Classification of Mental/Psychiatric Disorders

Personality Disorders in Relation to Mental Illness
Classification of Mental/Psychiatric Disorders

1.  The psychiatric/mental disorders are classified into two categories
2.  The organic and functional disorders as classified by

    1.Organic psychiatric disorder

            It is divided into two
       1.Organic disorder
           -Carcinoma
           -Endocrine disorder

      2.Psychoactive substance disorder
             - Alcohol related
             -Illicit drug
             -Others

  2.Function psychiatric disorder
      1.psychoses
         -Schizophrenia
         -Mood disorder
         -Others
      2.Neuroses
         -Obsessive compulsive
         -Phobias ets

•  It is important to recognize their signs and symptoms as manifested, their treatment lead to complete resolution. The diagnosis of these disorders depend on the diagnostic system
•  There are two diagnostic systems in common use the ICD and DSM
•  The ICD (International Classification of Diseases) of the WHO contains clinical description and diagnostic guidelines psychiatric disorders.

            o ICD- 10 provides a description of the main clinical features, associated features, and
                 diagnostic guidelines

•  DSM-IV- TR refers to 4th edition of the Diagnostic and Statistical Manual of Mental Disorders Text Revision of 2000 by the American Psychiatric Association

 Personality Disorder
Definition of Personality Disorders

•  Personality is defined as the totality of a person unique biosychosocial and spiritual traits that consistently influence behavior.
•  Disorder is defined as an extreme persistent variation from the normal range of one or more personality attributes (traits), causing the individual and/or family and or society to suffer 
•  Personality disorders concern maladaptive personalities in which there is an enduring pattern of perceiving, relating to, thinking about the environment and oneself
•  Personality disorders are chronic disorders marked by deviations in cognition, affect,impulse control and interpersonal functioning

 Etiology of Personality Disorders

•  Hereditary factors – Includes genetics, chromosomal abnormalities, infant temperamental differences, autonomic nervous system activity, neuro-psycho-physiological factors e. g abnormalities in the frontal and temporal cortices and their connections.
•  Constitutional factors – such as prenatal effects- nutrition, hypoxia at birth, low birth weight, birth complication, brain damage etc.
•  Psychological factors: Psychoanalytic theories; Fixation at the oral stage leads to dependant personality, Anankastic personality and histrionic personality. Poor parenting and sexual abuse also contribute to fixation.
•  Learning theory: Personality disorder is a result of maladaptive conditioning and modeling in child hood and adolescence.
•  Other early background factors: - Such as head injuries, encephalitis, chronic physical illness, childhood separation, hyper kinetic disorder and conduct disorder in childhood, and social environmental conditions, overcrowding in the family house.

 Personality Disorders in Relation to Mental Illness

•  Personality is defined as the totality of a person unique biosychosocial and spiritual traits that consistently influence behaviour.
•  When an individual’s personality and functioning are maladaptive and deviate markedly from the culture, the designation of a personality disorder is assigned
•  This is a disease process in which a pattern of perceiving relating to and thinking about an environment and oneself are exhibited in a wide range of social and personal contexts
•  The following traits are likely in individuals with a personality disorder:

1.  Interpersonal relations that range from distant to overprotective
2.  Suspiciousness,
3.  Social anxiety
4.  Failure to conform to social norms
5.  Self destructive behaviours
6.  Manipulation and splitting of staff

•  Prognosis is poor and clients experience long term disability and may have other psychiatric disorders

: Neurotic Mental Disorders
Overview of Neurotic Disorders

•  Neuroses can be defined as abnormal psychogenic (psychologically caused) reactions.
•  An anxiety neurosis would have predominantly anxiety symptoms, in neurotic depression there would be predominantly depressive symptoms
•  Neuroses typically have two components: a vulnerable personality and stress factors triggering the reaction
•  They can thus be seen as exaggerated forms of normal reactions to stressful events, i.e.they are inappropriate to the situation or stress, or the reaction occurs at a greater frequency or severity than normal
•  Neurotic, stress-related, and somatoform disorders have common historical origin with the concept of neurosis and association of a substantial proportion of these disorders with psychological causation.
•  Mixtures of symptoms, especially anxiety and depressive ones are common in these disorders
•  About one fourth of the population in developed countries will suffer from neurotic disorders during its lifetime course.
•  With the exception of social phobia their frequency is higher in women than in men (i.e.twice as common in females than in males)

 The following are the Neurotic, Stress-Related and Somatoform Disorders

•  Phobic anxiety disorders
•  Other anxiety disorders
•  Obsessive-compulsive disorder
•  Reaction to severe stress, and adjustment disorders
•  Dissociative [conversion] disorders
•  Somatoform disorders

Phobic Anxiety Disorders

•  Agoraphobia
•  Social phobias
•  Specific (isolated) phobias
•  Phobic anxiety disorder, unspecified

 Other Anxiety Disorders

•  Panic disorder (episodic paroxysmal anxiety)
•  Generalized anxiety disorder
•  Mixed anxiety and depressive disorder
•  Other mixed anxiety disorders
•  Other specified anxiety disorders
•  Anxiety disorder, unspecified

Obsessive-Compulsive Disorder (OCD)

•  Predominantly obsessional thoughts or ruminations
•  Predominantly compulsive acts (obsessional rituals)
•  Mixed obsessional thoughts and acts
•  Obsessive-compulsive disorder, unspecified

 Reaction to Severe Stress and Adjustment Disorders

•  Acute stress reaction
•  Post-traumatic stress disorder
•  Adjustment disorders
•  Other reactions to severe stress
•  Reaction to severe stress, unspecified

 Dissociative (Conversion) Disorders

•  Dissociative amnesia
•  Dissociative fugue
•  Dissociative stupor
•  Trance and possession disorders
•  Dissociative motor disorders
•  Dissociative convulsions
•  Dissociative anaesthesia and sensory loss
•  Mixed dissociative (conversion) disorders
•  Other dissociative (conversion) disorders
•  Dissociative (conversion) disorder, unspecified

 Somatization Disorder

•  Undifferentiated somatoform disorder
•  Hypochondriacal disorder
•  Somatoform autonomic dysfunction
•  Persistent somatoform pain disorder
•  Other somatoform disorders
•  Somatoform disorder, unspecified

 Other Neurotic Disorders

•  Neurasthenia
•  Depersonalization-derealization syndrome
•  Other specified neurotic disorders
• Neurotic disorder, unspecified

The Signs and Symptoms of Personality and Neurotic Mental
Disorders

Sign and Symptoms of Personality Disorder

•  Withdrawn personality – includes paranoid, schizoid and schizotypal personality disorders. People with these disorders often appear odd or eccentric.
•  Dependent personality – Includes anxious avoidant, passive aggressive and dependent personality disorders.
•  Inhibited personality – Includes anankastic (obsessive compulsive), hypochondrical,depressive (dysthymic)
•  Antisocial dramatic emotional flamboyant and erratic – Including histrionic,impulsive, borderline, narcissistic and dissocial Withdrawn Personality
•  Paranoid personality disorder

1.  They tend to interpret the action of others as being deliberately demeaning and threatening, they are oversensitive, jealous, suspicious, blame their own failures on others (projection),
2.  May develop paranoid delusions, hallucinations and overvalue their own ability, which may lead to impairment in their occupation.
3.  Also may predispose to episodes of paranoid psychosis.

•  Schizoid personality disorder

1.  They are indifferent to social relationships, reserved, shy, introspective and eccentric.They become loners and vagrants, lack close relationships, little interest in having sexual experiences with others, little interest in social situations, have preferences in numbers rather than people – they may function as mathematicians or with computers.
2.  They may have depression and fantasy

•  Schizotypal personality disorders

1.  Characterized by peculiarities and anomalies in ideation, appearance, speech and behaviour (eccentric), and deficits in interpersonal relationship.

 Dependent Personality

•  Anxious (avoidant) personality disorder

1.  It is characterized by social discomfort and self – consciousness, fear of rejection,negative evaluation and timidity.
2.  Also have restricted life styles, may avoid certain activities because of their excessive fears.

•  It is associated with depression, anxiety, phobias and anger at oneself for failing to develop social relationships
•  Also tension, apprehension, self consciousness, hypersensitivity to rejection and exaggerates potential danger
•  Dependant personality disorders

1.  It is also referred to as inadequate, passive or asthenic personality disorder.

•  Characterized by dependence on others, submissive behavior and remorselessness fear of being alone, and low self esteem.
•  Predisposes an individual to depressive disorder
•  Passive – aggressive personality disorder

1.  Characterized by passive resistance to demands for adequate social and occupational performance, childish behavior, and work slow on tasks that they do not wish to perform and often believe they are doing a better job than other think.

 Inhibited Personality

•  Anankastic Obsessive – compulsive) personality disorder

1.  Characterized by perfectionism, inflexibility, obsessional personalities,indecisiveness, pedantry and conventionality.
2.  Also rigidity, stubbornness, plans all activities far ahead in immutable detail.

•  More prone to develop depression, obsessive compulsive disorder or neurosis,hypochondria sis, anorexia nervosa, migraine and duodenal ulcer
•  Cyclothymic or cycloid personality disorder (cyclothymia)

1. It is characterized by persistent instability mood, periods of mild depression, mild
2. elation and it predisposes to bipolar mood disorder.

Antisocial Personality

•  Histrionic personality disorder

1.  It is characterized by excessive emotionality, attention seeking, suggestible, shallow and labile affect, graves attention , manipulative, prefers in door mats, liable to overdose themselves due to stress, and liable to develop conversion and somatization disorder.

• Emotionally unstable personality disorder
• Impulsive type (explosive or aggressive) personality disorder

1.  Is characterized by episodic loss of control of aggressive impulses, emotionally unstable, lack of impulse control, outburst of violence or threatening behavior.
2.  May also show genuine regret about their behavior and may batter their spouse and children.

•  Borderline personality disorder

1.  Is characterized by instability of self image or unclear or disturbed self image, intense and unstable relationships, repeated emotional crises, social threats, acts of self harm,chronic feelings of boredom, primitive defense mechanism, such as identification and projection.
2.  May develop transient psychotic symptoms, prone to depression, psychosis and psychoactive substance use disorder

•  Narcissistic personality disorder

1.  It is characterized by grandiosity fantasy, hypersensitivity, and lack of empathy.

•  Dissocial or antisocial personality disorder

1.  It is characterized by antisocial behaviour, history of conduct disorder such as truancy, prone to drug and alcohol abuse, cannot maintain relationships, low tolerance of frustration, aggressive, incapacity to experience guilt , not profit from punishment,blames others. It includes psychopathic or sociopathic personality disorder

•  Psychopathic personality disorder

1.  Three kinds of psychopathic disorder includes the predominantly aggressive,predominantly inadequate (pathological liar or psycho logic phantastica, swindlers,con men etc.) and creative psychopaths, who have high ability combined with their severe personality disorder

•  Psychopathic disorder is defined as persist ant disorder or disability of mind (whether or not including impairment of intelligence) which result in abnormal aggressive or seriously irresponsible conduct on the part of the patient.
•  Clinical Features of Psychopathic Disorder

1.  Affections, impulsive, egocentric, lacks empathy, lacking in shame ; totally guiltless/ no regret, no ability to profit from experience, including punishment, no life plans, unable to sustain emotional relationships, very low anxiety/tension, rarely seeks assistance, untreatable , lack of psychosis, lack of intellectual deficit and lacks criminal motive.

Sign and Symptoms of Neurotic Mental Disorders

•  Neurotic symptoms are unpleasant and lead to the individual seeking relief
• They are often accompanied by a decrease in social functioning, and individuals suffering from a neurosis have an increased mortality rate, including suicide and fatal head injuries
•  Individuals’ neurotic symptoms are common and thus can be regarded as normal. These include:

1. Inappropriate fears
2.  Anxiety and panic
3.  Brief bouts of depressive feelings
4.  Tension headaches
5.  Irritability
6.  Sleeplessness

•  Neurotics symptoms are often seen in general practice and may be the predominant symptoms in one sixth of individuals seen there and relevant in up to one-third.
•  Individuals suffering from neurosis are more frequently seen in a psychiatric outpatient clinic than as inpatients in psychiatric hospitals

Key Points

•  Personality disorder is defined as an extreme persistent variation from the normal range of one or more personality attributes (traits), causing the individual and / or family and or society to suffer.
•  Psychopathology/ symptomatologies of mental illness is a study of abnormal states of mind. It is an attempt to understand the disease process of the nervous system in terms of their causes and how they develop.
•  Neurotic, stress-related, and somatoform disorders have common historical origin with the concept of neurosis and association of a substantial proportion of these disorders with psychological causation.
•  Neurotic, stress-related, and somatoform disorders are Phobic anxiety disorders, Other anxiety disorders, Obsessive-compulsive disorder, Reaction to severe stress, and adjustment disorders, Dissociative [conversion] disorders and Somatoform disorders