At PsychGuides.com, our goal is to shed light on psychological disorders, allowing you to recognize, understand and cope with these challenging diagnoses in yourself, friends and family members. Our guides provide insight into depression, bipolar disorders, dementia and other psychological issues from multiple perspectives. The information you’ll find may surprise and enlighten you and will hopefully better equip you to manage these disorders.

Originally built as a repository for a series of studies and surveys, we’ve remade PsychGuides.com to be more informative and its guides more accessible to all ages. You can still access the original surveys and guides through the new pages. We’ll continue to make significant improvements to PsychGuides.com over the coming months, so please check back often.

Bipolar Disorder Defined

Bipolar disorder, formerly known as manic-depressive disorder, results in frequent mood swings, from soaring highs-known as mania-to crashing lows-commonly known as depression. These changes in mood directly affect an individual’s activity levels, energy and ability to carry out simple everyday tasks. Each distinct period of mania or depression may last from just a few minutes to several months. Typically, those diagnosed with bipolar disorder will experience symptoms for the remainder of their lives and may jeopardize jobs, relationships and their health if the disease goes untreated. However, proper medication and treatment can help to control the symptoms associated with bipolar disorder and allow sufferers to live more fulfilling lives.

Who Gets Bipolar Disorder?

Each year, more than 2 million people are diagnosed with bipolar disorder. Family history and genetics play a major role in the likelihood of being diagnosed with the disorder. This illness is most commonly seen in those whose parents or siblings also suffer from the ailment. If a family member is already a sufferer, the chance of a second family member being diagnosed with the condition increases by 15 to 20 percent. The disease affects both men and women, but men tend to experience more manic episodes and women more depressive episodes. One in five people diagnosed with bipolar disorder are in their early 20s, but it is not unusual for children as young as elementary school age to be diagnosed with this disorder.

Symptoms of Bipolar Disorder

Every human being experiences a variety of feelings and moods including anger, frustration and happiness. For someone who suffers from bipolar disorder, these natural emotions can become unbearable. The main difference between normal emotions and bipolar disorder is the inability to function normally while experiencing these feelings. Bipolar disorder manifests differently in each patient, and the symptoms of the condition vary tremendously in pattern, frequency and severity. While some patients are either manic or depressive almost exclusively, others alternate between the two, often within a short period of time. Some patients have frequent mood disturbances and others only have a few throughout their lives. The four usual types of episodes are mania, depression, hypomania and mixed affective; each of these has its own symptoms.

Mania is the main characteristic of bipolar disorder. During manic episodes, patients experience heightened emotions and feelings such as bursts of energy, poor financial choices, easily distracted, aggressiveness, talking rapidly, weight loss and a decreasing need to sleep. In severe cases, patients may hallucinate or hear voices. Sometimes, after the manic episode passes, the person may feel shame or embarrassment about actions taken during this period.

Hypomania can be described as a mild to moderate case of mania. While they share many of the same symptoms as those suffering from mania, hypomania sufferers retain the ability to carry out daily activities without losing touch with reality. Most people see someone with hypomania as simply being in an extremely good mood. In reality, people with hypomania tend to make poor decisions, and these often harm relationships, both personal and professional. Hypomania may escalate into mania over time.

In the depressed phase of bipolar disorder, patients experience extreme sadness, hopelessness, low self-esteem, lack of sleep, loss of energy and loss of interest in pleasurable things. In some cases, patients may have suicidal thoughts.

When patients have mixed affective episodes, they experience symptoms of both mania and depression. The patient feels depressed but becomes easily agitated and suffers from insomnia and anxiety. Sometimes, the patient can go from one extreme to the other in a matter of minutes; this can become unbearable not only to everyone else, but to the patient. When high energy is partnered with a low mood, the patient is more likely to be suicidal.

Diagnosis

Bipolar disorder is diagnosed by a physician or psychologist based on a patient’s answers to a series of questions regarding individual experiences and emotions. The answers to those questions, in addition to observations by the professional, determine which form of bipolar disorder the patient has. Once the diagnosis is made, the doctor will determine which treatment is best for specific symptoms of the disorder.

Treatment for Bipolar Disorder

The characteristics of bipolar disorder often make it difficult to lead a productive life. Because of this, it is necessary for those who think they may have the condition to seek treatment. Treatment can include medication, therapy and self-help.

The doctor will usually prescribe some sort of medication once a diagnosis has been made. The type of medication prescribed will depend on which phase of the illness the patient is in. Usually, the doctor prescribes a mood stabilizer, such as lithium. Mood stabilizers, as the name implies, reduce the frequency of mood changes. Anticonvulsants also have the same affect, although they are typically used for seizure patients. Antidepressants, such as citalopram, may be prescribed for those patients in a depressive episode.

Psychotherapy is another important aspect of treating bipolar disorder. A psychologist can help patients determine the triggers for the condition such as stress, sleep deprivation or even seasonal changes. They can also help patients learn how to cope with the illness, teach them steps to take when an episode occurs and life strategies. Sometimes, the psychologist will ask for a family-focused session in which the patient’s family can learn coping strategies and how to recognize episodes. Additionally, psychologists will monitor medications to ensure that the patient is obtaining the required results and can prescribe different medication if required until the treatment is successful in managing the disorder’s symptoms.

Bipolar patients cannot rely completely on medical professionals and medication to treat the condition. Learning as much as possible about the disorder and how to deal with it can aid in the treatment process tremendously. Additionally, seeking support from family, keeping stress to a minimum, participating in support groups, making healthy choices and monitoring moods can manage the disease, permitting sufferers to live a generally symptom-free and happy life.

• Medication Treatment of Bipolar Disorder 2000
• Bipolar Cover
• Guide for Patients and Families in PDF

View Resources

• Pendulum.org – Bipolar Disorder
• Stanford School of Medicine – The Bipolar and depression Research Program
• Umm.edu – Bipolar disorder – Introduction
• Ncbi.nlm.nih.gov – Manic depression; Bipolar affective disorder
• Wikipedia – Bipolar disorder

Antipsychotics are a group of drugs that are used to treat serious mental health conditions such as psychosis as well as other emotional and mental conditions. In addition, they are prescribed for the treatment of intractable hiccoughs and pain that can result from restlessness during palliative care.
Psychosis is a condition in which a patient loses contact with reality. The condition often includes hallucinations or delusions. When experiencing hallucinations, the patient often hears voices that aren’t actually there, while delusions related to psychosis consist of feelings or ideas that aren’t based on reality.

Antipsychotics help to control the symptoms of psychosis as well as less serious mental health conditions such as bipolar mood disorder that may develop into later psychosis. Antipsychotics reduce or increase the effect of neurotransmitters in the brain to regulate levels. Neurotransmitters help transfer information throughout the brain. The neurotransmitters affected include dopamine, noradrenaline, and serotonin. Dopamine is the primary neurotransmitter affected by taking antipsychotics; an overactive dopamine system may be one cause of the hallucinations and delusions commonly experienced during psychosis.

Effects of Antipsychotics

There are a variety of antipsychotic drugs in common use including:

• Amisulpride
• Aripiprazole
• Clozapine
• Olanzapine
• Paliperidone
• Quetiapine
• Risperidone

Antipsychotics are classified as major tranquilizers. They are separated into two groups with older antipsychotics developed prior to the 1970s known as typical antipsychotics and newer drugs known as atypical antipsychotics.
Antipsychotics provide an overall feeling of contentment when taken, usually without creating drowsiness. Those on the medication may experience periods of discomfort and restlessness. An increase in dosage over a short period can help to level overactive feelings out, though higher doses may also result in sleepiness.

The particular antipsychotic prescribed to a patient depends on the reaction the individual has to each drug tried. Each formulation of antipsychotic medication is intended to have the same basic effect, however, so finding the right one is a process of trial and error to determine which one works most effectively with the fewest side effects.

The older medications on the market were introduced in the mid-1950s to block dopamine.

While effective, they may induce side effects such as:

• Stiffness of joints and shaking
• Slowed thinking and a general sluggish feeling
• Restlessness
• Sexual dysfunction
• Tardive dyskinesia (continual tongue, mouth or jaw movements)

If side effects are experienced when taking antipsychotics, a lower dose will generally cause them to stop. If lower doses are ineffective in controlling the symptoms of psychosis, then the side effects can often be treated with the use of anticholinergic drugs, such as orphenadrine and procyclidine.
The newer brands of antipsychotics block less dopamine than the older brands do and also work on other neurotransmitters.

Side effects of the newer generation of drugs include:

• Sleepiness and general slowness
• Weight gain
• Sexual dysfunction
• Increased risk of diabetes
• Shaking (when taken in high doses)
• Tardive dyskinesia that can manifest in the arms and legs as well as the face

The primary advantages of the newer drugs are that they can improve symptoms that the older antipsychotics did not affect, such as lack of interest in previously enjoyed activities, lack of self-care and lowered motivation.

One antipsychotic drug that stands out from the rest is clozapine. Clozapine is generally more effective than the other drugs in handling the symptoms of psychosis along with reducing suicidal thoughts among schizophrenics. It has little effect on the movement-controlling dopamine systems, reducing the shakiness and stiffness side effects experienced with other drugs. It also does not generally result in tardive dyskinesia. It can make patients who use it drowsy, and it causes an increase in the production of saliva. Clozapine also reduces the white blood cell count in most users, increasing the chances of infection. This means that a patient taking clozapine will have to undergo regular blood tests, and the drug will need to be discontinued occasionally so that the bone marrow can produce the white blood cells that the patient’s body needs.

Length of Use

The length of time that a patient has to use antipsychotics is largely dependent on the condition that is being treated. If the patient only has a single schizophrenic episode, there is a 25 percent chance of nonreoccurrence, so continued use of drugs may be unnecessary. If taken to treat bipolar disorder, which is an ongoing condition, the drug treatment will also continue in an ongoing manner. If the medication is not taken, the symptoms of the condition it is used to treat will return. This return typically occurs within three to six months. Many users cease taking the drugs when they work because the patients believe that the drug is no longer needed. Decisions to cease antipsychotic use should be discussed with the prescribing physician before any patient stops taking medication so that the patient can gain a full understanding of the likely effects of doing so.

Use on Dementia in Elderly Patients

Antipsychotics are sometimes used to treat dementia in elderly patients. This use has its drawbacks as the medication can have serious side effects on the elderly. When treated in this way, older patients have a heightened risk of stroke and death. Risperidone is generally used for treatment of elderly people who are experiencing behavioral issues as a result of dementia. To avoid side effects, the drug is only used for a short period of time, with a limit of six weeks usually placed on its administration. It is also used only when other medications to treat aggression due to Alzheimer’s fail to work effectively and where the condition involves a risk of harm to the patient or those around the patient.

A 2004 Committee on Safety of Medicines study found that the risk of stroke in elderly patients being treated with antipsychotics was more than three times the normal, untreated, risk. In 2005, an FDA analysis of 17 medical trials of newer antidepressants (developed after the 1970s) used with elderly patients determined that the mortality rate of those patients showed a 1 to 2 percent increase over that of untreated patients.

• Editors, experts, and contents pages from the guidelines

View Resources

• Ncbi.nlm.nih.gov – Antipsychotic Drugs
• Web.williams.edu – Dopamine Receptor Blockade: Antipsychotic Drugs
• Live.psu.edu – Reducing off-label use of antipsychotic medications may save money
• Healthpsych.psy.vanderbilt.edu – The Behavioral Side Effects of Antipsychotic Medication for Schizophrenia
• Health.harvard.edu – Antipsychotic drugs for dementia

What Are Psychotic Disorders?

Psychotic disorders are mental disorders in which a person’s personality is severely confused and that person loses touch with reality. When a psychotic episode occurs, a person becomes unsure about what is real and what isn’t real and usually experiences hallucinations, delusions, off-the-wall behavior, chaotic speech and incoherency. A person behaving in this manner is often referred to as being schizophrenic.

A hallucination is an internal sensory perception that isn’t actually present and can be either visual or auditory. Smelling odors or having a funny taste in the mouth are other hallucinations that may occur. A delusion is defined as a false, inaccurate belief that a person holds on to. A grandiose delusion occurs when a person believes that their life is out of proportion as compared to what is really true. For example, a patient may believe that she is God or Jesus Christ. A persecutory delusion occurs when a person believes that there is a conspiracy amongst others to attack, punish or harass him. Although these hallucinations and delusions appear odd to others, they are very real to the person with the disorder.

What Are the Types of Psychotic Disorders?

Schizophrenia

The most common psychotic disorder is schizophrenia. Patients with this condition experience changes in behavior, delusions and hallucinations that last longer than six months. Those diagnosed with this type of disorder often show a decline in social function, school and work.

Schizoaffective Disorder

Patients with schizoaffective disorder have symptoms of both a mood disorder, such as depression and schizophrenia.

Schizophreniform Disorder

When a patient with schizophrenia has symptoms that last fewer than six months are diagnosed with schizophreniform disorder.

Brief Psychotic Disorder

When a patient has only short, sudden episodes of psychotic behavior, the condition is diagnosed as brief psychotic disorder. These episodes are typically a response to a stressful situation and usually last less than a month.

Delusional Disorder

Patients that have false, fixed beliefs involving real-life situations that could be true, such as having a disease or being conspired against, are diagnosed with delusional disorder. These delusions persist for at least one month.

Substance-Induced Psychotic Disorder

Sometimes, withdrawal from substances like methamphetamines and alcohol cause delusions and hallucinations. This is known as substance-induced psychotic disorder.

Psychotic Disorder Due to a Medical Condition

When psychotic disorder symptoms are a result of illnesses that affect the function of the brain, such as a brain tumor, the patient is diagnosed with psychotic disorder due to a medical condition.

Paraphrenia

Paraphrenia is schizophrenia in elderly patients.

Who Can Get a Psychotic Disorder?

Approximately 1 percent of the population suffers from a psychotic disorder. These conditions are most commonly found in people in their late teens to early thirties and effects men and women equally. Like many other mental disorders, psychotic disorders are often genetic. People who have a family member with this type of disorder are more likely to develop it than those who do not have a family history of it. It is also believed that these disorders are related to the hyper activity of chemicals in the brain that are vital to normal functioning. Additionally, those who experienced brain injury during fetal development or childhood are at a higher risk of developing the condition.

How Are Psychotic Disorders Diagnosed?

If the symptoms of a psychotic disorder appear in an individual, the doctor will conduct a physical exam as well as gather medical history. Once physical reasons for the abnormal behaviors are ruled out, the doctor will then refer the patient to a psychiatrist. Psychiatrists have a specific set of tools to properly diagnose a psychotic disorder.

How are Psychotic Disorders Treated?

The two main forms of treatment for psychotic disorders are medication and psychotherapy. The signature medications to treat psychotic disorders are antipsychotics. These medications aid in managing the symptoms of the disease like the hallucinations and delusions. Some examples of antipsychotics are pimozide, haloperidol, chlorpromazine and amisulpride. Depending on how each individual is affected by the medications, it may be necessary for the doctor to prescribe more than one consecutively until the proper medication is found that meets the required results.

Psychotherapy for psychotic disorders may include individual sessions, family sessions and support groups. While most patients are treated as outpatients, in severe cases, such as when the physical well-being is in danger, hospitalization may be necessary to stabilize the patient’s condition.

In addition to medication and psychotherapy, self-help can also aid in successfully managing living with psychotic disorders. It is important that the patient learn how to cope when these episodes occur. Studying and learning as much as possible about the specific disorder is vital to managing a healthy, happy, fulfilling life.

What Is the Prognosis for Those with Psychotic Disorders?

Many people who have been diagnosed with a psychotic disorder tend to lead productive lives and function normally with the proper treatment. The prognosis for those with psychotic disorders varies from person to person. For example, women tend to respond better to medication than men. Those with a family history of illness have a lower prognosis than those without. The number of negative symptoms also determines the individual prognosis as well as age; the older the patient, the more promising prognosis. Another important factor in determining prognosis is the individual’s support system. Most will never fully recover from or be cured of psychotic disorders and will need to continue treatment for the duration of their lives. To maintain mental and physical stability with the condition, it is important for patients to strictly follow the treatment recommended by their healthcare providers.

For more on the topic of Psychotic Disorders, we’ve included the following expert consensus documents as reference materials:

• Cover, editors, experts, and contents pages from the guidelines

View Resources

• IU – information about psychotic disorder
• Psychiatry Medicine IU – information about psychotic disorder
• UMN – general information about psychotic disorder
• Disorders – brief psychotic disorder
• Anger Disorders – general information about psychotic disorder

Estimates suggest that up to 70 percent of American adults have experienced at least one significant trauma during their lifetimes. Many of those people may subsequently have suffered from an emotional reaction known as posttraumatic stress disorder or PTSD. Further estimates suggest that 5 percent of the population currently lives with PTSD.

