Types Of Mental Illness

Attention-Deficit/Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) is a condition characterized by inattention, hyperactivity and impulsivity. The most commonly diagnosed behavior disorder in young people, the Center for Disease Control and Prevention (CDC) reports that ADHD affects an estimated 9 percent of children aged 3-17 and 2-4 percent of adults.

Although ADHD has its onset and is usually diagnosed in childhood, it is not a disorder limited to children—ADHD often persists into adolescence and adulthood and is frequently not diagnosed until later years.

Symptoms, Causes and Diagnosis

There are actually thought to be three different types of ADHD, each with different symptoms: predominantly inattentive, predominantly hyperactive/impulsive and combined. Diagnosing ADHD requires a comprehensive evaluation and cannot be done with one single test.Read more.

Treatment, Services and Support

A key aspect of treating ADHD is taking a “multimodal” approach. This means utilizing multiple methods for treatment including medical, educational, behavioral and psychological. Read more.

Living With ADHD

Children and Adolescents

ADHD may affect each child or youth differently, but it is important for parents to consider such areas as school, coexisting conditions and parenting strategies. Read more.

Adults

Relationships and work are two areas that may be affected in an adult living with ADHD. Learn about legal rights related to workplace modifications and cultural issues that may affect your experience learning to cope with ADHD. Read more.

 

More information available at our NAMI National website: www.nami.org

Autism Spectrum Disorders

Since the causes for Autism Spectrum Disorders are unknown, an ASD diagnosis is based purely on observations or behavioral reports. In contrast to other medical syndromes, ASDs are not diseases: They are developmental disorders that reflect differences in the way that children develop from very early on to adulthood. Within the category of ASDs, there are a number of different levels of severity.

Autism is recognized as receiving the most attention in the area of study. It is defined by difficulties in three areas; social deficits, communication problems, and repetitive or restricted behaviors, with the onset beginning by the age of three. Asperger Syndrome is a form of ASD that is often identified later than the age of three and usually after the age of five. It is associated with the social symptoms of autism and some repetitive interests or behaviors, but not with language or mental delays. Rett Syndrome and Child Disintegrative Disorder (CDD) are both rare forms of ASD that have specific patterns of onset. Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) is a form of ASD used to describe individuals who meet criteria for autism in terms of social difficulties but not in both communication and restricted, repetitive behaviors. This label is often used by professionals when they are not quite sure of a diagnosis or when the symptoms are mild. Several studies have been reported that several more children have PDD-NOS or less clear symptoms as have classic autism.

 

More information available at our NAMI National website: www.nami.org

Bipolar Disorder

Bipolar disorder is a chronic illness with recurring episodes of mania and depression that can last from one day to months. This mental illness causes unusual and dramatic shifts in mood, energy and the ability to think clearly. Cycles of high (manic) and low (depressive) moods may follow an irregular pattern that differs from the typical ups and downs experienced by most people. The symptoms of bipolar disorder can have a negative impact on a person’s life. Damaged relationships or a decline in job or school performance are potential effects, but positive outcomes are possible.

Two main features characterize people who live with bipolar disorder: intensity and oscillation (ups and downs). People living with bipolar disorder often experience two intense emotional states. These two states are known as mania and depression. A manic state can be identified by feelings of extreme irritability and/or euphoria, along with several other symptoms during the same week such as agitation, surges of energy, reduced need for sleep, talkativeness, pleasure-seeking and increased risktaking behavior. On the other side, when an individual experiences symptoms of depression they feel extremely sad, hopeless and loss of energy. Not everyone’s symptoms are the same and the severity of mania and depression can vary.

More than 10 million Americans have bipolar disorder. Because of its irregular patterns, bipolar disorder is often hard to diagnose. Although the illness can occur at any point in life, more than one-half of all cases begin between ages 15-25. Bipolar disorder affects men and women equally.

What Does Recovery Look Like

As people become familiar with their illness, they recognize their own unique patterns of behavior. If individuals recognize these signs and seek effective and timely care, they can often prevent relapses. But because bipolar disorder has no cure, treatment must be continuous.

Individuals who live with bipolar disorder also benefit tremendously from taking responsibility for their own recovery. Once the illness is adequately managed, one must monitor potential side effects.

The notion of recovery involves a variety of perspectives. Recovery is a holistic process that includes traditional elements of physical health and aspects that extend beyond medication. Recovery from serious mental illness also includes attaining, and maintaining, physical health as another cornerstone of wellness.

The recovery journey is unique for each individual. There are several definitions of recovery; some grounded in medical and clinical values, some grounded in context of community and successful living. One of the most important principles of recovery is this: recovery is a process, not an event. The uniqueness and individual nature of recovery must be honored. While serious mental illness impacts individuals in many challenging ways, the concept that all individuals can move towards wellness is paramount.

Bipolar disorder presents a special challenge because its manic, or hypomania, stages can be seductive. People with bipolar disorder may be afraid to seek treatment because they are afraid that they will feel flat, less capable or less creative. These fears must be weighed against the benefits of getting and staying well. A person may feel good while manic but may make choices that could seriously damage relationships, finances, health, home life or job prospects.

It is very common for people living with bipolar disorder to want to discontinue their medication because of side effects or because it has been a long time since the last episode of illness. However, it should be remembered that the progress one has attained is reliant upon continuing to take medication.

Causes, Incidence, and Risk Factors

Borderline Personality Disorder

Borderline Personality Disorder (BPD) is an often misunderstood, serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self image and behavior.  It is a disorder of emotional dysregulation. This instability often disrupts family and work, long-term planning and the individual’s sense of self-identity. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is just as common, affecting between 1 – 2 percent of the general population.The disorder, characterized by intense emotions, self-harming acts and stormy interpersonal relationships, was officially recognized in 1980 and given the name Borderline Personality Disorder. It was thought to occur on the border between psychotic and neurotic behavior.  This is no longer considered a relevant analysis and the term itself, with its stigmatizing negative associations, has made diagnosing BPD problematic. The complex symptoms of the disorder often make patients difficult to treat and therefore may evoke feelings of anger and frustration in professionals trying to help, with the result that many professionals are often unwilling to make the diagnosis or treat persons with these symptoms.  These problems have been aggravated by the lack of appropriate insurance coverage for the extended psychosocial treatments that BPD usually requires.  Nevertheless, there has been much progress and success in the past 25 years in the understanding of and specialized treatment for BPD.  It is, in fact, a diagnosis that has a lot of hope for recovery.What are the Symptoms of Borderline Personality DisorderBorderline Personality Disorder Diagnosis:  DSM IV Diagnostic Criteria

A pervasive pattern of instability of interpersonal relationships, self image and affects, and marked impulsivity beginning by early adulthood ** and present in a variety of contexts, as indicated by five (or more) of the following:

1)   Frantic efforts to avoid real or imagined abandonment.

Note:  Do not include suicidal or self-mutilating behavior*** covered in Criterion 5.

2)   A pattern of unstable and intense interpersonal relationships characterized by alternating between  extremes of idealization and devaluation.

3)  Identity disturbance:  markedly and persistently unstable self-image or sense of self.

4)   Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

Note:  Do not include suicidal or self-mutilating behavior*** covered in Criterion 5.

5)   Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior***.

6)   Affective [mood] instability.

7)   Chronic feelings of emptiness.

8)   Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9)   Transient, stress-related paranoid ideation or severe dissociative symptoms.

*Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association

** Data collected informally from many families indicate this pattern of symptoms may appear as early as the pre-teens

***The preferred term is self-harm or self-injury

Important Considerations about Borderline Personality Disorder

1.   The five of nine criteria needed to diagnose the disorder may be present in a large number of different combinations. This results in the fact that the disorder often presents quite differently from one person to another, thus making accurate diagnosis somewhat confusing to a clinician not skilled in the area.

2.  BPD rarely stands alone.  There is high co-occurrence with other disorders.

3.  BPD affects between 1 – 2 percent of the population.  The highest estimation, 2 percent, approximates the number of persons diagnosed with schizophrenia and bipolar disorder.

4.   Estimates are 10 percent of outpatients and 20 percent of inpatients who present for treatment have BPD

5.  More females are diagnosed with BPD than males by a ratio of about 3-to-1, though some clinicians suspect that males are underdiagnosed.

6.   75 percent of patients self-injure.

7.   Approximately 10 percent of individuals with BPD complete suicide attempts.

8.  A chronic disorder that is resistant to change, we now know that BPD has a good prognosis when treated properly.  Such treatment usually consists of medications, psychotherapy and educational and support groups.

9.  In many patients with BPD, medications have been shown to be very helpful in reducing the severity of symptoms and enabling effective psychotherapy to occur.  Medications are also often essential in the proper treatment of disorders that commonly co-occur with BPD.

10. There are a growing number of psychotherapeutic approaches specifically developed for people with BPD. Dialectical behavioral therapy (DBT) is a relatively recent treatment, developed by Marsha Linehan, Ph.D. To date, DBT is the best-studied intervention for BPD. Find out more about DBT in NAMI’s Borderline Personality Disorder Brochure.

11. These and other treatments have been shown to be effective in the treatment of BPD, and MANY PATIENTS DO GET BETTER!

Theories of Origins and Pathology of Borderline Personality Disorder

At this point in time, clinical theorists believe that biogenetic and environmental components are both necessary for the disorder to develop.  These factors are varied and complex.  Many different environments may further contribute to the development of the disorder.  Families providing reasonably nurturing and caring environments may nevertheless see their relative develop the illness. In other situations, childhood abuse has exacerbated the condition. The best explanation appears to be that there is a confluence of environmental factors and a neurobiological propensity that leads to a sensitive, emotionally labile child.

Co-occurring Disorders

Borderline Personality Disorder rarely stands alone.  BPD occurs with, and complicates, other disorders.

Co-morbidity with other disorders:

Major Depressive Disorder                                                —  60 percent

Dysthymia  (chronic, moderate to mild depression)          —  70 percent

Eating Disorders                                                               —  25 percent

Substance Abuse                                                               — 35 percent

Bipolar Disorder                                                                — 15 percent

Antisocial Personality Disorder                                          — 25 percent

Narcissistic Personality Disorder                                        — 25 percent

Treatment

One of the preliminary questions confronting families/friends is how and when to place confidence in those responsible for treating the patient.  Generally speaking, the more clinical experience the treatment provider has had working with borderline patients, the better.  Most often, a good “fit” with the primary therapist is the “key” to successful therapy intervention.

A discussion of hospitalization and treatment techniques, including specialized treatment for BPD, follows:

A.  Hospitalization:  Hospitalization in the care of those with BPD is usually restricted to the management of crises (including, but not limited to, situations where the individual’s safety is at risk).   It  is not uncommon for medication changes to take place in the context of a hospital stay, where professionals can monitor the impact of new medications in a controlled environment.  Hospitalizations are usually short in duration.

B.   Medications play an important role in the comprehensive treatment of BPD.  For more on this topic, refer to the section on this website “Medications Used and Studied in the Treatment of BPD”.

C.  Psychotherapy:  Psychotherapy is the cornerstone of most treatments for Borderline Personality Disorder.  Although development of a secure attachment to the therapist is generally essential for the psychotherapy to have useful effects, this does not occur easily with the BPD diagnosed individual, given the intense needs and fears about relationships.  The standard recommendation for individual psychotherapy involves one to two visits a week with an experienced clinician.  The symptoms of the disorder can be as difficult for professionals to experience as those experienced by family members.  Some therapists are apprehensive about working with individuals with this diagnosis.

There are currently three major psychotherapeutic approaches to treatment of BPD:

1.  Psychodynamic

2.  Cognitive-behavioral

3.  Supportive

D.  Group Modalities:  DBT and CBT interventions are often like classes with much focus and direction offered by the group leader(s) and with homework/practice exercises assigned between sessions based on the material presented during the session.  DBT, for example has a manual that is followed each week where both the lectures and the practice exercises are put together for easy access.  Some patients with BPD may be resistant to interpersonal or psychodynamic groups which require the expression of strong feelings or the need for personal disclosures.  However, such forums may be useful for these very reasons.  Moreover, such groups offer an opportunity for borderline patients to learn from persons with similar life experiences, which, in conjunction with the other modalities discussed here, can significantly enhance the treatment course.  Many individuals with BPD find it more acceptable to join self-help groups, such as AA.  Self-help groups that provide a network of supportive peers can be useful as an adjunct to treatment, but should not be relied on as the sole source of support.

E.  Family Therapy:  Parents, spouses and children bear a significant burden.  Often, family members are grateful to be educated about the borderline diagnosis, the likely prognosis, reasonable expectations from treatment, and how they can contribute.  These interventions often improve communication, decrease alienation, and relieve family burdens.  Some mental disorders, as in the treatment of schizophrenia, require close family involvement in the treatment process to be optimally effective.  There are now preliminary research data that suggest that family involvement is also very important in the effective treatment of borderline disorder.

Several organizations offer education programs and/or support to families challenged with mental health issues.  The National Alliance on Mental Illness (NAMI), The National Education Alliance for Borderline Personality Disorder (NEA-BPD), The Depression and Bipolar Support Association (DBSA) and the Mental Health Association(MHA) offer programs across the nation.

Family training and support programs such as NAMI’s Family to Family  and NEA- BPD’s Family Connections  (www.neabpd.org) are in great demand.  Nonetheless, too often many psychiatrists and other mental health clinicians continue to deny meaningful input from family members of a client with BPD.  This situation is especially frustrating for family members, who often provide the sole financial support for everyday living and treatment expenses, and much of the moral support, but who receive little or no response from the treating professionals.  Families are especially distressed when the treatment plan is not effective, and their loved one isolates them from their therapists.  Given the importance of the family in establishing functional relationships in the lives of people with borderline disorder, families should actively seek “family friendly” treatments and/or treatment providers and investigate family classes and support groups in their communities.

Suicidality and Self-harming Behavior

The most dangerous and fear-inducing features of BPD are the self-harm behaviors and potential for suicide.  An estimated 10 percent  kill themselves.  Deliberate self harming (cutting, burning, hitting, head banging, hair pulling) is a common feature of BPD.  Individuals who self harm report that causing themselves physical pain generates a sense of release and relief which temporarily alleviates excruciating emotional feelings.  Self-injurious acts can bring relief by stimulating production of endorphins, which are naturally occurring opiates produced by the brain in response to pain.  Some individuals with BPD also exhibit self-destructive acts such as promiscuity, bingeing, purging and blackouts from substance abuse.

It is important for the client, family, and clinician to be able to draw a distinction between the intent behind suicide attempts and self-injurious behaviors (SIB).  Patients and researchers frequently describe self-injurious behavior as a means of reducing intense feelings of emotional pain.  The release of the endogenous opiates provides a reward to the behavior.  Some data suggest that self-injurious behavior in BPD patients doubles the risk of suicide attempts. This dichotomy of intent between these two behaviors requires careful evaluation and relevant therapy to meet the needs of the patient.

Medications Studied and Used in the Treatment of Borderline Personality Disorder

There are two reasons why medications are used in the treatment of BPD.  First, they have proven to be very helpful in stabilizing the emotional reactions, reducing impulsivity, and enhancing thinking  and reasoning abilities in people with the disorder.  Second, medications are also effective in treating the other emotional disorders that are frequently associated with borderline disorder like depression and anxiety.

The group of medications that have been studied most for the treatment of borderline disorder are neuroleptics and atypical antipsychotic agents.  At their usual doses, these medications are very effective in improving the disordered thinking, emotional responses, and behavior of people with other mental disorders, such as bipolar disorder and schizophrenia.  However, at smaller doses they are helpful in decreasing the over-reactive emotional responses and impulsivity, and in improving the abilities to think and reason for people with BPD.  Low doses of these medications often reduce depressed moods, anger, and anxiety, and decrease the severity and frequency of impulsive actions.  In addition, clients with borderline disorder report a considerable improvement in their ability to think rationally.  There’s also a reduction, or elimination of, paranoid thinking, if this is a problem.

Medications Studied and Used in the Treatment of Borderline Disorder  is adapted from the book, “Borderline Personality Disorder Demystified ” by Dr. Robert O. Friedel, Marlowe & Co., 2004.

Side Effects of Medications Used to Treat Borderline Personality Disorder

All medications have side effects.  Different medications produce different side effects, and people differ in the amount and severity of side effects they experience.  Side effects can often be treated by changing the dose of the medication or switching to a different medication.  Antidepressants may cause dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, or weight gain or loss.  One class of antidepressants, the monoamine oxidase inhibitors (MAOIs) have strict food restrictions with the consequence of life threatening elevation of blood pressure. The SSRIs and newer antidepressants tend to have fewer and different side effects such as nausea, nervousness, insomnia, diarrhea, rash, agitation, sexual problems, or weight gain or loss.  Mood stabilizers could cause side effects of nausea, drowsiness, dizziness and possibly tremors.  Some require periodic blood tests to monitor liver function and blood cell count.

The group of medications that have been studied most for the treatment of borderline disorder are neuroleptics and atypical antipsychotic agents.  The neuroleptics were the first generation of medications used to treat psychotic disorders.  The atypical antipsychotics are the second generation of  medications developed to treat psychotic disorders.  A specific side-effect the neuroleptics may produce is called tardive dyskinesia.  This is an abnormal, involuntary movement disorder that typically occurs in those receiving average to large doses of neuroleptics.  The risk appears to be less with low doses of neuroleptics or the atypical antipsychotic agents.  Atypical antipsychotics and/or traditional narcoleptics could have the ability to produce weight gain, drowsiness, insomnia, breast engorgement and discomfort, lactation, and restlessness.  Some of the side-effects are temporary and others are persistent.  Before starting on a traditional neuroleptic or atypical antipsychotic, review the side-effect profile with the treating psychiatrist.

 


A portion of the above material provided with permission from:

Borderline Personality Disorder Demystified by Robert O. Friedel, M.D., Marlowe & Co., 2004

<pNational Education Alliance for Borderline Personality Disorder’s Teachers Manual for Family Connections, 2006

A BPD Brief, An Introduction to Borderline Personality Disorder by John G. Gunderson, M.D., 2006

Related Resources
A BPD Brief: An Introduction to Borderline Personality Disorder
Read an introduction to Borderline Personality Disorder which includes information on diagnosis, origins, course, and treatment.
Basic Library on Borderline Personality Disorder
Robert O. Friedel, M.D. author of Borderline Personality Disorder Demystified, and www.BPDdemystified.com shares a list of books on Borderline Personality Disorder.
Substance-Use Disorders Co-Occurring with Borderline Disorder
Fact sheet by Dr. Robert Friedel on substance abuse and borderline personality disorder.
Self-Injurious Behaviors and Suicidality in Borderline Disorder
Fact sheet by Dr. Robert Friedel on self injurious behaviors and suicide in individuals with borderline personality disorder.
Early Sea Changes in Borderline Personality Disorder
Article by Dr. Robert Friedel on the sea changes in research and practice in the field of borderline personality disorder.
More Resources…
Mental Illness Discussion Groups
Dozens of online groups for consumers, parents, spouses, siblings, teens and more. Get connected and find support.
Related Links
behavioraltech.org
Behavioral Tech, LLC a site founded by Dr. Marsha Linehan.
National Education Alliance for Borderline Personality Disorder (NEA-BPD)
A non-profit organization started by family members, consumers, and professionals to educate stake-holders about borderline personality disorder.
National Institute of Mental Health
Information from the NIH institute on borderline personality disorder.
www.bpdcentral.org
BDP Central, a site founded by author Randi Kreger.
www.bpdresourcecenter.org
Borderline Personality Disorder Resource Center (run by New York Presbyterian, the University Hospital of Columbia and Cornell).

More information available at our NAMI National website: www.nami.org

Dissociative Disorders

Dissociative disorders are so-called because they are marked by a dissociation from or interruption of a person’s fundamental aspects of waking consciousness (such as one’s personal identity, one’s personal history, etc.). Dissociative disorders come in many forms, the most famous of which is dissociative identity disorder (formerly known as multiple personality disorder). All of the dissociative disorders are thought to stem from trauma experienced by the individual with this disorder. The dissociative aspect is thought to be a coping mechanism — the person literally dissociates himself from a situation or experience too traumatic to integrate with his conscious self. Symptoms of these disorders, or even one or more of the disorders themselves, are also seen in a number of other mental illnesses, including post-traumatic stress disorder, panic disorder, and obsessive compulsive disorder.

Dissociative amnesia: This disorder is characterized by a blocking out of critical personal information, usually of a traumatic or stressful nature. Dissociative amnesia, unlike other types of amnesia, does not result from other medical trauma (e.g. a blow to the head). Dissociative amnesia has several subtypes:

  • Localized amnesia is present in an individual who has no memory of specific events that took place, usually traumatic. The loss of memory is localized with a specific window of time. For example, a survivor of a car wreck who has no memory of the experience until two days later is experiencing localized amnesia.
  • Selective amnesia happens when a person can recall only small parts of events that took place in a defined period of time. For example, an abuse victim may recall only some parts of the series of events around the abuse.
  • Generalized amnesia is diagnosed when a person’s amnesia encompasses his or her entire life.
  • Systematized amnesia is characterized by a loss of memory for a specific category of information. A person with this disorder might, for example, be missing all memories about one specific family member.

