What Does Bipolar Mania Look and Feel Like?

Posted on December 31, 2016 by JmaC

Whether you have bipolar disorder or you know someone with the condition, you’ll want to be aware of the signs of mania — the extreme highs that can lead to big risks with money, sex, and even safety.

If you see these signs in a loved one who has bipolar disorder, let them know your concerns and encourage them to tell their doctor.

If you’re the one with the condition, and a family member or friend tells you that they’re concerned, listen to them and get help as soon as possible. It can be hard to see mania in yourself, and you may even like how it feels. But you need to get it under control for your own health.

Common signs include:

Fast-Talking

The first outward sign might be super-fast speech, so quick that anyone listening can’t get a word in edgewise.

“Someone who is normally more thoughtful and interactive suddenly becomes hyper-talkative, talking over you and not really giving you a chance to get into the conversation,” says Dean MacKinnon, MD, an associate professor of psychiatry and behavioral sciences at The Johns Hopkins School of Medicine.

Inflated Ego

When someone is manic, they may say things that greatly exaggerate their abilities and sense of self-esteem.
For instance, they may think that “they are better at stuff — a better writer, a better artist — than people who are already accomplished in those things,” MacKinnon says. Or they may claim expertise that they don’t have.

Sleep Falls Apart

Mania can make someone cut way down on sleep or not sleep at all. They feel like they don’t need it.

“People burst out of bed in the middle of the night full of energy ready to take on the day, or they stay up late into the night busy with projects or other sorts of stimulation,” MacKinnon says.

At first, they may seem to get away with it. “They function perfectly fine the next day on little sleep,” MacKinnon says.

But the longer someone is sleep-deprived, the worse their bipolar symptoms become.

It Has a High Cost

During mania, people can take a lot of risks that they normally wouldn’t. And that can take big toll for a long time.

Just ask Tonya Williams, who found out she has bipolar disorder in 2008. When she was manic, she’d stay up night after night writing poetry, singing, or shopping online.

One time, “I opened 12 new credit accounts and went on a spending spree,” says Williams, now a lawyer in Raleigh, NC. “Everything I purchased, I bought in excess: towels and sheets, leather jackets, sneakers, trading cards, perfume. I racked up $77,000 in credit card debt and spent a sizeable retirement account.”

Eventually, her house was foreclosed on, her car was repossessed, and she had to file for bankruptcy.

Five years after going bankrupt, Williams now takes medication to control the mania and her other bipolar disorder symptoms. “I bought another house, got a new car, and my credit score is now over 700,” she says.

The Highs Aren’t Always Off the Charts

Mania has a less severe form, called “hypomania,” that can feel manageable.

“The only real difference with hypomania is the severity: how much it affects the person,” MacKinnon says. “The symptoms are generally the same.”

Hypomania can feel good. “My mania actually helps me get things done,” says Abigail Camarota, a jewelry designer and mother of three in Louisville, KY.

But hypomania can turn into full-blown mania or severe depression.

“When I am manic — and it’s taken me years to recognize the signs — I can’t sit down and rest. I want to work more, I want to finish more pieces,” Camarota says. “But I realize I need to take a step back because it will drive me crazy or make me physically sick if I don’t.”

It Can Feel Thrilling at First

Some people with bipolar disorder skip their medication because they like how the highs feel.

“Research shows it takes people about 10 years from the time of their first manic episode for them to really accept treatment,” MacKinnon says. “It’s not just because they like the way they feel when they’re manic. They’ve also lost the ability to gauge that their mood is abnormal.”

Be Aware of Triggers

Things like extreme stress, sleep deprivation, drugs, and alcohol can prompt a manic episode.  

This is why it’s so important for people with bipolar disorder to avoid alcohol and other drugs, make sure they get enough sleep, and learn ways to manage stress (such as exercise, positive relationships, and meditation).

Also, although mania can happen at any time of year, for some people it’s more common in the summer. Experts don’t know why. You should still look out for mania year-round, but when summer rolls around, keep the seasonal trend in mind.

