What Are the Signs of Depressive Illness?

Depression (a mood disorder)

Problems and misfortunes are a part of life. Everyone experiences unhappiness, and many people may become depressed temporarily when things don't go as they would like. Experiences of failure commonly result in temporary feelings of worthlessness and self-blame, while personal losses cause feelings of sadness, disappointment and emptiness. Such feelings are normal, and they usually pass after a short time. This is not the case with depressive illness.

What are the signs of depressive illness?

Depression becomes an illness, or clinical depression, when the feelings described above are severe, last for several weeks, and begin to interfere with one's work and social life. Depressive illness can change the way a person thinks and behaves, and how his/her body functions. Some of the signs to look for are:

 feeling worthless, helpless or hopeless,  sleeping more or less than usual,  eating more or less than usual,  having difficulty concentrating or making decisions,  loss of interest in taking part in activities,  decreased sex drive,  avoiding other people,  overwhelming feelings of sadness or grief,  feeling unreasonably guilty,  loss of energy, feeling very tired,  thoughts of death or suicide.

If you or someone you know has been experiencing a number of these symptoms, we hope this pamphlet will help you understand what is happening and encourage you or your friend to seek professional help.

What causes depression?

There is no one cause of depression, neither is it fully understood. The following factors may make some people more prone than others to react to a loss or failure with a clinical depression:

 specific, distressing life events,  a biochemical imbalance in the brain,  psychological factors, like a negative or pessimistic view of life.

There may also be a genetic link since people with a family history of depression are more likely to experience it.

How long does depression last?

The depressed feelings we all experience after a serious loss or disappointment may last for a short or a long time. How long depends on the person, the severity of the loss, and the support available to help the person to cope with it.

Clinical depression may also last for short or long periods. It rarely becomes permanent. Without professional treatment, it may end naturally after several weeks or months. With treatment, it may end much more quickly.

Does depressive illness follow a pattern? Unfortunately, once a person has had a clinical depression, he/she is more likely to suffer from depression again. For example, some people experience seasonal cycles of depression, particularly in winter. This is called Seasonal Affective Disorder (S.A.D.).

Five to ten percent of people who experience depression also experience states of exaggerated happiness or elation called mania. The occurrence of both depression and mania at different times is called bipolar affective disorder, while repeated experiences of depression alone is termed unipolar affective disorder.

How is depression treated?

Depression is the most treatable of mental illnesses. Most people who suffer from depression are helped by the treatment they get, which usually includes medication and/or psychological counselling. Support from family, friends and self-help groups can also make a big difference.

Many people who are seriously depressed wait too long to seek treatment or they may not seek treatment at all. They may not realize that they have a treatable illness, or they may be concerned about getting help because of the negative attitudes held by society towards this type of illness.

What can friends and family do?

It can be difficult to be with and to help someone who is seriously depressed. Some people who are depressed keep to themselves, while others may not want to be alone. They may react strongly to the things you say or do. It is important that you let them know that it is okay to talk about their feelings and thoughts. Listen and offer support rather than trying to contradict them or talk them out of it. Let them know you care. Ask them how you can help, and offer to contact their family doctor or a mental health professional. Find out about local self-help groups and attend a meeting with them. Try to be patient and non-judgemental. Most of all, don't do it alone - get other people to provide help and support too.

Do you need more help?

If you or someone you know needs more help than friends or family can provide, contact a community organization, such as the Canadian Mental Health Association, which can help you find additional support.

Post Partum Depression (a mood disorder) For every woman, having a baby is a challenging time, both physically and emotionally. It is natural for many new mothers to have mood swings after delivery, feeling joyful one minute and depressed the next. These feelings are sometimes known as the "baby blues", and often go away within 10 days of delivery. However, some women may experience a deep and ongoing depression which lasts much longer. This is called postpartum depression.

References to postpartum depression date back as far as the 4th century BC. Despite this early awareness, it has not always been recognized as an illness. As a result, postpartum depression continues to be under-diagnosed. It is an illness that can be effectively treated. The sooner the condition is diagnosed, the more effective the treatment. It is important to recognize and acknowledge the symptoms of postpartum depression in yourself or another as soon as possible. This can be difficult, since the depressive feelings often involve intense and irrational feelings of fear. The mother may fear she is losing her mind or fear that others may feel she is unfit to be a mother.

Women with postpartum depression may feel like they are bad mothers and be reluctant to seek help. It is important to remember that hope and treatment are available to women in need.

Defining postpartum depression

Researchers have identified three types of postpartum depression: baby blues; postpartum depression and postpartum psychosis.

The "baby blues" is the most minor form of postpartum depression. It usually starts 1 to 3 days after delivery, and is characterized by weeping, irritability, lack of sleep, mood changes and a feeling of vulnerability. These "blues" can last several weeks. It's estimated that between 50% and 80% of mothers experience them.

Postpartum depression is more debilitating than the "blues." Women with this condition suffer despondency, tearfulness, feelings of inadequacy, guilt, anxiety, irritability and fatigue. Physical symptoms include headaches, numbness, chest pain and hyperventilation. A woman with postpartum depression may regard her child with ambivalence, negativity or disinterest. An adverse effect on the bonding between mother and child may result. Because this syndrome is still poorly defined and under studied, it tends to be under reported. Estimates of its occurrence range from 3% to 20% of births. The depression can begin at any time between delivery and 6 months post-birth, and may last up to several months or even a year.

Postpartum psychosis is a relatively rare disorder. The symptoms include extreme confusion, fatigue, agitation, alterations in mood, feelings of hopelessness and shame, hallucinations and rapid speech or mania. Studies indicate that it affects only one in 1000 births.

Causes and risk factors

The exact cause of postpartum depression is not known. One factor may be the changes in hormone levels that occur during pregnancy and immediately after childbirth. Also, when the experience of having a child does not match the mother's expectations, the resultant stress can trigger depression. Studies have also considered the possible effects of maternal age, expectations of motherhood, birthing practices and the level of social support for the new mother.

There is no one trigger; postpartum depression is believed to result from many complex factors. It is important, however, to communicate to women with postpartum depression that they did not bring it upon themselves. One certain fact is that women who have experienced depression before becoming pregnant are at higher risk for postpartum depression. Women in this situation should discuss it with their doctor so that they may receive appropriate treatment, if required. In addition, an estimated 10% to 35% of women will experience a recurrence of postpartum depression.

The amount of sick leave taken during pregnancy and the frequency of medical consultation may also be warning signs. Women who have the most doctor visits during their pregnancy and who also took the most sick-leave days have been found to be most likely to develop postpartum depression. The risk increases in women who have experienced 2 or more abortions, or women who have a history of obstetric complications.

Other factors which increase the risk of postpartum depression are severe premenstrual syndrome (PMS), a difficult relationship, lack of a support network, stressful events during the pregnancy or after delivery.

How is postpartum depression treated?

Therapy, support networks and medicines such as antidepressants are used to treat postpartum depression. Psychotherapy has been shown to be an effective treatment, and an acceptable choice for women who wish to avoid taking medications while breastfeeding.

Coping with postpartum depression

First, remember that you are not alone - up to 20% of new mothers experience postpartum depression. Equally important is remembering that you are not to blame. Here are some suggestions for coping:

 Focus on short-term, rather than long-term goals. Build something to look forward to into every day, such as a walk, a bath, a chat with a friend  Look for free or inexpensive activities; check with your local library, community centre or place of worship  Spend time with your partner and/or close friends  Share your feelings and ask for help  Consult your doctor and look for a local support group

If you think a friend or family member is suffering from postpartum depression, offer your support and reassurance. You may be able to direct them towards useful sources of information about postpartum depression. Easing the isolation they feel is an important step.

Bi-polar Disorder (a mood disorder) We all experience changes in mood. Times of sadness or disappointment are natural reactions to the difficulties that occur in our lives. The loss of a loved one, problems at work or a deteriorating relationship can cause us to feel depressed. Similarly, a great success or relief from a problem makes us feel happy and content.

Our moods tend to be varied and shifting, but generally we feel as though we have some control over them. However, for people with mood disorders like depression and bipolar disorder, that sense of control is missing and that causes distress. Anyone who has experienced depression or a manic episode can readily tell you the difference between those illnesses and their own normal feelings of sadness or happiness.

Severe or prolonged depression is an illness that affects not only a person’s emotions, but also physical health, relationships and behaviour. At any given time, almost 3 million Canadians have serious depression. It is about twice as common in women.

Bipolar disorder, also called manic depression, is an illness in which there are periods of serious depression, followed by episodes of markedly elevated or irritable moods or “highs” (in the absence of drugs or alcohol). These mood swings are not necessarily related to events in the person’s life. Bipolar disorder affects approximately 1% of the population; it typically starts in late adolescence or early adulthood and affects men and women equally.

Depression and bipolar disorder can be treated. There is good reason for hope. By learning more about these conditions, you can help remove the stigma that prevents many people from seeking help.

Bipolar Disorder

People with bipolar disorder, or manic depressive disorder, experience alternating mood swings, from emotional highs (mania) to lows (depression). The condition can range from mild to severe.

It is not known what causes bipolar disorder. Research suggests that people with the condition have a genetic disposition. It tends to run in families. Drug abuse and stressful or traumatic events may contribute to or trigger episodes.

Symptoms of mania include:

• Feelings of euphoria, extreme optimism, exaggerated self-esteem

• Rapid speech, racing thoughts

• Decreased need for sleep

• Extreme irritability

• Impulsive and potentially reckless behaviour

Symptoms of the depression phase are the same as in major depression, described above.

Treatment is Available Depression and bipolar disorder are treatable. Learning to recognize the signs and triggers enables people to work with their doctors, other health professionals, family and friends to prevent recurrences from becoming severe.

The great majority of depressed people respond to treatment and nearly all who seek treatment will get some relief from their symptoms. Both medication and some forms of counselling or psychotherapy have been demonstrated to be effective.

Bipolar disorder is mainly treated with medication and psychotherapy. Medication helps to stabilize moods, while therapy helps people detect patterns and triggers and develop strategies for managing stress. Sometimes, electroconvulsive therapy, or ECT, is used.

What Can I Do?

Many people do not seek help for depression or bipolar disorder, sometimes because their symptoms prevent them from recognizing the seriousness of their situation. It can also result from the stigma that surrounds both these conditions, making people feel like they are weak or at fault. It is important to know that depression and bipolar disorder are treatable. Friends and family can be supportive by learning all they can about the condition affecting their loved one. You can learn more from support groups and community health associations. Seasonal Affective Disorder – SAD (a mood disorder)

Weather often affects people’s moods. Sunlight breaking through clouds can lift our spirits, while a dull, rainy day may make us feel a little gloomy. While noticeable, these shifts in mood generally do not affect our ability to cope with daily life. Some people, however, are vulnerable to a type of depression that follows a seasonal pattern. For them, the shortening days of late autumn are the beginning of a type of clinical depression that can last until spring. This condition is called “Seasonal Affective Disorder," or SAD.

