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Family Therapy and Mental Health

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Title: Family Therapy and Mental Health


1
Family Therapy and Mental Health
  • University of Guelph
  • Office of Open Learning

2
Course Instructor
  • Carlton Brown, M.Sc., M.Div., RMFT
  • 3-1216 Upper Wentworth Street, Hamilton ON L9A
    4W2
  • Tel 905-388-8728
  • Email carl_at_mftsolutions.ca
  • Slides http//www.mftsolutions.ca/Pages/MentalHea
    lthCourse.html

3
By the End of Today
  • Schizophrenia and Bipolar Disorder
  • DSM Criteria
  • Types of Intervention
  • Medications
  • Videos
  • Student Presentation
  • Experiential Activities

4
How Are We Doing So Far?
  • Comments and/or Fishbowl
  • What do you like about mental health?
  • What do you not like about mental health?
  • What do you want to do before the end of the
    course?

4
5
Definition of a Mental Disorder
  • clinically significant behavioral or
    psychological syndrome or pattern that occurs in
    an individual and that is associated with present
    distress (e.g., a painful symptom) or disability
    (i.e., impairment in one or more important areas
    of functioning) or with a significantly increased
    risk of suffering death, pain, disability, or an
    important loss of freedom.

6
Mental Disorder, continued
  • Must not be expectable and culturally sanctioned
    response to a particular event (e.g. death of
    loved one)
  • Must be a current manifestation of dysfunction
  • Deviant behaviour and conflicts with society are
    not included unless the deviance or conflict is a
    symptom of individual dysfunction, as above

7
But What About....
  • Mental Order, or a
  • Manual of the Sanities
  • Christopher Peterson and Martin E.P. Seligman
    (2004), Character Strengths and Virtues A
    Handbook and Classification. Washington DC and
    New York American Psychological Association and
    Oxford University Press

7
8
The DSM
  • Preamble
  • Childhood, Cognitive Disorders, Medical
    Conditions and Substance Abuse
  • Schizophrenia and Other Psychotic Disorders
  • Mood
  • Anxiety
  • Interlude
  • Body, Faking, DID, Sex, Eating, Sleeping,
    Impulse-Control and Adjustment
  • Personality and Postlude

9
Mental Illness Categories
  • Thinking
  • Feeling
  • Behaving

9
10
Beware of Categories!
  • Thinking affects feeling
  • e.g. expectation, mood, and winning the lottery
  • Feeling affects thinking
  • e.g. Becks Cognitive Triad
  • Im worthless
  • The world is unfair
  • Its not going to get better
  • Thinking and Feeling affect Behaviour
  • Behaviour affects Thinking and Feeling

10
11
Thinking (Psychosis)
  • DSM Chapter on Schizophrenia and Other Psychotic
    Disorders
  • psychosis si'kos?s
  • noun ( pl. -ses -?sez)
  • a severe mental disorder in which thought and
    emotions are so impaired that contact is lost
    with external reality.
  • ORIGIN mid 19th cent. from Greek psukhosis
    animation, from psukhoun give life to, from
    psukhe soul, mind.

11
12
Psychotic
  • delusions
  • hallucinations
  • lack of insight
  • or maybe with insight
  • broaden to include other positive symptoms of
    schizophrenia (disorganized speech, disorganized
    or catatonic behaviour)
  • too broad unable to cope with life
  • loss of ego boundaries

12
13
(No Transcript)
14
Im Still Here
  • The Truth About Schizophrenia

14
15
Schizophrenia
  • lasts for at least 6 months
  • includes at least one month of active symptoms
    (delusions, hallucinations, disorganized speech,
    disorganized behaviour, negative symptoms - 2 or
    more unless severe)

15
16
Schizophrenia and Other Psychotic Disorders
  • Schizophrenia
  • Schizophreniform Disorder
  • less than six months, better functioning
  • Schizoaffective Disorder
  • active symptoms before or after (active symptoms
    mood)
  • Delusional Disorder
  • one month of nonbizarre delusions

