Mental Disorders
Living with a Person Who Has a Mental Disorder
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admin 21 August, 2008
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About 51 million people in the United States have some form of emotional or mental disorder. Because mental illness is so common, many Americans cope with the day-to-day struggle of sharing a home with a person who is mentally ill. Living with a person who has a mental disorder can be challenging and stressful, and most family members are not adequately prepared for the experience. Many families also fear the stigma that still surrounds many types of mental illness. But effective treatments exist for many mental disorders, and help is readily available. The first step in dealing with a loved one’s problems is to recognize the warning signs of a mental disorder:
• confused thinking
• long periods of depression
• extreme mood swings (from elation to sadness)
• high levels of fear, worry, or anxiety
• withdrawal from people and activities
• significant changes in eating or sleeping habits
• rage
• delusions or hallucinations
• thoughts of suicide or homicide
• denying the existence of a problem
• unexplained physical illnesses
• substance abuse
The symptoms of many mental disorders are similar, so many families share the same experiences. The behaviors—including withdrawal, angry outbursts, or disorganized speech—that characterize certain mental disorders can be shocking and embarrassing when performed in public. If you are in such a situation, remember that the person cannot help what he or she is doing. Try to encourage the person to move to a more private place until he or she is calm. Discuss with the person’s doctor what to do in such situations so that you can be prepared the next time.
To help fight the stigma of mental illness, you can become an advocate for your loved one. Ask the doctor about the person’s specific needs and try to fill them. For example, someone who has delusional disorder may be able to hold a job but may need an understanding boss who is willing to overlook the person’s delusional behavior as long as it does not interfere with work. Many people have misconceptions about mental illness; you can work to correct these misconceptions and help them change their attitudes and the way they interact with people who are mentally ill.
Many people who live with someone who has a mental disorder find it helpful to join a support group. These groups offer a protective environment in which you can share your concerns and learn coping strategies from people who face similar challenges. If there is no local support group that deals with your particular situation, consider starting one. Other people in similar situations may be happy to participate.
Family or individual counseling often benefits partners or family members. A therapist or counselor familiar with the type of mental disorder involved can teach you about the disorder and suggest ways to handle typical situations you may encounter. Talk to a number of therapists before beginning counseling to find one who is knowledgeable about the disorder and with whom you feel comfortable.
Having a person with a mental disorder in the family alters the dynamics of family life. The affected person tends to become the focal point around which family life revolves. Caregivers or other family members can often feel slighted and overwhelmed, and may become resentful. Children, especially, can feel ignored. They also may feel embarrassed when an insensitive friend makes fun of the affected person. It is important to try to balance the needs of the person with the needs of the other members of your household. Plan special activities with the other members of your family—especially your children—to make them feel included and to draw you together as a family.
Caregivers can easily become overwhelmed by their responsibilities. Because of this, you should not attempt to handle everything yourself; the full responsibility of caregiving should never fall on one person. A caregiver who is on call 24 hours a day will burn out quickly. Schedule regular breaks from your caregiving duties. When you need an unscheduled break, arrange to have a dependable relative or a friend fill in for you.
Keep an updated list of things that need to be done. Identify as many people as possible who can provide help. Every member of your household can participate or contribute in some way. Ask your friends and relatives, too. Offer them choices from your list, such as doing chores, running errands, preparing meals, making telephone calls, and providing company. Be direct. Do not hesitate to ask for help whenever you need it.
If family members or friends cannot help, contact volunteer and community organizations, as well as your doctor and local hospitals and health organizations. If you belong to a support group, ask the group members for suggestions. You also may want to hire a professional caregiver through a licensed home health agency, such as a visiting nurse association.
Caring for yourself is an essential part of being a caregiver. To succeed as a caregiver, it is vital that you follow a healthy lifestyle. Eat a nutritious, well balanced diet, exercise regularly, do not smoke, and get plenty of sleep. Try to limit your intake of caffeine and alcohol. And be sure to use relaxation techniques, such as meditation and deep-breathing exercises, to relieve stress.
Categories : Mental Disorders
Psychotic Disorders
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A psychosis is a serious mental disorder in which a person loses touch with reality and cannot tell whether he or she is having a real-life experience or an unreal one. The two most common types of psychosis are schizophrenia and delusional disorder.
Schizophrenia
Schizophrenia is a devastating brain disorder that can be extremely disabling. The first signs of the disorder are often confusing and shocking to family and friends. Schizophrenia is characterized by profound disruptions in thought and emotion that can affect language, perception, and a person’s sense of self. It can produce a wide array of symptoms. Some symptoms, called positive symptoms, show an excess of or distortion in normal functioning. They include hearing voices or other hallucinations, delusions (such as the belief that radio or television programs are sending special messages directly to the affected person), disorganized or incoherent speech, unpredictable agitation, purposeless and bizarre behavior, and catatonia (unawareness and rigid or unusual postures). So called negative symptoms reflect a loss of normal functioning. They include a flat facial expression and tone of voice, a lack of speech fluency, apathy, and the inability to begin or maintain any type of goal-oriented behavior. No single symptom defines the disorder, but rather a pattern of symptoms that is accompanied by difficulty holding a job or functioning in society. Several subtypes of schizophrenia, defined by their predominant symptom, have been identified. For example, a person with paranoid schizophrenia is preoccupied by delusions or “hearing voices.”
