MENTAL HEALTH AWARENESS MONTH/OCTOBER

October 09, 2024

MENTAL HEALTH AWARENESS MONTH/OCTOBER

What is Mental Health?

Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It has intrinsic and instrumental value and is integral to our well-being.

At any one time, a diverse set of individual, family, community and structural factors may combine to protect or undermine mental health. Although most people are resilient, people who are exposed to adverse circumstances – including poverty, violence, disability and inequality – are at higher risk of developing a mental health condition.

Many mental health conditions can be effectively treated at relatively low cost, yet health systems remain significantly under-resourced and treatment gaps are wide all over the world. Mental health care is often poor in quality when delivered. People with mental health conditions often also experience stigma, discrimination and human rights violations.

Determinants of mental health

Throughout our lives, multiple individual, social and structural determinants may combine to protect or undermine our mental health and shift our position on the mental health continuum.

Individual psychological and biological factors such as emotional skills, substance use and genetics can make people more vulnerable to mental health problems.

Exposure to unfavourable social, economic, geopolitical and environmental circumstances – including poverty, violence, inequality and environmental deprivation – also increases people’s risk of experiencing mental health conditions.

Risks can manifest themselves at all stages of life, but those that occur during developmentally sensitive periods, especially early childhood, are particularly detrimental. For example, harsh parenting and physical punishment is known to undermine child health and bullying is a leading risk factor for mental health conditions.

Protective factors similarly occur throughout our lives and serve to strengthen resilience. They include our individual social and emotional skills and attributes as well as positive social interactions, quality education, decent work, safe neighbourhoods and community cohesion, among others.

Mental health risks and protective factors can be found in society at different scales. Local threats heighten risk for individuals, families and communities. Global threats heighten risk for whole populations and include economic downturns, disease outbreaks, humanitarian emergencies and forced displacement and the growing climate crisis.

Each single risk and protective factor has only limited predictive strength. Most people do not develop a mental health condition despite exposure to a risk factor and many people with no known risk factor still develop a mental health condition. Nonetheless, the interacting determinants of mental health serve to enhance or undermine mental health.

WHAT TO SAY TO SOMEONE WHO IS DEPRESSED

“I’m all alone”

Don’t say: “No you’re not! I’m sitting here with you right now. Doesn’t my caring about you mean anything?”

Do say: “I know that you’re feeling alone right now. Is there anything I can do to help? I’m just glad to be with you – together we’ll get through this lonely feeling.”

“Why bother? Life isn’t worth living. There’s no point in going on”

Don’t say: “How can you think that? You have a great job and people who love you. You have everything to live for”

Do say: “I know it feels that way to you right now, but I want you to know that you matter to me and you matter to others who love you. We’ll get through this hopeless feeling together”

“I’m dragging everybody else down with me”

Don’t say: “No you’re not! You see, I’m fine! I had a good day today. And besides I’m doing everything in the world to help you.”

Do say: “I know it feels that way to you right now, and yes, at times it is difficult for both of us – but remember we’ll get through this hopeless feeling together”

“What would it be like if I wasn’t here anymore?”

Don’t say: “Don’t be silly – what’s wrong with you?”

Do say: “I would miss you terribly as you’re very important to me. I want to grow old knowing you’re around. We’ll get through this together”

I’m expendable.”

Don’t say: “If you felt better about yourself, you wouldn’t say stupid things like that.”

Do say: “I know you’re feeling worthless right now, but we’ll get through this.”

“Nothing I do is any good. I’ll never amount to anything”

Don’t say: “What are you saying? You’re a highly respected (engineer), you’re a good (father). You’re blowing everything out of proportion.”

