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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)
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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
Treatment for Depression Kessler et al. 2003
Diagnoses in Psychotherapy 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