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Anxiety

Anxiety Disorders

It's normal to feel anxious from time to time, especially if your life is stressful. However, excessive, ongoing anxiety and worry that are difficult to control and interfere with day-to-day activities may be a sign of generalized anxiety disorder.

It's possible to develop generalized anxiety disorder as a child or an adult. Generalized anxiety disorder has symptoms that are similar to panic disorder, obsessive-compulsive disorder and other types of anxiety, but they're all different conditions.

Living with generalized anxiety disorder can be a long-term challenge. In many cases, it occurs along with other anxiety or mood disorders. In most cases, generalized anxiety disorder improves with psychotherapy or medications. Making lifestyle changes, learning coping skills and using relaxation techniques also can help.

Symptoms

Generalized anxiety disorder symptoms can vary. They may include:

  • Persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the events

  • Overthinking plans and solutions to all possible worst-case outcomes

  • Perceiving situations and events as threatening, even when they aren't

  • Difficulty handling uncertainty

  • Indecisiveness and fear of making the wrong decision

  • Inability to set aside or let go of a worry

  • Inability to relax, feeling restless, and feeling keyed up or on edge

  • Difficulty concentrating, or the feeling that your mind "goes blank"

Physical signs and symptoms may include:

  • Fatigue

  • Trouble sleeping

  • Muscle tension or muscle aches

  • Trembling, feeling twitchy

  • Nervousness or being easily startled

  • Sweating

  • Nausea, diarrhea or irritable bowel syndrome

  • Irritability

There may be times when your worries don't completely consume you, but you still feel anxious even when there's no apparent reason. For example, you may feel intense worry about your safety or that of your loved ones, or you may have a general sense that something bad is about to happen.

Your anxiety, worry or physical symptoms cause you significant distress in social, work or other areas of your life. Worries can shift from one concern to another and may change with time and age.

Causes

As with many mental health conditions, the cause of generalized anxiety disorder likely arises from a complex interaction of biological and environmental factors, which may include:

  • Differences in brain chemistry and function

  • Genetics

  • Differences in the way threats are perceived

  • Development and personality

Risk factors

Women are diagnosed with generalized anxiety disorder somewhat more often than men are. The following factors may increase the risk of developing generalized anxiety disorder:

  • Personality. A person whose temperament is timid or negative or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are.

  • Genetics. Generalized anxiety disorder may run in families.

  • Experiences. People with generalized anxiety disorder may have a history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event. Chronic medical illnesses or other mental health disorders may increase risk.

Diagnosis

To help diagnose generalized anxiety disorder, your doctor or mental health professional may:

  • Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition

  • Order blood or urine tests or other tests, if a medical condition is suspected

  • Ask detailed questions about your symptoms and medical history

  • Use psychological questionnaires to help determine a diagnosis

  • Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Treatment decisions are based on how significantly generalized anxiety disorder is affecting your ability to function in your daily life. The two main treatments for generalized anxiety disorder are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

Medications

Several types of medications are used to treat generalized anxiety disorder, including those below. Talk with your doctor about benefits, risks and possible side effects.

Bipolar

Bipolar Disorder

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).

Symptoms

There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.

  • Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).

  • Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.

  • Cyclothymic disorder. You've had at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).

  • Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Mania and hypomania

Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

  • Abnormally upbeat, jumpy or wired

  • Increased activity, energy or agitation

  • Exaggerated sense of well-being and self-confidence (euphoria)

  • Decreased need for sleep

  • Unusual talkativeness

  • Racing thoughts

  • Distractibility

  • Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

  • Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)

  • Marked loss of interest or feeling no pleasure in all — or almost all — activities

  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)

  • Either insomnia or sleeping too much

  • Either restlessness or slowed behavior

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive or inappropriate guilt

  • Decreased ability to think or concentrate, or indecisiveness

  • Thinking about, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Diagnosis

To determine if you have bipolar disorder, your evaluation may include:

  • Physical exam. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms.

  • Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms.

  • Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.

  • Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Diagnosis in children

Although diagnosis of children and teenagers with bipolar disorder includes the same criteria that are used for adults, symptoms in children and teens often have different patterns and may not fit neatly into the diagnostic categories.

Also, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems, which can make diagnosis more complicated. Referral to a child psychiatrist with experience in bipolar disorder is recommended.

Treatment

Treatment is best guided by a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse.

Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include:

  • Medications. Often, you'll need to start taking medications to balance your moods right away.

  • Continued treatment. Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.

  • Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.

  • Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.

  • Hospitalization. Your doctor may recommend hospitalization if you're behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic or major depressive episode.

The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups.

Depression

Depression

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.
 

Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

  • Feelings of sadness, tearfulness, emptiness or hopelessness

  • Angry outbursts, irritability or frustration, even over small matters

  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports

  • Sleep disturbances, including insomnia or sleeping too much

  • Tiredness and lack of energy, so even small tasks take extra effort

  • Reduced appetite and weight loss or increased cravings for food and weight gain

  • Anxiety, agitation or restlessness

  • Slowed thinking, speaking or body movements

  • Feelings of worthlessness or guilt, fixating on past failures or self-blame

  • Trouble thinking, concentrating, making decisions and remembering things

  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

  • Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

  • In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.

  • In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

  • Memory difficulties or personality changes

  • Physical aches or pain

  • Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication

  • Often wanting to stay at home, rather than going out to socialize or doing new things

  • Suicidal thinking or feelings, especially in older men

Causes

  • It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

  • Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.

  • Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.

  • Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.

  • Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.

Diagnosis

  • Your doctor may determine a diagnosis of depression based on:

  • Physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem.

  • Lab tests. For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it's functioning properly.

  • Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.

  • DSM-5. Your mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Types of depression

  • Symptoms caused by major depression can vary from person to person. To clarify the type of depression you have, your doctor may add one or more specifiers. A specifier means that you have depression with specific features, such as:

  • Anxious distress — depression with unusual restlessness or worry about possible events or loss of control

  • Mixed features — simultaneous depression and mania, which includes elevated self-esteem, talking too much and increased energy

  • Melancholic features — severe depression with lack of response to something that used to bring pleasure and associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt, agitation or sluggishness

  • Atypical features — depression that includes the ability to temporarily be cheered by happy events, increased appetite, excessive need for sleep, sensitivity to rejection, and a heavy feeling in the arms or legs

  • Psychotic features — depression accompanied by delusions or hallucinations, which may involve personal inadequacy or other negative themes

  • Catatonia — depression that includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture

  • Peripartum onset — depression that occurs during pregnancy or in the weeks or months after delivery (postpartum)

  • Seasonal pattern — depression related to changes in seasons and reduced exposure to sunlight

Treatment

  • Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.

  • If you have severe depression, you may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.

Eating Disorder

Eating Disorders

Eating disorders are serious conditions related to persistent eating behaviors that negatively impact your health, your emotions and your ability to function in important areas of life. The most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder.

Most eating disorders involve focusing too much on your weight, body shape and food, leading to dangerous eating behaviors. These behaviors can significantly impact your body's ability to get appropriate nutrition. Eating disorders can harm the heart, digestive system, bones, and teeth and mouth, and lead to other diseases.

Eating disorders often develop in the teen and young adult years, although they can develop at other ages. With treatment, you can return to healthier eating habits and sometimes reverse serious complications caused by the eating disorder.

Symptoms

Symptoms vary, depending on the type of eating disorder. Anorexia nervosa, bulimia nervosa and binge-eating disorder are the most common eating disorders. Other eating disorders include rumination disorder and avoidant/restrictive food intake disorder.

Anorexia nervosa

Anorexia (an-o-REK-see-uh) nervosa — often simply called anorexia — is a potentially life-threatening eating disorder characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight or shape. People with anorexia use extreme efforts to control their weight and shape, which often significantly interferes with their health and life activities.

When you have anorexia, you excessively limit calories or use other methods to lose weight, such as excessive exercise, using laxatives or diet aids, or vomiting after eating. Efforts to reduce your weight, even when underweight, can cause severe health problems, sometimes to the point of deadly self-starvation.

Bulimia nervosa

Bulimia (boo-LEE-me-uh) nervosa — commonly called bulimia — is a serious, potentially life-threatening eating disorder. When you have bulimia, you have episodes of bingeing and purging that involve feeling a lack of control over your eating. Many people with bulimia also restrict their eating during the day, which often leads to more binge eating and purging.

During these episodes, you typically eat a large amount of food in a short time, and then try to rid yourself of the extra calories in an unhealthy way. Because of guilt, shame and an intense fear of weight gain from overeating, you may force vomiting or you may exercise too much or use other methods, such as laxatives, to get rid of the calories.

If you have bulimia, you're probably preoccupied with your weight and body shape, and may judge yourself severely and harshly for your self-perceived flaws. You may be at a normal weight or even a bit overweight.

Binge-eating disorder

When you have binge-eating disorder, you regularly eat too much food (binge) and feel a lack of control over your eating. You may eat quickly or eat more food than intended, even when you're not hungry, and you may continue eating even long after you're uncomfortably full.

After a binge, you may feel guilty, disgusted or ashamed by your behavior and the amount of food eaten. But you don't try to compensate for this behavior with excessive exercise or purging, as someone with bulimia or anorexia might. Embarrassment can lead to eating alone to hide your bingeing.

A new round of bingeing usually occurs at least once a week. You may be normal weight, overweight or obese.

Rumination disorder

Rumination disorder is repeatedly and persistently regurgitating food after eating, but it's not due to a medical condition or another eating disorder such as anorexia, bulimia or binge-eating disorder. Food is brought back up into the mouth without nausea or gagging, and regurgitation may not be intentional. Sometimes regurgitated food is rechewed and reswallowed or spit out.

The disorder may result in malnutrition if the food is spit out or if the person eats significantly less to prevent the behavior. The occurrence of rumination disorder may be more common in infancy or in people who have an intellectual disability.

Avoidant/restrictive food intake disorder

This disorder is characterized by failing to meet your minimum daily nutrition requirements because you don't have an interest in eating; you avoid food with certain sensory characteristics, such as color, texture, smell or taste; or you're concerned about the consequences of eating, such as fear of choking. Food is not avoided because of fear of gaining weight.

The disorder can result in significant weight loss or failure to gain weight in childhood, as well as nutritional deficiencies that can cause health problems.

Causes

The exact cause of eating disorders is unknown. As with other mental illnesses, there may be many causes, such as:

  • Genetics and biology. Certain people may have genes that increase their risk of developing eating disorders. Biological factors, such as changes in brain chemicals, may play a role in eating disorders.

  • Psychological and emotional health. People with eating disorders may have psychological and emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behavior and troubled relationships.

Risk factors

Teenage girls and young women are more likely than teenage boys and young men to have anorexia or bulimia, but males can have eating disorders, too. Although eating disorders can occur across a broad age range, they often develop in the teens and early 20s.

Certain factors may increase the risk of developing an eating disorder, including:

  • Family history. Eating disorders are significantly more likely to occur in people who have parents or siblings who've had an eating disorder.

  • Other mental health disorders. People with an eating disorder often have a history of an anxiety disorder, depression or obsessive-compulsive disorder.

  • Dieting and starvation. Dieting is a risk factor for developing an eating disorder. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. There is strong evidence that many of the symptoms of an eating disorder are actually symptoms of starvation. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.

  • Stress. Whether it's heading off to college, moving, landing a new job, or a family or relationship issue, change can bring stress, which may increase your risk of an eating disorder.

Complications

Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely you are to experience serious complications, such as:

  • Serious health problems

  • Depression and anxiety

  • Suicidal thoughts or behavior

  • Problems with growth and development

  • Social and relationship problems

  • Substance use disorders

  • Work and school issues

  • Death

Diagnosis

Eating disorders are diagnosed based on signs, symptoms and eating habits. If your doctor suspects you have an eating disorder, he or she will likely perform an exam and request tests to help pinpoint a diagnosis. You may see both your primary care provider and a mental health professional for a diagnosis.

Assessments and tests generally include:

  • Physical exam. Your doctor will likely examine you to rule out other medical causes for your eating issues. He or she may also order lab tests.

  • Psychological evaluation. A doctor or mental health professional will likely ask about your thoughts, feelings and eating habits. You may also be asked to complete psychological self-assessment questionnaires.

  • Other studies. Additional tests may be done to check for any complications related to your eating disorder.

Your mental health professional also may use the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment

Treatment of an eating disorder generally includes a team approach. The team typically includes primary care providers, mental health professionals and dietitians — all with experience in eating disorders.

Treatment depends on your specific type of eating disorder. But in general, it typically includes nutrition education, psychotherapy and medication. If your life is at risk, you may need immediate hospitalization.

Healthy eating

No matter what your weight, the members of your team can work with you to design a plan to help you achieve healthy eating habits.

Psychotherapy

Psychotherapy, also called talk therapy, can help you learn how to replace unhealthy habits with healthy ones. This may include:

  • Family-based therapy (FBT). FBT is an evidence-based treatment for children and teenagers with eating disorders. The family is involved in making sure that the child or other family member follows healthy-eating patterns and maintains a healthy weight.

  • Cognitive behavioral therapy (CBT). CBT is commonly used in eating disorder treatment, especially for bulimia and binge-eating disorder. You learn how to monitor and improve your eating habits and your moods, develop problem-solving skills, and explore healthy ways to cope with stressful situations.

Medications

Medication can't cure an eating disorder. However, certain medications may help you control urges to binge or purge or to manage excessive preoccupations with food and diet. Drugs such as antidepressants and anti-anxiety medications may help with symptoms of depression or anxiety, which are frequently associated with eating disorders.

Grief

Prolonged Grief Disorder

Grief is a natural response to the loss of a loved one. For most people, the symptoms of grief begin to decrease over time. However, for a small group of people, the feeling of intense grief persists, and the symptoms are severe enough to cause problems and stop them from continuing with their lives. Prolonged grief disorder is characterized by this intense and persistent grief that causes problems and interferes with daily life.

Grief is a natural response to the loss of a loved one. For most people, the symptoms of grief begin to decrease over time. However, for a small group of people, the feeling of intense grief persists, and the symptoms are severe enough to cause problems and stop them from continuing with their lives. Prolonged grief disorder is characterized by this intense and persistent grief that causes problems and interferes with daily life.

Symptoms and Diagnosis

An individual with prolonged grief disorder may experience intense longing for the person who has died or preoccupation with thoughts of that person. In children and adolescents, the preoccupation may focus on the circumstances around the death. Additionally, the individual may experience significant distress or problems performing daily activities at home, work, or other important areas. The persistent grief is disabling and affects everyday functioning in a way that typical grieving does not.

 

For a diagnosis of prolonged grief disorder, the loss of a loved one had to have occurred at least a year ago for adults, and at least 6 months ago for children and adolescents. In addition, the grieving individual must have experienced at least three of the symptoms below nearly every day for at least the last month prior to the diagnosis.

Symptoms of prolonged grief disorder (APA, 2022) include:

  • Identity disruption (such as feeling as though part of oneself has died).

  • Marked sense of disbelief about the death.

  • Avoidance of reminders that the person is dead.

  • Intense emotional pain (such as anger, bitterness, sorrow) related to the death.

  • Difficulty with reintegration (such as problems engaging with friends, pursuing interests, planning for the future).

  • Emotional numbness (absence or marked reduction of emotional experience).

  • Feeling that life is meaningless.

  • Intense loneliness (feeling alone or detached from others).

In addition, the person’s bereavement lasts longer than might be expected based on social, cultural, or religious norms.

An estimated 7%-10% of bereaved adults will experience the persistent symptoms of prolonged grief disorder (Szuhany et al., 2021). Among children and adolescents who have lost a loved one, approximately 5%-10% will experience depression, posttraumatic stress disorder (PTSD), and/or prolonged grief disorder following bereavement (Melhem et al., 2013).

Some individuals may be at greater risk of developing prolonged grief disorder, including older adults and people with a history of depression or bipolar disorder. Caregivers, especially if they were caring for a partner or had experienced depression before the loss, are also at greater risk. The risk for prolonged grief is also greater when the death of the loved one happens very suddenly or under traumatic circumstances (Szuhany et al., 2021).

Prolonged grief disorder often occurs along with other mental disorders such as PTSD, anxiety or depression. Sleep problems are also common; an estimated 80% of people with prolonged grief disorder experience long-term poor sleep (Szuhany et al., 2021).

The inclusion of the diagnostic criteria for prolonged grief disorder in DSM-5-TR allows clinicians to use a common standard to differentiate between normal grief and this persistent, enduring, and disabling grief.

Treatment

For most people, grief-related symptoms following the death of a loved one decrease over time and do not impact their everyday functioning. Although feelings and symptoms of grief may sometimes increase at different points in time, they do not usually require mental health treatment. However, for people who develop the more intense, ongoing symptoms of prolonged grief disorder, evidence-based treatments are available. Treatments using elements of cognitive-behavioral therapy (CBT) have been found to be effective in reducing symptoms.

One type of treatment, complicated grief treatment, incorporates components of CBT and other approaches to help adapt to the loss. It focuses on both accepting the reality of the loss and restoration—working toward goals and a sense of satisfaction in a world without the loved one (Szuhany et al., 2021). (More information at the Columbia University Center for Prolonged Grief.)

CBT can also be helpful in addressing symptoms that occur along with prolonged grief disorder, such as sleep problems. Research has shown that CBT for insomnia is effective in improving sleep. Research also suggests that CBT can be effective with children and adolescents experiencing symptoms of prolonged grief (Melham, et al., 2013; Boelen et al., 2021).

Bereavement support groups can also provide a useful source of social connection and support. They can help people feel less alone, thus help avoid the isolation that could increase the risk for prolonged grief disorder. There are currently no medications to treat specific symptoms of grief.

Despite the existence of effective treatments, people experiencing ongoing intense grief may not seek help. One study found that among caregivers with prolonged grief disorder, the majority did not access mental health services (Lichtenthal et al., 2011).

OCD

OCD

Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.

You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior — the vicious cycle of OCD.

OCD often centers around certain themes — for example, an excessive fear of getting contaminated by germs. To ease your contamination fears, you may compulsively wash your hands until they're sore and chapped.

If you have OCD, you may be ashamed and embarrassed about the condition, but treatment can be effective.

Symptoms

Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not realize that your obsessions and compulsions are excessive or unreasonable, but they take up a great deal of time and interfere with your daily routine and social, school or work functioning.

Obsession symptoms

OCD obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behavior or ritual. These obsessions typically intrude when you're trying to think of or do other things.

Obsessions often have themes to them, such as:

  • Fear of contamination or dirt

  • Doubting and having difficulty tolerating uncertainty

  • Needing things orderly and symmetrical

  • Aggressive or horrific thoughts about losing control and harming yourself or others

  • Unwanted thoughts, including aggression, or sexual or religious subjects

Examples of obsession signs and symptoms include:

  • Fear of being contaminated by touching objects others have touched

  • Doubts that you've locked the door or turned off the stove

  • Intense stress when objects aren't orderly or facing a certain way

  • Images of driving your car into a crowd of people

  • Thoughts about shouting obscenities or acting inappropriately in public

  • Unpleasant sexual images

  • Avoidance of situations that can trigger obsessions, such as shaking hands

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.

You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they're intended to fix.

As with obsessions, compulsions typically have themes, such as:

  • Washing and cleaning

  • Checking

  • Counting

  • Orderliness

  • Following a strict routine

  • Demanding reassurance

Examples of compulsion signs and symptoms include:

  • Hand-washing until your skin becomes raw

  • Checking doors repeatedly to make sure they're locked

  • Checking the stove repeatedly to make sure it's off

  • Counting in certain patterns

  • Silently repeating a prayer, word or phrase

  • Arranging your canned goods to face the same way

Obsessions

Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety, fear or disgust. Many people with OCD recognize that these are a product of their mind and that they are excessive or unreasonable. However, the distress caused by these intrusive thoughts cannot be resolved by logic or reasoning. Most people with OCD try to ease the distress of the obsessional thinking, or to undo the perceived threats, by using compulsions. They may also try to ignore or suppress the obsessions or distract themselves with other activities.

Examples of common content of obsessional thoughts:

  • Fear of contamination by people or the environment

  • Disturbing sexual thoughts or images

  • Religious, often blasphemous, thoughts or fears

  • Fear of perpetrating aggression or being harmed (self or loved ones)

  • Extreme worry something is not complete

  • Extreme concern with order, symmetry, or precision

  • Fear of losing or discarding something important

  • Can also be seemingly meaningless thoughts, images, sounds, words or music

Compulsions

Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors typically prevent or reduce a person's distress related to an obsession temporarily, and they are then more likely to do the same in the future. Compulsions may be excessive responses that are directly related to an obsession (such as excessive hand washing due to the fear of contamination) or actions that are completely unrelated to the obsession. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.

Examples of compulsions:

  • Excessive or ritualized hand washing, showering, brushing teeth, or toileting

  • Repeated cleaning of household objects

  • Ordering or arranging things in a particular way

  • Repeatedly checking locks, switches, appliances, doors, etc.

  • Constantly seeking approval or reassurance

  • Rituals related to numbers, such as counting, repeating, excessively preferencing or avoiding certain numbers

  • People with OCD may also avoid certain people, places, or situations that cause them distress and trigger obsessions and/or compulsions. Avoiding these things may further impair their ability to function in life and may be detrimental to other areas of mental or physical health.

Causes

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

  • Biology. OCD may be a result of changes in your body's own natural chemistry or brain functions.

  • Genetics. OCD may have a genetic component, but specific genes have yet to be identified.

  • Learning. Obsessive fears and compulsive behaviors can be learned from watching family members or gradually learned over time.

Risk factors

Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:

  • Family history. Having parents or other family members with the disorder can increase your risk of developing OCD.

  • Stressful life events. If you've experienced traumatic or stressful events, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD.

  • Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders.

Complications

Problems resulting from obsessive-compulsive disorder may include, among others:

  • Excessive time spent engaging in ritualistic behaviors

  • Health issues, such as contact dermatitis from frequent hand-washing

  • Difficulty attending work, school or social activities

  • Troubled relationships

  • Overall poor quality of life

  • Suicidal thoughts and behavior

Diagnosis

Steps to help diagnose obsessive-compulsive disorder may include:

  • Psychological evaluation. This includes discussing your thoughts, feelings, symptoms and behavior patterns to determine if you have obsessions or compulsive behaviors that interfere with your quality of life. With your permission, this may include talking to your family or friends.

  • Diagnostic criteria for OCD. Your doctor may use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

  • Physical exam. This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications.

Diagnostic challenges

It's sometimes difficult to diagnose OCD because symptoms can be similar to those of obsessive-compulsive personality disorder, anxiety disorders, depression, schizophrenia or other mental health disorders. And it's possible to have both OCD and another mental health disorder. Work with your doctor so that you can get the appropriate diagnosis and treatment.

Treatment

Obsessive-compulsive disorder treatment may not result in a cure, but it can help bring symptoms under control so that they don't rule your daily life. Depending on the severity of OCD, some people may need long-term, ongoing or more intensive treatment.

The two main treatments for OCD are psychotherapy and medications. Often, treatment is most effective with a combination of these.

Psychotherapy

Cognitive behavioral therapy (CBT), a type of psychotherapy, is effective for many people with OCD. Exposure and response prevention (ERP), a component of CBT therapy, involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn ways to resist the urge to do your compulsive rituals. ERP takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.

Medications

Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first.

Antidepressants approved by the U.S. Food and Drug Administration (FDA) to treat OCD include:

  • Clomipramine (Anafranil) for adults and children 10 years and older

  • Fluoxetine (Prozac) for adults and children 7 years and older

  • Fluvoxamine for adults and children 8 years and older

  • Paroxetine (Paxil, Pexeva) for adults only

  • Sertraline (Zoloft) for adults and children 6 years and older

Panic

Panic Attacks

A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.

Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends. But if you've had recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, you may have a condition called panic disorder.

Although panic attacks themselves aren't life-threatening, they can be frightening and significantly affect your quality of life. But treatment can be very effective.

Symptoms

Panic attacks typically begin suddenly, without warning. They can strike at any time — when you're driving a car, at the mall, sound asleep or in the middle of a business meeting. You may have occasional panic attacks, or they may occur frequently.

Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides.

Panic attacks typically include some of these signs or symptoms:

  • Sense of impending doom or danger

  • Fear of loss of control or death

  • Rapid, pounding heart rate

  • Sweating

  • Trembling or shaking

  • Shortness of breath or tightness in your throat

  • Chills

  • Hot flashes

  • Nausea

  • Abdominal cramping

  • Chest pain

  • Headache

  • Dizziness, lightheadedness or faintness

  • Numbness or tingling sensation

  • Feeling of unreality or detachment

One of the worst things about panic attacks is the intense fear that you'll have another one. You may fear having panic attacks so much that you avoid certain situations where they may occur.

Diagnosis

Your primary care provider will determine if you have panic attacks, panic disorder or another condition, such as heart or thyroid problems, with symptoms that resemble panic attacks.

To help pinpoint a diagnosis, you may have:

  • A complete physical exam

  • Blood tests to check your thyroid and other possible conditions and tests on your heart, such as an electrocardiogram (ECG or EKG)

  • A psychological evaluation to talk about your symptoms, fears or concerns, stressful situations, relationship problems, situations you may be avoiding, and family history

You may fill out a psychological self-assessment or questionnaire. You also may be asked about alcohol or other substance use.

Criteria for diagnosis of panic disorder

Not everyone who has panic attacks has panic disorder. For a diagnosis of panic disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists these points:

  • You have frequent, unexpected panic attacks.

  • At least one of your attacks has been followed by one month or more of ongoing worry about having another attack; continued fear of the consequences of an attack, such as losing control, having a heart attack or "going crazy"; or significant changes in your behavior, such as avoiding situations that you think may trigger a panic attack.

  • Your panic attacks aren't caused by drugs or other substance use, a medical condition, or another mental health condition, such as social phobia or obsessive-compulsive disorder.

If you have panic attacks but not a diagnosed panic disorder, you can still benefit from treatment. If panic attacks aren't treated, they can get worse and develop into panic disorder or phobias.

Treatment

Treatment can help reduce the intensity and frequency of your panic attacks and improve your function in daily life. The main treatment options are psychotherapy and medications. One or both types of treatment may be recommended, depending on your preference, your history, the severity of your panic disorder and whether you have access to therapists who have special training in treating panic disorders.

Psychotherapy

Psychotherapy, also called talk therapy, is considered an effective first choice treatment for panic attacks and panic disorder. Psychotherapy can help you understand panic attacks and panic disorder and learn how to cope with them.

A form of psychotherapy called cognitive behavioral therapy can help you learn, through your own experience, that panic symptoms are not dangerous. Your therapist will help you gradually re-create the symptoms of a panic attack in a safe, repetitive manner. Once the physical sensations of panic no longer feel threatening, the attacks begin to resolve. Successful treatment can also help you overcome fears of situations that you've avoided because of panic attacks.

Seeing results from treatment can take time and effort. You may start to see panic attack symptoms reduce within several weeks, and often symptoms decrease significantly or go away within several months. You may schedule occasional maintenance visits to help ensure that your panic attacks remain under control or to treat recurrences.

Medications

Medications can help reduce symptoms associated with panic attacks as well as depression if that's an issue for you. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:

  • Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).

  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants. The SNRI venlafaxine (Effexor XR) is FDA approved for the treatment of panic disorder.

  • Benzodiazepines. These sedatives are central nervous system depressants. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepines are generally used only on a short-term basis because they can be habit-forming, causing mental or physical dependence. These medications are not a good choice if you've had problems with alcohol or drug use. They can also interact with other drugs, causing dangerous side effects.

PTSD

PTSD

Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Most people who go through traumatic events may have temporary difficulty adjusting and coping, but with time and good self-care, they usually get better. If the symptoms get worse, last for months or even years, and interfere with your day-to-day functioning, you may have PTSD.

Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function.

Symptoms

Post-traumatic stress disorder symptoms may start within one month of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships. They can also interfere with your ability to go about your normal daily tasks.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.

Intrusive memories

Symptoms of intrusive memories may include:

  • Recurrent, unwanted distressing memories of the traumatic event

  • Reliving the traumatic event as if it were happening again (flashbacks)

  • Upsetting dreams or nightmares about the traumatic event

  • Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Avoidance

Symptoms of avoidance may include:

  • Trying to avoid thinking or talking about the traumatic event

  • Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

  • Negative thoughts about yourself, other people or the world

  • Hopelessness about the future

  • Memory problems, including not remembering important aspects of the traumatic event

  • Difficulty maintaining close relationships

  • Feeling detached from family and friends

  • Lack of interest in activities you once enjoyed

  • Difficulty experiencing positive emotions

  • Feeling emotionally numb

Changes in physical and emotional reactions

Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:

  • Being easily startled or frightened

  • Always being on guard for danger

  • Self-destructive behavior, such as drinking too much or driving too fast

  • Trouble sleeping

  • Trouble concentrating

  • Irritability, angry outbursts or aggressive behavior

  • Overwhelming guilt or shame

For children 6 years old and younger, signs and symptoms may also include:

  • Re-enacting the traumatic event or aspects of the traumatic event through play

  • Frightening dreams that may or may not include aspects of the traumatic event

Intensity of symptoms

PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you're stressed in general, or when you come across reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.

Diagnosis

To diagnose post-traumatic stress disorder, your doctor will likely:

  • Perform a physical exam to check for medical problems that may be causing your symptoms

  • Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them

  • Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:

  • You directly experienced the traumatic event

  • You witnessed, in person, the traumatic event occurring to others

  • You learned someone close to you experienced or was threatened by the traumatic event

  • You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)

You may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.

Treatment

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but can also include medication. Combining these treatments can help improve your symptoms by:

  • Teaching you skills to address your symptoms

  • Helping you think better about yourself, others and the world

  • Learning ways to cope if any symptoms arise again

  • Treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs

You don't have to try to handle the burden of PTSD on your own.

Psychotherapy

Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:

  • Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative beliefs about yourself and the risk of traumatic things happening again. For PTSD, cognitive therapy often is used along with exposure therapy.

  • Exposure therapy. This behavioral therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares. One approach uses virtual reality programs that allow you to re-enter the setting in which you experienced trauma.

  • Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them.

Your therapist can help you develop stress management skills to help you better handle stressful situations and cope with stress in your life.

All these approaches can help you gain control of lasting fear after a traumatic event. You and your mental health professional can discuss what type of therapy or combination of therapies may best meet your needs.

You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.

Medications

Several types of medications can help improve symptoms of PTSD:

  • Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.

  • Anti-anxiety medications. These drugs can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.

  • Prazosin. While several studies indicated that prazosin (Minipress) may reduce or suppress nightmares in some people with PTSD, a more recent study showed no benefit over placebo. But participants in the recent study differed from others in ways that potentially could impact the results. Individuals who are considering prazosin should speak with a doctor to determine whether or not their particular situation might merit a trial of this drug.

You and your doctor can work together to figure out the best medication, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.

Schizophrenia

Schizophrenia

Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling.

People with schizophrenia require lifelong treatment. Early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook.

Symptoms

Schizophrenia involves a range of problems with thinking (cognition), behavior and emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. Symptoms may include:

  • Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.

  • Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.

  • Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.

  • Extremely disorganized or abnormal motor behavior. This may show in a number of ways, from childlike silliness to unpredictable agitation. Behavior isn't focused on a goal, so it's hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.

  • Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn't make eye contact, doesn't change facial expressions or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.

In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.

Diagnosis

Diagnosis of schizophrenia involves ruling out other mental health disorders and determining that symptoms are not due to substance abuse, medication or a medical condition. Determining a diagnosis of schizophrenia may include:

  • Physical exam. This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.

  • Tests and screenings. These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. The doctor may also request imaging studies, such as an MRI or CT scan.

  • Psychiatric evaluation. A doctor or mental health professional checks mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance use, and potential for violence or suicide. This also includes a discussion of family and personal history.

  • Diagnostic criteria for schizophrenia. A doctor or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment

Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed.

A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include a psychologist, social worker, psychiatric nurse and possibly a case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.

Medications

Medications are the cornerstone of schizophrenia treatment, and antipsychotic medications are the most commonly prescribed drugs. They're thought to control symptoms by affecting the brain neurotransmitter dopamine.

The goal of treatment with antipsychotic medications is to effectively manage signs and symptoms at the lowest possible dose. The psychiatrist may try different drugs, different doses or combinations over time to achieve the desired result. Other medications also may help, such as antidepressants or anti-anxiety drugs. It can take several weeks to notice an improvement in symptoms.

Because medications for schizophrenia can cause serious side effects, people with schizophrenia may be reluctant to take them. Willingness to cooperate with treatment may affect drug choice. For example, someone who is resistant to taking medication consistently may need to be given injections instead of taking a pill.

Stress

Stress Management

Stress management offers a range of strategies to help you better deal with stress and difficulty (adversity) in your life. Managing stress can help you lead a more balanced, healthier life.

Stress is an automatic physical, mental and emotional response to a challenging event. It's a normal part of everyone's life. When used positively, stress can lead to growth, action and change. But negative, long-term stress can lessen your quality of life.

Stress management approaches include:

  • Learning skills such as problem-solving, prioritizing tasks and time management.

  • Enhancing your ability to cope with adversity. For example, you may learn how to improve your emotional awareness and reactions, increase your sense of control, find greater meaning and purpose in life, and cultivate gratitude and optimism.

  • Practicing relaxation techniques such as deep breathing, yoga, meditation, tai chi, exercise and prayer.

  • Improving your personal relationships.

Agora

Agoraphobia

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed. You fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.

The anxiety is caused by fear that there's no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again.

People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fear can be so overwhelming that you may feel unable to leave your home.

Agoraphobia treatment can be challenging because it usually means confronting your fears. But with psychotherapy and medications, you can escape the trap of agoraphobia and live a more enjoyable life.

Symptoms

Typical agoraphobia symptoms include fear of:

  • Leaving home alone

  • Crowds or waiting in line

  • Enclosed spaces, such as movie theaters, elevators or small stores

  • Open spaces, such as parking lots, bridges or malls

  • Using public transportation, such as a bus, plane or train

These situations cause anxiety because you fear you won't be able to escape or find help if you start to feel panicked or have other disabling or embarrassing symptoms.

In addition:

  • Fear or anxiety almost always results from exposure to the situation

  • Your fear or anxiety is out of proportion to the actual danger of the situation

  • You avoid the situation, you need a companion to go with you, or you endure the situation but are extremely distressed

  • You experience significant distress or problems with social situations, work or other areas in your life because of the fear, anxiety or avoidance

  • Your phobia and avoidance usually lasts six months or longer

Diagnosis

Agoraphobia is diagnosed based on:

  • Symptoms.

  • In-depth interview with your health care provider or a mental health provider.

  • Physical exam to rule out other conditions that could be causing your symptoms.

Treatment

Agoraphobia treatment usually includes both psychotherapy — also called talk therapy — and medicine. It may take some time, but treatment can help you get better.

Talk therapy

Talk therapy involves working with a therapist to set goals and learn practical skills to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of talk therapy for anxiety disorders, including agoraphobia.

Cognitive behavioral therapy focuses on teaching you specific skills to better tolerate anxiety, directly challenge your worries and gradually return to the activities you've avoided because of anxiety. Cognitive behavioral therapy is usually a short-term treatment. Through this process, your symptoms improve as you build on your initial success.

You can learn:

  • What factors may trigger a panic attack or panic-like symptoms and what makes them worse.

  • How to cope with and tolerate symptoms of anxiety.

  • Ways to directly challenge your worries, such as whether bad things are actually likely to happen in social situations.

  • That anxiety gradually decreases and that feared outcomes tend not to happen if you remain in situations long enough to learn from them.

  • How to approach feared and avoided situations in a gradual, predictable, controllable and repetitive manner. Also known as exposure therapy, this is the most important part of treatment for agoraphobia.

If you have trouble leaving your home, you may wonder how you could possibly go to a therapist's office. Therapists who treat agoraphobia are aware of this problem.

If you feel homebound due to agoraphobia, look for a therapist who can help you find alternatives to office appointments, at least in the early part of treatment. The therapist may offer to see you first in your home or meet you in what you consider a safe place. Some therapists also may offer some sessions by video, over the phone or through email.

If the agoraphobia is so severe that you cannot access care, you might benefit from a more intensive hospital program that specializes in the treatment of anxiety. An intensive outpatient program usually involves going to a clinic or hospital for either a half or full day over a period of at least two weeks to work on skills to better manage your anxiety. In some cases, a residential program may be needed. This includes a stay in the hospital for a period of time while receiving treatment for severe anxiety.

You may want to take a trusted relative or friend to your appointment who can offer comfort, help and coaching, if needed.

Medicines

Certain types of antidepressants are often used to treat agoraphobia. Sometimes anti-anxiety medicines are used on a limited basis. Antidepressants are more effective than anti-anxiety medicines in the treatment of agoraphobia.

  • Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of panic disorder with agoraphobia. Other types of antidepressants also may effectively treat agoraphobia. Antidepressants also are used for other mental health conditions, such as depression.

  • Anti-anxiety medicine. Anti-anxiety medicines called benzodiazepines are sedatives that, in limited situations, your health care provider may prescribe to relieve anxiety symptoms. Benzodiazepines are generally used only on a short-term basis for relieving anxiety that happens suddenly, also called acute anxiety. Because they can be habit-forming, these medicines are not a good choice if you've had long-term problems with anxiety or problems with alcohol or drug misuse.

It may take weeks for medicine to help manage symptoms. And you may have to try several different medicines before you find one that works best for you.

Both starting and ending a course of antidepressants can cause side effects that create uncomfortable physical sensations or even panic attack symptoms. For this reason, your health care provider likely will gradually increase your dose during treatment, and slowly decrease your dose when you're ready to stop taking medicine.

ADHD

ADHD

ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

Signs and Symptoms

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

  • daydream a lot

  • forget or lose things a lot

  • squirm or fidget

  • talk too much

  • make careless mistakes or take unnecessary risks

  • have a hard time resisting temptation

  • have trouble taking turns

  • have difficulty getting along with others

Types

There are three different ways ADHD presents itself, depending on which types of symptoms are strongest in the individual:

  • Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

  • Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

  • Combined Presentation: Symptoms of the above two types are equally present in the person.

Because symptoms can change over time, the presentation may change over time as well.

Causes of ADHD

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies link genetic factors with ADHD.1

In addition to genetics, scientists are studying other possible causes and risk factors including:

  • Brain injury

  • Exposure to environmental risks (e.g., lead) during pregnancy or at a young age

  • Alcohol and tobacco use during pregnancy

  • Premature delivery

  • Low birth weight

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

Diagnosis

Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Diagnosing ADHD usually includes a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.

Learn more about the criteria for diagnosing ADHD

Treatments

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment before medication is tried. What works best can depend on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

Learn more about treatment options

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