LECTURE NOTES FOR THE STUDENTS OF DIPLOMA COURSE IN PERFORMING ART THERAPY
A psychological disorder, also known as a mental disorder, is a pattern of behavioral or psychological symptoms that impact multiple life areas and/or create distress for the person experiencing these symptoms.
APPROACHES TO STUDY
There are three approaches to delineate psychiatric disorders.
Symptomatic approach: The Diagnostic and Statistical Manual of Mental Disorders (DSM) of American Psychiatric Association and
International Statistical Classification of Diseases and Related Health Problems (ICD) of World Health Organization identified specific disorders as psychiatric disorders. List of mental disorders are available here:
http://en.wikipedia.org/wiki/List_of_mental_disorders
Cultural approach: Psychiatric complaints vary with culture. Therefore, deviation from culture specific norm is considered as psychiatric disorders.
Statistical approach: Deviations from the normal range of specific trait are treated as psychiatric disorders. For example, low mood or depressive mood is normal but it is abnormal when it crosses normal range. Normal range is usually tested by specific psychological questionnaire or instruments. Beck depression scale is useful instrument to assess depressive illness. Community level psychiatric disorders can be studied through General Health Questionnaire.
MAJOR DISORDERS
Generalized Anxiety disorder :
Generalized anxiety disorder (GAD) is a common, chronic disorder characterized by long-lasting anxiety that is not focused on any one object or situation. Those suffering from generalized anxiety disorder experience non-specific persistent fear and worry, and become overly concerned with everyday matters. It is characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance.
Ref: Text book of anxiety disorder
Depression:
Depression (also called dejection, despair, and disheartenment) is a state of low mood and aversion to activity that can have (or causes) an effect on a person's thoughts, behavior, feelings, world view, and physical and subjective well-being.Depressed people may feel sad,anxious, empty, hopeless, worried, helpless, worthless, guilty, irritable, hurt, or restless. They may lose interest in activities that once were pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details, or making decisions, and may contemplate or attempt suicide. Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains, or digestive problems that are resistant to treatment. Beck depression scale is useful instrument to assess depressive illness
Obsessive compulsive disorder:
Obsessive–compulsive disorder (OCD) is a type of anxiety disorder primarily characterized by repetitive obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to perform specific acts or rituals).
The Y-BOCS, a 10-item, clinician-administered scale, has become the most widely used rating scale for OCD. The Y-BOCS is designed to rate symptom severity, not to establish a diagnosis. The clinician should first ask the patient to complete the Y-BOCS symptoms checklist and should review the completed checklist with the patient. This can be a first step in helping patients recognize all the thoughts and behaviors that are part of their illness, and allows the clinician and patient to agree on the symptoms being rated. The checklist can also be used to select target symptoms for treatment.
Somatoform:
The somatoform disorders are actually a group of disorders, all of which fit the definition of physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause; as such, they are a diagnosis of exclusion. It includes
- Conversion disorder: A somatoform disorder involving the actual loss of bodily function such as blindness, paralysis, and numbness due to excessive anxiety
- Somatization disorder: involves multiple physical complaints which do not have a medical explanation. A patient would complain about many symptoms. [8]
- Hypochondriasis: A somatoform disorder involving persistent and excessive worry about developing a serious illness. It is a psychological disorder in which an exaggerated belief that symptoms signify a life-threatening illness is developed when the individual is actually preoccupied with minor symptoms.
- Body dysmorphic disorder
- Pain disorder
- Undifferentiated somatoform disorder – only one unexplained symptom is required for at least 6 months.
Included among these disorders are false pregnancy, psychogenic urinary retention, and mass psychogenic illness (so-called mass hysteria).
Dissociative: Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity or perception. People with dissociative disorders usedissociation, a defense mechanism, pathologically and involuntarily. Dissociative disorders are thought to primarily be caused by psychological trauma.
The five dissociative disorders listed in the American Psychiatric Association's
DSM-IV are as follows:
[1]
- Depersonalization disorder: periods of detachment from self or surrounding which may be experienced as "unreal" (lacking in control of or "outside of" self) while retaining awareness that this is only a feeling and not a reality.
- Dissociative amnesia (formerly psychogenic amnesia): the temporary loss of recall memory, specifically episodic memory, due to a traumatic or stressful event. It is considered the most common dissociative disorder amongst those documented. This disorder can occur abruptly or gradually and may last minutes to years depending on the severity of the trauma and the patient.[2]
- Dissociative fugue (formerly psychogenic fugue): reversible amnesia for personal identity, usually involving unplanned travel or wandering, sometimes accompanied by the establishment of a new identity. This state is typically associated with stressful life circumstances and can be short or lengthy.[3]
- Dissociative identity disorder (formerly multiple personality disorder): the alternation of two or more distinct personality states with impaired recall among personality states. In extreme cases, the host personality is unaware of the other, alternating personalities; however, the alternate personalities are aware of all the existing personalities.[3]
- Dissociative disorder not otherwise specified: used for forms of pathological dissociation that do not fully meet the criteria of the other specified dissociative disorders.
Hypochondriasis:
A somatoform disorder involving persistent and excessive worry about developing a serious illness. It is a psychological disorder in which an exaggerated belief that symptoms signify a life-threatening illness is developed when the individual is actually preoccupied with minor symptoms.
Mood disorder:
Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR) classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature.[1] The classification is known as mood (affective) disorders in ICD 10.
Schizophrenia :
Schizophrenia is a chronic, severe, and disabling brain disorder that has affected people throughout history. About 1 percent of Americans have this illness.1
People with the disorder may hear voices other people don't hear. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them. This can terrify people with the illness and make them withdrawn or extremely agitated.
People with schizophrenia may not make sense when they talk. They may sit for hours without moving or talking. Sometimes people with schizophrenia seem perfectly fine until they talk about what they are really thinking.
The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative symptoms, and cognitive symptoms.
Positive symptoms
Positive symptoms are psychotic behaviors not seen in healthy people. People with positive symptoms often "lose touch" with reality. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. They include the following:
Hallucinations are things a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices. The voices may talk to the person about his or her behavior, order the person to do things, or warn the person of danger. Sometimes the voices talk to each other. People with schizophrenia may hear voices for a long time before family and friends notice the problem.
Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near.
Delusions are false beliefs that are not part of the person's culture and do not change. The person believes delusions even after other people prove that the beliefs are not true or logical. People with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can control their behavior with magnetic waves. They may also believe that people on television are directing special messages to them, or that radio stations are broadcasting their thoughts aloud to others. Sometimes they believe they are someone else, such as a famous historical figure. They may have paranoid delusions and believe that others are trying to harm them, such as by cheating, harassing, poisoning, spying on, or plotting against them or the people they care about. These beliefs are called "delusions of persecution."
Thought disorders are unusual or dysfunctional ways of thinking. One form of thought disorder is called "disorganized thinking." This is when a person has trouble organizing his or her thoughts or connecting them logically. They may talk in a garbled way that is hard to understand. Another form is called "thought blocking." This is when a person stops speaking abruptly in the middle of a thought. When asked why he or she stopped talking, the person may say that it felt as if the thought had been taken out of his or her head. Finally, a person with a thought disorder might make up meaningless words, or "neologisms."
Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others. Catatonia is rare today, but it was more common when treatment for schizophrenia was not available.2
"Voices" are the most common type of hallucination in schizophrenia.
Negative symptoms
Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder to recognize as part of the disorder and can be mistaken for depression or other conditions. These symptoms include the following:
- "Flat affect" (a person's face does not move or he or she talks in a dull or monotonous voice)
- Lack of pleasure in everyday life
- Lack of ability to begin and sustain planned activities
- Speaking little, even when forced to interact.
People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by the schizophrenia.
Cognitive symptoms
Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when other tests are performed. Cognitive symptoms include the following:
- Poor "executive functioning" (the ability to understand information and use it to make decisions)
- Trouble focusing or paying attention
- Problems with "working memory" (the ability to use information immediately after learning it).
Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress.
CHILDHOOD DISORDERS
Mental retardation (MR) is defined by the American Association on Mental
Retardation (AAMR) as referring to substantial limitations in present functioning,
characterized by subaverage intellectual functioning existing concurrently with
related limitations in two (2) or more applicable adaptive skill areas. The adaptive
skill areas mentioned in the definition are communication, self-care, home living,
social skills, community use, selfdirection, health and safety, functional
academics, leisure and work. Mental retardation manifests before age 18.
Classifications
POSSIBLE REFERRAL CHARACTERISTICS
A. Intellectual
1. Sub-average intellectual functioning; performs poorly on verbal and nonverbal intelligence tests
2. Difficulty applying abstract processes, such as conceptualization,
generalization, transfer
3. Limited intellectual functioning in areas such as memory,
imagination, creativity
B. Academic
1. Subaverage learning performance in basic academic skills
2. Experiences difficulty in activities requiring reading and listening
comprehension, such as following complex directions, gaining
insight into problem situations and generalizing from rules and
principles
3. Oral communication skills generally exceed written
communication skills
4. Limited in incidental learning acquired through experience
C. Behavior
1. Lacks age-appropriate social skills
2. Difficulty in comprehending social situations
Low frustration tolerance
4. May exhibit poor self-concept
5. Seeks approval, therefore easily influenced
D. Communication
1. Below average for age in language skills
2. Displays limited vocabulary
3. Delayed speech and language
4. Displays articulation disorders
5. Limited written communication skills
6. Slow processing of questions often resulting in delayed responses
E. Physical
1. Physical development generally proceeds at a slower rate
2. May manifest acute or chronic health pro
SLEEP DISORDERS
Sleep disorder refers to difficulty falling asleep and staying asleep with no obvious cause that causes problems in the physical, mental and social functioning of individual.
