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Contents
Purpose……………………...………………………….………………………..……..………. 1
Introduction
Welcome to NAMI IOWA………………………………….………………...……..….
NAMI IOWA Background Sheet………………………….………………...……….....
NAMI IOWA Membership Benefits….……………………………...………...……....
Facts About Mental Illness…………………………………………………...……..….
2
3
4
5
Affective Disorders
Bipolar Disorder…………………………………………………...…………………… 7
Depression………………………………………………………..………….…………. 9
Depression in the Elderly…………………………………………………….………… 12
Postpartum Depression……………………………………….………….….…………. 14
Real Men. Real Depression……………………………………………………………. 16
Seasonal Affective Disorder (SAD)…………………………...……………..………… 18
Women and Depression…………………………………………………….………….. 20
Anxiety Disorders
Anxiety Disorders…………………………………………………………….…..……. 22
Obsessive Compulsive Disorder (OCD)………………….……………………….…… 24
Posttraumatic Stress Disorder……………………………………….…………..…….. 26
Childhood Disorders
Anxiety Disorders in Children and Adolescents……………………..………………… 28
Asperger Syndrome………………………………………………….………………… 30
Attention Deficit Hyperactivity Disorder (ADHD)……………….…………………… 32
Autism…………………………………………………………………………….…… 34
Bipolar Disorder in Children and Adolescents…………………...…………….……… 36
Bullying………………………………………………………………………………… 38
Childhood Schizophrenia………………………………………………………...…….. 41
Conduct Disorder………………………………………………………………….…… 43
Depressive Disorders in Children and Adolescents…………………………………… 45
Dual Diagnosis During Adolescence….……………………………………………….. 47
Neurobiological Disorders…………………………………………………….…….…. 49
Obsessive Compulsive Disorder in Children and Adolescents (OCD)…………….….. 51
Oppositional Defiant Disorder (ODD)……………………………………………......... 53
Posttraumatic Stress in Children and Adolescence…………………………………..... 55
Reactive Attachment Disorder………………………………………………………… 56
Separation Anxiety Disorder………………………………………………………….. 58
Tourette's Disorder…………………………………………………………………….. 60
Child Miscellaneous
Identifying Potential Violence in Middle and High School Students………………… 62
Parents’ Guide to Educational Rights……………………………………………...…... 64
Questions to Ask Before Inpatient Psychiatric Treatment of Children………………... 66
Questions to Ask Your Doctor About Psychiatric Medications for Children and Adol.. 67
Co-occurrence
Co-occurrence of Depression With Cancer………………………………………….. 68
Co-occurrence of Depression With Diabetes………………………..………………... 70
Co-occurrence of Depression With General Medical Disorders…………………….. 75
Co-occurrence of Depression With Heart Disease…………………………...……… 77
Co-occurrence of Depression With Medical, Psychiatric, Substance Abuse…..……… 79
Co-occurrence of Depression With Parkinson’s Disease……………………………. 81
Co-occurrence of Depression With Stroke……………………………………..……… 85
Criminal Justice System
Criminalization of the Mentally Ill………………...……………………….…...…….. 87
Dealing with the Criminal Justice System……………………………………..……… 90
Dual Diagnoses
Aids and Mental Illness………………………………………………………..………. 92
Dual Diagnosis: Mental Illness and Mental Retardation…………………….………. 94
Dual Diagnosis: Mental Illness and Substance Abuse…………………….….……… 96
Eating Disorders
Anorexia Nervosa………………………………………………………………..…….. 98
Bulimia Nervosa…………………………………………………………….…….… 100
Education Programs
Family-to-Family……..……………...………………………..…….………...……...
Peer-to-Peer…………………………………………………………………..………
Provider Education…………………..……………………………………..………..
NAMI Basics………………………………………………………..………
102
102
102
102
Employment and Mental Illness
The ADA and Employment of Persons With Psychiatric Disabilities……….….…… 103
Dealing With Mental Illness in the Workplace………………………………..…..… 105
Job Accommodations for People Who Have a Mental Illness…………….....……… 106
Questions on ADA's Role for Workers with Psychiatric Disabilities……………… 107
Family Issues
Family Issues and Coping………………………………………………..……...…… 109
Grief…………………………………..…………………………………..……..…… 111
Guidelines for Dealing With a Person With Mental Illness………….……..……… 113
Improving Medication Compliance………………………………………..………… 114
Interrupting the Hallucination Process……………………………………....……….. 115
Minimizing Relapses…………………………………………………….…..……….. 116
Responding to Delusions……………………………………………….…..………… 118
Tips for Reaching Someone Who Won’t Accept Treatment…………………………. 119
Ministry
Ministry, Mental Illness, and Communities of Faith…………………………………. 120
Personality Disorders
Borderline Personality Disorder………………….…………………………………..
Dissociative Amnesia………………………………………………………...………
Dissociative Identity Disorders (Multiple Personality)……………………....………
Personality Disorders……………………………………………….………...………
122
124
126
128
Schizophrenic Disorders
Schizoaffective Disorder…………………………………………………..…………. 130
Schizophrenia………………………………………………………………………… 132
Suicide
Suicide…………………………………………………………………….………..… 134
Teenage Suicide……………………………………………………………....……… 136
Support Groups
NAMI IOWA Support Groups……………………………………..…….……….…. 138
Miscellaneous
Disclosure of Mental Health Information……………………………………………...139
Hospitalization for Mental Illness……………………………………………………...140
Questions you may want to ask your doctor……………………………………………141
1
Purpose
This handbook was created as a resource for family members, consumers, mental health professionals,
and business professionals. Informatio1n on mental illness and mental health issues has been provided.
It is hoped that the information contained within will explain illnesses and issues in enough detail to
give the reader a general understanding of the topic.
NAMI IOWA encourages recipients of this handbook to share the information with others. The
Handbook can be downloaded in its entirety or specific pages can be downloaded. In addition, NAMI
IOWA offers educational presentations based on topics covered in this handbook as well as
educational classes. All three modes of education enhance people’s understanding of mental illness and
mental health issues.
NAMI IOWA offers the information in this handbook for general educational and informational
purposes only. This information is not intended as a substitute for advice, treatment, or
recommendations from healthcare professionals. It is important to follow the advice of your physician
and other health care professionals regarding your individual medical and health care needs.
1
2
Welcome to NAMI IOWA
NAMI IOWA (National Alliance on Mental Illness-Iowa, Inc) is a nonprofit, tax-exempt organization which
offers mutual support, education about mental illness, and advocates for the needed services. There are many
forms of mental illness; for example, Bipolar (Manic Depression), Major Depression, Schizophrenia, and
Neurobiological Disorders of children.
We are pleased to welcome you and hope that we can be of help to you. Members of NAMI IOWA are families
and caring friends of persons with a Mental Illness (adults, adolescents, or children), and persons who have such
an illness. These consumers of mental health services are valued members of NAMI IOWA.
Because Mental Illness frequently strikes a person in adolescence or early adulthood, it is a devastating
experience for the individual and the family. Physically, emotionally, and financially the impact is enormous.
Medical and social services are complex and frightening to approach, difficult to comprehend, and hard to
access. Adjusting to living with the illness requires effort on the part of the consumer, the family, and friends.
Depending on how well and how much a person will be able to achieve varies. Common to all; however, is the
need for a comprehensive, continuing program of caring services. We, therefore, offer a range of education,
support, and advocacy programs aiming to:
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*
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Provide a caring, supportive environment in sharing meetings..
Present informative programs on topics related to Serious Mental Illnesses
Advocate for a comprehensive state mental health system that provides effective services for mentally ill
persons in their communities, including: adequate housing, rehabilitative services, sufficient income,
schooling, and employment options.
Counteract the stigma which remains associated with these illnesses.
Encourage the support of research in the causes and treatments of Mental Illness.
We offer several educational programs to bring knowledge and awareness to communities throughout
the state. Programs are offered to family members, individuals with mental illness, parents and
caregivers of children and adolescents with a mental illness, teachers and mental health providers.
NAMI IOWA operates through its affiliates throughout the state of Iowa and in a state office centrally located in
Des Moines. Affiliates in the greater Des Moines area and other population centers bring NAMI IOWA within
the reach of most Iowans.
Affiliate meetings are usually of two types: (1) a sharing meeting for informal, supportive conversation, and the
exchange of information by members; and (2) an educational program with a speaker who may be a mental
health professional, a public official, or other person whose activity touches on the needs of persons with a
Mental Illness. These meetings are held monthly and are open to all interested persons without requirement of
membership. Several communities also offer a Connection Recovery Support Group for people with mental
illness to share and learn from each other and find support. We hope you will choose to join in these activities.
Newsletters are distributed at intervals by the affiliates and by the state office. Members also receive
publications from the National Alliance on Mental Illness (NAMI) which NAMI IOWA is affiliated with.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
3
NAMI IOWA Background
A non-profit tax-exempt organization and affiliate of the National Alliance on Mental Illness
What is NAMI?
It is a grassroots organization founded in Madison, Wisconsin, in September 1979, by fewer than 300 family
members. It is a self-help organization made up of families of persons with Mental Illness, of those persons
themselves, and of friends. Since the need is so great and support of each other is so important in working with
family members and individuals with mental illness, the organization has grown like wildfire. Now, over 30
years after that Madison, Wisconsin meeting, there are more than 1,200 self-help support groups nationwide
with more than 220,000 members.
What is available in Iowa?
NAMI IOWA was formed in 1984. There are 12 affiliates and 20 support groups in the state and other
information contacts located around the state. Our office provides families and individuals with mental illness
with support, systems advocacy, and information services.
What is the difference between Mental Illness and Mental Retardation?
Mentally Retarded have a diminished intellectual capacity usually present since birth. Those with Mental
Illnesses are usually of normal intelligence although they may have difficulty performing at a normal level due
to their illness.
Who are the seriously mentally ill adults?
One out of every four families has a member who suffers from a Serious Mental Illness. It affects the rich and
the poor, the urban dweller and the rural population, people from all walks of life.
Children with Severe Emotional Disturbance (SED)
A functional impairment, which substantially interferes with, or limits a child or adolescent role; or functioning
in family, school, or community activities; or from achieving or maintaining one or more developmentally
appropriate social, behavioral, cognitive, communicative, or adaptive skills.
What is mental illness?
It is a “no fault” brain disease. The brain is part of the body; it too can become ill. It is good to know that more
progress has been made in research of the brain. We can be proud that the University of Iowa is in the forefront
of this research.
Are there medications available for the disease?
Yes. At this time there are medications that reduce the symptoms markedly for most people but do not cure the
illness.
Why is mental illness becoming a major issue?
Mentally ill persons occupy more hospital beds than persons suffering from Cancer, Lung, and Heart Diseases
combined. This is a widespread illness that wishful thinking cannot drive away.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
4
How Does Membership With
NAMI IOWA Benefit You?
Through NAMI IOWA you have access to…
Automatic membership to the National Alliance on Mental illness (NAMI).
NAMI’s newsletter (The Advocate), which brings you informative and timely articles concerning the latest
research regarding Neurological Brain Disorders, the status of major legislation at the federal level and in state and
local governments, provocative editorials, book reviews, and more!
NAMI IOWA’s newsletter, distributed three or four times a year, to keep you informed on mental health issues
in Iowa.
Legislative Alerts: Keeping you abreast of current legislative activities in the federal and state government; and
alerting you whenever immediate action needs your voice to influence a vote which may impact the lives of
persons suffering from Neurobiological Brain Disorders.
Stigma Alerts: A notice of current or pending media pieces which misrepresent and/or discriminate against
persons suffering from Mental Illness.
Handbook of Mental Illnesses, The Children’s Mental Health Resources Book, and other literature with clear,
concise descriptions of mental illnesses including: Schizophrenia, Major Depression, Bipolar Disorder,
Schizoaffective Disorder, and Anxiety Disorder among others.
Staff members dedicated to the special concerns of families who have a loved one suffering with a Mental
Illness.
Toll-free Helpline offering science-based information, support, and referral services: (800) 417-0417.
Notification of state and regional conferences with programs designed to enhance members’ knowledge in the
area of education, advocacy, and research.
Notification about NAMI’s national convention where you can meet with, and talk to, the leading researchers
and experts in the mental health field.
Technical assistance from NAMI IOWA staff in the areas of: building affiliate membership, fundraising, state
and local advocacy efforts, media relations, and public education.
Our educational programs: Family-to-Family, Peer-to-Peer, Provider Program, and NAMI Basics.
Our support groups: Family support groups and the Connection Recovery Support Group.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
5
Facts about Mental Illness
What is mental illness?

Mental Illnesses are biologically-based brain diseases that can severely disturb a person’s ability to think,
feel, and relate to other people and the environment.

New England Journal of Medicine in March 1990 reported, “definitive evidence that Schizophrenia is a
brain disease and that it involves more than genetic susceptibility.”
What are some of the more disabling Mental Illnesses? How common are they?

Schizophrenia is a brain disease that often strikes young people between the ages of 16 and 25. In any given
year, nearly two million Americans age 18 and over have a diagnosis of schizophrenia. Some people with
Schizophrenia experience hallucinations. They cannot distinguish between what is real and what is not.
The exact causes are not known, but are believed to be biological, sometimes involving genetic factors.

Depressive disorders—including Major Depression and Manic Depressive Illness (Bipolar Disorder)—are
very common and range widely in severity. Within any given one year period, 6.3 percent of the
population—about 15 million Americans—suffer from these disorders.

The number one reason for hospital admissions nationwide is a psychiatric disorder. At any moment,
almost 21 percent of hospital beds are filled by patients with a psychiatric disorder.

Mental Illness is more common than Cancer, Diabetes, Heart Disease, or Arthritis.
How many children and adolescents have Mental, Behavioral or Developmental
Disorders?

A conservative estimate is that 12 percent or 7.5 million of the country’s 63 million youths under age 18
have Mental, Behavioral, or Developmental Disorders. Only about a fifth of the 7.5 million who need
mental health treatment receive it.

Attention Deficit Hyperactivity Disorder (ADHD) is a common mental disorder which affects 3 to 5 percent
of the nation’s school-age children.
How much does mental illness cost the nation?

The total costs associated with serious mental in the United States in 2002 totaled over 300 billion dollars
per the National Institute of Mental Illness (NIMH)..
How are persons with Mental Illness stigmatized?

Mentally ill people are feared or stereotyped as irrational, aggressive, and violent. In fact, they are more
likely to be isolated, passive, and withdrawn. Often they are blamed for falling victim to an illness that is
clearly biologically based.

They are denied the opportunity to rebuild their lives in the community because of discrimination in
housing, employment, and insurance coverage.
6
Is there hope for persons suffering from Mental Illness?

Through research, scientists have made great advances in understanding the nature of mental illness in the
last ten years. The development of sophisticated scanning devices to take detailed “pictures” of the brain,
genetic mapping to determine the causes of mental illness, and research on new medications have led to
numerous breakthroughs in the last decade.

The National Alliance on Mental Illness (NAMI) is a national, grassroots self-help organization of families
and friends of people with Serious Mental Illnesses, and those people themselves. Dedicated to improving
the lives of seriously mentally ill people, NAMI began in 1979 with 254 people, and has grown to
encompass 220,000 members and 1,200 affiliate chapters nationwide. NAMI works to educate Americans
about symptoms and treatment of disorders, improve treatment and access to appropriate medical therapies,
reduce the stigma of mental illness, and increase scientific research in treatment approaches and
neuroscience.
●
The treatment success rate for a first episode of Schizophrenic is 60 percent, 65-70 percent for Major
Depression, and 80 percent for Bipolar Disorder according to National Mental Health Advisory Council in
1993.
Other Facts
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Serious Mental Illnesses (SMI) interfere with employment. The unemployment rate among adults with
serious mental disorders hovers at 90 percent. (National Institute on Disability and Rehabilitation Research,
1992.)
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Approximately one-third of the over 600,000 homeless people in the United States have a Severe
Mental Illness.
●
In 2006, 1.25 million people with Mental Illnesses were incarcerated in American prisons and jails.
Source: The National Institute of Mental Health, Office of Scientific Information, 5600 Fishers Lane, Room 15-105, Parklawn Bldg,
Rockville MD 20857
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
7
Bipolar Disorder

Bipolar Disorder is a disorder of mood involving episodes of serious mania and serious depression.
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This disorder affects approximately 1 percent of the general population. Both men and women are equally
affected.
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About one-third of depressed people are diagnosed as having Bipolar Disorder, but experts believe that
about one-half of all depressed people are actually bipolar.
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The symptoms of Bipolar Disorder typically appear in adolescence or early adulthood.

When one parent has Bipolar Disorder, each one of the children has a 17 percent chance of developing a
depressive illness at some point in their lives. Approximately 10 percent will develop depression and about
7 percent will develop Bipolar Disorder.
Bipolar Disorder Sub-Types (I and II):

In Bipolar I Disorder, persons experience one or more manic episodes or mixed episodes (symptoms of
mania and depression mixed together in one single episode) of bipolar disorder. Often these individuals will
also have had one or more major depressive episodes. Persons with this sub-type may have some free
intervals where they do not experience any symptoms.

Bipolar II Disorder is characterized by the occurrence of one or more major depressive episodes
accompanied by at least one hypomanic episode (mania without psychotic symptoms). Symptom-free
intervals may also exist in this sub-type of Bipolar Disorder.
Symptoms
Depression:
Mania:
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Persistent sad or “empty” mood
Changes in appetite, weight, or sleep patterns
Decreased energy
Feelings of hopelessness, loss, or guilt
Thoughts of death or suicide
Difficulty thinking or remembering
Loss of interest in ordinary activities
Irritability
Excessive crying
Excessive “high” mood
Increased energy and activity
Decreased need for sleep
Unrealistic beliefs in one’s abilities and powers
Extreme irritability or distractibility
Uncharacteristically poor judgment
Racing thoughts
Obnoxious or provocative behavior
Drug and/or alcohol abuse
8
Causes

Bipolar Disorder is a biological brain disease that appears to be genetically-based and tends to run in
families.

Bipolar Disorder is a disorder of mood caused by a chemical imbalance in the frontal lobe of the brain.
During a manic episode, there is increased activity in the frontal lobe; during a depressive episode, there is
decreased activity in the frontal lobe of the brain.
Treatments

A full physical examination, intake of family history, and psychological evaluation should be completed by
a mental health professional or family physician before any treatment takes place.

Medications, such as Lithium and Depakote, are usually very effective in controlling mania and preventing
the recurrence of both manic and depressive episodes.
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Antidepressant medications are often used to supplement the treatment of depressive episodes.
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Electro-convulsive Therapy (ECT) is effective for approximately 80 percent of those experiencing a severe
depressive episode who do not respond to medications. These treatments are typically followed by
medication therapy for maintenance.
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Psychotherapy is often used in combination with medication therapy and usually takes the form of
interpersonal therapy, behavior therapy, and/or cognitive therapy.
Suggested Readings
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Handbook of Lithium Therapy by Johnson, F. Neil
Helping the Depressed Person Get Treatment by NIMH
Learning to Cope with Depression & Manic Depression by Copeland, Mary Ellen
Lithium & Manic Depression: A Guide by the Lithium Information Center/Univ of Wisconsin
Moodswing by Fieve, M.D., Ronald
Suicide: Why? by Wrobleski, Adina
Schizophrenia & Manic Depressive Disorder by Torrey, Bowler, Taylor, & Gottensman
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
9
Depression
What is clinical depression?
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It is more than being temporarily “down” or “blue”, lasting several weeks accompanied by other symptoms.
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It is a physical illness involving a chemical imbalance in the brain.
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It can be described as a “blue” period.
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It affects the total person – behavior, mood, and thoughts as well as physical health, academic, or work
performance and the ability to handle everyday situations.
Types of clinical depression
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Major Depression: a combination of symptoms, often severe and disabling. Occurrences vary.
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Dysthymia: less severe, long-term chronic, does not disable, but person cannot function up to potential.
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Manic Depressive/Bipolar Illness: not as common, Depression cycles with Mania. Affects thinking,
judgment, and social behavior which leads to serious problems and embarrassment.
If you have four or five of these symptoms every day within a two-week period, see a doctor or mental health
professional.
Symptoms
Depression:
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Sad/empty mood
Loss of interest in ordinary activities
Sleep disturbance (more or less)
Eating disturbance (more or less)
Difficulty concentrating, making decisions
Hopelessness, worthlessness
Death/suicide
Guilt
Irritability
Increased crying
Loss/gain of weight
Chronic aches/pains unresponsive to treatment
Mania:
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Boundless energy
Increased activity
Increased risk-taking behavior/poor judgment
Drug and/or alcohol abuse
Easily distracted
POS (rapid, disorganized speech)
Grandiose/delusional thinking
Impulsive/erratic behavior
Decreased sleep
Irritability
FOI (racing thoughts)
Fatigue/loss of energy
10
Causes

Not known specifically.

Current beliefs:
(1) Chemical imbalances in the frontal lobe of the brain.
(2) Data suggests a genetic link, as it has shown to run in families.
(3) Some medications can trigger a depressive episode.
(4) Other factors can influence the onset of a depressive episode, such as a stressful environment, low selfesteem, pessimistic thinking, and being easily overwhelmed.
Treatments

About 80-90 percent of persons can be helped, usually in a matter of 4-6 weeks.

Psychological therapies: for less severe cases may be used alone, or often used along with medications for
optimal results.
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Electro-convulsive Therapy (ECT): used if situation is life threatening, Depression is severe, if medications
are not effective, for pregnant women who cannot take medications, or for severe mania.

Most important: asking for help, because people fail to recognize the symptoms.

Only 1 in 3 people get help because of the following:
(1) Symptoms are often blamed on the person, considered a weakness.
(2) People are misdiagnosed.
(3) A person becomes so disabled that he/she is unable to ask for help.
●
A full physical examination, intake of family history, and psychological evaluation should be completed
by a mental health professional or family physician before any treatment takes place.
●
Medications often provide for a quicker, more cost-effective mode of treatment for those diagnosed with
Severe Depressions. If depressive episodes reoccur, then the patient typically stays on medication.
●
In order to be effective, medication compliance is especially important. However, it has been estimated
that 70 percent of patients fail to take 25 to 50 percent of their medication, which is predictive of poor
outcome.
When serious

School and job performance decrease.
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There can be increased alcohol and drug use (alcohol is a depressant and makes it worse).
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There is increased running-away behavior.
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There is an increased feeling of worthlessness and hopelessness.
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There is an increased incident of suicide.
If untreated
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It does not go away.
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Fifteen percent of persons with severe, untreated Depression commit Suicide.

Suicide is the eighth leading cause of death in the United States.
11
In summary

Clinical Depression is a serious physical illness.

It is not due to poor parenting or weak character.

It is not hopeless.
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It affects 190 million Americans every year.
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Women are twice as likely to have an episode of Depression in their lifetime as men. One-fourth of all
women and one-eighth of all men will be affected.

Depression affects all ages and all cultures.

Depressive illnesses are the second most common group of the major mental illnesses, occurring in 8.3
percent of the population (Anxiety Disorders makes up 14 percent, Schizophrenia makes up 1.5 percent).

Eight percent or 15 million adults are affected by Depression in their lifetime.
Suggested Readings
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Learning to Cope with Depression & Manic Depression by Copeland, Mary Ellen
The Depression Workbook by Copeland, Mary Ellen
Helping the Depressed Person Get Treatment by NIMH
Do You Have a Depressive Illness by Klein, Donald & Wender, M.D., Paul
Suicide: Why? by Wrobleski, Adina
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
12
Depression in the Elderly

More than one-half of nursing home residents have diagnosable mental disorders, and less than 20 percent
of these residents are actually getting the mental health care they need.

The prevalence of Major Depression among the elderly living in the community is usually estimated at less
than 3 percent. The rates of Major or Minor Depression among elderly people range from 5 percent in
primary care clinics to 15 to 25 percent in nursing homes.

One study found that Depression in patients admitted to a nursing home raises the risk of death within the
year by 60 percent, regardless of their physical health at the time of admission.

Symptoms such as memory problems, confusion, and physical symptoms are often seen in other illnesses
that are characteristic of the elderly population (e.g., Alzheimer's, Dementia). This common symptomology
makes the recognition of Depression in later life difficult.

Depression in late life frequently coexists with other illnesses and disabilities. For example, the rate of
Depression has been estimated at 40 percent in persons with Cancer and 20 to 50 percent in Heart Disease
victims.

Depression in late life also occurs in the context of numerous social, developmental, and biological events.
For instance, loss of a spouse or sibling due to death, retirement, and decrease in immune system response
often accompany advancing age.
Symptoms
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Memory problems
Confusion
Persistent sad or “empty” mood
Decreased energy
Thoughts of death or suicide
Irritable
Difficulty thinking or making
decisions
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Aches and pains that do not respond
to treatment
Changes in appetite, weight,
or sleep patterns
Feelings of hopelessness, loss, or
guilt
Loss of interest in ordinary activities
Excessive crying
Causes

Depressive Illnesses are biological brain diseases that appear to be genetically-based and tend to run in
families.

Depression is a disorder of mood caused by a chemical imbalance in the frontal lobe of the brain.
13
Treatments

A full physical examination, intake of family history, and psychological evaluation should be completed by
a mental health professional or family physician before any treatment takes place.

Medications such as Prozac, Zoloft, Norpramine, Pamelor, and others, are the primary choice of treatment.
It is suggested that approximately 60 percent of elderly patients clinically improve from medication therapy.

In order to be effective, medication compliance is especially important. However, it has been estimated that
70 percent of patients fail to take 25 to 50 percent of their medication, which is predictive of poor outcome.

When being prescribed antidepressant medication, it is also important to communicate with the doctor any
other medications the individual may be taking; some antidepressants may react negatively when used in
combination with other medications.

Psychotherapy is often used in combination with medication therapy and usually takes the form of
interpersonal therapy, behavior therapy, and/or cognitive therapy. Significant and continuing life events,
altered life roles, lack of social support, and chronic medical illnesses may require psychosocial support and
new coping skills.

Electro-convulsive Therapy (ECT) has an important role in the treatment of Depression in elderly adults.
ECT is often stated to be safer than antidepressants in the elderly. However, advancing age may heighten
the probability of post-ECT confusion, especially in the very old.
Suggested Readings






Learning to Cope with Depression & Manic Depression by Copeland, Mary Ellen
Everything You Need to Know About Prozac by Jonas, Jeffrey & Schaumburg, Rod
The Depression Workbook by Copeland, Mary Ellen
Overcoming Depression by Papolos, Demitri & Janice
Suicide by Durkheim, Emile
Understanding Depression by Klein, Donald & Wender, M.D., Paul
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
14
Postpartum Depression (PDD)
●
It is estimated that 10 to 28 percent of new mothers are affected by Postpartum Depression.
●
There are two kinds of Postpartum: Postpartum blues or “baby blues,” affects approximately 50 to 80
percent of new mothers; and Postpartum Depression, affects 10 to 16 percent of women, and 26 percent of
adolescent mothers.
●
It begins 3 to 4 days after delivery and tends to resolve by day 12. If symptoms last longer than 2 weeks, the
individual should seek medical attention.
●
Babies are less likely to receive proper care when PPD is not treated.
●
Up to 30 percent of women who have experienced a major depressive episode prior to conception will
develop PPD.
●
There are safe and effective treatments for PPD.
Symptoms
●
●
●
●
●
●
●
Inability to sleep
Feelings of sadness
Exhaustion
Uncontrollable crying
Thoughts of death or suicide
Changes in appetite
Thoughts of harming the baby
or yourself
●
●
●
Feelings of guilt
May become forgetful
Worries about your ability to be a
good mother
● Difficulty completing simple tasks
● Worries about baby’s health
● Poor concentration
Causes
●
Contributing factors may be physiological, sociological, psychological, and genetic.
●
Hormonal factors play a major role in influencing central nervous functioning.
●
Instability in your marriage or relationship.
15
●
A history of Depression or Bipolar Disorder in blood relatives.
●
Poor social support.
●
Unpleasant life events happening around the time of the pregnancy or birth.
Treatments
●
Additional emotional support or extra help caring for the newborn.
●
Psychotherapy, counseling, and support groups could make a significant difference in the well-being of the
mother, the child, and the family.
●
Awareness of the impact of these disorders is only the beginning and attention needs to be directed toward
prevention.
Other Resources
Medscape Mental Health, http://psychiatry.medscape.com
Postpartum Support International, (631) 422-2255 or www.postpartum.net/
Depression after Delivery, (800) 944-4773 or www.depressionafterdelivery.com
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
16
Real Men. Real Depression.
Men and Depression
Depression is a serious but treatable medical condition that can strike anyone regardless of age, ethnic
background, socioeconomic status, or gender. However, Depression may go unrecognized by those
who have it, their families and friends, and even their physicians. Men, in particular, may be unlikely
to admit to depressive symptoms and seek help. But Depression in men is not uncommon: in the
United States every year, depressive illnesses affect an estimated 7 percent of men (more than six
million men).
Depression comes in different forms, just as is the case with other illnesses such as Heart Disease. The
three main depressive disorders are: Major Depressive Disorder, Dysthymic Disorder, and Bipolar
Disorder (Manic-Depressive Illness). Not everyone with a depressive disorder experiences every
symptom. The number and severity of symptoms may vary among individuals and also over time.
Symptoms











Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed,
including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Trouble sleeping, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide, or suicide attempts
Restlessness, irritability
Persistent physical symptoms, such as headaches, digestive disorders, and
chronic pain, which do not respond to routine treatment
Research and clinical findings reveal that while both men and women can develop the standard
symptoms of Depression, they often experience Depression differently and may have different ways of
coping. Men may be more willing to report fatigue, irritability, loss of interest in work or hobbies, and
sleep disturbances rather than feelings of sadness, worthlessness, and excessive guilt. Some researchers
question whether the standard definition of Depression and the diagnostic tests based on it adequately
capture the condition as it occurs in men.
Men are more likely than women to report alcohol and drug abuse or dependence in their lifetime;
however, there is debate among researchers as to whether substance use is a "symptom" of underlying
Depression in men, or a co-occurring condition that more commonly develops in men. Nevertheless,
Substance Abuse can mask Depression, making it harder to recognize Depression as a separate illness
that needs treatment.
17
Instead of acknowledging their feelings, asking for help, or seeking appropriate treatment, men may
turn to alcohol or street drugs when they are depressed or become frustrated, discouraged, angry,
irritable, and sometimes violently abusive. Some men may deal with Depression by throwing
themselves compulsively into their work, attempting to hide their Depression from themselves, family,
and friends; other men may respond to Depression by engaging in reckless behavior, taking risks, and
putting themselves in harm's way. Four times as many men as women die by suicide in the United
States, even though women make more suicide attempts during their lives. In light of research
indicating that suicide is often associated with Depression, the alarming suicide rate among men may
reflect the fact that men are less likely to seek treatment for Depression. Many men with Depression do
not obtain adequate diagnosis and treatment, which may be life saving.
More research is needed to understand all aspects of Depression in men, including how men respond to
stress and feelings associated with Depression, how to make them more comfortable acknowledging
these feelings and getting the help they need, and how to train physicians to better recognize and treat
Depression in men. Family members, friends, and employee assistance professionals in the workplace
also can play important roles in recognizing depressive symptoms in men and helping them get
treatment.
Seek Help for Depression
If you are having symptoms of Depression or know someone who is, seek help. There are several
places in most communities where people with Depressive Disorders can be diagnosed and treated.
Help is available from family doctors, mental health specialists in mental health clinics or private
clinics, and from other health professionals.
A variety of treatments, including medications and short-term psychotherapies (i.e., "talking"
therapies), have proven effective for Depressive Disorders. More than 80 percent of people with a
Depressive Illness improve with appropriate treatment. Not only can treatment lessen the severity of
Depression, but it may also reduce the duration of the episode and may help prevent additional bouts of
Depression.
For More Information
National Institute of Mental Health
Public Inquiries
6001 Executive Boulevard
Room 8184, MSC 9663, Bethesda, MD 20892-9663
Toll-Free: 1-866-227-NIMH (6464) FAX: 1-301-443-4279
TTY: 1-301-443-8431
E-mail: [email protected]
Web site: http://www.nimh.nih.gov
NIH Publication No. 03-5297 Printed March 2003
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
18
Seasonal Affective Disorder (SAD)

Approximately 6 percent or 10 million Americans are estimated to suffer from SAD.

