Self acceptance is defined as "an individual's acceptance of all of his/her attributes, positive self- or negative.' It includes body acceptance, protection from negative criticism, and believing in one's capacities. Self Acceptance Many people have low self-acceptance. There can be many reasons for this, but one widely accepted theory is that because we develop our self-esteem, in part, from others appreciating us, people with low self-acceptance may have had parents who lacked empathy during their childhood. Consequently, in their adult lives, they may need much stronger affirmation from others than most people do. In other words, ordinary levels of approval do not "move the needle" on their self-esteem. Some people with low self -acceptance try to bolster it by accomplishing great things. But this only helps your self-esteem for a while. That's because achievement is a poor substitute for intimacy. In addition, these people are often under the impression that "taking it" when suffering is the main reflection of their value. It's hard for them to believe in genuine caring, and when it does come their way, they are suspicious of it. Of course, self-acceptance (or lack thereof) does not exist in a vacuum it actually has profound effects on your physical and psychological health. For that reason, it is worth understanding what these effects are, and what you can do about it. The emotional and physical consequences of low self-acceptance. Without self-acceptance, your psychological well-being can suffer, and often, beneficial interventions are less helpful for you than for others with higher self-acceptance. For example, practicing mindfulness can help many people reduce the impact of stress. But when you cannot accept yourself, it becomes less effective. Also, if you have a physical illness such as rheumatoid arthritis, not accepting yourself can make you more anxious about your body. In this context, your automatic negative thoughts increase. In addition, if you feel negatively about yourself, the brain regions that help you control emotions and stress have less gray matter than someone with a greater degree of self-acceptance - that is, these regions actually have less tissue to "work with." This lack of gray matter may also appear in regions of the brainstem that process stress and anxiety. Stress signals from these latter regions, in turn, disrupt the emotional control regions. So, poor self-acceptance may disrupt emotional control in two ways: directly, by disrupting the brain regions that control it, and also indirectly, by increasing stress signals in your brain that subsequently disrupt these regions. How to bolster your self-acceptance There are three ways to increase self-acceptance: 1. self-regulation 2 self-awareness 3 self-transcendence. Self-regulation involves suppressing negative emotions such as self-hatred, refocusing on the positive aspects of yourself, and re-framing negative situations so that you see the opportunities in them. For example, looking for ways in which negative criticism can help you grow constitutes re-framing. However, self-control may be less powerful than we think. The lack of self-acceptance can be deeply unconscious that is, it can exist at a level beyond our conscious control. Also, when you do not accept or forgive yourself, 'you" are still split from "yourself" you do not feel "together." Both of these parts - the one that needs to forgive, and the one that needs to be forgiven are at odds with each other. In this situation, self-transcendence can be helpful. When you are "self-transcendent," you rely less on things outside of yourself to define you. Instead, you turn to an unforced sense of connectedness with the world. You can achieve this by contributing to work, family, or the community at large. The goal is to seek unity with some system in a way that is heartfelt and authentic. Any of the methods I've described in this post may also contribute to self-transcendence. Fortunately, just like self-acceptance, self-transcendence also engenders physical changes in the brain. It has been associated with increased serotonin transporter availability in the brainstem. As mentioned earlier, this same region impacts self-acceptance. Transcendental meditation is another potential tool to consider for self -transcendence. It decreases cortisol and reduces your stress response. Meditation as a path to self-acceptance Self-acceptance can also be achieved by two other kinds of meditation: mindfulness meditation and loving-kindness meditation. Mindful attention to emotions involves not "judging," but observing, your emotions when they arise. This can lower your brain's emotional. A response to anxiety and distress. It effectively "calms down" your amygdala. Having more compassion toward yourself appears to be helpful in increasing self-acceptance. Loving-kindness meditation can help you achieve this state by changing the activity in regions of the brain that perceive and process emotions. For example, people previously numb to praise may be able to become more accepting of it. It is also associated with greater connectivity within the brain. This makes sense, as lack of self-acceptance has been associated with excessive right-hemisphere activity in the brain. Loving-kindness meditation provides a potential way to correct this.

What is a defense mechanism? It is how we deal with emotions, feelings, which is broken down into immature defense mechanism and mature defense mechanism. “Anna Freud | Child Psychoanalysis | Defense Mechanisms Here is the complete list. The complete list was developed by Sigmund Freud, Dr. Anna Freud who helped revolution of the field of psychoanalysis which was created by psychiatrists. Later splitting into the field of psychology. A common misperception is that psychiatrists are pill push driven by the pharmaceutical industry. Some of the best therapists are psychiatrists. Who is Dr. Anna Freud? Anna Freud | Child Psychoanalysis | Defense Mechanisms Anna Freud , (born Dec. 3, 1895, Vienna—died Oct. 9, 1982, London), Austrian-born British founder of child psychoanalysis and one of its foremost practitioners. She also made fundamental contributions to understanding how the ego, or consciousness, functions in averting painful ideas, impulses, and feelings. The youngest daughter of Sigmund Freud, Anna was devoted to her father and enjoyed an intimate association with developing psychoanalytic theory and practice. As a young woman she taught elementary school, and her daily observation of children drew her to child psychology. While serving as chairman of the Vienna Psycho-Analytic Society (1925–28), she published a paper (1927) outlining her approach to child psychoanalysis. Publication of Anna Freud’s Das Ich und die Abwehrmechanismen (1936; The Ego and Mechanisms of Defense, 1937) gave a strong, new impetus to ego psychology. The principal human defense mechanism, she indicated, is repression, an unconscious process that develops as the young child learns that some impulses, if acted upon, could prove dangerous to himself. Other mechanisms she described include the projection of one’s own feeling into another; directing aggressive impulses against the self (suicide being the extreme example); identification with an overpowering aggressor; and the divorce of ideas from feelings. The work also was a pioneer effort in the development of adolescent psychology. In 1938 Anna Freud and her father, whom she had cared for during a number of years of his terminal illness, escaped from Nazi-dominated Austria and settled in London, where she worked at a Hampstead nursery until 1945. During World War II she and a U.S. associate, Dorothy Burlingham, recounted their work in Young Children in Wartime (1942), Infants Without Families (1943), and War and Children (1943). Anna Freud founded the Hampstead Child Therapy Course and Clinic, London, in 1947 and served as its director from 1952 to 1982. She viewed play as the child’s adaptation to reality but not necessarily as a revelation of unconscious conflicts. She worked closely with parents and believed that analysis should have an educational influence on the child. A summation of her thought is to be found in her Normality and Pathology in Childhood (1968). Source: Brittanica (2023)

Who is Dr. Carl Jung ? Carl Gustav Jung was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philosophy, psychology, and religious studies. He worked as a research scientist at the Burghölzli psychiatric hospital, in Zurich, under Eugen Bleuler. Jung established himself as an influential mind, developing a friendship with Sigmund Freud, founder of psychoanalysis, conducting a lengthy correspondence, paramount to their joint vision of human psychology. Jung is widely regarded as one of the most influential psychologists in history. Freud saw the younger Jung not only as the heir he had been seeking to take forward his "new science" of psychoanalysis, but as a means to legitimize his own work: Freud and other contemporary psychoanalysts were Jews facing rising antisemitism in Europe, and Jung was Christian. Freud secured Jung's appointment as president of Freud's newly founded International Psychoanalytical Association. Jung's research and personal vision, however, made it difficult to follow his older colleague's doctrine and they parted ways. This division was painful for Jung and resulted in the establishment of Jung's analytical psychology, as a comprehensive system separate from psychoanalysis. Scholar Yosef Hayim Yerushalmi believed Jung's later antisemitic remarks may be a clue to the schism. Among the central concepts of analytical psychology is individuation—the lifelong psychological process of differentiation of the self out of each individual's conscious and unconscious elements. Jung considered it to be the main task of human development. He created some of the best known psychological concepts, including synchronicity, archetypal phenomena, the collective unconscious, the psychological complex and extra-version and introversion. Jung was also an artist, craftsman, builder and prolific writer. Many of his works were not published until after his death and some remain unpublished. The World Within - Carl Jung, MD in His Own Words Source: Wikipedia (2023)

Alan Wilson Watts (6 January 1915 – 16 November 1973) was an English writer, speaker and self-styled "philosophical entertainer" , [2] known for interpreting and popularising Japanese, Chinese and Indian traditions of Buddhist, Taoist, and Hindu philosophy for a Western audience. Born in Chislehurst, England, he moved to the United States in 1938 and began Zen training in New York. He received a master's degree in theology from Seabury-Western Theological Seminary and became an Episcopalpriest in 1945. He left the ministry in 1950 and moved to California, where he joined the faculty of the American Academy of Asian Studies. [3] He has such an amazing perspective on life and how to deal with adversity.

Getting Started with Mindfulness Mindfulness Meditation Jon Kabat-Zinn --a leader in the field of mindfulness and health--has defined mindfulness as "paying attention in a particular way: on purpose, in the present moment, and non-judgementally." This means consciously paying attention to our senses, and to our feelings, without further judgment. For example, mindfulness could be practiced by focusing on the sensation of water rushing over your hands as it falls from a faucet, or by feeling and accepting sadness without trying to push it away or to evaluate it. Research has linked mindfulness meditation with reduced anxiety , more positive emotions , and, with enough practice , permanent structural changes in the brain that sustain these benefits . Before beginning, know that meditation is a skill that requires practice. In the beginning it might seem as if unwanted thoughts constantly intrude your mind and the serenity associated with meditation might be brief. With time your ability to meditate, and to control your focus, will improve. Listed below are instructions to help you begin mindfulness meditation. Planning For the best results meditation should be a daily exercise. Meditating for 30 minutes a day might be a great goal, but it might not be realistic for your life. If 30 minutes doesn't seem doable, try to start with 10 to 15 minutes a day. Create a schedule that you can stick to, rather than one that you will give up on in a week. Posture How you sit isn't too important--just make sure you are comfortable, but not so relaxed that you will doze off. It will be OK to sit on the floor, in a chair, and with your legs either crossed or straight. Keep your spine upright and find a pose that you can maintain without too much discomfort. Thoughts Allow your thoughts to come and go. The more you try to control them, the more invasive they will become. Like our senses, thoughts are a normal part of our existence. Acknowledge your thoughts and let them pass naturally. Breathing Focus on your breathing . Take full but gentle breaths through your nose and notice the rising and the falling of your belly. Notice how your body changes as air enters and then leaves your lungs. This is the key to mindfulness meditation. Focusing on the sensation of your breathing will quickly bring you into the present and connect your mind with your body. Summary Plan to devote 10 to 15 minutes to meditation each day, and more if you think you can. Find a relaxing posture and begin to focus on your breathing. Pay attention to each breath and the sensations in your body. Allow thoughts to enter your mind and then fade away without judgment or resistance. After they have passed return your focus to breathing. Continue this process for the duration of meditation.

Investigation by BMJ Questions Antipsychotic's Approval for Agitation in AD How the FDA approved an antipsychotic that failed to show a meaningful benefit but raised the risk of death The US Food and Drug Administration (FDA) approved the antipsychotic drug brexpiprazole (Rexulti) for agitation due to Alzheimer’s disease despite questionable efficacy data and a known higher risk of death, alleges a new investigation in the BMJ . Journalist Robert Whitake r took a deep dive into the safety and efficacy data soon after the FDA approved the new indication for the drug in May of this year. After sifting through the data and watching the agency's April 14 advisory panel meeting, he concluded that brexpiprazole presented no advance, despite winning the backing of both the advisory committee and the FDA. The advisory panel meeting "just seemed like a rubber-stamp exercise rather than a probing of really what are the risks and benefits of this drug," Whitaker told Medscape Medical News . Whitaker wrote that "no benefit was seen at the US sites in the one study that provided the primary evidence for approval." And yet, the lack of efficacy in the US was never discussed by any of the advisers, he told Medscape . Brexpiprazole , along with other antipsychotics such as aripiprazole , risperidone , and olanzapine have long been used off label to treat dementia-related agitation. But in 2005, the FDA warned against this use, noting that older patients were at higher risk for death, primarily due to strokes and other cardiovascular events. Indeed, all the antipsychotics — including the new label for brexpiprazole — carry boxed warnings on the increased risk of death. Whitaker reported that the mortality risk with brexpiprazole was four times higher than with placebo. Meanwhile, the US Centers for Medicare and Medicaid Services (CMS) has campaigned against the inappropriate use of antipsychotics in nursing homes at least since the start of an initiative in 2012. Not 'Statistically Persuasive' Still, Otsuka and Lundbeck , the manufacturers of brexpiprazole , decided to pursue FDA approval for agitation. Such an approval would allow the companies to essentially rebrand the medication and specifically market it for agitation — at an estimated monthly cost of $1400, noted Whitaker in his article. Whitaker reported that the FDA was skeptical of the manufacturers' first two pivotal controlled studies, telling them in a 2017 meeting that the agency did not consider a 3.8-point reduction in symptoms on the Cohen-Mansfield Agitation Inventory (CMAI) scale with the 2-milligram dose when compared with placebo to be "statistically persuasive." An international group determined in 2021 that a "minimal clinically important difference" on the CMAI scale was 17 points, Whitaker reported. The FDA ordered Otsuka and Lundbeck to conduct a third trial. In that study, there was a maximum 5.3-point improvement over placebo on the 174-point CMAI, far short of the 17 points considered to be clinically important, Whitaker noted. And yet, in its approval, the FDA wrote that "patients who received 2 mg or 3 mg of Rexulti showed statistically significant and clinically meaningful improvements in total CMAI scores compared to patients in the placebo group at week 12." Whitaker told Medscape that he asked FDA why the results were considered "clinically meaningful." First, the agency said it could not respond in time for his deadline. It later told him that he would have to file a Freedom of Information Act request to get answers. The reporter also said he received no response to multiple requests for comment from Rajesh Narendran, MD , a professor of psychiatry at the University of Pittsburgh, Pittsburgh, Pennsylvania, and the chair of the FDA advisory committee that weighed the approval. Lon Schneider, MD , a professor of psychiatry, neurology, and gerontology at the University of Southern California's Keck School of Medicine, Los Angeles, told Whitaker that brexpiprazole was no different than other antipsychotics. It offers the "same small points of difference on the CMAI scale," and "the same level of side effects, the same black box warning," he said. The FDA has a "lower standard of approval" than it did two decades ago, Schneider told the BMJ reporter. FDA: Drug Fills Unmet Need But in a response to Medscape Medical News , the FDA defended the approval process. The agency granted brexpiprazole a fast-track approval — signaling that it was an advance over existing therapies and that it fills an unmet medical need. The agency also gave it a priority review. "Both fast track and priority review are programs intended to help ensure that therapies for serious conditions are approved and available to patients as soon as it can be concluded that the therapies' benefits justify their risks," an FDA spokesperson told Medscape . "The clinical benefits of Rexulti are stated in the prescribing information," he added. " This submission was discussed at an advisory committee meeting on April 14; the overwhelming majority of the advisory committee members agreed with FDA's conclusion that the drug is effective and that the benefit risk assessment was favorable for the use of Rexulti in the treatment of agitation in patients with dementia due to Alzheimer's disease ," said the spokesperson. Whitaker said the approval " is going to open the floodgates for the use of this antipsychotic," adding that "the FDA is saying this drug is different from the drugs that are being prescribed off label right now. That's the message to the prescribing population and that's exactly the message that Otsuka and Lundbeck are going to market their drug with." The BMJ reporter also noted that a number of patient advocacy groups — including the Alzheimer's Association, the Alliance for Aging Research, Leaders Engaged on Alzheimer's Disease, and Us Against Alzheimer's — have backed brexpiprazole. Many of these organizations also receive funding from Otsuka and other drug makers, Whitaker reported. Medscape sought comment from Otsuka but received no response. Medicare Coverage a Given A CMS spokesperson told Whitaker that the agency still posits that, "Antipsychotic medications are especially dangerous among the nursing home population because of their potentially devastating side effects, including death," and that the agency would "continue its efforts to reduce the prescribing of unnecessary antipsychotics in nursing homes." However, the spokesperson also told Whitaker that Medicare already covers brexpiprazole. Part D drug plan formularies must include brexpiprazole since it was previously FDA-approved for schizophrenia , the spokesperson said. The drug plans can, however, "add limits to this medication to prevent inappropriate use," the spokesperson told Whitaker. A CMS spokesperson confirmed to Medscape Medical News the quotes given to Whitaker.

An Engineered Human-Antibody Fragment with Fentanyl Pan-Specificity That Reverses Carfentanil-Induced Respiratory Depression Anti Fentanyl “We expect this antibody to be a valuable new weapon for fighting the opioid crisis.” Human Anti-body that targets carfentanil, Fentanyl and related opioids reverses overdose effects in preclinical study A study found that an anti-fentanyl antibody reversed the signs of carfentanil overdose. In the study, the investigators developed an antibody in single-chain fragment variable format that binds with very high affinity to several variants of fentanyl, including carfentanil—the most dangerous variant. They designed the antibody to enter the bloodstream quickly via intramuscular injection and to persist in the body in order to offer long-term protection. 1 Upon administering the antibody to rodents in the study, the investigators found that administration shortly following an overdose of carfentanil reverses the signs of the potentially deadly respiratory depression caused by carfentanil overdose. 1 The investigators concluded that these results show that the antibody has the potential to be a more powerful and longer-lasting treatment for synthetic opioid overdose. “We expect this antibody to be a valuable new weapon for fighting the opioid crisis,” said study senior author Kim D. Janda, PhD, the Ely R. Callaway, Jr. professor of chemistry at Scripps Research, in a press release. 1

This is an amazing video about how to find the underlying real you. Most often many live their life with a lack of awareness. Our priorities are all mixed up. Our wants are our needs and our needs are our wants. What imprint do you want to live in this world when we return to the ground? Who are you? Why do you exist? What is the point of your breath and life? How do you affect other people lives? One of the most inspiring people that I have gained the most awareness is Alan Watts, who an amazing English philosopher who pretty much knows most religions of the world. He can literally quote from each religious textbook. One of the fundamental principles is be God's plan through your action not because of fear of God. The truth of God is there that exist without one belief in him/her and there those are devout followers. Where does freedom of choice come from? Can we stop feeling hungry? We is a devout Buddhist after learning about all different types of religious which is a why of life or perspective on life, trying to reach enlightenment. Source: Alan Watts

TOPLINE: An analysis of high school students from 1999 to 2021 showed teens with low-risk behaviors grew from about 40% in 1999 to nearly 60% by 2021. Mental health problems, such as sadness and suicidality, increased, and behavioral risks, such as carrying a weapon and fighting, decreased. METHODOLOGY: Researchers analyzed 22 years of data pulled from the Youth Risk Behavior Survey covering 178,658 high school students in the United States. Teens self-reported mental health symptoms such as sadness, hopelessness, or thoughts of suicide and behavioral risks like substance use, sexual activity, and violence on repeated surveys. The analysis identified five adolescent mental and behavioral health risk profiles: Low everything; high sex; high everything, which included teens with above-average levels in all mental and behavioral health factors; high substance use; and high internalizing. TAKEAWAY: The low everything profile grew from 40% in 1999 to nearly 60% in 2021; the high internalizing profile grew from 9% to nearly 18% in 2021. The high sex (20% in 1999), high everything (13%), and high substance use (10%) profiles all decreased in prevalence over time, falling to approximately 10%, 5%, and 4%, respectively, by 2021, with pronounced decreases during the COVID-19 pandemic period (2019-2021). Younger adolescents were more likely to have a low everything or high internalizing profile, while older adolescents saw higher numbers in the high sex and high everything profiles. Women made up about 66% of the high internalizing group over the span of the study period, while men made up about 35% and were more prevalent in the high everything (58%) and high substance use (61%) groups. IN PRACTICE: “Results provide a clear picture showing that over the past two decades, a far lower proportion of adolescents are engaged in high levels of behavioral health risk behaviors or behavioral risks combined with mental health risks, while far more are showing limited engagement in all such risk behaviors,” the study authors wrote. “It is important to assess the repercussions of these changes for individual and societal well-being.” SOURCE: The study was led by Rebekah Levine Coley, PhD, at the Counseling, Developmental & Educational Psychology Department at the Lynch School of Education and Human Development at Boston College in Chestnut Hill, Massachusetts. It was published online on March 18 in Pediatrics. LIMITATIONS: The study did not include all mental health disorders, such as anxiety or eating disorders. The birth control item in the survey only included heterosexual sex, and the weapon-carrying item only focused on school settings. Demographics were limited to men or women and did not include information on family income or location. Small proportions of ethnic groups, such as American Indian/Alaskan Native and Native Hawaiian/Pacific Islanders, limited statistical power. The study excluded teens not in school. The study only tracked trends over time and did not explore the reasons behind them. Note: This article originally appeared on Medscape .

