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What is Mental Illness?
A mental illness is a treatable brain disease. It is a flaw in brain chemistry and not a character flaw.
The following two paragraphs are extracted from “Information About Mental Illness and the Brain” published by the National Institute of Mental Health. Click “more information” at the end of the second paragraph to continue reading this article.
We can all be “sad” or “blue” at times in our lives. We have all seen movies about the madman and his crime spree, with the underlying cause of mental illness. We sometimes even make jokes about people being crazy or nuts, even though we know that we shouldn’t. We have all had some exposure to mental illness, but do we really understand it or know what it is? Many of our preconceptions are incorrect. A mental illness can be defined as a health condition that changes a person’s thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning. As with many diseases, mental illness is severe in some cases and mild in others. Individuals who have a mental illness don’t necessarily look like they are sick, especially if their illness is mild. Other individuals may show more explicit symptoms such as confusion, agitation, or withdrawal. There are many different mental illnesses, including depression, schizophrenia, attention deficit hyperactivity disorder (ADHD), autism, and obsessive-compulsive disorder. Each illness alters a person’s thoughts, feelings, and/or behaviors in distinct ways. In this module, we will at times discuss mental illness in general terms and at other times, discuss specific mental illnesses. Depression, schizophrenia, and ADHD will be presented in greater detail than other mental illnesses.
Not all brain diseases are categorized as mental illnesses. Disorders such as epilepsy, Parkinson’s disease, and multiple sclerosis are brain disorders, but they are considered neurological diseases rather than mental illnesses. Interestingly, the lines between mental illnesses and these other brain or neurological disorders is blurring somewhat. As scientists continue to investigate the brains of people who have mental illnesses, they are learning that mental illness is associated with changes in the brain’s structure, chemistry, and function and that mental illness does indeed have a biological basis. This ongoing research is, in some ways, causing scientists to minimize the distinctions between mental illnesses and these other brain disorders. In this curriculum supplement, we will restrict our discussion of mental illness to those illnesses that are traditionally classified as mental illnesses, as listed in the previous paragraph. more information
Simply stated, mental illnesses are disorders of the brain affecting the whole person, both the body and the mind. Mental illness can affect anyone regardless of age, economic background, race and whether or not there is a family history of mental illness. There are many causes of mental illnesses such as birth trauma, chemical imbalances in the brain, and other biological, environmental, social and cultural factors.
The good news is that more information is available today about the human brain than ever before. As a result, people are learning that a mental illness does not mean you are “crazy” or that you should be able to simple “snap out of it;” or, if you are experiencing a mental illness, it is not due to “personal weakness” or “a flaw in character.”
Some of the major mental illnesses are:
Affective disorders, sometimes called “mood disorders,” include severe depression, mania or bipolar-depressive illnesses;
Schizophrenic disorders are a large group of disorders of differing origins and include such symptoms as delusions (false beliefs, despite obvious proof to the contrary), hallucinations. (seeing or hearing things that are not present), thought disorders (manifested by disconnected speech or, in severe cases, incoherence), loss of self-identity, withdrawal from the outside world, and abnormal psychomotor activity (rocking, pacing, or immobility).
Anxiety disorders, although a prominent symptom of both schizophrenia and the affective disorders, in another group of disorders anxiety is the major symptom. This includes fear or anxiety that is severe or lasting such as generalize anxiety, agoraphobia and simple phobias, post-traumatic stress disorder, panic attacks, and obsessive-compulsive disorders;
Personality disorders such as antisocial personality, border-line personality and paranoid personality are demonstrated in individuals who have a general failure to adjust to socially acceptable norms of behavior and are incapable of establishing adequate social relationships.
Some other kinds of mental illness are:
Dementia (such as Alzheimer’s disease);
Eating disorders such as bulimia and anorexia nervosa;
Alcohol and other drug abuse;
Psychoses and conduct disorders.
If mental illness doesn’t affect you directly, it could affect someone close to you, thus affecting you indirectly. Mental illness is a treatable disease and with proper treatment, people can get well and lead productive lives.
(The following information was extracted from the National Institute of Mental Health website. Click http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml for additional information)
Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, and keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder.
People with anxiety disorders feel extremely fearful and unsure. Most people feel anxious about something for a short time now and again, but people with anxiety disorders feel this way most of the time. Their fears and worries make it hard for them to do everyday tasks.
Five major types of anxiety disorders are:
All of us worry about things like health, money, or family problems at one time or another. But people with GAD are extremely worried about these and many other things, even when there is little or no reason to worry about them. They may be very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks.
GAD develops slowly. It often starts during the time between childhood and middle age. Symptoms may get better or worse at different times, and often are worse during times of stress.
People with GAD may visit a doctor many times before they find out they have this disorder. They ask their doctors to help them with the signs of GAD, such as headaches or trouble falling asleep, but dont always get the help they need right away. It may take doctors some time to be sure that a person has GAD instead of something else.
Common symptoms of GAD:
worry very much about everyday things for at least six months, even if there is little or no reason to worry about them;
cant control their constant worries;
know that they worry much more than they should;
have a hard time concentrating;
are easily startled; and
have trouble falling asleep or staying asleep.
common body symptoms are:
feeling tired for no reason
muscle tension and aches
having a hard time swallowing
trembling or twitching
feeling out of breath
having to go to the bathroom a lot
Everyone double-checks things sometimes – for example, checking the stove before leaving the house, to make sure it’s turned off. But people with OCD feel the need to check things over and over, or have certain thoughts or perform routines and rituals over and over. The thoughts and rituals of OCD cause distress and get in the way of daily life.
The repeated, upsetting thoughts of OCD are called obsessions. To try to control them, people with OCD repeat rituals or behaviors, which are called compulsions. People with OCD can’t control these thoughts and rituals.
Examples of obsessions are fear of germs, of being hurt or of hurting others, and troubling religious or sexual thoughts. Examples of compulsions are repeatedly counting things, cleaning things, washing the body or parts of it, or putting things in a certain order, when these actions are not needed, and checking things over and over.
People with OCD have these thoughts and do these rituals for at least an hour on most days, often longer. The reason OCD gets in the way of their lives is that they can’t stop the thoughts or rituals, so they sometimes miss school, work, or meetings with friends, for example.
For many people, OCD starts during childhood or the teen years. Most people are diagnosed at about age 19. Symptoms of OCD may come and go and be better or worse at different times.
People with OCD:
have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly neat.
do the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again.
have unwanted thoughts and behaviors they can’t control.
don’t get pleasure from the behaviors or rituals, but get brief relief from the anxiety the thoughts cause.
spend at least an hour a day on the thoughts and rituals, which cause distress and get in the way of daily life.
Panic disorder is a real illness that can be successfully treated. It is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.
Common Symptoms of Panic Disorder
A fear of one’s own unexplained physical symptoms is also a symptom of panic disorder. People having panic attacks sometimes believe they are having heart attacks, losing their minds, or on the verge of death. They can’t predict when or where an attack will occur, and between episodes many worry intensely and dread the next attack.
Panic attacks can occur at any time, even during sleep. An attack usually peaks within 10 minutes, but some symptoms may last much longer. Panic disorder affects about 6 million American adults and is twice as common in women as men. Panic attacks often begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another. The tendency to develop panic attacks appears to be inherited.
Post-traumatic stress disorder (PTSD) is a real illness. It is an anxiety disorder that some people develop after seeing or living through an event that caused or threatened serious harm or death. PTSD can happen to anyone at any age. Children get PTSD too.
You dont have to be physically hurt to get PTSD. You can get it after you see other people, such as a friend or family member, get hurt. Living through or seeing something thats upsetting and dangerous can cause PTSD. This can include:
Being a victim of or seeing violence
The death or serious illness of a loved one
War or combat
Car accidents and plane crashes
Hurricanes, tornadoes, and fires
Violent crimes, like a robbery or shooting
Common Symptoms of PTSD
Its natural to be afraid when youre in danger. Its natural to be upset when something bad happens to you or someone you know. But if you feel afraid and upset weeks or months later, its time to talk with your doctor. You might have post-traumatic stress disorder.
Symptoms include flashbacks or bad dreams, emotional numbness, intense guilt or worry, angry outbursts, feeling “on edge,” or avoiding thoughts and situations that remind them of the trauma. In PTSD, these symptoms last at least one month.
Flashbacks, or feeling like the scary event is happening again
Scary thoughts you cant control
Staying away from places and things that remind you of what happened
Feeling worried, guilty, or sad
Feeling on edge
Thoughts of hurting yourself or others.
Children who have PTSD may show other types of problems. These can include:
Behaving like they did when they were younger
Being unable to talk
Complaining of stomach problems or headaches a lot
Refusing to go places or play with friends
Social phobia usually starts during the child or teen years, usually at about age 13. A doctor can tell that a person has social phobia if the person has had symptoms for at least six months. Without treatment, social phobia can last for many years or a lifetime.
Social phobia (or social anxiety disorder) is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of going to work or school or doing other everyday things.
People with social phobia are afraid of doing common things in front of other people; for example, they might be afraid to sign a check in front of a cashier at the grocery store, or they might be afraid to eat or drink in front of other people. All of us have been a little bit nervous, at one time or another, about things like meeting new people or giving a speech; however, people with social phobia worry about these and other things for weeks before they happen.
Most of the people who have social phobia know that they shouldnt be as afraid as they are, but they cant control their fear. Sometimes, they end up staying away from places or events where they think they might have to do something that will embarrass them. That can keep them from doing the everyday tasks of living and from enjoying times with family and friends.
Common symptoms of social phobia:
are very anxious about being with other people.
are very self-conscious in front of other people; that is, they are very worried about how they themselves will act.
are very afraid of being embarrassed in front of other people.
are very afraid that other people will judge them.
worry for days or weeks before an event where other people will be.
stay away from places where there are other people.
have a hard time making friends and keeping friends.
may have body symptoms when they are with other people, such as:
(The following information was extracted from the National Institute of Mental Health website. Click http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml for additional information)
What is attention deficit hyperactivity disorder?
