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Monday, October 31, 2011

ADHD or Childhood Bipolar Disorder?

Question: Why do little kids get diagnosed with ADHD or ADD before the possibility of bi-polar?                                                                        -Kaitlyn F., Woodhaven, NY

Answer: Diagnosis of mental illnesses is almost entirely based on a person exhibiting a particular set of thoughts and behaviors or in clinical jargon “symptoms” that indicate the diagnosis.  ADHD and bipolar disorder share several symptoms including hyper-activity, short attention span, and lack of impulse control.  Since ADHD is much more common than bipolar disorder in children (about 4 cases of ADHD for every 1 of bipolar disorder), sometimes a clinician can mistakenly diagnose ADHD when in fact it is bipolar disorder.  Interestingly, recent research has shown that it is very common for children with bipolar disorder to also have ADHD.

You raise an important but difficult question.  ADHD and bipolar disorder have commonalities that sometimes confuse professionals.  However, the treatment courses for each are very different.  This makes the need for accurate diagnosis that much more important.

Friday, September 30, 2011

Mood Swings = Bipolar Disorder?!

Question: I’m getting a lot of mood swings and day by day it's getting worse.  Are these signs of bipolar disorder? 
                                                                                             Juan S., Astoria, NY
Answer: One of the defining characteristics of bipolar disorder is periods of sadness and hopelessness (depression) followed by periods of hyper-activity and euphoria (manic) or vice versa; periods of manic thoughts followed by periods of depression.  That’s why some people call it “manic-depressive disorder”.  Very often these “mood” symptoms are combined with “behavior” symptoms.  For example, during a manic phase, a person might be restless, have racing thoughts, act impulsively (eg. Shopping spree).

What is important to recognize though, is that everyone has mood swings on occasion.  We all go through periods where we are happy and periods when we are sad, and generally we are somewhere in the middle of that continuum.  You should start being concerned when these periods are extreme happiness or sadness, last a significant amount of time, and are affecting your daily functioning.  

If you think that you may have bipolar disorder, it’s a good idea to get a professional opinion by visiting a mental health professional.  There are millions of people that have bipolar disorder who live successful and fulfilling lives.  The key is speaking with a professional and finding the proper help for you.

Tuesday, August 9, 2011

Always Worrying


Question: I have a big anxiety problem.  I worry about everything; my dog, school, parents, brothers, school work, everything.  I take sleeping pills at night, but what can I do during the day to stop it?
                                                               -Christine B., Ridgewood, NY

Answer: Christine, perhaps the most important thing to realize about anxiety, is that often once you recognize (or believe) that you have an anxiety problem it can feed on itself.  Sometimes people become anxious about becoming anxious and that definitely doesn’t help any.  For that reason, I strongly recommend that if you think you have an anxiety problem, you consult with a professional.  That way, in addition to having a clearer picture of the problem, it will also be easier to avoid being anxious about anxiety because you will know that you have someone that can help you with it. 
 
There are many methods that can be helpful with anxiety including behavioral techniques such as muscle relaxation and square breathing, cognitive techniques that help focus on “living in the moment” or on the source of the anxiety, and anti-anxiety medications that can be helpful as well.  A mental health professional can help you with your anxiety using the above tools and much more.  Thousands of people have overcome anxiety problems with proper help, you can do it too!  Best of luck.

Sunday, August 7, 2011

Is Depression Hereditary

Question: My mother and sister both have had serious problems with depression and anxiety.  Is this hereditary?  Should I be worried?
                                                                            -Joe R., Jackson Heights, NY

Answer: There is a lot of research being done on this topic.  It is definitely more common to have a mental illness if someone else in your immediate family does.  Understanding why that is where it gets complicated.  Research has shown a hereditary biological factor to many mental illnesses.  However, in addition to biological factors, there are also important social factors that play a role in mental illnesses.  For example, if someone was laid-off of their job then they would be more likely to be depressed.  Similarly, growing up and/or living with others that have a negative outlook on life can influence your own view of the world and methods for coping with challenges.
The bottom line is that while there are some hereditary and social factors, every person and situation is unique.  If you think you might have a mental illness, as usual, I recommend getting an evaluation from a professional.  Also, there are many support groups and programs for family members of those with mental illnesses.  A great resource for this in New York is the National Alliance on Mental Illness (NAMI).

Tuesday, August 2, 2011

Veteran PTSD Indicators

Question: My son is returning from serving in the army next month and I was wondering how I could tell if he has any mental health problems.  I keep hearing about veterans having problems, so I want to know what to watch out for.
                                                                        -Jennifer M., Glendale, NY
Answer: A large number of returning service members are dealing with mental health issues including post traumatic stress disorder (PTSD), depression, and anxiety disorders.  Therefore, it is important to watch for signs of any of these problems so that they can be addressed properly without waiting for a crisis.

Here are a few of the more common symptoms that turn up for returning veterans: Increased irritability or  getting angry over small things, hyper-vigilance- being overly nervous about noises or other things that are happening as well as difficulty sleeping  due to anxiety, flashbacks and disassociation- reliving in the mind a particularly scary moment from the battlefield, relationship problems- this can be caused by the long separation during deployment but can also be a related to increased irritability due to depression or PTSD.

As always, if you are concerned that there may be a problem, it never hurts to get an evaluation.  In the case of a veteran, I would recommend contacting the Veteran Affairs (VA) or finding a mental health professional that specializes in veterans or trauma treatment as they would be best suited to evaluate and treat any issues.

Monday, May 16, 2011

Mental Health Insurance Parity

Question: My son has been having anxiety attacks about once a week for a few months already.  However, my insurance has very bad coverage for mental health and I can’t really afford it.  I heard something about health care reform changing mental health insurance.  Is it true?  And if so, how can I take advantage of it?
                                                                                     -Susan M., Flushing, NY

Answer: A challenging situation, but I strongly encourage you to take your son in for treatment.  Most clinics have a sliding scale based on income etc. and although it may still be very difficult, the other option could have long-term effects especially on a child.

As part of health care reform, “mental health parity” laws were passed.  They require that any PRIVATE insurance provider give the same level of coverage to mental healthcare that they do for physical healthcare, however this law has just begun to be implemented and does not apply to any public insurance provider such as Medicare or Medicaid. 

In New York State, a similar law was passed in 2006 called “Timothy’s Law”.  It mandates employers to provide specific minimum levels of coverage for mental healthcare.  The details of the law are beyond the scope of this column, however you can learn more about it at www.timothyslaw.org.

Friday, May 13, 2011

Psychiatrist/Psychologist/Social Worker: Where to Begin

Question: A few months ago, I was laid off from my job and haven’t been able to find work yet.  It’s been a really hard time for me and my family and I’m feeling really depressed because of the whole situation.  I want to get some help, but when I started looking around I heard a lot of different terms like psychiatrist, social worker, psychologist and I don’t know which one could help me best.
                                                                                   -Bill H., Glendale, NY

Answer: I’m sorry to hear about your difficult situation and I hope you are able to find work soon; however I am glad that you recognized the need for help and that you are actively seeking it.  That is a courageous and admirable step.

Psychiatrists, psychologists, and social workers each have a unique skill set and therefore are best suited for particular kinds of mental health care services.  Psychiatrists are medical doctors with a specialty in “psychiatry” or the treatment of mental illness.  Most psychiatrists mainly prescribe psychoactive medication like antidepressants or anti-anxiety medication.  They usually do not do psychotherapy.  Psychologists provide psychotherapy and are also experts in psychological testing.  In the vast majority of the U.S. they cannot prescribe medication because they do not have any medical training.  Social workers provide psychotherapy and do not do psychological testing or medication prescription.

So, depending on what you need (medication, therapy etc.), you would see the appropriate professional.  I recommend starting with a social worker or psychologist and asking them to evaluate you and help you determine which kind(s) of help would be best for you.

Best of luck.

Thursday, April 14, 2011

Healthy Blogging

Question: My 15 year old brother has depression and anxiety.  He goes to therapy once a week and is on medication.  The reason why I am writing to you is that he always tells everybody about all of his moods.  He blogs about it and always says how he’s feeling on Facebook.  It’s really embarrassing for me, but he says that it makes him feel better.  I don’t want to stop him if it really is good for him, but how do I know that?
                                                                   -Joshua Landers, Kew Gardens, NY

Answer: Blogging and talking online about personal and general mental health issues has become increasingly common.  The reason why is because it provides an outlet for people to express their feelings and “get it off their chest”.  It is a valuable tool that has helped many people cope with otherwise overwhelming feelings and situations.  Additionally, finding like-minded people online often helps people deal with the stigma surrounding mental illness.
If your brother says that blogging and talking online is helping him; then it probably is.  The stigma surrounding mental illness is not limited to the person with the diagnosis but also often includes family and friends.  It sounds like at this point your brother is more comfortable with discussing mental illness than you are.  This is not surprising when you consider that he is receiving more support than you are.  I would recommend trying out a family support group in your area.  National Alliance onMental Illness (NAMI), Depression and Bipolar Support Alliance (DBSA), and many other local community and religious organizations have these groups that help family members cope with and support someone living with a mental illness.

Monday, April 4, 2011

Online Advice

Question: Sometimes when I am going through a rough time I go online and describe my situation on Yahoo Answers and other people give me all kinds of advice.  How do I figure out who to listen to?

Answer: The online world has put a wealth of information about mental health right at our fingertips.  Many people appreciate this because it provides an easy and anonymous way to learn more about a condition.  This would be a great thing, if not for two important considerations. 