Schizophrenia is often misunderstood. Many people mistakenly think that the disorder causes multiple personalities. Some people may fear that a person with schizophrenia is violent and dangerous, although most people affected with schizophrenia are not violent. The best way to think of schizophrenia is to compare a normal brain to a functioning telephone switching system in which the calls (in the form of perceptions) come in and are routed to the proper destination. But in the brain of a person with schizophrenia, the switching system malfunctions. Incoming calls can be sent along the wrong pathway, leave the pathway, or arrive at the wrong destination. Incoming perceptions and outgoing messages become disorganized or blocked.
More than 2 million people in the United States have schizophrenia. It usually appears during young adulthood. Onset can be either sudden or gradual. Researchers have found that susceptibility to schizophrenia may be inherited, but there is also some evidence that impairment in fetal brain development may also have a role in the disorder. Many people with schizophrenia are severely disabled and stigmatized by the disorder, which affects their careers and relationships.
Antipsychotic medications (such as haloperidol, thioridazine, or fluphenazine) are prescribed to treat the hallucinations and delusions that frequently occur and may also help improve emotional expression. Most of these medications are taken by mouth, but seriously affected people may have to take them by injection. Antipsychotic medications can produce side effects such as muscle spasms, drowsiness, faintness, dry mouth, blurred vision, sensitivity to sunlight, and constipation. Some men who take these medications have difficulty with sexual function.
Only one person in five fully recovers from schizophrenia, and about 10 percent of affected people remain severely ill over long periods, even with treatment. In another 50 percent, symptoms improve, sometimes significantly. Most people with schizophrenia will need treatment for the rest of their lives. Some people with schizophrenia may deny that they need medications and refuse to take them. Others forget to take their medications because of the disorganized thinking that is characteristic of the disease.
This behavior makes it difficult to help a friend or family member who may be showing signs of schizophrenia. If you know someone who may have schizophrenia, you may be more successful in getting him or her to seek treatment by focusing on one symptom, such as depression or difficulty sleeping. Above all, try to maintain a caring, helpful manner when approaching someone who may have this type of psychotic disorder, since they often are anxious and suspicious of others.
Delusional Disorder
Many people with schizophrenia have delusions (tenaciously held false beliefs), but not all people with delusions have schizophrenia. Doctors diagnose a person with a delusional disorder if he or she has a persistent delusion that involves a situation that could occur in daily life, such as being poisoned or followed, but shows no other signs of schizophrenia. Aside from the odd manifestations of the delusion, the person’s behavior is not unusual, and his or her functioning at home and work is not impaired.
Delusions fall into a number of distinct categories. The most common type of delusion is that of persecution by others. People with this type of delusional disorder believe that their friends, family, or coworkers are conspiring to drug or spy on them or to ruin their reputations.
Another form of delusional disorder that is frequently encountered is delusional jealousy, in which the person takes everyday occurrences, such as a partner’s returning home a bit late from work, as evidence of unfaithfulness. Erotic delusions compel the affected person to believe that he or she is loved by someone with high status, such as the president of the company he or she works for or a famous actor. People who have grandiose delusions believe that they have special powers that could save the world or cure a disease. Delusional disorder also can take the form of somatic delusions, in which the person thinks that there is something seriously wrong with his or her body—that it is misshapen, produces a foul odor, or has insects crawling on it.
The treatment of choice for a delusional disorder is drug therapy, but drugs are not always successful in treating the disorder. Delusions that persist for a long period can be difficult for doctors to treat. If the affected person is unable to function in daily life, or if he or she poses a threat to himself or herself or others, the person will have to be hospitalized.
Categories : Mental Disorders
Sleep Disorders
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admin 20 August, 2008
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The amount of sleep needed each night varies from person to person, but most healthy men need 8 to 81⁄2 hours of sleep per night to be fully alert during the day. If a man does not get enough sleep—even for one night—he may experience drowsiness that disrupts his daily routine.
Certain medical conditions and drugs also can interrupt sleep and cause daytime drowsiness. Problems such as asthma, congestive heart failure, and rheumatoid arthritis or any other painful condition can keep you from getting a good night’s sleep. Medication used to treat high blood pressure or heart disease, and asthma medications such as theophylline, also can interfere with sleep. Alcohol can help you to fall asleep but causes sleep disruption later in the night and can produce early morning headaches. The sedative effects of alcohol also can put you at increased risk for motor vehicle collisions if you drink and drive. Caffeine, which stays in the body for 3 to 7 hours after ingestion, makes it harder to fall asleep and stay asleep. The nicotine in cigarettes and nicotine patches is a stimulant that also can disrupt sleep.
Many men who work the night shift have difficulty sleeping. Most night-shift workers get less sleep overall than day workers. The human sleep-wake cycle is designed to prepare the body for sleep at night and wakefulness during the day. These natural rhythms make it harder for a person to sleep during the day and to work at night. In addition, lights, noise (such as from telephones), and family members can be annoying distractions that disrupt daytime sleep.
