Mental Health Symptoms

Delusions, on the other hand, are persistent beliefs or belief systems that are not based in reality and often cause the person experiencing them to be anxious or paranoid. Many of these delusions have a theme (a common thread), which frequendy involves feelings of threat, concerns about being personally targeted by a conspiracy, obsessive thoughts, or inordinate concerns about ill health. If a person has both hallucinations and delusions, these experiences tend to feed off one another and confirm one another s content. Hallucinations tend to support the delusional beliefs, and the delusions usually are related to the hallucinations. However, you can have the experience of one without the experience of the other, meaning that some people have delusions without hallucinations and some have hallucinations without delusions. 

Although hallucinations and delusions are common symptoms of schizophrenia, psychotic mood disorders (depressive or bipolar), and a few other disorders, 

If a family member notices any of the symptoms previously mentioned in a loved one, then it may be that the loved one is depressed and should be evaluated by a mental health professional. If a loved one is expressing suicidal thoughts, or it is discovered that he or she has put his or her affairs in order (has sold or given away significant amounts of personal property, written a will, settled debts, etc.), then it would be critical to get help for that person as quickly as possible. Suicide is a major concern with people who abuse drugs, since a majority of suicides in the United States are attempted under the influence of drugs or alcohol. 

For years, psychiatric and drug abuse disorders were not even treated together. Now we know they commonly co-occur, which means for many years clients were getting only partial treatment. Even today we are still not sure how to treat these co-occurring conditions simultaneously in a consistently effective way with both psychotherapy and pharmacotherapy (see Chapter 5). The next century is likely to see many advances in both pharmacotherapy and psychotherapy to treat co-occurring conditions. There are effective methods to treat drug abuse and to treat other co-occurring psychiatric disorders. The next frontier in research is to learn how to combine these approaches in a way that can treat multiple disorders at once  

However, if a person who has a drug problem is consistently breaking rules, defying authority, manipulating people, and seemingly acting without a heart or without a conscience toward others, then you may wish to consider whether 

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Nonsteroidal anti-inflammatory medications (NSAIDs) are used for many aches and pains and are available over the counter in such forms as ibuprofen (brand names Motrin and Advil, as well as a generic form), naproxen (brand name Aleve and a generic form), and others. There have been reports of depression, anxiety, paranoia, psychosis, and confusion with these medications. Sildenafil (brand name Viagra), used for male sexual dysfunction, has been reported to cause aggression, delusions, hallucinations, mania, paranoia, and confusion in rare cases. Therapists will treat patients who are taking steroids, over-the-counter NSAIDs, and Viagra. When these patients have mental health symptoms, they need to be evaluated by their physician to see if the medication is contributing to the psychiatric symptoms. 

Diagnosis of Mental Health Symptoms Following Terrorist Attacks... 

Tapp LC, Baron S, Bernard B, et al. Physical and mental health symptoms among NYC transit workers seven and one half months after the WTC attacks. Am J Ind Med 2005 47 475 83. 

Srisurapanont M, Jarusuraisin N, Kittirattanapaiboon P Treatment for amphetamine dependence and abuse. Cochrane Database Syst Rev 4 CD003022, 2001 Srisurapanont M, Ali R, Marsden J, et al Psychotic symptoms in methamphetamine psychotic in-patients. Int J Neuropsychopharmacol 6 347-352, 2003 Substance Abuse and Mental Health Services Administration Overview of Findings From the 2002 National Survey on Drug Use and Health (DHHS Publ No SMA 03-3774). Rockville, MD, Substance Abuse and Mental Health Services Administration, 2003... 

The most useful diagnostic criteria for ADHD is the Diagnostic and Statistical Manual of Mental Health Disorders, 4th edition, Text Revision (DSM-IV-TR) (Table 39-1). The DSM-IV-TR defines three subtypes of ADHD (1) predominately inattentive, (2) predominantly hyperactive/impulsive, and (3) combined, in which both inattentive and hyperactive symptoms are evident.11... 

Women with vasomotor symptoms taking hormone therapy have better mental health and less depressive symptoms compared to those taking... 

There are specific symptoms that family members, friends, coworkers and professionals can look for to help determine whether there are other problems besides drug use. Identifying other mental or physical health concerns can help a person advocate for specialized services for a client or his or her loved one, friend, or coworker in order to provide for the best care possible. However, identification of these signs or symptoms only warns there may be another problem — it does not tell you what the problem may be. If signs of other problems are noted, you should recommend a comprehensive evaluation by a professional trained in this type of assessment (e.g., a clinical psychologist, psychiatrist, or mental health professional with similar skills) if you do not feel ready to make that assessment yourself. That way you will know for sure what your client needs help with. 

