The International Consortium in Psychiatric Epidemiology (ICPE) was established in 1998 by WHO to carry out cross-national comparative studies of the prevelences and correlates of mental disorders. The graphics describe the findings of ICPE surveys in seven countries in North America (Canada and USA), Latin America (Brazil and Mexico), and Europe (Germany, Netherlands, and Turkey), using a version of the WHO Composite International Diagnostic Interview (CIDI) to generate diagnoses. The results are reported using DSM-III-R and DSM-IV criteria without diagnostic hierarchy rules for mental disorders and with hierarchy rules for substance-use disorders. Retrospective reports suggest that mental disorders typically had early ages of onset, with estimated medians of 15 years for anxiety disorders, 26 years for mood disorders, and 21 years for substance-use disorders. All three classes of disorder were positively related to a number of socioeconomic measures of disadvantage (such as low income and education, unemployed, unmarried). Analysis of retrospective age-of-onset reports suggest that lifetime prevelences had increased in recent cohorts, but the increase was less for anxiety disorders than for mood or substance-use disorders. Delays in seeking professional treatment were widespread, especially among early-onset cases, and only a minority of people with prevailing disorders received any treatment. Theme Papers Contributing ICPE authors: Laura Andrade (University of Sao Paulo, Sao Paulo, Brazil); J.J. Caraveo-Anduaga (Mexican Institute of Psychiatry, Mexico City, Mexico); Patricia Berglund (University of Michigan, Ann Arbor, MI, USA); R. Bijl (Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands); R.C. Kessler, Olga Demler, and EllenWalters (Harvard Medical School, Boston, MA, USA); C. Kylyc¸ (Hacettepe University Medical School, Ankara, Turkey); D. Offord (Chedoke-McMaster Hospital, Hamilton, Canada); T. B.Ustun (WHO, Geneva, Switzerland); and H-U. Wittchen (Max Planck Institute of Psychiatry, Munich, Germany). Cross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology. Bulletin of the World Health Organization, 2000, 78 (4):413-426
Distress – Common; caused by a problem or event; usually not severe (may be severe); usually short lasting; professional help not usually needed; professional help can be useful; DIAGNOSIS NOT NEEDED Disorder –Less common; may happen without any stress; often with high severity; usually long lasting; professional help usually needed – needs to be DIAGNOSED Mental illnesses must meet diagnostic criteria which are based on scientific and empirical research and are codified in international classifications of mental illnesses – such as the International Classification of Disease (ICD-10) or the Diagnostic and Statistical Manual-Revised (DSM – IVR). So, separation of mental distress from mental disorder requires a diagnosis of mental illness. Mental distress: an emotional, cognitive or behavioral state that is stressful to the individual and which can at times negatively impact their social, vocational or interpersonal interactions for a period of time. These states often involve human reactions to common environmental stresses. Examples of mental distress include: feelings of being upset after not receiving a work promotion; unhappy or sad feelings after the breakup of a relationship; anger at the person who broke a prized possession; worry about the results of a test; These states are all within the expected and “normal” range of human experiences and are not disorders of mental functioning. These experiences can be quite intense and may involve the expression of physical symptoms such as headaches or difficulty sleeping. These experiences may lead the individual suffering from them to seek help from others, such as friends, family members, religious leaders or even health professionals. Mental distress is found on a continuum, ranging from mild to moderate to severe. Individuals vary considerably in their experience of mental distress. For example, one person may become very upset, tearful and experience headaches and stomach pains for a day or more when they learn that they have failed to pass a test. Another person may become upset and angry for a few hours and then go out to a party with friends. In some cases, this mental distress can not only be intense but also prolonged and have a significant effect on usual functioning. For example the state of mourning that occurs when a loved one dies or the state of “depression” that can occur after a long term intimate relationship ends (such as in a divorce). These examples fall within the severe end of the mental distress continuum and are not generally considered to be mental disorders because they are common responses to common life events, represent a common human reaction to these types of events and do not generally require extraordinary interventions in order to lead to their resolution. However, in some cases, severe mental distress can turn into a mental disorder (such as bereavement turning into depression). Mental disorders (also called mental illnesses) differ from mental distress in a number of important ways. They are disturbances of emotion, cognition or behavior which may occur spontaneously, that is without any environmental event leading to their expression. They tend to be severe, with symptoms that are problematic to the individual and often visible to friends, family and others. They usually lead to functional impairment in one or more spheres: interpersonal; social; vocational. They show prolonged presence and often require extraordinary interventions (such as medication or psychological treatments) before they are substantively improved. They are presumed, or confirmed, to follow from physiologically demonstrated brain dysfunction (shown by neurocognitive testing, MRI testing, etc.).
Mental disorders are also called mental illnesses or psychiatric illnesses and are categorized according to diagnostic criteria There are two different sets of diagnostic criteria – International Classification of Diseases (ICD) Diagnostic Statistical Manual of Mental Disorders Both sets of criteria are similar in that they consist of syndromes (collections of signs and symptoms) From Wikipedia, the free encyclopedia: http://en.wikipedia.org/wiki/ICD “ The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. Every health condition can be assigned to a unique category and given a code, up to six characters long. Such categories can include a set of similar diseases. The International Classification of Diseases is published by the World Health Organization (a.k.a. WHO). The ICD is used world-wide for morbidity and mortality statistics, reimbursement systems and automated decision support in medicine. This system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics. The ICD is a core classification of the WHO Family of International Classifications (WHO-FIC). An important alternative to ICD coding is the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the primary diagnostic system for psychiatric and psychological disorders within the United States and is used as an adjunct diagnostic system in many other countries. Since the 1990s, the APA and WHO have worked to bring the DSM and the relevant sections of ICD into concordance, but some small differences remain.” Individuals may be outside the norm in one or more domains of brain functioning but unless the signs and symptoms they experience fit into a SYNDROME they do not have a mental disorder/mental illness, they may however have mental distress that can be helped by psychological (such as counseling) or social (such as community) activities. Not all disturbances of brain functioning are mental disorders Some can be a normal or expected response to the environment – for example: grief when somebody dies or acute worry, sleep problems and emotional tension when faced with a natural disaster such as a hurricane
Ascertaining The Likelihood of a Mental Disorder When addressing the question of – Is the patient likely to have a psychiatric diagnosis? – the clinician must consider the following questions. A “yes” to two or more of these questions should raise the probability that the patient may have a psychiatric disorder and should then trigger the next steps in the diagnosis and intervention cascade available within the health care system. Questions to consider when determining whether or not the patient is likely to have a Mental Disorder - The Quick Screen Method: QUICK SCREEN FOR MENTAL DISORDER Is the patient’s emotional state, cognitive function or behaviour very distressing or caused significant problems to them or to those around them? Does the patient exhibit a lack of social convention that he/she is unaware of? Are the patient’s emotions, reasoning or behaviour markedly different than his/her social, cultural and economic peers? Are those people who are closest to and most caring of the patient seriously concerned that the patient may be ill, even if they attribute the problems to an environmental condition?
