Clinical Aspects of

Mental Health,

Developmental

Disabilities,

Addictive Diseases

& Co-Occurring

Disorders

Welcome New Employees

After this presentation, you will be

able to: Understand the term

Serious and Persistent

Mental Illness (SPMI).

Discuss psychotic and

chronic, Anxiety

and/or Mood Disorders

that are associated

with SPMI.

Understand the

differences between

Developmental

Disabilities and SPMI.

Identify signs and

symptoms of

Schizophrenia and

Bipolar Disorder.

Discuss Addictive

Diseases and

identify the signs

and symptoms of

substance abuse

and dependence.

Serious and Persistent Mental Illness

(SPMI) Overview and Definition SPMI is defined as chronic mental illness which interferes with

a individual’s daily functioning.

Individuals with SPMI have a wide range of needs, such as developing the ability to live independently; obtaining and maintaining employment or other meaningful activities; improving the quality of their family and social relationships; and managing moods and other psychiatric symptoms.

Many of these individuals also have substance abuse problems and some have also been diagnosed with personality disorders, in particular, borderline personality disorder.

Many individuals with SPMI are indigent or have limited financial resources, and often will not have health benefits.

Wellness Management and

Recovery Planning

All individuals should be treated with respect and dignity. This means treating our clients the way that we would like to be treated when receiving any type of professional service.

Treatment and services should be Person Centered- meaning client-centered and client-directed. Our approach is focused on the client’s needs and the client is in charge.

Treatment goals are recovery focused. This means helping the client identify and achieve personal goals.

“Mental health recovery is a

journey of healing and

transformation enabling a person

with a mental health problem to

live a meaningful life in a

community of his or her choice

while striving to achieve his or her

full potential.”

The Fundamental

Components of Recovery 1. Self-Direction: individual directs their own path of recovery

2. Individualized and Person-Centered: path to recovery directed by individual’s strengths, needs, preferences, experiences.

3. Empowerment: Individuals have the authority to speak for themselves and participate in all decision making that will affect their lives.

4. Holistic: recovery encompasses all aspects of an individual’s life: mind, body, and spirit.

5. Non-Linear: not a step by step process, but one based on growth, set backs, and learning experiences.

6. Strengths-Based: focuses on valuing and building on the multiple capacities, resiliencies ,talents, coping abilities and inherent worth of individuals.

The Fundamental

Components of Recovery

7. Peer Support: Mutual support—including the sharing of experiential knowledge and skills and social learning—plays important role in recovery

8. Respect: Community, systems, and societal acceptance and appreciation of clients—including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery.

9. Responsibility: Individuals have a personal responsibility for their own self-care and journeys of recovery.

10. Hope: Recovery provides the essential and motivating message of a better future—that people can and do overcome the barriers and obstacles that confront them.

#11 Resiliency - the ability to “bounce back” after difficult experiences; everyone has the ability to develop resiliencyS

Individuals receiving services are considered to be full

partners in the process of recovery from serious

mental illness.

In client-centered services, the

services are based on decisions

made with the client and always in

the client’s best interest.

In client-directed services, the

services are based on decisions

made and goals set by the

individual receiving the services

The person receiving services

decides which issues will be

addressed by mental health

services. The person sets the goals

(outcomes) toward which the team

is working.

Although the treatment team

may develop a treatment plan

that includes reducing

symptoms, and managing the

client’s mental illness and its

effect on his or her life, these are

not the main goals of the

plan…only a way to achieve the

real goals, which are the client’s

goals.

It's not what we think is best for

the client, but what the client

wants for himself/herself.

Treatment Team Services are delivered through teams of individuals with different clinical and rehabilitation strengths and interests.

Each team usually consists of:

The client

Case managers

Psychiatrists

Other mental health professionals (psychologists, therapists, social workers)

Other medical professionals (e.g., nurses, pharmacologists)

Treatment Services Medication Services The use of medication is very

often needed for clients with SPMI.

Effective treatment requires contact and coordination with medical services providers.

The primary medical care provider should also be informed and involved in the ongoing treatment of clients. This helps the client get and stay healthy. When primary care and psychiatric providers communicate, this avoids the prescribing of medications that do not work well together or might even harm the client.

Psychotherapy

Individual, group, and family support/education

models are all useful

interventions for adults with

serious mental illness.

Getting family members

involved when appropriate can be an important part

of providing support and

care for a client,

particularly if the client is in crisis.

Treatment Services

Research has demonstrated that clients with supportive,

involved families have fewer

psychiatric hospitalizations.

Case managers need to remember that a model of

family support and

education about the effects

of mental illness and the recovery process is an

effective tool in working

with clients.

Individual and group treatment can be helpful

when provided at the

client’s level of functioning

and phase of recovery.

Clients who are low

functioning often need

structured, low-demand

group treatment that

provides support, reality

orientation, and

activities/recreation.

Treatment Services Social skills training is valuable. Individual work

should fit the client’s level of functioning.

This might mean, for example, 20-minute sessions,

or perhaps a longer session when it is needed by

the client to work on a particular problem.

Psychotherapy is generally best used with clients

who can accept and benefit from talk therapy.

This approach requires clients to understand how

their thoughts, feelings and behaviors affect their

ability to get their needs met.

Crisis The focus is on crisis prevention rather than crisis response!

Crisis prevention is achieved through:

Assessments that look at the whole person and how he or she is

functioning in all aspects of life. Understanding early warning signs

and triggers for crisis should be part of the assessment process.

Services and contacts with clients should be on flexible schedules

or as the need for assistance arises. Walk-in or drop-in

appointments and phone lines should be available to a client who

may be entering a crisis phase.

Frequent contact with all individuals receiving services.

Tracking and supervision that identifies individuals at risk for crisis

(no-shows, anniversaries, etc.).

Adequate continuum of care.

Diagnoses It is important to rule out other causes, as sometimes

people suffer severe mental symptoms or even

psychosis due to undetected, underlying medical

conditions or substance abuse.

For this reason, a medical history should be taken and a physical

examination and laboratory tests should be done to rule out other

possible causes of the symptoms before concluding that a person

has a particular disorder.

Additionally, since commonly abused drugs may cause symptoms

that look like a mental health disorder, blood or urine samples

from the person can be tested for the presence of these drugs.

Many times, one disorder may have similar symptoms to another

disorder.

Conducting a complete psychosocial history and assessment are

also critical steps in making an accurate diagnosis.

Diagnostic Statistical

Manual of Mental Disorders The American

Psychiatric

Association

developed this

manual as a

standard reference

that classifies mental

disorders.

DSM 5 (5th edition) was

published in 2014.

Key changes and structural

updates are included in the

latest revision to align with

World Health Organization’s International Classification of

Diseases (ICD)

DSM-5 (American Psychiatric Association, 2013)

Schizophrenia Spectrum &

Other Psychotic Disorders

Key features: delusions

hallucinations grossly disorganized behavior and/or

speech

catatonic behavior negative symptoms (reduced emotional

expression, social withdrawal, lack of motivation, lack of feeling pleasure, reduced personal self care)

Bipolar & Related Disorders

Manic Episode (3 or more of these symptoms lasting at least a week)

Elevated mood

Inflated self-esteem

Pressured speech

Flight of ideas/racing thoughts

Distractibility

Increased goal directed activity

Expansiveness

Decreased need for sleep

Excessive involvement in risky activities

Major Depressive Episode (5 or more symptoms present during the same 2-week period)

Depressed mood

Diminished interest or pleasure in activities

Weight loss/gain or decreased appetite daily

Insomnia or hypersomnia

Psychomotor agitation

Fatigue or loss of energy

Feelings of worthlessness or excessive/inappropriate guilt

Diminished ability to think or concentrate

Recurrent thoughts of death, suicidal ideation or suicidal attempt/plan.

Depressive Disorders

Major Depressive Disorder (5 or

more symptoms present during the same 2-

week period)

Depressed mood

Diminished interest or pleasure in

activities

Weight loss/gain or decreased

appetite daily

Insomnia or hypersomnia

Psychomotor agitation

Fatigue or loss of energy

Feelings of worthlessness or

excessive/inappropriate guilt

Diminished ability to think or

concentrate

Recurrent thoughts of death, suicidal

ideation or suicidal attempt/plan.

Persistent Depressive

Disorder (Dysthymia) depressed mood present for at least 2 years + 2 or more of the following)

Poor appetite or overeating

Insomnia or hypersomnia

Low energy or fatigue

Low self esteem

Poor concentration

Feelings of hopelessness

*During this 2 year period, no more

than 2 months at a time- without symptoms

Anxiety Disorders

Panic Disorder Must have had unexpected and recurrent Panic Attacks along with at least one of the following:

Persistent concerns of having more Panic Attacks.

Concerns about the meaning or consequences of the Panic Attacks. ( E.g., lose of control, feelings of going "crazy", or of having a heart attack )

Significant behavioral changes related from the Panic Attacks.

Generalized Anxiety Disorder Excessive anxiety and worry occurring more days than not for at least 6 months + at least 3 or more of the following

Restlessness or feeling on edge

Easily fatigued

Difficulty concentrating

Irritability

Muscle tension

Sleep disturbance

Trauma and Stressor-Related

Disorders

Posttraumatic Stress Disorder

Psychological distress that develops after exposure to a traumatic event or experience.

Adjustment Disorder

Development of emotional or behavioral symptoms in response to an identifiable stressor.

Substance Use Disorders When an alcohol or drug user can't stop using alcohol or

drugs even if he or she wants to, the person may have a

substance use disorder. The urge is too strong to control,

even if the person knows the drug is causing harm.

When people start taking drugs and alcohol, they don't plan to get addicted. However, drugs and alcohol change

the brain. People start to need the drug just to feel normal.

It can quickly take over a person's life.

The urge or need to use drugs or alcohol can become more

important than the need to eat or sleep. The urge to get

and use the substance can fill every moment of a person's

life. The addiction replaces all the things the person used to enjoy. Addiction is a brain disease.

Substance Use Disorders

Drugs and alcohol change how the brain works.

These brain changes can last for a long time.

They can cause problems like mood swings,

memory loss, even trouble thinking and making

decisions.

Addiction is a disease, just as diabetes and

cancer are diseases. Addiction is not simply a

weakness. People from all backgrounds, rich or

poor, can get an addiction. Addiction can

happen at any age. National Institute on Drug Abuse

Symptoms of Substance Use Disorders Substance is often taken in larger amounts or over a longer period

than was intended.

There is a persistent desire or unsuccessful efforts to cut down or

control substance use.

A great deal of time is spent in activities necessary to obtain

substance, use substance, or recover from its effects.

Craving, or a strong desire or urge to use the substance.

Recurrent substance use resulting in a failure to fulfill major role

obligations at work, school, or home.

Continued substance use despite having persistent or recurrent social

or interpersonal problems caused or exacerbated by the effects of

the substance. DSM-5 (American Psychiatric Association)

More Symptoms of Substance Use

Disorders Important social, occupational, or recreational activities are given up

or reduced because of substance use.

Recurrent substance use in situations in which it is physically

hazardous.

Substance use is continued despite knowledge of having a persistent

or recurrent physical or psychological problem that is likely to have

been caused by or exacerbated by substance.

Tolerance (A need for increased amounts of the substance to

achieve intoxication or desired effect or markedly diminished effect

with continued use of the same amount of substance)

Withdrawal

Mild: presence of 2-3 symptoms

Moderate: presence of 4-5 symptoms

Severe: presence of 6 or more symptoms

DSM-5 (American Psychiatric Association)

Co-Occurring Disorders When two disorders or illnesses occur in the same

person, simultaneously or one after another, they

are called co-occurring.

This also implies interactions between the illnesses

that affect the course and prognosis of both.

In particular, many people addicted to drugs or

alcohol are also diagnosed with other mental

disorders and all illnesses must be treated.

Although substance abuse disorders often occur

along with other mental illnesses, this does not

mean that one causes the other, even when one

comes first. National Institute on Drug

Abuse

Co-Occurring Disorders Co-occurring disorders can present in a variety of ways.

Primary substance use

disorder (with

secondary mental

health disorder)

Primary mental health

disorder (with

secondary substance

use disorder)

Primary dual disorder

(person has both a

mental health and a

substance use disorder,

and they are both

primary)

Disorders commonly associated with

Child & Adolescent Conduct Disorder

aggressive conduct that causes or threatens physical harm to other people or animals

non- aggressive conduct that causes property loss or damage

deceitfulness or theft

serious violations of rules

Oppositional Defiant Disorder loses temper

argues with adults

actively defies or refuses to comply with adults' requests or rules

deliberately annoys people

blames others for his or her mistakes or misbehavior

touchy or easily annoyed by others

angry and resentful

spiteful or vindictive

Reactive Attachment Disorder

Pattern of inhibited, emotionally withdrawn behavior toward adult caregivers due to absent or grossly underdeveloped attachment between child and caregiver.

Neurodevelopmental Disorders Group of conditions with onset in the developmental period.

Disorders in this classification typically recognized early in

development before a child enters grade school, and is

characterized by impairments of personal, social,

academic or occupational functioning.

The range of developmental deficits vary from specific

limitations of learning or control of executive functions to

global impairments of social skills or intelligence.

DSM-5 (American Psychiatric Association, 2013)

Neurodevelopmental Disorders Intellectual Disability is characterized by deficits in general mental abilities such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning and learning from experience.

Previously identified by IQ score > now based on based adaptive functioning which determines the level of support needed.

Specifiers range from:

Mild

Moderate

Severe

Profound

DSM-5 (American Psychiatric Association, 2013)

Autism spectrum Characterized by persistent

deficits in social communication and interaction across multiple contexts. In addition to restricted, repetitive patterns of behavior, interests or activities.

Communication Disorders Includes language, speech sound

disorder, social communication and childhood-onset fluency disorders (stuttering)

ADHD Impairing levels of inattention

(unable to stay on task, seeming to not listen), disorganization (losing materials), and/or hyperactivity-impulsivity (overactive, fidgeting, inability to wait) at levels that are inconsistent with age or developmental level.

Questions?