What is the cause of psychiatric conditions such as depression, bipolar and schizophrenia?

This question commonly asked by patients is actually fairly complex to answer. First, one must realize that the vast majority of psychiatric conditions are not diseases but are disorders or syndromes. The term "disease" implies a specific entity with a specific pathological cause or etiology. A syndrome on the other hand is a collection of symptoms which co-occur in a specified way but their is usually no single identifiable cause. Disorders also generally represent a group of symptoms which co-occur that the medical community has described as an entity. The term "disorder" is also not value laden like the term disease (i.e. disease=bad; disorder=neutral, present)

The large majority of today's psychiatrists would answer the above question by describing the "Bio-psycho-social" model. This has been the mainstay of psychiatric education for the last 20 or so years. It is basically the view that psychiatric disorders have multifactorial causes generally falling into three domains: biologic, psychological, and social. For any specific individual there may be differing levels of importance placed on any of these domains. The "bio-psycho-social" model does not work so well when studying large samples of patients but this way of thinking about mental illness works fairly well to determine the etiology of a particular individual's psychiatric problem.

For example, a 19 year old male patient who recently left home to enter college presents with 3 months of depression including symptoms of difficulty with concentration, decreased interests, decreased energy and decreased appetite. The patient states that he grew up in a divorced family and was raised by his father from the age of 11. He states that he also recently has had a break up with his girlfriend with whom he has dated for the last 3 years. The patient thinks that she must have met someone new around the time he left for college. He feels a sense of rejection and low self esteem. He reports a distant relationship with his mother who he describes as "too busy dealing with her own problems". The patient's mother has a psychiatric history of anxiety and depression. In addition to the above, the patient is worried about his worsening grades in school and whether his father will continue to help financially to finish out the school year.

Biological: family history of depression/anxiety, late adolescent age, drug use?, medical causes of depression?
Psychological: How does this person deal with a break up? Was he really rejected or is this just his perception? Does moving away from home and loss of a girlfriend unconsciously bring back prior losses. Maybe there is an increased sense of rejection because he blamed himself for his mom leaving. "I was just another of my mom's problems"
Social: What is his college like? Are people generally friendly or is it a difficult place to meet people? Does he have a roommate to talk with? Why does dad pressure him financially about grades? Would dad continue this negative pressure if he knew his son were depressed? Is the school too academically difficult? Would it be easier to go to a smaller school closer to home? what other environmental stressors are present? What if this patient suddenly won 5 million kronor and met a beautiful swedish girl; would his depressive symptoms suddenly disappear?

Now, you know the bio-psycho-social approach to understanding mental illness. There are many other theories or models out there (some of them pretty wack-o) to explain mental illness. This is currently the most broadly accepted. I hope to present some others throughout the coming week.

Postat av: psykos


Tack för kommentaren på bloggen.

Fin blogg ni har :)

Jag länkar till er så länge ni inte sänder ut några religiösa budskap å så :P eller är scientologer :P ( tro mig finns många psyk-vetare där ute som är scientologer!)

Kram! P

2008-11-25 @ 08:47:48
URL: http://psykiatrin.blogg.se/
Postat av: Camilla

Intressant inlägg!

2008-11-25 @ 14:41:48
Postat av: Camilla

Intressant inlägg!

2008-11-25 @ 14:42:04

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