Schizoaffective Disorder: Part 2

Like most psychiatric disorders, diagnosis is based on clinical features. Most physicians will also perform laboratory tests to ensure that the effects are not due to illicit drugs or any other medical disorder like HIV, temporal lobe epilepsy, hypothyroidism or prolonged steroid usage.

Individuals with schizoaffective disorder usually require both medications and psychotherapy. Both anti psychotics and mood stabilizing drugs are used to treat these individuals. Psychotherapy can help diminish distorted or negative thoughts, improve social skills and boost self-confidence. Family or group therapy has been found to be more effective in helping people deal with real life issues. Family group therapies also provide a decrease in social isolation and helps maintain a check on the psychotic episodes.

The overall prognosis for patients with schizoaffective disorder is better than those with schizophrenia but treatment is life long. Unfortunately, most people tend to develop severe depression or mania and eventually become non-complaint with therapy. Many end up with legal problems and remain confined to psychiatric facilities.

Antisocial Personality Disorder Part 1

Antisocial personality disorder is a chronic mental disorder where one’s thinking, perceiving things and relationship with others is impaired. Individuals with antisocial personality disorder do not care about what is right or wrong, they do whatever they please. The one current theme in their behavior is violating the rights of others and consistently ending up in conflicts. These individuals continue to lie, are angry, violent and also abuse alcohol and drugs. The majority of these individual have problems at home, school and at work.


Typical signs of this disorder include

Disregard and violating rights of others

Persistent lying, cheating or fraudulent behavior

Manipulative

Persistent legal problems

Threatening or intimidating others

Aggressive and violent tendencies

Lack of remorse

Impulsive behavior

Abusive relationships

Irresponsible at work

Anti social personality disorder peaks in the 20s and then the behaviour diminishes over time. The chief reason for this decline is that many individuals end up in prison for their violent acts.

Why the disorder occurs is a mystery but believed to be related to bad genes, bad environment or just bad luck. Individuals at greatest risk for antisocial personality are those who have a family history of mental problems, history of childhood sexual or physical abuse, having a chaotic or unstable childhood or loss of a parent at an early age.

Passive-aggressive behavior disorder: Part 2

Features of the disorder include:

- Repeatedly putting things off
- Deliberately forgetting to do things
- Being stubborn and acting dumb
- Having intense dislike of people in authority
- Frequently complaining and whining about mundane things
- Intentionally working slowly
- Feel unappreciated and want to be constantly praised
- Always blaming others for their misfortunes
- Dislike novel ideas even when practical and useful
- Continuously arguing for no apparent reason

Treatment

There is no easy way to treat this disorder because the individuals are very stubborn and never see themselves as the problem. Unless someone forces them into therapy such as family, friends or employers, the behavior continues for life. These individuals have minimal insight into their negative behavior and always see fault in others. Some individuals may seek therapy after realizing they are not getting anywhere in life.

There are no drugs that can cure passive aggressive behavior. Counseling and supportive therapy do help, but relapse is common. In rare cases, anti depressant drugs may help control the negative attitude but many individuals are not compliant. When the individual is aware of his/her behavior, it is recommended that one stop drinking alcohol as it can make the negative attitude worse. Other methods which have yielded partial success include yoga, family and cognitive behavior therapy.

The prognosis for individuals with passive aggressive behavior is poor. Many end up lonely, isolated, become paranoid and develop depression.

Does lack of sleep cause depression? Part 1

There has been a dramatic rise in childhood depression in the past 2 decades and no one knows why. A recent study by US researchers indicates that perhaps going to bed early may protect teenagers against depression and suicidal ideations. The latest study in 12-18 year olds showed that those teenagers who went to bed after midnight were 24% more likely to have depression than who went to bed at 10 pm. Moreover individuals who slept less than 5 hours a night had a nearly 71% higher risk of depression than who slept at least 7 hours.

The latest work from Columbia university medical center in NY looked at data gathered from over 15,000 teenagers collected in the 90s. The study revealed that at least one in fifteen teenagers was found to have depression.

All the data indicated that going to bed after midnight was a risk factor for depression and these individuals were more likely to develop suicidal thoughts when compared to children who went to bed at 10 pm. Besides the sleep factor, depression was found to be more likely in girls, older teenagers and in those teenagers who felt that their parents cared little about them.

Lead researcher Dr James Gangwisch does admit that perhaps it is the depression that could be causing the poor sleep patterns. However, it was observed that some of these teenagers only developed symptoms of depression after developing poor sleep habits. Lack of adequate sleep has been linked to aberrant mood changes including loss of concentration, impulsivity and anxiety.

Mother’s depression worsens asthma in children! Part 2

"Intuitively, it may seem that we're dealing with a chicken-egg situation, but our study suggests otherwise. The fact that mom's depression was not affected by how often her child had symptoms really caught us off guard, but it also suggested which factor comes first," Riekert said.

Since depression can profoundly affect mental health concentration, cause fatigue and diminish concentration, it may weaken the mother’s ability to manage her child’s asthma. Asthma is a common respiratory ailment which often gets worse in winter and some children require daily treatments and multiple doctor visits.

"Mom is the one who must implement the doctor's recommendations for treatment and follow-up, and if she is depressed she can't do it well, so the child will suffer," said chief scientist Michiko Otsuki said in news press release.

This simple observational study may be true but there are many other factors in African Americans that have not been looked at. The economy, finances, physical health, obesity or lack of transport- all these can lead to worsening of not only asthma but many other medical disorders.

The study can be viewed online on the Journal of Pediatric Psychology Nov 2009.

Can inositol help reverse depression?

Over the years, alternative health care practitioners have been advocating a variety of herbs and nutrients for the treatment of depression. One of nutrients which is widely consumed by depressed individuals is inositol.

Inositol is a simple molecule and used by the body to make important components of the cell membrane. Products made from inositol are believed to play a vital role in signaling events in the body. Most individuals get adequate levels of inositol from food and no one has ever been identified as having inositol deficiency. Further, there is no relationship between depression and inositol levels in the body.

Inositol is readily available in most health food stores without a prescription and recommended for the treatment of a variety of mental disorder including depression. Because many depressed patients take a number of health supplements and other products, it has been difficult to evaluate the role of inositol. Of course, as with all supplements the vendors of inositol claim it is a miracle product. As far as consumers are concerned, there are a few anecdotal reports of inositol and depression. The majority of depressed individuals claim that the supplement does nothing.

In the past few years, four double blind trials have evaluated 141 depressed individuals who took inositol. Inositol was compared with an anti depressant or a placebo.

The Results?

The results did not show any evidence that inositol had anti depressant activity. Even though most of these studies were of short duration and the sampling population was small, inositol turned out to be just another hyped up supplement. The only good thing to come of the trials was that the supplement was safe and not associated with any side effects.

So where does the individual with depression stand?

Like many nutrients and herbs, inositol has failed to live up to expectations when it is properly evaluated in clinical studies. Nevertheless, the health supplement industry continues to market the product for many illnesses. A month’s supply of inositol is about $30. For those who are depressed and do not have money to spare, forget inositol and spend your money wisely on something that works. For those who are depressed and have money, cherries are in season- go eat some.

Depression and Pregnancy

The majority of women who do get pregnant are delighted and looking forward to having a baby. It is a time of joy and there is a gradual change in life style. Women who are pregnant often get doted upon and are treated well. Great effort is made in society to protect the physical well being of the pregnant mother. However, it is now recognized that pregnancy is also a time of emotional stress and a fair number of women do develop depression. Even though it is well known that post partum women do develop depression and the blues, it was not appreciated until recently that depression during the pregnancy can also be quite moderate to severe in intensity. Many pregnant women with depression have been overlooked and underdiganosed. Unfortunately, depression during pregnancy has often been disregarded and never adequately treated.

