04/01/2006

Mental Health and Vocational Disability: A Quick Guide to Mood Disorders

by Peter Manzi

As a career counselor for over 25 years and vocational consultant for disability hearings (about 2500) since 1993, I can attest to the huge, vocational impact created by severe and chronic forms of mental health problems, classified in the DSM-IV TR as Axis I mental disorders. This impact is felt in the individual's greatly diminished capacity to work and earn a living. The two most prevalent mental disorders are Mood Disorders (depression, dysthymia and bi-polar disorders) and Anxiety Disorders (PTSD and stress disorders, generalized anxiety disorder, panic disorder, obsessive compulsive disorder, social phobia, and specific phobia). Both mood and anxiety disorders are the mental impairments seen most often in Social Security Disability hearings. While it is known that more severe forms of disorders, such as dementia and schizophrenia (and other psychotic disorders) are more debilitating and likelier result in permanent disability, mood disorders can have psychotic features, and anxiety disorders can severely limit a person's ability to function outside of his or her own residence. The more severe psychoses and dementias have a much lower incidence than mood and anxiety disorders, and some affect people no longer working or employable. Moreover, in general, mood and anxiety disorders are more responsive to treatments (group and individual psychotherapy, counseling and psychotropic medications) than psychotic disorders and dementia and related disorders.

It behooves career counselors to understand the DSM's classification of mental disorders, their symptomology and likely course, and treatment modalities. While career counselors may or may not be trained in clinical mental health counseling techniques, they will interact with depressed, bi-polar and anxious clients, and need to know how these disorders affect their lives. Most career counseling models recognize the value of focusing on the whole person, as the separation of personal and career issues is at best factitious and more likely, specious (Herr, Cramer & Niles, 2004). To aid career counselors working with people experiencing mood and anxiety disorders, I propose a "quick guide" of what behaviors the client is likely to experience (both present and absent) that have a significant impact on a client's work adjustment. The first part of this article covers Mood Disorders. The second part, appearing later in Career Convergence, examines Anxiety Disorders and introduces specific counseling interventions for both disorders.

Symptoms of Mood Disorders:

Depression (Found in Major Depression. Bi-Polar and Dysthymic Disorders)
- loss of interest in work activities, inclusive of social interactions with superiors,
co- workers and customers/clients;
- disturbance or fluctuations in sleep, appetite, and weight (vegetative symptoms)
- fatigue/loss of energy - inability to meet work load demands (quantity and quality)
- psychomotor agitation or retardation, especially for timed/quota/high detail work, e.g., technical or production type jobs
- diminished ability to concentrate
-depressed mood , i.e., forgetfulness, negative thinking about others, feeling worthless.


Bi-polar Disorder I and II

In addition to a depressed mood, there may be hypomanic or manic moods present.
Hypomanic moods generally do not cause impaired social or occupational functioning.

Manic mood
- grandiose or inflated self-esteem - lack of realistic appraisal of skills and abilities. Makes deals and promises which can't be kept.
- talkative and pressured talking -may interrupt others, speak floridly, finish sentences of others
- impatient, easily irritated, angered and often aggressive (especially when frustrated)
- flight of ideas and racing thoughts -diminished ability to focus, stay on task
- distractibility -not able to multi-task well
- increased goal directed activity -generally positive but not when too intense and incongruous with other staff
- psychomotor agitation, e.g., restless, jittery, always moving but dysfunctionally
- rapid cycling, with four separate mood episodes - depressive, manic, hypomanic
and mixed (depressive and manic). The rapid cycling creates unpredictability and
uneven if not erratic behaviors within each of the four mood states.
- excessive involvement in pleasurable activities e.g., pornography, flirtations, sexual gestures, extravagant spending/budgeting, excessive lunch hours/breaks

Dysthymia
- lower grade features of depressed mood- chronic, persistent depressive symptoms that are not seen as a major departure from the person's functioning, unlike major depression. Lacks vegetative symptoms of depression.
- lack of interest and enthusiasm - low morale
- self critical and self-deprecatory -not likely to take lead or initiative in work
assignments and projects, e.g., not good enough
- social withdrawal - committee/group work and interactions likely to suffer

Impact on Work Related Behaviors

In accord with the Disability Evaluation Under Social Security(2003) any of the symptoms of the above disorders can impact work related behaviors in four general areas:

1) UNDERSTANDING AND MEMORY: The ability to understand and remember work locations and procedures, including instructions that range from short and simple to detailed and complex.

2) SUSTAINED CONCENTRATION AND PERSISTENCE: The ability to carry out instructions ranging from simple to complex; the ability to maintain attention and concentration for extended periods of time; the ability to perform duties within a schedule, maintain regular attendance, and be punctual within customary expectations; the ability to make work related decisions and judgments of a simple to complex nature; and assumes the person is able to work independently without close monitoring or supervision by other workers and to work alongside or in close contact with others (staff, customers/clients) without being distracted by them.

3) SOCIAL INTERACTION with coworkers, the general public and supervisors; and

4) ADAPTATION to changes in the work setting, travel to and from work, awareness of hazards and taking precautions, and ability to set realistic goals or make plans independently of others.

Clinical Issues Facing Career Counselors

My plan for working on career issues with clients with Mood Disorders is based on three factors:

1) the client's support system and network at work and at home, including any work readiness or supported employment programs

2) compliance with treatments- including medications, individual and group counseling/support groups, and our own objectives and goals for career development, and

3) any co-morbidity or coexisting conditions of a mental, physical or chemical nature that complicate both the mental disorder and career development activities. For example, substance abuse and dependence coexists with many mood disorders, especially bi-polar disorders. Also heart disease is often associated with depression.

In summary, there are a number of complex issues for career counselors working with clients with mood disorders. I also recommend counselors familiarize themselves with the current psychotropic medications used to treat such disorders and recommend the, Psychotropic Drugs (2005) by Keltner and Folks.

[Go to Part 2].

Peter Manzi, Ed. D, NCC, NCCC, MCC, CDFI is a part-time faculty member in counseling and education and a full-time vocational consultant and counselor, who resides in Rochester NY. His interests include technology in counseling and career development and education, working with diverse populations, people with disabilities, and the relationship between mental health and career development. He can be contacted at parmcede@hotmail.com