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Mental Illness 101 Mental Illness 101
Presentation at the New Grantees’ Presentation at the New Grantees’ ConferenceConference
US Department of LaborUS Department of LaborHomeless Veterans Reintegration ProgramHomeless Veterans Reintegration Program
August 1, 2006August 1, 2006
Cynthia Bisbee, Ph.D.Cynthia Bisbee, Ph.D.CC Bisbee & AssociatesCC Bisbee & Associates
Montgomery, ALMontgomery, AL
Copyright © 2006 Cynthia Bisbee, Ph.D.
Types of Mental IllnessTypes of Mental Illness
Copyright © 2006 Cynthia Bisbee, Ph.D.
Definition of Definition of Mental DisorderMental Disorder
A clinically significant behavioral or A clinically significant behavioral or psychological syndrome or pattern psychological syndrome or pattern that occurs in an individual and that occurs in an individual and that is associated with present that is associated with present distress or disability or with a distress or disability or with a significantly increased risk of significantly increased risk of suffering death, pain, disability or suffering death, pain, disability or an important loss of freedom.an important loss of freedom.
Copyright © 2006 Cynthia Bisbee, Ph.D.
Definition ofDefinition ofMental DisorderMental Disorder
Not merely an expectable and Not merely an expectable and
culturally sanctioned response to a culturally sanctioned response to a
particular event such as death of a particular event such as death of a
loved oneloved one
Must be within an individualMust be within an individual
Classifies disorders, not peopleClassifies disorders, not people
Copyright © 2006 Cynthia Bisbee, Ph.D.
Serious Mental IllnessSerious Mental Illness
Always Included in DefinitionAlways Included in DefinitionSchizophreniaSchizophreniaMajor DepressionMajor DepressionBipolar DisorderBipolar Disorder
Sometimes IncludedSometimes IncludedSevere Anxiety DisordersSevere Anxiety DisordersCognitive DisordersCognitive DisordersSome Personality DisordersSome Personality Disorders
Copyright © 2006 Cynthia Bisbee, Ph.D.
Criteria for SchizophreniaCriteria for Schizophrenia
Characteristic Characteristic symptomssymptomsDelusionsDelusionsHallucinationsHallucinationsDisorganized SpeechDisorganized SpeechDisorganized BehaviorDisorganized BehaviorNegative SymptomsNegative Symptoms
Flat AffectFlat Affect Lack of MotivationLack of Motivation
Social/Social/Occupational Occupational DysfunctionDysfunction
Lasting at Least Lasting at Least Six MonthsSix Months
Copyright © 2006 Cynthia Bisbee, Ph.D.
Criteria for Major Criteria for Major DepressionDepression
Depressed MoodDepressed Mood Diminished InterestDiminished Interest Weight Loss or GainWeight Loss or Gain Sleep DisturbanceSleep Disturbance Restlessness or Restlessness or
Being Slowed DownBeing Slowed Down Fatigue & Loss of Fatigue & Loss of
EnergyEnergy Thoughts of DeathThoughts of Death
Feelings of Feelings of Worthlessness or Worthlessness or Excessive GuiltExcessive Guilt
Difficulty Thinking Difficulty Thinking & Concentrating& Concentrating
Symptoms Occur Symptoms Occur Every Day Every Day
Significant Significant Distress & Distress & ImpairmentImpairment
Copyright © 2006 Cynthia Bisbee, Ph.D.
Criteria for Bipolar Criteria for Bipolar DisorderDisorder
Manic EpisodesManic EpisodesElevated moodElevated moodGrandiosityGrandiosityDecreased need for Decreased need for
sleepsleepTalkativenessTalkativenessRacing thoughtsRacing thoughts Increased goal-Increased goal-
directed activitydirected activity
Marked ImpairmentMarked ImpairmentOccupationOccupationSocial relationshipsSocial relationships
(or) Hospitalization(or) Hospitalization (or) Psychotic (or) Psychotic
FeaturesFeatures May Alternate with May Alternate with
Depressive Depressive EpisodesEpisodes
Copyright © 2006 Cynthia Bisbee, Ph.D.
Symptoms of Mental Symptoms of Mental IllnessIllness
PerceptionsPerceptions
ThoughtsThoughts
MoodsMoods
BehaviorBehavior
Copyright © 2006 Cynthia Bisbee, Ph.D.