The functions of the brain can be described within six primary domains: Thinking or cognition perception or sensing emotion or feeling signaling physical or somatic Behavior
WHAT ARE DELUSIONS?? Delusions are fixed, unbending beliefs that are incompatible with the beliefs held by the majority of people in the individual’s culture or subculture. These beliefs are held with rigid conviction despite incontrovertible or obvious evidence of their falsehood. False … NOT REAL!!! Persistent … DON’T GO AWAY! Not shared by others of same socio-cultural group… FAMILY & FRIENDS FIND IT ODD Regarded as real and held with conviction despite being given ample evidence to the contrary… NO PROOF IS ENOUGH!! Must be evaluated from within socio-cultural context ... NOT IN LINE WITH CULTURAL BELIEFS Examples of Types of Delusions: Some of the more common types of delusions are grandiose, persecutory, religious, jealous and somatic delusions. Grandiose: Delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person Persecutory Delusions: Delusions that the person is being malevolently treated in some way Religious: Individual’s beliefs revolve around religious themes (e.g., belief that he/she has been selected by God to carry out his bidding). Jealous: Delusions that the individual’s sexual partner is being unfaithful Somatic: Delusions that the person has some physical defect or general medical condition
Schizophrenia Schizophrenia is a mental illness which affects one person in every hundred. Schizophrenia interferes with a person’s mental functioning and behaviour, and in the long term may cause changes to their personality. The first onset of schizophrenia is usually in adolescence or early adulthood. Some people may experience only one or more brief episodes of psychosis in their lives, and it may not develop into schizophrenia. For others, it may remain a recurrent or life-long condition. The onset of the illness may be rapid, with acute symptoms developing over several weeks, or more commonly, it may be slow, developing over months or even years. During onset, the person often withdraws from others, gets depressed and anxious, and develops unusual fears or obsessions. It is characterized by two different sets of symptoms. Positive symptoms refer to symptoms that appear, like delusions, thinking things that aren’t true, or hallucinations, seeing or hearing things that aren’t there. Negative symptoms refer to things that are taken away by the illness, so that a person has less energy, less pleasure and interest in normal life activities, spending less time with friends, being less able to think clearly. What are the symptoms of schizophrenia? Positive symptoms of schizophrenia include: Delusions – false beliefs of persecution, guilt or grandeur, or being under outside control. These beliefs will not change regardless of the evidence against them. People with schizophrenia may describe outside plots against them or think they have special powers or gifts. Sometimes they withdraw from people or hide to avoid imagined persecution. Hallucinations – most commonly involving hearing voices. Other less common experiences can include seeing, feeling, tasting or smelling things, which to the person are real but which are not actually there. Thought disorder – where the speech may be difficult to follow, for example, jumping from one subject to another with no logical connection. Thoughts and speech may be jumbled and disjointed. The person may think someone is interfering with their mind. Other symptoms of schizophrenia include: Loss of drive – when the ability to engage in everyday activities such as washing and cooking is lost. This lack of drive, initiative or motivation is part of the illness and is not laziness. Blunted expression of emotions – where the ability to express emotion is greatly reduced and is often accompanied by a lack of response or an inappropriate response to external events such as happy or sad occasions. Social withdrawal – this may be caused by a number of factors including the fear that someone is going to harm them, or a fear of interacting with others because of a loss of social skills. Lack of insight or awareness of other conditions – because some experiences such as delusions or hallucinations are so real, it is common for people with schizophrenia to be unaware they are ill. For this and other reasons, such as medication side-effects, they may refuse to accept treatment which could be essential for their well being. Thinking difficulties – a person’s concentration, memory and ability to plan and organize may be affected, making it more difficult to reason, communicate, and complete daily tasks. Facts about Schizophrenia: Schizophrenia is a chronic lifelong disorder Often requires lifelong treatment Symptoms are disabling to the individual and distressing to family and friends One in ten people with schizophrenia commits suicide The burden for caring for people with Schizophrenia most often falls on families Schizophrenia is not caused by poor parenting Schizophrenia is not ‘split personality’ People who have Schizophrenia are not violent unless they are acutely ill Schizophrenia runs in families The exact cause is unknown but it is a brain disorder Schizophrenia is not caused by stress Schizophrenia affects between 1 and 2% of people worldwide Men and women are equally affected Medications can help reduce and control symptoms The symptoms of schizophrenia: Refer to the following website for a description of the symptoms of Schizophrenia: Psychiatry 24x7.com http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=schizophrenia_symptoms&page=ecall All content of this Internet site is owned or controlled by Janssen Pharmaceutica NV, and is protected by worldwide copyright laws. You may download content only for your personal use for non-commercial purposes, but no modification or further reproduction of the content is permitted. The content may otherwise not be copied or used in any way.
As mood falls from -3 to -8 the person may experience the following: Depressed or Sad mood Decreased Interest in things Difficulty enjoying things Problems with concentration Problems with attention Low energy Sleep problems Changes in appetite Feeling physically slowed down Feeling restless and unable to settle Having negative thoughts Thinking about death and suicide As mood falls from -8 to -10 the person may experience the following: Depressed or Sad mood Decreased Interest in things Difficulty enjoying things Problems with concentration Problems with attention Low energy Sleep problems Changes in appetite Feeling physically slowed down Feeling restless and unable to settle Having negative thoughts Thinking about death and suicide PLUS: Impaired Function: Difficulty working Difficult going to school Difficulty completing household chores and responsibilities Difficulty caring for children Difficulty connecting with partner/spouse Difficulties engaging in social activities
As mood goes from +3 to +8 the person may experience the following: Elevated/expansive mood Grandiosity Intrusiveness Euphoria/Elation Intense irritability Decreased Need for sleep Pressured Speech Racing thoughts Distractibility Hyper-activity Agitation Aggression Reckless Behavior As mood goes from +8 to +10 the person may experience the following: Elevated/expansive mood Grandiosity Intrusiveness Euphoria/Elation Intense irritability Decreased Need for sleep Pressured Speech Racing thoughts Distractibility Hyper-activity Agitation Aggression Reckless Behavior Grandiose Delusions PLUS: IMPAIRED FUNCTIONING!!
Low or depressed mood most of the time for a long time Many physical complaints can accompany the low mood Many problems with work, at home or in relationships with others because of the low mood The low mood often does not respond to changes in the environment This can happen without an obvious cause How is a ‘Depressive Episode’ different from feeling sad? Mood is low for a long time and is accompanied by characteristic mood/affect, thought/cognition, behavior, physical and functional disturbances. Disturbances in perception and signaling may also occur. This shift in mood is persistent and sustained Shift in mood state position is largely independent of life circumstances although individuals with depression may continue to be ‘reactive’ or responsive to events in their lives: Non-reactive Mood: Mood is not affected by external circumstances. For example, a patient suffering from depression fails to feel better, even temporarily, when something good happens or when socializing with friends; When presented with bad news the individual’s expression fails to demonstrate any expected reaction. Reactive mood: Some reactivity, positive or negative fluctuation in mood influenced by positive or negative circumstances, is retained. This negative shift of the mood state position has an ‘autonomous driver’ or is not under the control of the individual. A stressful life event may precipitate the onset of a depressive episode in some individuals but once the stressor is removed the mood remains low (shifted mood state position does not return to normal baseline). It is associated with impaired functioning in one or more areas of the person’s life ie., interpersonal, social, occupational or academic functioning. For a useful description of Clinical Depression refer to the following website: http://www.psychiatry24x7.com/homes/depression.jhtml
How is Mania different from being extremely happy? Mood state position is shifted towards the positive pole of the graph. This shift is accompanied by characteristic mood/affect, thought/cognition, perception, behavior, physical and functional disturbances. This shift in mood is persistent and sustained. It is largely independent of life circumstances although it may be influenced by external events. It has an ‘autonomous driver’ or is not under the control of the individual. It occurs without an externally reinforcing situation or event. It is associated with impaired functioning in one or more areas of the person’s life ie., interpersonal, social, occupational or academic functioning. For a useful description of Bipolar Disorder refer to the following website: http://www.psychiatry24x7.com/homes/bipolar.jhtml
Signaling: Our hard-wired danger response mechanism. Every organism on the planet from an ant to a human being has a Signaling Mechanism. Without it we and all other creatures on the planet would die! Our signaling mechanism is what allows us to jump out of the way of oncoming traffic; sharpen our senses to the slightest change in our environment when we are afraid; gets us ready to run to escape from danger or prepares us to fight to protect ourselves. It also helps us focus when we have to study to pass an exam or drive a vehicle safely during a bad storm. When the brain senses danger from signals received from the environment through our 5 senses it reacts before we have time to THINK about it… this is an automatic ‘reflex’!... If the brain waited for us to think before we acted in danger situations we would most likely never live to know about it!! As soon as the brain senses danger it turns an our ‘adrenaline tap’... This activates a whole cascade of reactions that results in our bodies being prepared to react and protect itself. The Signaling Physiologic cascade is hardwired for survival Result of the Physiologic cascade: Increased heart rate Sweating Tension Increased delivery of blood to the muscles Sharpened sight and hearing Inhibition of digestion Extreme alertness
Dysfunction of the danger signaling mechanism can lead to triggering of the ‘physiologic cascade’ in the absence of real danger: This is called ‘Anxiety’
Physical Symptoms: Insomnia Palpitations Increased heart rate Suffocation Dizziness Shaking or tremors Shortness of breath Stomach upset Restlessness Diarrhea Change in appetite Flushing Blushing Sweating Faintness Chest pain Thinking/Cognitive Symptoms: Worry/Apprehension Difficulty making decisions Poor concentration Repeatedly thinking the same distressing thoughts: ie., Obsessions & Ruminations Catastrophic thinking Increased or Decreased awareness of one’s surroundings Confusion Behavioral Symptoms: Aggression Avoidance Agitation Restlessness Substance use: Alcohol Benzodiazepines Sleep Medicines Social Withdrawal Repeated behaviors (Compulsions)
Normal Versus Pathologic Anxiety? Anxiety can be normal or pathologic . Normal anxiety is an expected, transient response to stress (ie., feeling anxious on a first date or when preparing for an exam, or while anticipating standing up and making a speech). Anxiety which is pathologic occurs in the absence of danger and is excessive or inappropriate to the situation. Pathologic anxiety has an intensity that exceeds the person’s capacity to endure it; is persistent rather than transient; is associated with impairment of the person’s ability to function optimally in his/her daily life; and leads to dysfunctional coping strategies such as avoidance and withdrawal. Pathologic anxiety is associated with the mental disorders known as anxiety disorders and is caused by dysfunction and dysregulation of the body’s danger signaling mechanisms.
What is anxiety? Anxiety is a term which describes a normal feeling people experience when faced with threat or danger, or when stressed. When people become anxious, they typically feel upset, uncomfortable and tense and may experience many physical symptoms such as stomach upset, shaking, headaches, etc. Feelings of anxiety are caused by experiences of life, such as a new relationship, a new job or school, illness, accident, etc. Feeling anxious is appropriate in these situations and usually we feel anxious for only a limited time. These feelings are not regarded as clinical anxiety, but are a part of everyday life. What are anxiety disorders? The anxiety disorders are a group of illnesses, each characterized by persistent feelings of intense anxiety. There are feelings of continual or extreme discomfort and tension, and may include panic attacks. People are likely to be diagnosed with an anxiety disorder when their level of anxiety and feelings of panic are so extreme that they significantly interfere with daily life and stop them from doing what they want to do. This is what characterizes an anxiety disorder as more than normal feelings of anxiety. Anxiety disorders affect the way the person thinks, feels and behaves and, if not treated, cause considerable suffering and distress. They often begin in adolescence or early adulthood and may sometimes be triggered by significant stress. Anxiety disorders are common and may affect one in twenty people at any given time. All anxiety disorders are characterized by heightened anxiety or panic as well as significant problems in everyday life.
Social phobia People with social phobia fear that others will judge everything they do in a negative way. They believe they may be considered to be flawed or worthless if any sign of poor performance is detected. They cope by either trying to do everything perfectly, limiting what they are doing in front of others, especially eating, drinking, speaking or writing, or they withdraw gradually from contact with others. They will often experience panic symptoms in social situations and will avoid many situations where they feel observed by others (such as in stores, movie theatres, public speaking, social events, etc.)
Obsessive compulsive disorder This disorder involves intrusive unwanted thoughts (obsessions) the performance of elaborate rituals (compulsions) in an attempt to control or banish the persistent thoughts or to avoid feelings of unease. The rituals are usually time consuming and seriously interfere with everyday life. For example, people may be constantly driven to wash their hands or continually return home to check that the door is locked or that the oven is turned off. People with this disorder are often acutely embarrassed and keep it a secret, even from their families.
Post-traumatic stress disorder Some people who have experienced major traumas such as war, torture, hurricanes, earthquakes, accidents or personal violence continue to feel terror long after the event is over. They may experience nightmares or flashbacks for years. The flashbacks are often brought about by triggers related to the experience.
Behavior: Our ability to interact with others and our environment through ‘doing’. Actions in response to internal or external stimuli. We use all of these brain functions every second of every day and are largely unaware that we are doing so. Our brain integrates all of these functions to enable us to do even the simplest task.
What is Attention Deficit Hyperactivity Disorder? Attention Deficit Hyperactivity Disorder is the most commonly diagnosed behavioural disorder of childhood. In any six-month period, ADHD affects an estimated 4 -6 % of young people between the ages of 9 and 17. Boys are two to three times more likely then girls to develop ADHD. Although ADHD is usually associated with children, the disorder can persist into adulthood. Children and adults with ADHD are easily distracted by sights and sounds and other features of their environment, cannot concentrate for long periods of time, are restless and impulsive, or have a tendency to daydream and be slow to complete tasks Symptoms The three predominant symptoms of ADHD are 1) inability to regulate activity level (hyperactivity); 2) inability to attend to tasks (inattention); and 3) impulsivity, or inability to inhibit behaviour. Common symptoms include varying degrees of the following: Poor concentration and brief attention span Increased activity - always on the go Impulsive - doesn't stop to think Social and relationship problems Fearless and takes undue risks Poor coordination Sleep problems Normal or high intelligence but under perform at school For useful information about ADHD refer to the following website: http://www.psychiatry24x7.com/homes/adhd.jhtml
Table: World: DALYs in 2000 attributable to selected causes by age Adapted from: World Health Organization (2003). Caring for children and adolescents with mental disorders. Setting WHO directions. Page 3, Figure 1. World: DALYs in 2000 attributable to selected causes, by age and sex. Child and Adolescent Health Comparative Burden of Illness for Mental Illness 4 2 Cardiovascular Diseases 5 3 Malignant Neoplasms 29 12 Neuro-psychiatric conditions (including self-inflicted injuries) Ages 10-19 Ages 0-9
Child and Adolescent Mental Disorders WHO Health Report, 2001 2.0 Substance Use Disorders 20.9 Any Disorder 10.3 Disruptive Behavioral Disorders 6.2 Mood Disorder 13.0 Anxiety Disorder 6 Month Prevalence (%) Age = 9-17 Disorder
Cross-national Comparisons of the Onset of Psychiatric Disorders Age of onset distributions of any anxiety disorders* Age of onset distributions of any mood disorders* Age of onset distributions of any substance use disorders* *Data for Germany were omitted because of the narrow age range of the sample
Prevalence of Mental Disorders in Young People <ul><li>Population Prevalence </li></ul><ul><li>Depression (6%) </li></ul><ul><li>Psychosis (1%) </li></ul><ul><li>Anxiety Disorders (10%) </li></ul><ul><li>ADHD (4%) </li></ul><ul><li>Anorexia Nervosa (0.2%) </li></ul><ul><li>Total (15 – 20%) </li></ul><ul><li>Translation to the </li></ul><ul><li>“ average” Classroom </li></ul><ul><li>Depression (2) </li></ul><ul><li>Psychosis (rare) </li></ul><ul><li>Anxiety Disorders (3) </li></ul><ul><li>ADHD (1) </li></ul><ul><li>Anorexia Nervosa (rare) </li></ul><ul><li>Total (4 – 5) </li></ul>
What is Stigma? <ul><li>In the context of mental health, stigma is the use of negative labels to identify a person living with mental illness. It is about disrespect and keeps mental illness in the closet. Stigma is a barrier and discourages individuals and their families from getting the help they need. It closes minds and fuels discrimination. Many say that living with the stigma is worse than living with the illness itself. (CMHA) </li></ul><ul><li>Source: http://www.cmha.ca/bins/content_page.asp?cid=284-683-1549-2352-2354&lang=1 </li></ul>
Stigma is a major cause of discrimination and exclusion-WHO <ul><li>It hampers the prevention of mental health disorders, the promotion of mental well-being and the provision of effective treatment and care. </li></ul><ul><li>It also contributes to the abuse of human rights. </li></ul><ul><li>Source: http://www.euro.who.int/mentalhealth/topics/20061129_3 </li></ul>
Ten Things You Can Do to Fight Stigma and Discrimination <ul><li>Learn more about mental illnesses, to become more informed. </li></ul><ul><li>Listen to people who have experienced mental illness-how they have been stigmatized, how it affected their lives. </li></ul><ul><li>Watch your language-avoid terms and expressions that can perpetuate stereotypes, such as 'lunatics', 'nuts' or 'schizophrenic'. </li></ul><ul><li>Monitor media and report stigmatizing material. </li></ul><ul><li>Source: Adapted from Telling is Risky Business: Mental Health Consumers Confront Stigma, by Otto Wahl, Rutgers University Press, 1999 http://www.cmha.ca/bins/content_page.asp?cid=284-683-1549-2352-2354-2402&lang=1 </li></ul>
Ten Things You Can Do to Fight Stigma and Discrimination <ul><li>Respond to stigmatizing material in the media. Protest such material to those responsible-journalists, editors, advertisers, movie producers - and provide more appropriate information. </li></ul><ul><li>Speak up about stigma. When someone misuses a psychiatric term (such as 'schizophrenic'), tells a joke that ridicules mental illness or makes disrespectful terms, let them know you find it hurtful and unacceptable. </li></ul><ul><li>Talk openly about mental illness. The more mental illness remains hidden, the more people will continue to believe it is shameful </li></ul><ul><li>Source: Adapted from Telling is Risky Business: Mental Health Consumers Confront Stigma, by Otto Wahl, Rutgers University Press, 1999 http://www.cmha.ca/bins/content_page.asp?cid=284-683-1549-2352-2354-2402&lang=1 </li></ul>
Ten Things You Can Do to Fight Stigma and Discrimination <ul><li>Demand change from your elected representatives. Speak up on issues such as insurance parity, limited funding for research and inadequate budgets for mental health services. </li></ul><ul><li>Support organizations that fight stigma and discrimination. Join them, donate money to them and volunteer for them. </li></ul><ul><li>Contribute to research related to mental illness and stigma. </li></ul><ul><li>Source: Adapted from Telling is Risky Business: Mental Health Consumers Confront Stigma, by Otto Wahl, Rutgers University Press, 1999 http://www.cmha.ca/bins/content_page.asp?cid=284-683-1549-2352-2354-2402&lang=1 </li></ul>
<ul><li>Most young people with mental disorders will go on to be successful at school and live productive and positive lives when receiving proper treatments for their mental illness. </li></ul><ul><li>Some young people have severe and persistent mental disorders which respond poorly to current treatments (as in all other illnesses) and may require greater supports </li></ul><ul><li>Mental illness does not respect any boundaries of race, class or geography. </li></ul><ul><li>Young people with mental illness are more likely to be victims not perpetrators of violence </li></ul><ul><li>Young people with mental illnesses have difficulty accessing best possible care and face substantial stigma </li></ul><ul><li>Early identification and provision of best evidence treatments have the opportunity to substantially improve outcomes </li></ul>What do we know about young people with mental illnesses?
Thinking About Causes and Effects <ul><li>How do we know what causes what? </li></ul><ul><li>Is there anything about mental disorders that makes thinking about causation difficult? </li></ul><ul><li>How do we know what works in the treatment of mental disorders? </li></ul><ul><li>Is there anything about mental disorders that makes thinking about treatment difficult? </li></ul>
Correlation VS Causality? Correlation Causality Risk factors are Correlations and not Causes What is a Risk Factor?
Types of Risk Factors <ul><li>Causal – these factors always or usually always cause the disease (eg: exposure to HIV) </li></ul><ul><li>Associated – these factors may contribute to the cause of the disease but do not actually cause the disease (eg: pneumonia in a person who is bed-ridden) </li></ul><ul><li>Co-related – these factors may or may not contribute to the cause of the disease (eg: bullying and depression) but do not cause it </li></ul>
How do we know what works? <ul><li>How is scientific evidence created? </li></ul><ul><li>Is all scientific evidence created equal? </li></ul><ul><li>How do we evaluate scientific evidence? </li></ul><ul><li>How do we apply scientific evidence to evaluation of treatment? </li></ul><ul><li>How do we apply scientific evidence to choosing and evaluating programs? </li></ul><ul><li>What is the difference between “evidence of absence” and “absence of evidence”? </li></ul>
Knowing What Works <ul><li>Scientific evidence is created through experiments, not through other kinds of research </li></ul><ul><li>Not all scientific evidence is equal: it is hierarchically evaluated using internationally accepted criteria </li></ul><ul><li>Any treatment or program can be scientifically evaluated to see if it works </li></ul><ul><li>Many treatments/programs have not yet been properly evaluated so we really do not know if they work or not </li></ul>
What is a Mental Disorder ? <ul><li>Term that is frequently used interchangeably with the term mental illness </li></ul><ul><li>Identifies that the brain is not functioning properly in one or more of its six domains – this leads to signs and symptoms (so what are signs and symptoms?) </li></ul><ul><li>Leads to significant functional impairment in one or more domains of usual living (intimacy; social relationships; school; work; etc.) </li></ul><ul><li>Is consistent with best validated international classifications of disease – ICD or the DSM </li></ul><ul><li>Causes are complex – due to complicated gene, environment and neurodevelopment interactions </li></ul>
Genetics Family history of depression, anxiety, alcohol abuse Environmental Stress Birth trauma Nutritional deprivation Infections Toxins Clinical Depression Symptom Expression Abnormal Brain Development = Vulnerability/Predisposition Birth Abnormal Brain Function Cultural Factors Environmental Insults +/- Prolonged Severe Stressors Infancy Childhood Adolescence Adult Some Signs & Symptoms but No Disease No Disease
Are all brain disturbances mental disorders ? <ul><li>Not all disturbances of brain functioning are mental disorders </li></ul><ul><li>Some can be a normal or expected response to the environment – for example: grief when somebody dies or acute worry, sleep problems and emotional tension when faced with a natural disaster such as a hurricane </li></ul>
Normal “life” or mental disorder - What’s the difference between mental distress and mental disorders? The 2 D ’s Distress Disorders Less common Frequently onsets without environmental challenges Frequently long term (may be chronic and episodic) – significant functional impairment Must meet recognized diagnostic criteria Frequently requires professional intervention Usually responds well to evidence based treatments Usually helped by appropriate supports and positive lifestyle activities Common A response to environmental challenges May be adaptive Usually short term and not severe – does not significantly impair functioning Should not be “diagnosed” Usually does not require professional intervention Usually responds well to “usual” supports and positive lifestyle activities
Identification of young people who may have a mental disorder – science or art? <ul><li>Screening tools that have been validated in specific youth populations may be used (pros and cons) </li></ul><ul><li>Increasing the level of understanding and providing knowledge about potential “clues” to responsible adults who have knowledge of individual young people (teachers, coaches, religious leaders, etc.) </li></ul>
Identification may be Difficult in the School Setting <ul><li>It can be more difficult to differentiate “Distress” from “Disorder” in young people than in adults </li></ul><ul><li>The “presentation” of the illness may be different at different times </li></ul><ul><li>If a student is using drugs or alcohol the effects of those substances can be confusing </li></ul><ul><li>Sometimes the student does not share the symptoms (such as low mood or hallucinations) </li></ul><ul><li>Sometimes the student is not known to the teacher </li></ul>
Identification Keys <ul><li>Is the student previously known to have significant mental health problems or a mental disorder? (family member) </li></ul><ul><li>Has there been a recent significant change in mood, cognition, behavior? </li></ul><ul><li>Are the person’s problems causing distress to them or to others or is there a lack of social convention? </li></ul><ul><li>Has there been a noticeable decrease in functioning: social, academic, other? </li></ul><ul><li>Are there substantial and unexplained major changes in peer group participation – especially peer group “slide”? </li></ul><ul><li>Are parents or others raising concerns? </li></ul><ul><li>Does a close friend have a mental disorder or a major mental health problem? </li></ul>
FUNCTIONS OF THE BRAIN Perception or Sensing Emotion or Feeling Behavior Physical or Somatic Signaling (being responsive and reacting to the environment) Thinking or Cognition
What are the Symptoms of Mental Disorders? Thinking Mental Disorders are Associated with Disturbances in 6 Primary Domains of Brain Function: Perception Emotion Signaling Behavior Physical
WHAT IS THINKING or COGNITION? Communicating Attending Focusing Reading Comprehension Arithmetic Memory Planning Contemplating Processing Judgment Insight
DISTURBANCE IN THOUGHT CONTENT REAL UNREAL APPROPRIATE EXCESSIVE DELUSIONS
What are Delusional Beliefs? <ul><li>False </li></ul><ul><li>Persistent </li></ul><ul><li>Not shared by others of same socio-cultural group </li></ul><ul><li>Regarded as real and held with conviction despite being given ample evidence to the contrary </li></ul><ul><li>Must be evaluated from within socio-cultural context </li></ul>
WHAT IS PERCEPTION? Our ability to use our five senses to see, hear, taste, smell, and touch. See Hear Smell Taste Touch
Disturbances of Perception Normal Hallucination Illusion
Mental Disorders of COGNITION and PERCEPTION: Psychosis
What is Psychosis? <ul><li>“ Psychosis” is a disturbance in thinking and perception that is characterized by a loss of contact with reality and that is caused by abnormal brain functioning. </li></ul>
What is Schizophrenia? <ul><li>Schizophrenia is the most common of the psychotic disorders. It is a chronic, severe, and disabling brain disorder characterized by the presence of delusions, hallucinations, disorganized thinking, disorganized behavior, disturbances in affect, disturbances in initiation and motivation (avolition), and functional impairment. </li></ul><ul><li>Affects 1% - 1.5% of individuals </li></ul><ul><li>Men and Women are equally affected </li></ul><ul><li>Usually begins between ages 14 and 25 years </li></ul>
PSYCHOSIS: WHAT TO LOOK FOR? <ul><li>Is the person acting differently and in an unusual manner? </li></ul><ul><li>Does the person show signs of or admit to hallucinations? </li></ul><ul><li>Does the person show a thought form disorder – does his or her speech make sense? </li></ul><ul><li>Is the person isolating from others? </li></ul><ul><li>Is the person espousing bizarre and unusual ideas? </li></ul>
PSYCHOSIS: WHAT TO DO? <ul><li>Discuss concerns with other teachers and student support staff. </li></ul><ul><li>Investigate the family situation and discuss concerns with appropriate family members. </li></ul><ul><li>Support suggestions to seek mental health assessment. </li></ul><ul><li>Provide mental health assessors with appropriate information following appropriate consent provision. </li></ul><ul><li>Participate in discussions with young person, health providers and family about school related issues. </li></ul>
PSYCHOSIS: WHAT NOT TO MISS? <ul><li>Voices telling the person to harm him/her self or others. </li></ul><ul><li>Delusions that can lead to unpredictable behavior (for example: suspicions of others leading to violence). </li></ul>CAUTION
Emotions and Moods – What am I feeling inside?
Transient shift towards (-) pole consequent to (-) life events Transient shift towards (+) pole consequent to (+) life events Normal range and intensity of mood Normal Baseline ‘ Normal’ Mood Graph +3 -3
Mental Disorders of Emotion and Feeling: Depression and Bipolar Disorder
What are the Mood Disorders? <ul><li>Unipolar Mood Disorders </li></ul><ul><li>Bipolar Mood Disorders </li></ul>Example: Major Depressive Disorder Example: Bipolar Disorder
What Happens if the Baseline Shifts Toward the Negative Pole - Depression 0 +3 -3 Normal range and intensity of mood
Normal range and intensity of mood Normal Baseline What Happens if the Baseline Shifts Toward the Positive Pole - Mania 0 +3 -3
How is a ‘Depressive Episode’ different from feeling sad? This can happen without can obvious cause Low or depressed mood most of the time for a long time Many problems with work, at home or in relationships with others because of the low mood Many physical complaints can accompany the low mood The low mood often does not respond to changes in the environment
DEPRESSION: WHAT TO LOOK FOR? <ul><li>Difficult to explain frequent and persistent physical complaints (headaches; stomach aches; fatigue; etc) </li></ul><ul><li>Loss of interest in usual life activities </li></ul><ul><li>Loss of pleasure in those things usually found to be pleasurable – hopelessness </li></ul><ul><li>Decreased functioning at home at work/school with family or with peers/friends </li></ul><ul><li>Thoughts of death/suicide or preparation for death </li></ul>
DEPRESSION: WHAT TO ASK? <ul><li>How are you feeling inside of yourself? – How long have you been feeling that way? </li></ul><ul><li>Have you been feeling hopeless? </li></ul><ul><li>What does the way that you are feeling now prevent you from doing? – What would you be doing if you were not feeling the way you are feeling now? </li></ul><ul><li>Are you thinking or feeling that life is not worth living or that you would be better off dead? What have you thought about doing? </li></ul><ul><li>Do not agree to keep self-harm or suicide confidential. </li></ul>
Depression: What to Do? <ul><li>Depression is highly treatable with the proper medications and the proper psychological therapies, so the young person with depression should be referred to the most appropriate health care provider. </li></ul><ul><li>Academic expectations may need to be modified due to depression effects on motivation and cognition. </li></ul><ul><li>Be aware of the risk of suicide – discuss with health providers what the role of educators should be in each individuals case. </li></ul><ul><li>Develop a youth supporting educational/health collaboration with appropriate consents. </li></ul>
DEPRESSION: WHAT NOT TO MISS? <ul><li>Always ask about suicidal thoughts and suicide plans </li></ul><ul><li>If you are not sure for even a tiny bit – ask someone with expertise to immediately evaluate </li></ul>CAUTION
How is ‘Mania’ different from feeling extremely happy? Mood is mostly elevated or irritable Significant problems in daily life because of the mood Is not caused by a life problem or life event Many behavioral, physical and thinking problems Mood may often not reflect the reality of the environment
BIPOLAR DISORDER: WHAT TO LOOK FOR <ul><li>History of at least one depressive episode and at least one manic episode. </li></ul><ul><li>Rapid mood changes including irritability and anger outbursts. </li></ul><ul><li>Self-destructive or self-harmful behaviors – including: spending sprees; violence towards others; sexual indiscretions; etc. </li></ul><ul><li>Drug or alcohol overuse, misuse or abuse. </li></ul><ul><li>Psychotic symptoms including: hallucinations and delusions </li></ul>
Youth Suicide <ul><li>Youth suicide is a rare but tragic event for any community </li></ul><ul><li>Most youth suicide is associated with the presence of a mental disorder (often depression) that has either not been diagnosed or is not being appropriately treated. </li></ul><ul><li>Youth suicide is not the result of the usual stresses of being a teenager. </li></ul><ul><li>Suicide attempts need to be differentiated from self-harm events – they require different approaches to deal with them. </li></ul><ul><li>The use of youth specific suicide assessment tools (such as the TASR-A) can assist professionals in the evaluation of youth suicide risk. </li></ul>
Youth Suicide: Well Established Risk Factors <ul><li>Presence of a mental disorder </li></ul><ul><li>Previous suicide attempt (especially in boys) </li></ul><ul><li>Family history of suicide </li></ul><ul><li>Family history of mental disorder </li></ul><ul><li>Substance abuse </li></ul><ul><li>Juvenile justice involvement </li></ul>
General Specific Empathy Gentle Inquiry I can see how difficult things have been for you lately… You seem to be having a hard time… Would you help me understand how this has been for you? How have things been for you lately? Have you ever felt life was not worth living? Have you ever tried to do anything to yourself that could have seriously harmed you or killed you? Direct Inquiry Assessing for Suicide
What Is Signaling? Prepared to Fight or Flee for Safety & Protection Internal Signals DANGER! Brain Registers DANGER! Initiation of Physiologic Cascade Heart Rate Tension Alertness Perception Sensory Perception Taste Touch Nose Ears Eyes
What Is Anxiety? ANXIETY Internal Signals Thoughts Physical Emotions No Danger Brain Registers DANGER! Initiation of Physiologic Cascade Heart Rate Tension Alertness Perception Sensory Perception Taste Touch Nose Ears Eyes !? ! ! !
What is Normal Anxiety? Situation or Trigger: First date Preparing for an exam Performing at a concert Giving a speech Moving from home Climbing a tall ladder Anxiety: Apprehension Nervousness Tension Edginess Nausea Sweating Trembling Transient Does not significantly interfere with a person’s well-being Does not prevent a person from achieving their goals
What is Pathologic Anxiety? Situation or Trigger: First date Preparing for an exam Performing at a concert Giving a speech Moving from home Climbing a tall ladder ANXIETY Symptom Domains: Signaling Cognition Thinking Behavior Physical <ul><li>Persistent </li></ul><ul><li>Excessive & Inappropriate </li></ul><ul><li>Intensity </li></ul><ul><li>Causes Impairment </li></ul><ul><li>Leads to dysfunctional coping: </li></ul><ul><li>-Avoidance </li></ul><ul><li>-Withdrawal </li></ul>
MENTAL DISORDERS OF SIGNALING: THE ANXIETY DISORDERS
GENERALIZED ANXIETY DISORDER (GAD): WHAT TO LOOK FOR? <ul><li>Does the youth have many persistent physical symptoms that cause distress but for which there is no good medical explanation – such as: headaches; stomachaches; pain; etc. </li></ul><ul><li>Does the youth worry about many things, much more than other people seem to worry? </li></ul><ul><li>Does the person have trouble “letting go” of the worry? </li></ul><ul><li>Does she or he usually seem tense or “on edge”? </li></ul><ul><li>Is the worrying of such intensity that it interferes with the young person enjoying life or doing things that he or she would like to do? </li></ul>
GENERALIZED ANXIETY DISORDER (GAD): WHAT TO ASK? <ul><li>Would you or others consider you to be a worrier? </li></ul><ul><li>Do you tend to worry a lot about most things? </li></ul><ul><li>What are the most common worries that you have? </li></ul><ul><li>Does your body “worry” by getting headaches; stomach aches; pains; etc.? </li></ul><ul><li>How do your worries get in the way of you doing things you like to do or in enjoying life? </li></ul><ul><li>Do you sometimes just feel overwhelmed by your worries? </li></ul>
GENERALIZED ANXIETY DISORDER(GAD): WHAT TO DO? <ul><li>GAD is highly treatable with specific psychological interventions (such as CBT) so referral to a person expert in that type of therapy is suggested. </li></ul><ul><li>Reassurance is not usually helpful – at best it provides only minor temporary decrease in symptoms and consistent reassurance can encourage “clingy” behaviours. </li></ul><ul><li>Providing simple and practical suggestions about specific anxiety items (such as: since you are worrying about your test why not make sure you have a chance to study for at least one hour tonight) is useful. </li></ul>
GENERALIZED ANXIETY DISORDER (GAD): WHAT NOT TO MISS? <ul><li>Depressive symptoms or clinical depression </li></ul><ul><li>Suicidal ideas or plans </li></ul><ul><li>Alcohol over-use; misuse; abuse </li></ul>CAUTION
Social Anxiety Disorder (SAD) <ul><li>Unrealistic and irrational fear of social situations in which the person feels that he or she is under scrutiny by others </li></ul><ul><li>Feeling of embarrassment and may have occasional panic attacks in the feared situation only </li></ul><ul><li>Avoidance of social situations </li></ul><ul><li>Severe distress / Wanting social contact </li></ul><ul><li>Six months or longer </li></ul><ul><li>Functional Impairment </li></ul>
SOCIAL ANXIETY DISORDER (SAD): WHAT TO LOOK FOR? <ul><li>Does the person get very anxious in one or more social situations that involve strangers or groups – such as classrooms or lunch rooms? </li></ul><ul><li>Does the youth avoid speaking up in class or are there specific situations that are avoided – the locker room in gym class for example. </li></ul><ul><li>Does the person get easily embarrassed in a social situation or think that other people are judging him/her or paying particular attention to him/her. </li></ul><ul><li>Does the person ever have a panic attack in social situations or places where many people congregate? </li></ul>
SOCIAL ANXIETY DISORDER (SAD): WHAT TO ASK? <ul><li>What kinds of situations cause you to feel anxious, embarrassed or panicky? </li></ul><ul><li>What do you do when you feel this way? </li></ul><ul><li>How do these feelings/thoughts affect your life? </li></ul><ul><li>What do these feelings/thoughts stop you from doing that you would otherwise do? </li></ul>
SOCIAL ANXIETY DISORDER (SAD): WHAT TO DO ? <ul><li>Provide information about what you think the problem is to the young person and inform them that there may be help for their concerns. </li></ul><ul><li>SAD is highly treatable with cognitive behaviour therapy so a referral to someone with that skill set is indicated. </li></ul><ul><li>Exposure treatment is also useful – sometimes a teacher along with a student support worker (psychologist, social worker) can create a classroom exposure plan. </li></ul><ul><li>Public speaking organizations such as “toast masters” are helpful. </li></ul>
SOCIAL ANXIETY DISORDER: WHAT NOT TO MISS? <ul><li>Depressive symptoms or clinical depression </li></ul><ul><li>Alcohol over-use; misuse; abuse </li></ul>CAUTION
What is a Panic Attack? 0 10 Panic Attack: Heart pounding Sweating Trembling Air hunger Smothering Chest pain Stomach pain Nausea Dizziness Tingling/numbness of feet & hands Feeling flushed Feeling chilled 10 minutes TIME Am I going Crazy?! Am I going to DIE?! Am I having a heart attack?!
PANIC DISORDER: WHAT TO LOOK FOR? <ul><li>Does the person have panic attacks – rapid onset of panic feelings and physical symptoms such as rapid or irregular heartbeat; breathing problems; tingling; light-headedness; etc.? </li></ul><ul><li>Does the person worry about getting an attack? </li></ul><ul><li>Does the person avoid going to places where an attack has happened or where they worry they might get an attack? </li></ul><ul><li>Do the panic attacks negatively affect the person’s life or prevent them from doing what they would like to do? </li></ul>
Obsessive Compulsive Disorder (OCD) <ul><li>Obsessions - recurrent, intrusive, unwanted thoughts or images or impulses that cause significant distress and functional impairment </li></ul><ul><li>Compulsions – recurrent, repetitive behaviours that are time consuming and cause significant distress or functional impairment </li></ul><ul><li>Person realizes that the obsessions and compulsions are excessive and unrealistic but can not control them </li></ul>
OBSESSIVE COMPULSIVE DISORDER (OCD): WHAT TO LOOK FOR? <ul><li>Does the person have repetitive behaviors or rituals such as checking; ordering; counting; etc.that they can not easily stop? </li></ul><ul><li>Does the person have repetitive thoughts that are upsetting to them and that they can not easily stop? </li></ul><ul><li>Do these behaviors or thoughts cause them difficulties in their everyday life? </li></ul>
Post Traumatic Stress Disorder (PTSD) <ul><li>Severe and persistent emotional response to a situation in which the safety or body integrity of the person is threatened (rape, war, earthquake, train wreck) </li></ul><ul><li>Symptoms noted 6 weeks or longer after the trauma and include: re-experiencing; autonomic hyper-arousal; avoidance </li></ul><ul><li>Functional Impairment </li></ul>
1. The Acute Stress Response Emotional Cognitive Physical Behavioral Disturbances & Functional Impairment Intensity of Impairing Symptoms DAYS WEEKS MONTHS Trauma Affects 100% of the Population What to do? Resume usual activities Mobilize emotional supports Resolves without medical treatment Lasts days - weeks May impair functioning Affects all domains of brain functioning
2. Post Traumatic Stress Disorder Intensity of Impairing Symptoms DAYS WEEKS MONTHS CAUTION Trauma Re-experiencing Avoidance/Numbing Hyper-arousal Functional Impairment Failure of stress response to resolve CAUTION
POST TRAUMATIC STRESS DISORDER (PTSD): WHAT TO LOOK FOR? <ul><li>Was there a traumatic event – and if so, what was the event? </li></ul><ul><li>What symptoms is the person having now? Does the person have symptoms in all three categories: re-experiencing; avoidance/numbness; hyper-arousal? </li></ul><ul><li>What symptoms did the person have immediately ( 1 – 3 days) after the event? </li></ul><ul><li>What symptoms did the person have later (4 weeks after the event)? </li></ul><ul><li>Do the symptoms that the person is having cause significant problems in their every day life? </li></ul>
PTSD and the School Setting <ul><li>Stress symptoms immediately following a traumatic event are NORMAL and do not require interventions. Information about this should be provided to students, parents and staff. </li></ul><ul><li>Some interventions (such as CISD) may not be helpful and may even be harmful. </li></ul><ul><li>Following a traumatic event schools could provide quiet spaces with staff support after school hours and “identification” of symptomatic youth 4 – 6 weeks after the event. </li></ul><ul><li>Symptomatic students can be offered CBIT or other evidence based psychological interventions. </li></ul><ul><li>Avoid the pressure to “do something” and focus on doing “the right thing”. </li></ul><ul><li>With a suicide – consider identification of high-risk youth (friends of the deceased). </li></ul>
What are Disturbances in BEHAVIOUR? <ul><li>Avoidance </li></ul>Often the most conspicuous expression of the Mental Disorders to others Loss of motivation (Avolition) Social Withdrawal Loss of Social Graces Odd Behaviours Violence Suicide
MENTAL DISORDERS OF BEHAVIOR: ADHD Conduct Disorder Substance Abuse
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) <ul><li>Onsets before age seven </li></ul><ul><li>Three Major Domains: </li></ul><ul><ul><li>Attention </li></ul></ul><ul><ul><li>Hyperactivity </li></ul></ul><ul><ul><li>Impulsivity </li></ul></ul><ul><li>Functional Impairment </li></ul>
ADHD: WHAT TO LOOK FOR? <ul><li>Compared to others his/her age is the person persistently and much more: </li></ul><ul><li>Hyperactive (on the go; can not stay still; etc.) </li></ul><ul><li>Impulsive (does things without thinking; gets into trouble often because of not considering possible outcomes of his/her actions, etc.) </li></ul><ul><li>Problems with sustained attention (often does not finish tasks; forgets easily; etc/) </li></ul><ul><li>Girls may have substantial problems with sustained attention and not exhibit symptoms of hyperactivity and impulsivity </li></ul><ul><li>Many of these symptoms may diminish in intensity with age but may not completely disappear. </li></ul><ul><li>Always assess for learning disorder(s) and be aware of substance misuse. </li></ul><ul><li>Self-esteem and demoralization (this is not an ego-dystonic problem)! </li></ul>
ADHD: What to do? <ul><li>Discuss with young person how they perceive their problems, the diagnosis and the treatment. </li></ul><ul><li>Utilize intervention strategies that have been demonstrated to be successful for the young person – do not waste your time on interventions that have not worked or are not likely to work. </li></ul><ul><li>Encourage a strength based framework – find the things that he/she does well or suggest activities that do not depend on sustained attention. </li></ul><ul><li>Understand the pros and cons of medication treatment. </li></ul>
CONDUCT DISORDER (“DELINQUENCY”) <ul><li>Onsets before adolescence </li></ul><ul><li>Persistent violations of social rules, norms and values </li></ul><ul><li>Legal difficulties </li></ul><ul><li>May include violent confrontations with others </li></ul><ul><li>May include cruelty to animals or people </li></ul><ul><li>Functional Impairment </li></ul>
Dealing with Conduct Disorder <ul><li>Identification of mental disorders that may contribute to conduct disturbance is important – such as: ADHD; learning disorders; depression; substance abuse. </li></ul><ul><li>Support and guidance for young people – finding alternative for expression (such as sports; arts; etc.); developing more responsible peer group relationships </li></ul><ul><li>Working with other professionals to assist with behavioral responsive interventions in the classroom and schoolyard </li></ul>
Helping – Get Well, Stay Well, Keep Well <ul><li>All helping interventions act on the brain – and assist in one or more of the functions of the brain </li></ul><ul><li>Psychological (counseling; specific psychotherapies) – common effects </li></ul><ul><li>Somatic (medications; others) </li></ul><ul><li>Social (groups; communities; etc.) </li></ul><ul><li>Physical (sleep, exercise, etc.) </li></ul>
What are Treatments Expected to Do? <ul><li>Improve the symptoms that the person is suffering from </li></ul><ul><li>Improve the person’s ability to function at home; at work; with friends; etc. </li></ul><ul><li>Stop the disorder from coming back </li></ul>
How to think about treatments (remember evidence) <ul><li>Specific treatments – treatments that have been demonstrated to show significant positive effects in a specific disorder (for example: SSRI medicine in adolescent depression; CBT in social anxiety disorder, etc.) </li></ul><ul><li>General or non-specific “treatments”– interventions that have been shown to help ameliorate some symptoms in many different disorders (for example: biblotherapy; psycho-education; social supports, etc.) </li></ul><ul><li>Supportive interventions – interventions that are likely to have overall positive results: they are good for you (for example: getting enough sleep, exercise, good nutrition, etc.) </li></ul>
Tips to Fight Mental Disorders Depression <ul><li>Go outside </li></ul><ul><li>Exercise </li></ul><ul><li>Be social </li></ul><ul><li>Stop thinking so much </li></ul><ul><li>Talk to people you trust </li></ul><ul><li>Relax </li></ul><ul><li>Stay away from booze and drugs </li></ul><ul><li>Laugh </li></ul><ul><li>Problem solve (use your head!) </li></ul><ul><li>Structure your day </li></ul>Depression is very treatable with a combination of medication, psychotherapy and counseling. Some things you can do to help include:
Treatment Bipolar Disorders <ul><li>Bipolar disorder is a medical condition that requires medication </li></ul><ul><ul><li>Mood stabilizers </li></ul></ul><ul><ul><li>Antidepressants </li></ul></ul><ul><li>Counseling is also helpful, along with support from family and friends </li></ul><ul><li>The same things you do to help yourself with depression will also help in bipolar disorder BUT it is ESSENTIAL that you maintain a consistent biological rhythm. That means, going to bed about the same time every night and getting about 8 hours of sleep every night. Drugs or alcohol can precipitate a manic or depressive episode – so avoid or highly limit their use. </li></ul>
Treatment Psychosis <ul><li>Early intervention is important-Getting help early minimizes the risk of disruption in daily life and is critical to a successful recovery </li></ul><ul><li>Treatment for psychosis includes antipsychotic medication, individual and family counseling, and support to help individual get back to their normal daily routines. </li></ul><ul><li>Treatment also includes educating the individual about the disorder and encouraging healthy living </li></ul><ul><li>Additional educational and vocational programs are also often needed. </li></ul>
Treatment Psychosis-continued <ul><li>Focus will also be on decreasing the risk factors to prevent relapse and aid in a successful recovery. </li></ul><ul><li>Treatment will depend on the severity of the symptoms and how long they have been present along with the possible causes. </li></ul>
Tips to Fight Mental Disorders Anxiety Disorders <ul><li>Exercise Daily </li></ul><ul><li>Relax – deep breathing exercises, yoga, tai chi, meditation </li></ul><ul><li>Sleep well – 8 hours a night </li></ul><ul><li>Learn to laugh </li></ul><ul><li>Limit alcohol and drug consumption </li></ul><ul><li>Eat a well-balanced diet </li></ul><ul><li>Add variety to your life </li></ul><ul><li>Create a support network </li></ul><ul><li>Learn to manage your life </li></ul><ul><li>Challenge your perfectionism </li></ul><ul><li>Challenge the thoughts that make you feel anxious: are they really true? </li></ul>Professional treatment is helpful and includes, psychotherapy, counseling or medication
Treatment Eating Disorders <ul><li>Eating disorders are a mental illness </li></ul><ul><li>Eating disorders demonstrate complex emotional and physical problems and require a range of professional treatments for successful recovery. </li></ul><ul><ul><li>Medical treatment for weight related health problems </li></ul></ul><ul><ul><li>Nutritional counseling </li></ul></ul><ul><ul><li>Psychological therapy </li></ul></ul><ul><ul><li>Medications for Bulimia may be helpful </li></ul></ul>
Getting Help Useful links <ul><li>Sun Life Financial Chair in Adolescent Mental Health: http://www.teenmentalhealth.org/ </li></ul><ul><li>Canadian Health Network: http://www.canadian-health-network.ca/1mental_health.html </li></ul><ul><li>http://www.phac-aspc.gc.ca/chn-rcs/index-fra.php (French) </li></ul><ul><li>Canadian Mental Health Association, National Office: http://www.cmha.ca/ </li></ul><ul><li>Canadian Mental Health Association, Ontario Division: http://www.ontario.cmha.ca/ </li></ul><ul><li>Centre for Addiction and Mental Health: http://www.camh.net </li></ul><ul><li>http://www.camh.net/fr/index.html (French) </li></ul><ul><li>Health Canada, Mental Health Web site: </li></ul><ul><li>http://www.hc-sc.gc.ca/hppb/mentalhealth/index.html </li></ul><ul><li>http://www.phac-aspc.gc.ca/index-fra.php (French) </li></ul><ul><li>National Alliance for the Mentally Ill: http://www.nami.org/ </li></ul><ul><li>SAMHSA’s National Mental Health Information Centre: </li></ul><ul><li>http://nmhicstore.samhsa.gov/publications/Publications_browse.asp?ID=176&Topic=Mental+Illnesses%2FDisorders </li></ul><ul><li>MindMatters: A Mental Health Promotion Resource for Secondary Schools: http://www.mindmatters.edu.au/default.asp </li></ul><ul><li>Continuing Medical Education (CME) mental health information: http://www.cmellc.com/topics/ </li></ul>
Other Helpful Resources <ul><li>Transitions: Student Reality Check (Book) </li></ul><ul><li>Metal Health Training for Teachers (Resource book) </li></ul><ul><li>Understanding Depression and Suicide in Adolescents (Training program) </li></ul><ul><li>Evidence-Based Medicine for Patients (Book) </li></ul><ul><li>When Something’s Wrong: Strategies for Teachers (Book) </li></ul><ul><li>All these programs and books can be found at the Sun Life Financial Chair in Adolescent Mental Health website </li></ul>
THE END <ul><li>For further information and resources: </li></ul><ul><li>www.teenmentalhealth.org </li></ul>