Fear and anxiety are very closely related. Per the DSM5 fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. Physical symptoms are also commonly associated including increased heart rate, difficulty breathing, sweating and/or nausea. Anxiety and fear are both states that all people will feel. When fear/anxiety are excessive, persistent and begin to impact functioning is when we can consider labeling it with a specific disorder. In children anxiety can present in many different ways including with increasing episodes of crying, having tantrums, poor sleep or frequent physical complaints (headaches/stomach aches). ( Written by Dr. Parikh, 2021)

Anxiety is a normal emotion to feel when you life is stressful. However, some individuals experience a persistent, ongoing worry that is out of proportion to the stressors that interferes with their day-to-day activities.  These individuals can experiences symptoms including feeling restless, fatigue, irritability, muscle tension, difficulty concentrating and sleep disturbances. 

Anxiety is a normal emotion to feel when your life is stressful. However, some individuals experience a persistent, ongoing worry that is out of proportion to the stressors that interferes with their day-to-day activities.  These individuals can experience symptoms including feeling restless, fatigue, irritability, muscle tension, difficulty concentrating and sleep disturbances. Children with generalized anxiety disorder are frequently over self-critical, avoid activities in which they feel they cannot perform to their standards and can seek frequent reassurance from caregivers/teachers about their performance

Depression is a feeling that most people will have at some point in their lives. Depression is broadly characterized by the DSM5 as the presence of sad, empty or irritable mood. When this change in mood is persistent and leads to impairment that affect an individual’s capacity to function is when we consider labeling it a disorder, with Major Depressive Disorder being the most common.  ( Written by Dr. Parikh, 2021)

• Common symptoms of depression include:
• Diminished interest or pleasure in activities
• Changes in weight (decrease or increase)
• Poor sleep
• Low energy
• Decreased concentration
• Feelings of worthlessness, hopelessness or inappropriate guilt
• Recurrent thoughts of death

Depression is a feeling that most people will have at some point in their lives. Depression is broadly characterized by the DSM5 as the presence of sad, empty or irritable mood. When this change in mood is persistent and leads to impairment that affect an individual’s capacity to function is when we consider labeling it a disorder, with Major Depressive Disorder being the most common.  ( Written by Dr. Parikh, 2021)

• Common symptoms of depression in children and adolescents include:
• Increased irritability and tantrums
• Diminished interest or pleasure in activities
• Declining performance in school (decreased concentration)
• Changes in weight (decrease or increase)
• Poor sleep
• Low energy
• Feelings of worthlessness, hopelessness or inappropriate guilt
• Recurrent thoughts of death

ADHD is a neurodevelopmental disorder that is defined by the DSM5 as impairing levels of inattention, disorganization and/or hyperactivity-impulsivity – that are inconsistent with developmental level or age. The symptoms of ADHD broadly fall into two categories – the hyperactivity/impulsivity and the inattention symptoms. Some children who are diagnosed with ADHD will continue to have symptoms as adults. Hyperactivity symptoms tend to decrease with increasing age. Symptoms commonly include failing to give close attention to details, difficulty sustaining attention, poor organization, losing things, avoids tasks requiring effort, talk excessively and being forgetful in daily activities.  ( Written by Dr. Parikh, 2021)

ADHD is a neurodevelopmental disorder that is defined by the DSM5 as impairing levels of inattention, disorganization and/or hyperactivity-impulsivity – that are inconsistent with developmental level or age. The symptoms of ADHD broadly fall into two categories – the hyperactivity/impulsivity and the inattention symptoms. Symptoms commonly include failing to give close attention to details, difficulty sustaining attention, poor organization, losing things, avoids tasks requiring effort, talk excessively, blurt out answer, difficulty waiting or taking turns, difficulty remaining seated. ( Written by Dr. Parikh, 2021)

Bipolar disorder, as described by the National Institute of Mental Health (NIMH) is “a mental disorder that causes unusual shift in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.” Bipolar disorder is characterized by episodes called mania or hypomania. 

Episodes of mania are characterized by at least 7 days (distinct period) of abnormally elevated mood with decrease in need for sleep with symptoms including inflated self-esteem, more talkative, being easily distracted and excessive involvement in activities that have painful consequences (spending spree, sexual indiscretions). Other people will notice this distinct period and frequently lead to hospitalization. Episodes of hypomania are characterized similar symptoms, however the symptoms do not last as long and are less impairing. 

Bipolar disorder is not having ‘mood swings’ or frequent drastic changes in your mood within one day.

Post traumatic stress disorder or PTSD can occur after an exposure to a traumatic or stressful event. Psychological distress following a traumatic event can be quite variable amongst different people. Some individuals after exposure to such an event will exhibit symptoms including re-experiencing the event, recurrent dreams of the event, increased startle response, avoidance of reminders, inability to remember aspects of the event, exaggerated negative beliefs about oneself, negative emotional state, feeling detached from other, anger outbursts, reckless behavior.

Post traumatic stress disorder or PTSD can occur after an exposure to a traumatic or stressful event. Psychological distress following a traumatic event can be quite variable amongst different people. Some children/adolescents will develop ongoing symptoms including poor sleep, feeling irritable, loss of interest, increased aggression/violence, re-experiencing the event, problems in school, problems focusing, worrying about dying, regression (acting younger than their age) and frequent physical symptoms (I.e. headaches or stomach aches).

Panic disorder can occur after an individual has experienced their first panic attack. It is characterized by a persistent concern or worry about additional panic attacks and a significant change in behavior to attempt to avoid panic attacks. 

Panic disorder can occur after an individual has experienced their first panic attack. It is characterized by a persistent concern or worry about additional panic attacks and a significant change in behavior to attempt to avoid panic attacks. In children this can particularly present as school avoidance, avoidance of previously preferred activities or frequent physical complaints (I.e. headaches or stomachaches).

Mood stabilizers are medications primarily used in the treatment of Bipolar I/II Disorder and Schizoaffective disorder. These medications work by preventing the lows (depression) and highs (mania/hypomania) that occur during these illnesses.

Certain mood stabilizers can also be used for the treatment of Schizophrenia, adjunctive treatment of depression and irritability associated with autism. They are sometimes used ‘off label’ to target symptoms including anger, irritability, impulsivity and self harm. These medications can be used in both children and adults.

Medications in this category include:

• Lithium
• Valproic acid, divalproex (Depakote)
• Carbamazepine (Tegretol)
• Lamotrigine (Lamictal)

Atypical Antipsychotics (e.g. aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone)

Lithium is the oldest, most studied and likely most effective mood stabilizer. Valproic acid, carbamazepine and lamotrigine were initially developed as anticonvulsants. Atypical antipsychotics were initially developed for the treatment of psychosis.

The mood stabilizers have their own individual side effects, and many require monthly to yearly lab monitoring. While these medications are effective, they can have long term side effects. Therefore careful monitoring and follow up with your doctor is necessary.

Your doctor can work with you to identify the best mood stabilizer for you based on your symptoms, medical history and family history.

Stimulant medications are the best treatment available for Attention-Deficit/Hyperactivity Disorder (ADHD). In large studies stimulants have been shown to have large response rates in the treatment of ADHD – higher than almost any other medications used in Psychiatry. In general, stimulants work by increasing the level of norepinephrine and dopamine in our brains, the neurotransmitters that are deficient in ADHD. There are two main classes of stimulants: amphetamine based and methylphenidate based.

• Amphetamine Based
• Methylphenidate Based
• Adderall / Adderall XR
• Concerta
• Dexedrine
• Daytrana
• Evekeo
• Focalin / Focalin XR
• Mydayis
• Metadate CD / Metadate ER
• Vyvanse
• Ritalin / Ritalin LA / Ritalin SR

These medications come in both short-acting and long-acting forms. The short-acting forms are usually taken 2-3 times per day, while the long acting forms are usually taken 1 time per day and can last anywhere from 6-13 hours. For some the long-acting forms are not only more convenient but also more tolerable.

The most common side effects to stimulant medications are headache, upset stomach, increased blood pressure and dizziness. Some of these may resolve after a few weeks. Some common effects that your doctor will monitor for are reduced appetite (with weight loss), increased anxiety, difficulty sleeping, hallucinations and sudden/repetitive movements (tics).

In Children/Adolescents, there are been concern regarding growth reductions. However, studies have now proven that final height is not affected by stimulant use.

What are psychosocial treatments for ADHD?

While stimulant medications are the best available treatment for ADHD, they are sometimes unable to be given due to side effects or other ongoing medical problems. Psychosocial treatments for ADHD have also proven to be effective for reducing symptoms.

Psychosocial treatments are particularly important for children and adolescents with ADHD. In this age, behavioral modification has showing to be effective (backed by a large evidence base). It is important to help target symptoms outside of those immediately treated by medication including academic performance, peer relationships and parent relationship. These treatments teach parents skill to best support their child and children the skills to overcome their ADHD with skills such as time management.

Combination treatment (medication + psychosocial treatment) has been proven to lead to the best results.

Psychosocial treatments can also be beneficial for adults. Therapists can help support adults with ADHD by teaching new techniques to cope with their symptoms by utilizing Cognitive-Behavioral Therapy (CBT). Therapists can also teach various behavioral management techniques such as organization and time management skills.

While stimulant medications are the best available treatment for ADHD, they are sometimes unable to be given due to side effects or other ongoing medical problems. Psychosocial treatments for ADHD have also proven to be effective for reducing symptoms. 

Psychosocial treatments are particularly important for children and adolescents with ADHD. In this age, behavioral modification has showing to be effective (backed by a large evidence base). It is important to help target symptoms outside of those immediately treated by medication including academic performance, peer relationships and parent relationship. These treatments teach parents skill to best support their child and children the skills to overcome their ADHD with skills such as time management. 

Combination treatment (medication + psychosocial treatment) has been proven to lead to the best results.

Psychosocial treatments can also be beneficial for adults. Therapists can help support adults with ADHD by teaching new techniques to cope with their symptoms by utilizing Cognitive-Behavioral Therapy (CBT). Therapists can also teach various behavioral management techniques such as organization and time management skills.

When indicated, medications can be used to supplement psychosocial treatments which are the mainstay for OCD treatment. The primary medications use din the treatment of OCD are antidepressants. The FDA approved antidepressants utilized in OCD include:

• Clomipramine (Anafranil)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

These medications work by increasing the level of serotonin in your brain, which then leads to multiple ‘downstream’ effect. However there are a number of other medications from different classes that your doctor could prescribe for OCD depending on other conditions you may have.

There are non-medication treatments for patients who have severe symptoms despite medications/psychosocial treatments including deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS).

Psychosocial interventions are the primary treatment for OCD. A specific type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP) is the type of therapy that has proven to be effective. This type of therapy involves creating a hierarchy of your feared objects/obsessions and working through them one by one with your therapist. For instance if you are afraid of germs, an exposure that could be completed is touching a public trash can! Your therapist will work with you to create a schedule and work through it. Completing ERP can lead to you being able to manage your obsessions and compulsions, and stop them from interfering in your life.

As part of your initial assessment, your psychiatrist may order initial screening laboratory evaluations. Labs may be ordered to rule out undiagnosed medical conditions as the cause of the symptoms your having. These labs can include a complete metabolic panel (CMP), complete blood count (CBC), vitamin B12 , folate, thyroid stimulating hormone, urine toxicology, urinalysis, fasting lipid panel or testing for sexually transmitted diseases.

• Test
• Relevance
• Complete Metabolic Panel (CMP)
• Assessment of metabolic status including liver functioning
• Complete Blood Count (CBC)

Assessment of medical conditions that can mimic symptoms of psychiatric diseases such as fatigue/low energy

Vitamin B12

Low levels can lead to a variety of symptoms including confusion, irritability, depression, mania, personality changes, delusions and fatigue/weakness.

Folate

Low levels have been linked with depression and a poor response to antidepressant medication

Thyroid stimulating hormone

Altered levels can cause symptoms including anxiety and mood disorder, psychosis, fatigue, weight gain and confusion.

Urine toxicology

To screen for drug use which can mimic symptoms seen in symptoms of psychiatric diseases.

Urinalysis

Can identify causes of confusion (mental status changes)

Lipid panel

Some psychotropic medications can have adverse effects on cholesterol levels. Certain psychiatric populations are at high risk of lipid abnormalities.

Sexual transmitted disease testing

Risk of STD is higher among certain psychiatric patients and untreated can lead to mood and behavioral changes.