TYPES OF MENTAL ILLNESS

“NEUROSES”

• NO BREAK WITH REALITY

• DEPRESSION, ANXIETY, SUBSTANCE ABUSE

• VERY COMMON

• CONTINUOUS NOT DISCRETE

• MUCH CO-MORBIDITY

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• DYSTHYMIA - LONGER LASTING

(TWO YEARS), LOWER LEVEL• DISTRESS - REACTIVE TO LIFE

EVENT, GOES AWAY WHEN CONDITIONS CHANGE, NOT A DISORDER

CAUSES

• VARIED

• SOME GENETIC

• EARLY LOSS EVENTS AND ABUSE

• CURRENT LOSSES OR TRAUMAS

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 FREQUENT AND CHRONIC

• DYSTHYMIA CHRONIC

• DISTRESS ENDS WITH POSITIVE EVENTS OR ADJUSTMENT

TREATMENT

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

• NOT MORE EFFECTIVE THAN OLDER DRUGS

• 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, ANXIOUSNESS, DREAD

• PHYSICAL

• HEART PALPITATIONS, TREMBLING, STOMACH UPSET, FAINTING

MAJOR TYPES

• PHOBIAS - INTENSE FEAR OF A SPECIFIC OBJECT OR SITUATION

• PANIC - SITUATIONAL, EPISODIC

• OBSESSIVE-COMPULSIVE - PREOCCUPYING THOUGHTS OR BEHAVIORS

• GENERALIZED ANXIETY 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

• ANTI-ANXIETY - XANAX

• SSRI’S

• 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

• LESS MEDICATION