Related Terms

• Adjustment disorder, agoraphobia, antipsychotics, anxiety, anxiety disorders, autism, behavioral therapy, body dysmorphic disorder, brain disease, brain disorder, CBT, conversion disorder, cognitive behavioral therapy, dissociative disorders, GAD, generalized anxiety disorder, identify disorder, Kanner's syndrome, neurological disease, neurological disorder, obsessive compulsive disorder, OCD, mental illness, personality disorders, phobia, post-traumatic stress disorder, psychiatric, psychiatrist, psychosocial treatment, psychotherapy, psychotic, psychosis, psychosomatic disorder, PTSD, SAD, schizophrenia, serotonin, social anxiety disorder, somatization disorder, somatoform disorder.

Background

• Psychiatric disorders, also called psychological disorders, are illnesses of the brain that cause disruptions in a patient's thinking, feeling, moods, and ability to relate to others. Psychiatric disorders are classified into different groups, including anxiety disorders, mood disorders, adjustment disorders, developmental disorders, somatoform disorders, dissociative disorders, personality disorders, and psychotic disorders.

• Psychiatric disorders can occur in patients of all ages, genders, races, and ethnic backgrounds. The exact cause of psychiatric disorders remains unknown. Researchers believe a combination of factors, including genetics and environmental stimuli (such as traumatic events), may lead to the development of mental illnesses.

• Although there are currently no cures for psychiatric illnesses, treatment, including psychotherapy and medications, may help manage symptoms and prevent relapses. Patients generally receive a combination of therapy and medications to treat their conditions.

• Patients should take medications exactly as prescribed. This means patients should not change their dosages or stop taking their medications without first consulting their healthcare providers. Even though newer medications have fewer side effects and an increasing number of psychiatric patients are following their treatment plans, treatment adherence is still a problem among patients with psychiatric illnesses. Some patients, especially schizophrenics, may fail to take their medications because they do not believe they have a problem.

• Family, friends, and caregivers may also benefit from therapy to help them learn how to cope with the patient's illness. Support groups are also available for both patients and their loved ones.

Types of Psychiatric Disorders

• Anxiety disorders:

• Overview: Anxiety is an unpleasant complex combination of emotions often accompanied by physical sensations, such as heart irregular heartbeat (palpitations), nausea, angina (chest pain), shortness of breath, tension headache, and nervousness.

• Unlike the relatively mild, brief anxiety that can be caused by a stressful event, such as testing, a job interview, or the death of a loved one, anxiety disorders last at least six months and can worsen if not treated.

• Causes: Anxiety disorders tend to run in families. Studies suggest that an imbalance of the brain's chemical messengers (neurotransmitters), such as serotonin, gamma-amino butyric acid (GABA), epinephrine, and norepinephrine, may contribute to anxiety disorders. An anxiety disorder may also develop in response to a traumatic event, such as a car accident, a marital separation, or abuse. Some prescription and non-prescription medications, such as caffeine, amphetamine, and decongestants, may cause symptoms of anxiety. Many medical conditions, such as diabetes, asthma, epilepsy, migraine headaches, bipolar disorder, and depression, may cause or mimic symptoms of anxiety disorders. Nutritional deficiencies stemming from poor diet and/or digestion may also contribute to anxiety.

• Symptoms: Physical symptoms may include irregular heart beat (palpitations), angina (chest pain), hot flashes or chills, cold and clammy hands, nausea, frequent urination, diarrhea, shortness of breath, sweating, dizziness, tremors, muscle tension or aches, fatigue, and insomnia. Emotional or psychological symptoms may include apprehension, uneasiness, dread, impaired concentration or selective attention, restlessness, nightmares, irritability, confusion, behavioral problems (especially in children and adolescents), nervousness, jumpiness, self-consciousness, insecurity, fear of dying or going crazy, and a strong desire to escape. These symptoms vary in severity and duration, depending on the specific type of anxiety disorder.

• Generalized anxiety disorder (GAD) is characterized by excessive, unrealistic worry that lasts six months or more. In adults, the anxiety may focus on issues such as health, money, or career. Physical symptoms may also appear such as nervousness or heart palpitations. Depression commonly accompanies this anxiety disorder.

• Patients with obsessive compulsive disorder (OCD) are plagued by persistent, recurring thoughts (obsessions) that reflect exaggerated anxieties or fears. Typical obsessions include worrying about being contaminated with germs or fears of behaving improperly or acting violently. The obsessions may lead an individual to perform a ritual or routine (compulsions), such as washing the hands, repeating phrases, or hoarding.

• Panic disorder is characterized by repeated, unexpected panic attacks. These panic attacks strike without warning and usually last about 15-30 minutes. Panic disorder may also be accompanied by agoraphobia, which is a fear of being in places where escape or help would be difficult in the event of a panic attack. Agoraphobia is characterized by individuals likely to avoid public places (e.g. shopping malls) or confined spaces (e.g. airplanes).

• Post-traumatic stress disorder (PTSD) can follow an exposure to a traumatic event, such as a sexual or physical assault, witnessing a death, the unexpected death of a loved one, or fighting in combat. There are three main symptoms associated with PTSD. 1) Patients typically relive the traumatic event in flashbacks or nightmares. 2) Patients typically avoid people, places, and things related to the trauma and are emotionally detached from others. 3) Patients feel physiologically aroused and often have difficulty sleeping, poor concentration, or feel irritable.

• A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that actually presents little to no danger. Common phobias include fear of animals (e.g. spiders or snakes), fear of flying, and fear of heights. In the case of a severe phobia, one might go to extreme lengths to avoid the thing that is feared.

• Separation anxiety is a normal part of child development. It consists of crying and distress when a child is separated from a parent or away from home. If separation anxiety persists beyond a certain age or interferes with daily activities, then it may be a sign of separation anxiety disorder.

• Social anxiety disorder (SAD) is characterized by extreme anxiety about being judged by others or behaving in a way that might cause embarrassment or ridicule. This intense anxiety may lead to avoidance behavior. Physical symptoms associated with this disorder include heart palpitations, faintness, blushing, and profuse sweating. Performance anxiety, better known as stage fright, is the most common type of social phobia.

• Diagnosis: GAD is diagnosed when an individual spends at least six months worrying excessively about everyday problems.

• Panic disorder, or panic attack, is diagnosed when a patient either has four attacks within four weeks or one or more attacks followed by at least one month of persistent fear of having another attack. Also, a minimum of four of the symptoms listed for panic disorders must have developed during at least one of the attacks.

• Phobia is associated with extreme anxiety with exposure to the object or situation. The individual recognizes that his or her fear is excessive or unreasonable and finds that normal routines, social activities, or relationships are significantly impaired as a result of these fears.

• A mental health professional will diagnose obsessive-compulsive disorder after a thorough evaluation. Criteria are based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a clinical book of mental illness diagnoses. OCD diagnosis is based on recurrent and persistent thoughts, impulses, or images that are intrusive and cause distress. Patients have thoughts that are not simply excessive worries about real problems. Individuals recognize that these thoughts, images, or impulses are a product of the mind and attempt to ignore or suppress them. Compulsions must meet specific criteria, including repetitive behaviors (e.g. hand washing) or repetitive mental acts (e.g. counting silently) that the individual feels driven to perform.

