What is the estimated fiscal cost of schizophrenia in the United States?
What are the most distinguishing characteristics of schizophrenia?
• Impairments in social functioning
• Problems working/fulfilling other instrumental roles
• Difficulties caring for oneself
What does your text estimate to be the percentage of homeless persons who have schizophrenia?
10 - 20%
What are the most common types of symptoms of schizophrenia?
• Positive symptoms, e.g. hallucinations, delusions, disorganization of speech and behavior
• Negative symptoms, e.g. social withdrawal, apathy, anhedonia, poverty of speech
• Cognitive impairments, e.g. memory difficulties, planning ability, abstract thinking
• Problems with mood, e.g. depression, anxiety, anger
What is the lifetime prevalence of schizophrenia
.55 - 1%
Describe the "social drift" hypothesis and the "environmental stress" hypothesis.
• Social drift: debilitating effects of schizophrenia on capacity to work result in lowering of socioeconomic means, and hence poverty
• Environmental stress: high levels of stress associated with poverty precipitate schizophrenia in some individuals who would not otherwise develop the illness
What "cognitive impairments" are associated with schizophrenia?
• Difficulties in verbal and visual learning and memory
• Working memory
• Abstract reasoning/executive functioning
• Speed of information processing
What are common comorbid disorders associated with schizophrenia
• Substance-use disorders
What are some clinical features of schizophrenia that interfere with treatment?
• Lack of insight into fact that they have psychiatric illness, or even any problems at all
• Noncompliance occurring because of severe negativity often present
• Paranoia and distrust
What percentage of persons with schizophrenia will relapse with medication noncompliance?
50 - 75%
Comment on schizophrenia's association with violence.
• Rates assumed to be higher; in fact, rates of all severe mental illnesses relatively higher than general population
• Actually lower than rates for depression and bipolar: 8% for first weeks following discharge and 14% over 1-year
• Much more likely to be victims of violence and violent crime
What are the advantages of using a structured clinical interview rather than a more open format when assessing for schizophrenia?
• Provide definitions of the key symptoms, thus making explicit the specific symptoms required for diagnosis
• Variations in interviewing style are minimized, thus enhancing comparability of diagnostic assessments
Describe the stress-vulnerability model.
• Assumes that symptom severity and related impairments have a biological basis determined by combination of genetic and early environmental factors
• Stress, including discrete events such as traumas and exposure to ongoing conditions, can impinge on vulnerability, precipitating relapses and worse outcomes
What are some gender differences in regards to the course and treatment of schizophrenia
• Women have milder overall course and later onset
• Men are more likely to receive treatment
• Social skills training may be more helpful to men
What are some biological and physiological issues, other than genetics, that may play a role in the development of schizophrenia?
• Obstetric complications
• Maternal exposure to influenza
• Other environmental-based insults to developing fetus
What are the nine possible symptoms of a major depressive episode? How many must an individual have in order to qualify for a MDE?
• 5 of 9:
• Depressed mood
• Diminished interest or pleasure in all, or almost all, activities (one of above is required)
• Significant weight loss or weight gain or a decrease or increase in appetite
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthless or excessive or inappropriate guilt
• Diminished ability to think or concentrate, or to make decisions
• Recurrent thoughts of death, suicidal ideation, plans, or attempts
What are some of the provisionary depressive conditions covered under the category of "depressive disorder NOS"?
• Premenstrual dysphoric disorder
• Minor depressive disorder
• Recurrent brief episode disorder
• Postpsychotic depressive disorder of schizophrenia
• Major depressive episode superimposed on psychotic or delusional disorders
• Depression due to general medical conditions
What are some diagnoses that share symptoms with depression?
• Adjustment disorders
• Bipolar disorder
• Depression due to a general medical condition
What are the two large-scale epidemiological studies on mental illness in the U.S.? When were their findings published? What were their individual contributions?
• The Epidemiological Catchment Area Study: 1980s, first to definitively determine the prevalence of psychiatric problems in the US
• National Comorbidity Study: 1994, prevalence of co-occurring DSM-III-R (recently replicated in 2005)
What is the lifetime prevalence rate for major depression? Dysthymia?
What is known about the prevalence of depression in older adults?
• Exceeds that of any other mental disorder
What are likely causes of higher rates of depressive disorders in nursing home facilities?
• Loss of functional independence
• Loss of familiar surroundings
• Decreased access to pleasant activities or loved ones
• Comorbid physical illnesses
What is negativistic thinking, and what are some characteristics of individuals with this cognitive style?
• A style of thinking that is overly pessimistic and critical
• Poor self esteem
• Passive when difficulty arises
How does learned helplessness or passive coping skills exacerbate depressive symptoms?
Avoid proactive attempts to solve problems because anticipate that they are not capable of implementing a successful solution; avoidance often results in more problems
What are the three main tenets of positive psychology?
• Putting strengths to work in achieving a balance of three lives:
o Pleasant life
o Good life
o Meaningful life
Compared to nondepressed persons, what is the number of disability days reported by people with depressive disorders?
What is the mean duration of dysthymia?
Compared to major depression or depression NOS, what is the prognosis of someone with dysthymia? What number of those with dysthymia will receive treatment?
• Worse than those and are as disabled
• Fewer than half
What are factors that help in the recovery from a depressive disorder?
• Early diagnosis and treatment with therapy, medication, or both
• Facing few stressful life events
• Has a solid support network
• Initial early recovery
What are areas to assess before making a diagnosis of a depressive disorder
• Medical illness
• Drug and alcohol abuse
• Grief and bereavement
• Depression due to other psychiatric disorders
• Depression in older adults
What is currently the most common theory about the origin of depressive disorders?
Multifaceted, with causes resulting from interactions of psychological, social, and biological factors
What are factors that mediate the development of depressive symptoms during negative life events
Social and psychological resources available
What is known about the role of neurotransmitters in the development of depression?
Dysregulation rather than deficiency causes depression