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

2. 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

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

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

5. Scope of Psychosis

6. 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

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

8. 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

9. 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

10. 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

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

14. 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

15. 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.”

16. Treatment Helps Mindy Manage Schizophrenia https://maketheconnection.net/conditions/schiz ophrenia?condition_id=8&story_id=517 https://maketheconnection.net/conditions/schiz 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.

17. 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

18. Positive Symptoms of Schizoaffective Hallucinations Delusions Thinking Disturbances

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

20. Bipolar Disorder

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

22. 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

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

24. 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 – https://www.youtube.com/watch?v=oUI5xS_IH24

26. Community Activity This is Sam….

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

28. QUESTIONS ???

29. VA RESOURCES Madison VA System (608) 256-1901 William S. Middleton Memorial Veterans, 2500 Overlook Terrace, Madison, WI 53705 Milwaukee VA System(414) 384-2000 Clement J. Zablocki VA Medical Center 5000 W National Ave., Milwaukee, WI Tomah VA System(608) 372-3971 Tomah VA Medical Center 500 E. Veterans Street, Tomah, WI 54660 2500 Overlook Terrace

30. Community Resources SAMHSA: Substance Abuse and Mental Health Services Administration - http://www.samhsa.gov/http://www.samhsa.gov/ NIMH: National Institute of Mental Heath https://www.nimh.nih.gov/index.shtml NAMIWisconsin: http://www.namiwisconsin.org/http://www.namiwisconsin.org/ Make the Connections: http://maketheconnection.net/