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Research on Depression in the Workplace.

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Mental Health Matters Journal for Psychiatrists & GP's

MHM Volume 7 Issue1 small

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Literacy is a luxury that many of us take for granted.  We depend on written communication for information, guidance, and access to heath care information That is why SADAG created SPEAKING BOOKS and revolutionized the way information is delivered to low literacy communities. It's exactly what it sounds like.a book that talks to the reader in his or her local  language, delivering critical information in an interactive, and educational way.

The customizable 16-page book, accompanied by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood..

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 30 titles, such as TB, Malaria, Polio, Vaccines for over 30 countries.

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BIPOLAR MOOD DISORDER IS REPORTEDLY ON THE RISE. OR COULD IT BE NORMAL MOODINESS BEING MISDIAGNOSED? AHEAD OF NATIONAL BIPOLAR AWARENESS DAY ON 26 MAY, BALANCED LIFE INVESTIGATES . By GfIfiqs Horning PHOTOGRAPHY: GALLKETTYIMAGES Tecently, bipolar mood disorder (BMD) has slipped out of the stigma closet where most mental disorders are still confined, with celebrities such as Catherine Zeta-Jones and Russell Brand admitting to being sufferers. Even the fictional heroine Carrie Mathison on Homeland has it. While most mental health professionals are pleased, some, led by senior lecturer of psychiatry at University College London, Dr Joanna Moncrieff, fear it is contributing to the disorder being too readily diagnosed. In her book The Bitterest Pills: The troubling story of antipsychotic drugs, Dr Moncrieff argues that BMD has become a 'fashionable diagnosis', applied too liberally to general mood swings and often leading to the prescription of heavyweight antipsychotic drugs to many people who don't require it, at a cost to their well-being and their wallets. She reports that in the past 10 years, prescriptions for antipsychotics have soared and a high proportion are being used to treat the upsurge in bipolar diagnoses. WHAT IS BMD? Bipolar disorder is a severe mood disorder and the sixth leading cause of disability in the world, says Cassey Chambers, operations director at The South African Depression and Anxiety Group (Sadag). We receive hundreds of calls from patients and loved ones struggling to understand or cope with bipolar diagnoses,' she says. And it's much more than a simple mood swing: 'Sufferers experience sudden and dramatic shifts in emotions, which have little to do with external situations'. Clinical psychologist Dr Colinda Linde says that in the high or 'manic' phase, sufferers are ecstatic or irritable with racing thoughts, rapid speech, inflated confidence and boundless energy, needing very little sleep. Severe mania occasionally becomes psychotic, which is when you lose touch with reality and experience grandiose delusions, hear voices and see visions, making BMD difficult to distinguish from schizophrenia. In the low or depressive phase of BMD, sufferers can feel slow and sluggish, and lose interest in things. They may struggle to sleep or eat (or do too much of both), have problems concentrating or remembering, and can be overwhelmed with feelings of worthlessness and guilt, prolonged sadness and crying spells, making it difficult to function. COUNTING COSTS The euphoric manic phase leaves BMD sufferers reckless and easily distracted, so they'll often spend too much money, engage in risky sexual activities, abuse alcohol and drugs, and make disastrous business or financial decisions. They are also at risk of car and other accidents. In the depths of a severe depressive phase, they can also be a high suicide risk. People with BMD are more likely to try suicide than those suffering regular depression, and their attempts also tend to be more lethal, says Cassey. 'Psychiatric care and medication reduce the risk of suicide in those suffering from bipolar disorder from 30% to less than three percent.' ARE YOU AT RISK? BMD affects about one percent of the population, often starting in adolescence, though the average age of onset is 25. Men are more likely to start with a manic episode and have more of these, while women are more prone to depressive episodes. The exact cause of the disorder is still unclear, but is believed to be a combination of biochemical, genetic and psychological factors. Research has shown a link to a chemical imbalance in the brain and identified genes that may be associated, says Cassey. Your biological clock may be involved too, as the mania and depression are often cyclical and occur at certain times of the year, with changes in season sometimes precipitating episodes. 'Stress can also be a major trigger, as mood is so delicately balanced in BMD,' says Dr Linde, especially stress caused by key life events such as retrenchment, divorce or the death of a loved one. FINDING HELP There's no cure for the disorder, but there are many ways to manage it successfully. The earlier it's diagnosed the better, so treatment can begin, says Cassey. If left undiagnosed, the impact can be devastating to the sufferer, their family and community. Episodes can last from days or weeks to years, and more than 80% of people who have one episode will have another. If you suspect you have a problem, ask your doctor to refer you to a psychiatrist experienced with BMD and with whom you feel comfortable. Diagnosis is made through taking a history of manic or depressive episodes, as well as family history —there are no laboratory tests for it. 'There needs to be at least one manic episode to be diagnosed with bipolar 1/ says Dr Linde. And it takes at least one hypomanic episode (where mood is not severe enough to cause problems with working or socialising, and there are no psychotic features) to be diagnosed with bipolar 2, in which the main symptom is episodes of dysthymic mood (mild depression). TREATMENT TODAY BMD largely needs a chemical intervention, advises Dr Linde. But it is generally only for those patients who suffer psychotic depressive episodes that the powerful (and pricey) antipsychotics should be used, and carefully monitored, to avoid side effects, such as weight gain, high cholesterol, raised glucose that can lead to diabetes and heart disease, and even loss of brain tissue. Most BMD medication takes the form of mood stabilisers. These are not typical antidepressants, and can make bipolar patients cycle more frequently and worsen their condition. They may take a while to have an effect and show side effects until the optimal dosage is established. Dr Linde says that mood stabilisers need to be taken on a long-term basis to prevent a relapse, however well someone may feel. OTHER OPTIONS Almost two thirds of those in the bipolar spectrum have an anxiety disorder, reports Cassey, and there's mounting evidence of the effectiveness of cognitive behavioural therapy (CBD) in treating this as well as depression. 'CBD with medication is a common and effective treatment combination,' she says. But there are also effective steps you can take yourself. Dr Rakesh Jain, visiting clinical professor of psychiatry at Texas Tech University School of Medicine in the US, told delegates at the 2014 Congress of the SA Society of Psychiatrists held in Durban that numerous clinical studies have now shown that exercise and mindfulness meditation could be 'equally or more effective' than medication in preventing the return of depression, and should be prescribed along with it. Dr Jain advises 30 minutes of moderate exercise a day, five times a week (brisk walking, running and swimming), and two hours of meditation a week. That's just under 20 minutes a day of quietly 'paying attention in a particular way: on purpose, in the present moment, non-judgementally', in your office or at home. And it needn't cost a cent. For more information or support groups, contact The South African Anxiety and Depression Group (Sadag) on 0800 21 22 23, SMS 31393 or visit MAY 2015

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