Frequently Asked Questions

How common is mental illness?
Brain and behavior disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older – about 1 in 4 adults – suffer from one or more of these disorders in a given year. Brain and behavior disorders are common among children in the United States and are increasingly being recognized and diagnosed at an early age. Just over 20 percent (or 1 in 5) children live with a debilitating mental illness.

What are the most frequent types of mental illness?
Out of the 10 leading causes of disability identified and tracked in the United States and other developed countries; four are brain and behavior disorders: major depression, bipolar disorder, schizophrenia and obsessive-compulsive disorder.

It is estimated that:

• 18% of American adults will suffer from an anxiety disorder each year
• 7% of Americans will suffer from major depressive disorder each year
• 4% of American adults will suffer from attention deficit/ hyperactivity disorder each year
• 4% of American adults will suffer from post-traumatic stress disorder each year
• 3% of American adults will suffer from bipolar disorder each year
• 1% of American adults will suffer from schizophrenia each year
• 1% of American adults will suffer from obsessive compulsive disorder each year
• 1 in every 110 8-year-old children are diagnosed with an autism spectrum disorder

How are mental health diagnoses made in young children?
Just like adults, children with mental illness are diagnosed after a doctor or mental health specialist carefully observes signs and symptoms. Some primary care physicians can diagnose children, but most will make a referral to a specialist who is better trained in diagnosing and treating children. Before diagnosing a mental illness, the doctor or specialist will try to rule out other possibilities for the symptoms or behaviors causing concern. Generally, the process involves:

• Evaluating the familial history of any important medical problems, including any brain and behavior disorders.
• Tracking the development of current concerns – how long have the symptoms or behaviors been an issue; how the overall development of the child is; etc.
• Creating a personal history for the child: e.g., if any physical or psychological traumas have been experienced; are there any issues at school or with socializing. This history may include input from parents, teachers, and other caretakers.
• In the United State, brain and behavior disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).

Are there early warns signs to look out for before the illnesses reach a critical state?
Early warning signs and symptoms in adults include:

• Confused thinking
• Prolonged depression (sadness or irritability)
• Feelings of extreme highs and lows
• Excessive fears, worries and anxieties
• Social withdrawal
• Dramatic changes in eating or sleeping habits
• Strong feelings of anger
• Delusions or hallucinations
• Growing inability to cope with daily problems and activities
• Suicidal thoughts
• Denial of obvious problems
• Numerous unexplained physical ailments
• Substance abuse

Early warning signs and symptoms in older children and pre-adolescents include:

• Substance abuse
• Inability to cope with problems and daily activities
• Changes in sleeping and/or eating habits
• Excessive complaints of physical ailments
• Defiance of authority, truancy, theft and/or vandalism
• Intense fear of weight gain
• Prolonged negative mood, often accompanied by poor appetite or thoughts of death
• Frequent outbursts of anger

Early warning signs and symptoms in younger children include:

• Changes in school performance
• Poor grades despite strong efforts
• Excessive worry or anxiety (i.e., refusing to go to bed or school)
• Hyperactivity
• Persistent nightmares
• Persistent disobedience or aggression
• Frequent temper tantrums

Where can I find mental health resources in my community?
The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a services locator for mental health and substance abuse treatment programs and resources nationwide. Call 1-800-950-6264 and select option #2. To learn more about insurance coverage for mental health services and for questions concerning Social Security Income Disability issues or Supplemental Security call 1-800-772-1213. A comprehensive list of resources can be found on our website: bbrfoundation.org/resources.

 

What is schizophrenia?
Schizophrenia is a severe and debilitating brain and behavior disorder affecting how one thinks, feels and acts. People with schizophrenia can have trouble distinguishing reality from fantasy, expressing and managing normal emotions and making decisions. Thought processes may also be disorganized and the motivation to engage in life’s activities may be blunted. Those with the condition may hear imaginary voices and believe others are reading their minds, controlling their thoughts or plotting to harm them.

Most people with schizophrenia suffer from symptoms either continuously or intermittently throughout life and are often severely stigmatized by people who do not understand the disease. Contrary to popular perception, people with schizophrenia do not have “split” or multiple personalities and most pose no danger to others. However, the symptoms are terrifying to those afflicted and can make them unresponsive, agitated or withdrawn. People with schizophrenia attempt suicide more often than people in the general population, and estimates are that up to 10 percent of people with schizophrenia will complete a suicide in the first 10 years of the illness — particularly young men with schizophrenia.

While schizophrenia is a chronic disorder, it can be treated with medication, psychological and social treatments, substantially improving the lives of people with the condition.

What are the symptoms of schizophrenia?
Schizophrenia can have very different symptoms in different people. The way the disease manifests itself and progresses in a person depends on the time of onset, severity and duration of symptoms, which are categorized as positive, negative and cognitive. All three kinds of symptoms reflect problems in brain function. Relapse and remission cycles often occur; a person can get better, worse and better again repeatedly over time.

• Positive symptoms, which can be severe or mild, include delusions, hallucinations and thought disorders. Some psychiatrists also include psychomotor problems that affect movement in this category. Delusions, hallucinations and inner voices are collectively called psychosis, which also can be a hallmark of other serious mental illnesses such as bipolar disorder. Delusions lead people to believe others are monitoring or threatening them, or reading their thoughts. Hallucinations cause a patient to hear, see, feel or smell something that is not there. Thought disorders may involve difficulty putting cohesive thoughts together or making sense of speech. Psychomotor problems may appear as clumsiness, unusual mannerisms or repetitive actions, and in extreme cases, motionless rigidity held for extended periods of time.
   
• Negative symptoms reflect a loss of functioning in areas such as emotion or motivation. Negative symptoms include loss or reduction in the ability to initiate plans, speak, express emotion or find pleasure in life. They include emotional flatness or lack of expression, diminished ability to begin and sustain a planned activity, social withdrawal and apathy. These symptoms can be mistaken for laziness or depression.
   
• Cognitive symptoms involve problems with attention and memory, especially in planning and organizing to achieve a goal. Cognitive deficits are the most disabling for patients trying to lead a normal life.

What are the subtypes of schizophrenia?

• Paranoid schizophrenia — feelings of extreme suspicion, persecution or grandiosity, or a combination of these.
• Disorganized schizophrenia — incoherent thoughts, but not necessarily delusional.
• Catatonic schizophrenia — withdrawal, negative affect and isolation, and marked psychomotor disturbances.
• Residual schizophrenia — delusions or hallucinations may go away, but motivation or interest in life is gone.
• Schizoaffective disorder — symptoms of both schizophrenia and a major mood disorder, such as depression.

At what age do the symptoms of schizophrenia appear?
Schizophrenia affects men and women equally. It occurs at similar rates in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30.
Men tend to experience symptoms earlier than women. Most of the time, people do not get schizophrenia after age 45. Schizophrenia rarely occurs in children, but awareness of childhood onset schizophrenia is increasing.

It can be difficult to diagnose schizophrenia in teens. This is because the first signs can include a change of friends, a drop in grades, sleep problems and irritability — behaviors that are common among teens.

How is schizophrenia diagnosed and treated?
A combination of factors can predict schizophrenia in up to 80 percent of youth who are at high risk of developing the illness. These factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis. In young people who develop the disease, this stage of the disorder is called the “prodromal” period.

Currently, schizophrenia is diagnosed by the presence of symptoms or their precursors for a period of six months. Two or more symptoms, such as hallucinations, delusions, disorganized speech, and grossly disorganized or catatonic behavior, must be significant and last for at least one month. Only one symptom is required for diagnosis if delusions are bizarre enough or if hallucinations consist either of a voice constantly commenting on the person’s behavior/thoughts, or two or more voices “conversing.” Social or occupational problems can also be part of the diagnosis during the six-month period.

