Diagnosis
In order to determine a diagnosis and identify potential complications, the following steps may be taken:
1. Physical examination: Your doctor will conduct a thorough examination to rule out any physical conditions that could be causing your symptoms.
2. Lab tests: These may include assessments of your thyroid function or screenings for alcohol and drug use.
3. Psychological evaluation: A doctor or mental health professional will engage in discussions with you regarding your symptoms, thoughts, emotions, and behavioral patterns. You might also be asked to complete a questionnaire to provide additional insight.
Determining the specific mental illness
Sometimes it can be challenging to pinpoint the exact mental illness underlying your symptoms. However, investing time and effort into obtaining an accurate diagnosis will aid in determining the most appropriate treatment. The more information you have, the better equipped you will be to collaborate with your mental health professional in understanding the significance of your symptoms.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, outlines the defining symptoms for each mental illness. Mental health professionals utilize this manual for diagnosing mental conditions, while insurance companies refer to it for treatment reimbursement.
Classes of mental illness
The primary classes of mental illness include:
1. Neurodevelopmental disorders: These encompass a wide range of problems that typically manifest in infancy or childhood, often before a child begins formal schooling. Examples include autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), and learning disorders.
2. Schizophrenia spectrum and other psychotic disorders: Psychotic disorders involve a detachment from reality, such as delusions, hallucinations, disorganized thinking, and speech. Schizophrenia is a prominent example, although other disorder categories can also feature reality detachment.
3. Bipolar and related disorders: This class includes disorders characterized by alternating episodes of mania (excessive activity, energy, and excitement) and depression.
4. Depressive disorders: These encompass disorders that affect emotional well-being, such as the level of sadness and happiness, and can disrupt daily functioning. Examples include major depressive disorder and premenstrual dysphoric disorder.
5. Anxiety disorders: Anxiety is an emotion marked by anticipation of future danger or misfortune, accompanied by excessive worrying. It may involve behavioral patterns aimed at avoiding anxiety-inducing situations. This class includes generalized anxiety disorder, panic disorder, and phobias.
6. Obsessive-compulsive and related disorders: These disorders involve preoccupations or obsessions, as well as repetitive thoughts and actions. Examples include obsessive-compulsive disorder, hoarding disorder, and trichotillomania (hair-pulling disorder).
7. Trauma- and stressor-related disorders: These are adjustment disorders in which a person struggles to cope during or after a stressful life event. Examples include post-traumatic stress disorder (PTSD) and acute stress disorder.
8. Dissociative disorders: These disorders disrupt a person’s sense of self, as observed in dissociative identity disorder and dissociative amnesia.
9. Somatic symptom and related disorders: Individuals with these disorders experience physical symptoms causing significant emotional distress and functional impairments. These symptoms may or may not be associated with diagnosed medical conditions, but the reaction to the symptoms is abnormal. Disorders in this class include somatic symptom disorder, illness anxiety disorder, and factitious disorder.
10. Feeding and eating disorders: These disorders involve disturbances in eating patterns that impact nutrition and health, such as anorexia nervosa and binge-eating disorder.
11. Elimination disorders: These disorders pertain to inappropriate elimination of urine or stool, either unintentionally or deliberately. Bed-wetting (enuresis) is an example.
12. Sleep-wake disorders: This class comprises sleep disorders severe enough to require clinical attention, including insomnia, sleep apnea, and restless legs syndrome.
13. Sexual dysfunctions: These disorders involve problems with sexual response, such as premature ejaculation and female orgasmic disorder.
14. Gender dysphoria: This refers to the distress accompanying a person’s expressed desire to be of a different gender.
15. Disruptive, impulse-control, and conduct disorders: These disorders entail difficulties with emotional and behavioral self-control, such as kleptomania or intermittent explosive disorder.
16. Substance-related and addictive disorders: This class encompasses issues associated with excessive use of substances like alcohol, caffeine, tobacco, and drugs. It also includes gambling disorder.
17. Neurocognitive disorders: These disorders impair cognitive abilities and reasoning. They are acquired rather than developmental and can arise from conditions or diseases such as traumatic brain injury or Alzheimer’s disease.
18. Personality disorders: Personality disorders involve enduring patterns of emotional instability and unhealthy behavior that lead to problems in life and relationships. Examples include borderline, antisocial, and narcissistic personality disorders.
19. Paraphilic disorders: These disorders involve sexual interests that cause personal distress, impairment, or harm to others. Examples include sexual sadism disorder, voyeuristic disorder, and pedophilic disorder.
20. Other mental disorders: This class includes mental disorders resulting from other medical conditions or those that don’t meet the full criteria for any of the above disorders.
Treatment
The specific treatment for your mental illness depends on its type, severity, and what works best for you. In many cases, a combination of treatments yields the most favorable outcomes.
If you have a mild mental illness with well-managed symptoms, treatment from your primary care provider may be sufficient. However, for severe mental illnesses like schizophrenia, a team-based approach is often necessary to address all psychiatric, medical, and social needs.
Your treatment team may consist of the following professionals:
– Family or primary care doctor
– Nurse practitioner
– Physician assistant
– Psychiatrist (medical doctor specializing in mental illness diagnosis and treatment)
– Psychotherapist (such as a psychologist or licensed counselor)
– Pharmacist
– Social worker
– Family members
Medications
While psychiatric medications don’t provide a cure for mental illness, they can significantly alleviate symptoms and enhance the effectiveness of other treatments, such as psychotherapy. The choice of medication depends on your specific situation and individual response to the prescribed medication.
Commonly prescribed classes of psychiatric medications include:
1. Antidepressants: Used to treat depression, anxiety, and other related conditions, these medications can improve symptoms such as sadness, lack of energy, difficulty concentrating, and loss of interest in activities. Antidepressants are non-addictive and do not induce dependency.
2. Anti-anxiety medications: These drugs target anxiety disorders like generalized anxiety disorder and panic disorder. They may also help alleviate agitation and insomnia. Long-term anti-anxiety drugs are typically antidepressants effective for anxiety as well. Fast-acting anti-anxiety medications offer short-term relief but have the potential for dependency, making them ideal for short-term use.
3. Mood-stabilizing medications: Primarily used for bipolar disorders involving alternating manic and depressive episodes, mood stabilizers are occasionally combined with antidepressants for depression treatment.
4. Antipsychotic medications: Typically prescribed for psychotic disorders like schizophrenia, these medications may also be used for bipolar disorders or in conjunction with antidepressants for depression treatment.
Psychotherapy
Psychotherapy, also known as talk therapy, involves discussions with a mental health professional to explore your condition and related issues. Through psychotherapy, you gain insight into your condition, moods, feelings, thoughts, and behaviors. This process equips you with coping strategies and stress management skills.
Numerous psychotherapy approaches exist, each with its own methodology for enhancing mental well-being. Psychotherapy is often completed successfully
within a few months, but some cases may require long-term treatment. It can be conducted one-on-one, in a group setting, or with family members.
When selecting a therapist, it’s crucial to feel comfortable and confident in their ability to listen and understand your perspective. It’s also important for your therapist to grasp the life experiences that have shaped your identity and worldview.
Brain-stimulation treatments
Brain-stimulation treatments are occasionally employed for depression and other mental health disorders when medications and psychotherapy prove ineffective. These treatments include electroconvulsive therapy, repetitive transcranial magnetic stimulation, deep brain stimulation, and vagus nerve stimulation. It’s vital to understand the potential risks and benefits associated with each recommended treatment.
Hospital and residential treatment programs
In severe cases where mental illness impairs your ability to care for yourself or poses immediate harm to yourself or others, psychiatric hospitalization may be necessary. Treatment options may include 24-hour inpatient care, partial or day hospitalization, residential treatment that provides temporary supportive living arrangements, or intensive outpatient treatment.
Substance misuse treatment
Substance use problems frequently coexist with mental illness, often hindering treatment progress and exacerbating the mental health condition. If you’re unable to quit drug or alcohol use independently, seeking treatment is essential. Discuss your treatment options with your doctor.
Active participation in your care
Collaborating with your primary care provider or mental health professional, you can determine the most suitable treatment based on your symptoms, their severity, personal preferences, medication side effects, and other relevant factors. In some cases, when a mental illness is particularly severe, a doctor or loved one may need to guide your care until you regain the ability to actively participate in decision-making.
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