Unit 2: Mental Health Reflection

http://www.visionsteen.com/2014/06/find-the-top-mental-health-facility-for-teens-in-southern-california/

"Approximately 20% of adolescents have a diagnosable mental health disorder" (Schwarz, NCCP) and these symptoms usually appear during adolescence. Depression, anxiety, schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder, eating disorders and other mental illnesses are commonly found in adolescents. If these illnesses are left untreated, they can have lasting effects or even harm the person who has them. That's why N.E.W. School took 8 weeks to learn about mental illnesses and their physical effects, being able to recognize the symptoms, even in fictional characters and raising awareness for these illnesses through creative mediums. 

One of the earlier and smaller projects we did in N.E.W. school was labeling a cauliflower as if it were a brain, looking at the physiology of the brain. We used a website for reference so that we could cut up the brain to symbolize the right and left sides of the brain, then label the parts inside to represent sections of the brain. An example would be the brain stem is the cauliflower stem because it is they resemble each other. Then on a separate document, we made a key with a paragraph of what each of the parts does and how it affects neurotransmitters, hormones, and overall mental health. 

After we finished labeling the cauliflower, we moved onto part 2. Part 2 was when the teacher physically altered the brain, with our group we had a tumor in the back of the brain. We researched it and found it to be medulloblastoma, a tumor found in the cerebellum. It is usually found in young children.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2003000200008

When we finished researching the symptoms of medulloblastoma, we had to write a narrative from the perspective of the patient, the parent or the doctor dealing with this disease. I decided to write it from the point of view of the patient, taking account nausea and trauma they would be dealing with. The story can be found on this blog or with this link. 

A larger project our class worked on was the Romeo and Juliet Psychoanalysis. To lead up to the essay we acted out the play in class. This helped us better understand the emotions and interactions between characters before analyzing their behavior to write our essay. 

Romeo and Juliet acting

After finishing the play, we each got to pick a character and pick what mental disorder they most likely have by using the book and online resources as evidence. I picked Mercutio and diagnosed him with intermittent explosive disorder (IDE) because of his sudden outbursts. This essay helped me better understand how to find scientific resources to back up analyzed claims and recognize the symptoms and signs of mental disorders. 

Storyboards for the Mental Health Awareness Project

The last project I will talk about is the culminating mental health unit project where we had to pick a creative medium to raise awareness for a mental health disorder of our choice. I chose depression and rose awareness for it by creating an animatic (unfinished animation) of a day in a person with undiagnosed depression. 

 This project helped me better understand how it feels to have a mental disorder, how to recognize it in other people and be able to raise awareness for mental health disorders in general. I called my animatic Silent Sickness, because depression is not something easily seen by the eye. This project also helped me learn how to use the tools at my disposal to make something greater, since I had to use an animation program, online resources, a voice recording program, and an editing software. Overall, this project culminates science, english and technology because it used narrative techniques, scientific thought and technology knowledge. 

Showing the animatic at the Exposition

To restate all the above points, each of these projects helped me better understand the concept of mental health and learn how to recognize and raise awareness for mental health disorders. I used Science to better learn about the physical and neurological implications, Technology to research and educate about these disorders, and English to be able to communicate my points effectively, whether through narrative or analytical techniques. This unit helped me understand the emotional and mental points of view of people with mental health disorders, who are all around us. 

Forensics and DNA Testing

Forensics and DNA testing
(Also seen under Science Page)

There was a murder, but no one knows who it was. The suspects are Capulet, Lady Capulet, Paris, Benvolio, Friar Lawrence and others at the scene of the murder. It was the murder of Romeo and Juliet.

To learn which one of the suspects did it, the students at N.E.W. school will have to learn how to use gel electrolysis to separate the macro molecules in DNA so that the matching DNA can be found.

The first step in this process was creating the chamber to hold the DNA in. For this project, the chamber was a plastic box. Two wires were measured out, and in the next step, they will each be electrically charged, one positive and one negative. Since DNA macro molecules are negatively charged, they will be attracted to the positive charge.

Then the students had to cut out rivets in a piece of cardboard for each DNA sample to go in. After that, the chamber is filled with agarose for the DNA to go in. Each sample would be compared to the one of the murderer and depending on the mass, they will go farther down the agarose. The one that is right at the same spot as the murderer probably belongs to the murderer.

