Stuck in a tunnel HELPING CHILDREN WITH MENTAL HEALTH ISSUES Presentation Objectives Understanding the basics of mental health in children Understanding the warning signs of mental health issues in children Understanding mental health disorders Understanding Mood Disorders Understanding Dissociative Disorders Where to go for help THE BASICS UNDERSTANDING MENTAL HEALTH IN CHILDREN What is mental health in children? Mental health in childhood means reaching developmental and emotional milestones, and learning healthy social skills and how to cope when there are problems (CDC, 2014). What are mental disorders in children? Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions (CDC, 2014) Attention-Deficit/Hyperactivity Disorder Autism Spectrum Disorders Mood and Anxiety Disorders Tourette Syndrome (TS) DEPRESSION A DEEPER LOOK DOWN THE TUNNEL DEPRESSION SYMPTOMS DEPRESSION TREATMENTS DISSOCIATIVE DISORDERS A DEEPER LOOK DOWN THE TUNNEL DISSOCIATIVE DISORDERS SYMPTOMS DISSOCIATIVE DISORDERS TREATMENTS RESOURCES FOR HELP Resources in our local area in NC: Division of Mental Health:Mental Health Association of Central Carolinas: mhacentralcarolinas.org Mental Health Association in Greensboro:Online Help: American Psychiatric Association:Centers for Disease Control and Prevention:National Institute of Mental Health:National Alliance on Mental Illness:NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services: REFERENCES MentalHealth.gov. (2014). Personality Disorders. Retrieved from MentalHealth.gov:Mentalheath.gov. (2014). Depression. Retrieved from MentalHealth.gov:to-look-for/mood-disorders/depression/ NAMI. (2014). Dissociative Disorders. Retrieved from National Alliance on Mental Illness:NAMI. (2014). Mental Illnesses Dissociative Identity Disorder. Retrieved from National Alliance on Mental Illness:play.cfm&ContentID=165620&MicrositeID=0 NAMI. (2014). What is Depression? Retrieved from National Alliance on Mental Illness:New, Julie (2014). Week 13 DQ 1. Winston-Salem, NC: Salem College New, Julie (2014). Moving too fast. Winston-Salem, NC: Salem College WEBMD. (2014). Depression Health Center. Retrieved from WebMD: Appendix A MAJOR AND MINOR DEPRESSION; DISSOCIATIVE DISORDERS; MULTIPLE PERSONALITY DISORDER Additional Studies OTHER DISORDERS THAT CAN AFFECT CHILDREN Disorder Information Major and Minor Depression Signs & SymptomsTreatments, Services, Support Agencies Major depression is a mood state that goes well beyond temporarily feeling sad or blue (NAMI, What is Depression?, 2014). It is a serious medical illness that affects ones thoughts, feelings, behavior, mood and physical health (NAMI, What is Depression?, 2014). Depression is a life-long condition in which periods of wellness alternate with recurrences of illness (NAMI, What is Depression?, 2014). Depression can include feelings of sadness, loss of interest in activities, changes in weight and sleeping habits, feelings of worthlessness (Mentalheath.gov, 2014). There are many types of depression and they can be minor to major and continue for many years. Types of depression include disorders such as Atypical, postpartum, bipolar, seasonal and psychotic (WEBMD, 2014) There are three well-established types of treatment: medications, psychotherapy and electroconvulsive therapy (ECT). A new treatment called transcranial magnetic stimulation (rTMS), has recently been cleared by the FDA for individuals who have not done well on one trial of an antidepressant (NAMI, What is Depression?, 2014). Treatments that can work well with Major and Minor Depression include Cognitive Behavioral Therapy; Interpersonal Therapy, Psychodynamic Therapy, Psychoeducation and Self-help and support groups (NAMI, What is Depression?, 2014).electroconvulsive therapy (ECT) transcranial magnetic stimulation (rTMS) Disorder Information Dissociative Disorders Signs & SymptomsTreatments, Services, Support Agencies They are marked by a dissociation from or interruption of a person's fundamental aspects of waking consciousness (such as one's personal identity, one's personal history, etc.) (NAMI, 2014). Thought to stem from trauma experienced by the individual (NAMI, 2014). Symptoms of these disorders, or even one or more of the disorders themselves, are also seen in a number of other mental illnesses, including post-traumatic stress disorder, panic disorder, and obsessive compulsive disorder (NAMI, 2014). Treatment for individuals with such a disorder may stress psychotherapy, although a combination of psychopharmacological and psychosocial treatments is often used (NAMI, 2014). Disorder Information Multiple Personality Disorder Signs & SymptomsTreatments, Services, Support Agencies Is a dissociative disorder involving a disturbance of identity in which two or more separate and distinct personality states (or identities) control an individual's behavior at different times (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014) Often people living with DID are depressed or even suicidal and self- mutilation is common in this group. Approximately one-third of individuals affected complain of auditory or visual hallucinations (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014). Problems that personality disorders can cause include interfering with a persons life, (they can) create problems at work and school and cause issues in personal and social relationships (MentalHealth.gov, 2014) Treatment for DID consists primarily of psychotherapy with hypnosis (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014). The therapist attempts to make contact with as many alters as possible and to understand their roles and functions in an individuals life (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014). The goal of the therapist is to enable the individual to achieve breakdown of the patient's separate identities and their unification into a single identity (NAMI, Mental Illnesses Dissociative Identity Disorder, 2014) Appendix B PERSUASIVE DEVELOPMENT DISORDER-NOT OTHERWISE SPECIFIED (PDD-NOS) & AUTISM SPECTRUM DISORDERS (ASD) DisorderDescriptionSigns & SymptomsTreatments Persuasive Development Disorder-Not Otherwise Specified (PDD-NOS) Neurobehavioral Disorder PDD refers to the class of conditions to which autism belongs (Yale School of Medicine, 2014) PDD is not a diagnosis, but PDD-NOS is and is also known as Atypical Personality Disorder At this time there are no specific guidelines for this diagnosis and with no guidelines research is difficult Symptoms start at later ages than Autism symptoms Children diagnosed with PDD-NOS have an under-connectivity of electrical activity within and between the hemispheres of the brain. Atypical or inappropriate social behavior Uneven skill development (motor, sensory, visual-spatial organizational, cognitive, social, academic, behavioral) Poorly developed speech and language comprehension skills Difficulty with transitions Deficits in nonverbal and/or verbal communication Increased or decreased sensitivities to taste, sight, sound, smell and/or touch Perseverative (repetitive or ritualistic) behaviors (i.e., opening and closing doors repeatedly or switching a light on and off) (Brain Balance Achievement Centers, 2014) Integrate physical, sensory-motor, and cognitive exercises with simple dietary changes to correct the underlying connection issue and reduce or eliminate negative symptoms and behaviors. (Brain Balance Achievement Center, 2014)physical, sensory-motor, and cognitive exercises simple dietary changes Tailored plans for each student Play therapy and social skills training Important for family to advocate for these children because they are often overlooked. DisorderDescriptionSigns & SymptomsTreatments Autism Spectrum Disorders (ASD) Autism spectrum disorder (ASD) diagnosis is often a two-stage process. The first stage involves general developmental screening during well- child checkups with a pediatrician or an early childhood health care provider. The second stage involves a thorough evaluation by a team of doctors and other health professionals with a wide range of specialties (National Institute of Mental Health, n.d.). Reliable diagnosis can usually be made by age 2 First introduced in 1943 by Dr. Leo Kenner Autism begins to manifest itself within the first few months of a childs life Characterized by social interaction issues and delayed or deviant communication development (Yale School of Medicine, 2014) There is a range of multiple symptoms, levels of impairment, and skills that make up the Autism Spectrum. Signs and symptoms vary from child to child Make little to no eye contact Do not look or listen to people like others Fail to respond when spoken to Do not respond to their own name Delayed communication development Echolalia- repeating words or phrases that they hear Have unusual tone when speaking, if they are verbal Trouble understanding, relating, and reacting to other peoples feelings Missed social cues Individualized plans work best Many nonverbal children respond well to sign language Best for children to have routines Early intervention is key Using focused and challenging learning activities Families should get as much training as possible Measuring and recording progress and or lack of progress Social skills training Play therapy There a few medications that may help with certain symptoms, but no real medication has been approved for Autism as a whole Under IDEA: free screenings and early intervention services to children from birth to age 3. IDEA also provides special education and related services from ages 3 to 21 (National Institute of Mental Health, n.d.). Appendix C DUAL DIAGNOSIS; SUBSTANCE ABUSE DISORDER; BIPOLAR AFFECTIVE DISORDER Disorder Information Dual Diagnosis Signs & SymptomsTreatments, Services, Support Agencies Dual diagnosis is a term used to describe people with mental illness who also have problems with drugs and/or alcohol (The National Alliance on Mental Illness, 2013b, p. 1). Dual diagnosis is more common than you might think many people with mental illness have ongoing substance abuse problems, and many people who abuse drugs and alcohol also experience mental illness (The National Alliance on Mental Health, 2013a, para 1). Almost 1/3 of those with all mental