Bipolar4LifeSupport

What is a panic attack?

A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning, and for no apparent reason. In addition to the anxiety, various other symptoms may also occur during a panic attack. These include one or more of the following:
•A thumping heart (palpitations).
•Sweating and trembling.
•Dry mouth.
•Hot flushes or chills.
•Feeling short of breath, sometimes with choking sensations.
•Chest pains.
•Feeling sick (nauseated), dizzy, or faint.
•Fear of dying or going crazy.
•Numbness, or pins and needles.
•Feelings of unreality, or being detached from yourself.

The physical symptoms that occur with panic attacks do not mean there is a physical problem with the heart, chest, etc. The symptoms mainly occur because of an overdrive of nervous impulses from the brain to various parts of the body during a panic attack. This overdrive of nervous impulses can lead to the body producing hormones which include adrenaline (epinephrine). This is sometimes referred to as a ‘fight or flight’ response. This kind of reaction is normal in people when we feel we are in danger. During a panic attack the body can react in the same way.

During a panic attack you tend to over-breathe (hyperventilate). If you over-breathe you blow out too much carbon dioxide which changes the acidity in the blood. This can then cause more symptoms such as confusion and cramps, and make palpitations, dizziness, and pins and needles worse. This can make the attack seem even more frightening, and make you over-breathe even more, and so on. It can sometimes result in a faint. A panic attack usually lasts 5-10 minutes, but sometimes they come in waves for up to two hours.

Related articles q

Anxiety
Obsessive-compulsive Disorder
Phobias

What is panic disorder?

At least 1 in 10 people have occasional panic attacks. If you have panic disorder it means that you have repeated (recurring) panic attacks. The frequency of attacks can vary. About 1 in 50 people have panic disorder.

In panic disorder, there may be an initial event which causes panic but then the attacks after that are not always predictable. If you have panic disorder, you also have ongoing worry about having further attacks and/or worry about the symptoms that you get during attacks. For example, you may worry that the thumping heart (palpitations) or chest pains that you get with panic attacks are due to a serious heart problem. Some people worry that they may die during a panic attack.

Related blogs Q

Anxious all the time? You’re not alone

Panic attacks – nothing to panic about

Agoraphobia

What causes panic attacks?

Panic attacks usually occur for no apparent reason. The cause is not clear. Slight abnormalities in the balance of some brain chemicals (neurotransmitters) may play a role. This is probably why medicines used for treatment work well. Anyone can have a panic attack, but they also tend to run in some families. Stressful life events such as bereavement may sometimes trigger a panic attack.

Articles you may like _

Managing stress with exercise
My goal is to help others with OCD to help themselves
Reduce your stress with your New Year’s resolutions
Deputy Prime Minister sets out mental health action plan
More Wellbeing articles ▶
Panic disorder, agoraphobia and other fears

Some people with panic disorder worry about having a panic attack in a public place where it is difficult to get out of, or where help may not be available, or where it can be embarrassing. This may cause them to develop agoraphobia. About 1 in 3 people with panic disorder also develop agoraphobia. See separate leaflet called Agoraphobia.

If you have agoraphobia you have a number of fears of various places and situations. So, for example, you may be afraid to:
•Be in an open place.
•Enter shops, crowds, and public places.
•Travel in trains, buses, or planes.
•Be on a bridge or in a lift.
•Be in a cinema, restaurant, etc, where there is no easy exit.
•Be anywhere far from your home – many people with agoraphobia stay inside their home for most or all of the time.

You may also develop other irrational fears. For example, you may think that exercise or certain foods cause the panic attacks. Because of this you may fear (develop a phobia) for certain foods, or avoid exercise, etc.

Support groups e

No Panic
Anxiety Alliance

Find support near you ▶

Dealing with a panic attack

To ease a panic attack, or to prevent one from getting worse, breathe as slowly and as deeply as you can. Really focus on your breathing. Learning and using relaxation techniques may help. Many people find that deep breathing exercises are useful. This means taking a long, slow breath in, and very slowly breathing out. If you do this a few times, and concentrate fully on breathing, you may find it quite relaxing.

Some people find that moving from chest breathing to tummy (abdominal) breathing can be helpful. Sitting quietly, try putting one hand on your chest and the other on your abdomen. You should aim to breathe quietly by moving your abdomen with your chest moving very little. This encourages the lower chest muscle (diaphragm) to work efficiently and may help you avoid over-breathing.

What is the treatment for panic attacks and panic disorder?

No treatment is needed if you have just an occasional panic attack. It may help if you understand about panic attacks. This may reassure you that any physical symptoms you get during a panic attack are not due to a physical disease. It may help to know how to deal with a panic attack.

