Category Archives: Mental Health

Positive Dreams and a Peaceful Mind




Positive Dreams and a Peaceful Mind: Research Study

A new study conducted at the University of Turku (southwestern Finland) has found that our waking mind truly has an effect on our dreams. Sigmund Freud believed that dreams reveal the unconscious mind. It has long been believed that dreams can also reveal certain aspects of our conscious mind and daily thinking, feeling and over all well-being. Dream researchers in the past have focused more on the dreams of people experiencing various mental disorders rather than the positive aspects of dreaming and well-being. Do you have happier dreams if you are a happier person? Most researchers of well-being have focused on happiness and have neglected the important aspect of “peace of mind”.

Pillerin Sikka, Doctoral Candidate in Psychology at the University of Turku and Lecturer in Cognitive Neuroscience at the University of Skovde, and lead author in a recent article published in the Nature group Journal of Scientific Reports stated: “We wanted to address these important gaps in both dream and well-being research and to study how dream emotions are related to not only different aspects of waking ill-being, but also to different aspects of waking well-being, including peace of mind. In fact, this is the first study to look at how peace of mind relates to dream content.”




She went on to state, “Peace of mind is a state of inner peace and harmony, a more complex and durable state of well-being traditionally associated with happiness in the Eastern cultures”.

The study’s co-author Antti Revonsou, a Professor of Psychology at the University of Turku and Professor of Cognitive Neuroscience at the University of Skovde added that, “Even though it has rarely been directly measured in studies of well-being, in several philosophical traditions and spiritual approaches, peace of mind has always been regarded as central to human flourishing”.

Researchers in the study asked healthy individuals to fill out a questionnaire that measured their “ill-being” or “well-being” while awake and were then asked over the next three weeks to keep a daily dream diary which they would fill out each morning upon awakening detailing their dreams and rating the emotions experienced in those dreams. It was found that individuals experiencing higher levels of peace of mind experienced more positive dream emotions while those experiencing higher levels of anxiety also experienced higher levels of negative dream emotions.

These results concluded that if we are to understand how dreams are related to our waking state, we need to focus not only on symptoms of mental “ill-being” but also need to measure various aspects of “well-being”. Sikka explained that although some aspects of what we typically consider to be “well-being” did not seem to be related to dream content. There seemed to be something unique about “peace of mind”.

It has been proposed by researchers that one explanation for these conclusions is that possibly people who have higher levels of “peace of mind” may be better able to regulate their emotions not only when they are awake but also when they are dreaming. Obviously, the opposite would then be true for individuals with higher levels of anxiety.

Sikka concluded that the next step in research may be to find whether the ability to regulate emotions and maintain a higher-level of self-control is something that is fundamental to people with higher levels of “peace of mind” and whether improving these skills could actually lead to higher levels of peace of mind.

Adapted by Paul Susic Ph.D. Licensed Psychologist from article “Sweeter Dreams in a Peaceful Mind” ScienceDaily, August 24, 2018

Story Source:

Materials provided by University of Turku.

Journal Reference:

Pilleriin Sikka, Henri Pesonen, Antti Revonsuo. Peace of mind and anxiety in the waking state are related to the affective content of dreams. Scientific Reports, 2018; 8 (1) DOI: 10.1038/s41598-018-30721-1


Dissociative Disorders: DSM-V Diagnostic Codes




Dissociative Disorders: Overview

In order to diagnose and treat dissociative disorders, you need to understand the basic concept that dissociation refers to a disconnection or lack of connection between two things that are associated with each other. The DSM-V published by the American Psychiatric Association in 2013 states that dissociative disorders “are characterized by disruption of and/or discontinuity of the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.” They also go on to state that dissociation symptoms are “”a” unbidden and unpleasant intrusions into awareness and behavior, with accompanying losses of continuity in subjective experience (i.e. “positive” dissociative symptoms); and/or “b” and inability to access information or to control mental functions that normally are readily amenable to access or control; (i.e. ‘negative’ dissociative symptoms” (APA, 2013, p. 826).

Some research indicates that about three quarters of people will experience disassociation after a traumatic experience. It is believed that the brain tries to protect itself when individuals experience distressing, traumatic circumstances, although most people will not go on to develop a dissociative disorder.

Diagnostic Considerations:

The International Society for the Study of Trauma and Dissociation (2013) have addressed five different types of dissociation considered in the DSM-V: depersonalization, derealization, amnesia, identity confusion, and identity alteration. Depersonalization is usually referred to as a “sense of being detached from, or “not in” one’s body,” whereas derealization is a sense of the world not being real. Amnesia is a loss in the ability to retrieve information that has previously been stored, which an individual should remember. Identity confusion refers to an unusual change in an individual’s sense of self. Identity alteration “is the sense of being markedly different from another part of oneself…subtler forms of identity alteration can be observed when a person uses different voice tones, range of language, or facial expressions” (ISSTD, 2003, para.7).




As with other mental health disorders, dissociative symptoms may overlap with other disorders, and may be caused by medical illness or be related to substance use and abuse. Neurological conditions have been found that seem to mimic dissociative disorders such as traumatic brain injuries, seizures and neurocognitive disorders.
Substances of use and abuse have also been known to trigger dissociative symptoms such as marijuana, hallucinogenics, ecstasy, ketamine, and salvia (APA, 2013). All clients who present to mental health clinicians with dissociative symptoms need to be referred for a medical evaluation to determine whether treatment is ethically within their field of expertise.

Traumatic experiences are always at the very core of the development of dissociative symptoms. Psychologists and mental health clinicians always need to consider the possibility of a diagnosis of posttraumatic stress disorder or acute stress disorder, in order to determine whether these diagnoses would better address the dissociative symptoms. Clients and patients with dissociative disorders sometimes describe out of body experiences, sometimes have been known to believe they are possessed or even hear voices that may cause a clinician to believe the patient has a psychotic disorder or the psychotic symptoms associated with depression.

Dissociative disorders are comorbid with several other mental health diagnosis including anxiety, depression and substance use disorders. Among children, disassociation has frequently been misidentified as behavioral concerns such as inattention ADHD and temper tantrums as well as oppositional defiant disorder.

Prevalence:

The prevalence rate of these disorders is relatively high, usually estimated to be in the range of 2% to 10% of the general population. Individuals experiencing these disorders are vulnerable and at high risk. They are known to be at a very high risk of comorbid disorders and suicidal behaviors.

Cause:

While researchers have concluded that there does not appear to be a genetic component to dissociation, there does appear to be environmental and biological factors involved. In almost all cases, dissociative disorders appear to be linked to traumatic experiences, frequently early in life. Some of precipitating experiences for children and adolescents seem to involve emotional, physical and sexual abuse; experiencing violence; the death or loss of loved ones; chronic neglect; physical injury, accidents, disasters and medical procedures. In the case of dissociative identity disorder, the American Psychiatric Association (2013) have identified a 90% prevalence rate of childhood abuse and neglect. Depersonalization/derealization disorder seems to be linked to the experience of interpersonal conflicts and emotional abuse.

Treatment:

Among adults, dissociative disorders seem to be some of the most difficult mental conditions to treat. Although dissociative disorders are almost always associated with trauma, some of the traditional treatments for acute posttraumatic stress disorder such as exposure therapy are ineffective and frequently even counterproductive with these individuals. The effectiveness of medications has also had mixed reviews.

Treatment for dissociative disorders is usually conducted on a individual basis in an outpatient setting over a long period of time. Many of the treatments are psychodynamic in nature, also incorporating other approaches such as cognitive behavioral therapy, dialectical behavior therapy, eye movement desensitization and reprocessing and hypnosis. Most people with dissociative identity disorder receive medications to relieve the distressing symptoms.

Specific information related to each of the dissociative disorders and related treatments are on the following pages below.

Dissociative Disorders: DSM-V Diagnostic Codes

300.14 (F44.81) Dissociative Identity Disorder

300.12 (F44.0) Dissociative Amnesia

Specify if:

300.13 (F44.1) With dissociative fugue

300.6 (F48.1) Depersonalization/Derealization Disorder

300.15 (F44.89) Other Specified Dissociative Disorder

300.15 (F44.9) Unspecified Dissociative Disorder

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

International Society for the Study of Dissociation. (2004). Guidelines for the evaluation and treatment of dissociative symptoms in children and adolescents. Journal of Trauma & Dissociation, 5, 119-150. doi: 10. 1300/J229v05n03_09


Disruptive, Impulse-Control, and Conduct Disorders: DSM-V Diagnostic Codes





Disruptive, Impulse-Control, and Conduct Disorders: Overview

Basic characteristics of disorders that fall within the category of disruptive, impulse-control, and conduct disorders are aggressive and self-destructive behaviors, destruction of property, conflict with authority figures, disregard for personal or social norms, and persistent outbursts of anger disproportionate to the situation (APA, 2013). Behaviors within this category are behaviors that infringe upon or violate the rights of others or vary significantly from the norms of society.

It is important to understand that nearly all children and adolescents experience symptoms of defiance, disobedience, and breaking rules at some point in their childhood development. In disruptive, impulse-control, and conduct disorders the behaviors are much more frequent, pervasive and result in impairment to the individual’s lives. These behaviors also significantly exceed the normative behaviors for their culture, age and gender.

Diagnostic Considerations:

Although the underlying cause of these disorders vary, they all seem to share the common characteristics of problems in regulating behaviors and emotions. All of these disorders result in significant impairment in daily functioning. These disorders are less common in females than males and the age of onset tends to be in childhood or adolescence. It is considered very rare for these types of behaviors to first manifest themselves in adulthood. There appears to be a developmental relationship between conduct disorder and oppositional defiant disorder in that individuals who receive a diagnosis of conduct disorder in their preadolescent years frequently have been diagnosed with oppositional defiant disorder at an earlier point in time. Approximately two thirds of children diagnosed with oppositional defiant disorder still meet the diagnostic criteria three years later. One of the higher risk indicators for conduct disorder is an earlier onset and diagnosis of oppositional defiant disorder. Researchers have concluded that children are three times more likely to receive a diagnosis of conduct disorder if they were previously diagnosed with oppositional defiant disorder. Also, mental health clinicians need to closely monitor clients with conduct disorder as there is a very strong connection between conduct disorder and antisocial personality disorder. Approximately 40% of individuals diagnosed with conduct disorder eventually meet the criteria for a diagnosis of antisocial personality disorder.




Developmental Causation:

There has been much research over the years related to the cause and/or etiology of disruptive, impulse control and conduct disorders. The most common causative factors include environmental, emotional, familial, and genetic factors. Although grouped together, there appear to be various and at times different developmental pathways to each disorder. Research has not currently identified many genetic factors associated with the disruptive behavior disorders although the genetic links to ADHD appear to be significant. Also, the biological contributions to disruptive or conduct disorders appear to be very limited. Most research and clinical experience seem to identify environmental causation to be the most significant. Negative experiences within the family including substance abuse by caregivers, caregiver criminality, low socioeconomic status, severe family dysfunction, negative interactions between parent and children, modeling of aggression, and abuse and neglect have been identified as some of the higher risk factors associated with the development of these disorders.

Some cognitive deficits have also been identified which include social-cognitive information processing and issues related to being rejected by peers. Neurological research has identified brain structures within the limbic system which is associated with the formation of emotions and memories in the frontal lobe, which is involved in planning and controlling impulses, and have also been identified as having some connection to disruptive and conduct disorders. In addition to the neurological irregularities, there has been some suggestion that imbalances in testosterone may also play some role in the development of disruptive behavioral and impulse control behaviors.

Treatment:

Treatment for the disruptive, impulse-control and conduct disorders can be very complex due to the various risk and etiological factors. Evidence-based treatments for these disorders usually falls within the categories of parent and family interventions, cognitive behavioral therapy and psychopharmacological treatment.

Psychosocial treatments or counseling related interventions usually seem to focus on parent training approaches which include improving positive time between parents and children, modeling behaviors, behavioral reinforcement of rewards and consequences and the development of positive coping skills for dealing with difficult behaviors.
Cognitive behavioral therapy can help to modify cognitive distortions which seem to underly disruptive behaviors. These therapeutic approaches assist children and adolescents to develop better problem-solving skills focused on improving control, recognizing social difficulties and triggers for their disruptive behaviors, and pursuing more effective alternatives. Interventions focusing on the parents and appropriate medications are also very common.
For very young children, parent training should be the primary treatment approach. For more chronic or severe behaviors, psychologists and mental health clinicians should consider a multidimensional treatment approach that involves teachers, parents, and mental health providers.

Individuals diagnosed with pyromania and kleptomania have been found to respond to psychopharmacological interventions. Also, cognitive behavioral therapy and dialectical therapy have been found to be helpful in some circumstances.

Individual diagnostic codes related to disruptive, impulse control and conduct disorders along with specific etiological and treatment information can be found on the following pages.

Disruptive, Impulse-Control, and Conduct Disorders: DSM-V Diagnostic Codes

313.81 (F91.3) Oppositional Defiant Disorder
Specify current severity: Mild, Moderate, Severe

312.34 (F63.81) Intermittent Explosive Disorder

___.__ (___,__) Conduct Disorder

Specifiy whether:
312.81 (F91.1) Childhood-onset type

312.32 (F91.2) Adolescent-onset type

312.89 (F91.9) Unspecified onset

Specify if: With limited prosocial emotions
Specify current severity: Mild, Moderate, Severe

301.7 (F60.2) Antisocial Personality Disorder

312.33 (F63.1) Pyromania

312.32 (F63.3) Kleptomania

312.89 (F91.8) Other Specified Disruptive, Impulse-Control, and Conduct Disorder

312.9 (F91.9) Unspecified Disruptive, Impulse-Control, and Conduct Disorder

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) of the American Psychiatric Association (2013)



The 4 Stages of Addiction




Four Stages of Addiction:

According to the dictionary addiction means:

1. Being abnormally tolerant to and dependent on something that is psychologically or physically habit forming (especially alcohol and narcotic drugs).

2. An abnormally strong craving.

3. (Roman Law) a formal award by a court sentence of a thing or person to another (as of a debtor to his creditor), a surrender to a master; “under Roman law, addiction was the justification for slavery”.

The Chinese have a saying about heroin ‘You begin chasing the dragon but then it jumps on your back and begins chasing you’. Jackie Pullinger, the British woman who set up a ministry in Hong Kong t, wrote a book about her experiences there in ‘Chasing the Dragon’.




This expression relates to smoking heroin, but it could be applied for all mood altering drugs, alcohol, painkillers, tranquilizers, speed, solvents, LSD, cocaine, heroin, crack, ecstasy, barbiturates, and cannabis. It can apply to adrenalin based addictions like gambling, sex, shopping, people (co-dependency) and eating disorders.
Addiction doesn’t just happen. There is a progression towards chemical dependency, or any other addiction. It passes through four main stages.

1. Experimental Stage of Addiction

The Experimental Stage could happen out of curiosity or peer pressure. The user may say “I’ll just try it I don’t have to use it again” The user may experience pleasure or mood swings. The outcome may be intoxication or being stoned, or a ‘rush’ of some sort. Many who experiment with drugs do not progress to the next stage of addiction.

This may start in early teens (sometimes younger) with trying alcohol, cigarettes or cannabis. It is easy to get high because of the body’s low tolerance. Often done with their peers away from a parent or guardian. It may be seen as acting grown up, or a simple act of rebellion.

2. The Recreational Stage of Addiction

During the recreational stage the user may use at the weekends with friends, just to unwind from a stressful week. Looking for relief. Tolerance increases and more substances may be used, amphetamines (speed), larger quantities of alcohol. Symptoms may include stopping out late, suffering hangovers.

The user is by now starting to plan for use. Waiting for the weekend to be with friends, but also risk taking may increase by smoking on the way to school. Starting to lie about how much, and what is being used. Parents may react at this stage by grounding their child.

3. The Early Dependency Stage

During this stage, the regular user becomes an abuser. Now maintaining an addictive lifestyle that starts to affect others. The young user may be missing school and stealing money to feed the habit. Older users may be struggling to keep their job and running up debts. There is a daily preoccupation to source drugs and this often leads to meeting dealers.

4. The Full Dependency Stage

During this stage of addiction, there is a self destructive and compulsive desire to escape to oblivion, or escape from reality. Sobriety is too difficult to face. If left untreated, the addict may now face despair and risks premature death through overdose, suicide, accidents or side effects. Many end up with legal problems, imprisonment and family breakdown.

Addiction causes two main problems, a chemical (or an adrenalin) dependency problem, and a lifestyle problem. These are explored within the framework of other articles. Has addiction faced you or your family?

About the Author: Alan J Butler is a Recovery Coach and has worked with recovering addicts and ex offenders for the last 10 years. He spent 3 years living on site as a staff member of the Ovis Farm Project in Devon, England. He is an Associate of Life for the World Trust, an organisation whose aim is to equip the church to reach marginalised people. He holds a Diploma in Coaching & Mentoring from the Institute of Counselling, Glasgow. He welcomes comments at http://www.therecoverycoach.co.uk

Article Source: http://EzineArticles.com/?expert=Alan_J_Butler


Trauma and Stressor-Related Disorders: DSM-V Diagnostic Codes




Trauma and Stressor-Related Disorders: New category

The trauma and stressor related disorders category is a new chapter in the DSM-V. This category now includes post traumatic stress disorder, acute stress disorder, reactive attachment disorder (RAD), adjustment disorders and the new diagnostic category, disinhibited social engagement disorder (DSED). In the previous DSM-IV-TR, acute stress disorder and posttraumatic stress disorder were included in the anxiety disorders category. These disorders are now included in the same diagnostic category in the DSM-V because of their common roots in external events.

Trauma and Stressor-Related Disorders: Overview

Besides being placed in the new category, a significant change includes the necessity for the stressor criterion for posttraumatic stress disorder and acute stress disorder to be met. The stressor or traumatic event can be either directly or indirectly experienced or witnessed by an individual receiving a diagnosis of either post traumatic stress disorder or acute stress disorder. The traumatic event can be experienced by a family member or friend, having a significant effect on the individual receiving the diagnosis.

The term trauma usually refers to a significant response to a very distressing experience such as a terrible accident, sexual assault, abuse, combat or exposure to natural or human disasters. Stressful events can be either emotionally or physically harmful or both and can involve either a single experience or repetitive events over a period of time. Traumatic events can affect different people in very different ways, but have the overall experience of threatening their physical, emotional or spiritual welfare. The trauma is always experienced as overwhelming the individual’s ability to cope.

Some of the more common traumatic events have included sexual and physical assault, robbery, combat, terrorist attacks being kidnapped and taken hostage, being tortured, disasters, child abuse, automobile accidents and life-threatening illnesses. Traumatic events may also include witnessing a person’s death or serious injury through violence, war, accidents or natural disasters.




Prevalence:

The prevalence rate of traumatic related disorders is very high among the general population in the United States. The lifetime prevalence rate among men is 3.6% with a rate of 9.7% among women. The rate among children does not seem to be currently available although it is recognized that children who have experienced traumatic events are also at very high risk of developing posttraumatic stress disorder. The prevalence rates of acute stress disorder are between 6% and 94% depending upon the type of stressor involved. It is estimated that approximately 1% of children under the age of five have some degree of reactive attachment disorder. Children who are placed in foster care or are orphaned are at a much higher risk of developing reactive attachment disorder. Adjustment disorders are estimated to be between 2% and 8% in community-based samples of children, adolescents and among the elderly.

Diagnosis:

The onset of traumatic stress related disorders also increases the risk of associated mental health disorders such as anxiety, depression, sleeping and eating disorders, problems with substance use and suicidal ideation. It is also common for individuals diagnosed with a traumatic or stress related disorder to also have symptoms of somatic symptom disorder and/or attention deficit hyperactivity disorder and impulse control disorders. Many children who survived traumatic events are also misdiagnosed as having attention deficit hyperactivity disorder. Children diagnosed with reactive attachment disorder are also frequently mistaken for children with attention deficit hyperactivity disorder or oppositional defiant disorder and frequently have behavioral problems during childhood and throughout their adolescent years.

Important information:

It is important for mental health counselors and clinicians to understand that with the new category of traumatic stress related disorders that the most fundamental feature is trauma rather than anxiety serving as the precipitant to the development of the disorder.
Specific information and treatment information related to each of the individual diagnosis within the category of trauma and stress related disorders follows on subsequent pages.

Trauma and Stressor-Related Disorders: DSM-V Diagnostic Codes

313.89 (F94.1) Reactive Attachment Disorder
Specify if: Persistent
Specify current severity: Severe

313.89 (F94.2) Disinhibited Social Engagement Disorder

Specify if: Persistent
Specify current severity: Severe

309.81 (F43.10) Posttraumatic Stress Disorder (includes Posttraumatic Stress Disorder for Children 6 Years and Younger)

Specify whether: With dissociative symptoms
Specify if: With delayed expression

308.3 (F43.0) Acute Stress Disorder

___.__ (___.__) Adjustment Disorders

Specify whether:
309.0 (F43.21) With depressed mood
309.24 (F43.22) With anxiety
309.28 (F43.23) With mixed anxiety and depressed mood
309.3 (F43.24) With disturbance of conduct
309.4 (F43.25) With mixed disturbance of emotions and conduct
309.9 (F43.20) Unspecified
309.89 (F43.8) Other Specified Trauma-and Stressor-Related Disorder
309.9 (F43.9) Unspecified Trauma-and Stressor-Related Disorder

Diagnostic Information and Criterion for Trauma and Stressor-Related Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes:





Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes: Overview

Psychiatric diagnosis that fall within the category of schizophrenia spectrum and other psychotic disorders are characterized by abnormalities in one or more of the following five categories: hallucinations, delusions, disorganized thinking, disorganized or abnormal motor behavior (including catatonia) negative symptoms. This section includes information related to each of the specific schizophrenia spectrum and other psychotic disorders included in the DSM-5. These include delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, substance/medication-induced psychotic disorder, psychotic disorder due to another medical condition and catatonia.

Psychotic disorders involve a variety of both positive and negative as well as some related cognitive symptoms. Positive symptoms involve thoughts and behaviors that you would not usually expect while negative symptoms involve the absence of expected experiences. Some of the basic positive symptoms include hallucinations and delusions, as well as thinking or movement disorders in which the individual seems to lose touch with reality. Hallucinations are sensory experiences such as visual and auditory hallucinations, olfactory hallucinations, gustatory hallucinations (tasting), or tactile or somatic hallucinations in which a person feels things that are not really there or do not seem to have an actual physical stimulus. Delusions are rigid beliefs that do not seem to have any basis in reality and from which an individual cannot be persuaded otherwise. Auditory hallucinations seem to be the most common and tactile hallucinations are frequently associated with withdrawal or intoxication from substances. Olfactory and gustatory hallucinations often indicate a possible underlying medical problem. Disorganized thoughts often referred to as thought disorder involves disruptions in thinking in such a way that communication becomes difficult. Disorganized or abnormal motor behavior frequently referred to as movement disorder, includes agitation, recurrent motions or an inability to respond or move in relation to specific stimuli such as with catatonia.

Negative symptoms within the schizophrenia spectrum category include a lack of motivation, pleasure or engagement in what are believed to be normal activities of daily living or the normal experiencing of emotion. Problems with cognitive symptoms are usually related to having a difficulty with executive functioning, memory or attention.

Schizophrenia Spectrum and Other Psychotic Disorders: Prevalence

According to the APA (2013) psychotic disorders are fairly uncommon, citing prevalence rates of disorders within the schizophrenia spectrum category to range from 0.2% to 0.7%. These do not account for any cross-cultural considerations that are not identified in the DSM-5 but seem to be commonly found in specific cultures throughout the world.




Individuals who experience psychotic disorders have various characteristics and experiences. For about 50% of the individuals diagnosed within this category, they experience a lifelong struggle of trying to maintain their symptoms and a modest level of functioning in their lives. A small minority of individuals who have a later age of onset and frequently a higher level of functioning, seem to be able to manage their symptoms more adequately over their lifetime.

The presence of positive symptoms of psychosis does not always indicate the presence of a psychotic disorder. Medical conditions and substance use and abuse can also lead to the onset and often the exacerbation of psychotic symptoms. In many or most cases, it is probably better for a mental health clinician to refer clients with psychotic symptoms for a thorough medical examination.

Cause and Treatment:

At the present time, researchers have not determined the cause of schizophrenia and other psychotic disorders. Medical conditions and substance use as well as other mental health conditions can lead or contribute to the severity of schizophrenia spectrum and other psychotic disorders. Studies have found a strong genetic connection among individuals with schizophrenia spectrum disorders and have identified various physiological conditions associated with psychosis. Individuals with first-degree relatives who have a condition within the schizophrenia spectrum may be as much as 10 times higher risk of developing the symptoms of psychotic disorders. Neuroscientific researchers have found that individuals with schizophrenic spectrum disorders have different brain structures and physiological components from those who do not.

The main focus of the treatment of schizophrenia and related disorders includes medications for the relief of symptoms and the management of relapse. Psychological interventions are used to promote coping, and for preventing relapse, providing assistance through supportive measures to attain the highest level of functioning in an individual’s activities of daily life.

The same treatment principles seem to apply to all disorders within the schizophrenic spectrum. In the acute phase, clinicians will try to manage the most acute symptoms through medication management and supportive services. Following the medication management of the acute symptoms, clinicians may then focus more on psychosocial treatments to reduce stress and assist the client and their families through psychoeducation and supportive services to maintain a relatively higher managed level of psychosis that allows them to function at the highest level possible in their lives. Finally, as they continue with their medications, clinicians can then attend to preventing relapse through psychological treatments which include skills training, psychoeducation, cognitive behavioral therapy, family interventions, supported employment and other psychological support services within the treatment community. Strong therapeutic relationships have been identified to be very important in assisting and promoting more positive attitudes and compliance with medications.

Please see below the specific schizophrenia spectrum and other psychotic disorders diagnostic codes as well as important diagnostic and treatment information.

Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes:

301.22 (F21) Schizotypal (Personality) Disorder

297.1 (F22) Delusional Disorder

Specify whether: Erotomanic type, Grandiose type, Jealous type, Persecutory type, Somatic type, Mixed type, Unspecified type

298.8 (F23) Brief Psychotic Disorder

Specify if: With marked stressor(s), Without marked stressor(s), With postpartum onset

295.40 (F20.81) Schizophreniform Disorder

Specify if: With good prognostic features, Without good prognostic features

295.90 (F20.9) Schizophrenia

___.__ (__.__} Schizoaffective Disorder
Specify whether:

295.70 (F25.0) Bipolar Type

295.70 (F25.1) Depressive Type

___.__ (__.__) Substance/Medication-Induced Psychotic Disorder

Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal

___.__ (__.__) Psychotic Disorder Due to Another Medical Condition
Specify whether:

293.81 (F06.2) With Delusions

293.82 (F06.0) With Hallucinations

293.89 (F0 61) Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

293.89 (F06.1) Catatonia Disorder Due to Another Medical Condition

293.89 (F06.1) Unspecified Catatonia
Note: Code first 781.99 (R29.818) other symptoms involving nervous and musculoskeletal systems.

298.8 (F28) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder

298.9 (F29) Unspecified Schizophrenia Spectrum and Other Psychotic Disorder

Diagnostic Information and Criterion for Schizophrenia Spectrum and Other Psychotic Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist


Obsessive-Compulsive and Related Disorders: DSM-5 Diagnostic Codes




Obsessive-Compulsive and Related Disorders: Introduction

Conditions which fall within the category of Obsessive-Compulsive and Related Disorders all share some key features of obsessions and compulsions. Obsessions are recurrent, persistent and intrusive anxiety provoking thoughts or images resulting in subsequent repetitive behaviors referred to as compulsions. Obsessions may include thoughts, feelings, ideas and sensations that compel a person to do specific behaviors or compulsions. Some of the more common obsessions include excessive counting, ruminating about physical flaws, hoarding and picking at one’s skin. Some of the resulting rituals which are common among individuals diagnosed with obsessive-compulsive disorder frequently include recurrent handwashing, frequently checking doors and locks and avoidance of specific situations. For an individual to be considered for a diagnosis of obsessive-compulsive disorder it must be disruptive to their daily existence and functioning. Disorders listed in this category all share the common feature of excessive preoccupation along with the subsequent engagement in repetitive behaviors.

Changes from the DSM-4 TR to the DSM-5:

There were significant changes from previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Obsessive-compulsive disorder was previously classified in the DSM-4 TR as an anxiety disorder. The new DSM-5 has created a standalone chapter separate from the other anxiety disorders. This also follows revisions within the ICD 10 CM which also classifies OCD separately from anxiety disorders. However, there should never be any confusion as to the close relationship between obsessive-compulsive disorders and anxiety disorders. When the separation of obsessive-compulsive disorder from anxiety disorders was anticipated prior to the publication of the new DSM-5, psychiatrists supported the move significantly more often than other mental health clinicians, with only 40% to 45% of other mental health professionals supporting the move to the new category. Many psychologists, counselors and other mental health professionals did not support the change because of the fact that most treatment protocols for obsessive-compulsive disorder are also similar for anxiety and other related disorders. As is the case with most anxiety related disorders and depression, comorbidity is frequently the rule rather than the exception.




Some of the new disorders that fall within this category include excoriation (skin picking) disorder, substance/medication -induced obsessive compulsive and related disorder, hoarding disorder and obsessive-compulsive and related disorder due to another medical condition. Also, the diagnosis of trichotillomania (hair pulling disorder) was moved from the DSM-4 TR classification of impulse control disorders to this new classification of Obsessive-Compulsive and Related Disorders in the DSM-5.

Diagnosis:

An important aspect of diagnosis is to differentiate obsessive-compulsive disorder from other mental health disorders by the key features of obsessive preoccupation and repetitive behaviors. Once this has been accomplished, diagnosis can proceed.

Diagnosis of obsessive-compulsive disorder can be challenging in that there is a high level of comorbidity with other diagnosis. It is very common for a person with this diagnosis to also exhibit

symptoms of anxiety disorders and depression; eating disorder; somatoform disorder; hypochondriasis; impulse-control disorder, especially kleptomania; and attention deficit hyperactivity disorder (ADHD). Also, there is a significant amount of literature considering the comorbidity between obsessive-compulsive disorder and Tourette’s syndrome.

Prevalence:

It has been estimated that as many as one in 100 or 2 to 3 million adults currently have obsessive-compulsive disorder. Among children it is estimated that nearly one in 200 or 500,000 children and adolescents may receive this diagnosis. These estimates do not include other related disorders. Hoarding is believed to affect about 4% of the general population. Trichotillomania may affect as many as 2.5 million Americans, and as many as 3.8% of college students are believed to exhibit symptoms of excoriation.

Treatment for Obsessive-Compulsive and Related Disorders:

The most commonly reported treatments include a combination of medication and psychological treatments. Some studies have found cognitive behavioral therapy to be more effective than treatment with drugs or often has been found to be an appropriate replacement after the initial symptoms have been reduced. The International Obsessive-Compulsive Disorder Foundation has recommended exposure and response prevention (ERP), which is a type of cognitive behavioral therapy and has concluded that this type of therapy may reduce the symptoms by as much as 60% to 80% for active participants in therapy.

General information on obsessive-compulsive disorder can be found on subsequent pages along with information specific to each diagnosis within the new DSM-5 category of Obsessive-Compulsive and Related Disorders.

Obsessive-Compulsive and Related Disorders DSM-5 Diagnostic Codes:

300.3 (F42) Obsessive-Compulsive Disorder
Specify if: Tic-related

300.7 (F45.22) Body Dysmorphic Disorder
Specify if: With muscle dysmorphia

300.3 (F42) Hoarding Disorder
Specify if: With excessive acquisition

312.39 (F63.2) Trichotillomania (hair pulling disorder)

698.4 (L96.1) Excoriation (skin picking) Disorder

294.8 (F06.8) Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
Specify if: With obsessive-compulsive disorder-like symptoms, With appearance preoccupations, With hoarding symptoms, With hair pulling symptoms, With skin picking symptoms.

300.3 (F42) Other Specified Obsessive-Compulsive and Related Disorder

300.3 (F42) Unspecified Obsessive-Compulsive and Related Disorder

Diagnostic Information and Criterion for Obsessive-Compulsive and Related Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



Unnecessary Medication Use Associated With Dementia Diagnosis




Introduction to the study:

A recent study conducted at the University of Sydney has found that inappropriate and unnecessary medications seem to be routinely prescribed for newly diagnosed dementia patients. This longitudinal research study of 2,500 people was conducted in collaboration with the University of Kentucky and Yale University and published in the Journals of Gerontology: Medical Sciences.

Estimates of people currently living with dementia is approximately 50 million worldwide. In Australia the estimate is approximately 425,000 costing the country more than $15 billion per year and is currently the second leading cause of death.




Study and Conclusions:

The lead author, Dr. Danijela Gnjidic, NHMRC Dementia Leadership Fellow and Senior Lecturer from the Faculty of Pharmacy and Charles Perkins Centre at University of Sydney stated that “Our study found that following a diagnosis of dementia in older people, medication use increased by 11 per cent in a year and the use of potentially inappropriate medications increased by 17 percent”. She went on to say, “These medications are typically recommended for short term use but are commonly used long term by people with dementia,”

Some of the more common unnecessary and inappropriate medications are pain pills, sleep aids, depression medications and drugs for acid reflux referred to as proton pump inhibitors

A number of reasons were given to account for this including a lack of time in the patient and physician encounters, inappropriate guidelines, difficulty in setting goals with the patient and difficulty in the communication and comprehension of the patient.
She stated, “These findings are of major concern and highlight the importance of weighing up the harms and benefits of taking potentially unnecessary medications as they may lead to increased risk of side effects such as sedation or drowsiness, and adverse drug events such as falls, fractures and hospitalization.” She felt that increased efforts need to be made to support the recognition and potential use of medications that are inappropriate to minimize harm to patients.
Finally, Dr. Gnjidic concluded that “For Australians living with dementia and their caregivers (who commonly are responsible for managing medications for people with dementia), the key is to communicate closely with general practitioners, pharmacists and other health professionals to make informed decisions and to practice good medicine management techniques to minimize the risk of side effects.” Also, she commented that “Deprescribing unnecessary medications may improve an individual’s quality of life and can reduce unnecessary healthcare cost.”

Adapted by Paul Susic Ph.D. Licensed Psychologist from article at ScienceDaily: Dementia Diagnosis Linked to Unnecessary Medication Use dated Apr. 19, 2018

Story Source:

Materials provided by University of Sydney. Note: Content may be edited for style and length.

Journal Reference:

Danijela Gnjidic, George O Agogo, Christine M Ramsey, Daniela C Moga, Heather Allore. The impact of dementia diagnosis on patterns of potentially inappropriate medication use among older adults. The Journals of Gerontology: Series A, 2018; DOI: 10.1093/gerona/gly078



Generalized Anxiety Disorder: What is it exactly?




Generalized Anxiety Disorder: An Overview

Generalized anxiety disorder is a form of anxiety that is chronic, lasts for at least six months and is not accompanied by obsessions, phobias or panic attacks. A person with generalized anxiety disorder experiences constant worry and anxiety without all the comorbid symptoms of other anxiety disorders. To be given a diagnosis of this anxiety disorder, you must be focused on two or more specific, stressful life experiences such as significant concern related to work, finances, relationships or other issues most days for a minimum of six months. Individuals with generalized anxiety disorder often spend a lot of time worrying and tend to have several or many significant concerns. However, it is very difficult to manage any control over your worries and anxiety when you have this disorder. Also, the worries tend to be significantly out of proportion to the actual threat involved.




If you have generalized anxiety disorder, you will most often have at least three of the following six symptoms, most days for a minimum of six months:

• Irritability
• difficulty concentrating
• difficulties with sleep
• being fatigued easily
• feeling restless
• tension in the muscles

Another important aspect of generalized anxiety disorder is that you will experience a significant level of distress and impairment in daily activities related to work, school and social experiences.

