Download DEFINITION OF MENTAL ILLNESS

Mental Illness (Adult)
KNR 270
Mental Illness
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Effects 50 million in US
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5-7% of adults have a serious mental
illness
5-9% of children
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World Health Organization notes MI is the
leading disability world-wide
Only about ½ seek help
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Stigma and discrimination
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Society fears people with MI are violent
DEFINITION OF MENTAL
ILLNESS
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Behavior that significantly deviates
from the norm
Society sets standards for norm
As society becomes more pluralistic,
fewer behaviors will be considered
abnormal
Society can change criteria of
normal or abnormal
CRITERIA
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Consistently inappropriate
Evidenced for some duration
Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR,
2000)
American Psychiatric Association
Leisure functioning is part of criteria
DSM-IV-TR
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Detailed classification system
Used to design treatment
Rated on 5 axes
Axis I: Clinical Syndromes
(Current Condition)
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Disorders evident in
infancy, childhood, or
adolescence
Substance-related
Schizophrenia & other
psychotic disorders
Mood disorders
Anxiety disorders
Factitious disorders
Somatoform disorders
Dissociative disorders
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Delirium, dementia,
amnesic, & other
cognitive disorders
Sexual & gender
identity disorders
Eating disorders
Sleep disorders
Impulse control
disorders
Adjustment disorders
Axis II: Longstanding Conditions Associated
with Personality Disorders & Mental
Retardation
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Axis II only used to identify a longterm underlying problem
Personality disorders: paranoid,
schizoid, histrionic, narcissistic,
antisocial, borderline, obsessivecompulsive
Mental retardation
Remaining axes used to identify factors
contributing to or being affected by disorder
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Axis III: General medical conditions
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Axis IV: Psychosocial & environmental
problems
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Physical problems
Psychosocial stress
Axis V: Global Assessment of Functioning
Scale (GAF)
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Current level of adaptive functioning in social
relationships, occupational functioning, and
use of leisure time
MI subdivided
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Neuroses
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Most frequent
Recognizes presence of maladaptive behavior
& effect on person
 Mild depression, anxiety, phobia
Psychoses
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More serious
Lack of realization that behaviors is obvious or
present
Unable to objectively evaluate reality
 Schizophrenia
SCHIZOPHRENIA(S)
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Not multiple or split personalities
More of a disintegration of
personality, departure from reality
Thought disorder
Often diagnosed 15-25
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Stress can aggravate
Effect on person’s future
Could be gradual or sudden onset
Heavy pot smoking might raise risk
Schizophrenia Criteria:
2 or more of:
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Delusions
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Only 1 if delusion is bizarre, such as
being abducted in a space ship from
the sun
Hallucinations
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Only 1 if at least 2 voices talk to one
another or a voice keeps a running
commentary in thoughts
Schizophrenia Criteria:
2 or more of:
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Speech
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Incoherent, disorganized
Negative symptoms
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Flat affect, reduced speech, lack of
volition, deteriorating personal hygiene,
increased suspicion people are talking
behind one’s back
SCHIZOPHRENIA
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Delusions
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Disturbance in content of thought
Persecutory or paranoid
Thought broadcasting
Thought insertion
Grandiose
Religious
SCHIZOPHRENIA
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Hallucinations
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Disturbances in perceptions
Most often auditory
“Voices” speak to the person
Tactile
Could be connected to any sense
Visual is rare unless drug or alcohol
abuse
SCHIZOPHRENIA
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Other problems
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Hard time making choices or decisions
Hard time thinking clearly
Socially withdrawn
Flat or blunted affect
Lack of interest or joy
Loose associations
Word salad or nonsense words
Types of Schizophrenia
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Paranoid type
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Disorganized type
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Preoccupied with delusions or frequent
auditory hallucinations
Disorganized behavior & speech, affect
that is flat or inappropriate
Catatonic type
