Emotional Health

Emotional/Mental Disorders

Emotional Health

Crisis Clinic, King County– 24-hour phone line: 206-461-3222– Toll free: 866 4CRISIS (866-427-4747)– TDD line: 206-461-3219– Chat also available

Outside of King County, call 911 or 1-800-SUICIDE Health & Human Services Community Information

– 206-461-3200/800-621-4636– TDD: 206-461-3610

What is Emotional /Mental Health?

Accurate perception of reality Adaptation to change Ability to cope Ability to think in organized manner Ability to assess one’s own behavior

Emotional/Mental Disorders

General classifications

Diagnostic classifications

General Classifications

Neurosis Psychosis

Neurosis

Emotional disorder caused by unresolved conflicts, leads to anxiety

A neurotic person can grasp reality A neurotic person has irrational thoughts Behavior may not make sense A neurotic person is aware of irrational

thoughts, behaviors, but has problems fixing them

Neurosis

Pop culture example Pop culture example #2

Psychosis

Sense of reality is distorted– Hallucinations: hearing/seeing something

that does not exist– Delusions: Irrational beliefs not based on

reality Extremely disorganized thinking Personality changes

Psychosis

Example: Center for Addiction and Mental Health video

Michael (PBS News Hour, 0-1:43) Dennis Allard interviews his brother,

Tony (YouTube; private video – may not be accessible, October 2014)

Diagnostic Classifications

Diagnostic and Statistical Manual of Mental Disorders (DSM-V) published in 2013

Many categories of disorders, as well as individual disorders:– Anxiety disorders– Obsessive-compulsive disorder– Post-traumatic stress disorder– Mood disorders– Schizophrenia

Schizophrenia

Schizophrenia

A “psychotic disorder” Severe disturbances in perception,

thought, mood, behavior, or a combination

Affects ~1% of population Affects individuals around the globe

(MINDS Foundation, India, via YouTube)

Schizophrenia Characterized by: Positive Symptoms (should not be

present)– Delusions– Hallucinations– Disorganized speech

William (Learner.org excerpt via YouTube) Example: clang association/clanging

– Disorganized or catatonic behavior

Schizophrenia

Also characterized by: Negative symptoms (something is

missing)– Flat affect– Poor rapport– Difficulty with abstract thinking– Lack of self-care

Schizophrenia

Work, social relations, self-care are significantly affected

Minor physical anomalies: wide-set eyes, ear malformations, curved fifth finger, visible blood vessels in nailbeds (children)

Signs occur for at least six months, at least one month of active signs

Disturbance not due to chemical substance Change in DSM-V: “Schizophrenia Spectrum” &

Other Psychotic Disorders

Schizophrenia Profiles

Maurizio Baldini (MentalHealth.com, story) Gerald (YouTube; first 3 minutes of 8) Heather (YouTube; 5:30) Georgianna (YouTube; 3:04) Four Stories (YouTube: 0:24-2:00, 4:38-7:11)

Schizophrenia Symptom: Catatonic Behavior

Caveat: catatonia also its own disorder Abnormalities in speech, senses, movements

– Video clip (YouTube) Excessive, sometimes violent motor activity; or

mute, unmoving, stuporous– Echolalia

Example in autism (YouTube)

– Echopraxia Example from film footage (YouTube)

More examples (NLMNIH, via YouTube; 11:33)

autism

Schizophrenia Symptom: Disorganized Speech, Behavior

Incoherent speech Disorganized behavior Flat or inappropriate emotional

response Peter (YouTube; ~2:35 of 3:35)

Schizophrenia Symptoms: Hallucinations, Delusions

Hallucination: a false sensory experience– Exercise in empathy – Anderson Cooper,

CNN, 2014 Delusion: a false belief Hallucinations and delusions are created

by mind vs. external stimuli One or more delusions

– Persecution, grandeur

Schizophrenia Profiles

9-year old Rebecca (ABC News) Linda Carmella Sibio Louis Wain’s disease progression (or

here) ABC 20/20 Program from 2000 (6:04) Girogianna (via YouTube)

Possible Causes

Genetics Environment Brain abnormalities Neurotransmitter hypothesis

Schizophrenia and Genetics

There is no one gene associated with schizophrenia Group(s) of genes may produce brain development

abnormalities– If affected brain regions become overstressed, they may

not work at all, leading to schizophrenia symptoms Genes to Cognition chromosome map Schizophrenia’s Genetics Revealed (University of

Queensland, via YouTube)

Heredity and schizophrenia (schizophrenia.com) Genetic predisposition may not be enough

Schizophrenia and Environment

Prenatal care, including nutrition (Vitamin D), influenza vaccination

Complications at birth (newborn breathing issues, maternal hypertension, others)

Exposure to virus during pregnancy Relationship between schizophrenia and poverty

– Do complications inherent in poverty increase likelihood for getting schizophrenia, or

– Does poverty result because an individual diagnosed with schizophrenia is impaired?

