Children and Anxiety Disorders
Post-Traumatic Stress Disorder
Most people experience feelings of anxiety before an important event such as a big exam, business presentation or first date. Anxiety disorders, however, are illnesses that cause people to feel frightened, distressed and uneasy for no apparent reason. Left untreated, these disorders can dramatically reduce productivity and significantly diminish an individual’s quality of life.
How common are anxiety disorders?
Anxiety disorders are the most common mental illness in America; more than 19 million are affected by these debilitating illnesses each year. Anxiety disorders cost the U.S. $46.6 billion in 1990 in direct and indirect costs, nearly one-third of the nation’s total mental health bill of $148 billion.
What are the different kinds of anxiety disorders?
Characterized by panic attacks, sudden feelings of terror that strike repeatedly and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal discomfort, feelings of unreality, and fear of dying.
Repeated, intrusive and unwanted thoughts or rituals that seem impossible to control.
Post-Traumatic Stress Disorder
Persistent symptoms that occur after experiencing a traumatic event such as war, rape, child abuse, natural disasters, or being taken hostage. Nightmares, flashbacks, numbing of emotions, depression, and feeling angry, irritable, distracted and being easily startled are common.
Extreme, disabling and irrational fear of something that really poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives.
Generalized Anxiety Disorder
Chronic, exaggerated worry about everyday routine life events and activities, lasting at least six months; almost always anticipating the worst even though there is little reason to expect it. It can be accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea.
What are the Treatments for Anxiety Disorders?
Treatments have been largely developed through research conducted by NIMH and other research institutions. They are extremely effective and often combine medication or specific types of psychotherapy. More medications are available than ever before to effectively treat anxiety disorders. These include antidepressants or benzodiazepines. If one medication is not effective, others can be tried. New medications are currently under development to treat anxiety symptoms. The two most effective forms of psychotherapy used to treat anxiety disorders are behavioral therapy and cognitive-behavioral therapy. Behavioral therapy tries to change actions through techniques such as diaphragmatic breathing or through gradual exposure to what is frightening. In addition to these techniques, cognitive-behavioral therapy teaches patients to understand their thinking patterns so they can react differently to the situations that cause them anxiety.
Is it possible for anxiety disorders to coexist with other physical or mental disorders?
It is common for an anxiety disorder to accompany another anxiety disorder, or in some cases depression, eating disorders or substance abuse. Anxiety disorders can also coexist with physical disorders. In such instances, these disorders will also need to be treated. Before undergoing any treatment, it is important to have a thorough medical exam to rule out other possible causes.
What is bipolar disorder?
Bipolar disorder, or manic depression, is a serious brain disorder that causes extreme shifts in mood, energy, and functioning. It affects 2.3 million adult Americans, which is about 1.2 percent of the population, and can run in families. The disorder affects men and women equally. Bipolar disorder is characterized by episodes of mania and depression that can last from days to months. Bipolar disorder is a chronic and generally life-long condition with recurring episodes that often begin in adolescence or early adulthood, and occasionally even in children. It generally requires lifelong treatment, and recovery between episodes is often poor. Generally, those who suffer from bipolar disorder have symptoms of both mania and depression (sometimes at the same time).
What are the symptoms of mania?
Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:
- either an elated, happy mood or an irritable, angry, unpleasant mood
- increased activity or energy
- more thoughts and faster thinking than normal
- increased talking, more rapid speech than normal
- ambitious, often grandiose, plans
- poor judgement
- increased sexual interest and activity
- decreased sleep and decreased need for sleep
What are the symptoms of depression?
Depression is the other phase of bipolar disorder. The symptoms of depression may include:
- depressed or apathetic mood
- decreased activity and energy
- restlessness and irritability
- fewer thoughts than usual and slowed thinking
- less talking and slowed speech
- less interest or participation in, and less enjoyment of activities normally enjoyed
- decreased sexual interest and activity
- hopeless and helpless feelings
- feelings of guilt and worthlessness
- pessimistic outlook
- thoughts of suicide
- change in appetite (either eating more or eating less)
- change in sleep patterns (either sleeping more or sleeping less)
What is a “mixed” state?
A mixed state is when symptoms of mania and depression occur at the same time. During a mixed state depressed mood accompanies manic activation.
What is rapid cycling?
Sometimes individuals may experience an increased frequency of episodes. When four or more episodes of illness occur within a 12-month period, the individual is said to have bipolar disorder with rapid cycling. Rapid cycling is more common in women.
What are the causes of bipolar disorder?
While the exact cause of bipolar disorder is not known, most researchers believe it is the result of a chemical imbalance in certain parts of the brain. Other evidence suggests that the disorder results from impairments of the function of intracellular signaling pathways (the “machinery” inside nerve cells) within specific areas of the brain. Scientists have found evidence of a genetic predisposition to the illness. An active area of research involves trying to understand what those genes are that lend susceptibility to developing the disorder. Bipolar disorder tends to run in families, and close relatives of someone with bipolar disorder are more likely to be affected by the disorder. Sometimes serious life events such as a serious loss, chronic illness, illicit or prescription drug use or financial problems, can trigger an episode in some individuals with a predisposition to the disorder. There are other possible “triggers” of bipolar episodes: the treatment of depression with an antidepressant medication may trigger a switch into mania, sleep deprivation may trigger mania, or hypothyroidism may produce depression or mood instability. It is important to note that bipolar episodes can and often do occur without any obvious trigger.
How is bipolar disorder treated?
While there is no cure for bipolar disorder, it is a treatable and manageable illness. After an accurate diagnosis, most people can be successfully treated. Medication is an essential part of successful treatment for people with bipolar disorder. Maintenance treatment with a mood stabilizer substantially reduces the number and severity of episodes for most people, although episodes of mania or depression may occur and require a specific additional treatment. In addition, psychosocial therapies including, cognitive-behavioral therapy, interpersonal therapy, family therapy, and psychoeducation are important to help people understand the illness and to develop skills to cope with the stresses that can trigger episodes. Changes in medications or doses may be necessary, as well as changes in treatment plans during different stages of the illness.
Medications used to treat mania
Medications commonly used to treat manic episodes of bipolar disorder are called mood stabilizers, and they include lithium (Eskalith or Lithobid) and divalproex sodium (Depakote).
- Lithium has long been used as a first line treatment for acute mania in people with bipolar disorder. Lithium is effective for preventing episodes of mania from occurring and for treating an episode after it has begun. However, for some individuals, lithium is ineffective and for others, lithium has a variety of side effects that may make it an undesirable treatment option.
- Depakote is an anticonvulsant that has been used to treat epilepsy since 1983, but it was approved as a treatment for manic episodes of bipolar disorder in 1995. Depakote seems to be as effective as lithium for treating mania and it has fewer side effects, although it may not be appropriate for people with a history of liver problems.
- Other anticonvulsant medications have also been used to treat mania, including lamotrigine (Lamictal) which was recently approved by the Food and Drug Administration for treatment of bipolar disoder. These include carbamazepine (Tegretol) and topiramate (Topamax). However, these two medications have not been officially approved by the FDA for the treatment of bipolar disorder and have their own side effects.
- Mania may also be treated acutely with antipsychotic medications. This class of medications includes Olanzapine (Zyprexa), which is FDA approved for the treatment of acute mania.
Medications used to treat depression
During depressive episodes, people with bipolar disorder may need additional treatment with an antidepressant medication. Because of the risk of triggering mania, doctors often prescribe an antidepressant only after the individual is already receiving a therapeutic dose of lithium or an anticonvulsant mood stabilizer. Research suggests that mood stabilizers can protect against antidepressant-induced switches into mania. Antidepressant medications relieve depression, elevate mood, and activate behavior, but it often takes three to four weeks to respond. Sometimes a variety of different antidepressants and doses will be tried before finding the medication that works best for a particular individual.
