Full text unavailable

You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.

PI 17S(5):4-16 (1997)

Epidemiology of Mental Illness in the United States: An Overview of the Cost Effectiveness of Psychotherapy for Certain Patient Populations

Author: Susan G. Lazar MD

Abstract

Four prototypical patient profiles will serve to illustrate some common and problematic situations with mental illness that many Americans face.

A is an 11-year-old boy with an anxiety disorder. Despite his above-average intelligence, he has difficulty reading and has already repeated the fourth grade. Antianxiety medications have been of some help, at times, in controlling his anxiety symptoms, but they are sedating, potentially addicting, and cannot address the underlying problem.
Mrs. B is a 32-year-old pregnant, working mother of two, who has a major depression. Although she has a family history of depression, her recurrent illness began with the death of her father when she was 10. Intermittently depressed as a child, she has nevertheless become well-educated and has married, and had two children. Although her income is very important in sustaining her family, like many patients with major depression, she cannot work. Although she has responded to antidepressant
Dr. Lazar is Supervising and Training Analyst, Washington Psychoanalytic Institute; Clinical Professor of Psychiatry, Uniformed Services University of the Health Sciences, Georgetown University School of Medicine, and George Washington University School of Medicine.
Page 4
medication in the past, both she and her physician are very reluctant to use it now during her pregnancy. Psychotherapy has been very helpful in the past, but her HMO will not certify more than a very brief course of treatment.
C is a 17-year-old boy with dysthymia and occasionally serious depressive episodes with concomitant loss of control of his brittle juvenile onset diabetes mellitus. His physician and his parents are concerned about his recurrent episodes of ketoacidosis when his blood sugar is not kept in more consistent control. They have come to feel that, if C's depression were to improve, his cooperation in the control of his diabetes would also improve.
Ms. D was a gifted child but was sexually abused at an early age. Having

PI 17S(5):4-16 (1997)

Epidemiology of Mental Illness in the United States: An Overview of the Cost Effectiveness of Psychotherapy for Certain Patient Populations

Author: Susan G. Lazar MD

Abstract

Four prototypical patient profiles will serve to illustrate some common and problematic situations with mental illness that many Americans face.

A is an 11-year-old boy with an anxiety disorder. Despite his above-average intelligence, he has difficulty reading and has already repeated the fourth grade. Antianxiety medications have been of some help, at times, in controlling his anxiety symptoms, but they are sedating, potentially addicting, and cannot address the underlying problem.
Mrs. B is a 32-year-old pregnant, working mother of two, who has a major depression. Although she has a family history of depression, her recurrent illness began with the death of her father when she was 10. Intermittently depressed as a child, she has nevertheless become well-educated and has married, and had two children. Although her income is very important in sustaining her family, like many patients with major depression, she cannot work. Although she has responded to antidepressant
Dr. Lazar is Supervising and Training Analyst, Washington Psychoanalytic Institute; Clinical Professor of Psychiatry, Uniformed Services University of the Health Sciences, Georgetown University School of Medicine, and George Washington University School of Medicine.
Page 4
medication in the past, both she and her physician are very reluctant to use it now during her pregnancy. Psychotherapy has been very helpful in the past, but her HMO will not certify more than a very brief course of treatment.
C is a 17-year-old boy with dysthymia and occasionally serious depressive episodes with concomitant loss of control of his brittle juvenile onset diabetes mellitus. His physician and his parents are concerned about his recurrent episodes of ketoacidosis when his blood sugar is not kept in more consistent control. They have come to feel that, if C's depression were to improve, his cooperation in the control of his diabetes would also improve.
Ms. D was a gifted child but was sexually abused at an early age. Having