In the course of one year, an estimated 22% of Americans,
about one in five, suffer from a diagnosable mental disorder. In addition, four of the ten leading causes
of disability in the United States and other developed countries are mental
disorders such as depression, bipolar disorder, schizophrenia, and
obsessive-compulsive disorder. However
two-thirds of those suffering from psychological disorders will not receive
treatment due to the stigma and cost associated with mental health
treatment. Overall, minorities share the
same prevalence rate of mental disorders as Caucasians; however, there are
great disparities in the rate of mental health care for minorities as compared
to the non-minority population.
While there are over 300 different types of mental illness
that can be diagnosed, we will cover three major categories of mental
disorders: mood disorders, including depression and bipolar; anxiety disorders;
and schizophrenia. Over 450 million
people worldwide are affected by mental disorders at any given time, and these
numbers are expected to increase in the future.
Mood Disorders
Mood disorders, such as depression, seasonal affective
disorder, and bipolar disorder, refer to psychological problems in which the
primary symptom is a disturbance in mood.
You might see someone as moody, unable to predict if the person will be
in a good or bad mood from one day to the next.
Depression
About one in ten Americans suffer some form of depression,
with women experiencing clinical
depression twice as often as men.
The incidence of depression starting in childhood and adolescence has
dramatically increased over the past ten years.
We have already begun to see this trend, as the number of college
students with depression has doubled over the last 13 years. While depression can develop at any age of
onset is the mid-twenties.
How can you tell the difference between having the blues and
clinical depression? The symptoms of
depression are:
·
Depressed mood most of the day, nearly every day
·
Frequent crying
·
Withdrawing, isolating oneself from others
·
Lack of interest in activities that are
typically enjoyable
·
Increase or decrease in appetite resulting in
significant weight loss or weight gain
Insomnia, disturbed or restless sleep, or
sleeping more than usual
·
Feeling tired most of the time, regardless of
how much sleep you have had
·
Low self-esteem, feelings of hopelessness and
worthlessness
·
Difficulty concentrating, remembering things,
and focusing on a task, and indecisiveness
·
Frequent thoughts of suicide
Many people have experienced some of these symptoms at one
point or another in their lives; however, clinically depressed individuals
experience most of these symptoms every day and have felt this way for at least
two weeks. Most people can find ways of
pulling themselves out of feeling down, but when you have clinical depression,
the normal methods you have used in the past to cope with the blues don’t
work. Clinical depression can range from
mild to severe depression and can result in significant impairment in
functioning, such as not being able to get out of bed to attend classes or go
to work or have the energy or motivation to take care of your basic needs for
food, hygiene, and rest. Some depressed
people tend to become irritable, negative, and uncommunicative, which can cause
greater stress and conflict in their relationships. Depression has been described as constantly
having a black cloud over your head, and not being able to get out from
underneath it no matter what you do.
There are several causes or triggers for depression to
develop. Research suggests that if you
have a family history of depression or any type of mood disorder, you are more
prone to developing a depressive disorder.
In fact, rates of depression for a child with a depressed parent are two
to four times greater than for children without this type of heredity. While there is no single gene that causes
depression, your genetic makeup can make you more vulnerable to depression. Neurotransmitters and hormone levels play a major
role in the way your brain regulates your mood and emotions. Two neurotransmitters, serotonin and
norepinephrine, are often found to be deficient in people with depression.
However, biological processes are not the only explanation
for depression. You may have a family
history of depression and never develop depressive symptoms as this only puts
you in a higher risk category for this disorder. Other life events, stressors,
and losses can activate this pre-disposition, causing depression. In addition, you may have no genetic
predisposition and still become clinically depressed. Depression can be caused by many factors such
as:
·
Loss of a significant relationship
·
Death of a family member or friend
·
Physical or sexual abuse or assault
·
Serious illness or health problems
·
Experiencing numerous setbacks and problems
simultaneously
Having a support system, effective coping strategic, and a
positive attributional style can make the difference between succumbing to
depression or being protected during stressful and adverse times in our lives.
There are many ways to treat depression, but the most efficacious
treatment approach is a combination of counseling and medication. Counseling can help people develop effective
and healthy coping skills, learn stress management strategies, focus on
developing an optimistic explanatory style, and improve relationships and
social skills. Medication, such as
antidepressants, have been found to be very helpful in the treatment of treatment
of depression, as they act to increase the serotonin or norepinephrine levels
to a normal and functional range. Some
of the newer antidepressants are Prozac, Paxil, Zoloft, Serzone, Remeron,
Effexor, and Lexapro. It takes 4 to 6
weeks for an antidepressant to be fully effective, and there may be side
effects such as dry mouth, decreases sexual drive, drowsiness, constipation, or
diarrhea. Most of these will disappear
after 2 weeks of taking the medication.
Most people take an antidepressant for 6 months to a year
and then are able to taper off of the medication without a reoccurrence of
symptoms. If you have had three separate
episodes of depression, recovering from each episode and then relapsing, this
can be a sign that your depression is chemically caused and an indication that
you may need to continue taking an antidepressant medication long-term.
Herbal supplements, such as St. John’s Wort, have also been
touted as a treatment for depression, although there is some debate as to how
effective they truly are. Most health
care providers agree that St. John’s Wort can be somewhat effective in
alleviating mild depression. As is the
case with all herbal supplements, St. John’s Wort is not subject to FDA
approval nor has it been put through the clinical trials prescription
medication has undergone to establish its therapeutic dose and efficacy. However, the National Institute of Mental
Health, the National Center for Complementary and Alternative Medicine, and the
Office of Dietary Supplements are currently conducting a $4 million collaborative
four-year study to investigate the safety and effectiveness of St. John’s Wort,
and so more definitive information will be available in the near future.
Exercise and activity level also play a significant role in
alleviating and insulating people from depression. Again it seems that the endorphin levels and
effects on brain chemistry and hormonal levels are part of the explanation for
why this is a powerful antidote for depression.
Suicide
Suicide is the third leading cause of death for young adults
15 to 24 years old and the eleventh leading cause if all death in the United
States. Men commit suicide four times
more than women do, and 72% of all suicides are committed by white men. Suicide occurs most often among Americans age
65 and older. However, women are three
times more likely than men to attempt suicide.
Men tend to employ more lethal methods such as using firearms, hanging,
or jumping from high places, while women tend to use slower methods such as
overdosing with pills or cutting their wrists, which allow more time for
medical attention. Twice as many Whites
complete suicide as African Americans, with Asian Americans being one of the
lowest risk groups in terms of ethnicity.
The suicide rate for the Hispanic population is lower than for Whites
but higher than for African Americans.
Why do people attempt or commit suicide? The majority of suicidal people have
depressive disorders and feel helpless and powerless over their lives. They say things like “I just want the pain to
stop” and don’t see any other options available to them. There are some risk factors associated with
suicidal behavior such as having:
·
Little to no support system
·
Made previous suicide attempts
·
A family history of mental illness, including
substance abuse
·
A family history of suicide
·
Problems with drugs or alcohol
·
Possession of a firearm
·
Exposure to suicidal behavior of others,
including through the media
It is estimated that there are 300,000 suicide
attempts made each year in the United States, or more than one every 2 minutes. Some people say that suicidal gestures or
threats are merely a cry for attention and ignore them. But left ignored, the
person may go ahead and take the next step to attempt suicide because no one
seems to care. It is always best to take
any threats or talk about suicide seriously and act accordingly. What should you do if a friend or family
member talks to you about thoughts of suicide?
Bipolar Disorder
Another important mood disorder is Bipolar Disorder, a
condition that was previously known as manic depression. Bipolar refers to the extreme mood swings
individuals with this disorder experience. From feeling euphoric, energetic,
and reckless to feeling depresses, powerless, and listless. It is the least common of the mood
disorders. Men and women are equally
likely to develop this condition, and the average age of onset for the first
manic episode typically occurs in the early twenties. This change in mood or “mood swing” can last
for hours, days, weeks, or months, and it is found among all ages, races,
ethnic groups, and social classes. The
illness tends to run in families and appears to have a genetic link, as it is
more likely to affect the children of parents who have the disorder. When one parent has bipolar disorder, the
risk to each child is estimated to be 15 percent to 30 percent. When both parents have bipolar disorder, the
risk increases to 50 percent to 75 percent.
We have already described depression in great detail in the
previous section. Bipolar disorder
involves both having depressive periods and manic episodes. Mania is characterized by the following:
·
Excessive energy, needing little sleep
·
Racing thoughts, feeling as though your mind is
going 50 mph
·
Rapid speech, changing from topic to topic
quickly in conversation
·
Irritability
·
Impulsive and reckless behavior, for example,
going on spending sprees, increased involvement in sexual activity, and drug
and alcohol use
·
Trying to do too much, feeling as though you can
accomplish a great deal
·
Being easily distracted
·
Exciteability
Many people with bipolar disorder will tell you that they
enjoy the “highs” but dread the lows.
However, manic behavior can become very destructive because when people
are in a manic phase they can create enormous credit card debt, abuse drugs and
alcohol, drive recklessly, and often feel invincible. They stay up all night and feel very little
need for rest or food and eventually their bodies can’t function and they
collapse. Mood stabilizers such as
Lithium and Lithobid and anticonvulsant medications such as Depakote,
Neurontin, Topomax, and Lamictal have been used to treat bipolar disorder,
along with psychotherapy.
Anxiety Disorder
Bill, a very talented and bright twenty-six-year old, has a
very promising career as an executive in a large accounting firm. However, he is in jeopardy of losing his job
because of his absenteeism and tardiness.
He has missed several important meetings with clients and not been able
to get his work done on time as a result.
It can take him hours to get to work even though he lives 15 minutes
away, and sometimes he doesn’t go to work even though he is in the car and
ready to go. Bill has a routine in the
morning that involves checking the windows, doors, iron, stove, and garage door
five times to ensure that things are secure and safe. Sometimes he drives away and then returns to
the house to check again. He feels a
need to turn the handles on doors five times, and if he loses track, he starts
all over again.
Susan has been having such severe panic attacks in the car
while driving to work that she has needed to pull over. Her heart races, her breathing is labored,
and she sometimes feels as though she is having a heart attack and might
die. She is frightened of being in the
car alone and might die. She is
frightened of being in the car alone and having an attack and being unable to
get help, or of having a car accident.
She is beginning to be afraid to leave her house and feels safer at
home. She has declined invitations to go
out with her friends and only goes out when absolutely necessary.
She feels as though she is losing control of
her life.
John worries constantly about what other people think of
him. When he hears people laughing, he
assumes that they are laughing at him.
He has trouble having conversations with people because he believes
whatever he says will sound stupid and that people will not like him. He also plays conversations over and over in
his head when he is trying to go to sleep, thinking about what he should have
said and worrying about how people are judging him.
Bill, Susan, and John are all suffering from anxiety disorders. While everyone tends to feel nervous or worry
about something at some point in their lives, people with anxiety disorders
feel anxious most, if not all, of the time.
They also feel out of control and powerless to alleviate their anxiety,
and tend to worry about becoming anxious, so their anxiety causes them even
greater anxiety. Anxiety is related to
fear and is part of daily life. Some
anxiety can even be helpful and motivating at times. Anxiety is a physiological, adaptive response
to danger or potential threat and can enhance performance and keep us out of
harm’s way. Anxiety disorders are
differentiated from daily stress as characterized by:
·
Intense, often debilitating, in which people
sometimes think they are going to die
·
Long lasting, persisting after the danger or
stressful event has passed
·
Dysfunctional, causing significant interference
in your life
Anxiety disorders include generalized anxiety disorder
(GAD), obsessive-compulsive disorder (OCD) such as Bill’s problem, post traumatic
stress disorder, panic disorder which describes Susan’s symptoms, and phobias
such as the social phobia John suffered from in the example above. Approximately 19 million Americans have an
anxiety disorder, and women are twice as likely as men to suffer from panic
disorder, post-traumatic stress disorder, generalized anxiety disorder,
agoraphobia, and other specific phobias.
There is a genetic component associated with developing an anxiety
disorder as studies suggest that you are more likely to develop one if your
parents have one. Certainly environmental
stressors and events can be instrumental in whether this predisposition is
activated or not.
The treatment for anxiety disorders usually involves a
combination of medication and counseling.
There is some evidence that a deficiency in the neurotransmitter
serotonin or a disturbance in metabolizing serotonin or a disturbance in
metabolizing serotonin is associated with this condition and taking an
antidepressant increases the serotonin levels in the brain. Individuals suffering from anxiety disorders
can also benefit from learning stress management, relaxation, and ways of
coping with the stress. Exercise, good
nutrition, and avoidance of stimulants such as caffeine can also be helpful in
alleviating anxiety.
Schizophrenia
Schizophrenia is one of the most severe mental disorders as
it is characterized by profound distortions in one’s thought processes,
emotions, perceptions, and behavior. People
with schizophrenia experience hallucinations (seeing things that are not there,
hearing voices), delusions (believing that you are Jesus, the CIA is after you,
or that radio waves are controlling your mind), and disorganized thinking
(wearing multiple coats, scarves, and gloves on a warm day, shouting and
swearing at passersby, maintaining a rigid posture and not moving for
hours). The movie A Beautiful Mind gives a glimpse into the life of one schizophrenic,
John Nash, and his recovery.
There are several types of schizophrenia: paranoid,
disorganized, catatonic, and undifferentiated.
This disabling illness affects 1 percent of the U.S population, and
symptoms typically surface in people in their late teens and early
twenties. Men and women are equally
likely to develop schizophrenia, and it seems to run in families. Schizophrenia is often confused with multiple
personality disorder, which is an entirely separate and distinct mental
illness. While people with multiple
personality disorder display two or more distinct identities or personalities
that take control of the person’s life, people with schizophrenia do not have
multiple, separate, enduring personalities.
There are many theories to explain what causes
schizophrenia. Some research suggests
that heredity accounts for about 80 percent of the cause of schizophrenia and
the other 20 percent is due to environmental stressors or situations. Researchers have also identified a number of
abnormalities in the brains of diagnosed schizophrenics, including smaller
temporal lobes, enlargement of the ventricles, and cerebral atrophy in the
frontal lobes. There is further
investigation looking at how the variations in chromosome-22 genes may be
linked to schizophrenia. Individuals
with schizophrenia also seem to have nearly double the number of dopamine
receptors in their brains, leading to the theory that too much dopamine is
being released into the brain pathways and causing schizophrenia symptoms. The antipsychotic medications act to block
the receptors and prevent the transmission of dopamine, reducing the amount of
dopamine in the system that is creating this chemical imbalance.
While there is no cure for schizophrenia, there are
antipsychotic medications, such as Seroquel, Risperidone, Zyprexa, Geodon, and
Abilify that can effectively treat this illness and enable people to live
functional, satisfying lives. Psychotherapy
can be helpful in developing problem solving approaches, in addition to
identifying stressors and triggers, and early detection of a psychotic
episode. Unfortunately some people with
schizophrenia are unable to recognize that they are delusional or irrational,
and so do not get treatment or take their medications on a regular basis.
