Depression

Depression is one of the two most common psychiatric disorders , in equal first place with anxiety.

People talk about ‘clinical depression’. This is simply a reflection of the level of severity of symptoms or personal suffering. There is confusion for some, in that we all have our sad moments in life, and most of us (thankfully) are not depressed, most of the time. The difference in clinical or major depression is that there is a persistent lowness of mood or unhappiness over weeks, accompanied by an inability to experience the usual joy in things such as pastimes, relationships, food or work. Even the little things can become a struggle, and then sleep and energy begin to deteriorate, and negative thoughts begin to dominate the landscape.

Inevitably this changes a person’s perspective, and it becomes harder and harder to ’see the lighter side of life’. Thankfully there are many effective ways of attacking depression - medicines, talking therapies, neurostimulation, lifestyle and environmental alterations. Of course, safety is of paramount importance to us all, and this can be very frightening for the depressed person, their family and carers. As ever, the earlier the intervention the better. Then as the depression lifts, and the person moves into recovery, there can be a transition in focus to relapse prevention and personal development.  

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is the umbrella term for all the Attentional Disorders. This is can be confusing for people, as ADHD can present in a number of ways that seem, on the surface, to be quite different. For instance, many younger people will have prominent hyperactivity, meaning that they are intensely restless and unable to ‘sit still’. This may be so prominent that their underlying inattention and distractibility are less easy to spot, and they seem to be impulsive and unreliable, and may even be disruptive to others as well as themselves, getting themselves into trouble and tending to fail at school.

In contrast, many people with inattention appear, if anything, to be rather under-animated and lacking in drive and motivation. This group may be suffering from the ‘inattentive and disorganised’ version of ADHD, commonly referred to as Attention Dysfunction Disorder, or ADD.

Either way, ADHD/ ADD can be hugely disruptive to the individual and those around them. Problems often start in school, but can continue into early adult and even persist into late adult life.

At its heart, ADHD (or ADD) is considered to be a highly treatable ‘neuro-developmental’ disorder. Put simply, the problem seems to be that the brain is struggling in certain areas to communicate as efficiently as it should.

People suffering with ADHD (ADD) are frequently pretty clever, but seem unable to translate their intelligence into achieving as they should, because the internal brain communication system seems overwhelmed. This leads to being easy distracted, and delaying or procrastinating in task completion.

Over time, the person becomes increasingly frustrated and may even become depressed, which can lead to more problems – moodiness, anger problems, anxiety and substance abuse to try to self-medicate.

The good news is that, as mentioned above, once properly diagnosed, this condition usually responds really well to treatment – whether this is medication, ADHD/ ADD coaching, or preferably a combination of such remedies. Some people may also respond in part to dietary change, and there are other novel approaches that are currently being researched. 

Others may also have other (coexisting) conditions. For example, many people report suffering high levels of anxiety and at times real difficulties in regulating their mood: “mood dysregulation.” These Coexisting conditions need to be addressed at the same time, to allow the person to move forward constructively in their lives.

Bipolar Disorder

Bipolar disorder (previously known as Manic-depressive disorder) has been recognized since the time of Ancient Greeks. Hippocrates described the conditions of melancholia and mania.

However, it has only been over the past 20-30 years that this condition of disturbed mood and activity has been appreciated and recognized. There can be good outcomes with complete recovery particularly if the illness is recognized and treated early. Sadly, this has not always been the case.

The lifetime incidence of bipolar disorder ranges from about 1 to 3.5% of the population. Although there is a strong genetic basis to this illness and the need to consider medication as an important tool for recovery, the experts in the area emphasise that patient self-management is fundamental.

The individual and the participant in the recovery must become their own expert in their bipolar illness as they work with their clinician and support team. The individual narrative is important to any clinician in understanding the context and meaning of the bipolar disorder.

Bipolar disorder can be a very serious condition. It can drive the sufferer to a level of despair that endangers their own survival. It is hoped that those who are suffering can seek the tools and advice early from clinicians with the experience to recognize bipolar in its many forms. The bipolar does not have to dominate one’s life.

Borderline Personality Disorder

Borderline Personality disorder is a term widely used in the Mental Health arena and has come to mean different things to different people. In Western Australia, many clinicians use the term 'emotionally unstable personality disorder', which more or less refers to the same disorder.

However, for those who have this condition, it is important that it is accurately diagnosed so that it can serve as a relief and an explanation for the person who has it. It can help them come to some understanding of what has happened in their life to date.

The correct diagnosis will also lead to much better management and treatment to reduce any regrettable consequences.

What does it mean?

