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Slide 1:

A Very Brief Historical Look at Mental Illness (cont’d) 1917 American Medico-Psychological Association and National Commission on Mental Hygiene Uniform census statistics in mental hospitals Post-WW II U.S. Army/Veteran’s Administration Nomenclature World Health Organization (WHO) International Classification of Diseases (ICD) - 6 th Ed. included a Mental Disorders section for the first time

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A Very Brief Historical Look at Mental Illness (cont’d) Diagnostic and Statistical Manual: Mental Disorders DSM-I 1952 DSM-II 1960 DSM-III 1980 DSM-III-R 1987 DSM-IV 1994

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DSM-IV No longer have to choose between “Mental” and “Physical” Disorder Multi-axial Diagnosis System: Mental Illness/Substance Abuse/ Developmental Disabilities Personality Disorders Medical Problems Psychosocial Stressors “causes distress, impairs or interferes with relationships and ability to function”

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“BioPsychoSocial” Biological Genetic Toxic exposure Medical Psychological Thought patterns Behavior Personality Social Abuse Circumstances Lack of resources

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Overview of Mental Disorders in DSM-IV Disorders of Infancy, Childhood, or Adolescence Mental Retardation, Pervasive Developmental Disorders, Attention-Deficit and Disruptive Behavior Disorders Delirium, Dementia, and Cognitive Disorders Medical emergencies, Alzheimer’s, Amnesia Mental Disorders due to a General Medical Condition “Organic”; Hypothyroidism, Infection, Anemia, Cancer Substance-Related Disorders Abuse vs. Dependence, Intoxication, Withdrawal , Persisting Schizophrenia and other Psychotic Disorders Schizophrenia subtypes, Delusional Disorder, Psychosis NOS

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Overview of Mental Disorders in DSM-IV (cont’d) Mood Disorders Major Depression, Bipolar Disorder Anxiety Disorders Panic Disorder, Obsessive-Compulsive Disorder, PTSD, Phobias, Generalized Anxiety Disorder Somatoform Disorders Conversion Disorder, Hypochondriasis, Pain Disorder Factitious Disorders Munchausen’s vs. Malingering

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Overview of Mental Disorders in DSM-IV (cont’d) Dissociative Disorders “Multiple Personality Disorder”, Fugue, Amnesia Sexual and Gender Identity Disorders Dysfunction, Paraphilias, Transvestite vs. “Transsexual” Eating Disorders Anorexia, Bulimia Sleep Disorders Dyssomnia, Narcolepsy, Parasomnia (Terrors, Sleepwalking) Impulse-Control Disorders Kleptomania, Pyromania, IED, Pathological Gambling

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Overview of Mental Disorders in DSM-IV (cont’d) Adjustment Disorders Personality Disorders Cluster A: “Odd-Eccentric” Paranoid, Schizoid, Schizotypal Cluster B: “Dramatic-Emotional” Antisocial, Borderline, Histrionic, Narcissistic Cluster C: “Anxious-Fearful” Avoidant, Dependent, Obsessive-Compulsive

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Mental Status Examination I Approaching a person with mental illness II. Appearance and behavior III. Speech and thought pattern IV. Mood vs. Affect V. Thought content VI. Attention, concentration, knowledge-base VII. Insight, judgment

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* Must include 1 of these DSM-IV-TR. Washington, DC: American Psychiatric Association. 2000. S leep : Insomnia or hypersomnia I nterest : Depressed mood,* loss of interest or pleasure* G uilt : Feelings of worthlessness E nergy : Fatigue C oncentration : Diminished ability to think or make decisions A ppetite : Weight change P sychomotor : Psychomotor retardation or agitation S uicide : Preoccupation with death  5 Symptoms in the same 2-week period DSM-IV-TR Criteria for Major Depressive Episode (MDE)

Impact of Untreated Depression:

Impact of Untreated Depression Morbidity Comorbid medical illness Suicide attempts Accidents Mortality 35,000 suicides per year Fatal accidents Death due to related illness (substance abuse) Societal and Functional Burdens Dysfunctional families Divorce Substance abuse Absenteeism Decreased productivity Job-related injuries Lost jobs Failure to advance in career or school Preskorn, 1999

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Quality Of Life And Psychiatric Morbidity In Generalized Anxiety Disorder Massion et al. Am J Psychiatry. 1993;150:600.

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Quality Of Life In Panic Disorder % Markowitz et al. Arch Gen Psychiatry. 1989;46:984. Marital Discord (Past 2 Weeks) Use Of ER (Past Year) Financial Dependence (Welfare or Disability)

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Diagnosis And Treatment Lower Costs Of Panic Disorder Salvador-Carulla et al. Br J Psychiatry . 1995;166(suppl 27):23 Costs ($K) 70 50 30 10 Non-psychiatric Medical Visits Hospitalization Laboratory Tests Lost Productivity

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Suicidality In Social Phobia Suicide Attempts Felt so Low You Wanted To Commit Suicide Schneier et al. Arch Gen Psychiatry . 1992;49:282 Suicidality (rate/100) Uncomplicated social phobia (N=112) Comorbid social phobia (N=249) No disorder (N=9953)

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Trauma Target Symptoms of PTSD Re-experiencing Avoidance/Numbing Hyperarousal American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 1994 .

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Schizophrenia: Socioeconomic Impact 1% of American population affected 25% of all hospital-bed days 40% of all long-term-care days 20% of all Social Security benefit days Total cost: $33 billion/year

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