Schizophrenia

Overview

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which causes significant distress for the individual, their family members, and friends. If left untreated, the symptoms of schizophrenia can be persistent and disabling. However, effective treatments are available. When delivered in a timely, coordinated, and sustained manner, treatment can help affected individuals to engage in school or work, achieve independence, and enjoy personal relationships.

Onset and Symptoms

Schizophrenia is typically diagnosed in the late teen years to the early thirties and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties). A diagnosis of schizophrenia often follows the first episode of psychosis, when individuals first display symptoms of schizophrenia. Gradual changes in thinking, mood, and social functioning often begin before the first episode of psychosis, usually starting in mid-adolescence. Schizophrenia can occur in younger children, but it is rare for it to occur before late adolescence.

The symptoms of schizophrenia generally fall into the following three categories:

Psychotic symptoms include altered perceptions (e.g., changes in vision, hearing, smell, touch, and taste), abnormal thinking, and odd behaviors. People with psychotic symptoms may lose a shared sense of reality and experience themselves and the world in a distorted way. Specifically, individuals typically experience:

  • Hallucinations, such as hearing voices or seeing things that aren’t there
  • Delusions, which are firmly held beliefs not supported by objective facts (e.g., paranoia – irrational fears that others are “out to get you” or believing that the television, radio, or internet are broadcasting special messages that require some response)
  • Thought disorder, which includes unusual thinking or disorganized speech

Negative symptoms include loss of motivation, disinterest or lack of enjoyment in daily activities, social withdrawal, difficulty showing emotions, and difficulty functioning normally. Specifically, individuals typically have:

  • Reduced motivation and difficulty planning, beginning, and sustaining activities
  • Diminished feelings of pleasure in everyday life
  • “Flat affect,” or reduced expression of emotions via facial expression or voice tone
  • Reduced speaking

Cognitive symptoms include problems in attention, concentration, and memory. For some individuals, the cognitive symptoms of schizophrenia are subtle, but for others, they are more prominent and interfere with activities like following conversations, learning new things, or remembering appointments. Specifically, individuals typically experience:

  • Difficulty processing information to make decisions
  • Problems using information immediately after learning it
  • Trouble focusing or paying attention

Risk Factors

Several factors contribute to the risk of developing schizophrenia.

Genetics: Schizophrenia sometimes runs in families. However, it is important to know that just because someone in a family has schizophrenia, it does not mean that other members of the family will have it as well. Genetic studies strongly suggest that many different genes increase the risk of developing schizophrenia, but that no single gene causes the disorder by itself. It is not yet possible to use genetic information to predict who will develop schizophrenia.

Environment: Scientists think that interactions between genetic risk and aspects of an individual’s environment may play a role in the development of schizophrenia. Environmental factors that may be involved include living in poverty, stressful surroundings, and exposure to viruses or nutritional problems before birth.

Brain structure and function: Scientists think that differences in brain structure, function, and interactions among chemical messengers (called neurotransmitters) may contribute to the development of schizophrenia. For example, differences in the volumes of specific components of the brain, in the way regions of the brain are connected and work together, and in neurotransmitters, such as dopamine, are found in people with schizophrenia. Differences in brain connections and brain circuits seen in people with schizophrenia may begin developing before birth. Changes to the brain that occur during puberty may trigger psychotic episodes in people who are vulnerable due to genetics, environmental exposures, or the types of brain differences mentioned above.

Treatments and Therapies

The causes of schizophrenia are complex and are not fully understood, so current treatments focus on managing symptoms and solving problems related to day to day functioning. Treatments include:

Antipsychotic Medications

Antipsychotic medications can help reduce the intensity and frequency of psychotic symptoms. They are usually taken daily in pill or liquid forms. Some antipsychotic medications are given as injections once or twice a month, which some individuals find to be more convenient than daily oral doses. Patients whose symptoms do not improve with standard antipsychotic medication typically receive clozapine. People treated with clozapine must undergo routine blood testing to detect a potentially dangerous side effect that occurs in 1-2% of patients.

