Demystifying+Psychiatric+Services

=**Demystifying Psychiatric Services**=

Definition of Psychoses
Psychosis is a term used to describe an array of signs and symptoms suggesting a form of thinking that breaks from reality. It is a nonspecific cluster of signs and symptoms that may occur in a broad array of medical, neurologic and surgical disorders, or as a consequence of pharmacologic treatment, substance abuse or the withdrawal of drugs/alcohol.

Description of Psychoses
Psychosis is a syndrome. The predominant characteristics of this syndrome are used in determining its classification of either organic or functional mental disorders. Psychosis is characterized by:

· an adherence either to fixed, false beliefs outside the normal range of a person's subculture, or by   · a hallucinatory experience or by what is known as thought disorder: thinking that does not follow any rational line. Delusions, or false beliefs, are beliefs that cannot be altered despite logical arguments, and interfere with ability to function

Types of Psychoses :

1. Organic Brain Disorders.

-caused by:

· -organic disorders (like thyroid abnormalities) that cause structural defects or physiologic dysfunction of the brain

· -neuro- chemical abnormalities of the brain

-a common signs of organic brain disorders is delirium. · -delirium includes disturbances of attention, memory, orientation. · -disorientation to time and space, · -incoherent thoughts and speech. ** 2. Substance-Induced Psychosis ** : · -caused by drug, alcohol and/or inhalant misuse, · -one of the most common causes of psychosis. common signs of substance-induced psychosis include panic, anxiety, fear of "losing your mind," fearful disorientation, delusions, and hallucinations. Mania. Sometimes, but not always, alternating with periods of depression, mania includes episodes of mood elevation.

During a manic episode: · a person will be excessively optimistic, · may show increased energy, · have excessive drug and alcohol use, · have less need for sleep, · may be excessively talkative, and · show poor judgment or lack of common sense · make dangerous or unusual decisions.

Symptoms of Psychoses
Persons with psychoses, whatever the cause of their problem, may exhibit one or more of the following characteristics: 1. Disordered Thinking. Most commonly, people with thought disorders suffer delusions, i.e., false beliefs that cannot be shaken by the application of a logical argument. 2. Disordered Perception. An example of disordered perception is a hallucination, where there is no contribution from the senses to be misinterpreted, but rather the impression of something existing that is not actually there. Commonly, it is hearing, seeing, feeling or smelling things that are not there. Auditory and visual hallucinations can be a sign of psychosis due to a psychiatric disorder, but they may be evidence of brain tumors or a reaction to poison or drugs. 3. Language Disorders. A psychotic person may be incapable of answering a question directly or sticking to one topic. Psychotic people may also stop talking in mid sentence and abruptly fall silent. Another clue to psychosis is an excess of literal or concrete thinking, such as that shown in the patient who, upon being asked what was on his mind, replied, "My skull." 4. Disturbance of Affect: Many people with psychosis show inappropriate or labile affect; that is, their apparent emotion is either not consistent with what they are thinking, or fluctuates much more rapidly than normal. Thus, a psychotic person may laugh, cry, and show rage, all within a few minutes.

Treatment of Psychoses
A physician (often a psychiatrist) will help develop a treatment plan that best serves the individual. Medications are often one component of that treatment plan. The drugs used to treat psychoses are often referred to as major tranquilizers. Their principal action, however, is not to cause tranquility or sedation, but to reduce or completely eliminate psychotic symptoms and behavior. These anti-psychotic drugs appear to act by blocking the chemical receptors in the brain that normally link up via the chemical nerve messenger called dopamine. Medications may include chlorpromazine (Thorazine) or Haloperidol (Haldol).

**1.** **Centralized Intake – Mental Health** (phone: 204-958-9660)
 * Provides the single port of entry for all services in the Winnipeg Regional Health Authority (WRHA) Child and Adolescent Mental Health Program
 * Focus is to enable clients and families to access appropriate programs and services based on their individual needs
 * Referrals for service can be made by families, caregivers, physicians, mental health professionals, or the clients themselves.

**a. Manitoba Adolescent** **Treatment** **Center**
Description of Services:
 * Provides mental health services/programs to children and adolescents who experience psychiatric and/or emotional disorders.
 * Services/programs are both community and hospital based, and available to children/adolescents and their families.
 * Services range from brief interventions to intensive long-term treatment.
 * Treatment is provided from a variety of perspectives and is delivered in partnership with parents and collateral agencies.