Treatment can help if you have repeated (recurring) attacks (panic disorder). The main aim of treatment is to reduce the number and severity of panic attacks.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a type of specialist talking treatment. It is probably the most effective treatment. Studies show that it works well for over half of people with panic disorder (and agoraphobia).
•Cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as panic attacks and agoraphobia. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and false ideas or thoughts which you have. For example, the ideas that you may have at the beginning of a panic attack, wrong beliefs about the physical symptoms, how you react to the symptoms, etc. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful. Therapy is usually done in weekly sessions of about 50 minutes each, for several weeks.
•Behavioural therapy aims to change behaviours which are harmful or not helpful. This may be particularly useful if you have agoraphobia with panic disorder where you avoid various situations or places. The therapist also teaches you how to control anxiety when you face up to the feared situations and places. For example, by using breathing techniques.
•Cognitive behavioural therapy (CBT) is a mixture of the two where you may benefit from changing both thoughts and behaviours.

If you have CBT and it works, the long-term outlook may be better than with treatment with antidepressants. However, CBT may not be available in every area, and does not suit everyone.

Antidepressant medicines

These usually work well to prevent panic attacks in more than half of cases. (These medicines are often used to treat depression, but have been found to work well for panic disorder too, even if you are not depressed.) They work by interfering with brain chemicals (neurotransmitters) – such as serotonin – which may be involved in causing symptoms of panic.
•Antidepressants do not work straightaway. It takes 2-4 weeks before their effect builds up and may take up to eight weeks to work fully. A common problem is that some people stop the medicine after a week or so as they feel that it is doing no good. You need to give them time to work.
•Antidepressants are not tranquillisers, and are not usually addictive.
•There are several types of antidepressants, each with various pros and cons. For example, they differ in their possible side-effects. However, selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used to treat panic disorder.
•If SSRIs do not work, imipramine or clomipramine is sometimes used.

Note: after first starting an antidepressant, in some people some anxiety symptoms become worse for a few days before they start to improve.

If it works, it is usual to take an antidepressant for panic disorder for at least a year. At the end of a course of treatment, you should not stop an antidepressant suddenly, but you should reduce the dose gradually under the supervision of a doctor. In about half of people who are successfully treated, there is a return of panic attacks when treatment is stopped. An option then is to take an antidepressant long-term. The attacks are less likely to return once you stop antidepressants if you have had a cognitive behavioural course (see below).

A combination of CBT and antidepressants may work better than either treatment alone.

What is agoraphobia?

Many people think that agoraphobia means a fear of public places and open spaces. But this is just part of it. If you have agoraphobia you tend to have a number of fears of various places and situations. So, for example, you may have a fear of:
•Entering shops, crowds, and public places.
•Travelling in trains, buses, or planes.
•Being on a bridge.
•Being in a lift.
•Being in a cinema, restaurant, etc, where there is no easy exit.
•Being anywhere far from your home.

But, they all stem from one underlying fear. That is, a fear of being in a place where help will not be available, or where you feel it may be difficult to escape to a safe place (usually to your home).

When you are in a feared place you become very anxious and distressed, and have an intense desire to get out. The anxiety usually causes physical symptoms, such as:
•A fast heart rate.
•A thumping heart (palpitations).
•Shaking (tremor).
•Sweating.
•Dry mouth.
•Feeling sick (nauseated).
•Chest pain.
•Headaches.
•Stomach pains.
•A ‘knot in the stomach’.
•Fast breathing.

You may even have a panic attack (see separate leaflet called Panic Attack and Panic Disorder).

Even thinking about going to such places can make you anxious. To avoid this anxiety, you tend to avoid feared places.

The severity of agoraphobia can vary greatly. Some people with agoraphobia can cope quite well outside their home by sticking to familiar areas and routines. Some people with agoraphobia can go out from their home and travel on buses, trains, etc, without getting anxious if they go with a friend or family member. There may be times when they have good spells where they cope better than at other times.

However, to prevent anxiety, many people with agoraphobia stay inside their home for most or all of the time. But, by avoiding the feared situations, this can often cause the fear to grow stronger and the problem may get worse. So, agoraphobia can be disabling and greatly affect your life.

Who has agoraphobia?

Agoraphobia typically develops between the ages of 25 and 35 and is usually a lifelong problem unless treated. However, it can sometimes develop at a younger or older age than this.Twice as many women as men are affected.

Agoraphobia and panic disorder

Many, but not all, people with agoraphobia also have a condition called panic disorder. This is also discussed in the separate leaflet called Panic Attack and Panic Disorder. Briefly, people with panic disorder have panic attacks that occur suddenly, often without warning. A panic attack is like a sudden and severe attack of anxiety and fear.

If you have panic disorder you may worry about having a panic attack in a public place, which is embarrassing, difficult to get out of, or where help may not be available. Therefore, you may develop agoraphobia – a fear of being in such places – because you have panic disorder.

Anxious all the time? You’re not alone

Panic attacks – nothing to panic about

How is agoraphobia diagnosed?

You are likely to have agoraphobia if:
•You avoid situations that cause anxiety, such as going out of the house and being in open spaces.
•Your symptoms are caused by anxiety and not related to some other condition such as depression.
•You feel anxiety in two or more of the following situations: crowds, public places, travelling alone, or away from home.

What are the treatment options for agoraphobia?

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) helps you to change certain ways that you think, feel and behave. It is a useful treatment for various mental health problems, including phobias.
•Cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as anxiety, depression and phobias. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and false ideas or attitudes which you have that can make you anxious. The aim is then to change your ways of thinking to avoid these ideas. It can help your thought patterns to be more realistic and helpful.
•Behavioural therapy aims to change any behaviours which are harmful or not helpful. For example, with phobias your behaviour (your response to the feared object) is harmful, and the therapist aims to help you to change this. Various techniques are used, depending on the condition and circumstances. For example, in agoraphobia, the therapist will usually help you to face up to feared situations, a little bit at a time. A first step may be to go for a very short walk from your home with the therapist who gives support and advice. Over time, a longer walk may be possible, then a walk to the shops, and then a trip on a bus, etc. The therapist teaches you how to control anxiety when you face up to the feared situations and places. For example, by using deep breathing techniques. This technique of behavioural therapy is called exposure therapy – where you are exposed more and more to feared situations, and learn how to cope.
•Cognitive behavioural therapy is a mixture of the two where you may benefit from changing both thoughts and behaviours.

CBT is usually done in weekly sessions of about 50 minutes each, for several weeks. You have to take an active part, and are given homework between sessions. For example, you may be asked to keep a diary of your thoughts which occur when you become anxious.

Note: unlike other forms of psychotherapy, CBT does not look into the events of the past. CBT aims to deal with, and to change where appropriate, your current thought processes and/or behaviours.

CBT usually works well to treat most phobias, but does not suit everyone. However, it may not be available on the NHS in all areas.

Anxiety Alliance
Reading Well Books on Prescription

Find support near you ▶

Antidepressant medicines

These are commonly used to treat depression, but also help to reduce the symptoms of phobias, even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) – such as serotonin – which may be involved in causing anxiety symptoms.
•Antidepressants do not work straightaway. It takes 2-4 weeks before their effect builds up. A common problem is that some people stop the medicine after a week or so, as they feel that it is doing no good. You need to give it time. It is best to persevere if you are prescribed an antidepressant medicine.
•Antidepressants are not tranquillizers, and are not usually addictive.
•There are several types of antidepressants, each with various pros and cons. For example, they differ in their possible side-effects. However, selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used for anxiety disorders.

Why do relaxation exercises?

Some people relax with sport, exercise, listening to music, watching TV, reading a book, etc. However, some people find it helpful to follow specific relaxation exercises. This leaflet gives a summary of two commonly used routines – muscular relaxing exercises, and deep breathing exercises. These two techniques are particularly useful to combat the two common physical symptoms of anxiety – muscular tension and over-breathing. There is some evidence that they may also help to ease symptoms of depression.

Like anything else, you need to practise these at first. However, hopefully, you can then use them in everyday life whenever you feel tense or anxious.

Related blogs Q

Why being stress aware matters

Panic attacks – nothing to panic about

Agoraphobia

Muscular relaxation

Planned times for regular positive relaxation

Find a quiet warm place where you won’t be disturbed. Choose a time of day when you do not feel pressured to do anything else. Lie down on your back, or sit in a well-supported chair if you are not able to lie down. Try to get comfortable and close your eyes. Perhaps lie on a firm bed of some cushions. The routine then is to work on each of your muscle groups. With each group of muscles, firstly tense the muscles as much as you can, then relax them fully. Breathe in when you tense the muscles, and breathe out when you relax.

To start with, concentrate on your breathing for a few minutes. Breathe slowly and calmly. Each time you breathe out say words to yourself such as ‘peace’ or ‘relax’. Then start the muscle exercises, working around the different muscle groups in your body.
•Hands – clench one hand tightly for a few seconds as you breathe in. You should feel your forearm muscles tense; then relax as you breathe out. Repeat with the other hand.
•Arms – bend an elbow and tense all the muscles in the arm for a few seconds as you breathe in; then relax as you breathe out. Repeat the same with the other arm.
•Neck – press your head back as hard as is comfortable and roll it slowly from from side to side; then relax.
•Face – try to frown and lower your eyebrows as hard as you can for a few seconds; then relax. Then raise your eyebrows (as if you were startled) as hard as you can; then relax. Then clench your jaw for a few seconds; then relax.
•Chest – take a deep breath and hold it for a few seconds; then relax and go back to normal breathing.
•Stomach – tense the stomach muscles as tightly as possible; then relax.
•Buttocks – squeeze the buttocks together as much as possible; then relax.
•Legs – with your legs flat on the floor, bend your feet and toes towards your face as hard as you can; then relax. Then bend them away from your face for a few seconds; then relax.

Then repeat the whole routine 3-4 times. Each time you relax a group of muscles, note the difference of how they feel when relaxed compared to when they are tense. Some people find it eases their general level of ‘tension’ if they get into a daily routine of doing these exercises.

p

6
Spotting stress
Everyday life

Obviously, you cannot do all the above when ‘out and about’. However, the principle of full tension followed by relaxation of a group of muscles can help to ease anxiety in everyday situations. Therefore, in situations when you feel tension or anxiety rising, try either of the following:
•Twisting your neck around each way as far as it is comfortable; then relax.
•Fully tensing your shoulder and back muscles for several seconds; then relax.

Articles you may like _

Managing stress with exercise
Deputy Prime Minister sets out mental health action plan
Beverlea’s story – I’ve learnt to live with the noises in my head
Giving and caring may improve your health
More Wellbeing articles ▶
Deep breathing exercises

Many people have a tendency to breathe faster than normal when they are anxious. Sometimes this can make you feel a little dizzy, which makes you more anxious and you breathe even faster, which can make you more anxious, etc. If you practise ‘deep breathing’ when you are relaxed, you should be able to do this when you feel tense or anxious to help you to relax.

Try the following for 2-3 minutes. Practise this every day until you can do it routinely in any stressful situation:
•Breathe slowly and deeply in through your nose, and out through your mouth in a steady rhythm. Try to make your breath out twice as long as your breath in. To do this, you may find it helpful to count slowly ‘one, two’ as you breathe in, and ‘one, two, three, four’ as you breathe out.
•Mainly use your lower chest muscle (your diaphragm) to breathe. Your diaphragm is the big muscle under the lungs. It pulls the lungs downwards which expands the airways to allow air to flow in. When we become anxious we tend to forget to use this muscle and often use the muscles at the top of the chest and our shoulders instead. Each breath is more shallow if you use these upper chest muscles. So, you tend to breathe faster, and feel more breathless and anxious, if you use your upper chest muscles rather than your diaphragm.
•You can check if you are using your diaphragm by feeling just below your breastbone (sternum) at the top of your tummy (abdomen). If you give a little cough, you can feel the diaphragm push out here. If you hold your hand here you should feel it move in and out as you breathe.
•Try to relax your shoulders and upper chest muscles when you breathe. With each breath out, consciously try to relax those muscles until you are mainly using your diaphragm to breathe.

What are the symptoms of phobia?

If you come near to, or into contact with, the feared situation you become anxious or distressed. In addition you may also have one or more unpleasant physical symptoms. These can be, for example, a fast heart rate, palpitations, feeling sick, shaking (tremor), sweating, dry mouth, chest pain, a ‘knot in the stomach’, and fast breathing.

The physical symptoms are partly caused by the brain which sends lots of messages down nerves to various parts of the body when you are anxious. In addition, you release stress hormones (such as adrenaline) into the bloodstream when you are anxious. These can also act on the heart, muscles and other parts of the body to cause symptoms.

You may even become anxious by just thinking of the feared situation. You end up avoiding the feared situation as much as possible, which can restrict your life and cause suffering.

Related articles q

Anxiety
Social Anxiety Disorder
Obsessive-compulsive Disorder

There are different types of phobia

Social anxiety disorder

This is also known as social phobia and it is possibly the most common phobia. With social anxiety disorder you become very anxious about what other people may think of you, or how they may judge you. Therefore, you fear meeting people, or ‘performing’ in front of other people, especially strangers. You fear that you will act in an embarrassing or humiliating way, and that other people will think that you are stupid, inadequate, weak, foolish, crazy, etc. You avoid such situations as much as possible. See separate leaflet called Social Anxiety Disorder for more details.

Related blogs Q

Anxious all the time? You’re not alone

Agoraphobia

What’s metabolism? Your thyroid gland and you

Agoraphobia

This too is common. Many people think that agoraphobia means a fear of public places and open spaces. But this is just part of it. If you have agoraphobia you tend to have a number of fears of various places and situations.

For example, you may have a fear of:
•Entering shops, crowds, and public places.
•Travelling in trains, buses, or planes.
•Being on a bridge or in a lift.
•Being in a cinema, restaurant, etc, where there is no easy exit.

But they all stem from one underlying fear. That is, a fear of being in a place where help will not be available, or where you feel it may be difficult to escape to a safe place (usually to your home). When you are in a feared place you become anxious and distressed, and have an intense desire to get out. Therefore, to avoid this anxiety many people with agoraphobia stay inside their home for most or all of the time. See separate leaflet called Agoraphobia for more details.

Articles you may like _

Managing stress with exercise
My goal is to help others with OCD to help themselves
Reduce your stress with your New Year’s resolutions
Deputy Prime Minister sets out mental health action plan
More Wellbeing articles ▶
Other specific phobias

There are many other phobias of a specific thing or situation – for example:
•Fear of confined spaces or of being trapped (claustrophobia).
•Fear of certain animals.
•Fear of injections or needles.
•Fear of vomiting.
•Fear of being alone.
•Fear of choking.
•Fear of the dentist.
•Fear of flying.

However, there are many others, some quite rare.

Support groups e

Anxiety Alliance
Reading Well Books on Prescription

Find support near you ▶

What is the treatment for phobias?

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) helps you to change certain ways that you think, feel and behave. It is a useful treatment for various mental health problems, including phobias.
•Cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as anxiety, depression and phobias. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and false ideas or attitudes which you have that can make you anxious. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful.
•Behavioural therapy aims to change any behaviours which are harmful or not helpful. For example, with phobias your response to the feared object (anxiety and avoidance) is not helpful. The therapist helps you to change this. Various techniques are used, depending on the condition and circumstances. For example, for agoraphobia the therapist will usually help you to face up to feared situations, a little bit at a time. A first step may be to go for a very short walk from your home with the therapist who gives support and advice. Over time, a longer walk may be possible, and then a walk to the shops, then a trip on a bus, etc. The therapist may teach you how to control anxiety when you face up to the feared situations and places. For example, by using deep breathing exercises. This technique of behavioural therapy is called exposure therapy where you are exposed more and more to feared situations, and learn how to cope.
•Cognitive behavioural therapy (CBT) is a mixture of the two where you may benefit from changing both thoughts and behaviours.

CBT is usually done in weekly sessions of about 50 minutes each, for several weeks. You have to take an active part, and are given homework between sessions. For example, you may be asked to keep a diary of your thoughts which occur when you become anxious.

Note: unlike other forms of talking treatments (psychotherapy), CBT does not look into the events of the past. CBT aims to deal with your current thought processes and/or behaviours, and helps to change them where appropriate.

CBT usually works well to treat most phobias, but does not suit everyone. However, it may not be available on the NHS in all areas. See separate leaflet called Cognitive Behavioural Therapy (CBT) for more details.

Antidepressant medicines

These are commonly used to treat depression, but they also help to reduce the symptoms of phobias (particularly agoraphobia and social phobia), even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing anxiety symptoms.
•Antidepressants do not work straightaway. It takes 2-4 weeks before their effect builds up and anxiety is helped. A common problem is that some people stop the medicine after a week or so, as they feel that it is doing no good and it is too early to tell if the medication is working.
•Antidepressants are not tranquillizers, and are not usually addictive.
•There are several types of antidepressants, each with various pros and cons and they differ in their possible side-effects. However, selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used for anxiety and phobic disorders. Examples of SSRIs are escitalopram and sertraline.
•Note: after first starting an antidepressant, in some people anxiety symptoms can become worse for a few days before they start to improve. Your doctor or practice nurse will want to keep a check on you in the first weeks of treatment to see how you manage.

A combination of CBT and an SSRI antidepressant may work better in some cases than either treatment alone.

Benzodiazepines

Benzodiazepines such as diazepam are sometimes called minor tranquilisers but they can have serious side effects. They often work well to ease symptoms of anxiety. The problem is they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Therefore, they are not a useful long-term treatment of phobias. However, a short course, or even a single dose, may be useful for a phobia which occurs rarely. For example, if you have a fear of flying in a plane, a short course just before a flight may help.

Schizophrenia is a mental illness. Symptoms include hallucinations (such as hearing voices), false ideas (delusions), disordered thoughts and problems with feelings, behaviour and motivation. The cause is not clear. In many people symptoms come back (recur) or persist long-term but some people have just one episode of symptoms that lasts a few weeks. Treatment includes medication, talking treatments and social support.

What is schizophrenia and who gets it?

Schizophrenia is a serious mental health condition that causes disordered ideas, beliefs and experiences. In a sense, people with schizophrenia lose touch with reality and do not know which thoughts and experiences are true and real and which are not.

Some people have wrong ideas about schizophrenia. For instance, it has nothing to do with a split personality. Also, the vast majority of people with schizophrenia are not violent.

You should be aware that some people feel that schizophrenia should be abolished as a concept. They believe that the term is unscientific, stigmatising and does not address the root causes of serious mental distress. However, many members of the medical profession still find the term schizophrenia useful.

Schizophrenia develops in about 1 in 100 people. It can occur in men and women. The most common ages for it first to develop are 15-25 in men and 25-35 in women.

What are the symptoms of schizophrenia?

There are many possible symptoms. They are often classed into positive and negative. Positive symptoms are those that show abnormal mental functions. Negative symptoms are those that show the absence of a mental function that should normally be present.

Related articles q

Antipsychotic Medicines
Hearing Voices – A Self Help Guide
Cognitive Behavioural Therapy (CBT)

Positive symptoms include the following
•Delusions. These are false beliefs that a person has and most people from the same culture would agree that they are wrong. Even when the wrongness of the belief is explained, a person with schizophrenia is convinced that they are true. For example, a person with schizophrenia may believe that neighbours are spying on them with cameras in every room, or a famous person is in love with them, or that people are plotting to kill them, or there is a conspiracy about them. These are only a few examples and delusions can be about anything.
•Hallucinations. This means hearing, seeing, feeling, smelling, or tasting things that are not real. Hearing voices is the most common. Some people with schizophrenia hear voices that provide a running commentary on their actions, argue with them, or repeat their thoughts. The voices often say things that are rude, aggressive, unpleasant, or give orders that must be followed. Some people with schizophrenia appear to talk to themselves as they respond to the voices. People with schizophrenia believe that the hallucinations are real.
•Disordered thoughts. Thoughts may become jumbled or blocked. Thought and speech may not follow a normal logical pattern. For example, some people with schizophrenia have one or more of the following: •Thought echo. This means the person hears his or her own thoughts as if they were being spoken aloud.
•Knight’s-move thinking. This means the person moves from one train of thought to another that has no apparent connection to the first.
•Some people with schizophrenia may invent new words (neologisms), repeat a single word or phrase out of context (verbal stereotypy), or use ordinary words to which they attribute a different, special meaning (metonyms).
Symptoms called disorders of thought possession may also occur. These include: •Thought insertion. This is when someone believes that the thoughts in their mind are not their own and that they are being put there by someone else.
•Thought withdrawal. This is when someone believes that thoughts are being removed from their mind by an outside agency.
•Thought broadcasting. This is when someone believes that their thoughts are being read or heard by others.
•Thought blocking. This is when there is a sudden interruption of the train of thought before it is completed, leaving a blank. The person suddenly stops talking and cannot recall what he or she has been saying.

Negative symptoms include the following
•Lack of motivation. Everything seems an effort – for example, tasks may not be finished, concentration is poor, there is loss of interest in social activities and the person often wants to be alone.
•Few spontaneous movements and much time doing nothing.
•Facial expressions do not change much and the voice may sound monotonous.
•Changed feelings. Emotions may become flat. Sometimes the emotions may be odd, such as laughing at something sad. Other strange behaviours sometimes occur.

Negative symptoms can make some people neglect themselves. They may not care to do anything and appear to be wrapped up in their own thoughts. Negative symptoms can also lead to difficulty with education, which can contribute to difficulties with employment. For families and carers, the negative symptoms are often the most difficult to deal with. Persistent negative symptoms tend to be the main cause of long-term disability.

Families may only realise with hindsight that the behaviour of a relative has been gradually changing. Recognising these changes can be particularly difficult if the illness develops during the teenage years when it is normal for some changes in behaviour to occur.

Other symptoms

Other symptoms that occur in some cases include difficulty planning, memory problems and obsessive-compulsive symptoms.

How is the diagnosis made?

Some of the symptoms that occur in schizophrenia also occur in other mental health conditions such as depression, mania, or after taking some street drugs. Therefore, the diagnosis may not be clear at first. As a rule, the symptoms need to be present for several weeks before a doctor will make a firm diagnosis of schizophrenia.

Not all symptoms are present in all cases. Different forms of schizophrenia occur depending upon the main symptoms that develop. For example, people with paranoid schizophrenia mainly have positive symptoms which include delusions that people are trying to harm them. In contrast, some people mainly have negative symptoms and this is classed as simple schizophrenia. In many cases there is a mix of positive and negative symptoms.

Sometimes symptoms develop quickly over a few weeks or so. Family and friends may recognise that the person has a mental health problem. Sometimes symptoms develop slowly over months and the person may gradually become withdrawn, lose friends, jobs, etc, before the condition is recognised.

Related blogs Q

Anxious all the time? You’re not alone

Panic attacks – nothing to panic about

What is the cause of schizophrenia?

The exact cause is not known. It is thought that the balance of certain brain chemicals (neurotransmitters) is altered. Neurotransmitters are needed to pass messages between brain cells. An altered balance of these may cause the symptoms. It is not clear why changes occur in the neurotransmitters.

Genetic (hereditary) factors are thought to be important. For example, a close family member (child, brother, sister, parent) of someone with schizophrenia has a 1 in 10 chance of also developing the condition. This is 10 times the normal chance. A child born to a mother and father who both have schizophrenia has a 1 in 2 chance of developing it too. However, one or more factors appear to be needed to trigger the condition in people who are genetically prone to it. There are various theories as to what these might be. For example:
•Stress such as relationship problems, financial difficulties, social isolation, bereavement, etc.
•A viral infection during the mother’s pregnancy, or in early childhood.
•A lack of oxygen at the time of birth that may damage a part of the brain.
•Illegal or street drugs may trigger the condition in some people. For example, those who use cannabis heavily are six times more likely to develop schizophrenia than non-users. Many other drugs of abuse such as amfetamines, cocaine, ketamine and lysergic acid diethylamide (LSD) can trigger a schizophrenia-like illness.

Are any tests needed?

Blood and urine tests may be done to rule out physical causes of the symptoms or drug/alcohol use. People already diagnosed with schizophrenia may also have tests done if they suddenly become worse.

What are the treatments for schizophrenia?

Treatment and care are usually based in the community rather than at hospitals. The National Institute for Health and Care Excellence (NICE) recommends that the patient’s social circumstances be assessed and their family involved as soon as possible. Most areas of the UK have a community mental healthcare team which includes psychiatrists, nurses, psychologists, social workers, etc. A key worker such as a community psychiatric nurse or psychiatric social worker is usually allocated to co-ordinate the care for each person with schizophrenia.

However, some people need to be admitted to hospital for a short time. This is sometimes done when the condition is first diagnosed so that treatment can be started quickly. Hospital admission may also be needed for a while at other times if symptoms become severe. A small number of people have such a severe illness that they remain in hospital long-term.

People with schizophrenia often do not realise or accept that they are ill. Therefore, sometimes when persuasion fails, some people are admitted to hospital for treatment against their will by use of the Mental Health Act. This means that doctors and social workers can force a person to go to hospital. This is only done when the person is thought to be a danger to themself or others.

Antipsychotic medication

The main medicines used to treat schizophrenia are called antipsychotics. They work by altering the balance of some brain chemicals (neurotransmitters). Antipsychotic medication is used to relieve the symptoms. Antipsychotic medicines tend to work best to ease positive symptoms and tend not to work so well to ease negative symptoms. Antipsychotic medicines are also used to prevent recurring episodes of symptoms (relapses). Therefore, antipsychotic medication is usually taken on a long-term basis. There are various antipsychotic medicines and different ones may be used in different circumstances. They are broadly divided into two categories:
•Newer or atypical antipsychotics. These are sometimes called second-generation antipsychotics and include amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and sertindole. One of these medicines is commonly used first-line for new cases. This is because they seem to have a good balance between chance of success and the risk of side-effects. However, if you are already taking a typical medicine and feel well on it, there is no need to change to a newer one.
•Older typical well-established antipsychotics. These are sometimes called first-generation antipsychotics and include chlorpromazine, trifluoperazine, haloperidol, flupentixol, zuclopenthixol and sulpiride.

There are some differences between the various antipsychotic medicines. Therefore, one may be better for an individual than another. For example, some are more sedating than others. A specialist in psychiatry usually advises on which to use in each case. In most cases, the specialist will start you on either risperidone or olanzapine. The others are usually kept in reserve for people who have problems or do not respond to these medicines.

A good response to antipsychotic medication occurs in about 7 in 10 cases. However, symptoms may take 2-4 weeks to ease after starting medication and it can take several weeks for full improvement. Even when symptoms ease, antipsychotic medication is normally continued long-term. This aims to prevent relapses, or to limit the number and severity of relapses. However, if you only have one episode of symptoms that clears completely with treatment, one option is to try coming off medication after 1-2 years. Your doctor will advise.

Depot injections of an antipsychotic medicine. In some cases, an injection of a long-acting antipsychotic medicine is used once symptoms have eased. The medicine from a depot injection is slowly released into the body and is given every 2-4 weeks. This aims to prevent relapses. The main advantage of depot injections is that you do not have to remember to take tablets every day.

What about side-effects from antipsychotic medicines? Side-effects can sometimes be troublesome. There is often a trade-off between easing symptoms and having to put up with some side-effects from treatment. The different antipsychotic medicines can have different types of side-effects. Also, sometimes one medicine causes side-effects in some people and not in others. Therefore, it is not unusual to try two or more different medicines before one is found that is best suited to an individual.

The following are the main side-effects that sometimes occur. However, you should read the information leaflet that comes in each medicine packet for a full list of possible side-effects.
•Common side-effects include: dry mouth, blurred vision, flushing and constipation. These may ease off when you get used to the medicine.
•Drowsiness (sedation) is also common but may be an indication that the dose is too high. A reduced dose may be an option.
•Some people develop weight gain. Weight gain may increase the risk of developing diabetes and heart problems in the longer term. This appears to be a particular problem with the atypical antipsychotics, notably clozapine and olanzapine.

Movement disorders develop in some cases. These include:
•Parkinsonism – this can cause symptoms similar to those that occur in people with Parkinson’s disease. For example, tremor and muscle stiffness.
•Akathisia – which is like a restlessness of the legs.
•Dystonia – which means abnormal movements of the face and body.
•Tardive dyskinesia – which is a movement disorder that can occur if you take antipsychotics for several years. It causes rhythmical, involuntary movements. These are usually lip-smacking and tongue-rotating movements, although it can affect the arms and legs too. About 1 in 5 people treated with typical antipsychotics eventually develop tardive dyskinesia.

Atypical antipsychotic medicines are thought to be less likely to cause movement disorder side-effects than typical antipsychotic medicines. Reduced incidence of movement disorder is the main reason why an atypical antipsychotic medicine is often used first-line. Atypicals do, however, have their own risks. In particular, the risk of weight gain. If movement disorder side-effects occur then other medicines may be used to try to counteract them.

p

6
Schizophrenia
Psychological treatments

Cognitive behavioural therapy (CBT). Psychological treatments include a variety of talking treatments, in particular a treatment called cognitive behavioural therapy (CBT). CBT is used as a treatment for various mental health and physical problems and is being increasingly used as a treatment for schizophrenia. CBT aims to help you to change the way that you think, feel and behave. CBT is actually a wide term which includes various types of therapy. You may be asked to keep a diary of important events in your life and the way you feel about them. Your therapist may challenge your beliefs and ask you to explain them. You may be asked to try out new ways of behaving and reacting.

CBT and other talking treatments are not alternatives to medicines. They are used in some cases in addition to medication. NICE recommends up to 16 CBT sessions. This is because studies have found that, on average, CBT reduces the chance of being admitted or re-admitted to hospital, can reduce symptom severity and can improve social functioning.

Family intervention. This may be offered and consists of about 10 therapy sessions for relatives of patients with schizophrenia. It has been found to reduce hospital admissions and the severity of symptoms for up to two years after treatment.

Art therapy. This has been found to be helpful, particularly if you have negative symptoms.

Social and community support

This is very important. Often the key worker plays a vital role. However, families, friends and local support groups can also be major sources of help. Contact details of the head offices of the main support organisations are listed in links at the end of this leaflet. However, these organisations also have many local groups throughout the UK.

Encouraging physical health

It is quite common for people with schizophrenia not to look after themselves so well. Such things as smoking, lack of exercise, obesity and an unhealthy diet are more common than average in people with schizophrenia. Weight gain may be a side-effect of antipsychotic medicines. All of these factors may lead to an increased chance of developing heart disease and diabetes in later life.

Therefore, as with everyone else in the population, people with schizophrenia are encouraged to adopt a healthy lifestyle – not to smoke, to take regular exercise, to eat healthily, etc.

Support groups e

Hearing Voices Network
Rethink Mental Illness

Find support near you ▶

What is the outlook (prognosis)?
•In most cases there are recurring episodes of symptoms (relapses). Most people in this group live relatively independently with varying amounts of support. The frequency and duration of each relapse can vary. Some people recover completely between relapses. Some people improve between relapses but never quite fully recover. Treatment often prevents relapses, or limits their number and severity.
•In some cases, there is only one episode of symptoms that lasts a few weeks or so. This is followed by a complete recovery, or substantial improvement without any further relapses. It is difficult to give an exact figure as to how often this occurs. Perhaps 2 in 10 cases or fewer.
•Up to 2 in 10 people with schizophrenia are not helped much by treatment and need long-term dependent care. For some, this is in secure accommodation.
•Depression is a common complication of schizophrenia.
•It is thought that up to a third of people with schizophrenia abuse alcohol and/or illegal drugs. Helping or treating such people can be difficult.
•About 1 in 10 people with schizophrenia commit suicide.

The outlook is thought to be better if:
•Treatment is started soon after symptoms begin.
•Symptoms develop quickly over several weeks rather than slowly over several months.
•The main symptoms are positive symptoms rather than negative symptoms.
•The condition develops in a relatively older person (aged over 25).
•Symptoms ease well with medication.
•Treatment is taken as advised (that is, compliance with treatment is good).
•There is good family and social support which reduces anxiety and stress.
•Abuse of illegal drugs or alcohol does not occur.

Newer medicines and better psychological treatments give hope that the outlook is improving.

http://www.bipolar4lifesupport.co on line support group