Mental Health Awareness Education Summit January 23, 2016 Faith Edgren & Roxane Rausch MHICM RANGE

Mental Health Intensive Case Management (MHICM) Rural Access Network for Growth Enhancement (RANGE) We are the only RANGE in Wisconsin Team of 4: Psychiatrist, RN and Social Workers Eligibility: – Veteran – Enrolled in VA Healthcare – Reside 65 miles from Waupaca, WI – Currently underserved – Clinically Appropriate

MHICM RANGE Program Foundation: 10 Fundamental Components of Recovery What we do: – Weekly appointments – Work together in partnership – Focus on recovery

Veterans We Serve Diagnosed with a Several Mental Illness (SMI) Schizophrenia Schizoaffective Bi-Polar Disorder Major Depressive Disorder w/ Sever Psychosis

Scope of Psychosis

Risk Factors Psychosis may affect persons of all types regardless of age, gender, race, and/or ethnicity Individual risk factors (dependent on the diagnosis) Familial and genetic factors: many psychotic disorders Impaired physical and/or mental health

Risk Factors continued….. Substance or alcohol abuse Stress intolerance Ineffective coping

Acute Psychosis Depends on internal factors such as loss, trauma, pain and environment. In many cases, psychosis is reversible and there are no residual effects Problems with daily activities Cognitive Dysfunction Impairment in personal, social, and/or occupational function Risk for violence to self/and or others

Chronic Psychosis Dependent on internal factors High rates of recidivism, homelessness, incarceration, joblessness, and long term disability Danger to self and/or others Premature mortality Costly to family and society

Schizophrenia 1% of population has schizophrenia Most common psychotic disorder Increased risk of suicide Increased risk factor with positive family history of schizophrenia First break-adolescence or young adulthood Neurotransmitter involved-Dopamine

Positive Symptoms of Schizophrenia Hallucinations Delusions Psychosis Illusions Agitation Hostility Bizarre Behaviors Association Disturbances Disorganized Speech

Negative Symptoms of Schizophrenia Alogia, Affective Blunting, Avolition, Anhedonia and Restricted emotion Social withdrawal Dependency Lack of ego boundaries Concrete thought processes Lack of self-care Sleep disturbance

The nurse working with a client who is newly diagnosed with schizophrenia would include which of the following in the client's teaching? a. “Schizophrenia is curable if the correct medication and dosages are achieved.” b. “Schizophrenia has been found to be nonresponsive to medications, and we will work mostly on helping you with daily activities.” c. “Schizophrenia is caused by pathology in the cerebellum, and there are medications that are helpful in this area.” d. “Schizophrenia is an illness that involves neurotransmitters, most particularly the dopamine system.”

Treatment Helps Mindy Manage Schizophrenia ophrenia?condition_id=8&story_id=517 ophrenia?condition_id=8&story_id=517 Mindy joined the Navy, but her enlistment was cut short with the onset of schizophrenic symptoms. After her military discharge, she began counseling at VA. Her medical team helped her understand her condition and find ways to manage her symptoms. Consistent professional support enables Mindy to find solutions for living well.

Schizoaffective Is a major psychiatric disorder similar to schizophrenia Is a biological disorder which likely results from an imbalance in brain chemicals Develops in about 1 in 200 people (.05%) Affects all aspects of daily living, including work, social relationships and self-care

Positive Symptoms of Schizoaffective Hallucinations Delusions Thinking Disturbances

Negative Symptoms of Schizophrenia Affective Blunting Anhedonia (Decrease in ability to experience pleasure) Apathy Poverty of Speech or Content of Speech Inattention

Bipolar Disorder

Type I Manic phase: (Required) – Disturbed sleep pattern – Sleep deprivation – Imbalanced nutrition – Hypothermia – Deficient fluid volume – Noncompliance

Type II Hypomanic: – Inflated self-esteem – Decreased need for sleep – More talkative or pressured to keep talking – Flight of ideas – Increase in goal-directed activity

Type II cont’d Depressive phase: – Disturbed sleep pattern – Imbalanced nutrition – Fatigue – Self-care deficit – Nausea – Disturbed thought processes – Sexual dysfunction -Self-injury

Signs and Symptoms Manic episode: an abnormally and persistently elevated, expansive, or irritable mood for a duration of at least 1 week Three (or four if the mood is irritable) of seven additional symptoms: – Inflated self-esteem or grandiosity – Decreased need for sleep – Being more talkative or having pressured speech – Flight of ideas or racing thoughts – Distractibility – Increase in goal-directed activity or psychomotor agitation – Excessive involvement in pleasurable activities that have a high potential for painful consequences –

Community Activity This is Sam….

Community Activity Veteran Immediate Family NurseSpouse/ChildrenPolice OfficerDistrict AttorneyJudgeHospitalFriendCo-WorkerCounty WorkerDoctor Office

QUESTIONS ???

VA RESOURCES Madison VA System (608) William S. Middleton Memorial Veterans, 2500 Overlook Terrace, Madison, WI Milwaukee VA System(414) Clement J. Zablocki VA Medical Center 5000 W National Ave., Milwaukee, WI Tomah VA System(608) Tomah VA Medical Center 500 E. Veterans Street, Tomah, WI Overlook Terrace

Community Resources SAMHSA: Substance Abuse and Mental Health Services Administration - NIMH: National Institute of Mental Heath NAMIWisconsin: Make the Connections: