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Mental Health:
A Report
of the Surgeon General
Fact
Sheets
Major Mental Disorders:
Symptoms and Treatments
Department of Health and
Human Services
December 1999
Mental health is fundamental to a person's overall health, indespensable to personal well being and instrumental to a productive life. If you believe that you or a loved on are experiencing what might be the symptoms of a mental disorder, do not hesitate - seek treatment now. Many mental disorders are readily treated; many people can recover.
David Satcher, M.D., Ph.D
Assistant
Secretary for Health and Surgeon General
Table of Contents
Depression
Bipolar Disorder
Schizophrenia
Panic Disorder
Obsessive-Compulsive
Disorder
Post-Traumatic Stress Disorder
Alzheimer's Disease
Attention Deficit
Hyperactivity Disorder
Autism
What Is Depression?
Depression is a serious medical illness. In contrast to the normal emotional experiences of sadness, loss, or passing mood states, depression is persistent and can interfere significantly with an individual's ability to function.
What Are the Symptoms of Depression?
Symptoms of depression include persistent sad mood, loss of interest or pleasure in activities that were once enjoyed, change in appetite or weight, difficulty sleeping or oversleeping, physical slowing or agitation, energy loss, feelings of worthlessness or inappropriate guilt, difficulty thinking or concentrating, and recurrent thoughts of death or suicide. A diagnosis of unpolar major depression (or major depressive disorder) is made if a person has five or more of these symptoms and impairment in usual functioning nearly every day during the same two-week period. Major depression often begins between ages 15-30 or even earlier. Episodes typically recur. An estimated 5.3 percent of American adults ages 18 to 54 suffer from unipolar major depression in a given year.
Some people have a chronic but less severe form of depression, called dysthymia (or dysthymic disorder), that is diagnosed when depressed mood persists for at least two years and is accompanied by at least two other symptoms of depression. An estimated 1.6 percent of American adults ages 18 to 54 have dysthymia in a given year. Many people with dysthymia also have major depressive episodes. While unipolar major depression and dysthymia are the primary forms of depression, a variety of other subtypes exist.
Depression can be devastating to all areas of a person's everyday life, including family relationships, friendships, and the ability to work or go to school. Many people still believe that the emotional symptoms caused by depression are "not real," and that a person should be able to shake off the symptoms if only he or she were trying hard enough. Because of these inaccurate beliefs, people with depression either may not recognize that they have a treatable disorder or may be discouraged from seeking or staying on treatment because of feelings of shame and stigma. Too often, untreated or inadequately treated depression leads to suicide.
Research has shown that stress in the form of loss, especially death of close family members or friends, may trigger major depression in vulnerable individuals. In addition, research supports existence of a genetic component to risk of depression.
What Treatments Are Available for Depression?
Antidepressant medications are widely used, effective treatments for depression. Antidepressant drugs are known to influence the functioning of certain neurotransmitters (chemicals used by brain cells to communicate), primarily serotonin, norepinephrine, and dopamine, known as monoamines. Older medications - tricyclic antidepressants (TCAs) and monoamine oxidase Inhibitors (MAOIs) - affect the activity of all of these neurotransmitters simultaneously. Their disadvantage is that they can be difficult to tolerate due to side effects or, in the case of MAOIs, dietary and medication restrictions. Newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), have fewer side effects than the older drugs, making it easier for patients to adhere to treatment. Both generations of medications are effective In relieving depression, although some people will respond to one type of drug, but not another. Medications that take entirely different approaches to treating depression are now in development.
Psychotherapy is also effective for treating depression. Certain types of psychotherapy, cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been shown to be particularly useful. More than 80 percent of people with depression improve when they receive appropriate treatment with medication, psychotherapy, or the combination.
Recently there has been enormous interest in herbal remedies for various medical conditions including depression. One herbal supplement, hypericum or St. John's wort, has been promoted as having antidepressant properties. However, no carefully designed studies have determined the antidepressant efficacy of this supplement. NIMH is currently enrolling patients in the first large-scale, multi-site, controlled study of St. John's wort conducted in the U.S. as a potential treatment for depression.
For More Information
Mental Health: A Report of the Surgeon General can be viewed at www.surgeongeneral.gov
National Institute of Mental Health
Office
of Communications and Public Liaison
Information Resources and Inquiries
Branch
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD
20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
FAX: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail:
nimhinfo@nih.gov
NIMH home page
address: www.nimh.nih.gov
Substance Abuse and Mental Health Services
Administration
Center for Mental Health Services
Office of External
Liaison
Room 15C-05, Parklawn Building
5600 Fishers Lane
Rockville,
MD 20857
Phone: 301-443-2792
FAX: 301-443-5163
SAMHSA home page
address: www.samhsa.gov
CMHS Knowledge Exchange Network (KEN)
P.O.
Box 42490
Washington, DC 20015
Phone: 1-800-789-2647
FAX:
301-984-8796
KEN home page address: www.mentalhealth.org
U.S. Department of Health and Human Services
Mental Health: The Cornerstone of Health
Home page address:
www.mentalhealth.org/cornerstone
What Is Bipolar Disorder?
Bipolar disorder, also known as manic-depressive illness, is a serious brain disease that causes extreme shifts in mood, energy, and functioning. Men and women are equally likely to develop this disabling illness, which affects approximately 1 percent of American adults ages 18 to 54 in a given year. Different from normal mood states of happiness and sadness, symptoms of bipolar disorder can be severe and life threatening. Bipolar disorder, which tends to run in families, typically emerges in adolescence or early adulthood and continues to flare up across the life course, disrupting work, school, family, and social life. Bipolar disorder is characterized by symptoms that fall into several major categories.
What Are the Symptoms of Bipolar Disorder?
Episodes of Depression: Symptoms include a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant change in appetite or body weight; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings of worthlessness or inappropriate guilt; difficulty thinking or concentrating; and recurrent thoughts of death or suicide.
Episodes of Mania: Abnormally and persistently elevated (high) mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; goal-directed activity done to excess such as spending money; physical agitation; and excessive involvement in risky behaviors or activities. Episodes of hypomania, or mild mania, include symptoms such as increased energy, elevated mood, irritability, and intrusiveness, which may cause little impairment in functioning but are noticeable to others.
Psychosis: Somtimes, severe depression or mania is accompanied by periods of psychosis. Psychotic symptoms include: hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's cultural concepts). Psychotic symptoms associated with bipolar disorder typically reflect the extreme mood state at the time.
"Mixed" state: Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation.
Episodes of mania, depression, or mixed state typically recur and become more frequent across the life span. These episodes, especially early in the course of illness, are separated by periods of wellness during which a person suffers few to no symptoms. When four or more episodes of illness occur within a 12-month period, the person is said to have bipolar disorder with rapid cycling. Bipolar disorder is often complicated by co-occurring alcohol or substance abuse.
What Treatments Are Available for Bipolar Disorder?
A variety of medications are used to treat bipolar disorder. But even with optimal medication treatment, many people with bipolar disorder do not achieve full remission of symptoms. Certain forms of psychotherapy, in combination with medication, often can provide additional benefit. These include cognitive-behavioral therapy, psychoeducation, and family therapy.
Lithium has long been used as a first-line treatment for bipolar disorder. Anti-convulsant medications, particularly valproate and carbamazepine, have been used as alternatives to lithium in many cases. Newer anticonvulsant medications, including lamotrigine and gabapentin, are being studied to determine their efficacy as mood stabilizers in bipolar disorder. Some research suggests that different combinations of lithium and anticonvulsants may be helpful.
During a depressive episode, people with bipolar disorder commonly require treatment with antidepressant medication. The relative efficacy of various antidepressant medications in this disorder has not yet been determined by adequate scientific study. Typically, lithium or anticonvulsant mood stabilizers are given along with an antidepressant to protect against a switch into mania or rapid cycling, which can be provoked in some people with bipolar disorder by antidepressant medications.
In some cases, the newer, atypical antipsychotic drugs such as clozapine or olanzapine may help relieve severe or refractory symptoms of bipolar disorder and prevent recurrences of mania. Further research is necessary, however, to establish the safety and efficacy of atypical antipsychotics as long-term treatments for bipolar disorder.
