Transcript September 12, Schizophrenia

TWO TOPICS
• DEFINITION OF MENTAL ILLNESS
• NATURE OF SCHIZOPHRENIA
WHY WANT DEFINITION OF
MENTAL ILLNESS?
• DISTINGUISH FROM NORMAL
• INDICATE NEED FOR MENTAL
HEALTH TREATMENT
• WHAT CONDITIONS SHOULD BE
REIMBURSED?
• DETERMINE CRIMINAL LIABILITY PUNISH OR TREAT?
DSM-IV DEFINITION (1)
• “MENTAL DISORDER IS A
CLINICALLY SIGNIFICANT
BEHAVIORAL OR PSYCHOLOGICAL
PATTERN THAT IS ASSOCIATED WITH
PRESENT DISTRESS OR DISABILITY.”
DISTRESS OR DISABILITY
• MUST HAVE EITHER DISTRESS
(MENTAL PAIN) OR DISABILITY (LOSS
OF FUNCTIONING)
• EITHER MUST REALLY BOTHER
PEOPLE - E.G. THINK LEFT STOVE ON
• OR HAVE NEGATIVE IMPACT ON
THEIR LIVES - E.G. SCHIZOPHRENIA
DSM (2)
• “IN ADDITION, THIS PATTERN MUST
NOT BE MERELY AN EXPECTABLE
AND CULTURALLY SANCTIONED
RESPONSE TO A PARTICULAR EVENT,
FOR EXAMPLE, THE DEATH OF A
LOVED ONE.”
NOT EXPECTABLE RESPONSE
•
•
•
•
•
BEREAVEMENT EXCLUSION
SYMPTOMS ARE NORMAL
ROMANTIC BREAKUPS
SOLDIER ENTERING COMBAT
MUST KNOW CONTEXT
DSM (3)
• “WHATEVER ITS ORIGINAL CAUSE, IT
MUST CURRENTLY BE A
BEHAVIORAL, PSYCHOLOGICAL, OR
BIOLOGICAL DYSFUNCTION IN THE
INDIVIDUAL.”
INTERNAL DYSFUNCTION
• SOME PSYCHOLOGICAL SYSTEM
(MOOD, FEAR, THOUGHT, EMOTION,
ETC.) IS NOT FUNCTIONING
PROPERLY - SOMETHING IS WRONG
• WRONG CONTEXT OR TOO SEVERE
OR TOO ENDURING
• MANY CAUSES – BIOLOGICAL,
PSYCH., SOCIAL – OF M.I.
DSM (4)
• “NEITHER DEVIANT BEHAVIOR (E.G.
POLITICAL, RELIGIOUS, OR SEXUAL)
NOR CONFLICTS BETWEEN THE
INDIVIDUAL AND SOCIETY ARE
MENTAL DISORDERS UNLESS THE
DEVIANCE OR CONFLICT IS A
SYMPTOM OF A DYSFUNCTION IN
THE INDIVIDUAL.”
DEVIANCE OR M.I.?
• ONLY MENTAL DISORDER WHEN
SOME MECHANISM IS UNABLE TO
FUNCTION AS IT IS SUPPOSED TO
• ALCOHOLIC OR ADDICT WHO CAN’T
STOP DRINKING OR TAKING DRUGS
• NOT JUST DEFIANCE OF RULES
• VERY DIFFICULT TO DISTINGUISH
SUMMARY
• MENTAL DISORDER IS HARMFUL
INTERNAL DYSFUNCTION
• CAUSES CAN BE PSYCHOLOGICAL,
BIOLOGICAL, OR SOCIAL
• DISTINGUISH FROM EXPECTABLE
RESPONSES TO STRESSORS AND
FROM SOCIAL DEVIANCE
PSYCHOSES
• MOST SEVERE KIND OF M.I.
• SCHIZOPHRENIA
• BI-POLAR (MANIC DEPRESSION)
SCHIZOPHRENIA
• PERHAPS MOST IMPORTANT MENTAL
ILLNESS
• CREATES STEREOTYPE OF MENTAL
ILLNESS - CRAZY, NUTS, BIZARRE
IMPORTANCE
• MOST ADMISSIONS AND RESIDENTS
OF PUBLIC MENTAL HOSPITALS
• SEVERITY AND CHRONICITY MEAN
COSTLY AND DIFFICULT TO TREAT
• PUBLIC POLICY - HOMELESSNESS,
NOTORIOUS CRIMES
• TREMENDOUS PERSONAL AND
FAMILY BURDEN
A BEAUTIFUL MIND
• JOHN NASH
SYMPTOMS
• THOUGHT DISORDER
POSITIVE SYMPTOMS
• THOUGHT INSERTION AND
BROADCAST
• LOOSE ASSOCIATION
• HALLUCINATIONS
• DELUSIONS – PARANOIA,
GRANDIOSITY
Source: www.wheelmeon.org/schizophrenia.jpg
1993
Source: http://www.wheelmeon.org/schizophrenia.jpg
NEGATIVE SYMPTOMS
• FLAT AFFECT
• LACK OF PLEASURE - ANHEDONIA
• ISOLATION
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
• ABOUT 1% PREVALENCE IN WIDE
VARIETY OF TIMES AND PLACES
CORRELATES
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LOW SOCIAL CLASS
CAUSE OR CONSEQUENCE?
NO SEX DIFFERENCES
NO ETHNIC DIFFERENCES
NO INTELLIGENCE DIFFERENCES
EARLY ONSET - 16-25 YEARS
ALMOST ALL NOT 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