TS Workbook 3

N eu r o science te a m P a r tne r s
t r e a tment
TeamSolutions
Understanding Your Illness

By Kay Johnson McCrary, EdD
About the Author Lead Editor
Kay Johnson McCrary, EdD, developed, directed, and taught in patient and family education programs for the South Carolina Department of Mental Health from 1984 until 2007, when she retired from the position of Director of Patient and Family Education at Bryan Psychiatric Hospital in Columbia, South Carolina. She has made numerous national professional presentations on this topic related to the education of people with mental illness.
Kathy Puskar, DrPH, is a Tenured Professor at the University of Pittsburgh, and Interim Chair, Department of Health & Community Systems in the School of Nursing. Dr. Puskar has a Masters in Psychiatric Nursing, a Masters of Public Health and a Doctorate in Public Health specializing in community mental health from the University of Pittsburgh. She is Director of a Masters program in psychiatric nursing, and she teaches and supervises undergraduate, masters and doctoral nursing students in the clinical practice of psychiatric nursing. Dr. Puskar has conducted individual psychotherapy, group and family therapies with a variety of patients. Her major interests focus on schizophrenia, bipolar illness, depression, mental health promotion, resilience and coping methods. Dr. Puskar has more than 100 publications related to mental health in interdisciplinary journals, and she serves on several editorial boards. Dr. Puskar is also a member of Whos Who of American Women. Dr. Puskar was elected a Fellow of the National Academics of Practice, the American Academy of Nursing and is a Past President of The American Psychiatric Nurses Association (APNA). She is a recipient of the Pennsylvania Nightingale Award for Research and the American Psychiatric Nurses Association Research Award. She has received funds from the National Institutes of Health, National Institute of Nursing Research, Eli Lilly and Company and The Staunton Farm Foundation to study mental health, stress, coping and medication adherence.
This educational program was developed solely for the benefit of the patient, and is not intended to provide individual financial gain.
OL59046 PRINTED IN USA 2009, LILLY USA, LLC. ALL RIGHTS RESERVED.
TeamSolutions Workbook 3 Understanding Your Illness
Contributing Editors
Reviewers
Karen C. Tugrul, RN, BSN, is a psychiatric nurse from Cincinnati, Ohio. During her 22 year career, she has served in community, acute and emergency settings both in clinical and administrative positions. She has spent the majority of her career participating in research on the biological causes and treatment of mood disorders and schizophrenia and has participated in more than 40 clinical trials investigating new agents and new indications for existing medications. Ms. Tugrul has lectured nationally and internationally and has authored or coauthored more than 30 publications on the treatment of bipolar disorder, schizophrenia, and schizoaffective disorder. She has served on the Editorial Boards of Directions in Psychiatric Nursing and Bipolar Disorders and as an independent consultant for 15 years. Diana Streevey King, MS, LMFT, works at Eli Lilly and Company in the Neuroscience Business Unit. Before joining Eli Lilly and Co., she specialized in working with people with severe mental illness, addictions, and child advocacy, using a strengths-based, recovery approach for individuals and their families.
Cynthia Miller, RNC, is a Registered Nurse for the State of Idaho, Department of Health and Welfare, Adult Mental Health Services. She has developed and implemented psychoeducational programming in a variety of inpatient and outpatient settings and has used Team Solutions and Solutions for Wellness extensively. Sharon Sousa, Ed.D, APRN, BC, is an Associate Professor of Community Nursing at the University of Massachusetts, Dartmouth. Dr. Sousa has participated in academic research, teaching and speaking. In 2006, she received the Public Service Award from the University of Massachusetts for her work with the persistently mentally ill. She has developed the Levels of Recovery from Psychotic Illness Scale and uses this intervention to enhance insight with this population and promote their adherence to psychotropic medications. She has developed the Compeer Program at the University of Massachusetts Dartmouth. This program matches students and individuals suffering from mental illness in a big brother-big sister type of relationship. She also has participated in genetic studies researching the causes of schizophrenia and bipolar disorder.
Acknowledgments
Robert John McCrary, Ph.D., psychologist and my husband for 38 years, has regularly processed whatever project Im on with me, sharing his considerable experience, wisdom, and kind-hearted values, making my work better. Mary McCrary Baylor, my daughter and my right hand on the first edition, helped with word processing, proofreading, and served as a sounding board, making, helpful recommendations to keep the language clear and understandable.
Contents
Workbook Goals
Content Objectives:
Session 1 Session 2 Session 3
Identifying the Changes Understanding the Changes When Personal Changes May Be Symptoms
4 13 22 32 42 51 61 71 82
Session 4 Acceptance Session 5 Session 6 Session 7
Symptoms Are Important for Diagnosis and Recovery Symptoms Checklist (Part 1) Symptoms Checklist (Part 2) Mental Illness
After completing this workbook, participants will be familiar with: 1. Common symptoms of schizophrenia and bipolar disorder. 2. Reasons why people may have symptoms. 3. Common feelings about dealing with a difficult illness. 4. Things people can do to promote recovery. 5. Signs and symptoms of a relapse. 6. How to handle an emergency.
Treatment Plan Objectives:
Session 8 Reasons for Symptoms of
Session 9
Making the Diagnosis
Session 10 Mental Illness: Test Your Knowledge 91 Session 11 Feelings Session 12 Reducing Risk of Relapse Session 13 Symptom Monitoring Tools Session 14 What to Expect
100 110 122 132
1. Participants will gain knowledge during each session as evidenced by improving at least 25% from pre- to post-Topic Assessment. 2. Participants will choose and use knowledge and skills as evidenced by selecting and attaining one personal practice goal per session. 3. Participants will demonstrate skill acquisition as evidenced by correctly completing a monitoring form and/or by role-playing at least one coping skill after completing the workbook.
Family Friendly Session good for use in family sessions or groups
TeamSolutions Workbook 3 Understanding Your Illness Session 1 Identifying the Changes
Identifying the Changes Facilitator Notes

Main Learning Points: This is the first session. Every session except this one will begin with a review of the Main Learning Points from the last session.
Tips for this Session 1. As this is the first session in this workbook,
Potential Problem for this Session
you may have people who do not know each other. In that case, take the time for introductions, starting with yourself. 2. Consider using the telephone game as a group activity to illustrate changes in perception. Set up two lines and have each line play the telephone game where a message is whispered into the ear of the first person to pass on to the next person in line. When the message gets to the end of the line, have each end person restate the message. Talk about how the message changes depending how each person hears and processes the message. Point out the common misperceptions. 3. You may want to write on the board or a flipchart the dictionary definitions of some words that the participants will be reading and seeing. 4. If you use the suggestion for topic introduction, you may want to have paper and a pencil or pen for each person on their chair or desk.
When psychiatric symptoms first emerge, it is often difficult, and sometimes impossible, for the person who is experiencing the symptoms to recognize and understand what is happening. The individual usually attempts to make sense of the changes that are occurring within a framework that they know and understand.
Possible Responses 1. Express compassion for their courage in facing
their challenges.
2. Reinforce that they will be able to learn about their
illness. 3. Reassure that, together, you will explore the facts and consider different explanations.
General Tip
Dont forget to smilein this important first session and in every session. If participants see that you are pleased to be here, any anxiety they have may be alleviated a bit sooner. Let the participants be able to tell by looking at you that you are pleased to be together and that the following sessions will be a good experience for everyone.
Suggestion for Topic Introduction and Relevance to Participants

(Have a photograph of an object, such as a flower or a piece of fruit. Use a cover sheet so that the photograph cant be seen unless you show it. Ask each person to come to the front as his or her name is called to look at the photograph, and, without saying anything, return to his or her seat and sit quietly. After everyone has seen the photo)
Lets answer the first six questions on the Topic Assessment before we start, just to see how familiar we are with this topic.
Topic Assessment Answer Key 1. D 2. C 3. A 4. C
Please write what you saw in the photo. When you finish, fold your paper in half and Ill pick it up Then please sit quietly, without talking.
(When everyone is done)
Lets look at what you saw. (Flip through their responses and summarize them.
Most people will write just one word, for example: Flower. A few may be very precise, writing something similar to, A pink carnation in a clear glass vase thats sitting on a yellow tablecloth.)
Did everyone see the same thing? No, we didnt. Some people saw only a flower. Others also saw colors. Some people saw the vase and the tablecloth in addition to the flower. Everyone saw the exact same photo. Any ideas on why there were differences in what we saw? (Listen, encourage, and reply to responses.) Today we are going to start understanding those differences in peoples perceptions how things register differently in our brains. This matters because how we perceive something has a lot to do with how we communicate and function. The title of this session is Identifying the Changes. How might a session about this be helpful?
T topic introduction R relevance to participant I identify objectives M materials for session M motivate to use
Topic Assessment

Mark one:
Directions:
Pre
Post
Your Score: + out of 4
1. Read each question carefully. 2. Read every answer before marking one. 3. Mark only one answer to each question. Name: Date:
1. Which of the following is correct?
A. Everyones brain should work perfectly. B. Everyone can control how their brain works. C. People who have a mental illness are always ill. D. Everyones brain makes mistakes sometimes. A. Always know they are ill. B. Never know they are ill. C. Are often uncomfortable and confused at first. D. Must change all their future goals and plans. B. False
2. P eople who see the world differently:
3. Everyone perceives things a little differently.
A. True

4. When a person experiences major changes in how they perceive the world:
A. They need to be in a hospital. B. They must take medicine. C. They might benefit by talking with someone they trust about the changes. D. They should keep it to themselves because it will eventually go away.
Topic Assessment

5. I feel I am confident that I understand what has happened to me with my illness.
Strongly Disagree Disagree
Neither Agree Agree Strongly Nor Disagree Agree
Unsure
6. This information is important for me to know.
At the end of the session, answer these questions before turning in this paper: 7. This session helped me.
8. What I liked about this session:
9. How this session could have been better for me:
Identifying the Changes

Objectives for this Session
1. Identify a simple description of how the brain functions. 2. U nderstand that no ones brain works perfectly.
How does anybody make sense of the world we live in? The simplest answer is, Through the five senses. We see, hear, taste, touch, and smell whats going on around us. That is how we know whats going on in our world. But does everyone perceive (meaning to experience the world using the five senses) things the same way?
Main Learning Point #1 People perceive and experience
What in the World!
For example, a small group of people the world differently. are waiting for a bus. Does each of them see the bus exactly the same when it pulls up to the curb? Does the man whos wearing glasses see the bus the same as the woman who has great eyesight? Does the woman with a bad cold and stopped-up nose smell the bus exhaust fumes the same as the person next to her who doesnt have a cold? Does the young mother whose baby is crying notice as many things as someone who is not distracted? To make this even more complicated, everyone who is watching the bus arrive is filtering it through their personal views of the world and their memories. Suppose we hear the brakes on the bus hiss when it pulls up to the curb. A man who works as an auto mechanic might hear this sound and think that the brakes sound like they are in good working order. On the other hand, a small child might get very scared when they hear the hissing sound. We all see the world a little differently depending on the experiences we have had in our lives and our perceptions of what is going on around us. Certain qualities that were born with can also affect how we see the world. The brain is the organ that brings together our five senses, perceptions and memories. These make up our individual awareness and understanding of whats going on in the world. Although we do not fully understand exactly how the brain works, we do have a basic understanding of how our thoughts, feelings, and views tend to guide our daily lives.
2 8
Use Your Head! (Your Brain, Actually.)

We use our brain to understand our world and to help us make decisions every day. We usually do this with our brain getting information from the world through our basic senses of seeing, hearing, touching, smelling, and tasting. Once this information enters the brain, we use more than 100,000 brain cells called neurons, along with brain chemicals called neurotransmitters, to process the information to help us understand our world. Even though all of us have similar feelings and often share similar experiences in life, no two brains see the world exactly the same. To illustrate how we can hear and understand things differently, lets do an exercise. Form two lines. The first person in each line will be handed a written statement which is to be whispered into the ear of the next person in line. The second person will then whisper the statement to the third person in line, who will, in turn, whisper it into the fourth persons ear, and so on. When passing the information along, the statement can only be said one time. When the message gets to the last person, he or she will tell the group what he or she heard and write it on the board. Finally, the original statement will be written on the board. We will talk about how the message was changed as it was passed along.
Main Learning Point #2 No brain works perfectly.
No Brain Works Perfectly

The exercise we did is just one example of how we get information and how our brains may interpret it. Given that the brain uses more than 100,000 connections for carrying messages, it is easy to understand that no brain works perfectly all the time. When our brain misinterprets the surroundings over and over, we may become uncomfortable and even confused about what is going on around us. We may have to work even harder to understand things that other people who do not have a mental illness might understand very easily. Our perceptions may be very different from what we have experienced in the past. To help understand these changes, it is important to figure out when you first noticed something different. Maybe it was: A different thought. A different or strange feeling. A big mood change. An unusual reaction. Anxiety or discomfort in being someplace or being around others. An experience with one of your five senses that you never had before, like hearing, seeing, or smelling things you didnt understand.
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No Brain Works Perfectly

(continued)
To help you identify and recognize when these changes might have occurred, fill out the Identifying the Changes exercise. Keep in mind that since everyone sees the world differently, there are no right or wrong answers to the statements below and on the next page.
Identifying the Changes Exercise: I first noticed something being different on . (When) when it happened. (Where it happened)
I was at I remember I felt I thought
. (What experienced that was different) might be a reason for the way I felt. (Seeking an answer)
Differences can make life more interesting!
When Different Perceptions Get Uncomfortable
Sharing how we feel with people we trust can help us recognize and identify individual perception changes that are causing problems.
Main Learning Point #3 Being open with people we trust can help us if we are having changes in perceptions.
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Review & Moving Forward

The main learning points of this session are:
1. 2. 3.
Move Forward Choose a Personal Practice Option
Its important to practice new knowledge and skills. What will you do between now and the next session? Please choose one option from the list below:
1. STUDY. I am going to reread my handout at least once.
2. S HARE. I will share my handout with someone in my support
etwork. I will ask n to read it and talk with me about when I first noticed changes in my perceptions.
3. I NSIGHT. I will talk to
(insert name of someone your trust who knows you well) and ask him or her if he or she noticed any changes in my behavior recently.
4. OTHER: Take an Extra Step Forward (optional) 5. WRITE. I will write about changes that have become problems for
me. I will figure out what I might do to fix it.
If there is time left before the end of the session, you might talk about your personal practice goals. How will you remember and complete your goal by the next session?
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TeamSolutions Workbook 3 Understanding Your Illness Session 2 Understanding the Changes
Understanding the Changes Facilitator Notes

Main Learning Points from last session: Identifying Changes 1. People perceive and experience the world differently. 2. No brain works perfectly. 3. Being open with people we trust can help us if we are having changes in perceptions. Review Personal Practice Options from last session.
Remember
General Tip
It is important to acknowledge and discuss participants successes, progress, and challenges.

