psychotropic medications and diagnoses in social services

Psychotropic Medications Psychotropic Medications and Diagnoses in Social and Diagnoses in Social

ServicesServices

Misty Harding, MS, LCMFTMisty Harding, MS, LCMFT

Director Youth ServicesDirector Youth Services

Salvation Army WichitaSalvation Army Wichita

Welcome and IntroductionsWelcome and Introductions

•WelcomeWelcome•HousekeepingHousekeeping• IntroductionsIntroductions• Information is a guideline Information is a guideline

– DO NOT DIAGNOSE UNLESS YOU DO NOT DIAGNOSE UNLESS YOU ARE QUALIFIED AND THE PERSON ARE QUALIFIED AND THE PERSON IS YOUR PATIENTIS YOUR PATIENT

– Updated with DSM-5 informationUpdated with DSM-5 information

THE BRAIN AS A CHEMICAL THE BRAIN AS A CHEMICAL REACTIONREACTION

Brain Chemical ReactionsBrain Chemical Reactions

• NeuronsNeurons

• SynapsesSynapses

• NeurotransmittersNeurotransmitters– SerotoninSerotonin– AdrenalinAdrenalin

• UptakeUptake

• ReuptakeReuptake

NeuronsNeurons

Medication as Chemical Medication as Chemical BalanceBalance• SSRISSRI

– Prozac, Welbutrin, Lexapro, Prozac, Welbutrin, Lexapro, PaxilPaxil

• Anti-psychoticAnti-psychotic– Thorazine, Haldol, Clozaril, Thorazine, Haldol, Clozaril,

RisperdalRisperdal• MAOIMAOI

– MonoAmine OxidaseMonoAmine Oxidase– Mebanazine, Octamoxin, Mebanazine, Octamoxin,

PhenelzinePhenelzine• TriCyclicsTriCyclics

– Imipramine, Loratadine Imipramine, Loratadine (antihistamine)(antihistamine)

• Stimulant/Non-stimulant Stimulant/Non-stimulant (focus)(focus)

• Other (Mood Stabilizers)Other (Mood Stabilizers)– Anti-convulsantAnti-convulsant– Blood pressure stabilizerBlood pressure stabilizer– AntihistamineAntihistamine

DIAGNOSING and TREATING DIAGNOSING and TREATING DYSFUNCTIONDYSFUNCTION

Change from DSM-IV to Change from DSM-IV to DSM-5DSM-5• Multiaxial (DSM-IV)Multiaxial (DSM-IV)

– Axis 1 – clinicalAxis 1 – clinical– Axis 2 – pervasiveAxis 2 – pervasive– Axis 3 – medicalAxis 3 – medical– Axis 4 – psychosocialAxis 4 – psychosocial– Axis 5 - GAFAxis 5 - GAF

• Dimensional (DSM-5)Dimensional (DSM-5)– Sharing of symptomsSharing of symptoms– Risk factorsRisk factors– More NOS categoriesMore NOS categories– GeneticsGenetics– ComorbidityComorbidity– Shared treatment Shared treatment

responseresponse– Organized by:Organized by:

• Internalizing vs externalizingInternalizing vs externalizing• Developmental/lifespan Developmental/lifespan

considerationsconsiderations• Includes culture and gender Includes culture and gender

factorsfactors

Definition of a Mental Definition of a Mental Disorder (Per DSM-5)Disorder (Per DSM-5)• ““A mental disorder is a syndrome characterized by clinically A mental disorder is a syndrome characterized by clinically

significant disturbance in an individual’s cognition, emotion significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental primarily between the individual and society are not mental disorders unless the deviance or conflict results from a disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”dysfunction in the individual, as described above.”

Purpose of a mental Purpose of a mental disorder diagnosisdisorder diagnosis

• Determine prognosisDetermine prognosis

• Steer treatment planningSteer treatment planning

• Direct treatmentDirect treatment

• Diagnosis does NOT always mean the Diagnosis does NOT always mean the client NEEDS treatmentclient NEEDS treatment– Based on level of distress/impairmentBased on level of distress/impairment– 33rdrd party info is highly recommended party info is highly recommended

DiagnosticsDiagnosticsPrincipal DiagnosisPrincipal Diagnosis• Primary for clinical visitPrimary for clinical visit

• Causing the majority of Causing the majority of dysfunctiondysfunction

• Becomes the focus of Becomes the focus of treatmenttreatment

• More validity if based More validity if based upon measures/testing upon measures/testing (evidentiary)(evidentiary)– Some in the DSM-5Some in the DSM-5– Some require further Some require further

trainingtraining– Entire section on Culture Entire section on Culture

assessmentassessment

Provisional Diagnosis (no Provisional Diagnosis (no more Rule Out)more Rule Out)

• PresumptivePresumptive

• Not enough infoNot enough info

• When the diagnosis is When the diagnosis is based upon a specific based upon a specific time frametime frame

MENTAL HEALTH INFORMATIONMENTAL HEALTH INFORMATION

• Best information Best information comes from;comes from;– ClientClient– FamilyFamily– DoctorDoctor– TherapistTherapist– PharmacistPharmacist– PsychiatristPsychiatrist– CounselorCounselor– Case managersCase managers

• Hypochondriasis Hypochondriasis preventionprevention– DysfunctionDysfunction– IssueIssue– Level of Level of

functioningfunctioning

Common Diagnoses in Social Common Diagnoses in Social ServicesServices• DysfunctionDysfunction

– Bipolar DisorderBipolar Disorder– ADHDADHD– DepressionDepression– Psychotic Disorders (Schizophrenia, Delusional)Psychotic Disorders (Schizophrenia, Delusional)– Trauma DisordersTrauma Disorders– Substance/Chemical Abuse**Substance/Chemical Abuse**– Mental Retardation/Developmental Delay**Mental Retardation/Developmental Delay**

• Personality DisordersPersonality Disorders– BorderlineBorderline– AntisocialAntisocial

Bipolar DisorderBipolar Disorder

• Per DSM IVPer DSM IV– ““The essential feature of Bipolar I The essential feature of Bipolar I

disorder is a clinical course that is disorder is a clinical course that is characterized by the occurrence of characterized by the occurrence of one or more Manic Episodes or Mixed one or more Manic Episodes or Mixed Episodes. Often individuals have also Episodes. Often individuals have also had one or more Major Depressive had one or more Major Depressive Episodes.”Episodes.”

Bipolar DisorderBipolar Disorder

• Per DSM-5 “Bipolar and related disorders are Per DSM-5 “Bipolar and related disorders are separated from the depressive disorders in DSM-5 separated from the depressive disorders in DSM-5 and placed between the chapters on schizophrenia and placed between the chapters on schizophrenia spectrum and other psychotic disorders and spectrum and other psychotic disorders and depressive disorders in recognition of their place as a depressive disorders in recognition of their place as a bridge between the two diagnostic classes in terms of bridge between the two diagnostic classes in terms of symptomatology , family history, and genetics.symptomatology , family history, and genetics.

• Adds Disruptive Mood Dysregulation Disorder for Adds Disruptive Mood Dysregulation Disorder for clients under 18 “who exhibit persistent irritability clients under 18 “who exhibit persistent irritability and frequent episodes of extreme behavioral and frequent episodes of extreme behavioral dyscontrol.”dyscontrol.”

Bipolar DisorderBipolar Disorder• Possible BehaviorPossible Behavior

– Manic behaviorManic behavior• EuphoricEuphoric• Indiscriminate enthusiasm for sexual/interpersonal Indiscriminate enthusiasm for sexual/interpersonal

relationshipsrelationships• Inflated self-esteemInflated self-esteem• Alternating mood between euphoria and irritability Alternating mood between euphoria and irritability

(complaining/hostile)(complaining/hostile)• Decreased need for sleepDecreased need for sleep• Speech is loud, rapid, difficult to understand (thoughts Speech is loud, rapid, difficult to understand (thoughts

move faster than the mouth)move faster than the mouth)• CompulsiveCompulsive• Poor judgmentPoor judgment

– DepressionDepression– Anxious distressAnxious distress– Significant impairment in occupation, relationships Significant impairment in occupation, relationships

and/or activities/energyand/or activities/energy

Bipolar DisorderBipolar Disorder• Common medications with side effectsCommon medications with side effects

– Depakote (anticonvulsant)Depakote (anticonvulsant)•Shaking, nausea, drowsiness, headacheShaking, nausea, drowsiness, headache

– Lamictal (anticonvulsant)Lamictal (anticonvulsant)•Dizzy, drowsy, fatigueDizzy, drowsy, fatigue

– Lithium (salt)Lithium (salt)•Tremors, thirst, diarrhea, vomitingTremors, thirst, diarrhea, vomiting

