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| {{Mental disorder}} | | {{Mental disorder}} |
| {{CMG}} | | {{CMG}}; {{AE}} {{KS}} |
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| == Diagnosis ==
| | {{SK}} General learning disability; intellectual disability |
| Many [[mental health professionals]], particularly psychiatrists, seek to [[diagnose]] individuals by ascertaining their particular mental disorder. Some professionals, for example some [[clinical psychologists]], may avoid diagnosis in favor of other assessment methods such as formulation of a client's difficulties and circumstances.<ref>Kinderman, P. and Lobban, F. (2000) Evolving formulations: Sharing complex information with clients. Behavioural and Cognitive Psychotherapy, 28(3), 307-310.</ref> The majority of mental health problems are actually assessed and treated by family physicians during consultations, who may refer on for more specialist diagnosis in acute or chronic cases. Routine diagnostic practice in mental health services typically involves an interview (which may be referred to as a [[mental status examination]]), where judgements are made of the interviewee's appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of relatives or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. [[Psychological testing]] is sometimes used via paper-and-pen or computerized questionnaires, which may include [[algorithms]] based on ticking off standardized diagnostic criteria, and in relatively rare specialist cases neuroimaging tests may be requested, but these methods are more commonly found in research studies than routine clinical practice.<ref>HealthWise (2004) [http://health.yahoo.com/topic/mentalhealth/symptoms/medicaltest/healthwise/tp16780 Mental Health Assessment.] Yahoo! Health</ref><ref>Davies, T. (1997) [http://www.bmj.com/cgi/content/full/314/7093/1536 ABC of mental health: Mental health assessment] ''British Medical Journal 314:1536</ref> Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.<ref>Kashner TM, Rush AJ, Surís A, Biggs MM, Gajewski VL, Hooker DJ, Shoaf T, Altshuler KZ. (2003) Impact of structured clinical interviews on physicians' practices in community mental health settings. Psychiatr Serv. 2003 May;54(5):712-8. PMID 12719503</ref> It has been found that most clinicians evaluate patients using an unstructured, open-ended approach, with limited training in evidence-based assessment methods, and that inaccurate diagnosis may be common in routine practice.<ref>Shear MK, Greeno C, Kang J, Ludewig D, Frank E, Swartz HA, Hanekamp M. (2000) Diagnosis of nonpsychotic patients in community clinics. ''Am J Psychiatry.'' Apr;157(4):581-7 PMID 10739417</ref>
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| [[Comorbidity]] is very usual with mental disorders, i.e. same person can suffer one or more disorder. The work for fifth version of [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-V) | | == [[Mental disorder overview|Overview]] == |
| <ref>[http://www.dsm5.org/ DSM-V Prelude Project website]</ref> has raised some questions about dimensional diagnostic criteria compared to categorical diagnostic criteria. Journal of Abnormal Psychology (Vol 114, Issue 4) <ref>[http://content.apa.org/journals/abn/114/4 Journal of Abnormal Psychology - Vol 114, Issue 4]</ref> devoted a whole issue to discuss about categorical and dimensional diagnostic criteria. In short it the argument is that diagnosis of mental disorder can be based on several overlapping dimensions and not categorical and/or two-dimensional classes. One possibility in diagnosis is to have several (>2) dimensions overlapping and that it is harder to describe. In the following picture idea is that multiple dimension lines are crossed with one diagnostic line and the combination of crossing points is basis for a diagnosis.<br>
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| [[Image:Multidimensional diagnosis.JPG|center]]
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| In practical clinical settings it might be problematic to find several disorders in different dimensions and also differentiate the position of specific disorder in its dimensional axis like the picture indicates.
| | == [[Mental disorder historical perspective|Historical Perspective]] == |
| | == [[Mental disorder classification|Classification]] == |
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| == Differential Diagnosis == | | == [[Mental disorder pathophysiology|Pathophysiology]]== |
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| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| | == [[Mental disorder causes|Causes]]== |
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| === Anxiety Disorders === | | == [[Mental disorder differential diagnosis|Differentiating Mental Disorder from other Diseases]] == |
| * Acute stress disorder
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| * Agoraphobia
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| * Generalized anxiety disorder
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| * [[Obsessive compulsive disorder]]
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| * Panic disorder
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| * [[Posttraumatic Stress Disorder]]
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| * Social phobia
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| * Specific phobia
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| === Childhood Disorders === | | == [[Mental disorder epidemiology and demographics|Epidemiology and Demographics]] == |
| * Asperger's disorder
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| * Attention-Deficit disorder
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| * Autistic disorder
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| * Conduct disorder
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| * Oppositional defiant disorder
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| * [[Separation Anxiety Disorder]]
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| * [[Tourette's syndrome]]
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| === Cognitive Disorders === | | == [[Mental disorder risk factors|Risk Factors]] == |
| * [[Ddx:Delirium|Delirium]]
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| * [[Dementia]] in alcoholism
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| * [[Dementia]] of Alzheimer type
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| * Multi-infarct dementia
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| * Other [[Dementia|dementia]]
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| === Eating Disorders === | | == [[Mental disorder screening|Screening]] == |
| * [[Anorexia Nervosa]]
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| * [[Bulimia Nervosa]]
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| === Mood Disorders ===
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| * [[Bipolar Disorder]]
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| * Cyclothymic disorder
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| * Dysthymic disorder
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| * Major depressive disorder
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| === Personality Disorders ===
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| * Antisocial personality
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| * Borderline personality
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| * Dependent personality
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| * Histrionic personality
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| * Obsessive-compulsive personality
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| === Schizophrenia (and other) ===
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| * Brief psychotic disorder
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| * Delusional disorder
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| * Psychotic disorders
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| * Schizoaffective disorder
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| * Schizophreniform disorder
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| * Shared psychotic disorder
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| === Substance-Related Disorders ===
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| * Alcoholism
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| * Amphetamines
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| * Cannabis
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| * Cocaine
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| * Hallucinogens
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| * Inhalants
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| * Nicotine
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| * Opinoids
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| * Phencyclidines
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| * Sedatives
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| == Treatment == | | == [[Mental disorder natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
| {{main|Treatment of mental disorders}}
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| Mental health services may be based in hospitals, clinics or the community. Often an individual may engage in different treatment modalities. They may be under [[case management]] (sometimes referred to as "service coordination"), use inpatient or [[partial hospitalization|day treatment]], utilize a [[Clubhouse Model of Psychosocial Rehabilitation|psychosocial rehabilitation]] program, and/or take part in an [[Assertive Community Treatment]] program. Individuals may be treated against their will in some cases, especially if assessed to be at high risk to themselves or others. Services in some countries are increasingly based on a [[Recovery model]] that supports an individual's journey to regain a meaningful life.
| | ==Diagnosis== |
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| ===Psychotherapy===
| | [[Mental disorder diagnostic criteria|Diagnostic Criteria]] |[[Mental disorder history and symptoms|History and Symptoms]] | [[Mental disorder physical examination|Physical Examination]] | [[Mental disorder laboratory findings|Laboratory Findings]] | [[Mental disorder electrocardiogram|Electrocardiogram]] | [[Mental disorder CT|CT]] | [[Mental disorder MRI|MRI]] | [[Mental disorder other imaging findings |Other Imaging Findings]] |
| A major option for many mental disorders is [[psychotherapy]]. There are several main types. [[Cognitive behavioral therapy]] (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. [[Psychoanalysis]], addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. [[Systemic therapy]] or [[family therapy]] is sometimes used, addressing a network of signicant others as well as an individual. Some psychotherapies are based on a [[humanistic psychology|humanistic]] approach. There are a number of specific therapies used for particular disorders, which may be offshoots or hybrids of the above types. [[Mental health professionals]] often employ an [[Integrative Psychotherapy|eclectic or integrative approach]]. Much may depend on the [[therapeutic relationship]], and there may be problems with [[Trust (social sciences)|trust]], confidentiality and engagement.
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| ===Medication=== | | ==Treatment== |
| A major option for many mental disorders is [[psychiatric medication]]. There are several main groups. [[Antidepressants]] are used for the treatment of [[clinical depression]] as well as often for anxiety and other disorders. There are a number of antidepressants beginning with the tricylics, moving through a wide variety of drugs that modify various facets of the brain chemistry dealing with intercellular communication. Beta-blockers, developed as a heart medication, is also used as an antidepressant. [[Anxiolytics]] are used for [[anxiety disorder]]s and related problems such as insomnia. [[Mood stabilizers]] are used primarily in [[bipolar disorder]]. Lithium A(a metal) and Lamictal (an epileptic drug) are notable for treating both mania and depression. The others, mainly targeting [[mania]] rather than depression, are a wide variety of epilepsy medications and antipsychotics. [[Antipsychotics]] are used for [[psychosis|psychotic disorders]], notably for positive symptoms in [[schizophrenia]]. [[Stimulants]] are commonly used, notably for [[ADHD]]. Despite the different conventional names of the drug groups, there can be considerable overlap in the kinds of disorders for which they are actually indicated. There may also be [[off-label use]]. There can be problems with [[adverse effects]] and [[Compliance (medicine)|adherence]].
