1
Q
social stigma
A
key concepts of social stigma is stereotype, prejudice and discrimination
2
Q
stereotype
A
involves a belief or cognition the generalizes a population
3
Q
prejudice
A
having negative affection or emtion towards a population due to stereotype
4
Q
discrimination
A
acting negatively towards a population due to certain characteristics
5
Q
self-stigma
A
internalize negative stereotypes, prejudice and discrimination they have.
Feel rejected by society
inhibits socialization with society
effects self-esteem
6
Q
factors of stigma
A
media, society, family and self
7
Q
Mood disorders
A
are disturbances that primarily impact how we feel (emotion). Mood disorders influence the lens through which we see ourselves, those closest to us, and our daily lives. These disturbances go beyond the normal fluctuations in mood that most people experience. An example of a mood disorder is depression.
8
Q
Thought disorders
A
primarily impact the way we think. Thought disorders can influence all aspects of cognition such as concentration, organization, judgment, insight, and other executive functions of the brain and in serious cases, can lead to a detachment from reality. An example of a thought disorder is schizophrenia.
9
Q
Behaviour disorders
A
ls known as personality disorders, occur when the development of personality is altered, often through negative or traumatic life events. Behaviour disorders impact the way we respond to life experiences. These responses tend to be negative, and can profoundly impact our ability to function and to develop and maintain relationships. An example of such a disorder is borderline personality disorder.
10
Q
Neurocognitive and pervasive developmental disorders
A
are the final two categories. Alzheimer Disease and vascular dementia are considered neurocognitive disorders and autism spectrum disorders are considered pervasive developmental disorders. Both neurocognitive and pervasive developmental disorders can impact all aspects of brain function including thought, behaviour and mood, depending on the severity of the disorder.
11
Q
mental disorders
A
referral to disorders to the mind.
12
Q
causes of mental disorders
A
bio medical and bio-psycho-social
13
Q
Bipolar disorder
A
are brain disorders that cause changes in a person’s mood, energy and ability to function. Bipolar disorder is a category that includes three different conditions — bipolar I, bipolar II and cyclothymic disorder.
14
Q
Bipolar l disorder
A
can cause dramatic mood swings. During a manic episode, people with bipolar I disorder may feel high and on top of the world, or uncomfortably irritable and “revved up.“ During a depressive episode they may feel sad and hopeless. There are often periods of normal moods in between these episodes. Bipolar I disorder is diagnosed when a person has a manic episode.
15
Q
Manic episode
A
a period of at least one week when a person is very high spirited or irritable in an extreme way most of the day for most days, has more energy than usual and experiences at least three of the following, showing a change in behavior:
- Exaggerated self-esteem or grandiosity
- Less need for sleep
- Talking more than usual, talking loudly and quickly
- Easily distracted
- Doing many activities at once, scheduling more events in a day than can be accomplishedIncreased risky behavior (e.g., reckless driving, spending sprees)
- Uncontrollable racing thoughts or quickly changing ideas or topics
16
Q
Hypomanic episode
A
is similar to a manic episode (above) but the symptoms are less severe and need only last four days in a row. Hypomanic symptoms do not lead to the major problems that mania often causes and do not require hospitalization.
17
Q
Major depressive episode
A
is a period of two weeks in which a person has at least five of the following (including one of the first two):
Intense sadness or despair; feeling helpless, hopeless or worthless, Loss of interest in activities once enjoyed, Feeling worthless or guilty, Sleep problems — sleeping too little or too much, Feeling restless or agitated (e.g., pacing or hand-wringing), or slowed speech or movements, Changes in appetite (increase or decrease), Loss of energy, fatigue, Difficulty concentrating, remembering making decisions, Frequent thoughts of death or suicide
Bipolar disorder can disrupt a person’s life and relationships with others, particularly with spouses and family members, and cause difficulty in working or going to school. People with bipolar I often have other mental disorders such as attention-deficit/hyperactivity disorder (ADHD), an anxiety disorder or substance use disorder. The risk of suicide is significantly higher among people with bipolar disorder than among the general population.
18
Q
Bipolar risk
A
Bipolar disorder can run in families. In fact, 80-90 percent of individuals with bipolar disorder have a relative with either depression or bipolar disorder. However, environmental factors can also contribute to bipolar disorder — extreme stress, sleep disruption and drugs and alcohol may trigger episodes in vulnerable patients.
19
Q
Bipolar treatment
A
Bipolar disorder is very treatable. Medication alone or a combination of talk therapy (psychotherapy) and medication are often used to manage the disorder over time. Each person is different and each treatment is individualized. Different people respond to treatment in different ways. People with bipolar disorder may need to try different medications and therapy before finding what works for them.
Medications known as “mood stabilizers” are the most commonly prescribed type of medication for bipolar disorder. Anticonvulsant medications are also sometimes used. In psychotherapy, the individual can work with a psychiatrist or other mental health professional to work out problems, better understand the illness and rebuild relationships. A psychiatrist is also able to prescribe medications as part of a treatment plan. Because bipolar disorder is a recurrent illness, meaning that it can come back, ongoing preventive treatment is recommended. In most cases, bipolar disorder is much better controlled if treatment is continuous.
In some cases, when medication and psychotherapy have not helped, a treatment known as electroconvulsive therapy (ECT) may be used. ECT uses a brief electrical current applied to the scalp while the patient is under anesthesia. The procedure takes about 10-15 minutes and patients typically receive ECT two to three times a week for a total of six to 12 treatments.
Since bipolar disorder can cause serious disruptions and create an intensely stressful family situation, family members may also benefit from professional resources, particularly mental health advocacy and support groups. From these sources, families can learn strategies to help them cope, to be an active part of the treatment and to gain support for themselves.
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Q
Bipolar ll
A
Bipolar II disorder involves a person having at least one major depressive episode and at least one hypomanic episode (see above). People return to usual function between episodes. People with bipolar II often first seek treatment because of depressive symptoms, which can be severe.
People with bipolar II often have other co-occurring mental illnesses such as an anxiety disorder or substance use disorder.
21
Q
Bipolar ll treatment
A
Treatments for bipolar II are similar to those for bipolar I — medication and psychotherapy. Medications most commonly used are mood stabilizers and antidepressants, depending on the specific symptoms. If depression symptoms are severe and medication is not working, ECT (see above) may be used. Each person is different and each treatment is individualized.
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Q
Cyclothymic disorder
A
Cyclothymic disorder is a milder form of bipolar disorder involving many mood swings, with hypomania and depressive symptoms that occur often and fairly constantly. People with cyclothymia experience emotional ups and downs, but with less severe symptoms than bipolar I or II.
Cyclothymic disorder symptoms include the following:
For at least two years, many periods of hypomanic and depressive symptoms (see above), but the symptoms do not meet the criteria for hypomanic or depressive episode.During the two-year period, the symptoms (mood swings) have lasted for at least half the time and have never stopped for more than two months.
23
Q
Cyclothmic treatment
A
Treatment for cyclothymic disorder can involve medication and talk therapy. For many people, talk therapy can help with the stresses of ongoing high and low moods. People with cyclothymia may start and stop treatment over time.
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Q
Depression
A
Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.
Depression symptoms can vary from mild to severe and can include:
Feeling sad or having a depressed moodLoss of interest or pleasure in activities once enjoyedChanges in appetite — weight loss or gain unrelated to dietingTrouble sleeping or sleeping too muchLoss of energy or increased fatigueIncrease in restless activity (e.g., hand-wringing or pacing) or slowed movements and speechFeeling worthless or guiltyDifficulty thinking, concentrating or making decisionsThoughts of death or suicide
Symptoms must last at least two weeks for a diagnosis of depression.
Also, medical conditions (e.g., thyroid, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes.
Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime.
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Depression vs grief vs sadness
The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”
But sadness and depression are not the same. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:
In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks.In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.For some people, the death of a loved one can bring on major depression. Losing a job or being a victim of a physical assault or a major disaster can lead to depression for some people. When grief and depression co-exist, the grief is more severe and lasts longer than grief without depression. Despite some overlap between grief and depression, they are different. Distinguishing between them can help people get the help, support or treatment they need.
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Depression risk factor
Depression can affect anyone—even a person who appears to live in relatively ideal circumstances.
Several factors can play a role in depression:
Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.
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Treatment for depression
Depression is among the most treatable of mental disorders. Between 80 percent and 90 percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.
Before a diagnosis or treatment a health professional should conduct a thorough diagnostic evaluation, including an interview and possibly a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem. The evaluation is to identify specific symptoms, medical and family history, cultural factors and environmental factors to arrive at a diagnosis and plan a course of action.
Medication: Brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants might be prescribed to help modify one’s brain chemistry. These medications are not sedatives, “uppers” or tranquilizers. They are not habit-forming. Generally antidepressant medications have no stimulating effect on people not experiencing depression.
Antidepressants may produce some improvement within the first week or two of use. Full benefits may not be seen for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist can alter the dose of the medication or add or substitute another antidepressant. It is important to let your doctor know if a medication does not work or if you experience side effects.
Psychiatrists usually recommend that patients continue to take medication for six or more months after symptoms have improved. Longer-term maintenance treatment may be suggested to decrease the risk of future episodes for certain people at high risk.
Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, psychotherapy is often used in along with antidepressant medications. Cognitive behavioral therapy (CBT) has been found to be effective in treating depression. CBT is a form of therapy focused on the present and problem solving. CBT helps a person to recognize distorted thinking and then change behaviors and thinking.
Psychotherapy may involve only the individual, but it can include others. For example, family or couples therapy can help address issues within these close relationships. Group therapy involves people with similar illnesses.
Depending on the severity of the depression, treatment can take a few weeks or much longer. In many cases, significant improvement can be made in 10 to 15 sessions.
Electroconvulsive Therapy (ECT) is a medical treatment most commonly used for patients with severe major depression or bipolar disorder who have not responded to other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12 treatments. ECT has been used since the 1940s, and many years of research have led to major improvements. It is usually managed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant.
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Related condition to depression
```
Postpartum depression
Seasonal affective disorder (Seasonal depression)
Persistent depressive disorder
Premenstrual dysphoric disorder
Disruptive mood dysregulation disorder
Bipolar disorders
```
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Mental illness
Mental illnesses are health conditions involving changes in thinking, emotion or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.
Mental illness is common. In a given year:
nearly one in five (19 percent) U.S. adults experience some form of mental illnessone in 24 (4.1 percent) has a serious mental illnessone in 12 (8.5 percent) has a substance use disorder*
Mental illness is treatable. The vast majority of individuals with mental illness continue to function in their daily lives.Mental health is the foundation for thinking, communication, learning, resilience and self-esteem. Mental health is also key to relationships, personal and emotional well-being and contributing to community or society.
Many people who have a mental illness do not want to talk about it. But mental illness is nothing to be ashamed of! It is a medical condition, just like heart disease or diabetes. And mental health conditions are treatable. We are continually expanding our understanding of how the human brain works, and treatments are available to help people successfully manage mental health conditions.
Mental illness does not discriminate; it can affect anyone regardless of your age, gender, income, social status, race/ethnicity, religion/spirituality, sexual orientation, background or other aspect of cultural identity. While mental illness can occur at any age, three-fourths of all mental illness begins by age 24.
Mental illnesses take many forms. Some are fairly mild and only interfere in limited ways with daily life, such as certain phobias (abnormal fears). Other mental health conditions are so severe that a person may need care in a hospital.
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Mental health diagnosis
Mental health conditions are treatable and improvement is possible. Many people with mental health conditions return to full functioning.
It is not always clear when a problem with mood or thinking has become serious enough to be a mental health concern. Sometimes, for example, a depressed mood is normal, such as when a person experiences the loss of a loved one. But if that depressed mood continues to cause distress or gets in the way of normal functioning, the person may benefit from professional care.
Some mental illnesses can be related to or mimic a medical condition. Therefore a mental health diagnosis typically involves a full evaluation including a physical exam. This may include blood work and/or neurological tests.
People of diverse cultures and backgrounds may express mental health conditions differently. For example, some are more likely to come to a health care professional with complaints of physical symptoms that are caused by a mental health condition. Some cultures view and describe mental health conditions in different ways from most doctors in the United States.
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Mental health treatment
The diagnosis of a mental disorder is not the same as a need for treatment. Need for treatment takes into consideration how severe the symptoms are, how much symptoms cause distress and affect daily living, the risks and benefits of available treatments and other factors (for example, psychiatric symptoms complicating other illness).
Mental health treatment is based upon an individualized plan developed collaboratively with a mental health clinician and an individual (and family members if the individual desires). It may include psychotherapy (talk therapy), medication or other treatments. Often a combination of therapy and medication is most effective. Complementary and alternative therapies are also increasingly being used.
Self-help and support can be very important to an individual’s coping, recovery and wellbeing. A comprehensive treatment plan may also include individual actions (for example, lifestyle changes, support groups or exercise) that enhance recovery and well-being.
Primary care clinicians, psychiatrists and other mental health clinicians help individuals and families understand mental illnesses and what they can do to control or cope with symptoms in order to improve health, wellness and function.
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Addiction
Addiction is a complex condition, a chronic brain disease that causes compulsive substance use despite harmful consequences. People with addiction (substance use disorder) have an intense focus on using a certain substance, such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug when they know it will causes problems. Yet a number of effective treatments are available and people can recover from addiction and lead normal, productive lives.
People with a substance use disorder have disturbed thinking, behavior and body functions. Changes in the brain’s wiring are what cause people to have intense cravings for the drug and make it hard to stop using the drug. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory and behavior control.
People can develop an addiction to:
Alcohol
Marijuana
PCP,
LSD
and other hallucinogensInhalants, such as, paint thinners and glue
Opioid pain killers, such as codeine and oxycodone, heroin
Sedatives, hypnotics and anxiolytics (medicines for anxiety such as tranquilizers)
Cocaine,
methamphetamine
and other stimulants
Tobacco
These substances can cause harmful changes in how the brain functions. These changes can last long after the immediate effects of the drug — the intoxication. Intoxication is the intense pleasure, calm, increased senses or a high caused by the drug. Intoxication symptoms are different for each substance.
Over time people with substance use disorder build up a tolerance, meaning they need larger amounts to feel the effects.
According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including:
to feel good –
feeling of pleasure,
“high”to feel better – e.g., relieve stressto do better – improve performancecuriosity and peer pressure
People with addictive disorders may be aware of their problem, but be unable to stop it even if they want to. The addiction may cause health problems as well as problems at work and with family members and friends. The misuse of drugs and alcohol is the leading cause of preventable illnesses and premature death.
Symptoms of substance use disorder are grouped into four categories:
Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use
Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use
Risky use: substance is used in risky settings; continued use despite known problems
Drug effects: tolerance (need for larger amounts to get effect); withdrawal symptoms (different for each substance)
Many people experience both mental illness and addiction. The mental illness may be present before the addiction. Or the addiction may trigger or make a mental disorder worse.
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Treatment for addiction
People can recover from addiction. Effective treatments are available.
The first step on the road to recovery is recognition of the problem. The recovery process can be hindered when a person denies having a problem and lacks understanding about substance misuse and addiction. The intervention of concerned friends and family often prompts treatment.
A health professional can conduct a formal assessment of symptoms to see if a substance use disorder exists. Even if the problem seems severe, most people with a substance use disorder can benefit from treatment. Unfortunately, many people who could benefit from treatment don’t receive help.
Because substance misuse affects many aspects of a person’s life, multiple types of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. Treatment approaches that address an individual’s situation and any co-occurring medical, psychiatric and social problems can lead to sustained recovery.
Medications are used to control drug cravings and relieve severe symptoms of withdrawal. Therapy can help addicted individuals understand their behavior and motivations, develop higher self-esteem and cope with stress. Other treatment methods may include:
HospitalizationTherapeutic communities (highly controlled, drug-free environments)Outpatient programs
Many people find self-help groups for individuals (Alcoholics Anonymous, Narcotics Anonymous) as well as their family members (Al-Anon or Nar-Anon Family Groups) useful.
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Risk and protection factors do drug misuse and addiction
Aggressive behavior in childhood/Good self-control
Lack of parental supervision/Parental monitoring and support
Drug experimentation/Academic competence
Community poverty/Neighborhood pride
Poor social skills/Positive relationships
Availability of drugs at school/School anti-drug policies
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13 principles of effective drug addiction treatment
1. Addiction is a complex, but treatable, disease that affects brain function and behavior.
2. No single treatment is appropriate for everyone.
3. Treatment needs to be readily available.
4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
5. Remaining in treatment for an adequate period of time is critical.
6. Counseling— individual and/or group —and other behavioral therapies are the most commonly used forms of drug abuse treatment.
7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
8. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure it meets his or her changing needs.
9. Many drug-addicted individuals also have other mental disorders.
10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
11. Treatment does not need to be voluntary to be effective.
12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
13. Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.
36
How to help the family members retarding addictions
Some suggestions to get started:
Learn all you can about alcohol and drug misuse and addiction.Speak up and offer your support: talk to the person about your concerns, and offer your help and support, including your willingness to go with them and get help. Like other chronic diseases, the earlier addiction is treated, the better.Express love and concern: don’t wait for your loved one to “hit bottom.” You may be met with excuses, denial or anger. Be prepared to respond with specific examples of behavior that has you worried.Don’t expect the person to stop without help: you have heard it before - promises to cut down, stop - but, it doesn’t work. Treatment, support, and new coping skills are needed to overcome addiction to alcohol and drugs.Support recovery as an ongoing process: once your friend or family member is receiving treatment, or going to meetings, remain involved. Continue to show that you are concerned about his/her successful long-term recovery.
Some things you don’t want to do:
Don't preach: Don’t lecture, threaten, bribe, preach or moralize.Don't be a martyr: Avoid emotional appeals that may only increase feelings of guilt and the compulsion to drink or use other drugs.Don't cover up, lie or make excuses for his/her behavior.Don't assume their responsibilities: taking over their responsibilities protects them from the consequences of their behavior.Don't argue when using: avoid arguing with the person when they are using alcohol or drugs; at that point he/she can’t have a rational conversation.Don’t feel guilty or responsible for their behavior; it’s not your fault.Don't join them: don’t try to keep up with them by drinking or using.
