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Mental Health Overview Nationwide 50 million Americans suffer from a mental illness in a given year Mental Illness is more common than: Cancer Diabetes Heart Disease Psychiatric disorders are the number 1 reason for hospital admissions nationwide Mental illness is treatable Causes Biological Causes Biochemical Disturbances Genetics Infections- can cause brain damage Brain defects or injury Prenatal damage Poor nutrition, exposure to toxins Psychological Causes Severe psychological trauma suffered as a child, such as emotional, physical or sexual abuse An important early loss, such as the loss of a parent Neglect Poor ability to relate to others Causes Environmental Death Factors or divorce A dysfunctional family life Living in poverty Feelings of inadequacy, low self-esteem, anxiety, anger or loneliness Changing jobs or schools Social or cultural expectations (For example, a society that associates beauty with thinness can be a factor in the development of eating disorders.) Substance abuse by the person or the person's parents Stress Academic Homesickness Peer relationships Family Identity Work Illness Stigmization 35% of people with diagnosable disorders seek treatment The single most common barrier to seeking treatment is Shame Types of Mental Illness Mood Disorders Anxiety Disorders Psychotic Disorders Personality Disorders Impulse Control and Addictive Disorders Eating Disorders/Body Image Other ( Adjustment Disorders, Dissocative Disorders, Factitious Disorders, Sexual and Gender Disorders, Somotoform Disorders, Mental Retardation) DSM The Diagnostic and Statistical Manuals of Mental Health (DSM) are handbooks developed by the American Psychiatric Association These manuals contain listings and descriptions of psychiatric diagnoses, analogous to the International Classification of Diseases manual (ICD) DSM-I and DSM-II The DSMs have changed as the prevailing concepts of mental disorders have changed DSM-I (1952) reflected Adolf Meyer’s influence on psychiatry, and classified mental disorders as various “reactions” to stressors DSM-II (1968) dropped the reactions concept, but DSM-I and DSM-II Both the DSM-I and DSM-II had problems with reliability in diagnosing mental illness Both lacked standardized diagnostic criteria and assessment instruments (Frances, Mack, Ross, First, 2000) DSM-III DSM-III (1980) – A watershed event American psychiatry It outlined a research-based, empirical, and phenomenologic approach to diagnosis, which attempted to be atheoretical with regard to etiology DSM-IV DSM-IV continues the DSM-III tradition It is characterized as the “biologic” approach to diagnosis It contains listings and descriptions of psychiatric diagnoses DSM-IV The DSM-IV serves as: Guide for clinical practice Facilitates research and improved communication between clinicians and researchers Is a tool used to teach psychopathology DSM-V DSM-V is currently being developed and is tentatively due for publication in 2013 What does the term mental disorder imply? Is there really a distinction between mental disorders and physical disorders? “…there is much “physical in “mental” disorders and much “mental” in “physical” disorders.” (DSM-IV Introduction, p. xxi) The DSM does not classify people; it classifies disorders (i.e., an individual with schizophrenia vs. “the schizophrenic”) People classify people Mental Disorders A clinically significant behavioral or psychological syndrome or pattern Individual is experiencing present distress or disability (i.e., significant impairment of functioning) Individual has a significantly increased risk of suffering death, pain, disability, or an important loss of freedom The syndrome is not an expected cultural response (DSM-IV Introduction, xxii) DSM-IV Multiaxial System The five-axis classification system Axis I: Clinical disorders Axis II: Personality disorders, mental retardation Axis III: General medical conditions Axis IV: Psychosocial and environmental problems Axis V: Global assessment of functioning DSM-IV Multiaxial System Axis I Clinical syndromes that generally develop in late adolescence or adulthood Ex: schizophrenia, bipolar disorder, panic disorder, posttraumatic stress disorder, alcohol abuse, major depression Axis I conditions are considered DSM-IV Multiaxial System Axis II: personality disorders and mental retardation Also used to note maladaptive personality traits and behavior problems DSM-IV Multiaxial System Axis III Medical conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders Examples: Asthma in patients with anxiety AIDS in a patient with new-onset psychosis (brain lesions) Cirrhosis of the liver in a patient with alcohol dependence DSM-IV Multiaxial System Axis IV Psychosocial stressors encountered by the patient within the previous 12 months that have contributed to: Development of a new mental disorder Recurrence of a previous mental DSM-IV Multiaxial System Psychosocial stressors include problems with: Primary support group Social environment Education Occupation Housing Economic Access to health care services Interaction with the legal system Environmental problems Psychosocial stressors should be described in as much detail as needed to indicate how it affects the patient’s functioning Even mild stressors should be noted if they figure into the clinical presentation DSM-IV Multiaxial System Axis V Patient’s global level of functioning both at the time of evaluation and during the past year Clinician consults the Global Assessment of Functioning scale to determine the level of functioning (See DSM-IV) The GAF is based on 0-100 scale Mental Health Diagnosis Example: A Axis I: Bipolar disorder, most recent episode manic, 296.44 Axis II: No diagnosis Axis III: No diagnosis Axis IV: Loss of important relationship Axis V: Global assessment of function = 60 patient may have a diagnosis in all five of the axes Anxiety Disorders Panic Disorder Obsessive Compulsive Disorder Post Traumatic Stress Disorder Social Anxiety Disorder Specific Phobias Generalized Anxiety Disorder Symptoms of Anxiety Disorders Feelings of panic, fear and uneasiness Uncontrollable, obsessive thoughts Repeated thoughts or flashbacks of traumatic experiences Nightmares Ritualistic behaviors, such as repeated hand washing Problems sleeping Cold or sweaty hands Shortness of breath Palpitations An inability to be still and calm Dry mouth Numbness or tingling in the hands or feet Nausea Muscle tension How Common Are Anxiety Disorders? Anxiety disorders affect about 19 million adult Americans. Most anxiety disorders begin in childhood, adolescence and early adulthood. They occur slightly more often in women than in men, and occur with equal frequency in Caucasians, blacks and Hispanics. Treatment of Anxiety Disorders Medication-Medicines used to reduce the symptoms of anxiety disorders include anti-depressants and anxiety-reducing medications. Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people by talking through strategies for understanding and dealing with their disorder. Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of psychotherapy in which the person learns to recognize and change thought patterns and behaviors that lead to troublesome feelings. Types of Depression Situational/Adjustment Bereavement Seasonal Clinical Depression Psychotic Depression Bipolar (Manic-Depressive Illness) Dysthymia Post-Partum Depression Situational/Adjustment Variable mood correlated to circumstances Minimal change in sleep, appetite, energy No change in self-attitude Suicidal thought unlikely Typically lasts less than one month Seasonal Seasonal depression, called seasonal affective disorder (SAD), is a depression that occurs each year at the same time, usually starting in fall or winter and ending in spring or early summer. It is more than just "the winter blues" or "cabin fever." Symptoms of winter SAD may include the seasonal occurrence of: Fatigue Increased need for sleep Decreased levels of energy Weight gain Increase in appetite Difficulty concentrating Increased desire to be alone Dysthmia Dysthymia, sometimes referred to as chronic depression, is a less severe form of depression but the depression symptoms linger for a long period of time, perhaps years. Those who suffer from dysthymia are usually able to function normally, but seem consistently unhappy. Symptoms of dysthymia include: Difficulty sleeping Loss of interest or the ability to enjoy oneself Excessive feelings of guilt or worthlessness Loss of energy or fatigue Difficulty concentrating, thinking or making decisions Changes in appetite Thoughts of death or suicide Clinical Depression An illness, not a weakness Serious disturbances in work, social, and physical functioning including suicidal thought Not relieved by circumstances May last for months or years untreated Persistent and intense mood change Clinical Depression Who and When 1.5 million young adults in US each year Fewer than half seek treatment 1 of 4 women and 1 of 10 men develop depression during their lifetime Often begins in early adult years Family history, substance abuse, and stress increase risk Clinical Depression Signs and Symptoms Extreme sadness, guilt, shame Decreased concentration, poor academic performance or work performance Decreased interest/enjoyment in daily activities Increased irritability, arguments Change in sleep, appetite, energy Social withdrawal Clinical Depression Treatment Anti-Depressant medications (effective,improved safety & tolerability, not habit forming) Psychotherapy (individual, group, cognitive behavioral,self-help) Day treatment, hospitalization Exercise, sleep hygiene, light therapy, ECT http://www.youtube.com/watch?v= F5YubjEqbZ8 Psychotic Depression Roughly 25% of people who are admitted to the hospital for depression suffer from what is called psychotic depression. What Are the Symptoms of Psychotic Depression? Anxiety (fear and nervousness) Agitation Paranoia Insomnia (difficulty falling and staying asleep) Physical immobility Intellectual impairment Psychosis Bipolar Disorder 2% general population over a lifetime Half of cases begin before age 20 Episodic extremes between states depressed state and excitable, euphoric/irritable, impulsive state Strong family linkage Occurs equally in men and women Symptoms of Bipolar Disorder Symptoms of mania ("the highs"): Excessive