Mental Health and Illness An Epidemiological Perspective 1

Mental Health and Illness An Epidemiological Perspective 1

Mental Health-Everybody’s Business • Peter Sims • Professor of Public Health medicine • University of Papua New Guinea • <petersims@upng. ac. pg> 2

Teaching and Learning Aims • There is ignorance, superstition, stigma and fear around Mental Illness • Aetiology, pathogenesis diagnosis and treatment are imperfect. • There is a different paradigm and a less rigorous epidemiology 3

Often sad, sometimes mad, occasionally bad • • The medical model is insufficient Diagnosis is largely clinical and experiential 4

More of an art than a science • Treatment is pragmatic • Prevention is about the politics of health • “populations, people pressures, poverty” 5

Mental Health is a worldwide problem 6

Mental illness is common 6 in 10 women and 4 in 10 men in Western Europe and North America will have a significant mental illness during their lifetime Mental illness can affect any one of us Mental illness occurs in all societies and cultures 7

We are all vulnerable 8

A Holistic Approach Arrow of Time BODY CULTURE MIND SPIRIT 9

Intelligence IQ = 100 IQ I. Q. = the Mental Age x 100 the Chronological age 10

Personality • Each human being is unique • We all have different personalities • My personality reflects genetic inheritance and Environment 11

Behaviour SUPER-EGO The Parent EGO The Adult ID The Child 12

The Subconscious Mind The Conscious The Subconscious 13

A Classification • Affective Disorders • Anxiety, depression, mania, obsessional disorders Substance abuse problems Drugs, alcohol Learning disorders • Schizophrenia • Subnormality Simple, Hebephrenic, Catatonic, paranoid • Organic states • Delirium, dementia • Personality Disorder • Abnormal personality, Psychopathy 14

The Classification of Mental Illness: The Neuroses Depression, Anxiety, Mania, Obsessions and compulsions (usually the patient retains insight and orientation; they experience deep distress and may commit suicide) The Psychoses Schizophrenia, puerperal psychosis (the patient is disorientated, deluded, and lacking in insight) The Dementias Progressive deterioration with loss of recent memory and deterioration of a normal personality, They may be primary or more commonly secondary to another condition e. g. alcohol, stroke 15

Clinical Diagnosis 16

The Classification of Mental Illness Drug Problems Addictive drugs, (Heroin, Cocaine, Amphetamines, ) alcohol and drug related illness-psychosis, delirium and dementia Personality Disorders A personality and behaviour that is damaging to the individual and/or to society and which is not tolerated by the dominant culture Mental subnormality/learning disorders: Problems around intelligence and ability to learn on the basis of teaching and experience 17

Aetiology Inheritance-Genetics/Intrauterine environment Schizophrenia, Huntington’s Drug Abuse Alcohol, Heroin etc Upbringing Neurological diseases Mothering, education, parenting Trauma/head injury MS, Brain tumour Biochemistry/metabolic Porphyria, Diabetes Infections. HIV, Syphilis, CJD Vascular-CVA Nutrition/PCM 18

Treatment and Care Hospital Care Community Care 19

Preventive Networks Church, Family, Home, Friends, Work 20

The Mental Health Act Compulsory Psychiatric Treatment Criminal responsibility Power of attorney 21

Mental Handicap/learning disability The mind of a young child in the body of an adult 22

Canst thou not minister to a mind diseased, Pluck from the memory a rooted sorrow, Raze out the written troubles of the brain, And with some sweet oblivious antidote Cleanse the stuff’d bosom of that perilous stuff Which weighs upon the heart? Macbeth 23