Questions to Help Identify Individuals with Psychiatric Illness
The following questions, grouped by symptoms, can help the counselor identify individuals who may have psychiatric illness. By no means should a counselor routinely ask all of these questions. Instead, her or she should determine which of these symptoms are most relevant and ask appropriate questions based on the family/psychiatric history. The counselor should refer an individual suspected to have significant psychiatric symptoms for a psychiatric evaluation.
Mania
Have you had a period of a week or more during your life when you have felt unusually good or high? Was this clearly different from your usual mood, so much so that your relatives and friends noticed the change?
The counselor also may ask questions about the presence of irritability lasting one week or more, which is also a symptom of mania that can occur independent of high moods.
Other features that may characterize mania include a reduced need to sleep, pressured speech, racing thoughts, grandiosity, distractibility, increased energy and activity, and engagement in risky behaviors.
Depression
Have you ever had a period lasting at least two weeks when you felt depressed, sad, or hopeless day in and day out? Was there ever a sustained period when you were no longer interested in or able to enjoy your usual activities?
Other features that characterize depression include increased or decreased appetite, weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, feelings of worthlessness or excessive guilt, diminished concentration, loss of interest in normal activities, reduced energy, and suicidal thoughts.
Psychosis
Have you ever had the experience of hearing people talking to you or about you when no one was present? Have you ever thought that people were following you, conspiring against you, or monitoring your activities? (The genetic counselor should attempt to determine if such an event in fact occurred.) Have you ever had thoughts that were not your own but were implanted in your mind?
Other pertinent symptoms of psychosis include
hallucinations in other modalities (visual, tactile, gustatory, olfactory);
delusions (any belief that an individual now holds or at one time held with great conviction that clearly is not true); and
psychotic symptoms (may include incoherent speech, avolition or amotivation, catatonia, and flat or blunted affect).
Keep in mind that psychosis can occur in depression, mania, schizophrenia, schizoaffective disorder, and brief psychotic disorder. Psychosis also can occur in the context of medical conditions such as hyperthyroidism and can result from exposure to illicit drugs or medications.
delusions (any belief that an individual now holds or at one time held with great conviction that clearly is not true); and
psychotic symptoms (may include incoherent speech, avolition or amotivation, catatonia, and flat or blunted affect).
Keep in mind that psychosis can occur in depression, mania, schizophrenia, schizoaffective disorder, and brief psychotic disorder. Psychosis also can occur in the context of medical conditions such as hyperthyroidism and can result from exposure to illicit drugs or medications.
Anxiety
Symptoms of anxiety can manifest in a variety of ways, including
Excessive worry: Do you have a tendency to worry excessively about minor things, and are you unable to stop yourself from worrying throughout the day?
Excessive worry is the core feature of generalized anxiety disorder, specifically when accompanied by other symptoms such as irritability, fatigue, tension, an inability to relax, and poor concentration.
Panic attack: The counselor might ask the client directly if he or she has panic attacks. The client may describe abrupt onset of terror occurring out of the blue and associated with a variety of physical symptoms, including heart palpitations, difficulty catching his or her breath, or a feeling that he or she will die or go crazy. Panic attacks characteristically last less than 30 minutes.
Phobia: Do you have any phobias or unusually strong fears?
Specific situations (social or situational) can result in a phobia, such as a phobia of heights or a social phobia (for example, fear of eating in public). Agoraphobia is a fear of being away from safety, with the feeling that something dreadful will happen if the individual enters an "unsafe" place.
Q. What is mental health?
A. Mental health has to do with how you feel about yourself, how you feel about others, and how you are able to meet and handle the demands of life. It is not the absence of problems. Rather, it describes the ability to balance problems with appropriate coping skills. We know that the right amount of sleep and exercise, a proper diet, appropriate medical care, and caring relationships can go a long way toward improving both our physical and mental health.
Q. What are mental illnesses?
A. Mental illnesses are diseases that cause mild to severe disturbances in thinking, feeling and behavior. These disturbances may sign)ficantly impair a person's ability to cope with life's ordinary demands and routines. Just like physical illnesses, mental illnesses vary greatly by type and severity.
Q. Can mental illnesses be successfully treated?
A. Yes, depending on the type and severity of the mental illness, a person can learn to cope, improve, or experience a full recovery with proper care and treatment. Recently, there have been sign)ficant advancements in treatments for schizophrenia and clinical depression.
Q. What are the most common types of mental illnesses?
A. Anxiety disorders are the most common mental illnesses. The three main types are phobias, panic disorders and obsessive-compulsive disorders.
Q. What causes mental illnesses?
A. Many psychiatric disorders can be linked directly to a biological origin. Others may be emotional or psychological reactions to environmental or social situations. Some of these disorders may be temporary, caused by extreme stress or life changes. Treatment may include medicines, psychotherapies, and social supports.
Q. What is clinical depression?
A. Clinical depression is marked by intense feelings or thoughts of sadness and despair that lasts more than a few weeks and interrupt functioning in daily life. It is one of the most treatable mental illnesses, but it requires professional treatment with medication, psychotherapy, or a combination of both. As with many illnesses, if treatment is needed, the earlier it begins, the more effective it can be.
Q. If I am being treated for a mental illness, what can I do to help myself?
A. To make the most of your treatment, form a partnership with your mental health care provider; continue your treatment as recommended (improvement often takes place within six to eight weeks); join a support group; and take good care of yourself by eating well, exercising, and gefflng plenty of rest.
Q. Does stress cause mental illness?
A. When you are constantly reacting to stressful situations without making adjustments to counter the effects, stress can cause physical, emotional and behavioral disorders that can affect your health, vitality, peace-of-mind, as well as personal and professional relationships. It is estimated that 75-90 percent of visits to primary care physicians are stress related.
Q. How do I get help for a mental illness?
A. The first step is to talk to your doctor to see if there is any underlying physical cause for your symptoms. If none is found, your doctor may refer you to a mental health specialist. Mental health professionals include psychiatrists, psychologists, counselors and social workers. Psychiatrists and other doctors may prescribe medications to treat mental illness. Most mental health professionals have expertise in psychological and behavioral interventions. For some disorders, medications and psychological treatments work best together.
Q. Does medical insurance cover treatment?
A. Insurance policies vary greatly, but most private insurance and health maintenance organization (HMO) plans contain some mental health benefits. Unfortunately, many plans do not provide equal treatment for physical and mental illnesses. Contact your health insurance provider for details on your coverage for treatment of mental illnesses.
Q. When I compare my mental health coverage to my physical health coverage, what should I look for
A. Most often the disparity between mental and physical health coverage occurs in three areas: arbitrary limits on inpatient and outpatient visits; discriminatory copayments limiting affordability of care; and low lifetime and annual caps for people with mental illnesses. These limits often do not provide for enough treatment for people who need long-term care.
Q. Have any states moved to end the disparity between mental and physical health care coverage?
A. Yes, five states -- Maryland, Minnesota, Maine, New Hampshire and Rhode Island -- have passed 'parity" legislation stating that private insurance companies cannot discriminate on health care benefits. The Maryland and Minnesota measures are the best because they apply to all mental and emotional disorders, including those that affect children.
Q. What can I do to improve my insurance coverage for mental illnesses?
A. Write your state representative about your concerns. Request that he or she support parity for mental illnesses by drafting or endorsing legislation that will end discrimination. Tell your employer or benefits administrator that you support equitable mental health coverage.
Source: NMHA.
