Know more about psychiatric diagnoses

Dr M.J Thomas (www.drmjthomas.com)

Many believe that all people have some degree of psychiatric illness. This is not true. Just as every person looks different from one another, all people think and feel differently. What they think and feel at any given moment is not important to diagnose psychiatric illness. It is the consistency and pattern of thinking and the emotional reactions to them, its illogicality and inappropriateness, the sustainability of its pattern over time despite attempts at correction and the duration of changed behaviour, that are the parameters that help diagnosis. These changes affect the entire personality, verbal behaviour as well as non-verbal behaviour and affect most functions of the person. People decide to seek professional help when these changes cause appreciable distress to themselves or their peers and family. The use of medicines at this time can control the symptoms, if not cure them. However, to achieve beneficial results, one needs to monitor the progress under their doctor’s expertise.

Illness of feelings

People usually have two distinct kinds of feelings: sadness and happiness. How you express these feelings differs from person to person and from time to time. You may express them with anger, anxiety, or any other form of emotional expression. Normally, you are in control of these expressions. As human beings evolve further, they can control their expressions better and express them within their culturally sanctioned limits. However, in one’s mind, these feelings persist until one can switch them off. In normal circumstances, people can voluntarily switch them off and focus on other, more important thoughts. When a person becomes ill, his ability to switch off these disturbing thoughts weakens. The thoughts and the associated feelings persist, and their expressions come out of control.

Affective disorders

‘Affective disorder’ is a state in which people lose control of their feelings. They present with an illness manifested by extreme sadness or depression, or extreme happiness or euphoria. People with this illness can have a continuous illness, an episodic illness with normalcy in between or an illness which changes from one mood to another periodically. They can express these mood changes in many forms, such as anger, irritability, crying, social withdrawal, reduced interactions and so on, or being elated, overtalkative, overactive, hypersexual, grandiose, stubborn, and so on. Let us try to understand a little more about them.

CLINICAL DEPRESSION

A period of depressed mood, which lasts for several days or a few weeks, is a normal part of life. These feelings are often referred to as “depression,” instead of “sadness”. They typically do not constitute clinical depression. People experiencing clinical depression are likely to experience substantial changes in mood, thinking, behaviour, activities, and self-perception. A depressed person often has difficulty making decisions. He dwells on negative thoughts continuously, focuses on unpleasant experiences which he cannot forget ever, describes himself as a failure, reports that things are hopeless and feels as though he is a burden to others. The changes in mood result in irritability, anger, emptiness, anxiety and sometimes suicide.

For a better understanding, see this video about ‘clinical depression’: https://ihavenotv.com/my-depression

BIPOLAR DISORDER OR MANIC-DEPRESSIVE DISORDER

This is also a disorder of the mood, just like clinical depression. However, in this illness, people experience mood changes from extreme depression to extreme euphoria, alternating with each other. There are periods of normal intervals in between. Treatment of this illness is more complicated since the medicines used for the depressive phase are different from those used for the euphoric phase, and the patient needs to be monitored frequently to identify the mood changes and to institute quick corrections in medicines. For a better understanding, see this video about ‘bipolar disorder or Manic-depressive disorder’: https://www.youtube.com/watch?v=vcCBacPWLrc, https://www.youtube.com/watch?v=AMsyfoLb9C0

There are also mood-stabilising medicines that control fluctuations. However, they are potentially very toxic and need strict supervision by the caregivers and the doctor. There are two such medicines used for the control of bipolar or manic-depressive disorder. These are ‘Lithium’ and ‘Sodium Valproate.’ Lithium is most effective in stabilising the mood in persons who get strong symptoms of mania, while sodium valproate is more useful in persons who get primarily depression and mild forms of mania. Lithium is a highly toxic drug if misused. Hence, the caregivers need to take responsibility for administering lithium themselves.

Lithium should not be taken in double doses at any time since blood levels can increase suddenly, producing toxicity. It can result in unconsciousness and fits.
If the patient develops vomiting, watery diarrhoea or fever, lithium must be stopped immediately. Restart only after the disease subsides, only after a lithium blood test.
Mild tremors of the hands appear occasionally. If it is severe, consult the doctor.
Lithium levels and serum creatinine should be monitored at least once in 3 months. Lithium needs to be stopped if kidney has any problems.
Once in 6 months, T3, T4, and TSH should be checked to rule off thyroid disorder.