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Psychiatry Fast Five Quiz: What Do You Know About Anxiety Disorders? Stephen Soreff, MD

Posted on December 31, 2016 by JmaC

http://reference.medscape.com/viewarticle/870991

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Anxiety Disorders

Posted on December 31, 2016 by JmaC

Background

Anxiety disorders are the most common type of psychiatric disorders. Many patients with anxiety disorders experience physical symptoms related to anxiety and subsequently visit their primary care providers. Despite the high prevalence rates of these anxiety disorders, they often are underrecognized and undertreated clinical problems.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), [1] anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. These disorders include separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder (social phobia), panic disorder, agoraphobia, generalized anxiety disorder, substance/medication-induced anxiety disorder, and anxiety disorder due to another medical condition. Obsessive-compulsive disorder (included in the obsessive-compulsive and related disorders), acute stress disorder, and posttraumatic stress disorder (included in the trauma and stress-related disorders) are no longer considered anxiety disorders as they were in the previous version of the DSM. However, these disorders are closely related to anxiety disorders and the sequential order of these chapters in the DSM-5 reflects this close relationship.

Anxiety disorders appear to be caused by an interaction of biopsychosocial factors, including genetic vulnerability, which interact with situations, stress, or trauma to produce clinically significant syndromes. (See Pathophysiology and Etiology.)

Symptoms vary depending on the specific anxiety disorder. (See Clinical Presentation.)

Treatment usually consists of a combination of pharmacotherapy (see Medication) and/or psychotherapy. (See Treatment Strategies and Management.)

Anatomy

The brain circuits and regions associated with anxiety disorders are beginning to be understood with the development of functional and structural imaging. The brain amygdala appears key in modulating fear and anxiety. Patients with anxiety disorders often show heightened amygdala response to anxiety cues. The amygdala and other limbic system structures are connected to prefrontal cortex regions. Hyperresponsiveness of the amygdala may relate to reduced activation thresholds when responding to perceived social threat. [2, 3] Prefrontal-limbic activation abnormalities have been shown to reverse with clinical response to psychologic or pharmacologic interventions.

Pathophysiology

In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms. [4]

Positron emission tomography (PET) scanning has demonstrated increased flow in the right parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients with panic disorder. [5]MRI has demonstrated smaller temporal lobe volume despite normal hippocampal volume in these patients. [6] The CSF in studies in humans shows elevated levels of orexin, also known as hypocretin, which is thought to play an important role in the pathogenesis of panic in rat models. [7]

 

Etiology

Anxiety disorders in general

The first consideration is the possibility that anxiety is due to a known or unrecognized medical condition. Substance-induced anxiety disorder (over-the-counter medications, herbal medications, substances of abuse) is a diagnosis that often is missed.

Genetic factors significantly influence risk for many anxiety disorders. Environmental factors such as early childhood trauma can also contribute to risk for later anxiety disorders. The debate whether gene or environment is primary in anxiety disorders has evolved to a better understanding of the important role of the interaction between genes and environment. [13] Some individuals appear resilient to stress, while others are vulnerable to stress, which precipitates an anxiety disorder.

Most presenting anxiety disorders are functional psychiatric disorders. Psychological theories range from explaining anxiety as a displacement of an intrapsychic conflict (psychodynamic models) to conditioning (learned) paradigms (cognitive-behavioral models). Many of these theories capture portions of the disorder.

The psychodynamic theory has explained anxiety as a conflict between the id and ego. Aggressive and impulsive drives may be experienced as unacceptable resulting in repression. These repressed drives may break through repression, producing automatic anxiety. The treatment uses exploration with the goal of understanding the underlying conflict. Cognitive theory has explained anxiety as the tendency to overestimate the potential for danger. Patients with anxiety disorder tend to imagine the worst possible scenario and avoid situations they think are dangerous, such as crowds, heights, or social interaction.

Panic disorder

Panic disorder appears to be a genetically inherited neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone [14] ; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol [15] ; diminished benzodiazepine receptor function; and disturbances in serotonin, [16] serotonin transporter (5-HTTLPR) [17] and promoter (SLC6A4) genes, [18] norepinephrine, dopamine, cholecystokinin, and interleukin-1-beta. [19] Some theorize that panic disorder may represent a state of chronic hyperventilation and carbon dioxide receptor hypersensitivity. [8] Some epileptic patients have panic as a manifestation of their seizures. Genetic studies suggest that the chromosomal regions 13q, 14q, 22q, 4q31-q34, and probably 9q31 may be associated with the heritability of panic disorder phenotype. [20]

The cognitive theory regarding panic is that patients with panic disorder have a heightened sensitivity to internal autonomic cues (eg, tachycardia). Triggers of panic can include the following:

  • Injury (eg, accidents, surgery)
  • Illness
  • Interpersonal conflict or loss
  • Use of cannabis (can be associated with panic attacks, perhaps because of breath-holding) [21]
  • Use of stimulants, such as caffeine, decongestants, cocaine, and sympathomimetics (eg, amphetamine, MDMA [“ecstasy”]) [22]
  • Certain settings, such as stores and public transportation (especially in patients with agoraphobia)
  • Sertraline can induce panic in previously asymptomatic patients. [23]
  • The SSRI discontinuation syndrome can induce symptoms similar to those experienced by panic patients.

In experimental settings, symptoms can be elicited in people with panic disorder by hyperventilation, inhalation of carbon dioxide, caffeine consumption, or intravenous infusions of hypertonic sodium lactate or hypertonic saline, [24] cholecystokinin, isoproterenol, flumazenil, [25] or naltrexone. [26] The carbon dioxide inhalation challenge is especially provocative of panic symptoms in smokers. [27]

Social anxiety disorder (social phobia)

Genetic factors seem to play a role in social phobia. Based on family and twin studies, the risk for social phobia appears to be moderately heritable. [28, 29]

Social phobia can be initiated by traumatic social experience (eg, embarrassment) or by social skills deficits that produce recurring negative experiences. A hypersensitivity to rejection, perhaps related to serotonergic or dopaminergic dysfunction, is present. Current thought is that social phobia appears to be an interaction between biological and genetic factors and environmental events.

A psychoanalyst would likely conceptualize social anxiety as a symptom of a deeper conflict-for instance, low self-esteem or unresolved conflicts with internal objects. A behaviorist would see phobia as a learned, conditioned response resulting from a past association with a situation with negative emotional valence at the time of association (eg, social situations are avoided because intense anxiety was originally experienced in that setting). Even if no danger is posed in most social encounters, an avoidance response has been linked to these situations. Treatment from this perspective aims to weaken and eventually separate the specific response from the stimulus.

Specific phobia

Genetic factors seem to play a role in specific phobia as well (eg, in blood-injury phobia), and the risk for such phobias also seems to be moderately heritable. [28] In addition, specific phobia can be acquired by conditioning, modeling, or traumatic experience.

Agoraphobia

Agoraphobia may be the result of repeat, unexpected panic attacks, which, in turn, may be linked to cognitive distortions, conditioned responses, and/or abnormalities in noradrenergic, serotonergic, or GABA-related neurotransmission.

 

Epidemiology

United States statistics

Anxiety disorders are the most common type of psychiatric disorders in the United States. The lifetime prevalence of anxiety disorders among American adults is 28.8%. [42]

Social anxiety disorder (social phobia) is the most common anxiety disorder; it has an early age of onset—by age 11 years in about 50% and by age 20 years in about 80% of individuals that have the diagnosis—and it is a risk factor for subsequent depressive illness and substance abuse. [40]  The 12-month prevalence estimate of social anxiety disorder for the United States is approximately 7%. [1]

According to two major studies in the United States—the Epidemiological Catchment Area (ECA) study [41] and the National Comorbidity Survey (NCS) study[42] —in conjunction with other studies, the estimated lifetime prevalence rates for individual anxiety disorders are 2.3-2.7% for panic disorder, 4.1-6.6% for generalized anxiety disorder, and 2.6-13.3% for social phobia.

Further, the NCS reported the following lifetime (and 30-day) prevalence estimates: 6.7% (and 2.3%) for agoraphobia, 11.3% (and 5.5%) for simple (ie, specific) phobia, and 13.3% (and 4.5%) for social phobia. [43, 44]

International statistics

The prevalence of specific anxiety disorders appears to vary between countries and cultures. A cross-national study of the prevalence of panic disorder found lifetime prevalence rates ranging from 0.4% in Taiwan to 2.9% in Italy. The median prevalence of social anxiety disorder in Europe is 2.3%. [1]

In some Far East cultures, individuals with social anxiety disorder may develop fears of being offensive to others rather than fears of being embarrassed. In Japan and Korea, this syndrome is referred to as taijin kyofusho. [1]

Prevalence of anxiety disorders by race

The ECA study found no difference in rates of panic disorder among white, African American, or Hispanic populations in the United States.

Sex ratio for anxiety disorders

The female-to-male ratio for any lifetime anxiety disorder is 3:2 (see the image below).

Anxiety. Chart showing the female-to-male sex ratiAnxiety. Chart showing the female-to-male sex ratio for anxiety disorders. Adapted from Kessler et al, 1994.

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Age distribution for anxiety disorders

Most anxiety disorders begin in childhood, adolescence, and early adulthood (see the image below). Separation anxiety is an anxiety disorder that commonly begins in childhood and often includes anxiety related to going to school. This disorder may be a precursor for adult anxiety disorders, most commonly panic disorder. According to the DSM-5, separation anxiety disorder can begin in adulthood.

Anxiety. Age of onset for anxiety disorders based Anxiety. Age of onset for anxiety disorders based on specific anxiety disorder type.

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Panic disorder demonstrates a bimodal age of onset in the NCS study in the age groups of 15-24 years and 45-54 years. The age of onset for OCD appears to be in the mid 20s to early 30s.

Most social phobias begin before age 20 years (median age at illness onset, 16 years [43] ).

Agoraphobia usually begins in late adolescence to early adulthood (median age at illness onset, 29 years [43] ).

In general, specific phobia appears earlier than social phobia or agoraphobia. The age of onset depends on the particular phobia. For example, animal phobia is most common at the elementary school level and appears at a mean age of 7 years; blood phobia appears at a mean age of 9 years; dental phobia appears at a mean age of 12 years; and claustrophobia appears at a mean age of 20 years. Most simple (specific) phobias develop during childhood (median age at illness onset, 15 years). [43] and eventually disappear. Those that persist into adulthood rarely go away without treatment.

New-onset anxiety symptoms in older adults should prompt a search for an unrecognized general medical condition, a substance abuse disorder, or major depression with secondary anxiety symptoms.

Prognosis

Anxiety disorders have high rates of comorbidity with major depression and alcohol and drug abuse. Some of the increased morbidity and mortality associated with anxiety disorders may be related to this high rate of comorbidity. Anxiety disorders may contribute to morbidity and mortality through neuroendocrine and neuroimmune mechanisms or by direct neural stimulation, (eg, hypertension or cardiac arrhythmia). Chronic anxiety may be associated with increased risk for cardiovascular morbidity and mortality.

Considerable evidence shows that social phobia (social anxiety disorder) results in significant functional impairment and decreased quality of life. [45, 46]

Severe anxiety disorders may be complicated by suicide, with or without secondary mood disorders (eg, depression). The Epidemiological Catchment Area study found that panic disorder was associated with suicide attempts (odds ratio = 18 compared with populations without psychiatric disorders). How much of the association of panic disorder with suicide is mediated through the association of panic disorder with mood and substance abuse disorders is unclear. Acute stress may play a role in producing suicidal behavior. The presence of any anxiety disorder, phobias included, in combination with a mood disorder appears to increase likelihood of suicide attempts compared with a mood disorder alone. [47] Suicide attempts can be precipitated by adverse life events such as divorce or financial disaster. The effects of acute stress in producing suicidal behavior are increased in those with underlying mood, anxiety, and substance abuse problems.

Phobias are highly comorbid. Most comorbid simple (specific) and social phobias are temporally primary, while most comorbid agoraphobia is temporally secondary. Comorbid phobias are generally more severe than pure phobias. Social phobia is also frequently comorbid with major depressive disorder and atypical depression, which results in increased disability. [46, 48] Despite evidence of impairment, only a minority of individuals with simple (specific) phobia ever seek professional treatment.

Interestingly, in clinical samples, over 95% of the patients reporting agoraphobia also present with panic disorder, while in epidemiologic samples, simple agoraphobia appears to be more prevalent than panic disorder with agoraphobia.[49]

Patient Education

Education can be obtained through books, newsletters, support groups, and the Internet. Some useful Web sites are as follows:

Family members should receive information about the effect of anxiety disorders on mood, behavior, and relationships. Family members can assist in care by reinforcing the need for medical treatment and supervision. Family members may also assist by providing a collaborative resource for monitoring the severity of the patient’s anxiety symptoms and response to treatment interventions.

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Bipolar Affective Disorder Differential Diagnoses

Posted on December 31, 2016 by JmaC

Diagnostic Considerations

The diagnosis of bipolar affective disorder, or manic-depressive illness (MDI), is based on the patient’s history and clinical course.

Other conditions to be considered include the following:

  • Epilepsy
  • Fahr disease
  • Acquired immunodeficiency syndrome (AIDS)
  • Medications (eg, antidepressants can propel a patient into mania; other medications may include baclofen, bromide, bromocriptine, captopril, cimetidine, corticosteroids, cyclosporine, disulfiram, hydralazine, isoniazid, levodopa, methylphenidate, metrizamide, procarbazine, procyclidine)
  • Circadian rhythm desynchronization
  • Cyclothymic disorder
  • Multiple personality disorder
  • Oppositional defiant disorder (in children)
  • Substance abuse disorders (eg, with alcohol, amphetamines, cocaine, hallucinogens, opiates)
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Bipolar Affective Disorder Clinical Presentation Physical Examination

Posted on December 31, 2016 by JmaC

Bipolar affective disorder is characterized by periods of deep, prolonged, and profound depression that alternate with periods of an excessively elevated or irritable mood known as mania.

Manic episodes are feature at least 1 week of profound mood disturbance, characterized by elation, irritability, or expansiveness (referred to as gateway criteria). At least 3 of the following symptoms must also be present [2] :

  • Grandiosity
  • Diminished need for sleep
  • Excessive talking or pressured speech
  • Racing thoughts or flight of ideas
  • Clear evidence of distractibility
  • Increased level of goal-focused activity at home, at work, or sexually
  • Excessive pleasurable activities, often with painful consequences

Hypomanic episodes are characterized by an elevated, expansive, or irritable mood of at least 4 consecutive days’ duration. The diagnosis of hypomania requires at least three of the symptoms above. The difference being that in hypomania these symptoms are not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization and are not associated with psychosis.

Major depressive episodes are characterized as, for the same 2 weeks, the person experiences 5 or more of the following symptoms, with at least 1 of the symptoms being either a depressed mood or characterized by a loss of pleasure or interest [2]:

  • Depressed mood
  • Markedly diminished pleasure or interest in nearly all activities
  • Significant weight loss or gain or significant loss or increase in appetite
  • Hypersomnia or insomnia
  • Psychomotor retardation or agitation
  • Loss of energy or fatigue
  • Feelings of worthlessness or excessive guilt
  • Decreased concentration ability or marked indecisiveness
  • Preoccupation with death or suicide; patient has a plan or has attempted suicide

See Clinical Presentation for more detail.

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Bipolar Affective Disorder Clinical Presentation

Posted on December 31, 2016 by JmaC

History

Correct diagnosis of a disorder leads to proper effective treatment. No where is that more relevant than in diagnosing a patient with bipolar affective disorder, or manic-depressive illness (MDI).

Perform a thorough clinical assessment for patients with a manic, hypomanic, or mixed episode, or those with a bipolar depression episode, including information about the patient’s clinical and psychosocial status, medical and psychiatric comorbidities, current and past medications as well as medication compliance, and substance use. [3] Obtain a detailed review of symptoms, symptom severity, and their effects on daily functioning in combination with the use of a standard tool. [3]

The diagnosis of bipolar disorder type I (BPI) requires the presence of a manic episode of at least 1 week’s duration or that leads to hospitalization or other significant impairment in occupational or social functioning. The episode of mania cannot be caused by another medical illness or by substance abuse. These criteria are based on the specifications of the DSM-5. [2] The Department of Veterans Affairs and Department of Defense (VA/DOD) recommend using a standardized rating scale such as the Young Mania Rating Scale to assess the severity of a manic episode. [3]

Manic episodes are feature at least 1 week of profound mood disturbance, characterized by elation, irritability, or expansiveness (referred to as gateway criteria). At least 3 of the following symptoms must also be present [2] :

  • Grandiosity
  • Diminished need for sleep
  • Excessive talking or pressured speech
  • Racing thoughts or flight of ideas
  • Clear evidence of distractibility
  • Increased level of goal-focused activity at home, at work, or sexually
  • Excessive pleasurable activities, often with painful consequences

The mood disturbance is sufficient to cause impairment at work or danger to the patient or others. The mood is not the result of substance abuse or a medical condition.

Hypomanic episodes are characterized by an elevated, expansive, or irritable mood of at least 4 consecutive days’ duration. At least 3 of the following symptoms are also present [2] :

  • Grandiosity or inflated self-esteem
  • Diminished need for sleep
  • Pressured speech
  • Racing thoughts or flight of ideas
  • Clear evidence of distractibility
  • Increased level of goal-focused activity at home, at work, or sexually
  • Engaging in activities with a high potential for painful consequences

The mood disturbance is observable to others. The mood is not the result of substance abuse or a medical condition. The episode is not severe enough to cause social or occupational impairment.

Major depressive episodes are characterized as, for the same 2 weeks, the person experiences 5 or more of the following symptoms, with at least 1 of the symptoms being either a depressed mood or characterized by a loss of pleasure or interest [2]:

  • Depressed mood
  • Markedly diminished pleasure or interest in nearly all activities
  • Significant weight loss or gain or significant loss or increase in appetite
  • Hypersomnia or insomnia
  • Psychomotor retardation or agitation
  • Loss of energy or fatigue
  • Feelings of worthlessness or excessive guilt
  • Decreased concentration ability or marked indecisiveness
  • Preoccupation with death or suicide; patient has a plan or has attempted suicide

Symptoms cause significant impairment and distress and are not the result of substance abuse or a medical condition

The mixed symptomatology is quite common in patients presenting with bipolar symptomatology. This often causes a diagnostic dilemma [63] and has prompted a revision to the definition of bipolar disorder in DSM-5. With the aim of capturing mixed symptoms more effectively, the “mixed episode” diagnosis has been eliminated in favor of a “mixed features specifier” that could be added to any mood bipolar disorder diagnosis. [64] Other specifiers include anxious distress, rapid cycling, mood-congruent psychotic features, catatonia, peripartum onset and seasonal pattern.

Of interest, when investigating bipolar mixed states, Swann and colleagues concluded that although controversy exists regarding the definitions and properties of mixed states, the concept of mixed states and their characteristics over a range of clinical definitions and diagnostic methods has remained consistent. [65]Moreover, “distinct characteristics related to the course of illness emerge at relatively modest opposite polarity symptom levels in depressive or manic episodes.” [65]

In addition to the well-known differences between manic and hypomanic episodes, other key differences exist between BPI and BPII that may be used to help distinguish between the 2 types of conditions. Data from 1429 bipolar patients included in the National Epidemiological Survey on Alcohol and Related Conditions showed significant differences between BPI and BPII patients in unemployment, a history of a suicide attempt, depressive symptoms (eg, weight gain, feelings of worthlessness), and the presence of specific phobias. [66]

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Drug & Alcohol Addiction Treatment

Posted on December 31, 2016 by JmaC

Millions of Americans, in fact 22.5 million, needed treatment for drug or alcohol use disorders in 2014. Addiction is a well-researched field, with multiple treatment avenues available for those who are ready to ask for the help they need and want to lead a healthier life. But it also means that treatment options can feel overwhelming at first glance.

How do I know I have an addiction?

Technically the term “addiction” isn’t used anymore when it comes to getting a diagnosis. In the most recent edition Diagnostic and Statistical Manual of Mental Disorders, drug and alcohol addiction are called “use disorders” (i.e. Alcohol Use Disorder; Opioid Use Disorder). The three most common symptoms of a use disorder include needing more of the substance over time to achieve the same effect, experiencing withdrawal symptoms when stopping use, and being unable to quit even when you know there is a big problem.

Use disorders can range from mild to severe, depending on the number of symptoms you have. These symptoms include:

  • Being incapable of limiting drug or alcohol use.
  • Making unsuccessful attempts to curtail use.
  • Spending much time using or obtaining the substance.
  • Experiencing cravings to use.
  • Falling behind in work, school, or family responsibilities due to use.
  • Continuing use even when aware of the problems it causes.
  • Abandoning former interests or hobbies to engage in use.
  • Drinking alcohol or using drugs in unsafe situations, such as driving.
  • Requiring more of the substance to achieve the same effect.

What should be my first step towards recovery?

Asking for help gives you the best chance in changing the pattern of addiction. Going it alone rarely works, and isolating will only set you up for relapse. Getting help can look like talking to your doctor, a mental health professional, or a loved one. You can also enlist the support of strangers by attending a support group such as Alcoholics Anonymous and asking for local recommendations. Addiction is common, so never be silent for fear that you still shock your doctor or counselor. Their job is to help you take that next step.

Do I need to see a doctor or a mental health professional?

Yes. They will respect your confidentiality, so you should feel free to share all information about your patterns of use. A doctor or mental health professional can evaluate you to determine whether you meet the criteria for a use disorder. Drinking and drug use can cause serious damage to your body, so it’s important to get checked out by a doctor. He or she will conduct a physical exam and other necessary tests. When you go to your appointment, share with your doctor any symptoms you’ve experienced, your habits of use, and other major stressful life events that have occurred recently. The more information you can give them, the better care you will receive.

How can I get help for a loved one with an addiction?

First, understand that recovery requires a willingness to change. However, that doesn’t mean you have to wait until things hit rock bottom to approach your loved one about their harmful behavior. If you’re considering planning an intervention or approaching your loved one about the addiction, always talk with a professional first about how to avoid harm. They may recommend that they be in the room with you to have the difficult conversations. If your loved one isn’t ready to change, self-help groups like Al-Anon also can provide emotional support and guidance for you and your family.

What are the characteristics in an excellent treatment program?

For drug and alcohol use disorders, there are a variety of treatment options. How do you know which is best for you? A stellar treatment program will:

  • Offer you detoxification support.
  • Address all the person’s needs that the addiction impacts.
  • Offer you counseling and behavioral support.
  • Consider medication as an option.
  • Evaluate you for other mental health concerns.
  • Educate you about healthy coping skills and habits.
  • Provide follow-up services to prevent future use.

What will happen once I decide to seek treatment?

There are three major components to quitting drug and alcohol use. The first is detoxification, where a person abstains from using so that the substance can leave their body. Medication is often prescribed during this stage to reduce the intensity of symptoms. The second step involves seeking treatment, which might include additional medications, counseling, and evaluation of other mental health problems. Treatment occurs in outpatient or inpatient programs. Finally, you will need to find support for the long-term to prevent relapsing on the substance.

Should I choose inpatient or outpatient treatment?

Depending on the resources available, what your health insurance is willing to cover, the intensity of the disorder, and the type of use disorder, mental health professionals may suggest inpatient or outpatient behavioral health treatment.

Inpatient treatment – Inpatient programs are 24-7 facilities that provide housing, medical care, and therapy for those with severe addictions. Over half of people who receive treatment for drug or alcohol use disorders participate in inpatient treatment. Inpatient treatment programs include short-term detox centers, long-term programs which last anywhere from a few weeks to a year, or recovery programs which provide housing to bridge the transition to independent living. Long-term programs are often recommended for those with an additional mental illness diagnosis who require extra support or persons with a criminal history.

Outpatient treatment – Outpatient treatment can range from a individual therapy session once a week to more intensive day programs that offer individual and group therapy, psychoeducational classes, and other activities. The distinguishing factor is that outpatient treatment is not 24-7 and does not always provide onsite medical care. Individuals may transition to outpatient treatment from detox centers or longer inpatient treatment programs.

What types of therapy have been proven to work?

Many types of therapy and multiple behavioral interventions have proven effective in treating addiction. The most commonly used therapy is cognitive behavioral therapy, which helps people evaluate and correct negative thought patterns and behaviors that lead to addiction. Behavioral therapy such as REBT can provide positive reinforcement strategies that encourage continuing with sobriety. Group therapy has also proven effective when it happens concurrently with individual counseling. Multidimensional family therapy examines how improving the functioning of a family system can reduce the triggers of drug and alcohol abuse.

An increasingly common tool used in treatment addiction is called motivational interviewing (also known as MI). Used by doctors, therapists, and other health professionals, motivational interviewing is a conversational technique that helps a person assesses their readiness to stop the behavior and seek treatment. Rather than trying to convince a person to change a habit, MI acknowledges that there are good things and bad things about using drugs and alcohol and not using them. This helps an individual become more comfortable with moving towards making a permanent change.

Will I be prescribed medication?

Medication alone can’t cure drug and alcohol use disorders, but it can prove extremely effective in reducing the symptoms of withdrawal and the possibility of relapse. Pharmacotherapy can also help reduce the symptoms of other mental illnesses, such as anxiety and depression, that promote drug and alcohol use. Medications are commonly prescribed for those addicted to opioids (including prescriptions drugs and heroin) and alcohol.

Opioid use medications include methadone, buprenorphine, and naltrexone. Methadone and buprenorphine work to reduce cravings and the intensity of withdrawal symptoms, and naltrexone keeps opioids from having their usual effect in the brain. While these medications do not cure the addiction, they help prepare an individual for therapy and evaluating what changes can help them maintain sobriety.

methadone

Alcohol use medications include naltrexone, acamprosate, and disulfiram. Acamprosate diminishes symptoms of withdrawal such as feelings of depression or anxiety, thereby reducing the chance of relapse. Disulfiram (also known as Antabuse) produces unfavorable physical reactions when someone drinks alcohol, such as nausea and facial redness.

What lifestyle changes can I make to prevent relapse?

Once you leave a treatment program, you might find that your old triggers will be waiting on the doorstep when you get home. It’s important to explain to your friends and family that you’re serious about recovery. Develop relationships that aren’t based on drinking or using drugs. Know when and where support groups meet in your neighborhood. Maintain a distance from people, places, and events that promote old habits. Most people with use disorders experience relapse. While a relapse might be upsetting, it is no excuse to give up hope.

Living a healthier life can also lift your mood, give you energy, and reduce the cravings for alcohol or drugs. Getting a proper night’s rest, exercising regularly, and coping with stress effectively can make a huge difference. Relaxation techniques such as mindfulness and yoga can also prove instrumental in recovery.

Can alcohol and drug use disorders really be treated?

Yes! Be aware however, that detox is just the first step. Addiction is chronic, meaning that it is a lifelong challenge. Stressful events, anxiety, depression, and other factors can trigger a relapse, so most people need long-term support for their decision to quit. Maybe you’ll always crave the substance, or maybe you won’t, but you can control what goes into your body. Remember, a day where you don’t use is better than one that you do. Make the choice to start your recovery today.

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Anger Test

Posted on December 31, 2016 by JmaC

https://www.psychologistworld.com/stress/angertest.php

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How to meditate properly

Posted on December 30, 2016 by JmaC

Increasing numbers of people are looking for ways to relieve stress. This can be no surprise seeing that the price tag on everything is rising and effort is getting harder to help keep and find. Relaxation has changed over the years. In the early days you can get a book and sit during intercourse reading for around one hour, maybe two. This used to be enough to get the daily stress off your brain. It was like drifting to a different universe. This doesn’t help any longer, and that’s why everybody is asking “how do you meditate?”

 

These days, when you are getting into bed, all that’s necessary to do is get to sleep. Many people lack the energy by sitting during sex reading a magazine. It is because we are worked so difficult within our waking lives.

Many individuals would rather sit and relax, or possibly watch a film or two. However, you will find those who would sit in the quiet room and meditate. Many reasons exist for the reason why you would meditate, the most crucial of those being to unwind.

Lots of people find that following a good meditation session they think revitalized and ready for any new day. This is the reason you should meditate each morning. It sets you up for any day to get anything and everything you want.

Lots of people say which they find meditation to become little intimidating. This can be only due to the fact that they have no idea how powerful it’s, or because they are not doing it properly. Meditation gets easier as time passes, and you’re simply not expected being an expert straight off the bat.

Part one is to discover room or place in places you won’t be disturbed. Makes it quiet, sit along with your legs crossed and close the eyes. The very best position would be to site with your on the job the knees and your back straight. Relax and think of nothing. Let all your worries go, with them relax your entire muscles. After you have focused on clearing your brain you might be.

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Spiritual Life – How to Live a More Spiritual Life

Posted on December 30, 2016 by JmaC

You’ll find that there’s so much of ideological concepts around these days that try to clarify the best way to live a more spiritual life, and the way to access an energy that will enable us to cure our self physically and emotionally by virtue of an intelligent power that occur itself by way of functions of unearthly occurrences.

Live a Spiritual Life

Seriously! What a mouthful, aint it? This is my very own: Spiritual: The knowledge of ones link to a power which is undetectable and all knowing. The concept that an intelligent omniscient power manifests material shifts by desire, request or intent has grown to become an increasing number of a suitable perception for many. A lot of people call these works, wonders or acts of synchronicity. Carl Jung created the term synchronicity. What it mainly means is when someone is in necessity of some thing, an actual manifestation will occur which correlates in doing what that person required. He called it “Meaningful Simularities.” Never let the terminology shake you.
When you trust in a The lord or energy will help you, you definitely feel that this particular power can show itself by means of emotional and physical healing. So if you’re agreeing to all or portion of what I’m saying, then you most definitely also believe that when you connect with this energy then a acts of synchronicity/miracles can take place more regularly.
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