Emotional Health

Emotional Health Emotional/Mental Disorders

Emotional Health • Crisis Clinic, King County • 24-hour phone line: 206-461-3222 • Toll free: 866 4CRISIS (866-427-4747) • TDD line: 206-461-3219 • Chat also available • Outside of King County, call 911 or 1-800-SUICIDE • Health & Human Services Community Information • 206-461-3200/800-621-4636 • TDD: 206-461-3610

What is Emotional /Mental Health? • Accurate perception of reality • Adaptation to change • Ability to cope • Ability to think in organized manner • Ability to assess one’s own behavior

Emotional/Mental Disorders • General classifications • Diagnostic classifications

General Classifications • Neurosis • Psychosis

Neurosis • Emotional disorder caused by unresolved conflicts, leads to anxiety • A neurotic person can grasp reality • A neurotic person has irrational thoughts • Behavior may not make sense • A neurotic person is aware of irrational thoughts, behaviors, but has problems fixing them

Neurosis • Pop culture example

Psychosis • Sense of reality is distorted • Hallucinations: hearing/seeing something that does not exist • Delusions: Irrational beliefs not based on reality • Extremely disorganized thinking • Personality changes

Psychosis • Example: Center for Addiction and Mental Health video • Dennis Allard interviews his brother, Tony (YouTube)

Diagnostic Classifications • Diagnostic and Statistical Manual of Mental Disorders (DSM-V) published in 2013 • Many categories of disorders, as well as individual disorders: • Anxiety disorders • Obsessive-compulsive disorder • Post-traumatic stress disorder • Mood disorders • Schizophrenia

Anxiety Disorders, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder

Anxiety Disorders • Characterized by feelings: • Apprehension • Fear • Alarm • Terror • Anxiety occurs in situation where average individual is unaffected

Anxiety Disorders - Resources • General Information: Anxiety Disorders Association of America • Therapist lookup • Free webinars with registration • Anxiety Thursdays (fee = $50 for group; OCD, panic disorder, social anxiety, trichotillomania) • Info: 206-285-0900; dkosins@u.washington.edu • Place: 318 W. Galer St., Suite #201

Generalized Anxiety Disorder • Vague feeling of worry or dread • Job, family, home, health, etc. • A feeling that something is wrong • Worry is out of control • Characterized by: fatigue, restlessness, irritability, difficulty concentrating, muscle tension, sleep disturbances • Occurs for at least six months • Experienced distress is significant • Video Clip

Specific(Simple) Phobia • Fear is focused on particular object/situation • Anxiety is out of proportion to situation • Example: claustrophobia; others? • Distress interferes with life • Duration at least six months • Video: phobia of dogs (Animal Planet) • Video clip #1 (short); Video clip #2 (longer; 4:28)

Panic Disorder • Panic attacks are recurrent, expected or unexpected • Panic attack symptoms: four or more of the following • Increased heart rate • Increased breathing frequency • Sweating • Trembling • Chest pain/discomfort • Nausea • Dizziness • Fear of dying/losing control, feelings of detachment • Attacks not due to chemical substance • Fear of having unexpected panic attacks

Panic Disorder • Used to be distinguished as with or without agoraphobia • Agoraphobia • Anxiety over situations/places where escape is difficult or even embarrassing • Usually situations outside the home • The situations are avoided or endured with extreme discomfort • Video Clip, Colin’s Story (NHS Choices) • Agoraphobia now a separate disorder

Obsessive-Compulsive Disorder • In 2013, DSM-V recognized OCD as its own disorder (formerly an Anxiety Disorder) • Obsession • Recurrent, persistent thought, impulse or image experienced as inappropriate, marked by anxiety • Thought, impulse, image not about real-life problems • Person attempts to ignore/suppress • Individual recognizes irrationality • Examples

Common Obsessions • Need for order, organization, exactness • Concern over contamination • Fear of evil thoughts • Fear of doing harm to self or others

Obsessive-Compulsive Disorder • Compulsion • Repetitive behaviors/acts relating to obsession • Behaviors/acts aimed at reducing anxiety • Examples

Common Compulsions • Counting to a specific number • Arranging objects in specific ways • Cleaning, bathing • Seeking of reassurance • Behavior repetition

Video Clips • Pop culture • Real life

Obsessive-Compulsive Disorder • Obsession/Compulsion • Person may or may not recognize obsessions/compulsions are unreasonable • Obsessions/compulsions cause significant distress • Not due to chemical substance • Yale-Brown Obsessive-Compulsive Scale • Obsessive-Compulsive Disorder Screening Quiz (PsychCentral.com)

OCD Treatment, Resources • Treatment: medication, cognitive-behavior therapy • Gamma knife surgery (some researchers have found brain cysts as long-term side effect) • “Giving Obsessive-Compulsives Another Lifestyle” (GOAL) potluck meetings at Swedish Hospital (747 Broadway), 3rd Saturdays, 10am-1pm, cafeteria alcoves

Post-Traumatic Stress Disorder • In 2013, DSM-V recognized PTSD as a “Trauma- and Stressor-Related Disorder” (formerly an Anxiety Disorder) • Person exposed to an event threatening injury or death to self/others (examples) • Event re-experienced • Images/thoughts/perceptions • Dreams • Intense reactivity to cues or symbols of event • Example (0:40-5:09; disturbing clip)

Post-Traumatic Stress Disorder • Avoidance of triggers, reduced responsiveness • Thoughts, feelings, conversations • Activities, places, people associated with trauma • Inability to recall an aspect of the trauma • Reduced participation in activities • Feeling of detachment • Sense of shortened future