For More Information
Mental Health: A Report of the Surgeon General can be viewed at www.surgeongeneral.gov
National Institute of Mental Health
Office
of Communications and Public Liaison
Information Resources and Inquiries
Branch
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD
20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
FAX: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail:
nimhinfo@nih.gov
NIMH home page
address: www.nimh.nih.gov
Substance Abuse and Mental Health Services
Administration
Center for Mental Health Services
Office of External
Liaison
Room 15C-05, Parklawn Building
5600 Fishers Lane
Rockville,
MD 20857
Phone: 301-443-2792
FAX: 301-443-5163
SAMHSA home page
address: www.samhsa.gov
CMHS Knowledge Exchange Network (KEN)
P.O.
Box 42490
Washington, DC 20015
Phone: 1-800-789-2647
FAX:
301-984-8796
KEN home page address: www.mentalhealth.org
U.S. Department of Health and Human Services
Mental Health: The Cornerstone of Health
Home page address:
www.mentalhealth.org/cornerstone
What is Schizophrenia?
Schizophrenia is a devastating illness now known to be a disorder of the brain. The most chronic and disabling of the severe mental disorders, schizophrenia affects an estimated 1.3 percent of American adults ages 18 to 54 in a given year. Most people with schizophrenia suffer chronically or episodically throughout their lives, often losing opportunities for careers and relationships. They are also stigmatized by lack of public understanding about the disease.
What Are the Symptoms of Schizophrenia?
The first signs of schizophrenia, which typically emerge in young people in their teens or twenties, are confusing and often shocking to families and friends. Distorted perceptions of reality, including hallucinations and delusions, are common and are accompanied by disordered thinking, blunted emotional expression, unusual speech or behavior, and social withdrawal. These symptoms seriously impair an individual's ability to function in everyday life.
While suicide is a serious and common danger in people who have schizophrenia, most with the illness are not violent towards others. More typically, they are withdrawn and prefer to be left alone. As in people who do not have any mental illness, substance abuse significantly raises the risk of violence in people with schizophrenia. In addition, people suffering from paranoid symptoms, which can become worse if medication is stopped, may also be at higher risk for violent behavior.
Many years of family, twin, and adoption studies indicate that vulnerability to schizophrenia can be inherited. However, the research also shows that genes are not solely responsible for the illness. Environmental influences, perhaps occurring during fetal development, may also play a role in schizophrenia.
What Treatments Are Available for Schizophrenia?
A number of new, effective medications for schizophrenia with fewer side effects than older medications have been introduced in the past decade. The newer drugs-known as atypical antipsychotics-are very effective in the treatment of psychosis, including hallucinations and delusions, and may also be helpful for treating reduced motivation or blunted emotional expression.
While these newer treatments have improved the lives of many people with schizophrenia, few individuals recover completely. However, supportive, reality-oriented, individual psychotherapy, and cognitive-behavioral approaches that teach coping and problem-solving skills, can help. Over time, many people learn successful ways of managing even severe symptoms.
Because of the nature of the disorder, some people with schizophrenia may deny that they need medications and may either refuse to take them or stop taking them because of undesired side effects. Remembering to take medications may be difficult because of the disorganized thinking characteristic of people with schizophrenia.
A major goal of research is the discovery of new, effective and safe treatments for schizophrenia that can be given in longer acting doses. In addition, research is focusing on the relationships among genetic, behavioral, developmental, social and other factors to identify the cause or causes of schizophrenia.
For More Information
Mental Health: A Report of the Surgeon General can be viewed at www.surgeongeneral.gov
National Institute of Mental Health
Office
of Communications and Public Liaison
Information Resources and Inquiries
Branch
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD
20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
FAX: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail:
nimhinfo@nih.gov
NIMH home page
address: www.nimh.nih.gov
Substance Abuse and Mental Health Services
Administration
Center for Mental Health Services
Office of External
Liaison
Room 15C-05, Parklawn Building
5600 Fishers Lane
Rockville,
MD 20857
Phone: 301-443-2792
FAX: 301-443-5163
SAMHSA home page
address: www.samhsa.gov
CMHS Knowledge Exchange Network (KEN)
P.O.