Substance-Related Substance-Related DisordersDisorders
Types of DisorderTypes of DisorderSubstance-inducedSubstance-induced
IntoxicationIntoxication
WithdrawalWithdrawal
Various psychiatric Various psychiatric
symptomssymptoms
Substance UseSubstance Use DependenceDependence
AbuseAbuse
SubstancesSubstancesAlcoholAlcoholAmphetaminesAmphetaminesCaffeineCaffeineCannabisCannabisCocaineCocaineHallucinogensHallucinogens InhalantsInhalantsNicotineNicotineOpioidsOpioidsPhencyclidinePhencyclidineSedative-hypnoticsSedative-hypnoticsPolysubstancePolysubstance
Copyright © 2006 Cynthia Bisbee, Ph.D.
Causes of Mental IllnessCauses of Mental Illness
Copyright © 2006 Cynthia Bisbee, Ph.D.
Causes of Mental IllnessCauses of Mental Illness
Biological CausesBiological Causes
Environmental EffectsEnvironmental Effects
Interaction of Biology and Interaction of Biology and
EnvironmentEnvironment
Copyright © 2006 Cynthia Bisbee, Ph.D.
Biology ofBiology ofSerious Mental IllnessesSerious Mental Illnesses
Brain DisorderBrain DisorderAnatomyAnatomyFunction (metabolism)Function (metabolism)ChemistryChemistry
Causes of Brain DisorderCauses of Brain DisorderGeneticsGeneticsViral TheoriesViral TheoriesBrain InjuryBrain Injury
Copyright © 2006 Cynthia Bisbee, Ph.D.
Schizophrenia:Schizophrenia:Chemical Imbalance in the Chemical Imbalance in the
BrainBrain
SpeakingSpeakingBrain CellBrain Cell
ListeningListeningBrain CellBrain Cell
SynapseDopamine
Vesicle
ReceptorSite
Too Much Dopamine =Too Much Dopamine = Positive Symptoms Positive Symptoms
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The Role of EnvironmentThe Role of Environment
Some Disorders May Be LearnedSome Disorders May Be Learned
Some Result from TraumaSome Result from Trauma
Environment Affects the Course of Environment Affects the Course of
the Disordersthe Disorders
StigmaStigma
Copyright © 2006 Cynthia Bisbee, Ph.D.
Treatment ofTreatment of Mental Illness Mental Illness
Copyright © 2006 Cynthia Bisbee, Ph.D.
Intervention GoalsIntervention Goals
Remission of SymptomsRemission of SymptomsPositivePositive
NegativeNegative
Maintenance of StabilityMaintenance of Stability
Enhanced Quality of LifeEnhanced Quality of Life
Role RecoveryRole Recovery
Copyright © 2006 Cynthia Bisbee, Ph.D.
MedicationsMedications
AntipsychoticsAntipsychotics
AntidepressantsAntidepressants
Mood StabilzersMood Stabilzers
AnxiolyticsAnxiolytics
Side Effects MedicationsSide Effects Medications
Copyright © 2006 Cynthia Bisbee, Ph.D.
Anti-psychotic MedicationsAnti-psychotic Medications
Used to combat psychotic symptomsUsed to combat psychotic symptomsHallucinationsHallucinationsDelusionsDelusionsConfused ThinkingConfused ThinkingAltered PerceptionsAltered PerceptionsDisorganized SpeechDisorganized SpeechOther signs of psychosisOther signs of psychosis
Copyright © 2006 Cynthia Bisbee, Ph.D.
Antipsychotic Medications Block Antipsychotic Medications Block DopamineDopamine
SpeakingSpeakingBrain CellBrain Cell
ListeningListeningBrain CellBrain Cell
Dopamine
Antipsychotic Medication
Blocks Receptor Site
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Examples of Examples of Anti-psychotic MedicationsAnti-psychotic Medications
ZyprexaZyprexa RisperdalRisperdal SeroquelSeroquel GeodonGeodon ClozarilClozaril AbilifyAbilify
HaldolHaldol LoxitaneLoxitane ThorazineThorazine MellarilMellaril StelazineStelazine ProlixinProlixin NavaneNavane SerentilSerentil
Copyright © 2006 Cynthia Bisbee, Ph.D.
Anti-depressant Anti-depressant MedicationsMedications
Used to Relieve Symptoms of Used to Relieve Symptoms of DepressionDepressionSadnessSadnessFeelings of FailureFeelings of FailureLoss of Interest in LifeLoss of Interest in LifeSleep DisturbancesSleep DisturbancesExcessive GuiltExcessive GuiltLoss of Energy/FatigueLoss of Energy/FatigueThoughts of Death and Suicidal ThoughtsThoughts of Death and Suicidal Thoughts
Copyright © 2006 Cynthia Bisbee, Ph.D.
Examples ofExamples ofAnti-depressant Anti-depressant
MedicationsMedications ProzacProzac ZoloftZoloft EffexorEffexor CelexaCelexa SerzoneSerzone RemeronRemeron PaxilPaxil WellbutrinWellbutrin LexaproLexapro
DesyrelDesyrel ElavilElavil TofranilTofranil PamelorPamelor MarplanMarplan NardilNardil AscendinAscendin SinequanSinequan
Copyright © 2006 Cynthia Bisbee, Ph.D.
Mood StabilizersMood Stabilizers
Used to Treat Symptoms of ManiaUsed to Treat Symptoms of ManiaRapid TalkingRapid TalkingDecreased Need for SleepDecreased Need for SleepRacing ThoughtsRacing ThoughtsDistractibilityDistractibilityIrritabilityIrritabilityBehavioral ExcessesBehavioral ExcessesGrandiosityGrandiosity
Copyright © 2006 Cynthia Bisbee, Ph.D.
Examples ofExamples ofMood StabilizersMood Stabilizers
LithiumLithiumEskalithEskalithLithobidLithobidLithaneLithane
DepakoteDepakote TegretolTegretol NeurontinNeurontin ZyprexaZyprexa TopamaxTopamax
Note: Some of Note: Some of these medications these medications are also used to are also used to treat seizurestreat seizures
Copyright © 2006 Cynthia Bisbee, Ph.D.
Anti-anxiety MedicationsAnti-anxiety Medications
Used to Treat Symptoms of AnxietyUsed to Treat Symptoms of AnxietyNervousnessNervousnessPanicPanicShortness of BreathShortness of BreathTremblingTremblingFeeling of ChokingFeeling of ChokingHeart PalpitationsHeart PalpitationsObsessions & CompulsionsObsessions & Compulsions
Copyright © 2006 Cynthia Bisbee, Ph.D.
Examples ofExamples ofAnti-anxiety MedicationsAnti-anxiety Medications
XanaxXanax AtivanAtivan KlonapinKlonapin BusparBuspar
ValiumValium LibriumLibrium SeraxSerax EquanilEquanil MiltownMiltown VistarilVistaril TranxeneTranxene
Copyright © 2006 Cynthia Bisbee, Ph.D.
Side Effects MedicationsSide Effects Medications(Anti-parkinsonians)(Anti-parkinsonians)
Used to Relieve Side Effects of Used to Relieve Side Effects of Anti-psychotic MedicationsAnti-psychotic MedicationsStiff MusclesStiff MusclesUnsteady GaitUnsteady GaitTremorsTremorsEyes Rolling BackEyes Rolling BackRestless FeelingRestless Feeling
Copyright © 2006 Cynthia Bisbee, Ph.D.
Examples ofExamples ofSide Effects MedicationsSide Effects Medications
CogentinCogentin
ArtaneArtane
BenadrylBenadryl
AkinetonAkineton
Copyright © 2006 Cynthia Bisbee, Ph.D.
Stimulants (special use)Stimulants (special use)
Used to Treat Symptoms of Used to Treat Symptoms of
Attention Deficit/Hyperactivity Attention Deficit/Hyperactivity
Disorder Disorder Mainly Used in ChildrenMainly Used in Children
HyperactivityHyperactivity
Inability to Pay AttentionInability to Pay Attention
DistractibilityDistractibility
Copyright © 2006 Cynthia Bisbee, Ph.D.
Examples ofExamples ofStimulant MedicationsStimulant Medications
RitalinRitalin
AdderallAdderall
DexedrineDexedrine
CylertCylert
ConcertaConcerta
Copyright © 2006 Cynthia Bisbee, Ph.D.
Side Effects ofSide Effects ofMedicationsMedications
DrowsinessDrowsiness
Dry MouthDry Mouth
Blurred VisionBlurred Vision
DizzinessDizziness
TremorsTremors
Sexual DysfunctionSexual Dysfunction
High Heart RateHigh Heart Rate
Weight GainWeight Gain
Slurred SpeechSlurred Speech
Sensitivity to SunSensitivity to Sun
Some Are Some Are
AddictiveAddictive
Copyright © 2006 Cynthia Bisbee, Ph.D.
Psychosocial InterventionsPsychosocial Interventions
AssessmentAssessment Education about Education about
Illness Self Illness Self ManagementManagement
Counseling/Counseling/TherapyTherapyIndividualIndividualGroupGroup
Crisis InterventionCrisis Intervention
RehabilitationRehabilitationSocial SkillsSocial SkillsVocationalVocational
Family ServicesFamily ServicesEducationEducationFamily TherapyFamily Therapy
Case Case ManagementManagement
Copyright © 2006 Cynthia Bisbee, Ph.D.
