Mood Disorders

 

If you have a mood disorder, your general emotional state or mood is distorted or inconsistent with your circumstances and interferes with your ability to function. You may be extremely sad, empty or irritable (depressed), or you may have periods of depression alternating with being excessively happy (mania).  Anxiety disorders can also affect your mood and often occur along with depression.

 

Mood disorders include

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• Major depressive disorder — prolonged and persistent periods of extreme sadness

• Bipolar disorder — also called manic depression or bipolar affective disorder, depression that includes alternating times of             depression and mania

• Seasonal affective disorder (SAD) — a form of depression most often associated with fewer hours of daylight in the far northern     and southern latitudes from late fall to early spring

• Cyclothymic disorder — a disorder that causes emotional ups and downs that are less extreme than bipolar disorder

• Premenstrual dysphoric disorder — mood changes and irritability that occur during the premenstrual phase of a woman's cycle     and go away with the onset of menses

• Persistent depressive disorder (dysthymia) — a long-term (chronic) form of depression

• Disruptive mood dysregulation disorder — a disorder of chronic, severe and persistent irritability in children that often includes     frequent temper outbursts that are inconsistent with the child's developmental age

• Depression related to medical illness — a persistent depressed mood and a significant loss of pleasure in most or all activities       that's directly related to the physical effects of another medical condition

• Depression induced by substance use or medication ― depression symptoms that develop during or soon after substance use or     withdrawal or after exposure to a medication

 

Depression (Major Depressive Disorder)

Symptoms of Clinical Depression

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A person who suffers from a major depressive disorder (sometimes also referred to as clinical depression or simply depression) must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This depressed mood must represent a significant change from the person’s normal mood.

Social, occupational, educational, or other important functioning must also be negatively impacted by the change in mood. For instance, when a person who’s depressed starts missing work or school, or has stopped going to classes or their usual social engagements (such as hanging out with friends).

 

Clinical depression is characterized by the presence of 5 or more of these depressive symptoms

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• Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad, blue, “down in the dumps,” or empty) or observations made by others (e.g., appears tearful or about to cry). (In children and adolescents, this may present as an irritable or cranky, rather than sad, mood.)

• Markedly diminished interest or pleasure in all, or almost all, activities every day, such as no interest in hobbies, sports, or other things the person used to enjoy doing

• Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day

• Insomnia (inability to get to sleep or difficulty staying asleep) or hypersomnia (sleeping too much) nearly every day

• More days than not, problems with sitting still, including constant restlessness, pacing, or picking at one’s cloths (called psychomtotor agitation by professionals); or the opposite, a slowing of one’s movements, talking very quietly with slowed speech (called psychomotor retardation by professionals)

• Fatigue, tiredness, or loss of energy nearly every day — even the smallest tasks, like dressing or washing, seem difficult to do and take longer than usual

• Feelings of worthlessness or excessive or inappropriate guilt nearly every day (e.g., ruminating over minor past failings)

• Diminished ability to think or concentrate, or indecisiveness, nearly every day (e.g., appears easily distracted, complains of memory difficulties)

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

 

Types of Depression

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Depressive disorders come in many different types, and while there are many similarities to each type of depression, each has its own unique set of symptoms.

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The most commonly diagnosed form of depression is Major Depressive Disorder, a condition whose primary symptom is an overwhelming depressed mood for more than two weeks. The depressed mood affects all facets of the person’s life, including work, home life, relationships and friendships. A person with this kind of depression often finds it difficult to do much of anything or get motivated, so even going to seek treatment for this condition can be challenging.

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Another type of depression is called Dysthymia. Dysthymia is similar to Major Depressive Disorder, but the symptoms occur over a much longer period of time – more than 2 years. This is considered a chronic form of depression, and treatment can be challenging as an individual with Dysthymia has often already tried all manner of treatment. Individuals diagnosed with this condition can also suffer from occasional bouts of Major Depressive Disorder.

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A third type of depression is referred to as Adjustment Disorder with Depressed Mood. This condition is diagnosed when a person is adjusting to some new facet or change in their lives that has caused a great deal of stress. This disorder can even be diagnosed when a person is experiencing a good event in their life – such as a new marriage or a baby being born. Because the individual usually just needs a little additional support in their lives during this stressful time, treatment is time-limited and simple.

While there are many types of depression, some kinds of this condition seem to be related to changes in the length of days or seasonality. A seasonal depression is called Seasonal Affective Disorder (SAD). People with Seasonal Affective Disorder suffer the symptoms of a Major Depressive Disorder only during a specific time of year, usually winter. This appears to be related to the shorter days of winter, and the lack of sunlight in many parts of the country.

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Depression is also a symptom of other disorders, such as Bipolar Disorder. Bipolar disorder is sometimes considered a “mood disorder,” but is not a form of depression. Bipolar disorder is characterized by swings of a person’s mood from depression to Mania (mania is when a person is feeling lots of energy — like they are on top of the world and can do almost anything, often trying to do just that). The cycling mood changes from severe highs (mania) and lows (depression) can sometimes be dramatic and rapid in some people, but most often they are gradual.

 

After pregnancy, hormonal changes in a woman’s body may trigger symptoms of depression. More than half of the women suffering from Postpartum Depression will experience it again with the birth of another child. It is critical to identify this danger and treat it early. During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman’s body increases greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops back down to their normal non-pregnant levels. Researchers think the fast change in hormone levels may lead to depression, just as smaller changes in hormones can affect a woman’s moods before she gets her menstrual period.

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Bipolar Affective Disorder

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Bipolar Affective Disorder is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

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There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

 

• Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.

• Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.

• Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

• Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.

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Signs and Symptoms

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People having a manic episode may

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• Feel very “up,” “high,” or elated

• Have a lot of energy

• Have increased activity levels

• Feel “jumpy” or “wired”

• Have trouble sleeping

• Become more active than usual

• Talk really fast about a lot of different things

• Be agitated, irritable, or “touchy”

• Feel like their thoughts are going very fast

• Think they can do a lot of things at once

• Do risky things, like spend a lot of money or have reckless sex

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People having a depressive episode may

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• Feel very sad, down, empty, or hopeless

• Have very little energy

• Have decreased activity levels

• Have trouble sleeping, they may sleep too little or too much

• Feel like they can’t enjoy anything

• Feel worried and empty

• Have trouble concentrating

• Forget things a lot

• Eat too much or too little

• Feel tired or “slowed down”

• Think about death or suicide

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People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.

 

Anxiety

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Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect nearly 30 percent of adults at some point in their lives. . But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.

 

Women are more likely than men to experience anxiety disorders.

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Anxiety refers to anticipation of a future concern and is more associated with muscle tension and avoidance behavior.

Fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction – either staying to fight or leaving to escape danger.

 

Anxiety disorders can cause people to try to avoid situations that trigger or worsen their symptoms. Job performance, school work and personal relationships can be affected.

 

In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must

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• Be out of proportion to the situation or age inappropriate

• Hinder your ability to function normally

 

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, specific phobias, agoraphobia, social anxiety disorder and separation anxiety disorder.

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Types of Anxiety Disorders

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Generalized Anxiety Disorder

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Generalized anxiety disorder involves persistent and excessive worry that interferes with daily activities. This ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Often the worries focus on everyday things such as job responsibilities, family health or minor matters such as chores, car repairs, or appointments.

 

Panic Disorder

 

The core symptom of panic disorder is recurrent panic attacks, an overwhelming combination of physical and psychological distress. During an attack several of these symptoms occur in combination:

• Palpitations, pounding heart or rapid heart rate

• Sweating

• Trembling or shaking

• Feeling of shortness of breath or smothering sensations

• Chest pain

• Feeling dizzy, light-headed or faint

• Feeling of choking

• Numbness or tingling

• Chills or hot flashes

• Nausea or abdominal pains

• Feeling detached

• Fear of losing control

• Fear of dying

 

Because symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness and may go to a hospital ER. Panic attacks may be expected, such as a response to a feared object, or unexpected, apparently occurring for no reason. The mean age for onset of panic disorder is 22-23. Panic attacks may occur with other mental disorders such as depression or PTSD.