– Geodon (antipsychotic)Geodon (antipsychotic)•Blurred vision, dry mouth, weight gainBlurred vision, dry mouth, weight gain

– Anti depressants?Anti depressants?•Takes away depressionTakes away depression•Leaves maniaLeaves mania

ADD/ADHDADD/ADHD

• Per DSM-IVPer DSM-IV– ““The essential feature of The essential feature of

Attention-Deficit/Hyperactivity Disorder is a Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or persistent pattern of inattention and/or hyperactivity-impulsivity that is more hyperactivity-impulsivity that is more frequent and severe than is typically frequent and severe than is typically observed in individuals at a comparable level observed in individuals at a comparable level of development… There must be clear of development… There must be clear evidence of interference with evidence of interference with developmentally appropriate social, developmentally appropriate social, academic, or occupational functioning.”academic, or occupational functioning.”

ADHDADHD

• Per DSM-5 “The essential feature of Per DSM-5 “The essential feature of attention-deficit/hyperactivity attention-deficit/hyperactivity disorder (ADHD) is a persistent disorder (ADHD) is a persistent pattern of inattention and/or pattern of inattention and/or hyperactivity that interferes with hyperactivity that interferes with functioning, or development.”functioning, or development.”

ADD/ADHDADD/ADHD

• Possible BehaviorPossible Behavior– Careless mistakes, lack attention to detailCareless mistakes, lack attention to detail– Move from one task to another quickly, without Move from one task to another quickly, without

finishingfinishing– DisorganizedDisorganized– Fidgetiness, squirming, running, climbingFidgetiness, squirming, running, climbing– Difficulty with leisureDifficulty with leisure– ImpatientImpatient– Marked impairment in two settings; home, Marked impairment in two settings; home,

work, schoolwork, school

ADD/ADHDADD/ADHD

• Common medications with side Common medications with side effectseffects– StimulantsStimulants

•Adderall, Concerta, FocalinAdderall, Concerta, Focalin

•Weight loss, sleep problems, jitteryWeight loss, sleep problems, jittery

– Non-stimulantsNon-stimulants•Straterra, Intuniv, Kapvay (new)Straterra, Intuniv, Kapvay (new)

•Nausea, vomiting, constipation, headacheNausea, vomiting, constipation, headache

DepressionDepression

• Per DSM-IVPer DSM-IV– ““The essential feature of Major Depressive The essential feature of Major Depressive

Disorder is a clinical course that is characterized Disorder is a clinical course that is characterized by one or more Major Depressive Episodes by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypo-without a history of Manic, Mixed, or Hypo-manic Episodes.” “The essential feature of a manic Episodes.” “The essential feature of a Major Depressive Episode is a period of at least Major Depressive Episode is a period of at least 2 weeks during which there is either depressed 2 weeks during which there is either depressed mood or the loss of interest or pleasure in mood or the loss of interest or pleasure in nearly all activities.”nearly all activities.”

Major Depressive DisorderMajor Depressive Disorder

• Per DSM-5 “Unlike in DSM-IV, this chapter Per DSM-5 “Unlike in DSM-IV, this chapter ‘Depressive Disorders’ has been separated ‘Depressive Disorders’ has been separated from the previous chapter ‘Bipolar and from the previous chapter ‘Bipolar and Related Disorders.’ The common feature of Related Disorders.’ The common feature of all of these disorders is the presence of sad, all of these disorders is the presence of sad, empty, or irritable mood, accompanied by empty, or irritable mood, accompanied by somatic and cognitive changes that somatic and cognitive changes that significantly affect the individual’s capacity to significantly affect the individual’s capacity to function. What differs among them are issues function. What differs among them are issues of duration, timing, or presumed etiology.”of duration, timing, or presumed etiology.”


