The mandate of Canadian Mental Health Association/Peel Branch, which is determined by our Board of Directors, is to serve individuals with severe mental illness, the most prevalent illnesses being schizophrenia, psychotic and mood disorders. However, our Resource Centre receives calls about several issues, including the ones below.

The content below is provided for information purposes only. For additional detail, we suggest that you visit the websites listed or www.211ontario.ca for service listings across Ontario and searchable by geographical area served.

The following information is paraphrased from a book called DSM-IV Made Easy. The Diagnostic and Statistical Manual of Mental Disorders-IV, or DSM-IV provides clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study, and treat people with various mental disorders. DSM-IV Made Easy provides easier to understand information and a copy is available in our library.

Cognitive Disorders
     Delirium
     Dementia (Alzheimer’s)
     Amnestic Disorder)

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
     Mental Retardation
     Learning Disorders
     Pervasive Developmental Disorders (Autism, Rett’s, Asperger’s)
     Attention-Deficit/Hyperactivity Disorder
     Conduct Disorder
     Oppositional Defiant Disorder
     Tourette’s Disorder
     Separation Anxiety Disorder

Suggested Websites

Anxiety Disorders Association of Ontario – www.anxietydisordersontario.ca
Autism Ontario – www.autismontario.com
Asperger’s Society of Ontario – www.aspergers.ca
Canadian Neurological Sciences Federation – www.cnsfederation.org (click on General Information and scroll to Canadian Brain and Nerve Health Coalition for agency listings)
Children’s Mental Health Ontario – www.kidsmentalhealth.ca
Learning Disabilities Association of Ontario – www.ldao.ca
Ontario Association on Developmental Disabilities – www.oadd.org
Tourette Syndrome Association of Ontario – www.tourettesyndromeontario.ca

American:
National Institute of Neurological Disorders and Stroke – www.ninds.nih.gov (click on Disorders for links to more information and resources)

Cognitive Disorders

Cognitive Disorders include but are not limited to:

Delirium
Dementia (Alzheimer’s)
Amnestic Disorder

Delirium

Delirium is the most common cognitive disorder. It usually begins suddenly and fluctuates in intensity, often lasting less than a week. Sometimes mistaken for other mental disorders including psychosis, depression, mania, hysteria, or a personality disorder, it can be caused by a general medical condition, be substance-induced, or due to multiple causes. Delirium is a disease that changes the way the brain works.

Symptoms include:

• Decreased awareness of one’s environment,
• A cognitive deficit

Decreased awareness looks like this:

• Someone finds it difficult to maintain and/or shift attention during interactions with others
• He/she might become drowsy or sleepy
• His/her thinking slows, making problem solving more difficult
• He/she might be easily distracted, rapidly shifting focus from one thing to another.

The cognitive deficit shows up in:

• Language – rambling, disjointed, pressured, or incoherent speech, or speech leaping from one topic to another; may also have difficulty writing or naming things
   
• Memory – recent events aren’t remembered; older memories (especially from childhood) are usually the last to go
   
• Orientation – at first there is disorientation about date, day, month, year, then place, relatives and friends. (People remember their own identities except in severe cases.)
   
• Perception – boundaries are fuzzy, colours are brighter, and images distorted. Some may have illusions (misidentifying what they see), false perceptions (hallucinations), and in later stages might have incomplete, changing, or poorly organized delusions (false beliefs attached to hallucinations).

Dementia (including Alzheimer’s)

Dementia means “loss.” The disorder, which usually starts gradually, includes a decline from a previous level of functioning, and memory loss. As with delirium, recent memories go first. As a dementia worsens, remote memories go. In addition to memory loss, someone with dementia suffers at least one of the following cognitive deficits:

• aphasia (can’t remember words, so they use wordy, roundabout expressions)
• apraxia (although physically capable of performing some motor acts, they are unable to do so)
• agnosia (failure to recognize or identify objects despite intact sensory function)

People with dementia are vulnerable to psychosocial stresses. Some might become paranoid or irritable; others might shoplift; some might compulsively make lists. If they become frustrated or frightened they may have angry outbursts, or become restless and pace. People may wander from home. In the final stage of dementia, they may lose all useful speech and self-care. Medical and neurological evaluation is necessary to diagnose dementia. The cause is often biological, e.g. Huntington’s disease, multiple sclerosis, AIDS.

The most common cause of senility, Dementia of the Alzheimer’s type, affects about 3% of people over age 65. The risk increases with age. The first sign is a change in personality. Someone may become more obsessive, secretive or sexually active. Alternatively he/she may become apathetic, more emotional, or lose his/her sense of humour. Typically an Alzheimer’s patient will live six to eight years after the disease begins, following these stages:

• one to three years of growing forgetfulness
• two to three years of increasing disorientation, loss of language skills and inappropriate behaviour. Hallucinations and delusions may appear
• a final period of severe dementia, which includes disorientation and loss of self-care

Amnestic Disorder

Most people have heard the word “amnesia.” All amnestic disorders are due to brain damage. It could be due to head trauma, surgery of the temporal lobe, hypoxia, stroke, or some forms of encephalitis, but the most frequent cause is chronic alcohol use with accompanying vitamin B1 (thiamine) deficiency. A person with an amnestic disorder has severe short term memory loss – enough so that he/she can’t recall events that occurred moments earlier. However, he/she can usually repeat what he/she has just heard. Persons are disoriented for time and often for place. Some don’t care about their memory problems; others do and make up stories to hide it.

When the disorder is due to a general medical condition:

• the person develops impaired memory and can’t learn new or recall old information
• symptoms impair work functioning
• symptoms don’t occur solely during a delirium or dementia
• history, physical exam or laboratory data shows that a general medical condition probably directly caused the disorder

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

The disorders categorized as being usually first diagnosed in childhood include but are not limited to:

Mental Retardation
Learning Disorders
Pervasive Developmental Disorders (Autism, Rett’s, Asperger’s)
Attention-Deficit/Hyperactivity Disorder
Conduct Disorder
Oppositional Defiant Disorder
Tourette’s Disorder
Separation Anxiety Disorder

This is a separate section in the DSM and is provided for convenience only, not meant to suggest that there is any clear distinction between “childhood” and “adult” disorders. Although most individuals with these disorders seek help during childhood or adolescence, sometimes the disorders are not diagnosed until adulthood.

Mental Retardation

Mental Retardation is a behavioural syndrome related to low intelligence. Onset is usually in infancy or before birth. Before age 18 it’s mental retardation; after 18 yr. it’s a dementia. These two criteria are necessary for a diagnosis:

• A standard individual IQ test results in an IQ of less than 70
• Impaired ability to adapt to the demands of normal life

Causes are:

• Genetic – about 5% (Chromosomal abnormalities, Tay-Sachs, tuberous sclerosis)
• Early Pregnancy Factors – about 30% (Trisomy 21 – Down’s syndrome, substance use by mother, infections)
• Later Pregnancy and Perinatal Factors – about 10% (Prematurity, anoxia, birth trauma, fetal malnutrition)
• Acquired Childhood Physical Conditions – about 5% (Lead poisoning, infections, trauma)
• Environmental Influences and Mental Disorders – about 20% (Cultural deprivation, early-onset schizophrenia)
• Unknown Factors – about 30% (no identifiable cause)

It affects about 1% of the population. Males outnumber females about three to two. Most (85%) have Mild Mental Retardation (IQ of 50 to 70) and are educable. About 10% have Moderate Mental Retardation (IQ high 30’s to low 50’s) and can learn social and occupational skills but may never be able to live independently. Less than 5% have Severe Mental Retardation (IQ low 20’s to high 30’s) and may learn to perform simple jobs and read a few words. Only 1% – 2% have Profound Mental Retardation (IQ in the low 20’s or below).

Co-occurring mental retardation or intellectual disability and mental illness is known as dual diagnosis.

Learning Disorders

People with learning disorders have far more difficulty learning certain academic skills. Diagnosis must be made from a standardized, individualized test. These tests show that a person’s ability to read, do math or write are substantially less than what would be expected for their age, intelligence and education. Learning disorders include:

• Reading Disorder
• Mathematics Disorder
• Disorder of Written Expression

Pervasive Developmental Disorders (Autism, Rett’s, Asperger’s)

With Pervasive Developmental Disorders, children fail to develop normally in a number of areas, including the ability to:

• Interact socially
• Communicate verbally and nonverbally
• Use their imaginations

Autistic Disorder, Rett’s Disorder and Asperger’s Disorder are considered Pervasive Developmental Disorders. A child with Autistic Disorder has impaired social interactions and communications, and stereotyped behaviours and interests. Rett’s Disorder is characterized by slow head growth, delayed language, poorly coordinated gait, and loss of purposeful hand movements and social engagement. Although similar to Autistic Disorder, a child with Asperger’s Disorder does not have delayed/impaired language.

Attention-Deficit/Hyperactivity Disorder

Some mothers say their children kicked more in utero, or cried more as a baby. Symptoms of ADHD (Attention-Deficit Hyperactivity Disorder) typically begin before a child starts school but the disorder is not usually diagnosed until age 9. Children usually have a normal IQ but because of trouble focusing, may not do well in school. Tending to be impulsive they may say things that hurt others’ feelings, making them unpopular. A person with ADHD has trouble sitting quietly and needs to be “on the go.” Many children have a learning disability in reading, and a Conduct Disorder or Oppositional Defiant Disorder.

Generally, impulsive behaviour decreases during the teen years, but in some cases, a teen might use substances. Some adults continue to have interpersonal problems, a quick temper, and difficulty dealing with stress.

Conduct Disorder

After 12 months or more of repeatedly violating rules, age-appropriate societal norms or the rights of others, Conduct Disorder may be diagnosed. Three or more of the following behaviours must have occurred in the previous six months:

• Frequent bullying or threatening
• Starts fights often
• Uses weapon that could cause serious injury (gun, knife, club, broken glass)
• Physical cruelty to people
• Physical cruelty to animals
• Theft with confrontation (armed robbery, extortion, mugging, purse snatching)
• Forced sex on someone
• Deliberately set fires to cause serious damage
• Deliberately destroyed property of others
• Break and enter
• Frequent lies or broken promises to avoid obligations
• Burglary, forgery, or shoplifting
• Stays out at night against parents’ wishes (before age 13)
• Run away overnight twice or more (or once for extended period)
• Frequent truancy before age 13

Oppositional Defiant Disorder

After six or more months if someone shows defiant, hostile, negativistic behaviour, Oppositional Defiant Disorder (ODD) may be diagnosed. The symptoms must impair work, school or social functioning and not occur during a mood or psychotic disorder. As well four or more of the following must be present:

• Losing temper
• Arguing with adults
• Actively defying or refusing to carry out the rules or requests of adults
• Deliberately doing things that annoy others
• Blaming others for own mistakes or misbehaviour
• Being touchy or easily annoyed by others
• Being angry and resentful
• Being spiteful or vindictive

Tourette’s Disorder

Tourette’s Disorder is a Tic Disorder, characterized by one or more vocal tics and multiple motor tics. A “tic” is a movement or vocalization that is non-rhythmic, rapid, repeated, stereotyped, and sudden. Work, social or personal functioning is impaired.

Eye blinking is often the first motor tic symptom. Some tics are complex, e.g. someone might do deep knee bends, retrace steps, or twirl while walking. The location and severity of tics can change with time.

Vocal tics include barks, clicks, coughs, grunts and understandable words. Between 10% and 30% have “coprolalia,” meaning that they utter obscenities.

The average onset is age 7; most have the disorder before age 18. With maturity, many people can suppress their tics, but not for more than three consecutive months.

Separation Anxiety Disorder

If someone experiences excessive anxiety that is inappropriate to their development stage, about being separated from home or the people they’re attached to, a diagnosis of Separation Anxiety Disorder may be made. The symptoms must last for more than four weeks, begin before age 18, impair school, social or personal functioning and do not occur during a pervasive developmental disorder or psychotic disorder. Sometimes the disorder develops after a life stress, e.g. death of relative or pet, move to new neighbourhood. Three or more of the following symptoms must persist/recur:

• Excessively distressed anticipating or experiencing separation from home/parents
• Excessively worried about loss of or harm to parents
• Excessively worried about being separated from parent by a serious event (e.g. becoming lost)
• Refuses or is reluctant to go somewhere (e.g. school) because of separation fears
• Excessively afraid to be alone, without parents at home
• Refuses or is reluctant to sleep away from home or go to sleep without being near parent
• Recurrent nightmares about separation
• Recurrent physical symptoms