About Mental Disorders 

 

Statistics From The Mental Health of Young People in Australia National Survey of Mental Health and Wellbeing, October 2000

• 1 in 10 children between the ages of 6 and 12 experience persistent feelings of sadness
• 11.2% of all children have the symptoms of Attention Deficit Hyperactivity Disorder
• approximately 3% of children 17 & under have a conduct disorder
• Autism Spectrum Disorders occur in as many as 5 out of 10,000 children
• up to 10% of women suffer an eating disorder during adolescence, less for men
• 1 in 10 children have some sort of learning disability

As you can see, you are not alone if your child has a mental illness. Here are some facts about the more common forms of mental illness in children and adolescents.  Depression Depressive disorders occur less frequently in children than adults, but rise dramatically in adolescence where depression is more frequent than in adulthood. Parents need to be aware of the symptoms that may signal depression in children, as children may not be able or willing to express their feelings. 

Symptoms may include:

• a marked drop in school performance
• loss of interest in activities once enjoyed
• sudden outbursts of anger, aggression and/or crying
• suicidal thoughts
• excessive fear or anxiety
• abuse of alcohol, drugs and/or self
• constant physical complaints with no apparent cause
• excessive concentration on studying or avoiding contact with friends.

Some of the more common symptoms are:

• constant thoughts and fears about safety of self and/or parent
• refusing to go to school
• frequent stomach aches and other physical complaints
• extreme worries about sleeping away from home
• overly clingy behavior at home
• panic or tantrums at times of separation

Parents should be alert to the signs of severe anxiety so that they can intervene early to prevent complications. Early treatment can prevent future difficulties, such as, loss of friendships, failure to reach social and academic potential, and feelings of low self esteem.  A fact sheet produced by the Mental Health Information Service Generalized Anxiety Disorder (GAD) Generalized anxiety disorder is marked by unrealistic and excessive worry, accompanied by constant and often unnecessary concern about anything or everything. Less frequent in children, the irrational worry is accompanied by a feeling of constant apprehension.

Panic Disorder
Panic attacks occur when the body gives off the same distress signals that occur when someone is faced with a life-threatening or similar event - yet no trigger is present. This means that a child may be sleeping, relaxing or just going about their daily business when they suddenly feel some or all of the symptoms of a panic attack including: chest pain, palpitations and trembling legs. These symptoms are in themselves very frightening.

Agoraphobia
Agoraphobia is an anxiety disorder characterized by an uneasiness, fear or dread about leaving familiar surroundings. This may include a reluctance to travel, particularly on public transport, or to be in crowded places. It is associated with severe physical symptoms of anxiety and panic attacks. It is a condition related to anxiety, depression, panic and other phobias.  Obsessive Compulsive Disorder Obsessive Compulsive Disorder is characterized by intrusive thoughts (obsessions) and behaviors (compulsions). Individuals with OCD are besieged by patterns of unwanted, repetitive thoughts and repetitious behaviors that are distressing and difficult to ignore or overcome.  Severe anxiety problems in children can be treated. Treatments generally include a combination of the following: individual or family therapy, medication, behavioural treatments, and consultation with the school.  Adolescents and parents of children who seem to be exhibiting signs of an anxiety disorder should contact a child and adolescent psychiatrist, or their local mental health centre (see ‘Community Health Centre’ in the local White Pages).  Telephone information and support lines can also provide valuable information and advice about anxiety and children, contact Lifeline on 131 114, Kids Helpline on 1800 551 800, www.reachout.com.au  or Anxiety Disorders Support and Information on 1 300 74 992. 

Oppositional Defiant Disorder (ODD)

Many children are oppositional and difficult from time to time. Oppositional Defiant Disorder, however, is diagnosed when there is a history of continuous uncooperative and hostile behavior that is more extreme than that displayed by other children of the A fact sheet produced by the Mental Health Information Service same age and developmental level. The behavior can adversely affect the child’s social, family, and academic life and cause problems for the parents, family and careers.  Children who exhibit a number of the following behaviors should be assessed for the possibility of ODD:

• problems controlling temper
• continually argues with adults
• actively defies or refuses to comply with adults' requests or rules
• deliberately annoys people
• blames others for mistakes or misbehavior
• is touchy or easily annoyed by others
• angry and resentful
• spiteful and vindictive

Conduct Disorder (CD)
Children with conduct disorder exhibit behavior that shows a persistent disregard for the norms and rules of society and other people’s basic rights. Conduct disorder, affects approximately 3% of adolescents under 17.  Children who exhibit a number of the following behaviors should be assessed for the possibility of conduct disorder:

• stealing
• frequent lying
• deliberately lighting fires
• truancy
• deliberate cruelty to animals and/or humans
• disregard for other people’s property and self
• starting fights
• forcing others into sexual acts

Treatment for conduct disorder is essential. This usually takes the form of behavior therapy and psychotherapy, in either individual or group sessions. While Conduct Disorder is distinct from ADHD and personality disorders these conditions are often present in the same individual.  More information can be obtained from your local GP or Community Health Centre.  Are ODD and CD connected?  Conduct Disorder is sometimes considered to be a more extreme form of Oppositional Defiant Disorder. When a child has Conduct Disorder there are usually safety concerns as the behavior can become dangerous to the individual, their family and others.  Children with ODD on the other hand are annoying rather than dangerous.  A fact sheet produced by the Mental Health Information Service Autism (Spectrum Disorders) Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders (PDDs) include, autistic disorder, pervasive development disorder not otherwise specified (PDD-NOS) and Asperger’s syndrome. There are also two very rare disorders, Rett’s syndrome and childhood disintegrative disorder. This group of disorders are usually first diagnosed in early childhood. They can present in varying levels of severity but will all impair a child’s thinking, feeling, language, and ability to relate to others.  Autism often becomes apparent at around the age of 2 ½ years. It is marked by a dramatically impaired ability to communicate and interact with others. Children with autism also have a low level of activity and range of interests. These disorders do not have a single cause. It is thought that a number of biological and psychosocial influences are involved. Although autism usually begins in childhood, it is a lifelong disorder.

Symptoms may include: impaired communication – never learning to speak properly impaired comprehension flat facial expression and vocal tone repetition of phrases or words heard in conversation or on TV difficulties maintaining eye contact difficulties initiating and sustaining conversation very specific and unusual preoccupations and attachments extreme preference for routines and acute distress at change in the environment. Parents are usually the first to notice that something is different about their child, perhaps from birth. The baby may show a lack of interest in people or objects or may focus closely on one item for lengthy periods. Sometimes symptoms can appear in children who had previously been developing normally.  There are many different therapies that seek to improve the individual symptoms of Autism Spectrum Disorders.  Early detection and intervention is essential to help maximize a child’s potential. For more information, it is best to contact an autism support organization for advice regarding appropriate doctors.

Learning Disabilities
Whilst learning disabilities are not mental illnesses, some of the signs and symptoms may mimic, or co-exist with, mental illness. Children with learning disabilities are usually within the general range of intelligence. They may try hard at school and home, but never seem to master tasks.  It is believed that learning disorders are caused by an irregularity within the nervous system that interferes with the receiving, processing and communication of information. Some children with learning disorders are also hyperactive and some exhibit a short attention span. 

Some common symptoms are:

• difficulty understanding and following instructions
• trouble remembering what they’ve just been told
• A fact sheet produced by the Mental Health Information Service
• failing to master reading, spelling, writing, and/or math skills,
• difficulty distinguishing right from left;
• difficulty identifying words or a tendency to reverse letters, words, or numbers
• lacking coordination in walking, sports, or small activities such as holding a pencil or tying a shoelace.
• easily losing or misplacing homework, schoolbooks, or other items.
• inability to understand the concept of time; and confused by ‘yesterday’, ‘today’, and ‘tomorrow’.

A child and adolescent psychiatrist who specializes in learning difficulties can evaluate the child, and work with school professionals and others to determine the extent of any learning disorder. They can make recommendations for special educational requirements, speech therapy and learning techniques. It is important to address these problems, as they can affect a child’s self-confidence, and hence, future potential.

Sleep Problems
Many children have sleep problems. Some examples are:

• frequent awakening during the night
• talking during sleep
• difficulty falling asleep
• waking up crying
• feeling sleepy during the day
• nightmares
• bedwetting
• sleepwalking

As most parents will know, these symptoms are fairly standard occurrences for children.  Normally they are due to irregular sleeping habits, separation anxiety or emotional difficulties. Whilst patting or rocking a child to sleep is beneficial, it is not a long term solution. If the problem interferes with the child’s regular activities, or occurs several times a night, it could be beneficial to see your local GP. Fortunately, most sleep problems tend to) disappear as the child gets older.

ATTENTION DEFICIT HYPERACTIVITY DISORDER

The term ADHD describes children who are inattentive, impulsive, and frequently also very active at levels higher than expected for their mental and chronological age.  Although the disorder is usually diagnosed during childhood, it may continue into adulthood.

What Are The Symptoms?

• hyperactivity and restlessness – the person always seems to be on the move

• compulsive aggression - disruptive at home and in school, disturbs other children, and may behave in potentially dangerous ways excitable, impulsive and unpredictable behavior; frustration may lead to temper tantrums

• difficulty with tolerating failure or frustration – may cry often and easily

• short attention span – difficulty with concentration

• poor muscle and eye-hand co-ordination

• poor sleeping habits

• normal or high IQ - yet experiences difficulties at school.  

ADHD cannot be ‘cured’ but interventions can be used to gain some control over problematic behavior. A multi-pronged approach to treatment is most useful, with a variety of interventions available from parents, schools and professionals.  Medication may be used, particularly Ritalin and dexamphetamine. This type of treatment has provoked controversy because of perceived similarities of this medication to illegal drugs such as amphetamines. It is important to learn about the pros and cons of medication and discuss these with your doctor.  Behavior management techniques may help parents and teachers to control problematic behavior; additional one-to-one help in the classroom may also prove useful.

BIPOLAR DISORDER

 Bipolar disorder, which used to be called manic depressive illness, is a disorder of mood, characterized by extreme mood swings. The mood swings are episodic: in between episodes the person is usually completely well. Bipolar disorder is a neurobiological brain disorder and is strongly genetic. A person fluctuates between high mood “mania” or “hypomania” and low mood “depression”.

What Is Mania?

• Hypomania - Activity and thought speeds up, there is less need to sleep, mood is high, with a sense of well being but there is often irritation and intolerance towards other people. Ideas flow quickly and thought processes are relatively intact. The person feels well and in control - but may not see the consequences of his or her behavior and may react angrily if confronted. Judgment is affected and people may become unable to make complex decisions. People may refuse medication or suggestions to seek help. If hypomania is not treated, lack of sleep and high level of activity may lead to acute mania where thinking is disjointed and distorted. Hallucinations and delusions are common and may appear very real to the person. The person is usually not capable of looking after him/herself. 

• Delirious Mania - The person appears confused and bewildered and may seem very disturbed. This stage often follows some days or weeks of not eating or sleeping, so the symptoms may be caused by poor nutrition and physical exhaustion. Without treatment, people can die in this stage of manic illness. This stage is often mistakenly diagnosed as a schizophrenic illness.

What Is Depression?

Depression is the opposite of mania. Thoughts are slower, mood is low and there may be feelings of sadness and emptiness. Thinking is difficult and it is hard to make decisions. The person may be incapable of or uninterested in performing everyday tasks. Sleeping is disturbed - it may be difficult to get to sleep with periods of wakefulness in the early hours of the morning followed by oversleeping into the late morning.  The person may have an increase in or a complete lack of appetite. There is a decrease or loss of libido. Self-confidence is low and there is a generally pessimistic outlook regarding self and others.

Patterns of Bipolar Disorder

Bipolar disorder usually develops in adolescence and early adulthood. Stress is usually the trigger for early episodes of mood disorder but after a number of episodes, the episodes of mania or depression can develop without any obvious trigger. 

• Bipolar I - the person has episodes of mania and depression which are severe.

• Bipolar II - the person has episodes of hypomania which generally do not disrupt normal activities. People often only seek help for the episodes of severe depression in this type of disorder.

• Mixed States - sometimes mania and depression happen at the same time: the person may be laughing and crying at the same time or feel sad but driven to high levels of activity.

• Rapid Cycling Disorder (4 or more episodes per year) - many more women than men develop rapid cycling moods after a number of years of mood disorder.

What are the Causes of Bipolar Disorder?

Bipolar mood disorder is thought to have a genetic component. In families where one person has manic depressive illness, there are often other family members who have episodes of depressive illness or hypomania. It is not known if there is a gene for bipolar disorder or if it is a vulnerability to severe mood swings that is passed on through families.

Other Possible Causes of Mood Swings

It is important to know that not all mood swings are caused by bipolar disorder. Some of the possible causes may be some physical illnesses such as diabetes. Recreational drugs, alcohol and medications can have an impact on mood swings. Mood swings can also be caused by viral or bacterial infection in the brain. If there is no history of mood disorder in your family then you should have a full physical check up to find out why you are having mood swings.

What Treatment is Available?

Treatment very often includes mood stabilizer drugs such as lithium carbonate, carbamazepine or sodium valproate. Anti-psychotic medication may be used to stop manic symptoms and antidepressant drugs are used in the depressive phase of the illness. Support, education and counseling may also help the person find ways of coping with the disorder and learn to recognize triggers for episodes of mood disorder.

SCHIZOPHRENIA

Schizophrenia is a serious mental illness that changes how a person thinks, feels and behaves. It also changes how they perceive the world, themselves and other people.  About 1% of the population of most countries has schizophrenia although symptoms may differ from culture to culture.

Symptoms vary widely between people who have schizophrenia. They may be mild or severe. Some people experience one episode of the illness and having received treatment do not relapse. Others have more frequent episodes but remain well for a lot of the time. Still others remain unwell and require a high level of ongoing support and treatment.

Medication is usually a central part of the treatment. This can be very effective although side effects can be problematic. Counseling, social support, assistance with employment, accommodation, finances and education are also important in assisting the person and their family to cope with the illness.

Symptoms of Schizophrenia

Delusions

These are false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person’s usual cultural concepts (US National Institute of Mental Health).

Hallucinations

These refer to a person’s perception of something that does not really exist in their environment. The most common form of hallucination is auditory, e.g. when a person ‘hears’ voices.

Disordered thinking

A person may think very quickly or in bizarre or confused ways, making it difficult for others to follow their train of thought.

Flat or inappropriate affect

‘Affect’ means feelings or emotions, so a person is often unresponsive or finds it difficult to feel appropriate emotions at an appropriate time.

Cognitive impairment

A person has difficulty with mental processes like memory or concentration.

Withdrawal

A person does not want to interact with others and spends a lot of time alone.

Loss of motivation

A person loses their ‘drive’ to do things, including basic self-care.

 What causes schizophrenia?

The causes of schizophrenia are not yet clearly understood although a combination of factors is seen as the most likely.

These include:

• genetics

• a biochemical imbalance in the brain

• environmental stressors

• drug use.

Treatment of Schizophrenia

Medication

Antipsychotic medication is usually prescribed for those with schizophrenia. This medication can help to control the symptoms, particularly the delusions or hallucinations that a person may experience. There are two main kinds of medication that are commonly prescribed. They are known as the ‘typicals’ and the ‘atypicals.’ The ‘typicals’ refer to the medications that have been widely used over many years, while the ‘atypicals’ refer to the newer drugs. Although the newer drugs often produce fewer side effects some people respond better to the older medications.

‘Atypical’ antipsychotic medications

‘Typical’ antipsychotic medications

Clozapine (Clozaril, Clopine) Chlorpromazine (Largactil)

Olanzapine (Zyprexa) Haloperidol (Haldol)

Risperidone (Risperdal) Thioridazine hydrochloride (Melleril)

Each person is different and medication options need to be explored with a psychiatrist on an individual basis.

Rehabilitation services can assist the person to find and maintain accommodation, education, social skills, contacts and employment.

Cognitive Behavioral Therapy (CBT) can be useful in helping the person learn ways of managing their schizophrenia. Supportive or insight-oriented counseling may also be beneficial.

Hospitalization may be necessary at times if the person becomes unwell or their medication needs to be changed or stabilized.

Support groups offer people with schizophrenia and their families the opportunity to meet people in a similar situation, share experiences, and find support, education and reassurance.

Psycho-education is useful in helping to understand the illness and reduce stigma

 REFERENCES

• American Academy of Child and Adolescent Psychiatry www.aacap.org

• American Psychiatric Association www.psych.org

• Autism Association of NSW, www.autismnsw.com.au

• The National Institute of Mental Health (NIMH) US Department of Health and Human Services

• Barlow, D.H. and Durand, V.M. (1999) Abnormal Psychology 2nd Edition Brooks/Cole Publishing USA

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