What Is PTSD?

Posttraumatic stress disorder occurs in some cases when people are exposed to a very stressful event, which is known as an extreme stress trigger. To be diagnosed with PTSD, they must continue to experience symptoms of PTSD for at least one month after exposure to this trigger.

Who Experiences PTSD?

Although women are twice as likely as men to develop PTSD, anyone who experiences an extremely traumatic event may develop posttraumatic stress disorder. Examples of extreme stress triggers include:

• Criminal assault or rape
• Natural disasters
• Serious accidents
• Combat exposure
• Child physical or sexual abuse or severe neglect
• Witnessing traumatic events
• Imprisonment/hostage/displacement as refugees
• Torture
• The sudden unexpected death of loved ones

Although other types of stress may be severe and can be quite upsetting, they typically do not result in PTSD. Such events might include the death of an elderly parent, divorce, or job loss.

What Are the Symptoms of PTSD?

People with PTSD typically experience three main types of symptoms. First, they may reexperience the traumatic event that led to developing PTSD. This can include:

• Flashbacks in which they feel that the triggering event is recurring even while they are awake
• Distressing recollections of the traumatic event
• Nightmares of the event
• Exaggerated physical and emotional reactions to triggers that remind them of the event

The second type of symptom involves emotional numbing or even avoidance. It may include the following symptoms or behaviors:

• Avoidance of places, thoughts, activities, conversations, and feelings related to the event or trauma
• Feelings of detachment
• Loss of interest
• Restricted emotions

The third symptom type relates to increased arousal related to the event and may be indicated by:

• Outbursts of anger
• Irritability
• Difficulty sleeping
• Hypervigilance
• Difficulty concentrating
• Exaggerated startle responses

Related Conditions and Problems

In addition to the symptoms listed above, people with PTSD may face an array of other symptoms. With successful treatment, many of these symptoms will improve. The person with PTSD may require extra treatment to address the full scope of conditions related to PTSD.

Panic Attacks

People who have experienced a significant trauma may have panic attacks when they are exposed to a trigger that reminds them of the inciting trauma. For instance, someone who develops PTSD as a result of combat exposure may have a panic attack upon hearing a loud noise that reminds them of an explosion. During a panic attack, the person will commonly experience intense discomfort or fear. This may be accompanied by psychological or physical symptoms, which might include:

• Sweating
• Racing or pounding heart
• Sortness of breath
• Shaking or trembling
• Dizziness
• Nausea
• Chest pain
• Numbness
• Hot flushes
• Tingling

People may experience a sense of detachment or may even feel as though they are dying, going crazy, or having heart attacks.

Severe Avoidance Behavior

One of the most common symptoms of PTSD is avoidance of anything that reminds the person of the original event. Avoidance can sometimes extend to everyday situations. In some cases, this type of avoidance becomes so severe that the individual is unable to leave his or her home.

Depression

Many people suffering from PTSD also experience depression. They may be unable to take pleasure or interest in activities they once enjoyed. Unjustified feelings of self-blame or guilt are common.

Suicidal Thoughts

In some instances, depression may become so severe that the person with PTSD experiences thoughts of suicide because of feelings that life is simply not worth continuing.

Substance Abuse

People with PTSD may also use drugs or alcohol in an effort to numb the pain they are experiencing. They may misuse over-the-counter drugs or prescription drugs. This substance abuse can magnify the symptoms of PTSD.

Treatments for PTSD

There are two primary types of treatment available for PTSD: psychotherapy and medication. Some people are able to fully recover from posttraumatic stress disorder using psychotherapy alone, but others need a combination of both treatments to achieve full recovery.

Psychotherapy alone is often best for people who experience mild symptoms, those who should not take medication due to pregnancy or because they are breastfeeding, and people who prefer not to take medication.

Medication may be a good option for individuals with severe symptoms or those who have lived with their symptoms for a long time. People who have additional psychiatric problems such as anxiety or depression may also require medication.

Psychotherapy

Professionals may use three types of psychotherapy when treating PTSD: cognitive therapy, anxiety management, and exposure therapy. If they are treating children with PTSD, they may also use play therapy. During anxiety management, patients learn how to better cope with their symptoms through relaxation training, breathing retraining, and positive thinking and self-talk. Therapists may teach patients how to control their anxiety and fear by relaxing the major muscle groups in their bodies, one at a time. In order to deal with hyperventilation, therapists teach patients how to use slow breathing techniques to combat tingling, dizziness, and palpitations. During positive thinking and self-talk, therapists help people to replace negative thoughts with positive thoughts when they are faced with reminders of the original trauma. Therapists may also use assertiveness training to teach patients how to express their emotions without pushing others away.

Medication

Several types of medication are available to treat posttraumatic stress disorder. These include antidepressants, mood stabilizers, and antianxiety medications.

People with acute PTSD who have had symptoms for fewer than three months may require medication for between six and 12 months. Individuals with chronic PTSD who have had symptoms for longer than three months may need medication for a minimum of one year. In some instances, people may relapse and begin to experience symptoms after they have ceased therapy and stopped taking medication. This can happen even years after the end of the treatment. If this happens, they may need to resume psychotherapy and medication.

For more on the topic of PTSD, we’ve included the following expert consensus documents as reference materials:

• Full reprint in PDF: Treatment of Posttraumatic Stress Disorder
• Guide for Patients and Families in PDF

View Resources

• MiTalk – more information about PTSD
• VetAffairs – treatment of PTSD
• MentalHealth – PTSD overview
• PTSD Nebraska – PTSD services in nebraska
• PubMedHealth – general information about PTSD

• Expert Consensus Treatment Guidelines for Bipolar Disorder:
  A Guide for Patients and Families
• Consenso De Los Expertos del Guia Para el Tratamiento del Disturbio Bipolar:
  Un Guia Para Los Pacientes y las Familias
• Expert Consensus Treatment Guidelines for Schizophrenia:
  A Guide for Patients and Families
• Consenso De Los Expertos del Guia Para El Tratamiento De La Esquizofrenia:
  Un Guia Para Los Pacientes y Las Familias
• Expert Consensus Treatment Guidelines for Obsessive-Compulsive Disorder:
  A Guide for Patients and Families
• Expert Consensus Treatment Guidelines for
  Agitation in Older Persons with Dementia:
  A Guide for Families and Caregivers

• Treatment of Dementia and Agitation: A Guide for
  Families and Caregivers
• Bipolar Disorder: A Guide for Patients and Families (2004)
• Depression During the Transition to Menopause: A Guide for Patients and Families
• Depression in Older Adults: A Guide for Patients and Families
• El Tratamiento del Disturbio Bipolar Guia Para Los Pacientes y las Familias (1996)
• Major Depression During Conception and Pregnancy: A Guide for Patients and Families
• Obsessive-Compulsive Disorder: A Guide for Patients and Families
• Postpartum Depression: A Guide for Patients and Families
• Posttraumatic Stress Disorder: A Guide for Patients and Families
• Premenstrual Dysphoric Disorder: A Guide for Patients and Families
• Psychiatric and Behavioral Problems in Mental Retardation: Resource Guide
• Schizophrenia: A Guide for Patients and Families

Mental retardation is a developmental disorder where a person’s mental abilities do not fully develop in line with people of an equivalent age. It is quite common, with the condition affecting around 1 to 3 percent of the population, according to the University of Maryland Medical Center. In many cases—between 75 and 90 percent of cases—it is mild and doesn’t severely affect people’s day-to-day activities. It is usually diagnosed before the person reaches 18.

What to Look For

Because it affects mental abilities, families should keep an eye on how their children develop. Is your child meeting standard targets? Can your child walk, talk, and hold items at the expected ages? In mild cases, you may observe difficulties during the school years, with your child falling behind in class.

That’s not to say that these symptoms are solely indicative of retardation; there could be several causes for a child not doing well at school or failing to develop as expected. A checkup at the doctor should always rule out hearing difficulties, epilepsy, and other conditions that may affect a child’s ability to learn or coordinate movement.

In a clinical setting, the presence of mental retardation is dependent on three criteria:

• The person must be under the age of 18
• IQ is below 70
• Two or more adaptive behaviors are limited

While the first two conditions are fairly clear, let’s look at adaptive behavior. This means the appropriate behaviors required to live and function in society. These might include:

• Grooming and dress
• Learning and abiding by rules, including social, legal, and societal
• Managing elements of life such as money, work, and friendships
• Communicating and understanding ideas and thoughts

Those with moderate or severe mental retardation will always show symptoms within the first few years—often showing speech and coordination issues early on. Less severe retardation may not be detected until the later years of development.

There is no cure for mental retardation, but assistance can be given so that it doesn’t affect the sufferer’s life too badly, depending on the extent of the disability. Those with IQs below 20, for example, often require specialized treatment, which can require a specialized environment. Those with IQs over 50, often described as mild mental retardation, can live independently and hold down a job. It all depends on the combination of issues that person has.

What Are the Causes of Mental Retardation?

Causes vary, and in most cases, no one cause is responsible. Down syndrome is perhaps one of the most well-known causes—along with all the other chromosomal abnormalities—but other issues can result in mental retardation, including fetal alcohol syndrome, iodine deficiency, and certain diseases and heavy metals.

Around 75 percent of cases have no known cause, so it’s hard to see how parents can prevent having a child with mental retardation. It’s important to remember that being a parent to a child with an intellectual disability is hard enough without blaming yourself.

Family Support: Mild Retardation

Those suffering from mild retardation often are slower than their peers at absorbing information. They may function at a high enough level to live independently, however, and this should be the family’s aim: to get that person into work and living a normal life.

Encouragement from an early age is vital. Your child will need to learn slowly and have lots of reinforcement. Make sure that you ask you child plenty of questions about simple things that your child sees. Your child will likely be stressed at school, so consider homeschooling as an option. Alternatively, there are specialized schools that can help child develop at their own rates.

In general, those suffering from mental retardation work best with short instruction periods and in small groups. You also need to remember that they won’t understand complex words or instructions. They also work best with a partner with similar development issues who can reinforce ideas.

Exercises work best when they are simple. Games are best when they have few rules, although no-rules soccer is never a good idea. Spud, tag, or simple hand clap games are ideal.

Equally, ensure your child mixes with children of their own ability, not necessarily age, on a regular basis. This will help your child to develop social skills. Again, make sure you encourage your child to respond to and answer questions, as this is a vital part of learning.

As your child ages, be prepared to answer some difficult “why am I this way” questions. Focus on the positives, and that will help you, as well as your child. In addition, your child will eventually need to get a job. There is a wide variety of schemes to help your child find employment. These tend to offer below-average wages but offer a sympathetic environment to those with mental retardation. Often they encourage socialization and offer social activities.

Family Support: Moderate to Severe Retardation

Those with severe or moderate retardation may not be able to function well in society without significant support. A child with an IQ of below 20 will likely need care throughout life. Fortunately there are homes that will do this if necessary—these are vital if the child becomes an orphan or if parents are otherwise unable to take on care.

Like those with mild retardation, however, the child should be exposed to schooling wherever possible. A specialized school is normally necessary here, as these will be familiar with dealing with common issues. Always make sure you have arrangements in place to ensure your child’s wellbeing in the event you are unable to look after him or her. The challenges associated with severe or moderate retardation are similar to those for children with mild retardation—they’re just more severe.

Final Thoughts

A child with mental retardation should always remain part of the community, and that’s the aim of modern social, schooling, and work programs. Whether your child has severe or mild retardation, there will be challenges throughout, but the reward will be seeing your child integrate into society.

Set realistic goals for you and your child, and make sure you seek out support groups for yourself as well. After all, if you’re stressing or upset about anything, it helps to know and talk to those who are going through the same thing. It’s good to talk, so make sure your child knows that too.

Depression during pregnancy is a very difficult and sensitive subject. Statistics from the American Congress of Obstetricians and Gynecologists suggest that between 14 and 23 percent of women suffer from some form of depression during pregnancy. There are many questions that the pregnant woman and her family must struggle with. Is she truly suffering from depression or is her behavior caused by normal pregnancy hormones? If she is suffering from depression, what can she do? What can her family do? Are there any treatments that won’t harm the baby?

Because of hormonal changes during pregnancy, a woman may not realize that she is suffering from depression. At first, depression may not seem different from the anxiety, fatigue, difficulty concentrating and many other symptoms that are typical of pregnancy. However, when a woman is depressed these symptoms are more frequent and severe. If she is depressed, the symptoms last for more than two weeks and prevent the woman from anticipating the joy of bringing a new life into the world. She may also experience other symptoms that are clearly associated with depression such as persistent sadness, feelings of worthlessness or thoughts of suicide.

If a woman has suffered from depression in the past, she may be quicker to realize her situation than a woman who has never had depression before. It is important that anyone with depression seek help, so a woman who doesn’t recognize her depression is at greater risk than a woman who is aware of her situation. A depressed pregnant woman may not have the will to take care of herself and her unborn baby. She may not eat properly. She may drink or smoke or engage in life-threatening behavior. As a result, her baby could be born with developmental problems.

Treatments

Once she has agreed to seek medical care, a pregnant woman with depression will look for treatments that will not harm her unborn child. She should not assume that the only treatment for depression is antidepressant medication. There are many other therapies that may help her cope with mild depression. Such therapies include exercise, acupuncture, psychotherapy and support groups.

• Exercise helps ease depression by releasing neurotransmitters and endorphins in the brain, which elevates mood. It reduces immune system chemicals that can worsen depression and increases body temperature, which has a calming effect.
• Researchers have recently shown that acupuncture can alleviate depression symptoms. A 2010 study at the Stanford School of Medicine concluded that depression-specific acupuncture reduced depression symptoms in pregnant women who were diagnosed as being at risk of a major depressive disorder. This type of acupuncture targets the acupuncture points known to be associated with depression relief.
• Psychotherapy has been used to treat depression for many years. This approach may include interpersonal therapy, which focuses on reducing strain in relationships, and cognitive-behavioral therapy, which identifies pessimistic thoughts and beliefs and works to change them.
• Support groups have consistently been proven to reduce symptoms and improve self-esteem in people suffering from depression. There are depression support groups everywhere, including online, and it is important to find one that the patient is comfortable participating in.

These therapies, accompanied by the support of family and friends, might be enough to manage a woman’s depression during her pregnancy. They should be the first choice of action for women who have been diagnosed with mild or moderate depression.

Medication

In cases of severe depression or if alternative therapies do not alleviate depression symptoms, many medical professionals believe that antidepressant drugs are the best choice to protect the health of mothers and babies. Pregnant women are justifiably concerned about the long-term effects of taking medication during pregnancy. Although all medications cross the placenta, retrospective studies have shown that many of the major antidepressants on the market have been used by pregnant women with no known ill effects. Doctors are particularly comfortable prescribing the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) to pregnant women. Evidence shows that the rate of infants with birth defects born to women who took SSRIs during pregnancy is the same as the rate of those who did not. There is similar evidence about tricyclic antidepressants.

Pregnant women contemplating using drugs to treat their depression will want to consider all their options and ask their doctor about possible health problems in the newborn or developmental delays in the future. It is important to weigh the health issues that could affect the unborn child due to depression symptoms against the possible ill effects of an antidepressant drug. SSRIs are so well-regarded by the medical community that experts may recommend that a woman with severe depression during her pregnancy continue her medication after the baby is born in order to stave off the possible onset of postpartum depression.

Woman Who Become Pregnant while Taking Anti-Depressants

Up to this point, this discussion has been about the care and treatment of a woman who develops depression during her pregnancy. What about women who become pregnant while taking antidepressants? In this situation, the woman and her doctor must weigh the pros and cons of continuing this medication. Research suggests the greatest risk to the fetus would be in the first trimester, so a woman and her doctor must address this issue as early in the pregnancy as possible.

What Can Family Members Do?

If you are a friend or family member of a pregnant woman whom you suspect is suffering from depression, you should do what you can to support her and encourage her to seek help. Do not ignore her expressions of sadness and despair, but instead listen with understanding and patience. Encourage her to seek a diagnosis and treatment, and follow up with her to ensure that the treatment is effective. It is imperative that a pregnant woman know if she is suffering from depression because it affects her health and the health of her baby.

Research on the treatment of depression is ongoing and researchers are developing new therapies all the time. The important thing is to recognize when a pregnant woman may be depressed and to encourage her to seek treatment as quickly as possible. That way she can take good care of herself and her developing child.

