Dec 22, 2015
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