# Presentation: 239303

## Mental Illness 101  

- Presentation at the New Grantees’ Conference
- US Department of Labor
- Homeless Veterans Reintegration Program
- August 1, 2006
- Cynthia Bisbee, Ph.D.
- CC Bisbee & Associates
- Montgomery, AL

## Types of Mental Illness

## Definition of Mental Disorder

- A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom.

## Definition ofMental Disorder

- Not merely an expectable and culturally sanctioned response to a particular event such as death of a loved one
- Must be within an individual
- Classifies disorders, not people

## Serious Mental Illness

- Always Included in Definition
- Schizophrenia
- Major Depression
- Bipolar Disorder
- Sometimes Included
- Severe Anxiety Disorders
- Cognitive Disorders
- Some Personality Disorders

## Criteria for Schizophrenia

- Characteristic symptoms
- Delusions
- Hallucinations
- Disorganized Speech
- Disorganized Behavior
- Negative Symptoms
- Flat Affect
- Lack of Motivation

- Social/Occupational Dysfunction
- Lasting at Least Six Months

## Criteria for Major Depression

- Depressed Mood
- Diminished Interest
- Weight Loss or Gain
- Sleep Disturbance
- Restlessness or Being Slowed Down
- Fatigue & Loss of Energy
- Thoughts of Death

- Feelings of Worthlessness or Excessive Guilt
- Difficulty Thinking & Concentrating
- Symptoms Occur Every Day
-  Significant Distress & Impairment

## Criteria for Bipolar Disorder

- Manic Episodes
- Elevated mood
- Grandiosity
- Decreased need for sleep
- Talkativeness
- Racing thoughts
- Increased goal-directed activity

- Marked Impairment
- Occupation
- Social relationships
- (or) Hospitalization
- (or) Psychotic Features
- May Alternate with Depressive Episodes

## Symptoms of Mental Illness

- Perceptions
- Thoughts
- Moods
- Behavior

## Substance-Related Disorders

- Types of Disorder
- Substance-induced
- Intoxication
- Withdrawal
- Various psychiatric symptoms
- Substance Use
- Dependence
- Abuse

- Substances
- Alcohol
- Amphetamines
- Caffeine
- Cannabis
- Cocaine
- Hallucinogens
- Inhalants
- Nicotine
- Opioids
- Phencyclidine
- Sedative-hypnotics
- Polysubstance

## Causes of Mental Illness

## Causes of Mental Illness

- Biological Causes
- Environmental Effects
- Interaction of Biology and Environment

## Biology ofSerious Mental Illnesses

- Brain Disorder
- Anatomy
- Function (metabolism)
- Chemistry
- Causes of Brain Disorder
- Genetics
- Viral Theories
- Brain Injury

## Schizophrenia:Chemical Imbalance in the Brain

- Schizophrenia:Chemical Imbalance in the Brain

**Speaking****Brain Cell**

**Listening****Brain Cell**

**Synapse**

- Too Much Dopamine = Positive Symptoms

- Copyright © 1998  Patricia L. Scheifler MSW, PIP

## The Role of Environment

- Some Disorders May Be Learned
- Some Result from Trauma
- Environment Affects the Course of the Disorders
- Stigma

## Treatment of Mental Illness

## Intervention Goals

- Remission of Symptoms
- Positive
- Negative
- Maintenance of Stability
- Enhanced Quality of Life
- Role Recovery

## Medications

- Antipsychotics
- Antidepressants
- Mood Stabilzers
- Anxiolytics
- Side Effects Medications

## Anti-psychotic Medications

- Used to combat psychotic symptoms
- Hallucinations
- Delusions
- Confused Thinking
- Altered Perceptions
- Disorganized Speech
- Other signs of psychosis

## Antipsychotic Medications Block Dopamine

**Speaking****Brain Cell**

**Listening****Brain Cell**

- Copyright © 1998  Patricia L. Scheifler MSW, PIP

## Examples of Anti-psychotic Medications

- Zyprexa
- Risperdal
- Seroquel
- Geodon
- Clozaril
- Abilify

- Haldol
- Loxitane
- Thorazine
- Mellaril
- Stelazine
- Prolixin
- Navane
- Serentil

## Anti-depressant Medications

- Used to Relieve Symptoms of Depression
- Sadness
- Feelings of Failure
- Loss of Interest in Life
- Sleep Disturbances
- Excessive Guilt
- Loss of Energy/Fatigue
- Thoughts of Death and Suicidal Thoughts

## Examples ofAnti-depressant Medications

- Prozac
- Zoloft
- Effexor
- Celexa
- Serzone
- Remeron
- Paxil
- Wellbutrin
- Lexapro

- Desyrel
- Elavil
- Tofranil
- Pamelor
- Marplan
- Nardil
- Ascendin
- Sinequan

## Mood Stabilizers

- Used to Treat Symptoms of Mania
- Rapid Talking
- Decreased Need for Sleep
- Racing Thoughts
- Distractibility
- Irritability
- Behavioral Excesses
- Grandiosity

## Examples ofMood Stabilizers

- Lithium
- Eskalith
- Lithobid
- Lithane
- Depakote
- Tegretol
- Neurontin
- Zyprexa
- Topamax

- Note:  Some of these medications are also used to treat seizures

## Anti-anxiety Medications

- Used to Treat Symptoms of Anxiety
- Nervousness
- Panic
- Shortness of Breath
- Trembling
- Feeling of Choking
- Heart Palpitations
- Obsessions & Compulsions

## Examples ofAnti-anxiety Medications

- Xanax
- Ativan
- Klonapin
- Buspar

- Valium
- Librium
- Serax
- Equanil
- Miltown
- Vistaril
- Tranxene

## Side Effects Medications(Anti-parkinsonians)

- Used to Relieve Side Effects of Anti-psychotic Medications
- Stiff Muscles
- Unsteady Gait
- Tremors
- Eyes Rolling Back
- Restless Feeling

## Examples ofSide Effects Medications

- Cogentin
- Artane
- Benadryl
- Akineton

## Stimulants (special use)

- Used to Treat Symptoms of Attention Deficit/Hyperactivity Disorder
- Mainly Used in Children
- Hyperactivity
- Inability to Pay Attention
- Distractibility

## Examples ofStimulant Medications

- Ritalin
- Adderall
- Dexedrine
- Cylert
- Concerta

## Side Effects ofMedications

- Drowsiness
- Dry Mouth
- Blurred Vision
- Dizziness
- Tremors
- Sexual Dysfunction

- High Heart Rate
-  Weight Gain
- Slurred Speech
- Sensitivity to Sun
- Some Are Addictive

## Psychosocial Interventions

- Assessment
- Education about Illness Self Management
- Counseling/Therapy
- Individual
- Group
- Crisis Intervention

- Rehabilitation
- Social Skills
- Vocational
- Family Services
- Education
- Family Therapy
- Case Management

## Illness Self Management/ Patient Education

- Giving Information about the Illness
- Symptoms
- Treatment
- Course
- Helping Client Learn to Manage Own Illness

## Management Skillsfor Recovery

- Medication Adherence
- Healthful Lifestyle
- Therapeutic Environment
- Illness Monitoring
- Relapse Prevention

**Notes:**
Management--day to day coping with the illness strategies carried out by the consumer and family

Adherence to medication regimen, including monitoring effects and working with the doctor to get proper adjustment

Healthful lifestyle--doing what you can to remain healthy

Therapeutic environment--keeping an appropriate balance of an active and routine lifestyle, with stress and stimulation management--tightwire

Symptom monitoring and relapse prevention

## Medication Adherence

- Adherence = “Sticking to” the Medication Plan
- Barriers to Adherence
- The Person’s Condition
- Chronic Illness
- Complex Medication Plan

## Antipsychotic Medications Block Dopamine

**Speaking****Brain Cell**

**Listening****Brain Cell**

- Copyright © 1998  Patricia L. Scheifler MSW, PIP

## Stop Taking Antipsychotics Blockade  Gradually Disappears

- Stop Taking Antipsychotics Blockade  Gradually Disappears

**Speaking****Brain Cell**

**Listening****Brain Cell**

- Copyright © 1998  Patricia L. Scheifler MSW, PIP

## SpeakingBrain Cell

**Speaking****Brain Cell**

**Listening****Brain Cell**

- No Antipsychotic Medication:Positive Symptoms Reappear ( Relapse)

- Copyright © 1998  Patricia L. Scheifler MSW, PIP

## What Is Illness Monitoring?

- Learning about Illness
- Developing Awareness of Symptoms
- Watching for Signs of Relapse
- Mapping Illness Cycles

## Importance ofIllness Monitoring

- Helps Prevent Relapse
- Look for Illness Cycle
- Indicate Possible Need for Medication Adjustment
- Helps Measure Effects of Treatment

## Relapse Checklist*

- Medication Change
- Physical Illness
- A Stressful Event or Overstimulation
- Alcohol or Drugs
- Sugar, Caffeine, or Change of Diet
- Too Many Fluids
- Illness Cycle
- Copyright © 1982 Patricia Scheifler