• Major Depression During Conception and Pregnancy: A Guide for Patients and Families

View Resources

• Unc.edu – Perinatal Mood and Anxiety Disorders
• Columbia.edu – Childhood Asthma Linked to Depression during Pregnancy
• CDC.gov – Reproductive Health
• AHRQ.gov – Acupuncture helps with depression during pregnancy
• FDA.gov – Drugs

Whether you live with bipolar disorder or live with someone who has it, you may be well aware of the issues associated with it. Even if no one in your household has the condition, chances are that you know someone who has it, as it affects around 1 percent of people. That’s around 3 million people in the US.

Bipolar Disorder: The Basics

Bipolar disorder is a mood disorder. We all have moods—good ones, bad ones, and grumpy ones. However, bipolar disorder creates mood changes that are completely at odds with events. You might feel incredibly miserable during an otherwise entertaining film or you may find yourself feeling ecstatic at a funeral. These sorts of moods can make it difficult to function, which is why it’s a disorder.

Moods are also classified by the way they make you feel. A high mood means you feel happy and content—or even euphoric. A low mood means you feel sad and miserable—possibly angry. Some mood disorders, such as major depressive disorder means you only feel low moods. These are often called unipolar disorders, as there is only one mood. As you might guess, bipolar disorders involve two moods—the high and the low.

Mood changes can happen at a whim and are not controllable by the person who has the condition. They are real conditions involving real biological changes within the brain. Because of this, however, they are treatable.

Diagnosing the Disorder

Because of the way bipolar disorder is thought to happen, there are no lab tests that can diagnose the disease. This makes diagnosis harder, which is why patients spend an average of eight years seeking help for this distressing condition.

In brief, there are four main types of mood that the person may suffer from:

• Mania: An episode of extremely elevated mood lasting for a week or longer.
• Hypomania: Less severe than full-blown mania, but mood is still elevated for a week.
• Depression: A two-week period of intense misery.
• Mixed: Mania and depression alternating during the day; alternatively, both may be present simultaneously.

These definitions are brief and do not tell the whole story. Mania may be accompanied by intense activity, enhanced creativity, and complete irresponsibility. Occasionally, the manic person will have hallucinations or delusions. Both mania and depression may be accompanied by insomnia.

How Can I Help Myself?

The first step is to see a healthcare professional. Explain what exactly is wrong, how your symptoms present, and other parts that seem relevant. Your doctor may prescribe medication, suggest counseling, or a combination of the two.

The first stage of medication is to get the extremes under control. This may require a combination of drugs. Note any side effects and whether your symptoms improve or get worse. Different combinations work for different people, so the first combination may not be the correct one for you. However, most of these drugs require at least a month to work; some can take as long as six months to fully take hold. You need to keep taking the medication on a regular basis to ensure the best and quickest route to recovery.

Once your symptoms are under control, your doctor will prescribe maintenance doses. To keep your symptoms under control, you need to take these doses as prescribed. Bipolar disorder is a lifelong condition—while it may ebb and flow, it will never be completely cured. In addition, you need to take part in any therapy sessions your doctor recommends.

It helps to be completely honest and open when seeking treatment. If you are involved with anything that could worsen the disorder, such as self-medicating on prescription, nonprescription, or illegal drugs, you need to tell your doctor. This then ensures the appropriate treatment is prescribed. Around 50 percent of people who are bipolar seek solace in substance abuse, including alcohol, opiates, and benzodiazepines, so it’s not unusual.

The most important thing is, however, to learn everything you can about your illness. The more you know, the more you can do something about it. Consider taking a mood chart, tracking your mood each day. You can see the signs of progress throughout the month.

How Can I Help a Family Member?

Those seeking help need support. You may offer physical support, such as helping them get to appointments, feeding them, and keeping track of where they are. You might offer emotional support, encouraging them, being nonjudgmental, and providing someone to talk to.

You can also help the person take medication and watch your loved one for signs of suicide—a particular risk when a combined manic-depressive episode (a mixed episode) hits. Learn the signs of each type of episode, so you can adjust what to expect each day.

Recovery cannot be rushed. If your loved one doesn’t want to do something, be understanding. The most important thing is to push for a solid recovery, not just a mere reduction in symptoms.

Medication for Depression and Mania

Bipolar disorder combines two major but opposing symptoms: mania and depression. The treatment for one is not the same as the treatment for the other. Your doctor will be able to recommend something for your exact symptoms.

The first major class of drug is a mood stabilizer. These generally reduce manic and hypomanic episodes. The three most common drugs are lithium, valproate, and carbamazepine. You will need to undergo blood tests to ensure these drugs are working and not producing dangerous side effects. As a rule of thumb, doctors use lithium for euphoric mania, valproate for mixed episodes, and carbamazepine for those who experience rapid changes in mood. However, your personal medical history may require a combination of these or an exclusion.

If you have anxiety, something that’s not uncommon with bipolar disorder, you may be prescribed a benzodiazepine or something like haloperidol or perphenazine. These drugs help calm you or soothe yo to sleep.

Finally, you may need an antidepressant. These might include citalopram, fluoxetine, or another SSRI. All combinations will need to be carefully monitored to ensure the right effects occur: lower mood when manic and raised mood when depressed.

It’ll Be Fine

Bipolar disorder cannot be cured, but it is very treatable. Talk to your doctor today to see what can be done. If someone you love suffers from bipolar disorder, learn everything you can to help them get through this condition.

Dementia is a disease that can bring grief to a family if it isn’t handled correctly. There are so many myths circulating about the illness, and many people do not understand that dementia is a manageable condition. In fact, many families living with a dementia patient can find some peace and a little stability. It just takes a clear understanding of what dementia is and how it can be managed.

First, everyone must realize the dementia is a symptom of another, more complex disease or disorder. It isn’t contagious and you can’t just “come down with it” like a cold.There is always something else that leads to the dementia.

These conditions include:

• Alzheimer’s disease
• Narrowing blood vessels (vascular dementia)
• Head injuries
• Multiple strokes
• Years of alcoholism
• Brain tumors
• Brain infection
• Vitamin B12 deficiency
• Thyroid disease
• Kidney disease
• Liver disease

Some of these conditions only cause a temporary form of dementia that can be overcome with physical therapy, medication and time. Other forms of dementia are degenerative, so they get worse as the years go on. If your loved one suffers from the latter versions, it is best to make their time with you as enjoyable as possible. To do so, you may have to accommodate the dementia sufferer while the disease is still manageable.

Cause of Discomfort

One of the most well-known and daunting parts of caring for a dementia patient is cause by agitation. When the patient becomes agitated, he can display violent and disturbing behavior that is uncharacteristic of your loved one. Caregivers often feel responsible for the behaviors, but the guilt helps no one. The agitation always has a source. Something physical or medical causes the meltdown. It is not personal most of the time.

The most common causes of agitation episodes are:

• Pain and discomfort from sitting in the same position, illness or injury
• Changes in environment or routine
• Overstimulation
• Lack of sleep
• Hunger or thirst
• Loneliness
• Medications that can cause aggression and agitation
• Being too cool or warm
• Impending medical procedures
• Poor communication
• Routine disruptions
• Poor lighting

Anything that takes the dementia patient out of his comfort zone can cause an explosive and sometimes violent episode that the condition is known for. However, careful consideration of the person’s routine, medical requirements and social needs can curb many of the problems before they begin.

Avoiding the Meltdowns

As you and the dementia patient get to know one another, start picking up cues to her discomfort. These will be the signs that help you set the meltdown avoidance plan into motion as the disease progresses. When you start to see those cues, check the environment for uncomfortable conditions. Look at the clock, and consider the routine to rule out medication, hunger, thirst or sleep. Adjust the temperatures, provide a little company or get visitors out of the room. As you get to know the disease, you will find that certain things almost always set the patient off, so those are the things you correct first to avoid a meltdown.

If everything is fine, it is time to distract the patient. Use a favorite item or conversation topic. Maybe it’s time for an activity like a walk outside-fresh air is great for dementia patients, and exercise can help too-or another favorite activity. Soothing the patient is important if nothing else works. Soft tones, touching or hugs if welcome (approach the person from the front and slowly) or simply talking is sometimes enough to thwart the dreaded meltdown.

Communicating Smart

The way you speak with the loved one suffering from dementia also matters. You must avoid confrontation and too many questions coming too rapidly. If you must ask a question, keep the phrasing simple and leave plenty of time for the person to answer. In fact, all of your communication should be simple, loud enough to hear and clearly spoken. Avoid current slang terms, and try to keep the sentences short if the person is easily confused. Always offer reassurance, and be prepared to repeat statements and questions as needed. Engage the person in conversation regularly to help curb loneliness.

Finding Support

Everyone touched by dementia in any way will need an outlet to express their frustrations, joys and fears. That is why many medical institutions offer groups for families and patients. Being around other people going through the same thing can help you and the person suffering from the dementia. It will also give you another chance at an activity that everyone can enjoy. If you can’t get out of the house, there are Internet chat groups and rooms. Telephone helplines are also available with the support you need to get through the frustration and tips to help as well.

Maintaining the Medicine

A very important part of living with someone with dementia is maintaining medical treatment, appointments and care. Some of the worst parts of the disease can be brought on by other conditions left undiagnosed or complications due to medication. Keep regular appointments with physicians and hire home care if needed to keep your loved one in the best shape possible. Good health is one important way to slow the progression of the dementia as well.

Dementia patients are not untouchable people in our society. They are our moms, dads, aunts uncles and children, who are people full of personality. The dementia is just the disease eating away at the brain and not the person carrying it. So, when communicating with and caring for the patient, remember that she is not acting out-the disease is. Once you have an understanding of what is really going on in your loved one’s body, you can help gather and provide the care needed to make that person’s life a rich and vital one.

• Treatment of Dementia and Agitation: A Guide for Families and Caregivers (2005) in pdf, Small print
• Treatment of Agitation in Older Persons with Dementia Handout for Patients and Families in pdf, Large Print (1998)

View Resources

• Ncbi.nlm.nih.gov – Priorities for people living with dementia: education, counseling, research
• Alzheimers.gov – For the people helping people with Alzheimer’s
• DH.gov.uk – Dementia
• Health.gov.au – Know the Signs of Dementia
• Agedcareaustralia.gov.au – Help for people living with dementia

Epilepsy is a set of chronic neurological disorders that are characterized by seizures. The seizures may be provoked or unprovoked, and they may be recurrent. A single seizure that is combined with some brain alterations can increase the chance of seizures in the future.

Who Gets Epilepsy?

Epilepsy results from the excessive or abnormal activity of the brain. This activity, called hypersynchronus neuronal activity, can cause more seizures as an epileptic ages. About 50 million people worldwide have epilepsy. New onset cases of epilepsy are most common in the elderly and in infants, and those recovering from brain surgery are more likely to have an epileptic seizure. Epilepsy isn’t a single disorder, so it should be considered as syndromic. This means it will have different symptoms that result because of the activity of the brain. Seizures, of course, are the main symptom, but not all seizures are caused by epilepsy.

Can Epilepsy Be Cured?

If you or a loved one has epilepsy, you may wonder if it can be cured. The answer is no, although it can be controlled well with medication in some cases. Even with medication, about 30 percent of patients have problems controlling their seizures, and in these cases, doctors might suggest that patients have surgery. Some people who develop epilepsy will grow out of the disorder; epilepsy in some forms can be confined to the stages of childhood.

What Causes Epileptic Seizures?

Epileptic seizures are diagnosed by the fact that the seizures are spontaneous. However, some kinds of epilepsy will be triggered by certain factors. This kind of epilepsy is called reflex epilepsy. Things like heat stress, sleep, sleep deprivation, and emotional stress can all be triggers for someone with reflex epilepsy. Catamenial epilepsy is when a seizure is related to the menstrual cycle.

Different age groups tend to have different triggers for epilepsy. Infants may have epilepsy caused by trauma, metabolic disorders, or other conditions. Adolescents and adults may suffer from CNS lesions, which can cause epileptic fits. Brain tumors and trauma can also cause epilepsy in this age group. For older adults and the elderly, cerebrovascular disease can cause epilepsy. This is not the only reason, though. Other causes include degenerative diseases, head trauma, and tumors in the central nervous system.

Mutations in genes can also cause epilepsy. These mutated genes are most commonly causes of generalize epilepsy and infantile seizure syndromes. In these cases, sodium channels may stay open too long, which causes the neurons in the brain to be hyperexcitable.

What Kind of Seizures Are There?

If you have epilepsy, you might have partial or focal onset seizures or distributed generalized seizures. Partial seizures can be simple partial seizures or complex partial seizures. These seizures can spread through the brain. This is called secondary generalization and can be divided into categories depending on which parts of the body are involved.

Some types of these seizures include:

• Absence (petit mal)
• Myoclonic
• Clonic
• Tonic
• Tonic-clonic (grand mal)
• Atonic

Some children may exhibit behaviors that are not caused by epilepsy but may be confused with epileptic seizures.

These include:

• Shudders
• Nodding or rocking
• Conversion disorder

What Kind of Epilepsy Can I Have?

Epilepsy comes in four main groups. Each syndrome has a different combination of seizure types, ages, EEG findings, treatments, and prognosis.

These groups can be divided into these types and more:

• Rolandic epilepsy
• Frontal lobe epilepsy
• Infantile spasms
• Juvenile myoclonic epilepsy
• Juvenile absence epilepsy
• Hot water epilepsy
• Lennox-Gastaut Syndrome
• Landau-Kleffner Syndrome
• Dravet Syndrom
• Progressive myoclonus epilepsies
• Reflex epilepsy
• Rasmussen’s syndrome

This is just a short list of the many types of epilepsy syndromes. The classifications divide the syndromes into groups by the location and area of the brain that is affected. The syndromes are divided into:

• Localization-related epilepsy
• Generalized epilepsy
• Epilepsies of unknown localization

What Are Some Common Seizure Syndromes?

People who have seizures during sleep may have autosomal dominant nocturnal frontal lobe epilepsy, also known as ADNFLE. Dravet’s syndrome might be indicated if an infant has epileptic seizures that don’t respond well to treatment. The first seizure usually occurs with a fever. Ohtahara syndrome is rare, but it starts in the first weeks of life. The EEG will show the characteristics of this syndrome, but the prognosis is poor. About 50 percent of infants with this syndrome pass away within the first year, and the rest can be intellectually disabled or have cerebral palsy. Primary reading epilepsy’s main trigger is reading.

How Are Seizures Managed?

You may manage your seizures with medication. Operations may cure certain types of epilepsy in some cases, although the surgery required is often risky. A special diet may have an effect on the quantity or duration of seizures, and in others, the stimulation of the vagus nerve might help.
When a seizure occurs, the person should be moved away from sharp objects and something soft should be placed under his head. When possible, the patient should be rolled on his side to prevent fluids from entering the airway. If this isn’t done, it can result in choking and death. It is important to seek medical help if is the first seizure the patient has had, the seizure lasts more than five minutes or if it happens more than once without a patient waking up.

There are over 20 medications approved for the treatment of seizures.

Some of these include:

• Clorazepate
• Clonazepam
• Felbamate
• Pregabalin
• Tiagabine
• Valproic acid

Some medications are still under clinical trials, so they have not been released. Medications that can interrupt a seizure include diazepam and lorazepam. For cases of refractory status epilepticus, paraldehyde, midazolam, or pentobarbital may be used.

These anticonvulsants are normally safe; however, 88 percent of patients in one survey had reported at least one side effect. Most of these are mild and happen less when patients take the minimum dosage needed.

Some side effects include:

• Aplastic anemia
• Rashes
• Liver toxicity
• Mood changes
• Sleepiness

The goal of the medication is to stabilize and control seizures with minimal side effects.

View Resources

• Eeoc.gov – Questions and answers about epilepsy in the workplace and the Americans with disabilities ACT
• VA.gov – Epilepsy
• NY.gov – Epilepsy Fact Sheet
• Nih.gov – Epilepsy
• Ghr.nlm.nih.gov – Pyridoxine-dependent epilepsy

Do the Elderly Face Depression?

Depression over the age of 65 can be difficult; patients may have difficulty functioning and feel distressed. Later-life depression can be caused by medical illnesses. About 15 percent of people over 65 have symptoms of depression, and these symptoms can make them feel physically ill and increase mortality.

Depression can make it harder for people to enjoy the things that they normally enjoy. Memory and concentration can be affected as well. Families of those who are depressed may also suffer, so it’s important that everyone involved is educated about how to handle this condition.

What Is Depression in Older Adults?

Late-life depression affects older people in many aspects of their lives. Depression can affect factors such as the level of energy a person has, relationships, and sleep patterns. Depression lasts for several weeks; it isn’t just a passing feeling. Depression may be triggered by a loss of the ability to function at normal levels or by emotional stress, although it can also present for no noticeable reason.

People who have depression need medical treatment to correct the imbalances in their brains’ chemicals. Without treatment, depression can last for weeks, months, or even years, and it may worsen over time.

