Understanding Psychosis

By  Sara Coffey, D.O.



Often patients and family members have a hard time understanding how a person can be psychotic.  Psychosis is defined as grossly impaired reality testing. Psychosis can be present in several mental illnesses including, schizophrenia, schizoaffective disorder, bipolar disorder and even depression.

The stigma or lack of information surrounding these disorders leaves them feeling guilty or ashamed. I often explain to them that the brain is an organ just like the heart, the kidneys or the liver. And just as our heart, kidneys or liver can become diseased, so can our brain.

The brain is a complicated organ with several different functions. It helps regulate our breathing, our heart rate, and our temperature and handles more complex tasks such as vision and hearing, pain sensations as well as processing complex thoughts or emotions. It is easy for us to understand that if the heart becomes damaged it might not pump as effectively, but it is often harder for us to understand what happens if the brain becomes compromised or unwell. A brain with mental illness may start to hear things that are not there, or experience thoughts that cannot be explained and seem irrational.  A person may become excessively anxious for no reason, or depressed without warning or cause.

In the world of mental illness we use terms to describe such experiences like hallucinations and delusions.  A patient with hallucinations might experience voices talking to them when no one is present. When we recall that one function of the brain is to process and interpret sound it is easy to see how auditory hallucinations might occur if that part of the brain is compromised.

Patients can have delusions that people are out to harm them for no reason, and without proof, or delusions that they are famous powerful figures in history. And again, when we look at how the mind works, how complex processes are taking place that help us navigate who we are and what we do, it makes sense that if something wasn’t working normally in the brain that a person could have a belief that was false.

Although these symptoms might make sense when we look at the brain as an organ, or a tool performing a function, it doesn’t lessen the impact mental illness has on families. Often mental illness takes away what we consider the heart or personality of person and this can be extremely difficult to cope with. Furthermore, the simplicity of understanding is not without criticism. For instance although we are learning more and more about the brain every day, there is still no cure for mental illness, only treatment for symptoms, and often times the treatment cannot fully clear the symptoms of certain diseases.

However, it is important to know that psychosis, like other mental illness symptoms, is not the fault of the person with the illness or the family who cares for them. These symptoms are part of a complex illness that affects patients unwillingly every day.

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Posted in: bipolar disorder,delusion,depression,hallucination,psychosis,Sara Coffey DO,schizophrenia,stigma

Lessons Learned in the Wake of Tragedy

By Gina Newsome Duncan, M.D.





Dr. Molly McVoy recently blogged about the horrific shootings of Representative Gabrielle Giffords and others on Saturday, January 8, 2011. This tragic incident has sparked widespread national debate about all aspects of the case, including mental health treatment in this country and links between violence and mental illness.



The fact is that most people with mental illness are not violent, and that violence is most often caused by those who are not mentally ill. However, this incident does provide an opportunity for us as a nation, to seriously consider the state of our mental health services. If we examine it carefully, we can possibly prevent further acts of violence, and also think about how we help those who are in need of mental health treatment.



It is an unfortunate reality that mental illness remains largely shrouded in stigma, and tragic events such as this often help to only deepen that stigma in the minds of the public. As a result of this stigma, many people live with unnecessary shame and suffering, not seeking the help that they need. Most often, the primary victim is the person living with the illness, and by extension, their loved ones. Very rarely, however, untreated illness can lead to tragic consequences that reach far beyond the person with the illness and his or her family.



Like physical illness, mental illness has the best outcome when recognized and treated early. We should let this tragedy be a call to become more proactive in addressing issues of mental illness in our communities.

There are several important steps that can be taken:



1) As a public, we can become more informed about the signs, symptoms and treatment of mental illness.



2) We can all work to  destigmatize mental illness. The American Psychiatric Association’s Council on Communications is actively involved using this blog and with other activities.



3) Educate yourself on how mental health is funded in your community and let your vote count when issues of mental health funding are on the ballot.





It is true that there are rare situations in which a person with a severe mental illness may become violent. In most cases, this violence will be self-directed in the form of suicidal acts, but in rare instances, it may be directed toward others as well. What can be done in those situations?



1) If you are personally experiencing a mental illness and are having thoughts of harming yourself or others, it is important that you seek help from a doctor, therapist, or 911 immediately.



2) If you are the friend or family member of a person experiencing a severe mental illness and you are concerned due to actions or statements they have made that they may be a danger to themselves or others, it is important that you seek help from a doctor, therapist, or by calling 911 immediately.



a. Be as detailed about your concerns as possible.



b. Do not let your concern go unheard, put it in writing.



c. Firearms and weapons should be kept sealed and locked, or ideally, removed from the home.



d. Unfortunately, many communities do not have adequate crisis prevention resources. Familiarize yourself with the procedures your community does have for involuntary hospitalization. You can get this information by calling your local health department, hospital department of psychiatry, emergency room, community mental health center, family physician, or police department.

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Posted in: crisis,getting help,Gina Duncan MD,mental health,mental illness,stigma,violence

Supporting Gay Youth as a Way to Prevent Suicide

By Tristan Gorrindo, MD



Coming out of the closet is one of the hardest things that a gay, lesbian, or bisexual person will do.

“Coming out,” is the process of revealing to friends, parents, family members, and acquaintances that he or she is gay. It is more that just a simple act or decision to announce that a person is gay, but rather a process that unfolds overtime, usually in small steps. For many people, it involves telling one person, then a group of friends or family members, then classmates or co-workers, and finally the world at large. But for each person, the journey is different and often filled with emotional ups and downs.

Recent events in the national media have highlighted the issues surrounding coming out and youth suicide. By some estimates, as many as nine gay youth died by suicide since September 1, 2010. Government officials and celebrities have publicly referred to this as a national crisis.



Many population scientists have tried to understand why gay teens are at such high risk for suicide -- by some estimates 7 times the national average for their age. And although there are many possible contributors to what might make a gay teen suicidal, we must first remember that all teens, gay and straight alike, are struggling with basic questions about self-identity.



A friend of mine once described being a teenager is like, “being at a costume ball where the costumes and guests are constantly changing.” As part of normal teenage development, teens are “trying on” different roles, different groups of friends, and even different kinds of dress. It is a time when teens are first experimenting with the idea of romantic relationships and at the same time trying to separate from their parents. Gay teens have the added burden of sorting out the confusing, often negative messages from the culture about what it means to be gay. When these ingredients mix -- unsure sense of self-identify, novice experience with romance, trying to separate from one’s parents, and fear of what it means to be gay -- gay teens run the risk of feeling quite isolated and alone.



Regardless of one’s personal views of homosexuality, I think we can all agree on the importance of supporting our youth during difficult times. The American Psychiatric Association is committed to reducing the stigma around homosexuality and to promoting the psychological health of gay, straight, and bisexual individuals.



We owe it to our teens to make sure that they know that coming out is not a process that they have to go through alone. A wide variety of resources exist, from grass-roots YouTube videos which offer gay teens hope, as in The Make It Better Project, to 24-hour suicide hotline for gay teens offered through The Trevor Project. Additionally, The National Suicide Prevention Lifeline also is available 24/7 at 1-800-273-TALK (8255) to anyone struggling with suicidal thoughts. The Healthy Minds website is a source of clear factual information on sexual orientation. And let us not forget the parents that may also be struggling with how to help their gay child; for them there is support and advice offered through PFLAG.

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Posted in: gay/lesbian/bisexual,getting help,LGBT,parenting,sexual orientation,stigma,suicide prevention,teens,Tristan Gorrindo MD

Athletes Suffer from Depression Too

By Claudia L. Reardon, M.D.

Athletes don’t get depressed, right? After all, they are so physically fit and healthy that they must be equally emotionally healthy. Unfortunately, this is not true. Just like the rest of us, athletes can be at risk for depression. This is the case all the way from the school-aged child playing on a recreational team, up to the professional athlete who makes a living playing his or her sport.



