At this time, about 63% of Americans are part of the labor force.  Many employers offer programs designed to promote wellness and connect individuals with treatment options.  In addition, they promote the ability to handle and reduce stress. 
 
The CDC (Centers for Disease Control) reports that 1 in 5 adults (18 and older) reported suffering from mental illness in 2016.  Additionally, 71% reported headaches, feelings of being overwhelmed, or anxiety, all overt symptoms of stress. 
 
Mental health disorders are also closely linked to other physical conditions like heart disease, diabetes, and muscular problems.  Treating the physical and mental disorders separately will cost two to three times more than treating those without combination issues.  By combining the treatment plans, the savings could amount to $37 billion to $67 billion each year.  This means employers can reduce health care costs across the board and have healthier employees.
 
Further, the CDC says that employees with a high risk of depression had the highest health cost during a three year period following the initial assessment.  This includes others at risk from smoking and obesity.  Depression will affect performance at least 20% and affects cognitive abilities about 35%.  However, of those who report moderate depression only 57% receive treatment and for those with severe depression only 40%.
 
Excess stress and other mental health issues translates to negatively affecting:

• Job performance
• Productivity
• Interactions with other employees
• Communication
• Physical issues
• Functionality

 
Especially when mental and physical treatment plans are combined, employer sponsored wellness programs have proven beneficial to both the company and the employees.  Through a combined plan:

• Communications can be combined using the structures already in place
• Social networks become available
• Programs and policies are united
• Offering incentives for healthy behaviors
• Employers can track progress

 
As an employer you have some options.

• Offer self-assessment mental health tools
• Establish clinical screenings by qualified mental health professionals with clinical referrals as appropriate.  These can be free to the employee or offered at a reduced cost.
• Reduce co pays on depression medications
• Programs for lifestyle changes
• Host in-office programs to discuss stress reduction techniques
  • Breathing exercises
  • Meditation
  • Mindfulness
  • Focus improvement
• Treat disrespectful comments or actions as you would any other form of prejudice or discrimination
• Provide managers and supervisors with the tools to identify signs of stress and depression
• Give employees the opportunity to voice opinions

 
There are a number of insurers who provide plans to help implement a mental health program.  This can include videos, emails, education and other initiatives to help management and employees deal with the issues in the workplace.

​The CDC (Centers for Disease Control) estimates that 20% of adults over the age of 55 will experience some form of mental health disorder.  This can include some sort of cognitive issue (forgetfulness all the way to some degree of dementia), mood swings (generally depression), and anxiety. 
 
With depression as the most common form of mental disorder in seniors, it can affect social interactions and impair the ongoing treatment of other chronic conditions.  It is often dismissed as a normal part of aging or under treated. 
 
In reality, depression or other mental illnesses are not a normal part of the aging process.  Left untreated, it will affect the person's ability to function, lead to a poorer quality of life, and can actually slow the healing from physical illnesses and surgeries.
 
Mental health can easily decline after a serious illness like stroke or chronic conditions like Parkinson’s, arthritis, or cancer.  Medication can often play a part with drug interactions between prescriptions that are overlooked.  Older adults have needs that change including loss of friendships, relocating to other parts of the country, and changes in living conditions.  All of this needs to be considered during the treatment of mental health issues.
 
The good news is that older adults can be helped with the same success as those who are younger.  With some psychotherapy and anti-depressant medication, it is reported that 80% will recover.
 
Some symptoms you may want to watch for include:

• Sadness that persists.  If the person remains depressed longer than two weeks, keep tabs to see if it is improving.  If not, consider help with a mental health professional.
• Consistent sleep issues
• Trouble concentrating
• Everyone forgets things.  However if it becomes consistent, occurs more frequently, or in familiar surroundings, start paying closer attention.
• Over use of alcohol
• Confusion with the medication regimen

If these indicators accumulate or become more serious, it is a sign that the individual may need some professional help.
 
Many older adults continue to thrive even on their own.  Some habits that seem to help are:

• Exercising to the best of their physical ability.  This can include gardening in raised beds, walking, dancing, etc.
• Reading.  Joining with others to discuss books is a good way to stimulate mental agility.  Reading as a group event allows for socializing and forces people to read something they would not normally pick up.  There are a number of websites that offer discussion questions.  Check with your local public library for suggestions.

 
The health system in the United States offers Medicare that covers 80% of a physical health issue but only 50% for a mental health condition.  Fear of overspending can often impact an older adult's reluctance to seek mental health assistance.  Studies have shown that over 60% of older adults with a mental health issue will not receive the help necessary to bring them back to a stable head space.

A psychiatrist is a medical doctor (M.D.) who becomes specialized to effectively treat mental health issues. If you're wondering how to become a psychiatrist, there are a few vital steps to take.

Psychiatrists diagnose, treat, and help prevent emotional and behavioral disorders. To do this they will use a number of techniques or methods including therapy, interventions, and medication.
​

​To achieve a career as a psychiatrist, you must first have a bachelor’s degree from an accredited institution. These degrees are often in the pre-med area, psychology, sciences, or a combination.  The degree does not have to be science related though.  Any degree with the appropriate pre-requisites will suffice.  Academic advisors can help develop a program of classes to keep you on track.

Psychiatrists are medical doctors, so it is necessary to start with the MCAT (medical college admissions test), get admitted to a MD or DO Program.  After graduating medical school (4 years), begins years of clinical residency.  For psychiatry, the standard general residency is four years.  Many psychiatrists will work additional years to sub-specialize.  

In order to practice any type of medicine, physicians must be licensed in the state(s) in which they will work.  This includes psychiatrists.  This license must be maintained in good standing which will include continuing medical education credits and renewal.

While in college and during residency, the individual usually settles on a specialty in which he or she wishes to practice.  The classes and clinical work should focus on those areas.  The choices include:

• Behavioral Science – This focuses on human behavior involving emotions, personality, and social actions.  It involves biochemical, pharmacological, and physiological personality actions and traits.
• Cognitive, Affective, and Behavioral Neuroscience – This deals with neurological components that explain how people think, remember, make decisions, and deal with emotions.
• Psychopathology – This deals with serious disorders and how they can be treated.  It also explores the legal and ethical elements of the treatments.  Frequently it delves into multicultural influences

Psychiatrists work with patients either in private practice, in a hospital, or other institutional setting.  Away from the patient, they review and record notes and assure that treatment protocols are being followed.  They may meet with patients' families, support groups, or other interested parties.

Specialization can involve illnesses like anxiety or sociopathy, or with a demographic element like children, older adults, or veterans.  In some cases the working hours are very regular, but it is not unusual for psychiatrists to work extended hours in some settings.
  
There are a number of historical issues that influence the treatment and those who are seeking help.  Psychiatrists help dispel myths and stigmas and promote healthy mental and physical outlooks for their patients.

The psychiatrist will also need to understand the brain and how it works.  People perceive and process information in different ways and the interrelationship of the nervous system and behavior becomes critical in many cases.

Communication skills are particularly important in psychiatry.  How someone explains their symptoms and digging out the details can make a big difference when it comes to making the correct diagnosis.  Better care is often provided after a thorough evaluation.

Stress is an emotional strain that comes as a result of difficult or adverse circumstances.  It is an emotional response to external factors but can have physical symptoms as well.  Some of the physical issues are:

• Digestive problems
• Reproductive issues
• Muscle tension
• Headaches
• Fatigue
• High blood pressure
• Chest Pain

 
Mental health issues include:

• Anxiety
• Irritability
• Depression
• Anger
• Feeling overwhelmed
• Racing thoughts
• Worry
• Making bad decisions

 
Situations that cause us concern are called stressors.  Stressors can be negative like relationship issues or financial problems.  Stressors are also internal like pessimism about life, worrying about something that may or may not happen or self perception.
 
Stress is basically our perception of something difficult to deal with.  Stressors are somewhat individualized in that what may bother one person has no affect on another.  Strict deadlines may have you in a tizzy but  your coworker thrives in that atmosphere.  Common external stressors are:

• Major life changes (good or bad)
• Work or school
• Relationships
• Finances
• Overworked
• Commitments including family

 
Internal issues include:

• Lack of flexibility
• Pessimism
• Negative self image
• Unrealistic expectations

 
There are some indicators to show that you are having difficulty dealing with stress:

• Work or school performance drop
• “Self medicating” with alcohol, drugs, or tobacco or an increased use of any of them
• Difficulty dealing with daily situations
• Withdrawal from friends, family, or social situations
• Sudden irrational outbursts
• Taking dangerous chances
• Thinking of hurting yourself or others

 
There are definitely some ways you can learn to adapt or handle the stress in your life:

• Activity – Regular exercise can make you feel better.  Rhythmic pursuits like walking, dancing, and swimming are some of the best choices, especially if you try to focus on the sensations around you.  Park further from the entrance and enjoy a brisk walk into the building.  Turn on your favorite tunes and dance around the home.  Greet people you see along the way.  When you go out for a smoke break, just once per day, walk around the building instead.
• Interactions – Instead of texting, look up and speak to someone.  If your friends make you more anxious or worried, spend less time with them.  If you are trying to build some friendships, there are many free activities.  Try your local library movie night and join in the discussions afterward.
• Healthy eating – A diet of processed and convenience food, sugary snacks, and refined carbohydrates will only worsen the situation.  Eating good, lean protein, fruits, vegetables, reducing caffeine and sugar and drinking enough water every day will help you feel physically better and then more capable of handling the challenges that come your way.

 

In the clinical world of mental health, a sociopath and a psychopath are each classified as someone with antisocial personality disorder (ASPD).  These are individuals who cannot understand others' feelings.  In general, they have no guilt for doing harm.  They may be charming.  The terms sociopath and psychopath are often debated in academic circles, and many consider them to be the same thing.  Others apply small differences to the conditions.  
 
Shared behavior between sociopaths and psychopaths are:

• Disregard for laws
• Disregard for social rules or patterns
• Disregard for the rights of others
• No remorse
• No guilt
• Aggressive or even violent behaviors

 
Being selfish, acting out, or acting rebelliously are not, in themselves, cause for a diagnosis of ASPD.  However, if the symptoms are ongoing and are not altered by punishment or changes in lifestyle, the outcome is often different.  People with ASPD rarely if ever feel bad about what they are doing or how they are treating others. 
 
Sociopaths are generally nervous and can burst into anger easily.  They have few acquaintances and probably few to no friendships because they have difficulty maintaining relationships.  As a rule, they are less educated and frequently live on the fringes of society.  Crimes they commit are generally spontaneous. 
 
Psychopaths are very charming people and find it easy to manipulate others.  Because they are so charismatic, they seem disarming.  They are usually well educated and hold steady jobs.  While they do not form relationships, they learn how to imitate emotions.  They appear normal.  For this reason it can be difficult for a victim to realize they have been targeted.  Their crimes are very well planned and executed and plan for contingencies.
 
Psychiatric diagnoses usually center on the “nature versus nurture” theory.  Psychopaths are genetically predisposed to their behavior, while sociopaths are developed from childhood trauma or abuse.
 
To be diagnosed with ASPD, an individual over 18 must clearly demonstrate at least three of the following behaviors. 

• Clear disrespect for social norms and laws.
• Lies, uses false identities, and uses others for personal gain.
• Avoids long-term plans; ignores consequences.
• Aggressive behavior like frequent fights.
• Ignores personal safety or that of others.
• Ignores personal responsibilities like work habits or paying bills
• Has no guilt or remorse for actions.

 
Other indicators can be:

• Not learning from mistakes
• Threats and intimidation
• Frequent crimes
• Unwarranted risks
• Substance addiction
• Inability to maintain relationships
• For individuals younger than 15, animal abuse or cruelty

 
Both psychopaths and sociopaths are a risk to society and a danger to others in many cases.  Violence is not a required element for a diagnosis of ASPD but it is often found as a trait in those who have been so diagnosed.  Because of their ability to dissociate from others and lack of remorse, psychopaths are typically the more dangerous of the two.  Many convicted serial killers have been diagnosed as psychopaths.
 
Not everyone who has an antisocial personality disorder is a psychopath or a sociopath.  It is estimated that as much as 3% of the population has ASPD.  It is more common in males, those with substance abuse, and in prisons.

A psychiatrist is a physician, medical doctor, that specializes in patients with temporary or chronic mental health issues.  They provide the best treatment options and care with compassion and patience.  A psychiatrist may prescribe medication (unlike a psychologist) when counseling and therapy have been ineffective or as a temporary measure until the patient is stable.  Psychiatry deals with mental disorders that originate in the brain, but they do not treat organic disorders like stroke, tumors, or epilepsy.  Sometimes behavioral issues appear that have an organic origin and a psychiatrist will be able to diagnose the difference.
 
In psychiatry the treatment options can vary depending on the success of the psychotherapy and medications.  It can also depend on the amount of social and emotional support received from friends and family members.  With progress, the medication can be reduced and therapy sessions adjusted.  If relapse occurs, it may be necessary to move to new treatment options or to resume some of the therapy sessions.
 
In addition to basic psychology, the psychiatrist must understand the medications available, as well as side effects and reliance on those drugs.  Many conditions can be treated without medication interventions.
 
Some mental illnesses or conditions are mild or temporary; some are severe and chronic.  Depression is one of those conditions that may run the gamut of severity.  Finding the cause of an illness can be critical to therapy.  For example, mild depression many be the result of a recent tragic event, like the death of a spouse and can be handled with appropriate psychological techniques.  Anxiety frequently involves a phobia (fear) in certain situations and can greatly affect a person's ability to act, such as a fear of flying can affect that person's career.  This is generally handled through psychological counseling and occasionally with medication depending on the degree of fear and the cause.
 
More severe cases are those people who suffer from hallucinations, delusions, and schizophrenia.  Through medications and treatment options many of these patients are able to function in normal situations.  Much of the result depends on accurate diagnosis and therapy to allow the individual to cope with the disorder.
 
Other disorders treated by psychiatrists are:

• Bipolar
• Trauma related conditions
• Eating disorders
• Obsessive-compulsive
• Sleep disorder
• Substance abuse
• Other personality disorders

 
It may take more than a single visit to diagnose the condition or disorder.  After that time, a plan of treatment is initiated.
 
Mental health issues have a wide range of causes and severity.  It is not always necessary to see a psychiatrist.  Sometimes the issues can be resolved through group discussion and therapy or other counseling.
 
Basically, a psychiatrist will assess mental and physical symptoms and help develop a plan for the treatment and recovery.  They can:

• Provide urgent care for sudden onset
• Help manage long-term illnesses
• Advise on lifestyle
• Work with you individually, as a group, or with others
• Provide second opinions
• Refer to other health care providers
• Admit someone to in-patient care

 

Mental health issues effect each one of us, every day.  Simple anxiety can escalate and systemic problems like schizophrenia are real illnesses just like a broken bone or cancer. 
 
By becoming aware of mental health issues you can develop a knowledge of the various factors involved in taking care of one's mental health.  Unfortunately there is still a significant stigma attached to mental health issues and diseases.  Awareness campaigns focus on productive discussions and acceptance of the reality of mental illnesses and how we can raise awareness and support those suffering from them.
 
There are a number of ways to get involved in mental health awareness:

• Discuss mental health openly-  Sharing information on social media or through conversations is important. Just be sure the information you are sharing is based on real medical evidence and not common myths or stereotypes. 
• Tools – There are other online blogs, screening tools, and telehealth services that offer anonymity and help others recognize symptoms as needing treatment.  Speaking about it at other wellness-oriented facilities like gyms could provide someone the impetus needed to get help.  Libraries or other public forums offer information about how to access resources in the community.
• Support Advocacy – MHA and NAMI offer help lines and support for mental health issues. Through financial and volunteer efforts you can support these and other programs.  Encourage others to do the same.  Use social media like Facebook and LinkedIn to make others aware of the availability of help and to encourage mental health awareness.
• Be a Friend – If possible, support any of your friends and acquaintances who you believe are having difficulty with mental health issues.  This includes those who are grieving, lonely or feeling lost.  Sometimes a friendly ear is all that is necessary.  Hearing others speak honestly about their problems can help them feel heard and respected.
• Self Care – Take care of your own mental health.  Talk to your psychiatrist or counselor and read about new techniques and programs.  Practice wellness and participate in programs.  Take your mental health as seriously as you do your physical well being.
• Legislative – In Congress there are pending changes to Medicaid and behavioral health funding.  Protecting funding and support for these issues is critical to continued services for many thousands of Americans.  Contact your legislative representatives and let them know how you feel about this problem and how their actions can help reduce the number of people suffering.

