SIGNS & SYMPTOMS OF MENTAL ILLNESS & SUBSTANCE USE

DISORDERS

Goal:

Learn about the different types of mental illness and substance abuse disorders.

Identify the signs of mental illness and develop an effective approach to addressing individuals who present with these symptoms.

Objectives:

• Learn about and be able to describe anxiety disorders, mood disorders, thought disorders, and substance abuse disorders.

Learn the signs and symptoms of anxiety disorders, mood disorders, thought disorders, and substance abuse disorders.

Learn how to respond to suicidal & homicidal threatsLearn effective strategies for approaching an individual who

is experiencing symptoms of mental illness and/ or substance abuse disorders.

Learn how and where to send an individual for professional help.

Why is this topic important?

According to the National Alliance on Mental Illness, almost two and a half million Ohioans suffer from a mental disorder in any given year.

The Global Burden of Disease study, conducted by the World Health Organization, the World Bank and Harvard University, reported that mental illness is second only to cardiovascular disease in regard to societal burden, including years of life lost to premature death or disability.

Impact of Disorders

Impact of Disorders

The Cost to Ohioans

The cost of untreated mental illnesses is immense, with direct and indirect

costs to Ohio totaling more than $6.5 billion a year.

The Cost to Ohioans

Missed educational opportunities and failure in school 58% percent of children with mental illness do not graduate from high school.

Lost productivity and unemployment Employees who are depressed are twice as likely to miss work and seven

times more likely to be less productive on the job.

Increased crime and incarceration More than half of Ohio’s inmates have some type of mental illness; 12 percent

are diagnosed with a severe mental illness. Most youth in juvenile justice facilities have a diagnosable mental health

disorder.

The Cost to Ohioans

Inappropriate use of hospital emergency departments Comprehensive community-based mental health

services can dramatically reduce public hospital admissions and lengths of stay.

Premature death, including suicide In Ohio, more than 1,300 lives are lost to suicide each

year, and the average life span of a person with a severe mental illness is 25 years shorter than for someone without this illness.

What is Mental Illness?

A mental illness is a medical condition that disrupts a person's:• thinking, • feeling, mood, • ability to relate to others and • daily functioning.

Just like physical illnesses, mental illnesses exist on a continuum

A Continuum of Health

Mild Headache

Severe Headache Migraine Brain

Tumor

Prevalence of Disorders

Anxiety Disorders – 18.1% Mood Disorders – 9.5% Substance Use Disorders – 3.8%

Schizophrenia – 1.1%

Symptoms

Symptoms are the internal experience of an illness; Feeling hopeless, worthless, lethargic, & suicidal are

symptoms of depression People will often report physical symptoms rather than

emotional symptoms

Signs

Signs are the external manifestation of an individual’s symptoms or experience ; Significant changes in appetite, mood & sleep, or

irritability & talking about death or dying are signs of possible depression

These may be much easier for us to see

Mood Disorders

Mood disorders are a group of mental illnesses that cause significant disturbances in a persons mood

Approximately 9.5% of the population will experience a mood disorder in a given year

Mood disorders are split into 2 broad categories; Depressive Disorders – Can be mild, moderate, or severe Bipolar Disorders

Most Common Mood Disorders

Major Depressive Disorder The leading cause of disability in the US for ages 15-44 Major depressive disorder affects approximately 6.7

percent of the U.S. population age 18 and older in a given year

Bi-Polar Disorder Bipolar disorder affects approximately 2.6 % of the U.S.

population age 18 and older in a given year.

Major Depressive Disorder

Major depression is an illness that goes well beyond temporarily feeling sad or blue. It is a serious medical illness that affects one’s thoughts, feelings, behavior, mood and physical health.

The leading cause of disability in the US for ages 15-44.

Affects approximately 6.7% of the population in a given year.

.

Major Depressive Disorder

SIGNS – Depressed moodSadnessSocial withdrawalPoor concentrationFatigueUnexplained physical aches & painsAppetite disturbancesIncreasing drug or alcohol useIrritability

Major Depressive Disorder

SYMPTOMS –Sadness Feelings of worthlessness & hopelessness InsomniaLack of motivationExcessive guilt Thoughts of suicideIncreasing drug or alcohol useFrequent crying

Bipolar Disorder

Bipolar disorder affects approximately 2.6 % of the U.S. population in a given year.

This mental illness causes unusual and dramatic shifts in mood, energy and the ability to think clearly.

Bipolar disorder is a chronic illness with recurring episodes of mania and depression that can last from one day to months.

Bipolar Disorder

SIGNS OF MANIA -Extreme irritability and/or euphoria, Agitation or angerSurges of energyTalkativenessRisk taking behavior (AOD use, impulsivity)Grandiose ideas or delusionsRapid speech Lack of insight & follow through

Bipolar Disorder

SYMPTOMS OF MANIAReduced need for sleepEuphoria Feeling agitatedSignificant increase in energyExcitability

Anxiety Disorders

Anxiety disorders are a group of mental illnesses that cause people to feel: excessively frightened, distressed, or uneasy during situations in which most other people would not

experience these same feelings.

Approximately 18.1% of the population will experience an anxiety disorder in a given year.

Most Common Anxiety Disorders

Panic Disorder

Obsessive-Compulsive Disorder

Post-Traumatic-Stress-Disorder

Panic Disorder

Panic disorder is an anxiety disorder characterized by frequent panic attacks.

A panic attack is an uncontrollable panic response to ordinary, nonthreatening situations.

Signs & symptoms of a panic attack include- sweating; hot or cold flashes; choking or smothering

sensations; racing heart; labored breathing; trembling; chest pains; faintness; numbness; nausea; disorientation; or feelings of dying, losing control, or losing one's mind.

Obsessive Compulsive Disorder

OCD is an anxiety disorder characterized by the presence of obsessions (internal) & compulsions (external).

Obsessions are intrusive, irrational thoughts; unwanted ideas or impulses that repeatedly appear in

a person's mind, i.e. "I may have left the gas stove on; I need to go check it fast"

Compulsions are repetitive rituals; such as hand washing, counting, checking, hoarding

or arranging

Post Traumatic Stress Disorder

PTSD is an anxiety disorder than can develop after experiencing a traumatic event.

Signs & Symptoms of PTSD; Persistent Re-experiencing; Nightmares, flashbacks,

intrusive thoughts, persistent remembering Avoidant/Numbness Responses ; efforts to avoid

feelings, locations or triggers associated with the trauma Increased Arousal; Exaggerated startle response,

difficulty sleeping, difficulty concentrating

Thought Disorders

A thought disorder is evident when an individual has serious problems with thinking, feelings, and behavior

The primary cluster of symptoms in a thought disorder are psychotic symptoms, indicating a loss of contact with reality

The most common thought disorder is Schizophrenia, which affects 1.1% of the population in a given year

Schizophrenia

1/3 of individuals will experience one episode psychotic episode, another 1/3 will experience multiple episodes, with no symptoms in between episodes, and the last 1/3 will experience persistent psychotic symptoms throughout the lifespan

Schizophrenia is one of the least common disorders, but can be the most disabling.

Without early intervention, long term functioning can be severely impaired.

Schizophrenia

SIGNS – False belief about self or others (delusions)ParanoiaHearing or seeing non-existent things (hallucinations), Disconnected speech or thinkingFlat affectFeelings that don’t match the situationDifficulty in conversations due to incoherance or

disorganization

Schizophrenia

SYMPTOMS –ConfusionFeeling of mistrust, paranoiaHallucinations DelusionsLack of motivation, depression

Substance Use Disorders

Addiction/Chemical dependencySubstance abuse

Substance Abuse

A maladaptive pattern of substance use leading to clinically significant impairment or distress.

Substance Abuse

SIGNS & SYMPTOMS –

Increasing drug or alcohol useFailure to maintain major role obligationsSubstance use when it is physically hazardousSubstance related legal problemsSubstance use when it causes interpersonal

impairment

Addiction / Substance Dependence

A chronic relapsing condition characterized by compulsive drug-seeking and abuse and by long-

lasting chemical changes in the brain

Addiction / Substance Dependence

SIGNS & SYMPTOMS – Increased useTolerance for substanceWithdrawal symptomsAttempts to quit usingUsing more or for longer than intended Much time/activity to obtain, use, recover Important social, occupational, or recreational activities given up

or reducedUse continues despite knowledge of adverse consequences (e.g.,

failure to fulfill role obligation, use when physically hazardous)

Withdrawal Symptoms

Abnormal physical or psychological features that follow the abrupt discontinuation of a drug that has the capability of producing physical dependence.

Common withdrawal symptoms include sweating, tremors, vomiting, anxiety, insomnia, and muscle pain.

Suicidal Ideation

Characterized as a spectrum that ranges from fleeting suicidal thoughts to completed suicide

Suicidal ideation is more common than suicide attempts or completed suicide.

General Risk Factors

Family history of suicidePast attemptsMale, white, age greater than 65 yearsWidowed or divorcedLiving alone; no children under the age of 18 in the

householdPresence of stressful life eventsAccess to firearms

Psychiatric Risk Factors

90 percent of completed suicides in all age groups are associated with psychiatric disorders, including substance abuse.

The most common psychiatric disorders associated with completed suicide are major depression and alcohol abuse

Suicide Rates 1993 - 2010

Suicide Facts

Every 13.7 minutes someone in the United States dies by suicide.Nearly 1,000,000 people make a suicide attempt every year.90% of people who die by suicide have a diagnosable and

treatable psychiatric disorder at the time of their death.Most people with mental illness do not die by suicide.Recent data puts yearly medical costs for suicide at nearly $100

million.Men are nearly 4 times more likely to die by suicide than

women. Women attempt suicide 3 times as often as men. Suicide rates are highest for people between the ages of 40 and

59.

Warning Signs

Observable signs of serious depression: Unrelenting low mood Pessimism Hopelessness Desperation Anxiety, psychic pain and inner tension Withdrawal/ isolation Sleep problems

Increased alcohol and/or other drug useRecent impulsiveness and taking unnecessary risks

Warning Signs

Threatening suicide or expressing a strong wish to die• Making a plan:• Giving away prized possessions• Sudden or impulsive purchase of a firearm• Obtaining other means of killing oneself such as

poisons or medicationsUnexpected rage or angerImprovement in mood

How To Approach

Always pick a private time & place when you won’t be rushed, & the person you are approaching will feel comfortable

Do not presume you understand what they are going through or where they are coming from

Open the door for the person to speak openly about what they may be experiencing – listen

Let them speak about what may be going on

What To Say?

Share your observations about their behaviors, & any signs of mental illness or substance use disorders you have noticed

Invite them to do most of the talkingDo not judgeStick to ‘I statements’ – “I’ve noticed you haven’t been

hanging out as much lately, is something going on?”Use language that is comfortable for youHave referral information ready for themRefrain from giving advice

What to Say?

Be prepared for the person to resist you – they may not be ready to talk yet.

Set yourself up as a person who will provide consistent emotional support & understanding – they may come back to you later.

If the person is in a crisis situation – ensure that you have the appropriate information you may need ready for them.

Where to Access Help

211 – Often a good starting point for referrals. Mental health agencies – Comprehensive services for

mental health needs, drug & alcohol treatment. Private Practices – For individual counseling needs.

Private insurance often needed, some have sliding scale available.

Hospitals – Emergency care, crisis situations, stabilization services, some long term supports.

Peer support groups – For both mental health & drug & alcohol needs.

Local Resources

Mobile Crisis – 216. 623.6888ADAMHS Board – 216. 241.3400Recovery Resources – 216.431.4131NAMI – 216.875. 7776CIT Trained Police Officers – For Crisis Situations

Recovery

The recovery journey is unique for each individual.

There are several definitions of recovery; some grounded in medical and clinical values, some grounded in context of community and some in successful living.

RECOVERY IS A PROCESS, NOT AN EVENT.

Mental Health First Aid

Over 100,000 people trained since 2008Over 500 trained by Recovery ResourcesAdult and Youth versionsLearn more at www.recres.org Contact Johni Fiber at 216.431.4140 for

more information

Other Trainings with Recovery Resources

Health and WellnessVerbal De-escalation TrainingLeadership and teamwork developmentSexual Harassment PreventionDrug Free Safety Program Training

Employees Supervisors Train the Trainer Policy review and development Drug screening