To extract the DNA, first, the suspects had to chew the side of the mouth. Then they had to grab a cup from a cell, remembering where they got it from. Then they had to swish the salt water in their mouth for 30 seconds then spit it back in their cup. Each of the suspects got a number. Then they repeated the process so there could be two samples.

The suspects were chewing at the epithelial tissue, taking off cells and spitting them out. Inside the cells are nuclei, the brains of the cell. Inside the round organelle is a DNA strand of molecules in the shape of a double-helix. To get to the DNA, the cell membrane and nucleus need to be broken with a chemical breakdown. The students at NEW have to do this, dying it so it can be seen under a microscope. The enzyme protease (ends in -ase, like most all enzymes) is what is usually used to break open the nucleus and membrane. Since protease isn't easily available, the students will be using laundry detergent mixed with water.

The groups each had to make a set amount of mild detergent, a 5 mL to 15 mL ratio. Then they extracted DNA from the cups, and the more people they wanted to test, the more detergent and DNA they would need. To extract the DNA, they used a pipette, and took out 5 mL to put into a test tube, then added 5 mL of detergent. After a few minutes of swishing the solution, 5 mL of ethanol are added to the top.

Restrictive enzymes cut the DNA into smaller slices, and in different parts depending on the DNA. Some will be shorter and others are longer so they will traverse the gel faster or slower. Our class will have to use whole DNA.

Next, they had to take out the DNA from each test tube and move it to a micro tube. They could start to see clumps forming in the clear ethanol. Then they added .25 mL of blue methylene and one drop of glycerin.

Then a buffer solution was made with water and 1% baking soda. This went over the gel electrolysis chamber.

The comb was taken out and the electric wires were added in. Now the gel chamber and DNA are ready. The methylene is used to die the DNA and the glycerin weighs it down.

To finish off the DNA Lab, we had to put the DNA into the gel electrolysis chambers. To do this we first had to take out the comb from the gel, however, there was a problem with the gel. It stuck to the comb, so the whole block of gel was taken out of the plastic box. The groups then had to improvise and cut slits with a knife, then inject 200 microliters of DNA with a micro pipet into the slit. After that, the students then put alligator clips on the stainless steel wires, the negative side on the side of the DNA and the positive clip on the opposite side. Then they were connected to the electric box. Everyone moved away from the boxes to make sure not to get electrocuted.

There was a significant problem. During lunch, the power went out so the results won't be what they want them to be, but we still learned a lot from this experience.

Building a Deltahedron

During core, we were given a puzzle. To make a shape with 4 equilateral triangles with 6 popsicle sticks, no more, no less. Many students thought of overlapping the shapes so that it made a star with enough triangles, but they weren't equilateral or there were too many. Instead, our group made a Deltahedron, which is a pyramid with a triangle base. First, we glued the base together, then added the three other vertices so they all met up in the middle. The ending result was this:

TED Talk: Sebastian Junger "Our lonely society makes it hard to come home from war"

Today we watched a TED Talk about PTSD and its causes. Sebastian Junger states that he had a minor case of Temporary PTSD when he came home from a trip to war, but ended up having it go away rather quickly. The problem is, however, when soldiers come back from war and they end up with chronic PTSD that lasts for years and years, and the rates seemed to be going up.

TED Talk Sebastian Junger 

Junger concluded that the PTSD rates that were going up weren't from more trauma, but by how the soldiers were treated when the war was over. He thought over the Apaches and Cherokee Indian tribes that he had studied in college and wondered why the rates of PTSD hadn't been high in these nations that battled frequently with the US or other tribes. He decided that the reason was because they went home to a tribe that understood what they'd been through. He realized that since these soldiers were leaving their close knit platoon to a lonely society, they were going to have higher rates of trauma that might not actually be there. He says that depression in society goes up the wealthier people are because people lose those bonds. After 9/11 people all bonded over that trauma, so soldiers were less traumatized after war during the time the country was unified. Now that the country is starting to break apart again, people are experiencing more long term PTSD.

Depression in Young People

These are notes taken about a webinar by the National Institute of Mental Health. This is a review of everything talked about during the webinar. 

Why is there Depression?

Sadness and depression can be an evolutionary protection device from negative outcomes. It may be a physic pain or a way of changing one's environment. There may be positivity to negativity. It may be a protection from infections or how we focus on the past (an analytical rumination of thinking).

Is this sadness or depression? For about 3 weeks, a girl named Christina's mood is low, she spends her time alone. Her grades are lowering and she cannot concentrate. Her parents separated very recently.

Five of the following symptoms are present for two or more weeks:

Depressed mood for most of the day, or irritable mood, it has to be present most of the time
Markedly diminished interest or pleasure at all
Significant change in weight when not dieting or weight gain
Insomnia or Hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
Diminished ability to think or concentrate
Recurrent thoughts of death (not just fear of dying) recurrent suicidal ideation without a specific plan or an attempt or specific plan to commit suicide

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Prevalence

10-17% In adults
1-2% in pre-pubertal children
Adolescents with depression are 30% more likely to die of suicide
In its severe form, it affects 9% of adolescents
Second leading cause of people living with disability
More prevalent than other diseases, even cancer

Genes and Environment: Potential Causes

Genes: 30-50% of the liability to depression
Gene-environment correlation: e.g. Increased genetic liability for lifetime traumas
Gene-environment interaction: different genotypes respond to environmental variability in different ways

Ex. Christina's mother is diagnosed with depression during pregnancy. It may pass down to the child. Christina's father lives far away and sees her rarely. He drinks and his company went bankrupt. Since Christina shares genes with both of these people, she has a higher liability in having depression. They also experienced traumatic events, which may affect her more. But since they are correlated, they may end up working together passively or actively. Ex: Since Christina's mother is depressed, they may both become depressed since they share the same genes and experiences.

Dr Kendler used a study on identical and fraternal twins to see how much environment affects liability. Having a traumatic life event increases the chances dramatically. The lowest chances are the ones with genetics that don't react as strongly. The opposite leads to a higher chance of depression in the presence of a life event. So some people may have completely different reactions to the same event.

With the onset of puberty, girls are more likely to have depression than boys. There is a 1 to 2 ratio. It may have to do to with cognitive processing, greater exposure to psychological stressors, or hormonal mechanisms. Girls with an earlier start in their menstrual cycle are more likely to become depressed, it may be because of hormones, or a psychological stressor, or over exposure to other people, they feel uncomfortable around.

There is a debate on whether childhood depression correlates with adult depression, but adolescent depression has shown pathways to adult depression.
Anxiety: early on anxiety precedes depression
Alcohol: Probably an "internalising" way of handling depression
ODD/CD: The strongest predictors for later depression
Behaviour problems and depression are related
40% had disruptive behaviour in their childhood
Highest risk in girls
Youth with CD are twice more likely to have it
Irritable and disruptive behaviour are shown to be directly correlated. What we need to find out is how this transition starts and finding out who has depression and who doesn't.

Depression is a heterogeneous syndrome. It is useful to think of two abnormalities

-Negativity bias and missing the positive
It is more common for someone with anxiety or depression to misinterpret a neutral face as sad or angry.
-They will pick up what is negative in their environment
They will be more likely to miss the positive, such as a smile. A depressed person will relate a smile back to positive less than someone else. Anti-depressants work highly in these areas.
Motivation and reward processing
-Most people go after rewards and feel good when they get it
Anticipatory anhedonia: People with depression will not take the effort to get that reward
People will see this as lazy or a motivation problem, but with depression, it is more that the person can't see why this would be important
Ex: Christina used to dance, but she stopped because they are "no fun at all" She has stopped sending texts to her friends.
People with no processing in the longitudinal segment of the brain are more likely to be depressed in life; this is the segment of the brain that has reward processing.

Phycological and Medical Treatments

Christina's diagnosis was delayed for 18 months. Why?
Parents focused on irritability/oppositionality
Teachers focused on academic performance
She herself could not talk about it, except in terms such as "boring", "annoying" etc.
She was only diagnosed after she took her first overdose and then it became apparent that she had been "cutting" for a while.
It was still hard to explain to her parents the meaning of the problem
She herself was still perplexed

Awareness is key to diagnosis.
Screening is only appropriate in samples that are at high risk. Screening can range from single questions to a questionnaire. Diagnosis should also address the presence of manic symptoms, underlying medical causes (rare), risk assessment, such as past attempts of suicide and cases of depression. They shouldn't have access to guns or drugs.

Not all causes are changeable, such as environment or genes. You may be able to change the relationship between the mother and child or the father and child. Medication can have an effect on behaviour, feelings, and thoughts through the brain, but so does psychological treatments.

The first treatment is a reuptake in serotonin, fluoxetine, sertraline, citalopram
Psychological treatments such as interpersonal treatment or cognitive therapy

There haven't been any sign that one is better than the other. In mild cases, start with CBT/IPT
Some studies show that using them both may be the best
About 60% of young people respond to an antidepressant, however, 50% respond to placebo. This may be related to the severity of the depression, the higher the severity of the depression, the lower they affect to placebo.
The numbers needed to treat a person are 10 and the numbers needed to harm is 112. This is particularly important in the context of suicidality debate and the black box warning.

NEW Core Romeo and Juliet Final

During the entirety of the Mental Health Unit for our core classes we were reading the play Romeo and Juliet. To finish off the unit, two groups had to work together to film an adaptation of the play using a specific theme. My group had to do Act III with a western theme.

Here is the video:

We had about 4 hours to give each other roles and rewrite the script so it would fit inside a ten minute video and be adapted. Then we had 2 more hours to actually execute and film it, then the break to edit and upload. The other themes were:
Act I:  Hunger Games
Act II: Keeping up with the Kardashians
Act III: Western
Act IV: Harry Potter
Act V: Real Housewives

Eating Disorders

Today in NEW, the students had discussions about eating disorders. In groups of three, each person researched a specific disorder. Here are the links to information about each of these disorders, along with key facts discussed among the group.

Anorexia Nervosa 
Anorexia Nervosa is the physiatric disease with the highest death rate (5%-20%). It is most commonly found in women, but there have been growing numbers of men who have also contracted this disease. It is a mental disorder that makes the person feel like they have to lose weight or else they feel worthless. The individual has irregular eating behaviors that lead to them not eating what is necessary for them to survive, as they feel guilt when eating. They essentially end up starving themselves, which is what leads to the high mortality rate. The physical causes have been tied to genetics, nutritional deficiencies, and irregular hormone functions. There are many environmental factors as well, such as careers that promote weight loss, trauma, thin culture in media and peer pressure.

Bulimia Nervosa 
The individual binge eats then feels guilt from eating and purges themself. It can be vomiting, laxatives, over-exercising. They usually have low self-esteem, they can have discolored teeth, callouses. They might have swelling in their jaw and cheek area. They're isn't any dramatic weight change. They won't eat in front of people and make trips to the bathroom after eating. It affects 1-2% of people, 80-90% of them are women and is usually paired

Binge Eating Disorder
Most common eating disorder in America. It is when they get anxious about how they eat and eats a lot in one sitting. They can end up having diabetes and being overweight, feeble bones, fatigue. Eating episodes are usually caused by anxiety, some people who binge eat don't realize it. Some people do it while watching TV. They usually eat foods high in sodium and fat. 3.5% of the population has this disease.

Teens and Mental Health: Suicide Prevention

Today the people of Project SUCCESS came to talk to us about mental health. People don't tend to talk about mental health as much as physical health. Project SUCCESS is a student support program. They provide free counseling, groups, and substance abuse groups.

Now, what is a mental illness?
Some people see a stigma around mental illness as if it doesn't exist and the person is just 'crazy' or 'worried' or 'sad'. Mental disorders is a diagnosable illness that affects a person's thinking, emotional state, and behavior. It disrupts the person's ability to work or attend school, carry out daily activities or engage in satisfying relationships.
Diagnosis
The only way to get a diagnosis is if you meet certain criteria by a medical professional.
What is anxiety?
When I think of anxiety, I think of someone who is nervous and has trouble putting themselves out there in worry that it would add up to regrets.
There is normal anxiety and then there is problematic anxiety. When anxiety is good it keeps you on your toes and ready to perform, like before a test or public speaking. It keeps you ready to go.
The problem is when there is a persistent or severe worry that becomes hard to control. This is when the anxiety is greater than the actual situation. Symptoms must be present for 6 months or longer. There are many versions of anxiety.
Some symptoms of anxiety:
Emotional: Feeling of dread, difficulty to concentrate, tense, nervous, expecting the worst, short-tempered, restless, jittery, watching for signs of danger, feeling like your mind has gone blank
Physical: Heavy heart rate, sweating, shortness of breath, nausea, insomnia
It becomes a problem once the anxiety is constant and overwhelming, interferes with relationships and activities, and interrupts daily activities, such as going to school, work, hanging out with friends, going to the store, etc.
Types of anxiety
Generalized anxiety: having an obsessive and constant worry
Social anxiety: overwhelming worry and self-consciousness about everyday social situations
Specific phobias: intense fear of a specific object
Panic disorder: feelings of terror that strike suddenly and repeatedly with no warning
Others: Obsessive Compulsive Disorder and Post Traumatic Disorder
What could be causes of anxiety?
Anxiety can be caused by genetics, substance abuse, medical conditions or brain chemistry. It can be caused by environmental reasons like abuse, trauma, high stress and violence. It can also be caused by life circumstances such as significant losses and major disappointments, divorce, stressful situations, unresolved family conflict, extremely high expectations of yourself or put on by others.
What is depression?
When someone has depression they have a loss of enjoyment or depressed mood for two or more weeks. Impairment function socially, occupationally, and or educationally.
5 or more of the following symptoms:
Depressed mood or irritability
Decreased interest or pleasure in most activities
Significant weight change or change in appetite
Change in sleep; insomnia or hypersomnia
Change in activity, agitation or apathy
Fatigue or loss of energy
Guilt/worthlessness
Concentration: diminished ability to think or concentrate
Suicidality: thoughts of suicide or has a plan

Sadness and Depression are very different
Sadness is a normal human emotion all people experience it, usually caused by a difficult, challenging, hurtful, or disappointment, feeling bad about something in particular and when something changes, it goes away
Depression: Isn't caused by a certain event, and it won't just go away
Some causes for Depression: Trauma, loss, it might be hereditary, or in your brain chemistry, or environmental reasons, or medications or alcohol or drugs. Depression can also occur without any of these causes.
Treatments for mental disorders
It is a necessity to help get over it.
There's psychotherapy, and/or medication, most effective if put together
To receive treatment, visit your doctor. they can rule out and medical issues, refer to any necessary resources and prescribe medication if needed.
Seek out counseling resources: involves talking with a mental health professional about medical problems.
Why is it necessary?
Without treatment: the symptoms can get worse, other problems can occur
Problems in school, running away, social isolation, drug and alcohol abuse, internet addiction, reckless behavior, violence, low self-esteem, self-harm behaviors or suicide.
Teen suicide
There is a difference between self-harm and suicide.
People can see suicide as the only way to recover.
Not a lot of people with a mental disorder commit suicide but
90% of people who commit suicide are untreated or under-treated.
2nd leading death for 10-24 year olds.
QPR
Warning signs of suicide: Talking about death, they give out their possessions, self-harm, if someone who is usually depressed is suddenly happy, threats to kill themselves, making a plan, strong wish to die, preoccupied with death, anxious and depressed, not sleeping, abusing substances.
Behavioral clues: Previous attempt, acquiring a gun or stocking on pills, co-occurring depression, moodiness, hopelessness, putting personal affairs in order, giving away prized possessions, sudden interest or disinterest in religion, unexplained anger, aggression and irritability.
Situational clues: Being expelled from school, fired from their job, family problems, alienation, loss of a major relationship, death of a friend or family member especially if by suicide, diagnosis of a serious or terminal illness, sudden loss of freedom, fear of punishment, a victim of assault or bullying.

Q uestion .... a person about suicide
P ersuade ....them to get help
R efer .... to other resources
You can be direct about it and ask, "are you suicidal? are you thinking of ending your life?, do you wish you were dead?" etc. Always ask, but if you can't get someone who can have resources available.
Persuade them by saying "will you let me help you, will you go with me to get help?"
Suicide is not the problem, only the solution to a perceived unsolvable problem
Refer them to others like teachers, counselors, student advisors.
Say "I'm on your side, I want you to live" etc. At school you can refer to academic counselors, teachers, CAPE, on-site counselors.
Outside of school:
Police officers, therapists, a trusted adult/parent, suicide hotline, any emergency room.
Call 911 if:
they have a weapon
overdose on pills
immediate intent to kill self or others
posts on social media threatening suicide