Wednesday, December 31, 2008

The high risks of homophobia


A new study published in the December 29 online edition of Pediatrics adds further evidence that parental attitudes toward their gay, lesbian, bisexual and transgendered children can have deleterious effects on the youth.
Based on their sample of 224 gay, lesbian, bisexual and transgendered adults in California, researchers found that teens rejected by their families were eight times more likely to attempt suicide, six times more likely to struggle with depression, and three time more likely to engage in high risk drug and sexual behaviors.
Two additional notes of interest: First, gay Latinos encountered the most negative reactions from their families and had the highest risk factors for HIV and mental health problems.
Second, the study found that forbidding a gay teen from socializing with their gay peers carried the same risk as physical or verbal abuse.
You can read more about the study at Discover.
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Tuesday, December 30, 2008

Defining mental illness again

As the American Psychiatric Association prepares the fifth edition of the Diagnostic and Statistical Manual (DSM), a chorus of criticism about the closed-door process continues to crescendo. The Los Angeles Times ran a story on December 29 titled “DSM psychiatry manual's secrecy criticized” detailing the arguments of Dr. Robert Spitzer and others in favor of publicly airing the decision-making process of what qualifies as mental illness.
The venerable Dr. Spitzer, who edited the third edition of the DSM, widely considered the version to beat, argues for l’gealite as a prophylactic against big pharmaceutical interests who may want to pathologize and ultimately medicate the most trivial of human behavior. Although psychiatrists working on the DSM V are limited to $10,000 annually from big pharma, such a restriction may be too little, too late.
Dr. David Kupfer, who is overseeing the newest edition, told the Times that he wants to reduce the number of diagnoses.
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Saturday, December 27, 2008

72-Hour Observations

Weekend News

Army to establish mental health board
Since 2003, 15 Army recuiters have committed suicide, prompting the armed service to form a suicide prevention board. Their task will be to study the mental health of recruiters, one of the Army's most stressed-out job classes. Read more about it at The Fayetteville Observer.

Insurance and mental health
A study published in the December 24/31 issue of the Journal of the American Medical Association found that psychiatric patients who insurance with a lower share of cost tended to get treatment more frequently. Read more about it the Washington Post.

But if they were in Afghanistan...
Mental health patients in that country are numerous, according to experts, but treatment is hard to come by. So Afghanistan sends its mentally ill to feed on bread, water and pepper at shrines, or chains them to trees. Read more at UPI.com.Sphere: Related Content
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Friday, December 26, 2008

Some mental health patients remain invisible

Violations of the human rights of psychiatric patients may not be as uncommon as I'd like to imagine them. On December 23, the Associated Press ran an item "Mental patients isolated for years despite laws" on the MSNBC web site. Virginia, Connecticut, Florida, California, Pennsylvania, Oregon, Massachusetts and Maryland were among the states listed to have put patients into long-term seclusion for lack of any other treatment alternatives.
Typically the patients are chronically violent. For instance, the story refers to Cesar Chumil, who has been in a three-room "containment suite" since 1993. He had 300 incidents of assaulting staff and another 100 of assaulting patients before going into confinement.
Simple isolation was not the most egregious encroachment on patients’ rights cited. Others involved long-term restraint: one man strapped to a bed for 2½ years in Florida, another tied to a bed for over a year in Connecticut.
The AP story opens up a Pandora’s Box of questions about behavioral management, staff biases, and physician perception.
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Wednesday, December 24, 2008

Missouri shows how it's done


Probably every one of us in the mental health profession can produce a (hopefully) short roster of psychiatrists whose prescribing practices are flawed. Some of them would like to squeeze their patient’s symptom presentations into formulaic drug regimens whereas others would under- or overprescribe.
Five years ago, the state of Missouri’s Behavioral Pharmacy Management Program began an ambitious educational outreach to those physicians operating on the edges of psychiatry. The program paid off well this year when the Substance Abuse and Mental Health Services Administration (SAMHSA) awarded them one of their highly-regarded Science and Service Awards for 2008.
This innovative and voluntary program provides physicians with suggested prescribing strategies as well as clinical considerations. Physicians who continue to experience the same issues are offered per consultation.
"This is a model on how states can increase the quality of care that Medicaid residents with severe mental illnesses receive while encouraging more efficient use of taxpayer dollars," said Joseph Parks, M.D., Medical Director of Missouri's Department of Mental Health. "Through this project, many opportunities for coordination of care have been identified, resulting in improved quality of care and enhanced quality of life for persons with mental illness."
You can read more about this innovative program on the SAMHSA website.
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Thinning wallets and bulging waists


