Mental health

Mental health describes the ability to cope with the transitions, traumas, and losses that are normal parts of everyone's lives in a way which allows people's personalities to remain intact and contributes to their emotional growth. Professionals have been debating the exact definition of mental health formany years. People who are mentally healthy learn to accept, understand, andcope with conflicts and distress, rather than trying to repress them.

The ability to function is the most obvious characteristic of mental health.People who are mentally healthy can sustain relationships with their family and friends, and fulfill their responsibilities at work, school, and home. People who are mentally healthy see the actions and motivations of other peoplein a realistic way. For example, they do not think that their families are trying to poison them. Mentally healthy people have normal thought processes and are basically logical and reasonable. In American society, anxiety and lackof self-esteem are the major obstacles to achieving mental health.

Mental illnesses are complex disorders that involve people's capacities to think, feel, and act. They have a devastating impact on patients and their families. Most people do not understand mental illnesses, and fear them. In the United States, there is a stigma attached to mental illness; Americans tend tothink that people who have mental illnesses are disgraceful. Each year, onein 10 Americans experiences some disability from a mental illness that is diagnosable, according to the National Institute of Mental Health. Five millionAmerican adults suffer from the most severe mental illnesses: schizophrenia,affective (mood) disorders (manic-depressive illness and major depression), and anxiety disorders (panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and phobias). Some mental illnesses are diseases thatare caused by a biological imbalance and disturbance; others are entirely mental in origin. Mental disorders cost more than $150 billion per year in theUnited States; this includes the cost of social service and disability payments to patients, and lost productivity and premature death. Anyone can sufferfrom a mental illness at any age.

Schizophrenia, a thought disorder that is believed to be caused by chemical abnormalities in the brain, is the most chronic and disabling mental disorder.It is the most common psychosis, which is an impairment of thinking in whichpeople interpret reality and daily events in a very abnormal way. Schizophrenia may be difficult to treat and is the most likely mental illness to be permanent. If affects men and women equally and usually develops in the late teens or early twenties. The cause of schizophrenia is not known, but many researchers believe that is it an inherited disorder. Some believe that genetic and environmental factors contribute to schizophrenia. More than two million adults in the United States are schizophrenic. Only 20% recover completely and10% eventually commit suicide.

People who are schizophrenic withdraw from people and activities and live ina fantasy world. For example, they think they are being persecuted, or that the government is trying to kill them. They have hallucinations in which theyhear voices and see visions, delusions in which they have false beliefs aboutcommonly held views of reality, and strange thought patterns. Their conversation may jump from one idea to another that is completely unrelated, or makeno sense; it may be vague, abstract, or repetitive. People with schizophreniausually have periods of schizophrenic behavior and periods of less impairedfunctioning. There are three types of schizophrenia: catatonic, disorganized,and paranoid. In catatonic schizophrenia, the patient may be in a stupor orbe unable to talk, or may go back and forth between excitement and stupor. Indisorganized schizophrenia, the patient is incoherent and either shows no expression or displays inappropriate emotions. In paranoid schizophrenia, the patient is preoccupied by one or more delusions.

Manic-depressive illness and major depression are the two most severe affective (mood) disorders. Each year, nearly 18 million Americans 18 years of age and older suffer from these affective disorders, according to the National Institute of Mental Health. Depression is very treatable, but many people will be unable to function for weeks or months because they do not get treatment. Depression usually improves within weeks of the start of treatment. Continuedtreatment prevents people from becoming depressed again. These disorders arecomprised of various kinds of depression. Women are nearly twice as likely tosuffer from depression as men are. Depression often accompanies medical problems like a heart attack, stroke, diabetes, or cancer. When it occurs along with these other illnesses, often it is not diagnosed. People who are seriously depressed are more likely than others to have a heart attack or commit suicide. People with affective (mood) disorders are likely to get the disorder again and again.

Manic-depressive illness, also called bipolar illness, affects more than 2.3million American adults. Men and women are equally likely to suffer from manic-depressive illness. It usually appears in people between the ages of 15 and25, and is more likely to strike people who are immediate relatives of others with the illness. About 20% of people with this disorder commit suicide. People with manic-depressive illness have periods of mental illness in which they have episodes of excitement and hyperactivity (mania). These episodes canoccur alone or they can alternate with periods of depression. The illness ischaracterized by violent mood swings which go from euphoria to deep despair.In people with manic-depressive illness, these mood swings occur with no relation to events in their environments. Feelings may take over to such an extent that they lose touch with the real world. During manic episodes, patients may need to be hospitalized. They may feel very "high" and capable of doing more than is reasonable, and irritated when things do not go right. They are restless, talk a lot, are likely to sleep less, and are easily distracted. In some cases, symptoms progress to grandiose delusions and disruptive, psychoticbehavior. If left untreated, the manic episode may last for weeks. The depressed phase is the most common form of the illness. During this phase, peopleappear depressed nearly all the time. They lose interest in their normal activities, may lose or gain weight, and usually experience different sleeping patterns. They may withdraw from others, be tired, feel worthless, and have trouble concentrating. If left untreated, this phase can last for months. It iscommon for people with manic-depressive illness to have two or more completecycles (a manic episode followed by a major depression) within one year.