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| ===Other===
| | [[Mental disorder medical therapy|Medical Therapy]] | [[Mental disorder psychotherapy|Psychotherapy]] | [[Mental disorder surgery|Surgery]] | [[Mental disorder prevention|Prevention]] | [[Mental disorder social impacts|Social Impacts]] | [[Mental disorder cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Mental disorder future or investigational therapies|Future or Investigational Therapies]] |
| Electroconvulsive therapy ([[ECT]]) is sometimes used in severe cases when other interventions for severe intractable depression have failed. [[Psychosurgery]], best known as the form known as a "frontal lobotomy", is no longer generally used. [[Psychoeducation]] may be used to provide people with the information to understand and manage their problems. Creative therapies are sometimes used, including [[music therapy]], [[art therapy]] or [[drama therapy]]. Lifestyle adjustments and supportive measures are often used, including [[peer support]], [[self-help]] and supported housing or employment. Some advocate [[dietary supplements]] based on published randomized double-blind, placebo controlled trials<ref>Lakhan SE; Vieira KF. [http://www.nutritionj.com/content/7/1/2 Nutritional therapies for mental disorders]. ''Nutrition Journal'' 2008;7(2).</ref>. Many things have been found to help at least some people. A [[placebo]] effect may play a role in any intervention.
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| == Prognosis ==
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| There is substantial variation over time between disorders, and between individuals. Functional ability may also vary across different domains. There may be [[remission]] of symptoms, but also [[relapse]]. Rates of [[recovery]] vary. A number of individual and social factors have been linked to prognosis.
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| Despite often being characterized in purely negative terms, mental disorders can involve above-average creativity, non-conformity, goal-striving, meticulousness, or empathy.<ref name="Rogers&Pilgram05"/> The public perception of the level of disability associated with mental disorders can change.<ref>Ferney, V. (2003) [http://www.newyorkcityvoices.org/2003janmar/20030318.html The Hierarchy of Mental Illness: Which diagnosis is the least debilitating?] ''New York City Voices'' Jan/March</ref>
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| == Prevalence ==
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| [[WHO]] estimated that about 450 million people worldwide currently suffer from some form of mental or behavioural disorder.<ref>[http://www.who.int/whr/2001/chapter1/en/index.html WHO | The world health report]</ref> One in four people will suffer from mental illness at some time in life, according to a report from the WHO.<ref>[http://www.psychiatrictimes.com/p020101a.html Mental Health Care in the Developing World]</ref><ref>[http://news.bbc.co.uk/2/hi/health/1578755.stm Mental problems 'hit one in four']</ref>
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| Numerous large-scale surveys of the [[prevalence]] of mental disorders in adults in the general population have been carried out since the 1980s based on self-reported symptoms assessed by standardized structured interviews, usually carried out over the phone. Mental disorders have been found to be common, with over a third of people in most countries reporting sufficient criteria at some point in their life.<ref>WHO International Consortium in Psychiatric Epidemiology (2000) [http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862000000400003&lng=&nrm=iso Cross-national comparisons of the prevalences and correlates of mental disorders] ''Bulletin of the World Health Organization'' v.78 n.4</ref> The [[World Health Organization]] is currently undertaking a global survey of 26 countries in all regions of the world, based on [[ICD]] and [[DSM]] criteria.[http://www.hcp.med.harvard.edu/wmh/index.php] The first published figures on the 14 country surveys completed to date, indicate that, of those disorders assessed, anxiety disorders are the most common in all but 1 country (prevalence in the prior 12-month period of 2.4% to 18.2%) and mood disorders next most common in all but 2 countries (12-month prevalence of 0.8% to 9.6%), while substance disorders (0.1%-6.4%) and impulse-control disorders (0.0%-6.8%) were consistently less prevalent. The United States, Colombia, the Netherlands and Ukraine tended to have higher prevalence estimates across most classes of disorder, while Nigeria, Shanghai and Italy were consistently low, and prevalence was lower in Asian countries in general. Cases of disorder were rated as mild (prevalence of 1.8%-9.7%), moderate (prevalence of 0.5%-9.4%) and serious (prevalence of 0.4%-7.7%).<ref>WHO World Mental Health Survey Consortium. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15173149 Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.] ''JAMA.'' Jun 2;291(21):2581-90.</ref> However, these are widely believed to be underestimates, due to poor diagnosis (especially in countries without affordable access to mental health services) and low reporting rates, in part because of the predominant use of self-report data, rather than semi-structured instruments such as the [[Structured Clinical Interview for DSM-IV]] (SCID); actual lifetime prevalence rates for mental disorders are estimated to be between 65% and 85%.