Most often, before a physician will diagnose you as having this anxiety disorder he/she will have ruled out most possible medical causes of chronic anxiety such as thyroid problems, drug-induced anxiety and hyperventilation. Generalized anxiety disorder also often occurs at the same time as depression. A competent psychologist or mental health clinician will quickly try to distinguish whether the anxiety should be treated as the primary or secondary disorder. It is often difficult to tell which came first.

This anxiety disorder can develop at any age. Among children and adolescents, the focus of worries will tend to be related to school or performance in sports. The source of concern among adults can be related to a variety of circumstances. It is believed that generalized anxiety disorder affects approximately 4% of the population in the United States and may be slightly more common among women (55% to 60%) than men.

Generalized anxiety disorder is not usually associated with any specific phobias. However, Aaron Beck M.D., has suggested that the disorder may be related to some “basic fears” of a broad-based nature. They may include:

• fear of being unable to cope
• fear of failure
• fear of disease and death
• fear of abandonment or rejection
• fear of losing control

Generalized anxiety disorder may be exacerbated by any circumstance that increases your perception of danger or seems threatening. The underlying cause is unknown although it is believed to be related to some combination of heredity and experiences in childhood such as excessive expectations of parents, fears of abandonment or rejection by others.

Treatment for Generalized Anxiety Disorder:

Cognitive Behavioral Therapy

Often some form of cognitive behavioral therapy is used to treat generalized anxiety disorder. Utilizing this type of psychotherapy involves identifying themes of worry and fearful self-talk which is then challenged and replaced by more positive, constructive thoughts. More realistic, positive thoughts are used to replace counterproductive thoughts which are then practiced and internalized over time. Cognitive behavioral therapy may also utilize guided imagery to replace negative with more positive themes of mental imagery.

Medication

Medications may be recommended for generalized anxiety disorder in moderate to severe cases. These medications may involve the use of both anxiety medications and antidepressants. Frequently, the anxiety medication Buspar may be used. At other times SSRI antidepressants may be used such as Luvox, Zoloft, Paxil or Serzone either alone or in conjunction with| Buspar.

Relaxation Training

Relaxation training for generalized anxiety disorder usually involves some type of deep breathing and relaxation techniques to reduce the generalized worry and feeling of anxiety. Also, a consistent exercise program may also be included.

Problem-solving

Problem-solving usually takes the form of systematically working through and solving issues in our lives that seem to be a focus of worries. The focus becomes on solutions as opposed to the worries themselves. If there is no practical solution to a problem, the focus then becomes on ways to cope with the situation rather than continuing to worry about it. Sometimes, we may need to learn to accept things that we cannot change.

Distraction

Distraction can also be used at times to help cope with worries that are not amenable to treatment with cognitive behavioral therapy or problem-solving. Distraction may involve diverting your attention to other activities such as listening to music, talking on the telephone, exercising, cooking, reading or solving puzzles.

Personality and Lifestyle Changes

Intervention along these lines tend to focus on the use of methods usually described to assist with panic disorder such as increased downtime, stress management, regular exercise, and eliminating stimulants and sweets from your diet. It may also involve resolving problems with others, changing attitudes toward perfectionism, a need to please others or an excessive need to feel in control.

By Paul Susic Ph.D. Licensed Psychologist


Prozac Medication: The Benefits, Side Effects and Dosages




Prozac Medication: An Overview

Prozac is a medication used to treat depression, obsessive-compulsive disorder, bulimia, and frequently severe symptoms of premenstrual syndrome. Prozac is within the drug classification referred to as selective serotonin reuptake inhibitors (SSRI’s), which is believed to help maintain a elevated level of the neurotransmitter serotonin in the brain.

Serotonin is a neurotransmitter in the brain which is believed to affect moods. This neurotransmitter is usually quickly reabsorbed after its initial release from neurons in the brain. It is believed that excess serotonin between the neurons is blocked by medications such as Prozac from being taken back up into the releasing neurons resulting in increased levels of serotonin in the brain.

Prozac is most often prescribed to treat depression of the moderate to severe variety which interferes with daily functioning and most often is referred to as major depression. The symptoms of major depression include low mood and low energy, changes in sleeping habits and appetite, decreased sex drive, feelings of guilt or worthlessness, difficulty concentrating, slowed thinking, and suicidal thoughts. However, Prozac can be taken for a variety of other mental health disorders including obsessive-compulsive disorder, premenstrual dysphoric disorder as well as others. It is most often prescribed for adolescents, adults and the elderly but may occasionally be prescribed for children.

Prozac Medication for Obsessive- Compulsive Disorders:

In addition to being used for the treatment of depression, Prozac is also used to treat obsessive-compulsive disorder. Obsessions are thoughts that won’t go away, and compulsions are repetitive behaviors and actions which are done to relieve anxiety often associated with the obsessions. Prozac is used at times to also treat bulimia which is a binge eating disorder which involves deliberate vomiting and has also been used to treat other eating disorders including obesity.

Premenstrual Dysphoric Disorder:

Under the brand name Serafem which includes the active ingredients in Prozac, this depression medication is sometimes prescribed for premenstrual dysphoric disorder (PMDD), which is often referred to as premenstrual syndrome (PMS) including mood changes such as anxiety, depression, persistent anger, irritability, and mood swings. There are various physical problems associated with PMDD, including bloating, breast tenderness, headache and joint muscle pain. Symptoms usually tend to begin about 1 to 2 weeks before a woman’s premenstrual period. They are frequently severe enough to interfere with a woman’s daily activities, functioning and relationships.

Prozac Medication: Precautions

You should always be open and honest with your doctor when your taking Prozac. Always give a complete medical history, including liver problems, kidney disease, seizures, heart problems, allergies and history of diabetes. This depression medication has been known to make individuals dizzy or drowsy, making it necessary to be cautious when engaging in activities that require alertness such as driving or using heavy machinery. Alcohol should be limited when on this medication. Caution is also advised if you have diabetes, alcohol dependence or liver disease. Also, caution should be taken when this medication is being used by the elderly as they are more sensitive to the effects of the drug. This drug should only be used if necessary if an individual is pregnant as the medication passes into the breast milk. Because of the possible risk to the infant, breast-feeding while on this medication is not recommended. Consultation with your physician about the benefits and risks of Prozac used during pregnancy and breast-feeding is imperative. Obviously, you should never share your Prozac with others.




Important Facts About This Depression Medication

It has been noted that there can be some very serious and at times even fatal reactions to occur when Prozac is taken at the same time as some other antidepressants such as the MAO inhibitors. Also, you need to be careful when taking high doses of Prozac over a prolonged period of time. If you are taking any other medications for depression or any other prescription or nonprescription drugs you need to notify your physician before beginning on Prozac.

Prozac Side Effects:

Although the Prozac side effects seem to be less than some of the earlier generation antidepressant medications such as desipramine, amitriptyline and nortriptyline, there are still side effects that you need to be aware of. Some of the more common side effects of Prozac are sweating, dry mouth, drowsiness, headache, insomnia and nausea. Some of the side effects that are less likely but at times even more severe are loss of appetite and unusual weight loss, uncontrollable movements such as tremors, decreased interest in sex, flu-like symptoms, and either unusual or severe mood changes. Even less likely but even more potentially serious Prozac side effects include trouble swallowing, vision changes, white spots and swelling on the mouth and tongue, painful and/or prolonged erection and changes in sexual ability. The most severe side effects associated with Prozac are irregular and fast heartbeat, and fainting. Allergic reactions to Prozac are relatively rare but may include itching, rash, swelling, trouble breathing and dizziness. If you notice any reactions after beginning treatment with Prozac, you need to notify your pharmacist or physician immediately. A more complete listing of Prozac side effects follows.

The Most Common Prozac Side Effects:

Abnormal vision, abnormal ejaculation, abnormal dreams, increased anxiety, reduced sex drive, dry mouth, dizziness, flushing, flulike symptoms, headache, gas, impotence, itching, insomnia, loss of appetite, nervousness, nausea, sinusitis, rash, sleepiness, sweating, sore throat, upset stomach, tremors, yawning, vomiting, weakness

Less Common Prozac Side Effects:

Agitation, abnormal taste, weight gain, sleep disorders, bleeding problems, confusion, chills, weight gain, ringing in the ears, palpitations, loss of memory, increased appetite, high blood pressure, frequent urination, ear pain, emotional instability

There have been other very rare side effects reported while taking Prozac. If you develop any unexplained or new symptoms after initiating treatment with this depression medication you need to contact your physician immediately.

Drug Interactions:

In addition to the Prozac side effects mentioned above, there are also concerns for negative food and drug interactions when taking this antidepressant medication. As mentioned previously, Prozac should never be taken at the same time as you are taking MAO inhibitors. This can cause a very serious medication interaction. Also, when Prozac is taken with other medications the effect may be increased, decreased or altered in other ways. You should always check with your doctor when Prozac is taken with the following medications:

Alprazolam (Xanax)
Carbamazepine (Tegretol)
Clozapine (Clozaril)
Diazepam (Valium)
Digitoxin (Crystodigin)
Drugs that impair brain function, such as sleep aids and narcotic painkillers
Flecainide (Tambocor)
Haloperidol (Haldol)
Lithium (Eskalith)
Other antidepressants (Elavil)
Phenytoin (Dilantin)
Pimozide (Orap)
Tryptophan
Vinblastine (Velban)
Warfarin (Coumadin)

Special Warnings if You are Pregnant or Breast-feeding:

Prozac has not been adequately studied for its effects on pregnancy. If you are pregnant or plan to become pregnant in the near future, you need to talk with your physician as soon as possible to determine whether you should continue taking this depression medication. Prozac is known to appear in breast milk, so breast-feeding is obviously discouraged when taking this drug.

Prozac Dosage:

It is most common for your Prozac dosage to be taken once or twice a day and should be taken exactly as prescribed by your physician. It needs to be taken regularly to be effective. If it is possible, you should take your Prozac dosage at the same time every day.

Some patients have found that it can take as much as four weeks to feel any significant effects and get some relief from their depression. Doctors will also commonly maintain the treatment regimen for about nine months after the first initial three-month treatment trial. Some individuals who experience obsessive-compulsive disorder may not feel the full effects for as much as five weeks.

The Recommended Prozac Dosage:

The most common starting dosage of Prozac is 20 mg daily taken in the morning. Your physician may increase your dose after several weeks if there has been no improvement in symptoms. Elderly people with kidney and liver disease, and any other individual taking other medications may have their dosage adjusted by their doctor.

When taking a dosage of Prozac over 20 mg, the doctor may ask you to take it once a day in the morning or may ask that you to take two smaller doses in the morning and also at noontime.

The usual Prozac dosage for depression ranges between 20 mg and 60 mg. For obsessive-compulsive disorder, the usual dosage of Prozac ranges from 20 mg to 60 mg per day, although at times a maximum of 80 mg may be prescribed. The usual dosage of Prozac for bulimia nervosa is 60 mg taken in the morning. As with other disorders, the doctor may start at a lower dosage and increase to this level over a period of time. The most common Prozac dosage for premenstrual dysphoric disorder is 20 mg per day.

For some individuals who have been treated successfully with the daily form of Prozac, their doctor may switch them to a long acting form sometimes referred to as Prozac weekly. Your physician may ask you to skip your daily doses for seven days and then take your first weekly capsule.

If you miss your dose of Prozac you should take it as soon as you remember. If a significant time has passed however, you should skip that dosage and resume your normal dosage schedule.

Over dosage of Prozac:

Prozac like all medications, needs to be taken as recommended. Dosages more than the recommended amount can be dangerous and even fatal. Also, combining Prozac with certain other medications or drugs may cause symptoms of over dosage. If you suspect an overdose, you need to contact your doctor or go to an emergency room immediately.

The most common symptoms of Prozac over dosage include rapid heartbeat, nausea, seizures, vomiting and sleepiness. Some of the less common symptoms of Prozac over dosage include stupor, sweating, rigid muscles, low blood pressure, mania, coma, delirium, fainting, high fever and irregular heartbeat.

By Paul Susic Ph.D. Licensed Psychologist