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The Handbook:

Table of Contents

Introduction

Brain Disorders

Coping in Crisis

Medications

Resources for Care

Effects on the Family

Public Health Services

Financial Resources

Working with the System


Appendices:

NAMI Phone Numbers

DuPage Health Services

Chicago Area Hospitals

Community Resources

Legal Resources

Books, Videos, Journals

Hospitalization Form

Judicial Admission Form

Declaration of Treatment

Drug Reimbursement

Mental Illness  (Brain Disorders)

Symptoms of Brain Disorders

Symptoms may vary, but all mentally ill persons have thoughts, feelings, or behavioral characteristics that result in an inability to cope with the ordinary demands of life. Most of the following may be useful in recognizing warning signs of mental illness. While a single symptom or isolated event does not necessarily indicate mental illness, professional help should be sought if symptoms persist or worsen.

» Social Withdrawal

• Sitting and doing nothing
• Friendlessness; abnormal self-centeredness
• Dropping activities such as occupations and hobbies
• Decline in academic or athletic performance

» Depression

• Loss of interest in once pleasurable activities
• Expression of hopelessness, helplessness, inadequacy
• Changes in appetite, weight loss or sometimes gain
• Behaviors unrelated to events or circumstances
• Excessive fatigue and sleepiness, or an inability to sleep
• Pessimism; perceiving the world as "dead"
• Thinking or talking about suicide

» Thought Disorders

• Inability to concentrate or cope with minor problems
• Irrational statements
• Poor reasoning, memory, and judgment
• Peculiar use of words or language structure
• Excessive fears or suspiciousness

» Expression of Feelings

• Hostility from one formerly passive and compliant
• Indifference, even in highly important situations
• Inability to cry, or excessive crying
• Inability to express joy
• Inappropriate laughter

» Behavior

• Hyperactivity/inactivity or alterations between the two
• Deterioration in personal hygiene and appearance
• Involvement in automobile accidents
• Drug or alcohol abuse
• Forgetfulness and loss of valuable possessions
• Attempts to escape through geographic change: frequent moves or hitch-hiking trips
• Bizarre behavior (staring, strange posturing)
• Unusual sensitivity to noises, light, colors, clothing
• Changes in sleeping and eating habits

» Cognitive Impairment

• Disorientation in time, place or person
• Inability to find way in familiar settings
• Inability to solve familiar problems
• Impaired memory for recent events
• Inability to wash and feed oneself, urinary or fecal incontinence

There may be physical symptoms having no organic cause. They may range from daily headaches or migraines induced by tension, to nausea, pain, and other complaints. These psycho-physiological symptoms are very real, and the individual really suffers. An underlying medical disease such as hypothyroidism, multiple sclerosis, brain tumor, or disordered metabolism can mimic symptoms of mental illness. A thorough physical examination should be the first step when brain disorder is suspected.

Often, symptoms of brain disorders are cyclic, varying in severity from time to time. Duration of an episode can also vary from weeks to months for some, and many years or a lifetime for others.

Major Types of Brain Disorders

Schizophrenia

Schizophrenia is a disorder of the brain that affects mental processes, such as thinking and judgment, sensory perception, and the ability to appropriately interpret and respond to situations or stimuli.

Many clinicians describe typical schizophrenic symptoms as either "positive" (experiences which are present but should be absent) or "negative" (experiences which are absent but should be present). Positive and negative do not mean good or bad.

Positive symptoms include:

• Hallucinations (hearing, feeling, seeing or smelling things which exist only in the individual's mind)
• Delusions (persistent false beliefs), suspiciousness
• Marked thought disorder (communication difficulties, incoherence)
• Bizarre and disorganized behavior
• Oversensitivity of the senses
• Loosening of associations
• Negative symptoms include:
• Alogia (deficiency in flow of thought, speech)
• Anhedonia (inability to experience pleasure)
• Blunted affect (lack of emotion or flatness of emotion)
• Asociality (social withdrawal)
• Amotivation (lack of interest, persistence, or initiative)
• Apathy (lack of feeling, indifference)
• Poor personal hygiene
• Inappropriate social behavior

Positive refers to symptoms that are observable. Negative refers to the absence of normal behavior and attitudes. Both are part of the illness, but each person affected by the illness may have a predominance of either group of symptoms.

Medications are generally effective in controlling the positive symptoms yet are little or no help in altering the negative symptoms.

Schizophrenia is not a split personality, nor can it be treated through psychoanalysis. It is an impaired process of the brain. It is no one's fault. Symptoms can be diminished with medication.

