Mental Illness 101 Mental Illness 101

DR. ABHINAV KUMARDR. ABHINAV KUMARPROFESSOR AND HEAD OF SEXOLOGY DEPARTMENTPROFESSOR AND HEAD OF SEXOLOGY DEPARTMENT

INSTITUTE OF SEX SCIENCESINSTITUTE OF SEX SCIENCESSEX CITYSEX CITY

Types of Mental IllnessTypes of Mental Illness

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 is that occurs in an individual and that is associated with present distress or associated with present distress or disability or with a significantly disability or with a significantly increased risk of suffering death, increased risk of suffering death, pain, disability or an important loss of pain, disability or an important loss of freedom.freedom.

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

Serious Mental IllnessSerious Mental Illness

� Always Included in DefinitionAlways Included in Definition� SchizophreniaSchizophrenia� Major DepressionMajor Depression� Bipolar DisorderBipolar Disorder

� Sometimes IncludedSometimes Included� Severe Anxiety DisordersSevere Anxiety Disorders� Cognitive DisordersCognitive Disorders� Some Personality DisordersSome Personality Disorders

Criteria for SchizophreniaCriteria for Schizophrenia

� Characteristic Characteristic symptomssymptoms� DelusionsDelusions� HallucinationsHallucinations� Disorganized SpeechDisorganized Speech� Disorganized BehaviorDisorganized Behavior� Negative SymptomsNegative Symptoms

� Flat AffectFlat Affect� Lack of MotivationLack of Motivation

� Social/Occupational Social/Occupational DysfunctionDysfunction

� Lasting at Least Six Lasting at Least Six MonthsMonths

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 Being Restlessness or Being

Slowed DownSlowed 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

Criteria for Bipolar DisorderCriteria for Bipolar Disorder

� Manic EpisodesManic Episodes� Elevated moodElevated mood� GrandiosityGrandiosity� Decreased need for Decreased need for

sleepsleep� TalkativenessTalkativeness� Racing thoughtsRacing thoughts� Increased goal-Increased goal-

directed activitydirected activity

� Marked Marked ImpairmentImpairment� OccupationOccupation� Social relationshipsSocial relationships

� (or) Hospitalization(or) Hospitalization� (or) Psychotic (or) Psychotic

FeaturesFeatures� May Alternate with May Alternate with

Depressive Depressive EpisodesEpisodes

Symptoms of Mental IllnessSymptoms of Mental Illness

� PerceptionsPerceptions

� ThoughtsThoughts

� MoodsMoods

� BehaviorBehavior

Causes of Mental IllnessCauses of Mental Illness

Causes of Mental IllnessCauses of Mental Illness

� Biological CausesBiological Causes

� Environmental EffectsEnvironmental Effects

� Interaction of Biology and Interaction of Biology and

EnvironmentEnvironment

Biology ofBiology ofSerious Mental IllnessesSerious Mental Illnesses

� Brain DisorderBrain Disorder� AnatomyAnatomy� Function (metabolism)Function (metabolism)� ChemistryChemistry

� Causes of Brain DisorderCauses of Brain Disorder� GeneticsGenetics� Viral TheoriesViral Theories� Brain InjuryBrain Injury

Schizophrenia:Schizophrenia:Chemical Imbalance in the BrainChemical Imbalance in the Brain

SpeakingSpeakingBrain CellBrain Cell

ListeningListeningBrain CellBrain Cell

SynapseDopamine

Vesicle

ReceptorSite

Too Much Dopamine =Too Much Dopamine = Positive Symptoms Positive Symptoms

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

Intervention GoalsIntervention Goals

� Remission of SymptomsRemission of Symptoms� PositivePositive� NegativeNegative

� Maintenance of StabilityMaintenance of Stability� Enhanced Quality of LifeEnhanced Quality of Life� Role RecoveryRole Recovery

MedicationsMedications

� AntipsychoticsAntipsychotics� AntidepressantsAntidepressants� Mood StabilzersMood Stabilzers� AnxiolyticsAnxiolytics� Side Effects MedicationsSide Effects Medications

Anti-psychotic MedicationsAnti-psychotic Medications

� Used to combat psychotic symptomsUsed to combat psychotic symptoms� HallucinationsHallucinations� DelusionsDelusions� Confused ThinkingConfused Thinking� Altered PerceptionsAltered Perceptions� Disorganized SpeechDisorganized Speech� Other signs of psychosisOther signs of psychosis

Antipsychotic Medications Block Antipsychotic Medications Block DopamineDopamine

SpeakingSpeakingBrain CellBrain Cell

ListeningListeningBrain CellBrain Cell

Dopamine

Antipsychotic Medication

Blocks Receptor Site

Examples of Examples of Anti-psychotic MedicationsAnti-psychotic Medications

� ZyprexaZyprexa� RisperdalRisperdal� SeroquelSeroquel� GeodonGeodon� ClozarilClozaril� AbilifyAbilify

� HaldolHaldol� LoxitaneLoxitane� ThorazineThorazine� MellarilMellaril� StelazineStelazine� ProlixinProlixin� NavaneNavane� SerentilSerentil

Anti-depressant MedicationsAnti-depressant Medications� Used to Relieve Symptoms of Used to Relieve Symptoms of

DepressionDepression� SadnessSadness� Feelings of FailureFeelings of Failure� Loss of Interest in LifeLoss of Interest in Life� Sleep DisturbancesSleep Disturbances� Excessive GuiltExcessive Guilt� Loss of Energy/FatigueLoss of Energy/Fatigue� Thoughts of Death and Suicidal ThoughtsThoughts of Death and Suicidal Thoughts

Examples ofExamples ofAnti-depressant MedicationsAnti-depressant Medications

� ProzacProzac� ZoloftZoloft� EffexorEffexor� CelexaCelexa� SerzoneSerzone� RemeronRemeron� PaxilPaxil� WellbutrinWellbutrin� LexaproLexapro

� DesyrelDesyrel� ElavilElavil� TofranilTofranil� PamelorPamelor� MarplanMarplan� NardilNardil� AscendinAscendin� SinequanSinequan

Mood StabilizersMood Stabilizers� Used to Treat Symptoms of ManiaUsed to Treat Symptoms of Mania

� Rapid TalkingRapid Talking� Decreased Need for SleepDecreased Need for Sleep� Racing ThoughtsRacing Thoughts� DistractibilityDistractibility� IrritabilityIrritability� Behavioral ExcessesBehavioral Excesses� GrandiosityGrandiosity

Examples ofExamples ofMood StabilizersMood Stabilizers

� LithiumLithium� EskalithEskalith� LithobidLithobid� LithaneLithane

� 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

Anti-anxiety MedicationsAnti-anxiety Medications� Used to Treat Symptoms of AnxietyUsed to Treat Symptoms of Anxiety

� NervousnessNervousness� PanicPanic� Shortness of BreathShortness of Breath� TremblingTrembling� Feeling of ChokingFeeling of Choking� Heart PalpitationsHeart Palpitations� Obsessions & CompulsionsObsessions & Compulsions

Examples ofExamples ofAnti-anxiety MedicationsAnti-anxiety Medications� XanaxXanax� AtivanAtivan� KlonapinKlonapin� BusparBuspar

� ValiumValium� LibriumLibrium� SeraxSerax� EquanilEquanil� MiltownMiltown� VistarilVistaril� TranxeneTranxene

Side Effects MedicationsSide Effects Medications(Anti-parkinsonians)(Anti-parkinsonians)

� Used to Relieve Side Effects of Anti-Used to Relieve Side Effects of Anti-psychotic Medicationspsychotic Medications� Stiff MusclesStiff Muscles� Unsteady GaitUnsteady Gait� TremorsTremors� Eyes Rolling BackEyes Rolling Back� Restless FeelingRestless Feeling

Examples ofExamples ofSide Effects MedicationsSide Effects Medications

� CogentinCogentin� ArtaneArtane� BenadrylBenadryl� AkinetonAkineton

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

Examples ofExamples ofStimulant MedicationsStimulant Medications

� RitalinRitalin

� AdderallAdderall

� DexedrineDexedrine

� CylertCylert

� ConcertaConcerta

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 AddictiveSome Are Addictive

Psychosocial InterventionsPsychosocial Interventions� AssessmentAssessment� Education about Education about

Illness Self Illness Self ManagementManagement

� Counseling/TherapyCounseling/Therapy� IndividualIndividual� GroupGroup

� Crisis InterventionCrisis Intervention

� RehabilitationRehabilitation� Social SkillsSocial Skills� VocationalVocational

� Family ServicesFamily Services� EducationEducation� Family TherapyFamily Therapy

� Case ManagementCase Management

Illness Self Management/ Illness Self Management/ Patient EducationPatient Education

� Giving Information about the IllnessGiving Information about the Illness� SymptomsSymptoms� TreatmentTreatment� CourseCourse

� Helping Client Learn to Manage Own Helping Client Learn to Manage Own IllnessIllness

Management SkillsManagement Skillsfor Recoveryfor Recovery

� Medication AdherenceMedication Adherence

� Healthful LifestyleHealthful Lifestyle

� Therapeutic EnvironmentTherapeutic Environment

� Illness MonitoringIllness Monitoring

� Relapse PreventionRelapse Prevention

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

Antipsychotic Medications Block Antipsychotic Medications Block DopamineDopamine

SpeakingSpeakingBrain CellBrain Cell

ListeningListeningBrain CellBrain Cell

Dopamine

Antipsychotic Medication

Blocks Receptor Site

Stop TakingStop Taking AntipsychoticsAntipsychotics Blockade Gradually Disappears Blockade Gradually Disappears

SpeakingSpeakingBrain CellBrain Cell

ListeningListeningBrain CellBrain Cell

SpeakingSpeakingBrain CellBrain Cell

ListeningListeningBrain CellBrain Cell

No Antipsychotic Medication:No Antipsychotic Medication:Positive Symptoms ReappearPositive Symptoms Reappear

( Relapse) ( Relapse)

What Is What Is Illness Monitoring?Illness Monitoring?

� Learning about IllnessLearning about Illness

� Developing Awareness of SymptomsDeveloping Awareness of Symptoms

� Watching for Signs of RelapseWatching for Signs of Relapse

� Mapping Illness CyclesMapping Illness Cycles

Importance ofImportance ofIllness MonitoringIllness Monitoring

� Helps Prevent RelapseHelps Prevent Relapse

� Look for Illness CycleLook for Illness Cycle

� Indicate Possible Need for Medication Indicate Possible Need for Medication

AdjustmentAdjustment

� Helps Measure Effects of TreatmentHelps Measure Effects of Treatment

Relapse Checklist*Relapse Checklist*� Medication ChangeMedication Change� Physical Illness Physical Illness � A Stressful Event or OverstimulationA Stressful Event or Overstimulation� Alcohol or DrugsAlcohol or Drugs� Sugar, Caffeine, or Change of DietSugar, Caffeine, or Change of Diet� Too Many FluidsToo Many Fluids� Illness CycleIllness Cycle

Taking ActionTaking Action� Ensure Compliance with MedsEnsure Compliance with Meds� Seek Medical Treatment & RestSeek Medical Treatment & Rest� Daily Relaxation SkillsDaily Relaxation Skills� Decrease StimulationDecrease Stimulation� Avoid Drugs & AlcoholAvoid Drugs & Alcohol� Cut Caffeine, Sugar & FluidsCut Caffeine, Sugar & Fluids� Consult MD for Possible Medication Consult MD for Possible Medication

AdjustmentAdjustment

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

Crisis InterventionCrisis Intervention

� Telephone Telephone

� Clinic BasedClinic Based

� Mobile OutreachMobile Outreach

� In-Home InterventionIn-Home Intervention

Skills TrainingSkills Training

� Social SkillsSocial Skills

� Academic SkillsAcademic Skills

� Vocational SkillsVocational Skills

Psychiatric RehabilitationPsychiatric Rehabilitation� Readiness AssessmentReadiness Assessment� Readiness DevelopmentReadiness Development� Choosing Rehabilitation GoalsChoosing Rehabilitation Goals

� LivingLiving� LearningLearning� WorkingWorking� SocializingSocializing

� Getting & Keeping Environments of ChoiceGetting & Keeping Environments of Choice

� 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

Continuum of Learning Continuum of Learning EnvironmentsEnvironments

� Hospital TreatmentHospital Treatment� Partial Hospitalization ServicesPartial Hospitalization Services� Outpatient TherapiesOutpatient Therapies� ClubhouseClubhouse� Adult EducationAdult Education� Supported EducationSupported Education

Continuum of Working Continuum of Working OpportunitiesOpportunities

� Pre-vocational TrainingPre-vocational Training� Vocational TrainingVocational Training� Volunteer JobsVolunteer Jobs� Jobs in Mental Illness FacilitiesJobs in Mental Illness Facilities� Supported EmploymentSupported Employment� Transitional EmploymentTransitional Employment� Part-time and Full-time Regular Part-time and Full-time Regular

EmploymentEmployment� Consumer-run BusinessConsumer-run Business

Family ServicesFamily Services

� SupportSupport

� EducationEducation

� ConsultationConsultation

� TherapyTherapy

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

Interacting with a PersonInteracting with a Personwith Mental Illness Symptoms: with Mental Illness Symptoms:

Communication Skills Communication Skills

� 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;

reflect feelingsreflect feelings� 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

Interacting with a PersonInteracting with a Personwith Mental Illness Symptoms:with Mental Illness Symptoms:

SafetySafety� Remain calmRemain calm� Speak slowly and clearlySpeak slowly and clearly� Avoid invading personal spaceAvoid invading personal space� Do not move quickly, especially toward Do not move quickly, especially toward

the personthe person� Do not touch the personDo not touch the person� Do not challenge the personDo not challenge the person

Special Issues for Homeless Special Issues for Homeless People with Mental IllnessPeople with Mental Illness� Lack of TrustLack of Trust� Hierarchy of NeedsHierarchy of Needs� Disability Caused by Mental IllnessDisability Caused by Mental Illness

� Effect of active symptomsEffect of active symptoms� No energy to accomplish daily tasksNo energy to accomplish daily tasks� Inability to planInability to plan

� Consistent Need for SupportConsistent Need for Support

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

My Special Thanks To 2006 My Special Thanks To 2006 Cynthia Bisbee, Ph.D.Cynthia Bisbee, Ph.D.