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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

Bipolar Disorder and Suicide Risk

Physical Proof and a Big Shocker – Bipolar Disorder and Suicide Risk

Bipolar HeadI read a lot of news about bipolar disorder and other psychiatric disorders (OCD, ADHD, chronic depression, borderline personality disorder, etc.).  In my reading, I came across an article that describes brain scan abnormalities in teens and young adults who have attempted suicide but I found a lot more.

A study conducted at Yale School of Medicine examined brain scans of 26 young adults and teenagers with bipolar disorder who had attempted suicide.  These were compared with scans of 42 bipolar patients who had not attempted suicide and with 45 non-bipolar subjects.  The results were not really surprising – as many research studies are not.

The bipolar patients, who had attempted suicide, showed abnormalities when compared to the other two groups, specifically in the  which showed “less integrity”.

Frontal lobe animationThis means that the frontal lobe (which controls impulses) is not as “connected” to areas that control emotion, motivation and memory.  Researchers indicate that the brain abnormalities may disrupt the ability of the impulse control mechanism to filter emotion and motivational messages appropriately.

In short this means that those patients can’t stop negative emotions and impulses to do something drastic… like attempt suicide and not surprisingly, less integrity or more abnormality – likely means more suicide attempts.

While it is good that they are discovering some physical proof of actual defect, eventually to move bipolar disorder into a category that can be scientifically documented, it doesn’t offer a lot of real-life solutions.  Most of us who are bipolar or know someone who is bipolar, know that there is something wrong or at least different about our brain…and it only makes sense that a person, who is trying to kill himself, is probably a little worse off.

As usual, I found myself thinking “…and… the point is…” which I often do when I read a synopsis of a largely inconsequential research study but then something caught my eye.  It was something that was a lot worse than I thought – statistics.

About 4 percent of Americans are afflicted with bipolar disorder, though sometimes we feel like it is others who are afflicted.  That is not surprising either.  Some groups show a slightly lower percentage at about 2.6 percent of the population.

Bipolar SuicideWhat surprised me was the statistic regarding suicide.  The article – that is from a reputable source – indicates that 25 to 50 percent of people with bipolar disorder are likely to attempt suicide and that 15 to 20 percent are likely to succeed.  Wow.  I didn’t know that.  Funny thing that I didn’t know since of the 20 or so bipolar people I have been close friends with at one time or another – at least four of them are dead.

When searching for confirmation (which I found from the NIH that about 1 in 5 bipolar patients complete suicide), I also found a number of additional shocking statistics:

  • Bipolar disorder results in a 9.2 year reduction in lifespan
  • Bipolar disorder is the 6th leading cause of disability, worldwide
  • Bipolar disorder is found in all races, ethnicities, ages, genders and socioeconomic groups
  • A child with one bipolar parent has a 15-30% chance of having the disorder
  • A child with two bipolar parents has a 50-75% chance of having the disorder
  • There are 3.4 million CHILDREN with depression in the US but up to one-third of those kids may actually have bipolar disorder
  • Bipolar disorder criteria have likely been met for at least 1 percent of all adolescents

Maybe these aren’t shocking for you.  Maybe you already knew all this – but maybe you didn’t.

I have known I had bipolar disorder for a long time – and have known a lot more people with bipolar disorder and I didn’t know all this stuff or maybe like everything else, I chose not to remember.

Food for thought; Take your medicines!

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.

Depression in Children

It may not seem possible, and most people don’t want to think about depression in children.

Different from developmental disorders such as ADHD or Autism Spectrum Disorders and different from mental disorders such as Schizophrenia, which have obvious symptoms, Depression can occur in children.

Childhood DepressionUp until about 20 years ago, depression in children wasn’t widely recognized.  It wasn’t that the depression didn’t exist; it was undoubtedly just that we didn’t know about it.  Two decades ago, even if the child was aware that “something” was wrong, the parents, teachers, and other adults were likely to dismiss it as a “stage” or “phase” that the child was going through.

