Mental Health Problems

Tourette Syndrome

Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics.

The first symptoms of TS are almost always noticed in childhood.

Between 1 and 10 children per 1,000 have Tourette’s and as many as 10 per 1,000 people may have tic disorders.

Some of the more common tics include:

  • Eye blinking and other vision irregularities
  • Facial grimacing
  • Shoulder shrugging
  • Head or shoulder jerking

Perhaps the most dramatic and disabling tics are those that result in self-harm such as:

  • Punching oneself in the face
  • Vocal tics
    • Coprolalia – uttering swear words
    • Echolalia – repeating the words or phrases of others

Many with TS experience additional neurobehavioral problems including:

  • Inattention
  • Hyperactivity
  • Impulsivity
  • Obsessive-compulsive symptoms
    • Intrusive thoughts/worries
    • Repetitive behaviors

Although TS can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood. As a result, some individuals may actually become symptom free or no longer need medication for tic suppression.

Because tic symptoms do not often cause impairment, the majority of people with TS require no medication for tic suppression. However, effective medications are available for those whose symptoms interfere with functioning. There is no one medication that is helpful to all people with TS, nor does any medication completely eliminate symptoms. Effective medications are also available to treat some of the associated neurobehavioral disorders that can occur in patients with TS.

Seasonal Affective Disorder

Seasonal affective disorder (SAD) is a form of depression that occurs during specific seasons, most commonly during the fall and winter. However, the condition can occur at any time of the year, including during the summer. People who get the mood disorder have normal mental health throughout most of the year and experience depressive symptoms around the same time repeatedly, year after year.

The incidence of the condition varies with geography. For example, it tends to be more common in the northern or polar regions.

The cause of SAD is not yet known, but it’s believed to be related to the availability of sunlight. Light affects your internal body clock, which helps you regulate when to sleep and when to be awake. Some scientists believe that a fluctuation in the body’s production of melatonin, a hormone that helps induce sleep, might be the cause of SAD. Other researchers speculate that a lack of serotonin, a brain chemical or neurotransmitter that seems to be triggered by sunlight, is the cause of SAD. People who are depressed often have decreased levels of serotonin in their brains.

Common symptoms of SAD include:

  • Excessive sleep
  • Inactivity and low energy levels
  • Negative feelings and depression
  • Increased appetite
  • Weight gain
  • Headaches
  • Anxiety
  • Self-imposed isolation

If you are diagnosed with seasonal affective disorder (SAD), your doctor may choose one of several approaches to your treatment.

  • Light Therapy — Short periods of exposure to light can help ease depression. Doses of sunlight are measured in “lux.” For example, the sun emits about 90,000 lux and blue sky reflects about 45,000 lux. Treatments could range from two hours of light at 2500 lux every morning to 30 to 40 minutes of light at 10,000 lux every morning. However, light therapy in the evening may interrupt sleep patterns.There are few, if any, side effects to the eyes from using light therapy. Sometimes, an hour walk in the morning can help without any other treatment.
  • Medication — Your doctor may prescribe an antidepressant in combination with light therapy or if light therapy isn’t effective. Antidepressants often are used when the condition occurs in the summer.
  • Psychotherapy — Psychotherapy may help you identify ways to avoid behaviors or environments that tend to trigger episodes of SAD, or to reduce stress in your life, which may worsen the symptoms.
  • Carefully timed supplementation of the hormone melatonin.

In addition to the treatments described above, there are a number of things you can do to help your body cope with seasonal depression. For example, try increasing the amount of light in your home or workplace by opening window shades. Increase your physical activity as exercising regularly can help relieve stress. Also, you may want to consider visiting a warm, sunny place during the winter, such as vacationing in a tropical location.

Klüver-Bucy Syndrome

Klüver-Bucy syndrome is a rare behavioral impairment that is associated with damage to both of the anterior temporal lobes of the brain. The amygdala has been a particularly implicated brain region in the pathogenesis of this syndrome.