1) A lot of online information comes from unreliable sources.  For example, Yahoo Answers is essentially a forum where anyone can give you advice on what they think would be a good solution for your situation. 


2) While mental illness can appear to be almost identical in two people, it almost never is.  The nature of mental illness includes a large component that has to do with each person’s individual social and environmental history.  This is important because when someone online says “I have been there and this is what worked for me”, that person’s similar “sounding” experience may have little relevance to yours. 

A good source of basic information about mental illness is the National Institute of Mental Health (NIMH).   

However, as I always emphasize in this column, if you think you may need help it is always best to get evaluated by a professional.  That way you are speaking to someone qualified to address any issues and with enough personal information about you to make an informed recommendation.

Friday, March 4, 2011

Parental Psychiatric Intervention #2

Question:  My 20 yr old son has been diagnosed with schizoaffective disorder. He takes medication and attends day programs.  His symptoms of hearing voices, seeing things etc. come and go depending on the medication levels. He is playing video games -- grand theft auto. I never let that happen when he was younger and I dislike it totally but one of his case workers said it helps him with his thought process and keeps him from acting out.  This doesn’t sound right.  I think there are good games he could play that would help his cognitive thinking and rebuild his self --prior to the diagnosis he was working, driving, and planning to study film in college.  I would appreciate your opinion on this.
                                                                             -Katrina M.  
Answer:  Hi Katrina,
I'm sorry to hear about your son's illness, but also glad to hear from you; clearly a caring and involved parent.  I hesitate to offer an opinion on your particular situation because I don't know your son well enough (or at all!). 
One of the unusual things about mental health is that treatment and things that are healthy and helpful can vary greatly from one person to the next.  It is a possibility that the video games are indeed helping your son, but with the facts I have there is no way for me to know.  I imagine you have discussed your particular question with some degree of depth with the case worker you mention.  Since you are not completely satisfied with what you are hearing, perhaps it would be a good idea to get a second opinion from another professional who knows your son well.
Another thing I wonder about is what your son's feelings are on the topic.  Although he is ill, he is old enough to have his own say on the hobbies he chooses.  It's definitely not easy to cope with schizoaffective disorder and if this makes him really happy then perhaps it is good.
I hope this is a little helpful.

Friday, February 25, 2011

Parental Psychiatric Intervention

Question: I am so mad right now because my daughter’s dad admitted her to a 72 hour watch at a mental health hospital.  I am so against it because I think I can help her. He won’t even let me and I am her mother, so do you think this will make her worse?  She is 16 and very introverted, she’s a sweetie and I think he drove her to this madness!  She had been cutting and taking meds from her dad and grandmothers cabinets.
 
Do you have any advice as to how I can help her from a distance?  I don’t spend a lot of time with her and live in a different city.  Any advice would be so appreciated.
                                               Laura S.,  Jamaica Estates, NY
Answer: Hi Laura,
I am sorry to hear about the situation with your daughter. I wish I could give you some advice that would really be helpful, but I know too little about the situation. So, instead let me share a few tips. Hope it's helpful!
 
I don't know what you're relationship is like with your daughter, but I imagine it would be helpful to her if you called or visited. Being admitted into a psychiatric hospital can be scary and confusing especially for someone her age. More than anything else, she may just want to hear that you are there for her, love her, and want to help in any way you can.
 
I'm not sure how familiar you are with how psychiatric hospitals work. After observing you're daughter for 72 hours they will make a recommendation based on what they saw (watching her behavior first hand and interacting with her should give the staff a pretty good picture of her situation). My suggestion is to discuss with the hospital staff what their recommendations are and the reasoning behind them. Since they will be much more familiar with your situation, they may also have more specific ideas on how you can help and support your daughter through this crisis.
 
Often times, people think that professional help with mental health issues is not necessary. Sometimes, you may be able to help your daughter without any other intervention, but it is always good to err on the side of caution and get a professional opinion on the situation. That is what appears to be happening at the hospital. (Once again, I'm speaking generally without the details of your situation)
 
I hope this helps a little. I know that when a loved one is having mental health problems it can be challenging for everyone in the family as well; so do take care of yourself.

Tuesday, February 1, 2011

Hiding Depression

Question: I have 4 children, and spend most of my day at home taking care of the house and kids.  I get really depressed sometimes but I don’t want to tell anyone about it because my husband has a professional position and I’m concerned that it will affect his job.  What should I do?
-Miriam Gwenryth, Middle Village, NY

Answer: Miriam, it is not unusual for housewives to get depressed.  If you are not comfortable seeking professional help than there are some other options that you can look at to address the issue on your own.  

Often, staying cooped up in the house all day can cause someone to begin feeling bored, lonely, or “stir crazy”.  Finding new hobbies or activities that you enjoy can be very helpful in alleviating the feelings of boredom or lack of accomplishment.  Perhaps there is a group or club in your community that you would like to get involved or participate in.  Lately, with the growth spurt of internet groups and networks there are additional opportunities to connect with other people that have similar interests.

I understand your hesitancy in seeking consultation with a mental health professional, but I do want to encourage you to give it more thought.  One of the things that motivates me to write this article each month is the unfortunate statistic that each year more than 60 percent of individuals with a mental illness don’t get any help.  Every day, people such as yourself don’t seek help because of the stigma, however in your case you have given a lot of thought to seeking help.  Perhaps it would be worthwhile to consider just taking the next step.

Monday, January 24, 2011

Mental Illness and Social Networks

Question: I have been living with depression for years.  I see a doctor and a therapist and I have been able to get through school and hold down a 9-5 job.  My problem is that I have no family in the U.S. and have no social life.
                                                         -Tim Surley, Flushing, NY
Answer: Tim, any social worker will tell you that social environment plays a key role in every individual’s mental wellbeing.  That being said, unfortunately the key services provided in mental healthcare do not address this area. 

However, I am glad to tell you that there are options and opportunities that you can try on your own that can help you create a social life.  First of all, there is a model called a psychosocial clubhouse which provides just this; a supportive place for individuals with mental illness to hang out and create social connections.  In Queens, the Venture House is a great example of an organization that provides this kind of environment.  However, wherever you live, there are hundreds of psychosocial clubhouses throughout the United States. 

Another thing that has helped a lot of people in recent years is the advent of social networking and specialized online forums.  For example, psychcentral.com has a great forum for people with mental illness to meet others and create social connections.  Facebook and Twitter also has a lot of groups and chat rooms for individuals with mental illness.  Upon checking out these sites, I was surprised and happy to discover that these forums were not being used just for support but also for social connections.

The bottom line is that the mental healthcare system doesn’t directly address this issue, but with personal initiative and some internet know how; you can find several areas to grow your own social network.

Tuesday, January 18, 2011

The Arizona Tragedy and the Stigma of Mental Illness

Statement by Jacob Berelowitz, LMSW
Executive Director, Talk Therapy Television

The recent tragic events in Arizona have once again generated nationwide discussion about our approach to mental illness.  Some groups are pushing for laws that make it easier to force involuntary psychiatric treatment on individuals with mental illness.  However, as others have pointed out, Arizona is one of the easiest states to involuntarily commit an individual, yet nothing of the sort happened.   

In another area, advocacy groups are taking this opportunity to highlight the lack of adequate mental health care services in Arizona and throughout the United States.  There is no question about the need for more services, however due to budgetary concerns, on the federal and state levels, cuts continue to be made to these services.  It is important that these conversations continue as they shape the views of our nation on these important topics and ultimately affect the way mental health care services are delivered.  However, one has to wonder if other factors could be of equal or greater importance in preventing this sort of tragedy from happening again and improving the state of mental health in the United States.

A recent study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that in 2009 less than 4 out of every 10 individuals with a diagnosable mental disorder received any mental health care services.  However, the lack of available services is not the only reason for this lack of care.  Many individuals don’t seek out treatment because they are afraid of losing their jobs if word of their condition came out.  Others have little understanding of what mental illness is; leading them to A) never recognize the illness and suffer needlessly for years, or B) wonder how they could possibly be helped by psychotherapy or medication.

Not all of the facts have yet come to light in the particular case in Arizona, but it appears that Mr. Loughner’s need for mental health treatment was identified by college officials who encouraged him to seek help.  While mental health services have been recently cut in Arizona, had Mr. Loughner (or his parents) sought out help, if not at a local clinic then even in the emergency room, it is likely that he would have been identified as an individual in need of treatment and would have begun receiving help.  The college officials knew that he needed help, his parents knew that he needed help, yet it seems that he never did seek it out.  Why?  Not because there were no services available.  That is a valid issue, but not something that would prevent someone from making initial contact with an emergency room or mental health clinic.  The key here, in my opinion, is lack of understanding of mental illness and its treatment options and the strong stigma that surrounds mental illness.

Perhaps some good can come out of the tragedy that happened in Arizona this past week.  The public conversation has turned, albeit temporarily, to the topic of mental illness.  The challenge now is twofold: keeping this dialogue and discussion going for as long as possible and focusing on the issues that can truly improve the number of individuals that receive quality mental health care.  Perhaps, in addition to talking about the need for more services and debating the merits of involuntary psychiatric treatment, we might also focus on the core of the problem; lack of education and stigma.  

The U.S. Surgeon General’s Report on Mental Health in 1999 said it best “Stigma impedes people from seeking help for fear the confidentiality of their diagnosis or treatment will be breached.  For our nation to reduce the burden of mental illness, to improve access to care, and to achieve urgently needed knowledge about the brain, mind and behavior, stigma must no longer be tolerated.”