MH - Final Exam

Experience of psychosis

Varies greatly from person to person. Each person may have very different symptoms

Psychotic episodes

Periods of time when symptoms of psychosis are strong and interfere with daily life.

When do first episode of psychosis occur?

In adolescence or early adult life

The three phases of psychosis

Prodrome Phase, Acute Phase, and Recovery Phase

Prodrome phase

During this period the person starts to experience changes in themselves, but have not yet started experiencing clear-cut psychotic symptoms

Prodrome phase symptoms

- difficulty screening out distracting information and sensations

- difficulty focusing or understanding what they are hearing

- can last from several months to a year or more

Acute Phase

When characteristic psychotic symptoms - such as hallucinations, delusions and very odd or disorganized speech or behaviours - emerge and are most noticeable

Recovery

Within a few weeks or months of starting treatment, most people begin to recover. Many of the symptoms get less intense or disappear, and people are generally better able to cope with daily life

What is Schizophrenia?

A severe mental disorder characterized by profound disruptions in thinking, perception, language and sense of self

What does Schizophrenia Include?

- psychotic experiences, such as hearing voices or delusions

- Can impair social, educational, economic functioning

may also experience changes to the way they think and have trouble expressing themselves and managing basic daily tasks. They may become withdrawn and isolated

Recovery from schizophrenia

a gradual process that is unique to each person. The symptoms usually improve and become easier to manage

- promotes the values of hope, empowerment and optimism

What kind of disorder is schizophrenia?

It is a neurological disorder, equally diagnosed with both genders

Importance of treatment for schizophrenia

- To stabilize acute psychotic symptoms with anti-psychotic medication

- To reduce the likelihood of relapse and re-hospitalization

- To ensure appropriate treatment

Symptoms of schizophrenia

- Positive symptoms are exaggerated behaviors and seen as psychotic symptoms

- Negative symptoms include loss of behaviors

- Cognitive symptoms include difficulty with executive functions. Memory, logical thought, coherent speech

Positive symptoms Hallucination: distortion exaggeration of perception the senses

-Auditory, 70% experience most common, can be both negative or positive

-Visual, 20% see things that others do not see

-Olfactory, smelling things

-touch

-Taste

Positive symptoms Delusions

Ideas that are strange and out of touch reality

Ideas a person believes wholeheartedly but have no bases for fact

Types - Positive symptoms Delusions

- Delusions of persecution/paranoia

- Delusions of reference: attaching special and personal meaning to the actions of others or to objects and events

- Delusions of grandeur: being great, or a savior, reduce peace to the world

- Delusions of control: thoughts and feelings can be controlled by others

Negative symptoms schizophrenia

- not access to experiences and emotions that society normally have

- Expression of feeling and thoughts are lost

- Behaviours that are absent among individuals with schizophrenia but present among the general population

Types - Negative symptoms of dementia

- Flat affect: perception that one no longer has feelings, emotional flatness

- Anhedonia: Lack of drive, no medication to cure negative symptoms

- Apathy: lack of feelings, emotions, interests, or concern

Cognitive symptoms of schizophrenia

- Breakdowns of sequential thinking: can't get a linear abc in thinking

- Difficulty making sense of everyday sights, sounds and feelings

- Sensitivity to background noises, colors

CBT and schizophrenia - Develop motivation

goals and values, help them move through. Process of change

CBT and schizophrenia - Psychoeducation

learn about the illness, don't blame, understand you have a condition like any other condition

How therapist asks questions discretely (schizophrenia)

- Breakdown some of their beliefs

- With hallucination: not necessarily block it out

- If voices tell you to do things, understanding that it's just a voice, no need to act on it

- Eliminate symptoms

- Mindfulness based - you have symptoms its destructive, but walking through how to live well despite it

Communication handout (5 pages)

Look at handout, read and skim through it

CAMH Bipolar module

Understanding facts and myths, knowing how to respond to someone who is exhibiting symptoms

Diagnostic criteria for mood disorders

- Depression: Major Depressive Disorder requires 2+ weeks of low mood or loss of interest plus other symptoms (sleep, appetite, energy, concentration issues).

- Bipolar: Bipolar I requires at least one manic episode; Bipolar II requires hypomania + a depressive episode.

- Persistent patterns: Disorders like dysthymia (PDD) or cyclothymia involve long-lasting, less intense symptoms over years.

Gender - mood disorders

Depression is 2-3× more common in women; bipolar rates are similar across genders.

