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Mood & Food

on Monday, 27 May 2013.

We've heard it before. More evidence...

Mood & Food

It’s time to send your patients to the “Farm-acy,” Drew Ramsey, MD, told attendees at the American Psychiatric Association Annual Meeting. Ramsey, assistant clinical professor of Psychiatry at Columbia University College of Physicians & Surgeons, was one of several speakers at the standing room only workshop “Prescription Brain Food: From Bench to Table.”

The brain, Ramsey explained, needs to be nourished; he noted it consumes about 420 calories a day. To function properly, the brain requires omega-3 fatty acids, folate, fiber, choline, iron, zinc, and vitamins B12, D, and E among other nutrients. So can a patient’s diet affect their mood and mental (in addition to physical) well-being?

Yes, Ramsey answered, pointing to some interesting studies exploring diet, nutrition, and mood disorders. In one study, researchers followed 10,094 initially healthy participants for a median of 4.4 years.1 To better understand the association between diet and mood, participants were assigned a Mediterranean dietary pattern score, which positively weighted the consumption of vegetables, fruit and nuts, cereal, legumes and fish.  A monounsaturated- to saturated-fatty-acids ratio and moderate alcohol(Drug information on alcohol) consumption also had a positive influence on the score. On the other hand, consumption of meat, meat products, and whole-fat dairy were negatively weighted. The researchers found an inverse relationship between adherence to the Mediterranean diet and risk for depression, suggesting this diet has a protective role against the development of mood disorders.

Similarly, Ramsey told attendees about a study comparing a diet high “whole” foods (eg, high in vegetables, fruits and fish) with a diet high processed foods.2 Tasnime N. Akbaraly, PhD, and colleagues found that those who most closely followed the whole foods diet had lower odds of depression as measured by the Center for Epidemiologic Studies – Depression scale (odds ratio = 0.74) while those who had ate diets high in processed foods had increased odds of developing depression (OR = 1.58). This could have great clinical implications, Ramsey explained, since patients with psychiatric disorders often don’t eat properly.

The diet-mood link seems to be evident across the lifecycle, he added. Ramsey sharedfindings from a study of 7,114 adolescents aged 10-14 years.3 Participants completed dietary questionnaires, which were then used to determine healthy and unhealthy diet quality scores. The Short Mood and Feelings Questionnaire was used to measure depression. Once again, this study found an inverse relationship between good, healthy eating and the development of depression. Indeed, adolescents with higher unhealthy diet scores had a 79% increased risk of depression, Ramsey noted.

With increasing data supporting good nutrition for improved mood, Ramsey said all clinicians should take the time to chat with their patients about their diet, nutrition, and making good choices. “It is a low-cost, risk free intervention that will help your patients,” he said.

He advised clinicians to routinely discuss diet and nutrition with patients during visits, inquiring about what they eat and creating an open dialogue. He counsels his patients as appropriate to try to include healthier choices, like beans to increase folate intake. Mushrooms add lycopenes to the diet, he added. He reminds patients to consume fatty fish, and reminds them that there are options beside salmon. He suggests that his patients swap berries for other sugar-filled desserts and to favor grass-fed beef when consuming meat.

At the very least, patients will be eating healthier. But Ramsey believes these steps and patients’ visits to the “Farm-acy” will help them to build a better brain.

National Alliance on Mental Illness (NAMI) - North Carolina 2013 Crisis Intervention Team Conference

on Sunday, 24 February 2013.

McGraw Systems Proud To Support This Important Event

National Alliance on Mental Illness (NAMI) - North Carolina 2013 Crisis Intervention Team Conference

The Crisis Intervention Team (CIT) is a partnership formed to divert individuals living with mental illness from arrest through the creation of more effective interactions among law enforcement, providers, individuals with mental illness and their families.

The 2013 North Carolina Statewide CIT Conference provided opportunities for collaboration that moved us toward our common goals of safety, understanding and services to those with mental illness in crisis. The Keynote Speaker was Justice Evelyn Lundberg Stratton, co-founder and former co-chair of the Judges' Leadership Initiative, a professional association that supports cooperative mental health programs in the criminal justice system. Justice Stratton shared her vision that the courts, in partnership with the mental health system, can affect positive change in the lives of many defendants whose mental illness has led to criminal activity.

