Navigating Your Depression Relapse

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Like many other common medical conditions, such as high blood pressure, depression is highly treatable, but there is also a risk that the symptoms will return. According to Dr. William Marchand, a clinical associate professor of psychiatry at the University of Utah School of Medicine, the risk of recurrence, or a relapse after a full remission, for a person who has had one episode is 50%. For a person who has had two episodes, the risk is about 70%. For someone with three episodes or more, the risk rises to around 90%. This is why having a prevention plan in place is critical. “Depression is often a chronic illness, but with a good prevention plan in place, it is often possible to prevent recurrences entirely or limit the severity and duration if depression does return.” A prevention plan must include maintenance treatment, which is “treatment that is continued after symptoms are in remission to prevent recurrence.” It is also important to understand what might be triggering a possible relapse, and how you can prevent or minimize the influence of those triggers. Here are three common triggers that could cause a relapse:

  • Not Following Treatment: “The biggest issue regarding relapse has to do with children and adults not following through on their treatment plan,” said Deborah Serani, Psy.D, a clinical psychologist. This can include anything from skipping therapy sessions to missing doses of your medications to ending your therapy too soon.
  • Ruminating: Those who suffer from depression tend to dwell on their supposed flaws and failures. These negative self-referential ruminations play a major role in relapse.
  • Not Knowing Your Personal Vulnerabilities: Since we are all unique, triggers can be specific to each individual’s situation. To identify your triggers, learn how to recognize the who, what, whys and whens of your emotional and physical life,” Serani said.

Sometimes it is not possible to prevent yourself from a relapse. However, by knowing the early signs and getting treatment right away, you can prevent a full blown episode or lessen its severity and length.



ADHD May Lead to Obesity in Boys

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While ADHD has been linked to struggles with drugs and alcohol, less schooling and more arrests, a study shows that it may also be linked to weight problems.  In this study published in Pediatrics, researchers connected the impulsive behavior that can characterize ADHD with overeating that contributes to calorie overload. The 33-year study tracked boys with attention deficit hyperactivity disorder into adulthood. They found that men who were hyperactive as children were twice as likely to have higher body-mass-index readings and rates of obesity than men who didn’t have the condition as children. Of the men who were diagnosed with ADHD as kids, 41% were obese compared with 22% of men who didn’t have ADHD as children. The average rate of obesity for me in this age group was 24%.

The study was first designed to investigate new insights into brain-structure differences among people with ADHD, but when researchers received a grant to perform brain MRI scans on the men to evaluate their psychiatric health, many of the study participants were too large to fit in the scanner. “One of these gentlemen really wanted to help out, but we had to squeeze him in, inch by inch,” says Dr. Francisco Xavier Castellanos, the study’s senior author. The scientists began asking the men for height and weight measurements to see if they would fit inside the MRI machine. They found that nearly three times as many men from the childhood hyperactivity group couldn’t fit in the scanner. Curious, the study researchers decided to systematically collect data on the men’s weight. “There had been suggestions in the past that ADHD might be related to obesity,” says Castellanos. “There were a lot of checks to make sure this was not due to other conditions. We were able to confirm that this risk seemed really related to childhood diagnosis of ADHD.”

It is not clear why this disorder would lead men with ADHD to weigh so much more than their peers. However, the researchers suspect that impulsivity and poor decision making skills played a role. “We live in a society with supersized amounts of food,” says Castellanos. “If someone has less than the average amount of self-control because of the ADHD, they are less able to withstand the temptations of food.” The results suggest that among the other behavioral issues that children with ADHD may face, maintaining a healthy weight might be an additional concern and struggle for them.



Get Outside with ADHD

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For kids who have ADHD, getting outside in the great outdoors can be really good for them. Research suggests that being outside in natural environments reduces the severity of ADHD symptoms in kids. “Being outside provides ADHD children with a more open environment to appropriately express their energy,” says Roberto Olivardia, Ph.D, a clinical psychologist and clinical instructor in the department of psychiatry at Harvard Medical School. Psychotherapist Terry Matlen, ACSW, agreed. “Children who are hyperactive and impulsive can release tension far easier being outside running, jumping, swinging and playing sports than sitting indoors.” It also gives kids the opportunity to get their bodies moving and heart pumping, which also helps to reduce ADHD symptoms, according to Stephanie Sarkis, Ph.D, a psychotherapist and author of several books on ADHD. “Exercise increases dopamine levels in the brain, and these levels are naturally low in the ADHD brain.” Here are some fun ideas and engaging outdoor activities that can get your child with ADHD moving outside:

  • Structured and Simple Activities: “Structured, organized activities with simplified instructions such as art or creative activities, playing tag and yoga can be helpful for children with ADHD,” said Sarkis.
  • Team Sports: Healthy competition can be engaging and stimulating for your child. Try to get him or her involved in team sports such as soccer, baseball, basketball, volleyball, football or tennis.
  • Individual Activities: Some kids might thrive in team sports, however there are many that “have problems with social skills and poor motor skills (clumsiness),” said Matlen. They might not enjoy team sports, so activities such as running, swimming or biking might be best suited for them.
  • Natural Activities: “Children with ADHD are curious and most love nature,” Matlen said. She suggests everything from gardening to setting up bird feeders could be great activities for kids with ADHD. This way they can, for example, quietly wait for birds to feed, which is a great skill for them to develop.
  • Yard Work: Matlen also suggests “activities like painting the fence, raking leaves [and] hauling things in the wheelbarrow.” These types of activities are effective since it forces kids to use their bodies against resistance which offers a calming effect, much like some therapeutic activities occupational therapists use.



The Positive Symptoms of Schizophrenia

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Schizophrenia causes two types of symptoms: negative and positive. However, “positive” doesn’t necessarily mean “good”. Positive symptoms of schizophrenia are things that are “added” or “new” to your personality that significantly impact your life. The most common positive symptoms of schizophrenia include:

  • Hallucinations: You hear voices. The hallucinations will seem real and can involve sight, hearing, taste, smell, and/or touch.
  • Delusions: You believe something that cannot be proven or continue to believe something that has been proven to be false or wrong. A common delusion for those with schizophrenia is to believe you are an important historical or political person, or that there is poison in your food.
  • Confused and Disorganized Speech and Behavior: For example, a person might not make sense when talking or will easily get off the subject of the conversation. They might dress oddly, such as wearing many shirts at once, or wearing winter clothing during the summer. It is also possible that they might exhibit socially inappropriate behavior, such as urinating in public.

Positive signs of schizophrenia usually can be reduced or prevented with medicines. If you or someone you know suffer from schizophrenia and experience any of these “positive” signs, speak with a doctor to find out the best treatment plan for these symptoms.



Symptoms of Schizophrenia

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Schizophrenia is an illness that can affect a person’s ability to think clearly, manage emotions, and interact with others. It can affect each person differently. The symptoms of schizophrenia include:

  • Negative Symptoms: In the case of schizophrenia, “negative” does not mean “bad”. Negative symptoms are things that are “lost” from one’s personality, thus influencing his or her outlook on life. One may act in the following way as a result:
    • Does not care about things
    • Lose interest or drive to do things
    • Not taking care of oneself, such as not bathing regularly
    • Difficulty communicating how he or she feels
    • Become angry with strangers for no reason and react to others in other harmful ways
  • Positive Symptoms:Similar to negative symptoms, “positive” does not mean “good”. Positive symptoms are things “added” or “new” to one’s personality, which influence his or her experience in life. These symptoms include:
    • Hallucinations
    • Delusions
    • Thoughts and speech that are confusing
  • Cognitive Symptoms:These symptoms revolve around how one thinks and are often not obvious to oneself or others. They can include:
    • Memory loss
    • Not being able to understand things well enough to make decisions
    • Having trouble talking clearly to others

Symptoms tend to start during adolescence or young adulthood, but they can also start later in life. They might appear suddenly or develop slowly and one may not be aware of his or her symptoms. The negative symptoms of schizophrenia usually appear first. Positive symptoms can start within days, months or years after the negative symptoms. Some early signs of the disorder may include performing worse in school, thinking that people are trying to do harm, or changes in one’s personality, such as not wanting to see people. These signs are not necessarily indicative of schizophrenia; however, if one is noticing them as well as the symptoms above, he or she should speak with his or her doctor.



Guide to Tweens and Teens with ADHD

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Raising a tween or teen can be a challenge. When the child has ADHD, it can be even more challenging.

A study from Massachusetts General Hospital found that teens with attention deficit hyperactivity disorder are more likely to partake in risky behavior, such as smoking and abusing drugs, than their peers who don’t have the disorder. Other studies have shown that teens with ADHD are not only more likely to experiment with drugs, but more likely to do so at an earlier age, to boot. They are also more prone to depression and suicide.