 
May is mental health month.  Celebrate it by spreading the word about the services available and how good mental health is important.  Don't restrict your work to a single month.  Continue the fight throughout the year to help others in need.
 

Stress is all around us.  It is at work, at home, socially, and many other places.  Managing the stress is difficult but in order for you to continue to perform at your best, there are ways to cope.
 
Problem and Emotion
There are two primary coping skills, problem-based and emotion-based.  Problem-based is situational like when you need to end a relationship or change jobs or deal with household repairs.  Emotion-based is when you need to deal with your feelings.  A good example is the loss of a loved one.  You cannot change the situation, you need to find ways to process your own emotions.
 
Sometimes you need both skills.  If so, talk to your counselor about which may be best targeted first.  For example, if you are upset about a bad performance review, it would be best to not speak until you have had time to calm down and process the information.  If the review was accurate, how can you change your behavior or skills to improve.
 
Skills
Some coping techniques can include:

• Asking for help from a friend or professional.  For a career-oriented stressor, there are employment counselors at community colleges or major universities.  For serious safety issues there are women's shelters.  Religious organizations offer volunteers to advise or suggest options.
• List.  Create a list of tasks that can help.  Then review the list to see which are doable and prioritize your actions.  Then work the plan.
• Boundaries.  If someone makes you feel inferior, limit your time with them.  See them in social situations where you can move around, if at all possible.
• Time management.  Not every call or email requires an immediate response.  Group return calls to use your time more effectively.  For children, except for emergency situations, give them specific times twice a day (like 10 a.m. and 2 p.m.) when they can call and make it a coordinated call.  Each child will get a chance to speak and offer their side of the situation or make a request.

 
What to Avoid
There are a number of strategies that have gained popularity but may actually be detrimental to your health and should be avoided:

• Alcohol and Drugs – Substances won't resolve your issues; they only mask the problems for a period of time.  In fact “self medicating” may actually create worse or larger problems.
• Stress Eating – Over eating or too much unhealthy food can lead to disorders.  The same is true with restricting or failing to eat. 
• Over Sleeping – This is another temporary escape if you sleep too much.  A solid 7 to 9 hours a night is appropriate.
• Retail Therapy – Shopping is another gateway resolution that can backfire and leave you in a worse position.

 
Most of these suggestions are reactions.  You should also develop some proactive strategies.  An example with weight loss when you have an upcoming holiday is that you need to decide how you will avoid overeating.  The bottom line is to find what works for you.  A counselor or therapist can help significantly.

Impulse control disorders (ICD) refer to the conditions characterized by difficulty in controlling emotions and behaviors. The behavior of the patient often violates the rights of others and results in conflict with the law and societal norms.
The common forms of impulse control disorders include oppositional defiant disorders, conduct disorders, kleptomania, pyromania, and intermittent explosive disorders. These disorders tend to coexist in patients with alcoholism or addiction to recreational drugs. [1]
Also, men are slightly more prone to develop impulse control disorders than women. Here is a brief discussion about the common signs and symptoms of impulse control disorders.
​
Core Symptoms of impulse control disorders
The extent to which impulse control disorders share genetic, clinical, biological, and phenomenological features is not fully understood. Yet, several ICDs share a few core qualities as given below:

• Diminished or complete lack of control over problematic behaviors
• An insatiable craving or appetitive urge prior to the engagement in problematic behaviors
• Repetitive engagement in violent or aggressive behaviors in spite of adverse consequences
• A hedonic feeling or quality experienced while performing problematic behaviors

These features of impulse control behaviors have led to a description of these conditions being behavioral addictions.
These disorders appear to have clinical overlap with compulsive behaviors and possess the domain of impulsivity and compulsivity. However, compulsivity and impulsivity usually occur simultaneously or at different times, thereby complicating our understanding of their behaviors.

