8. Early schizophrenia warning signs Ö Social withdrawal Ö Hostility or suspiciousness Ö Deterioration of personal hygiene Ö Flat, expressionless gaze Ö Inability to cry or express joy Ö Inappropriate laughter or crying Ö Depression Ö Oversleeping or insomnia Ö Odd or irrational statements Ö Forgetful; unable to concentrate Ö Extreme reaction to criticism Ö Strange use of words or way of speaking
9. Signs and symptoms of schizophrenia A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of patients. Often, these delusions involve illogical or bizarre ideas or fantasies. Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
10. Disorganized Speech . Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things. Disorganized behavior. Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as: A decline in overall daily functioning Unpredictable or inappropriate emotional responses Behaviors that appear bizarre and have no purpose Lack of inhibition and impulse control.
11. Causes of schizophrenia Genetic causes of schizophrenia Schizophrenia has a strong hereditary component. Individuals with a first degree relative (parent or sibling) who has schizophrenia have a 10 percent chance of developing the disorder, as opposed to the 1 percent chance of the general population. But schizophrenia is only influenced by genetics, not determined by it. While schizophrenia runs in families, about 60% of schizophrenics have no family members with the disorder. Furthermore, individuals who are genetically predisposed to schizophrenia don’t always develop the disease, which shows that biology is not destiny.
12. Environmental causes of schizophrenia Twin and adoption studies suggest that inherited genes make a person vulnerable to schizophrenia and then environmental factors act on this vulnerability to trigger the disorder. As for the environmental factors involved, more and more research is pointing to stress, either during pregnancy or at a later stage of development. High levels of stress are believed to trigger schizophrenia by increasing the body’s production of the hormone cortisol. Research points to several stress-inducing environmental factors that may be involved in schizophrenia, including: ∞ Prenatal exposure to a viral infection ∞ Low oxygen levels during birth (from prolonged labor or premature birth) ∞ Exposure to a virus during infancy ∞ Early parental loss or separation ∞ Physical or sexual abuse in childhood
13. Brain chemical imbalances There is evidence that chemical imbalances in certain neurotransmitters, proteins, and amino acids play a role in causing schizophrenia. Dopamine — Dopamine is the primary brain chemical implicated in schizophrenia. The dopamine hypothesis suggests that an excess of dopamine in the brain contributes to schizophrenia. Glutamate — Glutamate is another important neurotransmitter implicated in schizophrenia. Studies show an underactivity of glutamate in schizophrenic patients. This supports the dopamine hypothesis, since dopamine receptors inhibit the release of glutamate. Abnormal brain structure In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role in schizophrenia. Enlarged brain ventricles are seen in some schizophrenics, indicating a deficit in the volume of brain tissue. There is also evidence of abnormally low activity in the frontal lobe , the area of the brain responsible for planning, reasoning, and decision-making. Some studies also suggest that abnormalities in the temporal lobes, hippocampus, and amygdala are connected to schizophrenia’s positive symptoms. But despite the evidence of brain abnormalities, it is highly unlikely that schizophrenia is the result of any one problem in any one region of the brain.
14. Effects of schizophrenia When the signs and symptoms of schizophrenia are ignored or improperly treated, the effects can be devastating both to the individual with the disorder and those around him or her. Some of the possible effects of schizophrenia are: Relationship problems – Relationships suffer significantly because people with schizophrenia often withdraw and isolate themselves. Paranoia can also cause a person with schizophrenia to be suspicious of friends and family. Disruption to normal daily activities – Schizophrenia causes significant disruptions to daily functioning, both because of social difficulties and because everyday tasks become hard, if not impossible to do. A person’s delusions, hallucinations, and disorganized thoughts typically prevent him or her from doing normal things like bathing, eating, or running errands. Alcohol and drug abuse – Schizophrenics frequently develop problems with alcohol or drugs, which are often used in an attempt to self-medicate, or relieve symptoms. In addition, they may also be heavy smokers, a complicating situation as cigarette smoke can interfere with the effectiveness of medications prescribed for the disorder. Increased suicide risk – People with schizophrenia have a high risk of attempting suicide. Any suicidal talk, threats, or gestures should be taken very seriously. People with schizophrenia are especially likely to commit suicide during psychotic episodes, during periods of depression, and in the first six months after they’ve started treatment.
