Assignment Code: MCFT-002/TMA-2/ASST-2/2021-22

Course Code: MCFT-002

Assignment Name: Mental Health and Disorders

Year: 2021-2022

Verification Status: Verified by Professor

Maximum Marks: 100

Note:

(i) Answer all the questions in both sections.

(ii) Answers to questions of Section “A” should not exceed 300 words each.

Section A - Descriptive Questions

(10x6=60 marks)

Q1. What are the common cognitive disorders? (10)

Ans) The common cognitive disorders are:

Delirium

Delirium is characterised by the sudden onset of cognitive impairment and associated behavioural changes. It's often overlooked or misdiagnosed, resulting in significant morbidity and mortality. A family therapist should be able to recognise, evaluate, and intervene in a variety of situations.

Case Vignette of Delirium:

Mr. X, a 65-year-old retired engineer, was discovered walking around the market in a confused and disoriented state and was taken to the emergency services. He didn't look the interviewer in the eyes and didn't respond to most of his queries. He remembered his name and address, but not the day or the month. He couldn't recall the circumstances that led up to his admission. The patient's wife noticed a shift in his behaviour. He became agitated and appeared to have an excessive amount of energy. He appeared to be angrier and more anxious than usual. He was having trouble sleeping at night. During the night, his condition worsened ("Sun-downing effect"). He was discovered to have hypertension and diabetes after further investigation. He was receiving treatment on a sporadic basis. This illness was most likely caused by fluctuations in his blood sugar level and the threat of diabetic ketoacidosis.

Dementia

Dementia is defined as a progressive weakening of cognitive processes that occurs in clear consciousness. In contrast to focal or specialised deficits like amnestic disease or aphasia, it denotes a decline in two or more intellectual functions. Dementia is distinguished from the fluctuating short-term cognitive deficiencies of delirium by its permanent and stable type of impairment. Dementia should be distinguished from mental retardation because the former refers to a loss or deterioration of earlier cognitive and functional abilities.

Amnestic Disorder

Amnestic disorder is defined as the inability to learn and retain new information, as well as the inability to recollect previously taught knowledge or prior experiences, which must be severe enough to interfere with personal, social, or vocational functioning. It should not be used in cases of delirium or dementia. As evidenced by the history, physical examination, and laboratory data, these illnesses are secondary syndromes induced by systemic medical or primary brain abnormalities, substance use disorders, or medication adverse effects. Amnestic disorder can be either transitory (memory impairment that lasts less than a month) or chronic (memory impairment that lasts more than a month) (if memory impairment lasts for more than one month).

Q2. What are the risk factors that are associated with somatoform disorders? (10)

Ans) Somatoform means "in the form of" or "in soma" (body), implying that this is a non-somatic sickness. In basic health care and general hospital settings, somatoform disorders are commonly encountered. Multiple physical symptoms (abdominal pain, headaches, back ache, neck pain, joint pains, nausea, vomiting, impaired balance, loss of touch, and unusual sensations of pain or discomfort) are a common feature of somatoform disorders that cannot be fully explained by the presence of general medical conditions or illnesses. As a result, these symptoms are referred to as "medically unexplained symptoms." Individuals suffering from somatoform illnesses frequently exaggerate and dramatize their bodily concerns.

The results of all conceivable laboratory tests will be normal, yet the symptoms will linger. These people will not accept doctors' or medical practitioners' promises that the many bodily symptoms are not caused by anything physical. As a result, these patients drop out and begin looking for a new doctor. As a result, they seek therapy from multiple physicians at the same time, resulting in a convoluted and, at times, dangerous combination of treatments. These people are frequently subjected to medical examinations, diagnostic tests, and hospitalizations. However, the findings of the investigation do not support the presence of any subjective physical symptoms or sickness.

