Your Teenager: Just Moody… or Something More?

By Ken Duckworth from NAMI Blog

“Is my teen normal?”

As a child and adolescent psychiatrist and father of 3 teenagers myself,  I get asked this question by people in my community all the time—at the grocery store, at the community pool and at cookouts. It’s pretty clear to me this is an important public health concern for the people I know.

First, anxiety is normal and often healthy. It relates back to our human wiring—the evolutionary protection for being prepared for threats, like an incoming mastodon. In the modern day, we still have the same kind of alarm system even though the stresses are different.

For instance, it is natural to get anxious before the SAT exam because of the weight our society places on it. It’s perfectly acceptable to get anxious before your first week at sleep-away camp or trying out for a school play. Anxiety can be motivating to a point, but anxiety can also be overwhelming and disabling.

One way to answer the question is to look at your teen’s level of functioning. Does the anxiety reduce his ability to perform at school or engage with friends? Are the symptoms of anxiety stopping her from pursuing what she wants?

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When It Could Be a Mental Health Condition

Anxiety disorders often co-occur with other conditions, such as depression. Major depression in teens is an important public health concern and, like anxiety, often responds to treatment. Depression is characterized by more than 2 weeks of persistent sadness (or irritability, hostility) coupled with most of the following warning signs: sleep troubles, appetite changes, physical complaints, negative or hopeless thinking, concentration problems, loss of interest in activities and, most concerning, suicidal thoughts.

Family history of mood and anxiety conditions can increase the risk for some teens. People with trauma histories may be quicker to experience threat and anxiety based on the past. Teens who are stressed by divorce, are being bullied—on social media or at school—or who have problems “fitting in” in social circles are also at risk.

A full clinical assessment from a health care provider is a worthy investment of time and resources to determine a diagnosis if you’re seeing any of the signs I mentioned in your teen. There are a few medical concerns that can mimic anxiety and depression, so it’s a good idea to look for those—examples are thyroid disorders and substance use disorders.

Once a comprehensive assessment is made, the next step is forming a treatment plan that your teen can buy into. It is challenging yet essential to get your child’s acceptance and collaboration into any plan to approach these issues. While some kids will quickly acknowledge their vulnerabilities, others will be more resistant. This spectrum is natural and expected—not everyone will want support.

Communicating with Your Child

How do you talk with a teen you are worried about? Listening to them is the best first rule. Speak from your own experience. I don’t encourage parents to lead with a diagnosis—I begin with a supportive focus on the functional problems they are having, like with friends for example. This can often be something both the parent and teen can connect on. Loving a teen into care can be difficult, but keeping lines of communication open is key. You don’t need to get to yes on everything, but you may need to get to a professional. I tell parents that their job is to get their teen to my office, but it’s mine to get them back for a follow-up visit.

At the end of the day, I may not be able to give a well-rounded answer at the soccer field, but I hope that what I’ve shared will help if you are concerned about your child’s mental health.

– See more at: http://www.nami.org/Blogs/NAMI-Blog/February-2015/Your-Teenager-Just-Moody-or-Something-More#sthash.X8CfxZfh.dpuf

Study Finds Treatment-Resistant BPD Responds Better to ECT Than Medication

Bipolar Disorder. Image Credit: xpixel | shutterstock

Bipolar Disorder. Image Credit: xpixel | shutterstock

From Psychiatric News Alert: Electroconvulsive therapy (ECT) for treatment-resistant bipolar disorder appears to be more effective than an algorithm-based pharmacologic treatment in terms of symptom improvement, says the report “Treatment-Resistant Bipolar Depression: A Randomized Controlled Trial of Electroconvulsive Therapy Versus Algorithm-Based Pharmacological Treatment” in the January American Journal of Psychiatry. But remission rates did not differ between the two groups and remained modest regardless of treatment choice for this challenging clinical condition.

According to the research, ECT treatment was significantly more effective than the pharmacological treatment. For more details of the research, see the Psychiatric News article. There were possible limitations noted by Mauricio Tohen, M.D., Dr.P.H., and Christopher Abbott, M.D., M.S., additionally stating:

“In spite of the above limitations, this report adds major value to the evidence-based data on the use of ECT as a treatment option for bipolar depression.”

For more research on the use of ECT in depressive disorders, see the Psychiatric News article, “Ketamine Outperforms ECT in Depression Study.”

Crowd Funding Movie Project: Her

Her is about seventeen-year-old Kristen who loves her family, idealizes her best friend, Lexus, and has a secret crush on John. However normal her life sounds, Kristen is not like other kids her age. She feels frustrated, isolated, and confused and knows something is wrong with her. She is unable to please her abrasive mother and is scared to confront her abusive stepfather. Kristen’s imaginary friend, Mr. Sharp encourages her feelings of self-loathing and pushes her to cut herself. Soon, she can’t take much more, and a failed suicide attempt lands her in a mental hospital with a diagnosis of BPD. From there, Kristen begins her journey to survival. She struggles to understand her mental illness and fights to be a survivor against her own worst enemy: self-blame.

The crowd-funding page for this book-to-movie project is at THIS HATCHFUND LINK.

“I know, first-hand, that a diagnosis like this can be a turning point in a young person’s life. One out of every four people struggles with mental illness – stop and think and you’ll discover that you probably know someone who is going through that right NOW.  Yes, mental illness is the dark secret so many live with. Now you can help change this.

The Project’s Goal:

To change the perception of mental illness  To provide hope to those who seek help Help those suffering from mental illness, and their, families cope. We can make a difference by showing teens that they are not alone on this journey and that there is light at the end of the tunnel. I want to lend a helping hand out of suffering, so that suicide will never be a viable option again.

Next Meeting Addressing the Assessment and Prevention of Prodromal States

This month’s speakers are – Carla Means Ransom, M.A., LMFT, intensive services manager and Carissa Hsu, MFTI Clinical Therapist. They will present information about the Center for the Assessment and Prevention of Prodromal States (CAPPS), which is a family therapy based program that targets the transitional age youth ages 16 – 25 years. The program is funded by the Los Angeles County Department of Mental Health and located at Harbor UCLA. CAPPS works with the population who are showing prodromal symptoms, which are what an individual may experience prior to developing a mental illness.

The “prodromal syndrome” is not a diagnosis, but the technical term used by mental health professionals to describe a specific group of symptoms that may precede the onset of a mental illness. For example, a fever is “prodromal” to measles, which means that a fever may be a risk factor for developing this illness. However, not everyone who has a fever goes on to develop measles. In order to prevent measles from developing, you would try to get rid of your fever and take care of any other symptoms you might have. “At CAPPS, we focus on taking care of symptoms that may precede the onset of psychosis.”

Psychosis affects between 1% and 3% of the population, and typically emerges between the ages of 15 and 30. The prodromal phase of psychosis is the critical time period when individuals are showing signs that they are at risk for developing a psychotic illness.  This at risk phase may last anywhere from a couple of days to a couple of years. During this time, individuals often experience symptoms of psychosis at a subthreshold level of intensity or at full intensity for short periods of time. Individuals and their families may also notice changes in functioning, such as trouble with school or work and social withdrawal or anxiety.

Study: Child & Family Focused CBT Improves Symptoms of Pediatric Bipolar Disorder

From Psychiatric News Alert. A form of cognitive behavior therapy that involves the child with the family may be efficacious in reducing acute mood symptoms and improving long-term psychosocial functioning among children with bipolar disorder, according to a report appearing online in the Journal of the American Academy of Child and Adolescent Psychiatry.

Previous studies have found that family-based psychosocial treatments are effective adjuncts to pharmacotherapy among adults and adolescents with bipolar disorder (BD).

Amy E. West, Ph.D., of the University of Illinois-Chicago, and colleagues, randomly assigned 69 youth, aged 7 to 13 with bipolar I, II, or not otherwise specified (NOS) disorder (according to DSM-IV-TR) to either child and family focused CBT (CCF-CBT) or standard psychotherapy. CFF-CBT integrates principles of family-focused therapy with those of CBT and actively engages parents and children.

Both treatments consisted of 12 weekly sessions followed by six monthly booster sessions delivered over nine months. Independent evaluators assessed participants at baseline, week 4, week 8, week 12 (post-treatment), and week 39 (six-month follow-up).

They found that the CFF-CBT participants attended more sessions, were less likely to drop out, and reported greater satisfaction with treatment than controls. CFF-CBT demonstrated efficacy compared with standard psychotherapy in reducing parent-reported mania at post-treatment and depression symptoms at post-treatment and follow-up. Global functioning did not differ at post-treatment but was higher among CFF-CBT participants at follow-up.

For more on bipolar disorder in adolescents, see the Psychiatric News article “Link Found Between Glutamate, Adolescent Bipolar Disorder.

The Difference Between Bipolar Disorder and Schizophrenia

There are numerous mental illnesses that the medical field recognizes today, ranging from anxiety issues to depression and beyond. Two of the most serious problems are schizophrenia and bipolar disorder. They’re also two of the most confusing issues, largely due to the fact that they share a number of similar symptoms. Because of this, it’s often difficult for even professional psychiatrists to make an accurate diagnosis between the two. 

However, there are a few things that can help. First, it’s worth understanding the differences and similarities. For starters, schizophrenia is classified as a psychotic disorder that leads to delusions, hallucinations, and more. Bipolar disorder is a mood disorder, though it may manifest in ways that often seem similar to schizophrenia. 

The source of most confusion comes from the overlapping symptoms. For example, things like mania, depression, suicidal thoughts, social issues, and more are all common in both types of mental illness. The biggest difference lies in hallucinations. While those with bipolar disorder can experience hallucinations, they’re far more common among schizophrenics. And even when they do occur in those with a bipolar disorder, the patient will usually be far more alert and expressive when explaining those hallucinations. 

Many who begin to experience mental illness likely won’t even realize that they are suffering from the symptoms of one of these diseases – at the very least, they won’t be able to identify the specific issue they’re dealing with. Today, most psychiatrists will rely on counseling and on scans of brain activity in order to understand the exact problem. Since schizophrenic patients will show a loss of gray matter in their brain and those with bipolar disorder won’t show that loss, this is the primary method of distinguishing between the two when no other methods are working. 

No matter the problem, there are solutions. Modern medicine has led to numerous treatments that can help patients overcome bipolar disorder and schizophrenia. But the first step is simply figuring out which of the two one is suffering from. To find out more, contact us today.

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May is Mental Health Awareness Month

It is a time to remember that mental health is part of overall health. Mental health affects thought processes, relationships, productivity and the ability to adapt to changes in circumstances or cope with adversity.

So does mental illness.

One in four adults experience mental health problems in any given year. Those problems can contribute to onset of more serious long-term conditions. One in 17 adults lives with mental illness such as major depression, bipolar disorder or schizophrenia. Approximately one-half of chronic mental illness begins by the age of 14 and three-quarters by age 24.  Unfortunately, long delays−sometimes decades−often occur between the time symptoms first appear and when people get help.

Mental Health Awareness Month a time to learn to recognize early symptoms of mental illness and the importance of talking about concerns with a doctor or mental health professionals. Early identification and treatment can make a big difference for successful management of a condition.

For example, major depression is a mood disorder that is more serious than “feeling blue” or temporary sadness. Some people may experience it only once, but more than half have at least one additional episode over their lifetimes. Be alert to any combinations of the following symptoms:

  • Depressed mood (sadness)
  • Poor concentration
  • Insomnia
  • Fatigue
  • Disturbance of appetite
  • Feelings of guilt
  • Thoughts of suicide

Bipolar disorder involves cycles of both depression and mania.  It is different from the “ups and downs” that most people experience, involving dramatic shifts in mood, energy and ability to think clearly. Symptoms also are not the same in everyone; some people may experience intense “highs,” while others primarily experience depression. Mania involves combinations of the following symptoms:

  • Euphoria
  • Surges of energy
  • Reduced need for sleep
  • Grandiosity
  • Talkativeness
  • Extreme irritability
  • Agitation
  • Pleasure-seeking
  • Increased risk-taking behavior

Schizophrenia is a different type of mental illness, but can include features of mood disorders. It affects a person’s ability to think clearly, manage emotions, make decisions and relate to other people. Untreated, it also may include psychosis–a loss of contact with reality. Symptoms include:

  • Difficulty with memory
  • Difficulty in organizing thoughts
  • Lack of content in speech
  • Emotional flatness
  • Inability to start or follow through with activities
  • Inability to experience pleasure
  • Delusions
  • Hallucinations

Other types of mental illness include attention-deficit hyperactivity disorder (ADHD), anxiety disorders (including posttraumatic stress disorder), borderline and personality disorder. Mental Health Awareness Month is a time to learn about them. One resource is the National Alliance on Mental Illness (NAMI) which offers information through its website www.nami.org and HelpLine 1-800-950-NAMI (6264). With affiliates in hundreds of communities nationwide, NAMI also offers free education classes and support groups to individuals and families affected by mental illness.

Anyone who experiences symptoms of mental illness should see a doctor for a focused discussion about mental health concerns and assessment of potentially related physical conditions. The next step may be referral to mental health specialist. A range of treatment options exist. Education and connecting with others who have walked the same path or are facing similar issues also can play an important role

During Mental Health Awareness Month, please also talk about what you learn with family, friends and others. Help end the silence and stigma around mental illness that discourages people from getting help. This is a month to make a difference in our communities.

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