Tag Archives: #AtoZChallenge

Anxiety and Depression in Children With and Without Autism #AtoZChallenge

Welcome to day one on the 2017 #AtoZChallenge on neurodevelopmental disorders. I experience a great deal of anxiety around this challenge particularly because, like I said in my theme reveal post, I am currently in the re-assessment process. On the day I published my theme reveal post, I received an E-mail from the clinical neuropsychologist in charge of my second opinion answering questions I had taken to my psychological assessment. One of them concerned depression. I have suffered from depressive symptoms since childhood. I pointed this out, in a way to reassure her that depression is somewhat normal for me and hence she didn’t need to pull out the major depressive disorder criteria. A reaction i did not expect, was that depression presents itself differently in children and for this reason it might be that in fact my challenging behavior was a symptom of childhood-onset depression.

I share this story because, for today, I am focusing on anxiety and depression as they relate to autism. I will start by sharing a bit about how these conditions present themselves in typical children, as it might be I’m not autistic or suffering from any neurodevelopmental condition after all.

Depression and Anxiety in Typical Children

Depression and anxiety are serious conditions that are different from normal sadness or worry. Common symptoms in anyone with depression or anxiety include negative thoughts, excessive worrying, diffculty concentrating, feelings of hopelessness or worthlessness. Particulalrly in youg children, depression and anxiety are however hard to recognize, as they may present differently than they would in older children or adults. For example, depression may show as irritability and anger, withdrawal, vocal outbursts or crying, or physical symptoms such as headaches or stomach problems. Anxiety can also present with physical symptoms or it may show as developmental regression. Some children with anxiety disorders may become clingy, fidget a lot or go to the toilet frequently.

It may be tempting to label a child who displays disruptive behavior, such as irritability, as “naughty”. However, treating behavior related to anxiety or depression like it is willful defiance, will only make it worse. Rather, if a child shows significantly more behavoral issues than their peers, it is advised to seek professional help.

Anxiety and Depression in Autistic Children

Many of the signs of childhood anxiety and depression are common in autistic children. It may therefore be hard to tell whether a symptom is due to anxiety or depression or it is due to autsm. For example, many autistic children (and adults) fidget as a way of regulating sensory input. Treating this and other sensory difficulties as anxiety will make it worse, as treatment for anxiety might include exposure. If a sensory stimulus is physically uncomfortable or painful rather than feared, no amount of exposure will cure this.

Social withdrawal is also a common sign of both childhood anxiety and depression and autism. However, to autistic children and adults, social interaction is often overwhelming, so again, withdrawal may be a coping strategy rather than a symptom.

Interestngly, some autistics may appear less autistic when they’re depressed or anxious. This may be the case if the autistic’s normal social interaction style is “active but odd”, eg. talking on and on about a particular topic without regard for the other person. For example, I once read about a teenage boy who usually kept on talking about trains. When he stopped perseverating on this topic, his carers assumed he was doing better. After all, he was showing less socially disruptive behavior. In reality, the boy was seriously depressed. He was, for him, withdrawn and had lost interest in what used to be a favorite topic of his.

#AtoZChallenge Theme Reveal 2017: Maybe This Is a Big Mistake, But…

As regular visitors to my blog know, I am currently in the re-assessment process regarding my psychiatric diagnosis. Last year, my psychologist removed my autism diagnosis, that I’d had since 2007. I initially went along, because her reasoning – that I had some type of brain njury instead – seemed plausible at the time. Besides, I wanted to spare myself the emotional rollercoaster of yet another assessment. I had several since my initial diagnosis after all, though most of these reports disappeared. After my psychologist decided to diagnose me with just a personality disorder and depression though, I decided to seek an independent second opinion anyway. I’ve never had an assessment more thorough than this one, I must admit.

I participated in the #AtoZChallenge twice already. In 2015, I had autism as my theme. In 2016, I went with general mental health. This year, I’m still in doubt even as I write this post. Brain injury, premature birth and disability rights crossed my mind, but I have a hard time thinking of topics for each letter that are relevant to these themes. Since I don’t know yet what the outcome of my re-assessment will be, I am rather daring by picking “neurodevelopmental disorders” again. This is broader than autism, so I can have an excuse and write on unrelated topics if it turns out I’m not diagnosable as autistic after all. Neurodevelopental disorders are still a major (special) interest of mine. However, I don’t know yet how I will handle the outcome of my assessment, so it might be I’ll be so depressed I’ll stop blogging. My blog has been rather inactive lately anyway. If it turns out I’m not diagnosed with autism, I’ll hopefully finish the challenge and then close the chapter. I contemplated skipping A to Z and choosing this theme for #Write31Days in October (if that challenge stll exists) should I be diagnosed with autism again. However, maybe my blog will have died of inactivity by then. In an attempt to kick it when it’s down, I’ll take on the #AtoZChallenge anyway. Wish me luck.

Z – #AtoZChallenge on Mental Health

Welcome to the last day in the #AtoZChalleng eon mental health, dedicated to the letter Z. I am just in time to publish my post, as I was at my parents’ two hours way all day. I did take my computer, so don’t worry, this post was not my reason to leave. Anyway, today’s words are all on a common theme. Here goes.

Z-Drugs

Z-drugs are a few medications, most of whose generic names start with Z, eg. zaleplon, zopiclone and zolpidem. Besides the letter they start with, they have in common that they work similarly to benzodiazapines but are not benzos. There are three subgroups of Z-drugs, all of which are GABAA agonists, meaning they increase the availability of this neurotransmitter. Z-drugs are used in the treatment of insomnia. Some have advantages over benzdiazepine sleeping pills.

Zombie

Many psychiatric patients, especially those on long-term units, seem a bit zombielike to outsiders. I discussed this when discussing lethargy in my letter L post too. Negative symptoms of schizophrenia and other psychotic disorders may cause people to act like “zombies”, but so do many psychiatric medications, including antipsychotics, anti-anxiety medications and certain antidepressants.

ZZZ

Last year, I discussed sleep in my post on the letter Z for ZZZ. To finish off this year’s challenge, I am going to discuss the same topic. Sleep disorders are common among people with mental illness and of course can be a mental illness themselves.

There are two forms of sleep disorders. Dyssomnias are disorders in the quantity, quality or timing of sleep, such as insomnia or hypersomnia. Parasomnias are characterized by unusual physiological or behavioral events that limit sleep, interfere with certain stages of sleep or with the transition from sleeping to waking. Sleepwalking is an example of a parasomnia.

Like I said, sleep disorders can occur on their own but can also be part of another mental illness. For example, many people with clinical depression experience insomnia, usually waking up way too early in the morning. Some people with depression conversely experience hypersoomnia, sleeping far too much.

Y – #AtoZChallenge on Mental Health

Welcoe to the letter Y post in the #AtoZChallenge on mental health. This was definitely the hardest letter of all. In fact, I cheated a little, because I have only one word and it’s practcally unrelated to mental health. I use it to talk about an important topic in mental health though. Here goes.

Ypsilon

Ypsilon is of course the Greek letter from which the Latin Y is derived. However, it is also the Dutch organization for family members of people with schizophrenia and other psychotic disorders. Like I said, it’s a little out of left field, but I want to use this word to discuss the importance family plays in severe mental illness and recovery from it.

A few years ago, there was some debate that revolved around the question whether organizations of families of patients should receive government funding, or whether it should only be organizations of patients themselves. Ypsilon spoke up, saying that people with severe mental illness cannot necessarily advocate for themselves. Never mind that there’s an organization for people with schizophrenia and related disorders too, called Anoiksis.

Some other organizations, like the Association of Manic-Depressives and Relatives (that’s the literal translation of the Dutch name), allow both patients and family to be active members in the organization. I don’t know how each group is represented on the board of directors. However, this organization makes it clear that patients and family should really work together towards a common goal. Note that bipolar disorder is often as severe a mental illness as schizophrenia, so Ypsilon’s argument that people with severe mental illness can’t advocate for themselves, holds no ground.

Family are, of course, important in people’s mental health recovery. However, it’s still the patients who have the first-hand experience of mental illness. As such, they should always be at the center of their recovery process. Ypsilon is an okay’ish organization in this sense, often cooperating with Anoiksis and having destigmatization as a goal. Other organizations, however, often do not value patients’ input.

X – #AtoZChallenge on Mental Health

Welcome to the letter X post in the #AtoZChallenge on mental health. I have two words for you today, so this is a short post. Here goes.

(E)X-Patient

I have said this when discussing “survivor” in my letter S post, but many patients have endured traumatic experiences while in psychiatric care. As such, many are happy to be freed from psychiatry. There is a movement called the C/S/X movement. The C stands for “consumer”, ie. those still in psychiatric care. The S stands for “survivor”. Once consumers/survivors have completely freed themselves from psychiatry, many feel comfortable only with the label “ex-patient”, which signifies they are no longer involved with psychiatric care.

Xanax

Xanax, the brand name for alprazolam, is one of the strongest benzodiazepine tranquilizers. Xanax is commonly used to treat anxiety or panic. Other benzodiazepines are also used as sleeping pills, but I’ve never heard Xanax being used for this purpose.