A newborn baby until about the age of 3 months will require time to sleep almost > 20 hours/day. Children will need time to sleep for 8-14 hours depending on the age of the child. But of course this varies depending also from the child
You should begin to see that your baby has sleep disorders:
- Woke up almost every night
- Have hours of sleep is almost the same with you
- Sleep continues at noon
- Or have a bad temper because of lack of sleep at night.
- Primary insomnia: Chronic difficulty in falling asleep and/or maintaining sleep when no other cause is found for these symptoms.
- Bruxism: Involuntarily grinding or clenching of the teeth while sleeping.
- Delayed sleep phase syndrome (DSPS): inability to awaken and fall asleep at socially acceptable times but no problem with sleep maintenance, a disorder of circadian rhythms.
- Narcolepsy: Excessive daytime sleepiness (EDS) often culminating in falling asleep spontaneously but unwillingly at inappropriate times. Also often associated with cataplexy, a sudden weakness in the motor muscles that can result in collapse to the floor.
- Night terror: Sleep terror disorder: abrupt awakening from sleep with behavior consistent with terror.
- Parasomnias: Disruptive sleep-related events involving inappropriate actions during sleep; sleep walking and night-terrors are examples.
- Sleep apnea, obstructive sleep apnea: Obstruction of the airway during sleep, causing lack of sufficient deep sleep, often accompanied by snoring. Other forms of sleep apnea are less common. When air is blocked from entering into the lungs, the individual unconsciously gasps for air and sleep is disturbed. Stops of breathing of at least ten seconds, 30 times within seven hours of sleep, classifies as apnea.
- Sleepwalking or somnambulism: Engaging in activities that are normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject.
- Nocturia: A frequent need to get up and go to the bathroom to urinate at night. It differs from Enuresis, or bed-wetting, in which the person does not arouse from sleep, but the bladder nevertheless empties.
Sleep disorders of children
Sleep problems are classified into two major categories. The first is dyssomnias. In children, dyssomnias may include:
- Sleep-onset difficulties
- Limit-setting sleep disorder
- Inadequate sleep hygiene
- Insufficient sleep syndrome
- Snoring and obstructive sleep apnea (OSA)
The second class of sleep disorders is parasomnias. Examples of common parasomnias include:
- Sleepwalking
- Night terrors
- Nightmares
- Rhythmic movement disorders such as head banging or rocking.
VISUAL IMPAIRMENT
Vision is normally measured using a Snellen chart. A Snellen chart has letters of different sizes that are read, one eye at a time, from a distance of 20 ft. People with normal vision are able to read the 20 ft line at 20 ft-20/20 vision—or the 40 ft line at 40 ft, the 100 ft line at 100 ft, and so forth. If at 20 ft the smallest readable letter is larger, vision is designated as the distance from the chart over the size of the smallest letter that can be read.
Snellen chart is modified for children. This chart includes pictures - like horses of different sizes or different geometrical figures. Some are given below:
"Visual impairment including blindness" means an impairment in vision that, even
with correction, adversely affects a child's educational performance. The term
includes both partial sight and blindness. Visual impairment or low vision is a severe reduction in vision that cannot be corrected with standard glasses or contact lenses and reduces a person's ability to function at certain or all tasks. The World Health Organization (WHO) defines impaired vision in five categories:
- Low vision 1 is a best corrected visual acuity of 20/70.
- Low vision 2 starts at 20/200.
- Blindness 3 is below 20/400.
- Blindness 4 is worse than 5/300
- Blindness 5 is no light perception at all.
- A visual field between 5° and 10° (compared with a normal visual field of about 120°) goes into category 3; less than 5° into category 4, even if the tiny spot of central vision is perfect.
This impairment refers to abnormality of
the eyes, the optic nerve or the visual center for the brain resulting in decreased
visual acuity.
Students with visual impairments are identified as those with a corrected visual
acuity of 20/70 or less in the better eye or field restriction of less that 20 degrees at
its widest point or identified as cortically visually impaired and functioning at the
definition of legal blindness.
