Abdominal Breathing

Your breathing directly reflects the level of tension you carry in your body. Under tension, your breathing usually becomes shallow and rapid, and occurs high in the chest. When relaxed, you breathe more fully, more deeply, and from your abdomen. It’s difficult to be tense and to breathe from your abdomen at the same time.

Some of the benefits of abdominal breathing include: • Increased oxygen supply to the brain and muscles

• Stimulation of the parasympathetic nervous system - this part of autonomic nervous system (controlling automatic functions like breathing and heart) promotes a state of calmness. It works in a fashion exactly opposite to the sympathetic branch of your nervous system, which stimulates a state of emotional arousal and the very physiological reactions underlying a panic attack. 
• A greater feeling of connectedness between the mind and body. A few minutes of deep abdominal breathing helps to calm thoughts and relaxes your whole body. 
• Lower blood pressure and heart rate, promoting calmness. 
• Improved concentration. If your mind is racing, it is difficult to focus your attention. Abdominal breathing will help you to quiet your mind leaving you open to problem solving and logical thought. 

If you suffer from phobias, panic or anxiety disorders, it is likely that you will have one or two problems with your breathing.

• You breathe too high in your chest or your breathing is shallow. 
• You have a tendency to hyperventilate - breathing out too much carbon dioxide relative to the oxygen you take into your bloodstream. 
• Shallow, chest level breathing, when rapid can lead to hyperventilation, which in turn, can cause symptoms very similar to those associated with panic attacks.

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Progressive Muscle Relaxation

Progressive muscle relaxation is a technique used to teach you how to mitigate anxiety and stress, and to recognise when you tense up. It is essentially the tensing up and relaxation of each major muscle group. Included here are instructions for you to learn how to do progressive muscle relaxation on your own.

• Sit or lie in a comfortable position. Make sure your legs are uncrossed. • Start by becoming aware of your breathing. Breathe calmly and regularly. Concentrate on the word “relax” as you breathe out.
• Breathe right down to the base of your lungs, and then let the air out slowly. • Firstly, tense the muscles of your arms and hands - clench your fists, and then relax. Pay attention to the difference between tension and relaxation. Concentrate on relaxing these muscles. 
• Next, tense the muscles in your shoulders and upper arms. Do this by pushing your shoulders down and clenching your arms to your sides. Once again, concentrate on the tension, relax and feel the difference. 
• Now, tense your neck and back, arching your back and holding the tension. Again, relax and enjoy the feeling of relaxation. 
• Next, tense the muscles in your face, screw your face up and clench your jaw; relax and feel the muscles and lines smooth out. Feel your tongue, eyelids and jaw relax. T
• Tense your chest and stomach. To do this, take a deep breath and harden your stomach muscles. Once again, relax. 
• Finally, tense the muscles in your lower back and hips by arching your back and tensing your buttocks. Hold the tension and feel the relaxation. 
• Let this feeling of relaxation spread through your entire body. Keep your breathing regular and deep.

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Dialectical Behaviour Therapy

Dialectical behaviour therapy (DBT) is a form of therapy related to cognitive behavioural therapy that was originally developed to treat borderline personality disorder. It focuses on helping people control their emotions by recognising and accepting them.

There are three main aspects of dialectical behaviour therapy - cognitive behavioural therapy, validation and dialectics.

The cognitive behavioural aspect helps patients to learn new ways to think, feel and behave. This involves learning how to interact with people in new ways, exposing oneself to negative feelings, thoughts or situations, recognising negative thought patterns and learning how to adapt behaviour in a positive way.

The validation aspect helps patients understand that their feelings are reasonable given the situations they are in. This, alongside a push for change, helps a person feel less invalidated than cognitive behavioural therapy alone would. The dialectics part teaches a person to resolve the difference between selfacceptance and changes in behaviour.

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Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) is a type of psychotherapy that helps a person learn how to challenge unhelpful thinking, habits, feelings and behaviours. The main focus of CBT is how thinking (cognition) affects behaviour (actions).

It is used to treat a wide range of psychological problems, including:

• Anxiety disorders 
• Depression 
• Low self-esteem 
• Anger 
• Irrational fears (phobias) 
• Hypochondria 
• Substance abuse 
• Problem gambling 
• Eating disorders 
• Insomnia 
• Relationship problems 
• Emotional or behavioural problems in children and teenagers

It involves using practical self-help strategies, to bring out positive actions immediately. As a therapeutic method, it requires work on the part of the patient. In CBT this entails recording your thoughts and behaviour and actively challenging whether they are reasonable things to feel negatively about.

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Benzodiazepines

Benzodiazepines are a class of medication used to treat anxiety disorders and sleep disorders in the short term. As a general rule, they are not taken continuously for the long term. Some examples include diazepam and alprazolam.

Side effects of benzodiazepines include:

• Drowsiness 
•  Dizziness 
• Decreased alertness and concentration 
• Depression 
• Disinhibition 
• Impaired motor function 
• Impaired balance 
• Nausea 
• Libido changes 

One of the main problems with benzodiazepine usage is the likelihood of dependence and addiction. Signs of benzodiazepine dependence include:

• Feeling unable to cope without the drug 
• Unsuccessful attempts to cut down on usage 
• Tolerance to the effects of benzodiazepines 
• Withdrawal symptoms such as anxiety, depression, shakiness and headaches when not using the drug

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Antipsychotics

Antipsychotics are medications used in the treatment of schizophrenia and other psychotic disorders. They are also useful in treating psychosis in bipolar disorder and some have mood stabilising effects. They reduce or eliminate psychotic symptoms such as paranoia, confused thinking, delusions and hallucinations.

They work by correcting some chemical imbalances in the brain, such as dopamine. The effects of antipsychotics are generally felt within several weeks of treatment, however it may take longer to feel the full effect.

There are two types of antipsychotics available, typical antipsychotics and atypical (newer) antipsychotics. Atypical antipsychotics have the advantage of fewer side effects.

Side effects of antipsychotics include:

• Drowsiness 
• Weight gain 
• Loss of menstrual periods in women 
• Dizziness 
• Stiffness or trembling in muscles 
• Constipation 
• Sexual problems 
• Fluid retention 
• Dry mouth 
• Headaches Rarely, tardive dyskinesia (involuntary movements of the mouth or face). 

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Mood Stabilisers

 A mood stabiliser is a type of psychiatric medication used to treat disorders characterised by extreme mood swings, such as bipolar disorder. Mood stabilisers are also used for borderline personality disorder and schizoaffective disorder. There are a wide range of mood stabilising medications, from a range of different medication classes.

Some of the most common mood stabilisers are lithium, sodium valproate and lamotrigine. Some mood stabiliser side effects include:

• Nausea, vomiting and diarrhoea 
• Trembling 
• Increased thirst and need to urinate 
• Temporary weight gain 
• Drowsiness 
• A metallic taste in the mouth 
• Problems with kidney and thyroid function 
• Weight gain 
• Drowsiness and low energy 
• Changes in liver function 
• Headaches 
• Confusion 
• Temporary hair loss

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Antidepressants

There is a huge range of antidepressants available, and they are generally used to treat depression, anxiety disorders, schizoaffective disorder and sometimes bipolar depression. They work because people with anxiety and depressive disorders often have an imbalance of chemicals such as serotonin in the brain. They can take up to six weeks for the full effects to be shown. Approximately seventy percent of people feel a reduction in symptoms with the first antidepressant they try.

Some of the possible side effects of antidepressants as a class include:

• Nausea 
• Increased appetite/weight gain 
• Sexual problems including a loss of libido, erectile dysfunction and decreased orgasms 
• Fatigue and drowsiness  Insomnia 
• Dry mouth 
• Blurred vision 
• Constipation 
• Dizziness 
• Agitation 
• Irritability 
• Anxiety

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The Importance of Medication Compliance

It is important to take your medication regularly as prescribed by your doctor. Otherwise you may experience problems such as relapse and withdrawal effects.

There are many reasons why someone may not want to take their medications including but not limited to:

• Forgetting to take medication 
• Feeling that you don't need to take them any more 
• Not believing the medications will work. 

Often, the problem with medication compliance is that you may forget to take your medication regularly. Ways to help you remember your medication include:

• Setting a daily routine, for example, taking your morning dose at breakfast time or before a shower 
• Setting an alarm on your mobile phone or alarm clock 
• Use a daily pill container - this can help you if you are not sure if you have taken the medication 

While you may feel like your mental illness is cured once you are stabilised, unfortunately many illnesses require long-term medication regimes to prevent the symptoms from coming back. With these illnesses, it is especially important not to stop medication cold turkey as this can lead to unpleasant withdrawal symptoms. It is important to discuss any concerns you may have with your psychiatrist before discontinuing any medications.

It is a bad idea to stop medications without the approval of your doctor for a number of reasons. Firstly, you may relapse and experience symptoms of your disorder again. Stopping cold turkey is not advised. When medications such as antidepressants are discontinued abruptly, you may experience symptoms known as 'withdrawal'. These symptoms may include psychiatric symptoms for example mania, psychosis and anxiety and other symptoms, for example spasms, nausea, chills, diarrhoea, or changes in appetite. This is not an exhaustive list of withdrawal symptoms.

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Dementia

Dementia is a progressive condition of cognitive decline that is commonly associated with memory loss, despite the fact that there are other symptoms. The most common cause of dementia is Alzheimer's disease.

Symptoms may vary depending on the cause and area of the brain affected. These symptoms include:

• Memory loss 
• Trouble recalling recent events or remembering people and places 
• Trouble finding the right words 
• Inability to perform tasks such as following a recipe or writing a letter 
• Problems with judgement 
• Mood swings, aggression and agitation 
• Not keeping up with self-care such as grooming or bathing 
• Misplacing things 
• A loss of judgement 
• Personality changes 
• Apathy

As dementia progresses, psychotic symptoms such as hallucinations, paranoia, and abnormal behaviour tend to appear.

While incurable, there are a number of treatments that will treat the symptoms of dementia. These include medications to combat anxiety, depression, agitation, sleep disturbance, aggression and psychosis. Counselling for the patient and family can be helpful as well. Additionally, medications known as acetylcholinestrase inhibitors such as donepezil may allow for minor improvement in dementia, as well as delay the progress a little bit.

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Attention-Deficit Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) is a common disorder characterised by hyperactivity, inattention and impulsivity. Symptoms are generally apparent in early childhood, however a diagnosis may be made later in life. It appears that ADHD has a genetic component.


 ADHD symptoms include but are not limited to:

• Difficulty focusing on one thing 
• Being easily distracted 
• Forgetting things 
• Becoming bored easily 
• Often losing things 
• Daydreaming 
• Difficulty processing information 
• Fidgeting/squirming 
• Talking non-stop 
• Dashing around and playing with everything they see 
• Having trouble sitting still 
• Having difficulty doing quiet activities 
• Impatience 
• Interrupting conversations 

ADHD is usually treated by the prescription of stimulant medications – they work in 70-80% of cases. While the use of stimulants is controversial, as long as the medication is administered responsibly there should be no chance of addiction.

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Schizophrenia and Other Psychotic Disorder

Schizophrenia is a serious mental illness characterised by hallucinations, delusions, disordered thoughts and agitation. It affects about one in every hundred people and occurs in every race, culture and sex. Some people with schizophrenia only have a few episodes of the illness, and others experience it chronically. There is a high suicide rate amongst individuals who suffer from schizophrenia.

There are three types of symptoms associated with schizophrenia - positive symptoms, negative symptoms and cognitive symptoms. These may be accompanied with depressive and other mood symptoms.

Positive symptoms are the most well known symptoms, including hallucinations (voices, seeing things that aren’t there), delusions (paranoia, religious, mind reading, feeling as if thoughts are being inserted into your head), disorganised speech and bizarre behaviour. These are most easily treatable with medications.

Cognitive symptoms include being easily distracted, impaired memory, poor problem solving and decision-making skills, illogical thinking and impaired judgement.

If you have schizophrenia you may have negative symptoms such as having trouble with day-to-day functioning as the illness involves more than psychosis. You may lack motivation to do daily activities such as cooking and bathing. Social events and conversations are difficult for sufferers, as you may not understand that your behaviour is inappropriate.

Psychosis may also accompany certain medical conditions and drug abuse.

Antipsychotics are the first line treatments for schizophrenia. There is a variety of available, such as the typical antipsychotic haloperidol. Also available are atypical antipsychotics such as quetiapine. These medications affect dopamine, a chemical in the brain. These can effectively control your symptoms. It is important to stay on your medications in case of relapses.

Psychological therapy such as cognitive behavioural therapy (CBT) can allow you to combat negative thinking to manage symptoms and gain control over your life. Education about schizophrenia is very important for you and loved ones, so that you can understand more about the disease.

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