happiness, hopefulness, and excitement Sudden changes from being joyful to being irritable, angry, and hostile Restlessness Rapid speech and poor concentration Increased energy and less need for sleep High sex drive Tendency to make grand and unattainable plans Tendency to show poor judgment, such as deciding to quit a job Drug and alcohol abuse Increased impulsivity Some people with bipolar disorder can become psychotic, seeing and hearing things that aren't there and holding false beliefs from which they cannot be swayed. During depressive periods ("the lows”) symptoms include: Sadness Loss of energy Feelings of hopelessness or worthlessness Loss of enjoyment from things that once were pleasurable Difficulty concentrating Uncontrollable crying Difficulty making decisions Irritability Increased need for sleep Insomnia A change in appetite causing weight loss or gain Thoughts of death or suicide Attempting suicide Bipolar Disorder Treatment Mood stabilizer medication Psychotherapy May require emergency hospitalization http://www.youtube.com/watch?v=h5aSa4tmVNM http://www.youtube.com/watch?v=65RgUquD7zA http://www.youtube.com/watch?v=8Ki9dgG3P5M Facts About Suicide 3rd leading cause of death in 15-24 year olds Men 4 times more than women Highest rate in white men over 65 Alcoholism associated with up to half of all suicides Mood disorders account for 60-80% of suicides 50-75% seek help before suicide but 50% have never seen a psychiatrist Risk for Suicide History of attempt Males>Females Family history of suicide Native American Mood Disorder or Substance Abuse White>Black Social/Environmental Factors Can Increase Risk for Suicide Humiliating life events Loss History of childhood abuse Interpersonal discord Social isolation What to Do? Listen For: Life isn’t worth living I feel my family would be better off without me. Suicide is the only way out. Take my (something); I don’t need it anymore. Ending the pain is all I care about. Next time, I’ll take enough pills to do it right. How to Help Do Voice concerns Get professional help immediately Tell someone or call the police Don’t Assume the situation will take care of itself Leave the person alone Be sworn to secrecy Act shocked Challenge or dare Argue or debate moral issues Suicide Prevention Decrease social isolation Identify victimization, rejection, mental illness,and substance abuse Treat depression Reduce hopelessness Skill building around mood regulation Secure or remove firearms Decrease barriers around help seeking Post Traumatic Stress Can develop after a person has experienced or witnessed a traumatic or terrifying event in which serious physical harm occurred or was threatened. PTSD is a lasting consequence of traumatic ordeals that cause intense fear, helplessness, or horror, such as a sexual or physical assault, the unexpected death of a loved one, an accident, war, or natural disaster. Families of victims can also develop posttraumatic stress disorder, as can emergency personnel and rescue workers. http://www.youtube.com/watch?v=JBUjLXtedfc Symptoms of PTSD Symptoms of PTSD most often begin within three months of the event. In some cases, however, they do not begin until years later. The severity and duration of the illness vary. Some people recover within six month, while others suffer much longer. Symptoms of PTSD often are grouped into three main categories, including:reliving, avoiding, and increased arousal Symptoms of PTSD Re-living: may include flashbacks, hallucinations and nightmares. They also may feel great distress when certain things remind them of the trauma, such as the anniversary date of the event. Avoiding: may avoid people, places, thoughts or situations that may remind him or her of the trauma. Have feelings of detachment and isolation from family and friends Increased arousal: excessive emotions; problems relating to others, including feeling or showing affection; difficulty falling or staying asleep; irritability; outbursts of anger; difficulty concentrating; and being "jumpy" or easily startled. The person may also suffer physical symptoms, such as increased blood pressure and heart rate, rapid breathing, muscle tension, nausea and diarrhea. Who can suffer from PTSD? Victims of trauma related to physical and sexual assault face the greatest risk for PTSD. How Common Is PTSD? About 3.6% of adult Americans about 5.2 million people suffer from PTSD during the course of a year, and an estimated 7.8 million Americans will experience PTSD at some point in their lives. PTSD can develop at any age, including childhood. Women are more likely to develop PTSD than are men. This may be due to the fact that women are more likely to be victims of domestic violence, abuse and rape. Treatment Treatment for PTSD may involve psychotherapy (a type of counseling), medication or both. Therapy Cognitive-behavior therapy, which involves learning to recognize and change thought patterns that lead to troublesome emotions, feelings and behavior. Psychodynamic therapy focuses on helping the person examine personal values and the emotional conflicts caused by the traumatic event. Family therapy may be useful because the behavior of the person