**MATC Services and Programs**
(120 Tecumseh) || -12 to18 yrs || -intensive multi-disciplinary treatment interventions -follow-up services || -inpatients and day treatment clients, || (120 Tecumseh) || -12 to18 yrs -grades 7 to 12 || -1/2 day group therapy -1/2 day school (Montcalm School) || -30 students || (228 Maryland) || -3 to 18 yrs || -various therapies (play/group/individual) -consults & psychiatric assessments || -individual and/or family || (228 Maryland) || -6 to 18 yrs || - psychiatric consults, assessment, education, support for families and caregivers || -clients with complex neurodevelopmental issues -IQ 70 or lower || (228 Maryland) || -6 to 18 yrs || -school issues only || -any student with identified mental health issues in school || (228 Maryland) || -18 mth to 5 yrs || -assessment and treatment recommendations || -families and their children ||
 * **Service/Program** || **Age Range** || **Focus** || **For Whom** ||
 * Intensive Treatment Services
 * Day Treatment Program
 * Community Child and Adolescent Treatment Services –CCATS
 * Neurodevelopmental Services
 * SMHRT Team-School Mental Health Resource Team
 * Early Childhood Clinic

(228 Maryland) || -age 6 to 17 yrs || -consultation, assessment, and treatment || -youth with signs and symptoms of ADHD -youth with ADHD and co-morbid diagnoses || (170 Doncaster) || -12 to 18 yrs || -mental health assessment and treatment || -youth involved with criminal justice system || (505-180 King) || -13 to 35 yrs || -psychiatric services
 * **Service/Program** || **Age Range** || **Focus** || **For Whom** ||
 * ADHD Clinic
 * Youth Forensic Services –YFS
 * Early Psychosis Prevention and Intervention Service – EPPIS

-2 yr ceiling on service || -individuals experiencing and recovering from an early episode of psychosis || (505-180 King)
 * Youth Addictions – Centralized Intake

Phone: 1-877-710-3999 || -youth and adolescents up to 18 yrs of age || -info on //The Youth Drug Stabilization Act// (gov’t legislation) -info on Addiction Services for youth in MB -coordinates admissions to the youth addictions stablaization unit || -parents -general public ||

**b.** **Health Science Centre - HSC**
Description of Services: · Coordinated service for children, adolescent, and families in crisis · Treatment is provided in the community, the emergency department and inpatient facilities.

**HSC Programs and Services**
-rapid intervention and return to community with coping skills and Increased functioning, or -refer to longer term treatment facilities, when necessary || -children, adolescents and families with mental health issues, who are in crisis and do not require inpatient services || (2 Units at PY1) -one unit has 7 beds -the other unit has 8 beds || -6 to 18 yrs || -provides safety, assessment and begins treatment -goals are to quickly return student home, community and to promote appropriate ambulatory mental health care, as needed || -children and adolescents with mental health issues in crisis || -assessment and consultation with a view of short-term crisis intervention and stabilization || -children and adolescents || -direct assessment and treatment || -children and adolescents with medical illness contributing to mental health difficulties || -deal with more complex and multi-systems problems -can include psychotherapies, pharmacotherapy and social/emotional interventions || -children and adolescents ||
 * **Service/Program** || **Age Range** || **Focus** || **For Whom** ||
 * Intensive Child & Adolescent Treatment Services - ICATS || -6 to18 yrs || -intensive short-term psychiatric intervention (up to 3 months)
 * Inpatient Services
 * Eating Disorders Service || -12 to 17 yrs || -various therapies specific to eating disorders || -adolescents being treated for eating disorders ||
 * **Service/Program** || **Age Range** || **Focus** || **For Whom** ||
 * Child and Adolescent Acute Assessment Services (CAAAS) || -6 to 18 yrs || -provides urgent assessment, often as follow-ups to ER visits
 * Consultation-Liaison Services || -6 to 18 yrs || -consults to Children’s Hospital and community regarding the mental health needs of patients with illnesses or need surgery
 * Outpatient Mental Health Services (OMHS) || -6 to 18 yrs || -multi-disciplinary and multi-modal therapeutic approaches

**c. St. Boniface Hospital**
Description of Services:
 * Also provides mental health education, care, service delivery, and does some research.

** St. Boniface Hospital - Programs and Services **
-partners with many community agencies || -children and adolescents with psychological trauma || -services are provided at home, in school, the community, or at the hospital site -multi-disciplinary team approach || -children and adolescents with anxiety disorders ||
 * **Service/Program** || **Age Range** || **Focus** || **For Whom** ||
 * Adolescent & Child Collaborative Community Intervention Service (ACCCIS) || -13 to18 yrs || -consultation and education to those experiencing significant difficulties resulting from psychological trauma
 * Anxiety Disorders Service || -6 to 18 yrs || -consultation, assessment and treatment
 * Tourettes’s Disorder Service || -up to 18 yrs

-18 to 21yr olds -limited service (group therapy) || -consult, assess and treat -also involves families /caregivers -services are provided at home, in school, the community, or at the hospital site -multi-disciplinary team approach || -children and adolescents with Tourettes Syndrome in conjunction with other associated disorders ||


 * 24 Hour Emergency Services**

· Mobile Crisis Unit (Wpg Only): 204-949-4777 · Kids Help Phone: 1-800-668-6868

** WITH CHILDREN and ADOLESCENTS **
( From The National Institute of Mental Health (NIMH), U.S. Department of Health and Human Services.) The following are some of the common psychiatric diagnoses from DSM-IV associated with children and adolescents. This list is designed to be a quick reference of diagnostic terminology and not a diagnostic tool. Only qualified mental health diagnosticians can diagnoses mental health disorders.

1. ** Affective Disorders ** - include the disorders of mood or feeling, bipolar and childhood depressive disorder. ** • Depression ** is diagnosed when there are feelings of sadness, hopelessness, irritability, changes in eating and/or sleeping, loss of energy, inability to concentrate, recurring thoughts of suicide. ** • Bipolar Disorder ** (manic depression) involves mood swings from extreme highs or mania to extreme lows or depression. Mania is marked by irritability, hyperactivity, and impaired judgment. Children or teenagers exhibit risk-taking behaviors and may even become psychotic. 2. ** Anxiety Disorders ** - is exaggerated anxiety, when there is no nothing to be anxious about. Recent studies indicate that a biochemical imbalance is a major cause for these disorders.

** • Social Phobia ** - child fears social situations with unfamiliar people. ** • OCD - Obsessive Compulsive Disorder ** refers to persistent and recurring thoughts or behaviors that are intrusive and cause severe anxiety and distress. Compulsions refer to repetitive behaviors like hand washing, checking, hoarding or mental acts like counting and repeating words quietly. · ** Panic Disorder ** - by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. ** • Post-Traumatic Stress Disorder (PTSD) ** - occurs when a child experiences an unexpected, shocking event, either first-hand, hearing about, or watching it happen. Intense feelings of fear result and the ability to cope are greatly affected. Symptoms include recurring, distressing memories or dreams of the event, detachment from others, and persistent irritability, lack of concentration, and hyper-vigilance. ** • Separation Anxiety ** - when a child has intense anxiety, unpleasant feeling or physical symptoms as a result of excessive fear of being separated from home or from the person to whom the child is attached. The child may worry to the point of having nightmares; refuse to go to school or to sleep alone. 3. ** Eating Disorders ** ** • Anorexia Nervosa ** - another eating disorder that we hear of more and more today. It occurs when a child or teen refuses to maintain normal or minimal (85%) body weight. This occurs more in females. They greatly fear gaining weight even though they are well below the norm. Without treatment this condition can become life threatening. Withdrawal, depression, and irritability are common behavior changes. ** • Bulimia Nervosa ** - occurs when a child or adolescent has multiple episodes of binge eating and purging. They attempt to avoid weight gain by vomiting, laxative abuse, enemas, use of diuretics, and fasting. Self-concept is closely connected to body weight and shape for these children. Severe medical conditions such as kidney failure or heart arrhythmia can result. 4. ** Attention-Deficit and Disruptive Behavior Disorders ** - the most often diagnosed category.

** • Attention Deficit and Hyperactivity Disorder (ADHD) ** is characterized by a significant short attention span and overactivity. These children act before thinking, are restless, and have trouble concentrating. Cooperation with teachers and coaches is difficult. Symptoms generally occur before age seven. Includes Combined Type, Predominantly Inattentive, Predominantly Hyperactive-Impulsive Types. ** • Conduct Disorder ** - when behavior breaches society’s moral practices. Children can be aggressive and cruel to people and animals and generally show no concern for the feelings and rights of others. ** • Oppositional Defiant Disorder ** - the disruptive behavior is not as severe as those with Conduct Disorder and typically does not involve cruelty to animals or destruction of property.
 * 5. Pervasive Development Disorder ** - a disorder that occurs when a child's brain cannot process information properly and the child exhibits thought distortions and developmental delays. Pervasive Developmental Disorders, including Autism affect 1 to 1.5 of 1000 children.