A mild form of SAD, often referred to as the “winter blues," causes discomfort, but is not incapacitating. However, the term “winter blues” can be misleading; some people have a rarer form of SAD which is summer depression. This condition usually begins in late spring or early summer.

Awareness of this mental condition has existed for more than 150 years, but it was only recognised as a disorder in the early 1980s. Many people with SAD may not be aware that it exists or that help is available.

SAD can be a debilitating condition, preventing sufferers from functioning normally. It may affect their personal and professional lives, and seriously limit their potential. It is important to learn about the symptoms, and to know that there is treatment to help people with SAD live a productive life year-round.

What Causes SAD?

Research into the causes of SAD is ongoing. As yet, there is no confirmed cause. However, SAD is thought to be related to seasonal variations in light A “biological internal clock” in the brain regulates our circadian (daily) rhythms. This biological clock responds to changes in season, partly because of the differences in the length of the day. For many thousands of years, the cycle of human life revolved around the daily cycle of light and dark. We were alert when the sun shone; we slept when our world was in darkness. The relatively recent introduction of electricity has relieved us of the need to be active mostly in the daylight hours. But our biological clocks may still be telling our bodies to sleep as the days shorten. This puts us out of step with our daily schedules, which no longer change according to the seasons. Other research shows that neurotransmitters, chemical messengers in the brain that help regulate sleep, mood, and appetite, may be disturbed in SAD.

What are the Symptoms?

SAD can be difficult to diagnose, since many of the symptoms are similar to those of other types of depression or bipolar disorder. Even physical conditions, such as thyroid problems, can look like depression. Generally, symptoms that recur for at least 2 consecutive winters, without any other explanation for the changes in mood and behaviour, indicate the presence of SAD. They may include:

 change in appetite, in particular a craving for sweet or starchy foods  weight gain  decreased energy  fatigue  tendency to oversleep  difficulty concentrating  irritability  avoidance of social situations  feelings of anxiety and despair

The symptoms of SAD generally disappear when spring arrives. For some people, this happens suddenly with a short time of heightened activity. For others, the effects of SAD gradually dissipate.

Symptoms of summer depression may include:

 poor appetite  weight loss  trouble sleeping

Who is at Risk?

Research in Ontario suggests that between 2% and 3% of the general population may have SAD. Another 15% have a less severe experience described as the “winter blues."

SAD may affect some children and teenagers, but it tends to begin in people over the age of 20. The risk of SAD decreases with age. The condition is more common in women than in men.

Recent studies suggest that SAD is more common in northern countries, where the winter day is shorter. Deprivation from natural sources of light is also of particular concern for shift workers and urban dwellers who may experience reduced levels of exposure to daylight in their work environments.

People with SAD find that spending time in a southerly location brings them relief from their symptoms.

How is SAD Treated?

If you feel depressed for long periods during autumn and winter, if your sleep and appetite patterns change dramatically and you find yourself thinking about suicide, you should seek professional help, for example, from your family doctor. There is effective treatment for SAD. Even people with severe symptoms can get rapid relief once they begin treatment.

People with mild symptoms can benefit from spending more time outdoors during the day and by arranging their environments so that they receive maximum sunlight. Trim tree branches that block light, for example, and keep curtains open during the day. Move furniture so that you sit near a window. Installing skylights and adding lamps can also help.

Exercise relieves stress, builds energy and increases your mental and physical well-being. Build physical activity into your lifestyle before SAD symptoms take hold. If you exercise indoors, position yourself near a window. Make a habit of taking a daily noon-hour walk. The activity and increased exposure to natural light can raise your spirits.

A winter vacation in a sunny destination can also temporarily relieve SAD symptoms, although symptoms usually recur after return home. At home, work at resisting the carbohydrate and sleep cravings that come with SAD. Many people with SAD respond well to exposure to bright, artificial light. "Light therapy," involves sitting beside a special fluorescent light box for several minutes day. A health care professional should be consulted before beginning light therapy.

For people who are more severely affected by SAD, antidepressant medications are safe and effective in relieving symptoms. Counseling and therapy, especially short-term treatments such as cognitive- behavioural therapy, may also be helpful for winter depression.

Increasing your exposure to light, monitoring your diet, sleep patterns and exercise levels are important first steps. For those who are severely affected, devising a treatment plan with a health care professional consisting of light therapy, medication and cognitive-behavioural therapy may also be needed. Obsessive Compulsive Disorder (an anxiety disorder)

Obsession is a popular term these days. It expresses fascination for a person or object; it is the name of a well-known fragrance for men and women. All of which seems to suggest that obsession is an acceptable, even a desirable sensation. But for people with obsessive-compulsive disorder, obsession creates a maze of persistent, unwanted thoughts. Those thoughts lead them to act out rituals (compulsions), sometimes for hours a day

Obsessive-compulsive disorder (OCD) is any anxiety disorder - one of a group of medical disorders which affects the thoughts, behaviour, emotions and sensations. Collectively, these disorders are among the most common of mental health problems. It is estimated that 1 in 10 people suffers from an anxiety disorder sometime in their life.

While a complete cure for OCD is rare, specialized treatment can bring many people long-term relief from their symptoms. Education is the first important step in removing the social stigma and lack of knowledge which keep people from looking for medical and other professional help.

When worry becomes obsession

Worries and doubts, superstitions and rituals are common to most everyone. OCD occurs when worries become obsessions, and the compulsive rituals so excessive, that they dominate a person's life. It is as if the brain is a scratched vinyl record, forever skipping at the same groove and repeating one fragment of song.