Many people taking antipsychotic medications have side effects such as weight gain, dry mouth, restlessness, and drowsiness when they start taking these medications. Some of these side effects subside over time, but others may persist, which may cause some people to consider stopping their antipsychotic medication. Suddenly stopping medication can be dangerous and it can make schizophrenia symptoms worse. People should not stop taking antipsychotic medication without talking to a health care provider first.

Shared decision making between doctors and patients is the recommended strategy for determining the best type of medication or medication combination and the right dose. You can find the latest information on warnings, patient medication guides, or newly approved medications on the U.S. Food and Drug Administration (FDA) website.

Psychosocial Treatments

Cognitive behavioral therapy, behavioral skills training, supported employment, and cognitive remediation interventions may help address the negative and cognitive symptoms of schizophrenia. A combination of these therapies and antipsychotic medication is common. Psychosocial treatments can be helpful for teaching and improving coping skills to address the everyday challenges of schizophrenia. They can help people pursue their life goals, such as attending school, working, or forming relationships. Individuals who participate in regular psychosocial treatment are less likely to relapse or be hospitalized. For more information on psychosocial treatments, see the Psychotherapies webpage on the NIMH website.

Family Education and Support

Educational programs for family members, significant others, and friends offer instruction about schizophrenia symptoms and treatments, and strategies for assisting the person with the illness. Increasing key supporters’ understanding of psychotic symptoms, treatment options, and the course of recovery can lessen their distress, bolster coping and empowerment, and strengthen their capacity to offer effective assistance. Family-based services may be provided on an individual basis or through multi-family workshops and support groups. For more information about family-based services in your area, you can visit the family education and support groups page on the National Alliance on Mental Illness website.

Coordinated Specialty Care

Coordinated specialty care (CSC) is a general term used to describe recovery-oriented treatment programs for people with first episode psychosis, an early stage of schizophrenia. A team of health professionals and specialists deliver CSC, which includes psychotherapy, medication management, case management, employment and education support, and family education and support. The person with early psychosis and the team work together to make treatment decisions, involving family members as much as possible. Compared to typical care for early psychosis, CSC is more effective at reducing symptoms, improving quality of life, and increasing involvement in work or school. Check here for more information about CSC programs.

Assertive Community Treatment

Assertive Community Treatment (ACT) is designed especially for individuals with schizophrenia who are at risk for repeated hospitalizations or homelessness. The key elements of ACT include a multidisciplinary team, including a medication prescriber, a shared caseload among team members, direct service provision by team members, a high frequency of patient contact, low patient to staff ratios, and outreach to patients in the community. ACT reduces hospitalizations and homelessness among individuals with schizophrenia. Check here for more information about ACT programs.

How can I help someone I know with schizophrenia?

Caring for and supporting a loved one with schizophrenia can be very challenging. It can be difficult to know how to respond to someone who is experiencing psychosis.

Here are some things you can do to help your loved one:

  • Help them get treatment and encourage them to stay in treatment
  • Remember that their beliefs or hallucinations seem very real to them
  • Tell them that you acknowledge that everyone has the right to see things their way
  • Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior
  • Check to see if there are any support groups in your area

Some symptoms require immediate emergency care. If your loved one is thinking about harming themselves or others or attempting suicide, seek help right away:

Finding Help

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the Behavioral Health Treatment Services Locator for finding mental health treatment facilities and programs. SAMHSA’s Early Serious Mental Illness Treatment Locator provides information about treatment facilities that offer coordinated specialty care. For additional resources, visit the NIMH Help for Mental Illnesses page.

Join a Study

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit directly from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge to help others in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your doctor about clinical trials, their benefits and risks, and whether one is right for you.

Zonisamide – Zonegran

What is zonisamide?

Zonisamide is used together with other medicines to treat partial seizures in adults and teenagers at least 16 years old.

Zonisamide may also be used for purposes not listed in this medication guide.

Warnings

Taking zonisamide can cause permanent vision loss. Tell your doctor right away if you have any eye pain or redness or any changes in your vision.

Some people have thoughts about suicide while taking zonisamide. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Before taking this medicine

You should not use zonisamide if you are allergic to it.

