What is bipolar disorder?

Bipolar disorder is a disorder of mental function in which the person’s mood can swing between two (‘bi’) poles ranging from the elated hyperactivity of mania on the one hand to the flatness of depression on the other. It was previously called manic-depressive illness. 

How common is it and who gets it? 

About 1 in 100 people in the population suffer from bipolar disorder. It tends to run in families, and men and women are equally likely to develop it. The usual age of onset is in the late teens or 20s (especially). It tends to develop in some women after childbirth or during menopause.

What causes bipolar disorder?

The cause is believed to be a combination of factors including genetics, biochemistry, and stress. Studies point to genetic transmission, including the observation that children of parents with it have an increased risk. There is thought to be a chemical imbalance in the brain, which can be corrected with appropriate medication. Stress may be responsible for triggering the problem in some cases. 

What is normal and abnormal? 

A normal person has a fluctuation or swinging of moods varying from moderate liveliness to moderate lethargy, depending on circumstances from day to day or month to month. It is normal to feel flat sometimes and elated at others. However, people with bipolar disorder have extreme moods unrelated to external events. They are prone to exhibit behavior that is uncharacteristic and not usually socially acceptable. 

They may have periods of normal human behavior lasting for a short time or for many months sandwiched in between the two extremes of mania and depression. The degree of bipolar disorder can range from mild to severe. Some people may only experience episodes of mania or hypomania, without sliding into depression. Most sufferers are able to lead relatively normal lives.

What are the symptoms? 

The mania ‘pole’:  This phase is where the mood is mainly elevated, irritable, and argumentative. Close relatives or associates are more likely to recognize the beginning of the manic phase than the sufferer, who may have no insight into their condition. It usually begins with a less severe degree of mania (called hypomania) which may stay at this stage or progress to the manic stage. 

1. Stage 1: Hypomania 

• Increasing activity and restlessness; ‘high’ 
• Reduced sleep, early waking.
• Leaping out of bed early and vigorously.
• Talkative; fast speech.
• Easily distracted. 
• Decreasing work performance 
• Enthusiastically starts (rarely finishes) new projects. 
• Increased sexual drive and activity.

Stage 2: Mania 

• ‘High as a kite’ 
• Reckless behavior (e.g. spending sprees, running up debts, sexual promiscuity) 
• Wild, garrulous speech 
• Grandiose ideas and plans
• Impaired judgment/lack of insight 
• Hasty decisions (e.g. job resignation, marriage) 
• Paranoia 
• Racing thoughts; flights of ideas the person may be out of touch with reality, such as having delusions (false beliefs) or hallucinations. Behavior may include singing, dancing or laughing for no reason.

The depression ‘pole’: There are typical depressive symptoms but with a tendency to be more severe with bipolar disorder. The onset is gradual, and sufferers become increasingly withdrawn and lose interest in things that they normally enjoy. There is a slowing down of many basic functions such as energy, appetite, sex drive, speech, and movement. Sleep is affected. Problems multiply with pessimism, guilt feelings and reduced self-esteem and confidence. Some feel unable to face the world and that life is not worth living and may stay shut in their room. Thoughts about death and suicide are common and indicate the need for urgent attention. 

What should be done?

Since the illness is most easily treated in its early stages, it is best to see or speak to a psychiatrist as soon as possible if you suspect that either you or an acquaintance is bipolar. Doctors often rely heavily on information from people other than the patient to make the diagnosis. Sufferers tend to lack insight, fail to realize their problem, and tend to conceal it from their doctors. There are no available diagnostic laboratory tests.

What is the treatment of bipolar disorder?

The good news is that it responds well to modern medications, which aim to correct an apparent chemical imbalance in the nervous system. Antidepressants are used for the depressive phase. The treatment should be carefully supervised so that relapses can be prevented. Supportive psychotherapy is also important. Patients with severe episodes, especially the first one, usually require hospitalization. With appropriate treatment and support, most people with bipolar disorder can lead full and productive lives.

References

• Murtagh’s patient education, sixth edition © mcgraw-hill
• Ainslie Meares, Life Without Stress, Penguin Books, Melbourne, 1991. 
• Norman Vincent Peale, The Power of Positive Living, Vermilion, London, 1996.

Disclaimer: All contents on this site are for general information and in no circumstances, information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility for any damage done by the misuse or use of the information.

What is anxiety?

Anxiety is an uncomfortable inner feeling of fear or imminent disaster. Most of us experience some temporary degree of anxiety in our lives, sometimes with just cause and at other times without. It can be a common normal human reaction to stress, and being anxious over appropriate things may help to make us more responsible, caring people. Some people, however, are constantly anxious to the extent that it is abnormal and interferes with their lives. Severe cases of anxiety can lead to panic attacks or hyperventilation.

What are the symptoms?

The symptoms can vary enormously from feeling tense and tired to panic attacks. 

Symptoms include: 

• Tiredness or fatigue
• Dry mouth, difficulty swallowing.
• Apprehension: ‘something awful will happen’ 
• Sleep disturbances and nightmares 
• Irritability 
• Muscle tension/headache 
• Rapid heart rate and breathing 
• Sweating
• Trembling 
• Diarrhea 
• Flare-up of an illness (e.g. dermatitis, asthma) 
• Sexual problems

What are the Risk Factors? 

Various physical illnesses—such as high blood pressure, coronary disease, asthma and perhaps cancer—can be related to persistent stress and anxiety. It may aggravate a drug problem such as smoking and drinking excessively. It can cause a breakdown in relationships and work performance. It can lead to the serious disorder of depression. Because an overactive thyroid can mimic an anxiety state, it is important not to overlook it.

What is the treatment?

• Self-help

 It is best to avoid drugs if possible and to look at factors in your lifestyle that cause you stress and anxiety and modify or remove them (if possible). Be on the lookout for solutions. Examples are changing jobs and keeping away from people or situations that upset you. Sometimes confronting people and talking things over will help. Follow a healthy lifestyle based on good nutrition, exercise, recreational activity and moderation or abstinence from the harmful CATS—caffeine, alcohol, tobacco, and social drugs. 

• Special advice 

Be less of a perfectionist: do not be a slave to the clock; do not bottle things up; stop feeling guilty; approve of yourself and others; express yourself and your anger. Resolve all personal conflicts. Make friends and be happy. Keep a positive outlook on life and be moderate and less intense in your activities. Seek a balance of activities, such as recreation, meditation, reading, rest, exercise and family/social activities.

• Relaxation

Learn to relax your mind and body: seek out special relaxation programs such as yoga and meditation. Make a commitment to yourself to spend some time every day practicing relaxation. About 20 minutes twice a day is ideal, but you might want to start with only 10 minutes. 

1. Sit in a quiet place with your eyes closed but remain alert and awake if you can. Focus your mind on the different muscle groups in your body, starting at the forehead and slowly going down to the toes. Relax the muscles as much as you can.
2. Pay attention to your breathing: listen to the sound of your breath for the next few minutes. Breathe in and out slowly and deeply. 
3. Next, begin to repeat the word ‘relax’ silently in your mind at your own pace. When other thoughts distract you, calmly return to the word ‘relax’. 
4. Just ‘let go’: this is a quiet time for yourself, in which the stresses in body and mind are balanced or reduced.

• Counselling

 Your doctor will counsel you to help you cope with your fear and stress. This may include behavior therapy, which will help you learn to confront these fears, or cognitive behavioral therapy, which will teach you how to identify, evaluate, control, and modify your negative fearful thoughts and behaviors. 

• Medication

Our Psychiatrist at Westminster Ortho Med Clinic will recommend tranquilizers only as a last resort or to help you cope with a very stressful temporary period when your anxiety is severe, and you cannot cope without extra help. Tranquilizers can be very effective if used sensibly and for short periods.

References:

• Richard Carlson, Don’t Sweat the Small Stuff, Hyperion, NewYork, 1997. 
• MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL
• Richard Carlson & Wayne Dyer, You Can be Happy No Matter What, Amazon, New York, 1999. 
• Ainslie Meares, Life Without Stress, Penguin Books, Melbourne, 1991. 
• Norman Vincent Peale, The Power of Positive Living, Vermilion, London, 1996.

