Mental Health Clinic: Psychosis, Mania, and Other Ailments of the Mind

Understanding Common Mental Illnesses and Disorders: A Technical Review

The Global Landscape of Mental Health

According to the World Health Organization (WHO), over one billion people, or approximately 1 in 8 globally, live with a mental disorder. These conditions serve as a leading cause of years lived with disability and impose a staggering economic burden, including an annual productivity loss of nearly one trillion dollars. Clinical classification primarily relies on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) and the ICD-11, which categorize disorders based on symptomatic clusters and functional impairment. Modern psychiatry utilizes the biopsychosocial model, examining the intersection of neurobiology, psychological traits, and social determinants of health to understand etiology.

Anxiety Disorders: The Most Prevalent Class

Anxiety disorders represent the most common category of mental illness, affecting approximately 19.1% of adults in the United States annually.

• Generalized Anxiety Disorder (GAD): Characterized by excessive, difficult-to-control worry for at least six months. Under the DSM-5-TR criteria for GAD, adults must present at least three of six core symptoms: restlessness, easy fatigability, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
• Panic Disorder: Identified by recurrent, unexpected panic attacks and a persistent fear of future attacks or their consequences.
• Social Anxiety Disorder (SAD): Marked by intense fear of negative evaluation or scrutiny in social situations, often leading to significant avoidance behaviors.

Depressive and Mood Disorders

Affective disorders are a primary driver of global disability, with Major Depressive Disorder (MDD) affecting roughly 5% of adults worldwide in 2024.

• Major Depressive Disorder (MDD): Diagnosis requires five or more symptoms during a two-week period, with at least one being depressed mood or anhedonia (loss of interest). Clinicians use the SIGECAPS mnemonic to screen for these criteria: Sleep changes, Interest loss, Guilt, Energy depletion, Concentration issues, Appetite changes, Psychomotor agitation/retardation, and Suicidal ideation.
• Bipolar Disorders: These involve distinct periods of mania or hypomania alternating with depressive episodes. Bipolar I is defined by at least one manic episode, while Bipolar II requires a hypomanic episode and a major depressive episode.

Trauma- and Stressor-Related Disorders

• Post-Traumatic Stress Disorder (PTSD): PTSD occurs following exposure to a traumatic event. It is characterized by four symptom clusters: intrusion (i.e. flashbacks), avoidance of reminders, negative alterations in mood/cognition, and marked hyperarousal.
• Adjustment Disorders: These involve emotional or behavioral symptoms in response to an identifiable stressor, occurring within three months of the stressor’s onset.

Neurodevelopmental and Behavioral Disorders

• ADHD: Characterized by persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning.
• Autism Spectrum Disorder (ASD): Defined by persistent deficits in social communication and interaction, alongside restricted, repetitive patterns of behavior or interests.

Personality Disorders

Personality disorders are enduring patterns of inner experience and behavior that deviate markedly from cultural expectations.

• Cluster B (Dramatic/Erratic): This includes Borderline Personality Disorder (BPD), characterized by instability in interpersonal relationships, self-image, and affects, along with marked impulsivity.
• Cluster C (Anxious/Fearful): Includes Obsessive-Compulsive Personality Disorder (OCPD), which is distinct from OCD and focuses on perfectionism and control.

Psychotic Disorders

• Schizophrenia: A severe mental illness involving distortions in thinking, perception, emotions, and sense of self. Symptoms are divided into positive (hallucinations, delusions) and negative (diminished emotional expression, avolition).

The Path Forward

    While effective treatments exist, including psychotherapy and pharmacotherapy, a significant treatment gap remains. Globally, most people with mental disorders do not have access to effective care. Future directions in psychiatric nosology, such as the Research Domain Criteria (RDoC), aim to shift toward biological and neuroscience-based classification to improve precision in diagnosis and treatment.

Disclaimer: I am not a medical doctor. If you are having a psychotic break, please call 911 or 988. If you are outside of the US or UK, please call your local emergency services hotline. Be well!

See also:

Channel 4 News - David Harewood on his psychosis, being a British black actor in America and Brexit 'ugliness.'