Born in colder months (late winter/early spring)

Schizophrenia and Brain Abnormalities

Difficult to ascertain– Not necessarily obvious damage but

abnormalities on a cellular level Prefrontal cortex, hippocampus Enlarged brain ventricles (USMLE Pathology Slides)

Fei Du, PhD, and colleagues found evidence of abnormalities in both myelin and axons (Biological Psychiatry, 2013)

Schizophrenia & Neurotransmitters

Dopamine– Schizophrenics tend to have increased

sensitivity/too much released– Hypothesized due to amphetamine effects

Glutamate– Schizophrenia may inhibit glutamate– Hypothesized due to PCP effects

Serotonin– Elevated levels may be associated with schizophrenia– Hypothesized due to hallucinogen effects

Schizophrenia Treatment

Medications– Side effects

Uncontrollable movements (shaking, fidgeting, involuntary facial contortions)

Weight gain High blood sugar, cholesterol Loss of sex drive

Psychosocial therapy Hospitalization

– WA: Involuntary Treatment Act (72 hrs); petitions required for longer periods

– 2015: Joel’s Law approved in House, not (yet) in Senate

Schizophrenia Treatment

Although many diagnosed with schizophrenia are disabled, others are able to work and function

Tony Allard: His brother conducts an interview (YouTube; at least through 5:00)– Dennis Allard’s blog

Living with Schizophrenia: A Call for Hope and Recovery

Schizophrenia Resources

Crisis Clinic: 206-461-3222 (1-866-4CRISIS toll free)

Community House Mental Health (206-362-0560)

Snohomish County: (425) 388-7215

Anxiety Disorders, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder

Anxiety Disorders

Characterized by feelings:– Apprehension– Fear– Alarm– Terror

Anxiety occurs in situation where average individual is unaffected

Anxiety Disorders - Resources

General Information: Anxiety Disorders Association of America– Therapist lookup– Free webinars with registration

Anxiety Thursdays (fee = $50 for group; OCD, panic disorder, social anxiety, trichotillomania)– Info: 206-285-0900;

dkosins@u.washington.edu– Place: 318 W. Galer St., Suite #201

Generalized Anxiety Disorder

Vague feeling of worry or dread– Job, family, home, health, etc.

A feeling that something is wrong Worry is out of control Characterized by: fatigue, restlessness,

irritability, difficulty concentrating, muscle tension, sleep disturbances

Occurs for at least six months Experienced distress is significant Video Clip

Specific(Simple) Phobia

Fear is focused on particular object/situation Anxiety is out of proportion to situation Example: claustrophobia; others? Distress interferes with life Duration at least six months Video: phobia of dogs (Animal Planet)

– Video clip #1 (short); Video clip #2 (longer; 4:28)– Or here (YouTube) if above not working

Panic Disorder

Panic attacks are recurrent, expected or unexpected Panic attack symptoms: four or more of the following

– Increased heart rate– Increased breathing frequency– Sweating– Trembling– Chest pain/discomfort– Nausea– Dizziness– Fear of dying/losing control, feelings of detachment– Attacks not due to chemical substance

Fear of having unexpected panic attacks

Panic Disorder

Used to be distinguished as with or without agoraphobia

Agoraphobia– Anxiety over situations/places where escape is

difficult or even embarrassing– Usually situations outside the home– The situations are avoided or endured with extreme

discomfort– Video Clip, Colin’s Story (NHS Choices)

Agoraphobia now a separate disorder

Obsessive-Compulsive Disorder

In 2013, DSM-V recognized OCD as its own disorder (formerly an Anxiety Disorder)

Obsession– Recurrent, persistent thought, impulse or image

experienced as inappropriate, marked by anxiety– Thought, impulse, image not about real-life

problems– Person attempts to ignore/suppress– Individual recognizes irrationality– Examples

