|
Page 1, 2, 3, 4, 5, 6
Abstract
For more than 16 years, the author has focused his clinical practice on the evaluation and treatment of mental disorders. Here he presents two common patient scenarios, which are amalgams of many patient cases. He refers to these cases throughout this report to highlight specific themes, opinions, and/or observations about individuals having mental disorders. This article focuses on the psychological domain of chronic stress as resulting from allosteric overload, how it manifests, what factors exacerbate it, and how chronic stress can be managed effectively with a holistic plan that includes the appropriate use of psychosocial strategies, therapeutic lifestyle changes, and several "core" orthomolecular therapies.
Introduction
For more than 16 years, I have focused my clinical practice on the evaluation and treatment of mental disorders. This has afforded me a tremendous amount of education and clinical experience with this vulnerable group of patients. While I cannot speak of any particular patient as being "typical," since they are all individuals with their own unique histories and physical makeup, all such patients have presented with consistent commonalities (and themes). Here I present two common patient scenarios, which are amalgams of many patient cases. I will refer to these cases throughout this report to highlight specific themes, opinions, and/or observations about the evaluation and management of individuals having serious mental disorders.
Scenario 1: This patient, whom I will refer to as Mary, is a 32-year-old female with chief complaints of fatigue, insomnia, depression, and anxiety. The onset of her depression began 5 years ago following her marriage. She met her husband while in graduate school. After dating for 8 years, they decided to get married. Soon after their marriage, they started having difficulties getting along. Often they would not see each other for weeks at a time owing to their different work schedules. They have no children and are uncertain if their marriage should continue. They have not sought couples counseling.
Mary is tired for much of the day. If she is lucky, she may exercise once each week. She seldom eats breakfast, often rushing through lunch while working at her desk. Over the past year, her work performance has declined and people have noticed that she appears less sharp. She avoids most of her coworkers because she does not want to "waste" valuable time at work. Her boss has told her on numerous occasions that she needs to be more sociable because people often perceive her as cold, detached, and unfriendly. At dinnertime, Mary typically eats alone while watching television. Shortly after dinner, Mary will do some work and then watch more television. She tries to get to sleep by midnight. Her sleep is fragmented. She wakes up several times each night worrying about her marriage, her job, and how unwell she feels. She used to go to church on Sundays, but stopped since her husband finds that "religious" thing silly.
She saw her family doctor several times over the past 4 to 5 months. She was told that she has clinical depression and generalized anxiety disorder. At the first visit, she was prescribed sertraline hydrochloride (50 mg/day) and told that she has a biochemical imbalance that requires psychotropic medication. She is taking sertraline hydrochloride (150 mg/day), lorazepam (1 mg sublingually as needed), and zopiclone (7.5 mg at bedtime/day).
Scenario 2: This patient, whom I will refer to as Mark, is a 22-year-old male with a chief complaint of schizophrenia. He was diagnosed 4 years ago after being admitted to the hospital near the university that he attended. At the time of his first episode of psychosis, he had just ended a tumultuous relationship, and he had been smoking cannabis daily for months as well as occasionally using amphetamines to improve his focus and get his homework done expeditiously. During his first episode of psychosis, he was in the hospital for 2 weeks, where his mental state normalized after he was administered a couple of haloperidol injections, followed by lorazepam as needed for acute anxiety (1 mg), and risperidone (5 mg) given nightly. At discharge, he was told to remain on the risperidone and lorazepam until he could be evaluated by a psychiatrist in the community.
About a month later, a community psychiatrist told Mark that he likely had schizophrenia and that he would need medication for the rest of his life. Mark left the psychiatrist's office irritated and thinking that the visit was a "complete waste of time." He took himself off his medications within a couple of weeks without any guidance. Several months later, another relationship went awry after he had fallen deeply in love with a different woman. Following this breakup, Mark began to use cannabis daily. After a few weeks he started isolating himself, stopped eating, became paranoid, and said bizarre things to people whom he knew and to complete strangers. Eventually, a concerned friend took Mark to the emergency room of a nearby hospital. While waiting, Mark became agitated. He was restrained forcefully, and given medication to quickly sedate him. He was kept for 2 weeks in a locked unit, where no visitors were allowed to see him. Then he was placed in a less strict mental health ward for approximately 2 months. He was discharged on the following medications: olanzapine (10 mg twice daily), paroxetine (30 mg/day), clonazepam (1 mg twice daily), and zopiclone (7.5 mg at bedtime).
When Mark was in my office for the first time, he was still taking these medications despite feeling that they were making him sick and progressively unwell. He weighed 230 pounds (his weight prior to medication was 170 pounds), felt tired most of the day, complained of an inability to concentrate (could not watch television or read without losing his focus), had no passion or enthusiasm for life, and felt "useless" as a person.
Mark has been away from university for 3 years and lost touch with most of his friends, all of whom have graduated. Mark normally goes to bed around 1 or 2 in the morning and sleeps until noon or later. He does nothing all day and feels bored most of the time unless he is smoking. He spends at least 4 to 6 hours on the Internet, much of that time on pornography websites. Mark was assigned to an assertive community treatment (ACT) team, but he feels that they care very little about his life and situation. Mark's case worker sees him once a week but only asks about the medications. That does little to promote Mark's well-being.
The psychiatrist told Mark on many occasions that he was a tremendous success since his psychotic symptoms have all but resolved. Mark felt awful and wanted to see if he could potentially get off his medications and return to university. His parents were unwilling to entertain the notion of Mark's discontinuing medication. They told him that he would need to remain on medication while living in the family home.
Mark and Mary's stories are similar in that both individuals found it progressively more difficult to moderate their stress levels amidst the storms of their lives. Both individuals succumbed to the effects of chronic stress, which has been defined as "ongoing demands that threaten to exceed the resources of an individual in areas of life such as family, marriage, parenting, work, health, housing, and finances."1 When an individual is faced with chronic stress, it may seem enduring and without a clear ending. Somehow while unwell, the mentally ill individual has to manage his/her stress levels while moderating its problematic effects. The term allostasis, coined by Sterling and Eyer, defined as achieving "stability through change," was constructed to describe a process in which an individual adjusts to life's stresses over time.2 While the specifics of these stabilizing adjustments (i.e., adaptive responses) are beyond the scope of this article, adaptation through change demands the synchronous activation of neural, neuroendocrine, and neuroendocrine-immune mechanisms.3
Mark and Mary experienced the effects of allosteric overload, which led to signs and symptoms of mental distress and/or physical dis-ease (denoting an imbalanced or disrupted physical state). This results when an allosteric system fails to habituate to the recurrence of the same stressor, fails to shut off following overwhelming stress, and/or whose response is deficient resulting in heightened activation of other, normal counter-regulatory systems.3,4 Unmitigated chronic stress because of allosteric overload will typically cause psychological and physiological dysregulation, especially in people who are vulnerable to mental illness.
This article will focus on the psychological domain of chronic stress as resulting from allosteric overload, how it manifests, what factors exacerbate it, and how it can be managed effectively. Chronic stress is a systemic problem. Prolonged distress can damage the body and "mind," strain patients' adaptive capabilities, disrupt neurotransmitters, and deplete essential nutrients such as energy and enzyme cofactors. Vulnerable individuals can destabilize until they experience or relapse into episodes of mental illness.
Manifestations and Triggers of Mental Breakdown
1. Mental Distress Signals of Inadequate Allostasis
All individuals differ in their abilities to achieve adequate or productive allostasis when faced with an overload of life stresses. It is obvious that Mark and Mary displayed different observable signals of mental distress. Mary presented with constant worrying, insomnia, and depression, while Mark's signals of mental distress involved cannabis addiction, paranoia, and bizarre behavior. Though I have not statistically analyzed the different types of mental distress signals that my patients have displayed over the past 16 years, the most common ones that I've observed are listed in Table 1 in no particular order.
Table 1: Mental Distress Signals of Inadequate Allostasis
Anxiety, persistent or intense episodic
Depression
Despair
Helplessness
Insomnia
Lack of optimism (absence of a positive outlook)
Anger
Denial
Guilt
Hostility
Hyperactivity
Isolation
Restlessness
Shame
Addictive behaviors (e.g., using cannabis and alcohol) to anesthetize feelings
Inability to delay gratification
Not eating, undereating, or overeating
Habitual cutting or the desire to harm oneself
Suicidal thoughts
Homicidal thoughts
Delusions
Dissociation
Depersonalization
Grandiosity
Hallucinations
Hyperreligiosity or bizarre religious beliefs
Mania
Obsessions
Paranoia
Persecutory thoughts
Page 1, 2, 3, 4, 5, 6
|