Tips for this Session
This session is to let individuals know that everyones brain can misinterpret the world in which we live and that, at times, our emotions and perceptions can become distorted and cause us problems in life. This session may be one of the first reality checks people have to talk with people they trust and confirm their emotions and perceptions. This section ends by setting up the use of mental health professionals in helping to assess if the perception problems are psychiatrically significant enough to be defined as symptoms. During this session, validate the normal fears everyone has when our minds misunderstand something. Reassure the group that there are effective methods to help us when our brains are not working at their best. After completing the Barriers to Seeking Treatment Self-Evaluation, talk about it together. You may want to ask, Which one of these barriers do you think got the most checks today? Acknowledge their fears and concerns.
Offer unconditional positive support to all participants. Validate everyones experiences as real to them. Allow for differences. Explain the fact that we are all different is a good thing.
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When you were in school, did you ever study for a test, thinking you knew the material well, but when you took the test, you didnt do very well? What were the conditions in your life when that happened to you? Was there anything else going on during that testing period that could have influenced your thinking? Im thinking about things like test anxiety, studying for multiple tests, being sick, having trouble with a relationship, lack of sleep, or hunger. All these things can influence us! And our brain can work at different levels. This session will look at understanding the problem of intense emotional reactions. We will also consider how to correct problems that result from these. Lets review the main points from our last session and answer the first six questions on the Topic Assessment before we start, just to see how familiar we are with this topic.
Topic Assessment Answer Key 1. B 2. A 3. D 4. D
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Review of Session 1: Identifying Changes

Main Learning Points of Session 1 What were the main learning points of Session 1? If you did not attend the last
session, you may guess, and also write the answers as people say them: 1. People perceive and experience the w 2. No b n works perfectly. 3. B eing open with people we t changes in perceptions.
d differently. t can help us if we are having
What personal practice option(s) did you choose? Did you complete your personal practice yet? 1. Yes. How did it go?
Personal Practice Option Review:
2. No. What got in the way of completing your practice?
If you still plan to complete your practice, when will you do it? 3. I didnt choose a personal practice option.
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Topic Assessment

Mark one:
Directions:
Pre
Post
1. It i s always easy to know if our brain is working correctly.
A. True

B. False
2. I f my emotions seem to be more intense than usual and I have trouble doing my usual activities, I can:
A. Talk to someone I trust. B. Ignore it and wait until it goes away. C. Explode and let my emotions take over. D. Have a couple of alcoholic drinks.
3. If I talk to a mental health professional:
A. I will be locked up. B. He or she would not understand. C. I will lose it. D. I will have taken the first step in getting better.
4. Talking to a mental health professional means:
A. I must be crazy. B. I had to have been thinking of suicide. C. I will never reach my life goals. D. Im simply trying to get better.

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5. I am confident I can cope with strong emotional reactions.
Unsure
Topic Assessment

At the end of the session, answer these questions before turning in this paper: 7. This session helped me.
17
Understanding the Changes

1. I dentify 1 way strong emotional reactions can interfere with reaching your goals. 2. Recognize 2 ways others may be able to help you recognize and define emotional problems.
Changes that Challenge.
There are times when life events are difficult to deal with. Life can change quickly. Sometimes the reasons for change and trouble in our lives are obvious, like when we lose a loved one. Other times, we may not understand why we are having trouble. During these times, we often know something is wrong, but we arent sure why. Our emotions may be so strong that we get scared that we cant control them. During these periods of intense emotions, our view of the world can be affected. We may find it hard to understand what is going on. There are times you may have strong emotions. This could be intense fear, anger, anxiety, depression, extreme happiness, or even love for someone. Sometimes, you may not fully understand why these emotions are so strong. The emotion may have started out from something that happened to you, but your response was almost too strong, even uncomfortable. You may not understand why you cant seem to get rid of the strong emotions.
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The Brain and Emotions

The brain is the organ you use to help you understand your world and your emotional reactions to it. When you have strong emotions Main Learning Point #1 coming from your brain, it can be very hard to understand what is Your brain processes causing you to be upset. Strong your emotions. emotions affect the brains ability to understand and solve the situation. During these strong emotions, your brain may not work well. You may end up being very confused.
Main Learning Point #2 Intense emotions can reduce your ability to cope and function. Taking Action
When your thoughts and emotions start to interfere with daily life and prevent you from getting things done, you may need to take some action. The first step to take is to talk about what youre thinking with someone you trust. This can be a friend, family member, or mental health professional. By sharing your thoughts with someone you trust, you can get feedback that may help you. Sometimes this feedback is all you need and you may feel better. Other times, the trusted one can let you know that you might benefit from seeing a mental health professional (like your treatment team members and your prescriber).
Main Learning Point #3 It is helpful to share your thoughts with someone you trust.
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The Brain and Emotions

(continued)
The goal of a mental health professional is to help you identify the problem thats getting in your way of reaching your life goals. Although it may be hard at first to speak with a professional, everyone could benefit from talking to a professional at some time during their life. Mental health professionals are trained to help you find the answers you need. Talking to a professional is often the first major step you can take to solve your problems. Just as the person with high blood pressure needs someone to check their blood pressure frequently, someone who has intense thoughts and emotions can be helped by a mental health professional.
Main Learning Point #4 Talking with a professional means you are trying to make your life better.
Self-Evaluation of Barriers to Seeking Treatment.
Although anyone could benefit from mental health treatment, many people do not get treatment when they need to for a number of reasons. Check the reasons you might not want to talk with a professional.

1. Stigma or fear of being treated differently by others. 2. Hospitalization or being locked up. 3. General fear of what may be discovered. 4. Being over-medicated. 5. Being labeled as mentally ill. 7. Cost of treatment. 8. People finding out. 9. It will make it worse.
10. Other
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1. 2. 3. 4.
etwork. I will ask n to read it and talk with me about understanding emotional changes. about
3. G AIN INSIGHT. I will ask 4. OTHER:
what he or she remembers about the last time I was upset.
Take an Extra Step Forward (optional) 5. WRITE. I am going to write down my memories of the thoughts I
had when I was emotionally upset.
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TeamSolutions Workbook 3 Understanding Your Illness Session 3 When Personal Changes may be Symptoms
When Personal Changes may be Symptoms Facilitator Notes

Main Learning Points from last session: Understanding the Changes 1. Your brain processes your emotions. 2. Intense emotions can reduce your ability to cope and function. 3. It is helpful to share your thoughts with someone you trust. 4. Talking with a professional means you are trying to make your life better. Review Personal Practice Options from last session.
General Tip
This session will help the participant become familiar with the personal symptoms of his or her mental illness.
Provide support, hope, and reassurance that the identification of ones own symptoms is valuable for the person to learn in order to get back on track with their life goals. Inform participants that everyone is unique and no two people have the exact same symptoms.
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Medical science has discovered that having a mental illness is often due to physical changes that happen in the brain. The Surgeon General made the statement in 1999 that linked mental illnesses to physical illnesses. Certain areas of the brain are known to be involved with psychiatric symptoms. Most people who are diagnosed with a mental illness can be effectively treated once their particular symptoms are targeted. This is important background information for you to know as we talk about todays topic, When Personal Changes May Be Symptoms. How do you think knowing more about this would benefit you? Lets review the main points from our last session and answer the first six questions on the Topic Assessment before we start, just to see how familiar we are with this topic.
Topic Assessment Answer Key 1. A 2. D 3. C 4. D
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Review of Session 2: Understanding the Changes

session, you may guess, and also write the answers as people say them: 1. Your b 2. Intense e n processes your emotions.
s can reduce your ability to cope and function. t.
3. It is helpful to share your thoughts with someone you t 4. Talking with a professional means you are trying to make your l e better.
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Topic Assessment

Mark one:
Directions:
Pre
Post
1. M ental illnesses are sometimes due to physical biochemical processes in the brain.
A. True

B. False
2. H aving a mental illness means:
A. I am disabled, need disability benefits, and should give up my life goals. B. I did something wrong to get it. C. There is no treatment, cure, or hope. D. I can to learn how to manage it so it doesnt control my life.
3. Talking about my symptoms with a mental health professional will:
A. Stop all symptoms. B. Cause the symptoms to get worse. C. Help both of us learn if I have symptoms of mental illness. D. Get me locked up.
4. If I admit to having an illness:
A. Everyone will be afraid of me. B. I will not be the same person I always have been. C. I should tell everyone who knows me. D. I can start doing things to reduce the effects on my life.

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5. I am confident I understand how an emotional change may be a symptom.
Unsure
Topic Assessment

At the end of the session, answer these questions before turning in this paper:
7. This session helped me.

Strongly Disagree Disagree Neither Agree Agree Strongly Nor Disagree Agree
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When Personal Changes may be Symptoms

1. I dentify that some thoughts and feelings that cause problems for you may be symptoms of your illness. 2. Identify 1 cause of mental illness (brain chemical imbalance). 3. U nderstand that developing a mental illness is not something you caused.
One of the first steps in helping yourself get better is to figure out whether problems or symptoms are bothering you. Some symptoms may seem like normal reactions such as being nervous or sad. Other kinds of reactions may seem more unusual. People dont like to talk about them much. For example, seeing strange things or believing things that no one else believes. No matter what types of symptoms you may have, its important to take an honest look at what they are. Thats because symptoms may cause other problems in your life without you realizing it. You can take a big step in getting the right type of treatment by talking about the exact experiences and problems you had in the past, or may be having now, with a mental health professional.
Fill in the blank: A mental health professional that I find helpful to talk to is .
Are Symptoms Present?
Main Learning Point #1 Sharing your thoughts, feelings, and experiences with a mental health professional can help you identify whether you have symptoms.
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Some Symptoms Require Medication

If your prescriber thinks your problems may be due to a biochemical imbalance or misfiring (messages not getting where they need to) in your brain, you may be given a medicine to balance the thinking process. Unfortunately, because we are all different, it may take a while to find the best medicine for your specific symptoms. It is important to remember that if the first medication doesnt work, it is not anyones fault. It just takes time to match the right medicine with the problem.
Main Learning Point #2 It may take time and several different medicines to find the right one.
As symptoms start going away, most people are happier and enjoy life a lot more. This doesnt mean that if symptoms get better, problems will suddenly go away. Rather, when symptoms get better, people can pay more attention to their goals. Energy can be put into other things that are important, like school, work, or relationships. If a person figures out what symptoms are causing the problem, he or she can look for ways to reduce or manage them. Fill in the blank: My most important goal is
.
As symptoms go away, you can focus more on your goals
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Who Is To Blame?
After some of the symptoms are identified, its normal to wonder where they came from. A common thought is that you must have done something wrong (such as abusing substances) to cause the problems. However, most mental illnesses are not the result of anything you have done. It is true that the use of alcohol and other substances can make symptoms worse, but it has not been proven that their use actually causes any of the illnesses. In other words, it is no ones fault to have symptoms. No one caused it, and no one is to blame.
Main Learning Point #2 Developing a mental illness is no ones fault.
Circle the best answer: I [do / do not] blame someone for the problems
Ive been having.
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Do I Have Symptoms?
In the next few sessions, we will look more closely at the symptoms of mental illness. We will complete several checklists to help you decide if you are having symptoms. If you identify symptoms, you may consider whether you have an illness. You will want to talk about this with your prescriber. It is normal for people who have a mental illness to wish that they did not have it. At times, the symptoms may even go away for short periods, and the diagnosed person may think, I must be cured because I dont have any symptoms right now. Much like people who have high blood pressure and dont have a high reading all the time, people with mental illness will not have symptoms all the time. It is wise to get all of the facts so you can get relief from your problems. Even if you and your prescriber decide symptoms are present, symptoms can be treated successfully.
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1. 2. 3.
1. STUDY. I am going to reread my handout at least once. 2. S HARE. I will share my handout with someone in my support
system. I will ask talk with me about it.
to read it and
3. D ISCUSS. I will talk to
about any problems Im having and why I think they are happening. I will ask his or her opinion.
4. OTHER: Take an Extra Step Forward (optional) 5. WRITE. I am going to write down what I understand about why
I have been having problems lately.
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TeamSolutions Workbook 3 Understanding Your Illness Session 4 Acceptance
Acceptance Facilitator Notes

Main Learning Points from last session: When Personal Changes May Be Symptoms 1. S haring your thoughts, feelings, and experiences with a mental health professional can help you identify whether you have symptoms. 2. It may take time and several different medications to find the right one. 3. Developing a mental illness is no ones fault. Review Personal Practice Options from last session.
Note
Tip for this Session
This session could be used for family/friend groups or sessions. It offers an opportunity for the participant and family to practice skill-building together.
Materials Needed to Accompany Participant Handout: Discovering Things about Yourself
This is a powerful session with important insights that need to be processed. Discussion should not be cut short. It is okay to take two meetings if necessary to fully cover this topic.
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How many of you grew up with brothers or sisters?
(Listen to their responses. Some participants may want to tell you how many siblings they have. This is part of engaging participants in the process, so take the time.)
Did your brothers and sisters sometimes bother you? Did you ever have to make changes because of them, such as sharing a bedroom? Did they ever change the television channel to watch one of their shows, and you couldnt watch yours? I know a person who wanted to watch cartoons every day after school, but she had an older brother and sister who wanted to watch the teenage dance show, American Bandstand. She always thought it was unfair that she couldnt watch cartoons, but there were two of them so she was outnumbered. Finally she realized she kind of liked watching her siblings dance, and she eventually started dancing with them every day. At the beginning, she was annoyed because she felt forced to watch the dance show. She thought it was unfair. Over time, though, she learned that the show wasnt so bad, and she learned how she could have fun with it herself. It turned out that the change wasnt so bad after all.
Today, we are going to talk about acceptance. It is normal to feel resistant to a diagnosis of mental illness when it is first made. However, you can begin to understand that you can cope with, and even manage, the illness. This is called acceptance, and once you accept the illness, you can begin to work toward your recovery. Lets review the main points from our last session and answer the first six questions on the Topic Assessment before we start, just to see how familiar we are with this topic.
Topic Assessment Answer Key 1. A 2. D 3. A 4. C
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Review of Session 3: When Personal Changes May Be Symptoms

Main Learning Points of Session 3
hat were the main learning points of Session 3? If you did not attend the last W session, you may guess, and also write the answers as people say them: 1. S haring your thoughts, f s, and experiences with a mental health professional can help you identify whether you have symptoms. 2. I t may take time and several different m right one. 3. Developing a m l illness is no ones fault. s to find the
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Topic Assessment

Mark one:
Directions:
Pre
Post
1. E arly acceptance of having a mental illness may cause mixed emotions.
A. True

B. False
2. Total Acceptance of a disorder is when:
A. A cure happens. B. A person takes medicines as directed. C. A person gives up. D. A person takes care of his or her mental and physical health to the best of his or her ability.
3. A dmitting that you have a psychiatric illness is one of the first steps toward recovery.
A. True

B. False
4. The main part of acceptance of a mental illness is:
A. Admitting that it is your fault that you became ill. B. Realizing you could have done something to prevent the illness. C. Becoming active in working to manage the illness. D. Developing a strong mind to overcome the symptoms.

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5. I am confident I have accepted my illness.
Unsure
Topic Assessment


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Acceptance
1. I dentify 1 way acceptance is an action step towards getting better. 2. Understand that accepting a mental illness is a process that takes time.
Early Acceptance
Throughout life, we all face times when we have to cope with things we dont want to deal with. The most common response to learning that we may have a serious health problem is to ask for a second opinion. It is normal to hope that the diagnosis is wrong. Once we admit something is wrong, however, we can begin to find out what can be done to make things better. This stage is called early acceptance. People move into acceptance shortly after the admittance stage. Admitting to yourself that something is not right is important and is often the first step towards the recovery process. The real progress towards recovery begins in the acceptance stage. Being uncomfortable is understandable. Main Learning Point #1 In the early acceptance stage, you usually do not feel comfortable. You Acceptance is taking the first steps have to deal with something you have to achieve your life goals. never experienced before and that you It is the opposite of giving up! have little knowledge about. To top it off, the organ that you need to understand your situationyour brainis what is not working correctly. Try not to be too fearful. Many individuals have been where you are now and have found answers and solutions to the problems. By gaining knowledge and understanding of your mental illness, you can develop the skills necessary to manage your illness and get back on the road to recovery.
Main Learning Point #2 Acceptance may be uncomfortable at first.
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Michaels Story
Sometimes it helps to look at things from someone elses point of view so that you can learn more about yourself. The story you are about to read includes actual events that happened; however, the names have been changed to keep it confidential. This story explains how Michael, a college student, started having problems and how those problems affected his life over a one-year period. As you read about what happened to him, think about some of the experiences youve had in your own life. Think of ways you were able to overcome some of the problems you have had. After reading Michaels Story, youll be asked to talk about and list your ideas on things Michael could have done to manage his problems and improve his life. Part I: Introduction Michael, a college junior who was majoring in history, usually got As and Bs in his classes. Over the past year, his grades slipped, and he dropped two courses to avoid failing grades. Michael took a summer job as a waiter in a local restaurant, and he usually went out with his friends after work. Halfway through the summer, Michael and another waiter got into an argument. The argument got worse and turned into a fist fight. Michael was stronger than the other waiter and pushed him against the counter. The waiter hit his head and passed out. In anger, Michael slammed his fist against a window. Glass broke around him, and people in the restaurant started running toward the door. The police arrived and Michael went with them to the police station.
Whats Your Opinion?
What are some things Michael could have done when he noticed his grades slipping?
List some ways that Michael might have avoided getting into a fist fight with
the other waiter:
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Michaels Story
(continued) Describe some ways Michael may be able to avoid arguments like this one in the future:
Acceptance Takes Time Keep in mind that you will have an emotional reaction to being told that you have a mental illness. It takes time to come to acceptance. Many life skills are developed over time. For example, think about watching babies when they first learn how to walk. Its difficult! They fall and they fall, but what else? They keep getting up and trying again. We all did it! Learning how to balance and take steps took time, effort, and people in our life who coached and helped us. No child has been able to just get up and walk without first learning and then practicing. Give yourself time to adjust to this new change in your life. Small steps will get you to your goals.
Main Learning Point #3 Acceptance of a mental illness is a process that takes time.
Having to learn the skills needed to deal with a mental illness is like learning to walk. Hopefully, by working with your treatment team coaches and using the information in this set of workbooks, you will learn helpful steps in your recovery. Dont worry if it seems to be taking a lot of time, and if others seem to be doing better than you in finding their answers. Just as everyone learns to walk at different rates, everyone develops skills in managing their mental illnesses at their own pace. No two people have exactly the same illness. We must all take our own learning steps at our own pace.
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1. 2. 3.
s ystem. I will ask to read it and talk with me about where they think I am with accepting my illness.
3. R EAD. I will reread Michaels Story and find two similarities
to my situation.
4. OTHER: Take an Extra Step Forward (optional) 5. D ISCOVERY. I will complete the Discovering Things about Yourself
handout and bring it to the next session.
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Discovering Things About Yourself

ou read Michaels Story and came up with ways Michael might be able to Y manage his symptoms and problems. You may be able to use some of these ideas to manage the difficulties youre having and improve your own life. Answer each of the questions in this section. Use the new ideas you discussed or listed from Michaels Story to help you answer the questions.
Describe a time in your life when you felt as though you lost control:
What could you have done to stay in control?
What can you do to avoid situations in the future that may cause you to lose control? (Use any ideas you may have talked about after Michaels Story.) What are some of the things you can do to keep your stress at a comfortable level?
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Why is it important to keep your stress at a comfortable level?
What are your thoughts about taking medicine for your symptoms?
TeamSolutions Workbook 3 Understanding Your Illness Session 5 Symptoms are Important to Diagnosis and Recovery
Symptoms are Important to Diagnosis and Recovery Facilitator Notes

Main Learning Points from last session: Acceptance 1. A cceptance is taking the first steps to achieve your life goals. It is the opposite of giving up. 2. Acceptance may be uncomfortable at first. 3. Acceptance of a mental illness is a process that takes time. Review Personal Practice Options from last session.
Remember General Tip
You can refer to the two-sided laminated Facilitators Delivery Checklist when using Team Solutions materials as a reminder of important facilitator tips.
Tips for this Session 1. Think of this session as moving from disarming
the participants (Session 1 4) resistance to having an illness to arming him or her with specific knowledge and skills that allow him or her to be in charge and learn ways to manage the illness. 2. If you use the topic introduction listed on the next page, you will want to draw on the board or a flip chart, if possible. If you are unable to do that, you may want to draw each piece of the diagram on separate pieces of paper and put them on the wall when you get to that point of the introduction. 3. W hen you have written answers on the participant handout, remember to take time to review them as a class for an interactive exercise.
There are three small things you can do to make your sessions supportive events for participants to look forward to: First, miss people who arent there. Follow up and let them know you missed them. Send a get well card if he or she is sick. Second, celebrate birthdays and any other personal milestones. Announce at the beginning of class it is a participants birthday. Give him or her a card and, if feasible, a small gift. Third, wear bright colors on days you have groups or family sessions. Bright colors can give everyone a little lift.
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When a person is sick and decides he or she needs to go to the doctor or a clinic, what is he or she hoping for?
(Examples of some possible replies include, The person wants to feel better, The person wants the doctor to recognize whats wrong, and The person wants the doctor to fix him.)
Lets review the main points from our last session and answer the first six questions on the Topic Assessment before we start, just to see how familiar we are with this topic.
Topic Assessment Answer Key 1. B 2. A 3. B 4. B
Whats that called?

(Help them get to the word diagnosis.)
And how does the medical person figure out what the diagnosis is?
(Look for the answer, Symptoms. Establish this chain of events and write it on the board, a flip chart or papers to hang on the wall.)
Symptoms
Diagnosis
Relief
The person wants relief. He or she wants the medical person to look him or her over (see symptoms), decide whats wrong (give diagnosis), and treat it to make it better. This is great! You have just covered a lot of important things that we will be studying in this workbook. Today we will talk about symptoms.
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Review of Session 4: Acceptance

session, you may guess, and also write the answers as people say them:
1. A e is taking the first steps to achieve your life goals. It is the opposite of giving up. 2. Acceptance may be u 3. Acceptance of a mental i e at first. s is a process that takes time.
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Topic Assessment

Mark one:
Directions:
Pre
Post
1. S ymptom means:
A. Name of an illness. B. Sign of an illness. C. Test to determine an illness. D. An illness is definitely present. B. False B. False B. False
2. O ne example of a prescriber is a Nurse Practitioner.
A. True

3. A mental illness is not a physical disease.
A. True

4. Only a doctor can monitor symptoms.
A. True

5. I am confident I know what my symptoms are.
Unsure

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Topic Assessment

46
Symptoms Are Important to Diagnosis and Recovery

1. I dentify what is a symptom. 2. Understand the role of a prescriber. 3. Recognize that a mental illness is a brain disease.
What is a symptom? The dictionary defines symptom as a condition of an illness that can be used to determine if an illness is present. A symptom is a sign of illness especially when it causes a person to notice changes in their normal function, sensations, or appearance.
Main Learning Point #1 A symptom is a sign that an illness is present.
Why are symptoms important? Symptoms play a very important role in any illness, regardless of the part of the body that is affected. Symptoms let you know that something is not right by causing discomfort. They can also make it harder for you to do the things you would normally do. Symptoms may cause you to seek relief by going to a clinic, a doctor, or another trained medical person (such as a nurse practitioner) who can prescribe medicine. Someone who is qualified to prescribe medicine, including a doctor, is called a prescriber. The prescriber carefully looks at all of the symptoms, together with any other important information, and makes a diagnosis. In other words, the prescriber identifies the illness.
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Why are symptoms important?

(continued)
An illness that I have been diagnosed with and treated for is

. The symptoms that led me to go to a prescriber were .
Symptoms are, by far, the most important clues for making a correct diagnosis. Your prescriber will work with you to identify the symptoms and evaluate them. The following information about the symptoms is important: 1. The type of symptoms youre having. 2. How severe the symptoms are. 3. How long you have had these symptoms. 4. What your life was like before these symptoms appeared. 5. How old you were when the symptoms first appeared. 6. If you have ever taken medicine to treat similar symptoms. 7. If you did take medicine: a. Did the symptoms improve? b. I f the symptoms improved, how soon after treatment started did you start feeling better? c. Did any of your symptoms go away?
Main Learning Point #2 Symptoms are necessary to make a correct diagnosis.
In addition to symptoms, the prescriber will also consider other important factors such as your family history of illness and lab test results.
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Why are symptoms important?

(continued)
When the part of the body that has the problem is the brain, its called a mental illness. The brain is an organ, just like the heart, lungs, liver, and kidneys. Any organ can become diseased.
Main Learning Point #3 A mental illness is a brain disease.
List any three organs in the human body. Beside each organ, list a disease that that organ can have: ORGAN DISEASE 1. 2. 3.
Trained medical professionals are skilled at recognizing symptoms, but a person with a mental illness can also learn how to recognize symptoms. This is called symptom monitoring. Symptom monitoring is a recovery tool. It can help you control illness by helping you respond to early warning symptoms of a relapse.
Main Learning Point #4 Monitoring symptoms is an important recovery tool.
Do you know someone who uses symptom monitoring to stay well?

Yes
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No
If yes, what medical condition does the person have? Circle one: Asthma Other: High blood pressure Substance abuse Diabetes

1. 2. 3. 4.
s ystem. I will ask talk with me about it.
to read it and
3. L EARN. I will know the name of my prescriber by the next session
and let the facilitator know who it is.
4. OTHER: Take an Extra Step Forward (optional) 5. A SK. The next time I meet with my prescriber, I will talk with him
or her and decide one or two symptoms I should watch for. I will tell my treatment team about if they start to happen.
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TeamSolutions Workbook 3 Understanding Your Illness Session 6 Symptoms Checklist (Part 1)
Symptoms Checklist (Part 1) Facilitator Notes

Main Learning Points from last session: Symptoms Are Important to Diagnosis and Recovery 1. A symptom is a sign that an illness is present. 2. Symptoms are essential for making a correct diagnosis. 3. A mental illness is a brain illness. 4. Monitoring symptoms is an important recovery tool. Review Personal Practice Options from last session.
Remember
Tips for this Session 1. Do three things throughout this session.
It is important to acknowledge and discuss participants successes, progress, and challenges.

Note
a. First, walk around and offer support as they fill out the checklist. b. Second, as each item is read, be sure it is understood before moving to the next symptom. c. Third, at the end of each list of symptoms, pause for discussion before moving on to the next category of symptoms. 2. Explain to participants that they probably will not have every type of symptom mentioned in this session.
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In the last session we learned the importance of symptoms and how we use them to decide what the correct diagnosis is. Whats even more helpful is for you to talk to your prescriber and treatment team about your own symptoms. You need to be a part of that discussion when you go in for medical care. When you go for your appointment, do you tell your prescriber about how you are doing with your symptoms? Do you tell him or her which symptoms have cleared up, which are getting worse, what (if any) new symptoms you have, and which symptoms bother you the most? Does your prescriber ask you questions about your symptoms to check how you are doing? Raise your hand if you talk about these types of things at your appointments. Would it be helpful for you to be able to discuss your symptoms like this with your prescriber? In this session and the next one, you will learn how to come up with your own checklist of symptoms. Lets review the main points from our last session and answer the first six questions on the Topic Assessment before we start, just to see how familiar we are with this topic.
Topic Assessment Answer Key 1. B 2. C 3. A 4. B
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Review of Session 5: How Medicine for Mental Illness Works

session, you may guess, and also write the answers as people say them: 1. A symptom is a sign that an i 3. A mental illness is a b 4. M n illness. s is present.
2. Symptoms are essential for making a correct d g symptoms is an important recovery tool.
s.
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Topic Assessment

Mark one:
Directions:
Pre
Post
1. I dentifying symptoms:
A. Should be done by a trained professional. B. Can help you get better treatment. C. Happens only at the time treatment begins. D. Is limited to adults.
2. A n example of a negative symptom is:
A. Not being able to control how much money I spend. B. Blaming others for my problems. C. Not having much to say. D. Not being able to stop crying.
3. Cognitive symptoms appear when the brain cant process information well.
A. True

B. False B. False
4. Positive symptoms are a sign of improvement.
A. True

5. I am confident I know how to recognize when I have symptoms.
Unsure
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Topic Assessment


55
Symptoms Checklist (Part 1)

1. I dentify any positive symptoms that you have (if you have positive symptoms). 2. I dentify any negative symptoms that you have (if you have negative symptoms). 3. Recognize any cognitive symptoms that you have (if you have cognitive symptoms).
Identifying Personal Symptoms There are several types of symptoms that are possible signs of mental illness
positive symptoms, negative symptoms, cognitive symptoms, and mood symptoms (depressive, mania, and mixed mania).
During this session and the next session, you will look at a checklist of each of these types of symptoms and check off any that you have had in the past six weeks. This checklist will help to identify your symptoms. There are a many reasons you should identify symptoms: 1. I t will help you recognize the symptom as a sign of an illness that can be treated, which makes the symptom not so frightening. This can give you hope. 2. I t will help your treatment team to be more helpful because you are better able to talk about your symptoms. 3. I t will help you track how you are doing. This may help you prevent a relapse and help you move forward in your recovery.
Main Learning Point #1 Identifying and talking about symptoms with your treatment team leads to better treatment.
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(continued)
It is not uncommon, in both schizophrenia and bipolar disorder, for some other types of symptoms to appear later. It is a good idea to save this checklist to refer to in the future. Updating your symptoms list is something you may want to do every so often.

Instructions: Put a check in the box beside any symptom you have had during the past six weeks.
Positive Symptoms are add on symptoms that are not present when the brain is working right. Over-stimulated Senses
Symptom Checklist:
1. Certain colors bother methey seem too bright or intense. 2. There are too many noises and soundsI cant focus on what I want to hear. 3. Noises are louder than usual sometimes. 4. Lights really bother methey are too bright. 5. Other: . 1. I see ghost-like figures. 2. What I see in the mirror is not me. 3. I hear a voice that no one else can hear. 4. I hear two voices talking about me. 5. A voice (not my own) tells me to do things. 6. My food or drink tastes as if it has been poisoned. 7. I smell sweet odors. 8. It feels like something is crawling on my skin. 9. Other:
Hallucinations
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(continued) Overly Suspicious
1. I have many fears about being harmed or killed. 2. I think people are plotting against me. 3. I believe someone is watching me. 4. I think someone is trying to poison me. 5. I think people are following me. 6. I believe messages are being sent about me. 7. I believe someone is playing tricks on me. 8. I think people are talking about me or making fun of me. 9. My neighbors are bothering me. 10. I believe somebody goes through my things and moves them. 11. Other: .
Main Learning Point #2 Positive symptoms are add on symptoms that are not present when the brain is working right.
egative Symptoms are missing behaviors and abilities that are present N when the brain is working right.

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1. Often, it is hard to relate to other people. 2. Usually, I would rather be alone than with other people. 3. I do not feel like planning or beginning any tasks. 4. Often, I feel like staying in bed all day. 5. I do not feel like washing myself, combing my hair, or getting dressed. 6. I hardly ever want to talk with others. 7. It is so hard to figure out what to do first. 8. Few things make me happy. 9. People have told me I do not show emotion in my face or voice. 10. I do not want to do anything. 11. Other: .

(continued) Having Difficulty Talking to Others
1. I think it is hard to start a conversation because I do not have anything to say. 2. It is hard to express my thoughts. 3. I cant understand people when they speak. 4. People sometimes do not understand what I am saying. 6. Other: .
Main Learning Point #3 Negative symptoms are missing behaviors and abilities that are present when the brain is working right.
ognitive Symptoms happen C when the brain is not able to process information well. Trouble Concentrating
1. It is hard to pay attention for long periods of time. 2. At times, I have too many thoughts. 3. My thoughts are sometimes jumbled or confused. 4. I have so many ideas that I jump from one to another quickly. 5. At times, I have trouble reading books or following movies. 6. It is sometimes hard to focus on what people are saying to me. 7. At times, it is hard getting my thoughts together. 8. I cant hear well over background noises. 9. Sometimes I lose my train of thought. 10. I have problems with my memory. 11. Other: .
Main Learning Point #4 Cognitive symptoms happen when the brain is not able to process information well.
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1. 2. 3. 4.
s ystem. I will ask to read the symptom lists and check those that I have had in the past six months. to help me plan
3. P LAN. I will ask 4. OTHER:
a way we can work together to track my symptoms.
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Symptoms Checklist (Part 2) Facilitator Notes

Main Learning Points from last session: Symptoms Checklist (Part 1) 1. Identifying and talking about symptoms with your treatment team leads to better treatment. 2. Positive symptoms are add-on symptoms that are not present when the brain is working right. 3. Negative symptoms are missing behaviors and abilities that are present when the brain is working right. 4. Cognitive symptoms happen when the brain is not able to process information well. Review Personal Practice Options from last session.
Note General Tip
Tips for this Session 1. This is Part 2 of the My Symptoms Checklist.
As participants continue to complete the checklist, be available to offer assistance if desired. Remind participants they will probably not have every type of symptom mentioned.
Encourage participants to identify personal examples of the main learning points. Talk about it. If we dont, we may be on totally different wavelengths. By talking about what the participants understand about the lesson, you can determine if the participants understand the material. Discussion allows you to know whether to explain more or to move on because the participants have adequate comprehension.
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Last time we met, we began making a personal symptom checklist. Why would someone want to do that? What are the benefits?
(Compile a list of their responses on the board or a flip chart, if you have one. If not, talk about this topic and encourage everyone to participate.)
Topic Assessment Answer Key 1. C 2. B 3. A 4. D
It sounds like there are many good reasons to work on a personal symptom checklist. Today we will complete the lists.
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Review of Session 6: Symptoms Checklist (Part 1)

session, you may guess, and also write the answers as people say them: 1. I dentifying and talking about s treatment team leads to better treatment.
s with your
2. P ositive symptoms are a -on symptoms that are not present when the brain is working right. 3. N egative symptoms are m g behaviors and abilities that are present when the brain is working right. 4. C ognitive symptoms happen when the b process information well. n is not able to
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Topic Assessment

Mark one:
Directions:
Pre
Post
1. Which of the symptoms listed below is a manic symptom:
A. I think people are plotting against me. B. I am confused. C. Not being able to control how much money I spend. D. Not being able to stop crying.
2. M anic symptoms, but not depressed symptoms, are outside the normal range of moods.
A. True

B. False
3. I n mixed mania, symptoms of depression are present at the same time with symptoms of mania.
A. True

B. False
4. Which of the symptoms listed below is a depressed symptom?
A. There are too many noises and soundsI cant focus on what I want to hear. B. The radio is broadcasting my thoughts. C. I am being watched and followed. D. I cant follow the plots of TV programs I used to enjoy.

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5. I am confident I can learn to manage my symptoms.
Unsure
Topic Assessment


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1. I dentify depressed symptoms that you have (if you have depressed symptoms). 2. I dentify manic symptoms that you have (if you have manic symptoms). 3. Recognize mixed manic symptoms that you have (if you have manic symptoms).
Symptom Checklist: Instructions: Put a check in the box beside any symptom you have had during the
past six weeks.
ymptoms of Depression appear when a persons mood thermostat S is broken, allowing moods to go below the standard range of moods.
1. My life is no longer good, and I dont think it will ever be good again. 2. I used to have hobbies but I gave them up. 3. I dont have the energy to leave my house. 4. I cant follow the plots of TV programs that I used to enjoy. 5. I cant enjoy reading like I used to because I just cant focus now. 6. I cant stop crying. 7. Food is not good or importantI forget to eat. 8. My sex drive is reduced. 9. I am no good to anyone. The world would be better off without me. 10. I wish I could sleep and be rested but I just toss and turn. 11. I sleep too much and cant get out of bed. 12. I wish I were dead. 13. I do not want to interact Main Learning Point #1 with other people and I quit calling my friends. Symptoms of depression appear 14. Other: when your mood thermostat .
allows moods to go below the standard range of moods.
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(continued) Symptoms of Mania appear when a persons mood thermostat is broken, allowing moods to go above the standard range of moods.
1. I have so much energy. 2. I keep having all these really great ideas. 3. It is fun and powerful to drive fast. 4. Who needs sleepnot me. 5. I cant focus on anything. 6. Other people cant keep up with methey get on my nerves. 7. My thoughts are racing through my head so fast I cant keep up with them. 8. I feel very sexy nowI dont want to miss anything good in life. 9. I am too much of a man or woman for just one person. 10. It takes money to make money and I am going to spend and be rich. 11. Who worries about bills coming duenot me. 12. I have a lot to say and you should listen and benefit. 13. I have my rights and I will stand up for them. 14. I am applying for more credit cards because mine are at their limit. 15. Other: .
Main Learning Point #2 Symptoms of mania appear when your mood thermostat allows moods to go above the standard range of moods.
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(continued) ymptoms of Mixed Mania appear when a persons mood thermostat is S broken, allowing moods to go above and below the standard range of moods at the same time. People who have a mixed manic episode may have several symptoms of depression and several symptoms of mania together. The person often has a depressed mood as well as the signs of a manic episode.
1. I am sad and hopeless but it doesnt matter because I have so much energy. 2. I wish I were dead. 3. I cant focus on anything. 4. I am not getting much sleep at night and I am tired, but my body seems to have the energy to go all day. 5. My sex drive is really high. 6. My thoughts are racing through my head so fast I cant keep up with them. 7. Im irritable and grouchy. 8. People around me tell me I talk too much. 9. Other: .
Main Learning Point #3 Symptoms of mixed mania appear when your mood thermostat allows moods to go above and below the standard range of moods at the same time.
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Recording My Symptoms
Look at all of the boxes youve marked on both checklists (Sessions 6 & 7) and
answer the following questions:
Which symptoms have bothered you the most over the past month?
1. 2. 3. 4.
Which symptoms never seem to go away?
1. 2. 3. 4.
Which symptoms have gotten better over the past month?
1. 2. 3. 4.
What makes these symptoms better or worse?

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1. 2. 3. 4.

1. 2. 3.
s ystem. I will ask talk with me about it.
to read it and
3. P LAN. I will ask 4. OTHER:
to help me plan a way we can work together to monitor for symptoms.
Take an Extra Step Forward (optional) 5. DISCUSS. I will discuss the checklist from sessions 6 and 7 with a
family member or friend so they will have a better understanding of my symptoms.
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TeamSolutions Workbook 3 Understanding Your Illness Session 8 Reasons for Symptoms in Mental Illness
Reasons for Symptoms in Mental Illness Facilitator Notes

Main Learning Points from last session: Symptoms Checklist (Part 2) 1. Symptoms of depression appear when your mood thermostat allows moods to go below the standard range of moods. 2. Symptoms of mania appear when your mood thermostat allows moods to go above the standard range of moods. 3. Symptoms of mixed mania appear when your mood thermostat allows moods to go above and below the standard range of moods at the same time. Review Personal Practice Options from last session.
Tips for this Session 1. This is a lengthy session with complex information.
General Tip Trash Can Quality Indicator. Check the quality
You know the participants, so draw from your experience and knowledge as how to best use these materials. It is empowering for participants to have knowledge about the scientific basis of their illness, even if they do not remember it in great detail. You may want to make this a two-session review for greater retention. 2. You may want to draw diagrams on the board to illustrate each section. For example, for the first diagram, What Brain Chemicals Are Supposed to Do, draw a profile of a head. Draw in arrows for: a. Receive (point-down, line up back of eyes, from center top of head). b. Process (draw dotted lines for neural pathways between first point and frontal cortex area over eyebrows). c. Make decisions (arrow to frontal cortex area over eyebrows). 3. Ask for examples of symptoms that arise from each connection problem. To encourage examples, give situations such as, If he is walking down a busy sidewalk and this type of brain chemical imbalance effect is happening, what might he be experiencing?
indicators for your program to see how its received. Some obvious examples are pre- to post-session Topic Assessment score changes, number of referrals, participant feedback, etc. Dont forget the trash canits an excellent quality indicator. If participant handouts are thrown away as participants leave the room, its an indication they werent engaged. It should also tell you something if diplomas and/or reinforcers are also thrown away. Watch for signs of disengagement and modify your sessions accordingly. Accepting and using feedback helps you grow professionally.
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Have any of you ever tried to repair a car? Raise your hands if you have. I see a few of you have. Well, from what I understand about auto repair, it is helpful to know how everything connects to make the motor work right. It is great when you can work with someone who knows how to make car repairs and can teach you what might be wrong. So there are two things we need to know to fix a motor: 1. How it is connected when it works right. 2. What is happening when it doesnt work right. Lets review the main points from our last session and answer the first six questions on the Topic Assessment before we start, just to see how familiar we are with this topic.
Topic Assessment Answer Key 1. B 2. C 3. B 4. B
( You may want to write these two points on the board.)
Does that make sense to everybody? This is also a way to understand illness in the brain. To understand what might not be working right in a mental illness, we need to know how things are connected when it works right. We also need to know what is happening in our brains when they dont work right. Today we will talk about reasons for symptoms in psychiatric illness.
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Review of Session 7: Symptoms Checklist (Part 2)

session, you may guess, and also write the answers as people say them:
1. S ymptoms of d n appear when your mood thermostat allows moods to go below the standard range of moods. 2. S ymptoms of m a appear when your mood thermostat allows moods to go above the standard range of moods. 3. S ymptoms of mixed mania appear when your mood t t allows moods to go above and below the standard range of moods at the same time.
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Topic Assessment

