Mental Health Disorders

Our Current View of Mental Health Disorders
Historically, mental illness was viewed as a punishment from God or some kind of weakness. This was very easy to believe since some of the symptoms of depression involve feelings of guilt and a sense of worthlessness. This would often blend in with depression induced cognitive distortions and become part of a core negative belief about oneself.

With advances in psychiatric treatment and medication treatment we now look at a mental heath disorder as a medical illness, similar to diabetes or high blood pressure. These disorders also have a genetic component to them; they are chronic in nature and tend to get better or worse depending on the treatment and patient compliance. We understand that the brain is an organ and can have illnesses which are separate from the person’s true identity. The ability of patients with depression or an anxiety disorder to stop being depressed or anxious is the same as the ability of patients to stop being diabetic or hypertensive. That is, without the right treatment, the chances are very slim that the disorder will spontaneously get better on its own.

As in diabetes and hypertension the treatment can require medications and a change in the life style. The good news is that we now have more medications available for treatment of various psychiatric disorders with fewer side effects than the previous generations of medications. Also, most psychiatric medications are not addictive. They help to improve the function of certain brain circuits that are involved in the processing of our feelings.

The physicians at the Recovery Road Program are also aware of the need to be very careful about using addictive medications in patients who are in recovery from addiction. It is also important to recognize that people who are in recovery from depression and anxiety usually also require a change in the way that the individual processes feeling information. This can require a training program such as that which is provided through the Recovery Road Program [Back to Page Top]

Specific Mental Health Disorders

Bipolar Disorder
This is also called manic depressive disorder. It is a common mood disorder that unfortunately is associated with a bad name. But the truth is that bipolar disorder can be a blessing sometimes if properly treated as Dr K Jamison wrote in her book, The Unquiet Mind. “So why would I want anything to do with the illness because I honestly believe that as a result of it I have felt more things, more deeply, had more experience, loved more and been more loved, laughed more, laughed more for having cried more often, appreciated more the springs, for all the winters”. Dr Jamison did not write that unless she had been properly treated. Unfortunately sometimes bipolar disorder can not be diagnosed properly and that leads to a lot of problems for the patient. It is now known that giving usual anti-depressant medication to a patient with bipolar disorder without mood stabilizers can lead to agitation and adverse effects of the medication. Bipolar patients can be enjoyable to work with as they all share common features of being outgoing people and have a sense of humor when the are stable. Universally speaking patients with Bipolar Disorder all hate taking medication which is the most challenging part in treatment, especially when they are in a hypomanic phase. I have many times heard the following statement from a patient in hypomanic phase “Why are you upset that I am happy, I am finally happy. Do you want me to be depressed so you can make more money, I hate you.“ The problem with hypomania is that if it is not controlled it can lead to either a manic or severe depressive episode.

So how do you make the diagnosis of Bipolar Disorder? The DSM IV RT describes bipolar disorder as a mood disorder that is characterized by having at least one manic episode for type I and at least one hypomanic episode for type II.

So what is a manic episode?
A manic episode is one side of the coin of bipolar disorder which is a mood disorder. During a manic episode there is a noticeable change in mood from the normal non-depressed state to either an elevated or irritable mood, that lasts for at least a week or more. Remember the mood change has to be present. The mood change has to be associated with at least 3 or 4 of the following:

• Distractibility. This is the most common symptom and is usually characterized by the inability to pay attention to any activity for very long.
• Insomnia in mania typically means having high energy and requiring less sleep. (This differs from insomnia in depression, in which the patient has low energy plus an inability to sleep.)
• Grandiosity. Patients with this symptom have an inflated sense of themselves, which, in severe cases, can be delusional. Close to 60% of all manic patients experience feelings of omnipotence. Sometimes they feel that they are godlike or have celebrity status.
• Flight of ideas. Thoughts literally race.
• Activity. An increase in intensity in goal-directed activities occurs, which is related to social behavior, sexual activity, work, school, or combinations.
• Speech. Excessive talking is present.
• Thoughtlessness. Excessive involvement in high-risk activities is present (e.g., unrestrained shopping, promiscuity). Mood disturbance may be severe enough to damage one's job or social functioning or relationships with others, or which requires hospitalization to prevent harm to others or to the self.
  

