Category: Panic Disorder

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By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief of Adult Psychiatry

May is Maternal Mental Health Awareness Month.  One in five women will develop a maternal mental health disorder.  They are also referred to as perinatal mood and anxiety disorders (PMADs) to emphasize that women experience more than postpartum depression during pregnancy and after birth.  Women who have symptoms of PMADs might not seek help because of guilt, shame, or embarrassment for feeling something different than the expected norms of motherhood.  Awareness and education are important to reduce stigma so mothers and babies get the help they need.

PMADs can occur during pregnancy or up to one year after giving birth. The most common PMAD is the “baby blues”, affecting up to 80% of new mothers.  Symptoms include sudden mood swings, loneliness, sadness, crying spells, loss of appetite, problems sleeping, irritability, restlessness, and anxiety.  These symptoms are a normal adjustment to changes in hormones and resolve without treatment in two to three weeks.

About 10% of women experience depression during pregnancy and about 15% during the first year postpartum.  Feeling sad, hopeless, helpless, or worthless; fatigue, difficulty sleeping or sleeping too much, appetite changes, difficulty concentrating, crying, loss of interest or pleasure; lack of interest in, difficulty bonding with, or excessive anxiety about the baby; feelings of being a bad mother, and fear of harming the baby or self are symptoms of peripartum depression.  Risk factors include poverty, being a teen mother, advanced maternal age; personal or family history of depression, anxiety, or postpartum depression; premenstrual dysphoric disorder, inadequate support, financial stress, relationship stress; complications in pregnancy, birth or breastfeeding; a history of abuse or trauma, a major recent life event, birth of multiples, babies in neonatal intensive care, infertility treatments, thyroid imbalance, and diabetes.

Anxiety can occur alone, or with depression, in 10% of new mothers.  Symptoms include constant worry, racing thoughts, inability to sit still, changes in sleep or appetite, feeling that something bad is going to happen; and physical symptoms like dizziness, hot flashes, and nausea.  Some mothers may also have panic attacks with shortness of breath, chest pain, dizziness, a feeling of losing control, and numbness and tingling.  Risk factors are a personal or family history of anxiety, previous perinatal depression or anxiety, and thyroid imbalance.

Post-traumatic stress disorder (PTSD) can occur in up to 6% of mothers following a traumatic childbirth.  Possible traumas are prolapsed cord, unplanned C-section, use of vacuum extractor or forceps to deliver the baby, baby going to NICU; and feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery.  Women who have experienced a previous sexual trauma are also at a higher risk for developing postpartum PTSD.  Intrusive re-experiencing of the traumatic event, flashbacks or nightmares; avoidance of stimuli associated with the event; increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response); anxiety and panic attacks, and feeling a sense of unreality and detachment are symptoms of PTSD.

Obsessive-compulsive disorder (OCD) can occur in 3% to 5% of new mothers.  Obsessions are persistent, repetitive thoughts or mental images, often related to the baby. Obsessions can be so bizarre or disturbing that they can be mistaken as psychosis.  Compulsions are repetitive acts performed to reduce obsessions.   Mothers are distressed by the obsessions which can lead to a fear of being left alone with the baby or hypervigilance in protecting the baby.  Mothers with postpartum OCD know that their thoughts are out of the ordinary and are unlikely to ever act on them.

Postpartum psychosis is the most severe of the PMADs.  It is often associated with an episode of bipolar disorder. It is rare, occurring in 1 to 2 per 1000 women.  The onset is abrupt, within 48 to 72 hours and up to two weeks after delivery. This is a psychiatric emergency, requiring immediate treatment.  Mothers may experience hallucinations (hearing voices or seeing things) and/or delusions (believing things that aren’t true.)  If psychosis occurs as part of a bipolar manic episode, there might be additional symptoms such as irritability, hyperactivity, decreased need for or inability to sleep, paranoia and suspiciousness, rapid mood swings, difficulty communicating, and confusion or memory loss. Risk factors are a personal or family history of bipolar disorder or a psychotic disorder.  Most women with postpartum psychosis do not have violent delusions but there is an up to 5% rate of infanticide or suicide due to acting on delusions or having irrational judgement.

PMADs are the most common complication of pregnancy and childbirth.  They are treatable with psychotherapy and/or medication and early intervention provides relief for the mother and ensures the baby’s wellbeing.

