Mental Health Monday: What it is like to have Seasonal Affective Depressive Disorder.

Hey Guys! Welcome back to another Mental Health Monday! You have probably been wondering where I have been! Well it has to do with today’s topic of Seasonal Affective Depressive Disorder (SADD or SAD). Tis the season for darkness around 4:30-5:00 pm.

Seasonal Affective Depressive Disorder can happen in the summer too. It is rare but does occur. Today though we are going to be talking about winter SADD. Now, as you all know I have clinical depression. This makes me more likely to have SADD, however you do not need to have clinical depression to have SADD. You may also not trigger your Clinical Depression with SADD. Absolutely depends on the person. Today, I am going to talk from my experiences, not necessarily researched evidence.

I grew up in Northeastern Pennsylvania. Cold, literally a majority of the year; so as long as I can remember the darkness made me miserable. But this was normal. When I moved to North Carolina though, I didn’t realize how miserable I had been because now I had more sunlight exposure for a longer part of the year. My experience also tells me I am sensitive to not only darkness but several other things including: temperature drop, barometric changes and altitudes. These typically go hand in hand so there’s no surprises here.

My signs and symptoms start in mid-October with me having more difficulty than normal controlling my temperature (thyroid disease; always cold). I am typically wearing at least two pairs of socks and a sweater. Next, my need for sleep drastically increases. I go from needing 4-6 hours minimum to about 8-14 depending on the situation. Doesn’t sound like a big difference but my goodness is it! My eating habits usually go out the window as if working night shift didn’t already do that; leading to weight gain. I do not like to go outside or socialize. I feel bad for my puppy because all he wants to do is go to the park his normal two times a day but that even becomes difficult for me. I literally have to write down on a post it that “Maverick cannot suffer because you do not want to go outside.”

There is more but those are my major issues. Others include my hair falling out more, my memory fades, I have increased headaches and joint pain and so on. I cope but by far the worst is when the Seasonal Affective turns into or partners with my Clinical Depression. I spend days guessing if I should make a psychology appointment. Typically, I do wait long enough (ugh, I know) until I have a “mental health event” (prettier and less harmful term for a breakdown). Example being, this week I put up our Christmas tree that we have had for only four years. I cried because it would not light up and I had to go to Target to get more lights. Reality: it’s not about the lights. It’s that the Christmas tree is the only thing that really makes me happy this time of year because it reminds me of my mom and dad and my childhood home. My parents did and still give the Griswold’s a run for their money. So, I emailed my psychologist for an appointment. I am very lucky that the experiences I have had with therapy and my clinical depression in the past makes seeking help so much easier now. I am not embarrassed and willingly go.

I do encourage you though, as HARD as it is, to take preventative measures to help yourself. I went out and bought natural light lightbulbs that cost an arm and a leg, worth it. I make sure I go outside for at least 20 minutes a day, even if I have to write it down to remember it. I try my absolute hardest to go to the gym. Usually this fails so I make my 20 minutes of outside time a walk. Make it a point to do things you love even if it is in small increments. Make lists if this is the only way you can remember things. It’s ok!  If Seasonal Affective is new for you or you are just struggling more, go see your doctor. Any doctor, it could even be your primary care if you do not have a psychologist.

I want to put a reminder in here that you can always call the Suicide Hotline toll free at 1-800-273-8255. Please note that you do not need to be suicidal to call, you can just simply need help. They will direct you to the care that is best for you. Suicide rates can increase this time of year. Not only because of the darkness and weather but because of holidays. They can be quite complicated for people. I am 100% here for you if you need someone to vent to.

Hope you all are doing great and I cannot wait to get back into the swing of things! Have a wonderful Mental Health Monday and Break the Stigma!

World Mental Health Day!

Happy world mental health day 2018! I am so glad that I get to be a small part in breaking the stigma and making mental health part of our every day!

Mental Health Monday: Substance Abuse Disorders -Alcohol

Welcome back to Mental Health Monday! Today we will be talking about Substance Abuse Disorders. Specifically we will discuss Alcohol which is also called Ethanol and can be abbreviated as ETOH. Substances are used by people because they can have varying effects. The two usual feelings are increased pleasure or decrease in feelings.

Substance abuse disorders include the following:

• Abuse of alcohol or other drugs which lead to work, school, home or health problems.
• Dependence on these substances.

Symptoms of substance dependence are:

• Tolerance for the substance; the amount needs to constantly be increased to get the same effect.
• Problems with withdrawal.
• Use of larger amounts than intended.
• Problems cutting back or controlling use.
• A lot of times spent getting the substance, using it, and recovering from it.
• The person gives up or reduces time in normal social situations like school and work.
• Using despite knowing consequences.

About 8% of the population age 12 and older have a substance abuse disorder in a given year. These disorders tend to start in the teenage or early adult years with the mean being 20 year old. Substance abuse is twice as high in males than in females. Often times, substance abuse occurs with other mental health disorders and just the same, people with anxiety or mood disorders are twice as likely to use a substance. Substances are used as self medication to deal with the side effects. This is usually because these substances are either legal or more easily accessed than mental health care and medication.

Alcohol makes people less alert and impairs concentration and coordination. The government defines low risk social drinking as the following:

• Men: no more than four drinks per day, no more than 14 drinks a week.
• Women: no more than three drinks per day, no more than 7 drinks per week.
• 65+ years old: no more than three drinks a day.

The US Standard drink equivalents are as followed:

• 12 oz beer at approximately 5% alcohol.
• 8-9 oz of malt liquor at approximately 7% alcohol.
• 5 oz of table wine at approximately 12 % alcohol.
• 1.5 oz of spirits at approximately 40% alcohol.