with PTSD can have an affect on other family members. Group therapy may be helpful by allowing the person to share thoughts, fears and feelings with other people who have experienced traumatic events. Obsessive Compulsive Disorder Common obsessions include: Fear of dirt or contamination by germs. Fear of causing harm to another. Fear of making a mistake. Fear of being embarrassed or behaving in a socially unacceptable manner. Fear of thinking evil or sinful thoughts. Need for order, symmetry or exactness. Excessive doubt and the need for constant reassurance Treatment Medication Therapy: Various types of psychotherapy, including individual, group and family therapy Hoarding OCD tendencies to keep all belongs Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress, and/or indecision associated with discarding. Symptoms The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others). The hoarding symptoms are not restricted to the symptoms of another mental disorder Hoarding Personality Disorders Personality disorders: People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school or social relationships. In addition, the person's patterns of thinking and behavior significantly differ from the expectations of society and are so rigid that they interfere with the person's normal functioning. Examples include antisocial personality disorder, obsessive-compulsive personality disorder and paranoid personality disorder. Psychotic Disorders Schizophrenia: People with this illness have changes in behavior and other symptoms -- such as delusions and hallucinations -- that last longer than six months, usually with a decline in work, school and social functioning. Schizoaffective disorder: People with this illness have symptoms of schizophrenia, as well as a serious mood or affective disorder, such as severe depression, mania (a disorder marked by periods of excessive energy) or bipolar disorder (a disorder with cyclical periods of depression and mania). Psychotic Disorders Schizophreniform disorder: People with this illness have symptoms of schizophrenia, but the symptoms last less than six months. Brief psychotic disorder: People with this illness have sudden, short periods of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick -- usually less than a month. Psychotic Disorders Delusional disorder: People with this illness have delusions involving real-life situations that could be true, such as being followed, being conspired against or having a disease. These delusions persist for at least one month. Shared psychotic disorder: This illness occurs when a person develops delusions in the context of a relationship with another person who already has his or her own delusion(s). Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from some substances, such as alcohol and crack cocaine, that may cause hallucinations, delusions or confused speech. Psychotic Disorders Psychotic disorder due to a medical condition: Hallucinations, delusions or other symptoms may be the result of another illness that affects brain function, such as a head injury or brain tumor Paraphrenia: This is a type of schizophrenia that starts late in life and occurs in the elderly population. Symptoms of a Psychotic Disorder Hallucinations and delusions. Hallucinations are unusual sensory experiences or perceptions of things that aren't actually present, such as seeing things that aren't there, hearing voices, smelling odors, having a "funny" taste in your mouth and feeling sensations on your skin even though nothing is touching your body. Delusions are false beliefs that are persistent and organized, and that do not go away after receiving logical or accurate information. For example, a person who is certain his or her food is poisoned, even if it has been proven that the food is fine, is suffering from a delusion. Psychotic Disorders Other possible symptoms of psychotic illnesses include: Disorganized or incoherent speech Confused thinking Strange, possibly dangerous behavior Slowed or unusual movements Loss of interest in personal hygiene Loss of interest in activities Problems at school or work and with relationships Cold, detached manner with the inability to express emotion Mood swings or other mood symptoms, such as depression or mania How Common Are Psychotic Disorders? About 1% of the population worldwide suffers from psychotic disorders. These disorders most often first appear when a person is in his or her late teens, 20s or 30s. They tend to affect men and women about equally. Treatment Medication Psychotherapy: Various types of psychotherapy, including individual, group and family therapy, may be used to help support the person with a psychotic disorder. http://putlocker.bz/watch-a-beautiful- mind-online-free-putlocker.html Eating Disorders Eating disorders involve extreme emotions, attitudes and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common eating disorders. Body Image & Eating Disorders Messages about Food What messages have you received (from parents, peers, media, etc.) about food? How are messages about food different for women and men? Some statistics Eating disorders have increased threefold in the last 50 years 