Major Mental Disorders (MMD)

The acronym MMD stands for Major Mental Disorder of which there are five broad categories:  anxiety disorder, mood disorder, psychotic disorder, dementia, and eating disorder.  These mental illnesses are not a result of one cause but rather an interplay of a variety of factors which include environment, genetics, and lifestyle.

mmd

Anxiety Disorders

An anxiety disorder is positive in a diagnosis if the patient has any of these three symptoms:

  • illogical or inappropriate fearful and anxious response to objects, events, people, and situations
  • inability to control these fear responses
  • having no control over anxious feelings so much so that it disrupts normal functioning

Anxiety disorders are specifically manifested by these mental sub-illnesses:

  • Generalized Anxiety Disorder (GAD) — GAD is characterized by excessive or chronic worrying about one or many areas of life such as family, income, career, friends, and school, among other things.  The fears may often be unfounded and skew off tangent; if there is some basis, the amount of worrying is excessively way out of proportion to the real situation.  A person afflicted with GAD may find himself unable to go about his life normally because of excessive dread.
  • Panic Disorder — characterized by feelings of terror and fear which may or may not occur suddenly.  These are repeated panic attacks accompanied by physical symptoms such as rapid heartbeat, chest pain, sweat, tremors, and disorientation.
  • Phobias — intense fear, often irrational, of something that actually does not pose any immediate or even potential danger.  Ex.  fear of enclosed spaces (claustrophobia); fear of crowds (agoraphobia);  fear of darkness (achluophobia)
  • Post-Traumatic Stress Disorder (PTSD)  — often characterized by emotional numbness and recurring vivid memories of traumatic incidents.

 

Psychotic Disorders

Psychotic disorders are known as a set of mental illnesses that involve a distortion of reality.  To someone plagued with psychosis, delusions (assignations of unreal meaning to normal and innocent events) and hallucinations (experiences of non-existent things that are not connected to any genuine sources such as hearing voices) are perceived to be as real as normal people see things to be.

Mental maladies under psychotic disorders are:

  • Schizophrenia — a serious mental disorder that is marked by distorted thought patterns, hallucinations, delusions, and paranoia, all of which lead the individual toward strange, irrational behaviours.  Schizophrenics may hear voices not attached to any source or may believe in delusions such as being a real princess or warrior.
  • Schizo-affective Disorder — a variant of schizophrenia mixed with mood disorders such as mania or depression.

Mood Disorders

Mood disorders are also known as affective disorders.  Persistent feelings of sadness or abnormal elation over a certain period of time may qualify under this mental malady.  Extreme emotional fluctuations also characterize this category under which these illnesses belong:

  • Bipolar Disorder — a disorder identified by extreme changes in mood from mania (“high” mood state) to depression (“low” mood state).     major mental disorder
  • Clinical Depression — surpasses the normal feelings of sadness and puts one in a chronic state of pessimism, hopelessness, emptiness, worthlessness, anxiousness, and other severely low mood situations.  Patients cannot just bounce back from their low moods, unlike unafflicted individuals who have the abilities to cope with abysmal feelings.  Clinical depression has been known to be the cause of some suicide cases.
  • Dysthymic Disorder — an illness marked with constant low-grade depression for more than two years.  Symptoms include low energy, feelings of hopelessness and low self-esteem, sleep and appetite problems, poor focus, and indecisiveness.

The danger to these depressive mood disorders is that the risk for suicide among sufferers is high.

Dementias

Dementia refers to a slew of mental health problems symptomised by rapidly declining memory and other cognitive functions.  Dementia is diagnosed when the one or more of the following are impaired:

  • Memory
  • Ability to concentrate or pay attention
  • Visual perception
  • Language and communication abilities
  • Judgement and reasoning

The cause to all these impairments are brain cell damages which hinder these cells from communicating adequately with each other.  Alzheimer’s disease makes up a large percentage of dementia cases, followed closely by vascular dementia and dementia due to medical problems such as Parkinson’s and Huntington’s disease.  Toxic substances such as drugs, alcohol, mercury, lead, etc. can contribute to the development of dementia as well.

Eating Disorders

Eating disorders involve extreme thoughts, attitudes, and behaviour towards food and weight.  These disorders manifest as either of these issues:

  • Anorexia Nervosa  — a condition that is indicated by an overwhelming and all-consuming dread of being fat.  Anorexics have a distorted body image and obsessive thoughts about food, calories, and weight on which they impose severe restrictions.  For sufferers, one can never be too thin.  Anorexia is dangerous because the condition can cause death from suicide, cardiac arrest, starvation, and other medical complications.
  • Bulimia Nervosa —  an eating disorder in which the sufferer chronically binge eats and then frantically purges the calories consumed as an attempt to lose weight or not gain the pounds from overeating.  Bulimics, like anorexics, have an obsession with food; only they overeat with the thought that they can purge their “sins” later.  A person with bulimia can consume between 3,000 – 5,000 calories in a short hour.  In the next, he often guiltily purges what he has consumed by inducing vomiting, applying enemas, exercising voluminously, or going on crash diets.  The constant binge-and-purge cycle wreaks havoc on the metabolic system, forcing bulimics to gain weight over time.
  • Binge Eating Disorder — chronic overeating without any purging involved.  The cycle moves around binge eating, feeling guilty and ashamed for gluttony,  then emotional eating again to assuage the guilt.  Binge eaters are usually obese and may suffer from hypertension, cardiovascular disease, depression, and anxiety.

 

These major mental illnesses are treatable but need the help of professional mental health practitioners.  The stigma associated with mental maladies however is the main cause of why  people avoid treatment or fail to recognize that they need treatment.  More information and education about mental illnesses should be provided so that early stages may be recognized and tended to correctly.

Antipsychotic Medication

Antipsychotic medications are prescribed drugs used to treat people with some form psychosis.  Psychosis is an umbrella of mental disorders that are characterized by radically impaired emotions and thought patterns, so convoluted that the afflicted person actually loses touch with reality.  These mental disorders include bipolar disorder, borderline personality disorder (BPD), schizophrenia, and paranoia, all of which include the psychotic marks of delusions and hallucinations in their roster of symptoms.

ANTIPSYCHOTIC-DRUGS

How Do Antipsychotic Drugs Work?

Antipsychotic drugs target the neurotransmitters in the brain which are dopamine, noradrenaline, serotonin, and acetylcholine.  These brain chemicals have the main hand in regulating moods, emotions, and behaviour.  Of all these neurotransmitters, dopamine is the most important target.

By changing the effect these neurotransmitters currently have on an individual’s brain, antipsychotic drugs can suppress, reduce, or even prevent the onslaught of:

  • hallucinations (ex. hearing voices)
  • delusions (perceiving things, situations, and events not based on reality.  Ex.  A delusional person may firmly believe that the restaurant waitresses are laughing at him because they know his spouse has been cheating with someone else…even if they do not know him.)
  • Extreme mood swings
  • Thought disorders

What antipsychotics cannot do is cure a patient of his mental disorder.  These drugs can only act on the symptoms not on the entire illness.

Types and Side Effects

Antipsychotic medication was introduced in the 1950s and has to a large extent been successful in alleviating hallucinatory and delusional symptoms in psychotic patients so much so that these individuals have been able to lead a relatively normal life.  Although a boon to the mental health field at that time, early antipsychotics (termed typical) possessed its fair share of mild to severe side effects which manifested as:

  • muscle stiffness
  • tremors and spasms
  • restlessness
  • increased skin sensitivity to sunlight
  • low blood pressure
  • liver poisoning; so with some typical medications, liver tests may be mandatory
  • Parkinson’s disease-like symptoms
  • gastrointestinal disturbance
  • weight loss
  • skin rashes, ranging from mild to serious cases which may develop into Stevens-Johnson syndrome, a life-threatening illness  (rare side effect)
  • spontaneous ejaculation
  • tinnitus (ringing in the ears)
  • vertigo
  • drooling
  • excessive thirst

These typical drugs are still prescribed today because there are patients who tolerate these better than the newer atypical drugs.

Atypical antipsychotic drugs are considered the newbies in its category although the first, clozapine (Clorazil) was formulated over twenty years ago in 1990.  Atypicals have fewer side effects thanantipsychotic meds the older typical antipsychotics and are thus more often prescribed as a first-line treatment.

Most of the atypical drugs were developed for the treatment of schizophrenia and mania.  These are contraindicated for people with cardiovascular problems or with a history of epilepsy or Parkinson’s disease.  Many of these drugs such as risperidone and olanzapine should not be prescribed to older people as they increase the risk for stroke.  Atypical drugs may also compromise cognitive skills such as driving or operating heavy machinery.

The most noteworthy side effect of atypical antipsychotics is weight gain, increased appetite, and other metabolic issues.  Other side effects are:

  • dizziness
  • extreme sleepiness
  • low blood pressure when standing
  • fainting
  • rapid heartbeat (tachychardia); slow heartbeat, irregular heartbeat
  • tardive dyskinesia — uncontrollable movements of the lips, tongue, face, trunk, and limbs.  Usually a side effect of long-term drug use.
  • Parkinsonism
  • insomnia
  • anxiety; restlessness; agitation
  • raised prolactin levels provoking milk production
  • sexual problems
  • seizures
  • indigestion
  • headache
  • lethargy; lack of energy; tiredness
  • drooling
  • impulsive behaviour like gambling (attributable to Aripiprazole)
  • unusual taste sensations
  • numb lips and mouth
  • still muscles
  • raised levels of enzymes in liver
  • loss of menstrual periods
  • blurred vision

Side effects vary from individual to individual.  Other symptoms not on the common list may manifest as well; so, medical monitoring is crucial.

Withdrawing Intake of Antipsychotic Drugs

It is highly inadvisable to suddenly stop taking the prescribed drugs once already under antipsychotic medication.  Doctor’s approval is highly recommended as one has to follow a medical plan for a gradual and slow withdrawal from the drug over a period of several weeks or months.  While there are people who can stop taking their prescriptions without issues, the majority usually experience a recurrence of psychotic symptoms when suddenly going off their medications.

Furthermore, withdrawing from the drug is not a simple matter of gradual decrease of intake.  Situational factors such as timing of circumstances and availability of support from family and friends are crucial to making this huge leap.  Withdrawal can begin when there are no life-changing events or stressful things going on such as moving house, getting a new job, travelling to a new place, etc.  But as people can never be pigeon-holed, there are some patients that do withdrawals well when preoccupied with new things going on in their life.  No matter what type of patient one is, it is important to know that the manner of withdrawing from antipsychotic drugs is crucial because the aim is to avoid relapses.

Paranoia

paranoia (1)

Understanding Paranoia

Paranoia is a state of mind in which the individual thinks other people are out to do him harm, physically, socially, or otherwise.  It encompasses an irrational dread of some present or impending disaster or bad thing for which other people are responsible.  Paranoid thoughts are often unfounded but the paranoid person believes all these as realities.

Being on one’s toes or being rightfully distrustful of other people do not make one a true paranoid; but, when this same individual starts weaving complex scenarios justifying their suspicions and experiencing intense suffering and fear from their thoughts to the exclusion of rationality, then he may be diagnosed as paranoid, possibly with schizophrenia.

Psychotic or schizophrenic people often have these persecutory delusions so that they live in fear of being harmed, controlled, plotted against, vilified, and socially disparaged.  These individuals often feel they are of particular importance and that is why they feel singled out for persecution.  Severe cases of paranoia may include hearing of voices, all malicious or threatening.

Causes of Paranoia

By itself, paranoia is not classified as a mental illness as schizophrenia and bipolar disorders are.  Instead, it is an indicator that something is wrong and that there is some underlying mental health issue or even a neurological disease such as Parkinson’s and Huntington’s disease.

Paranoia may also be caused by street drugs such as barbiturates, LSD, marijuana, and cocaine.  Impaired cognitive functions and chronic fatigue from chronic sleep deprivation may generate paranoia as well.

Traumatic life experiences such as a spouse’s betrayal or sudden loss of a job can cause a person to have extreme thoughts of persecution.  Uncontrollable environmental disasters such as bombings and high crime may understandably trigger paranoid delusions, some justified but most not.

Recent research has also discovered that individuals who have problems understanding other people’s perspectives and have low empathetic abilities tend to make negative assumptions of other people’s behaviour.  While these characteristics by themselves do not automatically make one paranoid, stressful life events may push such an individual toward feeling more threatened and consequently, paranoid.

paranoid-person-quotes-2

 

Treatments for Paranoia

One unfortunate side effect of paranoia is that the individual may not think of himself as needing any kind of help.  In fact, a genuinely paranoid person may think that their patterns of thoughts have developed from rational deductions and inferences of their personal observations.  While their beliefs are far from reality, paranoid people may scoff at treatments unless they suspect that they could partly be wrong.  Herein lies the difficulty in persuading a paranoid person to accept psychological or psychiatric intervention.

Treatments for paranoia may include:

  • Talking Treatments

Talking treatments refer to therapies that encourage patients to talk about their thoughts and emotions with a mental health professional.  Talking to trained therapists help paranoid persons come to terms with their fears and to perceive them as they are.  Doing so also help individuals take more control over their thoughts, allowing them to make positive thought and behavioural changes.  Talking treatments may involve the following therapy types:

  • Medication

Antipsychotic drugs such as clozapine, risperidone, and olanzapine may be prescribed for severe paranoia.  Know that paranoid people may be highly suspicious of drugs, even prescribed ones, as they may have delusions of their own doctor conspiring against them.

  • Hospitalization / Day Care Centres

In cases when a severely paranoid person becomes violent or is threat to himself and others, the person may be admitted to the hospital whether he goes voluntarily or not.  Once, he has been stabilized, he may be discharged and entitled to a treatment plan.

Care centres also exist as aftercare hostels where patients have the opportunity to live under a supportive environment.  Under such an arrangement, acute paranoia sufferers may be given the chance to develop the skills needed for getting back in society and reacquiring some independence.

 

Hearing Voices

hearing voices

Utter the admission that you are hearing voices and expect to be instantly be consigned to the social loony bin.  Indeed, hearing voices can signal schizophrenia, borderline personality disorder (BPD), or psychosis.  But the stigma is bucking.

Some voice hearers today refuse to acknowledge the traditional diagnosis of mental illness.  With the help of support groups, they have shifted their paradigms to believe they are mentally sound but just gifted with the added ability to have unusual but meaningful experiences.  The problem, they say, does not lie with the voices but with the way one relates to them.

Hearing voices is not as rare a phenomenon as most people think.  The on-line journal, The Conversation, reveals that between 5-13% of adults will hear voices or have some sort auditory hallucination at some point in their lives.

Auditory hallucination or paracusia is defined as hearing sounds without external auditory stimuli.  This should be differentiated from endaural phenomena in which perceived sounds are not caused by external stimuli either but are caused by problems in the ear or some part of the auditory system.

voices in my headHow Voices are Heard

People with auditory hallucination often experience hearing voices in the following ways:

  • Voice speaks the person’s thoughts
  • Voices are heard talking to each other, oftentimes in argument
  • Voice narration of one’s actions
  • Voice engaging the person in conversation

The voices can seem to be inside a person’s head, or to be coming from someone in the room (even if no other person is present) or both.

Research at Durham and Stanford Universities found that their subjects hear all sorts of voice characteristics and personalities.  Most perceive negative, aggressive, and threatening voices which often engender fear, anxiety, and depression in the hearer.  There are however others who report that they also hear positive, supportive voices.

Rachel Waddingham is one such case.  She hears 13 voices.  One belongs to an irked adolescent and another to an impudent 3-year-old.  The scariest for her is the voice she dubbed the Scream, a female voice that sounds full of suffering and pain.  Her other voices make nasty remarks, often repeating what she heard when she was a child.

Coping with the Voices

In most instances, hearing voices is traumatizing and debilitating.  For one, the voices may be heard throughout the day, disrupting daily tasks.  Voices are usually reported to be menacing and very negative.  These generally threaten or degrade the hearer, constantly pounding on their self-esteem, and heightening fears and insecurities.  The hearer feels he cannot control these voices nor talk about them because of the stigma surrounding this phenomenon.  As such, the person withdraws into himself and becomes increasingly isolated from others.

Traditional psychiatry responded to voice hearing with medications.  While drugs had reduced incidences of auditory hallucinations in some cases, it had also brought unwanted side effects such as obesity, diabetes, and akathisia.  Mental health professionals would also not allow voice hearers to talk about their voices because this would be acknowledging their delusions.  The old aim was to distract voice hearers from their auditory hallucinations.

Research today has shown though that some voice hearers are able to cope with their affliction without any psychiatric intervention.  These are people who have learned to see their condition as an added talent or ability, not a disorder.  Mental health professionals and researchers are starting to look at the phenomenon in the same way.

Voice hearers who have found a way to co-exist with their voices believe that one cannot allow these voices any control.  If an individual permits himself to be frightened and debilitated of what the voices say, he will not be able to cope.  If one believes himself stronger than these are, then he will find himself able to live well with them.

In light of the research, psychiatrists and psychologists in the UK and the Netherlands have developed new strategies.  Voice hearers are now encouraged to focus on their experiences with their voices and get to know these better.  Patients are advised to listen but not necessarily obey and to engage with the voices at their own time and place.  The new framework is for the individual to accept the voices as a controllable part of himself for his own growth and resolution.

Getting Help

Managing one’s life around these hallucinations is a challenge.  One way to gain some recovery ground is to join support groups.  Some of these are run by Hearing Voices Network (HVN), a global network started in Netherlands in 1987.  These support groups give voice hearers a sense of belongingness, company, and most importantly, specialness rather than a perception of one’s self as a mental patient.  HVN makes it possible for people to swap stories and coping strategies.

It is important for the voice hearer to begin to acknowledge that the voices belong to him.  It may a difficult step but a crucial one.  It is also greatly beneficial if the hearer can discover what triggers these voices to appear in order to better plan a coping strategy.