What is the organic view based on?
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The medical model's school of thought is that mental disorders are believed to be the product of physiological factors. The medical model, which is more widely used by psychiatrists than psychologists, treats mental disorders as physical diseases whereby medication is often used in treatment. Show
Supporters of the medical model usually consider symptoms to be telltale signs of the inner physical disorder. They believe that if symptoms are connected, it can be characterized as a syndrome. Medical Model AssumptionsThe biological approach of the medical model focuses on genetics, neurotransmitters, neurophysiology, neuroanatomy, and so on. Psychopathology says that disorders have an organic or physical cause. The approach suggests that mental conditions are related to the brain's physical structure and functioning. Symptoms of mental illness, such as hallucinations, can be categorized as syndromes caused by disease. These symptoms allow a psychiatrist to make a diagnosis and prescribe treatment. The Use of Medication in TreatmentBased on the medical model, mental illness should be treated, in part, as a medical condition. This treatment is typically the use of prescription medications. Medications for mental illness change brain chemistry. In most cases, these medications add or modify a chemical that is responsible for problems with mood, perception, anxiety, or other issues. In the correct dosage, medication can have a profoundly positive impact on functioning. Brain Chemistry of Anxiety DisordersStudies have shown that those who suffer from anxiety disorders, including phobias, have a problem with the regulation of serotonin levels in their brains. Serotonin is a chemical that acts as a neurotransmitter. Neurotransmitters modulate the signals between neurons and other cells. Serotonin acts in the brain and, among other processes, moderates mood. A serotonin level that is too high or too low can cause both depression and anxiety. Consequently, phobias are often treated with a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Normally serotonin is released from a nerve cell into the synaptic gap between cells. It is recognized by the second nerve cell, which then transmits a signal to the brain. The serotonin is then recaptured by the first nerve cell. Healthy people differ significantly in their overall personality, mood, and behavior. Each person also varies from day to day, depending on the circumstances. However, a sudden, major change in personality and/or behavior, particularly one that is not related to an obvious event (such as taking a drug or losing a loved one), often indicates a problem. (See also Overview of Mental Illness Overview of Mental Illness Mental health (psychiatric or psychologic) disorders involve disturbances in thinking, emotion, and/or behavior. Small disturbances in these aspects of life are common, but when such disturbances... read more .) Sudden changes in personality and behavior can be roughly categorized as involving one of the following types of symptoms:
These categories are not disorders. They are just one way doctors organize different types of abnormal thought, speech, and behavior. These changes in personality and behavior can be caused by physical or mental health problems. People may have more than one type of change. For example, people with confusion due to a drug interaction sometimes have hallucinations, and people with mood extremes may have delusions. Confusion and deliriumConfusion and delirium Delirium Delirium is a sudden, fluctuating, and usually reversible disturbance of mental function. It is characterized by an inability to pay attention, disorientation, an inability to think clearly... read more refer to a disturbance of consciousness. That is, people are less aware of their environment and, depending on the cause, may be excessively agitated and belligerent or drowsy and sluggish. Some people alternate between being less alert and being overly alert. Their thinking appears cloudy and slow or inappropriate. They have trouble focusing on simple questions and are slow to respond. Speech may be slurred. Often, people do not know what day it is, and they may not be able to say where they are. Some cannot give their name. Delirium often results from a serious, newly developed physical problem or a reaction to a drug, especially in older people. People who have delirium need immediate medical attention. If the cause of delirium is identified and corrected quickly, delirium often resolves. DelusionsDelusions are fixed false beliefs that people hold despite evidence to the contrary. Some delusions are based on a misinterpretation of actual perceptions and experiences. For example, people may feel persecuted, thinking that a person behind them on the street is following them or that an ordinary accident is purposeful sabotage. Other people think that song lyrics or newspaper articles contain messages that refer specifically to them (called a delusion of reference). Some beliefs seem more plausible and can be difficult to identify as delusions because they could occur or have occurred in real life. For example, people occasionally are followed by government investigators or have their work sabotaged by coworkers. In such cases, a belief can be identified as a delusion by how strongly people hold the belief despite evidence to the contrary. Other delusions are easier to identify. For example, in religious or grandiose delusions, people may believe they are Jesus or the president of the country. Some delusions are quite bizarre. For example, people may think that their organs have all been replaced by machine parts or that their head contains a radio that receives messages from the government. Disorganized speechDisorganized speech refers to speech that does not contain the expected logical connections between thoughts or between questions and answers. For example, people may jump from one topic to another without ever finishing a thought. The topics may be slightly related or entirely unrelated. In other cases, people respond to simple questions with long, rambling answers, full of irrelevant detail. Answers may be illogical or completely incoherent. This type of speech differs from the difficulty expressing or understanding language (aphasia Aphasia Aphasia is partial or complete loss of the ability to express or understand spoken or written language. It results from damage to the areas of the brain that control language. People may have... read more ) or forming words (dysarthria Dysarthria Dysarthria is loss of the ability to articulate words normally. Speech may be jerky, staccato, breathy, irregular, imprecise, or monotonous, but people can understand language and use it correctly... read more ) that is caused by a brain disorder such as stroke. Occasionally misspeaking or intentionally being evasive, rude, or humorous is not considered disorganized speech. Disorganized behaviorDisorganized behavior refers to doing quite unusual things (such as undressing or masturbating in public or shouting and swearing for no apparent reason). People with disorganized behavior typically have trouble doing normal daily activities (such as maintaining good personal hygiene or obtaining food). HallucinationsHallucination refers to hearing, seeing, smelling, tasting, or feeling things that are not actually there. That is, people perceive things, seemingly through their senses, that are not caused by an outside stimulus. Any sense can be involved. The most common hallucinations involve