Mental Health 101

Cari Guthrie Cho, LCSW-CChief Operating OfficerThreshold Services, Inc.

Common Mental Health Disorders

Thought Disorders Schizophrenia Schizoaffective

Mood Disorders Major Depression Bipolar Disorder

Personality Disorders Borderline Personality Disorder

Anxiety Disorders Post Traumatic Stress Disorder Obsessive Compulsive Disorder

WHAT CAUSES MENTAL ILLNESS?

Family Inheritance / Genetic Causes:No specific gene has been foundInheritance does not explain all casesCurrent thinking – genetic vulnerability and environmental damage both needed

Environmental CausesEarly brain damageViruses

Schizophrenia Biological brain disease that effects

about 1% of the population worldwide. Cause is not known. Treatment can

improve but not cure this illness. Effects a person’s ability to tell the

difference between real and unreal experiences.

Effects a person’s ability to remember, think logically and act appropriately in society.

Onset usually 18 – 25 years old

Risk of Developing Schizophrenia

POSITIVE SYMPTOMS

Something added to normal mental process.

Hallucinations (sensory misperceptions) Hearing something that isn’t there Seeing something that isn’t there Odd physical sensations

Delusions (“false ideas”) Constant feeling of being watched or followed Preoccupation with religion Grandiose delusions – believing someone has

powers that other people don’t have

POSITIVE SYMPTOMS

Disorganized Speech Inability to communicate clearly Thoughts don’t come out in logical fashion Moving from one topic to another Using made up words

Disorganized Behavior Failure to attend to personal hygiene Inability to organize behavior that is

inappropriate to the situation Poor social skills

NEGATIVE SYMPTOMS

Normal mental functions that are lost or severely impaired. Loss of what is enjoyable or interesting. Anhedonia – loss of pleasure or interest in

activities that were enjoyed before Alogia – decreased amount of speech Apathy – poor motivation and ability to initiate

activities Lack of social interest – social withdrawal Blunted affect – lack of facial expression,

muted or absent emotional response

MOST COMMON COURSE

Repeated episodes in early adulthood, gradual loss of functional capacity and increasing negative symptoms.

Wide variation in outcomes has been seen – some studies show 50% of patients gain functional independence. Most studies show majority of patients have symptoms and some functional impairment throughout their lives.

COGNITIVE IMPAIRMENT

EXECUTIVE FUNCTIONS – capacity to organize actins to achieve a goal.

ATTENTION – ability to remain focused and not be distracted.

SECONDARY MEMORY – remembering what you did a week ago and it’s consequences.

WORKING MEMORY – ability to use information that has been learned to solve problems.

INFORMATION PROCESSING – ability to use environmental cues accurately and make accurate judgments about the environment.

GOALS OF TREATMENT

Treat acute episodes of psychotic symptoms, prevent relapse and support recovery.

Prevent future episodes by: Learning early warning signs; Intervene with additional support or

medications when warning signs appear;

Avoid stressors that lead to relapse.

TREATMENT OF SCHIZOPHRENIA Most important medications are called anti-

psychotics Most effective on positive symptoms

50 - 80% of patients show significant improvement

Except for clozapine, no one agent has been shown consistently to be more effective than another on average

Cognitive Therapy usually not successful Skills training is helpful – helping client learn

how to deal with stressors, signs of relapse, personal hygiene, employment skills, etc.

Medications Traditional/Typical drugs – side

effects – dry mouth, tardive dyskenesia

List of a few drugs Haldol Prolixin Navane Loxitane Stelazine

Medications Newer medications or atypical meds are now often

used first They have fewer movement related side effects Metabolic side effects – people are developing

diabetes, high cholesterol on these newer meds List of drugs:

Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripipizole (Abilify)

Clozaril – only medication to have positive affect on negative symptoms

Depression Persistent mood change lasting at least two weeks. Depressed mood Lack of interest in daily activities Significant weight change Significant sleep change Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness Poor concentration Recurrent thoughts of death Significant impairment in social, work, or other

areas of life

Course of illness

May begin at any age. Some people have isolated

incidents related to stress or trauma Many have increasingly frequent

episodes as they get older May have psychotic symptoms as

well Medications and therapy have most

success in treatment over time.

Treatment for Major Depression

Traditional meds – Anti Depressants SSRI’s – impact different (Serotonin)

neurotransmitters in the brain Prozac Elavil Effexor Wellbutrin

Therapy – cognitive behaviorial therapy; support groups; skills training are all helpful.

Bipolar Disorder Bipolar I - A combination of one or more

Manic episodes as well as one or more Depressed episodes

Bipolar II – A combination of one or more depressed episodes as well as one or more hypomanic episodes.

Average age of onset is 20 years old. More than 90% have multiple episodes 10 – 15% will complete suicide – usually in

depressed episode

Manic Episode Distinct period of abnormally and persistently

elevated, expansive, or irritable mood – for at least one week in duration

Inflated self esteem Decreased need for sleep Increased talking Flight of ideas, racing thoughts Distractible Increase in goal directed activity Excessive involvement in pleasurable activities

that could have negative consequences – buying sprees, sexual indiscretions, foolish investments

Causes significant impairment in social or employment functioning

May have psychotic features

Hypomanic Episode

Same symptoms as Manic episode except for: Duration at least 4 days Changes are observable by others –

uncharacteristic of the person Not severe enough to cause

impairment in social or employment functioning

Course of illness

May begin at any age. Some people have isolated

incidents related to stress or trauma Others have increasingly frequent

episodes as they get older May have psychotic symptoms as

well Medications and therapy have most

success in treatment over time.

Treatment for Bipolar Disorders

Mood Stabilizers Depakote Lithium These medications need regular lab

work done because of effects on Liver or Kidney functioning

Anti depressants Therapy – cognitive behaviorial

therapy; support groups; skills training are all helpful.

Schizoaffective Disorder

Period of illness with a combination of symptoms for Schizophrenia as well as Major Depressive, Manic, or Mixed episode

Delusions or hallucinations present for at least 2 weeks during period of illness

Mood episode symptoms are present most of the time during the period of illness

Treatment for Schizoaffective D/O

Mood stabilizers Anti psychotics Anti depressants Therapy – skills training most helpful;

cognitive therapy may not be as useful due to thought disorder aspect of illness.

Borderline Personality Disorder

A pervasive pattern of unstable relationships, self image

Marked impulsivity beginning in early adulthood

Frantic efforts to avoid “abandonment”

Unstable relationships characterized by extremes of idealization and devaluation

Identity disturbance

What is Borderline Personality Disorder?

Impulsivity that is self damaging Recurrent suicidal behavior,

gestures, or self mutilating behavior Intense labile moods Chronic feelings of emptiness Inappropriate, intense anger;

inability to control anger Transient, stress related paranoid

ideation or dissociation

Treatment for Borderline Personality Disorder

For Personality disorders, medications are not useful – you can’t medicate someones personality.

Medications may be prescribed for particular symptoms such as depression or anxiety

Therapy – particularly Dialectical Behavioral Therapy (DBT) has proven successful.

What Is Recovery? Recovery is possible for people with mental

illness. You must offer HOPE! Recovery is different for each person. Recovery means that you have a successful,

high quality of life even though you have a mental illness.

Recovery means that you might maintain a job, use supports, have friends, go to school, or have a home.

Recovery may mean that you experience symptoms everyday, but you can manage them and still do the things you want to do.

Recovery does not mean that you are cured!

WHAT YOU CAN DO

Have HOPE – people to recover, clients can have more fulfilling lives, if you don’t believe it – they never will either!

Don’t take things personally – if a client yells at you or curses at you – it’s probably not about you – it’s about them feeling out of control because of depression, hearing voices, or any other symptom they are having.

Be where the client is at – put yourself in their shoes – how would you feel if you were homeless and hearing voices and having a bunch of people telling you what to do?

WHAT YOU CAN DO Have HOPE It’s all about the relationship – you have to build

trust before you can effect any change. Help them with the basics first – food, clothing, shelter, entitlements, etc. They will see that you care about them and can help them – trust will start to build so that you can talk about other things like symptoms and medications, etc.

Revise expectations, at least temporarily – acknowledge symptoms of illness. If the client does not think they have a mental illness then talking to them about mental illness is just going to piss them off. Talk to them about other stuff instead – family, work, interests – find something positive, a strength, to focus on – not the negative all the time.

WHAT YOU CAN DO Have HOPE Avoid over-stimulation – groups, lots of noise,

loud noise, multiple conversations can be too much. Someone with depression make breakdown; someone with schizophrenia may become agitated and more delusional

Set limits/boundaries – should be reasonable and flexible if needed. Allow for the client to have input and choice whenever possible, but be CONSISTENT with each client.

Selectively ignore – give people space. Do you really need to tell that client to stop pacing? Who is it hurting?

WHAT YOU CAN DO Have HOPE Keep communications simple and

respectful. Support the patient’s medication

regimen – monitor meds; communicate with the doctor and treatment team

Learn to recognize signals for help – appropriate crisis intervention – know how to calm a situation not agitate it.

WHAT YOU CAN DO Have a positive attitude – watch your

language about clients – don’t use terms like “punishment”, “lazy”, or “resistant”

Ask for help whenever you need it – Supervisor Crisis Center Treatment provider Me

Have HOPE!