Defining Mental Illness¹

We can all be "sad" or "blue" at times in our lives. We have all seen movies about the madman and his crime spree, with the underlying cause of mental illness. We sometimes even make jokes about people being crazy or nuts, even though we know that we shouldn't. We have all had some exposure to mental illness, but do we really understand it or know what it is? Many of our preconceptions are incorrect. A mental illness can be defined as a health condition that changes a person's thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning. As with many diseases, mental illness is severe in some cases and mild in others. Individuals who have a mental illness don't necessarily look like they are sick, especially if their illness is mild. Other individuals may show more explicit symptoms such as confusion, agitation, or withdrawal. There are many different mental illnesses, including depression, schizophrenia, attention deficit hyperactivity disorder (ADHD), autism, and obsessive-compulsive disorder. Each illness alters a person's thoughts, feelings, and/or behaviors in distinct ways. In this module, we will at times discuss mental illness in general terms and at other times, discuss specific mental illnesses. Depression, schizophrenia, and ADHD will be presented in greater detail than other mental illnesses.

Not all brain diseases are categorized as mental illnesses. Disorders such as epilepsy, Parkinson's disease, and multiple sclerosis are brain disorders, but they are considered neurological diseases rather than mental illnesses. Interestingly, the lines between mental illnesses and these other brain or neurological disorders is blurring somewhat. As scientists continue to investigate the brains of people who have mental illnesses, they are learning that mental illness is associated with changes in the brain's structure, chemistry, and function and that mental illness does indeed have a biological basis. This ongoing research is, in some ways, causing scientists to minimize the distinctions between mental illnesses and these other brain disorders. In this curriculum supplement, we will restrict our discussion of mental illness to those illnesses that are traditionally classified as mental illnesses, as listed in the previous paragraph.

Mental Illness in the Population²

Many people feel that mental illness is rare, something that only happens to people with life situations very different from their own, and that it will never affect them. Studies of the epidemiology of mental illness indicate that this belief is far from accurate. In fact, the surgeon general reports that mental illnesses are so common that few U.S. families are untouched by them.⁴⁴

Few U.S. families are untouched by mental illness.

Mental Illness in Adults

Figure 1

Scientists estimate that one of every four people is affected by mental illness either directly or indirectly.

Even if you or a family member has not experienced mental illness directly, it is very likely that you have known someone who has. Estimates are that at least one in four people is affected by mental illness either directly or indirectly. Consider the following statistics to get an idea of just how widespread the effects of mental illness are in society: ^{4, 25, 44}

• According to recent estimates, approximately 20 percent of Americans, or about one in five people over the age of 18, suffer from a diagnosable mental disorder in a given year.
• Four of the 10 leading causes of disability—major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder—are mental illnesses.
• About 3 percent of the population have more than one mental illness at a time.
• About 5 percent of adults are affected so seriously by mental illness that it interferes with their ability to function in society. These severe and persistent mental illnesses include schizophrenia, bipolar disorder, other severe forms of depression, panic disorder, and obsessive-compulsive disorder.
• Approximately 20 percent of doctor's appointments are related to anxiety disorders such as panic attacks.
• Eight million people have depression each year.
• Two million Americans have schizophrenia disorders, and 300,000 new cases are diagnosed each year.

Warning Signs for Mental Illness³

Each mental illness has its own characteristic symptoms. (See Section 10 for information about some specific illnesses.) However, there are some general warning signs that might alert you that someone needs professional help.⁴ Some of these signs include

• marked personality change,
• inability to cope with problems and daily activities,
• strange or grandiose ideas,
• excessive anxieties,
• prolonged depression and apathy,
• marked changes in eating or sleeping patterns,
• thinking or talking about suicide or harming oneself,
• extreme mood swings—high or low,
• abuse of alcohol or drugs, and
• excessive anger, hostility, or violent behavior.

A person who shows any of these signs should seek help from a qualified health professional.

Diagnosing Mental Illness³

Mental Illness and the Brain⁴

The term mental illness clearly indicates that there is a problem with the mind. But is it just the mind in an abstract sense, or is there a physical basis to mental illness? As scientists continue to investigate mental illnesses and their causes, they learn more and more about how the biological processes that make the brain work are changed when a person has a mental illness.

The Basics of Brain Function

Before thinking about the problems that occur in the brain when someone has a mental illness, it is helpful to think about how the brain functions normally. The brain is an incredibly complex organ. It makes up only 2 percent of our body weight, but it consumes 20 percent of the oxygen we breathe and 20 percent of the energy we take in. It controls virtually everything we as humans experience, including movement, sensing our environment, regulating our involuntary body processes such as breathing, and controlling our emotions. Hundreds of thousands of chemical reactions occur every second in the brain; those reactions underlie the thoughts, actions, and behaviors with which we respond to environmental stimuli. In short, the brain dictates the internal processes and behaviors that allow us to survive.

Figure 2

The neuron, or nerve cell, is the functional unit of the nervous system. The neuron has processes called dendrites that receive signals and an axon that transmits signals to another neuron.

How does the brain take in all this information, process it, and cause a response? The basic functional unit of the brain is the neuron. A neuron is a specialized cell that can produce different actions because of its precise connections with other neurons, sensory receptors, and muscle cells. A typical neuron has four structurally and functionally defined regions: the cell body, dendrites, axons, and the axon terminals.

The cell body is the metabolic center of the neuron. The nucleus is located in the cell body and most of the cell's protein synthesis occurs here.

A neuron usually has multiple fibers called dendrites that extend from the cell body. These processes usually branch out somewhat like tree branches and serve as the main apparatus for receiving input from other nerve cells.

The cell body also gives rise to the axon. The axon is usually much longer than the dendrites; in some cases, an axon can be up to 1 meter long. The axon is the part of the neuron that is specialized to carry messages away from the cell body and to relay messages to other cells. Some large axons are surrounded by a fatty insulating material called myelin, which enables the electrical signals to travel down the axon at higher speeds.

Near its end, the axon divides into many fine branches that have specialized swellings called axon terminals or presynaptic terminals. The axon terminals end near the dendrites of another neuron. The dendrites of one neuron receive the message sent from the axon terminals of another neuron.

Figure 3

Diagram of a synapse.

The site where an axon terminal ends near a receiving dendrite is called the synapse. The cell that sends out information is called the presynaptic neuron, and the cell that receives the information is called the postsynaptic neuron. It is important to note that the synapse is not a physical connection between the two neurons; there is no cytoplasmic connection between the two neurons. The intercellular space between the presynaptic and postsynaptic neurons is called the synaptic space or synaptic cleft. An average neuron forms approximately 1,000 synapses with other neurons. It has been estimated that there are more synapses in the human brain than there are stars in our galaxy. Furthermore, synaptic connections are not static. Neurons form new synapses or strengthen synaptic connections in response to life experiences. This dynamic change in neuronal connections is the basis of learning.

Figure 4

Neurons relay their information using both electrical signals and chemical messages in a process called neurotransmission.

Neurons communicate using both electrical signals and chemical messages. Information in the form of an electrical impulse is carried away from the neuron's cell body along the axon of the presynaptic neuron toward the axon terminals. When the electrical signal reaches the presynaptic axon terminal, it cannot cross the synaptic space, or synaptic cleft. Instead, the electrical signal triggers chemical changes that can cross the synapse to affect the postsynaptic cell. When the electrical impulse reaches the presynaptic axon terminal, membranous sacs called vesicles move toward the membrane of the axon terminal. When the vesicles reach the membrane, they fuse with the membrane and release their contents into the synaptic space. The molecules contained in the vesicles are chemical compounds called neurotransmitters. Each vesicle contains many molecules of a neurotransmitter. The released neurotransmitter molecules drift across the synaptic cleft and then bind to special proteins, called receptors, on the postsynaptic neuron. A neurotransmitter molecule will bind only to a specific kind of receptor.

The binding of neurotransmitters to their receptors causes that neuron to generate an electrical impulse. The electrical impulse then moves away from the dendrite ending toward the cell body. After the neurotransmitter stimulates an electrical impulse in the postsynaptic neuron, it releases from the receptor back into the synaptic space. Specific proteins called transporters or reuptake pumps carry the neurotransmitter back into the presynaptic neuron. When the neurotransmitter molecules are back in the presynaptic axon terminal, they can be repackaged into vesicles for release the next time an electrical impulse reaches the axon terminal. Enzymes present in the synaptic space degrade neurotransmitter molecules that are not taken back up into the presynaptic neuron.

The nervous system uses a variety of neurotransmitter molecules, but each neuron specializes in the synthesis and secretion of a single type of neurotransmitter. Some of the predominant neurotransmitters in the brain include glutamate, GABA, serotonin, dopamine, and norepinephrine. Each of these neurotransmitters has a specific distribution and function in the brain; the specifics of each are beyond the scope of this module, but a few of the names will arise in reference to particular mental illnesses.

Investigating Brain Function

Mental health professionals base their diagnosis and treatment of mental illness on the symptoms that a person exhibits. The goal for these professionals in treating a patient is to relieve the symptoms that are interfering with the person's life so that the person can function well. Research scientists, on the other hand, have a different goal. They want to learn about the chemical or structural changes that occur in the brain when someone has a mental illness. If scientists can determine what happens in the brain, they can use that knowledge to develop better treatments or find a cure.

Figure 5

Scientists use a variety of imaging techniques to investigate brain structure and function.

The techniques that scientists use to investigate the brain depend on the questions they are asking. For some questions, scientists use molecular or biochemical methods to investigate specific genes or proteins in the neurons. For other questions, scientists want to visualize changes in the brain so that they can learn more about how the activity or structure of the brain changes. Historically, scientists could examine brains only after death, but new imaging procedures enable scientists to study the brain in living animals, including humans. It is important to realize that these brain imaging techniques are not used for diagnosing mental illness. Mental illnesses are diagnosed by the set of symptoms that an individual exhibits. The imaging techniques described in the following paragraphs would not enable the mental health professional to diagnose or treat the patient more effectively. Some of the techniques are also invasive and expose patients to small amounts of radiation. Research studies using these tests are generally not conducted with children or adolescents.

One extensively used technique to study brain activity and how mental illness changes the brain is positron emission tomography (PET). PET measures the spatial distribution and movement of a radioactive chemical injected into the tissues of living subjects. Because the patient is awake, the technique can be used to investigate the relationship between behavioral and physiological effects and changes in brain activity. PET scans can detect very small (nanomolar) concentrations of tracer molecules and achieve spatial resolution of about 4 millimeters. In addition, computers can reconstruct images obtained from a PET scan in two or three dimensions.

PET requires the use of compounds that are labeled with positron-emitting isotopes. A positron has the same mass and spin as an electron but the opposite charge; an electron has a negative charge and a positron has a positive charge. A cyclotron accelerates protons into the nucleus of nitrogen, carbon, oxygen, or fluorine to generate these isotopes. The additional proton makes the isotope unstable. To become stable again, the proton must break down into a neutron and a positron. The unstable positron travels away from the site of generation and dissipates energy along the way. Eventually, the positron collides with an electron, leading to the emission of two gamma rays at 180 degrees from one another. The gamma rays reach a pair of detectors that record the event. Because the detectors respond only to simultaneous emissions, scientists can precisely map the location where the gamma rays were generated. The radioactive chemicals used for PET are very short lived. The half-life (the time for half of the radioactive label to disintegrate) of the commonly used radioisotopes ranges from approximately two minutes to less than two hours, depending on the specific compound. Because a PET scan requires only small amounts (a few micrograms) of short-lived radioisotopes, this technique can be used safely in humans.

PET scans can answer a variety of questions about brain function, including where the neurons are most active. Scientists use different radiolabeled compounds to investigate different biological questions. For example, radiolabeled glucose can identify parts of the brain that become more active in response to a specific stimulus. Active neurons metabolize more glucose than inactive neurons. Active neurons emit more positrons, and this shows as red or yellow on PET scans compared with blue or purple in areas where the neurons are not highly active. (Different computer enhancement techniques may use a different color scheme, but the use of a spectrum with red indicating high activity and blue indicating low activity is common.) Scientists can use PET to measure changes in the activity of specific brain areas in a person who has a mental illness. Scientists can also investigate how the mentally ill brain changes after a person receives treatment.

PET imaging is not the only technique that researchers use to investigate how mental illness changes the brain. Different techniques provide different information to scientists. Another important technique is magnetic resonance imaging (MRI). Unlike PET, which reveals changes in activity level, MRI is used to look at structural changes in the brain. For example, MRI studies reveal that the ventricles, or spaces within the brain, are larger in individuals who have schizophrenia compared with those of healthy individuals. Other techniques that scientists use to investigate function in the living brain include single photon emission computed tomography (SPECT), functional magnetic resonance imaging (fMRI), and electroencephalography (EEG). Each technique has its own advantages, and each provides different information about brain structure and function. Scientists often use more than one technique when conducting their research.

Scientists believe that mental illnesses result from problems with the communication system in the brain.

The Causes of Mental Illnesses⁵

At this time, scientists do not have a complete understanding of what causes mental illnesses. If you think about the structural and organizational complexity of the brain together with the complexity of effects that mental illnesses have on thoughts, feelings, and behaviors, it is hardly surprising that figuring out the causes of mental illnesses is a daunting task. The fields of neuroscience, psychiatry, and psychology address different aspects of the relationship between the biology of the brain and individuals' behaviors, thoughts, and feelings, and how their actions sometimes get out of control. Through this multidisciplinary research, scientists are trying to find the causes of mental illnesses. Once scientists can determine the causes of a mental illness, they can use that knowledge to develop new treatments or to find a cure.

The Biology of Mental Illnesses

Figure 6

Scientists understand that mental illnesses are associated with changes in neurochemicals. For example, in people who have depression, less of the neurotransmitter serotonin (small circles) is released into the synaptic space than in people who do not (more...)

Most scientists believe that mental illnesses result from problems with the communication between neurons in the brain (neurotransmission). For example, the level of the neurotransmitter serotonin is lower in individuals who have depression. This finding led to the development of certain medications for the illness. Selective serotonin reuptake inhibitors (SSRIs) work by reducing the amount of serotonin that is taken back into the presynaptic neuron. This leads to an increase in the amount of serotonin available in the synaptic space for binding to the receptor on the postsynaptic neuron. Changes in other neurotransmitters (in addition to serotonin) may occur in depression, thus adding to the complexity of the cause underlying the disease.

Scientists believe that there may be disruptions in the neurotransmitters dopamine, glutamate, and norepinephrine in individuals who have schizophrenia. One indication that dopamine might be an important neurotransmitter in schizophrenia comes from the observation that cocaine addicts sometimes show symptoms similar to schizophrenia. Cocaine acts on dopamine-containing neurons in the brain to increase the amount of dopamine in the synapse.

Treating Mental Illnesses⁶

At this time, most mental illnesses cannot be cured, but they can usually be treated effectively to minimize the symptoms and allow the individual to function in work, school, or social environments. To begin treatment, an individual needs to see a qualified mental health professional. The first thing that the doctor or other mental health professional will do is speak with the individual to find out more about his or her symptoms, how long the symptoms have lasted, and how the person's life is being affected. The physician will also do a physical examination to determine whether there are other health problems. For example, some symptoms (such as emotional swings) can be caused by neurological or hormonal problems associated with chronic illnesses such as heart disease, or they can be a side effect of certain medications. After the individual's overall health is evaluated and the condition diagnosed, the doctor will develop a treatment plan. Treatment can involve both medications and psychotherapy, depending on the disease and its severity.

At this time, most mental illnesses cannot be cured, but they can usually be treated effectively to minimize the symptoms and allow the individual to function in work, school, or social environments.

Medications

Figure 7

Medicines are one part of an effective treatment plan for mental illnesses.

Medications are often used to treat mental illnesses. Through television commercials and magazine advertisements, we are becoming more aware of those medications. To become fully effective, medications for treating mental illness must be taken for a few days or a few weeks. When a patient begins taking medication, it is important for a doctor to monitor the patient's health. If the medication causes undesirable side effects, the doctor may change the dose or switch to a different medication that produces fewer side effects. If the medication does not relieve the symptoms, the doctor may prescribe a different medication.²

Sometimes, individuals who have a mental illness do not want to take their medications because of the side effects. It is important to remember that all medications have both positive and negative effects. For example, antibiotics have revolutionized treatment for some bacterial diseases. However, antibiotics often affect beneficial bacteria in the human body, leading to side effects such as nausea and diarrhea. Psychiatric drugs, like other medications, can alleviate symptoms of mental illness but can also produce unwanted side effects. People who take a medication to treat an illness, whether it is a mental illness or another disease, should work with their doctors to understand what medication they are taking, why they are taking it, how to take it, and what side effects to watch for.

Occasionally, the media reports stories in which the side effects of a psychiatric medication are tied to a potentially serious consequence, such as suicide. In these cases, it is usually very difficult to determine how much suicidal behavior was due to the mental disorder and what the role of the medication might have been. Medications for treating mental illness can, like other medications, have side effects. The psychiatrist or physician can usually adjust the dose or change the medication to alleviate side effects.

The Stigma of Mental Illness⁷

"The last great stigma of the twentieth century is the stigma of mental illness."

—Tipper Gore, wife of the former U.S. Vice President³⁷

Figure 8

Words can hurt. Many derogatory words and phrases are used in relation to mental illness. However, these words maintain the stereotyped image and not the reality about mental illness. Try not to use these words, and encourage students not to use them. (more...)

"Mentally ill people are nuts, crazy, wacko." "Mentally ill people are morally bad." "Mentally ill people are dangerous and should be locked in an asylum forever." "Mentally ill people need somebody to take care of them." How often have we heard comments like these or seen these types of portrayals in movies, television shows, or books? We may even be guilty of making comments like them ourselves. Is there any truth behind these portrayals, or is that negative view based on our ignorance and fear?

Stigmas are negative stereotypes about groups of people. Common stigmas about people who are mentally ill are

• Individuals who have a mental illness are dangerous.
• Individuals who have a mental illness are irresponsible and can't make life decisions for themselves.
• People who have a mental illness are childlike and must be taken care of by parents or guardians.
• People who have a mental illness should just get over it.¹¹

Each of those preconceptions about people who have a mental illness is based on false information. Very few people who have a mental illness are dangerous to society. Most can hold jobs, attend school, and live independently. A person who has a mental illness cannot simply decide to get over it any more than someone who has a different chronic disease such as diabetes, asthma, or heart disease can. A mental illness, like those other diseases, is caused by a physical problem in the body.

Stigmas against individuals who have a mental illness lead to injustices, including discriminatory decisions regarding housing, employment, and education. Overcoming the stigmas commonly associated with mental illness is yet one more challenge that people who have a mental illness must face. Indeed, many people who successfully manage their mental illness report that the stigma they face is in many ways more disabling than the illness itself. The stigmatizing attitudes toward mental illness held by both the public and those who have a mental illness lead to feelings of shame and guilt, loss of self-esteem, social dependence, and a sense of isolation and hopelessness.^{11, 44} One of the worst consequences of stigma is that people who are struggling with a mental illness may be reluctant to seek treatment that, in most cases, would significantly relieve their symptoms.

Providing accurate information is one way to reduce stigmas about mental illness. Advocacy groups protest stereotypes imposed upon those who are mentally ill. They demand that the media stop presenting inaccurate views of mental illness and that the public stops believing these negative views. A powerful way of countering stereotypes about mental illness occurs when members of the public meet people who are effectively managing a serious mental illness: holding jobs, providing for themselves, and living as good neighbors in a community. Interaction with people who have mental illnesses challenges a person's assumptions and changes a person's attitudes about mental illness.

Providing accurate information is one way to reduce stigmas about mental illness.

Attitudes about mental illness are changing, although there is a long way to go before people accept that mental illness is a disease with a biological basis. A survey by the National Mental Health Association found that 55 percent of people who have never been diagnosed with depression recognize that depression is a disease and not something people should "snap out of."³⁴ This is a substantial increase over the 38 percent of survey respondents in 1991 who recognized depression as a disease.

The Consequences of Not Treating Mental Illness⁸

Most people don't think twice before going to a doctor if they have an illness such as bronchitis, asthma, diabetes, or heart disease. However, many people who have a mental illness don't get the treatment that would alleviate their suffering. Studies estimate that two-thirds of all young people with mental health problems are not receiving the help they need and that less than one-third of the children under age 18 who have a serious mental health problem receive any mental health services. Mental illness in adults often goes untreated, too. What are the consequences of letting mental illness go untreated?

In September 2000, the U.S. surgeon general held a conference on children's mental health. The former surgeon general, Dr. David Satcher, emphasized the importance of mental health in children by stating, "Children and families are suffering because of missed opportunities for prevention and early identification, fragmented services, and low priorities for resources. Overriding all of this is the issue of stigma, which continues to surround mental illness."⁴⁵

The consequences of mental illness in children and adolescents can be substantial. Many mental health professionals speak of accrued deficits that occur when mental illness in children is not treated. To begin with, mental illness can impair a student's ability to learn. Adolescents whose mental illness is not treated rapidly and aggressively tend to fall further and further behind in school. They are more likely to drop out of school and are less likely to be fully functional members of society when they reach adulthood.⁴⁵ We also now know that depressive disorders in young people confer a higher risk for illness and interpersonal and psychosocial difficulties that persist after the depressive episode is over. Furthermore, many adults who suffer from mental disorders have problems that originated in childhood.⁴⁴ Depression in youth may predict more severe illness in adult life.²⁷ Attention deficit hyperactivity disorder, once thought to affect children and adolescents only, may persist into adulthood and may be associated with social, legal, and occupational problems.¹⁴

Mental illness impairs a student's ability to learn. Adolescents whose mental illness is not treated rapidly and aggressively tend to fall further and further behind in school.

The high incidence of mental illness has a great impact on society. Depression alone causes employers to lose over $23 billion each year due to decreased productivity and absenteeism of employees.⁴⁶ The Global Burden of Disease Study, conducted by the World Health Organization, assessed the burden of all diseases in units that measure lost years of healthy life due to premature death or disability (disability-adjusted life years, or DALYs). Over 15 percent of the total DALYs were due to mental illness.²⁶ In 1996, the United States spent more than $69 billion for the direct treatment of mental illnesses. Indirect costs of mental illness due to lost productivity in the workplace, schools, or homes represented a $79 billion loss for the U.S. economy in 1990.⁴⁴

Treatment, including psychotherapy and medication management, is cost-effective for patients, their families, and society. The benefits include fewer visits to other doctors' offices, diagnostic laboratories, and hospitals for physical ailments that are based in psychological distress; reduced need for psychiatric hospitalization; fewer sick days and disability claims; and increased job stability. Conversely, the costs of not treating mental disorders can be seen in ruined relationships, job loss or poor job performance, personal anguish, substance abuse, unnecessary medical procedures, psychiatric hospitalization, and suicide.³

Information about Specific Mental Illnesses⁹

A diagnosis of mental illness is rarely simple and straightforward. There are no infallible physiological tests that determine whether a person has a mental illness. Diagnosis requires that qualified healthcare professionals identify several specific symptoms that the person exhibits. Each mental illness has characteristic signs and symptoms that are related to the underlying biological dysfunction. The following sections describe the symptoms and outcomes of three mental illnesses that are highlighted in this curriculum supplement: depression, attention deficit hyperactivity disorder, and schizophrenia.

Finding Help for Someone with Mental Illness¹¹

As a teacher, you may occasionally have students who show symptoms of or who have significant risk factors for a mental illness. A first step for helping these students is to contact the school nurse or guidance counselor. These individuals should know the appropriate next steps to take, including directing the student's parents or guardians to contact their physician or their city or county mental health services.

If you think a friend or colleague might have a mental illness, encourage him or her to see a physician. Physicians can make referrals to mental health specialists in the community. In addition, your state or county health departments may offer services for people struggling with a mental illness. The National Mental Health Association has an affiliate network throughout the country. The programs offered by the NMHA affiliates include support groups, public education and advocacy campaigns, rehabilitation, and housing services. You can access the NMHA's affiliate network through its Web site: http://www.nmha.org/nav/section/affiliate.cfm.

The Additional Resources for Teachers section describes other online resources about mental illnesses (page 53).

References

1.

Agency for Health Care Policy and Research. Treatment of depression—newer pharmacotherapies. Summary, Evidence Report/Technology Assessment, Number 7. 1999. Retrieved June 27, 2001, from http://www​.ahcpr.gov/clinic/deprsumm.htm. [PMC free article: PMC4781268] [PubMed: 11487802]

2.

American Psychiatric Association. Psychiatric medications. 1993a. Retrieved December 18, 2002, from http://www​.psych.org​/public_info/medication.cfm.

3.

American Psychiatric Association. Psychotherapy. 1993b. Retrieved December 19. 2002, from http://www​.psych.org​/public_info/psythera.cfm.

4.

American Psychiatric Association. Mental illness (an overview). 1994. Retrieved January 11, 2003, from http://www​.psych.org​/public_info/overview.cfm.

5.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Press; 2000.

6.

Barkley RA. Attention-deficit hyperactivity disorder. 1998. Retrieved July 8, 2001, from http://www​.sciam.com​/1998/0998issue/0998barkley.html. [PubMed: 9725940]

7.

Booth B, Fellman W, Greenbaum J, Matlen T, Markel G, Morris H, Robin AL, Tzelepis A. Myths about ADD/ADHD. 2001. Retrieved July 8, 2001, from http://www​.add.org/content/abc/myths​.html.

8.

Castellanos FX, Giedd JN, Marsh WL, Hamburger SD, Vaituzis AC, Dickstein DP, Sarfatti SE, Vauss YC, Snell JW, Lange N, Kaysen D, Krain AL, Ritchie GF, Rajapakse JC, Rapoport JL. Quantitative brain magnetic resonance imaging in attention-deficit hyperactivity disorder. Archives of General Psychiatry. 1996;53:607–616. [PubMed: 8660127]

9.

Castellanos FX, Giedd JN, Berquin PC, Walter JM, Sharp W, Tran T, Vaituzis AC, Blumenthal JD, Nelson J, Bastain TM, Zijdenbos A, Evans AC, Rapoport JL. Quantitative brain magnetic resonance imaging in girls with attention-deficit/hyperactivity disorder. Archives of General Psychiatry. 2001;58:289–295. [PubMed: 11231836]

10.

Commission on Behavioral and Social Sciences Education, National Research Council. How People Learn: Brain, Mind, Experience, and School. Washington, DC: National Academies Press; 2000.

11.

Corrigan P, Lundin R. Don’t Call Me Nuts. Tinley Park, IL: Recovery Press; 2001.

12.

Egan MF, Goldberg TE, Koachana BS, Callicott JH, Mazzanti CM, Straub RE, Goldman D, Weinberger DR. Effect of COMT Val ^108/158 Met genotype on frontal lobe function and risk for schizophrenia. Proceedings of the National Academy of Sciences USA. 2001;98:6917–6922. [PMC free article: PMC34453] [PubMed: 11381111]

13.

George M. Depression PET scan. 1993. Retrieved July 13, 2001, from http://www​.nimh.nih.gov/hotsci/scandep​.html.

14.

Jaska P. Fact sheet on attention deficit hyperactivity disorder (ADHD/ADD). 1998. Retrieved July 18, 2001, from http://www​.add.org/content​/abc/factsheet.htm.

15.

Joint Committee on National Health Education Standards. National Health Education Standards: Achieving Health Literacy. Atlanta, GA: American Cancer Society; 1995.

16.

Loucks-Horsley S, Love N, Hewson PW, Stiles KE. Designing Professional Development for Teachers of Science and Mathematics. Thousand Oaks, CA: Corwin Press; 1998.

17.

National Alliance for the Mentally Ill. Schizophrenia. 2001. Retrieved June 27, 2001, from http://www​.nami.org/helpline​/schizophrenia.html.

18.

National Institutes of Health. Diagnosis and treatment of attention deficit hyperactivity disorder. NIH consensus statement. 1998. Retrieved July 8, 2001, from http://odp​.od.nih.gov​/consensus/cons/110/110_statement.htm. [PubMed: 10868163]

19.

National Institute of Mental Health. Attention deficit hyperactivity disorder. 1996. Retrieved July 3, 2001, from http://www​.nimh.nih.gov/publicat/adhd​.cfm.

20.

National Institute of Mental Health. Schizophrenia. 1999a. Retrieved July 3, 2004, from http://www​.nimh.nih.gov​/publicat/schizoph.cfm.

21.

National Institute of Mental Health. Archival record—early recognition and treatment of schizophrenia and bipolar disorder in children and adolescents. 1999b. Retrieved July 17, 2001, from http://www​.nimh.nih.gov​/events/earlyrecognition.cfm.

22.

National Institute of Mental Health. Depression in children and adolescents: A fact sheet for physicians. 2000a. Retrieved June 27, 2001, from http://www​.nimh.nih.gov​/publicat/depchildresfact.cfm.

23.

National Institute of Mental Health. Depression. 2000b. Retrieved June 27, 2001, from http://www​.nimh.nih.gov​/publicat/depression.cfm.

24.

National Institute of Mental Health. NIMH research on treatment for attention deficit hyperactivity disorder (ADHD): The multimodal treatment study—questions and answers. 2000c. Retrieved June 27, 2001, from http://www​.nimh.nih.gov/events/mtaqa.cfm.

25.

National Institute of Mental Health. The numbers count: Mental disorders in America. 2001a. Retrieved July 3, 2001, from http://www​.nimh.nih.gov​/publicat/numbers.cfm.

26.

National Institute of Mental Health. The impact of mental illness on society. 2001b. Retrieved June 27, 2001, from http://www​.nimh.nih.gov/publicat/burden​.cfm.

27.

National Institute of Mental Health. Depression research at the National Institute of Mental Health. 2001c. Retrieved June 27, 2001, from http://www​.nimh.nih.gov​/publicat/depresfact.cfm.

28.

National Institute of Mental Health. The invisible disease: Depression. 2001d. Retrieved June 27, 2001, from http://www​.nimh.nih.gov​/publicat/invisible.cfm.

29.

National Institute of Mental Health. Bipolar disorder. 2001e. Retrieved July 17, 2001, from http://www​.nimh.nih.gov​/publicat/bipolar.cfm.

30.

National Institute of Mental Health. Attention deficit hyperactivity disorder. 2001f. Retrieved June 27, 2001, from http://www​.nimh.nih.gov​/publicat/helpchild.cfm.

31.

National Institute of Mental Health. Information about St. John’s wort. 2001g. Retrieved July 13, 2001, from http://www​.nimh.nih.gov​/publicat/stjohnswort.cfm.

32.

National Institute of Mental Health. When someone has schizophrenia. 2001h. Retrieved June 28, 2001, from http://www​.nimh.nih.gov​/publicat/schizsoms.cfm.

33.

National Mental Health Association. Did you know? Retrieved July 3, 2001, from http://www​.nmha.org/infoctr/didyou.cfm.

34.

National Mental Health Association. Depression survey reveals dramatic changes in public opinion: Disease or state of mind? 2001. Retrieved July 18, 2001, from http://www​.nmha.org/newsroom​/system/news​.vw.cfm?do=vw&rid=316.

35.

National Research Council. National Science Education Standards. Washington, DC: National Academies Press; 1996.

36.

Pearlson GD. Neurobiology of schizophrenia. Annals of Neurology. 2000;48:556–566. [PubMed: 11026439]

37.

Pfizer Inc. Mental illness stigma and bias assailed at historic White House conference. Pfizer Views. 2000. Making News. Retrieved July 15, 2003, from http://www​.viewsmakingnews​.com/policy/mental_health.shtml.

38.

Rapoport JL, Castellanos FX, Gogate N, Janson K, Kohler S, Nelson P. Imaging normal and abnormal brain development: New perspectives for child psychiatry. Australian and New Zealand Journal of Psychiatry. 2001;35:272–281. [PubMed: 11437799]

39.

Rapoport JL, Giedd J, Kumra S, Jacobsen L, Smith A, Lee P, Nelson J, Hamburger S. Childhood-onset schizophrenia. Progressive ventricular change during adolescence. Archives of General Psychiatry. 1997;54:897–903. [PubMed: 9337768]

40.

Ratey J. An update on medications used in the treatment of attention deficit disorder. FOCUS Archives, National Attention Deficit Disorder Association. 1998. Retrieved July 8, 2001, from http://www​.add.org/images2/medupdate.htm.

41.

Sowell ER, Toga AW, Asarnow R. Brain abnormalities observed in childhood-onset schizophrenia: A review of the structural magnetic resonance imaging literature. Mental Retardation and Developmental Disabilities Research Review. 2000;6:180–185. [PubMed: 10982495]

42.

Stoll AL, Renshaw PF, Yurgelun-Todd DA, Cohen BM. Neuroimaging in bipolar disorder: What have we learned? Biological Psychiatry. 2000;15:505–517. [PubMed: 11018223]

43.

Thompson PM, Vidal C, Giedd JN, Gochman P, Blumenthal J, Nicolson R, Toga AW, Rapoport JL. Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proceedings of the National Academy of Sciences USA. 2001;98:11650–11655. [PMC free article: PMC58784] [PubMed: 11573002]

44.

U.S. Department of Health and Human Services. Mental health: A report of the surgeon general. 2000. Retrieved July 8, 2001, from http://www​.surgeongeneral​.gov/Library/MentalHealth/home.html.

45.

U.S. Public Health Service. Report of the surgeon general’s conference on children’s mental health: A national action agenda. 2000. Retrieved June 27, 2001, from http://www​.surgeongeneral​.gov/cmh/childreport.htm. [PubMed: 20669515]

46.

Veggeberg SK. The big story in depression: What isn’t happening. Brainwork—The Neuroscience Newsletter. 1997. Retrieved July 3, 2001, from http:/www​.dana.org/articles/bwn_1097.cfm.

47.

Weinberger D, Torrey EF, Berman K. Schizophrenia PET scan. 1990. Retrieved July 13, 2001, from http://www​.nimh.nih.gov/hotsci/scanschi​.htm.

48.

Yatham LN, Liddle PF, Shiah IS, Scarrow G, Lam RW, Adam MJ, Zis AP, Ruth TJ. Brain serotonin2 receptors in major depression: A positron emission tomography study. Archives of General Psychiatry. 2000;57:850–858. [PubMed: 10986548]

Glossary

accrued deficits

The delays or lack of development in emotional, social, academic, or behavioral skills that a child or adolescent experiences because of untreated mental illness. The mental illness keeps the individual from developing these life skills at the usual stage of life. An individual may never fully make up for these deficiencies.

acute

Refers to a disease or condition that has a rapid onset, marked intensity, and short duration.

antidepressant

A medication used to treat depression.

anxiety

An abnormal sense of fear, nervousness, and apprehension about something that might happen in the future.

anxiety disorder

Any of a group of illnesses that fill people's lives with overwhelming anxieties and fears that are chronic and unremitting. Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, phobias, and generalized anxiety disorder.

attention deficit disorder (ADD)

See attention deficit hyperactivity disorder.

attention deficit hyperactivity disorder (ADHD)

A mental illness characterized by an impaired ability to regulate activity level (hyperactivity), attend to tasks (inattention), and inhibit behavior (impulsivity). For a diagnosis of ADHD, the behaviors must appear before an individual reaches age seven, continue for at least six months, be more frequent than in other children of the same age, and cause impairment in at least two areas of life (school, home, work, or social function).

autism

A mental illness that typically affects a person's ability to communicate, form relationships with others, and respond appropriately to the environment. Some people with autism have few problems with speech and intelligence and are able to function relatively well in society. Others are mentally retarded or mute or have serious language delays. Autism makes some people seem closed off and shut down; others seem locked into repetitive behaviors and rigid patterns of thinking.

axon

The long, fiberlike part of a neuron by which the cell carries information to target cells.

bipolar disorder

A depressive disorder in which a person alternates between episodes of major depression and mania (periods of abnormally and persistently elevated mood). Also referred to as manic-depression.

cerebrum

The upper part of the brain that consists of the left and right hemispheres.

chronic

Refers to a disease or condition that persists over a long period of time.

cognition

Conscious mental activity that informs a person about his or her environment. Cognitive actions include perceiving, thinking, reasoning, judging, problem solving, and remembering.

conduct disorder

A personality disorder of children and adolescents involving persistent antisocial behavior. Individuals with conduct disorder frequently participate in activities such as stealing, lying, truancy, vandalism, and substance abuse.

delusion

A false belief that persists even when a person has evidence that the belief is not true.

dendrite

The specialized fibers that extend from a neuron's cell body and receive messages from other neurons.

depression (depressive disorders)

A group of diseases including major depressive disorder (commonly referred to as depression), dysthymia, and bipolar disorder (manic-depression). See bipolar disorder, dysthymia, and major depressive disorder.

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)

A book published by the American Psychiatric Association that gives general descriptions and characteristic symptoms of different mental illnesses. Physicians and other mental health professionals use the DSM-IV to confirm diagnoses for mental illnesses.

disease

A synonym for illness. See illness.

disorder

An abnormality in mental or physical health. In this module, disorder is used as a synonym for illness.

dysthymia

A depressive disorder that is less severe than major depressive disorder but is more persistent. In children and adolescents, dysthymia lasts for an average of four years.

electroconvulsive therapy (ECT)

A treatment for severe depression that is usually used only when people do not respond to medications and psychotherapy. ECT involves passing a low-voltage electric current through the brain. The person is under anesthesia at the time of treatment. ECT is not commonly used in children and adolescents.

electroencephalography (EEG)

A method of recording the electrical activity in the brain through electrodes attached to the scalp.

electroshock therapy

See electroconvulsive therapy.

frontal lobe

One of the four divisions of each cerebral hemisphere. The frontal lobe is important for controlling movement and associating the functions of other cortical areas.

gray matter

The portion of brain tissue that is dark in color. The gray matter consists primarily of nerve cell bodies, dendrites, and axon endings.

hallucination

The perception of something, such as a sound or visual image, that is not actually present other than in the mind.

hypothalamus

The part of the brain that controls several body functions, including feeding, breathing, drinking, temperature, and the release of many hormones.

illness

A problem in which some part or parts of the body do not function normally, in a way that interferes with a person's life. For the purpose of this module, other terms considered to be synonyms for illness include disease, disorder, condition, and syndrome.

magnetic resonance imaging (MRI)

An imaging technique that uses magnetic fields to take pictures of the structure of the brain.

major depressive disorder

A depressive disorder commonly referred to as depression. Depression is more than simply being sad; to be diagnosed with depression, a person must have five or more characteristic symptoms nearly every day for a two-week period.

mania

Feelings of intense mental and physical hyperactivity, elevated mood, and agitation.

manic-depression

See bipolar disorder.