The legal Blood Alcohol Concentration (BAC) across the United States is 0.08%. This is the legal amount of alcohol that is required to be issued a Driving Under the Influence.

Short term problems caused by alcohol include physical injuries, aggression, antisocial behavior, sexual risk taking, suicide and self injury. Long term problems caused by alcohol use include alcohol abuse disorders, other substance abuse disorders such as illicit drugs, depression, anxiety, social problems like avoiding work or school, and physical health problems such as organ damage and failure.

The medical complications of alcohol include: slurred speech, motor impairment, confusion, memory and concentration problems, poor decision making, choking, vomiting, depressed breathing, seizures, coma and death. Wernicke-Korsakoff Syndrome is a disease in which you lack Vitamin B (thiamine). Vitamin deficits are often seen in alcoholics. Alcohol Poisoning occurs when large amount of alcohol is consumed in a small amount of time. This is also called binging. Signs of alcohol poisoning start at a BAC of 0.16% and significant death rates start at 0.3%. Always call 911 in the situations. These people cannot recover at home.

Hangovers are a group of signs and symptoms that you have after drinking large amounts of alcohol. Some hangovers can take up to 24 hours to go away but thankfully usually do resolve on their own with adequate hydration, electrolyte replacement and ibuprofen. The actual cause of the hangover is when your BAC drops significantly to zero, typically occurring the next morning. Other reasons you don’t feel well is because alcohol irritates the lining of the stomach, drops blood glucose levels, has an autoimmune inflammatory response, causes you to produce more urine making you dehydrated, and it causes blood vessels to contract causing the headaches. You will see the following symptoms:

• Fatigue and weakness
• Excessive thirst and dry mouth
• Headaches and muscle aches
• Nausea, vomiting or stomach pain
• Poor or decreased sleep
• Increased sensitivity to light and sound
• Dizziness or a sense of the room spinning
• Shakiness
• Decreased ability to concentrate
• Mood disturbances, such as depression, anxiety and irritability
• Rapid heartbeat

You should call a doctor if the hangover does not go away on its own or you start seeing symptoms of severe alcohol poisoning. These include:

• Confusion
• Vomiting
• Seizures
• Slow breathing (less than eight breaths a minute)
• Irregular breathing (a gap of more than 10 seconds between breaths)
• Blue-tinged skin or pale skin
• Low body temperature (hypothermia)
• Difficulty remaining conscious
• Passing out (unconsciousness) and can’t be awakened

The Rapid Alcohol Problems Screen or the RAPS4 is a questionnaire designed to determine if someone is drinking over the “normal” low risk drinking level. It gets its name for the four points it asks about: R: remorse , A: amnesia, P: performance, S: starter drinking behavior.

The questions are as followed:

1. During the past year, have you had a feeling of guilt or remorse after drinking?
2. During the past year, has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?
3. During the past year, have you failed to do what was normal expected from you because of drinking?
4. Do you sometimes take a drink in the morning when you first get up?

If YES is answered to at least one of the four questions, it is suggestive that their drinking is harmful to their health and well being. At this time the person should have a full medical evaluation by a professional.

Treatment can go two typical ways but these are not always the case. The first is the family and friends of the person have an intervention and they talk about different things. Usually how great of person they are but how alcohol is controlling them and making them a different person. The family and friends usually offer help and have a rehab set up for the person to go to. The other way that I see often is through the hospital. People come in and are very intoxicated. We give them different medications like Precedex and Librium to safely detox them. Once they are medically stable we can transfer them to a rehab facility or psychiatric facility based on the needs of the patient. Unfortunately, often times we send them home because they are not ready to accept the help and they continue on with their addiction. The underlying cause of drinking needs to be assessed and treated as well!

 

Thanks for coming back! Next week we continue with Illicit Drug Abuse.

1. http://www.MentalHealthFirstAid.org
2. 2. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption
3. 3. https://www.alcohol.org/faq/what-is-alcohol-poisoning/
4. 4. https://www.mayoclinic.org/diseases-conditions/hangovers/symptoms-causes/syc-20373012

Mental Health Monday: Obsessive Compulsive Disorder (OCD)

Welcome Back! This Monday we are going to be talking about Obsessive Compulsive Disorder or OCD. We will also briefly cover some subgroups.  OCD is classified under an anxiety disorder. It is the least common, affecting about 1% of the population with onset at about 19 years,  but one of the most disabling mental health disorders. Obsessive thoughts and compulsive behaviors make up this disorder. It is usually a life long illness and boys commonly are affected more often then girls.

Obsessive thoughts are reoccurring thoughts, feelings or images that are intrusive and unwanted and cause anxiety. The most common type of thoughts include fear of contamination, the need for equality or stability, safety, sexual or aggressive impulses and religious preoccupation. Compulsions are repetitive behaviors or acts that a person performs to relive the anxiety from their thoughts. Some common compulsions are washing, double checking, repeating, reordering, counting or hoarding.

“Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds (2).”

The causes of OCD are unknown but there are some risk factors that include: genetics in a first degree relative, brain structure (frontal cortex and subcortical structures are different), and sexual or physical abuse as a child. Some children develop OCD after a Steptococcal infection. It is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

Treatments include medication and cognitive therapy. These people often suffer from other mental health disorders that should be treated in conjunction with the OCD. Serotonin reuptake inhibitors (SRIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants are medications used to treat OCD. SRIs often require higher daily doses in the treatment of OCD than of depression, and may take 8 to 12 weeks to start working.  A type of therapy called Exposure and Response Prevention can also help in teaching people about their compulsions, how to recognize them and adapt.