Foundation-funded research to find markers, such as abnormal brain scans or blood chemicals that can help detect early disease and allow for quicker interventions is now being done. Scientists are also working to understand the genetic and environmental mechanisms that combine to cause schizophrenia. As more is discovered about chemical circuitry and structure of the brains of people with the disease, better diagnostic tools and early intervention techniques can be developed. This is crucial for schizophrenia as it is believed that with every psychotic episode, increased damage is done to the brain.

Is there a cure for schizophrenia?
While no cure exists for schizophrenia, it is treatable and manageable with medication and behavioral therapy, especially if diagnosed early and treated continuously. Those with acute symptoms, such as severe delusions or hallucinations, suicidal thoughts or the inability to care for oneself, may require hospitalization. Antipsychotic drugs are the primary medications to reduce the symptoms of schizophrenia. They relieve the positive symptoms through their impact on the brain’s neurotransmitter systems. Cognitive and behavioral therapy can then help “retrain” the brain once symptoms are reduced.

These approaches improve communication, motivation and self-care and teach coping mechanisms so that individuals with schizophrenia may attend school, go to work and socialize. Patients undergoing regular psychosocial treatment comply better with medication, and have fewer relapses and hospitalizations. A positive relationship with a therapist or a case manager gives a patient a reliable source of information about schizophrenia, as well as empathy, encouragement and hope. Social networks and family member support have also been shown to be helpful.

 

What is Bipolar Disorder?
Bipolar disorder, formerly known as manic-depressive illness, is a brain and behavior disorder characterized by severe shifts in a person's mood and energy, making it difficult for the person to function. More than 5.7 million American adults or 2.6 percent of the population age 18 or older in any given year have bipolar disorder. The condition typically starts in late adolescence or early adulthood, although it can show up in children and in older adults. People often live with the disorder without having it properly diagnosed and treated.

What are the symptoms of Bipolar Disorder?
Bipolar disorder causes repeated mood swings, or episodes, that can make someone feel very high (mania) or very low (depressive). The cyclic episodes are punctuated by normal moods.

Mania Episode Signs and Symptoms:

• Increased energy, activity, restlessness
• Euphoric mood
• Extreme irritability
• Poor concentration
• Racing thoughts, fast talking, jumping between ideas
• Sleeplessness
• Heightened sense of self-importance
• Spending sprees
• Increased sexual behavior
• Abuse of drugs, such as cocaine, alcohol and sleeping medications
• Provocative, intrusive or aggressive behavior
• Denial that anything is wrong

Depressive Episode Signs:

• Sad, anxious or empty-feeling mood
• Feelings of hopelessness and pessimism
• Feelings of guilt, worthlessness and helplessness
• Loss of interest or pleasure in activities once enjoyed, including sex
• Decreased energy, fatigue
• Difficulty concentrating, remembering or making decisions
• Restlessness and irritability
• Sleeplessness or sleeping too much
• Change in appetite, unintended weight loss or gain
• Bodily symptoms not caused by physical illness or injury
• Thoughts of death or suicide

How is bipolar disorder diagnosed?
Bipolar disorder cannot yet be diagnosed physiologically by blood tests or brain scans. Currently, diagnosis is based on symptoms, course of illness, and family history. Clinicians rule out other medical conditions, such as a brain tumor, stroke or other neuropsychiatric illnesses that may also cause mood disturbance. The different types of bipolar disorder are diagnosed based on the pattern and severity of manic and depressive episodes.  Doctors usually diagnose brain and behavior disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:

• Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person’s normal behavior.
• Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.
• Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.
• Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.
• Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.

How is bipolar disorder treated?
While no cure exists for bipolar disorder, it is treatable and manageable with psychotherapy and medications. Mood stabilizing medications are usually the first choice in medication.  Lithium is the most commonly prescribed mood stabilizer. Anticonvulsant medications are usually used to treat seizure disorders, and sometimes offer similar mood-stabilizing effects as antipsychotics and antidepressants. Bipolar disorder is much better controlled when treatment is continuous. Mood changes can occur even when someone is being treated and should be reported immediately to a physician; full-blown episodes may be averted by adjusting the treatment.

In addition to medication, psychotherapy provides support, guidance and education to people with bipolar disorder and their families. Psychotherapeutic interventions increase mood stability, decrease hospitalizations and improve overall functioning. Common techniques include cognitive behavioral therapy, psychoeducation, and family therapy.

What is the difference between depression and bipolar disorder?
The main difference between bipolar disorder and major clinical depression is the presence of manic episodes. This is why depression alone is not enough to diagnose an individual with bipolar. However, one manic episode (meeting DMS-IV criteria) is sufficient to make a bipolar diagnosis.

 

What is depression?
Clinical depression is a serious condition that negatively affects how a person thinks, feels, and behaves. In contrast to normal sadness, clinical depression is persistent, often interferes with a person’s ability to experience or anticipate pleasure, and significantly interferes with functioning in daily life. Untreated, symptoms can last for weeks, months, or years; and if inadequately treated, depression can lead to significant impairment, other health-related issues, and in rare cases, suicide.

What are some of the signs and symptoms of depression?
A person is diagnosed with a major depression when he or she experiences at least five of the symptoms listed below for two consecutive weeks. At least one of the five symptoms must be either (1) depressed mood or (2) loss of interest or pleasure.

Symptoms include:

• Depressed mood most of the day, nearly every day
• Markedly diminished interest or pleasure in activities most of the day, nearly every day
• Changes in appetite that result in weight losses or gains unrelated to dieting
• Changes in sleeping patterns
• Loss of energy or increased fatigue
• Restlessness or irritability
• Feelings of anxiety
• Feelings of worthlessness, helplessness, or hopelessness
• Inappropriate guilt
• Difficulty thinking, concentrating, or making decisions
• Thoughts of death or attempts at suicide

How is depression diagnosed and treated?
The first step to being diagnosed is to visit a doctor for a medical evaluation. Certain medications, and some medical conditions such as thyroid disorder, can cause similar symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor eliminates a medical condition as a cause, he or she can implement treatment or refer the patient to a mental health professional.

Once diagnosed, a person with depression can be treated by various methods. The mainstays of treatment for depression are any of a number of antidepressant medications and psychotherapy, which can also be used in combination.

Why is depression more prevalent in women than in men?
Depression is twice as common among women as among men. About 20 percent of women will experience at least one episode of depression across their lifetime. Scientists are examining many potential causes for and contributing factors to women’s increased risk for depression. Biological, life cycle, hormonal and psychosocial factors unique to women may be linked to women’s higher depression rates. Researchers have shown, for example, that hormones affect brain chemistry, impacting emotions and mood.

Before adolescence, girls and boys experience depression at about the same frequency. By adolescence, however, girls become more likely to experience depression than boys. Research points to several possible reasons for this imbalance. The biological and hormonal changes that occur during puberty likely contribute to the sharp increase in rates of depression among adolescent girls. In addition, research has suggested that girls are more likely than boys to continue feeling bad after experiencing difficult situations or events, suggesting they are more prone to depression.

What is Postpartum Depression (PPD)?
Women are particularly vulnerable to depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. Many new mothers experience a brief episode of mild mood changes known as the “baby blues.” These symptoms usually dissipate by the 10th day. PPD lasts much longer than 10 days, and can go on for months following child birth. Acute PPD is a much more serious condition that requires active treatment and emotional support for the new mother. Some studies suggest that women who experience PPD often have had prior depressive episodes.

What happens during menopause?
Menopause is defined as the state of an absence of menstrual periods for 12 months. Menopause is the point at which estrogen and progesterone production decreases permanently to very low levels. The ovaries stop producing eggs and a woman is no longer able to get pregnant naturally. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.

What about depression later in life?
For older adults who experience depression for the first time later in life, other factors, such as changes in the brain or body, may be at play. For example, older adults may suffer from restricted blood flow, a condition called ischemia. Over time, blood vessels become less flexible. They may harden and prevent blood from flowing normally to the body’s organs, including the brain. If this occurs, an older adult with no family or personal history of depression may develop what some doctors call “vascular depression.” Those with vascular depression also may be at risk for a coexisting cardiovascular illness, such as heart disease or a stroke.

What efforts are underway to improve treatment of depression?
Researchers are looking for ways to better understand, diagnose and treat depression among all groups of people. Studying strategies to personalize care for depression, such as identifying characteristics of the person that predict which treatments are more likely to work, is an important goal.
(Sources: National Institute of Mental Health and National Women’s Health Center.)

What are the five types of anxiety disorders that are well known?

1. Generalized Anxiety Disorder
2. Obsessive-Compulsive Disorder (OCD)
3. Panic Disorder
4. Post-Traumatic Stress Disorder (PTSD)
5. Social Phobia (or Social Anxiety Disorder)
   
    

What is generalized anxiety disorder?
Generalized Anxiety Disorder (GAD) is an exaggerated anxiety and tension that persists for months on end and affects approximately 6.8 million Americans or about 3.1 percent of the population. GAD causes people to anticipate catastrophe and worry excessively about many things, from overarching concerns such as health, money or work to more routine concerns such as car repairs or appointments. GAD affects twice as many women as men, and the anxiety becomes so severe, normal life and relationships become impaired.

Worries can be accompanied by physical symptoms, such as fatigue, headaches, muscle tension and aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes. The disorder usually develops gradually and may begin anytime during life, although the risk is highest between childhood and middle age. It is diagnosed when someone spends at least six months worrying excessively without a specific focus of the fear and an inability to control the anxiety.

What is Obsessive-Compulsive Disorder?
Obsessive-Compulsive Disorder (OCD) is an anxiety disorder marked by fearful ideas and ritualistic behaviors. Obsessions are repetitive thoughts or impulses, such as a fear of getting infected from someone else’s germs or hurting a loved one. These obsessions create excessive anxiety and stress for the person affected. Although the thoughts are intrusive and unwanted, the person with OCD cannot stop them. Compulsions are repetitive behaviors people with OCD feel compelled to perform in an attempt to control or decrease the anxiety created by the obsessions. This can include things like constantly checking that an oven is off to prevent a fire, or frequent cleaning or hand-washing to avoid contamination.

What is Panic Disorder?
Panic disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress. It is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom or a fear of losing control. Panic attacks can occur at any time, even during sleep. An

What is Post-Traumatic Stress Disorder?
Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. After traumatic events, such as death, an earthquake, war, car accidents, floods or fires, it is not uncommon for people to experience feelings of heightened fear, worry, sadness or anger. If the emotions persist, however, or become severe, or the person gets triggered into reliving the event in their daily life, this can affect the person’s ability to function and may be a sign of PTSD.

What is Social Phobia?
Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation, such as a fear of speaking in formal or informal situations, or eating or drinking in front of others. In its most severe form, social phobia may be so broad that a person experiences symptoms almost anytime they are around other people.

How are anxiety disorders diagnosed?
Primary care physicians and psychiatrists diagnose someone as having an anxiety disorder if symptoms occur for six months on more days than not, and significantly interfere with the person’s ability to function at home, work or school.

Doctors perform physical and psychological evaluations to rule out other causes for the symptoms of anxiety. Cardiovascular disease, thyroid problems, menopause, substance abuse and/or drug side effects, such as from steroids, may cause symptoms similar to those of an anxiety disorder.

What is Autism?
Autism, more commonly referred to as autism spectrum disorder (ASD) by clinicians and families, is a biological condition that limits a child’s ability to develop social relationships and communicate. As a result, children often have significant problems in learning and experience many behavioral difficulties. The condition is usually life-long, although overall outcome is improving. Approximately every 1 in every 110 eight-year-olds in the U.S. are diagnosed as ‘on the spectrum’ of ASD.

Did you know ADHD is one of the most common childhood psychiatric disorders?
Some children with ADHD continue to have it as adults. And many adults who have the disorder don't know it. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity.