Mental Health Disorders 101

Transcription

1 Mental Health Disorders 101

2 Mehvash Ali Clinical Psychologist Advising Administrator Disability Coordinator Let`s start!

3 NAMI Statistics College Students with Mental Disorders

4 My Counseling Center Experience U. Of Washington U. Of Michigan Ohio State U Southern Illinois Seattle U

5 Stats College Mental Health National Alliance onmental Illness Anxiety and Depression are top concerns 40% don t seek support Center for Collegiate Mental Health 33.2% considered suicide 26% of those who sought help had hurt themselves intentionally American College Health Association 18% prevalence for depression 13% prevalence for anxiety 10% seriously considered suicide Centers for Disease Control and Prevention Suicide is 10 th leading cause of death 2011 World Health Organization 20.3% had mental disorders 16.4% received treatment Emory University 1000 deaths by suicide in American Colleges every year

6 1 Mental Disorders in College DSM 2 3 Role Boundaries and Referrals Common Dx 4

7 Disorder Classification System DSM Diagnostic and Statistical Manual of Mental Disorders International Statistical Classification of Diseases and Related Health Problems Major Classification Categories DSM 5 Typical age of onset is important

8 Definition Mental Disorder DSM 5 Definition. What exactly is a Mental Disorder? A mental disorder is a syndrome characterized by clinically significant disturbance in an individual s cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental Disorders are usually associated with distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as death of a loved one, is not a mental disorder. Socially deviant behavior (e.g. political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.

9 Role Boundaries: Referral and Limits Don t Diagnose or suggest a possible diagnosis Insist on going for counseling Refer to an individual counselor Remind them of all the reasons they have to be happy Give a lot of advice Wait to refer till situation gets too bad Be afraid to ask about suicidality Forget to take care of yourself

10 Role Boundaries: Referral and Limits Do watch for the following symptoms: Changes in behavior Nervousness (e.g., fidgeting, pacing) Increased irritability Poor concentration Withdrawal/isolation Lack of energy Incomplete work or Change in quality of work Decrease participation in class Depression (e.g., tearfulness, crying) Decrease in attendance Change in personal hygiene Change in sleep or appetite Impaired speech or distorted thoughts Threats regarding self or others Substance abuse (e.g., alcohol, prescription medications etc.) Cuts, bruises or burns

11 Role Boundaries: Referral and Limits Do Know university and community resources for referrals Refer student to disability services if diagnosed Know about Students of concern type committees on campus Work in your limits of expertise Consult with counseling staff if in doubt Express your concern using specific examples of behavior Clearly communicate your limits (training, role conflict, objectivity) Provide information about referral resources Be prepared for inaction or rejection of referral Willing to walk student over or have student call from your office if needed Do follow-up the expression of concern and referral with an Do check for suicidality if you re concerned

12 Role Boundaries: Referral and Limits ADAA recommends the following steps if you suspect someone you know is suicidal: 1. Ask them directly 2. Make safety a priority 3. Be there for them (within your limits and with self care in mind) 4. Give them tools for self help 5. Remain in contact

13 Disorder Classification System Neurodevelopmental dx Schizophrenia spectrum and other psychotic dx Bipolar and related dx Depressive dx Anxiety dx Obsessive compulsive and related dx Trauma and stress related dx Dissociative dx Somatic symptom and related dx Feeding and eating dx Elimination dx Sleep-wake dx

14 Disorder Classification System Sexual dysfunctions Gender dysphoria Disruptive, impulse control and conduct dx Substance related and addictive dx Neurocognitive dx Personality dx Paraphilic dx Other mental dx Medication induced movement dx and other adverse effects of medications Other conditions that may be a focus of clinical attention

15 Category: Depressive Disorders 01 Disruptive Mood Dysregulation Dx Premenstrual Dysphoric Dx Major Depressive Dx Persistent Depressive Dx 03 IDEA

16 Major Depressive Dx: Diagnostic Criteria Sad mood or anhedonia* present nearly everyday most of the day for at least 2 weeks Must include at least 4 of the following at the same time: Weight and appetite changes Sleep changes (insomnia or hypersomnia) Loss of energy or fatigue Psychomotor agitation or retardation Feelings of worthlessness or guilt Diminished ability to concentrate or indecisiveness Thoughts of death, suicidality

17 Persistent Depressive Dx: Diagnostic Criteria Depressed mood for at least 2 years Must also include at least 2 of the following: Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self esteem Poor concentration or indecisiveness Hopelessness

18 Category: Anxiety Disorders Separation Anxiety Dx Selective Mutism Social Anxiety Dx Panic Dx Agoraphobia Generalized Anxiety Dx Specific Phobia PTSD**

19 Generalized Anxiety Dx: Diagnostic Criteria Excessive worry and anxiety that is difficult to control about a variety of things for at least 6 months Associated symptoms should include 3 or more in the same period: Restlessness or feeling keyed up or on edge Being easily fatigued Difficulty concentrating or mind going blank Irritability Muscle tension Sleep disturbance (difficulty falling or staying asleep, or restlessness, unsatisfying sleep)

20 Social Anxiety Dx: Diagnostic Criteria Anxiety in social or performance situations for at least 6 months Fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others (social interactions, being observed, or performing in front of others) Fears associated with showing anxiety in front of others or being negatively evaluated Phobic situation has to consistently (not just sometimes) produce fear or anxiety Social situations are avoided or endured with intense fear/anxiety If intense fear is restricted to speaking or performing in public only, specify performance type only.

