Problems do not go away. They must be worked through or else they remain, forever a barrier… M. Scott Peck

“But I don’t want to go among mad people,” Alice remarked. “Oh, you can’t help that,” said the Cat. “We’re all mad here. I’m mad. You’re mad.” “How do you know I’m mad?” said Alice. “You must be,” said the Cat, “or you wouldn’t have come here.” Lewis Carrol, Alice in Wonderland

ADULT DIAGNOSES Depression Schizophrenia Bipolar Disorder (Manic Depressive Illness) Personality Disorders Substance Abuse

Depression DSM IV TR Criteria Course of illness Effect on caregiving Comorbidities

Schizophrenia DSM IV TR Criteria Course of illness Effects on caregiving Comorbidities

Bipolar Disorder DSM IV TR Criteria Course of illness Effect on caregiving Comorbidities

Personality Disorders DSM IV TR Criteria Course of illness Effect on caregiving Comorbidities

Substance Abuse: Drugs, Alcohol & Polysubstance DSM IV TR Criteria Abuse v. dependence Course of illness Effects on caregiving Comorbidities

Kids’ Diagnoses Depression Bipolar (controversial, especially before 13 years old) ADD Behavioral consequences in kids whose parent has an unstable mental illness

Working with parents with unstable mental illnesses Compliance v. noncompliance Drug addiction Assessment

Long-term prognosis Depression Good prognosis if compliant with medication and supportive therapy Schizophrenia Fair prognosis if compliant with medication, therapy and social supports Poor prognosis with marked deterioration if noncompliant Bipolar Disorder Good prognosis if compliant with medication Unfortunately, often prefer to be unmedicated

Long-term prognosis Personality Disorder Generally difficult to treat Problems arise because of co-occurring substance abuse &/or poor judgment, impulsivity and disrupted interpersonal relationships Substance Abuse Fair prognosis if complies with medication & supportive therapy. However, relapse is anticipated. Poor prognosis with marked deterioration if untreated.

Medications Antidepressants Antipsychotics Antimanics Anxiolytics Drugs that treat cravings

Antidepressants SSRIs Prozac, Zoloft Paxil Available as pills, liquids Actions: thought to block reuptake of serotonin Duration: varies. Takes 4-6 weeks for full effect.

Antidepressants NSRIsEffexor, Cymbalta Available in pill form Actions: thought to act by blocking reputake of serotonin & norepinephrine Duration: varies. Can take 1-4 weeks for full effect

Antipsychotics Haldol Available in pill, liquid and short-acting or long-acting shot (get every 4 weeks) Actions: blocks dopamine receptors. Treats short- term psychotic symptoms Duration: pill form lasts 6-10 hours; Long-acting shot lasts 28 days

Antipsychotics Risperdal Available in pill or long-acting shot form Actions: blocks serotonin, dopamine & histamine receptors For short-term treatment of psychotic symptoms or for irritability associated with manic behavior Duration: pill form lasts 6-7 hours Long-acting shot lasts 7 weeks but can take 3 weeks to start working

Antipsychotics Geodon Available in pill and short-acting shot form Actions: dopamine & serotonin antagonist Treats positive and negative symptoms of schizophrenia with minimal EPS side effects Rapid control of agitation and psychotic symptoms Rapid short-term treatment of manic or mixed symptoms Pill form lasts 12 hours but IM best for acute symptoms

Antimanics Lithium Available as pill or liquid Action: alters chemical transmissions in neurons Duration: 1-3 weeks for full effect Use additional alternate medication for short term treatment of symptoms Maintain adequate fluid intake, scheduled blood tests

Antimanics Depakote/Depakene Antiepileptic/mood stabilizer Often used as an alternative to Lithium Available as pills, syrup sprinkles Actions: May inhibit nerve transmission in CNS and may increase brain level of GABA

Mood Stabilizers Lamictal Available in pill form Action: inhibits certain neurotransmitters Important info: can cause life-threatening complications if given with depakote

Mood Stabilizers Topamax Available as pill or sprinkles Action: unknown

Resources Directory of Health & Human Services in Metropolitan Chicago Haymarket House Hull House Thresholds