Diagnosis of Mental Illnesses

Assisted Living FacilityLimited Mental Health Training

Mission: Protect the Vulnerable, Promote Strong and Economically Self- Sufficient Families, and Advance Personal and Family Recovery and Resiliency.

Rick Scott, GovernorEsther Jacobo, Interim Secretary

Florida’sPlanning Council

Advocacy + Effective Planning Councils=

Quality Services

6 6 Categories of Mental Illnesses/Disorders

1) Schizophrenia/Psychotic Disorders2) Mood Disorders3) Anxiety Disorders4) Personality Disorders5) Cognitive Disorders6) Substance Related Disorders

When someone has a substance related disorder and another mental health disorder (such as depression), they are said to have a “co-occurring disorder.”

1. Schizophrenia/PsychoticDisorders

General name for a group of disorders Persons with schizophrenia experience:

−Distortions in reality such as hallucinations, delusions, and disorganized speech.

−Disorganized and fragmented thoughts, perceptions, and emotions.

Symptoms among people with schizophrenia will vary and may come and go over the course of a person’s life.

Delusions

Beliefs that continue even with evidence to the contrary

Do not discount the person’s experience. Listen for what may be real. Avoid a debate or argument about the

delusion which only increases tension in the situation.

Let them know that you will listen and attend to their concerns.

Hallucinations

Disturbances of perception such asvision, hearing, smell, taste, and touch.

Hearing voices is the most common hallucination.

Ask for help from the case manager about how best to communicate with the person.

Inform case manager if this is a new symptom.

Not all persons who experience delusions and/or hallucinations have schizophrenia and not all persons with schizophrenia experience these symptoms.

Other PsychologicalSymptoms

Disorganized speech Disorganized behavior (e.g., sloppy

appearance) Difficulty initiating or following through on

task and may need prompts When the person does not present any

behavior that requires attention, they can easily be forgotten

Physical Symptoms

Vague and/or incoherent speech. Engage in conversations with themselves. Peculiar gestures, postures or movements. They use monotone voice or they may

remain silent May perform the same task repeatedly

People with SchizophreniaCan Benefit from:

Structure Routine Participating in productive daily activity Safe and secure environment Peer Support Services

2. Mood Disorders

Depression Bi-Polar Disorder

Bipolar DisorderSymptoms

Symptoms of Depression– Symptoms of depression are similar to

clinical depression, but they alternate with mania.

Symptoms of Mania– The person may get by with only a few hours

of sleep or go for days without sleep and lose none of their energy. Speech becomes loud and rapid. They have an inflated self-esteem, and engage in high risk activities. May have outbursts of irritability.

Bipolar DisorderTreatment

Medication– Lithium is the most common medication

to treat the symptoms of bipolar disorder.

When a person is experiencing the symptoms of mania, be non-confrontive in your speech and body language.

Avoid placing undue restriction on the person’s behavior unless it is harmful to themselves or others.

Depression

Situational– Is temporary and usually caused by an

event such as loss of a loved one. Resolved when situation returns to normal.

Clinical– Is more enduring and/or reoccurring and

requires treatment. It is not triggered by external events

Depression Symptoms

Psychological– Feelings of sadness, irritability,

worthlessness, anxiety, hypercritical of themselves, isolation, difficulty concentrating or making decisions, and suicidal thoughts.

Physical– Fatigue, engages in agitated behavior such

as pacing or hand wringing, sleep difficulties, changes in appetite, decreased sex drive.

Depression Treatment

Medication Behavior Therapy Insight Therapy Environmental Supports– Use of relaxation tapes– Structured activities– Daily routines

3. Anxiety Disorders

An intense, painful experience of anxiety, often accompanied by feelings of guilt or

worthlessness.

Feelings of extreme fear with no apparent reason. Physical symptoms such as trouble breathing, bowel distress, stomach upset, headaches, flushes, chills, sweating, sleep problems.

