Mental Illness (Adult)

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Mental Illness (Adult)

• KNR 270

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Mental Illness

• Effects 50 million in US
• 5-7 of adults have a serious mental illness
• 5-9 of children
• World Health Organization notes MI is the leading
  disability world-wide
• Only about ½ seek help
• Stigma and discrimination
• Society fears people with MI are violent

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DEFINITION OF MENTAL ILLNESS

• Behavior that significantly deviates from the
  norm
• Society sets standards for norm
• As society becomes more pluralistic, fewer
  behaviors will be considered abnormal
• Society can change criteria of normal or abnormal

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CRITERIA

• Consistently inappropriate
• Evidenced for some duration
• Diagnostic and Statistical Manual of Mental
  Disorders (DSM-IV-TR, 2000)
• American Psychiatric Association
• Leisure functioning is part of criteria

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DSM-IV-TR

• Detailed classification system
• Used to design treatment
• Rated on 5 axes

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Axis I Clinical Syndromes (Current Condition)

• Disorders evident in infancy, childhood, or
  adolescence
• Substance-related
• Schizophrenia other psychotic disorders
• Mood disorders
• Anxiety disorders
• Factitious disorders
• Somatoform disorders
• Dissociative disorders

• Delirium, dementia, amnesic, other cognitive
  disorders
• Sexual gender identity disorders
• Eating disorders
• Sleep disorders
• Impulse control disorders
• Adjustment disorders

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Axis II Longstanding Conditions Associated with
Personality Disorders Mental Retardation

• Axis II only used to identify a long-term
  underlying problem
• Personality disorders paranoid, schizoid,
  histrionic, narcissistic, antisocial, borderline,
  obsessive-compulsive
• Mental retardation

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Remaining axes used to identify factors
contributing to or being affected by disorder

• Axis III General medical conditions
• Physical problems
• Axis IV Psychosocial environmental problems
• Psychosocial stress
• Axis V Global Assessment of Functioning Scale
  (GAF)
• Current level of adaptive functioning in social
  relationships, occupational functioning, and use
  of leisure time

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MI subdivided

• Neuroses
• Most frequent
• Recognizes presence of maladaptive behavior
  effect on person
• Mild depression, anxiety, phobia
• Psychoses
• More serious
• Lack of realization that behaviors is obvious or
  present
• Unable to objectively evaluate reality
• Schizophrenia

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SCHIZOPHRENIA(S)

• Not multiple or split personalities
• More of a disintegration of personality,
  departure from reality
• Thought disorder
• Often diagnosed 15-25
• Stress can aggravate
• Effect on persons future
• Could be gradual or sudden onset
• Heavy pot smoking might raise risk

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Schizophrenia Criteria 2 or more of

• Delusions
• Only 1 if delusion is bizarre, such as being
  abducted in a space ship from the sun
• Hallucinations
• Only 1 if at least 2 voices talk to one another
  or a voice keeps a running commentary in thoughts

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Schizophrenia Criteria 2 or more of

• Speech
• Incoherent, disorganized
• Negative symptoms
• Flat affect, reduced speech, lack of volition,
  deteriorating personal hygiene, increased
  suspicion people are talking behind ones back

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SCHIZOPHRENIA

• Delusions
• Disturbance in content of thought
• Persecutory or paranoid
• Thought broadcasting
• Thought insertion
• Grandiose
• Religious

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SCHIZOPHRENIA

• Hallucinations
• Disturbances in perceptions
• Most often auditory
• Voices speak to the person
• Tactile
• Could be connected to any sense
• Visual is rare unless drug or alcohol abuse

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SCHIZOPHRENIA

• Other problems
• Hard time making choices or decisions
• Hard time thinking clearly
• Socially withdrawn
• Flat or blunted affect
• Lack of interest or joy
• Loose associations
• Word salad or nonsense words

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Types of Schizophrenia

• Paranoid type
• Preoccupied with delusions or frequent auditory
  hallucinations
• Disorganized type
• Disorganized behavior speech, affect that is
  flat or inappropriate
• Catatonic type
• Stupor or motor immobility, mutism or marked
  negativism, peculiar posturing, mannerisms or
  grimacing, echolalia

