Bipolar Disorder

Once known as manic-depressive illness or manic depression, this psychiatric disorder affects mood, energy, concentration and the ability to function. The disorder is evident when there is a distinct mood shift from elation to hopelessness. When the manic periods are less severe, they are known as hypomanic episodes.

To date, there are three types of bipolar disorder: bipolar I disorder, bipolar II disorder and cyclothymic disorder.

Types of Disorders

Bipolar I Disorder

The length of clear manic episodes is at least seven days and requires hospitalization. Depressive episodes last around two weeks. Depressive and manic symptoms can occur alongside each other.

Bipolar II Disorder

Unlike bipolar I disorder, this type is typically characterized by depressive and hypomanic episodes. These are called episodes with mixed features. Full-blown manic episodes do not define this disorder.

Cyclothymic Disorder

Also known as cyclothymia, this type of disorder widely varies. It is defined by periods of hypomanic symptoms and periods of depressive symptoms lasting for at least two years. In adolescents and children, they must last for one year. Symptoms do not meet the diagnostic requirements for hypomanic and depressive episodes.

Diagnosis and Treatment

Only a doctor or licensed healthcare provider can properly diagnose these disorders. Physical exams and other medical tests will be performed to ensure there is not another underlying or presenting condition. A mental health evaluation will then be completed. Diagnosis by a mental healthcare provider is usually based on symptoms, lifetime/family history and experiences.

Major Depressive Disorder

Major depressive disorder (MDD) is rooted in genetic, biological, environmental and psychological factors. While this disorder usually presents itself in adulthood, sometimes after a major illness, it can show up in children and adolescents as irritability rather than low mood. In adults, MDD can be caused by medications used to treat a medical condition. All cases, even the most severe, can be successfully treated. The sooner a patient is diagnosed, the easier the disorder is to treat.

There are five forms of presentation: persistent depressive disorder (dysthymia), postpartum disorder, psychotic depression, seasonal affective disorder and bipolar disorder.

Types of Presentations

Persistent Depressive Disorder (dysthymia)

Persistent depressive disorder is a low mood that can span the length of two years. A patient may have major depressive episodes and periods of less severe symptoms. To be diagnosed with this disorder, symptoms must last for two years.

Postpartum Disorder

Postpartum goes beyond the typical baby blues characterized by mild depression and anxiety symptoms that usually clear up two weeks after birth. With this disorder, patients experience a major depression pre- or postpartum. This experience is marked by sadness, anxiety and exhaustion. Given the severity of these symptoms, patients have trouble caring for themselves and their offspring.

Psychotic Depression

Psychotic depression is an unfortunate combination of severe depression and psychosis, with delusions and hallucinations.

Seasonal Affective Disorder

Seasonal affective disorder usually occurs during the winter months when there is a lack of sunshine. Symptoms include social isolation, sleeping too much and weight gain. This disorder can occur every year during the onset of the colder months.

Bipolar Disorder

Bipolar disorder is not the same as depression, but is included with MDD for the periods of morbidly low moods that are similar to the benchmarks of major depression.

Diagnosis and Treatment

Depression, even in the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Treatment includes medications and psychotherapy separately or in tandem. However, if the patient is not progressing, electroconvulsive therapy and similar brain stimulation therapies can be explored. Antidepressants may improve the way the brain sends out signals to control mood and stress. Doctors may try several antidepressants at varying doses to manage symptoms and side effects. These medications are to be taken for two to four weeks before the effectiveness can be assessed. If the patient would like to get off the medication after six months to a year, a doctor should monitor them to prevent withdrawal symptoms.

Psychotherapy is a valuable tool when dealing with depression, including cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. Brain stimulation therapies are a solid alternative when medication and therapy do not produce the desired results, or when a first-line intervention is needed. Electroconvulsive therapy (ECT) can be performed on an outpatient basis as a series of sessions.

Anxiety Disorder

Life can make anyone anxious. Traffic, school exams and stressful decisions can make someone doubt their abilities to an extreme degree. However, these feelings of dread usually pass. A patient with anxiety may never feel at ease and may even develop worsening symptoms. The impact of these symptoms can be observed when performing daily activities, including work, school and social interactions.

Anxiety disorders fall into the categories of generalized anxiety disorder, panic disorder, and a multitude of phobia-related disorders.

Types of Disorders

Generalized Anxiety

Generalized anxiety disorder expresses itself through an unreasonable amount of worry every day for at least six months. These worries can include everyday life circumstances, such as work, health and social interactions. Those that suffer from this disorder may feel on edge and experience unsatisfying sleep, irritability, difficulty concentrating and uncontrollable worry.

Panic Disorder

Panic disorder is the unexpected or triggered reoccurrence of sudden periods of overwhelming fear that peaks within minutes. The sufferer may experience feelings of doom, heart palpitations, smothering sensations and a feeling of being out of control. These attacks are so distressing many self-isolate to save themselves the embarrassment of someone witnessing them. Some may develop agoraphobia as a result.

Phobias

Phobias are the avoidance of certain objects or situations. These may be common fears, such as snakes, or flying. The fear generally outweighs the degree of danger truly presented. Sufferers may develop irrational behaviors to cope with the overwhelming anxiety.

Sufferers of social phobia have an intense fear of social or performance situations. They excessively worry that others will negatively evaluate them to great embarrassment based on their actions and behaviors.

Agoraphobia is the intense fear of using public transportation, being in open or enclosed spaces, being part of a crowd or being left outside of the house by oneself. Many fear the loss of control and being ridiculed for suffering a panic attack.

Separation anxiety disorder is not just for children. Adults can deeply fear being separated from those who give them comfort and/or their attachment figures. Many will avoid being alone for that reason, have trouble sleeping due to nightmares, and experience distressing physical symptoms when thoughts occur about unexpected or anticipated separation.

Diagnosis and Treatment

A combination of psychotherapy and medication are used to treat anxiety disorders. Therapy must be customized to each patient’s specific worries and needs. Cognitive behavioral therapy teaches new ways/approaches to thinking, behaving, socializing and reacting to triggers. Exposure therapy works in the same way. This type of therapy allows patients to confront plaguing anxieties by engaging in fearing-inducing situations or guided relaxation exercises. Medication can relieve the symptoms of anxiety. These include benzodiazepines, antidepressants and beta-blockers.

Schizophrenia

Schizophrenia is a complicated mental disorder that cannot be cured. Many sufferers of schizophrenia seem to have lost touch with reality and exhibit signs of extreme confusion or paranoia. This chronic and severe mental disorder impacts thinking, feeling and behavior. While relatively uncommon, the symptoms can be disabling and alarming to those who do not fully understand this disorder. Onset usually occurs between 16 and 30 years of age. Although rare, children can have schizophrenia and must deal with symptoms that will last the rest of their life.

Symptoms

Symptoms are broken down into positive, negative and cognitive. As an important note.

Positive symptoms refer to the ability to feel. Positive symptoms are characterized by the departure from reality that includes hallucinations, delusions, and thought and movement disorders.

Negative symptoms are focused upon a specific numbness. Negative symptoms include disassociation from normal emotions, producing a flat affect that reduces feelings of enjoyment, speaking and sustaining activities.

Cognitive symptoms can be subtle or severe, depending on the patient. Symptoms include decreased thinking and memory retention. Many have trouble understanding information and using it upon learning something new. Making decisions and focusing are a challenge. Many sufferers benefit from being in group homes where caregivers can ensure safety and relative good health.

Diagnosis and Treatment

The cause of schizophrenia is unknown, making its treatment somewhat of a challenge. Eliminating and reducing symptoms is the general focus of treatments. Antipsychotics can be given as pills, liquids or injections. After the patient and doctor have found a suitable medication and dose, they may explore psychosocial treatments. These treatments focus on learning coping skills so patients may work or go to school. They also prevent relapses and hospitalization. Coordinated specialty care blends medication, psychosocial therapies and family involvement.

Psychosis

Psychosis is the term used to describe a state in which the sufferer has lost their sense of reality. These periods of illness are called psychotic episodes and must be handled by an experienced mental health professional. The patient may suffer from delusions and hallucinations of extreme distress to themselves and others. Speech may be incoherent, and there may be marked inappropriate behavior, such as screaming in public places and clothing removal.

Symptoms

Early symptoms include a shift in school and work performance, sudden trouble concentrating, new, odd or zero feelings. If the patient has a significant drop in hygiene or can no longer distinguish between fantasy and reality, a psychotic episode may be imminent.