Anxiety DisorderTreatment

Medication–Minor tranquilizers

Therapies– Behavior and Insight therapies

Environmental Adaptations– Calm, quiet environment– Quiet area– Relaxation and/or music tapes– Daily routines– Affirmations or worth

4. Personality Disorders

Paranoid Antisocial Schizoid Dependent Obsessive-

Compulsive

Passive-Aggressive

Histrionic Avoidant Narcissistic

Interpersonal relationships Tolerance of rules Tolerance with delayed gratification Their ability to conduct themselves within

social norms Coping mechanisms which are rigid and

inflexible Maladaptive ways of perceiving, thinking

or relating

People usually haveproblems with:

5. Cognitive Disorders

Clause deficits to

–Memory

– Attention

– Processing Speed

Delirium and dementia are two types of cognitive disorders

Delirium

Reduced level of

– Consciousness

– Sensory misperception

– Disturbance of sleep/wake cycle

– Disorientation

–Memory Impairment

Delirium (cont’d.)

Rapid onset Brief duration if treated properly Symptoms change intensity

Delirium is a medical emergency. This means that people with delirium should be seen right away by a physician

Dementia

Impairs at least one other area of cognitive functioning:

– Language

– Ability to carry out motor activities

– Ability to carry out motor activities

– Executive function• Reasoning

• Judgment

• Planning

• Organization

Dementia (cont’d.)

Symptoms

–Multiple cognitive deficits that impair a person’s functioning

– A decline from previous functioning

– Impairs memory

• New information

• Previously learned information

Difference betweenDelirium & Dementia

Dementia usually has a:– A slower onset–More stable symptoms–Much longer duration

People with dementia are usually alert, while people with delirium are NOT alert

6. Substance RelatedDisorders

Maladaptive patterns of substance use which lead to significant impairment or distress for the person. Negative Consequences–Work – Family relationships– Social relationships– Legal status– Physical health– Psychological health

Substance Dependence

– Need for increasing the amount of the drug to achieve desired effect

–Withdrawal symptoms

– Overdoses which are potentially life threatening

6. Substance RelatedDisorders (cont’d.)

Classes of Substances involved in Substance-Related Disorders

Alcohol

Cannabis

Hallucinogens

Nicotine

Sedatives

Anxiolytics

Amphetamines (includes methamphetamines)

Caffeine

Cocaine

Inhalants

Opioids

Hypnotics

PCP

Substance-RelatedDisorders Treatment

A person should receive immediate medical attention if they have been abusing drugs and experience the following symptoms:

Lack of Energy Disorientation Hallucinations Convulsions

Comorbidity

Often, individuals are diagnosed with two or more disorders, which is called “comorbidity.”

The term “co-occurring” is used when referring to individuals with a mental disorder and a substance abuse use disorder such as depressive disorder and alcohol dependence.

Principles ofRecovery & Resiliency

Recovery is/includes

Strength-based: recognize my abilities, talents and skills

Holistic: consider all the aspects of who I am – mind, body, spirit

Responsibility: I have the primary responsibility for my journey to recovery. I can trust myself.

Support: I need help from my peers and mental health staff

Choice

Mental illness does not define who I am It’s about “me” I have the right to make choices Choices are the center of my services People respect my choices People give me feedback to assist in

recovery People support me in achieving my goal

Principles ofRecovery & Resiliency (cont’d.)

Principles ofRecovery & Resiliency (cont’d.)

Hope

Is fundamental to human dignity

Provides me with the belief that life can get better

Helps me to not give up

Stigma

Stigma is common for people with mental disorders

Because of stigma people may avoid those with mental disorders

Stigma sometimes makes people hide their symptoms and avoid seeking treatment

Stigma When assisting people with mental illness

staff should:

– Consider their personal attitudes about mental disorders

– The language they use

– How they interact with someone wit a mental disorder

– How others ALF residents interact with persons with mental illness, because other residents may also stigmatize persons with mental disorders

Stigma

Important not to blame the persons with mental disorders for their disorders

Important to NOT see the persons with mental disorders as helpless

Important to understand that persons with mental disorders are not always out of control, often learning ways to manage and cope with their symptoms

Stigma - Language

Language is powerful

Use person first language– A person is NOT defined by his/her

diagnosis– Do NOT refer to people as:

• Schizophrenic• Instead say he/she is “a person with

schizophrenia

Avoid terms such as “crazy” “psycho” or “nuts”