Clarifying misconception about mental disorders: Part II

Last week, we started the discussion of clarifying common misconceptions about mental disorders. We explained that they often occur as a result of chemical abnormalities in the brain, and covered the three domains of risk factors for mental disorders as biological, psychological and social risk factors.

Additionally, we clarified that these risk factors are similar to risk factors for hypertension or diabetes which are not absolute. Someone with a family history of hypertension or diabetes may not develop the condition while some people with no previous family history will go on to develop it. And I summarised that the risk factors for mental illness work in exactly similar fashion.

We also highlighted the fact that treatment interventions follow the same outline, with bio-psycho-social approaches combined for the best outcomes. Breaking this down further, biological treatments may include the use of medications, psychological interventions may include the use of psychotherapies and social interventions such as prevention of school bullying are also important.

Lastly, we affirmed that mental illnesses are medical conditions that can be successfully managed and treated in hospitals, even though we clarified that they are usually chronic conditions that require long-term use of medications and frequent clinic follow up appointments…..just like what obtains for hypertension and diabetes.

We continue the narration this week, with explanations about how common mental disorders are, the common types and how substance abuse leads to mental health problems.

How common are mental disorders?

Mental disorders are very common, affecting one in every four persons at some point in their lifetime (lifetime prevalence of 25 per cent); whereas, at any given point in time, one in every 10 persons (point prevalence of 10 per cent) would be suffering from a mental disorder. These are global figures as established by the World Health Organisation (WHO).

What this translates into, with Nigeria’s estimated population of 180 million people, is that at any point in time, as many as 18 million Nigerians may be suffering from a mental disorder. And that as many as 45 million Nigerians may be at risk of developing a mental disorder at some point in their lifetime. Thus, we can safely conclude that mental disorders are very common.

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Furthermore, the prevalence is rising over time, as we become increasingly more isolated, socially disconnected and lack access to close, confiding relationships in our complex world.

What are the common mental disorders?

The commonest mental disorders are depression and anxiety disorders. Others, though less common include psychotic disorders and substance use disorders. A common misconception is to imagine that mental disorder means ‘madness’ where the affected individual is roaming the streets, and wearing dirty rags.

But this is just a small fragment of mental disorders, usually seen in psychotic illnesses, and even in those scenarios, they will get well and return back to normal functioning with treatment and rehabilitation. But by far the commonest conditions are depression and anxiety….which cause significant emotional distress to affected persons, even while not being obvious to most people that anything is the matter with them.

Thus mental disorders occur along a spectrum, ranging from mild conditions such as anxiety; to moderate conditions such as depression; to severe conditions such as psychosis. But the good thing is that they are all very treatable, and can be well controlled and managed without any problems, even for chronic psychotic disorders.

Another way of looking at the common mental disorders is to consider them by age group. For example, attention deficit hyperactivity disorder (ADHD) and qutism are disorders of childhood.

Depression, anxiety, psychotic and substance use disorders are commonly a problem of adolescence and adulthood, while dementia is a common disorder among the elderly.

How does substance abuse cause mental illness?

Substance abuse causes the brain to release large amounts of the feel-good chemicals in the brain such that they experience intense euphoria and enjoy the sensation. Thus, they keep repeating the experience until they become hooked and can no longer function without the drugs.

It gets to a stage where the entire behaviour of such an individual is controlled and revolve around simply getting the drug, taking it and feeling high. They simply want to remain in the clouds and continuously be in a state of artificial euphoria, created as a result of the feel-good chemicals being released by their brains every time they take the drugs.

Thus personal functioning suffers, and every other thing in their life becomes unimportant, as long as they are able to get the drugs and feel high on it. Thus, warnings at work will fall on deaf ears, school performance will drop and so on.

They may even lose their jobs or be expelled from school etc. Apart from the pattern of addictive behaviour which becomes abnormal, it may cause psychosis by distorting the normal balance of brain chemicals. It can also lead to anxiety and depressive disorders.