Thursday, January 10, 2008

Anxiety Disorders

From the Canadian Mental Health Association website, http://www.cmha.ca/bins/index.asp?lang=1, is this article about various types of anxiety disorders, including panic disorder, phobias, social phobia, post-traumatic stress disorder, and generalized anxiety disorder, http://www.cmha.ca/bins/content_page.asp?cid=3-94&lang=1:

ANXIETY DISORDERS

One of Canada's most common illnesses is also the least understood

Everyone feels anxious at times. Challenges such as workplace pressures, public speaking, highly demanding schedules or writing an exam can lead to a sense of worry, even fear. These sensations, however uncomfortable, are different from the ones associated with a anxiety disorder. People suffering from an anxiety disorder are subject to intense, prolonged feelings of fright and distress for no obvious reason. The condition turns their life into a continuous journey of unease and fear and can interfere with their relationships with family, friends and colleagues.
Anxiety disorders are the most common of all mental health problems. It is estimated that they affect approximately 1 in 10 people. They are more prevalent among women than among men, and they affect children as well as adults. Anxiety disorders are illnesses. They can be diagnosed; they can be treated.

But all too often, they are mistaken for mental weakness or instability, and the resulting social stigma can discourage people with anxiety disorders from seeking help. Understanding the facts about anxiety disorders is an important step. Realising that they are medical disorders which can be treated will help to remove the stigma, and encourage people with anxiety disorders to explore the treatments available.

What exactly are anxiety disorders?

Anxiety disorders are a group of disorders which affect behaviour, thoughts, emotions and physical health. Research into their origins continues, but it is believed they are caused by a combination of biological factors and an individuals personal circumstances, much like other health problems, such as heart disease or diabetes. It is common for people to suffer from more than one anxiety disorder; and for an anxiety disorder to be accompanied by depression, eating disorders or substance abuse. Anxiety disorders can also coexist with physical disorders, in which case the physical condition should also be treated.

Some of the signs to look for are:

Panic Disorder - As the name suggests, panic disorder is expressed in panic attacks which occur without warning, accompanied by sudden feelings of terror. Physically, an attack may cause chest pain, heart palpitations, shortness of breath, dizziness, abdominal discomfort, feelings of unreality and fear of dying. When a person avoids situations that he or she fears may cause a panic attack, his or her condition is described as panic disorder with agoraphobia.

Phobias - Phobias are divided into two categories: social phobia, which involves fear of social situations, and specific phobias, such as fear of flying, blood and heights.

Social Phobia - People with social phobia feel a paralysing, irrational self-consciousness about social situations. They have an intense fear of being observed or of doing something horribly wrong in front of other people. The feelings are so extreme that people with social phobia tend to avoid objects or situations that might stimulate that fear, which dramatically reduces their ability to lead a normal life.

Specific Phobias - Fear of flying, fear of heights and fear of open spaces are some typical specific phobias. People suffering from a specific phobia are overwhelmed by unreasonable fears, which they are unable to control. Exposure to feared situations can cause them extreme anxiety and panic, even if they recognize that their fears are illogical.

Post-Traumatic Stress Disorder - A terrifying experience in which serious physical harm occurred or was threatened can cause post-traumatic stress disorder. Survivors of rape, child abuse, war or a natural disaster may develop post-traumatic stress disorder. Common symptoms include flashbacks, during which the person re-lives the terrifying experience, nightmares, depression and feelings of anger or irritability.

Obsessive-Compulsive Disorder - This is a condition in which people suffer from persistent unwanted thoughts (obsessions) and / or rituals (compulsions) which they find impossible to control. Typically, obsessions concern contamination, doubting (such as worrying that the iron hasn't been turned off) and disturbing sexual or religious thoughts. Compulsions include washing, checking, organizing and counting.

Generalized Anxiety Disorder -Characterized by repeated, exaggerated worry about routine life events and activities, this disorder lasts at least six months, during which time the person is affected by extreme worry more days than not. The individual anticipates the worst, even if others would say they have no reason to expect it. Physical symptoms can include nausea, trembling fatigue, muscle tension, or headache.

How can anxiety disorders be treated?

There are two main medical approaches to treating an anxiety disorder: (1) drug therapy and (2) cognitive-behavioural therapy (CBT). Combining the two types of treatment can be effective.

Because most anxiety disorders have at least some biological component, anti-depressants and anti-anxiety drugs are generally prescribed. It is important to inquire about possible side effects of any medication.

Therapeutic strategies can be effective in reducing symptoms in each of the anxiety disorders. The techniques used include cognitive restructuring, to help people turn their anxious thoughts, interpretations and predictions into thoughts which are more rational and less anxious. People with anxiety disorders may also benefit from controlled exposure to feared objects or situations.
Specific CBT techniques have been developed to help assist with particular anxiety disorders. People with panic disorder, for instance, can benefit from breathing retraining, which shows them how to slow their breathing and use meditation when they're feeling anxious.

Support groups and educational resources can also be included in treatment. Anxiety disorders place a great burden on the individuals affected, their families and friends. Learning all you can about the particular condition touching your life can help you develop tools for living with an anxiety disorder, or living with someone who has an anxiety disorder.

A proper diagnosis is key to putting a person with an anxiety disorder on the right treatment path. Many people go undiagnosed for 10 years or more. Since research suggests that many general health care practitioners are unaware of all the appropriate treatments for anxiety disorders, you might consider the option of a specialized anxiety disorder clinic. If such a facility is not available in your area, ask your doctor to look into specialized treatments.
Where to go for more information

For further information about anxiety disorders, contact a community organization like the Canadian Mental Health Association to find out about support and resources available in your community.

Monday, December 31, 2007

Afghan War and Mental Health Problems

From the Monday, October 29, 2007, News section of the Toronto Star, page A2, is another article about the mental health toll on soldiers participating in the war in Afghanistan:

AFGHAN WAR TAKES ITS TOLL
Mental-health problems common after soldiers return to Canada

Alison Auld

The Canadian Press

Halifax - Hundreds of Canadian soldiers returning from Afghanistan are suffering from a range of mental-health problems linked to their deployment, according to new data.

But even with this latest information, the military admits it still has little understanding of how many troops might be affected by the rigours of war and operational stress over the long haul.

About 28 per cent of the 2,700 Canadian Forces soldiers who were screened after serving in the war-torn country were found to have symptoms of one or more mental-health problems, including depression, panic disorders and suicial tendencies.

Of those, 17 per cent exhibited signs of high-risk drinking, about 5 per cent showed symptoms of post-traumatic stress disorder, or PTSD, and another 5 per cent had symptoms of major depression.

"It's significant, but it's commensurate with the difficult nature of the operation," Dr. Mark Zamorski, head of the military's deployment health section, said in an interview from Ottawa about the data he compiled in August. "It's concerning because we ask our members to put a lot on the line."

The military might also be capturing only a small number of troops suffering from mental-health problems because it lacks a comprehensive information system that both tracks soldiers' health over a long period of time and gathers data from all sources.

Soldiers are supposed to undergo screening sometime between 90 and 180 days after they return home from their deployment. But if they develop mental-health problems after that period, they won't be included in Zamorski's data.

An official with Veterans Affairs said that since the Afghan mission began five years ago, the number of clients receiving care for PTSD at the department's clinics has risen to 6,500 from 1,800. That figure could include vets from previous conflicts.

Friday, December 21, 2007

Do You Know the Warning Signs of Suicide?

Knowing these facts may help you to help yourself or family members or friends or coworkers to get help when needed in dealing with thoughts about suicide.

From the American Association of Suicidology, http://www.suicidology.org/displaycommon.cfm?an=2, here is an article about understanding the warning sides and what to do to help.


UNDERSTANDING AND HELPING THE SUICIDAL PERSON

Be Aware of the Warning Signs


Are you or someone you know at risk of suicide? Get the facts and take appropriate action.

Get help immediately by contacting a mental health professional or calling 1-800-273-TALK (8255) for a referral should you witness, hear, or see anyone exhibiting any one or more of the following:

Someone threatening to hurt or kill him/herself, or talking of wanting to hurt or kill him/herself.

Someone looking for ways to kill him/herself by seeking access to firearms, available pills, or other means.

Someone talking or writing about death, dying or suicide, when these actions are out of the ordinary for the person.

Seek help as soon as possible by contacting a mental health professional or calling 1-800-273-TALK (8255) for a referral should you witness, hear, or see someone you know exhibiting any one or more of the following:

Hopelessness
Rage, uncontrolled anger, seeking revenge
Acting reckless or engaging in risky activities, seemingly without
thinking
Feeling trapped - like there's no way out
Increased alcohol or drug use
Withdrawing from friends, family and society
Anxiety, agitation, unable to sleep or sleeping all the time
Dramatic mood changes
No reason for living; no sense of purpose in life

Here is an easy mnemonic to remember these warning signs:
IS PATH WARM?

