Psychiatrists,clinical psychologists & nursing staff work with patients in a secure environment. There is a medical physician available for treatment of
co-morbid medical problems. Specialist’s consultations. e.g. neurology is available as per need.The hospital provides treatment for following illnesses
in a safe and secure environment:
- Bipolar Affective Disorder
- Obsessive Compulsive Disorder
- Generalized Anxiety Disorder
- Post Traumatic Stress Disorder
- Specific Phobias
- Social Phobias
- Treatment Of Depression & Anxiety Spectrum Disorder
- Attention Deficit Hyperactivity Disorder
- Schizophrenia And Other Psychotic Disorders
What is bipolar disorder?
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood,
energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different
from the normal ups and downs that everyone goes through from time to time.
Bipolar disorder symptoms can result in damaged
relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this
illness can lead full and productive lives.Bipolar disorder often develops in a person's late teens or early adult years. At least half of all cases start before age 25.
Some people have their first symptoms during childhood, while others may develop symptoms late in life.
Bipolar disorder is not easy to
spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for
years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must
be carefully managed throughout a person's life.
What are the symptoms of bipolar disorder?
People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.
Extreme changes in eneWhat are the symptoms of bipolar disorder?
People with bipolar disorder experience unusually intense
emotional states that occur in distinct periods called "mood episodes." An
overly joyful or overexcited state is called a manic episode, and an extremely
sad or hopeless state is called a depressive episode. Sometimes, a mood episode
includes symptoms of both mania and depression. This is called a mixed state.
People with bipolar disorder also may be explosive and irritable during a mood
Extreme changes in energy, activity, sleep, and behavior go along
with these changes in mood. It is possible for someone with bipolar disorder to
experience a long-lasting period of unstable moods rather than discrete episodes
of depression or mania.A person may be having an episode of bipolar disorder if
he or she has a number of manic or depressive symptoms for most of the day,
nearly every day, for at least one or two weeks. Sometimes symptoms are so
severe that the person cannot function normally at work, school, or home.
Symptoms:- of bipolar disorder are described below.
mania or a manic episode include:
depression or a depressive episode include:
- A long period of feeling "high," or an overly happy or outgoing mood
- Extremely irritable mood, agitation, feeling "jumpy" or "wired."
- Talking very fast, jumping from one idea to another, having racing thoughts
- Being easily distracted
- Increasing goal-directed activities, such as taking on new projects
- Being restless
- Sleeping little
- Having an unrealistic belief in one's abilities
- Behaving impulsively and taking part in a lot of pleasurable,
high-risk behaviors, such as spending sprees, impulsive sex, and impulsive
- A long period of feeling worried or empty
- Loss of interest in activities once enjoyed, including sex.
- Feeling tired or "slowed down"
- aving problems concentrating, remembering, and making decisions
- Being restless or irritable
- Changing eating, sleeping, or other habits
- Thinking of death or suicide, or attempting suicide.
In addition to mania and depression, bipolar disorder can cause a range of moods, as shown on the scale.
One side of the scale includes severe depression, moderate depression, and mild low mood. Moderate depression may
cause less extreme symptoms, and mild low mood is called
dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood.
At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may
have increased energy and activity levels that are not as severe as typical
mania, or he or she may have episodes that last less than a week and do not
require emergency care. A person having a hypomanic episode may feel very good,
be highly productive, and function well. This person may not feel that anything
is wrong even as family and friends recognize the mood swings as possible
bipolar disorder. Without proper treatment, however, people with hypomania may
develop severe mania or depression.
During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal
thinking. People in a mixed state may feel very sad or hopeless while feeling
Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations
or delusions. The psychotic symptoms tend to reflect the person's extreme mood.
For example, psychotic symptoms for a person having a manic episode may include
believing he or she is famous, has a lot of money, or has special powers. In the
same way, a person having a depressive episode may believe he or she is ruined
and penniless, or has committed a crime. As a result, people with bipolar
disorder who have psychotic symptoms are sometimes wrongly diagnosed as having
schizophrenia, another severe mental illness that is linked with hallucinations
People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have
relationship problems, or perform poorly in school or at work. At first, it's
not easy to recognize these problems as signs of a major mental illness.
Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time.
Between episodes, many people with bipolar disorder are free of symptoms, but
some people may have lingering symptoms.
Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of
Mental Disorders, or DSM. According to the DSM, there are four basic types
of bipolar disorder:
1.Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days,
or by manic symptoms that are so severe that the person needs immediate hospital
care. Usually, the person also has depressive episodes, typically lasting at
least two weeks. The symptoms of mania or depression must be a major change from
the person's normal behavior.
2.Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with
hypomanic episodes, but no full-blown manic or mixed episodes.
3.Bipolar Disorder Not Otherwise Specified (BP-NOS)
is diagnosed when a person has symptoms
of the illness that do not meet diagnostic criteria for either bipolar I or II.
The symptoms may not last long enough, or the person may have too few symptoms,
to be diagnosed with bipolar I or II. However, the symptoms are clearly out of
the person's normal range of behavior.
4.Cyclothymic Disorder, or Cyclothymia
, is a mild form of bipolar disorder. People who have cyclothymia have
episodes of hypomania that shift back and forth with mild depression for at
least two years. However, the symptoms do not meet the diagnostic requirements
for any other type of bipolar disorder.
Some people may be diagnosed with
rapid-cycling bipolar disorder. This is when a person has four or more
episodes of major depression, mania, hypomania, or mixed symptoms within a
year.Some people experience more than one episode in a week, or even within one
day. Rapid cycling seems to be more common in people who have severe bipolar
disorder and may be more common in people who have their first episode at a
younger age. One study found that people with rapid cycling had their first
episode about four years earlier, during mid to late teen years, than people
without rapid cycling bipolar disorder.Rapid cycling affects more women than
Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more
severe episodes than when the illness first appeared.Also, delays in getting the
correct diagnosis and treatment make a person more likely to experience
personal, social, and work-related problems.
Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most
cases, treatment can help reduce the frequency and severity of episodes.
What illnesses often co-exist with bipolar disorder?
Substance abuse is very common among people with bipolar disorder, but the reasons for this link are
unclear.Some people with bipolar disorder may try to treat their symptoms with
alcohol or drugs. However, substance abuse may trigger or prolong bipolar
symptoms, and the behavioral control problems associated with mania can result
in a person drinking too much.
Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, also co-occur often among
people with bipolar disorder.Bipolar disorder also co-occurs with attention
deficit hyperactivity disorder (ADHD), which has some symptoms that overlap with
bipolar disorder, such as restlessness and being easily distracted.
People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease,
diabetes, obesity, and other physical illnesses. These illnesses may cause
symptoms of mania or depression. They may also result from treatment for bipolar
Other illnesses can make it hard to diagnose and treat bipolar disorder. People with bipolar disorder should
monitor their physical and mental health. If a symptom does not get better with
treatment, they should tell their doctor.
What are the risk factors for bipolar disorder?
Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no
single cause. Rather, many factors likely act together to produce the illness or
Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person's
chance of developing the illness. Genes are the "building blocks" of heredity.
They help control how the body and brain work and grow. Genes are contained
inside a person's cells that are passed down from parents to children.
Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the
illness, compared with children who do not have a family history of bipolar
disorder. However, most children with a family history of bipolar disorder will
not develop the illness.
Brain structure and functioning
Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar
disorder. Newer brain-imaging tools, such as functional magnetic resonance
imaging (fMRI) and positron emission tomography (PET), allow researchers to take
pictures of the living brain at work. These tools help scientists study the
brain's structure and activity.
Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy
people or people with other mental disorders. For example, one study using MRI
found that the pattern of brain development in children with bipolar disorder
was similar to that in children with "multi-dimensional impairment," a disorder
that causes symptoms that overlap somewhat with bipolar disorder and
schizophrenia.This suggests that the common pattern of brain development may be
linked to general risk for unstable moods.
Learning more about these differences, along with information gained from genetic studies, helps scientists
better understand bipolar disorder. Someday scientists may be able to predict
which types of treatment will work most effectively. They may even find ways to
prevent bipolar disorder.
How is bipolar disorder treated?
To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain
better control of their mood swings and related symptoms. This is also true for
people with the most severe forms of the illness.
Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to
maintain control of bipolar symptoms. An effective maintenance treatment plan
includes medication and psychotherapy for preventing relapse and reducing
1. Mood stabilizing medications are usually the first choice to treat bipolar disorder. In general, people with bipolar
disorder continue treatment with mood stabilizers for years. Except for lithium,
many of these medications are anticonvulsants. Anticonvulsant medications are
usually used to treat seizures, but they also help control moods. These
medications are commonly used as mood stabilizers in bipolar disorder:
- Lithium was the first mood-stabilizing medication approved in the 1970s for treatment of
mania. It is often very effective in controlling symptoms of mania and
preventing the recurrence of manic and depressive episodes.
- Valproic acid or divalproex sodium (Depakote), is
a popular alternative to lithium for bipolar disorder. It is generally as
effective as lithium for treating bipolar disorder.
- More recently, the anticonvulsant lamotrigine received approval for maintenance treatment of
Other anticonvulsant medications, including gabapentin , topiramate , and oxcarbazepine are sometimes prescribed.
No large studies have shown that these medications are more effective
Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken
with other medications. Atypical antipsychotic medications are called "atypical"
to set them apart from earlier medications, which are called "conventional" or
Olanzapine , when given with an antidepressant medication, may help relieve symptoms of severe
mania or psychosis. Olanzapine is also available in an injectable form, which
quickly treats agitation associated with a manic or mixed episode. Olanzapine
can be used for maintenance treatment of bipolar disorder as well, even when a
person does not have psychotic symptoms. However, some studies show that people
taking olanzapine may gain weight and have other side effects that can increase
their risk for diabetes and heart disease. These side effects are more likely in
people taking olanzapine when compared with people prescribed other atypical
- Aripiprazole , like olanzapine, is approved for treatment of a manic or mixed episode.
Aripiprazole is also used for maintenance treatment after a severe or sudden
episode. As with olanzapine, aripiprazole also can be injected for urgent
treatment of symptoms of manic or mixed episodes of bipolar disorder.
- Quetiapine relieves the symptoms of severe and sudden
manic episodes. In that way, quetiapine is like almost all antipsychotics. In
2006, it became the first atypical antipsychotic to also receive FDA approval
for the treatment of bipolar depressive episodes.
- Risperidone and ziprasidone
are other atypical antipsychotics that
may also be prescribed for controlling manic or mixed episodes.
are sometimes used to treat symptoms of depression in bipolar disorder. People with bipolar
disorder who take antidepressants often take a mood stabilizer too. Doctors
usually require this because taking only an antidepressant can increase a
person's risk of switching to mania or hypomania, or of developing rapid cycling
symptoms. To prevent this switch, doctors who prescribe antidepressants for
treating bipolar disorder also usually require the person to take a
mood-stabilizing medication at the same time.
In addition to medication, psychotherapy, or "talk" therapy, can be an
effective treatment for bipolar disorder.It can provide support, education, and
guidance to people with bipolar disorder and their families. Some psychotherapy
treatments used to treat bipolar disorder include:
Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and
Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved
one. This therapy also improves communication and problem-solving.
Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their
daily routines. Regular daily routines and sleep schedules may help protect
against manic episodes.
Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so
they can seek treatment early, before a full-blown episode occurs. Usually done
in a group, psychoeducation may also be helpful for family members and
A licensed psychologist, social worker, or counselor typically provides these therapies. This mental health
professional often works with the psychiatrist to track progress. The number,
frequency, and type of sessions should be based on the treatment needs of each
person. As with medication, following the doctor's instructions for any
psychotherapy will provide the greatest benefit.
Electroconvulsive Therapy (ECT)—For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT)
may be useful. ECT, formerly known as "shock therapy," once had a bad
reputation. But in recent years, it has greatly improved and can provide relief
for people with severe bipolar disorder who have not been able to feel better
with other treatments.
Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does
not consciously feel the electrical impulse administered in ECT. On average, ECT
treatments last from 30–90 seconds. People who have ECT usually recover after
5–15 minutes and are able to go home the same day.
Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of
medications too risky. ECT is a highly effective treatment for severely
depressive, manic, or mixed episodes, but is generally not a first-line
ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side
effects typically clear soon after treatment. People with bipolar disorder
should discuss possible benefits and risks of ECT with an experienced doctor.
—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However,
if sleeplessness does not improve, the doctor may suggest a change in
medications. If the problems still continue, the doctor may prescribe sedatives
or other sleep medications.
People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications,
or supplements they are taking. Certain medications and supplements taken
together may cause unwanted or dangerous effects.
What can people with bipolar disorder expect from treatment?
Bipolar disorder has no cure, but can be effectively treated over the long-term. It is best controlled when
treatment is continuous, rather than on and off. In the STEP-BD study, a little
more than half of the people treated for bipolar disorder recovered over one
year's time. For this study, recovery meant having two or fewer symptoms of the
disorder for at least eight weeks.
However, even with proper treatment, mood changes can occur. In the STEP-BD study, almost half of those who
recovered still had lingering symptoms. These people experienced a relapse or
recurrence that was usually a return to a depressive state.If a person had a
mental illness in addition to bipolar disorder, he or she was more likely to
experience a relapse.Scientists are unsure, however, how these other illnesses
or lingering symptoms increase the chance of relapse. For some people, combining
psychotherapy with medication may help to prevent or delay relapse.
Treatment may be more effective when people work closely with a doctor and talk openly about their concerns
and choices. Keeping track of mood changes and symptoms with a daily life chart
can help a doctor assess a person's response to treatments. Sometimes the doctor
needs to change a treatment plan to make sure symptoms are controlled most
effectively. A psychiatrist should guide any changes in type or dose of
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Depression: When the Blues Don't Go Away
Everyone occasionally feels blue or sad, but these feelings usually pass
within a couple of days. When a person has depression, it interferes with his or
her daily life and routine, such as going to work or school, taking care of
children, and relationships with family and friends. Depression causes pain for
the person who has it and for those who care about him or her.
Depression can be very different in different people or in the same person
over time. It is a common but serious illness. Treatment can help those with
even the most severe depression get better.
What are the symptoms of depression?
- Ongoing sad, anxious or empty feelings
- Feelings of hopelessness
- Feelings of guilt, worthlessness, or helplessness
- Feeling irritable or restless
- Loss of interest in activities or hobbies that were
once enjoyable, including sex
- Feeling tired all the time
- Difficulty concentrating, remembering details, or
difficulty making decisions
- Not able to go to sleep or stay asleep (insomnia); may
wake in the middle of the night, or sleep all the time
- Overeating or loss of appetite
- Thoughts of suicide or making suicide attempts
- Ongoing aches and pains, headaches, cramps or
digestive problems that do not go away.
Can a person have depression and another illness at the same time?
Often, people have other illnesses along with depression. Sometimes other
illnesses come first, but other times the depression comes first. Each person
and situation is different, but it is important not to ignore these illnesses
and to get treatment for them and the depression. Some illnesses or disorders
that may occur along with depression are:
- Anxiety disorders, including post-traumatic stress
disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, social
phobia, and generalized anxiety disorder (GAD);
- Alcohol and other substance abuse or dependence;
- Heart disease, stroke, cancer, HIV/AIDS, diabetes, and
Studies have found that treating depression can help in treating these
When does depression start?
Young children and teens can get depression but it can occur at other ages
also. Depression is more common in women than in men, but men do get depression
too. Loss of a loved one, stress and hormonal changes, or traumatic events may
trigger depression at any age.
Is there help?
There is help for someone who has depression. Even in severe cases,
depression is highly treatable. The first step is to visit a doctor. Your family
doctor or a health clinic is a good place to start. A doctor can make sure that
the symptoms of depression are not being caused by another medical condition. A
doctor may refer you to a mental health professional.
The most common treatments of depression are psychotherapy and medication.
Several types of psychotherapy-or "talk therapy"-can help people with
depression. There are two main types of psychotherapy commonly used to treat
depression: cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT).
CBT teaches people to change negative styles of thinking and behaving that may
contribute to their depression. IPT helps people understand and work through
troubled personal relationships that may cause their depression or make it
For mild to moderate depression, psychotherapy may be the best treatment
option. However, for major depression or for certain people, psychotherapy may
not be enough. For teens, a combination of medication and psychotherapy may work
the best to treat major depression and help keep the depression from happening
again. Also, a study about treating depression in older adults found that those
who got better with medication and IPT were less likely to have depression again
if they continued their combination treatment for at least two years.
Medications help balance chemicals in the brain called neurotransmitters.
Although scientists are not sure exactly how these chemicals work, they do know
they affect a person's mood. Types of antidepressant medications that help keep
the neurotransmitters at the correct levels are:
- SSRIs (selective serotonin reuptake inhibitors)
- SNRIs (serotonin and norepinephrine reuptake inhibitors)
- MAOIs (monoamine oxidase inhibitors)
These different types of medications affect different chemicals in the
Medications affect everyone differently. Sometimes several different types
have to be tried before finding the one that works. If you start taking
medication, tell your doctor about any side effects right away.
For cases in which medication and/or psychotherapy does not help treat
depression, electroconvulsive therapy (ECT) may be useful. ECT, once known as
"shock therapy," formerly had a bad reputation. But in recent years, it has
greatly improved and can provide relief for people with severe depression who
have not been able to feel better with other treatments.
ECT may cause short-term side effects, including confusion, disorientation
and memory loss. But these side effects typically clear soon after treatment.
Research has indicated that after one year of ECT treatments, patients show no
adverse cognitive effects.
Why do people get depression?
There is no single cause of depression. Depression happens because of a
combination of things including:
Genes - some types of depression tend to run in
families. Genes are the "blueprints" for who we are, and we inherit them from
our parents. Scientists are looking for the specific genes that may be involved
Brain chemistry and structure
- when chemicals in the brain are not at the right levels, depression can occur. These
chemicals, called neurotransmitters, help cells in the brain communicate with
each other. By looking at pictures of the brain, scientists can also see that
the structure of the brain in people who have depression looks different than in
people who do not have depression. Scientists are working to figure out why
these differences occur.
Environmental and psychological factors - trauma, loss of a loved one, a difficult relationship, and other stressors can trigger
depression. Scientists are working to figure out why depression occurs in some
people but not in others with the same or similar experiences. They are also
studying why some people recover quickly from depression and others do not.
It was really hard to get out of bed in the morning. I just wanted to hide
under the covers and not talk to anyone. I didn't feel much like eating and I
lost a lot of weight. Nothing seemed fun anymore. I was tired all the time, and
I wsn't sleeping well at night. But I knew I had to keep going because I've got
kids and a job. It just felt so impossible, like nothing was going to change or
I started missing days from work, and a friend noticed that something
wasn't right. She talked to me about the time she had been really depressed and
had gotten help from her doctor. I called my doctor and talked about how I was
feeling. She had me come in for a checkup and gave me the name of a specialist,
who is an expert in treating depression.
Now I'm seeing the specialist on a regular basis for "talk" therapy, which helps me learn
ways to deal with this illness in my everyday life, and I'm taking medicine for
depression. Everything didn't get better overnight, but I find myself more able
to enjoy life and my children.
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“I couldn’t do anything without rituals. They invaded every aspect of my
life. Counting really bogged me down. I would wash my hair three times as
opposed to once because three was a good luck number and one wasn’t. It took me
longer to read because I’d count the lines in a paragraph. When I set my alarm
at night, I had to set it to a number that wouldn’t add up to a ’bad’ number.”
“I knew the rituals didn’t make sense, and I was deeply ashamed of them,
but I couldn’t seem to overcome them until I had therapy.”
“Getting dressed in the morning was tough, because I had a routine, and if
I didn’t follow the routine, I’d get anxious and would have to get dressed
again. I always worried that if I didn’t do something, my parents were going to
die. I’d have these terrible thoughts of harming my parents. That was completely
irrational, but the thoughts triggered more anxiety and more senseless behavior.
Because of the time I spent on rituals, I was unable to do a lot of things that
were important to me.”
People with obsessive-compulsive disorder (OCD) have persistent, upsetting
thoughts (obsessions) and use rituals (compulsions) to control the anxiety these
thoughts produce. Most of the time, the rituals end up controlling them.For
example, if people are obsessed with germs or dirt, they may develop a
compulsion to wash their hands over and over again. If they develop an obsession
with intruders, they may lock and relock their doors many times before going to
bed. Being afraid of social embarrassment may prompt people with OCD to comb
their hair compulsively in front of a mirror-sometimes they get “caught” in the
mirror and can’t move away from it. Performing such rituals is not pleasurable.
At best, it produces temporary relief from the anxiety created by obsessive
Other common rituals are a need to repeatedly check things, touch things
(especially in a particular sequence), or count things. Some common obsessions
include having frequent thoughts of violence and harming loved ones,
persistently thinking about performing sexual acts the person dislikes, or
having thoughts that are prohibited by religious beliefs. People with OCD may
also be preoccupied with order and symmetry, have difficulty throwing things out
(so they accumulate), or hoard unneeded items.
Healthy people also have rituals, such as checking to see if the stove is
off several times before leaving the house. The difference is that people with
OCD perform their rituals even though doing so interferes with daily life and
they find the repetition distressing. Although most adults with OCD recognize
that what they are doing is senseless, some adults and most children may not
realize that their behavior is out of the ordinary.
OCD can be accompanied by
eating disorders, other anxiety disorders, or depression. It strikes men and
women in roughly equal numbers and usually appears in childhood, adolescence, or
early adulthood. One-third of adults with OCD develop symptoms as children, and
research indicates that OCD might run in families.
The course of the disease is quite varied. Symptoms may come and go, ease
over time, or get worse. If OCD becomes severe, it can keep a person from
working or carrying out normal responsibilities at home. People with OCD may try
to help themselves by avoiding situations that trigger their obsessions, or they
may use alcohol or drugs to calm themselves.
OCD usually responds well to treatment with certain medications and/or
exposure-based psychotherapy, in which people face situations that cause fear or
anxiety and become less sensitive (desensitized) to them. New treatment
approaches for people whose OCD does not respond well to the usual therapies
include combination and augmentation
(add-on) treatments, as well as modern techniques such as deep brain
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Generalized Anxiety Disorder (GAD)
“I always thought I was just a worrier. I’d feel keyed up and unable to relax. At times it would come and go,
and at times it would be constant. It could go on for days. I’d worry about what
I was going to fix for a dinner party, or what would be a great present for
somebody. I just couldn’t let something go.”
When my problems were at their worst, I’d miss work and feel just terrible about it. Then I worried that I’d
lose my job. My life was miserable until I got treatment.
“I’d have terrible sleeping problems. There were times I’d wake up wired in the middle of the night. I had
trouble concentrating, even reading the newspaper or a novel. Sometimes I’d feel
a little lightheaded. My heart would race or pound. And that would make me worry
more. I was always imagining things were worse than they really were. When I got
a stomachache, I’d think it was an ulcer.”
People with generalized anxiety disorder (GAD) go through the day filled with exaggerated worry and tension,
even though there is little or nothing to provoke it. They anticipate disaster
and are overly concerned about health issues, money, family problems, or
difficulties at work. Sometimes just the thought of getting through the day
GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months.
People with GAD can’t seem to get rid of their concerns, even though they
usually realize that their anxiety is more intense than the situation warrants.
They can’t relax, startle easily, and have difficulty concentrating. Often they
have trouble falling asleep or staying asleep. Physical symptoms that often
accompany the anxiety include fatigue, headaches, muscle tension, muscle aches,
difficulty swallowing, trembling, twitching, irritability, sweating, nausea,
lightheadedness, having to go to the bathroom frequently, feeling out of breath,
and hot flashes.
