Problems do not go away. They must be worked through or else they remain, forever a barrier…
M. Scott Peck
“But I don’t want to go among mad people,” Alice remarked.
“Oh, you can’t help that,” said the Cat. “We’re all mad here. I’m mad. You’re mad.”
“How do you know I’m mad?” said Alice.“You must be,” said the Cat, “or you wouldn’t
have come here.”Lewis Carrol, Alice in Wonderland
ADULT DIAGNOSESDepression
Schizophrenia
Bipolar Disorder (Manic Depressive Illness)
Personality Disorders
Substance Abuse
DepressionDSM IV TR Criteria
Course of illness
Effect on caregiving
Comorbidities
SchizophreniaDSM IV TR Criteria
Course of illness
Effects on caregiving
Comorbidities
Bipolar DisorderDSM IV TR Criteria
Course of illness
Effect on caregiving
Comorbidities
Personality DisordersDSM IV TR Criteria
Course of illness
Effect on caregiving
Comorbidities
Substance Abuse:Drugs, Alcohol & Polysubstance
DSM IV TR CriteriaAbuse v. dependence
Course of illness
Effects on caregiving
Comorbidities
Kids’ DiagnosesDepression
Bipolar (controversial, especially before 13 years old)
ADD
Behavioral consequences in kids whose parent has an unstable mental illness
Working with parents with unstable mental illnesses
Compliance v. noncompliance
Drug addiction
Assessment
Long-term prognosisDepression
Good prognosis if compliant with medication and supportive therapy
SchizophreniaFair prognosis if compliant with medication ,
therapy and social supportsPoor prognosis with marked deterioration if
noncompliantBipolar Disorder
Good prognosis if compliant with medicationUnfortunately, often prefer to be unmedicated
Long-term prognosisPersonality Disorder
Generally difficult to treatProblems arise because of co-occurring
substance abuse &/or poor judgment, impulsivity and disrupted interpersonal relationships
Substance AbuseFair prognosis if complies with medication &
supportive therapy. However, relapse is anticipated.
Poor prognosis with marked deterioration if untreated.
MedicationsAntidepressantsAntipsychoticsAntimanicsAnxiolyticsDrugs that treat cravings
AntidepressantsSSRIs Prozac, Zoloft
PaxilAvailable as pills, liquidsActions: thought to block reuptake of
serotoninDuration: varies. Takes 4-6 weeks for full
effect.
AntidepressantsNSRIs Effexor, CymbaltaAvailable in pill formActions: thought to act by blocking reputake
of serotonin & norepinephrineDuration: varies. Can take 1-4 weeks for full
effect
AntipsychoticsHaldolAvailable in pill, liquid and short-acting or
long-acting shot (get every 4 weeks)Actions: blocks dopamine receptors. Treats
short-term psychotic symptomsDuration: pill form lasts 6-10 hours;
Long-acting shot lasts 28 days
AntipsychoticsRisperdalAvailable in pill or long-acting shot formActions:
blocks serotonin, dopamine & histamine receptors
For short-term treatment of psychotic symptoms or for irritability associated with manic behavior
Duration: pill form lasts 6-7 hoursLong-acting shot lasts 7 weeks but can take 3
weeks to start working
AntipsychoticsGeodonAvailable in pill and short-acting shot formActions: dopamine & serotonin antagonist
Treats positive and negative symptoms of schizophrenia with minimal EPS side effects
Rapid control of agitation and psychotic symptoms
Rapid short-term treatment of manic or mixed symptoms
Pill form lasts 12 hours but IM best for acute symptoms
AntimanicsLithiumAvailable as pill or liquidAction: alters chemical transmissions in
neuronsDuration: 1-3 weeks for full effect
Use additional alternate medication for short term treatment of symptoms
Maintain adequate fluid intake, scheduled blood tests
AntimanicsDepakote/Depakene
Antiepileptic/mood stabilizerOften used as an alternative to Lithium
Available as pills, syrup sprinklesActions: May inhibit nerve transmission in
CNS and may increase brain level of GABA
Mood StabilizersLamictalAvailable in pill formAction: inhibits certain neurotransmittersImportant info: can cause life-threatening
complications if given with depakote
Mood StabilizersTopamaxAvailable as pill or sprinklesAction: unknown
ResourcesDirectory of Health & Human Services in
Metropolitan Chicago312-491-7800www.communityresourcenetwork.org
Haymarket HouseHull HouseThresholds