Download types of mental illness

TYPES OF MENTAL ILLNESS
OVERVIEW
• DEPRESSION
• ANXIETY
• SUBSTANCE ABUSE
DEPRESSION
• UNLIKE SCHIZ AND BIPOLAR
• MUCH MORE COMMON –
ESPECIALLY RECENTLY
• “AGE OF DEPRESSION”
ADULT PREVALENCE
25
20
15
10
5
0
1 year
lifetime
Treatment for Depression
4
3.5
3
2.5
2
% of pop.
1.5
1
0.5
0
1981-82
1991-92
2001-02
Diagnoses in Psychotherapy
40
35
30
25
1987
1997
20
15
10
5
0
Depression
Depression Articles 1966-2001
7000
6000
5000
4000
3000
2000
1000
0
1966 1970 1974 1978 1982 1986 1990 1994 1998
Publications
Psychotropic Prescribing in USA
(IMS - S Units)
10000000
9000000
8000000
7000000
6000000
5000000
4000000
3000000
2000000
1000000
0
Antidepressant
Antipsychotic
1990 1992 1994 1996 1998 2000 2001
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 OF DEPRESSION
• CONTINUOUS
• HOW SEVERE AND HOW LONG
TYPES
• MAJOR DEPRESSION - ABOVE
• PSYCHOTIC (MELANCHOLIC) - MORE
SEVERE, IMMOBILE, SUICIDAL
• DYSTHYMIA – LOWER LEVEL BUT
LONGER LASTING (TWO YEARS)
• DISTRESS - REACTIVE TO LIFE
EVENT, GOES AWAY WHEN
CONDITIONS CHANGE, NOT A
DISORDER
CAUSES
•
•
•
•
•
VARIED
CURRENT LOSSES AND TRAUMAS
CHRONIC OPPRESSIVE SITUATIONS
EARLY LOSS EVENTS AND ABUSE
SOME GENETIC/BIOLOGICAL
CHARACTERISTICS
• GREAT VARIANCE ACROSS SOCIETIES
(3% - 30%)
• IN U.S. 10% EACH YEAR; 20% OVER
LIFETIME
• 2/3 WOMEN
• INVERSE WITH SOCIAL CLASS
• MOST AMONG YOUNG, ELDERLY
PROGNOSIS (COURSE)
• COURSE HIGHLY VARIABLE
• MDD USUALLY RECURRENT
• AVERAGE EPISODE ABOUT 3 - 6
MONTHS
• DYSTHYMIA CHRONIC
• DISTRESS ENDS WITH POSITIVE
EVENTS
TREATMENT
• TREATED WITH SELECTIVE
SEROTONIN REUPTAKE INHIBITORS
(SSRI) - PROZAC, PAXIL, XOLOFT
• NOT MORE EFFECTIVE THAN
EARLIER DRUGS
• FEWER SIDE EFFECTS, BETTER
TOLERATED, LESS ADDICTIVE,
FEWER OVERDOSES
• HIGHER RISK OF SUICIDE?
TREATMENT (CONT.)
• COGNITIVE THERAPY
• PSYCHOTHERAPY
• COMBINATION OF DRUGS AND
PSYCHOLOGICAL THERAPY MIGHT
BE BEST
SYMPTOMS
• PSYCHOLOGICAL
• UNEASE, FEAR, WORRY,
ANXIOUSNESS, DREAD
• PHYSICAL
• HEART PALPITATIONS, TREMBLING,
STOMACH UPSET, FAINTING
MAJOR TYPES
• PHOBIAS - INTENSE FEAR OF A
SPECIFIC OBJECT OR SITUATION
• PANIC - SITUATIONAL, EPISODIC
• GENERALIZED ANXIETY DISORDER
MAJOR TYPES
• OBSESSIVE-COMPULSIVE PREOCCUPYING THOUGHTS OR
BEHAVIORS
MAJOR TYPES
• SOCIAL ANXIETY DISORDER
MAJOR TYPES
• POST-TRAUMATIC STRESS DISORDER
COMORBIDITY
• VERY HIGH COMORBIDITY WITH
DEPRESSION
• MOST DEPRESSED PEOPLE ALSO
ANXIOUS
• ANXIOUS PEOPLE OFTEN DEPRESSED
CHARACTERISTICS
• GREAT VARIANCE ACROSS SOCIETIES
• IN U.S. 20% EACH YEAR, 30% OVER
LIFETIME
SOCIAL CHARACTERISTICS
• 2/3 FEMALE
• HIGH ETHNIC VARIATION
• E.G. BLACKS MORE PHOBIAS,
HISPANICS MORE PANIC, JEWS MORE
OBSESSIVE-COMPULSIVE
TREATMENT
•
•
•
•
MEDICATION
SSRI’S
ANTI-ANXIETY - XANAX
BEHAVIOR THERAPY
SUBSTANCE
DEPENDENCE/ABUSE
• DEPENDENCE
• FREQUENT AND EXCESSIVE USE
• GROWING TOLERANCE/PROBLEMS
WITH WITHDRAWAL
• ABUSE
• PROBLEMATIC CONSEQUENCES OF
USE - FAMILY, WORK, LEGAL
CHARACTERISTICS
• ALCOHOL ABUSE OR DEPENDENCE 10% YEAR, 25% LIFETIME
• DRUG ABUSE OR DEPENDENCE - 3%
YEAR; 12% LIFETIME
CHARACTERISTICS
•
•
•
•
•
2/3 MALE
YOUNG PEOPLE
MIXED RESULTS ON SOCIAL CLASS
MUCH ETHNIC VARIATION
E.G. ISLAMIC, ASIANS, JEWS LITTLE,
IRISH AND EASTERN EUROPE MUCH,
BLACKS CURVILINEAR
TREATMENT
•
•
•
•
VARIATION IN TREAT OR PUNISH?
MUCH TREATMENT INVOLUNTARY
GROUP THERAPY - AA
SOME MEDICATION