Insomnia and reducing suicide - the importance of sleep

The risk of suicide in people with insomnia could be reduced if they are able to get more sleep. 

Suicide is one of the major leading causes of death. Approximately 1 million people die each year worldwide from suicide. Suicidal behaviour is complex. Relevant risk factors vary with age, gender, and ethnic group and may even change over time. However, more than 90% of people who kill themselves have depression or another diagnosable mental or substance abuse disorder, often in combination with other mental disorders. Prior suicide attempt, family history of mental disorder or substance abuse, family history of suicide, family violence, including physical or sexual abuse, firearms in the home, incarceration and exposure to the suicidal behaviour of others are among the risk factors ( Agargun, M. Y., Lütfullah Beşiroğlu, 2005).

A very recent study found a relationship between sleep duration and suicidal thoughts in people with insomnia (Linden Oliver, University of Pennsylvania). Specifically, researchers discovered that every one-hour increase in sleep duration was associated with a 72 percent decrease in the likelihood of moderate or high suicide risk.

“We were surprised by the strength of the association between sleep duration and suicide risk,” said primary author Linden Oliver, M.A., clinical research coordinator for the University of Pennsylvania Behavioural Sleep Medicine Research Program.

“A 72 percent decrease in the likelihood of moderate or high suicide risk with a one-hour increase in sleep is interesting given the small sample size.”

Everyone’s individual sleep needs vary. In general, most healthy adults are built for 16 hours of wakefulness and need an average of eight hours of sleep a night. However, some individuals are able to function without sleepiness or drowsiness after as little as six hours of sleep. Others can't perform at their peak unless they've slept ten hours.

Earlier studies have also found that people with insomnia are up to twice as likely to commit suicide as people who don't have such difficulties sleeping. A 2011 study in teens found that those who had sleep problems at ages 12 to 14 were 2.5 times more likely to have suicidal thoughts in their late teen years.

Depending on the person, insomnia could be a cause or an effect of depression. Insomnia can lead to a very specific type of hopelessness, and hopelessness by itself is a powerful predictor of suicide ( Dr. W. Vaughn McCall).

Every cell in our bodies runs on a 24-hour clock, tuned to the night-day / light-dark cycles. It can be said that the brain acts as timekeeper, keeping the cellular clock in sync with the outside world so that it can govern our appetites, sleep, moods and much more. The research also shows that the clock may be broken in the brains of people with depression even at the level of the gene activity inside their brain cells (Proceedings of the National Academy of Sciences, the University of Michigan Medical School).

In a normal brain, the pattern of gene activity at a given time of the day is so distinctive that the authors could use it to accurately estimate the hour of death of the brain donor, suggesting that studying this "stopped clock" could conceivably be useful in forensics. By contrast, in severely depressed patients, the circadian clock was so disrupted that a patient's "day" pattern of gene activity could look like a "night" pattern and vice versa. 

Sleep is essential for a person’s health and well-being. Sleeping poorly increases the risk of poor mental health and physical health. As such, it is important to recognise the link between sleep and mental health and to highlight a dire need for people to begin to take sleep seriously as a health concern.

Understanding Psychosis

 

The word psychosis is used to describe a mental health problem that can affect the brain, so that there is a loss of contact with reality. When someone develops a mental health problem in this way it is called a psychotic episode. According to Rethink Mental Illness charity, about 3 out of every 100 people will experience a psychotic episode, making psychosis more common than diabetes. Most people make a full recovery from the experience.

The word ‘psychotic’ relates to ‘psychosis’, which is a psychiatric term, and describes experiences, such as hearing or seeing things or holding unusual beliefs, which other people don’t experience or share. Psychotic experiences are surprisingly common, but can also lead to diagnosis such as schizophrenia, bipolar disorder, schizo-affective disorder, paranoia, several depression or puerperal psychosis (a very severe form of postnatal depression).

One sign of psychosis is that a person lacks insight into their own state of mind. Psychosis distorts the senses, making it very difficult for the ill person to tell what is real from what is not real. Someone experiencing a first-episode psychosis may not understand what is happening. Symptoms are unfamiliar and frightening, leaving the person confused and distressed. If they do not know the facts and have no real understanding about mental illness, their distress may be increased by negative myths and stereotypes.

A psychotic episode occurs in 3 phases: (1) Prodrome, (2) Acute, (3) Recovery.

1. PRODROME - refers to the early symptoms and signs of an illness that precede the characteristic manifestations of the acute, fully developed illness. It is defined as the period of time from the first change in a person until development of the first frank psychotic symptoms.

2. ACUTE - clear psychotic symptoms are experienced, such as disorganised thinking, hallucinations or delusions.

3. RECOVERY - psychosis is treatable and most people recover, however, the pattern of recovery varies from person to person.

