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Mental Illness (Adult)

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Mental Illness (Adult) KNR 270 Mental Illness Effects 50 million in US 5-7% of adults have a serious mental illness 5-9% of children World Health Organization notes ... – PowerPoint PPT presentation

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Title: Mental Illness (Adult)


1
Mental Illness (Adult)
  • KNR 270

2
Mental Illness
  • Effects 50 million in US
  • 5-7 of adults have a serious mental illness
  • 5-9 of children
  • World Health Organization notes MI is the leading
    disability world-wide
  • Only about ½ seek help
  • Stigma and discrimination
  • Society fears people with MI are violent

3
DEFINITION OF MENTAL ILLNESS
  • 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

4
CRITERIA
  • 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

5
DSM-IV-TR
  • Detailed classification system
  • Used to design treatment
  • Rated on 5 axes

6
Axis I Clinical Syndromes (Current Condition)
  • Disorders evident in infancy, childhood, or
    adolescence
  • Substance-related
  • Schizophrenia other psychotic disorders
  • Mood disorders
  • Anxiety disorders
  • Factitious disorders
  • Somatoform disorders
  • Dissociative disorders
  • Delirium, dementia, amnesic, other cognitive
    disorders
  • Sexual gender identity disorders
  • Eating disorders
  • Sleep disorders
  • Impulse control disorders
  • Adjustment disorders

7
Axis II Longstanding Conditions Associated with
Personality Disorders Mental Retardation
  • Axis II only used to identify a long-term
    underlying problem
  • Personality disorders paranoid, schizoid,
    histrionic, narcissistic, antisocial, borderline,
    obsessive-compulsive
  • Mental retardation

8
Remaining axes used to identify factors
contributing to or being affected by disorder
  • Axis III General medical conditions
  • Physical problems
  • Axis IV Psychosocial environmental problems
  • Psychosocial stress
  • Axis V Global Assessment of Functioning Scale
    (GAF)
  • Current level of adaptive functioning in social
    relationships, occupational functioning, and use
    of leisure time

9
MI subdivided
  • Neuroses
  • Most frequent
  • Recognizes presence of maladaptive behavior
    effect on person
  • Mild depression, anxiety, phobia
  • Psychoses
  • More serious
  • Lack of realization that behaviors is obvious or
    present
  • Unable to objectively evaluate reality
  • Schizophrenia

10
SCHIZOPHRENIA(S)
  • Not multiple or split personalities
  • More of a disintegration of personality,
    departure from reality
  • Thought disorder
  • Often diagnosed 15-25
  • Stress can aggravate
  • Effect on persons future
  • Could be gradual or sudden onset
  • Heavy pot smoking might raise risk

11
Schizophrenia Criteria 2 or more of
  • Delusions
  • Only 1 if delusion is bizarre, such as being
    abducted in a space ship from the sun
  • Hallucinations
  • Only 1 if at least 2 voices talk to one another
    or a voice keeps a running commentary in thoughts

12
Schizophrenia Criteria 2 or more of
  • Speech
  • Incoherent, disorganized
  • Negative symptoms
  • Flat affect, reduced speech, lack of volition,
    deteriorating personal hygiene, increased
    suspicion people are talking behind ones back

13
SCHIZOPHRENIA
  • Delusions
  • Disturbance in content of thought
  • Persecutory or paranoid
  • Thought broadcasting
  • Thought insertion
  • Grandiose
  • Religious

14
SCHIZOPHRENIA
  • Hallucinations
  • 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

15
SCHIZOPHRENIA
  • Other problems
  • 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

16
Types of Schizophrenia
  • Paranoid type
  • Preoccupied with delusions or frequent auditory
    hallucinations
  • Disorganized type
  • Disorganized behavior speech, affect that is
    flat or inappropriate
  • Catatonic type
  • Stupor or motor immobility, mutism or marked
    negativism, peculiar posturing, mannerisms or
    grimacing, echolalia

17
SCHIZOPHRENIA (S)
  • Thought to be a chemical imbalance
  • Symptoms may be controlled by meds
  • Predictors of poor outcome
  • Early age onset, family history, withdrawal,
    prior history
  • Can be side effects to medication
  • Tardive dyskensia
  • Involuntary movements of tongue, face, mouth, or
    jaw associated with long-term use of
    antipsychotics
  • May be irreversible

18
Mood or Affective Disorders
  • Depression
  • Mania
  • Bipolar

19
DEPRESSION
  • Different than everyday sadness
  • Impairs everyday functioning
  • Diminished interest or pleasure
  • Fatigue and energy loss
  • Memory loss
  • Weight loss or gain
  • Difficulty thinking
  • Loss of concentration
  • Sense of worthlessness or quilt
  • Sleeping (insomnia or sleeping too much)
  • Suicide

20
MANIA
  • Extreme elation
  • Inflated self-esteem
  • Decreased need for sleep
  • Racing thoughts
  • Physical activeness
  • Increased talkativeness
  • Increased risk-taking

21
BIPOLAR-AFFECTIVE
  • 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

22
Anxiety Disorders
  • Generalized anxiety
  • Panic attack
  • Phobias
  • Posttraumatic Stress Disorder
  • Obsessive-Compulsive Disorder
  • Dissociative Identity Disorder

23
ANXIETY DISORDERS
  • Intense fear or panic that appears to be
    unjustified
  • Always anticipates disaster
  • Symptoms
  • Shortness of breath
  • Increased heart rate
  • Dizziness
  • Chest pains
  • Fear dying or going insane

24
Panic Attack4 or more
  • 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
  • Dizzy, lightheaded, faint or unsteady
  • Nausea or other abdominal discomfort
  • Numbness or tingling
  • Sweating
  • Shortness of breath or smothering sensation
  • Trembling

25
Phobias
  • Social Phobia
  • Most common phobia
  • Irrational fear of situations where may be
    watched judged by others
  • Public speaking
  • Trembling, sweating, racing heart
  • Avoids situations
  • Agoraphobia
  • Claustrophobia

26
Posttraumatic Stress Disorder (PTSD)Criteria
  • Experienced or witnessed a traumatic event that
    has both of these elements
  • 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

27
Posttraumatic Stress Disorder (PTSD)Criteria
  • Repeatedly relives the event in at least 1 way
  • 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

28
Posttraumatic Stress Disorder (PTSD)Criteria
  • Repeatedly avoids the trauma-related stimuli
    has numbing or general responsiveness in 3
  • 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

29
Posttraumatic Stress Disorder (PTSD)Criteria
  • Repeatedly avoids the trauma-related stimuli
    has numbing or general responsiveness in 3
  • 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

30
Posttraumatic Stress Disorder (PTSD)Criteria
  • At least 2 of symptoms of hyperarousal were not
    present before the traumatic event
  • Insomnia
  • Irritability
  • Poor concentration
  • Hypervigilance
  • Increased startle response

31
Obsessive-Compulsive Disorder
  • 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
  • Inherited
  • Shortage of serotonin
  • Stress

32
OBSESSIVE-COMPULSIVE DISORDERS
  • Obsession persistent preoccupation with
    unreasonable ideas or feelings
  • Compulsion irresistible impulse to perform
    irrational acts
  • Obsession cleanliness / Compulsion handwashing
  • Can have thoughts without behaviors

33
Obsessive-Compulsive DisorderCriteria
  • For obsessions must have all
  • 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 ones
    own mind

34
Obsessive-Compulsive DisorderCriteria
  • For compulsions must have all
  • 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

35
Obsessive-Compulsive DisorderCriteria
  • For compulsions must have all
  • 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

36
Obsessive-Compulsive DisorderCriteria
  • At some point, may recognize that obsessions or
    compulsions are unreasonable or excessive
  • Obsessions /or compulsions associated with 1
  • Cause severe distress
  • Take up more than 1 hour/day
  • Interfere with usual routine, or work, social or
    personal functioning

37
Most Prevalent Obsessions
  • 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

38
Most Prevalent Compulsions
  • 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

39
DISSOCIATIVE IDENTITY DISORDER (DID)
  • 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

40
Personality Disorders
  • Antisocial Personality
  • Borderline Personality
  • Self centered
  • Manipulative
  • Failure to reach potential

41
Antisocial Personality
  • 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
  • Psychopaths
  • Sociopaths

42
Borderline Personality Disorder
  • Rapid mood changes
  • Intense, unstable interpersonal relationships
  • Hard time controlling emotions
  • Intense, inappropriate, uncontrollable anger
  • Self-damaging impulsive behavior
  • Compulsive spending, gambling, sexual behaviors
  • Overly sensitive to criticism or rejection

43
Considerations/Accommodations
  • Stay calm be supportive
  • Ask how to help
  • Clear/concise directions
  • Empathy
  • Patience
  • Good feedback on how doing
  • Refrain from expressing displeasure

44
Considerations/Accommodations
  • Know about medication side effects
  • Sun sensitivity
  • Dry mouth
  • Sedation/drowsiness
  • Blurred vision
  • Fluctuations in ability
  • Stress management programs
  • Relaxation programs
  • Expressive arts programs

45
Considerations/Accommodations
  • Physical activity can decrease anxiety
  • Watch use of sharp supplies
  • Transportation
  • Scholarships
  • Try to involve with others to decrease social
    isolation
  • Others???

46
COMMUNICATING
  • Confusion about what is real
  • Difficulty concentrating
  • Overstimulation
  • Preoccupation with internal
  • Be simple straight forward
  • Be brief, repeat
  • Limit input dont force discussion
  • Get attention before preceding

47
COMMUNICATING
  • Agitation
  • Fluctuating emotions
  • Withdrawal
  • Belief in delusions
  • Recognize allow exit
  • Dont take words or actions personally
  • Initiate conversations
  • Dont argue

48
COMMUNICATING
  • Discussion about voices
  • Low self-esteem
  • Acknowledge, but explain you do not hear them
  • Stay positive reinforcing
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