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).
ADHD has three subtypes:
- Predominantly hyperactive-impulsive
- Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
- Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.
- Predominantly inattentive
- The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.
- Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.
- Combined hyperactive-impulsive and inattentive
- Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.
- Most children have the combined type of ADHD.
Treatments can relieve many of the disorders symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.
What are the symptoms of ADHD in children?
Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.
Children who have symptoms of inattention may:
- Be easily distracted, miss details, forget things, and frequently switch from one activity to another
- Have difficulty focusing on one thing
- Become bored with a task after only a few minutes, unless they are doing something enjoyable
- Have difficulty focusing attention on organizing and completing a task or learning something new
- Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
- Not seem to listen when spoken to
- Daydream, become easily confused, and move slowly
- Have difficulty processing information as quickly and accurately as others
- Struggle to follow instructions.
Children who have symptoms of hyperactivity may:
- Fidget and squirm in their seats
- Talk nonstop
- Dash around, touching or playing with anything and everything in sight
- Have trouble sitting still during dinner, school, and story time
- Be constantly in motion
- Have difficulty doing quiet tasks or activities.
Children who have symptoms of impulsivity may:
- Be very impatient
- Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
- Have difficulty waiting for things they want or waiting their turns in games
- Often interrupt conversations or others activities.
ADHD Can Be Mistaken for Other Problems
Parents and teachers can miss the fact that children with symptoms of inattention have the disorder because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, compared with those with the other subtypes, who tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive subtypes just have emotional or disciplinary problems.
How is ADHD diagnosed?
If ADHD is suspected, the diagnosis should be made by a professional with training in ADHD. This includes child psychiatrists, psychologists, developmental/behavioral pediatricians, behavioral neurologists, and clinical social workers. After ruling out other possible reasons for the child’s behavior, the specialist checks the child’s school and medical records and talks to teachers and parents who have filled out a behavior rating scale for the child. A diagnosis is made only after all this information has been considered. More about Diagnosis
How is ADHD treated?
Currently available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education or training, or a combination of treatments. More about Treatment
If unsure where to go for help, talk to someone you trust who has experience in mental health—for example, a doctor, nurse, social worker, or religious counselor. Ask their advice on where to seek treatment. If there is a university nearby, its departments of psychiatry or psychology may offer private and/or sliding-scale fee clinic treatment options. Otherwise, check the Yellow Pages under "mental health," "health," "social services," "crisis intervention services," "hotlines," "hospitals," or "physicians" for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for a mental health problem, and will be able to tell you where and how to get further help.
Follow this link to the National Institutes of Mental Health brochure about Attention Deficit Hyperactivity Disorder: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml
(The following information was extracted from the National Institute of Mental Health website. Go to http://www.nimh.nih.gov/health/publications/autism/complete-index.shtml for additional information)
What are Autism Spectrum Disorders?
Autism Spectrum Disorders (ASD), also known as Pervasive evelopmental Disorders (PDDs), cause severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. These disorders are usually first diagnosed in early childhood and range from a severe form, called autistic disorder, through pervasive development disorder not otherwise specified (PDD-NOS), to a much milder form, Asperger syndrome. They also include two rare disorders, Rett syndrome and childhood disintegrative disorder.
Common Symptoms of Autism Spectrum Disorders
Parents are usually the first to notice unusual behaviors in their child. In some cases, the baby seemed "different" from birth, unresponsive to people or focusing intently on one item for long periods of time. The first signs of an autism spectrum disorder can also appear in children who had been developing normally. When an affectionate, babbling toddler suddenly becomes silent, withdrawn, self-abusive, or indifferent to social overtures, something is wrong.
(The following information was extracted from the National Institute of Mental Health website. Go to http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml for additional information)
What is bipolar disorder?
Bipolar disorder is a serious brain illness. It is also called manic-depressive illness. People with bipolar disorder go through unusual mood changes. Sometimes they feel very happy and "up," and are much more active than usual. This is called mania. And sometimes people with bipolar disorder feel very sad and "down," and are much less active. This is called depression. Bipolar disorder can also cause changes in energy and behavior.
Bipolar disorder is not the same as the normal ups and downs everyone goes through. Bipolar symptoms are more powerful than that. They can damage relationships and make it hard to go to school or keep a job. They can also be dangerous. Some people with bipolar disorder try to hurt themselves or attempt suicide.
People with bipolar disorder can get treatment. With help, they can get better and lead successful lives.
Common Symptoms of Bi-polar Disorder
Bipolar mood changes are called "mood episodes." People may have manic episodes, depressive episodes, or "mixed" episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that last a week or two-sometimes longer. During an episode, the symptoms last every day for most of the day.
Mood episodes are intense. The feelings are strong and happen along with extreme changes in behavior and energy levels.
People having a manic episode may:
Feel very "up" or "high"
Feel "jumpy" or "wired"
Talk really fast about a lot of different things
Be agitated, irritable, or "touchy"
Have trouble relaxing or sleeping
Think they can do a lot of things at once and are more active than usual
Do risky things, like spend a lot of money or have reckless sex.
People having a depressive episode may:
Feel very "down" or sad
Feel worried and empty
Have trouble concentrating
Forget things a lot
Lose interest in fun activities and become less active
Feel tired or "slowed down"
Have trouble sleeping
Think about death or suicide.
How is bipolar disorder different in children and teens than it is in adults?
When children develop the illness, it is called early-onset bipolar disorder. This type can be more severe than bipolar disorder in older teens and adults. Also, young people with bipolar disorder may have symptoms more often and switch moods more frequently than adults with the illness.
Can bipolar disorder coexist with other problems?
Yes. Sometimes people having very strong mood episodes may have psychotic symptoms. These are strong symptoms that cause hallucinations (when people believe things that are not real). People with mania and psychotic symptoms may believe they are rich and famous, or have special powers. People with depression and psychotic symptoms may believe they have committed a crime or that their lives are ruined.
Sometimes behavior problems go along with mood episodes. A person may drink too much or take drugs. Some people take a lot of risks, like spending too much money or having reckless sex. These problems can damage lives and hurt relationships. Some people with bipolar disorder have trouble keeping a job or doing well in school.
(The following information was extracted from the National Institute of Mental Health website. Go to http://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/index.shtml for additional information)
Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individuals sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.
Common Symptoms of BPD
While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.
People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.
(The following information was extracted from the National Institute of Mental Health website. Go to http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml for additional information)
Warning Signs of Depression
Warning Signs of Suicide
Depression Screening Test
What Is Depression?
Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious illness, and most who experience it need treatment to get better.
Many people with a depressive illness never seek treatment. But the vast majority, even those with the most severe depression, can get better with treatment. Intensive research into the illness has resulted in the development of medications, psychotherapies, and other methods to treat people with this disabling disorder.
What are the different forms of depression?
There are several forms of depressive disorders. The most common are major depressive disorder and dysthymic disorder.
Major depressive disorder, also called clinical depression or major depression, is characterized by a combination of symptoms that interfere with a persons ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a persons lifetime, but more often, it recurs throughout a persons life.
Dysthymic disorder, also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.
Some forms of depressive disorder exhibit slightly different characteristics than those described above, or they may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include:
Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions.
Maternal depression, which is diagnosed if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth. (more information)
Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.
Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes-from extreme highs (e.g., mania) to extreme lows (e.g., depression). (more information)
Common symptoms of depression
People with depressive illnesses do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness.
Changes in behavior and attitude – these include
General slowing down or sleeping more
Different Feelings and perceptions – these include
Loss of self-esteem
Emotional flatness or emptiness
Loss of sexual desire
Loss if interest in activities or hobbies one pleasurable
Extreme self-blame or guilt
Suicidal thoughts or actions.
Physical complaints – these include
Loss of appetite, or weight gain
Unexplained headaches, backaches
What illnesses often co-exist with depression?
Depression often co–exists with other illnesses. Such illnesses may precede the depression, cause it, and/or be a consequence of it. It is likely that the mechanics behind the intersection of depression and other illnesses differ for every person and situation. Regardless, these other co–occurring illnesses need to be diagnosed and treated.
Anxiety disorders, such as post–traumatic stress disorder (PTSD), obsessive–compulsive disorder, panic disorder, social phobia and generalized anxiety disorder, often accompany depression. People experiencing PTSD are especially prone to having co-occurring depression. PTSD is a debilitating condition that can result after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat.
People with PTSD often re–live the traumatic event in flashbacks, memories or nightmares. Other symptoms include irritability, anger outbursts, intense guilt, and avoidance of thinking or talking about the traumatic ordeal. In a National Institute of Mental Health (NIMH)–funded study, researchers found that more than 40 percent of people with PTSD also had depression at one-month and four-month intervals after the traumatic event.
Alcohol and other substance abuse or dependence may also co–occur with depression. In fact, research has indicated that the co–existence of mood disorders and substance abuse is pervasive among the U.S. population.
Depression also often co–exists with other serious medical illnesses such as heart disease, stroke, cancer, HIV/aids, diabetes, and Parkinsons disease. Studies have shown that people who have depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co–existing depression.7 Research has yielded increasing evidence that treating the depression can also help improve the outcome of treating the co–occurring illness.
How do women experience depression?
Depression is more common among women than among men. Biological, life cycle, hormonal and psychosocial factors unique to women may be linked to womens higher depression rate. Researchers have shown that hormones directly affect brain chemistry that controls emotions and mood. For example, women are particularly vulnerable to depression after giving birth, when hormonal and physical changes, along with the new responsibility of caring for a newborn, can be overwhelming. Many new mothers experience a brief episode of the "baby blues," but some will develop postpartum depression, a much more serious condition that requires active treatment and emotional support for the new mother. Some studies suggest that women who experience postpartum depression often have had prior depressive episodes.