hearing things (auditory hallucinations), usually voices. The voices often make derogatory comments about the person or command the person to do something. Not all hallucinations are caused by a mental disorder. Psychedelic drugs Hallucinogens Hallucinogens are a class of drugs that cause profound distortions in people's perceptions. Hallucinogens distort and intensify sensations, but the actual effects are variable and unpredictable... read more , such as LSD, mescaline, and psilocybin, are referred to as hallucinogens because they can cause visual hallucinations. Some types of hallucinations are more likely to be caused by a neurologic disorder Introduction to Symptoms of Brain, Spinal Cord, and Nerve Disorders Disorders that affect the brain, spinal cord, and nerves are called neurologic disorders. Neurologic symptoms—symptoms caused by a disorder that affects part or all of the nervous system—can... read more . For example, before a seizure occurs, people may smell something when there is no smell (an olfactory hallucination). Mood extremesMood extremes include outbursts of rage, periods of extreme elation ( ) or depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more , and, conversely, constant expression of little or no emotion (appearing unresponsive or apathetic). CausesAlthough people sometimes assume that changes in personality, thinking, or behavior are all due to a mental disorder, there are many possible causes. All causes ultimately involve the brain, but dividing them into four categories can be helpful:
Mental disordersMental disorders include
DrugsDrugs may affect personality or behavior when they cause
Rarely, certain antibiotics and drugs used to treat high blood pressure cause changes in personality and behavior. Disorders that mainly affect the brainThese disorders can affect personality, mood, and behavior. They include
Bodywide disorders that also affect the brainBodywide disorders that also affect the brain include
Less commonly, Lyme disease Lyme Disease Lyme disease is a tick-transmitted infection caused by Borrelia species, primarily by Borrelia burgdorferi and sometimes by Borrelia mayonii in the United States. These... read more EvaluationDuring the initial evaluation, doctors try to determine whether symptoms are due to a mental or physical disorder. The following information can help people decide when a doctor’s evaluation is needed and help them know what to expect during the evaluation. Warning signsIn people with changes in personality or behavior, certain symptoms and characteristics are cause for concern. These warning signs include
When to see a doctorPeople who have warning signs should be seen by a health care practitioner as soon as possible. Law enforcement may need to be called if people are violent. What the doctor doesDoctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination, including a neurologic examination Neurologic Examination When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the nervous system. Examination of the nervous system—the... read more with a (which evaluates the ability to pay attention, memory, mood, and ability to think abstractly, follow commands, and use language, among other things). What they find during the history and physical examination often suggests a possible cause of the changes and the tests that may need to be done (see table ). Questions include when symptoms began. Many mental disorders begin in a person's teens or 20s. If a mental disorder begins during middle age or later, especially if there is no obvious trigger (such as loss of a loved one), the cause is more likely to be a physical disorder. A physical disorder is also more likely to be the cause when mental symptoms change significantly during middle age or later in people with a chronic mental disorder. If changes began recently and suddenly in people of any age, doctors ask about conditions that can trigger such changes. For example, they ask whether people have just started or stopped taking a prescription or recreational drug. Doctors ask about other symptoms that may suggest a cause, such as
People are also asked whether they have previously been diagnosed and treated for a mental or seizure disorder. If they have been treated, doctors ask whether they have stopped taking their drugs or decreased the dose. However, because people with mental disorders may also develop physical disorders, doctors do not automatically assume that any new abnormal behavior is caused by the mental disorder. Doctors ask about physical disorders people have (such as diabetes) and about their lifestyle (such as their marital status, job situation, educational background, use of alcohol, tobacco, and recreational drugs, and living arrangements). Doctors also ask whether family members have had any physical disorders that can cause mental symptoms (such as multiple sclerosis). During the physical examination, doctors look for signs of physical disorders that can cause changes in mental status, particularly the following:
Confusion and delirium are more likely to result from a physical disorder. People with mental disorders are rarely confused or delirious. However, many physical disorders that cause changes in behavior do not cause confusion or delirium, but they often cause other symptoms that may appear to be a mental disorder. Doctors bend the person's neck forward. If doing so is difficult or painful, meningitis may be the cause. Doctors check the legs and abdomen for swelling, which may result from kidney or liver failure. If the skin or whites of the eyes look yellow, the cause may be liver failure. Doctors may examine the interior of the eyes with a handheld device that looks like a small flashlight (called an ). If doctors see swelling in part of the optic nerve (papilledema Papilledema Papilledema is a condition in which increased pressure in or around the brain causes the part of the optic nerve inside the eye to swell. Visual symptoms may be fleeting disturbances in vision... read more ), pressure within the skull may be increased, and tumors or bleeding in the brain may be the cause of the mental symptoms. Table  TestingTypically, tests include the following:
For most people known to have a mental disorder, no further testing is needed if their only symptoms are worsening of their typical symptoms, if they are awake and alert, and if results of these tests and their physical examination are normal. For most other people, blood tests to check for HIV infection are usually done. Other tests are done based mainly on the symptoms and examination results (see table ). Tests may include
TreatmentThe underlying condition is corrected or treated when possible. Whatever the cause, people who are a danger to themselves or others typically need to be hospitalized and treated whether they are willing or not. Many states require that such decisions be made by someone appointed to make health care decisions for the mentally ill person (called a surrogate decision maker Default Surrogate Decision Making If a person is unable to make decisions about personal health care, some other person or people must provide direction in decision making. The general term for such person is surrogate decision... read more ). If the person has not appointed a decision maker, doctors may contact the next of kin, or a court may appoint an emergency guardian. People who are not dangerous to themselves or others can refuse evaluation and treatment, despite the difficulties their refusal may create for themselves and their family. Key Points
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