illnesses and about 1/2 of those with severe mental illnesses are also substance abusers. Greater than 1/3 of those who abuse alcohol and greater than 1/2 of those who abuse drugs also have a mental illness (The National Alliance on Mental Health, 2013a). A dual diagnosis may present in a variety of combinations of mental illnesses/disorders and addictions (The National Alliance on Mental Health, 2013b). Abandoning friends or family in favor of new activities or a new crowd Struggling to keep up with school or work Lying or stealing in order to continue an addictive behavior Staying up late at night and sleeping during the day Trying to quit using drugs, drinking, gambling or having unsafe sex, but relapsing repeatedly Expressing feelings of guilt or regret about a compulsive behavior Seeking out larger doses of drugs, more alcoholic beverages or more extreme high-risk behavior in order to get the same high Experiencing withdrawal symptoms after trying to quit a harmful substance or cutting down the dose (Foundations Recovery Network, 2014, para 12). Deliberately withdraws from others, refusing offers of friendship or support Believes things that arent true (delusions) or has sensory experiences that arent shared by others (hallucinations) Expresses feelings of despair, hopelessness or worthlessness for two or more weeks in a row Feels compelled to follow complicated rituals and maintain high standards of order in order to relieve internal anxiety Has trouble holding a job, keeping an apartment or maintaining friendships because of behavioral issues or mood swings Has dramatic changes in mood and energy levels Uses drugs, alcohol or compulsive behaviors to manage moods or cope with stress (Foundations Recovery Network, 2014, para 13). For treatment to be effective, both the mental illness/disorder and the addiction must be considered (Foundations Recovery Network, 2014). Because of the variety of combinations of addictions (alcohol and/or drugs) and mental illnesses/disorders (mood disorder, anxiety disorder, personality disorder, or eating disorder), no single treatment will work for everyone (Foundations Recovery Network, 2014). Psychiatric treatment will be more successful if the patient stops their drug and/or alcohol abuse (The National Alliance on Mental Illness, 2013a). Treatment for drug and/or alcohol abuse can include in-patient detox, self-help groups, cognitive- behavioral therapy, and even medication (The National Alliance on Mental Illness, 2013a). Treatment of the mental illness/disorder will depend on which mental illness/disorder the patient suffers from (Foundations Recovery Network, 2014; The National Alliance on Mental Illness, 2013a). Services and Support Agencies: The National Alliance on Mental Illness (NAMI) Mental Illness, Drug Addiction, and Alcoholism (MIDAA) Foundations Recovery Network (dualdiagnosis.org) Substance Abuse and Mental Health Services Administration (SAMHSA) National Network of Depression Centers (NNDC) Disorder Information Bipolar Affective Disorder Signs & SymptomsTreatments, Services, Support Agencies Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks (National Institute of Mental Health, n.d.a, para 1). The four types of bipolar affective disorder are: Bipolar affective disorder I - at least one episode of mania or at least two mixed episodes with or without depression. Bipolar affective disorder II - one or more episodes of depression followed by a milder, manic episode. Cyclothymia - a milder form of bipolar affective disorder in which symptoms are less severe but longer lasting. It can turn into a full bipolar affective disorder. Rapid cycling bipolar disorder - your mood switches from mania to depression very quickly and then back again, with at least four episodes of either mania or depression within the period of a year (Bupa, 2014). The onset of bipolar disorder is usually in a person's late teens or early adult years, with at least 50% of all cases occurring before the age of 25 (National Institute of Mental Health, n.d.a). A long period of feeling "high," or an overly happy or outgoing mood. Extreme irritability; Talking very fast, jumping from one idea to another, having racing thoughts; Being easily distracted; Increasing activities, such as taking on new projects; Being overly restless; Sleeping little or not being tired; Having an unrealistic belief in one's abilities Behaving impulsively and engaging in pleasurable, high-risk behaviors (National Institute of Mental Health, n.d.a, para 13). Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks (National Institute of Mental Health, n.d.a, para 1). The four types of bipolar affective disorder are: Bipolar affective disorder I - at least one episode of mania or at least two mixed episodes with or without depression. Bipolar affective disorder II - one or more episodes of depression followed by a milder, manic episode. Cyclothymia - a milder form of bipolar affective disorder in which symptoms are less severe but longer lasting. It can turn into a full bipolar affective disorder. Rapid cycling bipolar disorder - your mood switches from mania to depression very quickly and then back again, with at least four episodes of either mania or depression within the period of a year (Bupa, 2014). An overly long period of feeling sad or hopeless Loss of interest in activities once enjoyed, including sex. Feeling tired or "slowed down" Having problems concentrating, remembering, and making decisions Being restless or irritable Changing eating, sleeping, or other habits Thinking of death or suicide, or attempting suicide (National Institute of Mental Health, n.d.a, para 13). Bipolar disorder is an illness which can require long-term treatment. Skilled medical management is needed. Different medications are used to treat acute episodes of mania and of depression, and other medications ('mood stabilizers') are used to keep episodes at bay or to augment acute treatments, in other words, a distinction is made between management of acute episodes and maintenance. Psychological therapies, such as counseling and psychotherapy, are unlikely to be effective by themselves, but are valuable in combination with physical therapies. Every person is different - he or she may need medication or combinations of medications that are quite different from somebody else with bipolar disorder. Compliance with medications is important for long term stability. Depending on the nature of the illness and how it is managed, hospitalization can sometimes be required. Treatments should take account the rare possibility of organic or medical causes for bipolar disorder (particularly if the person is 40 or older at the time of their first manic episode). Some psychotropic medications (e.g. antidepressant drugs) can cause mania, as can some steroids or stimulant drugs. Recurring mania is usually due to poor compliance with medication, or the particular medication not working properly. The use of medications during pregnancy is an extremely important issue and needs consultation with an expert (Black Dog Institute, 2014, para 1). Services and Support Agencies: The National Alliance on Mental Illness (NAMI) National Institute of Mental Health, National Institutes of Health (NIMH) Depression and Bipolar Support Alliance (DBSA) Helpguide.org Black Dog Institute International Bipolar Foundation (IBPF) Disorder Information Borderline Personality Disorder Signs & SymptomsTreatments, Services, Support Agencies Borderline personality disorder (BPD) is a serious mental illness that centers on the inability to manage emotions effectively. The disorder occurs in the context of relationships: sometimes all relationships are affected, sometimes only one Other disorders, such as depression, anxiety disorders, eating disorders, substance abuse and other personality disorders can often exist along with BPD (National Education Alliance for Borderline Personality Disorder, 2014, para 1). People with borderline personality disorder often: have difficulty controlling their thoughts and emotions, are impulsive and reckless, and have unstable relationships with other people (National Institute of Mental Health, n.d.b). Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separationssuch as vacations, business trips, or sudden changes of plansfrom people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder (National Institute of Mental Health, n.d.b, para 9). To be diagnosed with BPD one must show a long-term pattern of at least five of these symptoms. Extreme reactionsincluding panic, depression, rage, or frantic actionsto abandonment, whether real or perceived A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation) Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices) Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating Recurring suicidal behaviors or threats or self-harming behavior, such as cutting Intense and highly changeable moods, with each episode lasting from a few hours to a few days Chronic feelings of emptiness and/or boredom Inappropriate, intense anger or problems controlling anger Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality (National Institute of Mental Health, n.d.b, para 8). Several treatments have been shown to be effective in the treatment of BPD: Dialectical behavior therapy (DBT) a problem solving way of treating BPD created specifically for that purpose. It encourages the patient to focus on their current emotion and tries to help them find a balance between accepting and changing their behaviors. It is the most effective treatment for BPD. Cognitive Behavior Therapy (CBT) helps patients become aware of the way they think and act that may be negative or inaccurate. Mentalization-based therapy (MBT) helps patients become aware of what others are thinking and feeling. Transference-focused therapy (TFT) by using the relationship with the therapist as a conduit for understanding, the patient learns about their own emotions and interpersonal problems. Medications cant be used to cure BPD, but it can help manage some of the other conditions which are often seen in patients with BPD, such as depression, impulsiveness, and anxiety. Self-care patients are encouraged to take care of themselves through exercise, diet, and nutrition, as well as proper use of medications in order to manage symptoms of BPD (National Education Alliance for Borderline Personality Disorder, 2014). Services and Support Agencies: National Education Alliance for Borderline Personality Disorder (NEA.BPD) Treatment and Research Advancements National Association for Personality Disorder (TARA) Borderline Personality Disorder Resource Center Mental Health America (MHA) Appendix D ANOREXIA; BULIMIA; SCHIZOAFFECTIVE DISORDER; SCHIZOPHRENIA Disorder Information Anorexia Signs & SymptomsTreatments, Services, Support Agencies Anorexia nervosa is an eating disorder that causes people to obsess about their weight and the food they eat. People with anorexia nervosa attempt to maintain a weight that's far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively (www.mayoclinic.org).www.mayoclinic.org If you're concerned that a loved one may have anorexia, watch for these possible red flags: Skipping meals Making excuses for not eating Eating only a few certain "safe" foods, usually those low in fat and calories Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing Cooking elaborate meals for others but refusing to eat Repeated weighing of themselves Frequent checking in the mirror for perceived flaws Complaining about being fat Not wanting to eat in public (www.mayoclinic.org)www.mayoclinic.org Medical Care: may initially require feeding through a tube that's placed in their nose and goes to the stomach (nasogastric tube). Restoring a Health Weight: A dietitian can offer guidance on a healthy diet, including providing specific meal plans and calorie requirements that will help you meet your weight goals. Psychotherapy: Individual therapy. This type of therapy can help you deal with the behavior and thoughts that contribute to anorexia. A type of talk therapy called cognitive behavioral therapy (CBT) is commonly used. Therapy may be done in day treatment programs, but in some cases, may be part of treatment in a psychiatric hospital. Family-based therapy. This therapy begins with the assumption that the person with the eating disorder is no longer capable of making sound decisions regarding his or her health and needs help from the family. An important part of family-based therapy is that the family is involved in making sure that healthy-eating patterns are followed. This type of therapy can help resolve family conflicts and muster support from concerned family members. Family- based therapy can be especially important for children with anorexia who still live at home. Group therapy. This type of therapy gives you a way to connect to others facing eating disorders. And informal support groups may sometimes be helpful. (www.mayoclinic.org)www.mayoclinic.org Disorder Information Bulimia Signs & SymptomsTreatments, Services, Support Agencies Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, followed by frantic efforts to avoid gaining weight. It affects women and men of all ages. (www.thehelpingguide.org)www.thehelpingguide.org Warning Signs: *Calluses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting. Puffy chipmunk cheeks caused by repeated vomiting. Discolored teeth from exposure to stomach acid when throwing up. May look yellow, ragged, or clear. Not underweight Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia. Frequent fluctuations in weight Weight may fluctuate by 10 pounds or more due to alternating episodes of bingeing and purging. (www.thehelpingguide.org)www.thehelpingguide.org Breaking the binge-and-purge cycle: The first phase of bulimia treatment focuses on stopping the vicious cycle of bingeing and purging and restoring normal eating patterns. You learn to monitor your eating habits, avoid situations that trigger binges, cope with stress in ways that dont involve food, eat regularly to reduce food cravings, and fight the urge to purge. Changing unhealthy thoughts and patterns: The second phase of bulimia treatment focuses on identifying and changing dysfunctional beliefs about weight, dieting, and body shape. You explore attitudes about eating, and rethink the idea that self-worth is based on weight. Solving emotional issues: The final phase of bulimia treatment involves targeting emotional issues that caused the eating disorder in the first place. Therapy may focus on relationship issues, underlying anxiety and depression, low self-esteem, and feelings of isolation and loneliness. (www.the helpingguide.org) Disorder Information Schizoaffective Disorder Signs & SymptomsTreatments, Services, Support Agencies According to the DSM-IV-TR, people who experience more than two weeks of psychotic symptoms in the absence of severe mood disturbancesand then have symptoms of either depression or bipolar disordermay have schizoaffective disorder. Schizoaffective disorder is thought to be between the bipolar and schizophrenia diagnoses as it has features of both. (www. nami.org) Depressive symptoms associated with schizoaffective disorder can include: hopelessness, helplessness, guilt, worthlessness, disrupted appetite, disturbed sleep, inability to concentrate, and depressed mood (with or without suicidal thoughts). Manic (bipolar) symptoms associated with schizoaffective disorder can include increased energy, decreased sleep (or decreased need for sleep), distractibility, fast (pressured) speech, and increased impulsive behaviors (sexual activities, drug and alcohol abuse, gambling or spending large amounts of money). (www.Nami.org) Treatments such as cognitive behavioral therapy to target psychotic symptoms, supports groups including NAMIs Family-to-Family to increase family and community support, peer support and connection, and work-and-school rehabilitation, such as social skills training, are very helpful for people with schizoaffective disorder. Maintaining a healthy lifestyle is also of critical importance: the role of good sleep hygiene, regular exercise, and a balanced diet cannot be underestimated. (www.nami.org)www.nami.org Medications used for depression symptoms: antidepressant medications lithium antipsychotic medications Medications used for bipolar symptoms: mood-stabilizers such as lithium or anti-convulsants, valproic acid (Depakote), lamotrigine (Lamictal), and carbamazepine (Tegretol) (www.nami.org)www.nami.org Disorder Information Schizophrenia Signs & SymptomsTreatments, Services, Support Agencies Schizophrenia is a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior. Schizophrenia isn't a split personality or multiple personality. The word "schizophrenia" does mean "split mind," but it refers to a disruption of the usual balance of emotions and thinking. Schizophrenia is a chronic condition, requiring lifelong treatment. (www.mayoclinic.org)www.mayoclinic.org Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. Signs and symptoms may vary, but they reflect an impaired ability to function. (www.mayoclinic.org)www.mayoclinic.org Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. Signs and symptoms may vary, but they reflect an impaired ability to function. (www.mayoclinic.org)www.mayoclinic.org Signs may include: Delusions: These are false beliefs that are not based in reality. Hallucinations: These usually involve seeing or hearing things that don't exist. Disorganized thinking (speech): Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Extremely disorganized or abnormal motor behavior: This may show in a number of ways, ranging from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to perform tasks. Abnormal motor behavior can include resistance to instructions, inappropriate and bizarre posture, a complete lack of response, or useless and excessive movement. Negative symptoms. This refers to reduced ability or lack of ability to function normally. Some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as: Withdrawal from friends and family A drop in performance at school Trouble sleeping Irritability or depressed mood Lack of motivation Compared with schizophrenia symptoms in adults, teens may be: Less likely to have delusions More likely to have visual hallucinations (www.mayoclinic.org)www.mayoclinic.org In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than 45. (www.mayoclinic.org)www.mayoclinic.org Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene. (www.mayoclinic.org)www.mayoclinic.org Medications Typically used: Aripiprazole (Abilify); Asenapine (Saphris); Clozapine (Clozaril); Iloperidone (Fanapt); Lurasidone (Latuda); Olanzapine (Zyprexa); Paliperidone (Invega); Quetiapine (Seroquel) Risperidone (Risperdal); Ziprasidone (Geodon); Chlorpromazine; Fluphenazine; Haloperidol (Haldol); Perphenazine; Psychosocial Interventions: Once psychosis recedes, psychological and social (psychosocial) interventions are important in addition to continuing on medication. These may include: Individual therapy. Learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness. Social skills training. This focuses on improving communication and social interactions. Family therapy. This provides support and education to families dealing with schizophrenia. Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find and keep jobs. (www.mayoclinic.org)www.mayoclinic.org Disorder Information Obsessive-Compulsive Disorder Signs & SymptomsTreatments, Services, Support Agencies People with OCD generally: Have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; acts of violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly tidy Do the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again. Can't control the unwanted thoughts and behaviors. Don't get pleasure when performing the behaviors or rituals, but get brief relief from the anxiety the thoughts cause. Spend at least 1 hour a day on the thoughts and rituals, which cause distress and get in the way of daily life. (www.nimh.nih.gov)www.nimh.nih.gov OCD is generally treated with psychotherapy, medication, or both A type of psychotherapy called cognitive behavior therapy is especially useful for treating OCD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively. (www.nimh.nih.gov)www.nimh.nih.gov Appendix E POST TRAUMATIC STRESS DISORDER; ATTENTION DEFICIT HYPERACTIVITY DISORDER Disorder Information PTSD Signs & SymptomsTreatments, Services, Support