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SCHIZOPHRENIA (S)

• Thought to be a chemical imbalance
• Symptoms may be controlled by meds
• Predictors of poor outcome
• Early age onset, family history, withdrawal,
  prior history
• Can be side effects to medication
• Tardive dyskensia
• Involuntary movements of tongue, face, mouth, or
  jaw associated with long-term use of
  antipsychotics
• May be irreversible

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Mood or Affective Disorders

• Depression
• Mania
• Bipolar

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DEPRESSION

• Different than everyday sadness
• Impairs everyday functioning
• Diminished interest or pleasure
• Fatigue and energy loss
• Memory loss
• Weight loss or gain

• Difficulty thinking
• Loss of concentration
• Sense of worthlessness or quilt
• Sleeping (insomnia or sleeping too much)
• Suicide

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MANIA

• Extreme elation
• Inflated self-esteem
• Decreased need for sleep
• Racing thoughts
• Physical activeness
• Increased talkativeness
• Increased risk-taking

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BIPOLAR-AFFECTIVE

• Mood swings or cycles
• Tends to run in families
• Often treated with lithium
• Come off meds when feeling better cycle starts
  over again
• Some enjoy manic phase because feel so creative

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Anxiety Disorders

• Generalized anxiety
• Panic attack
• Phobias
• Posttraumatic Stress Disorder
• Obsessive-Compulsive Disorder
• Dissociative Identity Disorder

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ANXIETY DISORDERS

• Intense fear or panic that appears to be
  unjustified
• Always anticipates disaster
• Symptoms
• Shortness of breath
• Increased heart rate
• Dizziness
• Chest pains
• Fear dying or going insane

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Panic Attack4 or more

• Chest pain or discomfort
• Heart pounds, races or skips beats
• Chills or hot flashes
• Choking sensation
• Feeling unreal or detached from self
• Fear of dying

• Dizzy, lightheaded, faint or unsteady
• Nausea or other abdominal discomfort
• Numbness or tingling
• Sweating
• Shortness of breath or smothering sensation
• Trembling

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Phobias

• Social Phobia
• Most common phobia
• Irrational fear of situations where may be
  watched judged by others
• Public speaking
• Trembling, sweating, racing heart
• Avoids situations
• Agoraphobia
• Claustrophobia

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Posttraumatic Stress Disorder (PTSD)Criteria

• Experienced or witnessed a traumatic event that
  has both of these elements
• Actual or threatened death or serious injury to
  self or others
• Felt intense fear, horror or helplessness
• War, rape, 9/11, Katrina, Virginia Tech, etc.
• 9/10 Iraq Afghanistan veterans in VAs

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Posttraumatic Stress Disorder (PTSD)Criteria

• Repeatedly relives the event in at least 1 way
• Intrusive, distressing recollections in thoughts
  or images
• Repeated, distressing dreams
• Flashbacks or illusions that feel like the event
  is recurring
• Mental distress in reaction to internal or
  external cues that symbolize or resemble the
  event
• Physiological reactivity such as rapid heart
  beat, increased blood pressure in response to
  these cues

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Posttraumatic Stress Disorder (PTSD)Criteria

• Repeatedly avoids the trauma-related stimuli
  has numbing or general responsiveness in 3
• Tries to avoid thoughts, feelings, conversations
  connected to event
• Tries to avoid activities, people or places that
  recall the event
• Cannot recall an important feature of the event

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Posttraumatic Stress Disorder (PTSD)Criteria

• Repeatedly avoids the trauma-related stimuli
  has numbing or general responsiveness in 3
• Marked loss of interest or participation in
  activities important to person
• Feels detached or isolated from other people
• Restriction in ability to love or feel other
  strong emotions
• Feels life will be brief or unfulfilled

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Posttraumatic Stress Disorder (PTSD)Criteria

• At least 2 of symptoms of hyperarousal were not
  present before the traumatic event
• Insomnia
• Irritability
• Poor concentration
• Hypervigilance
• Increased startle response

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Obsessive-Compulsive Disorder

• 1/3 have onset before 15
• Second peak time is 30s
• 1/50 adults
• Likely to persist throughout life with varying
  degrees of severity
• No known cause
• Inherited
• Shortage of serotonin
• Stress

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OBSESSIVE-COMPULSIVE DISORDERS

• Obsession persistent preoccupation with
  unreasonable ideas or feelings
• Compulsion irresistible impulse to perform
  irrational acts
• Obsession cleanliness / Compulsion handwashing
• Can have thoughts without behaviors

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Obsessive-Compulsive DisorderCriteria

• For obsessions must have all
• Recurring, persisting thoughts, impulses or
  images inappropriately intrude into awareness
  cause marked distress or anxiety
• Ideas are not just excessive worries about
  ordinary problems
• Tries to ignore or suppress these ideas or
  neutralize them by thoughts or behaviors
• Insight that these ideas are a product of ones
  own mind

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Obsessive-Compulsive DisorderCriteria

• For compulsions must have all
• Feels need to repeat physical behaviors (hand
  washing) or mental behaviors (counting things,
  silently repeating words)
• Behaviors occur as response to obsession or in
  accordance with strictly applied rules

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Obsessive-Compulsive DisorderCriteria

• For compulsions must have all
• Aim of behaviors is to reduce or eliminate
  distress or prevent something that is dreaded
• Behaviors are either not realistically related to
  the events they are supposed to counteract or
  they are clearly excessive for that purpose

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Obsessive-Compulsive DisorderCriteria

• At some point, may recognize that obsessions or
  compulsions are unreasonable or excessive
• Obsessions /or compulsions associated with 1
• Cause severe distress
• Take up more than 1 hour/day
• Interfere with usual routine, or work, social or
  personal functioning

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Most Prevalent Obsessions

• Contamination fears of germs or dirt
• Imagining having harmed self or others
• Imagining loosing control of aggressive urges
• Intrusive sexual thoughts or urges
• Need to control things

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Most Prevalent Compulsions

• Repeated checking of doors, locks, electrical
  appliances, or light switches
• Frequent cleaning of hands or clothes
• Strict attempts to keep items in careful order
• Repetitious mental activities, such as counting
  or praying

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DISSOCIATIVE IDENTITY DISORDER (DID)

• Old multiple personality disorder
• Not multiple but fragmented
• Result of severe abuse
• Person develops alters to manage abuse
• Treatment is attempt to get all personalities
  reintegrated

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Personality Disorders

• Antisocial Personality
• Borderline Personality
• Self centered
• Manipulative
• Failure to reach potential

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Antisocial Personality

• Lack of regard for moral or legal standards of
  culture
• Marked inability to get along with others or
  abide by social rules
• Disregard of laws rights of others
• Also called
• Psychopaths
• Sociopaths

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Borderline Personality Disorder

• Rapid mood changes
• Intense, unstable interpersonal relationships
• Hard time controlling emotions
• Intense, inappropriate, uncontrollable anger
• Self-damaging impulsive behavior
• Compulsive spending, gambling, sexual behaviors
• Overly sensitive to criticism or rejection

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Considerations/Accommodations

• Stay calm be supportive
• Ask how to help
• Clear/concise directions
• Empathy
• Patience
• Good feedback on how doing
• Refrain from expressing displeasure

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Considerations/Accommodations

• Know about medication side effects
• Sun sensitivity
• Dry mouth
• Sedation/drowsiness
• Blurred vision
• Fluctuations in ability
• Stress management programs
• Relaxation programs
• Expressive arts programs

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Considerations/Accommodations

• Physical activity can decrease anxiety
• Watch use of sharp supplies
• Transportation
• Scholarships
• Try to involve with others to decrease social
  isolation
• Others???

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COMMUNICATING

• Confusion about what is real
• Difficulty concentrating
• Overstimulation
• Preoccupation with internal

• Be simple straight forward
• Be brief, repeat
• Limit input dont force discussion
• Get attention before preceding

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COMMUNICATING

• Agitation
• Fluctuating emotions
• Withdrawal
• Belief in delusions

• Recognize allow exit
• Dont take words or actions personally
• Initiate conversations
• Dont argue

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COMMUNICATING

• Discussion about voices
• Low self-esteem

• Acknowledge, but explain you do not hear them
• Stay positive reinforcing