Download Classification of Mental Disorders

Co-occurring Alcohol and Other Drug and
Mental Health Conditions in Alcohol and
other Drug Treatment Settings
Session 2:
Classification
of Mental Disorders
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Comorbidity Guidelines
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Refer to:
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Chapter 5
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Classification - Key Points
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Disorders represent particular combinations
of signs and symptoms grouped together to
form criteria as per DSM-IV-TR
Certain number of criteria need to be met
within a certain time frame for a person to be
diagnosed as having a disorder
Not all AOD workers are able to formally
diagnose the presence or absence of mental
health disorders
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Classification – Key Points
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(2)
Diagnoses of mental health disorders should
only be made by suitably qualified and
trained health professionals
Useful for all AOD workers to be aware of
characteristics of disorders so are able to
describe and elicit mental health symptoms
when undertaking screening and assessment,
and to inform treatment planning
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Symptoms without Diagnosis
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Classified as mental health disorder must
meet diagnostic criteria
However, large number in AOD services who
display symptoms but do not meet criteria
(Eg: anxiety but without an anxiety disorder)
Can still impact significantly on functioning
and treatment outcomes
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Categories of MH Disorders in
Comorbidity Guidelines
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Mood disorders
Anxiety disorders
Personality disorders
Psychotic disorders
Substance-induced disorders
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Mood Disorders
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Major depressive episodes
Manic episodes
Mixed episodes
Hypomanic episodes.
Major
depressive
episode
Depressed mood
Hypomanic
episode
Normal mood
Manic
episode
Elevated mood
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Major Depressive Episode
Some of following symptoms experienced
nearly every day for at least 2 weeks:
 Depressed mood or loss of interest or
enjoyment in activities
 Reduced interest or pleasure in almost all
activities
 Change in weight or appetite
 Difficulty concentrating or sleeping (i.e.,
sleeping too much or too little)
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Major Depressive Episode
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Restlessness and agitation
Slowing down of activity
Fatigue or reduced energy levels
Feelings of worthlessness or
excessive/inappropriate guilt
Recurrent thoughts of death, suicidal
thoughts, attempts or plans
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(2)
Manic Episode
Person experiences abnormally elevated,
expansive, or irritable mood for at least 1
week characterised by:
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Inflated self-esteem
Decreased need for sleep
Increased talkativeness or racing thoughts
Distractibility
Agitation or increase in goal directed activity (e.g.,
at work or socially)
Excessive involvement in pleasurable activities that
have a high potential for negative consequences.
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Hypomanic and Mixed
Episodes
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Hypomanic same as manic episode but is less
severe
May only last 4 days and does not require the
episode to be severe enough to cause
impairment in social or occupational
functioning
In mixed episode, person experiences both a
manic episode and major depressive episode
for at least 1 week
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Anxiety Disorders
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Many people feel anxious because they have
reason to eg: trouble with law, homelessness
Many in AOD treatment will experience
anxiety as consequence of intoxication,
withdrawal, or living without using AOD
Usually reduces over time with period of
abstinence
Problematic when persistent, or so frequent
and intense that prevents person from living
his/her life in the way that he/she would like
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Panic Attack
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Sweating
Shaking
Shortness of breath
Feeling of choking
Light headedness
Heart palpitations, chest
pain or tightness
Numbness or tingling
sensations
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Chills or hot flushes
Nausea and/or vomiting
Fear of losing control,
going crazy or dying
Feelings of unreality or
being detached from
oneself
Types of Anxiety Disorders
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Generalised anxiety disorder (GAD)
Obsessive compulsive disorder (OCD)
Panic disorder
Agoraphobia
Social phobia
Specific phobia
Post traumatic stress disorder (PTSD)
Acute stress disorder.
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PTSD
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Can develop after traumatic event
May experience some of following:
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Intrusions: re-experiencing event as
nightmares, or “flashbacks”
Avoidance: avoiding thoughts, feelings, people,
places or activities that remind him/her of the
event,
Hyperarousal: increased startle response,
irritability or anger, difficulty sleeping and
concentrating
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Personality Disorders
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Enduring destructive patterns of thinking,
feeling, behaving, and relating to other
people across wide range of social and
personal situations
Maladaptive traits are stable and long lasting
Tend to develop in adolescence or early
adulthood and are generally lifelong
Most common in AOD context ASPD and BPD
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AOD and Personality Disorders
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AOD use disorders may cause fluctuating
symptoms that mimic symptoms of
personality disorders
Eg: impulsivity, aggressiveness, selfdestructiveness, relationship problems, work
dysfunction, engaging in illegal activity,
dysregulated emotions and behaviour
Can be difficult to determine whether a
person has a personality disorder
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Antisocial Personality Disorder
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Failure to conform to social norms with
respect to lawful behaviour
Disregard for the wishes, rights and feelings
of others
Deceptive and manipulative in order to gain
personal profit or pleasure; may repeatedly
lie or con others
Reckless disregard for own or other’s safety
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Antisocial Personality Disorder
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(2)
Impulsive behaviour; decisions made on spur
of the moment, without forethought, and
without consideration of the consequences
for self or others
May lead to sudden change of jobs,
residences or relationships
Irritability and aggression; repeated
involvement in physical fights or assaults
Consistent and extreme irresponsibility
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Borderline Personality Disorder
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Persistent patterns of instability in
relationships, mood, and self-image
Marked impulsivity, particularly in relation to
behaviours that are self-damaging
Extreme efforts to avoid rejection or
abandonment
Pattern of unstable and intense relationships
Unstable self-image or sense of self
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Borderline Personality Disorder
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(2)
Impulsivity
Recurrent suicidal behaviour, threats or selfmutilating behaviour
Unstable mood
Chronic feelings of emptiness
Inappropriate, intense anger
Stress-related paranoid thoughts or severe
dissociative symptoms
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Psychotic Disorders
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Loss of touch with reality
Feelings, thoughts and perceptions severely
altered
Delusions and Hallucinations
May be due to intoxication or withdrawal
from substances
If the person experiences psychotic episodes
when not intoxicated or withdrawing, possible
they may have one of the disorders described
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Delusions
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Fixed, false beliefs not consistent with cultural
context
Involve a misinterpretation of perceptions or
experiences
Eg: feel that someone is out to get them,
they have special powers, or passages from
newspaper have special meaning for them
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Hallucinations
Disturbance of sensory perceptions
 Auditory (hearing voices or sounds)
 Visual (seeing things not present)
 Olfactory (smelling things not present)
 Tactile (feeling or sensing something)
 Gustatory (taste)
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Other Symptoms of Psychosis
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Disorganised speech
Grossly disorganised behaviour
Catatonic behaviour (eg decreased reactivity)
Affect flattening (reduced range of emotional
expressiveness)
Alogia (restricted thought and speech)
Avolition (reduced involvement with activities)
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Schizophrenia
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Most common and disabling of psychotic
disorders
Affects ability to think, feel and act
To be diagnosed symptoms must have been
continuing for a period of at least 6 months
Symptoms are grouped within 2 types:
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Positive symptoms
Negative symptoms
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Positive Symptoms of
Schizophrenia
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(Not as in pleasurable!)
Presence of excess or distortion of normal
functioning and include hallucinations,
delusions, disorganised speech, grossly
disorganised behaviour and catatonia
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Negative Symptoms of
Schizophrenia
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Absence of normal functioning including
affective flattening, avolition, alogia
Can cause significant impairment in a
person’s functioning
Classification of “types” of schizophrenia
depending upon the predominance of
symptoms displayed (paranoid, disorganised,
catatonic, undifferentiated, residual type)
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Other Psychotic Disorders
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Schizophreniform disorder: equivalent to
schizophrenia except its duration limited to
less than 6 months
Schizoaffective disorder: symptoms of
schizophrenia alongside major depressive,
manic or mixed episode
 2 types: i) bipolar type (if manic or mixed);
ii) depressive type (if major depressive)
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Substance-Induced Disorders
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Occur as direct consequence of AOD
intoxication or withdrawal
Diagnosis requires symptoms only present
following intoxication or withdrawal
If symptoms in absence of intoxication or
withdrawal, possible they have independent
mental health disorder
Symptoms tend to reduce over time with
period of abstinence
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Examples of Substance Induced
Disorders
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Alcohol use/withdrawal - symptoms of
depression or anxiety
Manic symptoms induced by intoxication with
stimulants, steroids, hallucinogens
Psychotic symptoms induced by withdrawal
from alcohol, intoxication with amphetamines,
cocaine, cannabis, LSD or PCP
Other disorders - substance-induced delirium,
amnestic disorder, dementia, sexual
dysfunction, sleep disorder
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Substance-Induced Psychosis
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Difficult to distinguish substance-induced
psychosis from other psychotic disorders
Substance-induced psychosis - symptoms
appear quickly and last relatively short time,
from hours to days until the effects of drug
wear off
Psychosis can persist for days, weeks, months
or longer
Possible individuals already at risk for
developing psychotic disorder triggered by
substance use
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Substance-Induced Psychosis
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(2)
Visual hallucinations more common in
substance withdrawal and intoxication
Stimulant intoxication more commonly
associated with tactile hallucinations, person
experiences physical sensation interpret as
having bugs under skin ("ice bugs" or
"cocaine bugs“)
Tactile hallucinations can occur in alcohol
withdrawal; auditory and visual hallucinations
are more common
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Substance-Induced Psychosis
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Stimulant psychosis sometimes more
agitated, energetic, more difficult to calm
with sedating or psychiatric medication
compared to non-drug induced psychosis
Difference with schizophrenia - lack of
negative and cognitive symptoms with return
to normal inter-episode functioning during
periods of abstinence
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Delirium
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Disturbance of consciousness and cognition
that represents significant change from
previous level of functioning
Reduced awareness of surroundings, difficulty
concentrating, may be difficult to engage
him/her in conversation
Changes in cognition include short-term
memory impairment, disorientation (in regards
to time or place), language disturbance (eg
difficulty finding words, naming objects,
writing)
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In sum…
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Not all clients with symptoms of mental
illness will meet diagnostic criteria
Diagnostic labels can be very useful but
should not be limiting!
Diagnosis needs to be undertaken by
trained professionals however important to
be aware of symptoms and to be able to
communicate with other professionals,
clients and families/carers
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