Box 42490
Washington, DC 20015
Phone: 1-800-789-2647
FAX:
301-984-8796
KEN home page address: www.mentalhealth.org
U.S. Department of Health and Human Services
Mental Health: The Cornerstone of Health
Home page address:
www.mentalhealth.org/cornerstone
What Is Panic Disorder?
Panic disorder is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. As a result, the diagnosis of panic disorder is frequently not made until extensive and costly medical procedures fail to provide a correct diagnosis or relief. An estimated 1.6 percent of American adults ages 18 to 54 suffer from panic disorder in a given year.
Many people with panic disorder develop intense anxiety between episodes. It is not unusual for a person with panic disorder to develop phobias about places or situations where panic attacks have occurred, such as in supermarkets or other everyday situations. As the frequency of panic attacks increases, the person often begins to avoid situations where they fear another attack may occur or where help would not be immediately available. This avoidance may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety.
Panic disorder typically strikes in young adulthood. Roughly half of all people who have panic disorder develop the condition before age 24. Women are twice as likely as men to develop panic disorder. Heredity, other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions are all believed to play a role in the onset of panic disorder. The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation. Fortunately effective treatments have been developed to help people with panic disorder.
What Treatments Are Available for Panic Disorder?
Treatment for panic disorder includes medications, cognitive-behavioral therapy (CBT), or the combination of these two. The selective serotonin reuptake inhibitors (SSRIs) are now the first line of medication treatment for panic disorder, other commonly used medications are tricyclic antidepressants, high potency benzodiazepines, and monoamine oxidase inhibitors (MAOIs). CBT, which teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety, has been found to be effective.
Appropriate treatment by an experienced professional can reduce or prevent panic attacks in 70 to 90% of people with panic disorder. Most patients show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode.
Can People With Panic Disorder Have Other Illnesses?
Research shows that panic disorder can coexist with other disorders, most often depression and substance abuse. Appropriate diagnosis and treatment of these co-occurring disorders are important to successfully treating panic disorder.
For More Information
Mental Health: A Report of the Surgeon General can be viewed at www.surgeongeneral.gov
The Anxiety Disorders Education Program,
National Institute of Mental,
6001 Executive Blvd., Room 8184, MSC
9663,
Bethesda, MD 20892-9663.
Phone: 301-443-4513
Toll-free:
1-88-88-ANXIETY (1-888-826-9438)
TTY: 301-443-8431
NIMH Anxiety
Disorders Web site: www.nimh.nih.gov/anxiety/anxietymenu.cfm
Substance Abuse and Mental Health Services
Administration
Center for Mental Health Services
Office of External
Liaison
Room 15C-05, Parklawn Building
5600 Fishers Lane
Rockville,
MD 20857
Phone: 301-443-2792
FAX: 301-443-5163
SAMHSA home page
address: www.samhsa.gov
U.S. Department of Health and Human Services
Mental Health: The Cornerstone of Health
Home page address:
www.mentalhealth.org/cornerstone
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is an anxiety disorder in which people suffer intensely from recurrent, unwanted thoughts (obsessions) or rituals (compulsions) that they feel they cannot control. Rituals such as hand-washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person's life.
OCD, which typically begins during adolescence or early childhood, is often a chronic, relapsing illness. An estimated 2.4 percent of American adults ages 18 to 54 have OCD in a given year. Men and women are equally likely to develop OCD.
There is growing evidence that OCD represents abnormal functioning of the brain. OCD is not caused by family problems or attitudes learned in childhood, such as an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. Fortunately, effective treatments have been developed to help people with OCD.
What Treatments Are Available for OCD?
Treatments for OCD, which combine medications and behavioral therapy (a specific type of psychotherapy), are often effective.
Medications proven effective in helping people with OCD are clomipramine, fluoxetine, fluvoxamine, sertraline, and paroxetine. If one drug does not work well, others should be tried. A number of other medications are currently being studied.
