The medical director for the New York State Office of Mental Health, Dr. Lloyd Sederer, MD spoke at Upstate this week about how families cope with mental illness. A graduate of Upstate’s College of Medicine, Sederer has a new book out, “The Family Guide to Mental Health Care,” from which this excerpt is drawn.
Sederer says as a family member or friend, your job is to help figure out when a professional diagnosis may be needed, and to help your loved one get it. He gives these three simple criteria for help deciding when to intervene:
* The person has shown significant changes in behavior, mood and thinking that impair functioning.
* These changes have persisted for at least two weeks and are not limited to hours or days.
* These changes have occurred without an evident cause (like a serious physical illness) or a major traumatic life event (like the loss of a loved one, a natural disaster or a significant job or school problem.)
Listen to an interview with Dr. Sederer on HealthLink on Air
Sederer goes on to list more specific criteria you may observe:
Basic habits like eating and sleeping
* Eating may be diminished or increased, or there may be new eating habits such as unusual choices of foods, secretive eating or not wanting to eat with others. With changes in eating there is frequently weight gain or loss that you can notice, but not always.
* Sleep may be decreased or increased, or its pattern changes significantly. There may be significant difficulty falling asleep, staying asleep or waking early and being unable to return to sleep. There may be noticeable daytime sleeping or staying in bed during the day for long periods of time.
Hygiene and self care
* Showering or bathing may become infrequent, with a person not only looking dirty but smelling poorly also.
* Dress may become unkempt, including wearing the same clothes for days or the clothes appearing dirty or disheveled.
* A person’s hair may go unwashed, unbrushed, and look matted or ragged.
* A person’s room may reflect the same inattention to hygiene, self care and tidiness (to the extent it existed before.)
* There may be a significant reduction in a person’s movements, making him or her look leaden or slow. Or there may be an ongoing increase in movement, including pacing or what looks like frantic activity.
* Work activities, chores, interests and hobbies, studies — any way the person usually spent time — may be markedly reduced. Or there may be a rather sudden, almost explosive, increase in activities, usually with few if any being completed.
Behavior (that is significantly different from what you have seen in the past)
* Isolation at home or in one’s room.
* Appearing highly preoccupied, as if something compelling is going on inside the person that he or she is not talking about.
* Talking to oneself, or when alone talking aloud as if someone else were there.
* Strange new behaviors, like locking doors, sealing windows, abruptly turning off a TV or radio (or responding oddly to something said on a program) wearing off combinations or multiple layers of clothing when the weather does not call for it.”
Socializing or other activities with people
* Not wanting to spend time with family. Avoiding family meals and outings.
* Not wanting to spend time with friends.
* Not answering calls or text messages that before were always attended to.
* Mood may become blue, sad or tearful. A person may talk of having lost interest or pleasure, or that life is not worth living. Pessimism prevails.
* There may be periods of intense worry, fear or anxiety.
* A person may become highly irritable or quick to get into arguments.
* Excitement may be prominent, without clear reasons. Everything seems overly important, for a brief moments, and then another matter takes over.
* Thinking may be sped up or slowed down, resulting in an increase in talking or a marked reduction.
* Indecision can prevail and a person is unable to decide even on simple matters.
* Guilty feelings may be out of proportion to any event.
* A person may express odd thoughts, different from what you have come to expect. He or she may interpret what is going on in strange ways, including thinking that the world has suddenly changed or that there are forces we don’t know about or that are dangerous.
* Thoughts expressed may not make sense, or may seem disjointed or confused.
* The person may respond to what he or she believes is a voice when there is no one speaking, or react to other nonexistent things (like wrinkling the nose at a nonexistent odor or training the gaze on a corner of the room with nothing in it.)
* The person may act in response to what appear to be highly developed and threatening concerns from within.
Smoking and alcohol or drug use
* Smoking more and chain smoking.
* Drinking more, drinking in order to fall asleep, or drinking alone or secretively.
* Heavy use of marijuana or other street drugs.
“If you see significant changes in a loved one’s behavior, mood, or thinking that impair functioning, and these changes last for weeks, seek professional help as soon as possible,” Sederer writes.
His book goes on to explain how to obtain an accurate diagnosis, along with descriptions of the “faces of mental illness.” He includes a chapters on medications and psychotherapy and rehabilitation.
Listen to Dr. Sederer’s interview on HealthLink on Air