I Ideation
S Substance Abuse
P Purposelessness
A Anxiety
T Trapped
H Hopelessness
W Withdrawal
A Anger
R Recklessness
M Mood Changes

What To Do

Here are some ways to be helpful to someone who is threatening suicide:

Be direct. Talk openly and matter-of-factly about suicide.
Be willing to listen. Allow expressions of feelings. Accept the feelings.
Be non-judgmental. Don’t debate whether suicide is right or wrong, or whether feelings are good or bad. Don’t lecture on the value of life.
Get involved. Become available. Show interest and support.
Don’t dare him or her to do it.
Don’t act shocked. This will put distance between you.
Don’t be sworn to secrecy. Seek support.
Offer hope that alternatives are available but do not offer glib reassurance.
Take action. Remove means, such as guns or stockpiled pills.
Get help from persons or agencies specializing in crisis intervention and suicide prevention.

Be Aware of Feelings

Many people at some time in their lives think about completing suicide. Most decide to live because they eventually come to realize that the crisis is temporary and death is permanent. On other hand, people having a crisis sometimes perceive their dilemma as inescapable and feel an utter loss of control. These are some of the feelings and thoughts they experience:

Can’t stop the pain
Can’t think clearly
Can’t make decisions
Can’t see any way out
Can’t sleep, eat or work
Can’t get out of depression
Can’t make the sadness go away
Can’t see a future without pain
Can’t see themselves as worthwhile
Can’t get someone’s attention
Can’t seem to get control

If you experience these feelings, get help!

If someone you know exhibits these symptoms, offer help!


Contact:

A community mental health agency
A private therapist or counselor
A school counselor or psychologist
A family physician
A suicide prevention or crisis center



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Thursday, December 13, 2007

Lower Birth Weight Babies Prone to Depression

This is an interesting study. Who would think that smaller babies would be more prone to depression than regular weight ones. But I'm not sure from the data available to the researchers, whether they know whether it is pre-term as well as full-term low birth weight or only the full-term low birth weight that may cause depression later in life.

From The Epoch Times, December 6 - 12, 2007, page A3:

SMALLER BABIES PRONE TO DEPRESSION, STUDY FINDS

Washington (Reuters) - Plump babies may really be happier babies, Canadian and British researchers reported on Monday in a study that found people who had a low birth weight were more likely to have depression and anxiety later in life.

Adverse conditions in the womb that interfere with a baby's growth may also cause brain differences, the researchers report in the December issue of Biological Psychiatry.

Ian Colman of the University of Alberta and colleagues in Britain, studied the records of 4,600 Britons born in 1946, who took part in a 40-year study.

"We found that even people who had just mild or moderate symptoms of depression or anxiety over their life course were smaller babies than those who had better mental health," Colman said in a statement.

"It suggests a dose-response relationship. As birth weight progressively decreases, it's more likely that an individual will suffer from mood disorders later in life."

The researchers simply looked at medical records and did not examine a possible cause. Colman said it is possible that when mothers are stressed, stress hormones are passing through the placenta to the fetus.

Not all small babies are fated to have poor mental health, the researchers said, noting that in 1946 records did not indicate whether the children were born prematurely.

Sunday, December 9, 2007

Electroshock Therapy: It's Back

From the Science section of the October 15, 2007, Maclean's magazine, page 68, is an article about who electroshock therapy is returning and considered the best way to treat severe depression:

A SHOCKING TRUTH

Once thought barbaric, electroshock therapy is making a comeback

by Brian Bethune


When American writer Ann Bauer penned a Salon article in May about the downward spiral of her autistic teenaged son and his seemingly impossible recovery, she told her readers everything. The frightening behaviour, the excrement-smeared sheets, even the time "he turned to look at me - his eyes empty and cold - then beat me until the neighbours heard me screaming and called 911." Everything, that is but the therapy that gave Bauer back her "sweet articulate" boy: electroconsulsive therapy (ECT), more commonly known as shock treatment. "Frankly" she later wrote, "I didn't feel like going through a hailstorm of reader outrage and Frankenstein jokes."

It's hard to blame Bauer, since she surely read right the prevailing public reaction to sending blasts of electricity through a human body. One present-day review of The Snake Pit, an earnest 1948 Hollywood drama that decried standard treatments for the mentally ill, mentions in passing that ECT is a 'dated" technique, "today regarded as barbaric." In fact, it's the review that's dated. ECT is back, in a big way, in medicine even if most people still think of it as a relic of an unenlightened past). And about time too, argue historian Edward Shorter and psychiatrist David Healy in Shock Therapy (UTP), their polemical but convincingly account of the rise, fall and rise again of "the penicillin of psychiatry."

Less than a century ago, psychiatrists had nothing to offer for the major crippling disorders of depression or bipolar illness. Some frustrated practitioners began work with drugs, the first stirrings of the pharmacological revolution to come; others with physical remedies - therapies designed to act on the diseased brain, not on the mind. Many sought to "shock" the brain into readjusting itself - the concept of shock treatment predates the idea of using electricity to deliver it. Insulin, in fact, was the first means of inducing convulsions that proved effective. (Just how they worked, to bring people out of catatonia or depression and banish suicidal compulsions remains a mystery. The current best guess is that ECT somehow reboots the brain, perhaps by repairing neurotransmitter receptors that bind to serotonin and dopamine, the two major "happiness" transmitters.)

But injections of insulin and later replacement drugs affected patients' health in other ways, and when Italian psychiatrist Ugo Cerletti pioneered the use of electricity as a delivery vehicle in 1938, mental health practitioners quickly embraced ECT. "It was a godsend," one reported at the time, "because, compared to nothing, it was an enormous relief. We used to see severe depressions and a suicide rate that was very, very high."

So what happened to give ECT is brain-frying reputation? It did have its problems; it didn't work on everyone; before psychiatrists administered muscle relaxants, the convulsions sometimes broke bones; there was frequent loss of memory, almost always restored within weeks, but real enough in the immediate aftermath; it just plan looked scary, with its gurneys and weird electrical machines, like - as Ann Bauer suggested - Victor Frankenstein's lab. Most importantly, ECT had natural enemies: psychoanalysts.

The entire biological logic of shock therapy was an affront to the psychological basis of analysis. As one Freudian asked in 1951, how could anything like this help someone whose real problem "is that his mother never loved him"? A 40-year-clash between medical paradigms, according to Shock Therapy, won over the chattering classes to the analysts' side, that ECT was a sadistic assault on wretched people who really needed to talk. ECT's public image was fixed by movies like The Snake and One Flew Over the Cuckoo's Nest (1975), in which Jack Nicholson's character emerged an apparent vegetable from a conflated lobotomy-ECT treatment. Temporary memory loss was inflated in public opinion into permanent memory obliteration. Drugs were accepted as the humane way forward.

But as drug-resistant depression became increasingly recognized, convulsion therapy began its comeback. By 2004, the World Psychiatric Association had endorsed it as a first-line treatment - the best available - for severe depression. So it was, at the Mayo clinic, that doctors were ready to use ECT on Ann Bauer's son. Eighteen hours after his first session, he was up and about, greeting his parents and playing cards. He would relapse and need further sessions, as well as drug therapy, but he had come "back to life," in Bauer's words. She decided to heed an appeal from the doctor who had referred her to the Mayo: "If you wish to help other parents of such adolescents, yo should disclose the fact that, despite its stigma, electroshock is one of the most effective treatments in medicine." "Everything he wrote," Bauer declared, "is true."

Monday, December 3, 2007

Another Article on Post-War Mental Health Issues

From the Monday, October 26, 2007, Toronto Star, News section, page A2, here is another article on the mental health issues arising in returning soldiers from Afghanistan. It seems to me that this is one of the additional reasons, besides the death and injury of soldiers, that Canada should not be involved in Afghanistan, in a war that cannot be won.

Afghan War Takes Its Toll

Mental health problems common afer soldiers return to Canada

Alison Auld
The Canadian Press

Halifax - Hundreds of Canadian soldiers returning from Afghanistan are suffering from a range of mental-health problems linked to their deployment, according to new data.

But even with this latest information, the military admits it still has little understanding of how many troops might be affected by the rigours of war and operational stress over the long haul.

About 28 per cent of the 2,700 Canadian Forces soldiers who were screened after serving in the war-torn country were found to have symptoms of one or more mental-health problems, including depression, panic disorders and suicidal tendencies.

