SCHIZOPHRENIA DISABILITIES POOR SOCIAL, FAMILY, AND WORK RELATIONSHIPS SIDE EFFECTS OF MEDICATION VIOLENCE WHEN IN PSYCHOTIC STATE SOCIAL STIGMA.

SCHIZOPHRENIA

DISABILITIES

• POOR SOCIAL, FAMILY, AND WORK RELATIONSHIPS

• SIDE EFFECTS OF MEDICATION

• VIOLENCE WHEN IN PSYCHOTIC STATE

• SOCIAL STIGMA

CAUSES

• USED TO THINK BAD FAMILIES WERE CAUSE (SCHIZOPHRENOGENIC MOTHER)

• NOW THOUGHT TO BE BRAIN DISORDER WITH GENETIC OR BIOLOGICAL CAUSE

CORRELATES

• ABOUT 1% PREVALENCE IN WIDE VARIETY OF TIMES AND PLACES

• NO SEX DIFFERENCES• NO ETHNIC DIFFERENCES• NO INTELLIGENCE DIFFERENCES• EARLY ONSET - 16-25 YEARS• LOWER SOCIAL CLASS - CAUSE?• FEW ARE MARRIED

PROGNOSIS (COURSE)

• USED TO THINK DEGENERATIVE

• NOW THOUGHT TO BE VARIABLE

• 1/3 CHRONIC; 1/3 EPISODIC; 1/3 RECOVER

• HIGH RATE OF SUICIDE - 10%

TREATMENT

• USED TO BE LONG STAYS IN MENTAL HOSPITALS

• NOW BRIEF, EPISODIC HOSPITAL STAYS ALONG WITH COMMUNITY TREATMENT (OR NEGLECT)

• MEDICATION SINCE 1950’S

• PHENOTHIAZINES AND CLOZAPINE

TREATMENT

• MEDICATION DOESN’T CURE, BUT CONTAINS - BUT MUST TAKE IT

• PSYCHOSOCIAL TREATMENTS - SOCIAL AND JOB SKILLS, HOUSING

• PSYCHOTHERAPY LESS CRITICAL

• HARDEST TO TREAT - MICA (MENTALLY ILL CHEMICAL ABUSERS)

MAJOR PROBLEMS

• INADEQUATE FUNDING FOR TREATMENT

• MANY DON’T ADMIT THAT THEY ARE ILL - STOP TAKING MEDICATIONS

• WHEN GET IN TROUBLE PUT IN JAILS AND PRISONS

DYSREGULATION OF MOOD

• ALTERATIONS OF WILD ELATION AND DEEP DEPRESSION

• CAN BE ACCOMPANIED BY DELUSIONS AND HALLUCINATIONS

• VERY DIFFERENT INTERPERSONALLLY THAN SCHIZOPHRENIA - CONNECTEDNESS

MANIC PHASE

• SUPER-CHARGED ENERGY WHEN MANIC (67)

• CREATES BEHAVIOR PROBLEMS (74)

• CAN BE VIOLENT (120)

• HIGH RATE OF ALCOHOL AND DRUG ABUSE

• HIGH CREATIVITY AND PRODUCTIVITY

DEPRESSIVE PHASE

• TOTAL BLEAKNESS WHEN DEPRESSED (111)

• HIGH RATE OF SUICIDE

CAUSE

• RUNS IN FAMILIES

• PROBABLE GENETIC CAUSE

• SEEMS TO BE UNIVERSAL

CORRELATES

• PREVALENCE BETWEEN 1/2% TO 1%

• NO SOCIAL CLASS DIFFERENCES

• NO ETHNIC DIFFERENCES

• SLIGHT SEX DIFFERENCE

• ONSET WAS 30-50 BUT GETTING YOUNGER

COURSE AND TREATMENT

• HIGHLY VARIABLE COURSE, BUT USUALLY CHRONIC

• MUCH HIGHER SOCIAL FUNCTIONING THAN SCHIZOPHRENIA

• LITHIUM MOST COMMON TREATMENT SINCE 1950’S

• CAN CONTROL CYCLES

JAMISON - UNQUIET MIND

• DIFFICULTIES OF TREATMENT

• AMBIVALENCE TOWARD MEDICATION (98)

• IMPORTANCE OF SOCIAL SUPPORT - INFORMAL AND PROFESSIONAL

• YAVI ASPECT?

DEPRESSION

• MUCH MORE COMMON THAN SCHIZ AND BIPOLAR

• 10% EACH YEAR; 20% OVER LIFETIME

• SEEMS TO BE INCREASING

Depression Articles 1966-2001

0

1000

2000

3000

4000

5000

6000

7000

1966 1970 1974 1978 1982 1986 1990 1994 1998

Publications

Treatment for Depression

0

0.5

1

1.5

2

2.5

3

3.5

4

1981-82 1991-92 2001-02

% of pop.

Kessler et al. 2003

Diagnoses in Psychotherapy

0

5

10

15

20

25

30

35

40

Depression NoneSpecified

19871997

Olfson et al. 2002

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

• DYSTHYMIC - LONGER LASTING (TWO YEARS) FEWER SYMPTOMS

• DISTRESS - REACTIVE TO LIFE EVENT, NOT A DISORDER

CAUSES

• VARIED

• SOME GENETIC

• EARLY LOSS EVENTS AND ABUSE

• CURRENT LOSSES AND TRAUMAS

CHARACTERISTICS

• GREAT VARIANCE ACROSS SOCIETIES (3% - 30%)

• 2/3 WOMEN

• INVERSE WITH SOCIAL CLASS

• MOST AMONG YOUNG, ELDERLY

PROGNOSIS (COURSE)

• COURSE HIGHLY VARIABLE

• OFTEN FREQUENT AND CHRONIC

• OFTEN ENDS WITH FRESH START EVENTS

TREATMENT

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

TREATMENT

• COGNITIVE THERAPY

• PSYCHOTHERAPY

• COMBINATION OF THERAPIES