Mental Health Manual 2021/2022

Table of contents Topics

Pages

SWG Word

6

Mental health principles:

10

OCD:

18

- Definition of mental health - Importance of mental health - Relation between mental health and public health - Stigma and misconceptions - Activities

- Definition - Related conditions - Causes and Risk factors - Symptoms - Prevention - Treatment - How can i assess treatment - What talking therapues might I be offered?

- Could i be offered to meet a social care support specialist?

- Ocd services - Activities

PFA: - What is PFA and what is not?

- Who needs PFA? - When is PFA provided?

- Where is PFA provided?

- Why is it important?

- Do and don'ts - Activities

24

Anxiety :

29

- Definition - When does anxiety become a mental disorder?

- Difference between normal anxiety and anxiety disorder - Psychological therapies - Medications - Self help for PTSD - Risk factors - Symptoms - Effects - Prevention - Treatment - Common myths about anxiety disorders

Depression :

40

- Definition - Types - Signs - Symptoms - Prevention - Treatment - Complications - Misconceptions

Pandemic Situation :

50

- Mental Tips to help people calm down and reduce their stress - Tools for coping with anxiety

General lines of Treatment :

52

Stress and burnout :

55

Stress and burnout among medical students:

65

- What is psychotherapy?

- Types of psychotherapy - How to choose the best therapist for yourself?

- Definition - Types - Symptoms - Causes - Prevention - Treatment - Difference between stress and burnout

- Results - Activities

Addiction:

68

ADHD:

73

Adolescent mental health:

85

Health behavior & behavioral change :

89

Gender based violence:

97

HIV:

101

- Dual diagnosis - What comes first, substance abuse or mental health problems?

- Recognizing a dual diagnosis and denial - Signs and symptoms - Treatment

- Definition - Symptoms - Types - Misconceptions - Treatment - Therapy - FA

- Key facts - Introduction - Mental health determinants - Emotional disorders - Behavioural disorders - Eating disorders - Psychosis - Suicide and self-harm - Risk talking behaviours - Promotion and prevention - Early detection and treatment - Who response

- Definition of health behavior - Understanding health behavior - Behavior change models - Methodology of behavioral change - Behavior change in practice

- Link between GBV and mental health - PFA

- Relation between HIV and mental health - Challenges faced by people living with HIV - HIV treatments and therapies

- PFA

Antisocial personality disorders:

103

PTSD:

107

Borderline Personality Disorder:

113

- Definition - Causes - Symptoms - Risk factors - Diagnosis - Treatment - How can psychotherapy help antisocial personality disorder?

- Prevention - When should I call my doctor about ASPD?

- Definition - Sign and symptoms - Risk factors - Treatment and therapy

- Sign and symptom - Risk factors - Treatment and therapies - Test and diagnosis - Seek and stick with treatment - Other elements of care - Finding help - Tips for family and caregivers

SWG word As we believe in what Matt Haig said “Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain.”

After more than two years of hard work, trying to gather all the possible information you need to know about Mental Health and Mental Disorders, Hereby we introduce to you the Mental Health Manual!

We tried so hard to gather all the available information in one document accessible, reachable, and easily used by you. This document contains all the major and most popular mental disorders everyone of us must know about. It will widen your scope of knowledge regarding mental issues and may help you support anyone in his/her own battle.

Mental Health matters, it refers to our emotional, psychological, and social well-being. It affects how we think, feel, and act!

It’s one of the major global health issues and good mental health is a right for each one living in this world. So we worked hard to make it easy to be understood, wishing we could do something to prevent the stigma, raise the awareness, and correct the misconceptions.

I’d like to thank the people who gave their time and effort to make this fabulous manual and make it come out light.

Enjoy reading!

MH manual SWG 21/22,

Mental Health Principles Definition of Mental Health: It is the state of well-being in which the individual: ● ● ● ●

Realizes his/her own abilities Can cope with the normal stress of life Can work productively and fruitfully Is able to make a contribution to the community

Importance of Mental Health: ● Mental Health equals physical health as it includes: emotional, psychological, and social well-being. ● It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. ● Mental health is important at every stage of life, from childhood and adolescence to adulthood.

Mental Health relation to Public Health: Mental health problems constitute a large and increasing part of the burden of disease worldwide.

As such, their prevention and the provision of adequate mental health care facilities are important public health goals.

The Centers for Disease Control and Prevention (CDC) recognize depression as a critical public health issue, as this mental illness is a leading cause of both injury and disease worldwide.

Many mental illnesses can lead to an increased chance of suicide, especially in high-income countries. With approximately 800,000 deaths from suicide each year and even more countless attempts, this is an escalating problem. According to the WHO, suicide is the second most common cause of death in teenagers and young adults aged 15 to 29.

Warning signs to have a mental disorder Rarely do major mental illnesses such as schizophrenia or bipolar disorder appear out of nowhere.

Usually, family members, friends, or individuals themselves recognize minor changes or feel that something is not right about their thoughts, emotions and behavior, before one of these illnesses appears in its full form.

Learning about the development of symptoms or early warning signs and taking action, as well as early intervention can help you reduce the severity of the disease.

Most of the mental illnesses are not considered diseases but rather behavioral disorders, so it is necessary to clarify the difference between disease, disorder, etc.

What is the difference between? ● ● ● ● ●

· · · · ·

Disorder Disease Syndrome Illness Condition

Disease: pathological process, has symptoms and needs to be cured.

a

specific

cause,

characteristic

Ex: Laryngitis.

Disorder: Functional Impairment ex, Depression.

Syndrome: Number of symptoms occurring together and characterizing a specific disease Ex: irritable bowel Syndrome.

Illness: Something that needs to be managed.

Condition: State of health “ill or well”, is the least specific Ex: pregnancy.

Stigma on Mental Health Mental illness stigma

The meaning of the word stigma is a mark, a stain, or a blemish. In relation to mental illness, stigma is when someone is marked, discredited or labeled as a collection of symptoms or a diagnosis (e.g. ‘psychotic’).

What are examples of mental illness stigma? ● When someone with a mental illness is called ‘dangerous’, ‘crazy’ or ‘incompetent’ rather than unwell, this is an example of stigma. ● It is also considered stigma when a person with mental illness is mocked or called weak for seeking help.

Stigma often involves inaccurate stereotypes. People with mental illness may be characterized as being more violent than the rest of the society. A person with anxiety may be labelled as being cowardly rather than having an illness. People with depression may be told to ‘snap out of it’. People living with schizophrenia are incorrectly described as having a ‘split personality’. These are all examples of stigma against people with mental health issues.

Why does stigma exist?

Stigma arises from the lack of understanding of mental illness (ignorance and misinformation), and also because some people have negative attitudes or beliefs towards it (prejudice). This consequently leads to discrimination against people with mental illness. Even some mental health professionals have negative beliefs about the people they care for.

Media can also play a part in reinforcing a stigma by: ● portraying inaccurate stereotypes about people with a mental illness ● sensationalizing situations through unwarranted references to mental illness ● using demeaning or hostile language For example, if a part of the media associates mental illness with violence, that promotes the myth that all people with a mental illness are dangerous. In fact, research shows people with mental illness are more likely to be victims of violence rather than perpetrators.

How does stigma affect people with mental illness: A person who is stigmatized may be treated differently and excluded from many things the rest of society takes for granted, leaving them marginalized.

They may become labelled by their illness, and so become vulnerable to prejudice and discrimination.

Dealing with the effects of prejudice and discrimination is distressing and can exacerbate mental illness. Many people say dealing with this is harder than dealing with the mental illness itself.

People with mental illness may also take on board the prejudiced views held by others, which can affect their self-esteem. They may feel ashamed or embarrassed. This can lead them to not seek treatment, to withdraw from society, and turn to alcohol and drugs or even to suicide.

How to deal with stigma: ● Don’t avoid getting treatment:

Don’t let your fear of being labelled or discriminated against, stop you from seeking help and treatment.

● Don’t believe that you are your illness: Someone with a broken ankle is not a broken ankle — they are more than their illness. So are you. If you have bipolar disorder, say ‘I have bipolar disorder’ rather than ‘I’m bipolar’. If you convince yourself first that you’re a person, not a walking illness, others will find it easier to see you that way too.

● Don’t take it personally:

Most discrimination comes from people who don’t understand or have little or no experience of mental illness. Try to consider it as their problem, not yours. ● Use facts: Mental illness is common. It is not a sign of weakness. Learn some useful facts and figures, and tell people about it.

● Tell your story (if you want):

The more mental illness remains hidden, the more people think it must be something to be ashamed of. People speaking out can have a positive impact. You can choose how much you reveal about your life. When people get to know someone with mental illness it helps reduce stigma.

● Join a support group:

You may find it helpful to join a support group of one of the mental health organizations. It can be useful to meet others in the same situation, and support groups often have resources that may help educate family members and others about mental illness.

Misconceptions about Mental Health Everyone is exposed to experience one or more of the mental disorders , which may be severe sometimes. A person with mental health issues usually faces stigma from his society and this stigma is due to lack of awareness about the nature of mental disorders , so here is the most common myths about mental illness :

1. You're either mentally ill or mentally healthy!

Mental health is a continuum and people may fall anywhere on the spectrum. Even if you are doing well, there's a good chance you aren't 100% mentally healthy. In fact, the U.S. Department of Health and Human Services estimates only about 17% of adults are in a state of "optimal" mental health.

2. Mental illness is a sign of weakness!

Mental strength is not the same as mental health. Just as someone with diabetes could still be physically strong, someone with depression can still be mentally strong. Many people with mental health issues are incredibly mentally strong. Anyone can make choices to build mental strength, regardless of whether they have a mental health issue or not.

3. You can't prevent mental health problems!

You certainly can't prevent all mental health problems as factors like genetics and traumatic life events play a role. But everyone can take steps to improve their mental health and prevent further mental illness.

Establishing healthy habits—healthy eating, getting plenty of sleep, participating in regular exercise—can also go a long way to improving how you feel. Similarly, getting rid of destructive mental habits, like engaging in self-pity or ruminating on the past, can also do wonders for your emotional well-being.

4. People with mental illness are violent!

Unfortunately, when the media mentions mental illness, it's often in regard to a headline about a mass shooting or domestic violence incident.

Although these headlines frequently portray many violent criminals as being mentally ill, most people with mental health problems aren't violent.

-The American Psychological Association reports that only 7.5% of crimes are directly related to symptoms of mental illness.

5. Mental health problems are forever!

Not all mental health problems are curable- schizophrenia, for example, doesn't go away. But most mental health problems are treatable.

The National Alliance on Mental Illness reports that between 70 and 90% of individuals experience symptom relief with a combination of therapy and medication. Complete recovery from a variety of mental health issues is often possible.

6. Having a mental illness means you are “crazy”!

Having a mental illness does not mean you are “crazy.” It means you are vulnerable. It means you have an illness with challenging symptoms.

7. Psychiatric medications are bad!

People tend to believe that psychiatric medicine is harmful. That, or they believe that psych meds are simply “happy pills” and “an easy way out” for those with mental illness Just like any other detrimental medical condition, mental illness is still an illness. For many with mental illness, medication is necessary, just like it would be for a diabetic taking insulin. For some individuals with mental illness, medication is needed for survival. For others, like those who have mild to moderate depression, anxiety, or ADHD, medication can help ease symptoms, so they can function normally.

Moreover, having regular therapy combined with medication can greatly improve one’s quality of life. To avoid dealing with their problems? This is simply a false claim.

8. Seeking help for mental illness will lead to being ostracized and worsening the symptoms!

Coming out about having a mental illness to anyone is definitely a difficult process, especially because people with mental health issues are so commonly misunderstood. Additionally, people who are unfamiliar with mental illness tend to think that they are the way they are because of nature, personality or attitude. But when you do have the strength, courage and bravery to open up to someone else, you are working to alleviate the stigma, increase awareness, empower yourself, grow as a person, and promote understanding of mental health. So don’t let others' perceptions scare you from getting the help you need.

It’s important that we prevent societal constructs from framing people as violent or “crazy” for having an illness that is beyond their control.

9. People with Mental disorders can't handle everyday responsibilities!

The perception that mentally ill people cannot complete work leads to systemic discrimination in employment. While it is true that those who suffer from mental illness have additional obstacles to overcome, most can still function as well as those without mental illness. Unfortunately, the idea that mental illness equals irresponsibility makes it difficult for those who need help finding treatment.

10. Mental health problems are permanent!

A mental health diagnosis is not necessarily a “life sentence.” Each individual’s experience with mental illness is different. Some people might experience episodes, between which they return to their version of “normal.” Others may find treatments — medication or talking therapies — that restore balance to their lives.

Some people may not feel as though they have fully recovered from a mental illness, and some may experience progressively worse symptoms.

11. Children don't experience mental health problems!

Even very young children may show early warning signs of mental health concerns. These mental health problems are often clinically diagnosable, and can be a product of the interaction of biological, psychological, and social factors.

Half of all mental health disorders show first signs before a person turns 14 years old, and three quarters of mental health disorders begin before age 24. Unfortunately, less than 20% of children and adolescents with diagnosable mental health problems receive the treatment they need.

Early mental health support can help a child before problems interfere with other developmental needs.

12. The mentally ill must be placed in a psychiatric hospital!

Not all patients should be placed in a clinic, but only a small percentage are placed and the rest can be dealt with through psychological sessions or through drug treatment.

13. Psychiatric drugs are addictive and have dangerous side effects!

Psychological drugs are the same as other medications and drugs known in physical cases, as long as the use of treatment is correct and under medical supervision, the drugs cannot be dangerous or addictive.

14. Mental illnesses are contagious!

Mental illnesses are not contagious at all. They are probably hereditary in some cases, but they are not contagious in any way. Rather, the patient must be taken care of well and must not be abandoned.

Obsessive Compulsive Disorder (OCDs) OCD definition: Obsessive-compulsive disorder (OCD) is an anxiety disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.

Many people have focused thoughts or repeated behaviors.

But these do not disrupt daily life and may add structure or make tasks easier. For people with OCD, thoughts are persistent and unwanted routines and behaviors are rigid, and not doing them causes great distress. Many people with OCD know or suspect that their obsessions are not true; others may think they could be true (known as poor insight). Even if they know their obsessions are not true, people with OCD have a hard time keeping their focus off the obsessions or stopping the compulsive actions.

Related Conditions Other conditions sharing some features of OCD occur more frequently in family members of OCD patients. These include, for example, body dysmorphic disorder (preoccupation with imagined ugliness), hypochondriasis (preoccupation with physical illness), trichotillomania (hair pulling), some eating disorders such as binge eating disorder, and neurologically based disorders such as Tourette’s syndrome. ● Body Dysmorphic Disorder ● Hoarding Disorder ● Hair-Pulling Disorder (Trichotillomania) ● Skin-Picking Disorder (Excoriation)

Causes of OCD

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include: ● Biology: OCD may be a result of changes in your body's own natural chemistry or brain functions. ● Genetics: OCD may have a genetic component, but specific genes have yet to be identified. ● Learning: Obsessive fears and compulsive behaviors can be learned from watching family members o arer gradually learned over time. ● Research suggests that OCD involves problems in communication between the front part of the brain and deeper structures of the brain.

These brain structures use a neurotransmitter (basically, a chemical messenger) called serotonin. Pictures of the brain at work also show that, in some people, the brain circuits involved in OCD become more normal with either medications that affect serotonin levels (serotonin reuptake inhibitors, or SRIs) or cognitive behavior therapy (CBT).

Risk factors Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include: ● Family history: Having parents or other family members with the disorder can increase your risk of developing OCD. ● Stressful life events: If you've experienced traumatic or stressful events, the risk may increase. This traumatic experience may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD. ● Other mental health disorders: OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse.

Symptoms Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you have obsessive-compulsive disorder.

With OCD, these thoughts and behaviors cause tremendous distress, take up a lot of time (at least one hour per day), and interfere with your daily life and relationships.

Most people with obsessive-compulsive disorder have both obsessions and compulsions, but some people experience just one or the other

Common obsessive thoughts in OCD include: ● ● ● ● ● ● ●

Fear of being contaminated by germs or dirt or contaminating others Fear of losing control and harming yourself or others Intrusive sexually explicit or violent thoughts and images Excessive focus on religious or moral ideas Fear of losing or not having things you might need Order and symmetry: the idea that everything must Superstitions; excessive attention to something considered lucky or unlucky

Common compulsive behaviors in OCD include: ● Excessive double-checking of things, such as locks, appliances, and switches. ● Repeatedly checking in on loved ones to make sure they’re safe. ● Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety. ● Spending a lot of time washing or cleaning. ● Ordering or arranging things “just so”. ● Praying excessively or engaging in rituals triggered by religious fear. ● Accumulating “junk” such as old newspapers or empty food containers.

Prevention and Treatment What treatments can help? Most people who get the right treatment see a significant improvement in their OCD. This page covers: ● Accessing treatment ● Talking therapies ● Medication ● Social care support ● Specialist OCD Services

How can I access treatment? ● The first step to getting treatment for OCD is to visit your GP. Your GP will ask about your symptoms and discuss different treatment options. ● Treatment for OCD should include talking treatments and medication (The National Institute for Health and Care Excellence (NICE) – the organization that produces guidelines on best practice in health care) ● The combination of treatments you are offered depends on how severe your OCD is, and what treatments have worked or not in the past. If you feel a treatment is not working for you, it is a good idea to discuss this with your GP, as there may be other alternatives available.

What talking therapies might I be offered?

You may be offered the following talking therapies for OCD, either on their own, or along with medication.

1. Cognitive Behavioral Therapy (CBT) ● Cognitive behavioral therapy (CBT) focuses on how your thoughts, beliefs, and attitudes affect your feelings, and behavior.

0.

Exposure and Response Prevention (ERP)

● Exposure and response prevention (ERP) is specifically designed for OCD. It encourages you to confront your obsessions and resist the urge to carry out compulsions. ● During ERP, your therapist will support you to deliberately put yourself in a situation that would usually make you feel anxious. Instead of performing your usual compulsion, you will be encouraged to try and tolerate the anxiety. ● ERP helps you to see that the uncomfortable feelings will eventually go away even if you don't perform a compulsion. ● This type of therapy can be challenging and may make you feel more anxious at first. It is a good idea to talk to a healthcare professional before you start the course, and discuss whether you are in a good place to start it.

0.

Cognitive Therapy

● Cognitive therapy focuses on identifying and changing negative feelings about yourself, to help you change unhelpful responses and behaviors.

Could I be offered social care support?

Depending on how your OCD impacts your life, you may be eligible for social care. Social care services support people who struggle to manage day-to-day activities. You can read more about social care in our guide to health and social care rights.

Specialist OCD services If your OCD is very severe and the above treatment options have not helped, you may be referred to a specialist OCD service. Unfortunately, not all areas have specialist services, and you might have to travel outside your local area.

Activities to be done within the session: 1. To reflect the difference between OCD and perfectionism.

One - Two - Four Dialogue Materials ● Paper and pen for participants ● Flipcharts for teamwork ● Timer

each

Instructions ● Specify a set of questions for each round of conversation, ideally one to three questions per round. Prepare one slide or flipchart paper with the questions for each round.

Flow 1. Introduce the process to participants: ● Participants will discuss each topic in 3 steps, first through individual reflection, then discussion in pairs, then in groups.

0.

Start the first round of conversation: ● Introduce the first question. Project a slide with this question, or write it on the flipchart. (You may include more than one question). Hand out pen and paper to each participant.

● Assign individual work. Ask participants to reflect individually on the question(s) and write down their answers. Give a time limit of 2-3 minutes. ● Assign working in pairs. Ask participants to formulate pairs and discuss their answers to the question(s). Announce a time limit of 3 to 5 minutes. ● Assign group work. After the time limit has expired, ask participants to form a group with another pair. Invite group members to share information from their previous paired discussions and to discuss the same question one more time. Announce a time limit of 5-7 minutes.

Ask team members to use the flipchart (if available) for taking notes.

2. I used to think… But now I think…

This is a good reflection protocol following an activity, or an event that should lead to experiencing, or learning something new. It could also be work towards a change in attitude about something. Basically, participants are asked to answer two questions quietly.

1. I used to think…

2. But now I think…

Give two to five minutes for reflecting or writing depending on the length of the activity and the learning expected. Then people can share their answers with the group. You can collect them on flipchart paper, or even type them to share later with participants or others. If you have a large group, you might want to break them into smaller groups so that each person can share.

3. OCD have some hidden types people can’t expect it.

This is a reason to get questions or flash cards to include and exclude types and how to describe them. Use some flashcards with words like, “washing hands”, “keeping everything if you need it later” or “puzzles,” that will help them discover and discuss the unreasonable ideas. This will help them to remember the answer and explanation better later on.

4. Silent Role play of different Situations (for OCD types) with voice over to show the conflict of ideas.

Celebrities have mental disorders "I felt like I was going into a very dark place, and I wasn't capable of getting up in the morning, so I signed up for something that would force me to be active" "I was on Prozac for a long time. It may have helped me out of jam for a little bit, but people stay on it forever. I had to get off at a certain point because I realized that, you know, everything’s just okay." “I have never been remotely ashamed of having been depressed. Never. What’s to be ashamed of? I went through a really rough time and I am quite proud that I got over it.

Psychological First Aid PFA is: Humane, supportive & practical assistance to fellow human beings who recently suffered a serious stressor. ● Non-intrusive, practical care and support ● Assessing needs and concerns ● Helping people to address basic needs (food, water) ● Listening, but not pressuring people to talk ● Comforting people and helping them to feel calm ● Helping people connect to information, services and social support ● Protecting people from further harm

PFA is : ● NOT something only professionals can do ● NOT professional counselling ● NOT a clinical or psychiatric intervention (although can be part of good clinical care) ● NOT “psychological debriefing” ● NOT asking people to analyze what happened or put time and events in order ● NOT pressuring people to tell you their story, or asking details about how they feel or what happened https://www.who.int/mental_health/world-mental-health-day/ppt.pdf

Who needs PFA? ● PFA is for distressed people who have been recently exposed to a serious crisis event. You can provide help to both children and adults. However, not

everyone who experiences a crisis event will need or want PFA. Do not force help on people who do not want it, but make yourself easily available to those who may want support. ● There may be situations when someone needs much more advanced support than PFA alone. Know your limits and get help from others, such as medical personnel (if available), your colleagues or other people in the area, local authorities, or community and religious leaders.

● We have listed people who need more immediate advanced support.

People in these situations need medical or other help as a priority to save a life: » people with serious, life-threatening injuries who need emergency medical care » people who are so upset that they cannot care for themselves or their children » people who may hurt themselves » people who may hurt others .

When is PFA provided?

Although people may need access to help and support for a long time after an event, PFA is aimed at helping people who have been very recently affected by a crisis event You can provide PFA when you first have contact with very distressed people. This is usually during or immediately after an event. However, it may sometimes be days or weeks after, depending on how long the event lasted and how severe it was.

Where is PFA provided?

You can offer PFA wherever it is safe enough for you to do so. This is often in community settings, such as at the scene of an accident, or places where distressed people are served (like health centers, shelters or camps), schools and distribution sites for food or other types of help. Ideally, try to provide PFA where you can have some privacy to talk with the person when appropriate. For people who have been exposed to certain types of crisis events, such as sexual violence, privacy and confidentiality are essential, as well as respecting the person’s dignity.

Why is it important?

Psychological First Aid is a supportive intervention for use in the immediate aftermath of disasters and terrorism. It’s important because it aims to: ● Establish a human connection in a non-intrusive, compassionate manner. ● Enhance immediate and ongoing safety ● Provide physical and emotional comfort.

● Calm and orient emotionally overwhelmed or distraught survivors. ● Help survivors to tell you specifically what their immediate needs and concerns are, and gather additional information as appropriate. ● Offer practical assistance and information to help survivors address their immediate needs and concerns. ● Connect survivors as soon as possible to social support networks, including family members, friends, neighbors, and community helping resources. ● Support adaptive coping, acknowledge coping efforts and strengths, and empower survivors; encourage adults, children, and families to take an active role in their recovery. ● Provide information that may help survivors cope effectively with the psychological impact of disasters. ● Be clear about your availability, and (when appropriate) link the survivor to another member of a disaster response team or to local recovery systems, mental health services, public-sector services, and organizations.

Do & Don’ts Things to Say and Do

Things NOT to Say nor Do

Try to find a quiet place to talk and Don’t pressure someone to tell their minimize outside distractions. story Stay near the person

Don’t interrupt or rush someone’s story.

Let them know you hear what they Don’t give your opinions of the are saying, for example, nod your person’s situation, just listen. head and stay attentive Be patient and calm.

Don’t touch the person if you’re not sure it is appropriate to do so.

Provide factual information IF you have it. Be honest about what you know and what you don’t know. “I don’t know but I will try to find out

Don’t judge what they have or haven’t done, or how they are feeling. Don’t say…” You shouldn't feel that way.” or “You should feel lucky you survived.”

Respect privacy. Keep the person’s Don’t make up things you don’t story confidential, especially when know. they disclose very private events.

Give information in a way the person Don’t use too technical terms. can understand - keep it simple.

Acknowledge how they are feeling, Don’t tell them someone else’s story and any losses or important events they share with you, such as loss of home or death of a loved one. “I’m so sorry…”

Acknowledge the person’s strengths Don’t talk about your own troubles. and how they have helped themselves.

Listen more, speak less

Don’t give false promises or false reassurances.

Don’t feel you have to try to solve all the person’s problems for them.

Don’t take away the person’s strength and sense of being able to care for themselves

Activities to be done within the session: 1. Prepare two corners in the room.. At one of them put a pad of paper and write on it the word “say” while at the other corner write on the pad “not to say” Tell the audience the sentence and ask them to forward to the corner they see it’s the right answer.

2. PFA is a situational event that won’t be exposed to it everyday, so they need to know the difference and aims very precisely so they don’t get misconceptions. They can use role-play as a main method to tell the trainer how people act and know, then the trainer can explain what is wrong and what is right.

3. Another way of being focused is to give them emotional videos or short films about support or people who need support.

4. We can use some messages from people in unfortunate situations who need support.

5. The thing is for PFA you can’t get them in a real example or situation, so they need to evoke their emotions so that it becomes memorable to

them, and to know when to help and how.

6. Role play of different situations & discuss the right technique.

Anxiety Definition of Anxiety ● Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. ● People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat. ● Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. ● Anxiety disorders differ from normal feelings of nervousness or anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect nearly 30 percent of adults at some point in their lives.

When does anxiety become a mental problem?

Anxiety disorders can cause people to try to avoid situations that trigger or worsen their symptoms. Job performance, school work and personal relationships can be affected.

In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must: ● Be out of proportion to the situation ● Be age inappropriate ● Hinder your ability to function normally

Here are several key differences between Normal Anxiety and Anxiety Disorder: ●

Stressor: Usually normal anxiety occurs in response to a stressor, such as an exam, an upcoming interview, a fight with a friend or a new job.

When you struggle with an anxiety disorder you’re anxious almost all of the time, yet there are times when you can’t spot the source of stress.

For instance, people with generalized anxiety disorder (GAD) can have a difficult time just getting through the day. Even seemingly small responsibilities, like paying the bills, make them feel anxious.

● Intensity and Length: An anxiety disorder also produces intense and excessive emotional responses. Even if you’re reacting to a stressor, your anxiety is disproportionate to that stressor. Many people are on edge before an exam, but a person with an anxiety disorder might be anxious several weeks beforehand, and will experience intense symptoms right before and during the exam. Also, normal anxiety is fleeting, while an anxiety disorder is ongoing and the feelings can last weeks or months. ● Impairment: When you struggle with an anxiety disorder, it affects your entire life. It impairs or interferes with your schoolwork, job and daily life.

Avoidance is a symptom of some anxiety disorders and can be quite debilitating. In other words, the anxiety disorder can cause you to avoid normal activities. You might skip class, miss a test, stop going to work, procrastinate grocery shopping or avoid anything that makes you feel anxious.

Types 1- Generalized Anxiety Disorder (GAD) GAD is the most common type of anxiety disorder. the main symptom of gad is over worrying about different activities and events. This may feel out of your control. If you have GAD you will typicaaly be anxious most of the time and you will usually feel ‘on edge’ and alert to your surroundings.

This can affect your day-to-day life. It might affect your ability to work, travel to places or leave the house and, due to it, you might get tired easily, have trouble sleeping and concentrating or even suffer physical symptoms, such as muscle tension and sweating.

It is common to have other conditions such as depression or other anxiety disorders if you have GAD. GAD can be difficult to diagnose because it does not have some of the unique symptoms of other anxiety disorders. Your doctor is likely to say you have gad if you have felt anxious for most days over six months and it has had a bad impact on areas of your life.

2- Panic Disorder Panic disorder results in regular panic attacks with no particular trigger.

They can happen suddenly and feel intense and frightening, also, it is possible to dissociate during panic attacks. You might as well worry about having another panic attack.

Certain situations can cause panic attacks, for example if you don’t like small spaces but have to use a lift. this doesn’t mean that you have a panic disorder. Panic disorder symptoms can include the following: ● ● ● ● ● ● ● ● ● ●

An overwhelming sense of dread or fear.

Chest pain or a sensation that your heart is beating irregularly.

Feeling that you might be dying or having a heart attack.

Sweating and hot flushes, or chills and shivering.

A dry mouth, shortness of breath or choking sensation.

Nausea, dizziness and feeling faint.

Numbness, pins and needles or a tingling sensation in your fingers.

A need to go to the toilet.

A churning stomach.

Ringing in your ears.

Story to reflect the symptoms One day, without any warning or reason, a feeling of terrible anxiety came crashing down on me. I felt like I couldn’t get enough air, no matter how hard I breathed. My heart was pounding out of my chest, and I thought I might die. I was sweating and felt dizzy. I felt like I had no control over these feelings and like I was drowning and couldn’t think straight.

“After what seemed like an eternity, my breathing slowed and I eventually let go of the fear and my racing thoughts, but I was totally drained and exhausted. These attacks started to occur every couple of weeks, and I thought I was losing my mind. My friend saw how I was struggling and told me to call my doctor for help.”

3- Social anxiety disorder Social anxiety disorder is sometimes known as social phobia. lots of people worry about social situations but if you have social anxiety you will have an intense fear or dread of social or performance situations. this can happen before, during or after the event.

Some common situations where you may experience anxiety: ● ● ● ●

Speaking in public or in groups.

Meeting new people or strangers.

Dating.

Eating or drinking in public.

You may be worried that you will do something or act in a way that is embarrassing. you might feel aware of the physical signs of your anxiety. this can include:

● ● ● ●

Sweating.

A Fast Heartbeat.

Shaky Voice.

Blushing.

You may worry that others will notice this or judge you. You might find yourself trying to avoid certain situations, and you might realize that your fears are excessive, but you find it difficult to control them.

4- Phobia ● A phobia is an overwhelming fear of an object, place, situation, feeling or animal. ● Phobias are stronger than fears. they develop when a person has increased feelings of danger about a situation or object. someone with a phobia may arrange their daily routine to avoid the thing that’s causing them anxiety.

Common examples of phobias include: ● Animal phobias – such as spiders, snakes or rodents. ● Environmental phobias – such as heights and germs. ● Situational phobias – such as going to the dentist. ● Body phobias – such as blood or being sick. ● Sexual phobias – such as performance anxiety. ● Agoraphobia Agoraphobia is a fear of being in situations where escape might be difficult. or situations where help wouldn’t be available if things go wrong. this could be: ● ● ● ●

Leaving your home.

Being in public spaces.

Using public transport.

Being in crowded spaces.

You might find that these situations make you feel distressed, panicked and anxious. you may avoid some situations altogether. this can affect day-to-day life.

5- Post-traumatic stress disorder (PTSD) Post-traumatic stress disorder (PTSD) is an anxiety disorder you might develop after a serious and frightening experience such as violence or war.

The condition was first recognized in war veterans, but a wide range of traumatic experiences can cause PTSD. You might develop PTSD after a traumatic experience such as an assault, accident or a natural disaster.

Symptoms can include: ● Having traumatic memories or dreams. ● Avoiding things that remind you of the event. ● Not being able to sleep and feeling anxious ● You may feel isolated and withdrawn.

Many people have some symptoms of trauma after a traumatic event, but for most people these go away with time and do not develop into PTSD.

Treatment: The main treatments for PTSD are psychological therapies and medication.

Psychological therapies 1. Trauma-focused cognitive behavioural therapies (TF-CBT) TF-CBT helps you to deal with your symptoms by helping you to change the way you think and behave. You may have to remember things that you find difficult to help you deal with your symptoms.

0.

Eye movement desensitisation and reprocessing (EMDR) This involves making eye movements while thinking about the traumatic event. It helps your brain to reprocess the event and deal with the painful memories in a new way until the event becomes less vivid.

Medication Medication is not helpful for most people with PTSD. But your doctor might offer you medication if: ● You find it hard to sleep ● You have another mental illness ● You would prefer to avoid therapy The most common medication for PTSD is antidepressants.

Self-help for PTSD Living with PTSD might feel overwhelming, but there are things you can try to cope with flashbacks:

● Focus on breathing – Concentrate on breathing slowly in and out while counting to 5. ● Find an object that reminds you where you are – Some people find it helpful to carry an object that reminds you that you are in the present, such as a keyring. ● Tell yourself that you’re safe – You could record phrases or write them down, to look at when you’re having a flashback. ● Comfort yourself – Do activities that make you feel calm and comfortable, like listening to music or watching your favourite TV programme. ● You can also take care of yourself through exercise, diet, daily routine, relationships and knowing how to recognise that you’re becoming unwell.

Risk factors: These factors may increase your risk of developing an anxiety disorder: ● Trauma: Children who endured abuse or witnessed traumatic events are at a higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event can also develop anxiety disorders. ● Stress due to an illness: Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future. ● Stress buildup: A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family, work stress, or ongoing worry about finances. ● Personality: People with certain personality types are more prone to anxiety disorders than others are. ● Other mental health disorders: People with other mental health disorders, such as depression, often also have an anxiety disorder.

● Having blood relatives with an anxiety disorder: Anxiety disorders can run in families. ● Drugs or alcohol: Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.

Symptoms What does anxiety feel like?

Anxiety feels different for everyone. You might experience some of the things listed below, and you might also have other experiences or difficulties that aren't listed here.

Effects on your body ● ● ● ● ● ● ● ● ● ● ● ● ● ●

A churning feeling in your stomach Feeling light-headed or dizzy Pins and needles Feeling restless or unable to sit still Headaches, backache or other aches and pains Faster breathing A fast, thumping or irregular heartbeat Sweating or hot flushes Problems sleeping Grinding your teeth, especially at night Nausea (feeling sick) Needing the toilet more or less often Changes in your sex drive Having panic attacks.

Prevention and treatment 1- Prevention

● Take care of your body by eating a well-balanced diet. Include a multivitamin when you can't always eat right. ● Limit alcohol, caffeine, and sugar consumption. ● Take time out for yourself every day. Even 20 minutes of relaxation or doing something pleasurable for yourself can be restorative and decrease your overall anxiety level. ● Trim a hectic schedule to its most essential items, and do your best to avoid activities you don't find relaxing. ● Keep an anxiety journal. Rank your anxiety on a 1-to-10 scale. Note the events during which you felt anxious and the thoughts going through your mind before and during the anxiety. Keep track of things that make you more anxious or less anxious. ● Interrupt hyperventilation. If you begin to hyperventilate, exhale into a paper bag and inhale the air within the bag. This increases the

amount of carbon dioxide you are inhaling, which can reduce the urge to hyperventilate. Inhaling from a bag will help relieve any dizziness or tingling you might feel.

2- Treatment: ● Self-treatment: ● Stress management: Limit potential triggers by managing stress levels. Keep an eye on pressures and deadlines, organize daunting tasks in to-do lists, and take enough time off from professional or educational obligations. ● Relaxation techniques: Certain measures can help reduce signs of anxiety, including deep-breathing exercises, long baths, meditation, yoga, and resting in the dark. ● Exercises to replace negative thoughts with positive ones: Write down a list of any negative thoughts, and make another list of positive thoughts to replace them. Picturing yourself successfully facing and conquering a specific fear can also provide benefits if the anxiety symptoms link to a specific stressor. ● Support network: Talk to a person who is supportive, such as a family member or friend. Avoid storing up and suppressing anxious feelings as this can worsen anxiety disorders. ● Exercise: Physical exertion and an active lifestyle can improve self-image and trigger the release of chemicals in the brain that stimulate positive emotions. ● Counseling and therapy ● Standard treatment for anxiety involves psychological counseling and therapy. ● This might include psychotherapy, such as cognitive behavioral therapy (CBT) or a combination of therapy and counseling. ● CBT aims to recognize and alter the harmful thought patterns that can trigger an anxiety disorder and troublesome feelings, limit distorted thinking, and change the scale and intensity of reactions to stressors. ● This helps people manage the way their body and mind react to certain triggers.

● Psychotherapy is another treatment that involves talking with a trained mental health professional and working to the root of an anxiety disorder. ● Sessions might explore the triggers of anxiety and possible coping mechanisms.

Medications: Several types of medication can support the treatment of anxiety Other medicines might help control some of the physical and mental symptoms. These include: ● Tricyclics: This is a class of drugs that have demonstrated helpful effects on most anxiety disorders other than obsessive-compulsive disorder (OCD). These drugs are known to cause side effects, such as drowsiness, dizziness, and weight gain. Two examples of tricyclics are imipramine and clomipramine. ● Benzodiazepines: These are only available on prescription, but they can be highly addictive and would rarely be a first-line medication. These drugs tend not to cause many side effects, except for drowsiness and possible dependency.

Diazepam, or Valium, is an example of a common benzodiazepine for people with anxiety.

● Antidepressants: While people most commonly use antidepressants to manage depression, they also feature in the treatment of many anxiety disorders. Serotonin reuptake inhibitors (SSRI) are one option, and they have fewer side effects than older antidepressants. They are still likely to cause nausea and sexual dysfunction at the outset of treatment. Some types include fluoxetine and citalopram.

Other medications that can reduce anxiety include: ● beta-blockers ● monoamine oxidase inhibitors (MAOIs) ● buspirone

Stopping some medications, especially antidepressants, can cause withdrawal symptoms, including brain zaps. These are painful jolts in the head that feel like shocks of electricity.

An individual planning to adjust their approach to treating anxiety disorders after a long period of taking antidepressants should consult their doctor about how best to move away from medications.

If severe, adverse, or unexpected effects occur after taking any prescribed medications, be sure to update a physician.

Common Myths About Anxiety Disorders: Although anxiety is so common, there are also many myths and misconceptions out there surrounding anxiety disorders and their treatment.

1. Myths: Anxiety isn’t a real disorder.

Fact : Anxiety disorder goes beyond the general worry of day to day life. They are characterized by feeling worried or fearful every day for six months. People with anxiety experience symptoms such as: ● Tightness in the chest ● Racing heart ● Difficulty concentrating ● Fear of dying or losing control ● Difficulty sleeping due to worry 0.

Myths: Medication is the only treatment for anxiety disorders.

Fact: There are many ways to treat anxiety disorders. Although medication is one option for managing anxiety and can be life-changing for some people, there are effective alternatives. For example, treatment strategies for anxiety can include: ● Meditation and relaxation techniques ● Cognitive behavioral therapy ● Individual or group-based strategies ● Exercise ● Problem-solving strategies

0.

Myths: Less stress will cure anxiety.

Fact: Of all of the myths about anxiety, one of the biggest is that removing stress from your life will completely remove your anxiety.

Living a less stressful lifestyle will, of course, help you with your symptoms, but this will not magically cure your mental health disease. Contrary to popular belief, anxiety disorders are not caused by stress, and you should undergo effective treatment in order to

learn how to properly manage your symptoms. Learning how to change your thought patterns can be so powerful.

0.

Myths: You don’t need professional help, with time you can get over anxiety on your own.

Fact: While some people believe that exercise, eating right, and avoiding caffeine is enough to combat anxiety, you will not see a lot of improvement. Only about a third of people who struggle with anxiety will actually seek treatment even though treatment has proven effective. One study found that medication is effective for 50% of people and cognitive behavioral therapy is highly effective for over 60% of people.

0.

Myth: Social anxiety is the same as being shy.

Fact: Social anxiety and being shy are not the same. On a basic level, social anxiety is an anxiety disorder, while shyness is considered part of someone’s personality. A key difference between shyness and social anxiety is the level of distress experienced. In most cases, being shy is a personal quality that is often not overly upsetting. Social anxiety, on the other hand, can be extremely debilitating and isolating.

Depression ● There are around 300 million depressed people in the world. ● Depression is a common mental disorder. Globally, it is estimated that 5.0% of adults suffer from depression. ● Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. ● More women are affected by depression than men. ● Depression can lead to suicide. ● There is an effective treatment for mild, moderate, and severe depression.

Definition of Depression: Depression is a mood disorder that involves a persistent feeling of sadness and loss of interest. It is different from the mood fluctuations that people regularly experience as a part of life. It consists of episodes during which the symptoms last for at least 2 weeks. Depression can last for several weeks, months, or years.

Depression Is Different From Sadness or Grief/Bereavement: - In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks.

- In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.

- For some people, the death of a loved one can bring on major depression.

Losing a job or being a victim of a physical assault or a major disaster can lead to depression for some people. When grief and depression coexist, the grief is more severe and lasts longer than grief without depression. Despite some overlapping between grief and depression, they are different.

Distinguishing between them can help people get the help, support or treatment they need.

Signs of depression: They can include: ● ● ● ● ● ● ● ● ● ● ● ● ●

Trouble concentrating, remembering details, and making decisions Fatigue Feelings of guilt, worthlessness, and helplessness Pessimism and hopelessness Insomnia, early-morning wakefulness, or sleeping too much Crankiness or irritability Restlessness Loss of interest in things once pleasurable, including sex Overeating, or appetite loss Aches, pains, headaches, or cramps that won't go away Digestive problems that don't get better, even with treatment Persistent sad, anxious, or "empty" feelings Suicidal thoughts or suicide attempts

Types of Depression:

• Major Depressive Disorder (unipolar Depression) • Manic Depression (Bipolar Disorder) • Atypical Depression • Dysthymia (Persistent Depressive Disorder) • Premenstrual Dysphoric Disorder (PMDD) 1- Major Depressive Disorder (unipolar Depression): • It is characterized by a persistent feeling of sadness or a lack of interest in outside stimuli. Unipolar depression is solely focused on the ”lows,” or the negative emotions and symptoms that you may have experienced.

• Subtypes: -Seasonal affective disorder or SAD is categorized as a disease directly caused by the time of the year. It occurs most often in the winter months when sunlight is not as readily available. The National Institute of Mental health states that SAD can be “effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone.”

Counseling and medication is also recommended.

-Psychotic depression often develops if you have been hallucinating or you believe in delusions that are not cohesive with reality. This can be caused by a traumatic event or if you have already had a form of depression in the past.

-Postpartum depression is a common occurrence among new mothers experiencing hormonal changes following childbirth. The stress of raising a new child as well as changes in and to your body can greatly affect your

mood. Additionally, the Canadian Mental Health Association states that parents who adopt can also suffer some of the symptoms of postpartum depression.

-Those with melancholic depression often exhibit the most typical signs of depression including weight loss and decreased interest in activities they once loved.

at least 3 of the following are required:

• A depressed mood that is distinctly different from the kind that is felt when a loved one is deceased • Depression that is worse in the morning • Waking up 2 hours earlier than usual • Observable psychomotor retardation or agitation • Significant weight loss or anorexia • Excessive or inappropriate guilt -Catatonic depression ,most likely experiencing motor problems and behavioral issues .You might be immobilized or have involuntary movements. According to the US National Library of Medicine National Institute of Health, it is a“ psychotic disorder that presents significant risk to the patient’s well-being, as well as an additional barrier to treating the underlying disorder. The signs and symptoms of catatonia interfere severely with essential activities of daily living ”.

2- Dysthymia (Persistent Depressive Disorder): • People with dysthymia describe their mood as sad or “down in the dumps,” but dysthymia is more than simply feeling sad.

Dysthymia is a chronic form of depression that can cause people to lose interest in normal daily activities, have low self-esteem along with an overall feeling of inadequacy and hopelessness, as well as difficulty with productivity.

Given the chronic nature of dysthymia, these feelings can last for years and negatively impact relationships, employment, education, and other daily activities.

People with dysthymia often find it difficult to be “upbeat”, even during good times. They might be perceived as gloomy, pessimistic, or a complainer.

• How is dysthymia different from major depression?

The depressed mood experienced with dysthymia is not as severe as major depressive disorder, but still evokes feelings of sadness, hopelessness, and loss of pleasure. While the symptoms of depression must be present for at least two weeks to be diagnosed with major depressive disorder ,a diagnosis of dysthymia requires having experienced a combination of depressive symptoms for two years or more .

3- Manic Depression (Bipolar Disorder): Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression) .When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly. Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any .

4- Premenstrual Dysphoric Disorder (PMDD): is a cyclic, hormone-based mood disorder, commonly considered a severe and disabling form of premenstrual syndrome (PMS). While up to 85% of women experience PMS, only around 5% of women are diagnosed with PMDD, according to a study in the American Journal of Psychiatry. While the core symptoms of PMDD relate to depressed mood and anxiety,

behavioral and physical symptoms also occur. To receive a diagnosis of PMDD, a woman must have experienced symptoms during most of the menstrual cycles of the past year and these symptoms must have had an adverse effect on work or social functioning.

What is the difference between PMDD and PMS? Premenstrual dysphoric disorder (PMDD) is a more serious condition than premenstrual syndrome (PMS). The symptoms present with PMS do not generally interfere with everyday function and are less severe in their intensity. While it is normal for women to experience fluctuation in mood in the days leading up to menstruation, the psychological symptoms of severe depression, anxiety, and suicidal thoughts do not occur with PMS. 5- Atypical Depression: Despite its name, atypical depression may in fact be one of the most prominent types of depression. Atypical depression is different from the persistent sadness or hopelessness that characterizes major depression. It is considered to be a “specifier” or a subtype of major depression that describes a pattern of depression symptoms, including oversleeping, overeating, irritability ,heaviness in the arms and legs, sensitivity to rejection, and relationship problems. One of the main hallmarks of atypical depression is the ability for the mood of the depressed individual to improve following a positive event

Depression may be a symptom in some disorders: - Anxiety - Generalized anxiety disorder - Social phobia

Symptoms:

• Depressed mood most of the day 10 • Anhedonia during most of the day • Insomnia • Marked weight loss ( more than 5% of body weight) • Psychomotor agitation or retardation • Fatigue and loss of energy • Feelings of worthlessness or guilt • Diminished ability to concentrate • Recurrent thoughts about death • Psychotic features • Atypical presentation (increased weight, appetite and sleep) .

-"It felt like I was really tired, all the time. I had no energy or emotion about anything." -"It feels like I'm stuck under a huge grey-black cloud. It's dark and isolating, smothering me at every opportunity. "

Disorders associated with depression: Often a person does not suffer from depression alone, as it is usually accompanied by other diseases such as: ● Generalized Anxiety Disorders. ● Schizophrenia. ● Bipolar disorder.

There is also another group of diseases caused by depression, which are: Paranoia: A chronic mental illness that is usually characterized by delusions, irrationality, or thoughts that the patient embraces and strongly believes, in exposure to persecution or conspiracy, or interprets the behavior of others in accordance with this belief. This disorder sometimes occurs in cases of severe depression and it is also accompanied by some auditory or visual hallucinations.

Psychosis: The word in English is derived from the Greek language, and it means the abnormal state of the mind.

It is used to describe a defect in the human contact with the surrounding reality. In this disorder, the patient suffers from delusional feelings and thoughts or behaves strangely sometimes while interacting with people around him. Moreover, the ability of the patient to take care of himself and do daily chores is less. This disorder often occurs in cases of "SEVERE DEPRESSION".

Panic disorder: It is a severe anxiety disorder that accompanies a panic attack, which is a sudden attack of intense fear and intense physical reactions when there is a real danger, or a clear cause for fear. Panic attacks can be very frightening.

When panic attacks occur, you may think you're losing control, having a heart attack, or even dying. These episodes of panic often accompany acute depressive episodes.

Eating Disorder: It features abnormal eating behavior and is characterized by, either excessive uncalculated eating, or extreme reduction of food, to the extent

that the body ends up in a state of starvation. This disorder occurs frequently with depression and generalized anxiety disorders.

Substance use disorders: Substance use disorders related to depression include drug or alcohol abuse and may amount to social, financial, legal, occupational, or physical harm. Millions of Americans take drugs or alcohol for a variety of reasons, including dealing with stress, anxiety, and managing depression.

Prevention: Do you or a loved one have depression? If so, you might know that treatments can help the condition. But what about ways to prevent it in the first place? There’s no clear answer. Most experts think it can not be prevented. Others aren’t sure. Most of the factors that increase the likelihood of you getting depression are things you can not control, like your genes, chemicals in your brain, and your environment. For many people, depression starts after a major life change or trauma. It can also happen if you have another health problem, such as cancer, diabetes, or Parkinson’s disease. You may not be able to totally protect yourself from them, but you can change how you handle the stress they could cause. If you already have depression, you can stop it from getting worse.

What can you do? There’s no sure way to prevent depression.

But you can: ● Find ways to handle stress and improve your self-esteem. ● Take good care of yourself. Get enough sleep, eat well, and exercise regularly. ● Reach out to family and friends when times get hard. ● Get regular medical checkups, and see your provider if you don’t feel right. ● Get help if you think you’re depressed. If you wait, it could get worse. ● Stick with your treatment plan. If you are on medicine, take it as prescribed, whether you feel good or not. ● Don’t skip therapy sessions. Let your doctor know what is and isn’t working for you. ● Avoid alcohol and recreational drugs. It may seem like these make you feel better, but they can actually make it harder to treat your depression. ● Try ways to fight stress, like meditation and yoga. ● Spend time with family and friends. Think about joining a support group. ● Do things that keep you connected to others. ● Know yourself. Pay attention to the things that seem to make your symptoms worse. ● Keep notes and tell your doctor or therapist about it.

● Don’t make big life decisions on a day when you’re feeling down. ● Talk to your therapist or doctor about medicine that can stop depression from coming back.

Treatment:

There are effective treatments for moderate and severe depression.

Health-care providers may offer psychological treatments such as behavioral activation, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), or antidepressant medication such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

Health-care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.

Psychosocial treatments are also effective for mild depression.

Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with extra caution

Complications/ what happens if depression is not treated: ● Depression can have a significant impact on the structure and function of many parts of the brain. This can result in many negative consequences. ● The economic burden of depression ● Depression affects a large number of young people in their 20s or 30s.

For this reason, it can have a major impact on the workforce and is one of the leading causes of disability worldwide. ● Compared to their coworkers, people with depression are 3 times more likely to take sick days, and 5 times more likely to be unemployed.

People with depression at work have trouble performing mental, social, and physical tasks. What is really bothersome is that the more severe the depression, the larger the workplace disability. ● The impact of depression on the person

With higher unemployment rates, depression can have a major impact on the person's income, which can increase the stress on their family. Those with depression make up a large portion of the users of welfare and social benefits. ● People with depression also tend to have low self-esteem and self-confidence. This can have a major impact on how they interact with their friends and family. They also have trouble functioning socially, communicating, and keeping relationships. This leads to the person feeling isolated and alone, and these feelings are linked to an increased risk of suicide. ● The impact of depression on health Depression has a strong link to many physical conditions. Depression can make the pain, distress, and disability from physical health problems more severe. Many people with depression are in much poorer health than the rest of the community. ● People with depression are less likely to have healthy lifestyles. They have a higher rate of cigarette smoking and lower exercise levels. This puts these people at higher risk of a large number of chronic diseases.