Obsessions are persistent ideas, thoughts, impulses or images; they are intrusive and illogical. Common OCD obsessions revolve around contamination, doubts (such as not being sure whether the lights are off or the door is locked) and disturbing sexual or religious thoughts. People with OCD may have extreme concerns about germs; they may have a terrible fear that they have harmed somebody. These thoughts cannot be stopped or ignored, even though the person usually knows they are unrealistic. Often, a person's obsessions are accompanied by feelings of fear, disgust and doubt, or the belief that certain activities have to be done just so".

People with OCD try to relieve their obsessions by performing compulsive rituals, over and over again, and often according to certain "rules". Typical compulsions are washing, checking and arranging things, and counting. These actions give them only temporary relief from their anxiety.

Cause and effect

OCD used to be considered the result of family troubles or attitudes learned in childhood. But it is now believed that the disorder has a neurological and genetic basis. Current research into its causes focuses on the workings of the brain and the influences of personal circumstances. OCD can occur in people of all ages, but it generally begins before 40. Studies show that the disorder usually begins during adolescence or early childhood. It affects men and women equally.

People with OCD are under great stress. The intensity of their symptoms varies: sometimes they are like background noise; at other times they are a deafening roar. Because individuals with OCD may spend an hour or more every day carrying out rituals, their ability to conduct a balanced life is impaired and their relationships at work and home can suffer.

Coping with OCD With early diagnosis and the right treatment, people can avoid the suffering that comes with OCD. They also have a greater chance of avoiding depression and relation-ship problems that often come with OCD.

Unfortunately, OCD tends to be underdiagnosed and undertreated. This is partly because many people with OCD are ashamed and secretive about their symptoms, and some do not believe they have a problem. Another factor is that many healthcare practitioners are not well informed about the condition.

Two effective treatments for OCD have been developed: medication and cognitive-behavioural therapy (CBT). Used together, these treatments can be effective.

The drugs used to combat OCD symptoms are those which affect levels of serotonin, a chemical messenger in the brain.

Psychotherapy techniques used to combat OCD symptoms are exposure and response prevention. These involve encouraging a person to stay in contact with the object or situation that forms the obsession, and to not perform the ritual to ease the pressure of that obsession. Depending on the intensity of the therapy, improvement may be seen within 2 or more months.

Support and understanding are vital

People with OCD feel severe stress; so do their loved ones. Knowing how to support a family member or friend with OCD begins with educating yourself about the disorder. This will give you the confidence to help them to understand that there are treatments which can help.

If you have OCD, it is important to be aware that doubts and discomfort during treatment are normal. Work with your doctor to adjust medication; don't hesitate to ask for second opinions about cognitive- behavioural therapy. It can help to know that, once you get your OCD under control, keeping it there is easier.

Children with OCD have special needs

Many adults diagnosed with OCD report that their symptoms begin in childhood. Coping with embarrassing compulsions and trying to hide them from friends and family can place great stress on a child.

Children with OCD appear to be more likely to have additional psychiatric problems. They may suffer from conditions such as panic disorder or social phobia, depression, learning disorders, tic disorders, disruptive behaviour disorders and body dysmorphic disorder (imagined ugliness).

Cognitive-behaviour therapy can help a child gain relief from OCD symptoms. Medication is generally given to children only when CBT has not achieved the desired results. Phobias & Panic Disorder (anxiety disorders)

Fear is a natural, instinctive reaction to dangerous situations. It is what causes us to escape from a burning building. A sudden rush of fear protects us, by alerting us to danger and stimulating adrenaline so that we think and move more rapidly than usual. But for people with phobias or panic disorder, fear is an overwhelming and unwelcome feature of their daily lives. They are struck by fears which they know are irrational and illogical, yet which are so powerful and unpredictable that they drastically change their lives to avoid feared situations.

Phobias and panic disorder are anxiety disorders, which are among the most common of mental health problems. In fact, it is estimated that 1 in 10 people are affected by anxiety disorders. These conditions are medical disorders, but they are often mistaken for weakness or self-indulgence. Because of this common mistake and because of the stigma associated with mental illness, people with anxiety disorders are often misunderstood and neglected, by society and sometimes by health care professionals.

Treatment exists to help people with phobias and panic disorder, and research into new therapies and techniques continues. By learning more about these conditions, you can help remove the social stigma that prevents so many people from seeking help to cope with their illness.

Specific phobias, social phobia

There are two categories of phobia: specific phobia and social phobia. Studies have shown that people with social phobia often experience in their developmental years a history of family break-up, shyness, infrequent dating and parental discouragement of socializing.

Specific Phobia - Specific phobias are believed to result from a combination of biological factors and life events. Some examples of specific phobias are fear of flying, heights, animals and blood. People with this type of phobia are consumed by inappropriate and involuntary fears. Their need to avoid those objects or situations which provoke high anxiety is so strong that they are unable to lead a normal life.

Social Phobia - A person with social phobia is excessively fearful of social or performance situations. They feel extreme anxiety about the possibility of being judged by others or behaving in ways which might cause embarrassment. They may have fears about being unable to continue talking in public, choking on food when eating in front of others or being unable to urinate in a public lavatory. This can lead to attacks which may involve heart palpitations, shortness of breath and profuse sweating. They will usually go to great lengths to avoid feared situations.

Panic Disorder

It is estimated that some 2 million Canadians suffer from panic disorder. Of those who have sought treatment for their symptoms, approximately two-thirds are women. Panic disorder typically begins in a person's late teen years, or early 2Os, but children are known to suffer from the disorder. Research is discovering more information about genetic causes of panic disorder. Studies have also shown that the occurrence or anticipation of stressful life events, anxiety in childhood, over-protective parental behaviour and substance abuse are common among people with panic disorder.

Agoraphobia frequently accompanies panic disorder. This is the fear of being in places or situations which would be difficult to escape from, or in which it would be difficult to find help, should a person suffer a panic attack.

Panic Disorder without Agoraphobia -Panic attacks are terrifying episodes during which the person is convinced they are about to die or collapse. Without warning, an individual is suddenly overwhelmed by emotional and physical sensations that signal imminent death. These can include heart palpitations, choking, nausea, faintness, dizziness, chest pain and sweating.

Panic Disorder with Agoraphobia - Women are roughly twice as likely as men to be diagnosed with panic disorder with agoraphobia. This occurs when a person with panic disorder goes to great lengths to avoid situations which they feel they could not escape from or obtain help if struck by a panic attack. In some cases, people develop a fear of being alone. People with agoraphobia often avoid public transport or shopping malls, others refuse to leave their homes, sometimes for years at a time.

Associated conditions

Anxiety disorders can co-exist; in other words, an individual may suffer from two disorders at the same time. People with social phobia and people with panic disorder are prone to agoraphobia. As well, phobia and panic disorder are often associated with other mental health problems. Depression and alcohol abuse are common. People with these disorders often suffer from a reduced quality of life. They may have problems in the workplace and find it difficult to function.

Treatment is available

Certain medications and cognitive-behaviour therapy (CBT) can be effective in treating social phobia. CBT techniques include expo-sure therapy, which helps people gradually become comfortable with frightening situations, and anxiety management training, which teaches techniques such as relaxation and deep breathing in order to control anxiety.

People with specific phobia can benefit from various medication and self-help therapies. A combination of behavioral and cognitive psychotherapies can be designed for each individual case. The techniques used include deconditioning, which helps a person become less anxious when confronted with an anxiety- producing situation.

Medication, in conjunction with psychosocial treatment, is often used to treat panic disorder. People are encouraged to understand their panic episodes, to explore exactly what triggers panic and to develop styles of coping with the sensations. Exercises in relaxation therapy give them tools to cope with rising tension or an anxiety-provoking situation.

What can I do?

Phobia and panic disorder are serious conditions, and can be as disruptive to family and work as a physical ailment. But it is important to understand that they are treatable. Friends can be supportive by learning all they can about the disorder, thereby increasing their sensitivity to the needs and concerns of an individual with phobia or panic disorder. Numerous support groups and community health associations exist to provide help to people affected by anxiety disorders. Post-Traumatic Stress Disorder (an anxiety disorder)

Difficult situations are part of life. We all must cope with tough circumstances, such as bereavement or conflict in our personal and professional relationships, and learn to move on. But sometimes people experience an event which is so unexpected and so shattering that it continues to have a serious effect on them, long after any physical danger involved has passed. Individuals with this kind of experience may suffer flashbacks and nightmares, in which they re-live the situation that caused them intense fear and horror. They may become emotionally numb. When this condition persists for over a month, it is diagnosed as post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is one of several conditions known as an anxiety disorder. This kind of medical disorder affects approximately 1 in 10 people. They are among the most common of mental health problems. Children and adults can develop PTSD. The disorder can become so severe that that the individual finds it difficult to lead a normal life. Fortunately, treatments exist to help people with PTSD bring their lives back into balance.

What causes it?

PTSD is caused by a psychologically traumatic event involving actual or threatened death or serious injury to oneself or others. Such triggering events are called 'stressors'; they may be experienced alone or while in a large group.

Violent personal assault, such as rape or mugging, car or plane accidents, military combat, industrial accidents and natural disasters, such as earthquakes and hurricanes, are stressors which have caused people to suffer from PTSD. In some cases, seeing another person harmed or killed, or learning that a close friend or family member is in serious danger has caused the disorder.

What are the signs?

The symptoms of PTSD usually begin within 3 months of the traumatic event. However, sometimes they surface many years later. The duration of PTSD, and the strength of the symptoms, vary. For some people, recovery may be achieved in 6 months; for others, it may take much longer.

There are three categories of symptoms. The first involves re-experiencing the event. This is the main characteristic of PTSD and it can happen in different ways. Most commonly the person has powerful, recurrent memories of the event, or recur-rent nightmares or flashbacks in which they re-live their distressing experience. The anniversary of the triggering event, or situations which remind them of it, can also cause extreme discomfort. Avoidance and emotional numbing are the second category of symptoms. The first occurs when people with PTSD avoid encountering scenarios which may remind them of the trauma. Emotional numbing generally begins very soon after the event. A person with PTSD may withdraw from friends and family, they may lose interest in activities they previously enjoyed and have difficulty feeling emotions, especially those associated with intimacy. Feelings of extreme guilt are also common.

In rare cases, a person may enter dissociative states, lasting anywhere from a few minutes to several days, during which they believe they are re-living the episode, and behave as if it is happening all over again. The third category of symptoms involves changes in sleeping patterns and increased alertness. Insomnia is common and some people with PTSD have difficulty concentrating and finishing tasks. Increased aggression can also result.

Other illnesses may accompany PTSD People with PTSD may develop a dependence on drugs or alcohol. They may become depressed. It is not uncommon for another anxiety disorder to be present at the same time as PTSD. As well, dizziness, chest pain, gastrointestinal complaints and immune system problems may be linked to PTSD. These are often treated as self-contained illnesses; the link with PTSD will be revealed only if a patient volunteers information about a traumatic event, or if a doctor investigates a possible link with psychological trauma.

How is PTSD treated?

Medication can help with the depression and anxiety often felt by people with PTSD, and assist them in re-establishing regular sleep patterns.

Cognitive-behavioural therapy and group therapy are generally felt to be more promising treatments for PTSD. They're often performed by therapists experienced in a particular type of trauma, such as rape counsellors. Exposure therapy, in which the patient re-lives the experience under controlled conditions in order to work through the trauma, can also be beneficial.

Research into the causes of PTSD and its treatment is ongoing. Determining which treatments work best for which types of trauma is currently under study. Eating Disorders

Our society's preoccupation with body image is reflected in the fact that, at any given time, 70% of women and 35% of men are dieting. More seriously, a 1993 Statistics Canada Survey reported that in women between the ages of 15 and 25, 1-2% have anorexia and 3-5% have bulimia. Eating disorders have the highest mortality rate of all mental illnesses, with 10% to 20% eventually dying from complications.

Clearly, these potentially life-threatening conditions are a growing problem. Despite their collective label, these disorders are not about food. Eating disorders are a way of coping with deeper problems that a person finds too painful or difficult to deal with directly. They are complex conditions that signal difficulties with identity, self-concept and self-esteem. Eating disorders cross cultural, racial and socio-economic boundaries, and affect men and women.

Eating disorders can be difficult to detect. The media glamourization of so-called ideal bodies, coupled with the view that dieting is a normal activity, can obscure a person's eating problems. It can be difficult for a person with an eating disorder to admit they have a problem. Knowing how to support someone with an eating disorder is also a challenge. Treatment is available - it can be a long process, but an eating disorder can be overcome. If you think that you, or someone you know, has an eating disorder, it is important to learn the facts. Gaining an understanding of these conditions is the first step in the journey to wellness.

Anorexia nervosa, bulimia nervosa and binge-eating

Three chronic eating disorders have been identified. Anorexia nervosa is characterized by severe weight loss due to extreme food reduction. Symptoms include:

 refusal to keep body weight at or above the normal weight for one's body type  dieting to extremes, usually coupled with excessive exercise  feeling overweight despite dramatic weight loss  loss of menstrual periods  extreme preoccupation with body weight and shape

Bulimia nervosa results in frequent fluctuations in weight, due to periods of uncontrollable binge eating, followed by purging. As well as a preoccupation with body image, symptoms include:

 repeated episodes of bingeing and purging, usually by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics - methods which are both ineffective and harmful  eating beyond the point of fullness

Binge-eating disorder, or compulsive eating, is often triggered by chronic dieting and involves periods of overeating, often in secret and often carried out as a means of deriving comfort. Symptoms include:

 periods of uncontrolled, impulsive or continuous eating  sporadic fasts or repetitive diets

Warning signs

Eating disorders can be difficult to detect. Someone suffering from bulimia can have a normal weight, but the activities they are engaging in can be deadly. Here are some warning signs:

 low self-esteem  social withdrawal  claims of feeling fat when weight is normal or low  preoccupation with food, weight, counting calories and with what people think  denial that there is a problem  wanting to be perfect  intolerance of others  inability to concentrate

What causes an eating disorder?

When someone has an eating disorder, their weight is the prime focus of their life. Their all-consuming preoccupation with calories, grams of fat, exercise and weight allows them to displace the painful emotions or situations that are at the heart of the problem and gives them a false sense of being in control.

There is no single cause. An eating disorder generally results from a combination of factors. Psychological factors include low self-esteem, feelings of inadequacy or lack of control, depression, anger or loneliness. Interpersonal factors include troubled family and personal relationships, difficulty expressing emotions and feelings, history of physical or sexual abuse. Media promotion of unrealistic images and goals, along with its tendency to equate a person's value with their physical appearance is another contributor.

The possibility of biochemical or biological causes is being studied. Some people with eating disorders have been found to have an imbalance of chemicals in the brain that control hunger, appetite and digestion, possibly as a result of the disorder.

Treatment for eating disorders

The sooner someone seeks help, the sooner they will benefit from treatment. However, people with an eating disorder usually work very hard to keep it secret, and find it very difficult to acknowledge that they have a problem. Diagnosis can be difficult, since the symptoms of eating disorders often occur in combination with depression, anxiety and substance abuse.

A multi-disciplinary approach is the most effective treatment route. This involves a thorough medical assessment, nutritional guidance, support, medical follow-up, individual, group and family therapy. Because eating disorders have a profound negative impact on all family members, the entire family may need counselling.

What can I do?

If you are struggling with an eating disorder, you are not alone. Many men and women have eating disorders and there is no shame attached in asking for help. The problem is too big to fix on your own, and help and support are available.

If you think someone you know has an eating disorder, learn what you can about these conditions. Express your concerns calmly and in a caring way. You can't force someone to change their behaviour, but you can let them know that you care and want to support them. Encourage the person to seek professional help. Don't lay blame and focus discussions on feelings, not food. Examine your own issues around food and weight. Be supportive, but do not enable the behaviour. Attention Deficit Disorders

Attention Deficit Disorder (also known as ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are terms used to describe patterns of behaviour that appear most often in school-aged children. Children with these disorders are inattentive, overly impulsive and, in the case of ADHD, hyperactive. They have difficulty sitting still, attending to one thing for a long period of time, and may seem overactive.

What are ADD and ADHD?

Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder are disorders that interfere with the learning process because they reduce the child's ability to pay attention. It is important to understand that ADD and ADHD are not disabilities in the learning process, although they may be present in addition to a learning disability. A learning disability is a neurological condition that affects the child's ability to learn.

ADD and ADHD are difficult to diagnose because they affect all areas of a child's life: family, school, friendships, team sports and work.

This pamphlet is intended to provide only some basic information on the impact of ADD and ADHD on the child and the potential emotional, social and family problems that may result. If you need more detailed information, you should contact a community organization that is dedicated to children with attention deficit disorders.

What are the emotional effects of ADD and ADHD?

Your child can have a wide range of emotional responses to ADD and ADHD, which can be confusing to both him/ her and to you. He / she may have already experienced years of frustration and failure which can lead to emotional stresses and further problems.

Some of the emotional responses are:

 aggressive or violent behaviour - Feelings of failure can result in aggressive or violent behaviour at home or outside it  withdrawal, anxiety and depression - Your child may turn inward and try to isolate him/herself from the rest of the work, or he/she may become anxious and depressed.  low self-esteem - If your child has been unable to have positive experiences because of ADD or ADHD, he/she will likely have trouble developing a healthy self-esteem.  physical symptoms - Possibly, your child will bury his/her feelings so deeply that they will come out in the form of headaches, stomach or back aches, or pains in the hands or legs.

What are the social effects?

Because ADD and ADHD are so hard to diagnose, you may be confused by your child's social behaviour. A teacher may not investigate difficult or disruptive behaviour because he / she cannot see the underlying attention problems. Two ways your child may try to mask his/her difficulty in the classroom or in a peer group are by:

 becoming the "class clown" or the "class bully," or  avoiding or refusing to become involved in activities where he/she is unsure of success.

How do ADD and ADHD affect the family? All members of your family will be affected by these disorders. As a parent, you may feel anger and guilt, and wonder if you could have prevented the problem or if you should have noticed it earlier. Your child's brothers and sisters may be confused about what exactly ADD and ADHD are. They may experience anger and anxiety about the situation because of their lack of understanding.

Overcoming the difficulties

If you think your child may have ADD or ADHD, your first goal should be to reduce the stress caused by the confusion and frustration your child is experiencing. It will be best if you work together with a team of professionals to find out what is wrong:

 Your family doctor should examine your child for physical causes, including seeing, hearing or speech problems.  A psychiatrist should work with your child to see if there are any emotional or social problems in addition to or caused by ADD or ADHD.  A psychologist or sociologist should examine the family environment.  An education specialist should examine your child's academic abilities and test for any seeing, hearing or speech difficulties.

Once this professional team has evaluated your child completely and the problem is correctly diagnosed, the team can recommend the most appropriate treatment program for your child.

With the right kind of help, most children with ADD or ADHD overcome their disabilities, and their emotional problems usually disappear. They do better at school, improve their relationships with family and friends, and will be more likely to achieve their full potential. With help from family, school and other professional people, children with ADD or ADHD have more than a good chance to grow up to be healthy, happy and productive adults.

Getting further help

If emotional, family or social problems continue, your child may need the support of a mental health professional. Your family doctor can refer you to the most appropriate people. Counselling for your child and the rest of the family may be what is needed to ease the problems and to teach all family members how to support each other through the difficult times. Schizophrenia

At first glance, schizophrenia may seem like a great puzzle. Its causes are still uncertain; its symptoms, variable.

Striking most often in the 16 to 30 year age group, affecting an estimated one person in a hundred, it is youth's greatest disabler.

But if it is a puzzle, it's one that is slowly being solved. New pieces are continually falling into place. Consider what we have learned about its symptoms.

Symptoms of schizophrenia

Schizophrenia often starts slowly. When the symptoms first appear, usually in adolescence or early adulthood, they may seem more bewildering than serious.

In the early stages, people with schizophrenia may find themselves losing the ability to relax, concentrate or sleep. They may start to shut long-time friends out of their lives. Work or school begins to suffer; so does their personal appearance. During this time, there may be one or more episodes where they talk in ways that may be difficult to understand and/or start having unusual perceptions.

Once it has taken hold, schizophrenia tends to appear in cycles of remission and relapse.

When in remission, a person with schizophrenia may seem relatively unaffected and can more or less function in society. During relapse, however, it is a different story. People with schizophrenia may experience one or all of these main conditions:

 delusions and/or hallucinations,  lack of motivation,  social withdrawal,  thought disorders.

Delusions are false beliefs that have no basis in reality. People with schizophrenia may think, for example, that someone is spying on them, listening to their thoughts, or placing thoughts in their minds.

Hallucinations most often consist of hearing voices that comment on behaviour, are insulting or give commands. Less often, people with schizophrenia may see or feel things that aren't there.

Disorganized thinking makes some people with schizophrenia feel mixed up. In conversation, they may jump randomly from one unrelated topic to another. Depression and anxiety frequently accompany these feelings.

The symptoms of schizophrenia vary greatly from person to person, from mild to severe. A specialist is needed to make the diagnosis, especially because there are no diagnostic tests.

Theories about the causes of schizophrenia

We know that schizophrenia is a biological disorder of the brain. The causes are not yet known, but there are several theories. There is strong evidence of important inherited factors. Many researchers are looking for genetic causes of schizophrenia that runs in families. Success may become more likely as genes for complex illnesses are found.

The characteristics of schizophrenia, along with its tendency to ebb and flow in cycles, makes it similar to auto-immune diseases.

New technology has provided some recent clues to the causes of schizophrenia.

Computer images of brain activity show that the part of the brain that governs thought and higher mental functions behaves abnormally in persons with schizophrenia.

