The Brain, Mental Health, and Social

StigmaMINI-MEDICAL SCHOOL FALL 2019

Patient Doctor Interview Next week!

► Worth 1 elective credit► Students who are interested will give names to Homeroom Teachers.► Max of 3 students. If more than 3 are interested, randomize with this site https://www.random.org/lists/

► Record names of participants in this spreadsheethttps://docs.google.com/spreadsheets/d/1hS49S36bisE7ybqZOVUNZ3eGY-3mem3MQ56TPPnNIWo/edit?usp=sharing

► Only CLODIERRSSS expected. Do a quick review!

What makes up the nervous system?

What makes up the nervous system?

Consists of Brain, Spinal Cord, and Nerves

Composed of the Central Nervous System and Peripheral Nervous System

Carries information throughout the body including:

Sensory information (what we feel)Motor Information (how we move)Together tells the body “what to do”

The Brain

► The brain is the center of the nervous system► Cells in the brain are grouped into:

► Neurons – the functional units of the brain► Glia – supporting cells in the brain

► The brain is divided into lobes (pieces) which carry out specific functions

► Although the brain is divided functionally, all parts of the brain work together in a complex fashion to keep us functioning► Neurons, connected by synapses,

communicate with each other to pass signals throughout the brain

Lobes of the Brain

How it works► Neurons = functional unit of the brain► Neurons are interconnected and pass

information through electrical and chemical signals► Similar to electrical wiring!

► The place where two neurons join is called a synapse

► Neurons can release messages in the form of neurotransmitters into the synapse► neurotransmitters bind to receptors on the

neighboring neuron, sending a message

Examples of Neurotransmitters

https://www.compoundchem.com/2015/07/30/neurotransmitters/

“A neurotransmitter is defined as a chemical messenger that carries, boosts, and balances signals between neurons, or nerve cells, and other cells in the body.”

Examples of Neurotransmitters

https://www.compoundchem.com/2015/07/30/neurotransmitters/

Is there a link between our brains and mental illness?

The Connection

“Researchers studying mental illness believe that abnormalities in how

particular brain circuits function contribute to the development of many

mental illnesses. Connections between nerve cells

along certain pathways or circuits in the brain can lead to problems with how the

brain processes information and may result in abnormal mood, thinking,

perception, or behavior.”https://www.webmd.com/mental-health/brain-mental-illness

What is mental illness?

What is mental illness?

“Mental illnesses are health conditions involving changes

in emotion, thinking or behavior (or a combination of

these). Mental illnesses are associated with distress and/or problems functioning in social,

work or family activities.”- American Psychiatric Association

The Brain and Mental Illness

https://youtu.be/MyxCjnHqBq8?t=85Play from 01:25 – 04:15

Mental Illness in America

► 1 in 5 Adults in the U.S. (46.6 million) experience mental illness each year► Nearly 1 in 25 adults live with a serious mental illness

► Mental illness affects everyone regardless of race, ethnicity, gender, or sexual orientation

► 1 in every 5 children ages 13-18 in America experiences or will experience mental illness► 50% of lifetime cases of mental illness begin by age 14;

75% by age 24

► Depression is the leading cause of disability worldwide and a major contributor to the global burden of disease

► There are often long delays between appearance of first symptoms and when people get help (sometimes decades)

Mental Illness Treatment in America

Consequences of Lack of Treatment

Serious mental illness costs America $193.2 billion in lost earnings per year

Difficulty adjusting to society:26% of homeless adults live with serious mental illness20% of state prisoners have a “recent” mental health condition70% of youth in juvenile justice systems affected

Individuals living with serious mental illness face increased risk of chronic medical conditions

Higher drop out rates for affected students with highest dropout rate of any disability group

Suicide = 10th leading cause of death in US, 2nd leading cause of death for people aged 10-34

90% of those who die by suicide have underlying mental illness

Minority Disparities

► Racial/Ethnic Minorities► Minority youth with behavioral issues

more often referred to juvenile justice system than white youth

► 48% of mentally ill whites received mental health services compared to: 31% of African Americans; 31% of Hispanics; 22% of Asians

► Sexual Minorities (e.g. LGBTQ):► 2x more likely as straight individuals to

have a mental health condition► Youth are 2x-3x more likely to attempt

suicide than straight youth

Minority Disparities

Critical Issues limiting Racial/Ethnic/Sexual minority mental health treatment includes:

- Less treatment access/Poorer quality of care- Higher stigma levels- Culturally Insensitive Health Care- Racism, bias, homophobia, or discrimination in treatment settings- Language Barriers- Lack of adequate health insurance coverage

To help, you can:•- Encourage mental health organizations to include more minorities on their staff/boards- Talk to legislators to support efforts to improve access to and quality of mental health services in your area- Speak up about the importance of equal minority mental health- Educate others about the disparities minorities face when seeking mental health treatment- Try to be more open and understanding to what minority communities might be experiencing that you might not

https://www.nami.org/Blogs/NAMI-Blog/July-2017/Disparities-Within-Minority-Mental-Health-Care

Anxiety Disorders

Kendall Jenner Ryan Reynolds Ariana GrandeGina Rodriguez Kid Cudi

Anxiety Disorders

Characterized by a general feature of excessive fear and/or anxiety (e.g. worrying about a future threat) on most days lasting for at least 6 months and adversely affecting the patient’s life

Some Anxiety disorders include: generalized anxiety disorder (GAD), agoraphobia, social anxiety disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder

Affects 18.1% (42 million) of Americans

An estimated 31.9% of adolescents had an anxiety disorder (NIH)

General Anxiety Disorder Signs

► Signs and Symptoms► Restlessness

► Difficulty concentrating

► Fatigue

► Irritability

► Impatience

► Easily distracted

► Muscle tension

► Trouble falling asleep or staying asleep

► Excessive sweating

► Stomach ache

► Headache

► Diarrhea

► Risk Factors► Age: Most GAD diagnosis occur in someone’s

20s

► Gender: GAD is approximately twice as common in women than in men

► Genetics: Approximately 25% of first-degree relatives of people with GAD are also affected

► Physical illness: GAD occurs in 14% of patients with diabetes.

► Stress: Stress may cause or exacerbate GAD.

► Substance abuse: Cocaine, other stimulating substances, nicotine, or cannabis usage may predispose to GAD.

GAD: Myths and Misconceptions

Myth #1: Anxiety is not a “real” illness.

• Everyone feels anxious or worried at times. Anxiety helps you respond appropriately to real danger, and it can help motivate you to excel at work and at home.

• However some individuals feel very anxious without reason and these worries may disrupt their daily life. Generalized anxiety disorder causes excessive or unrealistic anxiety and worry — well beyond what's appropriate for a situation.

Myth #2: Someone with Anxiety should avoid situations that cause stress.• Life is full of stressful unexpected situations. Developing

the habit of avoiding things that you know cause anxiety - like crowds of people, open spaces, or spiders - just reinforces the anxiety disorder. Effective anxiety treatment involves gradually and safely exposing you to the source of your anxiety so that you can learn to cope with it, not avoid it.

Depression

Miley Cyrus Demi LovatoWayne BradyDwayne Johnson

Depression

► Mood disorder characterized by persistently low mood and a feeling of sadness and loss of interest for at least two weeks. ► A persistent problem, not a passing one,

lasting on average 6 to 8 months.► Affects 6.9% (16 million) of Americans► Leading cause of disability worldwide + major

contributor to the overall global burden of disease.► Adults with a depressive disorder or symptoms

have a 64 percent greater risk of developing coronary artery disease.

► Cause of over 2/3s of the 30,000 reported suicides in the U.S. each year

► Despite high treatment success rate, 2/3 people suffering with depression do not actively seek nor receive proper treatment.

Depression Signs

► Signs and Symptoms (“SIG-E-CAPS”)► Sleep disturbance (increased or

decreased)

► Interest reduced (not enjoying anything)

► Guilt sensation and worthlessness

► Energy loss and fatigue

► Concentration problems

► Appetite problem (increased or decreased)

► Psychomotor agitation or retardation

► Suicidality

► Risk Factors► Sex - women are at greater risk

► Age - 18-44 years of age have the greatest risk

► Family history - genetic factors account for 40% of developing depression

► Early parental death

► Low confidence

► Chronic exposure to stress

► Major life changes, trauma, or stress

Depression: Myths and Misconceptions

Myth #1:  Depression and sadness are the same.

While an overwhelming sense of sadness is often a

symptom of depression, they are not one and the same. Sadness is fleeting

and temporary, but depression is a severe and persistent medical illness that interferes with one’s

ability to work, sleep, study, eat, and enjoy life.

Myth  #2: Depression is a sign of mental weakness.

