Recognizing Psychological Problems In Those You Serve

Psychiatric Disorders Overview

Mood Disorders

Anxiety Disorders

Eating Disorders

Attention Deficit Disorder

Major Depressive Disorder

Depressed mood. For children and adolescents, this may be irritable mood.

A significantly reduced level of interest or pleasure in most or all activities.

A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight.

Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia).

Behavior that is agitated or slowed down. Others should be able to observe this.

Major Depressive Symptoms (Cont.)

Feeling fatigued, or diminished energy. Thoughts of worthlessness or extreme guilt (not about

being ill). Ability to think, concentrate, or make decisions is

reduced. Frequent thoughts of death or suicide (with or without

a specific plan), or attempt of suicide.

Dysthymic Disorder A. A person has depressed mood for most the time almost

every day for at least two years. Children and adolescents may have irritable mood, and the time frame is at least one year.

B. While depressed, a person experiences at least two of the following symptoms:

Either overeating or lack of appetite. Sleeping to much or having difficulty sleeping. Fatigue, lack of energy. Poor self-esteem. Difficulty with concentration or decision making. Feeling hopeless. C. A person has not been free of the symptoms during the two-

year time period (one-year for children and adolescents).

Bipolar Disorder

There are two types of bipolar disorder: Bipolar I Disorder is diagnosed when a person has had at least

one manic or mixed episode, often along with a major depressive episode. It affects equal numbers of men and women in approximately 0.4% to 1.6% of the population.

Bipolar II Disorder is diagnosed when a person has had a major depressive episode along with at least one hypomanic episode. It affects more women than men in about 0.5% of the population.

10-15% of persons with Bipolar Disorder will die from suicide. For 90%, the condition is recurrent.

Bipolar Disorder

A. A person experiences a current or recent episode that is manic, hypomanic, mixed, or depressed.

To be a manic episode, for at least one week a person's mood must be out of the ordinary and continuously heightened, exaggerated, or irritable.

At least three of the following seven symptoms have been significant and enduring. If the mood is only irritable, then four symptoms are required.

Self-esteem is excessive or grandiose. The need for sleep is greatly reduced. Talks much more than usual. Thoughts and ideas are continuous and without a pattern or focus. Easily distracted by unimportant things.

Bipolar Disorder

An increase in purposeful activity or productivity, or behaving and feeling agitated.

Reckless participation in enjoyable activities that create a high risk for negative consequences (e.g., extensive spending sprees, sexual promiscuity).

The persons' symptoms do not indicate a mixed episode.

Seasonal Affective Disorder

A. A person has experienced a regular pattern of depressive episodes that begin at specific time of the year (e.g., fall or winter), and which are not related to specific yearly stressors such as school/college or seasonal unemployment.

B. The depression also ends or changes at a specific time of the year (e.g., spring).

C. The pattern has occurred for the most recent two years with no other symptoms outside of the pattern.

D. A person has had more seasonal depressions than non-seasonal depressions in his/her lifetime.

Anxiety Disorders

Fight or Flight ResponseFight or Flight Response Created for Survival Created for Survival

Heart races and pounds Short, Shallow Breath Muscles Tense Sweat More Eyes Dilate

Eyes Dilate Hands get Colder Increased Blood Sugar Digestion Shuts Down Immune System Shuts Down Brain Blood Shift

Impact of Anxiety on the Body

Muscular Headaches Migraine Headaches Fatigue Tremor Insomnia Digestive Problems Increased Startle Response Appetite Changes Increased Perspiration Other Physical Illnesses

Impact of Anxiety on the Mind

Increased worry Increased irritability Poor judgment Increased sensitivity Taking things more personally Depression Feeling overwhelmed Difficulty making decisions Negative Thinking

Sometimes We Underestimate the Danger

Sometimes We Overestimate The Danger

Panic Disorder

Difficulty breathing Sweating Chest pain or discomfort Unsteadiness, dizziness or faintness Feelings of unreality or detachment Trembling or shaking Tingling or numbness Nausea or abdominal distress

Panic Disorder (cont.)

Palpitations or tachycardia Choking or smothering sensations Hot flashes or cold chills Fear of Dying Fear of going crazy or losing control Fear of being embarrassed

Can be with or without agoraphobia.

Typical Situations Avoided by Agoraphobics

Driving Public transport Waiting in lines Crowds Stores Restaurants Theaters Going a long distance from home Long walks

Typical Situations Avoided by Agoraphobics (Cont.)