Dissociative fugue is a rare disorder. An individual with dissociative fugue suddenly and unexpectedly takes physical leave of his or her surroundings and sets off on a journey of some kind. These journeys can last hours, or even several days or months. Individuals experiencing a dissociative fugue have traveled over thousands of miles. An individual in a fugue state is unaware of or confused about his identity, and in some cases will assume a new identity (although this is the exception).

Dissociative identity disorder (DID), which has been known as multiple personality disorder, is the most famous of the dissociative disorders. An individual suffering from DID has more than one distinct identity or personality state that surfaces in the individual on a recurring basis. This disorder is also marked by differences in memory which vary with the individual’s “alters,” or other personalities. For more information on this, see the NAMI factsheet on dissociative identity disorder.

Depersonalization disorder is marked by a feeling of detachment or distance from one’s own experience, body, or self. These feelings of depersonalization are recurrent. Of the dissociative disorders, depersonalization is the one most easily identified with by the general public; one can easily relate to feeling as they in a dream, or being “spaced out.” Feeling out of control of one’s actions and movements is something that people describe when intoxicated. An individual with depersonalization disorder has this experience so frequently and so severely that it interrupts his or her functioning and experience. A person’s experience with depersonalization can be so severe that he or she believes the external world is unreal or distorted.

Treatment
Since dissociative disorders seem to be triggered as a response to trauma or abuse, treatment for individuals with such a disorder may stress psychotherapy, although a combination of psychopharmacological and psychosocial treatments is often used. Many of the symptoms of dissociative disorders occur with other disorders, such as anxiety and depression, and can be controlled by the same drugs used to treat those disorders. A person in treatment for a dissociative disorder might benefit from antidepressants or antianxiety medication.

 

Reviewed by Jack D. Maser, Ph.D. of the National Institute of Mental Health, Rockville, MD

 

Permission is granted for this fact sheet to be reproduced in its entirety, including the NAMI name, service mark, and contact information. (June 2000)
Related Resources
Find Support
Learn more about the full spectrum of programs and services that NAMI provides across the country for people living with mental illnesses, and their families and loved ones.
Mental Illness Discussion Groups
Dozens of online groups for consumers, parents, spouses, siblings, teens and more. Get connected and find support.

More information available at our NAMI National website: www.nami.org

Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder

What are dual diagnosis servicesDual diagnosis services are treatments for people who suffer from co-occurring disorders — mental illness and substance abuse. Research has strongly indicated that to recover fully, a consumer with co-occurring disorder needs treatment for both problems — focusing on one does not ensure the other will go away. Dual diagnosis services integrate assistance for each condition, helping people recover from both in one setting, at the same time.Dual diagnosis services include different types of assistance that go beyond standard therapy or medication: assertive outreach, job and housing assistance, family counseling, even money and relationship management. The personalized treatment is viewed as long-term and can be begun at whatever stage of recovery the consumer is in. Positivity, hope and optimism are at the foundation of integrated treatment.How often do people with severe mental illnesses also experience a co-occurring substance abuse problem

There is a lack of information on the numbers of people with co-occurring disorders, but research has shown the disorders are very common. According to reports published in the Journal of the American Medical Association (JAMA):

  • Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.
  • Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
  • Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

The best data available on the prevalence of co-occurring disorders are derived from two major surveys: the Epidemiologic Catchment Area (ECA) Survey (administered 1980-1984), and the National Comorbidity Survey (NCS), administered between 1990 and 1992.

Results of the NCS and the ECA Survey indicate high prevalence rates for co-occurring substance abuse disorders and mental disorders, as well as the increased risk for people with either a substance abuse disorder or mental disorder for developing a co-occurring disorder. For example, the NCS found that:

  • 42.7 percent of individuals with a 12-month addictive disorder had at least one 12-month mental disorder.
  • 14.7 percent of individuals with a 12-month mental disorder had at least one 12-month addictive disorder.

The ECA Survey found that individuals with severe mental disorders were at significant risk for developing a substance use disorder during their lifetime. Specifically:

  • 47 percent of individuals with schizophrenia also had a substance abuse disorder (more than four times as likely as the general population).
  • 61 percent of individuals with bipolar disorder also had a substance abuse disorder (more than five times as likely as the general population).

Continuing studies support these findings, that these disorders do appear to occur much more frequently then previously realized, and that appropriate integrated treatments must be developed.

What are the consequences of co-occurring severe mental illness and substance abuse

For the consumer, the consequences are numerous and harsh. Persons with a co-occurring disorder have a statistically greater propensity for violence, medication noncompliance, and failure to respond to treatment than consumers with just substance abuse or a mental illness. These problems also extend out to these consumers’ families, friends and co-workers.

Purely health-wise, having a simultaneous mental illness and a substance abuse disorder frequently leads to overall poorer functioning and a greater chance of relapse. These consumers are in and out of hospitals and treatment programs without lasting success. People with dual diagnoses also tend to have tardive dyskinesia (TD) and physical illnesses more often than those with a single disorder, and they experience more episodes of psychosis. In addition, physicians often don’t recognize the presence of substance abuse disorders and mental disorders, especially in older adults.

Socially, people with mental illnesses often are susceptible to co-occurring disorders due to “downward drift.” In other words, as a consequence of their mental illness they may find themselves living in marginal neighborhoods where drug use prevails. Having great difficulty developing social relationships, some people find themselves more easily accepted by groups whose social activity is based on drug use. Some may believe that an identity based on drug addiction is more acceptable than one based on mental illness.

Consumers with co-occurring disorders are also much more likely to be homeless or jailed. An estimated 50 percent of homeless adults with serious mental illnesses have a co-occurring substance abuse disorder. Meanwhile, 16% of jail and prison inmates are estimated to have severe mental and substance abuse disorders. Among detainees with mental disorders, 72 percent also have a co-occurring substance abuse disorder.

Consequences for society directly stem from the above. Just the back-and-forth treatment alone currently given to non-violent persons with dual diagnosis is costly. Moreover, violent or criminal consumers, no matter how unfairly afflicted, are dangerous and also costly. Those with co-occurring disorders are at high risk to contract AIDS, a disease that can affect society at large. Costs rise even higher when these persons, as those with co-occurring disorders have been shown to do, recycle through healthcare and criminal justice systems again and again. Without the establishment of more integrated treatment programs, the cycle will continue.

Why is an integrated approach to treating severe mental illnesses and substance abuse problems so important

Despite much research that supports its success, integrated treatment is still not made widely available to consumers. Those who struggle both with serious mental illness and substance abuse face problems of enormous proportions. Mental health services tend not to be well prepared to deal with patients having both afflictions. Often only one of the two problems is identified. If both are recognized, the individual may bounce back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them. Fragmented and uncoordinated services create a service gap for persons with co-occurring disorders.

Providing appropriate, integrated services for these consumers will not only allow for their recovery and improved overall health, but can ameliorate the effects their disorders have on their family, friends and society at large. By helping these consumers stay in treatment, find housing and jobs, and develop better social skills and judgment, we can potentially begin to substantially diminish some of the most sinister and costly societal problems: crime, HIV/AIDS, domestic violence and more.

There is much evidence that integrated treatment can be effective. For example:

  • Individuals with a substance abuse disorder are more likely to receive treatment if they have a co-occurring mental disorder.
  • Research shows that when consumers with dual diagnosis successfully overcome alcohol abuse, their response to treatment improves remarkably.

With continued education on co-occurring disorders, hopefully, more treatments and better understanding are on the way.

What does effective integrated treatment entail

Effective integrated treatment consists of the same health professionals, working in one setting, providing appropriate treatment for both mental health and substance abuse in a coordinated fashion. The caregivers see to it that interventions are bundled together; the consumers, therefore, receive consistent treatment, with no division between mental health or substance abuse assistance. The approach, philosophy and recommendations are seamless, and the need to consult with separate teams and programs is eliminated.

Integrated treatment also requires the recognition that substance abuse counseling and traditional mental health counseling are different approaches that must be reconciled to treat co-occurring disorders. It is not enough merely to teach relationship skills to a person with bipolar disorder. They must also learn to explore how to avoid the relationships that are intertwined with their substance abuse.

Providers should recognize that denial is an inherent part of the problem. Patients often do not have insight as to the seriousness and scope of the problem. Abstinence may be a goal of the program but should not be a precondition for entering treatment. If dually diagnosed clients do not fit into local Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups, special peer groups based on AA principles might be developed.

Clients with a dual diagnosis have to proceed at their own pace in treatment. An illness model of the problem should be used rather than a moralistic one. Providers need to convey understanding of how hard it is to end an addiction problem and give credit for any accomplishments. Attention should be given to social networks that can serve as important reinforcers. Clients should be given opportunities to socialize, have access to recreational activities, and develop peer relationships. Their families should be offered support and education, while learning not to react with guilt or blame but to learn to cope with two interacting illnesses.

What are the key factors in effective integrated treatment

There are a number of key factors in an integrated treatment program.

Treatment must be approached in stages. First, a trust is established between the consumer and the caregiver. This helps motivatethe consumer to learn the skills for actively controlling their illnesses and focus on goals. This helps keep the consumer on track,preventing relapse. Treatment can begin at any one of these stages; the program is tailored to the individual.

Assertive outreach has been shown to engage and retain clients at a high rate, while those that fail to include outreach lose clients. Therefore, effective programs, through intensive case management, meeting at the consumer’s residence, and other methods of developing a dependable relationship with the client, ensure that more consumers are consistently monitored and counseled.

Effective treatment includes motivational interventions, which, through education, support and counseling, help empower deeply demoralized clients to recognize the importance of their goals and illness self-management.

Of course, counseling is a fundamental component of dual diagnosis services. Counseling helps develop positive coping patterns, as well as promotes cognitive and behavioral skills. Counseling can be in the form of individual, group, or family therapy or a combination of these.

A consumer’s social support is critical. Their immediate environment has a direct impact on their choices and moods; therefore consumers need help strengthening positive relationships and jettisoning those that encourage negative behavior.

Effective integrated treatment programs view recovery as a long-term, community-based process, one that can take months or, more likely, years to undergo. Improvement is slow even with a consistent treatment program. However, such an approach prevents relapses and enhances a consumer’s gains.

To be effective, a dual diagnosis program must be comprehensive, taking into account a number of life’s aspects: stress management, social networks, jobs, housing and activities. These programs view substance abuse as intertwined with mental illness, not a separate issue, and therefore provide solutions to both illnesses together at the same time.

Finally, effective integrated treatment programs must contain elements of cultural sensitivity and competence to even lure consumers, much less retain them. Various groups such as African-Americans, homeless, women with children, Hispanics and others can benefit from services tailored to their particular racial and cultural needs.

Reviewed by Robert Drake, MD September 2003

Related Resources
About Medications
Information about medications used in the treatment of serious mental illnesses
Find Support
Learn more about the full spectrum of programs and services that NAMI provides across the country for people living with mental illnesses, and their families and loved ones.
Online Discussion
Living with Mental Illness & Substance Abuse
Find support, share knowledge, ask questions and meet people who’ve been there.
Mental Illness Discussion Groups
Dozens of online groups for consumers, parents, spouses, siblings, teens and more. Get connected and find support.
Related Links
Clinicaltrials.gov
Dual diagnosis research studies identified through the U.S. National Library of Medicine’s link to federally and privately funded studies worldwide.
Ken Minkoff, M.D.
A Web site with information on addictive psychiatry, dual disorders and more.
The Dual Diagnosis Website
A web-based informational resource on co-occurring disorders.

More information available at our NAMI National website: www.nami.org

Eating Disorders

What is anorexia nervosa

Anorexia nervosa is a serious, occasionally chronic, and potentially life-threatening eating disorder defined by a refusal to maintain minimal body weight within 15 percent of an individual’s normal weight. Other essential features of this disorder include an intense fear of gaining weight, a distorted body image, denial of the seriousness of the illness, and amenorrhea (absence of at least three consecutive menstrual cycles when they are otherwise expected to occur).

There are two subtypes of anorexia nervosa. In the restricting subtype, people maintain their low body weight purely by restricting their food intake and, possibly, by excessive exercise. Individuals with the binge eating/purging subtype also restrict their food intake, but also regularly engage in binge eating and/or purging behaviors such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas. Many people move back and forth between subtypes during the course of their illness.

What is Binge Eating Disorder (BED)

Individuals with binge eating disorder (BED) engage in binge eating, but in contrast to people with bulimia nervosa (BN) they do not regularly use inappropriate compensatory weight control behaviors such as fasting or purging to lose weight. Binge eating, by definition, is eating that is characterized by rapid consumption of a large amount of food by social comparison and experiencing a sense of the eating being out of control.

What is bulimia nervosa

Bulimia nervosa is a serious eating disorder marked by a destructive pattern of binge-eating and recurrent inappropriate compensatory behaviors to control one’s weight. It can occur together with other psychiatric disorders such as depression, obsessive-compulsive disorder, substance dependence, or self-injurious behavior. Bulimia nervosa is an invisible eating disorder, because patients are of normal weight or overweight. Binge eating is the rapid consumption of an unusually large amount of food in a short period of time. Unlike simple overeating, the hallmark feature of a binge is feeling out of control.

What is Eating Disorder Not Otherwise Specified (EDNOS)

The Diagnostic and Statistical Manual – 4th Edition (DSM-IV) recognizes two distinct eating disorder types, anorexia nervosa and bulimia nervosa. If a person is struggling with eating disorder thoughts, feelings or behaviors, but does not have all the symptoms of anorexia or bulimia, that person may be diagnosed with eating disorder not otherwise specified (EDNOS).

Anorexia Nervosa
NAMI’s Fact Sheet on Anorexia Nervosa
Binge Eating Disorder
NAMI’s Fact Sheet on Binge Eating Disorder
Bulimia
NAMI’s Fact Sheet on Bulimia
Eating Disorder Not Otherwise Specified (EDNOS)
NAMI’s Fact Sheet on Eating Disorder Not Otherwise Specified (EDNOS)
Healthy Eating
NAMI’s Fact Sheet on Healthy Eating
Related Resources
Find Support
Learn more about the full spectrum of programs and services that NAMI provides across the country for people living with mental illnesses, and their families and loved ones.
Online Discussion
Living with an Eating Disorder
Find support, share knowledge, ask questions and meet people who’ve been there.
Mental Illness Discussion Groups
Dozens of online groups for consumers, parents, spouses, siblings, teens and more. Get connected and find support.
Related Links
Academy for Eating Disorders
An international, multidisciplinary professional organization that promotes research, treatment, and prevention of eating disorders.
ANAD – National Association of Anorexia Nervosa and Associated Disorders
A non-profit corporation which seeks to alleviate the problems of eating disorders, especially anorexia nervosa and bulimia nervosa.
Anorexia Nervosa and Related Eating Disorders, Inc.
A non-profit organization that provides information about eating disorders.
Associacion Civil de Lucha Contra Desordenes Alimentarios
A Spanish website with information on eating disorders.
Clinicaltrials.gov
Eating disorder research studies identified through the U.S. National Library of Medicine’s link to federally and privately funded studies worldwide.
F.E.A.S.T.
F.E.A.S.T. is an organization of and for parents and caregivers to help loved ones recover from eating disorders by providing information and mutual support, promoting evidence-based treatment, and advocating for research and education to reduce the suffering associated with eating disorders.
National Eating Disorders Association
An organization dedicated to the elimination of eating disorders through research, prevention, treatment, and advocacy.
National Institute of Mental Health
Information from the NIH institute on eating disorders.
Nova: Dying to Be Thin
Companion website to the December 12th, 2000 broadcast of the PBS film “Dying to Be Thin.”

More information available at our NAMI National website: www.nami.org

Major Depression

Overview

Depression or depressive disorder may involve one or more of the following: feelings of melancholy, loss of energy and/or appetite, insomnia or hypersomnia and/or a loss of interest in others, sex and life generally. It may be related to specific events like a death in the family or it may be chronic and continuous with little apparent relationship to daily events. Depression negatively impacts every aspect of a person’s life including the way they feel about themselves and the way they sleep, eat and interact with others. It may be experienced for hours, days, weeks, months and years.

The most commonly occurring form of depression is dysthymia. Dysthymia can range from moderate to severe. Dysthymia is characterized by a generalized lack of enjoyment or pleasure in life including a loss of energy, appetite and sexual desire that continues for at least six months. People with dysthymia often withdrawal from all social activities.

The most severe form of depression is called “major depression”. Major depression can be totally incapacitating. Individuals with major depression withdrawal socially and may not even be able to get out of bed. Major depression is episodic. It may last days or weeks. It may occur once, or in episodes throughout a person’s lifetime.

While the causes are not clear, research has shown that major depression may be caused by imbalances of brain chemicals, specifically the neurotransmitters serotonin and norepinephrine. Other medical problems, medications and even viruses may cause or contribute to major depression. Major depression may occur at any age, from childhood to late in life. While anybody may experience major depression, research clearly shows that depression runs in families. If left untreated, it may become a chronic, debilitating illness that can be life threatening.

Approximately 9.5 million people in America experience episodes of major depression each year. According to the World Health Organization, depression will be the second largest medical burden in the world by 2020. Less than 25 percent of people with depression currently receive treatment despite the fact that 80 to 90 percent of people with depression can be effectively treated with therapy and medication. Many individuals with depression simply do not have the energy or willingness to seek help. They may also fear the stigma associated with mental illness generally. This is unfortunate, because new medications and therapies make it possible for individuals with major and moderate depression to live near normal lives.

Symptoms

Major depression is experienced in the body as well as in the mind. Typical symptoms of major depression last for more than two weeks and include deep feelings of melancholy that are not changed by good news or the comfort of others. A person suffering from depression may express feelings of uselessness, hopelessness, profound sadness, or despair. They may experience chronic headaches, fatigue, or digestive problems that do not respond to treatment. An individual that is deep in depression may not shower, change their clothes, or get out of bed. They may be irritable, angry, or unable to concentrate. People with a depressive illness cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years.

Many complaints seem more physical than mood-related. A person with depression might say that it is stress that causes their fatigue, sleeplessness, or changes in appetite. Men often mask their symptoms of depression with anger or by pouring their energy into work. Women seem especially vulnerable to depression following changes in body chemistry, particularly after the birth of a child. Depression among the elderly is often diagnosed incorrectly, since these people tend to lose energy and slow down in their activities as a direct response to aging. Children suffering from depression may cling to a parent, or pretend to be sick, become isolated, and/or refuse to go to school. They may worry that a parent will die or abandon them. It is common for a person with major depression to have suicidal thoughts, though they may not express them.

According to the National Institute of Mental Health (NIMH), half of those who experience clinical or major depression will experience it two or more times. About a quarter of those that experience major depression will suffer from it chronically throughout their life. Episodes of depression can become more frequent and occur with increasing severity without treatment.

Causes, Genetic Factors and Cultural Influences

Major depressive disorder is often associated with changes in brain structure or brain chemistry. Research shows that children of parents with depression are at greater risk of experiencing depression themselves.

Cultural and environmental factors may also play a role in major depression. Recent Center for Disease Control statistics shows that Asian American women have the highest suicide rate in the 15 to 24 and over-65 age groups. They also found that Asian American adolescent girls have the highest symptoms of depression. Asians are also more likely to explain symptoms of depression in terms of physical problems.

There is also evidence the Hispanic Americans born in the United States experience greater depression and attempt suicide more often than Non-Hispanics. In studies conducted among adults of Asian and Mexican origin, feelings of racial discrimination were found to have a strong correlation to symptoms of depression.

Risks

Alcohol and drug abuse, eating disorders, and anxiety disorders often coexist with major depression. A person who abuses alcohol and/or drugs to treat their depression may also become addicted to them. If this occurs, they may receive a “dual diagnosis” of depression and addiction. Depressed individuals often use or abuse alcohol and drugs to cope with the illness. Such use may actually intensify the symptoms and depth of the illness.

Sometimes, people under successful treatment for depression are uncomfortable with the side effects of the medication. These can include dry mouth, nausea, reduced sexual drive, tremors, anxiety, and weight gain. If the effects are severe enough, the person may decide to stop taking their medication, increasing their risk of returning to deep depression. They also may run the risk of experiencing severe physical symptoms if they abruptly discontinue their medication without a physician’s support.

Suicide is an extremely serious possibility in major depression. Surprisingly, the risk escalates when the depressed person begins to feel a little better and gains enough energy to commit suicide. Do not hesitate to contact 911 emergency services in a crisis.

Treatment

The treatment for major depression typically involves a combination of medications and therapy. While not 100 percent effective, such treatment can help individuals with depression lead effective and functional lives. The first step in treatment is getting a physical evaluation to rule out a medication reaction or other illnesses as a cause of the symptoms. The evaluation should include a comprehensive family history along with an assessment of alcohol and drug use. Some people with mild depression are helped with therapy alone. Individuals with major and moderate levels of depression may be prescribed combined treatments of medication and therapy for the most-effective relief.

There are four main types of medications commonly used to treat major depression. One group of drugs is called heterocyclics or tricyclics imipramine (Tofranil®), protriptyline (Vivactil®), clomipramine (Anafranil®), amoxapine (Asendin®), nortriptyline (Aventyl®), and desipramine (Norpramin®). More recent medications belong to the family of selective serotonin reuptake inhibitors fluoxetine (Prozac®), sertraline (Zoloft®), nefazodone (Serzone®), and paroxetine (Paxil®). Physicians may also prescribe MAO inhibitors phenelzine (Nardil®), tranylcypromine (Parnate®). The final medication is lithium (Lithonate®, Eskalith®, Lithobid®, or Lithotabs®), more typically used for bipolar disorder.