10% of the population is afflicted with an eating disorder 90% of the cases are young women and adolescent girls Up to 21% of college women show sub-threshold symptoms 61% of college women show some sort of eating pathology Three Types of Eating Disorders Anorexia nervosa- characterized by a pursuit of thinness that leads to selfstarvation Bulimia nervosa- characterized by a cycle of bingeing followed by extreme behaviors to prevent weight gain, such as purging. Binge-eating disorder- characterized by regular bingeing, but do not engage in purging behaviors. Anorexia Nervosa Begins with individuals restricting certain foods, not unlike someone who is dieting Restrict high-fat foods first Food intake becomes severely limited More on anorexia nervosa May exhibit unusual behaviors with regards to food. preoccupied with thoughts of food, and may show obsessive-compulsive tendencies related to food may adopt ritualistic behaviors at mealtime. may collect recipes or prepare elaborate meals for others. Bulimia Nervosa Qualitatively distinct from anorexia A binge may or may not be planned characterized by binge eating marked by a feeling of being out of control The binge generally lasts until the individual is uncomfortably or painfully full Bulimia Nervosa Common triggers for a binge dysphoric mood interpersonal stressors Intense hunger after a period of intense dieting or fasting feelings related to weight, body shape, and food are common triggers to binge eating Bulimia Nervosa Feelings of being ashamed after a binge are common behavior is kept a secret Tend to adhere to a pattern of restricted caloric intake usually prefer low-calorie foods during times between binges More on bulimia nervosa Later age at the onset of the disorder Are able to maintain a normal weight Will not seek treatment until they are ready Most deal with the burden of hiding their problem for many years, sometimes well into their 30’s Two subtypes purging type self-induced vomiting and laxatives as a way to get rid of the extra calories they have taken in non-purging type use a period of fasting and excessive exercise to make up for the binge Anorexia Risk of Death: The Deadliest of all Psychological Disorders Risk Factors for developing an eating disorder Personality/psychological Family factors influence Media Subcultures society existing within our Personality/Psychological Factors Sense of self worth based on weight Use food as a means to feel in control Dichotomous & rigid thinking Perfectionism Poor impulse control Inadequate coping skills Protective personality Factors Nonconformity Having a feminist ideology High self-esteem Belief that body weight and shape are out of one’s control Self-perception of being thin Media and Cultural Factors Culture bound syndrome Belief that being thin is the answer to all problems is prevalent in western culture Media and Cultural Factors Bulimia can be influenced by social norms It can be seen as a behavior, which is learned through modeling Women who are seen as being attractive by societies standards can be very susceptible to eating disorders as well Media and Cultural Factors Media images are inescapable devastating when we see idealized images in the media and feel they do not meet the expectations of our society Frequent readers of fashion magazines are two to three times more likely than infrequent readers to be dieting Historical Beauty Ideals The Celebrity Thin Ideal The Unreal Ideal http://homepage.mac.com/gapodaca/digital /bikini/bikini1.html http://demo.fb.se/e/girlpower/retouch/retouc h/ Jamie Lee Curtis The Thin-Ideal The avg. model weighs 23% less than the avg. American woman Longitudinal study from 19791988 showed that 69% of playboy models and 60% of Miss America contestants met weight criteria for anorexia Women’s bodies in the media have become increasingly thinner The Impact on Women One study showed that 55% of college women thought that they were overweight though only 6% were 94% of one sample of women wanted to be smaller than they currently were 96% thought that they were larger than the current societal ideal Half the women in a study said they would rather be hit by a truck than be fat Challenges to treatment Lack of motivation to change intrinsically reinforced by the weight loss, because it feels good to them may deny the existence of the problem, or the severity of it Lack of insight Not really about food. Impulse control and addiction disorders: People with impulse control disorders are unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing) and compulsive gambling are examples of impulse control disorders. Alcohol and drugs are common objects of addictions. Often, people with these disorders become so involved with the objects of their addiction that they begin to ignore responsibilities and relationships. Adjustment Disorder Adjustment disorder occurs when a person develops emotional or behavioral symptoms in response to a stressful event or situation. The stressors may include natural disasters, such as an earthquake or tornado; events or crises, such as a car accident or the diagnosis of a major illness; or interpersonal problems, such as a divorce, death of a