What are the common signs and symptoms of impulse control disorders?
The symptoms vary depending on the specific form of impulse control disorder a patient has. They may also show varying sets of symptoms depending on their age, gender, and the environment they are surrounded by. [2]
The symptoms of these conditions can be grouped under different categories such as physical, behavioral, psychosocial, and cognitive as discussed beneath. 
Physical symptoms:

• Burn marks on patients who engage in fire-starting tendencies
• Presence of multiple scars and injuries from engaging in violence or physical fights or due to the episodes of aggressive actions
• History of sexually-transmitted diseases resulting from risky sexual behaviors

Behavioral symptoms:

• Compulsive lying
• Tendency for stealing
• Participating in risky actions including sexual behaviors
• Starting fires
• Acting violently or aggressively against people including family members, animals, property, and objects

Psychosocial symptoms:

• Agitation
• Irritability
• Anxiety
• Depression
• Isolating oneself from family and friends
• A feeling of low self-worth
• Frequent episodes of emotional detachment

Cognitive symptoms:

• Acting on impulse
• Lack of logical thinking behind actions and behaviors
• Inability to remain calm and patient
• Obsessive thinking
• Compulsive thought pattern

These symptoms of impulse control disorders are more intense in patients with alcohol addiction. However, it has been found that proper treatment of ICDs together with counseling can help to control the aggressive and impulsive behaviors to a great extent. [3] [4]

Conclusion
Being aware of the symptoms of impulse control disorders can enable patients to seek appropriate medical intervention and prevent the harmful consequences related to the same. Find a psychiatrist near you for help. 
References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822522/
2. https://www.resourcetreatmentcenter.com/behavioral/impulse-control/symptoms-effects/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895996/o
4. https://americanaddictioncenters.org/co-occurring-disorders/impulse-control-disorder

Are you new to therapy or want to look into different types of treatment for your recovery? You may have a few questions about the first steps to take? One of them may be about the mental health evaluation, which is a common, yet misunderstood initial step.
 
Yes, it can sound a bit intimidating, but this is a simple way for a psychologist, psychiatrist,  or other healthcare provider to know more about what you are currently going through. So read on to learn more about the mental health evaluation so you know what to expect!

A mental health evaluation is like a psychological assessment. A medical professional, such as a psychologist, psychiatrist, or even family doctor, will perform the assessment. 
​
The evaluation could involve various components, including:
 
            •           Verbally answering questions
            •           Taking a physical test
            •           Completing  questionnaires
 
This is the first step and initial line of defense when looking for treatment for mental illnesses.  Other evaluation tools may also help professionals gain insight into one's personality.
 
No medical health professional will ever judge you for the results. They plan to work with you to help you understand and manage the symptoms that impact your life.
 
It may be a bit more comforting if you think of it as taking a medical test for a physical illness.  Let’s say, you suffer from physical symptoms. A doctor would order blood tests or X-rays to understand what causes your symptoms and develop a treatment plan for it.
 
Mental health evaluations do the same thing, with mental health professionals utilizing tools and tests to measure and observe behavior. Once they have the results, they will diagnose you and find appropriate treatments accordingly to the specific issues you have.

Mental health evaluations may have different components, such as behavioral observations, checklists, formal questionnaires, interviews, surveys, and more. The depth of the mental health evaluation will depend on the patient and what has to be assessed.
 
Usually, these evaluations take between 20-90 minutes, depending on why you are being evaluated. They can be done in-person or virtually, depending on your situation. Mental health evaluations online are becoming more common. 

​To help you get a gist of what to expect from mental health evaluations, here are the different types:
 
       •          Physical exams are done to help determine if you have a physical disorder or neurological issue
       •         Lab tests may be done, such as blood work or a urine test to, again, rule out physical disorders. You might also be asked about medicine, drug, and alcohol use to confirm that the symptoms you experience aren’t side effects
       •       The medical health professional will ask about your mental health history and personal history. They’ll ask how long you’ve been experiencing such symptoms, the medical history of mental health, psychiatric treatments received, as well as personal history and traumas
          •           Mental evaluations will discuss your symptoms in more detail, focusing on your behaviors, feelings, and thoughts. Your healthcare provider will observe how you appear and behave as he/she asks you questions to get more detail
       •       The cognitive evaluation is different from the mental evaluation, with your healthcare provider gauging your ability to recall information, use sound reasoning, and to think clearly. 
         •        Self-evaluations or self-assessments are done to get to know your thoughts, emotions, among other symptoms before getting support. This will help figure out what therapy you need as well as a preferred communication style.

Mental health evaluations are crucial to help determine what diagnosis you may have and what you need to treat your symptoms. Just make sure that a licensed professional will administer the assessments to get an accurate response and positive result.
 
If you would like to receive a mental health evaluation, do reach out to our office to find out more