Common Obsessions

Need for order, organization, exactness

Concern over contamination

Fear of evil thoughts Fear of doing harm

to self or others

Obsessive-Compulsive Disorder

Compulsion– Repetitive behaviors/acts relating to

obsession– Behaviors/acts aimed at reducing anxiety– Examples

Common Compulsions

Counting to a specific number

Arranging objects in specific ways

Cleaning, bathing Seeking of

reassurance Behavior repetition

Video Clips

Pop culture Real life Real life #2 (Taboo USA,

National Geographic)

Obsessive-Compulsive Disorder

Obsession/Compulsion Person may or may not recognize

obsessions/compulsions are unreasonable Obsessions/compulsions cause significant

distress Not due to chemical substance Yale-Brown Obsessive-Compulsive Scale Obsessive-Compulsive Disorder Screening Quiz

(PsychCentral.com)

OCD Treatment, Resources

Treatment: medication, cognitive-behavior therapy

Gamma knife surgery (some researchers have found brain cysts as long-term side effect)

“Giving Obsessive-Compulsives Another Lifestyle” (GOAL) potluck meetings at Swedish Hospital (747 Broadway), 3rd Saturdays, 10am-1pm, cafeteria alcoves

Post-Traumatic Stress Disorder

In 2013, DSM-V recognized PTSD as a “Trauma- and Stressor-Related Disorder” (formerly an Anxiety Disorder)

Person exposed to an event threatening injury or death to self/others (examples)

Event re-experienced– Images/thoughts/perceptions

– Dreams

– Intense reactivity to cues or symbols of event

– Example (0:40-5:09; disturbing clip)

Post-Traumatic Stress Disorder

Avoidance of triggers, reduced responsiveness– Thoughts, feelings, conversations– Activities, places, people associated with trauma– Inability to recall an aspect of the trauma– Reduced participation in activities– Feeling of detachment– Sense of shortened future

Post-Traumatic Stress Disorder

Persistent symptoms– Sleep difficulties– Irritability– Concentration difficulties– Exaggerated startle response

Significant distress Occurs for longer than a month

PTSD Resources

WA State Department of Veterans Affairs PTSD Program: 800-562-2308– Crisis Hotline: 800-273-TALK – VA Puget Sound Healthcare: 206-762-1010

(Seattle), 253-582-8440 (Tacoma)

PTSD Newsletter (via Yahoo groups) Search for therapists via Psychology Today Anxiety & Stress Reduction Center of Seattle

Quiz Time!

Socrative.com Room #: 189767 If prompted for name, provide an initial

or two

Name That Disorder

Jimmy experiences intense fear whenever he is in, or even near, a plane. Which anxiety disorder BEST describes the scenario?

Name That Disorder

Mike is insistent on straightening everything in his apartment. For example, towels must be folded in a specific manner and placed on a towel bar so that ends of towels are even with each other. Furniture is symmetrically organized around the room to ensure balance.

Name That Disorder

Julia experiences nightmares after she is robbed at gunpoint. She is unable to concentrate, not doing well in school, and making errors at work.

Mood Disorders

Mood Disorders

An exaggeration of mood (affect)– Depression– Mania– Anger– Irritability

Examples– Major depressive episode– Manic episode– Bipolar I, Bipolar II

Mood Disorders - Change in DSM-V

Proposed separate categories– Depressive Disorders– Bipolar and Related Disorders

Major Depressive Episode

Extreme sadness Loss of interest in daily activities Weight loss or gain Sleep disturbances Fatigue/loss of energy nearly every day Diminished ability to concentrate Recurrent thoughts of death Not due to a chemical substance Extreme impairment in daily functioning

Depressive Disorders

Dysthmic Disorder Major Depressive Disorder

– Single Episode– Recurrent

Two or more major depressive episodes At least two months criteria for major

depressive episode are unmet

Manic Episode

Distinct period of elevated mood, at least one week

Symptoms– Inflated self-esteem– Reduced sleep– Talkativeness– Racing thoughts, distractibility

Causes severe impairment Not due to chemical substance

Bipolar Disorders

“Manic depressive” Dramatic mood swings involving

depression, mania and/or hypomania– Hypomania generally less severe than

mania Video Clips (BBC)

Bipolar I Disorder

At least one manic or mixed episode– Mixed: major depressive and manic

episodes are evident There may also be major depressive

episodes and/or hypomania

Bipolar II Disorder

History of one or more major depressive episodes

History of one or more hypomanic episodes

No manic or mixed episodes Symptoms cause significant stress

Other Bipolar Diagnoses

Cyclothymic Disorder/ Cyclothymia

Rapid Cycling Bipolar Disorder

Bipolar Disorder Not Otherwise Specified

Other Bipolar Diagnoses