1 Mental Health and Illness Overview of Approaches, Definitions, Perspectives Mr. Dan King MA, M.Ed., Escalon High School Health Education

2 Continuous or discrete? Continuous model: Mental Health Mental Illness Healthy>>>>Adjustment reaction>>>>Neurosis>>>>Psychosis We all have differing degrees of mental health at different times in our lives. Most people aren ’ t at the extremes but fall somewhere in the middle. Anyone can become mentally ill, given the right circumstances.

Copyright © 2006 Cynthia Bisbee, Ph.D. Types of Mental Illness

Copyright © 2006 Cynthia Bisbee, Ph.D. Definition of Mental Disorder A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom.

Defining Mental Illness Clinical definition : Clinically significant behavioral problems Associated with distress (painful symptoms) Causes disability (impairment in functioning) A biological illness that responds to treatment Not to be confused with weakness of character

6 What is mental health? In our society, a mentally healthy person: Has self-esteem, self-acceptance Is realizing potential Is able to maintain fulfilling relationships Has a sense of psychological well-being Has sense of autonomy Has sense of competence, mastery, purpose However, other cultures may have different ideas about what mental health is.

Facts about Mental Illness  Has nothing to do with intelligence  Can happen to anyone  Chronic but not contagious  Difficult to diagnose and to treat  Treated but not cured  Mentally ill are not all dangerous  Should not be confused with terms psychopath or sociopath

Copyright © 2006 Cynthia Bisbee, Ph.D. Definition of Mental Disorder Not merely an expectable and culturally sanctioned response to a particular event such as death of a loved one Must be within an individual Classifies disorders, not people

Copyright © 2006 Cynthia Bisbee, Ph.D. Biology of Serious Mental Illnesses Brain Disorder – Anatomy – Function (metabolism) – Chemistry Causes of Brain Disorder – Genetics – Viral Theories – Brain Injury

Copyright © 2006 Cynthia Bisbee, Ph.D. Serious Mental Illness Always Included in Definition – Schizophrenia – Major Depression – Bipolar Disorder Sometimes Included – Severe Anxiety Disorders – Cognitive Disorders – Some Personality Disorders

Copyright © 2006 Cynthia Bisbee, Ph.D. The Role of Environment Some Disorders May Be Learned Some Result from Trauma Environment Affects the Course of the Disorders Stigma

Copyright © 2006 Cynthia Bisbee, Ph.D. Criteria for Schizophrenia Characteristic symptoms – Delusions – Hallucinations – Disorganized Speech – Disorganized Behavior – Negative Symptoms Flat Affect Lack of Motivation Social/Occupational Dysfunction Lasting at Least Six Months

Schizophrenia Symptoms Brain disease Includes psychosis Impacts 1 out of every 100 people. Does not differentiate across SES Onset is late teens, early adulthood. Positive Symptoms include : – hallucinations – delusional thinking Negative symptoms include – apathy – withdrawal.

Copyright © 2006 Cynthia Bisbee, Ph.D. Schizophrenia: Chemical Imbalance in the Brain Speaking Brain Cell Listening Brain Cell Synapse DopamineVesicleReceptor Site Too Much Dopamine = Positive Symptoms Copyright © 1998 Patricia L. Scheifler MSW, PIP

Mood Disorders Major Depression Symptoms Affects 5 percent of the general population Sad mood that lasts 2 weeks Loss of interest or pleasure in daily activities Changes in sleep, appetite, decreased energy Thought problems affect concentration, memory, decisions, feelings of guilt, worthlessness Risk of suicide is high Important to differentiate mental health from physical problems Responds well to treatment

Mood Disorders Major Depression  Loss of interest in food and self care  May not care about legal situation  Suicide risk is real and must be monitored  Risk of suicide may increase after medication

Copyright © 2006 Cynthia Bisbee, Ph.D. Criteria for Major Depression Depressed Mood Diminished Interest Weight Loss or Gain Sleep Disturbance Restlessness or Being Slowed Down Fatigue & Loss of Energy Thoughts of Death Feelings of Worthlessness or Excessive Guilt Difficulty Thinking & Concentrating Symptoms Occur Every Day Significant Distress & Impairment

Mood Disorders Mania/ Bipolar Disorder Symptoms  Euphoric Mood (elevated, high or happy)  Irritable Mood (touchy)  Three Stages of Mania Hypomania, Acute Mania, Psychosis  Bipolar Disorder - mood swings from depression to mania  Can be Rapid Cycling

Copyright © 2006 Cynthia Bisbee, Ph.D. Criteria for Bipolar Disorder Manic Episodes – Elevated mood – Grandiosity – Decreased need for sleep – Talkativeness – Racing thoughts – Increased goal-directed activity Marked Impairment – Occupation – Social relationships (or) Hospitalization (or) Psychotic Features May Alternate with Depressive Episodes

Anxiety Disorders Panic Disorders Symptoms  Prevalence is 1 to 2 percent of the population; Women twice as high as men.  Panic attacks occur without warning  Symptoms include intense fear, heart palpitations,chest pain, shortness of breath, dizziness  Person is concerned that the attacks will strike again

Anxiety Disorders Obsessive-Compulsive Disorder Symptoms  Obsessions are recurrent thoughts, images, impulses that cause anxiety. They are illogical,at times repulsive and/or center on violence or harm.  Compulsions are behaviors that are repetitive - attempts at reducing the anxiety created by the obsessions.

