Mental Illness & School Counseling

S. Emily CurtisSalem College

Monday, November 24, 2014

What is mental illness?

• “A mental illness is a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others, and daily functioning” (NAMI, 2014).

• “Mental illness can affect persons of any age, race, religion, or income” (NAMI, 2014).

• “Because mental illnesses have no cure, treatment must be continuous” (NAMI, 2014).

Mental Illness Myths• “Children don’t experience mental health problems”

(N.A., n.d.).– “Even young children may show signs of mental health

concerns” (N.A., n.d.).• “There is no hope for people with mental health

problems” (N.A., n.d.)– “Studies show that people with mental health problems get

better and many recover completely” (N.A., n.d.).• “Therapy and self-help are a waste of time” (N.A.,

n.d.).– “Treatment for mental health problems varies depending

on the individual and could include medication, therapy, or both” (N.A., n.d.).

School Counselors & Mental Illness

• “Professional school counselors do not provide long-term therapy in schools to address psychological disorders; however, they must be prepared to recognize and respond to student mental health crises and needs, and to address these barriers to student success by offering education, prevention, and crisis and short-term intervention until the student is connected with available community resources” (ASCA, 2009).

Attention Deficit Hyperactivity Disorder (ADHD)

• Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) is a common behavioral disorder that affects approximately 10% of children in the U.S. (KidsHealth, 2014 & Curtis, E., 2014).

• Symptoms can include the inability to concentrate or focus on a task for any length of time, becoming easily distracted, forgetfulness, fidgeting, squirming, excessive talking, interrupting, intruding, and impatience (WebMD, 2014 & Curtis, E., 2014).

• The term ADD is no longer in common use and has been replaced by the term inattentive ADHD (WebMD, 2014).

School Counseling & ADHD

• School counselors may be asked to work with students struggling with ADHD.

• Many symptoms and signs of ADHD may be viewed by educators as behavioral problems and not a mental disorder.

• Behavior therapy and choice theory/reality therapy could be applied in the school setting to manage signs and symptoms of ADHD.

Post Traumatic Stress Disorder (PTSD)

• Post-traumatic stress disorder (PTSD) is a mental illness that results from experiencing or witnessing a traumatic event (Mayo Clinic Staff, 2014 & Curtis, E., 2014).

• Statistics state that between 7 and 8% of the American population will struggle with PTSD at some point (U.S. Dept. of VA, 2014 & Curtis, E., 2014).

School Counseling & PTSD

• PTSD is not as common in schools as ADHD, but can present at any age.

• School counselors must be aware of any traumatic situations that students may have experienced and be prepared for PTSD symptoms at any time after the traumatic experience.

Conclusion• Mental illnesses are medical conditions that

deserve the same respect, consideration, and right to treatment as any other illness.

• School counselors are not responsible for long-term counseling services, treatment, or diagnosis of mental illness, but can be an important part of the collaboration process.

• There are many resources available to help people with mental illnesses or disorders. These resources should be available through school counselors.

References• ASCA. (2009). The Professional School Counselor and Mental Health. American School Counselor

Association. Retrieved from https://www.schoolcounselor.org/asca/media/asca/PositionStatements/PS_StudentMentalHealth.pdf.

• Banks, S.G. (2009) Choice Theory: Using Choice Theory and Reality Therapy to Enhance Student Achievement and Responsibility. The American School Counselor Association (ASCA).

• Capuzzi, D. & Gross, D.R. (2011). Counseling and Psychotherapy. (5th ed.) Alexandria, VA: American Counseling Association.

• KidsHealth. (2014). What is ADHD? The Nemours Foundation. Retrieved from http://kidshealth.org/parent/medical/learning/adhd.html.

• Mayo Clinic Staff. (2014). Post-traumatic Stress Disorder (PTSD). Mayo Foundation for Medical Education and Research. Retrieved from http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/definition/con-20022540.

• N.A. (n.d.) Mental Health Myths & Facts. Mental Health.gov: U.S. Department of Health & Human Services. Retrieved from http://www.mentalhealth.gov/basics/myths-facts/.

• NAMI. (2014). Mental Illness. National Alliance on Mental Illness. Retrieved from www.nami.org/Template.cfm?Section=By_Illness.

• U.S. Dept. of VA. (2014). PTSD: National Center for PTSD: How Common is PTSD? U.S. Department of Veteran’s Affairs. Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp.

• WebMD. (2014). ADD & ADHD Health Center. WebMD, LLC. Retrieved from http://www.webmd.com/add-adhd/guide/adhd-treatment-care.

