Module 10

manic phase may include

Abnormally high, expansive, or irritated mood Inflated self-esteem Decreased need for sleep Increased talking Racing thoughts Excessive risk-taking

Some of the dangerous symptoms of alcohol and tranquilizer withdrawal are:

Grand mal seizures Heart attacks Strokes Hallucinations Delirium tremens

There are five prominent categories of mental illness.

Mood disorders Thought disorders (schizophrenia and psychosis) Cognitive disorders (dementia, delirium, and traumatic brain injuries) Anxiety disorders Eating disorder

Remain patient

Remain patient and try to learn the person's first name and use it in conversation.

Repeat as Needed

Repeat your directions, as needed, maintaining a calm demeanor.

Paranoid Personality Disorder:

Tends to interpret the actions of others as deliberately threatening or demeaning Foresee being in a position to be used or harmed by others Perceives dismissive behavior from other people

approaching an individual in a psychotic episode

The individual may be overwhelmed by police presence. They may attempt to run out of fear of seeing an officer in uniform. They may confess to a crime to please the officer or end the line of questioning. They need visual cues to assist in understanding. They may need a more in-depth explanation of his rights and an advocate to verify comprehension of the situation or questions.

Generally, they have a history of one or more of the following

Truancy as a child or adolescent; may have run away from home Starting fights Using weapons Physically abusing animals or other people Deliberately destroying others' property Lying Stealing Other illegal behavior

Interviewing a person with intellectual or developmental disorders requires a special strategy:

Try to arrange a quiet setting for the interview. Give reassurance and help the person to relax. Identify yourself and what role you play. State the purpose for the interview

Anxiety Disorders

are a group of mental disturbances characterized by anxiety as a core symptom.

Psychosis

illness involving a distortion of reality that may be accompanied by delusions and/or hallucinations. Psychosis is most commonly seen in persons with schizophrenia, bipolar disorder, severe depression, or drug-induced disorders. Physical circumstances can also induce a psychotic state.

It is characterized by what?

impaired verbal communication (including abnormal speech patterns or loss of speech), lack of eye contact, a restricted range of interest, resistance to change of any kind, obsessive repetitive body movements, a lack of awareness of the existence or feelings of others, and social isolation.

Symptoms of schizophrenia typically happen when

typically manifest between the ages of 16 and 30, with the lifetime prevalence estimated to be about 1% of the population.

Mental Illness

"illness, disease, or condition that either substantially impacts a person's thought, perception of reality, emotional process, or judgment, or grossly impairs a person's behavior, as manifested by recent disturbance behavior." It is diagnosed based on behaviors and thinking, as evaluated by a psychiatrist, psychologist, licensed professional counselor, licensed social worker, or other qualified professional.

Steps to communicating with an individual psychosis

1. Approach calmly 2. remain patient 3. allow them to talk 4. Use Concrete words 5. Explain your actions 6. repeat as needed

Symptoms of excited delirium include:

Aggressive, threatening, or combative behavior which gets worse when challenged or injured Superhuman strength Insensitivity to pain Pressured, loud, or incoherent speech Sweating or continuing to sweat after physical exertion has ceased Dilated pupils or less reactive to light Rapid breathing High body temperature (105+ degrees F); subject will often disrobe due to profuse sweating

Allow them to talk

Allow them to verbally ventilate, and do not crowd their space.

