Depression
Everyone can experience feelings of unhappiness from time to time. However, in clinical depression these feelings of sadness are persistent and can affect quality of life. Depression is diagnosed by physicians and treatments are offered according to the level of severity.
Most individuals with depression will experience some of the symptoms below.
- Feeling unhappy most of the time although you may feel a little better in the evenings.
- You may feel worse at specific times of the day, and this is usually in the mornings.
- Feeling persistently tired.
- Feeling restless and agitated.
- Feeling irritable.
- Loss of appetite and weight. Although in some cases you may eat more and gain weight.
- Difficulty in falling asleep and waking up earlier than usual.
- A loss of enjoyment in life and activities which normally give you pleasure.
- Difficulty in making ordinary decisions.
- Difficulty coping with things that you are used too.
- Loss in your self-esteem.
- Feeling worthless, inadequate and hopeless.
- A loss of interest in sex.
- Avoiding other people.
- Having thoughts of self-harm or suicide.
There are a variety of evidence-based approaches that are used to treat depression. These can include talking therapies, medication or a combination of both. Combination therapy is usually the optimal treatment for more severe types of illness. The treatment that is offered is personalised.
Psychological treatments (otherwise recognised as talking therapies) can include counselling, cognitive behavioural therapy (CBT) and interpersonal psychotherapy. Counselling allows the opportunity for an individual to talk about their feelings in a protected environment with a trained therapist. CBT is a structured and goal directed therapy which focuses on individual thinking styles and existing behaviours to overcome and manage difficult emotions. Interpersonal therapies allow us to understand the difficulties we may be experiencing in our relationships and exploring alternative methods of coping.
There are a range of antidepressants available and if the depression is severe or is going on for a long time the clinician may suggest a course of antidepressants. The medication recommended will be tailored to your individual circumstances. First line treatment is usually with a class of medications called selective serotonin inhibitors (SSRIs) which are usually better tolerated and have fewer side effects.
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD is neuro-developmental disorder which usually appears in childhood. Individuals may present with over-activity, distractibility, difficulty with attention and impulsivity whereby they do things on the spur of the moment without adequate thought. These symptoms are to a degree that interfere with how you get on with other people and your performance at work or in education.
Other symptoms of ADHD you may experience include:
- Find it difficult to listen to other people. You may interrupt others, finish their sentences or make a comment at the wrong time.
- Challenging to follow instructions.
- Difficulty with organising activities and starting multiple things without ever finishing them.
- You find it hard to wait in a queue and may fidget or find it difficult to stand still.
- Forgetful and frequently misplacing objects.
- Irritability, easily frustrated and you can lose your temper quickly.
- Feeling restless or on edge. Have difficulty switching off from your thoughts or coping with stressful situations.
ADHD symptoms can continue into adult life. The symptom profile may change in adults with less overactivity but worsening of impulsivity, poor concentration and risk-taking behaviours. Adults with ADHD are more likely to experience depression, anxiety, low self-esteem, substance misuse and feeling easily overwhelmed in less structured environments.
Clinicians use a specialist classification system to make a diagnosis of ADHD. If you become aware of these difficulties, then you may consider consulting a psychiatrist. An assessment usually takes a total of 2 hours. The clinician will focus on the duration and the associated impairment with these symptoms.
There are both medication and psychological treatments available for ADHD. CBT, mindfulness and ADHD educational groups could be helpful. These interventions can help you to prioritise important tasks, assist with organisation and challenge the self-critical and anxious thoughts. Appropriate adjustment and support in your local environment can be useful.
There are medications which are available which can be initiated and stabilised by a psychiatrist.
Eating Disorders
An eating disorder is a medical diagnosis and is based on an individual’s eating patterns and physical investigations including weight, body mass index and blood tests. They can involve eating too much, too little or using harmful methods to reduce calories. People affected by an eating disorder can become preoccupied with their calorific intake and how to get rid of them. They are focused on their weight and body shape with constant checking behaviours. Individuals may avoid looking at themselves in a mirror or photographs to reassure themselves about their weight.