The exact number of females who develop depression during pregnancy is not known but is believed to be quite common. One large study indicates that anywhere from 7-12 percent of pregnant women may develop depression. Further, women who already have been diagnosed with major depression are at a high risk for relapse during pregnancy. One has to remember that many women stop their anti depressants during pregnancy to avoid damage to the fetus, thus making them even more vulnerable to relapse.

The question being asked to day is if there is a link between perinatal depression and adverse neonatal outcomes. Even though the topic is controversial, one review did conclude that presence of depression during pregnancy might be an independent risk factor for later adverse effects on both the mother and the fetus.

There is now ample evidence that when depression is untreated during pregnancy, it may lead to poor prenatal care. Medical and obstetrical difficulties, self-medication, illicit substance abuse, weaken bonding, suicide, and a higher risk of relapse of depression in the postpartum period.

What is of concern today is that despite the high number of females who develop depression during pregnancy, very few actually are diagnosed and adequately treated

Serenity: part 3

So what about the consumer?

For those who decide to take Serenity, start at the lowest dose. The supplement has been deemed safe when it is taken alone. The starting dose is about 150-200 mg/day. However, if you already taking other medications for your depression or bipolar disorder it is wise to discuss the issue with your physician before embarking on a complex hodge podge of drugs.

A month’s supply of Serenity can cost anywhere from $20-$40. Remember, many such herbal supplements are made in India and China, where unscrupulous manufacturers have sometimes added the actual drug inside the supplement. Further, dangerous contaminants in herbal products are not unheard off. Fakes and counterfeits are also abundant in the health supplement market. So in the end the caveat “buyer beware” should be well heeded.

Acupuncture and Depression: Part 1

Despite what some physicians claim, the treatment of depression with drugs is not great. The majority of individuals who have depression remain dis-satisfied with current day anti depressant drugs. Initially most drugs work to relieve symptoms of depression but after sometime, relapses are common. Moreover, the majority of drugs have side effects. For this reason, many patients have been turning to alternative health. One of the treatments that has advocated for treating depression is acupuncture.

Acupuncture has been widely touted to treat many types of pain syndromes, anxiety disorders and a whole host of other organic disorders. Now the alternative health care practitioners claim that acupuncture can be used to treat depression. Even though acupuncture has been practiced for decades in North America, not many randomized studies have been done to determine its efficacy. In the last decade, seven trials have compared acupuncture versus anti depressant medications in the treatment of mild to moderate depression. Most of these trials were conducted fairly, with proper inclusion and exclusion criteria. Patients were evaluated carefully and followed.

Does Caffeine worsen depression?

There are some individuals who drink coffee (caffeine) and are worried that it may worsen or even cause depression. Today, there is very little evidence to link caffeine and depression. Despite the fact that Caffeine is a brain stimulant; it does worsen depression in a fair number of individuals. Why this brain stimulant induces depression is a mystery. There are suggestions that caffeine may alter blood sugar levels and this may be one cause for the mood alterations. Other experts claim that perhaps caffeine induces a severe state of alertness and anxiety and thus the individual is no longer able to sleep or function properly and hence gets depressed

The number of individuals whose depression is worsened by caffeine is not known. In any case, if your depression gets worse after consuming caffeine, one should limit the intake of caffeine containing beverages. The caffeine beverages should be gradually deceased because abrupt discontinuation of caffeine can also lead to mild withdrawal symptoms such as headaches, lethargy, irritability, and anxiety. There are a few anecdotal reports indicating that lessening caffeine intake can lessen the severity of depression.

Caffeine is not as bad as what is made out in the lay media. It does have a few proven health benefits including ability to improve alertness, increasing concentration and allowing one to be more sociable. A number of French studies have shown that a daily cup of coffee can lead to a lesser degree of cognitive impairment with age. However despite its potential benefits, too much caffeine also has adverse effects. For the depressed individual, the trick is to consume the right balance of caffeine.

Vitamin B12 and depression

Physicians have known for a long time that individuals who have low levels of Vitamin B 12 develop many problems in their body, including depression. Vitamin B12 and related health supplements like folate are essential for function of neurochemicals in the brain. Many of minerals and vitamins act as co-factors and help in the synthesis of vital neurotransmitters in the brain.

However, the problem is that the brain is too complex. There are millions of nerves in the brain, each intricately linked and all working in harmony. Where B12 fits into this grand picture has remained a mystery. Besides B12, many other minerals have been linked to depression include, cooper, zinc, selenium and iron.

The most common cause of B12 deficiency is poor nutrition. One also has to remember that once depression sets in, the individual will further worsen the problem by not eating healthy. Individuals who develop depression often show little interest in food and tend to eat unhealthy foods thus worsening the cycle of depression.

While there has been a lot of hype about Vitamin B12 as a cure for depression, one should know that replenishing the diet with this vitamin does not always reverse the depression. However, that does not mean one should not eat healthy. All individuals who are depressed should eat a well balanced diet that contains all essential minerals, and vitamins including B 12. There is absolutely no point in buying vitamins from a health store. Vitamin B12 is found in ample amounts in many foods like breakfast cereals, meat, poultry, milk, and seafood.

For those who are on a vegetarian diet an over the age of 50, perhaps obtaining extra vitamins supplements may help.

All patients with depression should ensure that the health care professional has addressed any underlying medical disorder that can make your depression worse. Some of the common conditions that affect depression include under activity of the thyroid (hypothyroid) vitamins deficiencies and pernicious anemia. Once these conditions are treated, the depression may improve.

Current Recommendations on Electroconvulsive therapy Usage Part 2

ECT is used much less often today partly because of the availability of more potent and safer anti depressants and also the development of the field of psychotherapy. Plus, there are a variety of organizations and social support groups to help mental health patents overcome their disabilities

Even so, depression can take an acute turn for the worse with the individual going downhill fast and not eating, talking or even communicating. Some may develop acute psychosis and delusions and become very suicidal.

In these cases, ECT may offer a rapid therapeutic benefit compared to what is available and may be an excellent alternative. All current scientific data indicate that for acute depression with suicidal tendencies, ECT is an excellent form of therapy.

Many individuals who have had ECT in the past have found it helpful and seek the treatment when they feel depressed again.

ECT is relatively expensive. The costs of the treatment depend on which state one is receiving the therapy, the cost of anesthesia and the fees of the psychiatrist. On average the costs of ECT are about $ 800-$1200. The cost covers the fee for anesthesia, the psychiatrist and hospital admission. Most individuals receive anywhere from 6-8 treatments.

Many medical insurance plans and Medicare do reimburse the cost of ECT. While this may not sound cheap, it is a lot cheaper than taking anti depressant drugs for life

What is status of Electroconvulsive therapy today? Part 1

After nearly 30 years of extensive use, there is no doubt that electroconvulsive therapy (ECT) is beneficial in the treatment of some patients with depression. However, the use of ECT in schizophrenia, mania or other mental health disorders is in limbo.

The majority of studies of ECT on mania and schizophrenia are difficult to interpret and the results remain inconclusive. Today, ECT is not a part of the therapeutic regimen of these disorders, except for a few isolated cases.

A lot of evidence exists which shows that ECT is a good form of therapy for individuals with depression. In many instances it has even been shown to be more effective than the conventional drug therapy using anti depressants. Over the years, psychiatrists have learnt that entire brain stimulation produces significantly much better results than stimulating only one half of the brain. Further, like all things American, more is better- meaning that a higher current produces better and long lasting results than use of low current.

In the past, individuals who received ECT were never thoroughly investigated or followed up. Misconceptions of the treatment arose because of anecdotal reports by patients and non health care professionals. The background of the patient, his/her co morbidity, personality, use of medications and other medical problems were never taken into account and everything negative was blamed on ECT.

Further during the evolution of the treatment many of the psychiatrists also failed to maintain safeguards to protect the patient. Infact for the major part of the history of ECT it was felt that the treatment created monsters. Today a lot has changed.