None of this is inevitable, though. Here is some advice on how to better deal with the issues that parents of tweens and teens, with ADHD, contend with:

  • Educate Yourself: “The first and most important thing I would suggest is that parents educate themselves as much as they can about ADHD and ADHD symptoms,” says Ari Tuckman, PsyD. Knowing what to expect from your child could help to make it easier to deal with issues if and when they arise. If you are better prepared, you will be able to react in ways that will help your child rather than hurt him or her.
  • Educate Your Child: Teens are generally not good at recognizing the consequences of risky behaviors; and for teens with ADHD, they probably are even poorer at understanding cause and effect. Tuckman says, “As a parent, you need to talk to your child about ADHD and about how risky situations are more likely to lead to certain outcomes. That way, your teen may be more likely to understand the consequences of his actions and try to avoid situations that could be riskier.” For example, suppose your teen with ADHD doesn’t get along well with a classmate who takes the same bus to school. Explain that getting in trouble is therefore a lot more likely, if your teen sits near that classmate. Take the time to be clear and thoroughly explain such situations.

Every teenager, with ADHD or not, needs structure and support. As a parent, you can provide the proper support and intervene when necessary. When you know what you are doing and are prepared, you can help your teen with ADHD through this extra-challenging time.



Tips for Overcoming Binge Eating

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Binge eating disorder is characterized by compulsive overeating whereby people consume huge amounts of food and feel powerless to stop. It can be very difficult for a person to overcome binge eating, however if you develop a healthier relationship with food, you can overcome it. Here are some strategies to help overcome binge eating:

  • Manage Stress: It is very important to find alternative ways to handle stress and overwhelming feelings without using food. These can include exercising, meditating, using sensory relaxation strategies, and practicing breathing exercises.
  • Eat 3 Meals a Day plus Healthy Snacks: Eat breakfast to jump start your metabolism, and follow that by a balanced lunch, and then dinner. Eat healthy snacks in between each meal. Be sure to stick to scheduled mealtimes because skipping meals can often lead to binge eating later in the day.
  • Avoid Temptation: If you have junk food, desserts, and unhealthy snacks in the house, you are more likely to overeat. Fix this by clearing out your kitchen of your favorite binge foods.
  • Stop Dieting: Hunger from strict dieting can trigger food cravings and the urge to overeat. Instead of dieting, try focusing on eating in moderation. Find healthy foods that you enjoy and eat them only until you feel content, not uncomfortably stuffed.
  • Exercise: Exercise will help you lose weight in a healthy way, lift depression, improve overall health, and reduce stress. The natural mood-boosting effects of exercise can help put a stop to emotional eating.
  • Fight boredom: Distract yourself instead of snacking when you are bored. Talk a walk, read a book, call a friend or take up a hobby such as drawing.
  • Get Enough Sleep: When you are tired, you may want to keep eating in order to boost your energy. Try taking a nap or going to bed earlier instead.
  • Listen to Your Body: Learn to distinguish between physical and emotional hunger. If you recently ate and your stomach isn’t rumbling, you are probably not actually hungry. Let the craving pass.
  • Keep a Food Diary: Write down what you eat, when, how much and how you are feeling when you are eating. You might be able to see a pattern emerge that could reveal the connection between your moods and binge eating.
  • Get Support: You will likely succumb to your binge eating triggers if you lack a good support network. Lean on family and friends, join a support group and even consult a therapist, in order to get the support you need to overcome your disorder.


Name Change for Schizophrenia?

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Experts are beginning to think that the term “schizophrenia” is becoming outdated. Many are agreeing that the term schizophrenia tends to bring up negative images with significant stigma, suggesting discrimination, labeling, isolation and social rejection. Discussions have started to emerge about whether or not to change the term “schizophrenia” to something that is less stigmatizing. The most accepted new term, as of now, is salience syndrome. Many experts agree that salience would most accurately convey the actual experience of individuals with schizophrenia because it describes the internal process of reacting to and processing stimuli. Patients have yet to weigh in on this decision. Constantin Tranulis, M.D., Department of Psychiatry at the University of Montreal assessed their opinions.

Researchers asked 161 college students and 19 patients who were in the early stages of psychosis about the acceptability, validity, and impact of both diagnostic terms: schizophrenia and salience syndrome. The findings showed that no matter which name was assigned, the college students already had preconceived beliefs about the stigmatizing characteristics of the illness, including social rejection and discrimination. However, for patients who actually had the disorder, almost unanimously chose the term salience syndrome over schizophrenia. Their reason for their choice was that the change in name could help to protect them from experiencing the stigma associated with the term schizophrenia. They are concerned though that people will eventually know that salience syndrome and schizophrenia were the same disorder, and overtime, they will be subjected to the same negative stigmas. Tranulis added, “future studies with larger samples are warranted in order to clarify the role of labels on self-stigmatizing attitudes.”



Migraines and Children

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People tend to think of migraines as an adult problem, however kids get migraines too. These migraines may be linked in some way to behavior disorders in children. A recent study found that children with migraine headaches had a significantly higher risk for behavior disorders. This finding is similar to results from previous studies which show that children with migraines have a higher risk for depressive disorders, anxiety, and behaviors such as hyperactivity and attention problems. Behavior problems could be a trigger for migraine attacks in children, or they could be a result of migraines.

“It is hard to tease out the link between problems like depression and hyperactivity from migraine because all these conditions are common in children,” says Andrew D. Hershey, MD, PhD, the associate director of neurology research and professor of pediatrics at Cincinnati Children’s Hospital in Ohio. “Both behavior problems and headaches need to be checked out. The most important thing to realize is that children do get migraines. In fact, migraines are one of the top five childhood disorders, even more common than childhood asthma.”

Recognizing Migraine Symptoms in Children

Symptoms to keep an eye on:

  • A pounding type of headache- Children may have pain on both sides of the head or across the forehead
  • Pain that limits their activity or worsened due to activity
  • Pain that is moderate to severe
  • A headache that lasts from one to 72 hours
  • A headache that comes with nausea or vomiting
  • A headache becomes worse by sound or light

Since behavioral problems have been linked to migraines in studies, you should watch your child if they have a headache combined with symptoms like irritability, changes in sleep or appetite, trouble at school, mood swings, crying, withdrawing from friends or family, and lack of energy.

Minimizing Migraines in Children

Have your child follow these steps to help prevent migraines and possibly help prevent behavior problems related to migraines.

  • Drink fluids
  • Avoid caffeine
  • Eat healthy foods regularly
  • Get enough exercise
  • Get enough sleep

By helping your child identify and avoid stress, depression and anxiety, you can also help to reduce his or her migraines and behavior problems.

Until more is known about this link between behavior and migraine, the best thing for you to do is to be aware of how your child is feeling. Speak with your child’s doctor if your child is experiencing any symptoms of migraines or behavior problems.



Coping with Depression Setbacks

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As you are on your way to overcoming your depression, it is not uncommon for your depression symptoms to flare up again. You might experience a few bad days, sometimes referred to as setbacks, which are common hurdles in depression treatment that can slow a patient’s progress, says David Blackburn, PhD, a psychologist at Scott & White Hospital in Temple, Texas. Setbacks can unfortunately cause a vicious cycle, since they can often worsen a person’s depression symptoms. “They might get even more discouraged than they already are,” Blackburn explains.“  Try some of these strategies when you feel yourself slipping back into your depression:

  • Use Coping Techniques: Try to remember the strategies that you learned during your treatment of depression, such as avoiding thoughts that tend toward the absolute- “I can never do anything right.” Blackburn says that people who suffer from depression should try to take stressful events in stride and stop fixating on situations they have no influence over. “It’s important to recognize that you, as an individual, cannot control a situation or people in it,” Blackburn says. “The only thing you can control is how you respond.”
  • Improve Dietary and Exercise Habits: If you take care of your body, you will feel better, both mentally and physically. Even just a small amount of physical activity will improve your outlook. Try to eat plenty of fruits and vegetable per day, as well as plenty of whole grains and low-fat dairy products.
  • Ask About Adjusting Your Medication: If you are taking medicine for your depression, setbacks can occur if the medication becomes less effective. Sometimes a simple switch is all that is needed to move forward. If you feel that your medicine is causing your setbacks, speak with your doctor.
  • Consider Psychotherapy: If you have been managing your depression with medication alone, you might find that adding psychotherapy to your treatment regimen might be beneficial. “Medication can improve your mood to the point where psychotherapy can be more successful,” Blackburn says.