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Mental Illness 101

Presentation at the New Grantees Conference


US Department of Labor
Homeless Veterans Reintegration Program

August 1, 2006

Cynthia Bisbee, Ph.D.


CC Bisbee & Associates
Montgomery, AL
Types of Mental Illness

Copyright 2006 Cynthia Bisbee, Ph.D.


Definition of
Mental Disorder
A clinically significant behavioral or
psychological syndrome or pattern
that occurs in an individual and that is
associated with present distress or
disability or with a significantly
increased risk of suffering death,
pain, disability or an important loss of
freedom.

Copyright 2006 Cynthia Bisbee, Ph.D.


Definition of
Mental Disorder
Not merely an expectable and
culturally sanctioned response to a
particular event such as death of a
loved one
Must be within an individual
Classifies disorders, not people

Copyright 2006 Cynthia Bisbee, Ph.D.


Serious Mental Illness
Always Included in Definition
Schizophrenia
Major Depression
Bipolar Disorder
Sometimes Included
Severe Anxiety Disorders
Cognitive Disorders
Some Personality Disorders

Copyright 2006 Cynthia Bisbee, Ph.D.


Criteria for Schizophrenia
Characteristic Social/Occupational
symptoms Dysfunction
Delusions Lasting at Least Six
Hallucinations Months
Disorganized Speech
Disorganized Behavior
Negative Symptoms
FlatAffect
Lack of Motivation

Copyright 2006 Cynthia Bisbee, Ph.D.


Criteria for Major
Depression

Depressed Mood Feelings of


Diminished Interest Worthlessness or
Weight Loss or Gain
Excessive Guilt
Difficulty Thinking
Sleep Disturbance
& Concentrating
Restlessness or Being
Symptoms Occur
Slowed Down
Every Day
Fatigue & Loss of
Significant
Energy
Distress &
Thoughts of Death Impairment
Copyright 2006 Cynthia Bisbee, Ph.D.
Criteria for Bipolar Disorder

Manic Episodes Marked


Elevated mood Impairment
Grandiosity Occupation
Decreased need for Social relationships
sleep (or) Hospitalization
Talkativeness
(or) Psychotic
Racing thoughts
Features
Increased goal-
directed activity May Alternate with
Depressive
Episodes
Copyright 2006 Cynthia Bisbee, Ph.D.
Symptoms of Mental Illness

Perceptions

Thoughts

Moods

Behavior

Copyright 2006 Cynthia Bisbee, Ph.D.


Substance-Related
Disorders
Types of Disorder Substances
Substance-induced Alcohol
Amphetamines
Intoxication
Caffeine
Withdrawal
Cannabis
Various psychiatric Cocaine
symptoms Hallucinogens
Substance Use Inhalants
Nicotine
Dependence
Opioids
Abuse
Phencyclidine
Sedative-hypnotics
Polysubstance
Copyright 2006 Cynthia Bisbee, Ph.D.
Causes of Mental Illness

Copyright 2006 Cynthia Bisbee, Ph.D.


Causes of Mental Illness

Biological Causes

Environmental Effects

Interaction of Biology and

Environment

Copyright 2006 Cynthia Bisbee, Ph.D.


Biology of
Serious Mental Illnesses
Brain Disorder
Anatomy
Function (metabolism)
Chemistry
Causes of Brain Disorder
Genetics
Viral Theories
Brain Injury

Copyright 2006 Cynthia Bisbee, Ph.D.


Schizophrenia:
Chemical Imbalance in the Brain

Copyright 1998 Patricia L. Scheifler MSW, PIP


Synapse
Dopamine

Receptor
Site

Speaking Listening
Brain Cell
Brain Cell

Vesicle

Too Much Dopamine =


Positive Symptoms
Copyright 2006 Cynthia Bisbee, Ph.D.
The Role of Environment

Some Disorders May Be Learned

Some Result from Trauma

Environment Affects the Course of

the Disorders

Stigma

Copyright 2006 Cynthia Bisbee, Ph.D.


Treatment of
Mental Illness

Copyright 2006 Cynthia Bisbee, Ph.D.


Intervention Goals
Remission of Symptoms
Positive
Negative
Maintenance of Stability
Enhanced Quality of Life
Role Recovery

Copyright 2006 Cynthia Bisbee, Ph.D.


Medications
Antipsychotics

Antidepressants

Mood Stabilzers

Anxiolytics

Side Effects Medications

Copyright 2006 Cynthia Bisbee, Ph.D.


Anti-psychotic Medications
Used to combat psychotic symptoms
Hallucinations
Delusions
Confused Thinking
Altered Perceptions
Disorganized Speech
Other signs of psychosis

Copyright 2006 Cynthia Bisbee, Ph.D.