What Mood Disorders Should I Look For?

Major depressive disorder is one of the most serious mood disorders. About 1 to 2 percent of people over the age of 65 face this condition. These people may have had depression in their younger years, but for some, this will be the first episode.

Depression has two main symptoms:

• A depressed mood that lasts for two weeks or longer and persists throughout the day
• A loss of interest in hobbies or activities that are normally fun or enjoyable
• A person with depression might also have a few of these symptoms:
• Significant weight loss or weight gain
• Changes in appetite
• Restlessness
• Fatigue
• Feelings of guilt, worthlessness, or hopelessness
• Difficulty concentrating or remembering
• Thoughts of suicide or attempts at suicide

Delusions and hallucinations can also accompany a severe major depressive disorder episode. When these two symptoms are present, the depression is categorized as psychotic depression, which is most common in later life.

If you notice these symptoms in a family member it is important to seek help. Untreated depression is the number one cause of suicide in the United States, and older people have almost double the suicide risk of the general population. Early treatment is the best way to prevent these situations.

What Other Types of Depression Are There?

Older people might also have disorders such as dysthymic disorder and minor depressive disorder. The symptoms of these types of depression are not normally as severe as those of major depression, but they can still make it hard for a person to function. Treatment is still important, and it will help the patient feel better over time.

What Causes Depression?

Depression is caused by a chemical imbalance in the brain. This imbalance can be caused or worsened by certain types of medications that older patients may need to take, including blood pressure medications, muscle relaxants, or steroids. If you or a family member feels more depressed after switching medications, tell your doctor. The new medication may be causing symptoms that could be eliminated by the use of a different drug.

Is Depression Normal After the Death of a Loved One?

Some depression is normal after major life changes such as retirement, moving to a nursing home, having financial issues, or being lonely. Older people often face the death of loved ones and friends, and this can also be a trigger for depression. While sadness and some depression are expected in these situations, a physician should evaluate depressive episodes lasting for longer than two months after a loss.

How Is Late-Life Depression Different from General Depression?

Younger people who have depression might have problems sleeping, feel fatigued, or have trouble with eating too much or too little. However, for older adults, these symptoms can be part of the natural aging cycle, so it is important for doctors and family members to be aware of the person’s emotional state. Feelings of worthlessness, avoiding interactions with other people, problems with memory and concentration, and other psychological symptoms need to be evaluated for proper diagnosis.

How Is Depression Evaluated?

A complete medical and psychiatric evaluation is completed to diagnose depression for any age. A doctor will want to know when the patient started feeling symptoms of depression and if it has ever happened before. The severity of symptoms and how long they last is also important. Older individuals will have their mental statuses assessed, and laboratory tests may be completed. This will help rule out any medical conditions that could be causing or influencing the severity of the depression.
How Is Depression Treated?

If a medical illness is the reason for depression or is making depression worse, it will need to be treated separately. Depression is treated with medication and/or psychotherapy. One or the other might work better for an individual patient, but they can be combined in various proportions to help most patients work through difficult times. For very severe depression that isn’t responding to medication, electroconvulsive therapy may be considered. Most late-life cases of depression are treated with antidepressants that affect the brain’s chemistry to control moods. Selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed type of antidepressant.

These antidepressants include medications such as:

• Citalopram
• Fluoxetine
• Paroxetine
• Sertraline
• Fluvoxamine

These medications are often well tolerated by older patients, but citalopram and sertraline are considered the most effective of the SSRIs. Psychotic depression is usually treated with antipsychotic medications like risperidone or quetiapine.

• Editors, experts, and contents pages from the guidelines
• Depression in Older Adults: A Guide for Patients and Families

View Resources

• Mentalhealth.va.gov – Depression
• MedlinePlus – Depression – elderly
• Ncbi.nlm.nih.gov – Development and validation of a geriatric depression screening scale: a preliminary report.
• Nihseniorhealth.gov – About Depression

One in four women will experience an episode of depression at least once in their lives. Depression affects men at a much lower rate. However, many experiences unique to women, such as menstruation, pregnancy, and menopause, trigger depressive episodes.

Depression Caused by Menstruation

Some women experience severe symptoms of depression before they start menstruating each month. This mood disorder, called premenstrual dysphoric disorder (PMDD), may also share symptoms with premenstrual syndrome (PMS), like breast tenderness, bloating, or pain. However, the defining characteristic of PMDD is seemingly uncontrollable feelings of anger or moodiness.

Women with other family members with the disorder are more likely to have PMDD, which indicates that genes may play a role in who suffers from the condition. PMDD, like other mood disorders, may be caused by a problem with the brain’s chemistry. The fluctuating hormones caused by ovulation appear to trigger this condition.

To be diagnosed with the disorder, a woman must have at least five PMDD symptoms after ovulation each month. She must also have seven to ten days of good health, where none of these symptoms are present, each menstrual cycle.

Symptoms include:

• Lack of interest in common activities, such as hobbies
• Moderate to severe feelings of tension or anxiety
• Shifts in mood, such as feeling overly sensitive
• Moderate to severe feelings of hopelessness or depression
• Physical symptoms, such as weight gain, joint or muscle pain, or a headache
• Changes in sleeping patterns, such as sleeping too much or too little
• Changes in eating habits or food cravings
• Problems focusing or concentrating
• Low energy
• Unusual irritability or anger
• Feeling overwhelmed

Women who believe they may have PMDD should make an appointment with their gynecologist and possibly a mental health professional. The woman may be asked to keep a mood journal for at least two months before attempting treatment. However, severe symptoms may warrant an immediate intervention.

Women entering treatment can expect to take antidepressants as well as making behavioral and nutritional changes. Patients should limit their consumption of caffeine, alcohol, and salt. They should also consider lowering their sugar intake and eating more complex carbohydrate. Regular exercise and using relaxation techniques are also recommended. Psychotherapy can also be used to treat the depression often associated with PMDD.

Treating Depression While Pregnant

Women with depression should consider altering their treatment plan if they are pregnant or plan to conceive. If a woman has only mild depression, her doctor will often recommend managing her depression only through therapy while she tries conceive or is pregnant. Patients with severe depression may need to stay on their medication but can also switch to an antidepressant that is believed to be safe for pregnant women.

Women with a history of severe depression should also talk about postpartum depression with their doctors. Sometimes a doctor may advise a woman to start taking antidepressants during her last month of pregnancy, even if she stopped using antidepressants when she conceived. This cautionary measure can prevent these women from developing postpartum depression.

There are no studies on the effects of antidepressants on pregnant women due to ethical concerns. However, drug manufacturers do keep a list of women who use their drugs while pregnant as well as a list of any side effects the women and their children experience. This information helps doctors identify the possible risks to the fetus when determining if antidepressants are necessary.

Postpartum Depression

Most new mothers will have a short period of time where they experience symptoms of moodiness, irritability, or anxiety. These mood swings are known as postpartum blues. Postpartum blues begin after the third or fourth day after delivery, but the symptoms should stop after day 12. Women with symptoms that linger past two weeks are at higher risk for developing postpartum major depression.

Postpartum major depression is a serious mood disorder that causes a depressed mood for the majority of the day for at least two weeks. Some women with postpartum major depression experience fatigue, guilt, insomnia, and suicidal thoughts. Very severe cases can cause delusions or hallucinations, which in rare cases may lead a woman to harm her child.

Postpartum major depression is caused by changes in the body’s brain chemistry and is considered a biological illness. After birth, the amount of progesterone and estrogen in a woman’s body falls, which may trigger depression. Sometimes an underactive thyroid gland causes postpartum major depression, but this cause of depression is more easily treated. The same condition primarily caused by hormone changes is treated through therapy and sometimes medication. However, women breastfeeding their children should discuss the use of antidepressants with their doctor.

Depression Caused by Menopause

While most women will experience some changes in mood, hot flashes, and insomnia during menopause, these symptoms can also progress into major depression. Researchers believe that changes in hormones can trigger major depression, especially in women who have had depression in the past or have family members with depression.

Women with major depression will have one or both of two primary symptoms. They can have a depressed mood for most of the day for at least two weeks, or they may lose interest in treasured activities.

In addition to at least one of these symptoms, women can also experience:

• Lack of energy or fatigue
• Thoughts of suicide or death
• Changes in sleeping patterns
• Lack of concentration
• Persistent thoughts of worthlessness or guilt
• Restlessness

For severe major depression, doctors recommend antidepressants and hormone therapy in addition to psychotherapy. If the major depression symptoms are milder and the woman is still transitioning into menopause, a doctor may recommend trying only hormone therapy, especially if the woman has never experienced depression before. For women with mild symptoms who have fully transitioned into menopause, many doctors believe that antidepressants are more useful than hormone replacement.

In some cases, hormone therapy used to ease the symptoms menopause can trigger depression. In these cases, the hormone therapy may be altered or stopped altogether. Antidepressants may also be prescribed. In all cases, psychotherapy, particularly interpersonal therapy or cognitive-behavioral therapy, is recommended.

Women and Depression

Although two-thirds of patients treated for common depressive disorders are women, there is no comprehensive set of practice guidelines used for treating depressed women. Instead, doctors will try to treat depressed women based on any physical changes that are known to cause depression. In addition to hormone changes unique to women, depression can also be triggered by the same situations, genes, medical conditions, medications, and personality traits that cause depression in men.

• Editors, experts, and contents pages from the guidelines
• Premenstrual Dysphoric Disorder: A Guide for Patients and Families
• Major Depression During Conception and Pregnancy: A Guide for Patients and Families
• Postpartum Depression: A Guide for Patients and Families
• Depression During the Transition to Menopause: A Guide for Patients and Families

View Resources

• NIMH – What causes depression in women?
• Womenshealth.gov – Depression fact sheet
• CDC.gov – Depression Among Women of Reproductive Age and Postpartum Depression
• Depressiontoolkit.org – Depression During Pregnancy

Bipolar disorder is a medical condition that involves rapid mood swings between periods of good moods and those of irritability and depression. The condition is experienced equally by both men and women and generally manifests itself for the first time when the individual is between the ages of 15 and 25. So far, the cause of bipolar disorder is not known, but those who suffer from the condition are likely to have family members who also have bipolar disorder.

There are three types of bipolar disorder:

• Bipolar disorder type I
• Bipolar disorder type II
• Cyclothymia

Bipolar disorder type I was once known as manic-depression. It indicates those sufferers who have experienced any manic period-strong feelings of euphoria-as well as the depressive periods of the disorder at least once in their lifetimes. Bipolar disorder type II is a condition in which the individual doesn’t have fully manic episodes. Instead, the person has periods of hypomania. Hypomania is defined as a period of extremely high energy levels accompanied by impulsive behavior. Type II sufferers do experience the same depressive episodes as individuals with type I. Cyclothymia is the mildest form of bipolar disorder. Those with this type of the disorder experience less extreme mood swings, going from mild hypomania to depression. Because the hypomania is less severe, it is often overlooked as a symptom. This often leads those with the condition to be diagnosed as suffering only from depression.

Although the cause of the disorder may be unknown, there are a few common triggers. These include serious life changes, the taking of steroids or antidepressants, illicit drug use and sleepless periods.

Symptoms of the Condition

The manic phase experienced by those with bipolar disorder can last from several days up to as long as a few months at a time.

During this phase, individuals will exhibit a variety of symptoms, which may include:

• Lowered sleep requirements
• An inability to control emotions
• Lack of judgment
• Distraction
• Recklessness
• Elevated moods
• Being easily irritated
• An increase in involvement in activities

During the depressive phase, people with the disorder generally experience:

• Low moods
• A lack of concentration
• Difficulty in making decisions
• Memory problems
• A lack of appetite or overeating
• A loss of energy
• Lowered self-esteem
• Feelings of hopelessness, guilt or worthlessness
• Suicidal thoughts
• Sleep disorders
• Withdrawal from normal activities and friends

Because of the depressive periods, suicide rates are higher than normal among those with bipolar disorder. Those with the disorder are also more likely to abuse drugs or alcohol, increasing the severity of the condition.
In addition to the distinct high and low periods, those with the disorder may sometimes find that the symptoms of each can occur simultaneously. The manic and depressive states may also change quickly from one to the other, a condition known as a mixed state.

Testing for the Disorder

Diagnosing bipolar disorder requires extensive testing. A physician testing for the disorder will ask about the patient’s family history, looking for anyone else in the family who has the disorder. The physician will also ask about any mood swings experienced recently, and take a history of the mood swings including when they began. A medical history is also taken, which will include any other conditions that the patient may have and a list of all medications taken. The doctor will also supervise the individual’s mood for signs of mania and depression, as well as asking the patient’s family about any changes in behavior.

After medical questioning, the doctor will provide a thorough physical exam to determine if there is any other illness that may be causing the symptoms of the disorder. This exam will include laboratory tests for any thyroid conditions as well as checking on any drugs in the patient’s system. Though some drugs mimic symptoms of the disorder, the presence of those drugs does not mean that the disorder does not exist, as taking the drugs may itself be a symptom.

Treatment of Bipolar Disorder

Treatment of bipolar disorder is aimed at stabilizing the patient’s mood as much as possible. Even when the treatment proves successful, the patient may still experience both manic and depressive phases. With treatment, that the patient may avoid hospital stays, have a lowered desire to self-injure and function better in all of the phases of the condition.

During treatment, a physician will try to determine the triggers of the mood swings and provide the patient with exercises to complete when these triggering events occur. These exercises may help prevent the moods or lower their severity.

The physician will also use mood stabilizers, some of which include:

• Valproate
• Carbamazepine
• Lithium
• Lamotrigine

Along with mood stabilizers, the doctor might also prescribe antianxiety medications or antipsychotics to handle mood issues. Antidepressants are also used to help the patient deal with the depressive phases. The use of antidepressants raises the likelihood of experiencing hypomanic or manic periods, so they are usually used in conjunction with mood stabilizers.
For those patients who do not respond to medicine, electroconvulsive therapy might be used. This therapy consists of electrical currents applied to the patient while under anesthesia and will cause brief seizures when used. After the electroconvulsive therapy application, the physician may also use transcranial magnetic stimulation, which applies magnetic pulses of a high frequency to the patient’s brain.

Those patients experiencing severe symptoms may require hospitalization while the mood is stabilized. This may be necessary for either the manic or depressive stages of the disorder.

Treatment Issues

Outcomes tend to be more favorable for those patients who get help as soon as possible after the bipolar disorder first manifests. Issues with treatment sometimes occur when it has been successful. Those on medication who experience positive results often stop taking the medication, mistaking it for a cure rather than an ongoing stabilizing treatment. Patients may also stop taking medication if they miss the feelings of mania.

If the medication is stopped, the symptoms of the disorder often return. Stopping medication may also lead to an even higher chance of drug or alcohol abuse, an increase in suicidal thoughts and extreme judgment issues.

• Cover, editors, experts, and contents pages from the guidelines
• Patient-family guide

View Resources

• NIMH – Most Children with Rapidly Shifting Moods Don’t Have Bipolar Disorder
• Umm.edu – Bipolar disorder – Prognosis
• Bipolar.hs.columbia.edu – Bipolar Disorder and Genetics
• Wexner Medical Center – Manic Depression / Bipolar Disorder
• Faculty.washington.edu – Bipolar Disorder
• Discovery’s Edge – The Genomics of Bipolar Disorder

Depression affects more than 35 million adults each year. Of these, 6.5 million are over the age of 65. In the later years of a person’s life, changes occur that can lead to depression. These include medical illnesses, death of spouses or other loved ones and retirement. Depression prevents older adults from enjoying their lives like they did when they were younger. The effects of depression, however, extend far beyond changes in mood. Patients become less energetic, experience changes in sleep patterns, changes in their appetites and decline in physical health. However, depression is not always inevitable when it comes to aging. There are steps and strategies that older adults can focus on to overcome the symptoms of depression.

Causes of Depression in Older Adults

Health Problems

As people get older, their health typically begins to deteriorate. They may experience severe or chronic pain, become disabled or have surgeries or diseases that damage their bodies. These symptoms can cause a person to become depressed and feel useless.

Loneliness

Many elderly people live alone, usually due to the death of a spouse, have decreased mobility and no longer have driving privileges. These factors can contribute to feelings of loneliness and isolation.

Increased Sense of Purposelessness

When people reach retirement age or are physically challenged, they may feel a sense of purposelessness.

Fears

Anxiety over health issues or financial problems can cause one to become depressed. Additionally, as people get older, they become more afraid of death.

Bereavement

When people lose their spouses, friends or pets to death, they may become saddened; this can lead to depression. In this case, the bereaved might consider moving in with family members or friends.

Self-Help

Follow Doctors’ Orders

Once a patient is diagnosed with depression, it is important to follow the instructions given by the person’s health care provider. This may include taking medications such as antidepressants. The doctor may also instruct the patient to participate in regular psychotherapy sessions. It is important that the patient keeps the doctor informed of feelings, whether good or bad, and any side effects experienced due to the medication.

Get a Normal Amount of Sleep

Depression can affect sleep patterns by causing the patient to want to sleep all the time or to not sleep much at all. If the patient is having trouble doing so, the doctor can prescribe medications to either help the person fall asleep or to stay awake.

Exercise

Physical activity has been proven to be a mood-booster, often as effective as antidepressants, but without the dreaded side effects. Doing light housework, taking the stairs instead of the elevator, parking farther away and short walks are great exercise techniques. There are also many safe exercises, such as arm rotations, for those who may be confined to a wheelchair.

Eat Healthily

Eating a lot of sugar and junk food can cause the body to experience crashes. Instead, patients should eat healthy foods that provide energy and nourishment. For those unable to cook for themselves, having a family member or friend prepare meals reduces the chance of eating unhealthy.

Social Connections

One of the most important things a patient can do to help themselves get better is to maintain healthy relationships with others. This eliminates feelings of loneliness and isolation. Loved ones also provide the support and encouragement needed to help the patient recover from depression. If the patient is physically unable to get around, inviting others over or keeping in touch via email or phone can be effective as well. Additionally, participating in support groups for depression can make patients feel as though they are not alone and can seek advice from others who share their pain.

How Family and Friends Can Help

It’s hard to watch loved ones who suffer from depression, especially if they are senior citizens. Knowing how to help them can play an important role in their recovery. Simply telling the person that “everything will be just fine” doesn’t help much. Family and friends can make a huge difference by offering emotional support.

If family members suspect their loved ones are depressed, they should encourage them to visit their doctors immediately for an evaluation; the sooner the condition is diagnosed, the quicker patients can begin treatment.

If a loved one is diagnosed with depression, encourage that person to follow the doctor’s orders. Accompany that person to doctor visits or psychotherapy sessions. Additionally, assisting in taking medications and monitoring dosages will give the family member relief knowing that the loved one is following the prescription correctly.

Offering affection and emotional support can help encourage an older person to continue seeking help. Additionally, always lending an ear and listening with understanding and positivity lets patients know they are not alone.

Sometimes, depression can cause talk of death or suicide. This should not be taken lightly. Inform a doctor immediately if this occurs. If a doctor is unavailable, accompany the person to an emergency room.

Encouraging activities and exercises can also be beneficial to the loved one. Inviting the loved one to accompany you to social events or family gatherings can give a sense of self-worth and the feeling of being wanted and needed.

Being understanding when the loved one speaks negatively is part of helping a person get through depression. This is common, and negativity will decrease as the condition gets better.

Encourage the loved one to get a pet for the sake of companionship when alone. Taking care of the animal can create a sense of purpose.

Planning and preparing a healthy meal for the loved one can help reduce stress and make them feel loved and cared for.

For more on the topic of Living with Depression in Older Adults, we’ve included the following expert consensus documents as reference materials:

• Depression in Older Adults: A Guide for Patients and Families

View Resources

• NCBI – abstract information about depression in older adults
• Ufl.edu – more information about depression in older adults
• Centers for Disease Control and Prevention – state of mental health and aging in America
• Nihseniorhealth – types of depression
• PubMed – information about elderly depression

Menopause occurs after a woman has her last menstrual cycle. Both menopause and the time preceding it cause significant physical changes in a woman’s body. Women can decrease the undesirable effects of menopause by taking medication, undergoing therapy, and making behavioral changes.

Symptoms

Most women experience menopause between the ages of 48 and 55. Perimenopause can occur four to five years before the onset of menopause. During perimenopause, the woman may have irregular periods but begins to have other symptoms of menopause. Common menopause symptoms include:

• Night sweats
• Cold feet and hands
• Moodiness
• Increased fat around the abdomen
• Hot flashes
• Dizziness or headaches
• Vaginal dryness
• Insomnia
• Memory loss
• Weight gain

While menopause is part of the natural progression of aging, certain health situations can cause menopause to occur more quickly. The risk factors for early menopause are:

• Low weight
• Never giving birth
• Hypothyroidism
• Adrenal glands that do not produce adequate hormones
• Ovarian failure that occurs before age 40
• Chemotherapy or radiation
• Smoking

Major Depression

Menopause can trigger a severe mood disorder known as major depression. Women who have had depressive episodes previously, especially if the episodes were caused by childbirth or menstruation, are at a higher risk of developing major depression during menopause or perimenopause. To diagnose the problem, doctors use blood tests to determine the level of function of the ovaries and thyroid glands. The doctor concerned will also enquire about other possible symptoms and life stressors.

Doctors diagnose women as having major depression if they are depressed for most of the day for at least two weeks. Women who are no longer interested in activities they once enjoyed may also be diagnosed with major depression. Some women experience both of these primary symptoms. Major depression can also cause these secondary symptoms:

• Fatigue
• Restlessness
• Feelings of worthlessness or guilt
• Thoughts of suicide or death
• Trouble sleeping
• Oversleeping
• Trouble concentrating

The severity of the symptoms affects how doctors treat major depression. Doctors may prescribe hormone therapy, antidepressants, and psychotherapy to women with severe symptoms. Women with less severe symptoms might only use hormone therapy or antidepressants in conjunction with psychotherapy. Women who have fully transitioned into menopause may respond better to antidepressants than to hormone therapy. Those who begin to take antidepressants should expect to wait one to two months before feeling an improvement. Hormone therapy patients can expect a response in two to four weeks.

Hormone Therapy

Hormone therapy was once prescribed to most women who started menopause as a way to reduce common menopausal symptoms and prevent future health risks. Most women took hormone replacement therapy, which was a combination of supplemental progesterone and estrogen. Women who no longer had a uterus were prescribed estrogen replacement therapy, which used only supplemental estrogen. Taking only estrogen increases the risk of uterine cancer.

Hormone therapy may have more risks than benefits, however. Women in their early 60s who took hormone replacement therapy for several years showed an increased risk of blood clots, heart disease, breast cancer, and stroke. Hormone therapy for younger women, if it is taken for a shorter period of time, may yield worthwhile benefits without such substantial risks.

Hormone therapy can also be used to treat depression caused by menopause. For women who are in perimenopause, hormone therapy and psychotherapy may be the only elements needed for successful treatment. Women who never had a depressive episode before they entered menopause are also likely to respond positively to hormone therapy. However, some doctors recommend adding an antidepressant to the treatment plan if the depression is severe or the patient has had depression in the past.

Health Risks of Menopause

Women who have started menopause have an increased risk of developing some diseases, cancers, and other conditions. Menopause increases the risk of:

• Heart disease
• Osteoporosis
• Macular degeneration
• Colon cancer
• Glaucoma

Women should discuss these increased risks with their doctors. If a woman has other risk factors for these conditions, cancers, or diseases, her doctor may choose to monitor her more closely.

Adjusting to Menopause

A woman should make an appointment with her gynecologist when she enters perimenopause. After seeking her doctor’s advice, she should consider whether or not to begin hormone therapy. Many women wait until menopause symptoms are severe before trying hormones.

Women entering menopause should also be aware of the signs of depression. Even women who do not experience depression can be affected by possible upheaval during this period in their lives. Empty nest syndrome and other challenges of middle age, which often occur during menopause, can also cause unpleasant emotions. Menopause can trigger negative feelings about the body and self-identity. While these feelings are common, they may merit therapy.

Woman entering menopause should consider continuing or starting a regular exercise program. Women who are active experience fewer and milder symptoms of menopause. Exercise may also prevent postmenopausal weight gain. Weight-bearing exercise can also help keep bones strong. In fact, research suggests that exercise is more effective than hormone therapy in maintaining a desirable body fat ratio.

Menopausal women may also experience urinary stress incontinence. This is caused by muscle atrophy in the pelvic floor muscles caused by shifts in estrogen levels. Regularly completing Kegel exercises can help prevent further muscle atrophy and stop the condition from progressing.

Sex can become difficult for menopausal women. Vaginal dryness and tenderness is common, and these symptoms may reduce women’s interest in sex. Women should also be aware that their sex organs, including their outer genitals, will shrink. Due to hormone changes, menopausal women may have less interest in sex. All of these conditions can be treated and should be discussed with a doctor.

Supporting Someone with Menopause

Menopause can be a stressful time for any woman, but support from friends and family can make the transition easier. Some women believe that depression is a natural by-product of menopause; family members should encourage them to seek treatment rather than enduring their symptoms. Family members can also help menopausal women maintain healthy lifestyles by offering to exercise with them or keeping unhealthy foods out of the home.

Many changes that occur with menopause are caused by middle age and are not necessarily directly caused by hormonal changes. Family members should be sensitive to women’s feelings about these changes. Children can make a special effort to regularly talk to mothers experiencing empty nest syndrome. Spouses should also be aware that hormonal changes can impact their wives’ responses to sex, but clear communication and seeking help from a doctor as necessary can keep a physical relationship in good health.

For more on the topic of Living with Menopause, we’ve included the following expert consensus documents as reference materials:

• Depression During the Transition to Menopause: A Guide for Patients and Families

View Resources

• Princeton – information about menopause and hormone therapy
• UNL.edu – Menopause: Adaptation or Epiphenomenon?
• Rochester – general information about menopause
• CBS – why menopause?
• Cedars-Sinai – more information about menopause

One in 50 Americans has a form of obsessive-compulsive disorder (OCD) according to BBC Health statistics. While many feel alone or isolated from their friends and families, there is actually a lot of support available for those living with the condition and for those helping a family member with OCD. Knowledge of OCD is one of the main keys to dealing with this mental illness, and it is the quickest way to a better quality of life.

Obsessive Compulsive Disorder

Anyone who has obsessive doubts or worries that seriously interfere with the quality of his or her life may be diagnosed with OCD. While OCD is technically a brain disorder, it is usually considered to be a mental illness. Many people describe it as a mental hiccup because they find that their brains get fixated on a single event, such as hand-washing, and won’t let go, so they repeat the event over and over again.

Some people with OCD can be completely cured after treatment. Others may still have OCD, but they can enjoy significant relief from their symptoms. Treatments typically employ both medication and lifestyle changes including behavior modification therapy.

Signs of OCD

There are two parts to OCD: obsessions and compulsions. Many of the signs of the illness deal with obsessions and compulsory acts. Those with OCD usually only have one or two of these signs, but some have a broader range. Not all daily rituals result from OCD; some are completely normal worries and fears. It is only when these rituals interfere with life or are completely irrational that they are considered to be signs of OCD.

Obsessions Typical of OCD

People with OCD may obsess over germs, dirt, toxins and other contaminants. They might obsessively think about harming either themselves or others. They might be overly sexual, both in thoughts and physical urges. Some sufferers feel they must confess everything they do or even think, if they consider it to be forbidden. Some religious thoughts are OCD symptoms, especially if they involve moral doubt taken to extremes. People with OCD often have an overwhelming need to keep things in their proper places.

Compulsions Typical of OCD

Compulsive hand-washing and opening a door repeatedly are commonly used as signs of OCD on television. People with OCD may experience these compulsions in real life, but compulsions also come in many other forms. Examples include checking lights, counting items, arranging things in sets, repeating thoughts a number of times, hoarding, and praying. While most of these acts are fine in moderation, it is their repetitive nature that makes these compulsions signs of OCD. The overwhelming need to perform these actions is also part of a clinical definition of OCD.

Treatment Options for OCD

In addition to education for OCD patients and their families, there are two effective treatment methods for those with obsessive-compulsive disorder: medication and behavior therapy. During treatment, professionals usually try to ameliorate the current OCD episode and then attempt to prevent future episodes.

Behavior Therapy

Behavior therapy, also known as cognitive behavioral psychotherapy (CBT), is the first step in treating OCD. CBT uses exposure and response prevention. Patients are exposed to things that they fear. This exposure helps to lessen anxiety, because increased contact with an object of fear often lessens fears. Response prevention is therapy that attempts to remove people’s normal responses to the fears. For example, people who are afraid of germs can spend time around an object known to have germs (exposure) and then not allow themselves to repeatedly wash their hands afterwards (response prevention).

Cognitive therapy is often combined with behavior therapy. It addresses the thought processes behind the fears and helps patients realize that their rituals will not prevent or lower the chances of catastrophic events occurring.

There are other treatments that can be used with OCD, such as habit reversal, which replaces one ritual with something less severe; suppression, which helps switch off the symptoms; and satiation, which involves prolonged exposure to the symptom.

While there are no side effects to cognitive behavioral therapy, some people respond better to it than others. Patients who are less anxious about receiving treatment generally do better, as do those who are open to changing their habits. Patients should make sure to give feedback to therapists after each appointment to ensure they are getting the best care possible. Patients who cooperate with their therapists generally get the quickest results.

Medication Therapy

Medical professionals most commonly prescribe selective serotonin reuptake inhibitors (SSRIs), to people with OCD. These raise the amount of serotonin in the body. Brand names of SSRIs include Zoloft, Prozac, Paxil, Luvox, and Anafranil.

Medication typically takes about eight to ten weeks to start working well, but some results can show within three to four weeks. However, of people who use medication and no other therapy, less than 20 percent end up without symptoms. In addition, 20 percent of those who start on medication later need to switch medications to find one that is more effective for them.

Possible side effects of medications include nausea, insomnia, restlessness, diarrhea, sedation, weight gain, lowered libido, dry mouth, and dizziness.

OCD for Families

Many family members of OCD patients have their own questions and worries: When does this illness start? Is it inherited? What can I do? While talking to the doctor can help you understand OCD and what you can do to help, here are some basic answers to those questions.

OCD generally appears before the age of 40, and typically in childhood. According to the OCD Center, studies show that it may take 17 years for someone with OCD to get the correct diagnosis.

Research does not suggest that OCD is inherited; however, there are some genes that may play a part in its development. Children of parents with OCD have a slightly higher risk of developing the illness. Researchers do not know whether that increased risk is a genetic inheritance or comes from the children watching and emulating their parents.

People with OCD need to be handled with patience and understanding. They need you to support them and treat them the same way you do everyone else. Give them independence, a shoulder to cry on when needed, and listen when they need to vent.

For more on the topic of Living with OCD, we’ve included the following expert consensus documents as reference materials:

• Treatment of Obsessive-Compulsive Disorder Handout for Patients and Families in HTML

View Resources

• HealthFinder – more information about OCD
• Illinois – Grammar sticklers may have OCD
• Wright – general information about OCD by Dan Stein
• MIT - Neurobiology of OCD
• Yale – Research clinic for OCD

What is Postpartum Depression?

There are two forms of postpartum depression. The first form is postpartum or maternity blues, which is a mild mood condition that lasts for a short time. A more severe form, called postpartum major depression, is a serious, potentially life-threatening condition.

How Can I Recognize Postpartum Blues?

The postpartum blues have symptoms that usually occur within three or four days of giving birth. Family members or new mothers may recognize the symptoms, including mood swings, tearfulness, irritability, anxiousness, and sleeping difficulties, among others. These symptoms affect 50 to 80 percent of new mothers, so it’s important to monitor a new mother’s condition. If she shows signs and symptoms of postpartum depression for longer than two weeks, seek medical attention. One in five women with this condition develops postpartum major depression.

How Can I Recognize Postpartum Major Depression?

If a family member or friend has recently given birth, there are a few things that can tell you that she has developed postpartum major depression. This type of depression may begin immediately after birth or weeks later, and it is very serious. A major symptom is that the mother is depressed the majority of every day for at least two weeks. She will also show signs of losing interest in activities she once enjoyed. Some other symptoms include difficulty concentrating, feelings of worthlessness, guilt, insomnia, and recurring thoughts of death or suicide. About 10 to 15 percent of new mothers develop this form of depression, although it sometimes goes unrecognized for months after birth. It is important for new mothers to get professional help if these symptoms arise.

What Can I Expect from Treatment?

Treatment for postpartum depression depends on the severity of the patient’s symptoms. If the patient has the postpartum blues, these will only last for about two weeks. After this time, the depression tends to resolve on its own. When the depression becomes deeper and persists, the mother needs a different treatment. Some types of treatment include psychotherapy and antidepressant medications. Psychotherapy usually involves counseling sessions. Antidepressants come in different forms, and there has been no evidence of these medications causing problems for nursing infants. If the depression is severe, medical professionals may urge a new mother to take medications to help treat the chemical imbalance in her brain.
If a woman has become severely depressed and is having thoughts of suicide or psychotic thoughts, a doctor may want to keep her hospitalized to ensure her and her baby’s health and safety. Another rare type of treatment is electroconvulsive therapy, which doctors sometimes use when mothers do not want to take drugs or medications.
Antidepressant medications come in different chemical forms that have different types of side effects. Serotonin reuptake inhibitors, or SSRIs, are normally recommended for breast-feeding mothers. Some of these include:

• Sertraline
• Paroxetine
• Fluoxetine
• Citalopram

Breast-feeding mothers can also use an older type of treatment that uses tricyclic antidepressants. Some of these include:

• Imipramine
• Nortriptyline

For extremely severe depression with psychotic symptoms such as hallucinations or delusions, an antidepressant may be combined with an antipsychotic like Haldol, Risperdal, or Zyprexa.

Why Do I Have Postpartum Depression?

Experts don’t know exactly what causes postpartum depression. They believe it could be caused by hormones in a woman’s body that change during pregnancy and affect her brain’s chemistry. After she gives birth, the amount of estrogen and progesterone in her body is dramatically reduced, which may cause sensitive individuals to react by developing postpartum depression. Another possibility is that women with postpartum depression may have an underlying problem with an underactive thyroid gland after delivery. This issue is easy to treat if it is detected.
Currently, researchers are studying other biological or social problems that may cause postpartum depression. This type of depression is most likely linked to other forms of depression, since women who have suffered previously from depression of any kind are more likely to develop depression after giving birth. Women with relatives who have had depression also have a higher risk of developing postpartum depression.

Am I at Risk?

You may be at risk for postpartum depression if you have had a similar episode before. If you suffered from postpartum depression with the birth of your first child, for example, it is more likely that you will have postpartum depression again after the birth of your second child. If a woman has ever been depressed, her risk of developing postpartum depression increases from approximately 10 percent (women with no history of depression) to 25 percent. Women who suffer from manic-depressive illness or bipolar disorder also may need to be more careful after giving birth. These women have a very high risk of developing postpartum major depression.
Other factors might indicate a risk for postpartum depression. Some of these include depression during pregnancy, significant premenstrual symptoms prior to pregnancy, and relatives with bipolar disorder or depression. Stressful situations can also put a woman at a higher risk of developing postpartum major depression after she gives birth.

What Happens if a Woman Is Not Treated for Postpartum Depression?

Women who aren’t treated for postpartum depression can have a negative effect on their children. Studies have shown that depressed mothers interact less with their children, which can impact the children’s later behavior. Children might also have problems performing as well on developmental tasks when compared to children of mothers who are not depressed.

How Can Counseling Help?

Counseling and support can help women work through some of the mental aspects of postpartum depression. If the depression is severe, a mother may need a family member to stay with her at all times to offer support, reassurance, and validation of her abilities as a mother. Some of the common issues mothers face with postpartum depression include overwhelming fears about their new responsibilities and guilt about becoming depressed at what is supposed to be a happy time. Interpersonal and cognitive-behavioral therapies may help these mothers work through these feelings and put the problems into the proper perspective.

For more on the topic of Living With Postpartum Depression, we’ve included the following expert consensus documents as reference materials:

• Postpartum Depression: A Guide for Patients and Families

View Resources

• Health Utah – PPD: A cause for concern
• MayoClinic – information about Postpartum Depression
• Wisconsin – information about Postpartum Depression
• CDC – other PPD publications
• PubMed Health – general information about Postpartum Depression

Sharing a life and a home with someone who has premenstrual dysphoric disorder can be a challenge if you are unprepared. The symptoms of PMDD, if left untreated, can be disruptive to the sufferer’s life and the lives of everyone she lives with. Fortunately, there are studies, treatments and support to help everyone cope with the disorder that can be debilitating. To understand how to live with PMDD, you must first know a bit more about the disorder and how it is managed.

How it Works

PMDD is more than a little bloating and cramping before a period. It is a mood disorder that accompanies the other premenstrual symptoms. The PMDD gets more severe as the period draws near, escalating the sufferer to a state of very high tension, anxiety and aggression. It enhances other coexisting mood disorders to complicate any treatment for several days during the month.
PMDD is thought to be a brain chemistry malfunction that is triggered by ovulation. Symptoms usually begin after ovulation and last into the first days of the period. This cycle repeats itself every month. PMDD is tied to the hormonal changes triggered by ovulation, so it does not occur without this part of the menstrual cycle.
The condition affects up to 8 percent of women. It begins any time after the first period occurs in adolescence and until menopause occurs.

About the Symptoms

The condition involves much more than a bad time during a period. It is cyclical, occurring at the same point in the menstrual cycle each month. PMDD does not take over the entire month, however. Each sufferer must experience at least 7 to 10 days of no symptoms to qualify as a true PMDD patient. Coexisting condition symptoms are excluded from this.
The symptoms of PMDD are severe and usually life altering. Doctors require sufferers to have at least five of the following symptoms to support a diagnosis:

• Depression of hopeless feelings
• Feelings of anxiousness, tension or edge
• Irritability that increases as period nears
• Oversleeping or insomnia
• Lack of interest in favorite things
• No motivation
• Loss of energy
• Difficulty focusing and concentrating
• Loss of control feelings, feeling overwhelmed
• Severe physical manifestation of PMS symptoms like tender breasts, cramping, bloating, muscle pain and weight gain
• Suicidal thoughts

Any of these five symptoms show up after ovulation begins. They intensify to the point of overwhelming the patient until the period starts. During the first or second day, the symptoms subside and the patient begins to feel normal. This lasts up to 10 days before starting again.

Coping with the Condition

Once diagnosis and treatment has occurred, work still needs to be done at home to alleviate symptoms until the proper treatment is found. Sometimes it takes two or three cycles to figure out if a treatment works. During that time, the patient and family can make changes to make the symptoms more bearable.
Lifestyle changes can help get rid of some of the factors that can intensify PMDD symptoms. Turning to a healthy diet, giving up cigarettes and starting an exercise regimen are just a few things that can help. Obesity, smoking and poor diets are all common complications for the disorder. By changing these factors, you can help alleviate some of the physical and a few of the mental symptoms of the disease. Making these changes may also help the depression, seasonal affective disorder and bipolar disorder that often coexist with PMDD.
Relaxation techniques can help alleviate the anxiety and tension that are common in PMDD patients. Yoga, meditation and soothing hobbies are examples of relaxation techniques that can help dial down the tension after ovulation begins.
Keeping a journal helps you to understand the condition while helping the doctors see into every day of the condition. A PMDD journal can help pinpoint the start and finish of your condition as well as the triggers for the more severe episodes.
Combat the depression and overwhelming feelings by interacting with family and friends in therapy or group meetings. Sometimes, just knowing that you are not the only one going through condition can help tremendously. Try online chat rooms and groups, public support groups and talk therapy to find the best venting option for you and your situation.
Above all else, remember that this is a disease of the brain, and the sufferer has no control over it. Simply being supportive and accommodating through the days when PMDD symptoms surface can help everyone.
Regular visits to the doctor and medication dosages are also important to having a safe home with a PMDD sufferer. Take all medications as prescribed, even if there are no symptoms. Some drugs have a cumulative effect on the body and must build in the blood stream to work. The doctor’s appointments are meant to check on your progress and to detect any new symptoms. Keep these appointments to maintain a stable treatment process.

Not a Simple Condition

PMDD affects many women in many ways, so no one treatment or coping technique is perfect for all patients. By taking charge of the condition during medical treatment, you can begin on the road to living happily with a person who has PMDD. It is a disease the affects everyone it touches, but modern medicine and a few coping techniques makes sure that those contacts are not incendiary. After all, they never should be. The doctor will want to look for other coexisting conditions that the sufferer may have. Keep these conditions in mind when trying to plan on a way to change your lifestyle and life to fit around your PMDD treatment.

For more on the topic of Living with PMDD, we’ve included the following expert consensus documents as reference materials:

• Premenstrual Dysphoric Disorder: A Guide for Patients and Families

View Resources

• Wishard – information about PMDD
• SPU – PMDD and issues of quality of life
• OHSU – more info about PMDD
• NYU – general info about PMDD
• WomensHealth – more references about PMDD

You may feel that you are on your own if you or a loved one has been diagnosed with Post-Traumatic stress disorder. However, PTSD is a common problem and many resources are available for people affected by this anxiety disorder. Approximately 5 percent of people in the United States suffer from PTSD, and 8 percent of the population has had PTSD at some point. PTSD is generally caused by a traumatic event and is twice as likely to affect women as it is to affect men. The treatments for PTSD are highly effective at helping the affected individual, especially with the support of family members.

Causes

PTSD is generally caused by personally experiencing or witnessing a traumatic event. This can include a single event such as a serious accident, assault or sudden death of a loved one. Repeated experiences during childhood can cause PTSD such as abuse or neglect. Combat situations like being tortured, taken hostage or imprisoned can also cause PTSD. Less severe forms of stress such as getting divorced, being fired from a job or failing in school don’t usually cause PTSD.

Diagnosis

A diagnosis of PTSD requires the patient to exhibit specific sets of symptoms that last for at least one month. These symptoms can be classified into three general categories. The patient may reexperience the traumatic event, which may take the form of flashbacks that occur while the patient is awake or nightmares when the patient is sleeping. The patient may also experience exaggerated physical or emotional reactions to events known as triggers. The second set of symptoms for PTSD is avoidance behavior of things that are related to the traumatic event. This also includes a loss of interest in related activities or feelings of detachment from other people. The third set of PTSD symptoms is an increased level of arousal, which includes sleeping difficulty, problems with concentration, irritability and an exaggerated startle response.

Types

PTSD may be divided into subtypes including acute, chronic and delayed PTSD. The symptoms of acute PTSD last between one to three months and seriously impair the patient’s ability to function. The diagnosis may be changed to chronic PTSD when the symptoms last for longer than three months. Chronic PTSD is less likely to improve without treatment than acute PTSD, and these patients should seek treatment immediately. Delayed PTSD occurs when the symptoms recur after being absent for at least several months. This recurrence often happens on the anniversary of the event that initially caused the PTSD or when the patient experiences a similar event.

Treatment

The treatments for PTSD may generally be divided into psychotherapy and medication. Some patients respond well to one treatment modality, while other patients require both modalities. Psychotherapy is usually the best treatment for PTSD when the symptoms are mild or when medication is contraindicated, as is the case in pregnant or lactating women. Some patients may have a medical condition that prohibits the use of psychoactive medication used to treat PTSD. Medication is more likely to be the preferred treatment for PTSD when the symptoms are severe or persistent. Patients who have other psychiatric problems may also benefit from medication, especially when psychotherapy has been ineffective by itself.

Psychotherapy

The most effective forms of treatment for PTSD include anxiety management, cognitive therapy and exposure therapy. Anxiety management teaches patients skills that will help them cope with the symptoms of PTSD. These include relaxation training, breathing retraining, positive thinking, assertiveness training and thought stopping. Cognitive therapy involves changing the patient’s irrational beliefs that interfere with psychological functioning and create emotional disturbances. Exposure therapy requires the patient to confront specific triggers that produce the symptoms of the PTSD. This can include psychological exposure in the form of memories or physical exposure to real situations. Play therapy can also be an effective psychotherapy for children with PTSD, in which children act out their anxiety with recreational activities.

Medication

Selective serotonin reuptake inhibitors are the preferred antidepressants for the medical treatment of PTSD. SSRIs currently available in the United States include Zoloft, Paxil, Prozac, Luvox and Celexa. Other antidepressants that may be prescribed when SSRIs are ineffective include Effexor. The next choice of medication for treating PTSD is the older tricyclic antidepressants such as Elavil, although they have more side effects than the newer drugs.

A psychiatrist may also prescribe mood stabilizers such as Depakote if the patient shows a limited response to antidepressants. Mood stabilizers are most often used to treat PTSD when the patient’s primary symptoms are prominent anger or irritability. Patients are also likely to receive mood stabilizers if they have bipolar disorder.

Antianxiety medications such as benzodiazepines can be used to treat PTSD when anxiety is its most dominant symptom. The primary choices include Valium, Xanax, Klonopin and Ativan. Benzodiazepines should only used on a short-term basis due to the potential of a dependence developing.

Family Support

Family members can be an important part of a patient’s recovery from PTSD if they are good listeners and provide emotional support. They must avoid the temptation to simply tell patients to get on with their lives. Patients usually have the best chance of recovering from PTSD when they receive encouragement from family members to share the memories of the traumatic event.

The family members of a PTSD patient can also help the patient get rid of the guilt they often feel by telling them they are not to blame and are not alone. Family members must also have realistic expectations about a patient’s recovery from PTSD, while encouraging patients to seek exposure to triggers. Support groups are also a common method of helping patients and family members deal with PTSD. These support groups are available through a variety of organizations.

For more on the topic of Living With PTSD, we’ve included the following expert consensus documents as reference materials:

• Guide for Patients and Families in pdf

View Resources

• UOregon – War zone stress reaction and PTSD
• IOM – PTSD treatment
• Mason – information about PTSD
• UIC – veterans with PTSD
• SDSU – The psychobiology and psychopharmacology of PTSD

Schizophrenia is a chronic, severe mental disorder in which a person has a hard time telling the difference between what is real and not real. According to the National Institute of Mental Health, approximately 1 percent of the population suffers from this disorder. The disease can also affect families. Individuals with schizophrenia usually have difficulty keeping a job and caring for themselves. They must rely on family and friends for help. The disease is often misunderstood, but it is treatable, and in many cases, the individual can go on to lead a productive and normal life.

What Are the Symptoms of Schizophrenia?

People diagnosed with schizophrenia may display a variety of symptoms. These symptoms will often come and go, and in some cases, the individual may learn how to deal with the symptoms, so they are not noticeable. There are three categories of symptoms: positive symptoms, negative symptoms and cognitive symptoms.
Positive symptoms include:

• Hallucinations: A person may see, hear, smell or feel things that are not there. Most individuals who have been diagnosed with this disorder will hear voices. The voices may warn the person about dangers or tell the person to do things. The individual may spend a good deal of time talking to the voices inside their head. There may be several voices talking at one time, and the voices may even talk to one another.
• Delusions: A person with schizophrenia will often have false beliefs about something. The person may think that neighbors are spying on them or someone is out to get them. The individual will spend a large amount of time worrying about what others are thinking and doing to them.
• Thought and movement disorders: An individual with schizophrenia may have a hard time organizing thoughts into anything meaningful. They may stop speaking abruptly or speak in a garbled way. Body movements may become agitated or the person may not move at all. Negative symptoms are often associated with a disruption of normal emotions and behaviors. Individuals will show a lack of interest and pleasure in everyday life. There may be a lack of ability to maintain planned activities, and a person will often not speak when spoken to. A person who shows negative symptoms often needs help with everyday activities, such as personal hygiene. Cognitive symptoms are only found with testing. These types of symptoms include the inability to understand information and trouble focusing and paying attention. A person may also have problems knowing how to use information once they have received it. Cognitive symptoms make it difficult for an individual to lead a normal life without a large amount of emotional distress.

How Is Schizophrenia Treated?

According to the U.S. Department of Health and Human Services, because there is no exact known cause of schizophrenia, the best method of treatment is to try to eliminate the symptoms of the disease. This usually involves a variety of antipsychotic medications and psychosocial treatments. Medications can include:

• Risperidone
• Aripiprazole
• Paliperidone
• Olanzapine
• Quetiapine

Many individuals experience side effects when they first begin taking these medications regularly, which can include dizziness, blurred vision, rapid heartbeat, menstrual problems and skin rash. These symptoms usually go away after a few days, so it is important to continue taking the drugs. The symptoms of schizophrenia should also go away a few days after taking the medication. A person may have to try several different prescriptions before finding the one that is right. Medication is normally for the rest of your life. If you have schizophrenia and decide to stop taking your medications, you should see a physician to be weaned off slowly. You should never stop taking the medication suddenly.
Once a patient has been stabilized with medication, psychosocial treatments will begin. These treatments will help the person deal with everyday challenges, such as communicating, work, and relationships. According to the National Institute of Mental Health, a patient who undergoes psychosocial treatments is more likely to continue taking their medications, and they are less likely to suffer from relapse or be hospitalized.

How You Can Live with the Illness

If you have been diagnosed with schizophrenia, the best thing you can do is to take an active role in managing your illness. Learn the warning signs of a relapse, and have a plan of action to deal with those symptoms. The sooner you respond, the less time you will spend recovering. You can also learn coping skills to deal with the worst and most persistent symptoms.
Often drug abuse and schizophrenia go hand in hand. If you have been abusing drugs and alcohol, there are many places that will offer treatment for your drug addiction and the mental illness. You will get better results if you address the two problems together and find treatment for the two problems at the same time.

