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
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Quality Services
6 6 Categories of Mental Illnesses/Disorders1) 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.
DelusionsBeliefs 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.
HallucinationsDisturbances of perception such as
vision, 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
AlcoholCannabisHallucinogensNicotineSedativesAnxiolyticsAmphetamines (includes methamphetamines)
CaffeineCocaineInhalantsOpioidsHypnoticsPCP
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”