 How much psychiatry did you guys give? So some of this is probably a review that I love this. The amazing thing is that this statistics is actually correct. That is the rate of mental illness in the US when I'm poor. So almost half the adults in the US are going to develop at least one mental illness during their lifetime. So when we talk about psychopathology, we're talking about a mental disorder. But we're also talking about mental distress or maladaptive behavior. And most mental health issues are not identified by a mental health professional. They're identified by you, guys. They're the medical care provider. So I wanted to go over some of the disorders that you might be seeing in your clinics. So I'm going to hit on anxiety disorders, mood, psychotic, somatic symptom disorder, autism spectrum disorders, substance use disorders, the dementias, and personality disorders. So start with anxiety. Of course, this includes generalized anxiety, as well as the phobias, panic attacks, panic disorders, social and separation anxiety disorders. Characterized by excessive worry, it's difficult to control the features, have to have a duration of at least six months for a full diagnosis. So lifetime prevalence of anxiety in the US, 12.3% Utah, 12.6%, so we're right there with the rest of the US. Women are more likely than men. Average age of onset, 21.3 years old. So what you might see in your clinic is that perseveration about things that may go wrong, the inability to cope, the intolerance with uncertainty. So if you are saying you're not sure we're going to watch it, they have a very difficult time with this idea of just seeing what happens, that uncertainty. Difficulty concentrating, just the restlessness. Somatic symptoms, of course, we see headaches, the gastrointestinal issues are the first that always are very much exasperated by anxiety. Then we go into the mood disorders. This includes not just depression, but mania as well. Of course, depression characterized by the sad mood, fatigue, lack of interest in things that they normally found interesting or enjoyable. The differences change in eating habits, sleeping, hypersomnia, or not being able to sleep, but insomnia, of course, healthlessness, hopelessness, worthlessness, the inability to make simple decisions, even between chocolate and vanilla. Simple things like that sometimes. And the presentation in some individuals is not going to be sadness or a low mood, but it may be irritability or anger even. And mania, of course, we're looking at really an irritable mood or feeling like they're on top of the world. They don't need to sleep. They're just go, go, go, feeling super creative. It's really hard for people who are bipolar to stay on their medications because they feel so wonderful in this stage. They don't like to take the top off of their hypermoods. So lifetime prevalence, 20.8% in the US adult population. Again, women more likely than men, but then we have to say, well, are they more likely to report than men as well? So we can only do with what is reported. Average age of onset is about 30 years old, which actually is a little bit older than I would have normally thought because we are seeing a lot of depression and young kids. Grief is no longer an excluder. My video is not loading. Ah, here we go. It's just slow. Grief is no longer an exclusion in a mood disorder. If it's meeting the criteria for the duration, it can also be diagnosed. And it will also, grief, bereavement also responds to the same medications. So I don't know if you've seen grief giraffe. Have you? OK. Well, you're in for another treat, sorry. You have to sit through grief giraffe again. You can quit saying it. I'm going to do a laugh about this and I and the guys. It's just perfect. Based on Kugler Ross' stages, of course, they're not linear stages. So people go back and forth between them. And sometimes they'll feel like they're not getting through it because they've gone backwards rather than forward. So it's important to tell them that it's not linear at all. So what you might see in your clinics is that such effect, tearfulness, that a psychomotor retardation, they're just moving slower, they're talking slower. I work with a man who is so slow that it's almost painful and is all part of his depression. And again, they might come in where normally they're well taken care of and their hygiene is not what it should be. Mania, what you might see is that super elevated mood, they're overconfident, they're energetic, they've got pressured speech, they're super talkative. Lots of ideas like they can't hardly even get them out, they're coming so fast. So those are the things that you might see in your clinic. So it is important to assess for suicide. So some of the warning signs, of course, they're threatening. And we do see this in the clinic, especially when you give them a diagnosis that is degenerative, where they may end up blind. They're going to say, well, life isn't worth living, I'm just going to go home and shoot myself. Unfortunately, sometimes it does happen. So also, if they've got the means to hurt themselves, like they're an avid gun collector, talking or writing about death or suicide, that feeling of hopelessness, like there's no way that they can handle this. It's just totally hopeless. And then there's the passive suicidality where they're acting recklessly. They're doing things that actually could endanger their lives. Of course, increased use of alcohol drugs, withdrawing from people, that agitation. Actually, a mixed episode of mania and depression is the most risky time for suicide, because they do have the energy to actually complete a suicide. And then the dramatic change in the mood. So seek emergency help here at the Moran. You can always call us in the patient support program. But when you are out away from the Moran in your own practices, you may need to call the police to just escort the person to the local ER where they can be evaluated for a mental health hold. And then there is also the national suicide prevention lifeline. So psychotic disorders. Psychotic