News Item
The global financial crisis of the past year has hurt Americans and Canadians in more than just their wallets. Trends show that as a result of increased stress, many are eating more than usual and losing their battle against the bulge even as they try harder to diet.
"I've been seeing nearly three new patients a day for months, and 90 percent of them have stress-related eating issues," said Dr. Penny Kendall-Reed, a world-famous naturopathic physician and author who treats patients on how to utilize the brain and holistic measures for controlling food cravings without the unpleasant side-effects normally associated with dieting.
According to Dr. Kendall-Reed, as many people become more stressed about work stability and the economic downturn, they compulsively turn to food.
"Stress stimulates the hunger center in the brain, destabilizes our blood sugar, makes us resistant to our anti-hunger messengers, and reduces our levels of 'happy hormone' serotonin, all of which trigger cravings that inevitably lead to weight gain," said Dr. Kendall-Reed.
Dr. Kendall-Reed should know; her revolutionary, research-based No-Crave Diet concept, co-authored with her husband Dr. Stephen Reed, helps people take back control of their weight by teaching them how to counter the biological process that makes us crave the wrong foods, effectively silencing the craving urge fueled by stress.
"A standard complaint I get from patients at a time like this is that their diets are not working," said Dr. Kendall-Reed. "That's simply because stress promotes storage of calories, particularly around the midsection, which is the most dangerous place to gain weight and the hardest to remove."
Monitoring about 90 percent of her patients on the No-Crave Diet for six to eight weeks prior to when the financial crisis worsened in mid-October, Dr. Kendall-Reed noticed that they have continued to lose weight and report no recurrence of cravings.
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Tuesday, December 23, 2008

Young schizophrenic man shot in Florida

In Hallandale Beach, Florida, on Wednesday, December 17, an 18-year-old schizophrenic male named Johnny Mario Silfrain was shot in the leg by a Broward County Sheriff’s Deputy, according to the South Florida Sun-Sentinel. Mr. Silfrain had led police on a brief chase in a hearse he stole from a funeral he was attending. At the end of the pursuit, he attempted to run over deputies, leading them to open fire. Now, Silfrain has been undergoing evaluation at Memorial Regional Hospital in Hollywood, Florida.
Just the day before this incident, deputies had been called to the apartment Silfrain shares with this mother. He had become increasingly agitated, she told them, but by the time officers arrived, Silfrain had calmed down and was no longer judged to be dangerous, so the authorities left him at home. According to his mother, Silfrain was quite paranoid, believing people were watching and following him.
Prior to his first psychotic break, the young Silfrain was football player and a student in Advanced Placement classes.
While there aren’t enough details available at this time, it appears this crisis may present an opportunity for examining what systemic failures may have occurred in this case.
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Saturday, December 20, 2008

72-Hour Observations

Weekend Psych News

Milgram revisited
Researchers working on two separate studies have replicated the infamous 1963 Stanley Milgram experiments with equally unnerving results. You probably recall that in Milgram's original work, volunteers were instructed to deliver electrical shocks to a subject, an actor in reality, each time he answered a question incorrectly. Even when the actor cried out in pain, or became unresponsive, volunteers continued to shock them with increasing voltage.
Things haven't changed much since 1963. One of the current studies, found that 70% of the volunteers were willing to inflict up to 450-volt shocks to their unlucky victims.
Read more about the research on the BBC.

Narcissistic kids react aggressively to shame
New research found that kids who score high on narcissistic traits can become aggressive when faced with shaming experiences. Read more about this at the University of Michigan website.