Disorders of thinking

Some people develop thinking disorders. Emotional responses like depression are not the primary abnormality here. These people have continuous thoughts about the same topic without being able to let go of it. These are called ‘obsessive thoughts.’ Because these thoughts are often unpleasant, they can become very anxious. Anxiety leads them to do certain actions to control their thoughts. They are called ‘compulsions.’ They like to continue with the compulsions so that the repetitive thoughts disappear. However, things do not work in such expected lines. One is always unsure of what will work. Hence, they always doubt if they are doing the right thing. These doubts make them more anxious. Finally, many of them become very depressed and can even end their life. There are specific medicines to control this illness, which is called ‘obsessive-compulsive disorder’ or simply ‘OCD’. However, one may have to take these medicines for a prolonged period to get results.

For a better understanding, see this video about ‘obsessive-compulsive disorder’ or ‘OCD’ https://www.youtube.com/watch?v=TD-xPiwtyHA

Schizophrenias

Even though schizophrenia is comparatively rare, they are more talked about, since it is more dramatic in its presentation. Their presentations are striking, since these persons are strikingly illogical, and suspicious, and their perceptions, too, are illogical with auditory hallucinations. They can never be corrected with advice from others while they are ill. Their personality deteriorates over time, and they are ill at one glance. There are many types of schizophrenia, and if treated early, most people with this condition can return to normal life today. Treatment usually lasts a lifetime.

For a better understanding, see this video about ‘Schizophrenia’ https://www.youtube.com/watch?v=48YJMOcykvc

Other related topics

Dr M.J Thomas (www.drmjthomas.com)

Sleep

Sleep disturbance is a frequent problem in most cases of medical and psychiatric conditions, apart from situations of external distress. During stress, increased autonomic arousal gives rise to stress experience. This causes exaggerated reactions of different organs of the body, such as the brain, heart, lungs, and intestines, and so on, and results in anxiety. Anxiety has two components: a physical and psychological component. It activates the sleep centres in the brain to be over-vigilant, just as it makes all the bodily organs overactive. The disturbance in ‘sleep’ is the physical component, while the uncontrolled preoccupation with the distressing event is the psychological component. Eight hours of sleep is restorative for the brain. An anxious person often finds it difficult to sleep and gets interrupted sleep or wakes up too early, resulting in inferior quality and inadequate sleep. His brain becomes poorly rested and anxiety gets prolonged. Relaxation exercises and treatment of the causative factor can help people get proper sleep.

Conflicts in marriage

Marriage is a relationship that moves through various stages. It starts with ‘passion,’ and later, when passion fades, a more realistic view begins of seeing their partner as a human being with flaws. After this, they enter a stage of rebellion, where each partner’s self-interest comes to the fore. However, when they are stressed due to outside forces, they come together to manage their lives. Finally, when children have left, they rekindle their relationship as friends. During this stage, they face serious life situations, which make them come closer or drive themselves apart. At last, in old age, they explore a new life together.

Many marriages get strained during life due to insecure attachment, ego, arrogance, jealousy, anger, greed, poor communication, poor critical thinking skills, third-party influences, changes in financial state, physical health and so on. While divorce may be necessary for some, others may be able to salvage whatever is left of the marriage. Some of these problems can be sorted out with treatment. Negative communication is one such problem that is often due to depression in one partner, an introverted personality or insecurity. It can also include physical abuse. It can occur when partners have an extramarital affair. During this time, they can live like roommates rather than a married couple. Many partners with a stubborn personality, suspiciousness, or obsessive-compulsive disorder can live in this way if not treated. Children are very intuitive and recognise the schism soon, irrespective of how couples fake happiness. Poor libido, erectile incompetence, extramarital relationship, performance anxiety and others are also causes of marital conflicts that may have some requirements for medical management.

Problems of people with same-sex attraction and bisexuality are like others. Some of these relationship problems can be managed with medical management apart from counselling. Some of the personality types find it difficult to adjust to marital relationships. People with suspiciousness, rigidity and compulsiveness, attention seeking and borderline personality can be managed better with medical and counselling services in a combined fashion.

Anger

Intermittent explosive behaviour is an impulse-control disorder characterised by sudden episodes of unwarranted anger. The disorder is typified by hostility, impulsivity, and recurrent aggressive outbursts. A short temper can also be a sign of an underlying psychiatric condition. If your anger is causing you to hurt yourself or those around you, it is time to seek help.