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| A review that pooled surveys in different countries up to 2004 found overall average prevalence estimates for any anxiety disorder of 10.6% (in the 12 months prior to assessment) and 16.6% (in lifetime prior to assessment), but that rates for individual disorders varied widely. Women had generally higher prevalence rates than men, but the magnitude of the difference varied.<ref>Somers JM, Goldner EM, Waraich P, Hsu L. (2006) [http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2004/february/waraich.asp Prevalence and incidence studies of anxiety disorders: a systematic review of the literature.] ''Can J Psychiatry.'' Feb;51(2):100-13.</ref> A review that pooled surveys of mood disorders in different countries up to 2000 found 12-month prevalence rates of 4.1% for major depressive disorder (MDD), 2% for dysthymic disorder and 0.72% for bipolar 1 disorder. The average lifetime prevalence found was 6.7% for MDD (with a relatively low lifetime prevalence rate in higher-quality studies, compared to the rates typically highlighted of 5%-12% for men and 10%-25% for women), and rates of 3.6% for dysthymia and 0.8% for Bipolar 1.<ref>Waraich P, Goldner EM, Somers JM, Hsu L. (2004) [http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2004/february/waraich.asp Prevalence and incidence studies of mood disorders: a systematic review of the literature.] ''Can J Psychiatry.'' Feb;49(2):124-38.</ref>
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| Previous widely cited large-scale surveys in the United States were the Epidemiological Catchment Area (ECA) survey and subsequent National Comorbidity Survey (NCS). The NCS was replicated and updated between 2000 and 2003 and indicated that, of those groups of disorders assessed, nearly half of Americans (46.4%) reported meeting criteria at some point in their life for either a DSM-IV anxiety disorder (28.8%), mood disorder (20.8%), impulse-control disorder (24.8%) or substance use disorders (14.6%). Half of all lifetime cases had started by age 14 years and 3/4 by age 24 years.<ref>Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. (2005) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15939837 Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.] ''Arch Gen Psychiatry''. Jun;62(6):593-602.</ref> In the prior 12-month period only, around a quarter (26.2%) met criteria for any disorder - anxiety disorders 18.1%; mood disorders 9.5%; impulse control disorders 8.9%; and substance use disorders 3.8%. A substantial minority (23%) met criteria for more than two disorders. A minority (22.3%) of cases were classed as serious, 37.3% as moderate and 40.4% as mild.<ref>Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters, EE. (2005) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15939839 Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.] ''Arch Gen Psychiatry.'' Jun;62(6):617-27.</ref><ref>US National Institute of Mental Health (2006) [http://www.nimh.nih.gov/publicat/numbers.cfm The Numbers Count: Mental Disorders in America] Retrieved May 2007</ref>
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| A 2004 cross-European study found that approximately one in four people reported meeting criteria at some point in their life for one of the DSM-IV disorders assessed, which included mood disorders (13.9%), anxiety disorders (13.6%) or alcohol disorder (5.2%). Approximately one in ten met criteria within a 12-month period. Women and younger people of either gender showed more cases of disorder<ref>ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15128384 Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.] ''[[Acta Psychiatrica Scandinavica]]'' Suppl. (420):21-7.</ref>
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| A 2005 review of 27 studies have found that 27% of adult Europeans is or has been affected by at least one mental disorder in the past 12 months. It was also found that the most frequent disorders were anxiety disorders, depressive, somatoform and substance dependence disorders.<ref>Wittchen, H.U. and Jacobi, F. (2005). [http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&dopt=AbstractPlus&list_uids=15961293 Size and burden of mental disorders in Europe - a critical review and appraisal of 27 studies]. ''European Neuropsychopharmacology, 15, 4,'' pp. 357-76.</ref>
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| A 2005 review of prior surveys in 46 countries on the prevalence of schizophrenic disorders, including a prior 10-country WHO survey, found an average (median) figure of 0.4% for lifetime prevalence up to the point of assessment and 0.3% in the 12-month period prior to assessment. A related figure not given in other studies (known as lifetime morbid risk), reported to be an accurate statement of how many people would theoretically develop schizophrenia at any point in life regardless of time of assessment, was found to be “about seven to eight individuals per 1,000.” (0.7/0.8%). The prevalence of schizophrenia was consistently lower in poorer countries than in richer countries (though not the [[incidence (epidemiology)|incidence]]) but the prevalence did not differ between urban/rural areas or men/women (although incidence did).<ref>Saha S, Chant D, Welham J, McGrath J. (2005) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15916472 A systematic review of the prevalence of schizophrenia.] ''PLoS Med.'' 2005 May;2(5):e141.</ref>
