Mental Health Diagnosis and Psychopharmacology

1. Mental Health Diagnosisand Psychopharmacology

2. Goals / Expectations • The Crisis Worker’s role is not to diagnose mental illness, but to recognize symptoms when they present themselves and assess the need for intervention. • A crisis situation can cause symptoms of mental illness to become more acute and interfere with a person’s ability to utilize appropriate coping strategies • Acute symptoms of mental illness can impact mood, thinking or perceiving, behavior and physical health, and changes in mental status

3. Mental Health Symptoms Changes in Mood • Sadness coming out of nowhere; unrelated to events or circumstances • Expressions of hopelessness • Loss of interest in once pleasurable activities • Thinking or talking about suicide • Recent extreme excitement or euphoria (mania)

4. Mental Health Symptoms Changes in Thinking or Perceiving • Unexplained confusion/loss of orientation to person, place, time • Hallucinations • Delusions • Excessive fears or suspiciousness • Recent inability to concentrate • Irrational statements

5. Mental Health Symptoms Changes in Behavior • Sitting and staring at nothing for unusually long stretches of time • Dropping out of activities • Decline in academic or athletic performance • Hostility, from someone formerly pleasant and friendly • Inability to express emotions • Inappropriate laughter

6. Mental Health Symptoms Physical Changes • Hyperactivity or inactivity/alternations of these • Deterioration in personal care/hygiene • Unexplained weight gain or loss • Sleeping too much or being unable to sleep

7. Mental Status • Overall/General appearance (well-groomed, disheveled) • Overall/General Behavior (agitated, cooperative, unusual physical movements) • Affect (smiling, crying) • Appropriateness of affect given context (congruent or incongruent) • Speech (normal, pressured) • Thought content (appropriate, unusual, presence of delusions or hallucinations) • Orientation (person, place, time, circumstances) • Memory (if deficits in recent, remote or intermediate memory).

8. Self Harm • People engage in self harm or self injurious behaviors for different reasons. The pain/ behavior serves a purpose. • Self-harm behaviors are usually not suicidal in nature • If the self harm behavior is different than “typical” or baseline behavior then we need to respond differently. • It is important to inquire as to the purpose for the self harm behavior.

9. DSM • The standard manual used to diagnose in the U.S. is the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association • The DSM V (most recent revision) was released in June 2013. Most professionals have just begun utilizing the 5th edition. • Cautions about diagnoses and “labeling”

10. Psychotic Disorders

11. Psychotic disorders • These disorders include psychotic symptoms as a prominent aspect of presentation. • Psychosis is an “impairment that grossly interferes with the capacity to meet ordinary demands of life” and includes: • Delusions • Hallucinations • Disorganized thinking (speech) • Grossly disorganized or abnormal motor behavior (including catatonia) • Negative symptoms

12. Psychotic disorders • Psychotic Disorders include: • Schizophrenia - a disturbance of the brain’s functioning that can seriously alter the way people think, feel and relate to others. It is characterized by delusions, hallucinations, disorganized speech and behavior, and/or other symptoms that cause social or occupational dysfunction. • Schizoaffective Disorder -People with this illness have symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder. • Delusional Disorder

13. Delusion - defined • A delusion is a fixed, false belief that is resistant to reason or confrontation with actual fact. • Types – • Bizarre: Clearly impossible • Nonbizarre: Theoretically possible • The belief is not one ordinarily accepted by other members of the person's culture or subculture (e.g. it is not an article of religious faith)

14. Hallucinations - defined • A hallucination is a sensory experience of something that does not exist outside the mind. • Hallucinations can be caused by various physical and mental disorders, or by reaction to certain toxic substances. • They are usually manifested as visual or auditory images • Auditory are most common-voices that are perceived as distinct from the person’s own thoughts. • Others include: visual, tactile (touch), and olfactory (smell)

15. Disorganized Thinking/Speech • This symptom must be severe enough to interrupt effective communication. • Loose associations: switching from topic to topic • Disorganized and incoherent: “word salad” • Tangential: Answers to questions may be minimally or completely unrelated to the topic.

16. Negative Symptoms • Diminished emotional expression is the most common. This is evidenced by: • Lack of emotional facial expressions • Lack of eye contact • Monotone speech • Lack of body movements related to emotional expression

17. Mood Disorders

18. Mood Disorders • The basic symptom of a mood disorder is a disturbance in mood or affect. • Depressive Disorders Major Depressive Disorder Dysthymic Disorder Depressive Disorder, NOS • Bipolar Disorders • People with bipolar disorder experience unusually intense emotional states that occur in distinct periods An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode.

19. Symptoms: Depression • Crying, sadness, hopelessness, guilt/ worthlessness • Isolating, irritability, diminished interest or pleasure in daily activities • Weight/ appetite changes • Fatigue or loss of energy • Impaired decision-making, poor concentration, confusion • Feelings of worthlessness, helplessness, or excessive or inappropriate guilt • Diminished ability to think or concentrate or indecisiveness • Insomnia/ hypersomnia • Thoughts of death/ suicide Children/ adolescents may demonstrate depression through anger and irritability.

20. Symptoms: Bi-Polar Manic State • Inflated self-esteem or grandiosity • Decreased need for sleep • More talkative than usual or pressured to keep talking • Flight of ideas or subjective experience that thoughts are racing • Distractibility; drawn to unimportant or irrelevant stimuli • Increase in goal-directed activity • Excessive involvement in activities that could cause harm, I.e. spending sprees, excessive gambling, sexual indiscretions

21. Trauma-and Stressor-Related Disorders

22. Trauma-and Stressor-Related Disorders • Trauma- and stressor-related disorders include disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criteria • Includes: • Reactive Attachment Disorder • Posttraumatic stress disorder (PTSD) • Acute stress disorder • Adjustment disorders

23. Anxiety Disorders

24. Anxiety • Anxiety disorders are those that share features of excessive, irrational fear and dread. • Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of a future threat. • Anxiety Disorders include Generalized Anxiety Disorder, Panic Disorder, Agoraphobia (fear of being in open or public places), Separation Anxiety

25. Symptoms: Anxiety disorders • Excessive/ persistent worry • Irrational fears • Restlessness • Poor concentration • Muscle tension • Agitation • Panic attacks • Anxiety can dominate daily functioning

26. Substance Use Disorders

27. Substance Use Disorders • Substance use disorder describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress. • Includes 10 separate classes of drugs all of which activate the reward system in the brain: • Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, stimulants, and tobacco. • Gambling Disorder has also been added as there is evidence this also activates the reward system similar to those activated by substances.

28. Symptoms: Substance Use Disorders • Symptoms include: • Using a substance in larger amounts than originally intended over a longer period of time. • Worrying about stopping or consistently failed efforts to control one’s use • Use of the substance results in failure to fulfill major role obligations such as at home, work, or school.

29. Symptoms: Substance Use Disorders • Spending a large amount of time obtaining the substance • Continuing the use of a substance despite its having negative effects in relationships with others • Experiencing withdrawal symptoms after stopping use. • Withdrawal symptoms typically include anxiety, irritability, fatigue, nausea/vomiting, hand tremor or seizure in the case of alcohol

30. Opiates • In addition to Heroin, opiate medications include pain relievers such as morphine, Oxycontin and Vicodin. • Opiate medications are highly addictive and prolonged opiate use leads to damage of the sensory nerves and the brain which causes cells to stop producing endorphins • Opiate withdrawal can be rather unpleasant but is rarely fatal. Those withdrawing from opiates crave the drug and experience muscle and bone pain, insomnia, restlessness, nausea and vomiting, sweating, involuntary muscle twitches, dry mouth.

31. Alcohol Withdrawal • Withdrawal symptoms begin 6 to 48 hours after the last drink (peaking 24 to 35 hours) • The inhibition of brain activity caused by alcohol is abruptly reversed • Stress hormones are over-produced; over-exciting the central nervous system • 95% of people have mild to moderate withdrawal symptoms • 15 to 20% of people with moderate symptoms may experience brief seizures and hallucinations, but do not progress to full-blown DT’s • 5% of alcoholics experience delirium tremens (DT’s)

32. Delirium Tremens (DT’s) • Delirium tremens is a severe and potentially life-threatening form of alcohol withdrawal that involves sudden and severe mental or nervous system changes. • Usually develops 2 to 4 days after the last drink • More common in people with a long history of alcohol use and a prior history of significant withdrawal • The death rate from DTs is estimated to range from 1% to 5%.

