Mental illness

Mental disorder can be defines as an illness with psychological or behavioural manifestation and impairment in functioning due to social, genetic, physical or biological disturbances.

Put differently, mental disorder is the condition which arises from the adverse effect of poor mental health. There are two types of mental disorder:

1. Mental sub normality
2. Mental illness/disease

Mental sub-normality: mental sub-normality is a condition which gives rise to arrested or incomplete development of the mind. It can due to genetic or congenital abnormalities e.g.  abnormal chromosome as in the case of down syndrome or mongolism, infection such as rubella / German measles or syphilis, drugs during pregnancy which can be damage the developing brain in-utero or brain injury other causes are, anoxia or prematurity endocrine problems e.g. cretinism the condition may first be recognised by the parents who may first be recognised by the parents who may observe that the child is not developing intellectually like other children or that the behaviour is abnormal mild types of mental sub-normal may be detected by the results of intelligences tests (IQ tests) which will show that the child IQ is lower than that of his age group  ( mental age is lower than chronological age) and by observation of general behaviour of the child which may show that the child is slow to responds to environmental stimuli such as clapping of hands. Rehabilitation is aimed at helping the family to cope with the care of the child, protecting the society from the harm which some of the extreme cases can cause e.g. giving these children suitable training and treatment to control the sub-normal behaviour and to help them to live an independent behaviour and to help them to live an independent life as much as possible. In severe cases the child may be dependent on the family or the society forever. In general, a child is categorised as having, mental sub-normality if the IQ  is 70 and below.

The illness is characterized by symptoms evident of specific disturbance of function such as perception memory, learning emotion as well as general efficiency of individual it can precipitate major or several disorder.

Prenatal, perinatal and postnatal factors  

Prenatal are the events that occur during the 9 months period of pregnancy peri-natal event are those which occur the very time baby is being born. Postnatal events happen after delivery till 6 weeks. Examples of such event are:

1. Heredity or genetic
2. Drugs taking by woman.
3. Prolonged labour.
4. Use of multiple drugs or instrument
5. Infection, which in several cases lead to septicaemia.

Biological, psychological and socio- cultural factors

Biological factors

1. Heredity and genetic causes
2. Trauma or injury to head
3. Infections like meningitis cerebral malarial severe pneumonia, and infective hepatitis
4. Toxic substances
5. Drug abuse
6. Deficiency of essential food items (amino acids, vitamins etc.)

Psychological factors

Psychological factors are causes where one is being confronted with a situation which is new and for which one has no capacity to handle or which one finds difficult to adopt as new way of life. Those are

1. Stress
2. Crises
3. Conflict both at work or home
4. Maternal and or / or paternal deprivation
5. Social deprivation

Socio – cultural factors

Socio cultural factors are those occurrences in the community stemming from the culture of the people this include:

1. Taboos related to food
2. Taboos related to sex
3. Expression of aggression in the community e.g. religion, political or traditional.

Apart from the aforementioned causes there are some disorders. Some of them are:

1. Demon
2. Unappeased gods
3. Magic affection
4. Eating of forbidden food
5. Results of abomination
6. Synonymous with appearance of new moon
7. Contagious disease
8. Giving of injection in cases of High fever

As a primary health care provider, we should not totally discountenance these beliefs but try to let them know the real aetiology of the disorders

Classification of mental illness

Mental disorder may be classified into two bread headings namely:

1. Major mental disorders which is also called psychoses
2. Minor mental disorder or psychoneurosis

Major mental disorders

The major mental disorder can be sub-divider into:

•  Organic psychosis having bio-physiological origin with brain is impaired either by lesion tumour, infection or toxins.

Examples are:

• Epilepsy
• Intoxication with barbiturates, amphetamine, phenobarbitone, India hemp, alcohol etc.
• Senile dementia
• Functional psychoses occurring without brain disease or impairment. All that occurs is a change in the behaviour and action of the victims.

Examples are:

• Mania
• Depression
• Manic-depression psychosis
• Schizophrenia, which carries about 2/3 of all

Minor mental disorders

The minor mental disorder as the name implies is a form of disorder, which can be managed in general hospitals without necessary the psychiatric hospital at time the disorder can aggravate from minor to major depending on their intensity in the victims they are:

• Anxiety neurosis
• Hysterical neurosis
• Obessional neurosis
• Phobia
• Depressive neurosis

Different between neurosis and psychoses

Assessment of the patient mental state

This can be done through observation and conversation as it helps with the total evaluation of cases and individual. The following areas are noted:

1. Appearance: If appearance is neglected and patient look rough ragged and dirty this is a real sign of illness
2. Mood: Whether there is deviation from normal e.g. patient is mute, hilarious yelling crying or excited when not expected.
3. Orientation: Whether is aware of the happening in his environment i.e. if he is disorientated to time, person, place or things
4. Manners and attitude: The CHW observe and note the patients reaction to admission, how he expresses himself or herself. Whether sad or happy.
5. Hallucination: Whether patient talk to himself or herself, whether he her responses to a hallucinatory command or if he or she misidentifies objects.
6. Delusion: Note whether patient expresses any imaginary ideas e.g. am the king of Nigeria
7. Memory: During observation note whether the memory of the patient is faulty either for recent event or for remote events.
8. Judgement and insight: This is through interaction and interviewing. The statement made by the patient may have no sufficient realistic understanding e.g. am getting better because i am not having mental illness
9. The intelligence: This is the special area of the psychologist, but the health workers observation is of value. Note the intelligence of the patient, whether it decreases gradually.
10. Speech: During history taking or during contact with the patient, one can observe the change in the speech of the patient which can also be pointer in the diagnosis of a mental illness e.g.

• Speech in depression is dull and full of pity
• Speech in mania is rapid and witty.

All these variables are to be taken cognisance of while investigating and evaluating the progress of total recovery or improvement of patient’s condition reaction his total reaction to the new environment and situation as the interviewing is in progress should be noted.