Disclaimer: All contents on this site are for general information and in no circumstances information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility of any damage done by the misuse or use of the information.

The extent of the problem:

 Research reveals that 3% of Australians aged between 3 and 16 years have a depressive disorder each year. Major depression affects an estimated 8% of Australian teenagers, with about 60% experiencing suicidal ideas and up to 35% making a suicide attempt. The distressing problem of suicide is the second most common cause of death in this age group. Females attempt suicide about 14 times more than males, but males complete suicide 4 times more often. It is a national concern and needs to be taken very seriously in children. The incidence of depression increases markedly after puberty, especially in females. 

Types of depressive disorders 

There is a whole range of types of depression varying from sadness to feeling blue or down in the dumps to the extreme sadness and hopelessness of major depression. 

The main types of depression are:

• Depressed mood—feeling sad or blue is a minor, virtually normal, state that we get from time to time, but we still manage to carry on with life. 
• Dysthymia—a moderate state of depression in which mood is persistently low so that it interferes with a person’s ability to function normally in their life, including study and enjoyment.
• Major depression—the so-called ‘black dog’ or ‘black hole’; this is a serious illness that leads to a dysfunctional life with a breakdown of the basic drives, namely energy, eating, sleeping, sex, and enjoyment. These people are at risk of suicide.

What are the symptoms and signs of major depression? 

The following are typical characteristics: 

• Persistent sadness 
• Severe sleeping problems 
• Eating disorders and weight changes
• Apathy towards friends, school, and family
• Sense of worthlessness 
• Difficulty concentrating 
• Deterioration in school performance 
• Crying and emotional ups and downs 
• Complaints about physical symptoms such as headache 
• Persistent boredom and low energy 
• Acting out and risk-taking behavior
•  Reoccupation with death and dying 
• Suicide attempts (called para suicide). 

Risk factors

• Depression in a close relative 
• Major life stress 
• Recurrent stresses 
• Bullying
• Broken relationship 
• Child abuse
• Family break-up 
• Substance abuse (e.g., alcohol, drugs) 
• Social isolation—due to race or sexuality 
• Sexual maladjustment 
• School failure 
• Health problems
• Unemployment

How to help a depressed teenager:

• Listen to them and be alert to what they are saying and not saying. 
• Treat them with respect. 
• Take their problems and depression seriously. 
• Offer unconditional love and support.
• Be available to help when requested. 
• Be flexible and consistent.
• Encourage them to express their true feelings.
• Encourage them to do things that they enjoy. 

Advice for parents, carers, and friends

Follow the above guidelines. Encourage your child to get help without nagging or being judgmental (this includes talking things over with friends and people he or she is close to, respects, and relates to). Ask people close to you for advice and support. Do not cling to your child or show too much concern. Look closely at your own management style and skills and ask yourself whether you could improve or alter your approach. Take any talk about self-harm, including suicide, very seriously, and make sure your child’s environment is safe. 

Professional support

Ask your Psychiatrist and Psychologist for help and, if possible, encourage your child to see that it would be in his or her best interests to get help. The excellent treatments available include counseling and antidepressant medication, if necessary.

References:

• Richard Carlson, Don’t Sweat the Small Stuff, Hyperion, NewYork, 1997. 
• Murtagh’s patient education, sixth edition © mcgraw-hill
• Ainslie Meares, Life Without Stress, Penguin Books, Melbourne, 1991. 
• Norman Vincent Peale, The Power of Positive Living, Vermilion, London, 1996.

Disclaimer: All contents on this site are for general information and in no circumstances information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility of any damage done by the misuse or use of the information.

What is personality?

Personality is the distinctive personal characteristic of a person that identifies a unique recognizable individual. It includes one’s mental and behavioral characteristics, which are determined by inherited (genetic) patterns and developed by continuing interaction with outside life influences. This includes family interactions, peer pressure, and influential events plus personal drives.

What is a personality disorder?

 A person can be said to have a personality disorder if his or her behavior pattern does not adapt in an appropriate way to social conventions. This results in impaired social interaction and often leads to unhappiness and occupational failure. One characteristic is a consistent failure to adhere to accepted standards of behavior, upsetting people who come into close contact with them. The disorder comes on in adolescence or early adulthood. 

There are a whole variety of personality disorders, which can be classified as follows:

• Withdrawn (referred to as odd or eccentric): Subtypes include paranoid and schizoid. Characteristics are suspicious, oversensitive, shy, detached, defensive, emotionally cold, humorless, and argumentative. 
• Dependent (referred to as anxious, fearful, and inhibited): Subtypes include avoidant, dependent, obsessive-compulsive, and passive aggressive. Features are anxiety, self-consciousness, low self-esteem, passivity, avoidance of responsibility, indecisiveness, pedantry, procrastination, rigidity, fear of rejection and of failure. 
• Antisocial (often referred to as sociopathic or psychopathic): See subtypes below. The main feature is a defective capacity for affection or feeling for others. Tend to be irresponsible, unable to hold down jobs, and not capable of forming satisfactory relationships.

What are the features and types of antisocial personality disorder? 

A sociopathic person is by nature incapable of conforming to the restraints of the outside world. The antisocial group tends to come to the attention of doctors more frequently because of demanding, manipulative, angry or aggressive behavior. Although some sociopaths adapt and achieve success, most are inadequately adapted people who bumble along unhappily. Sadly, many upset the social norms, as they become disturbed when frustrated and regularly break the rules of society. They become well-known to the police and spend time in prison or under the care of the state. The estimated incidence of antisocial personality disorder is about 5 in 100 people. 

The following are identifiable subtypes: 

• Antisocial (‘mad dog’): Unable to conform to social norms, impulsive, insensitive, callous, repeated criminal behavior, reckless behavior, liar, low frustration level, repeated physical fights or assaults, lack of remorse, promiscuous, usually starts in teens.
• Histrionic (hysterical): Self-dramatic, egocentric, immature, vain, dependent, manipulative, easily bored, emotional scenes, inconsiderate, seductive, craves attention and excitement. 
• Narcissistic (‘prima donna’): Exhibitionist, morbid self-admiration, insensitive, craves and demands attention, exploits others, preoccupied with self-importance and power, lacks empathy and interest in others, bullying, no insight, arrogant and haughty attitudes. 
• Borderline (‘hell raiser’): Confused self-image, impulsive, ‘all or nothing relationships—unstable and intense, damaging reckless behavior (e.g. driving), drug abuse, full of anger and guilt, lacks self-control, possible uncontrolled gambling or spending or sexual activity. Intense outbursts of anger, anxiety, and depression. This group engages in frantic efforts to avoid abandonment and has a high incidence of suicide and apparent attempted suicide.

What can be done for an antisocial personality disorder? 

People with this unfortunate disorder need help. Because they tend to upset people and alienate friends and many others, they have difficulty finding support and treatment. The best treatment is from a supportive ‘therapeutic’ community and understanding and supportive professionals, particularly their Counsellors and Psychiatrists. Their families and other carers also need support and education. These people may respond well to psychological intervention and behavioral techniques. 

These include:

• Psychotherapy—especially cognitive behavior therapy, which provides insight and various ways of coping.
• Psychosocial Rehabilitation—helping to learn acceptable social skills. Medication has limitations but is most useful to treat those individuals who develop an anxiety state, depression, or psychosis.

References:

• Richard Carlson, Don’t Sweat the Small Stuff, Hyperion, NewYork, 1997. 
• MURTAGH’S PATIENT EDUCATION, SIXTH EDITION © MCGRAW-HILL
• Ainslie Meares, Life Without Stress, Penguin Books, Melbourne, 1991. 
• Norman Vincent Peale, The Power of Positive Living, Vermilion, London, 1996.

Disclaimer: All contents on this site are for general information and in no circumstances information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility of any damage done by the misuse or use of the information.

What is social phobia? 