• Possible BehaviorPossible Behavior– IrritabilityIrritability– Changes in appetite or weightChanges in appetite or weight– Changes in sleep patternsChanges in sleep patterns– Loss of energy/fatigueLoss of energy/fatigue– Feelings of guilt, worthlessness, and/or having Feelings of guilt, worthlessness, and/or having

“no” feelings“no” feelings– Recurrent thoughts of death or suicidal Recurrent thoughts of death or suicidal

thoughts/plans and/or attemptsthoughts/plans and/or attempts– AnxiousAnxious– Body aches/painsBody aches/pains– Loss of pleasure in previously pleasurable Loss of pleasure in previously pleasurable

activitiesactivities


• Common medications with side effects Common medications with side effects

• SSRISSRI– Prozac, Welbutrin, Lexapro, PaxilProzac, Welbutrin, Lexapro, Paxil– Non addictive but cannot be stopped Non addictive but cannot be stopped

abruptly, weight change, decline in sexual abruptly, weight change, decline in sexual functionfunction

• Anti-psychoticAnti-psychotic– Thorazine, Haldol, Clozaril, RisperdalThorazine, Haldol, Clozaril, Risperdal– Weight gain, high cholesterol, increased Weight gain, high cholesterol, increased

risk of diabetesrisk of diabetes

Psychotic DisordersPsychotic Disorders

• Per DSM-IVPer DSM-IV– These disorders “are all characterized by having These disorders “are all characterized by having

psychotic symptoms as the defining feature…The psychotic symptoms as the defining feature…The term term psychoticpsychotic has historically received a number has historically received a number of different definitions, none of which has of different definitions, none of which has achieved universal acceptance. The narrowest achieved universal acceptance. The narrowest definition of definition of psychoticpsychotic is restricted to delusions or is restricted to delusions or prominent hallucinations, with the hallucinations prominent hallucinations, with the hallucinations occurring in the absence of insight into their occurring in the absence of insight into their pathological nature…Finally the term has been pathological nature…Finally the term has been defined conceptually as a loss of ego boundaries defined conceptually as a loss of ego boundaries or a gross impairment in reality testing.”or a gross impairment in reality testing.”


• Per DSM – 5 Key Features that Define Per DSM – 5 Key Features that Define the Psychotic Disordersthe Psychotic Disorders– DelusionsDelusions– HallucinationsHallucinations– Disorganized thinking (speech)Disorganized thinking (speech)– Grossly disorganized or abnormal motor Grossly disorganized or abnormal motor

behaviorbehavior– Negative symptomsNegative symptoms

Psychotic DisordersPsychotic Disorders• DisordersDisorders

– Schizophrenia – more than 6 monthsSchizophrenia – more than 6 months• ParanoidParanoid• DisorganizedDisorganized• CatatonicCatatonic• Undifferentiated (not paranoid, disorganized, or Undifferentiated (not paranoid, disorganized, or

catatonic)catatonic)• Residual (not meeting all criteria – mostly flat) Residual (not meeting all criteria – mostly flat)

– Schizophreniform – 1 to 6 monthsSchizophreniform – 1 to 6 months– Schizoaffective – Depression and/or mania with Schizoaffective – Depression and/or mania with

schizophreniaschizophrenia– Delusional Disorder – nonbizarre delusion for at Delusional Disorder – nonbizarre delusion for at

least 1 monthleast 1 month– Brief psychotic Disorder – “nervous break Brief psychotic Disorder – “nervous break

down” with return to normaldown” with return to normal– Folie a Deux – shared delusion/psychotic Folie a Deux – shared delusion/psychotic

disorderdisorder


• Possible BehaviorsPossible Behaviors– Smiling/laughing/silly faces without appropriate Smiling/laughing/silly faces without appropriate

stimulistimuli– Loss of all interest/pleasureLoss of all interest/pleasure– Delusional beliefsDelusional beliefs– Pacing/rocking or immobilityPacing/rocking or immobility– Confusion/DisorientationConfusion/Disorientation– Loss of realityLoss of reality– Differing realityDiffering reality– Ritualistic/odd mannerismsRitualistic/odd mannerisms– 10% successfully commit suicide10% successfully commit suicide– Common for use of substances esp: nicotineCommon for use of substances esp: nicotine


• Common medications and side effectsCommon medications and side effects– Neuroleptics “take the neuron”Neuroleptics “take the neuron”

•Thorazine, Haldol, Prolixine, NavaneThorazine, Haldol, Prolixine, Navane

•Tremors, involuntary movements, muscle Tremors, involuntary movements, muscle rigidity, spasmsrigidity, spasms

– Atypical antipsychoticsAtypical antipsychotics•Clozaril – decrease in white blood cellsClozaril – decrease in white blood cells

•Abilify, Geodon, Risperdal – weight gain, Abilify, Geodon, Risperdal – weight gain, increased blood sugar and cholesterol increased blood sugar and cholesterol

Trauma DisordersTrauma Disorders

• Neuropsychosocial DevelopmentNeuropsychosocial Development– The more a brain system is used, the more it changes and The more a brain system is used, the more it changes and

morphs to reflect how it’s activated morphs to reflect how it’s activated (development/memory/learning)(development/memory/learning)

– From the moment of first trauma, neurodevelopment is impactedFrom the moment of first trauma, neurodevelopment is impacted

• New experience ALWAYS filtered through old experience for New experience ALWAYS filtered through old experience for context and understandingcontext and understanding

– Ability to bond and show empathy is directly related to early life Ability to bond and show empathy is directly related to early life relationshipsrelationships

– Trauma creates stimulitic arousal (heart rate, brain stimulus, Trauma creates stimulitic arousal (heart rate, brain stimulus, breathing)breathing)

– High arousal creates dissociation (check out)High arousal creates dissociation (check out)– Effects all levels of development including intelligence, mental Effects all levels of development including intelligence, mental

health, and physical growth health, and physical growth – **NMT slide*****NMT slide***


• Per DSM-5 “Trauma and Per DSM-5 “Trauma and stressor-related stressor-related disorders include disorders include disorders in which disorders in which exposure to a traumatic exposure to a traumatic or stressful event is or stressful event is listed explicityly as a listed explicityly as a diagnostic criterion…diagnostic criterion…close relationship close relationship between these between these diagnoses and diagnoses and disorders…anxiety disorders…anxiety disorders, obsessive-disorders, obsessive-compulsive…and compulsive…and dissociative disorders”dissociative disorders”

• DiagnosesDiagnoses– Reactive Attachment Reactive Attachment

Disorder (withdraw)Disorder (withdraw)– Disinhibited Social Disinhibited Social

Engagement DisorderEngagement Disorder– Posttraumatic Stress Posttraumatic Stress

DisorderDisorder– Acute Stress DisorderAcute Stress Disorder– Adjustment DisorderAdjustment Disorder– Other Specified Trauma-Other Specified Trauma-

and Stressor-Related and Stressor-Related DisorderDisorder

– Unspecified Trauma-and Unspecified Trauma-and Stressor-Related Stressor-Related DisorderDisorder


• Possible BehaviorsPossible Behaviors– AnxietyAnxiety– FearFear– Feeling “numb”Feeling “numb”– Dysphoria Dysphoria – AngerAnger– AggressionAggression– DissociationDissociation– FlashbacksFlashbacks

• MedicationMedication– Only two approved Only two approved

for treatment of for treatment of PTSDPTSD• Paxil Paxil

• ZoloftZoloft

– Other(s) may be Other(s) may be used to treat used to treat accompanying accompanying symptomssymptoms• Sleeping medsSleeping meds

• AntipsychoticsAntipsychotics

• Other antidepressantsOther antidepressants

Personality DisorderPersonality Disorder

• Per DSM-IVPer DSM-IV– ““A Personality Disorder is an enduring pattern of A Personality Disorder is an enduring pattern of

inner experience and behavior that deviates inner experience and behavior that deviates markedly from the expectations of the individual’s markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over in adolescence or early adulthood, is stable over time, and leads to distress or impairment.”time, and leads to distress or impairment.”


• Per DSM – 5 – Alternative approach Per DSM – 5 – Alternative approach to diagnosing – Section III – Page 761to diagnosing – Section III – Page 761– General criteria for Personality DisorderGeneral criteria for Personality Disorder

• Impairment in personality functioningImpairment in personality functioning

• One or more pathological personality traitsOne or more pathological personality traits

• Personality impairments are relatively inflexible and Personality impairments are relatively inflexible and pervasive pervasive

• Impairments are stable and traced back to Impairments are stable and traced back to adolescence or young adult hoodadolescence or young adult hood

• Not better explained by another mental disorderNot better explained by another mental disorder

• Not attributed to a substance or medical conditionNot attributed to a substance or medical condition

• Not normal for development or sociocultural Not normal for development or sociocultural environment environment

Personality DisorderPersonality Disorder• Possible BehaviorsPossible Behaviors

– Borderline Personality Disorder – “is a pattern of instability in Borderline Personality Disorder – “is a pattern of instability in interpersonal relationships, self-image, and affects, and marked interpersonal relationships, self-image, and affects, and marked impulsivity.”impulsivity.”• Avoids real or perceived abandonmentAvoids real or perceived abandonment• Unstable relationships (push/pull)Unstable relationships (push/pull)• Unstable self-imageUnstable self-image• Suicidal/self-harmSuicidal/self-harm• Intense moods and anger problemsIntense moods and anger problems• Paranoid and/or dissociativeParanoid and/or dissociative

– Antisocial Personality Disorder – “is a pattern of disregard for, Antisocial Personality Disorder – “is a pattern of disregard for, and violation of, the rights of others.” Commonly referred to as and violation of, the rights of others.” Commonly referred to as “psychopath,” or “sociopath.”“psychopath,” or “sociopath.”• Deceitful, manipulativeDeceitful, manipulative• Impulsive, failure to planImpulsive, failure to plan• Irritable/aggressiveIrritable/aggressive• Reckless disregard of safety for self and othersReckless disregard of safety for self and others• IrresponsibleIrresponsible• Lacks remorseLacks remorse• Prior to age 18,may have diagnosis of ODD, Conduct DO or Disruptive Prior to age 18,may have diagnosis of ODD, Conduct DO or Disruptive

DODO


• Common medication and side effectsCommon medication and side effects– Borderline Borderline

•Anti depressantsAnti depressants•Mood stabilizersMood stabilizers•Anti psychoticsAnti psychotics

– AntisocialAntisocial•Rarely seek treatmentRarely seek treatment•Lack insight and motivationLack insight and motivation•Anger and high frustrationAnger and high frustration

Suicide Risk is HIGH in Suicide Risk is HIGH in Social ServicesSocial Services• ““Suicidal behavior is seen in the context of a Suicidal behavior is seen in the context of a

variety of mental disorders, most commonly variety of mental disorders, most commonly bipolar disorder, major depressive disorder, bipolar disorder, major depressive disorder, schizophrenia, schizoaffective disorder, schizophrenia, schizoaffective disorder, anxiety disorders…substance use disorders…anxiety disorders…substance use disorders…borderline personality disorder, antisocial borderline personality disorder, antisocial personality disorder, eating disorders, and personality disorder, eating disorders, and adjustment disorders. It is rarely manifested adjustment disorders. It is rarely manifested by individuals with no discernible by individuals with no discernible pathology…”pathology…”

• Chaos and disruption are common in SS and Chaos and disruption are common in SS and exacerbate feelings of hopelessnessexacerbate feelings of hopelessness

Suicidal IdeationSuicidal IdeationIdeationIdeation• Thoughts• How to kill oneself• Most do not attempt

when having these thoughts

• Some may make suicide attempts– Some deliberately

planned to fail or be discovered

– Some carefully planned to succeed

– According to a Finnish study, over one fifth of people who actually died by suicide had discussed their aim with a doctor or other health care professional during their last session

Self-harmSelf-harm

• Repeated self inflicted Repeated self inflicted injuryinjury

• Shallow but painfulShallow but painful

• Surface injurySurface injury

• With purposeWith purpose– Reduce tensionReduce tension– Reduce anxietyReduce anxiety– Self punishmentSelf punishment– Resolve interpersonal Resolve interpersonal

conflictconflict– Immediate sense of reliefImmediate sense of relief– Addictive qualitiesAddictive qualities– NOT A SUICIDE ATTEMPT NOT A SUICIDE ATTEMPT

NOR EVIDENCE OF NOR EVIDENCE OF SUICIDAL IDEATIONSUICIDAL IDEATION

INFORMATION IS A WEAPON INFORMATION IS A WEAPON OR A TOOL?OR A TOOL?

• KnowledgeKnowledge

• NOT for diagnosing (unless NOT for diagnosing (unless qualified to do so)qualified to do so)

• NOT for providing psychotherapy NOT for providing psychotherapy (unless qualified to do so)(unless qualified to do so)

• NOT for medication managementNOT for medication management

• Best tool is referring and Best tool is referring and communicationcommunication

• Do not take mental illness Do not take mental illness lightlylightly

• **Cultural diversity and **Cultural diversity and faith/mental illnessfaith/mental illness

Questions?Questions?

• Misty A. Harding, MS, LCMFT

• Director of Youth Services; Residential and Foster Care

• Wichita City Command/Koch Center

• 350 N. Market

• Wichita, KS 67202

• 316-263-2769 x 181

• [email protected][email protected]

psychotropic medications and diagnoses in social services

Documents

mental disorders

gafdimensional dsm

mental functioning

multiaxial dsmivaxis

chemical balancessriprozac

social servicesmisty

clinical visitcausing

clinical course