Common Psychiatric Disorders
Major Depressive Disorder (MDD) is one of the most commonly seen disorders in psychiatric practice. Clients describe feeling sad or irritable for unexplainable reasons, often for long periods of time. This sadness may be accompanied by a loss of energy, loss of appetite, and insomnia. Clients have often reported to me that they have no desire to participate in any of the activities that they previously found pleasurable, and they may isolate themselves socially. You may feel like you are “in a fog” and cannot concentrate on day-to-day tasks. At its worst, depression can lead someone to feelings of guilt, hopelessness, and even thoughts of suicide. Thankfully, depression is very amenable to treatment with both medications and cognitive behavioral therapy. Top
Bipolar Disorder (AKA manic-depressive illness)
In bipolar disorder, clients suffer from mood swings between the extremes of depression (see Depression for a description) and episodes of mania. In a manic episode, clients can be extremely happy, or irritable. With this euphoria, comes increased energy, racing thoughts and a decreased need for sleep. You may be up all night doing projects or chores that you otherwise would not be doing. Clients are often told that they are talking too fast or going off on a tangent. You may have grandiose ideas of fame and fortune. It is during a manic episode that clients tend to become impulsive. They may engage in reckless spending sprees, participate in dangerous activities such as drug abuse, and hypersexual activity. These impulsive behaviors can have devastating consequences socially, occupationally, and financially. There are a good number of mood-stabilizing medications available to treat bipolar disorder. Each has its advantages and disadvantages. Contact me if you wish to have an evaluation and consider treatment options. Top
Generalized Anxiety Disorder (GAD)
Everyone has anxiety to some degree in certain situations. However when excessive worrying interferes with day-to-day functioning, it can have serious consequences. Clients report feeling “on-edge” all day, worrying about “every little thing.” This constant worrying causes a great deal of muscle tension, and fatigue and often interferes with sleep. It may have a negative impact on relationships and work. Anxiety disorders are easily treated with antidepressant medications, and also with cognitive behavioral therapy resulting in less worrying, improved energy, sleep, and concentration. Top
A panic attack is a very frightening experience to say the least. It can feel like a wave of overwhelming anxiety that comes “out of the blue.” Clients feel like they are hyperventilating, or having a heart attack. They may have sensations such as dizziness, tingling, or even what can be described as an out of body experience. When these attacks occur, you may feel like you are going to lose control, or even die. People that suffer panic attacks also tend to isolate themselves in the home, for fear of being in any place where a quick escape may be unavailable. Between panic attacks, clients tell me that the dread having another one. Cognitive behavioral therapy especially in combination with antidepressant medication is very effective in reducing these crippling symptoms. Top
Obsessive and Compulsive symptoms can be so distressing, that clients may be hesitant to seek treatment for them for fear of embarrassment, but are relieved to hear that it is quite a common illness. Obsessions are recurrent intrusive thoughts that cause marked distress and anxiety. “I can’t get the thought out of my head.” Sometimes these obsessions lead clients to perform compulsive rituals as a way of eliminating the anxiety they cause. Compulsions can take the form of constant checking, hand-washing, ritualistic counting or gestures, or an unrelenting focus on symmetry and orderliness. Sometimes OCD patients spend hours performing these compulsions, while neglecting their jobs, families, and even their own physical health. Like the other anxiety disorders, OCD is treatable with high dose antidepressants and with cognitive behavioral therapy. Top
A small amount of anxiety when meeting someone new or speaking in front of an audience is normal. But when the anxiety interferes to the point of avoiding any form of social interaction, it can have negative consequences. Clients that have social anxiety disorder report an intense fear of being judged, scrutinized, or looked down upon in any kind of social interaction. They are frightened of being humiliated or shunned by the group. In a society that frequently demands social interactions in our jobs, and relationships, this disorder can be very frustrating. Cognitive Behavioral Therapy and antidepressants are very effective in treating this condition. With successful treatment, many clients with social anxiety, are going to parties, and participating in public speaking with little to no difficulty. Top
Modern society and the media put a tremendous amount of pressure on teens and adults to appear slim. This has lead to an alarming number of young women and a smaller number of young men with eating disorders including anorexia nervosa and bulimia nervosa. In anorexia, the patient has an intense focus on being slim, avoiding gaining weight. They have a distorted image of their ideal body size, and will continue restricting food, exercising excessively or using other methods to compensate for any caloric intake, often to the point of dangerous health consequences. Bulimia nervosa is characterized by repeated episodes of compulsive overeating followed by tremendous guilt, and worry over gaining weight which leads patients to purge by means of vomiting, laxatives etc. Both these disorders have dangerous effects, and require close follow-up. Usually a multidisciplinary approach including a psychiatrist, psychotherapist, nutritionist, and primary care physician is required for effective treatment. Top
Attention Deficit Hyperactivity Disorder
ADHD is being diagnosed at an alarming rate these days. Too often behavioral problems in children are falsely attributed to the diagnosis, and needlessly medicated, when simple behavior therapy will suffice. When it does occur for real, it can cause severe difficulties at work, home, and in relationships. People that suffer from ADHD complain of an inability to focus on studies, or work without being distracted by any noise, movement, or other minor stimulus. They find themselves going over work over and over again, or simply avoiding it all together. Forgetfulness and silly mistakes are common resulting in declining grades, and poor performance on tasks at home or at work. Many children with the disorder are also hyperactive, impulsive, as if “driven by a motor.” They blurt out of turn, and can’t sit still, often resulting in disciplinary action at school. Fortunately, most children diagnosed with ADHD outgrow the disorder and function normally as adults. A small minority however continue to have severe symptoms as adults. These symptoms are treatable with medications (both stimulant and non-stimulant) as well as behavioral techniques. Top
Thought disorders include diagnoses like schizophrenia, and schizoaffective disorder. These are serious medical illnesses characterized by a difficulty distinguishing reality from fantasy. Patients with these disorders may suffer from frightening hallucinations such as hearing voices, delusions, and feelings of paranoia, which can frequently lead to agitation, violence, and even suicide. Patients are also notable for having blunted emotions, a decreased amount of speech or movement, and a nonsensical disorganized stream of thought. Antipsychotic medications are the mainstay of treatment, and given early diagnosis, strict adherence to meds, close follow-up, and a strong support network, patients can still lead productive fruitful lives. Top
Insomnia has numerous causes, and many manifestations. You may have a difficulty falling asleep, maintaining sleep, or simply complain of a shallow unrestful sleep. Either way, clients often suffer from excessive daytime sleepiness, sleep attacks, fatigue, and a difficulty performing their daytime duties. Deficient sleep can be a cause of or a sign of many psychiatric conditions. It is important to consider sleep habits, substance use, sleep apnea, and rule out other psychiatric disorders before treating with potentially habit-forming sedative medications. Used judiciously, in combination with behavioral techniques, medications can provide a much needed good night’s sleep. Top