Mental Illness 101

Presentation at the New Grantees’ Conference

US Department of Labor
Homeless Veterans Reintegration Program

August 1, 2006

Cynthia Bisbee, Ph.D.

CC Bisbee & Associates
Montgomery, AL
 Types of Mental Illness

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Definition of
Mental Disorder
★ A clinically significant behavioral or
psychological syndrome or pattern
that occurs in an individual and that is
associated with present distress or
disability or with a significantly
increased risk of suffering death,
pain, disability or an important loss of
freedom.

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Definition of
Mental Disorder
★ Not merely an expectable and
culturally sanctioned response to a
particular event such as death of a
loved one
★ Must be within an individual
★ Classifies disorders, not people

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Serious Mental Illness
★ Always Included in Definition
➝Schizophrenia
➝Major Depression
➝Bipolar Disorder
★ Sometimes Included
➝Severe Anxiety Disorders
➝Cognitive Disorders
➝Some Personality Disorders

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Criteria for Schizophrenia
★ Characteristic ★ Social/Occupational
symptoms Dysfunction
➝Delusions ★ Lasting at Least Six
➝Hallucinations Months
➝Disorganized Speech
➝Disorganized Behavior
➝Negative Symptoms
✙ Flat Affect
✙ Lack of Motivation

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Criteria for Major
Depression
★ Depressed Mood ★ Feelings of
★ Diminished Interest Worthlessness or
★ Weight Loss or Gain Excessive Guilt
★ Difficulty Thinking
★ Sleep Disturbance
& Concentrating
★ Restlessness or Being
★ Symptoms Occur
Slowed Down
Every Day
★ Fatigue & Loss of
★ Significant
Energy
Distress &
★ Thoughts of Death
Impairment
Copyright © 2006 Cynthia Bisbee, Ph.D.
Criteria for Bipolar Disorder

★ Manic Episodes ★ Marked

➝Elevated mood Impairment
➝Grandiosity ➝Occupation
➝Decreased need for ➝Social relationships
sleep ★ (or) Hospitalization
➝Talkativeness
★ (or) Psychotic
➝Racing thoughts
Features
➝Increased goal-
directed activity ★ May Alternate with
Depressive
Episodes
Copyright © 2006 Cynthia Bisbee, Ph.D.
Symptoms of Mental Illness

★ Perceptions

★ Thoughts

★ Moods

★ Behavior

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Substance-Related
Disorders
★ Types of Disorder ★ Substances
➝Alcohol
➝Substance-induced
➝Amphetamines
✙ Intoxication ➝Caffeine
✙ Withdrawal ➝Cannabis
✙ Various psychiatric ➝Cocaine
symptoms ➝Hallucinogens
➝Substance Use ➝Inhalants
➝Nicotine
✙ Dependence
➝Opioids
✙ Abuse ➝Phencyclidine
➝Sedative-hypnotics
➝Polysubstance
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Causes of Mental Illness

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Causes of Mental Illness

★ Biological Causes

★ Environmental Effects

★ Interaction of Biology and

Environment

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Biology of
Serious Mental Illnesses
★ Brain Disorder
➝Anatomy
➝Function (metabolism)
➝Chemistry
★ Causes of Brain Disorder
➝Genetics
➝Viral Theories
➝Brain Injury

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Schizophrenia:
Chemical Imbalance in the Brain

Copyright © 1998 Patricia L. Scheifler MSW, PIP

Synapse
Dopamine

Receptor
Site

Speaking Listening
Brain Cell
Brain Cell

Vesicle

Too Much Dopamine =

Positive Symptoms
Copyright © 2006 Cynthia Bisbee, Ph.D.
 The Role of Environment

★ Some Disorders May Be Learned

★ Some Result from Trauma

★ Environment Affects the Course of

the Disorders
★ Stigma

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Treatment of
Mental Illness

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Intervention Goals
★ Remission of Symptoms
➝Positive
➝Negative
★ Maintenance of Stability
★ Enhanced Quality of Life
★ Role Recovery

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Medications
★ Antipsychotics

★ Antidepressants

★ Mood Stabilzers

★ Anxiolytics

★ Side Effects Medications

Copyright © 2006 Cynthia Bisbee, Ph.D.

Anti-psychotic Medications
★ Used to combat psychotic symptoms
➝Hallucinations
➝Delusions
➝Confused Thinking
➝Altered Perceptions
➝Disorganized Speech
➝Other signs of psychosis

Copyright © 2006 Cynthia Bisbee, Ph.D.

