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Disorders

Mental Health Illnesses and Disorders. A mental disorder, also called a mental illness or psychiatric disorder, is a mental or behavioral pattern or anomaly.

Kids and Mental Disorders – ADHD

Children and mental disorders – when is too soon for diagnosis?

I spend a decent chunk of my time cruising chat boards and reading journals, news, social media posts and such about mental disorders.  My own “specialties” are Bipolar Disorder, Adult ADHD, Autism Spectrum DisorderBorderline Personality Disorder, Anxiety Disorder, Depression, Abuse Disorders, OCD… nevermind – I really “specialize” in them all, because I know most Attention Deficit Hyperactivity Disorderof these disorders within my social circle, and I know them on a professional level.

Anyway, I was on a Facebook page the other day for ADHD. (attention deficit hyperactivity disorder)  A woman posted a question about how to manage a kid with ADHD who wakes up and wreaks havoc within the house while everyone is trying to get ready for school and work.  Naturally he was disagreeable, confrontational, oppositional, had “meltdowns” – and it was all exhausting.  (pretty typical behavior for a truly ADHD kid)  A therapist once told me that the ADHD brain doesn’t “wake up” right away and cause all this trouble partly because their brain is not actually engaged yet.  The mom was asking for advice.

Comments on the page gave some really good answers. Some of them are common. Like plan your morning before you go to bed (get out clothes, get backpack ready, make lunch), let the kid make some choices – blah blah blah, stuff we have all heard.

Others were less common, but possibly better advice. Advices like; give the kid an extra 30 minutes to “wake up” in silence, give the child an incentive to get dressed NOW – like playing Minecraft after he is dressed.  I handle mine with the “don’t talk to him yet” option – waiting about 20-30 minutes before making him get busy.  His siblings aren’t allowed to bug him during this time either.  He can wrap himself in a blanket, stare at the wall or whatever – just don’t go back to sleep.

One lady suggested that the kid should be woken to take his meds an hour before he has to be out of bed. Then let him go back to sleep so that his medicines are working by the time he actually gets up.  I found that last piece of advice to be very helpful. My husband with adult ADHD takes his meds about 4 am and gets up at 6, ready to go rather than rude, obnoxious and unhelpful.

Mental Disorders - ADHDWhat troubled me was a comment from a woman who didn’t actually give advice, but chimed in to complain about how hard her four-year-old was to manage.  She said that he had been diagnosed with ADHD and was on meds, but also said that he had bipolar disorder, and still was a screaming banshee in the morning.  This gives me pause for concern.

I certainly can’t do anything about this particular kid, and I don’t really know the exact circumstances but I find the dual diagnosis with bipolar disorder very troubling for a four-year-old child.  Certainly, kids can exhibit ADHD symptoms at 4, and some will benefit from treatment.  But the medications weren’t working, and I am not so sure about the bipolar disorder.

Traditionally, until a few years ago, no one was willing to consider bipolar disorder as a pediatric concern.  Still today, though bipolar disorder obviously exists in childhood – most of the major issues don’t come out until adolescence.

The Diagnostic and Statistical Manual of Mental Disorders does not recognize the bipolar disorder in children under the age of 13

The National Institutes of Mental Health does acknowledge that bipolar disorder in children MAY exist but also warns that many children are misdiagnosed when the main problem is ADHDNIMH recommends that these children be labeled with Mood Dysregulation Syndrome until such time as a diagnosis can be relied upon.

The main problem in diagnosing young children with any mental disorder is that symptoms in children are vastly different from those in adults.  To complicate matters, symptoms of various Cerebrum Lobesdisorders in children are similar to one another.

Symptoms such as irritability, excessive mood swings, meltdowns, oppositional behavior, trouble in school, social inadequacies, explosive behavior, frequent frustration, and hyperactivity, etc. can point to a number of disorders.  Frankly the child may be ADHD, Bipolar, Depressed, Autism Spectrum… or even have food intolerance.

Because of our family history (not just mine), I watch my children very carefully.  I do analyze everything that happens, and I know that all of them probably have a disorder of one type or another.  Two may have ADHD, one is likely bipolar and one has Asperger’s or mild ASD.  I have sought treatment for some issues – but with others, I hesitate to run to a physician – likely a pediatrician who just doesn’t really know.

