Attention-deficit hyperactivity disorder
What is attention-deficit hyperactivity disorder?
Attention-deficit hyperactivity disorder (ADHD) is a mental illness that is characterized by hyperactive behaviors and difficulty with attention. ADHD is a condition that starts in childhood, one which most experts believe begins before the age of 12. While many people with ADHD will experience a decrease in their symptoms—perhaps even a resolution of their illness in some cases—as they reach adulthood, a significant percentage of people will continue to experience dysfunction and distress during their adult years.
While the number is higher in children, multiple studies suggest that approximately one in twenty-five American adults will meet diagnostic criteria for ADHD. ADHD is more common in males and often occurs with other learning disabilities, substance abuse problems and other mental illnesses such as mood disorders and anxiety disorders.
Common symptoms of adult ADHD can include:
It should be noted that people with ADHD experience their symptoms in multiple settings (e.g., academic, work, social or family obligations). For example, a young person who has difficulty paying attention in college classes and also struggles with completing his tasks at work would be a more classic example of an individual with ADHD than an older person who only describes an isolated difficulty with focusing during conversations with their spouse.
What causes ADHD and how is it diagnosed?
Scientists have not isolated a single gene that can be said to “cause” ADHD, but scientific studies suggest that people with ADHD may have problems with the chemicals in the brain that control a person’s level of alertness and attention (catecholamines).
There is no specific test (e.g., blood test or x-ray) that can diagnose a person with ADHD. Instead, diagnosis of ADHD is made by a mental health professional based on a clinical assessment that includes a formal history and other information such as academic records, psychological testing, and discussions with parents or other loved ones. Most adults with ADHD will have already been diagnosed—and perhaps treated for this condition—during childhood. For adults that are concerned that they might have ADHD, the first step is to connect with a properly trained mental health professional in order to schedule a face-to- face evaluation of their symptoms.
A proper psychiatric evaluation can be critical because an adult, specifically one without a prior history of ADHD, who experiences new or worsening symptoms of difficulty focusing may be more likely to be experiencing symptoms of a medical or psychiatric condition other than ADHD. These conditions could include depression, anxiety or substance abuse (e.g., marijuana or alcohol). Medical illnesses—such as thyroid disease, seizure, or stroke—can also mimic some of the symptoms associated with ADHD. Therefore, in addition to having a psychiatric evaluation, any adult with new symptoms of ADHD should have a physical exam and testing performed by their primary care physician in order to screen for common medical conditions that can cause similar symptoms.
What are the treatments for ADHD?
Many people with ADHD will find that the same treatments that were effective for them as children will continue to be effective during adulthood. For adults who are just beginning treatment for ADHD, psychiatric medications may be indicated. All treatment decisions should be discussed with one’s physicians as the risks and benefits for each individual may vary.
Many people will choose to be treated with stimulant medications, e.g., methylphenidate (Ritalin), dextroamphetamine (Dexedrine) or amphetamine salts (Adderall). These medications are generally thought to be “first-line treatments” and may be effective in more than 50 percent of individuals. Some people taking these medications will find that they have decreased appetite or problems sleeping. Other people may be at risk for heart problems including high blood pressure, arrhythmias, or even stroke.
Some people who are not able to use stimulant medications, or for whom these medications are ineffective, may be treated with other medications for their symptoms. These can include atomoxetine (Strattera), buproprion (Wellbutrin), or other antidepressants.
Many people will also find that psychotherapy is useful in treating their ADHD. Cognitive behavioral therapy is the best-studied and most efficacious form of psychotherapy for people with this illness.
With thorough treatment and the support of their loved ones, most people with ADHD can expect to live healthy lives and to see a significant decrease in their symptoms.
(Courtesy of the National Alliance on Mental Illness - Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., 01/2013)
Attention-deficit hyperactivity disorder (ADHD) is a mental illness that is characterized by hyperactive behaviors and difficulty with attention. ADHD is a condition that starts in childhood, one which most experts believe begins before the age of 12. While many people with ADHD will experience a decrease in their symptoms—perhaps even a resolution of their illness in some cases—as they reach adulthood, a significant percentage of people will continue to experience dysfunction and distress during their adult years.
