Overview of Mental Illness Officer Chad Stiles, RN/Paramedic Crisis Assessment Response Team

Definition of Mental Illness Disorder of emotional, thought, or cognitive process that impairs judgment, behavior or capacity to recognize reality. Disorder: a disruption of normal physical or mental functions DSM V – Diagnostic and Statistical Manual

Mental Illness is a disease Disease process as well as medical condition with symptoms that come and go. Genetic component Biochemical component Structural abnormalities in the brain Treatable with medications, therapy and support Who likes cake?

Myths about mental illness Individuals with mental illness are violent (Rueve and Welton, 2008) Individuals with mental illness are less intelligent People can convince those with delusions that are not real

Descriptions of the problem Downsizing and closing of psychiatric hospitals Discharging patient into communities without adequate community resources and support Lack 0f insurance coverage for mental health care

Major Mental Illness Schizophrenia Bipolar Disorder Schizoaffective Disorder Major Depressive Disorder Anxiety Disorders

Schizophrenia Positive Symptoms: Negative Symptoms: Delusions Hallucinations Disorganized speech/behavior Negative Symptoms: Diminished speech or thought Flat affect Lack of motivation Lack of connectedness

Approaching someone with schizophrenia Calm, even tone Maintain distance – don’t trap or move in too close Minimize stimulation Short, concrete questions Simple explanations, simple instructions Ask about hallucinations

Avoid Lie, deception, false promises Arguing Agree with delusions Violate personal space Raising your voice

Bipolar Disorder Mania/Hypomania Depression Mixed State Cycling May also have psychosis

Mania Increase energy Decrease need for sleep Racing thoughts Impulsiveness Poor Judgment Distractible Grandiose thinking (I am the president/I am God) Sexually promiscuous behavior Impulsive spending

Mixed State Hyper Easily Agitated Irritable, angry Hypersensitive to stimuli May mimic drug abuse High suicide risk

Depression Loss of interest, energy, motivation Hopelessness Increased/decreased sleep/appetite Suicidal thoughts Slowed thinking and/or response Guilt

Managing Mania Expect rapid mood changes Be alert for impulsiveness Gently refocus when asking questions Give simple, short directions

Things to remember with Bipolar Disorders May present with mixed state Mania or depression may last days or months Treatable Mania looks like cocaine or amphetamine high Often associated with substance abuse

Major Depression Develops over days to weeks, not minutes Episodic or chronic Treatable May or may not be triggered by life events High suicide risk, especially in early treatment

Schizoaffective Disorder A mixture of mood disorder and schizophrenia Better prognosis that schizophrenia but not as but not as good as mood disorder only

Observations of depression May avoid eye contact Speech may be soft, slow, hesitant May have poor hygiene, eating habits Poor concentration Loss of interest in activities

Management of Depressive Be patient Assess suicide risk Consider possibility that person may have already harmed self (overdose) Validate their feelings Don’t try to out of depression or minimize feelings

Anxiety Disorders Agoraphobia Generalized Anxiety Disorder OCD Panic Disorder Social Anxiety Disorder Hoarding

PTSD Flight,Fight,Freeze response Trauma – Primary or Secondary Re-experience symptoms Avoidance symptoms Hyperarousal symptoms Chidlren experience other symptoms Bedwetting Age appropriate behavior regression Acting out the event during playtime Being clingy with a parent or an adult

Flight Fight Freeze