Antipsychotic Medications Block
Dopamine
Dopamine

Copyright © 1998 Patricia L. Scheifler MSW, PIP

Speaking Listening
Brain Cell
Brain Cell

Antipsychotic
Medication
Blocks Receptor Site
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Examples of
Anti-psychotic Medications
★ Zyprexa ★ Haldol
★ Risperdal ★ Loxitane
★ Seroquel ★ Thorazine
★ Geodon ★ Mellaril
★ Clozaril ★ Stelazine
★ Abilify ★ Prolixin
★ Navane
★ Serentil

Copyright © 2006 Cynthia Bisbee, Ph.D.

Anti-depressant Medications
★ Used to Relieve Symptoms of
Depression
➝Sadness
➝Feelings of Failure
➝Loss of Interest in Life
➝Sleep Disturbances
➝Excessive Guilt
➝Loss of Energy/Fatigue
➝Thoughts of Death and Suicidal Thoughts
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Examples of
Anti-depressant Medications
★ Prozac
★ Desyrel
★ Zoloft
★ Elavil
★ Effexor
★ Tofranil
★ Celexa
★ Serzone ★ Pamelor

★ Remeron ★ Marplan
★ Paxil ★ Nardil
★ Wellbutrin ★ Ascendin
★ Lexapro ★ Sinequan

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Mood Stabilizers
★ Used to Treat Symptoms of Mania
➝Rapid Talking
➝Decreased Need for Sleep
➝Racing Thoughts
➝Distractibility
➝Irritability
➝Behavioral Excesses
➝Grandiosity
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Examples of
Mood Stabilizers
★ Lithium ★ Note: Some of
➝Eskalith these medications
➝Lithobid are also used to
➝Lithane treat seizures
★ Depakote
★ Tegretol
★ Neurontin
★ Zyprexa
★ Topamax

Copyright © 2006 Cynthia Bisbee, Ph.D.

Anti-anxiety Medications
★ Used to Treat Symptoms of Anxiety
➝Nervousness
➝Panic
➝Shortness of Breath
➝Trembling
➝Feeling of Choking
➝Heart Palpitations
➝Obsessions & Compulsions
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Examples of
Anti-anxiety Medications
★ Xanax ★ Valium
★ Ativan ★ Librium
★ Klonapin ★ Serax
★ Buspar ★ Equanil
★ Miltown
★ Vistaril
★ Tranxene

Copyright © 2006 Cynthia Bisbee, Ph.D.

Side Effects Medications
(Anti-parkinsonians)
★ Used to Relieve Side Effects of Anti-
psychotic Medications
➝Stiff Muscles
➝Unsteady Gait
➝Tremors
➝Eyes Rolling Back
➝Restless Feeling

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Examples of
Side Effects Medications
★ Cogentin

★ Artane

★ Benadryl

★ Akineton

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Stimulants (special use)
★ Used to Treat Symptoms of
Attention Deficit/Hyperactivity
Disorder
➝Mainly Used in Children
➝Hyperactivity
➝Inability to Pay Attention
➝Distractibility
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Examples of
Stimulant Medications

★ Ritalin

★ Adderall

★ Dexedrine

★ Cylert

★ Concerta

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Side Effects of
Medications
★ Drowsiness ★ High Heart Rate

★ Dry Mouth ★ Weight Gain

★ Blurred Vision ★ Slurred Speech

★ Dizziness ★ Sensitivity to Sun

★ Tremors ★ Some Are Addictive

★ Sexual Dysfunction
Copyright © 2006 Cynthia Bisbee, Ph.D.
Psychosocial Interventions
★ Assessment ★ Rehabilitation
★ Education about ➝Social Skills
Illness Self ➝Vocational
Management ★ Family Services
★ Counseling/Therapy ➝Education
➝Individual ➝Family Therapy
➝Group ★ Case Management
★ Crisis Intervention

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Illness Self Management/
Patient Education
★ Giving Information about the Illness
➝Symptoms
➝Treatment
➝Course
★ Helping Client Learn to Manage Own
Illness

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Management Skills
for Recovery

★ Medication Adherence

★ Healthful Lifestyle

★ Therapeutic Environment

★ Illness Monitoring

★ Relapse Prevention
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Medication Adherence

★ Adherence = “Sticking to” the

Medication Plan
★ Barriers to Adherence
➝The Person’s Condition
➝Chronic Illness
➝Complex Medication Plan

Copyright © 2006 Cynthia Bisbee, Ph.D.

Antipsychotic Medications Block
Dopamine

Copyright © 1998 Patricia L. Scheifler MSW, PIP

Dopamine

Speaking Listening
Brain Cell
Brain Cell

Antipsychotic
Medication
Blocks Receptor Site
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Stop Taking Antipsychotics
Blockade Gradually Disappears

Copyright © 1998  Patricia L. Scheifler MSW, PIP
Speaking Listening
Brain Cell
Brain Cell

Copyright © 2006 Cynthia Bisbee, Ph.D.

 No Antipsychotic Medication:
Positive Symptoms Reappear
( Relapse)

Copyright © 1998  Patricia L. Scheifler MSW, PIP
Speaking Listening
Brain Cell
Brain Cell

Copyright © 2006 Cynthia Bisbee, Ph.D.

 What Is
Illness Monitoring?

★ Learning about Illness

★ Developing Awareness of Symptoms

★ Watching for Signs of Relapse

★ Mapping Illness Cycles

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Importance of
Illness Monitoring

★ Helps Prevent Relapse

★ Look for Illness Cycle

★ Indicate Possible Need for Medication

Adjustment
★ Helps Measure Effects of Treatment

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Relapse Checklist*
★ Medication Change
★ Physical Illness
★ A Stressful Event or Overstimulation
★ Alcohol or Drugs
★ Sugar, Caffeine, or Change of Diet
★ Too Many Fluids
★ Illness Cycle

– Copyright © 1982 Patricia Scheifler

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Taking Action
★ Ensure Compliance with Meds
★ Seek Medical Treatment & Rest
★ Daily Relaxation Skills
★ Decrease Stimulation
★ Avoid Drugs & Alcohol
★ Cut Caffeine, Sugar & Fluids
★ Consult MD for Possible Medication
Adjustment
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Psychotherapy and
Counseling

★ Reality Based

★ Real-life Problem Solving

★ Individual Coping with Illness

★ Group Support and Peer Learning

★ Flexible Participation Standards

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Crisis Intervention

★ Telephone

★ Clinic Based

★ Mobile Outreach

★ In-Home Intervention

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Skills Training

★ Social Skills

★ Academic Skills

★ Vocational Skills

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Psychiatric Rehabilitation
★ Readiness Assessment
★ Readiness Development
★ Choosing Rehabilitation Goals
➝Living
➝Learning
➝Working
➝Socializing
★ Getting & Keeping Environments of Choice

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Continuum of Living
Environments
★ Long Term Hospital
★ Crisis Stabilization Facility
★ Group Treatment Setting
★ Family Living
★ Supported Living Apartments
★ Independent Living

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Continuum of Learning
Environments
★ Hospital Treatment
★ Partial Hospitalization Services
★ Outpatient Therapies
★ Clubhouse
★ Adult Education
★ Supported Education

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Continuum of Working
Opportunities
★ Pre-vocational Training
★ Vocational Training
★ Volunteer Jobs
★ Jobs in Mental Illness Facilities
★ Supported Employment
★ Transitional Employment
★ Part-time and Full-time Regular
Employment
★ Consumer-run Business
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Family Services

★ Support

★ Education

★ Consultation

★ Therapy

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Case Management
★ Service Coordination

★ Linkage

★ Connection to One Person

★ Help with Basic Needs

★ Broad View of Service Plan

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Interacting with a Person
with Mental Illness Symptoms:
Communication Skills
(Copyright Patricia Scheifler, MSW)

★ Give clear directives ★ Express caring and

★ Ask open-ended support
questions ★ Use parroting
★ Check out the whys of ★ Be concrete and brief
behavior
★ Express empathy;
★ Watch for signs of fading
reflectfeelings ★ Be low-key and low “EE”
★ Use no-choice choices ★ Avoid power struggles
★ Criticize behavior not ★ Allow for time out to “de-
person stim”
★ Use “I” statements ★ Do not tell lies
Copyright © 2006 Cynthia Bisbee, Ph.D.
 Interacting with a Person
with Mental Illness Symptoms:
Safety
★ Remain calm
★ Speak slowly and clearly
★ Avoid invading personal space
★ Do not move quickly, especially toward
the person
★ Do not touch the person
★ Do not challenge the person

Copyright © 2006 Cynthia Bisbee, Ph.D.

Special Issues for Homeless
People with Mental Illness
★ Lack of Trust
★ Hierarchy of Needs
★ Disability Caused by Mental Illness
➝Effect of active symptoms
➝No energy to accomplish daily tasks
➝Inability to plan
★ Consistent Need for Support

Copyright © 2006 Cynthia Bisbee, Ph.D.

 Interventions for
Mental Illness

★ No One
Intervention Is
Sufficient
★ We Have to
Approach from All
Directions

Copyright © 2006 Cynthia Bisbee, Ph.D.