Providing Insights for Better Mental Health

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Celebrities with mental disorders

on Saturday, 15 June 2013. Posted in General

God love them for stepping forward and spreading awareness!!!

Celebrities with mental disorders

Child Mistreatment, Psychotropics, Sunshine Act, Dr. Peter Breggin

on Sunday, 17 February 2013. Posted in General

Child Mistreatment Certainly a Factor in Mental Illness, Meds Do Help, The Sunshine Act

Child Mistreatment, Psychotropics, Sunshine Act, Dr. Peter Breggin

I'm currently reading Toxic Psychiatry by Dr. Peter Breggin. Say what you want to say about him but one thing I can agree with him on is child mistreatment does play a major factor in why some develop mental illnesses. My humble opinion is there are genetic factors involved in mental illness as I've seen psychotropics help people diagnosed with various affective disorders. I think the key here is does the field of psychiatry really know what's going on? How a psychiatrist can only see a patient in the form of someone they throw meds at with little to no psychotherapy training is not very smart. Same goes with therapists and psychologists not factoring in psychotropics. Also, Dr. Breggin, I hope you take a holistic approach with patients and not just focus on talk therapy and why psychotropics are toxic.  

On a totally separate note, in reading more of Dr. Breggin's works, the thought crossed my mind that he must be very happy with the recent passage of the Physician Payments Sunshine Act which is a U.S. federal law stipulating that healthcare manufactures must aggregate and monitor total amount spent on individual healthcare professionals and organizations through payments, gifts, travel and other means to provide consumers with a transparent view into physician and industry interactions..       

Computer-Based Therapists

on Saturday, 26 January 2013. Posted in General

I can see him/her, I just can't smell him/her!

Computer-Based Therapists

If you go to liveperson.com, you can find hundreds of psychologists and therapists just waiting to provide Internet-based psychotherapy. People are working more and more from home and using their computers, Internet connections and phones to stay connected so why not do the same for psychotherapy? Anyone had experience with this? Do you miss your therapist's couch? Do you miss looking at your patients in "real life" and not via a computer monitor? Maybe as part of the web conference, the patients and psychologist/therapist/psychologist could have live, interactive bStable sessions to view how the patient has done since the last visit via the symptom monitoring the patient has recorded. Sounds like a convenient, efficient and practical way of doing things. Anyone had experience with this type of approach?

Confidentiality and the Family: 5 Guidelines for Better Outcomes

on Saturday, 20 April 2013. Posted in General

We've always promoted bStable's use with loved ones, patients and providers to provide a 360 degree loop

Confidentiality and the Family: 5 Guidelines for Better Outcomes

By Michael Ascher, MD, Justine Wittenauer, MD, Alison Heru, MD, and Ellen Berman, MD |April 11, 2013

 
Dr Ascher is MD a fourth-year Resident in the department of psychiatry and behavioral sciences at Beth Israel Medical Center, New York. Dr Wittenauer is a third-year Resident in the department of psychiatry and behavioral sciences at Emory University, Atlanta, Ga. Dr Heru is Associate Professor in the department of psychiatry at the University of Colorado, Denver. Dr Berman is Clinical Professor in the department of psychiatry at the University of Pennsylvania in Philadelphia.
 

Families  are an underutilized resource in psychiatric practice. Given the current practice of brief hospitalizations,  families are expected to provide more illness monitoring and in-home care. When  family members are included and welcomed as members of the treatment team,  patient care improves and the psychiatrist’s job is easier. Reaching out to  the families of patients can help psychiatrists generate clearer diagnostic  formulations, develop more effective treatment, and plan for emergencies.

What  should psychiatrists do when patients don’t give permission to contact their  families?

Many  psychiatrists erroneously believe that the sharing of information with others,  without the patient’s explicit consent, is prohibited by the Health Insurance  Portability and Accountability Act (HIPAA). HIPPA violations may have serious  consequences, so it is important to have a clear understanding of what the  HIPPA 45 CFR 164.510(b) rule entails as well as its intended use.1  The following information is extracted from the website of the US Department of  Health and Human Services and provides  guidance for health care providers. Here are some guidelines:

(1)  Health care information may be shared with relevant individuals present when  the patient has given prior approval, or simply does not object1

(2)  Asking a friend to be in the interview room provides the implicit right to  disclose information in their presence

(3)  Clinicians also have the authority within the Privacy Act to share information  based on their professional judgment, believing that there would be no  objection to its discussion. For example, a clinician may share information  about medication with those providing transportation from the hospital

(4)  If the patient is not present but has requested an individual to gather  information for him or her, or is incapacitated by an emergency, a physician  may once again use best judgment in sharing information. This may include a  proxy picking up of medications from the pharmacy or receiving other protected  information

(5)  Physicians should be aware of state laws within their region of practice that  may affect the use of the Privacy Act within scenarios of emergency or safety  concern

Using  these guidelines, family members (or friends) who accompany the patient can be  invited into the interview and the benefits of their inclusion explained. Most  evidence-based family interventions are psychoeducational, where illness  symptoms and treatments are explained and feelings and beliefs about the illness  are explored. When patients understand the goal of family intervention is  psychoeducational, they are more likely to agree.

