VIRGIN ISLANDERS AND MENTAL ILLNESS
The enormous STIGMA which attaches to the mentally ill arises out of ignorance, and prejudice, and results in discrimination. There is no known country, society or culture in which people with mental illness are considered to have the same value and to be as acceptable as those who are not. And the Virgin Islands are no exception.

Most people are ignorant about mental illness, and most of what they think they know is wrong. Most people feel uncomfortable about mental illness, and their behavior reflects this. As a result, there is great stigma associated with mental illness. Stigma is a terrible reality for people with a mental illness, and they report that how others judge and treat them is one of their greatest barriers to a complete and satisfying life. Ironically, the public is mostly unaware of how many mentally ill people they know and encounter every day. They do not realize that mental illness affects people of all ages, in all kinds of jobs and at all educational levels, or that 1 in 5 people will experience a mental illness of some sort in his or her lifetime.

There is a real history of prejudice, misunderstanding, confusion and fear surrounding mental illness. People think there is something essentially wrong or bad about someone who is diagnosed with a mental illness. Such unfair opinions include the beliefs that people with a mental illness are brain-damaged, intellectually disabled, unimportant, untrustworthy, worthless, dangerous or violent.

Stigma most often makes itself felt as discrimination, fear and rejection towards the mentally ill. Many people have found that they lose their self-esteem and have difficulty getting adequate housing, loans, health insurance or jobs, and trouble making new friends. The stigma attached to mental illness is so pervasive that many people who suspect that they may be mentally ill are unwilling to seek help for fear of what others may think, making their illness more severe and their recovery take longer.

It is possible to cope with and combat the stigma surrounding mental illnesses. If you have a mental illness, you can decide who to tell, if anyone, and how much to tell. Being open about your condition may be a risk, but you may gain much-needed support and unburden yourself from a heavy secret and its attendant stress.

• Don't let the fear or anticipation of being stigmatized prevent you from seeking and getting proper treatment for your illness.
• Surround yourself with supportive people.
• Don't equate yourself with your illness. YOU are not an illness. So instead of saying, "I'm bipolar," say, "I have bipolar disorder" etc.
• Don't let stigma create self-doubt and shame. Remember that you have a medical condition, that it's not your fault and that effective treatments are available. Think of and use a comparison with diabetes, another chronic disease that requires daily medication but does not compromise many abilities if properly treated. For those with bipolar disorder, it helps to remember that many people take vitamin and mineral supplements and that lithium is just another mineral.
• Don't feel shamed, embarrassed or humiliated if someone knowingly or unknowingly ridicules your illness. Therapy may help you regain self-esteem and make you worry less what others think of you.
  
  

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WHAT IS A MENTAL ILLNESS?
We must understand mental illnesses are diseases, which cause mild to severe disturbances in thinking, perception and behavior. With the proper care and treatment, a person can resume their normal activities.

Unlike most disabling 'physical' diseases, mental illness usually begins very early in life. Half of all cases begin by age 14; three quarters have begun by age 24. Females have higher rates of mood and anxiety disorders. Males have higher rates of substance use disorders and impulse disorders.

There are frequently long delays between the onset of a mental disorder and the first seeking of treatment. The average is nearly a decade; the longest delays are upwards of 20 years. Untreated, psychiatric disorders can be more severe, and are more likely to become treatment resistant. And those individuals left untreated are often plagued with school failure, teenage childbearing, early marriage, marital instability violence and unstable employment.

The earlier in life the disorder begins, the less likely an individual is to seek therapy. Thus those who most need treatment are the least likely to get it. And 45% of those with one mental disorder have two or more disorders, a condition known as co-morbidity.

The question most frequently asked by those who know someone who has recently been diagnosed with a mental illness is, "Is it contagious?". The answer to this is no.

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TYPES OF MENTAL ILLNESSES AND THEIR SYMPTOMS
Anxiety Disorders
Anxiety disorders are the most common mental illnesses. Anxiety is a normal reaction to stress. People who suffer from phobias experience unreasonably extreme anxiety, fear or dread from a particular object or situation. When anxiety becomes an excessive, irrational dread of everyday situations or items, it becomes a disabling disorder. Some major types of anxiety disorders are:

• Generalized Anxiety Disorder (GAD): Panic disorders involve sudden, intense feelings of terror for no apparent reason and may create symptoms similar to a heart attack.
• Obsessive-Compulsive Disorder (OCD): People with obsessive-compulsive disorder try to cope with anxiety by repeating words or phrases or engaging in repetitive, ritualistic behavior such as constant hand washing.
• Panic Disorder is usually a reaction to an unexpected event.
• Post-Traumatic Stress Disorder (PTSD) Post-Traumatic Stress Disorder is usually the result of a traumatic event.
• Social Phobia or Social Anxiety Disorder. Social phobia affects mostly women, whose primary fear is that they will do something humiliating or embarrassing in front of others.

Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives.

Support groups for anxiety disorders can help end the painful isolation of suffering alone that can be disruptive and debilitating. An effective support group helps recovery through mutual support and provides updated information about causes and treatment, eliminating some of the myths about anxiety disorders. ADAA regularly lists new support groups and updates information about current groups. You can also read more about starting a support group on this website.

Attention Deficit Hyperactivity Disorder (ADHD, ADD)
Attention Deficit Hyperactivity Disorder, ADHD, also known as Attention Deficit Disorder (ADD) is one of the most common mental disorders of children. Children with ADHD have impaired functioning in home, school, and their relationships with peers. If untreated, the disorder can have long-term adverse effects into adolescence and adulthood. Unfortunately, some ADD/ADHD is not diagnosed until adulthood. Symptoms of ADHD will appear over the course of many months, and include:

• Impulsivity: a child who acts quickly without thinking first.
• Hyperactivity: a child who can't sit still; walks, runs, or climbs around inappropriately; talks when others are talking.
• Inattention: a child who daydreams or seems to be in another world and is easily distracted by what is going on around him or her.

These symptoms persist into adulthood in 30-50% of those diagnosed in childhood. Long-term complications often involve family functioning potentially influencing parental satisfaction, marital harmony and sibling development in negative ways.

How is ADHD diagnosed? If ADHD is suspected, the diagnosis should be made by a professional with training in ADHD. The specialist checks the child's school and medical records and talks to teachers and parents who have filled out a behavior rating scale for the child. A diagnosis is made only after all this information has been considered. Many treatments for ADHD are available, both behavioral therapy and medication.

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Autism Spectrum Disorders (Pervasive Developmental Disorders)
Autism is a complex developmental disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills. Autism is one of five disorders that fall under the umbrella of Pervasive Developmental Disorders (PDD) or Autism Spectrum Disorders (ASDs), a category of neurological disorders characterized by "severe and pervasive impairment in several areas of development."

How is autism diagnosed?
Autism may go unrecognized, especially in mildly affected children or when masked by more debilitating handicaps. Doctors rely on a core group of behaviors to alert them to the possibility of a diagnosis of autism. These behaviors are:

• impaired ability to make friends with peers or to initiate or sustain a conversation with others
• absence or impairment of imaginative and social play
• stereotyped, repetitive, or unusual use of language
• estricted patterns of interest that are abnormal in intensity or focus
• preoccupation with certain objects or subjects
• inflexible adherence to specific routines or rituals

Because hearing problems can also cause behaviors that can be mistaken for autism, children with delayed speech development should also have their hearing tested.

What causes autism? It's likely that both genetics and environment play a role. The theory that parental practices are responsible for autism has now been disproved. And in February 2009 a federal court ruled that there was no link between certain early childhood vaccines and autism that developed in three children. However, more research is needed in this area.

Do symptoms of autism change over time? For many children, things improve with treatment and with age; they may even grow up to lead normal or nearnormal lives. Children whose language skills regress early in life, usually before the age of 3, appear to be at risk of developing epilepsy or seizure-like brain activity. During adolescence, some of those with autism may become depressed or experience behavioral problems because of their inability to socialize with their peers.

How is autism treated? There is no cure for autism, although research is ongoing. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism. Most professionals agree that the earlier the interventions begin, the more customized to an individual's needs, the better.

• Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills. Family counseling for the parents and siblings of children with autism often helps everyone cope with the particular challenges of living with an autistic child.
• Medications: Doctors often prescribe an antidepressant medication to handle symptoms of anxiety, depression, or obsessive-compulsive disorder. Anti-psychotic medications may be used to treat severe behavioral problems. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity.

Prevalence. As many as 1.5 million Americans today are believed to have some form of autism. And this number is on the rise. Autism knows no racial, ethnic, or social boundaries; family income levels; lifestyle choices; or educational levels, and can affect any family and any child. Experts estimate that three to six children out of every 1,000 will have autism. And although the overall incidence of autism is consistent around the globe, it is four times more prevalent in boys than in girls.

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Bipolar Disorder (Manic-Depressive Illness)
Bipolar disorder, or manic depression, is a mental illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic and typically vary greatly over the course of a person's life. Over 10 million people in America have bipolar disorder, and the illness affects men and women equally. Bipolar disorder is a chronic and generally life-long condition with recurring episodes of mania and depression that can last from days to months. It often begins in adolescence or early adulthood; occasionally even in children. Most people generally require lifelong treatment. While medication is one key element in successful treatment of bipolar disorder, psychotherapy, support, and education about the illness are also essential components of successful treatment. Bipolar disorder puts its sufferers at a very great risk for suicide and any attempts or even threats in that direction should be taken very seriously.

Bipolar disorder often runs in families, and studies suggest a genetic component to the illness. A stressful environment or negative life events may interact with an underlying genetic or biological vulnerability to produce the disorder. But it is important to note that bipolar episodes can and often do occur without obvious triggers.

What are the symptoms of mania? Mania describes the activated phase of bipolar disorder. It may include:

• an elated, over-excited, happy mood or an irritable, angry, unpleasant mood
• increased physical and mental activity and energy
• racing thoughts and flight of ideas
• increased talking, more rapid speech than normal often called pressured speech
• making many ambitious, often grandiose plans, most of which are not completed or even started
• risk taking and such impulsive activity such as speeding, spending sprees, sexual indiscretions, and alcohol abuse
• decreased sleep without fatigue, or waking during the night and being unable to sleep again

What are the symptoms of depression? Depression is the other phase of bipolar disorder. Symptoms include:

• loss of energy, decreased activity and energy; often sleeping as much as possible
• prolonged sadness, often without any visible cause
• restlessness and irritability
• inability to concentrate or make decisions
• increased feelings of worry and anxiety
• less interest or participation in, and less enjoyment of activities normally enjoyed such as sex
• feelings of guilt and hopelessness
• change in appetite (either eating much more or much less than usual)
• change in sleep patterns (either sleeping much more or much less than usual)
• thoughts of suicide; planning how to do it

What are "mixed" state and rapid cycling? A mixed state exists when symptoms of mania and depression occur at the same time. When four or more episodes of illness occur within a 12-month period, the individual is said to have bipolar disorder with rapid cycling. Rapid cycling is more common in women.