Illness Self Management/ Illness Self Management/ Patient EducationPatient Education
Giving Information about the Giving Information about the IllnessIllnessSymptomsSymptomsTreatmentTreatmentCourseCourse
Helping Client Learn to Manage Helping Client Learn to Manage Own IllnessOwn Illness
Copyright © 2006 Cynthia Bisbee, Ph.D.
Management SkillsManagement Skillsfor Recoveryfor Recovery
Medication AdherenceMedication Adherence
Healthful LifestyleHealthful Lifestyle
Therapeutic EnvironmentTherapeutic Environment
Illness MonitoringIllness Monitoring
Relapse PreventionRelapse Prevention
Copyright © 2006 Cynthia Bisbee, Ph.D.
Medication AdherenceMedication Adherence
Adherence = “Sticking to” the Adherence = “Sticking to” the
Medication PlanMedication Plan
Barriers to AdherenceBarriers to Adherence
The Person’s Condition The Person’s Condition
Chronic IllnessChronic Illness
Complex Medication PlanComplex Medication Plan
Copyright © 2006 Cynthia Bisbee, Ph.D.
Antipsychotic Medications Block Antipsychotic Medications Block DopamineDopamine
SpeakingSpeakingBrain CellBrain Cell
ListeningListeningBrain CellBrain Cell
Dopamine
Antipsychotic Medication
Blocks Receptor Site
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Stop TakingStop Taking AntipsychoticsAntipsychotics Blockade Gradually Blockade Gradually
DisappearsDisappears
SpeakingSpeakingBrain CellBrain Cell
ListeningListeningBrain CellBrain Cell
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SpeakingSpeakingBrain CellBrain Cell
ListeningListeningBrain CellBrain Cell
No Antipsychotic Medication:No Antipsychotic Medication:Positive Symptoms ReappearPositive Symptoms Reappear
( Relapse) ( Relapse)
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What Is What Is Illness Monitoring?Illness Monitoring?
Learning about IllnessLearning about Illness
Developing Awareness of Developing Awareness of
SymptomsSymptoms
Watching for Signs of RelapseWatching for Signs of Relapse
Mapping Illness CyclesMapping Illness Cycles
Copyright © 2006 Cynthia Bisbee, Ph.D.
Importance ofImportance ofIllness MonitoringIllness Monitoring
Helps Prevent RelapseHelps Prevent Relapse
Look for Illness CycleLook for Illness Cycle
Indicate Possible Need for Indicate Possible Need for
Medication AdjustmentMedication Adjustment
Helps Measure Effects of TreatmentHelps Measure Effects of Treatment
Copyright © 2006 Cynthia Bisbee, Ph.D.
Relapse Checklist*Relapse Checklist*
Medication ChangeMedication ChangePhysical Illness Physical Illness A Stressful Event or OverstimulationA Stressful Event or OverstimulationAlcohol or DrugsAlcohol or DrugsSugar, Caffeine, or Change of DietSugar, Caffeine, or Change of DietToo Many FluidsToo Many Fluids Illness CycleIllness Cycle
– Copyright © 1982 Patricia ScheiflerCopyright © 1982 Patricia Scheifler
Copyright © 2006 Cynthia Bisbee, Ph.D.
Taking ActionTaking Action
Ensure Compliance with MedsEnsure Compliance with MedsSeek Medical Treatment & RestSeek Medical Treatment & RestDaily Relaxation SkillsDaily Relaxation SkillsDecrease StimulationDecrease StimulationAvoid Drugs & AlcoholAvoid Drugs & AlcoholCut Caffeine, Sugar & FluidsCut Caffeine, Sugar & FluidsConsult MD for Possible Medication Consult MD for Possible Medication
AdjustmentAdjustment
Copyright © 2006 Cynthia Bisbee, Ph.D.
Psychotherapy and Psychotherapy and CounselingCounseling
Reality BasedReality Based
Real-life Problem SolvingReal-life Problem Solving
Individual Coping with IllnessIndividual Coping with Illness
Group Support and Peer LearningGroup Support and Peer Learning
Flexible Participation StandardsFlexible Participation Standards
Copyright © 2006 Cynthia Bisbee, Ph.D.
Crisis InterventionCrisis Intervention
Telephone Telephone
Clinic BasedClinic Based
Mobile OutreachMobile Outreach
In-Home InterventionIn-Home Intervention
Copyright © 2006 Cynthia Bisbee, Ph.D.
Skills TrainingSkills Training
Social SkillsSocial Skills
Academic SkillsAcademic Skills
Vocational SkillsVocational Skills
Copyright © 2006 Cynthia Bisbee, Ph.D.
Psychiatric Psychiatric RehabilitationRehabilitation
Readiness AssessmentReadiness AssessmentReadiness DevelopmentReadiness DevelopmentChoosing Rehabilitation GoalsChoosing Rehabilitation Goals
LivingLivingLearningLearningWorkingWorkingSocializingSocializing
Getting & Keeping Environments of Getting & Keeping Environments of ChoiceChoice
Copyright © 2006 Cynthia Bisbee, Ph.D.
Long Term HospitalLong Term Hospital
Crisis Stabilization FacilityCrisis Stabilization Facility
Group Treatment SettingGroup Treatment Setting
Family Living Family Living
Supported Living Apartments Supported Living Apartments
Independent LivingIndependent Living
Continuum of Living Continuum of Living EnvironmentsEnvironments
Copyright © 2006 Cynthia Bisbee, Ph.D.
Continuum of Learning Continuum of Learning EnvironmentsEnvironments
Hospital TreatmentHospital TreatmentPartial Hospitalization ServicesPartial Hospitalization ServicesOutpatient TherapiesOutpatient TherapiesClubhouseClubhouseAdult EducationAdult EducationSupported EducationSupported Education
Copyright © 2006 Cynthia Bisbee, Ph.D.
Continuum of Working Continuum of Working OpportunitiesOpportunities
Pre-vocational TrainingPre-vocational TrainingVocational TrainingVocational TrainingVolunteer JobsVolunteer Jobs Jobs in Mental Illness FacilitiesJobs in Mental Illness FacilitiesSupported EmploymentSupported EmploymentTransitional EmploymentTransitional EmploymentPart-time and Full-time Regular Part-time and Full-time Regular
EmploymentEmploymentConsumer-run BusinessConsumer-run Business
Copyright © 2006 Cynthia Bisbee, Ph.D.
Family ServicesFamily Services
SupportSupport
EducationEducation
ConsultationConsultation
TherapyTherapy
Copyright © 2006 Cynthia Bisbee, Ph.D.
Case ManagementCase Management
Service CoordinationService Coordination
LinkageLinkage
Connection to One PersonConnection to One Person
Help with Basic NeedsHelp with Basic Needs
Broad View of Service PlanBroad View of Service Plan
Copyright © 2006 Cynthia Bisbee, Ph.D.
Interacting with a PersonInteracting with a Personwith Mental Illness Symptoms: with Mental Illness Symptoms:
Communication Skills Communication Skills (Copyright Patricia Scheifler, MSW)(Copyright Patricia Scheifler, MSW)
Give clear directivesGive clear directives Ask open-ended Ask open-ended
questionsquestions Check out the whys of Check out the whys of
behaviorbehavior Express empathy; Express empathy;
reflectfeelingsreflectfeelings Use no-choice choicesUse no-choice choices Criticize behavior not Criticize behavior not
personperson Use “I” statementsUse “I” statements
Express caring and Express caring and support support
Use parrotingUse parroting Be concrete and briefBe concrete and brief Watch for signs of fadingWatch for signs of fading Be low-key and low “EE”Be low-key and low “EE” Avoid power strugglesAvoid power struggles Allow for time out to “de-Allow for time out to “de-
stim”stim” Do not tell liesDo not tell lies
Copyright © 2006 Cynthia Bisbee, Ph.D.
Interacting with a PersonInteracting with a Personwith Mental Illness Symptoms:with Mental Illness Symptoms:
SafetySafetyRemain calmRemain calmSpeak slowly and clearlySpeak slowly and clearlyAvoid invading personal spaceAvoid invading personal spaceDo not move quickly, especially Do not move quickly, especially
toward the persontoward the personDo not touch the personDo not touch the personDo not challenge the personDo not challenge the person
Copyright © 2006 Cynthia Bisbee, Ph.D.
Special Issues for Special Issues for Homeless People with Homeless People with
Mental IllnessMental Illness
Lack of TrustLack of TrustHierarchy of NeedsHierarchy of NeedsDisability Caused by Mental IllnessDisability Caused by Mental Illness
Effect of active symptomsEffect of active symptomsNo energy to accomplish daily tasksNo energy to accomplish daily tasksInability to planInability to plan
Consistent Need for SupportConsistent Need for Support
Copyright © 2006 Cynthia Bisbee, Ph.D.
Interventions forInterventions forMental IllnessMental Illness
No One No One
Intervention Is Intervention Is
SufficientSufficient
We Have to We Have to
Approach from All Approach from All
DirectionsDirections