Transcript types of mental illness

SCHIZOPHRENIA
DISABILITIES
• POOR SOCIAL, FAMILY, AND WORK
RELATIONSHIPS
• SIDE EFFECTS OF MEDICATION
• VIOLENCE WHEN IN PSYCHOTIC
STATE
• SOCIAL STIGMA
CAUSES
• USED TO THINK BAD FAMILIES WERE
CAUSE (SCHIZOPHRENOGENIC
MOTHER)
• NOW THOUGHT TO BE BRAIN
DISORDER WITH GENETIC OR
BIOLOGICAL CAUSE
CORRELATES
• ABOUT 1% PREVALENCE IN WIDE
VARIETY OF TIMES AND PLACES
• NO SEX DIFFERENCES
• NO ETHNIC DIFFERENCES
• NO INTELLIGENCE DIFFERENCES
• EARLY ONSET - 16-25 YEARS
• LOWER SOCIAL CLASS - CAUSE?
• FEW ARE MARRIED
PROGNOSIS (COURSE)
• USED TO THINK DEGENERATIVE
• NOW THOUGHT TO BE VARIABLE
• 1/3 CHRONIC; 1/3 EPISODIC; 1/3
RECOVER
• HIGH RATE OF SUICIDE - 10%
TREATMENT
• USED TO BE LONG STAYS IN MENTAL
HOSPITALS
• NOW BRIEF, EPISODIC HOSPITAL
STAYS ALONG WITH COMMUNITY
TREATMENT (OR NEGLECT)
• MEDICATION SINCE 1950’S
• PHENOTHIAZINES AND CLOZAPINE
TREATMENT
• MEDICATION DOESN’T CURE, BUT
CONTAINS - BUT MUST TAKE IT
• PSYCHOSOCIAL TREATMENTS SOCIAL AND JOB SKILLS, HOUSING
• PSYCHOTHERAPY LESS CRITICAL
• HARDEST TO TREAT - MICA
(MENTALLY ILL CHEMICAL
ABUSERS)
MAJOR PROBLEMS
• INADEQUATE FUNDING FOR
TREATMENT
• MANY DON’T ADMIT THAT THEY ARE
ILL - STOP TAKING MEDICATIONS
• WHEN GET IN TROUBLE PUT IN JAILS
AND PRISONS
DYSREGULATION OF MOOD
• ALTERATIONS OF WILD ELATION
AND DEEP DEPRESSION
• CAN BE ACCOMPANIED BY
DELUSIONS AND HALLUCINATIONS
• VERY DIFFERENT
INTERPERSONALLLY THAN
SCHIZOPHRENIA - CONNECTEDNESS
MANIC PHASE
• SUPER-CHARGED ENERGY WHEN
MANIC (67)
• CREATES BEHAVIOR PROBLEMS (74)
• CAN BE VIOLENT (120)
• HIGH RATE OF ALCOHOL AND DRUG
ABUSE
• HIGH CREATIVITY AND
PRODUCTIVITY
DEPRESSIVE PHASE
• TOTAL BLEAKNESS WHEN
DEPRESSED (111)
• HIGH RATE OF SUICIDE
CAUSE
• RUNS IN FAMILIES
• PROBABLE GENETIC CAUSE
• SEEMS TO BE UNIVERSAL
CORRELATES
•
•
•
•
•
PREVALENCE BETWEEN 1/2% TO 1%
NO SOCIAL CLASS DIFFERENCES
NO ETHNIC DIFFERENCES
SLIGHT SEX DIFFERENCE
ONSET WAS 30-50 BUT GETTING
YOUNGER
COURSE AND TREATMENT
• HIGHLY VARIABLE COURSE, BUT
USUALLY CHRONIC
• MUCH HIGHER SOCIAL
FUNCTIONING THAN
SCHIZOPHRENIA
• LITHIUM MOST COMMON
TREATMENT SINCE 1950’S
• CAN CONTROL CYCLES
JAMISON - UNQUIET MIND
• DIFFICULTIES OF TREATMENT
• AMBIVALENCE TOWARD
MEDICATION (98)
• IMPORTANCE OF SOCIAL SUPPORT INFORMAL AND PROFESSIONAL
• YAVI ASPECT?
DEPRESSION
• MUCH MORE COMMON THAN SCHIZ
AND BIPOLAR
• 10% EACH YEAR; 20% OVER
LIFETIME
• SEEMS TO BE INCREASING
Depression Articles 1966-2001
7000
6000
5000
4000
3000
2000
1000
0
1966 1970 1974 1978 1982 1986 1990 1994 1998
Publications
Treatment for Depression
4
3.5
3
2.5
2
% of pop.
1.5
1
0.5
0
1981-82
1991-92
2001-02
Kessler et al. 2003
Diagnoses in Psychotherapy
40
35
30
25
20
1987
1997
15
10
5
0
Depression
None
Specified
Olfson et al. 2002
MOOD
• EITHER (OR BOTH) PRESENCE OF
NEGATIVE MOOD
• OR ABSENCE OF POSITIVE MOOD
PHYSICAL SYMPTOMS
•
•
•
•
LOW ENERGY, FATIGUE
SLEEP DISTURBANCES
APPETITE DISTURBANCES
VULNERABILITY TO MANY
PHYSICAL ILLNESSES
PSYCHOLOGICAL SYMPTOMS
• EMOTIONAL - SADNESS, APATHY,
LACK OF PLEASURE
• COGNITIVE - HOPELESSNESS AND
HELPLESSNESS, LOW SELF-ESTEEM
• BEHAVIORAL - WITHDRAWAL,
SUICIDE ATTEMPTS
TYPES
• MAJOR DEPRESSION - ABOVE
• PSYCHOTIC - MORE SEVERE,
IMMOBILE, SUICIDAL
• DYSTHYMIC - LONGER LASTING
(TWO YEARS) FEWER SYMPTOMS
• DISTRESS - REACTIVE TO LIFE
EVENT, NOT A DISORDER
CAUSES
•
•
•
•
VARIED
SOME GENETIC
EARLY LOSS EVENTS AND ABUSE
CURRENT LOSSES AND TRAUMAS
CHARACTERISTICS
• GREAT VARIANCE ACROSS SOCIETIES
(3% - 30%)
• 2/3 WOMEN
• INVERSE WITH SOCIAL CLASS
• MOST AMONG YOUNG, ELDERLY
PROGNOSIS (COURSE)
• COURSE HIGHLY VARIABLE
• OFTEN FREQUENT AND CHRONIC
• OFTEN ENDS WITH FRESH START
EVENTS
TREATMENT
• TREATED WITH SELECTIVE
SEROTONIN REUPTAKE INHIBITORS
(SSRI) - PROZAC, PAXIL, XOLOFT
TREATMENT
• COGNITIVE THERAPY
• PSYCHOTHERAPY
• COMBINATION OF THERAPIES