Mental Illness (Adult)

KNR 270

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

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

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

DSM-IV-TR

Detailed classification system Used to design treatment Rated on 5 axes

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

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

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

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

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 person’s future Could be gradual or sudden onset Heavy pot smoking might raise risk

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

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 one’s back

SCHIZOPHRENIA

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

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

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

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

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

Mood or Affective Disorders

Depression

Mania

Bipolar

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

MANIA

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

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

Anxiety Disorders

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

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

Panic Attack:4 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

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

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

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

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

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

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

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

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

Obsessive-Compulsive Disorder:Criteria

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 one’s own mind

Obsessive-Compulsive Disorder:Criteria

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

Obsessive-Compulsive Disorder:Criteria

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

Obsessive-Compulsive Disorder:Criteria

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

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

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

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

Personality Disorders

Antisocial Personality

Borderline Personality

Self centered Manipulative Failure to reach potential

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

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

Considerations/Accommodations

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

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

Considerations/Accommodations

Physical activity can decrease anxiety

Watch use of sharp supplies Transportation Scholarships Try to involve with others to

decrease social isolation Others???

COMMUNICATING

Confusion about what is real

Difficulty concentrating

Overstimulation

Preoccupation with internal

Be simple & straight forward

Be brief, repeat

Limit input; don’t force discussion

Get attention before preceding

COMMUNICATING

Agitation

Fluctuating emotions

Withdrawal

Belief in delusions

Recognize & allow exit

Don’t take words or actions personally

Initiate conversations

Don’t argue

COMMUNICATING

Discussion about voices

Low self-esteem

Acknowledge, but explain you do not hear them

Stay positive & reinforcing