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
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Specific Mental Health Disorders
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
- Activity. An increase in intensity
in goal-directed activities occurs,
which is related to social behavior, sexual activity, work, school,
- Speech. Excessive talking is
- 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
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
For information about meds go to www.crazymeds.com.
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Depression is another mood disorder that can be a separate illness or part of
bipolar disorder or sometimes as a complication of another medical disorder.
People with a major medical problem like heart problems, stroke, diabetes or
chronic pain can fall in the depression zone or what we call a mood disorder
secondary to medical condition. So, why do we call depression a medical disorder,
and how it is different than the normal sadness that we encounter in our daily
life. The truth is that emotions are very important to our wellbeing and our
ability to monitor whether our needs are being met. Normal sadness or grief is
part of our make up as human beings. In fact, it is unusual and possibly unhealthy,
not to experience sadness or grief when we lose something valuable like a job
or a relationship or lose someone to death. The difference is that in depression
the normal grief process does not proceed properly or the grief can be distorted
by an underlying depression. According to the DSM IV RT the depressive episode
has to last daily for at least 2 weeks and should be severe enough to interfere
with social, occupational and academic function. It is often accompanied by symptoms
which show that the underlying biorhythms of the body are not working either,
such as appetite, sleep, energy, and sex drive. There may be an inability to
see the positive side of things, an excessive focus on guilt and low self esteem.
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 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.
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
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
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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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.
- 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 foodmore than most people would eat in one mealin
short periods of time, then getting rid of the food and calories through vomiting,
laxative abuse, or over-exercising.
- Repeated episodes of binging and purging.
- Feeling out of control during a binge and eating beyond the point of comfortable
- 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
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