A type of behavioral therapy known as "exposure and response prevention" is very useful for treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts, and then is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety.
Can People With OCD Have Other Illnesses?
OCD is sometimes accompanied by depression, eating disorders, substance abuse, attention deficit hyperactivity disorder, or other anxiety disorders. When a person also has other disorders present, OCD is often more difficult to diagnose and treat.
Symptoms of OCD can also coexist and may even be part of a spectrum of other brain disorders, such as Tourette's syndrome. Appropriate diagnosis and treatment of other disorders are important to successful treatment of OCD.
For More Information
Mental Health: A Report of the Surgeon General can be viewed at www.surgeongeneral.gov
The Anxiety Disorders Education Program,
National Institute of Mental,
6001 Executive Blvd., Room 8184, MSC
9663,
Bethesda, MD 20892-9663.
Phone: 301-443-4513
Toll-free:
1-88-88-ANXIETY (1-888-826-9438)
TTY: 301-443-8431
NIMH Anxiety
Disorders Web site: www.nimh.nih.gov/anxiety/anxietymenu.cfm
CMHS Knowledge Exchange Network (KEN)
P.O.
Box 42490
Washington, DC 20015
Phone: 1-800-789-2647
FAX:
301-984-8796
KEN home page address: www.mentalhealth.org
U.S. Department of Health and Human Services
Mental Health: The Cornerstone of Health
Home page address:
www.mentalhealth.org/cornerstone
Post-Traumatic Stress Disorder
What Is Post-Traumatic Stress Disorder?
Post-traumatic stress disorder (PTSD), an anxiety disorder, can be an extremely debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Families of victims may also develop the disorder. About 3.6 percent of American adults ages 18 to 54 suffer from PTSD in a given year.
Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging, natural or human-caused disasters, accidents, or military combat. Those who may develop PTSD include military troops who served in Vietnam or the Gulf War; rescue workers involved in the aftermath of disasters like the Oklahoma City bombing; survivors of accidents, rape, physical and sexual abuse, and other crimes; immigrants fleeing violence in their countries; survivors of the 1994 California earthquake, the 1997 South Dakota floods, and hurricanes Hugo and Andrew; and people who witness traumatic events.
What Are the Symptoms of PTSD?
Many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event can also trigger symptoms. People with PTSD also experience emotional numbness and sleep disturbances, depression, anxiety, and irritability or outbursts of anger.
Feelings of intense guilt are also common. Most people with PTSD try to avoid any reminders or thoughts of the ordeal. PTSD is diagnosed when symptoms last more than 1 month.
What Treatments Are Available for PTSD?
Research has demonstrated the effectiveness of cognitive-behavioral therapy, group therapy, and exposure therapy, in which the patient repeatedly relives the frightening experience under controlled conditions to help him or her work through the trauma. Studies have also shown that medications help ease associated symptoms of depression and anxiety and help promote sleep.
Some studies show that debriefing people very soon after a catastrophic event may reduce some of the symptoms of PTSD. A study of 12,000 school children who lived through a hurricane in Hawaii found that those who got counseling early on did much better 2 years later than those who did not receive counseling.
Do Other Illnesses Tend to Accompany PTSD?
Co-occurring depression, alcohol or other substance abuse, or another anxiety disorder are not uncommon. The likelihood of treatment success is increased when these other conditions are appropriately diagnosed and treated as well.
Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, or discomfort in other parts of the body are common. Often, doctors treat the symptoms without being aware that they stem from PTSD.
Who Is Most Likely to Develop PTSD?
People who have been abused as children or who have had other previous traumatic experiences are most likely to develop the disorder. Research is continuing to pinpoint other factors that may lead to PTSD.
It used to be believed that people who tend to be emotionally numb after a trauma were showing a healthy response, but now some researchers suspect that people who experience this emotional distancing may be more prone to PTSD.
For More Information
Mental Health: A Report of the Surgeon General can be viewed at www.surgeongeneral.gov
The Anxiety Disorders Education Program,
National Institute of Mental Health,
6001 Executive Blvd., Room 8184,
MSC 9663,
Bethesda, MD 20892-9663
Phone: 301-443-4513.
