Understanding Mental Understanding Mental Illness, Cognitive Illness, Cognitive Impairment and Impairment and

AddictionAddiction

Developed by DATA of Rhode IslandDeveloped by DATA of Rhode IslandThrough a special grant from the Rhode Island Through a special grant from the Rhode Island

Department of Human Services Department of Human Services September 2006September 2006

Course GoalsCourse Goals

For participants to learn core For participants to learn core understanding of the origins and understanding of the origins and presentations of mental illness, cognitive presentations of mental illness, cognitive impairment and addiction.impairment and addiction.

Identify common types of mental illness, Identify common types of mental illness, cognitive disorders and addictioncognitive disorders and addiction

Why understand theories & Why understand theories & science of behavioral science of behavioral

disorders?disorders?To help reduce misunderstanding and stigmaTo help reduce misunderstanding and stigmato guide & ground your practice to guide & ground your practice choose & use approaches and interventions that choose & use approaches and interventions that are appropriate and effective to the persons we are appropriate and effective to the persons we serve. serve. To reduce stigma and prejudice toward persons To reduce stigma and prejudice toward persons with mental/behavioral disorderswith mental/behavioral disordersTo understand that frequently a person who has To understand that frequently a person who has one disorder may have one or more other one disorder may have one or more other disorders e.g. alcohol abuse and depression, disorders e.g. alcohol abuse and depression, cancer and depression or mental retardation and cancer and depression or mental retardation and anxietyanxiety

What is a mental illnessWhat is a mental illness

A mental disorder can span a range of severity A mental disorder can span a range of severity from transient adjustments to life from transient adjustments to life changes/psychosocial stresses to serious and changes/psychosocial stresses to serious and persisting illnesses. persisting illnesses.

Mental illness can adversely effects how a person Mental illness can adversely effects how a person feels, thinks, behaves and relates to others.feels, thinks, behaves and relates to others.

Mental disorders effect up to 20% of the population Mental disorders effect up to 20% of the population Common mental illness include: anxiety, Common mental illness include: anxiety,

depression, schizophrenia, bipoplar disorder, depression, schizophrenia, bipoplar disorder, and disorders of personalityand disorders of personality

Myths about Mental IllnessMyths about Mental Illness

1.1. Mental Illness is not a true illness like heart Mental Illness is not a true illness like heart disease….The facts is that psychiatric and disease….The facts is that psychiatric and addictive disorders have genetic and addictive disorders have genetic and biological causes. biological causes.

2.2. People with severe mental illness are People with severe mental illness are dangerous and violent…The fact is that the dangerous and violent…The fact is that the incidence of violence among persons with incidence of violence among persons with mental illness is about the same as the mental illness is about the same as the general population. Actually, persons with general population. Actually, persons with mental illness are more likely to be victims mental illness are more likely to be victims of violence. of violence.

Myth’s continuedMyth’s continued

3.3. Addiction is a lifestyle choice….Addiction Addiction is a lifestyle choice….Addiction is a result of changes in brain chemistry. is a result of changes in brain chemistry. Like other disorders, you can’t just will it Like other disorders, you can’t just will it away. away.

4.4. Depression and anxiety are signs that Depression and anxiety are signs that the person is weakthe person is weak

Common Adult Mental DisordersCommon Adult Mental Disorders

DepressionDepression

AnxietyAnxiety

SchizophreniaSchizophrenia

Bipolar DisorderBipolar Disorder

Recognizing depressionRecognizing depression

Depression has levels of severityDepression has levels of severityDisturbance of mood…sadness, irritabilityDisturbance of mood…sadness, irritabilityConfusionConfusionProblems with memory and concentrationProblems with memory and concentrationFatigueFatigueSleep and appetite disturbanceSleep and appetite disturbanceAnhedoniaAnhedonia Change in weightChange in weightPoor self care Poor self care Social isolationSocial isolationIncreased risk for suicideIncreased risk for suicide

How persons with depression may How persons with depression may come to your attentioncome to your attention

Difficulties carrying out routine activities Difficulties carrying out routine activities like house cleaning, feeding pets, personal like house cleaning, feeding pets, personal hygienehygiene

Withdrawal from social activitiesWithdrawal from social activities

Concern voiced by friends or neighborsConcern voiced by friends or neighbors

Crying or sadnessCrying or sadness

Recognizing anxietyRecognizing anxiety

Fears of dying or going crazyFears of dying or going crazyExcessive WorryExcessive WorryPanic attacksPanic attacksTremblingTremblingSweatingSweatingDizzinessDizzinessNausea, stomach painsNausea, stomach painsBreathlessnessBreathlessnessNot going out of apartment or out of doorsNot going out of apartment or out of doorsNightmaresNightmares

How persons with anxiety disorders may How persons with anxiety disorders may come to your attentioncome to your attention

Anxiety problems are harder to identify as Anxiety problems are harder to identify as they tend to occur behind closed doors.they tend to occur behind closed doors.