Borderline personality disorder is a potentially life-long disorder that starts in the adolescent and emerging adulthood years. At the core, there are three essential features that define or drive this disorder which have marked effects on the way we feel, and on our relationships and friendships:

• There is a marked inability to regulate emotions and anger flare-ups or ‘meltdowns’ can be common and way out of keeping with the situation. This is called 'emotional dysregulation' and some clinicians use the term anger dyscontrol to describe the temper flare-ups. Regrettably, others can get hurt when the sufferer acts intensely without thinking of the consequences. For many, friendships eventually break down and they find that others avoid or 'drift away' from them.
• It is said that those suffering with borderline personality have an unstable sense of who they are; or 'identity disturbance.’ They are always seeking validation and things in the world that they can connect to fill out or complete their sense of self and sometimes the person may become too involved with others’ lives or situations.
• Finally, and possibly related to this identity disturbance, is the deeply felt chronic sense of emptiness and boredom. This is frequently associated with a heightened sensitivity to being rejected and abandoned. Some writers have noted that the greatest fear that the patient with the borderline personality structure has is not the fear of death, dying or ill health but being of being abandoned and alone. This can help to explain why they would rather stick with ’the devil they know’ – such as damaging relationships or substance abuse, rather than being inclinated to seek another, better, more stable way of living.

How do you treat?

There is optimism that there are now better treatments once the diagnosis has been made. Of course, engagement in treatment is essential, and only the person suffering can make the decision to improve their situation. Engagement can be a short or a long term process, but it is worth putting in the effort, because there are now several effective and evidence-based ‘psychosocial’ treatments available, such as dialectical behaviour therapy (DBT) and Schema-focused therapy. As yet, no single treatment is considered the best.

What is important is that the therapist is validating, reliable and responsive to the needs of the person. Therapy encourages the person to enhance their self-control and to eventually connect safely their own feelings to events and their actions.

Currently medication is not considered first-line as a treatment for Borderline conditions, but it certainly can be helpful, if used carefully and only where needed. At the end of the day however, drug treatment has not been shown to change the course of the disorder over the long-term.

The good news is that most people do improve over time and can go on to lead fulfilling lives.

Complex Trauma

Complex Trauma describes history of early life exposure to multiple traumatic events often of an invasive, interpersonal nature and the wide-ranging, long-term effects of this exposure. These events are usually severe and pervasive, such as abuse or profound neglect.

They usually occur early in life and act to disrupt many aspects of the child’s development and the formation of a sense of self and identity.

Defence and Emergency Services

Defence Members and First responders experience daily stress and trauma, which can increase the chance of developing mental health problems. Even with their specialty training, constant exposure to distressing events, injuries and violence can all take its toll.

While they bear the immense responsibility of saving lives, at times our First Responders and Defence Members may unfortunately arrive too late. Besides law enforcement, other first responders include paramedics and firefighters, defence members, combat veterans, corrections officers, ‘000’ despatchers and other volunteer rescue workers.

Often, the images and situations they encounter during their day-to-day jobs can lead to an array of trauma related problems including post-traumatic stress disorder (PTSD), acute stress disorder and other co-occurring disorders.

Do traumatic events always impact negatively on people?

Certainly, traumatic events, by their very nature, can change people permanently - but quite often these changes are positive, causing people to re-assess their lives, their relationships and their beliefs in valuable and meaningful ways. People can gain insight into their character and their ability to cope and to utilise their support resources.

How often does it occur?

Unfortunately, being exposed to a traumatic event is not an uncommon experience, and not solely the province of the military. Surveys in Australia and overseas suggest that 50-65 per cent of people in the civilian community report at least one traumatic event in their lives.

This figure is obviously much higher for emergency services personnel such as police, fire fighters, ambulance officers and paramedics. The current data suggest that less that two per cent of Australian soldiers have developed PTSD following operational deployments, though figures from the US military indicate higher rates of up to 10 per cent.

Does everyone develop PTSD after a traumatic event?

It is normal for most people to experience some form of distress after highly traumatic events. This may be a variety of emotions including fear, guilt, shame, helplessness or anger. The good news is that most will return to normal functioning after a short period of time, from a few days to several weeks, without intervention.

However, even these people will still have recurrent memories of the event and some sadness or other emotions associated with these memories.

Symptoms of PTSD

PTSD symptoms include recurring nightmares, flashbacks, and intrusive, upsetting memories, stemming from their experiences while overseas. According to the U.S. Department of Veteran Affairs, veterans who have been affected by PTSD include 31% of those who served in Vietnam, 10% of the military that served in Desert Storm, 20% of Iraqi war veterans, and 11% of veterans from the war in Afghanistan.

Once afflicted with PTSD, war veterans are privy to depression, anxiety, and suicidal ideations. Reliving a horrifying memory can cause panic attacks and intense depression. According to a 2015 Vanity Fair article on PTSD and the military, many soldiers reported that seeing other people die, including the enemy is one of the more traumatic events that they have ever experienced in their lives.

One consequence of outliving an incident, while others die, is survivor guilt. This is a feeling that other first responders are vulnerable to experiencing, especially if they were not able to save those whose lives were in danger, or if they are confronted with a homicide that occurred after being alerted about imminent danger to life.

Treatment for First Responders

Importantly, PTSD is a highly treatable condition.  Helping First Responders and Defence Members requires evidence-based treatment for their ongoing difficulties and co-occurring disorders. Additionally, peer support is crucial in healing feelings of loneliness and despair. It’s important for licensed professionals who work with first responders to have the experience and compassion that is required.

At Salvado we remain very sensitive to the needs of the brave men and women who risk their lives on a daily basis in order to be of service to civilians in danger.

Our clinical team will provide you with an individualized treatment plan that will help you recover from the potential harms of mental health issues such as PTSD, psychological trauma and stress.

Therapy Methods for PTSD Treatment

We will work with you to build an effective package of care that is optimised to your individual needs, from the wide range of evidence-based options available through Salvado. These include Cognitive Behavioural Therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR), problem-focused and goal directed therapy with behavioural modification counselling, as well as Dialectical Behaviour Therapy (DBT) and Motivational Interviewing,

Learning relaxation techniques can also help first responders to control their stress levels, including the onset of panic. We offer access to meditation and yoga to help you to become grounded again, alleviate stress and re-experience feeling inner peace.

Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder, otherwise known as PTSD, is a severe and persistent mental health impairment that can occur following exposure to a single or to multiple traumatic events. These critical incidents typically involve exposure to a life-threat, either directly or as a witness and induce a response of intense fear and helplessness.

Full-blown PTSD typically has four clusters of symptoms.

• There are the re-experiencing symptoms such as terrifying flashbacks related to the event, even nightmares about the event.
• One will develop avoidance particularly to reminders of the trauma.
• The suffers can often develop negative cognitions and mood changes associated with the traumatic event; it is not uncommon to become depressed and highly anxious.
• There are arousal symptoms which reflect heightened sympathetic neural activation to stress: one can become very jumpy and easily startled by seemingly minor triggers. The sufferer can become prickly and easily irritated.

This not healthy for their relationships and friendships.

Schizophrenia and other Psychoses

The words Schizophrenia and Psychosis can be quite intimidating to hear, especially when a mental health professional says them. Occasionally, these words are swapped in general conversation with words like psychopath and split-personality, leading to further intimidation, confusion and even fear.

What clinicians are trying to describe with these diagnostic labels is a cluster of recognised 'symptoms' that some people experience, such as hallucinations and delusions, which seem to lead to a reduction in the affected person's ability to function in everyday life. It is this reduction in ability to function, such as misapprehending threat levels, or being unable to care for oneself, that leads people or those around them to seek help.

Hallucinations are commonly voices, or images, and occasionally other sensations, that the affected person experiences as if they were real, whilst others around them do not have these experiences. Delusions are rather fixed and often somewhat incredible beliefs that the person affected develops. Commonly these are persecutory in nature, and so are described as paranoid. If a person experiences voices (often derogatory and unpleasant) and has fearful beliefs that are very fixed, it is not surprising that they will often become distracted, leading them to stand out as 'not being there'., preoccupied or 'odd'.

Being psychotic disconnects a person from those around them, which may lead to a sense of isolation and fear, sometimes resulting in great anxiety and depression. It is actually unusual for psychosis to lead to aggression or violence, but when this does happen it tends to attract a lot of attention, leading to the common misapprehension that people suffering with psychosis are violent. In fact, people who are psychotic are simply disconnected socially, and may become very preoccupied with their symptoms (which seem completely real to them).

Gaining trust and developing a care plan that offers social support as part of  'treatment' is at the centre of trying to help people with psychosis. Helping carers and other supporters to better understand and continue to assist is another vital aspect of care. Medication in the form of antipsychotic, anxiety and antidepressant medications can also be very helpful in counteracting hallucinations, delusions and other psychotic symptoms.

Substance Addiction

Addiction is from the Latin word addictus which means enslaved.

For those suffering from a substance addiction problem, being it alcohol, substance, gambling, internet or sex, there is the experience of overwhelming loss of self-control. The addiction manifests as an almost irresistible compulsion to seek and take the craved-for ‘substance'. There is a struggle to contain and control this drive to 'seek and gorge’, the thinking and behaviour dominates everything, despite obvious harmfulness.

Ultimately, this loss of self-control can lead to immense suffering and the fragmentation of the ties that bind one to family, friends and mainstream society.

The young of our world (aged 10-24), who represent more than a quarter of the global population, are particularly at risk. Substance misuse is now one of the major causes of global disability, especially when it comes to the misuse of alcohol in males.

Treatment and management of substance addiction is a major challenge today and for tomorrow. Addiction is more than a choice for those in its grip. These substances exert an effect on the brain and its circuitry, by biological and psychological mechanisms that are only now becoming (partly) understood.

There are also differences in individual or family susceptibility to addiction. This is coded in our genes. Of course genes that have been switched on can also be switched off. Ultimately, this is how treatments and individual changes in behaviour such as abstinence and controlled use work.  

An important fact that drives eventual outcomes is that most cases of addiction do not usually develop immediately and the earlier the intervention the better the chance of avoiding an illness that can become destructive and unrelenting. Prevention is often better than cure, but it is never too late to find your personal recovery.