Instructor: Sandra Andrews, CPhT
Buzz Aldrin, Ludwig van Beethoven, Winston Churchill, Ernest Hemmingway, Billy Joel, Abraham Lincoln, J.K. Rowlings, Princess Diana, and Vincent Van Gough, names easily recognized throughout the world and of course, some of the some of the greatest minds and performers of our time, but what gives them commonality. The answer may not be what one might expect, but mental illness does not know the boundaries of fame and fortune. Despite the strides we have made to understand mental illness, it can still hold a stigmatism among the general public. Perhaps the reason mental illness has been so greatly misunderstood comes from the after effects it perpetuates and the media storms that almost certainly follow. Mark David Chapman, convicted of assonating former Beatle John Lennon in 1981, used a plea of insanity for his criminal defense. June 21st 1982, John Hinckley, Jr. was found not guilty by reason of insanity for the assignation attempt on then President Ronald Regan. Like Chapman, Hinckley suffered from delusions and became obsessed with a public figure. Hinckley's reason for shooting Regan was an attempt to win the love of actress Jody Foster. More recently, Jared Loughner, a former community college student in Tucson, Arizona, plead guilty to 19 charges of murder and attempted murder for his rampage on a meet and greet held by Arizona State Representative Gabrielle Giffords. The act left Representative Giffords, Loughner's target, permanently disabled and 6 others, include a 9-year-old girl, dead. Loughner, examined after his arrests by state health professionals, would later be diagnosed as a paranoid schizophrenic. Given these examples and far too many more to examine, it is understandable how the words, mental illness have earned the banner of stigmatism with the general public. However, mental illness reaches beyond what we view in the news media. According to the Centers for Disease Control (CDC) nearly 25% of all Americans suffer from some form of mental illness. Stretching this statistic further, the CDC also estimates that almost 50% of all Americans will develop mental illness sometime within their life. The CDC defines mental illness as: Collectively all diagnosed mental disorders or health conditions that are characterized by alterations in thinking, mood or behavior (or some combination thereof) associated with distress an/or impaired functioning. According to the Anxiety and Depression Association of America (ADAA) 18% of Americans suffer from some form of anxiety or depression, making it the most common form of mental illness in the United States. ADAA estimates that Americans spend nearly 42 billion dollars a year to combat the effects of anxiety and depression. Women are twice as susceptible to the effects of anxiety and depression as men as are those adults that fall between the ages of 40-59. While the majority of those who suffer from anxiety and depression remain within the 40-59 age group, children and young adults under the age of 18 have seen a rise in the number of diagnosed cases for their age group. 25 % of children ages 13-18 will develop some form of anxiety or depression within their lifetime and 5.9% of those children will be diagnosed at a severe level, meaning, the diagnosis of anxiety or depression has taken over their lives to the point where daily life functions become impossible. So what disease states falls under the diagnosis of an anxiety or depression? In accordance with the CDC definition of mental illness, the following disease states fall under the heading of anxiety and depression based mental illness: Generalized Anxiety Disorder (GAD) Obsessive-Compulsive Disorder (OCD) Including hoarding Panic Disorder Posttraumatic Stress Disorder (PTSD) Social Anxiety Disorder Specific Phobias Major Depressive Disorders Dysthymic Disorder Anxiety and depression may also be labeled as an associative disorder, meaning it is not the patient's primary diagnosis, but rather it has been diagnosed as a result of the primary disease state. Some common associative disease states for anxiety and depression include: Bipolar Disorder Eating Disorder Headache Irritable Bowel Syndrome Sleep Disorders Substance Abuse Chronic Pain Stress Fibromyalgia Body Dysmorphic Disorder Adult Attention Deficit Disorder As with any disease state, knowing the why and how are the first part to understanding and treating the disease and mental illness is no different. Like some other disease states, genetics may play a large role in the cause of certain forms of mental illness, yet others forms of mental illness are associated with environmental orders or conditions. However, the reasons behind mental illness cannot be simply explained by a single condition or cause. Take for example the reasons behind the development of depression and anxiety. Depression, according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), is a mood disorder. The DSM-IV is the desk reference physicians and other mental health professional use to diagnose mental health disease. From time to time there is not one of us that