For teachers

Mental Health

Training

October 2008 version

Chehil, LeBlanc and Kutcher ©Sun Life Financial Chair in Adolescent Mental Health Group

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Here’s what we know about mental disorders:

• Disturbancesofemotion,thinking,and/orbehaviour• Mayoccurspontaneously(withoutaprecipitant)• Severe(problematictotheindividualandothers)• Leadtofunctionalimpairment(Interpersonal,Social)• Prolonged• Oftenrequireprofessionalintervention• Derivefrombraindysfunctions–braindisorder• Israrely,ifever,causedbystressalone

Mental disorders are NOT:

• Itisnottheconsequenceofpoorparentingorbadbehavior. • Itisnottheresultofpersonalweaknessordeficitsinpersonality. • Itisnotthemanifestationofmalevolentspiritualintent. • Onlyinexceptionalcasesisitcausedbynutritionalfactors. • Itisnotcausedbypoverty.

How is the brain involved?

• Thebrainismadeupofcells,connectionamongstthecellsandvariousneurochemicals • Differentpartsofthebrainareprimarilyresponsiblefordoingdifferentthings(eg:movement) • Mostthingsabraindoesdependsonmanydifferentpartsofthebrainworkingtogetherinanetwork • Theneurochemicalsprovideameansforthedifferentpartsofthebraintocommunicate

WHaT HappeNs iNside THe braiN WHeN iT geTs sick?

• Aspecificpartofthebrainthatneedstobeworkingonaspecifictaskisnotworkingwell • Aspecificpartofthebrainthatneedstobeworkingonaspecifictaskisworkinginthewrongway • Theneurochemicalmessengersthathelpdifferentpartsofthebraincommunicatearenot

workingproperly

HOW dOes THe braiN sHOW iT’s NOT WOrkiNg Well?

• Ifthebrainisnotworkingproperly,oneormoreofitsfunctionswillbedisturbed• Disturbedfunctionsthatapersondirectlyexperiences(suchassadness,sleepproblems,etc.)are

calledSYMPTOMS• Disturbedfunctionsthatanotherpersonsees(suchasoveractivity,withdrawal,etc.)arecalledSIGNS• SignsandsymptomsBOTHcanbeusedtodetermineifthebrainmaynotbeworkingwell• Theperson’susuallifeordegreeoffunctioningisalsodisruptedbecauseofthesignsandsymptoms

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Distress:Common;causedbya

problemorevent;

usuallynotsevere(maybesevere);

usuallyshortlasting;professionalhelp

notusuallyneeded;professionalhelp

canbeuseful;

DIAGNOSISNOTNEEDED.

Disorders:Lesscommon;mayhappenwithoutanystress;oftenwithhighseverity;usuallylonglasting;professionalhelpusuallyneeded.NEEDSTOBEDIAGNOSED.

Mental disorders are associated with disturbances in six primary domains of brain function:

Thinking Signalling

Perception Physical

Emotion Behaviour

Whenthebrainisnotfunctioningproperlyinoneormoreofitssixdomains,andpersonexperiencesproblemsthatinterferewithhisorherlifeinasignificantway,theymayhaveamentaldisorder.

BUT...Not all disturbances of brain functioning are mental disorders.Somecanbeanormalorexpectedresponsetotheenvironment–forexample:griefwhensomebodydiesoracuteworry,sleepproblemsandemotionaltensionwhenfacedwithanaturaldisastersuchasahurricane.

What’s the What’s the difference between mental distress and mental disorders?

VS.

What causes mental illness?

Avarietyofdifferentinsultstothebraincanleadtomentalillness.BasicallythereareTWOmajorcausesthatcanbeindependentorcaninteract:

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geNeTics (theeffectofgenesonbraindevelopmentandbrainfunction)and

eNVirONMeNT (theeffectofthingsoutsidethebrainonthebrain–suchasinfection;malnutrition;severestress;etc)

Classification of Mental Disorders:

Mental Disorders of Thinking & Cognition: (Psychotic disorders)

WHaT are psycHOTic disOrders?

Psychoticdisordersareagroupof illnessescharacterizedbyseveredisturbances in thecapacitytodistinguishbetweenwhat is realandwhat isnot real. Thepersonwithpsychosisexhibitsmajorproblems in thinkingandbehavior. These include symptoms suchasdelusionsandhallucinations. These result inmany impairments thatsignificantly interferewith the capacity tomeetordinarydemandsof life. Schizophrenia isanexampleofapsychoticdisorderthataffectsabout1%ofthepopulation.

ThinkingorCognition

Perception orSensing

EmotionorFeeling

Behaviour

PhysicalorSomatic

Signaling(beingresponsiveandreactingtotheenvironment)

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Who is at risk for developing schizophrenia?Schizophrenia(SCZ)oftenbeginsinadolescenceandthereoftenmaybeagenetic component although not always. A family history ofSCZ,ahistoryofbirthtraumaandahistoryoffetaldamageinuteroincreases the risk forSCZ. SignificantmarijuanausemaybringonSCZinyoungpeoplewhoareathigherriskfortheillness.

What does schizophrenia look like?Delusions are erroneous beliefs that may involve misinterpretationof experiences or perceptions. One common type of delusion ispersecutory (also commonly called paranoid) in which the personthinksthatheorsheisbeingharmedinsomewaybyanotherperson,forceorentity(suchasGod, thepolice,spirits,etc.). Stronglyheldminorityreligiousorculturalbeliefsarenotdelusions.

Hallucinationsareperceptions(suchashearingsoundsorvoices,smellingscents,etc)thatmayoccurinanysensorymodalityintheabsenceofanactualsensorystimulus.Theycanbenormalduringtimesofextremestressorinsleeplikestates.Occasionallytheycanoccurspontaneously(suchasapersonhearingtheirnamecalledoutloud)butthesedonotcauseproblemswitheverydaylifeandarenotpersistent.

Thinking is disorganized in form and in content. For example, thepatternofspeakingmaynotmakesensetoothersorwhatisbeingsaidmaynotmakesenseorbeanexpressionofdelusionalideas.

Behaviorcanbedisturbed.Thiscanrangefrombehaviorsthataremildlysociallyinappropriatetoverydisruptiveandeventhreateningbehaviorsthatmayberesponsestohallucinationsorpartofadelusion.Self-groomingandself-caremaybealsocompromised.

Ayoungpersonwithschizophreniawillalsodemonstrateavarietyofcognitiveproblemsrangingfromdifficultieswithconcentrationto“higherorder”difficultiessuchaswithabstractreasoningandproblemsolving.Mostpeoplewith schizophrenia will also exhibit what are called “negative symptoms” which include: flattening of mood;decreasedspeech;lackofwill.

Apersonwithschizophreniamayexhibitdelusions,hallucinationsanddisorderedthinking(alsocalled“positivesymptoms”)aswellasnegativesymptomsatdifferenttimesduringtheillness.

