types of mental illness. overview depression anxiety substance abuse
Post on 19-Dec-2015
220 views
TRANSCRIPT
DEPRESSION
• UNLIKE SCHIZ AND BIPOLAR
• MUCH MORE COMMON – ESPECIALLY RECENTLY
• “AGE OF DEPRESSION”
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
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 (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
COMORBIDITY
• VERY HIGH COMORBIDITY WITH DEPRESSION
• MOST DEPRESSED PEOPLE ALSO ANXIOUS
• ANXIOUS PEOPLE OFTEN DEPRESSED
SOCIAL CHARACTERISTICS
• 2/3 FEMALE
• HIGH ETHNIC VARIATION
• E.G. BLACKS MORE PHOBIAS, HISPANICS MORE PANIC, JEWS MORE OBSESSIVE-COMPULSIVE
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