The interaction of these medications with individual body chemistry is not totally predictable. As a result, it may take several prescriptions over a period of weeks or months to identify the most appropriate drug treatment for an individual. The type and intensity of side effects may also vary by individual. Typical side effects including dizziness, insomnia, dry mouth, constipation, reduced sexual drive and performance, and weight gain may occur. Be sure to report unanticipated side effects to your doctor

In some cases electroconvulsive therapy (ECT) is used with individuals with life-threatening depression or who cannot take antidepressant medication. There may be more than one ECT procedure, conducted under mild anesthesia. It has proven to be an effective and safe procedure in these difficult situations.

There are short and long-term modes of therapy that are effective in treating depression. For some people, a short-term (10 to 20 week) course of therapy works best. Doctors can help a person identify problems and solutions and create new behaviors. This process can help the person change negative perceptions that contribute to depression. Other people with depression may undertake long-term talk therapy to resolve deep, historical issues. Physicians may also recommend changes in lifestyle, diet and exercise.

How You Can Help

If you think a friend or family member needs help, the National Institute of Mental Health (NIMH) recommends that you encourage the individual to get an evaluation from a mental health professional. Family members and friends can help an individual recognize that they have an illness that can be treated if they are willing. It is important to understand that diagnosing serious mental illness is not simple or straightforward. Your doctor may need to revise the initial diagnosis, treatment and drug therapies one or more times over a period of weeks or months to find the best treatment regimen.

Sometimes, family members and friends need to intervene if a loved one with serious mental illness refuses to obtain treatment. This can be a very difficult situation for both the individual with the illness and the family members and friends. It is important to obtain assistance from a mental health professional to guide you through the medical and legal issues involved in an intervention.

Family members and friends of a person with serious mental illness can help by offering their support and affection to the extent possible. It is important to understand that people with serious mental illness cannot simply “pull themselves together” and get better. The support of family members and friends over the long term can be invaluable to an individual with a serious mental illness. Support groups can also be invaluable. Consumer groups offer individuals with mental illness an opportunity to share their needs, concerns and struggles with others in the same situation. Consumer support groups are available in many communities.

Family members and friends need to become educated about serious mental illness. They also need to take care of their own emotional needs. Support groups can also help family members and friends cope with their loved one’s illness. Family support groups provide a place for family members to share their experiences and obtain current information and education about their loved one’s mental illness.

NAMI California maintains a list of NAMI affiliates in your community that offer resources and support to individuals and families needing help with serious mental illness. The list includes information, contact persons, crisis numbers, telephone listings, and email contacts.

Family physicians, mental health professionals, religious counselors, community mental health centers, social service agencies, state and private hospitals are also available to provide help and support as needed. NAMI California maintains a current list mental health professionals (psychiatrists, psychologists, care homes, etc.) that provide support for serious mental illness in your community.

NAMI California also offers the “Family-to-Family” program to educate and support families who have members afflicted with a serious mental illness.

Finally, and most importantly, do not hesitate to get help from your local 911 emergency service or suicide hotline in a crisis.

For additional information, visit these web sites

National Alliance for Research on Schizophrenia and Depression

Depression and Bipolar Support Alliance

Obsessive Compulsive Disorder (OCD)

It is difficult to estimate the number of people with OCD disorder, because so few of them seek help. A National Institute of Mental Health (NIMH) survey reports that OCD affects about three million Americans. Symptoms usually begin in young adulthood, although one third of people with OCD report experiencing some symptoms during their childhood. OCD can also be accompanied by eating disorders, depression, or other anxiety disorders. There is no single, identifiable cause for OCD. However, the combination of medication and therapy has proven to be an effective treatment for many people with OCD.

Symptoms

OCD is characterized by repeated behaviors sparked by anxious feelings or obsessions that may include contamination by dirt or germs, imagined harm to loved ones, runaway sexual urges, and devastating moral guilt. Compulsions are the repeated behaviors or rituals that the person is driven to complete perfectly to cope with their anxiety. A person with OCD feels obligated against their will to wash, clean, organize, or speak specific phrases in rituals that can consume hours of their days. For example, they may find themselves hoarding collections of objects that they have to count routinely to make sure none have disappeared. Some cannot leave the house without performing precise physical routines.

The chronic compulsions can become so complex that they adversely affect the person’s relationships, work, or schooling. It can be difficult to accurately diagnose OCD because symptoms resemble other anxiety or mood disorders. People with brain disorders like Tourette’s syndrome exhibit many of the same symptoms, and the two are often diagnosed together. According to NIMH, individuals are usually diagnosed with OCD when the compulsions begin to take more than one hour each day and interfere with normal routines. If you or a person in your life is experiencing these symptoms, an evaluation by a mental health professional is recommended.

Causes, Genetic Factors and Cultural Influences

Although no specific genes for OCD have been identified, scientists do believe there is a genetic component. When a parent has OCD, there is a low risk that a child will develop the disorder. Low levels of serotonin in the brain have been linked to OCD, and serotonin levels can often be influenced by genetics.

There are no apparent cultural factors influencing development or treatment of OCD.

Risks

People with OCD may abuse alcohol or drugs in an effort to treat their anxiety and some may become addicted. Addiction may make it difficult to effectively diagnose the true disorder.

People under treatment for OCD may become uncomfortable with the side effects of their medication. These can include loss of sexual desire or performance, dry mouth, nausea, drowsiness, and weight gain. If the effects are severe enough, the person may decide to stop taking their mediation, increasing their risk of returning to active OCD behaviors.

Because OCD may be accompanied by severe depression or anxiety disorders, the person may experience despair or entertain suicidal thoughts. They need to be taken seriously. Do not hesitate to contact 911 emergency services in a crisis.

Treatment

OCD cannot be cured at the present time, but medication and therapy has proven effective for many in reducing severity and occurrence of OCD episodes. Therapy can be used to treat acute, ongoing OCD as well as in maintaining the disorder over time. Many people with OCD respond well to antidepressant medications known as selective serotonin reuptake inhibitors (SSRI). An estimated 75 percent of people with OCD experience relief three weeks after they begin taking medication. Commonly used SSRI drugs include fluvoxamine (Luvox®), fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), and citalopram (Celexa®). Clomipramine (Anafranil®) is a tricyclic antidepressant that also has been proven effective in treating OCD.

Targeted therapy combined with medication has helped many people with OCD. Exposure therapy shows them that confronting their anxieties — such as touching dirt or grime — won’t harm them. Cognitive therapy can help the person with OCD to identify the thought patterns that create anxiety and learn new behaviors that disrupt the cycle of fear and compulsive behavior. Some people experience long-term, positive effects from talk therapy after 12-20 visits. Others may not respond as well.

How You Can Help

If you think a friend or family member needs help, the National Institute of Mental Health (NIMH) recommends that you encourage the individual to get an evaluation from a mental health professional. Family members and friends can help an individual recognize that they have an illness that can be treated if they are willing. It is important to understand that diagnosing serious mental illness is not simple or straightforward. Your doctor may need to revise the initial diagnosis, treatment and drug therapies one or more times over a period of weeks or months to find the best treatment regimen.

Sometimes, family members and friends need to intervene if a loved one with serious mental illness refuses to obtain treatment. This can be a very difficult situation for both the individual with the illness and the family members and friends. It is important to obtain assistance from a mental health professional to guide you through the medical and legal issues involved in an intervention.

Family members and friends of a person with serious mental illness can help by offering their support and affection to the extent possible. It is important to understand that people with serious mental illness cannot simply “pull themselves together” and get better. The support of family members and friends over the long term can be invaluable to an individual with a serious mental illness. Support groups can also be invaluable. Consumer groups offer individuals with mental illness an opportunity to share their needs, concerns and struggles with others in the same situation. Consumer support groups are available in many communities.

Family members and friends need to become educated about serious mental illness. They also need to take care of their own emotional needs. Support groups can also help family members and friends cope with their loved one’s illness. Family support groups provide a place for family members to share their experiences and obtain current information and education about their loved one’s mental illness.

NAMI California maintains a list of NAMI affiliates in your community that offer resources and support to individuals and families needing help with serious mental illness. The list includes information, contact persons, crisis numbers, telephone listings, and email contacts.

Family physicians, mental health professionals, religious counselors, community mental health centers, social service agencies, state and private hospitals are also available to provide help and support as needed. NAMI California maintains a current list mental health professionals (psychiatrists, psychologists, care homes, etc.) that provide support for serious mental illness in your community.

NAMI California also offers the “Family-to-Family” program to educate and support families who have members afflicted with a serious mental illness.

Finally, and most importantly, do not hesitate to get help from your local 911 emergency service or suicide hotline in a crisis.

For additional information, visit these web sites:

Related Resources
Living with Obsessive-Compulsive Disorder
Welcome to NAMI’s Living with Obsessive-Compulsive Disorder community. Here you will find support, get targeted information and connect with people who understand.
Find Support
Learn more about the full spectrum of programs and services that NAMI provides across the country for people living with mental illnesses, and their families and loved ones.
Online Discussion
Living with OCD
Find support, share knowledge, ask questions and meet people who’ve been there.
Mental Illness Discussion Groups
Dozens of online groups for consumers, parents, spouses, siblings, teens and more. Get connected and find support.
Related Links
Anxiety Disorders Association of America (ADAA)
National, non-profit membership organization dedicated to informing the public, providers, and policy-makers about anxiety disorders.
Clinicaltrials.gov
OCD research studies identified through the U.S. National Library of Medicine’s link to federally and privately funded studies worldwide.
National Institute of Mental Health
Information from the NIH institute on OCD.
Obsessive Compulsive Foundation
International, non-profit organization of individuals with OCD and their family, friends, providers, and concerned citizens working to educate the public and provide support to individuals with the disorder.

Panic Disorder

Overview

Panic disorder paralyzes people with overwhelming anxiety and fear. It affects an estimated 2.4 million people in the United States annually. It is a severe disorder in the family of chronic anxiety disorders that includes obsessive-compulsive disorder, post-traumatic stress disorder, social phobia and generalized anxiety disorder. Twice as many women as men are prone to the disorder. The symptoms of the disorder can worsen over time without treatment.

In the United States, 1.6 percent of the adult population, or more than 3 million people, will have panic disorder at some time in their lives.

Symptoms typically begin when an individual is in their late teens or early twenties. Studies by the National Institute of Mental Health (NIMH) show that one in ten people experience panic attacks during their lifetime. While everyone experiences mild, short-term anxiety in reaction to a pending social or business event, people with panic disorder experience severe, debilitating attacks in everyday situations. After enduring such an attack, individuals may begin to fear future attacks. This can create addtional fear and anxiety which, in fact, brings on more attacks. Fortunately, panic disorder can be successfully treated with a combination of medications and therapy.

Symptoms

Panic disorder is characterized by an attack of overwhelming anxiety and fear that appears to strike out of nowhere. It may occur repeatedly in stressful situations like driving in traffic or walking through crowded stores. It can also occur in familiar settings for no apparent reason. Attacks may occur during the day or night or even when a person is asleep. They may last minutes or hours. The physical reaction to whatever has stimulated the attack is unaccountably intense. A person may experience a racing heart, shallow breath, dizziness or chest pain. Some people believe they are having a heart attack or other life-threatening experience and rush to the hospital emergency room for assistance. Many people struggle with the disorder for years before getting an appropriate diagnosis and effective treatment.

According to NIMH, a person may be diagnosed with panic disorder if these attacks occur one or more times each month, accompanied with four of the following symptoms: dizziness, sweating, shortness of breath, heart palpitations, chest pain, a choking or smothering feeling, tingling, hot or cold flashes, fainting, trembling, nausea, feelings of unreality and specific fears of losing control, dying or going insane. People may or may not experience the same combination of symptoms from one panic attack to another. However, if they have the disorder, they will experience some or many of the symptoms listed.

Individuals with panic disorder may have other phobias and anxieties related to panic disorder. For example, they might fear being around other people or fear being alone. People with panic disorder can also have problems with depression and drug or alcohol abuse. As the disorder progresses, the person may avoid appointments or situations and locations that they associate with the attacks. Panic disorder can disrupt people’s routines at work, school and with friends and family. In rare cases, individuals with panic disorder can end up housebound with what is known as agoraphobia. Agoraphobia is a much more severe form of the disorder which prevents the individual from leaving their home.

There is no medical test for panic disorder. Diagnosis is made on the basis of symptoms, the course of illness, and family history.

Causes, Genetic Factors and Cultural Influences

The exact cause of panic disorder is not well understood.

Panic disorder runs in families. Thus, it appears that some genetic factor, in combination with environmental factors, may be responsible for an individual’s vulnerability to this condition. Other research has demonstrated that panic attacks can be caused by chemical imbalances in the brain.

Current research has not found definite cultural factors in panic disorder. Panic disorder may well be hereditary along with the depression that accompanies many sufferers. Twice as many women are affected as men.

Some treatments are found to be more effective in cultural segments than in others. In exposure therapy, an individual is presented with situations that trigger emotional or physical responses in an effort to desensitize them. This therapy has been found to be ineffective among African Americans.

Experts believe that anxiety disorders are caused by a combination of biological and environmental factors such as brain chemistry, life events, personality, and genetic predisposition. This makes an anxiety disorder much like other physical disorders, such as heart disease or diabetes.

Scientists also believe that stimulants such as caffeine can contribute to panic attacks.

Potential Risks

Panic attacks can occur at any time. If a person experiences a panic attack while driving a car or operating heavy equipment, they can put themselves and others at serious risk of harm. It is important for an individual who is experiencing a panic attack to get help and/or get into a safe situation as soon as possible.

People who have panic disorder may also experience severe depression. Depression can result in suicidal thoughts and actions. If a person talks about or exhibits signs of suicide, they should be taken seriously. Do not hesitate to contact 911 emergency services in a crisis.

Individuals with panic disorder may use alcohol and drugs to medicate themselves. This may lead to the abuse of alcohol and/or drugs and related problems.

Treatment

While panic disorder cannot presently be cured, up to 90 percent of people who have it are helped by therapy and medication. Intensive treatment usually lasts from 6 months to one year, although medication may be required for the remainder of the person’s lifetime.

Initially the doctor may prescribe anti-anxiety medications from the family of benzodiazepines. Some of the better-known, effective panic disorder drugs are clonazepam (Klonopin®), lorazepam (Ativan®), and alprazolam (Xanax®). Benzodiazepines typically have few side effects, aside from drowsiness. If the doctor diagnoses an underlying depression that contributes to the disorder, they might prescribe tricyclic antidepressants like imipramine (Tofranil®), protriptyline (Vivactil®), clomipramine (Anafranil®). More recently, physicians have prescribed new-generation antidepressants such as fluoxetine (Prozac®), sertraline (Zoloft®), fluvoxamine (Luvox®), paroxetine (Paxil®), and citalopram (Celexa®). Even older-generation antidepressants, MAO inhibitors such as phenelzine (Nardil®) or tranylcypromine (Parnate®), are still effective for many. Since individuals with anxiety disorder have unique chemical reactions to medications, doctors may try drugs individually or in combination with each other until they find the most-effective regimen. In cases where the person has a predicable, highly stressful occasion on their calendar, doctors may order a beta blocker to relieve shaking, heart pounding, and other physical reactions.

Combined with medication, therapy may be a valuable resource in treating panic disorder. Cognitive therapy can also be helpful in assisting the individual to change thought patterns that create or amplify fear. Behavioral therapy may alter how a person reacts to growing anxiety. Relaxation techniques can reduce the intensity of the attack as well as eliminate stress between episodes. People with panic disorder can also learn to identify patterns that appear before an attack and take immediate action to stop the episode.

How You Can Help

If you think a friend or family member needs help, the National Institute of Mental Health (NIMH) recommends that you encourage the individual to get an evaluation from a mental health professional. Family members and friends can help an individual recognize that they have an illness that can be treated if they are willing. It is important to understand that diagnosing serious mental illness is not simple or straightforward. Your doctor may need to revise the initial diagnosis, treatment and drug therapies one or more times over a period of weeks or months to find the best treatment regimen.

Sometimes, family members and friends need to intervene if a loved one with serious mental illness refuses to obtain treatment. This can be a very difficult situation for both the individual with the illness and the family members and friends. It is important to obtain assistance from a mental health professional to guide you through the medical and legal issues involved in an intervention.

Family members and friends of a person with serious mental illness can help by offering their support and affection to the extent possible. It is important to understand that people with serious mental illness cannot simply “pull themselves together” and get better. The support of family members and friends over the long term can be invaluable to an individual with a serious mental illness. Support groups can also be invaluable. Consumer groups offer individuals with mental illness an opportunity to share their needs, concerns and struggles with others in the same situation. Consumer support groups are available in many communities.

Family members and friends need to become educated about serious mental illness. They also need to take care of their own emotional needs. Support groups can also help family members and friends cope with their loved one’s illness. Family support groups provide a place for family members to share their experiences and obtain current information and education about their loved one’s mental illness.

NAMI California maintains a list of NAMI affiliates in your community that offer resources and support to individuals and families needing help with serious mental illness. The list includes information, contact persons, crisis numbers, telephone listings, and email contacts.

Family physicians, mental health professionals, religious counselors, community mental health centers, social service agencies, state and private hospitals are also available to provide help and support as needed. NAMI California maintains a current list mental health professionals (psychiatrists, psychologists, care homes, etc.) that provide support for serious mental illness in your community.

NAMI California also offers the “Family-to-Family” program to educate and support families who have members afflicted with a serious mental illness.

Finally, and most importantly, do not hesitate to get help from your local 911 emergency service or suicide hotline in a crisis.

For additional information, visit these web sites:

About Medications
Information about medications used in the treatment of serious mental illnesses
Find Support
Learn more about the full spectrum of programs and services that NAMI provides across the country for people living with mental illnesses, and their families and loved ones.
Online Discussion
Living with Panic Disorder
Find support, share knowledge, ask questions and meet people who’ve been there.
Mental Illness Discussion Groups
Dozens of online groups for consumers, parents, spouses, siblings, teens and more. Get connected and find support.
Related Links
Anxiety Disorders Association of America (ADAA)
National, non-profit membership organization dedicated to informing the public, providers, and policy-makers about anxiety disorders.
Clinicaltrials.gov
Panic disorder research studies identified through the U.S. National Library of Medicine’s link to federally and privately funded studies worldwide.
National Institute of Mental Health
Information from the NIH institute on panic disorder.

Freedom from Fear

Post Traumatic Stress Disorder

Overview

Post-Traumatic Stress Disorder (PTSD) is a debilitating anxiety disorder that fills people with fear and recurring terror. It typically stems from a horrifying event or series of threatening or violent incidents that happened to them in the past. According to The National Institute of Mental Health (NIMH), PTSD affects just over five million Americans. Women are twice as prone to developing the disorder as men. The onset of PTSD may be caused by a physically or emotionally violent act, or a life-threatening event, to the individual or their family members. Children may also develop PTSD if they are witness to or survivors of violence and abuse. People with PTSD may also develop one or more other anxiety disorders, suffer from depression, or abuse alcohol and drugs. In severe cases, the person may have trouble working, socializing, or visiting places where the trauma originally occurred or places that remind the individual of the experience.

Many people experience anxiety in remembering traumatic events in their lives. But people with PTSD repeatedly experience the event as a real-time incident that invades their daily activities or occurs in persistent nightmares. Ordinary work or social interactions with people can spark flashbacks or violent emotional reactions in individuals with PTSD. Fortunately, PTSD can be treated and managed with medications and therapy from professionals who specialize in the disorder. Some individuals experience recovery in six months, while others may remain on medication indefinitely to treat other underlying disorders such as depression or phobia.

Symptoms

Not everyone who experiences a profoundly disturbing physical or emotional event develops PTSD. The disorder was originally brought to the attention of the mental health community by military veterans who experienced life-threatening battles, saw or participated in killing, or whose lives were under constant peril. Today, PTSD diagnosis can be vital in treating survivors of violent crimes such as kidnapping, rape, or mugging. Other people with PTSD are among the survivors of natural disasters, or involved in horrific car, train or airplane accidents. Adolescents or adults who have experienced a long history of child abuse may also develop the disorder.

A person with PTSD may appear numb to people who were once dear to them. They may seem to have flattened human emotions in everyday interactions. On the other hand, an episode may flare out of nowhere and their moods will shift abruptly to irritability or explosive anger. If especially frightened by the association of a present event to their past, the person may become violent. They may be particularly vulnerable on the anniversary date of the original trauma. The individual may also experience long bouts of symptoms normally attributed to depression: sleeplessness, loss of interest in affection and sexuality, and loss of appetite. In children, PTSD may express itself through continuing emotional outbursts or acts of aggression. As the disorder progresses, the person may withdraw completely from work, school, friends and family.

Following the initial trauma, symptoms usually begin within three months. However, the illness has been known to develop years after the event. According to the NIMH, PTSD is diagnosed only if the symptoms last longer than a month. If you or a person in your life is experiencing these symptoms, an evaluation by a mental health professional is recommended to determine if there is a possibility of PTSD, or whether other anxiety or mood disorders are involved.

Causes, Genetic Factors and Cultural Influences

PTSD can occur in people of any age, including in children. Scientists have not discovered a genetic predisposition to PTSD. However, some anxiety disorders have genetic ties, and researchers continue to study whether children of adults with PTSD may be susceptible to the disorder. Other illnesses with genetic predispositions, including clinical depression or substance abuse, may accompany PTSD.

Current research has not found definite cultural factors in PTSD.

Risks

Occasionally adults as well as children may react aggressively to threats that do not appear to people around them.

Individuals with PTSD may have a chronic addiction to alcohol and drugs. They may display behavior that is confused, violent and unpredictable while under the influence of these substances.

People who have PTSD may also suffer from serious depression which may result in self-destructive or suicidal thoughts and behavior. If a person exhibits signs of suicide, they should be taken seriously. Do not hesitate to contact 911 emergency services in a crisis.

Treatment

No magic drug has been found to cure PTSD, and symptoms seldom go away completely. But PTSD can be effectively treated, managed, and minimized through the combined use of medication and intensive therapy. People with PTSD may find it helpful to attend PTSD support group meetings and share their concerns and feelings with others with similar experiences. A relatively new therapy called Eye Movement Desensitization and Reprocessing (EMDR) has been used with trauma survivors. With EMDR, the therapist leads the survivor through a range of physical eye exercises that can train the brain to react differently to memories.

A physician may initially prescribe anti-anxiety benzodiazepines like clonazepam (Klonopin®), lorazepram (Ativan®), and alprazolam(Xanax®) to temporarily regulate anxiety and sleeplessness. The FDA has cleared new medications called paroxetine (Paxil®), and sertraline (Zoloft®) for the direct treatment of PTSD. To treat underlying depression, the physician will prescribe selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac®), sertraline (Zoloft®), fluvoxamine (Luvox®), paroxetine (Paxil®), and citalopram (Celexa®). SSRIs have proven to be more effective in the treatment of women with PTSD than in men. Doctors may try combinations of drugs to find the most-effective regimen.

Cognitive-behavior therapy is helpful in assisting the individual to cope with anxiety, manage their anger, and deal with stress. Often therapists will use imagery and other experiential techniques to allow the person with PTSD to fully remember and react to their trauma in a safe environment. People with PTSD learn relaxation techniques for use when old memories flood in from triggering events. By combining newly learned techniques, the person with PTSD is better prepared to return to an active life of everyday stress.

How You Can Help

If you think a friend or family member needs help, the National Institute of Mental Health (NIMH) recommends that you encourage the individual to get an evaluation from a mental health professional. Family members and friends can help an individual recognize that they have an illness that can be treated if they are willing. It is important to understand that diagnosing serious mental illness is not simple or straightforward. Your doctor may need to revise the initial diagnosis, treatment and drug therapies one or more times over a period of weeks or months to find the best treatment regimen.

Sometimes, family members and friends need to intervene if a loved one with serious mental illness refuses to obtain treatment. This can be a very difficult situation for both the individual with the illness and the family members and friends. It is important to obtain assistance from a mental health professional to guide you through the medical and legal issues involved in an intervention.

Family members and friends of a person with serious mental illness can help by offering their support and affection to the extent possible. It is important to understand that people with serious mental illness cannot simply “pull themselves together” and get better. The support of family members and friends over the long term can be invaluable to an individual with a serious mental illness. Support groups can also be invaluable. Consumer groups offer individuals with mental illness an opportunity to share their needs, concerns and struggles with others in the same situation. Consumer support groups are available in many communities.

Family members and friends need to become educated about serious mental illness. They also need to take care of their own emotional needs. Support groups can also help family members and friends cope with their loved one’s illness. Family support groups provide a place for family members to share their experiences and obtain current information and education about their loved one’s mental illness.

NAMI California maintains a list of NAMI affiliates in your community that offer resources and support to individuals and families needing help with serious mental illness. The list includes information, contact persons, crisis numbers, telephone listings, and email contacts.

Family physicians, mental health professionals, religious counselors, community mental health centers, social service agencies, state and private hospitals are also available to provide help and support as needed. NAMI California maintains a current list mental health professionals (psychiatrists, psychologists, care homes, etc.) that provide support for serious mental illness in your community.

NAMI California also offers the “Family-to-Family” program to educate and support families who have members afflicted with a serious mental illness.

Finally, and most importantly, do not hesitate to get help from your local 911 emergency service or suicide hotline in a crisis.

For additional information, visit these web sites

Anxiety Disorders Association of America

Psychosis

What Is Psychosis

Psychosis (psyche = mind, osis = illness) is defined as the experience of loss of contact with reality, and is not part of the person’s cultural group belief system or experience. Psychosis typically involves one of two major experiences:

A. Hallucinations can take the form of auditory experiences (such as hearing voices); less commonly, visual experiences; or, more rarely, smelling things that others cannot perceive. The experience of hearing voices has been matched to increased activity in the auditory cortex of the brain through neuroimaging studies. While the experience of hearing voices is very real to the person experiencing it, it may be very confusing for a loved one to witness. The voices can often be critical (i.e. “you are fat and stupid”) or even threatening. Voices also may be neutral (i.e. “the radio is on”) and may involve people that are known or unknown to the person hearing the voices. The cultural context is also important. For example, in some Native American cultures, hearing the voice of a deceased relative is part of a healthy grieving process.

B. Delusions are fixed false beliefs. Delusions could take the shape of paranoia (“I am being chased by the FBI”) or of mistaken identity (a young woman may say to her mother, “You are an imposter—not my mother”). What makes these beliefs delusional is that these beliefs do not change or modify when the person is presented with new ideas or facts. Thus, the beliefs remain fixed even when presented with contradicting information (the young woman continues to believe her mother is an imposter, even when presented with her mother’s birth certificate and pictures of her mother holding her as a baby). Delusions often are associated with other cognitive issues such as problems with concentration, confused thinking and a sense that one’s thoughts are blocked. These experiences can be short lived (e.g. after surgery or after sleep deprivation) or periodic (as when associated with a psychiatric condition or persistent likebipolar disorderor major depression).

More information available at our NAMI National website: www.nami.org

Schizoaffective Disorder

Schizoaffective disorder is one of the more common, chronic, and disabling mental illnesses. As the name implies, it is characterized by a combination of symptoms of schizophrenia and an affective (mood) disorder. There has been a controversy about whether schizoaffective disorder is a type of schizophrenia or a type of mood disorder. Today, most clinicians and researchers agree that it is primarily a form of schizophrenia. Although its exact prevalence is not clear, it may range from two to five in a thousand people (- i.e., 0.2% to 0.5%). Schizoaffective disorder may account for one-fourth or even one-third of all persons with schizophrenia.

To diagnose schizoaffective disorder, a person needs to have primary symptoms of schizophrenia (such as delusions, hallucinations, disorganized speech, disorganized behavior) along with a period of time when he or she also has symptoms of major depression or a manic episode. (Please see the section on Mood Disorders for a detailed description of symptoms of major depression or manic episode). Accordingly, there may be two subtypes of schizoaffective disorder:

(a) Depressive subtype, characterized by major depressive episodes only, and

(b) Bipolar subtype, characterized by manic episodes with or without depressive symptoms or depressive episodes.

Differentiating schizoaffective disorder from schizophrenia and from mood disorder can be difficult. The mood symptoms in schizoaffective disorder are more prominent, and last for a substantially longer time than those in schizophrenia. Schizoaffective disorder may be distinguished from a mood disorder by the fact that delusions or hallucinations must be present in persons with schizoaffective disorder for at least two weeks in the absence of prominent mood symptoms.

Online Discussion
Living with Schizoaffective Disorder
Find support, share knowledge, ask questions and meet people who’ve been there.
Mental Illness Discussion Groups
Dozens of online groups for consumers, parents, spouses, siblings, teens and more. Get connected and find support.
Related Links
ClinicalTrials.gov
A listing of ongoing recruiting research studies investigating schizoaffective disorder.
Facts About Schizoaffective Disorder
Information about schizoaffective disorder from UCLA’s Family Social Support Project
PubMed
A listing of published research on schizoaffective disorder.

More information available at our NAMI National website: www.nami.org

Schizophrenia

Schizophrenia is a serious mental illness that affects 2.4 million American adults over the age of 18. Although it affects men and women with equal frequency, schizophrenia most often appears in men in their late teens or early twenties, while it appears in women in their late twenties or early thirties. Finding the causes for schizophrenia proves to be difficult as the cause and course of the illness is unique for each person.

Interfering with a person’s ability to think clearly, manage emotions, make decisions and relate to others, schizophrenia impairs a person’s ability to function to their potential when it is not treated. Unfortunately, no single, simple course of treatment exists. Research has linked schizophrenia to a multitude of possible causes, including aspects of brain chemistry and structure, as well as environmental causes.

Discovering the Truth about Schizophrenia

Because the illness may cause unusual, inappropriate and sometimes unpredictable and disorganized behavior, people who are not effectively treated are often shunned and the targets of social prejudice. The apparent erratic behavior is often caused by the delusions and hallucinations that are symptoms of schizophrenia. Along with medication, psychosocial rehabilitation and other community-based support can help those with schizophrenia go on to lead meaningful and satisfying lives. A lack of appropriate services devoted to individuals living with schizophrenia has left many improperly placed in jails and prisons without the help they need.

Schizophrenia is often mischaracterized as an untreatable disease associated with violent behavior and many untrue and unfortunate stereotypes have developed. Most individuals living with schizophrenia are not violent; risk of violence is associated primarily withfactors such as psychotic symptoms or substance abuse. Even then, violent behavior is generally uncommon and the overall contribution of schizophrenia to violence in a community is small. When engaging in treatment, schizophrenia is a manageable disease. The varying nature of each case though means that recovery for every individual is different.

Like any other illness, schizophrenia can often have a profoundly negative effect on a person’s life, on their families and on their communities if not addressed. Suicide is a serious risk for those with schizophrenia, occurring at a much higher rate than the general population. However, the risk of suicide can be greatly reduced through the use of medication.

Getting an individual to take medication for his or her illness is difficult, especially when the person does not believe they are sick. Studies have shown that the majority of those living with schizophrenia do not believe themselves to be ill. This lack of awareness, or insight, is known as Anosognosia. To learn more about Anosognosia, read the NAMI Anosognosia Fact Sheet

A Positive Outlook

Led primarily by real people living with schizophrenia, there is a changing assumption on what is possible for those living with the illness. Long viewed as an incurable illness, new data suggests that as many as 50 percent of people diagnosed with schizophrenia have positive outcomes when they receive appropriate treatment. With new research and expanding knowledge for the causes of schizophrenia, the outlook for those living with schizophrenia continues to improve. To learn more about the latest in schizophrenia research, check the Latest Research page.

More information available at our NAMI National website: www.nami.org

Seasonal Affective Disorder

If you notice periods of depression that seem to accompany seasonal changes during the year, you may suffer from seasonal affective disorder (SAD). This condition is characterized by recurrent episodes of depression – usually in late fall and winter – alternating with periods of normal or high mood the rest of the year.