Benzodiazepines are highly controversial drugs because they are often overused and they can become addictive. In the Netherlands, for this reason, people can only get benzodiazepines covered by insurance if they have epilepsy, an anxiety disorder for which they’ve tried at least two antidepressants, or if they have severe mental illness requiring high doses of benzodiazepines (for chemical restraint). On this last ground, many severely mentally ill people take benzos on a daily basis. Worse yet, people without mental illness can get only one prescription for ten sleeping pills, to be used over the course of ten weeks, and even then they have to pay for them out of pocket. People in the psychiatric hospital almost always take sleeping pills much more frequently and many take them everyday. When patients are in the psychiatric hospital, benzos are paid for by insurance. I wonder whether I’ll get my benzodiazepines covered once I leave the institution. Depends on whether my condition is seen as a severe mental illness requiring high doses of benzodiazepines.

W – #AtoZChallenge on Mental Health

Welcome to the Letter W post in the #AtoZChallenge on mental health. This was a hard letter. In fact, up till a few days ago, I could only think of one word for it. I have however managed to think of a few more words.

Wellness Recovery Action Plan® (WRAP®)

The Wellness Recovery Action Plan® is a plan that people with mental illness use to regain their wellness if they’ve endured a distressing experience that might otherwise destabilize them. WRAP® was developed in the United States by Mary Ellen Copeland, who herself suffered from severe mental illness. It is rooted in the recovery model of mental illness. WRAP® focuses on people’s strengths rather than their deficits. However, it does include a crisis plan too. This crisis plan or advance directive is written by the patient themself and lets others know when they need to take responsibility for the patient’s care. This allows the patient to stay in control even when they can no longer make decisions for themself. I found the interesting part was also the post-crisis plan, which is meant to reflect on ways to regain wellness and prevent another crisis. In traditional crisis plans, people are not taken care of after crises and their original plan is not revised.

Willpower

Of course, mental illness is not a choice. However, recovery is. It is often believed that willpower is the power to get over all one’s emotional or behavioral struggles, to be cured of one’s mental illness or addiction. I discussed willpower from a spiritual perspective a few months ago. In this light, willpower is the will to turn over one’s life to God (or another power greater than oneself). In the recovery movement, willpower is the will to take back control over one’s life in spite of mental illness. This might seem completely contradictory to the twelve-step view of willpower, ie. turning one’s life over to God. I see the two as peacefully co-existing. Allowing God to guide us on our journey, after all, does not mean we are not as humans responsible for the decsions we make.

Work-Out

Exercise is often thougth to greatly help with mental health. People who are depressed often benefit from getting moving. People with severe mental illness might use exercise, even if it does not cure their illness, to get into a daily or weekly rhythm.

V – #AtoZChallenge on Mental Health

Welcome to the letter V post in the #AtoZChallenge on mental health. Pfew, we’ve arrived at the last week and I’m looking forward to writing regular posts once again. This letter wasn’t too hard though. Here goes.

Visiting Hours

Mental hospitals, like most hospitals, have visiting hours. The difference is that they are particularly meant for patients from other units. Family often can come when they want.

Vitamins

Many mental institution patients take one or more vitamins or minerals. The reason is that many don’t have the healthiest diets and hence run a risk of vitamin deficiency. However, it is also thought that vitamin deficiencies may contribute to people’s mental illness. For example, depression may be associated with vitamin D deficiency.

Voice-Hearing

Many people with severe mental illnesses hear voices. Many people without severe mental illness do too, but they can function in spite of their voice-hearing. As such, voice-hearing itself does not indicate severe mental illness, even though until recently, you could be diagnosed with schizophrenia by merely hearing voices.

There is an international movement of voice-hearers. The most well-known organization supporting this movement is Intervoice in the UK. Intervoice aims to support people who hear voices, whether they’ve been diagnosed with a mental illness such as schizophrenia or not.

Core values of the hearing voices movement are:


  • Hearing voices, seeing visions and related phenomena are meaningful experiences that can be understood in many ways.

  • Hearing voices is not, in itself, an indication of illness, though difficulty coping with voices can lead to great distress.

  • When people are overwhelmed by their experiences, support should be based on respect, empathy, informed choice and an understanding of the personal meaning of this person’s voice-hearing.

Volunteers

Many mental hospitals and support organizations for people with severe mental illness employ volunteers. Volunteers might be visiting buddies, visiting the patient every so often. They may also help paid staff during day activities. My institution isn’t keen on employing volunteers. There was this staff member who would be laid off due to budget cuts and she offered to come back as a volunteer. The management said “No”, because volunteers cost some money too.

U – #AtoZChallenge on Mental Health

Welcome to the letter U post in the #AtoZChallenge on mental health. This was a hard letter once again and hence my post is very short. I have two words for you and they’re pretty irrelevant, but well. Here goes.

