19.1 Contents:
Severe Depressive Disorder 19.6
Dissociative Disorders, Hysteria, and Somatoform Disorders 19.9
19.2.1 Depending on the way in which mental health problems are defined 10% of the population, at any one time, can be said to be affected by some kind of mental health problem. Mental distress is experienced by many people without necessarily having an exact mental health diagnosis and such people often go unrecognised and untreated.
19.2.2 Only a small minority of people with mental health problems are referred to psychiatric services, and these are typically people with severe or chronic forms of mental illness. Most people with the more severe mental health problems are rarely seen by mental health professionals until late in the episode. Indeed the majority of people with mental health problems are managed entirely by the general practitioner or may never reach a health professional. Many of these people are frequently assessed initially, and usually treated in the general (ie. non-psychiatric) setting.
19.2.3 Mental health problems may give rise to attendance needs. These are usually in the form of supervision/watching-over, but severe mental illness may also give rise to needs for attention in connection with bodily functions. Mobility needs may also occur. In people with mental distress there may be combinations of disabilities, including a mix of physical and mental disabilities. The combination of these effects needs to be taken into consideration when assessing care needs.
19.2.4 Unfortunately, an unwarranted stigma is often attached to a diagnosis of mental illness despite greater understanding in the community in recent years. Some people with mental health problems, particularly depression, therefore may tend to minimise the mental health component and maximise symptoms that relate to physical disability. Moreover, a large number of physical disorders have psychological components. Both of these components need recognition and assessment in the proper determination of care needs.
19.3.1 Various forms of mental illness have been recognised in almost every culture in the world. Mental disorders encompass a very wide range of diverse illnesses which have been given a variety of different diagnostic labels. Although the nature and severity of disability in the individual case are of paramount importance in determining the nature and level of care needs, rather than the exact diagnosis of the condition giving rise to the disability, the following broad classification of mental health disorders greatly assists in predicting the likely range and extent of care needs which may be associated with them:
Severe Depressive Disorder, Manic-depressive psychosis (Bipolar Depression) (19.6)
Generalised Anxiety Disorder (19.7.3)
Phobic Anxiety Disorders (19.7.5)
Obsessive - Compulsive Disorder (19.7.6)
Mild Depressive Disorder (19.7.7)
The Personality Disorders (19.8)
Dissociative (and Conversion) Disorders, Hysteria and Somatoform Disorders (19.9)
Drugs and Alcohol (Chapter 22)
19.3.2 Leaving aside the dementias which are most common in the elderly, and are separately described in Chapter 21; and alcohol and drugs abuse, and eating disorders which are covered in Chapters 22 and 23 respectively, this chapter will concentrate on the mental disorders listed above [para 19.3.1]. Factitious disorders and malingering are also dealt with for convenience at the end of this chapter [Paragraphs 19.10 and 19.11]. However these disorders involve a conscious and deliberate attempt to feign illness and its symptoms and are thus not conventionally considered to be mental health disorders.
Psychoses are severe forms of mental illness which affect the whole personality and are used to describe sets of symptoms which commonly go together, create a severe burden on the affected person, and frequently give rise to major disturbances of thinking and behaviour which may pose considerable attendance needs. They can affect people of any level of intelligence, most of whom will have apparently developed normally, with no intellectual problems, during childhood and adult life until the onset of the mental condition. Psychoses affect thought, mood or behaviour singly or in combination. As a result many people with a psychotic condition will have high levels of physical and intellectual abilities but have difficulties in using them because of anxiety, lack of concentration, or apathy, etc, to an extent that they have problems coping with general daily tasks. Typically a person affected by a psychotic illness loses touch with reality, has disordered thought processes, delusions (false beliefs) and/or hallucinations (eg seeing non-existent things or hearing non-existent voices). They frequently lack insight (ie. they are not aware that they are ill). Some may be on medication which leaves them forgetful or drowsy or affects their bodily functions. The two most common psychoses are schizophrenia and manic-depressive psychosis.
