Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Major depression (or
major depressive disorder) is manifested by a combination of symptoms (see symptoms list below) that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A major depressive episode may occur only once; but more commonly, several episodes may occur in a lifetime. Chronic major depression may require a person to continue treatment indefinitely.
A less severe type of depression, dysthymia (or dysthymic disorder), involves long lasting, chronic symptoms that do not seriously disable, but keep one from functioning well or feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.
Another type of depressive illness is bipolar disorder (or manic depressive illness). Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression), often with periods of normal mood in between. Sometimes the mood switches are dramatic and rapid, but usually they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of depression. When in the manic cycle, the individual may be overactive, over talkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees and unsafe sex. Mania, left untreated, may worsen to a psychotic state.
Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.
In the 1950s and '60s, depression was divided into two types, endogenous
and neurotic. Endogenous means that the depression comes from within the body,
perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive
depression has a clear environmental precipitating factor, such as the death of
a spouse, or other significant loss, such as the loss of a job. In the 1970s and
'80s, the focus of attention shifted from the cause of depression to its effects
on the afflicted people. That is to say, whatever the cause in a particular
case, what are the symptoms and impaired functions that experts can agree make
up a depressive disorder? Although there is some argument even today (as in all
branches of medicines), most experts agree on the following:
A depressive disorder is a syndrome (group of symptoms) that reflects a
sad and/or irritable mood exceeding normal sadness or grief. More specifically, the sadness of
depression is characterized by a greater intensity and duration and by more
severe symptoms and functional disabilities than is normal.
Depressive signs and symptoms are characterized not only by negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). The functional changes of clinical depression are often called neurovegetative signs. This means that the nervous system changes in the brain cause many physical symptoms that result in diminished participation and a decreased or increased activity level.
Certain people with depressive disorder, especially bipolar depression
(manic depression),
seem to have an inherited vulnerability to this condition.
Depressive disorders are a huge public-health problem, due to its affecting millions of people. About 10% of adults, up to 8% of teens and 2% of preteen children experience some kind of depressive disorder.
The statistics on the costs due to depression in the United States include huge amounts of direct costs, which are for treatment, and indirect costs, such as lost productivity and absenteeism from work or school.
Adolescents who suffer from depression are at risk for developing and maintaining obesity.
In a major medical study, depression caused significant problems in the
functioning of those affected more often than did arthritis, hypertension,
chronic lung disease, and diabetes, and in
some ways as often
as coronary artery disease.
Depression can increase the risks for developing coronary artery disease,
HIV, asthma, and many other medical illnesses. Other complications of depression include its tendency to increase the morbidity (illness/negative health effects) and mortality (death) from these and many other medical conditions.
Depression can coexist with virtually every other mental health illness,
aggravating the status of those who suffer the combination of both
depression and the other mental illness.
Depression in the elderly tends to be chronic, has a low rate of recovery, and is often undertreated.
This is of particular concern given that elderly men, particularly elderly white
men have the highest suicide rate.
Depression is usually first identified in a primary-care setting, not in a
mental-health practitioner's office. Moreover, it often assumes various
disguises, which causes depression to be frequently underdiagnosed.
In spite of clear research evidence and clinical guidelines regarding
therapy, depression is often undertreated. Hopefully, this situation can change
for the better.
For full recovery from a mood disorder, regardless of whether there is a
precipitating factor or it seems to come out of the blue, treatment with
medication and/or electroconvulsive therapy (ECT) (see discussion below) and
psychotherapy are necessary.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizzyness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
HIV (human immunodeficiency virus) is the cause of AIDS (acquired immunodeficiency syndrome). HIV is a type of virus called a retrovirus, which infects humans when it comes in contact with a break in the skin or tissues such as those that line the vagina, anal area, mouth, or eyes.
Lyme disease is a bacterial illness, which is spread by ticks when they bite the skin. Initially the disease affects the skin causing a reddish rash associated with flu-like symptoms. It takes weeks to months after the initial redness of the skin for its effects to spread throughout the body. Lyme disease can be treated with antibiotics. Lyme disease can be prevented by using tick avoidance techniques.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Anorexia is an eating disorder characterized by markedly reduced appetite or total aversion to food. Anorexia is a serious psychological disorder and is a condition that goes well beyond out-of-control dieting. With anorexia, the drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. There are psychological and behavioral symptoms as well as physical symptoms of anorexia including: depression, social withdrawal, fatigue, food obsession, heart and gastrointestinal complications, kidney function, flaky skin, brittle nails, and tooth loss (this list is not exhaustive).
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Schizophrenia is a disabling brain disorder that may cause hallucinations and delusions and affect a person's ability to communicate and pay attention. Symptoms of psychosis appear in men in their late teens and early 20s and in women in their mid-20s to early 30s. With treatment involving the use of antipsychotic medications and psychosocial treatment, schizophrenia patients can lead rewarding and meaningful lives.
Impotence, also known as erectile dysfunction, is a common
problem among men characterized by the consistent inability to sustain an
erection sufficient for sexual intercourse or the inability to achieve
ejaculation, or both. Impotence can have emotional causes but most often it is
due to a physical problem.
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Borderline personality disorder is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with borderline personality disorder (BPD) suffer from a disorder of emotion regulation.
Dissociative identity disorder (formerly known as multiple personality disorder or split personality disorder) is a mental illness in which a person has at least two distinct personalities. Symptoms and signs include lapses in memory, feeling unreal, blackouts in time, hearing voices in their head that are not their own, not recognizing themselves in the mirror, and finding items in one's possession but not recalling how they were acquired. Treatment usually involves psychotherapy, medications, and sometimes hypnosis.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
Huntington's disease is the result of degeneration of neurons in areas of the brain. Huntington's disease is an inherited disorder. Early symptoms include mood swings, apathy, depression, and anger uncharacteristic of the individual. Judgement, memory, and other cognitive functions may become impaired. Presymptomatic testing is available for individuals who have a family history of Huntington's disease. Treatment includes medication and therapy for symptoms.
Chronic fatigue syndrome is a debilitating and complex disorder characterized by profound fatigue that lasts 6 months or longer, is not improved by bed rest, and may be worsened by physical or mental activity.
Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Obsessive compulsive disorder (OCD) is an anxiety disorder that causes a person to suffer repeated obsessions and compulsions. Symptoms include irresistible impulses despite a person's realization that the thoughts are irrational, excessive hand washing, skin picking, lock checking, or repeatedly rearranging items. People with OCD are more likely to develop trichotillomania, muscle or vocal tics, or an eating disorder. Treatment for OCD includes psychotherapy, behavioral therapy, and medication.
Antisocial personality disorder (ASPD) has many symptoms, signs, and causes. Therapy is one treatment option for antisocial personality disorder. It is closely related to other personality disorders (PD), such as borderline personality disorder and narcissistic personality disorder.
Grief is the feeling one experiences after a loss (of a friendship, death of loved one, job). Complicated grief refers to grief that lasts for more than a year. Mourning describes the customs and rituals that help a bereaved individual make sense of their loss.
ADHD afflicts approximately 3 percent to 5 percent of school-age children and an estimated 60 percent of those maintain the disorder into adulthood. Symptoms of adult ADHD include chronic lateness, anxiety, low self esteem, employment problems, difficulty controlling anger, impulsiveness, poor organization skills, procrastination, chronic boredom among others.
Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder characterized by the symptoms hyperactivity, impulsivity, and inattention. Treatment for ADHD may involve behavioral therapy and psychostimulant or antidepressant medication.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Psychotic disorders are a group of serious illnesses that affect the mind. Different types of psychotic disorders include schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, shared psychotic disorder, delusional disorder, substance-induced psychotic disorder, paraphrenia, and psychotic disorders due to medical conditions.
Seasonal affective disorder is a type of depression that tends to occur as the days grow shorter in the fall and winter. Symptoms of seasonal affective disorder include tiredness, fatigue, depression, irritability, body aches, poor sleep and overeating.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Asperger disorder is characterized as one of the autism spectrum disorders.
People with Asperger syndrome have normal to above-average intelligence but
typically have difficulties with social interactions and often have pervasive,
absorbing interests in special topics.
Abnormalities in the subtle use of language and interpretation of language
are common with Asperger syndrome, although language development (grammar,
syntax, etc.) is normal.
The degree of severity of symptoms can vary among affected individuals.
Anxiety and frustration may contribute to disruptive behaviors or
depression in people with Asperger syndrome.
Successful treatment generally involves one or multiple social, behavioral,
and/or educational interventions.
The personality and cognitive traits common to those with Asperger syndrome
are seen as beneficial by many, and many people ...
Major depression (or
major depressive disorder) is manifested by a combination of symptoms (see symptoms list below) that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. A major depressive episode may occur only once; but more commonly, several episodes may occur in a lifetime. Chronic major depression may require a person to continue treatment indefinitely.
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