• Although many of the symptoms of PTSD may be an appropriate initial response to a traumatic event, they are considered part of a disorder when they persist beyond three months.

• Treatment: Patients with anxiety disorders generally receive a combination of medications and psychotherapy.

• Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what is causing the anxiety disorder and how to deal with its symptoms. Many therapists use a combination of cognitive and behavioral therapies, this is often referred to as CBT (cognitive-behavioral therapy). CBT is based on the scientific fact that thoughts cause feelings and behaviors. The benefit of this fact is that an individual can change the way they think to feel and act better even if the situation causing the problem does not change.

• Patients may also take medications called benzodiazepines. These drugs are fast-acting sedatives that typically relieve anxiety symptoms within 30 minutes to one hour. The rapid relief makes these drugs very effective when taken during a panic attack or another overwhelming anxiety episode. Unfortunately, benzodiazepines can be addictive. If taken regularly for more than a couple of weeks, then physical and psychological addiction is likely to occur. Benzodiazepine may create tolerance, leading to larger doses needed to achieve the same effect, and serious withdrawal symptoms can occur when going off the medication, including increased anxiety, depression, and insomnia. Therefore, these medications should only be used short term.

• A benzodiazepine, called clonazepam (Klonopin®), is commonly used to treat social phobia and GAD. Lorazepam (Ativan®) is often used to treat panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and GAD.

• Anti-anxiety drugs, called azapirones, are commonly prescribed for GAD and OCD. Compared to benzodiazepines, the azapirones are slow acting, taking from two to four weeks to provide anxiety symptom relief.

• Medications, called antidepressants, may help reduce feelings of depression, anxiety, and OCD. Commonly prescribed antidepressants include fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), citalopram (Celexa®), and fluvoxamine (Luvox®). Side effects may include, but are not limited to, nausea, sexual dysfunction (including reduced sexual desire or orgasm difficulties), headache, diarrhea, agitation, nervousness, rash, restlessness, increased sweating, weight gain, drowsiness, or insomnia.

• Mood disorders:

• Overview: Mood disorders occur when patients experience episodes of depression, mania, and/or hypomania. Mood disorders can significantly interfere with an individual's thoughts, behavior, mood, activity, and physical health. Two of the most common mood disorders are depression and mania.

• Causes: Mood disorders tend to run in families. Studies suggest that a low or high level of neurotransmitters, such as serotonin, norepinephrine, or dopamine, cause mood disorders. Alcohol, smoking, and drug abuse may lead to mood disorders. Stressful life events, particularly a loss or threatened loss of a loved one or a job, can trigger symptoms of mood disorders. Long-term use of certain medications, such as some drugs used to control high blood pressure, sleeping pills, or birth control pills, may cause symptoms of depression in some people. Women experience depression about twice as much as men, which leads researchers to believe hormonal factors may play a role in the development of depression.

• Symptoms: Symptoms of major depression may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities usually enjoyed, and feelings of worthlessness or guilt. This type of depression may result in poor sleep, a change in appetite, severe fatigue, and difficulty concentrating. Severe depression may increase the risk of suicide.

• Individuals with atypical depression, as opposed to major depression, experience improved mood when something good happens. In addition, patients tend to have an increase in appetite or weight gain (as opposed to the reduced appetite or weight loss of "typical" depression), excessive sleeping (as opposed to insomnia), leaden paralysis (a severe form of fatigue or tiredness), and sensitivity to rejection.

• Dysthymia is a less severe type of depression (mild to moderate) than major depression. However, dysthymia is a long-term form of depression. Signs and symptoms are not usually disabling, and periods of mild depression can alternate with short periods of feeling normal.

• Having recurrent episodes of depression and elation (mania) is characteristic of bipolar disorder. Because this condition involves emotions at both extremes (poles), it's called bipolar disorder or manic-depressive disorder. Mania affects judgment, causing individuals to make unwise decisions. Some people have bursts of increased creativity and productivity during the manic phase. The number of episodes at either extreme may not be equal. Some people may have several episodes of depression before having another manic phase, or vice versa.

• Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. SAD usually occurs during the winter months. It may cause headaches, irritability, and a low energy level. SAD is not a chronic (long-term) depressive disorder.

• Postpartum depression is a more severe form of depression that can develop within the first six months after giving birth. For women with postpartum depression, feelings, such as sadness, anxiety, and restlessness, can be so strong that they interfere with daily tasks. Rarely, a more extreme form of depression known as postpartum psychosis can develop. Symptoms of this psychosis include a fear of harming oneself or one's baby, confusion, disorientation, hallucinations, delusions, and paranoia.

• Premenstrual dysphoric disorder (PMDD) occurs when depressive symptoms, such as crying, tiredness, and sadness, occur one week before menstruation and disappear after menstruation.

• Diagnosis: A diagnosis of depressive disorder is based on the criteria found in the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR), which was developed by the American Psychiatric Association. Blood tests may also be performed to determine if the levels of neurochemicals (brain chemicals), including serotonin, dopamine, and norepinephrine, are healthy.

• Treatment: Antidepressants are commonly used to reduce symptoms of depression.

• Serotonin-reuptake inhibitors (SSRIs) are commonly prescribed antidepressants. These drugs increase the amount of the neurochemical serotonin in the brain. This helps improve the patient's mood and energy levels. Commonly prescribed SSRIs include fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), citalopram (Celexa®), and fluvoxamine (Luvox®). Side effects of SSRIs may include: sexual dysfunction (including reduced sexual desire or orgasm difficulties), headache, diarrhea, agitation, nervousness, rash, restlessness, increased sweating, weight gain, drowsiness, and insomnia.

• Monoamine oxidase inhibitors (MAOIs) are less commonly prescribed antidepressants because they can cause serious side effects, including high blood pressure. MAOIs elevate the levels of neurochemicals in the brain synapses by inhibiting an enzyme called monoamine oxidase. Monoamine oxidase breaks down neurochemicals, including norepinephrine. When monoamine oxidase is inhibited, the norepinephrine is not broken down. As a result, higher levels of norepinephrine are present in the brain. Commonly prescribed MAOIs include phenelzine (Nardil®) and tranylcypromine (Parnate®).

• The most serious side effect associated with MAOIs is high blood pressure. An even more serious reaction, called hypertensive crisis, may occur if foods containing tyramine (e.g. aged cheese or wine) are consumed with MAOIs. Other side effects may include drowsiness, constipation, nausea, diarrhea, stomach upset, fatigue, dry mouth, dizziness, low blood pressure, lightheadedness, decreased urine output, decreased sexual function, sleep disturbances, muscle twitching, weight gain, blurred vision, headache, increased appetite, restlessness, trembling, weakness, and increased sweating.