 

Phobias, Specific Phobia

 

A specific phobia is excessive and persistent fear of a specific object, situation or activity that is generally not harmful. Patients know their fear is excessive, but they can’t overcome it. These fears cause such distress that some people go to extreme lengths to avoid what they fear. Examples are fear of flying or fear of spiders.

 

Agoraphobia

 

Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms. The fear is out of proportion to the actual situation and lasts generally six months or more and causes problems in functioning. A person with agoraphobia experiences this fear in two or more of the following situations:

• Using public transportation

• Being in open spaces

• Being in enclosed places

• Standing in line or being in a crowd

• Being outside the home alone

 

The individual actively avoids the situation, requires a companion or endures with intense fear or anxiety. Untreated agoraphobia can become so serious that a person may be unable to leave the house. A person can only be diagnosed with agoraphobia if the fear is intensely upsetting, or if it significantly interferes with normal daily activities.

 

Social Anxiety Disorder (previously called social phobia)

 

A person with social anxiety disorder has significant anxiety and discomfort about being embarrassed, humiliated, rejected or looked down on in social interactions. People with this disorder will try to avoid the situation or endure it with great anxiety. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public. The fear or anxiety causes problems with daily functioning and lasts at least six months.

 

Separation Anxiety Disorder

 

A person with separation anxiety disorder is excessively fearful or anxious about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six months in adults) and causes problems functioning. A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation. Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood.

 

Risk Factors

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The causes of anxiety disorders are currently unknown but likely involve a combination of factors including genetic, environmental, psychological and developmental. Anxiety disorders can run in families, suggesting that a combination of genes and environmental stresses can produce the disorders.

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Obsessive-Compulsive Disorder

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Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.

 

Signs and Symptoms

 

People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

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Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include

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• Fear of germs or contamination

• Unwanted forbidden or taboo thoughts involving sex, religion, and harm

• Aggressive thoughts towards others or self

• Having things symmetrical or in a perfect order

 

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include

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• Excessive cleaning and/or hand washing

• Ordering and arranging things in a particular, precise way

• Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off

• Compulsive counting

 

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally

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• Can't control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive

• Spends at least 1 hour a day on these thoughts or behaviors

• Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause

• Experiences significant problems in their daily life due to these thoughts or behaviors

 

 

Post-Traumatic Stress Disorder

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PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened even when they are not in danger.

 

Signs and Symptoms

 

Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Not everyone with PTSD has been through a

dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.

 

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

 

• At least one re-experiencing symptom

• At least one avoidance symptom

• At least two arousal and reactivity symptoms

• At least two cognition and mood symptoms

 

Re-experiencing symptoms include

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• Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating

• Bad dreams

• Frightening thoughts

 

Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

 

Avoidance symptoms include

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• Staying away from places, events, or objects that are reminders of the traumatic experience

• Avoiding thoughts or feelings related to the traumatic event

 

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

 

Arousal and reactivity symptoms include

 

• Being easily startled

• Feeling tense or “on edge”

• Having difficulty sleeping

• Having angry outbursts

 

Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

 

Cognition and mood symptoms include

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• Trouble remembering key features of the traumatic event

• Negative thoughts about oneself or the world

• Distorted feelings like guilt or blame

• Loss of interest in enjoyable activities

 

Cognition and mood symptoms can begin or worsen after the traumatic event but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members. 

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It is natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other Anxiety Disorders.

 

Do children react differently than adults?

 

Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. In very young children (less than 6 years of age), these symptoms can include

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• Wetting the bed after having learned to use the toilet

• Forgetting how to or being unable to talk

• Acting out the scary event during playtime

• Being unusually clingy with a parent or other adult

 

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge. 

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Insomnia

 

The predominant complaint in insomnia disorder is difficulty initiating or maintaining sleep, or nonrestorative sleep, occurring at least 3 nights per week for at least 3 months, despite adequate opportunity for sleep.

The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

 

The sleep disturbance does not occur exclusively during the course of another, more predominant, sleep disorder, such as narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or a parasomnia.

The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). However, insomnia can occur alongside or as a result of a coexisting mental (e.g., major depressive disorder) or medical condition (e.g., pain) as long as the insomnia is significant enough to warrant its own clinical attention and treatment. For instance, insomnia may also manifest as a clinical feature of a more predominant mental disorder.

 

Persistent insomnia may be a risk factor for Depression and is a common residual symptom after treatment for this condition.

With comorbid insomnia and a mental disorder, treatment may also need to target both conditions. Given these different courses, it is often impossible to establish the precise nature of the relationship between these clinical entities, and this relationship may change over time. Therefore it is not necessary to make a causal attribution between the two conditions.

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•  Episodic insomnia refers to when symptoms last at least 1 month but less than 3 months.

•  Persistent insomnia refers to chronic insomnia lasting 3 months or longer.

•  Recurrent insomnia refers to repeated episodes (1-3 month duration) of insomnia within the course of a year.

 

Attention Deficit Hyperactivity Disorder

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Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

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• Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.

• Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.

• Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

 

Signs and Symptoms

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Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity.Most children have the combined type of ADHD.

In preschool, the most common ADHD symptom is hyperactivity.

It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:

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• are more severe

• occur more often

• interfere with or reduce the quality of how they functions socially, at school, or in a job

 

Inattention

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People with symptoms of inattention may often

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• Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities

• Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading

• Not seem to listen when spoken to directly

• Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus or get easily sidetracked

• Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines

• Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms or reviewing lengthy papers

• Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones

• Be easily distracted by unrelated thoughts or stimuli

• Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

 

Hyperactivity-Impulsivity

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People with symptoms of hyperactivity-impulsivity may often

• Fidget and squirm in their seats

• Leave their seats in situations when staying seated is expected, such as in the classroom or in the office

• Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless

• Be unable to play or engage in hobbies quietly

• Be constantly in motion or “on the go,” or act as if “driven by a motor”

• Talk nonstop

• Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in conversation

• Have trouble waiting his or her turn

• Interrupt or intrude on others, for example in conversations, games, or activities

 

Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind normal development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.

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Addiction / Substance Misuse 

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Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems. Yet a number of effective treatments are available and people can recover from addiction and lead normal, productive lives.

 

People can develop an addiction to

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• Alcohol

• Cannabis/Marijuana

• PCP, LSD and other hallucinogens

• Inhalants, such as, paint thinners and glue

• Opioid pain killers, such as Codeine and Oxycodone 

• Heroin

• Sedatives, Hypnotics and Anxiolytics (medicines for anxiety such as tranquilizers)

• Cocaine, Methamphetamine and other Stimulants

• Tobacco

 

People with a substance use disorder have distorted thinking, behavior and body functions. Changes in the brain’s wiring are what cause people to have intense cravings for the drug and make it hard to stop using the drug. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory and behavior control.

These substances can cause harmful changes in how the brain functions. These changes can last long after the immediate effects of the drug — the intoxication. Intoxication is the intense pleasure, calm, increased senses or a high caused by the drug. Intoxication symptoms are different for each substance.

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Over time people with addiction build up a tolerance, meaning they need larger amounts to feel the effects.

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According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including​

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• to feel good — feeling of pleasure, “high”

• to feel better — e.g., relieve stress

• to do better — improve performance

• curiosity and peer pressure

 

People with addictive disorders may be aware of their problem, but be unable to stop it even if they want to. The addiction may cause health problems as well as problems at work and with family members and friends. The misuse of drugs and alcohol is the leading cause of preventable illnesses and premature death.

 

Symptoms of substance use disorder are grouped into four categories

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• Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use

• Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use

• Risky use: substance is used in risky settings; continued use despite known problems

• Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance)

 

Many people experience both mental illness and addiction. The mental illness may be present before the addiction. Or the addiction may trigger or make a mental disorder worse.

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• Addiction Resource Center

• Naltrexone  for Opioid & Alcohol Cravings  

       https://www.samhsa.gov

• Vivitrol for Opioid & Alcohol Cravings 

       https://www.vivitrol.com

• Suboxone Medication Assisted Treatment

       https://www.drugs.com

       https://www.suboxone.com

• Smoking Cessation

       https://www.chantix.com

       https://www.cdc.gov

       https://smokefree.gov/

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Eating Disorders

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There is a commonly held view that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

 

Signs and Symptoms

 

Anorexia nervosa

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People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, and eat very small quantities of only certain foods. Anorexia nervosa has the highest mortality rate of any mental disorder. While many young women and men with this disorder die from complications associated with starvation, others die of suicide. In women, suicide is much more common in those with anorexia than with most other mental disorders.

 

Symptoms include

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• Extremely restricted eating

• Extreme thinness (emaciation)

• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight

• Intense fear of gaining weight

• Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

 

Other symptoms may develop over time, including

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• Thinning of the bones (osteopenia or osteoporosis)

• Mild anemia and muscle wasting and weakness

• Brittle hair and nails

• Dry and yellowish skin

• Growth of fine hair all over the body (lanugo)

• Severe constipation

• Low blood pressure, slowed breathing and pulse

• Damage to the structure and function of the heart

• Brain damage

• Multiorgan failure

• Drop in internal body temperature, causing a person to feel cold all the time

• Lethargy, sluggishness, or feeling tired all the time

·       Infertility

 

Bulimia nervosa

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People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or relatively normal weight.

 

Symptoms include

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• Chronically inflamed and sore throat

• Swollen salivary glands in the neck and jaw area

• Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid

• Acid reflux disorder and other gastrointestinal problems

• Intestinal distress and irritation from laxative abuse

• Severe dehydration from purging of fluids

• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to stroke or heart attack

 

Binge-eating disorder​

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People with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

Symptoms include:

• Eating unusually large amounts of food in a specific amount of time

• Eating even when you're full or not hungry

• Eating fast during binge episodes

• Eating until you're uncomfortably full

• Eating alone or in secret to avoid embarrassment

• Feeling distressed, ashamed, or guilty about your eating

• Frequently dieting, possibly without weight loss

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Personality Disorders

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Emotional and Impulsive – borderline, histrionic and narcissistic

Anxious – avoidant, dependent and obsessive compulsive

Suspicious – paranoid, schizoid, schizotypal and antisocial

 

Borderline personality disorder (BPD)

You may

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• feel very worried about people abandoning you, and would do anything to stop that happening

• have very intense emotions that last from a few hours to a few days and can change quickly (for example, from feeling very happy and confident in the morning to feeling low and sad in the afternoon)

•  not have a strong sense of who you are, and it can change depending on who you're with

• find it very hard to make and keep stable relationships

• act impulsively and do things that could harm you (such as binge eating, using drugs or driving dangerously)

• have suicidal thoughts or self-harming behavior

• feel empty and lonely a lot of the time

• get very angry, and struggle to control your anger.

 

When very stressed, sometimes you might

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• feel paranoid

• have psychotic experiences, such as seeing or hearing things that other people don't

• feel numb or 'checked out' and not remember things properly after they've happened.

 

Histrionic personality disorder

You may

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• feel very uncomfortable if you are not the centre of attention

• feel much more at ease as the ‘life and soul of the party’

• feel that you have to entertain people

• flirt or behave provocatively to ensure that you remain the centre of attention

• get a reputation for being dramatic and overemotional

• feel dependent on the approval of others

• be easily influenced by others.

 

Narcissistic personality disorder

You may

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• believe that there are special reasons that make you different, better or more deserving than others

• have fragile self-esteem, so that you rely on others to recognise your worth and your needs

• feel upset if others ignore you and don’t give you what you feel you deserve

• resent other people’s successes

• put your own needs above other people’s, and demand they do too

• be seen as selfish and ‘above yourself’

• take advantage of other people.