Post-Traumatic Stress Disorder • Persistent symptoms • Sleep difficulties • Irritability • Concentration difficulties • Exaggerated startle response • Significant distress • Occurs for longer than a month

PTSD Resources • WA State Department of Veterans Affairs PTSD Program: 800-562-2308 • Crisis Hotline: 800-273-TALK • VA Puget Sound Healthcare: 206-762-1010 (Seattle), 253-582-8440 (Tacoma) • PTSD Newsletter (via Yahoo groups) • Search for therapists via Psychology Today • Anxiety & Stress Reduction Center of Seattle

Quiz Time! • Socrative.com • Room #: 189767 • If prompted for name, provide an initial or two

Name That Disorder • Jimmy experiences intense fear whenever he is in, or even near, a plane. Which anxiety disorder BEST describes the scenario?

Name That Disorder • Mike is insistent on straightening everything in his apartment. For example, towels must be folded in a specific manner and placed on a towel bar so that ends of towels are even with each other. Furniture is symmetrically organized around the room to ensure balance.

Name That Disorder • Julia experiences nightmares after she is robbed at gunpoint. She is unable to concentrate, not doing well in school, and making errors at work.

Schizophrenia

Schizophrenia • A “psychotic disorder” • Severe disturbances in perception, thought, mood, behavior, or a combination • Affects ~1% of population

Schizophrenia • Characterized by: • Positive Symptoms (should not be present) • Delusions • Hallucinations • Disorganized speech • Example: clang association/clanging • Disorganized or catatonic behavior

Schizophrenia • Also characterized by: • Negative symptoms (something is missing) • Flat affect • Poor rapport • Difficulty with abstract thinking • Lack of self-care

Schizophrenia • Work, social relations, self-care are significantly affected • Minor physical anomalies: crossed eyes, ear malformations, visible blood vessels in nailbeds (children) • Signs occur for at least six months, at least one month of active signs • Disturbance not due to chemical substance • Change in DSM-V: “Schizophrenia Spectrum” & Other Psychotic Disorders

Schizophrenia Profiles • Maurizio Baldini(MentalHealth.com, story) • Gerald(YouTube; first 3 minutes of 8) • Heather (YouTube; 5:30)

autism Schizophrenia Symptom: Catatonic Behavior • Caveat: catatonia also its own disorder • Abnormalities in speech, senses, movements • Video clip (YouTube) • Excessive, sometimes violent motor activity; or mute, unmoving, stuporous • Echolalia (repeating, mimicking speech) • Example in autism(YouTube) • Echopraxia (repeating, mimicking behavior)

Schizophrenia Symptom: Disorganized Speech, Behavior • Incoherent speech • Disorganized behavior • Flat or inappropriate emotional response • Peter (YouTube; ~2:35 of 3:35)

Schizophrenia Symptoms: Hallucinations, Delusions • Hallucination: a false sensory experience • Delusion: a false belief • Hallucinations and delusions are created by mind vs. external stimuli • One or more delusions • Persecution, grandeur

Schizophrenia Profiles • 9-year old Rebecca (ABC News) • Linda Carmella Sibio • Louis Wain’s disease progression • ABC 20/20 Program from 2000 (6:04) • Girogianna (via YouTube)

Possible Causes • Genetics • Environment • Brain abnormalities • Neurotransmitter hypothesis

Schizophrenia and Genetics • There is no one gene associated with schizophrenia • Genes to Cognition chromosome map • Heredity and schizophrenia (schizophrenia.com) • Genetic predisposition may not be enough

Schizophrenia and Environment • Prenatal care, including nutrition (Vitamin D), influenza vaccination • Complications at birth (newborn breathing issues, maternal hypertension, others) • Exposure to virus during pregnancy • Relationship between schizophrenia and poverty • Do complications inherent in poverty increase likelihood for getting schizophrenia, or • Does poverty result because an individual diagnosed with schizophrenia is impaired? • Born in colder months (late winter/early spring)

Schizophrenia and Brain Abnormalities • Difficult to ascertain • Not necessarily obvious damage but abnormalities on a cellular level • Prefrontal cortex, hippocampus • Enlarged brain ventricles (USMLE Pathology Slides) • Fei Du, PhD, and colleagues found evidence of abnormalities in both myelin and axons (Biological Psychiatry, 2013)

Schizophrenia & Neurotransmitters • Dopamine • Schizophrenics tend to have increased sensitivity/too much released • Hypothesized due to amphetamine effects • Glutamate • Schizophrenia may inhibit glutamate • Hypothesized due to PCP effects • Serotonin • Elevated levels may be associated with schizophrenia • Hypothesized due to hallucinogen effects

Schizophrenia Treatment • Medications • Side effects • Uncontrollable movements (shaking, fidgeting, involuntary facial contortions) • Weight gain • High blood sugar, cholesterol • Loss of sex drive • Psychosocial therapy • Hospitalization • WA: Involuntary Treatment Act (72 hrs); petitions required for longer periods

Schizophrenia Treatment • Although many diagnosed with schizophrenia are disabled, others are able to work and function • Tony Allard: His brother conducts an interview (YouTube; at least through 5:00) • Dennis Allard’s blog • Living with Schizophrenia: A Call for Hope and Recovery

Schizophrenia Resources • Crisis Clinic: 206-461-3222 (1-866-4CRISIS toll free) • Community House Mental Health (206-362-0560) • Snohomish County: (425) 388-7215

Emotional Health