While the number is higher in children, multiple studies suggest that approximately one in twenty-five American adults will meet diagnostic criteria for ADHD. ADHD is more common in males and often occurs with other learning disabilities, substance abuse problems and other mental illnesses such as mood disorders and anxiety disorders.
Common symptoms of adult ADHD can include:
- Difficulty focusing, e.g., problems maintaining attention or “staying on task.”
- Feelings of restlessness or being “unable to just relax.”
- Problems with disinhibition, e.g., difficulty waiting one’s turn, blurting out answers, or butting into conversations.
- Trouble maintaining a schedule, e.g., frequently missing/forgetting appointments or deadlines.
It should be noted that people with ADHD experience their symptoms in multiple settings (e.g., academic, work, social or family obligations). For example, a young person who has difficulty paying attention in college classes and also struggles with completing his tasks at work would be a more classic example of an individual with ADHD than an older person who only describes an isolated difficulty with focusing during conversations with their spouse.
What causes ADHD and how is it diagnosed?
Scientists have not isolated a single gene that can be said to “cause” ADHD, but scientific studies suggest that people with ADHD may have problems with the chemicals in the brain that control a person’s level of alertness and attention (catecholamines).
There is no specific test (e.g., blood test or x-ray) that can diagnose a person with ADHD. Instead, diagnosis of ADHD is made by a mental health professional based on a clinical assessment that includes a formal history and other information such as academic records, psychological testing, and discussions with parents or other loved ones. Most adults with ADHD will have already been diagnosed—and perhaps treated for this condition—during childhood. For adults that are concerned that they might have ADHD, the first step is to connect with a properly trained mental health professional in order to schedule a face-to- face evaluation of their symptoms.
A proper psychiatric evaluation can be critical because an adult, specifically one without a prior history of ADHD, who experiences new or worsening symptoms of difficulty focusing may be more likely to be experiencing symptoms of a medical or psychiatric condition other than ADHD. These conditions could include depression, anxiety or substance abuse (e.g., marijuana or alcohol). Medical illnesses—such as thyroid disease, seizure, or stroke—can also mimic some of the symptoms associated with ADHD. Therefore, in addition to having a psychiatric evaluation, any adult with new symptoms of ADHD should have a physical exam and testing performed by their primary care physician in order to screen for common medical conditions that can cause similar symptoms.
What are the treatments for ADHD?
Many people with ADHD will find that the same treatments that were effective for them as children will continue to be effective during adulthood. For adults who are just beginning treatment for ADHD, psychiatric medications may be indicated. All treatment decisions should be discussed with one’s physicians as the risks and benefits for each individual may vary.
Many people will choose to be treated with stimulant medications, e.g., methylphenidate (Ritalin), dextroamphetamine (Dexedrine) or amphetamine salts (Adderall). These medications are generally thought to be “first-line treatments” and may be effective in more than 50 percent of individuals. Some people taking these medications will find that they have decreased appetite or problems sleeping. Other people may be at risk for heart problems including high blood pressure, arrhythmias, or even stroke.
Some people who are not able to use stimulant medications, or for whom these medications are ineffective, may be treated with other medications for their symptoms. These can include atomoxetine (Strattera), buproprion (Wellbutrin), or other antidepressants.
Many people will also find that psychotherapy is useful in treating their ADHD. Cognitive behavioral therapy is the best-studied and most efficacious form of psychotherapy for people with this illness.
With thorough treatment and the support of their loved ones, most people with ADHD can expect to live healthy lives and to see a significant decrease in their symptoms.
(Courtesy of the National Alliance on Mental Illness - Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., 01/2013)
Anxiety disorders
What are anxiety disorders?
Anxiety disorders are a group of mental illnesses that cause people to feel excessively frightened, distressed, or uneasy during situations in which most other people would not experience these same feelings. When they are not treated, anxiety disorders can be severely impairing and can negatively affect a person’s personal relationships or ability to work or study and can make even regular and daily activities such as shopping, cooking or going outside incredibly difficult.
Anxiety disorders are the most common mental illnesses in America: they affect around 20 percent of the population at any given time. Fortunately there are many good treatments for anxiety disorders. Unfortunately, some people do not seek treatment for their illness because they do not realize how severe their symptoms are or are too ashamed to seek help.
What are the most common anxiety disorders?
Are there any known causes of anxiety disorders?
Although studies suggest that people are more likely to have an anxiety disorder if their parents have anxiety disorders, it has not been shown whether biology or environment plays the greater role in the development of these disorders. Some anxiety disorders have a very clear genetic link (e.g., OCD) that is being studied by scientists to help discover new treatments to target specific parts of the brain. Some anxiety disorders can also be caused by medical illnesses. Other anxiety disorders can be caused by brain injury.
What treatments are available for anxiety disorders?
Effective treatments for anxiety disorders include medications and psychotherapy. Psychotherapy techniques such as cognitive behavioral therapies are most useful in the treatment of anxiety disorders and are referred to as “first-line treatments.”
In most cases, a combination of psychotherapy and medications is most beneficial for people with severe anxiety disorders. Some commonly used medications for anxiety disorders are antidepressant medications called selective serotonin reuptake inhibitors (SSRIs).
The importance of having a good diet and getting enough sleep are known to decrease symptoms in people with anxiety disorders. Regular exercise has also been scientifically proven to be effective.
(Courtesy of the National Alliance on Mental Illness - Reviewed by Ken Duckworth M.D., and Jacob L. Freedman M.D., 04/2012)
Anxiety disorders are a group of mental illnesses that cause people to feel excessively frightened, distressed, or uneasy during situations in which most other people would not experience these same feelings. When they are not treated, anxiety disorders can be severely impairing and can negatively affect a person’s personal relationships or ability to work or study and can make even regular and daily activities such as shopping, cooking or going outside incredibly difficult.
Anxiety disorders are the most common mental illnesses in America: they affect around 20 percent of the population at any given time. Fortunately there are many good treatments for anxiety disorders. Unfortunately, some people do not seek treatment for their illness because they do not realize how severe their symptoms are or are too ashamed to seek help.
What are the most common anxiety disorders?
- Panic Disorder – Characterized by “panic attacks,” panic disorder results in sudden feelings of terror that can strike repeatedly and sometimes without warning. Physical symptoms of a panic attack include chest pain, heart palpitations, upset stomach, feelings of being disconnected, and fear of dying.
- Obsessive-compulsive Disorder (OCD) – OCD is characterized by repetitive, intrusive, irrational and unwanted thoughts (obsessions) and/or rituals that seem impossible to control (compulsions). Some people with OCD have specific compulsions (e.g., counting, arranging, cleaning) that they “must perform” multiple times each day in order to momentarily release their anxiety that something bad might happen to themselves or to someone they love.
- Posttraumatic Stress Disorder (PTSD) – When people experience or witness a traumatic event such as abuse, a natural disaster, or extreme violence, it is normal to be distressed and to feel “on edge” for some time after this experience. Some people who experience traumatic events have severe symptoms such as nightmares, flashbacks, being very easily startled or scared, or feeling numb/angry/irritable, that last for weeks or even months after the event and are so severe that they make it difficult for a person to work, have loving relationships, or “return to normal.”
- Phobias – A phobia is a disabling and irrational fear of something that really poses little or no actual danger for most people. This fear can be very disabling when it leads to avoidance of objects or situations that may cause extreme feelings of terror, dread and panic.
- Generalized Anxiety Disorder (GAD) – A severe, chronic, exaggerated worrying about everyday events is the most common symptom in people with GAD. This is a worrying that lasts for at least six months, makes it difficult to concentrate and to carry out routine activities, and happens for many hours each day in some people.
