Mental Disorders - Symptoms and Causes - Article Example

Mental Disorders Symptoms and causes. Bipolar Disorder Bipolar disorder is a mood disorder of the brain that causes unusual shifts in a person's mood. It also affects the person's energy and ability to function. Bipolar disorder used to be referred to a manic depression because of the high state (mania) and the low state (depression) that the person alternately experienced. These swings from high state to low state and back can be very extreme. Bipolar disorder is usually diagnosed in late adolescence or adulthood. Children may also have the disorder but the symptoms are difficult to distinguish from other childhood behavioural disorders. Because the disorder has two distinct phases- the high and the low- there are distinct sets of symptoms for each phase. The National Institute of Mental Health estimates that about 5.7 million American adults or about 2.6 percent of the population age 18 and older have bipolar disorder. They list the following symptoms. The mania or high phase is described as a high energy phase with symptoms which include a euphoric mood or extreme irritability, activity and restlessness; excessively "high' or euphoric mood; racing thoughts with distractibility, poor judgment; they can go for more than twenty four hours without sleep; unrealistic beliefs in one's powers; increased sex drive; aggressive behaviour. Reckless behaviour, for example excessive spending sprees, has been noted in this phase. People have been reported to have bought very expensive cars and then destroyed them in joy rides without being aware of their behaviour and the consequences of such behaviour. There have also been reports of extreme violence resulting in serious physical harm, sometimes even fatal, by people in a depressive phase. This phase is usually accompanied by abuse of drugs such as alcohol or cocaine. Their behaviour is generally very different from their usual behaviour, yet they are not able to determine that anything is wrong. The depressive or low phase is characterized mainly by a lasting sad or empty mood. In contrast to the manic phase energy is decreased with a feeling of fatigue. Other symptoms include feelings of hopelessness, pessimism, guilt, worthlessness or helplessness; loss of interest or pleasure in activities, difficulty concentrating and remembering; change in sleep and eating patterns; suicidal thoughts. The person can suffer from chronic body pain for which there seems to be no obvious cause. Thoughts of death or suicide and even attempts at suicide characterize this phase. In some instances psychosis can accompany the severe mania or depressive phases. The psychotic symptoms include hallucinations or delusions. The psychosis can sometimes be confused with schizophrenia. Although the mania and depression alternate in phases, in some people they may occur together and cause a mixed state which includes a combination of the symptoms resulting in agitation together with trouble sleeping. Another combination is that the person may feel very sad and hopeless while at the same time feel extremely energized. The causes of bipolar disorder are not yet clear. Research is on-going to determine the exact cause. However it is thought that there is no one factor that causes bipolar disorder but several factors acting together to produce the end result. A genetic component is suggested as bipolar disorder seems to run in families. But twin studies have not confirmed a single gene as responsible. Since when one twin has the disorder it is not always the case that the other twin will also have it. But, the research so far shows that the other twin is more likely to have it than another sibling. It may be a number of genes acting together and affected by the environment. New brain imaging techniques such as PRT and MRI scans show a difference in the brains of people with bipolar disorder, but the information is not sufficient enough yet to clearly identify the differences in the brains and the exact location in the brain that may house the cause of bipolar disorder. Chemical imbalances within the brain have also been implicated as a cause of bipolar disorder. A high level of the neurotransmitter norepinephrine can cause mania, whereas a low level can cause depression. Alcoholism Alcoholism is different from bipolar disorder in that it is not a mood disorder or of the brain, but it is a disease that causes the body to be dependent on alcohol. But there seems to be a cyclical association between bipolar disorder and alcoholism since especially the depressive phase of bipolar disorder has been known to motivate the person to consume alcohol and in turn being in the depressive phase encourages the individual to turn to alcohol. Alcoholism is more of an addiction where the person craves the alcohol and is unable to control how much he or she drinks. Some people however suffer from alcohol abuse without actually reaching the stage of dependency to be classified as alcoholism. In this state of abuse the person engages in excessive drinking but is not yet fully dependent on it. In both alcoholism and alcohol abuse the excessive drinking causes