MENTAL DISORDER Schizophrenia Schizophrenia (/ktsfrni/ or /sktsfrini/) is a mental s disorder characterized by a breakdown of thought processes and by poor emotional

responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social or occupational dysfunction. The onset of symptoms typically occurs in young adulthood, with a global lifetime prevalence of about 0.30.7%. Diagnosis is based on observed behavior and the patient'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 etymology of the term from the Greek roots skhizein (, "to split") and phrn, phren-(, -; "mind"), schizophrenia does not imply a "split personality", or "multiple personality disorder" (which is known these days asdissociative identity disorder)a condition with which it is often confused in public perception. Rather, the term means a "splitting of mental functions", because of the symptomatic presentation of the illness. SIGNS and SYMPTOMS A person diagnosed with schizophrenia may experience hallucinations (most reported are hearing voices), delusions (often bizarre or persecutory in nature), and disorganized thinking and speech. The latter may range from loss of train of thought, to sentences only loosely connected in meaning, to incoherence known as word salad in severe cases. Social withdrawal, sloppiness of dress and hygiene, and loss of motivation and judgment are all common in schizophrenia.[6] There is often an observable pattern of emotional difficulty, for example lack of responsiveness.[7]Impairment in social

cognition is associated with schizophrenia,[8] as are symptoms of paranoia; social isolation commonly occurs.[9] Difficulties in working and long-term memory, attention,executive functioning, and speed of processing also commonly occur.[2] In one uncommon subtype, the person may be largely mute, remain motionless in bizarre postures, or exhibit purposeless agitation, all signs of catatonia.[10] Late adolescence and early adulthood are peak periods for the onset of schizophrenia,
[2]

critical years in a young adult's social and vocational development.[11] In 40% of men

and 23% of women diagnosed with schizophrenia, the condition manifested itself before the age of 19.[12] To minimize the developmental disruption associated with schizophrenia, much work has recently been done to identify and treat the prodromal (pre-onset) phase of the illness, which has been detected up to 30 months before the onset of symptoms.[11] Those who go on to develop schizophrenia may experience transient or self-limiting psychotic symptoms[13] and the non-specific symptoms of social withdrawal, irritability, dysphoria,[14] and clumsiness[15] during the prodromal phase. Schneiderian classification In the early 20th century, the psychiatrist Kurt Schneider listed the forms of psychotic symptoms that he thought distinguished schizophrenia from other psychotic disorders. These are calledfirst-rank symptoms or Schneider's first-rank symptoms. They include delusions of being controlled by an external force; the belief that thoughts are being inserted into or withdrawn from one's conscious mind; the belief that one's thoughts are being broadcast to other people; and hearing hallucinatory voices that comment on one's thoughts or actions or that have a conversation with other hallucinated voices.Although they have significantly contributed to the current diagnostic criteria, the specificity of first-rank symptoms has been questioned. A review of the diagnostic studies conducted between 1970 and 2005 found that they allow neither a reconfirmation nor a rejection of Schneider's claims, and suggested that first-rank symptoms should be de-emphasized in future revisions of diagnostic systems. Positive and negative symptoms Schizophrenia is often described in terms of positive and negative (or deficit) symptoms. Positive symptoms are those that most individuals do not normally

experience but are present in people with schizophrenia. They can include delusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory and gustatory hallucinations, typically regarded as manifestations of psychosis.Hallucinations are also typically related to the content of the delusional theme.Positive symptoms generally respond well to medication. Negative symptoms are deficits of normal emotional responses or of other thought processes, and respond less well to medication. They commonly include flat or blunted affect and emotion, poverty of speech (alogia), inability to experience pleasure (anhedonia), lack of desire to form relationships (asociality), and lack of motivation (avolition). Research suggests that negative symptoms contribute more to poor quality of life, functional disability, and the burden on others than do positive symptoms. People with prominent negative symptoms often have a history of poor adjustment before the onset of illness, and response to medication is often limited.

MANAGEMENT

The primary treatment of schizophrenia is antipsychotic medications, often in combination with psychological and social supports. Hospitalization may occur for severe episodes either voluntarily or (if mental health legislation allows it) involuntarily. Long-term hospitalization is uncommon since deinstitutionalization beginning in the 1950s, although still occurs. Community support services including drop-in centers, visits by members of a community mental health team, supported employment and support groups are common. Some evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizophrenia. Medication The first-line psychiatric treatment for schizophrenia is antipsychotic medication, which can reduce the positive symptoms of psychosis in about 714 days. Antipsychotics, however, fail to significantly ameliorate the negative symptoms and cognitive dysfunction. Long term use decreases the risk of relapse.

The choice of which antipsychotic to use is based on benefits, risks, and costs. It is debatable whether, as a class, typical or atypical antipsychotics are better. Both have equal drop-out and symptom relapse rates when typicals are used at low to moderate dosages. There is a good response in 4050%, a partial response in 3040%, and treatment resistance (failure of symptoms to respond satisfactorily after six weeks to two or three different antipsychotics) in 20% of people. Clozapine is an effective treatment for those who respond poorly to other drugs, but it has the potentially serious side effect ofagranulocytosis (lowered white blood cell count) in 14%. With respect to side effects typical antipsychotics are associated with a higher rate of extrapyramidal side effects while atypicals are associated with considerable weight gain, diabetes and risk of metabolic syndrome. While atypicals have fewer extrapyramidal side effects these differences are modest.]Some atypicals such as quetiapine and risperidone are associated with a higher risk of death compared to the typical antipsychotic perphenazine, while clozapine is associated with the lowest risk of death. It remains unclear whether the newer antipsychotics reduce the chances of developing neuroleptic malignant syndrome, a rare but serious neurological disorder. For people who are unwilling or unable to take medication regularly, longacting depot preparations of antipsychotics may be used to achieve control. They reduce the risk of relate to a greater degree than oral medications. When used in combination with psychosocial interventions they may improve long-term adherence to treatment. Mental retardation Mental retardation (MR) is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors. It has historically been defined as an Intelligence Quotient score under 70. Once focused almost entirely on cognition, the definition now includes both a component relating to mental functioning and one relating to individuals' functional skills in their environment. As a result, a person with a below-average intelligence quotient (BAIQ) may not be considered mentally retarded. Syndromic mental retardation is intellectual deficits associated with other medical and

behavioral signs and symptoms. Non-syndromic mental retardation refers to intellectual deficits that appear without other abnormalities. SIGNS and SYMPTOMS The signs and symptoms of mental retardation are all behavioral. Most people with mental retardation do not look like they have any type of intellectual disability, especially if the disability is caused by environmental factors such as malnutrition or lead poisoning. The so-called "typical appearance" ascribed to people with mental retardation is only present in a minority of cases, all of which involve syndromic mental retardation. Children with mental retardation may learn to sit up, to crawl, or to walk later than other children, or they may learn to talk later. Both adults and children with mental retardation may also exhibit some or all of the following characteristics:

Delays in oral language development Deficits in memory skills Difficulty learning social rules Difficulty with problem solving skills Delays in the development of adaptive behaviors such as self-help or selfLack of social inhibitors

care skills

MANAGEMENT By most definitions mental retardation is more accurately considered a disability rather than a disease. MR can be distinguished in many ways from mental illness, such as schizophrenia ordepression. Currently, there is no "cure" for an established disability, though with appropriate support and teaching, most individuals can learn to do many things. There are thousands of agencies around the world that provide assistance for people with developmental disabilities. They include state-run, for-profit, and non-profit, privately run agencies. Within one agency there could be departments that include fully

staffed residential homes, day rehabilitation programs that approximate schools, workshops wherein people with disabilities can obtain jobs, programs that assist people with developmental disabilities in obtaining jobs in the community, programs that provide support for people with developmental disabilities who have their own apartments, programs that assist them with raising their children, and many more. There are also many agencies and programs for parents of children with developmental disabilities. Beyond that there are specific programs that people with developmental disabilities can take part in wherein they learn basic life skills. These "goals" may take a much longer amount of time for them to accomplish, but the ultimate goal is independence. This may be anything from independence in tooth brushing to an independent residence. People with developmental disabilities learn throughout their lives and can obtain many new skills even late in life with the help of their families, caregivers, clinicians and the people who coordinate the efforts of all of these people. Although there is no specific medication for mental retardation, many people with developmental disabilities have further medical complications and may be prescribed several medications. For example autisic children with developmental delay may be prescribed antipsychotics or mood stabilizers to help with their behavior. Use of psychotropic medications such as benzodiazepines in people with mental retardation requires monitoring and vigilance as side effects occur commonly and are often misdiagnosed as behavioural and psychiatric problems. Attention deficit disorder Attention deficit disorder (ADD) is one of the three subtypes of Attention-deficit hyperactivity disorder (ADHD). The term was formally changed in 1994 in the new Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) to "ADHD predominantly inattentive" (ADHD-PI or ADHD-I), though the term attention deficit disorder is still widely used. ADD is similar to the other subtypes of ADHD in that it is characterized primarily by inattention, easy distractibility, disorganization, procrastination, and forgetfulness; where it differs is in lethargy - fatigue, and having fewer or no symptoms of hyperactivity or impulsiveness typical of the other ADHD

subtypes. Different countries have used different ways of diagnosing ADD. In the UK, diagnosis is based on quite a narrow set of symptoms, and about 0.51% of children are thought to have attention or hyperactivity problems. The USA used a much broader definition of the term ADHD. As a result, up to 10% of children in the USA were described as having ADHD. Current estimates suggest that ADHD is present throughout the world in about 15% of the population. About five times more boys than girls are diagnosed with ADHD. Medications include two classes of drugs, stimulants and nonstimulants. Drugs for ADHD are divided into first-line medications and second-line medications. First-line medications include several of the stimulants, and tend to have a higher response rate and affect size than second-line medications. Although medication can help improve concentration, it does not cure ADD and the symptoms will come back once the medication stops. SIGNS and SYMPTOMS DSM-IV criteria The DSM-IV allows for diagnosis of the predominantly inattentive subtype of ADHD (under code 314.00) if the individual presents six or more of the following symptoms of inattention for at least six months to a point that is disruptive and inappropriate for developmental level:

Often does not give close attention to details or makes careless mistakes in Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow instructions and fails to finish schoolwork, chores, or duties

schoolwork, work, or other activities.

in the workplace (not due to oppositional behavior or failure to understand instructions).

Often has trouble organizing activities. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort

for a long period (such as schoolwork or homework).

Often loses things needed for tasks and activities (e.g. toys, school assignments, Is often easily distracted. Is often forgetful in daily activities. Often mixes up peoples' names or forgets them for short periods of time.

pencils, books, or tools).

An ADD diagnosis is contingent upon the symptoms of impairment presenting themselves in two or more settings (e.g., at school or work and at home). There must also be clear evidence of clinically significant impairment in social, academic, or occupational functioning. Lastly, the symptoms must not occur exclusively during the course of a pervasive developmental disorder,schizophrenia, or other psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder). MANAGEMENT It is difficult to say exactly how many children worldwide have ADHD because different countries have used different ways of diagnosing it, while some do not diagnose it at all. In the UK, diagnosis is based on quite a narrow set of symptoms, and about 0.51% of children are thought to have attention or hyperactivity problems. In comparison, until recently, professionals in the USA used a much broader definition of the term ADHD. As a result, up to 10% of children in the USA were described as having ADHD. Current estimates suggest that ADHD is present throughout the world in about 15% of the population. About five times more boys than girls are diagnosed with ADHD. This may be partly because of the particular ways they express their difficulties. Boys and girls both have attention problems, but boys are more likely to be overactive and difficult to manage. Children from all cultures and social groups are diagnosed with ADHD. However, children from certain backgrounds may be particularly likely to be diagnosed with ADHD, because of different expectations about how they should behave. It is therefore important to ensure that a child's cultural background is understood and taken into account as part of the assessment. MEDICATION

Recent studies indicate that medications approved by the U.S. Food and Drug Administration (FDA) in the treatment of ADHD tend to work well in individuals with the predominantly inattentive type. These medications include two classes of drugs, stimulants and non-stimulants. Drugs for ADHD are divided into first-line medications and second-line medications. First-line medications include several of the stimulants, and tend to have a higher response rate and effect size than second-line medications. Some of the most common stimulants are Methylphenidate (Ritalin, Concerta), Adderall and Vyvanse. Second-line medications are usually anti-depressant medications such as Zoloft, Prozac, and Wellbutrin. These medications can help with fidgeting, inattentiveness, irritability, and trouble sleeping. Some of the symptoms the medications target are also found with ADD patients. Although medication can help improve concentration, it does not cure ADD and the symptoms will come back once the medication stops. Medication works better for some patients while it barely works for others. Along with medication, behavioral therapy is recommended to improve organizational skills, study techniques or social functioning.