PSYCHOLOGICAL DISORDERS

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.