Age - mood disorders

Mood disorders often begin in adolescence or early adulthood; older adults show lower rates of depression

Ethnicity - mood disorders

In the U.S., European Americans show higher depression rates than African American or Hispanic groups; Native Americans show higher rates overall

Biological - Common risk factors - mood disorders

Genetics, brain chemistry, and family history increase risk (especially strong for bipolar disorder)

Environmental - Common risk factors - mood disorders

Stressful life events, trauma, and ongoing interpersonal conflict raise risk

Psychological - Common risk factors - mood disorders

Negative thinking styles, low self-esteem, and disrupted sleep routines contribute

Effective treatment for mood disorders

- Medications: Antidepressants (for depression) and mood stabilizers like lithium (for bipolar).

- Therapies: CBT, interpersonal therapy, and behavioral activation are effective for depression; social-rhythm therapy helps bipolar disorder.

- Other options: ECT or brain-stimulation techniques for severe or treatment-resistant depression.

Trevor project lecture- yellow highlights only

Skim through yellow highlighted "Intersectionality -mental health and 2SLGBTQIA youth"

Definition of concurrent disorder or dual diagnosis

Mental health issue and substance use issue

- Any combination of Mental Health Disorder (MHD) + Substance UseDisorder (SUD)= Concurrent Disorder

- 50 to 60% of people with a serious mental health issue have a concurrent substance use problem

Adverse Childhood Experiences

- The more ACEs a person had, the more likely the person was to have a wide array of have all kinds of chronic health problems

- Can still experience problems even if not having adverse childhood experiences

Resilience

Be able to adapt, overcome hardship

· Having opportunities to strengthen everyday functional skills and self-regulation.

· Having sources of faith, hope, and cultural traditions

The Four R's of Trauma-Informed Care

What are substance use disorders?

Includes...

o Alcohol

o Caffeine

o Cannabis

o Hallucinogens such as LSD

The Brains Reward System activated by substances

- Rewarding feeling people experience, may be so profound that they neglect other normal activities in favor of taking the drug

- Feelings of pleasure or euphoria, or a "high"

Nicotine - Early use of substances

Use during adolescence impacts the reward system, making it less sensitive to the usual rewards, thus priming the brain for more substance use and addiction.

Alcohol - Early use of substances

Impacts the frontal lobe which is responsible for judgment and controlling emotions.

Marijuana - Early use of substances

Increases the risk of developing depression, anxiety, and other mental health problems

CREATE - Potential relationships between substance use and mental health

can create psychiatric symptoms like psychosis

TRIGGER - Potential relationships between substance use and mental health

can trigger emergence of some mental health issues

MIMIC - Potential relationships between substance use and mental health

substance use can look like symptoms of psychiatric disorders

EXACERBATE - Potential relationships between substance use and mental health

Get it worse when using many alcohol and drugs

MASK - Potential relationships between substance use and mental health

may be hidden by substance use

INDEPENDENCE - Potential relationships between substance use and mental health

mental health disorder and substance use disorder may not be related to each other, but a common factor may underlie them both

Concurrent Disorders Ideal Treatment

- both must be treated ideally at the same time in order to identify best practices for each disorder and combine them

- An individual may be at one stage with an addiction and at another stage with a mental health issue

In our society, if substance use is a

- Moral issue then judge

- Criminal issue then incarcerate

- Disease then treat

How do people get better (concurrent disease)

o Get and stay in treatment

o Learn about their disorders

o Have peer and family support

o Have power and control over own life

Co-occurring disorders

o Neurobiological roots of substance use

o "There is only one addiction process, its core objective being the self-soothing of deep-seated fears and discomforts"

How to speak to clients - Co-occurring disorders

What is wrong with you? - What happened to you?

Relapse Prevention Model

- Relapse happens gradually

- Early warning signs of relapse

- And developing coping skills

Includes EMP

Emotional relapse

some people are more feelers - in denial, not thinking of using, isolating, irritability

Mental relapse

effort it takes to loop away from destructive behavior is really hard - effort it takes to loop away from destructive behavior is really hard

Physical relapse

physiological responses impact the way we think

Relapse prevention strategies

- Building awareness

- increase healthy leisure

- Increase positive risky behavior

- Plan for emergencies

- MET/CBT for adolescents' motivational enhancement therapy and cognitivebehavioural therapy

Recreation therapy approaches - 5 D's

- Delay

- Distract

- Deep breather

- De-catastrophize

- Drink a glass of water

Comparing step 12 AA to SMART recovery

Major differences like AA being spiritually-based and SMART being based on evidence and self-empowerment.

AA emphasizes what?

Admitting powerlessness, relying on a higher power, and full abstinence

SMART Recovery focuses on what four key tools?

Building motivation, coping with urges, problem-solving and lifestyle balance

Key distinction - Step 12 AA to SMART recovery

AA centers on surrender and spiritual support, while SMART emphasizes individual choice, cognitive-behavioral techniques, and tailoring recovery to personal goals.

