Information about Mental Illness and the Brain (2024)

Defining Mental Illness¹

We can all be "sad" or "blue" at times in our lives. We have all seen movies aboutthe madman and his crime spree, with the underlying cause of mental illness. Wesometimes even make jokes about people being crazy or nuts, even though we know thatwe shouldn't. We have all had some exposure to mental illness, but do we reallyunderstand it or know what it is? Many of our preconceptions are incorrect. Amental illness can be defined as a health condition that changes a person'sthinking, feelings, or behavior (or all three) and that causes the persondistress and difficulty in functioning. As with many diseases, mentalillness is severe in some cases and mild in others. Individuals who have a mentalillness don't necessarily look like they are sick, especially if their illness ismild. Other individuals may show more explicit symptoms such as confusion,agitation, or withdrawal. There are many different mental illnesses, includingdepression, schizophrenia, attention deficithyperactivity disorder (ADHD), autism, andobsessive-compulsive disorder. Each illness alters a person'sthoughts, feelings, and/or behaviors in distinct ways. In this module, we will attimes discuss mental illness in general terms and at other times, discuss specificmental illnesses. Depression, schizophrenia, and ADHD will be presented in greaterdetail than other mental illnesses.

Not all brain diseases are categorized as mental illnesses. Disorders such asepilepsy, Parkinson's disease, and multiple sclerosis are brain disorders, but theyare considered neurological diseases rather than mental illnesses. Interestingly,the lines between mental illnesses and these other brain or neurological disordersis blurring somewhat. As scientists continue to investigate the brains of people whohave mental illnesses, they are learning that mental illness is associated withchanges in the brain's structure, chemistry, and function and that mental illnessdoes indeed have a biological basis. This ongoing research is, in some ways, causingscientists to minimize the distinctions between mental illnesses and these otherbrain disorders. In this curriculum supplement, we will restrict our discussion ofmental illness to those illnesses that are traditionally classified as mentalillnesses, as listed in the previous paragraph.

Mental Illness in the Population²

Many people feel that mental illness is rare, something that only happens to peoplewith life situations very different from their own, and that it will never affectthem. Studies of the epidemiology of mental illness indicate that this belief is farfrom accurate. In fact, the surgeon general reports that mental illnesses are socommon that few U.S. families are untouched by them.⁴⁴

Few U.S. families are untouched by mental illness.

Mental Illness in Adults

Figure 1

Scientists estimate that one of every four people is affected by mentalillness either directly or indirectly.

Even if you or a family member has not experienced mental illness directly, it isvery likely that you have known someone who has. Estimates are that at least onein four people is affected by mental illness either directly or indirectly. Consider the followingstatistics to get an idea of just how widespread the effects of mental illnessare in society: ^{4, 25, 44}

According to recent estimates, approximately 20 percent of Americans,or about one in five people over the age of 18, suffer from adiagnosable mental disorder in a given year.
Four of the 10 leading causes of disability—majordepression, bipolar disorder, schizophrenia, andobsessive-compulsive disorder—are mental illnesses.
About 3 percent of the population have more than one mental illnessat a time.
About 5 percent of adults are affected so seriously by mental illnessthat it interferes with their ability to function in society. Thesesevere and persistent mental illnesses include schizophrenia,bipolar disorder, other severe forms of depression, panicdisorder, and obsessive-compulsive disorder.
Approximately 20 percent of doctor's appointments are related toanxiety disorders such as panic attacks.
Eight million people have depression each year.
Two million Americans have schizophrenia disorders, and 300,000 newcases are diagnosed each year.

Mental Illness in Children and Adolescents

Mental illness is not uncommon among children and adolescents. Approximately 12million children under the age of 18 have mental disorders.⁴ TheNational Mental Health Association³³ has compiled some statisticsabout mental illness in children and adolescents:

Mental health problems affect one in every five young people at anygiven time.
An estimated two-thirds of all young people with mental healthproblems are not receiving the help they need.
Less than one-third of the children under age 18 who have a seriousmental health problem receive any mental health services.
As many as 1 in every 33 children may be depressed. Depression inadolescents may be as high as 1 in 8.
Suicide is the third leading cause of death for 15- to 24-years-oldsand the sixth leading cause of death for 5- to 15-year-olds.
Schizophrenia is rare in children under age 12, but it occurs inabout 3 of every 1,000 adolescents.
Between 118,700 and 186,600 youths in the juvenile justice systemhave at least one mental illness.
Of the 100,000 teenagers in juvenile detention, an estimated 60percent have behavioral, cognitive, or emotional problems.

Warning Signs for Mental Illness³

Each mental illness has its own characteristic symptoms. (See Section 10 forinformation about some specific illnesses.) However, there are some general warningsigns that might alert you that someone needs professional help.⁴ Some ofthese signs include

marked personality change,
inability to cope with problems and daily activities,
strange or grandiose ideas,
excessive anxieties,
prolonged depression and apathy,
marked changes in eating or sleeping patterns,
thinking or talking about suicide or harming oneself,
extreme mood swings—high or low,
abuse of alcohol or drugs, and
excessive anger, hostility, or violent behavior.

A person who shows any of these signs should seek help from a qualified healthprofessional.

Diagnosing Mental Illness³

Mental Health Professionals

To be diagnosed with a mental illness, a person must be evaluated by a qualifiedprofessional who has expertise in mental health. Mental health professionalsinclude psychiatrists, psychologists, psychiatricnurses, social workers, and mental health counselors. Family doctors,internists, and pediatricians are usually qualified to diagnose common mentaldisorders such as depression, anxiety disorders, and ADHD. In many cases,depending on the individual and his or her symptoms, a mentalhealth professional who is not a psychiatrist will refer the patient to apsychiatrist. A psychiatrist is a medical doctor (M.D.) who has receivedadditional training in the field of mental health and mental illnesses.Psychiatrists evaluate the person's mental condition in coordination with his orher physical condition and can prescribe medication. Only psychiatrists andother M.D.s can prescribe medications to treat mental illness.

Mental Illnesses are Diagnosed by Symptoms

Unlike some disease diagnoses, doctors can't do a blood test or culture somemicroorganisms to determine whether a person has a mental illness. Maybescientists will develop discrete physiological tests for mental illnesses in thefuture; until then, however, mental health professionals will have to diagnosem*ntal illnesses based on the symptoms that a person has. Basing a diagnosis onsymptoms and not on a quantitative medical test, such as a blood chemistry test,a throat swab, X-rays, or urinalysis, is not unusual. Physicians diagnose manydiseases, including migraines, Alzheimer's disease, and Parkinson's diseasebased on their symptoms alone. For other diseases, such as asthma ormononucleosis, doctors rely on analyzing symptoms to get a good idea of what theproblem is and then use a physiological test to provide additional informationor to confirm their diagnosis.

When a mental health professional works with a person who might have a mentalillness, he or she will, along with the individual, determine what symptoms theindividual has, how long the symptoms have persisted, and how his or her life isbeing affected. Mental health professionals often gather information through aninterview during which they ask the patient about his or her symptoms, thelength of time that the symptoms have occurred, and the severity of thesymptoms. In many cases, the professional will also get information about thepatient from family members to obtain a more comprehensive picture. A physicianlikely will conduct a physical exam and consult the patient's history to ruleout other health problems.

Mental health professionals evaluate symptoms to make a diagnosis of mentalillness. They rely on the criteria specified in the Diagnostic andStatistical Manual of Mental Disorders (DSM-IV; currently, the fourthedition), published by the American Psychiatric Association, to diagnose aspecific mental illness.⁵ For each mental illness, the DSM-IV gives ageneral description of the disorder and a list of typical symptoms. Mentalhealth professionals refer to the DSM-IV to confirm that the symptoms a patientexhibits match those of a specific mental illness. Although the DSM-IV providesvaluable information that helps mental health professionals diagnose mentalillness, these professionals realize that it is important to observe patientsover a period of time to understand the individual's mental illness and itseffects on his or her life. We present the DSM-IV criteria for the specificdiseases discussed in this module in Section 10, Information aboutSpecific Mental Illnesses.