Unstable

People use the word “unstable” to describe the state of not feeling well mentally. In the description of care packages allocated to people, often the word “unstable” is used to describe someone’s psychological state. Of course, if a person is chronically depressed, for instance, they are not truly unstable in the literal sense of the word.

Unusual Experiences

“Unusual” is a word used to describe the experience of mental illness from an inclusive point of view. It sees mental illness as merely an experience that is uncommon. Everyone has unusual experiences at some point. For instance, many people experience totally benign hallucinations at times, for example when drifting off to sleep. As such, the experience of being mentally ill is merely an exaggerated form of ordinary human experience.

T – #AtoZChallenge on Mental Health

Welcome to the letter T post in the #AtoZChallenge on mental health. I’m a little late once again to publish this post, because this was a hard letter and I have once again been very tired. Here goes.

Transition

Transition or transfer happens when a patient moves from one setting into another. This could be from an acute unit to a rehabilitation, resocialization or long-term care unit. It could also be from a psychiatric unit into supported housing or community care.

Trauma

Like I said yesterday, many psychiatric patients have endured some form of trauma. Trauma is experienced differently by different people. The diagnostic manual defines trauma for the purpose of diagnosing post-traumatic stress disorder as having endured, been confronted with or witnessed a situation that is life-threatening, threatened or actually caused physical harm, or sexual violation. Starting with DSM-5, it is made explicit that being confronted with such a situation through the media does not count. As such, people who for exampe watched the 9/11 terrorist attacks on TV (ie. virtually the whole world) cannot claim to have been traumatized by it. First responders who witnessed the events themselves, of course, can. So can people who lost loved ones in the terrorist attacks.

Please note that this definition is only used for the purpose of diagnosing PTSD. People can be diagnosed with another stressor-related disorder (eg. adjustment disorder with PTSD features) if their experience does not meet the criteria for trauma but is still distressing.

Treatment Planning

Treatment plans, like I explained when discussing care plans, describe the person’s overall treatment and diagnosis. On long-term psychiatric units, treatment plans are revised every six months or so. A patient has the right to contribute to their treatment plan and to review it, but on my unit, during the actual meeting, patients are not in attendance. I have only been asked to contribute once and am lucky if I know when my treatment plan revision is. Obviously, informal patients (and most patients on a section) must consent to their treatment plan before it can be implemented. In reality though, I’ve not seen my treatment plan in years so I think consent is automatically assumed.

S – #AtoZChallenge on Mental Health

Welcome to day 19 in the #AtoZChallenge on mental health. We’ve arrived at the letter S. Here goes.

Self-Injury

Self-injury or self-harm is the deliberate infliction of wounds upon oneself. Some scientists make a distinciton between self-injury and self-harm. Self-injury is then seen as leaving relatively minor, local wounds such as cuts or burns. Many people with depression, anxiety or emotion regulation issues such as in borderline personality disorder self-injure. Self-harm then is the infliction of grave harm onto the self, such as amputation. This is seen more often, according to these scientists, in people with psychotic disorders such as schizophrenia. In reality, of course, only a small portion of even the most severely psychotic patients engage in severe self-mutilation.

In DSM-5, non-suicidal self-injury was introduced as its own mental health diagnosis. Prior to that, many people who self-injure were misdiagnosed, often with borderline personality disorder. The DSM-IV guidelines even said that, if someone self-injured to cope with overwhelming emotions, BPD should be diagnosed, even though BPD has nine criteria, five of which must be met for a diagnosis.

Self-Medication

Self-medication refers to the abuse of alcohol or drugs with the goal to cope with mental health problems. It can also refer to the use of prescription medications that haven’t been prescribed to that specific person. Many people “self-medicate” with alcohol, even though alcohol does not have any medical benefits (except in mouthwash). In fact, it can make symptoms worse. Same for drugs. For instance, many people with psychotic symptoms use cannabis because it seems to calm them, even though it is in reality thought to worsen psychotic symptoms.

Of course, some drugs sold on the streets actually do help with certain symptoms. For example, people with undiagnosed ADHD might start using stimulant drugs to counter their symptoms. It is for this reason that self-medication needs to be taken very seriously. In my post on dual diagnosis last October, I addressed the complicated relationship between alcohol or drug use and mental illness

Survivor

Many people were and still are treated for mental illness against their will. In the antipsychiatry movement, people who come out of (forced) psychiatric care are seen as survivors. Many mentally ill people have indeed endured traumatic experiences at the hands of professionals. Many also have had other traumatic experiences, which may’ve contributed to their mental health condition. As such, they’re also survivors.