Assignment Code: MCFT-002/TMA-2/ASST-2/2023-24

Course Code: MCFT-002

Assignment Name: Mental Health and Disorders

Year: 2023-24

Verification Status: Verified by Professor

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

Q1) Analyse any two models of mental health.

Ans) The conceptualization of mental health has evolved through various models, each shaped by the perspectives and insights of those seeking to define it. Understanding these diverse models provides a holistic view of the concept.

Biological Model: Mental Health as a Biological Entity

The traditional approach to defining health, particularly physical health, relies on biological determinants. The classic triad of 'the host, the agent, and the environment' is often used to explain the onset of diseases. In the context of mental health, this model emphasizes the ongoing physical processes within the brain as the primary determinant.

Observable emotions, behaviour, and affect are seen as manifestations of these underlying processes. While the biological model contributes significantly to understanding mental health, it faces challenges in identifying the complete structural, physiological, and biochemical basis of mental and behavioural disorders.

Mental Health as an Ecological Balance

From an ecological standpoint, mental health is viewed as a dynamic function of one's heredity and the cumulative effects of the material and non-material environment. This model posits mental health as a state of dynamic equilibrium, where health represents a dominance of positive adaptations, and disease indicates a prevalence of negative or unfavourable adaptation to the environment.

Positive mental health, according to this model, is characterized by an individual's ability to realize their own capabilities, cope with life stresses, work productively, and contribute to their community. Conversely, an inability to adapt positively results in a loss of mental health due to negative adaptation to the surrounding environment.

Q2) Describe characteristics of generalized anxiety disorder.

Ans) Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry and anxiety that extends beyond the normal concerns of healthy individuals. This chronic state of apprehension is not limited to specific events or circumstances, occurring on most days. The worry is disproportionate and prolonged, often revolving around everyday matters like work, finances, relationships, health, and routine tasks, with the focus frequently shifting from one concern to another.

Clinical characteristics for identifying GAD include:

Individuals who suffer from generalised anxiety disorder (GAD) are characterised by persistent and frequent worry, as well as excessive anxiety.

Difficulty Controlling Concern: When an individual has excessive worry, it becomes difficult for them to control their anxiety.

Apprehensive Expectation: There is a widespread and pervasive unfavourable expectation for a variety of events or activities, such as the performance at work or school.

Anxiety and concern are accompanied by symptoms such as restlessness, weariness, difficulties concentrating, irritability, muscular tension, and sleep disruptions that last for at least six months. These symptoms are associated with anxiety and worry.

A free-floating anxiety disorder is characterised by worry that is not limited to particular occurrences or circumstances, but rather is prevalent in every facet of one's life.

Significant Distress and Impairment: The anxiety, concern, or other physical symptoms that are associated to these emotional states create significant distress and impede both social and occupational functioning simultaneously.

Q3) Discuss the parameters involved in mental status examination.

Ans) Mental status examination (MSE) is a systematic assessment of an individual's cognitive, emotional, and behavioural functioning. It involves gathering information to understand the person's mental state at a specific point in time.

Several parameters are considered during an MSE, providing a comprehensive view of the individual's mental health:

1. Appearance and Behaviour: Observations of the individual's appearance, grooming, posture, and any unusual behaviours are noted. This includes factors like eye contact, facial expressions, and psychomotor agitation or retardation.

2. Speech and Language: Evaluation of the individual's speech patterns, rate of speech, clarity, coherence, and content. Changes in speech, such as pressured speech or tangentiality, can indicate underlying mental health issues.

3. Mood: Assessment of the individual's predominant emotional state, whether it is consistent with the overall situation, and if there are mood fluctuations.

4. Affect: Observation of the range and intensity of emotions expressed by the individual. Affect can be described as flat, blunted, labile, or appropriate to the situation.

5. Thought Process: Examination of how thoughts are organized and the logic behind them. This includes assessing for thought disorders, such as loosening of associations or thought blocking.

6. Thought Content: Exploration of the themes and topics of the individual's thoughts, including the presence of delusions, obsessions, or preoccupations.

7. Perception: Assessment of sensory perceptions, such as hallucinations or illusions, and the individual's interpretation of their environment.

8. Cognition: Evaluation of cognitive functions, including attention, memory, orientation, and problem-solving abilities. Cognitive impairments may indicate neurological or psychiatric disorders.

9. Insight: Understanding the individual's awareness and understanding of their own mental health condition. This includes their ability to recognize symptoms and the need for treatment.

10. Judgment: Assessment of the individual's decision-making abilities and understanding of the consequences of their actions.

Q4) Define psychosis. What are the causes of psychosis?

Ans) Psychosis is a complex psychiatric condition characterized by hallucinations, delusions, disorganized behaviour, and impaired reality testing. Hallucinations involve false perceptions without external stimuli, manifesting in auditory, visual, olfactory, tactile, or gustatory forms. Delusions are unshakable false beliefs unsupported by evidence and resistant to reasoning, categorized into themes such as persecution, reference, or grandiosity.

Individuals experiencing psychosis may exhibit disorganized behaviour, ranging from extreme excitement to slowed motor activities, abnormal feelings, and postures. Impaired reality testing means incorrectly interpreting experiences and drawing inaccurate conclusions about the external world. Patients with psychosis often lack awareness of their abnormal behaviour or the potential imaginary nature of their experiences.

Severe disturbances in social and personal functioning are common, leading to withdrawal from social situations and an inability to perform routine tasks. Seeking medical help is often hindered by the individual's belief that nothing is wrong.

Various causes underlie psychosis:

1. Psychological Conditions: Common psychiatric disorders like schizophrenia, delusional disorders, bipolar disorders, and depressive disorders can induce psychosis.

2. Physical Conditions: Medical conditions such as Alzheimer's disease, brain tumours, infections, head injuries, Parkinson's disease, diabetes, malaria, and endocrinological disorders may result in psychosis. Suspecting physical or medical disorders is crucial in individuals exhibiting abnormal behaviour.

3. Psychoactive Substance Use: Abuse of psychoactive substances like alcohol, cannabis, cocaine, amphetamines, and ketamine can trigger psychotic episodes. Abrupt cessation of substance use may also lead to drug withdrawal-induced psychosis. Treatment involves addressing substance abuse or withdrawal to alleviate psychotic symptoms.

Q5) How are the persons in close contact with a person suffering from manic episode likely to explain this episode in history taking?

Ans) When individuals in close contact with a person suffering from a manic episode engage in history-taking, they are likely to provide valuable insights into the affected person's behaviour, symptoms, and overall presentation. History-taking involves gathering information about the individual's past and current experiences, and the perspectives of those close to the person experiencing a manic episode can offer crucial details.

Observable Behaviours: Witnesses may describe heightened energy levels, increased activity, rapid speech, impulsivity, and decreased need for sleep. They might note restlessness, talkativeness, and engagement in multiple activities simultaneously.

Changes in Mood: Close contacts may highlight drastic mood swings, emphasizing the shift from the person's baseline mood to a highly elevated or irritable state. They might note exaggerated self-esteem, grandiosity, and an unrealistic sense of one's abilities.

Impaired Judgment: Observers may recount instances of impaired judgment, risky behaviours, and poor decision-making during the manic episode. This could include excessive spending, reckless driving, or engaging in activities with potential negative consequences.

Social Interactions: Descriptions of the person's social interactions may reveal increased sociability, impulsivity in forming relationships, and a decreased awareness of social norms. Contacts may note the individual's desire for constant social stimulation.

Impact on Functioning: Witnesses might discuss how the manic episode has affected the person's daily functioning, work, relationships, and overall quality of life. They may provide examples of disruptions in occupational or academic activities.

Duration and Recurrence: Information about the duration of the manic episode and any history of previous episodes is crucial. This can help in determining the pattern and course of the individual's manic episodes.

Family History: Gathering information about the family's psychiatric history can be relevant, as mood disorders often have a genetic component.

Q6) Discuss psychosocial rehabilitation of a mentally ill patient.

Ans) Psychosocial rehabilitation plays a crucial role in addressing chronic schizophrenia and bipolar affective disorder, two severe mental illnesses that significantly impact an individual's life.

Chronic Schizophrenia:

Chronic schizophrenia is characterized by a deteriorating course and disorganized behaviour. The clinical features include violence, inappropriate affect, self-neglect, wandering, and thought disorders. Management categorizes symptoms into positive (excess or distortion of normal functions) and negative (diminution or loss of normal functions). Effective intervention addresses both symptom categories.

Bipolar Affective Disorder:

Bipolar affective disorder involves episodes of mania and depression, with intervening periods of normalcy. Mania is marked by elation, overactivity, grandiosity, decreased need for sleep, and interfering behaviour. Depression features depressed mood, psychomotor retardation, hopelessness, lack of energy, decreased appetite, and sleep disturbances. Intervening periods may exhibit mild symptoms, irritability, mood fluctuations, and psychosocial dysfunction.

An individual with severe mental illness is expected to have specific characteristics, including a diagnosis of schizophrenia or major affective psychosis, recurrent admissions, and functional difficulties in areas like basic literacy, self-care, financial support, housing, social relationships, occupation, and close relationships. Additionally, challenges such as poor medication compliance, substance abuse, difficulties in follow-up and aftercare, frequent crises, and a history of self-harm or harm to others are common.

The Social Security Administration of America identifies four key areas of psychiatric disability: activities of daily living, social functioning, concentration and task persistence, and the ability to tolerate competitive work. Addressing these areas through psychosocial rehabilitation aims to improve the overall well-being and functioning of individuals with chronic schizophrenia and bipolar affective disorder. It involves a comprehensive approach that considers medical, psychological, and social factors to enhance the quality of life for those affected by these severe mental illnesses.

Section B - Short Answer Type Questions

Q1) Write short notes (in about 150 words each) on the following:

Q1. i) Deaf blindness

Ans) Deaf blindness is a unique and complex disability that involves the concurrent loss of both vision and hearing. Individuals with deaf-blindness face challenges in accessing information, communication, and navigating their surroundings. The combination of sensory impairments amplifies the impact on daily life, education, and social interactions.

Communication strategies for individuals with deaf blindness often include tactile signing, where information is conveyed through touch, and the use of assistive devices like Braille or communication boards. Mobility training becomes crucial to help them navigate their environment safely. Support services, such as interveners or interpreters, play a vital role in facilitating communication and access to information.

Deaf blindness is a spectrum, and individuals may have varying degrees of vision and hearing loss. The impact on their lives depends on factors such as the age of onset, the extent of sensory loss, and the availability of appropriate interventions and support systems.

Q1. ii) Psychoeducation

Ans) Psychoeducation is an approach that combines psychological principles with education to provide individuals with knowledge and skills to better understand and manage their mental health. It aims to empower individuals by offering information about mental health conditions, treatment options, coping strategies, and support resources.

This collaborative and informative process involves mental health professionals, educators, or peers delivering structured sessions to individuals or groups. Psychoeducation covers a range of topics, including symptom recognition, stress management, communication skills, and relapse prevention. It plays a crucial role in reducing stigma, promoting early intervention, and enhancing overall well-being.

Whether used in clinical settings, schools, or community programs, psychoeducation fosters a supportive environment where individuals can actively participate in their mental health journey, make informed decisions, and work towards achieving and maintaining psychological well-being.

Q1. iii) Types of social phobia

Ans) Social phobia, also known as social anxiety disorder, manifests in various types, each characterized by intense fear and avoidance of social situations due to concerns about judgment, embarrassment, or scrutiny.

Performance Anxiety (Performance Social Phobia): Fear of performing in front of others, such as public speaking, presenting, or performing on stage.

Interactional Anxiety (Interactional Social Phobia): Fear of social interactions, conversations, or small talk. Individuals may struggle with initiating or maintaining conversations.

Generalized Social Phobia: A pervasive fear of a wide range of social situations, not limited to specific events or interactions. It can impact various aspects of life, including work, school, and everyday activities.

Non-Performance Situations: Anxiety related to everyday activities, like eating, drinking, or writing in public. Fear of being observed during routine behaviours.

Specific Social Phobia: Limited to a particular situation or type of interaction, such as fear of crowds, speaking on the phone, or using public restrooms.

Q1. iv) Dementia

Ans) Dementia is a progressive neurological disorder characterized by a decline in cognitive function, affecting memory, thinking, and the ability to perform everyday activities. It is not a specific disease but rather a term encompassing various conditions that lead to cognitive impairment. Alzheimer's disease is the most common cause of dementia, contributing to about 60-70% of cases.

The symptoms of dementia include memory loss, difficulty in problem-solving, confusion, disorientation, and changes in mood and behaviour. As the condition advances, individuals may struggle with communication, face challenges in recognizing familiar faces, and experience personality changes.

Early diagnosis and management of dementia are crucial for providing appropriate care and support. While there is no cure for most forms of dementia, interventions, medications, and supportive therapies can help alleviate symptoms and improve the quality of life for both individuals with dementia and their caregivers.

Q1. v) Psychedelics

Ans) Psychedelics, also known as hallucinogens, are a class of substances that induce altered perceptions, thoughts, and emotions, often leading to vivid sensory experiences and a heightened sense of consciousness. Common psychedelics include lysergic acid diethylamide (LSD), psilocybin (found in certain mushrooms), and dimethyltryptamine (DMT).

These substances interact with serotonin receptors in the brain, particularly the 5-HT2A receptor, influencing mood, perception, and cognition. Psychedelics are distinct from other recreational drugs in that they do not typically induce addiction, and their effects are often unpredictable and highly subjective.

Research on psychedelics has gained renewed interest for their potential therapeutic benefits, such as in the treatment of depression, anxiety, and post-traumatic stress disorder (PTSD). However, their use also poses risks, including the potential for adverse psychological reactions and challenging experiences. Ongoing studies aim to better understand the mechanisms of action and therapeutic applications of psychedelics under controlled and supervised conditions.

Q1. vi) Physical consequences of substance abuse

Ans) Substance abuse can have profound and detrimental effects on physical health. The specific consequences vary depending on the substance involved, the duration of use, and individual factors.

1. Organ Damage: Prolonged substance abuse, especially of substances like alcohol and certain drugs, can lead to damage to vital organs such as the liver, kidneys, heart, and lungs.

2. Cardiovascular Issues: Substance abuse may contribute to cardiovascular problems, including increased heart rate, elevated blood pressure, and an elevated risk of heart disease.

3. Respiratory Complications: Smoking substances like tobacco or illicit drugs can damage the respiratory system, leading to issues such as chronic bronchitis, pneumonia, and a higher risk of respiratory infections.

4. Weakened Immune System: Substance abuse can compromise the immune system, making individuals more susceptible to infections and illnesses.

5. Malnutrition: Substance abuse can contribute to poor dietary habits, leading to malnutrition and related health issues.

Q1. vii) Reminiscence therapy

Ans) Reminiscence therapy is a therapeutic technique that involves recalling and discussing past experiences, often using prompts such as photographs, music, or specific items to trigger memories. This approach is commonly used in the care of older adults, particularly those with dementia or other cognitive impairments.

The primary goal of reminiscence therapy is to improve overall well-being by fostering positive emotions, enhancing self-esteem, and providing a sense of purpose and continuity. Through the process of reminiscing, individuals can share their life stories, which may lead to increased social interaction and a connection with caregivers or peers. This form of therapy has shown various benefits, including reducing symptoms of depression and anxiety, enhancing mood, and promoting a sense of identity and meaning in individuals dealing with memory loss. It can be conducted individually or in group settings, allowing participants to engage in a collective journey through their shared past.

Q1. viii) Dialectical behaviour therapy

Ans) Dialectical Behaviour Therapy (DBT) is a therapeutic approach developed by psychologist Dr. Marsha M. Linehan. It combines principles of cognitive-behavioural therapy (CBT) with elements of mindfulness and acceptance strategies. Initially designed to treat individuals with borderline personality disorder (BPD), DBT has proven effective for various mental health conditions.

DBT focuses on helping individuals develop skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Mindfulness encourages being present in the moment, distress tolerance teaches coping mechanisms for crises, emotion regulation targets managing intense feelings, and interpersonal effectiveness enhances communication and relationship skills. This therapy is structured, typically delivered through both individual therapy sessions and skills training groups. DBT emphasizes the acceptance of difficult emotions while simultaneously working on strategies for change.