Welcome New Employees. Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders

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1 Welcome New Employees Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders

2 After this presentation, you will be able to: Understand the term Serious and Persistent Mental Illness (SPMI). Discuss psychotic and chronic, Anxiety and/or Mood Disorders that are associated with SPMI. Understand the differences between Developmental Disabilities and SPMI. Identify signs and symptoms of Schizophrenia and Bipolar Disorder. Discuss Addictive Diseases and identify the signs and symptoms of substance abuse and dependence.

3 Serious and Persistent Mental Illness (SPMI) Overview and Definition SPMI is defined as chronic mental illness which interferes with a individual s daily functioning. Individuals with SPMI have a wide range of needs, such as developing the ability to live independently; obtaining and maintaining employment or other meaningful activities; improving the quality of their family and social relationships; and managing moods and other psychiatric symptoms. Many of these individuals also have substance abuse problems and some have also been diagnosed with personality disorders, in particular, borderline personality disorder. Many individuals with SPMI are indigent or have limited financial resources, and often will not have health benefits.

4 Wellness Management and Recovery Planning All individuals should be treated with respect and dignity. This means treating our clients the way that we would like to be treated when receiving any type of professional service. Treatment and services should be Person Centered- meaning client-centered and clientdirected. Our approach is focused on the client s needs and the client is in charge. Treatment goals are recovery focused. This means helping the client identify and achieve personal goals.

5 Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

6 The Fundamental Components of Recovery 1. Self-Direction: individual directs their own path of recovery 2. Individualized and Person-Centered: path to recovery directed by individual s strengths, needs, preferences, experiences. 3. Empowerment: Individuals have the authority to speak for themselves and participate in all decision making that will affect their lives. 4. Holistic: recovery encompasses all aspects of an individual s life: mind, body, and spirit. 5. Non-Linear: not a step by step process, but one based on growth, set backs, and learning experiences. 6. Strengths-Based: focuses on valuing and building on the multiple capacities, resiliencies,talents, coping abilities and inherent worth of individuals.

7 The Fundamental Components of Recovery 7. Peer Support: Mutual support including the sharing of experiential knowledge and skills and social learning plays important role in recovery 8. Respect: Community, systems, and societal acceptance and appreciation of clients including protecting their rights and eliminating discrimination and stigma are crucial in achieving recovery. 9. Responsibility: Individuals have a personal responsibility for their own self-care and journeys of recovery. 10. Hope: Recovery provides the essential and motivating message of a better future that people can and do overcome the barriers and obstacles that confront them. #11 Resiliency - the ability to bounce back after difficult experiences; everyone has the ability to develop resiliencys

8 Individuals receiving services are considered to be full partners in the process of recovery from serious mental illness. In client-centered services, the services are based on decisions made with the client and always in the client s best interest. In client-directed services, the services are based on decisions made and goals set by the individual receiving the services The person receiving services decides which issues will be addressed by mental health services. The person sets the goals (outcomes) toward which the team is working. Although the treatment team may develop a treatment plan that includes reducing symptoms, and managing the client s mental illness and its effect on his or her life, these are not the main goals of the plan only a way to achieve the real goals, which are the client s goals. It's not what we think is best for the client, but what the client wants for himself/herself.

9 Treatment Team Services are delivered through teams of individuals with different clinical and rehabilitation strengths and interests. Each team usually consists of: The client Case managers Psychiatrists Other mental health professionals (psychologists, therapists, social workers) Other medical professionals (e.g., nurses, pharmacologists)

10 Treatment Services Medication Services The use of medication is very often needed for clients with SPMI. Effective treatment requires contact and coordination with medical services providers. The primary medical care provider should also be informed and involved in the ongoing treatment of clients. This helps the client get and stay healthy. When primary care and psychiatric providers communicate, this avoids the prescribing of medications that do not work well together or might even harm the client. Psychotherapy Individual, group, and family support/education models are all useful interventions for adults with serious mental illness. Getting family members involved when appropriate can be an important part of providing support and care for a client, particularly if the client is in crisis.

11 Treatment Services Research has demonstrated that clients with supportive, involved families have fewer psychiatric hospitalizations. Case managers need to remember that a model of family support and education about the effects of mental illness and the recovery process is an effective tool in working with clients. Individual and group treatment can be helpful when provided at the client s level of functioning and phase of recovery. Clients who are low functioning often need structured, low-demand group treatment that provides support, reality orientation, and activities/recreation.

12 Treatment Services Social skills training is valuable. Individual work should fit the client s level of functioning. This might mean, for example, 20-minute sessions, or perhaps a longer session when it is needed by the client to work on a particular problem. Psychotherapy is generally best used with clients who can accept and benefit from talk therapy. This approach requires clients to understand how their thoughts, feelings and behaviors affect their ability to get their needs met.

13 Crisis The focus is on crisis prevention rather than crisis response! Crisis prevention is achieved through: Assessments that look at the whole person and how he or she is functioning in all aspects of life. Understanding early warning signs and triggers for crisis should be part of the assessment process. Services and contacts with clients should be on flexible schedules or as the need for assistance arises. Walk-in or drop-in appointments and phone lines should be available to a client who may be entering a crisis phase. Frequent contact with all individuals receiving services. Tracking and supervision that identifies individuals at risk for crisis (no-shows, anniversaries, etc.). Adequate continuum of care.

14 Diagnoses It is important to rule out other causes, as sometimes people suffer severe mental symptoms or even psychosis due to undetected, underlying medical conditions or substance abuse. For this reason, a medical history should be taken and a physical examination and laboratory tests should be done to rule out other possible causes of the symptoms before concluding that a person has a particular disorder. Additionally, since commonly abused drugs may cause symptoms that look like a mental health disorder, blood or urine samples from the person can be tested for the presence of these drugs. Many times, one disorder may have similar symptoms to another disorder. Conducting a complete psychosocial history and assessment are also critical steps in making an accurate diagnosis.

15 Diagnostic Statistical Manual of Mental Disorders The American Psychiatric Association developed this manual as a standard reference that classifies mental disorders. DSM 5 (5 th edition) was published in Key changes and structural updates are included in the latest revision to align with World Health Organization s International Classification of Diseases (ICD) DSM-5 (American Psychiatric Association, 2013)

16 Schizophrenia Spectrum & Other Psychotic Disorders Key features: delusions hallucinations grossly disorganized behavior and/or speech catatonic behavior negative symptoms (reduced emotional expression, social withdrawal, lack of motivation, lack of feeling pleasure, reduced personal self care)

17 Bipolar & Related Disorders Manic Episode (3 or more of these symptoms lasting at least a week) Elevated mood Inflated self-esteem Pressured speech Flight of ideas/racing thoughts Distractibility Increased goal directed activity Expansiveness Decreased need for sleep Excessive involvement in risky activities Major Depressive Episode (5 or more symptoms present during the same 2-week period) Depressed mood Diminished interest or pleasure in activities Weight loss/gain or decreased appetite daily Insomnia or hypersomnia Psychomotor agitation Fatigue or loss of energy Feelings of worthlessness or excessive/inappropriate guilt Diminished ability to think or concentrate Recurrent thoughts of death, suicidal ideation or suicidal attempt/plan.

18 Depressive Disorders Major Depressive Disorder (5 or more symptoms present during the same 2- week period) Depressed mood Diminished interest or pleasure in activities Weight loss/gain or decreased appetite daily Insomnia or hypersomnia Psychomotor agitation Fatigue or loss of energy Feelings of worthlessness or excessive/inappropriate guilt Diminished ability to think or concentrate Recurrent thoughts of death, suicidal ideation or suicidal attempt/plan. Persistent Depressive Disorder (Dysthymia) depressed mood present for at least 2 years + 2 or more of the following) Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self esteem Poor concentration Feelings of hopelessness *During this 2 year period, no more than 2 months at a time- without symptoms

19 Anxiety Disorders Panic Disorder Must have had unexpected and recurrent Panic Attacks along with at least one of the following: Persistent concerns of having more Panic Attacks. Concerns about the meaning or consequences of the Panic Attacks. ( E.g., lose of control, feelings of going "crazy", or of having a heart attack ) Significant behavioral changes related from the Panic Attacks. Generalized Anxiety Disorder Excessive anxiety and worry occurring more days than not for at least 6 months + at least 3 or more of the following Restlessness or feeling on edge Easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbance

20 Trauma and Stressor-Related Disorders Posttraumatic Stress Disorder Psychological distress that develops after exposure to a traumatic event or experience. Adjustment Disorder Development of emotional or behavioral symptoms in response to an identifiable stressor.