Agencies PTSD is triggered by experiencing or witnessing a traumatic or terrifying event can begin immediately after the event or years later, through flashbacks Intrusive Memories recurring memories of the event reliving the event through flashbacks nightmares Avoidance avoiding thinking or remembering the event avoiding people, places, and things that are a reminder of the event Negative Changes in Thinking/Mood negative feelings about self or others inability to have positive feelings feeling emotionally numb hopelessness memory problems, blocking out memories Changes in Emotional Reactions irritability, anger, aggressive behaviors guilt or shame self-destructive behavior trouble concentrating difficulty sleeping easily startled or frightened suicidal thoughts (Mayo Clinic Staff, 2014) Treatments Psychotherapy Cognitive Therapy Exposure Therapy Medications Antidepressants Anti-anxiety medication Sleep aids Services & Support Agencies U.S. Department of Veteran Affairsoffering support groups and information on managing and coping with PTSDwww.ptsd.va.gov ADAA - Anxiety & Depression Association of Americaprovides information about PTSDwww.adaa.org Disorder Information ADHD Signs & SymptomsTreatments, Services, Support Agencies Is a behavior disorder (KidsHealth, 2014) symptoms must be present before age 7 and have a negative impact in more than one area of daily life Combined ADHD the most common form of ADHD impulsivity inattentiveness hyperactivity Inattentive ADHD formerly known as ADD inattentiveness difficulty concentrating hyperactivity not a main symptom Hyperactive-Impulsive ADHD characterized by hyperactivity concentration, focus, and inattentiveness not a main symptom (WebMD, 2014) Treatments Medications Stimulant Medications Non-stimulant Medications Non-medicinal home treatments and symptom management Services & Support Agencies ADDA - Attention Deficit Disorder Associationwith support groups in Raleigh, NC and a list of medical professionals and therapistswww.adda.org CHADD - Children & Adults with ADHDproviding information on support groups, professional services and a virtual chapter of CHADDwww.chadd.org Disorder Information ADHD Signs & SymptomsTreatments, Services, Support Agencies Is a behavior disorder (KidsHealth, 2014) symptoms must be present before age 7 and have a negative impact in more than one area of daily life Combined ADHD the most common form of ADHD impulsivity inattentiveness hyperactivity Inattentive ADHD formerly known as ADD inattentiveness difficulty concentrating hyperactivity not a main symptom Hyperactive-Impulsive ADHD characterized by hyperactivity concentration, focus, and inattentiveness not a main symptom (WebMD, 2014) Treatments Medications Stimulant Medications Non-stimulant Medications Non-medicinal home treatments and symptom management Services & Support Agencies ADDA - Attention Deficit Disorder Associationwith support groups in Raleigh, NC and a list of medical professionals and therapistswww.adda.org CHADD - Children & Adults with ADHDproviding information on support groups, professional services and a virtual chapter of CHADDwww.chadd.org Appendix F SELF HARM; CUTTING; SUBSTANCE ABUSE DISORDER; Disorder Information Cutting Signs & SymptomsTreatments, Services, Support Agencies The most common type of self- harm, deliberately cutting yourself to cope with pain. (Mayo Clinic, 2014) Cutting isnt a suicide attempt, though it may look and seem that way. (Jed Foundation, 2014) Scars from cuts Fresh cuts or scratches Keeping sharp objects on hand Wearing long sleeves in hot weather (Mayo Clinic, 2014) Individual psychotherapy Hospitalization Disorder Information Self Injury/Self Harm Signs & SymptomsTreatments, Services, Support Agencies Self-injury, also called self-harm, is the act of deliberately harming your own body, such as cutting or burning yourself. It's typically not meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger and frustration. (Mayo Clinic, 2014) Scars, such as from burns or cuts Fresh cuts, scratches, bruises or other wounds Broken bones Keeping sharp objects on hand Wearing long sleeves or long pants, even in hot weather Claiming to have frequent accidents or mishaps Spending a great deal of time alone Pervasive difficulties in interpersonal relationships Persistent questions about personal identity, such as "Who am I?" "What am I doing here?" Behavioral and emotional instability, impulsivity and unpredictability Statements of helplessness, hopelessness or worthlessness (Mayo Clinic, 2014) Individual psychotherapy Medications for depression Hospitalization Disorder Information Substance Abuse Disorder Signs & SymptomsTreatments, Services, Support Agencies According to the DSM5, Each specific sub- stance (other than caffeine, which cannot be diagnosed as a substance use disorder) is addressed as a separate use disorder (e.g., alcohol use disorder, stimulant use disorder, etc.), but nearly all substances are diagnosed based on the same overarching criteria (American Psychiatric Publishing, 2014). Symptoms of substance use disorders may include: Behavioral changes Physical Changes