## Taking Action

- Ensure Compliance with Meds
- Seek Medical Treatment & Rest
- Daily Relaxation Skills
- Decrease Stimulation
- Avoid Drugs & Alcohol
- Cut Caffeine, Sugar & Fluids
- Consult MD for Possible Medication Adjustment

## Psychotherapy and Counseling

**Reality Based**
**Real-life Problem Solving**
**Individual Coping with Illness**
**Group Support and Peer Learning**
**Flexible Participation Standards**

**Notes:**
Psychotherapy can be beneficial

Needs to assist consumer with everyday coping with real-life problems and issues

Keep down the mysticism, metaphor, analogy--too confusing

Group very beneficial
support
peer learning
efficient

Participation standards need to be flexible--don’t overinterpret absences, lateness, and lack of participation as resistance

## Crisis Intervention

**Telephone **
**Clinic Based**
**Mobile Outreach**
**In-Home Intervention**

**Notes:**
Mental illness are unpredictable--crisis don’t happen only on normal business hours

## Skills Training

**Social Skills**
**Academic Skills**
**Vocational Skills**

**Notes:**
Many consumers with psychotic disorders--particularly schizophrenia--have poorly developed skills--they became ill at the time these life skills were being developed

Need training in social, academic, and vocational skills

## Psychiatric Rehabilitation

**Readiness Assessment**
**Readiness Development**
**Choosing Rehabilitation Goals**
**Living**
**Learning**
**Working**
**Socializing**
**Getting & Keeping Environments of Choice**

**Notes:**
Relatively recent addition to the intervention array 

Used to assist consumers in setting and attaining goals related to roles and environments of choice

## Long Term Hospital
Crisis Stabilization Facility
Group Treatment Setting
Family Living 
Supported Living Apartments 
Independent Living

**Crisis Stabilization Facility**
**Group Treatment Setting**
**Family Living **
**Supported Living Apartments **
**Independent Living**

- Continuum of Living Environments

**Notes:**
Array of residential alternatives depending on consumer living goals and need for support

## Continuum of Learning Environments

**Hospital Treatment**
**Partial Hospitalization Services**
**Outpatient Therapies**
**Clubhouse**
**Adult Education**
**Supported Education**

**Notes:**
Array of therapeutic or learning environments

Psychiatric Rehabilitation concept of therapy as learning

## Continuum of Working Opportunities

**Pre-vocational Training**
**Vocational Training**
**Volunteer Jobs**
**Jobs in Mental Illness  Facilities**
**Supported Employment**
**Transitional Employment**
**Part-time and Full-time Regular Employment**
**Consumer-run Business**

**Notes:**
Array of work opportunities depending on consumer goals and needs

## Family Services

**Support**
**Education**
**Consultation**
**Therapy**

**Notes:**
Fortunately we are treating families better than in the past (one hopes)

Used to blame them, refuse to involve them, then discharge patients from hospitals back to understandably unprepared families

Support--often the Alliance can do a better job than we do--good referral resource

Education--two goals
Better outcome for the client
Decreased stress and feeling of burden for family

Consultation - working on what the family needs help with, rather than what the clinician has diagnosed the family as needing

Therapy--can be useful if the family wants it

## Case Management

**Service Coordination**
**Linkage**
**Connection to One Person**
**Help with Basic Needs**
**Broad View of Service Plan**

**Notes:**
This is not the managed care definition of case management--means needs assessment, linkage, and coordination of an overall service plan

Case manager often has the broadest view of the service plan

## Interacting with a Personwith Mental Illness Symptoms: Communication Skills (Copyright Patricia Scheifler, MSW)

- Give clear directives
- Ask open-ended questions
- Check out the whys of behavior
- Express empathy; reflectfeelings
- Use no-choice choices
- Criticize behavior not person
- Use “I” statements

- Express caring and support
- Use parroting
- Be concrete and brief
- Watch for signs of fading
- Be low-key and low “EE”
- Avoid power struggles
- Allow for time out to “de-stim”
- Do not tell lies

## Interacting with a Personwith Mental Illness Symptoms:Safety

- Remain calm
- Speak slowly and clearly
- Avoid invading personal space
- Do not move quickly, especially toward the person
- Do not touch the person
- Do not challenge the person

## Special Issues for Homeless People with Mental Illness

- Lack of Trust
- Hierarchy of Needs
- Disability Caused by Mental Illness
- Effect of active symptoms
- No energy to accomplish daily tasks
- Inability to plan
- Consistent Need for Support

## Interventions forMental Illness

- No One Intervention Is Sufficient
- We Have to Approach from All Directions