TYPES OF MENTAL ILLNESS

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WHAT IS MENTAL ILLNESS?
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TWO TOPICS

• DEFINITION OF MENTAL ILLNESS
• NATURE OF SCHIZOPHRENIA

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WHY WANT DEFINITION OF MENTAL ILLNESS?

• DISTINGUISH FROM NORMAL
• INDICATE NEED FOR MENTAL HEALTH TREATMENT
• WHAT CONDITIONS SHOULD BE REIMBURSED?
• DETERMINE CRIMINAL LIABILITY - PUNISH OR TREAT?

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DSM-IV DEFINITION (1)

• MENTAL DISORDER IS A CLINICALLY SIGNIFICANT
  BEHAVIORAL OR PSYCHOLOGICAL PATTERN THAT IS
  ASSOCIATED WITH PRESENT DISTRESS OR DISABILITY.
  

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DISTRESS OR DISABILITY

• MUST HAVE EITHER DISTRESS (MENTAL PAIN) OR
  DISABILITY (LOSS OF FUNCTIONING)
• EITHER MUST REALLY BOTHER PEOPLE - E.G. THINK
  LEFT STOVE ON
• OR HAVE NEGATIVE IMPACT ON THEIR LIVES - E.G.
  SCHIZOPHRENIA

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DSM (2)

• IN ADDITION, THIS PATTERN MUST NOT BE MERELY AN
  EXPECTABLE AND CULTURALLY SANCTIONED RESPONSE TO
  A PARTICULAR EVENT, FOR EXAMPLE, THE DEATH OF A
  LOVED ONE.

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NOT EXPECTABLE RESPONSE

• BEREAVEMENT EXCLUSION
• SYMPTOMS ARE NORMAL
• ROMANTIC BREAKUPS
• SOLDIER ENTERING COMBAT
• MUST KNOW CONTEXT

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DSM (3)

• WHATEVER ITS ORIGINAL CAUSE, IT MUST CURRENTLY
  BE A BEHAVIORAL, PSYCHOLOGICAL, OR BIOLOGICAL
  DYSFUNCTION IN THE INDIVIDUAL.

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INTERNAL DYSFUNCTION

• SOME PSYCHOLOGICAL SYSTEM (MOOD, FEAR, THOUGHT,
  EMOTION, ETC.) IS NOT FUNCTIONING PROPERLY -
  SOMETHING IS WRONG
• WRONG CONTEXT OR TOO SEVERE OR TOO ENDURING
• MANY CAUSES BIOLOGICAL, PSYCH., SOCIAL OF
  M.I.

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DSM (4)

• NEITHER DEVIANT BEHAVIOR (E.G. POLITICAL,
  RELIGIOUS, OR SEXUAL) NOR CONFLICTS BETWEEN THE
  INDIVIDUAL AND SOCIETY ARE MENTAL DISORDERS
  UNLESS THE DEVIANCE OR CONFLICT IS A SYMPTOM OF A
  DYSFUNCTION IN THE INDIVIDUAL.

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DEVIANCE OR M.I.?

• ONLY MENTAL DISORDER WHEN SOME MECHANISM IS
  UNABLE TO FUNCTION AS IT IS SUPPOSED TO
• ALCOHOLIC OR ADDICT WHO CANT STOP DRINKING OR
  TAKING DRUGS
• NOT JUST DEFIANCE OF RULES
• VERY DIFFICULT TO DISTINGUISH

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SUMMARY

• MENTAL DISORDER IS HARMFUL INTERNAL DYSFUNCTION
• CAUSES CAN BE PSYCHOLOGICAL, BIOLOGICAL, OR
  SOCIAL
• DISTINGUISH FROM EXPECTABLE RESPONSES TO
  STRESSORS AND FROM SOCIAL DEVIANCE

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TYPES OF MENTAL ILLNESS
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PSYCHOSES

• MOST SEVERE KIND OF M.I.
• SCHIZOPHRENIA
• BI-POLAR (MANIC DEPRESSION)

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SCHIZOPHRENIA

• PERHAPS MOST IMPORTANT MENTAL ILLNESS
• CREATES STEREOTYPE OF MENTAL ILLNESS - CRAZY,
  NUTS, BIZARRE

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IMPORTANCE

• MOST ADMISSIONS AND RESIDENTS OF PUBLIC MENTAL
  HOSPITALS
• SEVERITY AND CHRONICITY MEAN COSTLY AND DIFFICULT
  TO TREAT
• PUBLIC POLICY - HOMELESSNESS, NOTORIOUS CRIMES
• TREMENDOUS PERSONAL AND FAMILY BURDEN

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A BEAUTIFUL MIND

• JOHN NASH

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SYMPTOMS

• THOUGHT DISORDER

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POSITIVE SYMPTOMS

• THOUGHT INSERTION AND BROADCAST
• LOOSE ASSOCIATION
• HALLUCINATIONS
• DELUSIONS PARANOIA, GRANDIOSITY

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Source www.wheelmeon.org/schizophrenia.jpg1993
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Source http//www.wheelmeon.org/schizophrenia.jpg
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NEGATIVE SYMPTOMS

• FLAT AFFECT
• LACK OF PLEASURE - ANHEDONIA
• ISOLATION

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DISABILITIES

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

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CAUSES

• USED TO THINK BAD FAMILIES WERE CAUSE
  (SCHIZOPHRENOGENIC MOTHER)
• NOW THOUGHT TO BE BRAIN DISORDER WITH GENETIC OR
  BIOLOGICAL CAUSE
• ABOUT 1 PREVALENCE IN WIDE VARIETY OF TIMES AND
  PLACES

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CORRELATES

• LOW SOCIAL CLASS
• CAUSE OR CONSEQUENCE?
• NO SEX DIFFERENCES
• NO ETHNIC DIFFERENCES
• NO INTELLIGENCE DIFFERENCES
• EARLY ONSET - 16-25 YEARS
• ALMOST ALL NOT MARRIED

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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

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TREATMENT

• USED TO BE LONG STAYS IN MENTAL HOSPITALS
• NOW BRIEF, EPISODIC HOSPITAL STAYS ALONG WITH
  COMMUNITY TREATMENT (OR NEGLECT)
• MEDICATION SINCE 1950S
• PHENOTHIAZINES AND CLOZAPINE

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TREATMENT

• MEDICATION DOESNT 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)

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MAJOR PROBLEMS

• INADEQUATE FUNDING FOR TREATMENT
• MANY DONT ADMIT THAT THEY ARE ILL - STOP TAKING
  MEDICATIONS
• WHEN GET IN TROUBLE PUT IN JAILS AND PRISONS