Reduced awareness of the environment which may result in:

An inability to stay focused on a topic or to switch topics Getting stuck on an idea rather than responding to questions or conversation Being easily distracted by unimportant things Being withdrawn, with little or no activity or little response to the environment

Emotional withdrawals

Anxiety Restlessness Irritability Insomnia Headaches Poor concentration Depression Social isolation

Emotional disturbances which may appear as:

Anxiety, fear, or paranoia Depression Irritability or anger Sense of feeling elated (euphoria) Apathy Rapid and unpredictable mood shifts Personality changes

Approach calmly

Approach them with a calm, yet cautious, demeanor, as yelling will likely startle and confuse them. Speaking slowly and clearly, introduce yourself and assure the individual that you are there to help, not hurt them.

relevant questioning methods

Ask short, simple questions, use simple language, and speak slowly. Ask open-ended rather than "yes/no" questions. A person with limited understanding may answer yes/no questions without full comprehension. When asking questions, wait patiently for a reply. The thought process of certain individuals takes longer. Repeat the question or information, if needed. Use pictures and diagrams if the person does not comprehend oral or written language. To crosscheck the person's responses, repeat their answers incorrectly. Most individuals who comprehend will correct the responses.

Persistently avoids stimuli in at least three of the following ways:

Attempts to avoid thoughts, dialogues, or feelings associated with trauma Tries to avoid activities, people, or situations that arouse recollections of the trauma Is unable to recall important aspects of trauma Has diminished interest in significant activities Feels detached and removed emotionally and socially from others Displays restricted range of affect by numbing feelings Has a sense of foreshortened future, such as no career, marriage, children, or normal life span

Characteristics specifically associated with substance abuse include the following

Chemical dependency or addiction from prolonged abuse of a drug (alcohol, prescription medications, or "street" drugs) Damage to central nervous system stemming from long-term use or large dosages of a drug Psychological disorders due to substance abuse: Paranoia from smoking a stimulant, such as crack cocaine Depression from prolonged alcohol use Anxiety from discontinued usage of heroin after having become physically dependent Adverse effects from using illegal drug and alcohol in combination with prescribed medications, such as masking of symptoms associated with a mental illness Self-medicating with illegal drugs and alcohol, creating dependency, as well as a roller-coaster effect due to lack of consistency and medical monitoring

examples of PTSD

Combat exposure Child sexual or physical abuse Terrorist attack Sexual or physical assault Serious accidents such as a car wreck Natural disasters such as a fire, tornado, hurricane, flood, or earthquake

Positive symptoms include:

Delusions of false and persistent beliefs that are not part of the individual's culture (for example, people with schizophrenia may believe that their thoughts are being broadcast on the radio) Hallucinations that include hearing, seeing, smelling, or feeling things that others cannot (most commonly, people with the disorder hear voices that talk to them or order them to do things) Disorganized speech that involves difficulty organizing thoughts, thought-blocking, and making up nonsensical words Disorganized or catatonic behavior

two most common mood disorders encountered by correctional officers are?

Depression and bipolar disorder, also known as manic depression

Experiences persistent symptoms of increased nervous system arousal that were not present before the trauma, in at least two of the following problem areas

Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating on tasks Consistently on watch for real or imagined threats that have no basis in reality Exaggerated startle reactions to non-threatening stimuli

social behavior characterstics

Does the individual associate (as an adult) with children or early adolescents? Is he/she eager to please? Do they ignore or not comprehend personal space? Do they display age-appropriate behavior? Is he/she easily influenced by others? Are they easily frustrated or aggressive in response to direct questioning?

speech characteristics

Does the individual have obvious speech defects? Is there limited response or understanding of questions? Are they inattentive? Do they become easily distracted and have difficulty staying on subject? Is his/her vocabulary or grammar lacking? Do they have difficulty describing facts in detail?

Negative symptoms include:

Flat affect (decreased emotional expressiveness, diminished facial expression, and apathetic appearance) Disillusionment with daily life Isolating behavior Lack of motivation Infrequent speaking, even when forced to interact

Susceptibility to PTSD is a function of several factors

Genetic predisposition Ecological factors Change in brain chemistry Temperament Past experiences (particularly traumatic events in early childhood) Nature and intensity of the event Social support system before and after trauma Spiritual beliefs Phase of maturational development at onset State of mind

performance tasks

Have the individual read/write simple phrases. Have them identify a telephone number in the phone book. Ask them to give directions to their home. Have them tell time. Ask them to count to 100 by multiples of 5. Have them define abstract terms (such as emotions or feeling terms). Ask them to explain how to make change from a dollar. Ask them to tie their shoes.

delayed-onset PTSD.

If the person is able to effectively deal with the trauma, it can then be put in the past. However, if trauma is not dealt with, it can continue and evolve into chronic PTSD. Sometimes, the trauma is suppressed and will reemerge months or years after the event

Explain your actions

If touching the individual is necessary, explain your actions prior to carrying them out to avoid the fight-or-flight response.

Behavioral Cues

Inappropriate or bizarre dress. Lethargic or sluggish body movements Impulsive or repetitious body movements Response to hallucinations Feelings of paranoia Self-injury Strange decorations (aluminum on windows) Pictures turned over Waste matter/trash on floors and walls (pack ratting Unusual attachment to childish objects or toys Lack of emotional response or inappropriate emotional reactions Extreme or inappropriate sadness

The most common TBI is a frontal lobe (forehead) injury, which may impact:

Initiation Problem solving Judgment Inhibition of behavior Planning/anticipation Self-monitoring Motor planning Personality/emotions Awareness of abilities/limitations Organization Attention/concentration Mental flexibility Speaking (expressive language

differences between mental illness and intellectual and developmental disabilities

Intellectual disability is associated with below-average intellectual functioning. Mental illness is unrelated to intelligence. Developmental disability occurs before the age of 22. Mental illness can develop at any point in a person's life. Intellectual disability involves permanent intellectual impairment. No medications can help. While there is no cure for mental illness, medications can control symptoms. Individuals who have an intellectual or developmental disability exhibit behavior that correlates to a very specific functional level. Individuals dealing with mental illness have erratic and less predictable behavior.

Behavioral symptoms that may accompany a TBI include:

Irritability, agitation, or insensitivity Aggression, anger, or abusive language Apathy, depression, anxiety, or paranoia Lack of restraint, reckless decision-making, or inappropriate or impulsive behavior Egocentric, lacking empathy Lack of concentration, difficulty with memory or remaining focused May appear to be resistant to authority or experience an increase verbal and physical altercations May not remember, or respond well to, instructions or questions May present as early dementia

Characteristics of an disability

Is attributable to a mental or physical impairment, or a combination of the two Substantially limits three or more specified life activities (self-care, language, learning, mobility, self-direction, independent living, and economic self-sufficiency) Is manifested before age 22, with the exception of mental retardation which is 18 years of age Reflects the person's need for extended or lifelong care, treatment, or other services, which are planned and coordinated according to that person's needs Can affect gross and fine motor skills Can be more severe in infants and young children (newborn to age five) with substantially delayed development or specific congenital or acquired conditions if services are not provided at a young age Is likely to continue indefinitely

The severity and duration of withdrawal is influenced by the level of dependency on the substance and a few other factors, including:

Length of time abusing the substance Type of substance abused Method of abuse (snorting, smoking, injecting, or swallowing) Amount taken each time Family history and genetic makeup Medical and mental health factors

Symptoms of Dementia

Memory problems (can relate to recent memory or memories of the past) Confabulation (some people who do not remember will make up facts to cover their lack of memory) Impaired thinking (person may not be able to complete simple tasks like dialing a phone or reading a simple sign)

The following actions are considered appropriate responses:

Notify medical staff as rapid chemical sedation can be lifesaving Remove physical restraints when feasible When using restraints, monitor the subject for positional asphyxiation

In addition to the aforementioned primary causes and factors listed that contribute to susceptibility for PTSD, other factors can affect the level of trauma experienced

Number, intensity, and duration of other traumatic events experienced prior to or concurrently with the event Age of victim (as age increases, probability of trauma decreases) Feelings of guilt, humiliation, and shame as a result of the incident

Mental health statistics

Of inmates with mental illnesses, 72% have aco-occurring substance-abuse disorder. In one study, approximately 28% of people with serious mental illness were arrested in a 10-year period, primarily for non-violent charges; many experienced repeat arrests. Within the juvenile justice system, 66% of boys and almost 74% of girls meet the diagnostic criteria for at least one major mental illness. At present, 3.5 million Americans suffer from a serious brain disorder: 2.2 million with schizophrenia and 1.3 million with bipolar disorder. It is estimated that, on any given day, 1.4 million are not receiving any treatment. More than 450,000 Americans with a recent history of mental illnesses are incarcerated in U.S. jails and prisons. This includes: 24% of state prison inmates, and 21% of local jail inmates. By comparison, about 6% of the general population has a serious mental illness. Exposure to infectious diseases and neglected medical problems are also more of a major problem for persons with a mental illness. Tuberculosis, some varieties of which are resistant to medications, spreads rapidly among the incarcerated. AIDS and venereal diseases also spread as a result of rape. Persons who are mentally ill frequently have difficulty describing their physical symptoms and are often ignored. When they are incarcerated, people with mental illness often lose access to Medicare, Medicaid, and Social Security benefits. Even when these benefits are restored upon release, reapplying for benefits can be time-consuming and complex. Without case management assistance to restore benefits, prisoners re-entering communities after prison are at risk ofre-offending or requiring costly emergency medical services. Incarcerating persons with severe mental illness costs twice as much as community treatment programs. While some jails and prisons provide adequate psychiatric services, many do not. People with mental illness who are incarcerated tend to have higher rates of homelessness, unemployment, co-occurring substance abuse disorders, and sexual and physical abuse than other inmates. All inmates are at risk for attacks, such as rape. Inmates who are confused by their illness and less able to defend themselves are more vulnerable. Once arrested, individuals with mental illness and substance abuse disorders spend on average 17 more days in jail than the person without who were charged with similar crimes. individuals who have schizophrenia or mental retardation commit more rule infractions, spend more time in lockup, and are less likely to obtain privileges than other inmates who are not classified as mentally ill

. Even though several signs may point to an offender as having intellectual or developmental disorders there may be other explanations, such as

Other developmental disorders Mental disorders Certain health problems and handicaps Drug and alcohol abuse problems

Poor thinking skills (cognitive impairment) which may appear as:

Poor memory, particularly of recent events Disorientation, for example, not knowing where you are or who you are Difficulty speaking or recalling words Rambling or nonsense speech Trouble understanding speech Difficulty reading or writing

depressive phase may include characteristics and behaviors listed previously for depression

Prolonged feelings of hopelessness or excessive guilt Weight loss or gain due to a change in eating habits Difficulty concentrating Difficulty making decisions Low energy/fatigue Changes in activity level Inability to enjoy usual activities Changes in sleeping habits Suicidal behavior Self-medicating behavior

Persistently re-experiences the event in at least one of the following ways:

Recurrent and intrusive distressing recollections Recurrent nightmares of the event Flashback episodes Intense psychological distress or exposure to internal/external cues that symbolize an aspect of this event

Behavior changes which may include

Seeing things that don't exist (hallucinations) Restlessness, agitation, or combative behavior Calling out, moaning, or making other sounds Being quiet and withdrawn, especially in older adults Slowed movement or lethargy Disturbed sleep habits Reversal of night-day sleep-wake cycle

Delirium can often be traced to one or more contributing factors:

Severe or chronic medical illness Changes in your metabolic balance, such as low sodium Medication Infection Surgery Diabetes Water intoxication High ammonia levels Alcohol or drug withdrawals

physical withdrawals

Sweating Racing heart Palpitations Muscle tension Tightness in the chest Difficulty breathing Tremor Nausea, vomiting, and/or diarrhea

Individuals with this disorder have one or more of the following

Unstable and intense personal relationships Impulsiveness with relationships, spending, food, drugs, sex Intense anger or lack of control of anger Recurrent suicidal threats Chronic feelings of emptiness or boredom Feelings of abandonment