Milder symptoms that can impair everyday function can include depression, anxiety, trouble falling or staying asleep, isolation and hopelessness. From the onset of psychotic symptoms to the start of treatment is called the duration of untreated psychosis (DUP).

Diagnosis and Treatment

Treatment should be administered as soon as symptoms appear. While that is not always possible, the earlier the treatment, the greater the chance the sufferer will have a full life after recovery. There is no guarantee that psychotic symptoms will never return. It is not currently possible to specify the root of psychosis. It may be a symptom of other mental illnesses, such as bipolar disorder or schizophrenia. In some cases, severe sleep deprivation, medication, medical conditions or substance abuse may cause psychosis. The diagnosis can only be made through psychologists, psychiatrists, or trained social workers.

Antipsychotic medications are used to treat psychotic episodes.

Insomnia

Many people around the world experience a night or two of unsatisfying or broken sleep. These nights can appear in times of severe stress or poor health. While many may claim to suffer from insomnia, the condition is actually quite complicated and could require medication. True insomnia is marked by the challenge of falling and/or staying asleep. Nighttime can evoke a sense of dread and add to the sense of pressure that the sufferer should be sleeping well but isn’t. These sleepless nights can result in low energy, poor concentration, mood instability and a shift in work or job performance.

What sets insomnia apart from a few nights of poor sleep is the duration.

Acute insomnia is a few nights of troubled sleep, perhaps even a week. These nights usually have a trigger, such as bad news or a loss of some degree. This is a sleep disruption rather than an ongoing condition. For a person to be considered a sufferer of insomnia, they must have at least three nights a week for at least three months of unsatisfying sleep. These nights can be the result of clinical disorders, shift work or certain medications. Insomnia is said to be comorbid when it is linked to certain medical or psychiatric medications that have led to a three month or longer period of poor sleep quality.

Diagnosis and Treatment

Treatment can include a potent combination of behavioral, psychological and medical elements. Doctors may adjust the doses of medications to see if that helps with sleep quality.

ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common disorder that is characterized by the sufferer’s inconsistent ability to focus and be composed. Often, this disorder can negatively impact function in adults and development in children. The disorder is marked by inattention, hyperactivity, and impulsivity. As a person ages, their symptoms will, too. Any of the three symptoms of inattention, hyperactivity or impulsivity may become more prominent and last into adulthood.

Types of Disorders

Inattention

Inattention is characterized by lack of persistence and focus when attempting to complete a task. The sufferer may also be disorganized, and their inability to concentrate is not caused by defiance or lack of understanding of the task.

Hyperactivity

Hyperactivity is when a sufferer compulsively moves around when it is not appropriate for the situation. Movements can include fidgeting, tapping and excessive talking.

Impulsivity

Impulsivity means the sufferer cannot control their fight or flight reflex. They may also seek immediate gratification through hasty actions without thinking of the long-term consequences.

Diagnosis and Treatment

There is currently no cure for ADHD. With the right treatment, symptoms can be reduced to increase functioning. Options include medication, psychotherapy and training. All these treatments can be combined. With the right dose of medication, children and adults can focus on learning and performing the tasks in front of them. Stimulants may be used to increase dopamine and norepinephrine levels. These chemicals are essential for thinking and attention. Stimulants may decrease the appetite and increase anxiety. Non-stimulant medications are also available if other health conditions are not compatible with prescription stimulants. However, these types of medications can take longer to work.

An antidepressant might also be prescribed by itself or in combination with a stimulant. These work best in children and adults with pre-existing anxiety. ADHD can negatively impact the family dynamic. Behavioral therapy can help change the behavior of children and adults in supportive sessions. This type of therapy can give sufferers ways to monitor their behavior, acquire positive coping skills and award praise when choosing more positive thoughts and actions.

Post-Traumatic Stress Disorder

Returning to normal life after a dangerous or shocking event is a complicated process. Post-traumatic stress disorder (PTSD) can result when fear becomes overwhelming and the fight or flight reflex is easily triggered. The brain naturally wants to protect the body from harm. Many who experience traumatic events will be able to recover on their own, generally after a six-month period. Over time, the stress associated with the event will not be easily triggered. However, some may not. Those who do not will be diagnosed with PTSD.