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BY: Elizabeth Wassenaar, MS, MD, Lindner Center of HOPE, Staff Psychiatrist and Medical Director of Williams House

 

Life can be overwhelming and we all would like to take a day off every once in a while. Likely, as helping professionals, we don’t take mental health days as often as we could actually benefit from them.  This is one of the reasons why, when a child or adolescent refuses to go to school, we may be initially sympathetic.  Maybe a day or two off will help, we may think.  In too many cases, however, we see that a day or two off turns into something much more problematic as parents and professionals struggle to get a school avoider back to school.  Homework piles up, grades start to fall, and friends wonder what has happened to their classmate.  Parents try many different tactics to try to get their child back to school; bribing, negotiating, punishing, or even carrying a child through the school door.

Children want to not go to school for many reasonable causes: kids can be cruel; learning can be difficult; anxiety about performance can be overwhelming; health concerns can require special privileges that feel too identifying; and getting up early in the morning is harder for some more than others. Furthermore, mental illness can make school attendance difficult for many additional reasons.  There are good reasons to keep children home from school – physical illnesses can be contagious, some stages of mental illness are better treated with mental rest, and in some cases of bullying the safest way to deal with an unsafe situation is to remove the child.

Nevertheless, school refusal is avoidance, and anxiety loves avoidance. Nothing is more reinforcing that one cannot handle something than not doing it.  So, after one has checked on physical health and for other explanations, how can professionals support parents to keep their children in school or break the cycle of school avoidance and school refusal?

  1. Help parents identify the behaviors of avoidance and link that to anxiety.

Avoidance is a coping mechanism for dealing with anxiety, which can become maladaptive when avoidance becomes the only options. Avoidance can look a lot of different ways –tantrums, tearfulness, vague physical symptoms, negotiation (more on that later), chaos, and so on.  Parents may not be able to recognize all of the forms avoidance can take. Helping them objectify avoidance will help them strategize on how to deal with it.

  1. We have to truly believe that avoiding school will not make it better.

It can be tempting to collude with anxiety that the precipitant needs to be avoided for all the reasons laid out in this article and we need to be internally convinced that anxiety is not correctly assessing the situation. As difficult as school can be, school occupies a unique place in a child’s life.  It is the place of work, play, and love.  Learning and playing are the main jobs of childhood.  Playing looks both like playing at recess and like experimenting in relationships with both friendship and love. Identity is formed and reformed through our work, play, and love.  When a child is not in school for an extended length of time, they are abrupting their opportunity for this developmental process to proceed.

  1. Negotiation is another way of avoiding and is a dangerous game.

Many of my patients have used a variety of negotiating tactics with their parent: “Let me go in later and then I’ll go, I promise” or “Let me catch up on my work today and I’ll go in tomorrow”. Small avoidances add up to large avoidance and are not moving towards your goal.  Reverse the negotiation and set up conditions that will allow an out as long one starts the day at school.  Often, once anxiety has lost its argument that one cannot handle going to school, staying in school through the day is easier to manage.

  1. Encourage parents to work with the school

Parents and school are on the same side of this concern – both parties want the child to be successful in school. For parents, this may be the first time dealing with school refusal, but it is most certainly not the first time the school has dealt with school refusal.  Most schools have a variety of plans to help keep a child in school.  Have parents reach out to the school and let them know what is going on.

  1. Set small goals that lead to the victory

The ultimate goal of full school participation is an overwhelming prospect. Depending on how severe the school refusal is, reintroducing school can be an extended process of gradually introducing larger and larger challenges.  Perhaps, on the first day, one can only walk through the school doors.  Maybe a student will be able to be in the school building, but not in classes.  Parents can engage trusted friends to provide motivation and encouragement through social interaction and distraction while at school.

  1. School has many different forms

Many families choose alternative school arrangements including home schooling, virtual schooling, and others, for a variety of reasons and this article is not meant to convict choices that do not have a child in a classroom every day. There are many viable options for school that provide an environment that promote healthy development.  When a family is making a decision to change the way school is delivered, help them examine what factors are involved in their decision.  If they are making the decision from a place of believing that the anxiety that drives school avoidance cannot be defeated then, help them with all the ways described above.

School is a venerable and sometimes dreaded rite of passage. A great deal rides on academic and social success in school which increases anxiety and can lead to school refusal.  As a team, parents, professionals, and schools can help keep children and adolescents in school and accomplishing their goals.

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On October 28, 2015, Dr. Elizabeth Wassenaar, Lindner Center of HOPE Psychiatrist and Williams House Medical Director, joined Lon Woodbury on the Woodbury Report radio show.  Their discussion focused on outlining the benefits of a residential assessment for mental health concerns in adolescents.

Click here to listen.

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When the subject of disabilities surfaces in our thoughts or conversations, it is common to first consider those caused by some type of physical ailment or affliction. Conditions such as arthritis, heart disease and back problems are certainly primary causes of long-term disabilities in our nation. However, mental illness is the leading cause of disability in U.S. citizens ranging in ages from 15 to 44, according to National Institute of Mental Health (NIMH) statistics.

What these numbers show is that many Americans and people around the world are affected by illnesses such as depression, bipolar disorder, schizophrenia and a host of other mood and anxiety disorders in the prime of their working lives. Unfortunately, these numbers show no sign of subsiding anytime soon. In fact, they continue to rise, as do the number of filings with the U.S. Social Security Administration (SSA) for disability benefits due to mental illnesses.

The SSA and Mental Illness Claims

The SSA has established specific criteria that qualify those suffering with mental disorders for disability benefits. Basically, it must be determined that an existing mental condition limits or impairs one’s ability to fulfill their work obligations. In most situations, assessments and evaluations must be performed by mental health professionals. Additionally, evidence must be submitted to the SSA that indicates the individual in question is unable to perform their assigned job duties as a consequence of their condition.

Getting Back on their Feet

It is important for those with mental health issues to make their employers aware of their situation. All too often, workers are hesitant or afraid to address their condition with their employers for fear of negative repercussions. But behavioral or productivity problems could lead to termination, which also often results in the loss of insurance, creating even more problems for these individuals in regard to receiving treatment.

When documented mental health issues are reported to an employer, they are obligated under Americans with Disabilities Act (ADA) regulations to accommodate that employee with whatever they need to successfully perform their job duties, or to make their working situation as comfortable as possible. In lieu of applying for disability benefits, this can allow an employee to continue to work while receiving mental health treatment and take measures that will eventually enable them to effectively manage their condition.

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This blog is written and published by Lindner Center of HOPE.

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Everyone seems to have busy schedules these days and stress is something nearly everyone suffers from as a result of it. Luckily, there are several things we can do to relieve stress in our everyday lives.

Massage. Getting a massage is a great way to relieve stress. It’s a way to relax your muscles, reduce pain, and improve circulation, which puts you in a mental and physical state for relaxation.

Meditation. From 15-30 minutes each day, meditation can serve as a great stress reliever. To meditate, give yourself some quiet time to let your thoughts run wild or to simply focus on your breathing. This small section of peace in your day can help you deal with stress, and perhaps relieve some.

Exercise. No matter what the physical activity is, this allows you time alone with your thoughts, while at the same time, releases endorphins to the brain, which make you feel better. Physical exercise also prevents obesity and additional health problems, which gives you less to be stressed about.

Organization. When you’re organized, you have greater peace of mind. The mind can rest when you know everything is in its proper place, and when things are clean. Even the sight of clutter has been said to cause stress, so tidy up!

Eating healthy. Foods that are high in fat or sugar have proven to be a source of depression. Some foods, including blueberries, salmon, and almonds, are said so be especially effective in reducing stress. It’s also a good idea to avoid caffeine after lunch so you can get a good night’s rest.

Disconnect. Letting go of your cell phone or lowering your internet use can lower stress by blocking some of the sources of stress. So turn off your electronics and live in the moment for a little while.

By following these easy ways to relieve stress, you’ll find yourself less tense and better able to tackle daily challenges.

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This blog is written and published by Lindner Center of HOPE.

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As most parents are well aware, the teen years can be trying and tumultuous times for both the adolescent and the adults in their lives. When a parent watches their once happy-go-lucky, gregarious child transforms into a moody teen, it can be a disquieting and often somewhat bewildering experience. Although moodiness is quite normal in teens, parents must also stay alert for signs of depression during their child’s adolescent years.

As a child moves through puberty, their bodies and brains undergo a series of rapid changes. Coupled with societal and peer influences — and depending on the environment at home — this can be a confusing and difficult period for an adolescent, often marked by anxiety and even moments of despair. But in normal situations, although they will surface from time to time, these symptoms come and go and are usually short-lived as the teen continues to progress toward achieving a balance in their life.

Signs of Depression

Teen depression affects approximately 10 to 15 percent of adolescents. Signs of potential sufferers of adolescent depression include:

– a persistent sad and melancholy demeanor

– expressed feelings of worthlessness or hopelessness

– constant fatigue

– hints at thoughts of suicide.

If left unaddressed, this affliction can have dire consequences. In fact, suicide is the third leading cause of death in teenagers.

Differences in Teen and Adult Depression

A number of contrasts exist between depression symptoms in adolescents and adults. For instance, adults will often withdraw from those around them and become more isolated. However teens, while withdrawing to a degree from the adults in their lives, will often continue to associate with their close friends.

Though a depressed teen may experience changes in sleeping patterns, they will still find time to sleep, even at odd hours. Adults are more prone to experience insomnia when they are depressed. In addition, depressed adolescents will generally express their feelings and emotions through anger and irritability, as opposed to depressed adults who are often more sad and withdrawn.

Parents must remain vigilant and “in-tune” with their child’s behaviors and attitudes throughout their teen years. If problems exist that appear to go beyond what is expected of the “normal” adolescent, parents should not hesitate to contact a mental health professional for advice.

Through expert diagnosis and counseling, and possibly the administration of anti-depressant medications, adolescent depression can be successfully treated, paving the way toward a healthy, productive adult life.

Click here to learn more.

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This blog is written and published by Lindner Center of HOPE.

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The prevalence of the “quarterlife crisis” – essentially, a midlife crisis that occurs in your 20s – seems to be on the rise.

Many young people experience some degree of stress, self-doubt and lack of motivation upon entering the “real world” after college. However, the phenomenon of the quarterlife crisis seems to be increasingly common as fewer young adults reach the traditional milestones of success, though pressures to achieve them remain the same.

Research shows that up to 86 percent of young adults feel pressure to succeed in careers and relationships by the time they reach age 30. However, only 11 percent actually attain conventional markers of achievement such as obtaining a steady job, getting married and having children by their 30th birthday. Likely due to this discrepancy, up to 73 percent of 26 to 30 year olds may experience a quarterlife crisis.

So what are some things you can do to deal with a quarterlife crisis? Experts say it’s important to redefine your idea of success and stop comparing yourself to others. Instead of despairing over why you don’t have your dream job or the perfect relationship, try defining success by what you have to offer others. Try volunteering and other skill- and character-building activities. Remember that life is not a race and that everyone is on their own path.

Dr. Paul E. Keck, Jr., President and CEO of Lindner Center of HOPE, recently gave a talk on this subject on LA Talk Radio’s Answers 4 the Family radio show. Check out Dr. Keck’s talk, “Failure to Launch – What’s Really Holding Back Emerging Adults?”

In some cases, quarterlife crises may lead to anxiety, depression, eating disorders or even addictive disorders. If you or a twenty-something family member is displaying signs of a psychological or addictive disorder, it’s important they receive prompt and effective treatment. Contact Lindner Center of HOPE for more information on screening and treatments for mood disorders and other conditions.

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This blog is written and published by Lindner Center of HOPE.

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Everyone experiences some level of worry or anxiety from time to time. But when that worry or anxiousness becomes overwhelming or subsists for long periods of time, there may be a deeper issue at hand.

In a given year, anxiety disorders affect roughly 18 percent of Americans over the age of 18, according to the National Institute of Mental Health (NIMH). Following are descriptions of some of the more prominent anxiety disorders:

Panic Disorder: A panic attack is a brief period of intense uneasiness, fear or distress. The duration of these attacks can range anywhere from minutes to a few hours. While the cause is not completely clear, it is thought that the tendency toward panic attacks could be genetic or linked to a traumatic occurrence in an individual’s life. Those suffering from panic disorders display an inability to properly process stressful situations and therefore react to them with a heightened sense of fear and apprehensiveness.

Obsessive-Compulsive Disorder (OCD): Those suffering with OCD are bombarded with persistent thoughts and fears usually focusing on one area. They develop repetitive behaviors in an attempt to “control” the things causing their fears, and end up becoming obsessed with their rituals.

Post-Traumatic Stress Disorder (PTSD): PTSD is the result of a terrifying or traumatic event in one’s life where they will re-experience the event and react with intense fear, anger, anxiety or even numbness. These episodes are usually brought about by exposure to a situation, thought or image reminding them of the original experience.

A combination of psychotherapy, behavior modification and medications are used for OCD treatment, PTSD treatment and the treatment of most other anxiety disorders. Mental health professionals continue to gain a better understanding of anxiety-related disorders, which has resulted in more effective methods of therapy.