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| Studies of the prevalence of personality disorders (PDs) have been fewer and smaller-scale, but a broader Norwegian survey found a similar overall prevalence of almost 1 in 7 (13.4%), based on meeting personality criteria over the prior five year period. Rates for specific disorders ranged from 0.8% to 2.8%, with rates differing across countries, and by gender, educational level and other factors<ref>Torgersen S, Kringlen E, Cramer V. (2001) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11386989 The prevalence of personality disorders in a community sample.] ''Arch Gen Psychiatry.'' 2001</ref> A US survey that incidentally screened for personality disorder found an overal rate of 14.79%.<ref> Grant BF, Hasin DS, Stinson FS, Dawson DA,Chou SP, Ruan WJ, Pickering RP. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15291684 Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions.] ''J Clin Psychiatry.'' Jul;65(7):948-58.</ref>
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| Approximately 7% of a preschool pediatric sample were given a psychiatric diagnosis in one clinical study, and approximately 10% of 1- and 2-year-olds receiving developmental screening have been assessed as having significant emotional/behavioral problems based on parent and pediatrician reports.<ref>Carter, AS., Briggs-Gowan, MJ. & Davis, NO. (2004) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14959805 Assessment of young children's social-emotional development and psychopathology: recent advances and recommendations for practice.] ''J Child Psychol Psychiatry.'' Jan;45(1):109-34.</ref>
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| == Professions and fields ==
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| {{main|Mental health professional}}
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| A number of [[professions]] have developed that specialise in the treatment of mental disorders, including the [[Medicine|medical]] speciality of [[psychiatry]] (including psychiatric nursing)<ref name=AJP154Editorial>A, N.C. (1997). What is Psychiatry? ''The American Journal of Psychiatry, 154'', 591-593.</ref><ref name=UM>University of Melbourne. (2005, August 19). ''What is Psychiatry?''. Retrieved April 19, 2007, from http://www.psychiatry.unimelb.edu.au/info/what_is_psych.html</ref><ref name=CPA>California Psychiatric Association. (2007, February 28). ''Frequently Asked Questions About Psychiatry & Psychiatrists''. Retrieved April 19, 2007, from http://www.calpsych.org/publications/cpa/faqs.html</ref>, the division of [[psychology]] known as [[clinical psychology]]<ref>American Psychological Association, Division 12, http://www.apa.org/divisions/div12/aboutcp.html</ref>, [[social work|Social Work]]<ref>Golightley, M. (2004) Social work and Mental Health Learning Matters, UK</ref>, as well as Mental Health Counselors, Marriage and Family Therapists, [[Psychotherapists]], [[Counselors]] and [[Public Health]] professionals. Those with personal experience of using mental health services are also increasingly involved in researching and delivering mental health services and working as mental health professionals.<ref>Goldstrom ID, Campbell J, Rogers JA, et al (2006) [http://www.springerlink.com/content/u132325343qlw4r0/ National estimates for mental health mutual support groups, self-help organizations, and consumer-operated services.] ''Administration and Policy in Mental Health and Mental Health Services Research'', 33:92–102</ref><ref>The Joseph Rowntree Foundation (1998) [http://www.jrf.org.uk/knowledge/findings/socialcare/SCR488.asp The experiences of mental health service users as mental health professionals]</ref><ref>Chamberlin J. (2005) User/consumer involvement in mental health service delivery. ''Epidemiol Psichiatr Soc.'' Jan-Mar;14(1):10-4. PMID 15792289</ref><ref>Terence V. McCann, John Baird, Eileen Clark, Sai Lu (2006) [http://www.blackwell-synergy.com/doi/abs/10.1111/j.1447-0349.2006.00432.x Beliefs about using consumer consultants in inpatient psychiatric units] ''International Journal of Mental Health Nursing'' 15 (4), 258–265.</ref> The different clinical and scientific perspectives draw on diverse fields of research and theory, and different disciplines may favor differing models, explanations and goals.<ref name="Rogers&Pilgram05">Rogers, A. & Pilgram, D. (2005) ''A Sociology of Mental Health and Illness'', Open University Press, 3rd Edition. ISBN 0335215831</ref>
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| == Movements ==