Our understanding of mental disorders is still evolving

I was personally diagnosed with the wrong disorder for over 15 years – and I was an adult.  How damaging would it have been if I had been labeled with a disorder that I did not have when I was only four years old?
The particular woman I described with the dual diagnosis child was beside herself.  Despite the fact that the four-year-old was receiving medical treatment for both disorders – it wasn’t working.  To me, this means that the treatment was with the wrong meds and for the wrong disorder(s).  In addition, her management skills weren’t the best.

As I said, I know that my children are likely to have disorders of their own but I don’t want to treat them for just any disorder.  I will want them to be treated for the right disease.  My advice to this parent, or any parent whose child had been put on medication that wasn’t working would be to seek a second opinion.

I am more emphatic about that advice if the doctor was willing to “add” a diagnosis to provide more medication; she should definitely seek another opinion.  Preferably the opinion of a pediatric Ritalin - ADHD Medicinepsychiatrist – or even a pediatric behavioral neurologist.  These specialists are few and far between, but it isn’t worth doing anything, but suffering through all the misery because the treatment isn’t working.

Medications are beneficial in the treatment of some types of mental disorders, but they do “change the brain”.  That is how they work – changing the brain can be harmful if you are changing it in the “wrong” directions.  Just seems like common sense.

Melissa Lind

New Online Tools for Anxiety Disorders

What can online tools for Anxiety Disorders do for free?

There has been a dramatic upsurge in websites, smartphone apps and hi-tech gadgets to monitor health conditions such as blood pressure, heart rate, and calorie output – all physical measurementsMental health doesn’t easily lend itself to computer monitoring.  Most people who need intervention go to a therapist or other mental health professional.  When that isn’t affordable, people usually “go it alone” which can have disastrous results.

Online Tools for Anxiety DisordersA new company “Joyable”, is developing an online web platform for people with anxiety disorders.  The company is a start-up venture that aims to create online tools for a variety of mental health conditions.  So far, they have raised over $2 million from Venture Capitalists – and “Angel Investors” which may bode well for additional funding.  Joyable will be starting with Social Anxiety Disorder but plans expansion into other conditions such as generalized anxiety, OCD, PTSD and others.  The big problem with this development is that it isn’t cheap.

The company plans to offer their online tools for a significant cost of $99 / month. Though hi-tech has entered the medical field in other areas, costs are usually low, if not free and available on a smartphone.  The developers state that their program is usable on a smartphone or tablet through the internet. They also have plans to develop a native app for smartphones and tablets as well, but they will probably still charge for the service.

The NIH reports that 15 million Americans may suffer from Social Anxiety Disorder but only about 15 percent of those are adequately treated – leaving 12 million or so, with unattended issues.  The good news is that there are online tools for people with a variety of mental health conditions, and some of those are free.

Not to disparage therapy – but a lot of it is talk and even with insurance, it can be expensive.  You talk, the therapist talks, you talk, the therapist listens.  If you are in group therapy – you also have to listen while others talk.  Sometimes the problems match your own; sometimes they don’t.  In a lot of cases, you may be able to get some insight from hearing others talk about the same thing – but the best information is stuff that you learn about yourself.

The best place to start looking for help online is through forums – nearly always free.  You can find plenty of people with nearly any mental disorder that you can chat with and take or leave the advice as you want.  There is also no shortage of educational – and even entertaining websites (like this one) that offer information, quizzes, daily planning – all for free.

Smartphone for Anxiety DisorderIf you are willing to pay a bit, there are online therapists who are cheaper than going to an office.  Therapists who will attend you privately on the computer – or even by phone.  Joyable is planning on offering three categories of activities – education, cognitive exercises, and behavioral activities.  They plan to have “coaches” who are “empathetic” and “good listeners” – trained by the company.

Psychologists oversee the program, but it is not very likely that you will get personal attention from a licensed professional.   With a little bit of work, you can probably get much of the same service at a low cost – or even without spending a dime. But for the future, the attention that the service may bring might provide promise and signal hope for people with mental disorders.

One development often leads to another. An App, even at a cost may provide assistance for those who won’t otherwise receive adequate care – particularly with disorder such as PTSD that don’t often get enough or the right kind of attention.  For now, you can probably skip the cost – and gather up the services yourself.

