TYPES OF MENTAL ILLNESS

OVERVIEW

• DEPRESSION

• ANXIETY

• SUBSTANCE ABUSE

DEPRESSION

• UNLIKE SCHIZ AND BIPOLAR

• MUCH MORE COMMON – ESPECIALLY RECENTLY

• “AGE OF DEPRESSION”

ADULT PREVALENCE

0

5

10

15

20

25

1 year lifetime

Treatment for Depression

0

0.5

1

1.5

2

2.5

3

3.5

4

1981-82 1991-92 2001-02

% of pop.

Diagnoses in Psychotherapy

0

5

10

15

20

25

30

35

40

Depression

19871997

Depression Articles 1966-2001

0

1000

2000

3000

4000

5000

6000

7000

1966 1970 1974 1978 1982 1986 1990 1994 1998

Publications

Psychotropic Prescribing in USA (IMS - S Units)

0100000020000003000000400000050000006000000700000080000009000000

10000000

1990 1992 1994 1996 1998 2000 2001

AntidepressantAntipsychotic

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