Post Traumatic Stress Disorder Symptoms  Exposure to an extremely stressful event.  Painful memories, nightmares,, suspicion, anxiety, depression, feelings of guilt and sleep difficulties  Symptoms worsen with exposure to similar events  Substance abuse is a common method to cope Symptoms in Jail  Jail environment can trigger symptoms  Jail inmates and personnel can trigger symptoms  Lack of privacy and loss of control are issues

Personality Disorders  Inflexible, maladaptive, ways of coping and relating  Difficulty in holding steady work and relationships  Difficult to change  Can co -exist with other mental illnesses  Behavior problems precipitate jail  Antisocial  Narcissistic  Borderline  Avoidant  Paranoid  Dependent  Schizotypal  Schizoid

Copyright © 2006 Cynthia Bisbee, Ph.D. Treatment of Mental Illness

Copyright © 2006 Cynthia Bisbee, Ph.D. Intervention Goals Remission of Symptoms – Positive – Negative Maintenance of Stability Enhanced Quality of Life Role Recovery

Copyright © 2006 Cynthia Bisbee, Ph.D. Medications Antipsychotics Antidepressants Mood Stabilzers Anxiolytics Side Effects Medications

Copyright © 2006 Cynthia Bisbee, Ph.D. Anti-psychotic Medications Used to combat psychotic symptoms – Hallucinations – Delusions – Confused Thinking – Altered Perceptions – Disorganized Speech – Other signs of psychosis

Copyright © 2006 Cynthia Bisbee, Ph.D. Examples of Anti-psychotic Medications Zyprexa Risperdal Seroquel Geodon Clozaril Abilify Haldol Loxitane Thorazine Mellaril Stelazine Prolixin Navane Serentil

Copyright © 2006 Cynthia Bisbee, Ph.D. Anti-depressant Medications Used to Relieve Symptoms of Depression – Sadness – Feelings of Failure – Loss of Interest in Life – Sleep Disturbances – Excessive Guilt – Loss of Energy/Fatigue – Thoughts of Death and Suicidal Thoughts

Copyright © 2006 Cynthia Bisbee, Ph.D. Examples of Anti-depressant Medications Prozac Zoloft Effexor Celexa Serzone Remeron Paxil Wellbutrin Lexapro Desyrel Elavil Tofranil Pamelor Marplan Nardil Ascendin Sinequan

Copyright © 2006 Cynthia Bisbee, Ph.D. Mood Stabilizers Used to Treat Symptoms of Mania – Rapid Talking – Decreased Need for Sleep – Racing Thoughts – Distractibility – Irritability – Behavioral Excesses – Grandiosity

Copyright © 2006 Cynthia Bisbee, Ph.D. Examples of Mood Stabilizers Lithium – Eskalith – Lithobid – Lithane Depakote Tegretol Neurontin Zyprexa Topamax Note: Some of these medications are also used to treat seizures

Copyright © 2006 Cynthia Bisbee, Ph.D. Anti-anxiety Medications Used to Treat Symptoms of Anxiety – Nervousness – Panic – Shortness of Breath – Trembling – Feeling of Choking – Heart Palpitations – Obsessions & Compulsions

Copyright © 2006 Cynthia Bisbee, Ph.D. Examples of Anti-anxiety Medications Xanax Ativan Klonapin Buspar Valium Librium Serax Equanil Miltown Vistaril Tranxene

Copyright © 2006 Cynthia Bisbee, Ph.D. Stimulants (special use) Used to Treat Symptoms of Attention Deficit/Hyperactivity Disorder – Mainly Used in Children – Hyperactivity – Inability to Pay Attention – Distractibility

Copyright © 2006 Cynthia Bisbee, Ph.D. Examples of Stimulant Medications Ritalin Adderall Dexedrine Cylert Concerta

Copyright © 2006 Cynthia Bisbee, Ph.D. Side Effects of Medications Drowsiness Dry Mouth Blurred Vision Dizziness Tremors Sexual Dysfunction High Heart Rate Weight Gain Slurred Speech Sensitivity to Sun Some Are Addictive