Guide to mental health

Stress

Defining stress

Stress is the body's reaction to a change that requires a physical, mental or emotional adjustment or response. It can come from any situation or thought that makes you feel frustrated, angry, nervous or anxious.

Ongoing stress is thought to be bad for health, although this is difficult to prove.

Common symptoms of stress

Manifestations of stress are numerous and varied but they generally fall into four categories:

• Physical: fatigue, headache, insomnia, muscle aches/stiffness, heart palpitations, chest pains, abdominal cramps, nausea, trembling, cold extremities, flushing or sweating and frequent colds.
• Mental: decrease in concentration and memory, indecisiveness, mind racing or going blank, confusion, loss of sense of humour.
• Emotional: anxiety, nervousness, depression, anger, frustration, worry, fear, irritability, impatience, short temper.
• Behavioural: pacing, fidgeting, nervous habits, increased eating, smoking, drinking, crying, yelling, swearing, blaming and even throwing things or hitting.

What are the causes of stress?

Stress is extremely difficult to measure and the causes of stress can vary. It may build up as a result of a particular circumstance or it can arise as a result of an on-going situation.

External stressors include:

• Physical environment: noise, bright lights, heat, confined spaces.
• Social rudeness: bossiness or aggressiveness on the part of someone else.
• Organisational: rules, regulations, "red tape," deadlines.
• Major life events: death of a relative, lost job, promotion, new baby.
• Daily hassles:commuting, misplacing keys, mechanical breakdowns.

Internal stressors include:

• Lifestyle choices: caffeine, not enough sleep, overloaded schedule.
• Negative self-talk: pessimistic thinking, self-criticism, over-analysing.
• Mind traps: unrealistic expectations, taking things personally, all-or-nothing thinking, exaggerating, rigid thinking.
• Stressful personality traits: perfectionist, workaholic, pleaser.

It is important to remember that most of the stress we have is self-generated. Recognising that we create most of our own upsets is an important first step to dealing with them.

Mastering stress

The following can be helpful in mastering stress:

Change lifestyle habits.

• Decrease caffeine.
• Well-balanced diet.
• Eat slowly.
• Regular exercise (at least 30 minutes, three times per week).
• Adequate sleep.
• Leisure time.
• Relaxation exercises.

Change stressful situations.

• Time and money management.
• Assertiveness.
• Problem-solving.
• Possibly leaving a job or a relationship.

Change your thinking.

• Look at things more positively.
• See problems as opportunities.
• Refute negative thoughts.
• Keep a sense of humour.

Diversion and distraction - take time out (anything from a short walk to a holiday) to get away from the things that are bothering you. This will not necessarily resolve the problem, but it gives you a break and a chance for your stress levels to decrease. Then, you can return to deal with issues feeling more rested and in a better frame of mind.

Anxiety

Defining anxiety

Anxiety is a feeling of unease, apprehension or worry, often accompanied by physical symptoms such as rapid heart beat, palpitations or shortness of breath. Everybody will feel anxious from time to time and anxiety is a natural reaction to a stressful situation. In some cases it can even improve performance.

For others, though, anxiety can become severe or prolonged. In fact, for one in 10 people in the UK, anxiety interferes with everyday life. This is called an anxiety disorder and is considered to be a mental health problem.

Anxiety is 'abnormal' if it:

• is out of proportion to the stressful situation
• persists when a stressful situation has gone, or the stress is minor
• appears for no apparent reason when there is no stressful situation.

Anxiety disorders include:

• Panic disorder. This involves recurring panic attacks - a severe attack of anxiety and fear which occurs suddenly, often without warning, and for no apparent reason.
• Obsessive-compulsive disorder (OCD). OCD consists of recurring obsessions, compulsions, or both. Obsessions are recurring thoughts, images, or urges that cause you anxiety or disgust.
• Post-traumatic stress disorder. This condition may follow a severe trauma such as a serious assault or a life-threatening accident.
• Social phobia. This is possibly the most common phobia. It is where you become very anxious about what other people may think of you, or how they may judge you.
• Specific phobias. Many people are phobic about specific things or situations such as claustrophobia or a fear of injections.
• Generalized anxiety disorder (GAD). A long-term condition causing the sufferer to have feelings of anxiety on most days.

Common symptoms of anxiety

Psychological symptoms can include:

• insomnia
• feeling worried or uneasy all the time
• feeling tired
• being irritable or quick to anger
• an inability to concentrate
• a fear that you are going "mad"
• feeling unreal and not in control of your actions
• detached from your surroundings.

It's also possible to experience a range of physical symptoms such as:

• abdominal discomfort
• diarrhoea
• dry mouth
• rapid heartbeat or palpitations
• tightness or pain in the chest
• shortness of breath
• dizziness
• frequent urination
• difficulty swallowing
• shaking.

What are the causes of anxiety disorders?

Anxiety may be a symptom of other mental health problems, such as depression or alcohol dependence. It can also be caused by substances such as ecstasy or caffeine or by withdrawal from long-term drugs like tranquillisers.

Sometimes anxiety can be associated with a physical illness, such as thyroid disorder. For this reason it's advisable to see your GP in order to rule out a physical cause.

Depression

Defining depression

Depression is an illness that involves the body, mood and thoughts that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not a sign of personal weakness and people with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months or years. Appropriate treatment, however, can help most people with depression.

Common symptoms of depression

As with many mental health problems, there are a number of symptoms of depression. The severity of the symptoms can vary from mild to severe. In general the more symptoms you have the more severe the depression. Symptoms include:

• low mood for most of the day, nearly every day
• loss of enjoyment and interest in life
• abnormal sadness, often with weepiness
• feelings of guilt, worthlessness, or uselessness
• poor motivation with even simple tasks seeming difficult
• poor concentration
• sleeping problems
• lacking in energy, always tired
• difficulty with affection, including going off sex
• poor appetite and weight loss or the reverse with comfort eating and weight gain
• irritability, agitation or restlessness
• physical symptoms such as headaches, palpitations, chest pains and general aches
• recurrent thoughts of death.

This presents a very bleak picture. However, it's important to remember that depression isn't an absolute - it's not simply a case of either you're depressed or you're not. There's a progression from feeling blue to the full clinical illness described above. Even then, you won't suffer from every symptom.

What are the causes of depression?

The exact cause is unknown. Anyone can become depressed and it can develop for no apparent reason. It can also be triggered by a life event such as a relationship problem, bereavement, redundancy or illness. In many people it is a combination of a low mood with some life problem that leads to a spiral down into depression.

Women tend to develop depression more often than men. Particularly common times for women to become depressed are after childbirth (postnatal depression) and the menopause.

A chemical imbalance in the brain might be a factor. This is not fully understood. However, an alteration in some chemicals in the brain is thought to be the reason why antidepressants work in treating depression.

Schizophrenia

Defining schizophrenia

Schizophrenia is one of the most complex of all mental health disorders involving a severe, chronic, and disabling disturbance of the brain. It affects about 1 percent of people all over the world and typically develops in the late teens or early twenties. Symptoms often lead to psychiatric treatment and hospitalisation.

Some people have wrong ideas about schizophrenia. For instance, it has nothing to do with a 'split personality'. Also, the vast majority of people with schizophrenia are not violent.

Common symptoms of schizophrenia

There are many possible symptoms. They are often classed into 'positive' and 'negative' symptoms. 'Positive' symptoms are those that show abnormal mental functions. 'Negative' symptoms are those that show the absence of a mental function that should normally be present.

'Positive' symptoms include the following:

• Delusions - hearing voices, seeing visions.
• Hallucinations - hearing, seeing, feeling, smelling, or tasting things that are not real.
• Disordered thoughts - thoughts may become jumbled or blocked. Thought and speech may not follow a normal logical pattern.

Symptoms called 'disorders of thought possession' may also occur. These include:

• Thought insertion. This is when someone believes that the thoughts in their head are not their own, and that they are being put there by an outside agency.
• Thought withdrawal. This is when someone believes that thoughts are being removed from their mind by an outside agency.
• Thought broadcasting. This is when someone believes that their thoughts are being read or heard by others.
• Thought blocking. This is when there is a sudden interruption of the train of thought before it is completed, leaving a blank. The person suddenly stops talking and cannot recall what he or she has been saying.

'Negative' symptoms include the following:

• Lack of motivation - everything seems an effort.
• Few spontaneous movements and much time doing nothing.
• Facial expressions do not change much and the voice may sound monotonous.
• Changed feelings - emotions may become 'flat'. Sometimes the emotions may be odd such as laughing at something sad.

Negative symptoms can make some people neglect themselves. They may not care to do anything and appear to be wrapped up in their own thoughts.

Other symptoms that occur in some cases include difficulty planning, memory problems and obsessive compulsive symptoms.

What is the cause of schizophrenia?

The exact cause is not known. It is thought that the balance of certain brain chemicals (neurotransmitters) is altered and that this may cause the symptoms. Although, it's not clear why changes occur in the neurotransmitters.

Genetic (hereditary) factors are thought to be important. However, one or more factors appear to be needed to trigger the illness in people who are genetically prone to it. There are various theories as to what these might be. For example, stress, a lack of oxygen at birth, use of illegal drugs. Heavy cannabis users are six times more likely to develop schizophrenia than non-users. Many drugs such as amphetamines, cocaine, ketamine, and LSD can trigger a schizophrenia-like illness.

If you have any concerns please do not hesitate in contacting your GP. There are also various other sources that you can refer to or contact for further help and information.