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Managing difficult patients: Their pain and yours
Published in Marian Stuart, Joseph Lieberman, The Fifteen Minute Hour, 2018
Marian Stuart, Joseph Lieberman
Racing thoughts can be managed with cognitive restructuring strategies. These techniques require patients to pay attention to their thoughts and to challenge their interpretations of various situations—in other words, to change their stories. Patients learn to monitor their thought patterns and to become aware of and recognize when their thinking is unduly negative. They can then modify their unrealistic assumptions (horror stories) and substitute more realistic, appropriate, and adaptive versions. The combination of relaxation training and cognitive restructuring is the essence of CBT.
Depression
Published in Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy, Primary Child and Adolescent Mental Health, 2019
Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy
Manic depression (bipolar disorder) in young people is hard to assess.7,8 To simplify somewhat, standard definitions require a distinct episode of elevated mood with three concurrent features from a list that includes various features of mania, especially euphoria or grandiosity (others are listed later in this paragraph). Some young people however have episodes that do not last the requisite four days (some may have ‘rapid cycling’ – frequent up-and-down changes of mood); while others have a baseline presence of ‘manic-like symptoms’, dominated by irritability rather than euphoria, without clear episodes. Young people in the second group often have a diagnosis of ADHD (see Chapter 31) or oppositional defiant disorder (see Chapter 30) – with symptoms in addition to irritability such as: social disinhibition, recklessness, intrusiveness, insensitivity, distractibility, restlessness, agitation, a decreased need for sleep, talkativeness, or racing thoughts. Some at least of the first group (those with episodes lasting less than four days) seem to develop strict bipolar disorder if followed for long enough. Most of the second group (those with baseline levels of manic-like or ADHD symptoms) probably do not, although, just to add to the confusion, they may be more at risk of developing depressive disorder, particular if they tend to be intermittently sad or angry. Transatlantic differences are particularly marked in relation to the frequency of diagnosis of bipolar disorder: a European perspective is that over-diagnosis of a bipolar tendency may inappropriately encourage the use in children of the sort of medications used to treat adult bipolar disorder.9 From a clinical point of view, it is probably best not to make a firm diagnosis (or accept someone else’s diagnosis) of bipolar disorder without definite out-of-character episodes of elevated mood (or irritability) combined with other manic features.10 This in any case is a task for specialist CAMHS.
Impact of psychosis in bipolar disorder during manic episodes*
Published in International Journal of Neuroscience, 2018
Elionor Nehme, Sahar Obeid, Souheil Hallit, Chadia Haddad, Wael Salame, Fouad Tahan
Psychotic symptoms are considered a typical manifestation of severe manic episodes [20,27]. Goodwin showed that 35–60% of manic episodes were accompanied by grandiose delusions, while 18–65% were associated with persecutory delusions, and 7–48% of patients experienced auditory hallucinations, and 19% display formal thought disorder [20]. Racing thoughts, the flight of ideas and distractibility can be present in up to 71% of patients with mania [20]. Hallucinations and delusions are common features of manic episodes, but tend to be brief and fragmented, and often have grandiose, religious or paranoid themes that typically resolve early during recovery phase [11,28]. These symptoms may represent the most prevalent psychotic symptoms in bipolar mania patients which grandiosity is a hallmark feature of mania [13].
Internet-Based Cognitive Behavioral Therapy for Insomnia in Appalachian Women: A Pilot Study
Published in Behavioral Sleep Medicine, 2020
Mairead E. Moloney, Ashley I. Martinez, Christal L. Badour, Daniela C. Moga
Pre-intervention, participants described difficulty falling asleep, staying asleep, or both. Rumination/racing thoughts were common. Most women discussed using medication to help them fall asleep. When asked what they thought caused their sleep issues, most participants cited social stressors (e.g., caregiving responsibilities) or grief. When discussing the loss of a loved one, several women mentioned depression.
How do adolescents with ADHD perceive and experience stress? An interview study
Published in Nordic Journal of Psychiatry, 2020
Caisa Öster, Mia Ramklint, Jenny Meyer, Johan Isaksson
Too many and too rapid thoughts were linked to stress. Speeding or racing thoughts and having multiple thoughts simultaneously were experienced as very stressful. These racing thoughts made it hard to concentrate on the task at hand, why some tasks became more time-consuming.