Healthy Minds. Healthy Lives.

Living in the Moment with Mindfulness

2012-01-11T12:06:00.001-05:00

By Brandon Cornejo M.D., Ph.D.

I hope your first week of 2012 was a good one! How are those New Year's resolutions going? If your goal is to exercise more, my "Mindfulness" two-part blog post should help you stay motivated. In part-one of my post, I discussed the concept of "mindfulness" or living in the moment.

Now I will share how you can use mindfulness to stay focused on a particular goal like exercising. Since exercise and mindfulness enhance mood, decrease stress, and improve negative thinking, these tips will benefit us all as we enjoy 2012!

Tips for staying in the present moment while exercising:

·         One of the most basic tools that you can use in mindfulness is your breathing. By focusing on the sensation of air traveling in and out of your body (just like you do during meditation), you can be grounded in the present moment.

·         You may also try a mantra to stay in the "now" (for example, runners often count out their footsteps – “1, 2, 3…1, 2, 3” – or a mountain biker or skier may constantly remind themselves to “relax”).

·         Applying either technique will keep you in the moment rather than thinking about negative thoughts and feelings that influence behavior in a non-productive fashion during your exercise.

·         Paying attention to physical feelings of your body and your surroundings as you exercise will prevent you from going into “automatic pilot” (when you act and react without conscious awareness).

·         By learning to stay present, you can accept physical discomfort as a temporary state that will soon pass.

·         As you continue your workout, you can “label” both positive and negative thoughts that occur while exercising. Labeling these thoughts will help you understand which thoughts and feelings are limiting your success and need to be changed.

Try out some of these tips and see how you start removing unwanted negative thoughts to overcome challenges that may have held you back in the past. Mindfulness matters when it comes to achieving that New Year's resolution this year.

Keeping Your New Year's Resolution with Mindfulness

2011-12-29T15:52:00.003-05:00

By Brandon Cornejo M.D., Ph.D.

How many of you are trying to get yourselves back into a regular gym and exercise routine for your New Year's resolution? When it comes to exercise, one of the biggest challenges is staying motivated and consistent. I hope I can help you with this two-part blog post on "Mindfulness."

What is Mindfulness?

Mindfulness is a nonjudgmental, present-centered awareness in which each thought, feeling, or sensation that arises is acknowledged and accepted.

Mindfulness as a Therapeutic Approach

Mindfulness based stress reduction means to focus your attention on the "now."

People practicing mindfulness work on not judging or evaluating the present moment but focus on simply “being” present.

People in a formal mindfulness class engage in daily meditation along with skill-building homework that ties them to the “here and now.”

How Does Mindfulness Work?

Mindfulness allows a person to pause calmly and reflectively before reacting to things.

Mindfulness may prevent relapse of clinical depression by allowing a person to have some “space” between who they are and their emotions.

Mindfulness based cognitive therapy (MBCT), a form of therapy that combines elements of mindfulness with cognitive based approaches to treatment, can be an effective approach for the treatment of anxiety or depressive disorders.

Mindfulness may enhance mood as well as help eliminate negative thoughts associated with depressive states.

So why is "mindfulness" important to keeping that New Year's resolution of daily exercise? Next week, I will post part two with my tips for staying in the present moment while exercising. Happy New Year's!

How to "Bully-Proof" Kids

2011-12-01T13:11:00.005-05:00

By Gariane Phillips Gunter, M.D.

Do you think October's national anti-bullying campaign was successful in stopping bullies? The Washington Post recently blogged about our country having a hard time defining bullying among kids. So, what can we, as parents, do to protect our children and teens? Here are some tips for "bully-proofing" your kids:

Distinguish between events and feelings - It is important to teach your children the difference in their interpretations of life situations. This helps kids learn to understand and relate to the feelings of others. They will be able to determine if someone is treating them appropriately - or if they are, in fact, being bullied.

Develop a sense of self - Another great way to bully-proof your child is to help them develop a sense of self. Encourage them to learn about and understand who they "are" because children who struggle to identify self-awareness or constantly strive to be their "hero" are never going to be able to live up to those expectations. This can be detrimental for their self-esteem - making them a direct target for bullying. Kids with low self-esteem are less likely to stick up for who they are which makes them prime targets for those looking to pick on someone (bullies often bully due to their own low self-esteem).

Monitor their online lives - Parents or caregivers should have access to online accounts and cell phones to ensure their teens' safety over the Internet. Cyberbullying continues to be a nationwide epidemic.

Positive activities - It is also important to encourage your kids to explore activities that make them feel good about themselves. Find something that they are really good at because it will help increase their overall self-esteem and feeling of self-worth. Encouraging courageous behavior is another great way to guide children. You can teach them to stand up for themselves and for their peers and other friends. When groups of kids or teens stand together to put an end to a bullying situation, the bully is more likely to back off and won't mess with your child again.

Following these tips when your kids are young is the best way to show them how to establish early on that they will not tolerate bullying.

Sources: http://www.makebeatsnotbeatdowns.org/, http://www.olweus.org/

Female Athlete Triad: Sport Gone Bad

2011-10-20T12:17:00.001-04:00

By Claudia L. Reardon, M.D.

Psychiatrists encourage nearly everyone to participate in sports and exercise. Sports not only improve physical health but also can greatly improve mental well-being. However, if girls and women take involvement in sports too far, they can suffer a well-described triad of symptoms. The so-called female athlete triad consists of the following three inter-linked health problems:

Insufficient caloric intake/disordered eating
Menstrual problems
Weak bones

Girls and women who participate in “leanness sports” that emphasize thinness (running, ballet, gymnastics, figure skating, and others) are particularly at risk. If they receive the message that being thinner could result in greater athletic success, they may try to cut down on their caloric intake to levels too low to support their levels of physical activity. This can result in full-blown eating disorders, irregular menstrual cycles, and weak bones (including osteoporosis at young ages).

Some common myths about the female athlete triad include the following:

If an athlete’s performance has not started suffering, then she must not have a problem. FACT: Even if an athlete’s performance has not started suffering, it eventually will. Not taking in enough calories to match activity level is not sustainable in the long-run.
It is normal for female athletes to stop menstruating. FACT: It is never normal for a female athlete to stop menstruating. There are serious health risks, especially bone loss, to not menstruating. Studies show that after three years of not menstruating, bone loss is likely to be permanent. Loss of future reproductive function could also occur.
If an athlete is not eating enough to match activity level, she is aware of what she's doing. FACT: Denial is powerful. Athletes will very often feel that they are being as healthy as possible, and that meticulous attention to diet is a sign of dedication to sport. Coaches, parents, and professionals will need to help the athlete see the problems with the behaviors.
An athlete who eats “healthy," is a top performer on the team, and excels in class is unlikely to have an eating disorder. FACT: Traits that are desirable in an athlete can make them more at risk of developing an eating disorder. Mental toughness, pursuit of excellence, performance despite pain, commitment to training, and being a team player are very similar to excessive exercise, perfectionism, denial of discomfort, and being self-less.

What can you do if someone you know might be suffering from the female athlete triad?

Share your concerns with the athlete.
Talk with the coach, athletic trainer, or school counselor.
Encourage the athlete to see a physician and dietitian. Not all health care professionals are familiar with the details of the female athlete triad; to help them out, you can send along this brochure with the athlete to the appointment.

Should your Doctor be your Friend?

2011-10-18T12:21:00.001-04:00

By Jeffrey Borenstein, M.D.

Last Friday, October 14th, I was asked to be a guest on the Dr. Drew show to address the important issue of the doctor-patient relationship. Our discussion centered on the friendship between Dr. Conrad Murray and Michael Jackson and the inappropriate crossing of boundaries.

First and foremost, the doctor-patient relationship is special, centered on trust, caring, and helping. But it is not a friendship – friendships are two way streets. The therapeutic alliance in the doctor-patient relationship is a one-way street – the doctor’s role is to help the patient.

Another issue we discussed was “doctor shopping." When a person who has a diagnosis of chemical dependency gets prescriptions from various doctors in order to misuse medications, typically pain meds or anti-anxiety meds (benzodiazepines), it's called "doctor shopping." When a physician is aware of this behavior or even suspects "doctor shopping," it's the doctor's duty to take action and stop filling prescriptions rather than enable such destructive behavior.

If you have a friend or family member misusing medication in this way, don’t sit by quietly. Taking appropriate action could save a life. Encourage your loved one to seek appropriate treatment. On the Healthy Minds Public Television series, we have two episodes which focus on chemical dependency, episodes #111 and #112 which can be seen at www.wliw.org/healthyminds.

The Significance of a Sleeping Brain

2011-09-27T14:59:00.004-04:00

By Sara Coffey, D.O.

As a mother of a newborn, "sleep" is an increasingly interesting and important topic in our household. Not only for my baby, but for my husband and myself - which brings me to the book Healthy Sleep Habits, Happy Child by Dr. Weissbluth. Since I'm a psychiatry resident as well as a mom, I'm especially drawn to Dr. Weissbluth's discussion on studies showing sleep linked to temperament and attention in children.

Children need sleep in order to develop. A sleeping brain is more than just a resting brain; it is a brain that's able to restore, process, and complete essential tasks that an active awake brain is unable to do. Dr. Weissbluth explains that for young infants, daytime sleeping or naps can help to enhance the brain’s capacity to think. When we become adults, our busy schedules cause us to forget the importance of these daytime respites and restorations. Our hectic grown-up days may not always allow naptime, but naps are essential to raising healthy infants and kids.

The significance of sleep doesn't only apply to young children. Did you know that teenagers need more sleep than pre-teens? So, to all parents who are noticing behavior problems, irritability, decreased concentration, or other changes in your children's moods, focus on their sleeping habits. HealthyMinds.org blogger Dr. Gariane Gunter shares how many hours of sleep a child needs according to his or her age in this post. I've included some of her tips below:

Birth-6 Months: Children need 16-20 hours
6-12 Months: Children need 14-15 hours
Ages 1-3: Children need 10-13 hours
Ages 3-10: Children need 10-12 hours
Ages 11-12: Children need 9-12 hours
Teenagers need 10-12 hours of sleep per night

Live Longer by Making Mental Wellness Your Mission

2011-09-19T13:28:00.024-04:00

By Felicia Wong, M.D.

September is National Recovery Month, and this year, SAMHSA announced the first National Wellness Week (September 19-25, 2011) to show why "wellness" is so important. Did you know, people with mental and substance use disorders die decades earlier than the general population, mostly due to preventable medical conditions?

Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues. In May, I suggested using these tools to cope better with stress and boost your overall well-being. Here's my "Top 8 Tips for Mental Wellness;" I hope you will take another look and share with your loved ones this week.

1) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.

2) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.

3) Stay Positive. Positive emotions can boost your ability to bounce back from stress.

4) Get Physically Active. Exercise can help relieve insomnia and reduce depression.

5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.

6) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.

7) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.

8) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.

Which tips on this list are missing in your life? Today is the perfect time to take action! Your wellness matters.

Helping Others Helps Your Mental Health: Why Volunteering Makes Us Happier

2011-09-06T15:15:00.006-04:00

By Roberto Blanco, M.D.

I had just sat down for Dr. Norden’s Neuroanatomy class when one of my classmates, who had just walked into lecture late, announced he heard on the radio that a plane had crashed into one of the World Trade Center Towers. As was her way, Dr. Norden showed immediate concern, and before I knew it, we were watching another plane fly into the second tower live on CNN in the front of the lecture hall. It was a surreal scene in Light Hall on Vanderbilt’s Medical campus; one that I did not expect to experience. The rest of the day was a blur of events and emotions – people in a state of shock, tears shed, classmates comforting each other, and Dr. Norden attempting to put things in perspective. Class was dismissed for the day, and the rush to call loved ones in New York City and Washington, D.C. began. My thoughts immediately turned to family members who lived in New York and worry when I was unable to reach them.

10 years ago, the world of every American changed. In response, the country and the world came together in support of the victims of the terrible tragedy. People from far and wide drove, some for thousands of miles, to reach New York City and care for complete strangers. People sacrificed their time, sweat, and a good portion of their lives and livelihoods to help those in need. Donations flooded in to support the victims’ families. A rush of prayers, love, and aid from across the globe also streamed in for those affected. It seemed that the world was one in giving to those who had lost.

I recently wrote a blog post here on happiness, human fulfillment, and flourishing. In that posting, I discuss human fulfillment and flourishing as the real definition of happiness and the final aim of all of what we do. A great way to help yourself and your own mental health is to help others. Feeling useful and needed is a wonderful way to work towards human fulfillment and recognize all you have for which to be grateful. Serving others is a sign of individual and community emotional health. Volunteering your time and talents also leads you to finding the love within yourself that you didn’t know you had. When faced with those who have lost and are truly in need, just like on September 11th, the true beauty of mankind comes out.

For Sunday's 10th Anniversary of September 11th, President Obama is calling for a national day of giving in memory of those who passed during the attacks. His goal is to have over 1 million Americans engaged in volunteer work on September 11th. The American Psychiatric Association has joined "Give an Hour" in aid of military members, veterans of Iraq and Afghanistan, and their families as part of the “I will” campaign to encourage that same spirit of service that was felt in the days following the attacks. So, think about joining us in giving by helping build a house for a needy family through an organization like Habitat for Humanity. Volunteer to distribute food or give to your local food bank. Help a friend move. Donate time or resources to a homeless shelter, spend time with the elderly, or serve at a local hospital. This September 11th, let’s honor those who died by helping a member of your community in need.
In photo: Dr. Blanco and another volunteer work together to build a home through Habitat for Humanity

Mental Illness or Muse? Amy Winehouse and Historic Artists with Bipolar Disorder

2011-07-29T13:31:00.004-04:00

By Mohammad Alsuwaidan, MD

We have no doubt lost a profound musical talent in the tragic death of Amy Winehouse this week. Her public struggle with substance abuse and bipolar disorder (commonly known as manic depression) has reignited curiosity about possible links between creativity and mental illness. In such unfortunate circumstances, it serves well to draw upon the lessons of history in making meaning out of sorrow.

A little more than 120 years ago, a misfortune befell another budding talent. A young painter entered a psychiatric hospital in Saint-Rémy-de-Provence, Southern France. Known by his neighbors in town as “fou roux" (the crazy redhead), he had been troubled with mental illness throughout his life. A few months prior, he had reached a crisis point and during his breakdown, he rushed to a brothel to see his friend - a prostitute named Rachel. He handed her a small wrapping of newspaper - telling her to “keep this object carefully” and ran off. Unwrapping it, she was shocked to find the freshly cut and still bloody lower portion of his left ear!

Vincent van Gogh holds legendary status in Art and his influence has crossed cultures and eras. To gaze onto the vivid colors and hypnotic swirls in his work is to be transported into another world - a morphed view of reality that can only be seen through his eyes. There is a tendency to romanticize van Gogh’s mental illness – which most respected psycho-biographers believe to have been bipolar disorder.

The notion that there is a fine line between creative genius and “craziness” is not new and has existed since ancient times. Most of this interest has focused on bipolar disorder; many famous figures have been speculated to have suffered from this mental illness: Beethoven, Edgar Allan Poe, Emily Dickinson, Victor Hugo, Charles Dickens, Edvard Munch, and many more. We continue to see this pattern in the modern day among celebrated actors, poets, painters, and musicians like Ms. Winehouse. Yet, despite our modern methods, illuminating the “line” or “link” between mental illness and creativity remains elusive. Studies show that a certain level of melancholy or mixed emotions may be needed to access the creative spring. Unfortunately this negative emotion may also underlie some of the symptoms seen in bipolar disorder.

Herein lies the eternal dilemma in the field of medicine – balancing benefits of treatments against their risks. Could some bipolar treatments dampen the creative drive? The evidence, both anecdotal and empirical, says yes.

Yet research also reveals that when individuals with bipolar disorder receive treatment, their overall productivity, focus, and organization improve. We know that the poet Robert Lowell produced the largest portion of his work after receiving lithium treatment for his bipolar disorder. And though some critics argue that his “pre-lithium” work is more striking in its poetic beauty, they admit that had it not been for the stabilizing effects of his treatment leading to many more – still beautiful – poems, we may have never known Lowell and his artistic mastery at all.

The message to mental health professionals is clear in my mind; we should attempt to treat highly-creative individuals with mood disorders with all the latest advancements including medications. BUT we should listen carefully and work with our patients to understand what effect treatment is having on their creative drive. Perhaps some individuals need some degree of discontent to “kindle the creative fire,” and we should step up to the challenge of helping them achieve a tolerable and productive balance.

At the young age of 37, after a manic episode of creating many paintings, Vincent van Gogh walked into an empty field outside his home, aimed a loaded revolver into his chest, and pulled the trigger. His famous last words, as he lay dying in his brother Theo’s arms, were "La tristesse durera toujours" (the sadness will last forever).

Perhaps had he not suffered some degree of sadness, you and I would have never heard of van Gogh. Perhaps had he lived longer, his influence would have been even greater. Perhaps the next van Gogh or Poe or Winehouse will walk into a mental health clinic next week suffocated by their sadness, yet possessed by creative inspiration. The questions are complex scientifically, ethically, and philosophically. But I believe that a balance can and should be reached (or at least approached) and that tragic endings can be re-written.

Dr. Mohammad Alsuwaidan is a psychiatrist with expertise in Mood Disorders at the University of Toronto and a Master of Public Health candidate at Johns Hopkins University. Learn more: http://www.mohammadalsuwaidan.com/

References:
KR Jamison, Touched with Fire: Manic Depressive Illness and the Artistic Temparment, Free Press Paperbacks (New York 1993). p.85
AW Flaherty, Frontotemporal and Dopaminergic Control of Idea Generation and Creative Drive. Journal of Comp. Neurology 493:147-153 (2005).
Santosa C.M. et al. Enhanced creativity in bipolar disorder patients: A controlled study. J. Affect. Disord. (2006), doi:10.1016/j.jad.2006.10.013
Flaherty, A. (2011). Brain illness and creativity: mechanisms and treatment risks. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 56(3), 132.

Can My Child Have Bipolar Disorder? Pediatric Bipolar Disorder: Fact or Fiction

2011-07-21T12:03:00.002-04:00

By Molly McVoy, M.D.

Can children really have bipolar disorder? Or, is it a parenting issue? Is this mental illness overly-diagnosed?

Many of these questions have been raised in the media with increased frequency over the last several months. What's most concerning is, that instead of focusing on diagnosis and treatment for children with serious mental illness, the debate has focused on who is to blame: is it parents, psychiatrists, drug companies, schools? The bottom line is that children are suffering, and parents are struggling to keep their children safe, healthy, and happy. More attention should be paid to actually helping these children, not to pointing fingers of blame.

Pediatric bipolar disorder is a rare but very real illness. The most recent statistics indicate the mental illness affects approximately 1.5% of children. Contrary to popular reports, the most recent studies also indicate the rates of pediatric bipolar disorder are not increasing over time, and the rates do not vary between US and non-US populations.¹

When pediatric bipolar disorder occurs, it can be very impairing. Affected children have extreme mood swings – not for minutes at a time but for days. Children can become suicidal, violent, and often feel quite out of control. When properly diagnosed and treated, the lives of these children and their families can improve dramatically. Treatment often involves a combination of mood stabilizing medication and intensive psychotherapy. But when missed or misdiagnosed, these children may go on to suffer for a lifetime.

Stigma continues to be associated with a mental health diagnosis, and nowhere is that truer than in pediatric mental illness. Perhaps, in the future, efforts will focus on how to help, not who to blame.

Links:

http://www.aacap.org/

http://www.bpkids.org/

References:

VanMeter, AR, Moreira, AL, Youngstrom, EA. Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J Clin Psychiatry. 2011, May 31.

Family Game Night Can Make You Smarter

2011-07-08T11:56:00.004-04:00

By Scott Benson, M.D.

My daughter brought two treats when she came home for college break. A new game, Bananagrams, and a new book by Richard Restak, M.D. and puzzle master Scott Kim called The Playful Brain: the surprising science of how puzzles improve your mind.

In this collaboration, Kim shares some of his favorite puzzle formats, and Dr. Restak explains the science behind the games. Together they cover a wide variety of puzzles that have been shown to keep us alert, thinking, and youthful in mind and spirit. fMRI data (which shows electrical activity in different parts of your brain) helps to tease out which areas of the brain are activated as people solve different types of puzzles.

Scientists have not been able to prove a direct link between these forms of brain exercise and prevention of various forms of dementia. But the puzzles, and games like Bananagrams, provide a focus for interpersonal interaction – playing with your family, talking with your neighbors – which does have a powerful effect on mood and our sense of well-being.

Summer is the perfect time to bond with your kids in a board game challenge. How do you get your family to put down their cell phones and turn off the TV to play a game? Please share suggestions!

Seeing Stars is a Serious Deal - Sports-Related Concussions

2011-06-13T12:45:00.003-04:00

By Claudia L. Reardon, M.D.

Concussions in athletes have received increased media attention recently. More and more evidence shows that there can be serious short- and long-term consequences of concussions if athletes return to physical activity too soon. A concussion is a brain injury and must be treated very seriously.

How do you know if someone has sustained a concussion? Signs and symptoms of a concussion after an athlete hits his/her head include:

Headache
Nausea/vomiting
Dizziness
Vision changes
Sensitivity to light and sound
Feeling confused or groggy
Concentration difficulties
Inability to remember events before or after the hit
Mood, behavior, or personality changes

Importantly, most athletes with concussions won’t experience all of these signs and symptoms. Some of them might not appear for hours or even days. If you, a coach, a game official, or medical provider suspect a concussion, take the following steps:

Remove the athlete from the game/practice immediately.
Seek medical attention.
Do not return to physical activity until cleared by a physician. Returning to activity too soon can cause long-term physical and psychiatric problems and even death.
When returning to play, do so gradually, under the guidance of your health care provider.

Sports participation has many positive physical and mental health benefits for children and adults alike. In the spirit of competition, athletes and coaches often want to do everything they can to win. However, if a concussion is suspected, it is not worth it to risk long-term brain damage to stay in the game to help the team.

What does Archbishop Desmond Tutu say about Mental Illness Stigma?

2011-06-07T15:08:00.004-04:00

Watch exclusive interviews with Archbishop Desmond Tutu and actress Lorraine Bracco who attended this year's APA Annual Meeting in May. Also included, video posts from HealthyMinds.org bloggers Dr. Claudia Reardon, Dr. Gariane Gunter, and Dr. Molly McVoy. Have a mental health issue on your mind? Our Healthy Minds bloggers will anwser right here! Let us know what you want to know

Towards A Healthier View of Happiness: Human Fulfillment

2011-06-02T18:10:00.002-04:00

By Roberto A. Blanco, M.D.

I believe that mistaking what one would call pleasure or joy with happiness is causing people a lot of unnecessary pain. In popular culture and the media, “happiness” is the feeling when you open a brand new bottle of soda, when you have a party with your friends, or when you get a new car. Consumer culture has subtle but noticeable effects on people’s beliefs to the point where most people buy into these images or ideals consciously or unconsciously to some extent.

But, this is not the meaning of happiness for which we should be striving. This is because pleasure, while it may be fun, is superficial and impossible to sustain. Even for people who live a “charmed life," it is impossible to find pleasure or joy in all events in life. In fact, unless there is some larger or longer-lasting definition of happiness such as human satisfaction that fills our lives, it is likely that we won’t be able to find joy in anything. Events that should provide joy will lose their effect eventually without some deeper meaning.

This may be why many people become depressed. A lot of us put pressure on ourselves to be “happy” all of the time. Because we confuse pleasure for happiness at times, the fact that we are not “happy” all of the time can lead to more dissatisfaction with life or lack of fulfillment. If happiness equates with pleasure or joy, how can we be happy and happy with ourselves when we are going through difficult but worthwhile transitions? What about during periods of grief?

It is often very difficult to sustain superficial happiness especially when the inevitable thoughts of ‘why am I feeling bad?’ or ‘why am I not happy?’ creep into the mind. These thoughts often cause people to feel guilt and then as if they are failures. To be joyful and smiling all of the time is just an unrealistic goal and we should not feel bad about ourselves if we happen to be in a difficult stage of life. We need to keep in mind that it is all part of a larger plan or goal of development, human fulfillment or self-actualization.

The search for a good definition of happiness is not a new idea and certainly not one that I thought of. Over 300 years before Christ and in his book entitled NicomacheanEthics, Aristotle proposed his definition of happiness to the ancient Greek people and laid out his arguments for the meaning of happiness. He argued that having true happiness is the best and final aim for human activity. Aristotle called true happiness “eudaimonia” which was a type of long-lasting happiness more consistent with human fulfillment or satisfaction. Aristotle also believed that happiness should be human fulfillment and not confused with joy or pleasure when he wrote:

For one swallow does not make a spring, nor does one sunny day;
similarly, one day or a short time does not make a man blessed and happy.

I agree that human fulfillment is a loftier goal than joy because when someone is having a difficult time or fallen on hard times, they can still be working towards human fulfillment. During these formative or growing experiences, we can still feel as we are fulfilled or fulfilling our own self-actualization even if we aren’t joyous. When we take into consideration human fulfillment, we no longer need to feel guilty or as failures during difficult times, transitional periods, or episodes of grief. We begin to see life from the wide angle of human fulfillment rather than from the small picture of pleasure.

Kahlil Gibran, the famous Christian mystic poet from the early 20th century, also believed in eudomainia. When Almustafa, the all-knowing visitor in the poem The Prophet, answers a woman’s question on pain, he exemplifies this belief in the beauty of human fulfillment and long-lasting satisfaction despite these painful episodes:

And could you keep your heart in wonder at the daily miracles of your life, your pain would not seem less wondrous than your joy;
And you would accept the seasons of your heart, even as you have always accepted the seasons that pass over your fields.
And you would watch with serenity through the winters of your grief.

As people living in a society where mental illness is so common, we must seek to understand happiness and human fulfillment. In the hopes of making happiness something more meaningful and sustainable, what we should be striving for is an eternal, longer-lasting form of happiness which is known as human fulfillment or as the Greeks called it eudaimonia. This is because human fulfillment rather than joy or pleasure allows for the different stages of our lives and growth without having to feel guilt or as if something is wrong. If we make human fulfillment the goal, we will live happier and more satisfying lives. Now the obvious question becomes, how do we achieve it?

1. Aristotle (1999). Nicomachean Ethics. (Martin Ostwald Trans.) Upper Saddle River, New Jersey: Prentice Hall, Inc.
2. Gibran, Kahlil (1964). The Prophet . New York: Alfred A. Knopf.

Make Mental Health Your Priority Every Month

2011-05-30T16:04:00.004-04:00

By Felicia Wong, M.D

As the month of May comes to an end, make a promise to yourself that personal mental wellness will remain a daily priority. Mental Health America has been working for 100 years to promote well-being for all Americans and recently developed a resource called 10 Tools to Live Your Life Well based on extensive scientific evidence.

Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues.

These "10 Tools" provide proven, healthy ways to cope with stress and boost your overall well-being. Make a commitment to follow this list and feel more relaxed, fulfilled, and focused long after Mental Heath Month is over. . .

1) Connect with Others. People who feel connected are happier and healthier--and may even live longer.

2) Stay Positive. People who regularly focus on the positive in their lives are less upset by painful memories.

3) Get Physically Active. Exercise can help relieve insomnia and reduce depression.

4) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.

5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.

6) Create Joy and Satisfaction. Positive emotions can boost your ability to bounce back from stress.

7) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.

8) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.

9) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.

10) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.

So now you know the tools. . . Today is the perfect time to start incorporating this list into your day-to-day routine. For more information, go to http://www.liveyourlifewell.org/ .

Yes, Food Addiction is Real. Do You Know Someone Suffering?

2011-05-06T14:47:00.010-04:00

By Sarah Johnson, M.D.
The obesity epidemic is a huge problem (no pun intended) due to associated medical problems and their burden on the healthcare system. In 2009, an estimated 25% of Americans met criteria for obesity. This figure has steadily increased since the 1970’s.

Obesity leads to heart disease, strokes, high blood pressure, diabetes, and may be associated with increased risk for depression. It has been suggested that over-eating and other eating behaviors associated with obesity may share features with drug and alcohol addiction. This would certainly explain why this epidemic is so difficult to combat.

The DSM IV-TR defines substance dependence as three or more of the following symptoms occurring within one year: tolerance, withdrawal symptoms, substance taken in larger amounts or for a longer duration than intended, attempts to cut back, excessive time spent pursuing, using or recovering from use, reduction or discontinuation of important activities because of use, and continued use despite adverse consequences.

Food cravings associated with binge eating can trigger the same area of the brain that is activated in drug craving. Although research is preliminary and limited at this time, specific foods such as carbohydrates may actually have a direct effect on mood in those who crave them.

Certain eating behaviors, such as restriction combined with overeating or binge-purge cycles may emulate addictive behaviors. Personality traits such as impulsivity have been found in samples of addicts and obese individuals. Children with behavior disorders such as ADHD and Conduct Disorder may be at increased risk for both addictions and obesity.

Prevention is the best way to reduce the impact of behaviors associated with obesity. While eating may have similarities with addiction, we live in a toxic food environment and awareness is key in prevention. Family members can seek help from medical professionals for loved ones who may be exhibiting pathological eating behaviors.

For more information: Corsica JA, Pelchat ML. Food addiction: true or false? Curr Opin Gastroenterol. 2010 Mar;26(2):165-9.
Wilson GT. Eating disorders, obesity and addiction. Eur Eat Disord Rev. 2010 Sep-Oct; 18(5):341-51.

2011-04-13T13:21:00.003-04:00

The Insanity Defense: Fact or Fiction?

By Molly McVoy, M.D.

When you hear about a defendant pleading insane at the time he or she committed a crime, what thoughts cross your mind? You may be thinking of those infamous court cases: John Hinckley, Andrea Yates, Brian David Mitchell (Elizabeth Smart's kidnapper), and most recently, Jared Laughner. It's common to feel conflicting emotions - anger, confusion, even sympathy - as you remember these high-profile defendants and traumatic court cases.

The word “sanity” is a legal term, not a mental health or clinical term. Generally, a determination of “sanity” in a court of law refers to whether a “mental disease or defect” (also a legal, not clinical term) causes a person to be unable to know the wrongfulness of his or her action.

Over time, the court clarified what qualifies as a “mental disease or defect,” and it's not always directly related to clinical diagnosis as used by practicing psychiatrists. Typically, severe mood and psychotic disorders do classify as a “mental disease or defect,” but many other psychiatric illnesses and personality disorders do not. Courts ultimately determine what illnesses do and do not qualify as a “mental disease or defect” under the “not guilty by reason of insanity” defense.

The application of this defense has also changed in scope. Early in American law, only if someone had total loss of memory or understanding would this defense apply. But in time, that became more liberal -- applying if someone was unable to know the wrongfulness of his or her actions or, because of illness, was unable to resist the urge to commit the crime.

After the attempted assassination of Ronald Reagan by John Hinckley, the standard became narrower once again, returning to apply only to those whose “mental disease or defect” prevented him or her from knowing the wrongfulness of the crime.

Finally, some states have an additional “guilty but mentally ill” statute that affects eventual sentencing but not strict guilt or innocence. You will probably hear more debate about the insanity defense in media's coverage of Jared Laughner. There may always be misunderstanding and controversy for this complicated, highly sensitive issue.

For more information:

http://www.aapl.org/

Why Women Must Exercise for Mental Health

2011-03-28T08:33:00.004-04:00

By Claudia Reardon, M.D.

Exercise has mental health benefits for men and women of all ages. However, there are unique factors to consider in thinking about the mental health benefits of exercise for women in particular. Compared to men, women have a two-fold increased prevalence of major depression throughout their reproductive life cycle. Exercise can be a very useful treatment for depression in women at any of a number of different times in their lives:

During pregnancy and breastfeeding: Depression is highly prevalent in women of childbearing age. Medications are often necessary to treat moderate to severe depression. However, many women wish to avoid treatment with medications during pregnancy and while breastfeeding. At least one study has shown that women who exercised regularly reported less depression in the first and second trimesters compared with women who did not exercise. The American College of Obstetricians and Gynecologists has recommended 30 minutes of moderate exercise on most days.

During the postpartum period: Exercise can also help to treat and prevent postpartum depression. One study has shown that postpartum women who exercised three times per week had less depression than postpartum women who did not exercise.

During the premenstrual period: Exercise can be useful to treat physical and emotional premenstrual symptoms. It is less clear if exercise by itself can treat the most severe of premenstrual syndromes (called “premenstrual dysphoric disorder”), but it is still a first-line treatment strategy that most physicians would recommend.

During menopause: Several studies have shown that aerobic exercise can improve both depression and insomnia occurring during menopause. Additionally, lower intensity exercise such as yoga has been shown to improve psychological well-being in menopausal women.

Importantly, women may experience barriers to exercise. Here are some examples of these barriers, and strategies to help address them:

Childcare issues: Women are often responsible for childcare, which makes it difficult for them to find opportunities to exercise. Gyms that offer childcare services can be helpful. Also, partners can share the workload.

Intimidation: Some women may feel uncomfortable working out in the coed environment of a gym. Consider taking women-only exercise classes, or walking or doing other exercise with women exercise buddies.

Self-consciousness about appearance: If a woman is already uncomfortable about her appearance, then she might worry that she’s drawing even more attention to her body by exercising, especially if wearing skimpy sports clothes. One strategy is to try walking, which can be done almost anywhere and in almost any type of clothing.

Guilt: Women, especially those who are family caretakers, sometimes describe feeling guilty about taking time for themselves to exercise. Remember, it is not a selfish thing to exercise. You are taking time to improve your physical and emotional health, which will allow you to more effectively be there for others. Besides, you deserve to experience the benefits of exercise!

Talking to Kids about the Earthquake in Japan

2011-03-17T15:30:00.008-04:00

By Adair Parr, M.D.

Our hearts and condolences go out to the people of Japan and the families involved in the earthquake and subsequent tsunami in Japan last week.

Everyone has seen the live images, captured on cell phones and video cameras, coming from Japan. They are vivid, dramatic, compelling, and scary. We have all watched the coverage on television and online as more and more photos and videos circulate showing the massive tsunami wave rolling over the sea wall, shaking houses and buildings, fires, explosions, and the massive destruction afterwards. The subsequent explosions of the nuclear reactor and news of a nuclear reactor meltdown near Sendei, Japan are also extremely disturbing.

Our 24 hour news cycle enhances the impact of these images which can be traumatizing for viewers of all ages. Media has a particularly powerful influence on children and adolescents, and the pictures it shows shapes a child’s perception of the world. Young children watching images of disaster believe that the event is happening in real time, and they’re in danger. At such times, helping children feel safe and protected in their own home and community is important. Parents should keep in mind the following tips when viewing photos and videos during and after disasters:

Be vigilant! Not all sources of media provide warnings about upcoming traumatic images.
Viewing traumatic images may be re-traumatizing.
Limit children’s exposure to media coverage of the event.
Co-view media coverage of the trauma and discuss content with children and adolescents.
Encourage children to draw, write, play music, and exercise in ways to express their feelings about the traumatic events.
Maintain structure and family routines.

HealthyMinds.org has more information on how to talk to your children about disasters.

How Much Sleep Do Kids Need?

2011-03-09T10:54:00.003-05:00

By Gariane Gunter, M.D.

Children these days are busier than ever! I often hear from parents that it is such a rush to fit everything in and still get the kids to bed on time. I struggle with the same dilemma at my house. As a mom, I understand how difficult early bedtimes can be, however, as a psychiatrist, I know why an adequate sleep schedule is so significant for our child's physical and emotional health.

The American Academy of Pediatrics Guide to Your Child's Sleep provides some helpful guidelines regarding just how much sleep children need at different stages in their development. Keep in mind that these numbers reflect total sleep hours in a 24-hour period. So if your child still naps, you'll need to take that into account when you add up his typical sleep hours.

Birth-6 Months, children need 16-20 hours
6-12 Months, children need 14-15 hours
Ages 1-3, children need 10-13 hours
Ages 3-10, children need 10-12 hours
Ages 11-12, children need 9-12 hours
Teenagers need 10-12 hours of sleep per night

Kids need a lot of sleep, huh?! Children and teens who are sleep deprived may show some difficult behaviors. They may display frequent irritability, overreact emotionally, have difficulty concentrating, forget things easily, wake often during the night, and may even display hyperactive behaviors.

Teaching kids how to keep a nighttime routine that gets them to bed early will help your children be at their best. Sweet Dreams!

Caring for the Mental Health of Your College Student

2011-02-14T13:10:00.002-05:00

By Roberto A. Blanco, M.D.

A recently released national survey on the state of mental health for entering college students revealed that this year's freshmen class has the highest stress levels in the history of the 25 year survey. There are several reasons. According to study authors, students face increased competitiveness and demands in high school as well as more financial challenges due to today's economy.

Although it's an exciting time, your child's transition to college can be a difficult one - especially if he or she suffers from a mental illness. Here are some things that you and your prospective college student should be thinking about prior to choosing a university and heading off to school:

1. What can I do to ease the college transition?

Some schools offer an orientation program over the summer to help students become comfortable with the campus and surroundings, learn organizational and study skills and socialize with fellow freshmen.

Apart from these organized programs, it is important that, as a parent, you work on transition issues and independence. Make sure that your child has all materials needed for school including an organizer and a computer. If your child is getting psychiatric treatment, teach your son or daughter the importance of their medicines, therapy and attending their appointments regularly. If they haven’t yet been self-administering their medications, before going to college, it is important that they learn and start taking their medicines without supervision.

If you have serious concerns about how your child will do with the college transition, you may want to consider schools close to home. Depending on the amount of concern, it may be best to choose a school which would allow your child to drive home for the weekend if needed.

2. What’s the quality of the college's mental health program?

Some colleges and universities do not have mental health services available through the school. If they don’t, you need to understand how a student can go about getting help. If the school is not in a major city, you need to make sure that there are enough providers close by so that your child can get the services that he or she needs in a timely manner.

Some universities have therapists but no psychiatric providers on staff. Others offer both counseling and psychiatric services but put a cap on the number of appointments at the university mental health center prior to referring students out to the community. All of this information should be provided by each individual school. And you should know all of this information prior to committing to a particular school, especially if your child is likely to use mental health services.

3. What is the educational environment of the university?

Some universities are known to be high-pressure, unforgiving environments. This could be due to the rigor, expectations or challenges of courses. Sometimes, this can be eased by a strong academic support team or advising system. Often, peers can make the university culture overly competitive in unhealthy ways. Some places are notorious for students stealing other students’ lecture materials and notes or not helping out when needed. If your child is particularly sensitive to stress, it may be best to go to a school where the environment is more collegial and supportive.

Other schools are notorious for having easy access to drugs or alcohol on campus. While drugs and alcohol are available at most schools, they are easier to get at some schools which are located in major cities or areas of high accessibility. If your child has a history of drug or alcohol abuse, you should be extra considerate of these location factors.

4. Will the financing of this school put my child in overwhelming debt?

While a good college education is one of the most important investments, your child should not mortgage his or her future by creating large amounts of unnecessary debt. In addition, universities with higher tuition may necessitate your child working during school to avoid excessive debt. This can also add stress. If schools are relatively equivalent in meeting your child’s long-term career goals, choose the college which will put your child in a better financial position after he or she graduates.

Of course, after your children go to college, you will want to monitor how they are doing intermittently. Particularly stressful times are usually at the beginning of school, around exam time (midterms and finals) and anytime a romantic relationship ends. Checking in around these times may be the most beneficial. If it turns out that they need more help than some parental TLC, make sure that they see a professional.

I hope that these suggestions have been helpful. Feel free to leave comments or questions for further discussion.

Yoga Helps Heal Heart & Emotional Scars of Cancer

2011-02-04T10:05:00.005-05:00

By Felicia Wong, M.D.

“Cancer is a very alienating and existential disease. I know of no other common disease that immediately causes so much fear, anxiety, depression, confusion, and a sense of impending disaster in a patient or his/her significant others when they hear the word “cancer” for the first time.” --- Murray Krelstein, MD, a psychiatrist and cancer survivor.

Although oncologists, family members, and friends can provide significant sources of support, adding a mental health professional to a cancer patient’s treatment team is often helpful. Talking about the emotions and worries associated with cancer can be difficult, and it is important to have a therapist who is familiar with these situations. Additionally, cancer patients and survivors often suffer from sleep disorders, depression, anxiety, fatigue, and other mood changes.

Researchers at the University of Rochester Medical Center found that among patients receiving chemotherapy, over three-quarters suffer from insomnia. Those who suffer from insomnia are, in turn, more likely to suffer from fatigue and depression. For 65% of cancer survivors, insomnia continues even after the completion of chemotherapy.

Cancer is a diagnosis that affects both body and mind. So, it makes sense that cancer patients and survivors practice yoga to improve their quality of life.

While research on the use of yoga for cancer is relatively new, there have been recent studies confirming yoga’s mental health benefits. A Harvard Health Publication highlights the benefits of yoga for stress, depression, and anxiety:

- By reducing perceived anxiety, yoga appears to adjust stress response systems. This, in turn, reduces heart rate, lowers blood pressure, and can make breathing easier.

- There is evidence that yoga practices helps increase heart rate variability, an indicator of the body's ability to respond to stress more flexibly.

Optimizing wellness after a cancer diagnosis and beyond involves a complex integration of interventions that address both the mind and the body. Ideally, a psychiatrist is part of the cancer treatment team. However, if this is not available, please ask your doctor for referrals.

For additional resources on coping with cancer:
http://www.cancersupportivecare.com/live.html

Talking To Kids About Disappointment In Sports

2011-02-01T08:00:00.003-05:00

By Claudia Reardon, M.D.

Participating in sports is generally thought of as a physically and emotionally healthy activity for children and teenagers. However, it is inevitable that children who play sports will at some point deal with disappointment. Not every play or game will go their way. While dealing with this disappointment can be difficult for children, it's also a great opportunity for growth. The excitement of the Super Bowl and other winter sporting events provide a chance to talk with your children about disappointment.

Here are some tips to keep in mind if you parent or coach a child or teenager who is dealing with disappointment in sports:

1. Acknowledge your child’s feelings about what happened. For example, you can say, “I understand that you are feeling really upset that you didn’t win the race.” Of course, this does not mean that you should agree with catastrophic statements that they might make, such as that they are the worst player that ever played or that their life is ruined because of a bad game.

2. It’s okay if kids don’t want to talk about a disappointing game or event immediately. You might simply acknowledge their feelings and tell them that you’re there for them to talk whenever they want to.

3. Help your children shift focus to what they did RIGHT on the playing field. This is especially important if your child is a perfectionist, in which case he or she is likely to focus on the one mistake rather than seeing the “big picture” of everything he or she has done right.

4. It’s certainly okay if your children’s disappointment leads them to want to improve their sports skills. Help them figure out exactly what skill they would like to improve, and then brainstorm ways to improve in that area. They might even ask for suggestions from the coach. Help your children set realistic goals and then give them praise as they work toward those goals.

5. Ask your children if they think their favorite athletes ever make mistakes in their sport. If these athletes said that they were terrible players and wanted to quit after one bad play or bad game, would your children agree with that? Of course not!

6. Disappointment is a great opportunity to reinforce resilience and determination. Remind your child that he or she is “the kind of person who doesn’t give up easily.”

7. If a child is disappointed in his or her sporting performance, that is not an excuse for poor sportsmanship. It is not okay for them to express their disappointment as anger toward the winner.

8. Remind your children that failing to make a good play or to win a game does not mean that they’re a failure overall. There still are lots of great things about them, and everyone fails sometimes. Remind them of all the things they have done well recently.

Understanding Psychosis

2011-01-31T09:31:00.017-05:00

By Sara Coffey, D.O.

Often patients and family members have a hard time understanding how a person can be psychotic. Psychosis is defined as grossly impaired reality testing. Psychosis can be present in several mental illnesses including, schizophrenia, schizoaffective disorder, bipolar disorder and even depression.

The stigma or lack of information surrounding these disorders leaves them feeling guilty or ashamed. I often explain to them that the brain is an organ just like the heart, the kidneys or the liver. And just as our heart, kidneys or liver can become diseased, so can our brain.

The brain is a complicated organ with several different functions. It helps regulate our breathing, our heart rate, and our temperature and handles more complex tasks such as vision and hearing, pain sensations as well as processing complex thoughts or emotions. It is easy for us to understand that if the heart becomes damaged it might not pump as effectively, but it is often harder for us to understand what happens if the brain becomes compromised or unwell. A brain with mental illness may start to hear things that are not there, or experience thoughts that cannot be explained and seem irrational. A person may become excessively anxious for no reason, or depressed without warning or cause.

In the world of mental illness we use terms to describe such experiences like hallucinations and delusions. A patient with hallucinations might experience voices talking to them when no one is present. When we recall that one function of the brain is to process and interpret sound it is easy to see how auditory hallucinations might occur if that part of the brain is compromised.

Patients can have delusions that people are out to harm them for no reason, and without proof, or delusions that they are famous powerful figures in history. And again, when we look at how the mind works, how complex processes are taking place that help us navigate who we are and what we do, it makes sense that if something wasn’t working normally in the brain that a person could have a belief that was false.

Although these symptoms might make sense when we look at the brain as an organ, or a tool performing a function, it doesn’t lessen the impact mental illness has on families. Often mental illness takes away what we consider the heart or personality of person and this can be extremely difficult to cope with. Furthermore, the simplicity of understanding is not without criticism. For instance although we are learning more and more about the brain every day, there is still no cure for mental illness, only treatment for symptoms, and often times the treatment cannot fully clear the symptoms of certain diseases.

However, it is important to know that psychosis, like other mental illness symptoms, is not the fault of the person with the illness or the family who cares for them. These symptoms are part of a complex illness that affects patients unwillingly every day.

Raising Awareness About Stuttering and Speech Disorders

2011-01-26T11:34:00.004-05:00

By Adair Parr, M.D.

The Oscar nominations were recently announced and one particular movie in the best picture category is a film which addresses a common problem: stuttering. The King’s Speech depicts the courageous efforts of King George VI of Britain, played by actor Colin Firth, to overcome a stutter which first began when he was a young boy. Although many films have featured characters who stutter, this is the first film to focus on the process of someone overcoming speech difficulties.

The King’s Speech highlights the speech therapy that the king went through to overcome his stutter. The movie aptly demonstrates his frustration with prior attempts at speech therapy. His work with Australian speech therapist Lionel Logue, portrayed by actor Geoffrey Rush in the film, allowed him to move beyond the previous failures that he had in speech therapy and to achieve success. The story is particularly inspiring as you watch this man deliver a powerful speech to the British people on the brink of World War II. Hopefully, the movie will result in less stigma about stuttering.

Here is a video of His Majesty King George delivering his actual speech on Sept. 3rd, 1939.

Stuttering is a type of speech disorder which affects the fluency of speech. Stuttering is a fairly common phenomenon. Approximately 1 percent of children stutter, and up to 5 percent may display transient stuttering. Stuttering begins during childhood, typically between ages 2 and 4 and may last throughout life. It may involve repetitions of words, prolongation of speech sounds and blocked sound.
What should you do if your child has a stutter or other speech disorder? It is recommended that you seek an evaluation from a certified speech-language pathologist. Your pediatrician, physician or school system may help you find local resources. More information on stuttering is available at the American Speech-Language Hearing Association website.

When Divorce Happens

2011-01-24T10:00:00.002-05:00

By Gariane Gunter, M.D.

A recent study was published in Health Day that discusses the mental health of children of divorced parents. While I am not in the position to support or deny the findings, the topic of divorce when children are involved is often a difficult one. Every family is different, but the following are some general tips for divorcing parents that can be helpful.

1. Attempt to keep a positive attitude during the point of separation. This is often a very trying time for the family. Stick to a routine and embrace the activities your children have always enjoyed.

2. Don’t forget to nurture yourself. Going for a walk, having coffee with a friend, or reading a good book are ways to rest and regain energy. It’s normal to feel exhausted when separating; and possibly for many months to follow.

3. Encourage kids to openly discuss their feelings, positive or negative, about what's happening.

It's important for divorcing, as well as already divorced parents, to sit down with their kids and encourage them to say what they're thinking and feeling. But you'll need to keep this separate from your own feelings. Most often, children experience a sense of loss of family and may blame you, the other parent, or both of you for what is going on in their lives. You really need to be prepared to answer questions your kids might raise. They might feel guilty and imagine that they "caused" the problem. Kids and teenagers may feel angry or frightened, or worried about their future. Counselors can assist with this difficult conversation and provide a safe environment if safety is a concern.

4. Although very tempting, try not to speak negatively about your former spouse when your children are present. This issue, often called “parental alienation” can be a problem. Doing things such as putting your child in the middle, saying negative things about the other parent, and using your child as a messenger puts your child in a “no win” situation and creates lifelong relationship issues for all involved. The reasons include the following:

• The comments may confuse and frighten children.
• Many of your concerns about your former spouse are difficult for you to express. It is very important that you keep these concerns to yourself. Children just do not have the emotional maturity to withstand information/situations that adults find stressful.
• Your child’s identity and self concept is based on parental behavior. Even if it is next to impossible to say anything good about your former spouse, try to do so. If this is impossible then don’t say anything.
• Children love to eavesdrop. Telephone conversations are their favorite snooping ground. Make all effort to not discuss your divorce-related difficulties on the telephone when your children are around.

5. During the crisis point of separation try to remember that your children need you both parents more than ever. This is not a time to deny access unless a professional deems it necessary to do so for safety related reasons.

6. It is important to accept the fact that a separation involves feelings of loss for children. Try not to panic if the following behaviors occur during the first few months of separation:

• Sleep difficulties like disrupted sleep, an inability to sleep, exhaustion etc.

• Social isolation

• Anger, intolerance, grumpiness

• Avoidance of divorce related conversations

• Obsessing about the divorce

• Appetite changes

• Feelings of worthlessness

• Tears and feelings of overwhelming sadness

7. Although many children do not ask to see a counselor when their parents separate, they usually find counseling very helpful.

8. It is important to acknowledge that children are very loyal and protective of their parents. If children are placed in loyalty binds they can experience anxiety. Try to alleviate their anxiety if they decided to “pick a side.” This is a coping skill which teens in particular use. If your child engages in “picking a side” try not to feel rejected.

9. Think of yourself as a survivor not a victim. And be patient. Everyone takes different times to heal.

The Truth About Domestic Violence

2011-01-20T08:00:00.012-05:00

By Roberto Blanco, M.D.

In my work with patients across the world, I can´t help but notice how many come to psychiatric clinics as a result of domestic violence. Despite its prevalence in other countries, domestic violence is also quite common in the United States. In the United States alone, 22 percent of women are physically assaulted by an intimate partner during their lifetimes and over 5 million are victims every year. Domestic violence touches all elements of society regardless of age, race, or socioeconomic status.

As a child psychiatrist, I can´t help but think of the smallest victims of domestic violence as I often see them in my clinical work. These are the children who are either involved secondarily by witnessing the abuse or become victims directly themselves. The effects of domestic violence on this population are far ranging and long lasting. As these children develop, they may struggle to deal with conflict. They may also become aggressive or experience severe depression, nightmares and other symptoms of post-traumatic stress, as well as other anxieties or fears.

The effects of domestic violence on children are dependent on the nature and severity of the abuse and on the developmental level of the child. Young babies and infants cannot understand why violence occurs in the home and so violence in this population can cause deep-seated changes in personality, self-esteem, and ways of interacting with others that can last for a lifetime. Often older children have a better understanding of what is going on, but still often blame themselves for the abuse and can have excessive guilt or anger as a result.

Domestic violence does not need to be only physical to qualify as a form of abuse. Abuse can also take the form of emotional, financial, or sexual control or disregard. Initially, characteristics of an abusive relationship can often be endearing such as wanting to be with you all of the time. Over time, this can become intense jealousy for no reason, excessive control over relationships and behaviors, and aggression or violence. Options for milder forms of emotional abuse can include family and/or individual therapy. For severe cases, there may be a need to get out of the situation or to a safe house. For more information on domestic violence, please see the American Pyschiatric Association's brochure Let´s Talk Facts About Domestic Violence.

Lessons Learned in the Wake of Tragedy

2011-01-19T11:38:00.001-05:00

By Gina Newsome Duncan, M.D.

Dr. Molly McVoy recently blogged about the horrific shootings of Representative Gabrielle Giffords and others on Saturday, January 8, 2011. This tragic incident has sparked widespread national debate about all aspects of the case, including mental health treatment in this country and links between violence and mental illness.

The fact is that most people with mental illness are not violent, and that violence is most often caused by those who are not mentally ill. However, this incident does provide an opportunity for us as a nation, to seriously consider the state of our mental health services. If we examine it carefully, we can possibly prevent further acts of violence, and also think about how we help those who are in need of mental health treatment.

It is an unfortunate reality that mental illness remains largely shrouded in stigma, and tragic events such as this often help to only deepen that stigma in the minds of the public. As a result of this stigma, many people live with unnecessary shame and suffering, not seeking the help that they need. Most often, the primary victim is the person living with the illness, and by extension, their loved ones. Very rarely, however, untreated illness can lead to tragic consequences that reach far beyond the person with the illness and his or her family.

Like physical illness, mental illness has the best outcome when recognized and treated early. We should let this tragedy be a call to become more proactive in addressing issues of mental illness in our communities.

There are several important steps that can be taken:

1) As a public, we can become more informed about the signs, symptoms and treatment of mental illness.

2) We can all work to destigmatize mental illness. The American Psychiatric Association’s Council on Communications is actively involved using this blog and with other activities.

3) Educate yourself on how mental health is funded in your community and let your vote count when issues of mental health funding are on the ballot.

It is true that there are rare situations in which a person with a severe mental illness may become violent. In most cases, this violence will be self-directed in the form of suicidal acts, but in rare instances, it may be directed toward others as well. What can be done in those situations?

1) If you are personally experiencing a mental illness and are having thoughts of harming yourself or others, it is important that you seek help from a doctor, therapist, or 911 immediately.

2) If you are the friend or family member of a person experiencing a severe mental illness and you are concerned due to actions or statements they have made that they may be a danger to themselves or others, it is important that you seek help from a doctor, therapist, or by calling 911 immediately.

a. Be as detailed about your concerns as possible.

b. Do not let your concern go unheard, put it in writing.

c. Firearms and weapons should be kept sealed and locked, or ideally, removed from the home.

d. Unfortunately, many communities do not have adequate crisis prevention resources. Familiarize yourself with the procedures your community does have for involuntary hospitalization. You can get this information by calling your local health department, hospital department of psychiatry, emergency room, community mental health center, family physician, or police department.

Shootings Stir Emotions, Call for Access to Affordable Care

2011-01-11T15:39:00.005-05:00

By Molly McVoy, M.D.

The tragic shooting in Arizona has spurred many emotional headlines and provocative stories in the news. News stories have used the words “insane,” “coldblooded,” “bizarre,” “evil” and “troubled.”

Whenever tragedies such as this occur, emotions are stirred and people often look for clear answers. Unfortunately, tragedies like this do not have easy answers. Whether or not mental illness is involved in this case, this may be a moment to look at every way to reduce the risk of another tragedy such as this in the future.

Rep. Giffords

U.S. Rep. Gabrielle Giffords, currently in an Arizona hospital as a result of the shooting, is a friend to the National Alliance for Mental Illness (NAMI) and has served as co-chair of several fundraisers for NAMI in Southeast Arizona.

There are so many ways in which the mental health system in the United States is broken. Treatment is often hard to access and expensive. Consistent treatment is often nearly impossible for those with severe mental illness. Advocating for improved access to quality mental health care is critically important at a time like this.

In addition, it is also important to remember that the likelihood of violence from those who struggle with mental illness is very low. Most of the violence perpetrated in this country is by individuals without mental illness. Most individuals suffering from mental illness are not violent.

No matter the cause, a time like this calls for reflection and action: examining all the factors that can be changed to minimize the risk of something like this happening in the future.

Six Tips for Talking to your Doctor about Medication

2011-01-11T07:51:00.024-05:00

By Claudia L. Reardon, M.D.

In my last blog, I addressed the factors psychiatrists consider in choosing a given psychiatric medication for a patient. I emphasized the importance of medication selection being a collaborative process between the physician and the patient. In the midst of an appointment with a psychiatrist, though, it can be difficult for a patient to know what to ask, and when and how to ask it. This article includes tips for patients to help them work with their physicians in finding the best medications.

Ask the psychiatrist, “How did you pick that medicine?” Even if you can think of nothing else to ask during an appointment, this single question will probably lead to a wealth of useful information. For example, it might lead to a discussion of the target symptoms, how the medication affects other medications or medical conditions, and side effects.
Make a list of medication questions to ask your psychiatrist at your next appointment. I find it extremely useful when my patients come in with a list of questions they have made since I last saw them in my office. This way, patients are sure not to forget to ask anything important to them.
Take notes during your appointments. It can be difficult to remember everything your psychiatrist says during your appointment, and so bringing a note pad and pen along to take notes can be useful so that later you can remember what was discussed.
Read books. There are a number of excellent books available for patients on psychiatric medications. In my experience, patients find especially useful the book Instant Psychopharmacology by Ronald Diamond, M.D.
Visit websites. Patients should be careful about which websites they visit, as not all are reliable sources of medication information. However, in addition to www.HealthyMinds.org, another reputable site is the NAMI medication website. Go to the NAMI webpage (www.nami.org) and click on the “Medications” tab on the top toolbar.
Try not to be embarrassed. Many patients are embarrassed to talk about concerns they have about medications, especially side effects that they find difficult to discuss. However, remember that physicians hear about all kinds of different side effects, and it is pretty hard to embarrass a physician when it comes to talk about the human body!

In addition to these strategies, you might have found others that work for you in keeping you engaged in your medication treatment. It is imperative to keep the lines of communication open with your psychiatrist and to remember that your physician is there to answer any questions you have.

Which Medicines and When: Collaborative Process of Finding the Right Medicines

2011-01-04T07:55:00.009-05:00

By Claudia L. Reardon, M.D.

Many patients have long and trying journeys on the way to finding medication regimens that work for their psychiatric symptoms. It isn’t always obvious why psychiatrists choose certain medications and avoid others for given patients. In this blog post, I will review the process by which a physician chooses a psychiatric medication. The more the patient knows about how the psychiatrist is thinking through the medication decision-making, the more active a role that patient can play in the process.

Psychiatrists consider the following issues when prescribing a medication:

Target symptoms. A patient might have many different symptoms, for example, depressed mood, anxiety, trouble with concentration, and severe insomnia. It is important to decide which symptoms should be addressed first, since it is likely that one single medicine will not help all of the symptoms. Doctors often prefer not to start multiple medications at the same time, as it otherwise can be difficult to figure out which medicine is helping or which is causing side effects. Thus, in a patient with the above symptoms, the physician might first choose to address the patient’s depressed mood with an antidepressant. Since trouble with concentration and severe insomnia could be caused by depression, it is possible that treatment with an antidepressant will help those symptoms as well. It is important to address the symptoms in the order that makes the most sense.
Psychiatric diagnosis. The physician cannot simply treat a target symptom with a medication without knowing the overall psychiatric diagnosis. For example, depressed mood could be due to many different diagnoses, including major depressive disorder, bipolar disorder, schizoaffective disorder, drug or alcohol abuse, or medical problems such as low thyroid. All of these would have different treatments. Major depressive disorder would be treated with antidepressants, while antidepressants can actually sometimes worsen bipolar disorder. Likewise, if a patient’s depression is caused by a medical problem, it is essential that the medical problem be addressed rather than simply “band-aiding” the symptom of depression with an antidepressant.
Medical conditions and other medications. It is critical that the physician be aware of all the patients’ medical issues and other medications they are taking. Certain psychiatric medications would be dangerous if prescribed to patients with certain medical problems. For example, some medications can worsen seizure disorders, cause abnormal heart rhythms, or worsen diabetes. Additionally, some psychiatric medications can have dangerous interactions with other medications.
Side effects. Psychiatrists must consider how a given medication’s side effects will impact a given patient. For example, a patient who drives heavy machinery for a living should probably not take a medication that causes drowsiness. On the other hand, sometimes physicians can “take advantage” of side effects. For example, if a patient is sleeping and eating poorly, the doctor might prescribe a medication with sleepiness and increased appetite as side effects.
History of response. If a patient or his or her family member has had a good response to a medication in the past, that might be a good reason to choose that medicine now.
Patient preferences. Finally, and most importantly, the physician must make sure that the patient is willing and able to take the medication being prescribed. If the patient feels that the side effects are intolerable, or simply cannot afford it, it doesn’t matter how reasonable the choice of medication might be since the patient will not take it. The physician should check with patient to ensure they are comfortable with the medication being prescribed. Likewise, patients should not hesitate to speak up if they have concerns about a medication being prescribed for them.

In summary, physicians consider a multitude of factors in choosing a psychiatric medication for a patient. Ultimately, the decision about a medication should be a collaborative one between the psychiatrist and the patient.

What’s the difference between all these medications?

2010-12-14T11:05:00.000-05:00

By Sara Coffey, D.O.

This is a question I am often asked by my patients. Several times a day we see commercials for prescription pills to treat a variety of diseases from high cholesterol to heart disease and treatment for mental illness is no different. Today I would like to talk about one of the most common mental illnesses, Depression and its treatment.

Depression affects roughly 15 million Americans adults, and it is an illness that can be readily treated with antidepressant medications, talk therapy or a combination of medication and talk therapy. Antidepressants have been around for decades and include several classes of medications that work on different chemicals in the brain, but today the first line treatment for depression are medications called, SSRI’s or Selective Serotonin Reuptake Inhibitors. For the most part medications in this class are very similar; they work by increasing the amount of serotonin between nerve cells which is thought to play a role in depression. Unlike a pain pill that works right away, antidepressants can take up to 4 to 6 weeks to have an affect.

Which SSRI a doctor chooses will depend on each individual patient. Just like every other medication, antidepressants can have side effects and interact with the body or other medications in a way that may be dangerous or uncomfortable for patients. Some SSRI’s may be more likely to make a person tired or sedated, while others may have a tendency to give a patient more energy. Depending on an individual’s depressive symptoms, your doctor might prescribe a medicine that would be more likely to help you fall asleep or feel more alert and energetic. Furthermore, certain SSRI’s have been studied more in patients with a particular medical disease, like heart disease for instance and this might leave a physician to try a medication that has research data to show that the medication is safe for their patient. Certainly, some medications work better in some patients than others, and after a period of 4-6 weeks of adequate dosages if no improvement in symptoms occurs your doctor will likely recommend increasing your dose or switching to another antidepressant to treat your depression. In some instances a physician might recommend augmenting your medication by adding another medication that works in a different way to treat your Depression.

Even if the first anti-depressant doesn’t seem to work for you, there are still other options for treatment. Newer medications that work on norepinephrine and dopamine in the brain are also used quite frequently to treat depression, and older medications to treat depression, although they often have more side effects are still effective in treating depression and can be used in refractory cases.

As a patient it is important for your prescribing doctor to know about your symptoms, side effects, and other medical history and current medications that you are taking. And, as always if you have any questions about the medications you are being prescribed don’t hesitate to ask your doctor about your concerns.

Bipolar in kids? Probably not.

2010-12-09T09:00:00.001-05:00

By Scott Benson, M.D.

The 5-year-old little girl had been referred to a therapist by her school because of her severe disruptive behavior. The almost daily tantrums had everyone concerned. She was uncooperative with the assessment and arrangements made for further evaluation. The therapist wrote a diagnosis of bipolar disorder.

The patient was certainly reactive to any limits and her tantrums seemed like they would never end. But she slept well at night; she rarely had behavior problems with her grandparents who provided afterschool care.

After a few parent training sessions with the little girl and her parents her behavior control improved. But continued treatment was threatened when her dad tried to get her on his new health insurance. The diagnosis of bipolar got the application bumped by the computer and it took a lot of calls and several letters to get her on the policy so that her treatment could continue.

At times it seems we are a little too quick to throw a label on a child’s behavior, and bipolar disorder seems to be the most popular current label.

But new research at the October meeting of the American Academy of Child and Adolescent Psychiatry found that children with some symptoms of mania probably do not have bipolar disorder.

Boris Birmaher, M.D., a child and adolescent psychiatrist at the University of Pittsburgh presented his group’s research. More than 2,000 children presenting to 10 different academic centers were included in the Longitudinal Assessment of Manic Symptoms (LAMS) study. 621 were found to have elevated symptoms of mania, but the full evaluation did not find sufficient symptoms for a diagnosis of bipolar disorder. Most had attention deficit hyperactivity disorder (ADHD), others had another disruptive behavior disorder. Children who did have bipolar disorder have poor function and are likely to require treatment in hospitals.

"Kids with manic symptoms don't necessarily have bipolar disorder," he told Reuters Health. On the other hand, "Many children with bipolar disorder are not being correctly diagnosed."

The LAMS study which will follow these children for five years should provide direction for the assessment and treatment of children with severe behavior problems. In the mean time parents should insist on an adequate evaluation for children with severe behaviors.

The Parents' Medication Guide for Bipolar Disorder in Children & Adolescents is a great source of information for understanding the evaluation process and treatment options. Or visit HealthyMinds.org for more information on bipolar disorder or mental health issues in children.

Parenting in the Internet Age

2010-12-08T07:45:00.005-05:00

By Molly McVoy, M.D.

Facebook, blogging, Twitter, email, texting. How is a parent supposed to keep up with all of the technology available to children and teens in today’s world? Many parents and children struggle with safety on the Internet. Although there are no easy answers, some simple steps can help keep you and your child safe.

First, and most important: all of the things that make a good parent in everyday life also make a good parent on the Internet. Spend time with your child in their daily life and spend time with them learning about what they do online. Educate yourself on your child’s school and social life. In the same way, educate yourself about the websites they visit and who they are talking to online.

In addition, keep their access to technology limited and in public settings. Put the computer in the kitchen or the living room – in other words, in a place where secrecy is difficult and monitoring is easy. Online time should only come after homework and other activities are done for the day. Also, talk about what they are doing online, but do not invade their privacy by reading emails unless absolutely necessary. If you suspect dangerous things are happening by or to your child online, then invading their privacy may be necessary. Otherwise, encourage open communication and respect their privacy.

For more information:

http://www.webwisekids.org/

http://www.kids.gov/6_8/6_8_computers_internet.shtml
http://www.attorneygeneral.gov/uploadedFiles/Consumers/cybersafety.pdf

Hypertexting and risky behaviors: A cautionary tale?

2010-12-06T13:32:00.002-05:00

By Tristan Gorrindo, M.D.

Last month, researchers at the American Public Health Association’s annual meeting reported some alarming statistics about the connection between high levels of message texting and risky behaviors. In a study of high school students in the Midwest, the researchers found a relationship between those that send more than 120 texts per school day (20% of the students surveyed fell into this group) and increased experimentation with cigarettes and alcohol, binge drinking, physical fighting, and a high number of sexual partners. These results were widely reported by several major media outlets including CNN and the Associated Press .

While the authors of this research clearly state that they don’t think that “hypertexting” causes students to drink more or engage in risky behaviors, I worry that this fine-point is lost on most people who are just reading the headlines.

Since most of us don’t remember our high school statistics class, I think it’s worth thinking about how two ideas can be related (as they are here) but not necessarily in a causal relationship. An analogy I often use is the finding that yellow teeth and lung cancer are highly connected in research studies. It isn’t that tartar covered teeth cause lung cancer, or that lung cancer causes teeth to yellow. It turns out that there is a common root-cause of both– that is smoking cigarettes causes both yellow teeth and lung cancer.

In a similar manner, there might be an underlying root-cause (or several different causes), which cause kids to use cigarettes and alcohol and to be hypertexters. These root-causes might include poor parental supervision, mental illness, or even a learning disability, just to name a few. But until we conduct more careful studies, we won’t know for sure.

Certainly, parents should know how many texts per day their child is sending. And in the same way that I encourage parents to talk to their kids about alcohol use or sexual activity, they should also be talking to their kids about the ways in which they are using technology.

Coping with Stress in America

2010-12-03T07:55:00.006-05:00

By Adair Parr, M.D.

A survey by the American Psychological Association highlighted the negative impact that stress can have on families and children. This is an extremely important topic that affects many family caregivers, who are under a great deal of stress taking care of loved ones. More and more Americans are affected by stress. The survey indicates that many Americans feel that they are experiencing unhealthy amounts of stress. The economy is one of the main reasons. Fewer are satisfied with the ways that their employer helps employees balance work and non-work demands and many are concerned about job stability.

In addition, stress impacts the entire family. Children recognize when their parents are stressed and that could make them feel sad and worried. Nevertheless, parents frequently underestimate the impact that their own stress has on their children.

Stress affects both our mental and physical health. Some people manage stress by smoking, drinking or over-eating. That can lead to bigger problems. The study shows that Americans understand the importance of healthy behaviors like getting enough sleep, exercising and eating healthy. However, lack of time and motivation gets in the way of following through on these goals. Willpower was identified as a barrier to many healthy behaviors, even when they are recommended by a health care provider.
Managing your stress is extremely important. Stress does affect the family members you care for. There are healthy ways to manage your stress. Some suggestions are: exercising or playing sports; listening to music; spending time with friends and family; going to religious services; journaling; and practicing yoga / meditation.

If you find that you are overwhelmed or suffering physical symptoms from stress like headache, poor appetite and insomnia, or if you are feeling depressed or suffering from chronic irritability and crying spells, you may need to see a mental health provider. The Healthy Minds website has brochures about dozens of mental health issues including early warning signs of mental illness.

Where to go for Mental Health

2010-12-02T07:55:00.010-05:00

By Sara Coffey, D.O.

Sara Coffey, D.O.

Trying to find the right doctor for you? With so many specialties and titles it can be confusing to navigate the complex array of mental health professionals. So, where do patients with mental illness start?

Understanding a doctors training and background may be the first place. Patients with mental illness may be seen by their primary care doctors, counselors, psychiatrists, or psychologists. But, what makes these professionals different? All physicians, either M.D.’s or D.O.’s (Osteopathic Doctors), have similar training. Most often, they have completed four years of undergraduate school, with an emphasis on science courses including biology and chemistry. Then they must pass an entrance exam to start a four-year medical school program where they will receive two more years of core science training as well as other courses to help them understand the human body, disease, and prevention. The last two years of medical school focus on clinical rotations through surgery, OB/GYN, psychiatry, internal medicine, family medicine, and include several months of extra training in a specialty area.

Upon completion of medical school, you are officially referred to as “doctor,” but a psychiatrist’s training does not end there. A residency program comes next with hands-on training under the guidance of a more seasoned physician. Take my background for example. As a psychiatry resident, my first year of residency training included two months working on an inpatient pediatric floor, two months on an inpatient general medical hospital floor, and two months on a neurology service. These rotations are important in psychiatry training because psychiatric patients often have other medical issues in addition to mental health problems. A physician should know the difference between anxiety and a heart attack.

It takes eight years or more of school and four to six years additional years of training to become a fully practicing psychiatrist. I’m on that path, and now I will be able to focus on my psychiatry specialty. That will give me the opportunity to learn the science and art of treating patients from experienced psychiatrists. My integrative medical training will also provide a solid foundation to work with a variety of patients and their mental illnesses.

Finding Meaning in Modern Life - Part 2

2010-12-01T08:19:00.000-05:00

By Roberto Blanco, M.D.
Last month, I wrote about Viktor Frankl’s book “Man’s Search For Meaning” and how some of the principles in his book could be applied to modern life. In response to the blog, one of the readers, Mukesh Samani, asked what it was in Dr. Frankl’s book that touched me the most. I would like to take this opportunity to thank Mr. Samani for his question and to respond.

What touched me the most from Dr. Frankl’s work was his motivation to live, share his experience, and teach something positive. As a psychiatrist during a time when any type of self-revelation was taboo and frowned upon, he showed great courage in revealing some of the darkest, innermost details of his life to the entire world. He did this so others could learn from his experience.

As a Psychiatrist, I work with many people who may be down on their luck or are the victims of unfortunate situations. Like Dr. Frankl, the ones who are able to discuss their situation, find some meaning from it, and continue to move forward, generally do the best.

Mr. Samani also asked what is special or specific in Dr. Frankl’s model of psychotherapy known as Logotherapy. Mr. Samani, I would refer you back to Dr. Frankl’s book which has a nice summary on Logotherapy. I am not an expert on Logotherapy. However, in short, it is a therapy which focuses on man’s desire to find meaning as the main motivating force in life.

I see following role models, like Dr. Frankl, as a way to find meaning in life. Looking back on your own life, is it clear which people affected you the most in positive ways? What was it about these people that moved or affected you? Did they have some special characteristic that set them apart from others or allowed them to connect with you? If so, finding out what that is and trying to reproduce it with others can give your life more meaning.

I have a lot of admiration for Dr. Frankl’s work and I appreciate the comment from “Mary” about a new documentary coming out on his life titled “Viktor and I.” I’ll be interested to see how he used his experiences in his professional life and what he was like on a personal level from the perspective of his close friends, family and colleagues. Thank you for your comments and questions.

National Caregivers Month: Alzheimer's Disease

2010-11-10T07:39:00.013-05:00

By Felicia Wong, MD

Alzheimer’s Disease is a progressive, irreversible brain disease. The cause is poorly understood, and there is no known cure. Symptoms of Alzheimer’s include memory loss, confusion, impaired judgment, personality changes, disorientation and loss of language skills. It is the most common form of irreversible dementia.

Watching someone you love slowly lose their memory, thinking and reasoning skills can be heartbreaking. Caring for a person with Alzheimer’s Disease is a difficult task and can become overwhelming at times. As Alzheimer’s patients gradually lose their memory and their skills , each day brings new challenges to the caregiver. This is why I wanted to recognize caregivers for Alzheimer's patients in November, which is National Family Caregivers Month and Alzheimer's Disease Awareness Month.

Over time, communication diminishes, rewards decrease, and without strong support from family, friends and the community, caregivers of Alzheimer's patients face challenges to their very own well-being. Maintaining emotional and physical fitness while providing care for a loved one with Alzheimer’s Disease is crucial. Preparing and protecting yourself, understanding your loved one’s experience, and accepting help from others can reduce the stress associated with care-giving, and maximize the joys of being there for a loved one.

Here is a link to tips to help caregivers of loved ones with Alzheimer’s cope.

Additional support for Alzheimer’s and Dementia Caregivers, including warning signs of caregiver burnout, and tips on how to plan your own self care can be found on Helpguide.

Find additional information on Alzheimer's and other issues affecting mental health in seniors on the American Psychiatric Association's Healthy Minds website.

National Family Caregivers Month: Self-Care for Caregivers

2010-11-08T15:47:00.019-05:00

By Felicia Wong, MD

I love helping others. That is why I became a doctor, and why I love my job as a psychiatrist. But when I was a pre-medical student in college, my mom shared the following words of wisdom with me: “In order to take care of others, you need to take care of yourself first.”

It took me a moment to understand the importance of the point she was making. I had taken a break from my community service projects due to a sports injury, and was eager to return to them. However, at that time, I was not fully recovered and was often in pain, and would tire easily. My mom encouraged me to take some more time off in order to focus on my own recovery and healing. Initially, I felt guilty taking the time out for myself. But in the end, I realized mom was right. Once I became strong and well again, I had so much more to offer to others.

Caregivers tend to be selfless, and expect a lot of themselves without recognizing their own need for self-care. Studies have found that caregivers have higher levels of depression and stress than non-caregivers. Sometimes caregivers are so committed to helping others that they forget to take care of themselves. They fail to recognize that if they drive themselves to exhaustion or sickness, they may not be able to help at all.

Warning signs of caregiver burnout from the non-profit Helpguide.org include:

You have much less energy than you used to
It seems like you catch every cold or flu that’s going around
You’re constantly exhausted, even after sleeping or taking a break
You neglect your own needs, either because you’re too busy or you don’t care anymore
Your life revolves around caregiving, but it gives you little satisfaction
You have trouble relaxing, even when help is available
You’re increasingly impatient and irritable with the person you’re caring for
You feel overwhelmed, helpless, and hopeless

Key strategies to prevent burnout include getting the help you need, seeking emotional support, and taking time out to care for yourself.

Learn and use stress-reduction techniques.
Attend to your own healthcare needs.
Get proper rest and nutrition.
Exercise regularly.
Take time off without feeling guilty.
Participate in pleasant, nurturing activities.
Seek and accept the support of others.
Seek supportive counseling when you need it, or talk to a trusted counselor or friend.
Identify and acknowledge your feelings.
Change the negative ways you view situations.
Set goals.

For additional strategies for self-care for caregivers, visit the Family Caregiver Alliance, and watch for my next post on caring for someone with Alzheimer's.

National Family Caregivers Month

2010-11-05T07:29:00.017-04:00

By Gariane Gunter, M.D.

November is National Family Caregivers Month and what a worthy group to stop and recognize. Those who are caregivers for family members or friends with mental illnesses need support and encouragement just as those caring for loved ones with other illnesses. There are many groups and resources available across the nation that are available to help. I would like to tell you about one of them.

The National Alliance on Mental Illness is a grassroots organization that was started in 1979. I have had the wonderful opportunity to work with them in my area and have seen firsthand the difference they make in the lives of those suffering from mental illnesses as well as their families. One special program they offer for family members is called Family-to-Family. The NAMI Family-to-Family Education Program is a free 12-week course for family caregivers of individuals with severe brain disorders (mental illnesses). NAMI recognizes that family members of people with serious mental illnesses need information and support to cope with the considerable stresses they experience.

The Family to Family Education Program is a structured, peer-led, 12-week information and support self-help class for such individuals. Research shows reduced subjective burden and increased empowerment among graduates. Family-to-Family classes are offered in hundreds of communities across the country. You can find more information on this program as well as many other resources available in your area by visiting NAMI online at www.nami.org. There you can find a support group, connect online in NAMI's discussion groups, contact your state or local NAMI and more. Caregivers please take the time to take care of you this month.

Concussion: Getting Back in the Game?

2010-11-01T07:25:00.005-04:00

American Psychiatric Association Healthy Minds blogger and sports psychiatriy expert Claudia Reardon, M.D., discusses concussions in young athletes in this video blog:

Depression: Should I Tell the Boss?

2010-10-28T07:33:00.003-04:00

By Gina Newsome Duncan, MD

Depression is the leading cause of disability among people ages 15-44, affecting nearly 7 percent of the adult population in a given year. That means that close to one in ten American adults is suffering from depression at any given point in time. A recent CNN Health article highlighted the dilemma one woman with depression faced when considering whether to tell her employer.

It may not be talked about much, but depression is most certainly present in the workplace. What are the effects? People suffering from depression can experience a decrease in concentration, difficulty making decisions, feelings of isolation, feeling slowed down in their thinking and mental processing, and poor sleep, which can lead to daytime fatigue. All of these factors can result in poor job performance. In fact,a decline in job performance is often the wake-up call that someone is experiencing depression and needs to do something.

If you feel that you may be suffering from major depressive disorder and are concerned about the effect on your work, what should you do?

A good first step is to talk with a psychiatrist or your primary care physician about your symptoms and explore possible treatment options. Psychiatrists and primary care physicians are familiar with employment issues and should be able to get you started on a plan to address your concerns.
Find out about your company’s Employee Assistance Program (EAP). It is in your company’s best interest for you to function at your optimal level, and most large companies offer some type of EAP. In most cases, confidentiality and privacy requirements apply to EAP services, and the employer does not usually know who is or is not using them, except in cases where the employer referred the worker to the EAP. Employee Assistance Programs offer a broad range of services, including psychological assessment, counseling, support and referrals.

Other things to keep in mind:

Depression is real, but it is not as visible as something like a broken leg. Depression can be difficult for others to accept as a true illness or valid reason for being excused from work. As a society, we can be stoic when it comes to issues of emotional distress; “Just suck it up and keep going,” we tell ourselves and others. It can be hard for others to understand or appreciate the effects of a major depressive episode or another mental illness unless they or a loved one have experienced it. Employers are beginning to understand that attending to their employees’ mental health is not just a nice thing to do, it makes good business sense.

Federal laws protect the rights of workers who become medically ill or disabled. This includes workers who are unable to work due to a mental illness such as major depression. However, employer sensitivity toward such employees can vary, particularly if the employee has not taken official medical leave but is frequently calling out sick or requesting time off for regular psychiatrist or therapist appointments during work hours.

Whether or not to disclose your illness to your boss and/or your coworkers is an individual decision that depends on your company’s culture and your own preference. But here are a couple of thoughts to keep in mind: If your symptoms are not affecting your job performance in a visible way and if, with the help of your doctor, you have started a treatment plan that you are finding helpful, then disclosing your illness to your employer may not be necessary. If, on the other hand, your symptoms are severe, causing frequent missed days of work or other job performance issues that threaten your employment, and if you have not yet started treatment, then being proactive and addressing the issue with someone you trust, like a doctor, Employee Assistance Program or a boss, can be an important step.

Have you experienced firsthand the effects of depression in the workplace? If so, how was it addressed? How can we reduce the culture of stigma that surrounds mental illness in the workplace?

Family-Based Treatment May Benefit Teens with Anorexia

2010-10-27T07:45:00.001-04:00

By Molly McVoy, MD

A recent Wall Street Journal article reported on a study regarding teens with anorexia. The results of the study, published in the Archives of General Psychiatry, indicate that having parents actively involved in the treatment of adolescents with eating disorders is more effective than the traditional one-on-one treatment with a therapist.

The study looked at 120 teenagers using the Maudsley model versus traditional one-on-one therapy. The Maudsley model encourages parents to take charge of the eating habits of their children with eating disorders, such as anorexia. At one year, the study found that about 50 percent of patients treated with this family based therapy were in remission versus 23 percent in the more traditional individual therapy.

Anorexia nervosa is a serious, often life-threatening illness in which patients fear gaining weight to such a degree they restrict their diet and maintain a body weight below the 85 percent of a healthy weight. Successful treatment is intensive, involving medical monitoring, dietary interventions, therapy and, at times, medication.

This study adds to accumulating evidence that family involvement is critical in successful treatment of adolescents with eating disorders. As more studies are published with similar data, treatment centers for eating disorders and increasingly involving families in the intensive treatment programs.

The HealthyMinds.org has more information on eating disorders.

ADHD: Can My Kid Just Outgrow It?

2010-10-25T09:50:00.002-04:00

By R. Scott Benson, MD

Won't he just outgrow it? This is the wish of every parent – that a little time, a little more love, or discipline, or happy thoughts will solve what might be a serious problem. And I hear this question often from parents of pre-schoolers who are having behavior problems in pre-K programs or daycare settings.

But we can’t wait. And now there is even more research to support the importance of a careful evaluation and treatment when indicated. This month’s Archives of General Psychiatry reports the results of a long term study of children who were diagnosed with ADHD between the ages of 4 and 6 years old. There was a control group of children without ADHD. As adolescents the children with the early diagnosis of ADHD had higher rates of depression and suicidal thoughts. Fortunately, there were no suicides in this study. Benjamin Lahey, Ph.D., the study director is a professor of health studies and psychiatry at the University of Chicago. He said the study “reinforces our belief that parents of young children with ADHD should pay close attention to their child’s behavior and its consequences and seek treatment to prevent possible long-term problems.”

So the better question is “What treatment is recommended for pre-schoolers?” And we have good science to help answer that question. Carefully managed studies have shown that pre-school children and their families should have at least 12 weeks of behavior management training as a first level of care. And this is not just any behavior management. At a conference in Florida, Dr. Regina Bussing recommended that families should consider a number of behavior training programs – the Positive Parenting Program, The Incredible Years, and Parent Child Interaction Therapy. These are intense programs that are very different from a few words of advice from a well-meaning pediatrician or the do-it-yourself manuals that are so prevalent in the bookstores.

Let us know of other successful behavior training programs in your community, and we will post those links here.

Supporting Gay Youth as a Way to Prevent Suicide

2010-10-22T09:37:00.002-04:00

By Tristan Gorrindo, MD

Coming out of the closet is one of the hardest things that a gay, lesbian, or bisexual person will do.

“Coming out,” is the process of revealing to friends, parents, family members, and acquaintances that he or she is gay. It is more that just a simple act or decision to announce that a person is gay, but rather a process that unfolds overtime, usually in small steps. For many people, it involves telling one person, then a group of friends or family members, then classmates or co-workers, and finally the world at large. But for each person, the journey is different and often filled with emotional ups and downs.

Recent events in the national media have highlighted the issues surrounding coming out and youth suicide. By some estimates, as many as nine gay youth died by suicide since September 1, 2010. Government officials and celebrities have publicly referred to this as a national crisis.

Many population scientists have tried to understand why gay teens are at such high risk for suicide -- by some estimates 7 times the national average for their age. And although there are many possible contributors to what might make a gay teen suicidal, we must first remember that all teens, gay and straight alike, are struggling with basic questions about self-identity.

A friend of mine once described being a teenager is like, “being at a costume ball where the costumes and guests are constantly changing.” As part of normal teenage development, teens are “trying on” different roles, different groups of friends, and even different kinds of dress. It is a time when teens are first experimenting with the idea of romantic relationships and at the same time trying to separate from their parents. Gay teens have the added burden of sorting out the confusing, often negative messages from the culture about what it means to be gay. When these ingredients mix -- unsure sense of self-identify, novice experience with romance, trying to separate from one’s parents, and fear of what it means to be gay -- gay teens run the risk of feeling quite isolated and alone.

Regardless of one’s personal views of homosexuality, I think we can all agree on the importance of supporting our youth during difficult times. The American Psychiatric Association is committed to reducing the stigma around homosexuality and to promoting the psychological health of gay, straight, and bisexual individuals.

We owe it to our teens to make sure that they know that coming out is not a process that they have to go through alone. A wide variety of resources exist, from grass-roots YouTube videos which offer gay teens hope, as in The Make It Better Project, to 24-hour suicide hotline for gay teens offered through The Trevor Project. Additionally, The National Suicide Prevention Lifeline also is available 24/7 at 1-800-273-TALK (8255) to anyone struggling with suicidal thoughts. The Healthy Minds website is a source of clear factual information on sexual orientation. And let us not forget the parents that may also be struggling with how to help their gay child; for them there is support and advice offered through PFLAG.

Anger: A Complicated Emotion

2010-10-20T07:45:00.002-04:00

Anger is a normal emotion that can be useful in coping with the world. But anger expressed in excess or suppressed can cause problems. Healthy Minds blogger Molly McVoy, M.D., talks about anger, how to recognize inappropriate anger and what to do about it.

Athletes Suffer from Depression Too

2010-10-18T07:45:00.005-04:00

By Claudia L. Reardon, M.D.

Athletes don’t get depressed, right? After all, they are so physically fit and healthy that they must be equally emotionally healthy. Unfortunately, this is not true. Just like the rest of us, athletes can be at risk for depression. This is the case all the way from the school-aged child playing on a recreational team, up to the professional athlete who makes a living playing his or her sport.

Whenever we see a news story about a famous athlete with depression or an athlete who has committed suicide, it tends to come as a big surprise since athletes tend to be glamorized and admired in our society. However, here are some things we know about the reality of depression in athletes:

1. Athletes seem to be at least as likely as the general population to suffer from depression.

2. Athletes who suffer multiple concussions are up to four times as likely as other athletes to suffer depression. Athletes in some sports, including football, hockey, and soccer, are especially likely to suffer concussions.

3. Overtraining syndrome can occur in athletes who are seriously training for an event and do so beyond the body’s ability to recover. Overtraining can look very similar to depression and can actually lead to full-blown depression. Like depression, overtraining can include fatigue, insomnia, appetite change, weight loss, difficulties with motivation, and poor concentration. Overtrained athletes usually notice that their sports performance worsens. They may develop more injuries; experience muscle and joint pain, and lose enthusiasm for their sport. If an athlete is overtrained, the treatment is usually to cut back on physical activity or do cross training at a lower intensity until the symptoms start to improve. If overtraining leads to full-blown depression, medication and/or talk therapy may also be helpful.

4. Besides concussions and overtraining, other common factors that can lead to depression in athletes include injuries, competitive failure, aging, retirement from sport, and the same daily stressors that can lead to depression in the general population.

5. In recent years, athletes across several sports have started to open up about their struggles with depression. Hopefully this will help athletes with depression to feel better about seeking help for this disorder.

Working with Schools When your Child has Problems

2010-10-14T07:40:00.037-04:00

By Gariane Gunter, M.D.

Well, we have made it through the first months of a new school year! However, for some students the start of a new year has been difficult. I have received many calls and heard numerous concerns from parents who are wondering how they can work with their child’s school to ensure a success. Below is a list of the Top Ten Tips for Working with Schools that was shared with me by a Lead School Psychologist in my area. I hope you have a great year!

Top Ten Tips for Working with Schools

Let the school know up front if you have concerns
It helps to be visible in the school but do not intrude on the learning
Every school is a little different in its approach

There are lots of different ways of working with student problems in schools. Not just one of them is right.
If you want to talk to a classroom teacher, ask to make an appointment with them. When teachers are with students, their first responsibility is to teach and supervise them.
School folks got into education for the joy of working with students.
School Psychologists and Special Teachers are there to study individual students. Help them by giving your specific observations. Your observations matter.
Lots of teachers and other school folks use e-mail, but remember that teachers check e-mail when they have planning or breaks.
If you have made a request and you haven’t received a response, don’t wait too long before asking about it. Sometimes requests do get lost.
Schools can be fun places to be; it is where all children gather to learn. Enjoy your time there too!

Reference: Shirley A. Vickery, PhD

A Parent’s Guide To Social Networking

2010-10-11T07:08:00.040-04:00

By Adair Parr, M.D.

If you are like most parents, your teenager knows more about social networking than you do. According to a Pew Internet Project study, nearly three-quarters of teens online use social networking sites. What’s more, many teenagers now access social networking through cell phones, further increasing their online presence. The phenomenal rise of Facebook is documented in the movie, The Social Network, which was number one at the box office this past weekend.

Are your teenagers on Facebook? Are you wondering where to draw the line? Many parents feel overwhelmed by understanding media and technology and feel that they will never catch up to their kids. While you may not text as fast as they do, making an effort to learn about social networking is important. Teens are designed to experiment with risky behavior and social networking is one area in which they may try such behaviors. By educating yourself on the topic, you will be better prepared as a parent to help your child to use media and social networking responsibly.

What can you do to help ensure your teen’s responsible use of social networking?

Talk to your kids about the media in their life. Ask your teen how social networking changes lives.
Keep the lines of communication open with your teen. Know who they are communicating with online.
Remind your teenager to limit the amount of personal information online.
Remember that everything your teenager posts is public information. Once it is posted, it is online forever.
Educate your teenager about cyberbullying and what to do if he or she is a victim of cyberbullying.
Model responsible media use behavior for your teenager.

The Healthy Minds website has additional information about mental health for college-age students and children. Check out these resources to help parents navigate the murky waters of social media:

It's Not Your Fault

2010-10-06T07:45:00.001-04:00

Healthy Minds. Healthy Lives. blogger Gariane Phillips Gunter, MD, talks about how individuals with mental illnesses cannot be blamed for mental illness and how to get help for someone struggling with mental health issues.

Finding Meaning in Modern Life

2010-10-05T07:45:00.005-04:00

By Roberto Blanco, M.D.

During recent travels, I visited the Yad Vashem Holocaust Museum in Jerusalem and came across Man’s Search for Meaning at the bookstore. It is written by Dr. Viktor Frankl, a Viennese professor and psychiatrist before World War II, who became a holocaust survivor. Dr. Frankl narrates his experiences and observations in different concentration camps and describes how, against all odds, he survived.

Dr. Frankl, however, did not intend the book to be solely a tale about survival. As he explained in his preface to the 1984 edition, he wrote the book so that others could see concretely that life, even in the most hopeless and miserable conditions, holds meaning. He wanted to show how having meaning in one’s life is the most important aspect to living fulfilling lives. In the book, Dr. Frankl proposed that he was able to survive because of luck and because his faith that his survival had some great meaning was unshakeable. During years spent in brutal conditions in concentration camps, Dr. Frankl was able to endure by finding some goodness to hold on to, even if sometimes this goodness could only be found in his head. He also observed how those who eventually lost motivation and hope usually did not survive much longer.

It is difficult not to be inspired by Dr. Frankl’s story, but it makes me think about how difficult it can be to feel fulfilled in our modern world. How can a man who had everything in his life taken away from him, find more meaning in his life than many who have all of the freedoms and material possessions they could want? I think that the answer lies in slowing down to appreciate the little things in life and to appreciate the meaning of it all. Every day should serve as a challenge to find a meaning, even if it is a small one.

The ways in which people find meaning depend on their age, current role in life, and developmental stage. Some people are motivated by special people in their lives; the relationships that provide meaning often change as people become independent of parents, find partners, and then have children of their own. Others develop a relationship with a higher power, which also can change as they grow and change themselves. And finally, having a mission, vocation, or cause often gives people meaning to their lives. These often change, as well, as people change careers, go back to school, or have other new experiences.

On a day-to-day basis, here are some things that you can do to answer the challenge of the day:

1. Be kind to another person.
2. Strike up a conversation with a friendly stranger.
3. Re-connect with an old friend.
4. Reminisce about that special memory that brings back positive feelings.
5. Further your cause or mission in some way.
6. Participate in a favorite hobby, sport, or special interest.
7. Pray.
8. Go for a walk.
9. Tell that special someone how you feel about them.

I’m interested to hear, what is it that brings meaning to your life?

Mental Illness in School: No Child Left Behind?

2010-09-28T09:09:00.000-04:00

By Molly McVoy, M.D.

How much do I tell my child’s teacher about her depression? About his bipolar disorder? About her ADHD? Will he fall behind if the teacher doesn’t know? Will she be judged if I tell the school? When do I get testing, an IEP, special Ed? What do those mean?

Parents of children with psychiatric illness struggle with these questions and many others. Often, there are no easy answers. A child’s success at school may be one of the best predictors of future success. Giving a child and his/her family the best tools to succeed in school is one of my top priorities as a child psychiatrist.

When deciding how much to tell your child’s school about his/her psychiatric illness, consider your child’s ability to function at school rather than his/her specific type of illness. You are not required to tell the school anything; that is up to you as a parent. If telling your child’s teacher about his/her psychiatric illness will give him/her a better chance to do well, then consider telling the teacher. If your child’s illness is affecting his/her day to day functioning and behavior at school, then consider telling the teacher. Teachers are your partners in helping your child succeed. If the illness is relatively well controlled and is not affecting his/her daily behavior at school, the school may not need to know. For more information, visit the American Academy of Child and Adolescent Psychiatry.

When it comes to accessing special education services, most schools and teachers want to do everything they can to help your child. I usually recommend families listen to the principal and teachers.They are the experts in education. However, if you are dissatisfied with the educational services you are receiving, my next recommendation is know your rights, know your state’s laws. Every state must provide a free education that meets the needs of each child – no matter what those needs are. What varies widely, however, is how each state manages that requirement. The U.S. Department of Education website has basic information on your rights as a parent and offers links to each state.html. Know your state law, know your rights. Come armed with that information and work with your doctor and school for your child to succeed!

Mental Health Disparities – Focus on Asian Americans

2010-09-23T07:00:00.001-04:00

By Felicia Wong, M.D.
The Office of Minority and National Affairs (OMNA) is a group within the American Psychiatric Association that works to promote diversity and cultural competence and to eliminate disparities in mental health care. They published a report on Asian Americans and Mental Health that revealed some troubling statistics.

photo courtesy Bjoern Kommerell

While the overall prevalence rate of mental illness is similar or somewhat lower among Asian Americans than whites, Asian Americans are significantly less likely to use mental health services than other populations.
Asian Americans are much less likely than whites to report mental health problems to friends or relatives, psychiatrists or other mental health specialists, or to physicians. It has been postulated that shame and stigma figure prominently in the lower utilization rates of Asian American/Pacific Islander (AA/PI) communities.
AA/PI’s often consider expression of mental illness a personal weakness and are more likely than Westerners to express emotional distress through physical symptoms.
The suicide rates of elderly Asian American women and young Asian American women (15‐24 years old) are significantly higher than that of other women of the same ages.

In an attempt to address the barriers to mental health care that pertain to the Asian American community, I created a website http://www.asianmentalwellness.com/ which I hope will dispel some of the misconceptions that the AA/PI community may have about mental health, and will provide information and links that will help raise awareness about the importance of mental health and wellness. Please share this website with those who you feel might find it useful.

Adult ADHD? Not just a diagnosis for kids

2010-09-21T07:50:00.002-04:00

By Felicia Wong, M.D.

There have been several posts addressing ADHD in children on our blog, but did you know that ADHD can affect adults as well? An interesting article in the Wall Street Journal discusses adult attention-deficit/hyperactivity (ADHD) disorder, a condition that may affect up to 10 million Americans, only 4.4 percent of whom know it.

According to government data, an estimated eight percent of U.S. children have ADHD, and some 50 percent outgrow it. But what happens to those who don’t?

It was only in 1980 that therapists began to recognize that ADHD could persist in adults, and even now, getting an accurate diagnosis is tricky. It is controversial topic that has people taking sides. Some experts think that too many adults (and children) are being medicated for ADHD, often by doctors who have little knowledge or experience with this disorder. Others argue that those adults who have experienced functional impairment could benefit from ADHD medications and behavioral therapy.

Some adults whose ADHD is left untreated can encounter negative consequences including high incidence of substance abuse, automobile accidents, difficulty staying employed and maintaining relationships. Yet, adults with ADHD can also be highly intelligent, energetic, charismatic and creative. Those with ADHD may have the ability to focus intently on a narrow range of topics that interest them.

Many adults with ADHD have developed skills to compensate for their distractibility. Some excel in school at an early age, and don’t run into any problems until college/ grad school or starting at a challenging new job. Suddenly, their coping mechanisms are not as effective anymore.

An excerpt from the Wall Street Journal article:

We see people from all of the professions who have managed to succeed despite the limitations, but they have often done it at significant cost," says Dr. Solanto. "They don't have time to enjoy life. They don't get their work done in the course of a day. They have to stay late after hours, or they are doing without sleep, frantically trying to meet deadlines. It ultimately takes a toll on their wellbeing and a toll on the people around them.

Adult ADHD is tricky to diagnosis and deciding whether to get help for it can be difficult as well. The symptoms that traditionally describe ADHD: restlessness, impatience, procrastination, chronic lateness, and difficulty getting organized, focusing, and finishing tasks are common in busy adults. But how can one tell if it’s just stress, or too much caffeine that is causing their symptoms? What about the stigma and perceptions associated with ADHD? What does it mean to suddenly discover at the age of 40, that you have ADHD?

The key word in determining whether an evaluation should be considered is impairment. As Dr. Jaksa from the article puts it, "Everyone gets distracted. Who's not late occasionally? But if you are chronically late, you lose your job and maybe your friends as well."

Experts say that those who suspect they have ADHD should have a thorough evaluation, with a psychologist or psychiatrist who specializes in the disorder, looking at how they functioned in early childhood, in school and social settings and personal relationships. Once ADHD is diagnosed, most experts recommend treatment with both medication and behavioral therapy.

Here are some adult ADHD key points:

• Adult ADHD can be comorbid with bipolar disorder, anxiety, and depression, further complicating diagnosis and treatment.

• For adults diagnosed with the condition, treatment can consist of behavioral therapy, medication, or both.

• People who think they may have ADHD should be evaluated by a psychiatrist who understands the disorder.

A recent study published in the August 25 issue of the Journal of the American Medical Association, cognitive behavioral therapy (CBT), "a form of psychotherapy that focuses on changing patterns of thought and behavior that are counterproductive, can help" adults with ADHD. For more information on that study and recent news about Adult ADHD – please visit the following links:

Los Angeles Times (8/24, Healy)

CNN (8/24, Landau)

HealthDay (8/24, Gardner)

Reuters (8/25, Pittman)

WebMD (8/24, Hendrick)

Concluding the Mental Health Checkup: Personal Statement

2010-09-18T11:49:00.007-04:00

By Gina Duncan, M.D.

Over the last several days, I provided a list of nine topics to reflect upon as you consider how you’re taking care of your mental health. Finally, to complete our mental health checkup, does the following statement apply to you:

“I am pleased with myself and where I am in my life. I acknowledge my past mistakes, but do not feel overburdened by them or unable to move forward. I am self-aware. I cannot always control my external circumstances, but I feel good about the way in which I am meeting the challenges I face, and I feel confident in my ability to succeed. I don’t expect myself to be perfect, but I do know that I am a person of worth who has something to offer this world. I have relationships that are meaningful, I contribute to others in ways that are fulfilling, and I feel in tune with myself and in sync with my surroundings.”

I want to encourage all of us to not just strive to “cope” with the stresses of everyday life, but to thrive.

What does mental health mean to you?

Mental Health Checkup: Mood, Concentration, Balance, Energy

2010-09-17T09:19:00.000-04:00

By Gina Duncan, M.D.

I’m rounding out my list of topics to consider in a personal mental health checkup. Keep in mind, this list is not exhaustive. It’s meant to provide a starting point to help you examine how you’re doing emotionally and mentally.

Mood — Do your moods feel pretty stable, or are you experiencing significant mood swings (either highs or lows)? Are you crying more than usual? Feeling persistently depressed for two weeks or more and any thoughts of suicide could indicate clinical depression.

Concentration — Are you able to focus on the task at hand, whether at work or at home, and get it done in a timely manner? Or, do you find yourself overrun with missed deadlines and undone chores? Often the first sign that our concentration is waning is when our productivity goes down. Poor concentration is a hallmark of attention deficit hyperactivity disorder (ADHD) but it can also be a symptom of depression and anxiety and should not be overlooked.

Balance — Is there an appropriate balance between your home life and your work life? Between family time with your kids and “date nights” for you and your spouse? Are you getting in some “me-time”, including physical exercise and spiritual pursuits? Achieving perfect balance in your life is probably not possible, but that doesn’t mean it’s not worth striving for! Juggling too many responsibilities is a prime way to end up stressed out and unhealthy.

Energy — Do you feel that you have the energy to do the things you need and want to do? Fatigue can be a sign of depression, anxiety and other mental illnesses, but it can also be a symptom of many physical illnesses including cancer, diabetes and sleep apnea. If you find that you are feeling unusually fatigued or have other concerning symptoms, it is important that you contact your doctor right away.

In my next blog entry, the last in this series, I’ll provide a statement to help you consider whether you are thriving or just coping.

Mental Health Checkup: Avoidance, Eating Habits

2010-09-16T07:45:00.005-04:00

By Gina Duncan, M.D.

I am continuing my list of topics to consider in a mental health checkup. Remember, if any of these issues raise red flags for you, your family doctor, family member or clergy may be a good place to get advice about next steps.

Avoidance — Do you feel like you’re avoiding yourself? It may seem like a funny question, but if you find yourself going out of your way to keep from being by yourself, then that could indicate that there is something you are trying to avoid emotionally. Many people find that their feelings of anxiety or worry are intensified when they are alone, and so they find ways to distract themselves by staying busy. We can often be unaware of this subconscious strategy to protect ourselves from painful feelings. If you think that this describes you, when you have a moment, go to a quiet place where you will be uninterrupted and sit quietly for a few minutes. How do you feel? Take a moment to write it down. If you find that even the thought of spending quiet time by yourself makes you tense, write that down as well. The goal is not to avoid your problems, but to find effective ways to deal with them.

Eating Habits — Has your appetite changed? Are you eating too much or too little? And what are you eating? If you find that you’re craving foods that are high in carbohydrates (sugar) and fat, or that you’re eating larger quantities than usual, it could be a sign of emotional eating as a response to stress. While temporarily satisfying, high sugar and fatty foods ultimately zap your energy and leave you feeling lower. Not to mention that the added pounds can become an additional source of stress.

Tomorrow I’ll round out my topics for a mental health checkup by discussing mood, concentration, balance and energy.

Mental Health Checkup: Tension, Anxiety and Tuning In

2010-09-15T08:00:00.010-04:00

By Gina Duncan, M.D.

Continuing my Mental Health Checkup series, here are some additional factors to consider as you evaluate your mental health:

Tension and Anxiety — Are you feeling tense and wound up all the time? How about nervous and anxious? Is it hard for you to unwind at the end of the day? We live in a fast-paced society and stress has become a common part of our everyday lives. If, however, you are finding that you’re unable to take mental breaks during the day where you can feel totally relaxed and worry-free even for a few moments, then that could indicate that your stress is approaching dangerous levels. Relaxation is a skill that many of us have to learn and practice. There have been some great previous posts with relaxation tips as well as ways to cope with anxiety and stress.

Writing in ajournal is one way
to stay "in touch" with yourself.

Tuned In — In general, how “in touch” do you feel with yourself? Do you feel like you’re experiencing emotions and you don’t know why, like being angry or crying “for no reason”? It’s not uncommon to get so busy that you don’t have time to process everything that is happening on an emotional level in real time. However, taking some time to write in a journal or talk to a friend can be critically important to good mental and emotional health, particularly when you find yourself in periods of great transition or change. The danger of being out of touch with yourself emotionally is that you may respond to difficult situations in ways that you later regret (such as impulsively sending off an angry email to your boss, or taking out your frustration on your kids). It is also difficult to advocate for yourself and your needs when you don’t know what those needs are. Being able to take a moment and identify that “I feel angry because _____.” or “I am hurt because _____.” can take you a long way in staying in touch with yourself.

Tomorrow I will write about avoidance and eating habits.

Could My Child Be Depressed?

2010-09-14T10:19:00.000-04:00

By Gariane Phillips Gunter, M.D

Most of us know someone who has suffered from depression at some point in their lives. However, did you know that depression is not just something that affects adults? Depression is a serious illness that can affect anyone, at any age, including children and adolescents. When a youth is depressed nearly every part of the young person's life is impacted as well as the lives of their family. If left untreated, pediatric depression can lead to problems in school and with friends, to accidents, to substance abuse, and, in its most extreme cases, to suicide. It can disrupt relationships among family members and friends, harm school performance and limit other educational opportunities. It can lead to other health problems through its effects on eating, sleeping, and physical activity. Because it has so many consequences, it is important that depression is recognized and treated successfully. When it is, most children can get back on track with their lives.

Children suffering from depression may not have the same symptoms as adults with the same diagnosis. While adults may appear down or tearful to those around them, children may appear more irritable or complain about physical symptoms such as stomach aches or headaches. Below are differences in symptoms that may be seen in adults versus children.

Youth living with depression need a thorough evaluation and comprehensive treatment from an appropriately trained professional. Each treatment must be tailored to the individual child or adolescent. Cognitive-behavioral therapy (CBT), a form of talk therapy, has been demonstrated to significantly contribute to recovery. In addition some antidepressant medications, when monitored, can be an effective part of the treatment for pediatric depression. If you think that someone you know may be suffering from depression, please encourage them to see their doctor.

The American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association released a revised and expanded version of The Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families, part of the ParentsMedGuide series of publications to help parents understand depression and treatment options.

Nine Topics to Consider in a Mental Health Checkup

2010-09-14T08:00:00.006-04:00

By Gina Duncan, M.D.

Yesterday, I wrote about the concept of a mental health checkup. Over the next few days I’ll provide a list of nine topics to consider when thinking about the state of your own mental health. While not exhaustive, the topics on this list are meant to provide a starting point to help you examine how you’re doing emotionally and mentally. If any of these items raise a red flag for you, be sure to talk with your doctor. If you are concerned that you may have anxiety, depression, or another mental illness, or if you need help finding a professional to talk to, see my previous post on finding a therapist for tips.

Sleep — How are you sleeping at night? Is it restful, or does it leave something to be desired? Poor sleep can often be the first sign that there is something troubling you emotionally. When under stress or dealing with a more serious mental illness, many people find that they cannot fall asleep as quickly as they used to because of excessive worry or a feeling of not being able to “turn off” their mind, and others find themselves waking up frequently throughout the night. For some, insomnia can be put to rest with simple sleep hygiene measures such as limiting caffeine in the evening and creating a bedtime ritual. For others, common over-the-counter (OTC) sleep aids such as Tylenol PM, Benadryl, and herbal medicines like melatonin can be helpful if used in limited quantities and for a limited amount of time. [Note: although they are advertised under many different brands, most OTC sleep medicines have diphenhydramine (generic Benadryl) as their active ingredient. Make sure to read the labels so you don’t take medicines you don’t need and to decrease your risk of unsafe combinations.] It’s always a good idea to first check with your doctor before beginning any OTC sleep regimen to make sure there are no harmful interactions with other medicines you’re taking.

Tomorrow, I’ll continue the checkup with information about evaluating tension and anxiety and being tuned in to your emotions.

Time for a Checkup: Lack of Illness vs. Health

2010-09-13T08:00:00.017-04:00

By Gina Duncan, M.D.

I recently spoke with a reporter from a Boston community newspaper who is planning an article spotlighting the concept of a “mental health checkup.” I think that this is a great idea, and something that is very much needed. Given that September is a time for new beginnings with many people going back to school and work, what better time than now to do a mental health checkup.

Many people go through their entire lives never encountering a mental health professional. That doesn’t mean, however, that they are mentally healthy, for the absence of illness does not necessarily equal health. Unfortunately, in our society we place a lot of emphasis on treating illness and much less on what it takes to stay healthy.

What is mental health? You can probably find many different definitions, but I would like to suggest one characteristic which I think is critical to the foundation of good mental health: knowing yourself, ie. being self-aware. I often tell my patients with depression and anxiety that they are in a position to be some of the most mentally healthy people around, because their illness has forced them to grapple with unhealthy patterns and learn new skills to cope with the stresses of everyday life. And in the process, they have come to know themselves much better. One of my professional goals is to bring the same skills that we as psychiatrists use in the office to people who would never come through our doors because they are not identified as being "mentally ill." They may be functioning and getting by, however, they are missing out on living life at the level of their "best self."

Over the next several days, I will post about important topics to consider as you do your own mental health checkup.

Reading, Writing and Anxiety? Helping Children Make the Transition Back To School

2010-09-09T13:38:00.002-04:00

By Adair Parr, M.D., J.D.

The arrival of September signals back to school for most children. It is an exciting time of year, as it means meeting new teachers and classmates, starting fall sports and getting back into the swing of the classroom. Most children have some degree of anxiety about starting school, especially when they are just starting school, entering middle or high school or are changing schools.

Despite such worries, many children adjust to a new school year fairly easily. Other children have some initial anxiety, which they overcome in the first days or weeks of school. These feelings are particularly common among elementary school children but may be experienced by middle school or high school students as well.

School-aged children and even teenagers may express feelings of anxiety through frequent headaches or stomachaches, rather than overt worries about school. For tips on how to help transition your child to the new school year, see “The ABCs of Starting School” on Healthy Minds.

When should you seek help if you suspect that school is making your child anxious?

For some children, feelings of anxiety associated with back to school interfere with functioning either at home or at school or socially. If your child continues to have difficulty with school more than a month after school has started, it is important to seek help.

*Talk to your child’s teacher or counselor to see what they have noticed.

*If your child has significant physical symptoms, like recurrent headaches or stomachaches, schedule a visit to the pediatrician.

*Talk to your child and ask whether anything is happening at school that frightens them or worries them.

*Ask your child about bullying, which may be contributing to your child’s anxiety.

After exploring these concerns, some children will need further help and may require a visit to a mental health professional for an evaluation. A school counselor or pediatrician can help with a referral if this is the case. A child’s main job is to learn; untreated anxiety can interfere with social and academic development.

Anxiety is commonly treated with cognitive behavior therapy but some children require medication. By being attentive to the many changes associated with starting school, you can help your child with this important transition.

Does the sandman still come to your house?

2010-09-08T10:08:00.001-04:00

By R. Scott Benson, M.D.

Keeping children up at night?

Some worrisome stories were on the evening news last week; but the part of the news broadcast that caught my attention were six ads for medication to promote a peaceful night of sleep.

These ads are having their desired effect as I have more and more families expressing concern about their children’s sleep. They read the stories about shifting school start times to improve teens’ school performance, but the first question they ask me is usually about the latest new medications.

Research is clear: there are many things that should be done before we reflexively open the medicine cabinet.

Consider the impact of 24-hour access to electronic communication tools. Does your child keep a cell phone in their room overnight? To talk to whom?
Remove televisions and computers from children’s bedrooms. There is strong evidence that easy access to these devices interferes with sleep.
Watch out for shifts in sleep schedules on the weekend. Most of us thought we could stay up late on weekend nights, make up for the sleep by staying in bed until noon on Saturday, and sleep in again on Sunday. But it only takes these two days to reset your biologic clock. No wonder that Monday finds a body at school but the mind is home in bed.
Plan evening routines so your child finishes activities (including homework) more than an hour before planned bedtime. It takes a while to settle after an hour of frustrating work on spelling words.

The first step in evaluating any concern about sleep is keeping a careful sleep diary. There are samples available at SleepEducation.com, the website of the American Academy of Sleep Medicine. The University of Michigan has a wealth of material on their website devoted to children’s sleep problems.

Sleep tight.

TXT me when U get there: Helicopter parenting as kids go off to college

2010-09-05T13:27:00.002-04:00

By Tristan Gorrindo, M.D.

Thousands of teenagers have headed to college and for many it is the first time that they lived away from home. And while this process of separation is often anxiety provoking for the college freshman, their parents may be equally anxious.

With modern technology, it has never been easier to stay in touch. Text messaging, cell phones, social networking websites, video chatting and email, have all made constant contact simple and expected. But at times it can go too far. In my clinical practice I have heard stories of parents who call each morning to wake their child up for class; parents who panic if they don’t get at least two text messages a day from their child; or, even parents who require that their child parade new college friends in front of a Skype camera before granting permission for their teen to befriend them.

But what is the developmental cost of this collegiate level helicopter parenting? Certainly parents want (and should) be involved in the lives of their child as they branch out into adulthood, but when parents’ constant checking in distracts or disrupts the process of development, college-aged kids have a problem.

The goal of moving away to college is just as much about forming one’s identity as it is about late-night cramming and classes. Further, it is a time for the young adult to develop self-reliance and responsibility for one’s actions. It’s also a time for teens to form new friendships. Well-meaning, but over-eager parenting has the ability to disrupt all of these normal developmental steps. Young adults need the chance to find others to depend on, to learn to pick up after their own disappointments, and to experiment with new behaviors without having to report back.

The exact amount of contact that parents and their college kids should have is a personal negotiation between each child and each parent. The best time for such negotiation is before a child departs for college, preferably before both parent and child are deep in separation anxiety. Parents need ground rules about how often they should expect texts from their child and guidance about how long they should wait before panicking if a phone call isn’t returned or a Skype call goes unanswered.

Kids can be asked how they would like to be contacted, and with what frequency. Establishing a regular routine around check-ins -- like calling Dad each Sunday morning on the phone for a debriefing of the past week and planning for the week to come -- can go a long way in managing parental anxiety. Perhaps, after a few weeks at school, parent and child can check-in on how these check-ins are going. With some experience at being apart, students may want to adjust the type and quantity of contact that they have with their parents.

Never before have college students and their parents had such a rich array of ways to stay engaged with one another. While kids continue to benefit from their parents guidance and interest, they also need to know that their parents believe in their new skills to pilot their own planes.

Getting Help Gets a Good Customer Review

2010-09-01T11:17:00.006-04:00

By Molly McVoy, M.D.

A recent survey published in Consumer Reports, found that respondents reported the highest satisfaction for the combination of medication and talk therapy, when compared to talk therapy or medication alone.

The survey reported on over 1500 people treated for anxiety, depression or both. They also found that readers reported a higher satisfaction with treatment by a psychiatrist than by other mental health professionals (psychologists, social workers, and licensed professional counselors).

This is good news for psychiatrists and the mental health community in general. This is one indicator that the public feels treatment works and that psychiatrists help.

In addition, this consumer report supports the scientific evidence we already have – depression and anxiety treatment does work! In study after study, approximately 2/3 of patients respond to treatment for depression with an even higher percentage responding to treatment for anxiety disorders.

The bottom line is, treatment works and, it appears, most of the public knows it!

Teach Teens and (Yourself!) how to W.A.I.T

2010-08-27T08:45:00.003-04:00

By Tristan Gorrindo, M.D.

By now, over 80 percent of teens have an account with Facebook, Twitter, or some other social networking site. A common feature on almost all of these sites is the ability to share with your friends whatever is on your mind. Commonly these posts appear on a “wall” or other profile page for everyone to see.

Postings come in several versions: short bits of text, pictures, movies, and links to other websites. And the content of these posts can range from mundane observations about the weather, to the exuberant joy of being accepted to a highly desirable college, and everything in between. With the average teen having hundreds of “friends” on Facebook every post is fairly public event.

Teenagers are often defined by their impulsivity and their limited appreciation of long-term consequences. As a child psychiatrist, I see how poorly thought through social network posts can have real-life consequences. For example, a teen facebooking, “I’m so mad at Jessica, I could kill her,” might result in suspension from school. Even posts about, “getting wasted last night,” can have consequences for participation in school athletics or college recruitment if adults stumble across them.

In my work with teens, I try to get them in the habit slowing down the entire process of posting, with the hope that they’ll think before they post. One such tool I’ve created is the mnemonic W.A.I.T.

W. Wide-audience

“W” asks the question: Would I say this in front of a school assembly? If a teenage boy, for example, has 800 friends on Facebook, it is then helpful for have him visualize standing in from of 800 peers at an assembly school assembly reading his Facebook posting aloud. Still sound like a good idea?

A. Affect

“A” asks the question: Am I in a good emotional place right now? Drawing from the basic notion that thoughts and feelings are connected, here teens learn to think about the ways in which their mood might be affecting what they are about to say.

I. Intent

“I” asks the questions: Might my intent be misunderstood? The teen tries some perspective-taking to determine if his or her comment might be misunderstood.

T. Today

…tomorrow, or the next day? “T” asks the question: Can this wait a day? In an effort to slow the emotional drive that pushes teens to post to the Internet, this intervention asks teens to evaluate the urgency of what they are about to say. Why is it so urgent? What will happen if I wait?

I recognize that it’s unrealistic to expect that teens will W.A.I.T. every time they want to share something on a social media site, but I ask the teens I work with to write it on a post-it and stick it on their computer with the hope that it’ll slow them down. Using this technique, teens learn a structured way of evaluating whether or not something belongs on the Internet. It also provides clinicians and parents with a structured conversation tool to engage teens in discussions about what they are posting online.

Happy posting.