3 Faulty Thinking Patterns in Depression

A gorgeous young lady walked into my office looking nicely dressed and corporate. Her story was that she was finding it very difficult to fall asleep at night and that this had been going on for weeks now. Less than 10 minutes into the interview she started weeping profusely stating she was anxious about her health and the possibility of her lack of sleep affecting her mental health. She was very worried about how this could impact her future and her chances of getting married. She also felt overwhelmed by a feeling of low self-esteem: she felt everyone else was better dressed and more intelligent compared to her.

This lady was actually experiencing the 3 patterns of faulty thinking that are common in people who are depressed or susceptible to becoming depressed. They are called the Cognitive triad of depression.

The Cognitive triad of depression entails negative thoughts about

# 1 Self

The individual sees him or herself as deficient, worthless or flawed. They tend to minimize their achievements and magnify their faults.

 
# 2 The world/environment

This entails a tendency to give negative interpretations to events or people around.

 

# 3 The Future

The future looks hopeless. He or she may view their current suffering as permanent.

 

Read up more about signs and symptoms of depression

Remember people with mental illness can live more productive lives. When you are better educated about what you’re dealing with, then you are never without hope. Let’s spread the awareness not the stigma. Talk to a professional today.

Q & A sessions with Dr. Edebi

Dear Doc, I have schizophrenia but I am currently stable on my meds. I will like to know if these antipsychotics are safe during pregnancy and breastfeeding.

---R.E

The use of antipsychotics during pregnancy and breastfeeding is largely safe. Though the data on the safety of the use of antipsychotic drugs in pregnancy and breastfeeding are limited, reports of harm to baby from the use of these drugs are very uncommon. All antipsychotics drugs are sedating therefore when the baby is born it advisable to look out for lethargy, sedation and appropriate developmental milestones.

Pregnancy and breastfeeding period is not a time to stop your medications rather it’s best you work closely with your doctor during this period instead.

 

For further reference on this check Here

That extreme excitement may be a tell-tale sign

My first case of mental illness just about when I was starting my residency training in psychiatry back in 2006 was a case of Bipolar Disorder.  

Jimmy (not real name) is like a younger brother and he came to pay me a visit at home. He appeared very happy however everything else seemed fine. He shared with me some of his new spiritual experiences and how he had become bolder and more expressive of himself. He simply said that he was having one of the best times of his life and that he had all these fabulous ideas going through his mind. We chatted till about 12 midnight then I had to stop the discussion simply because I had to go to work the following day. At about 3 a.m. Jimmy was up again. He woke me up saying that he wanted to chat some more because he had discovered that, in his words, “great men don’t have need of sleep.” It was at that point that it hit me that Jimmy was having a mental breakdown.

Jimmy has a condition called Bipolar Disorder. Read about the signs and symptoms Here and Here. The proportion of any population regardless of ethnicity, race or geographical location that is usually affected by this illness is usually about 2%. Young people with Bipolar disorder have far greater risk of committing suicide.

Some famous people who are known to have this illness are Ted Turner, an American Billionaire media mogul, founder of CNN; Jean Claude Van Damme-a very successful martial art actor; and Winston Churchill-a famous British Prime Minister who was noted for his leadership of the British Army during the Second World War.

Bipolar disorder, though challenging, can be managed when proper management is sought. Remember that “when you are better educated about what you are dealing with, then you are never without hope.” Let’s spread the awareness not the stigma. Talk to a professional today.

#demystifyingmentalillness
#PDoc
#diaryofapsychiatrist

“Doc, don’t you think most mental illnesses are spiritual attacks?”

This is a common question I encounter during some of our mental health awareness campaign programs. More often than not most people refer to episodes of mental breakdown as periods of “attacks”.

I consider myself as also being a spiritual person however here is my usual response to this commonly asked question

1. I believe that mental illnesses are not more spiritual than other physical illnesses. For instance the Bible listed madness¹ as a curse however it also listed fever², inflammation¹, burning fever¹ and blindness² as curses too. Do we then say when someone is blind or has a fever for instance, that he or she is cursed or demon possessed? The Bible records that Jesus cast out a demon from a ‘mad’ man and after the demons left, the man became sane.³ The same Bible recorded that Jesus also cast out a demon from a speech impaired (dumb) man too and the man started speaking.⁴ So will it be logical to argue that because of this isolated report that “majority” of speech impaired (dumb) persons are possessed? If this-"majority deduction"- doesn’t apply to the speech impaired why then is it different regarding mental illnesses?

 

 2.     Because science cannot explain the actual cause of most mental illnesses then it must be spiritual. Well you see it was just in the 19^th century – 1873 to be precise – that G.H. Armauer Hansen isolated the bacteria – Mycobacterium Leprae – that causes leprosy even though for thousands of years prior to that discovery leprosy was believed to be largely a curse from God or the gods. My point here is that because something is a popular belief for thousands of years does not make it true. I also believe that it is just a matter of time that causes of various mental illnesses will be better understood just like Leprosy is now better understood despite thousands of years of wrong myths and ignorance.

Like I said earlier, I consider myself a spiritual person and a man of faith, but the aim of this post is to cause a rethink of the notion that mental illnesses are largely “spiritual attacks”. This popularly held belief, particularly in Africa, has prevented many from seeking more appropriate and effective treatments that could have helped with many unnecessary years of suffering.

Let’s spread the awareness and not the stigma because "When you are better educated about what you are dealing with, then you're never without hope." Remember that people with mental illness can live more optimally fulfilling lives therefore talk to a professional today.

 

*Bible References: 1. Deuteronomy 28:28; 2. Deuteronomy 28:22; 3. Matthew 8: 28-34; 4. Luke 11: 14

 

NB: I gladly look forward to your comments, contributions and questions.

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Chioma’s Story: Demystifying Mental Illness series Part One

The day was Saturday August 1^st, 2015 when Chioma walked into my consulting room in the company of Chijioke, her husband. They had been married for about 5 years and had two lovely kids. Chioma was looking unkempt and appeared lost in a world of her own as she did not respond to any of my questions. Chijioke informed me that she had been this way in the last two years. She no longer participated in taking care of their young children. She always had to be persuaded and sometimes coerced to even attend to her personal hygiene like taking her bath, brushing her teeth and dressing up. Most times she just sat in a corner of the house almost motionless for hours. She had completely changed from her fun loving, caring and cheerful self. And this ‘strange’ behavior had persisted for almost two years.

Chijioke informed me that Chioma’s family members had taken her to various spiritual homes. Even though they had given various reasons for the cause of this strange illness every intervention did not seem to improve her situation. She was not getting any better therefore he had now finally decided to seek medical intervention and said he decided to go ahead without telling any of Chioma’s family members.

Following Chioma’s assessment, a diagnosis of schizophrenia was made and she was placed on medications. She returned two weeks later, this time she was better dressed and better kempt. In her husband’s words “she had made obvious improvement and was now about 60% her normal self before the illness.” She was sent home again to continue with the treatment. She then returned two weeks later, that is 28 days after her very first visit, and she had made even far more significant improvement. Chijioke reported that she was now engaged in the house chores and was now taking care of her children once again. In his own words she was now 99% are normal self.

This is about 4 months later and Chioma is still doing very fine. She is still on medications but more importantly she has got her life back. She can once again be a great wife to her darling husband and fantastic mum to her lovely children. You can imagine that this problem that lasted for 2 years was cheaply addressed in simply one month. The biggest challenge to mental illness, especially in counties like mine-Nigeria, is not the illness itself but ignorance about how to appropriately address this illness.

As far back as 1952, the first antipsychotic medication was created and the advents of antipsychotics have since revolutionized the management of such mental illnesses. I was inspired to share this story following a discussion I had with a new friend I met on Facebook (you know yourself) about the reality of the ignorance that still beclouds a lot of people, especially in Nigeria, from seeking proper care for their loved ones.

Let’s spread the awareness and not the stigma because "When you are better educated about what you are dealing with, then you're never without hope." Remember that people with mental illness can live more optimally fulfilling lives therefore talk to a professional today.

*Though the story is true, the real names of the individuals involved have not been used for confidential purpose.

Picture credit: culled from google images

4 Ways to help a loved one during a Manic Crisis

A manic crisis can be challenging especially for family members, friends and colleagues of the individual who is having a crisis. A manic crisis is one of the two-sided poles of a bipolar disorder which is also called a manic-depressive disorder.

Here are some few first aid tips to help deal with a manic situation in a loved one…

 

1.     Familiarize yourself with signs and symptoms of the illness so as to possibly detect the crisis early

A manic crisis is usually characterized by poor sleep or a reduced need for sleep. Characteristically, the affected individual sleeps for less than 4 hours daily. When awake they often busy themselves ‘noisily’ around the house, e.g. they may decide to watch T.V or play music aloud in the early hours of the day. You will also notice that the individual becomes either unusually happy or easily irritable. The individual may also become restless, hyperactive, talkative, and/ or become unusually disrespectful to others.

 

2.    Tactically engage the Individual who is having the crisis

During a manic crisis, the affected individual may make hurtful comments or act in annoying ways. It is very important during a crisis not to take these words or actions personally even though they are offensive. Communication may be difficult during a manic crisis therefore as much as possible stay calm and make your statements brief and simple. Even though the affected individual is easily irritable, they are not very likely to become physically aggressive with their loved ones.

3.     Seek for Help

Don’t handle a crisis alone. Reach out to other family members, friends and a professional. A manic crisis will always require proper intervention. This may sometimes mean admitting the individual in a hospital. Getting the individual to go for treatment during a crisis period may sometimes be very difficult since the affected individual often assumes that “there is nothing currently wrong with them”. I suggest that “forceful intervention” should always be the last resort after more respectfully humane and less traumatic approaches have failed. If possible, do engage the help of a professional as a guide and support to ensure the best approach for managing the crisis.

4.    Develop a Crisis Plan

During a phase of normalcy, i.e. when the individual is out of the woods, it is important to come up with a crisis plan. This plan should be placed somewhere the individual can easily assess it and it should also be shared with family members, friends and possibly colleagues. Among other things a crisis plan contains things like things you or others can do to help during a crisis and phone numbers of your health care provider.

 

 Final words, if you have a bipolar disorder, you are better off maintaining and staying on your ‘mood stabilizer’ medication rather than taking them intermittently. Just like the regular household electrical appliance, your gadgets are safer being constantly connected through the stabilizer rather than waiting for power fluctuations to occur before reconnecting them to the stabilizer.

Remember that people with mental illness can live more optimally fulfilling lives therefore talk to a professional today.

7 Ways I Overcame my Fear of Flying

Until 13^th November, 2013 I had no problem flying. I had even flown the previous day, that is 12^th November 2013, and I slept most part of the journey. However on my return trip we encountered a storm and it was a bit turbulent. I had never experienced such turbulence until then so of course I panicked inside even though I put up a calm look outside.It was after that experience on the 13^th of November 2013 that I developed a fear of flying.

Due to the nature of my job, I have had to fly over 230 times since that day. I fly an average of 3 times with total average of 2 hours 30 minutes weekly since November 2013. Last month, I did 6 flights in 8 days. I have since experienced even far worse turbulence than the initial experience that triggered my fear. Despite the terrible discomfort I experience before and during a flight I still had to do this weekly.

Normally, I will become anxious a day before my trips. When I get to the airport I will repeatedly use the rest room even though I had done that before leaving the house. I often also used the rest room at least once while on the flight. While on the flight, regardless of how much I tried, I wouldn’t be able to fall asleep. Many times I avoided seats that gave me a clear view of the wings of the wind because I had this fear of “what if the wings suddenly stop while we are in mid-air?” I will also often shut the windows once we are in the air. On one occasion, following a very brief slight turbulence, I started breathing fast and noticed I was beginning to gasp for air. I will listen and observe every change in sound engine and be overly alert to those occasional sounds from the cockpit or from other passengers. I am usually so tensed all through the flight and only feel relieved when we land.

My fear of flying lasted for a long time within this period however I am far more comfortable with flying now. Here are seven specifics things that I did that helped me manage my fear for flying:

# 1: I repeatedly faced my fear

Psychiatrists and psychologists will tell you that one sure way of feeding any fear is by avoiding what you fear. Many times I felt like quitting the job and often looked for an excuse not to fly. As a medical doctor I even considered taking medications that will help me sleep during a flight. Even though I had all these options racing through my head I never gave in to them. I knew that if I avoided flying I will only experience temporary relief but then worsen my fear for flying. Long-term, I will be missing out from making such trips.

# 2: I practiced relaxation techniques

Sometimes I practiced progressive muscle and deep breathing relaxation techniques when I noticed I was becoming much tensed during a flight. Doing this helped me on the particular day I almost had a panic attack that I described above.

# 3: I often distracted myself

Distraction is a form of cognitive behavioral therapy technique. It entails focusing on something else when your mind is preoccupied with anxious thoughts that are not helpful. For me I often read a book or wrote down my thoughts on “some issues of life” or a presentation. And sometimes during turbulence, I will just start counting from 1 to 60.

# 4: I paid attention to my faulty thinking and challenged them

Many times the fear of flying is associated with a form of distorted thinking called “catastrophizing.” Fears are perpetrated when you allow your thoughts to go unchallenged and unquestioned. You often say to yourself things like, “What if the engines fail? What if the plane cannot take off? What if today you are going to die?” There is a lot of uncertainty with the question “What if…” and it tends to worsen the anxiety. When such questions come up in my head I don’t just allow them to persist rather I challenged them and considered the rationality of these thoughts.

# 5: I permitted myself to be uncomfortable during turbulence

Sometimes the issue with flying is the fear of ‘being afraid’ (called the fear of fear) particularly during turbulence. Being anxious is a normal reaction to a perceived threat.The real problem is being overly anxious. Don’t try to numb yourself or be upset with yourself for being anxious during turbulence. Rather tell yourself it is okay to be uncomfortable during turbulence but remind yourself that “Though it is uncomfortable, it is not life threatening.”

# 6: I got informed

Since part of the reason for my fear was that I was concerned about the safety of planes I addressed this by getting better informed about planes. Do you know that between 1993 and 2000 there were 568 plane crashes in the US involving 53,487 passengers yet 51,207 survived? That means less than 5% of the passengers died in all those crashes. This information may not do so much but it is meant to further buttress that flying is quite safe.

# 7: I meditated

I am a Christian so I often focused my mind on Bible verses that talked about safety. I also often prayed before most flights and this helped me calm my worries. Rather than only focus on the process of the journey and be overly anxious if we were going to experience a storm or turbulence, I simply always imagined that we always landed safely and then give God thanks in advance for safe landing.

I do hope this piece helps someone out there. By the way that’s me about to take my 130th flight (I think) this year (2015)…Bon voyage