Posts tagged psychiatry

A common question asked of clinicians is, “What’s the difference between bipolar depression (also known as manic depression) and plain old depression? It’s a simple question to answer, because depression can either be a stand-alone diagnosis, or a part of another disorder, like bipolar. Therefore a mental health professional is going to examine whether there are other symptoms present (or have occurred in the past), to see if the depression is just depression, or whether it’s a part of a larger disorder.

Bipolar Includes Mania & Depression

If bipolar disorder includes a depressed mood, what else does bipolar include? We can find the answer to this question by looking at the old name for bipolar disorder, manic depression. The old name is pretty descriptive — bipolar is a combination of mania and depression, alternating in cycles.

What is mania? If we examine symptoms associated with mania, we see that it includes the following:

· Inflated self-esteem or grandiosity

· Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)

· More talkative than usual or pressure to keep talking

· Flight of ideas or subjective experience that thoughts are racing

· Attention is easily drawn to unimportant or irrelevant items

· Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

· Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

If three or more of these symptoms are present, then a person is considered to have a “manic episode” (or, if it is of less severity and length, a “hypomanic episode”). A manic episode also needs to have lasted for at least a week (a hypomanic episode, just four days) in order to be diagnosed. If an individual has signs that suggest he or she is having or has had a manic or hypomanic episode, in addition to episodes of severe depression, then typically that individual will quality for a bipolar diagnosis.

Depression Has no Mania

In ordinary depression, which clinicians refer to as “major depression” (sorry, there’s no equivalent “minor depression”), no manic or hypomanic episode is prevalent and the individual has no record or indication of having a manic or hypomanic episode in the past. A depressive episode is characterized by the following symptoms:

· Depressed mood most of the day, nearly every day

·  No interest or pleasure in all, or almost all, activities most of the day, nearly every day

· Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

· Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day

· Psychomotor agitation or retardation nearly every day

· Fatigue or loss of energy nearly every day

· Feelings of worthlessness or excessive or inappropriate guilt nearly every day

· Diminished ability to think or concentrate, or indecisiveness, nearly every day

· Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Five or more of these symptoms for longer than two weeks are needed in order to qualify for a depressive diagnosis, with no accompanying manic episode.

Source: http://psychcentral.com/lib/2007/whats-the-difference-between-bipolar-disorder-and-depression/all/1/

Adjustment disorder is a short-term condition that occurs when a person is unable to cope with, or adjust to, a particular source of stress, such as a major life change, loss, or event. Because people with adjustment disorders often have symptoms of depression, it is sometimes called “situational depression.” The type of stress that can trigger adjustment disorder varies depending on the person, but can include:

- Ending of a relationship or marriage

- Losing or changing job

- Death of a loved one

- Developing a serious illness (yourself or a loved one)

- Being a victim of a crime

- Having an accident

- Undergoing a major life change (such as getting married, having a baby, or retiring from a job)

- Living through a disaster, such as a fire, flood, or hurricane

Adjustment disorder can have a wide variety of symptoms, which may include:

- Feelings of hopelessness

- Sadness

- Frequent crying

- Anxiety

- Worry

- Headaches

- Stomach aches

- Heart palpitations

- Withdrawal or isolation from people and social activities

- Absence from work or school

- Dangerous or destructive behavior, such as fighting, reckless driving, and vandalism

- Changes in appetite, either loss of appetite, or overeating

- Problems sleeping

- Feeling tired or without energy

- Increase in the use of alcohol or other drugs

Adjustment disorder can occur in anyone, and at any age.

In terms of treatment, counseling or psychotherapy are the most common approaches.  Therapy helps the person understand how the stressor has affected his or her life. It also helps the person develop better coping skills. Support groups can also be helpful by allowing the person to discuss his or her concerns and feelings with people who are coping with the same stress. In some cases, medication may be used to help control anxiety symptoms or sleeping problems.