They have a higher risk of obesity and type 2 diabetes. They are at a much higher risk of not only having heart disease but also of dying from the condition. Depression can also have a negative impact on the immune system. ● Suicidal thoughts.

Misconceptions about depression: There are misconceptions about depression that can be harmful and that are not true. We are debunking these myths to help break the stigma surrounding depression.

1_ “It’s Not a Real Illness” Depression is something that should be viewed seriously and treated with therapy and medication.

2_ “You Can ‘Snap Out of It'” This is an outdated way of viewing depression.

People without an understanding of depression may view it as people deciding to wallow in sadness or grief. However, depression is not a choice or something that someone can decide to “snap out of” with a change in attitude.

3_ “If You Can Function, You’re Not Really Depressed” Depression affects everyone differently. For some, just getting out of bed in the morning feels impossible, while for others going to work and functioning in their daily lives is possible. However, both experience physical health issues– just because you may not be wearing a cast, doesn’t meant that you aren’t experiencing physical symptoms of pain. The same goes for depression.

4_ “There Has to Be a Reason You’re Depressed” While life challenges and traumatic events can contribute to an onset of depression, your genetics and brain chemistry also play a role. People can experience depression without having a “reason” behind it.

5_ “People With Depression Are Ungrateful or Lazy” This is another harmful myth, when the reality is that depression affects many people in a way that they are so fatigued to the point of not being able to finish simple tasks.

Pandemic situation Mental tips to help people calm down and reduce their stress: ● It is normal to feel sad, stressed, confused, scared or angry during a crisis. Talking to people you trust can help. Contact your friends and family. ● If you must stay at home, maintain a healthy lifestyle - including proper diet, sleep, exercise and social contacts with loved ones at home and by email and phone with other family and friends. ● Don’t use smoking, alcohol or other drugs to deal with your emotions. If you feel overwhelmed, talk to a health worker or counsellor. Make a plan on where to go to and how to seek help for physical and mental health needs if required. ● Get the facts. Gather information that will help you accurately determine your risk so that you can take reasonable precautions. Find a credible source you can trust such as WHO website or, a local or state public health agency. ● Limit worry and agitation by lessening the time you and your family spend watching or listening to media coverage that you perceive as upsetting. ● Draw on skills you have used in the past that have helped you to manage previous life’s adversities and use those skills to help you manage your emotions during the challenging time of this outbreak.

1- Firstly, accept that stress levels will likely be higher for many at this time and that whatever you’re feeling is valid considering the current context 2- Where possible, it is worth designating a space that is yours for work only. This separation can support you physically and mentally, and help get you into the appropriate headspace each time you settle in to work.

3- When planning your day, mention eating regular nutritious meals, renewing through exercise, connecting with others, and maintaining good sleep 4- To cope with loneliness while in (relative) physical isolation, Dr. Malik said that there are some “basic strategies that [the WHO] are advocating across the population, such as taking part in some form of physical activity, keeping to routines or creating new ones, engaging in activities that give a

sense of achievement connections.”

and,

importantly,

really

maintaining

social

5- Routine is very important for well-being, so if you’re living alone, write a list of the people and activities that lift your spirits; be sure to prioritize time for connecting with others and doing things you enjoy every day.

6- we can also reconnect with those hobbies and relaxation techniques that don’t require a screen reading, taking a bath, gardening, listening to music, playing music, journaling, writing, arts and crafts, cooking new recipes, stroking your pet, daydreaming, so much to savor and enjoy.

Tools for coping with anxiety: • One of the key factors of experiencing anxiety is a sense of feeling out of control, We’re not always able to control external circumstances; however, the practices of “mindfulness” and “meditation” have been scientifically proven to reduce stress and anxiety, and when practiced regularly, can help you feel more in control of your own state.

• The 4-7-8 breathing technique, also known as “relaxing breath,” involves breathing in for 4 seconds, holding the breath for 7 seconds, and exhaling for 8 seconds. https://www.medicalnewstoday.com/articles/324417 This can help with the following: - reducing anxiety - helping a person get to sleep - managing cravings - controlling or reducing anger responses - Some proponents claim that the method helps people get to sleep in 1 minute.

General Lines of Treatment A.

Psychotherapy

What is Psychotherapy?

Psychotherapy, or talk therapy, is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better, and can increase well-being and healing.

Issues that may be improved by psychotherapy include: difficulties in coping with daily life, the impact of trauma, medical illness or loss, like the death of a loved one, and specific mental disorders, like depression and anxiety. There are several different types of psychotherapy, and some types may work better with certain problems.

Psychotherapy may be used in combination with medication or other types of therapy.

Psychotherapy is often used in combination with medication to treat mental health conditions. In some circumstances medication may be clearly useful and in others psychotherapy may be the best option.

Types of Psychotherapy: ● ● ● ●

Cognitive behavioral therapy (CBT) Interpersonal therapy (IPT) Psychodynamic therapy Dialectical behavior therapy

Cognitive behavioral therapy (CBT) helps people identify and 1. change thinking and behavior patterns that are harmful or ineffective, replacing them with more accurate thoughts and functional behaviors. It can help a person focus on current problems and how to solve them. It often involves practicing new skills in the “real world.”

CBT can be helpful in treating a variety of disorders, including depression, anxiety, trauma related disorders, and eating disorders. For example, CBT can help a person with depression recognize and change negative thought patterns or behaviors that are contributing to their depression.

Interpersonal therapy (IPT) is a short-term form of treatment. It 0. helps patients understand underlying interpersonal issues that are troublesome, like unresolved grief, changes in social or work roles, conflicts with significant others, and problems relating to others. It can help people learn healthy ways to express their emotions as well as methods to improve communication, and how they relate to others. It is most often used to treat depression.

Psychodynamic therapy is based on the idea that behavior and 0. mental well-being are influenced by childhood experiences and inappropriate repetitive thoughts or feelings that are unconscious (outside of the person’s awareness). A person works with the therapist to improve self-awareness, and to change old patterns so he/she can fully take charge of his/her life.

Dialectical behavior therapy is a specific type of CBT that helps 0. regulate emotions. It is often used to treat people with chronic suicidal thoughts, and people with borderline personality disorder, eating disorders and PTSD. It teaches new skills to help people take personal responsibility in order to change unhealthy or disruptive behavior. It involves both individual and group therapy.

Psychoanalysis is a more intensive form of psychodynamic therapy.

0.

Sessions are typically conducted three or more times a week.

Supportive therapy uses guidance and encouragement to help 0. patients develop their own resources. It helps build self-esteem, reduce anxiety, strengthen coping mechanisms, and improve social and community functioning. Supportive psychotherapy helps patients deal with issues related to their mental health conditions which in turn affect the rest of their lives.

NOTE that the patient should be aware of these options of treatments, but ONLY a professional psychotherapist can make the decision regarding which method to use, according to the patient's condition and needs.

B. How to Choose the Best Therapist or Counselor for You There are a number of questions you can ask that will help you to choose a counselor:

1. What does it feel like for you to sit with the therapist?

Do you feel safe and comfortable? Is it easy to make small talk? Is the person down-to-earth and easy to relate to, or do they feel cold and emotionally detached?

0. What’s the counselor’s general philosophy and approach to helping?

Does your counselor approach human beings in a compassionate and optimistic way? Do they believe humans are born loving and lovable, or does the counselor believe people are genetically deficient?

0. Can the counselor clearly define how they plan to help you to solve whatever issue or concern has brought you to therapy?

Experienced counselors explain how they can help, are able to give you a basic “road map,” to their approach, and can even give an indication of how you will know when therapy is finished.

0. Can your counselor accept feedback and admit mistakes?

A healthy counselor is open to feedback and to learning that something they said hurt or offended you. The best therapists are willing to look at themselves, to check their feelings honestly and openly admit mistakes.

0. Does the counselor encourage dependence or independence?

Good therapy doesn’t solve your problems; it helps you to solve your own.

Likewise, good therapy doesn’t soothe your overwhelming feelings; it helps you learn to soothe your own feelings. If your counselor provides wisdom, answers, or emotional support without encouraging you to access your own resources, it is more likely you will become dependent on your therapist to help you feel better, rather than learning to depend on yourself.

0. Does the counselor make guarantees or promises?

It’s important for any healthcare provider, the therapist included, to provide hope but not absolute unconditional guarantees. If you have the will to change and put in the necessary time and energy, healing is possible.

0. Does your counselor adhere to ethical principles in regard to issues such as boundaries, dual relationships, and confidentiality?

There are numerous ethical guidelines designed to keep counselors from harming clients. Most importantly, there is a guideline barring against dual relationships. When a counselor gets their own needs (emotional or otherwise) met by the client, they have crossed a boundary, and the therapy process can be damaged or ruined. This is one of many ethical guidelines

Stress and Burnout Stress:

-In a medical or biological context stress is a physical, mental, or emotional factor that causes bodily or mental tension. Stresses can be external (from the environment, psychological, or social situations) or internal (illness, or from a medical procedure). Stress can initiate the "fight or flight" response, a complex reaction of neurologic and endocrinologic systems.

Types: 1. Acute stress -Acute stress is the most common type of stress. It’s your body's immediate reaction to a new challenge, event, or demand, and it triggers your fight-or-flight response. As the pressures of a near-miss automobile accident, an argument with a family member, or a costly mistake at work sink in, your body turns on this biological response. Acute stress isn't always negative. It's also the experience you have when riding a rollercoaster or having a person jump out at you in a haunted house.

Isolated episodes of acute stress should not have any lingering health effects. In fact, they might actually be healthy for you, as these stressful situations give your body and brain practice in developing the best response to future stressful situations. Severe acute stress such as stress suffered as the victim of a crime or life-threatening situation can lead to mental health problems, such as post-traumatic stress disorder or acute stress disorder.

2. Episodic acute stress When acute stress happens frequently, it’s called episodic acute stress. People who always seem to be having a crisis tend to have episodic acute stress. They are often short-tempered, irritable, and anxious. People who are “worry warts” or pessimistic, as in those who tend to look at the negative aspect of everything, also tend to have episodic acute stress.

Negative health effects are persistent in people with episodic acute stress.

It may be hard for people with this type of stress to change their lifestyle, as they accept stress as a part of life.

3. Chronic stress If acute stress isn't resolved and begins to increase or if it lasts for long periods of time, it becomes chronic stress. This stress is constant and doesn’t go away. It can stem from such things as: • poverty

• a dysfunctional family • an unhappy marriage • a bad job Chronic stress can be detrimental to your health, as it can contribute to several serious diseases or health risks, such as • heart disease • cancer • lung disease • accidents • cirrhosis of the liver • Suicide

Signs and symptoms • Acne: Some studies have found that higher levels of stress are associated with increased acne severity.

• Headaches: Stress is a common trigger for headaches. Many studies have found that increased stress levels are associated with increased headache frequency. One study of 267 people with chronic headaches found that a stressful event preceded the development of chronic headaches in about 45% of cases.

• Chronic Pain: Aches and pains are a common complaint that can result from increased levels of stress. Some studies have found that chronic pain may be associated with higher levels of stress as well as increased levels of cortisol. For example, one study compared 16 people with chronic back pain to a control group. It found that those with chronic pain had higher levels of cortisol.

• Frequent Sickness: If you feel like you’re constantly battling a case of the sniffles, stress may be to blame. Stress may take a toll on your immune system and can cause increased susceptibility to infections. In one study, 61 older adults were injected with the flu vaccine. Those with chronic stress were found to have a weakened immune response to the vaccine, indicating that stress may be associated with decreased immunity.

• Decreased Energy and Insomnia: Stress is associated with fatigue and disruptions in sleep, which may result in decreased energy levels.

• Changes in Libido: Many people experience changes in their sex drives during stressful periods. One small study evaluated the stress levels of 30 women and then measured their arousal while watching an erotic film.

Those with high levels of chronic stress experienced less arousal compared to those with lower stress levels.

• Digestive Issues: Digestive problems like diarrhea and constipation can also be caused by high levels of stress. Stress may especially affect those with digestive disorders such as irritable bowel syndrome (IBS) or

inflammatory bowel disease (IBD). These are characterized by stomach pain, bloating, diarrhea and constipation.

• Appetite Changes: Changes in appetite are common during times of stress. When you feel stressed out, you may find yourself either with no appetite at all or ravenously raiding the refrigerator in the middle of the night. These changes in appetite may also cause fluctuations in weight during stressful periods. Other possible causes of appetite changes include the use of certain medications or drugs, hormonal shifts and psychological conditions.

• Depression: Some studies suggest that chronic stress may contribute to the development of depression. One study of 816 women with major depression found that the onset of depression was significantly associated with both acute and chronic stress. -Remember that these studies show an association, but don’t necessarily mean that stress causes depression. More research is needed on the role of stress in the development of depression.

-Besides stress, other potential contributors to depression include family history, hormone levels, environmental factors and even certain medications.

• Rapid Heartbeat: A fast heartbeat and increased heart rate can also be symptoms of high stress levels. One study measured heart rate reactivity in response to stressful and non stressful events, finding that heart rate was significantly higher during stressful conditions.

• Sweating: Studies show that stress may cause increased sweating, for both people with sweating conditions like palmar hyperhidrosis and the general population. https://www.healthline.com/nutrition/symptoms-of-stress#section11

Causes of stress:

We must understand that People react differently to stressful situations.

What is stressful for one person may not be stressful for another, and almost any event can potentially cause stress. For some people, just thinking about a trigger or several smaller triggers can cause stress. There is no identifiable reason why one person may feel less stressed than another when facing the same stressor. Mental health conditions, such as depression, or a building sense of frustration, injustice, and anxiety can make some people feel stressed more easily than others. Previous experiences may affect how a person reacts to stressors.

Common major life events that can trigger stress include: • job issues or retirement • lack of time or money • bereavement • family problems • illness • moving home

• relationships, marriage, and divorce • abortion or pregnancy loss • driving in heavy traffic or fear of an accident • fear of crime or problems with neighbors • pregnancy and becoming a parent • excessive noise, overcrowding, and pollution • uncertainty or waiting for an important outcome • Some people experience ongoing stress after a traumatic event, such as an accident or some kind of abuse. Doctors will diagnose this as PTSD. • Those who work in stressful jobs, such as the military or the emergency services, will have a debriefing session following a major incident, and occupational healthcare services will monitor them for PTSD. • losing jobs • long-term unemployment • exams and deadlines • starting a new job.

• long-term health problems The amount of stress you feel in different situations may depend on many factors such as: • your perception of the situation – this might be connected to your past experiences, your self-esteem, and how your thought processes work (for example, if you tend to interpret things positively or negatively) • how experienced you are at dealing with that particular type of pressure • your emotional resilience to stressful situations • The amount of other pressures on you at the time • The amount of support you are receiving

Prevention and treatment Tips for managing stress: 1. Plan for expected events with visualization techniques rehearse upcoming stressful events in your mind to better prepare and help you feel more in control.

2. Reframe think positively! Put a difficult situation into a different perspective.

3. Visualize potentially negative situations and create a backup plan just in case things do not go as planned.

4. Relax with deep breathing techniques. Counteract the shallow breathing that stress creates. Breath in deeply through the nose, hold for a few seconds, and then exhale through the mouth.

5. Quiet your mind, Focus on a peaceful thought or a happy memory.

6. Relax tense muscles. Concentrate on purposely tensing a group of muscles, hold for a few seconds, and then release, This can help focus chaotic thoughts and release tension.

7. Decompress with stretching and exercise, This strategy can be done almost anywhere, at any time.

8. Get a massage, Massage therapy can relieve muscle tension resulting from stress.

9. Ask for help, This is a simple way to alleviate stress and people genuinely want to help!

10. Seek professional help before it gets out of control and results in undesirable consequences.

Burnout: Many of us are familiar with workplace burnout. the feeling of extreme physical and emotional exhaustion that often affects doctors, business executives, and first responders. Until now, burnout has been called a stress syndrome. However, the World Health Organization (WHO) recently updated its definition. It now refers to burnout as “syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed,” in the organization’s International Classification of Diseases diagnostic manual.

The three symptoms included in the list are: • feelings of energy depletion or exhaustion • increased mental distance from one’s job or feeling negative towards one’s career • reduced professional productivity

Types: - First, there ’s overload burnout. This is the kind of burnout that most of us are familiar with. With overload burnout, people work harder and ever-more frantically in search of success. Roughly 15% of employees in the survey fell into this category. They were willing to risk their health and personal life in pursuit of their ambition ,and tended to cope with their stress by venting to others .

- The second kind of burnout involves being under-challenged. People in this category feel underappreciated and bored, and grow frustrated because their jobs lack learning opportunities and room for professional growth. Roughly 9% of employees in the survey felt this way. Because under-challenged people find no passion or enjoyment in their work, they cope by distancing themselves from their job. This indifference leads to cynicism, avoidance of responsibility, and overall disengagement with their work.

- The final type of burnout, neglect, is the result of feeling helpless at work. The 21% of employees who fell into this category agreed with statements like, “When things at work don’t turn out as well as they should, I stop trying.” If you’re in this category, you may think of yourself as incompetent or feel like you’re unable to keep up with the demands of your job. Maybe you’ve tried to get ahead at work, faced barriers, and simply given up. Closely related to imposter syndrome, this condition tends to be characterized by passivity and lack of motivation.

Signs and symptoms • Alienation from work-related activities: Individuals experiencing burnout view their jobs as increasingly stressful and frustrating. They may grow cynical about their working conditions and the people they work with. They may also emotionally distance themselves and begin to feel numb about their work.

• Physical symptoms: Chronic stress may lead to physical symptoms, like headaches and stomachaches or intestinal issues.

• Emotional exhaustion: Burnout causes people to feel drained, unable to cope, and tired. They often lack the energy to get their work done.

• Reduced performance: Burnout mainly affects everyday tasks at work—or in the home when someone's main job involves caring for family members. Individuals with burnout feel negative about tasks. They have difficulty concentrating and often lack creativity.

It shares some similar symptoms of mental health conditions, such as depression. Individuals with depression experience negative feelings and thoughts about all aspects of life, not just at work. Depression symptoms may also include a loss of interest in things, feelings of hopelessness, cognitive and physical symptoms as well as thoughts of suicide https://www.verywellmind.com/stress-and-burnout-symptoms-and-causes -3144516

Causes of Burnout:

There are many causes for the development of burnout syndrome. The decisive factor is above all the attitude towards one’s own performance at work and in everyday life. A high need to meet one’s own high demands as well as for appreciation and recognition is typical. At the same time, those affected pay little, hardly any or no attention to their own psychological and physical limits.

➢ Personality traits with an increased risk of developing burnout syndrome: • perfectionist attitudes (“I have to do everything right and at 150 percent.

I can’t afford to make any mistakes. I’m responsible for everything. I have to satisfy everyone. I have to have everything under control.”)

• low expectation of competency (“I can't make it. I don't stand a chance.”)

• very pronounced need for harmony (“Everyone must be satisfied. I mustn’t offend anyone. I can't say no.”)

• The belief that they are being controlled from outside (“I am only a very small cog in a large machine. Others decide about me. I'm just a puppet.”) ➢ Frustration grows over time Those affected only notice their great exhaustion when the mood changes from euphoria to resignation. A feeling of inner emptiness spreads. It hits some people like a blow. The triggers include excessive workload, high time, deadline pressure, and a lack of a voice and communication in the company. The first thing that strikes friends and family is usually the increased irritability of the person affected. ➢ The causes of burnout have been studied by many researchers One aspect of burnout that is agreed upon by several researchers is that there are cyclical characteristics of burnout. One longitudinal study surveys 352 employees from an international financial consultancy firm once in 2005 and again in 2007, and according to it burnout is caused by the increase of demands and the loss of resources. Employees who were experiencing burnout at one point continued to accumulate more demands over the two years period. The amount of work increased; they became overloaded with work, and experienced difficulties balancing between their professional and private lives.

As you can see, a person may begin low in resources used to manage tasks, then get stressed in turn, and, as a result, demands begin to accumulate.

They work harder in order to catch up on the accumulated work, which causes them to lose even more resources. This study suggests that resources continue to be lost while demands continue to increase over time, and the cycle continues. (Brummelhuis, Hoeven, Bakker & Peper, 2011). ➢ Another study examines how sleep and burnout associate with one another A random sample of 734 individuals from an organization were surveyed about sleep difficulties, exercise, depression, and two of the components of burnout, exhaustion and cynicism. The results showed that burnout and sleep impairment have a significant relationship to one another even when controlling for other factors which may affect sleep. Whether sleep

difficulty is a cause or a symptom is not fully known, but it was shown to hinder the recovery process (de Beer, et al., 2014). Working long hours and having a demanding job are two factors that have been shown to lead to developing burnout, especially when one does not have a support system to voice problems and concern in the workplace or at home. ➢ Inability to balance work life and personal life, along with tension in personal life, can also produce feelings of burnout at work. Stressful events can prelude the development of burnout. It should be mentioned, however, that feelings of stress and burnout are not equivalent. One’s perception of stressful events in the workforce determines whether it will be a motivating factor or a cause of burnout (Szigethy, 2014). ➢ Predispositions to Burnout Many researchers have studied what makes some employees more susceptible to burnout than others. The study mentioned earlier, which surveyed employees once in 2005 and again in 2007, looked at personal style of motivation as a variable. This study found that although neither intrinsically or extrinsically motivated employees were able to diminish burnout by reducing their amount of demands, intrinsically motivated employees were able to build up more resources to deal with the demands through seeking help through support systems and asking for feedback.

Employees who were externally regulated did not manage job demands efficiently, and increased their time working, further affecting balance between work and home (ten Brummelhuis, et al., 2011). Tendency to have negative feelings, such as guilt and helplessness, and inclination to suppress stress have also been linked to predisposition to burnout. In addition, frequent feeling of fatigue can make one more susceptible (Szigethy, 2014).

Prevention and treatment

Tips for managing burnout (maintain balance): 1. Maintain physical well-being • Exercise • Eat healthy • Rest and maintain adequate sleep schedule 2. Foster relationships with friends and family • Spend quality time with family, spouse, and friends 3. Develop professional relationships with peers and colleagues • Share experiences • Encourage teamwork and share workloads • Be open to feedback from peers and use it to enhance your knowledge and expertise

4. Pursue hobbies!

• Engage in enjoyable activities that nurture your creative abilities • Maintain a sense of balance • Use leisure activities to reduce stress 5. Set limits • Limit work hours • Be honest with yourself and learn to forgive so that you are able to move forward after an adverse event • Schedule time to take care of routine chores • Learn to set priorities • Schedule time-out periods for vacations, power naps, meals and snacks 6. Reflection & Spirituality • Consistently take time to reflect on personal situations and identify needed change for the future • Regenerate with regular quiet times, meditation, prayer, journaling, religious services, spirituality practices, or time in nature 7. Debrief with others • Share your thoughts, feelings, and experiences with close friends, family, and colleagues • Seek professional help. It is available to you and completely confidential 8. Maintain Positive Attitudes • Acceptance and realism—refrain from wishful thinking and accept external realities • Realistic expectations—reasonably address the challenges and downsides of the medical profession • Recognize when change is necessary and maintain flexibility to make necessary changes • Appreciate the good things in life and work 9. Humor & Laughter • A good sense of humor can help you cope with stress • Exchange jokes and humorous stories to create a positive environment

Differences between stress and burnout: Burnout may be the result of unrelenting stress, but it isn’t the same as too much Stress.

Stress, by and large, involves too much: too many pressures that demand too much of you physically and mentally. However, stressed people can still imagine that if they can just get everything under control, they’ll feel better.

Burnout, on the other hand, is about not enough. Being burnt out means feeling empty and mentally exhausted, devoid of motivation, and beyond caring. People experiencing burnout often do not see any hope of positive change in their situations. If excessive stress feels like you are drowning in responsibilities, burnout is a sense of being all dried up. And while you are usually aware of being under a lot of stress, you don’t always notice burnout when it happens.

Stress

Burnout

Characterized over-engagement Exaggerated emotions Produces hyperactivity

urgency

by Characterized by disengagement

Emotional blunting and Produces hopelessness

helplessness

and

Loss of energy

Loss of motivation, ideals, and hope

Leads to anxiety disorders.

Leads to detachment and depression

Primary damage is physical

Primary damage is emotional

May kill you prematurely

May make life seem not worth living

Stress and burnout among medical students

Medicine is a never-ending path and a highly demanding career that appears to leave many medical students at the risk of stress and burnout. A gap in the literature exists regarding the assessment of stress and burnout among preclinical medical students. Although medical schools strive to support students during the training process and aim to graduate knowledgeable, skillful, and professional doctors, studies suggest that medical students experience high rates of personal distress. ● A Cross-sectional study was carried out at the Faculty of Medicine, Ain Shams University, Cairo, Egypt among 390 medical students. Data were collected using two validated instruments “Cohen’s Perceived Stress Scale” & “Maslach Burnout Inventory Scale.” The study aimed to estimate the frequency of stress and burnout among medical students and to investigate the relationship between stress, burnout level, medical students’ characteristics, and some health-related behaviors. ● Results: Nearly two thirds of the medical students 66.1% had high stress levels; the most prominent burn out subscale was depersonalization 75.6%. The main 3 reasons of stress among medical students were fear of hurting patients, students’ perception that their clinical practice is not enough and limited time for training. There was a highly statistically significant relationship between high stress levels, high burnout subscales, using hypnotics and smoking.

The study conclusion was that medical students are exposed to a great deal of stress, and burnout risk factors that mainly result from their worry about their future career and late exposure to clinical training.

Another study was carried out in the UK to assess psychological morbidity and symptoms of burnout in medical students during their undergraduate training, and to identify baseline factors that predict psychological morbidity in students in the final year of the course. It was a 5-year prospective longitudinal cohort study. Students were assessed in years 1, 4, and 5 of their medical undergraduate training by means of the GHQ-12 and the Maslach Burnout Inventory.

Firth¹ screened a large sample of fourth-year medical students at three universities and detected evidence of psychological morbidity in about one-third. Surtees and Miller² studied medical students in their first year of medical training at Edinburgh and found that half disclosed high levels of neurotic symptoms at the beginning of the academic year, one-third reporting symptoms at follow-up six months later. Guthrie et al.³ found strikingly similar rates of psychological morbidity in medical students at Manchester University, with one-third showing evidence of psychiatric morbidity midway through the first year.

Activities: 1. To reflect the difference between stress and burnout ● Separate the group into two (or more depending on the audience numbers) then give each one a red paper and a green paper. The green represents stress and the red represents burnout. ● Read out each sentence and ask the groups whether it is stress or burn out. Tell them they can’t answer verbally. They only can answer using the red or green paper and so on.

0.

This activity can be used for example to give tips on how to avoid stress and burnout between medical students.

Instructions: ● Pause for summaries.

Distribute blank index cards to each participant. Ask participants to write down a piece of advice related to the training topic in a phrase or a short sentence. Instruct participants to make the statement clear and memorable by creating a slogan, a jingle, a humorous one-liner, or an oxymoron. Announce a suitable time limit. At the end of this time, ask participants to stop writing.

Ask them to write a four-digit identification number on the other side of the card. Participants should remember this number so they can identify their card later. ● Form teams.

Organize participants in teams of three to seven members each. Seat each team around a table. Ask someone from each team to collect the advice cards from their team members and shuffle the packet of cards. ● Exchange and evaluate.

Give the packet of advice cards from the first team to the second one, from the second team to the third one, and so on, giving the cards from the last team to the first one. Ask members of each team to collaboratively review the pieces of advice and select the top two memorable ones. Announce a suitable time limit. ● Conclude the evaluation activity.

At the end of the allotted time, ask each team to read the two pieces of advice that were rated as the most memorable. After all teams read the two cards, ask each team to read the identification numbers on the back of the card. Ask the participants to whom the cards belong to stand up and lead a round of applause.

● Conduct a recall test.

Ask participants to quickly write down as many of these memorable pieces of advice as they can on a piece of paper. Identify and congratulate the participant who recalled the most items. ● Follow up.

Collect all the advice cards. Post the top items on a website or prepare posters for use with future groups.

0. Stress is boring because we always get stressed and experience burnout.

It’s better to get moving to the area they don’t know about by giving them some fun activities to do, like role play, or group discussions about their mothers’ behavior, fathers’ toughness, or exams stories so they can use laughing as an emotion then make a turnover to talk about what these things mean to them and how they stressful are they.

0. Mythological stories or historical events such as wars could be used, to keep them focused on the details while enjoying the stories at the same time. You can either narrate them yourself or you can ask the attendees to narrate, each with their own method, to keep them engaged.

0. Blind voting for some statistics Ask the participants to close their eyes and raise their hands for each situation they relate to, ask each question and count the raised hands loudly, then discuss the results 0. Give each member a paper containing symptom/cause and ask them to find their group/stage depending on mutual factors then discuss their opinions.

0. Divide the participants into groups (depending on number of stages).

Give each group the name of the stage only or the symptoms only, and they should explain it with roleplay. Other groups should guess the stage/symptoms then discuss.

Addiction Dual Diagnosis: Substance misuse and Mental Health Dealing with co-occurring disorders? Learn how to tackle addiction when you’re also dealing with depression, anxiety, or another mental health problem.

The link between substance misuse and mental health When you have both a substance misuse problem and a mental health issue such as depression, bipolar disorder, or anxiety, it is called a co-occurring disorder or dual diagnosis. Dealing with substance misuse, alcoholism, or drug addiction is never easy, and it’s even more difficult when you’re also struggling with mental health problems.

In co-occurring disorders, both the mental health issue and the drug or alcohol addiction have their own unique symptoms that may get in the way of your ability to function at work or at school, maintain a stable home life, handle life’s difficulties, and relate to others. To make the situation more complicated, the co-occurring disorders also affect each other. When a mental health problem goes untreated, the substance misuse problem usually gets worse. And when alcohol or drug misuse increases, mental health problems usually increase too.

Co-occurring substance misuse problems and mental health issues are more common than many people realize. According to reports published in the Journal of the American Medical Association: - Roughly 50 percent of individuals with severe mental disorders are affected by substance misuse.

- 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.

- Of all people diagnosed as mentally ill, 29 percent abuse alcohol or drugs.

While substance misuse problems and mental health issues don’t get better when they’re ignored—in fact, they are likely to get much worse—it’s important to know that you don’t have to feel this way. There are things you can do to conquer your demons, repair your relationships, and get on the road to recovery. With the right support, self-help, and treatment, you can overcome a co-occurring disorder, reclaim your sense of self, and get your life back on track.

What comes first: Substance misuse or the mental health problem?

Substance misuse and mental health disorders such as depression and anxiety are closely linked, although one doesn’t necessarily directly cause the other. Abusing substances such as marijuana or methamphetamine can cause prolonged psychotic reactions, while alcohol can make depression and anxiety symptoms worse.

Also, Alcohol and drugs are often used to self-medicate the symptoms of mental health problems. People often abuse alcohol or drugs to ease the symptoms of an undiagnosed mental disorder, to cope with difficult emotions, or to temporarily change their mood.

Unfortunately, self-medicating with drugs or alcohol causes side effects and in the long run often worsens the symptoms they initially helped to relieve.

Alcohol and drug misuse can increase the underlying risk for mental disorders. Since mental health problems are caused by a complex interplay of genetics, the environment, and other factors, it’s difficult to say if abusing substances ever directly causes them. However, if you are at risk for a mental health issue, abusing alcohol or drugs may push you over the edge. For example, there is some evidence that those who abuse opioid painkillers are at greater risk for depression, and heavy cannabis use has been linked to an increased risk for schizophrenia.

Alcohol and drug misuse can make symptoms of a mental health problem worse. Substance misuse may sharply increase symptoms of mental illness or even trigger new symptoms. Misuse of alcohol or drugs can also interact with medications such as antidepressants, anxiety medications, and mood stabilizers, making them less effective at managing symptoms and delaying your recovery.

Recognizing a dual diagnosis It can be difficult to identify a dual diagnosis. It takes time to tease out what might be a mental health disorder and what might be a drug or alcohol problem. The signs and symptoms also vary depending upon both the mental health problem and the type of substance being misused, whether it’s alcohol, recreational drugs, or prescription medications. For

example, the signs of depression and marijuana misuse could look very different from the signs of schizophrenia and alcohol misuse. However, there are some general warning signs that you may have a co-occurring disorder: Do you use alcohol or drugs to cope with unpleasant memories or feelings, to control pain or the intensity of your moods, to face situations that frighten you, or to stay focused on tasks?

Have you noticed a relationship between your substance use and your mental health? For example, do you get depressed when you drink? Or drink when you’re feeling anxious or plagued by unpleasant memories?

Has someone in your family grappled with either a mental disorder or alcohol or drug abuse?

Do you feel depressed, anxious, or otherwise out of balance even when you’re sober?

Have you previously been treated for either your addiction or your mental health problem? Did the substance misuse treatment fail because of complications from your mental health issue or vice versa?

Dual diagnosis and denial Denial is common in both substance misuse and mental health issues. It’s often hard to admit how dependent you are on alcohol or drugs or how much they affect your life. Similarly, the symptoms of conditions such as depression, anxiety, bipolar disorder, or PTSD can be frightening, so you may try to ignore them and hope they go away. Or you may be ashamed or afraid of being viewed as weak if you admit to having a problem.

But substance misuse and mental health issues can happen to any of us.

And admitting you have a problem and seeking help is the first step on the road to recovery.

Signs and symptoms of substance misuse Misused substances include prescription medications (such as opioid painkillers, ADHD medications, and sedatives), recreational or street drugs (such as marijuana, methamphetamines, and cocaine), and alcohol (beer, wine, and liquor). A substance misuse problem is not defined by what drug you use or the type of alcohol you drink though. Rather, it comes down to the effects your drug or alcohol use has on your life and relationships. In short, if your drinking or drug use is causing problems in your life, you have a substance misuse problem.

To help you spot the signs of a substance misuse problem, answering the following questions may help. The more “yes” answers you provide, the more likely your drinking or drug use has become a problem.

Have you ever felt you should cut down on your drinking or drug use?

Do you need to use more and more drugs or alcohol to attain the same effects on your mood or outlook?

Have you tried to cut back, but couldn’t?

Do you lie about how much or how often you drink or use drugs?

Are you going through prescription medication at a faster-than-expected rate?

Have your friends or family members expressed concern about your alcohol or drug use?

Do you ever feel bad, guilty, or ashamed about your drinking or drug use?

Have you done or said things while drunk or high that you later regretted?

Has your alcohol or drug use caused problems at work, school, or in your relationships?

Has your alcohol or drug use gotten you into trouble with the law?

Signs and symptoms of common co-occurring disorders The mental health problems that most commonly co-occur with substance abuse are depression, bipolar disorder, and anxiety disorders.

Common signs and symptoms of depression ● ● ● ● ● ● ● ● ●

Feelings of helplessness and hopelessness Loss of interest in daily activities Inability to experience pleasure Appetite or weight changes Sleep changes Loss of energy Strong feelings of worthlessness or guilt Concentration problems Anger, physical pain, and reckless behavior (especially in men)

Common signs and symptoms of anxiety ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

Excessive tension and worry Feeling restless or jumpy Irritability or feeling “on edge” Racing heart or shortness of breath Nausea, trembling, or dizziness Muscle tension, headaches Trouble concentrating Insomnia Common sign and symptoms of mania in bipolar disorder Feelings of euphoria or extreme irritability Unrealistic, grandiose beliefs Decreased need for sleep Increased energy Rapid speech and racing thoughts Impaired judgment and impulsivity Hyperactivity Anger or rage Other mental health problems that commonly co-occur with substance abuse or addiction include Schizophrenia, Borderline Personality Disorder, and PTSD.

Treatment for a dual diagnosis The best treatment for co-occurring disorders is an integrated approach, where both the substance misuse problem and the mental disorder are treated simultaneously. Whether your mental health or substance misuse problem came first, long-term recovery depends on getting treatment for both disorders by the same treatment provider or team.

Depending on your specific issues: Treatment for your mental health problem may include medication, individual or group counseling, self-help measures, lifestyle changes, and peer support.

Treatment for your substance misuse may include detoxification, managing of withdrawal symptoms, behavioral therapy, and support groups to help maintain your sobriety.

ADHD Definition: Attention deficit hyperactivity disorder (ADHD) is a condition that affects people's behaviour. People with ADHD can seem restless, may have trouble concentrating and may act on impulse. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adh d/#:~:text=Attention%20deficit%20hyperactivity%20disorder%20(ADHD)%2 0is%20a%20condition%20that%20affects,and%20may%20act%20on%20im pulse.

Symptoms: The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of 6. They occur in more than 1 situation, such as at home and at school.

Inattention: ● ● ● ● ● ● ●

Short attention span for age (difficulty sustaining attention) Difficulty listening to others Difficulty attending to details Easily distracted Forgetfulness Poor organizational skills for age Poor study skills for age

Impulsivity: ● ● ● ●

Often interrupts others Has difficulty waiting for his or her turn in school and/or social games Tends to blurt out answers instead of waiting to be called upon Takes frequent risks, and often without thinking before acting

Hyperactivity: ● Seems to be in constant motion; runs or climbs, at times with no apparent goal except motion ● Has difficulty remaining in his/her seat even when it is expected ● Fidgets with hands or squirms when in his or her seat; fidgeting excessively ● Talks excessively ● Has difficulty engaging in quiet activities ● Loses or forgets things repeatedly and often

● Inability to stay on task; shifts from one task to another without bringing any to completion These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline. (https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adh d/symptoms/ ) (https://www.hopkinsmedicine.org/health/conditions-and-diseases/adhdad d)

Types: Three major types of ADHD include the following: ● ADHD, combined type This, the most common type of ADHD, is characterized by impulsive and hyperactive behaviors as well as inattention and distractibility. ● ADHD, impulsive/hyperactive type This, the least common type of ADHD, is characterized by impulsive and hyperactive behaviors without inattention and distractibility. ● ADHD, inattentive and distractible type This type of ADHD is characterized predominately by inattention and distractibility without hyperactivity. (https://www.hopkinsmedicine.org/health/conditions-and-diseases/adhdad d)

Misconceptions: Myth # 1: ADHD is Not a Real Disorder ADHD cases have been described as far back as the textbook published in 1775 by Adam Weikard in German. Since that time, over 10,000 clinical and scientific publications have been published on ADHD (Barkley 2015).

Research studies show numerous differences between those with and without ADHD (Roberts et al. 2015). ADHD impairs major life activities including social, emotional, academic and work functioning. It is a lifespan disorder with the majority of children with ADHD continuing to struggle with symptoms as adults. ADHD also runs in families with a heritability chance of 57% for a child if a parent has ADHD, and a 70%–80% chance for a twin if the other twin has ADHD (Barkley 2015). Brain scan studies show differences in the development of the brain of individuals with ADHD, such as cortical thinning in the frontal regions, reduced volume in the inferior frontal gyrus, and reduced gray matter in the parietal, temporal, and occipital cortices (Matthews et al. 2014).

Myth # 2: ADHD is a Disorder of Childhood Long-term studies of children diagnosed with ADHD show that ADHD is a lifespan disorder. Recent follow-up studies of children with ADHD show that ADHD persists from childhood to adolescence in 50%–80% of cases, and into adulthood in 35%–65% of cases (Owens et al. 2015). A 16-year follow-up study of boys diagnosed with ADHD found that 77% continued to have full or subthreshold DSM-IV ADHD (Biederman et al. 2012). A study of girls ages 6–12 years with childhood ADHD found that 10 years later, they continued to have higher rates of ADHD and coexisting conditions, including higher rates of suicide attempts and self-injury, compared to girls without ADHD (Hinshaw et al. 2012).

Myth # 3: ADHD is Over-Diagnosed The rate of diagnosed ADHD in children has increased approximately 5% every year, according to the National Survey of Children’s Health, 2003—2011. This has led many to wonder if the condition is being over-diagnosed. But the report based on the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome found that children are being carefully diagnosed by healthcare practitioners. The vast majority (9 out of 10) of the 2,976 children diagnosed with ADHD had been diagnosed by practitioners using best practice guidelines (Visser et al.

2015). Possible explanations for increased diagnostic rates include improved awareness about ADHD among healthcare practitioners and parents, more screenings by pediatricians and other primary care givers, decreased stigma about ADHD, availability of better treatment options, and more cases arising from suspected environmental causes such prenatal exposure to toxins or high blood lead levels.

Myth # 4: Children with ADHD are Over-medicated Most evidence from research studies suggest that levels of treating ADHD with medication are either appropriate or that ADHD is undertreated (Connor 2015). According to the National Survey of Children’s Health (NSCH) 2003–2011, of the 5.1 million children with a current diagnosis of ADHD, 69% (or 3.5 million) were taking medication for ADHD. Data from the National Comorbidity Survey Adolescent Supplement, which included over 10,000 adolescents aged 13–18, found that only 20.4% of those with ADHD received stimulants (Merikangas et al. 2013). Data from the National Health and Nutrition Examination Survey report a 7.8% prevalence rate of ADHD among the 3,042 participants aged 8–15, but only about 48% of them were receiving treatment in the past 12 months (Merikangas et al.

2010).

Myth # 5: Poor Parenting Causes ADHD Research studies point to genetic (hereditary) and neurological factors (such as pregnancy and birth complications, brain damage, toxins and infections) as the main causes of ADHD rather than social factors including poor parenting. Twin studies of children with ADHD show that the family environments of the children contribute very little to their individual

differences in ADHD symptoms (Barkley, 2015). Although parenting practices do not cause ADHD, they can contribute to worsening of coexisting disorders such as oppositional defiant disorder (ODD) or conduct disorder (CD), and inconsistent parental discipline as well as low paternal involvement have been found to be associated with ADHD symptoms (Ellis et al. 2009).

Myth # 6: Girls Have Lower Rates and Less Severe ADHD than Boys ADHD in girls and women has been recognized only in the past few decades, and more research studies are reporting on the substantial impairments they experience, often to the same extent as boys. They are at risk for many of the same coexisting conditions and impairments as males―oppositional defiance disorder, conduct disorder, academic and social impairments, driving problems, substance abuse and risky sexual behavior. Adolescent girls with ADHD may be more prone than boys to eating disorders, but by young adulthood this difference is reduced (Owens et al. 2015). A 10-year follow-up study of girls aged 6–12 years by Hinshaw et al. (2012) found a higher risk for suicide attempts and self-injury by adulthood among the girls. The latest diagnosis data as reported by parents of children ages 4–17 in the National Health Interview Survey (NHIS) 2011–2013 found a diagnostic rate of 13.3% for boys and 5.6% for girls.

Other large community samples have found a similar gender ratio of 2.3:1.0, but by adulthood, studies have found that prevalence is nearly the same between genders (Owens et al. 2015).

(https://chadd.org/about-adhd/myths-and-misunderstandings/ )

Treatment

There are 5 types of medicine licensed for the treatment of ADHD: ● ● ● ● ●

methylphenidate lisdexamfetamine dexamfetamine atomoxetine guanfacine

These medicines are not a permanent cure for ADHD but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills. ● Some medicines need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended to assess whether the medicine is still needed. ● If you were not diagnosed with ADHD until adulthood, a GP and specialist can discuss which medicines and therapies are suitable for you. ● If you or your child is prescribed one of these medicines, you'll probably be given small doses at first, which may then be gradually increased. You or your child will need to see a GP for regular check-ups to ensure the treatment is working effectively and check for signs of any side effects or problems. ● It's important to let the GP know about any side effects and talk to them if you feel you need to stop or change treatment. ● Your specialist will discuss how long you should take your treatment but, in many cases, treatment is continued for as long as it is helping.

Methylphenidate Methylphenidate is the most commonly used medicine for ADHD. It belongs to a group of medicines called stimulants, which work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.

Methylphenidate may be offered to adults, teenagers and children over the age of 5 with ADHD. The medicine can be taken as either immediate-release tablets (small doses taken 2 to 3 times a day) or as modified-release tablets (taken once a day in the morning, with the dose released throughout the day).

Common side effects of methylphenidate include: ·

a small increase in blood pressure and heart rate

·

loss of appetite, which can lead to weight loss or poor weight gain

·

trouble sleeping

·

headaches

·

stomach aches

·

feeling aggressive, irritable, depressed, anxious or tense

Read more about methylphenidate for adults

Read more about methylphenidate for children Lisdexamfetamine Lisdexamfetamine is a medicine that stimulates certain parts of the brain.

It improves concentration, helps focus attention and reduces impulsive behaviour.

It may be offered to teenagers and children over the age of 5 with ADHD if at least 6 weeks of treatment with methylphenidate has not helped.

Adults may be offered lisdexamfetamine as the first-choice medicine instead of methylphenidate.

Lisdexamfetamine comes in capsule form, taken once a day.

Common side effects of lisdexamfetamine include: - decreased appetite, which can lead to weight loss or poor weight gain - aggression - drowsiness - dizziness - headaches - diarrhoea - nausea and vomiting Dexamfetamine Dexamfetamine is similar to lisdexamfetamine and works in the same way.

It may be offered to adults, teenagers and children over the age of 5 with ADHD. Dexamfetamine is usually taken as a tablet 2 to 4 times a day, although an oral solution is also available.

Common side effects of dexamfetamine include: ·

decreased appetite

·

mood swings

·

agitation and aggression

·

dizziness

·

headaches

·

diarrhoea

·

nausea and vomiting

Atomoxetine Atomoxetine works differently from other ADHD medicines.

It's a selective noradrenaline reuptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline.

This chemical passes messages between brain cells, and increasing it can aid concentration and help control impulses.

Atomoxetine may be offered to adults, teenagers and children over the age of 5 if it's not possible to use methylphenidate or lisdexamfetamine. It's also licensed for use in adults if symptoms of ADHD are confirmed.

Atomoxetine comes in capsule form, usually taken once or twice a day.

Common side effects of atomoxetine include: ·

a small increase in blood pressure and heart rate

·

nausea and vomiting

·

stomach aches

·

trouble sleeping

·

dizziness

·

headaches

·

irritability

Atomoxetine has also been linked to some more serious side effects that are important to look out for, including suicidal thoughts and liver damage.

If either you or your child begin to feel depressed or suicidal while taking this medicine, speak to your doctor.

Guanfacine Guanfacine acts on part of the brain to improve attention, and it also reduces blood pressure.

It may be offered to teenagers and children over the age of 5 if it's not possible to use methylphenidate or lisdexamfetamine. Guanfacine should not be offered to adults with ADHD. Guanfacine is usually taken as a tablet once a day, in the morning or evening.

Common side effects include: ·

tiredness or fatigue

·

headache

·

abdominal pain

·

dry mouth

Therapy As well as taking medicine, different therapies can be useful in treating ADHD in children, teenagers and adults. Therapy is also effective in treating additional problems, such as conduct or anxiety disorders, that may appear with ADHD. Here are some of the therapies that may be used.

Psychoeducation Psychoeducation means you or your child will be encouraged to discuss ADHD and its effects. It can help children, teenagers and adults make sense of being diagnosed with ADHD, and can help you to cope and live with the condition.

Behaviour therapy Behaviour therapy provides support for carers of children with ADHD and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage your child to try to control their ADHD. If your child has ADHD, you can identify types of behaviour you want to encourage, such as sitting at the table to eat. Your child is then given some sort of small reward for good behaviour.

For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.

Parent training and education programmes If your child has ADHD, specially tailored parent training and education programmes can help you learn specific ways of talking to your child, and playing and working with them to improve their attention and behaviour.

You may also be offered parent training before your child is formally diagnosed with ADHD. These programmes are usually arranged in groups of around 10 to 12 parents. A programme usually consists of 10 to 16 meetings, lasting up to 2 hours each.

Being offered a parent training and education programme does not mean you have been a bad parent – it aims to teach parents and carers about behaviour management, while increasing confidence in your ability to help your child and improve your relationship.

Social skills training Social skills training involves your child taking part in role-play situations and aims to teach them how to behave in social situations by learning how their behaviour affects others.

Cognitive behavioural therapy (CBT) CBT is a talking therapy that can help you manage your problems by changing the way you think and behave. A therapist would try to change how you or your child feels about a situation, which would in turn potentially change their behaviour.

CBT can be carried out with a therapist individually or in a group.

Other possible treatments There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements. However, there's no strong evidence these work, and they should not be attempted without medical advice.

Diet People with ADHD should eat a healthy, balanced diet. Do not cut out foods before seeking medical advice. Some people may notice a link between types of food and worsening ADHD symptoms. If this is the case,

keep a diary of what you eat and drink, and what behaviour follows.

Discuss this with a GP, who may refer you to a dietitian (a healthcare professional who specialises in nutrition).

Supplements Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial for people with ADHD, although the evidence supporting this is very limited.

It's advisable to talk to a GP before using any supplements, because some can react unpredictably with medicine or make it less effective.You should also remember that some supplements should not be taken long term, as they can reach dangerous levels in your body.

Tips for parents If you're the parent of a child with ADHD: · be sure your GP or specialist helps you understand the difference between ADHD and any other problems your child may have · think about who else needs to know about your child's ADHD, such as their school or nursery · find out the side effects of any medicine your child takes and what you need to look out for · getting to know people at local support groups can stop you feeling isolated and help you to cope https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adh d/treatment/

First Aid -Know how the condition affects the child.

Every child is different, and symptoms may exhibit differently. It is crucial to identify the problems a child will encounter due to their condition and how it affects various aspects of their life.

For example, some children will have difficulty paying attention and listening, while others need to slow down in whatever they are doing.

For the best advice, it is best to ask a doctor or a child therapist for ways to help them improve.

-Maintain a positive attitude.

The best assets a parent can have to meet the challenges of ADHD are having a positive attitude and common sense.

Parents who are calm and focused are more likely to connect with their children, helping them overcome symptoms brought by the condition.

-Provide clear directions and limits

A child with ADHD will need to know their limits and what others expect from them.

Some kids with this condition have problems reading between the lines and perform better with knowing precisely what they need to do and control.

Working with a child doctor or any GP, in general, can help narrow a few specific behaviours. They can also help set limits and provide a consistent follow-through of actions with consequences.

-Talk about it.

Encouraging open communication with a child about ADHD can help them better understand that it is nobody’s fault, nor is it a flaw. Talking about it can encourage ways to improve the condition and its causes.

-Counseling

Let’s face it – sometimes a parent cannot do it all. There are instances where a child will need professional help. Find a therapist specializing in individual counseling and is working well with children. Help from professionals can help both children and parents manage stress and anxiety.

-Connect with others for support and awareness.

Find a support organisation that raises awareness and supports people with ADHD. In that group, one can learn from the experiences of other parents in raising a child with attention deficit hyperactivity disorder.

-Be involved Be involved in the child’s journey by learning everything about ADHD. There is a great deal of information regarding the diagnosis and treatment of this condition. However, not all are based on scientific evidence. Learn to distinguish accurate information from what is not.

Per the latest research, there is still no permanent cure for ADHD. The good news is that there are positive steps to reduce its impact. https://www.firstaidproadelaide.com.au/blog/parenting-a-child-with-adhd/

Adolescent mental health Key facts •Globally, one in seven 10-19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group.

•Depression, anxiety and behavioral disorders are among the leading causes of illness and disability among adolescents.

•Suicide is the fourth leading cause of death among 15-19 year-olds.

•The consequences of failing to address adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

Introduction One in six people are aged 10-19 years. Adolescence is a unique and formative time. Physical, emotional and social changes, including exposure to poverty, abuse, or violence, can make adolescents vulnerable to mental health problems. Protecting adolescents from adversity, promoting socio-emotional learning and psychological well-being, and ensuring access to mental health care are critical for their health and well-being during adolescence and adulthood.

Globally, it is estimated that 1 in 7 (14%) 10-19 year-olds experience mental health conditions, yet these remain largely unrecognized and untreated.

Adolescents with mental health conditions are particularly vulnerable to social exclusion, discrimination, stigma (affecting readiness to seek help), educational difficulties, risk-taking behaviors, physical ill-health and human rights violations.

Mental health determinants Adolescence is a crucial period for developing social and emotional habits important for mental well-being. These include adopting healthy sleep patterns; exercising regularly; developing coping, problem-solving, and interpersonal skills; and learning to manage emotions. Protective and supportive environments in the family, at school and in the wider community are important.

Multiple factors affect mental health. The more risk factors adolescents are exposed to, the greater the potential impact on their mental health.

Factors that can contribute to stress during adolescence include exposure to adversity, pressure to conform with peers and exploration of identity.

Media influence and gender norms can exacerbate the disparity between an adolescent’s lived reality and their perceptions or aspirations for the future. Other important determinants include the quality of their home life

and relationships with peers. Violence (especially sexual violence and bullying), harsh parenting and severe and socioeconomic problems are recognized risks to mental health.

Some adolescents are at greater risk of mental health conditions due to their living conditions, stigma, discrimination or exclusion, or lack of access to quality support and services. These include adolescents living in humanitarian and fragile settings; adolescents with chronic illness, autism spectrum disorder, an intellectual disability or other neurological condition; pregnant adolescents, adolescent parents, or those in early or forced marriages; orphans; and adolescents from minority ethnic or sexual backgrounds or other discriminated groups.

Emotional disorders Emotional disorders are common among adolescents. Anxiety disorders (which may involve panic or excessive worry) are the most prevalent in this age group and are more common among older than among younger adolescents. It is estimated that 3.6% of 10-14 year-olds and 4.6% of 15-19 year-olds experience an anxiety disorder. Depression is estimated to occur among 1.1% of adolescents aged 10-14 years, and 2.8% of 15-19-year-olds.

Depression and anxiety share some of the same symptoms, including rapid and unexpected changes in mood.

Anxiety and depressive disorders can profoundly affect school attendance and schoolwork. Social withdrawal can exacerbate isolation and loneliness.

Depression can lead to suicide.

Behavioral disorders Behavioral disorders are more common among younger adolescents than older adolescents. Attention deficit hyperactivity disorder (ADHD), characterized by difficulty paying attention, excessive activity and acting without regard to consequences, occurs among 3.1% of 10-14 year-olds and 2.4% of 15-19 year-olds. Conduct disorder (involving symptoms of destructive or challenging behaviour) occurs among 3.6% of 10-14 year-olds and 2.4% of 15-19 year-olds. Behavioural disorders can affect adolescents’ education and conduct disorder may result in criminal behaviour.

Eating disorders Eating disorders, such as anorexia nervosa and bulimia nervosa, commonly emerge during adolescence and young adulthood. Eating disorders involve abnormal eating behavior and preoccupation with food, accompanied in most instances by concerns about body weight and shape. Anorexia nervosa can lead to premature death, often due to medical

complications or suicide, and has higher mortality than any other mental disorder.

Psychosis Conditions that include symptoms of psychosis most commonly emerge in late adolescence or early adulthood. Symptoms can include hallucinations or delusions. These experiences can impair an adolescent’s ability to participate in daily life and education and often lead to stigma or human rights violations.

Suicide and self-harm Suicide is the fourth leading cause of death in older adolescents (15-19 years)(2). Risk factors for suicide are multifaceted, and include harmful use of alcohol, abuse in childhood, stigma against help-seeking, barriers to accessing care and access to means of suicide. Digital media, like any other media, can play a significant role in either enhancing or weakening suicide prevention efforts.

Risk-taking behaviors Many risk-taking behaviors for health, such as substance use or sexual risk-taking, start during adolescence. Risk-taking behaviors can be an unhelpful strategy to cope with emotional difficulties and can severely impact an adolescent’s mental and physical well-being.

Worldwide, the prevalence of heavy episodic drinking among adolescents aged 15-19 years was 13.6% in 2016, with males most at risk.

The use of tobacco and cannabis are additional concerns. Many adult smokers had their first cigarette prior to the age of 18 years. Cannabis is the most widely used drug among young people with about 4.7% of 15-16 years-olds using it at least once in 2018.

Perpetration of violence is a risk-taking behavior that can increase the likelihood of low educational attainment, injury, involvement with crime or death. Interpersonal violence was ranked among the leading causes of death of older adolescent boys in 2019.

Promotion and prevention Mental health promotion and prevention interventions aim to strengthen an individual's capacity to regulate emotions, enhance alternatives to risk-taking behaviors, build resilience for managing difficult situations and

adversity, and promote supportive social environments and social networks.

These programs require a multi-level approach with varied delivery platforms – for example, digital media, health or social care settings, schools or the community – and varied strategies to reach adolescents, particularly the most vulnerable.

Early detection and treatment It is crucial to address the needs of adolescents with mental health conditions.

Avoiding institutionalization and over-medicalization, prioritizing non-pharmacological approaches, and respecting the rights of children in line with the United Nations Convention on the Rights of the Child and other human rights instruments are key for adolescents’ mental health.

WHO response WHO works on strategies, programmes and tools to assist governments in responding to the health needs of adolescents.

For example, the Helping Adolescents Thrive (HAT) Initiative is a joint WHO-UNICEF effort to strengthen policies and programmes for the mental health of adolescents. More specifically, the efforts made through the Initiative are to promote mental health and prevent mental health conditions. They are also intended to help prevent self-harm and other risk behaviors, such as harmful use of alcohol and drugs, that have a negative impact on the mental - and physical- health of young people.

WHO has also developed a module on Child and Adolescent Mental and Behavioral Disorders as part of the mhGAP Intervention Guide 2.0. This Guide provides evidence-based clinical protocols for the assessment and management of a range of mental health conditions in non-specialized care settings.

Furthermore, WHO is developing and testing scalable psychological interventions to address emotional disorders of adolescents, and guidance on mental health services for adolescents.

WHO’s Regional Office for the Eastern Mediterranean has developed a mental health training package for educators for improved understanding of the importance of mental health in the school setting and to guide the implementation of strategies to promote, protect and restore mental health among their students. It includes training manuals and materials to help scale up the number of schools promoting mental health.

Health behavior & Behavioral change Def. of "Health behavior" Dictionary def

Anything that an organism does involving an action and a response to stimulation.

WHO def “Any activity undertaken by an individual regardless of actual or perceived health status, for the purpose of promoting, protecting, or maintaining health, whether or not such behavior is objectively effective towards that end.”

Health behavior (locus of control and self efficiency) . "Self-efficacy" is the belief that you can succeed in a specific area of your life, and "locus of control" is how much control you feel you have over a situation. . Self-efficacy involves believing in your ability to go through the steps necessary to produce a desired outcome. For example, if you want to run a marathon, you'll have to run consistently, eat right, and follow through on stretching and strength to keep yourself injury-free. If you believe that you can do all of those things, then you have a high self-efficacy.

Self-Efficacy and Locus of Control As you can imagine, people with high self-efficacy in an area are more likely to believe that they can control the outcome of a situation. For example, Sue and Bart are in the same math class. Sue has high self-efficacy for math, but Bart has low self-efficacy for math. They're getting ready for a math test. Because Sue has high self-efficacy in math, she is more likely to believe that she can control whether she does well on the test or not. In contrast, Bart's low self-efficacy in this subject means that he might believe that no matter how much studying he does, he won't be able to be successful on the upcoming test.

Whether or not you believe that you can control the outcome of a situation is called locus of control. People who believe that they have control over a situation have an internal locus of control, whereas people who believe that outside factors have more control over a situation than they do have an external locus of control.

Behaviour change models (health belief model) Behavioral change is about altering habits and behaviors for the long term.

Behavioral change models include: 1- Transtheoretical model (stages of change)

2- Information–motivation–behavioral skills model

3- Behavior change wheel & COM-B model

4- health belief model

5- Integrated model

" Health belief model " The health belief model (HBM) is a social psychological health behavior change model developed in the early 1950s by social scientists at the U.S. Public Health Service in order to understand the failure of people to adopt disease prevention strategies or screening tests for the early detection of disease.

Later uses of HBM were for patients' responses to symptoms and compliance with medical treatments. .The HBM suggests that " a person's belief in a personal threat of an illness or disease together with a person's belief in the effectiveness of the recommended health behavior or action will predict the likelihood the person will adopt the behavior." . The HBM derives from psychological and behavioral theory with the foundation that the two components of health-related behavior are 1) the desire to avoid illness, or conversely get well if already ill.

2) the belief that a specific health action will prevent, or cure, illness.

There are six constructs of the HBM. The first four constructs were developed as the original tenets of the HBM. The last two were added as research about the HBM evolved : 1- Perceived susceptibility.

2- Perceived severity.

3- Perceived benefits.

4- Perceived barriers.

5- Cue to action.

6- Self-efficacy.

Methodology of behaviour change.

A behavior change method, or behavior change technique, is a theory-based method for changing one or several determinants of behavior such as a person's attitude or self-efficacy. Such behavior change methods are used in behavior change interventions.

Three of the most useful techniques are: 1- goal setting.

2- action planning.

3- self-monitoring.

Behaviour change in practice . Behaviour change in practice: group approaches.....

Preliminary research in the treatment of obesity suggests that group interventions may be at least as effective as individual interventions, presumably due to the social support created among individuals in the group. Given that a cost-effectiveness analysis may favor groups, further research is necessary on how the benefits of group process can be maximized. . Behaviour change in practice: targeting individuals......

This describes the emergence of motivational interviewing in the addictions field, and the development of broader negotiating methods for use in medical consultations about behaviour change. It is argued that much of this material should be relevant to the treatment of obesity in brief medical consultations. It should be possible to encourage patients to be much more active in the consultation, and for practitioners to avoid some of the pitfalls of ineffective advice-giving. Four potentially relevant clinical strategies are described.

Gender-based Violence Here is an abstract for a research that links the GBV with mental health: Abstract

Background In conflict-affected settings, women and girls are vulnerable to gender-based violence (GBV). GBV is associated with poor long-term mental health such as anxiety, depression and post-traumatic stress disorder (PTSD). Understanding the interaction between current violence and past conflict-related violence with ongoing mental health is essential for improving mental health service provision in refugee camps.

Methods Using data collected from 209 women attending GBV case management centres in the Dadaab refugee camps, Kenya, we grouped women by recent experience of GBV using latent class analysis and modelled the relationship between the groups and symptomatic scores for anxiety, depression and PTSD using linear regression.

Results Women with past-year experience of intimate partner violence alone may have a higher risk of depression than women with past-year experience of non-partner violence alone (Coef. 1.68, 95% CI 0.25 to 3.11). Conflict-related violence was an important risk factor for poor mental health among women who accessed GBV services, despite time since occurrence (average time in camp was 11.5 years) and even for those with a past-year experience of GBV (Anxiety: 3.48, 1.85–5.10; Depression: 2.26, 0.51–4.02; PTSD: 6.83, 4.21–9.44).

Conclusion

Refugee women who experienced past-year intimate partner violence or conflict-related violence may be at increased risk of depression, anxiety or PTSD. Service providers should be aware that compared to the general refugee population, women who have experienced violence may require additional psychological support and recognise the enduring impact of violence that occurred before, during and after periods of conflict and tailor outreach and treatment services accordingly.

PFA: LOOK DO allow the survivor to approach DO NOT ignore someone who you. Listen to their needs. approaches you and shares that s/he has experienced something bad, something uncomfortable, something wrong and/or violence.

DO ask how you can support with DO NOT force help on people by any basic urgent needs first. Some being intrusive or pushy. survivors may need immediate medical care or clothing.

DO ask the survivor if s/he feels comfortable talking to you in your current location. If a survivor is accompanied by someone, do not assume it is safe to talk to the survivor about their experience in front of that person.

DO NOT pressure the survivor into sharing more information beyond what s/he feels comfortable sharing. The details of what happened and by whom are not important or relevant to your role in listening and providing information on available services.

DO provide practical support like DO NOT overreact. Stay calm. offering water, a private place to sit, a tissue etc.

DO, to the best of your ability, ask DO NOT ask if someone has the survivor to choose someone experienced GBV, has been raped, has s/he feels comfortable with to been hit etc translate for and/or support them if needed.

LISTEN DO treat any information shared with confidentiality. If you need to seek advise and guidance on how to best support a survivor, ask for the survivor’s permission to talk to a specialist or colleague. Do so without revealing the personal identifiers of the survivor.

DO NOT write anything down, take photos of the survivor, record the conversation on your phone or other device, or inform others including the media.

DO manage any expectations on the DO NOT ask questions about what limits of your confidentiality, if happened. Instead, listen and ask applicable in your context. what you can do to support.

DO manage expectations on your DO NOT make comparisons role. between the person’s experience and something that happened to another person.

Do not communicate that the situation is “not a big deal” or unimportant.

What matters is how the survivor feels about their experience.

DO listen more than you speak.

DO say some statements of comfort and support; reinforce that what happened to them was not their fault.

DO NOT doubt or contradict what someone tells you. Remember your role is to listen without judgment and to provide information on available services.

LINK DO respect the rights of the DO NOT exaggerate your skills, make false survivor to make their own promises or provide false information. decisions.

DO share information on all DO NOT offer your own advice or opinion services that may be available, on the best course of action or what to do even if not GBV specialized next. services.

DO tell the survivor that s/he does not have to make any decisions now, s/he can change their mind and access these services in the future.

DO NOT assume you know what someone wants or needs. Some actions may put someone at further risk of stigma, retaliation, or harm.

DO ask if there is someone, a friend, family member, caregiver or anyone else who the survivor trusts to go to for support.

DO NOT make assumptions about someone or their experiences, and do not discriminate for any reason including age, marital status, disability, religion, ethnicity, class, sexual orientation, gender identity, identity of the perpetrator(s) etc

DO offer your phone or communication device, if you feel safe doing so, to the survivor to contact someone s/he trusts

DO NOT try to make peace, reconcile or resolve the situation between someone who experienced GBV and anyone else (such as the perpetrator, or any third person such as a family member, community committee member, community leader etc.)

DO ask for permission from DO NOT share the details of the incident the survivor before taking any and personal identifiers of the survivor with action. anyone. This includes the survivor’s family members, police/security forces, community leaders, colleagues, supervisors, etc. Sharing this information can lead to more harm for the survivor.

DO end the supportively.

conversation DO NOT ask about or contact the survivor after you end the conversation.

(https://reliefweb.int/sites/reliefweb.int/files/resources/gbv_pocket_guide.pd f)

HIV The relationship between HIV and Mental Health: ● People living with HIV are at a greatly increased risk of developing mental health conditions, often suffering from depression and anxiety as they adjust to their diagnosis and adapt to living with a chronic infectious disease. ● People living with mental health problems can also be at a higher risk of HIV. The risks are exacerbated by low access to information and knowledge of HIV, including how to prevent it, injection drug use, sexual contact with people who inject drugs, sexual abuse, unprotected sex between men and low use of condoms.

Challenges faced by people living with HIV: ● Currently, very few health services are addressing the HIV-related needs of people living with mental health issues or the mental health issues of people living with HIV. This situation needs to change. Studies conducted over five continents have estimated that HIV prevalence among people living with severe mental disorders could be between 1.5% in Asia and up to 19% in Africa. ● People living with HIV can experience mental health issues that can affect quality of life and stop them from seeking health care or adhering to treatment. Studies across 38 countries show that 15% of adults and 25% of adolescents living with HIV reported depression or feeling overwhelmed, which could be a barrier to adherence to antiretroviral therapy. ● In addition, treatment itself can cause a wide range of side-effects on the central nervous system, including depression, nervousness, euphoria, hallucinations and psychosis. Studies in Africa found a 24% prevalence of depression among people living with HIV. ● Identifying mental health issues among people living with HIV is critical; however, far too often those go undiagnosed and untreated.

There are many reasons for this, all of which need to be addressed.

People may not want to reveal their psychological state to health-care workers for fear of stigma and discrimination and health-care workers may not have the skills or training to detect psychological symptoms or may fail to take the necessary action for further assessment, management and referral if symptoms are detected. (https://www.unaids.org/en/resources/presscentre/featurestories/2018/octob er/mental-health-and-hiv-services )

HIV Treatments and Therapies Research shows that HIV treatment should begin as soon as possible after diagnosis to achieve the best health outcomes. HIV treatment usually includes a combination of medicines called antiretroviral therapy (ART).

Following a treatment plan, such as taking the medications prescribed by a health care provider, is critical for controlling and suppressing the virus.

Following the treatment plan can be difficult, but there are strategies that can help. For more information and helpful tips, see the HIV.gov page on Taking Medication Every Day. Starting ART also can affect mental health in different ways. Sometimes ART can help to relieve anxiety because knowing that you are taking care of yourself can provide a sense of security. However, coping with the reality of living with a chronic illness like HIV can be challenging. In addition, some antiretroviral medicines may cause symptoms of depression, anxiety, and sleep disturbance and may make some mental health issues worse.

For these reasons, it is important for people living with HIV to talk to their health care provider about their mental health. A conversation about mental health should be part of a complete medical evaluation before starting ART, and discussions about mental health should continue throughout treatment.

People living with HIV should be open and honest with their provider about any changes in their mental health, such as their thoughts or how they feel about themselves and life in general. People living with HIV should also discuss any alcohol or substance use with their provider. For more information, see the HIV.gov pages on Mental Health and HIV and Alcohol and Drug Use. People living with HIV should also tell their health care provider about any over-the-counter or prescribed medications they may be taking, including any psychiatric medicines, because some of these drugs may interact with antiretroviral medications. Learn how to get the conversation started with Tips for Talking with Your Health Care Provider. https://www.nimh.nih.gov/health/topics/hiv-aids PFA:

mentioned in the PFA topics

Antisocial Personality Disorder What is Antisocial Personality Disorder?

Antisocial personality disorder is a particularly challenging type of personality disorder characterised by impulsive, irresponsible and often criminal behaviour.

Someone with antisocial personality disorder will typically be manipulative, deceitful and reckless, and will not care for other people's feelings.

Like other types of personality disorder, antisocial personality disorder is on a spectrum, which means it can range in severity from occasional bad behaviour to repeatedly breaking the law and committing serious crimes.

Causes The cause of antisocial personality disorder is unknown. Genetic factors and environmental factors, such as child abuse, are believed to contribute to the development of this condition. People with an antisocial or alcoholic parent are at increased risk. Far more men than women are affected. The condition is common among people who are in prison.

Fire-setting and cruelty to animals during childhood are linked to the development of antisocial personality.

Some doctors believe that psychopathic personality (psychopathy) is the same disorder. Others believe that psychopathic personality is a similar but more severe disorder.

Symptoms

A person with antisocial personality disorder may: · Be able to act witty and charming · Be good at flattery and manipulating other people's emotions · Break the law repeatedly · Disregard the safety of self and others · Have problems with substance abuse · Lie, steal, and fight often · Not show guilt or remorse · Often be angry or arrogant https://www.mentalhealth.gov/what-to-look-for/personality-disorders/antis ocial-personality-disorder#:~:text=The%20cause%20of%20antisocial%20per sonality,men%20than%20women%20are%20affected

Risk factors: It's not known why some people develop antisocial personality disorder, but both genetics and traumatic childhood experiences, such as child abuse or neglect, are thought to play a role. ● A person with antisocial personality disorder will have often grown up in difficult family circumstances. One or both parents may misuse alcohol. Parental conflict and harsh, inconsistent parenting are also common. ● As a result of these problems, social services may become involved with the child's care. ● Sex: Men are more likely than women to develop ASPD. ● Biochemical, environmental, genetic, and lifestyle factors. (https://my.clevelandclinic.org/health/diseases/9657-antisocial-personality-d isorder )

Diagnosis: It is important to understand the difference between personality styles and personality disorders. A person who is shy or likes to spend time alone does not necessarily have an avoidant or schizoid personality disorder. The difference between personality style and a personality disorder often can be determined by assessing the person’s personality function in certain areas, including: ● Work ● Relationships ● Feelings/emotions ● Self-identity ● Awareness of reality ● Behavior and impulse control If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder. The doctor or therapist bases his or her diagnosis on the person’s description of the symptoms and on his or her observation of the person’s attitude and behavior. The therapist then determines if the person’s symptoms point to a personality disorder as outlined in the DSM-5.

What is a differential diagnosis of ASPD? A differential diagnosis means distinguishing between several health conditions with similar symptoms. Certain disorders may mimic ASPD, so it’s important for your healthcare provider to make the right diagnosis.

These disorders include: ● Borderline personality disorder, or unstable moods and manipulative behavior. ● Narcissistic personality disorder, or an inflated sense of self-importance. ● Substance abuse disorder, or an addiction to drugs or alcohol.

What is the treatment for antisocial personality disorder (ASPD)?

There is no set treatment for ASPD. Therapies such as medication or psychotherapy may help control specific behaviors, though. Studies suggest that symptoms of ASPD are worst around ages 24 to 44, then tend to improve after age 45.

Are there medications disorder (ASPD)?

for

antisocial

personality

Medication generally only helps people with aggression, depression or erratic moods alongside ASPD. Your healthcare provider may recommend: ● Antidepressants, which can regulate serotonin levels in your brain.

Examples include sertraline and fluoxetine. ● Antipsychotics, which can control violent behavior or aggression.

Examples include risperidone and quetiapine. ● Mood stabilizers, which help manage severe changes in mood or behavior. Examples include lithium and carbamazepine.

How can psychotherapy help antisocial personality disorder (ASPD)?

Cognitive behavioral therapy is a type of counseling that focuses on changing a person’s thinking and behavior. Therapy for ASPD may help people think about how their behavior affects others. Someone with ASPD may benefit from individual therapy, group therapy or family therapy.

PREVENTION Can antisocial personality disorder (ASPD) be prevented?

There isn’t a way to prevent ASPD. But if conduct disorder gets caught early in childhood, therapy may prevent the development of ASPD in adulthood. https://my.clevelandclinic.org/health/diseases/9657-antisocial-personality-di sorder#:~:text=Can%20antisocial%20personality%20disorder%20(ASPD,dev elopment%20of%20ASPD%20in%20adulthood.

When should I call my doctor about ASPD? If you or someone you know has any of the following symptoms, seek medical attention right away: ● Extreme changes in mood. ● Self-harm. ● Suicidal thoughts. ● Violent behavior.

PTSD Definition Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event

Signs and Symptoms While most but not all traumatized people experience short term symptoms, the majority do not develop ongoing (chronic) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms .that last much longer. In some people, the condition becomes chronic A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.

To be diagnosed with PTSD, an adult must have all of the following for :at least month ● ● ● ●

At least one re-experiencing symptom At least one avoidance symptom At least two arousal and reactivity symptoms At least two cognition and mood symptoms

Re-experiencing symptoms include: -Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating -Bad dreams -Frightening thoughts Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include: -Staying away from places, events, or objects that are reminders of the traumatic experience -Avoiding thoughts or feelings related to the traumatic event Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Arousal and reactivity symptoms include: -Being easily startled -Feeling tense or “on edge” -Having difficulty sleeping -Having angry outbursts Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include: -Trouble remembering key features of the traumatic event -Negative thoughts about oneself or the world -Distorted feelings like guilt or blame -Loss of interest in enjoyable activities Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.

It is natural to have some of these symptoms for a few weeks after a dangerous event. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

Do children react differently than adults?

Children and teens can have extreme reactions to trauma, but some of their symptoms may not be the same as adults. Symptoms, sometimes seen in very young children (less than 6 years old), can include: ● ● ● ●

Wetting the bed after having learned to use the toilet Forgetting how to or being unable to talk Acting out the scary event during playtime Being unusually clingy with a parent or other adult

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge

Risk Factors Anyone can develop PTSD at any age. This includes war veterans, children, and people who have been through a physical or sexual assault, abuse, accident, disaster, or other serious events. According to the National Center for PTSD, about 7 or 8 out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men, and genes may make some people more likely to develop PTSD than others.

Not everyone with PTSD has been through a dangerous event. Some people develop PTSD after a friend or family member experiences danger or harm. The sudden, unexpected death of a loved one can also lead to PTSD.

Why do some people develop PTSD and other people do not?

It is important to remember that not everyone who lives through a dangerous event develops PTSD. In fact, most people will not develop the disorder.

Many factors play a part in whether a person will develop PTSD or not.

Some examples are listed below. Risk factors make a person more likely to develop PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder.

Some factors that increase risk for PTSD include: Living through dangerous events and traumas Getting hurt Seeing another person hurt, or seeing a dead body Childhood trauma Feeling horror, helplessness, or extreme fear Having little or no social support after the event Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home ● Having a history of mental illness or substance abuse ● ● ● ● ● ● ●

Some factors that may promote recovery after trauma include: Seeking out support from other people, such as friends and family Finding a support group after a traumatic event Learning to feel good about one’s own actions in the face of danger Having a positive coping strategy, or a way of getting through the bad event and learning from it ● Being able to act and respond effectively despite feeling fear ● ● ● ●

Researchers are studying the importance of these and other risk and resilience factors, including genetics and neurobiology. With more research, someday it may be possible to predict who is likely to develop PTSD and to prevent it.

Treatments and Therapies The main treatments for people with PTSD are medications, psychotherapy (“talk” therapy), or both. Everyone is different, and PTSD affects people differently, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health provider who is experienced with PTSD. Some people with PTSD may need to try different treatments to find what works for their symptoms.

If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be addressed.

Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.

Medications The most studied type of medication for treating PTSD are antidepressants, which may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Other medications may be

helpful for treating specific PTSD symptoms, such as sleep problems and nightmares.

Doctors and patients can work together to find the best medication or medication combination, as well as the right dose. Check the U.S. Food and Drug Administration website for the latest information on patient medication guides, warnings, or newly approved medications.

Psychotherapy Psychotherapy (sometimes called “talk therapy”) involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but it can last longer. Research shows that support from family and friends can be an important part of recovery.

Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.

Effective psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms. One helpful form of therapy is called cognitive behavioral therapy, or CBT.

CBT can include: Exposure therapy This helps people face and control their fear. It gradually exposes them to the trauma they experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.

Cognitive restructuring This helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about something that is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.

There are other types of treatment that can help as well. People with PTSD should talk about all treatment options with a therapist. Treatment should equip individuals with the skills to manage their symptoms and help them participate in activities that they enjoyed before developing PTSD.

How Talk Therapies Help People Overcome PTSD Talk therapies teach people helpful ways to react to the frightening events that trigger their PTSD symptoms.

Based on this general goal, different types of therapy may: ● Teach about trauma and its effects

● Use relaxation and anger-control skills ● Provide tips for better sleep, diet, and exercise habits ● Help people identify and deal with guilt, shame, and other feelings about the event ● Focus on changing how people react to their PTSD symptoms. For example, therapy helps people face reminders of the trauma.

Beyond Treatment: How can I help myself?

It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better. If you are unsure where to go for help, ask your family doctor. You can also check NIMH's Help for Mental Illnesses page or search online for “mental health providers,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.

To help yourself while in treatment: 1.

2.

3.

4.

Talk with your doctor about treatment options Engage in mild physical activity or exercise to help reduce stress Set realistic goals for yourself Break up large tasks into small ones, set some priorities, and do what you can as you can 5. Try to spend time with other people, and confide in a trusted friend or relative.

6. Tell others about things that may trigger symptoms.

7. Expect your symptoms to improve gradually, not immediately 8. Identify and seek out comforting situations, places, and people Caring for yourself and others is especially important when large numbers of people are exposed to traumatic events (such as natural disasters, accidents, and violent acts).

Reference:https://www.nimh.nih.gov/health/topics/post-traumatic-stress-di sorder-ptsd

Borderline Personality Disorder Overview

Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships.

People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.

Signs and Symptoms

People with borderline personality disorder may experience mood swings and display uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly.

People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy or traitor the next day. These shifting feelings can lead to intense and unstable relationships.

Other signs or symptoms may include: ● Efforts to avoid real or imagined abandonment, such as rapidly initiating intimate (physical or emotional) relationships or cutting off communication with someone in anticipation of being abandoned ● A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation) ● Distorted and unstable self-image or sense of self ● Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating.

Please note: If these behaviors occur primarily during a period of elevated mood or energy, they may be signs of a mood disorder—not borderline personality disorder ● Self-harming behavior, such as cutting ● Recurring thoughts of suicidal behaviors or threats ● Intense and highly changeable moods, with each episode lasting from a few hours to a few days ● Chronic feelings of emptiness ● Inappropriate, intense anger or problems controlling anger ● Difficulty trusting, which is sometimes accompanied by irrational fear of other people’s intentions ● Feelings of dissociation, such as feeling cut off from oneself, seeing oneself from outside one’s body, or feelings of unreality

Not everyone with borderline personality disorder experiences every symptom. Some individuals experience only a few symptoms, while others have many. Symptoms can be triggered by seemingly ordinary events. For example, people with borderline personality disorder may become angry and distressed over minor separations from people to whom they feel close, such as traveling on business trips. The severity and frequency of symptoms and how long they last will vary depending on the individual and their illness.

Risk Factors

The cause of borderline personality disorder is not yet clear, but research suggests that genetics, brain structure and function, and environmental, cultural, and social factors play a role, or may increase the risk for developing borderline personality disorder. ● Family History People who have a close family member, such as a parent or sibling with the disorder may be at higher risk of developing borderline personality disorder. ● Brain Factors Studies show that people with borderline personality disorder can have structural and functional changes in the brain especially in the areas that control impulses and emotional regulation. But is it not clear whether these changes are risk factors for the disorder, or caused by the disorder. ● Environmental, Cultural, and Social Factors Many people with borderline personality disorder report experiencing traumatic life events, such as abuse, abandonment, or adversity during childhood. Others may have been exposed to unstable, invalidating relationships, and hostile conflicts.

Although these factors may increase a person’s risk, it does not mean that the person will develop borderline personality disorder. Likewise, there may be people without these risk factors who will develop borderline personality disorder in their lifetime.

Treatments and Therapies

Borderline personality disorder has historically been viewed as difficult to treat. But, with newer, evidence-based treatment, many people with the disorder experience fewer or less severe symptoms, and an improved quality of life. It is important that people with borderline personality disorder receive evidence-based, specialized treatment from an

appropriately trained provider. Other types of treatment, or treatment provided by a doctor or therapist who is not appropriately trained, may not benefit the person.

Many factors affect the length of time it takes for symptoms to improve once treatment begins, so it is important for people with borderline personality disorder and their loved ones to be patient and to receive appropriate support during treatment.

Tests and Diagnosis

A licensed mental health professional—such as a psychiatrist, psychologist, or clinical social worker -experienced in diagnosing and treating mental disorders- can diagnose borderline personality disorder by: ● Completing a thorough interview, including a discussion about symptoms ● Performing a careful and thorough medical exam, which can help rule out other possible causes of symptoms ● Asking about family medical histories, including any history of mental illness Borderline personality disorder often occurs with other mental illnesses.

Co-occurring disorders can make it harder to diagnose and treat borderline personality disorder, especially if symptoms of other illnesses overlap with the symptoms of borderline personality disorder. For example, a person with borderline personality disorder may be more likely to also experience symptoms of depression, bipolar disorder, anxiety disorders, substance use disorders, or eating disorders.

Seek and Stick with Treatment NIMH-funded studies show that people with borderline personality disorder who don’t receive adequate treatment are: ● More likely to develop other chronic medical or mental illnesses ● Less likely to make healthy lifestyle choices Borderline personality disorder is also associated with a significantly higher rate of self-harm and suicidal behavior than the general public.

People with borderline personality disorder who are thinking of harming themselves or attempting suicide need help right away.

If you or someone you know is in crisis, call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are free and confidential.

Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Read more on NIMH’s Suicide Prevention health topic page.

The treatments described on this page are just some of the options that may be available to a person with borderline personality disorder.

Psychotherapy Psychotherapy is the first-line treatment for people with borderline personality disorder. A therapist can provide one-on-one treatment between the therapist and patient, or treatment in a group setting.

Therapist-led group sessions may help teach people with borderline personality disorder how to interact with others and how to effectively express themselves.

It is important that people in therapy get along with, and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with the disorder to maintain a comfortable and trusting bond with their therapist.

Two examples of psychotherapies used to treat borderline personality disorder include: ● Dialectical Behavior Therapy (DBT): This type of therapy was developed for individuals with borderline personality disorder. DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help: o Control intense emotions o Reduce self-destructive behaviors o Improve relationships ● Cognitive Behavioral Therapy (CBT): This type of therapy can help people with borderline personality disorder identify and change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others, and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.

Read more on NIMH’s Psychotherapies health topic page.

Medications Because the benefits are unclear, medications are not typically used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms such as:

● mood swings ● depression ● other co-occurring mental disorders Treatment with medications may require care from more than one medical professional.

Certain medications can cause different side effects. Talk to your doctor about what to expect from a particular medication.

Read more in NIMH’s Mental Health Medications health topic.

Other Elements of Care Some people with borderline personality disorder experience severe symptoms and need intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care.

Therapy for Caregivers and Family Members

Families and caregivers of people with borderline personality disorder may also benefit from therapy. Having a relative or loved one with the disorder can be stressful, and family members or caregivers may unintentionally act in ways that can worsen their loved one’s symptoms.

Some borderline personality disorder therapies include family members, caregivers, or loved ones in treatment sessions. This type of therapy helps by: ● Allowing the relative or loved one to develop skills to better understand and support a person with borderline personality disorder ● Focusing on the needs of family members to help them understand the obstacles and strategies for caring for someone with borderline personality disorder. Although more research is needed to determine the effectiveness of family therapy in borderline personality disorder, studies on other mental disorders suggest that including family members can help in a person's treatment.

Finding Help

More information about finding a health care provider or treatment for mental disorders in general is available on our Help for Mental Illness webpage.

Tips for Family and Caregivers

To help a friend or relative with the disorder: ● Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with borderline personality disorder, but it is possible for them to get better over time. ● Learn about mental disorders, including borderline personality disorder, so you can understand what the person with the disorder is experiencing. ● Encourage your loved one who is in treatment for borderline personality disorder to ask about family therapy. ● Seek counseling for yourself from a therapist. It should not be the same therapist that your loved one with borderline personality disorder is seeing.

k