HOME Conference 2010 - Mental Health 101


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HOME Conference 2010 - Mental Health 101

  1. 1. Mental Health 101 Cari Guthrie Cho, LCSW-C Chief Operating Officer Threshold Services, Inc.
  2. 2. Common Mental Health Disorders <ul><li>Thought Disorders </li></ul><ul><ul><li>Schizophrenia </li></ul></ul><ul><ul><li>Schizoaffective </li></ul></ul><ul><li>Mood Disorders </li></ul><ul><ul><li>Major Depression </li></ul></ul><ul><ul><li>Bipolar Disorder </li></ul></ul><ul><li>Personality Disorders </li></ul><ul><ul><li>Borderline Personality Disorder </li></ul></ul><ul><li>Anxiety Disorders </li></ul><ul><ul><li>Post Traumatic Stress Disorder </li></ul></ul><ul><ul><li>Obsessive Compulsive Disorder </li></ul></ul>
  3. 3. WHAT CAUSES MENTAL ILLNESS? <ul><li>Family Inheritance / Genetic Causes: </li></ul><ul><ul><li>No specific gene has been found </li></ul></ul><ul><ul><li>Inheritance does not explain all cases </li></ul></ul><ul><ul><li>Current thinking – genetic vulnerability and environmental damage both needed </li></ul></ul><ul><li>Environmental Causes </li></ul><ul><ul><li>Early brain damage </li></ul></ul><ul><ul><li>Viruses </li></ul></ul>
  4. 4. Schizophrenia <ul><li>Biological brain disease that effects about 1% of the population worldwide. </li></ul><ul><li>Cause is not known. Treatment can improve but not cure this illness. </li></ul><ul><li>Effects a person’s ability to tell the difference between real and unreal experiences. </li></ul><ul><li>Effects a person’s ability to remember, think logically and act appropriately in society. </li></ul><ul><li>Onset usually 18 – 25 years old </li></ul>
  5. 5. Risk of Developing Schizophrenia
  6. 6. POSITIVE SYMPTOMS <ul><li>Something added to normal mental process. </li></ul><ul><ul><li>Hallucinations (sensory misperceptions) </li></ul></ul><ul><ul><ul><li>Hearing something that isn’t there </li></ul></ul></ul><ul><ul><ul><li>Seeing something that isn’t there </li></ul></ul></ul><ul><ul><ul><li>Odd physical sensations </li></ul></ul></ul><ul><ul><li>Delusions (“false ideas”) </li></ul></ul><ul><ul><ul><li>Constant feeling of being watched or followed </li></ul></ul></ul><ul><ul><ul><li>Preoccupation with religion </li></ul></ul></ul><ul><ul><ul><li>Grandiose delusions – believing someone has powers that other people don’t have </li></ul></ul></ul>
  7. 7. POSITIVE SYMPTOMS <ul><ul><li>Disorganized Speech </li></ul></ul><ul><ul><ul><li>Inability to communicate clearly </li></ul></ul></ul><ul><ul><ul><li>Thoughts don’t come out in logical fashion </li></ul></ul></ul><ul><ul><ul><li>Moving from one topic to another </li></ul></ul></ul><ul><ul><ul><li>Using made up words </li></ul></ul></ul><ul><ul><li>Disorganized Behavior </li></ul></ul><ul><ul><ul><li>Failure to attend to personal hygiene </li></ul></ul></ul><ul><ul><ul><li>Inability to organize behavior that is inappropriate to the situation </li></ul></ul></ul><ul><ul><ul><li>Poor social skills </li></ul></ul></ul>
  8. 8. NEGATIVE SYMPTOMS <ul><li>Normal mental functions that are lost or severely impaired. Loss of what is enjoyable or interesting. </li></ul><ul><ul><li>Anhedonia – loss of pleasure or interest in activities that were enjoyed before </li></ul></ul><ul><ul><li>Alogia – decreased amount of speech </li></ul></ul><ul><ul><li>Apathy – poor motivation and ability to initiate activities </li></ul></ul><ul><ul><li>Lack of social interest – social withdrawal </li></ul></ul><ul><ul><li>Blunted affect – lack of facial expression, muted or absent emotional response </li></ul></ul>
  9. 9. MOST COMMON COURSE <ul><li>Repeated episodes in early adulthood, gradual loss of functional capacity and increasing negative symptoms. </li></ul><ul><li>Wide variation in outcomes has been seen – some studies show 50% of patients gain functional independence. Most studies show majority of patients have symptoms and some functional impairment throughout their lives. </li></ul>
  10. 10. COGNITIVE IMPAIRMENT <ul><li>EXECUTIVE FUNCTIONS – capacity to organize actins to achieve a goal. </li></ul><ul><li>ATTENTION – ability to remain focused and not be distracted. </li></ul><ul><li>SECONDARY MEMORY – remembering what you did a week ago and it’s consequences. </li></ul><ul><li>WORKING MEMORY – ability to use information that has been learned to solve problems. </li></ul><ul><li>INFORMATION PROCESSING – ability to use environmental cues accurately and make accurate judgments about the environment. </li></ul>
  11. 11. GOALS OF TREATMENT <ul><li>Treat acute episodes of psychotic symptoms, prevent relapse and support recovery. </li></ul><ul><li>Prevent future episodes by: </li></ul><ul><ul><li>Learning early warning signs; </li></ul></ul><ul><ul><li>Intervene with additional support or medications when warning signs appear; </li></ul></ul><ul><ul><li>Avoid stressors that lead to relapse. </li></ul></ul>
  12. 12. TREATMENT OF SCHIZOPHRENIA <ul><li>Most important medications are called anti-psychotics </li></ul><ul><ul><li>Most effective on positive symptoms </li></ul></ul><ul><li>50 - 80% of patients show significant improvement </li></ul><ul><li>Except for clozapine, no one agent has been shown consistently to be more effective than another on average </li></ul><ul><li>Cognitive Therapy usually not successful </li></ul><ul><li>Skills training is helpful – helping client learn how to deal with stressors, signs of relapse, personal hygiene, employment skills, etc. </li></ul>
  13. 13. Medications <ul><li>Traditional/Typical drugs – side effects – dry mouth, tardive dyskenesia </li></ul><ul><li>List of a few drugs </li></ul><ul><ul><li>Haldol </li></ul></ul><ul><ul><li>Prolixin </li></ul></ul><ul><ul><li>Navane </li></ul></ul><ul><ul><li>Loxitane </li></ul></ul><ul><ul><li>Stelazine </li></ul></ul>
  14. 14. Medications <ul><li>Newer medications or atypical meds are now often used first </li></ul><ul><li>They have fewer movement related side effects </li></ul><ul><li>Metabolic side effects – people are developing diabetes, high cholesterol on these newer meds </li></ul><ul><li>List of drugs: </li></ul><ul><ul><li>Clozapine (Clozaril) </li></ul></ul><ul><ul><li>Risperidone (Risperdal) </li></ul></ul><ul><ul><li>Olanzapine (Zyprexa) </li></ul></ul><ul><ul><li>Quetiapine (Seroquel) </li></ul></ul><ul><ul><li>Ziprasidone (Geodon) </li></ul></ul><ul><ul><li>Aripipizole (Abilify) </li></ul></ul><ul><li>Clozaril – only medication to have positive affect on negative symptoms </li></ul>
  15. 15. Depression <ul><li>Persistent mood change lasting at least two weeks. </li></ul><ul><li>Depressed mood </li></ul><ul><li>Lack of interest in daily activities </li></ul><ul><li>Significant weight change </li></ul><ul><li>Significant sleep change </li></ul><ul><li>Psychomotor agitation or retardation </li></ul><ul><li>Fatigue or loss of energy </li></ul><ul><li>Feelings of worthlessness </li></ul><ul><li>Poor concentration </li></ul><ul><li>Recurrent thoughts of death </li></ul><ul><li>Significant impairment in social, work, or other areas of life </li></ul>
  16. 16. Course of illness <ul><li>May begin at any age. </li></ul><ul><li>Some people have isolated incidents related to stress or trauma </li></ul><ul><li>Many have increasingly frequent episodes as they get older </li></ul><ul><li>May have psychotic symptoms as well </li></ul><ul><li>Medications and therapy have most success in treatment over time. </li></ul>
  17. 17. Treatment for Major Depression <ul><li>Traditional meds – Anti Depressants </li></ul><ul><li>SSRI’s – impact different (Serotonin) neurotransmitters in the brain </li></ul><ul><ul><li>Prozac </li></ul></ul><ul><ul><li>Elavil </li></ul></ul><ul><ul><li>Effexor </li></ul></ul><ul><ul><li>Wellbutrin </li></ul></ul><ul><li>Therapy – cognitive behaviorial therapy; support groups; skills training are all helpful. </li></ul>
  18. 18. Bipolar Disorder <ul><li>Bipolar I - A combination of one or more Manic episodes as well as one or more Depressed episodes </li></ul><ul><li>Bipolar II – A combination of one or more depressed episodes as well as one or more hypomanic episodes. </li></ul><ul><li>Average age of onset is 20 years old. </li></ul><ul><li>More than 90% have multiple episodes </li></ul><ul><li>10 – 15% will complete suicide – usually in depressed episode </li></ul>
  19. 19. Manic Episode <ul><li>Distinct period of abnormally and persistently elevated, expansive, or irritable mood – for at least one week in duration </li></ul><ul><li>Inflated self esteem </li></ul><ul><li>Decreased need for sleep </li></ul><ul><li>Increased talking </li></ul><ul><li>Flight of ideas, racing thoughts </li></ul><ul><li>Distractible </li></ul><ul><li>Increase in goal directed activity </li></ul><ul><li>Excessive involvement in pleasurable activities that could have negative consequences – buying sprees, sexual indiscretions, foolish investments </li></ul><ul><li>Causes significant impairment in social or employment functioning </li></ul><ul><li>May have psychotic features </li></ul>
  20. 20. Hypomanic Episode <ul><li>Same symptoms as Manic episode except for: </li></ul><ul><ul><li>Duration at least 4 days </li></ul></ul><ul><ul><li>Changes are observable by others – uncharacteristic of the person </li></ul></ul><ul><ul><li>Not severe enough to cause impairment in social or employment functioning </li></ul></ul>
  21. 21. Course of illness <ul><li>May begin at any age. </li></ul><ul><li>Some people have isolated incidents related to stress or trauma </li></ul><ul><li>Others have increasingly frequent episodes as they get older </li></ul><ul><li>May have psychotic symptoms as well </li></ul><ul><li>Medications and therapy have most success in treatment over time. </li></ul>
  22. 22. Treatment for Bipolar Disorders <ul><li>Mood Stabilizers </li></ul><ul><ul><li>Depakote </li></ul></ul><ul><ul><li>Lithium </li></ul></ul><ul><ul><li>These medications need regular lab work done because of effects on Liver or Kidney functioning </li></ul></ul><ul><li>Anti depressants </li></ul><ul><li>Therapy – cognitive behaviorial therapy; support groups; skills training are all helpful. </li></ul>
  23. 23. Schizoaffective Disorder <ul><li>Period of illness with a combination of symptoms for Schizophrenia as well as Major Depressive, Manic, or Mixed episode </li></ul><ul><li>Delusions or hallucinations present for at least 2 weeks during period of illness </li></ul><ul><li>Mood episode symptoms are present most of the time during the period of illness </li></ul>
  24. 24. Treatment for Schizoaffective D/O <ul><li>Mood stabilizers </li></ul><ul><li>Anti psychotics </li></ul><ul><li>Anti depressants </li></ul><ul><li>Therapy – skills training most helpful; cognitive therapy may not be as useful due to thought disorder aspect of illness. </li></ul>
  25. 25. Borderline Personality Disorder <ul><li>A pervasive pattern of unstable relationships, self image </li></ul><ul><li>Marked impulsivity beginning in early adulthood </li></ul><ul><li>Frantic efforts to avoid “abandonment” </li></ul><ul><li>Unstable relationships characterized by extremes of idealization and devaluation </li></ul><ul><li>Identity disturbance </li></ul>
  26. 26. What is Borderline Personality Disorder? <ul><li>Impulsivity that is self damaging </li></ul><ul><li>Recurrent suicidal behavior, gestures, or self mutilating behavior </li></ul><ul><li>Intense labile moods </li></ul><ul><li>Chronic feelings of emptiness </li></ul><ul><li>Inappropriate, intense anger; inability to control anger </li></ul><ul><li>Transient, stress related paranoid ideation or dissociation </li></ul>
  27. 27. Treatment for Borderline Personality Disorder <ul><li>For Personality disorders, medications are not useful – you can’t medicate someones personality. </li></ul><ul><li>Medications may be prescribed for particular symptoms such as depression or anxiety </li></ul><ul><li>Therapy – particularly Dialectical Behavioral Therapy (DBT) has proven successful. </li></ul>
  28. 28. What Is Recovery? <ul><li>Recovery is possible for people with mental illness. You must offer HOPE! </li></ul><ul><li>Recovery is different for each person. </li></ul><ul><li>Recovery means that you have a successful, high quality of life even though you have a mental illness. </li></ul><ul><li>Recovery means that you might maintain a job, use supports, have friends, go to school, or have a home. </li></ul><ul><li>Recovery may mean that you experience symptoms everyday, but you can manage them and still do the things you want to do. </li></ul><ul><li>Recovery does not mean that you are cured! </li></ul>
  29. 29. WHAT YOU CAN DO <ul><li>Have HOPE – people to recover, clients can have more fulfilling lives, if you don’t believe it – they never will either! </li></ul><ul><li>Don’t take things personally – if a client yells at you or curses at you – it’s probably not about you – it’s about them feeling out of control because of depression, hearing voices, or any other symptom they are having. </li></ul><ul><li>Be where the client is at – put yourself in their shoes – how would you feel if you were homeless and hearing voices and having a bunch of people telling you what to do? </li></ul>
  30. 30. WHAT YOU CAN DO <ul><li>Have HOPE </li></ul><ul><li>It’s all about the relationship – you have to build trust before you can effect any change. Help them with the basics first – food, clothing, shelter, entitlements, etc. They will see that you care about them and can help them – trust will start to build so that you can talk about other things like symptoms and medications, etc. </li></ul><ul><li>Revise expectations, at least temporarily – acknowledge symptoms of illness. If the client does not think they have a mental illness then talking to them about mental illness is just going to piss them off. Talk to them about other stuff instead – family, work, interests – find something positive, a strength, to focus on – not the negative all the time. </li></ul>
  31. 31. WHAT YOU CAN DO <ul><li>Have HOPE </li></ul><ul><li>Avoid over-stimulation – groups, lots of noise, loud noise, multiple conversations can be too much. Someone with depression make breakdown; someone with schizophrenia may become agitated and more delusional </li></ul><ul><li>Set limits/boundaries – should be reasonable and flexible if needed. Allow for the client to have input and choice whenever possible, but be CONSISTENT with each client. </li></ul><ul><li>Selectively ignore – give people space. Do you really need to tell that client to stop pacing? Who is it hurting? </li></ul>
  32. 32. WHAT YOU CAN DO <ul><li>Have HOPE </li></ul><ul><li>Keep communications simple and respectful. </li></ul><ul><li>Support the patient’s medication regimen – monitor meds; communicate with the doctor and treatment team </li></ul><ul><li>Learn to recognize signals for help – appropriate crisis intervention – know how to calm a situation not agitate it. </li></ul>
  33. 33. WHAT YOU CAN DO <ul><li>Have a positive attitude – watch your language about clients – don’t use terms like “punishment”, “lazy”, or “resistant” </li></ul><ul><li>Ask for help whenever you need it – </li></ul><ul><ul><li>Supervisor </li></ul></ul><ul><ul><li>Crisis Center </li></ul></ul><ul><ul><li>Treatment provider </li></ul></ul><ul><ul><li>Me </li></ul></ul><ul><li>Have HOPE! </li></ul>