Trouble in Tampa Bay
The children's mental health center at Tampa Bay Academy was stripped of its license and shut down last week by Florida's Agency for Health Care Administration. According to Tampa Bay Online, the state made their move after finding "gross mimanagement" and "substandard conditions" at the 20-year-old facility.Sphere: Related Content
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Friday, December 19, 2008

Love and death on Long Island


By all accounts, Natalie Ciappa was bright, talented, and gregarious. At seven years old, Natalie was pushing a pink stroller through her Massapequa, New York, neighborhood and easily befriended another young girl, Katie. She was quick to share her dolls and her companionship with Katie, beginning a friendship that would continue until one sickening morning in June 2007.
That’s when Natalie laid unconscious on a couch in the home of 19-year-old Seewoo Sung. Her father worked frantically to revive his daughter while Mr. Sung feverishly tried to purge his home of any evidence of the previous night’s party . The efforts of both men proved futile: Mr. Sung would be arrested for tampering with physical evidence, a felony, and Mr. Ciappa could not breathe life into his daughter.
Natalie, the girl with the voice of an angel, the mind of scholar, and a heart of gold, was dead at 18 years old from a heroin overdose. Sadness turned to outrage in her native Nassau County. How could this happen to such a good girl, the one who was to begin studying criminal psychology at the State University of New York in the fall? The one who once snuck through a window to deliver birthday cake to a friend trapped in bed with mono? Once again, the bad guys had won.
In the weeks and months that followed, it seemed that a dam had ruptured. Grieving, tormented parents came forward to tell heartbreaking stories of their own children dying at the end of a needle in the neighborhoods of Long Island. The story had become all too familiar.
On Monday, December 16, Nassau County passed Natalie’s Law and on Tuesday, neighboring Suffolk County did the same. Under the legislation, a web site will be established showing the locations of all heroin arrests, similar to those mapping the whereabouts of registered sex offenders. Additionally, community members can reciprocate with law enforcement, providing information about “heroin hotspots” readily available online.
A start, yes, but little consolation for Natalie’s family and friends . Her mother, Doreen Ciappa, said this week, “Natalie was everybody’s dream child. She was in the honor society, a cheerleader and sang the national anthem at school events. We knew that she went to parties, and I was concerned that she was experimenting with pills or cocaine, but I never once considered heroin. If I had known, I believe that things would have been different.”
On the Respectance.com web site dedicated to Natalie’s memory, her lifelong friend Katie wrote,”I have no pictures to share or notes that you have written me in the past because I put them in the casket with you, I had wanted you to always have the memories we have shared because I know I will… If only you saw what a beautiful, intelligent, fun loving girl you were, maybe you would still be alive today.”
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Wednesday, December 17, 2008

A beautiful mind in Bakersfield

Finding good news about mental health can be positively daunting these days, so thank goodness for Ashley Nommensen, a Bakersfield, California high school senior who is making an impact beyond her years.
According to a December 12 post from columnist Marylee Shrider on Bakersfield.com, this brave young woman helped create a first-of-its-kind peer support group for teens and young adults experiencing mental illness. It is labor of love, borne of her own psychological struggles dating back to a bipolar-induced psychotic break at the age of 13.
Her group's moniker, Outspoken Young Minds, is certainly appropriate for Ashley, who has been traveling to tell her own story to gatherings of school counselors and community organizations. In July, she'll say even more at the 2009 NAMI (National Alliance on Mental Illness) National Convention when she appears there with her mother and Russ Sempell, president of the Kern County NAMI chapter, which has partnered with Ashley on this project.
Ashley's commitment to spreading the word that "normal is just a cycle on the washing machine" is a commendable breath of fresh air.
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Books: A gift for all of us

The tome Poets on Prozac: Mental Illness, Treatment, and the Creative Process edited by poet and psychiatrist Richard Berlin is a fascinating read for all of us in the human sciences. This collection of 16 essays is no mere academic re-exposition of the belabored connection between Psyche and Apollo. Rather, its authors bleed any romance from the sexy madman/woman-as-creative-genius archetype while infusing us with the hope that good therapy begets great art.Sphere: Related Content
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Tuesday, December 16, 2008

