Clinical Application Fields
Clinical Application Fields
There are four basic principles in the treatment of schizophrenia. Firstly, through medication, signs and the possibility of periods when the disorder gets heavier are tried to be decreased. It is really important that the patient adapts to medical treatment and follow his signs and inform his psychiatrists immediately and thus medication must be arranged accordingly. If the patient drinks alcohol, beneficial effects of his medicines may be ruined. If the patient uses substances like “weed” (marijuana, hashish) or cocaine, his signs will get harder and heavy periods will be seen frequently. Second basic principle in treatment is to decrease the patient’s compulsions. Within this frame, to decrease the tension arising from family relations is of great importance. To this end, patient’s family must have realistic expectations and a better communication with the patient as well as displaying a problem-solving attitude. It is really advantageous if the patient has meaningful activities such as going to school or work even though part-time. Both too much stimulant and too less are not desired and a kind of balance must be maintained preventing overstrain at home, work, school or during treatment course. The third basic principle is to provide patient certain coping skills. Their skills to solve their interpersonal conflicts and improve their relations with other people, cope with negative experiences and get over their psychological signs (delusions, hallucinations, anxiety, depression and so on) in more active ways. Fourth basic principle is to strengthen social foundations of the patient. Accordingly, patient’s family and friends must have more knowledge and realistic expectations about schizophrenia, the patients must comply with the treatment course and have a goal in his life. Even if the patient makes small steps in coping with his own problems and living a self-sufficient life, he must be encouraged. And it is also important that he knows that people around him love him and hope the best for him. Can people diagnosed as schizophrenic heal? Can they be healthy again? To what extent can they heal or become healthy again? There is no certain response to these questions which we have been discussing for years, yet an important part of these people become healthy again to a significant extent and some part of them heal to a nearly full extent. Within this context, if this disorder changes for the better, it means that the patient gets rid of his delusions, hallucinations, a good amount of decrease in negative signs and sustains certain level of work and school life. And it is also important to take necessary measures to prevent the recurrence of the disorder.
If we define the “change for the better” as a lack of definite sign for the last two years, a certain level of work or school life in at least the half of last two years, an independent life and money management, shopping, cooking and care for himself as well as sustaining a regular relationship with the partner or a friend, we can see that 40-70% of patients change for the better to an important amount thanks to the treatment. Healing after schizophrenia must be regarded as a process rather than a result since the prevention of recurrences is an important aim. In another word, longer periods without signs, sustaining a certain work or school life, personal care and a self-sufficient life and having a continuous relationship are especially desirable situations, which appear as a result of process and end up as a life-style.
Mania and Bipolar Disorder
The most important aspect of bipolar disorder is the extensive mood swings. The mania period is on one pole of these swings and depression on the other. This disorder is named as mood disorder since it firstly influences of a person’s mood (emotions). And also named as bipolar since a person’s emotions are swung between fervour (mania) and collapse (depression).
In the state of mania where fervour and outburst is seen, signs like a bloated mood (an excessive joy, enthusiasm) or easy anger (an excessive sensitivity and anger), decrease in the sleep need, grandiose thoughts in addition to exaggeration of talents and self-importance, more talkativeness, speedy thought flow, increase in effectiveness and internal strength, increase in attentiveness and impulsive behaviour without foreseeing negative results are encountered. These periods replace with period where one feels depressed, enjoys nothing, has interest in his habitual activities, less desire for eating, easy tiredness, sleep problems, feels bad and guilty from time to time, has difficulty in concentrating on one topic, focusing or deciding and thinks that “I wish I were dead and rescued”. These periods of mania and depression may last for days and weeks.
The most important stage of bipolar disorder treatment is the medical treatment. Those using their medicines regularly are known to sustain their well-being longer. However, medicines must be followed closely.
You can search for the following signs on your own just to test if you are in depression or not:
- Feeling really unhappy, desperate, pathetic, depressed and guilty
- Feeling tired and exhausted for most of the time, feeling as if you have no strength
- Finding difficult to do the smallest things
- Finding no pleasure in what you used to do previously
- Being too stressful and angry from time to time
- Not wanting to see people or being afraid of loneliness. Finding difficult to participate in social activities
- Unable to think precisely, concentrate on and remember things
- Thinking that you are unsuccessful in everything you do, criticizing and blaming yourself mostly
- Thinking that you are burden for other people
- Regarding life as “worthless”
- Seeing no future, having no hope, thinking everything you have made was a mistake and this will go on
- Being restless more than ever or feeling anger
- Running out of your self-confidence
- Thinking of what is wrong, what will be wrong, what is wrong about you non-stop
- Thinking that the life is full of injustices and there is an “injustice” just about everywhere
- Having difficulty in falling asleep or waking very early in the morning and being unable to fall asleep again; dreaming for a whole night or disturbing dreams from time to time
- No more pleasure in eating and having sex as it used to be, loss in appetite or excessive amount of eating just to decrease your tension
- Drinking excessive amount of alcohol all of a sudden
- Complaining about physical pains of which the reasons cannot be found
- Thinking that life flows in a meaningless way, having a general reluctance, having no zest for life, no connection with life, not many things tying you to life…
If some of the signs above are familiar to you, you have a possibility to be in depression. You should consult a psychiatrist without losing time…
Panic Attack and Panic Disorder
You must have at least four signs among following 13 to make a panic attack diagnosis:
- Palpitation, feeling heart-beats or increase in heart rate
- Trembling or convulsion
- Breathing difficulty or drowning sensation
- Chest pain or tightness
- Nausea or stomachache
- Dizziness, feeling like falling down or fainting
- Unreality feelings or sense of dissociation from self
- Getting numb or prickling
- Getting cold, tremor or hot flushes
- Fear of losing control or getting mad
- Fear of death
Personal experiences during a panic attack vary to a great extent. Some certain physical sensations (such as feeling heart beats) are directly connected to physiological changes. Others (like fearof death) arise after mental and emotional reactions shown for physical sensations mentioned before. One of the best ways of coping with panic attacks is to have knowledge hereabout since the doubt, uncertainty and fear of obscurity are the most powerful weapons of this disorder.
“Does your panic problem require assessment by a psyhciatrist?” This is the first thing you must know. If there is a diagnosis for psychological or psyhical disorder, you must have maximum knowledge of it. What is the reason? What are the other problems accompanying these? What kind of support must you have? How can you help yourself? To have a comprehensive knowledge about your own situation will be the most important foundation of your success in coping with this disorder.
Generalized Anxiety Disorder
The principal characteristic of generalized anxiety disorder is to feel over-anxious about lots of events and activities for at least six months. Sufferers find it difficult to control their anxieties. At least three additional signs from a list including restlessness, easy tiredness, difficulty in concenration, muscle strain and sleep disorders accompany anxiety and delusions. Those having generalized anxiety disorder do not describe their sadness as excessive all the time, however they express that they feel stressful as they are always sad, find it difficult to control their sadness or have dysfunctionality related to this situation in social, professional or other important fields of their lives.
The duration and frequency of anxiety depends on the realization possibility of the event or its possible effects. The individual cannot prevent distraction by unhappy or uneasy thoughts and experiences a difficulty in terminating their sadness. Adults with generalized anxiety disorder feel sad and anxious about daily, ordinary life conditions such as new responsibilities at work, financial problems, healthcare of family members, probable accidents incurred by their children or other minor issues (daily housework, repair of the car or being late for an appointment). During the course of this disorder, focus of sadness may shift to another.
Due to the accompanying muscle strain, there may be some trembling, twitching, clumsiness, pain in the muscles. Most of those with generalized anxiety disorder have physical signs (cold, moist hands; cotton mouth, sweating, nausea or diarrhea, a frequent need to urinate, swallowing difficulty or a “lump in the throat”) and overdone irritation responses. Depression signs are also seen frequently.
Obsessive-compulsive disorder (OCD) is taking excessive amount of time to do things, worrying, ruining ordinary daily functionalities and relations with other people. Obsessions are thoughts, impulses, fantasies or images that one cannot help but think and cause anxiety. Compulsions are mental actions or repeating behaviors to remove the obsession or eliminate the anxiety arising from these schemes. These schemes generally are aimed to protect “magically” from an undesirable event or avoid this event. Even though OCD has various appearances, those with such a disorder almost have same thoughts and behaviors.
Those washing their environments and themselves are the ones who cannot help but think dirt, filth, microbes or else foreign substances will stick to them. These people are continuously afraid of suffering these substances or harming other people. The main types of OCD are as follows:
Controllers are those inclined to hold themselves responsible of possible dangerous situations incurred by others in an excessive and meaningless way since they do not “do things properly”, they all the time control whether they lock the doors, windows, home appliances working with electric or gas and suppose something bad will happen if they do not.
Organizers feel compelled to put certain object in “their proper places” and have an organized environment. They feel disturbed even if the place of objects is changed, someone touches them or puts them in another place.
Obsessive thinkers are those who cannot evade their undesirable thoughts, fantasies and images they regard as harmful for others. These people can have repeating thoughts instead of displaying repeating ritual behaviors. They can employ methods like counting, praying or repeating certain words to fight with anxious thoughts in their minds.
Hoarders collect some unimportant objects and have difficulty in throwing these objects away.
Many people may have similar obsessions to the ones mentioned above to a degree. How many people do not control whether they lock the door or not? Someone can collect and read newspapers and do not throw them, but another person may find it silly. The most important criterion whether a situation is regarded something disturbing or not depends on to what extent it ruins one’s thoughts, behaviors and functionality.
Social Phobia (Social Anxiety Disorder)
The primary fear of a person with social phobia is to be humiliated, distressed or behave in a way that they feel ashamed in front of other people. These people are afraid of interacting with others or doing things in front of others and try to avoid these situations. Frequent social phobias can be listed as the fear of talking, eating or writing in front of others, using common toilets and participating in negotiations and each kind of meetings. These people are also afraid that other people will realise their anxiety in these situations and laugh at them.
An individual with social anxiety disorder avoids fearful situations. Less frequently, they force themselves to endure a social situation but experiences a high amount of anxiety during this activity. A clear anticipatory anxiety may occur very earlier about upcoming situations involving social participation (daily anxiety spells before joining a social event). Anticipatory anxiety causes a perception of fear and anxiety signs leading to an imaginary or real decrease in competence. This may result in a vicious circle paving the way for more problems and increase in anticipatory anxiety.
Insomnia is defined as the problem of falling asleep or remaining asleep or else lack of refreshing sleep for at least one month. These people generally complain about the difficulty in falling asleep and interruption in their sleep. The first complaint they put forward may change in time. For example, they may complain about the difficulty of falling asleep one time and remaining asleep for another. More rarely, they complain about the lack of refreshing sleep. However, if the individual has an apparent distress or dysfunctionality due to these complaints, insomnia is diagnosed.
In addition to overstimulation, there is also a negative conditioning against sleeping within the scope of insomnia. Excessive distress about being unable to sleep leads to a vicious circle. The more a person tries to fall asleep, the more they become disappointed and in so doing get stressed ahich makes it harder to fall asleep. They are conditioned in a negative way against the bed where they experience sleepless nights. When one does not try to fall asleep (while watching TV, driving car), they can easily fall asleep. Thus, these people can improve some sleeping habits disturbing their regular sleep pattern. If this situation becomes continuous, their well-being in day may be ruined, either. They may have emotional ups and downs, their will to work may decrease, their inner strength may lower, they may find it hard to focus on and feel tired and exhausted.
Marriage and Relationship Problems
For a long and successful marriage, some conflicts, disagreements and divisions are necessary. At first glance, you may think that the idea about healthy conflicts is not true. However, marriages become more powerful or end depending on how you deal disagrements or divisions. What matters is the way you discuss things together. Do you both increase the tension while discussing or try to find a solution and feel relaxed? So, we need to understand that healthy conflicts may always exist. In other words, they must know how to approach his/her partner during discussions or while handling disagreements. The important thing here is to attempt to brake the negative cycle during the interaction and make the communication better.
To prevent your outburst from ruining the communication between you, you must first become relaxed and calm. You must speak and listen to have a consequence after your discussion and make a more fertile one later. Besides, you should accept the validity of one another’s emotions and thoughts when problems arise.
At what stage of your life are you now? You may be married, single, separated, divorced or widow. You may or may not have children. You may have had or may have had intercourse before. You may have so many difficulties right now in your life or everything may be fine. You may have great satisfaction. We all have emotional needs like sincerity, closeness, love and compassion as well as sexual satisfaction in whatever period of our lives. Most of our emotional needs are more important than our sexual satisfaction. However, our sexual problems may challenge our most strong emotional relationships, either. For example; having orgasm is a satisfactory aspect of sexuality. However, orgasm is not a separate part of sexuality. Orgasm response depends on so many factors. It depends on being naturally stimulated; however, to experience sexuality thoroughly you should be at peace with yourself, with your thoughts about sexuality and opposite sex. Thus, to improve sexually is closely connected to being personally happy in life. Everyone deserves a satisfactory sexual life and the biggest obstacle to this is inadequate knowledge about that. Human beings are the most complicated species of all. So, apart from all other living creatures, sexuality is structured and learned leading to a pattern in human beings. Sexuality in humans is less instinctual. Just like any other skill, practice, experience and knowledge are needed to gain this skill.
Eating Disorders (Anorexia, Bulimia)
Eating disorders are determined with heavy disruptions in eating behavior. There are two main eating disorders: Anorexia nervosa and blumia nervosa. Anorexia nervosa is defined as the resistance against sustaining the lowest bodyweight, while blumia nervosa is determined on repeated periods where inappropriate concessive behaviors such a self-regurgitation, using lapactic, diuretic or other drugs, eating nothing or doing excessive exercise after repeating periods of binge eating. Primary characteristics of both anorexia nervosa and bulimia nervosa is the distorted perception about body shape and weight.
So many people drink alcohol yet most of them do not have any kind of problems. However, some drinkers have great problems with alcohol and want to stop. Thus, some of them ask for professional help and some of them try to quit drinking on their own.
Problems with alcohol do not occur in one night. They increase over a period of months or years. Generally, relatives of the person drinking have concerns before the relevant individual.
That some people are stigmatized as alcoholic gives an impression as if people are divided into two. If someone is alcoholic, it is considered as if they have no other option but to quit drinking completely; if not, they may keep drinking in whatever ways they choose. However, such a sharp line cannot be drawn for most of the time and even if the person is not alcoholic, the problems of drinking too much alcohol are well-known.
The most important question here is the amount of drinking taking place. It is known that excessive amounts of alcohol cause certain problems with health and society. However, the primary concept is excessive drinking similar to excessive eating even though such problems may not have arisen.