ADOLESCENT
PSYCH/YOUTH AT RISK
Definition
and introduction:
NRPA's
definition: Youth at risk come from all backgrounds, races, and areas of the
community. They are youth who are, or have the potential to be, influenced
negatively by family, environment, or peers; social factors that deter positive
mental and social growth. Also, those who do not have the financial resources
or have the ability to affect a positive change within their environment,
family or economic status.
Children
and young adults who, through low self-esteem or poor social skills, are prone
to become involved in crime, suicide, domestic abuse, drug and alcohol abuse,
early pregnancy, and school absenteeism.
Facts
about Adolescent Mental Health http://www.nccp.org/publications/pub_878.html
• Approximately 20% of adolescents
have a diagnosable mental health disorder.
• Many mental health disorders first
present during adolescence.
• Between 20% and 30% of adolescents
have one major depressive episode before they reach adulthood.
• For a quarter of individuals with
mood disorders like depression, these first emerge during adolescence.
• Between 50% and 75% of adolescents
with anxiety disorders and impulse control disorders (such as conduct disorder
or attention-deficit/hyperactivity disorder) develop these during adolescence.
• Suicide is the third leading cause
of death in adolescents and young adults.
• Suicide affects young people from
all ages, races, genders, and socioeconomic groups, although some groups seem
to have higher rates than others.
• Older adolescents (aged 15-19) are
at an increased risk for suicide (7.31/100,000).
• Between 500,000 and one million
young people aged 15 to 24 attempt suicide each year.
• Existing mental health problems
become increasingly complex and intense as children
transition into adolescence.
• Untreated mental health problems
among adolescents often result in negative outcomes.
• Mental health problems may lead to poor school performance, school
dropout, strained family relationships,
involvement with the child welfare or juvenile
justice systems, substance abuse, and engaging in risky sexual behaviors.
• An estimated 67% to 70% of youth in
the juvenile justice system have a diagnosable mental health disorder.
Mental
Disorders and At-Risk Behaviors:
• suicidal thoughts
• addictions—drugs, pornography,
alcohol
• Depression
• Anxiety
• Disruptive Disorders
• Conduct Disorder
• ODD
• ADHD
• Autism Spectrum Disorder
• PTSD
• Schizophrenia
• Eating Disorders
• Bipolar Disorder
SUICIDAL THOUGHTS
Warning
signs/Symptoms
It is
important to take the warning signs of teen suicide seriously and to seek help
if you thing that you know a teenager who might be suicidal. Here are some of
the things to look for:
• Disinterest in favorite
extracurricular activities
• Problems at work and losing interest
in a job
• Substance abuse, including alcohol
and drug (illegal and legal drugs) use
• Behavioral problems
• Withdrawing from family and friends
• Sleep changes
• Changes in eating habits
• Begins to neglect hygiene and other
matters of personal appearance
• Emotional distress brings on
physical complaints (aches, fatigues, migraines)
• Hard time concentrating and paying
attention
• Declining grades in school
• Loss of interest in schoolwork
• Risk taking behaviors
• Complains more frequently of boredom
• Does not respond as before to praise
http://www.teensuicide.us/articles2.html
Treatment
One of the most important aspects of
teen suicide prevention is support. The teenager needs to know that you support
and love him or her, and that you are willing to help him or her find hope in
life again. One of the most effective ways to prevent teen suicide is to
recognize the signs of suicidal thoughts and feelings, and seek professional
help. Some of the most effective teen suicide prevention programs consist of
identifying and treating the following problems:
• Mental and learning disorders
• Substance abuse problems
• Problems dealing with stress
• Behavior Problems (such as
controlling aggressive and impulsive behavior)
(prognosis,
teensuicide.us)
ADDICTIONS
According to Medilexicon's medical
dictionary:
Addiction is Habitual psychological or
physiologic dependence on a substance or practice that is beyond voluntary
control.
Withdrawal has many meanings, one of which is
a psychological and/or physical syndrome caused by the abrupt cessation of the
use of a drug in an habituated person.
According
to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),
published by the American Psychiatric Association:
Substance
dependence: When an
individual persists in use of alcohol or other drugs despite problems related
to use of the substance, substance dependence may be diagnosed. Compulsive and
repetitive use may result in tolerance to the effect of the drug and withdrawal
symptoms when use is reduced or stopped. This, along with Substance Abuse are
considered Substance Use Disorders.
• The signs and symptoms of substance
dependence vary according to the individual, the substance they are addicted
to, their family history (genetics), and personal circumstances.
• The person takes the substance and
cannot stop - in many cases, such as
nicotine, alcohol or drug dependence, at least one serious attempt was made to
give up, but unsuccessfully.
• Withdrawal symptoms - when body levels of that substance go below a certain
level the patient has physical and mood-related symptoms. There are cravings,
bouts of moodiness, bad temper, poor
focus, a feeling of being depressed and empty, frustration, anger, bitterness
and resentment.
• There may suddenly be increased
appetite. Insomnia is a common symptom
of withdrawal. In some cases the individual may have constipation or diarrhea.
With some substances, withdrawal
can trigger violence, trembling, seizures, hallucinations, and sweats.
• Addiction continues despite health
problem awareness - the individual continues taking the substance regularly,
even though they have developed illnesses linked to it. For example, a smoker
may continue smoking even after a lung or heart condition develops.
• Social and/or recreational sacrifices - some activities are given up
because of an addiction to something. For example, an alcoholic may turn down
an invitation to go camping or spend a day out on a boat if no alcohol is
available, a smoker may decide not to
meet up with friends in a smoke-free pub or restaurant.
• Maintaining a good supply - people
who are addicted to a substance will always make sure they have a good supply
of it, even if they do not have much money. Sacrifices may be made in the house budget to make sure the substance
is as plentiful as possible.
• Taking risks (1) - in some cases the addicted individual make take risks
to make sure he/she can obtain his/her substance, such as stealing or trading
sex for money/drugs.
• Taking risks (2) - while under the influence of some substances the
addict may engage in risky activities, such as driving fast.
• Dealing with problems - an addicted
person commonly feels they need their drug to deal with their problems.
• Obsession - an addicted person may
spend more and more time and energy focusing on ways of getting hold of their
substance, and in some cases how to use it.
• Secrecy and solitude - in many cases
the addict may take their substance alone, and even in secret.
• Denial - a significant number of people who are addicted to a substance
are in denial. They are not aware (or refuse to acknowledge) that they have a
problem.
• Excess consumption - in some
addictions, such as alcohol, some drugs and even nicotine, the individual
consumes it to excess. The consequence can be blackouts (cannot remember chunks of time) or physical symptoms, such as a
sore throat and bad persistent cough (heavy smokers).
• Dropping hobbies and activities - as
the addiction progresses the individual may stop doing things he/she used to
enjoy a lot. This may even be the case with smokers who find they cannot physically cope with taking part in their
favorite sport.
• Having stashes - the addicted
individual may have small stocks of their substance hidden away in different
parts of the house or car; often in unlikely places.
• Taking an initial large dose - this
is common with alcoholism. The individual may gulp drinks down in order to get drunk and then feel good.
• Having problems with the law - this
is more a characteristic of some drug and alcohol addictions (not nicotine, for
example). This may be either because the substance
impairs judgment and the individual takes risks they would not take if they were sober, or in order
to get hold of the substance they break the law.
• Financial difficulties - if the
substance is expensive the addicted individual may sacrifice a lot to make sure
its supply is secured. Even cigarettes, which in some countries, such as the
UK, parts of Europe and the USA cost over $11 dollars for a packet of twenty -
a 40-a-day smoker in such an area will need to put aside $660 per month, nearly
$8,000 per year.
• Relationship problems - these are more common in drug/alcohol addiction.
Treatment
These
typically focus on getting sober and preventing relapses. Individual, group
and/or family sessions may form part of the program. Depending on the level of
addiction, patient behaviors, and type of substance this may be in outpatient
or residential settings.
• Psychotherapy - there may be
one-to-one (one-on-one) or family sessions with a specialist.
• Help with coping with cravings,
avoiding the substance, and dealing with possible
relapses are key to effective addiction programs. If the patient’s family can become involved there is
a better probability of positive
outcomes.
• Self-help groups - these may help
the patient meet other people with the same problem, which often boosts motivation. Self-help groups can be
a useful source of education and
information too. Examples include Alcoholics Anonymous and Narcotics Anonymous. For those dependent on nicotine, ask
your doctor or nurse for information on local self-help groups.
• Help with withdrawal symptoms – the
main aim is usually to get the addictive substance out of the patient’s body as
quickly as possible. Sometimes the addict is given
gradually reduced dosages (tapering). In some cases a substitute substance is
given. Depending on what the person is addicted
to, as well as some other factors, the doctor may recommend treatment either as
an outpatient or inpatient.
DEPRESSION
Symptoms
• Persistent sad and irritable mood
• Loss of interest or pleasure in
activities once enjoyed
• Significant change in appetite and
body weight
• Difficulty sleeping or oversleeping
• Physical signs of agitation or
excessive lethargy and loss of energy
• Feelings of worthlessness or
inappropriate guilt
• Difficulty concentrating
• Recurrent thoughts of death or
suicide
Treatment
• Develop a caring, supportive school environment for
children, parents, and faculty.
• Ensure that every child and parent feels welcome in the school.
• Prevent all forms of bullying as a vigorously enforced school policy.
• Establish clear rules and publicize and enforce them fairly and consistently.
• Have suicide and violence prevention plans in place and
implement
them.
• Have specific plans for dealing with the media, parents,
faculty,
and students in the aftermath of suicide, school
violence,
or natural disaster.
• Break the conspiracy of silence (making it clear that it is
the duty
of every student to report any threat of violence
or
suicide to a responsible adult).
• Ensure that at least one responsible adult in the school
takes a
special interest in each student.
• Emphasize and facilitate home–school collaboration.
• Train faculty and parents to recognize the risk factors and
warning
signs of depression.
• Train faculty and parents in appropriate interventions for
students
suspected of being depressed.
• Utilize the expertise of mental health professionals in the
school
(school psychologists, school social workers, and
school
counselors) in planning prevention and
intervention,
as well as in training others.
ANXIETY
• Generalized anxiety disorder: This disorder
involves excessive, unrealistic worry and tension, even if there is little or nothing to provoke
the anxiety.
Symptoms vary depending on the type of
anxiety disorder, but general symptoms include:
• Feelings of panic, fear, and
uneasiness
• Uncontrollable, obsessive thoughts
• Repeated thoughts or flashbacks of
traumatic experiences
• Nightmares
• Ritualistic behaviors, such as
repeated hand washing
• Problems sleeping
• Cold or sweaty hands and/or feet
• Shortness of breath
• Palpitations
• An inability to be still and calm
• Dry mouth
• Numbness or tingling in the hands or
feet
• Nausea
• Muscle tension
• Dizziness
Treatment:
Fortunately,
much progress has been made in the last two decades in the treatment of people
with mental illnesses, including anxiety disorders. Although the exact
treatment approach depends on the type of disorder, one or a combination of the
following therapies may be used for most anxiety disorders:
• Medication: Drugs used to reduce the symptoms
of anxiety disorders include anti-depressants
and anxiety-reducing drugs.
• Psychotherapy:
Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process
in which trained mental health
professionals help people by talking through strategies for understanding and dealing with their
disorder.
• Cognitive-behavioral therapy:
People suffering from anxiety disorders often participate in this type of
psychotherapy in which the person learns to recognize and change thought
patterns and behaviors that lead to troublesome feelings.
• Dietary and lifestyle changes
• Relaxation therapy
http://www.medicalnewstoday.com/info/addiction/treatment-for-addiction.php
CONDUCT DISORDER
Children
and adolescents with this disorder
have great difficulty following rules and
behaving in a socially acceptable way. They are often viewed by other children, adults and social agencies
as "bad" or delinquent,
rather than mentally ill. Many factors may contribute to a child developing conduct disorder, including
brain damage, child abuse or neglect,
genetic vulnerability, school failure, and traumatic
life experiences.
Signs
and Symptoms:
• Aggression to people and animals
•
bullies,
threatens or intimidates others
•
often
initiates physical fights
•
has
used a weapon that could cause
serious physical harm to others (e.g.
a bat, brick, broken bottle, knife or gun)
•
is
physically cruel to people or animals
•
steals
from a victim while confronting them
(e.g. assault)
•
forces
someone into sexual activity
• Destruction of Property
•
deliberately
engaged in fire setting with the intention to cause damage
•
deliberately
destroys other's property
• Deceitfulness, lying, or stealing
•
has
broken into someone else's building, house, or car
•
lies
to obtain goods, or favors or to avoid obligations
•
steals
items without confronting a victim
(e.g. shoplifting, but without breaking
and entering)
• Serious violations of rules
•
often
stays out at night despite parental objections
•
runs
away from home
•
often
truant from school
Treatment:
Treatment
for conduct disorder is based on many factors, including the child's age, the
severity of symptoms, as well as the child's ability to participate in and
tolerate specific therapies. Treatment usually consists of a combination of the
following:
• Psychotherapy: is aimed at helping
the child learn to express and control anger in more appropriate ways. A type
of therapy called cognitive-behavioral therapy aims to reshape the child's
thinking (cognition) to improve problem solving skills, anger management, moral
reasoning skills, and impulse control. Family
therapy may be used to help improve family interactions and communication among
family members. A specialized therapy technique called parent management
training (PMT) teaches parents ways to positively
alter their child's behavior in the home.
• Medication: Although there is no
medication formally approved to
treat conduct disorder, various drugs may be used to treat some of its
distressing symptoms, as well as any other mental
illnesses that may be present, such as ADHD or major depression.
http://www.webmd.com/mental-health/mental-health-conduct-disorder?page=2
ODD
In
children with Oppositional Defiant Disorder (ODD), there is an ongoing pattern
of uncooperative, defiant, and hostile behavior toward authority figures that
seriously interferes with the youngster’s day to day functioning.
Symptoms:
• Frequent temper tantrums
• Excessive arguing with adults
• Often questioning rules
• Active defiance and refusal to comply with adult requests and rules
• Deliberate attempts to annoy or
upset people
• Blaming others for his or her
mistakes or misbehavior
• Often being touchy or easily annoyed by others
• Frequent anger and resentment
• Mean and hateful talking when upset
• Spiteful attitude and revenge
seeking
http://aacap.org/page.ww?name=Children+with+Oppositional+Defiant+Disorder§ion=Facts+for+Families
Treatment:
• parenting modification strategies
• social and emotional skills training for children
• in some cases, the addition of
medication to the therapy plan
• Working with your clinician, you can
make a difference for your child by learning
and using new:
• communication skills
• parenting skills
• conflict resolution skills
• anger management skills
ADHD
It is
normal for children to have trouble focusing and behaving at one time or
another. However, children with ADHD do not just grow out of these behaviors.
The symptoms continue and can cause difficulty at school, at home, or with
friends.
Symptoms:
• have a hard time paying attention
• daydream a lot
• not seem to listen
• be easily distracted from schoolwork
or play
• forget things
• be in constant motion or unable to
stay seated
• squirm or fidget
• talk too much
• not be able to play quietly
• act and speak without thinking
• have trouble taking turns
• interrupt others
Types
There are
three different types of ADHD, depending on which symptoms are strongest in the
individual:
• Predominantly Inattentive Type: It is
hard for the individual to organize or finish a task, to pay attention to details, or to follow
instructions or conversations. The person is easily distracted or forgets
details of daily routines.
• Predominantly Hyperactive-Impulsive
Type: The person
fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may
run, jump or climb constantly. The
individual feels restless and has trouble with impulsivity. Someone who is
impulsive may interrupt others a lot, grab
things from people, or speak at inappropriate times. It is hard for the person to wait their turn or
listen to directions. A person with
impulsiveness may have more accidents and injuries than others.
• Combined Type:
Symptoms of the above two types are equally present in the
person.
Treatment
• Stimulant and Non-stimulant
medications
• Exercise
AUTISM SPECTRUM DISORDER
Types:
• Autistic Disorder (also called
"classic" autism)
This is
what most people think of when hearing the word "autism." People with
autistic disorder usually have
significant language delays, social and communication challenges, and unusual
behaviors and interests. Many people with autistic disorder also have
intellectual disability.
• Asperger Syndrome
People
with Asperger syndrome usually have
some milder symptoms of autistic disorder.
They might have social challenges and unusual behaviors and interests. However,
they typically do not have problems with language
or intellectual disability.
• Pervasive Developmental Disorder –
Not Otherwise Specified(PDD-NOS; also called "atypical autism")
People
who meet some of the criteria for
autistic disorder or Asperger syndrome, but not all, may be diagnosed with PDD-NOS. People with PDD-NOS
usually have and milder symptoms than those with autistic disorder. The
symptoms might cause only social and communication challenges.
Signs and Symptoms
• ASDs begin before the age of 3 and last throughout a person's life, although
symptoms may improve over time. Some children with an ASD show hints of future
problems within the first few months of life. In others, symptoms might not
show up until 24 months or later. Some children
with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining
new skills, or they lose the skills
they once had.
A person
with an ASD might:
• Not respond to their name by 12
months
• Not point at objects to show
interest (point at an airplane flying over) by 14 months
• Not play "pretend" games
(pretend to "feed" a doll) by
18 months
• Avoid eye contact and want to be
alone
• Have trouble understanding other
people's feelings or talking about their own feelings
• Have delayed speech and language
skills
• Repeat words or phrases over and
over (echolalia)
• Give unrelated answers to questions
• Get upset by minor changes
• Have obsessive interests
• Flap their hands, rock their body,
or spin in circles
• Have unusual reactions to the way
things sound, smell, taste, look, or feel
Treatment:
There is no cure for ASDs. Therapies
and behavioral interventions are
designed to remedy specific symptoms and
can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions
that meet the specific needs of individual children. Most health care
professionals agree that the earlier the intervention, the better.
• Educational/behavioral
interventions: Therapists use highly structured and intensive skill-oriented training sessions to help
children develop social and language
skills, such as Applied Behavioral Analysis. Family counseling for the parents
and siblings of children with an ASD often
helps families cope with the particular challenges of living with a child with
an ASD.
• Medications: Doctors may prescribe
medications for treatment of specific autism-related
symptoms, such as anxiety, depression, or obsessive-compulsive
disorder. Antipsychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more anticonvulsant drugs. Medication
used to treat people with attention
deficit disorder can be used effectively to help decrease impulsivity and hyperactivity.
• Other therapies: There are a number of controversial therapies or interventions available, but few, if any, are
supported by scientific studies.
Parents should use caution before adopting any unproven
treatments. Although dietary interventions have been helpful in some children, parents should be careful that their child’s nutritional status is carefully
followed.
POST
TRAUMATIC STRESS DISORDER
Post-traumatic
stress disorder symptoms typically start within three months of a traumatic
event. In a small number of cases, though, PTSD symptoms may not appear until
years after the event.
Post-traumatic
stress disorder symptoms are generally grouped into three types: intrusive
memories, avoidance and numbing, and increased anxiety or emotional arousal
(hyperarousal).
Symptoms:
• Flashbacks, or reliving the
traumatic event for minutes or even days at a time
• Upsetting dreams about the traumatic
event
• Symptoms of avoidance and emotional
numbing may include:
• Trying to avoid thinking or talking about the traumatic event
• Feeling emotionally numb
• Avoiding activities you once enjoyed
• Hopelessness about the future
• Memory problems
• Trouble concentrating
• Difficulty maintaining close
relationships
• Symptoms of anxiety and increased
emotional arousal may include:
• Irritability or anger
• Overwhelming guilt or shame
• Self-destructive behavior, such as
drinking too much
• Trouble sleeping
• Being easily startled or frightened
• Hearing or seeing things that aren't
there
Post-traumatic
stress disorder symptoms can come and go. You may have more post-traumatic stress
disorder symptoms when things are stressful in general, or when you run into
reminders of what you went through. You may hear a car backfire and relive
combat experiences, for instance. Or you may see a report on the news about a
rape and feel overcome by memories of your own assault.
Treatment:
Post-traumatic
stress disorder treatment often includes both medication and psychotherapy.
Combining these treatments can help improve your symptoms and teach you skills
to cope better with the traumatic event — and life beyond it.
• Medications
• Several types of medications can
help symptoms of post-traumatic stress disorder
improve.
• Antipsychotics.In some cases, you
may be prescribed a short course of antipsychotics to relieve severe anxiety and related problems, such as
difficulty sleeping or emotional
outbursts.
• Antidepressants. These medications
can help symptoms of both depression and anxiety. They can also help improve sleep problems and improve your
concentration. The selective
serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are FDA-approved for
the treatment of PTSD.
• Anti-anxiety medications. These drugs
also can improve feelings of anxiety and stress.
• Psychotherapy
• Cognitive therapy. This type of talk therapy helps you recognize the
ways of thinking (cognitive patterns) that are keeping you stuck — for example,
negative or inaccurate ways of
perceiving normal situations.
• In PTSD treatment, cognitive therapy
often is used along with a behavioral therapy called exposure therapy.
• Exposure therapy. This behavioral
therapy technique helps you safely face the very thing that you find frightening, so that you can learn to cope with it effectively. A new approach to exposure
therapy uses "virtual reality"
programs that allow you to re-enter the setting in which you experienced trauma — for example, a "Virtual
Iraq" program.
• Eye movement desensitization and
reprocessing (EMDR). This type of therapy combines exposure therapy with a
series of guided eye movements
that help you process traumatic memories.
• All these approaches can help you
gain control of lasting fear after a traumatic
event. The type of therapy that may be best for you depends on a number of factors that you and your health care
professional can discuss.
• Medications and psychotherapy also
can help you if you've developed other problems
related to your traumatic experience, such as depression, anxiety, or alcohol
or substance abuse. You don't have to try to handle the burden of PTSD on your
own.
SCHIZOPHRENIA
Symptoms:
There are
five types of symptoms characteristic of schizophrenia: delusions,
hallucinations, disorganized speech, disorganized behavior, and the so-called
“negative” symptoms. However, the signs and symptoms of schizophrenia vary
dramatically from person to person, both in pattern and severity. Not every
person with schizophrenia will have all symptoms, and the symptoms of
schizophrenia may also change over time.
Delusions
• A delusion is a firmly-held idea
that a person has despite clear and obvious evidence that it isn’t true.
Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder.
Often, these delusions involve illogical
or bizarre ideas or fantasies. Common schizophrenic
delusions include:
• Delusions of persecution – Belief
that others, often a vague “they,” are out to get him or her. These persecutory
delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive
particles delivered through my tap
water”).
• Delusions of reference – A neutral environmental event is believed
to have a special and personal
meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them.
• Delusions of grandeur – Belief that
one is a famous or important figure, such as Jesus Christ or Napolean.
Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one
else has (e.g. the ability to fly).
• Delusions of control – Belief that one’s thoughts or actions are being
controlled by outside, alien forces. Common delusions of control include
thought broadcasting (“My private thoughts are being transmitted to others”),
thought insertion (“Someone is planting thoughts in my head”), and thought
withdrawal (“The CIA is robbing me of my thoughts”).
Hallucinations
• Hallucinations are sounds or other
sensations experienced as real when they exist only in the person's mind. While
hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some
other sound) are most common in
schizophrenia. Visual hallucinations are also relatively common. Research
suggests that auditory hallucinations occur when people misinterpret their own
inner self-talk as coming from an outside source.