Men, Children and Suicide Assessment

We in the US have vigorously moved toward screening a wide range of patients for suicidal risk, but researchers say we have far to go, especially where men and children are concerned.
Asking men during routine medical consults about suicidal thoughts can be uncomfortable for both physician and patient, leading to an abbreviated conversation along the lines of, "Are you depressed? No? So you don't think about suicide." This apprehensive sort of assessment may miss the real issue, though.
Researchers at the University of Western Sydney are encouraging us to remember that suicide is not necessarily connected with depression, especially in men.
In a fascinating study earlier this month, Professor John Macdonald, Co-director of the UWS Men's Health Information and Resource Centre, and his investigative team studied cases of attempted and completed suicides in Australian men ages 25 to 44. They concluded that there are social “pathways” to suicide for men. These include job pressures, (over- or under- or unemployed), separation from children or partners through divorce or other family ruptures, certain adverse childhood events and abuse of alcohol or drugs.
For more information, contact Mr. Macdonald directly via email.
Meanwhile, children's mental health concerns appear to be overlooked by many primary care providers. Perhaps these physicians, too, are reticent to imply that someone's child is struggling by merely asking the question. The University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health issued distressing results on Monday that found 56% of primary care providers are not asking parents about mental health issues their children may be facing.
“We found that more than one-half of parents report that their primary care physician never asks about whether they have mental health concerns for their child,” says Matthew M. Davis, M.D., M.A.P.P., director of the National Poll on Children’s Health. “We’re concerned that some PCPs may not ask about mental health problems because of not being able to address the issues themselves or because of the lack of specialty mental health services available to which they could refer kids if problems come up.”
In fact, according to 25% of the parents surveyed, found it difficult to get their children the services they need, although 62% did get them eventually.

Photo: Daniel Diaz

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Saturday, December 13, 2008

72-Hour Observations

Weekend Psych News

Georgia on our minds: As published here earlier this week, mental health officials in the Peach State have before them a plan to privatize their entire psychiatric care system. Today, the Atlanta Journal-Constitution is reporting that Gov. Sonny Perdue's mental health commission is requesting answers to "21 'critical questions' " about privatization in an apparent effort to preclude any hasty decisions.

Stress tips from Mental Health America: MHA has issued guidelines for reduing stress in these uncertain times. You can read about them at HealthNewsDigest.com.

Not in my backyard: Residents in Brooksville, Florida are hopping mad over a proposal that would place a facility treating men with co-occurring disorders in their neighborhood. One such neighbor, Amanda Goodell, is quoted in Hernando Today, "I lost my voice Wednesday going around talking to parents." At issue? Some neighbors are concerned that the facility's residents will pose a threat to area children.Sphere: Related Content
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Thursday, December 11, 2008

Psychiatric Issues Weigh Down Economy

In a report by the World Health Organization cited by News Blaze today, mental health issues account for more than 15% of the disease burden, or loss of productivity, in established economies such as the US. Psychiatric illness, then, weighs heavier than cancer.
The findings echo those of the journal Lancet which credited mental health dificulties for 14% of the disease burden.Sphere: Related Content
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Georgia Edges Toward Eliminating Public Psychiatric Hospitals

Their mental health infrastructure in shambles, their services under investigation by the US Justice Department and their money pool evaporating, Georgia's Department of Human Resources may just go for broke. They are considering a plan which would privatize the state's entire mental health network. Such a move would put Georgia boldly where no state has gone before. Florida and North Carolina made overtures to the private sector in their recent pasts, parceling off pieces of their psychiatric system to for-profit entities who then delivered grim results in the form of substandard services and stagnant outcomes.
As recently as September, Human Resources Commisioner B.J. Walker was publicly floating proposals allowing a measured amount of privatization. But when the Department quietly met in November, Walker laid out plans for a total surrender of the state system. When word got out to the media, considerable consternation ensued. Ellyn Jeager of the advocacy group Mental Health America politely expressed "serious reservations" about the strategy, telling the Atlanta Journal-Constitution, "Private companies are in the business to make money. I’m not sure it will improve the system.”
Then again, maybe they will. Georgia's state-run system has been faulted for negligent care resulting in a dizzying 136 patient deaths between 2002 and 2007. It's hard to imagine any privately held corporation would tolerate that many risks to its bottom line.

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Wednesday, December 10, 2008

Beating Victim at Patton State Dies

Patton State Beating Victim Dies A 49-year-old patient at Patton State Hospital has died at St. Bernardine Medical Center in San Bernardino, CA, according to a San Jose Mercury News report published this morning. The man was beaten 15 days ago by a 25-year-old peer who has since been charged with battery resulting in serious bodily injury. The victim's cause of death has not been immediately identified.Sphere: Related Content
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Tuesday, December 9, 2008

Mental Illness Can Kill


A brief article published on the Time web site December 3 shed long-overdue attention on the tragically shortened lifespan of patients enduring chronic mental health conditions. All the anecdotal observations of behavioral health professionals, though, had never framed our patients' untimely deaths as starkly as the National Association of State Mental Health Program Directors (NASMHPD).

Scrutinizing data from 16 states, the organization concluded severe mental illness mercilessly shaves an average 25 years off a patient's life. This study, titled "Morbidity and Mortality in People with Serious Mental Illness," was published two years ago, however. Time's citation of this rather dusty report is telling about the dearth of literature questioning this sobering state of affairs.
While this health crisis results from the conspiracy of mutltiple factors, incuding an impetuous healthcare system and an uneven system of decision-making among non-psychiatric care providers, our patients' lives provide the most direct and disquieting call for more attention.

The Psychiatric 'Lifestyle'
Undoubetdly chemical abuse portends an abbreviated life for anyone and psychiatric patients abuse alcohol and drugs at an alarmingly high rate. Estimates vary, but investigators more or less agree around 50% of the chronic mentally ill are substance abusers or addicts. Pair that with the emerging rule of thumb that drug addicts die within 15 to 20 years of the onset of their addiction and an unsettling outlook materializes.
Beyond the socially proscribed drugs, the chronic mentally ill smoke tobacco at nearly twice the rate of the rest of us. In a 2000 study published in the Journal of the American Medical Association, examiners found that 41% of psychiatric patients smoked versus 22.5% of the general population. Patients rhapsodize romantically of their tobacco because a good smoke really is the brightest moment in their otherwise hellish existence. Hospitals encourage the habit, too, because we know that nicotine provides a soothing balm to our customers’ otherwise pulsing nerves. Nurses distributing cheap generic cigarettes to a patient's trembling, nicotine-stained hands is a common visual in our post-modern mental health system.
Beyond the high walls of the hospital grounds, clients often lead cruel, unforgiving lives, especially those most seriously ill. They may sleep in parks or homeless shelters, with little or no money either because they are locked outside the entitlement system or because they spend what few dollars they do get on alcohol and drugs.
The luckier ones--those whose behavior can be maintained with minimal supervision and who receive government benefits--may win a bed at a board and care facility. Some of these housing businesses are well-maintained in tidy neighborhoods. All too many of them, though, are in dilapidated buildings where the stench of feces on bed sheets, urine in hallway corners and aging cigarette smoke permeate the air. Their locations are often in the tenderloin, where scoring a gram of crack is easier than buying a gallon of milk. Typically these patients receive the Federal government’s $637 per month in Supplemental Security Income, plus any additional monies their state provides. Typical board and care rents are around 90% of that amount. Filling our belly on $50 or $100 a month is virtually impossible for even the most frugal of us.
Feeding a drug addiction costs even more dearly. One favorite drug among psychiatric patients is crack, a 1/10th gram of which costs $10-$25 on the street. Another cherished drug, methamphetamine, will set a patient back about $25 for 1/4 gram, barely enough to get a party started. The swift decline of a drug-addicted client's cash supply, then, is easily predicted.
When one is fiending for another fix, there is no limit to what they might do or with whom they may do it. Trading sex for drugs is hardly unusual, but as condoms became a must-have for recreational intercourse, the opportunities for exposure to HIV and assorted other bugs increased. If you have to be anally penetrated by a stranger for your next bump of crystal, chances are you didn't stop off at the market for a pack of Trojans.
Injectable drugs are as much to blame as any informal sodomy for our patients' deteriorating health. Dirty needles carry the double trouble of HIV and Hepatitis C. People with chronic mental illness are infected with Hepatitis C at a staggering 11times the rate of the general population, and carry HIV at eight times than the rest of the population, according to a 2001 study published in the American Journal of Public Health. Survival rates for Hep C hover around a depressing 50% after just five years of infection.

In the face of these unforgiving statistics, the disheartening NASMHPD study referenced at the beginning of this post looks almost sanguine. The numbers reveal more than just life expectancies and callous realities, though. They mirror a blind spot in our present system of care that taunts us with the question, Do we care enough to do anything about it?

PHOTO: Courtesy of Martin Walls, Kent, UK.
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Friday, December 5, 2008

Spread the Happiness


When Rachel Dratch so brilliantly personified the wet-blanket character Debbie Downer on Saturday Night Live, we laughed in hilarious recognition of the party-poops in our own lives and their bummer effect on us. Now researchers have unearthed data illuminating just how sprawling a shadow our little Debbies cast.
A team of researchers from Harvard University and the University of California at San Diego recently undertook an expedition through the massive Framingham Study, a project started by the National Heart, Lung and Blood Institute in 1948 to find common causes of cardiovascular disease. The Framingham participants provided enough data that their friends and relatives could be traced to multiple degrees of separation.
Harvard’s Dr. Nicholas A. Christakis and UCSD’s James H. Fowler, co-authors of the current study, previously mined this data and demonstrated obesity and smoking ran in groups of friends and relatives. On this pass through Framingham, they closed-in on 12,067 study volunteers connected through 53,228 ties. A sample of their conclusions about happiness:

If you have a happy…Your chances of being happier are…
Friend within a half-mile42%
Next-door neighbor34%
Friend two miles away 22%
Acquaintance15.3%
Sibling within one mile14%
Spouse8%

You can read more about this study at the LA Times web site. Of course, sharing it with our own Debbies may not be wise. They bring us a lot of laughter, too.
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Tuesday, December 2, 2008

Half of College-Aged Adults are Mentally Ill... Right?

In an astonishing study published in this month's Archives of General Psychiatry, researchers found that nearly 50% of college-aged adults in the US struggle with some sort of mental health or chemical dependency issue.
A team led by Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University Medical Center, mined the data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. The college-aged group was then split between students and non-students.
Among those in school, the team detected 20% of the college-age adults wrestled with alcohol issues followed by a startling 18% displaying personality disorders. Among the non-students, nicotine dependence and personality disorders topped the list. Meanwhile, mood disorders surfaced in a relatively paltry 11% for students and 12% for those out of school.
The findings are staggering for the simple fact that they turn conventional wisdom on its head. According to the Diagnostic and Statistical Manual IV (DSM-IV), the bible of the metal health industry, Borderline Personality Disorder has been estimated to affect nearly 2% of the general population, Obsessive-Compulsive Personality Disorder shows up in about 1% and Narcissistic Personality Disorder trails them both, presenting in less than 1% of us.
Meanwhile,the same DSM-IV finds 1%-3% of us experiencing the symptoms of panic or generalized anxiety disorders. Even depression is believed to affect less than 10% of the general population.
This study's breathtaking findings can only lead us to conclude either we have an extraordinarily sick generation coming of age, or the study is flawed. Perhaps the devil is in the design. The data for the 2001-2002 study were gathered from face-to-face interviews and the current study's authors deconstructed their information. The real questions revolve around diagnosis versus presenting symptoms. Had those interviewed been formally diagnosed with the conditions reported? Or had they scored in certain ways on psychological testing scales during the survey? Given that only 25% of those surveyed actually sought out mental health treatment, one would be tempted to assume that their conclusions are based on series of questionnaires and behavioral scales. Today's study would be tenuous at best.
Until knowing the full design of the 2001 study and thereby making an informed conclusion, I for one will remain in blissful ignorance of the more alarming alternative.
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Wednesday, November 5, 2008

A Brand New Day in America


With yesterday's emotional and historic election of Barack Obama, my hope is that he can not only bring together a fragmented country, but a disintegrating world as well. After eight years of passive-aggressive American foreign policy, I'm hopeful that President-elect Obama can reach out to the world in ways his predecessor would not. And that after eight years of neglect at home, our new president can start our country back on the path of peace, prosperity and liberty for all.Sphere: Related Content
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Sunday, October 12, 2008

Economy is a 'Mental Health Disaster'