Most people with adjustment disorder recover completely. In fact, a person who is treated for adjustment disorder may learn new skills that actually allow him or her to function better than before the symptoms began.

Source: http://www.webmd.com/mental-health/mental-health-adjustment-disorder

Depression can often be difficult to fight as it usually drains you of your energy. And though you can’t overcome it by willpower alone, you still have some control, no matter how you feel. The suggestions below can help you with this.

1. Keep doing the activities you previously enjoyed (even if you don’t enjoy them as much when you’re depressed).

2. Try and build some exercise into your day as it releases endorphins – the body’s “feel good” hormones.

3. Know what your triggers and your risk factors are. For example, loneliness, stress, disappointment and pain are common triggers and risk factors for depression.

4. Stay in touch with your friends. Often those who are depressed start to isolate themselves – but that leads to loneliness - which makes depression worse.

5. Try and maintain some kind of routine, especially when it comes to getting up and going to bed. Taking naps in the daytime can cause insomnia and leave you feeling drained, so you have no energy.

6. Try to get a handle on how much you tend to worry. Take note of your thought patterns; don’t dwell on negatives. Instead, challenge faulty thinking so it’s much less pessimistic … and try to be thankful … and look for positives.

7. Make sure you do things that make you feel more relaxed. Often people who’re depressed feel uptight and agitated. So it’s important that you find things that help you to relax.  

8. Resist the temptation to self-medicate (especially through alcohol or substance abuse.) That will lead to greater problems - and make you feel much worse.

9. Seek out support. Talk to a good friend, or someone that you trust. You’ll usually find there’s someone who genuinely cares.

10. Talk to your doctor. It may be medication is the answer for you so don’t be afraid to try and get professional help.

1. 1 in 5 people in the Western world will battle mental illness. The other 4 in 5 will have a friend, relative, classmate or colleague who suffers from mental illness.

2. Mental illness affects a person’s mood, thought processes and actions. It is usually a source of considerable distress.

3. Symptoms vary depending on the person, and range from mild to severe.

4. Approximately 20% of those diagnosed with some form of mental illness will also battle substance abuse.

5. In terms of onset, 70% of mental health problems first appear in childhood or adolescence.

6. The highest reporting age group are those between 15 and 24 years.

7. Males are 2 to 3 times more likely than females to be diagnosed with some kind of substance dependency. Also, 25% of male drinkers fall into the high-risk drinkers category, compared to only 9% of female drinkers.

8. However, females are approximately 1.5 times more likely to meet the criteria for a mood or anxiety disorder than men.

9. Those in the lowest income households are significantly more likely to report having poor to fair mental health than those in the highest income households.

10. A significant proportion (estimated at around one-third) of those requiring mental health services actually receive the help they need. The majority do not.

11. The fact that people are less likely to tell friends or coworkers that a family member has a mental illness indicates that stigma is a major problem.

12. In fact, when interviewed a large number of people admitted that they would stop socialising with a friend who was known to have a serious mental illness.

13. Almost half the population think the term mental illness is simply an excuse for bad behaviour and/ or a lack of personal responsibility.

14. Mental illness is one of the highest causes of disability and premature death.

15. The World Health Organization estimates that depression will be the single largest medical burden on health by the year 2020.

Myth #1: Mental illnesses are not true illnesses like cancer or heart disease.

Fact: A physical illness like a heart attack can easily be detected by some simple tests. In contrast, mental illness is an invisible disease which can’t be observed by the general public. This can lead to judgment and to prejudice.

Myth #2: People with diagnosed with a mental Illness tend to have a lower IQ.

Fact: Mental Illness affects people across the entire IQ spectrum. In fact, many extremely intelligent people have been diagnosed with mental illness, are able hold down powerful jobs, and carry a high level of responsibility.

Myth #3: Most of those who suffer from mental illness are violent.

Fact: Very few sufferers are actually violent. In fact, research indicates that they are more likely to be victims of violence than perpetrators of violence.

Myth #4: It is mainly women who suffer from mental illness.

Fact: There are millions of people – both men and women - in all of the different mental illness categories.

Myth #5: Most people diagnosed with mental illness were abused as children.

Fact: Although the incidence of some types of mental illness is more highly correlated with childhood abuse, there are many, many people who have never been abused.

Myth #6: A lot of those who claim to be mentally ill are basically just selfish, or self-centred, individuals.

Fact: Many forms of mental illness have been shown to have their roots in chemical and neurological problems in the brains. They are not character defects.

Myth #7: People with mental illness can get better if they just work a bit harder at getting over their issues.

Fact: Although mental illness symptoms can often be managed successfully through a combination of medication and counselling, it is likely that suffers will continue to struggle throughout their life. It’s not just a matter of “trying a bit harder”.

Myth #8: Those who suffer from mental illness will never recover from their disorder.

Fact: Although many sufferers will continue to battle, or will find their symptoms resurface overtime, they can often manage these successfully. Thus, most of them will lead a fulfilling life.

It’s hard to break free from the cycle of self-harm – but a good place to start is by sharing how you feel with a counsellor or therapist. The following guidelines can help with this:

1. First, it takes a lot of courage to talk about self-harm - so be patient and understanding with yourself, and share in a way that is comfortable for you. For example, if talking face-to-face feels too threatening right now then start by writing your experiences down – in an email, a letter, or a journal you can share. Also, only share with others what you’re ready to share, and only answer questions that you feel you want to answer.

2. Second, bear in mind that it’s often very stressful to talk about something as deeply upsetting as self-harm - so you may feel even worse after sharing in a session. Realise that this is normal, and it doesn’t mean you’re worse. Also, old patterns and habits can be difficult to break – but in time you will feel better, less empty and alone.

3. It is often very helpful to isolate the triggers that lead to the feeling that you want to self-harm. Next, brainstorm better ways of dealing with the pain.

4. For example,

(i)  If you turn to self-harm to express how you feel, experiment with using the following instead:

· Art (painting, drawing, and so on)

· Writing (journaling, song writing, poetry, and so on)

· Writing down your feelings - then destroying the paper

· Listening to music that expresses how feel.

(ii) If you use self-harm to calm and soothe yourself

· Try relaxing in the bath, or wrapping yourself up in a cosy, warm blanket

· Spend time playing with your favourite pet

· Talk to a friend

· Listen to relaxing music

(iii) If you cut because you can’t access your feelings

· Talk to a friend (and maybe try to laugh together)

· Try placing an ice cube on different parts of your body

· Eat something with a strong taste, like a grapefruit or salsa

· Find an online self help chat room, and talk to someone there

(iv) If you use self-harm as a means of releasing tension or anger

· Try some vigorous exercise (such as running, dancing or swimming)

· Punch a cushion or mattress or scream into your pillow

· Rip up magazines or sheets of paper

· If you’re musical, play your instrument (piano, guitar, drums, and so on)

Some possible substitutes to replacing the cutting sensation include:

· Instead of cutting yourself, use a red pen to “mark the spot”

· Try rubbing ice cubes along the area of skin where you would normally cut, or

· Put rubber bands on your arms, wrists or legs and snap them instead of harming yourself.

These are just a few suggestions – and everyone is different – but keep on working and fighting to get free.

1. Be honest with yourself and admit that you’re putting off stuff that really needs to be done.

2. Try and figure out why you’re procrastinating. Is it because you don’t like it, it creates anxiety, you don’t understand it, it feels overwhelming, you’re disorganised …?

3. Decide to break the habit of procrastination by deliberately rewarding yourself for doing something you’d rather not do.

4. Make a pact with a friend –where you deliberately and regularly encourage each other, and hold each other accountable.

