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New Research Finds the Full Range of Anti-psychotic Medications Is Required
2006-04-07 06:15:00
Some of you might remember the report released last year saying that an older medication Trilafon was just as effective as the new MUCH more expensive medications. Even though NIMH commented later that the research did not support that belief, many Medicaid programs wrote the new medications out of their formularies. A follow-up to this research has reinforced the fact that most psychiatrists already know. Each person's body chemistry responds uniquely to each medication. The full range of medicaitons are required to find an effective choice. Besides, the side effect profile is much better for the newer medications. The permanent neurological damage evidenced by tardive dyskinesia too often caused by the older medications were often an unacceptable consequence of appropriate treatment. People shouldn't have to choose one scourge for another, especially if it's not necessary. NAMI Phase II of CATIE strongly reinforces the individualized nature of treatment for schizophrenia. ...
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Medicare Part D Is Chronically Ill
2006-04-05 06:23:00
Corpus Callosum has great post about an article that appeared in the New England Journal of Medicine. He brimes with pride at the "venerable" journals departure from it's usual decorum in commenting on Medicare Part D. It is a worthy read, and a withering criticism from a high respected journal with starched credentials. Here is an excerpt from the grand ol' journal. Part ?D? for ?Defective? ? The Medicare Drug-Benefit Chaos True, the program provides drug benefits for some Americans who previously had none. But because of its strange design, enrollment is falling far short of expectations. Officials in the Bush administration boasted that 25 million people are receiving benefits through Medicare Part D. But the government's data reveal that about 20 million of them already had adequate drug coverage through Medicaid, their employers or unions, or health maintenance organizations; as of late February, the new benefit was providing only 12 percent of the elderly with coverage ...
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A Depression Switch?
2006-04-03 18:42:00
Today there is a very popular and very good article on the research results on deep brain stimulation (DBS) as a treatment for depression. Some of those in the research study report that their depression is instantaneously switched on and off with the stimulator. This is very exciting news for those who are deeply depressed who have not benefited from therapy or medications. Clearly this is a last resort treatment. It involves brain surgury, inserting an electrode deep into the brain. This is clearly not for everyone. I would suggest that a person who has been treated with medication and therapy with multiple medications, psychiatrists and therapists (yes, some are better than others.), did not benefit from electro-convulsive therapy (ECT) and is depressed to the point of disability may be considered candidates for this procedure. It's likely to be a couple years before this procedure is approved for wider use. New York Times The operation borrowed a procedure called deep brai...
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Perception is Something We Do
2006-04-03 06:16:00
Mind Hacks is a great blog by a couple guys who have a passion for cognitive neuroscience. There is always something interesting to read there. Today I found a quote from PSYCHE, a journal about consciousness. They make what may sound like a face valid statement about what is perception. When I was in graduate school, perception was described as physiological and psychological means to sense and understand our environment. Attention and awareness while mentioned and studied as a mediating function hardly gained the prominence implied in the following quote. Perception is not something that happens to us, or in us. It is something we do. Think of a blind person taptapping his or her way around a cluttered space, perceiving that space by touch, not all at once, but through time, by skillful probing and movement. This is, or at least ought to be, our paradigm of what perceiving is. The world makes itself available to the perceiver through physical movement and interaction. While they...
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DoD Provides On-line Mental Health Self-Assessment Program
2006-04-02 23:26:00
Post Traumatic Stress Disorder (PTSD) is one of the more debilitating disorders associated with experiencing intense trauma such as a rape or living in a war zone. PTSD has been associated with symptoms of nightmares, flashbacks, extreme anxiety, inappropriate anger and violent behavior, and feelings of disconnection from family and friends. It has been associated with permanent changes in the associated with memory impairment and exaggerated startle response. Many stress related symptoms such as headaches, dizziness, chest pain and anxiety attacks also are common. Long-term studies of veterans associate PTSD with long-term health disorders thought to be associated with stress. A survey in mid-2004 by the military of 82nd Airborne paratroopers coming back to Fort Bragg from serving in Iraq suffered from post-traumatic stress disorder at almost the same rate as Vietnam War veterans. The rate reported for the paratroopers was 17.4%. The New England Journal of Medicine reported 16 per...
More About: Health , Mental , Mental Health , Assessment , Program

Prescriptions For Anti-depressants Dropping
2006-04-02 05:33:00
Today there is another rather lousy article about depression and the use of anti-depressants in the Los Angeles Times. They report there is a drop in the use of anti-depressants over the past year. First came the warning of a possible link between selective serotonin reuptake inhibitors and suicidal thoughts among children and adolescents. Then came a drop in sales ? 14% last year compared with the year before. Now research has found that a single medicine typically does not effectively treat depression for most people and that those with depression often stop taking the medicines altogether. The change is probably correctly attributed to the warnings of suicidal behavior with children and adults. This news and the type of articles I've been finding in the press about depression is spreading a lot of misinformation. Despite that, it is probably good news that the use of anti-depressants has dropped. It's been clear for awhile that many people who had a less than clinical level ...
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What's Happening to the Boys?
2006-03-31 15:39:00
Here is another angle on concern about today's adolescents and young adults. It appears that the malaise affecting African American adolescents and young men stretches across racial boundaries at least somewhat. More young adult males live at home stalling the transition to adulthood. There certainly has always been some cultural spill over from African Americans to Caucasions. Part of the attraction of the "cool-pose culture" has been the admiration it creates even among whites. But perhaps there is a bigger issue here. I suspect it's the economy and lack of adequate paying jobs that would enable young males to emancipate. This has to create a discouraged attitude among the young. Then I wonder if the new computer/internet generation has gotten lost in fantasy games more so than anyone has guessed, perhaps in part because of the lack of opportunities. If the American Dream is out of reach, then why get on with life at all? I certainly have seen this discouragement in individual...
More About: Gender issues , Boys , The Boys

Cultural Competency Resources
2006-03-29 06:39:00
I've added an archive of resources for Health and Mental Health Professionals on Cultural Compete ncy Link here: http://dare-to-dream.us/cultural_diversit y/ Let me know if you have some more resources and links I can add.
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What is Happening with Young African American Men?
2006-03-28 20:46:00
The NY Times published an article last week quoting some sobering statistics about inner city black youth. Six in 10 black men in their 30s who had dropped out of school had spent time in prison. Fifty percent of black youths don't finish high school. Unemployment for black high school dropouts has peaked at 72%. Orlando Patterson, a professor of sociology at Harvard, wrote a courageous article in the NY Times today. Despite recent economic advances of other minorities and African American women, generations of African American young men continue to failed to integrate in the larger culture. He challenges the the traditional explanations of bad schools, discrimination and few jobs. He suggest the African American culture is a major contributing factor. The culture has evolved in just 145 years from the tortured history of slavery, through the oppression of "Jim Crow" laws to the "cool-pose culture" of today. That "cool-pose culture" raises boy's self-esteem as effectively as it ...
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Ten Discipline Mistakes Parents Make
2006-03-26 03:34:00
Here is a great post for parents from Dr. Deborah Serani. 1. Yelling: May be an effective way to vent frustration, but children of parents who yell often learn to tune it out. Results: The behavior does not change, and children learn to be hostile. Better: Stop. Ask what it would feel like to be yelled at. Most children respond better to calm, reasonable commands. Leave yelling for emergencies like ?Look out for that car !?. . .?Don?t touch the barbecue!? 2. Demanding Immediate Compliance. Children and adults usually do not respond well to immediate demands. Such commands do not take into account how the person hearing the request may feel?what they are doing at that moment. Results: Commands that are demanded immediately are often tuned out, or blatantly refused. Better: Make a respectful but firm request. ?At the next commercial, please hang up your jacket.?...... ?When I come back from the bedroom, it?ll be time for us to go to get into pajamas?. 3. Nagging. Parents who nag ar...
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WaPo Misunderstanding Spreads
2006-03-24 20:06:00
Washington Post got the story about the study on depression all wrong yesterday. Now half of blogdom is blathering about the misinformation.
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News Reports Of Depression Study Confuses the Good News
2006-03-24 04:20:00
Results of the STAR*D Part 1 Depression study by funded by NIMH was published in January in the American Journal of Psychiatry. Yesterday, the report on STAR*D Part 2 of the study was released, but requires a subscription. The press release summarizing the results is at the NIMH site. I found two reports in the press about the study. The Washington Post got it all wrong. Antidepressants fail to cure the symptoms of major depression in half of all patients with the disease even if they receive the best possible care, according to a definitive government study released yesterday. ...Although the study showed that patients who do not respond well to one drug could be helped by another, the results are "discouraging for several reasons," Rubinow said in an editorial published in the New England Journal of Medicine, which also published the study. It is troubling that large numbers of patients continued to have problems, he said. Additionally, he noted that the drugs used in the s...
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Interpreting Children's Behavior
2006-03-22 19:50:00
Mental Notes had a great post a few days ago listing the kinds of indications to look for in understand if your child is suffering from a serious problem. Behavior can mean many things, often because of the context of situation. You may need help to figure out what needs the attention. I will take issue with one of his assertions. While it is true that a full assessment takes a lot of time and there is very little incentive from the doctor's perspective to do the full diagnostic and medicating as a trial is a widely used method of diagnostics, I'd advocate for the full evaluation before medicating. There are too many stories of "kids like zombies" floating around to say nothing about this. Bring your child to a mental health professional who will take a full 45 to 60 minute evaluation, or more to determine a diagnostic of ADHD. I've known several clinicians in my community who will take 2 to 3 sessions to do a complete background including some standardized tests. I think that...
More About: Child Development , Interpret

