Title: Mental Illness (Adult)

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Mental Illness (Adult)

KNR 270

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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

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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

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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

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DSM-IV-TR

Detailed classification system

Used to design treatment
Rated on 5 axes

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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

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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

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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

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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

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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

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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

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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

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SCHIZOPHRENIA

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

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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

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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

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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

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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

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Mood or Affective Disorders

Depression
Mania
Bipolar

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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

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MANIA

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

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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

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Anxiety Disorders

Generalized anxiety
Panic attack
Phobias
Posttraumatic Stress Disorder
Obsessive-Compulsive Disorder
Dissociative Identity Disorder

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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

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Panic Attack 4 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

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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

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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

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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

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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

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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

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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

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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

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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

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Obsessive-Compulsive Disorder Criteria

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

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Obsessive-Compulsive Disorder Criteria

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

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Obsessive-Compulsive Disorder Criteria

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

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Obsessive-Compulsive Disorder Criteria

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

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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
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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

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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

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Personality Disorders

Antisocial Personality
Borderline Personality
Self centered
Manipulative
Failure to reach potential

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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

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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

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Considerations/Accommodations

Stay calm be supportive

Ask how to help
Clear/concise directions
Empathy
Patience
Good feedback on how doing
Refrain from expressing displeasure

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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

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Considerations/Accommodations

Physical activity can decrease anxiety

Watch use of sharp supplies
Transportation
Scholarships
Try to involve with others to decrease social
isolation
Others???

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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

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COMMUNICATING

Agitation
Fluctuating emotions
Withdrawal
Belief in delusions

Recognize allow exit

Dont take words or actions personally
Initiate conversations
Dont argue

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COMMUNICATING

Discussion about voices

Low self-esteem

Acknowledge, but explain you do not hear them

Stay positive reinforcing