have not felt sad, but depression goes beyond the occasional sadness or feeling blue. Depression affects nearly 8% of all Americans or 25 million, each year and these numbers continue to climb every year. Amazingly, depression in women is diagnosed more frequently than men. According to the National Alliance on Mental Illness (NAMI), women are 70% more likely to receive a diagnosis of depression than men. Researchers have not yet uncovered the reasons behind this statistic, but one thing is certain. Depression that goes undiagnosed and subsequently untreated, is not only more threatening to the well being of the patient, but also potentially life threatening. The warning signs of depression can range from feeling depressed or a decreased or emptiness that does not go away, to the much more serious and alarming thoughts of suicide or the intent to commit suicide. Other symptoms of depression include: Loss of joy or interest in activities that used to be enjoyable A noticeable increase or decrease in appetite or a drastic change in weight In ability to sleep or sleep well Too much sleep or finding it difficult to get out of bed Feelings of agitation Fatigue or lack of energy In ability to make decisions, trouble concentrating, or ability to think clearly While depression is the one of the most commonly diagnosed mental illness in the United States, anxiety disorders account for a largest number of diagnosed mental illness cases in the United States. Anxiety disorders are often related to activities, which are social in nature and may be so distressful to those, affected that everyday actions, such as shopping, or even going outside cause panic. Patients that have been diagnosed with an anxiety disorder may also have difficulty with personnel relationships, causing the patient to isolate themselves from others. Low self-esteem and even drug abuse are also possible side effects of anxiety disorders. Some of the mostly commonly diagnosed anxiety disorders include; panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), phobias, general anxiety disorder (GAD), and social anxiety disorder. Panic disorders, which can strike the patient without warning, involves physical symptoms that may involve, chest pains, heart palpitations, labored breathing, gastrointestinal upset and lightheadedness as feel as causing the patient to have an extreme fear of dying or being disconnected from society. These feeling are often times so real to the patient that even the simple act of walking to the mailbox can become alarming. Panic disorders at their extreme can have a devastating effect on the patient, making everyday life almost impossible. Obsessive-Compulsive Disorder or OCD is just as it sounds, a disorder where the patient is struck by thoughts or actions that are repetitive, irrational or intrusive in nature. Patients diagnosed with OCD feel little to no control over their symptoms and rationalize their feeling or behavior through their actions. For example, a patient may be compelled to chronically clean, because they feel not doing so would bring harm to themselves or their loved ones. It should be pointed out that most patients diagnosed with OCD are aware of their obsessions and compulsions, but lack the means to rein control over those obsessions and compulsions. Posttraumatic Stress Disorder (PTSD) often associated with our military personnel, but is actually a disorder that may affect anyone that has experienced or witnessed a traumatic event. Trauma, such as abuse, life-threatening violence, or even natural disasters can be the trigger for PSTD that sets off symptoms like nightmares, flashbacks or feels of uncontrollable fear, anger, or irritability. Patients diagnosed with PSTD often times find it difficult to maintain relationships or even hold a steady job due to the pressures it places on them as they deal with the symptoms of PSTD. Patients with PSTD also may not be able to easily speak about their issues as they feel shame or embarrassment as a result of the trauma they witnessed or were a part of first hand. Phobias may be the most recognized form of anxiety disorders. Phobias, which are defined as a disabling or unreasonable fear where there really is no need for fear, can be extremely disabling to those affected by them. Agoraphobia, fear of being unable to escape unfamiliar places, many times leaves the patient unable to leave their home. Celebrity chef Paula Deen was affected as harshly by agoraphobia that she rarely stepped out of her home. Unfortunately this led to failed relationships and difficulty functioning with the chores associated with daily life. However, through self-perseverance and realization, Deen was able to conquer her agoraphobia. While Paula Deen may be a shinning example of hope for those who identify with agoraphobia, we should caution that each individual's experience with agoraphobia is different and treatment should be handled in coordination with licensed professional. Another well know example of phobia is acrophobia. Acrophobia is the fear of heights and belongs to the category of phobias that deal with the discomfort found in space and motion. According to Statisticbrain.com and the National Institutes of Mental health, approximately 10% of all Americans have fear of heights. Researchers actually believe this fear is equated from a previous experience of falling the person may have had during infancy or early childhood. Scientists have even gone, as far to stay that acrophobia is an evolutionary advantage. The reasoning behind this statement deals with the minds perception that the higher we are the greater our risk with falling and ultimately harm, becomes. Therefore as an act of self-defense the mind associates the view of heights with a more intense fear of falling. Science has also found this acrophobia becomes more pronounced when there are no safeguards, such as rails or barriers, set in place to protect against falling. There are far too many phobias for us to exam within this article, but for those who wish to obtain more information concerning phobias the National Institutes of Mental Health website, http://www.nimh.nih.gov/health/publications/anxiety-disorders/introduction.shtml, is a good place to begin. Finally, Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder also involve the extreme fear of dealing with the task of everyday life. Fatigue, tension, and an inability to concentrate are just a few symptoms associated with GAD. In some patients with GAD, the worry or fear can be so great, physical symptoms such as headaches and nausea and vomiting can be common. Social Anxiety Disorder, not unlike GAD, leaves the patient with an unusual or irrational fear of social situations, such as those associated with school or workplace. Patients that have been diagnosed with Social Anxiety Disorder find it difficult to maintain personal relationships due to their fear of humiliation or finding themselves in a situation where they might not know what to say or how to react. Patients with Social Anxiety Disorders frequently have symptoms similar to those associated with panic attacks, heart palpitations, dizziness, profuse sweating and shortness of breath. Anxiety disorders may also be symptoms of other mental illnesses as well, such as schizophrenia, a mental disorder where those affected suffer from delusions, disordered thinking and hallucinations, or depression. Patients affected by anxiety disorders are more likely to abuse drugs and alcohol. Patients that suffer from anxiety disorders may find the use of drugs and alcohol calm the fears associated with their disorder, but ultimately become addicted from over use of the substance. As is the case with a great number of disease states, anxiety disorders may have a connective link to genetics. Patients that are diagnosed with an anxiety disorder most likely have a parent that was also diagnosed with an anxiety disorder, but genetics are not the only determinate for anxiety disorders. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) is a term associated with a specific category of children that have been diagnosed with Obsessive-Compulsive Disorder (OCD) or tic disorders, for example, Tourette's syndrome, which experience worsening symptoms after the onset of step throat or scarlet fever, bacterial infections connected with group A Streptococcal infections. In 1998 Dr. Susan Swedo and her associates published the first paper explaining Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal. Dr. Swedo and her associates findings assessed that children diagnosed with PANDAS had a quick and sudden onset of OCD or tic disorder or if previously diagnosed with OCD or tic disorder had their symptoms suddenly worsen. The connect they found was group A Streptococcal, a bacterial infection usually found when strep throat or Scarlet fever has been diagnosed. The findings, while associating group A Streptococcal, found PANDAS was actually associated with the body's immune reaction to group A Streptococcal and not the actually affects of the infections. According to the research evaluated by Dr. Swedo and her colleagues, as infection becomes present in the body, the body's immune systems begins its defense by producing proteins to combat the bacteria. These proteins are known more commonly as antibodies and are readily clinically measure. However, exact trigger that causes the neuropsychiatric symptoms, OCD or tic disorder, is not yet completely known. Through their research Dr. Swedo and her colleagues have developed the following criteria when diagnosing a child with PANDAS: Children have had a previous diagnoses of Obsessive-Compulsive Disorder or tic disorder or had a sudden onset diagnose of OCD or tic disorder Generally appears in children from 3 years of age to puberty. Associated symptoms with PANDAS Bouts of abrupt rage Unexplained behavior changes Newly diagnosed case of Attention Deficit Hyperactivity Disorder (ADHD) or a previously diagnosed case that worsens Actions inconsistent with the child's age such as, fears at bedtime or separation anxiety Hypersensitivity Obvious changes in handwriting and/or math skills Polyuria, typically during an active infection Other immune