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Bipolar Basic Terminology:
Bipolar disorder is the medical name for manic depression.
The terms may be used interchangeably.
Bipolar disorder is a mental illness, but it is more appropriately described as a neurobiological brain disorder involving extremes in mood. It is one of the three major affective (mood) disorders.
The other two affective disorders are unipolar disorder (depression only) and
schizoaffective disorder. Most medical researchers believe that bipolar disorder is genetic.
Learning About Your Diagnosis
Family and friends to sometimes tell people with bipolar disorder
"Just snap out of it" or "just cheer up" or "pray to God and you will be healed."
This sort of well-meaning advice can be lethal to someone who is experiencing the disturbing states of mania or depression. The implication is that if we tried harder, we would not be having all these problems. What nonsense!
Remember, mental illnesses have a biological basis, just like other illnesses. There are plenty of scientific studies, which prove this. This is not a justification of the unusual behavior that happens during mania or depression, but rather an explanation of its origin.
Perhaps you have been to a doctor, and now have a prescription in your hand.
The doctor says, "Take as directed. In two weeks you will feel much better."
Is this true? What if you get side effects? What if nothing happens? How can you possibly survive the wait?
As difficult as this sound, you must be your own health care advocate. Don't expect your doctor to do it for you, or your significant other, or your parents, or your friends. Take charge of your diagnosis. Speak to your doctor about your concerns. In the beginning, you may need daily or weekly contact with the doctor.
Ask questions. Find answers.
You may wish to keep a journal or a mood chart. Learn to identify those in with things that make your episodes worse. Identify things, which seem to help.
Make adjustments to your daily life. Find support to help you through the rough times.
If you have been diagnosed with a mental illness such as bipolar disorder it is time to learn as much as you can, as fast as you can. There are books to read, organizations you can contact, real-world support groups, Internet mail lists and newsgroups, and Web-based chat areas. Plus, there are some excellent Web sites which you can visit on your journey of discovery.
Characteristics
Symptoms of Mania:
Increased energy, activity, restlessness, racing thoughts and rapid speech
Excessive euphoria
Extreme irritability and distractibility
Decreased sleep requirement
Uncharacteristically poor judgment
Increased sexual drive
Denial that anything is wrong
Overspending
Risk-behavior
Symptoms of Depression:
Persistent sad, anxious or empty mood
Feelings of hopelessness, pessimism, guilt, worthlessness or helplessness
Loss of interest or pleasure in ordinary activities, including sex
Decreased energy, feelings of fatigue
Difficulty in concentrating, remembering or making decisions
Change in appetite or weight
Thoughts of death or suicide
also this list was found at:
http://communities.msn.com/ABNORMALREALITY/whatisbipolardisorder.msnw
Bipolar Disorder
What is bipolar disorder?
Bipolar disorder, or manic depression, is a serious brain disorder that causes extreme shifts in mood, energy, and functioning. It affects 2.3 million adult Americans, or 1.2 percent of the population. Bipolar disorder is characterized by episodes of mania and depression that can last from days to months. Bipolar disorder is a chronic condition with recurring episodes that often begin in adolescence or early adulthood. It generally requires ongoing treatment.
What are the symptoms of mania?
Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:
either an elated, happy mood or an irritable, angry, unpleasant mood
increased activity or energy
more thoughts and faster thinking than normal
increased talking, more rapid speech than normal
ambitious, often grandiose, plans
increased sexual interest and activity
decreased sleep and decreased need for sleep
What are the symptoms of depression?
Depression is the other phase of bipolar disorder. The symptoms of depression may include:
depressed or apathetic mood
decreased activity and energy
restlessness and irritability
fewer thoughts than usual and slowed thinking
less talking and slowed speech
less interest or participation in, and less enjoyment of activities normally enjoyed
decreased sexual interest and activity
hopeless and helpless feelings
feelings of guilt and worthlessness
pessimistic outlook
thoughts of suicide
change in appetite
change in sleep patterns
What is a "mixed" state?
A mixed state is when symptoms of mania and depression occur at the same time. During a mixed state depressed mood accompanies manic activation. The symptoms during a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking.
What is rapid cycling?
Sometimes individuals may experience regularly alternating periods of mania and depression. When four or more episodes of illness occur within a 12-month period, the individual is said to have bipolar disorder with rapid cycling. Rapid cycling is more common in women.
What are the causes of bipolar disorder?
While the exact cause of bipolar disorder is not known, researchers believe it is the result of a chemical imbalance in the certain parts of the brain. Scientists have found evidence of a genetic predisposition to the illness. Bipolar disorder tends to run in families, and close relatives of someone with bipolar disorder are more likely to be affected by the disorder. Sometimes serious life events such as a serious loss, chronic illness, or financial problem, can trigger an episode in some individuals with a predisposition to the disorder. There are other possible "triggers" of bipolar episodes: the treatment of depression with an antidepressant medication may trigger a switch into mania, sleep deprivation may trigger mania, or hypothyroidism may produce depression or mood instability. It is important to note that bipolar episodes can also occur without an obvious trigger.
How is bipolar disorder treated?
While there is no cure for bipolar disorder it is a highly treatable and manageable illness. After an accurate diagnosis, most people (80 to 90 percent) can be successfully treated. Medication is an essential part of successful treatment for people with bipolar disorder. Maintenance treatment with a mood stabilizer substantially reduces the number and severity of episodes for most people, although episodes of mania or depression may occur and require a specific additional treatment. In addition, psychosocial therapies including, cognitive-behavioral therapy, interpersonal therapy, family therapy, and psychoeducation are important to help people understand the illness and cope with the stresses that can trigger episodes. Changes in medications or doses may be necessary, as well as changes in treatment plans during different stages of the illness.
Medications used to treat mania. Two medications commonly used to treat manic episodes of bipolar disorder are called mood stabilizers, and they include lithium (Eskalith or Lithobid) and divalproex sodium (Depakote).
Lithium has long been used as a first line treatment for acute mania in people with bipolar disorder. Lithium is effective for preventing episodes of mania from occurring and for treating an episode after it has begun. However, for some individuals, lithium is ineffective and for others, lithium has a variety of side effects that may make it an undesirable treatment option.
Depakote is an anticonvulsant that has been used to treat epilepsy since 1983, but it was approved as a treatment for manic episodes of bipolar disorder in 1995. Depakote seems to be as effective as lithium for treating mania and it has fewer side effects, although it may not be appropriate for people with a history of liver problems.
Other anticonvulsant medications have also been found to be effective treatments for mania, including carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topamax). However, these four medications have not been officially approved by the FDA for the treatment of bipolar disorder and have their own side effects.
Mania may also be treated acutely with antipsychotic medications in addition to a mood stabilizer. More research is needed to test the safety and efficacy of atypical antipsychotics, which may prove to be alternatives in the long-term treatment of bipolar disorder.
Medications used to treat depression. During depressive episodes, people with bipolar disorder may need additional treatment with an antidepressant medication. Because of the risk of triggering mania, doctors often prescribe lithium or an anticonvulsant mood stabilizer with an antidepressant. Antidepressant medications relieve depression, elevate mood, and activate behavior, but it often takes three to four weeks to respond. Sometimes a variety of different antidepressants and doses will be tried before finding the medication that works best for a particular individual.
There are several different types of antidepressants used to treat depression including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), or newer antidepressants that function in different ways.
Consumers and their families must be cautious during the early stages of treatment when energy levels and the ability to take action return before mood improves. At this time - when decisions are easier to make, but depression is still severe - the risk of suicide may temporarily increase.
What are the side effects of the medications used to treat bipolar 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, switching to a different medication, or treating the side effect directly with an additional medication.
Side effects of medications used to treat mania.
Lithium tends to have the most side effects of the mood stabilizers - including hand tremors, excessive thirst, excessive urination, and memory problems - but they often become less troublesome after a few weeks as the body adjusts to the medication. Particularly bothersome tremors can be treated with additional medication. Low thyroid function can be treated with thyroid supplements. In very few people, long-term lithium treatment can interfere with kidney function.
The other anticonvulsant mood stabilizers tend to have fewer side effects than lithium. Common side effects include nausea, drowsiness, dizziness, and tremors. Some people taking anticonvulsant mood stabilizers may develop liver problems or problems with white blood cell count and blood platelets, which can be severe. Therefore, blood tests to monitor liver function and blood cells may be an important part of treatment with some of these medications.
Side effects of medications used to treat depression. About half of the people taking antidepressant medications have mild side effects during the first few weeks of treatment.
Common side effects of tricyclic antidepressants (TCAs) include dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, or weight gain or loss.
Individuals taking monoamine oxidase inhibitors (MAOIs) may have to be careful about eating certain smoked, fermented, or pickled foods, drinking certain beverages, or taking some medications because they can cause severe high blood pressure in combination with the medication. MAOIs have other, less severe side effects as well.
The SSRIs and newer antidepressants tend to have fewer and different side effects, such as nausea, nervousness, insomnia, diarrhea, rash, agitation, or sexual problems.
BORDERLINE PERSONALITY DISORDER
Therapists use a book called "Diagnostic and Statistical Manual" (DSM) to make mental health diagnoses. They've outlined nine traits that borderlines seem to have in common; the presence of five or more of them may indicate BPD.
However, please note the following:
Everyone has all these traits to a certain extent. Especially teenagers. These traits must be long-standing (lasting years) and persistent. And they must be intense.
Be very careful about diagnosing yourself or others. In fact, don't do it. Top researchers guide patients through several days of testing before they make a diagnosis. Don't make your own diagnosis on the basis of a WWW site or a book!
Many people who have BPD also have other concerns, such as depression, eating disorders, substance abuse even multiple personality disorder or attention deficit disorder. It can be difficult to isolate what is BPD and what might be something else. Again, you need to talk to a qualified professional.
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DSM-IV Definition of BPD
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:
Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."
Following is a definition of splitting from the book I Hate You, Don't Leave Me by Jerry Kreisman, M.D. From page 10:
The world of a BP, like that of a child, is split into heroes and villains. A child emotionally, the BP cannot tolerate human inconsistencies and ambiguities; he cannot reconcile anther is good and bad qualities into a constant coherent understanding of another person. At any particular moment, one is either Good or EVIL. There is no in-between; no gray area....people are idolized one day; totally devalued and dismissed the next.
Normal people are ambivalent and can experience two contradictory states atone time; BPs shift back and forth, entirely unaware of one feeling state while in the other.
When the idealized person finally disappoints (as we all do, sooner or later) the borderline must drastically restructure his one-dimensional conceptionalization. Either the idol is banished to the dungeon, or the borderline banishes himself in other to preserve the all-good image of the other person.
Splitting is intended to shield the BP from a barrage of contradictory feelings and images and from the anxiety of trying to reconcile those images. But splitting often achieves the opposite effect. The frays in the BP's personality become rips, and the sense of his own identity and the identity of others shifts even more dramatically and frequently.
Identity disturbance: markedly and persistently unstable self-image or sense of self.
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 (5).
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.
Dissociation is the state in which, on some level or another, one becomes somewhat removed from "reality," whether this be daydreaming, performing actions without being fully connected to their performance ("running on automatic"), or other, more disconnected actions. It is the opposite of "association" and involves the lack of association, usually of one's identity, with the rest of the world.
There is no "pure" BPD; it coexists with other illnesses. These are the most common. BPD may coexist with:
Post traumatic stress disorder
Mood disorders
Panic/anxiety disorders
Substance abuse (54% of BPs also have a problem with substance abuse)
Gender identity disorder
Attention deficit disorder
Eating disorders
Multiple personality disorder
Obsessive-compulsive disorder
Statistics about BPD
BPs comprise:
2% of the general population
10% of all mental health outpatients
20% of psychiatric inpatients
75% of those diagnosed are women
75% have been physically or sexually abused
http://www.bpdcentral.com/resources/basics/main.html
AGORAPHOBIA:
Overview
Definition
An incapacitating fear of open spaces.
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Causes, incidences, and risk factors
Agoraphobia is a disorder characterized by avoidance of crowds, and open and public places, particularly if escape or assistance is not immediately available. It may occur alone, or may accompany panic disorder.
If it occurs with panic disorder, the onset is usually during the 20s, and women are affected more often than men. People with this disorder may become house bound for years, with resulting impairment of social and interpersonal relationships.
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Prevention
As with other panic disorders, prevention may not be possible. Early intervention may reduce the severity of the condition.
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Symptoms
Fear of being alone
Fear of losing control in a public place
Fear of being in places where escape might be difficult
Becoming house bound for prolonged periods
Feelings of detachment or estrangement from others
Feelings of helplessness
Dependence upon others
Feeling that the body is unreal
Feeling that the environment is unreal
Anxiety or panic attack (acute severe anxiety)
Unusual temper or agitation with trembling or twitching
Additional symptoms that may occur:
Lightheadedness, near Fainting
Dizziness
Excessive sweating
Skin flushing
Breathing difficulty
Chest pain
Heartbeat sensations
Nausea and vomiting
Numbness and tingling
Abdominal distress that occurs when upset
Confused or disordered thoughts
Intense fear of going crazy
Intense fear of dying
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Signs and tests
There may be a history of phobias, or the health care provider may receive a description of typical behaviors from family, friends, or the affected person. The pulse (heart rate) is often rapid, sweating is present, and the patient may have high blood pressure.
Agoraphobia
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Treatment
The goal of treatment is to help the phobic person function effectively. The success of treatment usually depends upon the severity of the phobia.
Systematic desensitization is a behavioral technique used to treat phobias. It is based upon having the person relax, then imagine the components of the phobia, working from the least fearful to the most fearful. Graded real-life exposure has also been used with success to help people overcome their fears.
Antianxiety and antidepressive medications are often used to help relieve the symptoms associated with phobias.
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Prognosis
Phobias tend to be chronic but respond well to treatment.
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Complications
Some phobias may have consequences that affect job performance or social functioning.
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Calling your health care provider
Call for an appointment with your health care provider if symptoms suggestive of agoraphobia develop.
Dissociation
Depersonalisation and Derealisation belong to a group of sensations known as Dissociation. This is not to be confused with dissociative identity disorder which effects less than 1% of the population. (This disorder has a number of different symptoms to that of anxiety disorders including amnesia)
Dissociation is also known as a 'self induced trance states' or 'altered states of consciousness'. The ability to dissociate is on a scale 0 -10.
0 = people who do not have this ability through to 10 which usually indicates dissociative identity disorder. People with panic disorder are about 4 - 5 on the scale and people with panic disorder do not go on to develop DID.
