Mental Health Disorders

In the past, mental illness has been viewed as a punishment from God or a form of weakness. However, with advances in psychiatric treatment and medication development, mental health disorders are now seen as medical illnesses, similar to diabetes or high blood pressure. These disorders also have a genetic component to them; they are chronic in nature and tend to get better or worse depending on the treatment and patient compliance. The brain is an organ and can have illnesses, which are separate from the person’s true identity. 

The ability of patients with depression or an anxiety disorder to stop being depressed or anxious is the same as the ability of patients to stop being diabetic or hypertensive. That is, without the right treatment, the chances are very slim that the disorder will spontaneously get better. As in diabetes and hypertension, treatment can require medications and a change in lifestyle. The good news is that we now have more medications available for the treatment of various psychiatric disorders with fewer side effects than previous generations. 

Most psychiatric medications are not addictive and they help to improve the function of certain brain circuits that are involved in the processing of our feelings. Dr. El Asyouty is aware of the need to be cautious about using addictive medications in patients who are in recovery from addiction. It is also important to recognize that people who are in recovery from depression and anxiety often require a change in the way that the individual processes feeling information. 

Bipolar Disorder

Also known as manic-depressive disorder, it is a common mood disorder that unfortunately  had been associated with a bad name because of the media and the press. Also what complicate the problem that it can take up to 10 years for properly diagnose and treat bipolar disorder and during this time, the patient and the people around the patients suffer because of the miss diagnosis and miss treatment.  

The most challenging part of the treatment of bipolar disorder, especially when patients are in a hypomanic phase, is when patients refuse to take their medication because they feel extremely happy and believe their medication is unnecessary. 

The problem with hypomania is that if it is not controlled it can lead to either a manic or severe depressive episode. The DSM V  describes bipolar disorder as a mood disorder that is characterized by having at least one manic episode for type I and at least one hypomanic episode for type II. During a manic episode, there is a noticeable change in mood from the normal non-depressed state to either an elevated or irritable mood that lasts for at least a week or more. The mood change has to be associated with at least 3 or 4 of the following:

• Distractibility: The most common symptom and is usually characterized by the inability to pay attention to any activity for an extended period of time.

• Insomnia in mania typically means having high energy and requiring less sleep. (This differs from insomnia in depression, in which the patient has low energy plus an inability to sleep.)

• Grandiosity: Patients have an inflated sense of themselves, which, in severe cases, can be delusional. Close to 60% of all manic patients experience feelings of omnipotence. Sometimes they feel that they are godlike or have celebrity status.

• Flight of ideas: Thoughts race and others may have a hard time following the patient’s train of thought. This could include incoherent babbling, or simply an inability to stay on topic.

• Activity: An increase in intensity in goal-directed activities occurs, which is related to social behavior, sexual activity, work, school, or combinations.

• Speech: Excessive talking is present.

• Thoughtlessness: Excessive involvement in high-risk activities is present (e.g., unrestrained shopping, promiscuity). A mood disturbance may be severe enough to damage one's job or social functioning or relationships with others, or which requires hospitalization to prevent harm to others or to the self. 

Mixed vs  pure Mania

Manic episodes themselves can be characterized as mixed mania or pure mania. In pure mania, either euphoria or irritability is present along with other symptoms of mania and there are no indications of depression. In mixed mania (also called a mixed state), depressed mood and manic symptoms occur for at least a week. Depression is present most of the day and nearly every day. Symptoms of mania are also present to a significant degree. What is a hypomanic episode?

With hypomania, the symptoms of mania are milder and of shorter duration (but they last at least four days). They do not affect social or work life as dramatically as mania. Notice that the difference is mainly about the severity and length of the episode. In hypomania, there is no impairment of the judgment. 

In fact, all patients consider it as a positive period in their life because they are more productive and can catch up with what they did not do when they were depressed, i.e. cleaning the house, doing laundry, etc. This helps to understand the statement of the angry hypomanic patient to their psychiatrist when he/she wants to treat the hypomanic episode. Bipolar Disorder should be highly suspected in the following population of depressed patients:

• Any patient with a family history of bipolar disorder in the 1st-degree relative should be treated as if they are bipolar even if they never had a manic or hypomanic episode.
  Psychotic symptoms associated with the first episode of mood disorder:
• The patient has failed an adequate trial of at least 3 anti-depressants or the antidepressant worked very fast but stopped working shortly thereafter.
• The patient who became manic or psychotic on antidepressants, other medication, or Marijuana.
• Post-partum depression.
• Family history of alcoholism.
• Patients who have attention deficit & mood disorders.

Major Depression

Depression is another mood disorder that can be a separate illness or part of bipolar disorder or sometimes as a complication of another medical disorder. People with a major medical problem can fall into depression or what we call a mood disorder secondary to a medical condition. So, why do we call depression a medical disorder, and how it is different than the normal sadness that we encounter in our daily life? 

Emotions are very important to our wellbeing and our ability to monitor whether our needs are being met. Normal sadness or grief is part of our make up as human beings. In fact, it is unusual and possibly unhealthy, not to experience sadness or grief when we lose something valuable like a job or a relationship or lose someone to death. The difference is that in depression the normal grief process does not proceed properly or the grief can be distorted by an underlying depression. 

According to the DSM IV RT, the depressive episode has to last daily for at least 2 weeks and should be severe enough to interfere with social, occupational and academic function. It is often accompanied by symptoms that show that the underlying biorhythms of the body are not working either, such as appetite, sleep, energy, and sex drive. There may be an inability to see the positive side of things, an excessive focus on guilt and low self-esteem.

Attention Deficit Disorder

ADD is a very common disorder that is under-diagnosed or under-treated in our society. It has always been looked at as an academic disease for children who are hyperactive. In fact, not all patients with ADD are hyperactive. 

The DSM IV had come up with 2 different types: One with hyperactivity and one without hyperactivity. We now know that it is not just a childhood illness. In fact, a lot of times ADD does not manifest itself until college years or maybe manifested later in life when the ADD is challenged. A person may have learned to cope with their ADD at a younger age, but as things get more complex, their coping strategies may break down and lead to problems. 

Some patients with ADD can manage to control the symptoms while they are in school because of the structured environment and support from the parents with schoolwork and not until they go to college does the ADD manifest itself and become a problem.

Some symptoms of attention problems:

• Forgetful in daily activity (i.e. late for appointments or meetings). Shows up to important meetings forgetting important material for the meeting, misplaces things like cell phones, driver's license, etc.
• Lacks or avoid tasks that require organization skills. Avoids or dislikes paperwork.
• Inability to pay attention or sustain focus in class or important meetings.
• Daydreaming when supposed to be focused. Gets easily distracted. Difficulty maintaining focus while reading and may have to re-read books, even when interested in the material. Does not to seem to be listening when spoken to.
• Impulsivity: frequent job changes, interrupting other people when they are talking.

Adverse effects of ADD on relationships:

Because relationships depend upon communicating and feeling acknowledged by the other person, when patients with ADD get distracted and don't follow through with their partner's request, the partner feels disrespected. Many relationships are adversely affected because of one partner having untreated ADD. How ADD interferes with recovery:

• Untreated patients with ADD have a lot of frustration due to their illness and continue to get negative feedback from others. This increases stress and can lead to relapse on addictive substances.
• ADD can affect the patient’s self-esteem and how they see themselves. If you don't believe in yourself you might fall into a negative train of thought, which goes like, “Why bother trying? I cannot get anything done right.” If this is not challenged, it can lead to the core belief of low self-esteem.
• Another problem is the impulsivity that can be a major factor in not being able to resist the craving for a drug and interferes with the ability to maintain sobriety.

Some of the theories about ADD state that the brain does not secrete enough dopamine (a brain messenger chemical). Patients with ADD may try to seek out activities that force the brain to secrete more dopamine in order to feel normal, including such behavior as drug use, which is known to increase the level of dopamine. They may also seek extreme athletic activities, which produce a lot of physical thrill. 

Anxiety Disorders

Anxiety disorders are characterized by feelings of alarm, worry or panic. While these feelings can be a normal response to life situations, they can be part of a disorder when the feelings interfere with function and getting needs met, instead of helping the person survive.

• Generalized Anxiety Disorder: the patient suffers from chronic daily feelings of anxiety or worry. This may be accompanied by patterns of thinking (such as catastrophic thinking) that exacerbates the feelings of anxiety.
• Obsessive-Compulsive Disorder: the patient suffers from repetitive thoughts that cause anxiety or distress and behaviors (compulsions) which serve to reduce the feelings of anxiety, usually only temporarily.
• Panic Attacks: the patient has episodic feelings of impending doom, apprehension, fearfulness or terror. This may be accompanied by symptoms of rapid heartbeat, sweating, shortness of breath, feeling that one is going to die, dizziness, chest pain, choking or fear of “going crazy”.
• Agoraphobia: the patient experiences fear when he or she is in a place where escape might be difficult or embarrassing. It may be accompanied by panic feelings. The person may not want to leave their house due to these feelings.
• Social Phobia: the patient experiences anxiety in social situations. The patient may then avoid these situations.
• Simple Phobia: the patient experiences anxiety in certain situations or in response to being exposed to certain objects.