17
Schizophrenia and Other Psychotic Disorders
  • Brief Psychotic Disorder
  • 1 day to less than 1 month
  • Shared Psychotic Disorder
  • same content as another person of longer duration
  • Psychotic Disorder due to a General Medical
    Condition (including substance-induced)
  • Psychotic Disorder Not Otherwise Specified (NOS)

18
Schizophrenia
  • Characteristic signs and symptoms
  • Positive and negative symptoms
  • Present for most of a month (less if treated)

19
Schizophrenia
  • Some signs persisting for at least 6 months
  • Marked social or occupational dysfunction
  • Not better accounted for by something else

20
Schizophrenia
  • Wide range of cognitive and affective dysfunction
  • A lot of variation among individuals

21
Schizophrenia
  • Positive symptoms
  • Excessive or distorted normal functions
  • Negative symptoms
  • Diminution or loss of normal functions

22
Positive Symptoms of Schizophrenia
  • Psychotic
  • Delusions distorted thought content
  • Hallucinations distorted perceptions
  • Disorganized
  • Disorganized speech distorted language and
    thought process
  • Grossly disorganized or catatonic behaviour
    distorted self-monitoring of behaviour

23
Negative Symptoms of Schizophrenia
  • Affective flattening
  • Restricted range and intensity of emotional
    expression
  • Alogia
  • Restricted fluency and productivity of thought
    and speech
  • Avolition
  • Restricted initiation of goal-directed behaviour

24
Delusions
  • Erroneous beliefs
  • Usually involve misinterpretations of perceptions
    or experiences
  • Many possible themes

25
Delusional themes
  • Persecutory someone (maybe you) is out to get me
  • Referential that TV announcer is talking about
    me, newspaper article is about me, biblical
    prophecy is about me
  • Somatic I have cancer, gas poisoning, a
    transmitter planted in my brain

26
Delusional themes
  • Grandiose I actually work for the CIA, Im the
    son of God, etc.
  • (personal experience two deities can coexist on
    the same floor, but not two government agents)
  • Religious delusions are common, especially if the
    person is having auditory hallucinations (Who is
    speaking?), and also because of lot of our
    subclinical cultural context is religious

27
Bizarre Delusions
  • Sometimes difficult to judge what is bizarre
  • If clearly impossible or not derivative of normal
    life experience, then bizarre
  • E.g. someone has removed all my internal organs
    and left no marks (bizarre) vs. the police are
    watching me when in fact not true (nonbizarre)

28
Hallucinations
  • Most common hearing a voice or voices
  • Must be fully awake
  • Must not be culturally condoned
  • One or more voices carrying out a running
    commentary on the persons behaviour is
    considered particularly characteristic of
    Schizophrenia

29
Disorganization
  • Thinking
  • Evidenced in speech, changes topics, tangential
    conversation, loose associations (I saw a duck
    which means Ill lose my job today)
  • Severely disorganized word salad,
    incomprehensible
  • Mild disorganization is normal in university
    course instructors and other non-schizophrenic
    individuals

30
Disorganization
  • Behaviour
  • Avolition, non goal oriented behaviour
  • Silliness
  • Unpredictable agitation
  • Poor attention to ADLs (activities of daily
    living), e.g. disheveled
  • Inappropriate, e.g. winter coat in summer, public
    masturbation, unpredictable shouting, swearing

31
Catatonia
  • Decreased reactivity to environment
  • Varying degrees
  • May be unaware of surroundings, may actively
    resist movement, assume bizarre posture, etc.
  • May be secondary to something else, not
    necessarily diagnostic of schizophrenia

32
Diagnosis
  • Characteristic Symptoms (2 or more)
  • Delusions (1 if bizarre)
  • Hallucinations (1 if commentary or two or more
    voices - see Im Still Here clip)
  • Disorganized speech
  • Disorganized behaviour
  • Negative symptoms
  • Social or occupational dysfunction