problems with health, relationships and work. It is difficult to identify specific symptoms of alcoholism, or to determine precisely when someone is suffering from alcohol addiction since alcohol and drinking are such integral parts of social life. Alcoholism usually starts off as innocent social drinking but then gradually becomes a habit and from there can slip into an addiction. A very common sign that someone is suffering from alcoholism is the denial of having a drinking problem. Other symptoms which are characteristic of addictions are drinking in secret and having rituals such as drinking before, with and after dinner; keeping alcohol in unlikely places at home and at work; feeling the compulsion to drink and getting irritable when the drink is not available or accessible; being unable to limit the amount of alcohol consumed and having to drink more and more to feel the effects of the alcohol. Some of the effects of the alcoholism that become obvious are not remembering conversations; losing interest in daily activities and having problems with social life. Another symptom is noticeable when the person does not drink, that is the withdrawal symptoms such as sweating and shaking and nausea. Those who abuse alcohol without necessarily being alcoholics suffer more or less the same symptoms except that they do not have the compulsion to drink and neither do they suffer the withdrawal symptoms if they do not drink. Since consuming alcohol has various effects of a person's emotional and psychological well being in addition to his physical health, there are many signs and symptoms in the functioning and daily life that can indicate an addiction. The individual may develop health problems and still continue to drink. The addiction also affects performance on the job and dealing with financial issues- bills go unpaid, etc. The risky behaviour symptomatic of alcohol addiction also puts others at risk, especially when driving under the influence. Family life and relationships suffer when the individual becomes depressed or irritable as a result of the drinking. Unlike bipolar disorder there are several factors that are considered to cause alcoholism. Since it is not actually a disease but an addiction, physical or medical factors are hard to identify as causing alcoholism. As with any other addiction it is usually a psychological response to difficult life factors that is expressed in the consumption of alcohol. And since alcohol generally numbs the senses and blocks bad feelings it is for some the solution to having to cope with negative feelings. Becoming addicted takes time as the alcohol gradually affects the chemicals in the brain. In particular alcohol affects the chemicals responsible for impulsiveness (inhibiting it), for exciting the nervous system (raising it), and for pleasure (raising it). So over a period of time the body craves alcohol to feel good again or to avoid negative feelings. Apart from the chemical factors, genetic factors may also make a person vulnerable to alcoholism. Psychological and social factors can cause excessive drinking which may then lead to alcoholism. Stress and anxiety, low self-esteem, may lead someone to drink alcohol. Family members who are dependent on alcohol can influence an individual to develop that habit, just as peer pressure can encourage an individual to become dependent on alcohol. Depression and other mental illnesses can also lead to dependence on alcohol. It is difficult to determine to what extent these factors will actually cause the person to end up in the addiction. And since alcoholism takes some time to develop as one drinks more and more heavily, the addiction is likely to develop. Treatment Bipolar Disorder Generally bipolar disorder is treated with chemicals, therapy or a combination of both. The American Psychiatric Association identified five types of medication. These include stabilizers (lithium, valproate, and carbamazepine), antimanic agents, antidepressant agents, adjunctive medication, and new or atypical medications (Fountoulakis et al, 2005). These are taken for extended periods of time. In some instances it is necessary to include other medications intermittently for episodes of mania and depression that are not controlled by the mood stabilizers. Lithium was the first mood stabilizer to be prescribed for bipolar disorder as it controls the mania and helps to prevent re-occurrence of both the mania and depression. Anti-convulsant medications are also useful for difficult episodes. Valproate is the common anti-convulsant and can be given together with lithium. Research is on-going to test other anti-convulsants for their efficacy in treating bipolar disorder especially in children. Antidepressants were thought to be effective to control the depression but may worsen the overall course of the bipolar disorder. So that adding an antidepressant to the drug therapy must be done with caution. The American Psychological Association recommends a multi-drug therapy as the first line of treatment, including lithium or valproate plus an antipsychotic. However if the symptoms are less severe, a single drug may suffice. Generally the complexity of the illness calls for a complex combination of drugs. Psychosocial treatments are also helpful in treating bipolar disorder. Various forms of psychotherapy are used including the traditional 'talk therapy', cognitive behavioural therapy, family therapy and psychoeducation. The psychosocial treatments provide support for the victim but also for the families. In fact most of the psycho-therapy programs are not geared only to the individual with bipolar disorder, but must include at least one other person as a support. Psychotherapy's main purpose is to stabilize moods and so help the victim to function better in life. Different therapies address different aspects of the disorder. Cognitive behavioural therapy helps with changing inappropriate and negative thought patterns and behaviours. Family therapy focuses on helping to reduce stress which can contribute to the person's illness. People with bipolar disorder and their families are taught about the illness and how to cope with it by psychoeducation. A newer technique, interpersonal and social rhythm therapy, has been gaining popularity as its effectiveness builds. It is helpful in regularizing daily routines and sleep patterns and indirectly helps to improve interpersonal relationships. Medications and therapy do not always work or may take a long time to have an effect. Other treatment strategies have been used. Electroconvulsive therapy (ECT) is used especially when psychosis or suicidality are present, or in any other case of intense episodes when medications are risky, for example in pregnant women. Herbal or natural supplements can sometimes have an effect in reducing mania or depressive episodes. St. John's Wort and omega-3 fatty acids in fish oil are natural products are still being tested for their ability to control episodes. Thyroid gland function is affected in people with bipolar disorder. Thyroid levels must be closely monitored by a physician since fluctuating levels can by themselves cause mood and energy changes, thus complicating the bipolar disorder even more. But the lithium treatment itself may also lower the level of thyroid. Thus the need for the monitoring. Medications are prescribed by psychiatrists, although some primary care physicians who do not specialize in psychiatry sometimes prescribe the medications. In that case it is recommended that the people with bipolar disorder be under the treatment of a psychiatrist never-the-less. A licensed psychologist, social worker, or counsellor typically provides the psychotherapies. They too should work in collaboration with a psychiatrist to monitor a patient's progress. Due to the complexity of the disorder there are several considerations for the practitioners. Bipolar disorder is a long-term and recurrent illness therefore treatment must be long-term and continuous. Therefore careful and frequent monitoring is necessary both by the prescribing psychiatrist and the psychotherapist, both of whom must always be working in collaboration with each other. Changes to the treatment plan may become necessary over time. The psychiatrist must be in charge of these changes The psychiatrist must also be aware if the patient is taking any other medication for other conditions, as these may interact with the bipolar medication. Being informed can help the psychiatrist to avoid full-blown episodes. Women, especially pregnant women should also have the guidance of the psychiatrist as medications could affect their pregnancy and their own health. Because of the complexity of the illness clinicians must be very skilled at recognizing the symptoms initially, not only the extreme mania and depressive phases but also the in between phases, i.e. the mixed phases and the hypomania. The clinician also needs to consult with family matters as patients cannot always remember and describe their mania phases. The treatment must include addressing the present phase but also there must be a plan for ongoing maintenance. The clinician must also be able to recognize when the patient requires hospitalization as ' an essential protective and stabilizing intervention that can allow more aggressive pharmacological treatment, withdrawal from prescribed or recreational drugs, reduction of risk of aggressive or self-injurious behaviour, and more complete evaluation' (Leahy, 2007). The National Institute of Mental Health outlines the avenues for obtaining treatment. The psychiatrist is the main mental health provider for bipolar disorder, but psychologists, psychiatric social workers and nurses can all assist with the treatment. There are many places one can go for treatment including medical schools, departments of psychiatry at hospitals, private offices and clinics of psychiatrists and other doctors, and public health centres. Alcoholism Treating alcoholism is also different from treating bipolar disorder as this is an addiction and so rehabilitation is the most effective treatment. However the process of getting someone into a rehabilitation program involves many steps, starting with the acceptance of the person and his willingness to be rehabilitated. The first stage is an evaluation to determine the extent of the alcohol dependency. If the person is not dependent on alcohol a brief intervention or counselling program can help. An alcohol-abuse specialist or counsellor will develop a treatment plan that includes goal-setting and behaviour modification. Cognitive behaviour therapy is also effective in counselling on alcohol addiction. A different form of therapy, aversion therapy is also used where the alcohol is paired with an unpleasant response. If the person is not able to reduce the level of drinking and is suffering physically, mentally and socially from the drinking then an outpatient or a residential treatment program is necessary. The treatment must start with detoxification and withdrawal. Medication may be prescribed to deal with withdrawal seizures. Since alcoholism is often accompanied by other health problems such as high blood pressure, liver and heart disease, medical treatment may have to accompany the detoxification process. This is then followed up by psychological support such as individual and group therapy and alcoholism support groups (e.g. AA- alcoholics anonymous). Like bipolar disorder, alcoholism can be managed with drugs. Disulfiram is an alcohol-sensitizing drug that produces a severe physical reaction if taken with alcohol. Naltrexone and acamprosate help to control the cravings for alcohol. A health care professional can also inject the alcoholic with Vivitrol once a month to reduce the urge to drink. A very important aspect of treating alcohol abuse is the therapy that involves the whole family and particular the partner of the addict. Couples therapy has been increasing as an effective component of the treatment. Advantages and Disadvantages of the treatment. Bipolar Disorder The difficulty with treatment for bipolar disorder lies in its complexity of symptoms and the fact that these symptoms exhibit at varying times. Therefore timing of treatment, especially drug treatment is crucial and needs very careful supervision. There are more than one approach to treatment with some favouring the use of antipsychotics and anti depressants and others favouring the use of mood stabilizers. Fountoullakis et al (2005) indicate a lack of hard evidence to support the preference of either approach over the other. However there is no doubt that bipolar disorder must be treated with drug therapy in some form. They report that generally the antipsychotics have been proven to be effective in acute mania. They also indicate that psychoeducation and psychotherapy must be added to the treatment, but must not replace the drug therapy. Although Lithium has been the major drug for treatment it is not without limitations. Rivas-Vasquez et al (2002) report 'that approximately 20-40% of patients with acute mania fail to respond adequately to lithium and that almost 40% of patients maintained on lithium have a recurrence of mania within 2 years after recovering from the acute episode'. They have also noted two other disadvantages of lithium, namely that some may develop a resistance to it after 3 years of treatment and that cases of mixed episodes, rapid-cycling and severe mania do not respond as favourably to lithium. Also, Lithium is known to have a low-tolerability. Other disadvantages include side effects such as tremors, weight gain and neurocognitive impairment. It is also slow-acting. Lithium may not work therefore with all individuals. In comparison studies have indicated minimal side effects with valproate and a quicker response time. The use of anti-depressants, though generally positive in effect, also has some disadvantages and cautions. Leahy (2007) informs that using antidepressants can increase the risk of cycling of the illness and further depressive episodes. He indicates also that some studies have reported an increased risk of suicidality, although this has been contradicted in some other studies. Rivas-Vasquez et al (2007) also caution about the use of anti-depressants in treating bipolar disorder. In addition to the increase rapid-cycling episodes mentioned by Leahy, they report an induction of acute mania as another risk with anti-depressants. They claim that there is not enough evidence to confirm a clear additional benefit to using an anti-depressant with lithium. More research is needed therefore to determine whether the benefits outweigh the disadvantages. In general side effects occur with almost any of the drugs used to treat bipolar disorder. The common side effects include weight gain, nausea, tremors, hair loss, anxiety and reduced sex drive. As noted before, careful monitoring by a psychiatrist is essential. There have been many positive reports of the use of psychotherapies in treating bipolar disorder. Rivas-Velasquez reports on a study with 101 patients in a 1-year program of Family Focused Therapy (FFT) combined with medication treatment. The benefits of the FFT were many, including improvement in the depressive symptoms and better communication among the family members. It is generally agreed that family support through family therapy is an essential aspect in the life of the individual. Alcoholism. One of the advantages of Behavioural Couples Therapy (BCT) for treatment of