5.  Sit down and think – in detail – about all the likely consequences of not doing what needs to be done. Be brutally honest, and try and picture what you’re life is going to look like 6 months, a year and five years from now ( if you continue to procrastinate).

6. Decide to break large tasks down into smaller, more achievable tasks, and then tackle these smaller tasks one at a time.

7. Recognise your progress, and affirm and praise yourself for making these changes – and doing things differently, even though it’s hard. 

At the movies, it’s easy to spot the psychopath. He’s the one with the charm and the smile, the one who’s ready to stab you with a knife. But it’s not so easy when it’s everyday life – and we’re not trained as doctors or as psychiatrists. However, professionals have highlighted a few warning signs that might indicate that this could be a psychopath. They include:

• Playing on our sympathy: Psychopaths will use us, will hurt and rip us off – then heartlessly play to our sympathetic feelings - and we blindly believe them and tend to let them off. But if this happens often, it shows a lack of conscience so don’t be fooled by their cheap and empty words.

• Being manipulative: Psychopaths, in general, love to play with your emotions. They want you to jump, squirm, feel anxious or afraid.

 • Being a parasite: The psychopath will use their charm and persuasion to get you to pay, or to meet their various needs. There’s rarely any benefit or payoff for you. You’re just being exploited – you’re a pawn in their hands. 

• Being deceitful: They’re con men who’ll trick you and lie constantly. Their life is a deception; you can’t trust a word. But if you point to a snag in their tangled web of lies they’ll vehemently deny it, and jump to their defence. 

• Highly charming: Psychopaths are usually charismatic characters. That is, they’re often mesmerizing, can pull in a crowd, and make a person feel like they’re a famous movie star. But it won’t last forever … they drop you and move on.

• Conceited: Psychopaths are caught up with themselves and their importance. They’re boastful, proud, haughty, heartless, arrogant – and like to undermine, criticise and put you down.

• Never accepting blame: The psychopath believes that they are never to blame - and they won’t accept any culpability.

• Being highly reactive: Although psychopaths can quickly cover up their anger, they will overreact to perceived slights and offences … or to insufficient deference, recognition and respect.

• Risk-takers: These types of individuals are extreme risk takers who draw in others to their games, schemes and plans. They’re hungry for power and they seek control – regardless of the risks or the danger this entails.

Note: Research indicates that psychopaths cannot be treated.  So put up your guard and keep a healthy distance – and don’t ever form a relationship with them.

Dependent personality disorder (DPD) is one of a cluster of disorders defined by symptoms of anxiety and fear. The specific, identifying symptoms include:

·  Being emotionally dependent on others; feeling they can’t take care of themselves

· Investing a lot of time and effort in trying to please significant people

· Displaying clingy, passive and needy behavior

· Avoiding disagreements for fear of losing approval and support

· Experiencing separation anxiety and intense fear of abandonment

· Finding it hard to be alone

· Putting the needs of others before their own

· Tolerating mistreatment and abuse for fear of disapproval and abandonment

· Being crushed, and feeling helpless, when relationships end – and forming new relationships as soon as possible

· Being unable to make even the simplest decision without the input and reassurance of others

· Rarely taking the initiative

· Avoiding personal responsibility

· Avoiding responsible jobs and careers that require independent, autonomous functioning

· Being over-sensitivity to criticism

· Feeling negative and pessimistic; expecting to disappoint and fail

· Having low self esteem and lacking confidence, including a belief that they are unable to care for themselves.

The cause of disorder is still unclear, and probably includes both a genetic and environmental component. Some researchers have speculated that it could be linked to an authoritarian or overprotective parenting style – which acts as a trigger for a genetic predisposition.

Treatment is usually initially sought for some other problem or concern – such as feeling overwhelmed – so that they can’t cope with life. Also, sufferers will often have a mood disorder so they seek help for depression or anxiety at first.

The normal treatment for this particular disorder is counselling or psychotherapy. However, the emphasis is short term therapy so the person doesn’t form a dependency – and then look to the counsellor to take care of them. Prognosis with support is generally good.

This is very similar to generalized social phobia. Those with the disorder think of themselves as being inadequate, unlikeable and socially inept. They fear being rejected, criticised or ridiculed and would rather avoid most social situations. The reasons can differ may be related to emotional neglect and peer group rejection in childhood and/ or adolescence. Symptoms may include the following:

- Hypersensitivity to rejection/criticism

- Self-imposed social isolation

- Extreme shyness or anxiety in social situations. (However, the person still has a strong desire for close and meaningful relationships)

-  May avoid physical contact with others (because it is associated with emotional or physical pain)

- Painful feelings of inadequacy

- Poor self-esteem

- Intense feelings of self consciousness

- Self hatred or self-loathing

- Mistrust of others

- Emotional distancing/ fear of intimacy

- Highly critical of their ability to relate naturally and appropriately to others

- Do not feel they can connect with others (although others may view them as easy to relate to)

- Intense feelings of inferiority.

- In more extreme cases, may suffer from agoraphobia.

Treatment approaches include social skills training, cognitive therapy, gradually increasing exposure to social situations, group therapy and, occasionally, drug therapy. Gaining and keeping the client’s trust is essential for progress to be made.

1. Take the lead: If you know someone has been unwell, don’t be afraid to ask how they are. They might want to talk about it, they might not. But just letting them know they don’t have to avoid the issue with you is important.

2. Avoid clichés: Phrases like ‘Cheer up’, ‘I’m sure it’ll pass’ and ‘Pull yourself together’ definitely won’t help the conversation! Being open minded, non-judgemental and listening will.

3. Ask how you can help: People will want support at different times in different ways, so ask how you can help.

4. Don’t just talk about mental health: Keep in mind that having a mental health problem is just one part of the person. People don’t want to be defined by their mental health problem so keep talking about the things you always talked about. Just spending time with the person lets them know you care and can help you understand what they’re going through.

5. Don’t avoid the issue: If someone comes to you to talk, don’t brush it off because this can be a hard step to take. Acknowledge their illness and let them know that you’re there for them.

6. Give them time: Some people might prefer a text or email rather than talking on the phone or face to face. This means they can get back to you when they feel ready. What’s important is that they know you’ll be there when they’re ready to get in touch.

7. Find out more: If you feel awkward or uncomfortable about the conversation, find out more about mental illness.

Source: http://www.time-to-change.org.uk/take-action/talk-about-mental-health/talk-someone-about-their-mental-health-problem

What we refer to as a sociopath is officially a person diagnosed as suffering from antisocial personality disorder. This is the third time the name has changed. The original description was “morally insane.” This was later changed to someone with a “psychopathic personality” – before the most recent name change. Common characteristics include the following:

· Superficial and insincere charm. Hence, they may blind people around them with their charm and wit - but it’s never genuine.

· Being domineering, manipulative and abusive.

· Expert con men. Have no problem lying; are often caught up in a web of lies, and display no remorse if their lying is uncovered.

· View people as instruments and victims for their own use. In their mind, “the end justifies the means” so they don’t allow anyone to stand in their way.

· Often derive pleasure from hurting and humiliating their victims.

· Are in love with themselves, and have a grandiose sense of what they deserve and are entitled to. For example, they see themselves as being above the Law.

· Beating the system and breaking the law without getting caught is a game for them. In fact, winning is the key motivator for this person – in everything they do and in all relationships.

· Have shallow emotions. Any warm expressive shows are merely feigned and are likely to serve an ulterior motive. They’re incapable of love and can’t experience empathy. Hence, they’re contemptuous of those who feel and show distress.

· Lack impulse control and live on the edge. They are huge risk takers so promiscuity, illegal drugs and gambling are all common. They are also likely to demonstrate criminal or entrepreneurial versatility.

· Refuses to accept responsibility for their actions. Are quick to blame others even when it’s clear that they themselves are to blame.

· Has a history of antisocial behaviours before age 15. This may take the form of repeatedly conning others, being disaffected at school, being involved in criminal activities (such as theft and arson), hurting others without remorse and being cruel to animals.

It is crucial to grasp that there is no known cure for a person diagnosed as a sociopath. In fact, it appears that therapy may even make them worse as they use what they’ve learned about human nature to exploit other peoples’ vulnerabilities. They then become more astute at manipulating others and have better excuses that are more believable.

Note: All psychopaths are sociopaths but not all sociopath are psychopaths. Psychopaths have an anti-social personality disorder that is accompanied by aggressiveness.

1. Autophobia is the dread of being alone, or isolated from others. It often surfaces when a person feels they are being ignored, or are unloved. It is sometimes associated with self-hatred. It can also be tied into a terror of being alone in a scary situation (such as being alone at home with intruders.)

2. Social anxiety is intense discomfort related to being around other people, and fearing negative judgement or evaluation. It is characterized by an intense fear of social embarrassment, negative criticism, shame, humiliation or being rejected. These lead to feelings of insecurity, and the powerful belief that the individual is basically inadequate.

3. Social isolation is an almost complete absence of contact with other human beings. Sometimes it’s imposed – although it may be chosen – and the impact on the person is usually negative. It can lead to feelings of loneliness, fear of being with others, or low self esteem. Over time, it can produce severe psychological damage.  

4. Schizoid personality disorder (SPD) is a personality disorder that must be diagnosed by a medical doctor or psychiatrist. It is characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, detachment, a lack of concern for the emotional needs of others and apathy. Many people with this diagnosis simultaneously demonstrate a rich, elaborate and exclusively internal fantasy world.

Avoidant Personality Disorder (AVPD) is a serious condition characterised by a pattern of withdrawal, self-loathing and heightened sensitivity to criticism.  According to DSM IV, people who suffer from AVPD display many of the following traits (Note: These must greatly interfere with the individual’s everyday life):

1.  Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection.

2. Is unwilling to get involved with people unless certain of being liked.

3. Shows restraint initiating intimate relationships because of the fear of being ashamed, ridiculed, or rejected due to severe low self-worth.

4. Is preoccupied with being criticized or rejected in social situations.

5. Is inhibited in new interpersonal situations because of feelings of inadequacy.

6. Views self as socially inept, personally unappealing, or inferior to others

7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Treatment: Sometimes symptoms can be reduced by taking SSRI antidepressants. Therapy programs typically involve social skills training, cognitive behavioral therapy and group therapy. Getting help with their sensitivity to criticism, their intense fear of rejection, and their social fears is a central part of therapy.

Source: http://outofthefog.net/Disorders/AVPD.html  (Adapted)

1. Being overwhelmed by deep feelings of sadness or hopelessness.

2. Lack of energy; feeling sluggish and lethargic. Alternatively, feeling restless and agitated.

3. Having no interest in, and deriving no pleasure from, activities they previously enjoyed.

4. Experiencing feelings of anxiety and panic.

5. Feeling as if they are in turmoil; feeling worried and irritable all the time. He or she may brood over things, or suddenly lash out in anger (because of their feelings of distress.)

6. Having difficulty organizing, concentrating or remembering things (where this wasn’t previously the case.)

7. Having a negative view of life and the world. Feeling pessimistic.

8. Being overwhelmed by feelings of worthlessness, shame and guilt. Often he or she will feel stupid, ugly, or like a total failure.

9. Marked changes in appetite or weight.

10. Experiencing sleep problems (Having difficulty falling asleep, staying asleep or sleeping too much.)

11. Isolating themselves; avoiding and withdrawing from friends and family.

12. Self-mutilation and suicidal thoughts.

For more information see: http://www.yalemedicalgroup.org/stw/Page.asp?PageID=STW000727