When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they
don’t avoid certain situations as a result of their disorder, people with GAD
can have difficulty carrying out the simplest daily activities if their anxiety
GAD affects about 6.8 million American adults, including twice as many women as men. The disorder develops
gradually and can begin at any point in the life cycle, although the years of
highest risk are between childhood and middle age.2 There is evidence
that genes play a modest role in GAD.
Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone. GAD is
commonly treated with medication or cognitive-behavioral therapy, but
co-occurring conditions must also be treated using the appropriate therapies.
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Post Traumatic Stress Disorder
“I was raped when I was 25 years old. For a long time, I spoke about the rape as though it
was something that happened to someone else. I was very aware that it had
happened to me, but there was just no feeling.”
“Then I started having flashbacks. They kind of came over me like a splash of water. I
would be terrified. Suddenly I was reliving the rape. Every instant was
startling. I wasn’t aware of anything around me, I was in a bubble, just kind of
floating. And it was scary. Having a flashback can wring you out.”
“The rape happened the week before Thanksgiving, and I can’t believe the anxiety and fear
I feel every year around the anniversary date. It’s as though I’ve seen a
werewolf. I can’t relax, can’t sleep, don’t want to be with anyone. I wonder
whether I’ll ever be free of this terrible problem.”
Post-traumatic stress disorder (PTSD) develops after a terrifying ordeal that involved physical harm or the
threat of physical harm. The person who develops PTSD may have been the one who
was harmed, the harm may have happened to a loved one, or the person may have
witnessed a harmful event that happened to loved ones or strangers.PTSD was
first brought to public attention in relation to war veterans, but it can result
from a variety of traumatic incidents, such as mugging, rape, torture, being
kidnapped or held captive, child abuse, car accidents, train wrecks, plane
crashes, bombings, or natural disasters such as floods or earthquakes.
People with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they
used to be close), lose interest in things they used to enjoy, have trouble
feeling affectionate, be irritable, become more aggressive, or even become
violent. They avoid situations that remind them of the original incident, and
anniversaries of the incident are often very difficult. PTSD symptoms seem to be
worse if the event that triggered them was deliberately initiated by another
person, as in a mugging or a kidnapping.Most people with PTSD repeatedly relive
the trauma in their thoughts during the day and in nightmares when they sleep.
These are called flashbacks. Flashbacks may consist of images, sounds, smells,
or feelings, and are often triggered by ordinary occurrences, such as a door
slamming or a car backfiring on the street. A person having a flashback may lose
touch with reality and believe that the traumatic incident is happening all over
Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of
the incident but occasionally emerge years afterward. They must last more than a
month to be considered PTSD. The course of the illness varies. Some people
recover within 6 months, while others have symptoms that last much longer. In
some people, the condition becomes chronic.
It can occur at any age, including childhood. Women are more likely to develop PTSD
than men, and there is some evidence that susceptibility to the disorder may run
in families. PTSD is often accompanied by depression, substance abuse, or one or
more of the other anxiety disorders.Certain kinds of medication and certain
kinds of psychotherapy usually treat the symptoms of PTSD very effectively.
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“I’m scared to death of flying, and I never do it anymore. I used to start dreading a
plane trip a month before I was due to leave. It was an awful feeling when that
airplane door closed and I felt trapped. My heart would pound, and I would sweat
bullets. When the airplane would start to ascend, it just reinforced the feeling
that I couldn’t get out. When I think about flying, I picture myself losing
control, freaking out, and climbing the walls, but of course I never did that.
I’m not afraid of crashing or hitting turbulence. It’s just that feeling of
being trapped. Whenever I’ve thought about changing jobs, I’ve had to think,
‘Would I be under pressure to fly?’ These days I only go places where I can
drive or take a train. My friends always point out that I couldn’t get off a
train traveling at high speeds either, so why don’t trains bother me? I just
tell them it isn’t a rational fear.”
A specific phobia is an intense, irrational fear of something that poses little or no actual danger. Some of
the more common specific phobias are centered around closed-in places, heights,
escalators, tunnels, highway driving, water, flying, dogs, and injuries
involving blood. Such phobias aren’t just extreme fear; they are irrational fear
of a particular thing. You may be able to ski the world’s tallest mountains with
ease but be unable to go above the 5th floor of an office building. While adults
with phobias realize that these fears are irrational, they often find that
facing, or even thinking about facing, the feared object or situation brings on
a panic attack or severe anxiety.
They usually appear in childhood or adolescence and tend to persist into adulthood. The causes of specific
phobias are not well understood, but there is some evidence that the tendency to
develop them may run in families.
If the feared situation or feared object is easy to avoid, people with specific phobias may not seek help; but
if avoidance interferes with their careers or their personal lives, it can
become disabling and treatment is usually pursued.
Specific phobias respond very well to carefully targeted psychotherapy.
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Social Phobia (Social Anxiety Disorder)
“In any social situation, I felt fear. I would be anxious before I even left the house, and it would escalate as I
got closer to a college class, a party, or whatever. I would feel sick in my
stomach-it almost felt like I had the flu. My heart would pound, my palms would
get sweaty, and I would get this feeling of being removed from myself and from
“When I would walk into a room full of people, I’d turn red and it would feel like everybody’s eyes were on me. I
was embarrassed to stand off in a corner by myself, but I couldn’t think of
anything to say to anybody. It was humiliating. I felt so clumsy, I couldn’t
wait to get out.”
Social phobia, also called social anxiety disorder, is diagnosed when people become overwhelmingly anxious and
excessively self-conscious in everyday social situations. People with social
phobia have an intense, persistent, and chronic fear of being watched and judged
by others and of doing things that will embarrass them. They can worry for days
or weeks before a dreaded situation. This fear may become so severe that it
interferes with work, school, and other ordinary activities, and can make it
hard to make and keep friends.
While many people with social phobia realize that their fears about being with people are excessive or
unreasonable, they are unable to overcome them. Even if they manage to confront
their fears and be around others, they are usually very anxious beforehand, are
intensely uncomfortable throughout the encounter, and worry about how they were
judged for hours afterward.
Social phobia can be limited to one situation (such as talking to people, eating or drinking, or writing on a
blackboard in front of others) or may be so broad (such as in generalized social
phobia) that the person experiences anxiety around almost anyone other than the
Physical symptoms that often accompany social phobia include blushing, profuse sweating, trembling, nausea, and
difficulty talking. When these symptoms occur, people with social phobia feel as
though all eyes are focused on them.
Women and men are equally likely to develop the disorder, which
usually begins in childhood or early adolescence. There is some evidence that
genetic factors are involved. Social phobia is often accompanied by other
anxiety disorders or depression, and substance abuse may develop if
people try to self-medicate their anxiety.
Social phobia can be successfully treated with certain kinds of psychotherapy or medications
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Treatment Of Depression & Anxiety Disorders
In general depression and anxiety disorders are treated with medication, specific types of psychotherapy, or both.
Treatment choices depend on problem and
the person’s preference. Before treatment begins, a doctor must conduct a
careful diagnostic evaluation to determine whether a person’s symptoms are
caused by a psychiatric disorder or a physical problem. If an anxiety disorder
is diagnosed, the type of disorder or the combination of disorders that are
present must be identified, as well as any coexisting conditions, such as
depression or substance abuse. Sometimes alcoholism, depression, or other
coexisting conditions have such a strong effect on the individual that treating
the anxiety disorder must wait until the coexisting conditions are brought under
People with depression or anxiety disorders who have already received treatment should tell their current doctor
about that treatment in detail. If they received medication, they should tell
their doctor what medication was used, what the dosage was at the beginning of
treatment, whether the dosage was increased or decreased while they were under
treatment, what side effects occurred, and whether the treatment helped them
become less anxious. If they received psychotherapy, they should describe the
type of therapy, how often they attended sessions, and whether the therapy was
Often people believe that they have “failed” at treatment or that the treatment didn’t work for them when, in
fact, it was not given for an adequate length of time or was administered
incorrectly. Sometimes people must try several different treatments or
combinations of treatment before they find the one that works for them.
Medication will not cure anxiety disorders, but it can keep them under control while the person receives
psychotherapy. Medication must be prescribed by physicians, usually
psychiatrists, who can either offer psychotherapy themselves or work as a team
with psychologists, social workers, or counselors who provide psychotherapy. The
principal medications used for anxiety disorders are antidepressants,
anti-anxiety drugs, and beta-blockers to control some of the physical symptoms.
With proper treatment, many people with anxiety disorders can lead normal,
Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these
medications begin to alter brain chemistry after the very first dose, their full
effect requires a series of changes to occur; it is usually about 4 to 6 weeks
before symptoms start to fade. It is important to continue taking these
medications long enough to let them work.
Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the
levels of the neurotransmitter serotonin in the brain, which, like other
neurotransmitters, helps brain cells communicate with one another.
Fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®), and citalopram (Celexa®)
are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and
social phobia. SSRIs are also used to treat panic disorder when it occurs in
combination with OCD, social phobia, or depression. Venlafaxine (Effexor®), a
drug closely related to the SSRIs, is used to treat GAD. These medications are
started at low doses and gradually increased until they have a beneficial
SSRIs have fewer side effects than older antidepressants, but they sometimes produce slight nausea or jitters when
people first start to take them. These symptoms fade with time. Some people also
experience sexual dysfunction with SSRIs, which may be helped by adjusting the
dosage or switching to another SSRI.
Tricyclics are older than SSRIs and work as well as SSRIs for anxiety disorders other than OCD. They are also
started at low doses that are gradually increased. They sometimes cause
dizziness, drowsiness, dry mouth, and weight gain, which can usually be
corrected by changing the dosage or switching to another tricyclic medication.
Tricyclics include imipramine (Tofranil®), which is prescribed for panic disorder and GAD, and clomipramine
(Anafranil®), which is the only tricyclic antidepressant useful for treating
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. The MAOIs most commonly
prescribed for anxiety disorders are phenelzine (Nardil®), followed by
tranylcypromine (Parnate®), and isocarboxazid (Marplan®), which are useful in
treating panic disorder and social phobia. People who take MAOIs cannot eat a
variety of foods and beverages (including cheese and red wine) that contain
tyramine or take certain medications, including some types of birth control
pills, pain relievers (such as Advil®, Motrin®, or Tylenol®), cold and allergy
medications, and herbal supplements; these substances can interact with MAOIs to
cause dangerous increases in blood pressure. The development of a new MAOI skin
patch may help lessen these risks. MAOIs can also react with SSRIs to produce a
serious condition called “serotonin syndrome,” which can cause confusion,
hallucinations, increased sweating, muscle stiffness, seizures, changes in blood
pressure or heart rhythm, and other potentially life-threatening conditions.
High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can
get used to them and may need higher and higher doses to get the same effect,
benzodiazepines are generally prescribed for short periods of time, especially
for people who have abused drugs or alcohol and who become dependent on
medication easily. One exception to this rule is people with panic disorder, who
can take benzodiazepines for up to a year without harm.
Clonazepam (Klonopin®) is used for social phobia and GAD, lorazepam (Ativan®) is helpful for panic disorder, and
alprazolam (Xanax®) is useful for both panic disorder and GAD.
Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off,
and anxiety can return once the medication is stopped. These potential problems
have led some physicians to shy away from using these drugs or to use them in
Buspirone (Buspar®), an azapirone, is a newer anti-anxiety medication used to treat GAD. Possible side effects
include dizziness, headaches, and nausea. Unlike benzodiazepines, buspirone must
be taken consistently for at least 2 weeks to achieve an anti-anxiety effect.
Beta-blockers, such as propranolol (Inderal®), which is used to treat heart conditions, can prevent the physical
symptoms that accompany certain anxiety disorders, particularly social phobia.
When a feared situation can be predicted (such as giving a speech), a doctor may
prescribe a beta-blocker to keep physical symptoms of anxiety under control.
Before taking medication for an anxiety disorder:
- Ask your doctor to tell you about the effects and side effects of the drug.
- Tell your doctor about any alternative therapies or over-the-counter medications you are
Ask your doctor when and how the medication should be stopped. Some drugs can’t be stopped
abruptly but must be tapered off slowly under a doctor’s supervision.
Work with your doctor to determine which medication is right for you and what dosage is best.
- Be aware that some medications are effective only if they are taken regularly and that
symptoms may recur if the medication is stopped.
Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist,
social worker, or counselor, to discover what caused an anxiety disorder and how
to deal with its symptoms.
Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people
change the thinking patterns that support their fears, and the behavioral part
helps people change the way they react to anxiety-provoking situations.
For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks
and help people with social phobia learn how to overcome the belief that others
are always watching and judging them. When people are ready to confront their
fears, they are shown how to use exposure techniques to desensitize themselves
to situations that trigger their anxieties.
People with OCD who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of
time before washing them. The therapist helps the person cope with the anxiety
that waiting produces; after the exercise has been repeated a number of times,
the anxiety diminishes. People with social phobia may be encouraged to spend
time in feared social situations without giving in to the temptation to flee and
to make small social blunders and observe how people respond to them. Since the
response is usually far less harsh than the person fears, these anxieties are
lessened. People with PTSD may be supported through recalling their traumatic
event in a safe situation, which helps reduce the fear it produces. CBT
therapists also teach deep breathing and other types of exercises to relieve
anxiety and encourage relaxation.
Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually
encounters the object or situation that is feared, perhaps at first only through
pictures or tapes, then later face-to-face. Often the therapist will accompany
the person to a feared situation to provide support and guidance.
CBT is undertaken when people decide they are ready for it and with their permission and cooperation. To be
effective, the therapy must be directed at the person’s specific anxieties and
must be tailored to his or her needs. There are no side effects other than the
discomfort of temporarily increased anxiety.
CBT or behavioral therapy often lasts about 12 weeks. It may be conducted individually or with a group of people
who have similar problems. Group therapy is particularly effective for social
phobia. Often “homework” is assigned for participants to complete between
sessions. There is some evidence that the benefits of CBT last longer than those
of medication for people with panic disorder, and the same may be true for OCD,
PTSD, and social phobia. If a disorder recurs at a later date, the same therapy
can be used to treat it successfully a second time.
Medication can be combined with psychotherapy for specific anxiety disorders, and this is the best treatment
approach for many people.
Ways To Make Treatment More Effective
Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance
the effects of therapy. There is preliminary evidence that aerobic exercise may
have a calming effect. Since caffeine, certain illicit drugs, and even some
over-the-counter cold medications can aggravate the symptoms of anxiety
disorders, they should be avoided. Check with your physician or pharmacist
before taking any additional medications.
The family is very important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not
help perpetuate their loved one’s symptoms. Family members should not trivialize
the disorder or demand improvement without treatment
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Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue
through adolescence and adulthood. Symptoms include difficulty staying focused
and paying attention, difficulty controlling behavior, and hyperactivity
ADHD has three subtypes:
Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
o Fewer than six symptoms of inattention are present, although inattention may
still be present to some degree.
- Predominantly inattentive
The majority of symptoms (six or more) are in the inattention category and
fewer than six symptoms of hyperactivity-impulsivity are present, although
hyperactivity-impulsivity may still be present to some degree.
Children with this subtype are less likely to act out or have difficulties
getting along with other children. They may sit quietly, but they are not paying
attention to what they are doing. Therefore, the child may be overlooked, and
parents and teachers may not notice that he or she has ADHD.
- Combined hyperactive-impulsive and inattentivent
o Six or more sySix or more symptoms of inattention and six or more symptoms of
hyperactivity-impulsivity are present.
o Most Children have the combined type of ADHD.
Treatments can relieve many of the disorder symptoms but there is no cure with. Treatment most people with
ADHD can be successful in school and lead productive lives. Researchers are
developing more effective treatments and interventions, and using new tools such
as brain imaging, to better understand ADHD and to find more effective ways to
treat and prevent it.