What are the criteria for the diagnosis of schizophrenia?1–positivesymptomsasdescribedabove(delusions,hallucinations,disorganizedthinking)2–negativesymptomsasdescribedabove3–behavioraldisturbancesasdescribedabove4–significantdysfunctioninoneormoreareasofdailylife(social,family,interpersonal,school/work,etc.)5–thesefeaturesmustlastforatleast6monthsduringwhichtimetheremustbeatleastonemonthof positivesymptoms

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What can i do if it is scZ?AyoungpersonwithSCZwillrequireimmediateeffectivetreatment–usuallyinaspecialtymentalhealthprogram(firstonsetpsychosisprogram).IfaneducatorsuspectsSCZareferraltothemostappropriatehealthprovidershouldbemadefollowingdiscussionwiththeparentsabouttheconcerns.

What do i need to watch out for?ManyyoungpeoplewithSCZwilldemonstrateaslowandgradualonsetoftheillness–oftenovertheperiodof6–9monthsormore.Earlysignsinclude:socialwithdrawal;oddbehaviors;lackofattentiontopersonalhygiene;excessivepreoccupationwithreligiousorphilosophicalconstructs;etc.Occasionallytheyoungpersonsufferingintheprodromemayexhibitveryunusualbehaviors–ofteninresponsetoadelusionorhallucinations.SometimesitmaybedifficulttodistinguishtheonsetofSCZ(alsocalleda“prodrome”)fromothermentaldisorders–suchasdepressionorsocialanxietydisorder.YoungpeoplesufferingfromtheprodromeofSCZmayalsobeginabusingsubstances–particularlyalcoholormarijuanaanddevelopasubstanceabusedisorderconcurrently.Occasionallytheyoungpersonmaysharebizarreideasormaycomplainaboutbeingpersecutedbyothersormayappeartoberespondingtointernalvoices.Rarelythesedelusionsorhallucinationsmaybeaccompaniedbyunexpectedviolentacts.

Questions to ask?Canyoutellmewhatyouareconcernedabout?Doyoufeelcomfortableinschool(yourclass)?Areyouhavinganyproblemsthinking?Areyouhearingorseeingthingsthatothersmaynotbehearingorseeing?

Mental Disorders of Emotion and Feeling: (Mood disorders)

Therearetwotypesofmooddisorderswhichincludeunipolarmooddisordersandbipolarmooddisorders.Unipolardisorderismajordepression,whereasbipolardisorderiswhenapersonexperiencescyclesofdepressionandmania.

depressiON

Not to be confused with the word “depression” which is commonly usedto describe emotional distress or sadness, depression means CLINICALDEPRESSION,whichisamentaldisorder.

What are the different types of depression?There are two common kinds of clinical depression, Major DepressiveDisorder (MDD) andDysthymic Disorder (DD). Both can significantly andnegativelyimpactonpeople’s lives.Theycanleadtosocial,personalandfamily difficulties as well as poor vocational/educational performanceandevenprematuredeathduetosuicide.Additionally,patientswithotherillnessessuchasheartdiseaseanddiabeteshaveanincreasedriskofdeathiftheyarealsodiagnosedwithdepression.Thisisthoughttobeduetothephysiologic affects that depression has on your body as well as lifestyleeffectssuchaspoorselfcare,increasedsmokingandalcoholconsumption.Individuals with clinical depression usually require treatment from healthprofessionalsbutinmildcasesmayexperiencesubstantialimprovementwithstrongsocialsupportsandpersonalcounseling.

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What do Mdd and dd look like?MDDisusuallyalife-longdisorderbeginninginadolescenceorearlyadulthoodandischaracterizedbyperiods(lastingmonthstoyears)ofdepressiveepisodesthatareusuallyself-limiting.Theepisodesmaybeseparatedbyperiods(lastingmonthstoyears)ofrelativemoodstability.Sometimesthedepressiveepisodesmaybetriggeredbyanegativeevent(suchasthelossofalovedone;severeandpersistentstresssuchaseconomicdifficultiesorconflict)butoftentheepisodesmayoccurspontaneously.Oftenthereisafamilyhistoryofclinicaldepression,alcoholism,anxietydisorderorbipolar(manic-depressive)disorder.

What is a depressive episode?Adepressiveepisodeischaracterizedbythreesymptomclusters: 1.mood 2.thinking (often called cognitive) and3.body sensations (often called somatic). MDD maypresentdifferentlyindifferentcultures,particularlyinthesomaticproblemsthatpeoplepresentwith.Symptoms:

• Must be severe enough to cause functionalimpairment(stopthepersonfromdoingwhatheorshewouldotherwisebedoing,ordecreasethequalityofwhattheyaredoing)

• Mustbecontinuouslypresenteveryday,mostofthedayforatleasttwoweeks

• Can not be due to a substance or medicine ormedical illness and must be different from thepersons usual state

These symptoms are:

Mood: •Feeling“depressed”;“sad”;“unhappy”(orwhatevertheculturalequivalentofthesedescriptorsis). •Feelingalossofpleasureoramarkeddisinterestinalloralmostallactivities. •Feelingsofworthlessness,hopelessnessorexcessiveandinappropriateguilt

Thinking: •Diminishedabilitytothinkorconcentrateorsubstantialindecisiveness •Suicidalthoughts/plansorpreoccupationwithdeathanddying

Body Sensations: •Excessivefatigueorlossofenergy. •Significantsleepproblems(difficultyfallingasleeporsleepingexcessively) •Physicalslownessorinsomecasesexcessiverestlessness •Significantdecreaseinappetitethatmayleadtonoticeableweightloss

criteria:FIVEoftheabovesymptomsmustbepresentEVERYDAYforMOSTOFTHEDAYduringthesametwoweekperiod;ONEoftheFIVEsymptomsMUSTBEeitherdepressedmoodorlossofinterestorpleasure.

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What can i do if it is depression?Youcan identify thedisorderandcounsel theperson with the disorder (including educationof thepersonand family) if it ismildand ifyouaretrainedincounseling.Ifthedisorderis more intense or the person is suicidal youshould immediately refer the person to thehealth professional best suited to treat the depression. Ideally this should be done incollaborationandwiththeactivesupportofthe school guidance counselor or identifiedschoolbasedmentalhealthprovider. Oncean interventionoccursand theyoungperson

isbackatschoolitisimportantthatyoubepartoftheongoingtreatmentteamandhelpdevelopandaddresslearningneeds.Youmayalsoneedtocontinuetoproviderealisticemotionalsupport.