Mixed or Pure Mania. Manic episodes themselves can be characterized as mixed mania or pure mania:

In pure mania, either euphoria or irritability is present along with other symptoms of mania and there are no indications of depression.

In mixed mania (also called a mixed state), depressed mood and manic symptoms occur for at least a week. Depression is present most of the day and nearly every day. Symptoms of mania are also present to a significant degree.

What is a hypomanic episode?
Hypomania. With hypomania the symptoms of mania are milder and of shorter duration (but they last at least four days). They do not affect social or work life as dramatically as mania. Notice that the difference is mainly about the severity and length of the episode. In hypomania there is no impairment of the judgment. In fact, all patients consider it as a positive period in there life because they are more productive and can catch up with what they did not do when they were depressed, i.e. cleaning the house, doing laundry, Taxes, work project or painting the garage. This helps to understand the statement of the angry hypomanic patient to their psychiatrist when he/she wants to treat the hypomanic episode.

Bipolar Disorder should be highly suspected in the following population of depressed patients:

• Any patient with a family history of bipolar disorder in the 1st degree relative should be treated as if they are bipolar even if they never had a manic or hypomanic episode.
  
  Psychotic symptoms associated with first episode of mood disorder.
• Patient who has failed an adequate trial of at least 3 anti-depressants or the antidepressant worked very fast but stopped working shortly thereafter.
• Patient who became manic or psychotic on antidepressant or other med or Marijuana.
• Post partum depression.
• Family history of alcoholism.
• Patients who have attention deficit & mood disorders.

For more information about bipolar disorder ask your mental health professional or go to www.mentalhealth.com mood disorder.
For information about meds go to www.crazymeds.com.

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So why it is difficult to treat? Some of the problems that are inherent in depression are that it affects the way we think and the way we perceive events in our lives. In a sense, when a person has depression the brain makes use of more trains of negative thoughts. The patient is not aware of this. For example, a patient with major depression will suffer from low energy which he or she will misinterpret as being lazy and not productive. So instead of blaming the illness the patient will blame self and feel guilty.

The treatment model in Recovery Road Medical Center is based on a cognitive behavioral therapy which helps the patient to identify the trains of negative thoughts that affect the emotional state of the person. Our highly qualified psychiatrists are also able to prescribe medication to help with the depression and to pave the road for the changes that need to happen.

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Anxiety Disorders
Anxiety disorders are characterized by feelings of alarm, worry or panic. While these feelings can be a normal response to life situations, they can be part of a disorder when the feelings interfere with function and getting needs met, instead of helping the person survive.

In Generalized Anxiety Disorder the person has chronic daily feelings of anxiety or worry. This may be accompanied by patterns of thinking (such as catastrophic thinking) that exacerbates the feelings of anxiety.

In Obsessive-Compulsive Disorder the person suffers from repetitive thoughts which cause anxiety or distress and behaviors (compulsions) which serve to reduce the feelings of anxiety, usually only temporarily.

In Panic Attacks the patient has episodic feelings of impending doom, apprehension, fearfulness or terror. This may be accompanied by symptoms of rapid heart beat, sweating, shortness of breath, feeling that one is going to die, dizziness, chest pain, choking or a fear of “going crazy”.

In Agoraphobia the person experiences fear when he or she is in a place where escape might be difficult or embarrassing. It may be accompanied by panic feelings. The person may not want to leave their house due to these feelings.

In Social Phobia the patient experiences anxiety in social situations. The patient may then avoid these situations.

In Simple Phobia the patient experiences in anxiety in certain situations or in response to being exposed to certain objects.

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Attention Deficit Disorder
ADD is another very common disorder that is under-diagnosed or under-treated in our society. It has always been looked at as an academic disease for children who are hyperactive. In fact, not all patients with ADD are hyperactive. The DSM IV had come up with 2 different types. One with hyperactivity and one without hyperactivity. We now know that it is not just a childhood illness. In fact a lot of times ADD does not manifest it self until college years or may be manifested later in life when the ADD is challenged. A person may have learned to cope with their ADD at younger ages but as things get more complex; their coping strategies may break down and lead to problems.

Some patients with ADD can manage to control the symptoms while they are in school because of the structured environment and support from the parents with school work and not until they go to college does the ADD manifest itself and become a problem.

So what are the symptoms of ADD?
Unfortunately again that can create a lot of confusion for patients since the DSM IV focuses(mostly) on the symptoms during childhood but not how ADD manifests itself in adult life.

Some symptoms of attention problems.

• Forgetful in daily activity (i.e. late for appointment or meetings). Shows up to important meetings forgetting important material for the meeting, misplaces things like cell phones, driving license...etc
• Lacks or avoid tasks that require organization skills. Avoids or dislikes paperwork. Late fees for credit cards or bills
• Inability to pay attention or sustain focus in class or important meetings. Day dreaming when supposed to be focused. Gets easily distracted. Difficulty maintaining focus while reading and may have to re-read books, even when interested in the material. Does not to seem to be listening when spoken to.

Some examples of impulsivity.

Impulsive job changes, interrupting other people when they are talking.

SUMMARY STATEMENT:
So as you see ADD can be a highly distractible illness and not just an academic illness for children. It can affect the patient's social, occupational and academic life.

Adverse effects of ADD on Relationships
Because relationships depend upon communicating and feeling acknowledged by the other person, when patients with ADD get distracted and don't follow through with their partner's request, the partner feels disrespected. Imagine you have a significant other who feels like you do not listen to him/her or do things opposite to what he/she asked you to do because of lack of attention. Many relationships are adversely affected because of one partner having untreated ADD.

How ADD interferes with recovery.

• Untreated patients with ADD have a lot of frustration due to their illness and continue to get negative feedback from others. This increases stress and can lead to relapse on addictive substances.
• Also ADD can affect the patient’s self esteem and how they see themselves. If you don't believe in yourself you might fall into that train of thought which goes like, “Why bother trying? I can not get anything done right.” If this is not challenged, it can lead to the core belief of low self esteem.
• Another problem is the impulsivity which can be a major factor in not being able to resist the craving for a drug and interferes with the ability to maintain sobriety.
  

Some of the theories about ADD state that the brain does not secrete enough dopamine( a brain messenger chemical). Patients with ADD may try to seek activities that force the brain to secrete more dopamine in order to feel normal, including such behavior as drug use, which is known to increase the level of dopamine. They may also seek extreme athletic activities which produces a lot of physical thrill. For more information we recommend Driven to Distraction MentalHealth.com.

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Eating Disorders
Although at the Recovery Road Medical Center we are not specialized in the treatment of eating disorders, it is very important to recognize these disorders, because they interfere with sobriety. Our mission and promise to our patients is to provide them with all available information and referrals to appropriate treatment programs. A lot of patients with eating disorders tend to use, abuse and ultimately become dependant on certain drugs like cocaine, methamphetamines or diet pills in order to loose weight.

Eating Disorders such as anorexia, bulimia, and binge eating disorder include extreme emotions, attitudes, and behaviors surrounding self image, weight and food issues. They are serious emotional and physical problems that can have life-threatening consequences for females and males.

Anorexia Nervosa is characterized by self-starvation and excessive weight loss.

Symptoms include:

• Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level.
• Intense fear of weight gain or being “fat”.
• Feeling “fat” or overweight despite dramatic weight loss.
• Loss of menstrual periods.
• Extreme concern with body weight and shape.

Bulimia Nervosa is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food–more than most people would eat in one meal—in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse, or over-exercising.

Symptoms include:

• Repeated episodes of binging and purging.
• Feeling out of control during a binge and eating beyond the point of comfortable fullness.
• Purging after a binge, (typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, or fasting).
• Frequent dieting.
• Extreme concern with body weight and shape.

Binge Eating Disorder (also known as Compulsive Overeating) is characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full. While there is no purging, there may be sporadic fasts or repetitive diets and often feelings of shame or self-hatred after a binge. People who overeat compulsively may struggle with stress, anxiety, depression, and loneliness, which can contribute to their unhealthy episodes of binge eating. Body weight may vary from normal to mild, moderate, or severe obesity.

Other Eating Disorders can include some combination of the signs and symptoms of anorexia, bulimia, and/or binge eating disorder. While these behaviors may not be clinically considered a full syndrome eating disorder, they can still be physically dangerous and emotionally draining. All eating disorders require professional help.

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