Psychiatric RehabilitationDiagnosis and psychiatric disabilityMental Illness and RehabilitationMultiaxial Assessment: Axis IMultiaxial Assessment: Axis IIMultiaxial AssessmentGAF scaleSample Diagnostic tableWhen is a Psychiatric Disorder significant in the VR system?VR & Psychiatric DisordersPsychotic DisordersSchizophreniaSymptomsSlide 14Co-morbidity IssuesSchizophrenia - TreatmentSchizoaffective DisorderVocational ImplicationsAccommodationsMood DisordersDepressionDepression: Comorbidity issuesDepression: RisksDepression: TreatmentBipolar DisordersBipolar: Manic symptomsBipolar: ComorbidityBipolar: TreatmentDementia & DeliriumDementia: CausesDementiaDeliriumPersonality DisordersDiagnostic traits of PDsDSM-IV General Diagnostic Criteria for PDsTreatment of PDsOther Rehab Psych TreatmentsLinksPsychiatric RehabilitationMedical & Psychosocial Aspects of DisabilityRCS 6080October 3, 2006Diagnosis and psychiatric disabilityShould be conducted by a trained diagnosticianIncludes an interview, record review and possibly some psychological testing.It should be “functional”In rehabilitation, the diagnosis should provide useful insight into the person’s problemIt should also allow for proper services.Psychiatric diagnoses are frequently stigmatizing and care should be made when discussing diagnosis with the client and others.Mental Illness and RehabilitationWide variety of psychiatric disordersVR disability coding system is out of datePsychotic disordersPsychoneurotic disordersCharacter disordersMore current use is the DSM-IV-TRMultiaxial Assessment: Axis IClinical disorders & other conditions that may be a focus of clinical attention Delirium, dementia and other cognitive disordersMental disorders due to a general medical conditionSubstance-related disordersSchizophrenia and other psychotic disordersMood disordersAnxiety disordersSomatoform disordersFactitious disordersDissociative disordersSexual and gender identity disordersEating disordersSleep disordersImpulse-Control Disorders NOSAdjustment disordersOther conditionsMultiaxial Assessment: Axis IIPersonality Disorders and Mental RetardationPersonality Disorders organized in clusters:Cluster A – Paranoid PD Schizoid PD, Schizotypal PDCluster B - Antisocial SP, Borderline PD, Histrionic PD, Narcissistic PDCluster C – Avoidant PD, Dependent PD, Obsessive-Compulsive PD, PD NOSMental Retardation – to be discussed in class on Developmental DisabilitiesMultiaxial AssessmentAxis III – General Medical Conditions such as diabetes, heart condition, low back pain, or any other medical problemsAxis IV – Psychosocial and Environmental Problems – such as suicidal ideation without plan, marital discord, legal or financial problems etc.Axis V – Global Assessment of Functioning (GAF)GAF scaleConsiders the psychological, social and occupational functioning on a 0-100 hypothetical mental-illness continuum (does not include impairment due to physical or environmental limitations)Low numbers implies poor functioning – suicidal gestures, inability to maintain personal hygiene, frankly psychotic, etcHigh numbers implies good functioning – has lots of friends, sought out by others, satisfied with life – few if any symptoms.Sample Diagnostic tableAxis I: 309.28 Adjustment Disorder with mixed anxiety and depressed mood. V61.21 Sexual Abuse of Child 296.23 R/O Major Depressive Disorder, Single Episode, Severe without Psychotic Features. 315.9 R/O Learning Disorder NOSAxis II: 799.9 Deferred, Passive-Aggressive traits notedAxis III: Type II diabetes – Insulin dependentAxis IV: Psychosocial Environmental Problems: problem with primary support group in social environment Also Occupational, Economic and Legal ProblemsAxis V: GAF – 50, Serious symptoms such as suicidal ideation and serious impairment in social functioning.When is a Psychiatric Disorder significant in the VR system?Does the psychiatric disorder severely restrict the daily functioning of the client?Is the psychiatric disorder persistent in nature?What is the likelihood that the individual will respond favorably to VR services. Some examples of these disorders are:Schizophrenia, residual typeSubstance/Alcohol Dependence, in remissionBipolar I DisorderVR & Psychiatric DisordersA psychiatric disorder may be significant to the VR system when it is the result of another condition:PTSD following a serious, violent injury (i.e. gunshot or auto accident)Depression or Adjustment disorder following a major disease, SCI, or TBIPsychotic DisordersSchizophreniaSeveral subtypes: paranoid, disorganized, catatonic, undifferentiated, & residualInvolves severe cognitive impairments, social isolationPositive symptoms can also include delusions and hallucinations.SchizophreniaEtiology: Unknown, some genetic and behavioral factorsAge of onset: Usually occurs during late adolescence to early adulthood. Onset is rare outside of this age range.Other demographics:Apparently it occurs in all ethnic groups, genders (onset seems to be a little earlier with males than females), socio-economic classesCourse of disease: Some people have only one such psychotic episode; others have many episodes during a lifetime, but lead relatively normal lives during the interim periods. However, the individual with “chronic” schizophrenia, or a continuous or recurring pattern of illness, often does not fully recover normal functioning and typically requires long-term treatment, generally including medication, to control the symptoms.SymptomsPositive SymptomsHallucinations Delusions Disorganized thoughts and behaviors Loose or illogical thoughts AgitationNegative SymptomsFlat or blunted affect Concrete thoughts Anhedonia (inability to experience pleasure) Poor motivation, spontaneity, and initiativeSymptomsDistorted perceptions of realityHallucinationsDelusionsDisordered thinkingEmotional expressionNormal vs. AbnormalCo-morbidity IssuesViolence?Substance AbuseNicotineSuicideSchizophrenia - TreatmentPsychopharmicological TreatmentNecessary for stabilization of acute casesComplianceSide effectsDuration of psychotropic treatmentPsychosocial TreatmentRehabilitationIndividual psychotherapyFamily