Use Concrete Words

Use concrete words and concepts when explaining what you need them to do.

symptoms of depression

Weight loss or gain due to a change in eating habits Difficulty concentrating Prolonged feelings of hopelessness or excessive guilt Difficulty making decisions Low energy/fatigue Changes in activity level Inability to enjoy usual activities Changes in sleeping habits Loss of interest in usual activities

Thought Disorder

a disorder of cognitive organization, characteristic of psychotic mental illness, in which thoughts and conversation appear illogical and lacking in sequence and may be delusional or bizarre in content.

normal distribution

a sharp dividing line between the two types of behavior does not exist. Adjustment seems to follow what is called a normal distribution, with most people clustered around the center and the rest spreading out toward the extremes

Cognitive disorders

affect learning, memory, perception, and problem solving, and defined as any disorder that significantly impairs the cognitive function of an individual to the point where normal functioning in society is impossible without treatment.

Anorexia nervosa

an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight

Delusions are often described as false beliefs not based on factual information such as

believing external forces are controlling thoughts, feelings, and behaviors, believing that trivial remarks, events, or objects have personal meaning or significance, or thinking you have specific powers.

traumatic brain injury (TBI)

blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. The severity of injury may range from a mild concussion to severe closed or open head injury and may result in short- or long-term problems with functioning with daily activities and social functioning

Schizophrenia

brain disorder that impacts the way a person thinks and is characterized by a range of cognitive, behavioral, and emotional experiences that can include: delusions, hallucinations, disorganized thinking, and grossly disorganized or abnormal motor behavior.

Hallucinations

can distort or heighten all five sense

Dementia is caused by???

changes in the brain which impact cognitive function, and it can be associated with a number of types of dementia such as Alzheimer's, Parkinson's, and Huntington's disease.

Co-occuring disorders

coexistence of both a mental health and a substance use disorder. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2014 National Survey on Drug Use and Health, approximately 7.9 million adults in the United States had co-occurring disorders

depression

common, widespread disorder that is a natural reaction to trauma, loss, death, and/or change. Most people have experienced some form of depression in their lifetime or even had repeated bouts with depression. Depression is treated with non-addictive medications, if needed, and should not be used with alcohol.

Treatment for substance abuse

critical element in a comprehensive system of care. Research conducted over the last decade has shown that the most successful models of treatment for people with co-occurring disorders provide integrated mental health and substance-abuse services.

Personality Disorder

deeply ingrained, inflexible pattern of relating, perceiving, and thinking serious enough to cause distress or impaired functioning. Personality disorders are usually recognizable by adolescence or earlier, continuing throughout adulthood, and become less obvious throughout middle age

Mental Health

defined as a person's mental health condition with regard to their psychological and emotional well-being. Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices.

Major Depressive Disorder (MDD)

defined as having a depressed mood for most of the day and a marked loss of interest or pleasure, among other symptoms present nearly every day for at least a two-week period. Suicidal thoughts or plans can occur during an episode of major depression, which can require immediate attention. MDD is thought to have many possible causes, including genetic, biological, and environmental factors. Adverse childhood experiences, stressful life experiences, and those with closely related family members who are diagnosed with the disorder are at increased risk.

Cognitive disorders are-

dementia, deliriums, and traumatic brain injuries

The Developmental Disabilities Assistance and Bill of Rights Act of 1990

developmental disability as a severe, chronic disability of a person five years of age or older.

Autism Spectrum Disorder

developmental disorder, affecting 1 or 2 per every 1,000 Americans usually appearing before age three

Why can co-occuting disorders be difficult to diagnose?

diagnose due to the complexity of symptoms, as both may vary in severity. In many cases, people receive treatment for one disorder while the other disorder remains untreated

There are three categories of symptoms associated with PTSD are

emotional, social, behavioral

Binge-eating disorder

frequently consuming unusually large amounts of food while feeling unable to stop eating

Specific anxiety disorders include

generalized anxiety disorder, panic disorder, separation anxiety disorder, and social anxiety disorder.