Common eating disorders can include bulimia nervosa, anorexia nervosa and binge eating disorder. Having an eating disorder can affect psychological and physical wellbeing. An individual’s focus and sleep can become disrupted. They may feel depressed and lose interest in socialising and progressively become withdrawn. An obsessional relationship may develop with food and eating habits.
Eating disorders can affect all the major organs in the body including the heart, gastrointestinal system, liver, kidneys and fertility. If you or your family are concerned that you may have an eating disorder then it is important that you seek professional help. Dr Yahya is trained in the recognition and management of eating disorders. Treatment needs to be tailored to the type of eating disorder and treatments ranging from individual and group psychotherapies, self-help programmes and medication.
Memory Problems and Dementia
Many individuals may become more forgetful as they age. People may worry that this is an early sign of a serious neurodegenerative illness such as dementia or Alzheimer’s disease. However, there can be many reasons for this, and this may be related to normal aging. Other causes can include depression, stress, grief, physical illnesses such as infections and vitamin deficiencies. If there are concerns, then it is helpful to consult a specialist psychiatrist who can facilitate the relevant assessments and investigations.
Dementia is a general term which is used to describe a group of conditions that can affect memory and an individual’s ability to function independently. It is a progressive disorder with deterioration following symptom onset.
Mild Cognitive Impairment (MCI) is a less serious memory problem. It does not interfere with everyday activities to the extent of dementia. Individuals may forget the names of people, places, passwords, misplace things or forget planned activities.
There are treatments available for dementia with the aim for individuals to stay independent and mobile for as long as possible.
There are pharmacological and psychosocial therapies that can be advised by a specialist.
Schizophrenia and Psychotic Disorders
Schizophrenia and psychotic disorders interfere with thinking, feeling and behaviour.
The person may experience hallucinations which can include hearing voices, smelling or feeling something which do not exist in reality. Delusions are described as beliefs which the individual is convinced by but others will perceive as unrealistic, mistaken or strange. The origin of these beliefs cannot be explained by culture, background or religion.
These disorders need specialist management. Medication may be required and can help to reduce the intensity of these experiences and improve clarity of thinking. Other treatment options include psychological therapies, structured activities and using the support from friends and family.
Bipolar Disorder
Bipolar disorder is a chronic episodic mental disorder which is associated with mood changes and behavioural disturbance. It is characterised by episodes of mania, hypomania and depression. In mania or hypomania the person’s mood is elevated, and they would present with increased energy and over activity. During a depressive episode there is a lowering of mood with subsequent decrease in energy and activity levels. In some cases, patients may present with mixed symptoms of depressed and elevated mood. These mood states can manifest in any order with one more dominant than the other.
If an episode of mania or depression becomes very severe then the individual may develop psychotic symptoms. During a manic episode the person may present with grandiose beliefs i.e. that they have special powers or are on a special mission. Psychotic symptoms in depression may include delusions of guilt, worthlessness and nihilism. During episodes of illness the person may continue to experience low grade depressive symptoms and problems with thinking.
There are various treatment approaches for bipolar disorder. Medication can be used to stabilise mood and reduce the chance of relapse. Cognitive Behavioural Therapy (CBT) can help with bipolar and identify coping skills. Psychoeducation is particularly useful and includes mood monitoring and identifying the earlier stages of relapse to prevent a full-blown episode.
Anxiety Disorders
Anxiety is a feeling which is experienced in situations of threat or difficulty. Some anxiety can be helpful as it allows us to remain alert and prepares our body for action.
The anxiety ameliorates either when a person adapts to the situation, there is a change in the situation or when they leave this environment. Excessive or intense anxiety which is disproportionate to the situation is not beneficial. If an individual experiences persistent anxiety or this occurs without any apparent reason, then this can be debilitating.
