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Understanding Mental
Illness, Cognitive
Impairment and Addiction
Developed by DATA of Rhode Island
Through a special grant from the Rhode Island
Department of Human Services
September 2006
Course Goals
For participants to learn core
understanding of the origins and
presentations of mental illness, cognitive
impairment and addiction.
Identify common types of mental illness,
cognitive disorders and addiction
Why understand theories &
science of behavioral disorders?
To help reduce misunderstanding and stigma
to guide & ground your practice
choose & use approaches and interventions that are
appropriate and effective to the persons we serve.
To reduce stigma and prejudice toward persons with
mental/behavioral disorders
To understand that frequently a person who has one
disorder may have one or more other disorders e.g.
alcohol abuse and depression, cancer and depression
or mental retardation and anxiety
What is a mental illness
A mental disorder can span a range of severity
from transient adjustments to life
changes/psychosocial stresses to serious and
persisting illnesses.
Mental illness can adversely effects how a person
feels, thinks, behaves and relates to others.
Mental disorders effect up to 20% of the population
Common mental illness include: anxiety,
depression, schizophrenia, bipoplar disorder,
and disorders of personality
Myths about Mental Illness
1. Mental Illness is not a true illness like heart
disease….The facts is that psychiatric and
addictive disorders have genetic and
biological causes.
2. People with severe mental illness are
dangerous and violent…The fact is that the
incidence of violence among persons with
mental illness is about the same as the
general population. Actually, persons with
mental illness are more likely to be victims
of violence.
Myth’s continued
3. Addiction is a lifestyle choice….Addiction
is a result of changes in brain chemistry.
Like other disorders, you can’t just will it
away.
4. Depression and anxiety are signs that
the person is weak
Common Adult Mental Disorders
Depression
Anxiety
Schizophrenia
Bipolar Disorder
Recognizing depression
Depression has levels of severity
Disturbance of mood…sadness, irritability
Confusion
Problems with memory and concentration
Fatigue
Sleep and appetite disturbance
Anhedonia
Change in weight
Poor self care
Social isolation
Increased risk for suicide
How persons with depression may
come to your attention
Difficulties carrying out routine activities
like house cleaning, feeding pets, personal
hygiene
Withdrawal from social activities
Concern voiced by friends or neighbors
Crying or sadness
Recognizing anxiety
Fears of dying or going crazy
Excessive Worry
Panic attacks
Trembling
Sweating
Dizziness
Nausea, stomach pains
Breathlessness
Not going out of apartment or out of doors
Nightmares
How persons with anxiety disorders may
come to your attention
Anxiety problems are harder to identify as
they tend to occur behind closed doors.
This person may be brought to your
attention by friends, family or other
providers
Recognizing psychosis or
schizophrenia
Psychotic symptoms include:
Difficulties with thinking
Withdrawal
Poor self care
Hallucinations…hearing voices, seeing things
Delusions…strange beliefs (e.g. controlled by the television)
Agitation
Disturbance in sleep or appetite
In a research study at Yale University, the common person can
accurately tell when someone is psychotic in under 10 minutes
Psychosis and schizophrenia are not the same, although symptoms are
similar
Psychosis continued
Psychosis can be caused by:
Schizophrenia
Bipolar disorder
Toxic reactions to medicine or substances
Dementia
Hormonal imbalance
Trauma
Infection, illness or toxins
The important thing to remember is that the
psychotic person needs immediate attention
from a qualified health care professional
Case study 1
Gary is 37 year old disabled male living independently in his apartment. In his
late twenties he was was in an accident that left him partially paralyzed. He
could walk with the aide of a walker though often he used a wheel chair. In
the previous week he had shown change in behavior, seeming to be more
hostile and suspicious of other residents. When interviewed by the resident
coordinator, he claimed to be
” Kunte Kinta” an escaped slave. He said
bounty hunter were after him to return him to slavery. Gary became agitated
and threatened the worker claiming he was working with the bounty hunters.
The worker called emergency services who in turn involved the local police.
Gary was transported to the local emergency room where he was
hospitalized with a provisional diagnosis of schizophrenia.
Later when reviewing the admitting lab work, the attending MD noted Gary had
an elevated white blood cell count indicating an infection. This coupled with
Gary being non-responsive to the anti-psychotic medications led the MD to
run further tests. He was diagnosed with meningitis and aggressively
treated with antibiotics. Within several days the psychosis cleared and gary
returned to his apartment with follow up care.
How persons with psychosis may come to
your attention
The person with psychosis is in many
ways most obvious to identify because
behavior is unusual.
Inability to meets normal responsibilities
Concerns voiced by others
Conflict with law
Symptoms of Bipolar Disorder
Racing thoughts
Pressured speech
Mood Instability
Agitation
Not sleeping
Grandiosity
Hostility
Sometimes psychosis
Person with Bipolar Disorder may
come to your attention
Unusual behavior
Complaints by others
Conflicts with others
Awake at all hours
Personality Disorders
Personality disorders are enduring and deep
seated patterns of behavior that frequently
brings the person into conflict with others.
Behaviors include: Distorted interpretation of self
and others
intensity of feelings are inappropriate to situation
Poor ability to control impulses
Persisting conflicts in relationships with others
How persons with personality disorder may
come to your attention
Violation of rules
Infringes on rights of others
Complaints by others
Conflicts with others
Persons often surrounded by “drama”
Blames others
What is a cognitive disorder
A cognitive disorder is a disturbance in the brains
ability to receive information, process information
or remember. Cognitive disorders can also effect
feeling and behavior. Common cognitive disorders
include:
Developmental disorders/ Mental retardation
Learning disabilities
Delirium
Dementia
Amnesic disorder
Cognitive & memory Deficits
Recognizing Cognitive Disorders
A person with cognitive deficits may have
difficulties:
Understanding or following through with
instructions
Have difficulties with activities of daily living
Remembering
Problem solving
Recognizing consequences
Recognizing risk
Controlling behavior
Cognitive Disorders
Can be:
Temporary or permanent
Gross or subtle
Genetic
Neurobiological
Due to toxins
Due to injury or illness
Reactions to medication
What is an addictive disorder
Substance use disorder includes two broad
categories of problems. These are substance
abuse and substance dependence.
Substance abuse is the impairment in some
aspect of a persons life as a result of use of a
substance.
Substance dependence is distinguished from
abuse by the addition of a physical and/or
psychological dependence on the substance.
Case Study # 2
Andy is a 63 year old male living in housing who came to the
attention of the service coordinator as he was behind on his rent. A
review of his financial status suggested that he had more than
adequate resources for living. In interviewing Andy, it was disclosed
that on “check” day he would go across the street from the
apartment complex, buy several gallons of vodka and spend the rest
on scratch tickets and a carton of cigarettes. He would then drink the
alcohol until it was gone and scratch the tickets. In recent months he
was without funds by the end of the 1st week of the month and was
surviving eating in the soup kitchen once daily.
Andy was referred to an area multi-service agency for treatment
services and was ultimately assigned a rep-payee to aide with his
finances. Andy was diagnosed with an alcohol problem, gambling
problem, malnutrition and dementia.
Prevalence of disorders
Over 1/3 of all patients who have a psychiatric
disorder also experience substance (AOD) abuse.
More than ½ the people who abuse AOD have
significant psychiatric symptoms
Over 1/3 of persons with cognitive disorders
experience psychiatric or AOD problems
Over half of all persons with cognitive impairment
due to traumatic brain injury (TBI) have co-occurring
psychiatric and AOD disorders
Over 1/3 of all persons with chronic medical
conditions have co-occurring psychiatric problems
Over 40% of persons with chronic pain develop AOD
dependence problems
Psychiatric & AOD Disorders
in the General Population
Lifetime Prevalence of SA
Disorders


