Archives: Consumer Topics

Women and Drinking

Exercise, diet, hormones, and stress: keeping up with all the health issues facing women is a challenge.Alcohol presents yet another health challenge for women. Even in small amounts, alcohol affects women differently than men. In some ways, heavy drinking is much more risky for women than it is for men.With any health issue, accurate information is key. There are times and ways to drink that are safer than others. Every woman is different. No amount of drinking is 100 percent safe, 100 percent of the time, for every woman. With this in mind, it's important to know how alcohol can affect a woman's health and safety.

How Much Is Too Much?

Sixty percent of U.S. women have at least one drink a year. Among women who drink, 13 percent have more than seven drinks per week.

For women, this level of drinking is above the recommended limits published in the Dietary Guidelines for Americans, which are issued jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services.

The Dietary Guidelines define moderate drinking as no more than one drink a day for women and no more than two drinks a day for men.

The Dietary Guidelines point out that drinking more than one drink per day for women can increase the risk for motor vehicle crashes, other injuries, high blood pressure, stroke, violence, suicide, and certain types of cancer.

Some people should not drink at all, including:

• Anyone under age 21
• People of any age who are unable to restrict their drinking to moderate levels
• Women who may become pregnant or who are pregnant
• People who plan to drive, operate machinery, or take part in other activities that require attention, skill, or coordination
• People taking prescription or over-the-counter medications that can interact with alcohol.

Why are lower levels of drinking recommended for women than for men? Because women are at greater risk than men for developing alcohol-related problems. Alcohol passes through the digestive tract and is dispersed in the water in the body. The more water available, the more diluted the alcohol. As a rule, men weigh more than women, and, pound for pound, women have less water in their bodies than men. Therefore, a woman's brain and other organs are exposed to more alcohol and to more of the toxic byproducts that result when the body breaks down and eliminates alcohol.

What is a drink?

A standard drink is:

• One 12-ounce bottle of beer or wine cooler
• One 5-ounce glass of wine
• 1.5 ounces of 80-proof distilled spirits

Keep in mind that the alcohol content of different types of beer, wine, and distilled spirits can vary quite substantially.

Next Page

Source: NIH Publication No. 08-4956
Revised 2008

Page last modified or reviewed by athealth on January 29, 2014

Working with Older Patients: Talking About Sensitive Subjects

Many older people have a “don’t ask/don’t tell” relationship with doctors about health care problems, especially about sensitive subjects, such as urinary incontinence or sexuality. Hidden health problems, ranging from foot disorders to mental illness, are a challenge. Addressing problems related to safety and independence, such as giving up one’s driver’s license or moving to assisted living, can be difficult. This chapter gives an overview of techniques for broaching sensitive subjects.

Try to take a universal, non-threatening approach. Start by saying, “Many people your age experience…” or “Some people taking this medication have trouble with…” Try: “I have to ask you a lot of questions, some that might seem silly. Please don’t be offended…” Another approach is to tell anecdotes about patients in similar circumstances as a way to ease your patient into the discussion.

Some patients avoid issues that they think are inappropriate for a doctor. One way to overcome this is to keep informative brochures and materials readily available in the waiting room. Following each topic listed below is a sampling of resources. Although the lists are not exhaustive, they are a starting point for locating useful information and referrals.

Advance Care Directives

Advance care directives, popularly known as ‘living wills,’ honor individual end-of-life preferences and desires. You may feel uncomfortable raising the issue, fearing that patients will assume the end is near. But, in fact, this is a conversation that is best begun well before end-of-life care is appropriate. Let your patients know that advance care planning is a part of good health care. You can say that increasingly people realize the importance of making plans while they are still healthy. You can let them know that these plans can be revised and updated over time or as their health changes.

An advance care planning discussion can take about 5 minutes with a healthy patient:

• Talk about the steps your patient would want you to take in the event of certain conditions or eventualities.
• Discuss the meaning of a health care proxy and how to select one.
• Give the patient the materials to review, complete, and return at the next visit. In some cases, the patient may want help in completing the form.
• Put a copy of the completed form in the medical record. Too often, forms are completed, but when needed, they cannot be found. Many organizations now photocopy the forms on neon-colored paper which is easy to spot in the medical record.
• Provide your patient with a copy of the completed form to keep. If appropriate, share the plan with family members.
• Revise any advance directives based on the patient’s changing health and preferences.

If your patient is in the early stages of an illness, it’s especially important for you to assess whether the underlying process is reversible. It’s also a good time to discuss how the illness is likely to play out.

For more information on advance care directives, contact:

Aging With Dignity

National Hospice and Palliative Care Organization

Driving Safety

Recommending that a patient limit driving—or that a patient surrender his or her driver’s license—is one of the most difficult topics a doctor has to address. Because driving is associated with independence and identity, giving up the right to drive is a very difficult decision.

As with other difficult subjects, try to frame it as a common concern of older patients. Mention, for instance, that aging can lead to slowed reaction times and impaired vision. Ask the patient about any car accidents. You might ask if she or he has thought about alternative transportation methods if driving is no longer an option. When necessary, warn patients about medications that may make them sleepy or impair judgment.

For more information on talking to patients about safe driving, contact:

American Medical Association
Physician's Guide to Assessing and Counseling Older Drivers

Elder Abuse and Neglect

Be alert to the signs and symptoms of elder abuse. If you notice that a patient delays seeking treatment or offers improbable explanations for injuries, for example, you may want to bring up your concerns. The laws in most states require helping professionals to report suspected abuse or neglect.

Older people caught in an abusive situation are not likely to say what is happening to them for fear of reprisal or because of diminished cognitive abilities. If you suspect abuse, ask about it in a constructive, compassionate tone. If the patient lives with a family caregiver, you might start by saying that caregivers deal with lots of stress and may sometimes lose their temper. If this is the case for your patient or his or her family, you can assist by recommending a support group or alternative arrangements (such as respite care). Give the patient opportunities to bring up this concern and if necessary, raise the issue yourself.

End-of-Life Care

Caring for patients at the end of life goes hand-in-hand with caring for older patients. For all patients, regardless of age or health, the real goal is to live well despite illness. Most older people have thought about the prospect of their own death and want to discuss their wishes regarding end-of-life care. You can help ease some of the discomfort simply by being willing to talk about dying and by being open to discussions about these important issues and concerns.

Of course, it is not always easy to determine who is close to death; even experienced clinicians find that prognostication can be difficult. Although you may have already talked with your patient about advance directives and other end-of-life concerns, still, it can be hard to know when is the right time to re-introduce this issue. Some clinicians find it helpful to ask themselves, “Would I be surprised if Mr. Flowers were to die this year?” If the answer is ‘no,’ then it makes sense to start working with the patient and family to address end-of-life concerns, pain and symptom management, home health, and hospice care. You can offer to help patients to review their advance directives. Include these updates in your medical records to ensure that patients receive the type of care they want.

Financial Barriers

Rising health care costs, especially for prescription drugs, make it difficult for some people to follow treatment regimens. Your patients may be too embarrassed to mention their financial constraints. It may be that simply putting the topic on the table is all the encouragement a patient needs. Doctors may feel awkward addressing this concern because they don’t know how to help their patients solve the problem.

Your State Health Insurance Assistance Program (SHIP) may be helpful. If you have online access, check with the Medicare Rights Center which has a database of state and national medication assistance (Medicaid) programs.

Long-Term Care

As you may know, long-term care is more than nursing home care. It includes many sources of care: informal caregiving, assisted living, home health services, adult day care, nursing homes, and community-based programs.

Early in your relationship with an older patient you can begin to talk about the possibility that he or she may eventually require long-term care of some kind. By raising this topic, you are helping your patient think about what they might need in the future and how to plan for those needs.

Mental Health

Despite many public campaigns to educate people about mental health and illness, there is still a stigma about mental illness. Older adults, who grew up with different ideas about mental health, may feel this stigma even more keenly and find mental health difficult to discuss.

Such conversations, however, can be lifesavers. Primary care doctors have a key opportunity to recognize when a patient is depressed and/or suicidal: In fact, 70 percent of older patients who commit suicide have seen a primary care physician within the previous month. This makes it especially important for you to be alert to the signs and symptoms of depression.

As with other subjects, try a general approach to bringing up mental health concerns. For instance, mention that many patients taking medications experience depression as a side effect and that the depression can be treated. Because older adults may have atypical symptoms, it is important to listen closely to what your patient has to say about trouble sleeping, lack of energy, and general aches and pains. It is easy to dismiss these as “just aging,” and leave depression undiagnosed and therefore untreated.

Another issue to consider is substance abuse, a major public health problem, even for older adults. Because “Baby Boomers” have a higher rate of lifetime alcohol and drug use than did their parents, the number of people in this age group needing treatment is likely to grow. One approach you might try is to mention that some medical conditions can become more complicated as a result of alcohol and other drug use. Another point to make is that alcohol and other drugs can increase the side effects of medication, or even reduce their effectiveness. From this starting point, you may find it easier to talk about alcohol or other drug use.

Sexuality

An understanding, accepting attitude and a sensitivity to verbal and other cues help promote a more comfortable discussion of sexuality. Depending on indications earlier in the interview, you may decide to approach the subject directly (for example, “Are you satisfied with your sex life?”) or more obliquely with allusions to changes that sometimes occur in marriage. If appropriate, you can follow up on patient cues. You might note that patients sometimes have concerns about their sex life and then wait for a response. Also effective are sharing anecdotes about a person in a similar situation or raising the issue in the context of physical findings (for example, “Some people taking this medication have trouble ... Have you experienced anything like that?”). Don’t assume that an older patient is no longer sexually active, does not care about sex, or necessarily is heterosexual. And, don’t forget to talk to your patient about the importance of safe sex.

Spirituality

For some older people, spirituality takes on new meaning as they age or face serious illness. By asking patients about their religious and spiritual practices, you can learn something about their health care choices and preferences. How a patient views the afterlife can sometimes help in framing the conversation.

For example, some patients with deeply held religious beliefs may believe in miracles, and this expectation may prevent them from making treatment decisions. For patients who report suffering and distress about illness or end-of-life, a referral to a hospital or nursing home chaplain may be helpful.

