Your psychiatrist, as a medical doctor, is very interested in understanding the details of how you’re feeling and functioning, especially if you’ve been prescribed psychiatric medications. Signs are objectively observed phenomena (such as the results of blood tests or the existence of hand tremors). Symptoms are what you experience firsthand and typically may not be observable to your psychiatrist during your visit. Symptoms may include oversleeping or trouble falling asleep, tearfulness, experiencing acute anxiety, or feeling scattered and unable to focus.
By explaining symptoms clearly, you help your doctor make the right diagnosis and develop the best treatment plan. It is helpful if you can describe the severity, how often they occur, how long they’ve been happening, and if you notice possible triggers or patterns to the symptoms. Please don’t hesitate to mention symptoms even if they seem embarrassing (such as sexual functioning or changes in bowel habits).
It can be helpful to make yourself a note to bring with you to your appointment in order to avoid forgetting important information during your visit. Include new symptoms you’ve had since your last visit, how things have improved and any questions you have. At times, people may minimize their symptoms and say they feel better than they really do. Unfortunately this might prevent your psychiatrist from making adjustments that could help your treatment be more effective.
Read more about psychiatric appointments from the American Psychiatric Association.
Blog Archives
Signs and Symptoms
Seasonal Affective Disorder (SAD)
“Seasonal affective disorder (also called SAD) is a type of mood disorder that occurs at the same time every year. If you’re like most people with seasonal affective disorder, your symptoms start in the fall and may continue into the winter months, sapping your energy and making you feel moody. Less often, seasonal affective disorder causes depression in the spring or early summer.
Treatment for seasonal affective disorder includes light therapy (phototherapy), psychotherapy and medications. Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own.”
Complete article, including symptoms, causes and treatment can be found at the Mayo Clinic website Seasonal affective disorder (SAD)
SAD may be associated with either depressive or bipolar symptoms. There’s evidence that the risk of experiencing SAD is related to where a person lives. In New Hampshire 9.7% of the population report symptoms but only 1.4% of Florida residents. Research has shown that bulimia, anxiety and other psychiatric disorders may also be effected by the change in seasons.
Did you know that children can also be effected by SAD? From the American Academy of Pediatrics: Winter Blues – Seasonal Affective Disorder and Depression
Problem Drinking
It’s not always easy to see when your drinking has crossed the line from moderate or social use to problem drinking. But if you consume alcohol to cope with difficulties or to avoid feeling bad, you’re in potentially dangerous territory. Alcoholism and alcohol abuse can sneak up on you, so it’s important to be aware of the warning signs and take steps to cut back if you recognize them. Understanding the problem is the first step to overcoming it…
From Alcoholism and Alcohol Abuse: Signs, Symptoms, and Help for Drinking Problems at HelpGuide, a website providing accurate and reliable information re: mental health, substance abuse and relationship issues. Further information is available about
- Understanding alcoholism and alcohol abuse
- Signs and symptoms of alcohol abuse
- Signs and symptoms of alcoholism (alcohol dependence) including tolerance and withdrawal
- Drinking problems, denial and common myths
- Effects of alcoholism and alcohol abuse, especially on relationships
- Getting help for alcoholism and alcohol abuse
- When a loved one has a drinking problem (including teenagers)
- Additional resources and references
Mental health issues and alcohol use may co-exist and in fact “reinforce” each other. Someone who struggles with feeling stressed and anxious may find that alcohol sometimes helps them to relax. However, increasing alcohol use may interfere with everyday responsibilities or relationships. These difficulties may then contribute to increased anxiety and worry. In an effort to manage these increasingly negative emotions a person may rely more and more on alcohol as a coping mechanism. Untreated anxiety can lead to alcohol abuse. Alcohol abuse can intensify anxiety. And so a “vicious cycle” is established.
Talking with your doctor or a mental health professional can help you determine if your drinking is having a negative effect on your well-being. There are many effective methods and treatments available.