Some women may also be susceptible to a severe form of premenstrual syndrome (PMS), sometimes called premenstrual dysphoric disorder (PMDD), a condition resulting from the hormonal changes that typically occur around ovulation and before menstruation begins. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.
Finally, many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It remains unclear why some women faced with enormous challenges develop depression, while others with similar challenges do not.
How do men experience depression?
Men often experience depression differently than women and may have different ways of coping with the symptoms. Men are more likely to acknowledge having fatigue, irritability, loss of interest in once pleasurable activities, and sleep disturbances, whereas women are more likely to admit to feelings of sadness, worthlessness and/or excessive guilt.
Men are more likely than women to turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, irritable, angry and sometimes abusive. Some men throw themselves into their work to avoid talking about their depression with family or friends, or engage in reckless, risky behavior. And even though more women attempt suicide, many more men die by suicide in the United States.
How do older adults experience depression?
Depression is not a normal part of aging, and studies show that most seniors feel satisfied with their lives, despite increased physical ailments. However, when older adults do have depression, it may be overlooked because seniors may show different, less obvious symptoms, and may be less inclined to experience or acknowledge feelings of sadness or grief.
In addition, older adults may have more medical conditions such as heart disease, stroke or cancer, which may cause depressive symptoms, or they may be taking medications with side effects that contribute to depression. Some older adults may experience what some doctors call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. Such hardening of vessels prevents normal blood flow to the bodys organs, including the brain. Those with vascular depression may have, or be at risk for, a co–existing cardiovascular illness or stroke.
Although many people assume that the highest rates of suicide are among the young, older white males age 85 and older actually have the highest suicide rate. Many have a depressive illness that their doctors may not detect, despite the fact that these suicide victims often visit their doctors within one month of their deaths.
The majority of older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both. Research has shown that medication alone and combination treatment are both effective in reducing the rate of depressive recurrences in older adults. Psychotherapy alone also can be effective in prolonging periods free of depression, especially for older adults with minor depression, and it is particularly useful for those who are unable or unwilling to take antidepressant medication.
How do children and adolescents experience depression?
Only in the past two decades have scientists and doctors begun to take seriously the risk of depression in children. Research has shown that childhood depression often persists, recurs and continues into adulthood, especially if it goes untreated. The presence of childhood depression also tends to be a predictor of more severe illnesses in adulthood.
A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to accurately diagnose a young person with depression.
Before puberty, boys and girls are equally likely to develop depressive disorders. By age 15, however, girls are twice as likely as boys to have experienced a major depressive episode.
Depression in adolescence comes at a time of great personal change–when boys and girls are forming an identity distinct from their parents, grappling with gender issues and emerging sexuality, and making decisions for the first time in their lives. Depression in adolescence frequently co–occurs with other disorders such as anxiety, disruptive behavior, eating disorders or substance abuse. It can also lead to increased risk for suicide.
Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary "phase" or is suffering from depression. Sometimes the parents become worried about how the childs behavior has changed, or a teacher mentions that "your child doesnt seem to be himself." In such a case, if a visit to the childs pediatrician rules out physical symptoms, the doctor will probably suggest that the child be evaluated, preferably by a psychiatrist or psychologist who specializes in the treatment of children.
Taking a depression-screening test is one of the quickest and easiest ways to determine whether you are experiencing symptoms of clinical depression. The depression-screening test on the Mental Health America website is completely anonymous and confidential.
This depression-screening test is NOT designed to respond to suicide crisis. If you believe you are at risk for suicide ……
- Dial 911 or go immediately to the nearest hospital Emergency Room for an evaluation.
- Call 703.777.0320 to reach emergency intervention services for people in Loudoun County who are experiencing severe emotional crises. Services are provided by Loudoun County’s Division of Mental Health and Substance Abuse Services.
- Call 703.527.4077 to reach the Crisis Link Regional Hotline.
- Call 1.800.273.TALK to reach the National Suicide Prevention Lifeline.
Click here to take the confidential depression-screening test on Mental Health America website.
(The following information was extracted from the National Institute of Mental Health website. Go to http://www.nimh.nih.gov/health/publications/eating-disorders/complete-index.shtml for additional information)
Binge Eating Disorders
Eating Disorders Not Otherwise Specified (EDNOS)
What Are Eating Disorders?
An eating disorder is marked by extremes. It is present when a person experiences severe disturbances in eating behavior, such as extreme reduction of food intake or extreme overeating, or feelings of extreme distress or concern about body weight or shape.
A person with an eating disorder may have started out just eating smaller or larger amounts of food than usual, but at some point, the urge to eat less or more spirals out of control. Eating disorders are very complex, and despite scientific research to understand them, the biological, behavioral and social underpinnings of these illnesses remain elusive.
The two main types of eating disorders are anorexia nervosa and bulimia nervosa. A third category is "eating disorders not otherwise specified (EDNOS)," which includes several variations of eating disorders. Most of these disorders are similar to anorexia or bulimia but with slightly different characteristics. Binge-eating disorder, which has received increasing research and media attention in recent years, is one type of EDNOS.
Eating disorders frequently appear during adolescence or young adulthood, but some reports indicate that they can develop during childhood or later in adulthood. Women and girls are much more likely than males to develop an eating disorder. Men and boys account for an estimated 5 to 15 percent of patients with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorder. Eating disorders are real, treatable medical illnesses with complex underlying psychological and biological causes. They frequently co-exist with other psychiatric disorders such as depression, substance abuse, or anxiety disorders. People with eating disorders also can suffer from numerous other physical health complications, such as heart conditions or kidney failure, which can lead to death.
How Are Men And Boys Affected?
Although eating disorders primarily affect women and girls, boys and men are also vulnerable. One in four preadolescent cases of anorexia occurs in boys, and binge-eating disorder affects females and males about equally.
Like females who have eating disorders, males with the illness have a warped sense of body image and often have muscle dysmorphia, a type of disorder that is characterized by an extreme concern with becoming more muscular.
Some boys with the disorder want to lose weight, while others want to gain weight or "bulk up." Boys who think they are too small are at a greater risk for using steroids or other dangerous drugs to increase muscle mass.
Boys with eating disorders exhibit the same types of emotional, physical and behavioral signs and symptoms as girls, but for a variety of reasons, boys are less likely to be diagnosed with what is often considered a stereotypically "female" disorder
Anorexia nervosa is characterized by emaciation, a relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight, a distortion of body image and intense fear of gaining weight, a lack of menstruation among girls and women, and extremely disturbed eating behavior. Some people with anorexia lose weight by dieting and exercising excessively; others lose weight by self-induced vomiting, or misusing laxatives, diuretics or enemas.
Many people with anorexia see themselves as overweight, even when they are starved or are clearly malnourished. Eating, food and weight control become obsessions. A person with anorexia typically weighs herself or himself repeatedly, portions food carefully, and eats only very small quantities of only certain foods. Some who have anorexia recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic form of anorexia, in which their health deteriorates over many years as they battle the illness.
According to some studies, people with anorexia are up to ten times more likely to die as a result of their illness compared to those without the disorder. The most common complications that lead to death are cardiac arrest, and electrolyte and fluid imbalances. Suicide also can result.
Many people with anorexia also have coexisting psychiatric and physical illnesses, including depression, anxiety, obsessive behavior, substance abuse, cardiovascular and neurological complications, and impaired physical development.
Other symptoms may develop over time, including:
- thinning of the bones (osteopenia or osteoporosis)
- brittle hair and nails
- dry and yellowish skin
- growth of fine hair over body (e.g., lanugo)
- mild anemia, and muscle weakness and loss
- severe constipation
- low blood pressure, slowed breathing and pulse
- drop in internal body temperature, causing a person to feel cold all the time
Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food (e.g., binge-eating), and feeling a lack of control over the eating. This binge-eating is followed by a type of behavior that compensates for the binge, such as purging (e.g., vomiting, excessive use of laxatives or diuretics), fasting and/or excessive exercise.
Unlike anorexia, people with bulimia can fall within the normal range for their age and weight. But like people with anorexia, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly, because it is often accompanied by feelings of disgust or shame. The binging and purging cycle usually repeats several times a week. Similar to anorexia, people with bulimia often have coexisting psychological illnesses, such as depression, anxiety and/or substance abuse problems. Many physical conditions result from the purging aspect of the illness, including electrolyte imbalances, gastrointestinal problems, and oral and tooth-related problems.
Other symptoms include:
- chronically inflamed and sore throat
- swollen glands in the neck and below the jaw
- worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acids
- gastroesophageal reflux disorder
- intestinal distress and irritation from laxative abuse
- kidney problems from diuretic abuse
- severe dehydration from purging of fluids
Binge-eating disorder is characterized by recurrent binge-eating episodes during which a person feels a loss of control over his or her eating. Unlike bulimia, binge-eating episodes are not followed by purging, excessive exercise or fasting. As a result, people with binge-eating disorder often are overweight or obese. They also experience guilt, shame and/or distress about the binge-eating, which can lead to more binge-eating.
Obese people with binge-eating disorder often have coexisting psychological illnesses including anxiety, depression, and personality disorders. In addition, links between obesity and cardiovascular disease and hypertension are well documented.
Eating disorder not otherwise specified (EDNOS) involves disordered eating patterns. EDNOS is described in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) as a "category [of] disorders of eating that do not meet the criteria for any specific eating disorder".
This category is frequently used to describe people who meet some, but not all, of the diagnostic criteria for anorexia nervosa or bulimia nervosa. For example, a person who shows almost all of the symptoms of anorexia nervosa, but who still has a normal menstrual cycle and/or body mass index can be diagnosed with EDNOS. A sufferer may experience episodes of binging and purging but may not do so frequently enough to warrant a diagnosis of bulimia nervosa. A person may also engage in binging episodes without the use of inappropriate compensatory behaviors; this is referred to as binge eating disorder.