Questions to ask:Haveyoulostinterestorpleasureinthethingsthatyouusuallyliketodo?Haveyoufeltsad,low,downorhopeless?Areyoufeelinglikeendingitall?IFthepatientanswersyestoeitherofthese,furtherassessmentofallofthesymptomsshouldbeexplored.

bipOlar disOrder

• Illnessischaracterizedbycycles(episodes)ofdepressionandmania

• Cyclescanbefrequent(daily)orinfrequent(manyyearsapart)

• Duringdepressiveormanicepisodesthepersonmaybecomepsychotic

• Suicideratesarehighinpeoplewithbipolarmooddisorder

in bipolar disorder how is How is ‘mania’ different from feeling extremely happy?

• Moodismostlyelevatedorirritable• Manybehavioral,physicalandthinking,problems• Significantproblemsindailylifebecauseofthe

mood• Moodmayoftennotreflecttherealityofthe

environment• Isnotcausedbyalifeproblemorlifeevent

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bipolar - What to look for:

• Historyofatleastonedepressiveepisodeandatleastonemanicepisode.• Rapidmoodchangesincludingirritabilityandangeroutbursts.• Self-destructiveorself-harmfulbehaviors–including:spendingsprees;violencetowardsothers;sexual

indiscretions;etc.• Drugoralcoholoveruse,misuseorabuse.• Psychoticsymptomsincluding:hallucinationsanddelusions

Mental Disorder of Signaling: (The Anxiety Disorders)

WHaT is geNeraliZed aNxieTy disOrder?GADisdescribedasexcessiveanxietyandworryoccurringforanextendedperiodoftimeaboutseveraldifferentthings.Thispersistentapprehension,worryandanxietycausesdistressandleadstophysicalsymptoms.

Who is at risk for developing gad?GADoftenbeginsinchildhoodoradolescenceandthereisalsoageneticorfamilialcomponent.OnceGADispresent,theseveritycanfluctuateandexacerbationsoftenoccurduringtimesofstress.OtherpsychiatricdisordersarealsoriskfactorsforGADsuchasdepression,panicdisorderandagoraphobia.

What does generalized anxiety disorder look like?GeneralizedAnxietyDisorder(GAD)ischaracterizedbyexcessiveanxietyandworryaboutmanydifferentthings.Theworryisoutofproportiontotheconcernorevent.Thisanxietyandworrymustbenoticeablygreaterthantheusualsocio-culturalnorms.YouthwithGADoftendonotpresentwithpanicattacksasinpanicdisorder.Oftentheypresentwithphysicalcomplaintssuchasheadaches,fatigue,muscleachesandupsetstomach.Thesesymptomstendtobechronicandyoungpeoplemaymissschoolorsocialactivitiesbecauseofthesephysicalsymptoms.

How do you differentiate gad from normal worrying?Anxiety can be broken into four categories:

1) Emotions –i.e.feelingfearful,worried,tenseoronguard.2) Body Responses–anxietycancausemanydifferentresponsesofthebodyincludingincreasedheart

rate,sweating,andshakiness,shortnessofbreath,muscletensionandstomachupset.3) Thoughts –whenexperiencinganxiety,peoplearemorelikelytothinkaboutthingsrelatedtorealor

potential sourcesofdangerandmayhavedifficulty concentratingonanythingelse.Anexample isthinkingsomethingbadisgoingtohappentoalovedone.

4) Behaviours –peoplemayengageinactivitiesthatcanpotentiallyeliminatethesourceofthedanger.Examples include avoiding feared situations, people or places and self medicating with drugs oralcohol.

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When does anxiety become a disorder?Thesephysical,emotionalandbehaviouralresponsestoperceiveddangerarenormalreactionsthatweexperienceeveryday.Manytimesthis‘anxietyresponse’isautomatic,andeverycreaturehastheseautomaticresponsesasawayofprotectingthemselvesfromdanger.However,anxietybecomesaproblemwhen:• Itisgreaterintensityand/ordurationthentypicallyexpectedgiventhecontext.• Itleadstoimpairmentordisabilityinwork,schoolorsocialenvironments.• Itleadstoavoidanceofdailyactivitiesinanattempttolessentheanxiety.

What are the criteria for the diagnosis of gad?1. Excessiveanxietyandworryoccurringforatleast6monthsaboutseveralthings2. Difficultycontrollingtheworry3. Theanxietyandworryareassociatedwith3ormoreofthefollowing:

a. Restlessnessorfeelingonedge,fatigued,difficultyconcentrating,muscletensionorsleepdisturbance.

4. Anxietyandworryarenotduetosubstanceabuse,amedicalconditionoramentaldisorder.5. Theanxietyandphysicalsymptomscausemarkeddistressandsignificantimpairmentindailyfunctioning.

What can i do if it is generalized anxiety disorder?Thefirstthingistoidentifytheproblemfortheyoungpersonandelicitassistancefromahelperknowledgeableabouttheproblem.SomepeoplewithGADwillexperienceimprovementsintheiranxietyandfunctioningwithsupportivecognitivebasedcounseling.Othersmayrequiremedication.ReferraltoanappropriatehealthprofessionalformedicalattentioncouldbeconsiderediftheGADissevereandifthefunctionalimpairmentisextensive.Forsome,merelyknowingthattheyhaveGADandreceivingsupportivecounselingmaybehelpfulenough.

Questions to ask?

Canyoutellmeaboutyourworries?Doyouor others see you as someone who worriesmuch more than he/she should? Do youor others consider you to be someonewhoworriesmuchmorethanmostpeopledo?Doyouhavetrouble“lettinggooftheworries”?Doyousometimesfeelsickwithworry–inwhat way? What things that you enjoydoingorwould like todoaremade lessenjoyableorareavoidedbecauseoftheworries? What if anything do you findmakes the worries better – is this for ashortoralongtime?

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sOcial pHObia

What is social phobia?

Socialphobia,alsoknownasSocialAnxietyDisorder,ischaracterizedbythepresenceofanintensefearofscrutinybyothers,whichmayresultinembarrassmentorhumiliation.

What does social phobia look like?Youngpeoplewithsocialphobiafear,doingsomethinghumiliatinginfrontofothers,orofoffendingothers.Theyfearthatotherswilljudgeeverythingtheydoinanegativeway.Theybelievetheymaybeconsideredtobeflawedorworthlessifanysignofpoorperformanceisdetected.Theymaycopebytryingtodoeverythingperfectly,limitingwhattheyaredoinginfrontofothersandgraduallywithdrawfromcontactwithothers.Youthwithsocialphobiaoftenexperiencepanicsymptomsinsocialsituations.Asaresulttheytendtoavoidsocialsituationssuchaspartiesorschoolevents.Somemayhaveadifficulttimeattendingclassormayavoidgoingtoschoolaltogether.Althoughyoungpeoplewithsocialphobiarecognizethattheirfearsareexcessiveandirrational,theyareunabletocontrolitandthereforeavoidsituationsthattriggertheiranxiety.ThepresentationofSocialPhobiamayvaryacrossculturesandalthoughitmayoccurinchildrenitusuallyonsetsintheadolescentyears.Itmustnotbeconfusedwith“shyness”andthestrengthofthefearsmaywaxandwaneovertime.

What are the criteria?Thefollowingmustbepresentforsomeonetohavesocialphobia:

• Markedandpersistentfearofsocialorperformancesituationsinwhichthepersonisexposedtounfamiliarpeople;Fearofembarrassmentorhumiliation

• Exposuretothefearedsituationalmostalwaysprovokesmarkedanxietyorpanic• Thepersonrecognizesthatthefearisexcessiveorinappropriate• Theavoidanceorfearcausessignificantimpairmentinfunctioninganddistress• Thefearedsocialorperformancesituationsareavoidedorelseenduredwithintenseanxietyordistress• Thesymptomsarenotduetoasubstance,medicineorgeneralmedicalcondition

Inchildren,SocialPhobiamaybeexpressedbycrying,tantrums,andavarietyofclingybehaviors.Otherpsychiatricdiagnoses that Social Phobia must be differentiated from include: Panic Disorder; Pervasive DevelopmentalDisorder;SchizoidPersonalityDisorder).

What can i do if it is social phobia?Thefirststepistheidentificationoftheproblem.Often,peoplewithSocialPhobiawillhavesufferedformanyyearswithoutknowingthereasonfor theirdifficulties. Sometimes just informingandeducatingthemabout theproblem can be helpful, particularly in mild cases. Treatment is not indicated unless the problem is causingsignificantfunctionalimpairmentbutcounselingusingcognitivebehavioraltechniquesandexposuretotheanxiety-provokingsituationinthecompanyofacounselormayhelpthepersonbetterdealwiththeirdifficulties.Ifthedisorder is severe, referral to an appropriate health care provider is indicated, and the counselor can provide ongoingsupport.Ateachermaybeabletoassistinbehaviourmodificationprograms(suchasgettingusedtoaclassroomsituation).Ifyouthinkastudentmayhavesocialphobiaitisimportantnottodrawattentionpublicallytotheirdifficultiesbutspeakwiththeminprivateaboutwhatyounotice–besupportive.

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What do i need to watch out for?SomeyoungpeoplewithSocialPhobiawilluseexcessiveamountsofalcohol tohelpdecreasetheiranxiety insocialsituations.Insomecases,SocialPhobiacanbeariskfactorfortheabuseofalcoholorothersubstances..InyoungchildrenitisimportanttodifferentiateSocialPhobiafromPervasiveDevelopmentalDisorderssuchasAutism.Childrenwithautism,incontrasttochildrenwithsocialphobia,willnotdemonstrateage-appropriatesocialrelationshipswithfamilymembersorotherfamiliarpeople.

Questions to askDosituationsthatareneworassociatedwithunfamiliarpeoplecauseyoutofeelanxious,distressedorpanicky?Whenyouare inunfamiliarsocialsituationsareyouafraidoffeelingembarrassed?Whatkindsofsituationscauseyoutofeelthatway?Dothosefeelingsofembarrassment,anxiety,distressorpanicstopyoufromdoingthingsyouwouldotherwisedo?Whathaveyounotbeenabletodoaswellasyouwouldliketodobecauseof

thosedifficulties?

WHaT is paNic disOrder?

PanicDisorderischaracterizedbyrecurrent,unexpected,anxiety(panic)attacksthatinvolvetriggeringanumberoffrighteningphysicalreactions.Thefrequencyandseverityofpanicattackscanvarygreatlyandcanleadtoagoraphobia(fearofbeinginplacesinwhichescapeisdifficult).

Who is at risk for developing panic disorder?Theonsetofpanicdisorderiscommonlybetweentheagesof15-25.Peoplewhohavefirst-degreerelativeswithpanicdisorderhavean8xhigherriskofalsodevelopingpanicdisorderthemselves.PanicDisorderisassociatedwithanareaofthebrainthatregulatesalertness.Disturbanceinthisareaofthebrainisoneexplanationforwhypanicattacksoccur.

What does panic disorder look like?Young people with panic disorder experience recurrent,unexpectedpanicattacksandtheygreatlyfearhavinganotherattack. They persistently worry about having another attackaswell as the consequences of having a panic attack. Somemayfeartheyare‘losingtheirmind’orfeeltheyaregoingtodie.Oftentheywillchangetheirbehaviourtoavoidplacesorsituationsthattheyfearmighttriggerapanicattack.Intime,thepersonmaycometoavoidsomanysituationsthattheybecomeboundtotheirhome.

What are the components of a panic attack?Thepersonhasfourofmoreofthefollowingsymptomswhichpeakwithin10minutes:

1. palpitations,poundingheartoracceleratedheartrate2. sweating3. tremblingorshaking4. sensationsofshortnessofbreathorsmothering5. feelingofchoking

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6. chestpainordiscomfort7. nauseaorabdominalpain8. feelingdizzy,unsteady,lightheadedorfaint9. feelingofunrealityorbeingdetachedfromoneself10.fearoflosingcontrolorgoingcrazy11.fearofdying12.numbnessortinglinginthebody13.chillsorhotflashes

What are the criteria for panic disorder?Assessing panic disorder involves evaluating 5 areas:

1. Panicattacks2. Anticipatoryanxiety3. Panicrelatedphobicavoidance4. Overallillnessseverity5. Psychosocialdisability

For a diagnosis of panic disorder, a patient must have:

1. Recurrentunexpectedpanicattacks2. Oneormoreoftheattackshasbeenfollowedby≥1monthof:

- Persistentconcernofhavingadditionalattacks- Worryabouttheimplicationsoftheattackoritsconsequences- Asignificantchangeinbehaviourasaresultoftheattacks

3. Canbe±agoraphobia4. Panicattacksarenotduetosubstanceabuse,medicationsorageneralmedicalcondition5. Panicattacksarenotbetteraccountedforbyanothermentaldisorder

What can i do if it is panic attack?The first thing is to identify the Panic Attack andprovide a calm and supportive environment untiltheattackpasses. Educationaboutpanicattacksand panic disorder is often very helpful andshouldideallybeprovidedbyaprofessionalwithgoodknowledge in thisarea. Counselingusingcognitivebehavioralmethodsmaybeofhelpandmedicationscanbeusedaswell.Theteacher’sroleinhelpingayoungpersonsufferingfromapanic disorder can also involve assisting themin dealing with their anxieties about havinganother attack and also helping them withstrategies to combat avoidance of socialsituations.Thereforeit isagoodideaforateachertobepartofthetreatmentplanningand treatment monitoring for a youth withpanicdisorder.