Symptoms of ADHD in children
Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be
inattentive, hyperactive, or impulsive sometimes, but for children with ADHD,
these behaviors are more severe and occur more often. To be diagnosed with the
disorder, a child must have symptoms for 6 or more months and to a degree that
is greater than other children of the same age.
Children who have symptoms of
Be easily distracted, miss details, forget things, and frequently switch from
one activity to another
Have difficulty focusing on one thing
Become bored with a task after only a few minutes, unless they are doing
Have difficulty focusing attention on organizing and completing a task or
learning something new
Have trouble completing or turning in homework assignments, often losing
things (e.g., pencils, toys, assignments) needed to complete tasks or activities
Not seem to listen when spoken to
Daydream, become easily confused, and move slowly
Have difficulty processing information as quickly and accurately as others
Struggle to follow instructions.
Children who have symptoms of
Fidget and squirm in their seats
Dash around, touching or playing with anything and everything in sight
Have trouble sitting still during dinner, school, and story time
Have difficulty doing quiet tasks or activities.
Children who have symptoms of
Blurt out inappropriate comments, show their emotions without restraint, and
act without regard for consequences
Have difficulty waiting for things they want or waiting their turns in games
ADHD Can Be Mistaken for Other Problems
Parents and teachers can miss the fact that children with symptoms of inattention have the
disorder because they are often quiet and less likely to act out. They may sit
quietly, seeming to work, but they are often not paying attention to what they
are doing. They may get along well with other children, compared with those with
the other subtypes, who tend to have social problems. But children with the
inattentive kind of ADHD are not the only ones whose disorders can be missed.
For example, adults may think that children with the hyperactive and impulsive
subtypes just have emotional or disciplinary problems.
Causes of ADHD
Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like
many other illnesses, ADHD probably results from a combination of factors. In
addition to genetics, researchers are looking at possible environmental factors,
and are studying how brain injuries, nutrition, and the social environment might
contribute to ADHD.
Genes. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several
genes that may make people more likely to develop the disorder.
Environmental factors. Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children. In addition,
preschoolers who are exposed to high levels of lead, which can sometimes be
found in plumbing fixtures or paint in old buildings, may have a higher risk of
Brain injuries. Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of
children with ADHD have suffered a traumatic brain injury.
Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than
supports it. In one study, researchers gave children foods containing either
sugar or a sugar substitute every other day. The children who received sugar
showed no different behavior or learning capabilities than those who received
the sugar substitute. Another study in which children were given higher than
average amounts of sugar or sugar substitutes showed similar results.
Food additives. Recent British research indicates a possible link between consumption of certain food additives like artificial colors or
preservatives, and an increase in activity. Research is under way to confirm the
findings and to learn more about how food additives may affect hyperactivity.
How is ADHD diagnosed?
Children mature at different rates and have different personalities, temperaments, and energy levels. Most
children get distracted, act impulsively, and struggle to concentrate at one
time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD
symptoms usually appear early in life, often between the ages of 3 and 6, and
because symptoms vary from person to person, the disorder can be hard to
diagnose. Parents may first notice that their child loses interest in things
sooner than other children, or seems constantly "out of control." Often,
teachers notice the symptoms first, when a child has trouble following rules, or
frequently "spaces out" in the classroom or on the playground.
No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather
information about the child, and his or her behavior and environment. A family
may want to first talk with the child's pediatrician. Some pediatricians can
assess the child themselves, but many will refer the family to a mental health
specialist with experience in childhood mental disorders such as ADHD. The
pediatrician or mental health specialist will first try to rule out other
possibilities for the symptoms. For example, certain situations, events, or
health conditions may cause temporary behaviors in a child that seem like ADHD.
Between them, Between them, the referring pediatrician and specialist will determine if a child:
- Is experiencing undetected seizures that could be associated with other
- Has a middle ear infection that is causing hearing problems
- Has any undetected hearing or vision problems
- Has any medical problems that affect thinking and behavior
- Has any learning disabilities
- Has anxiety or depression, or other psychiatric problems that might cause
- Has been affected by a significant and sudden change, such as the death of a
family member, a divorce, or parent's job loss.
Specialist will also check school and medical records for clues, to see if the child's home or school
settings appear unusually stressful or disrupted, and gather information from
the child's parents and teachers. Coaches, babysitters, and other adults who
know the child well also may be consulted.
The specialist also will ask:
- Are the behaviors excessive and long-term, and do they affect all aspects of
the child's life?
- Are the behaviors a continuous problem or a response to a temporary situation?
- Do the behaviors occur in several settings or only in one place, such as the
playground, classroom, or home?
The specialist pays close attention to the child's behavior during different situations. Some situations are
highly structured, some have less structure. Others would require the child to
keep paying attention. Most children with ADHD are better able to control their
behaviors in situations where they are getting individual attention and when
they are free to focus on enjoyable activities. These types of situations are
less important in the assessment. A child also may be evaluated to see how he or
she acts in social situations, and may be given tests of intellectual ability
and academic achievement to see if he or she has a learning disability.a learning disability.
Finally, if after gathering all this information the child meets the criteria for ADHD, he or she will be
diagnosed with the disorder.
How is ADHD treated?
Currently available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments
include medication, various types of psychotherapy, education or training, or a
combination of treatments.
The most common type of medication used for treating ADHD is called a "stimulant." Although it may seem
unusual to treat ADHD with a medication considered a stimulant, it actually has
a calming effect on children with ADHD. Many types of stimulant medications are
available. A few other ADHD medications are non-stimulants and work differently
than stimulants. For many children, ADHD medications reduce hyperactivity and
impulsivity and improve their ability to focus, work, and learn. Medication also
may improve physical coordination.
However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child
might not work for another. One child might have side effects with a certain
medication, while another child may not. Sometimes several different medications
or dosages must be tried before finding one that works for a particular child.
Any child taking medications must be monitored closely and carefully by
caregivers and doctors.
Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some
medications also come in short-acting, long-acting, or extended release
varieties. In each of these varieties, the active ingredient is the same, but it
is released differently in the body. Long-acting or extended release forms often
allow a child to take the medication just once a day before school, so they
don't have to make a daily trip to the school nurse for another dose. Parents
and doctors should decide together which medication is best for the child and
whether the child needs medication only for school hours or for evenings and
Does medication cure ADHD?
Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken.
Medications can help a child pay attention and complete schoolwork. It is not
clear, however, whether medications can help children learn or improve their
academic skills. Adding behavioral therapy, counseling, and practical support
can help children with ADHD and their families to better cope with everyday
problems. Research has shown that medication works best when treatment is
regularly monitored by the prescribing doctor and the dose is adjusted based on
the child's needs.
Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child change his or her
behavior. It might involve practical assistance, such as help organizing tasks
or completing schoolwork, or working through emotionally difficult events.
Behavioral therapy also teaches a child how to monitor his or her own behavior.
Learning to give oneself praise or rewards for acting in a desired way, such as
controlling anger or thinking before acting, is another goal of behavioral
therapy. Parents and teachers also can give positive or negative feedback for
certain behaviors. In addition, clear rules, chore lists, and other structured
routines can help a child control his or her behavior.
Therapists may teach children social skills, such as how to wait their turn, share toys, ask for help, or
respond to teasing. Learning to read facial expressions and the tone of voice in
others, and how to respond appropriately can also be part of social skills
How can parents help?
Children with ADHD need guidance and understanding from their parents and teachers to reach their full
potential and to succeed in school. Before a child is diagnosed, frustration,
blame, and anger may have built up within a family. Parents and children may
need special help to overcome bad feelings. Mental health professionals can
educate parents about ADHD and how it impacts a family. They also will help the
child and his or her parents develop new skills, attitudes, and ways of relating
to each other.
Parenting skills training helps parents learn how to use a system of rewards and consequences to change a
child's behavior. Parents are taught to give immediate and positive feedback for
behaviors they want to encourage, and ignore or redirect behaviors they want to
discourage. In some cases, the use of "time-outs" may be used when the child's
behavior gets out of control. In a time-out, the child is removed from the
upsetting situation and sits alone for a short time to calm down.
Parents are also encouraged to share a pleasant or relaxing activity with the child, to notice and point out
what the child does well, and to praise the child's strengths and abilities.
They may also learn to structure situations in more positive ways. For example,
they may restrict the number of playmates to one or two, so that their child
does not become overstimulated. Or, if the child has trouble completing tasks,
parents can help their child divide large tasks into smaller, more manageable
steps. Also, parents may benefit from learning stress-management techniques to
increase their own ability to deal with frustration, so that they can respond
calmly to their child's behavior.
Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle
disruptive behaviors and to encourage behavior changes. Finally, support groups
help parents and families connect with others who have similar problems and
concerns. Groups often meet regularly to share frustrations and successes, to
exchange information about recommended specialists and strategies, and to talk
Tips to Help Kids Stay Organized and Follow Directions
Schedule. Keep the same routine every day, from wake-up time to bedtime. Include time
for homework, outdoor play, and indoor activities. Keep the schedule on the
refrigerator or on a bulletin board in the kitchen. Write changes on the
schedule as far in advance as possible.
Organize everyday items. Have a place for everything, and keep everything in its place. This
includes clothing, backpacks, and toys.
Use homework and notebook organizers.
Use organizers for school material and supplies. Stress to your child the
importance of writing down assignments and bringing home the necessary books.
Be clear and consistent. Children with ADHD need consistent rules they can understand and follow.
Give praise or rewards when rules are followed.
Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
What conditions can coexist with ADHD?
Some children with ADHD also have other illnesses or conditions. For
example, they may have one or more of the following:
A learning disability
A child in preA child in preschool with a learning disability may have difficulty
. A child in preschool with a learning disability may have difficulty
understanding certain sounds or words or have problems expressing himself or
herself in words. A school-aged child may struggle with reading, spelling,
writing, and math.
Oppositional dOppositional defiant disorder Kids with this condition, in which a child is overly stubborn or rebellious,
often argue with adults and refuse to obey rules.
- Has a middle ear infection that is causing hearing problems
Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight,
or bully others. He or she may destroy property, break into homes, or carry or
use weapons. These children or teens are also at a higher risk of using illegal
substances. Kids with conduct disorder are at risk of getting into trouble at
school or with the police.
Anxiety and depression-
Treating ADHD may help to decrease anxiety or some forms of
Some children with ADHD may also have this condition in which extreme mood
swings go from mania (an extremely high elevated mood) to depression in short
periods of time
Very few children have this brain disorder, but among those who do, many
also have ADHD. Some people with Tourette syndrome have nervous tics and
repetitive mannerisms, such as eye blinks, facial twitches, orgrimacing.
Others clear their throats, snort, or sniff frequently,
or bark out words inappropriately. These behaviors can be controlled with medication.
Recognizing ADHD symptoms and seeking help early will lead to better outcomes for both affected children and
Can adults have ADHD?
Some children with ADHD continue to have it as adults. And many adults who have the disorder don't know it.
They may feel that it is impossible to get organized, stick to a job, or
remember and keep appointments. Daily tasks such as getting up in the morning,
preparing to leave the house for work, arriving at work on time, and being
productive on the job can be especially challenging for adults with ADHD.
These adults may have a history of failure at school, problems at work, or difficult or failed relationships.
Many have had multiple traffic accidents. Like teens, adults with ADHD may seem
restless and may try to do several things at once, most of them unsuccessfully.
They also tend to prefer "quick fixes," rather than taking the steps needed to
achieve greater rewards.
How is ADHD diagnosed in adults?
Like children, adults who suspect they have ADHD should be evaluated by a licensed mental health professional.
But the professional may need to consider a wider range of symptoms when
assessing adults for ADHD because their symptoms tend to be more varied and
possibly not as clear cut as symptoms seen in children.
To be diagnosed with the condition, an adult must have ADHD symptoms that began in childhood and continued
throughout adulthood.Health professionals use certain rating scales to determine
if an adult meets the diagnostic criteria for ADHD. The mental health
professional also will look at the person's history of childhood behavior and
school experiences, and will interview spouses or partners, parents, close
friends, and other associates. The person will also undergo a physical exam and
various psychological tests.
For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have had the disorder since
childhood, but who have not been diagnosed, may have developed negative feelings
about themselves over the years. Receiving a diagnosis allows them to understand
the reasons for their problems, and treatment will allow them to deal with their
problems more effectively.
How is ADHD treated in adults?
Much like children with the disorder, adults with ADHD are treated with medication, psychotherapy, or a
combination of treatments.
Medications. ADHD medications, including extended-release forms, often are prescribed for adults with ADHD, but not all of these medications
are approved for adults.However, those not approved for adults still may be
prescribed by a doctor on an "off-label" basis.
Although not FDA-approved specifically for the treatment of ADHD, antidepressants are sometimes used to treat
adults with ADHD. Older antidepressants, called tricyclics, sometimes are used
because they, like stimulants, affect the brain chemicals norepinephrine and
dopamine. A newer antidepressant, venlafaxine (Effexor), also may be prescribed
for its effect on the brain chemical norepinephrine. And in recent clinical
trials, the antidepressant bupropion (Wellbutrin), which affects the brain
chemical dopamine, showed benefits for adults with ADHD.
Adult prescriptions for stimulants and other medications require special considerations. For example, adults
often require other medications for physical problems, such as diabetes or high
blood pressure, or for anxiety and depression. Some of these medications may
interact badly with stimulants. An adult with ADHD should discuss potential
medication options with his or her doctor. These and other issues must be taken
into account when a medication is prescribed.
Education and psychotherapy. A professional counselor or therapist can help an adult with ADHD learn how
to organize his or her life with tools such as a large calendar or date book,
lists, reminder notes, and by assigning a special place for keys, bills, and
paperwork. Large tasks can be broken down into more manageable, smaller steps so
that completing each part of the task provides a sense of accomplishment.
Psychotherapy, including cognitive behavioral therapy, also can help change one's poor self-image by examining
the experiences that produced it. The therapist encourages the adult with ADHD
to adjust to the life changes that come with treatment, such as thinking before
acting, or resisting the urge to take unnecessary risks.
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Schizophrenia is a chronic, severe, and disabling brain disorder that has affected people throughout
history. About 1 percent of people
have this illness.
People with the disorder may hear voices other people don't hear. They may believe other people are
reading their minds, controlling their thoughts, or plotting to harm them. This
can terrify people with the illness and make them withdrawn or extremely
agitated.People with schizophrenia may not make sense when they talk. They may
sit for hours without moving or talking. Sometimes people with schizophrenia
seem perfectly fine until they talk about what they are really thinking.
Families and society are affected by schizophrenia too. Many people with schizophrenia have difficulty holding
a job or caring for themselves, so they rely on others for help.
Treatment helps relieve many symptoms of schizophrenia, but most people who have the disorder cope with
symptoms throughout their lives. However, many people with schizophrenia can
lead rewarding and meaningful lives in their communities. Researchers are
developing more effective medications and using new research tools to understand
the causes of schizophrenia. In the years to come, this work may help prevent
and better treat the illness.
The symptoms of schizophrenia fall into three broad
categories: positive symptoms, negative symptoms, and cognitive symptoms.
Positive symptoms are psychotic behaviors not seen in healthy people. People with positive symptoms often
"lose touch" with reality. These symptoms can come and go. Sometimes they are
severe and at other times hardly noticeable, depending on whether the individual
is receiving treatment. They include the following:
Hallucinations are things a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common
type of hallucination in schizophrenia. Many people with the disorder hear
voices. The voices may talk to the person about his or her behavior, order the
person to do things, or warn the person of danger. Sometimes the voices talk to
each other. People with schizophrenia may hear voices for a long time before
family and friends notice the problem.Other types of hallucinations include
seeing people or objects that are not there, smelling odors that no one else
detects, and feeling things like invisible fingers touching their bodies when no
one is near.