• Schizophrenic hallucinations are
usually meaningful to the person experiencing them. Many times, the voices are
those of someone they know. Most commonly, the voices are critical, vulgar, or
abusive. Hallucinations also tend to be worse when
the person is alone.
Disorganized speech
• Fragmented thinking is
characteristic of schizophrenia. Externally, it can be observed in the way a
person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought.
They may respond to queries with an
unrelated answer, start sentences with one topic and end somewhere completely different, speak
incoherently, or say illogical things.
Common signs of disorganized speech
in schizophrenia include:
• Loose associations – Rapidly shifting from topic to topic, with no
connection between one thought and
the next.
• Neologisms – Made-up words or phrases that only have meaning to the patient.
• Perseveration – Repetition of words and statements; saying
the same thing over and over.
• Clang – Meaningless use of rhyming words (“I said the bread and read
the shed and fed Ned at the head").
Disorganized behavior
• Schizophrenia disrupts goal-directed
activity, causing impairments in a person’s ability to take care of him or
herself, work, and interact with others. Disorganized behavior appears as:
• A decline in overall daily
functioning
• Unpredictable or inappropriate emotional responses
• Behaviors that appear bizarre and
have no purpose
• Lack of inhibition and impulse
control
Negative symptoms (absence
of normal behaviors)
• The so-called “negative” symptoms of
schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms
of schizophrenia include:
• Lack of emotional expression
–Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions.
• Lack of interest or enthusiasm –
Problems with motivation; lack of self-care.
• Seeming lack of interest in the
world – Apparent unawareness of the environment; social withdrawal.
• Speech difficulties and
abnormalities – Inability to carry a conversation; short and sometimes
disconnected replies to questions; speaking in monotone.
Types of schizophrenia
There are
three major subtypes of schizophrenia, each classified by their most prominent
symptom:
• paranoid schizophrenia
• disorganized schizophrenia
• catatonic schizophrenia
Signs and symptoms of
paranoid schizophrenia
The
defining feature of paranoid schizophrenia is absurd or suspicious ideas and
beliefs. These ideas typically revolve
around a coherent, organized theme or “story” that remains consistent over time. Delusions of persecution are the
most frequent theme, however delusions
of grandeur are also common.
People
with paranoid schizophrenia show a history
of increasing paranoia and difficulties in their relationships. They tend to
function better than individuals with other schizophrenic subtypes. In
contrast, their thinking and behavior is less disordered and their long-term
prognosis is better.
Signs and symptoms of
disorganized schizophrenia
• Disorganized schizophrenia generally
appears at an earlier age than other types of schizophrenia. Its onset is
gradual, rather than abrupt, with the person gradually retreating into his or
her fantasies.
• The distinguishing characteristics
of this subtype are disorganized speech, disorganized
behavior, and blunted or inappropriate emotions. People with disorganized
schizophrenia also have trouble taking care of themselves, and may be unable to
perform simple tasks such as bathing
or feeding themselves.
• The symptoms of disorganized schizophrenia include:
Impaired
communication skills
Incomprehensible
or illogical speech
Inappropriate
reactions (e.g. laughing at a
funeral)
Emotional
indifference
Infantile
behavior (baby talk, giggling)
Peculiar
facial expressions and mannerisms
|
•
|
|
People
with disorganized schizophrenia sometimes suffer from hallucinations and
delusions, but unlike the paranoid subtype, their fantasies aren’t consistent
or organized.
Signs and symptoms of
catatonic schizophrenia
•
• The hallmark of catanoic schizophrenia
is a disturbance in movement:
either a decrease in motor activity, reflecting a stuporous state, or an
increase in motor activity, reflecting an excited state.
Stuporous
motor signs. The stuporous state reflects a dramatic reduction in activity. The
person often ceases all voluntary
movement and speech, and may be extremely resistant to any change in his or her
position, even to the point of holding an awkward, uncomfortable position for
hours.
Excited
motor signs. Sometimes, people with catatonic schizophrenia pass suddenly from
a state of stupor to a state of extreme excitement. During this frenzied
episode, they may shout, talk rapidly, pace back and forth, or act out in
violence—either toward themselves or others.
• People with catatonic schizophrenia
can be highly suggestible. They may
automatically obey commands, imitate the actions of others, or mimic what
others say.
Treatment
Antipsychotic
drugs aren’t the only treatment people with schizophrenia need. Psychotherapy
and support are also key.
With
proper treatment, some individuals with schizophrenia can recover.
About a quarter of young people with
schizophrenia who get treatment get better within six months to two years,
research has found.
Another
35 to 40 percent see significant improvements in their symptoms after longer-term treatment—enough to let
them live relatively normal lives
outside hospitals with only minor symptoms.
Antipsychotic
drugs play a crucial role in treatment. These drugs don’t cure
schizophrenia. Instead, they reduce
symptoms such as delusions and hallucinations.
The drugs
can have side effects, such as physical agitation and muscle spasms. In addition, their long-term
use causes permanent neurological damage.
Reduced
symptoms don’t necessarily mean individuals are able to function effectively
outside a hospital, however.
Psychosocial
support can help make that possible.
Psychotherapy
can help individuals learn how to function in appropriate, effective and satisfying ways. By teaching individuals
how to cope, psychotherapy can
help people overcome dysfunction and regain their lives.
Individuals
may also need training in social skills or vocational counseling and job
training.
Family education, family psychotherapy and
self-help groups are also beneficial.
EATING DISORDERS
Eating
disorders -- such as anorexia, bulimia, and binge eating disorder – include
extreme emotions, attitudes, and behaviors surrounding weight and food issues.
Eating disorders are serious emotional and physical problems that can have
life-threatening consequences for females and males. Click on the links below
to learn more about the different types of eating disorders and their symptoms.
Anorexia
Nervosa
Anorexia
nervosa is a serious, potentially life-threatening eating disorder
characterized by self-starvation and excessive weight loss.
Symptoms
• Resistance to
maintaining body weight at or above a minimally normal weight for age and height.