You may not be able to take zonisamide if you have ever had a severe allergic to a sulfa drug.

Tell your doctor if you have ever had:

  • liver disease;
  • kidney disease;
  • high levels of ammonia;
  • stomach flu or illness causing diarrhea;
  • a growth disorder;
  • a bone disorder that causes soft or weak bones or low bone mineral density;
  • depression, or suicidal thoughts or actions;
  • if you have ever had metabolic acidosis (too much acid in your blood); or
  • if you have been on a ketogenic diet (high-fat, high-protein, low-carb).

Some people have thoughts about suicide while taking zonisamide. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Zonisamide may harm an unborn baby. Use effective birth control to prevent pregnancy, and tell your doctor if you become pregnant.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of zonisamide on the baby.

You should not breastfeed while using zonisamide.

Zonisamide is not approved for use by anyone younger than 16 years old.

How should I take zonisamide?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Zonisamide can be taken with or without food.

Swallow the capsule whole and do not crush, chew, break, or open it.

While using zonisamide, you may need frequent blood tests.

Do not stop using zonisamide suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor’s instructions about tapering your dose.

Do not share zonisamide with another person, even if they have the same symptoms you have.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include slow heart rate, feeling light-headed, fainting, and slow or shallow breathing.

What should I avoid while taking zonisamide?

Avoid driving or hazardous activity until you know how zonisamide will affect you. Your reactions could be impaired.

Drinking alcohol with this medicine can cause side effects.

Zonisamide side effects

Get emergency medical help if you have signs of an allergic reaction: any form of skin rashhivesfever, swollen glands, feeling weak or tired, severe muscle pain, unusual bruising or bleeding; yellowing of your skin or eyes; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: sudden mood or behavior changes, anxietypanic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), depressed, or have thoughts about suicide or hurting yourself.

Zonisamide may cause serious side effects. Call your doctor at once if you have:

  • eye pain or redness or any changes in your vision;
  • decreased sweating, feeling very hot;
  • signs of metabolic acidosis–confusion, vomiting, lack of energy, irregular heartbeats;
  • symptoms of a blood cell disorder–fever, chills, body aches, flu symptoms, sores in your mouth and throat;
  • symptoms of a kidney stone–severe pain in your stomach or lower back, blood in your urine;
  • increased or worsening seizures;
  • the first sign of any skin rash, no matter how mild; or
  • severe skin reaction–fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects of zonisamide may include:

  • drowsinessdizziness;
  • problems with memory or concentration;
  • feeling agitated or irritable;
  • loss of coordination, trouble walking; or
  • loss of appetite.

Zonisamide dosing information

Usual Adult Dose for Seizures:

16 years of age and older:
-Initial dose: 100 mg orally once a day
-Titration: After 2 weeks at 100 mg/day, the dose may be increased to 200 mg/day as either a single or divided dose (100 mg orally 2 times a day) for at least 2 weeks; it can then be increased to 300 mg/day, then 400 mg/day either as a single daily dose or divided into 2 daily doses, with the dose stable for at least 2 weeks to achieve steady state at each level
-Maintenance dose: 400 mg/day
-Maximum dose: 600 mg/day

Comments:
-This drug may be taken with or without food.
-Capsules should be swallowed whole.
-Because of the long half-life of this drug, up to 2 weeks may be required to achieve steady state levels upon reaching a stable dose or following dosage adjustment.
-The prescriber may wish to prolong the duration of treatment at the lower doses in order to fully assess the effects of this drug at steady state (noting that many of the side effects are more frequent at doses of 300 mg per day and above). Although there is some evidence of greater response at doses above 100 to 200 mg/day, the increase appears small and formal dose response studies have not been conducted.

Use: As adjunctive therapy in the treatment of partial seizures

Usual Pediatric Dose for Seizures:

Less than 16 years of age: Not recommended
16 years of age and older: See adult dosing

Detailed Zonisamide dosage information

What other drugs will affect zonisamide?

Taking zonisamide with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking zonisamide with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety or depression.

Other drugs may interact with zonisamide, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

How to manage stress

Explains what stress is, what might cause it and how it can affect you. Includes information about ways you can help yourself and how to get support.

What is stress?

We all know what it’s like to feel stressed, but it’s not easy to pin down exactly what stress means. When we say things like “this is stressful” or “I’m stressed”, we might be talking about:

  • Situations or events that put pressure on us – for example, times where we have lots to do and think about, or don’t have much control over what happens.
  • Our reaction to being placed under pressure – the feelings we get when we have demands placed on us that we find difficult to cope with.

“It’s overwhelming. Sometimes you can’t see beyond the thick fog of stress.”

There’s no medical definition of stress, and health care professionals often disagree over whether stress is the cause of problems or the result of them. This can make it difficult for you to work out what causes your feelings of stress, or how to deal with them. But whatever your personal definition of stress is, it’s likely that you can learn to manage your stress better by:

  • managing external pressures, so stressful situations don’t seem to happen to you quite so often
  • developing your emotional resilience, so you’re better at coping with tough situations when they do happen and don’t feel quite so stressed

Is stress a mental health problem?

Being under pressure is a normal part of life. It can help you take action, feel more energised and get results. But if you often become overwhelmed by stress, these feelings could start to be a problem for you.

Stress isn’t a psychiatric diagnosis, but it’s closely linked to your mental health in two important ways:

  • Stress can cause mental health problems, and make existing problems worse. For example, if you often struggle to manage feelings of stress, you might develop a mental health problem like anxiety or depression.
  • Mental health problems can cause stress. You might find coping with the day-to-day symptoms of your mental health problem, as well as potentially needing to manage medication, heath care appointments or treatments, can become extra sources of stress.

This can start to feel like a vicious circle, and it might be hard to see where stress ends and your mental health problem begins.

“[When I’m stressed] I feel like I’m on the verge of a breakdown.”

Why does stress affect me physically?

You might find that your first clues about being stressed are physical signs, such as tiredness, headaches or an upset stomach.

There could be many reasons for this, as when we feel stressed we often find it hard to sleep or eat well, and poor diet and lack of sleep can both affect our physical health. This in turn can make us feel more stressed emotionally.

Also, when we feel anxious, our bodies release hormones called cortisol and adrenaline. (This is the body’s automatic way of preparing to respond to a threat, sometimes called the ‘fight, flight or freeze’ response). If you’re often stressed then you’re probably producing high levels of these hormones, which can make you feel physically unwell and could affect your health in the longer term.

Vagus nerve stimulation (VNS)

Overview

Vagus nerve stimulation involves the use of a device to stimulate the vagus nerve with electrical impulses. An implantable vagus nerve stimulator is currently FDA-approved to treat epilepsy and depression. There’s one vagus nerve on each side of your body, running from your brainstem through your neck to your chest and abdomen.

In conventional vagus nerve stimulation, a device is surgically implanted under the skin on your chest, and a wire is threaded under your skin connecting the device to the left vagus nerve. When activated, the device sends electrical signals along the left vagus nerve to your brainstem, which then sends signals to certain areas in your brain. The right vagus nerve isn’t used because it’s more likely to carry fibers that supply nerves to the heart.

Why it’s done

Device placement in vagus nerve stimulationVagus nerve stimulationOpen pop-up dialog box

About one-third of people with epilepsy don’t fully respond to anti-seizure drugs. Vagus nerve stimulation may be an option to reduce the frequency of seizures in people who haven’t achieved control with medications.

Vagus nerve stimulation may also be helpful for people who haven’t responded to intensive depression treatments, such as antidepressant medications, psychological counselling (psychotherapy) and electroconvulsive therapy (ECT).

The Food and Drug Administration (FDA) has approved vagus nerve stimulation for people who:

  • Are 4 years old and older
  • Have focal (partial) epilepsy
  • Have seizures that aren’t well-controlled with medications

The FDA has also approved vagus nerve stimulation for the treatment of depression in adults who:

  • Have chronic, hard-to-treat depression (treatment-resistant depression)
  • Haven’t improved after trying four or more medications or electroconvulsive therapy (ECT), or both
  • Continue standard depression treatments along with vagus nerve stimulation

Additionally, researchers are studying vagus nerve stimulation as a potential treatment for a variety of conditions, including headaches, rheumatoid arthritis, inflammatory bowel disease, bipolar disorder, obesity and Alzheimer’s disease.

Risks

For most people, vagus nerve stimulation is safe. But it does have some risks, both from the surgery to implant the device and from the brain stimulation.

Surgery risks

Surgical complications with implanted vagus nerve stimulation are rare and are similar to the dangers of having other types of surgery. They include:

  • Pain where the cut (incision) is made to implant the device
  • Infection
  • Difficulty swallowing
  • Vocal cord paralysis, which is usually temporary, but can be permanent

Side effects after surgery

Some of the side effects and health problems associated with implanted vagus nerve stimulation can include:

  • Voice changes
  • Hoarseness
  • Throat pain
  • Cough
  • Headaches
  • Shortness of breath
  • Difficulty swallowing
  • Tingling or prickling of the skin
  • Insomnia
  • Worsening of sleep apnea

For most people, side effects are tolerable. They may lessen over time, but some side effects may remain bothersome for as long as you use implanted vagus nerve stimulation.

Adjusting the electrical impulses can help minimize these effects. If side effects are intolerable, the device can be shut off temporarily or permanently.

How you prepare

It’s important to carefully consider the pros and cons of implanted vagus nerve stimulation before deciding to have the procedure. Make sure you know what all of your other treatment choices are and that you and your doctor both feel that implanted vagus nerve stimulation is the best option for you. Ask your doctor exactly what you should expect during surgery and after the pulse generator is in place.

Food and medications

You may need to stop taking certain medications ahead of time, and your doctor may ask you not to eat the night before the procedure.

What you can expect

Before the procedure

Before surgery, your doctor will do a physical examination. You may need blood tests or other tests to make sure you don’t have any health concerns that might be a problem. Your doctor may have you start taking antibiotics before surgery to prevent infection.

During the procedure

Surgery to implant the vagus nerve stimulation device can be done on an outpatient basis, though some surgeons recommend staying overnight.

The surgery usually takes an hour to an hour and a half. You may remain awake but have medication to numb the surgery area (local anesthesia), or you may be unconscious during the surgery (general anesthesia).

The surgery itself doesn’t involve your brain. Two incisions are made, one on your chest or in the armpit (axillary) region, and the other on the left side of the neck.

The pulse generator is implanted in the upper left side of your chest. The device is meant to be a permanent implant, but it can be removed if necessary.

The pulse generator is about the size of a stopwatch and runs on battery power. A lead wire is connected to the pulse generator. The lead wire is guided under your skin from your chest up to your neck, where it’s attached to the left vagus nerve through the second incision.

After the procedure

The pulse generator is turned on during a visit to your doctor’s office a few weeks after surgery. Then it can be programmed to deliver electrical impulses to the vagus nerve at various durations, frequencies and currents. Vagus nerve stimulation usually starts at a low level and is gradually increased, depending on your symptoms and side effects.

Stimulation is programmed to turn on and off in specific cycles — such as 30 seconds on, five minutes off. You may have some tingling sensations or slight pain in your neck and temporary hoarseness when the nerve stimulation is on.

The stimulator doesn’t detect seizure activity or depression symptoms. When it’s turned on, the stimulator turns on and off at the intervals selected by your doctor. You can use a hand-held magnet to initiate stimulation at a different time, for example, if you sense an impending seizure.

The magnet can also be used to temporarily turn off the vagus nerve stimulation, which may be necessary when you do certain activities such as public speaking, singing or exercising, or when you’re eating if you have swallowing problems.

You’ll need to visit your doctor periodically to make sure that the pulse generator is working correctly and that it hasn’t shifted out of position. Check with your doctor before having any medical tests, such as magnetic resonance imaging (MRI), which might interfere with your device.

Results

Implanted vagus nerve stimulation isn’t a cure for epilepsy. Most people with epilepsy won’t stop having seizures or taking epilepsy medication altogether after the procedure. But many will have fewer seizures, up to 20 to 50 percent fewer. Seizure intensity may lessen as well.