SAD is equally prevalent among ethnic groups. Persons diagnosed with SAD typically have a family
history of Depression or SAD.

SAD is a cyclical illness, characterized by depressed periods in fall and winter beginning in October/
November and subsiding in March/April, which alternate with less depressed, non-depressed or even
elevated moods in spring and summer.

About 60 to 90 percent of persons who report symptoms of SAD are women ages 20-40. Four times as
many women than men suffer from SAD.

Most children affected by SAD have a parent or a first degree relative with SAD or another psychiatric
condition.

Seasonal factors such as allergies, psychosocial stressors (holiday depression), and work-related stressors
must be ruled out before SAD can be diagnosed.
Symptoms
Adults:
Children:








●
●
●
●
●
●
●
Decreased energy in the fall and winter
Tiredness and fatigue
Appetite changes (usually increased appetite)
Weight gain
Carbohydrate craving
Difficulty concentrating and getting tasks accomplished
Sadness or anxiety
Withdrawal from family and friends
Anxiety, school avoidance
Change in school performance
Tiredness and fatigue
Irritability
Temper tantrums
Vague physical complaints
Increased craving for junk food
(carbohydrate craving)
Causes

Researchers have targeted specific hormones and neurotransmitters that vary with daily as well as seasonal
patterns of sunlight.

SAD is caused by a response to changes in environmental light. It also may be triggered by a stressful event
or stressful environment.
19
Treatments

Consult your physician or a mental health professional for diagnosis and treatment.

Light therapy is a common form of treatment for SAD patients which usually involves exposing patients to
levels of artificial light 5 to 20 times brighter than ordinary indoor lighting. Studies show that anywhere
from 30 minutes to a few hours of light therapy in the morning, per day, relieves symptoms within days to 2
weeks in about 75 percent of SAD sufferers.

Light entering via the eye is thought to modify brain chemistry and physiology to correct the abnormalities
resulting from light deficiency in vulnerable individuals.

Alterations in lifestyles include the following: indoor lighting environment, exposure to natural sun light,
winter vacations, stress management, exercise, and dietary approaches are helpful in relieving the symptoms
of SAD.

Medications, psychotherapy, or a combination of both are also helpful in relieving the symptoms of SAD.
These forms of treatment are sometimes used as a supplement to light therapy.
Side Effects of Light Therapy





●
●
●
●
Irritability
Headaches
Insomnia
Dry eyes
Eye strain
Hypermanic symptoms
Fatigue
Dry nasal passages/sinuses
Sunburn-type reactions
Typically, persons receiving light therapy do not experience all of these side effects. Long-term adverse effects
have not been reported yet.
Suggested Readings






Do You Have a Depressive Illness? by Klein, Donald & Wender, M.D., Paul
Goodbye, Blues by Green, Bernard
Overcoming Depression by Papolos, Dimitri & Janice
The Good News About Depression by Gold, M.D., Mark
Understanding Depression by Klein, Donald & Wender, M.D., Paul
You Mean I Don’t Have to Feel This Way? by Dowling, Colette
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
20
Women and Depression

Twice as many women as men are affected by Depression.

Research indicates that 40 percent of women having a depressive disorder have also experienced an episode
during the postpartum period.

Approximately 20 to 80 percent of women report mild to minimal premenstrual mood or physical changes.

One study reported that 50 percent of infertile women exhibited some symptoms of Depression, with 40
percent demonstrating mild to moderate symptoms, and 7 percent severe symptoms.

It has been suggested that female social roles produce a variety of maladaptive styles of defining and coping
with life stresses. These styles increase the risk of developing or maintaining a depressive syndrome in
response to stress.
Symptoms





Persistent sad or “empty” mood
Decreased energy
Thoughts of death or suicide
Loss of interest in ordinary activities
Excessive crying
●
●
●
●
Changes in appetite, weight, or sleep patterns
Feelings of hopelessness, loss, or guilt
Difficulty thinking or remembering
Irritability
Causes


Depressive Illnesses are biological brain diseases that appear to be genetically-based and tend to run in
families.
Depression is a disorder of mood caused by a chemical imbalance in the frontal lobe of the brain.
Treatments



A full physical examination, intake of family history, and psychological evaluation should be completed by
a mental health professional or family physician before any treatment takes place.
Medications, such as Prozac, Zoloft, Norpramine, Pamelor, and others, are the primary choice of treatment
and most effective as well.
Psychotherapy is often used in combination with medication therapy and usually takes the form of
interpersonal therapy, behavior therapy, and/or cognitive therapy.
Approximately 80 percent of those who seek treatment for a depressive illness are helped within a matter of
weeks.
21
Risk Factors Specific to Women

Reproductive-related events, such as menstruation, pregnancy, childbirth, infertility, abortion, and
menopause, are unique experiences for women that have been hypothesized to be related to women’s
depression. These events can create added stress that may trigger the onset of depression.

Personality traits and other psychological factors may relate to gender differences in depression.
- Women are more likely to explain negative events as being caused by stable and internal factors. This is
often a result of women perceiving they have less control over their lives than their male counterparts.
- Feminine personality traits such as dependency, obsessionality, low self-esteem, and narcissism are
proposed to be predispositions to clinical depression.
- Women are viewed as having less ability to master a task (a “masculine” trait); women are more likely to
be viewed by others as being less skillful than men regardless of women’s actions and skill levels.
- Higher levels of stress from spousal abuse, social isolation, financial difficulties, and health problems also
contribute to depression in women.

Interpersonal roles and status may contribute to depression in women.
- Role obligations to care for, support, and show affection for others as a wife, mother, neighbor, and friend
can heighten women’s risk for stress and depression.
- Women have been found to be more vulnerable than men to stress-related problems in marriages, child
rearing, and caring for aging parents.

Other factors that affect Depression in women are victimization and poverty.
- Childhood sexual or physical abuse, marital or acquaintance rape, battery, sexual harassment in the
workplace, or sexual abuse by a therapist or health care provider are factors that contribute to depression.
- Compared to men, women disproportionately have less education, lower income, lower socioeconomic
status, and are more often unemployed. Each of these has been found to be related to depressive
symptomology.
Suggested Readings



Learning to Cope with Depression & Manic Depression by Copeland, Mary Ellen
Everything You Need to Know About Prozac by Jonas, Jeffrey & Schaumburg, Rod
The Depression Workbook by Copeland, Mary Ellen
Video
 Women and Depression by McGrath, et al
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
22
Anxiety Disorders

Anxiety Disorders are the most prevalent mental illnesses. A total of 13.3 percent or 19.1 million people
will experience an Anxiety Disorder in their lifetime. As many as 3 to 5 percent of children suffer from
these disorders.

Anxiety is an unpleasant state of mental tension accompanied by physical symptoms. Anxiety is usually an
ill-defined, irrational, distant, or unrecognized source of danger.
Symptoms





Shakiness
Jumpiness
Muscle aches
Trembling
Tension
●
●
●
●
●
Fatigue
Inability to relax
Feel on edge
Feel impatient
Feel irritable
●
●
●
●
High heart rate
Upset stomach
Worry
Fear a bad thing will happen
Causes

Anxiety Disorders appear to have a biological, genetic link. These disorders tend to run in families.

Some researchers believe Anxiety Disorders are caused by an increase in the adrenaline system.

Another possible cause of anxiety disorders is an abnormality in the part of the brain stem that controls
alertness.

Abnormalities in other parts of the brain have been suggested as the cause of Anxiety Disorders. However,
no definite area in the brain has been proven to cause the disorders.
Treatments

Medications can be effective in treating Anxiety Disorders. Some medications that are used are
Benzodiazepines (relaxants), such as Valium or Xanax. These medications relieve anxiety, relax muscles,
and induce sleep. Anti-depressants are also used to relieve the symptoms of Anxiety Disorders; however, it
usually takes 6 to 7 weeks for the medication to be effective. Note: these are not addictive in small doses.

Options in treating Anxiety Disorders are behavioral therapy, cognitive therapy, and relaxation techniques.

An important way to reduce problems with anxiety is to reduce caffeine intake.
23
Types of Anxiety Disorders
There are a variety of types of Anxiety Disorders, the most common types of disorders are the following:

Generalized Anxiety Disorder – The symptoms of anxiety last for 6 months or longer. It affects 2.8 percent
or 4 million people.

Panic Disorders – 3 percent of the population suffer from this disorder. A person with this disorder will
experience intense attacks of anxiety, called a panic attack, which lasts for 5 to 30 minutes. The person may
feel like he/she is having a heart attack; symptoms include choking, numbness, chest pain, fear he/she is
dying, or doing something uncontrollable. For a diagnosis to be made, a person must have four attacks in a
month or experience four weeks of fear of having another one.

Obsessive-Compulsive Disorder – 2.3 percent or 3.3 million of the population will be diagnosed with this
disorder. Obsessive-Compulsive Disorder has two components: (1) obsessive thoughts and (2) compulsive
behaviors. Obsessive thoughts are repeated, unwanted ideas or thoughts. For example, a person may have
thoughts of harming another person. The person attempts to ignore or suppress such thoughts, but can not.
Compulsions are repeated. Senseless behaviors are performed in response to obsessions or according to
certain rules. For example, a person may wash his/her hands repeatedly. This behavior is meant to prevent
or neutralize anxiety.
●
Posttraumatic Stress Disorder – 3.6 percent or 5.2 million of the population will be diagnosed with this
disorder. A person with this disorder will experience a brief state of anxiety or depression after an
occurrence such as rape, war, hostage, natural disaster, abuse, or a serious accident. Symptoms usually
appear within 3 months or longer.
Suggested Readings






The Anxiety and Phobia Workbook by Bourn, Edmund
Mending Minds by Heston, Leonard
Triumph Over Fear by Ross, Jerilyn
Obsessive Compulsive Disorder: A Guide by University of Wisconsin
Obsessive Compulsive Disorders by Levenkron, Steven
The Boy Who Couldn’t Stop Washing by Rapoport, Judith
Other Resources
The Anxiety Panic Internet Resource: www.algy.com/anxiety/index.shtml
Anxiety Disorders Association of America: www.adaa.org
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
24
Obsessive Compulsive Disorder (OCD)

OBSESSIONS – A persistent, irrational thought that repeatedly goes through a person’s mind. For
example, a person may think anything they touch will be contaminated and will contaminate other people.

COMPULSIONS – Repetitive, intentional acts performed in a certain way. The act is done to prevent
discomfort, but is usually not realistically connected to what it is supposed to prevent or is done very
excessively. For example, a person may wash his/her hands repeatedly in a very specific manner to rid them
of germs.

People with OCD may have either obsessions, compulsions, or may have both components of the disorder.
For a diagnosis of OCD, the obsession or compulsion must cause the person distress, be time consuming, or
interfere with everyday life. Usually, the person suffering from OCD knows that his/her behavior is bizarre
and will go to lengths to hide their behavior from others.

OCD symptoms usually begin during childhood or adolescence. However, OCD can occur at any age.
Symptoms
●
●
●
Repeated thoughts about contamination
Need to have things in a particular order
Concern about current ongoing difficulties
●
●
Repeated doubts
Aggressive or horrific impulses
Cause

The cause of OCD is unclear at this time. Scientific studies suggest that OCD is a biologically-based
illness. It appears that OCD results from a chemical imbalance in the brain. Research has found a genetic
link for OCD. Specifically, if you have OCD there is a 25 percent chance that one of your immediate family
members will have it also. OCD is not caused by poor parenting or an individual weakness in the person
with OCD.
Treatments

OCD will continue for years if left untreated. The symptoms may become less severe at times, but generally
OCD is a chronic illness.

The best treatment for OCD is the use of medication and therapy. Medications that regulate serotonin, a
neurotransmitter in the brain, reduce obsessive thoughts and compulsive behaviors. However, medication is
not completely effective for everyone with OCD. The style of therapy commonly used when treating OCD
is behavioral therapy. In this type of therapy a person is exposed to a feared object or thought, and then
discouraged from carrying out the usual compulsive response. The most effective way to treat OCD is to
use both medication and therapy.
25
Medications commonly used in treating OCD:

Clomipramine (Anafranil) is usually the first choice of medication.

Fluoxetine (Prozac).

The medications may take up to ten weeks to take effect.

If the OCD medication is not working, other medications such as Lithium, Fenfluramine, Buspirone, and
other antipsychotic medications may be beneficial.

Between 50 and 80 percent of patients with OCD improve with OCD medication; however, they still may
have some obsessional and compulsive behaviors that remain.
Suggested Readings





●
●
The Boy Who Couldn’t Stop Washing by Rapoport, Judith
Stop Obsessing! How to Overcome Your Obsessions and Compulsions by Foa, Edina G. and Wilson, Reid
Getting Control: Overcoming Your Obsessions and Compulsions by Baer, Lee
Over and Over Again, Understanding Obsessive-Compulsive Disorder by Neziroglu, Fugen and YaryuraTobias, Jose A.
Obsessive-Compulsive Disorder: A Guide by Anxiety Disorders Center by Madison WI: University of
Wisconsin (Copies available in Nancee Blum’s office, call 319-353-6180)
Brain Lock by Schwartz, Regan. Harper Collins
…Nine, Ten, Do It Again, A Guide to OCD: For People with OCD and Their Families by I’Anson, Kathryn
Other Resources
OC Foundation, PO Box 70, Milford CT 06460. The OC Foundation publishes an excellent newsletter and has
information about support groups. They also publish a newsletter for support group leaders.
www.ocfoundation.org
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
26
Posttraumatic Stress Disorder (PTSD)
●
PTSD usually appears within three months of the traumatic experience, but in some circumstances can
surface months or even years later.
●
PTSD can occur at any age, from childhood to old age, and traumatic stress can be cumulative over a
lifetime.
●
As many as 70 percent of adults in the United States have experienced at least one major trauma in their
lives, and many of them have suffered from the emotional reactions that are called PTSD.
●
Those diagnosed with PTSD experience these symptoms for longer than one month and are unable to
function as they did before the event.
Symptoms
Re-experience
Nightmares
Flashbacks
Hallucinations
Other vivid feelings of the event happening again
Exaggerated emotional and physical reactions to triggers that remind them of the event
●
●
●
●
●
Avoidance
Avoid thoughts, feelings, or conversations associated with the incident
Loss of interest
Feeling of detachment from others
Limited range of emotion
Feelings of hopelessness about the future
●
●
●
●
●
Increased arousal
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Becoming very alert or watchful
Jumpiness or being easily startled
●
●
●
●
●
Cause
●
Posttraumatic Stress Disorder (PTSD) is an Anxiety Disorder that can occur following exposure to a
traumatic event that caused intense fear, helplessness, or horror.
27
Treatments
A variety of methods are used in the treatment of this disorder, and it is important to recognize that each
individual will respond differently. In many cases, PTSD can be treated effectively with psychotherapy and/or
medication.
● Behavior therapy focuses on the development of relaxation and coping techniques.
● Cognitive therapy is designed to help an individual examine his/her thought patterns and learn to combat
negative and nonproductive thinking.
● Group therapy allows them to interact with others in similar situations and learn that their fears and feelings
are not uncommon.
Medication is often used as an adjunct to psychotherapy. Antidepressant and anti-anxiety drugs can be helpful in
reducing symptoms of PTSD such as sleep problems (insomnia, nightmares), depression, and edginess.
How common is PTSD?
●
About 5.2 million Americans ages 18 to 54 are diagnosed with PTSD.
●
Increased incidences of the disorder have also been found among inner-city youths and those recently
emigrated from troubled countries. Additionally, women seem to get PTSD more frequently than men.
●
Veterans are perhaps the community most associated with PTSD, or what was once referred to as "shell
shock" or "battle fatigue."
●
It is important to note that those with PTSD often use alcohol or other drugs in an attempt to self-medicate;
individuals with this disorder may also be at an increased risk for suicide.
Where can I find more Information about PTSD?
Excellent, general information about PTSD can be found through:
● Anxiety Disorders Association of America, Inc
11900 Parklawn Drive Suite 100, Rockville MD 20852-2624
Phone: (301) 231-9350, Web site: www.adaa.org
● National Organization for Victim Assistance
1757 Park Road NW, Washington DC 20010
Phone: (202) 232-6682, Web site: www.try-nova.org
Information specifically for veterans, such as the location of area clinics and programs, can be found through:
● Department of Veterans Affairs
Washington DC 20011
Phone: (800) 827-1000, Web site: www.va.gov
Reviewed by Al Fontana, Ph.D., Project Director, PTSD, VA-Northeast Program Evaluation Center
and Paul Errera, M.D., Associate Director, VA-NEPEC
Posttraumatic Stress Disorder Sourcebook by Glenn R. Schiraldi
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
28
Anxiety Disorders in
Children and Adolescents

Anxiety Disorders are the most prevalent mental illness in America. As many as one in ten children and
adolescents are affected.

Anxiety Disorders cause people to feel excessively frightened, distressed, and uneasy during situations in
which most others would not experience these symptoms. The reason for anxiety is usually from an illdefined, irrational, distant, or unrecognized source of danger.

Anxiety Disorders in children can lead to poor school attendance, low self-esteem, deficient interpersonal
skills, alcohol abuse, and adjustment difficulty.
Symptoms







Feel shaky
Jumpiness
Muscle aches
Trembling
Tension
High heart rate
Worry
●
●
●
●
●
●
●
Fatigue
Twitching
Impatient
Irritable
Upset stomach
Fear a bad thing will happen
Difficulty concentrating
Causes

Studies suggest that Anxiety Disorders tend to have both a biological and an environmental link. It has not
been established; however, which plays the greater role in the development of these disorders.

Abnormalities in parts of the brain have been suggested as a cause of Anxiety Disorders; although, no
definite area in the brain has been proven to cause the disorders.

Scientists at the National Institute of Mental Health and elsewhere have recently found that some cases of
OCD occur following infection or exposure to streptococcus bacteria. Further research is being done in this
area in order to pinpoint who is at greatest risk.
Treatments

Medication is an effective treatment for Anxiety Disorders. Medications serve the purpose of reducing
anxiety, relaxing muscles, and inducing sleep. It may take up to six or seven weeks before the medication
shows its effectiveness.

Psychotherapy, in the form of behavior therapy or cognitive-behavioral therapy, is an equally important and
effective form of treatment for Anxiety Disorders. Cognitive-behavioral therapy involves teaching a young
person to modify the way he/she thinks and behaves by practicing new behaviors. This enables the child to
better deal with his/her fears.
29

Parents and caregivers should learn to be understanding and patient when dealing with children with
Anxiety Disorders.
The most common types of Anxiety Disorders.
Generalized Anxiety Disorder (GAD):
GAD is characterized by chronic, exaggerated worry about everyday, routine life events and activities
that lasts at least six months. Usually the worst is anticipated and often there are complaints of
fatigue, tension, headaches, and nausea.
Obsessive Compulsive Disorder (OCD):
OCD is characterized by repeated, intrusive, and unwanted thoughts (obsessions) and/or rituals
that seem impossible to control (compulsions). Younger children are not as aware that their symptoms
are excessive. They instead may only feel distressed when they are prevented from carrying out their
compulsive habits. Adolescents may be aware that their symptoms do not make sense and are excessive.
Compulsive behaviors often include counting, arranging and rearranging objects, and excessive hand
washing.
Posttraumatic Stress Disorder (PTSD):
PTSD is characterized by nightmares; flashbacks; numbing of emotions; depression; feeling angry,
irritable and distracted; and being easily startled. Symptoms of this disorder may occur after
experiencing a trauma such as abuse, natural disasters, or extreme violence.
Suggested Readings





Mending Minds by Heston, Leonard
Triumph Over Fear by Ross, Jerilyn
Obsessive Compulsive Disorder: A Guide by University of Wisconsin
Obsessive Compulsive Disorders by Levenkron, Steven
The Boy Who Couldn’t Stop Washing by Rapoport, Judith
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
30
Asperger Syndrome (AS)

AS is different than Autism in that a child with AS does not experience a significant delay in
cognitive development or in the development of language skills. In addition, a child with AS can be
quite imaginative; whereas, children with Autism tend to be concrete thinkers.

It appears that boys are more likely to have AS than girls.

AS typically presents between ages two and six, but is often not recognized until later.
Symptoms
●
●
●
●
●
●
A very rigid adherence to specific
non-functional routines or rituals
(i.e., walks a certain route to school)
Lack of facial expressiveness
Lack of eye contact when being
spoken to
Self-directed orientation
Intense preoccupation with certain
specific (often unusual) topics
Lack of understanding of social cues
●
●
●
●
●
Preoccupation with certain
actions or objects with a
restricted range (i.e.,
interests of a narrow scope)
Lack of the use of normal
body posturing and gestures
Awkwardness in social
situations
Clumsiness caused by lack of
motor coordination
Failure to develop peer
relationships
Causes

The cause of AS is presently unclear, but it appears to have a somewhat later onset than Autism.

Motor delays or motor clumsiness may be seen in the preschool period.
Treatments

Medication may be helpful depending on the presence and extent of symptoms. For example, symptoms
such as hyperactivity, impulsivity, mood instability, temper outbursts, anxiety, depression, and obsessivecompulsive symptoms may be treated effectively with medication.
31

Psychotherapy in the form of group therapy led by a mental health professional may be helpful in treating
the social skills deficits associated with AS.

Educational interventions and accommodations should be closely coordinated between the parents and
school personnel.
Summary
Early intervention and treatment is the single most important effort a parent can make to influence the outcomes
for a child or adolescent with AS. Finding a clinician who can make the diagnosis of AS may be a significant
hurdle in getting appropriate treatment for your child.
Suggested Readings
●
●
●
Autism and AS by Frith, Uta
Asperger’s Syndrome: A Guide for Parents and Professionals by Attwood, Tony & Wing, Lorna
One Small Starfish: A Mother’s Everyday Advice, Survival Tactics & Wisdom for Raising a Special
Needs Child by Addison, Anne
For more information
Visit: www.aspergers.com
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
32
Attention Deficit Hyperactivity
Disorder (ADHD)

ADHD is estimated to affect 5 to15 percent of school-age children and often continues into adolescence and
adulthood. Two to three times more boys than girls are affected.

ADHD often co-occurs with other disorders such as the following: learning disabilities, oppositional defiant
disorder, conduct disorder, anxiety or mood disorders, language and communication disorders, and
Tourette’s disorder.

Fully one-third of those diagnosed with ADHD are later diagnosed with Depression or Bipolar Disorder.

A child must have at least six of these symptoms, lasting at least six months, with some symptoms having
started before age seven. These behaviors must also significantly interfere with at least two areas of life,
such as school and home.
Symptoms







Fidgets with hands or feet
Squirms in seat or feels restless
Has difficulty remaining seated when
required to do so
Easily distracted
Difficulty awaiting turn in games or group
situations
Blurts out answers to questions before they
have been completed
Difficulty following through on instructions
from others
●
●
●
●
●
Shifts from one uncompleted activity to another
Difficulty playing quietly
Talks excessively
Interrupts or intrudes on others
Does not seem to listen to what is being said to
him/her
● Loses things necessary for tasks or activities
● Engages in physically dangerous activities
without considering possible consequences
● Difficulty sustaining attention in tasks or play
activities
Causes

ADHD is a biological disorder that appears to be genetically or developmentally based.

The symptoms of Attention Deficit Hyperactivity Disorder (ADHD) frequently begin at birth, as seen in
feeding or sleeping problems.

Researchers believe that there may be either a chemical or electrical problem in the brain caused by
abnormalities in the development of the brain or genetic differences. For example, it appears that a lower
level of activity in some parts of the brain may cause inattention.

Environmental factors such as viruses, harmful chemicals, alcohol, drugs, and tobacco during pregnancy are
also considered as possible causes of ADHD. These factors may affect normal brain development, which
lead to the development of symptoms associated with ADHD.
33
Treatments

If ADHD is suspected, an assessment or evaluation may initially be done by a school psychologist, family
physician, or pediatrician. This individual may then refer a family to a specialist, such as a psychiatrist
and/or psychologist.

Medications such as Ritalin, Cylert, Dexedrine, Strattera, and Adderall are commonly used for treatment.
These stimulants increase activity in the parts of the brain that are underactive in youth with ADHD.
Approximately two-thirds of children with ADHD will respond to one of these medications.

Behavioral therapy in combination with medication has also been shown to be effective in treating ADHD.
This approach often involves strategies such as rewarding positive behavior changes and communicating
clear and consistent expectations. It is important to initiate a consistent behavior management program in
all areas of life (i.e., school and home).

It may be necessary and beneficial to provide a child with ADHD with special accommodations at school
that help him/her to succeed. For example, a teacher may seat the child in an area with few distractions or
may allow the child extra time on tests. If accommodations in a regular education classroom are not
effective, a special education classroom should be made available.

Educating parents and children is very valuable, as well as, in helping to manage this disorder.
Suggested Readings






Survival Strategies for Parenting Your ADD Child by Lynn, G. T.
The Hyperactive Child, Adolescent, and Adult: ADD thru the Lifespan by Wenderg, Paul H.
Maybe You Know My Kid: A Parent‘s Guide to Identifying, Understanding, and Helping your Child with
ADHD by Fowler, M.
Shelly the Hyperactive Turtle by Moss D. (ages 3-7)
Learning to Slow Down and Pay Attention by Nadeau, K., & Dixon, E. (ages 6-12)
The “Putting on the Brakes” Activity Book for Young People with ADHD by Quinn, M.D., Patricia O. &
Stern, M.A., Judith (ages 8-12)
Other Resources:

Children and Adults with Attention Deficit Disorders (CHADD), 8181 Professional Place, Suite 150,
Landover MD 20785, (800) 233-4050. To find the local Chapter near you go to
http://www.chadd.org/findchap2.cfm?cat_id=36&state=ia CHADD is a nonprofit parent-based
organization that provides family support, education, and advocacy.

Attention Deficit Information Network (Ad-IN), 58 Prince Street, Needham MA 02492, (781) 458-9895 or
www.addinfonetwork.com
Source: NIMH website, http://www.nimh.nih.gov/publicat/adhd.htm
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
34
Autism
●
Autism occurs in approximately 4.5 out of 10,000 live births. Approximately 15 to 20 out of 10,000
children have autistic-like behaviors.
●
As with many other developmental disabilities, Autism is more prevalent in males than females.
●
Autism can manifest itself very differently in different individuals. Some individuals may be antisocial,
some asocial, and others social. Likewise, some may be aggressive toward themselves and/or aggressive
toward others. Some individuals may have little or no language, some repeat or echo words or phrases, and
others may have normal language skills.
●
Many individuals with Autism have an impairment in one or more of their senses. This impairment may
cause their senses to be hypersensitive, hyposensitive, or may result in the person experiencing interference,
such as a continual ringing or buzzing in the ears. This affects their ability to process incoming sensory
information properly.
●
According to the Diagnostic and Statistical Manual for Mental Disorders-IV, at least six of these symptoms
must be present with onset prior to age three in order to be diagnosed with Autism. In addition, there also
need to be delays in either social interaction, social communication, or symbolic or imaginative play.
Symptoms
Social Interaction:
●
●
Marked impairment in the use of multiple
nonverbal behaviors
Lack of spontaneous seeking to share
interests and achievements with others
●
●
Failure to develop age-appropriate peer
relationships
Lack of emotional reciprocity
●
●
Marked impairment in conversational skill
Stereotyped and repetitive use of language
●
Inflexible adherence to nonfunctional
routines or rituals
Preoccupation with parts of objects
Communication:
●
●
Delay in or lack of spoken language development
Lack of spontaneous age-appropriate makebelieve or social imaginative play
Stereotyped patterns of behavior:
●
●
Preoccupation with at least one stereo-typed
and restricted pattern of interest to an
abnormal degree
Stereotyped and repetitive motor mannerisms
●
35
Causes

Some evidence suggests a genetic influence in Autism. Twin studies have shown a greater prevalence
among siblings who are identical twins than those who are fraternal twins.

Researchers have found abnormalities in the neural structure of the brain. For example, studies have shown
that areas of the limbic system and cerebellum are significantly underdeveloped and smaller in autistic
individuals. Studies have also shown abnormalities in brain chemistry. It appears that autistic individuals
have elevated levels of serotonin in their blood and cerebral spinal fluid compared to those without Autism.

Evidence also suggests that a virus can cause Autism. Exposure to viruses such as Rubella and
Cytolomegalo may increase the risk of Autism.

Toxins and pollution in the environment are suspected to lead to Autism, as well. There is no scientific
evidence; however, which indicates this.
Treatments

Some individuals are given medications to improve their general well-being. A medication that specifically
and consistently targets the symptoms of Autism has not been found. Ritalin, a stimulant, is the most widely
used medication to treat Autism.

Behavior modification, such as positive reinforcement and time-out, has been shown to be effective in
increasing appropriate behaviors and decreasing inappropriate behaviors. Communication skills and social
behavior are primarily targeted to be increased, while self-injurious behaviors are targeted to be decreased.

The use of Vitamin B6 with Magnesium supplements has also been shown to increase general well-being,
awareness, and attention in about 45 percent of children with Autism.

Other areas of treatment that have received attention include sensory integration training, auditory
integration training, visual training, and changing the individual’s diet in order to eliminate particular foods.
Suggested Readings
●
●
Nobody Nowhere by Williams, Donna
Thinking in Pictures by Gandin, Temple
Source: Center for the Study of Autism website, http://www.autism.org
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
36
Bipolar Disorder in
Children and Adolescents

Bipolar Disorder, also known as Manic-Depressive Illness, is a disorder of mood involving episodes of
Serious Mania and Serious Depression.

This disorder affects approximately 1 percent of the general population. Both men and women are equally
affected.

About one-third of depressed people are diagnosed as having Bipolar Disorder, but experts believe that
about one-half of all depressed people are actually Bipolar.

Bipolar Disorder usually starts in adult life, before the age of 35. Although rare in young children, it does
occur in teenagers.

A child who has one parent with Bipolar Disorder has a 17 percent chance of developing a depressive illness
at some point in his/her life. Approximately 10 percent will develop Depression, and about 7 percent will
develop Bipolar Disorder.
●
Severe and frequent manic symptoms have been correlated with increased psychosocial impairment among
children and adolescents. Manic symptoms not only interfere with daily activities, they also have long-term
consequences which may include interference with the mastery of developmental tasks such as regulating
emotions, acquiring competencies, and establishing and maintaining social relationships.
Bipolar Disorder Sub-Types (I and II):

In Bipolar I Disorder, persons experience one or more manic episodes or mixed episodes (symptoms of
mania and depression mixed together in one single episode) of Bipolar Disorder. Often these individuals
will also have had one or more major depressive episodes. Persons with this sub-type may have some free
intervals where he/she does not experience any symptoms.

Bipolar II Disorder is characterized by the occurrence of one or more major depressive episodes
accompanied by at least one hypomanic episode (mania without psychotic symptoms). Symptom-free
intervals may also exist in this sub-type of Bipolar Disorder.
Symptoms
Depression:
Mania:









●
●
●
●
●
●
●
●
●
Persistent sad or “empty” mood
Changes in appetite, weight, or sleep patterns
Decreased energy
Feelings of hopelessness, loss, or guilt
Thoughts of death or suicide
Difficulty thinking or remembering
Loss of interest in ordinary activities
Irritability
Excessive crying
Excessive “high” mood
Increased energy and activity
Decreased need for sleep
Unrealistic beliefs in one’s abilities and powers
Extreme irritability or distractibility
Uncharacteristically poor judgment
Racing thoughts
Obnoxious or provocative behavior
Drug and/or alcohol abuse
37
Causes

Bipolar Disorder is a biological brain disease that appears to be genetically-based and tends to run in
families.

Bipolar Disorder is a disorder of mood caused by a chemical imbalance in the frontal lobe of the brain.
During a manic episode, there is increased activity in the frontal lobe; during a depressive episode, there is
decreased activity in the frontal lobe of the brain.
Treatments

A full physical examination, intake of family history, and psychological evaluation should be completed by
a mental health professional or family physician before any treatment takes place.

Intervention should involve a biopsychosocial approach which incorporates both school intervention and
education of the child or adolescent and his/her family about the illness.

Medications, such as Lithium and Depakote, are usually very effective in controlling Mania, and preventing
the recurrence of both manic and depressive episodes, and are used for treating both adolescents and adults.
However, adolescents tend to alternate more quickly between depressive and manic episodes (i.e., rapid
cycling) than adults; this has been associated with poor response to Lithium. Antidepressant medications
may be used to supplement the treatment of depressive episodes.

Psychotherapy is often used in combination with medication therapy and usually takes the form of
interpersonal therapy, behavior therapy, and/or cognitive therapy. Psychotherapy helps the adolescent to
understand himself/herself, adapt to stresses, rebuild self-esteem, and improve relationships. Stressful life
events may act as precipitants for recurrent episodes and therefore need to be reduced.
Suggested Readings







Handbook of Lithium Therapy by Johnson, F. Neil
Helping the Depressed Person Get Treatment by NIMH
Learning to Cope with Depression & Manic Depression by Copeland, Mary Ellen
Lithium & Manic Depression: A Guide by Lithium Information Center/University of Wisconsin
Moodswing by Fieve, M.D., Ronald
Suicide: Why? by Wrobleski, Adina
Schizophrenia & Manic Depressive Disorder by Torrey, Bowler, Taylor, & Gottensman
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
38
Bullying
What is bullying?
Bullying is a physical or psychological intimidation or aggression that occurs repeatedly over time to a person,
typically weak and vulnerable, creating an ongoing pattern of harassment and abuse.










Bullying takes place two to three more times as often at school as compared to on the way to or from
school
At school, 40-75 percent takes place during breaks, such as at recess, in the bathrooms, in the corridors,
in the schoolyard
Boys are more likely to be engage in and be victims of bullying.
Girls are less likely to be physically intimidated and more apt to be belittled about their looks with
verbal abuse and gossip or to be ostracized or rejected
Girls are more likely to bully as a group
Bullying often leads to more violent behavior when the child grows up
One out of four elementary school bullies have criminal record by age 30; 60 percent of bullies in
grades 6 through 9, have a criminal record by age 24
One in three children is affected by bullying
Approximately 66 percent of students involved in school shootings report feeling persecuted, bullied, or
threatened by other students
Frequently bullied children are more likely to be depressed and suicidal
What are the warning signs?











Torn or damaged clothing
Loses things without a proper explanation
Does not bring friends home or rarely spends time with friends after school
Has unexplained bruises, injuries, cuts, and scratches
Chooses an “illogical” route home from school
Loses interest in school and grades decline
Seems unhappy, distressed, depressed, or has unexpected mood shifts with sudden outbursts of irritation
or anger
Often little appetite, headaches or stomachaches, especially before school
Sleeps restlessly with nightmares and possibly cries in his/her sleep
Takes or asks for money from family members
Seems fearful about attending school
What are the characteristics of a bully?
These are general characteristics. Use with caution.
 Have a more favorable view of violence than others
 Are aggressive, nasty, spiteful, and generally in opposition
 Have a marked need to dominate or control others
 Seem likely to insult, push around, or tease other children
 Often hot-tempered, impulsive and have low frustration tolerance
 Find it difficult to conform to rules
 Are good at talking themselves out of difficult situations
 Appear to be tough or show little sympathy towards those who are bullied
 Likely to engage in other anti-social behavior
39
What are the characteristics of the victim?
These are general characteristics. Use with caution.
Submissive or passive victim:
 Don’t do well in sports
 Is quiet, careful, sensitive, shy, cries easily
 Has poor self-esteem (negative self-image)
 Avoids fighting and is weaker than the bully, particularly boys
 Has few or no friends
 Relates better to adults than kids
Provocative victim:
 Is quick-tempered, may try to fight back if victimized
 Is often clumsy, restless, immature, unable to concentrate, and considered difficult
 May be hyperactive and have reading/writing problems
 May be disliked by adults because of irritating behavior
 May try to bully weaker and smaller students
Where does bullying take place?



Two to three times are bullied at school as compared to those who are bullied on the way to school
Approximately 40-75 percent take place during breaks – in the schoolyard, corridors, at recess,
bathrooms
On public playgrounds and sports and youth clubs
What can parents do if you suspect your child is being bullied?




Contact the school immediately
Talk to other parents
Have child keep a detailed record of incidents of harassment or bullying and how it is communicated to
the school
Talk to child about strategies about how to deal with the bully
What can parents do if your child is the bully?







Make it quite clear that you take bullying seriously and will not tolerate continuation of the behavior
Set up some consistent rules for family interactions; praise child when rules are followed, enforce a
negative consequence if rules are broken
Spend 15 minutes or more of quality time with your child every day; monitor and supervise activities;
know how their time is spent
Help child to use his or her energy and need to dominate in a more positive way
Maintain contact with school to see if behavior improves
If behavior doesn’t improve, get in touch with a mental health professional for more help
Be careful that you don’t encourage or model bullying with your own behavior and messages
What can a bystander/witness do?




Don’t join in; walk away and get help
Be a friend; listen to victim; let victim know you are there to talk
Report the incident to a teacher, counselor, or other adult
Let the bully know they’re wrong
What can be done to prevent bullying?







Create a safe climate and encourage all children to report bullying incidents
Set firm limits against unacceptable behavior
Use non-physical, non-hostile negative consequences if rules are broken
Be authoritative (not authoritarian) with children at home and in school
Initiate conversation about bullying and discuss; stress your strong disapproval
Encourage children to report incidents
Work with children to develop assertiveness and conflict resolution skills
40
Resources
Bullies & Victims: Helping Your Child Survive the Schoolyard Battlefield by Fried, Suellen and Paula
The Bullying Prevention Handbook: A Guide for Principals, Teachers, and Counselors by Hoover, John H. and
Oliver, Ronald
Keys to Dealing with Bullies by McNamara, Barry E. and Francine J.
Bullying at School: What We Know and What We Can Do (Understanding Children’s Worlds) by Olweus, Dan
Bullyproof: A Teacher’s Guide on Teasing and Bullying for Use with Fourth and Fifth Grade Students by Stein,
Nan; Sjostrom, Lisa; and Cappello, Dominic
Nobody Knew What to Do: A Story About Bullying by McCain, Becky Ray; Whitman, Albert & Company (ages
4-8).
The Hundred Dresses by Estes, Eleanor (ages 9-12)
Changing Perspectives: Paving the Path to Bully-Free Schools, Iowa Department of Education
Blueprints for the Violence Prevention: Book Nine by Olweus, Dan; and Limber, Sue; and Mahalic, Sharon
Websites:
www.bullying.org dedicated to letting victims of bullying tell their stories and allowing others to respond
www.greatschools.net/cgi-bin/showarticle/ia/215/?&page=1 What You Can Do to Stamp Out Bullying
www.stopbullyingnow.org provides information on bullying prevention
www.clemson.edu/olweus Olweus Bullying Prevention Program, a comprehensive, school-wide program
designed for use in elementary, middle, or junior high schools
www.cfchildren.org (Committee for Children) learn how you can promote the safety, well-being, and social and
academic development of children, including Steps to Respect: A Bully Prevention Program
www.mentalhealth.samhsa.gov/publications/allpubs/SVP-0051/ (15+ Make Time to Listen: Take Time to Talk
—about Bullying)
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
41
Childhood Schizophrenia

Schizophrenia is rare in children prior to the age of seven or eight. However, cases of Schizophrenia have
been seen in children as young as five years old.

If a child has a parent with Schizophrenia, he/she is considered to be at risk for developing the illness.
Research has found that the at-risk children who develop Schizophrenia show increased incidence of early
neurosensory, neuromotor, and attention deficits.

Many times the symptoms of Schizophrenia will be viewed as symptoms of Autism in children. For this
reason, some children with Schizophrenia will be incorrectly diagnosed as Autistic.

A child with the diagnosis of Autism may actually have Schizophrenia if the child has well developed
speech, normal or borderline IQ, and shows symptoms of Schizophrenia.

Schizophrenia is not a form of Mental Retardation. Mental Retardation is a developmental disability present
from birth that affects one’s intellectual capacity. On the other hand, Schizophrenia is a mental illness
typically having its onset in adolescence or early adulthood.

Schizophrenia is a disease of the brain which affects a person’s ability to think, feel, and relate to the
environment.
●
Schizophrenia affects 1 percent of the general population. It is twice as common as Alzheimer’s disease,
five times more common than Multiple Sclerosis, and sixty times more common than Muscular Dystrophy.

Schizophrenia is not caused by bad parenting or a personal weakness. Rather, it is a biological illness of the
brain.

For a diagnosis of Schizophrenia to be made, individuals must have two or more positive symptoms, or a
combination of one positive symptom and one or more negative symptoms for at least one month. Social or
occupational dysfunction needs to be present. Signs of the illness must persist for at least six months.
During this time some symptoms may subside; however, positive symptoms may be exhibited in a less
severe form.
Symptoms
Symptoms Commonly Seen in Children





●
●
●
Inappropriate giggling
Incongruity of affect
Blunting of affect
Perplexity
Rages
●
Self-directed aggression
Ambivalence
Delusions and hallucinations (less elaborate than
adults’)
Visual hallucinations
General Symptoms of Schizophrenia
Negative symptoms
Positive Symptoms




●
●
●
●
Lack of fluency of speech/thought
Lack of motivation and drive
Lack of capacity to enjoy
Lack of emotional expression
Hallucinations
Delusions
Disorganized speech
Disorganized behavior
42
Causes

Research studies suggest there is a genetic link in Schizophrenia. The probability of developing
Schizophrenia as the offspring of two parents, neither of whom has the disease, is 1 percent. The probability
of developing Schizophrenia as the offspring of one parent with the disease is approximately 13 percent.
The probability of developing Schizophrenia as the offspring of both parents with the disease is
approximately 35 percent.

Research has demonstrated that persons with Schizophrenia have functional (including brain chemicals) and
structural differences in the brain.

It is clear that genetics is not completely responsible for causing Schizophrenia. Environmental influences
appear to play a role as well. Some environmental influences that have been suggested to be a possible
contributor to the development of the illness are birth injury and prenatal complications, viral illnesses in the
mother during pregnancy, or other toxins during pregnancy.

Overall, Schizophrenia appears to be caused by a combination of genetic and environmental factors.
Treatments

Medication, known as antipsychotic, is the primary form of treatment for those diagnosed with
Schizophrenia.

Social and occupational rehabilitation are often used in conjunction with medication.

Support groups for individuals affected by Schizophrenia and their family members are helpful in
facilitating recovery.
Suggested Readings





Surviving Schizophrenia: A Family Manual by Torrey, M.D., E. Fuller
The Broken Brain by Andreasen, M.D., Nancy
Schizophrenia and Manic Depressive Disorder by Torrey, Bowler, Taylor & Gottesman
Schizophrenia: Symptoms, Causes and Treatments by Bernheim, Kayla F.
Coping With Mental Illness in the Family by Hatfield, Agnes
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
43
Conduct Disorder
●
The prevalence rate of Conduct Disorder has increased over the past years. The Diagnostic and Statistical
Manual of Mental Disorders-IV cites a prevalence rate of 6 to16 percent in boys and 2 to 9 percent in girls.
●
Conduct Disorder is commonly associated with lower-than-average intelligence, Attention Deficit
Hyperactivity Disorder, learning, mood, anxiety, and substance abuse disorders.
●
Conduct Disorder may occur as early as age 5 to 6 years but is usually diagnosed in late childhood or early
adolescence.
●
Many children with a Conduct Disorder are also diagnosed as having coexisting Depression or
Attention Deficit Hyperactivity Disorder.
●
For a diagnosis of Conduct Disorder to be made, a repetitive and persistent pattern of behavior in which the
basic rights of others are violated, or major age-appropriate societal norms and rules are violated must exist.
Also, the behavior needs to contain three or more of the symptoms of the disorder within the past twelve
months, with at least one symptom present in the past six months.
Symptoms
Aggression to People and Animals:
●
●
●
Steals from a victim while confronting
him/her (e.g., assault)
Physically cruel to others
Forces someone into sexual activity
●
●
Initiates physical fights or uses a weapon to
harm others (e.g., a bat, brick, knife, or gun)
Bullies, threatens, or intimidates others
●
Deliberately destroys other’s property
●
Steals items without confronting a victim
(e.g., shoplifting, but without breaking and
entering)
●
Often stays out at night despite parental
objections
Destruction of Property:
●
Deliberately engages in fire setting with
the intention to cause damage
Deceitfulness, Lying, or Stealing:
●
●
Breaks into someone else’s house, car, or
building
Lies to obtain goods, favors, or to avoid
obligations
Serious Violations of Rules:
●
●
Often truant from school
Runs away from home
44
Causes

There may be genetic factors that play a role in the cause of this disorder. Children of criminal or antisocial
parents tend to develop the same problems. An inherited trait of low-emotional arousal may have been
passed genetically to a child with Conduct Disorder. Individuals with Conduct Disorders may fail to
experience high-emotional arousal which may interfere with their ability to respond to praise and
punishment.

Some researchers suggest that because the disorder is so much more common in boys than girls, male
hormones may play a role. It is also suggested that a problem in the central nervous system could contribute
to the erratic and antisocial behavior.

Individuals with this disorder tend to come from social and family environments that are unpleasant, hostile,
and/or inconsistent. Other factors that may contribute to the development of Conduct Disorder include the
following: brain damage, child abuse, defects in growth, and school failure.

It is most likely that a combination of genetic, biological, environmental, and parenting influences play a
role in the development of this illness.
Treatments

Research shows that the future of these children and adolescents is likely to be very unhappy if they and
their families do not receive early, ongoing, and comprehensive treatment. Without treatment, these
children become adults who have difficulty meeting the demands of adulthood and continue to have
problems with relationships and holding a job.

Comprehensive treatment involves a collaboration between the child, his/her family, a child and adolescent
psychiatrist, other medical specialists, and teachers.

A consistently effective medical treatment for Conduct Disorder has not been found. Medications such as
Clonidine have been useful in increasing frustration tolerance and decreasing aggression in some children
and adolescents. Medication may also be used to treat those having difficulty with attention and
hyperactivity or Depression.

Current treatments primarily emphasize teaching the individual appropriate social skills and anger
management skills, family therapy, group therapy, placement outside the home, limit setting, consistency,
and behavior management.
Suggested Readings
●




Educational Rights of Children with Disabilities by Ordover, Eileen & Boundy, Kathleen
High Risk, Children Without a Conscience by Magid, Ken & McKelvey, Carole
Kids Out of Control by Cohen, Alan
Neurobiological Disorders in Children and Adolescents by Peschel, Enid & Richard & Howe, C & J
What’s Wrong With My Child? How to Understand and Raise a Behaviorally Difficult Child by Gattozzi,
Ruth
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
45
Depressive Disorders in
Children and Adolescents

One out of every ten high school students reports feeling depressed.

Clinical Depression is more than being temporarily “down” or “blue.” It is a physical illness involving a
chemical imbalance in the brain.

Depression affects the total person – behavior, mood, and thoughts as well as one’s physical health,
academic or work performance, and the ability to handle everyday situations.

The gender ratio (female:male) of Major Depression among prepubertal children is 1:1 and among
adolescents is 5:1.

In 1996 suicide was the third leading cause of death among 15 to 25 year olds and the fourth leading cause
among those aged 10 to 14 years old. Out of every 100,000 children, 5 will choose suicide.

It is estimated that for every one completed suicide, ten attempts are made.

More boys than girls commit suicide at a ratio of 4:1; however, girls make more suicide attempts. The most
common method of suicide is by the use of firearms.

From 1980 – 1996 the rate of suicide among African American males aged 15 to 19 years old increased by
105 percent.
Symptoms









Sad, empty mood
Loss of interest in ordinary activities
Sleep and/or eating disturbance
Psychomotor retardation or agitation
Difficulty concentrating
Difficulty making decisions
Hopelessness, worthlessness
Decreased school performance
Suicidal ideation, attempt or plan
●
●
●
●
●
●
●
●
●
Irritability
Fatigue
Feelings of aloneness
No plan for the future
Acting out
Truancy
Feelings of guilt
Skipping school, dropping clubs
Change in appearance
Causes

Depressive Illnesses are biological brain diseases that appear to be genetically-based and tend to run in
families.

Depression is a disorder of mood caused by a chemical imbalance in the frontal lobe of the brain.

Factors that can influence the onset of a depressive episode include a stressful environment, low self-esteem,
pessimistic thinking, and being easily overwhelmed.
46
Treatments

A full physical examination, intake of family history, and psychological evaluation should be completed by
a mental health professional or family physician before any treatment takes place.

Medications, such as Prozac, Zoloft, Norpramine, Pamelor, and others, are the primary choice of treatment
for those diagnosed with Severe Depression. Medication provides for a quicker recovery and is the most
cost-effective treatment as well.

Psychotherapy is often used in combination with medication therapy and may take the form of play therapy,
family therapy, interpersonal therapy, behavior therapy, and/or cognitive therapy. Psychotherapy is often
the primary mode of treatment for those diagnosed with mild and moderate forms of depression.
Prevalence of Major Depression

Preschoolers
0.3 percent

Prepubertal children
1.8 percent

Adolescents
4.7 percent
Suggested Readings
Books:






What’s Wrong With My Child? by Gattozzi, Ruth
Coping With Mental Illness in the Family by Hatfield, Agnes
Is Your Child Depressed? by Herskowitz, Joel
Helping Your Depressed Child by Kerns, Lawrence
Children and Adolescents With Mental Illness/A Parent‘s Guide by McElroy, Evelyn
High Times/Low Times: The Many Faces of Adolescent Depression by Meeks, John
Videotapes:




Adolescent Suicide: Dealing with the Crisis in the Community
Childhood Mental Illness: Truths, Needs, and Family Effects
Depression: The Road to Recovery
Out of the Shadows and Into the Light
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
47
Dual Diagnosis in Adolescence
●
Adolescents are often referred to treatment for Substance Abuse, but are not referred to a qualified mental
health professional for appropriate diagnosis and treatment of any underlying cause for their Substance
Abuse.
●
Families and caregivers know how difficult it is to find treatment for an adolescent who has a Substance
Abuse, but also is diagnosed with a brain disorder (Mental Illness), i.e., ADHD, Depression, or Bipolar
Disorder.
●
The combination of Mental Illness and Substance Abuse is so common that many clinicians now expect to
find it. Studies show that more than half of young persons with a Substance Abuse diagnosis also have a
diagnosable mental illness.
Recommendations for Family Member(s)
Get involved and stay involved
●
Listen to what your child is saying, walk in their shoes for a while.
●
Support your child in treatment and hear what they say about all their problems.
●
Praise your son or daughter for making progress.
●
Participate in evaluating the program and treatment.
Educate
Offer what you know to other families.
Assure that your child has a voice in the decision about treatment.
Respect your child’s and your own openness and readiness for disclosure.
Read everything, and ask other parents who have been through this.
●
●
●
●
Cause
●
Mental health and addiction counselors increasingly believe that brain disorders and Substance Abuse
disorders are biologically and physiologically based.
Treatments
●
Families and caregivers may feel angry and blame the adolescent for being foolish and weak-willed. They
may feel hurt when their child breaks trust by lying and stealing; but it is important to realize that Mental
Illness and often Substance Abuse are disorders that the adolescent cannot control without professional help.
48
●
Teens with difficult problems such as concurrent Mental Illness and Substance Abuse Disorders do not
respond to simplistic advice like "just say no" or "snap out of it." Psychotherapy and medication combined
with appropriate self-help and other support groups help most, but patients are still highly prone to relapse.
●
Treatment programs designed primarily for substance abusers are not recommended for individuals who
have a diagnosed Mental Illness.
●
Since dually-diagnosed clients do not fit well into most traditional 12-step programs, special peer groups
based on the principle of treating both disorders together should be developed at the community level.
Individuals who develop positive social networking have a much better chance of controlling their illnesses.
Healthy recreational activities are extremely important.
●
The presence of both disorders must first be established by careful assessment. This may be difficult because
the symptoms of one disorder can mimic the symptoms of the other. Seek referral to a psychologist or
psychiatrist.
Programs for treating mental illness and substance abuse
●
Support groups are an important component of these programs.
●
Adolescents support each other as they learn about the negative role that alcohol and drugs has had on their
lives.
●
They learn social skills and how to replace substance use with new thoughts and behaviors. They get help
with concrete situations that arise because of their brain disorder (Mental Illness).
●
Look into programs that have support groups for family members and friends.
Resources
Federation of Families for Children’s Mental Health, 1101 King Street Suite 420, Alexandria VA, (703) 6847710 or www.ffcmh.org
Patrick Friman, Ph.D., A.B.P.P., Director of Clinical Services & Research, Father Flanigan’s Boys’ Home, and
Associate Professor, Creighton University School of Medicine.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
49
Neurobiological Disorders of Children
●
Neurobiological Disorders such as Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major
Depressive Disorder, Obsessive Compulsive Disorder, Tourette’s Disorder, Borderline Personality Disorder,
Attention Deficit Hyperactivity Disorder, Anxiety and Panic Disorder, Autism, and Pervasive
Developmental Disorders are a class of severe and persistent Neurobiological Brain Disorders.

The Special Education Department has created Behaviorally Disordered as an “inclusive term for patterns of
situational inappropriate behavior which deviate substantially from behavior appropriate to one’s age and
significantly interfere with the learning process, interpersonal relationships, or personal adjustment of the
individual to such an extent as to constitute a Behavioral Disorder.”

Neurobiological Disorders are brain disorders that cause disturbances in thinking, feeling, or relating, and
result in a substantially reduced capacity for coping with the ordinary demands of everyday life.

Approximately 3 to 6 million children suffer from Clinical Depression.

Suicide is the third leading cause of death among young people aged 15 to 25.

Between 200,000 and 300,000 children suffer from Autism.

Attention Deficit Hyperactivity Disorder affects 3 to 10 percent of children.
Symptoms
●
●
●
●
●
●
Fall in school performance
Refusal to go to school
Persistent nightmares
Abuse of alcohol and/or drugs
Inability to cope with problems and daily activities
Frequent outburst of anger
●
●
●
●
●
●
A lot of worry or anxiety
Hyperactivity, fidgeting
Frequent, unexplainable temper tantrums
Changes in sleeping and/or eating habits
Prolonged negative mood and attitude
Many complaints of physical ailments
Causes
●
Serious emotional disturbance is a broad term used by school systems to classify students who exhibit any of
a wide variety of Behavioral Disorders or mental health problems.
●
Problems may be due to sociological or environmental causes (such as abuse, neglect, crime, poverty, or
emotional, neurotic, or life-adjustment issues) and includes children with Neurobiological Brain Disorders.

Neurobiological Disorders are brain diseases that have physical causes. They are no-fault diseases; poor
parenting does not cause these disorders (Nancy C. Andreason, M.D., Ph.D., 1985).
50
Treatments

Neurobiological Disorders are usually controlled by medication or a combination of medication and
psychotherapy.

Therapist generally talks extensively with the child about his/her feelings and conflicts, current problems,
and how to establish good relationships with those around him/her.

Behavioral Disorders may or may not respond to medication depending on the cause of the disorder.
Of 12 million American children suffering from
Neurobiological Disorders,
fewer than one in five receives treatment of any kind.

Children with Neurobiological Disorders need special accommodations in order to get an appropriate
education.

NAMI IOWA (Alliance for the Mentally Ill of Iowa) recommends that the educational system recognize the
specific definition and disability of Neurobiological Disorders. Also, educators must be trained on
Neurobiological Disorders, the symptoms, causes, treatments, and accommodations.
American Psychiatric Association, 1992, www.psych.org
American Academy of Child and Adolescent Psychiatry, www.aacap.org
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
51
Obsessive Compulsive Disorder
(OCD) in Children and Adolescents

OCD is an Anxiety Disorder characterized by obsessions (repeated involuntary thoughts, urges, impulses, or
worries) and compulsions (purposeless repetitive behaviors).

Approximately 1 million children and adolescents in the United States suffer from OCD. In other words,
OCD affects about 3 to 5 youngsters per average-sized elementary school and about 20 teenagers in a large
high school.

OCD is as or more prevalent than many other better known childhood illnesses such as Attention Deficit
Hyperactivity Disorder and Diabetes.

The symptoms of OCD may have their onset in children as early as age three or four, but very young
children and their parents may not recognize the symptoms.

OCD in children often exists concurrently with motor tics and/or Tourette’s Disorder.

OCD affects children and adolescents during a very important period of social development. It often affects
their schoolwork, home life, and friendships. While children are sometimes unable to understand that their
thoughts and actions are unusual, many adolescents feel embarrassed. They do not want to be “different”
from their peers and worry about their uncontrollable behavior.

Children and adolescents often involve family members in their rituals. For example, they may insist that
their laundry be washed several times, demand that parents check their homework repeatedly, or become
outraged if household items are in disarray.
Symptoms
Common Obsessions:
Common Compulsions:





●
●
●
●
●
●
Fear of contamination/serious illness
Fixation on lucky/unlucky numbers
Fear of danger to self or others
Need for symmetry or exactness
Repeated doubt
Cleaning/washing
Touching
Counting/repeating
Arguing/organizing
Checking/questioning
Hoarding
Causes

Research has shown that OCD tends to run in families and it appears that a biological imbalance of the brain
chemical serotonin can be passed on to succeeding generations. Thus, the tendency to develop OCD may be
inherited, but the actual disorder may not be.

OCD is not caused by bad parenting or an individual weakness in the person with OCD.
52
Treatments

OCD will continue for years if left untreated. The symptoms may become less severe at times, but generally
OCD is a chronic illness.

A primary form of treatment for OCD is medication. Medications that regulate serotonin reduce obsessive
thoughts and compulsive behaviors. However, medication is not completely effective for everyone with
OCD.

Behavior therapy is commonly used in combination with medication. This type of therapy exposes a person
to a feared object or thought. The person is then discouraged from carrying out the usual compulsive
response.

The most effective way to treat OCD is to use both medication and therapy.
Medications commonly used in treating OCD:

Clomipramine (Anafranil) is usually the first choice of medication.

Fluoxetine (Prozac)

Medications may take up to ten weeks to take effect.

If the medications most commonly used in treating OCD are not working, other medications such as
Lithium, Fenfluramine, Buspirone, and other antipsychotic medications may be beneficial.

Between 50 and 80 percent of patients with OCD improve with medication. However, they still may have
some obsessive and compulsive behaviors remaining.
Suggested Readings



The Boy Who Couldn’t Stop Washing by Rapoport, Judith
Obsessive Compulsive Disorders by Levenkron, Steven
Obsessive Compulsive Disorder: A Guide by University of Wisconsin (Copies available in Nancee Blum’s
office, call (319) 353-6180 to order)
Other Resources:

OC Foundation – PO Box 70, Milford CT 06460-0070 or www.ocfoundation.org . The OC Foundation
publishes an excellent newsletter and has information about support groups. They also publish a newsletter
for support group leaders.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
53
Oppositional Defiant Disorder (ODD)

Oppositional Defiant Disorder usually becomes evident before age eight. Onset is typically gradual,
occurring over the course of months or years. This disorder is typically seen in more males than females
before puberty, but the rates of occurrence are equal during adolescence.

Many of the symptoms of Oppositional Defiant Disorder are seen in children and adolescents with Mood
Disorders and Psychotic Disorders; therefore, care should be taken in making a diagnosis.

Attention Deficit Hyperactivity Disorder, learning disorders, and communication disorders are commonly
seen in children with Oppositional Defiant Disorder.

These behaviors must be seen more frequently than is typically observed in individuals of comparable age
and developmental level and must lead to significant problems in social or school functioning.

The diagnosis of Oppositional Defiant Disorder differs from Conduct Disorder in that it excludes symptoms
of violations of personal rights and social rules. The symptoms of Oppositional Defiant Disorder focus
more on annoying, difficult, and disruptive behavior.

Symptoms must be displayed regularly for at least six months.
Symptoms













Disobedient and hostile behavior toward authority
Stubbornness
Resistance to directions
Unwillingness to compromise, give in or negotiate with adults
or peers
Deliberate or persistent testing of limits by ignoring orders,
arguing, and failing to accept blame for misdeeds
Losing temper
Arguing with adults
Refusing to follow rules
Deliberately doing things to annoy others
Blaming others for his/her own mistakes or bad behavior
Being easily annoyed by other people
Being angry or resentful
Being spiteful or vindictive
54
Causes

The cause of Oppositional Defiant Disorder is unclear.

Research has shown that Oppositional Defiant Disorder is more common in children who have at least one
parent with a history of a Mood Disorder, Oppositional Defiant Disorder, Attention Deficit Hyperactivity
Disorder, Substance Abuse, or Antisocial Personality Disorder. Also, this disorder is commonly seen in
children whose parents have serious marital discord.
Treatments

An effective medical treatment for Oppositional Defiant Disorder has not been found.

Current treatments include family therapy, placement outside the home, limit setting, consistency, and
behavior management, and teaching appropriate social skills.

Treatment may include the management of other occurring disorders, such at Attention Deficit
Hyperactivity Disorder or Mood Disorders, with appropriate medications.
Suggested Readings Available





Educational Rights of Children with Disabilities by Ordover, Eileen & Boundy, Kathleen
High Risk, Children Without a Conscience by Magid, Ken & McKelvey, Carole
Kids Out of Control by Cohen, Alan
Neurobiological Disorders in Children and Adolescents by Peschel, Enid & Richard & Howe, C & J
What’s Wrong With My Child? How to Understand and Raise a Behaviorally Difficult Child by Gattozzi,
Ruth
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
55
Posttraumatic Stress Disorder in
Children and Adolescents
●
A child or adolescent who experiences a catastrophic event may develop ongoing difficulties known as
Posttraumatic Stress Disorder (PTSD).
●
The event usually involves a situation where someone's life has been threatened or severe injury has
occurred.
●
A child's risk of developing PTSD is related to the seriousness of the trauma, whether the trauma is
repeated, the child's proximity to the trauma, and relationship to the victim.
●
Children who experience repeated trauma may develop a kind of emotional numbing to deaden or block the
pain and trauma. This is referred to as dissociation.
●
Sexually traumatic events may include developmentally inappropriate sexual experience with or without
threatened or actual violence or injury.
●
The symptoms of PTSD may last from several months to years.
Symptoms
A child with PTSD may also re-experience the traumatic event by:
●
●
Having distressing dreams/nightmares
Developing repeated physical or emotional symptoms when the child is reminded of the event
Children with PTSD may also show the following symptoms:
●
●
●
●
●
●
●
●
Worry about dying at an early age
Losing interest in activities
Headaches and stomachaches
Showing more sudden and extreme emotional reactions
Problems falling or staying asleep
Problems concentrating
Disorganized or agitated behavior
Repeated enactment of the trauma through play
Treatments
Treatments used for Depression or Anxiety may be useful. Anti-depressants and anxiety-reducing medications
can ease the symptoms of depression, sleep problems, nightmares, flashbacks and help to control anger.
● Psychotherapy - which allows the child to speak, draw, play, or write about the event.
● Supportive psychotherapy and psycho-education for families and caregivers.
● Cognitive-behavioral therapy.
● Support group.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
56
Reactive Attachment Disorder
●
There are two types of Reactive Attachment Disorder.
Inhibited type - The child fails to initiate and to respond to most social interaction in a
developmentally appropriate way.
Disinhibited type - There is a pattern of thinly distributed attachments. This child
exhibits indiscriminate sociability or lack of selectivity in the choice of attachment figures.
●
Reactive Attachment Disorder (RAD) is a psychological and neurological disorder that occurs during the
first three years of life when a child does not attach and bond properly to the primary caregiver.
Symptoms
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
Severe need for control over everyone and everything, bossy
Argumentative - often over ridiculous things
Difficulty with eye contact, especially with parents - will look into your eyes while
lying to you
Superficially charming and engaging
Demanding/clingy - often at inappropriate times
Indiscriminate affection
Impulsive
Hypervigilant/hyperactive
Cruelty to animals and/or people
No conscience - shows no remorse
Destructive to property and self
Speech and language problems
Fascinated with fire, blood, gore, weapons, evil
Food issues - hoarding, gorging, refusing to eat, eating strange things
Very concerned about tiny hurts but brushes off large injuries
Often these behaviors are not seen by anyone but the parents
57
Causes
●
Abuse and/or neglect in the first three years of life
●
Multiple primary caregivers
●
Many foster care placements
●
Unresolved, ongoing pain - i.e., ear infections
●
Maternal substance abuse
●
Lack of attunement between mother and child
●
Young or inexperienced mother with poor parenting skills
Course
●
By definition, the onset of Reactive Attachment Disorder begins before five years of age.
●
The course appears to vary depending on individual factors in child and caregivers, the severity and duration
of the psychosocial deprivation, and the nature of the intervention. Considerable improvement or remission
may occur if an appropriate environment is provided. Otherwise, this disorder follows a continuous course.
Based on information provided in Diagnostic and Statistical Manual of Mental Disorders IV,
American Psychiatric Association and American Academy Child & Adolescent Psychiatry.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
58
Separation Anxiety Disorder
●
Separation Anxiety Disorder is estimated to occur in 4 percent of children and young adolescents.
●
The disorder occurs equally in males and females based on clinical samples.
●
Separation Anxiety Disorder is distinguished from Generalized Anxiety Disorder in that the anxiety
concerns separation from home and attachment figures.
●
Separation Anxiety can also be associated with Pervasive Developmental Disorders, Schizophrenia, or other
Psychotic Disorders. A diagnosis of Separation Anxiety Disorder is not given when it occurs with one of
these disorders.
●
Serious long-term effects such as Anxiety and Panic Disorder may occur if professional assistance is not
received.
●
Symptoms must be displayed for at least four weeks with onset before the age of 18 years.
Symptoms
Common symptoms when separation occurs or is anticipated:
● Stomachaches
● Headaches
● Nausea and vomiting
● Cardiovascular symptoms such as palpitations, dizziness, and faintness are
rare in younger children, but may occur in older individuals
Behaviors common among children with Separation Anxiety Disorder:
● Feeling unsafe in a room by themselves
● Displaying clinging behavior
● Excessive worry and fear about parents or about harm to themselves
● Shadowing parent around house
● Difficulty sleeping and frequent nightmares
● Exaggerated, unrealistic fears of animals, monsters, burglars
● Fear of being alone in the dark
59
Causes
●
Separation Anxiety Disorder may develop after some life stress (e.g., the death of a relative or pet, an illness
of the child or relative, a change of schools, a move to a new neighborhood, or immigration).
●
This disorder is found to be more common in first-degree biological relatives than in the general
population and may be more frequent in children of mothers with Panic Disorder.
Treatment
●
Play therapy, cognitive-behavioral therapy, and family therapy are used in conjunction with medication to
treat Separation Anxiety Disorder.
Suggested Readings
●
●
●
●
●
Educational Rights of Children with Disabilities by Ordover, Eileen & Boundy, Kathleen
High Risk, Children Without a Conscience by Magid, Ken & McKelvey, Carole
Neurobiological Disorders in Children and Adolescents by Peschel, Enid & Richard & Howe, C & J
What's Wrong With My Child? How to Understand and Raise a Behaviorally Difficult Child by Gattozzi,
Ruth
It’s Nobody’s Fault by Koplewicz, Harold
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
60
Tourette’s Disorder

Tourette’s Disorder is a neurobiological illness which typically begins to appear between the ages of 2 and
15 years, with a general age of onset at 7 years.

The disorder is approximately 3 times more common in males than in females and occurs in approximately
4 to 5 individuals per 10,000.

Research indicates that Tourette’s Disorder is genetically-based and tends to run in families.

The duration of the disorder is usually life-long, though periods of remission lasting from weeks to years
may occur.

About 50 percent of children diagnosed with the disorder suffer from diagnosable learning disabilities.

Motor tics commonly involve eye blinking, touching, squatting, deep knee bends, retracing steps, and
twirling when walking.

Vocal tics typically include various words or sounds such as clicks, grunts, yelps, barks, sniffs, snorts, and
coughs. Coprolalia, a vocal tic involving the uttering of obscenities, is present in a few individuals (less
than 10 percent).

Diagnostic criteria for Tourette’s Disorder (DSM-IV, 1994):
A. Both multiple motor and one or more vocal tics have been present at some time during the illness,
although not necessarily at the same time.
B. The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period
of more than 1 year, and during this period there is never a tic-free period of more than 3 consecutive
months.
C. The disturbance causes marked distress or significant impairment in social, occupational, or other
important areas of functioning.
D. The onset is before age 18 years.
E. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a
general medical condition (e.g., Huntington’s Disease or Post-viral Encephalitis).
Symptoms




Motor tics
Impulsivity
Mimicking the movements of others
Compulsive thought patterns
●
●
●
●
Self-mutilation
Aggressive behavior
Hyperactivity and distractibility
Coprolalia (vocal tics)
61
Cause

Research suggests that Tourette’s Disorder is genetically-based. However, not all individuals with a genetic
vulnerability to the disorder will develop it. In about 10 percent of those with Tourette’s Disorder there is
no evidence of a family pattern.
Treatments

A common form of treatment for Tourette’s Disorder is pharmacological treatment. Medications may take
the form of antidepressants, anticonvulsants, vitamins, anti-Parkinsonians, and stimulants.

Studies have also found that with the use of nicotine patches, tics can be reduced an average of 50 percent.
However, after 16 weeks the reduction may not be as noticeable.

Behavior therapy and/or psychotherapy are often used in combination with medication therapy.

An evaluation, diagnosis, and treatment can be sought through either a child psychiatrist, a family physician,
a mental health center, or a mental health specialist. A complete evaluation should consist of an intake of
family history, physical evaluation, and psychological evaluation.
Approximately 80 percent of patients who receive treatment for
Tourette’s Disorder are provided relief from their symptoms.
Suggested Readings





Coping With Mental Illness in the Family by Hatfield, Agnes
Children and Adolescents With Mental Illness/A Parent’s Guide by McElroy, Evelyn
Educational Rights of Children with Disabilities by Ordover, Eileen & Boundy, Kathleen
Neurobiological Disorders in Children and Adolescents by Peschel, Enid & Richard; and Howe, C & J
When Someone You Love Has Mental Illness by Woolis, Rebecca
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
62
Identifying Potential Violence in
Middle and High School Students
●
Juvenile violence has moved from America’s impoverished inner-city neighborhoods to more suburban and
rural areas over the past several years.
●
The perpetrators of such violence appear to be getting younger and younger, and the violent acts appear to
be becoming more and more serious and deadly.
●
Violence begins to escalate sharply at about fourteen years of age.
Causes Which May Contribute to Violence

A history of past victimization – Research involving schoolyard bullies indicates that about 80 percent of
bullies were first victims of bullying behavior from parents, siblings, peers, or others.

Hate words - Derogatory comments about race, ethnicity, sexuality, gender, and religion can set in motion a
chain of events that sometimes leads to violence.

Children and adolescents who feel isolated, neglected, ignored, and ridiculed – These children may be more
reactive to others; therefore, more at risk for acting out violently. Kids who feel very isolated in their
emotional pain may use aggressive behavior in an attempt to let people know how distressed they are.

A strong need for attention – Children who crave attention may be willing to engage in violent acts in order
to gain that attention.

Social skills deficits – These children do not know how to handle themselves in social situations and may
feel very powerless in those situations. Engaging in violence may give them that sense of power. In
addition, they may not have the ability to generate alternative interventions to conflict other than fighting.

School failure – This has been found to be a significant predictor of later violence.

A background of misconduct and trouble at home, school, and with the law – One of the best predictors of
future behavior is past behavior.

Anger management problems – Those children who respond very impulsively when angry are more likely to
engage in violence.

Dysfunctional thoughts – Children who believe that violence is acceptable; victims do not suffer, victims
deserve what they get, and/or have a hostile bias (i.e., quick and often false assumptions that others intend
harm) are more likely to use violence.

Dangerous school environment - The presence of gangs and students carrying weapons, as well as the
availability of drugs, contribute to a school environment conducive to violence.
63
Solutions
●
Educators should create an unwelcome environment for hate speech and symbols.
●
Immediately respond to every known incident, whether or not the incident is used in a joking or serious
manner.
●
School mapping identifies areas in and around the school that are known to be dangerous or disruptive.
●
The goals should be to provide an atmosphere in which every student is treated with respect and dignity to
decrease a possible risk factor for school violence.
●
After school, give young people somewhere to go, something productive to do, and someone who believes
in them.
●
Get youths involved in creating positive changes in their communities through community assessment,
policy development, and education of policy makers.
●
Train middle school and high school youth as peer mediators to help their peers resolve disputes without
resorting to violence.
●
Promote effective violence prevention curriculum at all grade levels.
●
Involve caring adults who can be role models for youth and personally help keep youth on the right path.
Resource
Iowa Association of Community Providers, Inc. at (515) 270-9495.
Source: Des Moines Child and Adolescent Center
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
64
Parents’ Guide to Educational Rights
●
The educational rights of children with disabilities are protected by two important federal laws, (1) the
Individuals with Disabilities Education Act (IDEA) and (2) Section 504 of the Rehabilitation Act of 1973
(Section 504).
●
The "IDEA" is a federal education law specifically for children with disabilities. It was designed to improve
educational opportunities for all children with disabilities by guaranteeing they have access to public
schools and to appropriate services. Because Iowa receives money from the federal government under this
program, every public school in Iowa must provide a free, appropriate education to each child with a
disability in their district.
●
Section 504 is not an education law but it applies to students with disabilities. Children with disabilities who
do not need the level of special education provided by IDEA, but who do need some special assistance in
school are covered by "Section 504". That usually means making certain "accommodations" for the
student's disability so that he/she can participate in general education and have access to all programs or
activities offered by the school.
Definitions
A child who has one or more of the following is considered a child with a disability under federal law:
●
●
●
Mental retardation
Visual impairments
Traumatic brain injury
● Hearing impairment
● Emotional disturbance
● Health impairments
●
●
●
Autism
Speech impairment
Specific learning disabilities
A person who has a physical or mental impairment that "substantially limits" one or more major life activities:
●
●
Seeing
Speaking
●
●
Hearing
Walking
●
●
Breathing
Learning
●
●
Caring for yourself
Doing manual tasks
●
An accommodation plan can be made to assist the student so that he/she can participate in school activities.
Examples of accommodations for students with certain learning disabilities include: shortened writing
assignments, oral test taking, or assistance taking notes in class. Physically-disabled students may need
wheelchair accessibility. Deaf students may need sign language to communicate.
●
An Individualized Education Plan (IEP) is a written plan for meeting the special education needs of a child
with a disability. A team of people who are familiar with the child’s needs, such as school personnel, meet
with the parents and develop a plan that spells out specific goals for the child's education progress.
65
Your child's IEP should contain the following:
- how the child is performing in school at this time
- a statement of measurable annual goals for the child's education
- a statement of specific education services that are to be provided to the child
- an explanation if the child will not be participating in the regular classroom
- the dates that services, supports, and modifications are to begin
- information on the child's progress towards meeting the annual goals
- for high school age children, the IEP must include information on "transition" services and information on
the students’ legal rights that transfer to him/her at the age of fourteen
●
A Behavioral Intervention Plan (BIP) is a plan developed by the school and parents to help a child control
his/her behavior. Such a plan may include the child's course of study, where the child sits in the classroom,
changes in classroom environment, or other "interventions." Behavior can be a child's way of
communicating unmet needs. If teachers and parents can determine what the child is trying to communicate
through certain behaviors, they can help the child learn more appropriate and effective ways to
communicate, eliminate, or reduce the behaviors.
Know Your Rights
●
●
●
●
●
●
●
●
●
You have the right to request an evaluation.
You have the right to agree to the method of evaluation.
You have the right to participate in making decisions about your child.
You have the right to participate in the educational planning for your child.
You have the right to examine all of your child's educational records.
You have the right to receive copies of your child's records (a small fee can be charged).
You have the right to receive all written and oral communications in your primary language.
You have the right to challenge school decisions about your child.
You have the right to have your child educated in the least restrictive school setting possible.
Suggested Readings
●
●
Educational Rights of Children with Disabilities by Ordover, Eileen L. & Boundy, Kathleen
Children and Adolescents with Mental Illness, A Parents Guide edited by McElroy, Ph.D., Evelyn
Researched and prepared by Terri Bailey, Norwalk IA
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
66
Questions to Ask Before Inpatient
Psychiatric Treatment of
Children and Adolescents
Psychiatric treatment in a residential facility or hospital is one option for treating a child or adolescent with a
mental illness. At some point in your child’s treatment, this level of care may be recommended by your currenttreating mental health professionals. This type of recommendation may leave you frightened and concerned.
Asking the following questions will help you gain a better understanding of the proposed inpatient treatment:
1. Why is inpatient psychiatric treatment being recommended for our child, and how will it help our child?
2. What are the other alternatives to residential or hospital treatment, and how do they compare?
3. Is a child and adolescent psychiatrist admitting our child to the facility?
4. What does the treatment program for inpatient treatment include, and how will our child be able to keep up
with school work?
5. What are the responsibilities of the child and adolescent psychiatrist and other people on the treatment
team?
6. How long will our child be in inpatient treatment, and how are these services paid?
7. If we are responsible for funding all or a portion of our child’s stay, what will happen if we can no longer
afford to keep our child in treatment, and inpatient treatment is still necessary?
8. How will we as parents be involved in our child’s treatment, including the decision for discharge and
after-care treatment?
9. Is this facility approved by the Joint Commission for the Accreditation of Healthcare Organizations
(JCAHO) as a treatment facility for youngsters of our child’s age, or will our child be on a specialized unit
or in a program accredited for treatment of children and adolescents?
10. How will the decision be made to discharge our child?
11. Once our child is discharged, what are the plans for continuing or follow-up treatment?
Parents should raise these questions prior to their child’s admission to the facility. It is also beneficial to request
and arrange a tour of the facility. Parents who are informed about the facility’s procedures and treatment plan
can more effectively contribute to their child’s treatment and advocate for his/her needs.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
67
Questions to Ask Your Doctor About
Psychiatric Medications for
Children and Adolescents
1. What is the medication name? Is it known by other names?
2. What is known about its helpfulness with other children who have a similar condition as my child?
3. How will the medication help my child? How long before I see improvement?
4. What are the most common side effects? What are the rare side effects?
5. Is the medication addictive?
6. What is the recommended dosage and how often is it taken?
7. Are there any laboratory tests that need to be done before my child begins taking this medication?
8. Will a child and adolescent psychiatrist be monitoring my child’s response to medication and make dosage
changes if necessary? How often will progress be checked and by whom?
9. Are there any other medications or foods that my child should avoid while taking the medication?
10. Are there any activities that my child should avoid while taking the medication?
11. How long will my child need to take this medication? How will the decision be made to stop this
medication?
12. What do I do if a problem develops (e.g., if my child becomes ill, doses are missed, or side effects develop)?
13. What is the cost of the medication (generic vs. brand name)?
14. Does my child’s school nurse need to be informed about this medication?
Source: Facts for Families, American Academy of Child and Adolescent Psychiatry
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
68
Co-occurrence of Depression With
Cancer
●
Each year more than 1.3 million Americans are diagnosed with Cancer.
●
Receiving such a diagnosis is often traumatic, causing emotional upset, sadness, anxiety, poor concentration,
and withdrawal.
●
Often this turmoil begins to abate within two weeks, with a return to usual functioning in about a month.
When that does not happen, the patient must be evaluated for Clinical Depression, which occurs in about 10
percent of the general population and in about 25 percent of persons with Cancer.
●
Early diagnosis and treatment are important because Depression adds to a patient’s suffering and interferes
with his/her motivation to engage in cancer treatment.
●
While it may be difficult to say whether fatigue or appetite loss are due to depression or to the cancer, their
presence along with other depressive symptoms strongly indicates a diagnosis of Clinical Depression.
●
When five or more of these symptoms last for longer than two weeks, are not caused by other illness or
medication, or disrupt usual functioning, an evaluation for depression is indicated.
Symptoms
●
●
●
●
●
Persistent sad or “empty” mood
Loss of interest or pleasure in ordinary activities
Decreased energy, fatigue, being “slowed down”
Sleep disturbances (insomnia, early waking, or
oversleeping)
Eating disturbances (loss of appetite or overeating)
●
●
●
●
●
●
Difficulty concentrating, remembering,
making decisions
Excessive crying
Feelings of guilt, worthlessness, helplessness
Thoughts of death or suicide; suicide attempts
Irritability
Chronic aches or pains for no apparent reason
Causes
●
Depression in cancer patients goes unrecognized for several reasons. Sometimes Depression is
misinterpreted to be a reaction to the diagnosis. Or the depressive symptoms are attributed to the cancer
itself, which can also cause appetite loss, weight loss, insomnia, and loss of energy. Finally, Depression
may be viewed as just the side effect of cancer treatments, such as Corticosteriods or Chemotherapy.
●
These diagnostic hurdles can be overcome by careful evaluation, which is important because regardless of
the cause, when Depression is present, it must be treated.
●
Studies also indicate that the more severe the medical condition, the more likely it is that a person will
experience Clinical Depression. Other factors which increase the risk of Depression in persons with Cancer
are history of depressive illness, alcohol or other substance abuse, poorly controlled pain, advanced disease,
disability or disfigurement, medications such as steroids and chemotherapy agents, the presence of other
physical illness, social isolation, and socio-economic pressures.
69
Treatments
●
Research shows that, compared to patients without Depression, depressed cancer patients experience greater
distress, more impaired functioning, and less ability to follow medical regimens. Studies also show that
treating Depression in these patients not only improves the psychological condition but reduces suffering
and enhances quality of life. Therefore, professionals, patients, and families must be alert for depressive
symptoms in cancer patients and seek evaluation for Depression when indicated.
●
With treatment, up to 80 percent of all depressed people can improve, usually within weeks. Treatment
includes medication, psychotherapy, or a combination of both. The severity of the Depression, the other
conditions present, and the medical treatments being used must be considered to determine the appropriate
treatment. Altering the cancer treatment may also help diminish depressive symptoms.
●
Antidepressant Medications - Several types of antidepressant medications are effective and none are habitforming. Most side effects can be eliminated or minimized by adjustment in dosage or type of medication,
so it is important for patients to discuss all effects with the doctor. Also, because responses differ, several
trials of medicine may be needed before an effective treatment is found. In severe Depression, medication is
usually required and is often enhanced by psychotherapy.
In special circumstances, low doses of psycho-stimulants can be used to treat Depression in cancer patients.
These may be used when standard antidepressants produce side effects that, due to the patient’s physical
condition, are either intolerable or medically dangerous. Also, psycho-stimulants may help alleviate postsurgical pain and their rapid effect (1 to 2 days) can aid medical recovery.
●
Psychotherapy - Interpersonal Therapy and Cognitive/Behavioral Therapy have also been shown to be
effective in treating Depression. These short-term (10 to 20 weeks) treatments involve talking with a
therapist to recognize and stop behaviors, thoughts, or relationships that cause or maintain Depression and to
develop more healthful and rewarding habits.
Psychological treatment of patients with Cancer, even those without Depression, has been shown to be
beneficial in a number of ways. These include improving self-concept and sense of control, reducing
distress, anxiety, pain, fatigue, nausea, and sexual problems. In addition, there is some indication that
psychological intervention may increase survival time in some Cancer patients.
●
Electro-convulsive Therapy (ECT) is a safe and often effective treatment for severe Depression. Because it
is fast-acting, it may be of particular use for Depression in cancer patients who experience severe weight
loss or debilitation, or who cannot take or do not respond to antidepressant medications.
●
Medical Management - The benefits from the standard treatments described above are maximized by the
effective management of pain and other medical conditions in depressed cancer patients.
Path to Healing
Depression can be overcome through recognition of symptoms, evaluations, and treatments by a qualified
professional. Family and friends can help by encouraging the depressed person to seek or remain in treatment.
Participating in a support group may be a helpful addition to treatment.
Information in this fact sheet provided by the National Institute of Mental Health
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
70
Co-occurrence of Depression With
Diabetes
Depression can strike anyone, but people with diabetes, a serious disorder that afflicts an estimated 16
million Americans,1 may be at greater risk. In addition, individuals with Depression may be at greater
risk for developing Diabetes. Treatment for Depression helps people manage symptoms of both
diseases, thus improving the quality of their lives.
Several studies suggest that Diabetes doubles the risk of Depression compared to those without the
disorder.2 The chances of becoming depressed increase as Diabetes complications worsen. Research
shows that Depression leads to poorer physical and mental functioning, so a person is less likely to
follow a required diet or medication plan. Treating Depression with psychotherapy, medication, or a
combination of these treatments can improve a patient's well-being and ability to manage Diabetes.
Causes underlying the association between Depression and Diabetes are unclear. Depression may
develop because of stress but also may result from the metabolic effects of Diabetes on the brain.
Studies suggest that people with Diabetes who have a history of Depression are more likely to develop
diabetic complications than those without Depression. People who suffer from both Diabetes and
Depression tend to have higher health care costs in primary care.3
Despite the enormous advances in brain research in the past 20 years, Depression often goes
undiagnosed and untreated. People with Diabetes, their families and friends, and even their physicians
may not distinguish the symptoms of Depression. However, skilled health professionals will recognize
these symptoms and inquire about their duration and severity, diagnose the disorder, and suggest
appropriate treatment.
Symptoms of Depression










Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide or suicide attempts
Restlessness, irritability
If five or more of these symptoms are present every day for at least two weeks and interfere with
routine daily activities such as work, self-care, and childcare or social life, seek an evaluation for
Depression.
71
Depression Facts
Depression is a serious medical condition that affects thoughts, feelings, and the ability to function in
everyday life. Depression can occur at any age. NIMH-sponsored studies estimate that 6 percent of 9to 17-year-olds in the U.S. and almost 10 percent of American adults, or about 19 million people age
18 and older, experience some form of Depression every year.4,5 Although available therapies
alleviate symptoms in over 80 percent of those treated, less than half of people with Depression get the
help they need.5,6
Depression results from abnormal functioning of the brain. The causes of Depression are currently a
matter of intense research. An interaction between genetic predisposition and life history appear to
determine a person's level of risk. Episodes of Depression may then be triggered by stress, difficult life
events, side effects of medications, or other environmental factors. Whatever its origins, Depression
can limit the energy needed to keep focused on treatment for other disorders, such as Diabetes.
Diabetes Facts
Diabetes is a disorder that impairs the way the body uses digested food for growth and energy. Most of
the food we eat is broken down into glucose, a form of sugar that provides the main source of fuel for
the body. After digestion, glucose passes into the bloodstream. Insulin, a hormone produced by the
pancreas, helps glucose get into cells and converts glucose to energy. Without insulin, glucose builds
up in the blood, and the body loses its main source of fuel.
In Type 1 Diabetes, the immune system destroys the insulin-producing beta cells of the pancreas. This
form of Diabetes usually strikes children and young adults, who require daily or more frequent insulin
injections or use an insulin pump for the rest of their lives. Insulin treatment; however, is not a cure,
nor can it reliably prevent the long-term complications of the disease. Although scientists do not know
what causes the immune system to attack the cells, they believe that both genetic factors and
environmental factors are involved.
Type 1 Diabetes accounts for about 5 to 10 percent of diagnosed Diabetes in the United States, occurs
equally in males and females, and is more common in Caucasians.
Symptoms
▪
▪
▪
Increased thirst and urination
Constant hunger
Weight loss
▪
▪
Blurred vision
Extreme fatigue
If not treated with insulin, a person can lapse into a life-threatening coma.
Type 2 Diabetes, which accounts for about 90 percent of Diabetes cases in the United States, is most
common in adults over age 40. Affecting about 6 percent of the U.S. population, this form of Diabetes
is strongly linked with obesity (more than 80 percent of people with type 2 Diabetes are overweight),
inactivity, and a family history of Diabetes. It is more common in African Americans, Hispanic
Americans, American Indians, and Asian and Pacific Islander Americans. With the aging of
Americans and the alarming increase in obesity in all ages and ethnic groups, the incidence of Type 2
Diabetes has also been rising nationwide.
72
Type 2 Diabetes is often part of a metabolic syndrome that includes obesity, high blood pressure, and
high levels of blood lipids. People with Type 2 Diabetes first develop insulin resistance, a disorder in
which muscle, fat, and liver cells do not use insulin properly. At first, the pancreas produces more
insulin, but gradually its capacity to secrete insulin falters, and the timing of insulin secretion becomes
abnormal. After Diabetes develops, insulin production continues to decline.
Symptoms
▪
▪
▪
▪
Fatigue
Nausea
Frequent urination or infections
Unusual thirst
▪
▪
▪
▪
Weight loss
Blurred vision
Slow healing of wounds or sores
Some people have no symptoms at all
Researchers estimate that about one-third of people with Type 2 Diabetes don't know they have it.
Many people with Type 2 Diabetes can control their blood glucose by following a careful diet and
exercise program, losing excess weight, and taking oral medication. However, the longer a person has
Type 2 Diabetes, the more likely he or she will need insulin injections, either alone or together with
oral medications.
Gestational Diabetes develops during pregnancy. Like Type 2 Diabetes, it occurs more often in
African Americans, American Indians, Hispanic Americans, and people with a family history of
Diabetes. Though it usually disappears after delivery, the mother is at increased risk of getting Type 2
Diabetes later in life.
Managing Diabetes
Research has shown that tight glucose control is the best way to prevent serious complications of
Diabetes, so the goal of Diabetes management is to keep blood glucose levels as close to the normal
range as possible. Healthy eating, physical activity, insulin injections, or using an insulin pump are
basic therapies for Type 1 Diabetes. Blood glucose levels must be monitored through frequent
checking. In recent years, research has led to better ways to manage Type 2 Diabetes and treat its
complications with improved monitoring of blood glucose, new drugs, and weight control
management. Blood pressure drugs called ACE (angiotensin-converting enzyme) inhibitors help to
prevent or delay Heart and Kidney disease.
People with Diabetes try to keep blood glucose (also called blood sugar) from rising too high or falling
too low. When blood glucose levels drop too low from some medicines--a condition called
hypoglycemia--a person can become nervous, shaky, and confused. Judgment can be impaired, and if
the level is low enough, a person can faint. High levels of blood glucose, called hyperglycemia, cause
tissue damage and lead to debilitating complications. Associated with acute long-term complications,
the disease can lead to blindness, heart and blood vessel disease, strokes, kidney failure, amputations,
and nerve damage. Uncontrolled Diabetes can complicate pregnancy. Because a large part of the
population is aging and Americans are increasingly overweight and sedentary, the prevalence of
Diabetes is predicted to increase.
73
Researchers continue to search for the causes of Diabetes and ways to prevent and cure the disorder.
Scientists are looking for genes that contribute to the different forms of Diabetes, are testing new
drugs, and are using bioengineering techniques to try to create artificial beta cells that secrete insulin.
Get Treatment for Depression
While there are many different treatments for Depression, they must be carefully chosen by a trained
professional based on the circumstances of the person and family. Prescription antidepressant
medications are generally well-tolerated and safe for people with Diabetes. Specific types of
psychotherapy, or "talk" therapy, also can relieve Depression. However, recovery from Depression
takes time. Antidepressant medications can take several weeks to work and may need to be combined
with ongoing psychotherapy. Not everyone responds to treatment in the same way. Prescriptions and
dosing may need to be adjusted.
In people who have Diabetes and Depression, scientists report that psychotherapy and antidepressant
medications have positive effects on both mood and blood sugar control.2 Additional trials will help us
better understand the links between Depression and Diabetes and the behavioral and physiologic
mechanisms by which improvement in Depression fosters better adherence to Diabetes treatment and
healthier lives.
Treatment for Depression in the context of Diabetes should be managed by a mental health
professional--for example, a psychiatrist, psychologist, or clinical social worker--who is in close
communication with the physician providing the Diabetes care. This is especially important when
antidepressant medication is needed or prescribed, so that potentially harmful drug interactions can be
avoided. In some cases, a mental health professional that specializes in treating individuals with
Depression and co-occurring physical illnesses such as Diabetes may be available. People with
Diabetes who develop Depression, as well as people in treatment for Depression who subsequently
develop Diabetes, should make sure to tell any physician they visit about the full range of medications
they are taking.
Use of herbal supplements of any kind should be discussed with a physician before they are tried.
Scientists have discovered that St. John's Wort, an herbal remedy sold over-the-counter and promoted
as a treatment for mild Depression, can have harmful interactions with some other medications. (See
the alert on the NIMH Web site: http://www.nimh.nih.go/events/stjohnwort.cfm)
Other mental disorders, such as Bipolar Disorder (Manic-Depressive Illness) and Anxiety Disorders,
may occur in people with Diabetes, and they too can be effectively treated. For more information about
these and other mental illnesses, contact NIMH.
Remember, Depression is a treatable disorder of the brain. Depression can be treated in addition to
whatever other illnesses a person might have, including Diabetes. If you think you may be depressed or
know someone who is, don't lose hope. Seek help for Depression.
For more information about Diabetes, contact:
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Office of Communications and Public Liaison
31 Center Drive, Room 9A04, MSC 2560
Bethesda MD 20892-2560
Phone: 301-496-3583
E-mail: [email protected]
Web site: http://www.niddk.nih.gov
74
References
1
Diabetes statistics. NIH Pub. No. 99-3892. Bethesda MD: National Institute of Diabetes and
Digestive and Kidney Diseases, March 1999.
2
Anderson RJ, Lustman PJ, Clouse RE, et al. Prevalence of depression in adults with diabetes: a
systematic review. Diabetes, 2000; 49 (Suppl 1): A64.
3
Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on
adherence, function, and costs. Archives of Internal Medicine, 2000; 160(21): 3278-85.
4
Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive disorders service system.
Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives
of General Psychiatry, 1993; 50(2): 85-94.
5
Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children
Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA
Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. Journal of the
American Academy of Child and Adolescent Psychiatry, 1996; 35(7): 865-77.
6
National Advisory Mental Health Council. Health care reform for Americans with severe mental
illnesses. American Journal of Psychiatry, 1993; 150(10): 1447-65.
For more information about depression and research on mental disorders, contact:
National Institute of Mental Health (NIMH)
Office of Communications and Public Liaison
Information Resources and Inquiries Branch
6001 Executive Blvd., Rm. 8184, MSC 9663
Bethesda MD 20892 9663
Phone: 301-443-4513
TTY: 301-443-8431
Fax: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail: [email protected]
Web site: http://www.nimh.nih.gov
All material in this fact sheet is in the public domain and may be copied or reproduced without
permission from the NIMH. Citation Of NIMH as the source is appreciated.
NIMH Depression Publications Toll-free: 1-800-421-4211
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
75
Co-occurrence of Depression With
General Medical Disorders
●
Clinical Depression commonly co-occurs with general medical illnesses, though it often goes undetected and
untreated.
●
The rate of Major Depression among persons in the community is estimated to be between 2 to 4 percent;
among primary care patients it is between 5 and 10 percent; and among medical inpatients it is between 10
and 14 percent.
●
An additional two to three times as many persons in these groups experience depressive symptoms.
Research suggests that recognition and treatment of co-occurring Depression may improve the outcome of
the medical condition, enhance quality of life, and reduce the degree of pain and disability experienced by
the medical patient.
●
Clinical Depression is a common and highly treatable illness affecting over 17 million American adults—
with or without a co-occurring condition—each year. Unfortunately, nearly two-thirds of them do not get
treatment, in part because the effects of Depression are not understood to be symptoms of an illness. With
proper treatment; however, nearly 80 percent of those with depressive illness can feel better, most within a
matter of weeks.
●
Depression affects mood, thought, body, and behavior. For some, it occurs in one of the more relatively
severe episodes known as Major Depression. Others have ongoing, less severe but also debilitating
symptoms known as Dysthymia. Still others have Bipolar Disorder (also known as Manic Depressive
Illness), with cycles of terrible “lows” and excessive “highs.”
●
If five or more symptoms last for two weeks or longer, or are severe enough to interfere with normal
functioning, an evaluation for Clinical Depression by a qualified health or mental health professional is
recommended.
Symptoms
Depression
Mania
●
●
●
●
●
●
●
●
●
●
●
●
●
●
Persistent sad, anxious or empty mood
Loss of interest or pleasure in activities, including sex
Irritability or excessive crying
Chronic aches and pains
Sleep disturbances
Eating disturbances
Decreased energy and fatigue
Thoughts of death or suicide
Difficulty with concentration, memory, or making decisions
Feelings of guilt, worthlessness, helplessness, hopelessness,
pessimism
●
●
●
●
●
Excessively “high” mood
Irritability
Decreased need for sleep
Increased talking, moving, and sexual
activity
Increased energy and activity
Racing thoughts
Poor judgment or decision-making
Grandiose notions
Being easily distracted
76
Causes
●
Symptoms of Depression such as weight loss, sleep disturbances, and low energy may also occur with
Diabetes, Thyroid Disorders, some Neurologic Disorders, Heart Disease, Cancer, and Stroke.
●
Loss of interest or memory also occur early in the course of disorders such as Parkinson's and Alzheimer’s
diseases.
●
Achiness or fatigue may be present in many other conditions. In such cases, careful assessment of an
individual’s emotional state and personal and family histories can help determine if one or two illnesses are
present.
●
Depression can occur as the biological result of a condition such as an under-active thyroid, or can be the
side-effect of one or a combination of medications, including over-the-counter medications. In such cases,
the Depression may be relieved by a change in dosage or type of treatment(s). On the other hand, it is not
unusual for a traumatic diagnosis, such as Cancer, to trigger a period of depressive symptomatology
including sadness, poor concentration, anxiety, or withdrawal. Careful monitoring of the length and severity
of depressive symptoms can determine if Clinical Depression is an additional diagnosis.
Treatments
●
When depressive illness is a co-occurring condition, it should be treated. With treatment, up to 80 percent of
those with Depression can show improvement, usually in a matter of weeks.
●
Common interventions include a range of antidepressant medications, focused short-term psychotherapy, or
a combination of the two.
●
In special circumstances, Electro-convulsive Therapy (ECT), a safe and effective treatment, may be
considered as an option. Which treatment is recommended depends on the severity of the Depression, the
type of co-occurring illness and its treatment, and to some degree, an individual preference.
●
Maximizing the treatment of the medical disorder may also help to diminish the depressive symptoms.
●
Treatment of Depression can improve a patient’s overall quality of life in several ways. It may enhance the
ability to follow the treatment regimen for the co-occurring medical condition, decrease complications, and
improve the eventual outcome.
●
Effective management of Depression can lessen the degree to which the patient is irritable, demanding, or
experiences overall problems in functioning; any of which may contribute to slower or more difficult
recovery, and greater stress and disability from the medical condition.
●
Controlling the Depression will often improve the cognitive symptoms that are a part of some illnesses.
●
Success involves a partnership with a health care provider so that an individual’s concerns can be addressed.
●
Negative thinking is a part of the Depression that will fade as symptoms resolve.
●
Family and friends can help by encouraging the depressed person to seek or remain in treatment and by
offering emotional support.
●
The following may be helpful adjuncts to treatment: support groups, mild exercise or hobbies, reading selfhelp materials.
Information in this fact sheet provided by the National Institute of Mental Health
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
77
Co-occurrence of Depression With
Heart Disease

Depression is a common, serious, and costly illness that affects 1 in 10 adults in the United States each year;
costs the nation between $30 to $44 billion annually; and causes impairment, suffering, and disruption of
personal, family, and work life.
●
Of particular significance, Depression often co-occurs with Heart Disease. When this happens, the presence
of the additional illness, Depression, is frequently unrecognized, leading to serious and unnecessary
consequences for patients and families.

About 18 to 20 percent of coronary heart patients without a history of heart attack may experience
Depression.
●
If a person has five or more of these symptoms for more than two weeks, it is important for these symptoms
to be brought to the attention of the individual’s health care provider.
Symptoms
●
●
●
●
●
Persistent sad or “empty” mood
Loss of interest or pleasure in ordinary activities,
including sex
Decreased energy, fatigue, being “slowed down”
Sleep disturbances (insomnia, early-morning
waking, or oversleeping)
Eating disturbances (loss of appetite and weight,
or weight gain)
●
●
●
●
●
●
Difficulty concentrating, remembering, making
decisions
Feelings of guilt, worthlessness, helplessness
Thoughts of death or suicide; suicide attempts
Irritability
Excessive crying
Chronic aches and pains that do not respond to
treatment
Causes
●
Research has documented a high correlation between Depression and increased risk of dying or impairment
in patients with Coronary Heart Disease.

Appropriate diagnosis and treatment of Depression may bring substantial benefits to the patient through
improved medical status, enhanced quality of life, a reduction in the degree of pain and disability, and
improved treatment compliance and cooperation.

In Coronary Heart Disease patients with a history of myocardial infarction (heart attack), the prevalence of
serious forms of Depression is estimated from 40 to 65 percent.
78

Major Depression puts heart attack victims at greater risk and appears to add to the patients’ disability from
Heart Disease. Depression can contribute to a worsening of symptoms as well as poor adherence to cardiac
treatment regimens.

People who survive heart attacks but suffer from Major Depression have a 3 to 4 times greater risk of dying
within six months than those who do not suffer from Depression.
Treatments

Though 80 percent of depressed people can be effectively treated, two-thirds of those suffering from this
illness do not seek or receive appropriate treatment. Effective treatments include both medication and
psychotherapy, which are sometimes used in combination.

Though depressed feelings can be a common reaction to Heart Disease, Clinical Depression is not the
expected reaction. For this reason, when present, specific treatment should be considered for Clinical
Depression even in the presence of Heart Disease.
Action Steps
●
Do Not Ignore Symptoms! Health care professionals should always be aware of the possibility of
Depression Co-occurring with Heart Disease. Patients or family members with concerns about this
possibility should discuss these issues with the individual’s physicians. A consultation with a psychiatrist or
other mental health clinician may be recommended to clarify the diagnosis.
●
Get the Word Out! NAMI IOWA emphasizes the importance of professional and public awareness of the
co-occurrence of Depression with Heart Disease and proper diagnosis and treatment of Depression.
●
Community, professional, and advocacy organizations, as well as the media can help spread important
messages about Depression Co-occurring with Heart Disease.
Information provided by National Institute of Mental Health.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
79
Co-occurrence of Depression With
Medical, Psychiatric, and
Substance Abuse Disorders
●
Depression is a common, serious, and costly illness that affects 1 in 10 adults in the United States each year;
costs the nation between $30 billion to $44 billion annually; and causes impairment, suffering, and
disruption of personal, family, and work life.
●
Though 80 percent of depressed people can be effectively treated, two-thirds of those suffering from this
illness do not seek or receive appropriate treatment.
●
Of particular significance, Depression often Co-occurs with Medical, Psychiatric, and Substance Abuse
Disorders. When this happens, the presence of both illnesses is frequently unrecognized and may lead to
serious and unnecessary consequences for patients and families.
Depression Co-occurs with Medical Illnesses
●
The rate of Major Depression among those with medical illnesses is significant. In primary care, estimates
range from 5 to 10 percent; among medical inpatients, the rate is 10 to 14 percent.
●
Depressed feelings can be a common reaction to many medical illnesses. However, Depression severe
enough to receive a psychiatric diagnosis is not the expected reaction to medical illness. For that reason,
when present, specific treatment should be considered for Clinical Depression even in the presence of
another disorder.
Research has shown that Major Depression occurs in the following:

Between 40 and 65 percent of patients who have had a heart attack. They may also have a shorter life
expectancy than non-depressed heart attack patients.

Approximately 25 percent of Cancer patients.

Between 10 and 27 percent of post-Stroke patients.
Failure to recognize and treat Co-occurring Depression may result in increased impairment and diminished
improvement in the medical disorder.
Proper diagnosis and treatment of Co-occurring Depression may bring substantial benefits to the patient through
improved medical status, enhanced quality of life, a reduction in the degree of pain and disability, and improved
treatment compliance and cooperation.
Depression Co-occurs with Psychiatric Disorders
A higher than average Co-occurrence of Depression with other psychiatric disorders, such as Anxiety and Eating
Disorders, has been documented.

Concurrent Depression is present in 13 percent of patients with Panic Disorder. In about 25 percent of these
patients, the Panic Disorder preceded the Depressive Disorder.
80

Between 50 and 75 percent of eating disorder patients (Anorexia Nervosa and Bulimia) have a lifetime
history of Major Depressive Disorder.
In such cases, detection of Depression can help clarify the initial diagnosis and may result in more effective
treatment and better outcome for the patient.
Depression Co-occurs with Substance Abuse Disorders
Substance Abuse Disorders (both alcohol and other substances) frequently co-exist with Depression.

Substance Abuse Disorders are present in 32 percent of individuals with Depressive Disorders. They cooccur in 27 percent of those with Major Depression and 56 percent of those with Bipolar Disorder.
Substance use must be discontinued in order to clarify the diagnoses and maximize the effectiveness of
psychiatric interventions. Treatment for Depression as a separate condition is necessary if the Depression
remains after the substance use problem is ended.
Action Steps
●
Do Not Ignore Symptoms! Health care professionals should be aware of the possibility of Depression
Co-occurring with Medical Illnesses. Individuals or family members with concerns about the Cooccurrence of Depression should discuss these issues with the physician. A consultation with a psychiatrist
or other mental health clinician may be recommended to clarify the diagnosis.
●
Get The Word Out! NAMI IOWA emphasizes the importance of (1) professional and public awareness of
the co-occurrence of Depression with medical, psychiatric, or substance abuse disorders; and (2) proper
diagnosis and treatment of Depression.
Information provided by National Institute of Mental Health
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
81
Co-occurrence of Depression With
Parkinson’s Disease
Depression can strike anyone, but people with Parkinson's disease, a progressive brain disorder
affecting more than 500,000 Americans,1 may be at greater risk. Treatment for Depression helps
people manage both diseases, thus improving the quality of their lives.
The true prevalence of Depression among people with Parkinson's disease is difficult to determine
because there are no standardized assessment tools designed to evaluate depressive symptoms in the
context of this illness. However, it is estimated to be quite common. As many as half of people with
Parkinson's may suffer from Depression.2
Despite the enormous advances in brain research in the past 20 years, Depression often goes
undiagnosed and untreated. People with Parkinson's, their families and friends, and even their
physicians may misinterpret Depression's warning signs, mistaking them for inevitable
accompaniments to Parkinson's disease. In addition, men, who are more likely to develop Parkinson's,
are more likely than women to have difficulty acknowledging Depression.
Symptoms of Depression










Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide or suicide attempts
Restlessness, irritability
If five or more of these symptoms are present every day for at least two weeks and interfere with
routine daily activities such as work, self-care, and childcare or social life, seek an evaluation for
Depression.
Symptoms of Depression may overlap with those of Parkinson's and other physical illnesses. However,
skilled health professionals will recognize the symptoms of Depression and inquire about their
duration and severity, diagnose the disorder, and suggest appropriate treatment.
82
Depression Facts
Depression is a serious medical condition that affects thoughts, feelings, and the ability to function in
everyday life. Depression can occur at any age. NIMH-sponsored research estimates that almost 10
percent of American adults, or about 19 million people age 18 and older, experience some form of
Depression every year.3 Although available therapies alleviate symptoms in over 80 percent of those
treated, less than half of people with Depression get the help they need.3,4
Depression results from abnormal functioning of the brain. The causes of Depression are currently a
matter of intense research. An interaction between genetic predisposition and life history appear to
determine a person's level of risk. Episodes of Depression may then be triggered by stress, difficult life
events, side effects of medications, or other environmental factors. Whatever its origins, Depression
can limit the energy needed to keep focused on treatment for other disorders, such as Parkinson's
disease.
People with Depression who have Parkinson's disease have a different symptom profile than those
without Parkinson's.2 The Parkinson's profile includes higher rates of anxiety, sadness without guilt or
self-blame, and lower suicide rates despite high rates of suicidal thoughts. Hormonal imbalances such
as hypogonadism and hypothyroidism, which can cause depressive symptoms, need to be looked at
carefully in these individuals. More research is needed to understand the relationship between
Parkinson's disease and Depression, Dementia, Anxiety Disorders, and Psychosis.
Parkinson's Disease Facts
Parkinson's disease is a chronic and progressive disorder of the brain primarily affecting the motor
system, but also affecting thinking and emotion. It results from the loss of brain cells that produce
dopamine, a chemical messenger that controls movement. The four primary symptoms of Parkinson's
are tremor or trembling in hands, arms, legs, jaw, and face; rigidity or stiffness of the limbs and trunk;
bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination.
Individuals may also have difficulty walking, talking, or completing other simple tasks. Early
symptoms are subtle and occur gradually. At present, there is no way to predict or prevent Parkinson's
disease.
Parkinson's disease affects both men and women. The disease is considerably more common in the
over-50 age group, with the increased life expectancy in this country and worldwide, an increasing
number of people will develop Parkinson's disease.
A variety of medications provide dramatic relief from the symptoms. However, no drug yet can stop
the progression of the disease, and in many cases medications lose their benefit over time. In such
cases, surgery may be considered. Some doctors recommend physical therapy or muscle-strengthening
exercises. Some new drugs have recently been approved, offering a wider choice of medications for
individuals with Parkinson's, while others are under investigation in this country and overseas in an
effort to obtain better therapeutic results with fewer side effects. Ongoing research is aimed at
discovering the cause of Parkinson's disease, finding better treatments, and ultimately preventing and
curing the disorder.
83
Get Treatment for Depression
Treating Depression can help people feel better and cope better with their Parkinson's treatment. While
prescription antidepressant medications are generally well-tolerated and safe for people with
Parkinson's, more research is needed to determine which antidepressants work best for people with
different subtypes of Parkinson's.2 Specific types of psychotherapy, or "talk" therapy, also can relieve
Depression. Studies have demonstrated the improvement of Parkinsonian symptoms in patients
receiving Electro-convulsive Therapy.5 Although there are many different treatments for Depression,
they must be carefully chosen by a trained professional based on the circumstances of the person and
family.
Treatment for Depression in the context of Parkinson's disease should be managed by a mental health
professional--for example, a psychiatrist, psychologist, or clinical social worker--who is in close
communication with the physician providing the Parkinson's disease treatment. This is especially
important when antidepressant medication is needed or prescribed, so that potentially harmful drug
interactions can be avoided. In some cases, a mental health professional that specializes in treating
individuals with Depression and co-occurring physical illnesses such as Parkinson's disease may be
available. People with Parkinson's who develop Depression, as well as people in treatment for
Depression who subsequently develop Parkinson's disease, should make sure to tell any physician they
visit about the full range of medications they are taking.
Use of herbal supplements of any kind should be discussed with a physician before they are tried.
Scientists have discovered that St. John's Wort, an herbal remedy sold over-the-counter and promoted
as a treatment for mild Depression, can have harmful interactions with some other medications. (See
the alert on the NIMH Web site: http://www.nimh.nih.gov/events/stjohnwort.cfm.)
Recovery from Depression takes time. Medications for Depression can take several weeks to work and
may need to be combined with ongoing psychotherapy. Not everyone responds to treatment in the
same way. Prescriptions and dosing may need to be adjusted. No matter how advanced the Parkinson's
disease; however, the person does not have to suffer from Depression. Treatment can be effective.
Other mental disorders, such as Bipolar Disorder (Manic-Depressive Illness) and Anxiety Disorders,
may occur in people with Parkinson's, and they too can be effectively treated. However, some
Parkinson's medications may worsen Mania in persons with co-occurring Bipolar Disorder.5 The
prevalence of Bipolar Disorder among individuals with Parkinson's is unknown, but people in
treatment for Parkinson's should be alert for symptoms of Bipolar Disorder. Bipolar Disorder is
characterized by intense mood swings and changes in behavior. For more information on Bipolar
Disorder and other mental illnesses, contact NIMH.
Remember, Depression is a treatable disorder of the brain. Depression can be treated in addition to
whatever other illnesses a person might have, including Parkinson's. If you think you may be depressed
or know someone who is, don't lose hope. Seek help for Depression.
For more information about Parkinson's disease, contact:
National Institute of Neurological Disorders and
Stroke (NINDS)
P.O. Box 5801
Bethesda MD 20824
Toil-free: 1-800-352-9424
Web site: http://www.ninds.nih.gov
84
References
1
Parkinson's disease backgrounder. National Institute of Neurological Disorders and Stroke. July 1,
2001. http://www.ninds.nih.gov/health_and_medical/pubs/parkinson's_disease_backgrounder.htm
2
Cognitive and emotional aspects of Parkinson's disease. National Institute of Neurological Disorders
and Stroke, National Institute on Aging, and National Institute of Mental Health working group
meeting, January 24-25, 2001. Unpublished summary.
3
Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive disorders service system.
Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives
of General Psychiatry, 1993; 50(2): 85-94.
4
National Advisory Mental Health Council. Health care reform for Americans with severe mental
illnesses. American Journal of Psychiatry, 1993; 150 (10): 1447-65.
5
McDonald W. Personal communication, 2001.
All material in this fact sheet is in the public domain and may be copied or reproduced without
permission from NIMH. Citation of NIMH as the source is appreciated.
DEPARTMENT OF HEALTH AND HUMAN SERVICES* PUBLIC HEALTH SERVICE*
NATIONAL INSTITUTES OF HEALTH NIH PUBLICATION No.02-5007 May 2002
For more information about depression and Parkinson's research at NIMH. contact:
National Institute of Mental Health (NIMH)
Office of Communications and Public Liaison
Information Resources and Inquiries Branch
6001 Executive Blvd., Rm. 8184, MSC 9663
Bethesda MD 20892-9663
Phone: 301-443 4513
TTY: 301-443-8431
Fax: 301-443-4279
Mental Health FAX 4U: 301-443-5158
Email: [email protected]
Web site: http://www.nimh.nih.gov
NIMH Depression Publications
Toll-free: 1-800 431-4211
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
85
Co-occurrence of Depression With
Stroke

Depression is a common, serious, and costly illness that affects 1 in 10 adults in the United States each year;
costs the nation between $30 billion to $44 billion annually; and causes impairment, suffering, and
disruption of personal, family, and work life.

Though 80 percent of depressed people can be effectively treated, two-thirds of those suffering from this
illness do not seek or receive appropriate treatment. Effective treatments include both medication and
psychotherapy, which are sometimes used in combination.

Though depressed feelings can be a common reaction to a Stroke, Clinical Depression is not the expected
reaction. For this reason, when present, specific treatment should be considered for Clinical Depression
even in the presence of a Stroke.

There are approximately 3 million Stroke survivors in the United States. In addition, an estimated 400,000
to 550,000 people experience Strokes each year, of which an estimated 10 to 27 percent experience Major
Depression. An additional 15 to 40 percent exhibit depressive symptomatology (not Major Depression)
within two months following Stroke.

Three-fourths of Strokes occur in people 65 years and over. With Stroke as a leading cause of disability in
older persons, proper recognition and treatment of Depression in this population is particularly important.

The average duration of Major Depression in Stroke patients has been shown to be just under a year.

Post-Stroke patients who are also depressed, particularly those with Major Depressive Disorder, are less
successful with rehabilitation, more irritable and demanding, and may experience personality change.
●
If a person has five or more of these symptoms for more than two weeks, it is important for these
symptoms to be brought to the attention of the individual’s health care provider.
Symptoms
●
●
●
●
●
Persistent sad or “empty” mood
Loss of interest or pleasure in ordinary
activities, including sex.
Decreased energy, fatigue, being “slowed
down”
Sleep disturbances (insomnia, earlymorning waking, or oversleeping)
Eating disturbances (loss of appetite and
weight,or weight gain)
●
●
●
●
●
●
Difficulty concentrating, remembering, making
decisions
Feelings of guilt, worthlessness, helplessness
Thoughts of death or suicide; suicide attempts
Irritability
Excessive crying
Chronic aches and pains that do not respond to
treatment
86
Causes

Of particular significance, Depression often Co-occurs with Stroke. When this happens, the presence of the
additional illness, Depression, is frequently unrecognized, leading to serious and unnecessary consequences
for patients and families.
●
Appropriate diagnosis and treatment of Depression may bring substantial benefits to the patient through
improved medical status, enhanced quality of life, a reduction in the degree of pain and disability, and
improved treatment compliance and cooperation.

Among the factors that affect the likelihood and severity of Depression following a Stroke are the location
of the brain lesion, previous or family history of Depression, and Pre-Stroke social functioning.
Treatment
●
The association between Depression and Stroke has long been recognized for its negative impact on an
individual’s rehabilitation, family relationships, and quality of life. Appropriate diagnosis and treatment of
Depression can shorten the rehabilitation process and lead to more rapid recovery and resumption of routine.
It can also save health care costs (e.g., eliminate nursing home expenses).
Action Steps
●
Do Not Ignore Symptoms! Health care professionals should always be aware of the possibility of
Depression Co-occurring with Stroke. Patients or family members with concerns about this possibility
should discuss these issues with the individual’s physicians. A consultation with a psychiatrist or other
mental health clinician may be recommended to clarify the diagnosis.
●
Get the Word Out! NAMI IOWA emphasizes the importance of professional and public awareness of the
Co-occurrence of Depression with Stroke and proper diagnosis and treatment of Depression.
●
Community, professional, and advocacy organizations as well as the media can help spread important
messages about Depression Co-occurring with Stroke.
Information provided by National Institute of Mental Health.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
87
Criminalization of the Mentally Ill
Mental Illnesses are neurobiological diseases that affect the brain. These illnesses include the following:
Schizophrenia, Bipolar Disorder, Major Depression, and Anxiety Disorders.
The major mental illnesses are diseases of the brain. We know
now that a person who is mentally ill has a medical disease just
as people have Heart Disease, Diabetes, or Cancer. In Mental
Illness, the part of the body that does not function well is the
brain. Depending on how the brain is affected, Mental
Illnesses take different forms. All are intensely disabling.

Over 5 million Americans suffer from a Mental Illness in any given year.

Severe Mental Illnesses are more common than Cancer, Diabetes, or Heart Disease.

Mental Illness disrupts a person’s ability to think, feel, and relate to others and his/her environment.

Mental Illnesses are very treatable illnesses. The treatment success rate is 60 percent for Schizophrenia,
80 percent for Bipolar Disorder, and 65 percent for Major Depression.

Criminalizing persons who have a Mental Illness makes no more sense than punishing persons with
Alzheimer’s Disease or brain tumors for the behavioral problems caused by their disease.
The Death Penalty:

NAMI IOWA (Alliance for the Mentally Ill) opposes the death penalty. If a death penalty is instated,
NAMI strongly opposes this sentence for persons who have a Mental Illness.

There is a strong belief in our society that people who have a Mental Illness are extremely violent. This
belief is not accurate. Research clearly shows that individuals with Serious Mental Illnesses are not more
dangerous than the general population when they are taking their medication.

A small subgroup of individuals with a Mental Illness, who are not taking medication, are more dangerous
than the general public. Dangerous behavior usually occurs because of symptoms of their illness, such as
voices telling them to harm someone or paranoid delusions. The majority (71 percent of persons) who are
assaultive or destructive of property have problems taking their medication. By taking medication, the
symptoms of their illness and the assaultive or destructive behavior can be controlled.

Because violent behavior shown by persons with a Mental Illness is usually a consequence of the disease,
they should be given appropriate treatment and rehabilitation for the illness, not punished for having a
biological disease.
88
Criminalization:

People who have a Mental Illness are not being served appropriately by the criminal justice system.

A criminal defendant is very rarely found to be insane - a term used to protect persons who have a Mental
Illness. Less than one-fourth of one percent of the number of defendants convicted of a felony are found to
be insane.

The majority of defendants with a Severe Mental Illness who commit a crime are destined for sentence to
state prison.

According to a 1999 Department of Justice report, at least 16 percent of the total jail and prison population,
or nearly 300,000 people, have a Serious Mental Illness – more than four times the number in state mental
hospitals.

Most persons with a Mental Illness who are in jail have no criminal charges whatsoever; many are in jail on
trivial charges, and a few on serious charges. Those with serious charges are individuals whose Mental
Illness has been left untreated.

In Iowa 25.9 percent of jails reported that they detain persons with a Serious Mental Illness who do not have
criminal charges against them.

The most common offenses cited by jails for arresting the mentally ill are assault/battery, theft, disorderly
conduct, and drug and alcohol-related crimes. Many of the offenses are merely manifestations of a Serious
Mental Illness, often untreated, and some are not even crimes.

More than one in five jails has no access to mental health services of any kind. Eighty-four percent of jails
report that corrections officers receive either no training or less than three hours training in the special
problems of mentally ill persons.

The jails are detaining many persons with a Serious Mental Illness, but do not have the services or personnel
to treat these individuals. Therefore, persons with a Mental Illness are punished for having a disease instead
of being given the appropriate treatment for the illness.
The Basic Steps for Developing a Jail Diversion Program
1. Designate a lead person for the planning process.
2. Identify the key agencies in the community and the people in those agencies who need to be involved.
● These usually will include police, jail administrators, jail mental health and health service
providers, district attorneys and prosecutors, public defenders, local judges and magistrates,
probation officers, community mental health and substance abuse treatment programs, housing
and social service providers, and consumer and family advocacy groups.
3. Meet regularly with all the key players to:
● Define the target group for diversion (e.g., people with Serious Mental Illnesses who have committed
non-violent crimes).
● Estimate the size of the target group for diversion.
● Identify the type and amount of services needed for the target group (e.g., screening for 100 percent of
the target group; same-day appointments upon diversion).
● Estimate the cost of needed services and locate funding sources.
● Agree on desired outcomes (e.g., fewer detainees with Mental Illnesses in the jail; fewer detainees
with Mental Illnesses released without adequate housing; a reduction in the number of jail days
per year).
● Specify measures for these outcomes.
89
4. Identify key positions for the diversion program:
● Create liaison positions.
● Recruit staff who reflect the cultural and racial diversity of program clients.
● Establish a specialized case management program.
5. Specify the pathways of the diversion process, using detailed flowcharts as a guide.
6. Designate specific responsibilities among participating agencies for each point in the pathway.
7. Develop a basic management information system to keep track of where people are in the diversion
process. This can be anything from informal 3x5 cards to standardized data entry screens on networked
personal computers.
8. Plan for the collection of basic data for the management information system and outcome data to justify the
program and help obtain future funding.
9. Communicate regularly with representatives from all key agencies through continued group meetings.
Recommendations:

Persons with a Mental Illness need to be given medical treatment for their illness.

Persons who commit a violent crime while they are psychotic should not be given the death penalty. Their
behavior should be recognized as symptomatic of a Mental Illness and the appropriate treatment should be
administered.

For persons with a known history of violence or criminal behavior, outpatient treatment should be closely
monitored to ensure medication compliance.

Comprehensive psychiatric services should be provided to inmates in jails. These services must include an
evaluation by a qualified mental health professional within 24 hours of admission to jail.

When inmates with Serious Mental Illnesses are released from jails, follow-up psychiatric care, as needed,
should be mandated by the courts as a condition of parole or probation.

Correction officers who work in jails and police officers in the community should receive annual training on
Serious Mental Illnesses.
Resources
●
Correct Care, A publication of the National Commission on Correctional Health Care (Vol 13, Issue 3,
Summer 1999, p 1)
● Persons with Severe Mental Illness in Jails and Prisons: A Review, by Lamb, M.D., H. Richard, and
Weinberger, Ph.D., Linda E., Psychiatric Services (Vol. 49, No. 4, April 1998)
● Jail Diversion, Creating Alternatives for Persons with Mental Illnesses brochure may be obtained free of
charge from Policy Research Associates, 345 Delaware Avenue, Delmar NY 12054, Phone: (866) 9626455; Fax: (518) 439-7612; Email: [email protected]
The research was funded by a grant from the National Institute of Mental Health (RO1-MH48523) Legal Studies Research Program to
Policy Research Associates, Inc., Henry J. Steadman, Ph.D., Principle Investigator.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
90
Dealing With the Criminal Justice
System
What should you know first about criminal law?
In criminal law, the outcome of a case depends as much on the facts of the case and the procedures followed in
developing that case as it does on the actual substantive law. Individuals involved in criminal cases will be most
affected by the procedural steps governing these cases from the time of arrest to the end of the case. Therefore, it
is essential to have a good criminal lawyer who has experience working with individuals with Mental Illness to
direct you through any encounter with the criminal justice system. If you are arrested, normally you won’t have
to stay in jail while you are waiting to appear in Court. A judge will set a bond, sometimes called “bail.” The
bail is normally 10-15 percent of the bond amount.
What is the difference between a misdemeanor and a felony?
Criminal violations come in two varieties, misdemeanors and felonies. Class 3 misdemeanor jail time is usually
30 days and may not exceed $500; Class 2 is usually 4 months and may not exceed $750; Class 1 is usually 6
months and may not exceed $2,500. Felonies may not exceed a fine of $150,000. Class 6 is a minimum of 6
months and maximum of 1.5 years; Class 5 is from 9 months to 2 years; Class 4 is from 1.5 years to 3 years;
Class 3 is from 2.5 years to 7 years; and Class 2 is from 4 years to 10 years.
When does an arrest take place?
An arrest occurs when the police take a person into custody in order to charge that person with a crime. To
make a lawful arrest, a police officer must believe that the person to be arrested committed a crime. This is
important in the context of Mental Illness because an arrest does not occur every time a person with Mental
Illness is picked up or taken into custody by police.
What is booking?
A person is booked by an entry showing his/her name and address, a list of any property taken from him/her, the
date and time of booking, and the submission of a booking information summary to the person making the entry
in the police or jail book. These booking information summaries are always open for public inspection. The
person is then fingerprinted and photographed.
What should the family do during the interrogation?
Family members should try to prevent the police from questioning a family member with Mental Illness without
a lawyer present. Any person who is questioned by the police and is not free to end the questioning and leave
the place where he/she is being questioned must be given a Miranda warning. (The right to remain silent, etc.)
The police must immediately stop questioning anyone who asks for a lawyer.
How do you find a lawyer?
Competent criminal lawyers are almost always available, even if your budget is limited. The first place to seek a
lawyer if you cannot afford to pay a full fee for a private lawyer is through public defender services, courtappointed attorneys, local criminal defense lawyers' associations, or local bar associations.
The United States Constitution guarantees legal representation to every defendant in a felony criminal case.
Therefore, if a defendant to a felony charge cannot afford a lawyer, the state must provide him/her with one.
What are your constitutional rights?
The person arrested has a right to procure and confer with counsel and to use a telephone or send a message for
the purpose of communicating with his/her friends or with counsel.
91
●
●
●
●
The Fourth Amendment guarantees the right against unreasonable searches and seizures. Usually a warrant
is required.
The Fifth Amendment guarantees the right against self-incrimination, which is the well-known right to
remain silent.
The Sixth Amendment guarantees the right to a speedy trial.
The Eighth Amendment protects people from cruel and unusual punishment. In addition, it protects the right
to treatment for acute medical problems, including psychiatric problems.
Who decides to file charges?
The decision to file charges is often made by the police and the prosecutor's office together.
What is jail diversion?
Jail diversion is a procedure in which a person with Mental Illness who has been charged with a crime agrees to
participate in treatment voluntarily. In exchange for participating in treatment, the charges are either dropped or
modified, pending satisfactory compliance with treatment. Jail diversion must be distinguished from probation
and a suspended sentence (which are similar), which entail a conviction being entered onto the defendant's
criminal record, either by guilty plea or by a verdict. This has resulted in a reduction in the mentally ill
population held in the county jail facilities.
Can a person stand trial if he/she is viewed as incompetent?
No person can be tried or sentenced for a crime if, because of a mental disease or defect, he/she cannot
understand the nature of the proceedings against him/her or assist his/her lawyer in preparing a defense. A
criminal found not competent to stand trial is usually subject to civil commitment for an indefinite period.
Sometimes medication is needed in order to achieve competency.
If a person is found competent to stand trial, can he/she invoke the insanity
defense?
Yes. A determination of competency does not prevent a defendant from raising the insanity defense.
Within the criminal justice system policymakers and practitioners can develop new means of working
collaboratively with other community institutions to assess, diagnose, and respond appropriately to criminal
involvement of mentally ill offenders.
What a family member/spouse should do
●
●
●
●
●
●
Make a list of the behaviors that make you think the person being incarcerated has an illness.
Take your list to a psychiatrist, psychologist, or your own doctor, to see if he/she thinks the person has an
illness.
Take your list and what the doctor suggested, and go to the City Clerk’s Office to fill out paperwork.
The paperwork is to have the person committed. This must be notarized.
Take all the paperwork to a judge.
Make sure you ask a lot of questions.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
92
AIDS and Mental Illness

Acquired Immune Deficiency Syndrome (AIDS) is, at this point, an incurable syndrome characterized by a
variety of diseases that appear in an individual due to damage to his/her immune system. AIDS is caused by
a virus called the Human Immunodeficiency Virus (HIV). Many times a person who is infected with HIV
will not have any symptoms for up to five years; thus will be unaware that he/she is infected. Although no
symptoms may be apparent, a person with HIV can infect someone else with the virus.

HIV lives in bodily fluids such as blood, semen, and vaginal fluids. The viruses are usually transmitted
through intercourse (vaginal or anal), oral sex, or sharing needles or syringes with someone who is infected.
Mothers may pass the virus on to their unborn children through their shared blood supply.
People who have a mental illness are at increased risk of HIV infection.

Rates of HIV and AIDS are higher in persons with Severe Mental Illness (Seeman, et al., 1990; Cournos, et
al., 1991; Sacks, et al., 1992).

In New York City during 1989-1991, the rate of HIV infection for persons admitted to the psychiatric unit
was 5.3 to 16 percent; the rate for persons admitted for child birth was 1.2 percent.

Impairments in judgment make the use of condoms and other safe sexual activities and clean needle
precautions less likely for persons with a Mental Illness.

People who have a Mental Illness, particularly the homeless, frequently live in impoverished, inner city
areas where HIV exists at an overall increased prevalence.

People who have a Mental Illness frequently encounter situations that lead to high-risk behavior such as
sexual coercion by others or sexual activity after substance abuse.

There is a clear lack of education about HIV and AIDS in persons with a Mental Illness in comparison to the
general population.
Preventions

People should be educated in relevant, usable, and understandable ways about how to prevent infection.
They especially need to be educated about the importance of latex condom use.

People with Mental Illness need appropriate support services to help them cope with their illness. These
services help the individual maintain recovery, which may decrease drug use and poor decision making.
93

HIV testing needs to be incorporated into the mental health system to alert persons who may have HIV of
their condition and ways to prevent the spread of the virus.

Assertiveness training for people who have a Mental Illness will empower them to stop some risky
behaviors, such as having unprotected sex.
Suggested Readings







100 Questions & Answers about AIDS by Ford, Michael Thomas
The Guide to Living with HIV Infection developed at the Johns Hopkins AIDS Clinic (Revised Edition) by
Bartlett, John G., M.D., & Finkbeiner, Ann K.
Staying Sane: When You Care for Someone with Chronic Illness by Pohl, M.D., Melvin & Kay, Ph.D.,
Deniston J.
Serenity: Support and Guidance for People with HIV, Their Families, Friends, and Caregivers by Reed,
Paul
Just Hold Me While I Cry by Stasey, Bobbie
After You Say Goodbye: When Someone You Love Dies of AIDS by Froman, Ph.D., Paul Kent
Face to Face: A Guide to AIDS Counseling by Diliey, James W.; Piesand, Cheri; & Helquist, Michael
For additional information on AIDS, contact AIDS Services at (800) 445-2437.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
94
Dual Diagnosis: Mental Illness and
Mental Retardation
●
The occurrence rate of Mental Illness in individuals who are Mentally Retarded is estimated to range from
10 to 40 percent; the average rate is 15 percent.
●
Individuals with Mental Retardation may experience any type of Mental Illness. These illnesses may be
Schizophrenia, Bipolar Disorder, Depression, Anxiety Disorders, or any other type of illness.
●
There is a 6 to 7 percent incidence of Depression in individuals with Mental Retardation. Depressive
Disorders are the most common disorder for people with Mental Retardation and seizures.
●
Over 65 percent of persons with Mental Retardation who were independently assessed as having a Dual
Diagnosis had not received clinical mental health treatment.
Symptoms
Schizophrenia
●
●
●
●
Altered affective responses
Bizarre rituals
Sleep disorder
May express simple grandiose or paranoid ideas
of reference
●
●
●
Interpersonal distancing
Fearfulness
Hallucinations without a complex
delusional system
●
Unrealistic family expectations
Anxiety
Symptoms of anxiety linked to external factors, such as:
●
●
Chronic frustration
Persistent interpersonal deprivations
Depression
●
●
●
Fears that family, caretakers, and friends no longer love or care for them
Increased fearfulness and dependence to the point of clinging
Vegetative signs
Bipolar
●
●
Mania may be on a smaller scale than what
is typical
Rapid cycles of depression and mania
●
●
Mania may be seen as positive progress
Grandiosity and aggressiveness seen as
symptom of the mental retardation
95
Diagnosis
●
Making a diagnosis is very complicated when the individual also has Mental Retardation. The symptoms of
Mental Illness many times look different in an individual with Mental Retardation. The research available
for clinicians regarding Dual Diagnosis assessment and issues is limited.
●
It is even more difficult to make a diagnosis when an individual has more severe forms of Mental
Retardation. Limited speech, communication skills, and cognitive functioning create more complications in
making a diagnosis.
●
Frequently inappropriate behavior is blamed on either the Mental Retardation or Mental Illness; one
diagnosis overshadows the other. The two diagnoses are not considered together, as dual medical disorders
create problems. By viewing the disorders separately, professionals not trained in Dual Diagnosis may shift
the person from the mental health system to the mental retardation system or vice versa. By doing this, the
individual never gets the appropriate treatment, because his/her dual disorders are not considered to be
interacting.
Treatment
●
Everyone with Mental Retardation who needs mental health services does not get referred for them.
●
Usually persons displaying aggressive or destructive behavior are the individuals who get referred for mental
health services. Individuals showing signs of Depression may get overlooked due to their lack of clearly
disruptive behaviors.
●
Mental Illnesses are primarily treated with medications. It is important to use the appropriate medication for
a specific illness. Frequently psychotropic medications are overused in persons with Mental Retardation.
Some medications are given to individuals merely to calm them down, and may be an inappropriate use.
Psychotropic medications should only be prescribed by a physician who is specially trained in the use of
these medications.
●
Clinicians are now becoming more concerned about dual diagnosis issues. More research is focusing on the
needs of this group of people. Services for, and treatment of, individuals with dual diagnoses are improving.
●
Many times a person will be shifted from one system to the other. Neither the mental retardation nor the
mental health systems are sure what to do, so they move the person back and forth.
●
People with Mental Retardation are less likely to receive a full array of mental health services from the
Community Mental Health Services. The treatment of choice tends to be the use of behavioral treatments.
The use of “talking” therapies or cognitive therapy is usually avoided.
●
It is important to note that behavioral disturbances related to psychiatric disorders are frequently the factors
blocking community integration, housing, social acceptance, and vocational success. Therefore, unless a
Mental Illness is treated, a person’s chance of being successful in the community is limited.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
96
Dual Diagnosis:
Mental Illness and Substance Abuse
●
Many families know how difficult it is to find treatment for their relatives who have a Mental Illness and
also abuse drugs or alcohol. Programs that treat people with Mental Illness usually do not treat substance
abusers, and programs for substance abusers are not geared for people with Mental Illness. Individuals with
both diagnoses often bounce from one program to another, or are refused treatment by single-diagnosis
programs.
●
Dual Diagnosis means the condition is especially complex and difficult to manage. Families with a duallydiagnosed member may experience twice the problems of those whose family member has only one
disorder.
●
The combination of Mental Illness and Substance Abuse is so common that many clinicians who work with
the persons who have a Mental Illness now expect to find it. Studies show that approximately 50 percent of
persons with Mental Illness also have a substance abuse problem. And more than half the persons with a
Substance Abuse diagnosis also have a diagnosable Mental Illness.
Some Symptoms of Substance Abuse
●
●
●
Money problems
Having new friends
Valuables disappearing
●
●
●
Long time in the bathroom
Dilated or pinpointed eyes
Needle marks
Causes
●
Mental health and addiction counselors increasingly believe that Mental Illness and Substance Abuse are
biologically- and physiologically-based.
●
Families may feel angry at the person and blame him/her for being foolish and weak-willed. They may feel
hurt when the person breaks trust through lying or stealing. But it’s important for them to realize that
Mental Illness and Substance Abuse are diseases and that the person cannot take control of the problem
without help.
Treatments
●
Psychotherapy, medication and Electro-convulsive Therapy (ECT) combined with appropriate self-help and
other support groups are most effective, but these patients are still highly prone to relapse.
●
Treatment programs designed only for substance abusers are not recommended for people who also have a
Mental Illness. Heavy confrontation, intense emotional jolting without adequate support, and
discouragement of use of appropriate medications tend to compound the problems of consumers. These
strategies may produce stress levels that make symptoms worse or cause relapse.
●
Increasingly, the psychiatric and drug counseling communities agree that both disorders must be treated at
the same time. Early studies show that when Mental Illness and Substance Abuse are treated together,
suicide attempts and psychotic episodes decrease rapidly.
●
The presence of both disorders must first be established by careful assessment. This may be difficult
because the symptoms of one disorder can mimic the symptoms of the other.
97
●
Once an assessment has confirmed a Dual Diagnosis of Mental Illness and Substance Abuse, mental health
professionals and family members should work together on a strategy for integrating care and motivating the
client.
● There are a growing number of model programs. All of them have support groups similar to Alcoholics
Anonymous and Narcotics Anonymous. Members support each other as they learn about the role of alcohol
and drugs in their lives.
● They learn social skills and how to replace substance use with new thoughts and behaviors. They get help
with concrete situations that arise because of Mental Illness. Several programs have support groups for
family members and friends.
If Your Loved One is Addicted to Drugs and/or Alcohol
1. Do not regard it as a family disgrace. Recovery from an addiction is possible, just as with other illnesses.
2. Do not nag, preach, or lecture to the addict/alcoholic. Chances are, he/she has already heard or told
him/herself everything you can say. You may only increase the need to lie or force him/her to make
promises that cannot be kept.
3. Guard against a “holier than thou” or martyr-like attitude.
4. Do not use the “if you loved me” approach. It is like saying, “If you loved me, you would not have
tuberculosis.”
5. Avoid threats unless you think them through carefully and definitely intend to carry them out. Idle threats
only make the addict/alcoholic feel you do not mean what you say.
6. Do not hide the alcohol/drugs or dispose of them. Usually this only pushes the addict into a state of
desperation.
7. Do not let the addict/alcoholic persuade you to drink or use with him/her. When you condone the
drinking/using, he/she may likely put off doing something to get help.
8. Do not be jealous of the method of recovery the addict/alcoholic chooses. You may feel left out when the
addict/alcoholic turns to other people for help to stay sober. If someone needed medical care, you would not
be jealous of the doctor.
9. Do not expect an immediate 100 percent recovery. As in any other illness, there is a period of
convalescence. There may be relapses and times of tension and resentment.
10. Do not try to protect the recovering person from drinking/using. He/she must learn on his/her own to say
“no” gracefully.
11. Do not do for the addict/alcoholic that which he/she can do for him/herself. You can not take the medicine
for him/her. Do not remove the problem before the addict/alcoholic can face it, solve it, or suffer the
consequences.
12. Do offer love, support, and understanding in the recovery.
Suggested Readings


Dual Diagnosis: Counseling the Mentally Ill Substance Abuser by Evans, Katie and Sullivan, J. Michael,
Dual Diagnosis of Major Mental Illness and Substance Disorder by Minkoff, Kenneth and Drake, Robert
E., Editors.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
98
Anorexia Nervosa
●
A person with Anorexia Nervosa is hungry, but he/she denies the hunger because of an irrational fear of
becoming fat.
●
Anorexia Nervosa is characterized by self-starvation, food preoccupation and rituals, compulsive exercising,
and often an absence of menstrual cycles.
●
The most common cause of death in a long-time anorexic is low serum potassium, which can cause an
irregular heartbeat.
●
Research suggests that about 1 percent or one out of every one-hundred young women between 10 and 20
years of age are starving themselves, sometimes to death.
Symptoms/Warning Signs
●
Refuses to maintain normal body weight
or weighs 85 percent or less than expected
for age and height
● In women, menstrual periods stop
● In men, levels of sex hormones fall
● Is terrified of becoming fat
●
●
●
●
●
Strange eating habits
Withdrawn
Irritable
Depressed
Feels fat even when
very thin
Causes
●
A person with a family member who has had Anorexia Nervosa is 12 times more likely to develop the
disorder.
●
People with Eating Disorders tend to be perfectionist, have anxiety, and have obsessive compulsive thoughts
and behaviors.
●
Some people feel smothered, abandoned, and misunderstood by family members.
●
Feels pressure from romantic partners and appearance-obsessed friends.
●
Triggers can sometimes cause Eating Disorders such as shock, loss, increased demands, puberty, starting a
new school, beginning a new job, death, divorce, marriage, family problems, teasing, and competition.
99
Treatments
●
Most people with Eating Disorders, especially in the beginning, resist treatment and behavior change. They
cling to the illusion that if they just lose enough weight, they will feel good about themselves, improve their
lives, and enjoy self-confidence and success.
●
Eating Disorders are treatable. Recovery is a difficult process that can take several months or even years.
The best help is working with physicians and counselors who help them both with the medical and
psychological issues that contribute to, or result from, the Eating Disorder.
●
First symptoms are easier to reverse than behaviors that have become entrenched. Arrange for him/her to
have a thorough evaluation and treatment, if it is indicated.
●
If your doctor or counselor recommends hospitalization, do it. It may be lifesaving.
●
Model health food and exercise behaviors; talk about the difference between dieting and healthy meal plans.
●
Encourage the person to talk things over with a physician or counselor. Talk to the person when you are
calm; be kind.
●
Never nag, plead, beg, bribe, threaten, or manipulate. Do not have power struggles.
●
Do not tell the person that he/she is not fat or it is good to have gained weight.
Further Resources
National Association of Anorexia Nervosa and Associated Disorders, P.O. Box 7, Highland Park IL 60035.
National Hotline: (847) 831-3438, Fax: (847) 433-4632, Web site: www.anad.org.
Anorexia Nervosa and Related Eating Disorders, Inc (ANRED), is affiliated with National Eating Disorder
Association (NEDA), (800) 931-2237, www.anred.com or www.nationaleatingdisorders.org
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
100
Bulimia Nervosa
●
Bulimia Nervosa is characterized by recurring periods of binge eating, during which large amounts of food
are consumed in a short period of time.
●
The bulimic is fearful of not being able to stop eating and is afraid of being fat.
●
He/she usually feels depressed and guilty after a binge.
●
The binges are followed by purging, through self-induced vomiting, abuse of laxatives and/or diuretics, or
periods of fasting.
●
The bulimic’s weight is usually in a normal or somewhat above normal range; it may fluctuate more than 10
pounds due to alternating binges and fasts.
●
Research suggests that about 4 percent or 4 out of 100 college-aged women have bulimia.
Symptoms/Warning Signs
●
●
●
●
Feels out of control while eating
Vomits, misuses laxatives
Exercises or fasts
Believes self-worth requires being thin
●
●
●
●
May shoplift
Risk-taking behavior
Weight may be normal or near normal
Abuses alcohol, drugs, and credit cards
Causes
●
A person with a family member who has had Anorexia Nervosa is 12 times more likely to develop the
disorder.
●
People with Eating Disorders tend to be perfectionist, have anxiety, and have obsessive compulsive thoughts
and behaviors.
●
Some people feel smothered, abandoned, misunderstood by family members.
●
Feel pressure from romantic partners and appearance-obsessed friends.
●
Triggers can sometimes cause Eating Disorders such as shock, loss, increased demands, puberty, starting a
new school, beginning a new job, death, divorce, marriage, family problems, teasing, and competition.
101
Treatments
●
Most people with Eating Disorders, especially in the beginning, resist treatment and behavior change. They
cling to the illusion that if they just lose enough weight, they will feel good about themselves, improve their
lives, and enjoy self-confidence and success.
●
Medication to relieve Depression and Anxiety. Also individual counseling to develop healthy ways of
taking control of one’s self.
●
Eating Disorders are treatable. Recovery is a difficult process that can take several months or even years.
The best help is working with physicians and counselors who help them with both the medical and
psychological issues that contribute to, or result from, Eating Disorders.
●
First symptoms are easier to reverse than behaviors that have become entrenched. Arrange for him/her to
have a thorough evaluation and treatment, if it is indicated.
●
If your doctor or counselor recommends hospitalization, do it. It may be lifesaving.
●
Model healthy food and exercise behaviors Talk about the difference between dieting and healthy meal
plans.
●
Encourage the person to talk things over with a physician or counselor. Talk to the person when you are
calm; be kind.
●
Never nag, plead, beg, bribe, threaten, or manipulate. Do not have power struggles.
●
Do not tell the person that he/she is not fat or it is good to have gained weight.
Further Resources
National Association of Anorexia Nervosa and Associated Disorders, P.O. Box 7, Highland Park IL 60035.
National Hotline: (847) 831-3438, Fax: (847) 433-4632, Web site: www.anad.org.
Anorexia Nervosa and Related Eating Disorders, Inc (ANRED), is affiliated with National Eating Disorder
Association (NEDA), (800) 931-2237, www.anred.com or www.nationaleatingdisorders.org
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
102
Education Programs
Family-to-Family
This free course provides basic education and skill training for family members and close friends who must cope
with the difficulties of their mentally ill relatives and friends. This twelve-session course is taught by highly
trained family members.
The curriculum focuses on major psychiatric illnesses, emphasizing the clinical treatment of these illnesses, and
teaching the knowledge and skills family members need to cope more effectively with them.
Session titles include the following: Brain Biology, Problem Solving, Medication Review, Inside Mental
Illness, Communication Skills, Self-care, Rehabilitation, and Advocacy.
Family-to-Family is dedicated to the idea that families are truly experts in coping with the unique challenges
presented by their relative with Mental Illness. Family members are often best suited to provide the on-going,
compassionate support needed by the child, spouse, parent, sibling, or friend based on their knowledge and
experience with the person with Serious Mental Illness.
Peer-to-Peer
This is a free nine-week course for individuals with severe brain disorders. Each two-hour session is taught by a
team of three trained “mentors” who are personally experienced at living well with Mental Illness.
Participants come away from the course with a binder of hand-out materials, as well as other tangible resources
such as an advance directive; a “relapse prevention plan” to help identify feelings, thoughts, behaviors, or events
that may warn of impending relapse; information on how to organize for intervention; mindfulness exercises to
help focus and calm thinking; and survival skills for working with providers and the general public.
Class topics include the following: Stigma and Discrimination, Relapse Prevention Planning, Story Telling,
Language, Emotions, Addictions, Spirituality, Medication, Coping Strategies, Decision Making, Relationships,
Empowerment, and Advocacy.
Provider Education
This is a ten-week course for mental health professionals of public and private agencies who work directly with
individuals suffering from severe and persistent brain disorders. Trained NAMI IOWA volunteer family
members, consumers, and mental health professionals teach as a team.
This course helps providers realize the hardships that families and consumers endure and appreciate the courage
and persistence it takes to find ways to reconstruct lives which must be lived, through no fault of the consumer
or family. Taught in addition to the academic medical information in the course are the emotional aspects and
practical consequences of these illnesses.
NAMI Basics
This is a six-week course for parents and primary caregivers of children and adolescents who are living with a
mental illness. It’s taught by parents or other primary caregivers who have lived similar experiences with their
own children. NAMI Basics allows families to connect to one another while learning about mental illness and
empowering themselves to overcome new challenges. It provides information families want and need about
their child.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
103
The Americans With Disabilities Act
(ADA)
& Employment of Persons With
Psychiatric Disabilities
What is the ADA?

The Americans with Disabilities Act (ADA) is a federal law regarding civil rights which makes
discrimination against people with disabilities in certain situations illegal.

Title I of the ADA provides that no employer with 15 or more employees shall discriminate against a
qualified individual with a disability because of the disability in regard to job application procedures, hiring,
advancement, employee compensation, job training, and other privileges of employment (42 USC 12112).
How is Disability Defined?

A disability is defined by the ADA in four ways.
1. A physical or mental impairment that substantially limits one or more of the major life activities of
an individual
2. A record of such an impairment
3. Being regarded as having such an impairment (42 USC 12102)
4. Persons discriminated against because they have a known association or relationship with an
individual with a disability also are protected

Mental impairments are defined as “...any mental or psychological disorder, such as...emotional or mental
illness” (29 CFR 1630.2).

The term “substantially limits” means,
1. A person is unable to perform a major life activity that the average person in the general population
can perform.
2. A person is significantly restricted as to the condition, manner, or duration under which he/she can
perform a particular major life activity (such as work) as compared to the condition, manner, or
duration under which the average person in the general population can perform that same major life
activity.
Employment, ADA, and Psychiatric Disabilities

The ADA makes it illegal for employers to ask an applicant about his/her medical or disability status.
Employers may require a medical exam after a job offer has been made as long as all applicants are required
to have an exam and the results are kept confidential. A job offer may be rescinded based on the results of
an exam only if the exclusionary criteria are job-related, consistent with business necessity, and demonstrate
that the applicant could not perform an essential function of the job.

An employer is not required to hire, promote, or retain any individual with a disability. The ADA serves to
protect persons who are qualified for a job. Being qualified for a job is defined as an individual with a
disability who, with or without reasonable accommodation, can perform the essential functions of the
employment position.
Reasonable Accommodations

Modification or adjustment to a job or the work environment that will enable a qualified applicant or
104
employee with a disability to participate in the application process or to perform essential job functions

Adjustments to assure that a qualified individual with a disability has rights and privileges in employment
equal to those of employees without disabilities

Making existing facilities used by employees readily accessible to and usable by an individual with a
disability, restructuring a job, modifying work schedules, acquiring or modifying equipment, providing
qualified readers or interpreters, or appropriately modifying examinations, training, or other programs
●
Employer reassigning a current employee to a vacant position for which the individual is qualified, if the
person is unable to do the original job because of a disability, even with an accommodation
●
Employers are not required to lower quality or quantity standards as an accommodation nor are they
obligated to provide personal use items such as glasses or hearing aids
●
An employer is only required to accommodate a “known” disability of a qualified applicant or employee
Specific Issues for Persons who have a Psychiatric Disability

Persons who have a psychiatric disability are in an awkward situation because they must show that they are
qualified for a job and also have a disability that substantially impairs a life area (usually work). This
situation is a catch-22 for the individual. If a person shows that he/she has a disability, it may mean that
he/she is then not qualified for the job, or vice versa.

Persons who have a psychiatric disability must decide whether or not to disclose their disability. This is a
difficult decision due to the stigma surrounding these disabilities. The disclosure of a psychiatric disability
may lead to a change in working relationships, misinterpretations of a person’s behavior as pathological,
harassment, isolation, and stigmatizing assumptions about his/her ability. However, disclosure may also
bring an individual support, understanding, the chance to educate others regarding the disability, and
improved self-esteem.
ADA Resources





Iowa Division of Persons with Disabilities – general information, (515) 242-6334 or (888) 219-0471, Web:
www.state.ia.us/government/dhr/pd
Job Accommodation Network – information on accommodations, (800) 526-7234, Web: www.jan.wvu.edu
Equal Employment Opportunity Commission–information on Title I and technical assistance, 1801 L Street
NW, Washington DC 20507 (800) 669-4000, Web: www.eeoc.gov
National Institute on Disability and Rehabilitation Research – technical assistance, (800) 949-4232, Web:
www.ed.gov/offices/OSERS/NIDRR
Iowa Civil Rights Commission – to report a violation of the ADA, (515) 281-4121 or (800) 457-4416,
Web: www.state.ia.us/government/crc
Fear, ignorance, and misperceptions about psychiatric disability undoubtedly contribute to employment
discrimination. Furthermore, the education of employers and co-workers about mental disorders as
well as employee willingness to disclose a psychiatric disability will be critical. Office of Technology
and Assessment, 1994
The information on this sheet was taken from Psychiatric Disabilities, Employment, and the Americans with Disabilities
Act, by the U. S. Congress, Office of Technology Assessment, 1994.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
105
Dealing with Mental Illness
In the Workplace
Four-step procedure:
Observation and Documentation

Watch for changes in attendance, on-the-job behavior, performance, productivity, and characteristics of
mental illnesses in all personnel.

If a pattern is noticed, document the behaviors – be specific.
Constructive Dialogues

If there is reason to believe that an employee is exhibiting signs of Mental Illness, address the issue with the
employee after consulting with an Employee Assistance Program (EAP) counselor.

Focus on job related issues, not private life.

Reassure the employee that the purpose is to regain the level of performance he/she is capable of
performing.

It is not the supervisor’s role to make a diagnosis, but to help a person seek treatment.
Referrals

Refer to an EAP counselor and explain employee’s situation to the EAP counselor.

If not available, refer to a psychiatrist, therapist, or to the Mental Health Center/hospital.

Present as a positive step, not as a punishment.
Follow-ups

Set follow-up session – agree on specific goals for meeting performance standards.

Show compassion without indulging in pity, monitor the employee’s performance without making him/her
feel spied on, and exhibit interest and concern without appearing nosy.

Consider impact of working with a mentally ill person on fellow employees – may be carrying an extra
workload; may feel frustrated.

Make necessary accommodations – these may include an adjusted work schedule, reducing distractions, etc.

Supervisor can suggest that co-workers see an EAP or other counselor for help in understanding the illness
and overcoming the resentment – also, information is available through NAMI IOWA.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
106
Job Accommodations for People
Who Have a Mental Illness

Employers are required by the Americans with Disabilities Act (ADA) to provide reasonable
accommodations to qualified employees who have a disability. The accommodations would allow a person
who possesses the skills and abilities needed for a job to succeed at the job regardless of his/her disability.
Accommodations that cause an undue hardship on the employer do not need to be provided.

The following are possible accommodations for an individual who has a Mental Illness. This list only offers
suggestions; accommodations must be made based on an individual’s needs.
Flexibility






Providing a self-paced workload and flexible hours
Allowing people to work at home, and providing necessary equipment
Providing supported employment opportunities
Keeping the job open and providing a liberal leave policy
Changing supervisors within the same organization
Providing time off for professional counseling
Supervision








Providing written job instructions
Providing significant levels of structure and one-to-one supervision
Providing easy access to supervisor
Developing strategies to anticipate and deal with problems before they arise
Providing encouragement along with criticism
Arranging for an individual to work under a supportive and understanding supervisor
Providing individualized agreements
Talking with employee about interpersonal skills without it affecting his/her record
Emotional Supports





Providing praise and positive reinforcement
Being tolerant of different behaviors
Allowing telephone calls during work hours to friends or others for needed support
Assisting the individual in coping with stress and crisis situations
Pairing individuals with other employees who are willing to help
Physical Accommodations



Modifying work area to minimize distractions
Modifying work area for privacy
Providing an environment that has reduced noise and natural light
Dealing with Co-workers’ Attitudes


Providing sensitivity training for co-workers
Facilitating open discussions with workers with and without disabilities to articulate feelings and to develop
strategies to deal with these issues
Taken from the President’s Committee on Employment of People with Disabilities, 1993
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
107
Questions on Americans With
Disabilities Act’s (ADA) Role for
Workers with Psychiatric Disabilities
Q. Are people with mental illnesses covered by ADA?
In general, yes. But people will not be covered just because they have been given a psychiatric label. The
ADA defines “an individual with a disability” on the basis of functional limitations, not medical diagnoses. The
definition of “disability” is a person with a physical or mental impairment that substantially limits one or more
major life activities, such as: caring for oneself, learning, and working.
People who are discriminated against on the basis of a past history of a disability or because they are
regarded as having a disability are also covered. This would include a past record of Mental Illness (i.e., a
history of treatment in a psychiatric hospital).
Q. Can employers ask if I have a mental illness?
No. This is one of the most fundamental protections the ADA brings to mental health consumers. An
employer covered under the ADA cannot ask applicants questions such as, “Do you have a disability?” or “Have
you ever had serious emotional problems?” The correct way for employers to make pre-employment inquiries is
describe the job duties and performance standards, then ask if the applicant can meet them. They may ask for
evidence of past work experience or references from a previous job.
Q. What if I never reveal I have an illness and I later find I need
accommodation?
You can be covered once you disclose your disability. Similarly, current employees who become disabled
may request accommodations.
Q. Does an employer have to make any accommodation I ask for?
No.
Q. What are reasonable accommodations for workers with Psychiatric
Disabilities?
Typically, accommodations for workers with Psychiatric Disabilities have included changes in the
supervisory process, the provision of human assistance, schedule modifications, changes in physical aspects of
the workplace, restructuring of job duties, and adjustment in policies.
Q. Will the ADA end pre-existing condition clauses or low lifetime limits on
insurance?
No. The ADA requires covered employers to offer the same benefits package to all workers. It does not
preclude the use of clauses that make insurance less useful to some workers or require comparability between
mental and other medical treatments.
108
Q. Who must comply with the ADA?
The ADA took effect on July 26, 1992, for employers with 25 or more workers. Two years later, coverage
expanded to include employers with 15 or more workers. There are no provisions to further expand coverage.
Q. Will employers by forced to hire people with disabilities?
One of the goals of the ADA is to increase employment among people with disabilities. The method;
however, is equal opportunity, not affirmative action.
The ADA does not; however, require employers to give preferential treatment or to develop a recruiting
program. It also does not require employers to hire people with disabilities who do not meet their qualification
standards.
Source: Community Support News of the Center for Psychiatric Rehabilitation, Boston MA
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
109
Family Issues and Coping
Why family education is so important

One in four families contains a member who has a Mental Illness.

Forty percent of persons with Serious Mental Illness live with their families.

Families frequently serve as caregivers and support persons for their family member. They are oftentimes
held responsible for the care of the individual.

Families can be the first line of defense against relapse. The majority of families can notice changes in their
family member prior to a psychotic episode.

Through family education and support, relapse rates decrease.
What happens to families when Mental Illness hits

Crisis – A crisis is defined as a disruption in the family from an uncontrollable life event. The occurrence of
a Mental Illness definitely fits the definition of a crisis. When this occurs, families may display the
following responses:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Psychological stress – people must modify their identity, image, and roles
Narrow, fixed spans of attention
Feel alienated and alone
Loss of identity
Reduced capacity to make decisions
Perform their usual social roles in an unsatisfactory way
Shock
Denial
Helpless confusion
Try to escape the situation

The family experiences grief and loss. People grieve the loss of the person they once knew before the
Mental Illness. There is a loss of hopes and dreams for the individual. Some people experience a complete
loss of the life they once knew. A job may come to an end, family relationships change, and friends may
distance themselves after symptoms appear.

Unfortunately, people coping with Mental Illness may continually go through grieving periods. Mental
Illness is commonly a cyclic illness. Individuals may go through times when they are relatively symptom
free and other periods when the illness dominates their lives. This cyclic pattern produces a continuous
grieving cycle. When the individual shows symptoms, the grieving process may begin all over for families.

Families blame themselves and feel guilty regarding the illness. Parents review and criticize their parenting
style. They also trace their family histories for evidence of Mental Illness. If illness is found in their family,
they blame themselves for passing on mental illness to their child.
●
Families experience stigma surrounding the illness of their family member. Many times families are
110
embarrassed about having Mental Illness affect their family. Embarrassment also occurs from the behavior
of the ill member. Families have difficulty getting support from others due to the general lack of
understanding about Mental Illness.

An overall lack of power is felt by families. They may feel responsible for their family member, but see
themselves as having little power to influence outcomes. Part of the lack of power comes from having
limited understanding and knowledge about Mental Illness and available services.

There is a threat to a family’s integrity and optimism. Hopes and dreams for the individual who is ill are
shattered. Families become angry about the unfairness of life. Many times anger is directed at God or some
other higher power. Families begin to question their basic understanding of the order of life.
Ways to cope

Educate yourself about Mental Illness, treatments, and services.

Take care of yourself.

Acknowledge fears you are having.

Be honest about your feelings and share them with someone.

Learn and practice relaxation techniques.

Get involved with a local affiliate of NAMI IOWA (Alliance for the Mentally Ill. of Iowa)
Suggested Readings



Surviving Schizophrenia: A Family Manual by Torrey, M.D., E. Fuller
Surviving Mental Illness by Hatfield, Agnes and Lefley, Harriett
When Someone You Love Has a Mental Illness by Woolis, Rebecca
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
111
Grief

Grief is a very normal emotion experienced when you learn that you or a family member has a Mental
Illness.

People grieve the loss of the person they once knew before the Mental Illness. There is a loss of hopes and
dreams for the individual. Some people experience a complete loss of the life they once knew. A job may
come to an end, family relationships change, and friends may distance themselves after symptoms appear.

Unfortunately, people coping with Mental Illness may continually go through grieving periods. Mental
Illness is commonly a cyclic illness. Individuals may go through times when they are relatively symptom
free and other periods when the illness dominates their lives. This cyclic pattern produces a continuous
grieving cycle. When the individual shows symptoms, the grieving process may begin all over for families.
Grieving Stages

Denial – The individual denies the truth of the situation or avoids talking about it or dealing with it. The
person will deny that the illness is a chronic illness. He/she will believe that the illness is episodic and will
disappear with medication; or is not a Mental Illness at all, merely a reaction to stress.

Anger – The individual asks, “Why me, why my family?” Anger may be directed at medical personnel, the
ill individual, God, or life in general. Anger at the ill individual is especially common due to the lack of
understanding of Mental Illness. Families frequently expect their member to pull him/herself together and
snap out of it. They tend to think that their family member has a choice in their Mental Illness. Many times
feelings of anger are secondary to feelings of sadness, pain, and fear.

Bargaining or guilt – People may experience feelings of helplessness. To combat these feelings, people
begin to search for other treatments to “fix” the situation. Individuals look for the cause of the illness. This
frequently leads families into their family histories of Mental Illness. A grandparent or aunt may have had a
Mental Illness. At this point guilt becomes a factor in the grief. Guilt is also experienced from feelings that
there is nothing anyone can do to help the ill individual. Parents frequently feel guilty over their parenting
style, incorrectly blaming themselves for causing the illness.

Depression – This stage embodies the abandonment of hopes and dreams. Searching for a magical cure
appears useless and meaningless. There is a sense of sorrow for the losses one is experiencing.

Acceptance – The illness is accepted for what it is. People will not be happy about the illness, but
understand what it is and that it is part of their lives.
These stages are not a step-by-step process. People may experience any of these stages at any time. Some
people never go through certain stages.
112
Ways to cope

Have a good cry.

Learn to pray, meditate, or do relaxation techniques.

Have a special friend with whom to share your feelings.

Talk out your feelings; do not be afraid to be honest about what you feel.

Have fun. Take time to do things you enjoy.

Spend time quietly in quiet places.

Seek help! Get support from others. Attend NAMI IOWA support groups.

Learn as much as you can about mental illness and support services available.

Recognize when you have had enough and take a break.
Grief is a passion to endure.
People can be stricken with it,
victims of it, stuck in it—
or they can meet it,
get through it,
and become quiet victors
through the active, honest, and courageous
process of grieving.
by Alla Renee Bozarth, Ph.D.
Suggested Readings





The Skipping Stone: Ripple Effects of Mental Illness on the Family by Wasow, Mona
Bereavement by Parkes, Colin Murray
Guilt Letting Go by Freeman, Lucy & Stream, Herbert
The Grief Recovery Handbook by James, John & Cherry, Frank
When Bad Things Happen to Good People by Kusher, Harold
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
113
Guidelines for Dealing with a Person
Who has a Mental Illness
Communication





Be respectful: talk to adults as adults.
Be calm, clear, and direct in communication.
Be as consistent and predictable as you can.
Set clear limits, rules, and expectations.
Keep a loving distance.
Acceptance





Accept the person as ill.
Attribute the symptoms to the illness.
Do not take the symptoms or the illness personally.
Reduce contact when your relative is especially ill.
Maintain a positive attitude, even during failures.
Personal dignity



Allow the person to be unable to do things yet retain dignity.
Notice and praise any positive steps or behavior.
Offer frequent praise and specific criticism.
Goals




Focus on current functioning and on achieving the best life possible in the present.
Translate long-term goals into a series of short-term goals.
Help the individual attain realistic short-term goals.
Take an “I don’t know” attitude in response to long-term questions.
Care for yourself



Do not let the illness create total chaos in your life.
Be active, engage in activities without the person who is ill.
Continue to educate yourself and talk to supportive people.
Source: When Someone You Love Has a Mental Illness by Rebecca Woolis, MFCC
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
114
- Improving Medication Compliance

LISTEN
Listen to what the consumer is saying. Respond to the fears and discomforts surrounding the
medication. The person may be experiencing some side effects that should be taken seriously.

DO NOT MINIMIZE THE DISCOMFORT
Remind the person that the benefits of the medication outweigh the discomfort. Help the person
develop ways to cope with discomforts. For example, develop an exercise routine if weight gain is
a problem because of the medication.

PROVIDE EDUCATION
Assist the individual in learning about the medications he/she is taking. It is helpful for people to
know the positive effects of medication as well as the side-effects. People should also learn what
will happen if the medication is discontinued or taken inconsistently.

USE THE MEDICATION OF CHOICE
If the individual prefers one medication that is equally effective over another, encourage the person
to discuss the medication with his/her doctor. The doctor should prescribe the preferred
medication as long as it is as equally effective as other medications.

CREATE A SIMPLE SYSTEM
Help the consumer find an easy way to remember to take his/her medication. You may develop a
chart or merely place a reminder on the front door. The key is to remind the person and develop the habit
of medication compliance.

CONSIDER USING INJECTIONS
Some medications can be injected on a monthly or bi-monthly basis. The injections eliminate the
need for someone to remember daily to take medication. However, some people do not like getting
shots, making this an unattractive option.

BE SUPPORTIVE YET FIRM
Give encouragement when the individual is medication-compliant. If the person will not take
his/her medication regularly, you may need to establish some clear rules and consequences. For
example, you may tell the individual that he/she may stay in his/her residence only if medication is
taken as prescribed.
Source: When Someone You Love Has a Mental Illness by Woolis, M.F.C.C., Rebecca
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
115
Interrupting the Hallucination Process

Establish a trusting and interpersonal relationship; be consistent and honest. You need to talk about the
hallucinations before the person is actively hallucinating.

Look and listen for evidence of hallucination. There are usually some signs that the person is beginning
to hallucinate. For example, the person may look around the room as if checking to see if someone is
speaking to him/her, or the person may laugh for no apparent reason.

Focus on the hallucinatory cues with the consumer and elicit the consumer’s observations and
sensations. It is important to be honest. For example, say to the consumer, “I noticed you were looking
around the room, are you hearing voices? What can I do to help you?” Talk to the person who is
hallucinating to find out how serious the hallucination is. If you can talk to the person long enough, the
hallucination may pass. However, if the hallucination continues for a long time or if the person may
cause harm to him/herself or others, it is best to get the person professional help.

If asked, point out simply that you are not experiencing the hallucination. Remember, the hallucination
is the consumer’s reality. Do not say that what they are seeing or hearing is not real.

Speak slowly and in brief sentences. You may also need to repeat yourself several times before the
person can process what you are saying. Therefore, it will be difficult for him/her to process stimuli.
Source: “Understanding and Communicating With a Person Who is Hallucinating,” a videotape
produced by Moller, M.S.N., A.R.N.P., C.S., Mary D. (1989).
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
116
Minimizing Relapses

People who have a mental illness experience relapses or episodes when their illness becomes symptomatic.
Even when an individual is taking medication, relapse may occur. However, relapses and the intensity of
relapses may be minimized by taking some preventive measures.
Preventive Measures

Encourage the most therapeutic day-to-day lifestyle including regular exercise, recreational activities, daily
routine, eating a balanced diet, and abstaining from the use of illegal drugs and alcohol.
Warning Signs
●
Any marked change in behavior patterns
(eating or sleeping patterns, social habits)
● Absent, excessive, or inappropriate emotions
and energy
● Any idiosyncratic behavior that preceded
past relapses
●
●
●
●
●
●
Social isolation
Trouble concentrating
Feeling tense and nervous
Impairment in communication
Difficulty in carrying out usual activities
Odd or unusual beliefs, thoughts, or perceptions

Approximately 50 percent of consumers report having similar behavior patterns each time they have a
relapse.

About 70 percent of consumers and 93 percent of family members state that they can see a change in the
consumer’s behavior prior to a relapse.

Know the effects of the consumer’s medications; learn what to look for in the event medications are not
taken properly.

Learn stress management techniques for you and the consumer. Frequently relapses occur when the
consumer is experiencing stress.
What to do if warning signs appear

Notify the doctor and request an evaluation.

Maintain involvement in any ongoing psychiatric treatment program.

Responsibly decrease any known environmental stressors.

Minimize any changes in routine.
117

Maintain essential aspects of the most therapeutic lifestyle; especially keeping the environment as calm,
safe, and predictable as possible.

If possible, discuss your observations with the individual and talk about the steps he/she might take to
prevent another relapse, hospitalization, or incarceration.
Being prepared

Talk with the consumer while he/she is well about his/her particular warning signs.

Develop a plan with the consumer regarding what to do in case of a relapse.

Have a crisis plan ready.

Keep emergency phone numbers and procedures in a convenient place.

Know your limits and how you will proceed if they are exceeded.

Tell the consumer calmly and clearly what your limits are, exactly what they need to do next, and what you
will do if those limits are exceeded. For example, “You may not throw things in this house. Please put that
cup down immediately. If you throw it, I will call the police.”
Suggested Readings



When Someone You Love Has a Mental Illness by Woolis, Rebecca
Surviving Schizophrenia: A Family Manual by Torrey M.D., E. Fuller
Surviving Mental Illness by Hatfield, Agnes & Lefley, Harriett
Much of the information on this sheet was taken from When Someone You Love Has a Mental Illness
by Woolis, M.F.C.C., Rebecca
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
118
Responding to Delusions

Do not question or discuss the details of delusional statements in any depth.

Do not try to convince or argue people out of a delusion. It will not work.

Do not tell people that what they are saying is crazy, delusional, or untrue—unless that is specifically asked
of you. Even then, do so with caution.

If the individual is calm - listen neutrally, calmly, and respectfully. Then do any or all of the following:
1. Respond to any non-delusional remarks that have been made.
2. Lead the conversation away from the delusional content.
3. Explicitly, but non-judgmentally, express your desire to change the subject.

If the individual insists on you making a comment about the delusional material, you can:
1. Say you do not know or hedge.
2. Acknowledge the person’s reality and be as respectful of his/her opinion as you are of your
own; explain that there is an honest difference of opinion or perception between you.

If strong feelings accompany the delusions, you can:
1. Acknowledge or address the emotions (fear, anger, anxiety, sadness) without commenting on the
delusion.
2. Offer assistance in coping with the feelings—for example, you can ask, “What can you or I do to
help you feel more safe?”
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
119
Tips for Reaching Someone Who
Won’t Accept Treatment

Put treatment in the context of the consumers’ lives. Be concrete about what they will gain by taking the
prescribed medications.

Start with consumers’ own agendas. Take seriously what they say they want for their own lives.

Be concerned about whether consumers follow through with agreed-on treatment plans. Ask specific
questions designed to open up dialogue rather than put consumers on the defensive.

Involve consumers as much as possible in decisions about their treatment. Provide information about
treatment options and resources that consumers can use to solve problems and enhance their lives.

Make sure consumers, their families, and involved agencies are kept informed about the treatment options
and plans. Be sensitive to the agendas and prejudices of these people and try to work with them.

Be willing to be tenacious when necessary. Be flexible about how you engage consumers. If they decline
medications, focus on “safe” topics first.

If warranted, connect medication compliance with continued community involvement. If necessary, try
linking medication use with activities the consumer wants and needs, such as obtaining spending money or
obtaining transportation.

Accept the fact that some consumers refuse treatment, or parts of treatment, despite all efforts. Offer what
you can, be it bowling or lunch. Individuals may be more willing to comply with treatment once a
relationship is established.

Plan for anticipated crises, use them to build trust, and follow through on promises. This will strengthen the
therapeutic alliance.
These tips are abstracted from an article originally written by Dr. Ronald Diamond for RELAPSE, a
magazine about issues in the management of persistent mental illness published at Yale University.
The material was borrowed, with gratitude, from the AMI/FAMI REPORTER, New York City, edited
by D. J. Jaffe.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
120
Ministry, Mental Illness, and
Communities of Faith
Serious Mental Illnesses are diseases of the brain that cause disturbances in a person's thinking, feeling, mood,
and ability to relate to others. They can diminish a person's capacity for coping with the regular demands of
ordinary life and can place tremendous burdens on family members and loved ones. Unfortunately, both
ignorance and fear continue to play leading roles in perpetuating the stigma that those with these no-fault brain
disorders face. This stigma leads to under-funding of government programs for public mental health services,
discrimination by insurance companies, lack of appropriate housing and employment options, and pervasive
media portrayals of persons with Mental Illnesses as violent, dangerous, or hopeless.
And yet persons with Mental Illnesses are all around us. According to the U.S Center for Mental Health
Services, at any given moment more than 48 million Americans are suffering from a "diagnosable" Mental
Illness, and 11 million are suffering from a "Severe" Mental Illness. Persons with Mental Illnesses are our
neighbors, our coworkers, our siblings, our friends. They are even members of our churches, our synagogues,
and other faith communities.
Religious communities are in a unique position to combat stigma and provide a message of acceptance and
hope. Proclaiming the values of social justice, respect for all persons, and nondiscrimination, faith communities
can reach out to individuals and families affected by Mental Illness in many helpful ways. Sharing the message
that all persons are worthy in the eyes of God, a faith community may be the only place where a person with a
Mental Illness truly feels accepted, valued, and loved. For people who find no other welcome in the larger
community, being welcomed in a house of prayer by a concerned and caring community can make a critical
difference for consumers with Mental Illnesses and their families. Churches, synagogues, and other places of
worship can spread the message that Serious Mental Illnesses are "diseases of the brain" and help families
understand that "it is not their fault." They can open their doors and their hearts to consumers and be a
supportive presence in their on-going recovery.
Outreach ideas for your community of faith:
●
Contact the NAMI local affiliate in your community and welcome them to your church, synagogue,
mosque or temple.
●
Promote workshops and forums in your congregation to teach people that Mental Illnesses are brain
disorders. Use materials and resources available from or recommended by NAMI.
●
Use stories and parables from your sacred scriptures as "teachable moments" in religious education
programs to teach children about Mental Illness and acceptance of those who seem different.
●
Provide space for support group meetings for family members and consumers with Serious Mental
Illnesses.
●
In liturgies and public worship services, pray for those who are hospitalized with Serious Mental Illnesses,
their family members and friends.
●
Have annual memorial liturgical services for persons in your community who have died as a result of
Mental Illness, lack of treatment, homelessness, or societal neglect.
121
●
In preaching, encourage members of your community to be open-minded and welcoming towards
community-based services -- including residential facilities in local neighborhoods.
●
Use congregational bulletins and newsletters to educate your members about Serious Mental Illness
during the annual Mental Illness Awareness Week each October.
●
Adopt resolutions affirming your faith community's ministry and mission to help those suffering from
Serious Mental Illnesses.
●
Contact your denominational headquarters for resource materials on Mental Illness. If none exist, offer
to help prepare them.
Further Resources:
●
NAMI: individuals may contact the NAMI IOWA Helpline at (515) 254-0417 or (800) 417-0417 outside Des
Moines to receive free information on serious mental illnesses such as Schizophrenia, Bipolar Disorder,
Major Depression, OCD, and Anxiety Disorders, as well as information on NAMI programs and support
groups nationwide.
●
NAMI-North Carolina: distributes "Creating a Circle of Caring: The Church and the Mentally Ill," which
may be obtained by writing 309 W Millbrook Road, Suite 121, Raleigh NC 27609 or calling
(919)788-0801. Web: www.naminc.org
●
Pathways to Promise: an interfaith technical assistance and resource center offering liturgical and
educational materials, program models, and networking information to promote caring ministry with
people with Mental Illness and their families. Write to: 5400 Arsenal Street, St. Louis MO 63139,
(314) 644-8400; www.pathways2promise.org
●
American Psychiatric Association: produces a "Mental Illness Awareness Guide" for clergy and
other spiritual leaders, available through the Division of Public Affairs, 1400 K Street, NW, Washington
DC 20005, (202) 682-6220 or (888) 357-7924; www.psych.org
●
National Organization on Disability: provides resources through their Religion and Disability Program
to promote persons with disabilities as full and participating members of religious communities. Write to:
910 - 16 Street, NW, Suite 600, Washington DC 20006, (202) 293-5960; www.nod.org
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
122
-Borderline Personality Disorder

Borderline Personality Disorder (BPD) is estimated to occur in about 2 percent of the population.

BPD is more commonly diagnosed in females than in males.

The course of BPD is chronic instability during early adulthood. The symptoms typically decrease with age
with more stability being achieved during a person’s thirties and forties.

Unfortunately, the diagnosis of BPD is not very reliable. Many researchers believe BPD is a form of
Posttraumatic Stress Disorder.

BPD commonly co-occurs with other disorders such as Substance Abuse, Depression, Eating Disorders,
Posttraumatic Stress Disorder, and Attention-Deficit/Hyperactivity Disorder.

The symptomology of BPD can generally be described as instability in mood, thinking, behavior, personal
relations, and self-image.

Suicide occurs in 8 to 10 percent of persons with BPD.
Symptoms









Efforts to avoid real or imagined abandonment
A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation
Identity disturbance: markedly and persistently unstable self-image or sense
of self
Impulsivity in at least two areas that are potentially self-damaging, such as
spending, sex, substance abuse, reckless driving, or binge-eating
Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
Affective instability due to a marked reactivity of mood, such as intense
episodic dysphoria, irritability, or anxiety usually lasting a few hours and
only rarely more than a few days
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger
Transient, stress-related paranoid ideation or severe dissociative symptoms
123
Causes

Currently, there is not a clear understanding of what causes BPD.

Many researchers believe some individuals have a high biological vulnerability to BPD. This disorder is
five times more common in individuals who have a first-degree relative with the disorder. This leads
researchers to conclude that there may be a genetic vulnerability for the development of BPD.

Environmental stress or trauma is also believed to be a possible cause of BPD. Individuals with the disorder
report a high rate of childhood sexual and physical abuse. The presence of child abuse may be important in
some individuals with BPD. However, it is neither a necessary nor a sufficient cause of BPD.

Family environment has also been studied as a cause of BPD. Some researchers see BPD as a distortion or
failure of an early developmental process. The specific process that failed to develop is believed to be the
establishment of a solid, autonomous self that is separate from others, and in particular from the utterly
dependent relationship with the mother. This theory of the cause of BPD is very controversial. Research
has not consistently found evidence to support this theory (The Information Exchange, 1990).
Treatments

Currently, there is not one specific method of treatment for BPD.

Some medications are useful in treating the symptoms of BPD. Typical medications that may be used are
anti-psychotics in low doses, certain anti-depressants, anti-anxiety medications, Depakote, and Lithium.

Psychotherapy over several months or years is the most common mode of treatment for BPD. Many
professionals suggest a combination of medication and psychotherapy as the most effective form of
treatment.
Suggested Readings



Mending Minds by Heston, Leonard
The Broken Brain by Andreasen, M.D., Nancy
Coping with Mental Illness in the Family by Hatfield, Agnes
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
124
Dissociative Amnesia
●
Dissociative Amnesia is an inability to recall important personal information that is too extensive to be
explained as normal forgetfulness.
●
A reversible memory impairment in which memories of personal experience cannot be retrieved in a verbal
form.
●
A reported gap or series of gaps in recall for aspects of the person’s life history. The gaps are usually related
to traumatic or extremely stressful events.
Types of memory disturbances:
●
Localized Amnesia is present in an individual who has no memory of specific events that took place, usually
traumatic. The loss of memory is localized with a specific window of time. For example, a survivor of a car
wreck who has no memory of the experience until two days later is experiencing localized amnesia.
●
Selective Amnesia happens when a person can recall only small parts of events that took place in a defined
period of time. For example, an abuse victim may recall only some parts of the series of events around the
abuse.
●
Generalized Amnesia is diagnosed when a person's amnesia encompasses his/her entire life.
●
Continuous Amnesia is defined as the inability to recall events subsequent to a specific time up to and
including the present.
●
Systematized Amnesia is characterized by a loss of memory for a specific category of information. A person
with this disorder might, for example, be missing all memories about one specific family member.
The latter three types of Dissociative Amnesia may ultimately be diagnosed as having a more complex form of
Dissociative Disorder.
Symptoms
●
●
●
●
●
●
●
●
●
●
●
Depressive
Depersonalization
Trance States
Analgesia
Spontaneous age regression
Inaccurate answers to questions
Causes
●
Present in any age group.
●
Most individuals possess a retrospective gap in memory.
Suicidal
Aggressive impulses
Self-mutilation
Interpersonal relationships
Impairment in work
125
●
Individuals who have had one episode of Dissociative Amnesia may be predisposed to develop amnesia for
subsequent traumatic circumstances.
●
Some individuals with Chronic Amnesia may gradually begin to recall dissociated memories.
Treatments
●
May use stress psychotherapy; although a combination of psychopharmacological and psychosocial
treatments are often used.
●
Many of the symptoms of Dissociative Disorders occur with other disorders, such as Anxiety and
Depression, and can be controlled by the same drugs used to treat those disorders.
●
A person in treatment for a Dissociative Disorder might benefit from antidepressants or anti-anxiety
medication.
Other Dissociative Disorders
Dissociative Fugue is a rare disorder. An individual with Dissociative Fugue suddenly and unexpectedly takes
physical leave of his/her surroundings and sets off on a journey of some kind. These journeys can range from
brief short periods to complex, usually unobtrusive wandering over long time periods (e.g., weeks or months).
An individual in a fugue state is unaware of, or confused about, his/her identity and in rare cases will assume a
new identity.
Dissociative Identity Disorder (DID), which has been known as Multiple Personality Disorder, is the most
famous of the Dissociative Disorders. An individual suffering from DID has more than one distinct identity or
personality state that recurrently takes control of behavior. This disorder is also marked by differences in
memory which vary with the individual's "alters" or other personalities.
Depersonalization Disorder is marked by a feeling of detachment or estrangement from one's own experience,
body, or self. These feelings of depersonalization are recurrent. Of the Dissociative Disorders,
Depersonalization is the one most easily identified with by the general public; one can easily relate to feeling as
they have in a dream, or in being "spaced out." Feeling out of control of one's actions and movements is
something that people describe when intoxicated. An individual with Depersonalization Disorder has this
experience so frequently and so severely that it interrupts his/her functioning and experience. A person's
experience with Depersonalization can be so severe that he/she believes the external world is unreal or distorted.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
126
Dissociative Identity Disorder
(formerly Multiple Personality Disorder)
●
Dissociative Identity Disorder (DID), previously referred to as Multiple Personality Disorder (MPD), is a
Dissociative Disorder involving a disturbance of identity in which two or more distinct personality states
exist (with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment
and self).
●
The person is usually unable to remember some of the events that occurred while other personalities were in
control.
●
The different identities, referred to as alters, may exhibit differences in personal history, different age and
gender, self-image, and identity, including a separate name. Alters may even differ in "physical" properties
such as allergies, right-or-left handedness, or the need for eyeglass prescriptions. These differences between
alters are often quite striking. Usually there is a primary identity that carries the individual’s given name
and is passive, dependent, guilty, and depressed.
●
Females tend to have more identities than do males, averaging 15 or more; whereas, males average
approximately 8 identities. Often alters are stable over time, continuing to play specific roles in the person's
life for years. Some alters may harbor aggressive tendencies, directed toward individuals in the person's
environment, or toward other alters within the person. The more controlling identity has more complete
memory; whereas, the passive identity tends to have more constricted memory.
Symptoms
●
●
●
●
●
●
●
●
●
●
Depression
Mood swings
Suicidal tendencies
Sleep disorder
Panic attacks
Eating disorders
Trances
Amnesia
Hallucinations
Substance abuse
Causes
●
Retrieving and dealing with memories of trauma is important for the person with DID, because this disorder
is believed to be caused by physical or sexual abuse in childhood.
●
Young children have a pronounced ability to dissociate, and it is believed that those who are abused may
learn to use dissociation as a defense. In effect, the child slips into a state of mind in which it seems that the
abuse is not really occurring to him/her, but to somebody else. In time, such a child may begin to split off
alter identities. Research has shown that the average age for the initial development of alters is 5.9 years.
127
Treatments
●
Individual therapy, medication for specific mood and anxiety symptoms, education about the illness, social skills
training, learning better communication, coping skills, and group support
●
At the time that a person with DID first seeks professional help, he/she is usually unaware of the condition.
Very common complaints in people with DID are episodes of amnesia or time loss. These individuals may be
unable to remember events in all or part of a preceding time period. They may repeatedly encounter unfamiliar
people who claim to know them, find themselves somewhere without knowing how they got there, or find items
that they do not remember purchasing among their possessions.
●
The therapist seeks to make contact with as many alters as possible and to understand their roles and functions in
the patient's life. In particular, the therapist seeks to form an effective relationship with any personalities that
are responsible for violent or self-destructive behavior and to curb this behavior.
●
The therapist seeks to establish communication among the personality states and to find ones that have memories
of traumatic events in the patient's past.
●
The goal of the therapist is to enable the patient to achieve breakdown of the patient's separate identities and
their unification into a single identity.
Suggested Readings


Assessment and Treatment of Multiple Personality and Dissociative Disorders by Block, James P.
Multiple Personality Disorder from the Inside Out by Cohen, Barry; Giller, Ester; and W., Lynn
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
128
Personality Disorders

Personality is defined as patterns of traits and behaviors that characterize an individual. Personality
organizes traits, coping styles, and ways of interacting in social situations for a person. Usually, Personality
development follows the expectations and demands of society.

Personality Disorders occur when an individual persistently has maladaptive ways of perceiving, thinking,
and relating to the world. An individual’s inner experience and behavior must consistently deviate from the
expectations and demands of his/her society or culture. Personality traits must be maladaptive and
inflexible, and also create significant functional impairment or subjective distress to be considered
disordered.

Personality Disorders typically appear in adolescence or early adulthood.

It is estimated that 15 percent of the general population suffers from a Personality Disorder (Armand
Nicholi Jr., M.D., The New Harvard Guide to Psychiatry, 1988).

When diagnosing a Personality Disorder, caution must be used. Many symptoms of these disorders are also
symptomatic of other Mental Illnesses. Personality Disorders are diagnosed only when the symptoms
appear before early adulthood, are typical of the individual’s long-term functioning, and do not occur
exclusively during an episode of another illness.
Symptoms




An enduring pattern of inner experience and behavior that deviates markedly from the expectations
of the individual’s culture. This pattern is demonstrated in two (or more) of the following areas:
1. cognition – the way a person perceives and interprets him/herself, other people, and events
2. affectivity – the range, intensity, liability, and appropriateness of emotional response
3. interpersonal functioning – the way a person interacts and responds to other people
4. impulse control – a person’s ability to control a desired response or behavior
The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or
early adulthood.
Cause

Possible causes of Personality Disorders include biological/genetic factors or dysfunction in early
development and learning. Currently, the cause of Personality Disorders is very speculative.
Treatment

The treatment of Personality Disorders varies depending on the specific disorder. Professionals suggest a
combination of psychotherapy and medication for most of the disorders.
129
Types
The following are specific types of Personality Disorders and descriptions taken directly from the Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, 1994).

Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that others’ motives are
interpreted as malevolent.

Schizoid Personality Disorder is a pattern of detachment from social relationships and a restricted range of
emotional expression.

Schizotypal Personality Disorder is a pattern of acute discomfort in close relationships, cognitive or
perceptual distortions, and eccentricities of behavior.

Antisocial Personality Disorder is a pattern of disregard for, and violation of, the rights of others.

Borderline Personality Disorder is a pattern of instability in interpersonal relationships, self-image, affects,
and marked impulsivity.

Histrionic Personality Disorder is a pattern of excessive emotionality and attention-seeking.

Narcissistic Personality Disorder is a pattern of grandiosity, need for admiration, and lack of empathy.

Avoidant Personality Disorder is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity
to negative evaluation.

Dependent Personality Disorder is a pattern of submissive and clinging behavior related to an excessive
need to be taken care of.

Obsessive-Compulsive Personality Disorder is a pattern of preoccupation with orderliness, perfectionism,
and control.

Personality Disorder Not Otherwise Specified is a category provided for two situations:
(1) The individual’s personality pattern meets the general criteria for a Personality Disorder and traits of
several different Personality Disorders are present, but the criteria for any specific Personality Disorder
are not met; or
(2) The individual’s personality pattern meets the general criteria for a Personality Disorder, but the
individual is considered to have a Personality Disorder that is not included in the classification (e.g.,
Passive-Aggressive Personality Disorder).
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
130
Schizoaffective Disorder
●
Schizoaffective Disorder is a controversial diagnostic category. This disorder is defined as concurrently
occurring symptoms of both Schizophrenia and Affective (mood) Disorders. Because the symptomology of
Schizoaffective is similar to Schizophrenia and Affective Disorders, some researchers believe
Schizoaffective is a subtype of one or both of these disorders. However, other researchers see
Schizoaffective Disorder as a separate and distinct disorder.
●
The person has symptoms of Depression or Mania for a large part of the time while he/she is actively ill and
when the illness has subsided.
Types of Schizoaffective Disorder
Bipolar Type: The disorder includes Manic or Manic and Depressive episodes.
Depressive Type: The disorder includes only Depressive episodes.
●
Schizoaffective Disorder is typically first displayed in early adulthood, but may occur at any time in life.
●
The prevalence rate of Schizoaffective Disorder is difficult to identify due to the difficulty in reliable
diagnosis. However, it is estimated to occur in less than one-percent of the population.
●
During the period of illness, the person has delusions or hallucinations for at least two weeks without any
prominent mood symptoms.
Symptoms
A continuous period of illness during which there is a period of a Major Depressive episode or a Manic
episode concurrent with two or more symptoms of Schizophrenia:
Symptoms of Schizophrenia
●
●
●
●
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
●
Negative symptoms, such as affective flattening,
decreased motivation, lack of fluency in speech/thought,
lack of capacity to enjoy
Symptoms of Depression
●
●
●
●
●
Depressed mood
Feelings of worthlessness
Irritability
Inability to enjoy activities
Change in eating patterns
●
●
●
●
●
Change in sleeping patterns
Fatigue or loss of energy
Restlessness
Inability to concentrate
Thoughts of death
Symptoms of Mania
●
●
●
●
●
Elevated, expansive, or irritable mood
Inflated self-esteem
Decreased sleep
More talkative
Racing Thoughts
●
●
●
●
Distractibility
Increase in goal directed activity
Excessive involvement in pleasurable activities
Irritability
131
Causes

The cause of Schizoaffective Disorder is unclear. Some researchers believe it may be a combination of
Schizophrenia and Affective Disorder, thus having the same cause as these disorders.

Schizoaffective Disorder has some genetic links. In some studies, individuals with Schizoaffective Disorder
have higher rates of Schizophrenia and lower rates of Mood Disorders in their families as compared to
individuals with Mood Disorders. In other studies, there are higher rates of Mood Disorders and lower rates
of Schizophrenia in families of an individual who has Schizoaffective Disorder than in families with a
member who has Schizophrenia.
Treatments

Treatment for Schizoaffective Disorder is largely based on the symptomology that the individual presents.

Lithium is commonly used to treat the bipolar type of the disorder.

Antipsychotic medications are effective in treating psychotic symptoms, such as delusions and
hallucinations.

Antidepressants may also be a useful mode of treatment.

Many times a combination of antidepressants and antipsychotic medications will be used to treat this
disorder.

Electro-convulsive Therapy (ECT) has been effective for individuals who do not respond to medications,
particularly for those with an acute illness.
Suggested Readings





Surviving Schizophrenia: A Family Manual by Torrey, M.D., E. Fuller
The Broken Brain by Andreasen, M.D., Nancy
Schizophrenia and Manic Depressive Disorder by Torrey, M.D., E. Fuller; Bowler, M.S., Ann E.; Taylor,
Ph.D., Edward H. & Gottesman, Ph.D., Irving I.
Overcoming Depression by Papolos, Dimitri & Janis
We Heard the Angels of Madness by Berger, Diane & Lisa
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
132
Schizophrenia

Schizophrenia is a disease of the brain which affects a person’s ability to think, feel, and relate to the
environment.

Schizophrenia affects 1.5 percent of the general population. It is twice as common as Alzheimer’s disease,
five times more common than Multiple Sclerosis, and sixty times more common than Muscular Dystrophy.

Schizophrenia is not caused by bad parenting or a personal weakness. Rather, it is a biological illness of the
brain.

Schizophrenia is not a form of Mental Retardation. Mental Retardation is a developmental disability present
from birth that affects one’s intellectual capacity. On the other hand, Schizophrenia is a mental illness
typically having its onset in adolescence or early adulthood.
Diagnostic criteria for Schizophrenia (DSM-IV):

Individuals must have two or more positive symptoms or a combination of one positive symptom and one or
more negative symptoms for at least one month.

Social or occupational dysfunction needs to be present. Ability to function at work, in interpersonal
relations, or self-care will be noticeably below abilities prior to the onset of the illness.

Signs of the illness must persist for at least six months. During this time some symptoms may subside;
however, positive symptoms may be exhibited in a less severe form.
Symptoms
Negative Symptoms




Lack of fluency of speech/thought
Lack of emotional expression
Lack of motivation and drive
Lack of capacity to enjoy
Positive Symptoms
●
●
●
●
Hallucinations
Delusions
Disorganized speech
Disorganized behavior
133
Causes

Research studies suggest there is a genetic link in Schizophrenia. The probability of developing
Schizophrenia as the offspring of two parents, neither of whom has the disease, is 1 percent. The probability
of developing Schizophrenia as the offspring of one parent with the disease is approximately 13 percent.
The probability of developing Schizophrenia as the offspring of both parents with the disease is
approximately 35 percent.

Research has demonstrated that persons with Schizophrenia have functional (including brain chemicals) and
structural differences in the brain.

It is clear that genetics is not completely responsible for causing Schizophrenia. Environmental influences
appear to play a role as well. Some environmental influences that have been suggested to be a possible
contributor to the development of the illness are birth injury and prenatal complications, viral illnesses in the
mother during pregnancy, or other toxins during pregnancy.

Overall, Schizophrenia appears to be caused by a combination of genetic and environmental factors.
Treatments

Medication, known as antipsychotics, is the primary form of treatment for those diagnosed with
Schizophrenia.

Social and occupational rehabilitation are often used in conjunction with medication.

Support groups for individuals affected by Schizophrenia and their family members are helpful in
facilitating recovery.
Suggested Readings





Surviving Schizophrenia: A Family Manual by Torrey M.D., E. Fuller
The Broken Brain by Andreasen, M.D., Nancy
Schizophrenia and Manic Depressive Disorder by Torrey, Bowler, Taylor, & Gottesman
Schizophrenia: Symptoms, Causes and Treatments by Bernheim, Kayla F.
Coping With Mental Illness in the Family by Hatfield, Agnes
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
134
Suicide

Suicide is the eleventh leading cause of death in the United States.

More men than women die by Suicide; the gender ratio is over 4:1.

The highest Suicide rates are for persons over 65.

Suicide is the second leading cause of death among young people 15 to 24 years.

Suicide completers are likely to have some type of psychiatric disorder.

Suicide is the number one cause of mortality among people with Depression. Death by suicide occurs in 15
percent of patients who have been hospitalized for Depression. (Health Learning Systems, 1994).
Warning Signs





Preoccupation with thoughts of death
Giving away prized possessions
Suicide threats
A settling of affairs
Accidental poisoning and self-destructive
behavior
●
●
●
●
Statements of worthlessness
Depression
A sudden apparent peace of mind
Possession of suicidal plans
What To Do

Believe It: When someone talks of Suicide, he/she should be taken very seriously. Accept what is said and
try to focus on the problem. Ask the person if he/she is thinking about giving up on life or ending it all.

Listen: A person who is feeling suicidal is in a state of emotional crisis and needs someone who will listen.
Acknowledge the person’s feelings of helplessness. By listening, you are being supportive; you are showing
you care.

Get Help: No matter what you conclude about the intensity of the crisis, you must get help. Call a suicideprevention center, crisis-intervention clinic, mental health clinic, physician, hospital emergency room, or
religious adviser. If you believe the person is in danger of taking action at once, do not leave him/her. Talk
about the problem and lead the person to one of the above places. If you feel that the situation is
immediately life-threatening, call the police.

Remove Weapons of Choice: If you learn about actual, specific plans that have been made toward Suicide,
stay with the person, if possible, and get help. Remove any self-destructive weapons the person talked
about.
135
What Not To Do

Do Not Give Advice: Other than seeking help for the person, you should not try to offer such advice as
“Everything will be all right,” or “Snap out of it.” Do not be judgmental, swear secrecy, debate whether
suicide is right or wrong, or increase guilt.

Do Not Delay Dealing with the Situation: Do not leave the person alone if you think the risk is immediate.
Call a suicide-prevention center.

Never Tell a Person that He/She Is Just Fooling: Not being believed may increase despair and might serve
as a challenge that could start self-destructive actions. Sometimes it is possible to deter a suicidal person by
removing the weapons of choice.
Suggested Readings



Suicide by Durkheim, Emile
Suicide/The Hidden Epidemic by Hyde, Margaret & Forsyth, Elizabeth Held
Healing After the Suicide of a Loved One by Smolin, Ann & Guinan, John
Suicide Prevention/Crisis Intervention Agencies in Iowa:










Cedar Rapids: Foundation II, Inc, (319) 362-1170
Davenport: Vera French Comm. Health Center/Mercy Hospital, (563) 383-1900; Hrs Avail: 24
Des Moines: Broadlawn’s Medical Center Crisis Team, (515) 282-5752; Hrs Avail: 24
Des Moines: Comm Telephone Services Crisis Line, (515) 244-1000 for crisis or (515) 244-1010 for
counseling; Hrs Avail: M-Th 3 pm – 8 am, Weekends/Holidays: 24
Des Moines: First Call For Help, (515) 246-6555 or (800) 532-1194; Hrs Avail: 24
Dubuque: Crisis Line, (563) 588-4016; Hrs Avail: 24
Iowa City: Crisis Intervention Center, (319) 351-0140; Hrs Avail: 24
Sioux City: Aid Center, (712) 252-5000
Waterloo: Crisis Services, (319) 233-8484; Hrs Avail: 24
OR contact your local hospital or Community Mental Health Center
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
136
Teenage Suicide
●
Most everyone at some time in his/her life will experience periods of anxiety, sadness, and despair. These
are normal reactions to the pain of loss, rejection, or disappointment. Those with Serious Mental Illnesses;
however, often experience much more extreme reactions that can leave them mired in hopelessness. When
all hope is lost, some feel that Suicide is the only solution. It is not.
●
Of those who commit Suicide, 75 percent tell someone before it happens.
●
On the average, two young people take their lives every month in Iowa.
●
About 90 percent of teenagers who commit Suicide suffer from a psychiatric disorder such as Depression,
Anxiety, or Substance Abuse.
●
In Iowa, among 10 to19 year-olds, Suicide kills more than homicide and less than motor accidents.
●
In Iowa, 9 percent of all suicides involving guns were committed by teenagers.
●
The Suicide rate for persons aged 15 to 24 increased more than any other age group since 1965.
●
Many of these signs go unrecognized. While suffering from one of these symptoms certainly does not
necessarily mean that one is suicidal, it is always best to communicate openly with a loved one who has one
or more of these behaviors, especially if they are unusual for that person.
●
Obvious signs for committing Suicide are putting one's affairs in order, such as giving or throwing away
favorite belongings. It cannot be stressed more strongly that any talk of death or Suicide should be taken
seriously.
Symptoms
●
●
●
●
●
●
●
●
Extreme personality changes
Significant loss or gain in appetite
Fatigue or loss of energy
Feelings of worthlessness or guilt
Sadness, irritability, or indifference
Having trouble concentrating
Extreme anxiety or panic
Poor school performance
●
●
●
●
●
●
●
Loss of interest in activities that used to be enjoyable
Difficulty falling asleep or wanting to sleep all day
Neglect of personal appearance or hygiene
Aggressive, destructive, or defiant behavior
Withdrawal from family and friends
Hallucinations or unusual beliefs
Drug or alcohol use or abuse
Causes
●
While the reasons that teens commit Suicide vary widely, there are some common situations and
circumstances that seem to lead to such extreme measures. These include the following: major
disappointment, rejection, failure, or loss such as breaking up with a girlfriend or boyfriend, failing a big
exam, or witnessing family turmoil.
●
Since the overwhelming majority of those who commit Suicide have a Mental or Substance-related
Disorder, they often have difficulty coping with such crippling stressors. They are unable to see that their
life can turn around and unable to recognize that Suicide is a permanent solution to a temporary problem.
Usually, the common reasons for Suicide listed above are actually not the "causes" of the Suicide, but rather
triggers for Suicide in a person suffering from a Mental Illness or Substance-related Disorder.
137
●
Research has also explored the specific brain chemistry of those who take their own lives. Recent studies
indicate that those who have attempted Suicide may also have low levels of the brain chemical serotonin.
Serotonin helps control impulsivity, and low levels of the brain chemical are thought to cause more
impulsive behavior.
If Warning Signs are Seen
●
What To Do:
Do not ignore warning signs. Take threats seriously.
Seek professional help. Call your local physician, hospital, or mental health center.
Discuss openly and frankly, if confided in. Do not dismiss feelings, problems, or get angry.
Stay calm and concerned.
Listen. Show interest and support.
Remove all weapons which are accessible
●
What Not To Do:
Never minimize or ignore statements about wanting to die.
Do not give advice, such as “Everything will be alright” or “Snap out of it.”
Do not be judgmental, swear secrecy, debate whether Suicide is right or wrong, or increase guilt.
Do not delay dealing with the situation. Do not leave the person alone if you think the risk is
there. Call a suicide-prevention center.
Recommended Resources
American Academy of Child & Adolescent Psychiatry
3615 Wisconsin Avenue, NW
Washington DC 20016-3007
Phone: (202) 966-7300
F ax: (202) 966-2891
Web site: www.aacap.org
SA/VE (Suicide Awareness/Voices of Education)
PO Box 24507
Minneapolis MN 55424-0507
Phone: (952) 946-7998
Web site: www.save.org or
Email: [email protected]
American Association of Suicidolgy
4201 Connecticut Avenue NW Suite 408
Washington DC 20008
Phone: (202) 237-2280
Fax: (202) 237-2282
Web site: www.suicidology.org
SPAN (Suicide Prevention Advocacy Network)
5034 Odin's Way
Marietta GA 30068
Phone: (888) 649-1366 (toll-free)
Fax: (770) 642-1419
Web site: www.spanusa.org
American Foundation for Suicide Prevention
120 Wall Street 22 Floor
New York NY 10005
Phone: (888) 333-AFSP (toll-free) or (212) 363-6237
Fax: (212) 363-6237
Web site: www.afsp.org or Email: [email protected]
Yellow Ribbon Suicide Prevention Program
P.O. Box 644
Westminster CO 80030-0644
Phone: (303) 429-3530
Fax: (303) 426-4496
Web site: www.yellowribbon.org
Suggested Reading
●
●
●
Night Falls Fast: Understanding Suicide by Jamison, Kay Redfield
His Bright Light: The Story of Nick Traina by Steel, Danielle
Suicide: Why? by Wrobleski, Adina
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
138
NAMI IOWA Support Groups
All too often family members and individuals dealing with a Mental Illness find themselves alone in coping with
the illness. Many times friends do not understand Mental Illness and have little empathy for the situation. The
myths about Mental Illness lead people into believing that the illness was caused by poor parenting or that the
individual can stop the illness him/herself. These myths leave family members and individuals isolated and
stigmatized, afraid to share with anyone that Mental Illness exists in their family.
NAMI IOWA (Alliance for the Mentally Ill) is working vigorously to ease the isolation and stigma felt by
family members and individuals. One way NAMI IOWA is doing this is through our support groups across
Iowa. These groups are made up of family members and friends of persons with a Mental Illness, individuals
with a Mental Illness, professionals, and other persons concerned about Mental Illness.
The support groups provide support and education; they are not therapy or meant to replace professional care.
NAMI IOWA groups provide members the chance to openly talk about their experiences and feelings about
Mental Illness. The NAMI IOWA group members offer each other support and understanding as individuals
who really know what it is like to live with Mental Illness.
Education is very important in NAMI IOWA support groups. Learning about Mental Illness, the causes, course,
treatment, and various services available is essential in dealing with the illness. The support groups offer
members a forum to learn such things as new medications, social security benefits, the latest research on
Schizophrenia, Bipolar Disorder, childhood disorders, spousal issues, coping strategies, and services that are
available. Many groups have professionals speak on issues or will sponsor seminars dealing with Mental
Illness. The goal of education is to allow members to accurately learn about Mental Illness and issues related to
Mental Illness.
The NAMI IOWA group nearest you or the group that best fits your needs would like to welcome you. To
attend a meeting, merely call the contact person provided through the NAMI IOWA office. Attendance to a
NAMI meeting is free, but membership has a small fee. You do not need to be alone in dealing with Mental
Illness; NAMI IOWA is with you. Please call our office if you have any more questions about the NAMI
support groups located in Iowa.
The most shocking thing about mental illness is how little people understand it.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
139
Disclosure of Mental Health
Information Iowa Code,
Chapter 228
228.8
Disclosures to Family Members
1. Information may be disclosed from a mental health professional or employee or agent of a mental health
facility to the spouse, parent, adult child, or adult sibling if ALL of the following conditions are met:
a. The disclosure is necessary to assist in the provision of care or monitoring of the individual’s treatment.
b. The spouse, parent, adult child, or adult sibling is directly involved in providing care to, or monitoring
the treatment of, the individual.
c. The involvement of the spouse, parent, adult child, or adult sibling is verified by the individual’s
attending physician, attending mental health professional, or a person other than the above.
2. A request for mental health information by a person authorized to receive such information under this
section shall be in writing, except in an emergency, as determined by the mental health professional
verifying the involvement of said person.
3. Unless the individual has been adjudged incompetent, the person verifying the involvement of above shall
notify the individual of the disclosure of the individual’s mental health information under this section.
4. Mental health information disclosed under this section is limited to the following:
a. A summary of the individual’s diagnosis and prognosis.
b. A listing of the medication(s) that the individual has received and is receiving and the individual’s
record of compliance in taking medication prescribed for the previous six months.
c. A description of the individual’s treatment plan.
FAMILIES HAVE THE RIGHT TO KNOW. IT IS THE LAW.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
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Hospitalization for Mental Illness
THE TREATMENT PROCESS
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Why Hospitalization? Individuals experiencing acute psychiatric symptoms or de-compensation that
severely impairs their capacity to function on a day-to-day basis may need to be hospitalized. Such acute
states frequently follow a crisis or stressful situations.
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Hospitalization on a psychiatric unit of a hospital offers security and hope for patients to overcome
behaviors in order to gain a more positive, productive, and satisfying life.
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During the first few days of hospitalization, the psychiatrist and staff work to assess the patient's condition.
Through patient and family interviews, medical and psychological examinations, specific problems are
identified, and the individual's course of treatment outlined.
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Patients are cared for by a multidisciplinary team consisting of psychiatrists, registered nurses, psychiatric
technicians, social workers, and other health care professionals.
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The treatment may consist of individual and group therapy to help patients understand and cope with their
Mental Illness. Medication therapy may also be used to improve functioning. Recreational activities play a
role in promoting recovery in the areas of motivation, social skills, and physical well-being.
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Family services and support are important in the treatment process. Psychological assistance in the form of
counseling, pain and stress management, support groups, and other services are available at most hospitals.
It is important for staff to observe interaction with family and friends of the patient. Therefore, these visits
are highly encouraged.
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Quiet rooms and private space are also available to patients needing a safe environment.
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Transitioning to the community when released from the hospital is an important step for the patient's
progress. A social worker, along with the patient, doctor, and family should work together to determine the
best living environment for the patient. Outpatient follow-up may be a necessary support following
hospitalization.
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
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Questions You May Want To Ask
Your Doctor
Address these questions to your Doctor, Pharmacist or Mental Health Professional.
General
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What is my diagnosis? Do you have any information on it for me to read?
What is known about the cause of this particular illness?
How certain are you of this diagnosis? If you are not certain, what other possibilities do you consider most
likely, and why?
Did the physical examination include a neurological exam? If so, how extensive was it, and what were the
results?
Are there any additional tests or exams that you would recommend at this point?
Would you advise an independent opinion from another psychiatrist at this point?
Who will be able to answer my questions at times when you are not available?
If your current evaluation is a preliminary one, how soon will it be before you will be able to provide a more
definitive evaluation of my illness?
Are you currently treating other patients with this illness? (Psychiatrists vary in their level of experience
with severe or long-term mental illnesses, and it is helpful to know the background of the psychiatrist who is
treating you or your relative.)
When are the best times, and what are the most dependable ways, for getting in touch with you?
Medication Questions
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What is the name of the medicine prescribed for me?
How is it supposed to help me? How soon will I notice a difference?
What will happen if I don’t take it? Can I be forced to take it?
May I have treatment without medication? Before I begin taking any medicine—or even if I am now taking
medicine—can I have a second opinion?
How is it supposed to make me feel? What are the “side effects” of the medicine? Will it affect any other
medical or physical problems I have?
Are there side effects that I should report immediately?
Is it similar to or different from the medicine I was taking before this?
How much should I take? How many times a day? What time of day? Before or after meals? What
happens if I take too much?
Would I benefit from other treatment besides medicine, like counseling?
Are there other medications that might be appropriate? If so, why do you prefer the one you have chosen?
How soon will I be able to tell if the medication is effective, and how will I know if it is effective?
How do you monitor medications, and what symptoms indicate that they should be raised or lowered?
If I stop taking my medication, when will it be out of my system?
Life Style Questions
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Can I drink alcohol or beer when taking this medicine? Is there any food or other drink I should avoid?
Are there other medicines I should avoid when taking this medicine?
Will this medicine affect my interest in sex?
(For males) Will it affect my ability to have an erection?
 Should I drive a car or operate machinery while taking this medication?
(For females) Should I take the birth control pill while taking this medicine? If I get pregnant while taking this
medicine, could it have any effect on my baby? Should I take it while nursing?
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Long Term Effects
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(For females in child bearing years) Will this affect my menstrual periods?
Is there anything else I should know about this medicine? How often will you review with me what
the medicine is doing? How long will I need to take this medicine? How soon may I take less?
If I take this medicine for a long time, what can it do to me?
What is Tardive Dyskinesia (TD)? Can I get TD from taking this medicine?**
What will happen if I stop taking this medicine? Will my symptoms return?
(For males) Will this medication render me to be impotent?
**Definition: This is a condition that involves rhythmical involuntary movements of the tongue, face,
mouth, or
jaw.
Treatment
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What treatment do you think would be most helpful? How will it be helpful? What will be the
contribution of the psychiatrist to the overall program of treatment?
Will treatment involve services by other specialists (i.e., neurologist, psychologist, allied health
professionals)? If so, who will be responsible for coordinating these services?
How long will treatment take, and how frequently will you and the other specialists be seeing the
patient?
What will be the best evidence that the patient is responding to treatment, and how soon will it be
before these signs appear?
What do you see as the family’s role in this program of treatment? In particular, how much access
will the family have to the individuals who are providing the treatment?
Some useful questions to ask in special situations:
If you or your relative has manic or depressive symptoms:
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Did you perform a thyroid screening? If so, what was the result? If not, do you think it would be
appropriate to perform one?
If you or your relative have been taking Lithium for six months or more:
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Have you performed an assessment of the kidney function? How frequently do you think there
should be reassessments of thyroid and kidney function in connection with the ongoing Lithium
treatment?
If you or someone you know would like more information on mental illness
or wish to request an educational presentation, please contact:
NAMI IOWA (National Alliance on Mental Illness - Iowa)
3839 Merle Hay Rd., Ste. 226, Des Moines, IA 50310
Phone and Fax: (515) 254-0417
Web: www.namiiowa.com; Email: [email protected]
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