Everyone has
experienced anxiety at some point in their lives. In fact, it is clear that
one’s anxiety/fear “alarm” is not in and of itself an illness, but is the
neurologic “warning system” of the body in response to perceived danger. The
“fight or flight” response of fear, with its effects on heart and breathing
rate, alertness, and changes in blood flow, can be helpful or even life saving
in a perilous situation (for example, if a bus is about to hit you unless you
take quick, evasive action). There is powerful evolutionary evidence that the
human fear response has been bred in our species as “survival insurance”.
However, in some the “alarm system” malfunctions; these syndromes are called
Anxiety Disorders.
• In Generalized Anxiety Disorder, the alarm may stay
on at a “simmer” most or all of the time, regardless of whether there is a true
threat or not. People often realize that their anxiety is irrational, but cannot
turn it down or off.
• In Panic Disorder, the alarm may abruptly crank up
to 100% with little or no perceived reason. The symptoms generally escalate
within a few seconds to a few minutes. Psychiatrists diagnose Panic Disorder
when the person has frequent panic attacks (at least four in a month).
•
There may be no threat to trigger the response, or in Phobia, a minor stressor
that the alarm system overreacts to with intense fear. Phobias are classified by
psychiatrists as:
• Simple phobias: irrational fear of an object or
living thing; i.e. fear of high places, water, driving, knives, spiders, dogs,
etc.)
• Social Phobia (fear of social situations, of being publicly
humiliated)
• Agoraphobia ( fear of being trapped in public places
without easy escape; i.e. grocery store, theater), often closely linked to panic
disorder
The impact of these irrational fear responses can be
devastating. Chronic anxiety can lead to significant medical problems such as
peptic ulcer disease, headache, muscle tension pain of the upper and lower back,
and other troubles. Panic and phobic anxiety will often lead to avoidance and
withdrawl from any potentially triggering situations, making daily work and home
tasks more and more difficult to complete. Because the physical symptoms of
anxiety often mimic critical medical problems such as heart attack or lung
disease, much time and expense may be spent to rule out these other
causes.
SYMPTOMS The symptoms of anxiety disorders fall in to three
major groups:
•EMOTIONAL:Nervousness; restlessness; worry;irritability;
exaggerated startle response; sense of dread or impending
doom.
•PHYSICAL: Shortness of breath; chest pressure or pain; fast heart
beat; pounding heart; insomnia; sweating; clamminess; dry mouth; dizziness;
nausea; loose stool; chills or hot flashes; pressure to urinate; lump in throat;
trembling; muscle tension; tingling.
•COGNITIVE: Problems in
concentration and attention; “catastrophic” thoughts (“I’m going to die”; “my
heart is going to stop”; “I’m going crazy”; “I’m losing control”); a sense of
loss of contact with one’s body or mind, or with reality.
CAUSES Like
most other psychiatric problems, anxiety is caused by a mix of influencing
factors:
• BIOLOGICAL: At a molecular level, anxiety is caused by a
disturbance in the interplay of chemicals that regulate the “fight/flight”
response. The subtype of panic disorder has been shown to run in families.
• PSYCHOLOGICAL: The anxiety response is primarily one of fear of
novelty - that is, a guarded response to something new and unpredictable.
Growing up in a family environment that frequently required guarding oneself
against unpredictability and danger (such as with family members who were
abusive, psychiatrically ill, or alcoholic) will often shape one’s outlook of
day-to-day life as similarly unpredictable and dangerous. In other families,
overly anxious, avoidant parents can reflect their viewpoint on their children,
who grow up conditioned to see the world as their parents did.
•
ENVIRONMENTAL: As with other emotional problems, here-and-now stress in one’s
daily life will usually act as a trigger to the amplified anxiety response. Job
stress, relationship or family conflict, and threatened losses of finanical or
medical health are common triggers. The use of (and withdrawl from) alcohol or
drugs can often trigger or worsen anxiety. Use of caffeine and nicotine can
worsen anxiety, also.
GETTING HELP
Anxiety disorders can be very
effectively treated. Treatment starts with a complete evaluation, including a
thorough history, physical exam and laboroatory tests (to rule out potential
physical causes of anxiety symptoms such as low blood sugar, heartbeat
irregularities, thyroid gland dysfunction, or too much caffeine). Once an
accurate diagnosis is made, treatment often follows these tracks:
•
BIOLOGICAL: Fast-acting anxiety relievers such as alprazolam (Xanax), lorazepam
(Ativan), clonazepam (Klonopin), and others can extinguish anxiety in the short
term. Because these powerful medicines can potentially cause dependency, they
are usually meant to be used only for a specified period of time. For complete
preventive treatment of panic anxiety, anti-depressant medications are most
commonly used. For generalized anxiety, buspirone (Buspar), anti-depressants, or
other medications are effective.
• PSYCHOLOGICAL: There are a number of
effective psychotherapy types for anxiety disorders.The counseling may focus on
defining and “demystifying” what the patient is anxious about.
•
ENVIRONMENTAL(SELF-HELP): This part of treatment includes all of the skills and
activities that people can learn to reduce the stressful triggers and and manage
their anxiety. See the ResilincePath document on Relaxation Tools for some
effective techniques in controlling one’s anxiety response. Regular aerobic
exercise (a brisk 20-minute walk 3 times a week) is a great anxiety fighter.
Massage therapy helps, as does meditation. Avoiding caffeine is must (careful
about chocolate and sodas!).
ResiliencePath: Depression
By Greg Sazima,
MD
Depressed mood is
an emotional state common at some time in life to just about everyone; feeling
"down" or "blue" is often a realistic response to a loss or other stress.
However, when your doctor or therapist speaks of a Depressive Disorder, he or
she is referring to a serious medical illness with both emotional and physical
symptoms.
Major Depression (as it is referred to clinically) is a very
big deal: nationally it causes as much or more loss of work time and
productivity as does heart disease. It often escapes recognition; depressed
people may not recognize the symptoms as they would those of an infection, bone
fracture, or heart attack. Depression tends to run in families. It occurs in
about 1 in 5 Americans at some point in his or her lifetime; women are twice as
likely as men to suffer from Major Depression.
SYMPTOMS Major
Depression is defined by psychiatrists as:
o the appearance of either 1)
depressed mood or 2) loss of interest or pleasure in usual activities most of
each day, nearly every day for at least 2 weeks, AND...
o the appearance
of at least four of these symptoms during the same time: o increase or
decrease in sleep o fatigue or loss of energy o increase or decrease in
appetite o feelings of worthlessness or guilt o feelings of mental
slowness or agitation o thoughts of death or suicide o trouble
concentrating or making decisions
o Other symptoms may include: frequent
waking; unrefreshing sleep; impaired function at work or school; loss of sex
drive; and medical complaints such as headache, nausea, feeling short of breath,
or body aches and pains without a clear cause.
o Sometimes alcohol and
drug use can masquerade as depression; self-limited periods of grief (i.e. after
the death of a loved one) isn't considered Major Depression, unless it persists
for at least 2 months.
o When a person has the above symptoms, more days
than not, for a long period of time (at least two years), this chronic
depressive condition is known as Dysthymia.
o Please see the separate
ResiliencePath document to learn more about the specific type of mood disorder
called Bipolar (Manic-Depressive) Disorder.
CAUSES Depressive
disorders tend to be influenced by multiple interacting factors acting at the
same time. These factors can be grouped into three types:
o BIOLOGICAL:
At a molecular level, depression is caused by a disturbance in chemicals that
regulate mood in response to stress. You may have heard of some of these
chemicals: serotonin, norepinephrine, dopamine are the most well known. These
neurochemical "messengers" transmit messages from one nerve cell to others; a
problem in the amount and/or activity of chemical transmission is thought to
lead to depressive symptoms. The vulnerability to a depressive disorder is
inherited; people with blood relatives who have been depressed are more likely
to have depression themselves (this is especially so with Bipolar Disorder).
It is also important to know that depression can be a life-long risk in those
who have had at least one episode; that is why it is so important to know all
you can about the warning signs and how to get help.
o PSYCHOLOGICAL: How
one deals with the ups and downs of life also plays a large role. The coping
skills that people have learned from their childhood experiences up through
adulthood affect their responses to day-to-day life experiences and stresses. It
is no surprise that people from dysfunctional family environments (especially
those who were abused as children) have much higher rates of depression as
adults.
o ENVIRONMENTAL: While one's biology and psychology can "set up"
the chances of depression, it usually takes some stress in one's present life
circumstances to tip the scales. Common stress factors include job pressure or
loss, relationship conflict, family problems, death of a loved one, and ongoing
health problems. The misuse of alcohol or drugs commonly adds to the risk of
becoming depressed.
GETTING HELP With the right kind of help, 85%
or more of those with depressive disorders can make a full recovery. Treatment
usually starts with a complete evaluation, including a thorough history,
physical exam, and laboratory tests (to rule out other medical problems that may
influence the depressive state). Once a diagnosis is made, treatment often
follows the three areas described above:
o BIOLOGICAL: Anti-depressant
medication is very commonly prescribed as part of treatment for depression. For
more severe states (poorly responsive to medications or swiftly worsening),
Electroconvulsive Therapy (ECT) can be a life-saving treatment.
o
PSYCHOLOGICAL: There are a variety of effective "talk therapies" used in the
treatment of depression. Often the counseling will focus on the causes and
effects of one's symptoms; all therapies have in common an alliance between
therapist and patient in supporting return to wellbeing.
o ENVIRONMENTAL:
This part of treatment includes all of the skills and activities that people
with depression can use to speed their recovery and prevent recurrence. These
skills include:
o Supportive social connections o Balancing work and
leisure o Regular aerobic exercise (i.e. a brisk 20 minute walk daily)
o Having a regular, healthy sleep pattern o Stress reduction techniques
o Healthy nutrition o Hobbies o Spiritual fellowship
FOR MORE
INFORMATION
Darkness Visible: A Memoir of Madness. William Styron A
powerful first-person description of depression by one of the best American
writers of this century.
Feeling Good. David Burns, MD A popular and
helpful book which focuses on the cognitive/behavioral treatment of
depression.
Listening to Prozac. Peter Kramer, MD A practicing
psychiatrist writes on depression and the ethical, personal and societal
issuesinvolved in treatment.
Changes in one’s
mood are an understandable response to the ebb and flow of daily life. But for
some, the changes can be intense and inappropriate to the stressors involved.
When your doctor or therapist speaks of Bipolar Disorder (also called
Manic-Depressive Disorder ), he or she is referring to a serious medical illness
often involving rapid and severe “swings” in mood from irrationally elevated
(manic) mood to severely depressed mood. Bipolar Disorder can profoundly disrupt
the daily life of the sufferer and his or her family. It can lead to lethal
results if untreated, due to suicide or poor judgment in regard to risk taking.
Nevertheless, there is good cause for hope. There are now multiple
effective treatments for Bipolar Disorder. With early diagnosis, the progression
of symptoms can be stopped and turned around.
Bipolar Disorder occurs
much less frequently than does Major (Unipolar) Depression; about 1 in 100
people suffer from Bipolar Disorder, while 15 in 100 acquire Unipolar Depression
at some time in their lives. Bipolar Disorder is likely to be a lifelong,
recurring problem. It affects men and women about equally. It tends to first
occur earlier in life than Unipolar Depression; a first episode almost always
occurs before age 35, and commonly occurs in one’s
teens.
SYMPTOMS Until recently, it was thought that most people
with Bipolar Disorder had a “classic” set of symptoms: periods of either extreme
highs or lows in mood, punctuated by periods of relatively normal mood. As
research has progressed, it turns out not to be that clean-cut. There are up to
40% of people with Bipolar Disorder who suffer from other forms of the
disorder.
In the most common form, these symptoms
predominate:
Manic Phase Symptoms: • increased energy •
inappropriate elation • decreased need for sleep • increased sexual
activity • sudden, easy irritability, suspiciousness, or rage • grandiose
thoughts • racing, disconnected thoughts • inappropriately loud or fast
speech • difficulty in responding to social cues in conversation (i.e. not
stopping or allowing others to respond) • uncharacteristic risk taking:
spending sprees, foolish investments, gambling, reckless driving, alcohol/drug
abuse • poor insight into one’s own moods (denial of mood changes) • (in
severe cases) delusions that one is all-powerful, has special powers, knows or
is God, etc.
Depressed phase symptoms: • daily depressed mood or loss
of interest • increase or decrease in sleep (most commonly,increased) •
increase or decrease in appetite • feelings of worthlessness or guilt •
fatigue or loss of energy • feelings of mental slowness or agitation •
thoughts of death or suicide • trouble concentrating or making decisions •
Other symptoms may include: frequent waking; unrefreshing sleep; impaired
function at work or school; loss of sex drive; and medical complaints such as
headache, nausea, feeling short of breath, or body aches and pains without a
clear cause.
The subtypes of Bipolar Disorder can be grouped as
follows:
• Bipolar I Disorder: “classic”, big swings from normal mood to
a manic or depressive state; swings last a week or more if untreated
•
Bipolar II Disorder: subtype where recurring depressive episodes are
intermingled with mild elevation in mood, which psychiatrists call hypomania
(“less than mania”).
• “Rapid-Cycling” /“Mixed” Types: In comparison to
“classic” Bipolar Disorder, people with “rapid-cycling” have swift,
unpredictable shifts in mood from day to day or even hour to hour; in the
“mixed” type, symptoms of both manic AND depressive phases can co-exist (i.e.
increased energy and impulsivity, yet with severely depressed mood). Recent
research suggests anti-convulsant medications may be particularly helpful for
these subtypes.
• Cyclothymia: A milder form of the illness, with
periodic swingsfrom mild elevation of mood to mild depression. Often treated
without ongoing medication, via psychotherapy and self-help.
CAUSES •
BIOLOGICAL: Even more than other mood disorders, Bipolar disorder tend to be
inherited. About 80 % have blood relatives with some form of depression, often
Bipolar. At a molecular level, all types of depression are caused by changes in
the brain’s chemicals that regulate mood in response to stress. It is also
important to know that the risk of recurrent mood swings of Bipolar Disorder are
almost always life-long in those who have had at least one episode.
•
PSYCHOLOGICAL: The coping skills people have learned from their childhood
experiences up through adulthood play a role in the frequency and severity of
mood changes. It is no surprise that people from dysfunctional families
(especially those who were abused) have much higher rates of mood disorders as
adults.
• ENVIRONMENTAL: While one’s biology and psychology can “set up”
the chances of Bipolar Disorder, it often takes some stress in one’s present
life circumstances to tip the scales. Common stress factors include job pressure
or loss, relationship or family conflict, death of a loved one, and ongoing
health problems. The misuse of alcohol or drugs adds to the risk. In addition,
some with Bipolar I Disorder have mood swings occurring regularly in certain
times of the year (a common pattern is depressive symptoms in the winter, and a
manic “swing” in the spring); these changes may be related to changes in the
length and/or amount of daylight.
GETTING HELP
It is
important, although disappointing, to note that Bipolar Disorder is almost
always a lifetime illness, requiring ongoing vigilance and/or treatment. But
with the right help, 70% or more of those with Bipolar disorders can respond
very well to treatment, with only minimal intrusion of the mood disorder on the
person’s full, functional life. Treatment usually starts with a complete
evaluation, including a thorough history, physical exam, and laboratory tests
(to rule out other medical problems). Once a diagnosis is made, treatment often
follows the three areas described above:
• BIOLOGICAL: Lithium carbonate
is the mood stabilizer used most often to treat the acute symptoms of mania, as
well as to help prevent recurrences of mania and depression. More recently,
anti-convulsants such as divalproate (Depakote), carbamazepine (Tegretol), and
others have been used effectively, especially in mixed or rapid-cycling subtypes
of Bipolar Disorder. In the depressive phase, anti-depressant medication may be
added. In severe states (i.e. with hallucinations, delusions, or agitation),
anti-anxiety and/or anti-psychotic medication may be used.
•
PSYCHOLOGICAL: “Talk” therapies focus on the causes and effects of one’s
symptoms, as well as mending relationships damaged in the acute phase of
illness. All therapies have in common an alliance between therapist and patient
in support of return to wellbeing.
• ENVIRONMENTAL: This includes all of
the skills and activities that people can use to speed their recovery and
prevent recurrence:
• Supportive social contacts • Balancing work and
leisure • Regular exercise • A regular, healthy sleep pattern • Stress
reduction • Healthy nutrition • Hobbies • Spiritual
fellowship
ResiliencePath: Relaxation Tools
By Greg Sazima,
MD
Techniques to
control your heart rate, breathing rate, and muscle tension can be valuable
tools in managing stress. It may take some practice to learn how to do these
well; but once you have become comfortable with the skills, you will be able to
use them effectively whenever you feel the effects of stress in your daily life.
The following are two exercises that are easy to learn and very effective; other
relaxation exercises exist and can be found in the health and wellness section
of most bookstores.
RELAXATION BREATHING Relaxation breathing
(also called “roll breathing” or “belly breathing”) helps you relax by gaining
control of some vital, basic physical functions - respiration rate and heart
rate. Anxiety often is fueled and amplified by the tendency of the anxious
person to breathe shallow, rapid breaths (hyperventilating), which reduces
oxygen content in the bloodstream. The heart commonly responds to the lower
oxygen content by beating more rapidly. The anxious person will often perceive
the increased heart rate and shortness of breath with even greater alarm: a
“feedback loop” of progressively rising anxiety can result.
How to do it:
Remember “4 by 4”
1) Inhale slowly through your nose, filling your lungs
on a slow count to 4. Fill your lower lungs first (which pushes your diaphragm
down and your abdomen out (hence the name “belly breathing”) and continuing to
inhale intoyour upper chest.
2) Hold the full breath for a count of
four.
3) Exhale slowly through your mouth, also on a count of four.
Visualize the tension leaving your body as you exhale and gain control of your
respiration.
4) Repeat the cycle of slow inhalation , hold, and
exhalation four times (or more).
PROGRESSIVE MUSCLE
RELAXATION People under stress commonly hold muscle groups at high tension;
their chronically overworked muscles become sore and inflamed as a result. It is
no surprise that some of the most common ailments leading to doctor visits
include low back pain, tension headache, and soreness of the neck and upper back
- all related to stress-induced muscle tension. Learning to control your
muscles’ state of resting tension is a great way to reduce stress, and even ease
your way into sleep without use of medication.
Nevertheless, just
“relaxing” all your muscles at once can seem impossible. The most effective way
of relaxation involves focusing on each muscle group separately, one at a time.
The trick here is to tense the muscle group first (to focus your mind on the
muscle group to be relaxed, like with biofeedback), then relax it. Visualizing
the tension leaving the relaxed muscle can enhance your relaxation.
How
to do it: Counting to 4 (again)
1) Find a comfortable place to relax with
all your muscles at gravity - lying on a bed, sitting in a chair with a high
padded back for your head or lying on a carpeted floor will all do. Before
starting, make a mental note of how tense your muscles feel (1= barely tense;
10= tight as a banjo...)
2) Start with your left hand. Clench it tightly
for a count of four. Release your fist slowly to a count of 4. Breathe deeply
and slowly while you tighten and release. Compare the feeling in your left hand
to your right hand; notice the difference.
3) Now tense your right hand
for a count of four, then release for a count of four. Remember to breathe
deeply and slowly, as you learned in the relaxation breathing
exercise.
4) Now move to your forearms, first tensing and releasing the
left forearm (remember the four count), then a pause to compare the difference,
then repeat with the right forearm.
5) Next, apply the same process to
your upper arms - first left, then a pause, then right. Keep breathing deeply
and slowly.
6) Your shoulders and neck are next. Shrug your
shoulders(both sides at once) to a four count, then relax. Work your neck by
pressing your head back hard (four count) and relax, then touch your chin to
your chest (four count) and relax.
7) Your face is next (no mirrors for
this part!). Wrinkle your forehead into a deep frown (four count) then relax.
Close your eyes tightly (four count) and relax. Grin as wide as you can (four
count) and relax. Purse your lips tightly (think lemons) and relax. Remember to
take slow, deep breaths.
8) Next is your upper body. Stretch your chest
muscles by taking a full breath, holding for four, the exhaling. Arch your back
tightly(four count) then relax. Suck your gut in tightly (four count) then
relax.
9) Next is the hips and buttocks. Press those buns together
tightly for a count of four, then relax.
10) Lastly, work on your legs -
first thighs, then lower legs, then feet and toes. With each group progress as
you did with your arms: tighten and relax on the left , then pause to note the
difference, then do the same right.
Pause for a moment and note the
difference in how your muscles feel, compared to your 1-10 rating of your
tension at the beginning of the exercise
ResiliencePath: Schizophrenia
By Greg Sazima,
MD
Of all mental
illnesses, Schizophrenia may be the disorder most misunderstood by the general
public- and the most potentially debilitating without proper treatment. The
common misconception about Schizophrenia (the term being derived from the Greek
roots meaning “split mind”) is that those with the illness have “split” or
multiple personalities.
In reality, Schizophrenia is a relatively rare
(less than 2 out of a hundred), inheritable disorder of neurochemical disruption
in certain areas of the brain governing thinking, relating to others, and other
functions. The type and degree of symptoms in the disorder can range from minor
to quite severe. It is as common in men as it is in women. Schizophrenia usually
develops for the first time in the late teens to early 30’s; rarely does one
show first signs and symptoms of the illness after age 45.
SYMPTOMS The most noticeable and troubling symptoms of the illness
are those that occur during times of increased life stress. These
include:
• Delusions: false, irrational beliefs that nevertheless are
“fixed” in the mind of the sufferer. People in this state may irrationally
believe that there is a plot to hurt or exploit them (a delusional state known
as Paranoia); others may believe that their thoughts are transmitted to others
or vice versa, as if by magic. These irrational thoughts can lead such people to
consider life-threatening behaviors in response, such as fleeing from a safe
environment.
• Hallucinations: disturbances in sensory perception. Most
common are auditory hallucinations (“hearing voices”), though the mind can play
tricks in vision, smell, touch, or taste also.
• Disordered Thinking:
People with acute psychosis commonly have a flow of thought in which ideas
expressed shift from one subject to another in a disconnected, even completely
unrelated way. They may shift from topic to topic with little or no insight into
how illogical they appear to others.
• Changeable Emotions: often those
in the acute phase of the illness will exhibit moods that seem inappropriate to
the situation; others remain very constricted and “locked in” in terms of
emotional response to the crisis
• Loss of function: in times of crisis,
there is a noticeable drop in the ability of the person to function at work, in
relationships, and even in basic self-care such as bathing, eating, and getting
rest.
Other signs and symptoms of Schizophrenia tend to be more or
less present on an ongoing basis, as opposed to emerging only during stressful
times. These symptoms, which clinicians call the deficit symptoms of the
illness, include:
• “flat”, apathetic mood and emotions • trouble in
relating to others emotionally • difficulty in certain kinds of learning
• social isolation and withdrawl • lack of initiative, interests, and
motivation • vague, unusual thought process (though not as pronounced as is
found during times of acute psychosis) • ongoing impairment of functioning
(again, not as severe as during acute psychotic periods)
CAUSES As
with many psychiatric illnesses, there is no simple, single cause identified.
While there is still much to understand about how Schizophrenia occurs,
researchers in the last twenty years have clarified a great deal about the
factors involved.
• BIOLOGICAL: At a biochemical level, it is clear that
many of the symptoms of Schizophrenia are associated with imbalances in the
brain’s use of dopamine, a chemical “messenger” (like serotonin and
norepinephrine) that allows nerve cells to communicate with each other. Areas of
the brain that modulate thought, mood and behavior rely on dopamine in very
complex ways. This problem is clearly inherited, with those in families with a
history of Schizophrenia having a ten times higher chance of having the illness.
Because of the evidence that Schizophrenia most commonly emerges in the late
teen/young adult years, researchers are looking into the possibility that
something in the physical maturation process (perhaps a hormonal or immune
cause) may trigger the development of dopamine inbalance.
•
PSYCHOLOGICAL: For a period of time in the sixties and seventies, there was a
popular movement to brand Schizophrenia as the result of poor parenting. This
has been completely disproven, as powerful genetic and other biologic evidence
has emerged. Unfortunately, many parents during that period were unfairly blamed
for an illness with effects that would challenge the best of parents.
•
ENVIRONMENTAL/SOCIAL: While there is no evidence that stressful events can
trigger the development of Schizophrenia, it is true that people with
Schizophrenia are quite vulnerable to stresses such as family conflicts,
relationship troubles, and others. Poor control of these stresses may easily
lead to the patient relapsing into acute psychotic crisis. Ongoing treatment by
doctors, therapists, and support groups/programs often may make the difference
between “weathering the storm” or needing acute hospitalization.
GETTING
HELP First, the bad news: Schizophrenia is a treatable, but not a curable
illness. In fact, an essential part of treatment for the person with
Schizophrenia (as well as the family) is the acceptance that it will require his
or her ongoing attention and care. Those who understand the illness and don’t
ignore or avoid treatment can often limit its effects a great deal - allowing
for a more full, independent life.
Treatment usually starts with a
complete evaluation, including a thorough history, physical exam, and laboratory
tests (in order to rule out other, usually acute illnesses that can cause acute
psychosis and thus can mimic Schizophrenia). Once a diagnosis is made, treatment
often follows these three areas:
• BIOLOGICAL: Anti-psychotic medications
to reduce the chemical disruptions are almost always used. These medications
work to reduce disordered thinking, hallucinations, and delusions, as well as
agitation and restlessness. Recently, there has emerged a number of new
medications with lower risk of side effects (compared to older anti-psychotic
medications). Like most psychiatric medicines, these need to be taken every day
to be effective. Your doctor also may also prescribe other medication to help
you with anxiety, insomnia or depressive symptoms if needed.
•
PSYCHOLOGICAL: Supportive psychotherapy for both the patient and family,
offering ongoing re-assessment, understanding, reassurance, education, and
guidance in judgment and decision-making all are part of psychotherapy. Patients
can use treatment best by keeping regular treatment appointments, taking their
medications accurately, and (with their loved ones) keeping on top of any
“brewing” symptoms of increased stress.
•ENVIRONMENTAL: This part of
treatment includes all of the skill and activities that people with
Schizophrenia can use to speed their recovery from acute illness and reduce the
chance of recurrence. • Support groups and contacts • Regular exercise •
Regular, healthy sleep pattern • Healthy nutrition • Avoid alcohol and
tobacco • Hobbies • Stress reduction techniques • Spiritual
fellowship
ResiliencePath: Alcoholism and Drug Abuse
By Greg Sazima,
MD
Over the last
twenty years, there has been an increasing awareness in the public of the
significance of alcohol and drug abuse and dependence in our society. Just about
everyone knows someone whose life has been affected by the problem; some by his
or her own uncontrolled use, others by the impact of the illness on a family
member or friend. About 13 in 100 Americans become alcohol dependent during
their lifetimes. For other drugs, including marijuana, cocaine, stimulants, PCP
and others, the rate is 6 out of 100. Together, about 1 in 5 people become
dependent at some point on alcohol or illicit drugs (these figures do not
include caffeine and nicotine, two other highly addictive substances). The risks
of medical illness, injury, and early death skyrocket in those who are affected.
Clearly, addictive substances play a powerful, destructive role in our nation’s
life and health.
SYMPTOMS While there is some disagreement in the
public about what is “abuse” or “dependence” versus “safe” use, the medical
profession generally defines dependence on alcohol or drugs as:
• A
pattern of pathological, out-of-control use, which may include: frequent
intoxication; regularly using more than one planned; unsuccessful attempts to
quit or cut down; lots of time spent in the preparation, use, and after- effects
of use; and use in order to relieve the withdrawal effects of prior use
•
Physical signs and symptoms, including tolerance (need for increasing amounts of
the substance to achieve an effect), withdrawal symptoms as the effect of the
substance wears off (a wide range of symptoms, specific to each substance), and
long-term health effects
• Continued use even in the setting of obvious
negative effects on his or her health, relationships, and work functioning - in
effect, the drug being in control of the person’s life.
CAUSES Like
other psychiatric disorders, substance dependence tends to be impacted by
multiple factors, best grouped into three areas:
• BIOLOGICAL: There is a
powerful genetic influence on the development of Alcohol Dependence, with
children of alcoholic parents being about FOUR times more likely to become
alcoholic themselves (sons’ risk being even higher than daughters’). Just how
this genetic vulnerability translates into the behavior of uncontrolled alcohol
use is not well defined, but likely involves altered sensitivity of nerve cells
to the effects of alcohol at a neurochemical level. The evidence for genetic
factors in other kinds of substance dependence is less solid.
•
PSYCHOLOGICAL: Alcohol, cocaine and other psychoactive substances (that is,
substances having an impact on mood, thought, and/or behavior) are often used to
“self-medicate” uncomfortable emotions. For example, an anxious person may use
alcohol to alleviate anxiety in social situations, and even come to believe that
his or her “personality” in social situation is more acceptable to others under
the influence than not. Fatigued, overworked, and/or depressed people may turn
to cocaine or stimulants in an attempt to get a “jump start”. The short-term
relief from these maneuvers can lure the user into avoidance of dealing with the
inevitable longer-term destructive effects of abuse. Sometimes the psychological
issues involved are more complex, with substance abuse being one of many signs
of the person’s sense of dependency, inadequacy, or distorted need to punish
himself or herself. Growing up in a childhood environment where one was exposed
to substance abuse as a regular part of family life can have the distorted
effect of “modeling” the destructive behavior as normal.
ENVIRONMENTAL:
Stress in one’s daily life will usually act as a trigger to an amplified
emotional response, which can put pressure on the chemically dependent person’s
vulnerability to use and The Effects of Substance Abuse on the Body It is
important to understand the potential damage that can be done to one’s health,
both short and long-term, by abuse of alcohol and drugs. Here’s a partial
list:
• General: Reduced life span; chronic poor sleep; poor judgment and
impulse control, with higher risk of fatality and injury due to auto accident,
weapons, assault, homicide
• Brain/Nervous System: Blackouts (periods of
memory loss for events while under the influence); chronic depression;
hallucinations; seizures; anxiety disorders; dementia (permanent, progressive
loss of memory and reasoning ability); peripheral neuropathy (exquisitely
intense pain of arms and/or legs, poorly relieved by medication)
• Digestive: Gastritis, peptic ulcers, cirrhosis
(irreversible scarring of the liver); much higher risk of cancers of the mouth,
stomach, liver, and bowel; poor nutrition (poor diet as well as direct
“poisoning” of the intestinal absorptive cells)
TREATMENT The first
step in getting help is recognizing there is a problem. Sometimes the chemically
dependent person sees it for him- or herself; in other cases loving family and
friends intervene. Often it only happens when the consequences of alcohol or
drug use make daily living unmanageable. Losing one’s job due to missed days or
poor performance, legal problems like arrest for driving under the influence,
and breakups of relationships are examples.
Once a need for treatment is
clear, the treatment always begins with a crucial first step: getting “off” the
alcohol or drug, known as detoxification. For chemically dependent people,
“detox” is a medical procedure that should only be done under a doctor’s
supervision to limit or avoid the symptoms of withdrawal - some of which are
serious and life-threatening. Psychiatric assessment is often neccessary to
check for symptoms of underlying depression or other emotional
problems.
Once the detox is complete, the next step in treatment is
reinforcing abstinence - the complete stopping of use. For those who are
chemically dependent, evidence shows that in the overwhelming majority of cases,
attempts at “social” or recreational use of drugs or alcohol result in relapse.
Clearly, the most effective part of treatment is going regularly to Alcoholics
Anonymous (AA), or other “12-step” support group, such as SMART Recovery
(http://www.smartrecovery.org).
For those with significant dependency or
a history of relapse, a period of intensive group therapy treatment is essential
to help the patient through the critical first few months of learning to live
without alcohol and/or drugs. This often starts with a full-day program
(Chemical Dependency Partial Hospital Program, or “CD-PHP”), then graduation to
a less intensive half-day program (Intensive Outpatient Program, or “CD-IOP”).
In these programs, the treatment is focused specifically on learning how to stay
“clean and sober”. For those for whom abstinence is improbable at home, a period
of treatment at a residential program may be most effective, or living for a
time at a supervised sober living environment while getting intensive outpatient
treatment.
Lastly: addiction is a life-long problem, and so its
treatment should be ongoing, through full abstinence and support groups
ResiliencePath: Recommended Reading
By Greg Sazima,
MD
GENERAL
TOPICS The Broken Brain. Nancy C. Andreasen, MD. A classic but accessible
text explaining brain function in psychiatric illness.
By Force of
Fantasy: How We Make our Lives. Ethel Person. A book on the wonder of our
unconcious minds.
The Essential Guide to Mental Health. Jack Gorman,
MD A thorough, clear guide on the latest in treatment.
When Someone
You Love Has A Mental Illness. Rebecca Woolis
PSYCHOTHERAPY Love’s
Executioner. Yalom, Irvin D., MD. A book of vignettes about the experience
of psychotherapy from the point of view of a master therapist.
The Drama
of the Gifted Child. Miller, Alice. An essential book for those from
dysfunctional families.
A Practical Guide to Cognitive Therapy. Dean
Schuyler.
Consumer’s Guide to Psychotherapy. Jack Engler and Daniel
Goleman
DEPRESSION Darkness Visible: A Memoir of Madness. William
Styron A powerful first-person description of depression by one of the best
American writers of this century.
Feeling Good: The New Mood Therapy.
David Burns, MD A popular and helpful book which focuses on
thecognitive/behavioral treatment of depression.
Listening to Prozac.
Peter Kramer, MD A practicing psychiatrist writes on depression and the
ethical, personal and societal issues involved in treatment.
Overcoming
Depression. Demitri Papolos and Janice Papolos.
Understanding Depression.
Donald Klein, MD,. and Paul Wender, MD.
ANXIETY DISORDERS The
Anxiety Disease. David Sheehan. A classic text on anxiety.
Social
Phobia. Richard Heimberg, MD, et al.
Triumph over Fear. Jerilyn
Ross. A first-person account of overcoming anxiety from the president of the
Anxiety Disorders Association of America.
ADHD Driven to
Distraction.Hallowell, Edward M., MD, and Ratey, John J., MD. A rich and
practical book on ADD.
BIPOLAR DISORDER An Unquiet Mind. Kay
Redfield Jamison, Ph.D. A moving autobiography of a psychologist’s own
struggle with Bipolar Disorder.
We Heard the Angels of Madness: A Family
Guide to Coping with Manic Depression. Diane Berger and Lisa
Berger.
GRIEF AND LOSS On Death and Dying. Kubler-Ross, Elizabeth,
PhD. The essential work on the process of grieving.
How We Die.
Nuland, Sherman, B., MD. A surgeon writes compassionately about the process
of dying.
Grief Recovery Handbook. James et. al.
Living When a
Loved One Has Died. Grollman
MEDICATIONS The Essential Guide to
Psychiatric Drugs. Jack Gorman, MD A user-friendly to how medicines work, how to
take them, etc.
Mind, Mood, and Medicine. Donald Klein, MD and Paul
Wender, MD. Dated (1982), but still helpful for anyone considering
medication.
OBSESSIVE/COMPULSIVE DISORDER The Boy Who Couldn’t
Stop Washing. Judith L. Rapoport, MD The best-selling book, written by one of
the leading mental health researchers in the US, on
OCD.
SCHIZOPHRENIA Family Care of Schizophrenia. Ian R.H. Falloon,
MD, et al.
Surviving Schizophrenia. Torrey, E. Fuller, MD. A
thorough, accessible guide for both patients and families out this
illness.
Understanding Schizophrenia. Richard Keefe and Phillip D.
Harvey.
ALCOHOLISM AND DRUG ABUSE The Big Book. Alcoholics
Anonymous.
Twelve Steps and Twelve Traditions. Alcoholics Anonymous.
The classic text of the recovery process.
Safe Passage. Brown,
Stephanie, PhD. A powerful book on recovery for adult children of
alcoholics.
A TIme to Heal. Cermak
Adult Children of Alcoholics.
Woititz
It Will Never Happen to Me. Black
Life Skills for Adult
Children. Woititz et al.
Beyond Co-Dependency. Beattie
Codependent
No More. Beattie
Free At Last: Meditations. Hazleden
Foundation
Help for Helpers. Hazleden Foundation
Living Sober.
Rational Steps to Quitting Alcohol. Albert Ellis.
Staying Sober.
(text and workbook) Terry Gorski. One of the country’s foremost experts on
preventing relapse