• Intense fear of weight gain or being “fat,” even
though underweight.
• Disturbance in the
experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the
seriousness of low body weight.
• Loss of menstrual
periods in girls and women post-puberty.
Eating
disorders experts have found that prompt intensive treatment significantly
improves the chances of recovery. Therefore, it is important to be aware
of some of the warning signs of anorexia nervosa.
Warning
Signs
• Dramatic weight loss.
• Preoccupation with weight, food, calories, fat grams, and
dieting.
• Refusal to eat certain
foods, progressing to restrictions against whole categories of food (e.g. no
carbohydrates, etc.).
• Frequent comments about
feeling “fat” or overweight despite weight loss.
• Anxiety about gaining
weight or being “fat.”
• Denial of hunger.
• Development of food
rituals (e.g. eating foods in certain orders, excessive chewing, rearranging
food on a plate).
• Consistent excuses to
avoid mealtimes or situations involving food.
• Excessive, rigid
exercise regimen--despite weather, fatigue, illness, or injury, the need to
“burn off” calories taken in.
• Withdrawal from usual
friends and activities.
• In general, behaviors
and attitudes indicating that weight loss, dieting, and control of food are
becoming primary concerns.
Health
Consequences of Anorexia Nervosa
Anorexia
nervosa involves self-starvation.; The body is denied the essential nutrients
it needs to function normally, so it is forced to slow down all of its
processes to conserve energy. This “slowing down” can have serious medical
consequences:
• Abnormally slow heart
rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as
heart rate and blood pressure levels
sink lower and lower.
• Reduction of bone
density (osteoporosis), which results in dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney
failure.
• Fainting, fatigue, and
overall weakness.
• Dry hair and skin, hair
loss is common.
• Growth of a downy layer
of hair called lanugo all over the body, including the face, in an effort to
keep the body warm.
About
Anorexia Nervosa
Approximately
90-95% of anorexia nervosa sufferers
are girls and women.
Between
0.5–1% of American women suffer from anorexia nervosa.
Anorexia
nervosa is one of the most common psychiatric diagnoses in young women.
Between
5-20% of individuals struggling with anorexia nervosa will die. The
probabilities of death increases within that range depending on the length of
the condition.
Anorexia
nervosa has one of the highest death rates of any mental health condition.
Anorexia
nervosa typically appears in early to mid-adolescence.
Binge Eating Disorder
Binge
Eating Disorder (BED) is a type of eating disorder not otherwise specified and
is characterized by recurrent binge eating without the regular use of
compensatory measures to counter the binge eating.
Symptoms
• Frequent episodes of
eating large quantities of food in short periods of time.
• Feeling out of control over eating behavior during
the episode.
• Feeling depressed, guilty, or disgusted by the
behavior.
There
are also several behavioral
indicators of BED including eating when not hungry, eating alone because of
embarrassment over quantities consumed, eating until uncomfortably full.
Health
Consequences of Binge Eating Disorder
The
health risks of BED are most commonly those associated with clinical obesity.
Some of the potential health consequences of binge eating disorder
include:
• High blood pressure
• High cholesterol levels
• Heart disease
• Diabetes mellitus
• Gallbladder disease
• Musculoskeletal problems
About
Binge Eating Disorder
• The prevalence of BED is
estimated to be approximately 1-5% of the general
population.
• Binge eating disorder
affects women slightly more often than men--estimates
indicate that about 60% of people struggling with binge eating disorder are female, 40% are male
• People who struggle with binge eating disorder can
be of normal or heavier than
average weight.
• BED is often associated
with symptoms of depression.
• People struggling with binge eating disorder often
express distress, shame, and guilt over their eating behaviors.
• People with binge eating disorder report a lower
quality of life than non-binge eating disorder.
Bulimia
Nervosa
Bulimia
nervosa is a serious, potentially life-threatening eating disorder
characterized by a cycle of bingeing and compensatory behaviors such as
self-induced vomiting designed to undo or compensate for the effects of binge
eating.
Symptoms
• Regular intake of large
amounts of food accompanied by a sense of loss of control over eating behavior.
• Regular use of
inappropriate compensatory behaviors such as self-induced vomiting, laxative or
diuretic abuse, fasting, and/or obsessive or compulsive exercise.
• Extreme concern with
body weight and shape.
The
chance for recovery increases the earlier bulimia nervosa is detected.
Therefore, it is important to be aware of some of the warning signs of bulimia
nervosa.
Warning
Signs of Bulimia Nervosa
• Evidence of binge
eating, including disappearance of large amounts of food in short periods of
time or finding wrappers and containers indicating the consumption of large
amounts of food.
• Evidence of purging
behaviors, including frequent trips to the bathroom after meals, signs and/or
smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
• Excessive, rigid
exercise regimen--despite weather, fatigue, illness, or injury, the compulsive
need to “burn off” calories taken in.
• Unusual swelling of the
cheeks or jaw area.
• Calluses on the back of
the hands and knuckles from self-induced vomiting.
• Discoloration or
staining of the teeth.
• Creation of lifestyle
schedules or rituals to make time for binge-and-purge sessions.
• Withdrawal from usual
friends and activities.
• In general, behaviors
and attitudes indicating that weight loss, dieting, and control of food are
becoming primary concerns.
• Continued exercise
despite injury; overuse injuries.
Health
Consequences of Bulimia Nervosa
Bulimia
nervosa can be extremely harmful to the body. The recurrent
binge-and-purge cycles can damage the entire digestive system and purging
behaviors can lead to electrolyte and chemical imbalances in the body that
affect the heart and other major organ functions. Some of the health
consequences of bulimia nervosa include:
• Electrolyte imbalances
that can lead to irregular heartbeats and possibly heart failure and death.
Electrolyte imbalance is caused by dehydration and loss of potassium and
sodium from the body as a result of purging behaviors.
• Inflammation and
possible rupture of the esophagus from frequent vomiting.
• Tooth decay and staining from stomach acids
released during frequent vomiting.
• Chronic irregular bowel
movements and constipation as a result of laxative abuse.
