How can I recognize a possible mental illness?

How can I recognize a possible mental illness? April 17, 2013

I began to explain the distinction between mental illnesses and disorders (including developmental disorders) last week. Today I will return to this discussion, with an explanation of how we can be a part of screening for mental illnesses, even if we have had no formal training.

This post has as its aim to encourage you to seek medical help for yourself or others rather than suffer in silence. As I began to explain in “Can a Christian Get Depressed?” we must get seek to eradicate all stigma associated with mental illness. Many of these conditions have treatments that can often alleviate the symptoms dramatically. But we will not address treatment today, not least because treatment is really rather complex.

The key to understanding the psychiatrist’s way of thinking about a mental illness is that these illnesses are episodic. In other words as a minimum they vary in their intensity, but in many cases it can even seem as if the illnesses go away altogether between what some call “breakdowns.” So, a developmental disorder, such as Autism, is not considered a mental illness because it has been present since birth (though often only recognized in the third or forth year of life). Also, a personality disorder is not considered a mental illness because its effects are again lifelong, pervasive and continual. I will not discuss personality disorders in this series much, except to say that some doctors are a little too eager to reach for that diagnosis in explaining odd behavior and symptoms. Really, it should be a careful diagnosis that first excludes treatable mental illnesses, since often people would include “untreatability” as part of the definition of a personality disorder.

What all this means is that people with a mental illness may not show many or any signs of that for much of their life. Thus, it can be a terrible shock when what can be very dramatic symptoms occur “out of the blue.”

Because, my goal here is not to turn you into a psychiatrist, let me focus on symptoms you should be aware of, and that should lead to you encouraging the person suffering to seek medical help:

1. Mood symptoms

The presence of any of the following symptoms may indicate the need to get an assessment for a possible diagnosis of a depressive episode. Note that you do not have to have all of these symptoms to have depression (see DSMIV criteria on which this is based):

  • A clear and persistent change of a persons normal mood that is unexplainable and is not responsive to changes around the person. What I mean by that is that we all have transient feelings of low mood, whereas depression represents a persistant low mood that in its most extreme form cannot be lifted by positive events such as hearing a good joke being told, or getting good news. This may actually feel more like an emptiness of mood or an inability to feel. Some people may feel guilty because they feel they “ought” to be happy, and yet cannot.
  • A lack of interest in, or perceived ability to perform, normal daily activities such that doing things becomes an effort. In some more extreme cases people may take to their beds and be unable to do any tasks.
  • A change in appetite (increased or decreased) leading to a change in weight (up or down) that is not explained by dieting efforts.
  • A significant increase or decrease in the amount of sleep taken. In particular waking up too early in the morning, feeling very tired.
  • A restlessness and excessive energy, or a significant reduction in energy leading to “slugishness“, often associated with fatigue.
  • Feelings of guilt or worthlessness which have no basis in fact, and which do not resolve when forgiveness is sought.
  • An inability to think clearly, concentrate, or make decisions
  • Thoughts of death, wishing to be dead, or the urge to commit self-harm or suicide (more about this in the next post)

People’s mood can also become too “high” or simply too “irritable.” It is vital to a correct diagnosis that the presence of the following symptoms at any point in a person’s life be taken into account. (see also the DSMIV criteria on which this is based)

Again, the following symptoms do not all need to be present for a diagnosis to be made, and non-experts should not attempt to make a diagnosis. It is appropriate, however, for someone to observe the possible presences of some of these symptoms and recommend the person seek medical help, perhaps accompanying them to the appointment:

  • A period of time where a patient appears unusually “high” This means they may be overly excited, with elevated or expansive mood. This kind of mood is hard to describe but like depressed mood has an effect on those witnessing it. At first you may feel the person is just very happy, and they may even appear to be “on top of the world.” But what psychiatrists call mania is every bit as damaging as depression (and in some cases more so). Sometimes the mood state will not seem particulalry happy but rather overly irritable and aggressive. Associated with this are the following, and again even just a couple of these being present may indicate the need for an expert assessment:
  • Inflated self-esteem or grandiosity. Here the person may believe that they are superior to others. They may believe they have a special ability to solve a problem. Self-belief is very important for getting things done, but when it gets excessive can cause all kinds of problems.
  • Decreased need for sleep. This is different from the lack of sleep experienced in depression as people will often still feels rested after for example only 3 hours of sleep. Sometimes there is a total absence of sleep, which can be very disruptive for people around them.
  • More talkative than usual for them, or a pressure to keep talking. This can feel exhausting to people trying to communicate with the person.
  • Speech is hard to follow as it jumps from one subject to another (usually with some connection in the mind of the person, but this may not be clear to the listener).
  • A feeling felt by the person that their own thoughts are racing
  • Distractibility, where things around the person will suddenly be the focus of their attention. Colors may seem more vibrant, sounds more interesting, making focusing on a task or conversation difficult
  • An increase in activity levels (either socially, at work or school, or sexually) or psychomotor agitation.
  • A reduction in inhibitions that lead to “excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)” (DSMIV). This can be especially hard to handle in a Christian context where someone who normally acts in a self-controlled manner may suddenly behave very out of character.

Of course all the above symptoms can vary a lot in their intensity and level of concern. What can start as relatively minor worries can escalate, so it is often a good idea to seek expert help at an early stage.

2. Psychotic symptoms

Psychotic symptoms are essentially alien to most of us. Unlike mood symptoms they do not really sit on a spectrum with normal experience. The only thing I can suggest to help you understand what they feel like, is imagine that moment when you have just woken from a very active, scary, energetic dream. For a few seconds you may believe the dream is real. Imagine feeling something as incredible as a dream was real all day.

Delusions are defined as fixed false or unusual beliefs, that are held with unshakable conviction and that are incompatible with a persons religious or cultural background. These will usually have a personal component to them. Thus, someone who is low in mood may believe that they have an incurable disease despite a clean bill of health from the doctor. They can be sometimes very bizarre. You can ask a person, “Have experienced any thoughts or ideas that have been troubling you, or that others might have considered unusual?” Examples of common delusions include a fixed belief that people are plotting against you, a belief that the TV or radio is communicating to you directly, or that others can put thoughts into your mind.

Hallucinations are defined as experiencing a stimulus that is not present as though it was. People often speak of “hearing voices” when they mean a voice inside their head, or a replay of a conversation they have already had. A hallucination is not recognized as coming from the person, but is “heard” by them as coming from outside. So, during a conversation a person may suddenly turn and answer someone who is not in the room. The auditory hallucinations commonly experienced by patients can speak to them, or can speak about them. They are often very derogatory and frankly offensive.

There can also be other associated symptoms, which can include social withdrawal and certain cognitive difficulties.

3. Anxiety

We all feel anxious at times, but excessive anxiety can be very disabling and can respond to treatment. Sometimes people will be anxious about specific things, other times they will not know why they are anxious. Sometimes “panic attacks” can be very disturbing, and may be hard initially to distinguish from symptoms with cardiac origins. People will sometimes be rushed to ER, only for extensive tests to suggest that anxiety is at the root of the problem. Don’t allow yourself or anyone affected to feel ashamed by this. For the sufferer, and those around them, the symptoms of panic attacks are very concerning, and as is always the case, it is better to seek urgent medical help and be told the all clear than to not go when you should have.

The next post will answer the vital question: What can we do to reduce the risk of suicide?

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