Major depression is the leading cause of disability in the United States andthroughout the world, according to a recent study by the World Health Organization, the World Bank, and Harvard University. Women tend to suffer from major depression more than men do. Major depression is a genuine psychiatric illness that affects both mind and body. People who suffer from major depressionhave persistently depressed thoughts and moods along with trouble sleeping and eating, and decreased energy. They have trouble concentrating, lose interest in their normal activities, do not respond to environmental changes (day and night, sun and rain), and feel guilty. Feelings of pessimism and self-deprecation can eventually become delusions of worthlessness. People with major depression usually retreat from relationships with other people, have trouble functioning in society, cannot enjoy life, and may even feel suicidal. Some people with major depression cannot work. They also show physical signs of depression: hollowness around the eyes, monotone speech, and slow walking. Occasionally, major depression runs its course without treatment in six to 12 months.

More than 16 million Americans ages 18 to 54 have anxiety disorders, and manyhave more than one. Anxiety is common in American society, and mild anxietymay even help people cope with stress. Intense anxiety about something that is about to happen or is thought to be about to happen, however, leads to anxiety disorders. People with anxiety disorders feel tension or terror about anunidentified danger. Anxiety is sometimes associated with physical illness ortraced back to childhood fears, stresses, or losses that people re-live later in live. The most serious anxiety disorders are: panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and phobias.

Each year, about 2.5 million Americans ages 18 to 54 suffer from panic disorder. Women are twice as likely as men to suffer from panic disorder, and halfof the people with this disorder develop it before they reach the age of 24.Panic disorders tend to run in families and many researchers believe that that biochemical factors may play a role in the disorder. Panic disorder is marked by sudden attacks of terror and irrational fear, a strong sense of doom, and physical symptoms like a racing heartbeat, difficulty breathing, sweating,weakness, dizziness, and feelings of unreality. These attacks cause people to experience what would be a normal reaction to a life-threatening or extremely physically demanding situation.

Each year, about 3.3 million Americans ages 18 to 54 suffer from obsessive-compulsive disorder (OCD), which affects men and women equally. It usually begins in late adolescence or young adulthood. OCD is characterized by unwanted persistent thoughts or behaviors that others perceive as senseless and repugnant. They often perform rituals (compulsions) such as washing their hands, counting, or cleaning over and over again with the hope that this will prevent the obsessive thoughts or make them go away. Obsessions include thoughts of violence, fears of becoming contaminated, and doubt. The obsessions and compulsions may not always occur at the same time. Left untreated, obsessions and the need to perform rituals can take over people's lives. Research shows that people with OCD have abnormalities in the functioning of their bran circuitry.OCD sometimes occurs along with depression or anxiety.

Each year, 5.2 million Americans ages 18 to 54 suffer from post-traumatic stress disorder (PTSD). It is usually associated with experiences during wars, but it can follow any traumatic event, like rape or another violent act, natural disasters. PTSD can occur at any age, but it is more likely to occur in women than in men. People with post-traumatic stress disorder recall the eventin such a way that it intrudes in their every day life and causes them to have disturbing dreams. This can occur years after the traumatic event. People with PTSD avoid important activities, feel numb emotionally, have difficulty sleeping, and are very cautious.

Phobias are persistent, irrational fears about an object or a situation. People with phobias have a compelling desire to avoid the object of their fear. They may be unable to control their emotions and go to extreme lengths to avoid what they are afraid of, even though they may know that their fear is excessive. People with phobias are often unable to function normally. Common phobias are fear of being in public places (called agoraphobia) and fear of beingin enclosed places (called claustrophobia). Phobias are not considered to bedisorders unless they disturb people's lives. Phobias may be a part of anxiety or panic attacks.

Many people with mental illnesses commit suicide. Potential warning signs ofsuicide include: withdrawal, moodiness (from upbeat one day to down in the dumps the next); a life crisis or trauma; a personality change; threats, even indirect, of suicide (for example, "I wish I'd never been born."); giving awaycherished possessions; depression; and aggression. The risk that people willactually commit suicide is greater for: older men, people who have lost a spouse due to divorce or death, alcoholics, and people with a history of suicide attempts or a family history of suicide. Men are four times more likely than women to commit suicide.

Mental illness is often difficult to diagnose. The symptoms are usually vague, and even severe mental illnesses need to be evaluated within the context ofthe patient's personal relationships, work, and family life. Diagnosis alsorelies heavily on the patient's description of how he/she feels and subjective experiences; these are often hard to describe. Normal personality differences among people make diagnosis even more difficult. Emotions, responses, attitudes, or behavior that are perfectly normal in one person may be a sign of amental illness in another. There are no standard tests or methods of mentalillness diagnosis that are absolutely accurate. Instead, mental illnesses aredescribed in terms of emotions, thoughts, behavior, and physical signs. Theyare measured by excess or deficits, how long they last and how intense theyare, timing, and rigidity.

Primary care physicians can treat many mental illnesses. Some people may be referred to mental health professionals called psychiatrists or psychologists,who evaluate emotional state and behavior. Psychiatrists are medical doctorswho also have four years of postgraduate training in psychiatry. Most psychiatrists are certified by the American Board of Psychiatry and Neurology. Someare specialists in areas like child or addiction psychiatry. They can prescribe medications and do physical exams. Psychologists are not medical doctors,but they have an advanced degree and specialized training in dealing with emotional issues. They do psychometric evaluations, psychotherapy, and sometimes use relaxation techniques. Some specialize in certain types of patients, such as those with physical or sexual problems. They do not prescribe medications or do physical exams. Psychoanalysts are psychiatrists or psychologists who have special training in a form of psychotherapy called psychoanalysis.

Research sponsored by the National Institute of Mental Health has shown thatmental illness can be defined, treated, and, to some extent, prevented. Thisresearch has also shown that treatment is cost-effective. During the 1990s, new medications were developed for some mental illnesses that are safer and more effective than those available before. The value of behavioral therapies was demonstrated and a new model of psychotherapy was developed. Treatments for schizophrenia, affective (mood) disorders, and anxiety disorders include:

  • Psychotherapy is a method of treating emotional problems in which thetherapist and the patient work together to develop a supportive relationship.The therapist encourages the patient to talk about his/her problems and to be optimistic that therapy can help. He/she may suggest ways to cope with these problems. Psychotherapy is often used along with medication. Behavioral therapy is one type of psychotherapy.
  • Antidepressive medications work better for depression that occurs in episodes, rather than chronic depression.There are three types of antidepressants: tricyclic antidepressants (TCAs), selective serotonin re-uptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). SSRIs are the most common type of antidepressant because they are not habit forming and side effects are mild and short term. Prozac, a well-known SSRI, is the most frequently prescribed drug for serious depression and obsessive-compulsive disorder.
  • Other medications for mental illnessincludes tranquilizers, anti-convulsants, and anti-anxiety drugs. Tranquilizers have a calming effect. Anti-convulsants prevent or relieve convulsions. Anti-anxiety drugs (anxiolytics) like diazepam (Valium) serve as sedatives andmuscle relaxants. They are, however, addictive. Side effects include drowsiness, loss of coordination, and confusion.
  • In electroconvulsive therapy (ECT), low-voltage electric current is used to induce convulsions and lossof consciousness. ECT works within a few days. Before the procedure, the patient receives an anesthetic (a barbiturate) and a muscle relaxant. Side effects include temporary memory loss, headaches, and muscle aches. ECT can be usedsafely on most patients, including those who have medical conditions and those who are older.
  • There are many types of relaxation therapy which teach people how to relax. In progressive muscle relaxation, people learn to focus on each muscle. Other relaxation techniques include suggestion, hypnosis,biofeedback, and meditation.

Treatments for specific conditions follow. There are many treatments for schizophrenia. During acute or severe episodes of schizophrenia, patients are usually hospitalized. Antipsychotic drugs, such as the phenothiazines, are usedto decrease excitement and agitated depression and improve thought processes.They usually improve the patient enough for release from the hospital, but if he/she stops taking them, symptoms return. These drugs also cause many sideeffects: dry mouth, skin that is sensitive to the sun, constipation, loss ofbladder control, blurred vision, a feeling of faintness when standing quickly, and tremors. Electroconvulsive therapy (ECT) is sometimes used in the hospital for acute cases. Psychotherapy may be used to help the patient to lead aless withdrawn life.

Treatment for affective (mood) disorders includes ECT, tranquilizers, anticonvulsants, hospitalization, and psychotherapy. ECT is considered one of the most effective and humane treatments for serious depression. It is used primarily for people who are having a major depressive episode. Psychotherapy is used, usually along with medication, to help people with depression understand why they are depressed and find other ways of coping with their conflicts. Antidepressants are most effective during isolated episodes of depression. For manic-depressive illness, tranquilizers are used to help control the manic phase and antidepressants are used for the episodes of depression. Lithium carbonate is the standard treatment for depressive episodes. Used regularly, it may prevent uncontrolled mood swings. Anticonvulsants may be prescribed for people who cannot tolerate lithium carbonate. ECT may be used for severe cases.People who are suicidal or are so depressed that they cannot care for themselves will be hospitalized. During depressed phases, psychotherapy provides emotional support to patients.

Treatment for anxiety disorders includes antidepressants, anti-anxiety drugs,psychotherapy, behavior therapy, and relaxation therapy. Panic disorder is treated with tricyclic antidepressants (TCAs). Anti-anxiety drugs may be usedfor a short period of time to relieve fear about the attacks themselves. Psychotherapy may be used to help find the cause of the attacks. Behavior therapyand relaxation therapy may help eliminate symptoms of panic disorder. Obsessive-compulsive disorder is treated with antidepressants or other drugs. Post-traumatic stress disorder is treated with tranquilizers and psychotherapy. Phobias are often treated with psychotherapy to uncover the cause and help people cope with their fear. Antidepressant drugs may also be used.

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