• Adjustment disorders:

• Overview: Adjustment disorders occur when an individual has a severe emotional reaction to a stressful event. The disorder may affect the patient's emotions, thoughts, and/or behavior. In essence, patients have difficulty adjusting to changes in their lives. This disorder usually lasts about six months.

• Adjustment disorders can affect patients of all ages. However, among adults, women are likely than men to suffer from adjustment disorders.

• Causes: Although stress is known to trigger symptoms of adjustment disorders, the exact cause of the condition remains unknown. Researchers believe that several factors, including genetics, life experiences, and chemical changes in the brain, may contribute to the condition.

• Symptoms: Emotional symptoms of adjustment disorders typically include feelings of hopelessness, lack of enjoyment, frequent crying, nervousness, suicidal thoughts, anxiety, feelings of desperation, difficulty concentrating, and feeling overwhelmed. Behavioral symptoms may include increased aggression, reckless driving, avoiding family or friends, and poor performance at work or school.

• Diagnosis: Patients are diagnosed with adjustments disorders after a thorough psychological examination is performed to evaluate the patient's signs and symptoms. Patients must meet certain criteria that are explained in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Criteria include: 1) Emotional or behavioral symptoms within three months of a stressful event. 2) Severe symptoms that include the inability of the patient to function in daily life and distress. 3) Symptoms improve six months after the stressful event.

• Treatment: Patients with adjustment disorders typically receive a combination of psychotherapy and medications.

• Psychotherapy is an interactive process between a patient and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help them with problem solving. The goal of therapy is to help patients learn how to understand and cope with their disorders. This includes learning how to maintain healthy relationships and prevent relapses in the future. Therapy may also provide emotional support to the patient. Psychotherapy is conducted in private individual, couple, group, or family sessions. Sessions range from 50 minutes for individuals to 90 or 120 minutes for groups.

• Anti-anxiety drugs, such as buspirone (Buspar®), or antidepressants, such as fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®), or citalopram (Celexa®), may also be prescribed to reduce symptoms and prevent relapses.

• Developmental disorders:

• Overview: Developmental disorders are illnesses of the brain that develop during infancy or childhood. Common developmental psychological disorders include autism and intellectual disability (mental retardation).

• Autism, also called Kanner's syndrome, is a brain disorder that is associated with a wide range of developmental problems, especially in communication and social interaction. The severity of symptoms varies among patients. Some patients may be able to live independently as adults, while others may require lifelong support. Patients with severe autism may be unable to communicate or interact with other people. The most severe autism occurs when the patient is completely unable to communicate or interact with others. Children with autism may develop normally during the first few months or years of life. Then, usually before the age of three, patients become less responsive to others.

• Intellectual disability is a condition that causes significantly impaired cognitive functioning from birth or early infancy that ultimately limits the individual's ability to perform normal daily activities. In the past, intellectual disability was commonly called mental retardation. However, since the term has acquired a negative social stigma over the years, it is now more commonly referred to as intellectual disability.

• Causes: Although developmental disorders appear to be related to abnormalities in the brain, the exact cause of these conditions remains unknown. Several theories have been suggested as possible causes. Most researchers believe that several factors, including genetics and co-existing medical conditions, contribute to developmental disorders. In some patients, autism has been linked to other medical conditions, such as fragile X syndrome, tuberous sclerosis, epilepsy, and Tourette's syndrome. In addition, problems during pregnancy (e.g. infection or a mother who drinks or uses drugs during pregnancy), the baby not getting enough oxygen during delivery, and disease (e.g. whooping cough, measles, or meningitis) may lead to the development of intellectual disabilities.

• Symptoms: Autistic patients generally experience developmental problems that affect their behavior, social skills, and language. The severity of symptoms varies among patients.

• Autistic patients may move constantly and/or perform repetitive movements, such as spinning or rocking. Patients typically develop specific routines or rituals and become highly disturbed if their schedules are even slightly changed. Autistic patients may be unusually sensitive to touch, sound, or light. Some patients may be aggressive. Patients (adults and children) may throw temper tantrums. Patients may have short attention spans, abnormalities in eating or sleeping habits, or extreme overactivity or underactivity.

• Autistic patients may appear deaf because they may not respond to their name or they may appear to not hear others talking. An autistic patient may avoid eye contact with others or be unable to properly use body language, facial expressions, or gestures. Autistic patients may resist cuddling and holding, appear unaware of others' feelings, or seem to prefer playing alone.

• Emotional symptoms vary considerably among autistic patients. Some patients may be unaware of others' feelings or be unable to express their own emotions. Some patients may be noticeably anxious or become depressed or frustrated when they are unable to communicate to others. Patients who express affection towards others may express this feeling indiscriminately.

• Most children with autism are slow to learn new things or develop new skills. However, an estimated 25% of patients have normal to high intelligence. Autistic patients with normal to high intelligence are quick learners, but still have difficulty communicating to others and applying their knowledge to everyday life.

• Autistic children usually say their first words later than normal. Patients may lose the ability to say words or sentences that they were able to say in early childhood. Some patients may speak with an abnormal tone or rhythm. Patients may be unable to start or maintain conversations with others. Patients may repeat words or phrases but be unable to understand how to use them.

• Patients with mild intellectual disabilities have intelligence quotients (IQs) of 52-69. From birth to age six, patients are able to develop social and communication skills, but motor coordination is slightly impaired. By late adolescence, patients are able to learn until about a sixth-grade level. They are generally able to learn appropriate social skills. Adults are usually able to work and support themselves. Some patients may need help during times of social or financial stress.

• Patients with moderate intellectual disabilities have IQs of 36-51. Children younger than six years old are able talk or communicate with others, but social awareness is generally poor. The patient's motor coordination is typically fair. Adolescents are able to learn some occupational and social skills. They may be able to learn how to travel alone in familiar places. Adults may be able to support themselves with a job. They usually require guidance and assistance during mild social or financial stress.

• Patients with severe intellectual disabilities have IQs of 20-35. Young children can say a few words, but their speech is limited. Motor coordination is generally poor. Adolescents can usually talk or communicate with others. They are able to learn simple habits. Adults typically require lifelong assistance and guidance with daily activities.

• Patients with profound intellectual disabilities have IQs of 19 or lower. Children younger than six years old have very little motor coordination and may require nursing care. Adolescents typically have limited motor and communication skills. Adults usually require lifelong nursing care.

• Diagnosis: There is currently no specific test designed to diagnose autism. Instead, a diagnosis is made after the healthcare provider evaluates the patient's signs and symptoms. Some healthcare providers use screening tests, including the checklist for autism in toddlers (CHAT) or the autism screening questionnaire to determine whether or not a patient has autism. CHAT is a 16-question survey, in which parents or caregivers respond "yes" or "no" to questions about their children's behavior. This test helps healthcare providers diagnose autism in patients who are 18 months old or younger. The autism screening questionnaire, also called the pervasive development disorder (PDD) assessment scale, is a brief survey, in which parents or caregivers rate the patient's developmental difficulties as nonexistent, resolved, mild, moderate, or severe. This test helps healthcare providers diagnose autism in patients who are four years old or older.

