Mental disorder

The classification of mental disorders is a complex and important issue ^[10] . The basic principles for the classification of mental disorders include ^[10] :

• the syndromological principle based on the concept of “single psychosis ”,
• the nosological principle, on the basis of which the diseases are divided according to a common etiology, pathogenesis and similarity of the clinical picture,
• the pragmatic (statistical) principle that has become relevant in connection with the development of national and international health organizations.

International Classification of Disease Classification

Mental and behavioral disorders are described in section V of the International Classification of Diseases of the 10th revision , developed by the World Health Organization (in Russia this classification has been adopted since 1997):

• 1.1 F00 — F09 - Organic, including symptomatic mental disorders
• 1.2 F10 — F19 - Mental and behavioral disorders associated with substance use
• 1.3 F20 — F29 - Schizophrenia, schizotypal and delusional disorders
• 1.4 F30 — F39 - Mood disorders (affective disorders)
• 1.5 F40 — F48 - Neurotic, stress-related and somatoform disorders
• 1.6 F50 — F59 — Behavioral syndromes associated with physiological disturbances and physical factors
• 1.7 F60 — F69 - Mature personality and behavioral disorders
• 1.8 F70 — F79 - Mental retardation
• 1.9 F80 — F89 - Mental developmental disorders
• 1.10 F90 — F98 - Emotional and behavioral disorders that usually begin in childhood and adolescence
• 1.11 F99 - Mental disorder without further elaboration

In developing this classification, another well-known system prepared by the American Psychiatric Association , “ Diagnostic and Statistical Manual of Mental Disorders, ” which sets standard criteria for diagnosis, was used ^[11] .

Ideas of what is and what is not a mental disorder change with the development of science. For example, a couple of decades ago, social phobia was not considered a mental disorder, and people who suffered from this ailment were considered simply particularly shy . Conversely, several decades ago, homosexuality was considered a mental disorder requiring treatment, and according to the modern ICD-10 , sexual orientation itself is not considered a disorder: only the psychological problems that may arise in connection with it are classified as diseases.

Other classifications of mental disorders

According to the etiological principle, mental disorders can be divided into two types ^[10] :

1. Exogenous types of mental disorders. Causal factors are directed from the outside, for example: alcohol, industrial poisons, narcotic substances, toxic substances, radiation, viruses, microbes, head injuries, psycho-injuries.

   A subspecies of exogenous disorders is psychogenic diseases arising in connection with “emotional stress, family and social problems”.

2. Endogenous types of mental disorders. Causal factors are internal. Example: chromosomal aberrations (abnormalities), gene diseases, diseases with a hereditary predisposition (arise from an injured gene and can be transmitted through several generations).

According to the severity and nature of the disorder, mental disorders can range from “mild disorders” to “life-threatening” ^[12] .

In Law

In jurisprudence, mental disorder is defined as a more precise term introduced in the Criminal Code of the Russian Federation instead of the outdated concept of mental illness ; includes temporary mental disorder, chronic mental disorder (disease), dementia , as well as other painful conditions (Article 21 of the Criminal Code of the Russian Federation). The presence of a mental disorder is a medical criterion that, along with the legal one (inability to recognize the significance of their actions or to manage them) determines the state of insanity in a person .

Jurisprudence refers to a chronic mental disorder as a long-lasting mental disorder, which can, however, proceed paroxysmally (that is, with an improvement or worsening of the mental state), but leave behind a persistent mental defect . Such mental diseases include: schizophrenia , epilepsy , progressive paralysis , paranoia , manic-depressive psychosis and other mental illnesses .

Under the temporary mental disorder, jurisprudence refers to mental illness that lasts relatively short and ends in recovery. These include: pathological intoxication ( delirium tremens ), reactive symptomatic conditions, that is, mental disorders caused by severe mental disturbances and feelings .

In Psychiatry and Psychopathology

In psychiatry and psychopathology, they are repelled by ICD-10 , and they mean by the term the clinically defined group of symptoms or behavioral symptoms listed in it that usually cause suffering and interfere with the functioning of the person ^[13] .

We can distinguish: organic mental disorders (that is, caused by organic disorders), personality disorders, behavioral disorders , emotional (affective) disorders , disorders associated (caused) by the use of psychoactive substances , post-traumatic stress disorder and others. Some of these groups may intersect.

In clinical psychology and pathopsychology

In pathopsychology (a section of clinical psychology ), in the systematization of mental disorders, they primarily take into account how the course (structure) of the mental processes themselves, certain components of brain activity, its links and factors, the loss of which is the cause of the formation of symptoms observed in the clinic, are disturbed ^{[14 ]} .

The main method of differential diagnosis in pathopsychology is the pathopsychological experiment , in the diagnostic conclusions of which the pathopsychologist can operate with a set of pathopsychological register syndromes .

In Psychology

Psychology generally uses this term to describe any state of the psyche other than healthy . Accordingly, the criteria for the presence of a mental disorder in this broad sense are the criteria that are inverse to the criteria for mental health , that is, any of the following:

• violation of the sense of continuity, constancy and identity of one’s physical and mental “ I ”;
• lack of a sense of constancy and identity of experiences in similar situations;
• uncriticality to oneself and one's own psychic production (activity) and its results;
• the mismatch of mental reactions (adequacy) to the strength and frequency of environmental influences, social circumstances and situations;
• the inability of self-management to conduct in accordance with social norms, rules, laws;
• inability to plan their own life and implement these plans;
• inability to change the way of behavior depending on changing life situations and circumstances.

The main signs of a mental or behavioral disorder, WHO experts call “disturbances in thinking, mood or behavior that go beyond existing cultural beliefs and norms” ^[7] , that is, psychological discomfort, deviation from the usual ability to perform work or training, “increase the risk of death , suffering or disruption ” ^[15] .

Patients with mental disorders may experience various physical, emotional, cognitive, behavioral, and perceptual symptoms ^[7] . For example:

• in terms of emotions, a person can feel particularly miserable and disproportionate to the events unhappy / “super-happy” or vice versa not have any adequate feelings ^[16] ,
• in thinking with a mental disorder, logical relationships of thoughts may be violated, extremely positive or immeasurably negative judgments about others and about oneself may appear, the ability of a critical assessment may be lost ^[17] ,
• in human behavior, the symptoms of mental disorders are expressed in the form of deviations from accepted in society forms of behavior ( sexual perversion , the commission of meaningless movements, obsessive actions, etc.) ^[18] .

In the diagnosis, the presence / absence of a somatic disease in a patient is checked first of all ^[15] . Indirect signs such as the absence of pathology of the internal organs or the difference between the clinic of the disease and the manifestation of somatic diseases indicate a possible mental disorder in the patient ^[15] .

For screening and preliminary diagnosis of various mental disorders, special diagnostic tests are used ^[19] .

The use of the term mental disorder should not be overly broad ^[20] . According to ICD-10, “isolated social deviations or conflicts without personality dysfunction should not be included in the group of mental disorders” ^{[2] [20]} .

Persons suffering from mental and behavioral disorders are observed in neuropsychiatric dispensaries .

The causes of many mental disorders are not fully understood ^[7] . Experts talk about the impact of a combination of biological, psychological and social factors (from heredity to stressful events) on the occurrence of mental illness ^[7] .

Resistance to mental disorders depends on the physical characteristics of the individual and his general mental development ^[21] . Different people react differently to mental suffering and problems: while some people easily recover from failures, others develop psychological disorders ^[21] .

The treatment of mental disorders is carried out by psychotherapeutic or drug and other somatic methods.

Psychotherapy includes various psychological methods that help with both mental and physical problems, for example, conducting conversations or performing exercises ^[22] . The main goals when using psychotherapy are to alleviate the suffering experienced by a person in the form of fears, depression, obsessive thoughts, sexual problems, etc., and to help get rid of adverse character traits and behaviors ^[23] .

Psychotherapy can be carried out both individually and in groups, families, and includes the following basic methods ^[24] :

• supportive psychotherapy (conversations);
• deep psychological therapy;
• behavioral psychotherapy .

Somatic treatment, especially the use of drugs, is used by psychiatrists to influence the well-being and behavior of people with mental disorders, to alleviate their suffering ^[25] . The use of drugs began after two French psychiatrists in the early 50s of the 20th century used chlorpromazine for the treatment of mentally ill patients ^[25] . After this, various antipsychotic drugs began to appear, thereby expanding the therapeutic arsenal ^[26] .

Somatic forms of treatment are used for most complex mental disorders, although their mechanism of action is not fully understood ^[27] . In addition, the use of medications often gives only the removal of symptoms of a mental illness, but not its cause, therefore, for example, severe psychotic symptoms may return after stopping the medication ^[28] .

Mental disorders, even in severe form, in principle, can be cured ^[5] . Often, the difficulty is that people tend to deny the presence of a mental illness due to fear of it or because of a lack of understanding of the essence of the disease in society ^[5] .

According to the World Health Organization, one in four to five people in the world suffers from one or another mental or behavioral disorder ^[29] . According to various sources, 10-50% of therapists' patients have mental disorders ^[30] , and the following prevalence of diseases among the entire population is called ^[15] :

• depression - 9-20%
• recurrent depressive disorder - 5-11%
• adaptation disorder - 0.5-2.5%
• dysthymia - 2-6%
• anxiety disorder - 5-10%
• panic disorder - 1.5-4%
• somatoform disorders - 1-4%
• addiction to alcohol - 7-8%

Manifestations of mental disorders bear the imprint of the socio-cultural environment in which the person was brought up. Therefore, the same mental disorder in different societies and cultures can manifest itself in different ways. In cultural and social strata, where mental disorders do not find understanding and support from others, the somatization of these disorders or their somatic orientation increases. For example, in China, major depression is more often somatized (patients complain of an upset internal organs), and in America and Europe it is more often characterized as apathy , loss of energy and emotions .

Common Forms

Mental disorders associated with fear are one of the most common forms of mental illness that one fifth of all people suffer throughout their lives ^[31] . Such disorders include generalized fear, panic disorders, various phobias , obsessions, stress disorders. Fear is not always a manifestation of the disease, and in most cases it is a normal reaction to danger, but often fear can become a symptom that indicates, for example, affective or sexual disorders ^[32] .

7% of women and 3% of men of all ages are annually diagnosed with depression , which in most people only happens once in a lifetime, rarely turning into a chronic disorder ^[33] . Depression can be cured, although it is often one of the most complex mental illnesses ^[33] .

Other common mental disorders in adults include:

• addiction to alcohol and psychoactive substances ,
• eating disorders: anorexia , bulimia , obesity ,
• sexual problems
• sleep disorder : insomnia , hypersomnia ,
• personality disorders
• schizophrenia
• Alzheimer's disease .

Most of the mental disorders in adults occur in childhood. According to various estimates, from 12 to 20 percent of all children (under 18) have mental disorders ^[33] . The main difficulties children face are divided into three main categories ^[34] :

• developmental disorders - children lag behind their peers in the development of various skills, experiencing emotional and behavioral difficulties in this regard,
• emotional disorders associated with affects and severely traumatized feelings,
• expansive behavioral disorders, expressed in the deviation of the child’s behavior from social norms or in the manifestation of hyperactivity .

• Mental defect
• Presumption of mental health

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• Belyalov F.I. Mental disorders in the practice of the therapist . - Irkutsk: RIO IGMAPO, 2013 .-- 327 p. - ISBN 978-5589786-088-3.
• Spasennikov B. A., Spasennikov S. B. Mental disorders and their criminal law significance. - Moscow: Yurlitinform , 2011 .-- 270 p. - 1000 copies. - ISBN 978-5-93295-835-3 .
• Tiganov A.S. , Snezhnevsky A.V. , et al. Guidelines for Psychiatry / Ed. Academician of the RAMS A.S. Tiganov. - M .: Medicine , 1999. - T. in 2 volumes.
• Kuperman V. B., Zislin I. M. Simulation of psychosis: semiotics of behavior // Russian literature and medicine. Body, regulations, social practice. Collection of articles / Edited by K. A. Bogdanov , Yu. Murashov, R. Nikolozi. - Moscow: New Publishing House , 2006. - S. 290-302. - 304 p. - (New materials and research on the history of Russian culture). - ISBN 5-98379-049-8 .
• Mental illnesses // Brockhaus and Efron Encyclopedic Dictionary : in 86 volumes (82 volumes and 4 additional). - SPb. , 1890-1907.
• Evtushenko V.Ya. The Law of the Russian Federation “On Psychiatric Care and Guarantees of the Rights of Citizens in its Delivery” in questions and answers / Editor-in-Chief Professor V.S. Hawks. - Moscow: Publishing House of CJSC Justicinform, 2009. - 302 p. - ISBN 978-5-9977-0001-0 .
• Pukhovskiy N.N. Therapy for Mental Disorders, or Other Psychiatry: A Study Guide for Higher Education Students. - Moscow : Academic project , 2003 . - 240 p. - (Gaudeamus). - ISBN 5-8291-0224-2 .

• Mental illness - an article from the Great Soviet Encyclopedia .