If you have problem with sleepiness, monitor your sleep-wake patterns. If you are consistently getting fewer than 8 hours of sleep per night, try to get more sleep by gradually moving to an earlier bedtime. If your schedule does not permit you to go to bed earlier, try to squeeze in a 30- to 60-minute daily nap. If you are sleepy, do not drive; sleepiness will increase your risk of having a collision.
If you think you are getting enough sleep but still feel sleepy during the day, you may have a sleep disorder. Talk to your doctor, who can evaluate your symptoms and prescribe appropriate treatment.
Some men have medically recognized sleep disorders. The most common sleep disorders are insomnia, sleep apnea, narcolepsy, and restless legs syndrome.
Insomnia
Most people need a full 8 hours of sleep, while some can function well with less. Many people, however, are unsatisfied with the amount of sleep they get. Insomnia refers to inadequate or poor-quality sleep, usually the result of difficulty falling asleep, frequent waking during the night, or rising too early in the morning. Once the person wakes during the night or early in the morning, he or she has difficulty going back to sleep. Insomnia can cause fatigue, lack of energy, difficulty concentrating, and irritability.
Insomnia that lasts only a few weeks or less is called transient insomnia. If episodes of insomnia occur from time to time, the problem is called intermittent insomnia. Insomnia that occurs on most nights and lasts a month or longer is called chronic insomnia.
Factors that may contribute to insomnia include being older and having a history of depression. Although insomnia occurs in men and women of all ages, it seems to be more common in women and older people. Transient insomnia and intermittent insomnia often occur in people who are experiencing temporary problems such as stress, noisy sleeping conditions, extreme heat or cold, jet lag, or side effects of medications.
The causes of chronic insomnia are more complex, often involving a number of underlying disorders. One of the most common causes of chronic insomnia is depression. Other causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson’s disease, and hyperthyroidism.
Lifestyle factors such as overuse of caffeine, alcohol, or other drugs; shift work; smoking cigarettes before bedtime; excessive daytime napping; or chronic stress also have a role in the development of insomnia. Stopping these behaviors may help eliminate insomnia.
If you have insomnia, your doctor will take a complete health history and a sleep history. To obtain a sleep history, the doctor will ask you to keep a sleep diary or interview your sleep partner to find out how much sound sleep you typically get each night. Transient and intermittent insomnia may require no treatment because it often clears up when the underlying problem, such as jet lag, is resolved. If your daytime performance is adversely affected by transient insomnia, your doctor may prescribe a short-acting sleeping pill for a brief period.
To treat chronic insomnia, your doctor will first diagnose and treat any underlying medical or psychological problems you may have. He or she may prescribe a sleeping pill, but only for a brief period to minimize unwanted side effects or dependence on the pills for sleep. Certain behavioral techniques also are often used to improve sleep. One such technique is relaxation therapy, which is used to eliminate anxiety and muscle tension. Some people with insomnia benefit from sleep restriction, which at first allows only a few hours of sleep each night, and gradually increases sleep time to a more normal span of time. Another helpful treatment is called reconditioning, which teaches the affected person to associate the bed and bedtime with sleep by avoiding use of the bed for any activity other than sleep or sex.
Sleep Apnea
Sleep apnea is a serious, potentially life-threatening breathing disorder that is characterized by brief, involuntary interruptions of breathing during sleep. There are two types of sleep apnea: obstructive and central. Obstructive sleep apnea, the most common type, occurs when air cannot flow into or out of the person’s nose or mouth because of an obstruction caused by a relaxed and sagging tongue or a sagging uvula (the small piece of tissue that hangs from the center of the back of the throat) during sleep. Central sleep apnea, which is less common, occurs when the brain fails to send the proper signals to the muscles used in breathing to continue regular inhalation and exhalation during sleep.
During any given night, a person with sleep apnea may involuntarily stop breathing 20 to 30 times per hour. These pauses in breathing are usually accompanied by snoring, although not everyone who snores has sleep apnea. The snoring occurs because, although the person continues to try to breathe, air cannot flow easily in and out of the mouth. Choking also can occur.
During the pause in breathing, the person is unable to inhale oxygen and exhale carbon dioxide, resulting in increased levels of carbon dioxide in the blood. This increase in carbon dioxide alerts the brain to wake the person. Breathing often resumes with a loud snort or a gasp. The frequent arousal prevents the person from getting enough sleep and often causes early morning headaches and daytime drowsiness. Daytime concentration and performance suffer due to sleep deprivation.
Sleep apnea occurs in all age groups but is more common in men than in women. More than 12 million people in the United States are estimated to have the disorder. People most likely to have sleep apnea are those who snore loudly and also are overweight, have high blood pressure, or have a physical abnormality inside the nose or upper airway. The problem appears to run in families, suggesting a possible genetic cause.
To diagnose sleep apnea, doctors use two tests, performed either at a sleep center or at home. One test is polysomnography, which records various body functions—such as the electrical activity of the brain, eye movement, muscle activity, heart rate, and blood oxygen levels—during sleep. A test called the multiple sleep latency test measures how fast a person falls asleep. (It takes most people 10 to 20 minutes to fall asleep; people who habitually fall asleep in fewer than 5 minutes are likely to require treatment for a sleep disorder.)
Treatment for sleep apnea depends on the underlying cause. Lifestyle changes are enough to reverse the disorder in some people. Such changes may include avoiding the use of alcohol, tobacco, and sleeping pills, all of which can make the airway more likely to collapse during sleep. Overweight people can benefit from losing weight. People in whom sleep apnea occurs only when they sleep on their backs are advised to sleep on their sides. The most common treatment for the disorder is called continuous positive airway pressure, in which the person wears a mask over the nose during sleep so that pressure from an air blower can force air through the nasal passages. The process also helps prevent the airway from collapsing during sleep. Side effects may include nasal irritation and drying, facial skin irritation, sore eyes, headaches, and abdominal bloating. Dental appliances can reposition the lower jaw and tongue during sleep to reduce the risk of airway obstruction. Medications are generally not effective for treating sleep apnea.
Some people with sleep apnea undergo surgery to increase the size of their airways. Common surgical procedures include removal of the adenoids (tissue at the back of the nasal cavity that helps the body fight infection), tonsils, nasal polyps, or uvula and part of the soft palate. People with life-threatening sleep apnea may need a tracheostomy, in which a small hole is made in the windpipe and a tube is inserted through which air can flow directly into the lungs while the person sleeps.
Narcolepsy
People who have narcolepsy experience such overwhelming daytime sleepiness— even after adequate sleep at night—that they become drowsy or fall asleep at inappropriate times and places during the day. Such “sleep attacks” can occur repeatedly during a given day and may come on without warning. Another classic symptom of narcolepsy is cataplexy (sudden episodes of loss of muscle function that cause the person to collapse suddenly or his or her neck to go limp). Sleep paralysis often occurs, preventing the affected person from moving while falling asleep or waking up. Some people also have vivid hallucinations while falling asleep. Such symptoms can seriously disrupt the person’s life and limit his or her activities.
Narcolepsy occurs in both men and women and can begin at any age. As many as 200,000 people are affected, although the problem is often underdiagnosed or misdiagnosed as depression, epilepsy, or side effects of medication. Doctors think that a disturbance in the normal order of sleep stages causes narcolepsy. Most people first go through a stage of nonrapid eye movement (NREM) when falling asleep, followed by a stage of rapid eye movement (REM), when dreaming and muscle relaxation occur. In people with narcolepsy, these stages are reversed.
To diagnose narcolepsy, doctors perform two tests—polysomnography and the multiple sleep latency test—at a sleep center or at the person’s home.
There is no cure for narcolepsy, but certain treatments can relieve symptoms. Drugs called central nervous system stimulants (such as methylphenidate, dextroamphetamine, or modafinil) can help manage the excessive daytime sleepiness caused by narcolepsy. Antidepressants (such as amitriptyline or fluoxetine) also are prescribed. An important part of treatment is scheduling short naps two to three times per day to help relieve daytime sleepiness. Some people with narcolepsy and their families find it helpful to join a support group where they can learn to deal with the emotional effects of the disorder, talk about occupational limitations, and find out how to avoid situations that could cause injury.
Restless Legs Syndrome
Restless legs syndrome is a sleep disorder in which a person experiences unpleasant sensations in the legs. People who have this disorder often describe the sensations as creeping, crawling, tingling, pulling, or painful feelings in the calves, although the entire leg can be affected. These sensations can occur when the person lies down or sits for long periods, such as in bed, at a desk, or riding in a car. Moving, rubbing, or massaging the legs brings relief, at least briefly. People with restless legs syndrome find it difficult to relax and fall asleep, often sleeping best during the morning hours. A lack of sufficient sleep at night causes daytime drowsiness and affects performance at home and at work. Many people with restless legs syndrome have periodic limb movement, which is characterized by involuntary jerking or bending leg movements that occur every 10 to 60 seconds during sleep.
The cause of restless legs syndrome remains unknown, but certain factors have been linked to the disorder. They include a family history of the disorder; pregnancy; low levels of iron in the blood; diseases such as kidney failure, diabetes, and rheumatoid arthritis; and a high caffeine intake.
Both men and women can develop restless legs syndrome, which is more common and more severe among older people. An accurate diagnosis often depends on how well the person can describe his or her symptoms because there is no visible abnormality in the legs and there is no diagnostic test to detect the disorder. Mild cases of restless legs syndrome respond well to self-treatments such as taking a hot bath, massaging the legs, using a heating pad or an ice pack, exercising, and eliminating caffeine. More serious cases are treated with benzodiazepines (such as clonazepam or diazepam) and opioids (such as codeine or propoxyphene). These drugs do not cure restless legs syndrome but only treat the symptoms. Some people respond well to a nondrug treatment called transcutaneous electric nerve stimulation (TENS), in which electrical stimulation is applied to the legs or feet for 15 to 30 minutes before bed to reduce leg jerking during sleep.
Categories : Mental Disorders
Anxiety Disorders
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Fear is the driving force behind anxiety disorders. Each of us experiences fear throughout the course of our lives. But instead of feeling the reasonable fear that helps us recognize and respond to immediate danger, such as narrowly avoiding a traffic accident, people with an anxiety disorder experience fear that occurs in response to dangers that are either imagined or not immediately threatening. Such people experience almost constant feelings of worry or dread that interfere with their daily activities, along with symptoms of anxiety such as rapid heartbeat and increased perspiration.
Anxiety disorders are the most prevalent mental disorders in adults. About 30 million people in the United States have some type of anxiety disorder, and twice as many women as men are affected. Anxiety disorders appear to arise from a combination of stressful life experiences, psychological traits, and genetic inheritance, although certain disorders—such as panic disorder—appear to have a stronger genetic component than others. The most common anxiety disorders include generalized anxiety disorder, phobias, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder.
Generalized Anxiety Disorder
People who have generalized anxiety disorder experience ongoing but unrealistic worry or dread about the circumstances of daily life. The excessive worries often pertain to many areas of the affected person’s life, including work, relationships, finances, personal health, the well-being of one’s family, perceived misfortunes, and impending deadlines. Affected people can experience a variety of symptoms, including feelings of fear and dread, restlessness, muscle tension, a rapid heart rate, light-headedness, poor concentration, insomnia, increased perspiration, cold hands and feet, and shortness of breath. Symptoms typically worsen during stressful periods.
Generalized anxiety disorder affects only half as many men as women. It begins in childhood or adolescence in about 50 percent of affected people but does not seem to run in families.
Phobias
There are three major types of phobias: specific phobias, social phobias, and agoraphobia. Specific phobias are those triggered by fear of a specific object, such as snakes or spiders. Claustrophobia (fear of enclosed spaces), acrophobia (fear of heights), and fear of flying or driving also fall into this category. About 8 percent of American adults experience one or more specific phobias in any given year. Typically developing in childhood, many specific phobias disappear by adulthood. Those that last into adulthood usually require treatment.
Social phobia describes persistent anxiety in social situations, based on fear of embarrassment or ridicule. People with a social phobia become preoccupied with concern that other people will notice their anxious symptoms—such as blushing, sweating, or trembling—or that their mind will go blank when speaking to someone else. Like stage fright, social phobia causes intense fear when the person is aware that other people can observe him or her doing even simple things, such as eating a meal in a restaurant or putting on a coat. A more general form of the disorder provokes fear during most interactions with other people. People with a social phobia often avoid socializing and even can have difficulty attending school or keeping a job. Performance anxiety and fear of public speaking also fall into this category of phobias. Social phobia affects men and women in equal numbers and usually develops in childhood or adolescence. It has been linked to shyness and tends to run in families.
Agoraphobia, a term that literally means “fear of the open marketplace,” refers to fear of being in public places, such as streets, shopping malls, theaters, airplanes, and other places where people gather. People with agoraphobia fear that they will not be able to escape from a given place or that no one will be available to help them in such circumstances. People with agoraphobia often do not venture out of their homes unless accompanied by someone else. Agoraphobia is the most serious type of phobia because in the most extreme cases, affected people refuse to leave their homes at all. The disorder most often develops from the constant worry, preoccupation, and avoidance that occurs following a series of panic attacks. Agoraphobia occurs twice as often in women as in men.
Many doctors use desensitization techniques to treat phobias. Desensitization involves gradually exposing a person to the trigger (object or situation that he or she fears) in an attempt to teach the person to react without fear. Medication and psychotherapy also are typically used to treat phobias.
Panic Disorder
Panic attacks are brief and very intense episodes of a high level of anxiety that often occur with no apparent cause. A panic attack can produce sweating, shortness of breath, rapid heart rate, chest pain, numbness or tingling, trembling, and nausea or stomach pains. Most affected people also report feeling that they are losing control, “going crazy,” or dying. An attack typically starts suddenly and builds to its maximum intensity in 10 to 15 minutes, rarely lasting more than 30 minutes. The experience provokes a strong urge to flee and often causes the person to seek help at a hospital emergency department. After the person experiences one or more panic attacks, he or she begins to anticipate more of them and may begin to avoid activities or situations, such as riding in an elevator, that seem to trigger them. Anxiety caused by merely thinking of the possibility of another attack can cause the person to become reclusive. Extreme cases of panic disorder can lead to agoraphobia (fear of being in public places).
Panic disorder is about twice as common in women as in men. Typically the disorder first appears between late adolescence and middle age. Panic attacks do not always indicate an underlying mental illness; up to 10 percent of people experience an isolated panic attack each year. A panic disorder can occur when other mental disorders, such as social phobia, generalized anxiety disorder, or depression, also are present. Doctors can confirm a diagnosis of panic disorder when the person has experienced at least two panic attacks and develops persistent concern about having additional attacks.
Obsessive-Compulsive Disorder
Obsessions are recurrent, intrusive thoughts, impulses, or images that the affected person perceives as being inappropriate, grotesque, or forbidden. These thoughts seem unlike the person’s usual thoughts and can cause anxiety and distress. The obsessions also seem uncontrollable, and the person becomes afraid that he or she will lose control and act upon them. Common themes of obsessions include contamination with germs, worry that the person has unknowingly inflicted harm upon someone else, or loss of control over violent or sexual impulses.
Compulsions, on the other hand, are repetitive behaviors or patterns of thought that reduce the anxiety that accompanies an obsession or that “prevent” some dreaded event from occurring. Compulsions can take the form of repeated, ritualistic patterns of hand washing, checking, counting, or praying. For example, the person may count to ten 30 times or may count backward. He or she may recite a certain prayer or passages from the Bible in a specific sequence. Compulsive rituals can consume long periods of time. The presence of both obsessions and compulsions constitutes obsessive-compulsive disorder.
Obsessive-compulsive disorder affects about 21⁄2 percent of Americans and is equally common among men and women. It typically begins in adolescence or young adulthood in males. As with generalized anxiety disorder, symptoms tend to worsen during stressful periods. There is strong evidence that the disorder runs in families.
Posttraumatic Stress Disorder
Posttraumatic stress disorder refers to the anxiety and disturbances in behavior that develop after experiencing an extreme trauma, such as witnessing a murder, experiencing torture, being in a serious accident, or participating in military combat. A critical feature of posttraumatic stress disorder is the psychological symptom of dissociation, a perceived detachment of the mind from the person’s emotional state or even from the body. Dissociation is also characterized by a dreamlike or unreal perception of the world and may be accompanied by poor memory of the traumatic event. Other symptoms of posttraumatic stress disorder include general anxiety, a heightened sense of arousal, avoidance of situations that elicit memories of the trauma, and intrusive recollections of the event in flashbacks, dreams, or recurrent thoughts. Symptoms of the disorder may be immediate or delayed, beginning 6 months or more after the traumatic event.
A person with posttraumatic stress disorder experiences decreased selfesteem and a loss of long-held beliefs about people or society. He or she begins to feel hopeless and permanently damaged by the traumatic experience and begins to have difficulty with personal relationships. Substance abuse often develops as the person attempts to relieve such feelings by using alcohol, marijuana, or sedatives.
Posttraumatic stress disorder is most common among women who are rape victims. Women are twice as likely to have the disorder as men. The disorder is also common in concentration-camp survivors and Vietnam War veterans. About half of all people with posttraumatic stress disorder recover within 6 months. For the others, the disorder typically persists for years and may dominate their lives.
Treatment of Anxiety Disorders Anxiety disorders are usually treated with some form of counseling or psychotherapy, often combined with drug treatment. Doctors now use more focused, time-limited forms of therapy that teach the affected person how to cope with the symptoms of anxiety rather than exploring unconscious conflicts. A critical element of such therapy is gradual but increasing exposure to the object or situation that causes the anxiety in order to stop the affected person from avoiding anxiety-inducing situations.
Medications that doctors typically prescribe to treat anxiety disorders are those that readjust imbalances in neurotransmitters (chemicals that carry messages between brain cells). Such medications include benzodiazepines, antidepressants (such as paroxetine or fluoxetine), and an antianxiety medication called buspirone. Benzodiazepines such as clonazepam, diazepam, and lorazepam have antianxiety and sedative effects but can be habit-forming. Buspirone is useful for treating generalized anxiety disorder and, unlike the benzodiazepines, is not addictive.
Categories : Mental Disorders
The Warning Signs of Suicide
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Depression is the number one risk factor for suicide. In fact, 70 percent of all people who commit suicide are depressed. Although men attempt suicide only a third as often as do women, men are more likely to be successful in the attempt. The highest suicide rates are for men over age 85, but suicide also is the third leading cause of death among younger men aged 15 to 24 years. Married men are less likely to attempt or commit suicide than are separated, divorced, or widowed men. Facing adverse life events, such as financial loss, can alter the chemistry in the brain, increasing the risk for suicide, especially if the person already has an emotional disorder or is abusing drugs or alcohol. Risk factors for suicide include a family history of an emotional disorder, substance abuse, suicide, or physical or sexual abuse; a prior suicide attempt; having a gun in the home; imprisonment; impulsive behavior; and exposure to the suicidal behavior of others (especially for teens or young men).
A suicide attempt—or even talking about suicide—should never be dismissed as a mere attention-getting ploy. Attempted suicide is always a cry for help from a person who is usually battling some type of emotional disorder, such as depression, or a substance abuse problem. Most people with depression or substance abuse can be treated successfully and go on to lead healthy lives. If someone you know begins talking about or threatening to commit suicide, take the person seriously and try to get him or her to see a doctor, or call a suicide hot line. A suicide attempt is often preceded by certain telltale warning signs, such as:
• talking about suicide or death, even jokingly
• difficulty dealing with the loss of a loved one or some other adverse life event
• withdrawal from friends and activities
• hoarding of pills or purchase of a gun
• abuse of drugs or alcohol
• giving away prized possessions
• a previous suicide attempt
• writing notes or poems about death
• changes in eating or sleeping habits
• neglect of personal appearance
The best way to prevent a suicide attempt is to get professional help for an emotional disorder or substance-abuse problem. Recognition of depression in older men can go a long way toward preventing suicide, especially if they are living alone. Limiting access to guns, especially in combination with treatment of an emotional disorder, also is an effective way to prevent suicide attempts in high-risk men. If someone you know is in immediate danger, call 911 or your local emergency number.
Categories : Mental Disorders
Mood Disorders
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Mood disorders, sometimes referred to as affective disorders, are a type of mental illness that affects a person’s mood. Everyone experiences occasional periods of sadness or euphoria (a strong sense of well-being), but people with a mood disorder feel these emotions more strongly than other people and for longer periods. About one in seven people is affected by a mood disorder each year. Possible causes include an inherited predisposition, an imbalance in brain chemicals that regulate mood, and environmental factors—or a combination of all three. The most common mood disorders include depression, bipolar disorder (formerly known as manic depression), and seasonal affective disorder (SAD). In general, mood disorders are among the most treatable of all mental disorders.
Depression
It is normal to feel unhappy in response to a personal loss or stressful situation, but such feelings usually go away with the passage of time. Depression, on the other hand, can cause deep feelings of sadness or despair that can last for months or even years. Depressed men often feel overwhelmed by life and become emotionally and physically withdrawn.
Depression is a serious condition that can have profound effects on a man’s quality of life. Long-term bouts of depression can negatively affect your ability to function at work and in social situations. It can also severely limit your capacity to enjoy the basic pleasures of life—your family, your friends, your favorite activities, and your sex life. More than 18 million people experience depression in the United States every year. It can occur at any age but usually seems to first appear between ages 25 and 45. Although men are only half as likely to have severe depression as are women, depressed men are four times as likely to commit suicide than depressed women (although women attempt suicide more frequently). In fact, men over age 55 have the highest risk of suicide among Americans. Untreated depression is the leading cause of suicide in the United States.
Symptoms of depression include persistent sadness or despair, insomnia, decreased appetite, irritability, apathy, withdrawal from social situations, loss of energy, poor self-esteem, feelings of hopelessness or helplessness, an inability to enjoy former interests, a decreased interest in sex, and suicidal thoughts. Depression also can cause you to lose interest in your appearance. The tone of your voice may be dull and flat and your pattern of speech monotonous. Frequent bouts of crying, often with no apparent cause, are common.
Some people have a recurrent but less severe form of depression, called dysthymia. Dysthymia is diagnosed when a depressed mood persists for at least 2 years and is accompanied by at least two other symptoms of depression. People with this milder form of depression are susceptible to periodic episodes of major depression.
Doctors think that a number of factors may combine to cause depression. A deficit in certain brain chemicals—particularly serotonin and norepinephrine— seems to cause the anxiety, irritability, and fatigue often experienced in the disorder. A family history of depression also can increase your chances of having the disorder. Certain environmental factors—such as exposure to violence or emotional or physical abuse—also seem to have a role. People who have low self-esteem or a pessimistic outlook seem to be more susceptible to depression than those who are more self-confident and optimistic.
The good news is that depression responds very well to treatment, even in people who have had the disorder for many years. Up to 90 percent of depressed people who receive treatment experience a reversal of their symptoms. If you have symptoms of depression, your primary care doctor probably will refer you to a psychiatrist (a doctor who specializes in treating mental disorders) for treatment. Before he or she prescribes any form of treatment, the psychiatrist will request that your primary care doctor perform a complete physical examination. If these evaluations reveal no physical cause for your symptoms, your psychiatrist will then conduct a psychological evaluation.
Doctors usually treat depression with antidepressant medication, often combined with psychotherapy or psychological counseling. The purpose of drug treatment is to correct any imbalance in brain chemistry. The most common drugs prescribed to treat depression are selective serotonin reuptake inhibitors (such as fluoxetine, fluvoxamine, and paroxetine) and tricyclic antidepressants (such as amitriptyline, desipramine, and nortriptyline). These drugs are not tranquilizers or sedatives and are not addictive. Antidepressant medications can improve the symptoms of depression in 4 to 6 weeks, although the person needs to continue taking them for at least 5 months (usually longer) after symptoms improve.
Psychotherapy may be recommended for an individual or a family, or in a group setting with other people who are experiencing depression. Individual psychotherapy takes place in the office of a psychiatrist or psychologist, in regularly scheduled 30- to 45-minute sessions. The goal of psychotherapy is to relieve the person’s distressing symptoms so that he or she can resume a normal routine. There are different types of psychotherapy. One type involves helping the person understand unconscious and unresolved conflicts. Another emphasizes changing negative patterns of thinking. A third attempts to replace ineffective behaviors with more positive constructive behaviors. Ask your therapist which type he or she recommends and why. Treatment can last several weeks, months, or years, depending on the severity of the depression.
In extreme cases of severe depression, a psychiatrist may admit the person to the psychiatric unit of a hospital for full, 24-hour care. The doctor will develop a treatment plan, which will be carried out by a team of mental health professionals that includes the psychiatrist, psychiatric nurses, a clinical psychologist, a social worker, rehabilitation therapists, and an addiction counselor, if needed. The treatment plan usually includes individual, group, or family therapy, along with medication. The person usually remains hospitalized for about 6 to 12 days.
Bipolar Disorder
Bipolar disorder, in which periods of deep depression alternate with episodes of euphoria or mania, affects about 1 percent of Americans. The disorder’s wide mood swings continue indefinitely, interrupted by periods of remission or normal mood. The depressed phase produces typical symptoms of depression, such as sadness or despair, loss of interest in favorite activities, fatigue, and thoughts of suicide. During the manic phase, affected people experience persistently elevated mood and energy, delusions of grandeur, feelings of invincibility, unrealistically high self-esteem, agitated movement, talkativeness, abrasive and rapid speech, racing thoughts and distractibility, poor judgment, poor impulse control, and a decreased need for sleep. Some people in the manic phase also go on unrestrained buying sprees or have impulsive, indiscreet sexual encounters. Extreme mania can lead to delirium (mental confusion) or paranoia (excessive or irrational suspiciousness). Manic states can last for days, weeks, or months and may begin gradually or suddenly. They are followed by a period of normal mood or by an episode of depression. Initial episodes of mania frequently occur between ages 15 and 25.
Bipolar disorder affects an equal number of men and women. It tends to run in families; up to 90 percent of those affected have a relative with either bipolar disorder or depression. The illness also has been linked to both an imbalance in brain chemistry and a deficiency in the production of certain hormones (substances produced by the body that control key bodily functions). The severe mood swings characteristic of the disorder can seriously affect a person’s life, upsetting personal relationships and disrupting routines at work. Although everyday occurrences can trigger a manic episode, dates that have significant meaning for the person, such as the anniversary of a parent’s death, are especially likely to trigger one.
Like depression, bipolar disorder is readily treatable, but because the affected person feels so elated and invincible, he or she may dismiss the need for treatment or refuse to comply with prescribed treatment. Medications that are most commonly used to treat bipolar disorder include mood stabilizers (such as lithium), antidepressants (such as fluoxetine or bupropion), and antipsychotic drugs (such as haloperidol), often in combination. The hallmark mood stabilizer for bipolar disorder is lithium carbonate, a naturally occurring mineral salt. Lithium controls the manic phase of bipolar disorder by affecting the central nervous system’s control over emotion. Its effectiveness depends on the amount of the drug in the bloodstream, so lithium must be taken exactly as prescribed. A blood test can be performed to ensure a therapeutic level. For people who do not respond well to lithium, doctors may use other mood stabilizers, such as divalproex sodium or carbamazepine. Most mood stabilizers produce side effects, including weight gain, thirst, hand tremors, and muscle weakness.
Doctors may prescribe antidepressants during the depressive phase of bipolar disorder, but they usually instruct the person to resume taking a mood stabilizer once the depressive phase has ended. Antipsychotic drugs are used predominantly for people whose manic phase has escalated into a psychotic episode (loss of awareness of reality).
Psychotherapy, also called talk therapy, can boost the effectiveness of the drugs used to treat bipolar disorder by helping those with the illness learn how to become more aware of their symptoms, deal with stressful life events, and comply with drug treatment. This kind of therapy works best when the therapist is experienced in treating bipolar disorder. Because families also are affected by the disorder, family members may be offered counseling to help strengthen relationships that have been strained by the illness. People with very severe cases of bipolar disorder may need hospitalization or, in extreme cases, electroconvulsive therapy, in which a current of electricity is passed through the brain to induce seizures. This treatment may be highly effective within a few weeks (usually three treatments per week). Memory loss may occur, but the memory returns within a few months.
Seasonal Affective Disorder
Seasonal affective disorder (SAD) is a type of mood disorder that brings on depression when the seasons change. The most common type of SAD is known as winter depression, which usually starts in the late fall or early winter and ends in spring. Many people without SAD feel “blue” and more fatigued when the days get shorter. However, people with winter depression experience true depression, along with symptoms that are not typical of a depressive disorder, including excessive sleeping, increased appetite, a craving for high-carbohydrate foods, irritability, and weight gain. A smaller number of people experience another form of the disorder known as summer depression, which usually begins in late spring or early summer. Signs of summer depression include the more typical depressive symptoms of decreased appetite, weight loss, and sleeplessness. The cause of summer depression is not known. Both forms of SAD seem to recur at the same time each year. SAD can occur along with a bipolar disorder or depression. Women are affected by SAD four times as often as men.
Doctors think that winter depression may be brought on by the reduction in the amount of sunlight that occurs during the winter months. A good argument for this theory is that SAD is more common in people living in the northern latitudes than in those living farther south. In addition, artificial, bright-light therapy, also known as phototherapy, is very effective in treating winter depression. In a typical phototherapy session, people with the disorder sit in front of a desktop light box or wear a light visor, initially for 10 to 15 minutes per day, increasing to 30 to 45 minutes per day. Benefits may not be seen for several days to several weeks. It is important to continue phototherapy until spring, when the person can obtain increased natural light from the sun. Phototherapy appears to have few side effects, although some people may experience headaches, fatigue, irritability, and insomnia if they take light therapy too late in the day. These side effects can be reduced by sitting farther from the light source or by decreasing the length of the phototherapy sessions.
Tanning beds are not recommended for the treatment of winter depression because they emit high levels of ultraviolet rays, which are harmful to the eyes and the skin. Phototherapy is often combined with drug therapy or psychotherapy to treat winter depression. The drug of choice for this type of SAD is called a monoamine oxidase inhibitor (such as isocarboxazid or phenelzine).
Doctors treat summer depression differently than the winter form of SAD. Summer depression responds better to the antidepressants usually prescribed for nonseasonal depression.
Categories : Mental Disorders