Mark one:
Directions:
Pre
Post
1. When medicine is taken the right way, schizophrenia and bipolar disorder can be cured.
A. True

B. False
2. The brain cannot normally process the information it receives:
A. If the person is given medicine. B. If an outside force is influencing the brain. C. If the person is sick due to schizophrenia or bipolar disorder. D. If interference is too great. B. False B. False
3. A fter psychiatric medicine improves symptoms, medicine can be stopped.
A. True

4. Schizophrenia happens to approximately 3 out of 100 people.
A. True

5. I am confident I can learn to manage my symptoms.
Unsure

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Topic Assessment

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Reasons for Symptoms in Mental Illness

1. Identify 3 ways brain chemicals carry messages in the brain. 2. I dentify how medicine might correct brain chemical imbalance and improve your symptoms.
The symptom checklist covers symptoms of schizophrenia and bipolar disorder. There are many theories as to why people may have these symptoms. One explanation is that these symptoms occur when the chemicals in the brain get out of balance. About one out of every 100 adults is diagnosed as having schizophrenia and about three out of every 100 adults are diagnosed as having bipolar disorder. It is not fully known why this happens to some people and not to others.
Main Learning Point #1 One reason why people develop symptoms is because brain chemistry gets out of balance.
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What Brain Chemicals Are Supposed to Do

The brain is a complicated and complex network of nerve cells. These nerve cells talk with each other by electrical impulses and chemical signals. The chemicals in the brain help to: 1. Receive the right information from the world around you. 2. Process or make sense of the information (pair it with memories). 3. Make decisions and decide what to do based on the information thats received and processed. The front cortex helps to guide you in new situations and make future plans.
Main Learning Point #2 The three steps in brain chemical communication include: receive information, process information and make decisions based on this information.
Receive Process
Make decisions
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(continued)
The Way The Brain Receives Information Schizophrenia and bipolar disorder affect the way the brain receives information in these ways:
1. Too much information can overload the brain.
Sometimes your senses (sight, smell, hearing, taste, and touch) become sensitive, or easily bothered by the world around you. Lights may seem too bright. Background noises may be too loud. You may find it hard to focus on one task because you are distracted by other things going on around you. The brain may have trouble sorting out what you see and hear. When your senses are overloaded like this, messages to your brain are often jumbled and confusing.
2. Information that the brain receives may not be accurate.
Any one (or more) of your senses can play tricks on you. When this happens, you might hear, see, taste, touch, or smell something that others do not experience. This is called a hallucination. The brain may not be receiving accurate information.
3. The brain may store information incorrectly.
Usually, when your brain puts a new experience into its memory bank, it tries to file the experience with other similar experiences. This makes it easier for your brain to pull up a memory when you need it. Sometimes the brain may receive new information but store it in the wrong file. This may cause you to have trouble remembering experiences when you want to. You may also respond with a wrong emotion, such as laughing at sad news.
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(continued)
The Way the Brain Processes Information Schizophrenia or bipolar disorder may affect the way the brain understands information in these ways:
1. The brain may process information too slowly or too quickly.
When this happens, your brain may be flooded with information. It can be overworked and overloaded. Response time may slow down because there is just too much information to think about. It may take longer to learn a new skill than before you became ill. Or, you may be processing information at such a fast rate that you lose focus, jump from topic to topic, have poor judgment, or may not be able to make good decisions.
2. The brain may not have all of the information it needs to understand the message.
This may cause your brain to receive only bits and pieces of information like pieces of a puzzle. When this happens, you may have to struggle to fit those pieces together so the message makes sense. Or, you may act impulsively because you do not have the patience to wait and get all of the facts and information you need to make a decision.
3. Your brain comes to the wrong conclusions.
Using incomplete messages can lead to illogical or incorrect conclusions resulting in false beliefs, such as delusions.
4. The mood messages may not fit the situation.
Brain chemicals that carry mood messages cant accurately fit the mood to the situation because they are out of balanceeither too high or too low. This may cause you to have severe or sudden changes in mood, such as being happy, sad, or irritable, without understanding why.
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(continued)
Making Decisions Can Be Difficult Some people who are ill find it very difficult to make decisions. And sometimes the decisions they make may not be in their best interest. But these might be the best decisions they can make at the time based on the information they have received and processed.
Main Learning Point #3 An ill brain may not be able to receive or process information correctly.
The good news is that medicine helps improve the way most people receive and understand information. Over time, making decisions may become easier as thoughts become clearer, moods become more stable, skills improve, and confidence increases. One of the best ways to relieve symptoms is to take medicine that will help adjust this chemical imbalance. The longer medicine is taken the way it is prescribed, the better the chances are that the symptoms will improve. Schizophrenia and bipolar disorder are illnesses that do not have a cure. Just because these illnesses cannot be cured does not mean a person cant have a full and meaningful life. More medicines and treatments for mental illnesses continue to be discovered. Medicine can help you manage symptoms. If you stop taking your medicine, your symptoms are more likely to return in the near future. Thats why it is important to take medicine, the way it is prescribed every day, even if you are getting better
and the symptoms have gone away. Main Learning Point #4 If medicine is stopped, the brain chemistry gets back out of balance and symptoms usually return.
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1. 2. 3. 4.
s ystem. I will ask talk with me about the way my brain works.
to read it and
3. WRITE. I will think about and write down some of the ways I think
my brain processes information. (Refer back to The Way the Brain Receives Information section of the handout.)
4. OTHER: Take an Extra Step Forward (optional) 5. CREATE. I will make a poster with a diagram to teach others about
how the healthy brain works (called the 3 steps of brain chemical communication). I will also add a message to the poster (for example, Balance is Healthy).
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TeamSolutions Workbook 3 Understanding Your Illness Session 9 Making the Diagnosis
Making the Diagnosis Facilitator Notes

Main Learning Points from last session: Reasons for Symptoms in Mental Illness 1. O ne reason why people develop symptoms is because brain chemistry gets out of balance. 2. The three steps in brain chemical communication include: receive information, process information and make decisions based on this information. 3. A n ill brain may not be able to receive or process information correctly. 4. I f medicine is stopped, the brain chemistry gets back out of balance and symptoms usually return. Review Personal Practice Options from last session.
Materials Needed for Topic Introduction: 2. Another aid that may be helpful in explaining how
Puzzle piece templates.

Tips for this Session 1. Consider using visual aids with this session to
prescribers make a diagnosis is a copy of the DSM. You can show the sections on schizophrenia and bipolar disorder, and pass the book around so the participants can hold it and flip through it.
introduce todays topic. Get sturdy poster board and cut it into a ten large jigsaw puzzle pieces (a template is included). Label the pieces as follows: a. Symptoms: Using Checklist b. Symptoms: How Long? c. Symptoms: How Severe? d. Symptoms: Triggers? e. How Quickly Symptoms Clear Up f. How Completely Symptoms Clear Up g. Age Symptoms First Appear h. Others in Family Have Mental Illness? i. Rule Out Other Illness-Causing Symptoms j. Symptoms from Alcohol or Street Drugs? Give each participant one or two pieces of the puzzle. Together, you will put the pieces together during class to solve the puzzle of how a diagnosis is made.
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Let me see a show of hands of who wants to get a correct diagnosis from your prescriber. I thought so! Everyone wants his or her diagnosis to be correct. Why is that important?
(After a few responses, introduce todays topic.)
Topic Assessment Answer Key 1. A 2. A 3. B 4. A
Do you know how a diagnosis is made? (NOTE: If you use the jigsaw puzzle, you may want
to hand out the puzzle pieces and put the puzzle together on a table or on the floor, saying, Lets do something fun. After the puzzle is together, have people read the pieces out loud.)
Symptoms: Using Checklist
Symptoms: How Severe?
How Quickly Symptoms Clear Up
Age Symptoms First Appear
Rule Out Other Illness Causing Symptoms
All of the information we see here are pieces to the puzzle that your prescriber puts together to come up with a correct diagnosis. Did you know there were so many pieces to put together? Today we will talk about how a diagnosis is made.
Symptoms: How Long?
Symptoms: Triggers?
How Completely Symptoms Clear Up
Others in Family Have Psychiatric Illness?
Symptoms from Alcohol or Street Drugs?
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Review of Session 8: Reasons for Symptoms in Mental Illness

Main Learning Points of Session 8
What were the main learning points of Session 8? If you did not attend the last session, you may guess, and also write the answers as people say them: 1. One reason why people develop symptoms is because brain c y gets out of balance. 2. The three steps in brain chemical communication include: receive information, process information and make d s based on this information. 3. An ill brain may not be able to receive or p information correctly. 4. I f medicine is stopped, the brain chemistry gets back out of b e and symptoms usually return. s
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Topic Assessment

Mark one:
Directions:
Pre
Post
1. A factor to consider when making a diagnosis is:
A. Lab test results. B. Height and weight. C. Highest educational level earned. D. Occupation.
2. S ymptoms for a person diagnosed with schizophrenia or bipolar disorder may change over time.
A. True

B. False
3. The Diagnosis and Statistical Manual (DSM) gives guidelines to family members for making diagnoses.
A. True

B. False B. False
4. Effects of alcohol and illegal drugs can imitate the symptoms of mental illness.
A. True

5. I am confident I can help my prescriber get the information needed to diagnose me correctly.
Unsure
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Topic Assessment


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1. N ame 3 things a prescriber must consider when making a diagnosis. 2. I dentify 1 reason why it is important to regularly monitor symptoms and talk about them with your prescriber.
How Mental Illness Is Diagnosed
A prescriber has to consider several things when making a diagnosis.

1. Symptoms
Symptoms are the most important thing for making a correct diagnosis. You and your prescriber can identify and talk about all the symptoms you are having. A symptom checklist is a helpful tool in this discussion. Additional information about symptoms is also needed, such as: 1. How long the symptoms have been a problem? 2. How severe are the symptoms? 3. What triggers the symptoms, or makes them worse? 4. How well and how soon do these symptoms respond to medicine?
A single symptom does not lead to a diagnosis. It takes a several symptoms that are present for a significant length of time.
2. O ther Factors
ooking at all of the symptoms makes up only part of the diagnosis. Other L factors include:
A. R esults from a Physical Examination and Medical History
Other medical conditions that might be causing the symptoms must be ruled out.
B. Your Family History
hese illnesses sometimes seem to run in families. You may have a T relative who has schizophrenia or bipolar disorder. One known fact is that these illnesses are not caused by problems the family members may have in getting along with each other.
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(continued) C. Your Age When Your Symptoms First Appeared
Most people with schizophrenia start having symptoms when they are in their teens or in their early 20s. Bipolar disorder usually, but not always, appears in young adulthood. Your prescriber may use blood tests and brain scans to rule out other possible causes for your symptoms. Medical conditions that could result in the same symptoms need to be considered (for example, low thyroid has many of the same symptoms as depression).
D. Lab Tests
Tests to identify alcohol or street drugs are also used because these substances can cause symptoms that resemble schizophrenia and/or mania or can make symptoms of these illnesses worse. Your prescriber may need to check for the presence of drugs or alcohol as a possible cause for your symptoms.
Main Learning Point #1 An accurate diagnosis is made by considering many things.
Main Learning Point #2 Avoid alcohol and illegal drugs they make symptoms worse.
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(continued) Guidelines for Diagnosing
Prescribers use the Diagnostic and Statistical Manual (DSM) as their guide when making a psychiatric diagnosis. The DSM is routinely updated with new editions. The DSM describes all mental illnesses, with a list of symptoms and criteria for each diagnosis. Because Main Learning Point #3 prescribers use the DSM, it makes it much more likely that you would get The Diagnostic and Statistical the same diagnosis no matter where Manual (DSM) is the guideline for you receive treatment. making a diagnosis.
Changes in Diagnosis and Symptoms May Happen
A diagnosis is sometimes hard to make and can change over time if symptoms change. Your prescriber and you will want to talk about symptoms regularly in order to provide you with the best Main Learning Point #4 possible treatment.
Diagnosis and symptoms may change over time, so continue to monitor them.
My diagnosis is: Circle your answer: I (agree / disagree) that this diagnosis is correct.
I (have / have not) had another psychiatric diagnosis in the past. If yes, what was it?
Another person in my family (has been / has not been) diagnosed as having a mental illness. If so, who is it and what diagnosis did he or she receive?

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The main learning point of this session is:
1. 2. 3. 4.
Move ForwardChoose a Personal Practice Option
s ystem. I will ask talk with me about my diagnosis.
to read it and
3. A CT. I will take my symptom checklist (from sessions 2 and 3) with
me to my next appointment to share with my prescriber.
4. OTHER: Take an Extra Step Forward (optional) 5. WRITE. I am going to write down my thoughts about
my diagnosis and my symptoms. I may share it with or bring it to the next session.
Motivation to Practice. How will practicing help you?
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Symptoms: Using Checklist
Symptoms: How Long?
Symptoms: How Severe?
Symptoms: Triggers?
How Quickly Symptoms Clear Up
How Completely Symptoms Clear Up
Age Symptoms First Appear
Others in Family Have Psychiatric Illness?
Rule Out Other Illness Causing Symptoms
Symptoms from Alcohol or Street Drugs?
10
TeamSolutions Workbook 3 Understanding Your Illness Session 10 Mental Illness: Test Your Knowledge
Mental Illness: Test Your Knowledge Facilitator Notes

Main Learning Point from last session: Making the Diagnosis 1. An accurate diagnosis is made by considering many things. 2. Avoid alcohol and illegal drugsthey make symptoms worse. 3. The Diagnostic and Statistical Manual (DSM) is the guideline for making a diagnosis. 4. Diagnosis and symptoms may change over time, so continue to monitor them. Review Personal Practice Options from last session.
Tips for this Session Potential Problems for this Session
For this session, divide the group into two teams (one way to do this is to count off, with odd numbers on one team and even numbers on the other. If you can locate a karaoke machine, borrow it, but this will still be an enjoyable session without one.) Make this session into a quiz show where team members can consult with each other before answering into the microphone. Encourage them to follow answers by applause or groans. You or another participant can be Master of Ceremonies to give the points and say, Right! or, Sorry, thats incorrect. Award the winning team prizes. Give the second place team small consolation prizes.
One of the participants does not want to participate.

Possible Responses
1. E ncourage but dont require participation. 2. I f the participant wont budge, ask him or her to be the audience and to applaud when a team makes a correct response. 3. As long as he or she is not disruptive, keep him or her as part of the group.
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Have you ever been hurt by a lie? Raise you hands if you have. Unfortunately, people can be hurt by following old wives tales that seem to make sense but are wrong. Just to give you an example, an infection control nurse had to treat a man who was using Vaseline to lubricate condoms. He thought he was being safe, but the Vaseline made holes in his condom, and he caught a sexually transmitted disease. It is so much better and safer to know the facts, and not believe myths or rumors. Are there any myths about mental illness? I see some heads nodding. I am here to tell you that there sure are some myths out there. Today we will talk about some truths and some myths about mental illness. We are going to do it a fun way by playing a game to see if we can figure out whats truth and whats myth. Lets review the main points from our last session and answer the first six questions on the Topic Assessment before we start, just to see how familiar we are with this topic.
Topic Assessment Answer Key 1. B 2. B 3. B 4. B
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Review of Session 9: Making the Diagnosis

session, you may guess, and also write the answers as people say them: 1. An accurate d 2. Avoid a
s is made after considering many things. l and illegal drugsthey make symptoms worse.
3. The Diagnostic and Statistical Manual (DSM) is the guideline for making ad s. 4. D iagnosis and symptoms may c to monitor your symptoms. e over time, so continue
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Topic Assessment

Mark one:
Directions:
Pre
Post
1. Medicine alone is all I need to get better.
A. True

B. False B. False B. False
2. My mental illness was caused by family conflicts during my childhood.
A. True

3. S chizophrenia means split personality.
A. True

4. P eople with schizophrenia or bipolar disorder are always disabled and unable to live on their own.
A. True

B. False
5. I am confident I know the difference between myths and the truth about my illness.
Unsure
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Topic Assessment

95
Mental Illness: Test Your Knowledge

1. Identify 2 myths about mental illness. 2. Identify 2 important truths about mental illness.
The more you know about your illness, the more youll be able to help yourself. Lets read each statement below and decide if it is true or false.
1. True or False: Schizophrenia means split personality. 2. True or False: Schizophrenia and bipolar disorder are not real illnesses. 3. True or False: People with schizophrenia or bipolar disorder are always
How Much Do You Know About Your Illness?
sick and are unable to live on their own. symptoms can be managed.
4. True or False: With continued treatment with medicine, many of my 5. True or False: Medicine alone is all I need to get better. 6. True or False: I can stop my medicine when my symptoms get better
or go away.
7. True or False: My illness was caused by family problems when
I was a kid.
8. True or False: People who have schizophrenia or bipolar disorder are
not very smart.
9. True or False: It is important to tell my prescriber and treatment
team if I think my symptoms may be getting worse or if I notice new symptoms. each persons own pace.
10. True or False: Recovery is different for each person, and happens at
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(continued) Answers: 1. F alse. The term schizophrenia does not mean split personality. Schizo-
means split and -phrenia refers to the brain. In schizophrenia, the brain has difficulties processing information. Messages from one part of your brain may not be sent to another part of your brain. Or, messages may be sent, but not completely. When this happens, you may be confused because you are getting only pieces of information, not the entire message. conditions with symptoms and physical differences in the brain. People with either of these diagnoses need medical help to get better.
Main Learning Point #1 Schizophrenia and bipolar disorder are medical illnesses of the brain.
2. F alse. Schizophrenia and bipolar disorder are real illnesses. These are medical
3. F alse. With treatment, many people who have these diagnoses are able to go
back to school or get a job. However, it may take longer to complete a school or training program than it would if the illness were not present.
Main Learning Point #2 With treatment, there is hope for recovery.
4. True. Although there is no cure, many symptoms can be improved or managed
if you keep taking your medicine as prescribed. Medication does more than just help relieve symptoms. It helps alter chemicals in the brain where an imbalance may be responsible for symptoms.
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(continued) Answers: 5. F alse. While medicine is often a basic part of your treatment, medicine alone
is not enough to move you toward recovery. Most people with schizophrenia or bipolar disorder find that additional therapies, such as increasing coping skills and learning new job skills, help them in their journey of recovery. your medicine the right way every day, even when symptoms go away. If you miss doses or stop taking it, symptoms are likely to return in a few days or weeks. disorder are medical health problems just like asthma, diabetes, and high blood pressure. They are not caused by family problems but by physical causes such as a chemical imbalance.
6. F alse. It is very important to take
Main Learning Point #3 Medicine is a basic part of treatment, but other therapies are also important for recovery.
7. F alse. Schizophrenia and bipolar
Main Learning Point #4 To stop taking medicine as prescribed greatly increases the chance of a relapse.
8. F alse. Like other illnesses,
schizophrenia and bipolar disorder occur in all types of people, regardless of how smart they are. However, poor control of symptoms or multiple recurrence may not allow a person to function as well as he or she did before the illness began.
9. True. If new symptoms start or old symptoms get worse, your prescriber
may want to adjust your treatment. It is important to tell your prescriber and treatment team about any possible symptoms. her own pace.
10. True. Recovery is different for each person. And each person recovers at his or
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1. 2. 3. 4.
1. STUDY. I am going to reread my handout at least once. 2. S HARE. I will share my handout with someone in my support
system. I will ask take the quiz with me.
to read it and
3. WRITE. I am going to write down my thoughts about my illness and
recovery. I will talk to
about it.
4. OTHER: Take an Extra Step Forward (optional) 5. CREATE. I will make a poster to teach others about one of the
answers I did not know before today.
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11
TeamSolutions Workbook 3 Understanding Your Illness Session 11 Feelings
Feelings Facilitator Notes

Main Learning Points from last session: Mental Illness Test Your Knowledge 1. Schizophrenia and bipolar disorder are medical illnesses of the brain. 2. With treatment, there is hope for recovery. 3. Medicine is a basic part of treatment, but other therapies are also important for recovery. 4. To stop taking medicine as prescribed greatly increases the chance of a relapse. Review Personal Practice Options from last session.
Note
Pace is very important in presenting this session because it is on a topic that will generate discussion. If your class is for one hour, but some of the time is taken up by arrivals and return escort, plan how much time you have to spend covering each of the nine elements. 1. Review of last session. 2. Optional pre-Topic Assessment. 3. Topic introduction. 4. Four pages of new material. 5. Concluding Review and Personal Practice Goals. 6. Optional post-Topic Assessment.
Plan the allocation of time in advance, writing times in the margin of your facilitator materials. Dont say, Six minutes each, because some will routinely be faster. Others, such as page 4 of the Participant Handout in this session, may need more time to allow for thinking about what to write and for discussion. Plan a reasonable time frame in advance and follow it. Keep moving on to the next topic so that everything will get covered. Know that it is okay not to exhaust a topic before moving onit is much better to leave the participants still animated and engaged with the topic and continue addressing in their Personal Practice Options.
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Do your emotions matter in how you respond to something important? Let me give you an example of what Im talking about. Suppose your dearly loved grandmother dies of cancer. Before the funeral, people keep telling you that shes better off now, that she no longer has pain. Does knowing that keep you from grieving your loss? Do your feelings matter?
(Encourage responses. After several responses, summarize.)
Topic Assessment Answer Key 1. C 2. A 3. B 4. A
It sounds like you recognize that feelings are definitely important. It sounds like the person losing his or her grandmother has a loss, and there is a need to grieve the loss. Today we will talk about feelings you may have in response to having an illness.
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Review of Session 10: Mental Illness Test Your Knowledge

session, you may guess, and also write the answers as people say them: 1. B ipolar disorder and schizophrenia are medical i of the brain. 2. With t t, there is hope for recovery. 3. Medicine is a basic part of treatment, but other t important for recovery. 4. To stop taking medicine as p chance of a relapse.
s are also d greatly increases the
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Topic Assessment

Mark one:
Directions:
Pre
Post
1. A stage of adjustment to a serious illness is:
A. Taking medicine. B. Finding comfort with friends or pets. C. Anger. D. Asking for help. A. Loneliness, isolation, and broken relationships. B. Staying out of jails and hospitals. C. Family interference. D. The system of care. B. False
2. S ome of the biggest problems of having a mental illness are:
3. You have the choice to focus your energy toward getting better.
A. True

4. S ince you had no choice about having your illness, you should have no shame about it.
A. True

B. False
5. I am confident I understand my feelings about having a mental illness.
Unsure
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Topic Assessment

104
Feelings
1. I dentify 1 of the feelings you had when you were diagnosed with your illness. 2. Identify 2 stages of adjustment to having a serious illness.
Coping With a Difficult Illness When bad things happen to people, they often experience a series of emotions. This happens in serious medical conditions, for example, when someone is diagnosed with cancer or learns that they need heart surgery. These emotions are perfectly normal. You may have some of these emotions because of your illness.
Recognizing Your Feelings Having a mental illness can cause problems that are more upsetting than the
symptoms of the illness itself. Loneliness, isolation, and broken relationships are some of the biggest problems. People with a psychiatric disorder may be embarrassed about having a potentially disabling condition. Many find that their symptoms get worse when they are with other people, so they choose to be alone much of the time.
Main Learning Point #1 Being lonely, isolated, and having broken relationships are some of the biggest problems in mental illness.
Many people are disappointed or even angry if they cant do the things they used to do. Going back to school, getting a job, or having a steady relationship are more difficult when someone has symptoms of mental illness that are not controlled. An important step in managing your illness is to recognize the way you feel. Once you can recognize your feelings, you will be in a better position to learn to cope with them.
Describe the feelings you have had since you were diagnosed with mental illness.
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No Fault, No Shame, and No Blame

any people dont understand that a mental illness is a medical illness. They M wonder why it happened to them. They are frustrated and even ashamed that they cant keep up with the plans they had before they became ill. Sometimes, they blame themselves (or others) for the illness.
Recent research has shown that physical events happen to some people before birth that might make a person more likely to develop schizophrenia or bipolar disorder. These physical events are sometimes changes that happen because of genes and other physical traits that are passed down from relatives. When this happens, the physical events are called genetic, meaning they were inherited. It is important to remember that this means that people do not get these illnesses because of family problems. A person does not get schizophrenia or bipolar disorder because of anything that happened to him or her or because there were problems in the family.
Say Aloud Together: Just like people who get cancer, I had no choice in getting
my illness. And its not my fault that I have this illness.
You had no choice or control over your illness so it is not your fault. No one should blame you for the illness when you have no choice in having it. You should not be and there is nothing to be ashamed or embarrassed about. of a medical condition. This is a no choice, no fault, no shame, no blame medical condition. situation. However, you do have it is not a no responsibility situation. What you are responsible for is your recovery. This is wonderful for you! What this means is that you have more control over your future than you may realize. You are the leader of your own life, and you can make choices to help you live the best life that you can.
Main Learning Point #2 You are not to blame for having an illness, but you are responsible for your recovery and being in control of your life.
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Rating Your Feelings:

isted below are some of the painful feelings people have described as they have L tried to adjust to having a mental illness. How are you feeling at this time?
Instructions: Rate your feelings on a scale of 1 (doesnt bother you) to 5 (bothers you the most). Embarrassed Guilty Angry Feel like its my fault Afraid Ashamed Lonely Doesnt bother me 1 1 1 1 1 1 1 2 2 2 2 2 2 2 No feelings about it 3 3 3 3 3 3 3 4 4 4 4 4 4 4 Bothers me a lot 5 5 5 5 5 5 5
Think about the following questions. You can write your thoughts after each question.
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These feelings bother me the most:
How I usually handle my feelings:
These are some of the ways I react to my feelings:
Reacting to Your Feelings

People who have a serious illness tend to go through a series of emotional reactions. At first, you may not believe you have an illness. How can this happen to me? Its not possible. It is common to doubt your diagnosis at first. You may even deny that you have an illness and miss an opportunity to get better by not starting treatment early. When your symptoms do not get better, you eventually realize that you really do have an illness that has changed your life. Some people feel victimized by their diagnoses and may react by giving up. I have this illness and theres nothing I can do about it. They feel defeated and believe they cant do very much to help themselves. Many people are discouraged or even angry. They look for a reason why this has happened to them. They may blame themselves or others. These are all normal reactions that most people facing serious illnesses seem to go through. But being trapped by these emotions can make progress difficult. The negative emotions may occupy your thoughts and can use up a lot of energy. A good way to get better is to start working on ways to manage the illness. Use your energy to focus on how you can best recover. have experienced:
Denial
Main Learning Point #3 The stages of adjustment to serious illness are denial, anger, depression, grief, and acceptance.
Instructions: Circle any of the stages of adjustment to serious illness that you Anger Depression Grief Acceptance
Main Learning Point #4 You can be bitter or get betterthe choice is yours. Use your energy to focus on getting better.
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1. 2. 3. 4.
s ystem. I will ask and talk with me about my feelings.
to read it
3. A CT. I will ask my treatment team to make an appointment for me to
talk about my feelings with a therapist.
4. OTHER: Take an Extra Step Forward (optional) 5. WRITE. I am going to write about my emotions at each stage of my
journey through this illness: Denial, Anger, Depression, Grief, and Acceptance. I will think about what Ive learned from my experiences. I may bring it to the next session.
109
12
TeamSolutions Workbook 3 Understanding Your Illness Session 12 Reducing Risk of Relapse
Reducing Risk of Relapse Facilitator Notes

Main Learning Points from last session: Feelings 1. B eing lonely, isolated, and having broken relationships are some of the biggest problems in mental illness. 2. You are not to blame for having an illness, but you are responsible for getting better and being in control of your life. 3. The stages of adjustment to serious illness are denial, anger, depression, grief, and acceptance. 4. You can be bitter or get betterthe choice is yours. Use your energy to focus on getting better. Review Personal Practice Options from last session.
Remember 2. Consider using the Fortune Cookie exercise
You can refer to the two-sided laminated Facilitators Delivery Checklist when using Team Solutions materials as a reminder of important facilitator tips.
Tips for this Session 1. This is a session that benefits from having a co-
facilitator who has gone through a relapse and who is committed to routinely monitoring his or her symptoms. If such a person is not available, you may want to show a small segment of a video or DVD that features someone who has a mental illness talking about how he or she reduces or manages the illness. A dramatic reading from a selected portion of a published first-person account will also make this class more relevant to the participants if a live role model isnt available.
(we have included in the back of this session). You may want to cut the two lists into individual items and have participants draw one to read. Reading lists aloud is a good technique, as it engages participants in the session. You could also ask participants to discuss each list item, processing the item through their own experiences.
110

Is there anyone here who wants to get sick again and have to be hospitalized, raise your hand. I am glad no one raised a hand. You choose recoveryyou want to be well and stay well! Thats wonderful. One more question. Raise your hand if you have a plan in place that will help you prevent a relapse.
(If no one raises a hand, acknowledge that.)
Topic Assessment Answer Key 1. B 2. A 3. A 4. A
Raise you hand if you want to have a plan to stay well and to reduce the chances of relapse or getting sick again.
(Encourage and acknowledge responses. If someone indicates they have a plan, then say,)
Good! I am counting on you to participate in todays session because our topic is about preventing a relapse. During this session, you will each develop a plan to reduce the risk of a relapse.
111
Review of Session 11: Feelings

session, you may guess, and also write the answers as people say them: 1. B eing lonely, isolated, and having broken r some of the biggest problems in mental illness. 2. You are not to blame for having an illness, but you are r for getting better and being in control of your life. 3. The stages of adjustment to serious illness are d depression, grief, and acceptance. 4. You can be bitter or get b your energy to focus on getting better.
s are e l, anger,
rthe choice is yours. Use
112
Topic Assessment

Mark one:
Directions:
Pre
Post
1. S etting up a buddy system to check in with a close friend to let him or her know how you are doing:
A. Will prevent a relapse. B. Will help you reduce the risk of a relapse. C. Has no effect on whether you get sick again. D. May trigger a relapse. B. False B. False
2. O ne of the four safeguards to use to prevent a relapse is managing stress.
A. True

3. A symptom that doesnt go away is a residual symptom.
A. True

4. I f a residual symptom gets worse, it is a warning sign that you may be relapsing.
A. True

B. False
5. I am confident I can recognize and reduce my risk of a relapse.
Unsure

113
Topic Assessment

114
Reducing the Risk of Relapse

1.Identify 2 of your residual symptoms. 2. I dentify 3 early warning symptoms you are likely to have if you are in danger of relapse.
The Danger of a Relapse Many people begin to feel better after a few weeks of treatment. But even if you are getting better, a relapse (return of symptoms) can happen. People who have a relapse may have to go to the hospital for treatment. However, there are ways to reduce the risk of a relapse and avoid having to go to the hospital: 1. Be aware of your symptoms. 2. Keep track of your symptoms daily. 3. H ave a buddy system. Let someone close to you know how you are doing, especially if youre not feeling well. 4. I f your symptoms get worse, or new ones appear, call your prescriber or treatment team right away. 5. D o not make several changes in your life at one timetoo much stress can cause you to get sick again. 6. Take your medicine every day. Missing doses or stopping medicine can upset your bodys chemical balance and cause a relapse. Talk to your prescriber or treatment team nurse about what to do if you miss a dose. 7. S tay away from alcohol and street drugs. They can trigger a relapse by upsetting the chemical balance in your brain and interacting with medicine.
Main Learning Point #1 Monitor symptoms to reduce the risk of a relapse.
115
Keeping Track of Symptoms

Even when people with psychiatric conditions are better, they may have some
symptoms that do not completely go away. These symptoms are called residual symptoms. Some residual symptoms are very bothersome, while others may just be annoying. They may not get better or worse for a long time and they seem to stay the same.
Go back and look at the symptoms you listed in Session 7s section Which symptoms never seem to go away? These are your residual symptoms.
Instructions: List those and any other residual symptoms you think you may have:
If these symptoms bother you, discuss them with your prescriber or a treatment team member. There may be ways to manage some of them. The goal is always to keep working to reduce how many symptoms you have and how much they bother you.
Main Learning Point #2 Symptoms that dont go away are residual symptoms.
116
Early Warning Symptoms

ew symptoms that appear suddenly or residual symptoms that get worse, warn N that a relapse may be near. Most people describe early warning symptoms or signs as, Changes you notice when you first start to relapse. Some of these changes may include: 1. Having trouble sleeping at night. 2. Having trouble focusingwatching a TV show might be more tiring than usual or you might have trouble focusing on things. 3. Changes in your energy leveleither speeding up or slowing down. 4. Forgetting things more often than usual. 5. Being nervous or worried all the time. 6. Hearing voices or seeing images that no one else hears or sees (hallucinations). 7. Being afraid of people, places, or things that you used to enjoy. 8. Having thoughts that people are talking about you, laughing at you, or sending messages about you. 9. Withdrawing from others or staying in your room a lot. 10. Suddenly having the impulse to spend money or start new projects.
Main Learning Point #3 Early warning signs are changes that let you know you may be relapsing.
117
Early Warning Symptoms

(continued) If you are not sure what your early warning signs are, talk to your prescriber,
treatment team, family members, or friends who know you well. If you have ever had a relapse, think about the signs and symptoms you had when you first started to get sick again.
Describe personal early warning signs on the lines below:
Watching for early warning signs is the best way to catch a relapse before you get too sick and have to be hospitalized. One way to keep track of early warning signs is to write them on a calendar on the day they happened. Also, its good to write down if the symptom has gotten worse since the last time you noted it. That way, you can show your prescriber or treatment team when the symptoms first started bothering you and if they have gotten worse over time. There are also symptom tracker sheets available to monitor symptoms. We will learn how to use these in our next session.
Watching for Early Warning Signs Can Help Prevent Relapse
Check your symptoms at the same time daily, as part of your routine. As you continue to improve, you and your treatment team may decide that you only need to do this every week or once a month. Call your prescriber or treatment team immediately if you notice early warning signs.
Main Learning Point #4 Call your prescriber or someone on your treatment team immediately if you notice early warning signs.
118

1. 2. 3. 4.
s ystem. I will ask to read it and talk with me about my personal early warning signs.
3. L IST and DISCUSS. I will continue to recall my residual symptoms
and early warning symptoms, and will add them to the list. I will talk to to see what residual symptoms he or she may have noticed.
4. OTHER: Take an Extra Step Forward (optional) 5. S TUDY. I will read the firsthand stories of other people recovering
from a mental illness. I will pay attention to any common themes of how they manage to stay well.
Motivation to Practice. How will practicing help you?
119
Ways to reduce the risk of a relapse:

1. Be aware of your symptoms. 2. Keep track of your symptoms daily. 3. H ave a buddy system. Let someone close to you know how you are doing, especially if youre not feeling well. 4. I f your symptoms get worse, or new ones appear, call your prescriber or treatment team right away. 5. D o not make several changes in your life at one timetoo much stress can lead to a relapse. 6. Take your medicine every day. Missing doses or stopping medicine can upset
your bodys chemical balance and cause a relapse. Talk to your prescriber or treatment team nurse about what to do if you miss a dose.
7. S tay away from alcohol and street drugs. They can trigger a relapse by
upsetting the chemical balance in your brain and interacting with medicine.
120
Early Warning Signs:

1. Having trouble sleeping at night. 2. Having trouble focusingwatching a TV show might be more tiring than usual, or you might have trouble concentrating. 3. Changes in your energy leveleither speeding up or slowing down. 4. Forgetting things more often than usual. 5. Being nervous or worried all the time. 6. Hearing voices or seeing images that no one else hears or sees (hallucinations). 7. Being afraid of people, places, or things that you used to enjoy. 8. Having thoughts that people are talking about you, laughing at you, or sending messages about you. 9. Withdrawing from others or staying in your room a lot. 10. Suddenly having the impulse to spend money or start new projects.
121
13
TeamSolutions Workbook 3 Understanding Your Illness Session 13 Symptom Monitoring Tools
Symptom Monitoring Tools Facilitator Notes

Main Learning Points from last session: Reducing Risk of A Relapse 1. Monitor symptoms to reduce the risk of a relapse. 2. Symptoms that dont go away are residual symptoms. 3. Early warning signs are changes that let you know you may be having a relapse. 4. C all your prescriber or someone on your treatment team immediately if you notice early warning signs. Review Personal Practice Options from last session.
Materials Needed to Accompany Participant Handout
General Tip
Symptom Tracker.
For most group sessions, breaking into small groups of three or four to be led by you and co-facilitators works best.
Examples are a great way to explain difficult concepts. When using examples, be sure to make them relevant to the everyday lives of the participants in your groupin their treatment settings and also in the communities in which they live.
122

Dont you wish mental illness could be as easy to check as a fever isjust use a thermometer!
( Wait for responses. Its possible that one of the participants already uses a tool to monitor his or symptoms. You might hear someone say something like, I use a symptom tracker or diary. Acknowledge any responses. If no participant introduces symptom monitoring tools, do so yourself, using something similar to the following statement.)
Lets review the main points from our last session before we start.
Topic Assessment Answer Key There is no pre- or post-Topic Assessment for this session although there are opinion questions and scales.
Today we will talk about symptom monitoring tools. Do you think this might be helpful to you?
123
Review of Session 12: Reducing Risk of A Relapse

session, you may guess, and also write the answers as people say them: 1. M 3. E arly w be having a relapse.
r symptoms to reduce the risk of a relapse. l symptoms. g signs are changes that let you know you may t team
2. Symptoms that dont go away are r
4. C all your prescriber or someone on your t immediately if you notice early warning signs.
124
Topic Assessment

Mark one:
Pre
Post
This session does not have a pre- or post-Topic Assessment test. It is a session for demonstrating symptom monitoring tools.
1. I am confident I know how to use a symptom tracker to help monitor my symptoms.
Unsure


125
Symptom Monitoring Tools

1. Identify 3 benefits of symptom monitoring. 2. Practice how to use a symptom tracker.
Monitoring Symptoms Today you will learn how to use two tools that are available to monitor psychiatric symptoms.
The Basics of Monitoring Symptoms:
1. I will check my symptoms every day, at the same time each day, as part of my routine. 2. W hen I see symptoms increasing or notice early warning symptoms, I will call my prescriber, someone on my treatment team, or a family member and tell them. If I am using a buddy system, I will also tell my buddy. 3. I will take my symptom monitoring tool with me when I have an appointment with my prescriber or my treatment team so we can look at it together. 4. I will save my completed symptom monitoring forms. This lets me and my treatment team look for illness cycles and look to see if there are patterns when I have symptoms (For example: winter depression).
Main Learning Point #1 A symptom monitoring tool can be used daily as part of your routine.
126
Advantages of Monitoring Symptoms

Many people in recovery say that using a symptom monitoring tool is one of
the most valuable ways they have found to take charge of their illness. This type of tool can help them as they work to stay well. Here are some things people in recovery have said:
Person 1: When there is a medication change, symptom monitoring lets me know if my new medicine or my new dosage is working. Person 2: I got better very slowly. Because I was monitoring my symptoms, I was able to actually see myself make progress over time. Person 3: Symptom monitoring picks up any early signs of a relapse. It lets me get medical attention immediately and have the best chance to nip a relapse in the bud. Main Learning Point #2 Symptom monitoring can help you learn if your medicine is working.
For the rest of this session, lets look at a symptom tracker, which is a tool you may want to use.
127

1. 2.
s ystem. I will ask to read it and talk with me about how best to develop a routine for using a symptom tracker.
3. U SE. I will start using the symptom tracker
(when). I will share it at our next session.
4. OTHER:
128
Symptom Tracker
Symptom Severity: No symptom = 0 Mild = 1 Moderate = 2
Severe = 3
Symptom 3 4 5 6 7 8
Day 1 2
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Took medication as prescribed
Yes
No
Was active today
Yes
No
Used drugs or alcohol
Yes
No
Hours I slept last night (please write down any problems you have with your sleep)
Comments
Week 1
Weight: Week 2
Weight: Blood Pressure:
Week3
Week 4
BMI:
Waist Circumference:
Blood Pressure:
Identify top three or four symptoms that you will monitor daily until your next meeting with your clinician. Please take a baseline weight, blood pressure, waist circumference, and BMI at the beginning of the month and then monitor weight bi-weekly. Please bring this sheet back with you for your first follow-up meeting so you can talk about it with your treatment team members.
Possible symptoms for daily monitoring by client: These are only suggestions. There may be other symptoms that you want to monitor.
I hear voices or noises and I dont know where they come from. I think people are watrching me or following me.
I see things no one else seems to see. Things sound or smell wrong. I feel afraid.
I dont want to do anything. My mood is extremely happy or elevated. I think about hurting myself. I get easily irritated or annoyed. I feel tired all the time. I dont need to sleep. My sex drive is very low, lower than normal.
I feel hopeless. I feel nervous or anxious. I feel sad or unhappy. My thoughts move so fast I cannot keep up with them. People tell me I talk too fast or too much. My sex drive is very high, higher than normal.
I cant understand what people are saying to me. I cant keep my mind on anything. I dont know how to plan for things.
I have trouble remembering things. I have trouble learning things.
I cant sleep. I dont enjoy anything. I dont brush my teeth.
I dont shower. I dont have anything to say to people.
Symptom Tracker
Symptom Severity: No symptom = 0 Mild = 1 Moderate = 2 Severe = 3
Symptom 3 4 5 6 7 8
Day 1 2
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
a.m.
p.m.
a.m.
p.m.
a.m.
p.m.
Took medication as prescribed
Yes
No
Was active today
Yes
No
Used drugs or alcohol
Yes
No
Hours I slept last night (please write down any problems you have with your sleep)
Comments
Week 1
Weight: Week 2
Week3
Week 4
BMI:
Waist Circumference:
Blood Pressure:
14
TeamSolutions Workbook 3 Understanding Your Illness Session 14 What to Expect
What to Expect Facilitator Notes

