Post-traumatic stress disorder is an anxiety disorder that's triggered by your memories of a traumatic event

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Overview

Post-traumatic stress disorder is an anxiety disorder that's triggered by your memories of a traumatic event -- an event that directly affected you or an event that you witnessed. The disorder commonly affects survivors of traumatic events, such as sexual assault, physical assault, war, torture, a natural disaster, an automobile accident, an airplane crash, a hostage situation or a death camp. Post-traumatic stress disorder also can affect rescue workers at the site of an airplane crash or a mass shooting. It can affect someone who witnessed a tragic accident.

Not everyone involved in a traumatic event experiences post-traumatic stress disorder. However, the disorder affects more than 5 million adults each year in the United States. Post-traumatic stress disorder is twice as common in women as it is in men. Treatment may involve a combined approach including medications and behavior therapy designed to help you gain control of your anxiety.

Signs and symptoms

Signs and symptoms of post-traumatic stress disorder typically appear within three months of the traumatic event. However, in some instances, they may not occur until years after the event and may include: § Flashbacks and distressing dreams associated with the traumatic event. § Distress at anniversaries of the trauma. § Efforts to avoid thoughts, feelings and activities associated with the trauma. § Feelings of detachment or estrangement from others and an inability to have loving feelings. § Markedly diminished interest or participation in activities that once were an important source of satisfaction. § In young children, delayed or developmental retrogression in such areas as toilet training, motor skills and language. § Hopelessness about the future -- no hope of a family life, career or living to old age. § Physical and psychological hypersensitivity -- not present before the trauma -- with at least two of the following reactions: trouble sleeping, anger, difficulty concentrating, exaggerated startle response to noise, and physiological reaction to situations that remind you of the traumatic event. These physiological reactions may include an increase in blood pressure, a rapid heart rate, rapid breathing, muscle tension, nausea and diarrhea. Risk factors

The severity of the traumatic event and how long the event lasted appear to be factors in the development of this disorder. Other factors that may increase the likelihood of developing post-traumatic stress disorder include:

§ A previous history of depression or other emotional disorder § A previous history of physical or sexual abuse § A family history of anxiety § Early separation from parents § Being part of a dysfunctional family § Alcohol abuse § Drug abuse

When to seek medical advice

It's normal to undergo a wide range of feelings and emotions after a traumatic event. The feelings you experience may include fear and anxiety, a lack of focus, sadness, changes in sleeping or eating patterns, or bouts of crying that come easily. You may have recurrent thoughts or nightmares about the event. If you have these disturbing feelings for more than a month, if they're severe or if you feel you're having trouble getting your life back under control, consider seeing your doctor or a mental health professional.

Overview

Schizophrenia is a chronic and often debilitating mental illness. The condition can cause you to withdraw from the people and activities in the world around you and to retreat into a world of delusions or separate reality.

Signs and symptoms

Signs and symptoms of schizophrenia may include:

§ Delusions -- personal beliefs not based in reality, such as paranoia that you're being persecuted or conspired against § Bizarre delusions -- for example, a belief in Martians controlling your thoughts § Hallucinations -- sensing things that don't exist, such as imaginary voices § Incoherence § Lack of emotions or inappropriate display of emotions § A persistent feeling of being watched § Trouble functioning at work or in social situations

Generally, schizophrenia causes a slowly progressive deterioration in the ability to function in various roles, especially in your job and personal life. The signs and symptoms of schizophrenia vary greatly. A person may behave differently at different times. He or she may become extremely agitated and distressed, or fall into a trance-like, immobile, unresponsive (catatonic) state, or even behave normally much of the time. Signs and symptoms that occur continuously and progressively may indicate schizophrenia. In general, schizophrenia has symptoms that fall into three categories -- negative, positive and cognitive:

Negative signs and symptoms

Negative signs and symptoms may appear early in the disease, and a person may not think he or she needs treatment. They're referred to as negative because they indicate a loss of behavior or of a personality trait. Negative signs generally accompany a slow deterioration of function, leading to your becoming less sociable.

Such signs may include:

§ Dulled emotions (lack of expression) § Inappropriate emotions (laughing while expressing terrifying images) § A change in speech (speaking in a dull monotone) Positive signs and symptoms Positive signs include hallucinations and delusions. They're called positive because they indicate a trait or behavior that's been added to the personality. § Hallucinations. Hallucinations occur when you sense things that don't exist. The most common hallucination in schizophrenia is hearing voices. You may carry on a conversation with voices that no one else can hear. Or you may perceive that voices are providing you instructions on what to do. Hallucinations may result in injuries to other people.

§ Delusions. Delusions are firmly held personal beliefs that have no basis in reality. The most common subtype of schizophrenia is paranoid schizophrenia, in which you hold irrational beliefs that others are persecuting you or conspiring against you. For example, some people with schizophrenia may believe that the television is directing their behavior or that outside forces are controlling their thoughts.

Cognitive signs and symptoms

These signs and symptoms tend to be more subtle than positive and negative ones. Cognitive signs and symptoms may include: § Problems making sense of incoming information § Difficulty paying attention § Memory problems

Misconceptions about schizophrenia

Schizophrenia may exist alone or in combination with other psychiatric or medical conditions. Misconceptions about schizophrenia and its relation to other mental illnesses abound. The following truths will help clarify what it is and is not:

§ Schizophrenia isn't the same as a split or multiple personality. Multiple personality disorder is a separate, rare condition. § Although some people with schizophrenia develop violent tendencies, most don't. Many withdraw into themselves rather than interact with others. § Not everyone who acts paranoid or distrustful has schizophrenia. Some people have a paranoid personality disorder, a tendency to be suspicious or distrustful of others, without the other features of schizophrenia. § Not everyone who hears voices is schizophrenic. Some people with depression may hear voices. Hearing voices may also occur as a result of a serious medical illness or from the effects of medication. Substance abuse and schizophrenia

While not necessarily a sign of schizophrenia, drug abuse is more common in people with schizophrenia. Nicotine is a commonly abused drug by people with schizophrenia; it's estimated that 75 percent to 90 percent of people with schizophrenia smoke compared with about one-quarter of the general population. Unfortunately some drugs, such as amphetamines, cocaine and marijuana, can make schizophrenia symptoms worse. Others, such as nicotine, can interfere with schizophrenia medications.

Causes

Researchers haven't identified the cause or causes of schizophrenia, although they believe genetic factors play a role. About 1 percent of the general population develops schizophrenia compared with 10 percent of those with a close family relative who has the disease. Chemical or subtle structural abnormalities in the brain may contribute to causing this illness.

When to seek medical advice

By its nature, schizophrenia often isn't an illness for which someone is likely to voluntarily seek treatment. To a person with schizophrenia, the delusions and hallucinations are real, and often he or she may believe there's no need for medical help. If you're a family member or friend of someone who is exhibiting possible signs of schizophrenia or another mental disorder, you may need to be the one who takes him or her to a medical professional for evaluation. Additionally, people with schizophrenia are more likely to attempt suicide, so if your loved one talks about committing suicide, seek professional help immediately.

Screening and diagnosis

Before making a diagnosis of schizophrenia, your doctor likely will rule out other possible causes of the signs that may suggest schizophrenia. It's possible that other mental or physical illnesses may cause signs similar to schizophrenia.

Your doctor will want to discuss your family and medical history and do a physical examination. Your doctor may ask for blood or urine samples to see if medications, substance abuse or another physical illness may be a factor in your signs.

Among the other mental illnesses that may at least partly resemble schizophrenia are depression, bipolar disorder, other psychoses, and abuse of alcohol and other drugs.

It's also possible that physical illnesses such as certain infections, cancers, nervous system disorders, thyroid disorders and immune system disorders may produce some psychotic signs. Psychosis is also a possible side effect of some medications. If no other underlying cause is found, doctors diagnose schizophrenia based on the signs and symptoms.

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