Delusions are false beliefs that are not part of the person's culture and do not change. The person believes delusions even after other
people prove that the beliefs are not true or logical. People with schizophrenia
can have delusions that seem bizarre, such as believing that neighbors can
control their behavior with magnetic waves. They may also believe that people on
television are directing special messages to them, or that radio stations are
broadcasting their thoughts aloud to others. Sometimes they believe they are
someone else, such as a famous historical figure. They may have paranoid
delusions and believe that others are trying to harm them, such as by cheating,
harassing, poisoning, spying on, or plotting against them or the people they
care about. These beliefs are called "delusions of persecution."
Thought disorders are unusual or dysfunctional ways of thinking. One form of thought disorder is called "disorganized thinking." This is when a
person has trouble organizing his or her thoughts or connecting them logically.
They may talk in a garbled way that is hard to understand. Another form is
called "thought blocking." This is when a person stops speaking abruptly in the
middle of a thought. When asked why he or she stopped talking, the person may
say that it felt as if the thought had been taken out of his or her head.
Finally, a person with a thought disorder might make up meaningless words, or
Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other
extreme, a person may become catatonic. Catatonia is a state in which a person
does not move and does not respond to others. Catatonia is rare today, but it
was more common when treatment for schizophrenia was not available.
"Voices" are the most common type of hallucination in schizophrenia.
Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder
to recognize as part of the disorder and can be mistaken for depression or other
conditions. These symptoms include the following:
- "Flat affect" (a person's face does not move or he or she talks in a dull or
- Lack of pleasure in everyday life
- Lack of ability to begin and sustain planned activities
- Speaking little, even when forced to interact.
People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This
may make them seem lazy or unwilling to help themselves, but the problems are
symptoms caused by the schizophrenia.
Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to recognize as
part of the disorder. Often, they are detected only when other tests are
performed. Cognitive symptoms include the following:
- Poor "executive functioning" (the ability to understand information and use it
to make decisions)
- Trouble focusing or paying attention
Problems with "working memory" (the ability to use information immediately
after learning it).
Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional
Schizophrenia affects men and women equally. It occurs at similar rates in all ethnic groups around the
world.. Schizophrenia rarely occurs in children, but awareness of
childhood-onset schizophrenia is increasing.It can be difficult to diagnose
schizophrenia in teens. This is because the first signs can include a change of
friends, a drop in grades, sleep problems, and irritability—behaviors that are
common among teens. A combination of factors can predict schizophrenia in up to
80 percent of youth who are at high risk of developing the illness. These
factors include isolating oneself and withdrawing from others, an increase in
unusual thoughts and suspicions, and a family history of psychosis. In young
people who develop the disease, this stage of the disorder is called the
People with schizophrenia are not usually violent. In fact, most violent crimes are not committed by people with schizophrenia.However, some symptoms are
associated with violence, such as delusions of persecution. Substance abuse may
also increase the chance a person will become violent.If a person with
schizophrenia becomes violent, the violence is usually directed at family
members and tends to take place at home.
But people with the illness attempt suicide much more often than
others. About 10 percent (especially young adult males) die by suicide. It is
hard to predict which people with schizophrenia are prone to suicide.
Substance abuse can make treatment for schizophrenia less effective. Some drugs, like
marijuana and stimulants such as amphetamines or cocaine, may make symptoms
Schizophrenia and smoking,
Addiction to nicotine is the most common form of substance abuse in people with schizophrenia. They are
addicted to nicotine at three times the rate of the general population (75 to 90
percent vs. 25 to 30 percent).The relationship between smoking and schizophrenia is complex. People with schizophrenia seem to be driven to
smoke, and researchers are exploring whether there is a biological basis for
this need. In addition to its known health hazards, several studies have found
that smoking may make antipsychotic drugs less effective.
Genes and environment. Scientists have long known that schizophrenia runs in families. The illness occurs in 1 percent of the general population, but
it occurs in 10 percent of people who have a first-degree relative with the
disorder, such as a parent, brother, or sister. People who have second-degree
relatives (aunts, uncles, grandparents, or cousins) with the disease also
develop schizophrenia more often than the general population. The risk is
highest for an identical twin of a person with schizophrenia. He or she has a 40
to 65 percent chance of developing the disorder.
Different brain chemistry and structure. Scientists think that an imbalance in the complex, interrelated chemical
reactions of the brain involving the neurotransmitters dopamine and glutamate,
and possibly others, plays a role in schizophrenia. Neurotransmitters are
substances that allow brain cells to communicate with each other. Scientists are
learning more about brain chemistry and its link to schizophrenia.
Because the causes of schizophrenia are still unknown, treatments
focus on eliminating the symptoms of the disease. Treatments include
antipsychotic medications and various psychosocial treatments.
Antipsychotic medications have been available since the mid-1950's. The older types are called conventional or
"typical" antipsychotics. Some of the more commonly used typical medications
In the 1990's, new antipsychotic medications were developed. These new medications are called second
generation, or "atypical" antipsychotics.
One of these medications, clozapine (Clozaril) is an effective medication that treats psychotic symptoms,
hallucinations, and breaks with reality. But clozapine can sometimes cause a
serious problem called agranulocytosis, which is a loss of the white blood cells
that help a person fight infection. People who take clozapine must get their
white blood cell counts checked every week or two. This problem and the cost of
blood tests make treatment with clozapine difficult for many people. But
clozapine is potentially helpful for people who do not respond to other
Other atypical antipsychotics were also developed. None cause agranulocytosis. Examples include:
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
- Paliperidone (Invega).
When a doctor says it is okay to stop taking a medication, it should be
gradually tapered off, never stopped suddenly.
Psychosocial treatments can help people with schizophrenia who are already stabilized on
antipsychotic medication. Psychosocial treatments help these patients deal with
the everyday challenges of the illness, such as difficulty with communication,
self-care, work, and forming and keeping relationships. Learning and using
coping mechanisms to address these problems allow people with schizophrenia to
socialize and attend school and work.
Illness management skills. People with schizophrenia can take an active role in managing their own illness. Once patients learn basic facts about
schizophrenia and its treatment, they can make informed decisions about their
care. If they know how to watch for the early warning signs of relapse and make
a plan to respond, patients can learn to prevent relapses. Patients can also use
coping skills to deal with persistent symptoms.
Integrated treatment for co-occurring substance abuse.
Substance abuse is the most common co-occurring disorder in people with
schizophrenia. But ordinary substance abuse treatment programs usually do not
address this population's special needs. When schizophrenia treatment programs
and drug treatment programs are used together, patients get better results.
Rehabilitation. Rehabilitation emphasizes social and vocational training to help people with schizophrenia function better in their
communities. Because schizophrenia usually develops in people during the
critical career-forming years of life (ages 18 to 35), and because the disease
makes normal thinking and functioning difficult, most patients do not receive
training in the skills needed for a job.
Rehabilitation programs can include job counseling and training, money management counseling, help in learning
to use public transportation, and opportunities to practice communication
skills. Rehabilitation programs work well when they include both job training
and specific therapy designed to improve cognitive or thinking skills. Programs
like this help patients hold jobs, remember important details, and improve their
Family education. People with schizophrenia are often discharged from the hospital into the care of their families. So it is important that
family members know as much as possible about the disease. With the help of a
therapist, family members can learn coping strategies and problem-solving
skills. In this way the family can help make sure their loved one sticks with
treatment and stays on his or her medication. Families should learn where to
find outpatient and family services.
The outlook for people with schizophrenia continues to
improve. Although there is no cure, treatments that work well are available.
Many people with schizophrenia improve enough to lead independent, satisfying
lives.Continued research and understanding in genetics, neuroscience, and
behavioral science will help scientists and health professionals understand the
causes of the disorder and how it may be predicted and prevented. This work will
help experts develop better treatments to help people with schizophrenia achieve
their full potential. Families and individuals who are living with schizophrenia
are encouraged to participate in clinical research
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