How is bipolar disorder treated? While there is no cure for bipolar disorder, it is a treatable and manageable illness. After diagnosis, most people can achieve a reasonable level of wellness. Medication is an essential element of successful treatment for people with bipolar disorder. In addition, psychotherapies such as cognitive-behavioral therapy (CBT) can be valuable in helping people to understand their illness and how to internalize skills to cope with the stresses that can trigger episodes.

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Borderline Personality Disorder
Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This often disrupts family and work life, long-term planning, and the individual's sense of self-identity. It affects 2% of the adult population, mostly young women. There is a high rate of self-injury without suicidal intent, as well as a significant rate of actual suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of all psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.

Symptoms of BPD: A person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, selfinjury, and drug or alcohol abuse. People with BPD often view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, or empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and this may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment to, and idealize the other person; but if a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to such rejection, reacting with anger and distress to a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulty feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.

People with BPD often exhibit other markedly impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, the anxiety disorders, and substance abuse.

Treatment of BPD: Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depression. Antipsychotic drugs may also be used when there are distortions in thinking. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD.

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Dementia of the Alzheimer's Type
The most prominent disorder of old age is Alzheimer's disease: 8 to 15 percent of people over age 65 have this form of dementia. It is one of the most feared mental disorders because of its gradual, yet relentless, attack on memory. Patients with Alzheimer's disease experience a gradual decline in functioning throughout the course of their illness. Depression and anxiety occur most frequently during the early stages, and psychotic symptoms and aggressive behavior occur later. The duration of the illness, from onset of symptoms to death, averages 8 to 10 years.

Diagnosis of Alzheimer's. Declines in cognitive functioning (the ability to think) have been identified both as part of the normal process of aging and as an indicator of Alzheimer's disease. So the tentative diagnosis of Alzheimer's disease requires not only memory impairment but also another cognitive deficit, such as language disturbance or the loss of executive functioning (the ability to plan). There are other disorders that coexist with, or share features of, Alzheimer's disease, complicating the diagnosis. Delirium is a common condition in older patients and can be confused with dementia in its acute stages: cognitive deficits are also prominent in both late-life depression and schizophrenia. Identification of Alzheimer's disease is also hampered by the widespread view of "senility" as a normal developmental stage. Early symptoms of the disease may be excused away or ignored by family members and the patient may be unable to give a history of their symptoms, making early detection and treatment difficult.

Behavioral Symptoms. Alzheimer's is associated with a range of symptoms including psychosis, depression, agitation, wandering, insomnia, incontinence, catastrophic outbursts, sexual disorders, and weight loss. These behavioral symptoms can have serious consequences: patient distress, premature institutionalization, and significant compromise of the quality of life of patients and their families. Even a modest reduction in these symptoms can produce substantial improvements in functioning and quality of life.

Treatment. Behavioral symptoms are treated with medications developed for the primary psychiatric symptoms. Treatment with the anti-depressants may not only relieve depressive symptoms but also improve functional ability. Cognitive therapy, which is most useful in the early stages of dementia, helps patients cope with depression. Behavioral therapy is seen as more promising for adults more severely afflicted with dementia because it helps caregivers identify, plan, and implement pleasant activities for the patient. Support for these caregivers is crucial because they are themselves at risk for depression, anxiety, and somatic problems of their own. And these symptoms place patients at risk for abuse by these caregivers.

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Depression
What is a depressive disorder? Major, clinical or unipolar depression is a serious medical illness. It's much more than just feeling "down in the dumps" or "blue" for a few days. It's feeling "down" and "low" and "hopeless" for weeks at a time. And it affects all types of people worldwide. Some people say that depression feels like a black curtain of despair coming down over their lives. Many people feel like they have no energy and can't concentrate. Others feel irritable all the time for no apparent reason. The symptoms vary from person to person, but if you feel "down" for more than two weeks, and these feelings are interfering with your daily life, you may be clinically depressed.

Most people who have gone through one episode of depression will, sooner or later, have another one. You may begin to feel some of the symptoms of depression several weeks before you develop a full-blown episode of depression. Learning to recognize these early triggers or symptoms and working with your doctor will help to keep the depression from worsening. Most people with depression never seek help, even though the majority who do will respond to treatment. Treating depression is especially important because it affects you, your family, and your work. Some people with depression try to harm themselves in the mistaken belief that how they are feeling now will never change. One in 10 people will have a depressive disorder in their lifetime, and in one of 10 cases, depression is a fatal disease as a result of suicide.

This is unfortunate, as depression is a treatable illness. Working with your doctor, you can learn to manage depression. You may have to try a few different medications to find the one that works best for you. Your doctor may also recommend that you see a therapist and/or make certain lifestyle changes. Change won't come overnight - but with the right treatment, you can keep depression from claiming your life.

• What are the causes of depression? Depression is not a weakness but a serious illness with biological, psychological, and social aspects to its cause, symptoms, and treatment.
• What is the general approach to treating depression? A person cannot will it away. Untreated, it will worsen. Undertreated, it will return. A combination of medications and therapy can relieve almost all of its symptoms, though they cannot cure the disease.
• How is depression diagnosed? Depression is diagnosed only clinically in that there is no laboratory test or X-ray for depression. Therefore, it is crucial to see a health practitioner as soon as you notice symptoms of depression in yourself, your friends, or family. The first step in getting appropriate treatment is a complete physical and psychological evaluation to determine whether the person, in fact, has a depressive disorder.
• What are its symptoms?
  • Persistent sad, anxious, or "empty" mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed
  • Negative thoughts, moods, and behaviors
  • Changes in bodily functions (for example, eating, sleeping, and sexual activity)
  • Suicidal ideation
• What treatments are available for depression? There are a considerable variety of antidepressant medications. In addition, several different types of short-term psychotherapies that have proven very effective for depression.
• 
  Depression and Bipolar Support Alliance (DBSA)
  730 N. Franklin Street, Suite 501
  Chicago, Illinois 60654-7225
  Toll-free: (800) 826-3632 Fax: (312) 642-7243
  www.dbsalliance.org
  
  Wing of Madness Depression Guide Since 1995, Wing of Madness has been providing information and support to people trying to deal with their depression or that of someone they know. It includes Articles; Learn More; Treatment; Viewpoints; Links; News Blog; Community; Support Forum; Reading: Recent Comments and Various Answers to (What does depression feel like?) wingofmadness.com

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Eating Disorders
An eating disorder is when a person exhibits severe disturbances in eating behavior, such as extreme reduction of food intake or extreme overeating, or feels extreme distress or concern about their body weight or shape. Anorexia nervosa, the best-known eating disorder, is characterized by extremely low body weight, negative body image distortion and an obsessive fear of gaining weight. Individuals control their body weight commonly through the means of voluntary starvation, purging, excessive exercise, diet pills and diuretic drugs. This dangerous condition primarily affects adolescent females and can be fatal in extreme cases. Diagnosis is based on a combination of behavior, reported beliefs and experiences, including:

• Extreme weight loss - down to only 85% of expected weight
• Cessation of periods in girls and decreased libido or impotence in males
• Symptoms of starvation, such as reduced metabolism, slow heart rate, anemia and stunted growth
• Dehydration; dry skin, chapped lips and brittle fingernails
• Thinning of the hair
• Pallid complexion and sunken eyes, fragile appearance
• Constipation
• Poor circulation, resulting in common attacks of "pins and needles" and purple extremities
• Obsessive thoughts about food, one's shape and weight, a belief that control over one"s food/body is synonymous with being in control of one's life
• Fear of becoming overweight, refusal to accept that one's weight is dangerously low even when it could be deadly, and refusal to acknowledge that one's weight is normal, or healthy
• Many other mental disorders are co-morbid, particularly depression, substance abuse and suicide attempts
• Behavior may be socially withdrawn or anti-social
• Excessive exercise, food restriction; secretive about these behaviors
• Aggressive when forced to eat "forbidden" foods
• Overly sensitive to references about body weight

Anorexic eating behavior is thought to originate from feelings of fatness and unattractiveness that alter how the affected individual evaluates and thinks about her body, food and eating. There is a high rate of reported child sexual abuse experiences among those with anorexia. Anorexia is thought to have the highest mortality rate of any psychiatric disorder: approximately 6% of those who are diagnosed with the disorder eventually die due to related causes. The suicide rate of people with anorexia is also higher than that of the general population and is thought to be the major cause of death for those with the condition.

Treatment is usually first focused on urgent, immediate weight gain, especially with those who are seriously ill and require hospitalization. Psychotherapy is an effective form of treatment and can lead to restoration of weight, return of menses among female patients, and improved psychological and social functioning. Family therapy has also been found to be an effective treatment for adolescents. Few drugs have been found to be effective for either treating anorexia, or preventing its relapse. It is common, however, for antidepressants to be prescribed, with the intent of treating the associated anxiety and depression.

Bulimia Nervosa; Binge-purge behavior. Bulimia is an illness in which a person binges on food or has regular episodes of significant overeating and feels a loss of control. The affected person then uses various methods -- such as vomiting or laxative abuse -- to prevent weight gain. Many (but not all) people with bulimia also have anorexia nervosa. The disorder is most common in adolescent girls and women. The affected person is usually aware that her eating pattern is abnormal and may experience fear or guilt with the binge-purge episodes. Eating binges may occur as often as several times a day for many months. These binges cause a sense of self-disgust, which leads to self-induced vomiting or excessive exercise.

• Symptoms of bulimia:
• Abuse of laxatives, diuretics, or enemas to prevent weight gain
• Binge eating followed by self-induced vomiting
• Frequent weighing
• Overachieving behavior
• Depressive signs and symptoms, problems with interpersonal relationships, self-concept and impulsive behaviors.

Treatment. Some doctors recommend a stepped approach for patients with bulimia. This treatment approach follows specific stages, depending on the severity of the bulimia, and the person's response to treatments.

• Therapies:
• Self-help groups like Overeaters Anonymous may be helpful for patients with mild cases.
• Cognitive-behavioral therapy (CBT) and nutritional therapy are treatments for bulimia that does not respond to support groups.

• Drugs:
• The drugs used for bulimia are typically antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). A combination of CBT and SSRIs is very effective. Bulimia is a chronic illness and many people continue to have some symptoms despite treatment, and relapses are common. This is no cause for despair.

Possible Complications. Bulimia can be dangerous and may lead to serious medical complications over time, including: dehydration, electrolyte abnormalities, inflammation of the throat and ripped esophagus, pancreatitis, constipation and hemorrhoids.

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Schizophrenia
What is schizophrenia?
Schizophrenia is a chronic, severe, and disabling brain disorder that has been recognized throughout recorded history. It affects about 1% of Americans. People with schizophrenia may hear voices other people don't hear; see what isn't there; believe that others are reading their minds; controlling their thoughts; or plotting to harm them. These experiences are terrifying and can cause fearfulness, withdrawal, or extreme agitation. People with schizophrenia may not make sense when they talk; may sit for hours without moving or talking much; or may seem perfectly fine until they talk about what they are really thinking. Because many people with schizophrenia have difficulty holding a job or caring for themselves, the burden on their families and society is significant and can be life-long.

The symptoms of schizophrenia include:
Unusual thoughts or perceptions, including auditory and visual hallucinations; delusions (believing something that is not true); disorders of movement; and cognitive deficits (problems with attention, certain types of memory, and the executive functions that allow us to plan and organize). Cognitive deficits are negative symptoms which represent a loss or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure in everyday life. These symptoms are hard to recognize as part of the disorder and can be mistaken for laziness or depression. They are the most disabling in terms of leading a normal life.

When does it start and who gets it?
Psychotic symptoms (such as hallucinations and delusions) usually emerge in women in their mid-20s to early 30s and in men in their late teens and early 20s. They seldom start after age 45 and or before puberty, although cases in children as young as 5 have been reported. In adolescents, the first signs can include a change of friends, a drop in grades, sleep problems, and irritability. Because many normal adolescents exhibit these types of behaviors as well, a diagnosis can be difficult to make at this stage. Research has shown that schizophrenia affects men and women equally, and occurs at a similar rate in all ethnic groups around the world.

Are people with schizophrenia violent?
People with schizophrenia are not especially prone to violence and often prefer to be left alone. Studies show that if people have no record of criminal violence before they develop schizophrenia and are not substance abusers, they are unlikely to commit crimes after they become ill. If someone with paranoid schizophrenia does become violent, it is most often domestic violence, directed at family members; and takes place at home.

What about suicide?
People with schizophrenia attempt suicide much more often than people in the general population. Young adult males are particularly likely to succeed. It is hard to predict which people with schizophrenia are prone to suicide, so if someone talks about or tries to commit suicide, professional help should be sought right away.

Does substance abuse cause schizophrenia? What does? Can it be inherited?
Most researchers do not believe that substance abuse causes schizophrenia, but people who have schizophrenia abuse alcohol and/or drugs more often than the general population. The most common form of this is an addiction to nicotine: they smoke at three times the rate of the general population.

Schizophrenia is believed to result from a combination of environmental and genetic factors. Scientists have long known that schizophrenia runs in families. We can't yet predict who will develop the disease by looking at genetic material: It is believed that interactions between genes and the environment are necessary for schizophrenia to develop. Many environmental factors have been suggested as risk factors, such as exposure to viruses or malnutrition in the womb; problems during birth; and psychosocial factors, like stressful environmental conditions.

How is schizophrenia treated?

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Substance Abuse: Alcohol, Narcotics
Alcoholism
The term "alcoholism" refers to a disease known as alcohol dependence syndrome, the most severe stage of a range of drinking problems. Alcoholism is called a progressive disease, meaning that over time the symptoms and effects of drinking alcohol become more intense and severe. The symptoms in the early stages differ from those during later stages as the disease progresses from heavy drinking to alcohol abuse to alcohol dependence. Because one of the most common symptoms of alcoholism is denial, diagnosing alcoholism can be difficult -- the diagnosis depends on the individual's willingness to honestly answer questions about their drinking. Usually, family members and friends closest to the drinker see the problem long before it is diagnosed in a medical setting. Alcoholism does tend to run in families, and scientific studies indicate that genetics play a role in a person's risk of abusing alcohol. But research shows that an individual's environment and peer influences also affect the risk of becoming alcoholic.

Symptoms of Alcohol Dependence include:

• Neglect of Other Activities: The drinker's alcohol use reduces or eliminates important social, work-related or recreational activities.
• Excessive Use: The drinker begins to consume larger amounts of alcohol over a longer period of time than intended.
• Impaired Control: The drinker makes repeated unsuccessful attempts to cut down or control how much he/she drinks.
• Persistence of Use: The drinker continues to consume alcohol despite knowing that his/her drinking is causing or contributing to a persistent or recurrent family, work, social, school, physical or psychological problem.
• Large Amounts of Time Spent in Alcohol Related Activities: The drinker spends an abnormal amount of time on activities involved with obtaining, using and/or recovering from the effects of alcohol.
• Withdrawal: When the drinker stops drinking for a short period of time, he/she experiences symptoms such as nausea, sweating, shaking or anxiety.
• Tolerance: The drinker needs increasing amounts of alcohol to achieve the same level of intoxication.

Drugs
Substance abuse can simply be defined as a pattern of harmful use of any substance for mood-altering purposes. There are substances that can be abused for their mood-altering effects that are not drugs at all - inhalants and solvents - and there are drugs that can be abused that have no mood-altering or intoxicating properties, such as anabolic steroids. Generally, when most people talk about substance abuse, they are referring to the use of illegal drugs. Recent research has shown that even marijuana may have more harmful physical, mental, and psychomotor effects than first believed, and the National Institute on Drug Abuse reports that marijuana users can become psychologically dependent, and therefore addicted. When it comes to illegal substances, society has determined that their use is harmful, and has placed legal prohibitions on their use in order to protect the individual and society from the costs involved with use of healthcare resources, lost productivity, the spread of disease, crime and homelessness.

Signs and symptoms of drug use include loss of communications skills, temper flare-ups, belligerent demands, loss of interest in relationships, inability to complete projects on time, lateness or absences from work, depression, anxiety, and other personality changes.

The following list of drugs and substances are the most commonly abused in the United States, according to the National Institute of Drug Abuse. Some are controlled and others prescription. Note, there are prescription drugs not on this list which can be addictive.

CANNABINOIDS: Hashish Marijuana	DISSOCIATIVE ANESTHETICS: Ketamine PCP	OTHER COMPOUNDS: Anabolic Steroids Inhalants
DEPRESSANTS: Barbiturates Benodiazepines Flunitrazepam (Rohypnol) GHB Methaqualone (Quaaludes)	OPIOIDS AND MORPHINE DERIVATIVES: Codeine Fentanyl Heroin Morphine Opium	STIMULANTS: Amphetamine Cocaine Ecstacy (MDMA) Methylphenidate (Ritalin) Nicotine
HALLUCINOGENS: LSD Mescaline Psilocybin

Substance Abuse (Alcohol, Narcotics) Information and Support

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SUICIDE: RISK FACTORS AND RESPONSE

WHAT SHOULD I DO IF I THINK SOMEONE IS SUICIDAL, OR I AM MYSELF? IF YOU THINK SOMEONE IS SUICIDAL: Do not leave him or her alone. Try to get them to seek immediate help from his or her doctor Eliminate access to firearms or other potential tools for suicide including unsupervised access to medications.

If you are in a crisis and need help urgently: Call this toll-free number 1-800-273-8255 (TALK), available 24/7. It is the National Suicide Prevention Lifeline, a service available to anyone. You may call for yourself or for someone you are concerned about. All calls are confidential.

Suicide is a major, preventable public health problem. In 2004, it was the eleventh leading cause of death in the U.S., accounting for 32,439 deaths. An estimated 8 to 25 suicide attempts occur for every completed suicide.

What are the risk factors for suicide? Research shows that risk factors for suicide include:

• Depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders). More than 90 percent of people who die by suicide have these risk factors.
• Prior suicide attempt(s).
• Family history of violence, including physical or sexual abuse; mental disorder or substance abuse; and of course suicide.
• Exposure to the suicidal behavior of others, such as family members, peers, or media figures.
• Firearms in the home - the method used in more than half of suicides.
• Stressful life events, such as incarceration, in combination with other risk factors, such a mental illness.

However, suicide and suicidal behavior are not normal responses to stress; many people have these risk factors, but are not suicidal.

Are women or men at higher risk?

• Suicide was the eighth leading cause of death for males and the sixteenth leading cause of death for females in 2004. Almost four times as many males as females die by suicide.
• Firearms, suffocation, and poison are by far the most common methods of suicide, overall. However, men and women differ in the method used, as shown below.

Do children and young people ever commit suicide?
YES. In 2004, suicide was the third leading cause of death for those aged 10 to 24. Young people are much more likely to use firearms, suffocation, and poisoning than other methods of suicide. Younger children were dramatically more likely to use suffocation.

Are older adults at risk?
Older Americans are disproportionately likely to die by suicide.

Are Some Ethnic Groups or Races at Higher Risk? Non-Hispanic Whites - 12.9 per 100,000 and American Indian and Alaskan Natives - 12.4 per 100,000. The lowest rates are: Hispanics - 5.9 per 100,000; Asian and Pacific Islanders - 5.8 per 100,000 and Non-Hispanic Blacks - 5.3 per 100,000

What can be done to prevent suicide?
Research has shown that mental and substance-abuse disorders are major risk factors for suicide, so many programs focus on treating these disorders. Cognitive therapy reduced the rate of repeated suicide attempts by 50 percent during a year of follow-up. A previous suicide attempt is among the strongest predictors of subsequent suicide, and cognitive therapy helps suicide attempters consider alternative actions when thoughts of self-harm arise. Research shows that older adults and women who die by suicide are likely to have seen a primary care provider in the year before death, so improving primary-care providers' ability to recognize and address risk factors may help prevent suicide among these groups. Improving outreach to men at risk is a major challenge in need of investigation.

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MEDICATIONS
There are now many medications that can help reduce the severity of the symptoms of many mental illnesses, but none of them provide a cure. However, the combination of the medication(s) prescribed with suitable psychotherapy can often provide enough relief that the person can "recover" enough to resume their life. It is important to understand that NONE of these drugs will have any effect on people who are not mentally ill: specifically, anti-anxiety or anti-depressant medicines WILL NOT GIVE YOU A HIGH. Medications for mental Illnesses are divided into five large categories - anti-psychotic, anti-manic, anti-depressant, anti-convulsant, and anti-anxiety medications.

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PSYCHOTHERAPIES
Psychotherapy is a way to treat people with a mental disorder by helping them understand their illness. It teaches people strategies and gives them tools to deal with stress and unhealthy thoughts and behaviors. It helps them manage their symptoms better and function at their best in everyday life. Sometimes psychotherapy alone may be the best treatment for a person, depending on the illness and its severity. Most times, psychotherapy is combined with medications. The kind of psychotherapy a person receives depends on his or her needs.

Cognitive behavioral therapy (CBT) is an extremely valuable blend of two therapies: cognitive therapy (CT) and behavioral therapy. Cognitive therapy focuses on a person's thoughts and beliefs, and how they influence a person's mood and actions. It aims to change a person's thinking to be more adaptive and healthy. Behavioral therapy focuses on a person's actions and aims to change unhealthy behavior patterns. CBT helps a person focus on his or her current problems and how to solve them. Both patient and therapist need to be actively involved in this process. The therapist helps the patient identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change their behaviors accordingly. CBT helps patients learn more adaptive and realistic interpretations of events. They learn how to identify what triggers episodes of the illness, and therefore prevent or reduce the chances of relapse.

Dialectical behavior therapy (DBT), a form of CBT which was developed specifically to treat people with suicidal thoughts and actions. The term "dialectical" refers to a philosophic exercise in which two opposing views are discussed until a logical blending or balance of the two extremes - the middle way - is found. DBT emphasizes the value of a strong and equal relationship between patient and therapist. The therapist consistently reminds the patient when his or her behavior is unhealthy or disruptive - when boundaries are overstepped - and then teaches the skills needed to better deal with similar situations in the future.

Interpersonal therapy (IPT) is most often used to treat depression or dysthymia (a more persistent but less severe form of depression). IPT helps identify how a person interacts with other people. When a behavior is causing problems, IPT guides the person to change the behavior. IPT explores major issues that may add to a person's depression, such as grief, or times of upheaval or transition. Sometimes IPT is used along with antidepressant medications. Basically, a therapist using IPT helps the patient identify troubling emotions and their triggers. The therapist helps the patient learn to express appropriate emotions in a healthy way.

Interpersonal and social rhythm therapy (IPSRT) was developed to treat bipolar disorder combined with medication. IPSRT combines the basic principles of IPT with behavioral psycho-education designed to help patients adopt regular daily routines and sleep/wake cycles, adhere to their medication regimen, and improve relationships. IPSRTmay be more effective than other types of psychotherapy combined with medication in helping to prevent a relapse of bipolar symptoms.

Family-focused therapy (FFT) was also developed for treating bipolar disorder. It assumes that a patient's relationship with their family is vital to the success of managing the illness. FFT includes family members in therapy sessions to improve family relationships, which may be strained as a result of the bipolar individual's illness. Therapists trained in FFT work to identify difficulties and conflicts among family members that may be worsening the patient's illness. Generally, the family and patient attend sessions together. The needs of each patient and family are different, and so those needs determine the exact course of treatment. However, the main components of a structured FFT usually include: Family education on bipolar disorder; Building communication skills to better deal with stress, and Solving problems together as a family.

It is very important to acknowledge and address the needs of family members. Research has shown that primary caregivers of people with bipolar disorder are at increased risk for illnesses themselves. And the caregivers were less likely to see a doctor for their own health issues.

These psychotherapies can be adapted to the needs of children and adolescents, depending on the illness. Studies have found that individual and group-based CBT are effective treatments for child and adolescent anxiety disorders. Other studies have found that IPT is an effective treatment for child and adolescent depression. Psychosocial treatments that involve a child's parents and family also have been shown to be effective, especially for disruptive disorders such as autism, conduct disorder or oppositional defiant disorder. Some effective treatments are designed to reduce the child's problem behaviors and improve parent-child interactions. Parents are taught the skills they need to encourage and reward positive behaviors in their children. Similar training helps parents manage their child's attention deficit/hyperactivity disorder (ADHD). This approach can be directed at children to help them learn problem solving, anger management and social interaction skills.

Family-based therapy may also be used to treat adolescents with eating disorders. One type proceeds through three phases:

• Weight restoration. Parents become fully responsible for ensuring that their teen eats. They learn how to avoid criticizing their teen. A therapist helps parents better understand their teen's disease.
• Returning control over eating to the teen. Once the teen accepts the control parents have over his or her eating habits, parents may begin giving up that control. Parents are encouraged to help their teen take more control over eating again.
• Establishing healthy adolescent identity. When the teen has reached and maintained a healthy weight, the therapist helps him or her begin to develop a healthy sense of identity and autonomy.

Many more approaches exist. Some types have been scientifically tested more often than others. Also, some of these therapies are constantly evolving. They are often combined with more established psychotherapies. A few examples of other therapies are:

• Psychodynamic therapy. Historically, psychodynamic therapy was tied to the principles of psychoanalytic theory, which asserts that a person's behavior is affected by his or her unconscious mind and past experiences. Now therapists who use psychodynamic therapy rarely include psychoanalytic methods. Rather, psychodynamic therapy helps people gain greater self-awareness and understanding about their own actions. It helps patients identify and explore how their unconscious emotions and motivations can influence their behavior.
• Light therapy. Light therapy is used to treat seasonal affective disorder (SAD), a form of depression that usually occurs during the autumn and winter months, when the amount of natural sunlight decreases. SAD occurs in some people when their bodies' daily rhythms are upset by short days and long nights. Research has found that the hormone melatonin is affected by this seasonal change. During light therapy, a person sits in front of a "light box" for periods of time, usually in the morning. The box emits full spectrum light, and sitting in front of it appears to help reset the body's daily rhythms.
• Expressive or creative arts therapy. Expressive or creative arts therapy is based on the idea that people can help heal themselves through art, music, dance, writing, or other expressive acts. One study has found that expressive writing can reduce depression symptoms among women who were victims of domestic violence. It also helps college students at risk for depression.
• Animal-assisted therapy. Working with animals, such as dogs, horses, or cats, may help some people cope with trauma, develop empathy, and encourage better communication. Companion animals are sometimes introduced in hospitals, psychiatric wards, nursing homes, homes and other places where they may bring comfort and have a mild therapeutic effect. Animal-assisted therapy has been increasingly used for children with mental disorders.
• Play therapy. Involves the use of toys and games to help a child identify and talk about his or her feelings, as well as establish communication with a therapist. A therapist can sometimes better understand a child's problems by watching how he or she plays.

How do I find a psychotherapist?
Your family doctor can help you find a psychotherapist. Other resources for locating services are listed at the bottom of this page.

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LIFESTYLE RECOMMENDATIONS
Lifestyle factors that impact our sense of wellness and have a positive impact on mental illnesses include: sleeping about seven hours a night without interruptions, exercising, eating healthy foods, drinking less alcohol/caffeine, spending time with loved ones, having quiet times, managing stress, and laughing. These lifestyle factors help all people to stay well.

In addition specific changes as small as being extremely conscientious about getting enough sleep and remembering to take the correct dosage of prescribed medication at the right time. More significant lifestyle changes such as moving to adopt a quieter lifestyle in a rural community and changing to a less stressful job can help enormously.

Get enough rest. Getting enough sleep is necessary for good health, not just mental health. Try to get seven to nine hours of sleep every night. Having trouble falling asleep or staying asleep or getting up way too early are all bad. Sleep disturbances can affect your mood and your body. They can make daily functioning hard and leave you more susceptible to stress. Being vigilant about one's sleeping habits, such as keeping regular bedtimes and avoiding intellectual stimulation just before bed, are the very best ways to stay healthy. Avoid situations likely to disrupt your sleeping routine.

Manage yourself. If you feel like you have too much to do, slow down and take one thing at a time. If you're feeling overwhelmed, make a list and PRIORITIZE it. Work on it one task at a time, in the order of urgency and importance. Understand what causes stress in your life. If you know where stress is coming from, you will be able to manage it better.

Know your limits. Let others know them, too. Learn how to say "no." It may be uncomfortable, or leave you feeling guilty at first, so practice it with those you know best and trust most. However this will greatly increase your sense of being in control over your own life.

Relax. Try to make time, on a regular basis, to do something you enjoy. Practice stress reduction techniques: deep breathing, yoga, meditation or massage therapy. Don't let anyone or anything interrupt this precious time of yours.

Eliminate Substance Abuse. If you find yourself smoking, drinking or using "recreational" drugs, this is a good time to seek help. Although they may seem to help you cope, these addictions can make your symptoms worse, delay your treatment and complicate recovery.

Last but not least, Exercise. Exercising relieves your tense muscles, improves your mood and sleep, and increases your energy and strength. It eases symptoms of anxiety and depression. It can be very simple: twenty minutes two or three times a week will do a lot. Get a dog and walk him!

People today often struggle to keep up with the demands of daily life. A recent national survey finds that one in three Americans is living with extreme stress in at least some area of their lives. Stress can come from a heavy workload, daily traffic jams, dealing with a health problem or injury, taking care of someone who's ill, financial worries, relationship troubles, parenting, or major life transitions like moving or starting a family.

Many of these strategies are related to managing workplace stress. These include making sure you take the vacations you're entitled to; changing jobs if stressed by your present position; reducing your hours to part-time work in some cases; and having regular counseling.

The support of your family and friends can really help you get through stressful times. Make a list of nearby friends and family members who are supportive and positive. Make a commitment to yourself to call, email or get together with them on a schedule that's realistic for you. Share what's on your mind honestly and openly. Don't hesitate to ask for help. Be direct about what you need. When you talk, also listen. Listen and respond. Offer help when you can. Talking to almost anyone can make you feel better.

Make social plans. Create opportunities to strengthen your relationships by doing fun things. Looking forward to special activities boosts our spirits, gives us energy and makes us more positive about life. Spending time with loving people you care about and trust and who care about you can ease stress and improve the way you feel in general. Lots of times a good friend can be more helpful than a psychologist - and is a lot cheaper too!

Religion and spirituality may also help you learn greater coping skills for times of stress. Spirituality may provide a sense of hope, meaning and purpose in your life, and is a way to bear suffering and illness. It is known to reduce anxiety and to lower the risk of depression. Allied to this is helping others. There is always someone out there who is worse off than you are. Helping them improves self-esteem and can give you a sense of purpose and achievement.

Reduce stress by feeling connected to a broad community. Find the right organization. Think about what you like to do, your skills and availability. Whatever your situation and your interests, there is probably a volunteer opportunity for you to contribute to in your community. Volunteering will help you build stronger connections with others - a proven way to protect your mental health.

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LOCATE MENTAL HEALTH SERVICES
With today's hectic pace it's normal to feel some stress. Stay connected to your psychiatrist and therapist. Ensure you get the care you need. All too often, people with mental illnesses develop other health conditions, because their physical health is overlooked. If your psychiatrist is not asking about your overall health, let him know that it's important to you that he does so. Get routine check-ups and visit your general practitioner when you're not feeling well. It may be due to your medicine or a symptom of your mental illness. But it could also be a different health problem.

Getting Help: Locate Services
If you are unsure where to go for help, talk to someone you trust who has experience in mental health. Listed below are the types of people and places that can make a referral to, or provide, diagnostic and treatment services.

• Your family (primary care) doctors, nurses, etc.
• Mental health specialists, such as:
  • Psychiatrists, psychologists, social workers and mental health counselors.
• Community mental health centers
  • Hospital psychiatry departments
  • Territory hospital outpatient clinics in both St.Croix and St.Thomas
  • Social service agencies
• Local medical and/or psychiatric societies
• Religious leaders/counselors

In the U.S. mental health care is not keeping up with the needs of consumers and improvements are needed to speed initiation of treatment as well as enhance the quality and duration of treatment. This is particularly true in the Virgin Islands where we have fewer than six psychiatrists to serve over 111,000 people.

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