This person may be brought to your This person may be brought to your attention by friends, family or other attention by friends, family or other providersproviders

Recognizing psychosis or Recognizing psychosis or schizophreniaschizophrenia

Psychotic symptoms include:Psychotic symptoms include:Difficulties with thinkingDifficulties with thinkingWithdrawalWithdrawalPoor self carePoor self careHallucinations…hearing voices, seeing thingsHallucinations…hearing voices, seeing thingsDelusions…strange beliefs (e.g. controlled by the television)Delusions…strange beliefs (e.g. controlled by the television)AgitationAgitationDisturbance in sleep or appetiteDisturbance in sleep or appetiteIn a research study at Yale University, the common person can In a research study at Yale University, the common person can accurately tell when someone is psychotic in under 10 minutesaccurately tell when someone is psychotic in under 10 minutes

Psychosis and schizophrenia are not the same, although symptoms Psychosis and schizophrenia are not the same, although symptoms are similarare similar

Psychosis continuedPsychosis continued

Psychosis can be caused by:Psychosis can be caused by:SchizophreniaSchizophreniaBipolar disorderBipolar disorderToxic reactions to medicine or substancesToxic reactions to medicine or substancesDementiaDementiaHormonal imbalanceHormonal imbalanceTraumaTraumaInfection, illness or toxinsInfection, illness or toxins

The important thing to remember is that the The important thing to remember is that the psychotic person needs immediate attention psychotic person needs immediate attention from a qualified health care professionalfrom a qualified health care professional

Case study 1Case study 1Gary is 37 year old disabled male living independently in his apartment. In his Gary is 37 year old disabled male living independently in his apartment. In his

late twenties he was was in an accident that left him partially paralyzed. He late twenties he was was in an accident that left him partially paralyzed. He could walk with the aide of a walker though often he used a wheel chair. In could walk with the aide of a walker though often he used a wheel chair. In the previous week he had shown change in behavior, seeming to be more the previous week he had shown change in behavior, seeming to be more hostile and suspicious of other residents. When interviewed by the resident hostile and suspicious of other residents. When interviewed by the resident coordinator, he claimed to be ” Kunte Kinta” an escaped slave. He said coordinator, he claimed to be ” Kunte Kinta” an escaped slave. He said bounty hunter were after him to return him to slavery. Gary became agitated bounty hunter were after him to return him to slavery. Gary became agitated and threatened the worker claiming he was working with the bounty hunters. and threatened the worker claiming he was working with the bounty hunters. The worker called emergency services who in turn involved the local police. The worker called emergency services who in turn involved the local police. Gary was transported to the local emergency room where he was Gary was transported to the local emergency room where he was hospitalized with a provisional diagnosis of schizophrenia. hospitalized with a provisional diagnosis of schizophrenia.

Later when reviewing the admitting lab work, the attending MD noted Gary had Later when reviewing the admitting lab work, the attending MD noted Gary had an elevated white blood cell count indicating an infection. This coupled with an elevated white blood cell count indicating an infection. This coupled with Gary being non-responsive to the anti-psychotic medications led the MD to Gary being non-responsive to the anti-psychotic medications led the MD to run further tests. He was diagnosed with meningitis and aggressively run further tests. He was diagnosed with meningitis and aggressively treated with antibiotics. Within several days the psychosis cleared and gary treated with antibiotics. Within several days the psychosis cleared and gary returned to his apartment with follow up care. returned to his apartment with follow up care.

How persons with psychosis may come to How persons with psychosis may come to your attentionyour attention

The person with psychosis is in many The person with psychosis is in many ways most obvious to identify because ways most obvious to identify because behavior is unusual.behavior is unusual.

Inability to meets normal responsibilitiesInability to meets normal responsibilities

Concerns voiced by othersConcerns voiced by others

Conflict with lawConflict with law

Symptoms of Bipolar DisorderSymptoms of Bipolar Disorder

Racing thoughtsRacing thoughtsPressured speechPressured speechMood InstabilityMood InstabilityAgitationAgitationNot sleepingNot sleepingGrandiosityGrandiosityHostilityHostilitySometimes psychosisSometimes psychosis

Person with Bipolar Disorder may Person with Bipolar Disorder may come to your attentioncome to your attention

Unusual behaviorUnusual behavior

Complaints by othersComplaints by others

Conflicts with othersConflicts with others

Awake at all hoursAwake at all hours

Personality DisordersPersonality Disorders

Personality disorders are enduring and deep Personality disorders are enduring and deep seated patterns of behavior that frequently seated patterns of behavior that frequently brings the person into conflict with others.brings the person into conflict with others.