Melissa Lind

Intermittent Explosive Disorder

Intermittent Explosive Disorder – More Than Just Anger

Intermittent Explosive Disorder (also called IED, that is appropriate as it can go off unexpectedly and cause significant damage)

Intermittent Hulk Explosive DisorderProbably everyone knows that teenage boy (or girl) who punched a hole through the wall.  Perhaps for some, this became a regular pattern of behavior during adolescence but most of those teenagers outgrew it.  In fact, at least one-quarter of teenage boys has done something dumb like punching a wall.

One boy I knew in high school even broke his hand by punching the roof of his car, and some boys were routinely doing stupid stuff.  Despite that, all of it was teenage angst and changes that can be attributed to the massive amounts of testosterone flowing through the male adolescent body – none of them had intermittent explosive disorder.

Intermittent Explosive Disorder is worse than punching a hole through a wall.

It typically is first identified in the early teens – but can be seen much earlier in some cases.    In order to be actually characterized as intermittent explosive disorder, an individual must have had three episodes of explosive behavior that is severely out of proportion to the stressor.

Intermittent Explosive Disorder HulkinsectThey must have broken or smashed something that is monetarily valuable (more than a few dollars), physically attacked or made explicit threats to attack someone with the intent of causing harm.  If these three episodes occur within the space of 12 months, the disorder is considered to be more severe.

Here is the catch.

How do you distinguish between IED, average – though extreme teenage behavior and other psychiatric conditions?  It turns out that IED is probably a diagnosis of “if nothing else fits” as other psychiatric disorders certainly overlap with similar symptoms – and you have to rule out the adolescent hormone issue.

Bipolar disorder may cause outbursts of extreme anger and agitation, Borderline personality disorder may cause outbreaks, ADHD patients can exhibit a severe lack of self-control, and drug abuse is always a potential cause.  Even though those diseases may cause IED-like events, a sustained behavior pattern is something to address.

Intermittent Explosive Disorder WarningA recent study reported by the National Institutes of Health shows that IED can actually affect up to 4 percent of adults and lead to an estimated 43 attacks over a lifespan.  The disorder may also increase that chance of depression, anxiety and substance abuse disorders.  People with IED have an obvious increased risk of legal trouble, financial difficulties, and divorce – that’s a no-brainer.

So the biggest problem for mental health professionals, like many other disorders, is to untangle all of the information leading in and out with a mix of behaviors and a mix of causes.  What came first – the chicken or the egg?  What came first – the drug abuse or the anger?  Which illness is more important – bipolar disorder or the IED?

One of the biggest clues may be in examining (or better, paying attention to) behavior that occurs before puberty.  In other words: What came first – the behavior or puberty?  Clearly if the behavior started before puberty, there was and is an issue.  If the behavior begins during adolescence – you have to wait (and hope) to see if the behavior goes away once the hormones are settled.

IED is not a simple diagnosis.

It requires a careful examination of an entire psychiatric and behavioral history – and the “ruling out” of a lot of other disorders that may be to blame.  Unfortunately, in the end – unless an underlying cause can be found, there is no medicationAnger management and cognitive behavioral therapy are likely the only answer – minimization of harm, not very satisfactory if it was your car window that got smashed in a fit of rage.

Melissa Lind

Is it Antisocial Personality Disorder?

Some teenagers act as if they have antisocial personality disorder

I once knew a family with a son who was diagnosed with antisocial personality disorder.  The “kid” had grown up in a wealthy subdivision with a father who was a former professional athlete.  The “kid” had everything that most “kids” would want.  In high school, he had a brand new car that he immediately totaled after a party.  He was in trouble with the law several times during high school.

When his father tried to put his foot down, his mother took the “kid’s” side.  She thought he would grow out of it.  Others said that his behavior was the result of “privilege”, which certainly didn’t help, but it is clear that not every wealthy kid is a spoiled brat – and a dangerous one at that.

Antisocial Personality DisorderRather than using his position and financial ability to go to college and earn a degree, he started doing drugs and got kicked out.  He was sent to a famous rehabilitation center where as soon as he “dried out”, he beat up a staff member and was thrown out.  He went home and beat up his girlfriend, but his mother hired the most expensive lawyer available, and he was given probation.  He was arrested with a sizeable amount of drugs – and again was bailed out by his mother.

This went on for a number of years – but the teenage behavior never stopped.  He finally exhausted the judge’s leniency and ended up in a state penitentiary.  Each time, he blamed his behavior on someone else.  He wouldn’t have gotten drunk if he hadn’t been so mad, he wouldn’t have beaten his girlfriend if she had just done what he said… and on and on.  This “kid” was 35 by the time he went to prison, but he never understood what he had done wrong.  It was still someone else’s fault.

When someone is disagreeable, people will often say “He is anti-social.”  What they are referring to is an actual psychiatric diagnosis, Antisocial Personality Disorder, but just because someone is disagreeable or even downright rude doesn’t mean they have the condition.

A personality disorder is a pervasive pattern of behavior that is not “acceptable” by cultural standards.  It is readily seen as abnormal behavior and usually starts in adolescence or early adulthood.  In order to qualify as a “disorder”, it must lead to personal distress or impairment.

Antisocial personality disorder cannot be diagnosed until the age of 18 because many of the “symptoms” seem like typical teenage behavior.  It is characterized by disregarding and violating the rights of other people.  Many teenagers act as if they have antisocial personality disorder – but they don’t.  In addition, in order to be labeled as “antisocial“, there must have been some conduct disorder symptoms before age 15 – or the time kids are often worst as teenagers.

Ashamed of Mental Health StigmasThings that kids do or say during the teen years, don’t count.

A person with antisocial personality disorder has a general disdain for the rights of other people and may violate those rights on a routine basis.  They may be charming, but ruthless and are likely to be irresponsible, irritable, and aggressive.  They are also likely to be in legal trouble and likely to abuse drugs or alcohol.

Antisocial Personality disorder also comes in a range of severity.  A person with mild antisocial personality disorder could be compared to a teenager who continuously borrows her mother’s jewelry when she has been told not to.  This would not be completely out of the norm in some teen girls, but in adults, it may indicate pathology.

People with more dangerous or harmful behavior are referred to as sociopaths or even psychopathsSociopaths have even less regard for someone else’s rights or property and may not even feel the need to argue if confronted – acting like a schoolyard bully.  Psychopaths are said to have a complete lack of conscience and are unable to recognize the violation and do not have the ability to empathize – something like “The Joker” in Batman.

People with antisocial behavior patterns are also extremely manipulative and splendid liars.  It is hard to tell what is true and what is not true.  They may appear to be friendly when they want something, or they may attempt suicide when they want something else.  It is a fine line to walk, whether to believe them or not.

Unfortunately, personality disorders are not something that can be changed through medication.  In this case, it is a failure of conscience, and there is no pill for that.  In some cases, therapy can work but the therapist must be very skilled in order to avoid being manipulated themselves.

Melissa Lind

Psychiatric Disorders and Geniuses

A lot of people like to think of themselves as geniuses.  Probably even more people with psychiatric disorders like to think of themselves as geniuses.

MichelangoWho can blame us – with examples such as Albert Einstein, Edgar Allen Poe, Beethoven, Michaelangelo, Charles Dickens, Ernest Hemingway, Winston Churchill, Charles Darwin, Isaac Newton… just to name a few.

As all of these stellar personalities are now deceased and most died before the advent of modern psychiatry, we can only surmise their disturbance – their genius however is clear.

Aristoteles, a Greek philosopher, once said, “There is no genius without having a touch of madness.”

Today, most who are diagnosed with a mental disorder– be it bipolar disorder, schizophrenia, borderline personality disorder, obsessive compulsive disorder, or even major depression, would be classified in previous times as “mad”.

A recent article in Psychiatric Times, by an actual physician – Nicholas Pediaditakis – attempts to link the occurrence of major mental disorders and geniusFreud called the difference in “temperament” of genius from that of “normal” people – “narcissistic neurosis”.

The basic theory as proposed by the author of the article says that people with certain mental disordersbipolar disorder, schizophrenia, and OCD in particular – ‘tend to “think” the world rather than “feel” it.’  He goes on to say that many are dysphoric and tend towards feeling a void and aloneness within themselves which can often lead to substance abuse and suicide – all too true.  His conclusion is that these illnesses cause an absence of adherence to social norms, not because you want to, but because you have to – but that it frees up parts of the brain for creative processes.

In addition, many artists, actors, comedians, writers acknowledge that much of their creativity comes from painpsychic pain not physical pain that is often experienced by those with mental disorders. This doesn’t seem to translate to genius in science, math, or other concrete areas, but the idea of a mind that has free space to concentrate on specialty areas does fit.

While I, personally, find offense in part of his statement (the part about wanting to think rather than feel) – I also find it true.  I, and those I know, would rather “think” rather than “feel”, but often we feel too much and cannot stop.

Aside from my bristling at the implication that mental illness is a choice – I find it amusing that science may be able to prove that there is a “mad genius” in me – someday.

Melissa Lind

A genius with a psychiatric disorder.

Bipolar Disorder and Adolescents

Symptoms of bipolar disorder in children and adolescents may look like other disorders

Traditionally bipolar disorder has been thought to first show in early adulthood – and more often in females.  Bipolar disorder was considered to be quite rare as few as 20 years ago, to be more exact. The first emergence came in the early 20s, mainly in females. But, our knowledge about bipolar disorder has grown rapidly in the last 20 years.

Instead of the single manic-depressive diagnosis – which included diagnostic criteria of both depressive periods, alternating with manic periods – described as “euphoria”?

Those who did not have clearly rhythmic, alternating periods of a “happy” and frantic manic phase with a classic depression period were mishandled, misdiagnosed, mistreated, or dismissed.

Bipolar ChildrenIn addition, it wasn’t really known that bipolar disorder could start in adolescence or even childhood, or that there are different types of bipolar disorder.  Today, it still isn’t “officially” recognized in the “psychiatric bible” – the Diagnostic Statistical Manual of Mental Disorders (DSM), but at least more practitioners do know that it exists.

Today, we don’t exactly know what causes bipolar disorder (only that there is a genetic link of some kind, and often some past trauma). But, we can at least identify adolescent and childhood bipolar illness.  We also recognize a variety of different types of bipolar disorder (Such as mixed manic episodes, rapid cyclers, people without a depressive phase, hypomania, dysphoria rather than euphoria and cyclothymia). We also have a “catch-all” type – Bipolar NOS or “not-otherwise-specified”.

Adolescent or childhood bipolar disorder is official known as: “early onset bipolar disorder”.  In fact, childhood bipolar disorder can be more serious than a similar disease in adults and may have slightly different symptoms.

Symptoms of bipolar illness in children can often be more severe, and the cycling period may be more frequent.  Children also have more mixed episodes.  Children also have slightly different symptoms – so even the depression phase of the cycle may not be obvious.

Pediatric patients (children and adolescents) with bipolar disorder may have:

Bipolar Disorder in Children•    Abrupt mood swings
•    Periods of hyperactivity followed by lethargy
•    Intense temper tantrums
•    Frustration
•    Defiant behavior
•    Chronic irritability

These symptoms have to appear in more than one setting (school and home) and cause “distress”.

The problem is that many of these symptoms may look like other disorders.  They might be disorders such as ADHD, childhood depression, anxiety disorder, obsessive compulsive disorder, conduct disorder, premenstrual syndrome, oppositional defiant disorder and others. The danger might come from a misdiagnosis and improper treatment.

Bipolar disorder is treated with anti-manic agents (lithium), anti-convulsants (Depakote, lamotrigine) or atypical antipsychotics (Abilify, Risperdal).  In many cases, anti-depressant won’t be needed.  Treatment for other disorders like ADHD or depression may make bipolar disorder worse. Childhood bipolar disorder is something that desperately needs treatment as the distress caused to the patient, and the family can predispose the youngster to

•    Drug or alcohol abuse
•    Stealing
•    Involvement with law enforcement
•    Poor social integration
•    Poor academic performance
•    Suicidal tendencies
•    Premature sexual behavior

The Balanced Mind has a good self-check list of symptoms that can help a parent or a teen decide if bipolar disorder might be an issue.  Self-testing is not always accurate and should be discussed with a doctor, (preferably with test results in hand).  Not all doctors accept pediatric bipolar disorder. Parents may have to seek advice from more than one mental health professional and be aware that insurance may not cover the illness.

Melissa Lind