Major depressive disorder- Clinical Depression
Vincent van Gogh's 1890 painting Sorrowing old man ('At Eternity's Gate')
Major depressive disorder (MDD) (also known as clinical depression, major depression, unipolar depression, or unipolar disorder; or as recurrent depression in the case of repeated episodes) is a mental disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and by a loss of interest or pleasure in normally enjoyable activities. This cluster of symptoms (syndrome) was named,
described and classified as one of the mood disorders in the 1980 edition of the American Psychiatric Association's diagnostic manual. The term "depression" is ambiguous. It is often used to denote this syndrome but may refer to other mood disorders or to lower mood states lacking clinical significance. Major depressive disorder is a disabling
condition that adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, around 3.4% of people with major
depression commit suicide, and up to 60% of people who commit suicide had depression or another mood disorder.[1]
The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status examination. There is no laboratory test for major depression, although physicians generally request tests for physical conditions that may cause similar symptoms. The most common time of onset is between the ages of 20 and 30 years, with a later peak between 30 and 40
Typically, patients are treated with antidepressant medication and, in many cases, also receive psychotherapy or counseling, although the effectiveness of medication for mild or moderate cases is questionable.[3] Hospitalization may be necessary in cases with
associated self-neglect or a significant risk of harm to self or others. A minority are treated with electroconvulsive therapy (ECT). The course of the disorder varies widely, from one episode lasting weeks to a lifelong disorder with recurrent major depressive episodes. Depressed individuals have shorter life expectancies than those without
depression, in part because of greater susceptibility to medical illnesses and suicide. It is unclear whether or not medications affect the risk of suicide. Current and former patients may be stigmatized.
The understanding of the nature and causes of depression has evolved over the centuries, though this understanding is incomplete and has left many aspects of depression as the subject of discussion and research. Proposed causes include psychological, psycho-social, hereditary, evolutionary and biological factors. Long-term substance abuse may cause or worsen depressive symptoms. Psychological treatments are based on theories of
personality, interpersonal communication, and learning. Most biological theories focus on the monoamine chemicals serotonin, norepinephrine and dopamine, which are naturally present in the brain and assist communication between nerve cells.
Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD
An artist's interpretation of one person with multiple "dissociated personality states."
Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD),[1] is an extremely rare mental disorder characterized by at least two
distinct and relatively enduring identities or dissociated personality states that alternately control a person's behavior, and is accompanied by memory impairment for important information not explained by ordinary forgetfulness. These symptoms are not accounted for by substance abuse, seizures, other medical conditions, nor by imaginative play in children.[2] Diagnosis is often difficult as there is considerable comorbidity with other
mental disorders. Malingering should be considered if there is possible financial or forensic gain, as well as factitious disorder if help-seeking behavior is prominent.[2][3][4][5] DID is one of the most controversial psychiatric disorders with no clear consensus regarding its diagnosis or treatment.[3] Research on treatment effectiveness still focuses mainly on clinical approaches and case studies. Dissociative symptoms range from common lapses in attention, becoming distracted by something else, and daydreaming, to pathological dissociative disorders.[6] No systematic, empirically-supported definition of "dissociation" exists.[7][8]
Although neither epidemiological surveys nor longitudinal studies have been done, it is thought DID rarely resolves spontaneously. Symptoms are said to vary over time.[6] In general, the prognosis is poor, especially for those with co-morbid disorders. There is little systematic data on the prevalence of DID.[4] The International Society for the Study of Trauma and Dissociation states that the prevalence is between 1 and 3% in the general
population, and between 1 and 5% in inpatient groups in Europe and North America.[5]
DID is diagnosed more frequently in North America than in the rest of the world, and is diagnosed three to nine times more often in females than in males.[4][7][9] The prevalence of DID increased greatly in the latter half of the 20th century, along with the number of identities (often referred to as "alters") claimed by patients (increasing from an average of two or three to approximately 16).[7] DID is also controversial within the legal system[3] where it has been used as a rarely-successful form of the insanity defense.[10][11] The 1990s showed a parallel increase in the number of court cases involving the diagnosis.[12]
Dissociative disorders including DID have been attributed to disruptions in memory caused by trauma and other forms of stress, but research on this hypothesis has been characterized by poor methodology. So far, scientific studies, usually focusing on memory, have been few and the results have been inconclusive.[13] An alternative hypothesis for the etiology of DID is as a product of techniques employed by some therapists, especially those using hypnosis, and disagreement between the two positions is characterized by intense debate.[3][14] DID became a popular diagnosis in the 1970s, 80s and 90s but it is unclear if the actual incidence of the disorder increased, if it was more recognized by clinicians, or if sociocultural factors caused an increase in iatrogenic presentations. The unusual number of diagnoses after 1980, clustered around a small number of clinicians and the suggestibility characteristic of those with DID, support the hypothesis that DID is therapist-induced.[15] The unusual clustering of diagnoses has also been explained as due to a lack of awareness and training among clinicians to recognize cases of DID.[16]
Cloth embroidered by a person diagnosed with schizophrenia
Schizophrenia is a mental disorder characterized by a breakdown of thought processes
and by impaired emotional responses.[1] Common symptoms include delusions, such as
paranoid beliefs; hallucinations; disorganized thinking; and negative symptoms, such as blunted affect and avolition. Schizophrenia causes significant social and vocational dysfunction. Symptom onset typically occurs in young adulthood, with a global lifetime prevalence of about 0.3–0.7%.[2] Diagnosis is based on observed behavior and the person's reported experiences.
Genetics, early environment, neurobiology, and psychological and social processes appear to be important contributory factors; some recreational and prescription drugs appear to cause or worsen symptoms. Current research is focused on the role of neurobiology, although no single isolated organic cause has been found. The many possible combinations of symptoms have triggered debate about whether the diagnosis represents a single disorder or a number of discrete syndromes. Despite the origin of the term from the Greek roots skhizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-; "mind"), schizophrenia does not imply a "split personality", or "multiple personality disorder" (which is known these days as dissociative identity disorder)—a condition with which it is often confused in public perception.[3] Rather, the term means a "splitting of mental functions", because of the symptomatic presentation of the illness.[4]
The mainstay of treatment is antipsychotic medication, which primarily suppresses dopamine (and sometimes serotonin) receptor activity. Psychotherapy and vocational and social rehabilitation are also important in treatment. In more serious cases—where there is risk to self and others—involuntary hospitalization may be necessary, although hospital stays are now shorter and less frequent than they once were.[5]
The disorder is thought mainly to affect cognition, but it also usually contributes to chronic problems with behavior and emotion. People with schizophrenia are likely to have additional (comorbid) conditions, including major depression and anxiety disorders; the lifetime occurrence of substance use disorder is almost 50%.[6] Social problems, such as long-term unemployment, poverty, and homelessness are common. The average life expectancy of people with the disorder is 12 to 15 years less than those without, the result of increased physical health problems and a higher suicide rate (about 5%).[2][7]
Hearing Voices
A paracusia, or auditory hallucination,is a form of hallucination that involves perceiving sounds without auditory stimulus. A common form involves hearing one or more talking voices. This may be associated with psychotic disorders such as
schizophrenia or mania, and holds special significance in diagnosing these conditions.[2] However, individuals may hear voices without suffering from diagnosable mental illness,[3] which could potentially be attributed to either auditory hallucinations or the microwave auditory effect.[4]
There are three main categories into which the condition can often fall: a person hearing a voice speak one's thoughts, a person hearing one or more voices arguing, or a person hearing a voice narrating his/her own actions.[5] These three categories do not account for
all types of auditory hallucinations.
Other types of auditory hallucination include exploding head syndrome and musical ear syndrome. In the latter, people will hear music playing in their mind, usually songs they are familiar with. Reports have also mentioned that it is also possible to get musical hallucinations from listening to music for long periods of time.[6] This can be caused by: lesions on the brain stem (often resulting from a stroke); also, tumors, encephalitis, or abscesses.[7] Other reasons include hearing loss and epileptic activity.[8]
Auditory hallucinations should not be confused with the microwave auditory effect, which does involve auditory stimulus, although is potentially indistinguishable from auditory hallucinations according to a declassified Pentagon report, which notes: "Microwave energy can be applied at a distance, and the appropriate technology can be adapted from existing radar units. Aiming devices likewise are available but for special circumstances which require extreme specificity, there may be a need for additional development. Extreme directional specificity would be required to transmit a message to a single hostage surrounded by his captors. Signals can be transmitted long distances (hundreds of meters) using current technology.".[9] Despite technological advancements in microwave hearing technology, contemporary psychiatric diagnosis does not consider the microwave auditory effect as a potential cause for people reportedly hearing voices in their head.
Bipolar disorder is characterized by transitions between depression and mania
Bipolar disorder, also known as bipolar affective disorder, manic-depressive disorder, or manic depression, is a mental illness classified by psychiatry as a mood disorder. Individuals with bipolar disorder experience episodes of an elevated or agitated mood known as mania alternating with episodes of depression.
Mania can occur with different levels of severity. At milder levels of mania, known as hypomania, individuals appear energetic, excitable, and may be highly productive. As mania becomes more severe, individuals begin to behave erratically and impulsively, often making poor decisions due to unrealistic ideas about the future, and may have great difficulty with sleep. At the most severe level, individuals can experience very distorted beliefs about the world known as psychosis.
Individuals who experience manic episodes also commonly experience depressive episodes; some experience a mixed state in which features of both mania and depression are present at the same time. Manic and depressive episodes last from a few days to several months.
About 4% of people suffer from bipolar disorder. Prevalence is similar in men and women and, broadly, across different cultures and ethnic groups. Genetic factors contribute substantially to the likelihood of developing bipolar disorder, and
environmental factors are also implicated. Bipolar disorder is often treated with mood stabilizing medications and psychotherapy. In serious cases, in which there is a risk of harm to oneself or others, involuntary commitment may be used. These cases generally involve severe manic episodes with dangerous behavior or depressive episodes with suicidal ideation. There are widespread problems with social stigma, stereotypes, and prejudice against individuals with a diagnosis of bipolar disorder. People with bipolar disorder exhibiting psychotic symptoms can sometimes be misdiagnosed as having schizophrenia.
The current term bipolar disorder is of fairly recent origin and refers to the cycling between high and low episodes (poles). The term "manic–depressive illness" or psychosis was coined by German psychiatrist Emil Kraepelin in the late nineteenth century,
split the classification in 1957, employing the terms unipolar disorder (major depressive disorder) and bipolar disorder.
People with Asperger syndrome often display intense interests, such as this boy's fascination with molecular structure.
Asperger syndrome (AS), also known as Asperger disorder (AD) or simply
Asperger's, is an autism spectrum disorder (ASD) that is characterized by significant difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development. Although not required for diagnosis, physical clumsiness and atypical (peculiar, odd) use of language are frequently reported.[1][2]
The syndrome is named after the Austrian pediatrician Hans Asperger who, in 1944, studied and described children in his practice who lacked nonverbal communication skills, demonstrated limited empathy with their peers, and were physically clumsy.[3] The
modern conception of Asperger syndrome came into existence in 1981[4] and went
through a period of popularization,[5][6] becoming standardized as a diagnosis in the early 1990s. Many questions remain about aspects of the disorder.[7] There is doubt about
whether it is distinct from high-functioning autism (HFA);[8] partly because of this, its
prevalence is not firmly established.[1] The diagnosis of Asperger's was eliminated in the 2013 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and replaced by a diagnosis of autism spectrum disorder on a severity scale.[9]
The exact cause is unknown. Although research suggests the likelihood of a genetic basis,[1] there is no known genetic cause[10][11] and brain imaging techniques have not identified a clear common pathology.[1] There is no single treatment, and the
effectiveness of particular interventions is supported by only limited data.[1] Intervention is aimed at improving symptoms and function. The mainstay of management is
behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness.[12] Most children improve as
they mature to adulthood, but social and communication difficulties may persist.[7] Some researchers and people with Asperger's have advocated a shift in attitudes toward the view that it is a difference, rather than a disability that must be treated or cured.[13][14]
Psychopathy or sociopathy is defined either as an aspect of personality or as a
personality disorder. As a personality disorder, it is characterized by enduring antisocial behavior, diminished empathy and remorse, and disinhibited or bold behavior. As an aspect of personality, it represents scores on different dimensions of personality found throughout the population in varying combinations. Definitions of psychopathy have varied significantly throughout history; different definitions continue to be used that are only partly overlapping and sometimes appear contradictory.[1]
American psychiatrist Hervey M. Cleckley's work on psychopathy probably influenced the initial diagnostic criteria for antisocial personality reaction/disturbance in the
Diagnostic and Statistical Manual of Mental Disorders (DSM), as did American
psychologist George E. Partridge's work on sociopathy. In 1980, the DSM introduced the diagnosis of antisocial personality disorder (ASPD), which includes the following
statement: "The essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. This pattern has also been referred to as psychopathy, sociopathy, or dissocial personality disorder."[2] Canadian psychologist Robert D. Hare later repopularised the construct of psychopathy in criminology with his Psychopathy Checklist.[1][3]
Although no psychiatric or psychological organization has sanctioned a diagnosis titled "psychopathy," assessments of psychopathy characteristics are widely used in criminal justice settings in some nations, and may have important consequences for individuals.[3] The term is also used by the general public, in popular press, and in fictional portrayals.[4]
Delusional disorder is an uncommon psychiatric condition in which patients present with delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect.[1][2] Delusions are a specific symptom of psychosis. Non-bizarre delusions are fixed false beliefs that involve situations that could potentially occur in real life; examples include being followed or poisoned.[3] Apart from their delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behaviour does not generally seem odd or bizarre.[4] However,
the preoccupation with delusional ideas can be disruptive to their overall lives.[4] For the diagnosis to be made, auditory and visual hallucinations cannot be prominent, though olfactory or tactile hallucinations related to the content of the delusion may be present.[5] To be diagnosed with delusional disorder, the delusion or delusions cannot be due to the effects of a drug, medication, or general medical condition, and delusional disorder cannot be diagnosed in an individual previously properly diagnosed with schizophrenia. A person with delusional disorder may be high functioning in daily life, and this disorder bears no relation to one's IQ.[6] According to German psychiatrist Emil Kraepelin,
patients with delusional disorder remain coherent, sensible and reasonable.[7] The
Diagnostic and Statistical Manual of Mental Disorders (DSM) defines six subtypes of the disorder characterized as erotomanic (believes that someone is in love with him or her), grandiose (believes that s/he is the greatest, strongest, fastest, richest, and/or most intelligent person ever), jealous (believes that the love partner is cheating on him/her), persecutory (believes that someone is following him/her to do some harm in some way), somatic (believes that he/she has a disease or medical condition), and mixed, i.e., having
features of more than one subtype.[5] Delusions also occur as symptoms of many other
mental disorders, especially the other psychotic disorders.
The DSM-IV, and psychologists, generally agree that personal beliefs should be evaluated with great respect to cultural and religious differences, since some cultures have widely accepted beliefs that may be considered delusional in other cultures.[8]