- Gastric rupture
is an uncommon but possible side effect of binge eating.
About
Bulimia Nervosa
• Bulimia nervosa affects
1-2% of adolescent and young adult women.
• Approximately 80% of bulimia nervosa patients are female.
• People struggling with bulimia nervosa usually
appear to be of average body weight.
• Many people struggling with bulimia nervosa
recognize that their behaviors are unusual and perhaps dangerous to their
health.
• Bulimia nervosa is
frequently associated with symptoms of depression and changes in social
adjustment.
• Risk of death from
suicide or medical complications is markedly increased for eating disorders
Eating
Disorder Not Otherwise Specified (EDNOS)
Eating
disorders such as anorexia and bulimia include extreme emotions, attitudes, and
behaviors surrounding weight and food issues. They are serious disorders
and can have life-threatening consequences. The same is true for a category of
eating disorders known as eating disorders not otherwise specified or EDNOS.
These serious eating disorders can include any combination of signs and
symptoms typical of anorexia and bulimia, so it may be helpful to first look at
anorexia and bulimia.
Symptoms
associated with anorexia nervosa include:
• Refusal to maintain body
weight at or above a minimally normal weight for height, body type, age,
and activity level
• Intense fear of weight gain or being “fat”
• Feeling “fat” or overweight despite dramatic weight
loss
• Loss of menstrual
periods
• Extreme concern with
body weight and shape
Symptoms
associated with bulimia nervosa include:
• Repeated episodes of
bingeing and purging
• Feeling out of control during a binge and eating
beyond the point of comfortable fullness
• Purging after a binge,
(typically by self-induced vomiting, abuse of laxatives, diet pills and/or
diuretics, excessive exercise, or fasting)
• Frequent dieting
• Extreme concern with
body weight and shape
The
following are some common examples of eating disorders not otherwise specified,
but your experience may be different. If you are concerned about your eating
and exercise habits and your thoughts and emotions concerning food, activity
and body image, we urge you to consult an ED expert.
Examples
of EDNOS
• Menstruation is still
occurring despite meeting all other criteria for anorexia nervosa.
• All conditions are
present to qualify for anorexia nervosa except the individual's current weight
is in the normal range or above.
• Purging or other
compensatory behaviors are not occurring at a frequency less than the strict
criteria for bulimia nervosa
• Purging without
Binging—sometimes known as purging disorder
• Chewing and spitting out
large amounts of food but not swallowing
The
commonality in all of these conditions is the serious emotional and
psychological suffering and/or serious problems in areas of work, school or
relationships. If something does not seem right, but your experience does not fall
into a clear category, you still deserve attention.
Treating
an Eating Disorder
Treatment
is available. Recovery is possible.
• Eating disorders are serious health conditions
that can be both physically and emotionally destructive.
• People with eating disorders need to seek
professional help.
• Early diagnosis and intervention significantly
enhance recovery.
• Eating disorders can become chronic, debilitating,
and even life-threatening conditions.
What
Does Treatment Involve?
The
most effective and long-lasting treatment for an eating disorder is some form
of psychotherapy or counseling, coupled with careful attention to medical and
nutritional needs. Some medications have been shown to be helpful.
Ideally, whatever treatment is offered should be tailored to the
individual; this will vary according to both the severity of the disorder and
the patient’s individual problems, needs and strengths.
Recommended
care is provided by multidisciplinary team including but not limited to a
psychologist, psychiatrist, social worker, nutritionist, and/or primary care
physician.
Care
should be coordinated and provided by a health professional with expertise and
experience in dealing with eating disorders.
Treatment
must address the eating disorder symptoms and medical consequences, as well as
psychological, biological, interpersonal and cultural forces that contribute to
or maintain the eating disorder. Nutritional counseling is also necessary
and should incorporate education about nutritional needs, as well as planning
for and monitoring rational choices by the individual patient.
Many
people with eating disorders respond to outpatient therapy, including individual,
group or family therapy and medical management by their primary care provider.
Support groups, nutrition counseling, and psychiatric medications
administered under careful medical supervision have also proven helpful for
some individuals. Family Based Treatment is a well-established method for
families with minors.
Inpatient
care (including hospitalization and/or residential care in an eating disorders
specialty unit or facility) is necessary when an eating disorder has led to
physical problems that may be life threatening, or when an eating disorder is
causing severe psychological or behavioral problems. Inpatient stays
typically require a period of outpatient follow-up and aftercare to address
underlying issues in the individual’s eating disorder.
The
exact treatment needs of each individual will vary. It is important for
individuals struggling with an eating disorder to find a health professional
they trust to help coordinate and oversee their care.
BIPOLAR DISORDER
Bipolar
disorder
is a serious mental illness in which common emotions become intensely and often
unpredictably magnified. Individuals with bipolar disorder can quickly swing
from extremes of happiness, energy and clarity to sadness, fatigue and
confusion. These shifts can be so devastating that individuals may choose
suicide.
All
people with bipolar disorder have manic episodes — abnormally elevated or
irritable moods that last at least a week and impair functioning. But not all
become depressed.
Bipolar
disorder
Manic
depression; Bipolar affective disorder
Bipolar
disorder is a condition in which people go back and forth between periods of a
very good or irritable mood and depression. The "mood swings"
between mania and depression can be very quick.
Causes,
incidence, and risk factors
Bipolar
disorder affects men and women equally. It usually starts between ages 15 - 25.
The exact cause is unknown, but it occurs more often in relatives of people with
bipolar disorder.
Types
of bipolar disorder:
• People with bipolar disorder type I have had at
least one manic episode and periods of major depression. In the past, bipolar
disorder type I was called manic depression.
• People with bipolar disorder type II have never had
full mania. Instead they experience
periods of high energy levels and impulsiveness that are not as extreme as mania (called hypomania). These periods alternate with episodes of depression.
• A mild form of bipolar
disorder called cyclothymia involves less severe mood
swings. People with this form alternate between hypomania and mild depression.
People with bipolar disorder type II or
cyclothymia may be wrongly diagnosed as having depression.
In
most people with bipolar disorder, there is no clear cause for the manic or
depressive episodes. The following may trigger a manic episode in people with
bipolar disorder:
• Life changes such as
childbirth
• Medications such as
antidepressants or steroids
Periods
of sleeplessness
•
• Recreational drug use
Symptoms
The
manic phase may last from days to months. It can include the following
symptoms:
• Easily distracted
• Little need for sleep
• Poor judgment
• Poor temper control
• Reckless behavior and
lack of self control
•
Poor
judgment
•
Sex
with many partners (promiscuity)
•
Spending
sprees
• Very elevated mood
•
Excess
activity (hyperactivity)
•
Increased
energy
•
Racing
thoughts
•
Talking
a lot
•
Very
high self-esteem (false beliefs about self or abilities)
• Very involved in
activities
• Very upset (agitated or
irritated)
These
symptoms of mania occur with bipolar disorder I. In people with bipolar
disorder II, the symptoms of mania are similar but less intense.
The
depressed phase of both types of bipolar disorder includes the following
symptoms:
• Daily low mood or
sadness
• Difficulty
concentrating, remembering, or making decisions
• Eating problems
•
Loss
of appetite and weight loss
•
Overeating
and weight gain
• Fatigue or lack of energy
• Feeling worthless, hopeless, or guilty
• Loss of pleasure in
activities once enjoyed
• Loss of self-esteem
• Thoughts of death and
suicide
• Trouble getting to sleep
or sleeping too much
• Pulling away from friends or activities that were
once enjoyed
There
is a high risk of suicide with bipolar disorder. Patients may
abuse alcohol or other substances, which can make the symptoms and suicide risk
worse.
Sometimes
the two phases overlap. Manic and depressive symptoms may occur together or
quickly one after the other in what is called a mixed state.
Signs
and tests
Many
factors are involved in diagnosing bipolar disorder. The health care provider
may do some or all of the following:
• Ask about your family
medical history, such as whether anyone has or had bipolar disorder
• Ask about your recent
mood swings and for how long you've had them
• Perform a thorough
examination to look for illnesses that may be causing the symptoms
• Run laboratory tests to
check for thyroid problems or drug levels
• Talk to your family
members about your behavior
• Take a medical history,
including any medical problems you have and any medications you take
• Watch your behavior and mood
Note:
Drug use may cause some symptoms. However, it does not rule out bipolar
affective disorder. Drug abuse may be a symptom of bipolar disorder.
Treatment
Periods
of depression or mania return in most patients, even with treatment. The main
goals of treatment are to:
• Avoid moving from one phase to another
• Avoid the need for a hospital stay
• Help the patient
function as well as possible between episodes
• Prevent self-injury and
suicide
• Make the episodes less
frequent and severe
The
health care provider will first try to find out what may have triggered the
mood episode. The provider may also look for any medical or emotional problems
that might affect treatment.
The
following drugs, called mood stabilizers, are usually used first:
• Carbamazepine
• Lamotrigine
• Lithium
• Valproate (valproic
acid)
Other
antiseizure drugs may also be tried.
Other
drugs used to treat bipolar disorder include:
• Antipsychotic drugs and
anti-anxiety drugs (benzodiazepines) for mood problems
Antidepressant medications
can be added to treat depression. People with bipolar disorder are more likely
to have manic or hypomanic episodes if they are put on antidepressants. Because
of this, antidepressants are only used in people who also take a mood
stabilizer.
Electroconvulsive
therapy (ECT) may be used to treat the manic or depressive phase of bipolar
disorder if it does not respond to medication. ECT uses an electrical current
to cause a brief seizure while the patient is under anesthesia. ECT is the most
effective treatment for depression that is not relieved with medications.
Transcranial
magnetic stimulation (TMS) uses high-frequency magnetic pulses to target
affected areas of the brain. It is most often used after ECT.
Patients
who are in the middle of manic or depressive episodes may need to stay in a
hospital until their mood is stable and their behavior is under control.
Doctors
are still trying to decide the best way to treat bipolar disorder in children
and adolescents. Parents should consider the possible risks and benefits of
treatment for their children.
SUPPORT
PROGRAMS AND THERAPIES
Family
treatments that combine support and education about bipolar disorder
(psychoeducation) may help families cope and reduce the odds of symptoms
returning. Programs that offer outreach and community support services can help
people who do not have family and social support.
Important
skills include:
• Coping with symptoms that are present even while
taking medications
• Learning a healthy
lifestyle, including getting enough sleep and staying away from recreational
drugs
• Learning to take
medications correctly and how to manage side effects
• Learning to watch for
the return of symptoms, and knowing what to do when they return
Family
members and caregivers are very important in the treatment of bipolar disorder.
They can help patients find the right support services, and make sure the
patient takes medication correctly.
Getting
enough sleep is very important in bipolar disorder. A lack of sleep can trigger
a manic episode. Therapy may be helpful during the depressive phase. Joining a
support group may help bipolar disorder patients and their loved ones.
• A patient with bipolar
disorder cannot always tell the doctor about the
state of the illness. Patients often have trouble recognizing their own manic symptoms.
• Changes in mood with
bipolar disorder are not predictable. It it is sometimes
hard to tell whether a patient is responding to treatment or naturally coming
out of a bipolar phase.
• Treatments for children
and the elderly are not well-studied.
TR FACILITIES FOR AT RISK YOUTH
Recreational
Therapists work in a variety of community and clinical settings for people of
all ages with physical and/or psychological disabitiies including but not
limited to:
• Psychiatric Hospitals
• Rehabilitation Hospitals
• Substance Abuse and
Addiction Treatment Facilities
• Skilled Nursing Facilities
• Residential and Day
treatment programs for children, adolescents, and seniors
• School
• Camps
• Community Senior Centers
• Community Recreation
Centers
• Medical Hospitals
• Forensic Facilities
(prisions, juvenile hall)
• Private Practice
Wilderness
Programs
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