PREDISPOSING AND PRECIPITATING

FACTORS TO MENTAL ILLNESS

Hyacinth C. Manood. MD, FPPA
 BIOLOGICAL
I.GENETICS
 - many major psychiatric disorders
have shown to have strong
hereditary predispositions.
Examples:

Schizophrenia
Bipolar Disorder and Major Depressive
disorders
 first degree relatives – 8 – 18x
 monozygotic twins – 33-90%
concordance
Tourette’s Disorder – autosomal
dominant
 BIOLOGICAL
 II. PSYCHONEUROENDOCRINOLOGY
 - refers to the structural and functional
relations between hormonal system and CNS
and the behaviors that modulate and arise from
it.


 HYPOTHALAMIC-PITUITARY-ADRENAL
1.Cushing’s Syndrome (inc. cortisol)
 > 50% mood disturbances
 > 10% psychosis and suicidal thoughts
 >cognitive impairments
- Decreasing the cortisol level normalizes mood

and mental status

 2.Addison’s Disease (Adrenal insufficiency)
 > apathy, withdrawal, impaired sleep and
decreased concentration.
 > replacement of glucocorticoids resolves
the above symptoms.


3.Depression
 > increased cortisol concentration
 > failure to suppress cortisol in response to
dexamethasone
 > increased adrenal size and sensitivity to
ACTH
 > blunted ACTH response to CRH
 > increased concentrations of CRH in the
brain
 4.Insulin – involved in learning and memory
 > lower insulin concentration in CSF of
patients with Alzheimer’s Disease.
 >depression is frequent in patients with
diabetes
 > antipsychotic effects dysregulate insulin
metabolism


 HYPOTHALAMIC-PITUITARY-GONADAL
AXIS
1.Testosterone
 > associated with increased violence and
aggression in animals;
 > testosterone improves mood and
decreases irriability in hypogonadal males
 > anabolic-androgenic steroids –
euphoria, increased energy, sexual arousal;
irriability, mood swings, violent feelings,
anger and hostility;
 > DHEA improves well-being and
functional status in both depressed and
normal individuals.


2.Estrogen and Progesterone

 > antipsychotic effect changes over
menstrual cycles
 > risk of tardive dyskinesia depends
partly on estrogen concentration;
 > Estrogen administration decreases
risks ad severity of Alzheimer’s dementia.
 > Estrogen has mood-enhancing
 3.Prolactin
 > increased PRL – depression, decreased
libido, stress intolerance, anxiety, increased
irritability;
 > severity of tardive dyskinesia


 HYPOTHALAMIC-PITUITARY-THYROID
AXIS
TRH - neuronal excitability, behavior,
neurotransmitter regulation.
Hyperthyroidism – fatigue, irritability,

insomnia, anxiety, restlessness, weight

loss, emotional lability; marked impairment
in memory and concentration; delirium and
dementia; psychotic feature : paranoia
Chronic hypotyroidism – fatigue, decreased


libido, memory impairment, irritability;

suicidal ideation common.


GROWTH HORMONE
 stressful experiences – decreased GH
 dec. GH – major depressive disorder and
dysthymia
ENDOGENOUS OPIOIDS - eating behavior

MELATONIN – circadian phase disorders

(jetlag)
 - increases speed of falling asleep
OXYTOCIN – sex

SUBSTANCE P - memory
 III.PSYCHONEUROIMMUNOLOGY
IV.
 > Stress lowers immune response.
 > HIV – depression
 > neurosyphilis – neuropsychiatric
manifestations
 > Schizophrenia
 > Major Depressive Disorder
 > Alzheimer’s disease
 > Chronic fatigue syndrome

 IV.BIOLOGICAL RHYTMS
 * SLEEP
 > deprivation leads to breakdown in
concentration, motor skills, self-care,
attention, judgement, communication;
hallucinations and illusions.

 PSYCHOLOGICAL
I. FREUD
STAGES OF PSYCHOSEXUAL
DEVELOPMENT
1.ORAL STAGE ( 0 – 1)
 - to establish a trusting dependence on
nursing and sustaining objects;
 - to establish comfortable expression and
gratification of oral libidinal needs without
excessive conflicts or ambivalence from
oral sadistic wishes.
PATHOLOGICAL: extremes of oral gratification

can result in libidinal fixations;

 - excessive optimism, narcissism,
pessimism, demandingness;
 oral traits - envy and jealousy
 2.ANAL STAGE (1 – 2)
 - a period of striving for independence
and separation from dependence
PATHOLOGICAL:

Fixation – orderliness, obstinacy,

stubbornness, willfulness, frugality, and

parsimony
If less effective – heightened ambivalence,

lack of tidiness, messiness, defiance, rage

ad sadomasochistic tendencies.


3.URETHRAL STAGE (2 – 3)
 - transitional; issues of control and
shaming
 4.PHALLIC STAGE ( 3 – 6)
 - castration anxiety; penis envy;
 - identification from parental figures
 - foundation for an emerging sense of
sexual identity
 - oedipal conflict resolution
 - internal source of regulation - superego


5.LATENCY STAGE ( 5-6 TO 11-13)

 - stage of relative quiescence or
inactivity of sexual drive;
 - homosexual affiliations; sublimation
 - development of important skills
PATHOLIGAL: lack of control leads to failure to

sublimate energies in the interests of

learning and development of skills.
 6.GENITAL STAGE (11-13 TO young adulthood)
 - ultimate separation from dependence
on and attachment to parents.
 -establishment of mature, nonincestous
object relations;

 2.ERIKSON
3.
 EPIGENETIC PRINCIPLE – development
occurs in sequential, clearly defined stages,
and that each stage must be satisfactorily
resolved for development to proceed
smoothly.


 - In relation to Freudian theory, Erikson

described a corresponding zone with a
specific pattern or mode of behavior.
EIGHT STAGES OF THE LIFE CYCLE:
1.TRUST VS. MISTRUST (birth – 18 months)
 - incorporation
 - development of basic trust
 - impairment leads to basic mistrust
>prolonged separation during infancy

 hospitalism or anaclitic depression

 later life
 dysthymia, depression, sense of
hopelessness
Ø Social mistrust Projection
Ø
 Paranoid or delusional disorders, Schizoid PD,
Schizophrenia, Substance abuse, thrill-seeking
 2.AUTONOMY VS SHAME AND DOUBT (18M –
3)
 - terrible two
If too much shame and doubt – obsessive

personality
Too rigorous toilet training – stingy,

meticulous, selfish
Too much shaming – delinquent behavior;

impulsive behavior


3.INITIATIVE VS GUILT ( 3 – 5)
 - active and intrusive
 - Oedipus complex
If excessive guilt – GAD and phobias

Punishment or severe prohibitions – sexual

 4.INDUSTRY VS INFERIORITY (5 – 13)
 - covers pleasure of production
 - learning new skills and takes pride in
things made
 - teachers and other role models are
important
If unprepared – sense of inferiority or

inadequacy
Extremes – feelings of inadequacy;

compensatory drive for money, power and

prestige; work can become the main focus
of life
5.IDENTITY VS. ROLE CONFUSION ( 13 – 21)
 - running away, criminality, overt
psychoses
Defenses – joining cults, gangs ; identifying

with folk heroes

 6.INTIMACY VS ISOLATION (21-40)
 - successful formation of stable marriage
and family


7.GENERATIVITY VS STAGNATION (40-60)

 - establishing and guiding the next
generation
 - depression
 - inc. substance use


8.INTEGRITY VS DESPAIR
 - acceptance
 - Psychosomatic illnesses,
Hypochondriasis, Depression
 - suicide rate is highest over age 65
 SOCIAL FACTORS
STRESS
 - Stress Diathesis Model of
Schizophrenia
 - Social Causation hypothesis
SOCIAL STATUS
LIFE EVENTS/ TRAUMATIC EVENTS
PHYSICAL TRAUMA/PHYSICAL ILLNESS
MALNUTRITION
POLLUTION
CROWDING

 STRESS DIATHESIS MODEL


 A person may have a specific

vulnerability (diathesis) that, when
acted on by a stressful influence,
allows the symptoms of schizophrenia
to develop.
 -integrates biological, psychosocial,
and environmental factors.
SOCIAL CAUSATION HYPOTHESIS


 The stresses experienced by

members of low socioeconomic group
contribute to the development of
schizophrenia.
 SOCIAL LEARNING THEORY:



A person can learn by imitating the
behavior of another person, but
personal factors are involved
 .
 - relies on role models,
identification, and human interactions.
THANK YOU & GOOD DAY