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Stupor or motor immobility, mutism or
marked negativism, peculiar posturing,
mannerisms or grimacing, echolalia
SCHIZOPHRENIA (S)
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Thought to be a chemical imbalance
Symptoms may be controlled by meds
Predictors of poor outcome
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Early age onset, family history, withdrawal,
prior history
Can be side effects to medication
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Tardive dyskensia
 Involuntary movements of tongue, face,
mouth, or jaw associated with long-term use
of antipsychotics
 May be irreversible
Mood or Affective Disorders
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Depression
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Mania
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Bipolar
DEPRESSION
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Different than
everyday sadness
Impairs everyday
functioning
Diminished interest
or pleasure
Fatigue and energy
loss
Memory loss
Weight loss or gain
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Difficulty thinking
Loss of
concentration
Sense of
worthlessness or
quilt
Sleeping (insomnia
or sleeping too
much)
Suicide
MANIA
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Extreme elation
Inflated self-esteem
Decreased need for sleep
Racing thoughts
Physical activeness
Increased talkativeness
Increased risk-taking
BIPOLAR-AFFECTIVE
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Mood swings or cycles
Tends to run in families
Often treated with lithium
Come off meds when feeling better
& cycle starts over again
Some enjoy manic phase because
feel so creative
Anxiety Disorders
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Generalized anxiety
Panic attack
Phobias
Posttraumatic Stress Disorder
Obsessive-Compulsive Disorder
Dissociative Identity Disorder
ANXIETY DISORDERS
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Intense fear or panic that appears
to be unjustified
Always anticipates disaster
Symptoms
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Shortness of breath
Increased heart rate
Dizziness
Chest pains
Fear dying or going insane
Panic Attack:
4 or more:
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Chest pain or
discomfort
Heart pounds, races
or skips beats
Chills or hot flashes
Choking sensation
Feeling unreal or
detached from self
Fear of dying
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Dizzy, lightheaded,
faint or unsteady
Nausea or other
abdominal discomfort
Numbness or tingling
Sweating
Shortness of breath or
smothering sensation
Trembling
Phobias
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Social Phobia
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Most common phobia
Irrational fear of situations where may
be watched & judged by others
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Public speaking
Trembling, sweating, racing heart
Avoids situations
Agoraphobia
Claustrophobia
Posttraumatic Stress Disorder (PTSD):
Criteria
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Experienced or witnessed a
traumatic event that has both of
these elements
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Actual or threatened death or serious
injury to self or others
Felt intense fear, horror or helplessness
War, rape, 9/11, Katrina, Virginia Tech,
etc.
 9/10 Iraq & Afghanistan veterans in VAs
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Posttraumatic Stress Disorder (PTSD):
Criteria
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Repeatedly relives the event in at least 1
way:
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Intrusive, distressing recollections in thoughts
or images
Repeated, distressing dreams
Flashbacks or illusions that feel like the event
is recurring
Mental distress in reaction to internal or
external cues that symbolize or resemble the
event
Physiological reactivity – such as rapid heart
beat, increased blood pressure in response to
these cues
Posttraumatic Stress Disorder (PTSD):
Criteria
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Repeatedly avoids the traumarelated stimuli & has numbing or
general responsiveness in 3
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Tries to avoid thoughts, feelings,
conversations connected to event
Tries to avoid activities, people or
places that recall the event
Cannot recall an important feature of
the event
Posttraumatic Stress Disorder (PTSD):
Criteria
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Repeatedly avoids the traumarelated stimuli & has numbing or
general responsiveness in 3
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Marked loss of interest or participation
in activities important to person
Feels detached or isolated from other
people
Restriction in ability to love or feel
other strong emotions
Feels life will be brief or unfulfilled
Posttraumatic Stress Disorder (PTSD):
Criteria
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At least 2 of symptoms of
hyperarousal were not present
before the traumatic event
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Insomnia
Irritability
Poor concentration
Hypervigilance
Increased startle response
Obsessive-Compulsive Disorder
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1/3 have onset before 15
Second peak time is 30s
1/50 adults
Likely to persist throughout life with
varying degrees of severity
No known cause
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Inherited
Shortage of serotonin
Stress
OBSESSIVE-COMPULSIVE
DISORDERS