Lifetime Prevalence of
Psychiatric Disorders
Tobacco 24%

Alcohol 14%
All other drugs
 Cannabis
 Cocaine
 Stimulants
 Sedatives
 Heroin
7.5%
4.2%
2.7%
1.7%
1.2%
0.4%
Major Depression 17%
Social phobia 13%
Simple phobia 11%
GAD 5.1%
Panic Disorder 3.5%
Personality Disorder 3.5%
Bipolar 1.6%
Schizophrenia 1.2%
Theoretical Models for
Behavioral Health Disorders
Common Factors Model
Psychiatric Disorders
Common Factors
Substance Use Disorders
• Familial factors (genetics)
• Life Experiences
• Neurobiological Dysfunction
Cognitive Disorders
Theoretical Models for
Co-occurring Disorders
Secondary Substance
Abuse Model
Psychiatric Disorders
Substance Use Disorders
• Psychosocial Risk factors
• Self medication
• Alleviation of dysphoria
• Super-sensitivity
• Stress Vulnerability
Theoretical Models for
Co-occurring Disorders
Secondary Psychopathology Model
Substance Use Disorders
Psychiatric Disorders
Cognitive Disorders
Theoretical Models for
Co-occurring Disorders
Bi-directional Model
Psychiatric Disorders
Substance Use Disorders
Cognitive Disorders
What is a Co-occurring
Disorder
Co-existence of a mental health
disorder, an alcohol and other drug
(AOD) problem and/or a cognitive
disorder. There is also high cooccurrence of medical problems.
These are also called:



dual disorders
co-morbid disorders
co-existing disorders
Challenges of working with
Adults with disabilities
Co-occurring Disorders is the rule and not the
exception making treatment more complex.
Higher rates of child welfare involvement,
homelessness, legal and medical problems.
More frequent and longer hospitalizations, higher
acute care and utilization rates.
Higher rates of cognitive deficits
Wrapping up
Screening and assessment of specific
disorders
Proven strategies for intervening
How to develop intervention plans that are
reasonable to your setting
Knowing your community resources
Responding to crisis situations
Intervention & Treatment Works
It is important to remember that these
problems are treatable.
The past 30 years have shown
tremendous improvement in the
successful treatment of all these problems.
Timely and effective interventions and
coordinated efforts yield the best results
Final Questions