Symptoms

Symptoms can occur as soon as three months after the event. Some sufferers may not feel the effects until years afterward. To be diagnosed with PTSD, symptoms must last longer than a month and interfere with normal functioning, such as at work or in relationships. Sufferers must have at least one re-experiencing and avoidant symptom, two arousal and reactivity symptoms, and two cognition and mood symptoms. Re-experiencing symptoms include flashbacks, nightmares and intrusive thoughts. Avoidance symptoms include isolating to avoid memory triggers, related thoughts and feelings about the traumatic event. Arousal and reactivity symptoms include being easily startled, feeling tense, difficulty sleeping and having unprovoked outbursts quite frequently. Cognition and mood symptoms include not being able to perfectly recall the traumatic event, feelings of doom about oneself and the world, unnecessary feelings of guilt or blame, and loss of interest in once enjoyable activities. PTSD may be followed by depression, addiction issues and anxiety disorders.

Diagnosis and Treatment

Medication and psychotherapy work well separately or together to treat PTSD. Antidepressants may help alleviate the fear and numbness associated with this condition. Psychotherapy involves talking to a mental health professional in a group or one-on-one session. Talking through these complicated feelings can last from six to 12 weeks. Some patients need more time to learn how to cope with and manage PTSD symptoms. Therapists can explore exposure therapy to face and control their fear, and cognitive restructuring to understand and overcome traumatic memories.

Dementia

Contrary to the common belief that dementia is a normal part of aging, it is not. Dementia is the result of a lifetime of physical diseases that have negatively impacted the nerve cells of the brain. Symptoms may not show up until much later in life. The sufferer will experience a shift in intelligence, mood and their perception of the world. Dementia is a group of thinking and social symptoms that impair daily functioning. There is not a specific cause for dementia.

It is a group of conditions that impair at least two vital brain functions, such as memory loss and judgment. Alzheimer’s disease is the most common form of dementia. The hippocampus, the part of the brain that controls memory and navigation, is negatively impacted during the onset of Alzheimer’s disease. Sufferers may repeat themselves, incorrectly remember their own name or get lost driving in their own neighborhood.

The four main diseases that cause dementia are frontotemporal dementia, dementia with Lewy bodies, vascular dementia and Alzheimer’s disease.

Symptoms

A diagnosis can only be made with lab tests and imaging. Common symptoms include memory loss, confusion, personality changes, communication difficulties and reasoning challenges. Symptoms may grow more noticeable at night. Each case of dementia is unique, as the areas of the brain that are affected by past physical diseases can vary.

Diagnosis and Treatment

Treatments focus on adjusting or harnessing the power of certain brain chemicals. Medications include cholinesterase inhibitors to improve memory retention and retrieval, such as Donepezil and Galantamine. Memantine is a NMDA receptor antagonist that works to improve memory and learning. Antidepressants might also be prescribed to improve low mood and irritability. In extreme cases, antipsychotics might be prescribed to treat severe cases of paranoia, hallucinations, agitation and delusions. Patients can attend therapy sessions that focus on cognition.

Cognitive Disorders

When a patient experiences an interruption or loss of normal brain functioning and processes, they may be diagnosed with cognitive disorders. Dementia, delirium and amnesia are all cognitive disorders.

Types of Disorders

Delirium

Delirium is a disruption of sound mental abilities that results in confused thinking and a decrease in situational awareness. Unlike dementia, delirium can be evident for hours or days. Delirium can be the result of severe or chronic illness, intoxication, withdrawal or infections. Sufferers will not be able to stay on topic and may get stuck on ideas. They may be disoriented, rambling or hallucinating.

Amnesia

Amnesia occurs after major surgery or an accident. Also known as amnestic syndrome, sufferers may experience great challenges in learning new information and forming new memories. Some types of amnesia are permanent.

Types of Disorders

There is no cure for dementia. Treatments focuses on adjusting or harness the power of certain brain chemicals. Medications include cholinesterase inhibitors to improve memory retention and retrieval, these include Donepezil and Galantamine. Memantine is a NMDA receptor antagonist that works to improve memory and learning. Antidepressants might also be prescribed to improve low mood and irritability. The first step in treating delirium is to identify and stop the underlying triggers, including medications and infections. The second step is to give the patient an opportunity to rest. This can include a hospital stay if the delirium is accompanied by violence or uninterrupted sleep. Amnesia cannot be treated. There are, however, techniques for enhancing memory through mental and physical therapy.

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