Five Warning Signs of Mental Illness
It is too easy to go about our busy lives and not notice symptoms of physical or mental illness. Our body has built-in warning systems which alert us to the signs that we need to pay attention.
Here are five warning signs of mental illness to watch for especially when you have two or more of these symptoms.
Long-lasting sadness or irritability
Extremely high and low moods
Excessive fear, worry, or anxiety
Dramatic changes in eating or sleeping habits
Below are a couple of self-report tests for warning signs of mental illness, which you can complete and score to see if you might be experiencing clinical depression. Keep in mind that depression can include anxiety symptoms, and when combined with an extreme shift in moods, then bipolar disorder is further evaluated. There are many other self-report mental health screening tools which you may consider, i.e., PBHCI – Mental Health Screening.
The PHQ-2 in Figure 1 Warning Signs of Mental Illness, below inquiries about the frequency of depressed mood and anhedonia over the past two weeks.
The PHQ-2 includes the first two items of the PHQ-9. The purpose of the PHQ-2 is not to establish a final diagnosis or to monitor depression severity, but rather to screen for depression in a “first step” approach. Patients who screen positive should be further evaluated with the PHQ-9 to determine whether they meet criteria for a depressive disorder. When scoring the PHQ-2, the range is from 0-6.
The authors identified a PHQ-2 cutoff score of three:
As the optimal cut point for screening purposes and stated that a cut point of two
Would enhance sensitivity, whereas a cut point of four
Would improve specificity.
Figure 1 Warning Signs of Mental Illness
The Patient Health Questionnaire-2 (PHQ-2)
(Kroenke, K. et al., 2003)
If you scored 3 or above, you might proceed to answer the questions in the self-report PHQ-9. The PHQ-9 in Figure 2 below is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.
The PHQ-9 incorporates DSM-IV depression diagnostic criteria with other leading major depressive symptoms into a brief self-report tool. The tool rates the frequency of the symptoms that factors into the scoring severity index. Question 9 on the PHQ-9 screens for the presence and duration of suicide ideation.
A follow-up, the non-scored question on the PHQ-9 screens and assigns weight to the degree to which depressive problems have affected the patient’s level of functioning. This tool is brief and useful in clinical practice.
The PHQ-9 can also be administered more than one time as an assessment tool to monitor improvement or increased levels of depression in response to treatment.
The PHQ-9 can make a tentative depression diagnosis. However, physical/environmental causes of depression, i.e., normal bereavement, or a history of manic/hypomanic episode should be taken into consideration.
It is always best to ask your primary care provider if it would be helpful to be further evaluated by a mental health professional who can assist with psychotropic medication management and to ascertain your levels of depression in response to the treatment plan.
Figure 2 Warning Signs of Mental Illness
The Patient Health Questionnaire-9 (PHQ-9)
(Kroenke, K. et al., 2001)
Overview for scoring the PHQ-9 is as follows:
Step 1: Questions 1 and 2 – Need one or both of the first two questions endorsed as a “2” or a “3” (2 = “More than half the days” or 3 = “Nearly every day”).
Step 2: Questions 1 through 9 – Need a total of five or more boxes endorsed within the shaded area of the form to arrive at the total symptom count (Questions 1-8 must be endorsed as a “2” or a “3,” and Question 9 must be endorsed as “1” a “2” or a “3”).
Use of the PQH-9 for treatment selection and monitoring as follows:
Step 1: A depression diagnosis that warrants treatment or a treatment change, needs at least one of the first two questions endorsed as positive (“more than half the days” or “nearly every day”) in the past two weeks. Also, the tenth question, about difficulty at work or home or getting along with others should be answered at least “somewhat difficult.”
Step 2: Add the total points for each of the columns 2-4 separately (Column 1 = several days; Column 2 = More than half the days, Column 3 = Nearly every day. Add the totals for each of the three columns together. This is the Total Score that equals the Severity Score.
Step 3: Review the Severity Score using the following TABLE for PHQ-9 Scoring:
++ If symptoms present > one month or severe functional impairment, consider active treatment.* If symptoms present > two years, then probable chronic depression which warrants antidepressants and psychotherapy (ask yourself, “in the past two years have I felt depressed or sad most days, even if I felt okay sometimes?”)
According to the National Alliance on Mental Illness (NAMI) each illness has its own set of symptoms, some combined, but here are some other common warning signs of mental illness in adults and adolescents.
Confused thinking or problems concentrating and learning
Extreme mood changes, including uncontrollable “highs” or feelings of euphoria
Prolonged or strong feelings of irritability or anger
Difficulties understanding or relating to other people
Changes in sex drive
Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don’t exist in objective reality)
Inability to perceive changes in one’s own feelings, behavior or personality (” lack of insight” or anosognosia)
Abuse of substances like alcohol or drugs
Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”)
Thinking about suicide
Inability to carry out daily activities or handle daily problems and stress
An intense fear of weight gain or concern with appearance
The good news is that you can go to your primary care provider and be prepared to talk about any of the symptoms you have been experiencing. Most primary care offices use the PHQ-2 and PHQ-9 as valid screening tools.
If you decide to complete the self-report brief screening tools, you may complete and take with you to your medical doctor. Some primary care physicians will feel comfortable prescribing an anti-depressant. Some of the primary care clinics like the Federally Qualified Healthcare Clinics (FQHC’s) offer same day service with the medical provider and a behavioral health consultant, psychologist or a licensed mental health therapist. They form what is called a primary care team who work to promote healing for the “whole person.”
The first step is getting a diagnosis and learning about your choices for treatment. Treatment goals have objectives that can help improve your daily living activities (DLA’s) for functioning at work, home, church, and other activities. There is no “one size fits all types of treatment.” Treatment options may include psychotropic medication, counseling (therapy), social support and psychoeducation.
Another first step is to love yourself and significant others in your life enough to “lovingly accept help.” Affirm this – “For good and for bad, in sickness and in health, I love myself and others unconditionally.” When we do this, we can change, grow, and expand our life to reach out and offer help to others. When we are healthy, we feel better about ourselves and mindful of our blessings with deep gratitude for life.
The second step is to gain hope for healing to have clarity for knowing your life purpose. With faith in a “Higher Power,” you find meaning and purpose and grow stronger day by day. Good Health is a blessing and we must be aware of any warning signs, so we can get help and begin to feel better. We must acknowledge self-care and know that “we are worth it.”