The disorder may be associated with herpes encephalitis and trauma, which can result in brain damage. Other conditions may also contribute to a diagnosis of Klüver-Bucy syndrome, including:

  • Alzheimer’s Disease
  • Ischemia
  • Anoxia
  • Progressive subcortical gliosis
  • Rett syndrome
  • Porphyria
  • Carbon monoxide poisoning

It causes individuals to put objects in their mouths and engage in inappropriate sexual behavior. Other symptoms may include:

  • Visual agnosia (inability to visually recognize objects)
  • Loss of normal fear and anger responses
  • Memory loss
  • Distractibility
  • Seizures
  • Dementia

It is rare for humans to manifest all of the identified symptoms of the syndrome; three or more are required for diagnosis.

There is no cure for Klüver-Bucy syndrome. The disorder is not life-threatening, but the patient can be difficult to manage. With treatment, symptoms may slowly decline.

Treatment is symptomatic and supportive, and may include drug therapy.

Depression

Depression is an illness that causes you to feel sad, to lose interest in activities that you’ve always enjoyed, to withdraw from others, and to have little energy. It’s different from normal feelings of sadness, grief, or low energy. Depression can also cause people to feel hopeless about the future and even to think about suicide.

Many people, and sometimes their families, feel embarrassed or ashamed about having depression. Don’t let these feelings stand in the way of getting treatment. Remember that depression is a common illness. Depression affects the young and old, men and women, all ethnic groups, and all professions.

If you think you may be depressed, tell your doctor. Treatment can help you enjoy life again. The sooner you get treatment, the sooner you will feel better.

Depression is a disease. It’s not caused by personal weakness and is not a character flaw. When you have depression, chemicals in your brain called neurotransmitters are out of balance. Most experts believe a combination of family history and stressful life events may cause depression.

Life events can include:

  • Childbirth, a death in the family, work, or relationships.
  • Finding out you have a long-term health problem, such as arthritis, heart disease, or cancer.
  • Health problems, such as anemia and an underactive thyroid gland (hypothyroidism).

Treating the health problem can usually cure the depression.

Just because you have a family member with depression or have stressful life events doesn’t mean you’ll get depression. You also may get depressed even if there is no reason you can think of.

The symptoms of depression may be hard to notice at first. They vary among people, and you may confuse them with just feeling “off” or with another health problem.

The two most common symptoms of depression are:

  • Feeling sad or hopeless nearly every day for at least 2 weeks.
  • Losing interest in or not getting pleasure from most daily activities nearly every day for at least 2 weeks.

A serious symptom of depression is thinking about death or suicide. If you or someone you care about talks about this or feeling hopeless, get help right away.

You also may:

  • Lose or gain weight. You also may feel like eating more or less than usual almost every day.
  • Sleep too much or not enough almost every day.
  • Feel restless and not be able to sit still, or you may sit quietly and feel that moving takes great effort. Others can easily see this behavior.
  • Feel tired or as if you have no energy almost every day.
  • Feel unworthy or guilty nearly every day. You may have low self-esteem and worry that people don’t like you.
  • Find it hard to focus, remember things, or make decisions nearly every day. You may feel anxious about things.

If you have some of these symptoms for at least 2 weeks, talk to your doctor. Treatment may be right for you.

Depression can be treated in various ways. Counseling, psychotherapy, or antidepressant medicines may be used. Two or all of these treatments may also be combined. Lifestyle changes, such as getting more exercise, also may help. Your doctor or mental health professional will help you find the best treatment.

If you have mild or moderate depression, your family doctor or a mental health professional, such as a counselor or psychologist, may treat you. If you have severe depression or if treatment is not helping, you may need to see a psychiatrist. Some people need to be treated in the hospital, especially if they have thoughts of suicide.

Work with your health care team to find the best treatment for you. It may take a few tries, and it can take several weeks for the medicine to start working. Try to be patient and keep following your treatment plan.

Depression can relapse. How likely you are to get depression again increases each time you have a bout of depression. Taking your medicines and continuing some types of therapy after you feel better can help keep that from happening. Some people need to take medicine for the rest of their lives. This does not stop them from living full and happy lives.

Let your doctor know if you think you are depressed. Depression is easy to overlook. The earlier you are treated, the more quickly you will get better.

Suicide

Many people who have depression have thoughts of death or thoughts of suicide, and depression can lead to suicide. Learn the warning signs of suicide, which include:

  • Talking, writing, reading, or drawing about death, including writing suicide notes and talking about items that can harm you, such as pills, guns, or knives
  • Giving things away
  • Using a lot of alcohol or drugs or both
  • Planning to harm yourself or others
  • Buying guns or bullets, stockpile medicines, or take other action to prepare for a suicide attempt. You may have a new interest in guns or other weapons
  • Hearing or seeing things that aren’t real
  • Thinking or speaking in a bizarre way that is not like your usual behavior

If a suicide threat seems real, call 911, a suicide hotline, or the police. Stay with the person, or ask someone you trust to stay with the person, until the crisis has passed. Don’t argue or challenge the person. Tell the person you don’t want him or her to die.

Attention Deficit-Hyperactivity Disorder

Attention deficit-hyperactivity disorder (ADHD) is a neurobehavioral disorder that interferes with a person’s ability to stay on a task and to exercise age-appropriate inhibition (cognitive alone or both cognitive and behavioral).

ADHD affects 3-5 percent of all North American children. ADHD is usually diagnosed in childhood, although the condition can continue into the adult years.

Some of the warning signs of ADHD include:

  • Failure to listen to instructions
  • Inability to organize oneself and school work
  • Fidgeting with hands and feet
  • Talking too much
  • Leaving projects, chores and homework unfinished
  • Having trouble paying attention to and responding to details

There are several types of ADHD: a predominantly inattentive subtype, a predominantly hyperactive-impulsive subtype, and a combined subtype.

There is no “cure” for ADHD. Children with the disorder seldom outgrow it; however, some may find adaptive ways to accommodate the ADHD as they mature.

The usual course of treatment may include medications such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine), which are stimulants that decrease impulsivity and hyperactivity and increase attention.

Most experts agree that treatment for ADHD should address multiple aspects of the individual’s functioning and should not be limited to the use of medications alone. Treatment should include:

  • Structured classroom management
  • Parent education (to address discipline and limit-setting)
  • Tutoring
  • Behavioral therapy for the child

Williams Syndrome

Williams syndrome (WS), also Williams–Beuren syndrome, is a developmental disorder that affects many parts of the body. This condition is characterized by mild to moderate intellectual disability or learning problems, unique personality characteristics, distinctive facial features, and heart and blood vessel (cardiovascular) problems.

Williams syndrome affects an estimated 1 in 7,500 to 20,000 people.

Williams syndrome is caused by the deletion of genetic material from a specific region of chromosome 7. The deleted region includes more than 25 genes, and researchers believe that a loss of several of these genes probably contributes to the characteristic features of this disorder.

Most cases of Williams syndrome are not inherited, but occur as random events during the formation of reproductive cells (eggs or sperm) in a parent of an affected individual. These cases occur in people with no history of the disorder in their family.

Williams syndrome is considered an autosomal dominant condition because one copy of the altered chromosome 7 in each cell is sufficient to cause the disorder. In a small percentage of cases, people with Williams syndrome inherit the chromosomal deletion from a parent with the condition.

People with Williams syndrome typically have difficulty with visual-spatial tasks such as drawing and assembling puzzles, but they tend to do well on tasks that involve spoken language, music, and learning by repetition (rote memorization). Affected individuals have outgoing, engaging personalities and tend to take an extreme interest in other people. Attention deficit disorder (ADD), problems with anxiety, and phobias are common among people with this disorder.

Young children with Williams syndrome have distinctive facial features including:

  • A broad forehead
  • A short nose with a broad tip
  • Full cheeks
  • A wide mouth with full lips
  • Small, widely spaced teeth and teeth that are crooked or missing

In older children and adults, the face appears longer and more gaunt.

A form of cardiovascular disease called supravalvular aortic stenosis (SVAS) occurs frequently in people with Williams syndrome. Supravalvular aortic stenosis is a narrowing of the large blood vessel that carries blood from the heart to the rest of the body (the aorta). If this condition is not treated, the aortic narrowing can lead to shortness of breath, chest pain, and heart failure. Other problems with the heart and blood vessels, including high blood pressure (hypertension), have also been reported in people with Williams syndrome.

Additional signs and symptoms of Williams syndrome include:

  • Abnormalities of connective tissue (tissue that supports the body’s joints and organs) such as joint problems and soft, loose skin
  • Increased calcium levels in the blood (hypercalcemia) in infancy
  • Developmental delays
  • Problems with coordination
  • Short stature
  • Medical problems involving the eyes and vision
  • Problems with the digestive tract
  • Problems with the urinary system

There is no cure for Williams syndrome. Treatment begins with cardiology evaluations, developmental and psychoeducational assessment. Patients should avoiding taking extra calcium and vitamin D, and treating high levels of blood calcium, if present. Blood vessel narrowing can be a significant health problem as well, and is treated on an individual basis. Physical therapy is helpful to patients with joint stiffness. Developmental and speech therapy may also be beneficial.

Binge Eating Disorder

Binge eating means eating large amounts of food in a short time. A person with binge eating disorder binges regularly for several months. When you binge, you feel like you can’t control your eating, and you feel unhappy about it afterward.

Binge eating disorder is not the same thing as bulimia. Unlike bulimia, if you have binge eating disorder, you don’t vomit or try other ways to get rid of calories. But you might try to limit how much food you eat between binges. Binge eating disorder is sometimes called compulsive overeating.

Binge eating disorder most often starts in the late teens or the young-adult years. It is more common in women than men. About 3 out of 100 females in North America have it. And experts estimate that 25 out of 100 people who are obese have it.

Experts are not sure what causes binge eating disorder, but it seems to run in families. Experts think that cultural attitudes about body shape and weight also play a role.

Binge eating disorder can be triggered by dieting, depression, or anxiety. It can even start because of boredom or stress, which is then relieved by binging. Your risk for binge eating increases if:

  • You or your parents are overweight.
  • You are a perfectionist. This means that you feel like you have to do everything exactly right all the time.
  • You have a poor body image, which means that you don’t like the way your body looks.
  • You live in a culture that values being thin.

Some people who binge have a normal weight. But over time, many people who have binge eating disorder gain weight and have problems from being obese. People with binge eating disorder also often have depression, anxiety, or other emotional problems.

Having an eating disorder is not a sign of weakness or a character flaw. And it is not something you can overcome with just willpower. Many people struggle with eating disorders for a long time. Some people try to keep it a secret or deny that they have a problem.

From time to time, most of us feel like we have eaten more than we should. But eating too much every now and then does not mean that you have binge eating disorder. If you have binge eating disorder, you may:

  • Eat way too much in a short period of time (less than 2 hours) on a regular basis.
  • Eat when you are not hungry, to ease stress or to comfort yourself.
  • Eat for emotional reasons, such as being sad, angry, lonely, or bored.
  • Feel like you can’t stop eating.
  • Eat faster than normal when you binge.
  • Eat so much that you feel painfully full.
  • Feel unhappy, upset, guilty, or depressed after you binge.
  • Eat alone because you are embarrassed about how much you eat.

Even if you don’t have all the symptoms of binge eating disorder, having even a few symptoms can be a sign of a problem that needs treatment. It is important to get help right away if you or someone you know has any of these symptoms.

In most cases, you will need treatment to get better. If you have binge eating disorder, treatment can prevent health problems, help you feel better about yourself, and improve the quality of your life.

Treatment for binge eating disorder includes getting counseling and, in some cases, taking medicine such as antidepressants. Your doctor may have you do both. You may need treatment for a long time to fully recover.

You also may need treatment for other problems that often occur with binge eating disorder. These can include: