Problems do not go away. They must be worked through or else they remain, forever a barrier…

M. Scott Peck

“But I don’t want to go among mad people,” Alice remarked.

“Oh, you can’t help that,” said the Cat. “We’re all mad here. I’m mad. You’re mad.”

“How do you know I’m mad?” said Alice.“You must be,” said the Cat, “or you wouldn’t

have come here.”Lewis Carrol, Alice in Wonderland

ADULT DIAGNOSESDepression

Schizophrenia

Bipolar Disorder (Manic Depressive Illness)

Personality Disorders

Substance Abuse

DepressionDSM IV TR Criteria

Course of illness

Effect on caregiving

Comorbidities

SchizophreniaDSM IV TR Criteria

Course of illness

Effects on caregiving

Comorbidities

Bipolar DisorderDSM IV TR Criteria

Course of illness

Effect on caregiving

Comorbidities

Personality DisordersDSM IV TR Criteria

Course of illness

Effect on caregiving

Comorbidities

Substance Abuse:Drugs, Alcohol & Polysubstance

DSM IV TR CriteriaAbuse v. dependence

Course of illness

Effects on caregiving

Comorbidities

Kids’ DiagnosesDepression

Bipolar (controversial, especially before 13 years old)

ADD

Behavioral consequences in kids whose parent has an unstable mental illness

Working with parents with unstable mental illnesses

Compliance v. noncompliance

Drug addiction

Assessment

Long-term prognosisDepression

Good prognosis if compliant with medication and supportive therapy

SchizophreniaFair prognosis if compliant with medication ,

therapy and social supportsPoor prognosis with marked deterioration if

noncompliantBipolar Disorder

Good prognosis if compliant with medicationUnfortunately, often prefer to be unmedicated

Long-term prognosisPersonality Disorder

Generally difficult to treatProblems arise because of co-occurring

substance abuse &/or poor judgment, impulsivity and disrupted interpersonal relationships

Substance AbuseFair prognosis if complies with medication &

supportive therapy. However, relapse is anticipated.

Poor prognosis with marked deterioration if untreated.

MedicationsAntidepressantsAntipsychoticsAntimanicsAnxiolyticsDrugs that treat cravings

AntidepressantsSSRIs Prozac, Zoloft

PaxilAvailable as pills, liquidsActions: thought to block reuptake of

serotoninDuration: varies. Takes 4-6 weeks for full

effect.

AntidepressantsNSRIs Effexor, CymbaltaAvailable in pill formActions: thought to act by blocking reputake

of serotonin & norepinephrineDuration: varies. Can take 1-4 weeks for full

effect

AntipsychoticsHaldolAvailable in pill, liquid and short-acting or

long-acting shot (get every 4 weeks)Actions: blocks dopamine receptors. Treats

short-term psychotic symptomsDuration: pill form lasts 6-10 hours;

Long-acting shot lasts 28 days

AntipsychoticsRisperdalAvailable in pill or long-acting shot formActions:

blocks serotonin, dopamine & histamine receptors

For short-term treatment of psychotic symptoms or for irritability associated with manic behavior

Duration: pill form lasts 6-7 hoursLong-acting shot lasts 7 weeks but can take 3

weeks to start working

AntipsychoticsGeodonAvailable in pill and short-acting shot formActions: dopamine & serotonin antagonist

Treats positive and negative symptoms of schizophrenia with minimal EPS side effects

Rapid control of agitation and psychotic symptoms

Rapid short-term treatment of manic or mixed symptoms

Pill form lasts 12 hours but IM best for acute symptoms

AntimanicsLithiumAvailable as pill or liquidAction: alters chemical transmissions in

neuronsDuration: 1-3 weeks for full effect

Use additional alternate medication for short term treatment of symptoms

Maintain adequate fluid intake, scheduled blood tests

AntimanicsDepakote/Depakene

Antiepileptic/mood stabilizerOften used as an alternative to Lithium

Available as pills, syrup sprinklesActions: May inhibit nerve transmission in

CNS and may increase brain level of GABA

Mood StabilizersLamictalAvailable in pill formAction: inhibits certain neurotransmittersImportant info: can cause life-threatening

complications if given with depakote

Mood StabilizersTopamaxAvailable as pill or sprinklesAction: unknown

ResourcesDirectory of Health & Human Services in

Metropolitan Chicago312-491-7800www.communityresourcenetwork.org

Haymarket HouseHull HouseThresholds