Mental illness mind body brain family and culture
Mental illness: mind, body, brain, family and culture Sid Williams 2019 1
Mental illness: the brain and the body Ø Today: the brain and the body Ø But: the mind, the family, the culture – not forgotten. 2
Take home messages Ø Keep an open mind about brain and body contributions to mental illness Ø Anxiety, depression, hallucinations, delusions can all be caused directly by brain-based disorders Ø But always consider psychological, family and cultural issues Ø If in doubt, discuss, refer, collaborate 3
Mrs Zhenzhen Smith Ø An unusual name Ø Frequent angry outbursts Ø Seeing ‘Chinesy’ relatives who didn’t speak to her Ø Good days and bad days Ø Diagnosis? 4
Dementia with Lewy bodies 1 Ø Vivid visual hallucinations, sometimes illusions Ø Muddle; memory relatively retained Ø Easily develop delirium Ø Fluctuation in function ++ Ø Antipsychotic drugs can Parkinsonism, falls, delirium 5
Dementia with Lewy bodies 2 Ø Alzheimer drugs can positive effect Ø Mild cognitive impairment with Lewy bodies occurs Ø Often perplexed, depressed, overwhelmed Ø May have Parkinson’s movement problems 6
Some causes of hallucinations Ø Delirium Ø Dementia Ø Stroke with Lewy bodies Cortex l Brain stem Ø Epileptic seizures (focal/partial) Ø Migraine Ø Drugs (e. g. propranolol, timoprolol) l 7
Some causes of hallucinations/hallucinationlike experiences Ø Sense of presence l Grief l Extreme stress Ø Doubling: l of oneself (doppelganger, autoscopy, out of body experiences) l of home (partition delusions) 8
Mrs Lucas and the brass plate 82 -year-old woman presents with depression + ‘a little vague’ Ø CT some atrophy, some white matter attenuation Ø CT (left) MRI (right) not Mrs Lucas 9
Mrs Lucas and the brass plate 2 Ø Perfectionist +/Ø Daughter Ruth lives with Mrs L. Ø Mr Lucas died 10 years before Ø Municipal Councillor, Fred Lucas swimming pool (closed), brass plate 10
Mrs Lucas and the brass plate 3 Ø Arrangement re ownership of home 2 yrs before Ø Renovation, repainting home 5 mths before Ø Painter made new frame for brass plate Ø Mrs Lucas became very distressed/depressed 11
Hypothesis, Best guess Ø Mrs Lucas difficulty dealing with/adapting to situation: l wouldn’t anyone? l perfectionism, need for control l White matter changes in the brain Hickie, I et al. (1995). Subcortical hyperintensities on magnetic resonance imaging: clinical correlates and prognostic significance in patients with severe depression. Biological Psychiatry 37(3): 151 -160 Hickie, I et al. (1997). Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression – a longitudinal evaluation. Biological Psychiatry 42(5): 367 -374 12 The LADIS Study Group. (2011) Cerebrovascular Diseases, 32(6): 577 -588
Mrs Lucas, outcome Ø With support, antidepressant recovery (more or less) Ø 2 years later significant cognitive problems ‘Vascular Dementia’ 13
Some causes of depression (apart from life circumstances) Ø Strokes Ø White matter changes Ø Dementia, Mild Cognitive Impairment Ø Other brain pathology l Parkinson’s disease l Huntington’s disease l Traumatic brain injury l Epilepsy 14
Some causes of depression Some drugs • Cortisone and cortisone-like • Beta-blockers l Childbirth l Season l Infections l Cancer l 15
Confabulations are not delusions Confabulation: filling the gaps in memory with imagined events or events from long ago. Ø Common in: l Alcohol related brain disorders (including Wernicke-Korsakoff) l Alzheimer’s disease l Other dementias Ø Not delusions, not psychotic, not treat with antipsychotic drugs Ø 16
Anxiety associated with impaired brain function Ø Catastrophic Ø Difficulties: reaction Remembering l Word-finding l Any function l Coping Ø Delirium l 17
All this and more in: Chapter 13 Anxiety and depression associated with brain pathology Chapter 14 False experiences and false beliefs associated with brain pathology 18
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