- Social Anxiety Disorder – An intense fear of social situations that leads to difficulties with personal relationships and at the workplace or in school is most common in people with social anxiety disorder. Individuals with social anxiety disorder often have an irrational fear of being humiliated in public for “saying something stupid,” or “not knowing what to say.”
Are there any known causes of anxiety disorders?
Although studies suggest that people are more likely to have an anxiety disorder if their parents have anxiety disorders, it has not been shown whether biology or environment plays the greater role in the development of these disorders. Some anxiety disorders have a very clear genetic link (e.g., OCD) that is being studied by scientists to help discover new treatments to target specific parts of the brain. Some anxiety disorders can also be caused by medical illnesses. Other anxiety disorders can be caused by brain injury.
What treatments are available for anxiety disorders?
Effective treatments for anxiety disorders include medications and psychotherapy. Psychotherapy techniques such as cognitive behavioral therapies are most useful in the treatment of anxiety disorders and are referred to as “first-line treatments.”
In most cases, a combination of psychotherapy and medications is most beneficial for people with severe anxiety disorders. Some commonly used medications for anxiety disorders are antidepressant medications called selective serotonin reuptake inhibitors (SSRIs).
The importance of having a good diet and getting enough sleep are known to decrease symptoms in people with anxiety disorders. Regular exercise has also been scientifically proven to be effective.
(Courtesy of the National Alliance on Mental Illness - Reviewed by Ken Duckworth M.D., and Jacob L. Freedman M.D., 04/2012)
Depression
What is major depression?
The normal human emotion we sometimes call “depression” is a common response to a loss, failure or disappointment. Major depression is different. It is a serious emotional and biological disease that affects one’s thoughts, feelings, behavior, mood and physical health. Depression is a life-long condition in which periods of wellness alternate with recurrences of illness and may require long-term treatment to keep symptoms from returning, just like any other chronic medical illness.
All age groups and all racial, ethnic and socioeconomic groups can experience major depression. Some individuals may only have one episode of depression in a lifetime, but often people have recurrent episodes. If untreated, episodes commonly last anywhere from a few months to many years. An estimated 25 million American adults are affected by major depression in a given year, but only one-half ever receive treatment.
What are the symptoms of major depression and how is it diagnosed?
Depression can be difficult to detect from the outside, but for those who experience major depression, it is disruptive in a multitude of ways. It usually causes significant changes in how a person functions in many of the following areas:
Mental healthcare professionals use the criteria for depression in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to develop a diagnosis.
There is a strong possibility that a depressive episode can be a part of bipolar disorder. Having a physician make the right distinction between unipolar major depression and bipolar depression is critical because treatments for these two depressive disorders differ.
What treatments are available?
There are three well-established types of treatment for major depression:
As devastating as this disease may be, it is very treatable in most people. Today the availability of treatment and understanding of depression has lessened the barriers that can prevent early detection, diagnosis and decision to seek treatment.
(Courtesy of the National Alliance on Mental Illness - Reviewed by Ken Duckworth, M.D., 04/2013)
The normal human emotion we sometimes call “depression” is a common response to a loss, failure or disappointment. Major depression is different. It is a serious emotional and biological disease that affects one’s thoughts, feelings, behavior, mood and physical health. Depression is a life-long condition in which periods of wellness alternate with recurrences of illness and may require long-term treatment to keep symptoms from returning, just like any other chronic medical illness.
All age groups and all racial, ethnic and socioeconomic groups can experience major depression. Some individuals may only have one episode of depression in a lifetime, but often people have recurrent episodes. If untreated, episodes commonly last anywhere from a few months to many years. An estimated 25 million American adults are affected by major depression in a given year, but only one-half ever receive treatment.
What are the symptoms of major depression and how is it diagnosed?
Depression can be difficult to detect from the outside, but for those who experience major depression, it is disruptive in a multitude of ways. It usually causes significant changes in how a person functions in many of the following areas:
- Changes in sleep. Some people experience difficulty in falling asleep, waking up during the night or awakening earlier than desired. Other people sleep excessively or much longer than they used to.
- Changes in appetite. Weight gain or weight loss demonstrates changes in eating habits and appetite during episodes of depression.
- Poor concentration. The inability to concentrate and/or make decisions is a serious aspect of depression. During severe depression, some people find following the thread of a simple newspaper article to be extremely difficult, or making major decisions often impossible.
- Loss of energy. The loss of energy and fatigue often affects people living with depression. Mental speed and activity are usually reduced, as is the ability to perform normal daily routines.
- Lack of interest. During depression, people feel sad and lose interest in usual activities.
- Low self-esteem. During periods of depression, people dwell on memories of losses or failures and feel excessive guilt and helplessness.
- Hopelessness or guilt. The symptoms of depression often produce a strong feeling of hopelessness, or a belief that nothing will ever improve. These feelings can lead to thoughts of suicide.
- Movement changes. People may literally look “slowed down” or overly activated and agitated.
Mental healthcare professionals use the criteria for depression in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to develop a diagnosis.
There is a strong possibility that a depressive episode can be a part of bipolar disorder. Having a physician make the right distinction between unipolar major depression and bipolar depression is critical because treatments for these two depressive disorders differ.
What treatments are available?
There are three well-established types of treatment for major depression:
- Medications. Medications often effectively control the serious symptoms of depression. It often takes two to four weeks for antidepressant medications to have their full effect.
- Psychotherapy. Several types of psychotherapy have been shown to be effective for depression, including cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Support groups offer opportunities to share frustrations and successes, referrals to specialists and community resources, and information about what works best when trying to recover. Research has shown that mild to moderate depression can often be treated successfully with either medication or psychotherapy alone but that both together are often more helpful. Severe depression appears more likely to respond to a combination of medication and psychotherapy.
- Electroconvulsive therapy (ECT). ECT is a highly effective treatment for select severe depression episodes and for severe depression with psychosis. When medication and psychotherapy are not effective in treating severe symptoms (e.g., acute psychosis or thoughts of suicide) or if a person cannot take antidepressants, ECT may be considered. Memory problems can follow ECT treatments, so a careful risk-benefit assessment needs to be made for this intervention.
As devastating as this disease may be, it is very treatable in most people. Today the availability of treatment and understanding of depression has lessened the barriers that can prevent early detection, diagnosis and decision to seek treatment.
(Courtesy of the National Alliance on Mental Illness - Reviewed by Ken Duckworth, M.D., 04/2013)
Stress
What is stress?
Stress can be defined as the brain’s response to any demand. Many things can trigger this response, including change. Changes can be positive or negative, as well as real or perceived. They may be recurring, short- term, or long-term and may include things like commuting to and from school or work every day, traveling for a yearly vacation, or moving to another home. Changes can be mild and relatively harmless, such as winning a race, watching a scary movie, or riding a roller-coaster. Some changes are major, such as marriage or divorce, serious illness, or a car accident. Other changes are extreme, such as exposure to violence, and can lead to traumatic stress reactions.
How does stress affect the body?
Not all stress is bad. All animals have a stress response, which can be life-saving in some situations. The nerve chemicals and hormones released during such stressful times, prepares the animal to face a threat or flee to safety. When you face a dangerous situation, your pulse quickens, you breathe faster, your muscles tense, your brain uses more oxygen and increases activity—all functions aimed at survival. In the short term, it can even boost your immune system.
However, with chronic stress, those same nerve chemicals that are life-saving in short bursts can suppress functions that aren’t needed for immediate survival. Your immunity is lowered and your digestive, excretory, and reproductive systems stop working normally. Once the threat has passed, other body systems act to restore normal functioning. Problems occur if the stress response goes on too long, such as when the source of stress is constant, or if the response continues after the danger has subsided.
How does stress affect your overall health?
There are at least three different types of stress, all of which carry physical and mental health risks:
Of all the types of stress, changes in health from routine stress may be hardest to notice at rest. Because the source of stress tends to be more constant than in cases of acute or traumatic stress, the body gets no clear signal to return to normal functioning. Over time, continued strain on your body from routine stress may lead to serious health problems, such as heart disease, high blood pressure, diabetes, depression, anxiety disorder, and other illnesses.
How can I cope with stress?
The effects of stress tend to build up over time. Taking practical steps to maintain your health and outlook can reduce or prevent these effects. The following are some tips that may help you to cope with stress:
(Courtesy of the National Institute of Mental Health)
Stress can be defined as the brain’s response to any demand. Many things can trigger this response, including change. Changes can be positive or negative, as well as real or perceived. They may be recurring, short- term, or long-term and may include things like commuting to and from school or work every day, traveling for a yearly vacation, or moving to another home. Changes can be mild and relatively harmless, such as winning a race, watching a scary movie, or riding a roller-coaster. Some changes are major, such as marriage or divorce, serious illness, or a car accident. Other changes are extreme, such as exposure to violence, and can lead to traumatic stress reactions.
How does stress affect the body?
Not all stress is bad. All animals have a stress response, which can be life-saving in some situations. The nerve chemicals and hormones released during such stressful times, prepares the animal to face a threat or flee to safety. When you face a dangerous situation, your pulse quickens, you breathe faster, your muscles tense, your brain uses more oxygen and increases activity—all functions aimed at survival. In the short term, it can even boost your immune system.
However, with chronic stress, those same nerve chemicals that are life-saving in short bursts can suppress functions that aren’t needed for immediate survival. Your immunity is lowered and your digestive, excretory, and reproductive systems stop working normally. Once the threat has passed, other body systems act to restore normal functioning. Problems occur if the stress response goes on too long, such as when the source of stress is constant, or if the response continues after the danger has subsided.
How does stress affect your overall health?
There are at least three different types of stress, all of which carry physical and mental health risks:
- Routine stress related to the pressures of work, family, and other daily responsibilities.
- Stress brought about by a sudden negative change, such as losing a job, divorce, or illness.
- Traumatic stress, experienced in an event like a major accident, war, assault, or a natural disaster where one may be seriously hurt or in danger of being killed.
Of all the types of stress, changes in health from routine stress may be hardest to notice at rest. Because the source of stress tends to be more constant than in cases of acute or traumatic stress, the body gets no clear signal to return to normal functioning. Over time, continued strain on your body from routine stress may lead to serious health problems, such as heart disease, high blood pressure, diabetes, depression, anxiety disorder, and other illnesses.
How can I cope with stress?
The effects of stress tend to build up over time. Taking practical steps to maintain your health and outlook can reduce or prevent these effects. The following are some tips that may help you to cope with stress:
- Seek help from a qualified mental health care provider if you are overwhelmed, feel you cannot cope, have suicidal thoughts, or are using drugs or alcohol to cope.
- Get proper health care for existing or new health problems.
- Stay in touch with people who can provide emotional and other support. Ask for help from friends, family, and community or religious organizations to reduce stress due to work burdens or family issues, such as caring for a loved one.
- Recognize signs of your body’s response to stress, such as difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy.
- Set priorities—decide what must get done and what can wait, and learn to say no to new tasks if they are putting you into overload.
- Note what you have accomplished at the end of the day, not what you have been unable to do.
- Avoid dwelling on problems. If you can’t do this on your own, seek help from a qualified mental health professional who can guide you.
- Exercise regularly—just 30 minutes per day of gentle walking can help boost mood and reduce stress. Schedule regular times for healthy and relaxing activities.
- Explore stress coping programs, which may incorporate meditation, yoga, tai chi, or other gentle exercises.
(Courtesy of the National Institute of Mental Health)