Diagnosis of Mental Illnesses

1. Diagnosis of Mental Illnesses Assisted Living Facility Limited Mental Health Training

2. Florida’sPlanning Council Advocacy + Effective Planning Councils= Quality Services

3. 6 6 Categories of Mental Illnesses/Disorders • Schizophrenia/Psychotic Disorders • Mood Disorders • Anxiety Disorders • Personality Disorders • Cognitive Disorders • Substance Related Disorders When someone has a substance related disorder and another mental health disorder (such as depression), they are said to have a “co-occurring disorder.”

4. 1. Schizophrenia/PsychoticDisorders • General name for a group of disorders • Persons with schizophrenia experience: • Distortions in reality such as hallucinations, delusions, and disorganized speech. • Disorganized and fragmented thoughts, perceptions, and emotions. • Symptoms among people with schizophrenia will vary and may come and go over the course of a person’s life.

5. Delusions Beliefs that continue even with evidence to the contrary • Do not discount the person’s experience. • Listen for what may be real. • Avoid a debate or argument about the delusion which only increases tension in the situation. • Let them know that you will listen and attend to their concerns.

6. Hallucinations Disturbances of perception such asvision, hearing, smell, taste, and touch.Hearing voices is the most common hallucination. • Ask for help from the case manager about how best to communicate with the person. • Inform case manager if this is a new symptom. • Not all persons who experience delusions and/or hallucinations have schizophrenia and not all persons with schizophrenia experience these symptoms.

7. Other PsychologicalSymptoms • Disorganized speech • Disorganized behavior (e.g., sloppy appearance) • Difficulty initiating or following through on task and may need prompts • When the person does not present any behavior that requires attention, they can easily be forgotten

8. Physical Symptoms • Vague and/or incoherent speech. • Engage in conversations with themselves. • Peculiar gestures, postures or movements. • They use monotone voice or they may remain silent • May perform the same task repeatedly

9. People with SchizophreniaCan Benefit from: • Structure • Routine • Participating in productive daily activity • Safe and secure environment • Peer Support Services

10. 2. Mood Disorders • Depression • Bi-Polar Disorder

11. Bipolar DisorderSymptoms • Symptoms of Depression • Symptoms of depression are similar to clinical depression, but they alternate with mania. • Symptoms of Mania • The person may get by with only a few hours of sleep or go for days without sleep and lose none of their energy. Speech becomes loud and rapid. They have an inflated self-esteem, and engage in high risk activities. May have outbursts of irritability.

12. Bipolar DisorderTreatment • Medication • Lithium is the most common medication to treat the symptoms of bipolar disorder. • When a person is experiencing the symptoms of mania, be non-confrontive in your speech and body language. • Avoid placing undue restriction on the person’s behavior unless it is harmful to themselves or others.

13. Depression • Situational • Is temporary and usually caused by an event such as loss of a loved one. Resolved when situation returns to normal. • Clinical • Is more enduring and/or reoccurring and requires treatment. It is not triggered by external events

14. Depression Symptoms • Psychological • Feelings of sadness, irritability, worthlessness, anxiety, hypercritical of themselves, isolation, difficulty concentrating or making decisions, and suicidal thoughts. • Physical • Fatigue, engages in agitated behavior such as pacing or hand wringing, sleep difficulties, changes in appetite, decreased sex drive.

15. Depression Treatment • Medication • Behavior Therapy • Insight Therapy • Environmental Supports • Use of relaxation tapes • Structured activities • Daily routines

16. 3. Anxiety Disorders An intense, painful experience of anxiety, often accompanied by feelings of guilt or worthlessness. • Feelings of extreme fear with no apparent reason. Physical symptoms such as trouble breathing, bowel distress, stomach upset, headaches, flushes, chills, sweating, sleep problems.

17. Anxiety DisorderTreatment • Medication • Minor tranquilizers • Therapies • Behavior and Insight therapies • Environmental Adaptations • Calm, quiet environment • Quiet area • Relaxation and/or music tapes • Daily routines • Affirmations or worth

18. 4. Personality Disorders • Paranoid • Antisocial • Schizoid • Dependent • Obsessive-Compulsive • Passive-Aggressive • Histrionic • Avoidant • Narcissistic

19. People usually haveproblems with: • Interpersonal relationships • Tolerance of rules • Tolerance with delayed gratification • Their ability to conduct themselves within social norms • Coping mechanisms which are rigid and inflexible • Maladaptive ways of perceiving, thinking or relating

20. 5. Cognitive Disorders • Clause deficits to • Memory • Attention • Processing Speed • Delirium and dementia are two types of cognitive disorders

21. Delirium • Reduced level of • Consciousness • Sensory misperception • Disturbance of sleep/wake cycle • Disorientation • Memory Impairment

22. Delirium (cont’d.) • Rapid onset • Brief duration if treated properly • Symptoms change intensity Delirium is a medical emergency. This means that people with delirium should be seen right away by a physician

23. Dementia • Impairs at least one other area of cognitive functioning: • Language • Ability to carry out motor activities • Ability to carry out motor activities • Executive function • Reasoning • Judgment • Planning • Organization

24. Dementia(cont’d.) • Symptoms • Multiple cognitive deficits that impair a person’s functioning • A decline from previous functioning • Impairs memory • New information • Previously learned information

25. Difference betweenDelirium & Dementia • Dementia usually has a: • A slower onset • More stable symptoms • Much longer duration • People with dementia are usually alert, while people with delirium are NOT alert

26. 6. Substance RelatedDisorders Maladaptive patterns of substance use which lead to significant impairment or distress for the person. • Negative Consequences • Work • Family relationships • Social relationships • Legal status • Physical health • Psychological health

27. 6. Substance RelatedDisorders (cont’d.) • Substance Dependence • Need for increasing the amount of the drug to achieve desired effect • Withdrawal symptoms • Overdoses which are potentially life threatening

28. Classes of Substances involved in Substance-Related Disorders Alcohol Cannabis Hallucinogens Nicotine Sedatives Anxiolytics Amphetamines (includes methamphetamines) Caffeine Cocaine Inhalants Opioids Hypnotics PCP

29. Substance-RelatedDisorders Treatment A person should receive immediate medical attention if they have been abusing drugs and experience the following symptoms: • Lack of Energy • Disorientation • Hallucinations • Convulsions

30. Comorbidity • Often, individuals are diagnosed with two or more disorders, which is called “comorbidity.” • The term “co-occurring” is used when referring to individuals with a mental disorder and a substance abuse use disorder such as depressive disorder and alcohol dependence.

31. Principles ofRecovery & Resiliency Recovery is/includes • Strength-based: recognize my abilities, talents and skills • Holistic: consider all the aspects of who I am – mind, body, spirit • Responsibility: I have the primary responsibility for my journey to recovery. I can trust myself. • Support: I need help from my peers and mental health staff

32. Principles ofRecovery & Resiliency (cont’d.) Choice • Mental illness does not define who I am • It’s about “me” • I have the right to make choices • Choices are the center of my services • People respect my choices • People give me feedback to assist in recovery • People support me in achieving my goal

33. Principles ofRecovery & Resiliency (cont’d.) Hope • Is fundamental to human dignity • Provides me with the belief that life can get better • Helps me to not give up

34. Stigma • Stigma is common for people with mental disorders • Because of stigma people may avoid those with mental disorders • Stigma sometimes makes people hide their symptoms and avoid seeking treatment

35. Stigma • When assisting people with mental illness staff should: • Consider their personal attitudes about mental disorders • The language they use • How they interact with someone wit a mental disorder • How others ALF residents interact with persons with mental illness, because other residents may also stigmatize persons with mental disorders

36. Stigma • Important not to blame the persons with mental disorders for their disorders • Important to NOT see the persons with mental disorders as helpless • Important to understand that persons with mental disorders are not always out of control, often learning ways to manage and cope with their symptoms

37. Stigma - Language • Language is powerful • Use person first language • A person is NOT defined by his/her diagnosis • Do NOT refer to people as: • Schizophrenic • Instead say he/she is “a person with schizophrenia • Avoid terms such as “crazy” “psycho” or “nuts”