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Obsession: persistent
preoccupation with unreasonable
ideas or feelings
Compulsion: irresistible impulse to
perform irrational acts
Obsession: cleanliness /
Compulsion: handwashing
Can have thoughts without
behaviors
Obsessive-Compulsive Disorder:
Criteria
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For obsessions must have all:
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Recurring, persisting thoughts, impulses or
images inappropriately intrude into awareness
& cause marked distress or anxiety
Ideas are not just excessive worries about
ordinary problems
Tries to ignore or suppress these ideas or
neutralize them by thoughts or behaviors
Insight that these ideas are a product of one’s
own mind
Obsessive-Compulsive Disorder:
Criteria
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For compulsions must have all:
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Feels need to repeat physical behaviors
(hand washing) or mental behaviors
(counting things, silently repeating
words)
Behaviors occur as response to
obsession or in accordance with strictly
applied rules
Obsessive-Compulsive Disorder:
Criteria
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For compulsions must have all:
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Aim of behaviors is to reduce or
eliminate distress or prevent something
that is dreaded
Behaviors are either not realistically
related to the events they are
supposed to counteract or they are
clearly excessive for that purpose
Obsessive-Compulsive Disorder:
Criteria
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At some point, may recognize that
obsessions or compulsions are
unreasonable or excessive
Obsessions &/or compulsions
associated with 1:
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Cause severe distress
Take up more than 1 hour/day
Interfere with usual routine, or work,
social or personal functioning
Most Prevalent Obsessions
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Contamination fears of germs or
dirt
Imagining having harmed self or
others
Imagining loosing control of
aggressive urges
Intrusive sexual thoughts or urges
Need to control things
Most Prevalent Compulsions
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Repeated checking of doors, locks,
electrical appliances, or light
switches
Frequent cleaning of hands or
clothes
Strict attempts to keep items in
careful order
Repetitious mental activities, such
as counting or praying
DISSOCIATIVE IDENTITY
DISORDER (DID)
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Old multiple personality disorder
Not multiple but fragmented
Result of severe abuse
Person develops “alters” to manage
abuse
Treatment is attempt to get all
personalities reintegrated
Personality Disorders
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Antisocial Personality
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Borderline Personality
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Self centered
Manipulative
Failure to reach potential
Antisocial Personality
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Lack of regard for moral or legal
standards of culture
Marked inability to get along with
others or abide by social rules
Disregard of laws & rights of others
Also called:
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Psychopaths
Sociopaths
Borderline Personality Disorder
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Rapid mood changes
Intense, unstable interpersonal
relationships
Hard time controlling emotions
Intense, inappropriate, uncontrollable
anger
Self-damaging impulsive behavior
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Compulsive spending, gambling, sexual
behaviors
Overly sensitive to criticism or rejection
Considerations/Accommodations
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Stay calm & be supportive
Ask how to help
Clear/concise directions
Empathy
Patience
Good feedback on how doing
Refrain from expressing displeasure
Considerations/Accommodations
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Know about medication side effects
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Sun sensitivity
Dry mouth
Sedation/drowsiness
Blurred vision
Fluctuations in ability
Stress management programs
Relaxation programs
Expressive arts programs
Considerations/Accommodations
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Physical activity can decrease
anxiety
Watch use of sharp supplies
Transportation
Scholarships
Try to involve with others to
decrease social isolation
Others???
COMMUNICATING
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Confusion about
what is real
Difficulty
concentrating
Overstimulation
Preoccupation with
internal
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Be simple &
straight forward
Be brief, repeat
Limit input; don’t
force discussion
Get attention
before preceding
COMMUNICATING
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Agitation
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Fluctuating
emotions
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Withdrawal
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Belief in delusions
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Recognize & allow
exit
Don’t take words
or actions
personally
Initiate
conversations
Don’t argue
COMMUNICATING
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Discussion about
voices
Low self-esteem
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Acknowledge, but
explain you do not
hear them
Stay positive &
reinforcing