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Questions to ask?Canyoudescribeinyourownwordswhathappenswhenyouhaveoneoftheseepisodes(somepeoplewillreferto themas“spells”)?Howmanyoftheseepisodeshaveyouhad in the lastweek, in the lastmonth? Whatdo theseepisodesmeantoyou?Whatdotheseepisodesstopyoufromdoingthatyouwouldotherwiseusuallydo?Whatdoyoudowhentheseepisodesoccur?Doyoueverfeelthatyouwouldliketobedeadorthinkthatyourproblemissogreat thatyoushouldkillyourself? Howdoyourfamily,friends,lovedones,etc.reacttotheseepisodes?Whatdotheysayistheproblem?

ObsessiVe cOMpulsiVe disOrder

ObsessiveCompulsiveDisorder (OCD) isananxietydisorder characterizedbyobsessionsand/or compulsions.Obsessionsarepersistent,intrusive,unwantedthoughts,imagesorimpulsesthatthepersonrecognizesasirrational,senseless, intrusive or inappropriatebut is unable to control. Compulsions are repetitivebehaviours,which thepersonperformsinordertoreduceanxietyassociatedwithanobsession.Examplesofthesearecounting,touching,washingandchecking.Both canbeof such intensity that theycauseagreatdealofdistressand significantlyinterferewiththeperson’sdailyfunctioning.Obsessionsaredifferentfrompsychoticthoughtsbecausethepersonknowsthattheyaretheirownthoughts(notputinsidetheirheadbysomeexternalforce)andthepersondoesnotwanttohavethethoughts. Compulsionsaredifferentfrompsychoticbehaviorsbecausethepersonknowswhyhe/sheisdoingtheactivityandcanusuallysaywhytheyaredoingthem.

Who is at risk for developing Ocd?

OCDoftenbeginsinadolescenceorearlyadulthood,althoughitcanstartinchildhood.Itisquitecommonandaffectsbothmenandwomen.First-degreerelativesofpeoplewithOCDaremorelikelytodevelopOCD.ItisimportanttonotethatpeoplewithOCDareathigherriskfordevelopingdepressionandotheranxietydisorders.

What does Ocd look like?

OCDshouldnotbeconfusedwithsuperstitionsorthoserepetitivecheckingbehaviorsthatarecommonineverydaylife.Theyarenotsimplyexcessiveworriesaboutreallifeissues.ApersonwithOCDwillhavesignificantsymptomsofeitherobsessionsorcompulsionsorboth.Thesesymptomswillbesevereenoughtocausemarkeddistress,aretimeconsuming(takeupmorethanonehourperday)andsignificantlyinterferewithaperson’snormalactivities(work,school,social,family,etc.).

Obsessions:• Recurrentandpersistentthoughts,impulsesorimagesthatareexperiencedasintrusiveandnot

appropriateandcausesignificantdistressoranxiety• Thesesymptomscannotbesimplyexcessiveworriesabouteverydaylife• Thepersonwiththesesymptomstriestosuppressorignorethem.Thepersonmaytrytoneutralize,

decreaseorsuppressthethoughtswithsomeotherthoughtoraction.• Thepersonknowsthatthethoughtsarecomingfromhis/herownmind.

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Compulsions:• Repetitive behaviors (such as checking,

washing, ordering) or mental acts (such ascounting,praying, repeatingwords silently)that the person feels driven to perform inresponse to an obsession or according torigidrules

• ThesebehaviorsormentalactsareaimedatpreventingorreducingdistressorpreventingsomedreadedeventorsituationBUTarenotrealisticallyconnectedtotheobsessionstheyaremeanttoneutralize

How do you differentiate between Ocd and psychosis?ThisisaveryimportantsteptotakeifyoususpectsomeonehasOCD.Ingeneral,patientswithOCDhaveinsightintothesenselessnessoftheirthoughtsandactionsandoftentrytohidetheirsymptoms.ThisdistinguishesOCDfrompsychoticdisorderssuchasschizophreniabecausethosepatientslackanyinsightintothesenselessnatureoftheirsymptoms.

What can i do if it is Ocd?YoucaneducatethestudentaboutOCDandhowitistreated.Ifthesymptomsareassociatedwithimpairment(socialoracademic)youshouldsendthestudenttotheschoolguidanceorhealthprofessionalwhocanthenreferthepersontotheprofessionalbestsuitedtoprovidetreatmentandyoucancontinuetoprovideeducationandsupporttothestudentifthatismutuallyagreedto.Oftenyoungpeoplewillbetreatedwithcognitivebehavioraltherapy(CBT).Sometimesthismayrequireateacher’sinput.Itisimportanttoknowifanyacademicmodificationsneed to be made to enhance learning opportunities for young people withOCD so including the teacher intreatmentplanningandtreatmentmonitoringisusuallynecessary.

Things to look for:Therearetwomainthingstowatchoutfor.Th

efirstisthepossibility

that the symptoms couldbepartofapsychosis. Therefore it is

veryimportanttoruleoutapsychosisdisorder.[PLEASEREVIEW

THESECTIONONPSYCHOSIS]Thesecondthingtowatchforis

theeffectOCDhasontheyoungperson’sclassmates.Sometimes

studentswithsevereOCDwill tryto involvetheirclassmates(or

their teachers) in their compulsions. If this happens then it can

cause significant problems at school. Educating yourself about

OCDandtheimportanceofnotparticipatingintheOCDrituals

important.

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Questions to ask:Areyouhavingthoughtsthatarecomingintoyourmindthatyoudonotwanttobethere?Canyoutellmewhatthosethoughtare?Dothose thoughtscauseyou tofeeluncomfortableoranxiousorupset?Doyouthinkthatthosethoughtsaretrue?Wheredoyouthinkthosethoughtsarecomingfrom?Howareyoutryingtodealwithorstopthethoughtsfromcoming?Whatdothethoughtsstopyoufromdoingthatyouwouldotherwisebedoing?Howmuchofthetimearethosethoughtsonyourmind?

Please describe the things that you are doing that are causingdistresstoyouorotherpeople.Canyoutellmewhyyouaredoingthosethings?Whatdoyouthinkwillhappenifyoudonotdothosethings? Whatdo those things thatyouaredoing stopyou fromdoingthatyouwouldotherwisebedoing?Howmuchtimedoyouspenddoingthoserituals?

WHaT is pOsT TrauMaTic sTress disOrder?

PostTraumaticStressdisorder(PTSD)developsafteratraumaoccursthatwaseitherexperiencedorwitnessedbythepatient.Itinvolvesthedevelopmentofpsychologicalreactionsrelatedtotheexperiencesuchasrecurrent,intrusiveanddistressingrecollectionsoftheevent.Thesemaybeintheformofnightmares,flashbacksand/orhallucinations.

Who is at risk for developing pTsd?NotallpeoplewhohaveexperiencedatraumaticeventwilldevelopPTSD.Indeed,mostwillnot.Riskfactorsincludepersonalorfamilyhistoryofdepressionoranxiety,severityofthetraumaandearlyseparationfromparents.

What does pTsd look like?ThesymptomsofPTSDdevelopwithin6monthsfollowingthetraumaticeventandareorganizedintothreecategories:

Re-experiencing Symptoms – recurrent,intrusive,distressingrecollectionsormemoriesoftheeventintheformofmemories,dreams,orflashbacksinwhichtheindividualperceiveshimself/herselftobere-livingtheeventasthoughitwasactuallyhappeningagaininthepresent.

Avoidance & Numbing Symptoms –avoidanceofanything–people,places, topics of conversation, food, drink, weather conditions,clothing,activities,situations,thoughts,feelings–thatareassociatedwithorareremindersofthetraumaticevent.Inadditionthepersonmayexperienceageneralnumbingofemotions,alossofinterestinpreviouslyenjoyedactivities,detachmentfromfamilyandfriends,andasenseofhopelessnessaboutthefuture.

Hyperarousal Symptoms –sleepproblems(difficultiesfallingasleepor staying asleep), irritability, angry outbursts, hypervigilance,exaggeratedstartleresponse,anddifficultyconcentrating.

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What are the criteria for the diagnosis of pTsd?1. Thepersonhasbeenexposedtoatraumaticeventinwhichbothofthefollowingwerepresent:

a. Thepersonfelttheirlifewasindangerorwitnessedsomeoneelse’slifeputindangerb. Thepersonexperiencedextremefear,helplessnessorhorror

2. Thetraumaticeventisre-experienced,includingoneormoreof:a. Recurrentintrusivememories,dreamsornightmaresrelivingtheeventwhichcausespsychological

distress.3. Avoidanceofthingsassociatedwiththeeventincluding3ormoreof:

a. Avoidthoughts,feelingsorconversations,avoidactivities,placesorpeople,inabilitytorecallaspectofthetrauma,decreasedinterestorparticipationinactivities,feelingdetachedorestrangedfromothers,restrictedrangeofaffect,senseofforeshortenedfuture.

4. Persistentsymptomsofincreasedarousalincluding2ormoreof:a. Difficultyfallingorstayingasleep,irritability,difficultyconcentrating,hypervigilance,exaggerated

startle response5. Durationofsymptomsgreaterthan1month.

Severityofsymptomscausesmarkeddistressandimpairmentindailyfunctioning.

How does pTsd differ from acute stress disorder or normal grieving?PTSDmustbedistinguishedfromnormalresponses(suchasgrief,distress)tosuchsituationsandfromAcuteStressDisorder(ASD)whichhassimilarsymptomstoPTSDbutwhichendsordiminishedgreatlyusuallywithoutformaltreatmentwithinfourweeksofthetraumaticevent.DurationandseverityofPTDSsymptomsmayvaryovertimewithcompleterecoveryoccurringwithinhalfayearorlessinhalformorecases.

What can i do if it is pTsd?Thefirst thing is to identify theyoungpersonwithPTSDandhelp themfindaknowledgeablehelperwhocanprovideeducationtothemaboutwhattheproblemisandhowitcanbetreated.It is importantnottoconfusePTSDwithnormalresponsestotraumaticeventsorwithASD.Donotcreatepathologywhereitdoesnotexist!ForpeoplewithPTSD,supportivecounselingusingcognitivetherapymethodsmaybeofhelp.Ifthedisorderiscausingsignificantdistressandimpairment,referraltoanappropriatehealthcareprovideris indicated,asmedicationmaybeneeded.

Things to look for:Some people who are exposed to significant traumatic

events may have exacerbations of pre-existing mental

health problems such as anxiety, depression or psychosis.

Identification and proper effective interventions for these

peopleintheposttraumaticsituationisimportant.Substance

abuse,especiallyinvolvingalcoholisverycommoninpeople

who have PTSD. Therefore it is important to screen for this

probleminpeoplewithPTSDandtotreatappropriately.

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What questions can i ask?Areyoubotheredbymemoriesorthoughtsofaveryupsetting

eventthathashappenedtoyou?Makesurethatyouaskaboutfrequency and persistence of symptoms and include clearevidenceoffunctionalimpairmentbeforeconsideringPTSD.

Mental Disorder of Physical : (Eating disorders)

WHaT is aN eaTiNg disOrder?

Therearetwomaintypesofeatingdisorders–anorexianervosaandbulimianervosa.Whiletheremaybesomeoverlappinginsymptomsbetweenthetwo,theyarelikelytohavedifferentcausesandthetreatmentsforthemdiffer.

Who is at risk for developing an eating disorder?Eatingdisordersusuallybegininadolescenceandmaycontinueintoadulthood.Girlsaremuchmorecommonlyaffectedthanboys.

What does anorexia Nervosa look like?AnorexiaNervosa(AN)ischaracterizedbyexcessivepreoccupationwithbodyweightcontrol,adisturbedbodyimage,anintensefearofgainingweightandarefusaltomaintainaminimallynormalweight.Postpubertalgirlsalsoexperiencealossofmenstrualperiods.TherearetwosubtypesofAN–arestrictingsubtype(inwhichtheyoungpersondoesnotregularlybingeorabuselaxativeorself inducevomiting)andabinge-eating/purgingsubtype(inwhichtheyoungpersonregularlybingesandabuseslaxativesorself-inducesvomiting).

What does bulimia Nervosa look like?BulimiaNervosa(BN)ischaracterizedbyregularandrecurrentbingeeating(largeamountsoffoodoverashorttimeaccompaniedbyalackofcontrolovertheeatingduringtheepisode)andbyfrequentandinappropriatebehaviorsdesignedtopreventweightgain(includingbutnotlimitedto:self-inducedvomiting;useoflaxatives,enemas;excessiveexercise).

How do you differentiate an eating disorder from normal teenage eating?Eatingpatternsinyoungpeoplecanbeveryerratic.Food fads are common as are periods of dietingand food restriction (often in response to concernsaboutweight).Adolescenceisalsoaperiodinwhichsomeyoungpeopleexperimentwithfoodtypesandeating experiments that may differ substantiallyfromthosecommontotheirfamiliesorcommunities.Thesearenoteatingdisorders.

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What are the criteria for the diagnosis of aN?1 – refusal to maintain body weight at or above a minimally normal weight for age and height resulting in a bodyweightlessthan85%ofthatexpected.2–intensefearofgainingweightorbecomingfatwhileunderweight.3–substantialdisturbancesinbodyimage(considersselftobefateventhoughisunderweight)ordenialof seriousnessofcurrentlowbodyweight.4–lossofmenstrualperiodsinpostpubertalgirls.

TheprevalenceofANisabout0.2–0.5percent.

What can i do if it is aN?YoungpeoplewithANdonotcomplainabouthavingANandmostdenythattheyhaveaproblemwithbeingunderweight.Usuallyafriend,teacherorfamilymemberwillnoticethesevereweightloss.AneducatorwhoisconcernedthatastudentmayhaveANshouldgentlyandsupportivelydiscuss the issuewith theyoungpersonandifafterthatdiscussionitseemsasifthereisapossibilityofANtheyoungpersonshouldbereferredtotheappropriatesupportpersonorhealthproviderintheschoolforfurtherassessmentandintervention.Suggestionsthattheyoungpersoneatmoreornegativecommentsontheyouth’sweightarecounterproductive.

What are the criteria for the diagnosis of bN?1–recurrentepisodesofbingeeatingwherebothofthefollowingarepresent:a)–eatinglargeamountsof

foodinashortperiodoftime;b)–feelingthateatingisoutofcontrol.2–recurrentinappropriatebehavioursinordertocontrolweight(suchas:self-inducedvomiting;misuseof laxative,diuretics,enemasorothermedications,fastingorexcessiveexercise).3–theabovemustoccuranaverageatleasttwiceaweekforaperiodof3months.4–selfperspectiveisoverlyinfluencedbybodyshapeandweight.5–theabovedoesnotoccurexclusivelyduringAN.

TherearetwosubtypesofBN–thepurgingtype(characterizedbyself-inducedvomitingormisuseoflaxative,diuretics,enemas,etc.);thenonpurgingtype(nouseoftheabove).

TheprevalenceofBNisabout1–3percent.

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What can i do if it is bN?YoungpeoplewithBNdonotcomplainabouthavingBNandmostdenythattheyhaveaproblemwitheating.BNisoftenhidden.ClassroomdiscussionsaboutBNandothereatingproblemsshouldbeundertakenwithsensitivitythattheremaybeayoungpersonwithunknownorunrecognizedBNinthegroup.

Questions to ask?How do you feel about yourself? Has anyone

askedyouifyouwerehavingproblemswithyour

eating?Doyousometimesfeelthatyoureatingmaybeoutofcontrol?

Mental Disorders of Behaviour: (ADHD, Substance Abuse, Conduct Disorder)

subsTaNce depeNdeNce aNd abuse

There is a spectrum of harm that can develop from using varioussubstances.Alongthisspectrumofharmisabuseanddependence.

What is substance abuse?The abuse of substances is amaladaptive pattern of substance use leadingtoclinicallysignificantimpairmentordistress,asmanifestedbyone(ormore)ofthefollowing,occurringwithina12-monthperiod:

1. Recurrentsubstanceuseresultinginafailuretofulfillmajorrole obligations at work, school, or home (e.g., repeatedabsencesorpoorworkperformance related to substanceuse; substance-relatedabsences, suspensionsorexpulsionsfromschool;neglectofchildrenorhousehold)

2. Recurrentsubstanceuseinsituationsinwhichitisphysicallyhazardous (e.g., driving an automobile or operating amachinewhenimpairedbysubstanceuse)

3. Recurrentsubstance-relatedlegalproblems(e.g.,arrestsforsubstance-relateddisorderlyconduct)

4. Continued substance use despite having persistent orrecurrent social or interpersonal problems caused or

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exacerbated by the effects of the substance (e.g., arguments with spouse about consequences ofintoxication,physicalfights)

What is substance dependence?Substancedependenceisamaladaptivepatternofsubstanceuse,leadingtoclinicallysignificantimpairmentordistress,asmanifestedbythree(ormore)ofthefollowing,occurringatanytimeinthesame12-monthperiod:

1. Tolerance,asdefinedbyeitherofthefollowing:• Aneedformarkedlyincreasedamountsofthesubstancetoachieveintoxicationordesiredeffect.• Markedlydiminishedeffectwithcontinueduseofthesameamountofsubstance.

2. Withdrawal,asmanifestedbyeitherofthefollowing:• thecharacteristicwithdrawalsyndromeforthesubstance.• thesame(oracloselyrelated)substanceistakentorelieveoravoidwithdrawalsymptoms.

3. Thesubstanceisoftentakeninlargeramountsoroveralongerperiodthanwasintended.4. Thereisapersistentdesireorunsuccessfuleffortstocutdownorcontrolsubstanceuse.5. Agreatdealoftimeisspentinactivitiestoobtainthesubstance,usethesubstance,orrecoverfromitseffects.6. Importantsocial,occupationalorrecreationalactivitiesaregivenuporreducedbecauseofsubstanceuse.7. The substance use is continued despite knowledge of having a persistent or recurrent physical or

psychological problem that is likely to have been caused or exacerbated by the substance (e.g.,continueddrinkingdespiterecognitionthatanulcerwasmadeworsebyalcoholconsumption).

What are types of substances that can be abused?Theabuseofsubstancesincludesthosethatarelegalandillegal.Thedefinitionofadrugasalegalorillegalsubstancedoesnotdetermineifthesubstancecaninducedependenceorabuse.Substancesincludesuchthingsasalcohol,nicotine,cannabis,amphetamines,cocaine,inhalants,opioids,hypnoticsandothers.

Avarietyofsubstancescanbesafelyusedinmoderationbymostpeopleassocialmodifiers(forexample,beerorotheralcoholtakenwithmealsorinsocialsituations).Substanceswhichmaybeabusedinsomesituationscanbetherapeuticinothers–forexample,heroinorcocainecanbeusedtotreatpainundermedicalsupervisionbutarealsowellknowntobeaddictivesubstanceswhenusedfornon-medicalpurposes.

What can i do if it is substance abuse/dependence?Firstitisimportanttoidentifytheproblem.Insomesituations,

cultural, social or economic factors may impede the identificationofthesubstanceproblem.Thepersonwiththeproblemwilloftendenytheproblemexistsandsometimesthe person’s family or loved ones will also deny that theproblemexists.Youngpeopleoftenproceedthoughapathof substance misuse for a long time (years) before someof themgoon toabuse. Mostyoungpeoplewhomisusesubstances likelydonotgoon toabuse them– thereforesubstancemisuse,althoughariskfactorforsubstanceabuseisnotnecessarilypredictiveofsubstanceabuse.Academicand social problems characterize the young person whosuffers from substance abuse – failing grades, missingclasses,Mondaymorningabsences,aggression,etc.

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Questions to ask?Trytodeterminetheamountsofthesubstanceused–rememberthatusecanbecontinuous(forexample:daily)orinbingepatterns(largeamountsusedsporadically–suchaseverythreetofivedays).Determineiftheyoungpersonsproblemsaredueinwholeorinparttoexcessiveuseofsubstances.Oneparticularlyimportantquestionis–“Howdoestaking(nameofsubstancehere)helpyouorhinderyouinyourschoolandsociallife”?

Substance abuse/dependence in young people usually requires professional intervention. Issues such asconfidentialitywill often arise so it is important that teachers understandwhat the expectations and limits toconfidentialityregardingsubstanceabuse/dependenceareintheirsetting.

Often the advice of a teacher or coach is an important step towards treatment for a youngperson abusingsubstances.Non-judgementalbutrealisticadvicefromateachercansometimesleadthemtotherealizationthattheyneedhelp.Someyoungpeopletrafficinthesubstancesthattheyuse.Theteacherthereforeneedstoknowthe school policy on drugs and abide by it.

What is suicide?

Suicidetheactofendingone’slife.Suicideitselfisnotamentaldisorderbutoneofthemostimportantcausesof suicide ismentalillness–mostoftendepression,bipolardisorder(manicdepression),schizophrenia,andsubstanceabuse.

Suicideisfoundineverycultureandmaybetheresultofcomplexsocial,cultural,religiousandsocio-economicfactorsinadditiontomentaldisorders.Thereasonsforsuicidemayvaryfromregiontoregionbecauseofthesefactors.Itisthereforeimportanttoknowwhatthemostcommonreasonsforsuicideareintheregioninwhichyouareworking.Thismaybedifficulttodetermineaccuratelybecauseofthe“taboos”andstigmaaroundsuicide.

The preferred methods of completing suicide may vary from location to location – ranging from firearms tofertilizerpoisoningtoself-burningtooverdosingonpills.Therefore,itisalsoimportanttoknowthemostcommonmethodsofsuicideintheregioninwhichyouareworking.

Things to look for:Somepeoplewithsubstancedependence/abusewillalsohave

othermentalhealthproblemssuchasdepressionoranxiety.If

theseproblems occur they shouldbe identifiedand help for

themprovided.Suicidemayoccurmorefrequentlyinpeople

withsubstanceproblems.Youthwhosufferfromuntreatedor

inadequately treatedADHDareat higher risk for substance

abuse.EffectivemedicationtreatmentofADHDdecreasesthe

riskforsubstanceabuse.

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What does suicide look like?Notallself-harmbehaviorsareattemptstocommitsuicide.Theremaybemanyreasonsforself-harmbehaviorsbesidessuicide.Theseincludeapersonattemptingtocryforhelp,forexamplefromapersonwhoisstuckinaharmfulsituationthattheycannotescapesuchasongoingsexualabuse.Certaintypesofpersonalitydisorderscommonly perform self-harm behaviors. A suicide attempt is distinguished from a self-harm behavior by theperson’sintenttodie.

Suicidal behavior has three components: ideation; intent, plans. 1. Suicidal ideation includes ideasaboutdeathordying,wishing thathe/sheweredead,or ideasabout

committingsuicide.Theseideasarenotpersistent.Theseideascanbefairlycommoninpeoplewithmentaldisordersorinpeoplewhoareindifficultlifecircumstances.Mostpeoplewithsuicidalideationdonotgoontocommitsuicidebutthesuicidalideationisariskfactorforsuicide.

2. The second component is suicidal intent. With suicidal intent, the idea of committing suicide is betterformedandmoreconsistentlyheldthaninsuicidalideation.Apersonwithsuicidalintentmaythinkaboutcommittingsuicidemostofthetime,imagingwhatlifewouldbelikeforfriendsandfamilywithouthim/her,etc.Thestrongestintentoccurswhenthepersondecidesthatshe/hewillcommitsuicide.

3. Thethirdcomponentisthesuicideplan.Thisisaclearplanofhowtheactofsuicidewilloccur.Vagueplans(suchas“somedayIwilljumpoffabridge”)areconsideredaspartofintent.Inasuicideplanthemeansofcommittingsuicidewillbeidentifiedandobtained(suchagun,poison,etc.),theplaceandtimewillbechosen.Thepresenceofasuicideplanconstitutesapsychiatricemergency.

What can i do if it is suicide?Thefirst thing is to identify thepresenceofsuicide ideation,intentandplans.Suicideideationandintentmaybenefitfromsupportiveorcognitivebasedcounseling.Thepresenceofasuicideplanshouldleadtoplacementofthepersoninasituationinwhichhe/shecanbesafeandsecure.Thatsituationshouldbetherapeuticandnotpunitiveandshouldbeaccompaniedbysupportiveandcognitivecounseling.Thefamilyor lovedonesmay requiresupportandhelpaswell.Non-judgmentalsupportivecounselingmaybeofassistanceinsuchsituation.Ifasuicidehashappened,thefamilyorlovedonesmaybenefitfromnon-judgmentalsupportivebereavementcounseling.

Ifateacherisfacedwithastudentwhoistalkingaboutorwritingaboutsuicidethenitisimportanttoincludeaneducatorfromguidanceorhealthtoassessthesituation.Generallyitisbettertoerronthesideofcautionandtaketheyoungpersontoalocationinwhichtheycanbesafe.Schoolsshouldhavepoliciesabouthowtodealwithasuicidalyouth–knowyourschool’spolicy.Ifthereisnopolicybringthisissuetotheattentionoftheprincipal.

Ifayoungperson suicides, therecanbenegative repercussionsamongstpeers, classmatesand teachers. It isimportantnot toforcestudentsorothers intorelivingoranalyzingtheevent. Traditionalcritical incidentstressdebriefinginterventionshavenotbeenshowntobehelpfulandmayevencauseharm.Asupportivespaceforthosestudentswhowishtouseitshouldbeprovidedafterschoolhoursandateacherorguidancecounselorknowntothestudentsshouldideallybeavailableforthosewhowishtotalk.Eachcommunitywillhaveitsowntraditionsfordealingwiththiskindofeventanditisnotnecessarytocreatehighlyaffectiveresponsestoasuicideintheschoolsetting.

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What are risk factors for suicide?Thefollowingarethemostcommon(andstrongest)riskfactorsforsuicideinyoungpeople.Rememberthatariskfactordoesnotmeansomethingthatcausesaneventtohappen,ratheritissomethingthatisrelatedtoaneventthathappens.

• Sex(male)• Depressionorothermentaldisorder• Previoussuicideattempt• Familyhistoryofsuicide• Excessivealcoholordruguse• Impulsivityorjuvenilejusticehistory

Suicideriskishighinpeoplewithmentaldisorders,inparticularthosewith:depression(ofallkinds);bipolar(manic-depression);schizophrenia;substanceabuse.Ifayoungpersontalkstoyouaboutsuicide,takethemseriously–itisamyththatpeoplewhotalkaboutsuicidewillnotattemptsuicide.

Questions to ask?Askaboutideation:“Haveyoubeenthinkingaboutdying,harmingyourselforsuicide?”Askaboutintent:“Haveyoudecidedthatyouwouldbebetteroffdeadorthatyoushouldkillyourself?”Askaboutplans:“Whatplanshaveyoumadetokillyourself(andobtainthedetails)?”