MEDICAL MODEL DIAGNOSES: (MANIA: Periods of over-active and excited…
MEDICAL MODEL DIAGNOSES:
BELIEFS OF THE MEDICAL/BIOLOGICAL MODEL:
Mental illness affects how a person thinks, feels and behaves.
It is an illness, syndrome, disease of the mind or brain.
Mental illness is a disease process, similar to physical illness. We can identify and treat the illness, and understanding its staging and prognosis.
There is a standardised set of criteria for identifying illness. For mental illness it is the DSM-V and ICD-10.
Symptoms are outward signs of chemical imbalance. They occur in patterns, or syndromes. They are related to the function of the brain.
‘Brain chemistry’ or ‘Brain science’ in the main area of knowledge for modern medical model psychiatry. We understand patterns of serotonin, dopamine, noradrenaline etc
It differs from neurology and neuroscience but increasingly is informed by them, as well as other forms of research.
All people respond differently to treatment.
The medical model is disempowering, discriminating and oppressive.
The chemical imbalance theory is highly contested, many are skeptical because of the seemingly simple equation of chemical imbalance= medication as problematic.
Critics argue that mental illness is problems of living, problems with society.
They argue that diagnostic manuals are not based on objective science, but rather, works of culture based on clinical consensus and utility.
There is no blood-test.
Historically, some diagnostic labels have marginalized, stigmatized and harmed those who are different from the mainstream (e.g., homosexuality was once a DSM diagnosis).
There is limited evidence of cross-cultural validity in diagnostic conceptualisations.
Counsellors who focus narrowly on diagnosis may only look for behaviours that fit within a medical or biological understanding of the person’s struggles (i.e., becoming reductionistic).
Priviledging of biological disorders (Axis I) over ‘environmentally created’ disorders (Axis II).
Reductionism- concern that may diagnosis preclude a focus on the client’s unique construction of his or her own experience.
New Science? No thanks!
Circadian medicine, after Seasonal Affective Disorder (helps the affect our circadian rhythm has on depression)
The link between the gut and the brain
Metabolic and inflammatory markers, metabolic depression?
Trauma research, Dr Sarah Bendell
MENTAL ILLNESS CAUSES:
Foetal alcohol contact
Discirmination, homophobia, transphobia, sexism
Exposure to war
Acquired brain injury
Recognises the fluidity and complexity of symptoms, understanding that some people will progress to more complex, acute or long-standing illness, others will not, and there are various factors that influence these stages.
Models which focus on traditional diagnostic categories are largely used to describe the syndromal patterns emerging after a first full-threshold episode.
There are biological markers and cognitive measure that broadly match the stages if we consider it as a disease process. The number of episodes of illness prior to diagnosis and treatment is a great predictor of cognitive impairment and functional disability, and there is evidence that early intervention can reverse cognitive damage.
One of the opportunities for social workers is to use a staging approach to think about when a person begins to move from experiencing illness, to experiencing disability.
vulnerability, at-risk-states, prodrome, onset, progression, recurrent, and chronicity.
Acknowledges that mental illness can be chronic
HIGH PREVALENCE DISORDERS:
Depression, Anxiety, Substance abuse.
Difficulty coping with everyday life, loss of enjoyment, motivation, confidence and hope, a feeling of discomfort, worry, despair, fear, hopelessness, irritation and anger.
LOW PREVALENCE DISORDERS:
Psychosis, schizophrenia, bipolar affective disorder, eating disorders.
Although many people live with these diagnoses, have their care and treatment managed by GPs and private psychiatrists, most people with one of them will have contact with tertiary public mental health services at one time or another.
THE MENTAL HEALTH ACT:
(Core principles and objectives)
It's a 'risk-focused act'
assessment and treatment are provided in the least intrusive and restrictive way.
people are supported to make and participate in decisions about their assessment, treatment and recovery.
individuals’ rights, dignity and autonomy are protected and promoted at all times.
priority is given to holistic care and support options that are responsive to individual needs.
the wellbeing and safety of children and young people are protected and prioritised
carers are recognised and supported in decisions about treatment and care.
A patient's awareness of themselves and their condition.
Judgement (as used on the mental health status exam) -
An assessment of the patient's ability to avoid behaviour that might be harmful to themselves or others.
POSITIVE VS NEGATIVE SYMPTOMS:
hallucinations, delusions, bizarre and agitated behaviour, grandiosity.
reduction in speech, slowing of thoughts, self-neglect, social withdrawal, absent or blunt emotional response, not feeling rested after sleep.
Typically, the onset of 3 types of symptoms at the same time:
Bizarre or disordered behaviour
Delusions and disordered thinking*
HALLUCINATIONS (perceptual disturbances):
Can occur on any sense.
Referred to as positive symptoms (anything extra)
Types of hallucinations:
seeing things that aren't visible to others
experiencing strange tastes without external stimuli
smelling unusual substances
the sensation of being touched, or objects feeling different to how they are traditionally felt
MENTAL STATE EXAMINATION (MSE):
A formal tool used by doctors and other mental health professions used to assess someone's mental state.
It's not open to interpretation, it always follows the same process and is always about what you saw TODAY.
Things included in the examination:
Mood and affect
Perception / Perceptual disturbances
Insight and judgement
TIME AND CHANGE - Important factors to know/look for when diagnosing mental illness:
did the person
seeming/acting different (patterns)?
What was their
, event or loss, or distress from crisis? (Did you feel sad for 4 days or 6 months)
did the person
ask for help
did they find it
? (History of contact with services)
, moderate or major, severe, chronic, acute?
, drug-induced, post-partum, acute-on-chronic?
? (when the experience of mental illness makes you feel good about yourself)
? (when the experience of mental illness makes you feel bad about yourself)
PSYCHOTIC ILLNESS IN SUMMARY:
First Episode of Psychosis (FEP) -
This is not a diagnosis of Schizophrenia, however it is a foot onto the pathway.
Brief Psychotic Reaction -
A one-off psychotic episode.
Medical illness such as infection must be ruled out, otherwise the diagnosis may be delirium.
Their episode may be drug-induced or be post-partum
Cluster A - Suspitious:
People who seem paranoid, weird and odd, but probably don't have the proper symptoms to be diagnosed with a psychotic illness.
May fit on the autistic spectrum.
Cluster B - Emotional and impulsive:
An expressive disorder
Where a lot of boys in the juvenile justice system are, with anti-social personality disorder
Where a lot of girls who self-harm are, with borderline-personality disorder.
Cluster C - Anxious
Avoidance Personality Disorder
Dependent Personality Disorder
Measure their lack of hope (we try to understand their thoughts, plan and intent)
Suicidal thoughts can be a part of any mental illness
More women attempt suicide, but more men complete suicide (Men over 80 are at greatest risk).
These days, people feel comfortable saying that mental illness is caused by trauma (as apposed to drugs or genes like it was in previous years).
People can have complex trauma (that affects their lives and mental health severely) and/or vicarious trauma
Periods of over-active and excited behaviour that have a significant impact on your day-to-day life.
Mania is a more severe form than hypomania, that lasts for a longer period (a week or more)
They can be experienced as part of a mood disorder (bipolar disorder, postpartum psychosis etc).
Uncontrollably excited, like you can't get your words out
Racing and jumbled thoughts
Like you're special and understand things others can't
Very easily distracted, unable to concentrate
Delusion and paranoia
Seeing/hearing/feelings things that aren't really there
Talking a lot, very quickly
Being rude, angry or aggressive
Forgetting to look after yourself (eating, cleaning, hygiene)
Misusing drugs or alcohol
Spending money innapropriately
Taking serious safety risks
A milder version of mania
A mood state characterised by persistent disinhibition and elevation (euphoria).
It may involve irritation, but less severely than full mania.
Lots of energy
Like you can perform tasks better and quicker than normal
Confident with high self-esteem
Impatient, irritable or angry
Attractive, flirtatious, with more sexual desire
More active than usual
Very talkative or writing a lot
Taking on extra responsibilities
Wearing extravagant colours
Sleeping very little
Making lots of jokes
Finding it hard to stay still