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Warning Signs of Severe Mental Illness
Kimberlee V Wilson, DO, MSAssistant Clinical Professor
Director of Inpatient ServicesOSU-CHS Department of Psychiatry
Disclosures I have nothing to disclose.
Serious Mental IllnessFederal definition: Person 18 or older who currently, or any time
in the past year, has had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified in DSM resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities, i.e., maintaining interpersonal relationships, activities of daily living, self-care, employment, and recreation.
Serious Mental Illness .... serious functional impairment, which
substantially interferes with or limits one or more major life activities, i.e.,
maintaining interpersonal relationships activities of daily living self-care employment recreation
Serious Mental Illness
Definition excludes developmental or substance use disorders, dementia, due to general medical condition.
Serious Mental Illness
SMIPotential to produce impairment Interfering with quality of lifeNot always severe or persistentEx: Depression, Anxiety,
Adjustment Disorder
Severe or Persistent Mental Illness
SPMIChronic and disablingSchizophrenia SpectrumBipolar I Disorder
SMI DSM-5 Disorders Schizophrenia Spectrum and Other Psychotic
Disorders
Bipolar and Related Disorders
Depressive Disorder
Obsessive-Compulsive Disorder
Panic Disorder
Post Traumatic Stress Disorder
Eating Disorders
SMI DSM-5 Disorders Schizophrenia Spectrum and Other Psychotic
Disorders * Persistent
Bipolar and Related Disorders * Persistent
Depressive Disorders
Obsessive Compulsive Disorders
Panic Disorder
Post Traumatic Stress Disorder
Eating Disorders
Prevalence Schizophrenia 1.1% population 2.4 Million Americans, ~ 9,000 Tulsa Metro residents
Bipolar Disorders 2.6% population 6.1 Million Americans
Depression 6.9% population 16 Million Americans
Anxiety Disorders 18.1% population 16 Million Americans
0.00%2.00%4.00%6.00%8.00%
10.00%12.00%14.00%16.00%18.00%20.00%
2016 US Adult Population
2016 US Adult Population
42 Million
2.4 Million6.1 Million
16 Million
Severe or PersistentDSM-5 Disorders
Bipolar Disorder
Schizophrenia Spectrum Schizophreniform Schizophrenia Schizoaffective disorders Schizotypal Personality Delusional Disorder
SchizophreniaPremorbid Signs
Schizoid Personality characteristics
Quiet, passive, introverted
Takes pleasure in few activities
Prefers solitary amusement (computer games, music, TV) to social activities, avoids team sports
SchizophreniaPremorbid Signs
Schizoid Personality characteristics
Does not enjoy close relationships, lacks close friends or confidants
Little interest in sexual experiences with another person
Appears indifferent to praise or criticism by others
Emotional coldness, detachment
SchizophreniaPremorbid Signs
Schizotypal Personality Characteristics
Ideas of reference different from delusions
Unusual perceptual experiences, including bodily illusions
Excessive social anxiety that doesn’t diminish with familiarity
SchizophreniaPremorbid Signs
Schizotypal Personality Characteristics
Odd beliefs or magical thinking that influences behavior and inconsistent with subcultural norms Superstitious, belief in telepathy or clairvoyance
Odd, eccentric or peculiar behavior or appearance
Odd thinking and speech Metaphorical, stereotyped, overelaborate
Prodrome Age of onset Males late teens – early to mid 20s Females early 20s – mid 30s
Behavior changes often misinterpreted for young adulthood transitions, problems adapting to new school or surroundings, loss of childhood relationships
Disconnecting from people or activities previously enjoyed
Sudden onset of obsessive-compulsive behavior
Phases of Psychosis
Signs and Symptoms
Withdrawal — complete social withdrawal and loss of interest in others
Drop in functioning — An unusual drop in functioning, at school, work or social activities, such as quitting sports, failing in school or difficulty performing familiar tasks
Problems thinking — Problems with concentration, memory or logical thought and speech that is hard to explain
Signs and Symptoms
Increased sensitivity — Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations
Apathy — Loss of initiative or desire to participate in any activity
Feeling disconnected — A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality
Signs and Symptoms
Illogical thinking — Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or childlike magical thinking
Nervousness — Fear or suspiciousness of others or a strong nervous feeling
Sleep or appetite changes — Dramatic sleep and appetite changes or decline in personal care
Signs and Symptoms
New preoccupation in abstract ideas, philosophy, and the occult or religious questions
Bizarre behavior and ideas
Mood changes — Rapid or dramatic shifts in feelings
Unusual affect
Active PhaseSchizophrenia
Two of more, each present for significant portion of time during a 1-month period, persisting for 6 months, and one must include 1, 2, or 3:1. Delusions2. Hallucinations3. Disorganized speech
1. Frequent derailment or incoherence4. Grossly disorganized or catatonic behavior5. Negative symptoms
1. Diminished emotional expression or avolition
Positive Symptoms
Hallucinations: Not based on real images
Auditory is most common Voices are single or multiple in conversation Often threatening, obscene, accusatory, insulting,
commanding or running commentary of patient’s life
Visual 2nd most common
Tactile, olfactory, gustatory are rare Should prompt a Neuro workup
Positive Symptoms
Cenesthetic Hallucinations
• Unfounded sensations of altered states in bodily organs• Burning sensation in the brain• Pushing sensation in the blood vessels• Cutting sensation in the bone marrow• Bodily distortions
Positive Symptoms
Illusions Distortions of real images or sensations Can occur in prodromal phase Can be substance-induced
Positive Symptoms Delusions: Fixed false beliefs Persecutory - being targeted by groups or authorities Grandiose – Often Self-Aggrandizing, i.e., “chosen
by God to punish the world for it’s sins”. Owns large entities, knows presidents or
celebrities Religious – tattooed Bible verses on body Somatic – implausible conditions, i.e., presence of
aliens inside the patient’s organs causing dysfunction
Positive Symptoms Disordered or Loosely Associated Thought Content Reflect patient’s ideas, beliefs, and interpretation of
stimuli Outside forces controlling what patient thinks or feels, or
the patient controls outside events, i.e., sunrise Thought broadcasting or insertion Receives special messages from the TV, radio, internet or
newspaper Preoccupation with invisible forces, radiation, witchcraft,
religion, esoteric, symbolic “Tulsa is a slut spelled backwards”
Positive Symptoms Aggression Agitation Poor impulse control Grab other’s property, change TV channels
abruptly, Throw things at others
Decreased social sensitivity Violence and Suicide attempts Often a result of command hallucinations
Negative Symptoms Flat affect: lack of emotion or expression
Monotone or nonspontaneous speech or Alogia
Poor self care and hygiene
Deficits in attention and memory
Thought blocking
Poverty of thought content
Schizoaffective Disorder
A major mood episode (depression or mania) concurrent with Schizophrenia symptoms of delusions, hallucinations, or disorganized speech or behavior.
Delusions or halluncinations for at least 2 weeks in the absence of a mood episode during the lifetime of the illness.
Bipolar Related Bipolar I Disorder
Bipolar II Disorder
Major Depressive Disorder
Bipolar I Disorder
Manic Episode Distinct period of abnormally and persistently elevated,
expansive or irritable mood
Increased goal directed activity or energy
Symptoms last at least one week and present most of the day nearly every day
Manic Episode During mood disturbance, 3 or more of the following
symptoms are present and are a noticeable change from the usual Inflated self-esteem or grandiosity Decreased need for sleep, i.e., feels rested after only
3 hrs More talkative then usual, feels pressure to keep
talking, difficult to interrupt Flight of ideas or feels thoughts are racing
Manic Episode Distractibility to irrelevant external stimuli Increased goal-directed or physical activity, either socially, at work or school or sexually Excessive activity with high potential for painful
consequences, unrestrained buying sprees multiple sexual indiscretions, foolish business investments
Manic Episode
The mood disturbance is sufficiently severe to: Cause marked impairment in social or occupational
functioning Require hospitalization to prevent harm to self or
others Develop psychotic features
Depressive EpisodeMarked opposite of mania in mood and activity.
Vegetative Depressed. Sad. Blue. Empty. May not be able to describe emotion. May not be able to cry
Withdrawal. Isolates to room or bed.
Lack of energy. Retarded movements.
Depressive Episode
Poor concentration or decision-making
Loss of interest or pleasure in people, activities and sex
Hopelessness. Worthlessness
Suicidal Ideation or preoccupation with death.
How it feels to be Bipolar
https://www.youtube.com/watch?v=0_sv7g4ZIKM&feature=youtu.be
SMI Impact Per CDC, people with serious mental illness (SMI) have a
life expectancy that is 25 years less than the general population
Depression is the leading cause of disability worldwide
Serious mental illness costs the United States an estimated $193 billion in lost earnings each year
90% of individuals who commit suicide have an underlying mental illness Suicide is the 10th leading cause of death in U.S. 2nd leading cause of death for people aged 15-24 Each day, 18-22 veterans die by suicide
SMI Impact NAMI (National Alliance on Mental Health) 1 in 5 adults will experience a mental illness in a given
year 1 in 25 (10 million) live with a serious mental illness Nearly 60% of adults with a mental illness did not receive
mental health services in the previous year
References http://www.nami.org/Learn-More/Mental-Health-By-the-
Numbers
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048500/
http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml
https://www.youtube.com/watch?v=0_sv7g4ZIKM&feature=youtu.be
https://youtu.be/SizS1nOOeJg