system diseases such as, Lyme Disease, Thyroid Disease, Celiac Disease, Lupus, Sydenham Chorea, Kawasaki's Disease, and acute Rheumatic Fever have also been associated with causing an sudden or worsening case of OCD or tic disorders Further information concerning Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus can be found at, http://www.pandasnetwork.org. Bipolar disorder, labeled as a manic-depressive illness by the National Institutes of Mental Health, patients diagnosed with this disease state experience days of extreme highs and extreme lows. The disease, which cycles between manic and depressive stages has no set pattern for the patient and can often have a damaging effect on the patient's life. Bipolar disorder is thought to begin its development during the late teen or young adult years. According to the National Institutes of Mental Health the median age for onset of bipolar disorder is 25 years of age. However, it should be noted that some patients may experience the first symptoms of Bipolar disorder during early childhood or some patients may develop symptoms later in life. The symptoms of Bipolar are not always easily diagnosed and can go undetected for years before the patient receives an appropriate diagnosis. It is estimated that more than 10 million Americans have bipolar disorder. Unlike depression or anxiety disorders, men diagnosed with bipolar disorder out number women. Symptoms of Manic Phase of Bipolar Disorder Long periods were the patient experiences an extremely elevated mood (or) A period were the patient experience radical periods of irritability, agitation or a feeling on edge Changes in behavior Quick talking and moving from one idea to the next with the mind continually speeding along in the though process Easily distracted Taking on too many projects Restlessness or anxiety In ability to sleep Overstated belief in one's ability Impulsiveness that often leads to the patient participating in activities found to be pleasurable, but high risk, for example, excessive spending, multiple sexual encounters or hasty business decision or investments Symptoms of Depression Phase of Bipolar Disorder Extreme periods of feeling worried or emptiness Extended periods were the patient exhibits no interests in activities they once enjoyed Changes in behavior Chronic feeling of tiredness or being run down Inability to concentrate or make decisions Feeling restless or short-tempered Extreme changes in the patient's eating, sleeping or other normal habits of daily living Constant thoughts of death or suicide or in some cases, even attempting suicide These are just a few of the basic symptoms of bipolar disorder. Patient's diagnosed with bipolar disorder may also experience psychotic symptoms as well. Episodes of hallucination or delusions are not unusual and may be as extreme as the patient believing they have gained fame and fortune in their manic or up phase or that they are in financial ruins and homeless in their depression or down phase. Over the last several years bipolar disorder has gained a substantial amount of attention with the media when several well-known personalities came out that they had been diagnosed as having bipolar disorder. One of the first to announce their diagnosis of bipolar disorder was former Today show host, Jane Pauley. Pauley, who was diagnosed with bipolar disorder at age 50, had been battling a reoccurring case of hives. According to Pauley, the hives had appeared at around age 7 and continued to reappear approximately every 7 years afterwards. Pauley notably called it the 7 year itch, but soon found the medications used to treat her hives, typically corticosteroids, had jump started episodes of manic highs and depressive lows. Pauley's behavior ranged from the manic, organizing a New York City wide voter registration at area high schools to the depressed, being unable to prepare for interviews. During one of Pauley's manic phases she even went as far to purchases a home on an impulse. Eventually Pauley's physicians diagnosed her as having bipolar disorder and after a brief stint at a psychiatric hospital and an appropriate regime of mood regulating medications, Pauley soon started to find closure with her diagnosis. Understanding the reasons behind bipolar disorders can sometimes be as frustrating as the disease itself. While science has not been able to conclusively target one primary trigger for bipolar disorder it has managed to draw some very stable conclusions. Some of the proposed reasons for bipolar disorder are: Biological - it appears that patients diagnosed with bipolar disorder have physical changes within their brains that are different then those who do not have bipolar disorder. While a direct change has not yet been isolated, the changes seem to be considerable Neurotransmitters- a disproportion of neurotransmitters, chemicals naturally produced by the brain, seems to be significantly responsible for the occurrence of bipolar disorder as well as other mood altering disease states, such as depression and anxiety Hormones- an uneven distribution of hormones both naturally