Behaviors include: Distorted interpretation of self Behaviors include: Distorted interpretation of self and others and others

intensity of feelings are inappropriate to situation intensity of feelings are inappropriate to situation

Poor ability to control impulsesPoor ability to control impulses

Persisting conflicts in relationships with othersPersisting conflicts in relationships with others

How persons with personality disorder may How persons with personality disorder may come to your attentioncome to your attention

Violation of rulesViolation of rules

Infringes on rights of othersInfringes on rights of others

Complaints by othersComplaints by others

Conflicts with othersConflicts with others

Persons often surrounded by “drama”Persons often surrounded by “drama”

Blames othersBlames others

What is a cognitive disorderWhat is a cognitive disorder

A cognitive disorder is a disturbance in the A cognitive disorder is a disturbance in the brains ability to receive information, brains ability to receive information, process information or remember. Cognitive process information or remember. Cognitive disorders can also effect feeling and disorders can also effect feeling and behavior. Common cognitive disorders behavior. Common cognitive disorders include: include: Developmental disorders/ Mental Developmental disorders/ Mental retardationretardationLearning disabilitiesLearning disabilitiesDeliriumDeliriumDementiaDementiaAmnesic disorderAmnesic disorderCognitive & memory DeficitsCognitive & memory Deficits

Recognizing Cognitive DisordersRecognizing Cognitive Disorders

A person with cognitive deficits may have A person with cognitive deficits may have difficulties:difficulties:Understanding or following through with Understanding or following through with instructionsinstructionsHave difficulties with activities of daily livingHave difficulties with activities of daily livingRememberingRememberingProblem solving Problem solving Recognizing consequencesRecognizing consequencesRecognizing riskRecognizing riskControlling behaviorControlling behavior

Cognitive DisordersCognitive Disorders

Can be:Can be:Temporary or permanentTemporary or permanentGross or subtleGross or subtleGeneticGeneticNeurobiological Neurobiological Due to toxinsDue to toxinsDue to injury or illnessDue to injury or illnessReactions to medicationReactions to medication

What is an addictive disorderWhat is an addictive disorder

Substance use disorder includes two broad Substance use disorder includes two broad categories of problems. These are substance categories of problems. These are substance abuse and substance dependence. abuse and substance dependence.

Substance abuse is the impairment in some Substance abuse is the impairment in some aspect of a persons life as a result of use of a aspect of a persons life as a result of use of a substance. substance.

Substance dependence is distinguished from Substance dependence is distinguished from abuse by the addition of a physical and/or abuse by the addition of a physical and/or psychological dependence on the substance.psychological dependence on the substance.

Case Study # 2Case Study # 2

Andy is a 63 year old male living in housing who came to the Andy is a 63 year old male living in housing who came to the attention of the service coordinator as he was behind on his rent. A attention of the service coordinator as he was behind on his rent. A review of his financial status suggested that he had more than review of his financial status suggested that he had more than adequate resources for living. In interviewing Andy, it was disclosed adequate resources for living. In interviewing Andy, it was disclosed that on “check” day he would go across the street from the that on “check” day he would go across the street from the apartment complex, buy several gallons of vodka and spend the rest apartment complex, buy several gallons of vodka and spend the rest on scratch tickets and a carton of cigarettes. He would then drink on scratch tickets and a carton of cigarettes. He would then drink the alcohol until it was gone and scratch the tickets. In recent the alcohol until it was gone and scratch the tickets. In recent months he was without funds by the end of the 1months he was without funds by the end of the 1stst week of the week of the month and was surviving eating in the soup kitchen once daily. month and was surviving eating in the soup kitchen once daily.

Andy was referred to an area multi-service agency for treatment Andy was referred to an area multi-service agency for treatment services and was ultimately assigned a rep-payee to aide with his services and was ultimately assigned a rep-payee to aide with his finances. Andy was diagnosed with an alcohol problem, gambling finances. Andy was diagnosed with an alcohol problem, gambling problem, malnutrition and dementia.problem, malnutrition and dementia.

Prevalence of disordersPrevalence of disordersOver 1/3 of all patients who have a psychiatric disorder Over 1/3 of all patients who have a psychiatric disorder also experience substance (AOD) abuse.also experience substance (AOD) abuse.

More than ½ the people who abuse AOD have significant More than ½ the people who abuse AOD have significant psychiatric symptomspsychiatric symptoms

Over 1/3 of persons with cognitive disorders experience Over 1/3 of persons with cognitive disorders experience psychiatric or AOD problemspsychiatric or AOD problems

Over half of all persons with cognitive impairment due to Over half of all persons with cognitive impairment due to traumatic brain injury (TBI) have co-occurring psychiatric traumatic brain injury (TBI) have co-occurring psychiatric and AOD disordersand AOD disorders

Over 1/3 of all persons with chronic medical conditions Over 1/3 of all persons with chronic medical conditions have co-occurring psychiatric problemshave co-occurring psychiatric problems

Over 40% of persons with chronic pain develop AOD Over 40% of persons with chronic pain develop AOD dependence problemsdependence problems

Psychiatric & AOD Disorders Psychiatric & AOD Disorders in the General Populationin the General Population

Lifetime Prevalence of SA Lifetime Prevalence of SA DisordersDisorders

Tobacco 24% Tobacco 24% Alcohol 14%Alcohol 14%

All other drugs 7.5%All other drugs 7.5% Cannabis 4.2%Cannabis 4.2%

Cocaine 2.7%Cocaine 2.7% Stimulants 1.7%Stimulants 1.7%

Sedatives 1.2%Sedatives 1.2% Heroin 0.4%Heroin 0.4%

Lifetime Prevalence of Lifetime Prevalence of PsychiatricPsychiatric DisordersDisorders

Major Depression 17%Major Depression 17%

Social phobia 13%Social phobia 13%

Simple phobia 11%Simple phobia 11%

GAD 5.1%GAD 5.1%

Panic Disorder 3.5%Panic Disorder 3.5%

Personality Disorder 3.5%Personality Disorder 3.5%

Bipolar 1.6%Bipolar 1.6%

Schizophrenia 1.2%Schizophrenia 1.2%

Theoretical Models for Theoretical Models for Behavioral Health Disorders Behavioral Health Disorders

Substance Use DisordersSubstance Use Disorders

Psychiatric DisordersPsychiatric Disorders

Common Factors Model Common Factors Model

Common Common FactorsFactors

• Familial factors (genetics)Familial factors (genetics)• Life ExperiencesLife Experiences• Neurobiological DysfunctionNeurobiological Dysfunction

Cognitive DisordersCognitive Disorders

Theoretical Models for Theoretical Models for Co-occurring DisordersCo-occurring Disorders

Substance Use DisordersSubstance Use DisordersPsychiatric DisordersPsychiatric Disorders

Secondary Substance Secondary Substance Abuse Model Abuse Model

• Psychosocial Risk Psychosocial Risk factorsfactors• Self medicationSelf medication• Alleviation of Alleviation of

dysphoriadysphoria• Super-sensitivitySuper-sensitivity

• Stress VulnerabilityStress Vulnerability

Theoretical Models for Theoretical Models for Co-occurring DisordersCo-occurring Disorders

Secondary Psychopathology Model Secondary Psychopathology Model

Substance Use DisordersSubstance Use Disorders Psychiatric Psychiatric DisordersDisorders

Cognitive DisordersCognitive Disorders

Theoretical Models for Theoretical Models for Co-occurring DisordersCo-occurring Disorders

Substance Use DisordersSubstance Use DisordersPsychiatric DisordersPsychiatric Disorders

Bi-directional Model Bi-directional Model

Cognitive Disorders Cognitive Disorders

What is a Co-occurring What is a Co-occurring DisorderDisorder

Co-existence of a mental health Co-existence of a mental health disorder, an alcohol and other drug disorder, an alcohol and other drug (AOD) problem and/or a cognitive (AOD) problem and/or a cognitive disorder. There is also high co-disorder. There is also high co-occurrence of medical problems.occurrence of medical problems.These are also called:These are also called: dual disordersdual disorders co-morbid disordersco-morbid disorders co-existing disordersco-existing disorders

Challenges of working with Challenges of working with Adults with disabilitiesAdults with disabilities

Co-occurring Disorders is the rule and not Co-occurring Disorders is the rule and not the exception making treatment more the exception making treatment more complex.complex.

Higher rates of child welfare involvement, Higher rates of child welfare involvement,

homelessness, legal and medical problems.homelessness, legal and medical problems. More frequent and longer hospitalizations, More frequent and longer hospitalizations, higher acute care and utilization rates. higher acute care and utilization rates.

Higher rates of cognitive deficitsHigher rates of cognitive deficits

Wrapping upWrapping up

Screening and assessment of specific Screening and assessment of specific disordersdisorders

Proven strategies for interveningProven strategies for intervening

How to develop intervention plans that are How to develop intervention plans that are reasonable to your settingreasonable to your setting

Knowing your community resources Knowing your community resources

Responding to crisis situationsResponding to crisis situations

Intervention & Treatment WorksIntervention & Treatment Works

It is important to remember that these It is important to remember that these problems are treatable.problems are treatable.

The past 30 years have shown The past 30 years have shown tremendous improvement in the tremendous improvement in the successful treatment of all these problems.successful treatment of all these problems.

Timely and effective interventions and Timely and effective interventions and coordinated efforts yield the best resultscoordinated efforts yield the best results

Final QuestionsFinal Questions