Social phobia is an abnormal fear or aversion to social gatherings, where the affected person feels subject to public scrutiny and avoids such anxiety-provoking situations as much as possible. It is sometimes referred to as social phobia disorder and is much more than shyness. It can vary from a predictable fear of a new social experience to an extremely morbid fear that significantly affects a person’s life. The basic fear is that of being regarded unfavorably by others and feeling embarrassed or humiliated by one’s appearance or performance.

 How common is it and who gets it?

It is the most common of all anxiety disorders. Studies indicate that about 1 in 7 people suffer from a social phobia at some time in their lives. Anyone can develop it. It is usual to have an early age of onset, with almost 100% of sufferers having it by the age of 20 and many of these by the age of 10. 

What are the typical situations? 

Although anxiety-provoking situations vary from person to person, the following are common: 

• Speaking engagements
• Meeting people, especially for the first time 
• Dealing with authority figures or professionals 
• Sitting for examinations
• Dating 
• Eating and drinking in public (e.g. in canteens) 
• Negotiating with others 
• Staff meetings 
• Using public toilets
• Writing while being watched 
• Receiving visitors 
• Entering a room where others are seated. A common factor in these situations is that people feel that they are in the ‘limelight’ and are being judged by other people.

What are the causes? 

We often hear the term ‘adrenaline rush’ when people in a stressful or exciting situation describe how they feel the adrenaline pumping around their bodies. It does indicate that the brain and other parts of the central nervous system are responding to stimuli. We call it sympathetic activity because it involves this component of the autonomic nervous system.

In people with social phobia, there is sympathetic overactivity as the responsible chemicals, particularly adrenaline and serotonin, are released in large amounts. The person cannot be blamed because the body goes into ‘automatic’ mode as a conditioned response. There may be a genetic (inherited) predisposition and there is evidence of a bad childhood experience in some people.

What are the symptoms?

Typical symptoms include one or more of the following: 

• Palpitations 
• Sweating
• Tremor or trembling

• Hot and cold flushes
• Light-headedness 
• ‘Butterflies’ in the stomach 
• Nausea 
• ‘Lump in the throat’ or difficulty swallowing. 
• Diarrhoea 
• Muscle tension or aching 
• Tension headache 
• Restlessness.

What is the outcome? 

The symptoms can certainly interfere with a person’s life and make him or her miserable. A panic attack can occur. When a person experiences these symptoms it tends to affect their self-image and may make them feel ‘stupid’ or weak. This response aggravates the problem, so a vicious cycle develops. It can also lead to other phobias such as agoraphobia (fear of open spaces or leaving home). Serious consequences include relationship breakdown, depression, substance abuse, especially of alcohol, and loss of employment opportunities. 

What is the treatment?

Self-help is difficult because the phobia does not usually go away on its own. Some people may be able to cope by avoiding certain stressful situations, but this does not solve the basic problem. Professional help should be sought. This includes counselling techniques and medications, which can be used separately or in combination. 

1. Counselling: The main psychological technique used is cognitive behavior therapy (CBT). Cognitions are thoughts, beliefs or perceptions and CBT involves the process of knowing or identifying, understanding or having insight into these thought processes. Certain thought processes in social phobia reinforce the belief that people are watching and judging you. The techniques attempt to identify and break these patterns to help you feel more comfortable with other people. The therapy then aims to help you change your behaviour, gradually face up to social situations and find them less threatening. Other techniques may include relaxation techniques and group therapy where other people share their experiences.
2. Medication: Sometimes your doctor will prescribe medication to treat social phobia, especially if anxiety and depression are involved. For social phobia with performance anxiety, a beta-blocking agent taken 30–60 minutes before a social event or performance can be beneficial. Check with your doctor, but remember they are not permitted in some competitive sporting events.

References:

• Murtagh’s patient education, sixth edition © mcgraw-hill
• Ainslie Meares, Life Without Stress, Penguin Books, Melbourne, 1991. 
• Norman Vincent Peale, The Power of Positive Living, Vermilion, London, 1996.

Disclaimer: All contents on this site are for general information and in no circumstances information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility of any damage done by the misuse or use of the information.