Do say: “I know it’s upsetting when things don’t work out the way you want them to – it’s upsetting for me to! Failure feelings are really painful, but we’ll get through this together”

“How long am I going to feel this way? It’s as if I’ll never get better”

Don’t say: “Come on. Nothing lasts forever – you know better than that”

Do say: “I know it’s scary to be in so much pain. Feelings come and go. We’ll get through this together”

If you need any further information for you or a loved one, please call SADAG on 011 262 6396 or 0800 567 567 or sms 31393, we are open 7 days a week from 8am – 8pm. You can also go to our website for more information www.sadag.co.za

BIPOLAR DISORDER

INTRODUCTION

Manic Depression is more than just a simple mood swing. You experience a sudden dramatic shift in the extremes of emotions. These shifts seem to have little to do with external situations. In the manic, or “high,” phase of the illness you aren’t just happy. You are simply ecstatic. Great burst of energy can be followed by a severe depression, which is the “low” phase of the disease. Periods of fairly normal moods can be experienced between cycles. These cycles are different for different people. They can last for days, weeks, or even months.

Symptoms of the manic phase include behaviour that is out of proportion to how you would normally act. You feel excessively good, “on top of the world,” and nothing will change your happiness. You are optimistic to the extreme. You may even have grandiose delusions. Nothing can stop you from accomplishing anything you want. Nothing can go possibly go wrong. You spend money like the proverbial “drunken sailor”. Sex is great, fabulous, you can’t get enough. You good judgment and caution have vanished.

You can be so hyperactive you can literally go for days with little or no sleep. You mind races. It is full of ideas like a car without brakes. In conversation you change from topic to topic in rapid fire fashion. You speak too loudly and rapidly. Others fail to understand you as your thoughts and speech become disorganized and incoherent. At times you can become enraged for not reason or when someone suggests you plans are unreasonable. If not treated, this phase can last as long as three months. But typically the depressive phase of the illness sets in. The symptoms of this phase of the disease are the same as the “regular” clinical or major depression.

Although manic-depressive illness can be disabling it also responds well to treatment. Since many other diseases can masquerade as manic-depression, it is important you or your loved on receive a competent medical evaluation as soon as possible.

WHAT IS A BIPOLAR DISORDER?

Bipolar disorder is a physical illness marked by extreme changes in mood, energy and behaviour. That’s why doctors classify it as a mood disorder.

Bipolar disorder – which is also known as manic-depressive illness and will be called by both names throughout this publication – is a mental illness involving episodes of serious mania and depression. The person’s mood usually swings from overly “high” and irritable to sad and hopeless, and then back again, with periods of normal mood in between.

Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as an illness, and people who have it may suffer needlessly for years or even decades.

Effective treatments are available that greatly alleviate the suffering caused by bipolar disorder. This brochure contains some frequently asked questions about bipolar disorder.

WHAT CAUSES MANIC DEPRESSION (OR BIPOLAR DISORDER)?

The exact cause of manic depression is not known, but it is believed to be a combination of biochemical, genetic and psychological factors.

Biochemistry

Research has shown that this disorder is associated with a chemical imbalance in the brain, which can be corrected with appropriated medication.

Genetics / Hereditary

Bipolar disorder tends to run in families. Researchers have identified a number of genes that may be linked to the disorder, suggesting that several different biochemicals problems may occur in bipolar disorder (just as there are different kinds of arthritis). However, if you have bipolar disorder and your spouse does not, there is only a 1 in 7 chance that your child will develop it. The chance may be greater if you have a number of relatives with bipolar disorder or depression.

Biological Clocks

Mania and depression are often cyclical, occurring at particular times of the year. Changes in biological rhythms, including sleep and hormone changes, characterise the illness. Changes in the seasons are often associated triggers.

Psychological Stress.

People who are genetically susceptible may have a faulty “switch-off” point – emotional excitement may keep escalating into mania: setbacks may worsen into profound depression.

Sometimes a stressful life event such as a loss of a job, marital difficulties, or a death in the family may trigger an episode of mania or depression.

At other times, episodes occur for no apparent reason.

Research continues to be needed to identify more clearly the causes, of manic depression and to find better ways of treating it.

The earlier treatment is started, the more effective it may be in preventing future episodes.

WHO GETS MANIC DEPRESSION?

Manic depression is common – affecting about 1% of the population. Men and women are equally affected. While the disorder has been seen in children, the usual age of onset is late adolescence and early adulthood. Mania, occasionally appears for the first time in the elderly, and when it does, it is often related to another medical disorder. Manic depression is not restricted to any social or educational class, race, or nationality. Although an equal number of men and women develop the illness, men tend to have more manic episodes. Women experience more depressive episodes. Many people with bipolar disorder are very well known. Some have won Academy Awards; others have created literary and fine-art masterpieces, or led their nations in critical times of history.

Very effective treatments for bipolar disorders are available.

IS MANIC DEPRESSION TREATABLE?

Fortunately, the answer to this question is “yes”. Treatment in the form of medication and counselling can be effective for most people with manic depression.

Bipolar disorder is similar to other lifelong illnesses – such as high blood pressure and diabetes – in that it cannot be “cured”. It can, however, be managed successfully through proper treatment, which allows most patients to return to productive lives.

On the other hand, if not diagnosed and not treated, the impact of the illness can be devastating to the individual, significant others, and society in general.

Around 85% of people who have a first episode of manic depression will have another. Because of this, maintenance treatment is essential in this illness. Good quality of life is usually possible with effective treatment.

WHAT ARE THE SYMPTOMS OF BIPOLAR DISORDER?

Over the course of bipolar disorder, four different kinds of mood episodes can occur:

Mania (manic episode)

During a manic episode, the mood can be abnormally elevated, euphoric, or irritable. Thoughts race and speech is rapid, sometimes non-stop, often jumping from topic to topic in ways that are difficult for other to follow. Energy level is high, self-esteem inflated, sociability increased, and enthusiasm abounds. There may be very little need for sleep (“a waste of time”) with limitless activity extending around the clock. During a manic episode, a person may feel “on top of the world” and have little or no awareness that the feelings and behaviours are not normal.

Mania comes in degrees of severity and, while a very little amount may be pleasant and productive, even the less severe form known as hypomania can be problematic and cause social and occupational difficulties. A manic episode is more severe than a hypomanic episode with a magnification of symptoms to the extent that there is marked impairment in interpersonal and social interactions and occupational functioning. Hospitalisation is often necessary. Severe mania can be psychotic – the person loses contact with reality and may experience delusions (false beliefs), especially of a grandiose (“I am the President”), religious (“I am God”) or sexual nature, and hallucinations (hearing voices or seeing visions). Psychotic mania may be difficult to distinguish from schizophrenia and, indeed, mistaking the former for the latter is not uncommon.

During a manic episode, judgement is often greatly impaired as evidenced by excessive spending, reckless behaviours involving driving, abuse of drugs and alcohol and sexual indiscretion, and impulsive, sometimes catastrophic business decisions.

Feeling unusually “high”, euphoric, or irritable (or appearing this way to those who know you well).

Plus at least four (and most often all) of the following:

Needing little sleep yet having great amounts of energy.
Talking so fast that others can’t follow your thinking.
Having racing thoughts.
Being so easily distracted that your attention shifts between many topics in just a few minutes.
Having an inflated feeling of power, greatness, or importance.
Doing reckless things without concern about possible bad consequences – such as spending too much money, inappropriate sexual activity, making foolish business investments.
Extreme irritability and distractibility
Abuse of alcohol or drugs
In very severe cases, there may be psychotic symptoms such as hallucinations (hearing or seeing things that aren’t there) or delusions (firmly believing things that aren’t true)

In a full-blown “major” depressive episode, the following symptoms are present for at least 2 weeks and make it difficult for you to function:

Feeling sad, blue, or down in the dumps or losing interest in things you normally enjoy.

Plus at least four of the following:

Trouble sleeping or sleeping too much
Loss of appetite or eating too much
Problems concentrating, remembering or making decisions
Feeling slowed down or feeling too agitated to sit still Feeling worthless of guilty or having very low self-esteem
Loss of energy or feeling tired all of the time
Prolonged sadness or crying spells
Pessimism, indifference
Recurring thoughts of suicide or death Severe depressions may also include hallucination or delusions

Mixed Episode

Perhaps the most disabling episodes are those that involve symptoms of both mania and depression occurring at the same time or alternately frequently during the day. You are excitable, or agitated as in mania but also feel irritable and depressed, instead of feeling on top of the world.

Mixed episodes sometimes known as dysphoric mania, occur in up to 40% of individuals with manic depression and can be particularly troublesome because they may be more difficult to treat.

Depression (major depressive episode)

During a depressive episode, mood is sad, blue, down-in-the-dumps, unhappy or irritable. Self-esteem is low, thoughts are negative, and there is loss of interest in usual activities and inability to experience pleasure. Concentrating is difficult and decision making impaired. Anxiety or agitation are common features of depression, although some individuals are drained of energy and are physically inert. Feelings of hopelessness and helplessness are common with both the present and future looking bleak. Guilt, crying and social withdrawal are additional features. Suicidal thoughts, plans, and attempts are common and, in fact, suicide is a cause of death in many people with depression. Physical findings associated with depression include sleep disturbance (either insomnia or oversleeping), appetite and weight loss (although overeating and weight gain are not uncommon), fatigue, loss of interest in sex, and bodily pains.

From the descriptions above it should be clear that manic depression is a serious medical illness that should not be confused with the happy and sad moods that occur in everyone from time to time. Untreated, manic depression can be devastating with great personal suffering, disruptive relationships, derailing careers, increased risk of death from suicide and accident, and enormous financial cost to the individual and society. Proper treatment, however, can be effective in returning people to more healthy and productive lives.

HOW DO I GET HELP? Contact SADAG on 0800 567 567 or 011 262 6396

If you suspect that you, a family member, or a friend has manic depression, you should consult a mental health professional. This can be done directly or through you family physician, your health maintenance organisation, or your community mental health centre. Self-help and support groups can also be helpful.

If you are not happy with physician or therapist, don’t be afraid to speak up or seek a second opinion. Many people go through more than one mental health professional before developing a comfortable partnership. Most of us are probably more aggressive about our choice of hairdresser or car mechanic. What could be more important than your health?

Since proper diagnosis is essential for effective treatment, see someone who is knowledgeable about manic depression. Psychiatrists are medical doctors who specialize in the diagnosis and treatment of mental illness. In addition to providing counselling, they are the only mental health professionals who can prescribe medication. Clinical psychologists, clinical social workers and nurse specialists can also diagnose and provide counselling and psychotherapy. Mental health counsellors can be useful sources of counselling, support and education. The best treatment is sometimes provided by several professionals working together to address the varied needs of an individual.

The outlook for people with bipolar disorder today is optimistic. Many new and promising treatments are being developed and with the right treatment most should be able to lead full and productive lives.

How can I tell the difference between bipolar disorder and ordinary mood swings?

Mood swings that come with bipolar disorder are severe, ranging from extremes in energy or “highs” to deep despair. The severity of the mood swings and the way they disrupt normal activities distinguish clinical mood episodes from ordinary mood changes.

When the mood swings are charted over time, daily, weekly, and seasonal patterns become evident. Doctors may diagnose bipolar disorder in patients with who have had one or more manic or hypomanic episodes. In many cases, these patients have also experienced one or more major depressive episodes. Manic episodes last at least one week; major depressive episodes last at least two weeks. Both types of episodes often last much longer. Many people have severe episodes of mania and depression in a single year. Others live for years without a new episode.

Caring for a Loved One with Schizophrenia

Discovering that someone you care about has schizophrenia can be traumatic. Making things worse is the need for long-term treatment to calm symptoms. A person with schizophrenia often becomes confused and agitated, which some may mistake as behaviour directed towards them.

All told, schizophrenia places a difficult burden on families. Fortunately, there are steps families can take to make the situation easier. The key is for families to understand what they face when a loved one has schizophrenia.

1. Is it easy to tell if a family member has schizophrenia?

Part of the problem is that schizophrenia often becomes evident in the person either in their late teens or early 20s. And the normal curve for adolescence is so broad. You can be really unusual and eccentric and still not be ill and not have schizophrenia.

When you have someone with schizophrenia, however, you perceive symptoms through behaviour, and most adolescents aren't terribly verbal with their parents during this time - even if you have the best relationship in the world.

2. Are there any obvious signs that a parent should pay attention to?

Even the best parents would be hard-pressed to notice the changes immediately. It isn't like the child goes to bed one night and then wakes up the next morning changed.

Normally, parents might look back and say, "You know, the last couple months, so-and-so has been really withdrawn, staying in their room, not wanting to come and eat with us or spend time with us." But that can be normal too, and that doesn't necessarily mean a person has schizophrenia.

Often the symptoms that will be very evident would be what we call the positive symptoms. These include hallucination, hearing things that aren't there, seeing things, smelling, tasting, something that's perceived through the senses that isn't there. Big clues include if the person just stops eating from things that they don't open themselves (such as milk containers), or if they talk about somebody trying to poison them. Schizophrenia is easier to discover when the clues are obvious.

3. Has the treatment of schizophrenia improved?

In the past you couldn't get a psychiatrist to give a diagnosis of schizophrenia for a teenager, because it had such a negative connotation. Now, the paradigm has shifted and the emphasis is on early diagnosis and treatment. This can make a world of difference.

What we know now that we didn't know ten or fifteen years ago is that each time there is a psychotic episode, there is damage done to a very sensitive part of the brain. As a result of many psychotic episodes, there are cognitive dysfunctions, poor decision making, poor memory, and poor concentration. I'm not saying there may not have been a little bit there to begin with, but you have to avoid the repeated psychotic episodes for the person to have the optimum outcome. We know this now; we didn't know it then. So early treatment really makes a difference.

The old medicines tended to be really toxic stuff. The term you'll hear for the old drugs are the "typical" and the new ones are the "atypical" ones. And the atypical ones, there're a hundred times better. But even they are not perfect, so it's not like we have something that can take away the symptoms. We have drugs now that help the person manage the remaining symptoms.

4. What are the concerns with the newer drugs?

They do have side effects and you need to be careful. Olanzapine, for example, can cause some people to gain weight and increase their glucose.

For parents and families, the immediate thing is to get the psychosis under control. And that's what I explain to people, "Maybe we'll just take this medicine for two months and then we'll switch to something else, but you have to get those symptoms under control quickly. You don't have the luxury of time and you do need medicine." There's no longer any though of letting the person just get through it and hope for the best.

5. How hard is it for families to make sure that a loved one stays on medications?

This is the main problem. It's an issue of power and control. Some family members think that, "Okay, you're on medicine now. This is over. We can move on with our lives, we don't want to talk about it any more." Other family members see all medications as drugs and evil, especially if there's any kind of chemical dependency history in the family.

We have to find what the best treatment is, and we have to make some adaptations in our life. And I try to get them to think of it like a vitamin. A vitamin doesn't cure you of anything, but a vitamin can help build up your stamina and it can build up your defenses against illness. Ultimately, it's the person's decision. I just try to give them the information and I tell them, "If I were in your shoes or if this were my child, this is what I would do."

6. How do you handle someone who is hallucinating?

It would be the equivalent of a heart attack to me. Often, people see these behaviors as a matter of choice and really are not aware of what's going on inside the person. What they would need immediately from the parents would be the same thing as calling 911 if your kid clutched their chest and keeled over: it's a medical emergency.

7. Could a parent do anything to comfort the child?

You try to make the person feel safe. They may perceive their family members as the enemy and may not be clear on what the family member wants to do by taking them to a psychologist, a clinical nurse specialist or a psychiatrist for an evaluation. They may feel even more threatened.

A lot of times, the way these young people get their first treatment is they really have to be taken to a psychiatric hospital against their will, which is horribly traumatic. It's just a devastating way to start, but that's what happens sometimes, unfortunately.

8. Is there any place a family can turn to for help?

I advise everyone to get in contact with the National Alliance for the Mentally Ill (NAMI). They are a wonderful resource for advocacy and education and they hold family group therapy sessions. It's helpful if they can find someone who they can trust, someone accessible that can help them through this process, because everybody needs help. The patient needs help, but the family needs help too. And I would say, most times, people haven't a clue about schizophrenia, and they think it's like the measles; that you get over it.

We have to be positive, especially with the new medicines. But I would say, for the most part, if you can keep the psychotic exacerbations to a minimum, the odds are greatly increased for leading a more normal life.