Whenever we see a news story about a famous athlete with depression or an athlete who has committed suicide, it tends to come as a big surprise since athletes tend to be glamorized and admired in our society. However, here are some things we know about the reality of depression in athletes:



1. Athletes seem to be at least as likely as the general population to suffer from depression.

2. Athletes who suffer multiple concussions are up to four times as likely as other athletes to suffer depression. Athletes in some sports, including football, hockey, and soccer, are especially likely to suffer concussions.



3. Overtraining syndrome can occur in athletes who are seriously training for an event and do so beyond the body’s ability to recover. Overtraining can look very similar to depression and can actually lead to full-blown depression. Like depression, overtraining can include fatigue, insomnia, appetite change, weight loss, difficulties with motivation, and poor concentration. Overtrained athletes usually notice that their sports performance worsens. They may develop more injuries; experience muscle and joint pain, and lose enthusiasm for their sport. If an athlete is overtrained, the treatment is usually to cut back on physical activity or do cross training at a lower intensity until the symptoms start to improve. If overtraining leads to full-blown depression, medication and/or talk therapy may also be helpful.



4. Besides concussions and overtraining, other common factors that can lead to depression in athletes include injuries, competitive failure, aging, retirement from sport, and the same daily stressors that can lead to depression in the general population.



5. In recent years, athletes across several sports have started to open up about their struggles with depression. Hopefully this will help athletes with depression to feel better about seeking help for this disorder.

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Posted in: athletes,Claudia Reardon MD,concussion,depression,exercise,sports,stigma

It's Not Your Fault

Healthy Minds. Healthy Lives. blogger Gariane Phillips Gunter, MD, talks about how individuals with mental illnesses cannot be blamed for mental illness and how to get help for someone struggling with mental health issues.

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Posted in: Gariane Phillips Gunter MD,mental illness,psychiatrist,stigma

Mental Illness in School: No Child Left Behind?

By Molly McVoy, M.D.

How much do I tell my child’s teacher about her depression? About his bipolar disorder? About her ADHD? Will he fall behind if the teacher doesn’t know? Will she be judged if I tell the school? When do I get testing, an IEP, special Ed? What do those mean?

Parents of children with psychiatric illness struggle with these questions and many others. Often, there are no easy answers. A child’s success at school may be one of the best predictors of future success. Giving a child and his/her family the best tools to succeed in school is one of my top priorities as a child psychiatrist.

When deciding how much to tell your child’s school about his/her psychiatric illness, consider your child’s ability to function at school rather than his/her specific type of illness. You are not required to tell the school anything; that is up to you as a parent. If telling your child’s teacher about his/her psychiatric illness will give him/her a better chance to do well, then consider telling the teacher. If your child’s illness is affecting his/her day to day functioning and behavior at school, then consider telling the teacher. Teachers are your partners in helping your child succeed. If the illness is relatively well controlled and is not affecting his/her daily behavior at school, the school may not need to know. For more information, visit the American Academy of Child and Adolescent Psychiatry.

When it comes to accessing special education services, most schools and teachers want to do everything they can to help your child. I usually recommend families listen to the principal and teachers.They are the experts in education. However, if you are dissatisfied with the educational services you are receiving, my next recommendation is know your rights, know your state’s laws. Every state must provide a free education that meets the needs of each child – no matter what those needs are. What varies widely, however, is how each state manages that requirement. The U.S. Department of Education website has basic information on your rights as a parent and offers links to each state.html. Know your state law, know your rights. Come armed with that information and work with your doctor and school for your child to succeed!

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Posted in: ADHD,children,family,Molly McVoy MD,stigma

Mental Health Disparities – Focus on Asian Americans

By Felicia Wong, M.D.

The Office of Minority and National Affairs (OMNA) is a group within the American Psychiatric Association that works to promote diversity and cultural competence and to eliminate disparities in mental health care. They published a report on Asian Americans and Mental Health that revealed some troubling statistics.











photo courtesy Bjoern Kommerell








• While the overall prevalence rate of mental illness is similar or somewhat lower among Asian Americans than whites, Asian Americans are significantly less likely to use mental health services than other populations.


• Asian Americans are much less likely than whites to report mental health problems to friends or relatives, psychiatrists or other mental health specialists, or to physicians. It has been postulated that shame and stigma figure prominently in the lower utilization rates of Asian American/Pacific Islander (AA/PI) communities.


• AA/PI’s often consider expression of mental illness a personal weakness and are more likely than Westerners to express emotional distress through physical symptoms.


• The suicide rates of elderly Asian American women and young Asian American women (15‐24 years old) are significantly higher than that of other women of the same ages.

In an attempt to address the barriers to mental health care that pertain to the Asian American community, I created a website http://www.asianmentalwellness.com/ which I hope will dispel some of the misconceptions that the AA/PI community may have about mental health, and will provide information and links that will help raise awareness about the importance of mental health and wellness. Please share this website with those who you feel might find it useful.

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Posted in: Asian American,Felicia Wong MD,stigma,suicide prevention

Getting Help: How to Start the Conversation and Find Professional Services

By Felicia Wong, M.D.

Many people don’t seek mental health care when they need it. This is particularly true for members of ethnic minorities, for whom physical illness is often considered more culturally acceptable than mental illness. Research has shown, for example, that Asian Americans are three times less likely than members of other ethnic groups to seek mental health services. This has more to do with lack of appropriate services, and barriers to services—including stigma, language and cultural differences—rather than the lack of need for services.

The important thing to remember is that with proper treatment, most symptoms of mental illness can be controlled. If the possibility of mental illness is a concern for you or someone you care about, please recognize there is no shame in seeking treatment and/or help.

Over the years, many people have asked me how to get help for themselves, a family member or a friend who is suffering. Navigating the mental health system is not easy, and the stigma and shame associated with mental illness make it even more difficult. Where someone may find it easy to ask a friend to recommend a family doctor or a dentist, people sometimes hesitate to ask about psychiatrists or therapists due to fears of being judged, or perhaps appearing "emotionally weak".

There are many places to go for help. A good place to start is by asking your family doctor or primary care doctor. In a crisis, emergency rooms can provide temporary relief for you or a loved one, and emergency room personnel may be able to guide you to further help.

Other potential resources include:

• mental health specialists such as psychiatrists, psychologists, social workers or mental health counselors;


• community mental health centers;


• hospital psychiatry departments, outpatient clinics and/or inpatient units;


• family services, social agencies, or clergy;


• peer support groups;


• private clinics and facilities;


• employee assistance program; or


• the phone book or web - search "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses.

For more information on how to find and choose a psychiatrist and what to expect in treatment, read about Choosing a Psychiatrist on Healthyminds.org,

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Posted in: Asian American,family,Felicia Wong MD,getting help,mental illness,minority mental health,psychiatrist,stigma,treatment

For Mental Health Month, Join a Former First Lady In Bringing Down Barriers to Mental Health Treatment.

By Roberto Blanco, M.D.



I was seeing a very depressed patient the other day and we were discussing how far he had fallen in his functioning since he had gotten ill. He said, “I used to be strong. I used to be able to provide for my family.” And yes, there was no doubt that he was unable to provide for his family now. Despite being relatively healthy physically, mental illness had made it so that he could not work, had difficulty leaving the house, or finding enjoyment in anything.



I try not to read too much into simple statements. But the phrase “I used to be strong” resonated with me because I think that it had something to do with why he waited until it was almost too late to seek treatment. While I think that he was trying to express the depths of his feelings of helplessness and need, his statement implied that he was now weak. Fatigue, lack of energy, and poor sleep from depression could make anybody weak. However, I don’t think that this is what he meant.



I often hear people stigmatizing mental illnesses like depression by saying that it only happens to “the weak”. One thing that I’ve learned from my experience practicing psychiatry is that it can affect anyone from CEOs to valedictorians to world-class athletes. Just like this patient indicated, it doesn’t matter how strong you are or think you are, mental illness can affect you if life and genetic predisposition put you in the wrong circumstances.



One of my main concerns with the stigmatization of mental illness is that if it is seen as a weakness, then the solution is often seen as needing to “be stronger”, deny a physiologic problem, and not seek help. As many mental illnesses are quite treatable with medications, psychosocial interventions, and therapy, this can often have tragic and unintended consequences such as loss of close relationships, occupations and careers, or even death.



The other concern is that if mental illness is seen as a fault of character and not as a group of illnesses, then appropriate and necessary resources and medical services won’t be available. In North Carolina, where I work, acknowledging that you need help is not the biggest barrier to treatment. Actually, it is trying to find a provider or an inpatient bed.



With the demand for inpatient psychiatric services skyrocketing in North Carolina, the number of psychiatric beds available has decreased and the outpatient mental health system, which was once a model nationally, has crumbled. It’s hard to imagine that with greatly increasing rates of kidney disease in this country that dialysis clinics or transplant services would be closing down. However, this is exactly what is happening to psychiatric services in North Carolina. It is a complex issue but is due to the national trend of closing state psychiatric hospitals as well as to the privatization and decentralization of outpatient mental health services.



Some people are taking notice of this disturbing trend, including the former First Lady of the United States, Rosalynn Carter. She has written a book on the mental health crisis in the United States and is encouraging people to be vigilant in taking care of their mental health, to overcome challenges, and to get involved.



May is Mental Health Month. So, please take this opportunity to join our former First Lady in advocating for mental illness treatment. Go to your local legislatures or call your congressional representatives and ask that they support funding for mental health services.

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Posted in: depression,getting help,Roberto Blanco MD,stigma,treatment

Talking about Mental Health

By R. Scott Benson, M.D.

In May a few years ago I was asked to give a talk to the seniors who exercised at the mall in the early morning hours. The timing was right for a mental health talk, since May is Mental Health Month.



The focus of my talk was new understanding of the brain and changing thoughts on the cause and treatment of mental illness. The audience was attentive but asked few questions. But after the talk an elderly man approached to clarify some comments I had made about schizophrenia. He called his wife over and they shared the painful story of their adult son’s deterioration as he developed unmistakable signs of this tragic disease.



This couple had been told by the treatment team that their parenting had caused their son’s condition and they needed to leave him alone so that he could recover. And they had carried a burden of guilt for years, viewing themselves as somehow toxic. I was able to answer a few of their questions and then I was encouraged them to join other families involved with our local chapters of Mental Health America and the National Alliance on Mental Illness.



The positive impact of these brave families sharing their stories was reinforced in a new survey from the American Psychiatric Association. And the results of this survey are a cause for celebration telling us how far we have come. More than a third said that stigma has declined, and openness about personal experiences by friends, family and public figures was influential.



The internet has become a valued source of information and was cited by 75% of those surveyed as at least moderately influential in reducing stigma associated with mental illness.



In addition to HealthyMinds, what are the reliable sources of information that have been useful to you? Where have you heard patient and family stories that have reduced stigma in your community?

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Posted in: family,mental health,NAMI,parenting,R Scott Benson MD,schizophrenia,stigma

This one is for my mother

By Gariane Phillips Gunter, M.D.

During my year as Mrs. United States and daily as a psychiatrist I am fighting to eliminate the negative stigma of mental illness. The presence of mental illness has been very real to me since I was a child. After many years or suffering without a clear cause, my mother was diagnosed with Bipolar disorder when I was in elementary school. Frequent hospitalizations, medication adjustments, ECT were part of a typical day in our household. Nevertheless, my mom is my mom, not “crazy”, “psycho” or a “freak”.



As an adult and now as a psychiatrist, the presence of stigma toward those suffering from a mental illness has become very evident to me. I believe that the source of much of this misperception is from a lack of understanding not a lack of compassion. Many people still do not know that mental illnesses are true biological illness similar to diabetes or hypertension.



They don’t understand that they are brain diseases, not character flaws. Having a mental illness does not mean that you are stupid, lazy, worthless or incompetent. You don’t develop a mental illness because you did something wrong or because you are a “bad” person. It is not your fault.



For you that are struggling with a mental illness, or have a family member who is, you are likely all too familiar with the devastating effects of stigma in your own life. Let us all work together to teach the truth about mental illnesses, as education is our most powerful weapon in the fight against stigma.



……………Be The Change You Hope To See In This World















9PAZK9VY4VER

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Posted in: bipolar disorder,mental illness,stigma