QUESTION

Hi Dr. Raj,

My father was diagnosed Schizophrenic; does this mean I will be Schizophrenic?

ANSWER:

Let’s begin with what Schizophrenia is; Schizophrenia is a mental illness that presents as a few different subtypes; it belongs to the group of disorders we refer to as “Psychotic Disorders”; what psychosis simply means is “a break with reality”; thus, if someone is experiencing auditory hallucinations (hearing voices without any stimulus in the enviornment) or believes that the FBI or CIA is following them when they are not, we would say that he or she is “psychotic”; Schizophrenia has an incidence rate of 1% world wide; what this means is you can take 1% of any population and estimate what the expected number of individuals with Schizophrenia would be; thus, it a very serious and not so uncommon mental illness.

Now, let’s turn to understanding how it works if your parents have certain diseases and what that means for you; we inherit 50% of our genetic material from each of our parents; the body uses this as a blueprint to build proteins that the body needs similar to how an architect uses a blueprint when building a house; you can imagine that if there is an error in the blueprint that then will carry over to an error in the house and cause a problem; well, in the same way, if we have an error in the blueprint that the cells of our body use, it can cause a problem as well; so, in regards to Schizophrenia, there are problems in the “blueprint” that the body is uses; however, just having the error in the blueprint does not seem to always cause the disease; if you take two identical twins (same exact blueprint) that have parents with Schizophrenia, you will find about 50% of the twins get the disease even though they both have the exact same blueprint.

Thus, what this means is that you need both the problem with the blueprint as well an environmental factor which then triggers the disease; we are not clear as to the exact nature of the triggers but stress in general seems to bring out our vulnerabilities; so to answer your question, you do have a genetic risk or predisposition greater than someone who does not have a Schizophrenic parent; however, even with the genetic predisposition, you are not necessarily going to get the disease; I would suggest developing a good working relationship with a therapist with whom you can learn coping strategies to prevent stress in your life from building up.

Do you remember, that old question about which straw broke the camels back; the usual answer is “The last one”; but if you really think about it, it’s the SUM TOTAL of all the straws. Thus, don’t let the straws of your life accumulate.

QUESTION

Hi Dr. Raj,

I’m having a bit of a problem finding the right psychologist for my problem. I’m 21 and have been self-injuring since I was 12. Do you know of any good resources in the New York area for people suffering with this issue? Thanks for your time.

ANSWER:

First of all let me acknowledge your commitment to wanting to learn how to better manage your mental and emotional life; as you know, it’s anything but simple; I think some of the most powerful individuals are those who are seeking insight into understanding themselves and why they do the things they do; thus, your ahead of many in that you seem committed to wanting to learn about yourself and how to manage your feelings.

With that said, I would suggest that the most important thing to monitor for anyone who has thoughts of self-injury is their safety; if anyone feels that they are not going to be able to control their urge of wanting to self injure, then they must check into a hospital to make sure that they stay safe; remember that a 3-5 day stay in the hospital is not a huge amount of time in the big picture.

The next issue to address is why people self injure; one reason they do so is in moments they feel emotionally overwhelmed; in fact there is a specific type of therapy that has been developed called DBT to help teach skills that help in such moments; DBT stands for Dialectical Behavior Therapy; this is a psychosocial treatment developed by Marsha Linehan specifically to treat individuals who have difficulty managing their emotions.

The basic idea is that at one end of the spectrum is emotional mind where at the other end of the spectrum is logical mind: those individuals that have difficulty managing their emotions and sometimes engage in self injurious behaviors live on the emotional end and have a difficult time accessing the logical parts of their mind; thus, DBT is designed to help access the logical mind and achieve the state of mind referred to as mindfulness.

Logical Mind————————-Mindfulness—————————-Emotional Mind

It has been shown to help manage one’s emotions which in turn can lead to a decrease is self injurious behaviors.

With regards to resources in NYC, I know that Roosevelt Hospital in NYC has a DBT based program that you may find helpful; they are located at 59th and 10th; their number is 1-212-523-6983; remember that as you learn to manage your emotions more efficiently, it will get easier; we can overcome unhealthy behaviors as long as we seek support and treatment by the right individuals.

QUESTION

My primary care doctor prescribed Prozac for me but I am afraid to take it. What are the side effects that I should be worried about when taking this medication?

ANSWER:

Prozac belongs to a class of medications that are based on their mechanism of action; medications belonging to this class are called selective serotonin reuptake inhibitor’s or and SSRI’s; low serotonin levels in the brain are thought to play a significant role in mood and anxiety disorders; this group of medications increase serotonin levels in the brain by selectively inhibiting the uptake of serotonin after it has been released; bottom line, serotonin levels are increased which in turn is correlated to an improvement in symptoms related to depression and anxiety disorders.

The most common side effects of this class are:

• Allergic or Toxic – Rash, Pruritus (skin inflammation)
• Neurological – Headache, Tremor, Dizziness, Asthenia
• Behavioral – Insomnia, Anxiety, Nervousness, Agitation, Abnormal dreams, Drowsiness and fatigue
• Autonomic – Excessive sweating
• Gastrointestinal – Nausea, Disturbances of appetite, Diarrhea
• Respiratory – Bronchitis, Rhinitis (inflammation of the nasal mucous membranes), Yawning
• Endocrine – Weight loss
• Musculoskeletal – Muscle pain, Back pain, Joint pain
• Urogenital – Painful menstruation, Sexual dysfunction, Urinary tract infection, Frequent micturition
• Miscellaneous – Chills

Keep in mind that not all SSRI’s cause all the above side effects and that different individuals respond differently to different SSRI’s; your doctor and you have to work together to see which medication suits you the best; always check with your doctor if you have any side effects (symptoms that were not present prior to starting a particular medication) and ask him or her if other options are available; also, keep a small journal of how you feel when starting any new medication; note down any changes in mood, appetite or energy; be sure to bring your notes to your visits with your physician; make sure to address your questions during your follow up visits; don’t be afraid to ask questions related to your working diagnoses and treatment plan; you have a right to ask questions of your health care providers and deserve answers if they are known; Lastly, only take prescription medications under the supervision of a physician. Take care of your self and keep the lines of communication open.