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WORKING WITH CLIENTS WITH MENTAL ILLNESSES

WORKING WITH CLIENTS WITH MENTAL ILLNESSES. Problems do not go away. They must be worked through or else they remain, forever a barrier… M. Scott Peck. “But I don’t want to go among mad people,” Alice remarked.

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WORKING WITH CLIENTS WITH MENTAL ILLNESSES

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  1. WORKING WITH CLIENTS WITH MENTAL ILLNESSES

  2. Problems do not go away. They must be worked through or else they remain, forever a barrier… M. Scott Peck

  3. “But I don’t want to go among mad people,” Alice remarked. “Oh, you can’t help that,” said the Cat. “We’re all mad here. I’m mad. You’re mad.” “How do you know I’m mad?” said Alice. “You must be,” said the Cat, “or you wouldn’t have come here.” Lewis Carrol, Alice in Wonderland

  4. ADULT DIAGNOSES • Depression • Schizophrenia • Bipolar Disorder (Manic Depressive Illness) • Personality Disorders • Substance Abuse

  5. Depression • DSM IV TR Criteria • Course of illness • Effect on caregiving • Comorbidities

  6. Schizophrenia • DSM IV TR Criteria • Course of illness • Effects on caregiving • Comorbidities

  7. Bipolar Disorder • DSM IV TR Criteria • Course of illness • Effect on caregiving • Comorbidities

  8. Personality Disorders • DSM IV TR Criteria • Course of illness • Effect on caregiving • Comorbidities

  9. Substance Abuse:Drugs, Alcohol & Polysubstance • DSM IV TR Criteria • Abuse v. dependence • Course of illness • Effects on caregiving • Comorbidities

  10. Kids’ Diagnoses • Depression • Bipolar (controversial, especially before 13 years old) • ADD • Behavioral consequences in kids whose parent has an unstable mental illness

  11. Working with parents with unstable mental illnesses • Compliance v. noncompliance • Drug addiction • Assessment

  12. Long-term prognosis • Depression • Good prognosis if compliant with medication and supportive therapy • Schizophrenia • Fair prognosis if compliant with medication , therapy and social supports • Poor prognosis with marked deterioration if noncompliant • Bipolar Disorder • Good prognosis if compliant with medication • Unfortunately, often prefer to be unmedicated

  13. Long-term prognosis • Personality Disorder • Generally difficult to treat • Problems arise because of co-occurring substance abuse &/or poor judgment, impulsivity and disrupted interpersonal relationships • Substance Abuse • Fair prognosis if complies with medication & supportive therapy. However, relapse is anticipated. • Poor prognosis with marked deterioration if untreated.

  14. Medications • Antidepressants • Antipsychotics • Antimanics • Anxiolytics • Drugs that treat cravings

  15. Antidepressants • SSRIs Prozac, Zoloft Paxil • Available as pills, liquids • Actions: thought to block reuptake of serotonin • Duration: varies. Takes 4-6 weeks for full effect.

  16. Antidepressants • NSRIs Effexor, Cymbalta • Available in pill form • Actions: thought to act by blocking reputake of serotonin & norepinephrine • Duration: varies. Can take 1-4 weeks for full effect

  17. Antipsychotics • Haldol • Available in pill, liquid and short-acting or long-acting shot (get every 4 weeks) • Actions: blocks dopamine receptors. Treats short-term psychotic symptoms • Duration: pill form lasts 6-10 hours; • Long-acting shot lasts 28 days

  18. Antipsychotics • Risperdal • Available in pill or long-acting shot form • Actions: • blocks serotonin, dopamine & histamine receptors • For short-term treatment of psychotic symptoms or for irritability associated with manic behavior • Duration: • pill form lasts 6-7 hours • Long-acting shot lasts 7 weeks but can take 3 weeks to start working

  19. Antipsychotics • Geodon • Available in pill and short-acting shot form • Actions: dopamine & serotonin antagonist • Treats positive and negative symptoms of schizophrenia with minimal EPS side effects • Rapid control of agitation and psychotic symptoms • Rapid short-term treatment of manic or mixed symptoms • Pill form lasts 12 hours but IM best for acute symptoms

  20. Antimanics • Lithium • Available as pill or liquid • Action: alters chemical transmissions in neurons • Duration: 1-3 weeks for full effect • Use additional alternate medication for short term treatment of symptoms • Maintain adequate fluid intake, scheduled blood tests

  21. Antimanics • Depakote/Depakene • Antiepileptic/mood stabilizer • Often used as an alternative to Lithium • Available as pills, syrup sprinkles • Actions: May inhibit nerve transmission in CNS and may increase brain level of GABA

  22. Mood Stabilizers • Lamictal • Available in pill form • Action: inhibits certain neurotransmitters • Important info: can cause life-threatening complications if given with depakote

  23. Mood Stabilizers • Topamax • Available as pill or sprinkles • Action: unknown

  24. Resources • Directory of Health & Human Services in Metropolitan Chicago • 312-491-7800 • www.communityresourcenetwork.org • Haymarket House • Hull House • Thresholds

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