Understanding Mental Illness A Review of the Disorders Paul Knoll, PhD, LMHC, CAP Director Recovery Center, TMH

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

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

General Signs of Mental Illness ObservableObservable ConfusionConfusion DisorientedDisoriented Darting looksDarting looks Talking to selfTalking to self Poverty of SpeechPoverty of Speech Pressured speechPressured speech Poor hygienePoor hygiene Inappropriate attireInappropriate attire Behavior ChangesBehavior Changes Flat AffectFlat Affect WithdrawnWithdrawn Sad or anxious moodSad or anxious mood PanicPanic Psycho somatic complaintsPsycho somatic complaints

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

SchizophreniaSymptoms  May appear non compliant  Agitated by voices and delusions -may look and act dangerous  Command hallucinations may actually be dangerous  More likely to respond to clear directions, and reassurance in a kind tone of voice  Poor hygiene - Not aware of their surroundings enough to know that they are not clean

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

Mood Disorders Major Depression Symptoms  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

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

Mood Disorders Mania/ Bipolar Disorder Symptoms  Legal problems may be the consequence of the disorder  Mood can swing from entertaining to hostile  Talkativeness can be irritating  If depressed, often cry, feel hopeless, become suicidal  Can be restless, pacing, demanding and destructive  Often non-compliant  Can be professional and well-educated

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  Lack of privacy and loss of control are issues  PTSD can be trigger years after the event

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

Substance Abuse Symptoms  85% of population have substance abuse problems  High correlation of substance abuse and other mental illnesses Symptoms Monitor risk of OD or withdrawalMonitor risk of OD or withdrawal Monitor abuse of prescription drugsMonitor abuse of prescription drugs Can mimic other Mental illnessesCan mimic other Mental illnesses Long term abuse can cause dementiaLong term abuse can cause dementia

Co-occurring Disorders  Presence of both a mental illness and substance abuse disorder  High prevalence rates  60% of persons with a mood disorder also have a substance abuse disorder  50% of persons with schizophrenia also have a substance abuse disorder

Common Factors of Mental Illness and Substance Abuse  Brain disorders  Lack of Insight  Chronic  Impacts Family  Shame and guilt  Needs Treatment

Dementia and other Cognitive Disorders Symptoms Memory problemsMemory problems ConfabulationsConfabulations Impaired thinkingImpaired thinking Impaired JudgmentImpaired Judgment Poor memory and may not follow directionsPoor memory and may not follow directions Treat individual as you would any with a disabilityTreat individual as you would any with a disability

Promoting Communication  Listening:attend to both verbal and nonverbal cues, hear and observe, and avoid distractions  Clarification: Restate.Repeat, Clarify, Question  Dealing with Silence  Respond Effectively  Maintain Personal Space  Open ended questions  Non verbal Cues

Basic Communication Guidelines  Short, clear direct sentences  Simple content  Low stimulation level  Don’t force communication  Be consistent  Don’t take actions or reactions personally

Basic Communication Guidelines  Be patient  Person may not “get” all the information  Be pleasant and firm  Praise cooperative behavior  Practice reflective listening  Know your non verbal communication

Basic Communication Guidelines  Short, clear direct sentences  Simple content  Low stimulation level  Don’t force communication if person is withdrawn  Be consistent  Don’t take actions or reactions personally  Person may not “get” all the information you provide  Be patient  Be pleasant and firm  Praise cooperative behavior  Practice reflective listening  Know your non verbal communication

Types of Non-Verbal Communication  Body Posture  Facial Expression  Eye Contact  Gestures