21 Substance Use Disorders When an alcohol or drug user can't stop using alcohol or drugs even if he or she wants to, the person may have a substance use disorder. The urge is too strong to control, even if the person knows the drug is causing harm. When people start taking drugs and alcohol, they don't plan to get addicted. However, drugs and alcohol change the brain. People start to need the drug just to feel normal. It can quickly take over a person's life. The urge or need to use drugs or alcohol can become more important than the need to eat or sleep. The urge to get and use the substance can fill every moment of a person's life. The addiction replaces all the things the person used to enjoy. Addiction is a brain disease.

22 Substance Use Disorders Drugs and alcohol change how the brain works. These brain changes can last for a long time. They can cause problems like mood swings, memory loss, even trouble thinking and making decisions. Addiction is a disease, just as diabetes and cancer are diseases. Addiction is not simply a weakness. People from all backgrounds, rich or poor, can get an addiction. Addiction can happen at any age. National Institute on Drug Abuse

23 Symptoms of Substance Use Disorders Substance is often taken in larger amounts or over a longer period than was intended. There is a persistent desire or unsuccessful efforts to cut down or control substance use. A great deal of time is spent in activities necessary to obtain substance, use substance, or recover from its effects. Craving, or a strong desire or urge to use the substance. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. DSM-5 (American Psychiatric Association)

24 More Symptoms of Substance Use Disorders Important social, occupational, or recreational activities are given up or reduced because of substance use. Recurrent substance use in situations in which it is physically hazardous. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused by or exacerbated by substance. Tolerance (A need for increased amounts of the substance to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount of substance) Withdrawal Mild: presence of 2-3 symptoms Moderate: presence of 4-5 symptoms Severe: presence of 6 or more symptoms DSM-5 (American Psychiatric Association)

25 Co-Occurring Disorders When two disorders or illnesses occur in the same person, simultaneously or one after another, they are called co-occurring. This also implies interactions between the illnesses that affect the course and prognosis of both. In particular, many people addicted to drugs or alcohol are also diagnosed with other mental disorders and all illnesses must be treated. Although substance abuse disorders often occur along with other mental illnesses, this does not mean that one causes the other, even when one comes first. National Institute on Drug Abuse

26 Co-Occurring Disorders Co-occurring disorders can present in a variety of ways. Primary substance use disorder (with secondary mental health disorder) Primary mental health disorder (with secondary substance use disorder) Primary dual disorder (person has both a mental health and a substance use disorder, and they are both primary)

27 Disorders commonly associated with Child & Adolescent Conduct Disorder aggressive conduct that causes or threatens physical harm to other people or animals non- aggressive conduct that causes property loss or damage deceitfulness or theft serious violations of rules Oppositional Defiant Disorder loses temper argues with adults actively defies or refuses to comply with adults' requests or rules deliberately annoys people blames others for his or her mistakes or misbehavior touchy or easily annoyed by others angry and resentful spiteful or vindictive Reactive Attachment Disorder Pattern of inhibited, emotionally withdrawn behavior toward adult caregivers due to absent or grossly underdeveloped attachment between child and caregiver.

28 Neurodevelopmental Disorders Group of conditions with onset in the developmental period. Disorders in this classification typically recognized early in development before a child enters grade school, and is characterized by impairments of personal, social, academic or occupational functioning. The range of developmental deficits vary from specific limitations of learning or control of executive functions to global impairments of social skills or intelligence. DSM-5 (American Psychiatric Association, 2013)

29 Neurodevelopmental Disorders Intellectual Disability is characterized by deficits in general mental abilities such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning and learning from experience. Previously identified by IQ score > now based on based adaptive functioning which determines the level of support needed. Specifiers range from: Mild Moderate Severe Profound Autism spectrum Characterized by persistent deficits in social communication and interaction across multiple contexts. In addition to restricted, repetitive patterns of behavior, interests or activities. Communication Disorders ADHD Includes language, speech sound disorder, social communication and childhood-onset fluency disorders (stuttering) Impairing levels of inattention (unable to stay on task, seeming to not listen), disorganization (losing materials), and/or hyperactivity-impulsivity (overactive, fidgeting, inability to wait) at levels that are inconsistent with age or developmental level. DSM-5 (American Psychiatric Association, 2013)

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