Diabetes Treatment News: Integrated Diabetes-Depression Treatment Improves Outcome

2013-01-16 / Mental Health / 0 Comments

Integrated Diabetes-Depression Treatment Improves Outcome

Integrating the treatment of type 2 diabetes and depression improves outcomes, including glycemic control and depression, for patients in the primary care setting, according to a study published in the January/February issue of the Annals of Family Medicine.

MONDAY, Jan. 16 (HealthDay News) — Integrating the treatment of type 2 diabetes and depression improves outcomes, including glycemic control and depression, for patients in the primary care setting, according to a study published in the January/February issue of the Annals of Family Medicine.

Hillary R. Bogner, M.D., of the University of Pennsylvania in Philadelphia, and colleagues conducted a randomized controlled trial — involving 180 primary care patients receiving pharmacotherapy for type 2 diabetes and depression — to determine whether an integrated treatment approach could improve glycemic control, adherence to medications, and depression symptoms. Patients received either integrated care, which involved additional education and guideline-based treatment recommendations and frequent monitoring of adherence and clinical status, or usual care. Depression was measured using the nine-item Patient Health Questionnaire (PHQ-9); medication adherence was assessed using the Medication Event Monitoring System; and glycated hemoglobin (HbA1c) was used to quantify the patient’s level of glycemic control.

The investigators found that, at 12 weeks, 60.9 percent of patients receiving integrated care achieved an HbA1c level of less than 7 percent, compared with 35.7 percent of those who received usual care. Patients in the integrated care group were also more likely to achieve remission of depression, with 58.7 percent scoring less than five on the PHQ-9 questionnaire compared with only 30.7 percent of patients receiving usual care.

“Our results show the usefulness of a simple, brief, integrated care management intervention for primary care patients with type 2 diabetes and depression,” the authors write.

NM hospital hires its first endocrinologist

The hospital recently hired a doctor with six years of experience treating American Indian patients to assist physicians who treat the most complex diabetic patients in the county.

Dr. George Ang, born in the Philippines, started work in Farmington in December as a physician at San Juan Health Partners. He’s the first endocrinologist at the health partnership or San Juan Regional Medical Center, hospital officials said.

Ang previously worked six years in Gallup at Rehoboth McKinley Christian Hospital and moved to Farmington in search of more patients. He expects to stay busy because of this area’s high rates of diabetes, especially among American Indians.

Endocrinologists are internal medicine physicians with additional training with the body’s glands that produce hormones.

While some endocrinologists specialize in treating health issues such as infertility or excessive or limited growth, Ang is content to work primarily with diabetic patients.

“I just happened to really love diabetes,” he said. “So this was a good fit for me because there is a huge need (for an endocrinologist) among the Native Americans.”

Local diabetes rates have long concerned health officials. Statewide, New Mexico has a diabetes rate of 10 percent. Among American Indians, more than 16 percent of the population has diabetes, said Sandra Grunwaldt, the diabetic education coordinator at the hospital.

Ang said an unhealthy lifestyle coupled with a wariness to medication contribute to the discrepancy in diabetes rates among ethnicities.

Ang said personable care can improve the chance of success when treating a patient for diabetes. Especially when treating American Indian patients, he said.

“They don’t like another specialist telling them they have to do this and this. That doesn’t really work, scaring them into shaping up,” Ang said. “What I’ve found is key to being successful is building trust, especially among the Native Americans.”

Building trust comes from congratulating patients for shedding a few pounds. Or by memorizing the generic equivalents to big-name medications that are available at Walmart at a lower cost, he said.

Accepting bad health problems as a way of life is also a problem when it comes to treating Navajo diabetes patients, Ang said.

“Some think (kidney disease) is a part of diabetes. Grandma and great grandma were on dialysis, mom is on dialysis and I’ll get kidney disease. That’s a big misconception,” Ang said. “We know we can prevent that but it’s difficult. … It’s a daily battle.”

The hospital is trying to improve treatment for all diabetic patients, Grunwaldt said. Ang’s hire is at one end of the spectrum, as he will treat the most complex and difficult cases.

Because of Ang “we can see people affected by the more severe, long-term effects of diabetes and reduce their risk of getting to the point,” Grunwaldt said.

The hospital is also trying to improve treatment and awareness for people who do not yet have the disease.

In addition to offering free six-week-long diabetes education courses to diabetic patients, the hospital will start at the end of January offering a Lifestyle Balance Program. It’s a similar education program for people who are at risk of getting diabetes, Grunwaldt said.

For treating diabetes, “lifestyle is key,” Ang said. “It’s more effective than any drug.”

Type 2 diabetes patients with hypertension do not need to rush to drug treatment

People with type 2 diabetes have to keep a close eye on their blood pressure. But that does not mean they have to start taking blood pressure drugs the minute they are diagnosed.

Middle-aged diabetes patients with high blood pressure have time to learn how to manage their blood pressure without the use of medications.

Waiting up to a year before starting drug treatment for high blood pressure leads to only a small reduction in life expectancy.
Learn to control your blood pressure without drugs.

High blood pressure – or hypertension – is harmful for anyone with or without diabetes. Having said that, diabetes patients with high blood pressure have an especially high risk for stroke, heart disease, kidney failure, loss of vision, and amputations.

Even though controlling high blood pressure can prevent these health problems, doctors and patients alike often fail to take the steps needed to lower blood pressure.

Many patients do not make the proper lifestyle changes, while their doctors can be hesitant to put them on additional drugs.

Until recently, the consequences of these treatment delays had not been measured. Neda Laiteerapong, M.D., of the University of Chicago, and colleagues used computer software to find out how much harm is caused by different delays in managing blood pressure in recently diagnosed diabetes patients.

The researchers found that a one-year delay causes only small damage. However, waiting 10 years or more can cause as much damage as smoking does in patients with heart disease.

According to both the American Diabetes Association and the National Institutes of Health, diabetes patients should aim for a blood pressure below 130/80 mmHg, a target that is lower than that recommended for the general public.

Yet, about two-thirds of adults with diabetes do not reach that goal, either because they lack access to proper health care or due to what can be called “clinical inertia” – when patients do not make lifestyle changes or when doctors are hesitant to push additional medications.

Most experts recommend that diabetes patients with moderately high blood pressure starting taking blood pressure medications within three months. For those with dangerously high blood pressure, they recommend starting drug treatment immediately.

The problem with beginning drug treatment so early is that patients do not have enough time to learn good habits and make the necessary lifestyle changes. Starting drug treatment early also means that patients have to start paying for those drugs sooner.

“We ask patients with diabetes to do a billion things,” says Dr. Laiteerapong. Patients have to juggle a variety of tasks, including testing their blood sugar, counting carbohydrates, and exercising for half an hour each day.

“Most, if not all, of this is new to them,” Dr. Laiteerapong explains. “They need time to adapt. It’s important to do this right, but our results say it’s not that important to do it so fast.”

The study’s findings suggest that doctors should work with patients to help them learn the necessary skills instead of racing into drug treatment.

According to the authors, diabetes patients with high blood pressure have “at least up to one year to focus on diabetes self-management and lifestyle modification.” That is, they have more time.

For their study, Dr. Laiteerapong and colleagues ran published data through computer software to determine the extent to which delaying hypertension treatment caused harm to recently diagnosed type 2 diabetes patients between 50 and 59 years of age.

“Among middle-aged adults with diabetes, the harms of a one-year delay in managing blood pressure may be small,” the researchers conclude.

“Health care providers may wish to focus on diabetes management alone in the first year after diagnosis to help patients establish effective self-management and lifestyle modification.

However, after the first year, it is clear that achieving and maintaining tight blood pressure control among US middle-aged adults with diabetes has the potential to generate substantial population-level health benefits.”

In other words, blood pressure drugs can wait. But after one year, it is clear that drug treatment is extremely valuable to the health of patients.

The study – which received financial support from the National Institutes of Health – is published in the Journal of General Internal Medicine.

Nearly 26 million individuals are affected by diabetes in the United States each year, with about seven million people going undiagnosed. Diabetes is a chronic metabolic disease with no cure in which a person has high blood sugar because the body does not produce enough insulin (Type 1) or because cells do not respond to the insulin that is produced (Type 2).

There are three main types of diabetes: Type 1, Type 2 and Gestational. Several groups of oral drugs, are effective for Type 2, such as Glucophage, Glucotrol, and Prandin, among many others. The therapeutic combination in Type 2 may eventually include injected insulin as symptoms worsen.

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ADHD treatment news: Demystifying the Myths and Misconceptions behind ADHD

2013-01-11 / Mental Health / 0 Comments

Demystifying the Myths and Misconceptions behind ADHD

The disease Attention Deficit Hyperactivity Disorder (ADHD) may be familiar to most people, but only a few are knowledgeable about its causes. It is necessary to secure oneself with knowledge about irregular behaviors and their medical explanations to prevent them and administer proper cures. Regrettably, most people’s notions about ADHD are enmeshed with various myths and misconceptions that consequently develop a stigma against patients with this psychological deficit.

For that reason, children with this attention and hyperactivity problem continue to be branded as troublemakers and spoiled brats, while adult patients are considered lazy and dumb. Most people believe that ADHD is not even a medically accepted condition or that it does not exist at all. Because of this, individuals with ADHD tend to be indifferent or isolated instead of having a concrete support system from their respective communities.

That situation is not effective at all because feeling ostracized and misjudged can aggravate their condition. Hence, the best way to tackle the issue is to first fix some of the incorrect impressions that people have against this behavioral disorder. For example, some believe that ADHD is just a way to increase the profits of drug companies and therapists.

However, the truth is that Attention Deficit Hyperactivity Disorder or ADHD exists and has been tormenting thousands of children across the globe. If not addressed immediately, this can be a lifetime problem that individuals and their families have to endure. Thankfully, there are several residential treatment centers today that can help heal not only the ADHD per se, but also the emotional wounds that other members of society have induced on the patients themselves.

Apart from serving as a shelter, these establishments also have a well-equipped residential treatment facility that can give the treatment needs of teens with ADHD. This demystifies yet another belief which claims that children who have ADHD are over-diagnosed and over-medicated. Certain people believe that the condition has grown to be an excuse for all misbehaving youths; however, professional psychologists can confirm that they have valid methods of diagnosing and treating ADHD.

Another myth is that the signs and symptoms of ADHD like loss of motivation, alcohol dependency, lazy learning habits, and sensitivity to food are all done on purpose and controllable. This misguided notion usually results in harsh parenting. To prevent such from occurring, parents should seek professional help from youth treatment centers that can provide all the necessary medical and emotional help their children need.

ADHD Program in Long Island, New York Finds Success with Executive Skills Training Curriculum

The Child and Adult Diagnostic and Treatment Program for ADHD, a division of East End Psychological Services ( http://www.eepservices.org ), is successfully treating ADHD in children, adolescents and adults by teaching strategies that enhance executive skills.

“Many people with ADHD struggle with executive skill deficits which are based in the biology of their brain. Thus, effective ADHD intervention involves strengthening the individual’s executive functions, which directly impact academic, career and social success. Executive skills permit individuals to manage or self-regulate themselves and guide behavior across time,” explains Dr. Joseph Volpe, Clinical Psychologist and Coordinator of the Program. “The ADHD Program at East End Psychological Services provides comprehensive executive skills training as a way to improve academic functioning, enhance career success and nurture personal relationships. Our methods for evaluating and teaching executive strategies have become especially valuable to our clientele at this time as many popular ADHD medications have been in short supply, especially less expensive generic medications.”

Before the training protocol is implemented, staff psychologists collect detailed background history about the individual. Next, clients are evaluated for baseline executive functions including attention span, behavioral inhibition, working memory, planning skills, and organizational abilities. Psychoeducational testing is provided when there is evidence for learning or other cognitive problems. Social-emotional and personality variables are tested as well. Direct consultation with school staff is part of the assessment process for school-aged children. Interviews with significant others are utilized when evaluating adults.

Through various interventions which include behavior modification techniques, cognitive therapy and behavioral counseling, clients learn how to improve impulse control, planning and organizational abilities, time management, emotional regulation, and working memory. These are skills that are necessary for success in the home, school, and/or employment settings. When assisting children, staff collaborate with parents and teachers so that these skills can be generalized between the home and school environments. With adults, the individual is trained to use these skills at college, at work and within their personal and social relationships.

Sachs Center Offers Parent Coaching To Help Children With ADHD

The Sachs Center in New York City now offers Coaching for parents struggling with their children, especially those diagnosed with ADHD. This specialized treatment is an affordable way for parents to learn about their child’s ADHD and how best to manage their behavior.

Parents with children diagnosed with ADHD often face additional parenting challenges. Children with ADHD require unique parenting skills to manage their outbursts, inability to focus and complete tasks, generally undesirable behavior, and most commonly, their tantrums.

The most important aspect to remember about tantrums is that the child is just trying to get their needs met. The Sachs Center parent coaching encourages caregivers to see that their child is looking for attention, or for something tangible such as food or a toy. Regardless, the parent’s best course of action is inaction; ignoring the behavior completely and maintaining their composure. The parent is encouraged to say, “When you calm down, then I can talk with you,” thereby removing the chance of emotional escalation. Otherwise, the parent’s return of an angry outburst will only add fuel to the tantrum’s fire. Once the anger passes, the child can then access their sadness for not getting their needs met, and that is when they reach to the parent for comfort and the tantrum ends.

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Bipolar Disorder Treatment News: Bipolar Doesn’t Make You Stupid, You Make You Stupid

2012-12-29 / Mental Health / 0 Comments

Bipolar Doesn’t Make You Stupid, You Make You Stupid

I am sick and tired of people using their diagnosis, or alternatively their med’s side effects, as excuses for their rotten behavior.

Unless you are currently in the throes of the psychoses of mania or the delusions of depression, you do have control over your behavior – even if you are moderately depressed or hypomanic, because in these states, you are still in touch with reality. You may really want to break that window or abandon your family or tell your boss off or jump off a bridge, but you do have the capability to stop yourself. It may be very difficult, but you’re not too far gone to no longer have free will.

While the moods that come with bipolar disorder can make rotten behavior really tempting, that rotten behavior is not in and of itself the symptoms of bipolar. It’s the moods that make bipolar what it is. It’s what you do with those moods that ruins your life and signals to you and other people that perhaps you need to see a doctor or spend some time in the hospital.

Bipolar is a mood disorder, not a self-control problem. True, there are some people with bipolar who have pathological self-control problems, and if that’s the case, they should be alarmed by this lack of control and go get some help. Maybe they have attention deficit disorder. If you’re not seeking help, you either don’t think it’s a problem, and someone really should tell you so, or you don’t care – and not caring is not the same as a pathological problem with self-control.

I am now convinced – putting aside breaks in reality that come with Bipolar I – that there are stupid people with bipolar and there are smart people with bipolar. Bipolar doesn’t make you stupid; your choices make you stupid, or smart.

I’m not going to elaborate on what brought me to this conclusion, although if you really want to know, you can ask my husband. He knows. And he knows that he had the ability to make different choices than what he made. People do not need to do everything they feel like doing, at the time that they feel it. So, it makes you uncomfortable to not follow through on what you’re feeling? It may make your skin crawl, like you want to claw it off yourself, but you do have the ability to stop. You have the ability to walk away from the temptation, perhaps go for a jog. Better yet, call your doctor.

Not taking the opportunity, no matter how extremely difficult it is and I understand how difficult it truly is, is your problem – not bipolar’s problem. You cannot understand how truly strong you can be until you try to stop yourself from acting on every whim in your hypomania or every lethargic and self-hating urge in your depression. Truly, and I know I will infuriate some with this accusation, if you do not learn to stop yourself in those mood states – or head off the mood at the beginning with meds, therapy, or lifestyle changes, which is infinitely easier than trying to ride out the mood without doing any damage to you or your family – you are all those bad labels being thrown at you: You are lazy, you are selfish, you are a jerk.

After being stable for two years, at first on meds and later with just lifestyle changes and cognitive-behavioral therapy (CBT), I’ve had a return of the mood swings this past month. It scares the crap out of me, so I swallowed my pride and saw my doctor today. Which brings me to this point, again…what do smart people with bipolar do when their symptoms worsen? They do something to try to get back to stable.

They amp up their CBT and lifestyle changes, comb through their mood charts for clues, go to the doctor, try new meds. The likely culprit for me is a hormone issue, so says my doc, so I got my blood drawn and will start a trial of progesterone supplements. They may work, or they may not. The point is, I didn’t feel well, so I sought help. Here’s another way people with bipolar look stupid – they settle for feeling unstable, they blame other people for their problems, they aren’t concerned enough by their symptoms to GO GET HELP.

You don’t want to feel stupid, and you don’t want others to think you’re stupid. No one does. So, empower yourself by taking charge of your life, your actions, your mood. Learn to assess your mood and then be able to feel your emotion without acting upon it. You are not bipolar; you are you, and you have bipolar. Bipolar is not your identity. Stop the rotten behavior that comes with your bipolar, whether you’re doing it by your own iron will, which I admit is exhausting, or much better yet, by meds and therapy and lifestyle changes. You have the full ability to make smart choices, even if you have bipolar disorder.

$3.7M program targets bipolar Hispanics

Mental health professionals with UT Medicine San Antonio and collaborating institutions are designing bipolar disorder treatments that will be relevant and culturally sensitive to Hispanics, thanks to a $3.7 million grant from the National Institutes of Health. Three research programs will target Mexican Americans, who represent the majority of U.S. Hispanics.

UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio.

“We will test for specific cultural factors that affect the response and engagement of Hispanics who have bipolar disorder,” said the study principal investigator, Dr. Charles L. Bowden. He leads a large group of experienced psychiatrists, psychologists and other scientists who will conduct the comprehensive program of research over the next five years.

Bipolar disorder, the sixth leading cause of disability worldwide, is a chronic condition characterized by rapid mood swings.

According to the National Institute of Mental Health (NIMH), bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels and the ability to carry out day-to-day tasks.

These shifts in mood and energy levels are more severe than the normal ups and downs that are experienced by everyone.

Annual prevalence of bipolar disorder among American adults is 2.6 percent, according to the NIMH. Prevalence of childhood-onset bipolar disorder is not well established.

The National Institutes of Health provided an Advanced Center award that is the first ever made for bipolar disorder research. One of the studies will test a novel design that has the potential to provide much more practical information to clinicians.

“This will aid clinicians in selecting specific treatments most likely to help an individual patient, rather than resorting to a trial-and-error approach that is currently often applied,” Bowden said.

Investigators will assess participants’ acceptance of treatment, their perception of side effects and their awareness of the illness. Innovative and culturally sensitive treatment approaches will be explored.

“The goal is to optimize treatment outcomes of bipolar disorder by considering characteristics of the communities in which people live,” Bowden said.

Two investigators will address the personal experiences of study participants. This will provide a biographical sense of the challenges that confront these patients in relationship to bipolar disorder and its impacts on their lives, families and community experience.

One of these investigators, Bryan Bayles is a cultural anthropologist, and the other, John Phillip Santos, is a nationally acclaimed writer on Hispanic migration to the U.S. Santos is a San Antonio native and faculty member of The University of Texas at San Antonio.

The research program involves collaborative work with the Center for Health Care Services, which is the primary organization charged with treatment programs for medically indigent persons with severe mental disorders in Bexar County, and the bipolar disorder research programs at the Texas Tech University Health Sciences Center at El Paso and Case Western Reserve University School of Medicine in Cleveland, Ohio.

Dr. Mauricio Tohen, a native of Mexico, is associate director of the overall program, which is titled “Optimizing Outcomes in Bipolar Illness Interventions in Hispanic Communities.” Jim Mintz, leads the statistical unit, and Dr. Vivek Singh and Jodi Gonzalez lead the major treatment studies.

Bowden recently was the sole North American author on a large international study that showed bipolar disorder features were more frequent in patients with major depressive episodes than indicated by existing criteria used by psychiatrists.

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Anxiety Treatment News: Anxiety Help for Fears and Phobias

2012-12-23 / Mental Health / 0 Comments

Anxiety Help for Fears and Phobias

Looking for anxiety help? If you struggle with panic attacks, chronic worry, social phobia, generalized anxiety disorder, phobias or obsessive compulsive disorder, here’s help that’s practical and powerful.

Anxiety disorders are generally very treatable, but when you experience one, you probably find it hard to overcome. The reason is that, while you have the ability to recover, anxiety literally Tricks you into using methods which make your fears worse rather than better.

This is the most natural thing in the world. Anxiety often feels like something that has invaded your life, something you have to resist and oppose. However, the worst problems come from our efforts to resist and remove anxiety, rather than from the anxiety itself.

People don’t get fooled by this trick entirely on their own. All too often, well meaning friends, doctors, and therapists get fooled by it as well, and unwittingly suggest methods to their patients which make the situation worse.

For instance, there’s a well publicized technique called “thought stopping”, in which snapping a rubber band against your wrist is supposed to help rid you of anxious thoughts. This is not the kind of anxiety help you need! It doesn’t work, because the more you tell yourself not to think something, the more you’ll think about it.

If you want a quick demonstration right now, take two minutes and don’t think about dancing elephants.

See what I mean? Don’t even think about thought stopping!

When anxiety Tricks you, you get fooled into using recovery methods which actually make your fears stronger and more persistent. The more you fight an anxiety disorder, the more it grows. It’s like putting out fires with gasoline.

People who struggle with chronic anxiety often say “the harder I try, the worse it gets”. This scares them, and makes them think they can’t recover. What it really means is they’ve been using methods that made it worse, and they need new methods.

Here on this site, you’ll find anxiety help that works. I’ll show you the anxiety treatment methods I’ve used in Chicago to help people overcome fears, phobias, and panic attacks for the last 20 years. You can use these therapy methods to outsmart the Anxiety Trick and achieve your own recovery from anxiety disorders.

Anxious, Fatigued or Depressed? Pills, Exercise or Diet Shouldn’t Top Your List of Treatments

Anxious, fatigued or depressed? You are not alone — one in five Americans is popping pills for these issues — but pills, exercise or diet shouldn’t top your list of treatments, says Bay Area author, founder of OwningPink.com and integrative medicine physician Dr. Lissa Rankin.

“What if I told you the medical profession has it all backwards?” Dr Rankin asked in her recent TEDx Talk.

“We’re suffering from an epidemic that modern medicine has no idea what to do with. People suffering from this epidemic are fatigued, anxious, depressed and suffering from vague physical symptoms…”

At a time when one in five Americans is taking prescription medication for these maladies, there is no question that there is an epidemic happening, and even more so among women.

According to a report from MedCo, a pharmacy benefit manager, one out of every four women has a prescription for some form of mental health medication.

In fact, these medications are the most widely prescribed of all medications here in the U.S. according to a Wall Street Journal article:
Psychiatric medications are among the most widely prescribed and biggest-selling class of drugs in the U.S. In 2010, Americans spent $16.1 billion on antipsychotics to treat depression, bipolar disorder and schizophrenia, $11.6 billion on antidepressants and $7.2 billion on treatment for ADHD, according to IMS Health, which tracks prescription-drug sales.

Statistics like these make me wonder whether our ideals about “mental health” might not just be skewed. They also make Dr. Rankin’s claim that she has a better solution all the more interesting. In fact, she says she has already had success in diagnosing the root cause of why her patients are depressed and anxious. She uses a wellness paradigm she calls the Whole Health Cairn, which helps patients evaluate their whole health in a paradigm-shifting way.

According to Dr. Rankin:
Cold, hard scientific evidence in reputable medical journals clearly proves that to be truly healthy both mentally and physically, it’s not enough to eat right, exercise, sleep eight hours a night, see your doctor for regular check-ups and take your medicine. This is why my Marin County integrative medicine practice was full of well-intentioned health nuts who were still depressed, anxious and sick.
When asked in an interview about her thoughts on antidepressants, she told me:
At least 75 percent and in some studies, up to 100 percent, of the effect of anti-depressants has been proven to be attributable to the placebo effect — which I believe is good news. This means that the potent cocktail of hope, positive belief, the support of a medical practitioner who cares and the physiological self-healing mechanisms that get triggered by the body when it wants to heal, are ever-powerful. Some studies even suggest that placebos work when the patient knows it’s a sugar pill. So why do we need the pill? Sure, every doctor will report some case studies where it’s truly a biochemical process, and once the biochemical disorder is reversed pharmaceutically, everything else falls into place. But I’d argue that most of the time, even if there is a biochemical component, it’s not purely biochemical.

This is shocking to me as one of the “25 percenters.” My Zoloft saved me from a bone-crushing bout of postpartum depression and I can assure you it wasn’t a placebo effect. I was sure Zoloft would not work for me. I had read those reports, but with three children to care for I was willing to try anything. For my family’s sake and with much grumbling, I resorted to popping my blue pill.

I remember the day I noticed it was working.

Another friend of mine also says she knows exactly when her antidepressants kicked in. She was driving in a busy mall parking lot, rushing to make a return with two yipping dogs in her car, when someone rudely rushed into the parking spot she had been waiting for. She says, she thought to her self, “Oh well” and kept looking. Then she stopped her car in shock. This kind of thing would have normally led to obscenities being screamed out the window, at the least.

So, we may be the exceptions to those reports of the placebo effect, however, could we be helped more by Dr. Rankin’s approach? Would looking at the whole of my life and figuring out my root cause eliminate my need for the little blue Zoloft pill I am terrified to stop taking?

To this Dr. Rankin says, “Patients know their bodies better than any doctor. If the patient tells me taking psychiatric medications is what they need in order to heal, I’m all for it. I’m just not a fan of treating every negative emotional state or vague physical symptom with psychiatric medications to the exclusion of helping patients diagnose and treat what’s underlying the depression or anxiety.”

According to Rankin, to know for sure whether or not I indeed “need” my Zoloft, I would need to look at my whole life — love life, professional life, creativity expression, spirituality, sexuality and see if there is anything out of balance. Once diagnosed and “the root cause underlying depression or anxiety” was found, her next step is “helping patients create an intuitively-driven, patient guided step-by-step action plan aimed at healing what is out of balance.”

The number one question she asks patients is: “What do you need in order to heal?”

And the answers they give are often shocking. Such as:

• I need to leave my husband.

• I need to move to Santa Fe.

• I need to finish my novel.

• I need to hire a nanny.

• I need to eat a vegan diet.

• I need to switch careers.

• I need to quit drinking.

According to Dr. Rankin, “Once the patient makes the diagnosis and writes ‘the prescription,’ the challenge lies in implementing the changes necessary to heal from the core.”

But not all doctors agree. One psychiatrist I spoke to about this subject wasn’t sold on Dr. Rankin’s approach, saying that “she’s simply presenting a PowerPoint of the obvious.”

“Yes, doctor, we would all prefer ‘healthy relationships, healthy professional lives, creative expression,’ but what interrupts that? It’s not so easy to simply talk/wish/guilt/’whatever’ ourselves into ‘changing.'”

But Dr. Rankin says she has had success with her program, as paradoxically simplistic and difficult as it may be.

One of her patients credits Dr. Rankin with newfound energy and relief from both malaise and physical illness, saying:

“When I first came to Lissa I had a myriad of mysterious medical maladies and zero mojo. I had invested six years of my life into various medical tests, treatments and failed plans of action… I (now) have boundless energy… and never have I been so happy.”

According to Dr. Rankin, “You can medicate someone all you want, but unless you’re helping her heal what underlies her depression or anxiety, you’re just putting a sad Band-aid on her soul, and the results will be limited.”

Well, I’m not quite ready to tear off my sad little band-aid, but I am happy to know there is an alternative for the growing number of pill poppers like me.

Fearless Youth: Prozac Extinguishes Anxiety by Rejuvenating the Brain

Once adult lab mice learn to associate a particular stimulus—a sound, a flash of light—with the pain of an electric shock, they don’t easily forget it, even when researchers stop the shocks. But a new study in the December 23 issue of Science shows that the antidepressant Prozac (fluoxetine) gives mice the youthful brain plasticity they need to learn that a once-threatening stimulus is now benign. The research may help explain why a combination of therapy and antidepressants is more effective at treating depression, anxiety and post-traumatic stress disorder (PTSD) than either drugs or therapy alone. Antidepressants may prime the adult brain to rewire faulty circuits during therapy.

Nina Karpova, Eero Castrén and their colleagues at the University of Helsinki’s Neuroscience Center created and extinguished fearful behaviors in mice. First, Castrén placed mice in a cage and repeatedly played a tone just before electrically shocking their feet. Soon the animals froze in fear whenever they heard the tone, at which point Castrén put them through “extinction training.” He moved the mice to a different cage and played the same tone again. This time there was no electric shock.

Researchers have previously shown that young mice less than three weeks old quickly learn that the tone is no longer a herald of danger and stop freezing in fear. But adult mice are harder to put at ease. Even if the adults become less fearful during extinction training, their relaxation is not permanent—a week later the tone turns them into statues again.

In Castrén’s study, adult mice that took fluoxetine while they went through extinction training behaved much like young mice—they lost their fear much faster than mice that were not taking the drug, and their anxiety did not return. In contrast, mice that were given fluoxetine but never went through extinction training remained anxious.

Castrén makes an analogy between these findings and the consensus that antidepressants in combination with therapy are almost always more effective than either antidepressants or therapy alone. Scientists know what most antidepressants do at the molecular level—they change the amounts of neurotransmitters in the spaces between neurons, for instance—but how these changes treat depression remains an open question. Research has not supported the idea that antidepressants treat depression simply by correcting chemical imbalances in the brain. More recently, researchers have hypothesized that depression kills neurons whereas antidepressants like Prozac encourage new neural growth in the brain. Castrén’s study suggests Prozac returns regions of the brain to an immature state in which neurons make or break more connections with one another than is typical of the adult brain. In other words, Prozac increases brain plasticity.

Castrén looked for characteristic electrical and molecular signs of plasticity in the brains of mice that received fluoxetine and in those that did not. Specifically, Castrén looked in the amygdala at neural circuits responsible for fear responses. He found that fluoxetine increased levels of a cell-adhesion molecule associated with young neurons and decreased the levels of a transporter protein associated with adult neurons. He also found greater changes in membrane potential in neurons from the brains of mice that had learned to relax. These neurons were also better at synchronizing their communication through a process called long-term potentiation, which is crucial for learning and memory.

“We know that a combination of antidepressant treatment and cognitive behavioral therapy has better effects than either of these treatments alone, but the neurobiological basis is not known,” Castrén says. “We show a possible mechanism is bringing the network into a more immature and plastic state.”

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Anxiety Treatment: Extreme perfectionism toying with minds

2011-06-15 / Mental Health / 0 Comments

Extreme perfectionism toying with minds

Psychologists think they may have found a catch-all treatment for anxiety, depression and eating disorders.

They say breaking down the habits of Australia’s many ‘clinical perfectionists’ – those who strive for perfection to the point of self sabotage – actually reduces the prevalence of accompanying, destructive disorders.

Twenty-five-year-old ‘Sarah’, as she wishes to be called, knows all too well what happens when perfectionism is taken to the extreme.

She hit rock bottom at the age of 11. Now a professional runner, she is in a much happier place, but says it took a lot of hard work to get there.

“Even as a young child my room was immaculate and I used to line up my stuffed toys in perfect order,” she said.

“My room had to be not touched and I remember I used to get quite upset when my sisters would come in and mess it up.

“Then at school I used to be the first person to want to finish my assignments and get good marks, just going that one step further with my projects.

“I was a high achiever and I wanted to do well. I wanted to push the boundaries. I enjoyed doing it, if you know what I mean, it was just me.”

But Sarah says being perfect wasn’t an easy quest, and by Year Six it began to take its toll.

“I started to withdraw a lot from my family and from school life and I used to get quite worked up so I had, almost like depression, at such a young age,” she said.

“I was striving to succeed in everything and it all became too much.”

I wanted to push the boundaries. I enjoyed doing it, if you know what I mean, it was just me.

Sarah now considers herself a “refined perfectionist”, but admits she is in a constant struggle with her old self.

When congratulated on a recent run she did, her response was: “I was actually disappointed with it… I did meet my goal, but my real goal was not that.”

Healthy versus unhealthy

Professor Tracey Wade from Flinders University, in South Australia, is presenting at an Australian Psychological Society conference in Coolum, on Queensland’s Sunshine Coast, this week.

She says clinical perfectionists have a habit of setting goals which, when met, they put down to being too easy.

“Healthy perfectionism is aiming for high standards, a lot of people do that, but it becomes unhealthy depending on how you manage that process,” she said.

“When you don’t achieve your standards all the time and you criticise yourself, then that tends to become associated with depression and anxiety and possibly eating disorders.

“So unhealthy perfectionists, even when they attain their goal, they think it couldn’t have been hard enough, so they raise the bar a bit higher.

“Healthy perfectionists can take pleasure in their achievements, they’re disappointed when they don’t achieve but they don’t judge themselves as not being worthwhile whereas an unhealthy perfectionist, if they attain their goal they don’t take much pleasure in it and if they don’t attain their goal they criticise themselves as a person and basically see themselves as being worthless.”

Kimberley Hoiles from Curtin University, in Western Australia, is doing her PhD on clinical perfectionism.

She is trialling an eight-week treatment program on a group of 40 self-confessed perfectionists.

Ms Hoiles says the aim is to reduce perfectionism while also reducing anxiety and depression, without specifically targeting those symptoms.

She says she is amazed at how widespread clinical perfectionism is.

“We’re all perfectionist and we all have certain things we do that are a bit funny here and there, but when it starts to interfere in our lives and we start to get anxious or depressed, then that’s when it starts to become more clinical perfectionism,” she said.

“I had this one woman who would spend hours cleaning this room she knew people would be sitting in.

“We did an experiment with her where we asked her to leave a dirty spoon in the sink, and she just couldn’t do it because she was too anxious about it.

“This other man I know was a handy man, in the process of renovating his bathroom.

“He was so anxious about painting the wall and putting the tiles up that he couldn’t actually do it, so he was avoiding doing it, avoiding that fear of failure, so he actually now showers outside.

“Usually perfectionists also have quite dichotomise standards in terms of dieting, so if they eat that one piece of chocolate then they’ve ruined their diet and they become very depressed.”

Unhealthy perfectionists, even when they attain their goal, they think it couldn’t have been hard enough, so they raise the bar a bit higher.
Professor Tracey Wade

Compassion over criticism

Professor Wade says clinical perfectionism is becoming more and more widespread in Australia. She suspects up to 30 per cent of the population may be vulnerable to the disorder.

“I think we have become more of an achievement-oriented society,” she said.

“Particularly schools are focussing on getting students to be competitive and to do well, sports can be quite competitive, so there’s a message out there that you have to be better than the next person.

“Certainly we want people to achieve and to do well but there are different ways of doing it… whether it’s through criticism, or though encouragement and self compassion.”

She too is working on a study of clinical perfectionism, attempting to develop resilience in a group of 1,000 13 to 15-year-olds.

“We have noticed that when we help people to overcome unhealthy perfectionism, it often helps to alleviate other disorders, such as anxiety and depression,” she said.

“It may be that helping to break the unhealthy perfectionism habit is a helpful catch-all treatment.”

Professor Wade says the key to overcoming unhealthy perfectionism is to see failures in context.

“Focus on your whole life and avoid the temptation to define yourself by a list of achievements,” she said.

“Self-compassion and kindness is also important, because criticism and abuse is not the way to get the best out of anyone, including yourself.”

Sarah has her own advice.

“I think a lot of it is to do with managing it,” she said.

“Sometimes when things get really hard in your life you may fall back on those traits initially, but when things settle down you know that that’s not the way to go anymore.

“Sometimes I just need to take a deep breath, and then I’m OK.”

What’s at the root of our tooth anxiety?

From those “teeth falling out” dreams to fear of the dentist, we do a lot of worrying about our pearly (or not-so-pearly) whites. So why all the anxiety about teeth? We’ll drill into it this week.

Read on to find out what’s on the show. You can also listen to the podcast by clicking the player below (or download it here, or from iTunes). (Originally aired Oct. 16, 2010)

If a stranger came up to you on the street and asked you to look into your mouth, would you say yes? What if that stranger was Sook-Yin Lee, and she had a microphone? Tune in to see who opens wide, and who doesn’t. (Also heard on Your DNTO)

A perfect set of pearly whites… that’s the image we’re sold in commercials. Everyone’s supposed to want that. But what if you don’t? Lisa Rundle tells us her story of orthodontic rebellion. (Also heard on Your DNTO)

Former Maple Leaf Todd Warriner tells us what it’s like for a hockey player to lose his teeth… and sports writer James Mirtle chats with Sook-Yin about the culture of “spittin’ Chicklets” in hockey. (Also heard on Your DNTO)

Raina Telgemeier has a lot of experience saying “ahhh.” When she was eleven years old,
she had an accident that led to four-and-a-half painful years of extreme dental treatment.
And she turned her traumatic tooth experiences into a graphic novel called Smile. She’ll tell us why the experience was so life-altering, and how it inspired her art.

Lots of people dislike going to the dentist because of concerns about physical pain. For Erik White, it was more about hurt feelings than hurt gums. He’ll tell us about his falling out with his childhood dentist.

So what’s fear of the dentist like from the other side? Sook-Yin sits down in the reclining chair to ask her dentist, Dr. Goldberg.

It’s the kind of thing that sounds like an urban legend: two teenagers with braces share an innocent (okay, relatively innocent) kiss, and wind up locked together by wires. But Jean Freeman lived that particular story… and she’ll tell us how she got out of it. (Also heard on Your DNTO)

The Tooth Fairy may seem harmless enough… and hey, who doesn’t love finding money under their pillow? But there’s a lot of anxiety around the good ol’ TF – mostly from the parents. Diane Flacks finds out why.

And what is it like for the kids when those chompers drop out? Sook-Yin talks with nine-year-old Max, who really just wants his two front teeth. (Also heard on Your DNTO)

The one-man band known as Bahamas (a.k.a. Afie Juryanen) probably isn’t the first Canadian musician to write an ode to hockey teeth. But he might be the first to write a song about hockey teeth that isn’t actually about missing chiclets. Bahamas will drop by the studio to tell us what the song is really about, and play it for us.

As an adult Jennifer Gee was always a bit anxious about her smile, so she went to see an orthodontist about getting braces. He tried his best to prepare her for all the potential pit-falls
but he forget to mention one pretty important thing… something her high school students took note of. She’ll reveal the one thing you really need to know when you’re getting braces.

Whiter! Brighter! Straighter! Is our quest for “perfect” teeth really healthy? Kirsten Bell has a unique perspective on that, since she’s an Australian ex-pat… and a cultural anthropologist. She’ll tell us what she’s observed about Canadian teeth, and why she thinks a dentist’s office is like a church. (Also heard on Your DNTO)

Most people who have bad teeth try to hide them by keeping their mouth shut, even refusing to smile. But not Jason Jones. He’ll tell us the story of his painfully bad teeth, and what happened when they appeared on the front page of the biggest newspaper in Canada. (And you can check out his before and after pics.) (Also heard on Your DNTO)

Anxiety reduction chemical identified

Researchers have pinpointed the action of a particular brain chemical in a specific area of the brain as key in regulating anxiety.

“We hope our finding will help pave the way for developing more selective treatments for anxiety disorders,” says Janet Menard, an associate professor in the Department of Psychology.

Dr. Menard’s team found that increasing levels of the brain chemical Neuropeptide-Y (NPY) in an area of the brain known as the lateral septum reduces the normal anxiety responses that occur in stressful situations. This discovery suggests that drugs selectively targeting NPY receptors in the brain could be more effective in treating anxiety than current treatment options and be less prone to abuse.

Dr. Menard’s new anxiety regulation findings were published in a recent issue of Pharmacology, Biochemistry and Behaviour.

Other groundbreaking research by researchers in the Behavioural Neuroscience group at Queen’s Department of Psychology includes:

• Richard Beninger, Head of Psychology – the role played by particular brain chemicals in the control of normal behaviour and in disorders such as schizophrenia and drug addiction.

• Cella Olmstead – recently pinpointed the area of the brain that controls impulsive behavior and identified mechanisms that affect how impulsive behavior is learned.

• Hans Dringenberg – how our brains develop during early life and how they continue to adapt and store new information.

• Niko Troje – the function behind the head-bobbing behavior frequently observed in pigeons and other birds.

These brain, behavior and cognition researchers are supported by funding from the Natural Sciences and Engineering Research Council of Canada (NSERC), and have recently benefited from laboratory renovations and infrastructure enhancements facilitated by an equipment grant from the federal funding agency.

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Anxiety Treatment News: Massage Therapy Lessens Anxiety in Mothers of Asthmatic Children

2011-05-27 / Mental Health / 0 Comments

80-year-old dementia sufferer’s ‘undignified’ treatment at Dundee hospital condemned

A Scottish hospital has been condemned over the treatment of an 80-year-old dementia patient who was not given the “care, dignity and respect she deserved”.

The 80-year-old woman, named only as Mrs V, was taken to Ninewells Hospital, in Dundee, with a chest infection in December 2008. She was given an “unacceptably high” number of sedatives over an 11-day period of treatment after she became anxious and distressed, the Mental Welfare Commission for Scotland said.

Staff at the hospital administered sedatives rectally 57 times and by injection 29 times before she died of pneumonia.

The woman’s condition meant she was unable to eat and was given no food. But she could see other people eating and could not understand why she was not, leading to further anxiety and distress.

The Mental Welfare Commission for Scotland said her treatment was degrading, unnecessary, and may have breached her human rights. The commission’s report, Starved of Care, said Mrs V was given repeated, uncomfortable and undignified administrations of sedative medication.

It also said staff did not display “the knowledge, behaviour and attitudes” needed to care for her properly. The report found Mrs V had been agitated and distressed before her transfer to the medical ward.

She thought she should be at home to care for her children. Family members told inspectors she was agitated during their visits and she begged them to take her home with them when they left.

But her agitation was heightened by not being able to eat. The report said: “There was a lack of shared understanding, across medical and mental health services for older people, about the best way to manage people with dementia who become physically unwell while in mental health care.

“We consider that Mrs V was not given the care, dignity and respect she deserved. It can be argued that her rights to privacy and dignity and right to be free from degrading treatment (articles eight and three of the European Convention on Human Rights) were infringed.

“While all members of the care team must reflect on our findings and examine their own individual attitudes and practice, we strongly advise the NHS to examine the performance of individual practitioners.

“Poor clinical decision-making and negative attitudes to people transferred from mental health care appear to have played a significant part in the problems we identified with Mrs V’s care and treatment. We consider that Mrs V’s care could and should have been better managed in an acute medical ward.”

The Dundee hospital, which was not named in the commission report, admitted that the standard of care received was unacceptable.

Dr Margaret McGuire, NHS Tayside director of nursing, said: “The standards of care received by this patient were woefully inadequate, wholly inappropriate and utterly unacceptable.

“Since this event we have initiated a number of service improvement programmes for dementia patients.

“As part of these improvements, we have appointed a nurse consultant in dementia care who is leading improvements in care for our dementia patients and ensuring all members of staff who care for dementia patients have appropriate training and education.”

The commission has revisited the hospital twice since the case and has acknowledged improvements in staff training for dementia care.

Music therapy enhances quality of life for patients with fibromyalgia

University of Granada researchers have proven that music therapy combined with other relax techniques based on guided imagery reduces significantly pain, depression and anxiety, and improves sleep among patients suffering from fibromyalgia. Thus, this therapy enhances patients’ quality of life. This pioneer experimental study in Europe has shown that these two techniques enhance the well-being and personal power of patients with fibromyalgia, who are allowed to take part in their treatment.

This research study was conducted with patients suffering from fibromyalgia from the provinces of Granada, Almería and Córdoba, Spain. They undertook a basal test at the beginning of the treatment, a post-basal test four weeks after the intervention, and another post-basal test eight weeks after the intervention, at the end of the study.

Treatment at home

The researchers applied a relaxation technique based on guided imagery and music therapy to patients, in a series of sessions conducted by a researcher. Patients were given a CD to listen at home. Then, researchers measured a number of variables associated to the main symptoms of fribromyalgia -as pain intensity, quality of life, impact of the condition on patient’s daily life, sleep disorders, anxiety, depression, self-efficiency, well-being. Then, patients were given the chance to participate in their own treatment through an understanding of their condition.

Massage Therapy Lessens Anxiety in Mothers of Asthmatic Children

Asthma is a common, chronic childhood disease, and when a child is asthmatic the entire family’s anxiety levels can rise. New research shows massage therapy lowers anxiety in mothers of asthmatic children.

Researchers set out to determine if learning to massage their own asthmatic children provided relief from anxiety among the children’s mothers, according to an abstract published on www.pubmed.gov.

“Studies showed a relation between the life quality of children suffering from asthma and the anxiety level of parents,” the researchers noted. “These parents are looking for ways to confront their stress, to reduce their anxiety in encountering with their asthmatic children, and to improve their performance.”

Sixty mothers with asthmatic children aged 5 to 14 years were divided into two groups: One that was trained to massage the head, neck, face, shoulder, hand, leg and back of their children every night before bedtime for one month; and one whose children received standard medical treatment.

The researchers found the daily massage sessions reduced the mothers’ anxiety. “Daily massage helped mothers to have more sense of participation in caring their children and as a non-pharmacological method can be accompanied with pharmacological methods,” the researchers wrote. “The results showed no significant difference in mean anxiety level between the two groups before the intervention but there was a significant difference between them after intervention.”

The study was conducted by personnel at the Department of Pediatrics Nursing, School of Nursing and Midwifery, Isfahan University of medical sciences, Isfahan, Iran.

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Mental Health Today: Mental health budget targets youth

2011-05-13 / Mental Health / 0 Comments

Mental health budget targets youth

Prime Minister Julia Gillard has called early intervention the centrepiece of her government’s $2.2 billion commitment to mental health unveiled in Tuesday’s budget.

Ms Gillard said over $400 million will be spent treating mental health issues in youth, when sufferers are most receptive.

Flanked by former Australian of the Year and mental health expert Patrick McGorry, Ms Gillard chatted with students at a Headspace centre in Melbourne’s west on Friday.

“It’s when people are young that they’re most likely to actually confront some of the most serious mental health conditions,” she said.
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“We understand if you can reach out to the community, if you can have people come into a space where they feel comfortable like this one, if we can have them access services early, that can make a real difference.”

The $419.7 million allocation will be spent over five years to triple the number of Headspace centres from 30 to 90.

Those centres will be backed by additional Early Psychosis Prevention and Intervention Centres, which provide more intensive treatment.

Professor McGorry, who pioneered the Headspace concept, said the funding was a huge boost to a “missing stream of care in the health system”.

He said young people suffering mental health issues can heal with timely treatment, and he called the plan the “antidote” to the failed institutionalisation system.

“(This funding) is going to strengthen our country because it’s going to mean that young people can rightfully take their place in the workforce,” Prof McGorry said.

“The big thing about mental health is that it does strike people in the most productive years of life and we’ve just accepted that until recently.”

Prof McGorry said the challenge for the private board of Headspace was to ensure the funds were spent effectively.

“These are precious dollars, as the prime minister said, they’ve been hard won, we’ve got to make sure the implementation stage is done right,” he said.

Headspace acts as a first point of contact for youth, and can provide counselling and referral services.

Labor’s Mental Health Minister Mark Butler confirmed $580 million of the $2.2 billion had been redirected from other mental health announcements.

Mr Butler said the Headspace centres would be set up in areas of need, with communities able to apply to the Headspace board.

No answer yet on mental health recommendations

The province released its official response to Judge Anne Derrick’s report on the death of Howard Hyde on Thursday.

But neither the minister of justice nor the minister of health could say how many of Derrick’s recommendations will be accepted.

Instead, the 50-page document, billed as Building Bridges, breaks up the 80 recommendations made by Derrick in December into five thematic thrusts.

Those themes — training, collaboration, use of force, supports within the criminal justice system, and mental health services — include “actions,” some already announced and underway.

“We need to be able to reassure people in this province who either have a mental health disorder or are concerned about these issues,” Health Minister Maureen MacDonald said at a press conference.

“The purpose of this response is designed to put in place, fill gaps, services, better training, better communication, better collaboration between (the departments of health and justice).”

How that collaboration will look will largely have to wait until the province releases its mental health and addictions strategy this fall.

Until then, there are few details, including any new investments available.

Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia, called the response an “excellent first step.”

“There’s a lot of work to be done yet, particularly the development of a mental health strategy for Nova Scotia,” said Ayer.

“We are waiting for that, and obviously, that’s going to be an important document in terms of how they’re going to move forward in terms of resourcing additional funds for mental health.”

Macarthur mental health groups welcome Federal Budget’s $2.2 billion

MACARTHUR mental health support group Beautiful Minds has applauded the $2.2 billion five-year mental health package announced as part of the Federal Budget last Tuesday.

Beautiful Minds founder Sandra McDonald congratulated the government on its investment but questioned how much funding would be poured into the Macarthur region.

“Mental health is such an under-funded area so to get an extra $1.5 billion will help address this serious lack of funding in our health system,” she said.

“People with mental illness need to be treated fairly so it’s great to see this funding coming through but I want to know how much of that will flow through to the Macarthur region.”

Mrs McDonald said staffing of mental health facilities was a big issue which needed to be addressed with the new funding. She said the Campbelltown Community Mental Health Centre had 60 staff catering to 2000 clients.

“We have such a need out here for that funding and I’d like to see additional staffing out here to help deal with mental health issues,” Mrs McDonald said.

City mental health clinic in default on bank loans

One of Baltimore’s largest providers of drug treatment services is in default on loans of up to $2.5 million, its bank says, raising questions about the financial well-being of a clinic that treats hundreds of addicts in the city.

Bank of America is suing Baltimore Behavioral Health Inc. for access to its financial records, alleging that the West Pratt Street clinic is in default and has refused to provide “critical financial information.” The bank also claims that clinic funds paid for board members’ monthly spa services, boat repairs and personal mortgage payments, an accusation that one BBH board member dismissed as unsupported “hype.”

The bank’s lawsuit, filed April 29 in Baltimore Circuit Court, is the latest in a string of recent challenges for BBH. Its revenue has dropped sharply since late 2009, when state mental health officials clamped down on its ability to bill for high-cost treatment, leading to layoffs and prompting the clinic to seek a buyer for its campus.

In late December, the U.S. Department of Labor opened an inquiry into BBH’s employee retirement plan after former workers said money deducted from their paychecks as far back as 2009 never reached their retirement plan accounts. A department spokesman this week declined to comment.

BBH, a private clinic that has received $65 million in government payments over the past five years, specializes in treating patients with both mental illness and drug addiction, mostly billing the Medicaid program for the poor and disabled. It says it treats 150 people a day, down from 225 a year ago.

The clinic was the subject of a Baltimore Sun investigation last year that revealed unusually high Medicaid billings and detailed the nonprofit organization’s control by several family members earning six-figure salaries.

Terry T. Brown, a BBH vice president, said the clinic remains committed to treating patients at its Southwest Baltimore campus. To raise needed cash, BBH hopes to sell its buildings and then lease back some space, he said. The adjacent B&O Railroad Museum has shown interest in buying the property.

“I’m hoping we’re viable to withstand the changes in our economic situation,” Brown said.

Bank of America says it is demanding access to the clinic’s books to conduct an audit. It claims the clinic has denied bank officials their contractual right to review those financial records for the past nine months.

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Mood Disorders Treatment Today

2011-04-29 / Mental Health / 0 Comments

Demi Lovato Reflects on Time at Timberline Knolls

Tucked away in a secluded woodland area off New Avenue, Timberline Knolls Residential Treatment Facility enjoys a relatively quiet existence, often going completely unnoticed by local residents.

Last November, however, a number of Internet sites reported that the Lemont facility was playing host to a high-profile patient—18-year-old Disney star Demi Lovato.

At the time, Lovato’s representatives said she had left a tour with the Jonas Brothers to receive treatment for “emotional and physical issues she has dealt with for some time.”

Recently, Lovato opened up about her experiences in interviews with People magazine and ABC’s 20/20, admitting she had received treatment at Timberline Knolls for cutting, bulimia and anorexia.

She also learned she was suffering from bipolar disorder, she said.

“I had no idea that I was even bipolar until I went into treatment,” she told Robin Roberts during the 20/20 interview that aired Friday.

From Oct. 30 to Jan. 27, Lovato received intense in-patient treatment at Timberline Knolls, which specializes in the treatment of eating disorders, substance abuse and addiction, and mood disorders in women.

“I worked harder in those three months than I ever did in my life,” Lovato told People. “I basically went through hours of therapy every day. … It was a battle, but I stuck it out.”

Since completing treatment, Lovato continues to work with a therapist nutritionist and sponsor in Los Angeles, People reports. She recently announced she was leaving her Disney Channel show, Sonny With a Chance, to focus on music and her recovery.

“I’ve never been more peaceful or happy in my life,” Lovato said. “What’s important is to help others get to this place.”
Timberline Knolls

Timberline Knolls is a 43-acre facility located in Lemont. It was founded in 2005 by a team of psychiatrists, psychologists and clinicians as an in-patient treatment center for women dealing with trauma, eating disorders and drug addiction.

“Our residents — adult women and adolescent girls — come to us when they need immediate, life-saving and life-changing help,” according to the center’s website. “Our vision is to help residents achieve lifelong recovery by bringing together clinical treatment with spiritual and emotional growth.”

In February, Timberline Knolls observed National Eating Disorders Awareness Week by hosting a number of special programs and guest speakers to “educate the public on eating disorders and body image issues while reducing the stigma surrounding eating disorders and improving access to treatment.”

New guidelines for assessing tic disorders

Clinical guidelines from the European Society for the Study of Tourette Syndrome have emphasised the importance of comorbid psychiatric disorders in assessing patients with Tourette’s and other tic disorders.

“Tic disorders represent a range of tics and co-existing symptoms with a varied and heterogeneous presentation,” the guidelines state.
“In most situations, a standard interview with a few additional questionnaires and rating scales are sufficient to guide diagnosis and treatment.

However, psychiatric comorbidity occurs in more than three-quarters of cases that are referred for specialised care.”

Attention deficit hyperactivity disorder is the most common comorbidity — occurring in up to 60 per cent of childhood and adult cases — followed by obsessive compulsive disorders, anger control problems, sleep disorders, learning disorders, mood disorders, anxiety disorders, and conduct and oppositional-defiant disorders.

Self-report scales can help to provide general information on psychopathology. The Child Behaviour Checklist can be completed by parents, and self-report questionnaires can be completed by adolescents. A range of tic-specific instruments are available, including the Yale Global Tic Severity Scale and the Shapiro Tourette Syndrome Severity Scale.

“The features that distinguish tics from other movement disorders — with the exception of akathisia [restless legs syndrome] and psychogenic movement disorders — are 1) the ability to suppress them for a while, and 2) the patient’s experience of tics as a (partly) voluntary movement to relieve an inner tension or premonitory focal sensory sensation.”

Neuropsychological assessment can be useful because of the high prevalence of learning disorders in children with tics. It can define the problems arising from the underlying disorder, and those resulting from the disruption caused to education.

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Anxiety Treatment News

2011-04-15 / Mental Health / 0 Comments

End of Chemo Treatment, Relief or Anxiety?

There is no question that completing a course of chemotherapy treatment is a milestone in the life of a patient. Tomorrow, my 89-yr-old mother will receive her sixth and final dose of chemotherapy for lymphoma. She was initially hesitant about chemo and the effects it would have on her but eventually agreed to go through treatment. As she approaches her final dose, I honestly wonder whether it’s time for celebration or anxiety.

Chemotherapy gives the patient the ability to confront cancer cells head on. The possible side effects are a reminder that the toxins are doing their job and crushing the cancer cells. The chemotherapy has been a ‘body guard’ of sorts for my Mom, attacking her tumor with a prescribed course of action. After tomorrow, my Mom will part ways with this powerful partner and protector and be on her own. Without the toxic soldiers on her side, I imagine she might feel vulnerable, anxious, and alone. My role as her caregiver and advocate will change again as I encourage and support her as she gets back to living life as a cancer-free woman.

Cognitive behaviour therapy (CBT) for anxiety and depression in adults with mild intellectual disabilities (ID): a pilot randomised controlled trial

Several studies have showed that people with intellectual disabilities (ID) have suitable skills to undergo cognitive behavioural therapy (CBT). Case studies have reported successful use of cognitive behavioural therapy techniques (with adaptations) in people with ID.

Modified cognitive behavioural therapy may be a feasible and effective approach for the treatment of depression, anxiety, and other mood disorders in ID. To date, two studies have reported group-based manaulised cognitive behavioural treatment programs for depression in people with mild ID.

However, there is no individual manualised programme for anxiety or depression in people with intellectual disabilities. The aims of the study are to determine the feasibility of conducting a randomised controlled trial for CBT in people with ID.

The data will inform the power calculation and other aspects of carrying out a definitive randomised controlled trial.

Methods: Thirty participants with mild ID will be allocated randomly to either CBT or treatment as usual (TAU). The CBT group will receive up to 20 hourly individual CBT over a period of 4 months.

TAU is the standard treatment which is available to any adult with an intellectual disability who is referred to the intellectual disability service (including care management, community support, medical, nursing or social support). Beck Youth Inventories (Beck Anxiety Inventory &Beck Depression Inventory) will be administered at baseline; end of treatment (4months) and at six months to evaluate the changes in depression and anxiety.

Medication Plus CBT Effective for Anxiety in Primary Care

Cognitive behavior therapy (CBT) in combination with psychotropic medication is highly effective for treating most anxiety disorders in primary care, new research suggests.

In a study of more than 1000 patients, those who underwent the Coordinated Anxiety Learning and Management (CALM) collaborative care program had significantly decreased symptoms of principal generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD), and comorbid SAD than did those randomized to receive usual treatment from their primary care physician.

“The purpose of this study was to address disorder-specific outcomes for each participant’s constellation of anxiety disorders,” write Michelle Craske, PhD, from the Department of Psychology at the University of California, Los Angeles, and colleagues.

They note that the study was designed to compare the CALM intervention and usual care for both principal and comorbid disorders “while mimicking real-world conditions” — and is the first to do so in a generalizable sample population.

The study is published in the April issue of Archives of General Psychiatry.

Learning to Stay CALM

The investigators note that it is common for people with anxiety disorders to seek treatment in primary care, “where evidence-based mental health treatments often are unavailable or suboptimally delivered.”

For this study, 1004 patients (70.9% female; mean age, 43.7 years) diagnosed as having GAD (n = 549), PD (n = 262), SAD (n = 132), or posttraumatic stress disorder (PTSD; n = 61) were enrolled at 1 of 17 primary care clinics in Seattle, Washington, San Diego, California, Los Angeles, California, or Little Rock, Arkansas, between 2006 and 2008.

The patients were randomized to receive either the CALM intervention (n = 503) for up to 12 months or usual care (n = 501).

Usual care consisted of continued treatment of medication and/or counseling by the current primary care physician and referral to a mental health specialist, if needed.

The CALM intervention included pharmacotherapy, computer-assisted CBT, or both, depending on patient preference.

“Given the relative dearth of highly trained mental health providers available in primary care settings, we designed the CBT program to be used by persons with minimal or no training in mental health,” report the researchers, adding that that the computerized program was developed to guide both the provider and patient.

The collaborative care pharmacotherapy model allowed patients to continue being treated by their primary care physicians while healthcare managers or anxiety clinical specialists relayed advice from psychiatrists and helped manage medications.

All study participants were evaluated at baseline and at follow-ups conducted by telephone survey 6, 12, and 18 months later.

Measurement tools included the Generalized Anxiety Disorder Severity Scale, Panic Disorder Severity–Self-report Scale, Social Phobia Inventory, and PTSD Checklist–Civilian Version. These tools for used to assess both GADs and comorbidities.

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Mental Health News

2011-04-12 / Mental Health / 0 Comments

Governor expects state to take over costs of mental health services

Governor Branstad expects that over the next four years, the State of Iowa will gradually take over the delivery of mental health services in Iowa — and pay most of the bills, too.

Branstad’s Department of Human Services director has been meeting with legislators of both parties since January to devise a new system that would replace the current hodge-podge of services for Iowa’s intellectually disabled and mentally ill citizens.

“It may well cost some more money, but I think the focus ought to really be on providing the best services, making sure they’re accessible everywhere in Iowa, that we have a uniform system that also provides assistance and treatment for people as close to home as possible.”

Iowa’s 99 counties currently manage and pay for much of the mental health care that’s available in Iowa. Lieutenant Governor Kim Reynolds says one of the problems, however, is that rural Iowans who’re suffering from a mental illness don’t have help nearby.

“Essential services exist only in a few counties,” Reynolds says.

Governor Branstad envisions expanding “telemedicine” services, so rural Iowans could talk with a psychiatrist via video conference. Branstad also expects to provide new state incentives to psychiatrists. “We have a shortage of psychiatrists in the state of Iowa,” Branstad says.

“We need to do more in terms of having more residencies and more opportunity to get that training in the state so they’re more likely to stay here.” A southeast Iowa deputy sheriff was shot last week by a man who had been diagnosed with bipolar disorder, an incident that has been cited by some legislators as an example of why it’s time to address the disparties in the state’s mental health care system. Branstad says there’s no “easy, simple” answer.

“This is an issue that needs to be handled in a very thoughtful way and I think we need to recognize even with the reforms and changes we’re talking about, there’s no assurance that’s going to prevent some tragic incidents like these from happening in the future,” Branstad says.

“But we certainly need to do all we can and we need to make sure the public is also aware of mental health issues and that we’re able to reach out and help people that have problems so we can prevent tragedies as much as possible.” The top Republican in the legislature describes the state’s current mental health care system as a “patchwork quilt” that lacks uniformity.

The top Democrat in the legislature says helping ensure Iowans have access to mental health services “at the local level” is key.

On another topic, the governor says he’s had “several discussions” about a bill which would allow utilities to begin collecting money from customers to finance a possible nuclear power facility in the state. Governor Terry Branstad says he’s confident state regulators would have the ability to monitor the situation and protect rate-payers.

“I think there’s a critical need for us to look at how we can, in the future, meet the additional energy needs of the state of Iowa,” Branstad says. “And I think we should be open to considering things like clean coal and nuclear as well as natural gas and wind, and the other sources that we have.”

Critics say utility customers might see double-digit increases in their bills as MidAmerican examines the possibility of building a new nuclear power facility in Iowa, with no guarantee the facility would eventually be built. Branstad says the bill legislators draft should ensure the Iowa Utility Board has the direct “responsibility to regulate” the rate increases associated with a new nuclear power plant.

“Remember, this is a long, involved process. As I understand it, it would be eight or nine years (before the facility is built),” Branstad says. “But we do need to think ahead and as we work to revitalize the economy and bring more business and jobs here, we want to make sure that we have affordable…power available for our citizens and we want to do it in a way that also is environmentally safe as well.”

A.A.R.P. held a news conference this morning to denounce the bill pending in the legislature, saying it fails to protect utility customers from astronomical increases in their power bills.

Move for smaller veterans mental health clinic

The U.S. Department of Veterans Affairs is taking steps to create an out-patient mental health clinic in Fort Wayne, with a budget request for $2.85 million in the coming federal fiscal year and a projected opening in March 2015.

It’s greatly scaled back from a now-scrapped 2009 plan for a $60 million, 200,000-square-foot veterans health facility in Fort Wayne.

The new plan calls for a 27,000-square-foot facility.

An aide to Republican U.S. Rep. Marlin Stutzman of Indiana said that the congressman and his staff have been talking about the project with officials from the Department of Veterans Affairs.

Stutzman chief of staff Tim Harris told The Journal Sentinel that the project is “in the early stages.”

The 2012 budget request includes $1.49 million for design and construction costs and $1.36 million for annual rent.

“It’s our understanding it’s a very positive step that it is where it is,” said Harris. “That doesn’t mean it’s a done deal.

“Where it is, we understand, is a good sign. What this says is the Fort Wayne facility has moved up on the priority list.”

At a hearing last Tuesday of the House Committee on Veterans’ Affairs, Stutzman asked department officials where the project stood.

“It is our experience that on sizable projects such as that, it’s typically better to construct new in order to get the functionality and capabilities and meet energy requirements,” said Robert Neary, acting director of the department’s Office of Construction and Facilities Management. “If there were a facility available in the area, we would look at it.”

Neary said that after the project is authorized, the department must search for and identify a site, obtain a purchase option and award a development contract for the clinic to be built and leased back to the VA for 20 years.

The Department of Veterans Affairs said in its 2012 budget proposal that it expects an increasing demand for mental health services even as the number of war veterans in the region declines.

4000 candles lit for mental health action

FOUR thousand candles on the lawns of Canberra’s Parliament House spell out a message to the federal government: “Fund hope for mental health”.

In the lead-up to the budget, campaigners are ramping up their plea for the government to make a real difference to the 4.4 million Australians with a mental illness.

And it appears the government is listening.

Mental Health Minister Mark Butler, who helped light one of the 4000 tea lights today, said the government was aware of a growing demand for action.

“There is no doubt that over the last year that sense of uneasiness has gotten a shift and a focus that it didn’t have before,” he told the small crowd.

“Their expectation (is that) their nation needs to do better on mental health.”

Mental health rated as the third most important issue among 1000 Australians interviewed for a survey, behind climate change and the economy, he said.

Labor has vowed to make mental health a priority in its second term of office.

Mental health advocates Ian Hickie and Patrick McGorry, the 2010 Australian of the Year, said Australians should expect a big investment from the government come the May 10 budget.

“There’s absolutely no excuse for not moving on this issue despite all the other atmospherics that are around at the moment,” Professor McGorry said.

But it can’t be expected to go it alone, with Prof McGorry urging the states to do their bit.

The 4000 candles each contained a dedication made by a member of lobby group GetUp!, in tribute to someone affected by a mental disorder.

Mr Butler was also handed a petition signed by 104,052 Australians urging the government to act.

Richmond to Begin Mental Health Court

The Richmond City Jail currently holds more than 1400 inmates. The jail was built to hold half that amount. Richmond Sheriff, C.T. Woody says overcrowding has been a problem for years and one way to fix it, is by getting rid of people who don’t belong there, like the mentally ill.

“The jail isn’t a place for them. They should be in a mental health facility. We can only give standard care. Standard care is not enough for those who are mentally ill,” says Woody.

Nearly twenty percent of those incarcerated at the City Jail are dealing with some form of mental illness and Sheriff Woody says because his staff can’t properly treat those inmates, it makes their job more dangerous.

Those defendants who are mentally ill will have a chance to get evaluated and then, a Richmond judge will have the option of recommending that person be placed under supervision, get treatment at a mental health facility or face jail time.

Sheriff Woody says proper treatment is essential because, “no one who has a mental health condition, that is violent, will be put back out there in the community.”

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