disorders are my favorite, just because I've done so much research in schizophrenia. They are, to me, amazing what the mind comes up with, that is as real as this. So that's including the schizophrenia spectrum disorders, of course, the delusional disorders, schizotypal, or schizotypal, depending on how you want to say it. It's both ways. Brief psychotic disorder and schizoaffective disorder. So major disruption in the thinking to the point of losing contact with reality, delusions, hallucinations, disorganized thinking, disorganized behavior. The positive symptoms and the negative symptoms, are you familiar with those in psychosis? OK, those symptoms that are added to were taken away from. Perfect. Catatonia is now its own separate category, but it can also be used as a specifier in schizophrenia as well in the new DSM-5. So we still don't know the exact etiology for schizophrenia spectrum disorders. We do know that there's a genetic component, but we haven't been able to replicate the polymorphisms in different populations. So it may be a series of different ideologies to get to the same presentation. And of course, then we also have the substance-induced psychosis that don't always go away either. So the prevalence of all the psychosis, about 2%, schizophrenia is about 1% except for in genetic isolates. The onset of late teens, males presenting earlier, onset earlier than women. So that late teens, very early 30s, is usually the time frame that they're going to present. Treatments, medications. Of course, medications still have a lot of side effects. Of course, getting the antidepressants, the mood stabilizers, the anti-anxieties, working with them with cognitive therapy, social skills training, stress reduction, because we do know that a stressful event can bring on another episode, and then voc rehab so that they can maintain employment or get employment where they're feeling productive. And that all helps towards keeping them stable. So what you might see in your clinic, of course, the paranoid statements of prosecution, talk of having special skills or a special mission purpose, the appearance that they might be responding to internal stimuli. I used to work with a psychiatrist that said, and I don't mean needy to go to the bathroom, which is internal stimuli, right? So hearing voices or seeing things that aren't there. This kind of thing that presents. I did an interview on a woman who I would talk to her and she would engage. And then she would look off to the side and do one of these and then come back and tell me something more. So she was obviously getting something from something that was not there. So you guys know all about what I mean by the derailment, clanging, thought-blocking. Those are all terms that are familiar to you. Clanging is like they're going to be rhyming. Oh, well, hell, I fell, you know, those kind of, called clanging, yeah. So the symptomatic symptom disorders that we've covered a little bit a few months ago with the couple cases that were here at the Moran, we're talking also besides the somatic symptom disorder, the illness anxiety disorder, which used to be called hypochondriasis, fictitious disorder, and then the all-out conversion disorder. So the characteristics of that are the physical symptoms that are very distressing or result in significant disruption and functioning, as well as the excessive or disproportionate thoughts, feelings, and behavior regarding those symptoms, OK? So conversion disorder is the only one that is considered a true psychological problem, brought on by some kind of psychological stressor or some issue that's not resolved. But the others, the DSM-5, when we changed from the 4 to the 5, they made it very clear that they may be the result of an unknown physical cause, just that we haven't been able to diagnose it yet. And the reason for that is that they found a large proportion were later found to actually have a physical cause related to them. So the idea behind that was not that it wasn't felt to be appropriate to kind of blame individuals for mental disorder when we just couldn't find the physical cause. Does that make sense? Of course, the term was coined by Freud, conversion, having that conflict, trauma, psychological, to physical. Along with conversion disorder, comorbidities that we see all the time, is that depression, anxiety, personality disorders, especially histrionic personality disorder going along with that? So this is what I was telling you about. Studies found that 25% to 50% of the diagnosed cases were eventually found out to have a medical condition. So that's why we're being very careful now with somatic symptom disorders. Most common in adolescence, most true cases will spontaneously resolve, but they can, under times of stress, again, have a recurrent episode. So we can specify if it's acute or persistent, those kind of things. Comprinting can make it worse. Doesn't help to confront. So psychotherapy, we focus on coping with the underlying conflicts that are going on, and giving them some insight, using CBT, cognitive behavioral therapy, to give us that insight. Once you shine the flashlight in a dark area, you can't unsee it. And that's why it's helpful. So once these can start to see what the issue is that has created this in their life, things start to change for them. So this functional vision loss spectrum I think was great, because it starts with the deliberate malingerer. It's like faking it. They know they're faking it to gain something, right? Whether it's disability, attention, whatever. And then you've got the worried imposter. Well, they think that there's something wrong, but he's really worried that there might be a serious problem. But he thinks he's a little bit exaggerated. And then you get the impressionable exaggerator. They know. They're really going to make it obvious for you to find something wrong, right? And then the suggestible innocent is convinced after some injury that they're going to be blind in one eye or that it's going to be worse than it truly may be. Autism spectrum disorders. We