Dec 4, 2013 / 5:00 am
So often in my column I am writing about ways in which the human brain can trip us up and make daily functioning in life more difficult.
In such a complex organ, small genetic differences can cause one person to experience the irrational delusions associated with psychosis, another to feel the deep pit of depression while many others may have no problems with their psychological health.
It is gratifying to be able to write about an interesting genetic condition which allows those who experience it to perceive things differently from many without it causing difficulty in life.
Synesthesia is a neurologically based condition, in which stimulation of one sense or cognitive pathway leads to an automatic and involuntary experience from a secondary one.
For example, one of the more common forms of this condition is called grapheme colour synesthesia where individuals perceive different letters and numbers as inherently tinted.
In the mind’s eye, the letter A may be red while B is green and every letter in the alphabet is linked with a specific colour that remains constant.
Instead of causing difficulties for people, this kind of synesthesia is usually reported as a pleasant or neutral experience and it can actually be helpful for memory as well as in creative pursuits. As a result, synesthesia is not considered a disorder but simply a genetic trait causing a difference in perception.
Although it is not the norm, synesthesia is not as rare as you might think. Roughly one in every 23 people experience some form of synesthesia and it affects men and women equally.
Grapheme colour synesthesia is one of the most common forms of this condition, but 60 different types have been identified.
Ordinal linguistic personification is another fairly common type of synesthesia in which days of the week or seasons are associated with specific personalities.
In number form, numbers, months or days of the week are linked with specific and precise locations in space and lexical gustatory synesthesia occurs when words in the spoken language bring on taste sensations on the tongue. In this particular synesthesia, the tastes are always reminiscent of foods eaten by the individual in early life.
Very little scientific research has been done to date on the many forms of synesthesia and it is still unknown what causes it. We do know there is some genetic basis for the condition as it runs strongly in families and seems to affect an area on chromosome two that can also be associated with conditions such as autism spectrum disorder and epilepsy. Individuals with either of these two disorders also seem to have a higher incidence of co-occurring synesthesia but the exact link between them is not understood.
The vast majority of people who experience true synesthesia, experience it from early childhood. In some cases however, it can begin after the use of psychedelic drugs, after a stroke or epileptic seizure or as a result of blindness or deafness. In these instances, it is called adventitious synesthesia and it seems to always link senses such as vision, hearing, taste or touch.
It will be interesting to learn more about this unique trait as research emerges on the subject. It is yet another mysterious and fascinating adaptation of the human brain.
Nov 27, 2013 / 5:00 am
Depression and bipolar disorder are very commonly seen in general medical practice and both are under-recognized and sometimes inappropriately treated. In one study, 15 percent of patients visiting an urban general practice were found to be currently experiencing clinical depression and another five percent were diagnosed as bipolar—only half of both groups had received any mental health treatment in the past year. Further, a full quarter of these depressed patients actually had bipolar disorder.
Those experiencing bipolar disorder were more likely to have suicidal thoughts, low self-esteem, co-existing alcohol abuse as well as a lifetime history of hallucinations and inpatient psychiatric care. Of the bipolar patients who had received some treatment, half reported recent treatment with an antidepressant medication while most did not receive a mood stabilizer in conjunction with it. This is not appropriate because antidepressants alone are not recommended for the treatment of bipolar disorder. While they may alleviate the depressed phase, they can often send a patient spiraling into a manic phase, which is just as dangerous.
It is disheartening to find two such treatable conditions are so often unrecognized and either untreated or inappropriately treated. Since approximately one in five people will experience some form of depression during their lifetime, it is important for the medical community as well as the general population to be aware of the signs and symptoms of depression and the availability of effective treatment.
Depression involves more than simply feeling blue. While persistent sadness is a hallmark symptom, there are other ways to identify the condition. Sadness out of proportion with what is going on in the individual’s life, disrupted sleep patterns, appetite changes, weight gain or loss, social withdrawal, loss of interest in once enjoyable activities, decreased sex drive, irritability, physical complaints such as frequent headaches or back pain and suicidal thoughts are all common symptoms of depression.
Bipolar disorder can look just like depression as one of its phases is depression. Careful diagnosis by a medical professional is important, but some things to be aware of include a history of at least one episode of mania. When an individual experiences a manic episode, it usually involves a combination of symptoms including feelings of excessive euphoria, abnormal feelings of power and confidence, increased energy, racing thoughts, extreme irritability, uncharacteristically bad judgment, increased sexual drive, less need for sleep and restlessness. A manic individual’s behaviour can be impulsive, reckless and sometimes dangerous. All of these need not be present to make the diagnosis. It is the variability in the presence and severity of these symptoms that make this diagnosis tricky.
Patients with bipolar disorder should almost always be seen by a psychiatrist. This is often a difficult disorder to treat and may require frequent changes in medication. The diagnosis is difficult and is usually associated with other psychiatric disorders including drug and alcohol abuse. It should not be taken lightly.
Nov 20, 2013 / 5:00 am
Some psychiatric diagnoses are very difficult. There can be several possible conditions with overlapping symptoms; the presence or absence of these symptoms may be very subjective. Some people have very atypical symptoms for a given condition and some people are not very good at describing how they feel or may not be very good observers of their own behaviour.
On the other hand, diagnosis is sometimes very simple. I often hear patients express skepticism that a diagnosis could be made after a brief encounter. Sometimes the diagnosis can be made in the first few minutes of an interview. If the symptoms are very clear, unequivocal and typical for a particular disorder, there may not be much question.
Bipolar disorder illustrates both of these extremes. On the one hand, if symptoms are mild there can sometimes be a question of ADHD, Borderline Personality Disorder or bipolar disorder. It may not be possible to make a definitive decision at the initial interview. One may have to wait to see the response to treatment or until the condition declares itself more clearly over time. If, however, the patient arrives in a manic state the diagnosis may be obvious in the waiting room or from the referral letter that precedes their arrival. It may remain only to make sure they are not abusing drugs, or taking some medication that could cause a similar presentation. If a brief interview reveals a family history of bipolar disorder, the diagnosis is even more certain.
Of course the diagnosis may not be the hard part in this case. Having a clear idea what one is dealing with is a good place to start but it does not necessarily lead to an immediate solution. There may be personality issues, lack of insight or cooperation, social or financial problems and a host of other complications that stand between a diagnosis and a successful treatment.
One would be quite justified to say that a brief interview and the prescription of medication are not sufficient even if both are correct. It would be quite correct to conclude that one does not know everything one needs to know about a person just because the diagnosis has been made and the broad outlines of treatment are known. Psychiatry is not a matter of simply applying treatment guidelines. There is an art to therapy that is much more ephemeral.
Sometimes even if you know all the facts and have the necessary treatment methods, you can’t succeed because the patient is indecisive, doesn’t believe what you say or is surrounded by people and circumstances that interfere with therapy. Maybe the therapist reminds them of someone from the past—a past partner or parent with whom they had issues. This phenomenon of reacting to someone on the basis of past experiences is known as transference. Therapists too can react to patients on the basis of their past experiences—counter-transference.
Whether the diagnosis is quick and easy or slow and difficult, successful therapy requires a therapeutic relationship based on trust. It is a partnership in which each party has to give the other the benefit of the doubt and work through difficult issues to understand what is going on. Often this means going through difficult times until treatment eventually begins to work. Communication is central to the process. Sometimes the message has to be repeated in many different ways before that understanding dawns, sometimes in a flash of insight.
Nov 6, 2013 / 5:00 am
An important link in the mental health care chain that often goes unrecognized is the role of family members as caregivers.
In many cases, family members play the primary role in caring for a loved one with a mental illness. They spend huge amounts of time and energy advocating on behalf of their loved one, seeking services and also very often go to large personal expense and take on debt to carry out care, treatment and support.
This service is invaluable - without these dedicated family members, many people would fall through the cracks in our healthcare delivery system.
Caring for a family member with a mental illness brings with it much of the same fear, doubt and stress that occur when there is a serious physical illness to deal with and there is very often a noticeable strain and impact on families. Often caregivers develop chronic illnesses of their own after living under this extreme stress for extended periods of time. Emotional and physical burn-out are also common for family caregivers who receive little or no outside support.
Family caregivers need and want support from healthcare professionals and peer support groups. Some such groups are available - including a group for family of individuals with Alzheimer’s disease through the Alzheimer Society of BC and a group for family of those with schizophrenia through the BC Schizophrenia Society. However, more such groups are needed and they need to be more visible within the mental health system so family members are aware of them and can access them when needed.
Respite is also a service family caregivers need so they can take breaks to recharge and avoid becoming burnt out or ill themselves.
Along with the need for support, family caregivers often want to be recognized by healthcare professionals and be more included and involved in the formal aspect of care. This is something that needs to be addressed while still protecting the rights of individual patients. Many times patients are willing to include their family members in treatment and meetings with healthcare professionals if they are encouraged or invited to do so.
Although it takes extra time for physicians to see family members in addition to the patient, it is often worthwhile in the long run as family can provide very useful information to care providers.
If the patient does not want to include them, family may still provide information to healthcare providers as long as they understand it will not be possible for the care provider to respond. This information can still be very useful in helping with care.
For all you family caregivers who are spending so much of your time and energy helping your loved ones - thank you.
Read more Mental Health articles
- Genetic knowledge - good or bad? Oct 30
- How should we treat depressed children? Oct 16
- Psychopathic criminality Oct 9
- SAD starts in childhood Oct 2
- KGH psychiatric beds in crisis Sep 25
- Steroid induced psychiatric disorders Sep 18
- The essence of mental illness Sep 11
- The importance of family communication Sep 4
- Traumatic brain injuries Aug 28
- Unsolicited advice Aug 21
- Synesthesia Jul 17
- What is it like to listen for a living? Jul 10
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