 

Avoidant (or anxious) personality disorder

You may

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• avoid work or social activities that mean you must be with others

• expect disapproval and criticism and be very sensitive to it

• worry constantly about being ‘found out’ and rejected

• worry about being ridiculed or shamed by others

• avoid relationships, friendships and intimacy because you fear rejection

• feel lonely and isolated, and inferior to others

• be reluctant to try new activities in case you embarrass yourself.

 

Dependent personality disorder

You may

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• feel needy, weak and unable to make decisions or function properly without help or support

• allow others to assume responsibility for many areas of your life

• agree to things you feel are wrong or you dislike to avoid being alone or losing someone's support

• be afraid of being left to fend for yourself

• have low self-confidence

• see other people as being much more capable than you are

• be seen by others as much too submissive and passive.

 

Obsessive compulsive personality disorder (OCPD)

You may

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• need to keep everything in order and under control

• set unrealistically high standards for yourself and others

• think yours is the best way of making things happen

• worry when you or others might make mistakes

• expect catastrophes if things aren’t perfect

• be reluctant to spend money on yourself or others

• have a tendency to hang onto items with no obvious value.

 

OCPD is separate from Obsessive Compulsive Disorder (OCD), which describes a form of behavior rather than a type of personality.

 

 

Paranoid personality disorder

You may

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• find it hard to confide in people, even your friends

• find it very difficult to trust other people, believing they will use you or take advantage of you

• watch others closely, looking for signs of betrayal or hostility

• read threats and danger – which others don’t see – into everyday situations.

 

Schizoid personality disorder

You may

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• be uninterested in forming close relationships with other people, including your family

• feel that relationships interfere with your freedom and tend to cause problems

• prefer to be alone with your own thoughts

• choose to live your life without interference from others

• get little pleasure from life

• have little interest in sex or intimacy

• be emotionally cold towards others

 

Schizotypal personality disorder

You may

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• find making close relationships extremely difficult

• think and express yourself in ways that others find ‘odd’, using unusual words or phrases

• behave in ways that others find eccentric

• believe that you can read minds or that you have special powers such as a ‘sixth sense’

• feel anxious and tense with others who do not share these beliefs

• feel very anxious and paranoid in social situations.

 

Antisocial personality disorder (ASPD)

You will be at least 18 years old. You may

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• put yourself in dangerous or risky situations, often without considering the consequences for yourself or for other people

•  behave dangerously and sometimes illegally

• behave in ways that are unpleasant for others

• feel very easily bored and act on impulse – you may find it difficult to hold down a job for long

• behave aggressively and get into fights easily

• do things – even though they may hurt people – to get what you want, putting your needs above theirs

• have a criminal record

• feel no sense of guilt if you have mistreated others

• believe that only the strongest survive and that you must do whatever it takes to lead a successful life because if you don’t grab opportunities, others will

• have had a diagnosis of conduct disorder before the age of 15.

 

This diagnosis includes ‘psychopathy’. This term is no longer used in the Mental Health Act but a ‘psychopathy checklist’ questionnaire may be used in your assessment.

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Psychotic Disorders

 

Psychotic Disorders are a group of serious illnesses that affect the mind. They make it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.

When symptoms are severe, people with psychotic disorders have trouble staying in touch with reality and often are unable to handle daily life. But even severe psychotic disorders usually can be treated.

 

Types

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There are different types of psychotic disorders, including

 

Schizophrenia: People with this illness have changes in behavior and other symptoms -- such as delusions and hallucinations that last longer than 6 months. It usually affects them at work or school, as well as their relationships.

 

Schizoaffective disorder: People have symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder.

 

Schizophreniform disorder: This includes symptoms of schizophrenia, but the symptoms last for a shorter time: between 1 and 6 months.

 

Brief psychotic disorder: People with this illness have a sudden, short period of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick -- usually less than a month.