For a better understanding, see this video about ‘Anger’ https://www.youtube.com/watch?v=ZLz2O41uXEo

UNDERSTANDING CLINICAL DEPRESSION

There are several types of clinical depression, which involve disturbances in mood, concentration, self-confidence, sleep, appetite, activity, and behaviour as well as disruptions in friendships, family and/or work. Clinical depression is different from experiences of sadness, disappointment, and grief familiar to everyone. This note will provide you with an understanding of the symptoms, causes, and treatment of clinical depression. A period of depressed mood, which lasts for several days or a few weeks, is a normal part of life and is not necessarily a cause for concern. Although these feelings are often referred to as “depression,” they typically do not constitute a clinical depression because the symptoms are relatively mild and of short duration, less than 3 months and should be correctly mentioned as “sadness”. Moreover, these symptoms are often related to stressful life events and improve with positive life changes. A person experiencing clinical depression, however, is likely to be experiencing substantial changes in their mood, thinking, behaviours, activities, and self-perceptions. A depressed person often has difficulty making decisions. A depressed person may also dwell on negative thoughts, ruminate on unpleasant experiences, describe him/herself as a failure, report that things are hopeless, and feel as though he is a burden to others. The mood changes brought on by depression frequently result in feelings of sadness, irritability, anger, emptiness, and/or anxiety. There are also some types of depression in which depressive episodes alternate with episodes of agitation and euphoria. A severe depressive episode can result in thoughts of death and suicide.

Symptoms of Depression

A significantly depressed mood or general absence of expression.
Inability to experience pleasure or feel interest in daily life.
Inexplicable crying spells, sadness, and/or irritability.
Sleeplessness or excessive sleep nearly every day. A substantial change in appetite or weight.
Fatigue or energy loss.
Diminished ability to concentrate.
Feelings of hopelessness or worthlessness.
Inappropriate feelings of guilt.
Lack of sexual desire.

Causes of Depression

Clinical depression is typically caused by a combination of biological, genetic, and stress factors. Many depressive episodes occur without any identifiable causes. Consumption of alcohol and addictive drugs may “mask” the symptoms of depression in some persons. Depressive disorders are treatable conditions and are not the result of weakness, personal failure, or a lack of willpower.

Treatment of Depression

If symptoms related to a depressive condition are interfering with your ability to do routine, day-to-day activities, or are disturbing significant people around you, you should consider seeking professional help. There is currently a variety of highly effective interventions available for the treatment of depression. If you seek treatment, the recommendations you receive will likely depend on the specific symptoms you have experienced, their duration and severity, and any previous history of depression.

SUICIDE PREVENTION

Danger Signals

At least 70 per cent of all people committing suicide give some clue to their intentions before they try. Becoming aware of these clues and the severity of the person’s problems can help prevent a tragedy. Many people convey their intentions directly with statements such as “I feel like killing myself,” or “I don’t know how much longer I can take this” (suicidal thoughts). Others in crisis may hint at a detailed suicide plan with statements such as “I’ve been saving up my pills in case things get really bad” or “Lately I’ve been driving my car like I don’t care what happens” (suicidal plans). In general, statements describing feelings of depression, helplessness, extreme loneliness, and/or hopelessness may suggest suicidal thoughts. It is important to listen to these “cries for help” because they are usually desperate attempts to communicate to others the need to be understood and be helped. Often, people thinking about suicide show outward changes in their behaviour. They may prepare for death by giving away prized possessions, making a will, or putting other affairs in order. They may withdraw from those around them, change eating or sleeping patterns, or lose interest in prior activities or relationships.

Myths about Suicide

MYTH: “You have to be psychiatrically ill even to think about suicide”. FACT: Most people have thought of suicide from time to time. Most suicides and suicide attempts are made by intelligent, temporarily confused individuals who are expecting too much of themselves, especially during a crisis.
MYTH: “Once a person has made a serious suicide attempt, that person is unlikely to make another”. FACT: The opposite is often true. Persons who have made prior suicide attempts are at greater risk of committing suicide.
MYTH: “If a person is seriously considering suicide, there is nothing you can do”. FACT: Most suicidal crises are time-limited and based on thinking to escape from their problems. Instead, they need to confront their problems directly to find other solutions – solutions that can be found with the help of concerned individuals who support them through the crisis period, until they can think more clearly.
MYTH: “Talking about suicide may give a person the idea”. FACT: The crisis and resulting emotional distress will have already triggered the thought in a vulnerable person. Your openness and concern in asking about suicide will allow the person experiencing pain to talk about the problem, which may help reduce his or her anxiety. This may also allow the person with suicidal thoughts to feel less lonely or isolated, and perhaps a bit relieved.

How You Can Help

Don’t be afraid to ask or talk directly about suicide. Encourage problem-solving and positive actions. Remember that the person involved in an emotional crisis is not thinking clearly. Talk about positive alternatives that may establish hope for the future. Although you want to help, do not take full responsibility by trying to be the sole counsel. Seek out resources that can lend qualified help. Let the troubled person know you are concerned, so concerned that you are willing to arrange help beyond that which you can offer.

OBSESSIVE-COMPULSIVE DISORDER

When a habit isn’t just a HABIT

All of us have patterns in our lives. We follow routines during most days, taking the same route to work or spending our free time in much the same ways. We all have patterns of behaviour, and most of us have reasons for doing things the way we do. In some people, however, the patterns are not just patterns. They are patterns that have run wild, patterns with a mind of their own. Such people have strange rituals. For example, they wash their hands too many times a day. They check to see that the lights are turned off so many times that they are late for work or cannot leave the house at all. To make matters worse, they are filled with unbearable anxiety or dread that something terrible will happen if things do not work their way. These people have obsessive-compulsive disorder. This disorder causes people to become haunted by repetitive thoughts (obsessions) or compelled to perform senseless, time-consuming rituals, or both (compulsions). Many people who have this disorder feel ashamed of their thoughts and behaviours and hide their condition. In recent years, awareness of obsessive-compulsive disorder (OCD) has increased, and effective treatments are available.

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is an illness that traps people in seemingly endless cycles of repetitive thoughts that will not leave their minds (obsessions) and feelings that they must repeat certain actions over and over (compulsions). The obsessions that intrude uncontrolled into the person’s everyday thinking may be frightening, disgusting, painful, or trivial. Most people with OCD realise that their obsessions do not make sense, but they are not able to control or suppress them. They may be able to explain in detail what their obsessions are, but not why they appear. In most cases, the obsessions cause extreme anxiety. Feelings of discomfort or dread can build up to an unbearable level. To relieve their anxiety, individuals with OCD feel they must do something. These feelings that they must repeat certain actions or rituals are their compulsions. Often, the rituals must be performed according to some rules. The rituals may be very simple and hardly noticeable, or they may be very elaborate. Rituals may be time-consuming, sometimes taking hours to finish, so they interfere with the person’s daily routine. Rituals do lessen anxiety, discomfort, or feelings of disgust, but only briefly. The fears and tensions soon return, causing the individuals to start their rituals all over again. People with OCD do not want to have obsessive thoughts, nor do they want to engage in time-consuming rituals. Recognising the bizarre nature of their obsessions and compulsions, many conceal their condition from others.

TREATMENT

Most people with OCD can be helped with medication. It allows most people to lead normal lives. OCD is not only distressing to the people affected but also hard on the people who live with them.

SOCIAL PHOBIAS

Social phobias start in adolescence and are based on a fear of scrutiny by other people, leading to avoidance of social situations. Social phobias can be discreet, for example, for public speaking, eating in public, meeting with the opposite sex, or diffuse, involving all situations outside most familiar circles. Direct eye-to-eye contact may be particularly bothersome in some cases. Social phobias are usually associated with low self-esteem and a fear of criticism. The person with social phobia anticipates and ruminates over the problems that can occur in a social contact, resulting in avoidance of the situation and extreme cases, social isolation. They experience features of anxiety such as rapid heartbeats, trembling, sweating, upset stomach, diarrhoea, muscle tension, blushing and confusion. The consequence of social phobia can be socially and economically devastating. It can result in a person dropping out of school, chronic unemployment and financial dependence, alcohol abuse, suicidal thoughts, and not getting married or having children. Social phobia is related to an imbalance of a chemical in the nerve cells. It also runs in families, especially among close relatives like parents and their children. Medication has been proven to help treat social phobias. Gradual exposure to an anxiety-provoking situation until the patient learns to identify and modify behaviour that contributes to his or her social phobia is helpful.