Main Learning Points from last session: Symptom Monitoring Tools 1. A symptom monitoring tool can be used daily as part of your routine. 2. Symptom monitoring can help you learn if your medicine is working. Review Personal Practice Options from last session.
Note 2. The relationship between you and the participants
Tips for this Session 1. Make it clear in todays session, the last session
of this workbook, that participants have the opportunity to continue to work on and maintain recovery as they leave this group. They have learned good information, and they have achieved an accomplishment by completing this workbook. Todays one-page session is a summary of the workbook. Cover the summary session in the usual manner, then move into a significant completion event. Ask participants if they would like to say a few words when they receive their certificates of achievement. You may want to ask a special guest to say a few words about the participants achievement. Be creative and make the session unique.
has become important to everyone over the past weeks. End this workbook with good closure and good memories. If possible, give each graduate a graduation gift from you that is something meaningful and encouraging. At the end of this session is a bookmark that you could offer as a small gift if you want.
132
Facilitator Notes
(continued)
General Note
If you are interested in an outcomes measurement for this workbook, you may want to consider using the Short-Form-12 Health Survey ( John E. Ware, Jr., 1994, revised 1998), the Quality of Life Index by Dr. W. O. Spitzer, 1980, or the COOP Chart for Primary Care Practices (Eugene C. Nelson, 1987). The Short-Form-12 Health Survey ( John E. Ware, Jr., 1994, revised 1998) is an abbreviated version of the Short-Form-36 Health Survey. This survey has 7 questions (using Likert scales from 1-5) regarding the persons views about their own health in the last four weeks. It addresses general health and how health affects the persons physical activities and daily activities. It also addresses emotional issues and feelings and whether either physical or emotional health has interfered with social activities. The Short-Form correlates extremely well with the longer, 36 health survey and offers a good way to gauge physical and emotional health. Cultural differences can create potential challenges in regards to the interpretation of questions and, ultimately, answers. A heightened awareness by clinicians can increase the reliability of results. The Quality of Life Index, by Dr. W. O. Spitzer, has both a 5 topic self-rating scale and a 5 topic clinician
scale, which allows clinicians to compare their impressions to a clients perception. The dimensions measured Activity, Daily Living, Health, Support, and Outlook. The clinician version measures from 0 - 2 with 0 indicating lower quality and 2 indicating higher quality of life. This instrument has been used in many studies and is considered a reliable and valid tool. The COOP scales (The Dartmouth/Northern New England Primary Care Cooperative Information Project) was developed to create a system to measure health status in physicians offices. One of the basic tenets of the charts is that the functioning of the person as a whole is more important than that of separate organ systems. You may have seen some of the graphic charts (e.g., the face charts to measure feelings). Other graphic charts measure daily activity levels, social activities, physical fitness, change in health, overall health, social support, and quality of life. These charts are widely used in studies and are found to have good reliability and high validity. They are rated as useful by high numbers of office staff and clients. The editors believe these scales fit the content of this workbook well. These and other health measures can be found in McDowell, (2006).

If you could do something that would help a friend, would you do it? We will assume that what you would need to do would not be too difficult.
(Encourage responses.)
Today we will talk about what you can do to keep working on your recoverylifestyle choices that can help you stay on your journey of recovery. Lets review the main points from our last session before we start.
Topic Assessment Answer Key There is no pre- or post-Topic Assessment for this session. T topic introduction R relevance to participant I identify objectives M materials for session M motivate to use
If you would do something good to help a friend, would you do something good for yourself? Do you treat yourself as good as you treat your friends?
(Pause)
Lets think about that! If you arent good to yourself, maybe its time you started.
133
Review of Session 13: Symptom Monitoring Tools

session, you may guess, and also write the answers as people say them: 1. A symptom m your routine.
g tool can be used daily as part of e
2. S ymptom monitoring can help you learn if your m is working.
134
Topic Assessment

Mark one:
Pre
Post
There is not a pre or post-Topic Assessment for this session. The emphasis today is review and the completion.
1. I am confident I know what to expect in the future and managing my illness.

Strongly Disagree Disagree Neither Agree Agree Strongly Nor Disagree Agree Unsure


135
Symptom Monitoring Tools

1. Identify 4 lifestyle choices to help you stay in recovery.
What Can I Expect in the Future? Most people want to know how their illness will affect their lives. Will I ever get back to normal? is a question they often ask their treatment team. No one can predict what will happen to you. Schizophrenia and bipolar disorder are ongoing mental illnesses that get better but cannot be cured. Most people who have schizophrenia or bipolar disorder will have to work at controlling their illness. It is very much the same way that people who have diabetes, asthma, or high blood pressure need to work at controlling their illnesses. Frequent relapses can make your illness worse and make it harder for you to stay well. It is best for you to do everything you can to prevent a relapse. These six steps will help you: 1. Take your medicine regularly. 2. H ave regular appointments to see your prescriber, who is your partner in treatment. 3. Keep track of your symptoms. 4. I f symptoms get worse, tell your prescriber or treatment team immediately.
Main Learning Point #2 What I do in my life affects my recovery and how well I stay. Main Learning Point #1 I am committed to managing my illness and getting on with my life.
5. L ive a balanced life that has enough sleep and rest, enough exercise, healthy eating, social networks, friends, fun, and good stress management. 6. Dont use alcohol or illegal drugs.
As you continue with your treatment, your focus is recovery. Schizophrenia and bipolar disorder are medical illnesses that can be treated. There is no cure for these illnesses at this time. But for most people, symptoms can be managed. And you can get back to being healthya new level of healthy.
136

1. 2.
Its important to practice new knowledge and skills. Although this is the last session in this workbook, you may still want to practice this important subject. Please choose one option from the list below:
s ystem. I will ask to read it and talk with me about six things to do to prevent a relapse.
3. L IST. I will write the list of six things to do to prevent a relapse and
post this list on my refrigerator, inside my room, or somewhere else where I will see it every day.
4. OTHER: Take an Extra Step Forward (optional) 5. R EMEMBER and WRITE. I will write my story about my past
relapses, and how they got me off track and made it harder for me to reach my goals. I will write what I learned and I will share that information with a member of my treatment team.
elebrate your accomplishments by doing something safe and fun today C with someone you care about.
137
He lost his job in 1832. He was defeated for the legislature in 1832. He failed in business in 1833. He was elected to the legislature in 1834, but he lost his fiance to death in 1835. He had a break-down in 1836. There were no hospitals then and no treatment. He was defeated for speaker in 1836. Then he was defeated for his bid for Congress in 1843. He was elected to Congress in 1846, but then lost the nomination bid for Congress in 1848. He was rejected for land officer in 1849. He was defeated for Senate in 1854. He lost the nomination for the Vice-Presidency in 1856, and was again defeated for the Senate in 1858. But in 1860, he was elected President of the United States. They did not call him mentally ill, they called him Mr. President. Abraham Lincolns life illustrates persistence and faith it is the story of a person whose sense of purpose helped him to overcome many obstacles in his way.
Cited by Edward G. Francell, Jr. at www.mentalhealth.com
Team Solutions
Certificate of Achievement
is presented to
for completion of
Understanding Your Illness
Facilitator
Date
References

ellenir, K. (2005). Mental Health Disorders Sourcebook (3rd B ed.). Detroit: Omnigraphics. Bipolar disorder guide. Retrieved November 11, 2007, from www.webmd.com/bipolar-disorder/guide/default.htm Torrey, E F & Knable, M. (2002).Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families and Providers. New York: Basic Books. orrey, F. (2001). Surviving Schizophrenia: A Manual for T Families, Consumers, and Providers (4th ed.). New York: HarperCollins Publishers, Inc. alsh, M.(1985). Schizophrenia: Straight Talk for Family and W Friends. New York: William Morrow & Co, Inc. Waltz, M.(2002). Adult Bipolar Disorders: Understanding Your Diagnosis and Getting Help. Sebastopol, CA: OReilly & Associates. einberger, D R. (1995) Research on Schizophrenia and W Schizoaffective Disorder, National Alliance for the Mentally Ill 15th Annual Convention. Washington, D.C. Weinberger, D R., (1986).The Pathogenesis of Schizophrenia: A Neurodevelopmental Theory. H.A. Nasrallah and D.R. Weinberger (Eds.), In The Neurology of Schizophrenia, (pp. 397 406). Amsterdam: Elsiever.
Burgess,W. (2006) The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers. New York: Penguin Group. Hyde, A. (1982). Living with Schizophrenia. Chicago: Contemporary Books. Long, P. Internet Mental Health. Retrieved 11/11/07, from http://www.mentalhealth.com. McDowell, (2006). Measuring health: A guide to rating scales and questionnaires, 3rd Edition. Oxford, NY; Oxford University Press. Miklowitz, D. (2002). The Bipolar Disorder Survival Guide: What You and Your Family Need to Know. New York: Guilford Press. Miller, R & Mason, S. (2002). Diagnosis Schizophrenia: A Comprehensive Resource for Patients, Families, and Helping Professionals. New York: Columbia University Press. Mondimore, F M. (1999). Bipolar Disorder: A Guide for Patients and Families. Baltimore: Johns Hopkins Press. Noll, R. (2000). The Encyclopedia of Schizophrenia and Other Psychotic Disorders (2nd ed.). New York: Facts on File, Inc. chizophrenia guide. Retrieved November 11, 2007, from S www.webmd.com/schizophrenia/guide/default.htm
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N eu r o science te a m P a r tne r s

Understanding Your Illness

TeamSolutions Workbook 3 Understanding Your Illness

TeamSolutions Workbook 3 Understanding Your Illness

Session 1 Session 2 Session 3

Session 4 Acceptance Session 5 Session 6 Session 7

Session 8 Reasons for Symptoms of

Making the Diagnosis

100 110 122 132

Family Friendly Session good for use in family sessions or groups

TeamSolutions Workbook 3 Understanding Your Illness Session 1 Identifying the Changes

Identifying the Changes Facilitator Notes

Potential Problem for this Session

2. Reinforce that they will be able to learn about their

TeamSolutions Workbook 3 Understanding Your Illness Session 1 Identifying the Changes

Suggestion for Topic Introduction and Relevance to Participants

TeamSolutions Workbook 3 Understanding Your Illness Session 1 Identifying the Changes

Your Score: + out of 4

2. P  eople who see the world differently:

3. Everyone perceives things a little differently.

TeamSolutions Workbook 3 Understanding Your Illness Session 1 Identifying the Changes

5. I feel I am confident that I understand what has happened to me with my illness.

Strongly Disagree Disagree

Neither Agree Agree Strongly Nor Disagree Agree

6. This information is important for me to know.

Strongly Disagree Disagree

Neither Agree Agree Strongly Nor Disagree Agree

Strongly Disagree Disagree

Neither Agree Agree Strongly Nor Disagree Agree

8. What I liked about this session:

9. How this session could have been better for me:

TeamSolutions Workbook 3 Understanding Your Illness Session 1 Identifying the Changes

Identifying the Changes

What in the World!

TeamSolutions Workbook 3 Understanding Your Illness Session 1 Identifying the Changes

Use Your Head! (Your Brain, Actually.)

Main Learning Point #2 No brain works perfectly.

TeamSolutions Workbook 3 Understanding Your Illness Session 1 Identifying the Changes

No Brain Works Perfectly

TeamSolutions Workbook 3 Understanding Your Illness Session 1 Identifying the Changes

No Brain Works Perfectly

I was at  I remember I felt I thought

Differences can make life more interesting!

When Different Perceptions Get Uncomfortable

TeamSolutions Workbook 3 Understanding Your Illness Session 1 Identifying the Changes

Review & Moving Forward

2. S  HARE. I will share my handout with someone in my support

3. I NSIGHT. I will talk to

me. I will figure out what I might do to fix it.

TeamSolutions Workbook 3 Understanding Your Illness Session 2 Understanding the Changes

Understanding the Changes Facilitator Notes

It is important to acknowledge and discuss participants successes, progress, and challenges.

TeamSolutions Workbook 3 Understanding Your Illness Session 2 Understanding the Changes

Suggestion for Topic Introduction and Relevance to Participants

TeamSolutions Workbook 3 Understanding Your Illness Session 2 Understanding the Changes

Review of Session 1: Identifying Changes

d differently. t can help us if we are having

Personal Practice Option Review:

2. No. What got in the way of completing your practice?

TeamSolutions Workbook 3 Understanding Your Illness Session 2 Understanding the Changes

2. Reinforce that they will be able to learn about their

2. P eople who see the world differently:

I was at I remember I felt I thought

2. S HARE. I will share my handout with someone in my support

3. I NSIGHT. I will talk to

Changes that Challenge.

Self-Evaluation of Barriers to Seeking Treatment.

2. S HARE. I will share my handout with someone in my support

3. G AIN INSIGHT. I will ask 4. OTHER:

2. H aving a mental illness means:

3. D ISCUSS. I will talk to

2. Total Acceptance of a disorder is when: