Your son may be doing well in school and get along with others, but be a bit withdrawn and have odd likes and dislikes. Then you might notice that his grades are slipping. He might lost interest in playing sports or give up his guitar and stop seeing the friends he used to jam with. His sleep habits might change-he might be unable to fall asleep or wake to early. Next, he might tell you for a few hours he heard voices of people who weren't there, or thought that he was being trailed by a spy. These strange voices or perceptions may go quickly and never turn into a lasting mental illness. However, these early signs of schizophrenia shouldn't be ignored. Your son needs a professional evaluation. Look for a psychiatrist who has experience with teens and psychosis. There are steps you can take to delay schizophrenia even if it is bound to come, writes Herbert Meltzer, a psychiatrist and professor at Northwestern University. If mental illness runs in the family, consider a candid conversation with your children: They need to know that experimenting with drugs is more dangerous for them than for other people. Any grandparent, parent, or sibling with schizophrenia or bipolar disorder means that they may have genes that put them at risk of psychosis. Marijuana may seem like a low-risk drug, but not for them- it could bring on the illness earlier. "Special K" (ketamine), cocaine, and methamphetamine are also dangerous. If your child has been diagnosed with ADHD and is taking Ritalin or amphetamines, the drugs may have brought on the voices and paranoia. Unusual stress like bullying could also trigger an underlying vulnerability. As a parent, you can work with your child and her school to limit the stress. If your household has become stressful, it might even be better for your child to live somewhere else, Meltzer noted. During the evaluation, your child's doctor should rule out contributions from other illnesses. Now is also the time to gather information from relatives about the course of their illness and treatment. Their history may be clues to what will work best for your child. The genes of bipolar disorder and schizophrenia overlap. If one sibling has been diagnosed with schizophrenia, other siblings are more likely to develop schizophrenia then bipolar disorder. If one child is showing early symptoms of schizophrenia, it's reasonable for his siblings to be concerned about themselves and you can help by having them evaluated as well. If a mother has bipolar disorder disease, a child with early symptoms could develop schizophrenia rather than bipolar disorder. It is important for anyone diagnosed with schizophrenia to undergo repeated tests for working memory, word memory, and speed of processing information, attention, and social understanding. A steady decline in even on area is a danger sign and treatment drugs can make a difference. The drugs Lurasidone, Olanzapine, and Risperidone may help improve performance. Look for signs of motor side effects for medication. Tardive dyskinesia- involuntary movements of the lip, tongue, and cheeks- has been linked to cognitive impairment. It's easy for people to forget to take medication. Consider long acting injectable medications that work from two weeks to three months. Five percent of patients with schizophrenia die from suicide, and many more try. Although clozapine has many side-effects, they can be minimized and the drug lowers suicide risk. Family and group therapy may be more helpful than individual therapy. The early signs of schizophrenia appear earlier in boys, usually between ages 16 and 25. The average age of onset is 18 in men and 25 in women. The later the onset, the better chance of a full life and quick action can make all the difference.
Work anxiety can drastically effect your quality of life and leave you counting down the minutes until five o'clock comes around. Roughly three out of every four people with stress or anxiety in their life say that it interferes with their daily lives, and the workplace is no exception. Anxiety can affect performances at work, the quality of work, relationships with colleagues, and relationships with supervisors. And if you have a diagnosed anxiety disorder, then these challenges may prove even more difficult. People report that deadlines and dealing with difficult people are the biggest causes of work related stress. Conflict in the workplace will elicit many different reactions. Some people love the drama, while others would rather hide under their desks until the commotion subsides. Regardless of whether or not you thrive from conflict, lack of effective communication at your job can cause quite a bit of anxiety. When several people in the office are visibly effected by the anxiety, the level of stress can almost feel contagious. People begin to miss more work, the quality of work goes down, and coworkers begin to gossip or vent rather then work together to solve the problem. People stop talking to one another, they start collecting mountains of grievances, and the environment can be downright toxic. The first step in managing work anxiety is to develop a self wellness plan. If you're getting adequate sleep, eating healthy, exercising, and engaging in social activities outside of work, then your odds for decreasing workplace anxiety are much greater. But reducing anxiety in the workplace requires more than mindfulness and a yoga class every once in awhile. You must also examine how you function in the workplace system and how you deal with others. Do you hide from your boss? Do you gossip with your co-worker in the neighboring cubicle? Do you wait to speak until your seething with anger or bursting into tears? There are a few simple strategies you can start examining and practicing to help you arrive at work calmer and not take worries home with you. In addition to seeking professional help to manage anxiety, you can use these interpersonal strategies to help lower overall anxiety in the office and help you stay calm, focused, and productive.
Know Everyone's Name
Having a solid one-to-one relationship with people in the office makes it easier to address problems with the original individual rather than gossiping or venting to someone else. This start's by knowing peoples names and their responsibilities. If you forget a person's name, don't be embarrassed to ask again. It's never to late to start building stronger relationships at the office.
Ask For Help
When work is hectic, it becomes all to easy to say "yes" even when you don't understand how to do something. But the discomfort of asking for help or clarification is worth it in the long run, and it can decrease overall anxiety about responsibilities. Asking for help also communicates to your superiors that you genuinely care about doing a good job.
Many workplaces are built on gossiping about coworkers or venting about others. Though this might provide temporary relief or entertainment, it only serves to build up tension and stress. You can almost feel it floating in the air when an office is full of this kind of negativity. Bonding with someone by talking about a third person is called "triangling", and it's an unhealthy way to manage work anxiety. Examples of triangles might include gossiping about a third person, criticizing someone behind their back, and using them as a scapegoat. Though it might be tempting to vent to a coworker, consider how you can keep the issue between you and the person with the conflict. Though it might be difficult at first, you can reduce your anxiety by approaching the individual and communicating the facts of the situation. Tell them that you would like to reach a resolution and are motivated to create an open and honest workplace. If you're an employer or supervisor, consider how you could encourage employees to work out conflict between themselves and approach you honestly if they have an issue with your leadership.
Set Honest Deadlines
Anxious people will sometimes agree to deadlines and timelines they know they cannot meet. Often it is better to be honest and upfront rather than to apologize later. Not every deadline is negotiable, but it will save you hours of anxiety if you can be honest upfront and work at a manageable pace. And if you finish the job ahead of time, then that will make you look even better.
Use Neutral Language
Learning to use neutral and calming language in the office can help bring down everyone's anxiety at work. Disagreements are more manageable when you begin a statement with, "Here is what I'm thinking," and end it with "What are you thinking?" This lets people feel like they have an input and makes them more likely to hear what your saying. Questions like, "What could we each do about this issue?" or "How could we prevent this from happening in the future?" are also great for problem-solving.
Stay In Contact
It's human instinct to avoid or cut off contact with people who make us feel uncomfortable, and the workplace is no exception. Maybe you stop replying to emails you don't know how to answer. Or perhaps you avoid the break room to avoid a bullying coworker. Maybe you try and duck out for the day before your boss can ask you a questions. The problem with avoidance is that it is only a very temporary solution. That twisting feeling in your stomach or other work anxiety symptoms will only get worse with time the more you use distance as a way to manage disagreement, confusion, or other difficult emotions. Contact is a muscle you have to flex to make it stronger. The more you approach problems and communication head-on, the less anxious it will make you in the long term. Great leaders maintain the ability to have contact with people who have different points of view or styles of work. Staying in contact can also help you improve on saying "no" to additional responsibilities that make you overworked and less effective in your job.
Don't Drag Others Down
Office drama can be entertaining at times, but it ultimately makes the environment more stressful and lowers morale. Try changing the subject when people talk poorly of coworkers or the boss, or simply come up with a reason to leave the room. Don't respond to texts or emails that seek to drag other people down.
Encourage In-Person Conversations
It can be incredibly difficult to decipher emotions and intentions electronically. Much workplace anxiety comes from misinterpreting emails or waiting to hear back from a difficult subject. If an issue is making you particularly anxious, don't be afraid to pick up the phone or have an in-person conversation about things.
Focus On Facts
Your mind and emotions can feel pulled in many different directions when you feel overloaded, underappreciated or misunderstood. The best way to lower anxiety is to control the conversation and what's communicated. Try to verbalize what specifically is causing your anxiety and ask other people to share their views. Then express how you would like the specific conflict resolved. Focus on the facts of the situation, and stay in the present. This probably isn't the best time to bring up past grievances, no matter how relevant they may seem. It will be tempting to pull out your arsenal of complaints when you feel reactive, but lowering anxiety is not about winning. It's about resolving.
Many workplaces offer therapy through employee assistance program (EAP) or can connect you to mental health resources in the community to help you manage anxiety. Though it may be intimidating to speak up about your anxiety, when you take responsibility for your wellness, you serve as a role model for others in the workplace. When you build more solid relationships, improve communication, and ask for help, the entire office will benefit. Anxiety is always present to some degree in your daily life, but it doesn't have to interfere with doing good work and enjoying your profession. Remember, though anxiety is an unpleasant emotion, it's also an opportunity for you to grow in your career. The more you face anxiety in the workplace rather then run away from it or simply complain about it, the more significant a stressor will have to be to make you feel off your game.
When people think about depression, they often divide it into one of two things- either clinical depression which requires treatment or "regular" depression that pretty much anyone can go through. As a condition, depression can be a difficult concept to grasp since we refer to it as both the symptom of a condition and a condition itself. From a medical standpoint, depression is defined as a mood disorder which causes a persistent feeling of sadness and the often profound loss of interest in things that usually bring you pleasure. It affects how you feel, think, and behave and can interfere with your ability to function and carry on with daily life. There are many different causes of depression, some of which we don't fully understand. Seven of the most common types of depression are as follows:
1. Major Depressive Disorder (MDD)
When people use the term clinical depression, they are generally referring to major depressive disorder (MDD). Major depressive disorder is a mood disorder characterized by a number of key features:
2. Persistent Depressive Disorder
Dysthymia, now known as persistent depressive disorder, refers to a type of chronic depression present for more days then not for at least two years. It can be mild, moderate, or severe.
3. Bipolar Disorder
Bipolar disorder is a mood disorder characterized by periods of abnormally elevated mood known as mania. These periods of A major can be mild (hypomania) or they can be so extreme as to cause marked impairment with a person's life, require hospitalization, or affect a person's sense of reality. The vast majority of those with bipolar illness also have episodes of major depression. In addition to depressed mood and markedly diminished interest in activities, people with bipolar depression often have a range of physical and emotional symptoms which may include:
4. Postpartum Depression
Pregnancy can bring about significant hormonal shifts that can often affect a woman's moods. Depression can have its onset during pregnancy or following the birth of a child. Postpartum depression is more than just the "baby blues". It can range from a persistent lethargy and sadness that requires medical treatment all the way up to postpartum psychosis, a condition in which the mood episode is accompanied by confusions, hallucinations, or delusions.
5. Premenstrual Dysphoric Disorder (PMDD)
Among the most common symptoms of premenstrual syndrome (PMS) are irritability, fatigue, anxiety, moodiness, bloating, increased appetite, food cravings, aches, and breast tenderness. Premenstrual dysphoric disorder (PMDD) produces similar symptoms, but those related to mood are more pronounced. They may include:
6. Seasonal Affective Disorder (SAD)
If you experience depression, sleepiness, and weight gain during the winter months but feel perfectly fine during spring, you may have a condition known as seasonal affective disorder (SAD), currently called major depressive disorder, with seasonal pattern. SAD is believed to be triggered by a disturbance in the normal circadian rhythm of the body. Light entering through the eyes influences this rhythm, and any seasonal variation in night/day pattern can cause a disruption leading to depression. SAD is more common in far northern or far southern regions of the planet and can often be treated with light therapy to offset the seasonal loss of daylight.
7. Atypical Depression
Do you experience signs of depression (such as overeating, sleeping too much, or extreme sensitivity to rejection) but find yourself suddenly perking up in face of a positive event? Based on these symptoms, you may be diagnosed with atypical depression, a type of depression which does not follow what was thought to be the "typical" presentation of the disorder. Atypical depression is characterized by a specific set of symptoms related to:
If you are considering couples counseling but are unsure about whether it will be worth your effort, you are not alone. Perhaps you have heard about the lack of success reported by a friend or tried it already yourself without much benefit. Here I will provide answers to some common questions I frequently hear from those who are wondering about whether it works, and for whom it works.
Why are so many skeptical about couples counseling?
It is understandable that many people are skeptical about the effectiveness of couples' counseling. Prior to the 1980's, the most common methods used in couples' work had limited success. The average success rate for most couples was about 50 percent. Useful skills were learned, including how to listen to each other and to appreciate the other's point of view. Attributions (explanations we give ourselves for the other persons behavior) were transformed from negative, to positive or neutral. The research of John Gottman helped to identify critical behaviors to avoid if you wanted to remain together "happily ever after" . These included cutting out the sarcasms and the contemptuous comments, while building the friendship as well as romance. This was all well and good, but not enough for lasting and profound changes in relationships. Even when couples reported less distress at the conclusion of therapy, the new habits tended to drop off over subsequent months and old problems returned.
How effective is couples therapy?
The good news is that couples counseling as it is currently practiced using Emotionally-Focused Therapy (EFT) is now roughly 75 percent effective. This is true according to the American Psychological Association and is based on over 25 years of research. Outcome studies have included couples therapy for high-stress clients such as military couples, veterans with PTSD, parents of chronically ill children, and infertile couples. Results are also positive and substantial across different cultural groups.
How do we measure effectiveness?
The most common outcome measure has been self-report using a particular questionnaire called the Dyadic Adjustment Scale (DAS). This measure has been used since 1976 and provides a good comparison of success rates now versus those from past decades. The major positive outcome is the reduction of complaints between partners. Post-treatment scores are compared to pre-treatment scores for the same couple, and also to the scores of couples who have been wait-listed for treatment. The positive results have consistently been found to continue for at least two years after the conclusion of treatment.
Who tends to be in the 25 percent failure group?
Couples who are in abusive relationships should not expect improvement in therapy until the abusive behavior stops. Separate therapy is often each recommended for each partner in order to work toward self control or to maintain safety, depending on the individual's needs. Likewise, EFT is not recommended for couples in the process of separating. The process of separating is contrary to the goals of EFT. Substance abuse in the absence of physical or emotional abuse does not preclude couples therapy as long as the addicted person is actively working to manage the addiction.
How does it work?
To briefly summarize, EFT is a systematic approach to changing the constricted patterns of interaction between distressed couples and thereby changing the emotional responses to each other. Unlike prior therapies which were directed at changing behaviors and thoughts, EFT leads to changes in emotional responses in a way that strengthens the emotional bond. The goal is to establish a more secure attachment. In my experience, it requires a minimum six-month commitment. Many couples require more time, depending upon other circumstances in their lives and the frequency of sessions.
How can one maximize the chances of a positive outcome?
Positive outcomes are most likely when the couple beginning therapy have a willingness to learn some basic skills and to become more self-aware as well as emotionally vulnerable to each other. Only very basic communication skills are necessary, such as using “feeling” words. Many people have difficulty distinguishing feelings from thoughts, usually because they were never taught to identify feelings as children. However, this skill can be learned, and it is encouraged during the therapy process. A second important characteristic of successful couples is the ability to stop seeing each other as the opponent but rather as a team member, working to improve mutual contentment. Seeing yourselves as being “on the same team” increases cooperation and also each person’s willingness to be emotionally vulnerable. Thirdly, the ability to feel empathy for the partner is a critical part of the work in EFT. Each person needs to have compassion for the other’s feelings of vulnerability and past emotional traumas. Lastly, a pre-requisite for success in couples’ work is the willingness of each person to own their part in the problems as well as the process of bringing about positive change. Many individuals come to couples therapy with a list of complaints about the other person and a desire for the therapist to validate the complaints and then change the behavior of the other person. Although there are often valid complaints, nothing is resolved unless both individuals are open to change some aspect of their own behavior.
You might hear the words anxiety attack and panic attack used interchangeably as if they mean the same thing. In fact, panic and anxiety have different features, and behavioral health professionals use the terms for specific symptoms and disorders. Panic attacks are often associated with sudden fear and anxiety with high-stress levels or excessive worrying. Some of the symptoms are similar, including rapid heart beat, shortness of breath, and dizziness. Each also has other symptoms that are unique. Everyone can experience panic attacks and anxiety, they are apart of the emotional and protective response hardwired into the human body. It's when either occurs frequently that there is cause for concern. No matter which you experience, it's important to understand their definitions, symptoms, and treatments.
Professionals who treat mental health conditions base diagnosis on definitions found in the "Diagnostic and Statistic Manual of Mental Disorders, 5th edition," known as the DSM-5. Though anxiety and panic attacks may feel the same at times, the subtle differences outlined in this handbook help identify each. The DSM-5 uses the term panic attack to describe the hallmark features associated with the condition known as panic disorder. However, panic attacks may occur in other psychiatric disorders and it is possible to have a panic attack with no disorder. The term "anxiety attack" is not defined in the DSM-5. Rather, "anxiety" is used to describe a core feature of several illnesses identified under the headings of anxiety disorders, obsessive-compulsive disorder, and trauma- and stressor-related disorders. Some of the most common disorders under these three headings include:
A panic attack is a sudden and intense feeling of fear, terror, nervousness, or apprehension. The symptoms are often so extreme that they cause a severe disruption during your day. Panic attacks usually occur out of the blue without an obvious, immediate trigger. In some cases, they are "expected" because the fear is caused by a known stressor such as a phobia. Panic attack symptoms peak within 10 minutes and then they subside. However, some panic attacks may last longer or may occur in succession, making it difficult to determine when on attack ends and the other begins. Following an attack, it is not unusual to feel stressed, worried, out-of-sorts, or "keyed up" for the remainder of the day. According to the DSM-5, a panic attack is characterized by four or more of the following symptoms:
In contrast, anxiety generally intensifies over a period of time and is highly correlated with excessive "worry" about some potential danger- whether real or perceived. If the anticipation of something builds up and the high amount of stress reaches a level where it becomes overwhelming, it may feel like an "attack". The symptoms of anxiety may include:
Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you think, feel, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks. Some forms of depression are slightly different, or they may develop under unique circumstances, such as:
Signs & Symptoms:
If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:
Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children. Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson's disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.
Risk Factors Include:
Depression, even in the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain simulation therapies may be options to explore.
Antidepressants are medications that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medications before finding the one that improves your symptoms and has manageable side effects. A medication that has helped your or a close family member in the past will often be considered. Antidepressants take time - usually 2 to 4 weeks- to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give the medication a chance before reaching a conclusion about its effectiveness. If you being taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms. You may have heard about an herbal medication called St. John's wort. Although it is a top selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John's wort before talking to your health care provider. Other natural products such as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center For Complementary and Integrative Health website.
Several types of psychotherapy (also called "talk therapy", or in a less specific form, counseling) can help people with depression. Examples of evidence based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information about psychotherapy is available on the NIMH website and in the NIMH publication Depression: What You Need To Know.
Brain Stimulation Therapies
If medication does not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:
Beyond Treatment: Things You Can Do
Here are other tips to help you or a loved one during treatment for depression: