WORKING WITH CLIENTS WITH MENTAL ILLNESSES

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WORKING WITH CLIENTS WITH MENTAL ILLNESSES
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• Problems do not go away. They must be worked
  through or else they remain, forever a barrier
• M. Scott Peck

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• But I dont want to go among mad people, Alice
  remarked.
• Oh, you cant help that, said the Cat. Were
  all mad here. Im mad. Youre mad.
• How do you know Im mad? said Alice.
• You must be, said the Cat, or you wouldnt
  have come here.
• Lewis Carrol, Alice in Wonderland

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ADULT DIAGNOSES

• Depression
• Schizophrenia
• Bipolar Disorder (Manic Depressive Illness)
• Personality Disorders
• Substance Abuse

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Depression

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

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Schizophrenia

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

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Bipolar Disorder

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

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Personality Disorders

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

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Substance AbuseDrugs, Alcohol Polysubstance

• DSM IV TR Criteria
• Abuse v. dependence
• Course of illness
• Effects on caregiving
• Comorbidities

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Kids Diagnoses

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

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Working with parents with unstable mental
illnesses

• Compliance v. noncompliance
• Drug addiction
• Assessment

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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

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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.

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Medications

• Antidepressants
• Antipsychotics
• Antimanics
• Anxiolytics
• Drugs that treat cravings

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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.

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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

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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

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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

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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

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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

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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

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Mood Stabilizers

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

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Mood Stabilizers

• Topamax
• Available as pill or sprinkles
• Action unknown

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Resources

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