There were several reasons for that way of thinking, such as:

  • A belief that children didn’t get depression – adolescents were dismissed as “moody,” younger children were dismissed as “difficult.”
  • Medication available for depression wasn’t appropriate for children due to severe side effects.  Newer antidepressants were not available until Prozac was approved in 1988 for adults.  These medications known as “serotonin specific reuptake inhibitors” (SSRIs) were not approved for children until 2002 and to date, only Prozac is recommended for depression in children though Zoloft and Luvox may be used for Obsessive Compulsive Disorder (OCD) in children.
  • The long-term effects of depression were not yet known.  Depression at any age can contribute to chronic diseases such as diabetes and heart disease.

Today, we recognize childhood depression.  About 11 percent of children have experienced at least one episode of childhood depression before the age of 18, according to the National Institute of Mental Health. Normal behavior can certainly vary from child to child and from age to age – as children are prone to “stages” that they will grow out of.  But if a child has an extended period of depression – it is something that should be properly addressed. Such serious issues should not be taken lightly.

Juveniles (those up to age 17) often have different symptoms of depression than those common in adults.  Children with depression may be excessively sad and lethargic, but depression may also show as:

  • Complaints of illness
  • Refusal to go to school
  • Clinging to a parent or caregiver
  • Excessive worrying
  • Sulking
  • Grouchiness
  • Anxiety
  • Acting out at school
  • Excessive negativeness
  • Feelings of being misunderstood

Depressed FeelingsThese symptoms are occasionally experienced by most children as they are growing up, but when symptoms persist for several months or interrupt normal activities and development, more investigation is needed.  One needs to find out what the cause may be.  If a child is being bullied – he or she may not want to go to school.  If a child complains of illness – it may truly be sick.  On the other hand if these events occur over and over, you need to discuss the problem with a doctor.  You may also need to see a child psychiatrist or psychologist.  In some cases, therapy may be warranted but in other cases, the child may benefit from medication suitable for depression.

In any event, you should not ignore symptoms of depression or any other mental illness signs – but investigate them.  It may be that your child is “going through a stage”, but it may be more serious.

Children complaining of illness may be depressed!

Obsessive Compulsive Disorder – OCD

Collecting, Organizing, Checking, Washing…. Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder.

OCD - Bug ObsessionIt is composed of two parts: Obsession and Compulsion.  Obsession is the portion of OCD that occupies your thoughts such as excessive concerns about cleanliness (my kids call this germophobia), extreme social fear, fear of harming someone, preoccupation with organization or other intrusive thoughts that create anxiety.  Compulsion is the physical manifestation of needing to do something about the obsessionsCompulsion results in behaviors such as ritualistic behaviors like excessive hand washing, repeatedly checking to make sure the stove is off, counting steps and other extreme behaviors such as hoarding.

OCD the Good
Once I while participating in a wedding, I was attending the rehearsal dinner at the home of the bride whose mother made the appetizers for over 200 people.  I was amazed at her management skills that made her capable of preparing appetizers from a single kitchen – right up until the time that when looking for the restroom adjacent to the laundry, I opened the pantry door.

There, staring at me were over 100 spice containers, of all the same brand, all the same size and all angled at a precise 45-degree angle so that the labels were all pointed exactly at my head.  I was so dumbfounded that I continued to stare and found that on the other shelves there were precise pyramids of 5 cans each of various vegetables – all the same brand, all the same size, with all the labels facing exactly the same direction.

Lining the floor were plastic bins, spaced 2 inches apart…exactly, containing 3 bags each of a variety of pasta, flour, rice…. all of course the same brand, carefully placed in the bin, with the label in exactly the same location.

This is OCD at its best – at least for others.  She had an obsession and a compulsion that created this superbly organized pantry.  Likely though, even this “good” OCD manifestation took up a lot of her time – and had a negative impact on her daily life and that of her family’s.

OCD is not always at its best however and can result in the opposite – hoarding.  I don’t have to go into this but if you haven’t seen it, you should watch “Hoarders” or “Hoarding, Buried Alive” for some insight.

OCD the Bad
In addition to situations like hoarding, OCD can also interfere with life in other ways.  I have a cousin with OCD, who before he was medicated, found himself unable to leave his driveway due to fears that he would back over a child with his car.  This caused him to spend hours – literally hours every morning starting the car, looking in the rear view mirror, getting out of the car to look behind it, getting back in the car, looking in the rear view mirror, getting out of the car….  He eventually found himself unable to work.

Obsessive Compulsive Disorder - OCD Confused MindOthers have found that OCD has limited their lives in similar ways.  Howie Mandel, a well-known comic, has talked about his Obsessive Compulsive Disorder.  It prevented him from appearing in public for many years, in part due to social fear but also due to fear of infection.  Even today, while his disease is “under control,” he does not ever shake hands or allow others to touch him.

How do I know if I have OCD?
A lot of people have rituals – such as specific routines before bed.  A lot of people have extreme concerns which may consume thoughts for a while – such as excessive concerns over money.  The difference in “normal” rituals and “normal” concerns is that they don’t typically impair normal life and they don’t become paralyzing.

Thoughts and behaviors that might indicate OCD:
•    Repeated thoughts or mental pictures about things such as
o    Germs
o    Dirt
o    Intruders
o    Violence
o    Hurting others
o    Embarrassment
o    Disorganization
o    Religious beliefs
•    Repeated behaviors such as:
o    Washing hands
o    Disinfecting surfaces
o    Locking and unlocking doors
o    Counting
o    Repeating steps over and over
o    Keeping unneeded things
o    Excessive grooming
•    Lack of ability to control or stop unwanted thoughts and behaviors
•    Repeated behaviors provide temporary relief from anxiety that is caused by obsessive thoughts
•    Repeated behaviors don’t provide any pleasure other than temporary relief
•    Spending at least 1 hour a day on thoughts and behaviors, creating a negative impact on daily life

The International OCD foundation reports that it takes around 15 years for most people to be diagnosed.  This may be due to hiding of symptoms – but it may also be due to lack of awareness of both the public and health professionals.

What can be done about OCD?
OCD can be treated – it usually cannot be cured but can be controlled.  First line treatment for OCD includes working with a properly trained therapist – most beneficially, one who is trained in cognitive behavioral therapy (CBT).  CBT uses “exposure to” unpleasant stimuli, carried on to the “what if” stage.  “What if” I touch that faucet without disinfecting it?  “What if” I get into the elevator without opening the door 10 times?  The “exposure” period is followed by “response prevention” where the patient chooses NOT to perform the behavior that the “exposure” usually causes.  Over time, the obsession and compulsive thoughts and behaviors become more manageable.
In other cases, medication may be needed – usually given in combination with CBT.  Some antidepressants (not all) will help with OCD.  Anti-depressants that have been shown to help include:
o    Luvox (fluvoxamine)
o    Prozac (fluoxetine)
o    Zoloft (sertraline)
o    Paxil (paroxetine)
o    Celexa (citalopram)
o    Lexapro (escitalopram)
o    Effexor (venlafaxine)

Other medications may also help but have not been “approved” to treat OCD.  Doctors who have found them helpful may use them regardless of whether they are officially approved to treat OCDMedications such as Cymbalta (duloxetine) have been reported to be helpful – and some patients may benefit from short-term use of anti-anxiety agents.

It is important to know that all medications may cause side effects and you should tell your doctor about any other medications you are taking.

Melissa Lind

Obsessive Compulsive Disorder (OCD) is a mental disorder characterized by intrusive thoughts that produce anxiety and by repetitive behaviors aimed at reducing that anxiety.

Obsessive Compulsive Disorder can be treated!