Antipsychotic Medications Block
Dopamine

Copyright 1998 Patricia L. Scheifler MSW, PIP


Dopamine

Speaking Listening
Brain Cell Brain Cell

Antipsychotic
Medication
Blocks Receptor Site
Copyright 2006 Cynthia Bisbee, Ph.D.
Examples of
Anti-psychotic Medications
Zyprexa Haldol
Risperdal Loxitane
Seroquel Thorazine
Geodon Mellaril
Clozaril Stelazine
Abilify Prolixin
Navane
Serentil

Copyright 2006 Cynthia Bisbee, Ph.D.


Anti-depressant Medications
Used to Relieve Symptoms of
Depression
Sadness
Feelings of Failure
Loss of Interest in Life
Sleep Disturbances
Excessive Guilt
Loss of Energy/Fatigue
Thoughts of Death and Suicidal Thoughts
Copyright 2006 Cynthia Bisbee, Ph.D.
Examples of
Anti-depressant Medications
Prozac
Desyrel
Zoloft
Elavil
Effexor
Tofranil
Celexa
Serzone Pamelor

Remeron Marplan
Paxil Nardil
Wellbutrin Ascendin
Lexapro Sinequan

Copyright 2006 Cynthia Bisbee, Ph.D.


Mood Stabilizers
Used to Treat Symptoms of Mania
Rapid Talking
Decreased Need for Sleep
Racing Thoughts
Distractibility
Irritability
Behavioral Excesses
Grandiosity
Copyright 2006 Cynthia Bisbee, Ph.D.
Examples of
Mood Stabilizers
Lithium Note: Some of
Eskalith these medications
Lithobid are also used to
Lithane treat seizures
Depakote
Tegretol
Neurontin
Zyprexa
Topamax

Copyright 2006 Cynthia Bisbee, Ph.D.


Anti-anxiety Medications
Used to Treat Symptoms of Anxiety
Nervousness
Panic
Shortness of Breath
Trembling
Feeling of Choking
Heart Palpitations
Obsessions & Compulsions
Copyright 2006 Cynthia Bisbee, Ph.D.
Examples of
Anti-anxiety Medications
Xanax Valium
Ativan Librium
Klonapin Serax
Buspar Equanil
Miltown
Vistaril
Tranxene

Copyright 2006 Cynthia Bisbee, Ph.D.


Side Effects Medications
(Anti-parkinsonians)
Used to Relieve Side Effects of Anti-
psychotic Medications
Stiff Muscles
Unsteady Gait
Tremors
Eyes Rolling Back
Restless Feeling

Copyright 2006 Cynthia Bisbee, Ph.D.


Examples of
Side Effects Medications
Cogentin

Artane

Benadryl

Akineton

Copyright 2006 Cynthia Bisbee, Ph.D.


Stimulants (special use)
Used to Treat Symptoms of
Attention Deficit/Hyperactivity
Disorder
Mainly Used in Children
Hyperactivity
Inability to Pay Attention
Distractibility
Copyright 2006 Cynthia Bisbee, Ph.D.
Examples of
Stimulant Medications

Ritalin

Adderall

Dexedrine

Cylert

Concerta

Copyright 2006 Cynthia Bisbee, Ph.D.


Side Effects of
Medications
Drowsiness High Heart Rate

Dry Mouth Weight Gain

Blurred Vision Slurred Speech

Dizziness Sensitivity to Sun

Tremors Some Are Addictive

Sexual Dysfunction
Copyright 2006 Cynthia Bisbee, Ph.D.
Psychosocial Interventions
Assessment Rehabilitation
Education about Social Skills
Illness Self Vocational
Management Family Services
Counseling/Therapy Education
Individual Family Therapy
Group Case Management
Crisis Intervention

Copyright 2006 Cynthia Bisbee, Ph.D.


Illness Self Management/
Patient Education
Giving Information about the Illness
Symptoms
Treatment
Course
Helping Client Learn to Manage Own
Illness

Copyright 2006 Cynthia Bisbee, Ph.D.


Management Skills
for Recovery

Medication Adherence

Healthful Lifestyle

Therapeutic Environment

Illness Monitoring

Relapse Prevention
Copyright 2006 Cynthia Bisbee, Ph.D.
Medication Adherence

Adherence = Sticking to the


Medication Plan
Barriers to Adherence
The Persons Condition
Chronic Illness
Complex Medication Plan

Copyright 2006 Cynthia Bisbee, Ph.D.


Antipsychotic Medications Block
Dopamine

Copyright 1998 Patricia L. Scheifler MSW, PIP


Dopamine

Speaking Listening
Brain Cell Brain Cell

Antipsychotic
Medication
Blocks Receptor Site
Copyright 2006 Cynthia Bisbee, Ph.D.
Stop Taking Antipsychotics
Blockade Gradually Disappears

Copyright 1998 Patricia L. Scheifler MSW, PIP


Speaking Listening
Brain Cell Brain Cell

Copyright 2006 Cynthia Bisbee, Ph.D.


No Antipsychotic Medication:
Positive Symptoms Reappear
( Relapse)

Copyright 1998 Patricia L. Scheifler MSW, PIP


Speaking Listening
Brain Cell Brain Cell

Copyright 2006 Cynthia Bisbee, Ph.D.


What Is
Illness Monitoring?

Learning about Illness

Developing Awareness of Symptoms

Watching for Signs of Relapse

Mapping Illness Cycles

Copyright 2006 Cynthia Bisbee, Ph.D.


Importance of
Illness Monitoring

Helps Prevent Relapse

Look for Illness Cycle

Indicate Possible Need for Medication

Adjustment

Helps Measure Effects of Treatment

Copyright 2006 Cynthia Bisbee, Ph.D.


Relapse Checklist*
Medication Change
Physical Illness
A Stressful Event or Overstimulation
Alcohol or Drugs
Sugar, Caffeine, or Change of Diet
Too Many Fluids
Illness Cycle
Copyright 1982 Patricia Scheifler

Copyright 2006 Cynthia Bisbee, Ph.D.


Taking Action
Ensure Compliance with Meds
Seek Medical Treatment & Rest
Daily Relaxation Skills
Decrease Stimulation
Avoid Drugs & Alcohol
Cut Caffeine, Sugar & Fluids
Consult MD for Possible Medication
Adjustment
Copyright 2006 Cynthia Bisbee, Ph.D.
Psychotherapy and
Counseling

Reality Based

Real-life Problem Solving

Individual Coping with Illness

Group Support and Peer Learning

Flexible Participation Standards

Copyright 2006 Cynthia Bisbee, Ph.D.


Crisis Intervention
Telephone

Clinic Based

Mobile Outreach

In-Home Intervention

Copyright 2006 Cynthia Bisbee, Ph.D.


Skills Training

Social Skills

Academic Skills

Vocational Skills

Copyright 2006 Cynthia Bisbee, Ph.D.


Psychiatric Rehabilitation
Readiness Assessment
Readiness Development
Choosing Rehabilitation Goals
Living
Learning
Working
Socializing
Getting & Keeping Environments of Choice

Copyright 2006 Cynthia Bisbee, Ph.D.


Continuum of Living
Environments
Long Term Hospital
Crisis Stabilization Facility
Group Treatment Setting
Family Living
Supported Living Apartments
Independent Living

Copyright 2006 Cynthia Bisbee, Ph.D.


Continuum of Learning
Environments
Hospital Treatment
Partial Hospitalization Services
Outpatient Therapies
Clubhouse
Adult Education
Supported Education

Copyright 2006 Cynthia Bisbee, Ph.D.


Continuum of Working
Opportunities
Pre-vocational Training
Vocational Training
Volunteer Jobs
Jobs in Mental Illness Facilities
Supported Employment
Transitional Employment
Part-time and Full-time Regular
Employment
Consumer-run Business
Copyright 2006 Cynthia Bisbee, Ph.D.
Family Services

Support

Education

Consultation

Therapy
Copyright 2006 Cynthia Bisbee, Ph.D.
Case Management
Service Coordination

Linkage

Connection to One Person

Help with Basic Needs

Broad View of Service Plan

Copyright 2006 Cynthia Bisbee, Ph.D.


Interacting with a Person
with Mental Illness Symptoms:
Communication Skills
(Copyright Patricia Scheifler, MSW)

Give clear directives Express caring and


Ask open-ended support
questions Use parroting
Check out the whys of Be concrete and brief
behavior
Express empathy; Watch for signs of fading
reflectfeelings Be low-key and low EE
Use no-choice choices Avoid power struggles
Criticize behavior not Allow for time out to de-
person stim
Use I statements Do not tell lies
Copyright 2006 Cynthia Bisbee, Ph.D.
Interacting with a Person
with Mental Illness Symptoms:
Safety
Remain calm
Speak slowly and clearly
Avoid invading personal space
Do not move quickly, especially toward
the person
Do not touch the person
Do not challenge the person

Copyright 2006 Cynthia Bisbee, Ph.D.


Special Issues for Homeless
People with Mental Illness
Lack of Trust
Hierarchy of Needs
Disability Caused by Mental Illness
Effect of active symptoms
No energy to accomplish daily tasks
Inability to plan
Consistent Need for Support

Copyright 2006 Cynthia Bisbee, Ph.D.


Interventions for
Mental Illness

No One
Intervention Is
Sufficient
We Have to
Approach from All
Directions

Copyright 2006 Cynthia Bisbee, Ph.D.