- There are several different types of antidepressants used to treat depression including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), or newer antidepressants that function in different ways. Recent data suggests that the anticonvulsant lamotrigine (Lamictal) may possess antidepressant effects in bipolar disorder. Once again, it is important to emphasize that treatment of depression in bipolar disorder without a mood stabilizing medication may result in “cycling” into a manic episode.
- Consumers and their families must be cautious during the early stages of treatment when energy levels and the ability to take action return before mood improves. At this time – when decisions are easier to make, but depression is still severe – the risk of suicide may temporarily increase.
What are the side effects of the medications used to treat bipolar disorder?
All medications have side effects. Different medications produce different side effects, and people differ in the amount and severity of side effects they experience. Side effects can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with an additional medication.
Side effects of medications used to treat mania.
- Side effects of lithium include hand tremors, excessive thirst, excessive urination, and memory problems. Side effects often become less troublesome after a few weeks as the body adjusts to the medication. Particularly bothersome tremors can be treated with additional medication. Low thyroid function can be treated with thyroid supplements. In very few people, long-term lithium treatment can interfere with kidney function.
- Common side effects of anticonvulsant mood stabilizers include nausea, drowsiness, dizziness, and tremors. Some people taking anticonvulsant mood stabilizers may develop liver problems or problems with white blood cell count and blood platelets, which can be severe. Therefore, blood tests to monitor liver function and blood cells may be an important part of treatment with some of these medications.
Side effects of medications used to treat depression.
About half of the people taking antidepressant medications have mild side effects during the first few weeks of treatment.
- Common side effects of tricyclic antidepressants (TCAs) include dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, or weight gain or loss.
- Individuals taking monoamine oxidase inhibitors (MAOIs) may have to be careful about eating certain smoked, fermented, or pickled foods, drinking certain beverages, or taking some medications because they can cause severe high blood pressure in combination with the medication. MAOIs have other, less severe side effects as well.
- The SSRIs and newer antidepressants tend to have fewer and different side effects, such as nausea, nervousness, insomnia, diarrhea, rash, agitation, or sexual problems, or weight gain or loss.
Children and Anxiety Disorders
An anxiety disorder is a mental health problem that can affect people of all ages, including children. In fact, anxiety disorders are the most common type of mental health disorder in children, affecting as many as ten percent of young people. All children experience some anxiety; this is normal and expected. For example, when left alone at preschool for the first time, many children will show distress; a young child with his or her own room may develop a fear of the dark. Such anxiety becomes a problem when it interrupts a child’s normal activities, like attending school and making friends or sleeping. Persistent and intense anxiety that disrupts daily routine is a mental health problem that requires intervention.
What are the most common anxiety disorders in children?
There are several types of anxiety disorders. The list below describes those most common to children.
Generalized Anxiety Disorder
Children with generalized anxiety disorder (GAD) have recurring fears and worries that they find difficult to control. They worry about almost everything—school, sports, being on time, even natural disasters. They may be restless, irritable, tense, or easily tired, and they may have trouble concentrating or sleeping. Children with GAD are usually eager to please others and may be “perfectionists,” dissatisfied with their own less-than-perfect performance.
Separation Anxiety Disorder
Children with separation anxiety disorder have intense anxiety about being away from home or caregivers that affects their ability to function socially and in school. These children have a great need to stay at home or be close to their parents. Children with this disorder may worry excessively about their parents when they are apart from them. When they are together, the child may cling to parents, refuse to go to school, or be afraid to sleep alone. Repeated nightmares about separation and physical symptoms such as stomachaches and headaches are also common in children with separation anxiety disorder.
Social phobia usually emerges in the mid-teens and typically does not affect young children. Young people with this disorder have a constant fear of social or performance situations such as speaking in class or eating in public. This fear is often accompanied by physical symptoms such as sweating, blushing, heart palpitations, shortness of breath, or muscle tenseness. Young people with this disorder typically respond to these feelings by avoiding the feared situation. For example, they may stay home from school or avoid parties. Young people with social phobia are often overly sensitive to criticism, have trouble being assertive, and suffer from low self-esteem. Social phobia can be limited to specific situations, so the adolescent may fear dating and recreational events but be confident in academic and work situations.
Obsessive-compulsive disorder (OCD) typically begins in early childhood or adolescence. Children with OCD have frequent and uncontrollable thoughts (called “obsessions”) and may perform routines or rituals (called “compulsions”) in an attempt to eliminate the thoughts. Those with the disorder often repeat behaviors to avoid some imagined consequence. For example, a compulsion common to people with OCD is excessive hand washing due to a fear of germs. Other common compulsions include counting, repeating words silently, and rechecking completed tasks. In the case of OCD, these obsessions and compulsions take up so much time that they interfere with daily living and cause a young person a great deal of anxiety.
Post-Traumatic Stress Disorder
Children who experience a physical or emotional trauma such as witnessing a shooting or disaster, surviving physical or sexual abuse, or being in a car accident may develop post-traumatic stress disorder (PTSD). Children are more easily traumatized than adults. An event that may not be traumatic to an adult—such as a bumpy plane ride—might be traumatic to a child. A child may “re-experience” the trauma through nightmares, constant thoughts about what happened, or reenacting the event while playing. A child with PTSD will experience symptoms of general anxiety, including irritability or trouble sleeping and eating. Children may exhibit other symptoms such as being easily startled.
What Can Parents and Caregivers Do?
By identifying, diagnosing and treating anxiety disorders early, parents and others can help children reach their full potential. Anxiety disorders are treatable. Effective treatment for anxiety disorders may include some form of psychotherapy, behavioral therapy, or medications. Children who exhibit persistent symptoms of an anxiety disorder should be referred to and evaluated by a mental health professional who specializes in treating children. The diagnostic evaluation may include psychological testing and consultation with other specialists. A comprehensive treatment plan should be developed with the family, and, whenever possible, the child should be involved in making treatment decisions.
What is major depression?
Major depression is a serious medical illness affecting 9.9 million American adults, or approximately 5 percent of the adult population in a given year. Unlike normal emotional experiences of sadness, loss, or passing mood states, major depression is persistent and can significantly interfere with an individual’s thoughts, behavior, mood, activity, and physical health. Among all medical illnesses, major depression is the leading cause of disability in the U.S. and many other developed countries.
More than twice as many women (6.7 million) as men (3.2 million) suffer from major depressive disorder each year. Major depression can occur at any age including childhood, the teenage years and adulthood. All ethnic, racial and socioeconomic groups suffer from depression. About three-fourths of those who experience a first episode of depression will have at least one other episode in their lives. Some individuals may have several episodes in the course of a year. If untreated, episodes commonly last anywhere from six months to a year. Left untreated, depression can lead to suicide.
Major depression, also known as clinical depression or unipolar depression, is only one type of depressive disorder. Other depressive disorders include dysthymia (chronic, less severe depression) and bipolar depression (the depressed phase of bipolar disorder or manic depression). People who have bipolar disorder experience both depression and mania. Mania involves abnormally and persistently elevated mood or irritability, elevated self-esteem, and excessive energy, thoughts, and talking.
What are the symptoms of major depression?
The onset of the first episode of major depression may not be obvious if it is gradual or mild. The symptoms of major depression characteristically represent a significant change from how a person functioned before the illness. The symptoms of depression include:
- persistently sad or irritable mood
- pronounced changes in sleep, appetite, and energy
- difficulty thinking, concentrating, and remembering
- physical slowing or agitation
- lack of interest in or pleasure from activities that were once enjoyed
- feelings of guilt, worthlessness, hopelessness, and emptiness
- recurrent thoughts of death or suicide
- persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
When several of these symptoms of depressive disorder occur at the same time, last longer than two weeks, and interfere with ordinary functioning, professional treatment is needed.
What are the causes of major depression?
There is no single cause of major depression. Psychological, biological, and environmental factors may all contribute to its development. Whatever the specific causes of depression, scientific research has firmly established that major depression is a biological brain disorder.
Norepinephrine, serotonin, and dopamine are three neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. Scientists believe that if there is a chemical imbalance in these neurotransmitters, then clinical states of depression result. Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers.
