Understanding Mental Health Illness

Understanding Mental Health Illness

Mental health is a vital part of the well being of a person. The following definition of health by the World Health Organization (WHO) stresses mental health as an integral aspect of health- “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2013). There is a wide array of mental disorders ranging from the less severe forms, such as eating disorders, anxiety disorders, and depression to more serious conditions, such as, schizophrenia, schizoaffective disorder, bipolar disorder, panic disorder etc (NAMI, 2013). Mental illnesses, as are physical illnesses, are affected by a number of factors including genetic, socioeconomic and environmental factors. Mental illnesses have a high prevalence rate across the world and in most cases they are left undiagnosed and consequently untreated. A 2004 world mental health survey conducted by the WHO pointed out higher prevalence rates across Western countries while Asian countries had lower rates. Statistics from the survey also attested to the important fact that roughly 35 % to 50% and 76% to 85% of people were undiagnosed in the developed and developing countries of the world respectively, indicating the need for more awareness, evaluation and appropriate intervention for mental illnesses across the world (WHO, 2004). The focus of this essay will be on schizophrenia as one of the important mental disorders. Particularly, the paper will discuss the various aspects of schizophrenia and relate it to a case study of a 19 year old Mr John who experienced a sudden onset of psychotic symptoms. Such a case study based approach will allow for a better understanding of the sociological dimensions of schizophrenia.

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Schizophrenia

Schizophrenia is a chronic mental disorder that is characterized by impairment in thought process leading to the patient having altered perception of reality and emotional response. In fact schizophrenia is now being understood as a collection of different mental disorders. Full blown psychosis is usually regarded as the late stage symptom of the disorder (Phillips et.al, 2005). The diagnostic and statistical manual of mental disorders (DSM IV) defines schizophrenia as a “mental disorder involving a range of cognitive and emotional dysfunctions that include perception, inferential thinking, language and communication, behavioural monitoring, affect, fluency and productivity of thought and speech, hedonic capacity, volition and drive, and attention” (APA, 2000). The DSMIV also specifies that the diagnosis of schizophrenia cannot be attributed to any single symptom but that a group of symptoms that impair functionality are usually involved. As per the US national statistics roughly 1 % of the population has schizophrenia and that the incidence rate is relatively standard across different countries and races. Among people with a genetic disposition, or a family member with a history of the disorder, there is a 10% incidence rate (NIH, 2013). The WHO statistics project the incidence rate at 3 per 10,000 people and a higher prevalence rate of 7 per 10,000 people in any population. The higher prevalence rate compared to the incidence rate is due to the chronicity of the disorder (WHO, 2013).

Symptoms of Schizophrenia

The symptoms of schizophrenia are generally classified into three types namely- positive symptoms, negative symptoms and cognitive symptoms (NIH, 2013). Positive symptoms refer to those that are observed among schizophrenia patients but are not present among the general population. For instance, symptoms such as auditory and visual hallucinations, disorganized thinking, delusions and catatonia or movement disorder are categorized as positive symptoms of schizophrenia. Hallucinations are the auditory or visual perceptions of the schizophrenia patient that are not felt by a healthy person (NIH, 2013).

The case study refers to a 19 year old teenager Mr. John who is experiencing auditory hallucinations where spirits are telling him to keep distance from others and that there is a future awaiting him. This is a clear example of the kind of auditory hallucination or the altered perceptions experienced by a schizophrenia patient. However, in the case study there is also the mention of Mr. John smoking cannabis recently. Though cannabis is generally accepted as safe for medicinal use, there is still considerable debate surrounding its potential psychiatric effects. An early British study, which was an extensive review of cannabis users, reported that the drug is potentially dangerous among people with pre-existing mental disorders. The study concluded that cannabis use triggers and aggravates psychotic episodes among schizophrenia patients (Johns, 2001). Other studies, such as Arendt et.al (2005) and Daniel et.al (2010), also conclude that cannabis use causes adverse psychotic effects among schizophrenia patients. From the case study, it can be inferred that cannabis usage could have possibly triggered the hallucinatory symptoms in John.

Other symptoms, such as avolition (lack of motivation), reduced social interaction, dull personality or what is called as ‘flat effect’ are the typical negative symptoms (NIH, 2013). In other words, negative symptoms are those social qualities and the drive that is usually found among normal people but are lacking among schizophrenia patients. With reference to the case study, Mr. John is also exhibiting some of these negative symptoms. John’s tendency to lock himself up in his bedroom and his refusal to come out to eat and interact with his mother and sister and his generally reduced social drive are suggestive symptoms of schizophrenia. Lastly, the cognitive symptoms refer to the various cognitive abilities that affect the day to day functioning of the patient including ‘poor memory’, ‘lack of focus’ and ‘poor executive functioning’ (NIH, 2013).

Schizophrenia -Age of Onset and Aetiology

The onset of schizophrenia is predominantly during the late adolescent and early adult years. Though early onset schizophrenia among children as well as late stage schizophrenia has been known it is only during the late teen and early adult years that the symptoms of schizophrenia begin to show up predominantly (NIH, 2013). This is baffling as researchers were thus far prescribed to the notion that human brain development assumes maturation at a very early stage in life. However, recent studies of the human brain have shown that the brain continues to grow and undergo structural adaptations during the stage of puberty (Bruer, 1999). In fact, studies have pointed out significant levels of grey matter changes during the late adolescent and early adult years (Blakemore et.al, 2010).

There is also significant transition in terms of the structural composition and the synaptic connections of the brain cells that control t…………………………