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Mental Health Issues and the University Student

Doris Iarovici, M.D.

Publication Year: 2014

Young adults entering college bring with them many problems—complicated family dynamics, identity issues, and extreme pressure to succeed, among others. Students’ mental health difficulties range from adjustment disorders to mood disorders, and growing numbers of them are seeking help on campus. But these students are also resilient and eager to learn, and even the most depressed among them steps onto campus with some degree of hope for a new and better phase of life. Doris Iarovici, a psychiatrist at Duke University Counseling and Psychological Services, sees in college and university mental health services an opportunity for mental health professionals to bring about positive change with young people during a crucial period of their development. In this practical and highly readable book, Dr. Iarovici describes the complexity and severity of the current college mental health crisis and narrates how college mental health services have evolved along with changes in student populations. She discusses students’ lifestyle problems and psychiatric concerns, using case vignettes to explore a variety of interventions. Included are discussions of substance abuse, relationship difficulties, eating disorders, depression and anxiety, and culture clashes. Problems uniquely addressed in this book include sleep disturbances and perfectionism. An essential component of the volume is a guide to making emergency assessments, from risk classification and hospitalization to public safety and communication within and outside the campus community. Psychiatrists, counselors, and social workers working with college-age students—both on campus and off—will find this guide invaluable.

Published by: The Johns Hopkins University Press

Title Page, Copyright Page

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pp. i-vi

Contents

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pp. vii-viii

Tables and Figures

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pp. ix-x

Part I: The Student in Context: The Interdependent Campus

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1. Crisis on the College Campus?

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pp. 3-7

College is becoming an aspiration for more and more of America’s youth. Nearly half of American 18- to 24-year-olds are enrolled in college at least part-time. With the rise of information technology and an increasingly global economy, higher education is also becoming more of a necessity for success...

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2. The Changing Face of the American University Student

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pp. 8-12

Along with the general increase in the numbers of young adults attending college, the demographics of the students in American universities have been changing in the past few decades. To most effectively help students with their mental health concerns, it’s essential to understand some of these changes and...

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3. Generational Issues on Campus

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pp. 13-21

The psychiatry resident is frustrated. He’s treated Ellen, a 20-year-old Caucasian sophomore with depression, for the first three months of her spring semester. With antidepressant medication and therapy, Ellen has steadily improved, and she’s pulled up her grades in all but one class: organic chemistry...

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4. The Psychiatrist’s Role in College Mental Health

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pp. 22-28

As the nature of the college counseling center has changed over time, so too has the role of the psychiatrist in providing mental health care to university students. Yet at the same time, some of the challenges we face now are not that different from those our predecessors grappled with as they tried to define best...

Part II: Clinical Challenges

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5. Sleep Problems on Campus

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pp. 31-43

Dave is a 19-year-old biracial sophomore from Texas who is having persistent difficulty falling asleep. He has come to the counseling center psychiatrist via referral from one of the psychology interns. He had initially gone to the student health service. When zolpidem was ineffective but clonazepam...

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6. Alcohol on Campus

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pp. 44-53

Juan, an 18-year-old Hispanic freshman from North Carolina, avoids eye contact and squirms in his seat. His left ankle is bandaged. He’s been mandated to come for an assessment following an emergency department evaluation over the weekend. He explains that he got drunk at a fraternity...

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7. Non-alcohol Substance Abuse on Campus

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pp. 54-61

Do any of your counseling centers/health centers currently provide buprenorphine treatment to students? We’re unfortunately seeing more and more students with opioid dependence at our college, and are starting to think about providing this at some point within the next year or so. This query recently appeared on a list-serve of college psychiatrists to which I...

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8. Loneliness and Relationships on Campus

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pp. 62-70

Jason, a 19-year-old Caucasian sophomore from New Jersey, comes in at the urging of his parents, who are concerned about his casual talk of suicide during their weekend visit. Jason appears to find the evaluation annoying and insists there’s nothing “psychiatric” wrong with him—just “unhappiness.”...

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9. Perfectionism

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pp. 71-77

Twenty-three-year-old Fang-Hua, a Chinese international student in her second year of graduate studies in biochemistry, is referred by the student health center after no physical cause accounted for her presenting complaints of fatigue and oversleeping. She is frustrated that the primary care doctor...

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10. Clash of Cultures: International Students

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pp. 78-85

The psychology intern on the clinical team presents a case for supervision. She evaluated Ajit, a 19-year-old man from India, who came in saying, “My professor told me to come here because I’m falling behind in class, but the real problem is I am lovelorn.” He describes falling in love with Jen, a...

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11 Clash of Cultures: LGBT Students

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pp. 86-97

In the last two decades, universities have attended to the increasing diversity among their students, which has led to greater acceptance of and attention to the needs of students from minority sexual orientations: lesbian, gay, and bisexual students. Transgender students, whose concerns center more on gender...

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12. Disordered Eating

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pp. 98-114

Nineteen-year-old Nicole, a Caucasian sophomore from North Carolina, is referred by her professor for panic during an exam and general poor academic performance. She tearfully admits that she has had increasing trouble concentrating and wonders if she might have ADHD. She also reports low energy...

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13. Difficulty Concentrating

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pp. 115-125

University life challenges students in many ways: intellectually, emotionally, physically, and socially. But almost all students see their primary goals on campus as academic, so problems that interfere with their concentration and academic performance rapidly get their attention and send them seeking help...

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14. Anxiety

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pp. 126-139

Anxiety and fear are universal human emotions, with significant adaptive functions in our lives. But surveys of college students suggest that in the past decade or two, more are experiencing problematic anxiety. Nearly half of students in the 2011 National College Health Assessment Survey reported experiencing...

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15. Depression and Other Mood Problems

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pp. 140-151

Many of the students described in previous vignettes listed depressive symptoms along with their other concerns, because mood complaints are common on campus. Determining whether a student has a mood disorder, or mood lability linked to another psychiatric diagnosis, or simply variability in mood...

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16. Psychotic Symptoms

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pp. 152-162

Adalet is a 23-year-old Turkish international graduate student in her first year of a comparative literature program. She comes in at the urging of her roommate, an Argentinian international student with whom she was randomly paired. The roommate accompanies Adalet to the session and states, “I think...

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17. Emergency Situations on Campus

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pp. 163-176

An economics professor brings 19-year-old Marissa for an urgent counseling center evaluation, concerned because she broke into tears in his office after he’d called her in to discuss a failing grade. He reports that she’d been a strong student at the beginning of the semester but lately had been skipping...

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18. Impulse Control Problems, Behavioral Addictions, and Other Problematic Behaviors

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pp. 177-186

Jim, a 22-year old Caucasian senior student from Texas, comes in at the suggestion of his fiancée, Allie. She is concerned that he has been spending too much time online, and his secretive habits regarding his computer use make her worry that he is viewing pornography. He explains that although...

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19. The Nontraditional Student

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pp. 187-196

Maria, a married Hispanic woman who returned to college this year, has to reschedule her initial assessment appointment twice before explaining to the front desk that she’s had trouble arranging childcare; she is then invited to bring her child with her, and an administrative staff member volunteers to watch the...

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20. Models of Treatment

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pp. 197-204

Carrie, a 21-year old Southeast-Asian (Indian) American junior, comes in complaining of depressive symptoms and declining academic performance. She begins sheepishly with “I did something stupid. I stopped my medicine.” She was seen for similar complaints a year ago and treated with an antidepressant...

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21. Treatment Challenges in the University Population

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pp. 205-216

Treating university students is fun and professionally rewarding work. They’re bright, motivated, and interesting, and the very issue that’s most challenging in their care—distinguishing normal developmental phases from more significant emerging psychopathology—is also what keeps the work intriguing and...

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Epilogue. Student Emotional Well-Being: Looking toward the Future

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pp. 217-220

Upon learning where I work, a first-year medical student recently told me, with some surprise, that at her Ivy League undergraduate school, one in five students supposedly used counseling services. She evidently considered this remarkably high. I asked whether it would it surprise her to learn that the majority of students...

Notes

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pp. 221-240

Index

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pp. 241-248


E-ISBN-13: 9781421412399
E-ISBN-10: 142141239X
Print-ISBN-13: 9781421412382
Print-ISBN-10: 1421412381

Page Count: 264
Illustrations: 4 line drawings
Publication Year: 2014