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.

Schizoaffective Disorder: Part 1

Schizoaffective disorder is a mental health disorder where an individual experiences a mixture of schizophrenia symptoms (hallucinations, paranoia or delusions) and of mood disorder symptoms (mania or depression).

The majority of individuals with schizoaffective disorder are loners and have difficulty holding jobs or attending school. Most end up living in a group homes or in a psychiatric facility. The symptoms of schizoaffective disorder are variable and range from paranoia, delusions, strange perceptions, hallucinations, disorganized thinking and paranoid thoughts — as well as a mood disturbance, such as depressed or manic mood. Other features may include bizarre thoughts like suicide or homicide, deficits in attention and memory, lack of concern for hygiene, change in appetite and profound sleep disturbances. These individuals are very antisocial and are usually shunned by people around them.  Most of these individuals are simply not able to function in society because the variety of symptoms which can be quite intense.

In many cases, the psychotic features and mood disturbances may appear in the same setting or may cycle on regular intervals. The major problem with schizoaffective individuals is that they rarely seek treatment on their own; most are brought to medical attention by concerned family members or law enforcement.

The cause of schizoaffective disorder is not known but believed to be due to an imbalance of certain brain neurotransmitters. Some experts speculate that exposure to chemicals during pregnancy or a viral illness may be responsible for the illness.

Agoraphobia: Fear of Spaces Part 2

While agoraphobia is not life threatening, it can severely limit one’s life style. Without treatment, many people are not able to leave their home. These individuals become entirely dependent on others for food, money or any other type of daily living activity. With time, depression and anxiety set in and many of these individuals turn to alcohol/substance abuse to help cope with the loneliness, seclusion and shame.

The treatment of agoraphobia is taxing and usually means facing one’s fears. The basic treatments include medications and psychotherapy. Current medications used to treat these individuals include SSRIs like Paxil, Zoloft or Prozac. Additional medications may include an anti anxiety medication like xanax or clonazepam. Drug treatment alone is seldom sufficient for control of agoraphobia and several types of psychotherapy may help. Cognitive behavior therapy helps change detrimental behaviors through desensitization. One also learns methods to cope with symptoms via relaxation techniques. For those who are afraid to leave the home to visit a psychotherapist, one can arrange treatment sessions at home or in a safe neighborhood.  Of course, this also adds to the expense and more importantly, psychotherapy is not cheap.
Self-care remedies that may help cope with agoraphobia include learning reassuring skills, practicing relaxation techniques, and not avoiding feared spaces. There are many online support groups where one can reach out for help. 

The overall prognosis of individuals with agoraphobia depends on the severity of symptoms. If medications are discontinued, relapse is common. Transient improvements do occur but overall most individuals lead a poor quality of life.

Agoraphobia: Fear of Spaces Part 1

Agoraphobia is a type of anxiety disorder that is linked to fear. Individuals who have agoraphobia generally have fear of being in a place where they do not feel safe. Individuals with agoraphobia usually avoid places where they feel they may develop a panic attack. In general, most public places are avoided because of the irresistible fear that they may not be able to seek help. The majority of these individuals remain trapped in their homes, where they feel safe and live a life of seclusion.

The typical symptoms of agoraphobia include extreme fear of being alone, fear of being in a crowded places, fear of losing control in a public place, feelings of insecurity when leaving the home, a dreadful sense of helplessness when outside the home, extreme dependence on others and a feeling that body is imaginary. The physical symptoms are similar to a panic attack and may include dizziness, fast heart rate, difficulty breathing, nausea, flushing, chest pain, feeling a loss of control, difficulty swallowing and stomach upset.
Some experts believe that agoraphobia is simply an extension of panic disorder. However not all individuals with a panic disorder develop agoraphobia.

Agoraphobia usually starts in late adolescence and peaks in the 2/3^rd decade of life. It is estimated that nearly 1-5 percent of individuals develop some degree of agoraphobia during their lifetime. The disorder tends to affect women more than men. Like most mental disorders, the exact cause of agoraphobia is a mystery. Rick factors for agoraphobia include having a diagnosis of panic disorder, having experienced physical, sexual or emotional abuse during childhood, tendency of being edgy or anxious, having a history of alcohol/substance abuse, and being a female.

Antisocial Personality Disorder Part 2

Antisocial personality disorder occurs in 5 % of men and about 1% of women, but these numbers are believed to be under estimates. As the disorder progresses, there is severe depression, anxiety, suicidal and reckless behavior, violence, risky and impulsive behavior, incarceration, alcohol and drug abuse and difficult interpersonal relationships. The majority end up being loners. The diagnosis of antisocial personality is based on the history.


Like many mental disorders, the treatment of anti social personality disorder is multidisciplinary. Treatment options vary from psychotherapy, stress and anger management and use of medications.

Psychotherapy and anger management are widely used to treat antisocial personality disorder but most of these individual have very little insight into their behavior and are not compliant with therapy. These individuals never voluntary seek treatment but only come to treatment when compelled to do so by law enforcement or risk incarceration.

Unfortunately there are no medications to cure this disorder. However, those who are depressed or anxious may be prescribed anti depressants or mood stabilizers. Extreme agitation or psychosis is often treated with anti psychotics. Those who are not able to manage themselves or in danger of harming themselves or others are often admitted to the hospital.

The prognosis for antisocial personality disorder is poor. Most treatments do not work chiefly because these individuals are not compliant with therapy and refuse to seek help. Because there is no way to prevent this disorder, experts recommend identifying those at the highest risk such as children who are abused or neglected. Taking steps at an early age can help boost self esteem and increase confidence. Both parents and teachers may be able to spot signs of trouble in early childhood and this is the point in time when behaviour therapy can help make a big difference in outcomes.

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.

Passive-aggressive behavior disorder: Part 1

Passive aggressive behavior is frequently used to describe individuals who always make up some type of excuse when demands are made of them. The majority of individuals with passive aggressive behavior will indicate that they will perform a task but later respond by making a passive excuse like procrastination, waste time, be stubborn, show intentional deliberate carelessness, pretend to forget and then make irrational condemnation of individuals in high authority. It is estimated that this behavior occurs in at least 1/7 individuals and is most common in both young men and women.

Passive aggressive personality disorder is a chronic disorder where the individual always initially agrees to meet the desires and demands of others, but in reality he/she passively oppose the tasks and then becomes very irate or hostile. These individuals have a long history of negative thoughts when demands are made to perform a duty both at work and in the social environment. This behavior is commonly first seen in the workplace, but in retrospect many families will admit that the behavior has been of long standing at home. Almost always the negative behavior results in breakdown of interpersonal relationships.

The behavior is expressed by repeated postponements, inattentiveness obstinacy, and intentional incompetence. Without fail, this behavior arises when a task is assigned by someone in higher authority.

No one know what causes this passive aggressive behavior but it is most likely related to bad genes or the environment.

Treatment of Borderline Personality Disorder

The treatment of individuals with borderline personality disorder (BPD) is quite difficult. Despite a better understanding of the disorder, most treatments do not live up to expectations. Both group and individual therapy have been shown to be only partially effective in a few patients.

In the last decade, a new psychosocial treatment known as dialectical behavior therapy (DBT) has been used to treat patients with BPD. The treatment combines the standard cognitive behavior techniques for emotional balance and reality testing. The treatment encourages tolerance awareness and acceptance of others. DBT has been derived from the Buddhists meditative ideology and is probably the first therapy to have had any significant benefit in BPD patients.

Drug therapy is often prescribed to treat specific symptoms of the BDP individual. The most commonly used drugs to treat BPD patients include anti-depressants which help alleviate the depressed or labile moods. When there are features of distorted/delusional thinking, anti-psychotics are also often prescribed.

There is now some evidence that the cause of BPD may be partly related to genetic factors and the environment. A number of these individuals do reveal a history of abuse (physical, emotional, sexual), neglect or separation as children. This abuse is most often perpetrated by a non caregiver. There is a strong belief that BPD may be triggered when the individual is re-exposed to any one of the prior abusive factors. Another aspect of BPD therapy is family support. However, these individuals create persistent havoc in the lives of people who try to help them.

When the triggers are identified, avoidance of these factors can make the disorder a lot easier to control with cognitive behavior therapy. Despite all the advances in therapy, majority of individuals with BPD lead a poor quality of life with frequent labile moods, spontaneous anger and impulsivity. Most are loners and make lives of everyone around them miserable.

Borderline Personality- Symptoms

Individuals with borderline personality often develop symptoms from acute events like loss of a job, failure at work, breakup of friendship, lack of career goals and most of all, a sense of having no identity

Many of these individuals view themselves as worthless or bad. Often they feel as they have been mistreated or deceived. They often complain of feeling bored, empty and lack of self recognition is quite common.

The symptoms of BPD generally are more severe when the individuals have little family support and no friends. The individual in turn makes desperate attempts to socialize.

Because of the persistent negative feelings or emotional traits, BPD individuals have few friends. While they do develop intense attachments, these are often stormy. These individuals are very labile in their feelings with emotions switching from love to hate in a matter of minutes. Loyalty to a friendship is rare because they constantly switch their feelings at the slightest hint of feeling poorly treated. Being highly sensitive to rejection, they often react with anger, self injury and spontaneous unrealistic decisions. In the middle of a vacation, they many cancel the trip and return back home. Sudden changes in plans are not common with these individuals.

Like manics, BPD individuals also act with impulsivity and may go on a spending spree, practice risky behaviors like sex with strangers, binge eating and drinking. In most cases BPD occurs as an isolated disorder but can occur in association with other mental health disorder like depression, substance abuse, mania and anxiety,

Borderline Personality- just what is it? part 2

At any one point in time, at least 1/5 individuals afflicted with BPD need long term mental health services and/or repeated admissions to psychiatric facilities. If help is sought out early, many individuals can improve with time, and lead fairly normal and productive lives.

Unlike individuals who have depression or manic disorder, BPD individuals develop similar but more intense feelings of anger, depression, anxiety and sadness –but the feelings only last a few hours. Associated with these symptoms are spontaneous acts of impulsive behaviors such as anger, self injury, drug or alcohol abuse.

Borderline Personality- just what is it?

These days whenever there is a fall out in a relationship or disagreement among friends/colleagues, at once, the term borderline personality (BPD) is used to describe the individual. Even though the term BPD is used liberally, very few people have little idea about the disorder.

Borderline personality disorder (BPD) is a somber mental illness distinguished by a pervasive instability in moods, interpersonal interactions, self-image, and conduct. Asides from the individual, everyone around him/her experiences turmoil.

Individuals who have BPD usually have difficulty with family and work relationships. The individual has no long-term plans and there appear to be a lack of identity. These individuals suffer from a problem with emotion control. The disorder is fairly common and affects nearly 2/100 young women. Many of these women do have a history of repeated self injury but without an intent to commit suicide but completed suicides are not unheard of.

Claustrophobia- fear of enclosed spaces: Part 2

Symptoms of claustrophobia include a rapid heart rate, sweating, hyperventilation, sensation of difficulty breathing, light headedness, dizziness, nausea, and a feeling of doom.

Most individuals with claustrophobia are always on the lookout for exits in a closed room, avoid elevators and subways, are scared flying in plane or taking a taxi.

The diagnosis of claustrophobia is based on the history and does not involve any type of radiological study.

Over the years, several treatments have been developed to treat this disorder. The treatments gradually desensitize the individual to close spaces and allows for changes in behavior.

Psychotherapy is targeted to help overcome the fear and helps manage the situation. Most people are taught how to relax using breathing exercise and be calm when in a claustrophobic environment. Cognitive behaviour therapy is also used to help individuals control the negative thoughts of fear.

A few individuals may also benefit from the use of anti depressants and anti anxiety agents. These drugs do not cure claustrophobia but help diminish the symptoms.

Of all the mental disorders, claustrophobia can be effectively treated and significantly improve the quality of life.

Claustrophobia- fear of enclosed spaces: Part 1

Claustrophobia is defined as a disorder which brings about an unrealistic fear of enclosed or small spaces. Individuals who have claustrophobia describe these sensations of feeling trapped and scared with no way out of the situation. Claustrophobia brings about symptoms of heightened anxiety or panic. The fear can be intense and can create an unbearable lifestyle.

Data indicate that anywhere from 2-5 percent of individuals are affected by claustrophobia. Overall females are more prone to the disorder than men. Unfortunately the majority of people who suffer from claustrophobia rarely seek help chiefly because they are unaware that treatments exist. Most individuals cope by avoiding enclosed spaces and live a severely restricted life style.