The anxiety disorders that are commonly encountered include generalised anxiety disorder (GAD), panic attacks and phobias.
In GAD the individual experiences symptoms of anxiety most of the time. Panic attacks are unpredictable, sudden and intense episodes of anxiety. The symptoms come on suddenly and reach their peak in 10 minutes or less. The individual may feel that they are going to die, they are going crazy, or they are choking.
Phobic anxiety disorders can include agoraphobia and social phobia. The person feels frightened by something which is not actually dangerous and doesn’t trouble most. They will avoid this stimulus because when they are away from this, they feel fine.
It is much better to get help then suffer in silence. There are a number of evidence-based treatment which are effective. These can include psychological therapies or the consideration of medication. In some cases, the combination of both may be recommended.
Social Phobia
A phobia is a fear which stops us from enjoying things or doing them easily. In social phobia the individual is anxious when they are with other people. They experience self-critical thoughts and worries that they may do something embarrassing. Social phobia can cause significant impairment with some individuals avoiding all social contact. With social phobia the difficult feelings can result in a panic attack when the person feels overwhelmingly anxious or terrified of losing control. Treatments for social phobia include self-help programmes, psychotherapy (particularly CBT) and medication in more challenging to treat cases.
Obsessive Compulsive Disorder (OCD)
Patients with OCD have distressing thoughts or experience urges, which they try to resist, but these still arise in a repetitive way. This can dominate the life of the individual and prevent them from enjoying activities or carrying out everyday tasks.
If you experience distressing thoughts coming into your mind even though you try to suppress them
OR
you have to count things/repeat the same activity over and over again to provide relief then you may have symptoms of OCD.
Effective treatment approaches include self-help programmes, psychological therapies and medication. For more severe manifestations of OCD a combination of psychological treatments and medication may be required.
Post-Traumatic Stress Disorder (PTSD)
We can all have an experience which is overwhelming, frightening or beyond our control. These can include being the victim of an assault or having a car accident. Many of us will be able overcome this experience without trauma treatment. However, others may experience a set of symptoms including flashbacks and nightmares, avoidance, emotional numbing and hypervigilance. These symptoms can cause them significant impairment in their everyday functioning. This is called Post-Traumatic Stress Disorder (PTSD) and needs professional help.
Individuals who have repeatedly experienced severe neglect or abuse as a child or adult or exposure to repeated violence or abuse as an adult, such as torture, abuse or imprisonment may have a similar set of reactions. These individuals may meet the criteria for a diagnosis of ‘Complex PTSD.’
There are various treatments including psychotherapy and pharmacological options. Cognitive behavioural therapy (CBT) is effective and helps the individual think differently about the traumatic memory. Eye Movement Desensitisation and Reprocessing Therapy (EMDR) is a popular and effective treatment which is also recommended in the UK national clinical guidance (NICE).
Problem Gambling
Problem gambling is defined as gambling which disrupts or damages personal, familial or recreational pursuits.
It is important to seek professional help if the gambling is causing financial, familial, occupational or health harms.
The management of problem gambling follows a biopsychosocial model. Psychological therapies which include cognitive behavioural therapy (CBT) have evidence for the management of this condition.
There are also medication options which can be discussed.
Pathological Grief
At some point in our life most individuals experience the death or loss of someone they love. Each person has their own way of coping with this loss and coming to terms with this. Grief is a natural mourning process. However, some may have a pathological grief reaction. Patients may experience persistent distressing symptoms and impairment or disability in important areas of functioning. In these circumstances it is important they seek professional support. The first line treatment for pathological grief is psychotherapy (taking therapy). However, some patients may require medication if there are coexistent symptoms of depression or post-traumatic stress disorder (PTSD).
Insomnia and Sleep Problems
Sleep problems are commonly enquired in clinical practise and by themselves can increase the risk of developing a mental disorder. The amount of sleep required is individualised.
The individual may have difficulty getting off to sleep, maintaining their sleep or waking up too early. Others may be sleeping too much, and this is causing significant disruption to their quality of life. They may experience nightmares or have other disturbing experiences in the night. As a consequence, they may be tired and sleep during the day. They may drink too much tea, coffee, soft or energy drinks and even resort to illegal drugs to keep them stimulated during the day.
Should the sleep problems persist or if there are concerning behaviours during the night then they should consult a professional. A comprehensive history and clinical examination will be required to determine the cause and decide on an appropriate treatment plan. Depending on the sleep disorders there are various treatments can be offered ranging from psychotherapy, behavioural strategies and medication.
Personality Disorder
An individual’s personality refers to a constellation of characteristics or traits that they have developed which shapes their thinking, feelings or behaviour. By their late teens or early twenties most have developed their own personality, and this usually allows them to establish relationships. However, for some their personality develops in a fashion that leads to them finding it difficult to kind to themselves or live with others. They may have difficulty keeping out of trouble, controlling feelings or behaviour and listening to others.
Individuals may find it difficult to change or adapt to normal life circumstances or changes in routine. These traits may have been visible to others since childhood and early teens. The manifestation of a personality disorder can cause disruption in the patients’ lives or those closest to them. The personality disorder can make individuals vulnerable to developing other mental illnesses or having drug and alcohol problems.
There is emerging evidence that personality disorders can be treated effectively. There is also evidence that they can improve slowly with age. The treatments for personality disorder can include both psychological therapies and medications. It is important that patient receive adequate support from trained professionals.
Alcohol Problems
Statistics in the United Kingdom indicate that over half of males and just under a half of females drink alcohol. Drinking at low risk levels and adhering to government recommendations includes drinking no more than 14 units of alcohol over the course of a week, having several drink free days and never binge drinking. Around 1 in 100 adults in Britain have alcohol dependence.
Symptoms of alcohol dependency include:
• an urge to have an alcoholic drink
• waking up with a tremor and feelings of nervousness
• drinking earlier in the day
• becoming tolerant and needing to drink more to feel the same effects, work and relationships begin to suffer
• using alcohol takes primacy with other aspects of life neglected
• the individual continues drinking despite the problems it is causing
Harmful use of alcohol can lead to psychosis, memory problems and organ damage. If the individual is drinking too much or there are concerns about alcohol dependence, then it is important they seek professional support. Treatments options include using psychological therapies and medications which should only be started by a specialist. It is also important to treat any secondary mental disorders such as anxiety or depression.
Seasonal Affective Disorder (SAD)
This describes changes in mood during the winter months when patients can present with depressive symptoms. The main symptoms of SAD are similar to those in depression except that they occur in the winter months. Symptoms of SAD which are different than those commonly encountered in depression including sleeping and eating more.
SAD gets better in the spring and around one third of people with SAD have a time when they feel more energetic in the spring and summer months. The reduced amount of light in the winter may influence the mood change in SAD. Treatments used for SAD include self-help programmes, light therapy and medication. Psychological therapies also have an evidence base and cognitive behavioural therapy may help symptoms and prevent recurrence.
Medically Unexplained Symptoms
Everyone experiences physical symptoms at various stages in their life. These may include aches, pains and odd sensations in our bodies. In most cases these symptoms usually resolve. If symptoms persist then a physical cause may be found although in some circumstances the investigations such as blood tests and x-rays may not reveal any new findings. These symptoms are commonly experienced and are described as medically unexplained. Commonly encountered medically unexplained symptoms can include muscular and joint pains, back pain, headaches and tiredness.
Research indicates that our minds and bodies are linked. The link between the two can be used to understand medically unexplained symptoms. Stress can present with physical symptoms which make us feel uncomfortable and ill. Worrying about these symptoms can exacerbate the stress and the bodily symptoms. Similarly for pain symptoms can continue in the longer term once the suspected injury has healed. Longstanding symptoms of pain can make individuals feel depressed and the depression can affect pain thresholds exacerbating this. A vicious cycle of pain and depression may develop with each impacting the other.
Treatments for medically unexplained symptoms may include psychotherapies including CBT and work around problem solving. Medications may also be considered and particularly if symptoms are related to an anxiety or depressive disorder.
Delirium
Delirium is described as a sudden onset of confusion and is caused by a physical condition. During this state of confusion, a patient would not be aware of their location, the time or what is happening to them. There is variation throughout the day and the presentation may be worse at night. Delirium can be triggered by a variety of factors which may include medical problems, surgery and medications. Delirium usually starts suddenly and improves when the underlying cause is addressed. It can be frightening both for the patient but also their loved ones. Statistics from the Royal College of Psychiatrists indicate that 2 out of 10 hospitalised patients experience an episode of delirium.
It is important to proactively treat any reversible causes of the dementia. Staying calm and using good communication is essential and will help the patient feel less distressed. It is important that they have their glasses/hearing aids, and they are supported to eat and drink. Environmental adaptations are needed with adequate lighting and bringing some familiar belongings from the home.
Mental Illnesses During Pregnancy
Pregnancy is often a happy time but can be very stressful with a constellation of physical and psychological stressors. It is normal to feel stressed during this period. However, 1 in 5 women have mental health problems in pregnancy or after birth. Depression and anxiety disorders are the most encountered mental disorders during pregnancy.
A history of mental health problems in the past increases the risk of developing a mental illness during pregnancy. The development of psychotic disorders or more severe forms of depression need urgent assessment and treatment from mental health professionals. It is important to get specialist advice if individuals have a history of mental illness or a re-emergence of symptoms.
Psychosexual Problems
Statistics indicate that about 35% of males and 54% of females experience sexual difficulties at some point during adulthood. However, even though this is common many do not seek active treatment for this. They are usually caused by a mix of physical and psychological factors.
Commonly encountered psychosexual problems with males include erectile dysfunction, premature or delayed ejaculation, lack of sexual desire and sexual addiction. Women may present with a lack of sexual desire or arousal, pain during sexual intercourse and a lack of sexual enjoyment or orgasm. An integrated approach is needed which incorporates both medical and psychological treatments.
Anger Problems
Everyone experiences anger and this may range from mild irritability to rage. However, if anger is suppressed or uncontrolled this may lead to destructive or violent behaviour. This can have significant effects on the individual’s mental health. It is important to understand the root cause of the anger and earlier life attachments. The anger may be a manifestation of mental illness. A variety of treatment approaches can be employed to treat uncontrolled anger. Psychological therapies including counselling and cognitive behavioural therapy would be the preferred intervention for such difficulties.
Relationship Problems
Sometimes relationships can cause significant stress and lead to the individual feeling overwhelmed. These difficulties can lead to feelings of anger and hopelessness. Anger can in fact become an interpersonal defence. Anger can be destructive on relationships and affect individual wellbeing. Effective problem solving and solution focused training may be effective in these situations. Working through the problems with a trained professional can have a significant difference. Psychological therapies would be the mainstay of treatment and can include counselling and various psychotherapies.
Substance Use Disorders
Drug addiction can have harmful physical, emotional and psychological consequences. The substance addiction can take over an individual’s life and lead to self-destructive behaviour. There are various types of drug addiction that encountered in clinical practise. Dr Yahya offers a personalised intervention to treat the substance disorder.
It is important to address the biological, psychological and social factors in drug addiction.
There are various psychological therapies including CBT and motivational therapy that can be enhance motivation from change to refrain from using.
For some types of substance use disorder medications may be required as part of the detoxification process.
References
• https://www.rcpsych.ac.uk/mental-health/problems-disorders
• https://www.mind.org.uk/information-support/types-of-mental-health-problems/
• https://www.psychiatry.org/patients-families/what-is-mental-illness
• https://www.apa.org/topics/mental-health-attitudes