Mental illness panorama Janet Cunningham,MD PhD Resident of psychiatry.

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1 Mental illness panorama Janet Cunningham,MD PhD Resident of psychiatry

2 Psychiatric disorders are common! Lifetime risk is 46%! 15 % of the population will at some point need professional psychiatric help. (USA, NCS, Replication, Kessler o.a. -05)

3 Years lived with disability, YLD WHO, Global burden of disease, 2004 update

4 It starts early (USA, NCS, Replication, Kessler o.a. 05)

5 Psychology vs. psychiatry

6 Pathophysiological classification Axel I Genotype Axel II Neurobiological phenotype Axel III Behavioral phenotype Axel IV Modifying/causal environmental factors Axel V Treatment and response

7 Neurovetenskaplig agenda – patofysiologisk klassifikation Axel I Genotype Axel II Neurobiological phenotype Axel III Behavioral phenotype Axel IV Modifying/causal environmental factors Axel V Treatment and response

8 DSM IV Axel I Clinical syndrome Axel II Personality disorders, Mental retardation Axel III Somatic disease or injury Axel IV Social problems Axel V GAF (FUNCTION!)

9 Emotions are biological programs Function: Protection Decisions Social communication Feelings are our subjective interpretation of emotions

10 Personality Genetics Cognitive factors Stress Demands Social Network Health Work capacity Well Being Stress - Vulnerability Model

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12 Psykiatrins uppgift Diagnosis and treatment Habilitating / rehabilitating Legal aspects

13 Psykiatrisk bedömning History Mental health status Structured interviews Symptom severity Somatic status! Function assessment Needs assessment

14 Patient history How did it start? Duration and pattern What is the problem? – Limitations? Other diagnosis Gestation/ Birth /Childhood development School Trauma/ Stress Substance abuse Family tree

15 SyndromeRisk in population Rel. risk with one sick parent Depression Unipolar 8%2x Bipolar1%9x Schizophrenia1%10x Alcohol abuse5% men 1% women 5x Panic syndrome0.5%12x Tourettes0,25%100x ADHD3%5x Anorexia0.5%10x

16 Symptoms 1. Emotional symtoms Mood (elevated, low) Affect = Basic emotions (ie) -Sadness – Fear – Anger – (Joy, surprise, love)

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18 PAUSE!

19 Symptoms 2. Perception symptoms ie. Illusions, Hallucinations, Delusions

20 Symptoms 3. Cognition (intellectual) function -Concentration, memory, focus, IQ, impulse control, (ADHD, Dementia, Depression…)

21 Symptoms 3. Cognition (intellectual) function -Concentration, memory, focus, IQ, impulse control, (ADHD, Dementia, Depression…) -Thoughts - Obsessive, rigid, repetitive, depressive.

22 Symptoms 4. Motor symtoms Over/ Under-active, manierisms, stereotypa, tics, cramps

23 Symptoms 5. Somatic symtoms Physiological parts of emotions Functional symptoms SOMATIC DISEASE?

24 Appearance Attitude Behavior Mood and affect Speech Thought process Thought content Perceptions Cognition Insight Judgment Suicidal thoughts Psychiatric status

25 Symtom criteria for depression DSM IV 1-Depressed mod most of the day 2-Decreased interest/ pleasure in almost all activities Weight change 5% due to appetite Difficulty concentrating Fatigue or Lack of energy Feelings of guilt or worthlessness Insomnia or hypersomnia Psychomotor agitation or retardation Suicidal thoughts /plans/ attempts 5 symptoms inc. 1 or 2 everyday for at least 2 weeks

26 Symtomkriterier för en depressiv episod Sänkt sinnesstämning Irritabilitet Minskat intresse och minskad glädje Koncentrationssvårigheter Energibrist Värdelöshetskänslor/Skuldkänslor Sömnstörning Förändrat rörelsemönster/mimik Aptitförändring /viktförändring Dödstankar, självmordstankar/planer/försök Ihållande symtom under minst två veckor! känslor tankar beteenden kroppsliga symtom

27 Why is the science so slow?

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29 regulation of motivation, behaviour, and emotions

30 T-celler och cytokiner

31 “Sickness response” vs Depression Sickness response – Trötthet – Nedsatt aptit – Sömnstörning – Sänkt stämningsläge – Försämrad kognition Depression – Trötthet – Nedsatt aptit – Sömnstörning – Sänkt stämningsläge – Försämrad kognition Isak Sundberg, ST-Läkare och Doktorand

32 Nature Reviews, 2008

33 Överdödlighet bland deprimerade Ökning jämfört med normalbefolkningen Suicid12* Annan våldsam död2.5* Circulationsorganens sjukdomar1.2* Andningsorganens sjukdomar2* Infektionssjukdomar9.4*

34 Överdödlighet vid paniksyndrom Ökning jämfört med normalbefolkningen Alla orsaker2 gånger Självmord7.5 gånger Cirkulationsorganens sjukdomar 2 gånger Infektionssjukdomar10 gånger

35 B-celler och antikroppar

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38 Hormoner bisköldkörtel

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41 Tarmfloran

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44 Publication on Biomarkers in Psychiatry