Toll-free:
1-88-88-ANXIETY (1-888-826-9438)
TTY: 301-443-8431
NIMH Anxiety Disorders web site:
www.nimh.nih.gov/anxiety/anxietymenu.cfm
This site is also hotlinked to the web site for the National Center for
Post-Traumatic Stress Disorder of the Department of Veterans Affairs at
www.ncptsd.org
Substance Abuse and Mental Health Services
Administration
Center for Mental Health Services
Office of External
Liaison
Room 15C-05, Parklawn Building
5600 Fishers Lane
Rockville,
MD 20857
Phone: 301-443-2792
FAX: 301-443-5163
SAMHSA home page
address: www.samhsa.gov
CMHS Knowledge Exchange Network (KEN)
P.O.
Box 42490
Washington, DC 20015
Phone: 1-800-789-2647
FAX:
301-984-8796
KEN home page address: www.mentalhealth.org
U.S. Department of Health and Human Services
Mental Health: The Cornerstone of Health
Home page address:
www.mentalhealth.org/cornerstone
What is Alzheimer's Disease?
Alzheimer's disease (AD) is the most common cause of dementia in older people. A dementia is a medical condition that causes loss of memory or intelligence. Every day, scientists learn more about AD, but right now the cause of the disease still is unknown, and there is no cure. An estimated 8 to 15 percent of people over age 65 suffer from AD. The disease usually begins after age 65, and the risk of developing AD goes up with age. However, AD is not a normal part of aging.
What Are the Symptoms of AD?
AD begins slowly. At first, the only symptom may be mild forgetfulness. People with AD may have trouble remembering recent events, activities, or the names of familiar people or things. Simple math problems may become hard for these people to solve. Such difficulties may be a bother, but usually they are not serious enough to cause alarm.
However, as the disease goes on, symptoms are more easily noticed and become serious enough to cause people with AD or their family members to seek medical help. For example, people with AD may forget how to do simple tasks, like brushing their teeth or combing their hair. They can no longer think clearly; and they begin to have problems speaking, understanding, reading, or writing. Later on, people with AD may become anxious or aggressive, or wander away from home. Eventually, patients may need total care. The course the disease takes and how fast changes occur vary from person to person. Some people only have the disease for 5 years, while others may have it for as many as 20 years.
How is AD Diagnosed?
Doctors may say that a person has "probable" AD. They will make this diagnosis by finding out more about the person's symptoms. A doctor may require a complete medical history, some basic medical tests, neuropsychological tests, or brain scans. Doctors at specialized centers can diagnose probable AD correctly 80 to 90 percent of the time. However, diagnosis cannot be confirmed until a doctor examines a person's brain tissue under a microscope. This tissue is obtained by autopsy after the person dies.
What Treatments Are Available for AD?
Currently, no treatment can stop AD. However, for some people in the early and middle stages of the disease, medications including tacrine, donepezil, and velnacrine may alleviate some cognitive symptoms. Also, some medicines may help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers.
People with AD should go to their doctor regularly. The doctor will evaluate the progression of the disease and treat any other illnesses that occur. The physician and other health professionals also can offer help and support to patients and their families. Most often, spouses or other family members provide the day-today care for people with AD. As the disease gets worse, people often need more and more care. This can be hard for caregivers and can affect their physical and mental health, family life, jobs, and finances.
Scientists at research centers across the country are trying to learn what causes AD and how to prevent it. They also are studying how memory loss happens. They are looking for better ways to diagnose and treat AD, to improve the abilities of people with the disease, and to support caregivers.
The major risk factors for AD are age and family history. Other possible risk factors include a serious head injury and lower levels of education. Scientists also are studying additional factors that may cause the disease, such as genetic factors, environmental factors, and viruses.
For More Information
Mental Health: A Report of the Surgeon General can be viewed at www.surgeongeneral.gov
The National Institute on Aging is the Federal Government's lead agency for AD research and funds Alzheimer's Disease Centers located throughout the United States. The centers carry out a wide range of research, including studies on the causes, diagnosis, treatment, and management of AD. To obtain a list of the centers, contact the following:
Alzheimer's Disease Education and Referral
(ADEAR) Center
P.O. Box 8250
Silver Spring, MD 20907-8250
Phone:
1-800-438-4380
E-Mail: adear@alzheimers.org
ADEAR home page address:
www.alzheimers.org
Further information is also available from the following:
Administration on Aging
330 Independence
Avenue, SW
Washington, DC 20201
Phone: 202-619-7501
AoA home page
address: www.aoa.gov
National Institute of Mental Health
Office
of Communications and Public Liaison
Information Resources and Inquiries
Branch
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD
20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
FAX: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail:
nimhinfo@nih.gov
NIMH home page
address: www.nimh.nih.gov
National Institute of Neurological Disorders
and Stroke
Office of Communications and Public Liaison
P.O. Box 5801
Bethesda, MD 20824
NINDS home page address:
www.ninds.nih.gov
CMHS Knowledge Exchange Network (KEN)
P.O.
Box 42490
Washington, DC 20015
Phone: 1-800-789-2647
FAX:
301-984-8796
KEN home page address: www.mentalhealth.org
U.S. Department of Health and Human Services
Mental Health: The Cornerstone of Health
Home page address:
www.mentalhealth.org/cornerstone
Attention Deficit Hyperactivity Disorder
What Is Attention Deficit Hyperactivity Disorder?
Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed psychiatric disorder of childhood, estimated to affect 3 to 5 percent of school-aged children. Two to three times as many boys as girls are affected by ADHD. Research shows that ADHD tends to run in families.
The core symptoms of ADHD include developmentally inappropriate levels of attention, concentration, activity, distractibility, and impulsivity. Children with ADHD usually have impaired functioning in peer relationships and multiple settings including home and school. ADHD has also been shown to have long-term adverse effects on academic performance, vocational success, and social-emotional development.
What Treatments Are Available for ADHD?
Psychostimulant medications, including methylphenidate, amphetamine, and pemoline, are by far the most widely researched and commonly prescribed treatments for ADHD. Numerous short term studies have established the safety and efficacy of stimulants and psychosocial treatments for alleviating the symptoms of ADHD.
A multisite study of children with ADHD recently concluded that the two most effective treatment modalities for elementary school children with ADHD are a closely monitored medication treatment and a treatment that combines medication with intensive behavioral therapy. The combination of medication and behavioral therapy was necessary to produce improvements in some outcomes such as academic performance and family relations.
Another study has shown that boys with ADHD who are treated with stimulants are significantly less likely to abuse drugs and alcohol when they get older. In previous studies, these same researchers found that nearly twice as many adults with ADHD (that was generally not diagnosed or treated until much later in life) also abused drugs and/or alcohol at some point in their lives, compared to adults without ADHD. More studies are needed to examine the long-term use of stimulant medications in children and adolescents.
Problems Faced by Families
ADHD can be reliably diagnosed when appropriate guidelines are used. Ideally, a health care practitioner making a diagnosis should include input from parents and teachers. But some health practitioners make a diagnosis without all this information and tend to either overdiagnose the disorder or underdiagnose it. Despite data showing that stimulant medication is safe, there are widespread misunderstandings about the safety and use of these drugs, and some health care practitioners are reluctant to prescribe them. Like all drugs, the medications used to treat ADHD do have side effects and need to be closely monitored.
Parents need to carefully evaluate treatment choices when their child receives a diagnosis of ADHD. When they pursue treatment for their children, families face high out-of-pocket expenses because treatment of ADHD and other mental illnesses is often not covered by insurance policies. In schools, treatment plans are often poorly integrated. In addition, there are few special education funds directed specifically for ADHD. All this leads to children who do not receive proper and adequate treatment. To overcome these barriers, parents may want to look for school-based programs that have a team approach involving parents, teachers, school psychologists, other mental health specialists, and physicians.
A two-day consensus conference on ADHD, held at the National Institutes of Health in November 1998, brought together national and international ADHD experts as well as representatives from the public.
For More Information
Mental Health: A Report of the Surgeon General can be viewed at www.surgeongeneral.gov
National Institute of Mental Health
Office
of Communications and Public Liaison
Information Resources and Inquiries
Branch
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD
20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
FAX: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail:
nimhinfo@nih.gov
NIMH home page
address: www.nimh.nih.gov
Substance Abuse and Mental Health Services
Administration
Center for Mental Health Services
Office of External
Liaison
Room 15C-05, Parklawn Building
5600 Fishers Lane
Rockville,
MD 20857
Phone: 301-443-2792
FAX: 301-443-5163
SAMHSA home page
address: www.samhsa.gov
CMHS Knowledge Exchange Network (KEN)
P.O.
Box 42490
Washington, DC 20015
Phone: 1-800-789-2647
FAX:
301-984-8796
KEN home page address: www.mentalhealth.org
U.S. Department of Health and Human Services
Mental Health: The Cornerstone of Health
Home page address:
www.mentalhealth.org/cornerstone
What Is Autism?
Autism, a brain disorder that affects 1 to 2 in 1,000 Americans with its onset in early childhood, too often results in a lifetime of impaired thinking, feeling and social functioning - our most uniquely human attributes. Autism typically affects a person's ability to communicate, form relationships with others, and respond appropriately to the world around them.
What Are the Symptoms of Autism?
Some people with autism are relatively high-functioning, with speech and intelligence intact, but others are mentally retarded, mute, or have serious language delays. For some, autism makes them seem closed off and shut down; others appear locked into repetitive behaviors and rigid patterns of thinking. An infant with autism may avoid eye contact, seem deaf, and abruptly stop developing language. The child may act as if unaware of the coming and going of others, or physically attack and injure others without provocation. Affected infants often remain fixated on a single item or activity, rock or flap their hands, sniff or lick toys, seem impervious to burns and bruises, and may even mutilate themselves. In addition to cognitive impairments, individuals with autism often suffer from multiple psychopathologies, including impulse-control disorders, psychoses, obsessive compulsive disorder, mood and anxiety disorders, and mental retardation.
Autism tends to run in families. in addition, research suggests that unaffected family members sometimes share with their ill relatives milder cognitive and behavioral characteristics similar to those of autism. However, specific genes for autism have not yet been identified.
What Treatments Are Available for Autism?
Both psychosocial and pharmacological interventions can improve the behavioral and cognitive functioning of individuals with autism. Ongoing studies are evaluating drug treatments for autism. These studies are examining dose range and regimen of medications, and their mechanisms of action, safety, efficacy, and effects on cognition, behavior, and development. Among psychosocial treatments for autism, parent training interventions that are tailored to the particular characteristics of the child and family are being studied.
Research has made it possible to identify earlier those children who show signs of developing autism and thus initiate early intervention. Both psychosocial and pharmacological interventions can improve the behavioral and cognitive functioning of individuals with autism.
For More Information
Mental Health: A Report of the Surgeon General can be viewed at www.surgeongeneral.gov
National Institute of Mental Health
Office
of Communications and Public Liaison
Information Resources and Inquiries
Branch
6001 Executive Blvd., Room 8184, MSC 9663
Bethesda, MD
20892-9663
Phone: 301-443-4513
TTY: 301-443-8431
FAX: 301-443-4279
Mental Health FAX 4U: 301-443-5158
E-mail:
nimhinfo@nih.gov
NIMH home page
address: www.nimh.nih.gov
Substance Abuse and Mental Health Services
Administration
Center for Mental Health Services
Office of External
Liaison
Room 15C-05, Parklawn Building
5600 Fishers Lane
Rockville,
MD 20857
Phone: 301-443-2792
FAX: 301-443-5163
SAMHSA home page
address: www.samhsa.gov
CMHS Knowledge Exchange Network (KEN)
P.O.
Box 42490
Washington, DC 20015
Phone: 1-800-789-2647
FAX:
301-984-8796
KEN home page address: www.mentalhealth.org
U.S. Department of Health and Human Services
Mental Health: The Cornerstone of Health
Home page address:
www.mentalhealth.org/cornerstone
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