Signs & Symptoms of Mental Illness & Substance use Disorders

1. Signs & Symptoms of Mental Illness & Substance use Disorders

2. Goal: Learn about the different types of mental illness and substance abuse disorders. Identify the signs of mental illness and develop an effective approach to addressing individuals who present with these symptoms.

3. Objectives: • Learn about and be able to describe anxiety disorders, mood disorders, thought disorders, and substance abuse disorders. • Learn the signs and symptoms of anxiety disorders, mood disorders, thought disorders, and substance abuse disorders. • Learn how to respond to suicidal & homicidal threats • Learn effective strategies for approaching an individual who is experiencing symptoms of mental illness and/ or substance abuse disorders. • Learn how and where to send an individual for professional help.

4. Why is this topic important? According to the National Alliance on Mental Illness, almost two and a half million Ohioans suffer from a mental disorder in any given year. The Global Burden of Disease study, conducted by the World Health Organization, the World Bank and Harvard University, reported that mental illness is second only to cardiovascular disease in regard to societal burden, including years of life lost to premature death or disability.

5. Impact of Disorders

6. Impact of Disorders

7. The Cost to Ohioans The cost of untreated mental illnesses is immense, with direct and indirect costs to Ohio totaling more than $6.5 billion a year.

8. The Cost to Ohioans • Missed educational opportunities and failure in school • 58% percent of children with mental illness do not graduate from high school. • Lost productivity and unemployment • Employees who are depressed are twice as likely to miss work and seven times more likely to be less productive on the job. • Increased crime and incarceration • More than half of Ohio’s inmates have some type of mental illness; 12 percent are diagnosed with a severe mental illness. • Most youth in juvenile justice facilities have a diagnosable mental health disorder.

9. The Cost to Ohioans • Inappropriate use of hospital emergency departments • Comprehensive community-based mental health services can dramatically reduce public hospital admissions and lengths of stay. • Premature death, including suicide • In Ohio, more than 1,300 lives are lost to suicide each year, and the average life span of a person with a severe mental illness is 25 years shorter than for someone without this illness.

10. What is Mental Illness? A mental illness is a medical condition that disrupts a person's: • thinking, • feeling, mood, • ability to relate to others and • daily functioning. Just like physical illnesses, mental illnesses exist on a continuum

11. A Continuum of Health

12. Prevalence of Disorders Anxiety Disorders – 18.1% Mood Disorders – 9.5% Substance Use Disorders – 3.8% Schizophrenia – 1.1%

13. Symptoms • Symptoms are the internal experience of an illness; • Feeling hopeless, worthless, lethargic, & suicidal are symptoms of depression • People will often report physical symptoms rather than emotional symptoms

14. Signs • Signs are the external manifestation of an individual’s symptoms or experience ; • Significant changes in appetite, mood & sleep, or irritability & talking about death or dying are signs of possible depression • These may be much easier for us to see

15. Mood Disorders • Mood disorders are a group of mental illnesses that cause significant disturbances in a persons mood • Approximately 9.5% of the population will experience a mood disorder in a given year Mood disorders are split into 2 broad categories; • Depressive Disorders – Can be mild, moderate, or severe • Bipolar Disorders

16. Most Common Mood Disorders • Major Depressive Disorder • The leading cause of disability in the US for ages 15-44 • Major depressive disorder affects approximately 6.7 percent of the U.S. population age 18 and older in a given year • Bi-Polar Disorder • Bipolar disorder affects approximately 2.6 % of the U.S. population age 18 and older in a given year.

17. Major Depressive Disorder Major depression is an illness that goes well beyond temporarily feeling sad or blue. It is a serious medical illness that affects one’s thoughts, feelings, behavior, mood and physical health. • The leading cause of disability in the US for ages 15-44. • Affects approximately 6.7% of the population in a given year. .

18. Major Depressive Disorder • SIGNS – • Depressed mood • Sadness • Social withdrawal • Poor concentration • Fatigue • Unexplained physical aches & pains • Appetite disturbances • Increasing drug or alcohol use • Irritability

19. Major Depressive Disorder • SYMPTOMS – • Sadness • Feelings of worthlessness & hopelessness • Insomnia • Lack of motivation • Excessive guilt • Thoughts of suicide • Increasing drug or alcohol use • Frequent crying

20. Bipolar Disorder • Bipolar disorder affects approximately 2.6 % of the U.S. population in a given year. • This mental illness causes unusual and dramatic shifts in mood, energy and the ability to think clearly. • Bipolar disorder is a chronic illness with recurring episodes of mania and depression that can last from one day to months.

21. Bipolar Disorder • SIGNS OF MANIA - • Extreme irritability and/or euphoria, • Agitation or anger • Surges of energy • Talkativeness • Risk taking behavior (AOD use, impulsivity) • Grandiose ideas or delusions • Rapid speech • Lack of insight & follow through

22. Bipolar Disorder • SYMPTOMS OF MANIA • Reduced need for sleep • Euphoria • Feeling agitated • Significant increase in energy • Excitability

23. Anxiety Disorders • Anxiety disorders are a group of mental illnesses that cause people to feel: • excessively frightened, • distressed, or • uneasy during situations in which most other people would not experience these same feelings. • Approximately 18.1% of the population will experience an anxiety disorder in a given year.

24. Most Common Anxiety Disorders Panic Disorder Obsessive-Compulsive Disorder Post-Traumatic-Stress-Disorder

25. Panic Disorder • Panic disorder is an anxiety disorder characterized by frequent panic attacks. • A panic attack is an uncontrollable panic response to ordinary, nonthreatening situations. • Signs & symptoms of a panic attack include- • sweating; hot or cold flashes; choking or smothering sensations; racing heart; labored breathing; trembling; chest pains; faintness; numbness; nausea; disorientation; or feelings of dying, losing control, or losing one's mind.

26. Obsessive Compulsive Disorder • OCD is an anxiety disorder characterized by the presence of obsessions (internal) & compulsions (external). • Obsessions are intrusive, irrational thoughts; • unwanted ideas or impulses that repeatedly appear in a person's mind, i.e. "I may have left the gas stove on; I need to go check it fast" • Compulsions are repetitive rituals; • such as hand washing, counting, checking, hoarding or arranging

27. Post Traumatic Stress Disorder • PTSD is an anxiety disorder than can develop after experiencing a traumatic event. • Signs & Symptoms of PTSD; • Persistent Re-experiencing; Nightmares, flashbacks, intrusive thoughts, persistent remembering • Avoidant/Numbness Responses ; efforts to avoid feelings, locations or triggers associated with the trauma • Increased Arousal; Exaggerated startle response, difficulty sleeping, difficulty concentrating

28. Thought Disorders A thought disorder is evident when an individual has serious problems with thinking, feelings, and behavior The primary cluster of symptoms in a thought disorder are psychotic symptoms, indicating a loss of contact with reality The most common thought disorder is Schizophrenia, which affects 1.1% of the population in a given year

29. Schizophrenia 1/3 of individuals will experience one episode psychotic episode, another 1/3 will experience multiple episodes, with no symptoms in between episodes, and the last 1/3 will experience persistent psychotic symptoms throughout the lifespan Schizophrenia is one of the least common disorders, but can be the most disabling. Without early intervention, long term functioning can be severely impaired.

30. Schizophrenia • SIGNS – • False belief about self or others (delusions) • Paranoia • Hearing or seeing non-existent things (hallucinations), • Disconnected speech or thinking • Flat affect • Feelings that don’t match the situation • Difficulty in conversations due to incoherance or disorganization

31. Schizophrenia SYMPTOMS – Confusion Feeling of mistrust, paranoia Hallucinations Delusions Lack of motivation, depression

32. Substance Use Disorders Addiction/Chemical dependency Substance abuse

33. Substance Abuse A maladaptive pattern of substance use leading to clinically significant impairment or distress.

34. Substance Abuse SIGNS & SYMPTOMS – Increasing drug or alcohol use Failure to maintain major role obligations Substance use when it is physically hazardous Substance related legal problems Substance use when it causes interpersonal impairment

35. Addiction / Substance Dependence A chronic relapsing condition characterized by compulsive drug-seeking and abuse and by long-lasting chemical changes in the brain

36. Addiction / Substance Dependence SIGNS & SYMPTOMS – Increased use Tolerance for substance Withdrawal symptoms Attempts to quit using Using more or for longer than intended Much time/activity to obtain, use, recover  Important social, occupational, or recreational activities given up or reduced Use continues despite knowledge of adverse consequences (e.g., failure to fulfill role obligation, use when physically hazardous)

37. Withdrawal Symptoms • Abnormal physical or psychological features that follow the abrupt discontinuation of a drug that has the capability of producing physical dependence. • Common withdrawal symptoms include • sweating, • tremors, • vomiting, • anxiety, • insomnia, and • muscle pain.

38. Suicidal Ideation Characterized as a spectrum that ranges from fleeting suicidal thoughts to completed suicide Suicidal ideation is more common than suicide attempts or completed suicide.

39. General Risk Factors Family history of suicide Past attempts Male, white, age greater than 65 years Widowed or divorced Living alone; no children under the age of 18 in the household Presence of stressful life events Access to firearms

40. Psychiatric Risk Factors 90 percent of completed suicides in all age groups are associated with psychiatric disorders, including substance abuse. The most common psychiatric disorders associated with completed suicide are major depression and alcohol abuse

41. Suicide Rates 1993 - 2010

42. Suicide Facts Every 13.7 minutes someone in the United States dies by suicide. Nearly 1,000,000 people make a suicide attempt every year. 90% of people who die by suicide have a diagnosable and treatable psychiatric disorder at the time of their death. Most people with mental illness do not die by suicide. Recent data puts yearly medical costs for suicide at nearly $100 million. Men are nearly 4 times more likely to die by suicide than women. Women attempt suicide 3 times as often as men. Suicide rates are highest for people between the ages of 40 and 59.

43. Warning Signs • Observable signs of serious depression: • Unrelenting low mood • Pessimism • Hopelessness • Desperation • Anxiety, psychic pain and inner tension • Withdrawal/ isolation • Sleep problems • Increased alcohol and/or other drug use • Recent impulsiveness and taking unnecessary risks

44. Warning Signs • Threatening suicide or expressing a strong wish to die • Making a plan: • Giving away prized possessions • Sudden or impulsive purchase of a firearm • Obtaining other means of killing oneself such as poisons or medications • Unexpected rage or anger • Improvement in mood

45. How To Approach Always pick a private time & place when you won’t be rushed, & the person you are approaching will feel comfortable Do not presume you understand what they are going through or where they are coming from Open the door for the person to speak openly about what they may be experiencing – listen Let them speak about what may be going on

46. What To Say? Share your observations about their behaviors, & any signs of mental illness or substance use disorders you have noticed Invite them to do most of the talking Do not judge Stick to ‘I statements’ – “I’ve noticed you haven’t been hanging out as much lately, is something going on?” Use language that is comfortable for you Have referral information ready for them Refrain from giving advice

47. What to Say? Be prepared for the person to resist you – they may not be ready to talk yet. Set yourself up as a person who will provide consistent emotional support & understanding – they may come back to you later. If the person is in a crisis situation – ensure that you have the appropriate information you may need ready for them.

48. Where to Access Help 211 – Often a good starting point for referrals. Mental health agencies – Comprehensive services for mental health needs, drug & alcohol treatment. Private Practices – For individual counseling needs. Private insurance often needed, some have sliding scale available. Hospitals – Emergency care, crisis situations, stabilization services, some long term supports. Peer support groups – For both mental health & drug & alcohol needs.

49. Local Resources Mobile Crisis – 216. 623.6888 ADAMHS Board – 216. 241.3400 Recovery Resources – 216.431.4131 NAMI – 216.875. 7776 CIT Trained Police Officers – For Crisis Situations

50. Recovery The recovery journey is unique for each individual. There are several definitions of recovery; some grounded in medical and clinical values, some grounded in context of community and some in successful living. RECOVERY IS A PROCESS, NOT AN EVENT.