Understanding Schizophrenia, Bipolar Disorder, and Depression

1. TYPES OF MENTAL ILLNESS

2. SCHIZOPHRENIA

3. DISABILITIES • POOR SOCIAL, FAMILY, AND WORK RELATIONSHIPS • SIDE EFFECTS OF MEDICATION • VIOLENCE WHEN IN PSYCHOTIC STATE • SOCIAL STIGMA

4. CAUSES • USED TO THINK BAD FAMILIES WERE CAUSE (SCHIZOPHRENOGENIC MOTHER) • NOW THOUGHT TO BE BRAIN DISORDER WITH GENETIC OR BIOLOGICAL CAUSE

5. 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

6. 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%

7. 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

9. 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)

10. 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

11. BI-POLAR DISORDER

12. DYSREGULATION OF MOOD • ALTERATIONS OF WILD ELATION AND DEEP DEPRESSION • CAN BE ACCOMPANIED BY DELUSIONS AND HALLUCINATIONS • VERY DIFFERENT INTERPERSONALLLY THAN SCHIZOPHRENIA - CONNECTEDNESS

13. 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

15. DEPRESSIVE PHASE • TOTAL BLEAKNESS WHEN DEPRESSED (111) • HIGH RATE OF SUICIDE

16. CAUSE • RUNS IN FAMILIES • PROBABLE GENETIC CAUSE • SEEMS TO BE UNIVERSAL

17. CORRELATES • PREVALENCE BETWEEN 1/2% TO 1% • NO SOCIAL CLASS DIFFERENCES • NO ETHNIC DIFFERENCES • SLIGHT SEX DIFFERENCE • ONSET WAS 30-50 BUT GETTING YOUNGER

18. 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

20. JAMISON - UNQUIET MIND • DIFFICULTIES OF TREATMENT • AMBIVALENCE TOWARD MEDICATION (98) • IMPORTANCE OF SOCIAL SUPPORT - INFORMAL AND PROFESSIONAL • YAVI ASPECT?

21. DEPRESSION

22. DEPRESSION • MUCH MORE COMMON THAN SCHIZ AND BIPOLAR • 10% EACH YEAR; 20% OVER LIFETIME • SEEMS TO BE INCREASING

23. Depression Articles 1966-2001

24. Treatment for Depression Kessler et al. 2003

25. Diagnoses in Psychotherapy Olfson et al. 2002

28. MOOD • EITHER (OR BOTH) PRESENCE OF NEGATIVE MOOD • OR ABSENCE OF POSITIVE MOOD

29. PHYSICAL SYMPTOMS • LOW ENERGY, FATIGUE • SLEEP DISTURBANCES • APPETITE DISTURBANCES • VULNERABILITY TO MANY PHYSICAL ILLNESSES

30. PSYCHOLOGICAL SYMPTOMS • EMOTIONAL - SADNESS, APATHY, LACK OF PLEASURE • COGNITIVE - HOPELESSNESS AND HELPLESSNESS, LOW SELF-ESTEEM • BEHAVIORAL - WITHDRAWAL, SUICIDE ATTEMPTS

31. TYPES • MAJOR DEPRESSION - ABOVE • PSYCHOTIC - MORE SEVERE, IMMOBILE, SUICIDAL • DYSTHYMIC - LONGER LASTING (TWO YEARS) FEWER SYMPTOMS • DISTRESS - REACTIVE TO LIFE EVENT, NOT A DISORDER

32. CAUSES • VARIED • SOME GENETIC • EARLY LOSS EVENTS AND ABUSE • CURRENT LOSSES AND TRAUMAS

33. CHARACTERISTICS • GREAT VARIANCE ACROSS SOCIETIES (3% - 30%) • 2/3 WOMEN • INVERSE WITH SOCIAL CLASS • MOST AMONG YOUNG, ELDERLY

34. PROGNOSIS (COURSE) • COURSE HIGHLY VARIABLE • OFTEN FREQUENT AND CHRONIC • OFTEN ENDS WITH FRESH START EVENTS

35. TREATMENT • TREATED WITH SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) - PROZAC, PAXIL, XOLOFT

37. TREATMENT • COGNITIVE THERAPY • PSYCHOTHERAPY • COMBINATION OF THERAPIES

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