The sensations of dissociation are many and varied. They include the following:
Derealisation:
feel as if you and/or your surroundings do not seem real
experience your surroundings through a diffused light, fog or mist
Depersonalisation:
feel as if you are "outside of your body"/ detached from your body, as though you are either standing alongside, above or behind it
Other:
feel as if you are falling into a void
sensitivity to light and sound
tunnel vision
feel as if your body is expanded so that it feels huge/larger than normal
feel as if your body has shrunk to minute proportions/ smaller than normal
feel as if your body is being pressed to the ground
stationary objects may appear to move
Other dissociative indicators are as followed
Driving a car and suddenly realise you don't remember what has happened during all or part of the trip
Listening to someone talk and realise did not hear part/all of what was just said
Experience feeling as though you are standing next to yourself and watching yourself do something
Sometimes sit staring off into space, thinking nothing and you are not aware of the passage of time
Many people indicate that they dissociate first, that is - experience depersonalisation and/or Derealisation and then panic or have a panic attack. as a result.
It is interesting to note, that although depersonalisation and derealisation symptoms are recognised as two of the most common spontaneous panic attack symptoms, the ability to dissociate is not mentioned in the main panic disorder literature. Nor is it mentioned that many people dissociate first and then panic or experience a panic attack. There has been speculation amongst psychiatrists who work in the area of dissociation that people with panic disorder do in fact dissociate first, but there has been no substantial research in this area. Which is disappointing. We have been researching this for over 10 years and we know from the feedback from clients and from emails that this is the case for so many of us.
Some of the research shows those of us who have the ability to dissociate, can induce a trance state within a split second. Most of us who have panic disorder are not aware that we are doing this and many of us panic when we move into an altered state. Our research also shows that people can experience an 'electric' shock feeling or a burning heat or a baring tingling heat in these altered states. This also adds to our fear that we are dying or going insane and we panic! Another research study shows that people can experience dizziness as a result of the dissociated states.
Most people who dissociate are also woken from sleep with nocturnal panic attacks. The research shows these attacks happen on the change of consciousness as we go to sleep or as we move from dreaming sleep to deep sleep or back to dreaming sleep. The change in consciousness during sleep, is similar to the change in consciousness we experience when we dissociate during the day.
Some people are frightened of their ability to dissociate other people are not. Some people are aware they have the ability to 'trance ' out, but don't recognise the deeper trance states as being part of the dissociate/trance states.
One of the easiest way people can induce a trance state is when we are relaxed and/or when we are staring: out of the window, driving, watching TV, reading a book, using the computer, when talking with someone. Fluorescent lights can trigger a trance state, so too can our self absorption..worrying about our next panic attack. The more absorbed we become the more we can induce a trance stare.
When we recover we will find this ability to be beneficial. Many of us with panic disorder are very creative and our creative abilities are heightened in the trance states. In fact many people use the trance states to induce their creativity.
For more information see also our question and answer section : Dissociation
Bronwyn's book, 'Power over Over' and the Panic Anxiety Management Videos, discuss and teach people how to learn to manage their dissociation. For more information see 'Power over Panic' or the 'Workshop Videos.'
http://www.panicattacks.com.au/about/anxdis/dissociation.html
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Signs of Verbal and Emotional Abuse
by Dr. Irene Matiatos with a former Client who's been there, done that
featured on www.obgyn.net
Do you wonder if your relationship may be abusive? Ask yourself the questions below. If you answer 'yes' to more than a few, you may want to take a closer look:
Does your partner:
Updated September 2000 ignore your feelings?
disrespect you?
ridicule or insult you then tell you its a joke, or that you have no sense of humor?
ridicule your beliefs, religion, race, heritage or class?
withhold approval, appreciation or affection?
give you the silent treatment?
walk away without answering you?
criticize you, call you names, yell at you?
humiliate you privately or in public?
roll his or her eyes when you talk?
give you a hard time about socializing with your friends or family?
make you socialize (and keep up appearances) even when you don't feel well?
seem to make sure that what you really want is exactly what you won't get?
tell you you are too sensitive?
hurt you especially when you are down?
seem energized by fighting, while fighting exhausts you?
have unpredictable mood swings, alternating from good to bad for no apparent reason?
present a wonderful face to the world and is well liked by outsiders?
"twist" your words, somehow turning what you said against you?
try to control decisions, money, even the way you style your hair or wear your clothes?
complain about how badly you treat him or her?
threaten to leave, or threaten to throw you out?
say things that make you feel good, but do things that make you feel bad?
ever left you stranded?
ever threaten to hurt you or your family?
ever hit or pushed you, even "accidentally"?
seem to stir up trouble just when you seem to be getting closer to each other?
abuse something you love: a pet, a child, an object?
compliment you enough to keep you happy, yet criticize you enough to keep you insecure?
promise to never do something hurtful again?
harass you about imagined affairs?
manipulate you with lies and contradictions?
destroy furniture, punch holes in walls, break appliances?
drive like a road-rage junkie?
act immature and selfish, yet accuse you of those behaviors?
question your every move and motive, somehow questioning your competence?
interrupt you; hear but not really listen?
make you feel like you can't win? damned if you do, damned if you don't?
use drugs and/or alcohol involved? are things worse then?
incite you to rage, which is "proof" that you are to blame?
try to convince you he or she is "right," while you are "wrong?"
frequently say things that are later denied or accuse you of misunderstanding?
treat you like a sex object, or as though sex should be provided on demand regardless of how you feel?
Your situation is critical if the following applies to you:
You express your opinions less and less freely.
You find yourself walking on eggshells, careful of when and how to say something.
You long for that softer, more vulnerable part of your partner to emerge.
You find yourself making excuses for your partner's behavior.
You feel emotionally unsafe.
You feel its somehow not OK to talk with others about your relationship.
You hope things will change...especially through your love and understanding.
You find yourself doubting your memory or sense of reality.
You doubt your own judgment.
You doubt your abilities.
You feel vulnerable and insecure.
You are becoming increasingly depressed.
You feel increasingly trapped and powerless.
You have been or are afraid of your partner.
Your partner has physically hurt you, even once.
If you feel your relationship may be verbally and emotionally abusive, talk to people you trust. Talk to clergy, call your local battered women's shelter, educate yourself, seek professional help. Do not allow verbal and emotional abuse to escalate to battery!
http://www.drirene.com/verbal1.htm
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Hypomania
A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
The disturbance in mood and the change in functioning are observable by others.
The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Criteria summarized from:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
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Schizophrenia
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Overview
Definition
A group of psychotic disorders characterized by disturbances in thought, perception, affect, behavior, and communication lasting longer than six months.
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Causes, incidences, and risk factors
Schizophrenia is a disease of the brain. Changes in neurophysiological function that characterize schizophrenia have been identified, but its exact causes are unknown. Genetic factors appear to play a role, as close relatives of a person with schizophrenia are more likely to develop the disorder. Problems with intrauterine development and birth may increase the risk for developing schizophrenia later in life.
Psychological and social factors may also play some role in its development. Previously held theories that considered schizophrenia a result of communication or child-rearing practices have been discredited. However, the level of social and familial support appears to influence the course of illness and may be protective against relapse.
There are five recognized types of schizophrenia:
catatonic, paranoid, disorganized, undifferentiated, and residual.
Features of schizophrenia include its typical onset before the age of 45; continuous presence of symptoms for six months or more; and deterioration from a prior level of social and occupational functioning.
Psychotic symptoms are present during the active phase and may include two or more of the following:
delusions - unfounded beliefs that are thought to be true even in the face of contradictory evidence
hallucinations - a sensory perception without an external stimulus (may affect hearing, taste, vision, smell, or sense of touch)
incoherence (not understandable) - disordered, and without logical connection
catatonic behavior - bizarre motor behavior marked by a decrease in reactivity to the environment, or hyperactivity that is unrelated to stimulus
flat affect - an appearance or mood that shows no emotion
No single characteristic is present in all types of schizophrenia. The risk factors include a family history of schizophrenia. Schizophrenia is thought to affect about 1% of the population worldwide. Schizophrenia appears to occur in equal rates among men and women, but women have a later onset. For this reason, males tend to account for more than half of clients in services with high proportions of young adults. Although the onset of schizophrenia is typically in young adulthood, cases of the disorder with a late onset (over 45 years) are known.
Childhood-onset schizophrenia begins after five years of age and, in most cases, after relatively normal development. Childhood schizophrenia is rare and can be difficult to differentiate from other pervasive developmental disorders of childhood, such as autism.
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Prevention
Unknown
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Symptoms
Catatonic type:
motor disturbances
stupor
negativism
rigidity
excitement
may be unable to take care of personal needs
decreased sensitivity to painful stimulus
Paranoid type:
delusional thoughts of a persecution or grandiose nature
anxiety
anger
violence
argumentative
Disorganized type:
incoherence (not understandable)
regressive behavior
flat affect
delusions
hallucinations
inappropriate laughter
mannerisms
social withdrawal
Undifferentiated type:
may have symptoms of more than one subtype of schizophrenia
Residual type:
the prominent symptoms of the illness have abated but some features, such as hallucinations and flat affect, may remain
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Signs and tests
The diagnosis of this disorder is difficult and controversial. Schizophrenia is a "diagnosis of exclusion" which is made if no other psychotic disorder can account for the type of symptoms and their duration. The following factors may suggest a schizophrenia diagnosis but do not confirm it:
developmental background
genetic and family history
changes from level of functioning prior to illness
course of illness and duration of symptoms
response to pharmacological therapy
CT scans of the head and other imaging techniques may identify some changes associated with schizophrenia in the research literature (such as enlarged ventricles in the brain) and may rule out other neuro~physiological disorders.
Schizophrenia
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Treatment
Treatment
During an acute episode of schizophrenia, hospitalization is often required to prevent self-inflicted harm or harm to others, and to provide for the persons basic needs such as food, rest, and hygiene.
