TYPES OF MENTAL ILLNESS

1. TYPES OF MENTAL ILLNESS

2. OVERVIEW • DEPRESSION • ANXIETY • SUBSTANCE ABUSE

3. DEPRESSION

4. DEPRESSION • UNLIKE SCHIZ AND BIPOLAR • MUCH MORE COMMON – ESPECIALLY RECENTLY • “AGE OF DEPRESSION”

5. ADULT PREVALENCE

6. Treatment for Depression

7. Diagnoses in Psychotherapy

8. Depression Articles 1966-2001

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

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

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

14. TYPES OF DEPRESSION • CONTINUOUS • HOW SEVERE AND HOW LONG

15. 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

16. CAUSES

19. CAUSES • VARIED • CURRENT LOSSES AND TRAUMAS • CHRONIC OPPRESSIVE SITUATIONS • EARLY LOSS EVENTS AND ABUSE • SOME GENETIC/BIOLOGICAL

20. 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

21. PROGNOSIS (COURSE) • COURSE HIGHLY VARIABLE • MDD USUALLY RECURRENT • AVERAGE EPISODE ABOUT 3 - 6 MONTHS • DYSTHYMIA CHRONIC • DISTRESS ENDS WITH POSITIVE EVENTS

22. TREATMENT

23. 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?

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

25. ANXIETY DISORDERS

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

27. MAJOR TYPES • PHOBIAS - INTENSE FEAR OF A SPECIFIC OBJECT OR SITUATION • PANIC - SITUATIONAL, EPISODIC • GENERALIZED ANXIETY DISORDER

28. MAJOR TYPES • OBSESSIVE-COMPULSIVE - PREOCCUPYING THOUGHTS OR BEHAVIORS

29. MAJOR TYPES • SOCIAL ANXIETY DISORDER

30. MAJOR TYPES • POST-TRAUMATIC STRESS DISORDER

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

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

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

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

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

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

37. 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

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