alcohol addiction is related to the fact that this addiction causes so much stress in relationships and interpersonal conflicts. This stress makes relapse more frequent. Powers et al (2008) describe the advantages of involving a spouse or partner in therapy when they state, ' a partner can be involved as a coach in the process of behaviour change, disorder-specific relationship issues can be addressed (protecting the patient from the negative consequences of his/her problem behaviour), or more general relationship functioning can be addressed'. BCT has the dual role of supporting with abstinence while at the same time helping with relationship distresses. These authors conducted a meta-analysis to examine the effectiveness of BCT for alcoholism treatment. Twelve studies with a total sample of 754 participants were analyzed. The major outcome of the studies was that BCT was effective in improving relationships. Although there was no direct evidence of BCT in supporting abstinence immediately after treatment, it was postulated that the improved relationships would with time lead to greater support for abstinence. So the factor was time. The analysis also did not show any relationship between the number of sessions for BCT and the effect of the therapy. In other words, brief BCT was as effective as extended BCT. This was considered an advantage for those situations where time for treatment and resources are limited. BCT can still therefore be effectively used. BCT performed better than individual-based treatments not only in the improving relationships but also showed better results for child adjustment and reduced violence. The advantages and disadvantages of treatment of alcoholism are seen by O'Farrell and Fals-Stewart (2003) as being related to whether the addict is willing to seek help or not. When the addict is unwilling to seek help, the family needs to develop coping strategies and initiate change in the situation in order to maintain their own stability. Any change they institute indirectly impacts on the addict's behaviour and can still lead to some rehabilitation. Al -Anon is a family support program that encourages the family members to detach from the addiction problem and seek support for themselves from other Al-Anon members. This program has been successful in reducing the stress on the families helped them to cope, but it did not bring about any change in the drinking habit of the addicted. Most of the family therapy programs discussed by these authors were advantageous in helping the families cope with the addiction. BCT was also reported as effective but an addition was the use of the medication, disulfiram in addition to the therapy. Abstinence was reported among the patients who took the disulfiram consistently. This led to the introduction of a contract along with the BCT between the addict and the partner to make the disulfiram a consistent part of the counselling. (O'Farrell and Fals-Stewart, 2003). Behavioural contracts have been used instead of disulfiram contracts with some addicts with success. Overall these authors reported several additional benefits to BCT, apart from the already reported improvement in relationships. There was substantial reduction in domestic violence and hospital and jail stays. The couples' children also improved in psychosocial functioning. Despite the positives outcomes of the studies with BCT, some studies showed that other forms of family therapy were more effective when there were serious communication problems in the family. The study also indicated that the use of disulfiram may not work for everyone. Medical limitations may prevent some from using disulfiram, and others may simply refuse to take it. The experience. For both of these mental disorders living with the illness is not only about the person with the illness. Both bipolar disorder and alcoholism have serious effects on the family or anyone close to the victim. Therefore the illness affects not only the person but every aspect of life. The effects can also be long-lasting, in some cases the individual must accept it as a lifetime challenge to be managed for the rest of his life. Individuals with bipolar disorder can have to cope with mood variations permanently. The stress of this realization of a lifetime commitment can add to the burden of the illness itself on both the individual and the family. Suicide rates are therefore high with this population. Leahy (2007) reports that 'Lifetime rates for completed suicide are 60 times higher than that for the general population, with a much higher rate of completed suicides for each attempt'. The quality of life is affected in many ways for individuals living with bipolar disorder. Because of the reduction in functioning caused by the mood swings, work and career become in jeopardy. Frequent absenteeism from work can lead to lower wages and in some cases to unemployment. It is difficult for some to maintain a good work record. The difficulty in finding a job and the financial pressures then cause further episodes of depression. The cycle can continue if the bipolar disorder is not managed carefully. It is indeed a cyclic process since if bipolar disorder begins in early adolescent or young adulthood it can interfere with the educational process. This can then have consequences such as increased difficulty in finding a job. The heightened frustration can lead to deviant behaviour with risk of arrest. The effects on the family include strained relationships with partners or spouses and the children in the family. Though family therapy can be helpful, the emotional strain on all members of the family is difficult to cope with. Bipolar disorder can have co morbid conditions that complicate the illness and therefore the treatment sometimes. Physical and medical conditions can develop as a result of the actual illness, the emotional consequences or the drug treatment. Obesity, heart disease, hypertension, hyperthyroidism, diabetes, hepatitis, increased rates of smoking and drug and alcohol abuse are some of these conditions that could be a consequence of the bipolar disorder. These conditions in themselves could lead to other indirect consequences such as pulmonary embolism as a result of the obesity. And again these conditions can in turn intensify the bipolar disorder symptoms. A high percentage of bipolar patients also suffer from anxiety disorders and personality disorders (Leahy, 2007). Negative life events trigger manic symptoms. Lack of sleep is a main trigger of manic episodes, therefore any events in life that interrupt sleep, worry, fear, anxiety, and loss are dangers to the individual. Individuals with bipolar disorder are at greater risk of not coping with what may seem like routine daily events to others. The characteristics of bipolar disorder are so unique that everyone's experience of living with this illness is different. What are common are the highs and the lows and especially in the beginning not understanding what was happening. The way the individual reacts to the highs and the lows is however different for each person. The effect of the media on individuals living with mental disorder is profound. Through television shows the media creates and perpetuates images and stigmas connected to mental illness. Though there are some positive images in the media, most of the portrayals of people with mental illness are negative. These negative images and stigmas affect their self-image, their attempts to seek help and their recovery process. They experience hostility and fear when interacting with the public. The discrimination they encounter makes it difficult for them to pursue their own goals, accomplish some everyday tasks and generally have a good quality of life. Many prefer not to seek job opportunities for fear of the stigma and discrimination they will have to face. Social life is generally curtailed or becomes non-existent as it becomes more and more difficult to be among people. The uncertainty of when and how a mental illness will manifest also contributes to the withdrawal from social activities. In a focus group session people with mental illness talked about what quality of life meant to them and what they needed. They described the need to improve their self-esteem and to feel worthwhile. Difficulty finding a job and therefore having too much on time on their hands was eroding their self-esteem. The need for people around them to understand the mental illness was important to reduce the discrimination they suffered. They appreciated the need for humour and a positive outlook on life and thus support groups of various types was an asset to them (Corring, 2002) In summary mental disorders such as bipolar disorder and alcoholism though different in many ways affect not only the lives of the individual but also those close to them. The challenges that these mental illness pose to living a quality life and functioning well make it necessary for the individual to seek treatment and to be well supported. Bibliography Corring, D. (2002). 'Quality of life: perspectives of people with mental illness and families'. Psychiatric Rehabilitation Journal, 25(4), 350-358. Fountoulakis, K.N., Vieta, T.E., Sanchez-Moreno, J., Kaprinis, S.G., Goikolea, J.M., & Kaprinis, G.S. (2005). Treatment guidelines for bipolar disorder: A critical review. Journal of Affective Disorders 86, 1 -10 Leahy, R. 2007, Bipolar disorder: Causes, contexts and treatments. Journal of Clinical Psychology. 63, (5), 417-424 Mayo Clinic (2008) Alcoholism. Mayo Foundation for Medical Education and Research. Retrieved December 1st, 2008 http://www.mayoclinic.com/print/alcoholism/DS00340/METHOD=print&DSECTION=all National Institute of Mental Health (n.d.) Bipolar Disorder. Retrieved December 1st, 2008 http://www.nimh.nih.gov/health/publications/bipolar-disorder/nimhbipolar.pdf O'Farrell, T.J. & Fals-Stewart, W. (2003) Alcohol abuse. Journal of Marital and Family Therapy. 29 (1), 121-146. Powers, M. B., Vedel, E. & Emmelkamp, P.M.G. 2008, 'Behavioral couples therapy for alcohol and drug use disorders: A meta-analysis'. Clinical Psychological review. 28, 952-962 Rivas-Vazquez, R.A., Johnson, S., Rey, G.J. & Blais, M. 2002, 'Current treatments for Bipolar Disorder: A review and update for psychologists'. Professional Psychology: Research and Practice. 33, (2), 212-223 Read More