About one percent of the adult population has schizophrenia. The first symptoms usually appear between the ages of 17 and 24 and can be confused with other common adolescent behaviors

The following table compiled by Dr. Irving I. Gottesman cited in Dr. E. Fuller Torrrey's book, Surviving Schizophrenia: A Manual for Consumers and Providers, presents the risk factors for Schizophrenia within the family.

Schizophrenia Risk:

Schizoaffective Disorders

Some patients have symptoms which place them somewhere on a spectrum between schizophrenia and manic-depressive illness. These disorders have not been very clearly defined or studied. They are marked by symptoms of both schizophrenia and mood disorders though not at the same time.

Physicians often treat these disorders with a combination of major tranquilizers and lithium.

Persons having these disorders generally do somewhat better than those with a diagnosis of schizophrenia though not as well as persons who experience mood disorders.

Affective Disorders

Affective disorders or mood disorders include depression (unipolar disorder) and manic-depressive illness (bipolar disorder). These are common psychiatric problems and affect five percent of the adult population at any given time. The essential characteristic is a disturbance in feeling or mood.

Bipolar or manic-depressive illness is characterized by cycles of persistent, severe depression or mania. Manic symptoms may include the following:

• boundless energy, enthusiasm, and need for activity
• rapid loud disorganized speech
• short temper
• argumentative
• involvement in activities which have painful consequences such as shopping sprees, reckless driving, and unwise business investments
• delusional

When depressed, the person may:

• have difficulty sleeping
• lose interest in daily activities
• lose his appetite
• suffer feelings of worthlessness, guilt or hopelessness
• exhibit feelings of sadness
• be unable to concentrate
• experience extreme irritability.

In unipolar depression only the depressive symptoms are present.

Psychotic symptoms often complicate mania as well as depression. When present, anti-psychotic medication or electro-convulsive therapy (ECT) is often needed to treat these symptoms.

Major depression (described above) should not be confused with reactive depression or "the blues." Reactive depression, sometimes called situational affective disorder, is a temporary condition triggered by life's problems. Should this condition persist, the affected individual should see a doctor to find out if it is becoming a major depression.

The following information from Joyce Burland, Ph.D., in the Family To Family Education Manual, suggests the risk factors for affective disorders within the family.

Major Depression Risk:

Bipolar Illness Risk:

Anxiety Disorders

When severe, anxiety may also be considered a mental illness. Anxiety disorders affect approximately seven to fifteen percent of the population. One particular form, panic disorder, is characterized by recurrent panic attacks in which the person experiences dizziness, chest discomfort, choking and sweating. These attacks generally last only a few minutes, but anticipation of an attack and the subsequent fear of helplessness often complicate the problem. Other forms of anxiety disorders include fear of specific objects called phobias. A common phobia is agoraphobia, a fear of going out. Obsessive-compulsive disorder (OCD) is a brain disorder characterized by special kinds of thoughts (obsessions) of such severity that they cause distress or interfere with everyday life.

Personality Disorders

Some people believe that the personality disorders, also called character disorders, do not constitute brain disorders, while others believe that, in their severe form, they do. These are some behaviors that may need professional attention.

This very broad category of disorders is related to rigid and deeply rooted impaired patterns in relating to, perceiving, and thinking about the environment and oneself.  These disorders are evident in individuals who fail to adjust to socially acceptable norms of behavior in vocational and social settings and who are incapable of establishing adequate, stable relationships.

Some of these disorders are:

Antisocial Personality Disorder

An individual who may be in continuous social or legal trouble and may appear to profit very little from parental or social discipline.

Borderline Personality Disorder

This is characterized by marked changes in mood for brief periods of time; having unstable, intense interpersonal relationships; proneness to unpredictable action which could be self-damaging; an unstable self-image.

Paranoid Personality Disorder

Characteristically, this disorder is typified by behaving towards others with unwarranted suspicion, envy, jealousy and stubbornness or feelings of having been taken advantage of, in the face of evidence to the contrary.

Obsessive-Compulsive Personality Disorder

This disorder is characterized by a pervasive pattern of perfectionism and inflexibility beginning in early adulthood and present in a variety of contexts. This disorder can interfere with task completion, preoccupation with details while losing sight of over-all goals, unreasonable insistence on a particular way of doing things, excessive devotion to work, indecisiveness, over-conscientiousness. It can also cause restricted expression of affection, lack of generosity, inability to discard worthless objects.

Cognitive Deficit Disorders

Although cognitive deficit disorders occur most frequently in the elderly, they can occur at any age. The two most common syndromes are delirium and dementia.

• Delirium
  Delirium is an acute and rapid decline in mental function characterized by agitation, disorientation, memory impairment, fluctuating level of consciousness, hallucinations and delusions. It is caused by some underlying physical process, most often drug toxicity, cardiovascular disease, infections or trauma. With treatment of the underlying cause full recovery follows in most cases.
• Dementia
  Dementia is a chronic global decline in mental function characterized by disorientation, memory impairment, and decreased self-care. While the most common cause of dementia is Alzheimer's Disease, other causes of dementia must be ruled out by thorough physical and laboratory examination.

Substance Abuse

Abusive use of drugs and alcohol can lead to serious depression and other symptoms characteristic of brain disorders. In and of themselves they are not usually the primary cause of the illness; however, such abuse may complicate diagnosis. Addiction may be considered an illness.

Abuse of alcohol, over the counter medication, prescribed medication, or street drugs is very common. Substance abuse can be the "great imitator." Approximately 50 percent of general psychiatric populations are also substance abusers. Substance use can be a form of self-medication for an individual seeking relief from symptoms of mental illness. This can often lead to substance abuse.

The abuse of these substances can complicate the treatment of mental illness and, for this reason, detoxification is often recommended as a first step in treatment. The success of a detoxification program rests upon the individual's motivation to participate. Should your relative have a substance abuse problem in addition to his brain disorder, his physician should be consulted regarding his psychiatric condition and medication relative to the detoxification program. Withdrawal from alcohol or drugs can cause severe side effects, and it is important to determine whether the individual should be in a supervised setting.

Fortunately, there is more recognition today of the complexity of problems, which may be severe, posed by the cross-over of substance abuse and brain disorders. Dual Disorders Anonymous (DDA) is a twelve-step program that offers support for this group. For more information, call (847) 490-9379.

Serious Disorders of Children and Adolescents

Some psychiatric disorders, such as autism, typically start in childhood while others, such as mood disorders, may be diagnosed in childhood, adolescence and adulthood. Although there is still much to learn about childhood disorders, it is generally accepted that many, if not most, of the disorders listed below are primarily neurobiological in nature.

• Autistic Disorder: the child fails to relate normally to parents and other people and has play that is rigid, repetitive and lacks variety. Seventy-five percent of children with autistic disorder also have mental retardation. Once present, autism typically affects the person for life, although about one-third of affected individuals will be able to attain some degree of independence.
• Attention Deficit Hyperactivity Disorder: either inattention or hyperactivity may be present, or both may occur. Inattention: The individual has difficulty paying attention, does not seem to listen when spoken to, and often makes careless mistakes. Hyperactivity: the individual talks excessively, intrudes on others, and has difficulty sitting still or playing quietly. Such behavior occurs both at school and at home.
• Anxiety Disorders: anxiety may or may not be associated with a specific situation. Anxiety and worry may be far out of proportion to the actual likelihood of an impact or impact of a feared event. Included among anxiety disorders are panic attacks, social phobia, obsessive-compulsive disorder and posttraumatic stress syndrome.
• Mood Disorders (Bipolar Disorder, Depression): in children, aggressive or hostile behaviors may mask underlying depression. Parents should consider the possibility of depression when there are unexplained physical complaints, a drop in school performance, social withdrawal, apathy, increased irritability, sleep or appetite changes, and suicidal behavior or ideation.
• Schizophrenia: schizophrenia usually starts in the late teens or 20's, and seldom occurs before adolescence, but some cases at age 5 or 6 have been reported. There is evidence, however, that certain structural changes in the brain are present at birth in individuals who later develop schizophrenia. The essential features are the same for children and adults, but it may be difficult to diagnose in children.
• Tourette's Disorder: this often begins when a child age 5 to 7 begins to have tics, such as eye blinking, grimacing, or shoulder jerks. Sudden vocalizations (barks, clicks, yelps) may appear later, and still later the person may involuntarily say words or phrases. Uttering obscene words out of context occurs in less that 10% of patients.

Summary of Major Types of Brain Disorders

The foregoing description of types of brain disorders and their symptoms is intended to develop a general understanding of the subject. To make a diagnosis, the psychiatrist consults the Diagnostic and Statistical Manual, 4th edition (DSM - IV). The NAMI Office and the Behavioral and Mental Health Services of the DuPage County Health Department each have copies.

Since the parent may find it necessary to cope with the behavior of a family member, the next topic offers some practical steps to take and provides some information about what to expect.

Clients and their families benefit from learning all they can about their illness.

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