21 Post Traumatic Stress Dx: Diagnostic Criteria Now part of Trauma and Stress Related Disorders Category Exposure to actual or threatened death, serious injury, or sexual violence Presence of one or more of the following intrusive symptoms following event: Recurrent involuntary and intrusive distressing memories of event Recurrent distressing dreams related to event Dissociative reactions (flashbacks) Distress (physiological or psychological) at exposure to internal or external cues that symbolize or resemble event Persistence avoidance of memories, thoughts, feeling, or external stimuli (people, places, activities, objects) associated with event Negative alteration in cognitions or mood Marked alterations in arousal and reactivity associated with event

22 Category: Eating and Feeding Disorders Rumination Dx Anorexia Nervosa Binge Eating Dx Pica Avoidant / Restrictive Food Intake Dx Bulimia Nervosa

23 Binge Eating Dx: Diagnostic Criteria Binge eating (within a discrete period) with sense of lack of control without associated purging or compensatory behaviors. Binge eating should include: Eating more rapidly than normal Eating until uncomfortably full Eating large amounts of food when not hungry Eating alone due to embarrassment Feeling disgusted, depressed or guilty afterwards

24 Bulimia Nervosa: Diagnostic Criteria Binge eating (within a discrete period) with sense of lack of control with associated purging or compensatory behaviors. Excessive eating in a discrete period of time Lack of control over eating during binge episode Compensatory behaviors to prevent weight gain Vomiting Laxatives Diuretics excessive exercise fasting or food intake restrictions Self evaluation excessively influenced by body shape and weight

25 Anorexia Nervosa: Diagnostic Criteria Two types: Restricting: Weight loss is accomplished by dieting, fasting, or excessive exercise Binge-eating/Purging: Weight loss is accomplished by vomiting, laxatives, diuretics, or enemas Significant restriction of caloric intake Significantly low weight Intense fear of gaining weight or becoming fat Excessive focus on and distorted view of body shape and weight Persistent lack of recognition of the seriousness of low weight

26 Category: Neurodevelopmental Disorders ADHD Specific Learning Dx Motor Dx Intellectual Disability Communication Dx Autism Spectrum Dx

27 ADHD: Diagnostic Criteria Two categories of symptoms: Inattentiveness Hyperactivity/impulsivity Symptoms must be present in childhood (before age 12 instead of age 6 as in the previous DSM) Symptoms must be present in two or more settings Symptoms must be significantly disruptive

28 ADHD: Diagnostic Criteria Inattentiveness Symptoms Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities Often has trouble holding attention on tasks or play activities Often does not seem to listen when spoken to directly Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked) Often has trouble organizing tasks and activities Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework) Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones) Is often easily distracted Is often forgetful in daily activities.

29 ADHD: Diagnostic Criteria Hyperactivity/Impulsivity Symptoms Often fidgets with or taps hands or feet, or squirms in seat Often leaves seat in situations when remaining seated is expected Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless) Often unable to play or take part in leisure activities quietly Is often "on the go" acting as if "driven by a motor Often talks excessively Often blurts out an answer before a question has been completed Often has trouble waiting his/her turn Often interrupts or intrudes on others (e.g., butts into conversations or games)

30 Specific Learning Dx: Diagnostic Criteria Persistent difficulties in reading, writing, arithmetic, or mathematical reasoning skills during formal years of schooling. Symptoms may include inaccurate or slow and effortful reading, poor written expression that lacks clarity, difficulties remembering number facts, or inaccurate mathematical reasoning. Current academic skills must be well below the average range of scores in culturally and linguistically appropriate tests of reading, writing, or mathematics. The individual s difficulties must not be better explained by developmental, neurological, sensory (vision or hearing), or motor disorders and must significantly interfere with academic achievement, occupational performance, or activities of daily living.

31 Resources: National Resources American Psychological Association: apa.org American College Health Association: acha.org National Alliance on Mental Health (NAMI) nami.org/collegeguide Jed Foundation: jedfoundation.org American Foundation for Suicide Prevention: afsp.org National Suicide Prevention Lifeline: suicidepreventionlifeline.org Basic psych concepts: Substance Abuse and Mental Health Services Administration (SAMHSA): National Institute of Mental Health: ULifeline: Anxiety and Depression Association of America: adaa.org Anxiety Resource Center: anxietyresourcecenter.org Social Anxiety Association: socialphobia.org National Eating Disorders Association (NEDA): nationaleatingdisorders.org National Institute for Drug Abuse: drugabuse.gov SLD online LD test:

32 Mehvash Ali