It can take months or even a year or longer of stimulation before you notice any significant reduction in seizures. Vagus nerve stimulation may also shorten the recovery time after a seizure. People who’ve had vagus nerve stimulation to treat epilepsy may also experience improvements in mood and quality of life.

Research is still mixed on the benefits of implanted vagus nerve stimulation for the treatment of depression. Some studies suggest the benefits of vagus nerve stimulation for depression accrue over time, and it may take at least several months of treatment before you notice any improvements in your depression symptoms. Implanted vagus nerve stimulation doesn’t work for everybody, and it isn’t intended to replace traditional treatments.

Additionally, some health insurance carriers may not pay for this procedure.

Studies of implanted vagus nerve stimulation as a treatment for conditions such as Alzheimer’s disease, headaches and rheumatoid arthritis have been too small to draw any definitive conclusions about how well it may work for those problems. More research is needed.

Mental Health – Anorexia

People with anorexia nervosa don’t eat enough, usually because they feel that their problems are caused by what they look like.

Anorexia Nervosa is an eating disorder characterised by restrictive eating and an intense fear of gaining weight. While anorexia is often recognised physically through excessive weight loss, it is a serious mental health problem.1,2

Someone with anorexia often has an intense fear of gaining weight and for many people they judge themselves and their worth based on their weight.3

Anyone can be affected by anorexia. While statistics show that anorexia is more commonly reported by young females, anorexia is increasingly being reported by men and boys, women over the age of 40, and in children as young as seven.4

What causes anorexia nervosa?

There is no single cause of anorexia and everyone’s reasons or triggers can be very different. It is usually understood as being due to a combination of factors.5

Psychological factors

Low self-esteem has been commonly associated as a trigger for the onset of anorexia.6 Many people with anorexia report feeling worthless and not good enough. Losing weight can start to feel like a sense of achievement and can become a way for some people to feel a sense of worth.

Certain personality traits such as perfectionism have also been found to make a person more likely to be affected by anorexia.7 Other psychological factors which are associated with anorexia include:8

  • other mental health conditions, particularly depressionself-harm and anxiety
  • finding it hard to handle stress and cope with life
  • having feelings of obsession and compulsion.
Social factors

We live in a society where body image is highly important. This means we are constantly being told that how we look reflects our worth which can leave us feeling increasingly ashamed of our bodies if they do not fit the model of what is a ‘good body’.

This can have an impact on our body-esteem and how we feel about ourselves. While these cultural and social pressures do not cause eating disorders, they can make those particularly vulnerable to developing an eating disorder feel more pressure to look a certain way and they can trigger an eating disorder.9

Biological factors

New research is looking into the genetic links that may underpin anorexia.10 There is also increasing work focusing on exploring the neurochemical and neurological make-up that may help us understand why some people develop anorexia and why some do not.11

Signs and symptoms of anorexia

It can be difficult to tell if you, someone you know or a friend has anorexia nervosa. Someone who has lost a lot of weight may have another type of health condition. However, particular signs that indicate that someone may have anorexia include are:12

Behavioural signs

  • Fear of fatness or pursuit of thinness.
  • Pre-occupation with body weight.
  • Distorted perception of body shape or weight, for example the person thinks they are overweight when actually they are underweight.
  • May underestimate the seriousness of the problem even after diagnosis.
  • May tell lies about eating or what they have eaten, give excuses about why they are not eating, pretend they have eaten earlier.
  • Not being truthful about how much weight they have lost.
  • Finding it difficult to think about anything other than food.
  • Strict dieting.
  • Counting the calories in food excessively.
  • Avoiding food they think is fattening.
  • Eating only low-calorie food.
  • Missing meals (restricting).
  • Avoiding eating with other people.
  • Hiding food.
  • Cutting food into tiny pieces – to make it less obvious they have eaten little and to make food easier to swallow.
  • Obsessive behaviour and rituals around eating.
  • Excessive exercising.
  • Social withdrawal and isolation, shutting yourself off from the world.