Magnetic Resonance Imaging, or MRI, has shown that the same area in the brain of some people with schizophrenia appears either to have deteriorated or not to have developed normally.

Computed Axial Tomography (popularly known as CAT scans) show that the fluid-filled spaces within the brains of people with schizophrenia tend to be larger than those in people without the illness.

Even the treatments physicians use today are giving scientists much-needed pieces to the puzzle. For example, some people with schizophrenia respond well when they are given medication that interferes with their body's production of the brain biochemical dopamine. This fact is leading researchers to speculate that either an over-production of dopamine or an over-sensitivity to it has something to do with the illness.

Treatments

A number of medications have been found that help bring biochemical imbalances in many people with schizophrenia closer to normal.

These medications can help a great deal in lessening hallucinations and delusions, and in helping maintain coherent thoughts. But, they usually have serious side effects contributing to non-compliance with medication and relapse.

Psychotherapy for individuals, groups or families is possible, and can mean a lot to people with schizophrenia and their loved ones. Psychotherapy can offer understanding, reassurance, insights and suggestions for handling the emotional aspects of the disorder and providing less stressful living situations.

Families can be a big help. Working closely with health care professionals, family members can learn about the illness. Families can also provide useful information to the health care professionals. They can find ways to support people with schizophrenia and provide a nurturing environment that encourages communication.

To the future

With proper and improved medication, extensive community support (especially in housing) and skilled psychotherapy, many people with schizophrenia will be able to function in the community. With these resources to draw from, many people with schizophrenia could live independently, work, enjoy family and friends. The search for a cure continues with hope for success increasing every day Psychosis

Psychosis is a serious but treatable medical condition that reflects a disturbance in brain functioning. A person with psychosis experiences some loss of contact with reality, characterized by changes in their way of thinking, believing, perceiving and/or behaving. For the person experiencing psychosis, the condition can be very disorienting and distressing. Without effective treatment, psychosis can overwhelm the lives of individuals and families.

Psychosis is a medical condition that affects the brain. It can be treated.

A person with psychosis may:

 experience confused thoughts  feel their thoughts have sped up or slowed down  feel preoccupied with unusual ideas  believe that others can manipulate their thoughts; or that they can manipulate the thoughts of others  perceive voices or visions that no one else can hear or see  feel 'changed' in some way  act differently than they usually would

Sometimes psychosis emerges gradually over time, so that in the early stages symptoms might be dismissed or ignored. Other times, symptoms appear suddenly and are very obvious to the individual and those around them. Symptoms vary from person to person and can change over time. The initial experience of psychotic symptoms is known as the 'first episode' of psychosis. It is important to pay attention to possible symptoms and seek help early.

What's it like to have psychosis?

"It was like I was having a million thoughts all at once and yet I was so disorganized, nothing was getting done. I was frightened and anxious because I felt someone was trying to harm me. Increasingly, I spent most of my time alone in my room doing nothing. I didn't want to be bothered with friends or family. The television started having special messages meant only for me and I was hearing voices commenting on what I was doing. Looking back, I realize things just weren't making sense anymore. At the time though, it seemed normal and I didn't mention what was happening with me to anyone. Since getting treatment, I understand that I was experiencing a health problem called psychosis."

Who's most likely to experience psychosis?

Psychosis can happen to anyone. Symptoms of psychosis most often begin between 16 and 30 years of age. Both males and females can be affected. Males tend to experience symptoms a few years earlier than females. Persons with a family history of serious mental illness are at increased risk of developing psychosis.

What causes psychosis?

When psychosis occurs for the first time it is difficult to know the cause. Psychosis is associated with a number of medical conditions including schizophrenia, depression, bipolar (manic-depressive) disorder and substance abuse, among others. Because the first episode of psychosis can signal a variety of conditions, it is important to seek a thorough medical assessment.

How is psychosis treated? Low doses of anti-psychotic medications are a key component of treatment, along with education and support for the individual and their family. Treatment strategies are aimed at allowing the individual to maintain their daily routines as much as possible. There have been tremendous advances in the treatment of psychosis during recent years, reducing the need for hospital stays and promoting faster, fuller recovery.

Typically, psychosis does not disappear on its own. Instead, if left untreated, the condition can worsen and severely disrupt the lives of individuals and families.

What should you do?

If you, or someone close to you, is experiencing symptoms of psychosis:

Don't wait. Look for help. Many persons with psychosis wait a long time before seeking treatment. But recovery is more difficult when effective treatment is delayed. Talk to your family doctor. They can refer you to a specialist for a full assessment. At present, early psychosis intervention is the focus of much interest in the mental health community. Many medical and mental health professionals are themselves learning about the best approaches to treatment. Some cities in Canada already have centres designed specifically for the treatment of early psychosis. Ask questions. Be persistent. It is important to consult with a medical professional who is familiar with early psychosis. Educate yourself. Get the facts. There is a great deal of information available about early psychosis and recent developments in treatment. An excellent starting point is the web site developed by the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia: www.eppic.org.au. Most public libraries provide free access to the internet.

Psychosis…

 is a common medical condition affecting 3% of the population  results from a disruption in brain functioning  can radically alter a person's thoughts, beliefs, perceptions and behaviour  affects males and females equally  tends to emerge during adolescence and young adulthood  is more likely to occur in families with a history of serious mental illness  can be effectively treated

If you suspect psychosis, don't ignore it.

Treatment is most effective when it is started early. With proper treatment, most people recover fully from the first episode of psychosis. For many, the first episode is also the last.