Key-point: Although diagnostic criteria for a depressive episode are the same for unipolar major depression and bipolar depression, these episodes differ in their natural history. BIPOLAR UPDATE Although the DSM-5-TR diagnostic criteria for a depressive episode are the same for unipolar major depression and bipolar depression, these episodes differ in their natural history (ie, patients with bipolar disorder have mania and/or hypomania), age of onset, suicide risk, associated comorbidities, and biological correlates. Most importantly, they differ dramatically in the effective medications. Thus, it is critical to diagnose these depressions correctly. To do so, you must take a good history for hypomania or mania. This is where diagnostic errors commonly occur. Start by informing the patient how important it is to have the correct diagnosis for effective treatment and that being wrong about the diagnosis can lead to wrong treatment that, at best, is ineffective and, at worst, very harmful (eg, antidepressants can cause a malignant transformation of bipolar disorder to a rapid cycling and treatment-resistant condition).1-3 This warning to the patient hopefully undermines possible reluctance to disclose manic symptoms because of the stigma of the diagnosis, because they enjoy the experience, or because they believe that it represents their normal mood and energy that they would like to return to and maintain. Start by describing an episode of mania or hypomania: how the episodes start, what symptoms occur at the outset, how individuals react when encountering a patient in a fresh mania, how it progresses over the next several days, and how it ends—typically with a crash into depression when they rapidly develop the opposite of all the symptoms they just had. The patient should first be asked to identify and then focus on periods when they were not significantly using any substances that might produce manic-like symptoms, such as amphetamines, cocaine, and alcohol. Here is how I describe the episodes: I note that typically, there are no precipitants to the onset of manias. This distinguishes them from the common comorbidity (in the patients I see, veterans) of posttraumatic stress disorder (PTSD), in which agitated, hyperactive states are precipitated when some trigger, interaction, or memory leads to a rush of adrenaline and the “fight or flight” response occurs. This agitation and irritability, which is generally an unpleasant experience, may continue for hours or even part of a day. However, if the patient can get away from the triggering stimulus, the symptoms will subside, and they will return to their baseline state. But with manias, the typical onset is when the patient wakes up, and the experience lasts much longer—at least some of the time. They note racing thoughts with many plans for things they would like to do that day and an unusual amount of energy, motivation, and self-confidence that they can do any and all of these things. They may feel invincible. They want to start new projects and ventures, clean and organize the house, add to their possessions, and contact neglected friends. The first person they meet, who might be a spouse or family member they are living with, notices that their speech is faster than usual. They may find it hard to understand as manic individuals (without realizing it) may be dropping syllables or whole words because the speech muscles cannot keep up with the speed of the thoughts. The listener will typically respond by asking the person to repeat what they said, urging them to take a breath or slow down, or maybe questioning how much coffee they had that morning. Ask the patient whether they have had feedback like that from listeners at the start of what might be manias. Next, the individual experiencing mania may tell the person about their plans. And they have a lot to say—they are talking much more than usual, chattier, and even disinhibited in speech, bringing up controversial topics they may regret later. Often, the listener may not agree that these are great plans and may worry that they are unrealistic, impossible, could strain painful medical or orthopedic problems that they have, or maybe the listener may feel there are more important things that the manic person should be doing with this new energy. This could lead to an irritable, if not violent, argument (depending on how insistent the disagreeing person is) because it is usually impossible to dissuade a person experiencing mania from doing what they want to do. They have supreme confidence that it will be easy, and the expenditures will not be a problem (even if they obviously will be a problem). Next, the person experiencing mania sets out to do those projects in “go-go-go” mode, feeling much less need for sleep and maybe skipping sleep completely for a night or 2. As noted, spending money almost invariably occurs to fund the ventures or add to things they collect; clothes are very common purchases, but there can be big-ticket items like vehicles, expensive lawn equipment, or foolish investments, including scams. The person will later recognize these decisions as foolish, but they seemed like perfect opportunities at the time. At night, the person experiencing mania wants to continue their projects, but their loved ones may urge them to come to bed, or they may have enough insight to realize they should at least try to sleep. But it is difficult because their brain is still racing with thoughts of plans, making new ones and modifying previous ones. Again, the contrast with what keeps patients with PTSD awake is important—the individual with PTSD has racing thoughts about past and present traumas, current worries, fears of sounds in the house, and disturbed awakenings and nightmares followed by the inability to return to sleep due to these negative thoughts. Patients with comorbid PTSD and bipolar disorder will have some nights when it is the mania keeping them up and others when the PTSD is the cause. Typically, PTSD is the cause of insomnia during bipolar depressions when they have this comorbidity. After several days or more, the event terminates, usually over a day or less, and there is the crash, as noted before. The victim can feel the energy draining from their body and brain as they lose interest in whatever they were doing and stop working on their projects, leaving them unfinished. They withdraw, do not want to talk to others, and slow down in all respects. Their mood becomes depressed, and suicidality may set in quickly. Patients experiencing mania may have living spaces littered with tools and supplies for unfinished projects. When the next mania comes along, they usually start entirely different projects and cannot be persuaded to finish the previous ones, which is another source of irritability and conflict with the spouse or family. Describing mania in this manner takes 5 to 10 minutes. Then, ask the patient whether they have had experiences like this. It counts for the diagnosis if it happened some years ago, but lately, they have been predominantly depressed. Very often, you will get a strong reaction to the effect that “this is exactly what happens to me; how could you know it so accurately?” They never knew this was mania. Or you may get a reaction that, no, this never happened—and it may be that all the hyperactivity thought to be mania was due to PTSD-triggered events or some other cause related to conflicts with people. The third possibility is that they had some of what you said, but other details were absent. In that case, you flesh out what they claim they did not have in your narrative and see whether it meets the criteria for mania or hypomania. Once you have determined that they have had manic episodes, the next step is to identify how long the spells last, whether they are rapid cyclers with 4 or more episodes per year (2 manias and 2 depressions would qualify), and whether it is bipolar I or II. This is important because, particularly with bipolar I and with rapid cycling, it is essential to avoid antidepressants. I will discuss treatment in later columns. Bipolar I is easily diagnosed if they have a history of psychosis with their manias or if they have been hospitalized because of the manias. The more difficult way to meet the criteria for bipolar I is if they have the third criterion in DSM-5-TR, which is “marked impairment in social or occupational functioning” due to behaviors in the manias. Marked impairment in relationships can come from promiscuity, infidelity to their partner, excessive demands of their partner, or employment of pornography that distresses their partner, all due to the hypersexuality typically associated with manias. I usually wait until now to bring up this symptom. Patients can be ashamed to admit that these things have happened, but by this point in the discussion, they may be ready to discuss it with the clinician. Also, there can be extreme arguments, domestic violence, and intense conflict with significant others, family, and friends about the projects and ideas that the person experiencing mania wants to do. That would also make it bipolar I. Marked impairment at work typically results from the person experiencing mania being very sure of how things should go at work and wanting to argue with bosses/others to have things done their way. In the process of such arguments, they can be fired, or they may impulsively quit good jobs, thinking that everyone at work is stupid compared with them and that they should seek employment elsewhere, only to regret quitting later when the mania subsides. Patients with bipolar I often have a history of many jobs in a short time due, on close inquiry, to their behavior during their manias. If the patient does not report criteria-meeting manic or hypomanic episodes, it is still possible that they are having prebipolar depressions and could have a mania in the future. Initial manias have occurred in older adults after decades of depressions. Predictors of when a unipolar depression diagnosis could change to bipolar include the following: family history of bipolar disorder; a younger age of onset; panic anxiety; a family history of completed suicide; past poor response to antidepressants (even 1 failed trial of an antidepressant should make one pause and wonder whether you missed the diagnosis of bipolar; do not wait until there have been 5 to 10 failed trials); a history of treatment-emergent irritability, agitation, or suicidality after antidepressants; psychotic features; and postpartum depression or psychosis. If enough of these predictors are present, including failure on previous antidepressant trials, consider treating the depression as a bipolar depression . Note: This article originally appeared on Psychiatric Times .

Mental health in the United Kingdom has worsened significantly since COVID-19 pandemic restrictions were imposed, according to a new report by the Institute for Fiscal Studies (IFS). The study confirmed previous findings, showing a “steady increase in reported mental health problems.” Eduin Latimer, a research economist at IFS, warned that rising mental health issues not only affect individuals but also contribute to an increase in the cost of paying benefits. Key Findings The report highlighted several concerning trends. These include: The percentage of working-age people who reported a long-term mental health condition has risen to 13-15%, up from 8%-10% in the mid-2010s. “Deaths of despair” — those caused by alcohol, drugs, or suicide — rose by 24% among 15- to 64-year-olds in 2023 compared with pre-pandemic levels. This contributed to a 5.5% rise in overall working-age mortality. NHS mental health service contacts increased by 36% between 2019 and 2024. Antidepressant prescriptions have risen by 12% since 2019. The number of 16- to 64-year-olds in England and Wales on disability benefits has climbed to 2.9 million (7.5% of this age group), a rise of 900,000 since the pandemic. Over half of new claims cite mental health as the primary condition. A Department for Work and Pensions survey found that 86% of incapacity and disability benefit claimants have a mental health condition, whether primary or secondary. The cost of working-age health-related benefits in 2023-2024 reached £48 billion, £12 billion more in real terms than in 2019-2020, representing 1.7% of GDP. The Office for Budget Responsibility forecasts this will rise to £67 billion by 2029–-2030. Sickness absence days per worker increased by 37% in 2022 compared with 2019. Public sector workers saw significant rises, including 14% in the NHS. Rise in Deaths of Despair Iain Porter, senior policy adviser at the Joseph Rowntree Foundation, which campaigns to end poverty, said there was “clear evidence of a deterioration in mental health in the population” and the trend was “real and growing.” Although greater openness has helped reduce stigma, the increase in deaths of despair underscores the severe impact of worsening mental health, he added. Disability benefit claimants report a range of mental health and behavioural conditions , with anxiety, depression, mood disorders, psychotic disorders, learning disabilities, and autism spectrum disorders being the most common. The report noted particularly fast growth in new disability claims for learning disabilities and autism since 2019. Long Wait Times Dr Subodh Dave, dean of the Royal College of Psychiatrists, called the report’s findings “worrying yet unsurprising.” He told Medscape News UK that 350,000 people with mental illness have waited more than a year for their first NHS appointment, with some waiting more than 2 years. He noted a 29% increase in the waiting list over the past 2 years — a trend he described as “worrying.” Mental illnesses can be treated effectively, particularly when they are identified early, Dave stressed. However, delays increase the risk for more complex conditions that can harm long-term health and prevent people leading fulfilling lives. Patients Struggle to Access Care Dave highlighted the well-known challenges facing NHS mental health services. “Community provision isn’t meeting patients’ needs, adult acute bed occupancy has remained above 95% since May 2022, and patients face unacceptable waits,” he said. “This is hurting individuals and the economy.” Saffron Cordery, interim chief executive of NHS Providers, warned that demand for mental health services has surged. Referrals reached “a record high” of 2 million in December 2024 and were 39% higher than before the pandemic. “The knock-on effects of this are worrying and far-reaching, with poor mental health the leading driver of ill-health related economic inactivity,” she said in a press release. Mental health charities are also struggling to meet demand. Dr Jaime Craig, a consultant clinical psychologist and director of policy and governance at the Association of Clinical Psychologists (ACP), told Medscape News UK that since the pandemic, those at the front lines of healthcare, particularly GPs, have seen an increasing number of patients with poor mental health. This was accompanied by a rise in the number of patients with complex combinations of psychological and physical health difficulties. For both groups, options to help them access effective specialist support can be limited. The ACP’s recent work on the lack of appropriate mental health support for immunocompromised people and their families is a good example of the growing need for specialist clinical health psychology support, and the impact of this being unavailable, Craig said. Craig also warned that healthcare workers are often left advising patients with few available options. “Those on the frontline of healthcare can be placed in the unenviable position of having little to help them advise their patients,” he said. They may also struggle to guide patients on how to safely navigate unregulated therapy services outside the NHS. Note: This article originally appeared on Medscape .

Anxiety is a normal human emotion that everyone experiences from time to time. However, when anxiety becomes excessive or debilitating, it can become a mental health disorder. Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults age 18 and older, or 18.1% of the population every year. There are many different types of anxiety disorders , including generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and specific phobias. GAD is characterized by excessive worry and anxiety that is difficult to control. Panic disorder is characterized by sudden, intense episodes of fear and anxiety that can lead to physical symptoms such as shortness of breath, chest pain, and dizziness. Social anxiety disorder is characterized by a fear of social situations that can lead to avoidance of social interactions. Specific phobias are characterized by a fear of a specific object or situation that can lead to avoidance of the feared object or situation. Source: Anxiety and Depression Association of America Anxiety disorders can have a significant impact on a person's life. They can interfere with work, school, relationships, and overall quality of life. In some cases, anxiety disorders can lead to suicide . Suicide is the 10th leading cause of death in the United States, and it is the second leading cause of death among young people ages 15-24. Anxiety disorders are a major risk factor for suicide. In fact, people with anxiety disorders are up to six times more likely to attempt suicide than people without anxiety disorders. There are a number of reasons why anxiety can lead to suicide: First, anxiety can make people feel hopeless and helpless. Second, anxiety can make people feel isolated and alone. Third, anxiety can make people feel like they're a burden to others. There are a number of things that can be done to prevent suicide in people with anxiety. These include early identification and treatment of anxiety disorders , providing support and education to families and friends of people with anxiety, and reducing access to lethal means of suicide. 7 Tips on How to Deal with Anxiety Mental health wellness is the state of being mentally healthy and well-functioning. It includes having a positive sense of self, being able to cope with stress, and having the ability to maintain healthy relationships. There are a number of things that you can do to promote mental health wellness. These include: Getting enough sleep Eating a healthy diet Exercising regularly Spending time in nature Connecting with loved ones Practicing relaxation techniques Seeking professional help if needed If you are struggling with anxiety or other mental health challenges, it is important to seek help. There are a number of resources available to you, including therapists, counselors, and support groups. You are not alone, and there is help available.