Appendix AMental Illness Description Including Signs and

SymptomsTreatments, Services, and Support Agencies

Attention Deficit Hyperactivity Disorder (ADD/ADHD)

•behavior disorder (KidsHealth, 2014)•symptoms must be present before age 7 and have a negative impact in more than one area of daily life•Combined ADHD

• the most common form of ADHD• impulsivity• inattentiveness• hyperactivity

•Inattentive ADHD• formerly known as ADD• inattentiveness• difficulty concentrating• hyperactivity not a main symptom

•Hyperactive-Impulsive ADHD• characterized by hyperactivity• concentration, focus, and

inattentiveness not a main symptom

(WebMD, 2014)

TreatmentsMedicationsStimulant MedicationsNon-stimulant MedicationsNon-medicinal home treatments and symptom management

Services & Support AgenciesADDA - Attention Deficit Disorder Association www.adda.org with support groups in Raleigh, NC and a list of medical professionals and therapists

CHADD - Children & Adults with ADHD www.chadd.org providing information on support groups, professional services and a virtual chapter of CHADD

Appendix A Mental Illness Description Including Signs and Symptoms Treatments, Services, and

Support Agencies

Post-traumatic Stress Disorder (PTSD)

triggered by experiencing or witnessing a traumatic or terrifying event can begin immediately after the event or years later, through flashbacksIntrusive Memories

recurring memories of the eventreliving the event through flashbacksnightmares

Avoidanceavoiding thinking or remembering the eventavoiding people, places, and things that are a reminder of the event

Negative Changes in Thinking/Moodnegative feelings about self or othersinability to have positive feelingsfeeling emotionally numbhopelessnessmemory problems, blocking out memories

Changes in Emotional Reactionsirritability, anger, aggressive behaviorsguilt or shameself-destructive behaviortrouble concentratingdifficulty sleepingeasily startled or frightenedsuicidal thoughts (Mayo Clinic Staff, 2014)

TreatmentsPsychotherapyCognitive TherapyExposure TherapyMedicationsAntidepressantsAnti-anxiety medicationSleep aids

Services & Support AgenciesU.S. Department of Veteran Affairs www.ptsd.va.gov offering support groups and information on managing and coping with PTSD

ADAA - Anxiety & Depression Association of America www.adaa.org provides information about PTSD

Appendix B: AnorexiaDisorder Description and Warning Signs Interventions and Treatments

Anorexia “Anorexia nervosa is an eating disorder that causes people to obsess about their weight and the food they eat. People with anorexia nervosa attempt to maintain a weight that's far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively” (www.mayoclinic.org).If you're concerned that a loved one may have anorexia, watch for these possible red flags: •Skipping meals •Making excuses for not eating •Eating only a few certain "safe" foods, usually those low in fat and calories •Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing •Cooking elaborate meals for others but refusing to eat •Repeated weighing of themselves •Frequent checking in the mirror for perceived flaws •Complaining about being fat •Not wanting to eat in public (www.mayoclinic.org)

Medical Care: may initially require feeding through a tube that's placed in their nose and goes to the stomach (nasogastric tube).Restoring a Health Weight:A dietitian can offer guidance on a healthy diet, including providing specific meal plans and calorie requirements that will help you meet your weight goals. Psychotherapy: •Individual therapy. This type of therapy can help you deal with the behavior and thoughts that contribute to anorexia. A type of talk therapy called cognitive behavioral therapy (CBT) is commonly used. Therapy may be done in day treatment programs, but in some cases, may be part of treatment in a psychiatric hospital. •Family-based therapy. This therapy begins with the assumption that the person with the eating disorder is no longer capable of making sound decisions regarding his or her health and needs help from the family. An important part of family-based therapy is that the family is involved in making sure that healthy-eating patterns are followed. This type of therapy can help resolve family conflicts and muster support from concerned family members. Family-based therapy can be especially important for children with anorexia who still live at home. •Group therapy. This type of therapy gives you a way to connect to others facing eating disorders. And informal support groups may sometimes be helpful. (www.mayoclinic.org)

Appendix B: Anxiety DisorderDisorder Description and Warning Signs Interventions and Treatments

Anxiety Disorder

Anxiety disorders are characterized by either manifest anxiety or by self-defeating behavior patterns aimed at warding off anxiety.-“Although anxiety can be experienced in a variety of ways, there are three basic patterns. Phobia’s acute stress disorder, and posttraumatic stress disorder involve a fear aroused be an identifiable object or situation” (Alloy, Riskind, & Manos, 2005, p.151).Common symptoms include: Feelings of panic, fear, and uneasinessProblems sleepingCold or sweaty hands and/or feetShortness of breathHeart palpitationsAn inability to be still and calmDry mouthNumbness or tingling in the hands or feetNauseaMuscle tensionDizziness (Retrieved from http://www.webmd.com/anxiety-panic).

-Although the exact treatment approach depends on the type of disorder, one or a combination of the following therapies may be used for most anxiety disorders:-Medication such as antidepressants and antianxiety- Psychotherapy- Cognitive behavioral therapy- Dietary and lifestyle changes- Relaxation therapy

Appendix B: Autism Spectrum Disorders (ASD)Disorder Description and Warning Signs Interventions and Treatments

Autism Spectrum Disorders (ASD)

First introduced in 1943 by Dr. Leo KennerAutism begins to manifest itself within the first few months of a child’s lifeCharacterized by social interaction issues and delayed or deviant communication development (Yale School of Medicine, 2014)There is a range of multiple symptoms, levels of impairment, and skills that make up the Autism Spectrum.“Autism spectrum disorder (ASD) diagnosis is often a two-stage process. The first stage involves general developmental screening during well-child checkups with a pediatrician or an early childhood health care provider. The second stage involves a thorough evaluation by a team of doctors and other health professionals with a wide range of specialties” (National Institute of Mental Health, n.d.).Reliable diagnosis can usually be made by age 2 Signs and symptoms vary from child to childMake little to no eye contactDo not look or listen to people like othersFail to respond when spoken toDo not respond to their own nameDelayed communication developmentEcholalia- repeating words or phrases that they hearHave unusual tone when speaking, if they are verbalTrouble understanding, relating, and reacting to other people’s feelingsMissed social cues

Individualized plans work bestMany nonverbal children respond well to sign languageBest for children to have routinesEarly intervention is keyUsing focused and challenging learning activitiesFamilies should get as much training as possibleMeasuring and recording progress and or lack of progressSocial skills trainingPlay therapyThere a few medications that may help with certain symptoms, but no real medication has been approved for Autism as a wholeUnder IDEA: “free screenings and early intervention services to children from birth to age 3. IDEA also provides special education and related services from ages 3 to 21” (National Institute of Mental Health, n.d.).

Appendix B: Bipolar Affective DisorderDisorder Description and Warning Signs Interventions and Treatments

Bipolar Affective Disorder

“Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks” (National Institute of Mental Health, n.d.a, para 1).The four types of bipolar affective disorder are:Bipolar affective disorder I - at least one episode of mania or at least two mixed episodes with or without depression.Bipolar affective disorder II - one or more episodes of depression followed by a milder, manic episode.Cyclothymia - a milder form of bipolar affective disorder in which symptoms are less severe but longer lasting. It can turn into a full bipolar affective disorder.Rapid cycling bipolar disorder - your mood switches from mania to depression very quickly and then back again, with at least four episodes of either mania or depression within the period of a year (Bupa, 2014).The onset of bipolar disorder is usually in a person's late teens or early adult years, with at least 50% of all cases occurring before the age of 25 (National Institute of Mental Health, n.d.a).Signs and Symptoms of a Manic Episode/Mania: “A long period of feeling "high," or an overly happy or outgoing moodExtreme irritabilityTalking very fast, jumping from one idea to another, having racing thoughtsBeing easily distractedIncreasing activities, such as taking on new projectsBeing overly restlessSleeping little or not being tiredHaving an unrealistic belief in one's abilitiesBehaving impulsively and engaging in pleasurable, high-risk behaviors” (National Institute of Mental Health, n.d.a, para 13).Signs and Symptoms of a Depressive Episode/Depression: “An overly long period of feeling sad or hopelessLoss of interest in activities once enjoyed, including sex.Feeling tired or "slowed down"Having problems concentrating, remembering, and making decisionsBeing restless or irritableChanging eating, sleeping, or other habitsThinking of death or suicide, or attempting suicide” (National Institute of Mental Health, n.d.a, para 13).

Treatment:Bipolar disorder is an illness which can require long-term treatment. Skilled medical management is needed.Different medications are used to treat acute episodes of mania and of depression, and other medications ('mood stabilizers') are used to keep episodes at bay or to augment acute treatments, in other words, a distinction is made between management of acute episodes and maintenance.Psychological therapies, such as counseling and psychotherapy, are unlikely to be effective by themselves, but are valuable in combination with physical therapies .Every person is different - he or she may need medication or combinations of medications that are quite different from somebody else with bipolar disorder.Compliance with medications is important for long term stability.Depending on the nature of the illness and how it is managed, hospitalization can sometimes be required.Treatments should take account the rare possibility of organic or medical causes for bipolar disorder (particularly if the person is 40 or older at the time of their first manic episode).Some psychotropic medications (e.g. antidepressant drugs) can cause mania, as can some steroids or stimulant drugs.Recurring mania is usually due to poor compliance with medication, or the particular medication not working properly.The use of medications during pregnancy is an extremely important issue and needs consultation with an expert (Black Dog Institute, 2014, para 1).Services and Support Agencies:The National Alliance on Mental Illness (NAMI)National Institute of Mental Health, National Institutes of Health (NIMH)Depression and Bipolar Support Alliance (DBSA)Helpguide.orgBlack Dog InstituteInternational Bipolar Foundation (IBPF)

Appendix B: Borderline Personality Disorder Disorder Descriptions and Warning Signs Interventions and Treatments

Borderline Personality Disorder

“Borderline personality disorder (BPD) is a serious mental illness that centers on the inability to manage emotions effectively. The disorder occurs in the context of relationships: sometimes all relationships are affected, sometimes only one… Other disorders, such as depression, anxiety disorders, eating disorders, substance abuse and other personality disorders can often exist along with BPD” (National Education Alliance for Borderline Personality Disorder, 2014, para 1).People with borderline personality disorder often: have difficulty controlling their thoughts and emotions, are impulsive and reckless, and have unstable relationships with other people (National Institute of Mental Health, n.d.b).“Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder” (National Institute of Mental Health, n.d.b, para 9).Signs and Symptoms of Borderline Personality Disorder: To be diagnosed with BPD one must show a long-term pattern of at least five of these symptoms.“Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceivedA pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eatingRecurring suicidal behaviors or threats or self-harming behavior, such as cuttingIntense and highly changeable moods, with each episode lasting from a few hours to a few daysChronic feelings of emptiness and/or boredomInappropriate, intense anger or problems controlling angerHaving stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality” (National Institute of Mental Health, n.d.b, para 8).

Treatment:Unlike some illnesses/disorders where medication is the first treatment explored, talk therapy is usually the first treatment used for BPD (National Education Alliance for Borderline Personality Disorder, 2014).Several treatments have been shown to be effective in the treatment of BPD:Dialectical behavior therapy (DBT) – a problem solving way of treating BPD created specifically for that purpose. It encourages the patient to focus on their current emotion and tries to help them find a balance between accepting and changing their behaviors. It is the most effective treatment for BPD.Cognitive Behavior Therapy (CBT) – helps patients become aware of the way they think and act that may be negative or inaccurate.Mentalization-based therapy (MBT) – helps patients become aware of what others are thinking and feeling.Transference-focused therapy (TFT) – by using the relationship with the therapist as a conduit for understanding, the patient learns about their own emotions and interpersonal problems.Medications – can’t be used to cure BPD, but it can help manage some of the other conditions which are often seen in patients with BPD, such as depression, impulsiveness, and anxiety.Self-care – patients are encouraged to take care of themselves through exercise, diet, and nutrition, as well as proper use of medications in order to manage symptoms of BPD (National Education Alliance for Borderline Personality Disorder, 2014).Services and Support Agencies:National Education Alliance for Borderline Personality Disorder (NEA.BPD)Treatment and Research Advancements National Association for Personality Disorder (TARA)Borderline Personality Disorder Resource CenterMental Health America (MHA)

Appendix B: BulimiaDisorder Description and Warning Signs Interventions and TreatmentsBulimia “Bulimia nervosa is an eating disorder

characterized by frequent episodes of binge eating, followed by frantic efforts to avoid gaining weight. It affects women and men of all ages.” (www.thehelpingguide.org)Warning Signs:*Calluses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting.• Puffy “chipmunk” cheeks caused by repeated vomiting.• Discolored teeth from exposure to stomach acid when throwing up. May look yellow, ragged, or clear.• Not underweight – Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia.• Frequent fluctuations in weight – Weight may fluctuate by 10 pounds or more due to alternating episodes of bingeing and purging. (www.thehelpingguide.org)

Breaking the binge-and-purge cycle: The first phase of bulimia treatment focuses on stopping the vicious cycle of bingeing and purging and restoring normal eating patterns. You learn to monitor your eating habits, avoid situations that trigger binges, cope with stress in ways that don’t involve food, eat regularly to reduce food cravings, and fight the urge to purge.• Changing unhealthy thoughts and patterns: The second phase of bulimia treatment focuses on identifying and changing dysfunctional beliefs about weight, dieting, and body shape. You explore attitudes about eating, and rethink the idea that self-worth is based on weight.• Solving emotional issues: The final phase of bulimia treatment involves targeting emotional issues that caused the eating disorder in the first place. Therapy may focus on relationship issues, underlying anxiety and depression, low self-esteem, and feelings of isolation and loneliness. (www.the helpingguide.org)

Appendix B: Cutting

Disorder Descriptions and Warning Signs Interventions and Treatments

Cutting The most common type of self-harm, deliberately cutting yourself to cope with pain. (Mayo Clinic, 2014) “Cutting isn’t a suicide attempt, though it may look and seem that way. (Jed Foundation, 2014)”Scars from cutsFresh cuts or scratchesKeeping sharp objects on handWearing long sleeves in hot weather(Mayo Clinic, 2014

Individual psychotherapyHospitalization

Appendix B: Dissociative DisordersDisorder Descriptions & Warning Signs Interventions and Treatments

Dissociative Disorders

“They are marked by a dissociation from or interruption of a person's fundamental aspects of waking consciousness (such as one's personal identity, one's personal history, etc.)” (NAMI, 2014). “Thought to stem from trauma experienced by the individual” (NAMI, 2014). “Symptoms of these disorders, or even one or more of the disorders themselves, are also seen in a number of other mental illnesses, including post-traumatic stress disorder, panic disorder, and obsessive compulsive disorder” (NAMI, 2014).

“Treatment for individuals with such a disorder may stress psychotherapy, although a combination of psychopharmacological and psychosocial treatments is often used” (NAMI, 2014).

Appendix B: Dual Diagnosis & Integrated Treatment of Mental Illness & Substance Abuse Disorder

Disorder Description and Warning Signs Interventions and Treatments

Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder

“Dual diagnosis is a term used to describe people with mental illness who also have problems with drugs and/or alcohol” (The National Alliance on Mental Illness, 2013b, p. 1).Dual diagnosis is more common than you might think – “many people with mental illness have ongoing substance abuse problems, and many people who abuse drugs and alcohol also experience mental illness” (The National Alliance on Mental Health, 2013a, para 1).Almost 1/3 of those with all mental illnesses and about 1/2 of those with severe mental illnesses are also substance abusers. Greater than 1/3 of those who abuse alcohol and greater than 1/2 of those who abuse drugs also have a mental illness (The National Alliance on Mental Health, 2013a). A dual diagnosis may present in a variety of combinations of mental illnesses/disorders and addictions (The National Alliance on Mental Health, 2013b).Signs: “Abandoning friends or family in favor of new activities or a new crowdStruggling to keep up with school or workLying or stealing in order to continue an addictive behaviorStaying up late at night and sleeping during the dayTrying to quit using drugs, drinking, gambling or having unsafe sex, but relapsing repeatedlyExpressing feelings of guilt or regret about a compulsive behavior.Seeking out larger doses of drugs, more alcoholic beverages or more extreme high-risk behavior in order to get the same highExperiencing withdrawal symptoms after trying to quit a harmful substance or cutting down the dose” (Foundations Recovery Network, 2014, para 12).Symptoms: “Deliberately withdraws from others, refusing offers of friendship or supportBelieves things that aren’t true (delusions) or has sensory experiences that aren’t shared by others (hallucinations)Expresses feelings of despair, hopelessness or worthlessness for two or more weeks in a rowFeels compelled to follow complicated rituals and maintain high standards of order in order to relieve internal anxietyHas trouble holding a job, keeping an apartment or maintaining friendships because of behavioral issues or mood swingsHas dramatic changes in mood and energy levelsUses drugs, alcohol or compulsive behaviors to manage moods or cope with stress” (Foundations Recovery Network, 2014, para 13).

Treatment:For treatment to be effective, both the mental illness/disorder and the addiction must be considered (Foundations Recovery Network, 2014).Because of the variety of combinations of addictions (alcohol and/or drugs) and mental illnesses/disorders (mood disorder, anxiety disorder, personality disorder, or eating disorder), no single treatment will work for everyone (Foundations Recovery Network, 2014).Psychiatric treatment will be more successful if the patient stops their drug and/or alcohol abuse (The National Alliance on Mental Illness, 2013a). Treatment for drug and/or alcohol abuse can include in-patient detox, self-help groups, cognitive-behavioral therapy, and even medication (The National Alliance on Mental Illness, 2013a).Treatment of the mental illness/disorder will depend on which mental illness/disorder the patient suffers from (Foundations Recovery Network, 2014; The National Alliance on Mental Illness, 2013a).Services and Support Agencies:The National Alliance on Mental Illness (NAMI)Mental Illness, Drug Addiction, and Alcoholism (MIDAA)Foundations Recovery Network (dualdiagnosis.org)Substance Abuse and Mental Health Services Administration (SAMHSA)National Network of Depression Centers (NNDC)

Appendix B: Major & Minor DepressionDisorder Descriptions & Warning Signs Interventions and Treatments

Major & Minor Depression

“Major depression is a mood state that goes well beyond temporarily feeling sad or blue” (NAMI, What is Depression?, 2014).“It is a serious medical illness that affects one’s thoughts, feelings, behavior, mood and physical health” (NAMI, What is Depression?, 2014).“Depression is a life-long condition in which periods of wellness alternate with recurrences of illness” (NAMI, What is Depression?, 2014). Minor depression can include feelings of sadness, loss of interest in activities, changes in weight and sleeping habits, feelings of worthlessness (Mentalheath.gov, 2014). There are many types of depression and they can be minor to major and continue for many years. Types of depression include disorders such as “Atypical, postpartum, bipolar, seasonal and psychotic” (WEBMD, 2014).

“There are three well-established types of treatment: medications, psychotherapy and electroconvulsive therapy (ECT)" (NAMI, What is Depression?, 2014)."A new treatment called transcranial magnetic stimulation (rTMS), has recently been cleared by the FDA for individuals who have not done well on one trial of an antidepressant” (NAMI, What is Depression?, 2014).Treatments that can work well with Major and Minor Depression include Cognitive Behavioral Therapy; Interpersonal Therapy, Psychodynamic Therapy, Psychoeducation and Self-help and support groups (NAMI, What is Depression?, 2014).

Appendix B: Multiple Personality DisorderDisorder Descriptions & Warning Signs Interventions and Treatments

Multiple Personality Disorder

“Is a dissociative disorder involving a disturbance of identity in which two or more separate and distinct personality states (or identities) control an individual's behavior at different times” (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014).“Often people living with DID are depressed or even suicidal and self-mutilation is common in this group" (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014)."Approximately one-third of individuals affected complain of auditory or visual hallucinations” (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014).Problems that personality disorders can cause include “interfering with a person’s life, (they can) create problems at work and school and cause issues in personal and social relationships” (MentalHealth.gov, 2014).

“Treatment for DID consists primarily of psychotherapy with hypnosis” (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014). “The therapist attempts to make contact with as many alters as possible and to understand their roles and functions in an individual’s life” (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014). “The goal of the therapist is to enable the individual to achieve breakdown of the patient's separate identities and their unification into a single identity” (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014)

Appendix B: Obsessive Compulsive Disorder (OCD) Disorder Description and Warning Signs Interventions and Treatments

Obsessive- Compulsive Disorder

“People with OCD generally:Have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; acts of violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly tidyDo the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again. Can't control the unwanted thoughts and behaviors. Don't get pleasure when performing the behaviors or rituals, but get brief relief from the anxiety the thoughts cause. Spend at least 1 hour a day on the thoughts and rituals, which cause distress and get in the way of daily life.” (www.nimh.nih.gov)

OCD is generally treated with psychotherapy, medication, or both “A type of psychotherapy called cognitive behavior therapy is especially useful for treating OCD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively.” (www.nimh.nih.gov)

Appendix B: Panic DisorderDisorder Description and Warning Signs Interventions and Treatments

Panic Disorder •Panic disorder comes along with the unpleasant and sudden episodes of panic attacks. The Mayo clinic defines panic attacks as, “sudden episode of intense fear that triggers severe physical reactions when there is not real danger or apparent cause. It’s the recurring, unexpected panic attacks and spent long periods in constant fear of another attack that lead to the condition of a panic disorder” (Retrieved from www.mayoclinic.org). -Panic attacks begin suddenly, without warning. •-attacks include the following symptoms: sense of doom or danger•- rapid heart rate•- sweating•- trembling•- chills•- chest pain•- faintness•- hyperventilation•- One of the worst parts of panic attacks is the intense fear that you will have another one. Therefore avoiding situations where they may occur. Some people even develop agoraphobia

- Panic attacks require medical attention- They are very difficult to manage on your own.- Panic attacks resemble a heart attack- Psychotherapy and medication are the main treatment options- Cognitive behavioral therapy helps clients understand the attacks and disorder, along with maintaining the symptoms and attacks- Medications reduced the symptoms and any depression that may be associated with the disorder. SSRIs, SNRIs, and Benzodiazepines- It can take up to several weeks before to notice any improvements.

Appendix B: Persuasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)

Disorder Description and Warning Signs Interventions and Treatments

Persuasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)

Neurobehavioral Disorder“PDD refers to the class of conditions to which autism belongs” (Yale School of Medicine, 2014)PDD is not a diagnosis, but PDD-NOS is and is also known as Atypical Personality DisorderAt this time there are no specific guidelines for this diagnosis and with no guidelines research is difficultSymptoms start at later ages than Autism symptomsChildren diagnosed with PDD-NOS have an under-connectivity of electrical activity within and between the hemispheres of the brain.Atypical or inappropriate social behaviorUneven skill development (motor, sensory, visual-spatial organizational, cognitive, social, academic, behavioral)Poorly developed speech and language comprehension skillsDifficulty with transitionsDeficits in nonverbal and/or verbal communicationIncreased or decreased sensitivities to taste, sight, sound, smell and/or touchPerseverative (repetitive or ritualistic) behaviors (i.e., opening and closing doors repeatedly or switching a light on and off)(Brain Balance Achievement Centers, 2014)

Integratephysical, sensory-motor, and cognitive exercises with simple dietary changes to correct the underlying connection issue and reduce or eliminate negative symptoms and behaviors. (Brain Balance Achievement Center, 2014)Tailored plans for each studentPlay therapy and social skills trainingImportant for family to advocate for these children because they are often overlooked.

Appendix B: Schizoaffective DisorderDisorder Description and Warning Signs Interventions and Treatments

Schizoaffective Disorder

“According to the DSM-IV-TR, people who experience more than two weeks of psychotic symptoms in the absence of severe mood disturbances—and then have symptoms of either depression or bipolar disorder—may have schizoaffective disorder. Schizoaffective disorder is thought to be between the bipolar and schizophrenia diagnoses as it has features of both.” (www. nami.org)Depressive symptoms associated with schizoaffective disorder can include: hopelessness, helplessness, guilt, worthlessness, disrupted appetite, disturbed sleep, inability to concentrate, and depressed mood (with or without suicidal thoughts). Manic (bipolar) symptoms associated with schizoaffective disorder can include increased energy, decreased sleep (or decreased need for sleep), distractibility, fast (pressured) speech, and increased impulsive behaviors (sexual activities, drug and alcohol abuse, gambling or spending large amounts of money). (www.Nami.org)

“Treatments such as cognitive behavioral therapy to target psychotic symptoms, supports groups including NAMI’s Family-to-Family to increase family and community support, peer support and connection, and work-and-school rehabilitation, such as social skills training, are very helpful for people with schizoaffective disorder. Maintaining a healthy lifestyle is also of critical importance: the role of good sleep hygiene, regular exercise, and a balanced diet cannot be underestimated.” (www.nami.org)Medications used for depression symptoms:antidepressant medicationslithiumantipsychotic medicationsMedications used for bipolar symptoms:mood-stabilizers such as lithium or anti-convulsants, valproic acid (Depakote), lamotrigine (Lamictal), and carbamazepine (Tegretol) (www.nami.org)

Appendix B: SchizophreniaDisorder Description and Warning Signs Interventions and TreatmentsSchizophrenia “Schizophrenia is a severe brain disorder in which people

interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior. Schizophrenia isn't a split personality or multiple personality. The word "schizophrenia" does mean "split mind," but it refers to a disruption of the usual balance of emotions and thinking. Schizophrenia is a chronic condition, requiring lifelong treatment.” (www.mayoclinic.org) “Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. Signs and symptoms may vary, but they reflect an impaired ability to function.” (www.mayoclinic.org)Signs may include:•Delusions: These are false beliefs that are not based in reality.•Hallucinations: These usually involve seeing or hearing things that don't exist.•Disorganized thinking (speech): Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated.•Extremely disorganized or abnormal motor behavior: This may show in a number of ways, ranging from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to perform tasks. Abnormal motor behavior can include resistance to instructions, inappropriate and bizarre posture, a complete lack of response, or useless and excessive movement.•Negative symptoms. This refers to reduced ability or lack of ability to function normally.Some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:•Withdrawal from friends and family •A drop in performance at school •Trouble sleeping •Irritability or depressed mood •Lack of motivation Compared with schizophrenia symptoms in adults, teens may be:•Less likely to have delusions •More likely to have visual hallucinations (www.mayoclinic.org)

“In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than 45.” (www.mayoclinic.org) “Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.” (www.mayoclinic.org)Medications Typically used:•Aripiprazole (Abilify)•Asenapine (Saphris)•Clozapine (Clozaril)•Iloperidone (Fanapt)•Lurasidone (Latuda)•Olanzapine (Zyprexa)•Paliperidone (Invega)•Quetiapine (Seroquel)•Risperidone (Risperdal)•Ziprasidone (Geodon)•Chlorpromazine•Fluphenazine•Haloperidol (Haldol)•PerphenazinePsychosocial Interventions:“Once psychosis recedes, psychological and social (psychosocial) interventions are important — in addition to continuing on medication. These may include: •Individual therapy. Learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness.•Social skills training. This focuses on improving communication and social interactions.•Family therapy. This provides support and education to families dealing with schizophrenia.•Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find and keep jobs.” (www.mayoclinic.org)

Appendix B: Seasonal Affective DisorderDisorder Description and Warning Signs Interventions and Treatments

Seasonal Affective Disorder

SAD- it’s a specific type of depression that’s related to the change in seasons-Symptoms begin in the fall and usually end when spring begins and the weather warms up- people become lethargic, no energy, moody, melancholy -According to the staff at the Mayo clinic, “Seasonal affective disorder is a subtype of major depression that comes and goes based on seasons, therefore there may be symptoms of major depression that come with SAD” (retrieved from www.mayoclinic.org).-Additional symptoms include: feeling hopeless, problems sleeping, agitated thoughts of suicide, low energy, hypersensitivity, appetite changes (weight gain).-SPRING AND SUMMER SAD- depression, weight loss, insomnia, poor appetite, anxiety

SAD is often treated with light therapy, medication, and psychotherapy. -Light Therapy- aka photo therapy. You literally sit in front of a special light therapy box so that you are exposed to a bright light. This seems to cause a change in brain chemicals that are associated to mood. -Light therapy works best for individuals who have fall/winter SAD. It starts working within days to two weeks and there are few side effects. -Medications- most people benefit from antidepressants-Psychotherapy- aka talk therapy. This includes; identifying and changing negative thoughts, learning healthy ways of dealing with SAD, and managing stressful situations

Appendix B: Self-Injury/Self-HarmDisorder Description and Warning Signs Interventions

and TreatmentsSelf-injury/Self-harm

Self-injury, also called self-harm, is the act of deliberately harming your own body, such as cutting or burning yourself. It's typically not meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger and frustration. (Mayo Clinic, 2014)Scars, such as from burns or cutsFresh cuts, scratches, bruises or other woundsBroken bonesKeeping sharp objects on handWearing long sleeves or long pants, even in hot weatherClaiming to have frequent accidents or mishapsSpending a great deal of time alonePervasive difficulties in interpersonal relationshipsPersistent questions about personal identity, such as "Who am I?" "What am I doing here?"Behavioral and emotional instability, impulsivity and unpredictabilityStatements of helplessness, hopelessness or worthlessness (Mayo Clinic, 2014)Individual psychotherapyMedications for depressionHospitalization

Individual psychotherapyHospitalization

Appendix B: Substance Abuse DisorderDisorder Description and Warning Signs Interventions and Treatment

Substance Abuse Disorder

According to the DSM5, “Each specific sub- stance (other than caffeine, which cannot be diagnosed as a substance use disorder) is addressed as a separate use disorder (e.g., alcohol use disorder, stimulant use disorder, etc.), but nearly all substances are diagnosed based on the same overarching criteria (American Psychiatric Publishing, 2014).Symptoms of substance use disorders may include:Behavioral changesPhysical ChangesSocial Changes(USDHHS, 2014)

Individual psychotherapyHospitalization or rehab institution

Appendix B: Tourette’s SyndromeDisorder Description and Warning Signs Interventions and Treatments

Tourette’s Syndrome

According the Mayo Clinic Staff, “Tourette’s Syndrome is a nervous system disorder that starts in childhood. It involves unusual repetitive movements or unwanted sounds that can’t be controlled” -Signs and symptoms show up between the ages of 2 and 12. - Males are 3 to 4 times more likely than females to develop this syndrome.- The symptoms become more controllable after the teen years.- Symptoms include: simple tics, eye blinking, head jerking, shoulder shrugging, finger flexing, hiccupping, yelling, throat clearing, and barking (yes barking). - These are often involuntary actions.

- There is no cure, you can live a normal life span with Tourette Syndrome. - No medication is helpful to everyone, none completely eliminate symptoms. - Possible helpful medications include: Haldol or Orap. These drugs block the neurotransmitter dopamine in the brain (used to control tics). Then there are botox injections and stimulant medications such as Adderall. - Therapy may include psychotherapy, behavior therapy and deep brain stimulants