Mental Illness 101 Presentation at the New Grantees’ Conference US Department of Labor Homeless Veterans Reintegration Program August 1, 2006 Cynthia.

Mental Illness 101 Mental Illness 101

Presentation at the New Grantees’ Presentation at the New Grantees’ ConferenceConference

US Department of LaborUS Department of LaborHomeless Veterans Reintegration ProgramHomeless Veterans Reintegration Program

August 1, 2006August 1, 2006

Cynthia Bisbee, Ph.D.Cynthia Bisbee, Ph.D.CC Bisbee & AssociatesCC Bisbee & Associates

Montgomery, ALMontgomery, AL

Copyright © 2006 Cynthia Bisbee, Ph.D.

Types of Mental IllnessTypes of Mental Illness


Definition of Definition of Mental DisorderMental Disorder

A clinically significant behavioral or A clinically significant behavioral or psychological syndrome or pattern psychological syndrome or pattern that occurs in an individual and that occurs in an individual and that is associated with present that is associated with present distress or disability or with a distress or disability or with a significantly increased risk of significantly increased risk of suffering death, pain, disability or suffering death, pain, disability or an important loss of freedom.an important loss of freedom.


Definition ofDefinition ofMental DisorderMental Disorder

Not merely an expectable and Not merely an expectable and

culturally sanctioned response to a culturally sanctioned response to a

particular event such as death of a particular event such as death of a

loved oneloved one

Must be within an individualMust be within an individual

Classifies disorders, not peopleClassifies disorders, not people


Serious Mental IllnessSerious Mental Illness

Always Included in DefinitionAlways Included in DefinitionSchizophreniaSchizophreniaMajor DepressionMajor DepressionBipolar DisorderBipolar Disorder

Sometimes IncludedSometimes IncludedSevere Anxiety DisordersSevere Anxiety DisordersCognitive DisordersCognitive DisordersSome Personality DisordersSome Personality Disorders


Criteria for SchizophreniaCriteria for Schizophrenia

Characteristic Characteristic symptomssymptomsDelusionsDelusionsHallucinationsHallucinationsDisorganized SpeechDisorganized SpeechDisorganized BehaviorDisorganized BehaviorNegative SymptomsNegative Symptoms

Flat AffectFlat Affect Lack of MotivationLack of Motivation

Social/Social/Occupational Occupational DysfunctionDysfunction

Lasting at Least Lasting at Least Six MonthsSix Months


Criteria for Major Criteria for Major DepressionDepression

Depressed MoodDepressed Mood Diminished InterestDiminished Interest Weight Loss or GainWeight Loss or Gain Sleep DisturbanceSleep Disturbance Restlessness or Restlessness or

Being Slowed DownBeing Slowed Down Fatigue & Loss of Fatigue & Loss of

EnergyEnergy Thoughts of DeathThoughts of Death

Feelings of Feelings of Worthlessness or Worthlessness or Excessive GuiltExcessive Guilt

Difficulty Thinking Difficulty Thinking & Concentrating& Concentrating

Symptoms Occur Symptoms Occur Every Day Every Day

Significant Significant Distress & Distress & ImpairmentImpairment


Criteria for Bipolar Criteria for Bipolar DisorderDisorder

Manic EpisodesManic EpisodesElevated moodElevated moodGrandiosityGrandiosityDecreased need for Decreased need for

sleepsleepTalkativenessTalkativenessRacing thoughtsRacing thoughts Increased goal-Increased goal-

directed activitydirected activity

Marked ImpairmentMarked ImpairmentOccupationOccupationSocial relationshipsSocial relationships

(or) Hospitalization(or) Hospitalization (or) Psychotic (or) Psychotic

FeaturesFeatures May Alternate with May Alternate with

Depressive Depressive EpisodesEpisodes


Symptoms of Mental Symptoms of Mental IllnessIllness

PerceptionsPerceptions

ThoughtsThoughts

MoodsMoods

BehaviorBehavior


Substance-Related Substance-Related DisordersDisorders

Types of DisorderTypes of DisorderSubstance-inducedSubstance-induced

IntoxicationIntoxication

WithdrawalWithdrawal

Various psychiatric Various psychiatric

symptomssymptoms

Substance UseSubstance Use DependenceDependence

AbuseAbuse

SubstancesSubstancesAlcoholAlcoholAmphetaminesAmphetaminesCaffeineCaffeineCannabisCannabisCocaineCocaineHallucinogensHallucinogens InhalantsInhalantsNicotineNicotineOpioidsOpioidsPhencyclidinePhencyclidineSedative-hypnoticsSedative-hypnoticsPolysubstancePolysubstance


Causes of Mental IllnessCauses of Mental Illness


Causes of Mental IllnessCauses of Mental Illness

Biological CausesBiological Causes

Environmental EffectsEnvironmental Effects

Interaction of Biology and Interaction of Biology and

EnvironmentEnvironment


Biology ofBiology ofSerious Mental IllnessesSerious Mental Illnesses

Brain DisorderBrain DisorderAnatomyAnatomyFunction (metabolism)Function (metabolism)ChemistryChemistry

Causes of Brain DisorderCauses of Brain DisorderGeneticsGeneticsViral TheoriesViral TheoriesBrain InjuryBrain Injury


Schizophrenia:Schizophrenia:Chemical Imbalance in the Chemical Imbalance in the

BrainBrain

SpeakingSpeakingBrain CellBrain Cell

ListeningListeningBrain CellBrain Cell

SynapseDopamine

Vesicle

ReceptorSite

Too Much Dopamine =Too Much Dopamine = Positive Symptoms Positive Symptoms

Cop

yrig

ht ©

199

8 P

atri

cia

L. S

chei

fler

MS

W, P

IP


The Role of EnvironmentThe Role of Environment

Some Disorders May Be LearnedSome Disorders May Be Learned

Some Result from TraumaSome Result from Trauma

Environment Affects the Course of Environment Affects the Course of

the Disordersthe Disorders

StigmaStigma


Treatment ofTreatment of Mental Illness Mental Illness


Intervention GoalsIntervention Goals

Remission of SymptomsRemission of SymptomsPositivePositive

NegativeNegative

Maintenance of StabilityMaintenance of Stability

Enhanced Quality of LifeEnhanced Quality of Life

Role RecoveryRole Recovery


MedicationsMedications

AntipsychoticsAntipsychotics

AntidepressantsAntidepressants

Mood StabilzersMood Stabilzers

AnxiolyticsAnxiolytics

Side Effects MedicationsSide Effects Medications


Anti-psychotic MedicationsAnti-psychotic Medications

Used to combat psychotic symptomsUsed to combat psychotic symptomsHallucinationsHallucinationsDelusionsDelusionsConfused ThinkingConfused ThinkingAltered PerceptionsAltered PerceptionsDisorganized SpeechDisorganized SpeechOther signs of psychosisOther signs of psychosis


Antipsychotic Medications Block Antipsychotic Medications Block DopamineDopamine



Dopamine

Antipsychotic Medication

Blocks Receptor Site

Cop

yrig

ht ©

199

8 P

atri

cia

L. S

chei

fler

MS

W, P

IP


Examples of Examples of Anti-psychotic MedicationsAnti-psychotic Medications

ZyprexaZyprexa RisperdalRisperdal SeroquelSeroquel GeodonGeodon ClozarilClozaril AbilifyAbilify

HaldolHaldol LoxitaneLoxitane ThorazineThorazine MellarilMellaril StelazineStelazine ProlixinProlixin NavaneNavane SerentilSerentil


Anti-depressant Anti-depressant MedicationsMedications

Used to Relieve Symptoms of Used to Relieve Symptoms of DepressionDepressionSadnessSadnessFeelings of FailureFeelings of FailureLoss of Interest in LifeLoss of Interest in LifeSleep DisturbancesSleep DisturbancesExcessive GuiltExcessive GuiltLoss of Energy/FatigueLoss of Energy/FatigueThoughts of Death and Suicidal ThoughtsThoughts of Death and Suicidal Thoughts


Examples ofExamples ofAnti-depressant Anti-depressant

MedicationsMedications ProzacProzac ZoloftZoloft EffexorEffexor CelexaCelexa SerzoneSerzone RemeronRemeron PaxilPaxil WellbutrinWellbutrin LexaproLexapro

DesyrelDesyrel ElavilElavil TofranilTofranil PamelorPamelor MarplanMarplan NardilNardil AscendinAscendin SinequanSinequan


Mood StabilizersMood Stabilizers

Used to Treat Symptoms of ManiaUsed to Treat Symptoms of ManiaRapid TalkingRapid TalkingDecreased Need for SleepDecreased Need for SleepRacing ThoughtsRacing ThoughtsDistractibilityDistractibilityIrritabilityIrritabilityBehavioral ExcessesBehavioral ExcessesGrandiosityGrandiosity


Examples ofExamples ofMood StabilizersMood Stabilizers

LithiumLithiumEskalithEskalithLithobidLithobidLithaneLithane

DepakoteDepakote TegretolTegretol NeurontinNeurontin ZyprexaZyprexa TopamaxTopamax

Note: Some of Note: Some of these medications these medications are also used to are also used to treat seizurestreat seizures


Anti-anxiety MedicationsAnti-anxiety Medications

Used to Treat Symptoms of AnxietyUsed to Treat Symptoms of AnxietyNervousnessNervousnessPanicPanicShortness of BreathShortness of BreathTremblingTremblingFeeling of ChokingFeeling of ChokingHeart PalpitationsHeart PalpitationsObsessions & CompulsionsObsessions & Compulsions


Examples ofExamples ofAnti-anxiety MedicationsAnti-anxiety Medications

XanaxXanax AtivanAtivan KlonapinKlonapin BusparBuspar

ValiumValium LibriumLibrium SeraxSerax EquanilEquanil MiltownMiltown VistarilVistaril TranxeneTranxene


Side Effects MedicationsSide Effects Medications(Anti-parkinsonians)(Anti-parkinsonians)

Used to Relieve Side Effects of Used to Relieve Side Effects of Anti-psychotic MedicationsAnti-psychotic MedicationsStiff MusclesStiff MusclesUnsteady GaitUnsteady GaitTremorsTremorsEyes Rolling BackEyes Rolling BackRestless FeelingRestless Feeling


Examples ofExamples ofSide Effects MedicationsSide Effects Medications

CogentinCogentin

ArtaneArtane

BenadrylBenadryl

AkinetonAkineton


Stimulants (special use)Stimulants (special use)

Used to Treat Symptoms of Used to Treat Symptoms of

Attention Deficit/Hyperactivity Attention Deficit/Hyperactivity

Disorder Disorder Mainly Used in ChildrenMainly Used in Children

HyperactivityHyperactivity

Inability to Pay AttentionInability to Pay Attention

DistractibilityDistractibility


Examples ofExamples ofStimulant MedicationsStimulant Medications

RitalinRitalin

AdderallAdderall

DexedrineDexedrine

CylertCylert

ConcertaConcerta


Side Effects ofSide Effects ofMedicationsMedications

DrowsinessDrowsiness

Dry MouthDry Mouth

Blurred VisionBlurred Vision

DizzinessDizziness

TremorsTremors

Sexual DysfunctionSexual Dysfunction

High Heart RateHigh Heart Rate

Weight GainWeight Gain

Slurred SpeechSlurred Speech

Sensitivity to SunSensitivity to Sun

Some Are Some Are

AddictiveAddictive


Psychosocial InterventionsPsychosocial Interventions

AssessmentAssessment Education about Education about

Illness Self Illness Self ManagementManagement

Counseling/Counseling/TherapyTherapyIndividualIndividualGroupGroup

Crisis InterventionCrisis Intervention

RehabilitationRehabilitationSocial SkillsSocial SkillsVocationalVocational

Family ServicesFamily ServicesEducationEducationFamily TherapyFamily Therapy

Case Case ManagementManagement


Illness Self Management/ Illness Self Management/ Patient EducationPatient Education

Giving Information about the Giving Information about the IllnessIllnessSymptomsSymptomsTreatmentTreatmentCourseCourse

Helping Client Learn to Manage Helping Client Learn to Manage Own IllnessOwn Illness


Management SkillsManagement Skillsfor Recoveryfor Recovery

Medication AdherenceMedication Adherence

Healthful LifestyleHealthful Lifestyle

Therapeutic EnvironmentTherapeutic Environment

Illness MonitoringIllness Monitoring

Relapse PreventionRelapse Prevention


Medication AdherenceMedication Adherence

Adherence = “Sticking to” the Adherence = “Sticking to” the

Medication PlanMedication Plan

Barriers to AdherenceBarriers to Adherence

The Person’s Condition The Person’s Condition

Chronic IllnessChronic Illness

Complex Medication PlanComplex Medication Plan


Antipsychotic Medications Block Antipsychotic Medications Block DopamineDopamine



Dopamine

Antipsychotic Medication

Blocks Receptor Site

Cop

yrig

ht ©

199

8 P

atri

cia

L. S

chei

fler

MS

W, P

IP


Stop TakingStop Taking AntipsychoticsAntipsychotics Blockade Gradually Blockade Gradually

DisappearsDisappears



Cop

yrig

ht ©

199

8 P

atri

cia

L. S

chei

fler

MS

W, P

IP




No Antipsychotic Medication:No Antipsychotic Medication:Positive Symptoms ReappearPositive Symptoms Reappear

( Relapse) ( Relapse)

Cop

yrig

ht ©

199

8 P

atri

cia

L. S

chei

fler

MS

W, P

IP


What Is What Is Illness Monitoring?Illness Monitoring?

Learning about IllnessLearning about Illness

Developing Awareness of Developing Awareness of

SymptomsSymptoms

Watching for Signs of RelapseWatching for Signs of Relapse

Mapping Illness CyclesMapping Illness Cycles


Importance ofImportance ofIllness MonitoringIllness Monitoring

Helps Prevent RelapseHelps Prevent Relapse

Look for Illness CycleLook for Illness Cycle

Indicate Possible Need for Indicate Possible Need for

Medication AdjustmentMedication Adjustment

Helps Measure Effects of TreatmentHelps Measure Effects of Treatment


Relapse Checklist*Relapse Checklist*

Medication ChangeMedication ChangePhysical Illness Physical Illness A Stressful Event or OverstimulationA Stressful Event or OverstimulationAlcohol or DrugsAlcohol or DrugsSugar, Caffeine, or Change of DietSugar, Caffeine, or Change of DietToo Many FluidsToo Many Fluids Illness CycleIllness Cycle

– Copyright © 1982 Patricia ScheiflerCopyright © 1982 Patricia Scheifler


Taking ActionTaking Action

Ensure Compliance with MedsEnsure Compliance with MedsSeek Medical Treatment & RestSeek Medical Treatment & RestDaily Relaxation SkillsDaily Relaxation SkillsDecrease StimulationDecrease StimulationAvoid Drugs & AlcoholAvoid Drugs & AlcoholCut Caffeine, Sugar & FluidsCut Caffeine, Sugar & FluidsConsult MD for Possible Medication Consult MD for Possible Medication

AdjustmentAdjustment


Psychotherapy and Psychotherapy and CounselingCounseling

Reality BasedReality Based

Real-life Problem SolvingReal-life Problem Solving

Individual Coping with IllnessIndividual Coping with Illness

Group Support and Peer LearningGroup Support and Peer Learning

Flexible Participation StandardsFlexible Participation Standards


Crisis InterventionCrisis Intervention

Telephone Telephone

Clinic BasedClinic Based

Mobile OutreachMobile Outreach

In-Home InterventionIn-Home Intervention


Skills TrainingSkills Training

Social SkillsSocial Skills

Academic SkillsAcademic Skills

Vocational SkillsVocational Skills


Psychiatric Psychiatric RehabilitationRehabilitation

Readiness AssessmentReadiness AssessmentReadiness DevelopmentReadiness DevelopmentChoosing Rehabilitation GoalsChoosing Rehabilitation Goals

LivingLivingLearningLearningWorkingWorkingSocializingSocializing

Getting & Keeping Environments of Getting & Keeping Environments of ChoiceChoice


Long Term HospitalLong Term Hospital

Crisis Stabilization FacilityCrisis Stabilization Facility

Group Treatment SettingGroup Treatment Setting

Family Living Family Living

Supported Living Apartments Supported Living Apartments

Independent LivingIndependent Living

Continuum of Living Continuum of Living EnvironmentsEnvironments


Continuum of Learning Continuum of Learning EnvironmentsEnvironments

Hospital TreatmentHospital TreatmentPartial Hospitalization ServicesPartial Hospitalization ServicesOutpatient TherapiesOutpatient TherapiesClubhouseClubhouseAdult EducationAdult EducationSupported EducationSupported Education


Continuum of Working Continuum of Working OpportunitiesOpportunities

Pre-vocational TrainingPre-vocational TrainingVocational TrainingVocational TrainingVolunteer JobsVolunteer Jobs Jobs in Mental Illness FacilitiesJobs in Mental Illness FacilitiesSupported EmploymentSupported EmploymentTransitional EmploymentTransitional EmploymentPart-time and Full-time Regular Part-time and Full-time Regular

EmploymentEmploymentConsumer-run BusinessConsumer-run Business


Family ServicesFamily Services

SupportSupport

EducationEducation

ConsultationConsultation

TherapyTherapy


Case ManagementCase Management

Service CoordinationService Coordination

LinkageLinkage

Connection to One PersonConnection to One Person

Help with Basic NeedsHelp with Basic Needs

Broad View of Service PlanBroad View of Service Plan


Interacting with a PersonInteracting with a Personwith Mental Illness Symptoms: with Mental Illness Symptoms:

Communication Skills Communication Skills (Copyright Patricia Scheifler, MSW)(Copyright Patricia Scheifler, MSW)

Give clear directivesGive clear directives Ask open-ended Ask open-ended

questionsquestions Check out the whys of Check out the whys of

behaviorbehavior Express empathy; Express empathy;

reflectfeelingsreflectfeelings Use no-choice choicesUse no-choice choices Criticize behavior not Criticize behavior not

personperson Use “I” statementsUse “I” statements

Express caring and Express caring and support support

Use parrotingUse parroting Be concrete and briefBe concrete and brief Watch for signs of fadingWatch for signs of fading Be low-key and low “EE”Be low-key and low “EE” Avoid power strugglesAvoid power struggles Allow for time out to “de-Allow for time out to “de-

stim”stim” Do not tell liesDo not tell lies


Interacting with a PersonInteracting with a Personwith Mental Illness Symptoms:with Mental Illness Symptoms:

SafetySafetyRemain calmRemain calmSpeak slowly and clearlySpeak slowly and clearlyAvoid invading personal spaceAvoid invading personal spaceDo not move quickly, especially Do not move quickly, especially

toward the persontoward the personDo not touch the personDo not touch the personDo not challenge the personDo not challenge the person


Special Issues for Special Issues for Homeless People with Homeless People with

Mental IllnessMental Illness

Lack of TrustLack of TrustHierarchy of NeedsHierarchy of NeedsDisability Caused by Mental IllnessDisability Caused by Mental Illness

Effect of active symptomsEffect of active symptomsNo energy to accomplish daily tasksNo energy to accomplish daily tasksInability to planInability to plan

Consistent Need for SupportConsistent Need for Support


Interventions forInterventions forMental IllnessMental Illness

No One No One

Intervention Is Intervention Is

SufficientSufficient

We Have to We Have to

Approach from All Approach from All

DirectionsDirections

Mental Illness 101 Presentation at the New Grantees’ Conference US Department of Labor Homeless Veterans Reintegration Program August 1, 2006 Cynthia.

Documents

h symptoms

individual h

hospitalization h

activity h

cynthia bisbee

h weight loss

serious mental illness

psychotic features h