How Families Can Help

Usually an individual who has been released from treatment for schizophrenia will be released into the hands of family members. If you are caring for a family member with the illness, it is important to know how to handle the illness. A physician may ask family members to talk to a therapist, who will teach family members coping strategies. Family members may also learn how to make sure a loved one knows how to stay on the medication and continue with treatment. Families should have all contact numbers and know where to take the individual for outpatient services and family services.
Self-help groups are available for both individuals with schizophrenia and their families. Your physician can usually point you to the best self-help groups in your area. It often helps to know there are others who are going through the same or similar circumstance. Knowing there are others with the same illness can help make you feel less isolated. You can ask questions and learn what works best for them, and you can even learn new methods to cope with schizophrenia.

For more on the topic of Living with Schizophrenia, we’ve included the following expert consensus documents as reference materials:

• Guide for Patients and Families in pdf

View Resources

• USA – An easy-to-read booklet on Schizophrenia
• WomensHealth – More information on schizophrenia
• BetterHealth – general information about Schizophrenia
• HealthInSite – references on Schizophrenia
• NIMH – rethinking Schizophrenia

People with OCD have excessive doubts, worries, or superstitions. While all people experience these problems occasionally, OCD patients’ worries can control their lives. They may cope with common problems by indulging in compulsions that are excessive or do not make logical sense.

Medical researchers have shown that OCD is a brain disorder that is caused by incorrect information processing. People with OCD say their brains become stuck on a certain urge or thought. In the past, OCD was considered untreatable. However, advances in therapy and medication have greatly increased the chance that someone with OCD can be successfully treated.

Possible Causes of OCD

While researchers have not yet identified any gene that causes OCD, there is some evidence that genetics may affect who develops the disorder. Children who have family members with OCD have a greater chance of developing OCD early in life. However, family members do not inherit specific symptoms from each other.

Sometimes OCD symptoms begin in childhood after the child has strep throat. Medical researchers believe that in this case an autoimmune mechanism is to blame. In these cases, treatment with antibiotics may be effective in combatting OCD symptoms.

Researchers know that OCD is triggered by communication problems between the brain’s deeper structures and the front part of the brain. These parts of the brain primarily use serotonin to communicate. This is why increasing the levels of serotonin in the brain can help to alleviate OCD symptoms. However, even though researchers know that low levels of serotonin can cause OCD symptoms, there is no laboratory test to diagnose OCD.

Symptoms

People with OCD symptoms have compulsions or obsessions that cannot be controlled without help.
Experiencing some OCD compulsions or obsessions does not mean someone has the disorder. In order for professionals to make an OCD diagnosis, the compulsions or obsessions must significantly impact the patient’s life.

While most OCD patients have both compulsions and obsessions, some may only have one or the other. Obsessions regularly occur without warning, and people with OCD feel that they cannot control them. Obsessions also trigger feelings of disgust, fear, or doubt. Common OCD obsessions include:

• Fear of contamination from dirt or germs
• Forbidden thoughts
• Excessive doubts about religion
• A compulsion to confess, tell, or ask questions
• Sexual thoughts that intrude on daily life
• A need to have objects organized in a particular manner
• Imagining self-harm or loss of control over aggression

OCD patients use compulsions to relieve the discomfort caused by obsessions. Common OCD compulsions include:

• Praying
• Touching
• Arranging or ordering objects
• Counting
• Checking
• Washing
• Hoarding
• Repeating actions

Treating OCD

When patients are first diagnosed with OCD, they enter the acute treatment stage. During this time, treatment is focused on stopping the current OCD episode. Once treatment is successful, a patient transitions into maintenance treatment. Maintenance treatment focuses on preventing further OCD episodes. Each stage of OCD treatment has the same three major components: therapy, medication, and education.

Therapy

Professionals use cognitive behavioral psychotherapy to treat patients diagnosed with OCD. This type of treatment provides patients with the psychological tools to help them resist the effects of their OCD. Cognitive behavioral therapy relies on three techniques to help treat OCD.

The first technique requires patients to be exposed to objects or situations that trigger their OCD. For example, patients who avoid handling money or door handles due to possible exposure to germs are encouraged to regularly use these objects.

The second technique asks patients to avoid initiating a ritual or other response after being exposed to the triggering object. Patients who touch objects they consider to be contaminated, for example, should avoid ritualistically washing their hands or other damaging behaviors.

The third technique requires patients to logically examine faulty assumptions. Patients who have OCD may believe that their failure to complete rituals has an adverse effect on themselves or people they love. Therapists help them examine this faulty reasoning. When patients are able to identify a logical fallacy, they are more likely to be able to resist completing their ritualistic response to triggering situations.

Medication

Not every OCD patient requires medication. However, many people diagnosed with OCD find taking a selective serotonin reuptake inhibitor (SSRI) can help curb their OCD symptoms. Currently, there are four SSRIs used to treat OCD, including:

• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Sertraline (Zoloft)
• Paroxetine (Paxil)

OCD patients should expect to take medication for three to four weeks before they experience any benefits. With a proper dosage, someone with OCD can expect to receive the maximum benefit from the medication in 10 to 12 weeks.

In some cases where a SRI is not effective, a therapist may prescribe a nonselective serotonin reuptake inhibitor such as clomipramine (Anafranil). Clomipramine affects serotonin, but it also impacts other neurotransmitters in the brain. For this reason, clomipramine is more likely to cause adverse reactions in OCD patients than are the other medications.

Education

Patients diagnosed with OCD should learn as much as they can about this disorder. They can combine learning about the disorder through reading and talking to others with OCD with regular meetings with a clinician. During the first meeting with the clinician, they should develop a treatment plan. OCD patients who are in the acute stage of treatment will likely see their clinician once a week to discuss their response to their medication and therapy.

Family Support for OCD

Family members can help OCD patients manage their disorder by being supportive and calm and by becoming informed about the disorder. They should offer compliments when the OCD patient avoids reacting to his or her compulsions. In some cases, it may be helpful for family members to offer their observations to the patient’s clinician.

Under no circumstances should a family member be critical or offer negative comments about the patient’s disorder. Such feedback is not helpful and is often detrimental to the patient. If family members have previously participated in OCD rituals with the patient, they should not immediately stop. Instead, the family members should discuss this problem with the OCD patient’s therapist.

Living with OCD

Patients who have successfully completed OCD treatment can expect to have monthly check-ins with their clinician for at least six months. They will likely complete at least a year of cognitive behavioral therapy and, if necessary, medication, before discontinuing these types of treatment.

Once patients discontinue cognitive behavioral therapy or medication, relapses are common. For this reason, some professionals recommend that patients continue to use medication if they do not want to continue therapy. Two to four relapses may indicate that the patient needs to take medication permanently. A patient should discuss even a minor relapse with a clinician to avoid further setbacks.

For more on the topic of OCD, we’ve included the following expert consensus documents as reference materials:

• Guidelines for the Treatment of Obsessive-Compulsive Disorder, in HTML
• A Guide for Patients and Families, in HTML

View Resources

• MedlinePlus – informatiom about OCD
• VCOY – general informatiom about OCD
• Wright.edu – OCD by Dan Stein
• MIT – neurobiology of OCD
• Stanford – Pharmacological treatments

Mental retardation is fairly common, and it occurs in approximately 1 to 2 percent of people. Psychiatric and behavior problems occur three to six times more in these individuals than in the general population, so the assessment of these patients is important in treating these issues.

How Is Mental Retardation Diagnosed?

Mental retardation is normally diagnosed before the age of 18 and is defined as when an IQ of a person is 75 or lower. Individuals will show signs of difficulty in two areas of adaptive skills, such as social skills, health, or safety. Significant psychiatric or behavioral problems are normally present, although the IQ is not necessarily related to an underlying psychiatric disorder. A person with mental retardation may need pharmacological or behavioral treatment if he is diagnosed with:

• Major depressive disorder
• Bipolar disorder
• Obsessive-compulsive disorder
• Schizophrenia
• Posttraumatic stress disorder
• Anxiety disorder

Treatment for this type of condition needs to be based on the specific needs of the individual; for example, a patient with epilepsy may react to certain medication very differently than someone without, so it’s important to keep the treatment as specific as possible. It can be more difficult to diagnose behavior or psychological conditions as the mental retardation becomes more severe, however.

What Kind of Behavior Problems Are Treated?

Behavior problems in an individual with mental retardation might be treated with medication or behavior therapy. If your family member has mental retardation and has any of these behaviors, treatment may be needed:

• Self-injury
• Physical aggression
• Destruction of property
• Hyperactivity
• Impulsivity
• Excessive dependency
• Sexually aggressive behavior

Other behaviors may also be treatable, which is why it is important to speak with a doctor or medical staff about a diagnosis.

How Will I Be Assessed?

If someone in your family has mental retardation, that person will be assessed by a doctor. Functional behaviors will be assessed. This includes an interview with the family and caregivers, a direct observation of the behavior, and an assessment of the behavior on a rating scale. This helps the medical provider decide the best course of treatment. Once a treatment plan is in place, an ongoing assessment will be completed. This will include repeated observation of the behaviors and will require the doctor to place the behaviors on a rating scale again at different times. A medical history will be taken, and a physical exam is always given. People with mild or moderate mental retardation will be more likely to receive a standard psychiatric interview for diagnosis, but even severe cases can be treated. You or a caregiver must give informed consent to have these tests and evaluations completed. If the individual with mental retardation is able, he or she will sign off the tests. If not, it will be up to the legally authorized representative.

What Will a Doctor Look For?

For those with mental retardation who are suffering from psychological or behavioral problems, doctors will start by looking for stressors in the environment. This could be the cause of worsening symptoms or things that could trigger symptoms. Some things to watch for include:

• The loss of a parent or friend
• Romantic breakups
• Being fired or losing a job
• Excessive noise
• School or work stress
• A lack of stimulation
• A lack of support from friends or family members
• Neglect
• Physical or sexual abuse
• Illness
• Sensory defects
• Seizures
• Trouble communicating
• A change of location

All of these things may increase the likelihood of increased behavioral issues.

What Is Psychosocial Treatment?

Psychosocial treatment is a multidisciplinary team approach. This means that you will be a part of your family member’s treatment, as the cooperation of the family and the patient is very important. The care will need to be continuous, and the environment will need to meet the needs of the individual with the behavioral or psychological problems. The family will need to provide timely access to care, to reduce psychosocial stress, and to increase support. The residence will need to meet the functional level of the patient, and the environment should be as nonrestrictive as possible.

Families can change the environment of the patient, which can help. For example, changing activities to make them easier or changing the physical environment can reduce some behavior issues. The family needs to discuss ways to manage the behavioral or psychological condition. Social and communication skills training is normally part of this process. Reinforcement procedures can help interrupt problem behaviors and reinforce positive behaviors.

How Can I Deal with Behavioral Issues?

Some problems can be helped with simple home strategies. For those with trouble sleeping, a regular bedtime routine can help. Restricting caffeine, promoting exercise, and avoiding hunger at bedtime may make it easier to sleep. For those with weight gain issues, making sure to watch signs of weight gain carefully when taking new medications is important. Structured meals, eating the right foods, and providing and encouraging fun exercises are important as well.

Will Medication Be Prescribed?

Medication is most likely to be prescribed when the presence of an identifiable diagnosis is possible. If that is not possible, treatment should focus on the specific behavioral problems, which may or may not be controlled with the use of medication. Individuals with mental retardation who take medications will need to be monitored to prevent drug interactions, as they may end up on more medications than the general population. Some strategies for medication delivery include:

• Keeping the medication regiment as easy as possible. This could mean once-a-day pills or extended-release pills.
• Start will smaller amounts of medications
• Avoid drug changes unless they are necessary

Medication will likely be provided if an individual is diagnosed with:

• Schizophrenia
• Bipolar disorder, manic or depressed
• Major depressive disorder
• Psychotic disorder
• Obsessive-compulsive disorder
• ADHD
• Panic disorder

Medication may also be recommended for those who have symptoms that interfere with their ability to interact or those who pose a physical risk to others due to aggression.

For more on the topic of Psychiatric and Behavioral Problems, we’ve included the following expert consensus documents as reference materials:

• Psychiatric and Behavioral Problems in MR: An Update.

View Resources

• PubMed – mental retardation and psychiatric illness
• NCBI – mental retardation and psychiatric disorders
• Connecticut Social Services – Americans with disabilities act
• Pubmed – mental retardation and psychiatric comorbidity
• SAMHSA – myths and facts about mental health
• NIHPA – Bases of mental disorders

Schizophrenia is a brain disease that affects approximately three million people in the United States alone. It is a highly treatable disease, and there are many new treatments for schizophrenia that can help improve people’s lives.

What Is Schizophrenia?

There are three types of schizophrenia, which are divided by the types of symptoms: positive, negative, and disorganized.

Positive/Psychotic Symptoms

People suffering from schizophrenia that presents with positive symptoms may have delusions or unusual thoughts, or feel extremely suspicious. They may be out of touch with reality and think that other people are plotting against them. They can suffer from audio or visual hallucinations. Normally, these hallucinations are negative or frightening.

People with schizophrenia may have a distorted view of the things around them. The things they see or smell may not represent real life, and this can make normal objects scary or unusual. People with schizophrenia may also be more sensitive to light, color, and other distractions.

Negative Symptoms

Negative symptoms of schizophrenia can include a lack of emotions and energy. People might have difficulty experiencing or expressing their emotions, empathizing with others, or relating to people. This can lead to isolation. People with negative symptoms may also have trouble concentrating and finishing projects. They could have to be reminded to do simple things such as bathing. Some symptoms are similar to those of depression. Schizophrenics may find the world uninteresting and flat, feeling that there is no point going out and doing things. They may also say little to nothing unless spoken to.

Disorganized Symptoms

Symptoms of schizophrenia can also be disorganized. These symptoms are similar to those of severe ADHD or autism. Confused thinking and speech is common, so patients are unable to carry on conversations or solve problems. They may repeat rhythmic gestures or completely stop moving for long periods of time.

How Will a Family Member with Schizophrenia Act?

You may notice schizophrenia developing between adolescence and the age of 40, which is the most common time that it first appears. However, children and older adults can also develop schizophrenia. If your loved one had been ill for a long period of time, this can be a precursor to schizophrenia. You may notice the first episode if the patient seeks help when delusions or hallucinations trigger unusual behavior. Patients who seek help have a good chance of recovering from the episode within a few months.

What Can I Expect from Schizophrenia?

If you have schizophrenia, you should know that the course of this brain disease varies greatly. Medication can often control your symptoms. If you take your medication exactly as directed, you will likely have a mild type of the disease. In that case, you will have only one or two relapses in total by the age of 45 and will show only minor symptoms. If you have moderate schizophrenia, you will likely have several major relapses by the age of 45, plus symptoms during stressful times, and you will have persistent symptoms between relapses. This often results from taking your medication most, but not all, of the time. Not taking medication at all or dropping out of treatment often causes a severe and unstable course of the disease. If you have this type, you will only be stable for a short period of time between relapses. You may have serious symptoms and need help with your day-to-day life.

How Does a Patient Recover?

Patients can recover from acute episodes. They will begin to stabilize when they take medications that control their symptoms. After that, they may still have some trouble with symptoms, but these will be much less severe. Between episodes, maintenance is important to prevent mild and persistent symptoms. During this phase, many patients continue to improve.

Is Diagnosis Important?

Diagnosis is important, especially because it’s important for doctors to treat schizophrenia as soon as possible. Early diagnosis can help stabilize and prevent many symptoms and help in a variety of other ways. Medical professionals’ top priority is to eliminate psychotic symptoms. They can usually do this within six weeks. Next, they will provide antipsychotic medications to help patients prevent relapse and hospitalization.

After patients are treated with antipsychotics, doctors reevaluate their treatment. A patient can sometimes be misdiagnosed, since some other disorders are similar to schizophrenia. If patients drink alcohol, they will need to decrease their intake or stop drinking entirely. Abusing alcohol or other substances can make schizophrenia much worse. Doctors and other hospital staff also want to reduce a patients’ risk of suicide, which is highest in the early years of schizophrenia. Such suicidal thoughts are treatable, and patients can take antipsychotics such as:

• Haloperidol
• Thioridazine
• Fluphenazine
• Chlorpromazine

There are also additional drugs available besides these conventional antipsychotics. Atypical antipsychotics like risperidone, quetiapine, and olanzapine can also be used and may have fewer side effects than conventional antipsychotics.

Should Patients Take Medication during Recovery?

Researchers have not found a cure for schizophrenia, so it is important to take any medications prescribed as they are given. The symptoms of schizophrenia can be controlled in most people as long as they take their medications. After the first episode, doctors recommend that patients stay on medication for 12 to 24 months before reducing the dose. Patients who have had more than one episode or those who have not fully recovered may need to be treated for a longer period of time, and some people may need treatment indefinitely.

Patients need to be careful and recognize side effects of medications, since some can cause fairly large problems. Extrapyramidal side effects can cause people to feel rigid or stiff, or they may feel like they need to keep moving all the time. Doctors may prescribe an anticholinergic in some cases to help treat this side effect. People can also develop tardive dyskinesia when they take antipsychotics for a long period of time. This results in the uncontrolled movement of the mouth. If this develops, simply switching the type of antipsychotic can help.

For more on the topic of Schizophrenia , we’ve included the following expert consensus documents as reference materials:

• Full reprint in PDF: Treatment of Schizophrenia 1999
• Guide for Patients and Families in PDF
• Selected Results from the 1996 Schizophrenia Policy Survey in PDF

View Resources

• MedlinePlus – general information about Schizophrenia
• Guidelines – treatment of patients with schizophrenia
• NIMH – recovery after schizophrenia
• NIMH – rethinking schizophrenia
• PubMed – general information about Schizophrenia

A behavioral emergency, also called a behavioral crisis or psychiatric emergency, occurs when someone’s behavior is so out of control that the person becomes a danger to everyone. The situation is so extreme that the person must be treated promptly to avoid injury to themselves or others. Time is of the essence in a behavioral emergency, so it is important to recognize the symptoms of this type of emergency and to realize the degree to which the situation can escalate if immediate steps are not taken to diffuse the situation.

The symptoms of a behavioral emergency include extreme agitation, threatening to harm yourself or others, yelling or screaming, lashing out, irrational thoughts, throwing objects and other volatile behavior. The person will seem angry, irrational, out of control and unpredictable. The unpredictable nature of this type of emergency can lead to injuries to bystanders if the sufferer displays violent behavior during the episode.

Reasons for Behavioral Emergencies

Behavioral emergencies can arise due to mental illness, substance abuse or another medical condition. Medical conditions that can cause the type of mental changes required for a behavioral emergency include low blood sugar related to diabetes or hypoglycemia, hypoxia, a traumatic brain injury or reduced blood flow to the brain and central nervous system infections such as meningitis.

In general, all possible physical medical conditions or substance abuse explanations should be ruled out before blaming a behavioral emergency on a mental illness, especially in someone who does not have a previous diagnosis or history of other symptoms. Mental changes that have a sudden onset or that are accompanied by incontinence, memory loss, excessive salivation or visual (in the absence of auditory) hallucinations are more likely to be caused by a physical condition rather than a mental illness.

Anxiety’s Role in Behavioral Emergencies

Anxiety is a common mental condition that can also lead to a behavioral emergency. Approximately 10 percent of all adults suffer from anxiety, making it the most prevalent psychiatric illness. Symptoms of anxiety include extreme uneasiness and worry, agitation and restlessness. Although the symptoms of anxiety are relatively easy to recognize, it is often misdiagnosed.
People who suffer from anxiety can have panic attacks, which are intense episodes of fear and tension that can overwhelm the sufferer and quickly lead to a behavioral emergency. The sufferer may lose the ability to concentrate, focus and rationalize feeling and body’s responses to those feelings.

Symptoms of a panic attack include:

• Racing or pounding heartbeat
• Heart palpations or an irregular heartbeat
• Dizziness
• Tingling or numbness of the fingers and mouth
• Uncontrollable shaking as though the person is very cold and teeth chattering
• Shortness of breath

If a sufferer learns to recognize the symptoms of an impending panic attack before the symptoms become too extreme, that person may avoid a behavioral emergency.

Anxiety is not the only mental medical condition that can result in a behavioral emergency. Depression, bipolar disorder and schizophrenia can all cause symptoms that can overwhelm the sufferer enough to lead them into a behavioral emergency, especially if these conditions are undiagnosed or untreated or if the sufferer abruptly stops taking his or her medication.

The Role of Violence in Behavioral Emergencies

The biggest danger of a behavioral emergency is that it may result in harm to the sufferer or bystanders. Up to 70 percent of those suffering from a behavioral emergency attempt to assault others or display behavior that can harm others, so this is a very real concern. The first priority should be the safety of all the people involved the situation, followed by attempts to diffuse the situation and the treatment of the sufferer to avoid future emergencies.

There are many reasons why someone may become violent during a behavioral emergency, including a real or perceived threat, fear and panic, head trauma or the influence of a substance. Warning signs of impending violence include pacing, yelling, making threats and clenched teeth or fists. These warning signs should be taken seriously and not overlooked, as ignoring them could have disastrous and even fatal results.

Ways that a sufferer may become violent include direct physical violence, the threat of physical violence with a weapon and throwing objects in the direction of others. Although the desire may be to help the sufferer, personal safety should be most important.

Techniques to Handle a Behavioral Emergency

If you are confronted with a behavioral emergency it is important to stay calm. Your fear and uneasiness will only escalate the situation and possibly make the sufferer’s panic and agitation worse. It is important to speak directly to the sufferer, establish and maintain eye contact and speak reassuringly. Do not make any sudden movements that can be misinterpreted by the sufferer and keep some distance between the two of you. Remain with the sufferer at all times.

When speaking to the sufferer, it is important to remain honest and truthfully answer any questions. If that person is having hallucinations, do not pretend that you see the hallucinations. This is not the time to tell the sufferer to make any decisions. It is important to remain supportive and not get accusatory or make the sufferer feel belittled. Asking the sufferer to perform simple tasks can help keep them present instead of losing them in a delusion or hallucination.

Behavioral emergencies can be stressful for all involved. These situations are not uncommon, so it is important to know how to deal with them. Keeping calm and keeping the sufferer as calm as possible will go a long way in making the situation as bearable and safe as possible until it is diffused completely. The sufferer will likely require intensive treatment after the episode to either recuperate from an underlying physical medical condition or to diagnosis and treat a mental medical condition or substance abuse problem. Treatment is important to reduce the chance of a second episode.

For more on the topic of Behavioral Emergencies, we’ve included the following expert consensus documents as reference materials:

• Treatment of Behavioral Emergencies
• Behavioral Emergencies Cover
• Behavioral Emergencies Intervention Algorithm (2 pages)

View Resources

• Guidelines.gov – Rapid response team.
• NIH.gov – Psychiatric emergencies.
• NIH.gov – An EMS approach to psychiatric emergencies.
• NIH.gov – What do consumers say they want and need during a psychiatric emergency?
• CDC.gov – Coping With a Disaster or Traumatic Event

Attention deficit hyperactivity disorder is a common mental illness characterized by the inability to concentrate or sit still. The condition is, of course, more involved than these two symptoms. However, when people think of ADHD, the image is of a young child squirming in his seat. The truth is that the condition manifests itself in ways that differ from one person to another. Patients are also not always kids. People who were not diagnosed as children find out about the condition as adults who have concentration and other related issues. By understanding the disorder and its symptoms, families may be able to better cope with an ADHD diagnosis in an adult or child in the household.

Causes

The myths surrounding ADHD often begin with the origins of the condition. Many people believe that children contract the disorder from eating too much sugar or watching too much television. In truth, the only thing that seems clear about the condition is that it is hereditary and develops in childhood. Properly diagnosed adults can pinpoint the symptoms in their own childhood that were left undiagnosed. The condition is now most commonly diagnosed in childhood, particularly in boys.

Another myth is that ADHD is caused by other mental health conditions. While the disorder may coexist with depression or bipolar disorder, there is little evidence that the coexisting condition caused the ADHD. The condition can appear as a lone psychiatric problem. However, this is usually not the case.

Symptoms

One of the most misunderstood areas of the condition is the symptom list. ADHD symptoms can make patients appear to be flaky adults, unruly children, shopaholics and procrastinators. Other mislabels for ADHD sufferers include procrastinators, impulsives, quitters and fidgeters. These labels are only description of the primary symptoms of the disorder, which can include:

• Being easily distracted
• Focus and concentration difficulties
• Task completion problems
• Daydreaming
• Squirming
• Being talkative
• Trouble sitting or stand still
• Moving and touching things constantly
• Being easily bored
• Difficulty listening to and following instructions
• Impatience
• Interruptive speaking
• Difficulty staying on topic or on task

People who have ADHD have their own collection of these symptoms that may end up
disrupting their daily lives. The key to remember is that no one will have every symptom, so your ADHD diagnosis may reflect that you are a dreamer who is impatient and impulsive, but you may not be hyperactive. This is perfectly acceptable. Identifying these symptoms in a person is the most important thing. Because there are so many ways to misinterpret the symptoms and to make a diagnosis, only a doctor should do so. Just remember that hyperactivity is not the predominant symptom for the disorder. In fact, most adult patients were missed as kids because they were quiet children who did not disrupt class. However, as adults, their symptom combinations created a need to seek mental health treatment.

Treatment

Medication is often thought to be the first line of defense for treating ADHD, but this is not true. Some patients use a therapy and medication combination, and others use no medication at all. The only way to treat the conditions is to identify the primary complaint for the ADHD sufferer. There are three categories of ADHD patients:

• Hyperactive-impulsive patients have most of the classic ADHD symptoms, but those symptoms are related to the hyperactivity. These patients are fidgety, impatient, talkative and have trouble focusing, for example.
• Inattentive patients primarily have symptoms that center on the inability to pay attention. They can’t focus, concentrate, follow instructions and often change topics, for example.
• The third category is a combination of the first two. Their symptoms span the ADHD symptom board with no predominant leader.

Treatment for the disorders also includes occupational therapy for those who need it. Patients who suffer from a coexisting condition also get treatment for that disorder. Bipolar disorder is a common codiagnosis that is treated with medications that also treat the ADHD. Therapies are designed to treat both conditions.

ADHD patients may try several combinations of treatments to alleviate symptoms before an effective one is found. Contrary to belief, there is no cure for the disorder and kids do not grow out of it. Many kids may find themselves seeking additional treatment as adults. Others may find ways to cope on their own. No matter which one occurs, the patient is never cured of the condition.

Prognosis

ADHD is often a disorder that can be managed. Severe cases exist that can be debilitating for the patients. These cases often come with other severe mental conditions that complicate the diagnosis and the patient’s life. Most ADHD patients function normally in society with no outward signs of their conditions.
Adults with ADHD should watch for signs of the condition in their families, as the hereditary link to ADHD is very strong. Parents regularly pass this along to their kids. Similarly, newly diagnosed patients usually find it easy to pinpoint the condition in others in their own family.

ADHD Surprises

It is a little-known fact that most ADHD sufferers are creative types. In fact, there are several celebrities that suffer from the mental condition. Justin Timberlake (singer, actor and producer) is one example.

There is evidence of high rates of ADHD among drug users. The drugs are used to slow down the thought processes so that the patient can function. However, drugs come with complications of their own, which can be hard on the impatient, impulsive, inattentive ADHD patient. Rehab takes time, a concept that many with ADHD have issues with.

ADHD may be complicated by food sensitivities and allergies. For this reason, nutritional services are often provided to children and families touched by the condition.

No matter what your condition may consist of, you can start to control the disorder with medical intervention along with some lifestyle and habit changes.

View Resources

• WomensHealth.gov – Health Information From Other Trustworthy Sources
• Drugabuse.gov – DrugFacts: Stimulant ADHD Medications – Methylphenidate and Amphetamines
• Loc.gov – Science Reference Services
• Ada.ky.gov – ATTENTION DEFICIT HYPERACTIVITY DISORDER
• Fda.gov – ADHD: Not Just for Kids

Dementia is a term used to describe a severe loss of mental ability. This includes, but is not limited to, the loss of memory. Memory loss is normal as people age, but when it starts to disrupt daily life, it may be due to dementia. Dementia is caused by underlying diseases that damage the brain’s tissues. This damage makes it hard for the brain to function correctly and leads to problems like memory loss and confusion.

What Causes Dementia?

Alzheimer’s disease and vascular disease are two primary causes of dementia. Head injuries, alcoholism, Parkinson’s disease, and other conditions are also causes, although these are less likely. If you know someone who is developing dementia, it is important to understand that the changes in thinking are due to brain damage, and that person will need to have a medical evaluation to determine if the dementia is temporary or permanent. Dementia due to infections and drug side effects can often be reversed, but that caused by progressive diseases usually cannot.

Who Gets Dementia?

In the United States, around 10 percent of people over the age of 65 have dementia. It is most common in people over 85. Dementia progresses over several years. People who have had multiple strokes may be more likely to develop dementia, as may patients with certain chronic diseases.

What Happens When Someone Gets Dementia?

Dementia may cause your loved one to become agitated. Behavior changes and emotional distress are common. Some people experience mild agitation, which makes them act in ways that are out of character. Those with more severe agitation may need caregivers or supervisors at hand who can be reassuring, because it is common for people in this state to become stubborn or nervous.

Agitation tends to get worse over time and is persistent. Some behavior issues you might encounter include:

• Demands for attention
• Pacing, searching, or rummaging
• Hitting
• Biting
• Yelling
• Threatening
• Stubborn refusals to participate
• Irritability and frustration

A patient may become agitated for physical, medical, psychiatric, or environmental reasons.

Physical and Medical Issues

If a person with dementia has not had agitation as a symptom in the past or is more strongly agitated than usual, the problem may be related to a medical or physical condition. A sudden illness can cause delirium, which is an episode of agitation and confusion caused by the illness. Some medical conditions that can cause this issue include:

• Pneumonia
• Dehydration
• Poor nutrition
• Bladder infections
• Chronic disease flares (e.g., diabetes or asthma)

You might also consider any new medications or recently changed doses.

Environmental Causes of Agitation

A person with dementia generally cannot handle uncertainty the way a healthy person can. This means that any change to his or her environment can cause the patient to become agitated. It is therefore important to make sure the patient’s environment is not too noisy, improperly heated, or poorly lit, as these factors can lead to increased agitation and other problems. It is also important to keep to a routine. The patient may become distressed if left along for too long or surrounded by too many people at once.

What Psychiatric Symptoms Can I Expect?

Some common psychiatric syndromes your loved one might experience include psychosis, anger, aggression, depression, and anxiety. People with psychosis may be out of touch with reality and irrational. They may imagine things that they think are real, and may experience delusions and hallucinations.

Patients with dementia can also become angry or aggressive. Dementia damages the brain’s ability to manage anger, which is called disinhibition. This can cause patients to lash out because they feel ignored, mistreated, or as though they are in danger. Frustration at being unable to complete simple tasks that used to be easy can be another cause of anger. The anger and aggression a person with dementia feels can take the form of verbal insults, accusations, refusals to cooperate, or even physical assaults in some cases. Self-injury is also possible. If you notice this type of behavior, make sure the environment is safe to reduce the chances of injury.

When patients cease to find joy in activities they may have previously enjoyed, they are likely to be depressed. This lack of enjoyment is a symptom, and it is not directly caused by the deterioration due to dementia. Treating depression can help patients and may reduce the chance of delusions. Anxiety may also manifest with depression, but this is actually an indication that dementia may be in its early stages.

How Can I Treat Dementia?

Providing the right kind of environment, treating a patient with medications, and getting support for the family are just some of the ways that professionals treat dementia and the agitation that goes along with it. For instance, some people may become agitated when they feel physically uncomfortable. Doctors will likely talk with the family about keeping the patient comfortable and providing a routine and support.

Medications can also help to lessen agitation. Sedation may be used in a crisis, and may make a patient drowsy for a few hours. There are long-term treatments that do not cause these effects, but it can sometimes take weeks before medication begins to work. An antipsychotic can reduce delirium and psychosis, and doctors sometimes prescribe benzodiazepines or trazodone to help with insomnia. They may prescribe antidepressants for depression or pain from arthritis when over-the-counter methods don’t work. Buspirone can help with long-term anxiety control. To reduce anger and aggression, a doctor might suggest divalproex for long-term treatment. An antipsychotic can also be used in some cases. The doctor will need to make sure that the patient does not have any other health conditions or medications that will interact with these drugs before prescribing medications.

For more on the topic of Dementia, we’ve included the following expert consensus documents as reference materials:

• Treatment of Agitation in Older Persons with Dementia
• A Guide for Families and Caregivers, (small print)
• A Guide for Families and Caregivers, (Large Print)
• Guidelines for the Treatment of Agitation in Older Persons with Dementia
• A Guide for Families and Caregivers

View Resources

• Ncdhhs.gov – Alzheimer’s Disease and Other Dementias
• Guideline.gov – Management of Alzheimer’s Disease and Related Dementias
• Ghr.nlm.nih.gov – Genetics Home Reference
• Nlm.nih.gov – Dementia due to metabolic causes
• Ncbi.nlm.nih.gov – Alzheimer’s disease and vascular dementia in developing countries: prevalence, management, and risk factors.

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