Mental health and mental illnesses

Anxiety is a normal human emotion. People feel anxious when facing problems, challenges, change or difficult decisions, and it can drive useful behaviour — like preparing for an exam. Anxiety disorders are dysfunctional responses to anxiety-inducing situations. The difference is severity: an anxiety disorder causes enough distress to interfere with someone's ability to lead a normal life.

Anxiety disorders are among the most common mental health concerns in Nigeria. As of 2017, over 4.9 million Nigerians — 2.7% of the population — had an anxiety disorder.

Types

Generalised anxiety disorder involves persistent, excessive worry that interferes with daily activities, often accompanied by restlessness, fatigue, difficulty concentrating, muscle tension or problems sleeping. The worry usually focuses on everyday things — work, family health, or minor matters like chores and appointments.

Social anxiety disorder involves significant anxiety about being embarrassed, humiliated, rejected or looked down on in social situations. People avoid the situation, or endure it with great anxiety. Common examples are extreme fear of public speaking, meeting new people, or eating and drinking in public. It lasts at least six months and disrupts daily functioning.

Panic disorder involves multiple unexpected panic attacks that happen without warning and aren't due to another condition. Some people with panic disorder also have agoraphobia — an intense fear of being overwhelmed or unable to escape, leading them to avoid unfamiliar places, crowds and open or enclosed spaces.

Symptoms

• Feelings of panic, fear or uneasiness
• Uncontrollable and obsessive thoughts
• Flashbacks to traumatic events
• Problems sleeping, and nightmares
• Shortness of breath, nausea or dizziness
• Muscle tension and heart palpitations
• Dry mouth
• Not being able to stay calm and still
• Cold, sweaty, numb or tingling hands or feet

Causes

Researchers don't know exactly what causes anxiety disorders, but a combination of factors appears to play a role: genetics (anxiety disorders can run in families); brain chemistry; environmental stress such as childhood abuse or neglect, bereavement, or experiencing violence; drug or alcohol withdrawal or misuse; and medical conditions affecting the heart, lungs or thyroid. Withdrawal from certain medications can also produce anxiety symptoms.

It's worth having a full physical examination to rule out other conditions, since anxiety symptoms can be the first signal of a medical problem.

Diagnosis

A healthcare provider will start with a medical evaluation — a physical examination, your medical history, any medications you take, and whether anyone in your family has been diagnosed with an anxiety disorder. A mental health professional will then ask about your symptoms, sleeping habits and other behaviours, using the criteria in the DSM-5 to reach a diagnosis.

Treatment

Each type of anxiety disorder has its own treatment plan, but common approaches include psychotherapy (particularly cognitive behavioural therapy), medications including anti-anxiety drugs and antidepressants, and complementary approaches such as stress and relaxation techniques.

Everyone occasionally feels sad, and may describe their mood as depressed. Usually those feelings are short-lived and pass within a couple of days. Clinical depression is different: it interferes with daily life and causes significant pain, both for the person and for those who care about them.

Depressive disorder is a mood disorder characterised by a pervasive, persistent low mood alongside low self-esteem and a loss of interest or pleasure in normally enjoyable activities. The symptoms interfere with the ability to work, sleep, study, eat and enjoy things.

As of 2017, about 7 million Nigerians — 3.9% of the population — had a depressive disorder.

Symptoms

• Feeling sad, irritable, empty or hopeless
• Losing interest or pleasure in activities you once enjoyed
• A significant change in appetite, or weight loss or gain unrelated to dieting
• Sleeping too little or too much
• Decreased energy, or increased tiredness and fatigue
• Restlessness — an inability to sit still, pacing, handwringing — or noticeably slowed movement or speech
• Feeling worthless or excessively guilty
• Difficulty thinking or concentrating, forgetfulness, or difficulty making minor decisions
• Thoughts of death, suicidal ideation, or suicide attempts

Causes

Several factors appear to contribute: brain chemistry, including an imbalance of neurotransmitters such as serotonin and dopamine; genetics — having a parent or sibling with depression makes you around three times more likely to develop it, though you can have depression with no family history at all; stressful life events such as bereavement, trauma, divorce, isolation or lack of support; medical conditions including chronic pain and diabetes; and medication, since some drugs list depression as a side effect. Substance use, alcohol included, can cause depression or make it worse.

Diagnosis

Diagnosis is based on a thorough understanding of your symptoms, medical history and mental health history. To receive a diagnosis of depression you must have five depression symptoms every day, nearly all day, for at least two weeks. Your provider may order blood tests to check whether an underlying medical condition is causing the symptoms.

Treatment

The three most common treatments are psychotherapy, medication and electroconvulsive therapy. Psychotherapy: cognitive behavioural therapy is currently the most effective form, teaching people to challenge self-defeating patterns of thinking and change counter-productive behaviour. Medication: antidepressants, usually SSRIs, produce significant improvement in mood for people with severe depression. Electroconvulsive therapy: pulses of electricity are sent through the brain via two electrodes; studies find it very effective for severe depression that has not responded to medication or therapy.

Many people fail to see that alcohol, tobacco and caffeine are drugs too. When a person takes a substance — alcohol, cocaine, cannabis, or some medications — molecules surge through the bloodstream into the brain and set off biochemical events that disturb its normal operation. Substance misuse can lead to various kinds of abnormal functioning.

Substance abusers rely on a drug excessively and chronically, damaging family and social relationships, functioning poorly at work, or putting themselves and others in danger. A more advanced pattern, substance dependence — also known as addiction — involves centring life on the drug and often acquiring a physical dependence marked by tolerance, withdrawal symptoms, or both. When tolerance develops, increasing doses are needed for the same effect.

As of 2018, about 14.3 million Nigerians — 14.4% of the population — had a substance use disorder.

Symptoms

• Using or drinking larger amounts, or over longer periods, than planned
• Continually wanting or unsuccessfully trying to cut down or control use
• Spending a lot of time getting, using, or recovering from use
• Craving, or a strong desire to use
• Ongoing use that interferes with work, school or home responsibilities
• Continued use despite relationship problems caused by it
• Giving up or reducing activities because of use
• Taking risks, such as driving under the influence
• Continuing despite physical or psychological problems it causes or worsens
• Developing tolerance — needing more for the same effect
• Withdrawal symptoms when not using, or using to avoid them

Causes

Substance use disorder is caused by multiple factors: genetic vulnerability, environmental stressors, social pressures, individual personality characteristics and psychiatric problems. Which factor matters most varies from person to person. Cultural and societal factors determine what counts as acceptable use, and public laws determine what is legal.

Substances people misuse fall into several categories: depressants such as alcohol and opioids, which slow the central nervous system; stimulants such as cocaine and amphetamines; hallucinogens such as LSD; and cannabis substances, which combine hallucinogenic, depressant and stimulant effects.

Diagnosis

A family doctor, psychiatrist or qualified mental health professional usually makes the diagnosis. Clinical findings depend on the substance, how often it is used and how recently. They may include weight loss, constant fatigue, red eyes, little concern for hygiene, laboratory abnormalities, unexpected changes in heart rate or blood pressure, and depression, anxiety or sleep problems.

Treatment

Treatment depends on your age and health history, the extent of symptoms and dependence, the substance involved, your tolerance for particular medicines or therapies, and your own preferences. Programmes are available on an inpatient or outpatient basis. Detoxification, where needed, and long-term follow-up management are important features of successful treatment — usually including group meetings, psychosocial support and continued medical supervision. Individual and family psychotherapy are often recommended to address what contributed to the disorder and what resulted from it.

Bipolar disorder — formerly called manic-depressive illness — causes unusual shifts in mood, energy, activity levels and concentration, which can make day-to-day tasks difficult. It is not as common as other disorders in Nigeria, but many people live with it.

Left untreated, bipolar disorder usually worsens. With a good treatment plan — psychotherapy, medication, a healthy lifestyle, a regular schedule, and early identification of symptoms — many people live well with the condition.

Types

Bipolar I disorder is defined by manic episodes lasting at least seven days, or by manic symptoms severe enough to need immediate medical care. Depressive episodes usually occur too, typically lasting at least two weeks.

Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes, where the hypomanic episodes are less severe than the manic episodes in bipolar I.

Cyclothymic disorder involves recurring hypomanic and depressive symptoms that aren't intense or long-lasting enough to qualify as full episodes.

Bipolar disorder is often diagnosed in late adolescence or early adulthood, though symptoms can appear in children.

Symptoms

• Manic episodes: periods of extremely elevated, irritable or energised behaviour
• Depressive episodes: periods of sadness, indifference or hopelessness
• Hypomanic episodes: less severe manic periods
• Mixed features: depressive and manic symptoms at the same time
• Rapid cycling: four or more episodes of mania or depression within a year

Causes

The cause is not known, but two factors appear to be involved. Biological differences: people with bipolar disorder appear to have physical changes in their brains, though the significance of these is still uncertain. Genetics: bipolar disorder is more common in people who have a first-degree relative — a sibling or parent — with the condition.

Diagnosis

Diagnosis may involve a physical examination, a thorough medical history covering symptoms, lifetime experiences and family history, medical tests such as blood tests to rule out conditions like hyperthyroidism, and a mental health evaluation. To be diagnosed you must have experienced at least one episode of mania or hypomania.

People with bipolar disorder are more likely to also have anxiety, ADHD, PTSD or a substance use disorder. Because memory is often impaired during mania, people may not remember experiencing it, which makes accurate diagnosis harder. Someone in a severe manic episode with hallucinations may be incorrectly diagnosed with schizophrenia, and bipolar disorder can also be misdiagnosed as borderline personality disorder. Being honest and thorough about all your symptoms matters — and it can help to bring someone who knows your history with you.

Treatment

An effective plan usually combines psychotherapy, medication, self-management strategies such as learning to identify early symptoms and triggers, and supportive lifestyle habits including exercise and meditation. Electroconvulsive therapy is used in cases that respond poorly to medication or where rapid symptom control is needed to prevent harm.

Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment. It can take months or years to find a plan that works well. That can be discouraging, but continuing treatment matters. Episodes typically recur over time; between them many people have no mood changes, though some have lingering symptoms that long-term treatment helps manage.