• Doctors diagnose intellectual disability after a medical history, physical examination, and intellectual quotient (IQ) test. If a patient does not show signs of adaptive behavior and scores well below average on the IQ test, then a positive diagnosis is made. To measure the patient's adaptive behavior, professionals compare the patient's abilities to other children of his or her age. Many skills, including daily living skills (e.g. getting dressed, feeding oneself, and using the bathroom), communication skills (understanding what is being said and being able to respond), and social skills are important to adaptive behavior. Patients with mild intellectual disabilities have intelligence quotients (IQs) of 52-69. Patients with moderate intellectual disabilities have IQs of 36-51. Patients with severe intellectual disabilities have IQs of 20-35. Patients with profound intellectual disabilities have IQs of 19 or lower.

• Treatment: The foundation of autism treatment is behavioral therapy. For more than 30 years, several different types of behavioral therapy have helped autistic patients improve their communication and social skills, as well as their learning abilities and adaptive behaviors. Behavioral therapy has been shown to reduce inappropriate behavior, including aggression, in autistic children. Evidence suggests that behavioral therapy is the most effective if it is started early in life when the patient is three to four years old or younger.

• Antipsychotic drugs have also been used to help treat aggressive, repetitive, and hyperactive behaviors in autistic patients. Autistic patients may take risperidone (Risperdal®), olanzapine (Zyprexa®), or quetiapine (Seroquel®).

• Antidepressants may help reduce repetitive behaviors, tantrums, aggression, and irritability in autistic patients. Serotonin-reuptake inhibitors (SSRIs) are commonly prescribed antidepressants. These drugs increase the amount of the neurochemical serotonin in the brain. This helps improve the patient's mood and energy levels. Commonly prescribed SSRIs include fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), citalopram (Celexa®), and fluvoxamine (Luvox®). SSRIs may cause side effects, such as nausea, sexual dysfunction (including reduced sexual desire or orgasm difficulties), headache, diarrhea, agitation, nervousness, rash, restlessness, increased sweating, weight gain, drowsiness, or insomnia.

• Many patients with intellectual disabilities (mental retardation) need help improving their adaptive skills, which are needed to live, work, and function in the community. Teachers, parents, and caregivers can help patients work on their daily living skills, communication skills, and social skills.

• Patients with developmental disorders that affect learning must have the option of receiving education that is tailored to their specific strengths and weaknesses. According to the Individuals with Disabilities Education Act, all children with disabilities, including autism and intellectual disabilities, must receive free and appropriate education. According to the law, members of the patient's school should consult with the patient's parents or caregivers to design and write an individualized education plan. Once all parties agree with the plan, the educational program should be started. The school faculty should document the child's progress in order to ensure that the child's needs are being met.

• Educational programs vary among patients. In general, most experts believe that children with disabilities should be educated alongside their non-disabled peers. The idea is that non-disabled students will help the patient learn appropriate behavior, as well as social and language skills. Therefore, some patients are educated in mainstream classrooms. Other patients attend public schools but take special education classes. If the disability is severe or profound, then patients may benefit from specialized schools that are designed to teach children with disabilities.

• Somatoform disorders:

• Overview: Somatoform disorders occur when patients experience physical symptoms that cannot be attributed to a specific disease or disorder. In order to be diagnosed with a somatoform disorder, symptoms must interfere with an individual's daily life.

• There are many different types of somatoform disorders, including conversion disorder, somatization disorder, and body dysmorphic disorder, all of which have unique symptoms.

• Causes: Several factors, including stress, parental upbringing, cultural influences, and biological makeup, may be involved in the development of somatoform disorders.

• Symptoms: Conversion disorder, formerly called hysteria, is a rare mental illness that occurs when a patient has physical symptoms, such as inability to speak or sudden blindness, which are caused by emotional distress. For instance, patients who witness a terrifying or traumatic event may suddenly lose their vision. These symptoms appear suddenly and involuntarily. Symptoms may include one or more of the following: inability to speak, difficulty or inability to walk, inability to swallow, blindness, deafness, paralyzed body part, non-epileptic seizures, hallucinations, numbness, loss of balance, loss of touch or pain sensation, abnormal gait, vomiting, diarrhea, and inability to urinate. Conversion disorder is different than other somatoform disorders because it primarily affects sensory and motor functions, which can normally be controlled. Conversion disorder is considered a temporary condition that usually resolves on its own in about one month.

• Somatization disorder, formerly called Briquet's syndrome, occurs when patients experience symptoms in many different organ systems that cannot be explained. Patients with somatization disorder experience at least four symptoms of pain, two symptoms in the digestive tract, one symptom involving the nervous system (brain and spinal cord), and one symptom affecting the reproductive tract. Symptoms of somatization disorder usually develop before the age of 30 and last throughout the patient's life. For unknown reasons, females are more likely to develop this disorder than males.

• Body dysmorphic disorder occurs when a patient becomes preoccupied with an exaggerated or imagined defect in his/her appearance. Patients may seek out plastic surgery or other procedures in an effort to correct their perceived bodily defects. Although most patients believe they have defects in facial features, individuals may become preoccupied with any body part. Symptoms of body dysmorphic disorder usually develop during adolescence. Symptoms usually fluctuate throughout the patient's life. Men and women are affected equally by body dysmorphic disorder.

• Diagnosis: Somatoform disorders are diagnosed after a physical and psychological examination. The healthcare provider will perform tests to determine whether or not there is a physical basis for the symptoms. If there appears to be no physical cause for the patient's condition, then a mental health professional is recommended.

• Patients must meet several criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) to be diagnosed with conversion disorder. 1) Symptoms must affect the patient's voluntary motor or sensory functions. 2) Symptoms can be linked to psychological factors or stressors that occurred before the condition developed. 3) The patient has no voluntary control over the symptoms. 4) There appears to be no physiological factor that is causing the symptoms. In other words, the patient does not suffer from any medical conditions that may cause symptoms. 5) Symptoms must cause significant distress or impairment. 6) Symptoms are not limited to pain or sexual dysfunction, and they cannot be attributed to another type of mental illness.

• Patients with somatization disorder must have at least four symptoms of pain, two symptoms in the digestive tract, one symptom involving the nervous system (brain and spinal cord), and one symptom affecting the reproductive tract to be diagnosed with the condition.

• A mental professional will use the Body Dysmorphic Disorder Questionnaire (BDDQ) to diagnose body dysmorphic disorder. Patients will respond to multiple questions regarding their thoughts and feelings about their personal appearance. A mental health professional may also ask a series of questions during a Body Dysmorphic Disorder Examination (BDDE). These questions are tailored to help determine if the patient is preoccupied with his/her physical appearance, is self conscious in public, avoids social situations and physical contact with others, overvalues appearance as a measurement of self-worth, goes to extreme lengths to change or improve his/her appearance, and frequently checks his/her appearance in mirrors or seeks approval from others.

• Treatment: Patients with somatoform disorders may receive antidepressants or anti-anxiety medications if they suffer from mood or anxiety disorders. However, most patients do not received medications because they have an increased risk of becoming psychologically dependent on drugs.

• Patients typically undergo group therapy and/or family therapy to help reduce symptoms of the disorder. This type of therapy may provide support to the patient and help friends and family members learn how to cope with the disorder.

• Cognitive behavioral therapy (CBT) may also be beneficial. This therapy involves teaching the patient how to think about problems in a new way in order to improve emotional and behavioral responses. The mental health professional will first help the patient identify unhealthy negative beliefs and behaviors. These negative behaviors or beliefs are then replaced with positive ones.

• Patients with somatoform disorders may also benefit from suggestive therapy. This involves having a healthcare provider suggest or state that the patient's symptoms will resolve on their own and their muscles and organs are not damaged. This reassures the patient and may help reduce feelings of nervousness or anxiety. However, healthcare providers should not discredit the patient's symptoms. Although there is no physical basis for their symptoms, the patient cannot voluntarily control them.

• Dissociative disorders:

• Overview: Dissociative disorders occur when individuals involuntarily try to escape from reality. For instance, patients may suppress troubling memories or even take on alternative identities. There are four main types of dissociative disorders: dissociative amnesia, dissociative identity disorder, dissociative fugue, and depersonalization disorder.

• Causes: Dissociative disorders usually develop in response to traumatic experiences. It appears to be a coping mechanism to keep troubling memories at bay. Dissociative disorders are most common among children who have been emotionally, physically, or sexually abused. In some cases, the disorder may develop in children who are raised in frightening or unpredictable environments. This is because a patient's personality is still developing during childhood. During these years, a child is more capable of stepping outside of reality to observe traumatic events as if it is happening to someone else. As a result, children are more susceptible than adults to developing these disorders. Once a child develops a dissociative disorder, he/she may use this coping mechanism throughout life.

• Symptoms: In general, dissociative disorders cause symptoms, such as blurred sense of identity, depression, anxiety, sense of being detached from oneself (depersonalization), perception that things and people are unreal (derealization), and memory loss (amnesia) of certain time periods, events, or people. Additional symptoms depend on the specific type of dissociative disorder.

• Dissociative amnesia causes unexplained memory loss of traumatic events that took place earlier in the patient's life.

• Dissociative identity disorder, also called multiple personality disorder, causes the patient to switch to alternate identities in stressful situations. Some patients believe they hear one or more people talking inside their heads. Each identity may have its own name and characteristics, including gender and voice. Patients with dissociative identity disorder usually have dissociative amnesia at the same time.

• Patients with dissociative fugue typically put a physical distance between themselves and their identity. For instance, patients may travel to a new location where they adopt an entirely new identity. Episodes may last anywhere from a few hours to several months. When the episodes ends, patients often feel disoriented and may have no recollection of what happened during the fugue.

• Depersonalization disorder causes patients to feel as though they are observing themselves from a distance. Patients might feel like they are watching themselves in a movie. In addition, some patients may have distorted views of the shape and size of their own bodies and things around them. It may feel like people are moving in slow motion or time is slowing down. People and things may seem unreal. Episodes usually only last a few minutes. Symptoms may come and go over several years.

• Diagnosis: During a physical examination, a healthcare provider may perform tests, such as a magnetic resonance imaging (MRI) scan of the brain, to rule out other possible causes of the symptoms. If a dissociative disorder is suspected, then a mental health professional will be recommended. The condition is diagnosed after a detailed psychological evaluation.

• Treatment: The primary treatment of dissociative disorders is psychotherapy. Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what is causing the anxiety disorder and how to deal with its symptoms.

• Cognitive behavioral therapy (CBT) may also be beneficial. This therapy involves teaching the patient how to think about problems in a new way in order to improve emotional and behavioral responses. The mental health professional will first help the patient identify unhealthy negative beliefs and behaviors. These negative behaviors or beliefs are then replaced with positive ones.

• In addition, some patients may also take antidepressants, anti-anxiety medications, or sedative to help reduce symptoms associated with dissociative disorders.

• Personality disorders:

• Overview: Personality disorders cause patients to feel or behave in socially distressing ways that impair their abilities to function, especially in relationships with others.

• There are 10 main personality disorders, which are categorized into three major groups. The first group, called cluster A, includes personality disorders that are characterized by odd behavior. This group includes paranoid, schizoid, and schizotypal personality disorders. Cluster B personality disorders are characterized by dramatic or emotional behavior. This group includes histrionic, narcissistic, antisocial, and borderline personality disorders. Patients with cluster C personality disorders are generally fearful and anxious. This group includes patients who are obsessive-compulsive, avoidant, and excessively dependent.

• Causes: Researchers believe several factors, including the patient's personal history and genetics, may lead to the development of personality disorders.

• Symptoms: Cluster A personality disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Symptoms of paranoid personality disorder may include hostility or aggression towards others, emotional detachment, inability to work collaboratively with others, as well as misconceptions that others are lying, cheating, or behaving maliciously to harm the patient. Symptoms of schizoid personality disorder include extreme introversion, fantasizing, emotional detachment, and fixation on the patient's own thoughts or feelings. Symptoms of schizotypal personality disorder may include indifference to and detachment from others, odd style of dressing or interacting with others, and having suspicious or paranoid ideas. Patients typically believe that their thoughts can influence people and events.

• Cluster B personality disorders include histrionic personality disorder, narcissistic personality disorder, antisocial personality disorder, and borderline personality disorder. Common symptoms of histrionic personality disorder include sensitivity to others' approval, false sense of intimacy with others, frequent mood swings, and attention-grabbing behavior. Symptoms of narcissistic personality disorder often include inflated ego, inability to empathize with others, excessive shame or anger in response to criticism, selfish behavior, and attention-grabbing behavior. Symptoms of antisocial personality disorder include frequent lying and stealing, lack of guilt after hurting others, lack of concern for others' feelings or wellbeing, irresponsibility, unreliability, and aggressive behavior. Symptoms of borderline personality disorder may include difficulty controlling emotions or impulses, dramatic changes in moods or opinions, aggressive behavior, fear of being alone, and suicidal thoughts.

• Cluster C personality disorders include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Common symptoms of avoidant personality disorder include voluntary isolation from others, extreme shyness, and hypersensitivity to criticism. Symptoms of dependent personality disorder typically include dependence on others to meet physical and emotional needs, tolerance of poor or even abusive treatment in order to maintain relationships, and fear of being alone. Symptoms of obsessive-compulsive personality disorder may include excessive concern with order and schedules, perfectionism, inflexible with change or disorder, and compulsive devotion to work.

• Diagnosis: Currently, there are no laboratory tests to diagnose personality disorders. A healthcare provider typically makes a diagnosis after reviewing the patient's medical history and performing a psychological exam. The healthcare provider may also ask friends and family members questions about the patient's behavior. Most healthcare professionals believe that a diagnosis should not be made until the patient is an adult. This is because many adolescents may appear to have symptoms of personality disorders when they do not actually have the disorder.

• Treatment: Psychotherapy, also called counseling or talk therapy, is the main treatment for personality disorders. Psychotherapy is an interactive process between a patient and a qualified mental health professional. The patient will explore thoughts, feelings, and behavior to help them with problem solving. The goal of therapy is to help patients learn how to cope with their condition. This includes learning how to maintain healthy relationships and prevent relapses in the future. Therapy may also provide emotional support to the patient. Psychotherapy is conducted in private individual, couple, group, or family sessions. Sessions range from 50 minutes for individuals to 90 or 120 minutes for groups.

• A type of psychotherapy called cognitive behavioral therapy may also help treat personality disorders. This therapy involves teaching the patient how to think about problems in a new way in order to improve emotional and behavioral responses. The mental health professional will first help the patient identify unhealthy, negative beliefs and behaviors. These negative behaviors or beliefs are then replaced with positive ones.

• Patients may also receive antidepressants, anti-anxiety medications, or sedatives to help reduce symptoms of personality disorders.

• Anticonvulsants may be prescribed to suppress impulsive and aggressive behavior, which is often associated with personality disorders. Commonly prescribed anticonvulsants include carbamazepine (Carbatrol® or Tegretol®) and valproic acid (Depakote®).

• Psychotic disorders:

• Overview: Psychotic disorders, also called psychosis, occur when patients are unable to differentiate between what is real and unreal. Psychotic symptoms may include hallucinations, irrational thoughts and fears, disorganized thoughts, and bizarre or inappropriate behavior.

• There are several different types of psychotic disorders, including schizophrenia, schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder.

• Causes: Researchers are still trying to identify the cause of psychotic disorders. It is thought that genetics may play a role because an estimated 10% of patients with family histories of schizophrenia develop the disorder compared to one percent of the general population. Chemical abnormalities in the brain may also contribute to the development of psychotic disorders.

• Symptoms: Schizophrenia is a brain disorder that causes patients to suffer from delusions and hallucinations for more than six months. Delusions occur when patients lose touch with reality. Common symptoms of schizophrenia include social withdrawal, intense anxiety, feelings of being unreal, loss of appetite, loss of hygiene, difficulty processing information, poor memory, depressed mood, and sense of being controlled by outside forces. The behavior of schizophrenic patients varies widely. In men, symptoms of schizophrenia usually develop when patients are in their teens or 20s. Women usually develop the disorder when they are 20-30 years old.

• Patients with schizoaffective disorder have symptoms of schizophrenia, as well as serious mood or affective disorder (e.g. depression bipolar disorder, or mania).

• Patients with schizophreniform disorder suffer from symptoms of schizophrenia. However, unlike schizophrenia, symptoms last six months or less.

• Brief psychotic disorder is an illness that occurs when patients have short periods of psychotic behavior, usually in response to stressful events, such as a death in the family. Patients usually recover in less than one month.

• Diagnosis: There is no clinical test available to diagnose psychotic disorders. Patients will first undergo a physical examination. The healthcare provider will rule out other possible causes of the symptoms, such as seizure disorders, metabolic disorders, brain tumors, or thyroid dysfunction. Once these conditions are ruled out, a psychological evaluation is recommended. The mental health professional diagnoses the specific psychotic disorder after reviewing the patient's symptoms and personal and medical history.

• Treatment: Patients with psychotic disorders usually receive a combination of psychotherapy and medications, called antipsychotics. In addition, rehabilitations programs and applied behavior analysis therapy may also be beneficial.

• Psychotherapy is an interactive process between a patient and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help them with problem solving. The goal of therapy is to help patients learn how to cope with their disorders. This includes learning how to maintain healthy relationships and prevent relapses in the future. Therapy may also provide emotional support to the patient. Psychotherapy is conducted in private individual, couple, group, or family sessions. Sessions range from 50 minutes for individuals to 90 or 120 minutes for groups.

• A type of psychotherapy, called family therapy, may be a beneficial treatment for both psychiatric patients and their family members. This type of therapy helps the family understand and learn how to cope with the patient's illness. Family members will learn how to identify possible situations that may trigger an episode in the patient. It may also provide emotional support to the patient.

• Patients with psychotic disorders may benefit from rehabilitation programs. These programs, which usually last several months, are tailored to the patient's individual needs. Rehabilitation programs typically include training in vocational and social skills to help the patient live independently and maintain a job.

• Antipsychotics (neuroleptics) are typically taken to reduce symptoms of psychosis. In order to be effective, these drugs must be taken regularly. Although these drugs cannot prevent relapses from occurring, they can help reduce the frequency of relapses. Commonly prescribed antipsychotics include clozapine (Clozaril®), risperidone (Risperdal®), olanzapine (Zyprexa®), quetiapine (Seroquel®), ziprasidone (Geodon®), and aripiprazole (Abilify®). According to the American Diabetes Association, some of these drugs may increase the risk of diabetes, obesity, and high blood pressure. Because nicotine interferes with antipsychotics, smokers may need to take higher doses of medications.

• In addition, anticonvulsants may be prescribed to suppress impulsive and aggressive behavior, which may be associated with psychotic disorders. Commonly prescribed anticonvulsants include carbamazepine (Carbatrol® or Tegretol®) and valproic acid (Depakote®). Side effects vary depending on the specific type of medication prescribed. The most common side effects associated with anticonvulsants include lethargy, nausea, dizziness, and anemia.

Complications

• Aggressive or violent behavior: Patients with psychiatric disorders may be more aggressive or violent than patients who are healthy. This is because many disorders cause patients to feel paranoid and their sense of reality may be blurred.

• Other mental illnesses: Patients with psychiatric disorders have an increased risk of developing other mental illnesses, including anxiety, depression, and eating disorders.

• Social isolation and interpersonal problems: Patients with psychiatric disorders, especially personality disorders and psychotic disorders, may have difficulty maintaining healthy relationships with others. This might happen if the disorder limits an individual's ability to relate to or communicate with others. Some individuals who experience aggressive behavior or impulsivity as a symptom of a psychiatric disorder may inadvertently exclude friends and family members. As a result, patients often feel socially isolated and alone.

• Suicide: Patients with psychiatric disorders may have suicidal thoughts or attempt to commit suicide. Anyone who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.

• Substance abuse: Patients with psychiatric disorders have an increased risk of becoming addicted to alcohol and/or drugs. Patients may turn to drugs to help them cope with their illness. However, drug use usually worsens symptoms of psychiatric disorders.

• Self-destructive behavior: Some psychiatric patients, especially those with borderline personality disorders, are more likely to engage in dangerous or risky behaviors, such as gambling. Also, patients with dependent personality disorder may stay in abusive relationships because they are afraid to be alone.

Tips For Friends and Family Members

• Support groups: Support groups can provide emotional support to friends and family members of patients with psychiatric disorders. Individuals are able to share their problems and provide support for one another.

• Education: Friends, family members, and caregivers should educate themselves about the patient's psychiatric illness. The more a caregiver knows about the condition, the better they can help the patient. Being educated on the illness may also help the caregiver learn how to communicate better with the patient.

Integrative Therapies

• Strong scientific evidence:

• Music therapy: Music therapy that includes either chorus or karaoke may improve interpersonal functioning in people with schizophrenia. Music therapy may also help reduce symptoms of schizophrenia, including psychosis. Non-classical music was found to be more effective than classical music. Also, it does not seem to make a difference if the music is live or recorded or if therapy is structured or not structured. Music therapy is generally known to be safe.

• Good scientific evidence:

• Hypnosis, hypnotherapy: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions and to change behaviors. Hypnotherapy techniques may be used as an adjunct to cognitive behavioral therapy (CBT) for the treatment of conditions such as anxiety, insomnia, pain, bed-wetting, post-traumatic stress disorder, or obesity. Better-quality research is necessary in this area.

• Use cautiously with mental illnesses (e.g. psychosis, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.

• Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to improve problem solving skills. Although prescription medications are usually the best way to help patients with schizophrenia, psychotherapy, especially cognitive therapy, may greatly enhance coping, social skills, and quality of life. It has also been shown to reduce psychotic relapse and re-hospitalization.

• Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.

• Therapeutic touch: There is some evidence that therapeutic touch may reduce anxiety in children with life-threatening illnesses, reduce stress in teenagers with psychiatric disease, and help relax premature infants. More research is needed before therapeutic touch can become a standard treatment for psychiatric disorders in children.

• Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.

• Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Yoga has been described as "the union of mind, body, and spirit." Healthy individuals with the aim to achieve relaxation, fitness, and a healthy lifestyle often practice yoga. Several human studies support the use of yoga therapy to treat schizophrenia and other psychiatric disorders.

• Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.

• Unclear or conflicting scientific evidence:

• 5-HTP: 5-HTP (5-Hydroxytroptophan) is the precursor for serotonin. Serotonin is the brain chemical associated with sleep, mood, movement, feeding, and nervousness. While other cells outside the brain, such as blood platelets and some cells in the intestine, make and/or use serotonin, all serotonin used by brain cells must be made within the neurons themselves. When serotonin is not properly constructed inside the brain, the result can be irritability, aggression, impatience, anxiety, and depression. It has been suggested that 5-HTP may reduce psychotic symptoms and mania or aid in panic disorder, but studies in people with schizophrenia have shown different results. Further well-designed research is needed to better understand the potential role of 5-HTP in psychiatric disorders.

• Avoid if allergic to 5-HTP. Use cautiously with a history of mental disorders. Avoid if pregnant or breastfeeding.

• Art therapy: Art therapy involves many forms of art to treat anxiety, depression, and other mental and emotional problems. Art therapy became a mental health profession in the 1930s. Today, it is practiced in hospitals, clinics, public and community agencies, wellness centers, educational institutions, businesses, and private practices. There is limited evidence suggesting that art therapy may aid in restoring communication in people suffering from schizophrenia, including in children. Some research suggests it may also help patients adhere to treatment more reliably. However, more studies are needed to determine the best use with this population.

• Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (such as turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.

• Betel nut: Betel nuts come from the areca tree, a tropical palm tree. In Asia, the nuts are combined with other ingredients and chewed similarly to the way tobacco is chewed in the West. Betel nut use refers to a combination of three ingredients: the nut of the betel palm, part of the Piper betel vine, and lime. These ingredients are wrapped in a betel nut leaf and placed inside the mouth. Based on the results of a few poorly designed human studies, chewing betel nut may improve symptoms of schizophrenia. However, side effects, such as tremors and stiffness, have been reported. More research is necessary before a firm conclusion can be drawn.

• The known toxicities of chewing betel nut likely outweigh any possible benefits. Avoid if allergic to betel nut or other plants of the Palmaceae family. Avoid with a history of asthma, Huntington's disease, urinary incontinence, mental illness, chest pain (angina), blood pressure disorders, irregular heartbeat (arrhythmia), heart attack, diabetes, kidney disease, low calcium levels, cancer, or thyroid disease. Avoid if pregnant or breastfeeding. Ingestion of 8-30 grams of areca nut may be deadly.

• Bowen therapy: Bowen technique has been used in psychiatric inpatient care settings, but its effectiveness for psychiatric disorders is unclear at this time.

• There is currently a lack of available scientific study on the safety of Bowen therapy. Based on case study that investigated Bowen therapy as a treatment for frozen shoulder, no adverse effects were reported. Avoid the "Coccyx Procedure" in pregnant women. Avoid the "TMJ Procedure" in people whose jaws have been surgically altered at the condyles. Avoid the "Breast Tenderness Procedure" in women with breast implants. Avoid using the Bowen technique in place of more proven therapies.

• Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. Chiropractors use many techniques, including spinal manipulative therapy, diet, exercise, X-rays, as well as interferential and electrogalvanic muscle stimulation. There is currently insufficient evidence to determine whether or not spinal manipulation can help manage emotional problems.

• Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously if at risk of developing tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency (disorder in which blood supply to the back of the brain is disrupted), aneurysms, unstable spondylolisthesis, or arthritis. Avoid if taking drugs, herbs, or supplements that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.

• Chromium: Early study shows a lack of effect of chromium supplementation on mental state and body weight in people with schizophrenia. Additional study is needed.

• Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.

• Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs (e.g. liver and kidneys). Some studies involving patients with schizophrenia report high blood copper levels with low urinary copper (suggesting that copper is being retained), and low blood zinc levels. In some of these cases, zinc was observed to be helpful as an anti-anxiety agent. The role of copper supplementation is not clear.

• Avoid if allergic or hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia. Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than six milligrams per liter. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking birth control pills. Use cautiously if at risk for selenium deficiency. The recommended dietary allowance (RDA) is 1,000 micrograms for pregnant women. The RDA for breastfeeding women is 1,300 micrograms.

• DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. Initial research reports that DHEA supplementation may help manage the negative, depressive, and anxiety symptoms of schizophrenia. In addition, DHEA may help reduce some of the side effects of prescription drugs that are used to treat this disorder. Further research is needed to confirm these results.

• Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants or drugs, herbs, or supplements that treat diabetes, heart disease, seizures, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.

• Ginkgo: Ginkgo biloba has been used medicinally for thousands of years. Based on ginkgo's proposed antioxidant effects, ginkgo has been studied in the treatment of schizophrenia. Although early study is promising, there is currently not enough scientific evidence to make a strong recommendation.

• Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin (Coumadin®)) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.

• Hypnosis, hypnotherapy: More high-quality studies are needed to determine the effectiveness and safety of hypnosis for schizophrenia.

• Use cautiously with mental illnesses (e.g. psychosis, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.

• Melatonin: Melatonin is a neurohormone produced in the brain. Levels of melatonin in the blood are highest before bedtime. Melatonin products have been used for a many medical conditions. It is most often used for people who have trouble sleeping (insomnia). Limited research suggests that melatonin may help reduce the time it takes schizophrenia patients to fall asleep. Further research is needed to better understand the role of melatonin in sleep disorders associated with schizophrenia.

• There have been reports of allergic reactions to melatonin taken by mouth. Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses for short-term use. Use cautiously if taking anticoagulants, anti-diabetic drugs, or drugs that lower blood pressure. Use cautiously with seizure disorders, psychiatric disorders, diabetes, glaucoma, or low blood pressure.

• Moxibustion: Moxibustion is a therapeutic method that is used in traditional Chinese medicine (TCM) acupuncture and Japanese acupuncture. During the therapy, an herb (usually mugwort) is burned above the skin to introduce heat into an acupuncture point and reduce symptoms. It may be applied in the form of a cone, stick, or loose herb; or it may be placed on the head of an acupuncture needle to manipulate the temperature gradient of the needle. Limited available evidence suggests that patients with schizophrenia may respond to a treatment regime that includes acupuncture and moxibustion. Additional research is needed in this area.

• Avoid with aneurysms, any kind of "heat syndrome," heart disease, convulsions, cramps, diabetic neuropathy, extreme fatigue, anemia, fever, or inflammatory conditions. Do not use over allergic skin conditions, ulcerated sores, skin adhesions or inflamed organs. Avoid using over the face, genitals, head, or nipples. Avoid in patients who have just finished exercising or taking a hot bath or shower. Not advisable to bathe or shower for up to 24 hours after a moxibustion treatment. Use cautiously over large blood vessels and thin or weak skin. Use cautiously if elderly or with large blood vessels.

• Omega-3 fatty acids: Omega-3 fatty acids are found in fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Preliminary evidence suggests that omega-3 fatty acid may help treat patients with schizophrenia. However, further research is needed to draw a firm conclusion.

• Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery. Omega-3 fatty acids appear safe during pregnancy and breastfeeding as long as they are taken in doses that do not exceed the recommended dietary allowance (RDA).

• Pet therapy: Pet therapy, also called animal-assisted therapy or AAT, is a goal-directed intervention in which an animal that meets specific criteria is used as part of a patient's medical treatment. Animals may be selected for friendliness, ability to interact in a non-threatening way, or simply for non-obtrusive companionship. Pet therapy is used to provide psychological benefits for patients with mental illness, such as emotional connection, stress reduction, and reduced feelings of loneliness or isolation. There is evidence that the presence of a pet dog among psychiatric inpatients promotes social interactions. In people with schizophrenia, there is evidence that pet therapy may lead to improved interest in rewarding activities, as well as better use of leisure time and improved motivation. There is also evidence of improvement in socialization skills, independent living, and general well-being. In a large, well-designed study, hospitalized patients with a variety of psychiatric disorders were found to have reduced anxiety after a single session of pet therapy. For most patients, the benefits were superior to those of a session of regular recreational therapy.

• Avoid if allergic to animal dander. Use only animals that have had veterinary screening, particularly in situations involving young children, frail elderly patients, or people with weakened immune systems. Do not provide unsupervised use of animals with the severely mentally ill or very young children. Avoid if afraid of animals or with a traumatic history involving animals.

• Prayer, distant healing: Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. Prayer on behalf of the ill or dying has played a prominent role throughout history and across cultures. Metaphysical explanations and beliefs often underlie the practice of prayer. Further research is needed to better understand the effectiveness of prayer for psychological disorders.

• Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches, and require an open dialog between patients and caregivers.

• Psychotherapy: Cognitively oriented psychotherapy for early psychosis (COPE) showed no beneficial treatment effect over the Early Psychosis Prevention and Intervention Centre (EPPIC). Preliminary studies also suggest that psychodynamic therapy and cognitive behavior therapy may be more effective treatments for personality development disorders than other forms of psychotherapy. More research is needed to evaluate these approaches.

• Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.

• Rutin: Rutin is a yellow crystalline flavonol glycoside that is found in various plants, especially the buckwheat plant, black tea, apple peels, onions, and citrus. A well-designed study suggests that O-[beta-hydroxyethyl]-rutosides may offer benefit for patients with schizophrenia. More studies are required in this area before a strong recommendation can be made.

• Avoid if allergic/hypersensitive to O-(beta-hydroxyethyl)-rutosides or plants that rutin is commonly found in, such as rue, tobacco or buckwheat. Use cautiously with skin conditions or in elderly patients. Use cautiously if taking medications for edema, diuretics, or anti-coagulation medications. Use cautiously if pregnant or breastfeeding.

• Spiritual healing: Early research suggests that when spiritual healing is added to psychotherapy, psychiatric patients have improved relaxation and sense of well being. However, additional research is needed to better understand the role of psychotherapy in treatment of psychiatric disorders.

• Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.

• Traditional Chinese medicine (TCM): Chinese medicine is a broad term that refers to many different treatments and traditions of healing. They share a common heritage of technique or theory that is rooted in ancient Chinese philosophy (Taoism) and dates back to more than 5,000 years ago. Based on early data, Chinese herbal medicines may help treat schizophrenia when combined with prescription medications. Schizophrenia should be treated by a qualified healthcare practitioner including a psychiatrist and pharmacist.

• Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ephedra (ma huang). Avoid ginseng if pregnant or breastfeeding.

• Fair negative scientific evidence:

• Choline: Choline is an amino alcohol that the body needs to produce acetylcholine. The largest dietary source of choline is egg yolk. Choline may also be found in high amounts in liver, peanuts, fish, milk, brewer's yeast, wheat germ, soy beans, bottle gourd fruit, fenugreek leaves, shepherd's purse herb, Brazil nuts, dandelion flowers, poppy seeds, some beans (e.g. mung beans), and a variety of meats and vegetables, including cabbage and cauliflower. Available research suggests that choline is not an effective treatment for schizophrenia.

• Avoid if allergic or hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.

• Evening primrose oil: Evening primrose oil contains an omega-6 essential fatty acid called gamma-linolenic acid (GLA), which is believed to be the active ingredient. Results from studies of mixed quality do not support the use of evening primrose oil for schizophrenia.

• Avoid if allergic to plants in the Onagraceae family (e.g. willow's herb or enchanter's nightshade) or gamma-linolenic acid. Avoid with seizure disorders. Use cautiously with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.

Prevention

• Children who are physically, emotionally, or sexually abused have an increased risk of developing mental illnesses, especially dissociative disorders or conversion disorders. Parents or caregivers of a child who has been abused or exposed to a traumatic event should talk to the child's doctor. The healthcare provider can recommend a mental health professional who may help the child learn healthy coping skills.

• Patients who develop symptoms of psychiatric disorders should visit their healthcare providers as soon as possible. Early diagnosis has been shown to improve the long-term prognoses of patients with mental illnesses.

• Patients with a history of psychiatric disorders should avoid situations that may trigger relapses. Stress is one of the most common triggers.

• Patients should take their medications exactly as prescribed in order to prevent relapses.

• Patients should continue therapy as needed in order to prevent relapses.

• Patients who have a strong support network of friends and family members are less likely to have relapses.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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