PUBH1382 Week 7 - MH2 2017

PUBH1382 Australian Health Care System

Week 7 (Section B): Mental Health 2
INSTRUCTORS: Mervyn Jackson & Amy Loughman

Learning Objectives
1. Understand the relevance of mental health to allied health practice
2. Identify roles, responsibilities and limitations of practice with respect to assisting
clients with mental health and illness, and relevant referral pathways.
3. Understand broad concepts related to mental health and illness, and current
classification systems
a. Signs vs symptoms
b. The concept of normal
c. Biopsychosocial causes
d. Classification of disorders - DSM5
4. Learn how to recognise symptoms of depression, anxiety and stress
5. Understand features of key types of psychological disorders
Appendix: Optional additional resources

1 RMIT University ©2017

Notes
1. Relevance of mental health to allied health practice
Recent research on psychological disorders in Australia suggests that almost half (46.3%) of
us will experience a diagnosable mental disorder in our lifetime (Slade, Johnston, Browne,
Andrews, & Whiteford, 2009). Whilst it is common for humans to experience symptoms
that might be key features of mental disorders from time to time, such as low mood or
worry, most psychological disorders can be considered acute demonstrations of otherwise
normal emotions, behaviours, and thought processes (Barlow & Durand, 2015).
Mental health affects people of all genders, ethnicity, cultural background, socioeconomic
and educational level. Therefore, mental health and illness are important considerations
for us all. Since allied health practitioners engage with many kinds of physical conditions
and disability, awareness of common mental health issues is important. Mood disorders
and other mental health difficulties are more prevalent in people experiencing physical
health disorders. Mental state is also directly relevant to the experience of pain, interest in
health-seeking behaviours, cognitive function such as concentration and memory,
adherence to treatment recommendations and general motivation.
One example of direct impacts on physical health as a result of mental state is depression
and motivation. Physical exercise is one of the most effective first-line treatments for
depressive symptoms (e.g. see Carek et al., 2011, and this fact sheet from the Black Dog
Institute). A number of physiological mechanisms are responsible for the anti-depressant
effect of exercise, including stimulating nerve cell growth in brain structures such as the
hippocampus, the release of endorphins, reducing blood pressure and improving sleep, as
well as distraction from worries and ruminating thoughts. However as discussed in further
detail below, one of the hallmark features of depression is a loss of motivation and physical
and mental energy. Lethargy and fatigue are common, and can be compounded by
insomnia or hypersomnia. Therefore the inherent difficulty with an otherwise fairly simple
recommendation of physical exercise for people experiencing mild to moderate depression
is the energy and motivation difficulties they can experience due to the depression. For this
reason, sometimes it is useful to begin with other therapeutic strategies so that the
individual has adequate energy to undertake the recommended exercise.


Another example can be seen in functional gastrointestinal conditions such as IBS. These
are highly comorbid with depression and anxiety, and there is considered to be a complex
shared aetiology, such that having either a mood disorder OR IBS predisposes the
individual to developing the other condition over time.
Most mental health disorders can be successfully managed via psychological, behavioural
and pharmacological modalities. Despite this, the treatment rate for mental disorders in
Australia was only 46% in 2009-2010 (Whiteford et al., 2014). Untreated mental disorders
have significant individual, social and economic burden due to loss of quality of life, strain
on interpersonal relationships, lost productivity and premature mortality. Therefore there
is significant opportunity and value in assisting people to identify avenues for achieving
positive mental health, particularly as an allied health practitioner.
2. Roles, responsibilities and limitations of practice
Roles and responsibilities of allied health practitioners lie mostly in their specific area of
practice, under the discipline-specific guidelines of the Australian Health Practitioner
Regulation Agency, AHPRA. If you are not familiar with those of your specific discipline, they
are available at this site. However, even if your specific allied health discipline does not
typically treat mental health conditions per se, your role as a trusted health practitioner
means it is a good idea to know how to provide basic assistance for people experiencing
common difficulties.
The use of the title ‘psychologist’ is protected in Australia under the Psychology Board of
Australia, such that only those registered with the PBA may use it. Whilst there are several
pathways to becoming a psychologist, this is typically restricted to those who are
completing or have completed significant postgraduate training in psychology. There are
similar limitations on the provision of psychological services in Australia currently available
via Medicare rebates under the Better Access to Psychiatrists, Psychologists and General
Practitioners through the MBS, or Better Access initiative. These services may only be provided
by eligible registered psychologists, social workers and occupational therapists who are
adequately trained may do so. However it is useful to know about these services, since they
may be available and suitable for people you may see in your allied health practice.


Details are available in the Fact Sheet, however briefly, patients may receive Medicare
rebates for up to ten individual and up to ten group allied mental health services per
calendar year, following referring from a GP. Psychological Therapy can be provided by a
psychologist who is registered with the Psychology Board of Australia, and Focussed
Psychological Strategies can be provided by either a psychologist (as above), or a social
worker or occupational therapist who meets practice standards for mental health and
ongoing continuing professional development.
Regardless of practitioner type, common ethical guidelines regarding delivery of mental
health care apply. These are guided by four principles.

1. Beneficence [or striving to bring benefit] – and where risk is present, balance decisions
in favour of benefit
2. Non-maleficence – avoid causing harm
3. Respect of autonomy – respect choices and preferences of the person experiencing
mental health problems
4. Justice – fairness in the risk/benefit balance
Even if you are unlikely to be delivering psychological services yourself, it is relevant to be
able to be aware of these services in your role as an allied health practitioner. Whilst formal
referral is typically provided from the patient’s GP, there may be instances where your
services are the main health services received and regular or effective contact with a GP
may not be present. The following sections will provide a background on concepts related
to mental health, and identifying potential need for psychological services.
3. Mental health concepts and classifications
Signs vs symptoms
A brief definitional note regarding signs and symptoms. Signs are clinically observable
phenomenon that indicate the presence of some condition, whether it be physical or
mental. An simple example is trembling in the hands or voice to indicate nervousness or
anxiety. On the other hand, a symptom refers to a subjectively experienced phenomenon


The concept of normal
The concept of normality is generated by the powerful majority (dominant part of society)
who define what is “acceptable” in society. Those people (the minority), who are different
from this normality concept are defined as abnormal and subsequently experience
dehumanization through prejudice and discrimination. To mark, label, and identify some
groups as different allows the majority in society to control others through fear of
difference. The resultant adverse effects are imposed on many of societies’ minority groups
(eg indigenous, gender, people in poverty and people experiencing mental health issues).
The reality of this labelling process is the negative impact on people experiencing mental
health issues through:
· denying or hiding a mental health diagnoses from non-family
· the loss of employment [when employers become aware of mental health issues]
· the reality of poverty [through loss of income]
· the loss of housing [controlled by landlords], and
· the creation of the extra burden [stigmatization] on those who are already
experiencing significant challenges in their current lives
However, delineating between normal and abnormal is useful and necessary in clinical
practice. Given the normality of mental difficulties in situations arising in everyday life, in
order to make this distinction, we must first consider the frequency, intensity and duration
of an individual’s symptoms. Additionally we must consider the context within which these
symptoms occur (American Psychiatric Association (APA), 2013). This context is defined by
an individual’s level of distress, functional impairment and what is societally or culturally
expected with reference to those symptoms. Together these aspects distinguish whether
or not someone is considered to be experiencing a psychological disorder or exhibiting
‘abnormal’ behaviour. Let’s explore each of these areas a little more closely.


Psychological distress can be defined as psychological pain or emotional disturbance
(Barlow & Durand, 2015). Alone psychological distress does not define abnormal
behaviour. For example when someone close to us dies it is considered normal to be
distressed (APA, 2013). In contrast, some mental disorders do not typically result in
distress, for example the manic episodes associated with bipolar disorder that by definition
involve elevated mood (APA, 2013).

Impairment is considered to have occurred when symptoms adversely affect an individual’s
functioning in social, occupational, academic or other important areas (APA, 2013).
Impairment is subjective to an individual’s circumstances. For example if someone
considers themselves shy however does not desire close friendships with others, then their
functioning is not considered impaired. In contrast, someone who desires close friendships
but finds social situations overwhelming due to their symptoms of anxiety may be deemed
impaired in social functioning.

Social or cultural standards, or norms, can also be used to define behaviour as abnormal.
Culture may be defined as the concepts, rules, practices and knowledge that are learned
and then communicated between generations (APA, 2013). Importantly, behaviour that is
considered abnormal or disordered in one culture may be considered acceptable in
another. For example, in most western cultures ritualistic behaviours that involve trance
like states and speaking with deceased ancestors are likely to be viewed as abnormal,
whereas other cultures view these practices as normal (Barlow & Durand, 2015). Therefore
cultural norms are an important but by no means an exhaustive method for defining
abnormal behaviour.

Biopsychosocial causes
Once we have concluded that an individual’s behaviour is abnormal and we have classified
their symptoms diagnostically, we might be left wondering why this person is experiencing
these symptoms in the first place?

We might be tempted to suggest that an individual’s psychopathology, is caused by a


particular circumstance, such as the loss of a loved one or their genes. But why then don’t
all individuals who experience loss or have a particular gene develop psychopathology?
This uni-dimensional approach that aims to identify the cause of psychopathology was
common-place until the late 1900s (Barlow & Durand, 2015). More recently however, we
have come to understand the need to consider important contributions of all aspects of an
individual’s life in understanding their behaviour, and thus psychopathology.

Championed by American psychiatrist George Engel (1977), the identification of
interactions of multiple factors formed the premise of the multi-dimensional
biopsychosocial model. In contrast to the established medical model that assumed
explanations of disorders lay in biological abnormality, Engel (1977) posited that in order to
understand psychopathology we must consider all aspects of an individual’s “system”. That
system comprises an individual’s biological circumstances, their psychological functioning,
as well as their social, and cultural environment.

Biological dimensions include factors that can be attributed to the physiological,
anatomical, or biochemical characteristics of an individual, notably genetic makeup and the
nervous system (Engel, 1977). Psychological dimensions refer to an individual’s thoughts,
feelings and behaviour. An individual’s thoughts reflect learned experience expressed
through beliefs about expectations of self and others (Beck, 1976). Social dimensions refers
to those aspects that reflect cultural and interpersonal influences, such as socio-economic
status, as well as cultural values and traditions. The biopsychosocial model emphasises the
need to consider that these dimensions interact in complex ways that may result in
psychopathology (Engel, 1977).


Classification of disorders
To simply define behaviour as abnormal does little however to aid understanding and thus
treatment of the distress or impairment of an individual’s symptoms. In order to do this, an
individual’s symptoms must first be classified. When mental health clinicians such as
psychiatrists and clinical psychologists identify abnormal behaviour, they make a
classification, or diagnosis, by reviewing the individual’s symptoms against an established
set of criteria. These criteria are represented as a classification of mental disorders, which
allows the clinician to draw important conclusions about that individual’s prognosis, to
recommend appropriate treatment and to communicate with other clinicians effectively.


Until the middle of last century the field of mental health lacked a standard set of
classifications by which professionals could accurately diagnose mental disorders (Burton,
Westen, & Kowalski, 2012). This changed in 1952 when the American Psychiatric Association
(APA) began publishing the Diagnostic and Statistical Manual of Mental Disorders (DSM-I;
APA, 1952). The current fifth edition of the manual (DSM-5) contains over 150 individual
classifications or ‘diagnosable disorders’ and provides important information regarding the
diagnostic features, the development and course of illness and prevalence of recognised
disorders.
We are going to take a closer look at some of these classifications later including the
following categories:
1. Mood/Affective Disorders
2. Anxiety Disorders
3. Substance Use Disorders
4. Personality Disorders
5. Schizophrenia

As the DSM-5 provides a classification of mental disorders, professionals are then able to
identify an individuals shared attributes (symptoms) in order to arrive at a diagnosis.
Importantly, once diagnosis occurs, clinicians are then able to review the research evidence
and, where appropriate, recommend and provide treatment for an individual (Spitzer,
1998).

4. Recognising signs and symptoms of depression, anxiety and stress
Signs and symptoms of depression come in many forms including behaviour, thoughts,
feelings and physical sensations.
Adapted from Beyond Blue is the following list of common signs and symptoms. The more
observable phenomena, or signs, are indicated with *. Note that many of the common
indications of depression are symptoms that may not be readily observable from an
outside perspective. However it is also important to note that not all of these signs and


symptoms are specific to depression. Understanding an individual’s personal experience
and in-depth assessment may be required for a diagnosis.
Behaviour
not going out anymore*
not getting things done at work/school*
withdrawing from close family and friends*
relying on alcohol and sedatives*
not doing usual enjoyable activities
unable to concentrate
Feelings
overwhelmed
guilty
irritable*
frustrated*
lacking in confidence
unhappy*
indecisive
disappointed
miserable*
sad*
Thoughts
'I’m a failure.'
'It’s my fault.'
'Nothing good ever happens to me.'
'I’m worthless.'
'Life’s not worth living.'
'People would be better off without me.'
Physical feelings
tired all the time
sick and run down
headaches and muscle pains
churning gut


sleep problems
loss or change of appetite
significant weight loss or gain*

As outlined by Beyond Blue Factsheets, the symptoms of anxiety conditions are
sometimes not all that obvious as they often develop slowly over time and it may be
difficult to distinguish between manageable, situational anxiety that we may all experience
at some time, and what could be considered ‘too much’.

Normal anxiety tends to be limited in time and connected with some stressful situation or
event, such as a job interview. The type of anxiety experienced by people with an anxiety
condition is more frequent or persistent, not always connected to an obvious challenge,
and impacts on their quality of life and day-to-day functioning. There are a number of
different anxiety conditions each with their own features as explained in more detail below,
however there are some common symptoms including the following symptoms and signs
(indicated by *):
Behaviour
*avoidance of situations that make you feel anxious which can impact on study, work or
social life
Thoughts
excessive fear, worry, catastrophizing, or obsessive thinking
Physical feelings
panic attacks
hot and cold flushes
racing heart*
tightening of the chest
quick breathing*
restlessness*
feeling tense, wound up and edgy


Useful for the assignment: See these resources on the signs and symptoms of stress,
and notice the different physical, behavioural and psychological manifestations.
5. Types of psychological disorders
Mood/affective disorders
A helpful way to conceptualise mood is as a continuum. At one end (or pole) lies severe
depression, characterised by sadness, hopelessness and emptiness (low mood) and/or a
general loss of interest or pleasure (anhedonia). At the other pole of the continuum lies
mania, characterised by persistently elevated or irritable mood, as well as increased energy
and goal oriented activity. Whilst it is normal for our mood to fluctuate for short periods,
particularly in response to stressful life events such as the breakdown of a relationship or
the death of a loved one, in general when someone’s mood is persistently polarized, we
consider their mood to be abnormal or disordered.

In addition to low mood or anhedonia, the episodes that characterise major depression are
accompanied by negative changes in energy, sleep, appetite, concentration and memory
for periods of two weeks or more (American Psychiatric Association (APA), 2013). Although
less common, bipolar disorder can be a severely debilitating mood disorder with manic
episodes characterised by an inflated sense of self-esteem (grandiosity), difficulty
concentrating, and a decreased need for sleep that may lead to excessive risk taking (APA,
2013). Whilst some individuals experience only the manic pole, this experience is rare and
most will experience episodes of both mania and depression, hence bi-polar disorder. It is
important to note that thoughts of death or suicide can be common in individuals with
mood disorders and need to be taken seriously and referred to appropriate professionals.

There is no single identified cause of mood disorders, biological, psychological, and social
factors may all contribute to their development. From a biological perspective, scientists
have been able to identify groups of genes as well as changes in brain chemicals
(neurotransmitters) that may predispose individuals to mood disorders (Barlow & Durand,
2015). Psychological factors identified as involved in the development and maintenance of
mood disorders include an individual’s negative beliefs about the self, the world and the


future (Beck, 2011). A depressed individuals thoughts feelings and behaviour often reflect
beliefs of worthlessness, injustice, and hopelessness (Beck, 2011). Social and cultural
circumstances such as a hostile or negative family environment as well as life events, such
as the death of a loved one, or a breakdown of a relationship are often associated with the
trigger of depressive and manic episodes (APA, 2013).

Anxiety disorders
Anxiety disorders are the most commonly experienced mental disorders in Australia, with
more than one in four meeting criteria in their lifetime (Slade, Johnston, Browne, Andrews
& Whiteford, 2009). Of the disorders historically classified as anxiety based, trauma related
disorders are most prevalent, with one in twenty Australians experiencing post-traumatic
stress disorder in the past year (Slade et al., 2009). Other commonly experienced anxiety
disorders include social phobia, agoraphobia, generalized anxiety disorder, obsessive
compulsive disorder, specific phobia, and panic disorder.

Like sadness, anxiety is a normal human response to situations that make us feel
uncomfortable. We have all felt a little anxious when we were asked to present in front of a
group of peers, in preparation for an important job interview or even when thinking about
asking someone out on a date. In fact in situations such as these, a certain amount of
anxiety is helpful, without it we would not have been so energetic in that presentation or
well prepared for that job interview, and we may never have bothered to ask the person
out on a date. Anxiety becomes abnormal when it overwhelms us and results in distress or
impairment in our capacity to do the things we need or would like to do (American
Psychiatric Association (APA), 2013).

Anxiety is formally defined as a negative mood state characterized by bodily symptoms of
physical tension and by apprehension about the future (APA, 2013). Anxiety may be
experienced as a subjective ‘feeling’ of discomfort and by a physiological response to
perceived threat that results in bodily changes such as muscle tension and behavioural
responses such as restlessness (APA, 2013). The typical human response is to avoid or
alleviate anxiety, hence its motivating qualities (Barlow & Durand, 2015). Anxiety disorders
are characterised by excessive fear and anxiety that result in subsequent disturbance in


behaviour and cognition (APA, 2013).

Anxiety has been categorised into a number of diagnosable disorders. Specific Phobia is
defined as excessive anxiety triggered in response to a specific feared object or situation,
such as a type of animal or receiving an injection (APA, 2013). Social phobia is specific to
social or performance situations in which the person fears judgement or scrutiny by others
(APA, 2013). Agoraphobia is defined as anxiety about or avoidance of places or situations,
such as public transport or open spaces, where escape is perceived as unavoidable or help
from others may be unavailable. Generalized anxiety disorder refers to circumstances in
which an individual has persistent and excessive worry about various aspects of their life,
such as their health or occupational/academic performance, to the point of significant
distress or impairment. Obsessive compulsive disorder is characterised by the presence of
obsessions (intrusive, unwanted thoughts or images) that compel an individual to perform
repetitive behaviours or mental acts, or compulsions (APA, 2013). Panic disorder is defined
by recurrent unexpected panic attacks. Panic attacks are sudden surges of excessive fear
that result in activation of the fight-or-flight response (APA, 2013). Importantly anxiety,


particularly panic attacks, also feature in many other mental disorders (APA, 2013).
As with mood disorders, research has demonstrated the role of biological, psychological
and social factors as contributing to the development of anxiety disorders. Some
individuals have a genetic predisposition towards being uptight or highly-strung (Barlow &
Durand, 2013). From a psychological perspective, beliefs about others and the world as
being dangerous or uncontrollable and an individual’s self-efficacy in coping are associated
with increased likelihood of anxiety disorders (Barlow & Durand, 2013). Additionally, social
experiences, particular early ones, such as those in which others model behaviour
contribute to our vulnerability to anxiety disorders (Barlow & Durand, 2013). Whilst no
individual factor alone has been demonstrated as sufficient, it has been proposed that
these factors may combine to form a triple vulnerability in predisposing an individual to an
anxiety disorder (Barlow & Durand, 2013). The onset of an anxiety disorders can occur at
any age. Some anxiety disorders are associated with childhood onset, such as separation
anxiety disorder and obsessive compulsive disorder, whilst others are more typically


recognised later in life, such as generalised anxiety disorder (APA, 2013).

Substance use disorders
Most Australians report drinking alcohol in the past 12 months, yet few report levels that
are considered alcoholism (Slade, Johnston, Browne, Andrews, & Whiteford, 2009). The use
of a substance is typically defined as abnormal or disordered when an individual continues
to use a substance despite significant related problems (American Psychiatric Association
[APA], 2013). In other words, an individual continues to use a given substance whilst
enduring the negative impact on their physical and psychological wellbeing, social
functioning or impairment in occupational or academic pursuits. Substance use disorders
are the second most common mental disorder Australians experience, with one in four
meeting criteria in their lifetime (Slade et al., 2009).

Substance use disorders involve a person’s harmful use or dependence on alcohol or other
prescription and illicit drugs (APA, 2013). Harmful use is defined as a pattern of


consumption or dependence that contributes to impaired psychological functioning or
physical harm (APA, 2013). Substance dependence itself is defined as a maladaptive pattern
whereby an individual experiences a desire to prioritise the substance over other
previously valued aspects of their life, and/or in spite significant substance-related
problems (APA, 2013). Substances that are typically classified as being associated with
harmful use are alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives,
stimulants and tobacco (APA, 2013).
By definition substance use disorders are destructive to the lives of those who experience
them, they have profound negative effects on some or all of an individual’s functioning.
Why then would someone continue to abuse a substance? The answer is a complex and
multi-dimensional one. Important research from the field of neuroscience has shown that
drugs that are used to excess, directly activate reward systems in the brain which are
implicated in the reinforcement of behaviour (APA, 2013). Typically we experience
activation of these pathways to some level through adaptive behaviours, such as personal
achievement or physical exercise. Substances however can directly stimulate these
pathways and lead to more intense activation, which may explain why individuals continue
to abuse substances despite their negative impact (APA, 2013). While the nature of the
mechanisms of different drugs vary, typically they result in the activation of the reward
system and consequently in feelings of pleasure or a high (APA, 2013). Substantial research
examining genetics has shown that some individuals likely inherit a vulnerability to
substance abuse disorders (Barlow & Durand, 2015). In addition to biological vulnerabilities
psychological factors such as learning from previous experiences, lower levels of
self-control and self-efficacy, and confidence in ones abilities to overcome challenges, is
linked to the development of substance abuse disorders (Barlow & Durand, 2015). Equally
the experience has been described by drug abusers as relieving negative mood states,
therefore the removal of unwanted symptoms is also likely to result in negative
reinforcement, increasing the likelihood of continued use (Barlow & Durand, 2013). From
social and cultural perspectives, research has established that environment provides at
least part of the vulnerability towards abuse. Notably, young people are significantly more
likely to develop substance related problems, such as alcohol abuse, when their immediate
family environment is subject to alcohol problems, when family cohesion is low, and when
peers use substances (Barlow & Durand, 2015).


While the typical course varies for each substance, the first episode of use usually occurs
between the mid-teens and early 20s (APA, 2013). The large majority of those who develop
a substance use disorder will do so before the age of 30, with those aged 18-29 at the
highest risk (APA, 2013). Australian males are more than twice as likely to experience a
substance related disorder as females (Slade et al., 2009). Whilst the course of some
substances, such as alcohol, tend to be variable, that is periods of remission and relapse,
other substances, such as opioids, tend to involve more continuous periods of use with
brief periods of abstinence (APA, 2013).

Treatment approaches for substance use disorders include medications that act as either
less harmful replacements or as deterrents by inducing aversive reactions to a given
substance (Barlow & Durand, 2015). Psychological treatments such as CBT and motivational
interviewing for substance use also have demonstrated efficacy (Barlow & Durand, 2015).
CBT for substance abuse seeks to address not only the issues and beliefs surrounding use
of the substance itself but also helps the individual to understand the impact of other
psychological and behavioural factors that may be perpetuating the substance use cycle
(Barlow & Durand, 2015). Additionally, whilst there has been little systematic empirical
validation, psychosocial support interventions such as Alcoholics Anonymous are a highly
popular treatment approach that advocate high levels of social support in combination
with behavioural principles in order to abstain from substance use (Barlow & Durand,
2015).

Regardless of the approach, the outcome of treatment of substance use disorders are
highly dependent on the motivation of the affected individual (Barlow & Durand, 2015).
Whilst complete lifelong remission is not a frequent outcome, research suggests a high
level of motivation accompanied by biological and psychological treatments offers the best
results (Barlow & Durand, 2015). More recently, programs that have utilised psychological
approaches aimed at prevention suggest that addressing the problem before it begins is
likely to have the greatest impact (Barlow & Durand, 2015).


Personality disorder
We all tend to naturally ‘categorise’ people based on enduring characteristic or traits of
their personalities. We might say that Julie is an introvert or that Paul is needy, we might
even use psychological terms to define personality, Lisa is manic or Richard is obsessive!
Personality traits reflect patterns in the way an individual thinks about and relates to
themselves, their environment and others (American Psychiatric Association (APA), 2013).
What if a person’s personality traits reflect a way of relating that results in distress or
impairment? It may be that this individual’s personality traits reflect an underlying
personality disorder.

A personality disorder is defined as a pervasive pattern of maladaptive behaviour and
negative inner experience that is evident in most, if not all aspects of a person’s life (APA,
2013). There are ten identified personality disorders categorised around three groups or
clusters that are based on descriptive similarities (APA, 2013). Individuals with Cluster A
type personality disorders appear odd, unusual or eccentric; and include paranoid,
schizoid, and schizotypal personality disorders. Those with Cluster B personality disorders
are overly dramatic, emotional, or erratic; and include antisocial, borderline, histrionic, and
narcissistic personality disorders. Cluster C is associated with anxiety and fearfulness; and
includes avoidant, dependent, and obsessive-compulsive personality disorders.


Prominent studies suggest that one in ten adults may experience symptoms that meet
criteria for a personality disorder (Lenzenweger, Lane, Loranger, & Kessler, 2007). Like
many mental disorders the specific causes of personality disorders remain unknown. A
number of different genes as well as environmental experience such as exposure to
trauma have been identified as playing an important role in their development. Imaging
research examining functioning of the brain has demonstrated differences in the way
people with personality disorders process and respond, suggesting that there may also be
a neurological basis to these disorders (Barlow & Durand, 2015).

By definition personality disorders become evident in adolescence or early adulthood and
tend to persist into adulthood (APA, 2013). Whilst symptoms will be evident prior, a
personality disorder may also be exacerbated by changes in an individual’s circumstances,
particularly social circumstances such as a loss of a partner or job (Barlow & Durand, 2015).
Unlike many mental disorders, personality disorders are not episodic in nature but rather
they are chronic and enduring (APA, 2013). Whilst some personality disorders abate in
intensity with age, particularly antisocial and borderline personality disorders, others tend
to be more enduring across the lifespan, notably obsessive-compulsive and schizotypal
personality disorders (APA, 2013).
The most common treatment for personality disorders remains psychotherapy (APA, 2013).
Psychotherapy such as CBT has demonstrated efficacy for many personality disorders, with
specific approaches proving more effective with specific disorders, for example dialectical
behavioural therapy (DBT) with borderline personality disorder (Koerner & Linehan, 2000).
Medications may also be helpful for some personality disorders, particularly in those such
as borderline personality disrorder that involve difficult self-regulating (Barlow & Durand,
2015). The social support offered by family and friends may also be of critical importance in
the treatment of personality disorders given common feelings of isolation associated with
some personality disorders (Barlow & Durand, 2105). Unfortunately many people who have
personality disorders lack insight, they are unaware that their way of relating is responsible
for difficulties, and struggle to make progress in treatment or do not present at all (Barlow


& Durand, 2013).

Schizophrenia
We all rely heavily on our senses and our thoughts to understand, communicate, and
interact with the environment and others. We often take for granted that these factors are
organised in such a way that enables us to function in complex and meaningful ways.
Individuals who experience schizophrenia have difficulty in some or all of the organisation
of their thoughts, senses, speech and even their emotional experience. Schizophrenia is a
complex condition that often has a devastating impact on an individual’s capacity to
function in society. Schizophrenia affects one in every 100 Australians; however the
disorder accounts for approximately 11% of mental health related hospitalisations and is
among the most severely impairing and debilitating health issues (Australian Institute of
Health and Welfare, 2006). Notably, the incidence of schizophrenia is higher for those in an
urban environment (American Psychiatric Association (APA), 2013).

Schizophrenia is characterized by a broad spectrum of symptoms that affect an individual’s
thoughts, emotions and behaviour (APA, 2013). These symptoms can be classified into
distinct categories, positive, negative, and disorganized. Positive symptoms are
distinguished by an excess or distortion of normal experience, and include delusions (rigid
beliefs despite substantial evidence to the contrary) and hallucinations (perceptual
experiences that occur in the absence of an external stimulus). Negative symptoms involve
deficits in normal behaviour such as diminished emotional expression or motivation
(Barlow & Durand, 2013). Disorganized symptoms include illogical speech or erratic
physical movement (APA, 2013). Given the variety and combinations of possible symptoms,
the experience and observable features that constitute schizophrenia vary significantly
from individual to individual.


A number of biological factors have been implicated in the development of schizophrenia,
including genetic predisposition, neurotransmitter imbalances (APA, 2013). Additionally,
environmental and psychological factors such as prenatal viral infection and psychological
stress have also been associated with the development of schizophrenia (APA, 2013).
Important research has also established that relapse may be triggered by family
environments that are hostile and critical (Barlow & Durand, 2015).
The positive symptoms of schizophrenia typically emerge between adolescence and the
early 30s (APA, 2013). Common age at onset varies based on gender, with males most likely
to experience there first psychotic episode in their early-to-mid 20s, and females in their
late-20s (APA, 2013). The onset of symptoms is typically slow, however can be sudden.
Whilst research has failed to establish clear predictors regarding course of an individual’s
schizophrenia, younger age at onset is associated with worse prognosis (APA, 2013). Whilst
only a small number of individuals recover from the illness completely, however many
more can expect positive outlook of some recovery (APA, 2013). Many individuals
experience an episodic chronic course and others experience an insidious, progressively
deteriorating one (APA, 2013).
Typical treatment incorporates psychological social and biological interventions in the form,
psychotherapy, community support and anti-psychotic medication (APA, 2013). Given the
chronicity of the disorder, treatment targets medication adherence and skills to counter
deficits which are aimed at reducing the rate of relapse (APA, 2013). Unfortunately
currently available treatments for schizophrenia rarely result in complete remission and


recovery (APA, 2013). Despite this, combined medication and psychotherapy treatments
have demonstrated efficacy in helping those with schizophrenia to manage their symptoms
and improve overall quality of life and functioning (APA, 2013).

Appendix: Optional additional resources
Depression
Listed below are links to interviews with individuals who are experiencing symptoms of
mood disorders. Whilst watching each interview, try to identify the features of these
disorders, as described above. Pay careful attention to the common symptoms and
consider these case presentations in the context of the biopsychosocial model.
Depression Interview: www.youtube.com/watch?v=4YhpWZCdiZc
Mania Interview: www.youtube.com/watch?v=zA-fqvC02oM
Further Resources:
Beyondblue:
Beyondblue is an independent, not-for-profit organisation working to increase awareness
and understanding of anxiety and depression in Australia and to reduce the associated
stigma.
Phone: 1300 22 4636
www.beyondblue.org.au/the-facts/depression

Lifeline:
Lifeline is a national charity providing all Australians experiencing a personal crisis with
access to 24 hour crisis support and suicide prevention services.
Phone: 13 11 14
www.lifeline.org.au

Suicideline:
SuicideLine is a 24/7 telephone counselling service offering professional support to people
at risk of suicide, people concerned about someone else’s risk of suicide, and people
bereaved by suicide.


Phone: 1300 651 251

www.suicideline.org.au/

References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Barlow, D. H., & Durand, V. M. (2015). Abnormal psychology: An integrative approach (7th
ed.). Stamford, CT: Cengage Learning.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY:
Guilford Press
Slade, T., Johnston, A., Browne, M. A. O., Andrews, G., & Whiteford, H. (2009). 2007 National
survey of mental health and wellbeing: Methods and key findings. Australian and New
Zealand Journal of Psychiatry, 43, 594-605 DOI: 10.1080/00048670902970882

Anxiety
Anxiety Interview: www.youtube.com/watch?v=Ii2FHbtVJzc

Further Resources:
Beyondblue:
Beyondblue is an independent, not-for-profit organisation working to increase awareness
and understanding of anxiety and depression in Australia and to reduce the associated
stigma.
Phone: 1300 22 4636
www.beyondblue.org.au/the-facts/anxiety

Anxiety Disorders Association of Victoria:
The Anxiety Disorders Association of Victoria is a not-for-profit, self-funded organisation.
We provide support, information and resources to individuals suffering from or affected by
anxiety, depression, and related issues.
Phone: (03) 9853 8089
www.adavic.org.au

Anxiety Recovery Centre Victoria:


The Anxiety Recovery Centre Victoria (ARCVic) is a state-wide, specialist mental health
organisation, providing support, recovery and educational services to people and families
living with anxiety disorders.
Phone: 1300 269 438
www.arcvic.org.au
References:
Harris, R. (2006). Embracing your demons: An overview of acceptance and commitment
therapy. Psychotherapy in Australia, 12(4), 2-8.

Substance Use
Further Information:
Below is a link to a confidential self-assessment alcohol and substance misuse screening
tool that provides those concerned about their own, or someone else’s substance use with
general feedback. The tool also offers information to professionals who may be seeking
general information.
Substance Screening: www.turningpoint.org.au/Treatment/Online-Self-Assessment.aspx

Further Resources:
Turning Point
Turning Point provides specialist treatment and support services to people affected by
drugs including heroin, alcohol, amphetamines and cannabis.
Phone: 1800 812 804
www.turningpoint.org.au

Direct Line


DirectLine provides free, anonymous and confidential 24-hour, 7-day counselling,

information and referral services for alcohol and drug-related matters.
DirectLine is Phone: 1800 888 236
http://www.health.vic.gov.au/aod/directline.htm

References
Personality disorders
Further Information:
Below is a link to an interview with an individual who is experiencing several symptoms of a
personality disorder. Whilst watching the interview, try to identify the features of
personality disorders, as described above. Pay careful attention to the common symptoms
and consider the case presentation in the context of the biopsychosocial model.
Personality Disorders Interview: www.youtube.com/watch?v=824H2W-h5Kg

Further Resources:
Spectrum:
Spectrum is a statewide service in Victoria that supports and works with local Area Mental
Health Services to provide treatment for people with personality disorder. Spectrum
focuses on those who are at risk from serious self-harm or suicide and who have
particularly complex needs.
Phone: (03) 8833 3050
www.spectrumbpd.com.au

References



Duncan, S. C., Duncan, T. E., & Strycker, L. A. (2006). Alcohol use from ages 9 to 16: A
cohort-sequential latent growth model. Drug and Alcohol Dependence, 81(1), 71-81.
doi:http://dx.doi.org/10.1016/j.drugalcdep.2005.06.001
Koerner, K., & Linehan, M. M. (2000). Research on dialectical behavior therapy for patients
with borderline personality disorder. Psychiatric Clinics of North America, 23(1), 151-167.
Lenzenweger, M., Lane, M., Loranger, A., & Kessler, R. (2007). DSM-IV personality disorders
in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6), 553–564
Schizophrenia
Further Resources:
Early Psychosis Prevention and Intervention Centre (EPPIC):
The Early Psychosis Prevention and Intervention Centre (EPPIC) is an integrated and
comprehensive mental health service aimed at addressing the needs of people aged 15-24
with a first episode of psychosis in the western and north-western regions of Melbourne.
Phone: (03) 9342 2800
www.eppic.org.au

Schizophrenia Research Institute:
The Schizophrenia Research Institute’s mission is to discover the ways to understand,
better treat, prevent and cure schizophrenia.
Phone: (02) 9295 8688
www.schizophreniaresearch.org.au/

References
Australian Institute of Health and Welfare. (2006). Australia’s health 2006: The tenth
biennial health report of the Australian institute of health and welfare. Australian Institute
of Health and Welfare, Canberra.


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PUBH1382​ ​Australian​ ​Health​ ​Care​ ​System

Appendix:​ ​Optional​ ​additional​ ​resources

1. Relevance​ ​of​ ​mental​ ​health​ ​to​ ​allied​ ​health​ ​practice

2. Roles,​ ​responsibilities​ ​and​ ​limitations​ ​of​ ​practice

3. Mental​ ​health​ ​concepts​ ​and​ ​classifications

Signs​ ​vs​ ​symptoms

The​ ​concept​ ​of​ ​normal

·​​ ​ ​ ​ ​ ​ ​the​ ​reality​ ​of​ ​poverty​ ​[through​ ​loss​ ​of​ ​income]

·​​ ​ ​ ​ ​ ​ ​the​ ​loss​ ​of​ ​housing​ ​[controlled​ ​by​ ​landlords],​ ​and

Classification​ ​of​ ​disorders

excessive​ ​fear,​ ​worry,​ ​catastrophizing,​ ​or​ ​obsessive​ ​thinking

hot​ ​and​ ​cold​ ​flushes

tightening​ ​of​ ​the​ ​chest

feeling​ ​tense,​ ​wound​ ​up​ ​and​ ​edgy

5.​ ​Types​ ​of​ ​psychological​ ​disorders

behaviour​ ​and​ ​cognition​ ​(APA,​ ​2013).

Substance​ ​use​ ​disorders

&​ ​Durand,​ ​2013).

Appendix:​ ​Optional​ ​additional​ ​resources

Depression​ ​Interview:​ ​www.youtube.com/watch?v=4YhpWZCdiZc

Mania​ ​Interview:​ ​www.youtube.com/watch?v=zA-fqvC02oM

Phone:​ ​1300​ ​651​ ​251

Anxiety​ ​Interview:​ ​www.youtube.com/watch?v=Ii2FHbtVJzc

DirectLine​ ​provides​ ​free,​ ​anonymous​ ​and​ ​confidential​ ​24-hour,​ ​7-day​ ​counselling,

ed.).​ ​Stamford,​ ​CT:​ ​Cengage​ ​Learning.

S-ar putea să vă placă și

PUBH1382 Australian Health Care System

Appendix: Optional additional resources

1. Relevance of mental health to allied health practice

2. Roles, responsibilities and limitations of practice

3. Mental health concepts and classifications

Signs vs symptoms

The concept of normal

· the reality of poverty [through loss of income]

· the loss of housing [controlled by landlords], and

Classification of disorders

excessive fear, worry, catastrophizing, or obsessive thinking

hot and cold flushes

tightening of the chest

feeling tense, wound up and edgy

5. Types of psychological disorders

behaviour and cognition (APA, 2013).

Substance use disorders

& Durand, 2013).

Appendix: Optional additional resources

Depression Interview: www.youtube.com/watch?v=4YhpWZCdiZc

Mania Interview: www.youtube.com/watch?v=zA-fqvC02oM

Phone: 1300 651 251

Anxiety Interview: www.youtube.com/watch?v=Ii2FHbtVJzc

DirectLine provides free, anonymous and confidential 24-hour, 7-day counselling,

ed.). Stamford, CT: Cengage Learning.