mental illness

A health condition that changes a person's thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning.

mental retardation

A condition in which a person has an IQ that is below average and that affects an individual's learning, behavior, and development. This condition is present from birth.

myelin

A fatty material that surrounds and insulates the axons of some neurons.

neuron (nerve cell)

A unique type of cell found in the brain and body that processes and transmits information.

neurosis

A term no longer used medically as a diagnosis for a relatively mild mental or emotional disorder that may involve anxiety or phobias but does not involve losing touch with reality.

neurotransmission

The process that occurs when a neuron releases neurotransmitters that relay a signal to another neuron across the synapse.

neurotransmitter

A chemical produced by neurons that carries messages to other neurons.

obsessive-compulsive disorder (OCD)

An anxiety disorder in which a person experiences recurrent unwanted thoughts or rituals that the individual cannot control. A person who has OCD may be plagued by persistent, unwelcome thoughts or images or by the urgent need to engage in certain rituals, such as hand washing or checking.

oppositional defiant disorder

A disruptive pattern of behavior of children and adolescents that is characterized by defiant, disobedient, and hostile behaviors directed toward adults in positions of authority. The behavior pattern must persist for at least six months.

panic disorder

An anxiety disorder in which people have feelings of terror, rapid heart beat, and rapid breathing that strike suddenly and repeatedly with no warning. A person who has panic disorder cannot predict when an attack will occur and may develop intense anxiety between episodes, worrying when and where the next one will strike.

phobia

An intense fear of something that poses little or no actual danger. Examples of phobias include fear of closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, and injuries involving blood.

pituitary gland

An endocrine organ closely linked with the hypothalamus. The pituitary secretes a number of hormones that regulate the activity of other endocrine organs in the human body.

positron

A positively charged particle that has the same mass and spin as—but the opposite charge of—an electron.

positron emission tomography (PET)

An imaging technique for measuring brain function in living subjects by detecting the location and concentration of small amounts of radioactive chemicals.

postsynaptic neuron

The neuron that receives messages from other neurons.

presynaptic neuron

The neuron that sends messages to other neurons by releasing neurotransmitters into the synapse.

psychiatrist

A medical doctor (M.D.) who specializes in treating mental diseases. A psychiatrist evaluates a person's mental health along with his or her physical health and can prescribe medications.

psychiatry

The branch of medicine that deals with identifying, studying, and treating mental, emotional, and behavioral disorders.

psychologist

A mental health professional who has received specialized training in the study of the mind and emotions. A psychologist usually has an advanced degree such as a Ph.D.

psychosis

A serious mental disorder in which a person loses contact with reality and experiences hallucinations or delusions.

psychotherapy

A treatment method for mental illness in which a mental health professional (psychiatrist, psychologist, counselor) and a patient discuss problems and feelings to find solutions. Psychotherapy can help individuals change their thought or behavior patterns or understand how past experiences affect current behaviors.

receptor

A molecule that recognizes specific chemicals, including neurotransmitters and hormones, and transmits the message into the cell on which the receptor resides.

relapse

The reoccurrence of symptoms of a disease.

reuptake pump

The large molecule that carries neurotransmitter molecules back into the presynaptic neuron from which they were released. Also referred to as a transporter.

risk

The chance or possibility of experiencing harm or loss.

risk factor

Something that increases a person's risk or susceptibility to harm.

schizophrenia

A chronic, severe, and disabling brain disease. People with schizophrenia often suffer terrifying symptoms such as hearing internal voices or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms may leave them fearful and withdrawn. Their speech and behavior can be so disorganized that they may be incomprehensible or frightening to others.

selective serotonin reuptake inhibitors (SSRIs)

A group of medications used to treat depression. These medications cause an increase in the amount of the neurotransmitter serotonin in the brain.

serotonin

A neurotransmitter that regulates many functions, including mood, appetite, and sensory perception.

single photon emission computed tomography (SPECT)

A brain imaging process that measures the emission of single photons of a given energy from radioactive tracers in the human body.

stigma

A negative stereotype about a group of people.

St. John's wort

An herb sometimes used to treat mild cases of depression. Although the popular media have reported successes using St. John's wort, it is not a recommended treatment. The scientific evidence for its effectiveness and safety is not conclusive.

symptom

Something that indicates the presence of a disease.

synapse

The site where presynaptic and postsynaptic neurons communicate with each other.

synaptic space

The intercellular space between a presynaptic and postsynaptic neuron. Also referred to as the synaptic cleft.

syndrome

A group of symptoms or signs that are characteristic of a disease. In this module, the word syndrome is used as a synonym for illness.

transporter

A large protein on the cell membrane of axon terminals. It removes neurotransmitter molecules from the synaptic space by carrying them back into the axon terminal that released them. Also referred to as the reuptake pump.

ventricle

One of the cavities or spaces in the brain that are filled with cerebrospinal fluid.

vesicle

A membranous sac within an axon terminal that stores and releases neurotransmitters.

Footnotes

1

Relevant to Lessons 1, 2, and 5

2

Relevant to Lesson 3.

3

Relevant to Lessons 2, 3, 4, and 5.

4

Relevant to Lessons 1, 2, and 4.

5

Relevant to Lessons 2, and 3.

6

Relevant to Lessons 4 and 5.

7

Relevant to Lessons 1, 2, 3, 4, and 5.

8

Relevant to Lessons 4 and 5.

9

Relevant to Lessons 2, 3, 4, 5, and 6.

10

In this module, the term depression refers to major depressive disorder. We will use the terms dysthymia and bipolar disorder specifically when we are referring to those types of depressive disorders.

11

Relevant to Lessons 1, 2, 3, 4, 5, and 6.