see a lot of autism spectrum disorders. Of course, in the DSM-5, we went from listing out each one into putting them as a spectrum disorder, including Asperger's childhood disintegrative disorders, PDD, those kind of things are all rolled in now with varying levels of symptoms and symptom severity. So a lot of what we're seeing is the deficits in the social communication and interaction, restricted or repetitive behaviors, a lot of sensory dysfunction, whether that be problems processing sensory from touch, auditory visual, both either not wanting any, the avoidant, or the staring at the lights needing more, so both ways. So along that autism spectrum, we can do things. We can do visual therapy for conversion, for death perception issues. The poor eye contact, the difficult visual patterns that they're looking through something rather than at it, people and objects, using their periphery rather than looking straight at things. These are telling you other kinds of problems that they may be experiencing. And actually, more than 70% don't really achieve that automatic kind of binocular vision pattern. So they are in need of therapies. But because, well, and also the prevalence, 1 in 88, 2012, 1 in 47 in Utah. Utah rates are high. There's some controversy over what the real numbers are right now, but they're still high no matter what they are. So what's the wrong way? You've got an handout on how to work with an autistic adult. And some people are fine with autistic. Some people like autistic person. But they see it as more of a characteristic of themselves rather than a label. So it just depends on the person. There's no politically correct way of talking about autism yet that is universal. So one of the things that you should be aware of, because direct eye contact is so uncomfortable for people on the autism spectrum, an eye exam is excruciating for them. You have to have somebody look straight in their eyes. And that's one thing that you should be aware of. The other thing is sometimes they have a hard time screening out everything around them. So if the exam room has lots of sensory overload kind of things in it in order to really talk to them, you may need to move to another area that's not quite so busy. Substance use disorders. We no longer distinguish between abuse and dependence. Now it's all one set of substance use disorders. Again, the criteria, the tolerance of withdrawals, using larger amounts over a longer period of time, wanting to quit and not being able to, the cravings, and then continued use even though it's creating problems in their lives. So those are just kind of some of the things. So the substance abuse disorders, there's a huge cost to that. If you take in lost work, the crime, the whole ball of wax, $740 billion annually in just the US. So it's a huge problem. So of course what you might see is the smell or obvious somebody's high. What we've seen a lot is these injuries sustained while they were super drunk, whatever. We've had people fall off bicycles. We've had people just found, have no idea what happened to them. They're found on the floor, whatever, that have obviously fallen or something, and it has some kind of injury. The drug seeking behavior, of course, this is when they are seeking a specific substance. And then they won't let you substitute. There's like, oh, I'm allergic to that, or it doesn't work, or whatever. But they know their pharmacology really well. And then exaggerating medical problems in order to get the opiates rather than Tylenol. And if you feel pressured, they're usually drug seeking, that kind of check in with yourself. What are you feeling? I put in a simple four question, the rap four handout. If there's an answer to yes, it's simple questions to ask somebody that when you suspect there may be an alcohol issue, that they may need treatment. Very simple to go and go through those and then refer them on to getting some help. Did I go the wrong thing? OK. So of course, the treatments, we can do intensive inpatient or outpatient treatment, 12-step programs, relapse rates are high. This is an addiction. Relapse rates are very high. But what to do is to do treat them with dignity and respect. Changing use habits is not easy. And even when abstinence isn't even an option, just cutting down is something. And then, of course, encouraging them to get the appropriate professional help that they need. OK, the dementias, including strokes, Alzheimer's, metabolic diseases, traumatic brain injuries, Parkinson's, Huntington's, all of those infections of the brain, spinal cord, anything that is creating this neurocognitive disorder. So the estimates, about 2 million people in the US, another 1 to 5 million, those 2 million have the severe form. Another 1 to 5 million have a mild to moderate form. Over 70 years old in 2010, the prevalence was about 14.7%. And the risk of dementia doubles every five years after age of 65. What did Betty Davis say? Old age is no place for sissies. So this is an image of a healthy brain versus advanced Alzheimer's. So the physical changes is very sad what's happening. So you've also got a handout there about working with people with domain, the patient that has dementia. And being reasonable, rational, and logical will just get you into trouble. Straight forward, simple sentences is what is going to get the results. Don't ask them if they will take the eye drops. Tell them if you ask and they say no, then you're stuck. If you say you will take these three times a day, simple, direct instructions work best. You also have a mini-mental status exam. This is one that we use all the time. Here at the Moran, you can always call us. We're happy to come down and do it for you. Out in your private practices or wherever you end up, you may want to take that with you just in case you just file it away and just in case you need to do a simple little mini-mental. You can even take just parts of this. We'll kind of give you an idea if you need to refer the personality disorders. So these are the impairments in personality. Self and interpersonal, the