Clinicians have found that very direct and simple questions are the best way to broach this subject. You might start, for instance, by asking, “What experiences are most important for you to be able to live well at this time in your life?” Follow-up questions might include, “What are your fears or worries about your illness?” and “You’ve lived a long life. How have you dealt with challenges in the past?”

Source: Adapted from Working with Your Older Patient: Chapter 5
National Institue on Aging
NIH Publication Number: 04-7187
August 2004
Page last modified/reviewed on January 24, 2014

What is a disorder of written expression?

Students with written expression disorder have a problem with their writing skills. Their writing skills are significantly below what is normal considering the student's age, intelligence, and education. The poor writing skills cause problems with the student's academic success or other important areas of life.

What signs are associated with a disorder of written expression?

Signs associated with a disorder of written expression include:

• Written sentences and paragraphs that are inadequately formed
• Excessive spelling errors
• Excessive punctuation errors
• Excessive grammatical errors
• Extremely poor handwriting

Students who suffer from a disorder of written expression frequently have:

• Low self-esteem
• Social problems
• Increased dropout rate at school

Disorder of written expression may also be associated with:

• Conduct disorder
• ADD and ADHD
• Depression
• Other learning disorders

Does this disorder affect both males and females?

Boys are found to have the disorder much more frequently than girls.

At what age does a disorder of written expression appear?

The disorder of written expression is usually brought to the attention of the child's parents in the fourth or fifth grade when writing skills become a very important part of the classroom experience. Because of a child's immature motor skills, the diagnosis of written expression disorder is usually not made before the child is at least eight (8) years old.

How often is the disorder of written expression seen in our society?

About five percent (5%) of students in the United States are thought to have written expression disorder.

How is written expression disorder diagnosed?

The students written work contains errors including:

• spelling
• grammatics
• punctuation
• sentence and paragraph organization

They also have very poor handwriting including:

• letters of the alphabet that are reversed
• letters of the alphabet that are rotated
• letters of the alphabet that are unrecognizable
• random mixture of cursive and printed letters

Because standardized group testing is not accurate enough to diagnose this disorder, it is very important that special psychoeducational tests be individually administered to the child to determine if a learning disorder is present. Special attention must be given to the child's ethnic and cultural background by the student's examiner.

How is a disorder of written expression treated?

Although educators attempt to intervene, there is no proven effective treatment for the disorder of written expression. Emphasis on the remedial teaching of writing and a heavy emphasis on student practice of writing may be helpful.

What happens to someone with a disorder of written expression?

With or without treatment, the disorder of written expression will gradually improve. However, even when good help is available, the student tends to have chronic problems with writing skills.

What can people do if they need help?

If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person.

Developed by John L. Miller, MD
Page last modified or reviewed on January 24, 2014

One in ten of America's children has an emotional disturbance such as attention deficit hyperactivity disorder, depression or anxiety, that can cause unhappiness for the child and problems at home, at play, and at school. Many of these children will be taken by their parents to their family physician or pediatrician, or, in many cases, a specialist in child mental health. The child will be carefully evaluated and may begin some type of therapy. There are many treatment options available. Choosing the right treatment for your child is very important. Each child is different. At times, psychotherapies, behavioral strategies, and family support may be very effective. In some cases, medications are needed to help the child become more able to cope with everyday activities.

If you are planning to have a doctor see your child, you should share a record of any of your child's medical problems, any medications your child is taking, including over-the-counter medications or vitamin and herbal supplements, and any allergic reactions your child has suffered. If a medication is prescribed for your child, there are certain questions you should ask. It will be helpful to take notes as it is easy to forget exactly what the doctor says.

• What is the name of the medication and how will it help my child? Is the medicine available in both brand-name and generic versions, and is it all right to use the less expensive (generic) medication? What is the name of the generic version? Is it all right to switch among brands, or between brand-name and generic forms?
• What is the proper dosage for my child? Is the dose likely to change as he or she grows?
• What if my child has a problem with the pill or capsule? Is it available in a chewable tablet or liquid form?
• How many times a day must the medicine be given? Should it be taken with meals, or on an empty stomach? Should the school give the medication during the day?
• How long must my child take this medication? If it is discontinued, should it be done all at once or slowly?
• Will my child be monitored while on this medication and, if so, by whom?
• Should my child have any laboratory tests before taking this medication? Will it be necessary to have blood levels checked or have other laboratory tests during the time my child is taking this medication?
• Should my child avoid certain foods, other medications, or activities while using this medication?
• Are there possible side effects? If I notice a side effect - such as unusual sleepiness, agitation, fatigue, hand tremors - should I notify the doctor at once?
• What if my child misses a dose? Spits it up?
• How well established and accepted is the use of this medication in children or adolescents?

You may think of other questions. Don't be afraid to ask. When you have the prescription filled, be sure the pharmacist gives you a flyer describing the medication, how it should be taken, and any possible side effects it may have. The label on the medication will have lots of information. Read the label carefully before giving the medication to your child. The label will give the name of the pharmacy, its telephone number, the name of the medication, the dosage, and when it should be taken. It will also tell you how many times the medication can be refilled.

If you want to learn more about your child's medication, you will find helpful books at your public library, or the reference librarian can show you how to look up the medication in the Physicians' Desk Reference (PDR). While a great deal of information about mental disorders and their treatment in children is available on the Internet, care is required to distinguish fact from opinion.

What Does "Off-label" Mean?

Based on clinical experience and medication knowledge, a physician may prescribe to young children a medication that has been approved by the U.S. Food and Drug Administration (FDA) for use in adults or older children. This use of the medication is called "off-label." Most medications prescribed for child mental disorders, including many of the newer medications that are proving helpful, are prescribed off-label because only a few of them have been systematically studied for safety and efficacy in children. Medications that have not undergone such testing are dispensed with the statement that "safety and efficacy have not been established in pediatric patients." The FDA has been urging that products be appropriately studied in children and has offered incentives to drug manufacturers to carry out such testing. The National Institutes of Health and the FDA are examining the issue of medication research in children and are developing new research approaches.

Help Your Child Take Medication Safely

• Be sure the doctor knows all medications—including over-the-counter medications and herbal and vitamin supplements—that your child takes.
• Read the label before opening the bottle. Make sure you are giving the proper dosage. If the medication is liquid, use a special measure—a cup, a teaspoon, a medicine dropper, or a syringe. Often a measure comes with the medicine. If not, ask your pharmacist which measure is most suitable to use with the medication your child is taking.
• Always use child-resistant caps and store all medications in a safe place.
• Never decide to increase or decrease the dosage or stop the medication without consulting the doctor.
• Don't give medication prescribed for one child to another child, even if it appears to be the same problem.
• Keep a chart and mark it each time the child takes the medication. It is easy to forget.

Source: National Institute of Mental Health
Page last reviewed January 24, 2014

Contents:

Part 1. What is depression?
Part 2. What causes depression?
Part 3. Men and depression research
Part 4. Suicide
Part 5. Treatment
Part 6. Find Help
Part 7. References

Depression is a serious medical condition that affects the body, mood, and thoughts. It affects the way one eats and sleeps. It affects how one thinks about things, and one's self perception. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition one can will or wish away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. However, appropriate treatment, often involving medication and/or short term psychotherapy, can help most people who suffer from depression.

"I can remember it started with a loss of interest in basically everything that I like doing. I just didn't feel like doing anything. I just felt like giving up. Sometimes I didn't even want to get out of bed." -Rene Ruballo, Police Officer

Depression can strike anyone regardless of age, ethnic background, socioeconomic status, or gender; however, large scale research studies have found that depression is about twice as common in women as in men.^1,2 In the United States, researchers estimate that in any given one year period, depressive illnesses affect 12 percent of women (more than 12 million women) and nearly 7 percent of men (more than six million men).³ But important questions remain to be answered about the causes underlying this gender difference. We still do not know if depression is truly less common among men, or if men are just less likely than women to recognize, acknowledge, and seek help for depression.

In focus groups conducted by the National Institute of Mental Health (NIMH) to assess depression awareness, men described their own symptoms of depression without realizing that they were depressed. Notably, many were unaware that "physical" symptoms, such as headaches, digestive disorders, and chronic pain, can be associated with depression. In addition, men were concerned that seeing a mental health professional or going to a mental health clinic would have a negative impact at work if their employer or colleagues found out. They feared that being labeled with a diagnosis of mental illness would cost them the respect of their family and friends, or their standing in the community.

Over the past 20 years, biomedical research, including genetics and neuroimaging, has helped to shed light on depression and other mental disorders - increasing our understanding of the brain, how its biochemistry can go awry, and how to alleviate the suffering caused by mental illness. Brain imaging technologies are now allowing scientists to see how effective treatment with medication or psychotherapy is reflected in changes in brain activity.⁴ As research continues to reveal that depressive disorders are real and treatable, and no greater a sign of weakness than cancer or any other serious illness, more and more men with depression may feel empowered to seek treatment and find improved quality of life.

Types of Depression

Just like other illnesses, such as heart disease, depression comes in different forms. This booklet briefly describes three of the most common types of depressive disorders. However, within these types, there are variations in the number of symptoms, their severity, and persistence.

Major depression(or major depressive disorder) is manifested by a combination of symptoms (see symptoms list below) that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A major depressive episode may occur only once; but more commonly, several episodes may occur in a lifetime. Chronic major depression may require a person to continue treatment indefinitely.

A less severe type of depression, dysthymia(or dysthymic disorder), involves long lasting, chronic symptoms that do not seriously disable, but keep one from functioning well or feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depressive illness is bipolar disorder(or manic depressive illness). Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression), often with periods of normal mood in between. Sometimes the mood switches are dramatic and rapid, but usually they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of depression. When in the manic cycle, the individual may be overactive, over talkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees and unsafe sex. Mania, left untreated, may worsen to a psychotic state.

Symptoms of Depression and Mania

Not everyone who is depressed or manic experiences every symptom. Some people experience only a few; some people suffer many. The severity of symptoms varies among individuals and also over time.

Depression

• Persistent sad, anxious, or "empty" mood.
• Feelings of hopelessness or pessimism.
• Feelings of guilt, worthlessness, or helplessness.
• Loss of interest or pleasure in hobbies and activities that were once enjoyable, including sex.
• Decreased energy, fatigue; feeling "slowed down."
• Difficulty concentrating, remembering, or making decisions.
• Trouble sleeping, early morning awakening, or oversleeping.
• Changes in appetite and/or weight.
• Thoughts of death or suicide, or suicide attempts.
• Restlessness or irritability.
• Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain that do not respond to routine treatment.

"You don't have any interest in thinking about the future, because you don't feel that there is going to be any future." -Shawn Colten, National Diving Champion

"I wouldn't feel rested at all. I'd always feel tired. I could get from an hour's sleep to eight hours sleep, and I would always feel tired." -Rene Ruballo, Police Officer

Mania

• Abnormal or excessive elation.
• Unusual irritability.
• Decreased need for sleep.
• Grandiose notions.
• Increased talking.
• Racing thoughts.
• Increased sexual desire.
• Markedly increased energy.
• Poor judgment.
• Inappropriate social behavior.

Co-Occurrence of Depression with Other Illnesses

Depression can coexist with other illnesses. In such cases, it is important that the depression and each co-occurring illness be appropriately diagnosed and treated.

Research has shown that anxiety disorders - which include post traumatic stress disorder (PTSD), obsessive compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder - commonly accompany depression.^5,6 Depression is especially prevalent among people with PTSD, a debilitating condition that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging, natural disasters, accidents, terrorism, and military combat. PTSD symptoms include: re experiencing the traumatic event in the form of flashback episodes, memories, or nightmares; emotional numbness; sleep disturbances; irritability; outbursts of anger; intense guilt; and avoidance of any reminders or thoughts of the ordeal. In one NIMH supported study, more than 40 percent of people with PTSD also had depression when evaluated at one month and four months following the traumatic event.⁷

Substance use disorders (abuse or dependence) also frequently co occur with depressive disorders.^5,6 Research has revealed that people with alcoholism are almost twice as likely as those without alcoholism to also suffer from major depression.6 In addition, more than half of people with bipolar disorder type I (with severe mania) have a co occurring substance use disorder.⁸

Depression has been found to occur at a higher rate among people who have other serious illnesses such as heart disease, stroke, cancer, HIV, diabetes, and Parkinson's.^6,9 Symptoms of depression are sometimes mistaken for inevitable accompaniments to these other illnesses. However, research has shown that the co occurring depression can and should be treated, and that in many cases treating the depression can also improve the outcome of the other illness.

Part 1. What is depression?
Part 2. What causes depression?
Part 3. Men and depression research
Part 4. Suicide
Part 5. Treatment
Part 6. Find Help
Part 7. References

Mental Disorders in America

Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older - about one in four adults - suffer from a diagnosable mental disorder in a given year.¹ When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.² Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion - about 6 percent, or 1 in 17 - who suffer from a serious mental illness.¹ In addition, mental disorders are the leading cause of disability in the U.S. and Canada.³ Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.¹

In the U.S., mental disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).⁴

Mood Disorders

Mood disorders include major depressive disorder, dysthymic disorder, and bipolar disorder.

• Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder.^1,2
• The median age of onset for mood disorders is 30 years.⁵
• Depressive disorders often co-occur with anxiety disorders and substance abuse.⁵

Major Depressive Disorder

• Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.³
• Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.^1,2
• While major depressive disorder can develop at any age, the median age at onset is 32.⁵
• Major depressive disorder is more prevalent in women than in men.⁶

Dysthymic Disorder

• Symptoms of dysthymic disorder (chronic, mild depression) must persist for at least two years in adults (one year in children) to meet criteria for the diagnosis. Dysthymic disorder affects approximately 1.5 percent of the U.S. population age 18 and older in a given year.¹ This figure translates to about 3.3 million American adults.²
• The median age of onset of dysthymic disorder is 31.¹

Bipolar Disorder

• Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year.^1,2
• The median age of onset for bipolar disorders is 25 years.⁵

Suicide

• In 2006, 33,300 (approximately 11 per 100,000) people died by suicide in the U.S.⁷
• More than 90 percent of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder.⁸
• The highest suicide rates in the U.S. are found in white men over age 85.⁹
• Four times as many men as women die by suicide⁹; however, women attempt suicide two to three times as often as men.¹⁰

Schizophrenia

• Approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year,¹¹ have schizophrenia.
• Schizophrenia affects men and women with equal frequency.¹²
• Schizophrenia often first appears in men in their late teens or early twenties. In contrast, women are generally affected in their twenties or early thirties.¹²

Anxiety Disorders

Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and specific phobia).

• Approximately 40 million American adults ages 18 and older, or about 18.1 percent of people in this age group in a given year, have an anxiety disorder.^1,2
• Anxiety disorders frequently co-occur with depressive disorders or substance abuse.¹
• Most people with one anxiety disorder also have another anxiety disorder. Nearly three-quarters of those with an anxiety disorder will have their first episode by age 21.5 ⁵

Panic Disorder

• Approximately 6 million American adults ages 18 and older, or about 2.7 percent of people in this age group in a given year, have panic disorder.^1,2
• Panic disorder typically develops in early adulthood (median age of onset is 24), but the age of onset extends throughout adulthood.⁵
• About one in three people with panic disorder develops agoraphobia, a condition in which the individual becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack.¹²

Obsessive-Compulsive Disorder (OCD)

• Approximately 2.2 million American adults age 18 and older, or about 1.0 percent of people in this age group in a given year, have OCD.^1,2
• The first symptoms of OCD often begin during childhood or adolescence, however, the median age of onset is 19.⁵

Post-Traumatic Stress Disorder (PTSD)

• Approximately 7.7 million American adults age 18 and older, or about 3.5 percent of people in this age group in a given year, have PTSD.^1,2
• PTSD can develop at any age, including childhood, but research shows that the median age of onset is 23 years.⁵
• About 19 percent of Vietnam veterans experienced PTSD at some point after the war.¹³ The disorder also frequently occurs after violent personal assaults such as rape, mugging, or domestic violence; terrorism; natural or human-caused disasters; and accidents.

Generalized Anxiety Disorder (GAD)

• Approximately 6.8 million American adults, or about 3.1 percent of people age 18 and over, have GAD in a given year.^1,2
• GAD can begin across the life cycle, though the median age of onset is 31 years old.⁵

Social Phobia

• Approximately 15 million American adults age 18 and over, or about 6.8 percent of people in this age group in a given year, have social phobia.^1,2
• Social phobia begins in childhood or adolescence, typically around 13 years of age.⁵

Agoraphobia

Agoraphobia involves intense fear and anxiety of any place or situation where escape might be difficult, leading to avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area.⁵

• Approximately 1.8 million American adults age 18 and over, or about 0.8 percent of people in this age group in a given year, have agoraphobia without a history of panic disorder.^1,2
• The median age of onset of agoraphobia is 20 years of age.⁵

Specific Phobia

Specific phobia involves marked and persistent fear and avoidance of a specific object or situation.

• Approximately 19.2 million American adults age 18 and over, or about 8.7 percent of people in this age group in a given year, have some type of specific phobia.^1,2
• Specific phobia typically begins in childhood; the median age of onset is seven years.⁵

Eating Disorders

The three main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.

• In their lifetime, an estimated 0.6 percent of the adult population in the U.S. will suffer from anorexia, 1.0 percent from bulimia, and 2.8 percent from a binge eating disorder. ¹⁴
• Women are much more likely than males to develop an eating disorder. They are three times as likely to experience anorexia (0.9 percent of women vs. 0.3 percent of men) and bulimia (1.5 percent of women vs. 0.5 percent of men) during their life. They are also 75 percent more likely to have a binge eating disorder (3.5 percent of women vs. 2.0 percent of men).¹⁴
• The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.¹⁵

Attention Deficit Hyperactivity Disorder (ADHD)

• ADHD, one of the most common mental disorders in children and adolescents, also affects an estimated 4.1 percent of adults, ages 18-44, in a given year.¹
• ADHD usually becomes evident in preschool or early elementary years. The median age of onset of ADHD is seven years, although the disorder can persist into adolescence and occasionally into adulthood.⁵

Autism

Autism is part of a group of disorders called autism spectrum disorders (ASDs), also known as pervasive developmental disorders. ASDs range in severity, with autism being the most debilitating form while other disorders, such as Asperger syndrome, produce milder symptoms.

• Estimating the prevalence of autism is difficult and controversial due to differences in the ways that cases are identified and defined, differences in study methods, and changes in diagnostic criteria. A recent study by the Centers for Disease Control and Prevention (CDC) reported the prevalence of autism among 8 year-olds to be about 1 in 110.¹⁶
• Autism and other ASDs develop in childhood and generally are diagnosed by age three.¹⁷
• Autism is about four times more common in boys than girls. Girls with the disorder, however, tend to have more severe symptoms and greater cognitive impairment.^16,17

Personality Disorders

• Personality disorders represent an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it.⁴ These patterns tend to be fixed and consistent across situations and are typically perceived to be appropriate by the individual even though they may markedly affect their day-to-day life in negative ways. Among American adults ages 18 and over, an estimated 9.1% have a diagnosable personality disorder.¹⁸
• Antisocial Personality Disorder - Antisocial personality disorder is characterized by an individual's disregard for social rules and cultural norms, impulsive behavior, and indifference to the rights and feelings of others. Approximately 1.0 percent of people aged 18 or over have antisocial personality disorder.¹⁸
• Avoidant Personality Disorder - Avoidant personality disorder is characterized by extreme social inhibition, sensitivity to negative evaluation, and feelings of inadequacy. Individuals with avoidant personality disorder frequently avoid social interaction for fear of being ridiculed, humiliated, or disliked. An estimated 5.2 percent of people age 18 or older have an avoidant personality disorder.¹⁸
• Borderline Personality Disorder - Borderline Personality Disorder (BPD) is defined by the DSM-IV as a pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts. Approximately 1.6 percent of Americans age 18 or older have BPD.¹⁸

References

1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.
2. U.S. Census Bureau Population Estimates by Demographic Characteristics. Table 2: Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2004 (NC-EST2004-02) Source: Population Division, U.S. Census Bureau Release Date: June 9, 2005. http://www.census.gov/popest/national/asrh/
3. The World Health Organization. The global burden of disease: 2004 update, Table A2: Burden of disease in DALYs by cause, sex and income group in WHO regions, estimates for 2004. Geneva, Switzerland: WHO, 2008. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf.
4. American Psychiatric Association. Diagnostic and Statistical Manual on Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.
5. Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry. 2005 Jun;62(6):593-602.
6. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 2003; Jun 18;289(23):3095-105.
7. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) : www.cdc.gov/ncipc/wisqars accessed April 2010.
8. Conwell Y, Brent D. Suicide and aging I: patterns of psychiatric diagnosis. International Psychogeriatrics, 1995; 7(2): 149-64.
9. Kochanek KD, Murphy SL, Anderson RN, Scott C. Deaths: final data for 2002. National Vital Statistics Reports. 2004 Oct 12;53 (5):1-115.
10. Weissman MM, Bland RC, Canino GJ, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychological Medicine, 1999; 29(1): 9-17.
11. Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry. 1993 Feb;50(2):85-94.
12. Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.
13. Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koen KC, Marshall R. The psychological risk of Vietnam for U.S. veterans: A revist with new data and methods. Science. 2006; 313(5789):979-982.
14. Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007; 61:348-58.
15. Sullivan PF. Mortality in anorexia nervosa. American Journal of Psychiatry. 1995 Jul;152(7):1073-4.
16. Centers for Disease Control and Prevention (CDC). Prevalence of Autism Spectrum Disorders?Autism and Developmental Disabilities Monitoring Network, United States, 2006. MMWR Surveillance Summaries 2009;58(SS-10)
17. Fombonne E. Epidemiology of autism and related conditions. In: Volkmar FR, ed. Autism and pervasive developmental disorders. Cambridge, England: Cambridge University Press, 1998; 32-63.
18. Lenzenweger, M.F., Lane, M.C., Loranger, A.W., Kessler, R.C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6), 553-564.

NIH Publication No. 06-4584
Updated/Reviewed: July 23, 2010

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Reviewed by athealth on February 8, 2014.

What is Migraine?

The pain of a migraine headache is often described as an intense pulsing or throbbing pain in one area of the head. However, it is much more; the International Headache Society diagnoses a migraine by its pain and number of attacks (at least 5, lasting 4-72 hours if untreated), and additional symptoms including nausea and/or vomiting, or sensitivity to both light and sound. Migraine is three times more common in women than in men and affects more than 10 percent of people worldwide. Roughly one-third of affected individuals can predict the onset of a migraine because it is preceded by an "aura," visual disturbances that appear as flashing lights, zig-zag lines or a temporary loss of vision. People with migraine tend to have recurring attacks triggered by a number of different factors, including stress, anxiety, hormonal changes, bright or flashing lights, lack of food or sleep, and dietary substances. Migraine in some women may relate to changes in hormones and hormonal levels during their menstrual cycle. For many years, scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Investigators now believe that migraine has a genetic cause.

Is there any treatment?

There is no absolute cure for migraine since its pathophysiology has yet to be fully understood. There are two ways to approach the treatment of migraine headache with drugs: prevent the attacks, or relieve the symptoms during the attacks. Prevention involves the use of medications and behavioral changes. Drugs originally developed for epilepsy, depression, or high blood pressure to prevent future attacks have been shown to be extremely effective in treating migraine. Botulinum toxin A has been shown to be effective in prevention of chronic migraine. Behaviorally, stress management strategies, such as exercise, relaxation techniques, biofeedback mechanisms, and other therapies designed to limit daily discomfort, may reduce the number and severity of migraine attacks. Making a log of personal triggers of migraine can also provide useful information for trigger-avoiding lifestyle changes, including dietary considerations, eating regularly scheduled meals with adequate hydration, stopping certain medications, and establishing a consistent sleep schedule. Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle. A weight loss program is recommended for obese individuals with migraine.

Relief of symptoms, or acute treatments, during attacks consists of sumatrptan, ergotaime drugs, and analgesics such as ibuprofen and aspirin. The sooner these treatments are administered, the more effective they are.

What is the prognosis?

Responsive prevention and treatment of migraine is incredibly important. Evidence shows an increased sensitivity after each successive attack, eventually leading to chronic daily migraine in some individuals With proper combination of drugs for prevention and treatment of migraine attacks most individuals can overcome much of the discomfort from this debilitating disorder. Women whose migraine attacks occur in association with their menstrual cycle are likely to have fewer attacks and milder symptoms after menopause.

What research is being done?

Researchers believe that migraine is the result of fundamental neurological abnormalities caused by genetic mutations at work in the brain. New models are aiding scientists in studying the basic science involved in the biological cascade, genetic components and mechanisms of migraine. Understanding the causes of migraine as well as the events that effect them will give researchers the opportunity to develop and test drugs that could be more targeted to preventing or interrupting attacks entirely. Therapies currently being tested for their effectiveness in treating migraine include magnesium, coenzyme Q10, vitamin B12, riboflavin, fever-few, and butterbur.

In 2010, a team of researchers found a common mutation in the gene TRESK which contains instructions for a certain potassium ion channel. Potassium channels are important for keeping a nerve cell at rest and mutations in them can lead to overactive cells that respond to much lower levels of pain. Large genetic analyses similar to the one used to identify TRESK will most likely lead to the identification of a number of other genes linked to migraine.

Source: The National Institute of Neurological Disorders and Stroke
Last updated by NINDS November 30, 2012

Reviewed by athealth on February 6, 2014.

by Thomas Haller and Chick Moorman

Many parents do not know how, do not want to, or lack the communication skills necessary to talk to their children about money in general. So when a money crisis develops, the potential to pass fearful and negative attitudes towards money to the next generation increases.

How effective are you at talking about money? What words do you use when you talk about money in front of or directly to your children? Below you will find a list of the ten best things you can say to your children about money. Use it to gage your money talk skill level.

1. "It's allowance time. Everybody get your envelopes!" One of the main reasons for having allowances is to teach children about budgeting. The envelope system will help you do that. Children are concrete thinkers. That means if it is not in their hands, it is not in their minds. Envelopes will help you make the teaching of budgeting a concrete process. Label envelopes with several budget areas, including savings, investment, charity, and spending. Children can divide their own allowance by placing the amount of money they choose in the appropriate envelopes.
2. "I'm willing to pay part of it." This phrase is useful when your child wants something that exceeds the budgeted amount you had earmarked in your budget. If you had $80 set aside for sneakers and they want a pair that costs over $100, this sentence defines your limit. It also invites the child to take responsibility for coming up with the difference. It curbs feelings of entitlement and allows children to take ownership for achieving their desires. In addition, if some of their money is invested in the article, they are more likely to take care of it.
3. "Did you bring any of your money?" This money talk question is helpful for those situations where children ask impulsively for things while you are shopping. It helps them to see that they need to have forethought in the money purchases they make.
4. "The car needs to be washed. What do you think that's worth?" The purpose of a child's allowance is so they can learn how to spend, save, and use money. If they want or feel they need more money than the allowance provides, there are additional ways to get it. Doing out of the ordinary jobs around the house, over and above their normal chores, is one way for them to earn additional income. This will help them internalize the concept that if they want more they can work more.
5. "Help me figure out the tip." This type of money talk helps children in several ways. In addition to providing a real life example to use basic math skills, it also gives children the awareness of the cost of the meal so they can appreciate what is being provided for them. Learning about tipping also gives children the message that being appreciative for the service provided is expressed in the form of a tip.
6. "Oh, I think you gave me the wrong change." Allow your children to overhear you telling cashiers or waiters when the change is incorrect. If you were short changed it models sticking up for yourself. If you received too much change, your words demonstrate honesty and communicate integrity around money.
7. "Our charity jar is almost full. What should we do with the money this time?" Teach the charity habit by contributing to a charity jar regularly at allowance time. Set a goal as a family as to how much you want to accumulate during a specific time frame. Watch as the jar fills up with the individual family contributions. Decide together where to donate the money. Give your children opportunities to have input on this important decision.
8. "Wow! I found a quarter. The money just keeps on coming." Money comes to us in a variety of ways and in unexpected times and places. Finding a coin on the ground is a sign that the universe is continually active in providing money for those who are open to receiving it. Stay open and allow the Attraction Principle to bring you money even in the smallest of ways. It is a sign that more it is on the way. Appreciate what you receive verbally so that your children can hear your gratefulness.
9. "Bummer. Sounds like you have a money problem. What can you do about it?" This piece of money talk communicates to children that the current money problem they face is their problem. It informs them you will be the supportive listener, but not a rescuer. With this style of language, you also remind yourself that there are times when allowing children to experience the consequences of their actions and choices is the best way for them to learn.
10. "You don't have to wait until you're a grown-up." Children can make money, own a business, save money, invest in the stock market, and give to charities. Money is not just for adults. It is for anyone who has parents that are willing to help their children become financially literate.

About the Authors

Chick Moorman and Thomas Haller are the authors of The 10 Commitments: Parenting with Purpose. They are two of the world's foremost authorities on raising responsible, caring, confident children. They publish a free monthly e-zine for parents. To sign up for it or to obtain more information about how they can help you or your group meet your parenting needs, visit their website today: www.personalpowerpress.com.

Reviewed by athealth on February 6, 2014.

For information on mood disorders, please see:

• Adjustment Disorders
• Depression 
• Bipolar Disorder

What is multiple personality disorder?

Multiple personality disorder is the former name for dissociative identity disorder.

What are dissociative disorders?

A dissociative disorder is the breakdown of one's perception of his/her surroundings, memory, identity, or consciousness.

There are four main kinds of dissociative disorders:

• Dissociative amnesia
• Dissociative fugue
• Dissociative identity disorder (previously called multiple personality disorder)
• Depersonalization disorder

For more information, see Dissociative Disorders

Reviewed by athealth on February 6, 2014.