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Panic Disorder

on Saturday, 14 December 2013. Posted in General

Part 1 of this 2-part podcast series, Stephen V. Sobel, MD, sheds some light on the pathogenesis.

Panic Disorder

Panic disorder is a tremendously vexing challenge: keys to its management include appropriate use of psychotropic medication and psychotherapy predicated on an understanding of the biopsychosocial underpinnings. In part 1 of this 2-part podcast series, Stephen V. Sobel, MD, sheds some light on the pathogenesis. (For Part 2, please click here).

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Parents With Bipolar Disorder - WAKE UP!

on Saturday, 27 April 2013. Posted in General


Parents With Bipolar Disorder - WAKE UP!





Offspring of Parents With Bipolar Disorder

By Karen Dineen Wagner, MD, PhD | February 8, 2010

Dr Wagner is the Marie B. Gale Centennial Professor and vice chair of the department of psychiatry and behavioral sciences and director of child and adolescent psychiatry at the University of Texas Medical Branch at Galveston.

It is generally held that the offspring of parents with bipolar disorder (BD) are at risk for BD. The degree of risk is an important question for both clinicians and parents. A

recent study of bipolar offspring by Birmaher and colleagues1 sheds light on this issue.

These authors compared the lifetime prevalence of bipolar and other psychiatric disorders in children whose parents had–or did not have–BD. The study involved 233 parents with BD and their 388 offspring and a control group of 143 parents without BD and their 251 offspring.

Parents with BD were recruited from outpatient clinics and advertisements for participation in the study. On the basis of diagnostic interviews, 158 parents had bipolar I disorder and 75 had bipolar II disorder. The majority (80%) of the parents interviewed were female. The mean age of parents with BD was 40 years. Sixty-four percent of parents reported that the onset of their mood disorder occurred before they

were 20 years old. Parents with BD were less likely to be married at the time of intake and had a slightly lower socioeconomic status than parents without BD.

The offspring of parents with BD did not have to be symptomatic to participate in the study. The mean age of these children was 12 years; 49% were female; and 88% were white. Fewer than half (42%) were living with both biological parents.

The rate of bipolar spectrum disorder in the offspring of parents with BD was 10.6% versus 0.8% in the offspring of control parents. The rate of bipolar I disorder was 2.1%; bipolar II disorder, 1.3%; and bipolar not otherwise specified (NOS), 7.2%. The rate of BD increased substantially–to 29%–when both parents had BD.

Overall, the offspring of parents with BD were at significantly greater risk (52%) for any Axis I disorder than those in the control group (29%).

The majority (76%) of these offspring experienced childhood-onset bipolar disorder before age 12 years. Bipolar NOS was the most common first episode of illness. Rates of comorbidity in these youths were high: 51% had anxiety disorder, 53% had disruptive behavior disorder, and 39% had attention-deficit/hyperactivity disorder (ADHD).


Psychiatric Times. Vol. No. February 8, 2010Psychiatric Times. Vol. No. February 8, 2010

The authors concluded that there is a 14-fold increase in the rate of bipolar spectrum disorder in youths who have a biological parent with BD. If both parents have BD, then the offspring are 3 times more likely to have BD.

The mean age of youths in this study was 12 years. Prevalence rates may therefore be an underestimate because some children with depression may become bipolar in adolescence. It is recommended that clinicians who treat adults with BD inquire about the functioning of their children to provide appropriate early intervention.

Posttraumatic stress disorder and substance abuse

In a family study of BD in youths, Steinbuchel and colleagues2 investigated the relationships among adolescent BD, posttraumatic stress disorder (PTSD), and substance use disorder (SUD). Because adults with BD who were severely abused as children are at high risk for SUD, these investigators sought to determine whether there is a similar association in adolescents.

A total of 105 adolescent offspring of parents with BD and a control group of 98 youths without mood disorders participated in this study. The diagnosis of BD was based on structured psychiatric interviews. SUDs included any alcohol(Drug information on alcohol) or drug abuse or dependence.

Rates of PTSD were significantly higher in adolescents with BD than in the control group. Sixteen percent of youths with BD had full or subthreshold PTSD compared with 3% in the control group. These youths had experienced trauma in the form of physical abuse, sexual abuse, witnessing of death, or family violence. Rates of SUDs were higher among youths with BD than in those in the control group (32% vs 4%, respectively). Alcohol was the most frequently used substance (86%) followed by marijuana (71%) and tobacco (29%).

What was the temporal order of these disorders? In half of the cases, BD preceded PTSD. In the other half of cases, PTSD was diagnosed before BD. For those youths in whom SUD developed, the majority had BD followed by PTSD and then SUD.

This study confirms an association between PTSD in adolescents with BD and subsequent development of SUD. Rates of SUD were higher in those youths who met full criteria for PTSD than for those with subthreshold symptoms. The findings reveal that BD increases the risk for PTSD, which in turn increases the risk for SUDs. The investigators suggest that treatment of adolescents with BD may prevent trauma related to the development of PTSD and subsequent SUD. It is recommended that clinicians who treat adolescents with BD evaluate for the presence of PTSD and SUD.


1. Birmaher B, Axelson D, Monk K, et al. Lifetime psychiatric disorders in school-aged offspring of parents with bipolar disorder: the Pittsburgh Bipolar Offspring study. Arch Gen Psychiatry. 2009;66:287-296.

2. Steinbuchel PH, Wilens TE, Adamson JJ, Sgambati S. Posttraumatic stress disorder and substance use disorder in adolescent bipolar disorder. Bipolar Disord. 2009;11:198-204.



Quiz on Suicide

on Wednesday, 30 January 2013.

Which of the following statements about suicide is false?

Quiz on Suicide

A. Community surveys suggest that approximately 5% of adults have made a serious suicide attempt. B. Mental health conditions most strongly associated with fatal and nonfatal suicide attempts include depression, bipolar disorder, PTSD, and alcohol and/or drug abuse. C. Occasional reactivity to negative emotional stimuli that occurs at least once per week as a reaction to depression. D. Men with a substance use disorder are more likely to die of suicide than are women with a substance abuse disorder. E. Older men with substance use disorders are at greater risk for death by suicide than are younger persons.

Resources on dementia for health care providers and caregivers

on Saturday, 20 April 2013. Posted in General

Some great resources to supplement the use of bStable for dementia monitoring

Resources on dementia for health care providers and caregivers


Mace NL, Rabins PV. The 36-Hour Day: A Family Guide to Caring for Persons With Alzheimer’s Disease, Related Dementia Illness, and Memory Loss in Later Life.Baltimore: Johns Hopkins University Press; 1999

Mayo Clinic Guide to Alzheimer’s Disease: The Essential Resource for Treatment, Coping, and Caregiving. bookstore; 2006.

Rabins PV, Lyketsos CG, Steele CD. Practical Dementia Care. New York: Oxford University Press; 1999.

Warner M, Warner E, Warner ML. The Complete Guide to Alzheimer’s-Proofing Your Home. West Lafayette, IN: Purdue University Press; 2000.

Radin L, Radin G. What If It’s Not Alzheimer’s? A Caregiver’s Guide to Dementia. Amherst, NY: Prometheus Books; 2008.

Web Sites – Disease-Related

NINDS—Dementia: Hope Through Research

AlzGene—Database of genetic association studies on Alzheimer disease

National Mental Health Association—Multi-Infarct Dementia

NINDS—Multi-Infarct Dementia

NINDS—Dementia With Lewy Bodies

NINDS—Frontotemporal Dementia

NINDS—Parkinson’s Disease

NINDS—Huntington Disease

NIH Senior Health—Parkinson’s Disease

Web Sites – Practice Guidelines

American Psychiatric Association—Practice Guideline for the Treatment of Patient’s With Alzheimer’s Disease and Other Dementias

American Association for Geriatric Psychiatry—Position Statements

AMA—Physician’s Guide to Assessing and Counseling Older Adult Drivers

American Academy of Neurology—Guideline Summary for Clinicians – Detection, Diagnosis, and Management of Dementia

American Academy of Neurology—Dementia Encounter Kit

American Geriatrics Society—Clinical Practice Guidelines – Dementia

Web Sites – Associations

Alzheimer’s Association

Lewy Body Dementia Association

The Association for Frontotemporal Dementias

American Parkinson Disease Association

Huntington’s Disease Society of America

Web Sites – Family and Caregiver Support

NIH Senior Health—Caring for Someone With Alzheimer’s

Alzheimer’s Disease Education and Referral Center

Family Caregiver Alliance


MedicAlert and Safe Return

NINDS, National Institute of Neurological Disorders and Stroke.

7. American Psychiatric Association, Work Group on Alzheimer’s Disease and Other Dementias. Practice Guideline for the Treatment of Patients With Alzheimer’s Disease and Other Dementias. 2nd ed. Washington, DC: American Psychiatric Association; 2007. Accessed December 25, 2009.


on Saturday, 26 January 2013.

bStable provides symptom monitoring for patients diagnosed with schizophrenia but what is the prevalance of Schizophrenia?


According to the NIMH:


  • Approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year, have schizophrenia.
  • Schizophrenia affects men and women with equal frequency.
  • Schizophrenia often first appears in men in their late teens or early twenties. In contrast, women are generally affected in their twenties or early thirties.

Significantly reduced activity in the inferior frontal gyrus

on Tuesday, 29 January 2013. Posted in General

Can this help determine children and young people at risk of bipolar disorder?

Significantly reduced activity in the inferior frontal gyrus

In a news release from the University of New South Wales, author Philip B. Mitchell, M.D. said, “Our results show that bipolar disorder may be linked to a dysfunction in emotional regulation and this is something we will continue to explore. And we now have an extremely promising method of identifying children and young people at risk of bipolar disorder. We expect that early identification will significantly improve outcomes for people that go on to develop bipolar disorder, and possibly even prevent onset in some people.”

Stand Up For Mental Health!

on Friday, 01 February 2013.

end mental health stigma today. Don't tolerate it in your life!

Stand Up For Mental Health!

It's Time to Stand Up!!!

There are some 46 Million American women, men and children with mental health disorders. Many are still in hiding because of stigma and shame. It's time for this to end. Those 46 million people need you. If you have a website, blog, or social profile, please join us. Isn't it time you stood up for mental health? Join the campaign now:


on Saturday, 26 January 2013. Posted in General

Patients are told to reduce stress but is that practical?



"Several studies have estimated that as many as 60% of people with bipolar disorder have an anxiety disorder. One study in 2004 showed that ore than 30% of bipolar disorder patients experience panic attacks".

bStable allows patients to identify triggers (stressful life events that are likely to spark episodes of mania or depression). Examples could be: deaths, anniversaries, traumas, etc. These can be recorded and communicated with your clinician or therapist.

Issues abound in out lives: work, school, money, time, health, kids and relationships: friends, family, etc. are the biggest stressors that we face. We can't eliminate stress and anxiety from our lives but can change how we deal with stress and anxiety.

Self monitoring using bStable is key but used in combination with CBT - Cognitive Behavioral Therapy - a great psychotherapeutic approach to address anxiety - has been said to be a very effective combo as reported by our bStable users. I'm also hearing a lot these days about IPSRT - Interpersonal and Social Rhythm Therapy that can help manage stressful life events. 

Stress Sucks but You Can Fight Back

on Saturday, 15 June 2013. Posted in General

How it kicks you in the ass and how you can boot it back

Stress Sucks but You Can Fight Back

Study: Dementia tops cancer, heart disease in cost

on Saturday, 20 April 2013. Posted in General

bStable for Alzheimer's To Be Released Soon!

Study: Dementia tops cancer, heart disease in cost

We have decided to release a version of bStable for Alzheimer's. Our new webpage for the bStable Alzheimer's offering will be available off our homepage soon!! 

From the AP on Fox News:

The biggest cost of Alzheimer's and other types of dementia isn't drugs or  other medical treatments, but the care that's needed just to get mentally  impaired people through daily life, the nonprofit RAND Corp.'s study found.

It also gives what experts say is the most reliable estimate for how many  Americans have dementia - around 4.1 million. That's less than the widely cited  5.2 million estimate from the Alzheimer's Association, which comes from a study  that included people with less severe impairment.

"The bottom line here is the same: Dementia is among the most costly diseases  to society, and we need to address this if we're going to come to terms with the  cost to the Medicare and Medicaid system," said Matthew Baumgart, senior  director of public policy at the Alzheimer's Association.

Dementia's direct costs, from medicines to nursing homes, are $109 billion a  year in 2010 dollars, the new RAND report found. That compares to $102 billion  for heart disease and $77 billion for cancer. Informal care by family members  and others pushes dementia's total even higher, depending on how that care and  lost wages are valued.

"The informal care costs are substantially higher for dementia than for  cancer or heart conditions," said Michael Hurd, a RAND economist who led the  study. It was sponsored by the government's National Institute on Aging and will  be published in Thursday's New England Journal of Medicine.

Alzheimer's is the most common form of dementia and the sixth leading cause  of death in the United States. Dementia also can result from a stroke or other  diseases. It is rapidly growing in prevalence as the population ages. Current  treatments only temporarily ease symptoms and don't slow the disease. Patients  live four to eight years on average after an Alzheimer's diagnosis, but some  live 20 years. By age 80, about 75 percent of people with Alzheimer's will be in  a nursing home compared with only 4 percent of the general population, the  Alzheimer's group says.

"Most people have understood the enormous toll in terms of human suffering  and cost," but the new comparisons to heart disease and cancer may surprise  some, said Dr. Richard Hodes, director of the Institute on Aging.

"Alzheimer's disease has a burden that exceeds many of these other  illnesses," especially because of how long people live with it and need care, he  said.

For the new study, researchers started with about 11,000 people in a  long-running government health survey of a nationally representative sample of  the population. They gave 856 of these people extensive tests to determine how  many had dementia, and projected that to the larger group to determine a  prevalence rate - nearly 15 percent of people over age 70.

Using Medicare and other records, they tallied the cost of purchased care -  nursing homes, medicines, other treatments - including out-of-pocket expenses  for dementia in 2010. Next, they subtracted spending for other health conditions  such as high blood pressure, diabetes or depression so they could isolate the  true cost of dementia alone.

"This is an important difference" from other studies that could not determine  how much health care cost was attributable just to dementia, said Dr. Kenneth  Langa, a University of Michigan researcher who helped lead the work.

Even with that adjustment, dementia topped heart disease and cancer in cost,  according to data on spending for those conditions from the federal Agency for  Healthcare Research and Quality.

Finally, researchers factored in unpaid care using two different ways to  estimate its value - foregone wages for caregivers and what the care would have  cost if bought from a provider such as a home health aide. That gave a total  annual cost of $41,000 to $56,000 per year for each dementia case, depending on  which valuation method was used.

"They did a very careful job," and the new estimate that dementia affects  about 4.1 million Americans seems the most solidly based than any before, Hodes  said. The government doesn't have an official estimate but more recently has  been saying "up to 5 million" cases, he said.

The most worrisome part of the report is the trend it portends, with an aging  population and fewer younger people "able to take on the informal caregiving  role," Hodes said. "The best hope to change this apparent future is to find a  way to intervene" and prevent Alzheimer's or change its course once it develops,  he said.

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Thanks Dr. Phelps!

on Sunday, 07 July 2013.

The attached image is from which is run by Dr. Jim Phelps. His review of bStable can be seen at the bottom of the page.

Thanks Dr. Phelps!

James Phelps, MD, is Director of the Mood Disorders Program at Samaritan Mental Health in Corvallis, Ore. His Web site,, gathers no information on visitors and produces no income for him or others. He is the author of Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder (New York: McGraw-Hill; 2006), from which he receives royalties. Dr Phelps stopped accepting honoraria from pharmaceutical companies in 2008. - See more at:


He is the section editor on Bipolar Disorder for the Psychiatric Times.

The Psychology Of Fight Club

on Saturday, 31 August 2013. Posted in General

Thanks to Brietta Mengel of Source:

The Psychology Of Fight Club


Fight Club’s narrator’s illness is the manifestation of trite and tedious modern life. Watch capitalism push fight club members to the edge in the following steps:

Board One(insomnia)

  • Side one
    • “We buy things we don’t need, with money we don’t have, to impress people we don’t like.”
    • 9-5 grind, obsession with trendy living
  • Side two
    • Neither sleep nor wakefulness
    • 24 hour fog
  • Side three
    • Doctor wont provide rx
    • Sent to support groups to see others in real pain
    • “feeling sorry for yourself plaza”
  • Side Four
    • Make yourself feel like a victim at prostate cancer support group
    • get a great rush
    • Cure your insomnia
    • Meet Tyler Durden: pull a card
    • Marla sees you as a phony, ruins the rush: find a new hobby
      • Card: ” Narrator: A new car built by my company leaves somewhere traveling at 60 mph. The rear differential locks up. The car crashes and burns with everyone trapped inside. Now, should we initiate a recall? Take the number of vehicles in the field, A, multiply by the probable rate of failure, B, multiply by the average out-of-court settlement, C. A times B times C equals X. If X is less than the cost of a recall, we don’t do one.
        Woman on plane: Are there a lot of these kinds of accidents?
        Narrator: You wouldn’t believe.
        Woman on plane: Which car company do you work for?
        Narrator: A major one.”
      • Experience Trauma, create imaginary friend, advance to board two
    • Go square: “pass go, do it again!”

Board Two(dissociative identity disorder)

  • Side one
    • Redemption through violence: get a rush
    • Who is Tyler Durden?
    • New Player Joins: Tyler Durden game piece placed at the same place
  • Side two
    • Apartment blown up, join Project Mayhem
    • What’s your hand? Draw a card
      • Card 1: Invisible hand of production. Capitalism moves towards the highest effiency for everyone.
      • Card 2: Tyler Durden pours lye on your hand. Experience another trial by fire.
  • Side three
    • Tyler sleeps with Marla, get jealous.
    • What direction are you headed, anyway?
      • Card 1:Homogenous capitalism: all experience can be reduced to a price. Everything can be bought and sold.
      • Card 2: Heterogeneous Capitalism: Some experiences are incompatible with normal buying and selling. Pick a sacred apple, buy/sell an orange.
  • Side four
    • Tyler kidnaps Marla, picks fight with you.
    • Realize you’re holding the gun and shoot Tyler in the mouth
    • Tyler disappears, you are hailed as Tyler
    • Watch credit card buildings blow up, holding Marla’s hand
    • “The first rule of fight club is: you don’t talk about fight club.”

Cultural Influence

  • Gentlemen’s Fight Club
    • Was founded in Menlo Park by tech workers in 2000
  • Princeton University Fight Club
    • Was founded in 2001, but broke the first rule of fight club by talking about it
  • Luke Helder
    • Planted pipe bombs in mailboxes across the U.S. trying to blow up a smiley face on the map
  • 17 y.o. founder of Manhatten fight club
    • Jailed for planting a bomb outside of capitalist standard-bearer Starbucks



United States Mental Healthcare

on Wednesday, 16 January 2013. Posted in General

Let's discuss mental healthcare in the United States

United States Mental Healthcare

Check out our interview with McGraw System's CEO Ben McGraw and join the discussion on your thoughts on mental healthcare in the United States

Weight Loss Is Possible & Serious Mental Illness

on Saturday, 20 April 2013.

Losing weight is hard enough!

Weight Loss Is Possible & Serious Mental Illness

A study published in the New England Journal of Medicine reports that a behavioral weight-loss program significantly reduced weight in overweight and obese adults with serious mental illness. Daumit and colleagues1 emphasized the importance of such an investigation, noting, “Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population.”
The study employed an intervention program that modified diet and activity tailored to persons with serious mental illness and concluded participants were able to lose weight. This is significant because medication adverse effects of weight gain and increased appetite, together with non-adherence found in some persons with schizophrenia, bipolar disorder, and other serious mental illnesses, are challenges clinicians and their patients often face.2

References 1. Daumit GL, Dickerson FB, Wang NY, et al. A behavioral  weight-loss intervention in persons with serious mental illness. N Engl J  Med. 2013 Mar 21. [Epub ahead of print] 2.  Lieberman JA, Stroup TS, McEvoy JP, et al. Clinical antipsychotic trials of  intervention effectiveness (CATIE). Effectiveness of antipsychotic drugs in  patients with chronic schizophrenia. N Engl J Med.. 2005;353:1209-1223.

For particulars on study design and research methods, please see the abstract at

What's the Purpose of a Cognitive Behavior Treatment Program Without Self Tracking?

on Tuesday, 22 January 2013. Posted in General

Therapists are not providing patients the tools they need to be successful with CBT

What's the Purpose of a Cognitive Behavior Treatment Program Without Self Tracking?

There are some great books out there on the subject of managing bipolar disorder using CBT (i.e. Michael Otto's book: Managing Bipolar Disorder - A Cognitive-Behavioral Approach) but as the famous quote from Peter Drucker states: "if you can't measure it, you can't manage it!" so why are thousands of therapists out there not giving the tools to their patients to track their thought patterns and measure progress towards goals?? 


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