33
Diagnosis, cont
  • C. Duration
  • Acute 1 month
  • Continuous signs 6 months
  • D. Exclude
  • Schizoaffective Disorder
  • Mood Disorder with Psychotic features
  • E. Exclude general medical condition or substance
    abuse

34
Diagnosis, cont.
  • F. Consider Autistic or other Pervasive
    Developmental Disorder, Schizophrenia may be
    added under certain conditions

35
Subtypes
  • 295.30 Paranoid (high functioning)
  • 295.10 Disorganized (hebephrenic)
  • 295.20 Catatonic (Echolalia, Echopraxia)
  • 295.90 Undifferentiated (Criterion A met)
  • 295.60 Residual (at least one past episode of
    schizophrenia, some continuing disturbance)

36
Schizophreniform Disorder
  • Like Schizophrenia (Criterion A met, delusions
    and hallucinations), except
  • Total duration is 1 6 months (i.e. less than 6
    months)
  • Dont have to have impaired social or
    occupational functioning (Criterion B)

37
Schizoaffective Disorder
  • A. Meets criterion A for Schizophrenia and at
    some point of active illness has a significant
    mood disturbance (depressed, manic or mixed)
  • B. At least two weeks of delusions or
    hallucinations without mood disturbance
  • C. Mood symptoms most of the time

38
Delusional Disorder
  • One or more nonbizarre delusions that persist for
    at least 1 month
  • Minor hallucinations allowed
  • Functioning is not impaired apart from the impact
    of the delusion, e.g. if the mafia are after me,
    I might wear a disguise

39
Delusional Subtypes
  • Erotomanic Anne Murray is in love with me
  • Grandiose I am an advisor to the president, or
    I have a special message from God (nonbizarre)
  • Jealous my spouse is unfaithful
  • Persecutory Im being poisoned, blackballed,
    talked about
  • Somatic I have bad body odor, lice, my bowel
    isnt functioning properly

40
Brief Psychotic
  • Sudden onset of positive symptoms
  • Lasts at least a day but less than a month, and
    the person returns to full functioning
  • Exclude Mood Disorder with Psychotic Features,
    Schizoaffective Disorder, Schizophrenia,
    substance abuse and general medical condition

41
Shared Psychotic
  • Develops in an individual who has a close
    relationship to another who already has a
    psychotic disorder with prominent delusions
  • Results in shared delusions
  • Very rare

42
The Positive and Negative Syndrome Scale (PANSS)
  • A medical scale used for measuring symptom
    severity in patients with schizophrenia
  • Name refers to the syndrome of positive symptoms
    (present) and negative symptoms (absent) observed

43
The Positive and Negative Syndrome Scale (PANSS)
  • Developed by Kay, S.R., Fiszbein, A. Opler, L.
    (1987)
  • Integration of the Brief Psychiatric Rating Scale
    and the Psychopathology Rating Scale
  • 30-item scale 7 positive symptoms, 7 negative
    symptoms, 16 general psychopathology items
  • Scored on 7-point Likert scale by severity

44
The Positive and Negative Syndrome Scale (PANSS)
  • Benefits
  • Broad evaluation
  • Good reliability and validity (used extensively
    in research)
  • Challenges
  • Assessment is based on patients perceptions
  • Long interview (30-40 min.) could be hard to
    focus or tiring for patient

45
Impact on Relationships
  • Video clip - A Beautiful Mind
  • True story
  • Man with schizophrenia
  • Well developed delusions
  • Some of what you see is true
  • Some of what you see is not true
  • Imagine being his wife

46
Psychosis and Marriage
  • Michael P. Maniacci, The Psychotic Couple in
    J. Carlson L. Sperry, eds (1998), The
    Disordered Couple (Bristol, PA Brunner/Mazel),
    pp. 57 - 81

47
Psychotics do Marry
  • Large variation in functioning
  • Often intelligent eccentric good mate
  • Tend to attract partners who are either
    controlling or dependent
  • Either tends to increase stress on the
    psychosis-prone partner so that illness
    precipitates

48
Development of Psychosis
  • Predispositions
  • Detached style of relating
  • Eccentric
  • Sense of not belonging, or of being different
  • Two parallel thought patterns develop
  • Consensually validated
  • Idiosyncratic (private fantasies)
  • Meet the minimum requirements of community, live
    in private world

49
Development of Psychosis
  • Add stress
  • Detached style leads to social isolation and
    makes goal-attainment difficult
  • Failed goals leads to setting higher goals and
    more failure
  • Retreat into private (fantasy) world, now even
    less successful
  • Biological vulnerability activated

50
Relational Dynamics
  • Controlling partner expects performance, places
    demands, increases stress, and obtains secondary
    gains when partner falls ill
  • Dependent partner leans on psychotic partner for
    leadership, increases stress, psychotic partner
    falls ill, and dependent partner rallies
    temporarily so the psychotic partner can rest

51
Postpsychotic Conflicts
  • Psychosis gives the affected partner a vacation
    but the experience is traumatic to the partner
    and to the patient

52
Treatment
  • Manage the psychosis
  • Engage the non-psychotic partner to address his
    or her needs and lend support and understanding
  • Explore the relational dynamics
  • Modify individual psychodynamics

53
Manage the Psychosis
  • Medication helps
  • Dopamine receptor antagonists (standard
    antipsychotics or neuroleptics)
  • Haldol (haloperidol)
  • Thorazine (chlorpromazine)
  • Serotonin-dopamine antagonists (atypical
    antipsychotics or neuroleptics)
  • Risperdal (risperidone)
  • Clozaril (clozapine)

54
Newer Antipsychotics
  • Olanzapine
  • Sertindole
  • Quetiapine

55
Treatment Protocols
  • Choose a medication that has tolerable side
    effects, start with a low dose
  • Standard antipsychotics have extrapyramidal side
    effects (movement disorders)
  • Atypical antipsychotics have a host of other side
    effects (leukopenia, weight gain)
  • Consider ECT as an alternative therapy

56
What MFTs can do
  • Encourage patients to be patient with their
    doctors (the right medication at the right dose
    takes time)
  • Encourage patients to tell their doctors what
    their side effects are (stiffness, weight gain,
    sexual dysfunction)
  • Encourage patients to stay on their medications
    even when they feel well

57
Effectiveness Research
  • William R. McFarlane et al. (2003), Family
    psychoeducation and schizophrenia a review of
    the literature. Journal of Marital and Family
    Therapy 29 (2), 223-245

58
Family Interventions for Schizophrenia
  • The Role of MFTs in Treatment
  • of Serious Mental Illness

59
Background The Concept of
Expressed Emotion
  • Expressed Emotion (EE)
  • Came about from studying why patients relapsed
  • Developed over a twelve year span, 1956-1968,
    involving three different research projects
  • Found that patients were more likely to relapse
    if returning home to their parents or wives

60
Background The Concept of
Expressed Emotion
  • Patients were believed to be susceptible to
    sensory overload
  • Three main components correlated highly with
    relapse
  • Criticism, hostility, and over-involvement
  • Challenge How to reduce these elements
  • without blaming families?

61
Family Interventions for Schizophrenia
  • Four levels of intervention
  • (Marsh Lefley, p.55)
  • Family Consultation
  • Family Education
  • Family Psychoeducation
  • Family Therapy

62
1) Family Consultation
  • Meet with family members at or close to initial
    crisis
  • Connect through identifying and normalizing
    feelings
  • Provide information regarding illness and
    treatment options
  • Help formulate service plan
  • Connect with community resources

63
2) Family Education
  • Approximately 80 of patients not on meds and 40
    on meds relapse within one year of discharge
  • By reducing high EE in families, relapse rates
    can go down to 13
  • Need to provide effective aftercare for patients
    by forming cooperative relationships with the
    patients families

64
2) Family Education
  • Survival Skills for Families
  • Information about illness
  • Information about illness management
  • Coping Strategies
  • Return to Functioning
  • Continued Treatment or Disengagement

65
3) Family Psychoeducation
  • Takes advantage of group cohesion to
  • address stigma and reduce isolation
  • increase hope and empower families
  • assist with problem solving
  • model appropriate boundaries

66
3) Family Psychoeducation
  • Psychoeducational approach is in use most
    extensively with families of patients with
    schizophrenia
  • Families are the de facto caretakers of
    individuals with schizophrenia since
    deinstitutionalization
  • Families can be trained to create an
    interactional environment that compensates for
    functional disability

67
3) Family Psychoeducation
  • Need to regulate attention and arousal by
  • Antipsychotic medication
  • Reducing the intensity, negativity, quantity, and
    complexity of stimuli from the environment

68
3) Family Psychoeducation
  • Educational Workshop
  • 4 -7 families, 1 ½ - 2 hours, bi-weekly for 6-24
    months
  • Begin with informal lecture and discussion with
    AV aids, handouts, etc.
  • Sessions centre around the Family Guidelines

69
3) Family Psychoeducation
  • Structure of sessions (p.376)
  • Socialize, follow-up on task and weeks events
  • Report from family
  • Present relevant biosocial information
  • Reminder/explanation of family guideline
  • Define a workable problem
  • Focus either on communication skills or problem
    solving
  • Review

70
3) Family Psychoeducation
  • Other techniques
  • Modeling (e.g. low-key)
  • Sharing common experiences
  • Normalize and validate
  • Mourning losses
  • Emphasize strengths
  • Build hope and optimism
  • Shifting boundaries (e.g. cross-parenting
    interventions)

71
4) Family Therapy
  • May be provided as an adjunct to other treatments
  • Not recommended in the acute or stabilization
    phases
  • Most common method is BFT (see Falloon, Boyd
    McGill, 1984 Miklowitz Goldstein, 1997 Mueser
    Glynn, 1999) with focus on communication skills
    and problem solving

72
4) Family Therapy
  • Medical Family Therapy (McDaniel, Hepworth
    Doherty, 1992)
  • Integrates concerns about health and illness in a
    systems framework for psychotherapy
  • An approach to psychosocial aspects of illness
  • Can be adapted and expanded with different
    theoretical orientations

73
Medical Family Therapy Techniques
  • Recognize biological dimension
  • Solicit the illness story
  • Respect defenses, remove blame, accept
    unacceptable feelings
  • Maintain communication
  • Attend to developmental issues
  • Increase a sense of agency in patient and family
  • Leave the door open for future contact

74
Soliciting the Illness Story
  • Listen empathically
  • Attempt to understand the families experience of
    the illness
  • Empathy, respect, non-judgemental, emphasize
    strengths

75
Soliciting the Illness Story
  • Sample questions
  • What do you think caused the illness?
  • What do you fear most about it?
  • What might make healing now a struggle for you?
  • What changes in the family do you think will be
    needed now?
  • How do you expect other family members will react
    to this?

76
Soliciting the Illness Story
  • Take a genogram with the family to trace their
    particular history with illness and loss
  • Find out about family beliefs, myths, or legacies
    about illness and health
  • What do these mean to family members?
  • How do they contribute to or create a barrier to
    healing?
  • Be sensitive to and curious about
  • Cultural differences and religious beliefs

77
Developmental Issues
  • Progression of illness
  • Interaction between illness and individual/
    family development
  • Interaction between illness, patient, family, and
    caregiver system
  • Put the Illness In its Place
  • Dont allow the illness to dominate the familys
    schedule or organize the familys emotional life

78
Family Treatment Models
  • Behavioural Family Therapy

79
Behavioural Family Therapy
  • Non-blaming stance ideal for these families
  • The concept that families develop patterns of
    behaviour that, while appearing counterproductive
    to the observer, nevertheless represent their
    best efforts to respond to their current
    circumstances is the cornerstone of BFT
    (Falloon, p.67)

80
Behavioural Family Therapy
  • Most extensively studied model of family
    intervention for severe mental illness
  • Combines education and social learning strategies
    designed to equip families with knowledge and
    skills to better manage illness
  • Particular focus on communication and
    problem-solving skills

81
Behavioural Family Therapy
  • Assessment (Falloon, 1991)
  • Conducted on two levels
  • Problem analysis
  • Functional analysis
  • Problem analysis is the process of pinpointing
    the exact behaviours that are causing concern
  • Functional analysis attempts to define the
    context in which these behaviours contribute to
    dysfunction

82
Behavioural Family Therapy
  • Problem Analysis
  • Individual, dyadic and family sessions are used
    to join with the family and to explore each
    family members perception of the problem
  • Patience and focus are needed to help family
    describe problem in specific behavioural terms
  • Charting may be used to track frequency of
    problem behaviours

83
Behavioural Family Therapy
  • Problem Analysis
  • At the completion of this phase the therapist
    will
  • Have pinpointed one or more family problems
  • Have defined the frequency of their occurrence
  • Have some preliminary hypotheses about the
    factors contributing to the problem(s)
  • A hierarchy of problems to address may need to be
    established

84
Behavioural Family Therapy
  • Functional Analysis
  • Extends problem analysis to the system level
  • Identifies antecedents and consequences of
    problem behaviour
  • Antecedents are stimuli that trigger behaviour
    (e.g. loud noise, drug use, lack of sleep)
  • Consequences are reinforcing stimuli that either
    increase or decrease probability of behaviour
    reoccurring

85
Behavioural Family Therapy
  • Sample questions for functional analysis
  • What would the person (or family) gain or lose if
    the problem were resolved?
  • Who (or what) reinforces the problem with
    attention, sympathy, and support?
  • Under what circumstances is the problem increased
    or decreased in intensity?
  • What do family members currently do to cope with
    the problem?

86
Behavioural Family Therapy
  • Functional Analysis
  • Also includes investigation into strengths and
    weaknesses of family in coping with problem
  • Coping methods are evaluated in terms of
    effectiveness
  • Shaping the familys existing coping skills is
    much easier than teaching new skills from scratch
  • Narrative exceptions
  • Solution focused translate old
    skills to new problem

87
Behavioural Family Therapy
  • Five Techniques
  • Education
  • Communication training
  • Problem-solving training
  • Operant conditioning
  • Contingency contracting

88
Behavioural Family Therapy
  • Education
  • Could include information on illness, individual
    and family development, principles of social
    learning, stress management, etc.
  • Goal is to provide family with rationale for
    management of the problem and subsequent
    interventions

89
Behavioural Family Therapy
  • Communication training
  • Skills include active listening, expressing
    positive feelings, making positive requests,
    expressing negative feelings, compromise and
    negotiation, and requesting time out
  • See Mueser p.64-66 in text for summary of skills
    and steps to training
  • Note communication skills need to precede
    problem-solving skills

90
Behavioural Family Therapy
  • 3. Problem-solving guidelines (Jacobson
    Christensen, 1996)
  • In stating a problem, try to begin with something
    positive
  • Be specific
  • Express your feelings
  • Be brief when defining problems
  • Both people should acknowledge their role in
    creating and maintaining problem

91
Behavioural Family Therapy
  • 3. Problem-solving guidelines
  • Discuss only one problem at a time
  • Paraphrase
  • Dont make inferences - talk only about what you
    can observe
  • Be neutral rather than negative
  • Focus on solutions

92
Behavioural Family Therapy
  • 3. Problem-solving guidelines
  • Behaviour change should include mutuality
  • and compromise
  • Discuss pros and cons of proposed solutions
  • Reach agreement

93
Behavioural Family Therapy
  • 4. Operant Conditioning Strategies
  • Two predominant methods
  • Shaping
  • Time out procedures
  • Taught through instruction, behavioural
    rehearsal, and modeling

94
Behavioural Family Therapy
  • 5. Contingency Contracting
  • Used to replace hostile, coercive, blaming
    patterns by cooperative, mutually pleasing
    behaviour
  • Contract between two or more family members that
    specifies behaviours each desires the other to
    perform
  • Rewards are included and specified

95
  • Lunch

96
Bipolar Disorder
  • Cynthia

96
97
Mr. Jones
97
98
Manic Episode
  • Abnormally and persistently elevated, expansive,
    or irritable mood
  • Must last at least 1 week or result in a hospital
    stay
  • At least 3 of
  • Inflated self esteem or grandiosity
  • Decreased need for sleep
  • Pressure of speech

99
Manic Episode, continued
  • At least 3 of, continued
  • Flight of ideas
  • Distractibility
  • Increased goal seeking or psychomotor agitation
  • Excessive involvement in risky, pleasurable
    activities (shopping, sex, foolish business
    investments)
  • Exclude Mixed Episode

100
Manic Episode, continued
  • Marked impairment in occupational or social
    functioning
  • Not due to substance or medical condition

101
Major Depressive Episode
  • Five or more of the following over a two week
    period, at least one of the first two
  • Depressed mood (irritable child or adolescent)
  • Diminished interest or pleasure in almost all
    activities most of the day, every day
  • Significant unintentional weight loss/gain
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation

102
Major Depressive Episode
  • Five or more, continued
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive guilt
  • Difficulty thinking or concentrating
  • Recurrent thoughts of death, SI, with or without
    plan
  • Exclude Mixed Episode
  • Significant impairment of occupational or social
    functioning

103
Major Depressive Episode
  • Not due to drugs or a medical disorder
  • Not due to bereavement

104
Mixed Episode
  • At least a week where, every day, the criteria
    are met for a manic episode and a major
    depressive episode
  • Marked impairment in social or occupational
    functioning or requires hospitalization or has
    psychotic features
  • Not due to drugs or a general medical condition

105
Hypomanic Episode
  • Abnormally and persistently elevated, expansive
    or irritable mood lasting at least 4 days
  • At least three of
  • Inflated self esteem or grandiosity (non
    delusional)
  • Decreased need for sleep
  • Pressure of speech

106
Hypomanic
  • At least three, continued
  • Flight of ideas
  • Distractibility
  • Increased goal-seeking or psychomotor agitation
  • Excessive involvement in high risk pleasure
    activities
  • Four of the above if irritable
  • Otherwise like Manic Episode except not
    delusional or hallucinatory

107
Bipolar Disorders
  • Bipolar I
  • One or more manic or mixed episodes
  • At least one major depressive episode
  • Dont count substance or medical condition
    induced episodes
  • Exclude schizoaffective disorder and other
    psychotic disorders

108
Bipolar Disorders
  • Bipolar II
  • One or more major depressive episodes
  • At least one hypomanic episode
  • Bipolar I
  • Mostly up, more likely hospitalized for mania
  • Bipolar II
  • Mostly down, more likely hospitalized for
    depression

109
Treatment
  • Lithium and other mood stabilizers
  • Very effective, bad side effects
  • Go back and review the treatments for
    schizophrenia
  • Apply the same techniques, adapted for primarily
    mood disorders

110
Stigma Mental Health
  • 1 in 5 Canadians will develop a mental health
    problem in their lifetime (CAMH)
  • Many do not seek help because of the stigma of
    having a mental health problem
  • Stigma includes
  • Prejudice (neg. attitudes)
  • Discrimination (neg. behaviours)

111
Stigma Mental Health
  • Stigma affects people in three ways
  • Exclusion from normal activities and
    opportunities including work, housing, etc.
  • Internalization stigma is internalized,
    contributing to shame and isolation
  • Contributes to maintaining the secret

112
330 430
  • Benny and Joon
  • Therapist tag
  • Charades
  • SRS

113
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114
430 500
  • Next class Friday, October 1st
  • Here (same place)
  • Personality Disorders
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