Myths and Facts about PTSD

By Harold Cohen, Ph.D.

Myth: PTSD is only seen in people with “weak characters” who are unable to cope with difficult situations in the same way that most of us do.

Fact: PTSD is a human response to markedly abnormal situations, and it involves specific chemical changes in the brain that occur in response to a person experiencing a traumatic event. Many of the symptoms of PTSD seem to be a direct result of such brain changes.

Myth: All of us have been through frightening experiences and have at least one symptom of PTSD as a result of that experience.

Fact: Although memories of frightening experiences may be similar to symptoms of PTSD (e.g., vivid memories), most persons do not have the severity of symptoms or impairment associated with PTSD. The specific brain-based responses seen in PTSD differ from those seen in normal anxiety. Similarly, the experiences of normal anxiety and of PTSD are markedly different.

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14 Things You Might Not Know About Depression

Depression is the second most common mental illness in America, but it is still misunderstood by many people. Education is the key to reducing the stigma associated with mental illness. The following are some little known facts about Depression.

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Understanding the Effects of Domestic Violence

Domestic violence physically, psychologically and socially affects women, men and their families.

Initially, the abuse usually is an attempt by one partner to exert control through intimidation, fear, verbal abuse or threats of violence. Victims of domestic violence may be isolated from friends, family and neighbors and lose their network of social support. With time, the abusive partner, or batterer, may use increasingly severe methods to maintain control. Eventually the violence may lead to serious injury and can result in hospitalization, or death.

Domestic violence robs victims of their fundamental right to maintain control over their own lives. Individuals who are abused live in fear and isolation in the one place they should always feel safe, their home. With tremendous courage and strength, they struggle each day to keep themselves and their children safe.

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Types of Domestic Abuse and How to Recognize Them

Adapted from an article written by Cathy Meyer

Whether domestic abuse is overt or covert, it is about control. Aggression is primitive and immature reactions to a sense of helplessness and feeling a loss of control. Domestic abuse, violet or non-violent is used to keep a sense of safety for the abuser.

Covert abuse is sly and underhanded. It is hard to identify and requires long term observation in some situations. It is made up of a few actions and creates an atmosphere of intimidation, uncertainty and perplexity in its victim.

There are many types of domestic abuse a spouse can inflict upon another spouse. Physical abuse, emotional abuse, verbal abuse, sexual abuse and financial abuse are some common ones.

Below are some guidelines that will help you identify some of the different types of abuse.

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Schizophrenia 101: What Causes Schizophrenia?

There is no known single cause of schizophrenia. Many diseases, such as heart disease, result from interplay of genetic, behavioral and other factors, and this may be the case for schizophrenia as well. Scientists do not yet understand all of the factors necessary to produce schizophrenia, but all the tools of modern biomedical research are being used to search for genes, critical moments in brain development, and other factors that may lead to the illness.

Is It Caused by a Chemical Defect in the Brain?

Basic knowledge about brain chemistry and its link to schizophrenia is expanding rapidly. Neurotransmitters, substances that allow communication between nerve cells, have long been thought to be involved in the development of schizophrenia. It is likely, although not yet certain, that the disorder is associated with some imbalance of the complex, interrelated chemical systems of the brain, perhaps involving the neurotransmitters dopamine and glutamate. This area of research is promising.

Is It Caused by a Physical Abnormality in the Brain?

There have been dramatic advances in neuro-imaging technology that permit scientists to study brain structure and function in living individuals. Many studies of people with schizophrenia have found abnormalities in brain structure (for example, enlargement of the fluid-filled cavities, called the ventricles, in the interior of the brain, and decreased size of certain brain regions) or function (for example, decreased metabolic activity in certain brain regions).

It should be emphasized that these abnormalities are quite subtle and are not characteristic of all people with schizophrenia, nor do they occur only in individuals with this illness. Microscopic studies of brain tissue after death have also shown small changes in distribution or number of brain cells in people with schizophrenia. It appears that many (but probably not all) of these changes are present before an individual becomes ill, and schizophrenia may be, in part, a disorder in development of the brain.

Developmental neurobiologists funded by the National Institute of Mental Health (NIMH) have found that schizophrenia may be a developmental disorder resulting when neurons form inappropriate connections during fetal development. These errors may lie dormant until puberty, when changes in the brain that occur normally during this critical stage of maturation interact adversely with the faulty connections. This research has spurred efforts to identify prenatal factors that may have some bearing on the apparent developmental abnormality.

In other studies, investigators using brain-imaging techniques have found evidence of early biochemical changes that may precede the onset of disease symptoms, prompting examination of the neural circuits that are most likely to be involved in producing those symptoms. Meanwhile, scientists working at the molecular level are exploring the genetic basis for abnormalities in brain development and in the neurotransmitter systems regulating brain function.

Do People Inherit Schizophrenia?

It has long been known that schizophrenia runs in families. However, schizophrenia is not passed on directly, like eye or hair color. Other conditions are necessary because other factors are involved. Otherwise, schizophrenia would always develop in both identical twins, since they have the same heredity.

Scientists are studying genetic factors in schizophrenia. It appears likely that multiple genes are involved in creating a predisposition to develop the disorder. In addition, factors such as prenatal difficulties like intrauterine starvation or viral infections, perinatal complications, and various nonspecific stressors, seem to influence the development of schizophrenia. However, it is not yet understood how the genetic predisposition is transmitted, and it cannot yet be accurately predicted whether a given person will or will not develop the disorder.

Several regions of the human genome are being investigated to identify genes that may confer susceptibility for schizophrenia. The strongest evidence to date leads to chromosomes 13 and 6 but remains unconfirmed. Identification of specific genes involved in the development of schizophrenia will provide important clues into what goes wrong in the brain to produce and sustain the illness and will guide the development of new and better treatments. To learn more about the genetic basis for schizophrenia, the NIMH has established a Schizophrenia Genetics Initiative that is gathering data from a large number of families of people with the illness.

People who have a close blood relative with schizophrenia are more likely to develop the disorder than are people who have no relatives with the illness. If both biologic parents have schizophrenia, there is nearly a 40% chance that their child will get it, too. This happens even if the child is adopted and raised by mentally healthy adults. In people who have an identical twin with schizophrenia, the chance of schizophrenia developing is almost 50%.

In contrast, children whose biological parents are mentally healthy-even if their adoptive parents have schizophrenia-have about a 1% chance of getting the disease. That is about the same risk as for the general population shown in the chart.

Chances of Developing Schizophrenia

• General population: 1%
• Brother or sister has schizophrenia: 8%
• One parent has schizophrenia: 10-12%
• Fraternal twin has schizophrenia: 14%
• Both parents have schizophrenia: 39%
• Identical twin has schizophrenia: 47-50%

Sources:

NIMH (National Institute of Mental Health)

John M. Grohol, Psy.D.

Jim Haggerty, M.D.

Schizophrenia 101: An Introduction to Schizophrenia

By Michael Bengston, M.D.

Throughout recorded history, the disease we now know as schizophrenia has been a source of bewilderment. Those suffering from the illness once were thought to be possessed by demons and were feared, tormented, exiled or locked up forever.

In spite of advances in the understanding of its causes, course and treatment, schizophrenia continues to confound both health professionals and the public. It is easier for the average person to cope with the idea of cancer than it is to understand the odd behavior, hallucinations or strange ideas of the person with schizophrenia.

As with many mental disorders, the causes are poorly understood. Friends and family commonly are shocked, afraid or angry when they learn of the diagnosis.

Expectations become more realistic as schizophrenia is better understood as a brain disease that requires ongoing treatment. Demystification of the illness, along with recent insights from basic neuroscience, gives new hope for finding more effective treatments for an illness that previously carried a grave prognosis.

Schizophrenia occurs in about 1 percent of the general U.S. population. That means that more than 3 million Americans suffer from the illness.

The disorder manifests itself in a broad range of unusual behaviors, which cause profound disruption in the lives of the patients suffering from the condition and in the lives of the people around them. Schizophrenia strikes without regard to gender, race, social class or culture.

One of the most important kinds of impairment caused by schizophrenia involves the person’s thought processes. The individual can lose much of the ability to rationally evaluate his surroundings and interactions with others.

There can be hallucinations and delusions, which reflect distortions in the perception and interpretation of reality. The resulting behaviors may seem bizarre to the casual observer, even though they may be consistent with the schizophrenic’s abnormal perceptions and beliefs.

Nearly one-third of those diagnosed with schizophrenia will attempt suicide. About 10 percent of those with the diagnosis will commit suicide within 20 years of the beginning of the disorder.

Patients with schizophrenia are not likely to share their suicidal intentions with others, making life-saving interventions more difficult. The risk of depression needs special mention due to the high rate of suicide in these patients.

The most significant risk of suicide in schizophrenia is among males under 30 who have some symptoms of depression and a relatively recent hospital discharge. Other risks include imagined voices directing the patient toward self-harm (auditory command hallucinations) and intense false beliefs (delusions).

The relationship of schizophrenia to substance abuse is significant. Due to impairments in insight and judgment, people with schizophrenia may be less able to judge and control the temptations and resulting difficulties associated with drug or alcohol abuse.

In addition, it is not uncommon for people suffering from this disorder to try to “self-medicate” their otherwise debilitating symptoms with mind-altering drugs. The abuse of such substances, most commonly nicotine, alcohol, cocaine and marijuana, impedes treatment and recovery.

The chronic abuse of cigarettes among schizophrenic patients is well-documented and probably related to the mind-altering effects of nicotine. Some researchers believe that nicotine affects brain chemical systems that are disrupted in schizophrenia; others speculate that nicotine counters some of the unwanted reactions to medications used to treat the disease.

It is not uncommon for people diagnosed with schizophrenia to die prematurely from other medical conditions, such as coronary artery disease and lung disease. It is unclear whether schizophrenic patients are genetically predisposed to these physical illnesses or whether such illnesses result from unhealthy lifestyles associated with schizophrenia.

Substance Use with Co-morbid Obesity in Patients with Bipolar Disorder

By Roger S. McIntyre, MD

The rising prevalence and dispersion of obesity in North America in the past decade is analogous to a communicable disease epidemic.¹ Longitudinal and cross-sectional associations between major depressive disorder, schizophrenia, and obesity have been established.^2,3 Existing evidence also indicates that there is an association between bipolar disorder and obesity.^3-8 For example, of the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) program, 377 were evaluated for height and weight. The average body mass index (BMI) for the sample was 27.7 ± 6.2 (normal BMI is 20 to 24.9). The results showed that 55% of the patients were either overweight (28%) with a BMI of 25 to 30 kg/m2 or obese (27%) with a BMI greater than 30 kg/m2, which is a much higher percentage than in the general population.⁸

Higher rates of excessive weight, obesity, and abdominal obesity are consistently reported in individuals with bipolar disorder in other epidemiological and clinical studies as well.^4,6 Identified risk factors for obesity in the bipolar disorder population include female sex, economic status, level of education, amount of physical activity, and treatment with weight-gain-promoting agents.^4,6 Additional determinants of body weight are total daily intake of simple carbohydrates, total energy intake, caffeine consumption, comorbid binge-eating disorder, and number of previous depressive episodes.^6,9

A look at the evidence

Compelling evidence also indicates that individuals with bipolar disorder are differentially affected by substance and alcohol use disorders.¹⁰ When examined alone and together, substance use disorders and obesity were associated with a multi-episode course of bipolar disorder, suicidality, depression severity, decreased probability of symptomatic remission, and shorter time to episode recurrence compared with non-substance abusing and healthy-weight persons with bipolar disorder.^10,11

Several investigations as well as media reports have pressed the point that moderate alcohol consumption may convey a protective effect for cardiovascular disease and diabetes.¹² A possible mediator of this association is the reduced BMI associated with habitual moderate alcohol intake. In the aggregate, however, the possible somatic benefits of alcohol use in patients with bipolar disorder are significantly overshadowed by the liability and hazardous dysfunction associated with alcohol-related conditions.

Over the past decade, there has been an increasingly audible clarion call to conceptualize excessive eating (phenotypically expressed as obesity) as an addictive behavior.¹³ A defining characteristic of addiction is the overpowering motivational strength and decreased ability to control the desire to obtain a substance despite economic, social, and health-related consequences.¹⁴ In the case of excess weight and obesity, afflicted individuals continue to forage and ingest food despite the obvious social, interpersonal, and medical consequences. Neurobiological investigations increasingly support a heuristic model-namely that obesity and substance use disorders are subserved by overlapping and functionally abnormal reward motivation neural networks.

Substance abuse, obesity, and bipolar disorder

To the best of our knowledge, our group was the first to primarily evaluate the interrelationship between substance use disorders and overweight/obesity in a large population sample of persons with bipolar I disorder.¹⁵ The encompassing aims of the investigation were to provide further refinement to the patho-physiological model subserving these co-occurring syndromes as well as to inform clinical practice.

The data for our analysis were extracted from the Canadian Community Health Survey-Mental Health and Well-Being; a component of the Canadian Community Health Survey, conducted by Statistics Canada. Respondents were residents of private dwellings; a multistage stratified cluster design was used to sample dwellings. Most interviews (86%) were conducted in person, the remainder by telephone. The responding sample totaled 36,984 persons aged 15 years or older, and the participation rate was high (77%).

BMI was computed after gathering information related to respondents’ height and weight. Alcohol dependence within the past year was determined using DSM-IV criteria, and illicit drug dependence within the past year was determined by self-report.¹⁶

In keeping with extant literature, individuals with bipolar I disorder had a significantly higher rate of substance dependence than did the general population. The age-adjusted rate of overweight/obesity in bipolar individuals was also significantly higher than reported in the general population (Table).

Overweight and obese participants with bipolar disorder had a significantly lower rate of substance dependence than did bipolar respondents with normal weight. The association between weight and substance dependence remained after a multivariate statistical analysis that controlled for the effect of socio-demographic factors, such as age and sex, as well as behavioral factors, including leisure-time physical activity and hypertension (Table).

In keeping with the a priori hypothesis, individuals with bipolar disorder with a history of substance dependence had lower rates of overweight and obesity than did non-substance-dependent bipolar respondents (Table). This association also remained after multivariate analysis.

Although not the primary emphasis of this study, we also determined that the inverse relationship between overweight/obesity and substance dependence applied to persons in the general population who did not screen positive for bipolar disorder.

Mechanisms behind the connection

When reviewed together, the results of our investigation indicated that 2 commonly encountered syndromes in bipolar disorder-overweight/obesity and substance dependence-are inversely associated. The translational value of these results has research and clinical implications. From the perspective of patho-physiological research, it could be conjectured that the interrelationship between both phenotypes in bipolar individuals reflects a common and competing abnormality in the brain reward system. For example, dopamine, a critical neurotransmitter in brain reward circuitry, is implicated in the patho-physiology of manic and depressive episodes, substance abuse, and obesity.

In keeping with this view, individuals who are obese or addicted to cocaine, alcohol, or opiates all exhibit similar down-regulation in striatal D2 receptor expression. An additional, or alternative, hypothesis is that opioidergic mechanisms may be salient because opioid receptor agonists stimulate appetite while opioid antagonists have the opposite effect. Other hypotheses would be that the relationship is an epiphenomenon of malnutrition and poor somatic health in substance-abusing individuals, or that the pharmacological treatments for bipolar disorder, which are often weight gain-promoting, are also salutary for substance use disorders.

Emerging models also indicate that ingestive neuropeptides (peptides that promote ingestion) may be salient to the association between food intake and alcohol-seeking behavior. The pleiotropic peptide leptin, for example, exerts effects on disparate somatic functions, including energy and temperature regulation, appetite, and reproductive hormonal function.^17-18 It has been documented that circulating leptin levels, which increase as a function of BMI, exert an effect on cravings for alcohol.^19,20

The results of our investigation need to be considered preliminary and in need of replication because of 4 methodological factors: first, a semistructured interview was used, rather than a clinical interview by a mental health practitioner; second, small sample size precluded adequate subgroup analysis; third, data collection was limited to the past year of substance use; and finally, the survey was based on self-report.

Summary

From a clinical perspective, all individuals with bipolar disorder who abuse alcohol or illicit substances need to be counseled on the benefits of adequate nutrition as part of a chronic disease-management model as it specifically relates to a comorbid substance use condition. Alternatively, one could conjecture that intensive weight management strategies in patients with bipolar disorder may alter their propensity for substance misuse, inviting the need for careful clinical surveillance. Preclinical models indicate that hunger intensifies cravings for illicit substance misuse, while caloric intake serves an opposing effect.^13,21-22 These data also provide the impetus for practitioners to consider somatic and nutritional aspects in all individuals with bipolar disorder, notably persons with abnormal body weight.

Source: www.psychiatrictimes.com/bipolar-disorder/article/10168/1166997

July 1, 2008
Psychiatric Times. Vol. 25 No. 8

CLINICAL

By Roger S. McIntyre, MD

Dr McIntyre is associate professor in the department of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit, University Health Network, in Toronto.
Evidence-Based References

McIntyre RS, McElroy SL, Konarski JZ, et al. Substance use disorders and overweight/obesity in bipolar I disorder: preliminary evidence for competing addictions. J Clin Psychiatry. 2007;68:1352-1357.

McIntyre RS, Soczynska JK, Beyer JL, et al. Medical comorbidity in bipolar disorder: re-prioritizing unmet needs. Curr Opin Psychiatry. 2007;20:406-416.

References

1. Mokdad AH, Bowman BA, Ford ES, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286:1195-1200.
2. Coodin S. Body mass index in persons with schizophrenia. Can J Psychiatry. 2001;46:549-555.
3. Simon GE, Von Korff M, Saunders K, et al. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry. 2006;63: 824-830.
4. McIntyre RS, Konarski JZ, Wilkins K, et al. Obesity in bipolar disorder and major depressive disorder: results from a national community health survey on mental health and well-being. Can J Psychiatry. 2006;51:274-280.
5. Elmslie JL, Silverstone JT, Mann JI, et al. Prevalence of overweight and obesity in bipolar patients. J Clin Psychiatry. 2000;61:179-184.
6. McElroy SL, Frye MA, Suppes T, et al. Correlates of overweight and obesity in 644 patients with bipolar disorder. J Clin Psychiatry. 2002;63:207-213.
7. McElroy S, Allison D, Bray G. Obesity and Mental Disorders. New York: Taylor & Francis; 2006.
8. Wang PW, Sachs GS, Zarate CA, et al. Overweight and obesity in bipolar disorders. J Psychiatr Res.2006;40:762-764.
9. Elmslie JL, Mann JI, Silverstone JT, et al. Determinants of overweight and obesity in patients with bipolar disorder. J Clin Psychiatry. 2001;62:486-491.
10. Goldberg JF. Bipolar disorder with comorbid substance abuse: diagnosis, prognosis, and treatment. J Psychiatr Pract. 2001;7:109-122.
11. Fagiolini A, Kupfer DJ, Houck PR, et al. Obesity as a correlate of outcome in patients with bipolar I disorder. Am J Psychiatry. 2003;160:112-117.
12. Fuchs FD, Chambless LE. Is the cardioprotective effect of alcohol real? Alcohol. 2007;41:399-402.
13. Volkow ND, O’Brien CP. Issues for DSM-V: should obesity be included as a brain disorder? Am J Psychiatry. 2007;164:708-710.
14. Volkow ND, Wise RA. How can drug addiction help us understand obesity? Nat Neurosci. 2005;8:555-560.
15. McIntyre RS, McElroy S, Konarski JZ, et al. Substance use disorders and overweight/obesity in bipolar I disorder: preliminary evidence for competing addictions. J Clin Psychiatry. 2007;68:1352-1357.
16. Tjepkema M. Alcohol and illicit drug dependence. Health Rep. 2004;15(suppl):9-19.
17. Auwerx J, Staels B. Leptin. Lancet. 1998;351:737-742.
18. Gale SM, Castracane VD, Mantzoros CS. Energy homeostasis, obesity and eating disorders: recent advances in endocrinology. J Nutr. 2004;134:295-298.
19. Kiefer F, Jahn H, Jaschinski M, et al. Leptin: a modulator of alcohol craving? Biol Psychiatry. 2001;49:782-787.
20. Kristensen P, Judge ME, Thim L, et al. Hypothalamic CART is a new anorectic peptide regulated by leptin. Nature. 1998;393:72-76.
21. Volkow ND, Wang GJ, Fowler JS, et al. “Nonhedonic” food motivation in humans involves dopamine in the dorsal striatum and methylphenidate amplifies this effect. Synapse. 2002;44:175-180.
22. Volkow ND, Wang GJ, Maynard L, et al. Brain dopamine is associated with eating behaviors in humans. Int J Eat Disord. 2003;33:136-142.

The Many Faces and Facets of Bipolar Disorder

The Many Faces and Facets of Bipolar Disorder – Full pdf file including pictures and personal stories

Bipolar disorder can show up in many costumes. It can be happy or sad, euphoric or desperate, energized or exhausted. It can party until dawn, unleash unparalleled creativity, and woo strangers. It can also terrify store clerks, drain bank accounts, and drive away loved ones. It can bring on the voices of heaven or hell.

More than two million American adults, or about 1 percent of the population age 18 and older in any given year, have bipolar disorder, according to the National Institute of Mental Health. The illness typically develops in late adolescence or early adulthood. It is often not recognized as an illness-instead chalked up to a personality quirk or diagnosed as unipolar depression-and people may suffer for years before they receive proper treatment.

Bipolar disorder is one of the most complex forms of mental illness-each case is unique to the particular patient. It’s not like the flu, in which the illness takes a predictable path, or even cancer, where a “cure” is always hoped for in spite of the unpredictability of the disease. There is no fail-safe remedy for bipolar disorder, and the symptoms of the diagnosis can often change throughout the life of the individual.
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Bipolar Disorder Statistics

Who is Affected by Bipolar Disorder
Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year.

The median age of onset for bipolar disorder is 25 years, although the illness can start in early childhood or as late as the 40’s and 50’s.

An equal number of men and women develop bipolar illness and it is found in all ages, races, ethnic groups and social classes.

More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component. Read more

Some Facts About Mental Illnesses

Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.

Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD), and borderline personality disorder. The good news about mental illness is that recovery is possible.

Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.

In addition to medication treatment, psychosocial treatment such as cognitive behavioral therapy, interpersonal therapy, peer support groups, and other community services can also be components of a treatment plan and that assist with recovery. The availability of transportation, diet, exercise, sleep, friends, and meaningful paid or volunteer activities contribute to overall health and wellness, including mental illness recovery.

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