occurring and synthetic, such as the effects Jane Pauley experienced, point to the origins of a bipolar diagnosis Inherited traits- patients that a first generation relative, such as a parent or sibling, have been found to be more likely to be diagnosed with bipolar disorder Environment- As is the case with many other disease states, our environment can heighten the effect of a disease state or even be responsible for its diagnosis. Stress, the loss of someone close or other traumatic events may be responsible for bipolar disorder in some patients, although this theory has not been conclusively proven It is clear that unlocking the reasons behind bipolar disorder will become more established as science and research gain a greater understand of the disease state and this will only come as time progress. Still the understanding that has already been established has helped pave the way for treatment that are able to bring the patient diagnosed with bipolar disorder some level ground. I still see things that are not here. I just choose not to acknowledge them. Like a diet of the mind; I choose not to indulge certain appetites; like my appetite for patterns; perhaps my appetite to imagine and dream. Professor John Nash from the movie, A Beautiful Mind Professor John Nash is one of the most prominent mathematicians of our time. In 1978 Professor Nash was awarded the John von Newmann Theory Prize and the Nobel Memorial Prize in Economic Science it 1994, but perhaps what Dr. Nash is best known for is his own personal battle with the mental disorder, schizophrenia. The 2001 movie, A Beautiful Mind chronicled the ups and downs of Professor John Nash's life, most of which was settled around his struggles with schizophrenia. While Hollywood may have taken some creative licensing in order to bring drama to the movie screen, it did manage to shine a light on a mental disorder that largely remains misunderstood. The National Institutes of Mental Health approximates that 1% of Americans lives with schizophrenia. Schizophrenia is a long-standing psychotic disorder where those affected by the disease state has difficulty telling the difference between what is real and what is not real. Many times those diagnosed with schizophrenia hear voices, delusions and hallucinations. Schizophrenia patients often fear others are controlling their thoughts or wanting to conspire against them in order to bring them harm. Schizophrenia patient may not make sense when they speak or they may sit speechless for hours, often times not making any movement at all. Schizophrenia may be so debilitating to the patient that function within a normal setting is impossible. Most schizophrenia patients find it difficult to hold a job, maintain a relationship or even care for themselves. The symptoms of schizophrenia fall within three distinguished categories, Positive Symptoms- psychotic behaviors that are not seen in healthy individuals, but often come and go. The behaviors, which may come and go, can be severe at times and virtually unnoticeable if the patient is receiving treatment. Some of the most common forms of psychotic behavior in schizophrenia include, Hallucinations- hearing, seeing, smelling, or feeling things that no one else can hear, see, smell or feel. Hearing voices is the most common hallucination seen with schizophrenia Delusions- belief that a situation is true despite being proven incorrect. Schizophrenia patients may have delusions that are bizarre such as believing the television is controlling their minds or that an inanimate is giving them orders Thought disorders- a dysfunctional way of thinking or not being able to organize thoughts or stop speaking abruptly while in mid-sentence Movement disorders- frantic body movements that become repetitive or at the opposite end of the spectrum, the patient may become catatonic Negative Symptoms- defined as interruptions to normal emotions and behaviors marked by symptoms they can easily be mistaken for depression or other illnesses. Patients with negative symptoms associated with schizophrenia often do not have the mental or physical means to care for themselves and personnel hygiene often suffers. Some of the negative symptoms may include, Flat affect - No movement in facial expressions or speaking in a monotonous voice No pleasure in everyday life Inability to maintain or begin activities Little to no verbal communication, even when interaction is demanded Cognitive Symptoms- the final symptom category for schizophrenia is sometimes difficult to recognize. Most times these symptoms are recognized as a result of testing the patient has undergone. Executive functioning or inability understand information and make a decision based on that information Inability to concentrate or pay attention Inability to us information soon after learning the information Schizophrenia unlike depression or bipolar disorder affects men and women the same. It also does not discriminate ethnically. Symptoms of schizophrenia typically begin around the age of 16, but as late as age 30. Schizophrenia rarely strikes past the age of 45, but