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Related conditions to addiction are
Gambaling addiction
Internet gaming addiction
Caffeine use addiction
38
Anxiety disorder
Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect more than 25 million Americans. But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.
Anxiety refers to anticipation of a future concern and is more associated with muscle tension and avoidance behavior.
Fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction – either staying to fight or leaving to escape danger.
Anxiety disorders can cause people into try to avoid situations that trigger or worsen their symptoms. Job performance, school work and personal relationships can be affected.
In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:
Be out of proportion to the situation or age inappropriateLast six months or longerHinder your ability to function normally
There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, specific phobias, agoraphobia, social anxiety disorder and separation anxiety disorder.
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Type of anxiety disorders
Generalized, panic, phobia, agrophobia, social anxiety disorder and separation anxiety
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Generalized anxiety disorder
Generalized anxiety disorder involves persistent and excessive worry that interferes with daily activities. This ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Often the worries focus on everyday things such as job responsibilities, family health or minor matters such as chores, car repairs, or appointments.
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Panic disorder
The core symptom of panic disorder is recurrent panic attacks, an overwhelming combination of physical and psychological distress. During an attack several of these symptoms occur in combination:
Palpitations, pounding heart or rapid heart rate, SweatingTrembling or shaking, Feeling of shortness of breath or smothering sensations, Chest pain, Feeling dizzy, light-headed or faint, Feeling of choking, Numbness or tingling, Chills or hot flashes,Nausea or abdominal pains feeling detached, Fear of losing control,Fear of dying
Because symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness. Panic attacks may be expected, such as a response to a feared object, or unexpected, apparently occurring for no reason. The median age for onset of panic disorder is 24. Panic attacks may occur with other mental disorders such as depression or PTSD.
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Phobia
A specific phobia is excessive and persistent fear of a specific object, situation or activity that is generally not harmful. Patients know their fear is excessive, but they can’t overcome it. These fears cause such distress that some people go to extreme lengths to avoid what they fear. Examples are fear of flying or fear of spiders.
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Agrophobia
Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms. The fear is out of proportion to the actual situation and lasts generally six months or more and causes problems in functioning. A person with agoraphobia experiences this fear in two or more of the following situations:
Using public transportationBeing in open spacesBeing in enclosed placesStanding in line or being in a crowdBeing outside the home alone
The individual actively avoids the situation, requires a companion or endures with intense fear or anxiety. Untreated agoraphobia can become so serious that a person may be unable to leave the house. A person can only be diagnosed with agoraphobia if the fear is intensely upsetting, or if it significantly interferes with normal daily activities.
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Social anxiety
A person with social anxiety disorder has significant anxiety and discomfort about being embarrassed, humiliated, rejected or looked down on in social interactions. People with this disorder will try to avoid the situation or endure it with great anxiety. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public. The fear or anxiety causes problems with daily functioning and lasts at least six months.
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Separation anxiety
A person with separation anxiety disorder is excessively fearful or anxious about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six months in adults) and causes problems functioning. A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation. Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood.
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Treatment for social anxiety
A person with separation anxiety disorder is excessively fearful or anxious about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six months in adults) and causes problems functioning. A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation. Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood.
47
Related condition to social anxiety
PTSD – posttraumatic stress disorderObsessive-compulsive disorderAcute stress disorderAdjustment disorder
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Eating disorder
Eating disorders are illnesses in which the people experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders typically become obsessed with food and their body weight.
Eating disorders affect several million people at any given time, most often women between the ages of 12 and 35. There are three main types of eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder.
People with anorexia nervosa and bulimia nervosa tend to be perfectionists with low self-esteem and are extremely critical of themselves and their bodies. They usually “feel fat” and see themselves as overweight, sometimes even despite life-threatening semi-starvation (or malnutrition). An intense fear of gaining weight and of being fat may become all-pervasive. In early stages of these disorders, patients often deny that they have a problem.
In many cases, eating disorders occur together with other psychiatric disorders like anxiety, panic, obsessive compulsive disorder and alcohol and drug abuse problems. New evidence suggests that heredity may play a part in why certain people develop eating disorders, but these disorders also afflict many people who have no prior family history. Without treatment of both the emotional and physical symptoms of these disorders, malnutrition, heart problems and other potentially fatal conditions can result. However, with proper medical care, those with eating disorders can resume suitable eating habits, and return to better emotional and psychological health.
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Anorexia nervosa
Anorexia nervosa is diagnosed when patients weigh at least 15 percent less than the normal healthy weight expected for their height. People with anorexia nervosa don't maintain a normal weight because they refuse to eat enough, often exercise obsessively, and sometimes force themselves to vomit or use laxatives to lose weight. Over time, the following symptoms may develop as the body goes into starvation:
Menstrual periods ceaseOsteopenia or osteoporosis (thinning of the bones) through loss of calciumHair/nails become brittleSkin dries and can take on a yellowish castMild anemia; and muscles, including the heart muscle, waste awaySevere constipationDrop in blood pressure, slowed breathing and pulse ratesInternal body temperature falls, causing person to feel cold all the timeDepression and lethargy
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Bulimia nervosa
Although they may frequently diet and vigorously exercise, individuals with bulimia nervosa can be slightly underweight, normal weight, overweight or even obese. But they are not as underweight as people with anorexia nervosa. Patients with bulimia nervosa binge eat frequently, and during these times sufferers may eat an astounding amount of food in a short time, often consuming thousands of calories that are high in sugars, carbohydrates and fat. They can eat very rapidly, sometimes gulping down food without even tasting it.
Their binges often end only when they are interrupted by another person, or they fall asleep or their stomach hurts from being stretched beyond normal capacity. During an eating binge sufferers feel out of control. After a binge, stomach pains and the fear of weight gain are common reasons that those with bulimia nervosa purge by throwing up or using a laxative. This cycle is usually repeated at least several times a week or, in serious cases, several times a day.
Many people don’t know when a family member or friend has bulimia nervosa because people almost always hide their binges. Since they don’t become drastically thin, their behaviors may go unnoticed by those closest to them. But bulimia nervosa does have symptoms that should raise red flags:
Chronically inflamed and sore throatSalivary glands in the neck and below the jaw become swollen; cheeks and face often become puffy, causing sufferers to develop a “chipmunk” looking faceTooth enamel wears off; teeth begin to decay from exposure to stomach acidsConstant vomiting causes gastroesophageal reflux disorderLaxative abuse causes irritation, leading to intestinal problemsDiuretics (water pills) cause kidney problemsSevere dehydration from purging of fluids
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Binge eating
People with binge eating disorder have episodes of binge eating in which they consume very large quantities of food in a brief period and feel out of control during the binge. Unlike people with bulimia nervosa, they do not try to get rid of the food by inducing vomiting or by using other unsafe practices such as fasting or laxative abuse. The binge eating is chronic and can lead to serious health complications, particularly severe obesity, diabetes, hypertension and cardiovascular diseases.
Binge eating disorder involves frequent overeating during a discreet period of time (at least once a week for three months), combined with lack of control and associated with three or more of the following:
Eating more rapidly than normalEating until feeling uncomfortably fullEating large amounts of food when not feeling physically hungryEating alone because of feeling embarrassed by how much one is eatingFeeling disgusted with oneself, depressed or very guilty afterward
Binge Eating Disorder also causes significant distress.
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Treaten for eating disorders
Eating disorders clearly illustrate the close links between emotional and physical health. The first step in treating anorexia nervosa is to assist patients with regaining weight to a healthy level; for patients with bulimia nervosa interrupting the binge-purge cycle is key. For patients with binge eating disorder it is important to help them interrupt and stop binges.
However, restoring a person to normal weight or temporarily ending the binge-purge cycle does not address the underlying emotional problems that cause or are made worse by the abnormal eating behavior. Psychotherapy helps individuals with eating disorders to understand the thoughts, emotions and behaviors that trigger these disorders. In addition, some medications have also proven to be effective in the treatment process.
Because of the serious physical problems caused by these illnesses, it is important that any treatment plan for a person with anorexia nervosa, bulimia nervosa or binge eating disorder include general medical care, nutritional management and nutritional counseling. These measures begin to rebuild physical well-being and healthy eating practices.
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Autism
Autism spectrum disorder (ASD) is a complex developmental disorder that can cause problems with thinking, feeling, language and the ability to relate to others. It is a neurological disorder, which means it affects the functioning of the brain. The effects of autism and the severity of symptoms are different in each person.
Autism is usually first diagnosed in childhood. About one in 68 children is diagnosed with autism according to the Centers for Disease Control and Prevention. Autism spectrum disorder is three to four times more common in boys than in girls.
Autism is most often a lifelong disorder, though there are more and more cases of children with ASD who eventually function independently, leading full lives. The information here focuses primarily on children and adolescents.
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Characteristic of autism
Autism differs from person to person in severity and combinations of symptoms. There is a great range of abilities and characteristics of children with autism spectrum disorders — no two children appear or behave the same way. Symptoms can range from mild to severe and often change over time.
Characteristics of autism spectrum disorder fall into three categories.
Communication problems – including difficulty using or understanding language. Some children with autism focus their attention and conversation on a few topic areas, some frequently repeat phrases and some have very limited speech.Difficulty relating to people, things and events – including trouble making friends and interacting with people, difficulty reading facial expressions and not making eye contact.Repetitive body movements or behaviors – such as hand flapping or repeating sounds or phrases.
Many children with autism are attentive to routines and sameness and have difficulty adjusting to unfamiliar surroundings or changes in routine. Many people with autism have normal cognitive skills, while others have cognitive challenges. Some are at greater risk for some medical conditions – such as sleep problems and seizures.
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Diagnosis and risk factors of autism
Early diagnosis and treatment are important to reducing the symptoms of autism and improving the quality of life for people with autism and their families. There is no medical test for autism. It is diagnosed based on observing how the child talks and acts in comparison to other children of the same age. Trained professionals typically diagnose autism by talking with the child and asking questions of parents and other caregivers.
Under federal law, any child suspected of having a developmental disorder can get a free evaluation. The American Academy of Pediatrics recommends that children be screened for developmental disorders at well-child preventive visits before age three.
Scientists do not clearly understand what causes autism spectrum disorder. Several factors probably contribute to autism, including genes a child is born with or environmental factors. A child is at greater risk of autism if there is a family member with autism. Research has shown that it is not caused by bad parenting, and it is not caused by vaccines.
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Treatment for autism
While children are not typically cured nor do they outgrow autism, studies have shown that symptoms can improve with early diagnosis and treatment. There is no single treatment for autism. Treatments can include intensive skill-building and teaching educational sessions, known as applied behavior analysis (ABA), and many more interactive, child-centered versions of behavior treatments. Treatment may also involve special training and support for parents, speech and language therapy, occupational therapy and/or social skills training.
Also, some children and adults with ASD have other kinds of psychological difficulties at some point in their lives, such as anxiety, ADHD, disruptive behaviors or depression. These difficulties can be treated with therapy or with medication. There are currently no medications that directly treat the core features of ASD.
In addition to treatment, regular and special education classrooms can be changed to help students with autism. Many students with autism can function better if the day is consistent and predictable. It is also helpful if information is presented so the student can learn by seeing as well as hearing and if students get to play and learn with nondisabled peers. A federal law — the Individuals with Disabilities Education Act, or IDEA — requires that special services be available to children identified with a disability. The services can include early intervention, support for birth through three years, and special education for children aged three through 21.
Use of complementary and alternative treatments is common among children with autism, for example, special nutritional supplements and diets. To date, there is little good scientific evidence that such treatments are effective and sometimes they have negative consequences; it is important to talk to your doctor before trying any complementary or alternative treatments.
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Hoarding disorder
People with hoarding disorder excessively save items that others may view as worthless. They have persistent difficulty getting rid of or parting with possessions, leading to clutter that disrupts their ability to use their living or work spaces.
Hoarding is not the same as collecting. Collectors look for specific items, such as model cars or stamps, and may organize or display them. People with hoarding disorder often save random items and store them haphazardly. In most cases, they save items that they feel they may need in the future, are valuable or have sentimental value. Some may also feel safer surrounded by the things they save.
Hoarding disorder occurs in an estimated 2 to 5 percent of the population and often leads to substantial distress and problems functioning.
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Consequences of hoarding
Hoarding disorder can cause problems in relationships, social and work activitives and other important areas of functioning. Potential consequences of serious hoarding include health and safety concerns, such as fire hazards, tripping hazards and health code violations. It can also lead to family strain and conflicts, isolation and loneliness, unwillingness to have anyone else enter the home and an inability to perform daily tasks such as cooking and bathing in the home.
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Diagnosing hoarding disorder
dividuals with hoarding disorder have difficulty discarding items because of strong perceived need to save items and/or distress associated with discarding. The symptoms result in the accumulation of a large number of possessions that congest and clutter living areas of the home or workplace and make them unusable. Specific symptoms for a hoarding diagnosis include:
Lasting problems with throwing out or giving away possessions, regardless of their actual value.The problems are due to a perceived need to save the items and to distress linked to parting with them.Items fill, block and clutter active living spaces so they cannot be used, or use is hampered by the large amount of items (if living spaces are clear it is due to help from others).
The hoarding causes major distress or problems in social, work or other important areas of functions (including maintaining a safe environment for self and others).
An assessment for hoarding may include questions such as:
Do you have trouble discarding (or recycling, selling or giving away) things that most other people would get rid of?Because of the clutter or number of possessions, how difficult is it to use the rooms and surfaces in your home?To what extent do you buy items or acquire free things that you do not need or have enough space for?To what extent do your hoarding, saving, acquisition and clutter affect your daily functioning?How much do these symptoms interfere with school, work or your social or family life?How much distress do these symptoms cause you?
Mental health professionals may also ask permission to speak with friends and family to help make a diagnosis or use rating scales* to help assess level of functioning.
Some individuals with hoarding disorder may recognize and acknowledge that they have a problem with accumulating possessions; others may not see a problem.
In addition to the core features of difficulty discarding, excessive saving and clutter, many people with hoarding disorder also have associated problems such as indecisiveness, perfectionism, procrastination, disorganization and distractibility. These associated features can contribute greatly to their problems functioning and overall severity.
Animal hoarding involves an individual acquiring large numbers (dozens or even hundreds) of animals. The animals may be kept in an inappropriate space, potentially creating unhealthy, unsafe conditions for the animals.
Many people with hoarding disorder also experience other mental disorders, including depression, anxiety disorders, attention deficit/hyperactivity disorder or alcohol use disorder.
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Causes and risk factors
It is not known what causes hoarding disorder, but researchers have identified a number of risk factors. Hoarding is more common among individuals with a family member who also has a problem with hoarding. Genetic research has begun to identify gene variants that may convey risk for hoarding. Brain injuries have also been found to cause secondary or acquired hoarding symptoms in some patients. A stressful life event, such as the death of a loved one, can also trigger or worsen symptoms of hoarding.
Hoarding disorder is also associated with distinct abnormalities of brain function and neuropsychological performance, distinct from those seen in people with OCD or other disorders.
Symptoms of hoarding, such as difficulty discarding items, usually start during the teen years. The average age at onset of first symptoms is 13. If not treated, hoarding disorder tends to be chronic, often becoming more severe over decades, as more and more clutter accumulates, causing more and more dysfunction. Early recognition, diagnosis and treatment are crucial to improving outcomes.
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Treatment for hoarding disorder
Treatment can help people with hoarding disorder decrease their saving, acquisition and clutter, and live safer, more enjoyable lives. There are two main types of treatment that help people with hoarding disorder: cognitive-behavioral therapy (CBT) and medication.
During CBT, individuals gradually learn to discard unnecessary items with less distress, diminishing their exaggerated perceived need or desire to save these possessions. They also learn to improve skills such as organization, decision-making and relaxation. For some people, medications are helpful and may help improve symptoms.
If you or someone you know is experiencing symptoms of hoarding disorder, contact your doctor or mental health professional. In some communities public health agencies can help address problems of hoarding and getting help for individuals affected. In some instances, it may be necessary for public health or animal welfare agencies to intervene.
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Obsessive compulsive disorder
is an anxiety disorder in which time people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.
Many people have focused thoughts or repeated behaviors. But these do not disrupt daily life and may add structure or make tasks easier. For people with OCD, thoughts are persistent and routines are rigid and not doing them causes great distress. Many people with OCD know or suspect their obsessions are not true; others may think they could be true (known as poor insight). Even if they know their obsessions are not true, people with OCD have a hard time keeping their focus off the obsessions or stopping the compulsions.
A diagnosis of OCD requires the presence of obsession and/or compulsions that are time-consuming (more than one hour a day), cause major distress, and impair work, social or other important function. About 1.2 percent of Americans have OCD and among adults slightly more women than man are affected. OCD often begins in childhood, adolescence or early adulthood; the average age symptoms appear is 19 years old.
is an anxiety disorder in which time people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.
Many people have focused thoughts or repeated behaviors. But these do not disrupt daily life and may add structure or make tasks easier. For people with OCD, thoughts are persistent and routines are rigid and not doing them causes great distress. Many people with OCD know or suspect their obsessions are not true; others may think they could be true (known as poor insight). Even if they know their obsessions are not true, people with OCD have a hard time keeping their focus off the obsessions or stopping the compulsions.
A diagnosis of OCD requires the presence of obsession and/or compulsions that are time-consuming (more than one hour a day), cause major distress, and impair work, social or other important function. About 1.2 percent of Americans have OCD and among adults slightly more women than man are affected. OCD often begins in childhood, adolescence or early adulthood; the average age symptoms appear is 19 years old.
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Obession
Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust. Many people with OCD recognize that the thoughts, impulses, or images are a product of their mind and are excessive or unreasonable. Yet these intrusive thoughts cannot be settled by logic or reasoning. Most people with OCD try to ignore or suppress such obsessions or offset them with some other thought or action. Typical obsessions include excessive concerns about contamination or harm, the need for symmetry or exactness, or forbidden sexual or religious thoughts.
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Compulsion
Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors are aimed at preventing or reducing distress or a feared situation. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible. Compounding the anguish these rituals cause is the knowledge that the compulsions are irrational. Although the compulsion may bring some relief to the worry, the obsession returns and the cycle repeats over and over. Some examples of compulsions:
Cleaningto reduce the fear that germs, dirt, or chemicals will "contaminate" them some spend many hours washing themselves or cleaning their surroundings.Repeatingto dispel anxiety, some people utter a name or phrase or repeat a behavior several times. They know these repetitions won’t actually guard against injury but fear harm will occur if the repetitions aren’t done.Checkingto reduce the fear of harming oneself or others by, for example, forgetting to lock the door or turn off the gas stove, some people develop checking rituals. Some people repeatedly retrace driving routes to be sure they haven’t hit anyone.Ordering and arrangingMental compulsionsto response to intrusive obsessive thoughts, some people silently pray or say phrases to reduce anxiety or prevent a dreaded future event.
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Treatment for ocd
One effective treatment is a type of cognitive-behavioral therapy known as exposure and response prevention. During treatment sessions, patients are exposed to the situations that create anxiety and provoke compulsive behavior or mental rituals. Through exposure, patients learn to decrease and then stop the rituals that consume their lives. They find that the anxiety arising from their obsessions lessens without engaging in ritualistic behavior. This technique works well for patients whose compulsions focus on situations that can be re-created easily. For patients who engage in compulsive rituals because they fear catastrophic events that can’t be re-created, therapy relies on imagining exposure to the anxiety-producing situations. Throughout therapy the patient follows exposure and response prevention guidelines on which the therapist and patient agree.
Cognitive-behavior therapy can help many OCD patients substantially reduce their OCD symptoms. However, treatment only works if patients adhere to the procedures. Some patients will not agree to participate in cognitive-behavioral therapy because of the anxiety it involves.
Medication
A class of medications known as selective serotonin reuptake inhibitors (SSRIs) is effective in the treatment of OCD. Patients who do not respond to one medication sometimes respond to another. Other psychotropic medications can also be effective. Noticeable benefit usually takes six to twelve weeks to occur.
Patients with OCD who have received appropriate treatment have shown to have increased quality of life and improved functioning. Successful treatment may improve the individual's ability to attend school, work, develop and enjoy relationships and pursue leisure activities.
Self-help and Coping
Keeping a healthy lifestyle and being aware of warning signs and what to do if they return can help in coping with OCD and related disorders. Also, using basic relaxation techniques, such as meditation, yoga, visualization, and massage, can help ease the stress and anxiety caused by OCD.
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Ptsd
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. PTSD is a real illness that causes real suffering.
PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II. But PTSD does not just happen to combat veterans. PTSD occurs in men and women, in people of any ethnicity, nationality or culture, and at any age. PTSD affects approximately 3.5 percent of U.S. adults, and lifetime risk for PTSD is estimated at 8.7 percent.
People with PTSD continue to have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.
A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, exposure could be indirect rather than first hand. For example, PTSD could occur in an individual who learns that a close family member or friend has died accidentally or violently.
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Symptoms for ptsd
Symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.
Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that bring on distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.Negative thoughts and feelings may include ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; or feeling detached or estranged from others.Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being easily startled; or having problems concentrating or sleeping.
Many people who are exposed to a traumatic event experience symptoms like those described above in the days following the event. For a person with PTSD, however, symptoms last for at least a month and often persist for months and sometimes years. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later. For people with PTSD the symptoms cause significant distress or problems functioning. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.
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Treatment for ptsd
Not everyone who experiences trauma develops PTSD, and not everyone who develops either requires psychiatric treatment. For some people, symptoms of PTSD subside or disappear over time. Others get better with the help of family, friends or clergy. But many people with PTSD need professional treatment to recover from psychological distress that can be intense and disabling. It is important to remember that trauma may lead to severe distress. That distress is not the individual’s fault, and PTSD is treatable.
Psychiatrists and other mental health professionals use various effective (research-proven) methods to help people recover from PTSD. Both talk therapy (psychotherapy) and medication provide effective evidence-based treatments for PTSD. One category of psychotherapy, cognitive behavior therapies (CBT), is very effective. Cognitive processing therapy, prolonged exposure therapy and stress inoculation therapy (described below) are among the types of CBT used to treat PTSD.
Cognitive Processing Therapy focuses on modifying painful negative emotions (such as shame, guilt, etc.) and beliefs (such as “I have failed”; “the world is dangerous”) due to the trauma. Therapists help the person confront such distressing memories and emotions.
Prolonged Exposure Therapy uses repeated, detailed imagining of the trauma or progressive exposures to symptom “triggers” in a safe, controlled way to help a person face and gain control of fear and distress and learn to cope. For example, virtual reality programs have been used to help war veterans with PTSD re-experience the battlefield in a controlled, therapeutic way.
Stress Inoculation Therapy involves a variety of ways to manage anxiety such as education, muscle relaxation training and biofeedback. This may include social skills training, role-playing, distraction techniques, positive thinking and self-talk.
Other psychotherapies such as interpersonal, supportive and psychodynamic therapies focus on the emotional and interpersonal aspects of PTSD. These may be helpful for people who don’t want to expose themselves to reminders of their traumas.
Medication can help to control the symptoms of PTSD. In addition, the symptom relief that medication provides allows many people to participate more effectively in psychotherapy.
Some antidepressants such as SSRIs and SNRIs (selective serotonin re-uptake inhibitors and selective norepinephrine re-uptake inhibitors), are commonly used to treat the core symptoms of PTSD. They are used either alone or along with psychotherapy or other treatments.
Other medications may be used to lower anxiety and physical agitation, or treat the nightmares and sleep problems that trouble many people with PTSD.
Group therapy encourages survivors of similar traumatic events to share their experiences and reactions in a comfortable and non-judgmental setting. Group members help one another realize that many people would have responded the same way and felt the same emotions. Family therapy may also help because the behavior and distress of the person with PTSD can affect the entire family.
Complementary and alternative therapies are also increasingly being used to help people with PTSD. These approaches provide treatment outside the conventional mental health clinic. They require less talking and disclosure than psychotherapy. They include acupuncture, animal-assisted therapy, virtual reality and stellate ganglion block technique (a procedure that anesthetizes nerves located in the neck).
In addition to treatment, many people with PTSD find being able to share their experiences and feelings with others who have similar experiences, such as in peer support groups, very helpful. Peers can share ideas about effective coping strategies.
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Related condition to ptsd
Acute stress disorder
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Schizophrenia
Schizophrenia is a chronic brain disorder that affects about one percent of the population. When schizophrenia is active, symptoms can include delusions, hallucinations, trouble with thinking and concentration, and lack of motivation. However, when these symptoms are treated, most people with schizophrenia will greatly improve over time.
While there is no cure for schizophrenia, research is leading to new, safer treatments. Experts also are unraveling the causes of the disease by studying genetics, conducting behavioral research, and by using advanced imaging to look at the brain’s structure and function. These approaches hold the promise of new, more effective therapies.
The complexity of schizophrenia may help explain why there are misconceptions about the disease. Schizophrenia does not mean split personality or multiple-personality. Most people with schizophrenia are not dangerous or violent. They also are not homeless nor do they live in hospitals. Most people with schizophrenia live with family, in group homes or on their own.
Research has shown that schizophrenia affects men and women about equally but may have an earlier onset in males. Rates are similar in all ethnic groups around the world. Schizophrenia is considered a group of disorders where causes and symptoms vary considerable between individuals.
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Symptoms of schizophrenia
When the disease is active, it can be characterized by episodes in which the patient is unable to distinguish between real and unreal experiences. As with any illness, the severity, duration and frequency of symptoms can vary; however, in persons with schizophrenia, the incidence of severe psychotic symptoms often decreases during a patient’s lifetime. Not taking medications, use of alcohol or illicit drugs, and stressful situations tend to increase symptoms. Symptoms fall into several categories:
Positive psychotic symptomsHallucinations, such as hearing voices, paranoid delusions and exaggerated or distorted perceptions, beliefs and behaviors.Negative symptomsDisorganization symptomsConfused and disordered thinking and speech, trouble with logical thinking and sometimes bizarre behavior or abnormal movements.Impaired cognition
Symptoms usually first appear in early adulthood. Men often experience symptoms in their early 20s and women often first show signs in their late 20s and early 30s. More subtle signs may be present earlier, including troubled relationships, poor school performance and reduced motivation.
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Risk factors of schizophrenia
Researchers believe that a number of genetic and environmental factors contribute to causation, and life stresses may play a role in the disorder’s onset and course. Since multiple factors may contribute, scientists cannot yet be specific about the exact cause in individual cases. Since the term schizophrenia embraces several different disorders, variation in cause between cases is expected.
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Treatment for schizophrenia
Though there is no cure for schizophrenia, many patients do well with minimal symptoms or periods of recovery. Drug treatment can reduce symptoms and greatly reduce future relapses. Psychological treatments such as cognitive behavioral therapy or supportive psychotherapy may reduce symptoms and enhance function, and other treatments are aimed at reducing stress, supporting employment or improving social skills. Treatment can help many people with schizophrenia lead highly productive and rewarding lives. As with other chronic illnesses, some patients do extremely well while others continue to be symptomatic or have impaired ability to function.