Mental health professionals evaluate symptoms to make a diagnosis of mentalillness.

Mental Illness and the Brain⁴

The term mental illness clearly indicates that there is a problem with the mind. Butis it just the mind in an abstract sense, or is there a physical basis to mentalillness? As scientists continue to investigate mental illnesses and their causes,they learn more and more about how the biological processes that make the brain workare changed when a person has a mental illness.

The Basics of Brain Function

Before thinking about the problems that occur in the brain when someone has amental illness, it is helpful to think about how the brain functions normally.The brain is an incredibly complex organ. It makes up only 2 percent of our bodyweight, but it consumes 20 percent of the oxygen we breathe and 20 percent ofthe energy we take in. It controls virtually everything we as humans experience,including movement, sensing our environment, regulating our involuntary bodyprocesses such as breathing, and controlling our emotions. Hundreds of thousandsof chemical reactions occur every second in the brain; those reactions underliethe thoughts, actions, and behaviors with which we respond to environmentalstimuli. In short, the brain dictates the internal processes and behaviors thatallow us to survive.

Figure 2

The neuron, or nerve cell, is the functional unit of the nervous system. Theneuron has processes called dendrites that receive signals and an axon thattransmits signals to another neuron.

How does the brain take in all this information, process it, and cause aresponse? The basic functional unit of the brain is the neuron. A neuron is a specialized cellthat can produce different actions because of its precise connections with otherneurons, sensory receptors, and muscle cells. A typical neuron has fourstructurally and functionally defined regions: the cell body, dendrites, axons, and the axon terminals.

The cell body is the metabolic center of the neuron. The nucleus is located inthe cell body and most of the cell's protein synthesis occurs here.

A neuron usually has multiple fibers called dendrites that extend from the cellbody. These processes usually branch out somewhat like tree branches and serveas the main apparatus for receiving input from other nerve cells.

The cell body also gives rise to the axon. The axon is usually much longer thanthe dendrites; in some cases, an axon can be up to 1 meter long. The axon is thepart of the neuron that is specialized to carry messages away from the cell bodyand to relay messages to other cells. Some large axons are surrounded by a fattyinsulating material called myelin,which enables the electrical signals to travel down the axon at higherspeeds.

Near its end, the axon divides into many fine branches that have specializedswellings called axon terminals or presynaptic terminals. The axon terminals endnear the dendrites of another neuron. The dendrites of one neuron receive themessage sent from the axon terminals of another neuron.

Figure 3

Diagram of a synapse.

The site where an axon terminal ends near a receiving dendrite is called thesynapse. The cell that sends out information is called thepresynaptic neuron, and the cell that receives the informationis called the postsynaptic neuron. It is important to note that thesynapse is not a physical connection between the two neurons;there is no cytoplasmic connection between the two neurons. The intercellularspace between the presynaptic and postsynaptic neurons is called thesynaptic space or synaptic cleft. An average neuron formsapproximately 1,000 synapses with other neurons. It has been estimated thatthere are more synapses in the human brain than there are stars in our galaxy.Furthermore, synaptic connections are not static. Neurons form new synapses orstrengthen synaptic connections in response to life experiences. This dynamicchange in neuronal connections is the basis of learning.

Figure 4

Neurons relay their information using both electrical signals and chemicalmessages in a process called neurotransmission.

Neurons communicate using both electrical signals and chemical messages.Information in the form of an electrical impulse is carried away from theneuron's cell body along the axon of the presynaptic neuron toward the axonterminals. When the electrical signal reaches the presynaptic axon terminal, itcannot cross the synaptic space, or synaptic cleft. Instead, the electricalsignal triggers chemical changes that can cross the synapse toaffect the postsynaptic cell. When the electrical impulse reaches thepresynaptic axon terminal, membranous sacs called vesicles movetoward the membrane of the axon terminal. When the vesicles reach the membrane,they fuse with the membrane and release their contents into the synaptic space.The molecules contained in the vesicles are chemical compounds calledneurotransmitters. Each vesicle contains many molecules of a neurotransmitter. Thereleased neurotransmitter molecules drift across the synaptic cleft and thenbind to special proteins, called receptors, on the postsynapticneuron. A neurotransmitter molecule will bind only to a specific kind ofreceptor.

The binding of neurotransmitters to their receptors causes that neuron togenerate an electrical impulse. The electrical impulse then moves away from thedendrite ending toward the cell body. After the neurotransmitter stimulates anelectrical impulse in the postsynaptic neuron, it releases from the receptorback into the synaptic space. Specific proteins called transportersor reuptake pumps carry the neurotransmitter back into thepresynaptic neuron. When the neurotransmitter molecules are back in thepresynaptic axon terminal, they can be repackaged into vesicles for release thenext time an electrical impulse reaches the axon terminal. Enzymes present inthe synaptic space degrade neurotransmitter molecules that are not taken back upinto the presynaptic neuron.

The nervous system uses a variety of neurotransmitter molecules, but each neuronspecializes in the synthesis and secretion of a single type of neurotransmitter.Some of the predominant neurotransmitters in the brain include glutamate, GABA,serotonin, dopamine, and norepinephrine. Each of theseneurotransmitters has a specific distribution and function in the brain; thespecifics of each are beyond the scope of this module, but a few of the nameswill arise in reference to particular mental illnesses.

Investigating Brain Function

Mental health professionals base their diagnosis and treatment of mental illnesson the symptoms that a person exhibits. The goal for these professionals intreating a patient is to relieve the symptoms that are interfering with theperson's life so that the person can function well. Research scientists, on theother hand, have a different goal. They want to learn about the chemical orstructural changes that occur in the brain when someone has a mental illness. Ifscientists can determine what happens in the brain, they can use that knowledgeto develop better treatments or find a cure.

Figure 5

Scientists use a variety of imaging techniques to investigate brain structureand function.

The techniques that scientists use to investigate the brain depend on thequestions they are asking. For some questions, scientists use molecular orbiochemical methods to investigate specific genes or proteins in the neurons.For other questions, scientists want to visualize changes in the brain so thatthey can learn more about how the activity or structure of the brain changes.Historically, scientists could examine brains only after death, but new imagingprocedures enable scientists to study the brain in living animals, includinghumans. It is important torealize that these brain imaging techniques are not used for diagnosing mentalillness. Mental illnesses are diagnosed by the set of symptoms that anindividual exhibits. The imaging techniques described in the followingparagraphs would not enable the mental health professional to diagnose or treatthe patient more effectively. Some of the techniques are also invasive andexpose patients to small amounts of radiation. Research studies using thesetests are generally not conducted with children or adolescents.

One extensively used technique to study brain activity and how mental illnesschanges the brain is positron emissiontomography (PET). PET measures the spatial distribution and movementof a radioactive chemical injected into the tissues of living subjects. Becausethe patient is awake, the technique can be used to investigate the relationshipbetween behavioral and physiological effects and changes in brain activity. PETscans can detect very small (nanomolar) concentrations of tracer molecules andachieve spatial resolution of about 4 millimeters. In addition, computers canreconstruct images obtained from a PET scan in two or three dimensions.

PET requires the use of compounds that are labeled with positron-emittingisotopes. A positron has the same mass and spin as an electron butthe opposite charge; an electron has a negative charge and a positron has apositive charge. A cyclotron accelerates protons into the nucleus of nitrogen,carbon, oxygen, or fluorine to generate these isotopes. The additional protonmakes the isotope unstable. To become stable again, the proton must break downinto a neutron and a positron. The unstable positron travels away from the siteof generation and dissipates energy along the way. Eventually, the positroncollides with an electron, leading to the emission of two gamma rays at 180degrees from one another. The gamma rays reach a pair of detectors that recordthe event. Because the detectors respond only to simultaneous emissions,scientists can precisely map the location where the gamma rays were generated.The radioactive chemicals used for PET are very short lived. The half-life (thetime for half of the radioactive label to disintegrate) of the commonly usedradioisotopes ranges from approximately two minutes to less than two hours,depending on the specific compound. Because a PET scan requires only smallamounts (a few micrograms) of short-lived radioisotopes, this technique can beused safely in humans.

PET scans can answer a variety of questions about brain function, including wherethe neurons are most active. Scientists use different radiolabeled compounds toinvestigate different biological questions. For example, radiolabeled glucosecan identify parts of the brain that become more active in response to aspecific stimulus. Active neurons metabolize more glucose than inactive neurons.Active neurons emit more positrons, and this shows as red or yellow on PET scanscompared with blue or purple in areas where the neurons are not highly active.(Different computer enhancement techniques may use a different color scheme, butthe use of a spectrum with red indicating high activity and blue indicating lowactivity is common.) Scientists can use PET to measure changes in the activityof specific brain areas in a person who has a mental illness. Scientists canalso investigate how the mentally ill brain changes after a person receivestreatment.

PET imaging is not the only technique that researchers use to investigate howmental illness changes the brain. Different techniques provide differentinformation to scientists. Another important technique is magneticresonance imaging (MRI). Unlike PET, which reveals changes inactivity level, MRI is used to look at structural changes in the brain. Forexample, MRI studies reveal that the ventricles, or spaces withinthe brain, are larger in individuals who have schizophrenia compared with thoseof healthy individuals. Other techniques that scientists use to investigatefunction in the living brain include single photon emission computedtomography (SPECT), functional magnetic resonance imaging (fMRI), andelectroencephalography (EEG). Each technique has its ownadvantages, and each provides different information about brain structure andfunction. Scientists often use more than one technique when conducting theirresearch.

Scientists believe that mental illnesses result from problems with thecommunication system in the brain.

The Causes of Mental Illnesses⁵

At this time, scientists do not have a complete understanding of what causes mentalillnesses. If you think about the structural and organizational complexity of thebrain together with the complexity of effects that mental illnesses have onthoughts, feelings, and behaviors, it is hardly surprising that figuring out thecauses of mental illnesses is a daunting task. The fields of neuroscience,psychiatry, and psychology address different aspects of the relationship between thebiology of the brain and individuals' behaviors, thoughts, and feelings, and howtheir actions sometimes get out of control. Through this multidisciplinary research,scientists are trying to find the causes of mental illnesses. Once scientists candetermine the causes of a mental illness, they can use that knowledge to develop newtreatments or to find a cure.

The Biology of Mental Illnesses

Figure 6

Scientists understand that mental illnesses are associated with changes inneurochemicals. For example, in people who have depression, less of theneurotransmitter serotonin (small circles) is released into the synapticspace than in people who do not (more...)

Most scientists believe that mental illnesses result from problems with thecommunication between neurons in the brain (neurotransmission). Forexample, the level of the neurotransmitter serotonin is lower in individuals whohave depression. This finding led to the development of certain medications forthe illness. Selective serotonin reuptake inhibitors (SSRIs) workby reducing the amount of serotonin that is taken back into the presynapticneuron. This leads to anincrease in the amount of serotonin available in the synaptic space for bindingto the receptor on the postsynaptic neuron. Changes in other neurotransmitters(in addition to serotonin) may occur in depression, thus adding to thecomplexity of the cause underlying the disease.

Scientists believe that there may be disruptions in the neurotransmittersdopamine, glutamate, and norepinephrine in individuals who have schizophrenia.One indication that dopamine might be an important neurotransmitter inschizophrenia comes from the observation that cocaine addicts sometimes showsymptoms similar to schizophrenia. Cocaine acts on dopamine-containing neuronsin the brain to increase the amount of dopamine in the synapse.

Risk Factors for Mental Illnesses

Although scientists at this time do not know the causes of mental illnesses, theyhave identified factors that put individuals at risk. Some of these factors areenvironmental, some are genetic, and some are social. In fact, all these factorsmost likely combine to influence whether someone becomes mentally ill.

Genetic, environmental, and social factors interact to influence whethersomeone becomes mentally ill.

Environmental factors such as head injury, poor nutrition, and exposure to toxins(including lead and tobacco smoke) can increase the likelihood of developing amental illness.

Genes also play a role in determining whether someone develops a mental illness.The illnesses that are most likely to have a genetic component include autism,bipolar disorder, schizophrenia, and ADHD. For example, the observation thatchildren with ADHD are much more likely to have a sibling or parent with ADHDsupports a role for genetics in determining whether someone is at risk for ADHD.In studies of twins, ADHD is significantly more likely to be present in anidentical twin than a fraternal twin. The same can be said for schizophrenia anddepression. Mental illnesses are not triggered by a change in a single gene;scientists believe that the interaction of several genes may trigger mentalillness. Furthermore, the combination of genetic, environmental, and socialfactors might determine whether a case of mental illness is mild or severe.

Social factors also present risks and can harm an individual's, especially achild's, mental health. Social factors include

severe parental discord,
death of a family member or close friend,
parent's mental illness,
parent's criminality,
overcrowding,
economic hardship,
abuse,
neglect, and
exposure to violence.

Treating Mental Illnesses⁶

At this time, most mental illnesses cannot be cured, but they can usually be treatedeffectively to minimize the symptoms and allow the individual to function in work,school, or social environments. To begin treatment, an individual needs to see aqualified mental health professional. The first thing that the doctor or othermental health professional will do is speak with the individual to find out moreabout his or her symptoms, how long the symptoms have lasted, and how the person'slife is being affected. The physician will also do a physical examination todetermine whether there are other health problems. For example, some symptoms (suchas emotional swings) can be caused by neurological or hormonal problems associatedwith chronic illnesses such as heart disease, or they can be a side effect ofcertain medications. After the individual's overall health is evaluated and thecondition diagnosed, the doctor will develop a treatment plan. Treatment can involveboth medications and psychotherapy, depending on the disease and its severity.

At this time, most mental illnesses cannot be cured, but they can usually betreated effectively to minimize the symptoms and allow the individual tofunction in work, school, or social environments.

Medications

Figure 7

Medicines are one part of an effective treatment plan for mentalillnesses.

Medications are often used to treat mental illnesses. Through television commercials and magazineadvertisem*nts, we are becoming more aware of those medications. To become fullyeffective, medications for treating mental illness must be taken for a few daysor a few weeks. When a patient begins taking medication, it is important for adoctor to monitor the patient's health. If the medication causes undesirableside effects, the doctor may change the dose or switch to a different medicationthat produces fewer side effects. If the medication does not relieve thesymptoms, the doctor may prescribe a different medication.²

Psychotherapy

Psychotherapy is a treatment method in which a mental healthprofessional (psychiatrist, psychologist, or other mental health professional)and the patient discuss problems and feelings. This discussion helps patientsunderstand the basis of their problems and find solutions. Psychotherapy maytake different forms. The therapy can help patients

change thought or behavior patterns,
understand how past experiences influence current behaviors,
solve other problems in specific ways, or
learn illness self-management skills.

Psychotherapy may occur between a therapist and an individual; a therapist and anindividual and his or her family members; or a therapist and a group. Often,treatment for mental illness is most successful when psychotherapy is used incombination with medications. For severe mental illnesses, medication relievesthe symptoms and psychotherapy helps individuals cope with theirillness.³

Just as there are no medications that can instantly cure mental illnesses,psychotherapy is not a one-time event. The amount of time a person spends inpsychotherapy can range from a few visits to a few years, depending on thenature of the illness or problem. In general, the more severe the problem, themore lengthy the psychotherapy should be.³

The Stigma of Mental Illness⁷

"The last great stigma of the twentieth century is the stigma of mentalillness."
—Tipper Gore, wife of the former U.S. Vice President³⁷

Figure 8

Words can hurt. Many derogatory words and phrases are used in relation tomental illness. However, these words maintain the stereotyped image and notthe reality about mental illness. Try not to use these words, and encouragestudents not to use them. (more...)

"Mentally ill people are nuts, crazy, wacko." "Mentally ill people are morally bad.""Mentally ill people are dangerous and should be locked in an asylum forever.""Mentally ill people need somebody to take care of them." How often have we heardcomments like these or seen these types of portrayals in movies, television shows,or books? We may even be guilty ofmaking comments like them ourselves. Is there any truth behind these portrayals, oris that negative view based on our ignorance and fear?

Stigmas are negative stereotypes about groups of people. Common stigmasabout people who are mentally ill are

Individuals who have a mental illness are dangerous.
Individuals who have a mental illness are irresponsible and can't makelife decisions for themselves.
People who have a mental illness are childlike and must be taken care ofby parents or guardians.
People who have a mental illness should just get overit.¹¹

Each of those preconceptions about people who have a mental illness is based on falseinformation. Very few people who have a mental illness are dangerous to society.Most can hold jobs, attend school, and live independently. A person who has a mentalillness cannot simply decide to get over it any more than someone who has adifferent chronic disease such as diabetes, asthma, or heart diseasecan. A mental illness, like those other diseases, is caused by a physical problem inthe body.

Stigmas against individuals who have a mental illness lead to injustices, includingdiscriminatory decisions regarding housing, employment, and education. Overcomingthe stigmas commonly associated with mental illness is yet one more challenge thatpeople who have a mental illness must face. Indeed, many people who successfullymanage their mental illness report that the stigma they face is in many ways moredisabling than the illness itself. The stigmatizing attitudes toward mental illnessheld by both the public and those who have a mental illness lead to feelings ofshame and guilt, loss of self-esteem, social dependence, and a sense of isolationand hopelessness.^{11, 44} One of the worst consequences of stigma is thatpeople who are struggling with a mental illness may be reluctant to seek treatmentthat, in most cases, would significantly relieve their symptoms.

Providing accurate information is one way to reduce stigmas about mental illness.Advocacy groups protest stereotypes imposed upon those who are mentally ill. Theydemand that the media stop presenting inaccurate views of mental illness and thatthe public stops believing these negative views. A powerful way of counteringstereotypes about mental illness occurs when members of the public meet people whoare effectively managing a serious mental illness: holding jobs, providing forthemselves, and living as good neighbors in a community. Interaction with people whohave mental illnesses challenges a person's assumptions and changes a person'sattitudes about mental illness.

Providing accurate information is one way to reduce stigmas about mentalillness.

Attitudes about mental illness are changing, although there is a long way to gobefore people accept that mental illness is a disease with a biological basis. Asurvey by the National Mental Health Association found that 55 percent of people whohave never been diagnosed with depression recognize that depression is a disease andnot something people should "snap out of."³⁴ This is a substantialincrease over the 38 percent of survey respondents in 1991 who recognized depressionas a disease.

The Consequences of Not Treating Mental Illness⁸

Most people don't think twice before going to a doctor if they have an illness suchas bronchitis, asthma, diabetes, or heart disease. However, many people who have amental illness don't get the treatment that would alleviate their suffering. Studiesestimate that two-thirds of all young people with mental health problems are notreceiving the help they need and that less than one-third of the children under age18 who have a serious mental health problem receive any mental health services.Mental illness in adults often goes untreated, too. What are the consequences ofletting mental illness go untreated?

In September 2000, the U.S. surgeon general held a conference on children's mentalhealth. The former surgeon general, Dr. David Satcher, emphasized the importance ofmental health in children by stating, "Children and families are suffering becauseof missed opportunities for prevention and early identification, fragmentedservices, and low priorities for resources. Overriding all of this is the issue ofstigma, which continues to surround mental illness."⁴⁵

The consequences of mental illness in children and adolescents can be substantial.Many mental health professionals speak of accrued deficits that occurwhen mental illness in children is not treated. To begin with, mental illness canimpair a student's ability to learn. Adolescents whose mental illness is not treatedrapidly and aggressively tend to fall further and further behind in school. They aremore likely to drop out of school and are less likely to be fully functional membersof society when they reach adulthood.⁴⁵ We also now know that depressivedisorders in young people confer a higher risk for illness and interpersonal andpsychosocial difficulties that persist after the depressive episode is over.Furthermore, many adults who suffer from mental disorders have problems thatoriginated in childhood.⁴⁴ Depression in youth may predict more severeillness in adult life.²⁷ Attention deficit hyperactivity disorder, oncethought to affect children and adolescents only, may persist into adulthood and maybe associated with social, legal, and occupational problems.¹⁴

Mental illness impairs a student's ability to learn. Adolescents whose mentalillness is not treated rapidly and aggressively tend to fall further and furtherbehind in school.

The high incidence of mental illness has a great impact on society. Depression alonecauses employers to lose over $23 billion each year due to decreased productivityand absenteeism of employees.⁴⁶ The Global Burden of Disease Study,conducted by the World Health Organization, assessed the burden of all diseases inunits that measure lost years of healthy life due to premature death or disability(disability-adjusted life years, or DALYs). Over 15 percent of the total DALYs weredue to mental illness.²⁶ In 1996, the United States spent more than $69billion for the direct treatment of mental illnesses. Indirect costs of mentalillness due to lost productivity in the workplace, schools, or homes represented a$79 billion loss for the U.S. economy in 1990.⁴⁴

Treatment, including psychotherapy and medication management, is cost-effective forpatients, their families, and society. The benefits include fewer visits to otherdoctors' offices, diagnostic laboratories, and hospitals for physical ailments thatare based in psychological distress; reduced need for psychiatric hospitalization;fewer sick days and disability claims; and increased job stability. Conversely, thecosts of not treating mental disorders can be seen in ruined relationships, job lossor poor job performance, personal anguish, substance abuse, unnecessary medicalprocedures, psychiatric hospitalization, and suicide.³

Information about Specific Mental Illnesses⁹

A diagnosis of mental illness is rarely simple and straightforward. There are noinfallible physiological tests that determine whether a person has a mental illness.Diagnosis requires that qualified healthcare professionals identify several specificsymptoms that the person exhibits. Each mental illness has characteristic signs andsymptoms that are related to the underlying biological dysfunction. The followingsections describe the symptoms and outcomes of three mental illnesses that arehighlighted in this curriculum supplement: depression, attention deficithyperactivity disorder, and schizophrenia.

Depression

Depression, or depressive disorders, is a leading cause of disability in theUnited States as well as worldwide. It affects an estimated 9.5 percent ofAmerican adults in a given year.²⁸ Nearly twice as many women as menhave depression.²⁵ Epidemiological studies have reported that up to2.5 percent of children and 8.3 percent of adolescents in the United Statessuffer from depression.²²

The symptoms of depression

Depression is more than just being in a bad mood or feeling sad. Everyoneexperiences these feelings on occasion, but that does not constitutedepression. Depression is actually not a single disease; there are threemain types of depressive disorders.^{23, 27} They are

major depressive disorder,¹⁰
dysthymia, and
bipolar disorder (manic-depression).

While some of the symptoms of depression are common during a passing "bluemood," major depressive disorder is diagnosed when a person has five or moreof the symptoms nearly every day during a two-week period.²⁷Symptoms of depression include

a sad mood,
a loss of interest in activities that one used to enjoy,
a change in appetite or weight,
oversleeping or difficulty sleeping,
physical slowing or agitation,
energy loss,
feelings of worthlessness or inappropriate guilt,
difficulty concentrating, and
recurrent thoughts of death or suicide.

When people have depression, their lives are affected severely: they havetrouble performing at work or school, and they aren't interested in normalfamily and social activities. In adults, an untreated major depressiveepisode lasts an average of nine months. At least half of the people whoexperience an episode of major depression will have another episode ofdepression at some point.⁴⁴

In children, depression lasts an average of seven to nine months withsymptoms similar to those in adults.⁴⁴ Symptoms in children mayinclude

sadness,
loss of interest in activities they used to enjoy,
self-criticism,
feelings that they are unloved,
hopelessness about the future,
thoughts of suicide,
irritability,
indecisiveness,
trouble concentrating, and
lack of energy.

Children and adolescents with depression are more likely than adults to haveanxiety symptoms and general aches and pains, stomachaches, and headaches.The majority of children and adolescents who have a major depressivedisorder also have another mental illness such as an anxiety disorder,disruptive or antisocial behavior, or a substance-abuse disorder. Childrenand adolescents who suffer from depression are more likely to commit suicidethan are other youths. As in adults, episodes of depression are likely torecur.⁴⁴

Dysthymia is less severe than major depressive disorder, but it is morechronic. In dysthymia, a depressed mood along with at least two othersymptoms of depression persist for at least two years in adults, or one yearin children or adolescents.²² These symptoms may not be asdisabling, but they do keep affected people from functioning well or feelinggood. Dysthymia often begins in childhood, adolescence, or earlyadulthood.²⁵ On average, untreated dysthymia lasts four yearsin children and adolescents.⁴⁴

A third type of depressive disorder is bipolar disorder, also calledmanic-depression. A person who has bipolar disorder alternates betweenepisodes of major depression and mania (periods of abnormally andpersistently elevated mood or irritability). During manic periods, theperson will also have three or more of the following symptoms:

overly inflated self-esteem,
decreased need for sleep,
increased talkativeness,
racing thoughts,
distractibility,
increased goal-directed activity or physical agitation, and
excessive involvement in pleasurable activities that have a highpotential for painful consequences.²⁷

While in a manic phase, adolescents may engage in risky or reckless behaviorssuch as fast driving and unsafe sex.

Bipolar disorder frequently begins during adolescence or young adulthood.Adults with bipolar disorder often have clearly defined episodes of maniaand depression, with periods of mania every two to four years. Children andadolescents with bipolar disorder, however, may cycle rapidly betweendepression and mania many times within a day.²⁹ Bipolar disorderin youths may be difficult to distinguish from other mental illnessesbecause the symptoms often overlap with those of other mental illnesses suchas ADHD, conduct disorder, or oppositional defiant disorder.

The causes of depression (depressive disorders)

Depression, like other mental illnesses, is probably caused by a combinationof biological, environmental, and social factors, but the exact causes arenot yet known. For years, scientists thought that low levels of certainneurotransmitters (such as serotonin, dopamine, or norepinephrine) in thebrain caused depression. However, scientists now believe that the interplayof factors leading to depression is much more complex. Genetic causes havebeen suggested from family studies that have shown that between 20 and 50percent of children and adolescents with depression have a family history ofdepression and that children of depressed parents are more than three timesas likely as children with nondepressed parents to experience a depressivedisorder.⁴⁴ Abnormal endocrine function, specifically of thehypothalamus or pituitary, may play a role incausing depression. Other risk factors for depressive disordersin youths include

stress,
cigarette smoking,
loss of a parent,
the breakup of a romantic relationship,
attention disorders,
learning disorders,
abuse,
neglect, and
other trauma including experiencing a naturaldisaster.²²

Depression, like other mental illnesses, is probably caused by acombination of biological, environmental, and social factors, but theexact causes are not yet known.

Scientists have studied changes in the brain associated with depressivedisorders. Imaging studies using PET have shown that brain activity incertain areas is substantially decreased in a depressed individual whereasactivity in other brain regions is increased compared with the sameindividual after successful treatment.¹³ PET imaging has alsoshown that depressed patients have lower neurotransmitter receptor bindingpotential in some areas of the brain.⁴⁸ Scientists looking atchanges in the brains of bipolar patients found decreases in the size of thecerebellum (the part of the brain that regulates balance and controlledmovements), changes in the metabolism of some chemical compounds, and adecrease in the activity of specific brain regions (prefrontal cortex)during the depression phase.⁴²

Treating depression

A variety of antidepressant medications and psychotherapies are used to treatdepression. The most effective treatment for most people is a combination ofmedication and psychotherapy.²³

Many of us are aware that medications are available to treat depressivedisorders—we see the ads on television and in magazines. Up to 70percent of people with depression can be treated effectively withmedication.⁴⁴ Medications used to treat depressive disordersusually act on the neurotransmission pathway. For example, some medicationsaffect the activity of certain neurotransmitters, such as serotonin ornorepinephrine. Different depressive disorders require different medicationtherapies. For example, individuals who have bipolar disorder are oftentreated with a mood-stabilizing drug, such as lithium, during their manicphase and a combination of mood-stabilizer and antidepressantmedications during their depressive phase.

Medications usually lead to relief from the symptoms of depression within sixto eight weeks. If one drug doesn't relieve symptoms, doctors can prescribea different antidepressant drug. As with drugs to treat other mentalillnesses, patients are monitored closely by their doctor for symptoms ofdepression and for side effects. Patients who continue to take theirmedication for at least six months after recovery from major depression are70 percent less likely to experience a relapse.¹

Psychotherapy helps patients learn more effective ways to deal with theproblems in their lives. These therapies usually involve 6 to 20 weeklymeetings. These treatment plans should be revised if there is no improvementof symptoms within three or four months.⁴⁴

The combination of medications and psychotherapy is effective in the majorityof cases and represents the standard care; however, doctors can employ othermethods. One therapy that is highly effective when antidepressants andpsychotherapy are not effective is electroconvulsive therapy(ECT), or electroshock therapy.²³ ECT is notcommonly used in children and adolescents. When ECT is performed, theindividual is anesthetized and receives an electrical shock in specificparts of the brain. The patient does not consciously experience the shock.ECT can provide dramatic and rapid relief, but the effects usually last afairly short time. After ECT, individuals usually take antidepressantmedications.

The combination of medications and psychotherapy is effective in themajority of cases.

A few years ago, the herbal supplement St. John's wort receivedgreat attention in the media as an over-the-counter treatment for mild tomoderate depression. However, many of the claims did not have goodscientific evidence to back them up. The effectiveness and safety of St.John's wort remain uncertain, and its use is generally notrecommended.³¹

Coping with depression

People who have depression (or another depressive disorder) feel exhausted,worthless, helpless, and hopeless. These negative thoughts and feelings thatare part of depression make some people feel like giving up. As treatmenttakes effect, these thoughts begin to go away. Some strategies that can helpa person waiting for treatment to take effect include

setting realistic goals in light of the depression and assuming areasonable amount of responsibility;
breaking large tasks into small ones, setting some priorities,and doing what one can as one can;
trying to be with other people and to confide insomeone—it is usually better than being alone andsecretive;
participating in activities that may make one feel better;
getting some mild exercise, going to a movie or a ball game, orparticipating in religious, social, or other activities;
expecting one's mood to improve gradually, not immediately(feeling better takes time);
postponing important decisions until the depression has liftedand discussing big decisions with family or friends who have amore objective view of the situation;
remembering that positive thinking will replace the negativethinking that is part of the depression as one's depressionresponds to treatment; and
letting one's family and friends help.²³

Suicide

A potential, tragic consequence of untreated depression is suicide. In 1997,over 30,000 people in the United States died from suicide, and suicide wasthe third leading cause of death among 10- to 24-year-olds.^{22, 25}Over 90 percent of these people had a mental illness, typically either adepressive disorder or a substance-abuse disorder.²⁵ Researchfrom the National Institute of Mental Health estimates that as many as sevenpercent of adolescents who develop a major depressive disorder becomevictims of suicide.²²

Danger signs that a teen may be considering suicide include

undergoing dramatic personality change;
giving away prized possessions;
writing notes or poems about death;
talking about suicide, even jokingly;
making comments such as, "I can't take it anymore" or "I won't bea problem for you much longer";
previously attempting suicide;
running away from home; and
See Also
Strange Fears of BTS Members
having other symptoms or risk factors for depression, such asdifficulty getting along with parents and friends, difficulty inschool, or acting bored or withdrawn.

Children and adolescents who are suicidal report feelings of depression,anger, anxiety, hopelessness, and worthlessness. They feel helpless tochange frustrating circ*mstances or to find a solution for their problems.In addition to depression, family conflicts and suicidal death of arelative, friend, or acquaintance are risk factors for suicide amongchildren and adolescents.⁴⁴ In the case of another person'ssuicide, children or teens may need intervention to prevent feelings ofguilt, trauma, or social isolation. Programs offered by school professionalsthat address these concerns can be extremely helpful for identifyinggrieving youths who may need help.

Public health approaches to preventing suicide include establishing telephonecrisis hot lines, restricting access to suicide methods (for example,firearms), counseling media to reduce "copycat" suicides, screening teensfor risk factors of suicide, and training professionals to improverecognition and treatment of mood disorders. Research about theeffectiveness of these methods indicates that the screening and trainingstrategies are more helpful for preventing suicides among young people thanthe other methods are.⁴⁴

Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosedbehavioral disorder of childhood. In any six-month period, ADHD affects anestimated 4.1 percent of youths ages 9 to 17. Boys are two to three times morelikely than girls to develop ADHD.²⁵ Although ADHD is usuallyassociated with children, the disorder can persist into adulthood.¹⁹One researcher⁶ estimated that as many as two-thirds of the childrenhe evaluated with ADHD continued to have the disorder in their twenties, andthat many of those who no longer fit the clinical description of ADHDnonetheless had significant problems at work or in other social settings.

The symptoms of ADHD

The three predominant symptoms of ADHD are impaired ability to regulateactivity level (hyperactivity), to attend to tasks (inattention), and toinhibit behavior (impulsivity).¹⁹ Individuals who have ADHD maydisplay predominantly hyperactive/ impulsive behavior, predominatelyinattentive behavior, or a combination of both. Children and adolescentswith ADHD

are often unpopular among their peers,
have trouble in school,
have higher injury rates than their peers,
have difficulty paying attention to details,
are easily distracted,
find it difficult and unpleasant to finish their schoolwork,
put off things that require continued mental effort,
make careless mistakes,
are disorganized,
appear not to listen when spoken to, and
fail to follow through on tasks.^{18, 30, 44}

The DSM-IV⁵ specifies several conditions in addition to thesymptoms listed above before making a diagnosis of ADHD. For a diagnosis ofADHD, the behaviors must

appear before age seven,
continue for at least six months,
be more frequent or severe than in other children of the sameage, and
cause dysfunction in at least two areas of life, such as school,home, work, or social settings.¹⁹

The diagnosis of ADHD can be made reliably using well-tested diagnosticinterview methods. However, as of yet, there is no independent valid testfor ADHD.

Among children, ADHD frequently occurs along with other learning, behavior,or mood problems such as learning disabilities, oppositional defiantdisorder, anxiety disorders, and depression.

The causes of ADHD

The exact causes of ADHD are unknown; however, research has demonstrated thatfactors that many people associate with the development of ADHD do not causethe disorder. For example, ADHD is not caused by minor head injuries, damageto the brain from complications during birth, food allergies, excess sugarintake, too much television, poor schools, or poor parenting.^{7, 19} No single cause of ADHD has been discovered. Rather, a numberof significant risk factors affecting neurodevelopment and behaviorexpression have been implicated. Events such as maternal alcohol and tobaccouse that affect the development of the fetal brain can increase the risk forADHD. Injuries to the brain from environmental toxins such as lack of ironhave also been implicated.

Scientists have investigated the role of the neurotransmitter dopamine in thedevelopment of ADHD because this neurotransmitter plays a key role inregulating movement, increasing motivation and alertness, and inducinginsomnia. The observation that ADHD tends to run in families stronglysuggests that the disease has a genetic component. Children who have ADHDusually have at least one close relative who also has thedisorder.²⁴ One group of researchers found that a child whoseidentical twin has ADHD is 11 to 18 times more likely to develop thedisorder than a nontwin sibling.

Investigations of particular genes involved in ADHD have focused on adopamine receptor gene (DRD) on chromosome 11 and the dopamine transportergene (DAT1) on chromosome 5.⁴⁴ Ongoing studies continue toexamine these genes and others as factors in ADHD. Most likely, acombination of several genes and environmental factors determines whether aperson has ADHD.

Imaging studies have shown differences in the brains of boys with ADHDcompared with boys who do not have ADHD. Researchers found that certainparts of the brain are, on average, smaller in boys with ADHD.⁸Other studies found that the total brain volume is smaller in girls who haveADHD than in control subjects; these results match similar findings aboutthe brains of boys with ADHD.⁹ Scientists have speculated thatthe changes in the particular brain regions may be involved in the inabilityto inhibit thoughts, which is a symptom of ADHD.

Treating ADHD

A variety of medications and behavioral interventions are used to treat ADHD.The most widely used medications are methylphenidate (Ritalin),d-amphetamine, and other amphetamines. These drugs are stimulantsthat affect the level of the neurotransmitter dopamine at thesynapse.⁴⁰ Nine out of 10 children improve while taking oneof these drugs.¹⁹

When used as prescribed by qualified physicians, these drugs are consideredquite safe. Side effects associated with moderate doses are decreasedappetite and insomnia. These side effects generally occur early in treatmentand often decrease with time. Some studies have shown that the stimulantsused to treat ADHD decrease growth rate, but ultimate height is notaffected.

Interventions used to treat ADHD include several forms of psychotherapy, suchas cognitive-behavioral therapy, social skills training, support groups, andparent and educator skills training. A combination of medication andpsychotherapy is more effective than either treatment alone in improvingsocial skills, parent-child relations, reading achievement, and aggressivesymptoms.²⁴

Treating ADHD with a combination of medication and psychotherapy is moreeffective than either treatment alone in improving social skills,parent-child relations, reading achievement, and aggressivesymptoms.

In addition to the well-established treatments described above, some parentsand therapists have tried a variety of nutritional interventions to treatADHD. A few studies have found that some children benefit from suchtreatments. Nevertheless, no well-established nutritional interventions haveconsistently been shown to be effective for treating ADHD.²⁴

Coping with ADHD

As the symptoms indicate, ADHD interferes with a person's daily life.Treatment is available to help individuals and relieve the symptoms, butsome simple strategies — including those listed below—can also help.

Asking the teacher or boss to repeat instructions (rather thanguessing what they were).
Breaking large assignments or job tasks into small, simple tasks.Set a deadline for each task and give a reward as each one iscompleted.
Making a list of what needs to be done each day. Plan the bestorder for doing each task. Then make a schedule for doing them.Use a calendar or daily planner to keep on track.
Working in a quiet area. Do one thing at a time. Take shortbreaks.
Writing things that need to be remembered in a notebook withdividers. Carry the book at all times.
Posting notes as reminders of things to do.
Storing similar things together.
Creating a routine. Get ready for school or work at the sametime, in the same way, every day.
Exercising, eating a balanced diet, and getting enough sleep.

Schizophrenia

Schizophrenia affects approximately 1 percent of the population, or 2.2 millionU.S. adults. Men and women are equally affected.^{25, 32} The illnessusually emerges in young people in their teens or twenties. Although childrenover the age of five can develop schizophrenia, it is rare beforeadolescence.²¹ In children, the disease usually developsgradually and is often preceded by developmental delays in motor or speechdevelopment. Childhood-onset schizophrenia tends to be harder to treat and has aless favorable prognosis than does the adult-onset form.

The symptoms of schizophrenia

There are many myths and misconceptions about schizophrenia. Schizophrenia isnot a multiple or split personality, nor are individuals who have thisillness constantly incoherent or psychotic. Although the media often portrayindividuals with schizophrenia as violent, in reality, very few affectedpeople are dangerous to others.³² In fact, individuals withschizophrenia are more likely to be victims of violence than violentthemselves.

Schizophrenia has severe symptoms. A diagnosis of schizophrenia requires thatat least two of the symptoms below be present during a significant portionof a one-month period:

delusions (false beliefs such as conspiracies, mind control, orpersecution);
hallucinations (usually voices criticizing or commenting on theperson's behavior);
disorganized speech (incomprehensible or difficult tounderstand);
grossly disorganized or catatonic behavior; and
negative symptoms such as flat emotions, lack of facialexpressions, and inattention to basic self-care needs such asbathing and eating.⁵

However, the presence of either one of the first two symptoms is sufficientto diagnose schizophrenia if the delusions are especially bizarre or if thehallucinations consist of one or more voices that keep a running commentaryon the person's behavior or thoughts.⁵

The DSM-IV specifies additional criteria for a diagnosis ofschizophrenia:

social or occupational dysfunction,
persistence of the disturbance for at least six months,
exclusion of a mood disorder,
exclusion of a substance-abuse or medical condition that causessimilar symptoms, and
consideration of a possible pervasive developmentaldisorder.⁴⁴

The course of schizophrenia varies considerably from one individual to thenext. Most people who have schizophrenia experience at least one, andusually more, relapses after their first psychotic episode.³²Relapses are periods of more intense symptoms of illness (hallucinations anddelusions). During remissions, the negative symptoms related to emotion orpersonal care are usually still present. About 10 percent of patients remainseverely ill for long periods of time and do not return to their previousstate of mental functioning. Several long-term studies found that as many asone-third to one-half of people with schizophrenia improve significantly oreven recover completely from their illness.⁴⁴

The causes of schizophrenia

Like the other mental illnesses discussed here, scientists are still workingto determine what causes schizophrenia. Also like the other mentalillnesses, genetic and environmental factors most likely interact to causethe disease. Several studies suggest that an imbalance of chemicalneurotransmitter systems of the brain, including the dopamine, GABA,glutamate, and norepinephrine neurotransmitter systems, are involved in thedevelopment of schizophrenia.^{20, 36}

Family, twin, and adoption studies support the idea that genetics plays animportant role in the illness. For example, children of people withschizophrenia are 13 times more likely, and identical twins are 48 timesmore likely, to develop the illness than are people in the generalpopulation.⁴⁴ Scientists continue to look at genes that mayplay a role in causing schizophrenia. One gene of interest to scientists whostudy schizophrenia codes for an enzyme that breaks down dopamine in thesynapse.¹² Investigations to confirm the role of this andother genes are ongoing.

Imaging studies have revealed differences in brain structure and function inindividuals with schizophrenia compared with control individuals. Brainimaging studies show that young people who have schizophrenia havestructural differences in their brains compared with individuals who do nothave schizophrenia. These changes include a reduced total volume of thecerebrum (the upper portion of the brain, which is dividedinto halves), a reduced amount of gray matter (the tissue thatmakes up a majority of the brain and consists mainly of neuron cell bodiesand dendrites), enlarged brain ventricles (the cavities, or spaces, in thebrain that are filled with cerebrospinal fluid), and otherabnormalities.^{38, 39, 41} PET scans of identical twins haverevealed that the twin with schizophrenia has lower brain activity in thefrontal lobes (the front section of the cerebral lobes) than does the twinwho does not have schizophrenia.⁴⁷ One group of researchers usedMRI to periodically scan the brains of teens with childhood-onsetschizophrenia and an age-matched control group over a five-year period. Theyfound that teens with schizophrenia lose four times the amount of neurons ina specific region of the brain that teens in the control grouplose.⁴³

Treating schizophrenia

There is no cure for schizophrenia; however, effective treatments that makethe illness manageable for most affected people are available. The optimaltreatment includes antipsychotic medication combined with a variety ofpsychotherapeutic interventions.⁴⁴

Since the 1950s, doctors have used antipsychotic drugs, such aschlorpromazine and haloperidol, to relieve the hallucinations and delusionstypical of schizophrenia. Recently, newer (also called atypical)antipsychotic drugs such as risperidone and clozapine have proven to be moreeffective. Early and sustained treatment that includes antipsychoticmedication is important for long-term improvement of the course of thedisease. Patients who discontinue medication are likely to experience arelapse of their illness.³²

People who manage schizophrenia best combine medication with psychosocialrehabilitation (life-skills training).¹⁷ Therapies that combinefamily and community support, education, and behavioral and cognitive skillsto address specific challenges help schizophrenic patients improve theirfunctioning and the quality of their lives.

The optimal treatment for schizophrenia includes antipsychotic medicationand psychotherapy.

Finding Help for Someone with Mental Illness¹¹

As a teacher, you may occasionally have students who show symptoms of or who havesignificant risk factors for a mental illness. A first step for helping thesestudents is to contact the school nurse or guidance counselor. These individualsshould know the appropriate next steps to take, including directing the student'sparents or guardians to contact their physician or their city or county mentalhealth services.

If you think a friend or colleague might have a mental illness, encourage him or herto see a physician. Physicians can make referrals to mental health specialists inthe community. In addition, your state or county health departments may offerservices for people struggling with a mental illness. The National Mental HealthAssociation has an affiliate network throughout the country. The programs offered bythe NMHA affiliates include support groups, public education and advocacy campaigns,rehabilitation, and housing services. You can access the NMHA's affiliate networkthrough its Web site: http://www.nmha.org/nav/section/affiliate.cfm.

The Additional Resources for Teachers section describes other online resources aboutmental illnesses (page 53).

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Glossary

accrued deficits: The delays or lack of development in emotional, social, academic, or behavioral skills that a child or adolescent experiences because of untreated mental illness. The mental illness keeps the individual from developing these life skills at the usual stage of life. An individual may never fully make up for these deficiencies.
acute: Refers to a disease or condition that has a rapid onset, marked intensity, and short duration.
antidepressant: A medication used to treat depression.
anxiety: An abnormal sense of fear, nervousness, and apprehension about something that might happen in the future.
anxiety disorder: Any of a group of illnesses that fill people's lives with overwhelming anxieties and fears that are chronic and unremitting. Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, phobias, and generalized anxiety disorder.
attention deficit disorder (ADD): See attention deficit hyperactivity disorder.
attention deficit hyperactivity disorder (ADHD): A mental illness characterized by an impaired ability to regulate activity level (hyperactivity), attend to tasks (inattention), and inhibit behavior (impulsivity). For a diagnosis of ADHD, the behaviors must appear before an individual reaches age seven, continue for at least six months, be more frequent than in other children of the same age, and cause impairment in at least two areas of life (school, home, work, or social function).
autism: A mental illness that typically affects a person's ability to communicate, form relationships with others, and respond appropriately to the environment. Some people with autism have few problems with speech and intelligence and are able to function relatively well in society. Others are mentally retarded or mute or have serious language delays. Autism makes some people seem closed off and shut down; others seem locked into repetitive behaviors and rigid patterns of thinking.
axon: The long, fiberlike part of a neuron by which the cell carries information to target cells.
bipolar disorder: A depressive disorder in which a person alternates between episodes of major depression and mania (periods of abnormally and persistently elevated mood). Also referred to as manic-depression.
cerebrum: The upper part of the brain that consists of the left and right hemispheres.
chronic: Refers to a disease or condition that persists over a long period of time.
cognition: Conscious mental activity that informs a person about his or her environment. Cognitive actions include perceiving, thinking, reasoning, judging, problem solving, and remembering.
conduct disorder: A personality disorder of children and adolescents involving persistent antisocial behavior. Individuals with conduct disorder frequently participate in activities such as stealing, lying, truancy, vandalism, and substance abuse.
delusion: A false belief that persists even when a person has evidence that the belief is not true.
dendrite: The specialized fibers that extend from a neuron's cell body and receive messages from other neurons.
depression (depressive disorders): A group of diseases including major depressive disorder (commonly referred to as depression), dysthymia, and bipolar disorder (manic-depression). See bipolar disorder, dysthymia, and major depressive disorder.
Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV): A book published by the American Psychiatric Association that gives general descriptions and characteristic symptoms of different mental illnesses. Physicians and other mental health professionals use the DSM-IV to confirm diagnoses for mental illnesses.
disease: A synonym for illness. See illness.
disorder: An abnormality in mental or physical health. In this module, disorder is used as a synonym for illness.
dysthymia: A depressive disorder that is less severe than major depressive disorder but is more persistent. In children and adolescents, dysthymia lasts for an average of four years.
electroconvulsive therapy (ECT): A treatment for severe depression that is usually used only when people do not respond to medications and psychotherapy. ECT involves passing a low-voltage electric current through the brain. The person is under anesthesia at the time of treatment. ECT is not commonly used in children and adolescents.
electroencephalography (EEG): A method of recording the electrical activity in the brain through electrodes attached to the scalp.
electroshock therapy: See electroconvulsive therapy.
frontal lobe: One of the four divisions of each cerebral hemisphere. The frontal lobe is important for controlling movement and associating the functions of other cortical areas.
gray matter: The portion of brain tissue that is dark in color. The gray matter consists primarily of nerve cell bodies, dendrites, and axon endings.
hallucination: The perception of something, such as a sound or visual image, that is not actually present other than in the mind.
hypothalamus: The part of the brain that controls several body functions, including feeding, breathing, drinking, temperature, and the release of many hormones.
illness: A problem in which some part or parts of the body do not function normally, in a way that interferes with a person's life. For the purpose of this module, other terms considered to be synonyms for illness include disease, disorder, condition, and syndrome.
magnetic resonance imaging (MRI): An imaging technique that uses magnetic fields to take pictures of the structure of the brain.
major depressive disorder: A depressive disorder commonly referred to as depression. Depression is more than simply being sad; to be diagnosed with depression, a person must have five or more characteristic symptoms nearly every day for a two-week period.
mania: Feelings of intense mental and physical hyperactivity, elevated mood, and agitation.
manic-depression: See bipolar disorder.
mental illness: A health condition that changes a person's thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning.
mental retardation: A condition in which a person has an IQ that is below average and that affects an individual's learning, behavior, and development. This condition is present from birth.
myelin: A fatty material that surrounds and insulates the axons of some neurons.
neuron (nerve cell): A unique type of cell found in the brain and body that processes and transmits information.
neurosis: A term no longer used medically as a diagnosis for a relatively mild mental or emotional disorder that may involve anxiety or phobias but does not involve losing touch with reality.
neurotransmission: The process that occurs when a neuron releases neurotransmitters that relay a signal to another neuron across the synapse.
neurotransmitter: A chemical produced by neurons that carries messages to other neurons.
obsessive-compulsive disorder (OCD): An anxiety disorder in which a person experiences recurrent unwanted thoughts or rituals that the individual cannot control. A person who has OCD may be plagued by persistent, unwelcome thoughts or images or by the urgent need to engage in certain rituals, such as hand washing or checking.
oppositional defiant disorder: A disruptive pattern of behavior of children and adolescents that is characterized by defiant, disobedient, and hostile behaviors directed toward adults in positions of authority. The behavior pattern must persist for at least six months.
panic disorder: An anxiety disorder in which people have feelings of terror, rapid heart beat, and rapid breathing that strike suddenly and repeatedly with no warning. A person who has panic disorder cannot predict when an attack will occur and may develop intense anxiety between episodes, worrying when and where the next one will strike.
phobia: An intense fear of something that poses little or no actual danger. Examples of phobias include fear of closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, and injuries involving blood.
pituitary gland: An endocrine organ closely linked with the hypothalamus. The pituitary secretes a number of hormones that regulate the activity of other endocrine organs in the human body.
positron: A positively charged particle that has the same mass and spin as—but the opposite charge of—an electron.
positron emission tomography (PET): An imaging technique for measuring brain function in living subjects by detecting the location and concentration of small amounts of radioactive chemicals.
postsynaptic neuron: The neuron that receives messages from other neurons.
presynaptic neuron: The neuron that sends messages to other neurons by releasing neurotransmitters into the synapse.
psychiatrist: A medical doctor (M.D.) who specializes in treating mental diseases. A psychiatrist evaluates a person's mental health along with his or her physical health and can prescribe medications.
psychiatry: The branch of medicine that deals with identifying, studying, and treating mental, emotional, and behavioral disorders.
psychologist: A mental health professional who has received specialized training in the study of the mind and emotions. A psychologist usually has an advanced degree such as a Ph.D.
psychosis: A serious mental disorder in which a person loses contact with reality and experiences hallucinations or delusions.
psychotherapy: A treatment method for mental illness in which a mental health professional (psychiatrist, psychologist, counselor) and a patient discuss problems and feelings to find solutions. Psychotherapy can help individuals change their thought or behavior patterns or understand how past experiences affect current behaviors.
receptor: A molecule that recognizes specific chemicals, including neurotransmitters and hormones, and transmits the message into the cell on which the receptor resides.
relapse: The reoccurrence of symptoms of a disease.
reuptake pump: The large molecule that carries neurotransmitter molecules back into the presynaptic neuron from which they were released. Also referred to as a transporter.
risk: The chance or possibility of experiencing harm or loss.
risk factor: Something that increases a person's risk or susceptibility to harm.
schizophrenia: A chronic, severe, and disabling brain disease. People with schizophrenia often suffer terrifying symptoms such as hearing internal voices or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms may leave them fearful and withdrawn. Their speech and behavior can be so disorganized that they may be incomprehensible or frightening to others.
selective serotonin reuptake inhibitors (SSRIs): A group of medications used to treat depression. These medications cause an increase in the amount of the neurotransmitter serotonin in the brain.
serotonin: A neurotransmitter that regulates many functions, including mood, appetite, and sensory perception.
single photon emission computed tomography (SPECT): A brain imaging process that measures the emission of single photons of a given energy from radioactive tracers in the human body.
stigma: A negative stereotype about a group of people.
St. John's wort: An herb sometimes used to treat mild cases of depression. Although the popular media have reported successes using St. John's wort, it is not a recommended treatment. The scientific evidence for its effectiveness and safety is not conclusive.
symptom: Something that indicates the presence of a disease.
synapse: The site where presynaptic and postsynaptic neurons communicate with each other.
synaptic space: The intercellular space between a presynaptic and postsynaptic neuron. Also referred to as the synaptic cleft.
syndrome: A group of symptoms or signs that are characteristic of a disease. In this module, the word syndrome is used as a synonym for illness.
transporter: A large protein on the cell membrane of axon terminals. It removes neurotransmitter molecules from the synaptic space by carrying them back into the axon terminal that released them. Also referred to as the reuptake pump.
ventricle: One of the cavities or spaces in the brain that are filled with cerebrospinal fluid.
vesicle: A membranous sac within an axon terminal that stores and releases neurotransmitters.

1: Relevant to Lessons 1, 2, and 5
2: Relevant to Lesson 3.
3: Relevant to Lessons 2, 3, 4, and 5.
4: Relevant to Lessons 1, 2, and 4.
5: Relevant to Lessons 2, and 3.
6: Relevant to Lessons 4 and 5.
7: Relevant to Lessons 1, 2, 3, 4, and 5.
8: Relevant to Lessons 4 and 5.
9: Relevant to Lessons 2, 3, 4, 5, and 6.
10: In this module, the term depression refers to majordepressive disorder. We will use the terms dysthymia andbipolar disorder specifically when we are referring tothose types of depressive disorders.
11: Relevant to Lessons 1, 2, 3, 4, 5, and 6.