Physical signs

  • Severe weight loss.
  • Lack of sexual interest or potency.
  • Difficulty sleeping and tiredness.
  • Feeling dizzy.
  • Stomach pains.
  • Constipation and bloating. 
  • Feeling cold or having a low body temperature. 
  • Growth of downy (soft and fine) hair all over your body (called Lanugo).
  • Getting irritable and moody.
  • Difficulty concentrating.
  • Low blood pressure.

What treatments are available?

Talking therapies

Talking therapies can last up to 12 months or more depending on how severe and persistent someone’s anorexia is. The aim of talking therapies is to help identify the feelings and fears that cause one to stop eating and to help develop a healthier attitude towards food and one’s body.13

  • Cognitive analytical therapy (CAT) – this is based on the theory that the unhealthy patterns which trigger anorexia, are usually developed during childhood. It involves three stages: reformulation (looking at past events that may provide a reason for unhealthy patterns), recognition (helping people see how these patterns contribute to anorexia) and revision (identification of changes which can break these unhealthy patterns).14
  • Cognitive behavioural therapy (CBT) – focuses on identifying and altering dysfunctional thought patterns, attitudes and beliefs which may trigger and perpetuate the person’s restrictive eating. The therapist helps the individual understand, identify and change eating disordered thoughts such as “everyone thinks I am fat”. A therapist can work with the individual with anorexia through specific behavioural interventions, such as promoting healthy eating behaviours through goal setting etc.15

Family therapy

One type of family therapy which is most often used with young people with anorexia is called ‘The Maudsley Approach.’ It is an intensive outpatient treatment programme where parents play an active and positive role in order to restore their child’s weight to normal healthy levels, give control of eating choices back to their child and encourages normal adolescent development.16

Inpatient treatment

Most people with anorexia do not need to have inpatient treatment, but for some it may be needed to manage poor physical health. The decision to start inpatient treatment will usually be made alongside someone’s therapist and GP and the type of treatment will be decided to suit the person’s needs.

Recreational drugs and alcohol

Explains the mental health effects of recreational drugs, what might happen if you use recreational drugs and also have a mental health problem, and suggestions for where to find support.

What are recreational drugs and alcohol?

Recreational drugs are substances people may take:

  • to give themselves a pleasurable experience
  • to help them feel better if they are having a bad time
  • because their friends are using them
  • to see what it feels like.

They include alcoholtobacco (nicotine), substances such as cannabisheroincocaine and ecstasy, and some prescribed medicines.

“All my experiences with recreational drug use started due to social influences, of wanting to ‘fit in’.”

Recreational drugs may be:

  • legal – such as nicotine and alcohol
  • illegal – this means it is against the law to have them or supply them to other people; most recreational drugs are illegal
  • controlled – these are drugs used in medicine, such as benzodiazepines; it is legal to take controlled drugs if a doctor has given you a prescription for them but it is illegal to have them if not; it is also illegal to give or sell controlled drugs to anyone else.

A number of substances previously known as ‘legal highs’ are now illegal – for example, mephedrone (‘meow meow’).

Drugs and the law

Possession and supply

Most drugs come under the Misuse of Drugs Act 1971, which makes it illegal to possess certain drugs and to supply them to others. They are classified as class A, B or C, depending on the presumed risk of harm they may cause.

New synthetic versions of existing drugs (previously called ‘legal highs’) come under the Psychoactive Substances Act 2016. These are chemicals made to mimic the effects of existing illegal drugs, for example cannabis or cocaine. The Psychoactive Substances Act, which came into effect in May 2016, makes it illegal to produce or supply these types of substances, or to possess them with the intention of supplying them.

The way street drugs are legally classified does not reflect how harmful they are to your mental health. Legal, illegal and controlled drugs can all have a negative impact on you, whichever Act of Parliament they come under and whatever class they are given.

Driving

  • It is illegal to drive if you are not fit to do so because of a drug you have taken, whether it is a legal, illegal or controlled drug.
  • It is illegal to drive with an illegal drug in your blood, whether or not it affects your driving.

Medical uses

Some of the substances discussed on these pages have potential medical uses: