Health and WellnessHoliday Brochure

2016

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From your colleagues in MEDCOM

Indiana Guard Reserve

MAJ Ungar-Sargon MD PhD

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Your take home guide and tips

To health and wellness

From your colleagues in the IGR

December 2016 Edition devoted toMental Health

As we enter the holiday season we dedicate this wellness bulletin to those colleagues suffering from Mental Illness

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THE MAGNITUDE OF THE PROBLEM OF MENTAL HEALTH

We underestimate those who suffer from mental illness mainly due to the social stigma and the many who suffer in silence without getting help because of shame.

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Veterans & Active DutyNearly 1 in 4 active duty members showed signs of a mental health condition, according to a 2014 study in JAMA Psychiatry.

Mental Health Concerns in MilitaryThere are three primary mental health concerns that you may encounter serving in the military.

Posttraumatic Stress Disorder (PTSD). Traumatic events, such as military combat, assault, disasters or sexual assault can have long-lasting negative effects such as trouble sleeping, anger, nightmares, being jumpy and alcohol and drug abuse. When these troubles don't go away, it could be PTSD. The 2014 JAMA Psychiatry study found the rate of PTSD to be 15 times higher than civilians.

Depression. More than just experiencing sadness, depression doesn't mean you are weak, nor is it something that you can simply "just get over." Depression interferes with daily life and normal functioning and may require treatment. The 2014

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JAMA Psychiatry study found the rate of depression to be five times higher than civilians.

Traumatic Brain Injury (TBI). A traumatic brain injury is usually the result of significant blow to the head or body. Symptoms can include headaches, fatigue or drowsiness, memory problems and mood changes and mood swings.

- See more at: http://www.nami.org/Find-Support/Veterans-and-Active-Duty#sthash.Jz900evk.dpuf

THE FACTS behind Mental Illness

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Everyone is affected by mental illness or knows someone suffering

Everyone feels a social stigma regarding mental illness…How do we approach victims without judging them?How do we make them feel less guilty about this disorder?How can we get them help?How we identify someone suffering Or even recognizes the symptoms in ourselves?Do we realize to what extent mental health affects performance and social and family relationships?

More statistics related to mental health disordersThe following are the latest statistics available from the National Institute of Mental Health Disorders, part of the National Institutes of Health:

Mental health disorders account for several of the top causes of disability in established market economies, such as the U.S., worldwide, and include: major depression (also called clinical depression), manic depression (also called bipolar disorder), schizophrenia, and obsessive-compulsive disorder.

An estimated 26% of Americans ages 18 and older -- about 1 in 4 adults -- suffers from a diagnosable mental disorder in each year.

Many people suffer from more than one mental disorder at a given time. Depressive illnesses tend to co-occur with substance abuse and anxiety disorders.

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Approximately 9.5% of American adults ages 18 and over, will suffer from a depressive illness (major depression, bipolar disorder, or dysthymia) each year. Women are nearly twice as likely to suffer from major

depression than men. However, men and women are equally likely to develop bipolar disorder.

While major depression can develop at any age, the average age at onset is the mid-20s.

With bipolar disorder, which affects approximately 2.6% of Americans age 18 and older in each year -- the average age at onset for a first manic episode is during the early 20s.

Most people who commit suicide have a diagnosable mental disorder -- most commonly a depressive disorder or a substance abuse disorder. Four times as many men than women commit

suicide. However, women attempt suicide more often than men.

The highest suicide rates in the U.S. are found in Caucasian men over age 85. However, suicide is also one of the leading causes of death in adolescents and adults ages 15 to 24.

Approximately 1% of Americans are affected by schizophrenia. In most cases, schizophrenia first appears in men

during their late teens or early 20s. In women, schizophrenia often first appears during their 20s or early 30s.

Approximately about 18% of people ages 18- 54 in each year, have an anxiety disorder in each year. Anxiety disorders include: panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD),

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and phobias (social phobia, agoraphobia, and specific phobia). Individuals with OCD frequently can have problems

with substance abuse or depressive or eating disorders.

In this monograph, we will focus on just a few common disordersIncluding:

1. Anxiety Disorders2. Panic Disorders3. Bipolar Disorders4. Depression5. Post-Traumatic Stress Disorders6. Eating Disorders7. Suicide prevention

1. Anxiety Disorders

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Definition

Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, school work, and relationships. There are several different types of anxiety disorders. Examples include generalized anxiety disorder, panic disorder, and social anxiety disorder.

Signs and Symptoms

Generalized Anxiety Disorder

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People with generalized anxiety disorder display excessive anxiety or worry for months and face several anxiety-related symptoms.

Generalized anxiety disorder symptoms include:

Restlessness or feeling wound-up or on edge Being easily fatigued Difficulty concentrating or having their minds go blank Irritability Muscle tension Difficulty controlling the worry Sleep problems (difficulty falling or staying asleep or restless,

unsatisfying sleep)

2. Panic Disorders

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Panic Disorder

People with panic disorder have recurrent unexpected panic attacks, which are sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom.

Panic disorder symptoms include:

Sudden and repeated attacks of intense fear Feelings of being out of control during a panic attack Intense worries about when the next attack will happen Fear or avoidance of places where panic attacks have occurred in the

past Symptoms that easily mimic heart attack or stroke Sense of foreboding in unfamiliar situations

Social Anxiety Disorder

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People with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others.

Social anxiety disorder symptoms include:

Feeling highly anxious about being with other people and having a hard time talking to them

Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others

Being very afraid that other people will judge them Worrying for days or weeks before an event where other people will be Staying away from places where there are other people Having a hard time making friends and keeping friends Blushing, sweating, or trembling around other people Feeling nauseous or sick to your stomach when other people are around

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3. Bipolar Disorder

Definition

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

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Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.

Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.

Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.

Signs and Symptoms

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.

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People having a manic episode may:

People having a depressive episode may:

Feel very “up,” “high,” or elatedHave a lot of energyHave increased activity levelsFeel “jumpy” or “wired”Have trouble sleepingBecome more active than usualTalk fast about a lot of different thingsBe agitated, irritable, or “touchy”Feel like their thoughts are going very fastThink they can do a lot of things at onceDo risky things, like spend a lot of money or have reckless sex

Feel very sad, down, empty, or hopelessHave very little energyHave decreased activity levelsHave trouble sleeping, they may sleep too little or too muchFeel like they can’t enjoy anything Feel worried and emptyHave trouble concentratingForget things a lotEat too much or too littleFeel tired or “slowed down”Think about death or suicide

Sometimes a mood episode includes symptoms of both manic and depressive symptoms. This is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual may feel very good, be highly productive, and function

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well. The person may not feel that anything is wrong, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.

4. Depression

Definition

Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

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Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.

Perinatal depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.

Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.

Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

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Signs and Symptoms

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

Persistent sad, anxious, or “empty” mood Feelings of hopelessness, or pessimism Irritability Feelings of guilt, worthlessness, or helplessness Loss of interest or pleasure in hobbies and activities Decreased energy or fatigue Moving or talking more slowly Feeling restless or having trouble sitting still Difficulty concentrating, remembering, or making decisions Difficulty sleeping, early-morning awakening, or oversleeping Appetite and/or weight changes Thoughts of death or suicide, or suicide attempts Aches or pains, headaches, cramps, or digestive problems without a

clear physical cause and/or that do not ease even with treatment

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her illness. Symptoms may also vary depending on the stage of the illness.

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5. Post-Traumatic Stress Disorder

Definition

PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened even when they are not in danger.

Signs and Symptoms

Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.

To be diagnosed with PTSD, an adult must have all the following for at least 1 month:

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At least one re-experiencing symptom At least one avoidance symptom At least two arousal and reactivity symptoms At least two cognition and mood symptoms

Re-experiencing symptoms include:

Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating

Bad dreams Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include:

Staying away from places, events, or objects that are reminders of the traumatic experience

Avoiding thoughts or feelings related to the traumatic event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Arousal and reactivity symptoms include:

Being easily startled Feeling tense or “on edge” Having difficulty sleeping Having angry outbursts

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Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

Trouble remembering key features of the traumatic event Negative thoughts about oneself or the world Distorted feelings like guilt or blame Loss of interest in enjoyable activities

Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members. 

It is natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

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6. Eating Disorders

Definition

There is a commonly held view that eating disorders are a lifestyle choice. Eating disorders are serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Signs and Symptoms

Anorexia nervosa

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People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, and eat very small quantities of only certain foods. Anorexia nervosa has the highest mortality rate of any mental disorder. While many young women and men with this disorder die from complications associated with starvation, others die of suicide. In women, suicide is much more common in those with anorexia than with most other mental disorders.

Symptoms include:

Extremely restricted eating Extreme thinness (emaciation) A relentless pursuit of thinness and unwillingness to maintain a normal

or healthy weight Intense fear of gaining weight Distorted body image, a self-esteem that is heavily influenced by

perceptions of body weight and shape, or a denial of the seriousness of low body weight

Other symptoms may develop over time, including:

Thinning of the bones (osteopenia or osteoporosis) Mild anemia and muscle wasting and weakness Brittle hair and nails Dry and yellowish skin Growth of fine hair all over the body (lanugo) Severe constipation Low blood pressure, slowed breathing and pulse Damage to the structure and function of the heart Brain damage Multi-organ failure Drop in internal body temperature, causing a person to feel cold all the

time Lethargy, sluggishness, or feeling tired all the time

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Infertility

Bulimia nervosa

People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or relatively normal weight.

Symptoms include:

Chronically inflamed and sore throat Swollen salivary glands in the neck and jaw area Worn tooth enamel and increasingly sensitive and decaying teeth

because of exposure to stomach acid Acid reflux disorder and other gastrointestinal problems Intestinal distress and irritation from laxative abuse Severe dehydration from purging of fluids Electrolyte imbalance (too low or too high levels of sodium, calcium,

potassium and other minerals) which can lead to stroke or heart attack

Binge-eating disorder

People with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. Thus, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

Symptoms include:

Eating unusually large amounts of food in a specific amount of time Eating even when you're full or not hungry

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Eating fast during binge episodes Eating until you're uncomfortably full Eating alone or in secret to avoid embarrassment Feeling distressed, ashamed, or guilty about your eating Frequently dieting, possibly without weight loss

Risk Factors

Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are 2½ times greater than among men. Like women who have eating disorders, men also have a distorted sense of body image. For example, men may have muscle dysmorphia, a type of disorder marked by an extreme concern with becoming more muscular.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders.

7. Suicide Prevention

Introduction

Suicide is a major public health concern. Over 40,000 people die by suicide each year in the United States; it is the 10th leading cause of death  overall. Suicide is complicated and tragic but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives.

Signs and Symptoms

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The behaviors listed below may be signs that someone is thinking about suicide.

Talking about wanting to die or wanting to kill themselves Talking about feeling empty, hopeless, or having no reason to live Planning or looking for a way to kill themselves, such as searching

online, stockpiling pills, or buying a gun Talking about great guilt or shame Talking about feeling trapped or feeling that there are no solutions Feeling unbearable pain (emotional pain or physical pain) Talking about being a burden to others Using alcohol or drugs more often Acting anxious or agitated Withdrawing from family and friends Changing eating and/or sleeping habits Showing rage or talking about seeking revenge Taking great risks that could lead to death, such as driving extremely

fast Talking or thinking about death often Displaying extreme mood swings, suddenly changing from very sad to

very calm or happy Giving away important possessions Saying goodbye to friends and family Putting affairs in order, making a will

If You Know Someone in Crisis

Call the toll-free National Suicide Prevention Lifeline  at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential.

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How Can I Help a Fellow Warrior in the IGR?

Strengthening our state defense force is a group effort. If you’re concerned about a friend or colleague, the most important thing you can do is to ask how they’re doing and to listen without judgment. The symptoms of a mental health condition can sometimes make individuals forget that mission success relies on staying healthy in mind as well as body. They might not realize that their worries are symptoms of mental illness. Listen patiently, offer encouragement and remind them that anyone can develop these symptoms, from privates to generals.Remind your fellow IGR soldier that the central mission of the state defense force is to maintain a strong healthy cadre ready to serve our State. Share the information here with him or her. Emphasize that talking to a counselor or MEDCOM officer won’t hurt their career or future in IGR, and that every service member has a duty to build resilience by seeking advice and treatment when it’s indicated.

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MEDCOM stands ready and able to help you through this. WE are developing a Mental Health force within MEDCOM to attend to your needs.If someone you know tells you about a mental health concern, don’t laugh it off or promise it will get better on its own, even if you want to comfort the person.

MEDCOM COMMANDERS

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for comments and other suggestions

please e mail Julian.ungar@igr.in.gov

editor

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