The Lunch Keynote was presented by Antonio Lambert, who provided an honest account of an individual living with a mental illness and how his struggles with the law ultimately led to his own recovery.

National speakers Clarke and Tracy Paris provided a 2-part workshop that helped police officers, police employees, and first responders deal with the struggles associated with police work, Cumulative Stress, and Post Traumatic Stress Disorder (PTSD). 

Neanderthal Psychologists & Therapists

on Saturday, 26 January 2013. Posted in General

Get a Computer or Die!

So this article from Psychiatric Times:

got me very upset. It is from Dr. Geller who is a Professor of Psychiatry at the University of Massachusetts Medical School and Facility Medical Director, Worcester Recovery Center and Hospital in Worcester, Mass. 

He obviously is in the Stone Ages!! Wake up dude! Basically to summarize the article... he thinks if you put a computer in a therapist's office, everyone in the world will have a patient's mental health records. What??? Comments??? 

Omega-3 Supplements

on Friday, 25 January 2013. Posted in General

bStable + Psychotropics, Exercise, Meditation and Eating Well + Fish Oil?

Omega-3 Supplements

Many bStable customers are either newly diagnosed, trying to stay "stable" or are having major problems with their psychotropic medication regimen and want to reset and establish a baseline to measure their progress towards wellness. Most of those who I talk with going through those various stages trying to regain and keep control of their life are experimenting with fish oil.

Lots of the bStable customers I have spoken with that have raved about using omega 3 fatty acid supplements have taken: Omax3, Nordic Naturals and OmegaVia.


A debate that is ongoing is do they help with mood disorders (seems they do) and if so, are the higher end brands worth the extra cost and if so, which ones are best. Thoughts? 

Overdiagnosis: Examine the Assumptions, Anticipate New Bipolar Criteria

on Saturday, 20 April 2013. Posted in General

Bipolar Disorder

Overdiagnosis: Examine the Assumptions, Anticipate New Bipolar Criteria
By James Phelps, MD | March 13, 2013
Dr Phelps 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. He stopped taking honoraria from pharmaceutical companies in 2008.
Overdiagnosis of bipolar disorder is an increasing concern, particularly since the widely cited study by Zimmerman and colleagues.1 Findings from that study indicate that there is a problem with overdiagnosis (positive predictive value of only 43%) as well as with the much less publicized parallel finding of 30% underdiagnosis (sensitivity of 70%).

A recent review noted a much lower underdiagnosis rate of 4.8%, which is an inaccurate interpretation of the original data.Zimmerman and colleagues themselves allude to the higher figure.3

Will the new criteria in DSM-5 address these varying claims of overdiagnosis and underdiagnosis? After all, concern about overdiagnosis is one of the driving forces behind these debated changes.4 I’ll take up that question in the next essay in this series, suggesting that the new criteria will not significantly improve positive predictive value—the most debated aspect of diagnostic accuracy. But an important step should precede that review of predictive value and specificity, namely, a careful examination of the very concept of overdiagnosis.

Consider the implicit assumptions.

Bipolar disorder is like bacterial sepsis or mononucleosis: a patient either has it or he does not. One of the origins of dichotomous diagnosis in psychiatry is bacterial. The discovery that many debilitating illnesses were caused by invasive bacteria was a tremendous medical advance. An illness was present if the offending agent was present and absent if it was not—the first of Koch’s 4 postulates. But this perspective has been carried forward into the realm of mental health, where emerging understanding of phenomenology is not consistent with this black-and-white, yes or no way of thinking.5,6

The DSM’s dichotomous system—mental illnesses are either present or absent—is an accurate model for bipolar disorders. Consider the sheer number of genes and consider the role of environmental variation in modifying gene impact, as seen in the short/long variation of the serotonin transporter gene and depression vulnerability, where an otherwise substantial gene effect is completely overridden by benign up-bringing.7Imagine the number of combinations of genes and environments possible and imagine the array of phenotypes that would emerge from them?

A DSM-5 committee considered all of these factors in their 2006 discussion of whether to introduce a spectrum approach to diagnosis in the upcoming edition. Virtually everyone involved was in favor of incorporating a “dimensional” approach (as opposed to the current “categorical” approach). Michael First8 wrote a masterful summary of those proceedings. Ironically, at this meeting, the mood disorders subgroup chose to work on the spectrum of depression severity, not the unipolar-bipolar spectrum. That side step leaves the entire “overdiagnosis” debate open, in spite of a new DSM.

The Structured Clinical interview for Diagnosis (SCID) is a valid gold standard. Even if one presumes that bipolar disorder can be regarded as present or absent and that a diagnostic system should operate accordingly, another major assumption remains: the SCID is a realistic gold standard against which to judge clinicians’ diagnoses. Obviously, the only way to judge diagnostic accuracy is to have some means of recognizing whether the illness is truly present. The SCID is accepted in this role, because psychiatry lamentably has little else to replace it. Is it adequate?

Administering the SCID consists of asking questions in a semi-structured fashion. All the SCID does is ensure that all relevant diagnostic questions are asked in a systematic fashion. The trick in using it is to keep the instrument from interfering too much with the patient’s account of his symptoms. At best, interference can be kept to a minimum.

So, why would we uncritically accept the idea that an SCID user who does not know the patient and whose relationship with the patient can only be hampered, not enhanced, by the instrument he is using, generates a more definitive diagnostic impression than a clinician who actually knows the patient? The advantage of the SCID is in its completeness. It does not otherwise enhance the accuracy of data. Those who accept that the study by Zimmerman and colleagues1 demonstrates overdiagnosis are tacitly accepting that a clinician who does not know the patient, wielding an instrument that does not enhance the clinical relationship, is the authority. If the SCID says bipolar disorder is absent while the clinician says it is present, the clinician is wrong.

While I deeply respect the importance of this kind of research, the underlying logic is necessarily simplistic. Therefore, any conclusion of overdiagnosis based on this study is likewise an oversimplification.

Consider a recent study of bipolar screening tests in which the gold standard was instead a 1-year confirmation of the initial diagnosis.9 While not ideal (eg, clinicians were not blind to their initial diagnosis), it has longitudinal validity regarding what the patient “truly has.” Or, consider a study of pediatric mood and attention-deficit diagnoses by Chilakamarri and colleagues10 in which underdiagnosis of bipolar disorder was a far greater problem than overdiagnosis, but which is cited far less frequently than the Zimmerman study.1 Perhaps because there was no SCID for the gold standard—only experienced clinicians?

Risks of overdiagnosis

None of the above considerations diminish the negative impact of an inappropriate diagnosis.8 The effect of potential “grief for the lost healthy self,” akin to the impact of a diagnosis of diabetes, should give pause. Stigma risks are broad, from the impact on the patient’s sense of self, to friendships and intimate relationships, to serious unintended consequences in divorce proceedings or employment. Treatment risks are also broad—certainly beyond those of serotonin reuptake inhibitors. The risk of diluting true bipolar disorders with a fundamentally different disorder is likewise significant, as is the impact through this dilution on our ability to identify appropriate treatments when psychiatry has more targeted options in the future.

In the next essay in this series, I will examine whether the new DSM criteria will significantly address this diagnostic dilemma: can they improve accuracy? That essay will focus on specificity. Can tightening DSM criteria (as DSM-5 attempts to do in 2 important ways) improve on specificity? How much of an improvement in positive predictive value can thus be produced? Will it raise the value of a bipolar diagnosis beyond a coin toss?

Overmedicating Patients

on Tuesday, 22 January 2013. Posted in General

Clinicians are sometimes flying blind

Overmedicating Patients

I once met a girl diagnosed with Bipolar Disorder I at an Annual DBSA event who was on 21 different medications! Yes, 21 medications! Obviously, the patient had multiple comorbid conditions and a lot of the patients I run into have several medications in their constantly changing "psychotropic cocktail". But 21?? I've seen psychiatrists fall into a deadly trap of chasing symptoms with psychotropics. Have you? Without constant and transparent visibility into how the patient is doing with a particular regimen, this trap is very easy to fall into. Thoughts?

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).

See more at:

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
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