Mental diseases: a public health problemMay, James Vance
Science
Mental diseases: a public health problem
May, James Vance
Mental health services; Psychology, Pathological
Very important because certain of the non-organic psychoses appear
to be a further development of mental traits or tendencies early
recognized as personal peculiarities or deviations from the normal. In
addition to the points already covered under the preceding headings,
the following important types should always be borne in mind and
appropriate inquiries made:
_Manic make-up_: Lively, active, sociable, pushing, talkative,
cheerful, optimistic; may be domineering, irritable and inclined to
cruelty; sometimes not very efficient, may be noted as changeable,
lacking in persistence, concentration and application. May show
transient blue spells or lowering of spirits.
_Depressive make-up_: Gloomy, worrisome, blue natures who feel
continuously inhibited or restrained and unable to make decisions;
easily discouraged.
_Cyclothymic make-up_: Emotionally unstable, either up or down, have
blue spells or are unduly cheerful and care-free.
_Shut-in make-up_: Shy, retiring, self-conscious, bashful, quiet,
secretive, seclusive and unsociable. Lack of interest in opposite
sex or definite aversion; often prudish and over-particular. Unusual
religious interest frequent. Inclined to day-dreaming, show fondness
for the abstract and mystical. Odd habits, hobbies or cranky pursuits
are common.
_Paranoid make-up_: Mistrustful, suspicious, tend to misunderstand;
unduly sensitive, feel discriminated against and have feelings of
self-importance. (These traits may be related to shut-in tendencies.)
Other types of make-up include the psychasthenic, neurasthenic and
hysterical; also the mentally retarded or undeveloped (feebleminded).
8. _Previous Attacks of Mental Disorder_:
Obtain dates, places where treated, apparent cause, duration of attacks
and general character of symptoms.
9. _Precipitating Cause of Present Psychosis_:
Try to determine what occurrence or situation appeared to bring
about the mental breakdown. Emotional strains, excitement, quarrels,
worries, griefs, disappointments, sexual episodes, separation, deaths,
childbirth, etc., financial loss, overwork, physical disease, etc.
10. _Onset and Symptoms of the Psychosis_:
Take as far as possible a spontaneous account beginning with date
when first symptoms were noticed in the patient. In this connection
particular attention should be given to changes in behavior, in mood,
in manner of speech, in attitude towards others and towards work.
Appearance of suspicious, unusual interests, peculiar ideas and
delusions?
Hallucinations in various fields and reaction to them?
Obtain as much as possible regarding trend of patient's ideas, topics
of conversation and content of hallucinations. What did voices say?
What was seen in visions?
Forgetfulness, impairment of memory, loss of orientation and clouding
of sensorium.
Always inquire regarding suicidal inclinations or attempts, threats of
violence, assaults or homicidal tendencies.
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