Antipsychotic or neuroleptic medications are used to control the symptoms of the illness. These medications are effective but are also associated with uncomfortable and sometimes dangerous side effects that appear to reduce compliance with regimens. Common side effects from traditional neuroleptics include sedation, weight gain, and "extrapyramidal symptoms" such as muscle contractions, problems of movement and gait, and feelings of inner restlessness or "jitters".
Long-term risks include a movement disorder called "tardive dyskinesia," which involves involuntary movements of the facial muscles or tongue. Newer agents known as "novel" antipsychotics appear to have a somewhat safer and more tolerable side-effect profile. They also appear effective in cases of "resistance" to older agents. Drug treatment is usually continuous, as relapse of symptoms is common when medication is discontinued.
Supportive and problem-focused forms of psychotherapy may be helpful for many individuals. Behavioral techniques such as "social skills training" can be used in a therapeutic setting, or in the clients natural environment, to promote social and occupational functioning.
Family interventions that combine support and education about schizophrenia ("psychoeducation") appear to help families cope and reduce relapse. Clients who lack family and social support may be helped by intensive case management programs that emphasize active outreach and linkage to a range of community support services.
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Prognosis
There are many different potential outcomes of schizophrenia. Most people with schizophrenia find their symptoms are improved with medication, and some achieve substantial control of symptoms over time. However, many others experience functional disability and are at risk for repeated acute episodes, particularly during the early stages of the illness.
Supported housing, vocational rehabilitation, and other community support programs may be essential to their community tenure. People with the most severe forms of his disorder may remain too disabled to live independently, requiring group homes or other long-term, structured living environments.
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Complications
Noncompliance with medication will frequently lead to a relapse of symptoms.
Physical illness occurs at high rates among people with schizophrenia due to psychiatric treatment itself (such as side effects from medication) and living conditions associated with chronic disability. These may go undetected because of poor access to medical care and to difficulties communicating with health-care providers.
Persons with schizophrenia have a high risk of developing a coexisting substance abuse problem, and use of alcohol and/or drugs increases the risk of relapse.
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Calling your health care provider
voices are telling you to hurt yourself.
You are unable to care for yourself.
You are feeling hopeless and overwhelmed.
You feel like you cannot leave the house.
You are seeing things that arent really there.
http://health.yahoo.com/health/dc/000928/1.html
Therapists and Therapy: Choosing the right one for you.
One of the most important support people you can have while you're healing is a skilled counselor. A good counselor provides hope,insight,information and consistent, loving support as you go threw the heal ing process. By encouraging you to develop your capacity to heal yourself, effective counselors work themselves out of ajob. Because they are not directly involved in your life, counselors have a unique point of view that can be a powerful catalyst for healing.
When you're looking for a counselor, it's helpful to take the attitude that you are a consumer making an informed choice about the person you're hiring to work with you. Even though you're seeking counseling to fill an emotional need, you are still paying for a service. Being a consumer gives you certain rights: the right to determine the qualities you want in your therapist, the right to choose a therapist who iiieets your needs, the right to be heard, believed, and treated with respect, the right to say no to any of the suggestions your therapist makes, the right to be satisfied by the services you're receiving, the right to freely discuss any problems that arise in therapy with your counselor, and the right to end a therapy relationship that isn't working for you.
Thinking in terms of rights may be hard for you when you think about seeing a therapist. Many of'us are intimidated by helping prof'essionals. It's easy to see them as the experts: We're the ones in'pain; they're the ones with the answers. The fact is that you are the real authority on your life and on what you need. Although your relationship with your therapist may be tremendously significant to you, it is essential that you don't relinquish all of your power in the counseling relationship.Remember that you are at the center of your life and your hearing.
A good counselor is one of the many resources you will use.
There are certain basic things that are necessary in a counselor. You should make sure your prospective counselor:
*Believes that you were abused
*Never minimizes your experience or the pain it's caused you.
*Has information (or is willing to get information) about the healing process for adult survivors ot'cliild sexual abuse
*Is willing to hear and believe the worst experiences you have to talk about
*Keeps the focus on vou, not on your abuser
*Doesn't push reconciliation or forgiveness
*Doesn't want to have a friendship with you outside of counseling
*Doesn't talk about his or her personal problems
*Doesn't want to have a sexual relationship with you, now or ever in the future
*Fully respects your feelings (grief, anger, rage, sadness, despair-, joy)
*Doesn't force you to do anything you don't want to do
*Encourages you to build a support system outside ot'thei-apy
*Encourages your contact with other survivors
*Teaches you skills to take care of yourself
*Is willing to discuss problems that occur in the therapy relaitionship
There are other things you may want in a counselor. You may want to see a counselor who is available for extra sessions or emergency phone calls. You may want to choose a man or a woman, a counselor who shares your race, ethnic background, religion, or sexual preference, or who has experience with another key issue in your life (alcoholism or disability, for instance). You mav want to see a therapist who is also a survivor. Money may be a major factor in your decision; you may need a counselor who has a sliding fee scale or who can see you for free at a clinic. Any of these (and other factors) can be important criteria in choosing your counselor. Try to remain flexible, however, because you may have to compromise if'you can't find exactly what you want in your area.
These are the characteristics I'm looking for in a counselorship
1.
2.
3.
4.
5.
I'd be willing to compromise on
1.
2.
3.
But I won't compromise on
1.
2.
3.
QUESTIONS FOR A POTENTIAL THERAPIST
Once you've come up with your list of wants, turn that list into questions:
(this r ones I have come up with as improtant to my system add or delated as u need )
1. Do you belive in MPD/DID?
2. How much work have you done with sexual abuse an MPD/DID?
3. How do you work with child alters? (talk, play therapy)
4. Do you have toys etc for child alters?
5. Do you belive writing an drawing are helpful?
6. How would you feel about my participation in a survivors group?
7. Could I schedule extra sessions or call you when I'm in crisis?
8. How would you handle it if I came to you and said there was a problem in therapy?"
9. Is there any circumstance in which you think sex between a therapist and a client is okay?
10. Is there any circumstance in which you think sex between a adult an a child under 18 is ok?
Once you ha e your list of questions, begin lookin for a therapist. This requires persistence and a little detective work. Ask friends, other survivors, or supportive family members for referrals. Ask people about their experiences in therapy. Ask for names. If you can't find names th' way, call an agency that deals with child abuse, rape, or domestic vio- is lence. They will probably be able to provide referrals.
Call the therapists on your list. Many counselors will give you ten or fifteen minutes of free time on the phone. Tell them you'd like to ask them a few questions. Then ask your most important ones. Discuss fees. If you like the way the person sounds and the cost is within vour range, make an initial appointment. An initial appointment does not meanyou're making a commitment to an ongoing therapy relationship. You and the counselor are both checking each other out. If you're not satisfied with the first person (or even if you think you might be), try one oitwo others so you can compare your reactions and feelings.
At that first meeting, ask the prospective therapist your remaining questions. Observe the way you feel in the session. It's not necessary that you feel good, or even relieved. You may be more stirred up after your session than before it. Effective counseling often leaves us feeling upset, anxious, angry, or uncomfortable. But you should feel that you've been listened to, respected, understood, and cared about.
Use the space below to record the way you felt after each initial session:
1. Counselors name:
Phone number:
Fee per session:
Insurance?
Did I feel respected and listened to?
Why or why not?
What did I like about the session?
What didn't I like?
How did I f'eel during and after the session (disappointed, hopeful, excited, scared)?
Why?
Could I imagine ever trusting this person?
Why or why not?
What, if anything, do I still need to find out?
Do I want to see this counselor again?
http://home.att.net/~boyym/Therapy.html
Social phobia
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Overview
Definition
a persistent irrational fear of situations in which the person may be closely watched and judged by others, as in public speaking, eating, or using public facilities (see also simple phobia).
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Alternative names
Phobia - social
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Causes, incidences, and risk factors
Social phobias are characterized by fear and avoidance of situations in which a person may be subject to the scrutiny of others. The fear may be complicated by a lack of social skills due to lack of practice or to a high level of anxiety. Everyday activities may generate anxiety, and the fears may be specific, such as using public restrooms or eating in public. The onset may occur in adolescence and be associated with parental overprotectiveness or limited social opportunity. Males and females are affected equally with this disorder.
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Prevention
Measures to improve self esteem are helpful. Social skills training may be helpful.
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Symptoms
Avoidance of social situations
Anxiety in social situations
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Signs and tests
Rapid heart rate
Elevated blood pressure
History of phobia
Description of behavior from family, friends, and affected person
Treatment
The goal of treatment is to help the person function effectively. The success of the treatment usually depends upon the severity of the phobia.
Systematic desensitization is a behavioral technique used to treat phobias. It based upon having the person relax, then imagine the components of the phobia, working from the least fearful to the most fearful. Graded real life exposure has also been used with success to help people overcome their fears.
Social skills training may involve social contact in a group therapy situation to practice social skills. Role playing and modeling are techniques used to help the person gain comfort in relating to others in a social situation.
Antianxiety and antidepressive medications are sometimes used to help relieve the symptoms associated with phobias.
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Prognosis
The outcome is generally good with treatment, and antidepressant medications have been shown to be very effective.
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Complications
Alcohol use to combat anxiety
Loneliness and social isolation
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Calling your health care provider
Call your health care provider or mental health professional if fear is affecting your social skills or impacting relationships with others.
POST-TRAUMATIC STRESS DISORDER:
Overview
Definition
A severe reaction to a traumatic event involving actual or threatened death or serious injury to self or others.
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Alternative names
PTSD
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Causes, incidence, and risk factors
Post-traumatic stress disorder (PTSD) can have an acute onset soon after the trauma, or a delayed onset in which the symptoms occur more than six months after the trauma. Acute PTSD resolves after three months, with a chronic form of the disorder persisting past that time. PTSD can occur at any age and can follow a natural disaster such as flood or fire, a man-made disaster such as war or imprisonment, assault, domestic abuse or rape. Such events produce stress in anyone, but not everyone develops PTSD.
The causes of PTSD are not known, but psychological, genetic, physical, and social factors may contribute to its development. PTSD alters the body's response to stress, effecting mediators such as stress hormones and neurotransmitters. Prior exposure to trauma may increase risk, suggesting a kind of learned response.
Social support appears to play a protective role. In studies of Vietnam veterans, those with strong support systems were less likely to develop PTSD than those without social support.
People with PTSD persistently re-experience the event in at least one of several ways: recurrent distressing dreams; recurrent recollections of the event, a sense of reliving the experience (flashbacks); and intense distress at events that symbolize an aspect of the event (such as anniversaries).
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Prevention
Early counseling and crisis intervention are important for people who have experienced extremely stressful situations. These interventions may help prevent chronic forms of PTSD and should be part of public health responses to groups at risk such as disaster victims.
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Symptoms
Symptoms of PTSD fall into three general categories:
1. Intrusive "reliving" of the event
recurrent distressing memories of the event
recurrent dreams of the event
flashback episodes when the event seems to be re-occurring
physiological reactions to situations involving "cues" to the traumatic event
2. Avoidance
inability to recall important aspects of the trauma
lack of interest in activities
feelings of detachment
sense of foreshortened future
psychic or emotional "numbing"
restricted range of affect
3. Arousal
irritability or outbursts of anger
sleeping difficulties
difficulty concentrating
exaggerated startle response
hypervigilence
Additional symptoms that may be associated with this disease include a sense of guilt about the event (including "survivor guilt"), as well as the following symptoms, which are typical of anxiety, stress, and tension:
paleness
heartbeat sensations
headache
fever
fainting
dizziness
agitation
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Signs and tests
Characteristic symptoms that persist after a history of unusual trauma lead to the diagnosis. Psychiatric and physical examinations are completed to rule out other disorders.
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Treatment
The aim of treatment is to reduce the symptoms by encouraging the affected person to recall the event, to express feelings, and to gain some sense of mastery over the experience. In some cases, the expression of grief helps to complete the necessary mourning process.Support groups are effective at providing a setting where people who have had similar experiences can share feelings. Treatment for depression, alcohol or substance abuse, or associated medical conditions may need to take place before symptoms of PTSD can be effectively addressed. Behavioral therapy can be used to treat avoidance symptoms. Behavior techniques used include the graded exposure and flooding technique (frequent exposure to an object that triggers symptoms). Medications that act upon the central nervous system may be used to reduce feelings of anxiety and associated symptoms. Antidepressant medications have been proven effective in treating PTSD, including newer agents such as Prozac, Paxil and Zoloft. Sedating agents can help with sleep disturbance. Anti-anxiety agents may be useful, but the benzodiazepines, a common class of these medications, can potentially become addictive.
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Prognosis
The best prognosis (probable outcome) is associated with symptoms that develop soon after the trauma, and with early diagnosis and treatment.
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Complications
depression, anxiety, and phobia may accompany this disorder
alcohol abuse and/or drug abuse
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Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if you are feeling overwhelmed by guilt, if you are impulsive and unable to contain your behavior, or if you are experiencing other acute symptoms of PTSD. Contact a health-care provider for help with ongoing problems such as recurrent thoughts, irritability, and problems with sleep.
This was shared with us from Artemis
BUMPING NEGATIVITY OFF THE AGENDA
There is a phrase in the computer profession that says, garbage in, garbage out.
It means that if a program is set up poorly and gives erroneous messages to the computer, it will yield only garbled output. Our minds work on much the same principle. If we put garbage such as negativity into our minds, our lives will reflect it by being more difficult and less joyful than we wish we were.
If, out of habit, we have been placing negative thinking at the top of our lifes agenda, we need to bump it to the very bottom-with the goal of eliminating it all together. As we replace negativity with upbeat and optimistic thinking, we create an environment where the seeds of creativity, humor, and love can take root.
Math is the only arena where a negative times a negative equals a positive. In the real life of emotions and beliefs, compounded negatives equal only more negatives. So when we allow our mind to dwell on pessimistic feelings and thoughts we develop a mental magnet that draws more negativity to us.
We can change that by a simple mental exercise. On days when you are feeling low, its important to support yourself by first becoming aware of your negative thoughts, then by consciously placing each one-one at a time-on the bottom of your mental agenda. Finally, put a comforting, affirming thought at the top of your agenda. Although this exercise may seem phony at first, persevere and you will begin to create a new habit of positive in, positive out.
I am committed to being a positive thinker.
I support myself by converting negative thoughts into positive thoughts.
I deserve to have a positive and fulfilling life.
Sue Thoele
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