Mental Health
Warning Signs
Changes in feelings such as fear and anger are a normal part of life. Personal situations, such as a divorce, loss of a job, or strained relationships with family or friends can cause emotional stress, thus making a person feel sad or blue. These are not unusual reactions. However symptoms that last longer than 2-3 weeks require attention. Certain thoughts and feelings associated with some experiences, however, may be warnings of more serious problems and the need for mental health intervention. It is not always easy to spot these warning signs, or figure out what they mean—qualified mental health professionals should be consulted in order to make an accurate diagnosis. The following feelings and experiences may be warning signs:
- finding little or no pleasure in life
- feeling worthless or extremely guilty
- crying a lot for no particular reason
- withdrawing from other people
- experiencing severe anxiety, panic or fear
- having very low energy
- losing interest in hobbies and pleasurable activities
- having too much energy, having trouble concentrating or following through on plans
- feeling easily irritated or angry
- experiencing racing thoughts or agitation
- hearing voices or seeing images that other people do not experience
- believing that others are plotting against you
- wanting to harm yourself or someone else
Myths
KIDS WILL BE KIDS
Myth: Teenagers don't suffer from "real" mental illnesses — they are just moody.
Fact : One in five teens has some type of mental health problem in a given year.
— National Institute of Mental Health/Harvard University Study June 2005
Myth: Talk about suicide is an idle threat that need not be taken seriously.
Fact : Suicide is the third leading cause of death among high school students and the second leading cause of death in college students. Talk about suicide should always be taken seriously.
— Jed Foundation
Myth: Childhood mental health problems are really the result of poor parenting.
Fact : If someone in your family has a mental illness, then you may have a greater chance of developing the illness, but mental illness generally has little or nothing to do with parenting.
— Surgeon General's Report on Mental Health
JUST SNAP OUT OF IT
Myth: Mental illness is not real and cannot be treated .
Fact : Mental disorders are as easy to diagnose as asthma, diabetes and cancer with a range of effective treatments for most conditions.
— Surgeon General's Report on Mental Health
Myth: We're good people. Mental illness doesn't happen to my family .
Fact: One in four families is affected by a mental health problem.
— National Alliance for the Mentally Ill
Myth: Eating disorders only affect celebrities and models.
Fact: Each year eating disorders and binge eating affect 24 million Americans. Eating disorders claim more lives each year than any other mental disorder.
— National Institute of Mental Health
IT'S JUST THE BLUES
Myth: Children are too young to get depressed, it must be something else.
Fact: More than two million children suffer from depression in the United States and more than half of them go untreated.
— US Center for Mental Health Services
Myth: It's not depression, you're just going through a phase.
Fact: Nineteen million adults in the United States suffer from some form of depression every year.
— National Institute of Mental Health
Myth: Senior citizens don't get depressed, it's just an expected part of aging.
Fact: Five million older Americans suffer from clinical depression and account for 20% of all suicides.
— Surgeon General's Report on Mental Health
THEY'RE JUST WEAK
Myth: A homeless person with a mental illness has little chance of recovery.
Fact: Homelessness can be significantly decreased when people are connected to case management, supported housing and related services.
— US Department of Housing and Urban Development
Myth: People who abuse drugs aren't sick they are just weak.
Fact: Over 66% of young people with a substance use disorder have a co-occurring mental health problem which complicates treatment.
— Surgeon General's Report on Mental Health
Myth: Troubled youth just need more discipline.
Fact: Almost 20% of youths in juvenile justice facilities have a serious emotional disturbance and most have a diagnosable mental disorder.
— US Department of Justice
WE JUST CAN'T AFFORD IT
Myth: Insurance doesn't need to cover mental health, it's not a big problem.
Fact: Fifty-four million Americans are affected by mental illness each year, regardless of ethnicity, sex or socioeconomic class.
— Surgeon General's Report on Mental Health
Myth: Doctors are too busy treating physical problems to deal with mental health.
Fact: Up to one-half of all visits to primary care physicians are due to conditions that are caused or exacerbated by mental illness.
— Collaborative Family Healthcare Coalition
Myth: Mental illness is a personal problem not a business concern.
Fact: Depression is the leading cause of disability in the United States over back problems, heart disease and liver failure.
— World Health Organization
Mental Health Facts for Adults
- 57.7 million adults suffer from a diagnosable mental disorder each year, 6% of adults suffer from severe mental disorders.
- Major depressive disorder (depression) affects 14.8 million adults and is the leading cause of disability for people ages 15-44.
- Bipolar disorder affects 5.7 million adults each year.
- In 2002 over 31,000 people died by suicide.
- 2.4 million adults suffer from schizophrenia.
- Anxiety disorders are the most common mental disorders. Approximately 40 million adults suffer from anxiety disorders including, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and specific phobia).
- Approximately 13% of adults suffer from one of three types of eating disorders, which include anorexia nervosa, bulimia nervosa and binge-eating disorder.
- The mortality rate among people with anorexia is estimated to be 5.6 percent per decade, which is about 12 times higher than the death rate due to all causes of death among females ages 15-24 in the general population.
- 4.1% of adults experience Attention Deficit Hyperactivity Disorder (ADHD) each year.
All statistics provided by the National Institute of Mental Health
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Depression
What is Depression?
Depression is a medical Illness & not just a feeling of hopelessness. It's more then just feeling sad. How common is Depression? Who is at risk to get Depression? What are the causes of Depression?
Biological causes: II. Genetic: For every possible physical and mental feature there is a gene in our cells. So is a gene for Depression. The parents of a depressed person are at a higher risk for depression. If a sibling has depressive illness then there is a 15% chance, that it will be there in another sibling .If the onset of depression is after the age of 40 yr. then chance of it being genetically transmitted is less.
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III. Hormonal imbalance: Though the exact mechanisms are not understood but imbalance of female sex hormones can lead to depression. Depressions in the postmenopausal and post partum (after delivery) period are the examples.
Psychological causes: I. Personality/ Attitudes: Following types of personality traits predispose to depressive illness.
Persons having above traits/attitudes are more likely to experience depressive episodes in their lives as compared to people who don't have such type of personality. II. Coping strategies with life events: How we deal with stressful events like separation/divorce/death, etc. determines how predisposed we are to depression. People who are Impulsive Aggressive Self centered Are more likely to have depression. Social causes and social supports: A lot of stressful life events like death/divorce/disease predispose to depression. Interpersonal relationships matter a lot - good relations with the friends / spouse / siblings have a positive effect in preventing depression. Single people are more prone to depression than couples. Similarly, studies have found divorced persons to be more prone to depression. What are the features of depression? Persistence of such feelings of lethargy / low energy / low mood despite all this indicates that the person may be suffering from clinical depression. Following are the features that a depressed individual experiences. Biological features (duration - 15 day or more)
Psychological features GOOD NEWS IS, IT IS EASILY DIAGNOSABLE & EASILY TREATABLE. What are the treatments available for depression? There are certain important things to be kept in mind regarding anti depressant use:
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Features of Anxiety
People who suffer from anxiety tend to experience physical symptoms such as palpitations, tremors, sweating, gastrointestinal discomfort, diarrhoea, muscle tension, shortness of breath, blushing and confusion. The first step in diagnosing an anxiety disorder is to rule out a physical cause: asthma, diabetes, seizure disorder, inner ear problems and hypothyroidism can all produce symptoms associated with anxiety.
Physical conditions can create or exacerbate anxiety as well. Also, those who suffer from cumulative stress may create a physiological condition (such as insomnia or impotence) that in turn makes the stress worse - initiating a destructive cycle. Over time, stress can raise blood pressure,contribute to ulcers, or impair neuroendocrine regulatory systems in the brain - the very one which control mood and anxiety disorders.
Without early intervention, some anxiety cases can become chronic. But many people - especially men - feel that seeking help is a sign of weakness. This is true for nearly all anxiety or mental health problems.
10 ways to cope
- Admit your need, and then seek professional help.
- Have a physician check for a physical cause of anxiety symptoms.
- Practise muscle relaxation and abdominal breathing regularly.
- Engage in regular physical exercise.
- Eat nutritiously. Eliminate caffeine. Stop smoking.
- Practise meditation and creative visualization.
- Learn positive self-talk and disregard negative messages.
- Identify and express your fears.
- Determine what meditation and / or alternative therapies are right for you.
- Explore the deeper side of your anxiety; give meaning to your suffering.
Doctors recommed eating plenty of complex carbohydrates
Vegetarian diet; it has been shown that people with vegetarian diet tend to be calmer than meat eaters.
Vitamin supplements also tend to help.
Lifestyle Changes:
Avoiding sugar and caffeine
Stop Smoking
ExerciseStudies show that people with vegetarian diet tend to be calmer than meat eaters. Meat and dairy products leave acid residues in the body, which can slow down the digestive tract. The result is the under-absorption of vitamins and minerals, which adds to the body's stress load. Physicians often use vitamin supplements to treat anxiety: 100 milligrams of a complete B-complex vitamin daily and 1000 milligrams of time-released vitamin C twice a day.
Exercise is vital, having a direct impact on the physiology that supports anxiety. Tension can be relieved by music workouts, which allow for more rapid metabolism of excess adrenaline. Exercise also stimulates the production of endorphins, the natural body chemicals that spur a sense of well-being and relaxation.
Another mind-body connection happens when people hyperventilate, which both reduces and alkalizes carbonic acid in the blood, sensitizing the nervous system and heightening anxiety. Diaphragmatic breathing is a key to calming the body and balancing the emotions. Learning breathing techniques allows the person to relate to anxiety in a new way.
Identifying specific anxieties can help clarify both the work that's needed and how best to cope, though some techniques seem effective across-the-board. Psychologists recommed a regular form of meditation, employing creative visualization and positive affirmations, in which the anxiety sufferer can find peace through images of comfort. This starts the process of acquiring a sense of control. Through meditation, a person can begin seeing himself more positively.
Anti-anxiety drugs provide relief, even if temporarily, while beta blockers (cardiac and anti-hypertension medications) stabilize the fight-or-flight response. Although some people report side effects to these drugs, remarkable successes have been recorded.
Given the potential for addiction, behavioural therapy is an important adjunctantive treatment to medication. The important thing is to reach out to people coping with such ills, say psychologists, so that they are able to control the symptoms rather than. the symptoms controlling them.
What is a Panic attack?
Panic attack is a sudden onset of apprehensions (anxiety) which can present with,
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chest pain/ discomfort
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sweating
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tremors
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choking sensation/ breathlessness
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nausea/ vomiting
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fainting / syncope/ feeling dizzy
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Feeling of impending doom, as if something is going to happen.
The cause of a Panic Attack is a sudden release of chemicals known as Adrenaline and Noradrenaline in our blood stream, because of more active Sympathetic Nervous System. The Sympathetic Nervous system has a lot of nerves going to the heart as well, so a sudden overactivity of this system leads to excitation of the Heart and manifests as palpitations & chest pain.
Genetic predisposition could also be a cause.
Psychological factors may not be very obvious but can be covert cause of anxiety.
How can I differentiate between a Heart Attack and a Panic Attack?
- In a Panic Attack the Chest Pain is generalized (not localized to left side of the chest) as in a heart attack.
- It does not get relieved with anti Angina drugs.
- A lot of other symptoms e.g. nauseating sensation & feeling of impending doom, as if something is going to happen, are present in a Panic Attack.
- A Normal E.C.G in the presence of an attack.
What should I do? Should I forget about it thinking that was just a panic attack?
No, you need treatment for this. A tendency for Panic Attacks cannot be wished away. You need to consult a psychiatrist for proper evaluation and treatment.
A Psychiatrist? I am not mad!! Why a Psychiatrist?
It’s a big myth that Psychiatrists are only for mad people. Psychiatrists are for sad people, for anxious people and a lot of other problems, which may not present with a psychiatric or mental symptom but have a psychiatric basis.
Self-medication, like taking Sleeping Pills or Anti Anxiety drugs can in fact be harmful. Ignoring the symptoms can also lead to difficult situations.
What is the treatment of Panic Attack? Just antianxiety Drugs?
No, Antianxiety drugs are one of the treatments. To decrease the levels of Adrenaline, Noradrenaline & hyper stimulation of nerves of the Heart other drug are also available.
Antidepressants also have an important role to play but they have to be taken under supervision of a psychiatrist
Are these drugs Sedative and/or Addictive? If a Start them once do I have to take them Always?
No, They are not sedatives; they are not addictive and need not be taken always. Normally it’s a course of 8 months to 12 months, after which the chemicals are brought back to the balance. Once there is improvement they have to be gradually tapered by your Doctor (but a full course of 8 –12 months is necessary).
Any other methods of treatment?
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Yes, Relaxation exercises.
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Breathing exercises.