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| The [[Consumer/Survivor Movement]] (also known as user/survivor movement) is made up of individuals (and organizations representing them) who are clients of mental health services or who consider themselves "survivors" of mental health services. The movement campaigns for improved mental health services and for more involvement and empowerment within mental health services, policies and wider society.<ref>Everett, B. (1994) [http://www.umaine.edu/JMB/archives/volume15/15_1-2_1994winterspring.html#abstract4 Something is happening: the contemporary consumer and psychiatric survivor movement in historical context.] ''Journal of Mind and Behavior'', 15:55–7</ref><ref>Rissmiller DJ & Rissmiller JH (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=16754765&dopt=Abstract Evolution of the antipsychiatry movement into mental health consumerism. ] ''Psychiatric Services'', Jun;57(6):863-6.</ref><ref>Oaks, D. (2006) [http://psychservices.psychiatryonline.org/cgi/content/full/57/8/1212 The Evolution of the Consumer Movement] ''Psychiatric Services'' 57:1212</ref> [[Patient advocacy]] organizations have expanded with increasing [[deinstitutionalization]] in developed countries, working to challenge the [[stereotypes]], [[stigma]] and exclusion associated with psychiatric conditions. An [[antipsychiatry]] movement fundamentally challenges mainstream psychiatric theory and practice, including the reality or utility of psychiatric diagnoses of mental illnesses.<ref name=AntiPsychCoal>The Antipsychiatry Coalition. (2005, November 26). The Antipsychiatry Coalition. Retrieved April 19, 2007, from www.antipsychiatry.org</ref><ref>Anthony Paul O'Brien, Martin Woods, Christine Palmer (2001) [http://www.blackwell-synergy.com/doi/abs/10.1046/j.1440-0979.2001.00183.x The emancipation of nursing practice: Applying anti-psychiatry to the therapeutic community.] Australian and New Zealand Journal of Mental Health Nursing 10 (1), 3–9.</ref>
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| <ref>Weitz D. (2003) Call me antipsychiatry activist--not "consumer" ''Ethical Hum Sci Serv.'' Spring;5(1):71-2. PMID 15279009</ref>
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| == Laws and policies ==
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| Three quarters of countries around the world have mental
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| health legislation. Compulsory admission to mental health facilities (also known as [[Involuntary commitment]] or [[sectioning]]), is a controversial topic. From some points of view it can impinge on personal liberty and the right to choose, and carry the risk of abuse for political, social and other reasons; from other points of view, it can potentially prevent harm to self and others, and assist some people in attaining their right to healthcare when unable to decide in their own interests.<ref name="WHORIGHTS">World Health Organization (2005) [http://www.who.int/mental_health/policy/who_rb_mnh_hr_leg_FINAL_11_07_05.pdf WHO Resource Book on Mental Health: Human rights and legislation] ISBN 924156282 (PDF)</ref>
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| All human-rights orientated mental health laws require proof of the presence of a mental disorder as defined by internationally accepted standards, but the type and severity of disorder that counts can vary in different jurisdictions. The two most often utilized grounds for involuntary admission are said to be serious likelihood of immediate or imminent danger to self or others, and the need for treatment. Applications for someone to be involuntarily admitted may usually come from a mental health practitioner, a family member, a close relative, or a guardian. Human-rights-orientated laws usually stipulate that independent medical practitioners or other accredited mental health practitioners must examine the patient separately and that there should be regular, time-bound review by an independent review body.<ref name="WHORIGHTS"/> An individual must be shown to lack the capacity to give or withhold informed consent (i.e. to understand treatment information and its implications). Proxy consent (also known as [[substituted decision-making]]) may be given to a personal representative, a family member or a legally appointed guardian, or patients may have been able to enact an [[advance directive]] as to how they wish to be treated.<ref name="WHORIGHTS"/> The right to [[supported decision-making]] may also be included in legislation.<ref>Manitoba Family Services and Housing. The Vulnerable Persons Living with a Mental Disability Act, 1996</ref> Involuntary treatment laws may be extended to those living in the community, for example [[Community Treatment Order]]s (CTOs) are used in [[New Zealand]], [[Australia]] and 38 states in the [[US]] and are being planned in the [[UK]].<ref>[http://news.independent.co.uk/uk/legal/article2137689.ece The Big Question: Will the new mental health Bill make Britain a safer place?]</ref>
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| The World Health Organization reports that in many instances national mental health legislation takes away the rights of persons with mental disorders rather than protecting rights, and is often outdated.<ref name="WHORIGHTS"/> In 1991, the [[United Nations]] adopted the [[Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care]], which established minimum human rights standards of practice in the mental health field. In 2006 the UN formally agreed the [[Convention on the Rights of Persons with Disabilities]] to protect and enhance the rights and opportunities of disabled people, including those with psychosocial disabilities<ref>[http://www.un.org/esa/socdev/enable/ ENABLE website] UN section on disability</ref>
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| The term [[insanity]], sometimes used [[Colloquialism|colloquially]] as a [[synonym]] for mental illness, is often used technically as a legal term.
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| == Perception and discrimination ==
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| === Media ===
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| {{main|Mental disorders in art and literature}}
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| Media coverage of mental illness comprises predominantly negative depictions, for example, of incompetence, violence or criminality, with far less coverage of positive issues such as accomplishments or [[human rights]] issues.<ref>Coverdate, J., Nairn, R. & Claasen, D. (2001) [http://www.blackwell-synergy.com/doi/abs/10.1046/j.1440-1614.2002.00998.x?journalCode=anpquick Depictions of mental illness in print media: a prospective national sample] ''Australian and New Zealand Journal of Psychiatry'', 36 (5), 697–700.</ref><ref>Edney, RD. (2004) [http://www.ontario.cmha.ca/content/about_mental_illness/mass_media.asp Mass Media and Mental Illness: A Literature Review] Canadian Mental Health Association</ref><ref>Diefenbach, D.L. (1998) [http://www3.interscience.wiley.com/cgi-bin/abstract/46099/ABSTRACT?CRETRY=1&SRETRY=0 The portrayal of mental illness on prime-time television] ''Journal of Community Psychology'' Vol 25, Issue 3, Pages 289-302</ref> Such negative depictions, including in children's cartoons, are thought to contribute to [[stigma]] and negative attitudes in the public and in those with mental health problems themselves, although more sensitive or serious cinematic portrayals have increased in prevalence.<ref>Sieff, E. (2003) [http://www.ingentaconnect.com/content/routledg/cjmh/2003/00000012/00000003/art00006 Media frames of mental illnesses: The potential impact of negative frames] ''Journal of Mental Health'', Vol 12(3) pp. 259-269</ref><ref>Wahl, O.F. (2003) [http://abs.sagepub.com/cgi/content/abstract/46/12/1594 News Media Portrayal of Mental Illness: Implications for Public Policy] ''American Behavioral Scientist'' Vol. 46, No. 12, 1594-1600</ref>
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| === General public ===
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| The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill.<ref>Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. (1999) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=10474548 Public conceptions of mental illness: labels, causes, dangerousness, and social distance.] ''Am J Public Health.'' Sep;89(9):1328-33.</ref> Japan has been reported to have more negative attitudes than Australia, although stigma appears common in both countries.<ref>Griffiths KM, Nakane Y, Christensen H, Yoshioka K, Jorm AF, Nakane H. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16716231 Stigma in response to mental disorders: a comparison of Australia and Japan.] ''BMC Psychiatry.'' May 23;6:21.</ref>
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| ===Violence===
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| The public fear of violence due to mental illness is a contentious topic. One US national survey indicated that a far higher percentage of Americans rated individuals described as displaying the characteristics of a mental disorder (for example Schizophrenia or Substance Use Disorder) as "likely to do something violent to others" compared to those described as being 'troubled'.<ref>Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S. (1999) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10474550 The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems.] ''American Journal of Public Health.'' Sep;89(9):1339-45.</ref> Research indicates, on balance, a higher than average number of violent acts by some individuals with certain diagnoses, notably antisocial or psychopathic personality disorders, but conflicting findings about specific symptoms (for example links between psychosis and violence in community settings) - but the mediating factors of such acts are most consistently found to be mainly socio-demographic and socio-economic factors such as being young, [[male]], of lower socio-economic [[status]] and, in particular, substance abuse (including [[alcohol]]).<ref name="Stuart03">Stuart, H. (2003) [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525086 Violence and mental illness: an overview.] '' World Psychiatry. June; 2(2): 121–124</ref><ref>Steadman HJ, Mulvey EP, Monahan J, Robbins PC, Appelbaum PS, Grisso T, Roth LH, Silver E. (1998) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=9596041 Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods.] ''Archives of General Psychiatry.'' May;55(5):393-401.</ref><ref name="Rogers&Pilgram05"/> Findings consistently indicate that it is many times more likely that people diagnosed with a serious mental illness living in the community will be the victim rather than the perpetrator of violence.<ref name="Stuart03"/><ref>Brekke JS, Prindle C, Bae SW, Long JD (2001). Risks for individuals with schizophrenia who are living in the community. Psychiatric Services. Oct;52(10):1358–66. PMID 11585953</ref> Violence by or against individuals with mental illness typically occurs in the context of complex social interactions (including in atmosphere of mutually high "[[expressed emotion]]"), including within a family setting,<ref>Solomon, PL., Cavanaugh, MM., Gelles, RJ. (2005) [http://tva.sagepub.com/cgi/content/abstract/6/1/40 Family Violence among Adults with Severe Mental Illness.] ''Trauma, Violence, & Abuse'', Vol. 6, No. 1, 40-54</ref> as well as being an issue in healthcare settings<ref>Chou, KR., Lu, RB., Chang, M. (2001) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11779087 Assaultive behavior by psychiatric in-patients and its related factors.] ''Journal of Nursing Research.'' Dec;9(5):139-51</ref> and the wider community.<ref>B. Lögdberg, L.-L. Nilsson, M. T. Levander, S. Levander (2004) [http://www.blackwell-synergy.com/links/doi/10.1111/j.1600-0047.2004.00322.x/abs/ Schizophrenia, neighbourhood, and crime.] ''[[Acta Psychiatrica Scandinavica]],'' 110(2) Page 92.</ref>
