Specialties

Depression

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Depression (one of the “Affective Disorders”) historically affected almost 10% of American adults. The pandemic has only worsened these numbers, with some studies suggesting rates as high as 30%. Feelings of sadness and despair are some of its starkest features, but more subtle signs – poor motivation, fatigue, excessive sleep (or too little), changes in appetite, crying spells, and changes in behavior - can all take their toll. Sometimes, depression results in impairments in school or work functioning, suicidal thoughts, or changes in rational thought processes.

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Although the causes of depression are often multifactorial (e.g., psychosocial stressors, genetics) occasionally an underlying medical condition (or a medication being taken for another condition) may be the cause. Determining the causes is important and a key element to successful treatment.

 

If you or a loved one might be suffering from depression, know that this is a treatable condition. Options include therapy and medications. In some cases, electroconvulsive therapy, transcranial magnetic stimulation, and/or hospitalization may be indicated. Our providers can help you decide what options are best for you.

Anxiety/Panic

 

Anxiety and panic are the most common psychiatric illnesses in the United States. Anxiety is generally characterized by excessive worry or fear that interferes with someone’s ability to function at home, work, or school. Short-term and time-limited anxiety (such as that associated with public speaking for instance) can be natural. However, when it begins to bleed into one’s regular life and relationships or begins to take on a pervasive and consuming property, it warrants careful attention.

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Signs and symptom of anxiety and panic may include:

• Worry

• Fear

• Elevated heart rate

• Palpitations

• Inability to concentrate

• Feeling “stuck”

• Sweating

• Feeling “hot”

• GI symptoms

• Sleep or appetite problems

• Feelings of losing control

 

Sometimes, an unrecognized underlying medical problem can cause or worsen anxiety and panic. Often, the causes are psychosocial stressors (i.e., job stress, interpersonal conflict), and occasionally, genetic and organic factors play a roll. Determining the causes is important so an effective treatment plan can be developed for you or your loved one. Our providers can help you develop the treatment plan that is best for you.

Obsessive Compulsive Disorder

 

Obsessive Compulsive Disorder (OCD) is often called a condition of degrees. It is characterized by an excessive worry or concern about something that would not bother someone without the disorder (the “obsession”), often followed by some act designed to permit the sufferer to exert some control over what they worry about (the “compulsion”). Some people call themselves “clean freaks” and like things neat and tidy. This is not OCD (though it may be called that colloquially). However, when one’s need (such as for cleanliness) begins to interfere with home, work, or school functioning, it warrants special attention. For instance, when excessive showering begins to make one late to work, a person should seek treatment.

 

Common obsessions include themes of cleanliness, order, and performance (i.e., whether the way one puts on their shirt feels right). Compulsions are the act one performs to relieve the discomfort associated with the obsession. This may include “checking and rechecking”, arranging, cleaning, and the like. Sometimes, the compulsion is a cognitive act rather than an actual physical act, such as counting or reciting a phrase in one’s head. Either way, the most important aspect of OCD is the degree to which these thoughts and acts interfere with one’s functioning. When they do, it’s time to get help.

 

OCD is often thought of as a “spectrum” disorder because it has many overlapping features with seemingly related conditions discovered in childhood, such as tic disorders (e.g., Tourette’s) and autism or Asperger’s Syndrome. Not commonly known, certain common childhood infections may be intimately associated with OCD.

 

Treatment for OCD almost always includes therapy and medications. Our providers can help find the right combination for you.

ADHD

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Although Attention Deficit Hyperactivity Disorder (ADHD) is a condition primarily affecting children, it is often a life-long condition that can appear in adults either as a recurrence of a once treated disorder or a seemingly new disorder that was never properly recognized or treated in childhood.

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Symptoms can include restlessness at school or work, poor impulse control, an inability to stay on task and/or poor concentration. More than a mere nuisance, these symptoms can interfere with job and school performance, precipitate problems with relationships and, in some cases, engender unhealthy behaviors to compensate for these deficits, such as drug and alcohol abuse. Effective treatment is possible and can meaningfully improve the lives of those most affected by ADHD.

Bipolar Disorder

 

Classically, bipolar disorder describes the swing – back and forth – between depression and mania. Mania (or a “manic episode”) describes the opposite of depression. Symptoms are often characterized as a feeling of euphoria, impulsivity, excessive spending, uncharacteristic risk taking, and striking, out-of-the-ordinary energy. When severe, bipolar disorder can include a belief that one has special powers or the harboring of delusions (often grandiose or persecutory). Sometimes these episodes are less severe (though still very much out of the ordinary) and may be called “hypomania.” Further still, sometimes an episode is characterized as a combination of mania and depression at the same time (often irritability or rage is prominent). We call these “mixed episodes.”

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Although a manic or mixed episode is often the most striking part of bipolar disorder, the typical patient spends most of their time depressed, not manic. Moreover, young people may describe feeling very “emotional” or “emotionally unstable.” While the feelings may not be caused by bipolar disorder, the patient may very well benefit from similar kinds of treatment.

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In either case, your doctor needs to know the difference as the treatment for depression and bipolar disorder are different even though they often have overlapping features. Our providers can determine the correct diagnosis and develop an appropriate treatment plan.

Schizophrenia / Psychosis

 

Psychosis is often the most striking symptom that may bring a patient to seek psychiatric care. This is because it represents the most significant deviation from normal thought and behavior. It comes in many forms including:
 

• Hallucinations (commonly “hearing voices” or “seeing things”)

• Delusions (often, though not always, persecutory in nature, i.e., a worry or belief that one is being spied on or is the subject of a conspiracy)

• Disorganization (disordered or confused thought processes and behaviors)

• Apathy

• Social Withdrawal

Psychosis is most commonly associated with schizophrenia, which often arises in the late teens to mid-20’s, but can also be a sign of other illnesses including bipolar disorder, delusional disorder and even several non-psychiatric illnesses that may have medical treatments. Determining the cause of the psychosis is important so that appropriate treatment can be started promptly.

Dementia (Alzheimer’s Disease)

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Dementia describes a group of cognitive disorders often present in older patients, with Alzheimer’s Disease being the best known example. As one ages, the brain often undergoes meaningful changes that may interfere with a person’s ability to think and function the way they did when they were younger. This may be due to the abnormal buildup of proteins in the brain’s cells (i.e., Alzheimer’s Disease) or the loss of blood flow (i.e., Vascular Dementia). Frontotemporal dementia (“Pick’s Disease”) and alcohol-associated dementia are less prominent but all the more striking.

 

Dementia is often associated with memory loss. That is, indeed, a prominent sign of most dementia. However, it is not always the most striking feature. Patients with dementia can have significant changes in behavior including agitation and combativeness, changes in personality, and even psychosis (e.g., delusions, visual hallucinations).

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Dementia is a progressive neurological illness for which treatment can sometimes slow, but not arrest, progression. Nevertheless, symptom control is important to ensure that a loved-one can live in their home for as long as possible. Treatment is often medication based but a multifaceted approach focused on services improves outcomes. Our providers can help you and your family evaluate the options available and guide your family through the challenges.

Alcohol/Substance Use

 

Alcohol, benzodiazepine (e.g., Ativan, Xanax, Valium), and opiate use problems can sneak up on a person, gradually blurring the line between responsible use and problem dependence. Complicating matters, these problems often have their roots in a legitimate prescription from a doctor with use that spiraled out of control. In either case, problem substance use and dependence very often have a genetic component that can cause one’s struggle for sobriety to feel like an uphill battle. Help is available.

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Two kinds of treatment are available: “detox” which is designed to slowly reduce one’s dependence on a substance or medication assisted treatment (i.e., suboxone). Dr. Havemann can help you find the right treatment to overcome your substance use problems or dependency.