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Counseling &,
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Psychotherapy
Electroconvulsive shock therapy involves passage of small amount of electric current for a very short duration across the brain, which leads to convulsions.
If current is passed through brain does it not cause burn /harm to the brain?
No, in E.C.T as small as 25 Joules of electric current is passed through the brain. In comparison, in case of a heart failure due to rhythm disturbances, as much as 200-300 joules are passed through the heart.
Numerous studies have demonstrated the safety of the procedure. In fact scientific studies have shown that patients who have received upto 100 ECTs in their lifetimes have not had any long term side effect or damage.
Is it not an old /out dated treatment?
Yes it is old treatment, 50 years old, and has still survived in medical field as a useful form of therapy, but it is not outdated. It is still one of the effective and widely used treatments in India.
But it must be used for very serious cases. Only for very seriously mad patients when drugs stop acting?
No, more than the MAD people it is for SAD people It can be very effective to lift up Depression .It can be used as the treatment of 1st choice in some illnesses e.g. Depressive & Catatonic stupor.
It must be given only to very young & healthy people who can bear the shock.
No, in fact, it can be given to old patients and pregnant women also. These people are more prone for side effects of drugs so E.C.T is much safer. It poses no danger to a pregnant woman.
So can a single shock treatment cure me from my illness?
No. The way we have a course of antibiotics for 5-7 days similarly ECT is also administered as a course of 6-8 sessions.
Saying NONE will be wrong, but side effects are much less compared to the useful effects. The commonly observed side effects include:
- Headache
- Bodyache.
- Forgetfulness (which is not permanent ) which remain for months only & memory is normal after that.
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The Boy could not stop washing his hands.......
The woman could not stop checking the lock.....
The man could no stop himself from praying to God again & again......
Out of every 10 patients coming to the psychiatrist, one patient is suffering from this illness.
But why can't these people simply stop it?
That is the PROBLEM. They are not mad people. They realize that it is Irrational /Inappropriate but it is a recurrent thought / impulse which is not in the control of the person (patient) and is called Obsessive thought. They try to stop or ignore it but cannot do it.
The thought is followed by some rituals /acts which are called Compulsion. A combination of obsessive thoughts followed by compulsive actions is known as an Obsessive Compulsive Disorder.
Oh yes!, I know somebody my office. We always feel the he's obsessed with cleanliness. His table, his dresses are always spotless. Is he suffering from an Obsessive Compulsive disorder?
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What are the other presentations of this disease?
Other presentations are:
Does this disorder come in childhood, or at any age? What is the cause of Obsessive Compulsive Disorder?
Is OCD treatable? How?
_____________________________________________________ Demystifying visit to a psychiatrist
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The third step is when the patient with the help of the therapist decides to change the thinking and behaviour, which he feels, are not able to help him/are impediments to handling a stressful situation.
Cognitive therapy They are the slogans or principles that we use to deal with different situations in our life. Few slogans are healthy and help in coping well. Some of the slogans on the other hand are unhealthy, irrational prejudices and biases. It is these irrational beliefs that the cognitive therapy aims to help. Behaviour therapy Here the focus is on behaviour and not emotions and thinking. Some particular behaviours like, These behaviours are very distressing to the patient and behaviour therapy aims at helping these by a few techniques. I. Relaxation: the patient is taught to relax his body and mind so that he doesn't have palpitations and sweating on seeing blood. II. Gradual exposure and systemic desensitization: the patient is gradually exposed to the feared object so that he is desensitized to it e.g. visiting increasingly more crowded rooms (in cases of claustrophobia). III. Exposure and response prevention: patient is exposed to dirt and not allowed to perform the behaviour e.g. washing hands. All these techniques are used under the guidance and supervision of a specialist. Psychoanalysis: Freud introduced this technique. It is a very long-term therapy, which requires many months (and perhaps the one requiring a couch and the doctor listening and taking notes..!), and so is not commonly used. It involves talking to the person and thereby understand the childhood experiences and conflicts, which might have resulted into the present illness. The patient also understands about the childhood conflicts and this is called gaining insight into his/her emotions. Hypnotherapy Perhaps the most mysterious sounding of all the techniques used but it in no way is witchcraft. It just involves taking the person to a special state of consciousness (with his consent), where it is possible to look into the unconscious processes of the mind. The advantage is that usually operating defenses, which prevent the true insight into the conflicts/causes, can be overcome. |
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