Most people with SAD are women whose illness typically begins in their twenties, although men also report SAD of similar severity and have increasingly sought treatment. SAD can also occur in children and adolescents, in which case the syndrome is first suspected by parents and teachers. Many people with SAD report at least one close relative with a psychiatric condition, most frequently a severe depressive disorder (55 percent) or alcohol abuse (34 percent).

What are the patterns of SAD

Symptoms of winter SAD usually begin in October or November and subside in March or April. Some patients begin to slump as early as August, while others remain well until January. Regardless of the time of onset, most patients don’t feel fully back to normal until early May. Depressions are usually mild to moderate, but they can be severe. Very few patients with SAD have required hospitalization, and even fewer have been treated with electroconvulsive therapy.

The usual characteristics of recurrent winter depression include oversleeping, daytime fatigue, carbohydrate craving and weight gain, although a patient does not necessarily show these symptoms. Additionally, there are the usual features of depression, especially decreased sexual interest, lethargy, hopelessness, suicidal thoughts, lack of interest in normal activities, and social withdrawal.

Light therapy, described below, is now considered the first-line treatment intervention, and if properly dosed can produce relief within days. Antidepressants may also help, and if necessary can be used in conjunction with light.

In about 1/10th of cases, annual relapse occurs in the summer rather than winter, possibly in response to high heat and humidity. During that period, the depression is more likely to be characterized by insomnia, decreased appetite, weight loss, and agitation or anxiety. Patients with such “reverse SAD” often find relief with summer trips to cooler climates in the north. Generally, normal air conditioning is not sufficient to relieve this depression, and an antidepressant may be needed.

In still fewer cases, a patient may experience both winter and summer depressions, while feeling fine each fall and spring, around the equinoxes.

The most common characteristic of people with winter SAD is their reaction to changes in environmental light. Patients living at different latitudes note that their winter depressions are longer and more profound the farther north they live. Patients with SAD also report that their depression worsens or reappears whenever the weather is overcast at any time of the year, or if their indoor lighting is decreased.

SAD is often misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections.

How is winter SAD treated with light

Bright white fluorescent light has been shown to reverse the winter depressive symptoms of SAD. Early studies used expensive “full-spectrum” bulbs, but these are not especially advantageous. Bulbs with color temperatures between 3000 and 6500 degrees Kelvin all have been shown to be effective. The lower color temperatures produce “softer” white light with less visual glare, while the higher color temperatures produce a “colder” skylight hue. The lamps are encased in a box with a diffusing lens, which also filters out ultraviolet radiation. The box sits on a tabletop, preferably on a stand that raises it to eye level and above. Such an arrangement further reduces glare sensations at high intensity, and preferentially illuminates the lower half of the retina, which is rich in photoreceptors that are thought to mediate the antidepressant response. Studies show between 50% and 80% of users showing essentially complete remission of symptoms, although the treatment needs to continue throughout the difficult season in order to maintain this benefit.

There are three major dosing dimensions of light therapy, and optimum effect requires that the dose be individualized, just as for medications.

  • Light intensity. The treatment uses an artificial equivalent of early morning full daylight (2500 to 10,000 lux), higher than projected by normal home light fixtures (50 to 300 lux). A light box should be capable of delivering 10,000 lux at eye level, which allows downward adjustments if necessary.
  • Light duration. Daily sessions of 20 to 60 minutes may be needed. Since light intensity and duration interact, longer sessions will be needed at lower intensities. At 10,000 lux – the current standard – 30-minute sessions are most typical.
  • Time of Day of exposure. The antidepressant effect, many investigators think, is mediated by light’s action on the internal circadian rhythm clock. Most patients with winter depression benefit by resetting this clock earlier, which is achieved specifically with morning light exposure. Since different people have different clock phases (early types, neutral types, late types), the optimum time of light exposure can differ greatly. The Center for Environmental Therapeutics, a professional nonprofit agency, offers an on-line questionnaire on its website, www.cet.org, which can be used to calculate a recommended treatment time individually, which is then adjusted depending on response. Long sleepers may need to wake up earlier for best effect, while short sleepers can maintain their habitual sleep-wake schedule.

Side effects of light therapy are uncommon. Some patients complain of irritability, eyestrain, headaches, or nausea. Those who have histories of hypomania in spring or summer are at risk for switching states under light therapy, in which case light dose needs to be reduced. There is no evidence for long-term adverse effects, however, and disturbances experienced during the first few exposures often disappear spontaneously. As an important precaution, patients with Bipolar I disorder – who are at risk for switching into full-blown manic episodes – need to be on a mood-stabilizing drug while using light therapy.

What should I do if I think I have SAD

If your symptoms are mild – that is, if they don’t interfere too much with your daily living, you may want to try light therapy as described above or experiment with adjusting the light in your surroundings with bright lamps and scheduling more time outdoors in winter.

If your depressive symptoms are severe enough to significantly affect your daily living, consult a mental health professional qualified to treat SAD. He or she can help you find the most appropriate treatment for you. To help you decide whether a clinical consultation is necessary, you can use the feedback on the Personalized Inventory for Depression and SAD at www.cet.org.

 

Reviewed by Michael Terman, Ph.D., Director, Winter Depression Program, New York State Psychiatric Institute at Columbia University Medical Center. New York City (February, 2004).

Permission is granted for this fact sheet to be reproduced, but it must include the NAMI name, logo, and contact information.

Related Resources
Find Support
Learn more about the full spectrum of programs and services that NAMI provides across the country for people living with mental illnesses, and their families and loved ones.
Mental Illness Discussion Groups
Dozens of online groups for consumers, parents, spouses, siblings, teens and more. Get connected and find support.

More information available at our NAMI National website: www.nami.org

Tourette’s Syndrome

Tourette’s disorder, or Tourette’s syndrome (TS) as it is frequently called, is a neurologic syndrome. The essential feature of Tourette’s are multiple tics that are sudden, rapid, recurrent, non-rhythmic, stereotypical, purposeless movements or vocalizations.

What are the symptoms of Tourette’s syndrome1

  • Both multiple motor and one or more vocal tics are present at some time during the illness, although not necessarily simultaneously
  • Occurrence many times a day nearly every day or intermittently throughout a span of more than one year
  • Significant impairment or marked distress in social, occupational, or other important areas of functioning.
  • Onset before the age of 182

Symptoms can disappear for weeks or months at a time and severity waxes and wanes.

What are the first tics that may be characteristic of Tourette’s syndrome

Usually, the facial tic, such as rapid blinking of the eyes or twitches of the mouth, may be the first indication a parent has that their child may have Tourette’s syndrome. Involuntary sounds, such as throat clearing and sniffing, or tics of the limbs may be an initial sign in other children.

Are any other symptoms associated with Tourette’s syndrome

Approximately 50 percent of patients meet criteria for attention deficit hyperactivity disorder (ADHD) and this may be the more impairing problem. Approximately one-third of patients meet criteria for obsessive-compulsive disorder (OCD) or have other forms of anxiety. Learning disabilities are common as well as developmental stuttering. Social discomfort, self-consciousness and depressed mood frequently occur, especially as children reach adolescence.

What causes these symptoms

Although the cause has not been definitely established, there is considerable evidence that Tourette’s syndrome arises from abnormal metabolism of dopamine, a neurotransmitter.3 Other neurotransmitters may be involved.

Can Tourette’s syndrome be inherited

Genetic studies indicate that Tourette’s syndrome is inherited as an autosomal dominant gene but different family members may have dissimilar symptoms. A parent has a 50 percent chance of passing the gene to one of his or her children. The range of symptomatology varies from multiple severe tics to very minor tics with varying degrees of attention deficit-disorder and OCD.

Are boys or girls more likely to have Tourette’s syndrome

The sex of the child can influence the expression of the Tourette’s syndrome gene. Girls with the gene have a 70 percent chance of displaying symptoms, boys with the gene have a 99 percent chance of displaying symptoms. Ratios of boys with Tourette’s syndrome to girls with Tourette’s syndrome are 3:1.

How is Tourette’s syndrome diagnosed

No blood analysis, x-ray or other medical test exists to identify Tourette’s syndrome. Diagnosis is made by observing the signs or symptoms as described above. A doctor may wish to use a CAT scan, EEG, or other tests to rule out other ailments that could be confused with TS. Some medications cause tics, so it is important to inform the professional doing the assessment of any prescribed, over-the-counter, or street drugs to which the patient may have been exposed.

What are the benefits of seeking early treatment of Tourette’s syndrome symptoms

When a child’s behavior is viewed as disruptive, frightening, or bizarre by peers, family, teachers, or friends, it provokes ridicule and rejection. Teachers and other children can feel threatened and exclude the child from activities or interpersonal relationships. A child’s socialization difficulties will increase as he reaches adolescence. Therefore, it is very important for the child’s self-esteem and emotional well-being that treatment be sought as early as possible.

What treatments are available for Tourette’s syndrome

Not everyone is disabled by his or her symptoms, so medication may not be necessary. When symptoms interfere with functioning, medication can effectively improve attention span, decrease impulsivity, hyperactivity, tics, and obsessive-compulsive symptomatology. Relaxation techniques and behavior therapy may also be useful for tics, ADD symptoms, and OCD symptoms.

How does Tourette’s syndrome affect the education of a child or adolescent with Tourette’s syndrome

Tourette’s syndrome alone does not affect the IQ of a child. Many children who have Tourette’s syndrome, however, also have learning disabilities or attention deficits. Frequently, therefore, special education may be needed for a child with Tourette’s syndrome. Teachers should be given factual information about the disorder and, if learning difficulties appear, the child should be referred to the school system for assessment of other learning problems.

What is the course of Tourette’s syndrome

Some people with Tourette’s syndrome show a marked improvement in their late teens or early twenties. However, tics as well as ADD and OCD behavior, may wax and wane over the course of the life span.

1 According to the Diagnostic and Statistical Manual of Mental Disorders (4th Edition), or DSM-IV
2 This is a change from the former edition, DSM-IIIR, that set maximum age of onset at 21 years of age.
3 A biochemical substance that transmits nerve impulses from one nerve cell to another at a synapse.

Reviewed by Charles T. Gordon, III, M.D., 2003

Related Resources
Tourette Syndrome Fact Sheet from NIH
National Institute of Health, National Institute of Neurological Disorders and Stroke, fact sheet on Tourette Syndrome.
Find Support
Learn more about the full spectrum of programs and services that NAMI provides across the country for people living with mental illnesses, and their families and loved ones.
Mental Illness Discussion Groups
Dozens of online groups for consumers, parents, spouses, siblings, teens and more. Get connected and find support.
Related Links
Tourette Syndrome Association
Web site of the national Tourette Syndrome Association (TSA).

More information available at our NAMI National website: www.nami.org