there has been an increase in the onset of pediatric case in the last several years. Although schizophrenia affects men and women equally, men normally see symptoms earlier than women. Diagnosing schizophrenia in teenagers is difficult due to the similarity between the symptoms of schizophrenia and the changes seen in behavior during puberty. Science has proven that schizophrenia has a large genetic factor. More than 10% of patients diagnosed with schizophrenia have a blood relative, a brother, sister, parent, that has also been diagnosed with schizophrenia. While research continues on the genetic link to schizophrenia there is one study that suggest schizophrenia may result from a more advanced rate of genetic mutations. Chemicals essential to the function of the brain may malfunction during genetic mutation, causing disruption to the brain growth and beginning the development of schizophrenia. Science also suggests that schizophrenia may be due to environmental factors. Factors such as malnutrition prior to birth, issues during the birthing process as well as exposure to certain viruses. Researchers are still exploring these aspects of schizophrenia, but continue to make great strides towards understanding the mysteries of this mental illness. Medications to Treat Mental Illness Medications used to treat mental illness may be broken down into several categories and some medications may span several different categories. One commonality all of these medications share regulation of treatment is essential in order for the patient to attain the most affect. Medications used to treat mental illness fall within the following categories: Antipsychotic Antidepressants Mood stabilizers Anticonvulsants Anti-anxiety Attention Deficit Hyperactive Disorder Some medications fall under multiple categories such as Prozac (fluoxetine) and Zyprexa (olanzapine), which can be categorized as both an antipsychotic and an antidepressant. Medications may also be delegated to treat one specific disease state, but found to be effective for other disease states as well. For example, Antidepressant medications such as Celexa (citalopram) and Cymbalta (duloxetine) are primarily prescribed to treat depression, but have also been found effective to treat anxiety disorders as well. Antidepressants are the first line of medications used to effectively treat depression. Antidepressants work to restore natural chemical balance to the brain, specifically the areas of the brain that are controlled by neurotransmitters. Neurotransmitters are responsible for most of the body's mood and emotional responses. Serotonin, norepinephrine, and dopamine are the neurotransmitters antidepressants work to replace or re-build. Selective serotonin reuptake inhibitors (SSRI) are the most commonly prescribed antidepressants used to treat depression. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are also effective for treating anxiety. Still a third category that works on neurotransmitter dopamine, such as the drug Wellbutrin (bupropion), has had successful results when treating depression. SSRIs and SNRIs include: SSRIs SNRIs Prozac (fluoxetine) Cymbalta (duloxetine) Celexa (citalopram) Effexor, Effexor XR (venlafaxine) Zoloft (sertraline) Pristiq (desvenlafaxine) Paxil (paroxetine) Lexapro (escitalopram) Some of the common side effects of SSRIs and SNRIs are: Headache (normally subsiding once patient has established medication therapy) Nausea (again, typically subsides once medication therapy has been established) Lethargy or feeling of drowsiness (subsides after several weeks of medication therapy) Feeling of anxiety or agitation Reduced sex drive may be seen for both men and women While antidepressive have been proven to be extremely successful for the treatment of depression, caution should be taken when prescribing antidepressive for children or adolescents under the age of 18. An FDA trail published in 2004 found that 4% of children or adolescents on antidepressant therapy thought about suicide or even attempted suicide. In 2005 the FDA required a black box warning, the highest warning that the FDA administers, stating the increased risk of suicidal thoughts or attempts in children and adolescents. In 2007 the FDA increase the warning to cover young adults up to the age of 24. Anxiety disorders, the most common form of mental illness, is treated with medication under three specific categories, Antidepressants, anti-anxiety and beta-blockers. Antidepressants, which of course are also used to treat depression, use the same mechanism to treat anxiety as they do depression. Consequently, the same side effects patients have when using antidepressants for depression, they also experience when using them for anxiety. Benzodiazepines or anti-anxiety medications are the next category of medications used to treat anxiety. Klonopin (clonazepam) is commonly used to treat social phobias and generalized anxiety disorder (GAD). Ativan (lorazepam) is prescribed for panic disorder and Xanax is typical the drug of choice for panic disorder and GAD. Beta- blockers are used to limit the physical