Bulimia nervosa

involves bingeing on food followed by avoiding food through vomiting or excessive exercising

Major Depressive Syndrome

is defined as a depressed mood or loss of interest in usual activities for at least two weeks, accompanied by depressive symptoms. Five or more symptoms are generally present during the same two-week period and are represented by a change from previous functioning and a depressed mood or loss of interest in usual activities must also be included in the symptoms.

Persons with Autism Spectrum Disorder may suffer from

keep them from effectively filtering and blocking painful sensations. These disorders can cause extreme pain due to loud noises and bright light that can move them toward frustration and acts of aggression.

anti-social personality disorder

manifests more in males. Individuals with this disorder display patterns of irresponsible and antisocial behavior, at or after age 18, and have trouble as an adult with authority. They are reluctant or unwilling to conform to society's expectations of family and work and although they know their actions are wrong, they carry them out anyway.

Developmental disability

means a severe, chronic disability that: is attributable to a mental or physical impairment or a combination of physical and mental impairments; is manifested before the person reaches 22 years of age; is likely to continue indefinitely; and results in substantial functional limitations to areas of major life activities such as a lack of capacity for independent living.

Intellectual disability

means significantly sub-average general intellectual functioning that is concurrent with deficits in adaptive behavior and originates during the developmental period

Bipolar disorder

mental illness involving mania (an intense enthusiasm) and depression. An individual with this disorder may quickly transition from the manic phase to the depressed phase as they cannot maintain the level of activity normally associated with mania for a long period of time.

Insanity

often used loosely to describe mental illness; however, it is not a medical term. Insanity is considered "a diminished capacity and inability to tell right from wrong." The definition varies from state to state and is generally used by the court with regard to an individual's competency to stand trial.

Post Traumatic Stress Disorder (PTSD)

psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.

mood disorder

psychological disorder characterized by the elevation or lowering of a person's mood, most commonly demonstrated by disturbances in one's emotional reactions and feelings.

Individual trauma

results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being

Excited delirium

serious and potentially deadly medical condition involving psychotic behavior, elevated temperature, and an extreme fight-or-flight response by the nervous system.

eating disorders

serious conditions related to persistent eating behaviors that negatively impact health, emotions, and ability to function in important areas of life.

Delirium

serious disturbance in mental abilities that results in confused thinking and a reduced awareness of your environment. The start of delirium is usually rapid and occurs within hours or a few days.

Offender With Mental Impairment

someone with mental illness who is arrested or charged with a criminal offense.

Delusions

strong beliefs that are not consistent with the person's culture, unlikely to be true, and may seem irrational to others.

Borderline Personality Disorder

tends to manifests more in females

Thinking normally involves three parts

thinking about something, stringing thoughts together on what you are thinking about, and, finally, the delivery or flow of a thought pattern.

Officers in contact with these individuals will notice certain behaviors such as what?

touch, repetitive behavior, insistence on routine, anxiousness in new situations, and a tendency to become confused easily. When interviewing, be patient, calm, and detached, which tends to help prevent agitation in questioning process.

Anxiety disorders typically develop

typically develop in childhood and persist to adulthood. Evidence suggests that many anxiety disorders may be caused by a combination of genetics, biology, and environmental factors. Adverse childhood experiences may also contribute to the risk for developing anxiety disorders

Dementia

umbrella term used to describe a decline in memory or brain function that impacts an individual's daily life. This is different from the normal decrease in short-term memory most people experience as they age.

Consequences

undiagnosed, untreated, or under treated co-occurring disorders can lead to a higher likelihood of experiencing homelessness, incarceration, medical illnesses, suicide, or even early death.

Substance use disoders

when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.