functioning, and the presence of the pathological personality traits. These are stable over time. It's that enduring pattern of thinking, feeling, behaving. So the prevalence of any personality disorder nine to almost 50% of the population that have a diagnosable personality disorder, we see traits in almost, oh, everybody's got traits. Let's face it. But we do cluster them, A, B, and C. Familiar with these. Cluster A are the auditic centric ones. Paranoid, schizoid, schizotypal, schizotypal. Schizotypal, you get a lot of magical thinking with that. Might not be quite to the level of a delusion. Definitely magical thinking. Cluster B, those are the dramatic emotional or erratic. We see more of these, antisocial. That, you know, we can trace back a true diagnosable antisocial behavior going back to, you know, the early teens, really. That's why we're asking about cruelty to animals and fire setting and things like that. Those are all those kind of things that are the early precursors to antisocial behavior. Borderline, that unstable interpersonal relationships. Black and white kind of thinking. You're either a hero or you're a villain. There's no in between. It's also marked by impulsivity. The histrionic, that excessive emotionality, attention seeker, everything's larger than life. Everybody's their very best friend. That's just kind of a histrionic personality. And of course, narcissistic. And we all know somebody who qualifies for this, actually, so that this pattern of grandiosity, that need for admiration and a true narcissistic personality, not just traits, but a true narcissistic personality has a very difficult time with empathy, putting themselves in somebody else's shoes. So in cluster C, these are the anxious or fearful ones, the avoidant personalities, the dependent, that excessive need for care, leading to that submissive or clingy behavior, and of course, obsessive compulsive personality disorder, not obsessive compulsive disorder. Which is more of the perfectionism, those kind of things, that preoccupation with order and interpersonal control. Love this. Repeat, repeat, repeat. OCDs are kind of termed the self-doubter disease. Did I turn that off? Did I check that? I better check it again. Did I really check it? I better check it again. So in a comprehensive assessment, recognizing that often psychiatric mental health issues are co-occurring with mental, medical problems. One of the perfect examples of that is chronic illness and depression. They go hand in hand. So are you including in your assessment of the eye conditions, also the degree to which the patient's thoughts, behaviors, feelings are connected to their condition. Are they disproportionate? Are they excessive? And if you recognize how the patient's thoughts, feelings, and behavior are impacting their functioning, then you can refer them on for more focused treatment, which will only help your treatment plan for them to succeed even better. So awareness is tricky. Give it a minute to load. My videos are slow in loading. So watch carefully. This is an awareness test. When it passes, does the team in mind make? The answer is 13. Did you get 13? Okay. But did you see the moon walking there? Did you see the bear? This is easy to miss something that you're not looking for. Attention can be very selective and if you're looking for something, you may miss other information at the expense of trying to find what you're looking for. I also use this example a lot in therapy with people of you find what you're looking for. So if you have a negative mindset, you're looking for the negative in mind. If you have a positive mindset, you look for the positive and guess what you find, you find the positive. People with psychopathology in your practice? It's never just one thing. So it's important for individuals, all of us, to recognize that mental illnesses are real, but they are treatable and people can and do recover. So having a conversation with somebody that you might believe is having some mental health issues, it's important to approach the conversation with respect and dignity. This is something that happens to all of us, to some extent or another. At some point in our lives and not to be blaming of that. And then also talk to them about what they can do. There's a variety of mental health professionals that can help or substance use professionals that can help, but there's also so much that they can do for themselves as well. Are they taking care of themselves? Are they getting their exercise? Are they eating properly? Are they getting sleep? You can't cope with anything, including a serious eye problem if you're not getting enough sleep. Relaxation, meditation. There's peer support groups. We offer the support groups here at the Moran for our patients. They are amazing. I've seen some really wonderful changes in people that came in just absolutely into spare. And after going through eight weeks, 16 weeks, sometimes they think Amy has a core group of people. She does a support group for eight weeks, then she takes one week break and then starts it again so new people can join. So it's a closed group, they get to really bond. And so they can continue on if they want. She's got a core group of people that have continued on for more than a year. And it's amazing the differences in their outlook. It's, I can't even stress that enough. So that peer support that they get and being with other people that are going through similar things, very, very helpful. Also any kind of self-help books based on CBT, Cognitive Behavioral Therapy, we're finding that that is the most widely researched and evidence-based therapy for many, many things. Not everything, but many things. And then also having that support system, that network of people that they can call on when they need to, you know, whether it's family, friends, their faith, whatever kind of social network making sure they have that. So a little, another aside. And there's my references. So thank you for getting up early. Thank you for paying attention, even though it was kind of a review for you.