Teen Depression Linked with Domestic Abuse as Adult
2006-03-19 22:22:00
Here is a very interesting research article about a link between depression and later victimization by domestic abuse. While, I don't find this surprising, it's gratifying to see connections that have the potential to influence the focus of psychotherapy. MedlinePlus Young women who had significant depression symptoms as teenagers were 86 percent more likely than their non-depressed peers to report serious partner violence 5 years later. This association still held after a number of potential risk factors, such as race, parents' education and history of childhood abuse from a caregiver, were taken into account. MORE I have always associated victimization with low self-esteem. Low self-esteem has often seemed to relate to an increased risk of depression. Certainly, victims of abuse often are also depressed. But to find a connection of adolescent depression with double the risk of future victimization is a strong association. Self-esteem has been one of those difficult to mea...
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Sometimes the Mental Health Business Is Very Hard
2006-03-16 02:36:00
This is a cross-posted comment to this article in THOUGHTS From the HEADoc. I have witnessed first hand our Mental Health Centers insidiously disappear under the name of reform. The State Hospitals are next on the chopping block. Our citizens have been totally eliminated from knowledge of what is really happening with that situation. Also first hand, I watched the jail population become almost exclusively of those with mental illnesses and chemical dependence, effectively keeping those people from public site for the most part. Most people don't appreciate the severity of the drug culture and how deeply it has penetrated our society at least until a family member becomes affected. It is no longer a ghetto problem only. Maybe my view of the situation is skewed because of the concentrations of populations I've worked with. The main difference I really have seen is that the blacks are treated in jail and most whites are treated outside of jail for the exact same problems. This sit...
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Sculpture of Churchill in a Straitjacket Stirs Controversy
2006-03-15 04:22:00
A British mental health advocacy organization came up with a provocative way to challenge the stigma of mental illness. They commissioned a sculpture of Winston Churchill in a straitjacket. The British Prime Minister, who led the British people through WWII, is widely considered a heroic figure inspiring honor, persistence against overwhelming odds, and unbending will. Many have taken exception to what they consider to be a undignified association. Churchill suffered from depression, an experience he called his "black dog." Rethink .org Rethink severe mental illness today (September 14) defied an official ban to protest at the ?last taboo? of mental health stigma and start a debate on how to overcome it. The charity had planned to unveil a ?black dog? statue of former Prime Minister Winston Churchill in a straitjacket in London's Trafalgar Square to draw dramatic attention to the stigma surrounding mental ill-health. But the statue, emblazoned with a ?prejudice, ignorance and ...
More About: Controversy , Sculpture , Advocacy , Hill , Chill

Control Leads To Abuse
2006-03-14 04:56:00
Abuse in relationships is way too common, often because we are not taught when we are young to identify relationships going awry. If you are in a relationship that sounds like this, consider the wisdom of continuing. The Sacramento Bee He wants to spend an excessive amount of time alone with you and he encourages you to flake on your friends, ditch school or skip practice. It can seem like a romantic gesture, but it's not. One partner's insistence on being the sole focus of the other's time and attention is a key warning sign of abuse, as the victim is slowly isolated from family, friends and favorite activities, experts say. He scrutinizes every detail of your life, including your friends, your hangouts and even your wardrobe. His controlling attitude means your cell phone is constantly in use, since he's always checking up on you. "In the early stages it gets misread as, 'Well, gosh, they care about me so much, they care about every little thing I'm doing,' " says Linda...
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Grading the State Mental Health Systems
2006-03-12 23:55:00
Cutting taxes can only mean one thing for people suffering from mental illness, there will be fewer and less quality in the services available. This is true for the public system certainly, but it is also likely to spread extensively into the private system. Public dollars tend to account for a significant part of the business for even the private mental health provider. Fewer dollars will mean a continued exodus of providers from direct service. Salaries have fallen hehind the market for master and doctoral level practitioners. That can only mean fewer new providers coming into the field, and more exiting the field for more lucrative opportinuties. The mentally ill account already for at least 25% and more likely 50% or more of the homeless in this country. That number can only go up as the services decline. Many working people end up disabled because they can't find sufficient services to help them put their lives together. Many of the homeless are disabled with too much pride t...
More About: Health , Mental , Mental Health , State , Systems

Are Generics the Same As Brand Name Meds?
2006-02-16 00:59:00
An informed consumer is critical to ensure quality care. The mental health professional needs feedback from the client to ensure care is effective. That is as much true for counselors as it is for psychiatrists. Insurance companies and now Medical Assistance have been increasingly using medication "formularies" to control the cost of their medication budget. Formularies limit the choice of medication for which the insurance company will pay. Often that is because there are a choice between brand name and generic medications or a choice among a number of equivalent brand names. Formularies also limit access to newly developed medications that are considered "experimental." While there may be some notable exceptions, formularies exist primarily to save money. Insurance companies and generic medication manufacturers insist that generic are as high quality as name brands. The Federal Drug Administration (FDA) sets standards that say generics must be equivalent in quality and potency...
More About: Brand , Medications , Medicare , Medicaid

On "Conscientious Objection" by Professionals
2006-02-08 03:48:00
"Cons cientious Objection" by professionals seems to me to be a practice whose ethics is tied to the setting in which one practices and the nature of the limitation one wishes to set. Julian Savulescu, writing about "Conscientious Objection" by physicians in The New British Medical Journal seems to have a much narrower and blanket view. blog.bioethics.net A doctors? conscience has little place in the delivery of modern medical care, writes Julian Savulescu at the University of Oxford. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. Imagine an intensive care doctor refusing to treat people over the age of 70 because he believes such patients have had a fair innings. Or imagine an epidemic of bird flu or other infectious disease that a specialist decided she valued her own life more than her duty to treat her patients. Such a set of values would be incompatible wit...
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Sexual Harassment Is Everywhere
2006-02-05 18:32:00
MedlinePlus Nearly two thirds of U.S. college students are affected by sexual harassment -- ranging from offensive jokes and gestures to touching and grabbing, according to a study released on Tuesday. Men are more likely to harass than women, but women and men are equally likely to be harassed on U.S. campuses, according to a report by the American Association of University Women. Researchers found that 62 percent of college students experienced sexual harassment, and 32 percent of college students said they were victims of physical harassment. "The primary form of harassment that we're seeing is actually non-contact: it tends to be remarks, gestures and jokes," Elena Silva, the report's co-author, said in a telephone interview. "But the fact that one third of college students are experiencing some form of physical harassment is certainly a concern." In a representative survey of 2036 undergraduates at U.S. colleges and universities, 41 percent said they had sexually harassed...
More About: Gender issues , Sexual , Sexual Harassment , Harassment , Where

A New Alternate Diagnostic Manual
2006-02-03 04:54:00
Clients often see diagnosis as some sort of magical rite of passage into the mysterious world of mental health treatment. Actually, diagnosis is largely overrated. Many clinicians wouldn't use it routinely in any formal way if insurance companies didn't require a diagnosis for payment. Diagnosis is helpful for communicating about treatment between professionals. But as a guide that carries any stable meaning over time, it's value is limited. People are much more complex and not amenable to fitting into catagories. And the diagnostic catagories are far from accurate and reliable across different episodes of illness or even between professionals seeing the same client at the same time. The structure of the DSM IV is based on how a group symptoms suggest a particular diagnosis from research and clinical experience of the participating professionals. Some clinicians have thought of the DSM IV as a recipe for diagnosis that removes much meaning from the practice. Diagnosis reduced...
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Medicare Part D Is a Mess
2006-01-08 20:01:00
Having trouble with Medicare Part D? You aren't the only one. Knight Ridder Many of Medicare's poorest and most sickly patients are going without their medications because of administrative glitches, misinformation and confusion surrounding the new Medicare prescription drug benefit. Experts had warned that many of the 6.4 million low-income people who get benefits from Medicare and Medicaid could miss out on their life-sustaining medicines when their drug coverage shifted on Jan. 1 from Medicaid to private plans sponsored by Medicare. In interviews, advocates for the elderly as well as lawmakers and seniors themselves indicated that that's happening. Some, such as Deborah King of New York, were placed automatically in new drug plans that don't cover their medications. Others were getting stuck with extra out-of-pocket fees because their new enrollment status couldn't be verified. Medicare's contingency plan for patients who aren't enrolled in drug plans also is proving ...
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Through His Webcam, a Boy Joins a Sordid Online World
2005-12-20 03:31:00
I ran across this article today and just had to share it. This is a story every parent of teenagers should read. The Internet offers the kind of access to information I never dreamed of as a child. Internet research has become 4th and 5th grade requirement in my local schools. But there is another side of the Internet that parents need to know about. Learn how to monitor your children's activities on the Internet. Software packages will limit their access and will save their activities for you to review at your leisure. Get involved. Make sure your child is safe. NY Times Weeks before, Justin had hooked up a Web camera to his computer, hoping to use it to meet other teenagers online. Instead, he heard only from men who chatted with him by instant message as they watched his image on the Internet. To Justin, they seemed just like friends, ready with compliments and always offering gifts. Now, on an afternoon in 2000, one member of his audience sent a proposal: he would pay Justi...
More About: Parenting , World , Online , Webcam , Line

Wellbutrin May Help Treat Meth Addiction
2005-11-23 19:41:00
Methamphetamine addiction has spread like a wild fire across the country. Here is some details about consequences of meth addiction. Narconon Methamphetamine can cause a variety of cardiovascular problems. These include rapid heart rate, irregular heartbeat, increased blood pressure, and irreversible, stroke-producing damage to small blood vessels in the brain. Hyperthermia (elevated body temperature) and convulsions occur with methamphetamine overdoses, and if not treated immediately, can result in death. Chronic methamphetamine abuse can result in inflammation of the heart lining, and among users who inject the drug, damaged blood vessels and skin abscesses. Methamphetamine abusers also can have episodes of violent behavior, paranoia, anxiety, confusion, and insomnia. Heavy users also show progressive social and occupational deterioration. Psychotic symptoms can sometimes persist for months or years after use has ceased. Acute lead poisoning is another potential risk for metha...
More About: Addiction , Treat , Well , Addict

Red Cross Need Mental Health Professionals
2005-11-13 20:29:00
Dare To Dream MH Library - Psychologist Driven to Help Hurricane Victims The Red Cross doesn't have enough mental health people in its data base, volunteering. I got an e-mail from the American Psychological Association, saying the Red Cross needs mental health volunteers. This was sent to every licensed member of the APA. Looking for a way to contribute to your skills to disaster relief? Call your local Red Cross. Click the link above to read of her experiences.
More About: Health , Mental , Mental Health

New NAMI Suicide Prevention Guides
2005-11-13 20:13:00
Dare To Dream MH Library - Suicide Prevention Guides In a typical high school classroom, three students -- one boy and two girls -- have attempted suicide over the past year. Since the U.S. Surgeon General's "Call to Action to Prevent Suicide" in 1999, focus has increased on suicide as a public health crisis -- which results in 30,000 deaths a year among all Americans -- but much remains to be done. NAMI (National Alliance on Mental Illness) -- focusing on an area of special need -- has published a set of guides to support people who attempt suicide, are treated in hospital emergency rooms, and survive. An estimated 30-50% of individuals who die from suicide have made previous attempts. "The guides bridge a gap in suicide prevention strategies," said NAMI executive director Michael J. Fitzpatrick. "They offer support to people most involved in crisis of a suicide attempt and are intended to reduce the risk of additional attempts." Each set consists of three brochures in English ...
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