This stigma is one of the main reasons why many people resort to suffer in

silence rather than to seek help. No one chooses to

develop depression. Would you think someone who suffers from Alzheimer’s disease, a broken bone, asthma, diabetes, heart

disease or osteoporosis as ‘weak’?

Myth #3: Depression isn’t a real medical illness.

While its symptoms may be difficult to examine, people

with depression have physical differences in their brain and neurotransmitter imbalances that directly

determine their condition.

Myth #4: Depression “goes away by itself”.

Like any medical condition, the longer one goes without

treatment, the harder it often is for the individual to

recover. Depression requires ongoing treatment and support and will not go

away by itself.

What to do if: someone tells you they are depressed

► Learn about depression ► Take time to find out about depression and how it can be treated.

► Listen with an open mind► When someone tells you they’re depressed, one of the most meaningful things you can do is listen

without judgement. Don’t try to give advice — just help them feel heard, understood, and accepted.

► Help them get help► Let them know that depression is common — and that help is available. Encourage them to reach

out to a doctor or therapist and offer to help them do that if you think it’s appropriate. ► Stay connected

► Check in often with the person you’re supporting. You may want to ask them how they’re doing, invite them to spend time with you, or offer to help with everyday tasks. The important thing is to show up, listen, and show that you care.

► Reach out to a trusted adult/professional► A trusted adult may be more capable of connecting your friend with services they may need.

Always reach out to an adult/911 if someone is talking about suicide as this is an emergency and requires immediate help.

What to do if: you are depressed

► Individual therapy can help you explore and understand your thoughts, feelings, and behaviors, build coping skills, and learn how to manage your depression in healthy ways.

► Group therapy has the same goals and benefits as individual therapy. And many people find connecting with other people who are experiencing depression to be extremely powerful.

► Medications like antidepressants and mood stabilizers can’t cure depression, but they do help some people manage their symptoms. Taking medication is a personal choice you make with your doctor.

► Peer-to-peer support groups like provide safe, confidential spaces for people to learn, share, and grow together. They also foster a sense of community and connection — which can help remind people living with depression that they’re not alone.

► Healthy lifestyle changes like eating healthier and exercising more can help some people find relief from mild to moderate symptoms of depression.

Eating Disorders

Gabourey Sidibe Zayn Malik Sir Elton John Lady Gaga

Eating Disorders

► Characterized by extreme and abnormal eating behaviors, such as insufficient or excessive eating

► At least 30 million people of all ages and genders suffer from an eating disorder in the U.S.► Affects 3% of 13-18-year olds

► Genetics, environmental factors, and personality traits all combine to create risk for an eating disorder.

► Eating Disorders include:► Anorexia nervosa: individuals have severe restriction of energy intake leading to a significantly low

body weight, intense fear of gaining weight/becoming fat, and a disturbance in the way they perceive their body weight. Individuals can excessively diet and/or exercise.

► Bulimia nervosa: individuals have recurrent episodes of binge eating and inappropriate compensatory purging to prevent weight gain (e.g. vomiting, laxative use) at least once a week for three months

► Binge eating disorder (BED): individuals have recurrent episodes of binge eating without compensatory purging. Binge eating is associated feeling loss of control about eating.

Eating Disorder SignsSigns and Symptoms of Anorexia

Nervosa

•Dramatic Weight Loss•Feeling cold all the time•Preoccupation with weight, food,

calories, fat grams, and dieting•Makes frequent commonest

about feeling “fat” despite weight loss

•Post puberty female has menstrual irregularities

•Fainting•Dental Problems (often as a result

of inducing vomiting)•Fine hair on body•Body Image Dissatisfaction

Signs and Symptoms of Bulimia Nervosa/Binge Eating Disorder

•Repeated episodes of eating large amounts of food in one sitting

•Feeling a lost of control during binging

•Forcing yourself to compensate for eating too much (e.g. vomiting, over-exercising, laxatives, diuretics, enemas, etc.) [bulimia]

•Dental Problems (often as a result of inducing vomiting)

•Distorted, excessively negative body image

•Not wanting to eat in public

Risk Factors

•Having a close relative with an eating disorder

•History of Dieting•Negative Energy Balance•Perfectionism (especially

self-oriented)•Body Image Dissatisfaction•Personal History of an Anxiety

Disorder•Weight Stigma/Teasing + Bullying

How does social stigma prevent people

from seeking care?

Social Stigma

► Stigma is defined as “stereotypes or negative views attributed to a person or groups of people when their characteristics/behaviors are viewed as different from or inferior to societal norms”

► Common Stigmas:► People with mental illness are dangerous, unpredictable, responsible for their illness, or generally incompetent► Self-stigma arises in patients where they believe they cannot recover, are underserving of care, or dangerous► Structural stigma can be seen in the lack of equal coverage for mental care as other types of health care

► Stigma and discrimination against patients and families prevent people from seeking mental health care due to feelings of shame, inadequacy, and many more negative emotions► Can lead to abuse, rejection and isolation, and exclude people from health care or support.

► Due to social stigma, individuals with mental health problems are among the least likely of any group with long-term health conditions to:► Find work► Be in a steady long-term relationship► Live in decent housing► Be Socially included in mainstream society

Stand up against Stigma

► Talk Openly About Mental Health► Educate Yourself and Others► Be Conscious of Language► Encourage Equality between Physical

and Mental Illness► Show Compassion for those with Mental

Illness► Choose Empowerment over Shame► Be Honest about Treatment► Let the Media know when they’re being

Stigmatizing► Don’t Harbor Self Stigma

https://www.nami.org/blogs/nami-blog/october-2017/9-ways-to-fight-mental-health-stigma

What is Mental Health?

What is mental health?

“Mental health is defined as a state of well-being in which

every individual realizes his or her own potential, can cope with the normal stresses of life,

can work productively and fruitfully, and is able to make a

contribution to her or his community.”

- World Health Organization

Promote Good Mental Health

1. Value Yourself

2. Take care of your body (eat nutritious meals, drink water, exercise, and get enough sleep)

3. Surround yourself with good people

4. Give Yourself in service of others (e.g. volunteer, help someone in need)

5. Learn how to deal with stress (e.g. Tai chi, yoga, writing, playing with a pet)

6. Quiet your mind (e.g. meditation, mindfulness)

7. Set Realistic Goals

8. Avoid Alcohol and Other Drugs (avoid self medicating)

9. Get help when you need it

Risk and Protective Factors

► Mental health is fluid and can change over time

► The presence of absence of various combinations of protective and risk factors contribute to mental health

► Maximize protective factors and reduce risk factors

► Protective Factors support you and make it more likely you will maintain good mental health as they reduce the impact of risk factors. Examples include:► Sense of self efficacy► Supportive family► Strong friendships► Healthy diet, exercise, and development► Optimism ► Achievement motivation

► Risk Factors exacerbate the impact of negative factors on your life and increase the likelihood you will experience declines in mental health. Examples include:► Chronic illness► Low socioeconomic status► Poor Nutrition and lack of sleep► Traumatic life experiences (e.g. loss of a parent)► Being abused or neglected► Discrimination► Perception of insignificance

https://i.pinimg.com/originals/1f/57/92/1f5792ef24b72940bc223a4cdbd6397c.jpg

• National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

• Crisis Text Line: Text “home” to 741741

• Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357)

• National Alliance on Mental Illness (NAMI) Helpline: 1-800-950-NAMI (6264)

Questions?

References

► “Any Anxiety Disorder.” National Institute of Mental Health, U.S. Department of Health and Human Services, www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml.

► “Brain Anatomy, Anatomy of the Human Brain.” Mayfieldclinic.com, Mayfield Brain and Spine, mayfieldclinic.com/pe-anatbrain.htm.

► “Eating Disorder Statistics.” National Association of Anorexia Nervosa and Associated Disorders, National Association of Anorexia Nervosa and Associated Disorders, anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/.

► “Mental Health By The Numbers.” National Alliance on Mental Illness, National Institutes of Health (NIH), www.nami.org/learn-more/mental-health-by-the-numbers.

► “What Is Mental Health?” MentalHealth.Gov, Footer Address U.S. Department of Health & Human Services, 5 Apr. 2019, www.mentalhealth.gov/basics/what-is-mental-health.

► “What Is Mental Illness?” American Psychiatric Association, American Psychiatric Association, 2019, www.psychiatry.org/patients-families/what-is-mental-illness.

► Shushanky, Larry. “Disparities Within Minority Mental Health Care.” National Alliance on Mental Illness, National Institutes of Health (NIH), 31 July 2017, www.nami.org/Blogs/NAMI-Blog/July-2017/Disparities-Within-Minority-Mental-Health-Care.