Caregiving in Chronic Mental Illness

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Caregiving in Chronic Mental Illness
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Depression as a

• Chronic, Recurring Illness

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Depression Epidemiology Approximately 10-40
of pts in the primary care setting have
significant depressive symptoms but DSM-IV criteria for major depressive disorder
The point prevalence for major depressive
disorder in Western industrialized nations is
2.3-3.2 for men 4.5- 9.3 for women
Lifetime risk for major depressive disorder is
7-12 for men 20-25 for women A 2005
survey of over 43,000 US adults aged 18 and older
found the 12 month prevalence of major depressive
disorder to be 5.3, lifetime incidence 13.2
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RISK FACTORS for Depression The primary risk
factors for major depressive disorder include
Female gender History of depressive illness in
first degree relatives Prior episodes of major
depression The explanation for the female
preponderance is not entirely clear, contributing
factors may include high incidence of
postpartum depression social factors (eg,
history of childhood abuse low self-esteem)
gender differences in metabolism of noradrenergic
serotonergic neurotransmitters
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Risk Factors, continued

• Both animal human studies suggest that early
  stressors
• (eg, childhood sexual abuse) cause long-term
• dysregulation of the hypothalamic-pituitary-adr
  enal (HPA) axis similar to that seen in depressed
  pts
• The HPA axis in women may be more susceptible
  to
• stress-induced dysregulation than in men
  contributing to an ?vulnerability to depression
  in adult women
• Other risk factors
• more remote family history of depressive
  disorder
• lack of social supports
• significant stressful life events
• current alcohol and substance abuse

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Model of Depression asChronic, Recurring Illness
1st Crisis
2nd Crisis
5th Crisis
3rd Crisis
4th Crisis
12
16
22
35
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Length and Depth of Depression Increases
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Impact of Treatment onDepression
1st Crisis
2nd Crisis
5th Crisis
3rd Crisis
4th Crisis
12
16
22
35
5
Length and Depth of Depression decreases
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Treatment

• Includes medication and cognitive therapy
• Individual learns to recognize emerging symptoms
  and respond
• Diet, lifestyle, exercise, stress management are
  all important
• Medication may be preventive

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Bipolar Disorder
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1. Clinical description, based on DSM-IV.
Bipolar disorder affects 1-1.5 of the
population in most modern societies. Like
depression, bipolar disorder is a mood disorder.
It was formerly termed manic-depressive disorder,
because patients have one or more manic or
nearly manic episodes, alternating with major
depressive episodes. 1st episode often in
mid-20s. Bipolar disorder often leads to
suicide.
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• From DSM-IV
• Summary description of a manic episode
• Manic Episode is defined by a distinct period
  during which there is an abnormally and
  persistently elevated, expansive, or irritable
  mood. This period of abnormal mood must last at
  least 1 week (or less if hospitalization is
  required).
• The mood disturbance must be accompanied by at
  least three additional symptoms from this list
• -inflated self-esteem or grandiosity,
• -decreased need for sleep,
• -pressure of speech,
• -flight of ideas,
• -distractibility,
• -increased involvement in goal-directed
  activities or psychomotor agitation, and
• Excessive involvement in pleasurable activities
  with likelihood of painful consequences
• If the mood is irritable (rather than elevated or
  expansive), at least four of the above symptoms
  must be present . . . .
• The disturbance must be sufficiently severe to
  cause marked impairment in social or occupational
  functioning or to require hospitalization, or it
  is characterized by the presence of psychotic
  features . . . . .

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Creativity and Mental Illness Link
Touched With Fire Manic Depressive Illness and
the Artistic Temperament by Kay Redfield Jamison
"This is meant to be an illustrative rather than
a comprehensive list . . .Most of the writers,
composers, and artists are American, British,
European, Irish, or Russian all are deceased . .
. Many if not most of these writers, artists, and
composers had other major problems as well, such
as medical illnesses, alcoholism or drug
addiction, or exceptionally difficult life
circumstances. They are listed here as having
suffered from a mood disorder because their mood
symptoms predated their other conditions, because
the nature and course of their mood and behavior
symptoms were consistent with a diagnosis of an
independently existing affective illness, and/or
because their family histories of depression,
manic-depressive illness, and suicide--coupled
with their own symptoms--were sufficiently strong
to warrant their inclusion."
autobiography An Unquiet Mind by Kay Redfield
Jamison
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from Jamison KEYH Asylum or psychiatric
hospital S Suicide SA Suicide Attempt
Writers Hans Christian Andersen, Honore de
Balzac, James Barrie, William Faulkner (H), F.
Scott Fitzgerald (H), Ernest Hemingway (H, S),
Hermann Hesse (H, SA), Henrik Ibsen, Henry James,
William James, Samuel Clemens (Mark Twain),
Joseph Conrad (SA), Charles Dickens, Isak Dinesen
(SA), Ralph Waldo Emerson, Herman Melville,
Eugene O'Neill (H, SA), Mary Shelley, Robert
Louis Stevenson, Leo Tolstoy, Tennessee Williams
(H), Mary Wollstonecraft (SA), Virginia Woolf (H,
S) Composers Hector Berlioz (SA), Anton
Bruckner (H), George Frederic Handel, Gustav
Holst, Charles Ives, Gustav Mahler, Modest
Mussorgsky, Sergey Rachmaninoff, Giocchino
Rossini, Robert Schumann (H, SA), Alexander
Scriabin, Peter Tchaikovsky Nonclassical
composers and musicians Irving Berlin (H), Noel
Coward, Stephen Foster, Charles Mingus (H),
Charles Parker (H, SA), Cole Porter (H) Poets
William Blake, Robert Burns, George Gordon, Lord
Byron, Samuel Taylor Coleridge, Hart Crane (S) ,
Emily Dickinson, T.S. Eliot (H), Oliver
Goldsmith, Gerard Manley Hopkins, Victor Hugo,
Samuel Johnson, John Keats, Vachel Lindsay (S),
James Russell Lowell, Robert Lowell (H), Edna St.
Vincent Millay (H), Boris Pasternak (H), Sylvia
Plath (H, S), Edgar Allan Poe (SA), Ezra Pound
(H), Anne Sexton (H, S), Percy Bysshe Shelley
(SA), Alfred, Lord Tennyson, Dylan Thomas, Walt
Whitman Artists Richard Dadd (H), Thomas
Eakins, Paul Gauguin (SA), Vincent van Gogh (H,
S), Ernst Ludwig Kirchner (H, S), Edward Lear,
Michelangelo, Edvard Meunch (H), Georgia O'Keeffe
(H), George Romney, Dante Gabriel Rossetti (SA)
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Vincent Van Gogh 1853-1890 750 paintings
1600 drawings 700 letters Life
history born and raised in the Netherlands Paris
1886-88 Arles 1888 (1st episode cut off his own
ear) hospitalized 1888-1890 Auvers-sur-Oise 3
months. Shot himself 7/27/1890
1887-88
1886
1887
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July 1890
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Schizophrenia
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Twin studies

• Why does one twin become schizophrenic and the
  other does not?
• Lower birth weight
• More physiological distress
• More submissive, tearful, sensitive
• Impaired motor coordination