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| ===Employment===
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| [[Employment discrimination]] is reported to play a significant part in the high rate of [[unemployment]] among those with a diagnosis of mental illness<ref>Heather Stuart (2006) [http://www.medscape.com/viewarticle/542517 Mental Illness and Employment Discrimination] ''Current Opinion in Psychiatry'' 19(5):522-526.</ref> Schemes to combat [[stigma]] have been prioritized by global and national psychiatric organizations, but their methods and outcomes have been criticized as counterproductive.<ref>Read, J., Haslam, N., Sayce, L., Davies, E. (2006) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17022790 Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach] ''[[Acta Psychiatrica Scandinavica]] Nov;114(5):303-18</ref>
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| | ==Case Studies== |
| | :[[Mental disorder case study one|Case #1]] |
| == See also == | | == See also == |
| * [[Psychopathology]] | | * [[Psychopathology]] |
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| * [[Anti-psychiatry]] | | * [[Anti-psychiatry]] |
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| ==Notes==
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| {{Reflist|2}}
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| === Further reading ===
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| * Atkinson, J. (2006) '''Private and Public Protection: Civil Mental Health Legislation''', Edinburgh, Dunedin Academic Press
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| * {{cite book | author=Hockenbury, Don and Sandy | title=Discovering Psychology | publisher=Worth Publishers | year=2004 | id=ISBN 0-7167-5704-4}}
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| * [[Roy Porter]], ''Madness. A Brief History'', Oxford University Press 2003
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| * Wiencke, Markus (2006) ''Schizophrenie als Ergebnis von Wechselwirkungen: Georg Simmels Individualitätskonzept in der Klinischen Psychologie''. In David Kim (ed.), ''Georg Simmel in Translation: Interdisciplinary Border-Crossings in Culture and Modernity'' (pp. 123-155). Cambridge Scholars Press, Cambridge, ISBN 1-84718-060-5
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| {{Mental illness (alphabetical list)}} | | {{Mental illness (alphabetical list)}} |
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| [[ar:مرض عقلي]]
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| [[zh-min-nan:Cheng-sîn-pēⁿ]]
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| [[ca:Malaltia mental]]
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| [[cs:Duševní porucha]]
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| [[da:Psykisk sygdom]]
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| [[de:Psychische Störung]]
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| [[et:Psüühika- ja käitumishäired]]
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| [[es:Enfermedad mental]]
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| [[eu:Buruko gaitza]]
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| [[fr:Maladie mentale]]
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| [[gl:Enfermidade mental]]
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| [[ko:정신과 질환]]
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| [[hi:मानसिक रोग]] | | [[hi:मानसिक रोग]] |
| [[he:הפרעה נפשית]]
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| [[id:Penyakit mental]]
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| [[is:Geðsjúkdómur]]
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| [[lt:Psichikos sutrikimas]]
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| [[nl:Psychische aandoening]]
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| [[ja:精神疾患]]
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| [[no:Psykisk lidelse]]
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| [[uz:Ruhiy kasallik]]
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| [[pl:Zaburzenie psychiczne]]
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| [[pt:Doença mental]]
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| [[ro:Boală mentală]]
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| [[ru:Психическое расстройство]]
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| [[simple:Mental illness]]
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| [[sk:Duševná choroba]]
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| [[sl:Duševna motnja]]
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| [[sr:Ментални поремећај]]
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| [[sh:Duševna bolest]]
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| [[sv:Psykisk störning]]
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| [[uk:Психічні захворювання]]
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| [[zh:心理疾病]]
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| {{jb1}}
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |