Over the years, advances in neurology and research have simplified the way psychologists, psychiatrists, and others diagnosis and treat mental health problems. In over one hundred years of mental health treatment, the symptoms and behaviors associated with certain mental health conditions have remained the same. Psychotic disorders, where the individual often can't distinguish between reality and their fantasies, still have auditory hallucinations. Depressed individuals still can't sleep and remain preoccupied with the past. Hyperactive children (Attention-Deficit Hyperactivity Disorder or ADHD) still exhibit uncontrollable restlessness.
When patients first began reclining on the couches of psychoanalytic psychiatrists, the depressed folks talked about their past. This led the founders of psychology and psychiatry to believe that issues that began in childhood caused many mental health problems. But questions were still not answered. Why would a bad relationship with your mother create the appetite loss found in depression, especially when eating problems only started several months prior to the session? By what strange mechanism would a childhood issue create an auditory hallucination, often years after the reported traumatic event? Many people had difficult childhoods, but they didn't hallucinate and have a great appetite. It became clear that many mental health problems also had a physical component that involved changes in concentration, sleep, appetite, speech pattern, energy level, perceptions (hallucinations), and motivation. Studies began to determine the connection, if indeed one was present, between the condition of the patient and the physical signs/symptoms that were also present.
The picture became easier to understand when chemicals in the brain called "neurotransmitters" were discovered. The brain consists of billions of neurons or cells that must communicate with each other. The communication between neurons maintains all body functions, informs us when a fly lands on our hand, or when we have pain. The communication between neurons is controlled by the brain's type and level of neurotransmitters. Neurotransmitters are chemical substances that control and create signals in the brain both between and within neurons. Without neurotransmitters, there would be no communication between neurons. The heart wouldn't get a signal to beat, arms and legs wouldn't know to move, etc.
As we discovered more about neurotransmitters, we began to identify which neurotransmitters controlled certain bodily functions or which were related to certain emotional/psychiatric difficulties. Serotonin, a neurotransmitter, was found to be related to body temperature and the onset of sleep. Research also identified Serotonin as related to depression and later to a variety of mental health conditions such as anorexia and obsessive-compulsive disorder.
As research in neurotransmitters continued, studies between neurotransmitters and mental conditions revealed a strong connection between amounts of certain neurotransmitters in the brain and the presence of specific psychiatric conditions. Using an everyday example, our automobile operates by using a variety of fluids such as engine oil, transmission fluid, brake fluid, and coolant (anti-freeze). Every automobile has a way to measure the levels or amounts of each of these needed liquids such as the dipstick for oil and transmission fluid and marked indicators for anti-freeze and brake-fluid levels. Using our dipstick to measure engine oil, for an example, we can find our engine to be found one, two, or even three quarts low. After a recent oil change, the dipstick may also tell us that we have excessive oil in the engine. To work properly, all fluid levels must be in the "normal range" as indicated by the dipstick. When we receive a blood test, values of certain blood components are given with the "normal range" also provided, indicating if a blood chemical is below or above the average range.
Neurological research has identified over fifty (50) neurotransmitters in the brain. Research also tells us that several neurotransmitters are related to mental health problems – Dopamine, Serotonin, Norepinephrine, and GABA (Gamma Aminobutyric Acid). Too much or too little of these neurotransmitters are now felt to produce psychiatric conditions such as schizophrenia, depression, bipolar disorder, obsessive-compulsive disorder, and ADHD.
Unfortunately, the body doesn't have a built-in dipstick for neurotransmitters, at least one that's inexpensive enough for community mental health practice. There are advanced imaging techniques such as Positron Emission Tomography (PET Scans) that are being utilized in research and in the development of medications that directly influence changes in specific neurotransmitters. Lacking a PET Scanner, most professionals evaluate neurotransmitter levels by looking for indicators in thought, behavior, mood, perception, and/or speech that are considered related to levels of certain neurotransmitters.
This is perhaps best illustrated in individuals with depressed mood. The mental health professional is often required to separate those who would benefit from counseling and those who may require counseling and an antidepressant medication. The key is looking for those symptoms that are known to be related to chemical changes in the brain. For example, situational depression often produces sad expressions, worry, pessimistic attitude and other features but does not create prolonged changes in the physical symptoms such as changes in sexual interest, appetite, or sleep. The continued presence of physical symptoms tells us that the brain's neurotransmitter levels have changed.
The technical aspects of neurotransmitter levels, the psychiatric symptoms they produce, and how medications have been developed to raise or lower the brain levels of these neurotransmitters can be very complicated. For this reason, the same procedure of explaining other medical conditions where medication brings symptoms back to the "normal range" is often used. Medical patients with high blood pressure, high blood sugar, or high cholesterol are informed that their body chemistry is too high, or in some cases, too low and must be corrected with medication.
For many years, mental health professionals have used the term "chemical imbalance" to explain the need for medications that are used to treat mental health conditions. This simple and commonly used explanation recognizes that the condition is a medical problem and that it can be treated with medication. The "chemical imbalance" explanation also reflects the overall theme of treatment – identifying what neurotransmitters are involved in the clinical symptom picture and with medication, attempting to return that neurotransmitter level back to the "normal range".
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