Module 1

Overview of Serious Mental Illness and Recovery

Statistics on Adults with Serious Mental Illness

26% of American adults have a mental illness.

6% of American adults have a serious mental illness. ( N IM H , 2 0 1 0 )

Leading cause of disability is serious mental illness.

Defining Serious Mental Illness

1. Speciflc psychiat ric diagnosis:

Schizophrenia

Bipolar disorder

Major depression ( D SM - 5 )

2. Signiflcant funct ional impairment :

Less than 60 GAF score ( SA M H SA , 2 0 0 2 )

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DSM-5 Criteria for Schizophrenia

At least two of the following symptoms for at least 1 month:

Posit ive Symptoms:

• Delusions

• Hallucinat ions

• Disorganized speech

• Disorganized or catatonic behavior

Negat ive Symptoms:

• Flat affect

• Social withdrawal

• Difflculty init iat ing behavior

• Anhedonia ( A PA , 2 0 1 3 )

Common Cognitive Impairments in Schizophrenia

Difflcult ies with execut ive funct ions:

• Problem-solving

• Reasoning

• Decision-making

Working memory impairments.

Slower processing speed.

Common Sensory Processing Impairments in Schizophrenia

1. Tend to miss and avoid sensory st imuli.

2. May not see or hear things that others not ice.

3. May have difflculty screening sensory st imuli.

4. Often overwhelmed by certain sounds, sights, smells, or touch.

5. May lose the opportunity to process necessary informat ion.

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Heterogeneity of Schizophrenia

No two individuals with schizophrenia are the same:

• Some individuals may experience posit ive symptoms.

• Others may experience negat ive symptoms.

• Some may experience signiflcant execut ive dysfunct ion.

• Others may have few issues with cognit ive or sensory processing.

Must appreciate the individual and ident ify areas of need.

Relationship of Symptoms & Impairments to Occupational Performance

(Mileu et al. 2005; Tandon et al. 2009)

A particular impairment or symptom does not translate to difficulties in occupational performance.

Knowledge Check

Susan works in a busy and noisy offlce. She has a diagnosis of schizophrenia. She was recent ly given a new and complicated assignment , but has yet to start . Her boss didn÷t spend much t ime giving her inst ruct ions. Although there may be several reasons why Susan has not started, what is the most likely explanat ion based on the exist ing research? Click Submit to check your answer.

A. Auditory hallucinat ions are interfering with Susan÷s ability to init iate her work.

B. Susan always flnds it challenging to init iate a new task in a busy and noisy environment .

C. The complex assignment and hurried inst ruct ions are making it difflcult for Susan to understand how to do the work.

Submit

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DSM-5 Criteria for Bipolar Disorder

At least one manic episode characterized by elevated, expansive, or irritable mood last ing at least 1 week and three or more of the following:

In‡ated self esteem or grandiosity.

Decreased need for sleep.

Pressured speech.

Flight of ideas/ racing thoughts.

Distract ibility.

Increase in goal-directed act ivity.

Excessive involvement in pleasurable act ivit ies that have a high potent ial for painful consequences. ( A PA , 2 0 1 3 )

Relationship of Bipolar Disorder and Occupational Performance

Associat ion between creat ivity and mania. ( J a m is o n , 1 9 9 3 )

Somet imes high levels of product ivity.

Can be debilitat ing with a negat ive impact on one÷s life.

Disrupts daily rout ines, interfering with work and social relat ionships.

DSM-5 Criteria for Major Depressive Disorder

At least one major depressive episode characterized by depressed mood or loss of interest or pleasure and at least 4 of the following symptoms:

Weight loss or weight gain.

Insomnia or hypersomnia.

Psychomotor agitat ion or retardat ion.

Fat igue.

Feelings or worthlessness.

Difflculty concentrat ing.

Suicidal ideat ions. ( A PA , 2 0 1 3 )

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Depression and Occupational Performance

Factors associated with greater occupat ional dysfunct ion:

Mult iple episodes.

Lack of t reatment . ( Pr a t t & B r o d y , 2 0 0 8 )

Nature of occupat ional performance problems in depression:

Impairments in self efflcacy.

Impairments in volit ion. ( Dun lo p e t al. 2 0 0 5 ; Fu rukaw a e t al. 2 0 1 0 )

Knowledge Check

There is a great deal of similarity in symptomatology and impairment among individuals with serious mental illness. Click Submit to check your answer.

A.True

B.False

Submit

A Change in Paradigms: Medical Model to Recovery Model

Recovery Model emphasizes the following principles:

Hope

Choice

Empowerment

Full part icipat ion

Presidents÷ New Freedom Commission stated:

…after a year of study, and after reviewing research and testimony, the Commission finds that recovery from mental illness is now a real possibility. The promise of the New Freedom Initiative – a life in the community for everyone - can be realized (p.1).

Click here to access the report summary.

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The Recovery Movement

Pat Deegan is a leader in the recovery movement. She is an advocate and innovator, developing technology and contribut ing signiflcant ly to the adopt ion of recovery-oriented pract ices.

Click here to view Showing Up for Recovery by Pat Deegan.

You can access more of her work at www.patdeegan.com.

Fundamental Components of Recovery

Knowledge Check

Explain how you would you alter these common pract ices to re‡ect a recovery oriented perspect ive?À Click Submit to check your answer.

Pract ice 1: The building has separate lunch rooms and bathroom for staff and clients.

Pract ice 2: Topics related to spirituality are avoided in t reatment .

Pract ice 3: All services are provided by licensed professionals.

Pract ice 4: The board for the mental health center consists primarily of professionals, family members, and community leaders.

Learner÷s response: Submit

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Occupational Therapy and Recovery

Ways that occupational therapy is consistent with recovery:

Support ing individuals in their goal to live life to the fullest .

Developing a sense of meaning and purpose.

Providing services that contribute to successful community living.

Promot ing choice through client-centered pract ices.

Believing in the potent ial of humans to realize a more posit ive future.

Challenges for occupational therapists:

Abdicat ing control of the decision-making process.

Allowing individuals to make mistakes in life.

Learn about recovery:

• The Nat ional Empowerment Center

• Mental Health Recovery Website

• Mental Health and Recovery: What Helps and What Hinders

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