Impulse Control Disorders can be grouped as a sub specialty of OCD but some can now stand on their own in the DSM V.  People with these disorders cannot control the urge to hurt themselves as a result of their anxieties. The difference between these disorders and self harm is that impulse control disorders are the main diagnosis. It can be hard to differentiate. Some of these disorders are the following : addictions to alcohol or drugs, eating disorders, compulsive gambling, sexual fantasies and behaviors involving non-human objects, suffering, humiliation of children, compulsive hair pulling, stealing, fire setting, and intermittent explosive attacks of rage.

Most recently trichotillomania and dermatillomania have been added as subgroups of OCD. Trichotillomania is hair pulling from anywhere on the body but typically the scalp, eyebrows and eyelashes are the most common. The most severe type of trichotillomania is oral fixation where people will eat there hair once pulled. this often times leads to surgery as patients get bowel obstructions. Trichotillomania usually starts between 9 – 13 years old. Anxiety as well as boredom can trigger this.

Dermatillomania is also called excoriation disorder or skin picking. People may pick at healthy skin, minor skin irregularities (e.g., pimples or calluses), lesions, or scabs. A wide range of ages are affected by this disease but puberty years are the typical onset. 1.4% of adults have dermatillonmania and usually it is mostly seen in women. Infections can be seen in these people as they will continue to pick the same areas over and over.

I was recently diagnosed with dermatillomania and minor trichotillomania. I have been picking at my skin for as long as I can remember and my mom also does it. I also pull at my eyebrows and eyelashes. The worst part is I know that I shouldn’t do it but it is difficult to stop. I have had cellulitis in my leg and have scars all over the place from picking. Thankfully my anti-depressant takes care of most of this and I have not had an infection in a long time.

Thanks for reading! Hope you enjoyed! Can’t wait to talk to you next week. If you have any disease that you would like me to go over, feel free to ask!

Resources:

1. MentalHealthFirstAid.org
2. OCD: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
3. PANDAS: https://www.nimh.nih.gov/health/publications/pandas/index.shtml
4. Impulse Control Disorders: https://psychcentral.com/lib/what-are-impulse-control-disorders/
5. Trichotillomania: http://www.mentalhealthamerica.net/conditions/trichotillomania-hair-pulling
6. Dermatillomania: http://www.mentalhealthamerica.net/conditions/excoriation-disorder-skin-picking-or-dermatillomania

Mental Health Monday: Post Traumatic Stress Disorder (PTSD)

Welcome back to Mental Health Monday. Today we will be talking about Post Traumatic Stress Disorder or PTSD. We will also talk about Acute Stress Disorder as this is a sub-type. PTSD is classified under an anxiety disorder. It affects about 3. 5% of the population with first experiences usually being around 23 years old (1). PTSD occurs after a person experiences a traumatic event. PTSD is typically associated with war and rape however it does include many other situations including the following; traffic accidents, physical accidents, assault of all kinds, sudden and unexpected death of a loved one, mugging, robbery, family violence, terror attacks, mass shootings, or severe weather events.

Acute Stress Disorder (ASD) is when the person that experiences these events can recover within three months and get back to a normal life. PTSD lasts much longer. ASD can very well turn into PTSD. This usually occurs when there are feelings of intense fear, helplessness, horror and there is no support fr the patient.

There are different types of symptom classifications for PTSD according to the NIMH (2):

• Re-experience Symptoms – flashbacks, nightmares and frightening thoughts.
• Avoidance Symptoms – avoiding triggers such as the places, events, or feelings
• Arousal and Reactivity Symptoms – easily startled, feeling tense or on edge, insomnia and anger
• Cognitive and Mood Symptoms – memory problems, negative thoughts, distorted feelings of guilt, blame, loss of interest in activities

*Children may have bed wetting, acting out, reverse in language or milestones, and being clingy towards one specific person.*

“To be diagnosed with PTSD, an adult must have all of the following for at least 1 month (2):

• At least one re-experiencing symptom

• At least one avoidance symptom

• At least two arousal and reactivity symptoms

• At least two cognition and mood symptoms”

There are very few risk factors as anybody can experience a trauma at any point in their life. There is no age restriction. Contrary to popular belief because of war (still predominately male), women are actually the gender most likely to experience PTSD.

Support groups are the leading cause of success in coping with PTSD. Medication such as antidepressants and sleeping medication may help but are almost always used in conjunction with talk therapy for PTSD. Talk therapy for PTSD usually last six to twelve months but can take as long as needed and may become chronic. Sometimes exposure therapy is used along with cognitive restructuring. This means that a reason for the events happening is found and discussed if possible.

This year I was diagnosed with ASD and eventually PTSD from witnessing and rendering care in a pedestrian versus car accident. It was May 31, 2018. It was really raining at my house so I left about 15 minutes earlier than I normally would have for work. It was super difficult to see because of the rain. I saw police lights on in the oncoming lane but thought nothing of it until I pulled up next to them. There was a man lying on the ground in front of a police car. The man had walked out in front of the police officer and landed about 25 feet away. Although I still cannot talk about details as the statute of limitations is not up, the police officer and I rendered care for about 15 minutes until the ambulance and fire company got there. I stayed until the very end because I had to talk with the police captain, fire chief, traffic police chief, and motor vehicle accident police chief. I was so calm throughout the whole thing. My nursing training was astonishing and I still cannot believe what I was capable of as I was never trained as a first responder or emergency room nurse. Once a nurse; always a nurse. The training always comes naturally. I did however get nauseated once because for the first time I did see brain matter that was alive and not from a bucket. Now during all of this it was pouring rain and I didn’t realize how wet I was until I stood up. Once I was in my car and wrapped up in a towel I keep in my car for situations like this, I called my mom as I drove to work. That’s when it all hit me and I was hysterical. This was just the adrenaline coming out. Once I got to work and changed clothes I was able to do my normal work. I went home after my shift and didn’t think anything of it. I woke up the next day and got ready for work.

Once I grabbed my keys I began to cry uncontrollably and had a panic attack. I was so scared to drive my car for the next few days because I was just waiting for the next accident. The reality though is one of these accidents happening is very rare to begin with let alone another one happening right afterwards. I couldn’t see or hear an ambulance without getting nauseated. Once the nightmares started though and I was waking up drenched in sweat or crying nonstop I knew it was time to go see my therapist again.

I went and talked to Dr. M and we went over the accident from beginning to end. Most of my issues surrounded the tremendous amount of “rescuers guilt.” It’s a very weird feeling and I really wish I had words to explain it, but until you experience something like that you can’t understand. Dr. M gave me some coping strategies and said since I have no prior traumas that it should take about 12 weeks to stop constantly thinking about the accident. It took me three months to get back to a okay place but I have to drive by the scene of the accident everyday. Not until recently did I notice I am not paying attention to that anymore as much. There are still random days I think about it but I do not get nauseated anymore when I hear or see sirens. Another interesting factor for me was there not being an obituary. Unfortunately but expected, the man did pass away. As a nurse we often times look for obituaries for our “closure.” This mans family chose not to release one and that was a little difficult for me. I still think about the officer that was with me. He was so young and looked so nervous. I wonder how he is coping. But my focus is on me now and trying to move on.

Thanks for coming back to another Mental Health Monday! Talk to you next week!

1. MentalhealthFirstAid.org
2. National Institute for Mental Health – https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml#part_145372

Mental Health Monday: Bipolar Disorder

This Monday we are going back to the psychosis disorders and talking about Bipolar Disorder. Bipolar disorder is classified by extreme mood swings. It has also been called manic-depressive disorder. These people have episodes of depression and mania but they can have long periods of normal moods in between. Often times mania can lead to psychosis. Bipolar disorder affects 2.8% of the total population; half of which have their first episode by 25. Both genders are affected equally. It can take a long time to be correctly diagnosed because patients have both episodes of mania and depression and may be normal in between long enough that only one of the disorders are recognized. There is also something called hypomania which a less extreme version of mania and the patients may still be able to function normally.

According to the NIMH (2) there are four sub-types of bipolar disorder:

• Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
• Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
• Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
• Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.

The depressive episodes have the same signs and symptoms as your typical clinical depression. That is found in Mental Health Monday Part 2: Depression. Here we are going to talk about the mania symptoms associated with Bipolar disorder. Please note that other mental health disorders can experience mania, it is just typically found in Bipolar patients more often.

Mania symptoms are as follows (1): increased activity, over activity, elevated mood which includes feeling of extreme happiness, insomnia, irritability, rapid thoughts and speech, lack of inhibitions which include reckless behavior (sexual risk taking, spending money), grandiose delusions (superhuman powers), and lack of insight making them not realize they are ill.

Risk factors for Bipolar disorder include (1): having relatives with bipolar disorder, pregnancy and complications from fetal development, births in winter or spring, social situation (poor income, single parents), recent stressful life events, recent birth, brain injuries and multiple sclerosis.

Treatments for Bipolar disorder include medication such as mood stabilizers, atypical antipsychotics, and antidepressants, psycho-education, cognitive behavioral therapy, interpersonal therapy, social therapy and family therapy. Rarely, electroconvulsive therapy is used as well. Sleeping medications can also help those who suffer from insomnia.

Thanks for coming back for another Mental Health Monday! Below you will find some resources!

1. MentalHeatlhFirstAid.org
2. National Institute of Mental Health – https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
3. http://www.pendulum.org
4. mentalhealthamerica.net

Mental Health Monday: Suicide and Non-Suicidal Self Injury

September is National Suicide Awareness Month and September 9-15 is National Suicide Awareness Week. We will get back to the psychosis disorders soon, but this week we are going to talk about suicide. *Please be aware this may be sensitive content and can be a trigger for some individuals. Discretion is advised.*

Suicide

Suicide is the act of taking one’s own life. This can be violent or non-violent. A suicide attempt is when people harm themselves with the intent to kill themselves but do not die as a result of these actions. Suicide is the 10th leading cause of death in the United States (2% of total population). Men are more likely to be successful with suicide and typically use more violent means whereas women attempt suicide more often with less violent means. Violent means include guns, knives (stabbings) and hanging. Non-violent means include overdoses, drownings and knives or razors (wrist slitting).

Risk factors can vary from ages to ethnicities. Some of the most common risk factors include: depression and other mental disorders, substance use, prior suicide attempts, family history, family or relationship violence, or incarceration. American Indian and Alaskan Native youth have a higher risk. LGBTQ teens also have a higher risk. Some signs, symptoms and wording you may hear a person at risk say vary as well. They include: talking about wanting to die or kill themselves, making a plan, talking about feelings of hopelessness, stating they have no reason to live, talking about being a burden, feeling trapped, or being in unbearable pain (may be physical), increase in substance use, anxiety, agitation, reckless behavior, sleeping too much or too little, withdrawal, rage, extreme mood swings, saying goodbye to family and friends, making a will, and giving away possessions they love.

If you have a suspicion that someone is having a crises and may hurt themselves you need to ask the following questions:

• Are you having suicidal thoughts?
• Are you thinking about killing yourself?

If the answer is yes to the previous questions or you’re still unsure ask these questions next:

• Do you have a plan on how you will kill yourself?
• Have you decided on when you would kill yourself?
• Have you taken any actions to secure the objects you need to carry out your plan of suicide?

Never leave these patients alone. Ask them if they would like to go to the hospital or to a doctor that they are comfortable with. When in doubt always call 911. Stay open and non-judgemental when talking. Always express empathy. They are not seeking attention in an unnecessary way. These people often times are looking for someone to just listen. Suicide is not about hurting oneself but the release of the pain and suffering they are experiencing.

Treatments for suicide often involve treatment of the underlying mental health disorder. Medications and cognitive therapy will be used. Sometimes though, acute hospitalization and mental health facilities are required. In the hospital I work at patients are monitored for a minimum of 24 hours if they answer yes to feeling like they are going to harm themselves. We observe them, a psychologist will come see them and they have what we call a safety sitter. Safety sitters are with the patient 24/7 to make sure they do not harm themselves. Everything is removed from the patient’s room and they have to wear paper scrubs. If patients are brought in by the police they will be what we called a 302. It is an involuntary commitment. The patient cannot leave for at least 72 hours and have to be cleared by the provider. The magistrate also gets involved and need to know when the patient is released. There is also a 201 which is a voluntary commitment. These patients know they are having a crises and are seeking help. They also have to stay for 72 hours but can leave with a 24 hours notice to the provider. If the patient seems like a danger to themselves or others though they can be changed to a 302. Sometimes, a patient cannot receive all the help they need in an acute care setting so they go to a psychiatric hospital for more long term regulation of their medications and more intense therapy than what a hospital can provide.

Some providers refer to suicidal patients as being actively suicidal and passively suicidal. Active refers to having a plan and intending to go through with that plan. Passive is when you do not have a plan but you would not stop anything happening to you. There are blurred lines sometimes with passive being used to refer to self harm as well.

Non-Suicidal Self Injury

There are a few names non-suicidal self injury is referred to as; this includes self harm, self mutilation, and parasuicide. This is injury that has no intention of ending in suicide. Sometimes it is quite difficult to tell the difference between self harm and a suicide attempt. There are many different types of self harm;

• cutting, scratching, or pinching skin enough to bleed or to leave a mark on the skin
• banging or punching objects to the point of bruising or bleeding
• ripping or tearing the skin
• carving words or patterns into the skin
• interfering with the healing of wounds
• burning the skin with cigarettes, matches, or hot water
• pulling out hair
• deliberate overdose on medications without intention of suicide
• sudden excessive tattooing or piercings

The main thing to understand about self harm is that it is a coping mechanism. It is helping make the mental pain they feel more physical, which in the mind of most people is more acceptable. It may be more harmful to try to get a person to stop self harm. Try to address the problem that is causing the self harm. Conversations have to be direct. 911 is always appropriate for these situations.

Personally, I have had a family member be actively suicidal and I have been passively suicidal. I had been awake for five days (eventually diagnosed as a manic episode). I came home from work and was finally so tired I decided to take my prescribed xanax. However, I did not take the prescribed dose of 0.25mg. I took 0.75mg, ran a warm bath, lit a candle and tried to relax. After an hour, I was still awake. So this time I took 75mg of benadryl. This is also three times the dose but I have an autoimmune disorder that prevents me from taking small doses of benadryl (so technically this was my prescribed dose). I assume I fell asleep because I remember waking up about 2-3 hours later with my dog licking my face, cold water and coughing from inhaling water. This should have ended otherwise but I am quite thankful that my puppy somehow got through a locked door. This is why he is now spoiled to high heavens. I have also carved things into my skin and I pick at my skin until it bleeds. This is all anxiety driven.

People are extremely judgemental about suicide. They find it to be selfish. They say that suicidal people are only thinking about themselves and not their loved ones. But the thing is that they are thinking about themselves, as they should be. They are so tired and fed up of all the pain and suffering that they feel like the only way out is to be dead.  They are NOT doing it to hurt the people they love. They are just trying to solve their problems.

Thanks again for reading. If you have any questions or just want to talk I am always here! Below are my resources and good places to find more information!

nimh.nih.gov

mentalhealthfirstaid.org

National Suicide Hotline (free and confidential)

• 1-800-273-TALK (8255)
• Text “Connect” to 741-741
• http://www.suicidepreventionlifeline.org

Spanish National Suicide Hotline

• 1-800-628-9454

Poison Control Center

• 1-800-848-6946

Suicide Prevention Resource Center

• http://www.sprc.org

Veterans Crisis Line

• 1-800-273-8255
• Press 1

The Trevor Project

• http://www.thetrevorproject.org
• 1-866-488-7386

To Write Love On Her Arms

• http://www.twloha.com

 

 

Mental Health Monday: Psychosis and Schizophrenia

Coming to you a little late since I am working the holiday. The next two or three weeks we will be talking about different disorders that are classified under psychosis. Psychosis is a general term that is defined as “a mental health problem in which a person has lost some contact with reality, resulting in a severe disturbances in thinking, emotion and behavior.” These disorders are less common in the mental health realm. Typically patients that are psychotic go through five phases:

1. Premorbid- at risk phase, no symptoms yet but are at a higher risk for developing psychosis.
2. Prodromal- becoming unwell phase, the person begins to experience symptoms.
3. Acute- psychosis phase, symptoms are very present and the patient is unwell.
4. Recovery- the journey to obtain wellness.
5. Relapse- may be one additional or multiple episodes.

Today we will be talking about Schizophrenia. We will also touch lightly on Schizoaffective Disorder.

Schizophrenia 

This is the most common of the psychotic disorders. It affects about 0.3-0.7% of the population. The Greek translation is “fractured mind.” This is in reference to the thoughts and perceptions become disordered and the person loses touch with reality. It is commonly experienced between 16-30 years old and is rarely seen newly diagnosed after 45. Both males and females are equally affected by schizophrenia but men show symptoms earlier. Recovery is sustained in about 14% of individuals.

The major symptoms include the following but are not limited to:

• Delusions- false beliefs, guilt, having a special mission, being controlled by another person(typically the government) or life form(typically aliens).
• Hallucinations- most commonly is hearing voices but can include seeing, feeling, tasting, or smelling things. More than one hallucination can occur at a time.
• Thinking Difficulties- cannot concentrate, poor memory, cannot communicate.
• Loss of drive- no self care, no motivation.
• Blunted Emotions- often times reacting inappropriately however can be the opposite and include monotone, lack of eye contact, lack of expressions.
• Social Withdrawal- these other symptoms make it very difficult to function and trust other people.

Risk factors for Schizophrenia include family genetics, urban living (thought to be the level of care of the mother during pregnancy), migration/immigration, social stress, marijuana use, infections in pregnant mothers in the first and second trimester, hypoxia at birth, winter and spring births (5 to 30% higher risk), and older age of father at conception. Dopamine is the neurotransmitter associated with Schizophrenia. Once again, it is unknown if low dopamine causes schizophrenia or schizophrenia causes low dopamine.

Schizophrenia treatments include antipsychotic medication which only help with the delusions and hallucinations, antidepressant medications which help with the lack of dopamine, psychoeducation, cognitive behavioral therapy (CBT), social skills training, and assertive community treatment (ACT) which includes care from multiple disciplines including family to set them up for success in the real world. ACT has shown most success in lowering the chances of rehospitalization.

Schizoaffective Disorder includes schizophrenia but adds in a mood disorder as well. The usual mood disorder is bipolar. It is very difficult sometimes to tell the difference between the two as they can have similar symptoms. Next week we will be discussing Bipolar Disorder.

Thanks again!

http://www.mentalhealthfirstaid.org

http://www.schizophrenia.com

Schizophrenia and related Disorders Alliance of America

• http://www.sardaa.org/schizophrenics-anonymous/

Mental Health Monday Part 2: Depression

Welcome back to the second part of the first Mental Health Monday. This time we will be discussing the second leading mental health disorder: depression. Please note that these subjects can be sensitive to some people. *Discretion is advised.*

Depression

Short term depressed moods are experienced by everybody. These are “the blues” and sadness. A major depressive mood disorder lasts for at least two weeks and affects the person’s ability to work, hold relationships and participate in daily activities. Major depressive mood disorders are 6.8% of reported illnesses making them number two in mental health illnesses. The median age is 32 which is much later than anxiety. Depression can occur with anxiety and substance abuse disorders. Unfortunately, people with major depressive mood disorders are prone to the return of the depression. Once again, females are the leading gender affected by this disorder. The most common types of mood disorders include:

• Major Depressive Disorder (often referred to as Clinical Depression) – generalized depressive episodes. Often hopelessness and helplessness are associated with this.
• Bipolar Disorder (2.8%, onset 25 years) – previously known as manic depressive disorder. Patients will often experience extreme mood swings from completely elated to mania to depression but will have long periods of normal moods in between.
• Postpartum Depression(21.9%) -depression during the first postpartum year. The “baby blues” are common after birth however if lasting longer than two weeks, depression is considered.
• Seasonal Depression also known as SAD – major depression with seasonal patterns. Fall and winter months are popular because there is less sunlight.

Causes and risks of depression include the following; a breakup, separation or divorce, poverty, loss of job, accidents with long term disability, bullying, crime victim, long term or chronic illnesses, death, birth, side effects of medications, other mental disorders, intoxication or withdrawal, hormonal changes, lack of sunlight, long term caregivers, family members with depression, people with more emotional personalities, abusive childhoods, females. Medical conditions that are known to cause depression are Parkinson’s disease, Huntington’s disease, traumatic brain injuries, strokes, hypothyroidism, lupus and other autoimmune disorders. Depression is caused by changes in natural brain chemistry. The main neurotransmitter that is involved is serotonin (although dopamine is likely involved too).

To be diagnosed with clinical depression, a person must have one of these two symptoms every day for a minimum of two weeks: an unusually sad mood or loss of enjoyment and interest in activities that used to be enjoyable. Other general symptoms include lack of energy, excessive tiredness, worthlessness, guilt when really not at fault, excessive thoughts about death or wishes to be dead, difficulty concentrating, moving slowly, agitation, sleeping too much or too little, and eating too much or too little.

Symptoms of depression can be further broken down to emotional, thoughts, behavioral, or physical. Emotions that may present are sadness, anger, guilt, lack of emotion, helplessness, hopelessness or irritability. Thoughts include self criticism, self blame, confusion, death and suicide, and impaired memory. Behavior includes crying, withdrawing, neglect of responsibilities, poor appearance and hygiene, illicit drug and alcohol use. Finally, physical symptoms include chronic fatigue, constipation, diarrhea, excessive over or under eating, headaches, loss of sexual desire, unexplained aches and pains.

Treatments include medication, supportive counseling, psychological therapies, and other medical treatments. Medication includes antidepressants with the most popular being selective serotonin reuptake inhibitors. These help the brain make more serotonin available. Supportive counseling is non judgemental listening by a professional (doctors, therapists, counselors, and clergy. Problem solving skills may be taught in this type of counseling. Psychological therapy is Cognitive Behavioral Therapy (CBT). I talked about this in Anxiety. Finally, some medical treatments include the controversial electroconvulsive therapy (ECT). Although ECT has been proven to help in some major depressive cases, the risks out weight the benefits. The major setback with ECT is memory loss.

When discussing major depressive disorders, we need to talk about suicide. This may be sensitive for some people so please read at your own comfort. Although suicide will have its own Mental Health Monday, I will briefly highlight it here. Suicide is the 10th leading cause of death in the United States. Males are 4 times more likely to die by suicide but females attempt suicide 3 times more than males. Men typically use more violent ways of suicide such as weapons whereas women use less violent ways such as overdosing. If someone you know is suicidal please ask them the following:

• Are you having suicidal thoughts?
• Are you thinking about killing yourself?

If they answer yes, continue with:

• Do you have a plan on how to kill yourself?
• Have you decided on when you would kill yourself?
• Have you taken any action to secure the objects you need to carry out your plan of suicide?

Please do not leave these people alone. Ask them what they would like to do. Do they want to go to the hospital? Do they already see a provider that they would like to go to? When in doubt call 911.

The best thing we can do is use the words death and suicide and kill. We as a society are very afraid of these words and think if we use these words we will encourage the person to follow through with their plan. This is simply not true. The more comfortable with these words, the more we can help people.

I was diagnosed with depression when I was 23 although honestly I probably was depressed when I was diagnosed with the anxiety when I was 16. My husband moved the Charlotte in January of 2015. I remember that’s when the excessive sadness would occur. No one knew of course because I could get through the day fine but would cry continuously throughout the night. I finally couldn’t handle it anymore and went to see my doctor in June of 2015. I was prescribed Lexapro (SSRI). I remember being so reluctant to take this medication, proving that the stigma had got to me too. But I took it and here we are three and a half years later and i’m still taking it and it’s working great.

Now I must say I am pretty lucky. The first medication they gave me was the one that worked for me. Please do NOT be discouraged if this is not the case for you. All of our brain chemistries are different and sometimes it can take multiple trial and errors for the correct treatment plan to be found for you.

I moved to Charlotte in July of 2015, six months after my husband. Everything was great and I even tried to cut my Lexapro in half. It did not work but the doctor said just give it more time. I was fine until November of that year. I started getting really sad again. Taking care of a sick puppy and working night shift was super hard on my body. My sleep was getting less and less. And of course I did not know anyone in Charlotte. Thankfully, I made a friend named Ben at the dog park. He had a dog named Hercules who played with Maverick every day. I still don’t know to this day if Ben actually listened to me but at least he pretended. Ben and Herc moved to California in January of 2016 which was difficult because I still had not made friends at work that I saw outside of work.

Around March I hit my breaking point. I was so tired and was up for 5 days (later I would learn that this was an episode of mania). I literally was sobbing because I was so tired. I would have done anything to sleep. I went home from working half a shift and ran a bath. I took a Xanax and burned a candle. Still after an hour I was not tired so I took Benadryl. I need to take about 3 times the normal dose of Benadryl to have any effect because of another illness that gave me a tolerance to Benadryl. Well, I finally fell asleep…in the bathtub. I woke up probably about two hours later in freezing cold water by my puppy licking my face. To this day I don’t know how Maverick got into the bathroom because the door was locked (although I was so tired who actually knows). I was coughing as I inhaled water as I slept. Some medical professionals would consider this a passive suicide attempt (will be discussed at a later time). This is when I would realize it was time for professional help. Some people that I talked to asked what could I possibly be depressed about? I had a job, a boyfriend, a dog, parents, a good support system. But the thing is it has nothing to do with this. Although a lack of these things could be attributes to depression they do not actually cause the depression.

A co-worker had seen a therapist and recommended him to me. I went to meet with him and so started my cognitive therapy that would last for about 9 months straight, 11 total. The first three times I went to see him, I cried and it took me 30 minutes just to get out of the door. To me this was finally admitting that I had a problem that I could not manage myself. We worked on so many things. It took no time at all to realize my main trigger which was my lack of ability to control situations. We came up with many plans and back up plans. He gave me a workbook to do which I thought was so silly but when you see your problems on an actual piece of paper it is therapeutic in some weird way. Thankfully, Dr. M helped me and in November I “graduated” therapy. I have had several “tune ups’ with him and will continue to need them as life goes on. I am still on Lexapro to this day. Unfortunately, I will never come off of it as I cannot make serotonin. The best thing my primary doctor told me was “People take antihypertensives and insulin all their life, why does taking antidepressants have to be different?” Having these disorders have helped me become a Mental Health Advocate and if my story helps just one person then it is so worth it.

Thanks for reading! I will post some resources below!

• MentalHealthFirstAid.org
• National Suicide Hotline 1-800-273-8255
• Spanish National Suicide Hotline 1-800-628-9454
• Master of Your Anxiety Workbook https://www.amazon.com/Mastery-Your-Anxiety-Panic-Treatments/dp/0195311353/ref=sr_1_16?ie=UTF8&qid=1535392708&sr=8-16&keywords=anxiety+workbook
• Overcoming Depression https://www.amazon.com/Overcoming-Depression-Cognitive-Approach-Treatments/dp/019537102X/ref=pd_sim_14_4?_encoding=UTF8&pd_rd_i=019537102X&pd_rd_r=d42a1e37-aa22-11e8-8742-1712fd196554&pd_rd_w=1NV3s&pd_rd_wg=lVmWE&pf_rd_i=desktop-dp-sims&pf_rd_m=ATVPDKIKX0DER&pf_rd_p=a180fdfb-b54e-4904-85ba-d852197d6c09&pf_rd_r=NA3PRNH7DRWW8EFRQ2CF&pf_rd_s=desktop-dp-sims&pf_rd_t=40701&psc=1&refRID=NA3PRNH7DRWW8EFRQ2CF

Mental Health Monday Part 1: Anxiety

Welcome to the first Mental Health Monday! Every Monday we will be discussing a mental health disorder, it’s signs and symptoms, treatments, etc. I will also be discussing my personal experiences with the illnesses if I have them. This week we will be having a two part discussion about the two most common mental health disorders; anxiety and depression, as these typically come together although they can be experienced completely separate. Please note that some of this information is sensitive. *Reader discretion is advised.*

Anxiety

Anxiety can be a healthy coping mechanism. It helps with flight or fight and can be motivating for everyday tasks. An anxiety disorder differs in intensity, how long it lasts and interferes with work, activities and relationships. Anxiety is mostly caused by the perceived threats in the environment that may or may not be real. Anxiety is the over reaction to these threats. It can be anything from an uneasy feeling to a panic attack. Anxiety sufferers typically have a low level of dopamine. It is not known if the low dopamine causes anxiety or vice versa.

Anxiety makes up 18.1% of mental health disorders that are reported. Typically, the median age of onset is just a mere 11 years old. Anxiety is more prevalent in females than males. There are several different types of anxiety disorders, the main ones are listed below with their percentages, median ages of onset, and a brief description:

• Specific Phobias (8.7%, 7 years) – avoidance and restriction of activities because of persistent and excessive fear. These can include places, events or objects. Commons phobias include spiders, snakes, mice, bugs, heights, animals, blood, injections, storms, flying, and enclosed spaces.
• Social Anxiety Disorders (6.8%, 13 years) – fear of any place public scrutiny may occur. Common triggers are speaking or eating in public, dating, and social events.
• Post-Traumatic Stress Disorder also known as PTSD (3.5%, 23 years) – occur after a distressing or catastrophic event. Common examples include war, accidents, assault, or witnessing any of these experiences.
• Generalized Anxiety Disorders also known as GAD (3.1%, 31 years) – overwhelming, unfounded anxiety and worry about things that may or may not go wrong accompanied by physical and psychological symptoms that occur for days and then not again for at least six months.
• Panic Disorders (2.7%, 24 years) – panic attacks are sudden onset of intense apprehension, fear and terror. To have a disorder, these attacks have to be reoccuring and for at least one month the person has to be worried about another attack.
• Obsessive-Compulsive Disorders also known as OCD (1%, 19 years) – this is the least common but one of the more disabling disorders. Obsessive thoughts and compulsive behaviors take over the patient. Common thoughts include fear of contamination, need for perfection and symmetry, and religious preoccupation.
• Agoraphobia (0.9%, 20 years) –  avoidance of social situations involving crowds. Typically these patients will not leave home. Type of Social Anxiety.

People most at risk for anxiety disorders include those with more sensitive natures, excessive shyness as a child, female gender, alcohol abuse, and trauma. Family influences include childhood abuse, poverty, family history of anxiety disorders, parental alcohol problems, separation, and divorce. Medical induced anxiety can come from endocrine conditions, cardiac conditions, respiratory conditions, metabolic conditions, side effects from prescribed drugs, intoxication and withdrawal from alcohol and illicit drugs.

Symptoms from anxiety can vary. There are physical, psychological and behavioral symptoms.  Some physical symptoms include pounding heart, hyper or hypoventilation, dizziness, tingling, nausea, vomiting, diarrhea, and tremors. Psychological symptoms include excessive fear, going blank, anger, irritability, restlessness, and sleep disturbance. Behavioral symptoms include avoidance, obsessive and compulsive behaviors.

There are two common treatments for anxiety disorder and they usually coincide with each other. Medication is the first treatment. Most antidepressants have been successful in treating anxiety and these are great because they can be used safely long term when under the care of a provider. Anti-anxiety medications (benzodiazepines) are also great but should be used cautiously as they are addicting. These should be used short term for crisis’. All medication is prescribed by professionals such as your primary care doctor or psychiatrist. The second treatment is cognitive behavioral therapy (CBT). Therapy has the strongest effectiveness. CBT is provided by a professional which are usually a psychologist, psychiatrist or trained counselor. CBT includes education about self management, problem solving, exposure therapy, emotional regulation through meditation and relaxation, relearning social skills, and relapse prevention and planning. Therapy can be in groups or in private.

A new “treatment” includes using marijuana. I use quotations because marijuana is not endorsed by physicians and providers. “The FDA has not recognized or approved the marijuana plant as medicine (2).” Medical marijuana or cannabis is becoming more popular and debilitating anxiety disorders are a condition for prescription, however it is as a last resort and has to be used in conjunction with prescribed medication.

If you know someone whose suffering the best thing you can do is bring it up to them. Make sure you are in a quiet place and are alone. More than likely this will be a relief but please note some of the more severe disorders may get angry. Offer to go with them to their doctor or therapist. Support them as long as it takes. If they seem to be a danger to themselves or others, do not leave them alone. If necessary, call 911 when you feel you cannot handle the situation. A few days of anger from someone beats them making rash, dangerous decisions.

I was diagnosed with generalized anxiety disorder when I was 16 although I was about 14 when the signs and symptoms first presented themselves. I would get palpitations and severe gastrointestinal distress. The thing about GAD is that usually you don’t know what your trigger is. I remember the first thing I “panicked” about was the kids walking out of high school my sophomore year to protest the firing of a long time teacher. I could not go to school because of my GI distress. The likely answer to this is that kids were going to have Saturday detention if they walked out. I was prescribed Xanax which is a short term anti-anxiety medication. It helped and I continued to use it until I was about 24. When I was 23 my anxiety and depression got out of control and I was suffering. I did end up seeking out the help of a therapist (thanks Dr. M). I had 11 months worth of cognitive therapy which included workbooks, planning, identification of triggers and lots of crying and anger. My issue…control. I did not like the unpredictability of a situation and my inability to control those situations. We came up with a slogan that I literally now have written everywhere and have passed on to other people.

You are not out of control, you are just less or more in control.

I will talk about my therapy more in part 2. Thanks for reading about anxiety. I will list my resource below and some websites you can find more information!

1. MentalHealthFirstAid.org
2. National Institute on Drug Abuse https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine

• Anxiety and Depression Association of America http://www.adaa.org
• National Institute of Mental Health http://www.nimh.nih.gov
• Mental Health America http://www.mentalhealthamerica.net