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TYPES OF MENTAL ILLNESS

TYPES OF MENTAL ILLNESS. “NEUROSES”. NO BREAK WITH REALITY DEPRESSION, ANXIETY, SUBSTANCE ABUSE VERY COMMON CONTINUOUS NOT DISCRETE MUCH CO-MORBIDITY. DEPRESSION. MOOD. EITHER (OR BOTH) PRESENCE OF NEGATIVE MOOD OR ABSENCE OF POSITIVE MOOD. PHYSICAL SYMPTOMS. LOW ENERGY, FATIGUE

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TYPES OF MENTAL ILLNESS

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  1. TYPES OF MENTAL ILLNESS

  2. “NEUROSES” • NO BREAK WITH REALITY • DEPRESSION, ANXIETY, SUBSTANCE ABUSE • VERY COMMON • CONTINUOUS NOT DISCRETE • MUCH CO-MORBIDITY

  3. DEPRESSION

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

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

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

  7. 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

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

  9. 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

  10. PROGNOSIS (COURSE) • COURSE HIGHLY VARIABLE • MDD FREQUENT AND CHRONIC • DYSTHYMIA CHRONIC • DISTRESS ENDS WITH POSITIVE EVENTS OR ADJUSTMENT

  11. 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?

  12. TREATMENT (CONT.) • COGNITIVE THERAPY • PSYCHOTHERAPY • COMBINATION OF DRUGS AND PSYCHOLOGICAL THERAPY MIGHT BE BEST

  13. ANXIETY DISORDERS

  14. SYMPTOMS • PSYCHOLOGICAL • UNEASE, FEAR, ANXIOUSNESS, DREAD • PHYSICAL • HEART PALPITATIONS, TREMBLING, STOMACH UPSET, FAINTING

  15. MAJOR TYPES • PHOBIAS - INTENSE FEAR OF A SPECIFIC OBJECT OR SITUATION • PANIC - SITUATIONAL, EPISODIC • OBSESSIVE-COMPULSIVE - PREOCCUPYING THOUGHTS OR BEHAVIORS • GENERALIZED ANXIETY DISORDER

  16. COMORBIDITY • VERY HIGH COMORBIDITY WITH DEPRESSION • MOST DEPRESSED PEOPLE ALSO ANXIOUS • ANXIOUS PEOPLE OFTEN DEPRESSED

  17. CHARACTERISTICS • GREAT VARIANCE ACROSS SOCIETIES • IN U.S. 20% EACH YEAR, 30% OVER LIFETIME

  18. SOCIAL CHARACTERISTICS • 2/3 FEMALE • HIGH ETHNIC VARIATION • E.G. BLACKS MORE PHOBIAS, HISPANICS MORE PANIC, JEWS MORE OBSESSIVE-COMPULSIVE

  19. TREATMENT • MEDICATION • ANTI-ANXIETY - XANAX • SSRI’S • BEHAVIOR THERAPY

  20. SUBSTANCE DEPENDENCE/ABUSE • DEPENDENCE • FREQUENT AND EXCESSIVE USE • GROWING TOLERANCE/PROBLEMS WITH WITHDRAWAL • ABUSE • PROBLEMATIC CONSEQUENCES OF USE - FAMILY, WORK, LEGAL

  21. CHARACTERISTICS • ALCOHOL ABUSE OR DEPENDENCE - 10% YEAR, 25% LIFETIME • DRUG ABUSE OR DEPENDENCE - 3% YEAR; 12% LIFETIME

  22. 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

  23. TREATMENT • VARIATION IN TREAT OR PUNISH? • MUCH TREATMENT INVOLUNTARY • GROUP THERAPY - AA • LESS MEDICATION

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