Of those, 17 per cent exhibited signs of high-risk drinking, about 5 per cent showed symptoms of post-traumatic stress disorder, or PTSD, and another 5 per cent had symptoms of major depression.

"It's significant, but it's commensurate with the difficult nature of the operation," Dr. Mark Zamorski, head of the military's deployment health section, said in an interview from Ottawa about the data he compiled in August. "It's concerning because we ask our members to put a lot on the line."

The military might also be capturing only a small number of troops suffering from mental-health problems because it lacks a comprehensive information system that both tracks soldiers' health over a long period of time and gathers data from all sources.

Soldiers are supposed to undergo screening sometime between 90 to 180 days after they return home from their deployment. But if they develop mental-health problems after that period, they won't be included in Zamorski's data.

An official with Veterans Affairs said that since the Afghan mission began five years ago, the number of clients receiving care for PTSD at the department's clinics had risen to 6,500 from 1,800. That figure could include vets from previous conflicts.

Saturday, December 1, 2007

Internet Bullying Led to Teenage Suicide

TEEN TRAGEDY
Faked online friendship led to girl's suicide, parents say


Justice urged after depressed 13-year-old befriended, then dumped by 'Josh'

Betsy Taylor
Associated Press

Dardenne Prairie, MO - Megan Meier thought she had made a new friend in cyberspace when a cute teenage boy named Josh contacted her on MySpace and began exchanging messages with her.

Megan, a 13-year-old who suffered from depression and attention deficit disorder, corresponded with Josh for more than a month before he abruptly ended their friendship, telling her he heard she was cruel.

The next day Megan committed suicide. Her family learned later Josh didn't exist; he was created by a former friend's family members.

Now Megan's parents hope the makers of the fraudulent social networking website profile will be prosecuted, and seek legal changes to safeguard youth on the Internet.

Her mother, Tina Meier, said she doesn't think anyone involved intended for the girl to kill herself.

"But when adults are involved and continue to screw with a 13-year-old, with or without mental problems, it is absolutely vile," she told the Suburban Journals of Greater St. Louis, which first reported on the case last week.

Meier said law enforcement officials told her the case didn't fit any law. But sheriff's officials have not closed the case and pledged to consider new evidence if it emerges.

Megan hanged herself in her bedroom on Oct. 16, 2006, and died the next day. Described as a "bubbly, goofy" girl, she loved spending time with her friends, watching movies and fishing with her dad.

Megan had been on medication but had been upbeat after striking up a relationship on MySpace with Josh Evans about six weeks before her death, her mother said.

Josh told her he had just moved to the nearby community of O'Fallon, where he was homeschooled and didn't have a phone number yet.

Megan's parents said she received a message from Josh on Oct. 15 last year, saying he didn't want to be her friend anymore, that he had heard she wasn't nice to her friends.

The next day, as Megan's mother headed out the door to take another daughter to the orthodontist, Megan was upset about Internet messages. She was upset about Internet messages. She asked Megan to log off. MySpace users must be at least 14, though began wasn't when she opened her account. A MySpace spokesperson did not return calls.

Someone using Josh's account was sending cruel messages. Then, Megan called her mother, saying bulletins were being posted, saying things like, "Megan Meier is a slut. Megan Meier is fat."

Megan's mother, who monitored her online messages, returned home and said she was shocked at the vulgar language her daughter was sending and told her so. Megan ran upstairs. Her father, Ron, tried to tell her everything would be fine. About 20 minutes later, she was found. She died the next day.

Her father said he found a message the next day from Josh, which he said authorities have not been able to retrieve, telling the girl she was a bad person and the world would be better without her. Another parent, learning of the fake McSpace account from her own daughter who had access to it, told Megan's parents in a counsellor's office about six weeks after her death. That's when they learned Josh was imaginary, they said.

The woman who created the fake profile has not been charged. She allegedly told the St. Charles County Sheriff's Department she created Josh to find out what Megan was saying about her child online.

A person who answered the door at the family house told an Associated Press reporter on Friday they had been advised not to comment.

Megan's parents are now separated and plan to divorce.

Aldermen in nearby Dardenne Prairie have proposed a new ordinance related to child endangerment and Internet harassment for consideration on Wednesday.

"Is this enough?" said Mayor Pam Fogarty.

"No, not by any stretch of the imagination, but it's something and you have to start somewhere."