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Diagnosing mental issues can be as much art as science

Someone with a mental disorder may be the last person to realize they need help. Often, it’s those around them who notice things aren’t right. Symptoms may include changes in mood, personality, personal habits and/or social withdrawal.

According to the World Health Organization, mental illnesses account for more disability in developed countries than any other group of illnesses, including cancer and heart disease; published studies report that about 25 percent of American adults have a mental illness and that nearly 50 percent of the population will develop at least one mental illness during their lifetime.

“There are clinical criteria that indicate treatment using medications, but that also can be somewhat of a challenge,” said Dr. Jeffery Talbot, director of the Research Center on Substance Abuse and Depression at the Roseman University of Health Sciences. “We often refer to the mental condition not as defined illnesses with defined causes because the symptoms can vary from patient to patient, so it would be fair to say the diagnosis … can be as much art as science.”

When it comes to diagnosing mental illness, the first clues a clinician gets often come from the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, compiled by the American Psychiatric Association. The DSM-5 form is filled out by patients on their initial visit.

Questions include: Have you had little interest in doing things?; Feeling, down, depressed or hopeless?; Avoiding situations that make you anxious?; Hearing things other people couldn’t hear, such as voices when no one else is around?; and Feeling detached or distant from yourself, your body, your physical surroundings, or your memories?

Patients can rate the impact of the symptom on their life on a scale of one to four.

One’s medical history will need to be disclosed as will all medications taken. The psychiatrist will then delve further into the person’s symptoms and note when they began.

Local psychologist Dr. Charles Colosimo takes many factors into consideration during the interview: appearance, mood, and whether cognizant functions are operating in the here and now.

“You can’t rely (just on) the DSM-5,” Colosimo said. “You have to get (symptoms) sorted out first of all to see if there’s any medical ideology or neurological ideology, or if there’s been a traumatic brain injury or some outside (trigger), or is it internal. I definitely will try to find out what the situation is that brought them in and how much the crisis or the clinical problem they’re having is affecting their daily functioning.”

Colosimo said personal situations, such as divorce or custody issues, are factors in mental distress.

He added that discerning between issues, such as bipolar and post-traumatic stress disorder (PTSD), in a patient is key.

“You have to figure out what the primary issue is,” Colosimo said. “That’s the one you focus on. If their bipolar has kicked in and caused them to be very unstable, or if they’re having a terrible time, they could not be taking their medication, or maybe they’re not even prescribed medication. All those things have to be sorted out in terms of where you go with it. … If it’s PTSD, you work with it and figure out what the trigger was and how to (treat it).”

He said some physical issues could manifest psychological ones.

“So, we always have to be on top of that,” Colosimo said.

While prescribing medication is often a first step, therapy is important to address the underlying cause.

How long does it take for people to get back on track and on with life? There’s no one answer.

“If someone comes in, and you determine they need therapy, you don’t want to give them four weeks of therapy,” said Patrick Bozarth, ‎executive director at Community Counseling Center of Southern Nevada, 714 E. Sahara Ave. “That’s not going to do anything.”

He estimated that a person would need at least six months of weekly sessions. Group therapy is seen as important because it provides peer support.

One’s position in life can be an indicator of mental challenges. Data from the National Health and Nutrition Examination Survey, 2009-12, shows that those living below the poverty line were nearly two and a half times more likely to have depression than people at or above the poverty level. Sometimes life’s day-to-day drama can bring on bouts of depression.

“We have a higher percentage of mental illness,” Bozarth said of Las Vegas. “I think that has to do with Las Vegas being a transient community. … For so long, we’ve had economic issues that affect the population. The housing crisis that we went through, and that still exists, unemployment, long-term unemployment and the inability to find a decent-paying job — these are all stress-ers that (lead to) anxiety.”

Those with mental health problems can affect the rest of the population, as well.

Bozarth said there’s a cost to society, seen in the panhandlers on the street or erratic driving as people turn to drugs or self-medicate.

“Theft, rape, violent crime can be attributed in part to mental health,” he said, “and certainly substance abuse issues.”

If you or someone you know is in crisis now, seek help immediately. Call 800-273- 8255 or dial 911.

Editor’s Note: This is part of an ongoing story series in View looking at mental health in Southern Nevada.

To reach Summerlin Area View reporter Jan Hogan, email jhogan@viewnews.com or call 702-387-2949.

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