People diagnosed with EDNOS may frequently switch between different eating disorders, or may with time fit all diagnostic criteria for anorexia or bulimia.
In general, clinical depression occurs in approximately 15 to 25 percent of the population, and women are twice as likely as men to experience depression. Because women are most likely to experience depression during the primary reproductive years (25 to 45), they are especially vulnerable to developing depression during pregnancy and after childbirth. Women who develop these disorders do not need to feel ashamed or alone; treatment and support are available.
Maternal depression encompasses a wide range of mood disorders that can affect a woman during pregnancy and after the birth of her child. It includes prenatal depression, the "baby blues," postpartum depression, and postpartum psychosis.
While many of the symptoms are the same across categories, a woman with postpartum depression experiences these symptoms much more strongly and can be impaired to the point where she is unable to do things she needs to do everyday. Unlike the baby blues which begin shortly after delivery, and resolve within a couple of weeks, postpartum depression can begin at anytime during the first year after giving birth and can last longer than baby blues. While a serious condition, it can be treated successfully with medication and counseling.
If a woman feels she might be experiencing maternal depression and her condition interferes in any way with her ability to do what she needs to do, it might be serious. She should not be afraid to tell her doctor if she has suicidal thoughts or has obsessive thoughts of harming herself or her baby.
Postpartum psychosis usually presents within a few days to a month after delivery, but can occur anytime during the first year. Symptoms may appear abruptly. This disorder has a 5% suicide rate and a 4% infanticide rate. Postpartum psychosis is a severe but treatable emergency and requires immediate admission to a psychiatric facility.
Risk Factors for perinatal depression.
Prior episodes of postpartum depression, depression during pregnancy, personal or family history of depression, unplanned pregnancy, complications during pregnancy or childbirth, preterm birth, abrupt weaning, poor support from a partner, being a single parent, having a history of severe PMS, experiencing multiple or stressful life events, social isolation, history of childhood trauma or abuse, and substance abuse.Treatment of maternal depression:
The two most common forms of treatment are psychotherapy and medications. The type of treatment will depend on the severity of the depression. If a woman is pregnant, plans on breastfeeding, or is breastfeeding, she needs to consult with a qualified physician who is knowledgeable about the latest research on the teratogenic effects of psychotropic medications. Non-clinical interventions such as rest, exercise, or a change in diet can sometimes be helpful. Also, finding a support group where other women having similar experiences willingly share their experiences can reassure the mother that she is not alone. For additional information, follow this link: http://postpartum.net/
( PSI:Postpartum Support International)
(The following information was extracted from the National Institute of Mental Health website. Go to http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml for additional information)
Schizophrenia is a chronic, severe, and disabling brain disorder that has been recognized throughout recorded history. It affects about 1 percent of Americans. People with schizophrenia may hear voices other people dont hear or they may believe that others are reading their minds, controlling their thoughts, or plotting to harm them. These experiences are terrifying and can cause fearfulness, withdrawal, or extreme agitation. People with schizophrenia may not make sense when they talk, may sit for hours without moving or talking much, or may seem perfectly fine until they talk about what they are really thinking. Because many people with schizophrenia have difficulty holding a job or caring for themselves, the burden on their families and society is significant as well.
Available treatments can relieve many of the disorders symptoms, but most people who have schizophrenia must cope with some residual symptoms as long as they live. Nevertheless, this is a time of hope for people with schizophrenia and their families. Many people with the disorder now lead rewarding and meaningful lives in their communities. Researchers are developing more effective medications and using new research tools to understand the causes of schizophrenia and to find ways to prevent and treat it.
Common Symptoms of Schizophrenia
The symptoms of schizophrenia fall into three broad categories:
- Positive symptoms are unusual thoughts or perceptions, including hallucinations, delusions, thought disorder, and disorders of movement.
- Negative symptoms represent a loss or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure in everyday life. These symptoms are harder to recognize as part of the disorder and can be mistaken for laziness or depression.
- Cognitive symptoms (or cognitive deficits) are problems with attention, certain types of memory, and the executive functions that allow us to plan and organize. Cognitive deficits can also be difficult to recognize as part of the disorder but are the most disabling in terms of leading a normal life.
Positive symptoms are easy-to-spot behaviors not seen in healthy people and usually involve a loss of contact with reality. They include hallucinations, delusions, thought disorder, and disorders of movement. Positive symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment.
Hallucinations. A hallucination is something a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices that may comment on their behavior, order them to do things, warn them of impending danger, or talk to each other (usually about the patient). They may hear these voices for a long time before family and friends notice that something is wrong. Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects (although this can also be a symptom of certain brain tumors), and feeling things like invisible fingers touching their bodies when no one is near.
Delusions. Delusions are false personal beliefs that are not part of the persons culture and do not change, even when other people present proof that the beliefs are not true or logical. People with schizophrenia can have delusions that are quite bizarre, such as believing that neighbors can control their behavior with magnetic waves, people on television are directing special messages to them, or radio stations are broadcasting their thoughts aloud to others. They may also have delusions of grandeur and think they are famous historical figures. People with paranoid schizophrenia can believe that others are deliberately cheating, harassing, poisoning, spying upon, or plotting against them or the people they care about. These beliefs are called delusions of persecution.
Thought Disorder. People with schizophrenia often have unusual thought processes. One dramatic form is disorganized thinking, in which the person has difficulty organizing his or her thoughts or connecting them logically. Speech may be garbled or hard to understand. Another form is "thought blocking," in which the person stops abruptly in the middle of a thought. When asked why, the person may say that it felt as if the thought had been taken out of his or her head. Finally, the individual might make up unintelligible words, or "neologisms."
Disorders of Movement. People with schizophrenia can be clumsy and uncoordinated. They may also exhibit involuntary movements and may grimace or exhibit unusual mannerisms. They may repeat certain motions over and over or, in extreme cases, may become catatonic. Catatonia is a state of immobility and unresponsiveness. It was more common when treatment for schizophrenia was not available; fortunately, it is now rare.2
The term "negative symptoms" refers to reductions in normal emotional and behavioral states. These include the following:
- flat affect (immobile facial expression, monotonous voice),
- lack of pleasure in everyday life,
- diminished ability to initiate and sustain planned activity, and
- speaking infrequently, even when forced to interact.
People with schizophrenia often neglect basic hygiene and need help with everyday activities. Because it is not as obvious that negative symptoms are part of a psychiatric illness, people with schizophrenia are often perceived as lazy and unwilling to better their lives.
Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed. They include the following:
- poor "executive functioning" (the ability to absorb and interpret information and make decisions based on that information),
- inability to sustain attention, and
- problems with "working memory" (the ability to keep recently learned information in mind and use it right away)
Cognitive impairments often interfere with the patients ability to lead a normal life and earn a living. They can cause great emotional distress.
When does it start and who gets it?
Psychotic symptoms (such as hallucinations and delusions) usually emerge in men in their late teens and early 20s and in women in their mid-20s to early 30s. They seldom occur after age 45 and only rarely before puberty, although cases of schizophrenia in children as young as 5 have been reported. In adolescents, the first signs can include a change of friends, a drop in grades, sleep problems, and irritability. Because many normal adolescents exhibit these behaviors as well, a diagnosis can be difficult to make at this stage. In young people who go on to develop the disease, this is called the "prodromal" period.
Research has shown that schizophrenia affects men and women equally and occurs at similar rates in all ethnic groups around the world.
Are people with schizophrenia violent?
People with schizophrenia are not especially prone to violence and often prefer to be left alone. Studies show that if people have no record of criminal violence before they develop schizophrenia and are not substance abusers, they are unlikely to commit crimes after they become ill. Most violent crimes are not committed by people with schizophrenia, and most people with schizophrenia do not commit violent crimes. Substance abuse always increases violent behavior, regardless of the presence of schizophrenia (. If someone with paranoid schizophrenia becomes violent, the violence is most often directed at family members and takes place at home.
What about suicide?
People with schizophrenia attempt suicide much more often than people in the general population. About 10 percent (especially young adult males) succeed. It is hard to predict which people with schizophrenia are prone to suicide, so if someone talks about or tries to commit suicide, professional help should be sought right away.
(The following information was extracted from the Wikipedia website. Go to http://en.wikipedia.org/wiki/Schizoaffective_disorder#Signs_and_symptoms for additional information)
Schizoaffective disorder is a psychiatric diagnosis. It describes episodic disorders where mood and schizophrenic symptoms are both present but a diagnosis of schizophrenia or depressive or manic episodes is not warranted. The disorder usually begins in early adulthood and rarely diagnosed in childhood (prior to age 13). Schizoaffective disorder is more common in women than in men. Despite the greater variety of symptoms, the illness course is more episodic and has an overall more favorable outcome than schizophrenia.
Schizoaffective disorder is classified by the ICD into five types: manic, depressive, mixed(manic and depressive), other and unspecified. The mainstay of treatment is pharmacotherapy with an antipsychotic and an antidepressant and/or mood stabilizer. Psychotherapy, vocational and social rehabilitation are also used.
If you or someone you know is in crisis, call
- 911 (local emergency services in Loudoun County)
- 703.777.0320 (Emergency Intervention Services, Loudoun County Mental Health)
- 703.547.4077 (Crisis Link Regional Hotline)
- 1.800.273.TALK (National Suicide Prevention Hotline)
What is Mental Health | Child and Adolescent Mental Health | Recovery From Mental Illnesses |
Mental Illnesses and Disorders | Depression Screening Test |Suicide Prevention |
Warning Signs of Depression | Warning Signs of Stress | Warning Signs of Suicide