side effects associated with anxiety. Such issues as trembling and sweating are common in those diagnosed with anxiety disorders. Beta-blockers, like Inderal (propranolol) are used to treat heart conditions and blood pressure, but are also effective for the physical symptoms of anxiety disorders as well. Common side effects of anxiety medications include, upset stomach, blurred vision, headache and nightmares. Common side effects with beta blocks may include, fatigue, cold hands, weakness and dizziness. Patients taking medications for anxiety disorders are cautioned to never suddenly stop taking their mediations as this may cause severe withdrawal problems and increased issues with anxiety. Medications used to treat bipolar disorder include antidepressants, antipsychotics, such as Seroquel (quetiapine) and Zyprexa (olanzapine), benzodiazepines, like Valium (diazepam) and Xanax (alprazolam), anticonvulsants, Depakote (divalproex) and Lamictal (lamotrigine) and finally Lithobid (lithium), which acts as a mood stabilizer. Symbyax an antidepressant, Prozac (fluoxetine) and a mood stabilizer Zyprexa (olanzapine) was created to specifically treat bipolar disorder and is one of the only medications approved by the FDA for bipolar disorder. As with other medications used to treat mental illness, side effects can range from headache and nausea to weight gain and decreased sexual performance. Patients that have more severe side effects or thoughts of suicide should contact their physician immediately in order to reevaluate treatment options. Finally, the antipsychotics are the conventional treatment for those diagnosed with schizophrenia. The most frequently used medications to treat schizophrenia include, Thorazine (chlorpromazine), Haldol (haloperidol), perphenazine (only available in generic form) and fluphenazine (only available in generic form). In the 1990 a second line of antipsychotics was developed to treat schizophrenia. Clozaril (clozapine) falls within the category of second-generation antipsychotics. This category of antipsychotics are effective in treating hallucinations and other psychotic episodes the patient may experience, but was found to cause a dangerous side effect, agranulocytosis. Agranulocytosis is the loss of white blood cells. White blood cells help to fight infection. Due to this rather serious side effect, patients that are using Clozaril must have a blood test known as a white blood cell count, competed every one to two weeks. This issue, along with the high cost of the drug, sometimes makes this therapy prohibitive for some patients. However in patients that have not responded well to other antipsychotic treatments, Risperdal (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine), Geodon (ziprasidone), Abilify (aripiprazole), or Invega (paliperidone), Clozaril may be the patient's only reliable option. Mental illness may have gained a bit more understanding over the last decade, but what we will gain in the next decade will go well beyond the treatments currently available. However to stay we have reached a full understanding of its causes and symptoms would be completely false. Pharmacy as taken leaps and bounds toward creating treatments that effective control these disease states, allowing the patients commissioned with them to lead a better and in most cases, normal life. Still these treatments do not come without warning. Understanding the potential side effects a drug may have will provide the patient with a greater understand of their treatment and bring about security an safety for the patient as well. Finally, as pharmacy technicians, whether in a retail or institutional setting, recognizing the potential for harm is a skill that is invaluable. Pharmacy technicians that identify issues with therapy related to mental illness medications should always notify the pharmacists. Knowledge is only beneficial when used appropriately and in pharmacy this requires the concurrent effort of the pharmacist and the pharmacy technician, always remembering that the safety of the patient is above all else. 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The National Institute of Mental Health, http://www.nimh.nih.gov/health/publications/mental-health-medications/what-medications-are-used-to-treat-bipolar-disorder.shtml, May 7 2013, accessed 29 April 2013 What Medications are used to Treat Depression? The National Institute of Mental Health, http://www.nimh.nih.gov/health/publication/mental-health-medications/what-medications-are-used-to-treat-depression.shtml, May 5 2013, accessed 30 April 2013 What Medications are used to Treat Schizophrenia? The National Institute of Mental Health, http://www.nimh.nih.gov/health/publication/mental-health-medications/what-medications-are-used-to-treat-schizophrenia.shtml, May 07 2013, accessed 30 April 2013 Which Groups have Special needs when taking Psychiatric Medications? The National Institute of Mental Health, http://www.nimh.nih.gov/health/publications/mental-health-which-groups-have-special-needs-when-taking-psychiatric-medications.shtml, April 2012, accessed 6 May 2013