• **Autism** - when a child fails to develop normal speech patterns (language) and does not relate to those around him (socialization.) Involves rigid play, an over/under responsiveness to stimuli and restricted interests. ** • Asperger’s Syndrome ** - No significant delay in language or cognitive development, but social difficulties and restricted interests. ** • PDD-NOS - (Not Otherwise Specified) ** ** • Tourette's Syndrome ** - a neurological disorder marked by sudden, rapid, involuntary movements such as facial tics. A tic is a sudden, rapid movement of some muscles that occurs repeatedly. Children with Tourette's may have additional diagnosis of OCD and/or ADHD. 6. ** Schizophrenia and other Psychotic Disorders ** - Disturbances in thinking, not mood. Includes childhood schizophrenia which is characterized by impairment of thinking, feeling, and/or relating to others. Symptoms may include hallucinations (hearing and seeing things that are not real) or delusions (false beliefs). Often involves low motivation and withdrawing from others. Schizoaffective Disorder has elements of psychotic symptoms and significant mood symptoms (depression or mania).

(DSM-IV, 1995)

** Mental Illness / Mental Health Issues **
as suggested by the Canadian Mental Health Association =** I. Classroom Accommodations **= = = Here are some ideas of the kinds of supports and arrangements, which may make it easier for students with mental illness to succeed in the classroom:

** Preferential seating ** Allow the student to choose his or her own seat. Being able to sit near the front or by the door may help him/her feel less distracted by others, and things going on in the classroom. ** Accompanier/student volunteer assistant ** Ask someone (another student, or a counseling staff member) to accompany the student to class and stay with him/her if they should need it. An accompanier/volunteer student assistant can also help the student take notes and provide informal support. ** Allow the student to bring a drink to class ** This can help alleviate dry mouth or tiredness often caused by medications. ** Pre-arranged breaks ** Arrange this with the student before class. Knowing when a break is coming can help the student anticipate and manage possible anxiety, stress, or extreme restlessness ** Tape recorder/ Computerized Notetaker ** Sometimes the anxiety of attending class interferes with effective notetaking. Having someone in class take notes, or recording the class so that notes can be taken later alleviates anxiety the student may have about having to capture all the information; This frees him/her to attend and participate more fully in class. ** Photocopy another student’s notes ** If notetakers are not available, copying notes from another student may allow the student to attend and participate more fully in class. If the student is unable to get notes from others, collect them on the student’s behalf. ** Exit plan ** Create a signal or plan with the student if they need to leave the class. This may involve having someone come and meet them or designating a safe, supervised area in the school, they can go to. =** II. Assignment Accommodations **=

** Substitute assignments ** Many people with mental health problems may experience anxiety at the thought of giving an oral presentation. Allow the student to present their oral presentation privately to only you, or substitute written assignments in place of oral presentation. ** Advance notice of assignments ** Knowing about what’s expected ahead of time can help the student to anticipate and plan his/her time, energy, and workload, and arrange for any support or academic adjustments. ** Extra time to finish assignments ** Extra time can be very helpful, and may make the difference between passing and failing a course. Make sure to negotiate the extra time with the student in advance of the due date, and put a specific date on it. ** Assignment assistance during hospitalization ** Staying connected to the student while he/she is in the hospital may mean that he/she can finish the course as planned, and not have to repeat the course.
 * Provide alternative formats for the student to demonstrate knowledge **

The student may be better able to demonstrate knowledge in ways that do not require lots of writing (e.g., a narrative tape instead of a written journal) or time pressure (an essay exam rather than only multiple choice, or an extra paper when performance on the exam was poor due to mental health problems). This may help the student if poor vision or concentration interferes with reading ability. III. Examination Accommodations Change in test format Altering the format of exams from a multiple choice to an essay format may help the student to demonstrate knowledge more effectively and with less interference from anxiety. Technical assistance Writing may be difficult due to medication side effects that create muscular or visual problems. Some computer software programs or other technological assistance might be able to help. Extended time A specific amount of extra time, (negotiate this before the exam) can help the student to focus on the exam content instead of the clock, and lessens the chance that anxiety or other symptoms will interfere with his/her performance. Breaking up exams Dividing an exam into parts that can be taken in two or three sessions over 1-2 days can help the student maintain focus and reduce the effect of fatigue. Taking exams in an alternate location A non-distracting, quiet setting helps reduce interference from anxiety or other symptoms or medication side effects. Provide the option of allowing the student to write exams in a separate room, with an individual overseeing instead of in a crowded classroom. Increase frequency of tests or examinations Providing a number of opportunities to demonstrate knowledge creates less pressure than having only a midterm or a final exam. Alternative formats for exams (e.g. read orally, dictated, scribed or typed) Reducing the amount of external pressure and distractions gives the student an equal
 * Textbooks on tape **