33. Delirium Tremens (DT’s) • Symptoms of DT’s • Profuse sweating • Rapid or irregular heart beat • High or low blood pressure • Seizures • Extremely aggressive behavior • Hallucinations • Other mental disturbances

34. Personality Disorders

35. Personality Disorders • An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

36. Personality Disorders • Paranoid • Schizotypal • Antisocial • Borderline • Histrionic • Narcissistic • Avoidant • Dependent • Obsessive-compulsive • Personality change due to another medical condition

37. Common Characteristics - Personality Disorders • Distrust and suspiciousness of others • Detachment from social relationships • Restricted range of emotional expression • Acute discomfort in close relationships • Disregard for, or violation of, the rights of others • Lack of impulse control • Instability in interpersonal relationships • Feelings of inadequacy • Hypersensitivity to perceived criticism

38. Dementia

39. Dementia • Dementia is a general term for loss of cognitive function, marked by memory problems, confused thinking and other mental abilities severe enough to interfere with daily life. It is caused by physical changes in the brain.

40. Dementia - Alzheimer’s Disease • Alzheimer’s disease is the most common type of dementia; accounts for an estimated 60 to 80 percent of cases. • Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. • Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.

41. Lewy Body Dementia • Lewy Body Dementia is the 2nd most common type of progressive dementia after Alzheimer's disease • Caused by protein deposits, called Lewy bodies, developing in nerve cells in regions of the brain involved in thinking, memory and movement (motor control) • Causes a progressive decline in mental abilities. • Often causes visual hallucinations • Another indicator of Lewy body dementia may be significant fluctuations in alertness and attention, which may include daytime drowsiness or periods of staring into space. • Similar to Parkinson's disease, Lewy body dementia can result in rigid muscles, slowed movement and tremors.

42. Other types of Dementia • Vascular dementia is a less common cause of dementia than Alzheimer’s, accounting for about 10 percent of dementia cases. • Impaired judgment or ability to make decisions more likely to be the initial symptom, as opposed to the memory loss often associated with the initial symptoms of Alzheimer's. • Occurs because of brain injuries such as microscopic bleeding and blood vessel blockage • Korsakoff’s syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). The most common cause is chronic alcohol abuse. • Memory problems may be strikingly severe while other thinking and social skills seem relatively unaffected.

43. Psychopharmacology

44. Psychopharmacology • Psychopharmacology is the branch of medicine that specializes in the use of medication to correct psychiatric illnesses. • Basic categories of psychotropic medications are anti-depressants, mood stabilizers, anti-anxiety, antipsychotics and stimulants.

45. Anti-Depressant Medications • Main Indications – Anxiety and Depression • These medications are typically SSRI’s (Selective Serotonin Reuptake Inhibitors) and increase the amount of Serotonin in the brain. • Include Prozac, Zoloft, Wellbutrin, Paxil, Effexor, Celexa, Lexapro, Cymbalta • SSRI’s are generally well-tolerated with few ongoing side-effects • Most common side effects include upset stomach if not taken with food, decrease in sexual desire – biggest reason people discontinue

46. Anti-Anxiety Medications • Benzodiazepines or “benzo’s” are commonly used as an anti-anxiety medication, as well as, an anticonvulsant, muscle relaxers, and hypnotics (sleeping pills) • These drugs have a high potential for dependency and are also commonly abused. • Contrary to belief, withdrawing from benzo’s will not kill an individual but it is very uncomfortable.

47. Common Names of Benzodiazepines • Xanax (Alprazolam) • Valium (Diazepam) • Klonopin (Clonazepam) • Ativan (Lorazepam)

48. Mood Stabilizers • These medications treat bi-polar symptoms of manic and depressive symptoms • Common mood stabilizers include Depakote, Lithium, Tegretol

49. Antipsychotic Medications • Antipsychotic medications lessen and help control psychotic symptoms. • Include Risperdal, Zyprexa, Seroquel, Haldol, Abilify • Can be injectable form • Many more side-effects than SSRI’s including dry mouth, tremors, weight gain, drowsiness

50. Stimulant Medications • Used to treat Attention-Deficit/Hyperactivity Disorder and Narcolepsy • Stimulant medications include: Adderall, Ritalin, Concerta, Vyvanse • Prone to misuse/abuse