Window of Tolerance

Look at images from study guide page 10

Avoid using - Language and suicide

Committed suicide, unsuccessful suicide, successful/completed suicide

Language to use instead - with suicide

Died by suicide, took their own life, attempted suicide

What is a common myth about people who talk about suicide?

People who talk about suicide are only trying to get attention. They won't really do it.

What is a misconception about discussing suicide with someone?

Talking about suicide to a person will make them suicidal.

What is a myth regarding suicide attempts that do not result in death?

If someone makes a suicide attempt, but does not die, they are just looking for attention.

What is a common misunderstanding about self-harm?

Self-harm is always a sign that someone is contemplating suicide.

Different type of suicide ideations

Look at study guide (page 12)

Self Awareness and Self Care - suicide

o Given my own history and background and current life events, is this the best time for me to be having this conversation with someone?

o Am I able to ground myself?

o Are you emotionally ready to have this conversation?

ISPATHWARM

o Ideation

o Substance use

o Purposelessness

o Anxiety

o Trapped

o Hopelessness

o Withdrawal

o Anger

o Recklessness

o Mood change

Observing and recognizing signs

• Thoughts

• Feelings

• Statements

• Physical signs

• Actions

• Stressful events or loss

• Sometimes there are no signs

Those contemplating suicide - Thoughts

o "I can't do anything right"

o "I can't carry on like this"

o "People will be better off without me"

Those contemplating suicide - feelings

o Helpless

o Hopeless

o Worthless

Those contemplating suicide - statements

o Direct: "I'm going to end it all", "I'd be better off dead"

o Indirect: "I am a burden, and people are better off without me", "my life has no purpose"

Physical signs: Suicide

• Lack of interest in appearance and hygiene

• Sleep disturbances

• Change or loss of appetite, weight

• Physical health complaints

Actions related to those contemplating suicide

o Withdrawing

o Loss of interest in favourite activities

o Misuse of drugs or alcohol

Starting the conversation - suicide

o "I noticed"

o "Sounds like you are..."

Ask directly and clearly: suicide

o "Are you feeling so bad that you're considering suicide?"

o "That sounds like a lot for one person to take. Has it made you think about killing yourself to escape?"

o "Do you have a plan to end your life?"

o "Are you planning to kill yourself?"

What if they say yes to thinking about suicide?

• Take the person seriously. Let them know you think this is important to talk about.

• Listen without judgment and give them your complete attention.

• Acknowledge their thoughts and feelings with compassion.

Consider the risk: Suicide

Ask them: "How often are you thinking about this?" "Do you have a plan about how to kill yourself?"

Vancouver Coastal Health EDP:

- Adult group - open it up go through

- Child and youth individual therapy - 1:1

- Binge eating disorder group - have a separate referral for this

Adult program pathway

- Referral from primary care provider then prep work including blood works

- Attend an information session

- Assessment with clinician and/or physician

What is an eating disorder?

- A mental health issue

- Disturbance in eating, image body weight

Eating disorder affects in health

Detrimental to psychological and health

Produces a temporary relief and sense of control (but becomes an unhealthy pattern)

Eating Disorder does not discriminate to whom?

- Larger body size

- Masculinity

- People of color

- LGBTQ

Anorexia Nervosa

- Restriction of energy intake relative requirements leading to a significant low body weight

- Intense fear of gaining weight or becoming fat even though underweight

- Psychological health issue with physical affects

Physical effects of Anorexia Nervosa DSM

- Impacts brain nerves, obsessive thoughts, be sad

- Hair can change, thin brittle

- Heart - fluctuation or slow heart rate

- Blood, muscles, joints, kidneys, body fluids, intestines, hormones, skin

Bulimia

Binging and purging - an amount of food that is larger than normal of one would eat

- feeling of lack of control like not stopping

- Compensatory behavior - vomiting, misuse of laxatives

- Self-evaluation is strongly influenced by body shape and weight

Symptoms of bulimia (physical)

Swelling on cheeks, gum disease, throat irritated

Other eating disorders

- Binge eating disorder DSM

- Avoidant/restrictive food intake disorder

- Orthorexia - not in DSM yet - to healthy and cautious about diet that its negative

How eating disorders are developed

- Genetic and biological factors

- Social and environmental factors

- Personality traits

- Mental health factors

Recreation therapy in eating disorders

o Using a persons leisure or recreation interests as a way to support with the recovery process or reach treatment goals

o Exploring how leisure lifestyle can impact the ED

Functional Intervention - Goal oriented service

- Meal support

- ADL

- Stress and anxiety management

Leisure Education - Goal oriented service

- Reconnect to old leisure

- Social skills

- Time management

- Building mastery

Recreation Participation - Goal oriented service

- Community integration

- Skill development

Impact ED has on leisure lifestyle

- Decreased enjoyment during activities, can be agonizing, maybe history of judgement

- Look at strategies to do things, pre planning