Scientists have also found evidence of a genetic predisposition to major depression. There is an increased risk for developing depression when there is a family history of the illness. Not everyone with a genetic predisposition develops depression, but some people probably have a biological make-up that leaves them particularly vulnerable to developing depression. Life events, such as the death of a loved one, a major loss or change, chronic stress, and alcohol and drug abuse, may trigger episodes of depression. Some illnesses such as heart disease and cancer and some medications may also trigger depressive episodes. It is also important to note that many depressive episodes occur spontaneously and are not triggered by a life crisis, physical illness, or other risks.
How is major depression treated?
Although major depression can be a devastating illness, it is highly treatable. Between 80 and 90 percent of those suffering from serious depression can be effectively treated and return to their normal daily activities and feelings. Many types of treatment are available, and the type chosen depends on the individual and the severity and patterns of his or her illness. There are three basic types of treatment for depression: medications, psychotherapy, and electroconvulsive therapy (ECT). They may be used singly or in combination.
- Medication. The first antidepressant medications were introduced in the 1950s. Research has shown that imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine can be corrected with antidepressants. Four groups of antidepressant medications are most often prescribed for depression:
- Tricyclic antidepressants (TCAs) – still widely used for severe depression. TCAs elevate mood in depressed individuals, re-establish their normal sleep, appetite and energy level , but it often takes three to four weeks for an individual to respond. These medications include amitriptyline (Amititril, Elavil), desipramine (Norpramine), doxepine (Sinequan), imipramine (Antipress, Imavate, Tofranil), nortriptyline (Aventyl, Pamelor), and protriptyline (Vivactyl).
- Monoamine oxidase inhibitors (MAOIs) – are often effective in individuals who do not respond to other medications or who have “atypical” depressions with marked anxiety, excessive sleeping, irritability, hypochondria, or phobic characteristics. These medications include phenelzine (Nardil) and tranylcypromine sulfate (Parnate).
- Selective serotonin reuptake inhibitors (SSRIs) – act specifically on the neurotransmitter serotonin. In general SSRIs cause fewer side effects than TCAs and MAOIs. These medications include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and escitalopram (Lexapro).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) – useful as first-line treatments in people taking an antidepressant for the first time and for people who have not responded to other medications. In general SNRIs cause fewer side effects than TCAs and MAOIs. These medications include Venlafaxine (Effexor)
- Bupropion (Wellbutrin) – newer antidepressant medication classified as a dopamine reuptake blocking compound. It acts on the neurotransmitters dopamine and norepinephrine. In general bupropion causes fewer side effects than TCAs and MAOIs.
- Consumers and their families must be cautious during the early stages of medication treatment because normal energy levels and the ability to take action often return before mood improves. At this time – when decisions are easier to make, but depression is still severe – the risk of suicide may temporarily increase.
- Psychotherapy. There are several types of psychotherapy that have been shown to be effective for depression including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). Research has shown that mild to moderate depression can often be treated successfully with either of these therapies used alone. However, severe depression appears more likely to respond to a combination of psychotherapy and medication.
- Cognitive-behavioral therapy (CBT) – helps to change the negative thinking and unsatisfying behavior associated with depression, while teaching people how to unlearn the behavioral patterns that contribute to their illness.
- Interpersonal therapy (IPT) – focuses on improving troubled personal relationships and on adapting to new life roles that may have been associated with a person’s depression.
- Electroconvulsive therapy (ECT). ECT is a highly effective treatment for severe depressive episodes. In situations where medication, psychotherapy, and a combination of the two prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or thoughts of suicide, ECT may be considered. ECT may also be considered for those who for one reason or another cannot take antidepressant medications.
What are the side effects of the medications used to treat depression?
All medications have side effects. Different medications produce different side effects, and people differ in the amount and severity of side effects they experience. About 50 percent of people who take antidepressant medications have some side effects during the first weeks of treatment, but these problems are usually temporary and mild. Side effects that are particularly bothersome can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with an additional medication.
- Tricyclic antidepressants (TCAs) cause side effects that include dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, and weight gain or loss.
- Monoamine oxidase inhibitors (MAOIs). Individuals taking MAOIs may have to be careful about eating certain smoked, fermented, or pickled foods, drinking certain beverages, or taking some medications because they can cause severe high blood pressure in combination with the medication. A range of other, less serious side effects occur including weight gain, constipation, dry mouth, dizziness, headache, drowsiness, insomnia, and sexual side effects (problems with arousal or satisfaction).
- SSRIs, and SNRIs tend to have fewer and different side effects, such as nausea, nervousness, insomnia, diarrhea, rash, agitation, or sexual side effects (problems with arousal or orgasm).
- Bupropion generally causes fewer common side effects than TCAs and MAOIs. Its side effects include restlessness, insomnia, headache or a worsening of preexisting migraine conditions, tremor, dry mouth, agitation, confusion, rapid heartbeat, dizziness, nausea, constipation, menstrual complaints, and rash. Bupropion (Wellbutrin) was temporarily removed from the market after its initial release because of the occurrence of seizures in some patients. However, further investigation showed that seizures were primarily associated with high doses (above the current maximum recommended dose of 450 mg/day), a history of seizures or brain trauma, an eating disorder, excessive alcohol use, or taking other drugs that can also increase the risk for seizures. With new warnings and lower recommended doses, the chance of having seizures has been greatly reduced.
Post-Traumatic Stress Disorder
What is post-traumatic stress disorder?
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur after someone experiences a traumatic event that caused intense fear, helplessness, or horror. PTSD can result from personally experienced traumas (e.g., rape, war, natural disasters, abuse, serious accidents, and captivity) or from the witnessing or learning of a violent or tragic event.
While it is common to experience a brief state of anxiety or depression after such occurrences, people with PTSD continually re-experience the traumatic event; avoid individuals, thoughts, or situations associated with the event; and have symptoms of excessive emotions. People with this disorder have these symptoms for longer than one month and cannot function as well as they did before the traumatic event. PTSD symptoms usually appear within three months of the traumatic experience; however, they sometimes occur months or even years later.
How common is PTSD?
Studies suggest that anywhere between 2 percent and 9 percent of the population has had some degree of PTSD. However, the likelihood of developing the disorder is greater when someone is exposed to multiple traumas or traumatic events early in life (or both), especially if the trauma is long term or repeated. More cases of this disorder are found among inner-city youths and people who have recently emigrated from troubled countries. And women seem to develop PTSD more often than men.
Veterans are perhaps the people most often associated with PTSD, or what was once referred to as “shell shock” or “battle fatigue.” The Anxiety Disorders Association of America notes that an estimated 15 percent to 30 percent of the 3.5 million men and women who served in Vietnam have suffered from PTSD.
What are the symptoms of PTSD?
Although the symptoms for individuals with PTSD can vary considerably, they generally fall into three categories:
- Re-experience – Individuals with PTSD often experience recurrent and intrusive recollections of and/or nightmares about the stressful event. Some may experience flashbacks, hallucinations, or other vivid feelings of the event happening again. Others experience great psychological or physiological distress when certain things (objects, situations, etc.) remind them of the event.
- Avoidance – Many with PTSD will persistently avoid things that remind them of the traumatic event. This can result in avoiding everything from thoughts, feelings, or conversations associated with the incident to activities, places, or people that cause them to recall the event. In others there may be a general lack of responsiveness signaled by an inability to recall aspects of the trauma, a decreased interest in formerly important activities, a feeling of detachment from others, a limited range of emotion, and/or feelings of hopelessness about the future.
- Increased arousal – Symptoms in this area may include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, becoming very alert or watchful, and/or jumpiness or being easily startled.
It is important to note that those with PTSD often use alcohol or other drugs in an attempt to self-medicate. Individuals with this disorder may also be at an increased risk for suicide.
How is PTSD treated?
There are a variety of treatments for PTSD, and individuals respond to treatments differently. PTSD often can be treated effectively with psychotherapy or medication or both.
Behavior therapy focuses on learning relaxation and coping techniques. This therapy often increases the patient’s exposure to a feared situation as a way of making him or her gradually less sensitive to it. Cognitive therapy is therapy that helps people with PTSD take a close look at their thought patterns and learn to do less negative and nonproductive thinking. Group therapy helps for many people with PTSD by having them get to know others who have had similar situations and learning that their fears and feelings are not uncommon.
Medication is often used along with psychotherapy. Antidepressant and anti-anxiety medications may help lessen symptoms of PTSD such as sleep problems (insomnia or nightmares), depression, and edginess.
What is schizophrenia?
Schizophrenia is a devastating brain disorder that affects approximately 2.2 million American adults, or 1.1 percent of the population age 18 and older. Schizophrenia interferes with a person’s ability to think clearly, to distinguish reality from fantasy, to manage emotions, make decisions, and relate to others. The first signs of schizophrenia typically emerge in the teenage years or early twenties. Most people with schizophrenia suffer chronically or episodically throughout their lives, and are often stigmatized by lack of public understanding about the disease. Schizophrenia is not caused by bad parenting or personal weakness. A person with schizophrenia does not have a “split personality,” and almost all people with schizophrenia are not dangerous or violent towards others when they are receiving treatment. The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings.
What are the symptoms of schizophrenia?
No one symptom positively identifies schizophrenia. All of the symptoms of this illness can also be found in other brain disorders. For example psychotic symptoms may be caused by the use of drugs, may be present in individuals with Alzheimer’s Disease, or may be characteristics of a manic episode in bipolar disorder. However, when a doctor sees the symptoms of schizophrenia and carefully asseses the history and the course of the illness over six months, he or she can almost always make a correct diagnosis.
The symptoms of schizophrenia are generally divided into three categories, including positive, disorganized and negative symptoms.
- Positive Symptoms, or “psychotic” symptoms, include delusions and hallucinations because the patient has lost touch with reality in certain important ways. “Positive” as used here does not mean “good.” Rather, it refers to having overt symptoms that should not be there. Delusions cause the patient to believe that people are reading their thoughts or plotting against them, that others are secretly monitoring and threatening them, or that they can control other people’s minds. Hallucinations cause people to hear or see things that are not there.
- Disorganized Symptoms include confused thinking and speech, and behavior that does not make sense. For example, people with schizophrenia sometimes have trouble communicating in coherent sentences or carrying on conversations with others; move more slowly, repeat rhythmic gestures or make movements such as walking in circles or pacing; and have difficulty making sense of everyday sights, sounds and feelings.
- Negative Symptoms include emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and lacks content, and a lack of pleasure or interest in life. “Negative” does not, therefore, refer to a person’s attitude, but to a lack of certain characteristics that should be there.
Schizophrenia is also associated with changes in cognition. These changes affect the ability to remember and to plan for achieving goals. Also, attention and motivation are diminished. The cognitive problems of schizophrenia may be important factors in long term outcome.
Schizophrenia also affects mood. Many individuals affected with schizophrenia become depressed, and some individuals also have apparent mood swings and even bipolar-like states. When mood instability is a major feature of the illness, it is called, schizoaffective disorder, meaning that elements of schizophrenia and mood disorders are prominently displayed by the same individual. It is not clear whether schizoaffective disorder is a distinct condition or simply a subtype of schizophrenia.
What are the causes of schizophrenia?
Scientists still do not know the specific causes of schizophrenia, but research has shown that the brains of people with schizophrenia are different, as a group, from the brains of people without the illness. Like many other medical illnesses such as cancer or diabetes, schizophrenia seems to be caused by a combination of problems including genetic vulnerability and environmental factors that occur during a person’s development. Recent research has identified the first genes that appear to increase risk for schizophrenia. Like cancer and diabetes, the genes only increase the chances of becoming ill, and do not cause the illness all by themselves.
How is schizophrenia treated?
While there is no cure for schizophrenia, it is a highly treatable and manageable illness. However, people may stop treatment because of medication side effects, disorganized thinking, or because they feel the medication is no longer working. People with schizophrenia who stop taking prescribed medication are at a high risk of relapse into an acute psychotic episode.
- Hospitalization. People who experience acute symptoms of schizophrenia may require intensive treatment including hospitalization. Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal thoughts, an inability to care for oneself, or severe problems with drugs or alcohol. It also is important to protect people from hurting themselves or others.
- Medication. The primary medications for schizophrenia are called antipsychotics. Antipsychotics help relieve the positive symptoms of schizophrenia by helping to correct an imbalance in the chemicals that enable brain cells to communicate with each other. As with drug treatments for other physical illnesses, many patients with severe mental illnesses may need to try several different antipsychotic medications before they find the one, or the combination of medications, that works best for them.
- Conventional Antipsychotics were introduced in the 1950’s and all had similar ability to relieve the positive symptoms of schizophrenia. Most of these older “conventional” antipsychotics differed in the side effects they produced. These conventional antipsychotics include chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril).
- New “Atypical” Antipsychotics. In the last decade new “atypical” antipsychotics have been introduced. Compared to the older “conventional” antipsychotics these medications appear to be at least equally effective for helping reduce the positive symptoms like hallucinations and delusions – but may be better than the older medications at relieving the negative symptoms of the illness, such as withdrawal, thinking problems, and lack of energy. The atypical antipsychotics include risperidone (Risperdal), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon).
- Current treatment guidelines recommend using one of the atypical antipsychotics other than clozapine as a first line treatment option for newly diagnosed patients. However, for people already taking a conventional antipsychotic medication that is working well, a change to an atypical may not be the best option. People thinking of changing their medication should always consult with their doctor and work together to develop the most safe and effective treatment plan possible.
- Psychosocial Rehabilitation. Research shows that people with schizophrenia who attend structured psychosocial rehabilitation programs and continue with their medical treatment manage their illness best. One of the most effective psychosocial approaches for the most severely ill or those with both mental illness and substance abuse, is the Program for Assertive Community Treatment (PACT), an intensive team effort in local communities to help people stay of the hospital and live independently. Available 24-hours a day, seven-days a week, PACT professionals meet their clients where they live, providing at-home support at whatever level is needed. Professionals work with clients to address problems effectively, to make sure medications are being properly taken, and to meet the routine daily challenges of life, such as grocery shopping and managing money.
- PACT programs are statewide in four states and growing in another 20 states. PACT is significantly reducing hospital admissions, and improving functioning and the quality of life for people with schizophrenia.
What are the side effects of the medications used to treat schizophrenia?
All medications have side effects. Different medications produce different side effects, and people differ in the amount and severity of side effects they experience. Side effects can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with an additional medication. Common inconvenient side effects of all antipsychotic drugs used to treat schizophrenia include dry mouth, constipation, blurred vision, and drowsiness. Some people experience sexual dysfunction or decreased sexual desire, menstrual changes, and significant weight gain. Other common side effects relate to muscles and movement problems. These side effects include: restlessness, stiffness, tremors, muscle spasms, and one of the most unpleasant and serious side effects, a condition called tardive dyskinesia.
- Tardive dyskinesia is a movement disorder where there are uncontrolled facial movements and sometimes jerking or twisting movements of other body parts. This condition usually develops after several years of taking antipsychotic medications and more predominantly in older adults. Tardive dyskinesia affects 15 to 20 percent of people taking conventional antipsychotic medications. The risk of developing tardive dyskinesia is lower for people taking the newer antipsychotics. Tardive dyskinesia can be treated with additional medications or by lowering the dosage of the antipsychotic if possible.
- Clozapine was the first atypical antipsychotic in the United States and seems to be one of the most effective medications, particularly for people who have not responded well to other medications. However, in some people it has a serious side effect of lowering the number of white blood cells produced. People taking clozapine must have their blood monitored every one or two weeks to count the number of white blood cells in the bloodstream. For this reason clozapine is usually the last atypical antipsychotic prescribed, and is usually used as a last line treatment for people that do not respond well to other medications or have frequent relapses.