A variety of antipsychotic medications are effective in reducing the psychotic symptoms present in the acute phase of the illness, and they also help reduce the potential for future acute episodes. Before treatment can begin, however, a psychiatrist should conduct a thorough medical examination to rule out substance abuse or other medical illnesses whose symptoms mimic schizophrenia.
Diagnosis and treatment can be complicated by substance misuse. People with schizophrenia misuse drugs more often than the general population. Substance misuse also reduces the effectiveness of treatment for schizophrenia. If a person shows signs of addiction, treatment for the addiction should occur along with treatment for schizophrenia.
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Recovery and rehabilitation for schizophernia
After the symptoms of schizophrenia are controlled, therapy can help people manage the illness. It can help people learn social skills, cope with stress, identify early warning signs of relapse and prolong periods of remission. Because schizophrenia typically strikes in early adulthood, individuals with the disorder often benefit from rehabilitation to help develop life-management skills, complete vocational or educational training, and hold a job. For example, supported-employment programs have been found to help persons with schizophrenia obtain self-sufficiency. These programs provide people with severe mental illness with competitive jobs in the community.
Many people living with schizophrenia receive emotional and material support from their family. Therefore, it is important that families be provided with education, assistance and support. Such assistance has been shown to help prevent relapses and improve the overall mental health of the family members as well as the person with schizophrenia.
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Living with schizophrenia
Optimism is important and patients, family members and mental health professionals need to be mindful that many patients have a favorable course of illness, that challenges can often be addressed, and that patients have many personal strengths that can be recognized and supported.
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Sleep disorder
Sleep disorders involve problems with the quality, timing and amount of sleep, which cause problems with functioning and distress during the daytime. There are a number of different types of sleep disorders, of which insomnia is the most common. Other sleep disorders are narcolepsy, obstructive sleep apnea and restless leg syndrome.
Sleep difficulties are linked to both physical and emotional problems. Sleep problems can both contribute to or exacerbate mental health conditions and be a symptom of other mental health conditions.
In primary care, 10-20 percent of people complain of significant sleep problems. 1 And our sleep problems are increasing – research has identified significant increases in the number and percentage of office visits for sleep related problems (a 30 percent increase from 1999 to 2010) and in the number of prescriptions for sleep medications (approximately 200 percent increase from 1999 to 2010).
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Sleep problem
Quality of sleep
Timing of sleep
Amount of sleep
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Important of sleep
Sleep is a basic human need and is critical to both physical and mental health. There are two types of sleep that generally occur in a pattern of three-to-five cycles per night:
Rapid eye movement (REM)Non-REM – known as deep sleep (when most dreaming occurs)
When you sleep is also important. Your body typically works on a 24-hour cycle (circadian rhythm) that helps you know when to sleep.
How much sleep we need varies depending on age and varies from person to person. Most adults need about seven to nine hours of restful sleep each night, according to the National Sleep Foundation. The Foundation revised its sleep recommendations in 2015 based on a rigorous review of scientific literature.
Many of us do not get enough sleep. Nearly 30 percent of adults get less than six hours of sleep each night and only about 30 percent of high school students get at least eight hours of sleep on an average school night.2
More than 50 million Americans have chronic sleep disorders.
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Consequences of lack of sleep
Sleep helps your brain function properly. Not getting enough sleep or poor quality sleep has many potential consequences. The most obvious concerns are fatigue and decreased energy, irritability and problems focusing. The ability to make decisions and mood can also be affected. Sleep problems often coexist with symptoms of depression or anxiety. Sleep problems can exacerbate depression or anxiety, and depression or anxiety can lead to sleep problems.
Lack of sleep and too much sleep are linked to many chronic health problems, such as heart disease and diabetes. Sleep disturbances can also be a warning sign for medical and neurological problems, such as congestive heart failure, osteoarthritis and Parkinson’s disease.
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Insomnia
Insomnia, the most common sleep disorder, involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10-15 percent report problems functioning during the daytime and 6-10 percent have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40-50 percent of individuals with insomnia also have another mental disorder. 1
Symptoms and Diagnosis
To be diagnosed with insomnia disorder, the sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems in work, school or other functioning. Not all individuals with sleep disturbances are distressed or have problems functioning.
To diagnose insomnia, a physician will rule out other sleep disorders (see Related Conditions below), medication side-effects, substance misuse, depression or other illness. Some medications and medical conditions can affect sleep.
A comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary and clinical testing (a sleep study). A sleep study allows the physician to identify how long and how well you’re sleeping and to identify specific sleep problems. A sleep diary is a record of your sleep habits to discuss with your physician. It includes information such as when you go to bed, get to sleep, wake up, get out of bed, take naps, exercise and consume alcohol and caffeinated beverages.
Sleep problems can occur at any age but most commonly start in young adulthood. The type of insomnia problems often vary with age. Problems getting to sleep are more common among young adults. Problems staying asleep are more common among middle-age and older adults.
Symptoms of insomnia can be
Episodic (with an episode of symptoms lasting one to three months)Persistent (with symptoms lasting three months or more)Recurrent (with two or more episodes within a year)
Symptoms of insomnia can also be brought on by a specific life event or situation.
Treatment and Self-help
Sleep problems can often be improved with regular sleep habits. (See list of healthy sleep tips below.) If your sleep problems persist or if they interfere with how you feel or function during the day, you should seek evaluation and treatment by a physician.
Sleep disorders should be addressed specifically regardless of mental or other medical problems that may be present. Chronic insomnia is typically treated with a combination of sleep medications and behavioral techniques, such as cognitive behavior therapy. Several types of medications can be used to treat insomnia and help you fall asleep or stay asleep. Most of these can become habit-forming and should only be used for short periods under the care of a doctor. Some antidepressants are also used to treat insomnia.
Most over-the-counter sleep medicines contain antihistamines, which are commonly used to treat allergies. They are not addictive, but they can become less effective over time.
Many people turn to complementary health approaches to help with sleep problems. According to the National Institutes of Health some may be safe and effective, others lack evidence about effectiveness. Some raise safety concerns.
Relaxation techniques, used before bedtime, can be helpful for insomnia.Melatonin supplements may be helpful for people with some types of insomnia. Long-term safety has not been investigated.Mind and body approaches, such as mindfulness/meditation, yoga, massage therapy and acupuncture lack evidence to show their usefulness, but are generally considered safe.Herbs and dietary supplements have not been shown to be effective for insomnia. There are safety concerns about some, including L-tryptophan and Kava.
Let your health care provider know about any alternative medicines or supplements you are taking.
Healthy sleep tips to address problems sleeping include:
Stick to a sleep schedule – same bed time and wake up time even on the weekendsAllow your body to wind down with a calming activity, such as reading away from bright lights; avoid electronic devicesAvoid naps especially in the afternoonExercise dailyPay attention to bedroom environment (quiet, cool and dark is best) and your mattress and pillow (should be comfortable and supportive)Avoid alcohol, caffeine and heavy meals in the evening
Source: National Sleep Foundation
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Obstructive sleep apnea
snoring, snorting/gasping or breathing pauses. This interrupted sleep causes daytime sleepiness and fatigue. Sleep apnea is diagnosed with a clinical sleep study. The sleep study (polysomnography) involves monitoring the number of obstructive apneas (absence of airflow) or hypopneas (reduction in airflow) during sleep.
Sleep apnea affects an estimated 2 to 15 percent of middle-age adults and more than 20 percent of older adults.1 Major risk factors for sleep apnea are obesity, male gender and family history of sleep apnea.
Lifestyle changes, such as losing weight if needed or sleeping on your side, can improve sleep apnea. In some cases a custom-fit plastic mouthpiece can help keep airways open during sleep. The mouthpiece can be made by a dentist or orthodontist. For moderate to severe sleep apnea, a doctor can prescribe a CPAP (continuous positive airway pressure) device. The CPAP works to keep airways open by gently blowing air through a tube and face mask covering your mouth and nose.
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Reared condition to sleep disorder
Hypersomnolence disorder involves excessive sleepiness even when getting enough sleep and difficulty waking up (may be confused, not fully awake, for a period of time)Narcolepsy involves excessive daytime sleepiness (“sleep attacks”) combined with sudden muscle weakness several times a weekBreathing-related sleep disorders (in addition to sleep apnea)Central sleep apneaSleep related hypoventilationCircadian rhythm sleep-wake disordersParasomnias (abnormal events or experiences during sleep)Non-rapid eye movement sleep arousal disordersNightmare disorderRapid eye movement sleep behavior disorderRestless legs syndrome – (associated with aches and pains throughout the legs which is relieved by movement of the leg, such as walking or kicking)
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Mental health beavhiours symptoms
Two types
- biomedical and
- biopsyhcosocial
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Icd 10 category from WHO
F00-F09 Organic, including symptomatic, mental disorders
F10-F19Mental and behavioural disorders due to psychoactive substance use
F20-F29Schizophrenia, schizotypal and delusional disorders
F30-F39Mood [affective] disorders
F40-F48Neurotic, stress-related and somatoform disorders
F50-F59Behavioural syndromes associated with physiological disturbances and physical factors
F60-F69Disorders of adult personality and behaviour
F70-F79Mental retardation
F80-F89Disorders of psychological development
F90-F98Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
F99-F99Unspecified mental disorder
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dsm-5 from APA
1. 1 neurodevelopement disorder
1. 2.2 Schizophrenia spectrum and other psychotic disorders
1. 2.3 Bipolar and related disorders
1. 2.4 Depressive disorders
1. 2.5 Anxiety disorders
1. 2.6 Obsessive-compulsive and related disorders
1. 2.7 Trauma- and stressor-related disorders
1. 2.8 Dissociative disorders
1. 2.9 Somatic symptom and related disorders
1. 2.10 Feeding and eating disorders
1. 2.11 Sleep–wake disorders
1. 2.12 Sexual dysfunctions
1. 2.13 Gender dysphoria
1. 2.14 Disruptive, impulse-control, and conduct disorders
1. 2.15 Substance-related and addictive disorders
1. 2.16 Neurocognitive disorders
1. 2.17 Paraphilic disorders
1. 2.18 Personality disorders
1. 3 Section III: emerging measures and models
1. 3.1 Alternative DSM-5 model for personality disorders
1. 2.19 eliminating disorder
1. 2.20 paraphillic Disorder
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mental health causes
stress or disability
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neuro- development disorder
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from an abnormality in development of the nervous system that causes mental dysfunction
related disorder include:
-intellect disability
-ADHD
-autism
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neuro- cognitive disorder
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from the lost of cognitive function for the brain after development
other disorders include:
-delirium
-dementia
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Common medication of adhd
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Amphetamines
Methamphetamine
Methylphenidate
Atomoxetine
Clonidine
Guanfacine
antidepressants (off label)
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Amphetamine
Stimulant For adhd:
Brand: Adderall generic: amphetamine/dextroamphetamine
Brand: Dexedrine generic: dextroamphetamine
Brand: Dextrostat generic: Dextroamphetamine
Brand Vyvanse generic: lisdexamfetamine
These medications include amphetamine, dextroamphetamine or lisdexamfetamine. Several are available in extended release form.
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Stimulant
Stimulants are the most commonly prescribed medications for ADHD. You might hear this class of drug referred to as central nervous stimulant (CNS) medications. Stimulants increase dopamine and norepinephrine in the brain to improve concentration while also decreasing fatigue. Stimulants are often the first course of medications used for ADHD treatment.
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Methamphetamine/desoxyn
Stimulant
Methamphetamine is related to ephedrine and amphetamine, with CNS stimulant activity, which reduces appetite and can raise blood pressure. In ADHD, its mechanism of action is unknown. These tablets are taken one to two times daily.
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Methylphenidate
Stimulant
Methylphenidate blocks the reuptake of norepinephrine and dopamine into neurons and is a mild stimulant. Brand names include:
Metadate
Concerta
Daytrana
RitalinMethylin (liquid and chewable methylphenidate)
Quillivant (extended release liquid methylphenidate)
Focalin (dexmethylphenidate)
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Non stimulant
Non-stimulants affect the brain differently than stimulants. Though these drugs affect neurotransmitters, they don’t increase dopamine levels. It also generally takes longer to see results. Non-stimulants come in a variety of classes. They might be used when stimulants prove unsafe, ineffective, or for a person who wants to avoid side effects of stimulants.
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Brand:Strattera generic: atomoxetine
Atomoxetine is not a stimulant. It prolongs the action of norepinephrine in the brain. It does not need to be tapered when it is discontinued. It is long acting, taken just once a day.
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Brand: Kapvay generic: Clonidine
Non stimulant Clonidine is used as a treatment for high blood pressure, and also to treat ADHD. The extended release form is Kapvay. Clonidine is used to reduce hyperactivity, impulsiveness, and distractibility. Since it is used to treat high blood pressure, patients taking it for ADHD may experience lightheadedness from reduced blood pressure.
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Brand: Intuniv generic: Guanfacine
Guanfacine is traditionally prescribed for high blood pressure in adults. Only the brand-name Intuniv may be used for ADHD in children. It may be help with memory and behavioral inhibition. It is helpful for improving aggression and hyperactivity, and is used as a single drug treatment for ADHD.
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Off label antidepressant
Antidepressants are not FDA-approved to treat ADHD, although some patients may have complex diagnoses and they may be prescribed these drugs along with ADHD medications.
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Schizophrenia medication
Anti psychotic
Brand: stelazide generic: Trifluoperazine
Brand : flupenthixol generic: trifluoperazine
Brand: Loxapine generic Loxitane
Perphenazine (Etrafon,Trilafon)
Chlorpromazine (Thorazine)
Haldol ( Haloperidol)
Prolixin (Fluphenazine Decanoate, Modecate, Permitil)
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Bipolar medication
Usually combined with mood stabilizer and anti psychotic
mood stabilizer: litium and valproic acid.
anti psychotic: Olanzapine (Zyprexa) Quetiapine (Seroquel)
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Categories of Antidepressants
SSRIs: selective serotonin reuptake inhibitors
SNRIs: serotonin and noradrenaline reuptake inhibitors
Noradrenaline reuptake inhibitors
TCAs: tricyclic antidepressants
RIMAs: reversible inhibitors of monoamine oxidase ATetracyclic antidepressants
Tetracyclic analogues of mianserin (sometimes called noradrenergic and specific serotonergic antidepressant [NaSSA])
MAOIs: Monoamine oxidase inhibitors
Melatonergic antidepressants
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SSRI antidepressants
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Generic: Citalopram brand: Celexa
Escitalopram, Lexapro
Fluoxetine, prozac
Fluvoxamine, luvox
Paroxetine, paxil
Sertraline, zoloft
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SNRIs (serotonin and noradrenaline reuptake inhibitors) antidepressants
Duloxetine
Venlafaxine
Desvenlafaxine
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Noradrenaline reuptake inhibitor/antidepressants
reboxetine
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TCAs (tricyclic antidepressants)
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Amitriptyline
Nortriptyline
Clomipramine
Dothiepin
Doxepin
Imipramine
Trimipramine*
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RIMA (reversible inhibitor of monoamine oxidase A)
Moclobemide
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Tetracyclic antidepressant
Mianserin
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Tetracyclic analogue of mianserin (sometimes called noradrenergic and specific serotonergic antidepressant [NaSSA])
Mirtazapine
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MAOIs (monoamine oxidase inhibitors) anti depressant
Phenelzine
| Tranylcypromine
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Melatonergic antidepressant
Agomelatine*
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Anti anxiety medication
BENZODIAZEPINES
alprazolam (Xanax) panic, generalized anxiety, phobias, social anxiety, OCD
clonazepam (Klonopin) panic, generalized anxiety, phobias, social anxiety
diazepam (Valium) generalized anxiety, panic, phobias
lorazepam (Ativan) generalized anxiety, panic, phobias
oxazepam (Serax) generalized anxiety, phobias
chlordiazepoxide (Librium) generalized anxiety, phobias
BETA BLOCKERS
propranolol (Inderal) social anxietyatenolol (Tenormin) social anxiety
TRICYCLIC ANTIDEPRESSANTS
imipramine (Tofranil) panic, depression, generalized anxiety, PTSD
desipramine (Norpramin, Pertofrane and others) panic, generalized anxiety, depression, PTSD
nortriptyline (Aventyl or Pamelor) panic, generalized anxiety, depression, PTSD
amitriptyline (Elavil) panic, generalized anxiety, depression, PTSD
doxepin (Sinequan or Adapin) panic, depression
clomipramine (Anafranil) panic, OCD, depression
OTHER ANTIDEPRESSANTS
trazodone (Desyrel) depression, generalized anxiety
MONOAMINE OXIDASE INHIBITORS (MAOIs)
phenelzine (Nardil) panic, OCD, social anxiety, depression, generalized anxiety, PTSDtranylcypromine (Parnate) panic, OCD, depression, generalized anxiety, PTSD
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
fluoxetine (Prozac) OCD, depression, panic, social anxiety, PTSD, generalized anxietyfluvoxamine (Luvox) OCD, depression, panic, social anxiety, PTSD, generalized anxiety sertraline (Zoloft) OCD, depression, panic, social anxiety, PTSD, generalized anxiety paroxetine (Paxil) OCD, depression, panic, social anxiety, PTSD, generalized anxietyescitalopram oxalate (Lexapro) OCD, panic,depression, generalized anxiety, social anxiety, PTSD, generalized anxietycitalopram (Celexa) depression, OCD, panic, PTSD, generalized anxiety
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)
venlafaxine (Effexor) panic, OCD, depression, social anxiety, generalized anxietyvenlafaxine XR (Effexor XR) panic, OCD, depression, social anxiety, generalized anxietyduloxetine (Cymbalta) generalized anxiety, social anxiety, panic, OCD
MILD TRANQUILIZER
buspirone (BuSpar) generalized anxiety, OCD, panic
ANTICONVULSANTS
Valproate (Depakote) panicPregabalin (Lyrica) generalized anxiety disorderGabapentin (Neurontin) generalized anxiety, social anxiety
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Ocd medication
For those suffering from obsessive-compulsive disorder (OCD), medications can reduce the degree of intensity of the worries and their corresponding distress. Medications do not prevent obsessions from occurring. However, when the medication lessens the strength of the worries, the patient can then use self-help skills to control them.
The SSRIs appear helpful in treating OCD, as well as the antidepressants clomipramine (Anafranil) and venlafaxine (Effexor). The anti-obsessional benefits of any of these medications may not be fully apparent until 5 to 10 weeks after treatment starts.
Imipramine, monoamine oxidase inhibitors (MAOIs), venlafaxine, alprazolam and the mild tranquilizer buspirone (BuSpar) also show some indications of being useful for certain individuals. In addition, some patients with OCD may also have an underlying mood disorder and can benefit by the drug lithium.
About 20% of individuals with OCD also have tics, which are sudden, uncontrollable physical movements (such as eye blinking) or Tourette’s syndrome, which includes vocalizations (such as throat clearing). The atypical antipsychotics such as risperidone, clozapine and quetiapine, and the blood pressure drugs clonidine and guanfacine, can help with these tics and Tourette’s symptoms. Your physician can help determine what medications can be used in combination with any of these.
Tricyclic antidepressants and Monoamine oxidase inhibitors (MAOIs) have not been shown to be helpful for OCD.
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Trauma medicaton
Medications can be effective in treating PTSD, acting to reduce its core symptoms as well as lifting depression and reducing disability. The SSRIs appear to be the medications of choice, with some study showing the benefits of tricyclic antidepressants, MAOIs and some anticonvulsants. However, research into the pharmacotherapy of PTSD lags behind that of the other anxiety disorders. In the years to come, other medications or newer drugs may prove more effective
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Sleeping disorder medication
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Benzodiazepines
Nonbenzodiazepine Hypnotics
Melatonin Receptor Agonists
Antidepressants
Orexin Receptor Antagonists
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Benzodiazepines
Class Summary
Benzodiazepine receptor agonists are the mainstay in treatment of insomnia. Flurazepam, temazepam, quazepam, estazolam, and triazolam are the benzodiazepines that are approved by the US Food and Drug Administration (FDA) as hypnotics. These drugs bind to a special benzodiazepine site on the gamma-aminobutyric acid (GABA) receptor complex, enhancing the activity of this neurotransmitter. All have variable half-lives and different metabolites that affect their onset and duration of action.
This class of drugs suppresses rapid eye movement (REM) sleep and reduces stages 3 and 4 sleep while increasing stage 2 sleep. The drug described here, temazepam, is only 1 example of this class of medications.
Temazepam (Restoril)View full drug information
Temazepam's intermediate rate of absorption and duration of action make it useful for treating initial and middle insomnia. Because temazepam has no active metabolite, cognitive impairment and grogginess the following day are reduced. Temazepam enhances the inhibitory effects of the GABA neurotransmitter on neuronal excitability that results by increased neuronal permeability to chloride ions. The shift in chloride ions results in hyperpolarization and stabilization of the neuronal membrane.
Triazolam (Halcion)View full drug information
Triazolam is frequently chosen as a short-term adjunct to behavioral therapy. This short-acting agent is effective in helping patients fall asleep. It is not effective in persons with sleep maintenance problems. Triazolam enhances the inhibitory effects of the GABA neurotransmitter on neuronal excitability that results by increased neuronal permeability to chloride ions. The shift in chloride ions results in hyperpolarization and stabilization of the neuronal membrane.
EstazolamView full drug information
Estazolam is an intermediate-acting agent with a slow onset of action and a long duration. It is a good agent for sleep-maintenance insomnia. It enhances the inhibitory effects of the GABA neurotransmitter on neuronal excitability that results by increased neuronal permeability to chloride ions. The shift in chloride ions results in hyperpolarization and stabilization of the neuronal membrane.
Quazepam (Doral)View full drug information
Quazepam is used for sleep-maintenance insomnia. It enhances the inhibitory effects of the GABA neurotransmitter on neuronal excitability that results by increased neuronal permeability to chloride ions. The shift in chloride ions results in hyperpolarization and stabilization of the neuronal membrane.
FlurazepamView full drug information
Flurazepam is frequently chosen as a short-term treatment of insomnia. It enhances the inhibitory effects of the GABA neurotransmitter on neuronal excitability that results by increased neuronal permeability to chloride ions. The shift in chloride ions results in hyperpolarization and stabilization of the neuronal membrane.
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Nonbenzodiazepine Hypnotics
Class Summary
These agents are used for the treatment of acute and short-term insomnia.
Zolpidem (Ambien, Edluar, Zolpimist, Intermezzo)View full drug information
Zolpidem binds at a benzodiazepine receptor subtype (omega I). This receptor is found more in the central nervous system (CNS) than in the peripheral nervous system, which helps to account for the drug's hypnotic effect without significant muscle-relaxant properties. Unlike benzodiazepines, zolpidem does not suppress normal sleep architecture.
Zolpidem is rapidly absorbed, with a fast onset of action (20-30 min), and thus is a good drug for sleep induction. It decreases sleep latency and increases sleep duration.
Zaleplon (Sonata)View full drug information
Zaleplon is not structurally related to benzodiazepines, barbiturates, or other drugs with known hypnotic properties. It interacts with the GABA-benzodiazepine receptor complex, causing sedation. It should be taken immediately before bedtime.
Zaleplon decreases the time to sleep onset. Its shorter onset of action means that peak serum concentrations are achieved within 1 hour of administration. This may account for the lower incidence of daytime grogginess and the reduced withdrawal rebound insomnia.
Eszopiclone (Lunesta)View full drug information
Eszopiclone is a nonbenzodiazepine hypnotic pyrrolopyrazine derivative of the cyclopyrrolone class. Its precise mechanism of action is unknown, but it is believed to interact with GABA receptors at binding domains close to or allosterically coupled to benzodiazepine receptors. It is indicated for treatment of insomnia by decreasing sleep latency and improving sleep maintenance. It has a short half-life (6 h).
The starting dose is 1 mg immediately before bedtime, with at least 7-8 h remaining before the planned time of awakening. The dose may be increased if clinically warranted to 2-3 mg HS in nonelderly adults, and 2 mg in elderly or debilitated patients.
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Melatonin Receptor Agonists
Class Summary
Melatonin receptor agonists (tasimelteon, ramelteon) have been approved by the FDA. Tasimelteon is indicated for non–24-hour sleep-wake disorder. Ramelteon is indicated for insomnia characterized by difficulty with sleep onset.
Tasimelteon (Hetlioz)View full drug information
Tasimelteon is a melatonin receptor agonist with high affinity for MT1 and MT2 receptors in the suprachiasmatic nucleus of the brain. MT1 and MT2 are thought to synchronize the body's melatonin and cortisol circadian rhythms with the day-night cycle in patients with non–24-hour disorder. It is indicated for non–24-hour sleep-wake disorder in the totally blind.
Ramelteon (Rozerem)View full drug information
Ramelteon is a melatonin receptor agonist with high selectivity for human melatonin MT1 and MT2 receptors. MT1 and MT2 are thought to promote sleep and to be involved in maintenance of circadian rhythm and normal sleep-wake cycles. Ramelteon is indicated for insomnia characterized by difficulty with sleep onset
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Antidepressants, Other
Class Summary
Although no antidepressants have been specifically approved for use in the treatment of sleep disorders, the cyclic antidepressant trazodone is routinely used for this purpose.
Trazodone (Olepro)View full drug information
Trazodone's mechanism of action is not fully understood but is believed to involve selective inhibition of serotonin uptake by brain synaptosomes and potentiation of behavioral changes induced by the serotonin precursor 5-HT. The major adverse effect of trazodone is sedation.
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Orexin Receptor Antagonists
Class Summary
Orexin promotes wakefulness. Antagonism of the orexin receptor suppresses this action by orexin.
SuvorexantView full drug information
Suvorexant is an orexin receptor antagonist. The orexin neuropeptide signaling system is a central promoter of wakefulness. Blocking the binding of wake-promoting neuropeptides orexin A and orexin B to receptors OX1R and OX2R by suvorexant is thought to suppress wake drive. It is indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance.
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Disruptive, impulse-control, and conduct disorders. Anti docial
Treatment of Impulse Control and Conduct Disorders
Cognitive-behavioral therapy (CBT) is the only treatment that can be used for all types of impulse-control disorders, according to Odlaug. This may include training to become aware of behavioral triggers and strategies to control them. Older children who are disruptive at school may require intensive behavior management.5
Other than CBT, finding successful treatment options is a work in progress. For example, experts disagree about using medication as treatment, and there are no FDA-approved drugs for these disorders. “Fluoxetine (Prozac) has shown some benefit for intermittent explosive disorder. Other selective serotonin reuptake inhibitors have had mixed results in kleptomania and pyromania,” says Odlaug.
The opiate antagonist naltrexone has been used successfully to treat pathologic gambling and kleptomania. “Naltrexone may be used for kleptomania and pyromania. This drug is especially useful if there is a family history of addiction,” Odlaug notes.
In older children, stimulant drugs used for ADHD may be tried for oppositional defiant disorder or conduct disorder. There is growing evidence that stimulant drugs may decrease verbal and physical aggression. They may be the first choice of drugs used in children and adolescents. “Stimulant drugs are a hot topic, but opinions are still mixed,” says Odlaug.
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