•Axel II Neurobiological phenotype
•Axel III Behavioral phenotype
•Axel IV Modifying/causal environmental factors
•Axel V Treatment and response
Neurovetenskaplig agenda –
patofysiologisk klassifikation
•Axel I Genotype
•Axel II Neurobiological phenotype
•Axel III Behavioral phenotype
•Axel IV Modifying/causal environmental factors
•Axel V Treatment and response
DSM IV
•Axel I Clinical syndrome
•Axel II Personality disorders,
Mental retardation
•Axel III Somatic disease or injury
•Axel IV Social problems
•Axel V GAF (FUNCTION!)
Emotions are biological programs
Function: Protection
Decisions
Social communication
Feelings are our subjective interpretation of
emotions
Stress - Vulnerability Model
Personality
Genetics
Cognitive factors
Stress
Demands
Social Network
Health
Work capacity
Well Being
Psykiatrins uppgift
Diagnosis and treatment
Habilitating / rehabilitating
Legal aspects
Psykiatrisk bedömning
•History
•Mental health status
•Structured interviews
•Symptom severity
•Somatic status!
•Function assessment
•Needs assessment
Patient history
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How did it start?
Duration and pattern
What is the problem? – Limitations?
Other diagnosis
Gestation/ Birth /Childhood development
School
Trauma/ Stress
Substance abuse
Family tree
Syndrome
Risk in
population
Rel. risk with one
sick parent
Depression
Unipolar
8%
2x
Bipolar
1%
9x
Schizophrenia
1%
10x
Alcohol abuse
5% men
1% women
5x
Panic syndrome
0.5%
12x
Tourettes
0,25%
100x
ADHD
3%
5x
Anorexia
0.5%
10x
Symptoms
1. Emotional symtoms
Mood (elevated, low)
Affect = Basic emotions (ie)
- Sadness – Fear – Anger – (Joy, surprise, love)
PAUSE!
Symptoms
2. Perception symptoms
ie. Illusions, Hallucinations, Delusions
Symptoms
3. Cognition (intellectual) function
- Concentration, memory, focus, IQ, impulse control, (ADHD,
Dementia, Depression…)
Symptoms
3. Cognition (intellectual) function
- Concentration, memory, focus, IQ, impulse control, (ADHD,
Dementia, Depression…)
- Thoughts - Obsessive, rigid, repetitive, depressive.
Symptoms
4. Motor symtoms
Over/ Under-active, manierisms, stereotypa, tics, cramps
Symptoms
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5. Somatic symtoms
Physiological parts of emotions
Functional symptoms
SOMATIC DISEASE?
Psychiatric status
Appearance
Attitude
Behavior
Mood and affect
Speech
Thought process
Thought content
Perceptions
Cognition
Insight
Judgment
Suicidal thoughts
Symtom criteria for depression DSM IV
1-Depressed mod most of the day
2-Decreased interest/ pleasure in almost all activities
Weight change 5% due to appetite
Difficulty concentrating
Fatigue or Lack of energy
Feelings of guilt or worthlessness
Insomnia or hypersomnia
Psychomotor agitation or retardation
Suicidal thoughts /plans/ attempts
5 symptoms inc. 1 or 2 everyday for at least 2 weeks
Symtomkriterier för en depressiv episod
Sänkt sinnesstämning
Irritabilitet
Minskat intresse och minskad glädje
Koncentrationssvårigheter
Energibrist
Värdelöshetskänslor/Skuldkänslor
Sömnstörning
Förändrat rörelsemönster/mimik
Aptitförändring /viktförändring
Dödstankar, självmordstankar/planer/försök
Ihållande symtom under minst två veckor!
känslor
tankar
beteenden
kroppsliga
symtom
Why is the science so slow?
regulation of motivation, behaviour, and emotions
T-celler och cytokiner
“Sickness response” vs Depression
• Sickness response
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Trötthet
Nedsatt aptit
Sömnstörning
Sänkt stämningsläge
Försämrad kognition
• Depression
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Trötthet
Nedsatt aptit
Sömnstörning
Sänkt stämningsläge
Försämrad kognition
Isak Sundberg, ST-Läkare och Doktorand
Nature Reviews, 2008
Överdödlighet bland deprimerade
Ökning jämfört med
normalbefolkningen
Suicid
12*
Annan våldsam död
2.5*
Circulationsorganens sjukdomar
1.2*
Andningsorganens sjukdomar
Infektionssjukdomar
2*
9.4*
Överdödlighet vid paniksyndrom
Alla orsaker
Självmord
Cirkulationsorganens
sjukdomar
Infektionssjukdomar
Ökning jämfört med
normalbefolkningen
2 gånger
7.5 gånger
2 gånger
10 gånger
B-celler och antikroppar
Hormoner
bisköldkörtel
Tarmfloran
Publication on
Biomarkers in Psychiatry