However, today the disorder can be treated with great success.
Causes
The actual cause of claustrophobia is not known and the disease does tend to run in families. Claustrophobia generally develops in early childhood and peaks in the 2/3rd decade of life. In some lucky individuals the condition can spontaneously disappear. When claustrophobia persists, treatment is necessary because the symptoms can affect work and life style.
Claustrophobia tends to be more common in individuals who have a history of anxiety when placed in an enclosed room or restricted space.

Individuals who regularly avoid situations that have brought on previous attacks may actually have a higher chance of developing an anxiety attack.

Agoraphobia: "unrealistic fear" Part 3

Once diagnosis of this disorder is made, treatment includes medications and behavior therapy. Medications like SSRIs, tricyclic anti depressants or anti anxiety medications do not cure the disorder but significantly reduce symptoms and panic sensations. In many cases, symptoms of agoraphobia can be controlled within 12 months.

Cognitive behavior therapy also helps people over come agoraphobia. One learns to cope with panic attacks using relaxation techniques. In this treatment, one is slowly desensitized to things that create panic.

There are some people who claim that herbal and dietary supplements like Kava may help but these supplements have also been linked to liver damage.
Individuals who have agoraphobia should definitely seek treatment because the disorder can be successfully treated in most cases. There are also support groups where one can connect with others and understand more about the disorder.

Finally those who have agoraphobia should avoid alcohol and use of illicit drugs- these recreational items just make the condition worse.

Agoraphobia: "unrealistic fear" Part 2

Experts believe that agoraphobia is a complication of a panic disorder. Most people avoid situations where they feel panic and thus live very sheltered lives. Unfortunately, the cause of agoraphobia is unknown. The disorder usually develops in late teens or early adulthood. It is estimated that 1-5 percent of individuals develop agoraphobia during their lifetime. Women are more prone to agoraphobia than men.

In some cases, fear of having a panic attack may be so great that one may not be able to leave safety of their home. In other cases, one learns to live a restricted lifestyle and is able to tolerate certain situations as long as one is accompanied by a dependent family member or friend. Risk factors that predispose to agoraphobia include having a panic disorder, a stress full experience earlier in life (child abuse), alcohol or substance abuse.

Agoraphobia can lead to social isolation, depression and make one overtly dependent on others. The despair often leads to alcohol and substance abuse to help cope with the situation of hopelessness and loneliness.

Agoraphobia: "unrealistic fear" Part 1

Agoraphobia is a mental disorder associated with unrealistic fear. The syndrome is intricately linked to anxiety. People who have agoraphobia fear being in certain places and easily develop panic like symptoms.

Agoraphobia tends to make people afraid even in open public places like elevators, bridges, high buildings, sporting events, use of public transportation, shopping malls and air planes. This fear can be so devastating that many people are trapped in their homes- this is the only place where they feel safe and rarely venture outside. Some individuals even fear being left alone at home, feel feeble and become dependent on others.

Agoraphobia is difficult to treat because it means confronting the fears. Other symptoms of agoraphobia include difficulty breathing, dizziness, sweating, fast heart rate, nausea, facial flushing, stomach cramps, chest pain, feeling complete lack of control, difficulty swallowing and a sense of doom.

Does lack of sleep cause depression? Part 2

"Adequate quality sleep could therefore be a preventative measure against depression and a treatment for depression," he added.

Chief executive at the mental health charity YoungMinds, Sarah Brennan said: "Enough sleep, good food and regular exercise and all essential to stay emotionally healthy. Nearly 80,000 children and young people suffer with depression, yet we are still failing to provide our young people with the help and support to cope with it and prevent it.”

She adds, “Providing parents with information about how to look after your body, for example by getting enough sleep, and how to get help if they are worried about their teenager, will ensure problems are tackled early and prevent serious mental health conditions such as depression."

Final point: While it may sound reasonable to assume that adequate sleep may prevent depression this is clearly not so. There are many individuals who do sleep well and yet feel depressed- clearly indicating that there are many other factors which play a role in development of depression. If sleep was the only factor then sedatives (and not anti depressants) would have long been a cure for depression; caveat- sedatives can in fact worsen 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.