CAUSES OF PSYCHOTIC EXPERIENCES

Almost anyone can have a brief psychotic episode. In general, psychotic experiences may be caused by:

• Physical causes, such as illness: For example through a lack of sleep or high fevers (including malaria, pneumonia, other viral infections). They can also be a result of damage to the brain or dementia, lead and mercury poisoning, or changes in blood sugar levels.
• Drug use: Alcohol, street drugs, prescription medication (including steroids) can result in a psychotic experience that may continue even if the drug has worn off.
• Changes in brain chemistry: It’s not clear though whether these changes are the cause or the effect of the psychotic experience.
• Inherited vulnerability: However, no single gene has been found to be responsible, though, and the majority of people who have these experiences have no known family history.
• Traumatic events such as abuse: Many people who have psychotic experiences have been physically, emotionally, or sexually abused, and feel a need to push their feelings and memories away, because they are so painful. Psychotic experiences may be an expression of these overwhelming feelings and forbidden thoughts, and a way of coping with trauma.

TREATMENT OF PSYCHOSIS

Treating psychosis involves education, medication, close monitoring of symptoms, stress management and creating a strong, supportive environment. These treatments all help to speed up the recovery process and promote good quality of life for both the person and the family. 

RECOVERY

Some of the most recent and hopeful news in psychosis research is emerging from studies in the field of Early Intervention. New studies challenge several long held myths in psychiatry about the inability of people with psychosis to recover. It now appears that such myths, by maintaining an overall pessimism about outcomes, may significantly reduce a persons opportunities for improvement and/or recovery. After three decades of empirical study, it is now clear that early intervention is an important part of the treatment strategy. Furthermore, the importance of family input for treatment and the benefits of supportive partnerships between clinicians and families are well established (Rethink Mental Illness Charity).

Cognitive Enhancers in Schizophrenia: non-pharmacological approach

This post is a follow up part to the previous post, which introduced the pharmacological approach to the enhancement of cognition in schizophrenia.

With no major clinical success to date in targeting cognitive deficits in schizophrenia, attention shifted to behavioural, neuro-cognitive interventions. These approaches are based on the assumption that a broad and intensive activation of neural processing systems can stimulate neural resources to improve their functioning. It is believed that intense activation of cognitive (mental) systems damaged in patients with schizophrenia could effectively lead to a general and lasting functional improvement. As a result, several cognitive training strategies have been developed and these can generally be divided into either (1) COGNITION-ENHANCING or (2) COMPENSATORY approaches. The former approaches train patients with laboratory tasks designed to improve specific abilities in various cognitive domains, such as perception, learning, or memory. On the contrary, the latter approaches attempt to bypass cognitive deficits and teach strategies to compensate for them by relying on aids or other processes (Tomás, Roder, & Ruis, 2010).

1) COGNITION-ENHANCING PROGRAMMES

• Cognitive Remediation Therapy (CRT)
• Cognitive Enhancement Therapy (CET)
• Integrated Psychological Therapy for Schizophrenia (IPT) 

CRT aims to improve attention, working memory, cognitive flexibility, planning and executive functioning. CRT is usually administered via use of a computer, with the tasks appearing on the monitor. Research to date demonstrates small to moderate durable effects of CRT and that irrespective of therapy characteristics CRT can provide benefits to patients with cognitive difficulties. Although having more symptoms is associated with smaller effects, all participants were shown to benefit from CRT.

CET is a recovery-phase intervention for symptomatically stable schizophrenic out-patients with reduced relapse risk (Hogarty et al., 2004). This programme tackles areas and disabilities of a wider functional range. For example, specifically designed exercises target analytic logic, decision making, strategic and foresightful planning, as well as the intuitive thinking that supports social cognition (thinking). CET is a small-group approach that combines approximately 75 hours of progressive software training exercises in attention, memory and problem solving with 1.5 hours per week of social cognitive group exercises. Consistent positive results are fund in processing speed and verbal memory. A drawback of this approach is that it is only applicable to patients with a certain intellectual level (with an IQ above 80) who are psychopathologically stable (Tomás et al., 2010).

IPT integrates neuro-cognitive and psychosocial rehabilitation methods.IPT is administered to groups and consists of five, hierarchically organised sub-programs: cognitive differentiation, social perception, verbal communication, social skills and interpersonal problem solving. Studies typically reveal the largest improvements in neuro-cognitive functioning, however, effects on psychosocial functioning tend to be smaller (Roder et al., 2006). More research is currently needed to evaluate the effectiveness of this approach.

2) COMPENSATORY REHABILITATION PROGRAMMES

• Errorless Learning (EL)
• Cognitive Adaptation Training (CAT)

EL involves two main procedures: prevention of errors during the learning phase and automation of perfect task execution (Terrace, 1963). It refers to teaching procedures that are designed in such a way that a learner/patient does not have to - and does not- makes mistakes as she/he learns new information and new procedures.

CAT uses environmental supports and various clues such as signs, check-lists or alarmed drug packaging. It also encourages organisation of belongings and the sequencing of appropriate routines.

In effect, compensatory strategies work to some extent, however, they do not succeed in achieving pre-morbid levels of performance (Tomás et al., 2010). Moreover, they are aimed at people with significant cognitive impairment that is difficult to restore and thus renders them less suitable for people with recent illness who are more intact.

References

Roder, V., Mueller, D. R., Mueser, K. T., & Brenner, H. D. (2006). Integrated psychological therapy for schizophrenia: is it effective? Schizophrenia bulletin, 32 Suppl 1, S81-93. doi:10.1093/schbul/sbl021 

Terrace, H. S. (1963). Discrimination learning with and without errors. Journal of the Experimental analysis of Behaviour, 6, 1-27.