The introduction of the phenothiazinc neuroleptic drug chlorpromazine in the treatment of schizophrenia is regarded by many as the most important event in 20th century psychiatry (Table 5.1 Swazey, 1974). Prior to chlorpromazine most schizophrenics could look forward to a lifetime in a state mental hospital. Though chlorpromazine and its successor neuroleptic drugs do not cure the disease, they favorably influence the fundamental symptoms so much that most patients can function reasonably well. Together with the advent of the community mental health move-... 

When is medication indicated in the treatment of psychiatric illness There is no short answer to this question. At one end of the continuum, patients with schizophrenia and other psychotic disorders, bipolar disorder, and severe major depressive disorder should always be considered candidates for pharmacotherapy, and neglecting to use medication, or at least discuss the use of medication with these patients, fails to adhere to the current standard of mental health care. Less severe depressive disorders, many anxiety disorders, and binge eating disorders can respond to psychotherapy and/or pharmacotherapy, and different therapies can target distinct symptom complexes in these situations. Finally, at the opposite end of the spectrum, adjustment disorders, specific phobias, or grief reactions should generally be treated with psychotherapy alone. 

Neurologists treat nervous system diseases that mainly cause physical symptoms. Therefore, they are concerned with both the CNS and the PNS. Mental health professionals, on the other hand, treat diseases that produce emotional, thought, and behavioral symptoms. As a result, we are more concerned with the CNS and, in particular, the brain. 

Depression is an imprecisely used term both in public circles and in the mental health community. It may refer to brief feelings of sadness or to a mood disturbance manifesting profound despair that persists over time. In the latter sense, depression represents the key symptoms of a psychiatric mood disorder. 

Patients with depression usually do not present initially to mental health professionals. Most visit their primary care physicians, complaining not of depressed mood but of other symptoms of depression. Fatigue, insomnia, loss of appetite, loss of interest in sex, muscle tension, body aches, and poor concentration are all commonly reported. These so-called masked presentations of depression may in part explain the documented failure of primary care physicians to diagnose depression reliably. This underscores the importance of considering depression in the differential diagnosis of physical complaints that appear vague or exaggerated. 

In contrast to panic disorder, the somewhat more subtle and persistent symptoms of GAD do not always command immediate attention. Although patients with GAD may present with a primary complaint of anxiety, they are more likely to complain of a physical ailment or another psychiatric condition or symptoms, for example, depression or insomnia. As such, many patients with GAD will seek treatment from a primary care physician long before recognizing the need for mental health care despite readily acknowledging that they have been anxious virtually all of their lives. 

With the notable exception of the Veteran s Administration (VA) hospital system, health care providers, both in primary care and mental health care, do a relatively poor job of identifying PTSD. There are two basic steps to diagnosing PTSD (1) determining that the patient has been exposed to a traumatic event, and (2) determining that the trauma-exposed patient is experiencing symptoms that fulfill diagnostic criteria for the disorder. 

In our experience, victims of TBI most often come to the attention of mental health care providers when referred by other clinicians. Their first psychiatric encounter may be a consultation during the initial postinjury hospitalization or later during active rehabilitation. Patients may also be referred for mental health treatment during the postconvalescent phase when faced with the realization that some of their physical dehcits may be permanent. As we mentioned earlier, TBI patients infrequently seek psychiatric care on their own, because they are often unaware that their psychiatric symptoms are a consequence of a past brain injury. 

Despite the overwhelming evidence for short-term effectiveness, only recently have studies begun to address long-term benefits of stimulant treatments. Prospective randomized controlled trials with durations of 12 to 24 months and doses up to 60 mg/day of MPH have been conducted to address this issue. The largest of these studies, the National Institute of Mental Health (NIMH)-sponsored Multimodal Treatment Study of Attention-Deficit Hyperactivity Disorder (MTA Study), showed that stimulants (either by themselves or in combination with behavioral treatments) lead to stable, long-term improvements in ADHD symptoms as long as the medication is taken (MTA Cooperative Group, 1999). 

Selective serotonin reuptake inhibitors. Currently available selective serotonin reuptake inhibitors (SSRIs) include fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram. At present, expert opinion does not support the usefulness of these serotonergic compounds in the treatment of core ADHD symptoms (National Institute of Mental Health, 1996). Nevertheless, because of the high rates of comorbidity in ADHD, these compounds are frequently combined with effective anti-ADHD agents (see Combined Pharmacotherapy, below). Since many psychotropics are metabolized by the cytochrome P450 system (Nemeroff et ah, 1996), which in turn can be inhibited by the SSRIs, caution should be exercised when combining agents, such as the TCAs, with SSRIs. 

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