Epidemiology

Somatoform diseases have a wide lifetime prevalence rate, ranging from 0.2 to 2% in women and less than 0.2 percent in men, according to epidemiological research. It is more common in those who live in rural areas and have a lower level of education. Individuals with somatoform disorders seek medical care in excess of what is required, resulting in higher health-care costs. Ninety percent of people with somatoform disorder get it before they reach the age of 25. The following are some of the risk factors for developing somatoform disorders:

1. Severe ongoing stressors,

   
   

2. Marital/family discord,

   
   

3. Poor social support,

   
   

4. Financial loss,

5. Living with a family member who has the disorder,

6. Parental substance abuse, and

7. Antisocial personality disorder in a family member.

Somatoform disorder is a chronic condition with a variable course that rarely goes away completely. It is unusual for people with this disease to go more than a year without experiencing symptoms or engaging in help-seeking behaviours.

Q3. Define disability according to the human rights perspective. (10)

Ans) People with disabilities are seen as ill, different from their non-disabled counterparts, and unable to manage their own lives since disability is viewed as a medical clinical problem. The faults and shortcomings in basic social structures and processes that fail to accommodate variations due to impairments are not considered in medical definitions. The link between impairment, disability, and handicap is defined by the World Health Organization (WHO). Impairment refers to damage or loss of organ-level functions or structures; disability refers to limitations in physical and psycho-cognitive activities at the individual level; and handicap relates to social abilities or relationships between individuals and society.

According to the ICF, the medical model regards disability as a personal problem caused directly by sickness, trauma, or another health condition that necessitates medical therapy in the form of personalised treatment by specialists. In accordance with the UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities, 1993, the Disability Manual focuses on the move from individual pathology to a social construct. The Standard Rules describe disability as a set of societal factors that impair a group of people by neglecting their requirements to access opportunities in a way that is appropriate to their circumstances.

Human Rights Definition of Disability

Human rights should be considered while defining disability. In 2009, the United Nations Convention on the Rights of Persons with Impairments emphasised the importance of human rights for people with disabilities. The social factors that hinder a group of people by ignoring their requirements to access opportunities in a different way than others are taken into account in the definition of disability. Disability is described as a disadvantage or restriction of activity brought about by a society that pays little or no attention to people with disabilities and thus excludes them from mainstream activities.

Q4. With the help of examples, distinguish between disability, impairment and handicap’ (10)

Ans) The World Health Organization (WHO) distinguishes between impairment, disability, and handicap definitions. The following are the definitions:

Any loss or aberration of psychological, physiological, or anatomical structure or function is considered an impairment. Dyslexia is an example of learning impairment, a reading impairment in particular. Let’s say the student has an above-average intelligence as well as good vision and hearing. Therefore, the impairment is the brain’s inability to decode words to be able to read. The brain cannot correctly associate the sounds with the letter symbols.

A disability is any constraint or lack of ability to execute an activity in the way or range regarded normal for a human being (due to an impairment). The inability to read is now the student’s learning disability. It can be improved by employing specific intervention programmes such as multi-sensory instruction in teaching reading.

A handicap is a disadvantage for a person as a result of an impairment or disability that limits or prevents that person from fulfilling a function that is normal for that person (depending on age, sex, social, and cultural factors).

The person may experience various learning handicaps in school, and he or she may fail in class. For example, the student may not be able to complete the reading requirements in class. However, if certain adjustments are provided for the learner, such as taping lectures and listening to books on audiotapes, then he or she may fare well, similar to his or her peers. This will decrease the student’s handicap and will not interfere with his or her progress in school.

Consider the case of a 15-year-old who is involved in an accident and loses his right arm. As a result, there is a deficiency. This person can no longer write or use his right arm as effectively as he could previously. As a result, you become disabled. This person is handicapped when he is unable to complete his function as a student, such as taking notes in class or writing an examination.

Q5. Describe the common features of normal grief. (10)

Ans) The common features of normal grief:

Grief that is simple or uncomplicated progresses in stages until it is resolved. There is a period of disbelief or shock following a bereavement. This might go on for a few weeks. Following that, there is a varied period of up to a year of obsession with the death, why it occurred, and what could have been done to avoid it, which is accompanied by recurrent feelings of loneliness. This is the middle stage of the process. The final stage is the healing phase, during which the bereaved person begins to form new relationships and resumes full participation in normal living activities.

Grief lasts a different amount of time for different people. Some people believe the usual duration is as brief as two months, while others believe it might last up to many years. Sorrow is a strong example of a 'adjustment effort' or a ‘mental reaction' to a loss, regardless of its duration. The basic mental mechanisms involved in shoring up defence and getting over the loss make the process of grief a good example of a 'adjustment effort' or a ‘mental reaction' to a loss. Bereavement is also a transitional and developmental crisis, whose resolution has an impact on the individual's adjustment and continued maturation or development.

Typically, a person experiencing grief will feel melancholy, which may or may not be pervasive, but is more analogous to the waves of feeling associated with sobbing. Such waves of emotions are triggered by memories of past events and objects associated with the deceased person. There is a recurring obsession with the deceased. The dead person is frequently referred to as living or referenced in talks in the early phases. The bereaved person experiences a sensation of emptiness and a severe lack of interest in daily activities. It is possible to convey feelings of helplessness and philosophising about life and one's powerlessness over one's destiny. The commencement of sleep is delayed, and it is linked to ruminations about the deceased person.

An individual's appetite may be considerably reduced, and he or she may develop anergia. Despite the fact that suicidal thoughts are less common in grieving, patients frequently express death desires ('Wish I was taken instead of him'). The bereaved person is frequently plagued with guilt, believing that he or she did not do enough to save the deceased person. There may also be resentment directed against caregivers who attended to the deceased last, with the belief that they did not do enough to rescue the person. When a young person dies suddenly and unexpectedly, especially if they had significant emotional relationships to the bereaved, the mourning reaction might be more extreme, resulting in a variety of severe emotional and behavioural disorders. Grief can substantially impede personal, interpersonal, and vocational functioning, at least in the early phases.

Q6. Analyse the need to study mental health in the present times. (10)

Ans) There is no health without mental wellness. A balanced sustenance of the mind, body, and spirit has been termed as general well-being. However, rather than the condition of health itself, the emphasis of attention over the years has been on the loss of health. As a result, the focus has shifted to conditions that signify a loss of health state (i.e., disease state), with the study of health state in general taking a second seat. A generally held belief that recognises the need to reduce the obvious distress and dysfunction associated with mental diseases is an example of such an approach.

While this idea is not incorrect in and of itself, it becomes unproductive after a certain point because it focuses on the resolution of the suffering and dysfunction as the ultimate aim. Such an approach might be explained as arising from the belief that mental health can be ensured by assuring the absence of mental diseases. This notion has been increasingly questioned throughout time, particularly in the last few decades. Mental disorders and mental health, it has been claimed, are two interrelated but separate categories that should be examined separately. As a result, rather than being utilised interchangeably or as a substitute for one another, the two structures require equal consideration.

To better grasp the problem, consider a student who is taking a written admission exam in preparation for an interview. To be considered for the interview, one must achieve a score higher than the cut-off mark on the written exam. Thus, a score over the cut-off point, or the absence of a score below the cut-off point, indicates that the student has qualified for the interview based on the written examination. It would not, however, assure that she or he receives the highest ranking. To achieve the highest ranking, one must strive for more than just avoiding a score below the cut-off mark. In the same way, the absence of mental abnormality or sub normality would just indicate that the person is not ill. The presence of some extra traits would be required to ensure the best possible state of health. As a result, while the absence of mental diseases is a prerequisite for mental well-being, the absence of mental disorders alone does not guarantee an individual's optimal functioning.

Section B - Short Answer / Objective Type Questions

(40 marks)

Q1. Write short notes (in about 150 words each) on the following: (5x8=40 marks)

i) WHO

Ans) The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of health". Headquartered in Geneva, Switzerland, it has six regional offices and 150 field offices worldwide. The WHO's mandate seeks and includes: working worldwide to promote health, keeping the world safe, and serve the vulnerable. It advocates that a billion more people should have: universal health care coverage, engagement with the monitoring of public health risks, coordinating responses to health emergencies, and promoting health and well-being. It provides technical assistance to countries, sets international health standards, and collects data on global health issues. The WHO has played a leading role in several public health achievements, most notably the eradication of smallpox, the near-eradication of polio, and the development of an Ebola vaccine. Its current priorities include communicable diseases, particularly HIV/AIDS, Ebola, COVID-19, malaria, and tuberculosis; non-communicable diseases such as heart disease and cancer; healthy diet, nutrition, and food security; occupational health; and substance abuse.

ii) Phenylketonuria

Ans) Phenylketonuria (also known as PKU) is a hereditary condition in which the amount of phenylalanine in the blood increases. If PKU is not treated, phenylalanine levels in the body can rise to dangerous levels, resulting in intellectual impairment and other major health issues. It involves the body's inability to convert phenylalanine, an amino acid contained in protein meals, to tyrosine due to a deficiency of the enzyme required for the conversion. Phenylalanine build-up causes improper brain growth and can lead to severe mental impairment. This condition can be reduced and improved by following a particular low-protein diet. PKU manifests itself in a variety of ways, from moderate to severe. Classic PKU is the most severe form of this illness. Until they are a few months old, infants with classic PKU appear normal. These youngsters will develop a persistent intellectual handicap if they are not treated. Seizures, developmental delays, behavioural issues, and psychiatric illnesses are all frequent. Excess phenylalanine in the body can cause a musty or mouse-like stench in untreated persons. Children with classic PKU have lighter skin and hair than their unaffected relatives, and they are more likely to develop skin problems like eczema.

iii) Diabetic Neuropathy

Ans) Diabetes can cause diabetic neuropathy, which is a type of nerve injury. High blood sugar (glucose) levels can harm nerves all over your body. The nerves in your legs and feet are the most commonly affected by diabetic neuropathy. Diabetic neuropathy symptoms can range from discomfort and numbness in your legs and feet to difficulties with your digestive system, urinary tract, blood vessels, and heart, depending on which nerves are impacted. Some people only experience minor signs and symptoms. Diabetic neuropathy, on the other hand, can be extremely unpleasant and devastating for some people.

This disorder develops as a result of a long-term state of diabetes, one of the symptoms of which is muscle wasting in the hands and feet. Peripheral neuropathy causes muscle weakness and loss of reflexes, especially in the ankle, causing a person's walking pattern to shift. Deformities such as hammertoes and midfoot collapse are possible. Sores and blisters may develop as a result of numbness in the affected areas, go unnoticed, and infection develops in the skin and bones, leading to amputations in the future if not treated swiftly.

iv) Hallucinations

Ans) Hallucinations are erroneous sensations that occur in the absence of a stimuli. A person begins to see things that do not exist in reality. Auditory, visual, olfactory, tactile, and gustatory hallucinations are erroneous illusions that can affect all five senses, including sound, sight, smell, touch, and taste. Hallucinations are sensory illusions that appear to be real but are actually generated by your mind. They have the ability to impact all five of your senses. You might, for example, hear a voice that no one else in the room can hear or see a fictitious image. Mental diseases, drug side effects, or physical conditions such as epilepsy or alcohol use disorder can all induce these symptoms. Depending on the reason of your hallucinations, you may need to see a psychiatrist, a neurologist, or a medical practitioner. Taking medicine to address a health condition is one type of treatment. To improve your hallucinations, your doctor may suggest changing your habits, such as drinking less alcohol and getting more sleep.

v) Empathy

Ans) Empathy is the ability to emotionally understand what other people are going through, to see things through their eyes, and to put yourself in their shoes. Essentially, it is placing yourself in the shoes of another person and experiencing what they are experiencing. When you witness someone suffering, you may be able to imagine yourself in their shoes and empathise with their situation. While most people are quite aware of their own sentiments and emotions, getting into another person's head can be more difficult. People who are able to empathise can "walk a mile in another's shoes," as it were. It enables people to comprehend what others are going through. For many people, watching another person in suffering and reacting with apathy or even hate is unfathomable. However, the fact that some people do respond in this way plainly shows that empathy is not a universal response to others' pain.

vi) Delirium

Ans) Delirium is characterised by the sudden onset of cognitive impairment and associated behavioural changes. It's often overlooked or misdiagnosed, leading in significant morbidity and mortality. A family therapist should be able to recognise, evaluate, and intervene in a variety of situations. Delirium is characterised by altered consciousness as well as cognitive, perceptual, and behavioural impairments. It occurs in 15 to 75 percent of cases where the disease has progressed. Delirium can be brought on by the primary disease, co-morbid physical diseases, or cancer treatment medicines. According to recent study, the prevalence of delirium ranges from 10% to 51%, while the incidence ranges from 4% to 31%. The prevalence of delirium in patients admitted to emergency rooms is estimated to be between 10% and 14%. Patients over the age of 60 who have dementia, cerebrovascular accidents, burns, infections, or are in an alcohol withdrawal condition are more likely to develop delirium.

vii) TC

Ans) Therapeutic communities (TCs) are a common form of long-term residential treatment for substance use disorders (SUDs). Residential treatment for SUDs emerged in the late 1950s out of the self-help recovery movement, which included groups such as Alcoholics Anonymous. Some such groups evolved into self-supporting and democratically run residences to support abstinence and recovery from drug use. Examples have included community lodges, Oxford Houses, and TCs. The first TC was the Synanon residential rehabilitation community, founded in 1958 in California.

Initially, TCs were run solely by peers in recovery. Over time and in response to the changing needs of participants, many TCs have begun incorporating professional staff with substance abuse counselling or mental health training, some of whom are also in recovery themselves. Today, programs often have medically trained professionals (e.g., psychiatrist consultants, nurses, and methadone specialists) as staff members, and most offer medical services on-site. According to a national survey of these programs, more than half of TC staff members are in recovery, and many have earned certification in addiction counselling or bachelors- or masters-level degrees.

viii) Supportive therapy

Ans) This intervention is designed to assist patients in coping with a sudden or extreme stressor that they have been unable to handle on their own. The goal of therapy is to relieve symptoms and assist patients in achieving a level of adaptive functioning comparable to their premorbid state. The therapist must comprehend the meaning of the stressor from the patient's perspective, as well as why it is linked to the presenting symptoms. The following are some supportive therapy techniques:

1. Guidance: Rather of attempting to change troublesome situations, the therapist assists in recognising and assessing challenges and suggests acceptable behaviours to adapt to the situation.

2. Environmental Manipulation: A therapist can assist in coping with emotional stressors by removing or altering stress-inducing factors in the environment.

3. Externalization of Interests: The patient is urged to return to activities that were meaningful to him or her prior to the stressor's appearance. This aids in enhancing social contact and moving one's attention away from oneself and onto external occurrences.

4. Reassurance: The therapist assures the patient that his or her sickness is treatable and that there is no need to lose hope. It is beneficial to patients who are afraid about or have doubts about their chances of recovery.

5. Persuasion: This strategy seeks to change the patient's attitude, which he or she is resisting. It gives the patient new life goals as well as examples of how to adjust to realistic changes.

6. Ventilation: A therapist can assist in the venting of fears, hopes, and ambitions by providing a non-judgmental and compassionate assessment of them.