Social Changes (USDHHS, 2014) Individual psychotherapy Hospitalization or rehab institution Appendix G SEASONAL AFFECTIVE DISORDER; TOURETTES SYNDROME; ANXIETY DISORDERS Disorder Information Seasonal Affective Disorder Signs & SymptomsTreatments, Services, Support Agencies SAD- its a specific type of depression thats related to the change in seasons Symptoms begin in the fall and usually end when spring begins and the weather warms up People become lethargic, no energy, moody, melancholy -According to the staff at the Mayo clinic, Seasonal affective disorder is a subtype of major depression that comes and goes based on seasons, therefore there may be symptoms of major depression that come with SAD (retrieved from-Additional symptoms include: feeling hopeless, problems sleeping, agitated thoughts of suicide, low energy, hypersensitivity, appetite changes (weight gain). -SPRING AND SUMMER SAD - depression, weight loss, insomnia, poor appetite, anxiety SAD is often treated with light therapy, medication, and psychotherapy. -Light Therapy- aka photo therapy. You literally sit in front of a special light therapy box so that you are exposed to a bright light. This seems to cause a change in brain chemicals that are associated to mood. -Light therapy works best for individuals who have fall/winter SAD. It starts working within days to two weeks and there are few side effects. -Medications- most people benefit from antidepressants -Psychotherapy- aka talk therapy. This includes; identifying and changing negative thoughts, learning healthy ways of dealing with SAD, and managing stressful situations Disorder Information Panic Disorder Signs & SymptomsTreatments, Services, Support Agencies Panic Disorder Panic disorder comes along with the unpleasant and sudden episodes of panic attacks. The Mayo clinic defines panic attacks as, sudden episode of intense fear that triggers severe physical reactions when there is not real danger or apparent cause. Its the recurring, unexpected panic attacks and spent long periods in constant fear of another attack that lead to the condition of a panic disorder (Retrieved from -Panic attacks begin suddenly, without warning. -attacks include the following symptoms: sense of doom or danger - rapid heart rate - sweating - trembling - chills - chest pain - faintness - hyperventilation - One of the worst parts of panic attacks is the intense fear that you will have another one. Therefore avoiding situations where they may occur. Some people even develop agoraphobia - Panic attacks require medical attention - They are very difficult to manage on your own. - Panic attacks resemble a heart attack - Psychotherapy and medication are the main treatment options - Cognitive behavioral therapy helps clients understand the attacks and disorder, along with maintaining the symptoms and attacks - Medications reduced the symptoms and any depression that may be associated with the disorder. SSRIs, SNRIs, and Benzodiazepines - It can take up to several weeks before to notice any improvements. Disorder Information Tourettes Syndrome Signs & SymptomsTreatments, Services, Support Agencies According the Mayo Clinic Staff, Tourettes Syndrome is a nervous system disorder that starts in childhood. It involves unusual repetitive movements or unwanted sounds that cant be controlled -Signs and symptoms show up between the ages of 2 and Males are 3 to 4 times more likely than females to develop this syndrome. - The symptoms become more controllable after the teen years. - Symptoms include: simple tics, eye blinking, head jerking, shoulder shrugging, finger flexing, hiccupping, yelling, throat clearing, and barking (yes barking). - These are often involuntary actions. - There is no cure, you can live a normal life span with Tourette Syndrome. - No medication is helpful to everyone, none completely eliminate symptoms. - Possible helpful medications include: Haldol or Orap. These drugs block the neurotransmitter dopamine in the brain (used to control tics). Then there are botox injections and stimulant medications such as Adderall. - Therapy may include psychotherapy, behavior therapy and deep brain stimulants Disorder Information Anxiety Signs & SymptomsTreatments, Services, Support Agencies Anxiety disorders are characterized by either manifest anxiety or by self- defeating behavior patterns aimed at warding off anxiety. -Although anxiety can be experienced in a variety of ways, there are three basic patterns. Phobias acute stress disorder, and posttraumatic stress disorder involve a fear aroused be an identifiable object or situation (Alloy, Riskind, & Manos, 2005, p.151). Common symptoms include: Feelings of panic, fear, and uneasiness Problems sleeping Cold or sweaty hands and/or feet Shortness of breath Heart palpitations An inability to be still and calm Dry mouth Numbness or tingling in the hands or feet Nausea Muscle tension Dizziness (Retrieved frompanic).panic -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 such as antidepressants and antianxiety - Psychotherapy - Cognitive behavioral therapy - Dietary and lifestyle changes - Relaxation therapy