Family  involvement is often misunderstood as being a hindrance to individuation, when  in fact family-oriented interventions can improve patient functioning, agency,  and autonomy. This is often the case when young adults are forced, because of  illness, to return home to live with their parents. The use of shared  decision-making may help the patients frame their long-term goals in line with  the goals of the family.2

Psychiatrists  can help the patient prepare for the family meeting. With a clear agenda, the  patient will be less anxious and be more accepting of family members working  with them. Psychiatrists can proceed, using one of the most underutilized  evidence-based interventions in psychiatry—family psychoeducation.

References 1. US  Department of Health and Human Services. Does the HIPAA Privacy Rule permit a  doctor to discuss a patient’s health status, treatment, or payment arrangements  with the patient’s family and friends? http://www.hhs.gov/hipaafaq/notice/488.html. Accessed  April 8, 2013. 2. Swindell JS,  McGuire AL, Halpern SD. Beneficent persuasion: pechniques and ethical  guidelines to improve patients’ decisions. Ann Fam Med. 2010;8:260–264.

Depression Prevalence

on Saturday, 26 January 2013.

That's a lot of people!

Depression Prevalence

According to WebMD:

The CDC says that about 9% of Americans report they are depressed at least occasionally, and 3.4% suffer from major depression.

The 9% are people who reported to surveyors that they felt depressed to some degree in the two weeks prior to being questioned. That includes the 3.4% of adults who meet the CDC’s criteria for major depression.

The analysis, part of the CDC’s Morbidity and Mortality Weekly Report(MMWR) for Oct. 1, was based on a survey of 235,067 people aged 18 and older in 45 states, Washington, D.C., Puerto Rico, and the Virgin Islands.

According to the MMWR, estimates for current depression in states and territories in 2006-2008 ranged from a low of 4.8% in North Dakota to 14.8% in Mississippi. People in Kentucky, New Jersey, North Carolina, Pennsylvania, and South Dakota did not participate in either the 2006 or the 2008 survey.

From wiki.answers.com:

340 million people in the world suffer from depression and rising

1 in 4 women will suffer from depression

1 in 10 men will suffer from depression (this statistic is not absolutely correct because more women are apt to see their doctor for depression than men do.)

Depression strikes all races, rich and poor.


Read more: http://wiki.answers.com/Q/How_many_people_in_the_world_suffer_from_depression#ixzz2J6DEV02m

Disease State Management Systems

on Saturday, 19 January 2013.

Great article on the importance of mood tracking

Disease State Management Systems

Mood tracking is a very important part of managing the disease state of individuals with various affective disorders such as bipolar disorder. Check out the article below and let's discuss how software can be used to help track and communicate a patient's disease state with clinicians or therapists. 

www.pendulum.org/bpnews/archive/001953.html

 

 

 

Effective Personalized Strategies for Treating Bipolar Disorder

on Saturday, 17 August 2013. Posted in General

Bipolar disorder causes havoc in patients’ lives. Even in the best of circumstances, successful treatment is challenging

Effective Personalized Strategies for Treating Bipolar Disorder

By Stephen V. Sobel, MD

Bipolar disorder causes havoc in patients’ lives. Even in the best of circumstances, successful treatment is challenging. Treatment targets constantly shift; patients are frequently nonadherent; and comorbidity is the rule, not the exception. Diagnosis of bipolar disorder is often difficult. Comorbidities need to be identified and addressed if treatment is to be effective.

The importance of an accurate diagnosis

With apologies to Charles Dickens, bipolar disorder is often experienced as the “best of times and the worst of times.” This polarity often causes bipolar disorder to be undiagnosed, overdiagnosed, or misdiagnosed. Bipolar disorder is associated with a significantly elevated risk of suicide. Moreover, bipolar patients often use highly lethal means for suicide.1 Contributing factors include early age at disease onset, the high number of depressive episodes, comorbid alcohol abuse, a history of antidepressant-induced mania, and traits of hostility and impulsivity.

Bipolar I disorder, with episodes of full-blown mania, is usually easier to diagnose than bipolar II disorder, with episodes of subtler hypomania. Recognizing that the primary mood state may be irritability rather than euphoria increases the likelihood of diagnosis as does the recognition that symptoms often last fewer than the 4 days required for diagnosis by DSM-IV.2 Focusing more on overactivity than mood change further improves diagnostic accuracy, and the use of structured questionnaires is helpful.

Given the greater frequency of depression than manic episodes in bipolar disorder, what clues indicate bipolar disorder rather than unipolar depression? The Table lists factors that may help identify unipolar depression.

A moving target needs moving treatment

Effective personalized treatment recognizes bipolar disorder as a biopsychosocial disorder, but mood-stabilizing medications are the backbone of treatment. These medications fall into 3 categories: lithium, antikindling/antiepileptic agents, and second-generation antipsychotics. The mechanisms of actions by which these medications work are numer-ous and include increasing levels of serotonin, γ-aminobutyric acid, and brain-derived neurotrophic factor (BDNF) and decreasing glutamate levels; modifying dopamine pathways; stabilizing neuronal membranes; decreasing sodium channels; decreasing depolarization; decreasing apoptosis; and increasing neural cell growth/arborization.

Double-blind placebo-controlled studies of the medications—lithium, divalproex, carbamazepine, and atypical antipsychotics—used to treat symptoms of acute mania have demonstrated a response rate of approximately 50% to these drugs. Response was defined as a 50% decrease in symptoms using the Young Mania Rating Scale (YMRS) with onset of response within a few days.

An increasingly intriguing aspect of treatment with lithium and atypical antipsychotics involves their effect on BDNF. In a study of 10 manic patients treated with lithium for 28 days, most (87%) showed an increase in BDNF level (ie, from 406 pg/mL to 511 pg/mL). 

Factors that suggest bipolar depression rather than unipolar depression

In a typical 3-week study of acute mania, approximately half of the benefit was seen by day 4. A 3-week, double-blind, inpatient study of olanzapine and risperidone in 274 patients with acute mania found that of 117 patients who had a less than 50% decrease in the YMRS score at 1 week, only 39% responded and 19% had symptom remission at end point. Of 40 patients with a less than 25% decrease in the YMRS score at 1 week, only 25% responded and only 5% had symptom remission at 3 weeks. Of 157 patients who had at least a 50% decrease in the YMRS score at week 1, 84% responded and 64% had symptom remission at 3 weeks.4 Clinically, a medication change should be considered for patients who do not demonstrate substantial benefit by week 1.

A meta-analysis comprising 16,000 patients who had acute mania found that the most effective agents were haloperidol, risperidone, and olanzapine. The least effective were gabapentin, lamotrigine, and topiramate.5

A combination of medications—typically lithium or an antiepileptic with an atypical antipsychotic—is often necessary to successfully treat acute mania. A meta-analysis found the response rate increased from 42% to 62% when an antipsychotic was added.6

Bipolar depression has proved to be more resistant to medication treatment than mania. The same medications are used, with lamotrigine for maintenance treatment. The FDA has approved Seroquel, Seroquel XR, and Symbyax (the combination of olanzapine and fluoxetine), for the acute treatment of bipolar depression. Studies of acute bipolar depression have typically lasted 8 weeks. Approximately half of the benefit oc-curs by week 2, with statistical separation from placebo between weeks 1 and 3.7-9

The best treatment is prevention

Patients who have bipolar disorder almost always require lifelong maintenance treatment, frequently with 2 medications: one to prevent the upside (ie, hypomania/mania), and another to prevent the downside (ie, depression).

Findings from a registration trial showed that lamotrigine more effectively prevented depressions than lithium but lithium prevented mania/hypomania more effectively than lamotrigine.10

Another study added placebo or lamotrigine to lithium treatment for 124 patients. The median time to relapse/recurrence was 3.5 months for those taking lithium monotherapy but 10 months for those who received combination treatment.11

The effectiveness of a combination maintenance regimen was also seen in a study of 628 patients with bipolar I disorder treated for 2 years: 65% of those taking lithium or divalproex alone experienced a recurrence compared with 21% who received quetiapine added to lithium or divalproex.12 However, combination treatment may result in more adverse effects and increased risk of drug-drug interactions.

The best mood stabilizer

The best mood stabilizer for a patient is the one he or she will take. No matter how effective a medication is, it will not relieve symptoms if it is not being taken. The key to effective personalized treatment of bipolar disorder is a good patient-physician connection in which the patient is part of the treatment decision-making process.

Psychotherapy is an integral part of the effective treatment of bipolar disorder, not just an augmentation strategy. Psychotherapies that are helpful include cognitive-behavioral therapy and social rhythm therapy.13 Psychotherapy can focus on several areas, such as education, comorbidities, medication adherence, and interpersonal relationships. In addition, therapy can challenge the automatic, distorted, and dysfunctional thoughts and help the patient maintain social rhythms (eg, consistent sleep). The involvement of family members in treatment enhances success.

Patients may stop taking their medications because the adverse effects become intolerable; they may miss what they perceive as their more satisfying and productive hypomania; and they might believe that a period without symptoms means that they are cured and no longer need medications. One study of 3640 patients with bipolar disorder who made 48,000 physician visits found that 24% of patients were nonadherent (defined as missing at least 25% of doses) 20% of the time. Factors associated with nonadherence included rapid cycling, suicide attempts, earlier onset of illness, anxiety, and alcohol abuse.14

Patients who have bipolar II disorder spend far more time depressed than hypomanic. Lithium appears to be less effective than antikindling agents for rapid cycling as well as for mixed bipolar disorder states.15

Maintenance treatment is necessary for patients with acute mania or acute depression; therefore, choose medications that are more tolerable to the patient to facilitate long-term adherence. Recognize that medications may need to be adjusted or changed—in the acute phase of illness, rapid efficacy is often the priority, while medication adherence is the priority during the maintenance phase.

Other factors to consider when choosing the best medication for a particular patient include:

• A history of treatment response

• A family history of response

• Adverse effects of a particular drug

• Drug interactions

• Pregnancy

• Breast-feeding

Antidepressants

The use of antidepressants in bipolar disorder is controversial because they may induce rapid cycling, especially in patients with episodes of rapid cycling.16 In a study by Altshuler and colleagues,17 patients who had breakthrough depression despite treatment with a mood stabilizer were treated with antidepressants for at least 60 days. Patients who had symptom remission for 6 weeks were followed up for 1 year: 36% of patients who continued antidepressants for longer than 6 months relapsed versus 70% who discontinued antidepressants before 6 months.

A randomized discontinuation study with antidepressants found no statistically significant symptomatic benefit in the long-term treatment of bipolar disorder.18 Trends toward mild benefits, however, were found in patients who continued antidepressants. This study also found, similar to studies of tricyclic antidepressants, that rapid-cycling patients had worsened outcomes with continuation of modern antidepressants, including SSRIs and SNRIs.

An NIMH study of 159 patients who had breakthrough depression despite receiving a mood stabilizer were treated with sertraline (mean dosage, 192 mg/d), bupropion (mean dosage, 286 mg/d), or venlafaxine (mean dosage, 195 mg/d) for 10 weeks with a 1-year follow-up.19 At the end of 1 year, only 16% of the patients had continued remission while more than 55% had switched to mania/hypomania. The worst results were seen with venlafaxine and the best with bupropion.

In a study by Sachs and colleagues,20 patients who had breakthrough depression despite being treated with mood stabilizers were randomized to paroxetine (mean dosage, 30 mg/d), bupropion (mean dosage, 300 mg/d), or placebo. No significant differences on any effectiveness or safety outcome, including remission rates or affective switch frequency, were found.

Overall, these studies indicate that the role of antidepressants is limited and that, in fact, a trial of a mood stabilizer cannot be considered to have failed unless the failure occurs in the absence of an antidepressant. A meta-analysis of 18 studies with 4105 patients found that combination treatment including a mood stabilizer and an antidepressant was not statistically superior to monotherapy.21

When symptoms persist

Establish the context of each appointment by focusing on changes in occupational, social, family, and health status. Evaluate medication regimens, with a focus on effectiveness for carefully chosen target symptoms and adherence to treatment, as well as medication tolerability and patient attitudes. Be alert to the emergence of early symptoms of mood change, and adjust medications if necessary. Remember that treatment modalities often need to change over time.

Mood stabilizers should be optimized with combination therapy for sustained remission. Antidepressants may worsen the disease course, and a true trial of a mood stabilizer can-not occur within the setting of antidepressants. If symptoms persist, ask: Is the patient taking anything that is making symptoms worse, eg, drugs, alcohol, or antidepressants? Is the patient taking the medications? Is treatment adequate? Is another condition (including subclinical hypothyroidism) interfering with treatment? Is psychotherapy being ignored?

Effects of Pharmacokinetic and Pharmacodynamic Changes in the Elderly

on Saturday, 20 April 2013. Posted in General

PK & PD Changes

Effects of Pharmacokinetic and Pharmacodynamic Changes in the Elderly

This interesting article explains and demonstrates the need for monitoring and altering psychotropic medications and dosages in older patients.

http://www.psychiatrictimes.com/display/article/10168/2123794?pageNumber=1

Getting an In-Depth Look at Depression

on Saturday, 15 June 2013. Posted in General

The mental health screening site Help Yourself Help Others provides this infographic showing that 17-20 million Americans develop depression each year. Common symptons and an explanation of the different forms of depression are listed below

Getting an In-Depth Look at Depression

God's Psychiatrist

on Monday, 08 July 2013.

Funny portrayal of a psychiatrist analyzing some events in the Old Testament

God's Psychiatrist

By H. Steven Moffic, MD

Chapter 1. A Psychiatrist in Biblical Times

In Genesis, it is described that man, and then presumably woman in a first example of matchmaking, is created in the image of God. Imagine a modern day psychiatrist time traveling back to observe this creation. If you don’t believe in such a God, but are a parent, think of a child created, at least half genetically speaking, in your image.

As holy as it may seem to be created in the image of a God, would a psychiatrist think that this was mentally healthy? What happens to the children of parents who want their children to fulfill their own dreams? Could it be too much of a narcissistic wish and expectation to be created in anyone’s image? Wouldn’t this make normal separation and individuation more difficult, the psychiatrist wondered?

Indeed, the psychological challenges and problems for Adam and Eve emerge quickly in the Garden of Eden. The psychiatrist observing this scenario wondered about offering a walk, as Freud did about a century ago with Mahler, to discuss the temptation and symbolic meaning of the Serpent and the Tree of Knowledge. But the psychiatrist wondered if this was an impossible paradox to resolve. Without knowledge, how does one understand the risks of obtaining knowledge?

So Eve goes ahead, and she and Adam are banished from the Garden in shame. If our psychiatrist could have met them in this wider world, perhaps they could have processed their shame and the current status of their relationship before they had children. Instead, the result is 2 sons, Cain and Abel, who portray the first sibling conflict and competition, so severe that Cain murders Abel.

After this tragedy, history seems to progress adversely until Noah. Noah is said to be the best of his time. In the Ark that he builds, his family, animals, and himself survive drastic environmental and climate changes. If a psychiatrist were also on the Ark, there would have been ample time to discuss how Noah felt about the responsibility of saving the world, and how he might prepare himself for a different future. As it turns out, he becomes drunk afterward. Noah might have needed detox and Alcoholic Anonymous; his family might have sought support from Al-Anon. However, just like the lives of so many modern day celebrities, their lives and the story goes on without completing treatment.

The next major figure is Abraham. No one claims to know, not even himself, why he is chosen to start a new religion. Later on in his life, sibling rivalry emerges again, but now between stepbrothers. After Abraham has his son Ishmael by the handmaiden, Hagar, Abraham and his wife Sarah have their own son, Isaac. Can’t you just predict the need for some challenging family therapy? Instead, Sarah, with the apparent approval and support of God, orders Ishmael to be banished. Abraham acquiesces, and God, to seemingly even things out a bit, says that Ishmael will start his own Kingdom, which many have taken to become the Arab people.

Abraham is later asked to sacrifice Isaac. Any psychiatrist might say that at times of exasperation, a parent might think of sacrificing their child. But this time it includes the actual preparation, without the apparent knowledge, of Sarah. Isaac is spared at the last minute, but to a psychiatrist, it might seem that he suffered PTSD. Sarah may have died soon afterward from the shock of grief.

Without treatment, as family problems are wont to do, the sibling conflicts continue in Isaac’s sons, Esau and Jacob, and then again in Jacob’s sons. Esau also goes off in exile, perhaps to start what will become the Roman people.

This story should be enough to call forth a psychiatrist, shouldn’t it? Finally, do we see the prototype of God’s psychiatrist in Jacob’s son, Joseph? Though Jacob’s favoritism, culminating in his giving Joseph the coat of many colors, seems to produce excessive narcissism, Joseph overcomes the trauma of being sold by his brothers and given jail time in Egypt, to use his prophetic interpretation of dreams. He attributes this skill to God, succeeding beyond anyone’s wildest dreams in a new culture, in which he prepares successfully for climate change, forgives his brothers, and is united with his father. After this family forgiveness, the cycle is broken and there is just “normal” sibling rivalry depicted in the Old Testament.

With the psychological path cleared in one way, but challenging in another, Moses arrives. A psychiatrist in the court might wonder if his stuttering was a consequence of an unusual child rearing, both in the Egyptian court, where he is adopted, and with the surreptitious involvement of his own family. Maybe he was dealing with buried anger, too. Moses, despite being so humble, has several outbursts of anger, which cost his entry into the Promised Land. Would anger management and/or a prn calming medication have helped him? If he were calmer, perhaps he would have recommended group psychotherapy for those disgruntled among his people, and maybe then sought psychoanalysis for himself. Following the death of Moses, the Old Testament ends.

Chapter 2. Psychiatry in the Common Era


Let’s go on to the Rabbis who replaced Jewish priests in the diaspora outside of Israel after the beginning of the Common Era. They seemed to grasp some therapeutic principles that would help sustain the Jewish people and keep them together over the next 2 millennia, despite pogroms, exiles, and most recently, the Holocaust. They came to interpret the Old Testament in different ways and on many levels, including the Talmud, Midrash, Kabalah, weekly Torah study around the world, and pastoral counseling. In the early Middle Ages, one particular Rabbi—Maimonides—who was a general physician and philosopher all in one, conveyed basic concepts of mental well-being, supportive psychotherapy, and even the basis of our most popular and evidence-based therapy, cognitive-behavioral psychotherapy.1

Nevertheless, there was still no formal field of psychiatry, that is, until a Jewish physician emerged about a century ago to complement the work of Kraepelin. Sigmund Freud, after a childhood as an honor student in Jewish religious schools, went on to take the new field of psychiatry to a different level with his psychoanalytic theories.

Like Joseph, Freud arrived at his conclusions after analyzing his own dreams. The difference is that Freud analyzed the conflictual issues in his dreams, and Joseph analyzed their prophetic meanings. In the ensuing therapeutic process, different levels of interpretation paralleled the Rabbis’ interpretation of the teachings in the Torah.

Was Freud God’s psychiatrist at long last? Not likely. Actually, Freud’s views may reflect why a psychiatrist was not around from the beginning of humanity in Biblical times. Freud, though publicly valuing his Jewish cultural background and involved with B’nai B’rith meetings in Vienna, was famous (or infamous) for claiming that religion was an illusion, an opium for the masses, and that belief in God was a matter of the transference of feelings toward one’s parents.

Freud also seems to underestimate anti-Semitism, which labeled psychoanalysis as that “Jewish science,” only leaving his home at the last minute when his daughter’s life was threatened. Since Jewish theology values action over thoughts and beliefs, Freud’s actions—to find new ways to heal people—couldn’t be more Jewish. What did it mean, then, that Freud died on Yom Kippur, the Day of Atonement, in 1939? And if he was thinking of his death in the physician-assisted morphine mental state, did he reassess his feelings about God?

What about that other famous psychiatrist from Vienna, who studied some with Freud? That was Viktor Frankl. In one of life’s ironies, he lived for a time in close proximity to Hitler. What if he, or another psychiatrist, had at one point been able to treat Hitler during his troubled childhood? As it turned out, however, Dr Frankl2 was about to go to America, only to have an existential crisis:

Should I foster my brainchild, logotherapy . . . or should I concentrate on my duties as a real child of my parents and stay by them?2

He returned home to find the letters of the Ten Commandments stating to honor thy father and mother. He let his Visa lapse. Sent not long after to Auschwitz, he became a sort of concentration camp psychiatrist, struggling to give meaning to the struggle to survive. That meaning was to see his wife again and to lecture about the psychological lessens learned. Only the latter came to pass. After the war, he resettled in Vienna and remarried a Christian woman. He soon published the perennial best seller, Man’s Search for Meaning, and established Logotherapy, a “therapy of meaning.”

Although I was trained in Freudian psychotherapy in the early 1970s, by the end of my clinical career, I came to follow the path of Freud to Frankl by focusing on the meaning of life for the decreasing amount of time I had with each patient.3

Did Dr Frankl end up believing in a God? He never would say.

In our time, it seems that the number of psychiatrists who believe in a God are increasing, parallel with the decreasing influence of Freud’s ideas. Jewish psychiatrists, although still prominent in the newer areas of group psychotherapy, cognitive therapy, understanding brainwashing, and even Freud’s predicted psychopharmacology, are nevertheless decreasing in their relative numbers.

Perhaps the notable example of a Jewish psychiatrist who clearly and overtly believes in God is Dr Abraham Joshua Twerski, who is also a Rabbi and scion of a Hasidic dynasty, and specializes in substance abuse. For a comparable Christian psychiatrist, we can cite the late Dr E. Mansell Pattison, who was also a minister.

Chapter 3. The Moral of the Story

What, then, is the moral of this tale, as Hannah, my grandchild of 2 Rabbis, would ask? Just in time, a valued teacher and colleague asked, “Isn’t God a Psychiatrist”? If God is a psychiatrist and we psychiatrists were also created in God’s image, and if we psychiatrists have come currently to view religion and psychiatry as more overlapping than conflictual, then together we can work to help and maybe even improve human nature. Amen.

References1. Pies RW. The Judaic Foundations of Cognitive-Behavioral Therapy. Bloomington, Ind; iUniverse; 2010.
2. Scully M. Viktor Frankl at Ninety: An Interview. First Things. April 1995. http://www.firstthings.com/article/2008/08/004-viktor-frankl-at-ninety-an-interview-18. Accessed April 1, 2013.
3. Moffic HS. The meaning of life in a 15-minute med check. Psychiatr Times. May 19, 2011. http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1864201. Accessed April 1, 2013.

- See more at: http://www.psychiatrictimes.com/god’s-psychiatrist-april-fool’s-tale-3-chapters/page/0/2#sthash.cfTiiQbN.dpuf

- See more at: http://www.psychiatrictimes.com/bipolar-disorder/god’s-psychiatrist-april-fool’s-tale-3-chapters#sthash.1Ku3jKyS.dpuf

Hope Services Has Deployed bStable!

on Thursday, 18 April 2019.

Hope Services is the leading provider of services to people with developmental disabilities in Silicon Valley. The term developmental disability refers to a severe and chronic disability that is attributable to a mental or physical impairment that begins before adulthood, such as intellectual disability, cerebral palsy, epilepsy, autism, and Down syndrome. Hope Services serves more than 3,900 people and their families in six counties and provide a broad spectrum of services for infants through seniors such as children’s services, day programs, staffing, mental health services, community living services, and senior services.

Hope also operates a number of businesses to raise funds and to provide employment for people with developmental disabilities, including a Recycle/Reuse business for clothing, household goods, and e-waste donations; Auto donations; HopeTHRIFT stores; and Employment (staffing solutions for businesses).

More than 60 years ago, a group of concerned parents who had children with special needs came together to change the way young people with developmental disabilities were treated. These courageous parents believed that their kids who had autism, cerebral palsy, Down syndrome and other related conditions deserved the same opportunities as everyone else.

Among their earliest achievements was opening one of the first preschools for these children. In 1952, 12 children with developmental disabilities walked through the door of a one-room schoolhouse in San Jose and entered a new world – a world where they could receive an education and make friends.

The founding families of what later grew to be Hope Services left a lasting legacy that reflects a simple philosophy that has guided the mission of Hope: to improve the quality of life for individuals with developmental disabilities.

Incorporating Health Information Technology Resources in Psychiatric Practice

on Wednesday, 16 January 2013. Posted in General

Computers in the Consulting Room

Incorporating Health Information Technology Resources in Psychiatric Practice

This was a fascinating article from the Psychiatric Times Vol. 29 No. 12. I was most interested in page 2 of the article that covered: "communication with patients" as that is the foundation of bStable. Page 3 covered "the impact of HIT on the patient experience, and especially on the relationship between doctor and patient, is an emerging area of interest in informatics research and a compelling issue for clinical study". Anyone reading this post have any thoughts or experience with HIT in the consulting room with patients or your therapist or clinician?

Iron Man 3: Reconciling Psychiatry’s Warring Camps

on Sunday, 28 July 2013.

Tony Stark could really use bStable to figure out what's going on in his head...

Iron Man 3: Reconciling Psychiatry’s Warring Camps
 

[Spoiler alert: You might choose to wait to watch the movie—or read this article. —Eds.]

In Iron Man 3, former arms manufacturer Tony Stark is a superhero who aspires to facilitate world peace. In the process, he wages a one-person war against villains who aim to overthrow the powers that be and attain world dominion. Given his mighty missions, who would expect Tony Stark (the Iron Man) to propose peace between warring schools of psychiatry and to attempt to reconcile the armies of the mind with the armies of the brain?

No one, probably—and that’s what makes this twist in Iron Man 3 so intriguing. Tony Stark embarks on a psycho-philosophical quest when he asks if he defines Iron Man, because he manufactures Iron Man’s suit, or if his personal identity is subsumed by this intense public persona. Jungians, Eriksonians, Kohutians—and others—will delight in this dilemma.

Admittedly, Iron Man 3 has a much more involved, action-oriented plot. The psychiatry subtext is just that: a subtext. Still, this subtext speaks directly to neuropsychiatrists, psychopharmacologists, psychotherapists, just plain psychiatrists—or whatever they call themselves. The epilogue that begins after the film ends fleshes out this footnote.

Neuropsychiatry figures prominently in this 2013 riff on the Marvel Comics 1963 character—but so do aerospace engineering and international politics. The MacGuffin of the movie is a substance known as “Extremis.” Extremis enters the CNS via a virus and binds with the brain, promoting DNA changes that send electronic and neurochemical signals to weaponize the body, impart superhuman strength, and make machines move by mind-power alone.

Iron Man 3 does not dwell on Extremis, but comic book fans will recall the original story line in which Extremis facilitates direct brain-based connections with inanimate armor.1 That process allows Tony Stark to become one with his armor. He can now accomplish humanly impossible feats. In other words, Tony becomes Iron Man, both in body and in mind. Hence, his existential identity question emerges.

Unlike some superheroes, Tony Stark is a mere mortal, even though he is a genius inventor and industrialist. He battled the bottle and was a philanderer, but he abandoned his wanton ways to become a philanthropist who devotes his vast fortune to saving the world, even (or especially) if it means putting his own life in peril. Iron Man’s red armor recollects the red cape of the Man of Steel, for both Iron Man and Superman fly through the air. However, Superman’s powers are inherent, while Iron Man’s abilities depend on man-made machinery.

Appropriately and convincingly, Stark is played by actor Robert Downey Jr, whose own struggles with substance abuse were well publicized. Downey’s back-story enhances the casting choice, as does his ability to combine tongue-in-cheek comedy with action-adventure swagger.2

Like Batman, Iron Man fetishizes gadgets. Both possess vast wealth. Unlike Batman, Iron Man designs and builds his own contraptions without relying on his butler. Stark understands neurotransmitters enough to explain how Extremis operates. His conversation sounds fanciful, except for the fact that strikingly similar engineering feats are already in the works.

Minds can communicate with machines in real life, and not just in reel life. For instance, recent news reports revealed that electrode-laden caps allow wearers to communicate with a plane via the mind alone.3 The cap-wearer makes the plane change course when he or she concentrates on making a fist with one hand or the other. The Defense Advanced Research Projects Agency has been experimenting with such technologies for years. Private industry will soon bring related bioengineering feats to commercial markets. Such One Step Beyond–style “mind-control” was previously the province of parapsychology, but no more.

Still, the Iron Man 3 story itself remains science fiction. In Iron Man 3, Extremis has supercharged an army of invaders. World powers and underground conspirators are in hot pursuit of this mysterious substance that can potentiate their evil goals. They are ready to battle Iron Man and anyone else who tries to obstruct their plans to overtake humanity. A once-suicidal scientist, an easily swayed botanist, and a drug-addicted actor figure into the fast-paced plot.

After the movie ends, and after Tony Stark has disarmed his enemies and rescued his love object, spectators are in for another surprise: an epilogue involving Tony Stark and Dr Bruce Banner. The epilogue screens after the last credits roll, when the film is officially over.

In this scene, Tony sits on a sofa, wearing his “civvies,” his armor out of sight. Tony recounts his triumphs and travails. Superhero fans know Dr Banner (Mark Ruffalo) as the physicist who turns into The Hulk whenever his anger is aroused. He becomes big, green, and amygdala-driven. Superficially, this scene looks like a teaser for the forthcoming Marvel film, Avengers 2, which features both Iron Man and The Hulk. However, psychiatrists who listen with their third ear hear tacit messages embedded in the dialogue, replete with reflections about rifts in mental health care.

Tony talks to Dr Banner “. . .and thank you, by the way, for listening. There’s something about getting it off my chest and putting it out there in the atmosphere, instead of holding this in. I mean, this is what gets people sick. . . . Wow, I had no idea you’re such a good listener. . . to be able to share all my intimate thoughts, my experiences with someone . . . it just cuts the weight of it in half. . . and the fact that you’re able to help me process . . . you heard me?”

At that moment, the camera shifts to Dr Banner, who sits in a chair behind the couch. How curious! A film that revolves around neuropsychiatry, DNA alterations, neurotransmitters, and bioengineering comes around full circle to highlight the importance of talking, processing, communicating, and sharing.

Tony Stark never implies that talking it out would have changed anything—or that he wanted to change anything. (Thank goodness, for that would deprive both him and his audience of both past and future action-adventures!)

Yet he endorses the value of making meaning out of life experiences, including save-the-world kind of experiences. He affirms his belief that psychotherapy can contribute to this philosophical pursuit. Unfortunately, he has chosen someone who is “not that kind of doctor.” It’s not just that Dr Banner is a physicist, and a hard scientist, but Dr Banner tells Tony that he does not have the “temper . . . or temperament” to do that kind of doctoring: Dr Banner turns into The Hulk when his emotions are aroused—not a good trait for a therapist.

DISCLOSURES

Dr Packer is Assistant Clinical Professor of Psychiatry and Behavioral Sciences at the Albert Einstein College of Medicine, Bronx, NY. She is also in private practice in New York City. She is the author of Superheroes and Superegos: Analyzing the Minds Behind the Masks (Santa Barbara, CA: Praeger/ABC-CLIO; 2010) and several other books, for which she receives royalties.

REFERENCES

1. Ellis W, Granov A. Iron Man Extremis Director’s Cut. New York: Marvel Comics; 2010.

2. Packer S. Superheroes and Superegos: Analyzing the Minds Behind the Masks. Santa Barbara, CA: Praeger/ABC-CLIO; 2010.

3. Kingson JA. An old Torah, older sunken boats and a seriously old primate. New York Times. June 10, 2013. http://www.nytimes.com/2013/06/11/science/old-sunken-boats-an-older-torah-and-a-seriously-old-primate.html?_r=0. Accessed July 12, 2013.

- See more at: http://www.psychiatrictimes.com/neuropsychiatry/iron-man-iii-reconciling-psychiatrys-warring-camps?GUID=027D74F9-294C-4019-B4F6-6C862BE2E981&rememberme=1&ts=27072013#sthash.LMZFrt8J.dpuf

Lithium, Lithium, Lithium, Lithium, Lithium, Lithium

on Saturday, 26 January 2013. Posted in General

Uh, Let's Stop and Think First People

Lithium, Lithium, Lithium, Lithium, Lithium, Lithium

I presented bStable as part of a session on computerized life management systems for the management of bipolar depression at the International Review of Bipolar Disorders May 8th, 2009 in Lisbon, Portugal with Dr. Andreas Erfurth, from the Department of General Medical Psychiatry, University of Vienna. 

At the conference I was AMAZED at how many researchers were totally fixated on lithium research! All I heard was them chirping like birds: "lithium, lithium, lithium, lithium, lithium". Then: "gold standard, gold standard, gold standard, gold standard".

Wow. I've talked with A LOT of people with bipolar disorder and FEW TO NONE are on Lithium. It can make:

your hands shake uncontrollably, make you very thirsty, want to pee a lot, diarrhea, throw up, pack on the pounds, mess with your memory, impair your concentration, make you drowsy, make your muscles feel weak, HAIR LOSS, make you look like a teenager with ACNE and FAT due to decreased thyroid function.

Sound fun?

The researchers should read this article:

http://www.sciencedaily.com/releases/2012/09/120921092502.htm

and stop the knee-jerk reaction "oh, you have bipolar disorder, let me put you on lithium" and start to THINK first and realize every patient is different. Thoughts??

McGraw Systems to Present at Caminar Mental Health Symposium

Written by Administrator on Friday, 12 May 2017.

On May 18, 2017 Caminar will host their annual educational symposium focused on new research in mental health and its impact on early diagnosis and treatment.

Panelists

  • Ben McGraw, President and CEO, McGraw Systems - Using bStable for active symptom monitoring to prevent crisis situations
  • Steven Adelsheim, M.D., Clinical Professor of Psychiatry and Behavioral Sciences, Stanford University - Adolescent mental health early intervention programs
  • Libby Craig, Crisis Text Line - Using data and tech to increase support for people in crisis
  • Rebecca Bernert, Ph.D., Director, Suicide Prevention Research Laboratory, Stanford Mood Disorders Center - New findings in suicide prevention and treatment
  • Kathleen Kara Fitzpatrick, Ph.D., Clinical Assistant Professor, Stanford University School of Medicine - Interventions for eating disorders in adolescents and young adults
  • Eric Kuhn, Ph.D., Research Clinical Psychologist, National Center for PTSD, VA Palo Alto - How tech is helping people manage mental health conditions, such as PTSD
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