Similar to previous chapters, this chapter examines disorders that result when an individual has a maladaptive response to his or her environment (internal or external). (See Chapter 11 for an explanation of the anatomy and physiology of the brain and nervous system.) However, even though some mental illnesses have organic causes in which neurotransmitters and other known brain functions play a role, there is no mental “anatomy” per se. Instead, behavioral health is a complex interaction among an individual’s emotional, physical, mental, and behavioral processes in an environment that includes cultural and spiritual influences.

Mental health may be defined as a relative state of mind in which a person who is healthy is able to cope with and adjust to the recurrent stresses of everyday living in a culturally acceptable way. Thus mental illness may be generally defined as a functional impairment that substantially interferes with or limits one or more major life activities for a significant duration.

Pathology

Fig. 12-1 A, This drawing by a patient with schizophrenia demonstrates thought disorder. B, Drawing by a delusional patient with schizophrenia.

Fig. 12-2 The perception of body shape and size can be evaluated with the use of special computer drawing programs that allow a subject to distort (increase or decrease) the width of an actual picture of a person’s body by as much as 20%. Subjects with anorexia consistently adjusted their own body picture to a size 20% larger than its true form, which suggests that they have a major problem with the perception of self-image.

Affect is observable demonstration of emotion that can be described in terms of quality, range, and appropriateness. The following list defines the most significant types of affect encountered in behavioral health:

• Blunted: moderately reduced range of affect.

• Flat: the diminishment or loss of emotional expression sometimes observed in schizophrenia, mental retardation, and some depressive disorders.

• Labile: multiple, abrupt changes in affect seen in certain types of schizophrenia and bipolar disorder.

• Full/wide range of affect: generally appropriate emotional response.

Term	Word Origin	Definition
amnesia		Inability to remember either isolated parts of the past or one’s entire past; may be caused by brain damage or severe emotional trauma.
anhedonia	an- no, not, without hedon/o pleasure -ia condition	Absence of the ability to experience either pleasure or joy, even in the face of causative events.
confabulation		Effort to conceal a gap in memory by fabricating detailed, often believable stories. Associated with alcohol abuse.
dyscalculia	dys- difficult calcul/o stone -ia condition	Difficulty with performing mathematical calculations.
dysphoria	dys- abnormal phor/o to carry, to bear -ia condition	Generalized negative mood characterized by depression.
echolalia	echo- reverberation -lalia condition of babbling	Repetition of words or phrases spoken by others.
euphoria	eu- good, well phor/o to carry, to bear -ia condition	Exaggerated sense of physical and emotional well-being not based on reality, disproportionate to the cause, or inappropriate to the situation.
hallucination		Any unreal sensory perception that occurs with no external cause.
hyperkinesis	hyper- excessive -kinesis movement	Excessive movement and activity.
stupor		From the Latin term for “numbness,” a stupor is a state of near unconsciousness.

Build the following terms.

8. condition of without pleasure ____________________________________________________________________

9. excessive movement _____________________________________________________________________________

Term	Word Origin	Definition
dementia	de- down, lack of ment/o mind -ia condition	Lack of normal mental functioning due to injury or disease. May include changes to personality as well as memory and reasoning.

An individual is considered an “abuser” if he or she uses substances in ways that threaten health or impair social or economic functioning. The term harmful use indicates a pattern of drug use that causes damage to health. If the term tolerance is used to describe someone’s usage, it means a state in which the body becomes accustomed to the substances ingested; hence the user requires greater amounts to create the desired effect. Individuals who exhibit a lessening or disappearance of a disease or disorder are said to be in remission. ICD-10-CM uses “in remission” codes instead of “history” codes.

Term	Word Origin	Definition
delirium tremens (DTs)		Acute and sometimes fatal delirium induced by the cessation of ingesting excessive amounts of alcohol over a long period.
dependence		Difficulty in controlling use of a drug.
intoxication	in- in toxic/o poison -ation process of	Episode of behavioral disturbance following ingestion of alcohol or psychotropic drugs. ICD-10-CM provides a code for blood alcohol level.
withdrawal state		Group of symptoms that occur during cessation of the use of a regularly taken drug.

Term	Word Origin	Definition
catatonia	cata- down ton/o tension -ia condition	Paralysis or immobility from psychological or emotional, rather than physical, causes.
catatonic schizophrenia	cata- down ton/o tension -ic pertaining to schiz/o split phren/o mind -ia condition	Also called schizophrenic catalepsy. This form of schizophrenia is dominated by prominent psychomotor disturbances that may alternate between extremes, such as hyperkinesis and stupor, and may be accompanied by a dreamlike (oneiric) state and hallucinations.
delirium		Condition of confused, unfocused, irrational agitation. In mental disorders, agitation and confusion may also be accompanied by a more intense disorientation, incoherence, or fear, and illusions, hallucinations, and delusions.
hebephrenia	hebe goddess of youth phren/o mind -ia condition	Although more often referred to as disorganized schizophrenia, hebephrenia was named for its original association with initial occurrence at the time of puberty. It is characterized by prominent affective changes, fleeting and fragmentary delusions and hallucinations, and irresponsible and unpredictable behaviors. Shallow, inappropriate mood, flighty thoughts, social isolation, and incoherent speech are also present.
oneirism	oneir/o dream -ism state	A state of a dreamlike hallucination.
paranoia	para- abnormal -noia condition of the mind	A type of delusional disorder, paranoia includes the inaccurate perception of suspicious thinking. Also called delusional disorder, or late paraphrenia.
psychosis	psych/o mind -osis abnormal condition	Disassociation with or impaired perception of reality; may be accompanied by hallucinations, delusions, incoherence, akathisia (the inability to sit still), and/or disorganized behavior.
schizophrenia	schiz/o split phren/o mind -ia condition	A group of disorders characterized by fundamental distortions of thinking and perception, coupled with affect that is inappropriate or blunted. The patient exhibits characteristic inability to recognize an appropriate perception of reality, although his/her intellectual capacity is usually intact (Fig. 12-1).
schizotypal disorder		Unlike the other forms of schizophrenia, patient exhibits anhedonia, eccentric behavior, cold affect, and social isolation. Also called borderline schizophrenia, latent schizophrenia and prodromal schizophrenia.

Term	Word Origin	Definition
bipolar disorder (BP, BD)	bi- two pol/o pole -ar pertaining to	Disorder characterized by swings between an elevation of mood, increased energy and activity (hypomania and mania), and a lowering of mood and decreased energy and activity (depression).
cyclothymia	cycl/o recurring -thymia condition of the mind	Disorder characterized by recurring episodes of mild elation and depression that are not severe enough to warrant a diagnosis of bipolar disorder.
dysthymia	dys- difficult -thymia condition of the mind	Mild, chronic depression of mood that lasts for years but is not severe enough to justify a diagnosis of depression. Euthymia is a normal range of moods and emotions.
major depressive disorder		Depression typically characterized by its degree (minimal, moderate, severe) or number of occurrences (single or recurrent, persistent). Patient exhibits dysphoria, reduction of energy, and decrease in activity. Symptoms include anhedonia, lack of ability to concentrate, and fatigue. Patient may experience parasomnias (abnormal sleep patterns), diminished appetite, and loss of self-esteem. SAD (seasonal affective disorder) is caused by decreased exposure to sunlight in autumn and winter.
mania	mania from the Greek term for “madness”	A state of an unstable, inappropriate mood.

Exercise 2:

Mental and Behavioral Disorders due to Known Physiological Conditions; Psychoactive Substance Use; Schizophrenia, Schizotypal, Delusional, and Other Non-Mood Psychotic Disorders; and Mood Disorders

Match the terms with their definitions.

A acute delirium induced by cessation of ingesting excessive amounts of alcohol over an extended period.

B state of unstable, inappropriate mood

C disorganized schizophrenia

D difficulty in controlling drug use

E group of symptoms that occur during cessation of the use of a regularly ingested drug

F episode of behavioral disturbance following ingestion of alcohol or psychotropic drugs

G disorder characterized by swings between elevation and lowering mood, energy and activity

H mild, chronic depression of mood that lasts for years

I form of schizophrenia dominated by prominent psychomotor disturbances that may alternate between extremes

J depression characterized by its degree or number of occurrences

K the lessening or disappearance of a disease/disorder

L form of schizophrenia in which patient exhibits anhedonia, cold affect, and social isolation

M pattern of drug use that damages health

N state in which the body becomes accustomed to ingested substances.

O paralysis/immobility caused by psychological causes

P condition of confused, irrational agitation

Decode the terms.

17. schizophrenia __________________________________________________________________________________

18. paranoia _______________________________________________________________________________________

19. psychosis ______________________________________________________________________________________

20. cyclothymia ____________________________________________________________________________________

21. oneirism _______________________________________________________________________________________

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Term	Word Origin	Definition
acrophobia	acro- heights, extremes -phobia condition of fear, sensitivity	Fear of heights.
agoraphobia	agora- marketplace -phobia condition of fear, sensitivity	Fear of leaving home and entering crowded spaces.
androphobia	andr/o man, men -phobia condition of fear, sensitivity	Fear of men.
anthropophobia	anthrop/o man -phobia condition of fear, sensitivity	Fear of scrutiny by other people; also called social phobia.
anxiety		Anticipation of impending danger and dread accompanied by restlessness, tension, tachycardia, and breathing difficulty not associated with an apparent stimulus.
claustrophobia	claustr/o a closing -phobia condition of fear, sensitivity	Fear of enclosed spaces.
delusion		Persistent belief in a demonstrable untruth or a provable, inaccurate perception despite clear evidence to the contrary.
dissociative identity disorder		Maladaptive coping with severe stress by developing one or more separate personalities. A less severe form, dissociative disorder or dissociative reaction, results in identity confusion accompanied by amnesia, oneirism, and somnambulism. Formerly termed multiple personality disorder.
dyslexia	dys- difficult lex/o word -ia condition	Inability or difficulty with reading and/or writing.
generalized anxiety disorder (GAD)		Anxiety disorder characterized by excessive, uncontrollable, and often irrational worry about everyday things that is disproportionate to the actual source of worry.
gynephobia	gyn/e female, women -phobia condition of fear, sensitivity	Fear of women.
illusion		Inaccurate sensory perception based on a real stimulus; examples include mirages and interpreting music or wind as voices.
obsessive-compulsive disorder (OCD)		Disorder characterized by recurrent, distressing, and unavoidable preoccupations or irresistible drives to perform specific rituals (e.g., constantly checking locks, excessive handwashing) that the patient feels will prevent some harmful event.
panic disorder (PD)		Anxiety disorder characterized by recurring, severe panic attacks. Common symptoms of an attack include rapid heartbeat, perspiration, dizziness, dyspnea, uncontrollable fear, and hyperventilation.