Mental IllnessMental Illness

An Understanding of Depression, An Understanding of Depression, Mania and Mania and

SchizophreniaSchizophrenia

Meghan M. Mc KeoughMeghan M. Mc Keough

Linfield College School of NursingLinfield College School of Nursing

What is a mental illness?What is a mental illness?

It is when someone lacks the ability to It is when someone lacks the ability to manage day to day events and/or manage day to day events and/or control their behavior so that basic control their behavior so that basic physical and emotional needs are physical and emotional needs are threatened or unmet.threatened or unmet.

Mental illnesses are not the result of a Mental illnesses are not the result of a personal weakness, lack of character, or personal weakness, lack of character, or

poor upbringing.poor upbringing.

These disorders can affect persons of any These disorders can affect persons of any age, race, sex, religion, or income.age, race, sex, religion, or income.

Why should I care?Why should I care?

Because understanding of mental health Because understanding of mental health issues brings awareness to the community issues brings awareness to the community and our surrounding environment.and our surrounding environment.

We will become a society that is accepting We will become a society that is accepting of others who do not fit our idea of a of others who do not fit our idea of a perfect population.perfect population.

What is mental illness like?What is mental illness like?

Mental illness is a Mental illness is a physical condition just physical condition just like asthma or arthritis.like asthma or arthritis.

But still society believes But still society believes that a person who is that a person who is mentally ill needs to mentally ill needs to show more willpower -show more willpower -

to be able to pull to be able to pull themselves out it. themselves out it.

… …....It is also like It is also like telling a person telling a person who has an who has an amputated leg to amputated leg to run across the run across the room.room.

But a person who has mental health issue But a person who has mental health issue has a “broken brain”.has a “broken brain”.

Myths of Mental IllnessMyths of Mental Illness

Mental illness is caused by bad parenting.Mental illness is caused by bad parenting.Fact: Most diagnosed individuals come from Fact: Most diagnosed individuals come from supportive homes.supportive homes.

The mentally ill are violent and dangerous.The mentally ill are violent and dangerous.Fact: Most are victims of violence.Fact: Most are victims of violence.

People with a mental disorder are not smart.People with a mental disorder are not smart.Fact: Numerous studies have shown that many Fact: Numerous studies have shown that many have average or above average intelligence.have average or above average intelligence.

Mental Illnesses Mental Illnesses in our Communityin our Community

DepressionDepression ManiaMania SchizophreniaSchizophrenia

DepressionDepression

What is Depression?What is Depression?

Depression is a medical issue that affects Depression is a medical issue that affects a persons mood to be down, blue and/or a persons mood to be down, blue and/or fed up. fed up.

Depression is the most common mood Depression is the most common mood disorder, affecting approximately 20 million disorder, affecting approximately 20 million people each year.people each year.

Signs and Symptoms of Signs and Symptoms of DepressionDepression

Persistent sad, anxious or Persistent sad, anxious or empty moodempty mood

Sleeping too much or too Sleeping too much or too little; odd time of wakinglittle; odd time of waking

Reduced or increased Reduced or increased appetite which results in appetite which results in weight gain or loss.weight gain or loss.

Irritability or restlessnessIrritability or restlessness

Fatigue or loss of energyFatigue or loss of energy Thoughts of death or Thoughts of death or

suicide, including suicide suicide, including suicide attemptsattempts

Feeling guilty, hopeless Feeling guilty, hopeless or worthlessor worthless

Difficulty concentrating, Difficulty concentrating, remembering or making remembering or making decisionsdecisions

What factors causes What factors causes depression?depression?

There is no single cause of There is no single cause of depression. depression.

But here are some factors But here are some factors that may contribute to it’s that may contribute to it’s development:development:

Psychological Psychological BiologicalBiological EnvironmentEnvironment

Evidence also suggests.Evidence also suggests.

Scientists have also found evidence which makes some people Scientists have also found evidence which makes some people with a genetic predisposition to major depression vulnerable to with a genetic predisposition to major depression vulnerable to the disorder. However not everyone with a family history the disorder. However not everyone with a family history develops depression.develops depression.

Some life event that may trigger episodes of depression:Some life event that may trigger episodes of depression: Death of a loved oneDeath of a loved one Major loss or changeMajor loss or change Chronic stressChronic stress Alcohol and drug abuseAlcohol and drug abuse Heart disease and cancerHeart disease and cancer medicationsmedications

How does depression work?How does depression work?

The way we respond to situations (with thoughts The way we respond to situations (with thoughts of hopelessness, anxiety, anger, etc.) effects of hopelessness, anxiety, anger, etc.) effects the emotions we feel, which in turn, effects the the emotions we feel, which in turn, effects the chemicals that are released within our body. chemicals that are released within our body.

And all emotional responses have a chemical And all emotional responses have a chemical consequence. Serotonin, a neurotransmitter consequence. Serotonin, a neurotransmitter (body chemical), is a major contributor in the (body chemical), is a major contributor in the depression cycle.depression cycle.

SerotoninSerotonin

When a person is depressed, their serotonin level When a person is depressed, their serotonin level is low, which causes several changes to the is low, which causes several changes to the body:body:

1.1. Pain Threshold LoweredPain Threshold Lowered: A depressed person feels more pain : A depressed person feels more pain from no apparent source. from no apparent source. (back pain is very common amongst sufferers)(back pain is very common amongst sufferers)

2.2. Sleep DisturbanceSleep Disturbance: A depressed persons day runs on an : A depressed persons day runs on an average of 22 hours, not 24. And there are many spikes in average of 22 hours, not 24. And there are many spikes in temperature throughout the night which causes a person to wake temperature throughout the night which causes a person to wake many times, resulting in not getting any REM sleep.many times, resulting in not getting any REM sleep.

The Cycle of DepressionThe Cycle of Depression

How Can I Help A Person With How Can I Help A Person With Depression?Depression?

Be sensitive to their feelings, and validate those Be sensitive to their feelings, and validate those feelings.feelings.

Teach emotion-coping skillsTeach emotion-coping skills:: Acknowledge and express emotions.Acknowledge and express emotions. Remind the person to challenge irrational thoughts and write them Remind the person to challenge irrational thoughts and write them

down in a journal.down in a journal. Teach that for every one negative thought they need to think of Teach that for every one negative thought they need to think of

two positive thoughts.two positive thoughts.

Teach problem-solving skillTeach problem-solving skill:: Help determine importance of problem while keeping down their Help determine importance of problem while keeping down their

stress and anxietystress and anxiety Break problem into small chunksBreak problem into small chunks Remind the person that it is ok to ask for helpRemind the person that it is ok to ask for help

ManiaMania(bipolar disorder)(bipolar disorder)

What is Mania?What is Mania?

Mania is part of a condition called bipolar Mania is part of a condition called bipolar disorder, also known as manic-depression.disorder, also known as manic-depression.

Bipolar disorder usually causes a person’s mood Bipolar disorder usually causes a person’s mood to alternate between symptoms of depression to alternate between symptoms of depression and mania, a heightened energetic state.and mania, a heightened energetic state.

This mood disorder affects more than two million This mood disorder affects more than two million Americans. Americans.

Signs and Symptoms of Signs and Symptoms of ManiaMania

Increased physical and Increased physical and mental activity & energymental activity & energy

Excessive irritability, Excessive irritability, aggressive behavioraggressive behavior

Decreased need for Decreased need for sleep; without sleep; without experiencing fatigueexperiencing fatigue

Exaggerated optimism Exaggerated optimism and self-confidenceand self-confidence

Racing speech and Racing speech and thoughts; flight of ideasthoughts; flight of ideas

Impulsiveness, poor Impulsiveness, poor judgmentjudgment

Reckless behavior: erratic Reckless behavior: erratic driving, sexual driving, sexual indiscretions, spending indiscretions, spending spreessprees

Grandiose delusionsGrandiose delusions

What Causes Mania?What Causes Mania?

The neurotransmitters: Norepinephrine, dopamine, and The neurotransmitters: Norepinephrine, dopamine, and serotonin, have been studied since the 1960s as factors serotonin, have been studied since the 1960s as factors in mania and depression. in mania and depression.

For example, during a manic episode, clients with bipolar For example, during a manic episode, clients with bipolar disorder have a significantly higher Norepinephrine and disorder have a significantly higher Norepinephrine and epinephrine levels than a depressed or euthymic (normal epinephrine levels than a depressed or euthymic (normal mood) person. mood) person.

Norepinephrine and epinephrine Norepinephrine and epinephrine are responsible for are responsible for “fight or flight” responses.“fight or flight” responses.

How Can I Help a Person Who How Can I Help a Person Who is Manic?is Manic?

Use a firm and calm Use a firm and calm approach when approach when communicating:communicating:““Lower your voice Lower your voice Don, or you will lose Don, or you will lose ______ privilege.”______ privilege.”

Remain neutral; avoid Remain neutral; avoid power struggles and power struggles and don’t cast judgments.don’t cast judgments.

Firmly redirect energy Firmly redirect energy into more appropriate into more appropriate and constructive and constructive behavior.behavior.

Do not yell or sound Do not yell or sound threatening, the goal threatening, the goal is to try to keep is to try to keep anxiety down in a anxiety down in a person who exhibits person who exhibits mania.mania.

SchizophreniaSchizophrenia

What is Schizophrenia?What is Schizophrenia?

Schizophrenia is a chronic and severe brain disorder. Schizophrenia is a chronic and severe brain disorder.

It is a disease that makes it difficult for a person to tell It is a disease that makes it difficult for a person to tell the difference between real and unreal experiences, to the difference between real and unreal experiences, to think logically, to have appropriate emotional think logically, to have appropriate emotional responses to others, aspects of memory and to act responses to others, aspects of memory and to act appropriately in social situations. appropriately in social situations.

The World Health Organization (WHO) has identified The World Health Organization (WHO) has identified schizophrenia as one of the ten most debilitating schizophrenia as one of the ten most debilitating diseases affecting all human beings.diseases affecting all human beings.

Symptoms of SchizophreniaSymptoms of Schizophrenia

The severity of The severity of symptoms varies from symptoms varies from one person to one person to another, and typically another, and typically symptoms will decline symptoms will decline and then reappear.and then reappear.

Symptoms are divided Symptoms are divided into into PositivePositive and and NegativeNegative symptoms. symptoms.

Positive SymptomsPositive Symptoms

Positive symptoms are characterized by abnormal thoughts, Positive symptoms are characterized by abnormal thoughts, perceptions, language and behavior.perceptions, language and behavior.

DelusionsDelusions:: False beliefs/thoughts win no basis in realityFalse beliefs/thoughts win no basis in reality

HallucinationsHallucinations: : Disturbances of sensory perception (hearing, seeing or Disturbances of sensory perception (hearing, seeing or feeling things not there)feeling things not there)

Disorganized Thinking/SpeechDisorganized Thinking/Speech: : Jumping from topic to topic, Jumping from topic to topic, responding to questions with unrelated answers or speaking incoherentlyresponding to questions with unrelated answers or speaking incoherently

Disorganized BehaviorDisorganized Behavior::Problems in performing directed daily Problems in performing directed daily

activities.activities. Catatonic BehaviorCatatonic Behavior: : Lowered environmental awareness, Lowered environmental awareness,

unresponsiveness, rigid posture, resistance to movement or instructions and unresponsiveness, rigid posture, resistance to movement or instructions and inappropriate postures.inappropriate postures.

Negative SymptomsNegative Symptoms

Negative symptoms are characterized by restrictions in Negative symptoms are characterized by restrictions in range and intensity of emotional expression, range and intensity of emotional expression, communication, body language and interest in normal communication, body language and interest in normal activities.activities.

Blunted (or flat) AffectBlunted (or flat) Affect: : Decreased emotional expressiveness, Decreased emotional expressiveness, unresponsive immobile facial appearance, reduced eye contact and body unresponsive immobile facial appearance, reduced eye contact and body language.language.

AlogiaAlogia: Reduced speech. Responses are detached and speech is not : Reduced speech. Responses are detached and speech is not fluid.fluid.

AvolitionAvolition: Lacking motivation, spontaneity, initiative. Sitting for lengthy : Lacking motivation, spontaneity, initiative. Sitting for lengthy periods or ceasing to participate in work or daily activities.periods or ceasing to participate in work or daily activities.

AnhedoniaAnhedonia: Lacking Pleasure or interest in activities that were once : Lacking Pleasure or interest in activities that were once enjoyable.enjoyable.

Attention DeficitAttention Deficit: Difficulty in concentrating: Difficulty in concentrating

What Causes Schizophrenia?What Causes Schizophrenia?

There is no one cause to this There is no one cause to this complex and puzzling illness, but complex and puzzling illness, but it is believed that some it is believed that some combination of genetic, biological combination of genetic, biological (virus, bacteria, or an infection) (virus, bacteria, or an infection) and environmental factors play a and environmental factors play a major role.major role.

There is currently no reliable way to There is currently no reliable way to predict whether a person will predict whether a person will develop the disease.develop the disease.

John Nash, a famous Schizophrenic. His life story made into a film, A Beautiful Mind.

What Occurs in the Brain of What Occurs in the Brain of Someone with Schizophrenia?Someone with Schizophrenia?Researchers believe an imbalance of Researchers believe an imbalance of

neurotransmitters may cause the symptoms of neurotransmitters may cause the symptoms of schizophrenia. Two neurotransmitters that have schizophrenia. Two neurotransmitters that have most been implicated as abnormal in most been implicated as abnormal in schizophrenia are dopamine and serotonin.schizophrenia are dopamine and serotonin.

The ability to produce images have helped in The ability to produce images have helped in identifying structural and functional differences identifying structural and functional differences in a schizophrenic brain versus a normal brain.in a schizophrenic brain versus a normal brain.

From The Looks of ItFrom The Looks of It

Brian imaging has shown a difference in:Brian imaging has shown a difference in: Enlargement of the ventricle Enlargement of the ventricle Decrease in the hippocampus Decrease in the hippocampus (controls emotional and (controls emotional and

working memory)working memory)

Decrease in overall sizeDecrease in overall size Abnormal development of pre-frontal cortex Abnormal development of pre-frontal cortex (forehead (forehead

region; controls information process, motivation, problem solving, region; controls information process, motivation, problem solving, decision making, and thinking speed)decision making, and thinking speed)

Schizophrenic brain Normal brain

Ventricles

How Can I Help a Person With How Can I Help a Person With SchizophreniaSchizophrenia

The following guidelines may be useful when talking to a The following guidelines may be useful when talking to a person whose speech is confused and disorganized.person whose speech is confused and disorganized.

1.1. Do not pretend that you understand the persons words or Do not pretend that you understand the persons words or meaning when you are confusedmeaning when you are confused

2.2. Tell the person that you are having difficulty understanding what Tell the person that you are having difficulty understanding what they are trying to communicatethey are trying to communicate

3.3. Place the difficulty of understanding upon yourself “I’m having Place the difficulty of understanding upon yourself “I’m having trouble following what you are saying.” not “You are not making trouble following what you are saying.” not “You are not making any sense.”any sense.”

4.4. Tell the person what you do understand; reinforce clear Tell the person what you do understand; reinforce clear communication.communication.

5.5. Keep their anxiety down by: a calm voice and firm direction Keep their anxiety down by: a calm voice and firm direction

TreatmentTreatment

With all three of these illnesses, With all three of these illnesses, treatment, with the right treatment, with the right combination of medications combination of medications and/or therapy, can help and/or therapy, can help stabilize the stabilize the moods that moods that interfere with interfere with a productive a productive life.life.

ConclusionConclusion

Overall, mental health is an Overall, mental health is an issue that effects issue that effects everyone. everyone.

And hopefully, throughout And hopefully, throughout the years, education will the years, education will curve the sigma of these curve the sigma of these brain disorders so that brain disorders so that hate, bias judgment and hate, bias judgment and discrimination will be discrimination will be gone.gone.

For More InformationFor More Information

Web sites that are worth a visit.Web sites that are worth a visit.

National Alliance for the Mentally Ill: National Alliance for the Mentally Ill: http://www.nami.orghttp://www.nami.org

National Alliance for Research on Schizophrenia and Depression: National Alliance for Research on Schizophrenia and Depression: http://www.narsad.orghttp://www.narsad.org American Foundation for Suicide Prevention: American Foundation for Suicide Prevention: http://www.afsp.orghttp://www.afsp.org American Psychiatric Association: American Psychiatric Association:

http://www.psych.orghttp://www.psych.org Anxiety Disorders Association of America: Anxiety Disorders Association of America: http://www.adaa.orghttp://www.adaa.org Bazelon Center for Mental Health Law:Bazelon Center for Mental Health Law:

http://www.bazelon.orghttp://www.bazelon.org National Institute of Mental Health: National Institute of Mental Health: http://www.nimh.nih.http://www.nimh.nih.govgov