Autism Spectrum Disorder
According to the National Institute of Mental Health, autism spectrum disorder (ASD) is characterized by:
- Persistent deficits in social communication and social interaction across multiple contexts;
- Restricted, repetitive patterns of behavior, interests, or activities;
- Symptoms must be present in the early developmental period (typically recognized in the first two years of life); and,
- Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment or disability that children with ASD can have. Some children are mildly impaired by their symptoms, while others are severely disabled. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) no longer includes Asperger’s syndrome; the characteristics of Asperger’s syndrome are included within the broader category of ASD.
There has been a good deal of controversy about the elimination of the Asperger’s diagnosis and it’s potential impact upon treatment, resources and educational process. Slate.com offers a thoughtful summary in You Do Not Have Asperger’s: What psychiatry’s new diagnostic manual means for people on the autism spectrum.
Additional resources include ASPEN Asperger Autism Syndrome Education Network in New Jersey and Autism Society Improving the Lives of All Affected by Autism.
In April 2013, the American Academy of Pediatrics released a report, along with extensive scientific research data, that concluded there is NO link between autism and the MMR vaccine, thimerosal, multiple vaccines given at once, fevers or seizures. See Vaccine Safety: Examine the Evidence.
ADHD Awareness
October is designated as ADHD Awareness Month. There are many excellent resources (websites, books, magazines) that provide a wealth of information about Attention Deficit Disorders. One is the ADDitude print and online magazine. Their expert panel includes Edward Hallowell, M.D. the author of Driven to Distraction and CrazyBusy. See their article, ADHD Awareness Month: 31 Myths in 31 Days — Debunked!
A new resource is the website Understood.org which will be launched in Oct 2014. It’s the result of collaboration between 15 of the most respected non-profit groups that specialize in attention, processing and learning disorders. The site provides data and also very specific strategies that can help parents help their kids with the multiple challenges they face. Much of the information provided targets specific age groups (pre-school, grade school, middle school and high school). Information provided includes suggestions for managing everyday challenges such as Ways to Handle Behavior Issues in Public Places, The Benefits of Getting Your Child Evaluated and Smartphone Solutions to Keep Your Teen Organized. When visiting the website you can sign up for a weekly email newsletter, view webinars and participate in Live Expert Chats. Understood.org helps parents to understand, support and advocate for their kids.
At Integrated Behavioral Care our staff provides both medical and psychotherapuetic treatment for ADHD in children and adults.
Student 504 plans
Section 504 of the U.S Rehabilitation Act of 1973 created and extended civil rights to people with disabilities. Section 504 helps to provide opportunities for children and adults with disabilities in education, employment and various other settings.
In public schools, or publicly funded private schools, it can be used to help students with physical or mental impairments by providing appropriate accommodations that make it possible for that child to benefit fully from the educational services that are provided to all general education students (note: a 504 plan is not the same as an Individualized Education Program (IEP) that required for special education students).
Any student with a physical, emotional or behavioral disability, or who is recovering from a chemical dependency, or who has an impairment (e.g. Attention Deficit Disorder) may be eligible for a 504 plan.
There are 4 steps involved:
- A referral is made, usually by a teacher, support staff, parent/legal guardian, physician, or therapist.
- A meeting is held which typically includes the parents, school principal, classroom teachers, and other school personnel (such as the school nurse, guidance counselor, psychologist, or social worker). Academic and medical records are reviewed and the parents are interviewed regarding their concerns.
- Planning for reasonable accommodations begins if the team determines the child is eligible to have a 504 plan put in place. Depending upon the nature of the child’s disability these accommodations may include:
preferential seating
extended time on tests and assignments
reduced homework or classwork
a second set of textbooks to keep at home
verbal, visual, or technology aids
behavior management support
adjusted class schedules or grading
verbal testing
excused lateness, absence, or missed classwork
pre-approved nurse’s office visits - 504 plans should be reviewed at least annually to determine if the accommodations are up to date and appropriate, based on the student’s needs. Any 504 plan team member, including the parent, may call for a 504 plan review at any time if there is an educational concern or change in the student’s needs.
For additional information The Statewide Parent Advocacy Network (SPANNJ) offers this Guide to Services for Children With Disabilities as well as a side-by-side comparison between Section 504 and IDEA (special education).
Campus Mental Health
As students prepare to start, or return to, college they may experience a mixture of pride and excitement, as well as some melancholy and apprehension. Academics and social life can be very rewarding and/or a tough adjustment for young people. Studies reveal that 30% of freshman college students feel overwhelmed a great deal of time. Students may look to friends, roommates and school staff for guidance and relief.
Fortunately most colleges and universities also offer mental health services for their students to help them meet these challenges. “Many college-age students suffer from anxiety, depression and other mental health concerns. Anxiety is the issue most often mentioned by college students who visited campus mental health services. Students also named depression as one of the top ten impediments to academic performance as well as stress, sleep difficulties, relationship and family difficulties.”
A brochure from Bazelon.org may be helpful to both students and their families in understanding and addressing these concerns. For more information see Campus Mental Health: Know Your Rights! a guide for college and university students seeking help for mental illness or emotional distress.
Postpartum Depression
Approximately 50-85% of new mothers experience the “baby blues” soon after giving birth. Symptoms may include sadness, anxiety, tearfulness. These symptoms appear a few days after giving birth and usually disappear within a week or so.
A postpartum depression (PPD) sets in later, generally four to six weeks after giving birth, and may last for months. About 10% of new mothers experience this more intense and longer lasting form of depression. A rapid decrease in some hormones after delivery is thought to be one contributing factor to the development of PPD. But other risk factors include life stressors, previous depressive episodes, complications during pregnancy and/or delivery, and a family history of mood disorders. Symptoms may include feelings of hopelessness, worthlessness, intense anxiety, irritability, difficulty bonding with the baby, loss of pleasure, feeling numb, as well as extreme fatigue.
Sometimes women are troubled by the stigma of PPD and may begin to believe that they are “bad mothers” and hesitate to seek treatment. However, it’s important to reach out for help, understanding and support.
The Depression During and After Pregnancy Fact Sheet offers additional information and guidance
About Psychotherapy
It can sometimes be difficult for clients to start psychotherapy. Unsure what the process will be like and perhaps feeling a little nervous. At other times, people feel excited or relieved to find a therapist whom they can meet and talk with about the help and support they need.
Psychotherapy is confidential and non-judgmental. It provides you with the opportunity to discuss personal concerns with an empathic and trustworthy expert in human behavior. In your first session, your therapist typically will ask a number of questions. This information helps in making an initial assessment of your situation. Important areas to discuss will likely include:
• Why you decided to come to therapy at this point in time.
• Your personal history or “life story”.
• Your current symptoms. These could be emotional problems, behavioral difficulty or how you see yourself.
• Your goals for treatment. What you would like to be different in your life.
Psychotherapy is not “one size fits all” and every therapist will strive to focus your therapy in ways that will be most helpful for you individually. As therapy progresses there are additional topics that may be very helpful to discuss:
• Your level of comfort and trust in your therapist. Although this may seem to be an awkward topic, the quality of the relationship between you is very important. Most therapists welcome these discussions and the opportunity to openly address any concerns.
• Ask questions if you need further information or explanation. Feel free to return to issues that you need to discuss in more depth. Express any doubts or disagreements you may have. Let your therapist know what is particularly helpful for you.
• Provide feedback regarding how you are feeling about therapy, whether or not you believe you are headed in the right direction. There may be additional concerns that you didn’t mention at the start of therapy, but would like to address now. Talk about thoughts you may have about changing the frequency of sessions (more often or less often), if you want to “take a break” or are wondering when you’ll know it’s time to end your therapy.
Understanding Schizophrenia
Schizophrenia is a mental disorder that effects approximately 1% of the population. It generally appears in late adolescence or early adulthood. However, it can emerge at any time in life. It is one of many brain diseases that may include delusions, loss of personality (flat affect), confusion, agitation, social withdrawal, psychosis, and bizarre behavior.
Sometimes in casual conversations, or even in the media, the term schizophrenia is misused. It is not the same thing as multiple personality disorder. Schizophrenia literally means “split mind”; not that it’s a disease of split personalities, but that the individual suffering from the disease is often split off from reality. It’s also important to note that many other conditions may include some of these same symptoms, so it is crucial to obtain a thorough psychiatric evaluation before arriving at a diagnosis.
A person with schizophrenia who receives treatment can lead a rewarding, productive and meaningful life in his or her community. The most effective treatment for schizophrenic patients is usually a combination of medication, psychological counseling, family support, and self-help resources.
Read more about the symptoms, causes and treatment of schizophrenia in Medical News Today.
Binge Eating
There are several types of eating disorders, including anorexia, bulimia and binge eating. Of these binge eating is the most common, effecting up to 5% of the population. Binge eating is defined as eating within a relatively short period of time (about 2 hours) an amount of food that is definitely larger than what most people of a similar age would eat during that same period of time and under similar circumstances.
Many people will admit to occasionally eating a large amount of food in a short period of time (e.g. Thanksgiving dinner), but this is not the same as having a binge eating disorder. Key features of a binge eating disorder include behaviors which occur at least 2 times/week for a period of 3 months or longer:
Rapidly eating large amounts of food
Eating even when you’re full
Hiding or stockpiling food to eat later in secret
Believing you’re unable to stop eating or control what you’re eating
Feeling extremely distressed or upset during or after bingeing
According to the National Eating Disorders Association, “the most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or psychological counseling, coupled with careful attention to medical and nutritional needs. Ideally, this treatment should be tailored to the individual and will vary according to both the severity of the disorder and the patient’s particular problems, needs, and strengths.”
Learn more about eating disorders at NEDA.
Hair Pulling and Skin Picking
Body Focused Repetitive Behaviors (BFRB) are a group of behaviors in which an individual damages his or her appearance, or causes physical injury through pulling, picking, biting or scraping of the hair, skin or nails. BFRBs are considered impulse control disorders. They usually occur when a person is feeling overly stressed or excited or when inactive or feeling bored. The sufferer may not be fully aware of their behavior at the time, or may find it pleasurable or relaxing. Family members may have a difficult time understanding these behaviors and sometimes feel helpless, irritated, or angry. This negative attention can increase stress and even make the problem worse.
BFRBs affect 2-5% of the population. Most BFRBs begin in early puberty or adolescence and frequently continue into adulthood. In childhood both males and females are affected equally, but in adulthood more females are affected. Types of BFRBs include:
Hair Pulling Disorder (Trichotillomania) – The compulsive urge to pull out hair from various parts of the body resulting in noticeable hair loss. Areas where pulling usually occur include scalp, eyelashes, eyebrows, arms, legs, and pubic area.
Skin Picking Disorder (Dermatillomania/Excoriation) – The compulsive urge to pick at one’s skin resulting in noticeable damage (sores, scabs, infections). Common areas include: face, head, cuticles, back, arms and legs, hands and feet.
Other BFRBs – Severe Nail Biting, Nose Picking, Hair Cutting, Cheek Biting
The stigma associated with these conditions can make individuals feel embarrassed, frustrated, or ashamed of their behavior, making it difficult to seek help. Oftentimes other mental health conditions occur alongside the BFRB, such as anxiety and depression.
Additional information is available at the Trichotillomania Learning Center.
Medication Management
When taking prescription medication it’s of utmost importance that all of your doctors are aware of all medications and any supplements you may be taking as well as other medical conditions you may have. Smartphone apps can be quite helpful for some people. These apps may involve simply listing your medications, including dosage and frequency (be sure to keep the list updated). This can be helpful when completing medical histories at doctor’s offices, as well as having available if you ever need to go to the emergency room (when it may be difficult to remember these details). Other mobile device apps assist in identifying possible drug interactions, reminding you daily when it’s time to take your medications, or alerting you when it’s time to refill the prescription.
As a medical consumer it’s important to be aware of the following:
- Drug – Food Interactions. Alcohol, caffeine, grapefruit juice, and dairy foods may either intensify or inhibit the effect of prescribed medication. Also, there are medications that specifically should be taken on either a full or an empty stomach.
- Drug – Drug Interactions. There may be prescription or over the counter medications that should be avoided when taking other medications.
- Drug – Supplement/Herbal Interactions. As an example, St. John’s wort can have a negative impact if you’re also taking prescription medication for depression or anxiety.
- Drug – Disease Interactions. For instance, someone with a heart condition needs to be sure that all of his/her doctors are aware of the condition and how it’s being treated. There are certain medications that might be helpful to the general population, but potentially harmful to a person with cardiac disease.
Read more about drug interactions here.
Taking medication exactly as prescribed makes it possible to determine if it’s having the intended effect and whether increasing or decreasing the dose may be indicated. If you haven’t been using the medication as your doctor advised, for whatever reason, it’ll be important to let the doctor know. Your doctor’s goal is to help you feel and function better. If you’re hesitant about medication, sharing your thoughts with your doctor can help you together in achieving this goal.
Finally, simply remembering to take medication is necessary, for which there are numerous tips and tricks.
Read more about adherence to drug treatment here.
Social Anxiety
Social phobia (also known as Social Anxiety Disorder) is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of going to work or school or other everyday activities. Everyone has felt anxious or embarrassed at one time or another. In fact, 80% of all people report that they were shy at some point in their lives. For example, meeting new people or giving a public speech can make anyone nervous. But people with social anxiety worry about these and other things for weeks before they happen. Frequently they will then want to avoid these situations.
Sometimes people with social anxiety are afraid of doing common things in front of other people. For example, they might be afraid to sign a check in front of a cashier at the grocery store, or they might be afraid to eat or drink if they believe other people are watching, or may avoid using public restrooms. At other times it may involve initiating conversations, interacting with authority figures or being assertive when necessary. Most people who have social anxiety know that they shouldn’t be as afraid as they are, but they haven’t found a way to control their fear. For some people, social anxiety is a problem only in certain situations, while others have symptoms in almost any social situation.
There are a number of effective treatments available. These include cognitive behavioral therapy, social skills training, relaxation and mindfulness techniques, as well as medications.
A Good Night’s Sleep
Roughly a third of Americans report sleep difficulty, most commonly insomnia. The World Health Organization defines insomnia as a problem of falling or staying asleep, or of not feeling refreshed after sleep at least 3 times a week. In addition this is accompanied by daytime sleepiness, difficulty concentrating or increased irritability. If you’re experiencing problems sleeping it’s important to let your doctor know. There are a number of physical causes that increase insomnia. These include sleep apnea, restless legs syndrome, acid reflux with heartburn, arthritis, back pain, menopause, and certain medications that interfere with sleep.
Other complicating factors include jet lag, shift work, physical discomfort from an injury or surgery. In some of these situations, your doctor may want to focus on treating the underlying condition and possibly order a sleep study to further diagnose your difficulty. Consult with you doctor before using any over the counter sleep aids.
However, it’s important to note that there a number of “natural” things you can do independently that have the potential of providing you a great deal of relief. These actions are oftentimes referred to as “sleep hygiene”. Just as dental hygiene helps keep teeth and gums healthy, sleep hygiene promotes healthy sleep patterns.
Control your sleep environment.
- If your mattress is uncomfortable, it may be time to replace it. Consumer Reports recommends a new mattress every 5-10 years. In the same way, pillows also need to be replaced regularly.
- The room should be dark, cool (between 60-68 degrees is ideal) and quiet. Yes, people believe that the TV helps them to fall asleep, however, if left on throughout the night it interferes with deep sleep, contributing to not feeling refreshed in the morning. In fact, research is showing that the use of electronic screens up to an hour before bed stimulates the brain and makes falling asleep more difficult. Backlit devices and LED screens have the greatest negative effect.
- Consider who’s in bed with you. A partner who snores or moves excessively during the night may be contributing to your sleep difficulty. In the same way, having babies or children in bed can also be disruptive. Finally, sharing your bed with pets can cause you to awaken multiple times during the night, by their moving about, making noise, or increasing the temperature in bed.
Prepare your body for sleep.
- Exercise regularly, but avoid strenuous exercise in the 3 hours before bedtime.
- Eat regular meals. Don’t go to bed hungry. A light snack (nothing heavy, greasy or highly spiced) can help.
- Notice how caffeine affects you. Some people need to reduce their intake, or at least avoid caffeine in the afternoon and evening.
- Avoid alcohol in the late evening. Yes it seems to induce relaxation, but it also disrupts the normal sleep cycle, interfering with restorative sleep.
- Avoid smoking, especially at night. Nicotine is a stimulant.
- Develop a bedtime routine. Make a to-do list for the next day, to help avoid trying to remember things when you should be relaxing in bed. Take a warm bath or shower. Perhaps set out your clothes for the next day. Listen to relaxing music. Enjoy some light pleasure reading for 15-30 minutes. Learn one of the many forms of relaxation that can help you “let go” of the day and clear your mind.
Final rules.
- Go to bed and wake up at the same time every day, 7 days a week. Once you’re no longer experiencing sleep difficulty you can indulge in “sleeping in” for 1 hour on the weekends.
- Use your bed only for sleep and sexual activity. Do not do your bills, catch up on work, have phone conversations, email, text, or eat in bed. You want to condition your body and mind so that being in bed = sleep.
- No clock watching. Turn your clock around or put it on the floor. Watching the minutes tick by tends to increase anxiety and frustration.
- If you continue to experience difficulties, despite efforts to change your behavior, psychotherapy is often very helpful. Anxiety or depression can contribute to insomnia. A therapist can help you find ways to “turn off” the thoughts that keep you awake.
What about naps? See the Harvard Health Letter.
Understanding Executive Function
Executive function can be thought of as the project manager or CEO of your brain. It’s in charge of making sure that chosen tasks are completed effectively: understanding what’s expected, planning the steps necessary and meeting the final deadline. Specific executive function skills include Emotional Control, Flexibility, Organization, Self-Monitoring, Task Initiation and Working Memory.
Kids differ in how they use executive skills. Difficulties are likely influenced by genes and heredity, as well as brain differences within the prefrontal cortex. Research has shown that kids with other disabilities and disorders such as ADHD, dyslexia, neurological conditions, mood disorders, autism and acquired brain injury are most often effected. Yet there are ways to help develop and strengthen these skills.
The National Institute of Health Public Access has an article: Interventions Shown to Aid Executive Function in Children 4–12 Years Old
Exercise, Mood and Anxiety
“When you have anxiety or depression, exercise often seems like the last thing you want to do. But once you get motivated, exercise can make a big difference.
Exercise helps prevent and improve a number of health problems, including high blood pressure, diabetes and arthritis. Research on anxiety, depression and exercise shows that the psychological and physical benefits of exercise can also help reduce anxiety and improve mood.
The links between anxiety, depression and exercise aren’t entirely clear — but working out can definitely help you relax and make you feel better. Exercise may also help keep anxiety and depression from coming back once you’re feeling better.” Read more from the Mayo Clinic.
More and more experts are emphasizing the importance of exercise, for both mental and physical health, especially for people who are stressed, anxious or depressed. Despite understanding this, many people feel blocked and unmotivated. They don’t have the interest or energy, or doubt if it really will make a difference for them.
This is one of the biggest challenges for people who aren’t feeling well emotionally… they focus on how they feel and make decisions based upon these feelings. Depressed and anxious feelings can’t necessarily be trusted to support your well-being. Better to rely on your common sense to guide decision making at times like this. Give yourself a chance. Even if you don’t feel like it, spending even a short period of time doing the things you know are likely to be helpful can make a difference. Talk with your doctor or therapist about specific strategies that may help you.