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16. What is Bipolar Disorder? Bipolar disorder— also known as manic depression or manic-depressive illness —involves dramatic shifts in mood from the highs of mania to the lows of major depression. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. Unlike ordinary mood swings, bipolar disorder is much more intense and disruptive to everyday functioning, affecting energy, activity levels, judgment, and behavior. During a manic episode, a person might impulsively quit a job, charge up huge amounts of debt, or feel rested after sleeping two hours. During a depressive episode, the same person might be too tired to get out of bed and full of self-loathing and hopelessness over his or her unemployment status and credit card bills. Bipolar disorder is more common than many think affecting nearly 3 out of every 100 adults in the U.S according to the National Institutes of Mental Health. Its causes aren’t completely understood, but bipolar disorder often runs in families. The first manic or depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood
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18. Signs and symptoms of mania In the manic phase of bipolar disorder, feelings of heightened energy, creativity, and euphoria are common. People experiencing a manic episode often talk a mile a minute, sleep very little, and are hyperactive. They may also feel like they’re all-powerful, invincible, or destined for greatness. But while mania feels good at first, it has a tendency to spiral out of control. People often behave recklessly during a manic episode—gambling away savings, engaging in inappropriate sexual activity, or making foolish business investments, for example. They may also become angry, irritable, and aggressive, picking fights, lashing out when others don’t go along with their plans, and blaming anyone who criticizes their behavior.
19. Common signs and symptoms of mania include: ♥ Feeling unusually “high” and optimistic OR extremely irritable ♥ Unrealistic, grandiose beliefs about one’s abilities or powers ♥ Sleeping very little, but feeling extremely energetic ♥ Talking so rapidly that others can’t keep up racing thoughts; jumping quickly from one idea to the next ♥ Highly distractible, unable to concentrate impaired judgment and impulsiveness ♥ Acting recklessly without thinking about the consequences ♥ Delusions and hallucinations (in severe cases)
20. Signs and symptoms of hypomania Hypomania is a less severe form of mania. People in a hypomanic state feel euphoric, energetic, and productive, but their symptoms are milder than those of mania and much less disruptive. Unlike manics, people with hypomania never suffer from delusions and hallucinations. They are able to carry on with their day-to-day lives. To others, it may seem as if the hypomanic individual is merely in an unusually good mood. But unfortunately, hypomania often escalates to full-blown mania or is followed by a major depressive episode. Signs and symptoms of bipolar depression The depressive phase of bipolar disorder is very similar to that of major depression. However, there are some notable differences. When compared to major depression, bipolar depression is more likely to include symptoms of low energy. People with bipolar depression tend to move and speak slowly and sleep a lot. They are also more likely to have psychotic depression, a condition in which they’ve lost contact with reality.
22. Signs and symptoms of a mixed episode A mixed episode of bipolar disorder features symptoms of both mania and depression. Common signs of a mixed episode include agitation, irritability, insomnia, appetite changes, loss of contact with reality, and suicidal thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide. Symptoms of Bipolar Disorder in Children and Teens Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day. Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.
23. Types of bipolar disorder The course of bipolar disorder varies widely from person to person, with unpredictable differences in the pattern and frequency of the manic and depressive episodes. Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes. Some have frequent mood disruptions, while others experience only a few over a lifetime. The duration and severity of each episode also differs. Each of the four types of bipolar disorder have a unique pattern of symptoms: Bipolar I Disorder – Mania and depression Bipolar I Disorder is the classic manic-depressive form of the illness, as well as the most severe type of bipolar disorder. It is characterized by at least one manic episode or mixed episode. Although a previous episode of major depression is not required for diagnosis, the vast majority of people with Bipolar I Disorder have experienced one. The typical course of Bipolar I Disorder involves recurring cycles between mania and depression.
24. Bipolar II Disorder – Hypomania and depression In Bipolar II disorder, the person doesn’t experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression. In order to be diagnosed with Bipolar II Disorder, you must have experienced at least one hypomanic episode and one major depressive episode in your lifetime. If you ever have a manic episode, your diagnosis would be changed to Bipolar I Disorder. Cyclothymia – Hypomania and mild depression Cyclothymia, also known as cyclothymic disorder, is a milder form of bipolar disorder. Like bipolar disorder, cyclothymia consists of cyclical mood swings. However, the highs and lows are not severe enough to qualify as either mania or major depression. To be diagnosed with cyclothymia, you must experience numerous periods of hypomania and mild depression over at least a two-year time span. Because people with cyclothymia are at an increased risk of developing full-blown bipolar disorder, it is a condition that should be monitored and treated. Rapid Cycling – Frequent episodes of mania, hypomania, or depression Rapid cycling is a subtype of bipolar disorder characterized by four or more episodes of mania, hypomania, or depression within one year. The shifts from low to high can occur over a matter of days or hours. Rapid cycling can occur within any type of bipolar disorder. It usually develops later in the course of bipolar disorder, but it is sometimes just a temporary condition.
25. Bipolar disorder and suicide The depressive phase of bipolar disorder is often very severe, and suicide is a major risk factor. In fact, people suffering from bipolar disorder are more likely to attempt suicide than those suffering from regular depression. Furthermore, their suicide attempts tend to be more lethal. The risk of suicide is even higher in people with bipolar disorder who have a high number of depressive episodes, mixed episodes, a history of alcohol or drug abuse, a family history of suicide, or an early onset of the disease. The warning signs of suicide include: † Talking about death, self-harm, or suicide † Feeling hopeless or helpless † Feeling worthless or like a burden to others † Putting affairs in order or saying goodbye † Acting recklessly, as if one has a “death wish” † Seeking out weapons or pills that could be used to commit suicide
26. Bipolar Disorder causes and triggers Research indicates that some people are genetically predisposed to bipolar disorder. But not everyone with an inherited vulnerability develops the illness, indicating that external factors also play a role. These external risk factors are called triggers. Triggers can set off a bipolar disorder or prolong an existing mood episode. Many episode of mania or depression occur, however, without an obvious trigger. Stress - Severe stress or emotional trauma can trigger either depression or mania in someone with a genetic vulnerability to bipolar disorder. Stress can also worsen a bipolar mood episode or extend its duration. Major Life Event - Major life events both good and bad can trigger an episode of bipolar disorder. These events tend to involve drastic or sudden changes, such as getting married, going away to college, starting a new job, or retiring.
27. Substance Abuse - While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression. Medication - Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that may induce mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication. Seasonal Changes - Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring. Sleep Deprivation – Loss of sleep, even as little as skipping a few hours of rest, can trigger an episode of mania.
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29. What is depression? It’s impossible to escape life’s ups and downs. Feeling unhappy or sad in response to disappointment, loss, frustration or a medical condition is normal. Many people use the word “depression” to explain these kinds of feelings, but that is really situational depression, which is a normal reaction to events around us. Clinical depression, though, overwhelms and engulfs your day to day life, interfering with your ability to work, study, eat, sleep, and have fun. It is unrelenting, with little if any relief.
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31. Signs and symptoms of depression There’s a vast difference between “feeling depressed” and suffering from clinical depression. The despondency of clinical depression is unrelenting and overwhelming. Some people describe it as “living in a black hole” or having a feeling of impending doom. They can't escape their unhappiness and despair. However, some people with depression don't feel sad at all. Instead, they feel lifeless and empty. In this apathetic state, they are unable to experience pleasure. Even when participating in activities they used to enjoy, they feel as if they're just going through the motions. The signs and symptoms vary from person to person, and they may wax and wane in severity over time.
32. Depression Signs and Symptoms Clinical depression is distinguished from situational depression by length and severity Feelings of helplessness and hopelessnes A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation. Loss of interest in dailly activities No interest in or ability to enjoy former hobbies, pastimes, social activities, or even sex. Appetite or weight changes Significant weight loss or weight gain—a change of more than 5% of body weight in a month. Sleep changes Either insomnia, especially waking in the early hours of the morning, or oversleeping. Psychomotor agitation or retardation Either feeling “keyed up” and restless or sluggish and physically slowed down. Loss of energy Feeling fatigued and physically drained. Even small tasks are exhausting or take longer Self-loathing Strong feelings of worthlessness or guilt. Harsh criticism of perceived faults and mistakes. Concentration problems Trouble focusing, making decisions, or remembering things.
33. Depression in men Depression is a loaded word in our culture. Many associate it, however wrongly, with a sign of weakness and excessive emotion. This is especially true with men. Depressed men are less likely than women to acknowledge feelings of self-loathing and hopelessness. How is depression expressed in men? Frequently, it comes out in more “socially acceptable” forms. Anger, aggression, reckless behavior and violence, along with substance abuse, can be signs of an underlying depression. You might hear complaints about fatigue, irritability, sleep problems, and loss of interest or sudden excessive interest in work and hobbies. Even though depression rates for women are twice as high as those in men, men are a higher suicide risk, especially older men.
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35. What is post-traumatic stress disorder (PTSD)? Post-traumatic stress disorder (PTSD) is a disorder that can develop following a traumatic event that threatens your safety or makes you feel helpless. Most people associate PTSD with battle-scarred soldiers – and military combat is the most common cause in men – but any overwhelming life experience can trigger PTSD, especially if the event is perceived as unpredictable and uncontrollable. Post-traumatic stress disorder (PTSD) can affect those who personally experience the catastrophe, those who witness it, and those who pick up the pieces afterwards, including emergency workers and law enforcement officers. It can even occur in the friends or family members of those who went through the actual trauma.
36. Traumatic events that can lead to post-traumatic stress disorder (PTSD) include: ψ War ψ Rape ψ Natural disasters ψ A car or plane crash ψ Kidnapping ψ Violent assault ψ Medical procedures (especially in kids )
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38. PTSD symptoms of increased arousal ∂ Difficulty falling or staying asleep ∂ Irritability or outbursts of anger ∂ Difficulty concentrating ∂ Hypervigilance ∂ Feeling jumpy and easily startled Other common symptoms of post-traumatic stress disorder ∂ Anger and irritability ∂ Guilt, shame, or self-blame ∂ Substance abuse ∂ Depression and hopelessness ∂ Suicidal thoughts and feelings ∂ Feeling alienated and alone ∂ Feelings of mistrust and betrayal ∂ Headaches, stomach problems, chest pain
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43. What is anorexia nervosa? Anorexia nervosa is characterized by an irrational dread of becoming fat coupled with a relentless pursuit of thinness. People with anorexia go to extremes to reach and maintain a dangerously low body weight. But no matter how much weight is lost, no matter how emaciated they become, it’s never enough. The more the scale dips, the more obsessed they become with food, dieting, and weight loss. The key features of anorexia nervosa are: ï Refusal to sustain a minimally normal body weight ï Intense fear of gaining weight, despite being underweight ï Distorted view of one’s body or weight, or denial of the dangers of one’s low weight
44. The difference between dieting and anorexia Eating disorders, including anorexia, often begin with normal dieting. A person may start dieting and exercising to get in shape, but as the pounds come off, a desire to lose even more weight is triggered. This cycle continues until the person almost completely stops eating. Many factors influence this destructive progression from healthy dieting to full-blown anorexia. For many anorexics, self-starvation is a way to feel in control. People with anorexia may feel powerless in their everyday lives, but they can control what they eat. Restricting food is a way to cope with painful feelings such as anger, shame, and self-loathing. Saying “no” to food, getting the best of hunger, and controlling the number on the scale make them feel strong and successful—at least for a short while. Unfortunately, this boost to self-esteem is short-lived. Anorexics believe that their lives will be better—that they’ll finally feel good about themselves—if they lose more weight. But no amount of dieting or weight loss can repair the negative self-image at the heart of anorexia. In the end, anorexia only leads to greater emotional pain, isolation, and physical damage.
45. Is it Diet or Anorexia? Healthy Dieting Anorexia Weight loss is viewed as a way to improve health and appearance. Weight loss is viewed as a way to achieve happiness. Self-esteem is based on more than just weight and body image. Self-esteem is based entirely on how much you weigh and how thin you are. Is an attempt to control weight Is an attempt to control your life and emotions The goal is to lose weight in a healthy way. Becoming thin is all that matters; health is not a concern.
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51. Effects of anorexia The severe calorie restriction of anorexia has dire physical effects. When the body doesn’t get the fuel it needs to function normally, it goes into starvation mode. It slows down to conserve energy and turns in on itself for essential nutrients. In essence, the body begins to consume itself. As the self-starvation continues and more body fat is lost, the medical complications pile up. The first physical signs and effects of anorexia are: ¨ Loss of menstrual periods ¨ Lack of energy and weakness ¨ Feeling cold all the time ¨ Dry, yellowish skin ¨ Constipation and abdominal pain ¨ Restlessness and insomnia ¨ Dizziness, fainting, and headaches ¨ Growth of fine hair all over the body and face
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54. People suffering from OCPD have careful rules and procedures for conducting many aspects of their everyday lives. While their goal is to accomplish things in a careful, orderly manner, their desire for perfection and insistence on going "by the book" often overrides their ability to complete a task. For example, one patient with OCPD was so preoccupied with finding a mislaid shopping list that he took much more time searching for it than it would have taken him to rewrite the list from memory. This type of inflexibility typically extends to interpersonal relationships. People with OCPD are known for being highly controlling and bossy toward other people, especially subordinates. They will often insist that there is one and only one right way (their way) to fold laundry, cut grass, drive a car, or write a report. In addition, they are so insistent on following rules that they cannot allow for what most people would consider legitimate exceptions. Their attitudes toward their own superiors or supervisors depend on whether they respect these authorities. People with OCPD are often unusually courteous to superiors that they respect, but resistant to or contemptuous of those they do not respect.
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56. One researcher has noted that people with OCPD appear to have been punished by their parents for every transgression of a rule, no matter how minor, and rewarded for almost nothing. As a result, the child is unable to safely develop or express a sense of joy, spontaneity, or independent thought, and begins to develop the symptoms of OCPD as a strategy for avoiding punishment. Children with this type of upbringing are also likely to choke down the anger they feel toward their parents; they may be outwardly obedient and polite to authority figures, but at the same time treat younger children or those they regard as their inferiors harshly.
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58. Treatments Psychotherapy Psychotherapeutic approaches to the treatment of OCPD have found insight-oriented psychodynamic techniques and cognitive behavioral therapy to be helpful for many patients. This choice of effective approaches stands in contrast to the limitations of traditional forms of psychotherapy with most patients diagnosed with OCD. Learning to find satisfaction in life through close relationships and recreational outlets, instead of only through work-related activities, can greatly enrich the OCPD patient's quality of life. Specific training in relaxation techniques may help patients diagnosed with OCPD who have the so-called "Type A" characteristics of competitiveness and time urgency as well as preoccupation with work.
59. It is difficult, however, for a psychotherapist to develop a therapeutic alliance with a person with OCPD. The patient comes into therapy with a powerful need to control the situation and the therapist; a reluctance to trust others; and a tendency to doubt or question almost everything about the therapy situation. The therapist must be alert to the patient's defenses against genuine change and work to gain a level of commitment to the therapeutic process. Without this commitment, the therapist may be fooled into thinking that therapy has been successful when, in fact, the patient is simply being superficially compliant.
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