loved one, loss of a job or a problem with substance abuse. Adjustment disorder usually begins within three months of the event or situation and ends within six months after the stressor stops or is eliminated. Dissociative Disorders Dissociation Psychogenic disruption in conscious awareness Complex mental activity that is independent from or not integrated within conscious awareness Automatisms Accomplishing a task with little or no conscious awareness Much of our life involves non-conscious mental activity (both perception and memory) Automatic, non-deliberate, not selfmonitored When is Dissociation a problem? Loss of overall, integrative control Unable to access information Loss of a coherent sense of self Dissociative Disorders Splitting apart of components (identity, memory, perception) of a persons personality that are usually integrated Types of Dissociative Disorders Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder Depersonalization Disorder Dissociative Amnesia Partial or total forgetting of past experience without a biological cause Almost always anterograde – blocking out a period of time after psychogenic cause (e.g. stress / trauma) Memory loss is often selective Relative indifference to loss of memory Remain well oriented to time and place Dissociative Amnesia: Patterns of Memory Loss Localized All events in a circumscribed period Selective amnesia amnesia Forget only certain events that occur during a circumscribed period Generalized amnesia Continuous amnesia Systematized amnesia Dissociative Fugue Amnesia + sudden, unexpected trip away from home Often involves the creation of a new identity Fugue state usually ends abruptly – then amnesic for events during the fugue Dissociative Identity Disorder Sense of self, or personality breaks up into two or more distinct identities which take turns “controlling” behaviour At least one “personality” is amnesic for the experiences of the others “Alter” often coconscious with the host Dissociative Identity Disorder Identities are often polarized Often each identity specializes in different areas of functioning, encapsulates different memories Very high proportion report significant trauma in childhood – possible strategy that children use to distance themselves from trauma Controversy re. cause of DID Faking - malingering Induced by therapy - iatrogenic Social Role Hypnotizability “False Memory Syndrome” Depersonalization Disorder Disruption in identity without amnesia Sense of strangeness or unreality in oneself Derealization Reduced emotional responsiveness Explaining Dissociative Disorders Most theories assume that dissociation is a way of escape from situations that are beyond coping powers Factitious disorders Conditions in which physical and/or emotional symptoms are experienced in order to place the individual in the role of a patient or a person in need of help. Sexual and gender disorders Sexual and gender disorders: These include disorders that affect sexual desire, performance and behavior. Sexual dysfunction, gender identity disorder and the paraphilias are examples of sexual and gender disorders. Somatoform disorders A person with a somatoform disorder, formerly known as psychosomatic disorder, experiences physical symptoms of an illness even though a doctor can find no medical cause for the symptoms. Characteristics Somatic complains of major medical maladies without demonstrable peripheral organ disorder Psychological problems and conflicts are important in initiating, exacerbating and maintaining the disturbance. Physical and laboratory examinations do not explain the vigorous and sincere patients´complaints. The morbid preoccupation interferes with and anxiety are frequently present and may justify specific treatment Differential diagnosis Medical conditions - multiple sclerosis, brain tumour, hyperparathyroidism, hyperthyroidism, lupus erythematosus Affective (depressive) and anxiety disorders – 1 or 2 symptoms of acute onset and short duration Hypochondriasis - patient´s focus is on fear of disease not focus on symptoms Panic disorder - somatic symptoms during panic episode only Differential diagnosis Conversion disorder - only one or two Pain disorder - one or two unexplained pain complaints, not a lifetime history of multiple complaints Delusional disorders - schizophrenia with somatic delusions or depressive disorder with hypochondriac delusions, bizzare, psychotic sy. Undifferentiated somatization disorder short duration (e.g. less than 2 years) and less striking symptoms Course of the illness Chronic relapsing condition, the cause remains unknown Onset from in adolescence to the 3th decade of life. Psychosocial and emotional distress coincides with the onset of new symptoms and health care-seeking behavior Clinical practice showed that typical episodes last 6 to 9 months with a quiescent time of 9 to 12 months.. Mental Retardation Condition of limited mental ability Low IQ on traditional test of intelligence Difficulty adapting to everyday life Onset of characteristics by age 18 Some causes include Organic retardation Cultural-familial retardation-IQ's 55-70result from growing up in a below average intellectual environment