Tomás, P., Roder, I. F. V., & Ruiz, J. C. (2010). cognitive Rehabilitation Programs in Schizophrenia: Current Status and Perspectives. International Journal of Psychology and Psychological Therapy, 10(2), 191-204.

Enhancing Cognition in Schizophrenia - pharmacological approach

Cognitive impairment is a core feature of schizophrenia, with more than 80% of patients showing significant impairments (Keefe & Fenton, 2007). The range of cognitive impairments in individuals with schizophrenia is broad, with the more robust and replicable deficits typically found in the domains of processing speed, episodic memory, working memory and executive function. These impairments have been shown to be associated with various impaired functional outcomes and thus development of new therapies to enhance cognition has become one of the most pressing challenges. Cognitive deficits persits throughout the course of the illness and as such, negatively affect daily functioning, work outcomes and treatment adherence. While anti-pscyhotic medications can control psychotic symptoms for the majority of patients, such improvements do not automatically transfer into the functional outcome, such as community functioning. Additionally, anti-psychotic drugs that are currently the main form of treatment in schizophrenia demonstrate only a modest positive effect on cognition.

Despite a large number of compelling rationales and significant body of preclinical data, there are no dramatic or consistent results that any one medication has the power to increase cognitive skills to the level of normal functioning. While a wide range of cholinergic, dopaminergic, glutamatergic and cannabinoid compounds have been developed, the Food and Drug Administration (FDA) has not yet approved any of the drug development programmes specifically aimed at treating cognitive impairments in schizophrenia.

Pharmacological approach: Potential Cognitive-Enhancing Drugs in Schizophrenia

1. Antipsychotic Drugs (APDs)

While numerous studies have demonstrated the dramatic efficacy of APDs in suppressing psychotic symptoms and preventing their recurrence, they have also revealed their inability to alleviate the negative and cognitive symptoms of the illness. There are, however, some studies that suggest that some of the newer atypical antipsychotics e.g. aripiprazole, clozapine, quetiapine, olanzapine, risperidone and ziprasidone, may provide minimal benefits in certain specific areas of cognition.

2. Donepezil, Rivastigmine, Galantamine

Researchers sometimes focus on drugs that have proved effective in other cognitively impaired conditions, such as in dementia. Several drugs approved for dementia stimulate acetylcholine by blocking its breakdown, which has been shown to improve cognition and slow cognitive decline. Donepezil belongs to this type. The results in schizophrenia field, however, are not very encouraging, with only a few studies showing somewhat minimal memory improvement.

Rivastagime has also been investigated but only in smaller-scale studies. No significant findings have been reported to date.

Evidence of cognitive benefit with galantamine has been mixed so far. The overall trend indicates that at lower doses galantamine exerts a positive effect on cognition but at higher doses it is consistently associated with negative results. The most effective dosage is yet to be established.

3. Nicotine and nicotinic receptors

It is now widely accepted that nicotinic receptor abnormalities are present in schizophrenia. The vast majority of studies found some positive effects, improvements were frequently recorded in working memory and attentional/executive control functions and in episodic memory. However, nicotine did not improve every measure examined in each study and the magnitude of the effects was not large. Additionally, nicotine as a therapeutic agent may be limited by tachyphylaxis.

4. Modafinil

Modafinil is a wakefulness-promoting agent, shown to be effective in enhancing cognition in sleep-deprived and healthy individuals, as well as in some psychiatric disorders. While having effect on many neurotransmitter systems, modafinil has an uncertain mechanism of action. Results at this stage appears to be inconclusive. Benefits demonstrated by early studies were not replicated by larger-scale studies.

NB: Non-pharmacological applications will be reviewed in a future post

Reference

Keefe, R. S. E., & Fenton, W. S. (2007). How should DSM-V criteria for schizophrenia include cognitive  impairment? Schizophrenia bulletin, 33(4), 912-20. doi:10.1093/schbul/sbm046

New combat stress helpline announced | BPS

New combat stress helpline announced | BPS

Problem solving for personality disorder

Mary McMurran and Stephen Coupe describe a promising approach to a distressing disorder

 

What is problem-solving therapy?

Problem-solving therapy has a solid evidence base for alleviating distress and improving social functioning in people with a range of psychological and health problems. This approach has considerable appeal for both therapists and clients, in that its basic principles are easy to understand, it does not pathologise individuals, and it empowers people to solve those problems that they prioritise. Applications of problem-solving therapy for people who are diagnosable with personality disorders have been pioneered by researchers and clinicians in the UK.

Social problem solving is the process by which individuals attempt to discover and apply adaptive means of coping with the wide variety of stressful problems encountered in the course of everyday living (D’Zurilla & Nezu, 2007). There is abundant evidence of an association between social problem-solving deficits and psychological distress, physical ill health, substance misuse, hostility and aggression, and mental health problems. Problem-solving therapy can help people to cope better with everyday problems and can lead to better mental and physical health. Problem-solving therapy teaches the skills required for effective social problem solving. These are the ability to recognise problems when they arise, define the problem clearly and accurately, set realistic goals for change, produce a diversity of possible solutions, anticipate outcomes, devise effective actions plans that have stepwise stages, and carry out those action plans to solve problems effectively. 

Click on the following link to read more about: Problem Solving Therapy

Coping with Suicidal Thoughts

There are times in life when we might feel totally, hopeless, helpless, overwhelmed with emotional pain. It can seem like there is no other way out of our problems, we've run out of ideas, possible solutions. Our problems seem unfixable. The pain feels like it will never end. We believe we've run out of options, and suicide is the only answer left.

Maybe the suicidal thoughts come to mind, and you might have mixed feelings about them. They can be frightening and confusing.

For some people, suicide may be a way of getting back at others, or showing them how much pain you're in. But after suicide, you won't be there to see that they feel guilty, or finally understand your pain.

Suicide is a permanent solution to a temporary problem.

Feelings will pass. Depression feels permanent, but it's transient. Things will change. Depression comes, and it goes. Depression and pain distort our thinking. It can seem like we're wearing very dark tinted 'gloomy specs'. Everything looks different to how it really is. Thoughts are thoughts - not necessarily how things are, although it certainly feels like the thoughts are true. Thoughts affect the way we feel, and thoughts and feelings affect the way we react, what we do.

Suicidal thoughts can result when we experience too much pain, without having enough resources to cope.

We therefore have two ways to get us through this horrible time:

1. Reduce the pain
2. Increase coping resources

REDUCE THE PAIN:

Self-soothing

Do something that will help you feel better, right now.

Perhaps collect items into an emergency bag or box that you can turn to.

Use all five senses to find things that will soothe you.

VISION – Focus your attention on looking at something nice, nature, a painting, watching a favourite programme or movie.

HEARING – Listen to a favourite piece of music, sound of nature, sing.

SMELL – Really notice smell – favourite soap, food, essential oil.

TASTE – Use sensation of taste to focus your attention. Eat mindfully -savouring each moment.

TOUCH – Wear soft comforting socks, stroke a pet, give yourself a hand massage.

Avoid drugs and alcohol

Whilst it seems like they help for a while, they will make your problems worse.

Ask yourself:

Are these thoughts facts or my opinion?

What has helped me feel better in the past?

What can I do right now that will help me feel better?

What gives my life meaning? What are my goals, dreams or life values? E.g. Family, friends, pets, helping others, faith, spirituality, community life, connecting with nature.

Tell yourself:

I've coped this far, I can get through the next .... (day, hour, 10 minutes)

Things will look better in time.

Depression is temporary - this will pass.

Suicide is a permanent solution to a temporary problem.

Depression is distorting my thinking - these thoughts are the voice of depression. They are not facts. I don't have to act on them.

The vast majority of people get better from depression. I will look back and be pleased that I chose to live.

Write things down

Safety Plan worksheet & Safety Plan Cards

INCREASE COPING RESOURCES – IMMEDIATE STEPS

Read and put your Safety Plan into action! 

Keep the Safety Plan where you can easily find it when you need it. Maybe make several copies – and keep them in several places (e.g. your room, your car, your purse).

Take one step at a time

Take things a little at a time. Set out to get through the next day, the next week or month, perhaps the next hour or even less. Tell yourself: "I've got through so far, I can get through the next hour".

Distraction

Do something else, and focus your attention fully on what you're doing (e.g. gardening, physical exercise, something creative, sudoku).

Talk to someone - now!

• A friend or family member
• A telephone helpline (E.g. Samaritans 08457 90 90 90)
• A health professional
• Go somewhere you'll feel safe - be with other people
• Go to the local Accident & Emergency department
• Call the local emergency number (E.g. 999, 112, 911)

Reference:

A huge thank you to Carol Vivyan who has put together an incredibly useful set of resources.

Vivyan, C. (2011), www.getselfhelp.co.uk

Mindfulness - what is it?

Mindfulness is an ancient Budhist practice which is very relevant for life today. It refers to a psychological quality that involves bringing one's complete attention to the present experience on a moment to moment basis. It could also be described as kind of non-judgemental, present-centered awareness in which each thought, feeling, or sensation that arises in the attentional field is acknowledged and accepted as it is.

Mindfulness is actually very simple concept. It is simply a practical way to notice thoughts, physical sensations, sights, sounds, smells – anything we might not normally notice. The actual skills might be simple, but because it is so different to how our minds normally behave, it takes a lot of practice. Mindfulness can simply be noticing what we don't normally notice, because our heads are too busy in the future or in the past - thinking about what we need to do, or going over what we have done.

For example, Carol Vivyan, explains how we are simply often set on auto-pilot in many activities of our life. In a car, we can sometimes drive for miles on automatic pilot, without really being aware of what we are doing. In the same way, we may not be really 'present' moment-by-moment, for much of our lives: We can often be 'miles away' without knowing it.On automatic pilot, we are more likely to have our "buttons pressed”: Events around us and thoughts, feelings and sensations in the mind (of which we may be only dimly aware) can trigger old habits of thinking that are often unhelpful and may lead to worsening mood.

By becoming more aware of our thoughts, feelings, and body sensations, from moment to moment, we give ourselves the possibMility of greater freedom and choice; we do not have to go into the same old “mental ruts” that may have caused problems in the past.

Mindfulness training has at least 5 broad beneficial effects, according to Felicia Huppert, Professor of Psychology of the University of Cambridge's Well-Being Institute. Specifically, mindfulness promotes:

• increased sensory awareness
• greater cognitive control
• enhanced regulation of emotions
• acceptance of transient thoughts and feelings
• the capacity to regulate attention

Mindful breathing

The primary focus in Mindfulness Meditation is the breathing. However, the primary goal is a calm, non-judging awareness, allowing thoughts and feelings to come and go without getting caught up in them. This creates calmness and acceptance. The following link takes you to the Mindful Breathing Script/Handout created by Carol Vivyan to help you started.

Mindul Breathing Script

Emotion regulation

Many of our intrusive thoughts come with an emotional flavour. Often these are negative – we suddenly remember a recent argument, which makes us angry, or the time we embarrassed ourselves in front of others. It is all to easy to get caught up by these intrusive emotional thoughts and to ruminate on them at length. Again, mindfulness encourages a more de-centred perspective on these feelings: they should be noted, and let pass. "Simply recognising your feelings gives you a choice in how you are going to respond, rather than reacting automatically in ways that lead to trouble", says Professor Huppert.

Using mindfulness to cope with negative experiences

As we become more practised at using mindfulness for breathing, body sensations and routine daily activities, so we can then learn to be mindful of our thoughts and feelings, to become observers, and subsequently more accepting. This results in less distressing feelings, and increases our level of functioning and ability to enjoy our lives.

Jon Kabat-Zinn uses the example of waves to help explain mindfulness. Think of your mind as the surface of a lake or an ocean. There are always waves on the water, sometimes big, sometimes small, sometimes almost imperceptible. The water's waves are churned up by winds, which come and go and vary in direction and intensity, just as do the winds of stress and change in our lives, which stir up waves in our mind. It's possible to find shelter from much of the wind that agitates the mind. Whatever we might do to prevent them, the winds of life and of the mind will blow, do what we may

"You can't stop the waves, but you can learn to surf" (Kabat-Zinn 2004).

World Mental Health Day

Monday 10 October is World Mental Health Day and I would like to use it as an opportunity to urge the government to continue to invest in mental health services. 

Every year one in six of us will experience mental ill health, yet only a quarter will seek treatment. The social cost of mental ill health is over £100bn – more than the entire NHS budget – and half of all mental health problems begin before the age of 15.

The government’s recent mental health strategy “No Health without Mental Health” sets out how important mental well-being is to every one of us and how much still needs to be done to ensure that people affected by mental ill health enjoy the same chances in life as everyone else. 

People with mental health problems tell us they require services that meet both their mental health and social needs. Yet the current reductions in social care and support to the voluntary sector are having a significant impact on the lives of those who are already marginalised and living in poverty.

The British Psychological Society and a number of other professional organisations, including the Royal College of Nursing and the Royal College of Psychiatrists, have written an open letter to the health secretary to call for action to coincide with World Mental Health Day.

As well as continued investment in mental health services, they want to see an emphasis on recovery, job opportunities and fighting discrimination, and call for service users and carers to be involved at the outset in planning, delivering and evaluating mental health services

To read more about World Mental Health Day, click on the following links:

http://www.who.int/mental_health/publications/mentalhealthday_brochure_2011.pdf 

http://www.wfmh.org/00WorldMentalHealthDay.htm

The Power of Positivity by Dr Fred Von Gunten

Dear all,

I have just finished reading The Power of Positivity, an e-book written by Dr Fred Von Gunten who, I am really proud to say, was one of the first followers joining this blog. It is through his e-mails and the 'first-hand' account in his e-book that I have come to understand much better the life of a bipolar sufferer. Fred has lived with the bipolar for 50 years and was one of the first to receive Lithium when the FDA approved it in 1971. Fred's great belief in the 'power of positivity' is beautifully captured in the e-book, in which he focuses on the benefits of positivity over negativity.

I would like to recommend this e-book to all of you because, in my eyes, it is a 'must read' for anyone who either suffers from the disorder or has ever wondered what the bipolar might be about.  The following review offers a good introduction to the e-book, which can be yours within seconds for a tiny little fee of $1.99 USD. The access link is provided at the end of this post.

Review by: Linda Lee Rathbun on Sep. 05, 2011 :
Anyone who has struggled with mental health issues, and anyone who wonders how they can achieve positive thinking in their life, will no doubt benefit from this book. The author shares his lifelong struggle with bipolar disorder, and offers ways to manage the disorder with medication and with the Power of Positivity. In this book, Fred Von Gunten has opened up his heart and life for all to learn from. It is only when experience is passed on that it becomes a learning tool, and in this case, also a positive force for everyone's life. I highly commend this book to all. Linda Lee Rathbun
(reviewed the day of purchase)

I would love to hear your thoughts on this. Please follow the link below:

https://www.smashwords.com/books/view/86502

Kindest Regards,

Denisa

Understanding Psychotic Experiences

Psychotic experiences, such as hearing voices, are surprisingly common, but can lead to diagnoses such as schizophrenia or bipolar disorder.

WHAT ARE PSYCHOTIC EXPERIENCES?

Also referred to as psychosis – a psychiatric term that describes experiences such as hearing voices seeing things or holding unusual beliefs, which other people don't hear/see or share. The psychotic episodes that a person experiences usually consist of hallucinations (seeing, hearing or feeling things that aren't there) and delusions (holding unusual/unfounded beliefs such as paranoia or feelings of importance). Some delusional ideas can be extremely frightening; for example, someone might believe that other beings are placing thoughts in their head, or trying to control or kill them. These ideas are called paranoid delusions.

These symptoms can be very distressing for sufferers and can lead them to become withdrawn, depressed and suicidal so it is vital that sufferers of psychosis get help. Psychiatrists regard these types of experiences as symptoms, and, depending on other factors, they will base a diagnosis on them. The diagnosis could be severe depression, schizophrenia, bipolar disorder, paranoia, psychotic illness, schizoaffective disorder, or puerperal psychosis (a very severe form of postnatal depression). These diagnoses are not clear-cut, and people may receive different diagnoses at different times.

Everyone’s experiences are unique. The majority hear voices, which may be recognizable or unfamiliar. There may be one or many of them talking to, or about, an individual. They might be present occasionally, or all the time, interfering with ordinary life, making concentration and conversation difficult. The voices may be benign and helpful, or hostile and nasty. Some people hear only positive voices, and may not regard them as a problem, others hear only negative ones, which causes great distress. The sufferers may feel the voices are in control of their body and can hurt them or punish them if they don’t do as they’re told. This may cause them to cut themselves or carry out other harmful types of behaviour.

Other psychotic experiences can take form of non-verbal thoughts, images and visions, tastes, smells and sensations, which have no apparent cause. For example, feeling as if insects were crawling under your skin, having a sensation like an electric shock, or smelling something that other people around you can’t. 

WHAT CAUSES PSYCHOTIC EXPERIENCES?

Almost anyone can have a brief psychotic episode resulting from a lack of sleep, through illnesses and high fevers, or abusing alcohol or drugs. There is considerable evidence that psychotic experiences are connected to using cannabis in some vulnerable people. Experiences of this kind can also be a result of damage to the brain or dementia, of lead and mercury poisoning, or changes in blood sugar levels. There are different ideas about why psychotic experiences develop. But it’s generally thought that some people are more vulnerable to them, and that very stressful or traumatic events make them more likely to occur. A person's own attitude to their experience, as well as the attitude of those around them, also plays a part.

The experiences may involve biological changes in brain structure or brain chemistry, but its not clear whether these are the cause or the effect of the psychotic experience. Research into whether there’s an inherited vulnerability is inconclusive. If one member of a family is diagnosed with schizophrenia or bipolar disorder, then there seems to be more chance of another family member being similarly diagnosed, but no single gene has been found to be responsible. Early experiences in life may be important in helping to prevent, or contributing to, problems. One theory suggests that overcritical or over-protective families make people more vulnerable. 

TREATMENT

Psychosis can be treated in a number of ways once it has been diagnosed: anti-psychotic drugs, psychological therapies, hospitalisation and self-help.

LITERATURE

Voicing Psychotic Experiences

Recent Advances in Understanding Mental Illness and Psychotic Experiences 

Bipolar1: A Psychotic Experience

The First Episode of Psychosis: A Guide for Patients and Their Families

References:

http://www.mind.org.uk/

http://www.glasgowpsychology.co.uk/psychosis.htm

Histrionic Personality Disorder (HPD)

Like other personality disorders, histrionic personality disorder is diagnosed based on a psychological evaluation and the history and severity of the symptoms. There is a lack of research on the causes of the HPD and thus they are not definitively known. It is suggested however that biological, developmental, cognitive and social factors play a crucial role. This disorder (Cluster B) is characterised by constant attention seeking and discomfort from not being the centre of attention. Histrionics tend to interrupt others to dominate the conversation and are sometimes referred to as drama queens with their theatrical performances and gestures. Those with the disorder may dress provocatively to gain the attention they crave, and be sexually seductive in inappropriate situations. However, there is a difference between being dramatic and being histrionic. Many people exhibit HP characteristics but would not be classified as having the disorder. The following symptoms of HPD may characterize someone who is described as 'dramatic', however, only in those diagnosed with the HPD the symptoms will be exhibited to a pathological degree.

SYMPTOMS

• Acting or looking overly seductive
• Being easily influenced by other people
• Being overly concerned with their looks
• Being overly dramatic and emotional
• Being overly sensitive to criticism or disapproval
• Believing that relationships are more intimate than they actually are
• Blaming failure or disappointment on others
• Constantly seeking reassurance or approval
• Having a low tolerance for frustration or delayed gratification
• Needing to be the center of attention (self-centeredness)
• Quickly changing emotions, which may seem shallow to others
  

TREATMENT

Treatment for HPD is difficult for a number of reasons. Often, sufferers do not believe that they have a personality disorder and do not believe they’re in need of therapy. Those who do seek treatment often do so for depression or anxiety – conditions that are frequently associated with HPD. The treatment usually involves psychotherapy and/or medication.

Many people with this disorder are able to function well socially and at work. Those with severe cases, however, might experience significant problems in their daily lives.

Personality Disorder – what is it actually?

Having talked to people from various backgrounds, I realize how many different definitions/ideas/images exist associated with the notion of a personality disorder. Therefore, it does not surprise me that it is often considered as one of the most controversial of all psychiatric diagnoses. There are no accurate figures, but an estimated 10% of the general population have some kind of personality disorder. Experts describe personality disorders as being ‘fuzzy at the edges’. One person may qualify for several different disorders, while a wide range of people may fit different criteria for the same disorder, despite having very different personalities.

Placing people into neat categories is almost impossible, because each individual is unique and personality is very complex. It’s a mistake to assume that giving people a diagnostic label means knowing more about them, and it’s too easy to use these terms in a judgemental way. Many of these diagnostic labels have been used in a way that stigmatises people.

Research from the Office of National Statistics states that as many as 5.4% of men have a personality disorder, and for women, it is 3.4%. Personality disorders are found more in younger age groups (25-44 year age group) and are equally common between males and females. In 1998, research carried out by the Office of National Statistics found that numbers of people with personality disorders are highest in institutional settings like prison, which has a population where 64% of male sentenced prisoners and 50% of female prisoners have been found to be suffering from a personality disorder.

Personality disorders typically start in adolescence and continue into adulthood. They may be mild, moderate or severe, and people may have periods of 'remission' where they can function well. They are caused by a combination of genetic reasons and experiences of distress or fear during childhood, such as neglect or abuse and can be broadly grouped into one of three clusters – A, B or C. NHS provides the following definitions of the groups.

Cluster A personality disorder

An individual regards other people as alien and usually shows patterns of behaviour that most people would regard as odd and eccentric. Others may describe them as living in a fantasy world of their own. An extreme example is paranoid personality disorder, where the person is extremely distrustful and suspicious.

 

Cluster B personality disorders

 

A person with a cluster B personality disorder struggles to regulate their feelings and often swings between positive and negative views of others. This can lead to patterns of behaviour that others describe as dramatic, unpredictable and disturbing. An example is borderline personality disorder, where the person is emotionally unstable, has impulses to self-harm and has very intense and unstable relationships with others.

 

Cluster C personality disorders

 

A person with a cluster C personality disorder struggles with persistent and overwhelming feelings of anxiety and fear. They tend to show patterns of behaviour that most people would regard as antisocial and withdrawn. An example is avoidant personality disorder, where the person appears painfully shy, is socially inhibited, feels inadequate and is extremely sensitive to rejection. The person may want to be close to others, but lacks the confidence to form a close relationship.

To know more about personality types follow the link to my related website.

Antidepressants cause relapse says study | BPS

Antidepressants cause relapse says study | BPS

Understanding Bipolar Disorder | BPS

Understanding Bipolar Disorder | BPS

Coping with Panic Attacks

A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning, and for no apparent reason. It is an exaggeration of the body's normal response to fear, stress or excitement. Panic attacks are extremely frightening and involve physical symptoms, including shaking, feeling faint, dizzy, confused or disorientated, rapid heartbeats, dry mouth, sweating, ringing in ears, hot or cold flushes, tingling or numbness in hands/ feet and chest pain.

During an attack, you may fear that the world is going to come to an end, or that you are about to die or go mad. The most important thing to remember is that, however dreadful you may feel during an attack, this is NOT going to happen. Panic attacks always pass and the symptoms are not a sign of anything harmful happening. The following is based on various useful resources provided by MIND – the leading mental health charity.

First Aid:

If you are having a panic attack, try cupping your hands over your nose and mouth, or holding a paper bag (not plastic!) and breathing into it, for about 10 minutes. This should raise the level of carbon dioxide in the bloodstream and relieve symptoms.

Other first-aid tips include running on the spot during a panic attack. If you feel unreal, carry and object, such as the photograph of a loved one, to anchor you in reality, or finger a heavily textured object (e.g. a strip of sandpaper). You could also distract yourself, by trying to focus on what is going on around you.

• The first step is recognising that you have the power to control your symptoms.
• Confront your fear – do not run away from it. You need to tell yourself that nothing bad is going to happen and the symptoms you are experiencing are caused by anxiety. Try to keep doing things and, if possible, do not leave the situation until the anxiety has subsided (Salkovskis, 2010)
• Accept that a panic attack is unpleasant and embarrassing, but that it is not life-threatening or the end of the world. By going with the panic, you are reducing its power to terrify you.
• Learn creative visualisation – for example, imagine you are in a place that symbolises peace and relaxation for you . You can practice this anywhere but, until you have got used to doing this, try sitting in a chair with your limbs as floppy as possible, and think of calming images.
• Use positive, present-tense affirmations – you can use visualisation to focus on situations that you fear. Imagine the situation and speak positively to yourself: 'I am doing well', 'This is easy'. These can be said silently or out loud.
  (NB: If you have been used to thinking negatively, over a long period of time, you will need to practice every day.)
• Learn a relaxation technique, which focuses on easing muscle tension and slowing down your breathing.
• Practice correct breathing – to avoid hyperventilation (over-breathing), which leads to panic attacks. Avoid breathing shallowly, from the upper chest, and breath more slowly from the abdomen. Put one hand on your upper chest and the other on your stomach. Notice which hand moves as you breathe. The hand on your chest should hardly move but the hand on your stomach should rise and fall.
• If necessary, make changes to your diet – eat regularly and avoid sugary foods and drinks, white flour and junk food to prevent unstable blood sugar levels , which can contribute to symptoms of panic. Caffeine, alcohol and smoking all contribute to panic attacks and are best avoided.
• If the self-help does not help, consult your doctor
• Therapies that can be considered include: Drug Therapy, Psychotherapy, Cognitive Behaviour Therapy (CBT), Behaviour Therapy as well as various Complementary and Alternative Therapies (e.g. acupuncture, aromatherapy, homeopathy).

Do you have bipolar?

The first question that you need to ask is, if you indeed have this condition. Learning the signs and symptoms will help you to weigh the need to seek out medical attention. If any of your symptoms are severe or you are considering harming yourself, you must seek immediate medical attention as soon as possible.

Bipolar individuals will go through an alternating pattern of highs and lows that play on their emotions. The highs are called episodes of mania. The lows are episodes of depression. The intensity of these highs and lows will vary from person to person and from one episode to the next. For some, the symptoms can be quite mild but for others they can be quite severe. In addition to this, you may also have very normal times too.

During the manic phase, there are a number of symptoms that can be observed.

• You may feel extremely happy and optimistic. You may feel euphoria. You may also have an inflated self esteem or ego.
  
  
• You may have very poor judgement, and you may know this by being told by others that you’ve made the wrong decision.

• Your speech can be very fast. Your mind is going crazy with thoughts (see earlier Racing Thoughts post below). You may be agitated and feel the need to move your body and your mind. Physical activity may be increased too.
  
  
• Many will be aggressive in their behaviour.

• Some people find this to be a time of problems with sleeping, problems with concentrating on what you should be doing. You may be easily distracted, and have problems getting tasks accomplished.

• You can be reckless or you may take chances on things that you normally would not do.

The depressive side of bipolar is often associated with depression like symptoms. These symptoms can include the following, often more than one symptom.

• Feeling very sad, very guilty or feeling that all is lost. Hopelessness is a common feeling here too. The trademark of a problem is that the symptom is unfounded and is persistent.

• You may be very tired, often not caring about getting your tasks accomplished. You may lose interest in the things that you do daily, normally. Even those things that you love to do may not be done.

• You may be very irritable, losing your temper for no real reason.

• You may not be able to sleep although you are tired. You may not be hungry and some will lose weight because of not eating properly here.

• Some have problems with pain, too. If you have pain that there is no real cause for, this can be a sign of depressive behaviour.

• The most serious of all symptoms and signs of depressive behaviour is that of thoughts of suicide. If you have these thoughts, your condition needs immediate attention.

If you think that you have any of these symptoms, then you need to work with your doctor to be diagnosed. It is necessary to get treatment and treatment really can help you!

Finally, Break The Vicious Cycle Of Bipolar: Overcome the Mood Swings That Have You Trapped! 

Anxiety Disorders

ANXIETY is a normal response to stress or danger. At times it's helpful because it can help prepare the body for action, and it can improve performance in a range of situations. It only becomes a problem when it is experienced intensely and it persistently interferes with a person's daily life.

Depression and anxiety commonly occur together. Not everybody who is anxious is depressed, but most depressed patients have some symptoms of anxiety.

CAUSES:

Are not fully known, but things to do with your family, your body and what has happened to you in the past are all believed to be involved.
Studies have shown that some people are born more likely to have high levels of anxiety. You are probably more likely to suffer from an anxiety disorder if someone in your family does.
Drug use and some physical conditions can also lead to increased anxiety as can one or more events that cause significant adjustments in everyday life (e.g. marriage, injury or retirement).

SYMPTOMS:

1) Psychological:

• Inner tension.
• Agitation.
• Fear of losing control.
• Dread that something catastrophic is going to happen, such as a blackout, seizure, heart attack or death.
• Irritability.
• Feelings of detachment, as if being trapped in a bubble separate from the world.

2) Physical:

• Racing heart beat (palpitations).
• Breathing fast, feeling short of breath or finding it hard to 'get breath'.
• Chest tightness.
• Dry mouth, butterflies in the stomach, feeling sick.
• An urge to pass urine.
• Tremor.
• Sweating.

Five major types of anxiety disorders are:

• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder (OCD)
• Panic Disorder
• Post-Traumatic Stress Disorder (PTSD)
• Social Phobia (or Social Anxiety Disorder)

TREATMENTS:

1) Psychological: Often tried first. They may include learning about the symptoms and realising that though they are frightening, they are not medically dangerous. Relaxation techniques can also be helpful.

People with OCD can be taught 'thought stopping' techniques to prevent obsessional thoughts.

Phobias can be treated by a number of techniques including 'graded exposure'.

2) Medicines

- Diazepam , Lorazepam - effective in quickly relieving the symptoms of anxiety. However, the body rapidly becomes used to these drugs and they can be addictive. Should not be used for longer periods.

-Buspirone

- Other medicines can help some of the physical symptoms of anxiety, for example propranolol (eg Inderal LA) can slow a fast heart beat and reduce tremor.

Antidepressants – such as Prozac (fluoxetine), Seroxat (paroxetine), Lustral (sertraline) and Cipramil (citalopram) – these appear to be better for panic disorder and OCD. A newer antidepressant Cipralex (escitalopram) is also proving to be beneficial in many patients with anxiety and panic disorders. Other antidepressants such as Gamanil (lofepramine) and Edronax (reboxetine) may be helpful for social phobias.