Wide, open spaces Closed in spaces Boats Staying at home alone Auditoriums Elevators Escalators

Prevalence

3-6 percent of the general population. Or 7 to 12 million people Single panic attack = over 30% or population All socioeconomic levels, professions and

types of persons. Reported more in females.

TREATMENT FOR PANIC

Medications: SSRI’s, Beta-blockers, tranquilizers.

Cognitive-Behavioral Psychotherapy Relaxation Training

Obsessive Compulsive Disorder

Biological/genetic A “disorder of uncertainty” Two types of symptoms: Obsessions – obsessive worrying and

intrusive obsessions (polar bear) Compulsions

Compusions

Checking Contamination Counting Ordering Rituals-cracks, praying, movements Repeating Hoarding Perfectionism Trichotillomania Treatment- SSRI, Exposure and Response Preventation

Posttraumatic Stress Disorder

Exposed to a traumatic event Distressing recollections Distressing dreams Flashbacks Distress at exposure to “reminding” events Efforts to avoid reminders of the event Inability to recall aspects of the event

PTSD (Cont.)

Diminished interest in normal activities Detachment or estrangement from others Restricted range of affect Sense of foreshortened future Insomnia Irritability/anger outbursts Difficulty concentrating Hypervigilance Exaggerated startle response Treatment-CBT, Meds, EMDR

Generalized Anxiety Disorder

Excessive anxiety and worry Difficulty controlling worry Restlessness, keyed up or on edge Being easily fatigued Difficulty concentrating or mind going blank Irritability Muscle tension Sleep disturbance Anxiety not focused as in Panic, Phobia or OCD Treatment-Relaxation training, CBT, Medications

Phobias

Marked and persistent fears that are excessive and unreasonable

Exposure evokes an immediate anxiety response. Person recognizes that the fear is unreasonable. Interferes significantly with the person’s normal

routine. Treatment-Tranquilizers, Systematic Sensitization

Social Phobia

Marked and persistent of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.

Humiliating or embarrassing Social or performance situations are avoided. Treatment- SSRI, Cognitive Therapy, Exposure

Eating Disorders

• Anorexia• Extreme weight loss

• Thin appearance

• Fatigue

• Dizziness or fainting

• Hair that thins, breaks or falls out

• Intolerance of cold

• Refusal to eat

• Denial of hunger

• Fear of gaining weight

• Preoccupation with food

Eating Disorders

BulimiaRegularly self-induce vomiting or misuse of laxatives,

diuretics or enemas after bingeing.

Also may use other methods to rid self of calories such as fasting, strict diet or excessive exercise. Still binges.

Disappears to bathroom immediately after a meal.

Preoccupation with food.

Attention Deficit DisorderHyperactive/Impulsive Type

Often fidgets with or taps hands or feet, or squirms in seat.

Often leaves seat in situations when remaining seated is expected

Running or climbing in situations where it is inappropriate

Blurting out answers before hearing the whole question

Talking excessively

Interrupting or intruding on others

Having difficulty waiting in line or taking turns

Unable to play or engage in leisure activities quietly

Feeling very restless, as if “driven by a motor”, or talk excessively.

Attention Deficit DisorderInattentive Type

Not giving close attention to details or making careless mistakes in schoolwork, work, or other activities

Often has difficulty sustaining attention in tasks or play activities

Often does not seem to listen when spoken to directly

Often has trouble organizing tasks and activities, often skipping from one uncompleted activity to another

Becomes easily distracted by irrelevant stimuli, like sights and sounds (or unrelated thoughts)

Fails to pay attention to instructions and makes careless mistakes, not finishing work, chores or duties

Loses or forgets things needed for a task, like pencils, books, assignments or tools

Avoids, dislikes or is reluctant to engage in things that take a lot of mental effort for a long period of time

Is often forgetful in daily activities

Conversion Disorder

80+% of Diagnosed Conversion Disorders were eventually found to be a physical diagnosis.

Disorders often misdiagnosed as Conversion Disorder:

a. Multiple Sclerosis

b. Lupus

c. Stroke

d. Parkinson's

Resources

Local clinicians (psychiatrists, psychologists, etc.)

Medical Assistance

Member Care Services

School Counselor Consultation

My email: psych-tl@msn.com

Thank You!

Terry L. Ledford, Ph.D.

Woodridge Psychological Associates, P.A.

Www.TerryLedford.com

(828) 287-7806

psych-tl@msn.com