Photo: Ivar van Bussel
As the financial crisis has gone global, we’re seeing more data emerge from other countries about its deleterious effects to mental health.
Last week, the British organization Rethink called for action to prevent a “mental health disaster” as reported by the BBC. Their announcement came as they released their survey of 2,000 Britons who reported that losing their home would be the most cataclysmic psychological event for them. In fact, losing one’s home ranked above losing one’s job.
It would seem that the US and Britain, as well as much of the Western world, are woefully unprepared to manage the onslaught of health problems borne of the global economic collapse. Perhaps the world is awaiting new hope to emerge from our upcoming presidential elections.Sphere: Related Content
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Wednesday, October 8, 2008

The Deadliest Kind of Economic Depression

Here’s a sobering kind of economic indicator: The number of suicides peak at the lowest point of a recession, according to Elizabeth Bernstein’s thoughful piece, “Angst Is Rising, but Many Must Forgo Therapy” in today’s Wall Street Journal Online.
Mind you, as a clinician on the front lines every single day, I haven’t seen evidence of this spike yet. In fact, I don’t think the recession or a depression will particularly affect the most seriously mentally ill patients. After all, they are on the receiving end of government benefits which, barring social cataclysm, is unlikely to end.
The people I worry about, though, are the middle-class clients, squeezed in every way possible. These are the folks who could lose their benefits if they lose their jobs, who are having to scale back just to feed their gas tanks, who are paying soaring prices at the grocery, and who have virtually no safety net, unlike the rich and the poor. They are, in my opinion, most at-risk for stopping or curtailing therapy, becoming more depressed and finally attempting suicide, some of them successfully.
See Bernstein’s article for a discussion on how many therapists and clients are managing in this miserable climate.
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Sunday, October 5, 2008

The Insanity of Methamphetamine


Evidence of the ravages of meth, from the Multnomah County (Oregon) Sheriff’s Office.

The boy jumped up and down on the gurney, naked save for soiled underwear. “Hey, you wanna f*** me? You all wanna f*** me, don’t you?!” he bellowed at us staff surrounding him as we strategized our next move. His screams were punctuated with what sounded like laughs but on more careful listening sounded like involuntary vocal chord spasms. Finally, with a little help from the police officers who delivered this 15-year-old kid to the emergency room, we were able to restrain him chemically and physically.
Some fifteen minutes later, I reentered the room hoping to find a calmer patient I could actually interview. No doubt he needed to be hospitalized, but whether psychiatrically, medically or both was yet to be decided. I was there to determine the psychiatric part.
As I approached the hospital bed to which this child’s legas and arms were leashed by hard rubber restraints, I realized he was motionless, soundly sleeping. He was breathing through his mouth, enough that I could see he had but a few tiny brown stubs doubling as teeth, eroded from at least a few years of what I suspected was methamphetamine abuse. If this wasn’t meth mouth, I didn’t know what was.
My suspicions were confirmed by the police and, later, the boy’s family. He had been a seemingly happy, normally social 11-year-old in the not too distant past, his teary-eyed mother explained. Everything changed with a snort. Apparently he and his skateboarding buddies from the neighborhood had been dabbling with pot for a little added excitement when an older kid in their mostly-white middle class neighborhood introduced them to meth, with promises of pleasure beyond their young imaginings.
From that day on our young patient burrowed himself deeper and deeper into a crystal crypt. His parents, both of whom had to work to keep the patient, his two siblings and themselves in the middle-class lifestyle to which they had all become accustomed, did whatever they could imagine and afford to help their son hoist himself from the tomb to no avail. “He was not interested in stopping and he didn’t care if he lived or died,” his mother recalled.
By 13, he was hallucinating, hearing voices that dictated his every move, but apparently never commanding him to kill himself or others. His addiction snowballed into a daily practice until he disappeared to the streets of Los Angeles nearly prior to this ER visit.
While a denizen of the Hollywood streets, according to police, the patient made his money by selling sexual favors to the men who cruise Santa Monica Boulevard in the twilight hours. Street friends told the officers that for about $10 he would allow anyone to perform oral sex. He’d perform oral sex or allow himself to be anally penetrated, with or without condoms, by any of the johns, ideally for $20, but they said he’d go lower if it was a slow night.
At this point, everyone seemed to agree, this little boy had not only lost his way, but contact with most of reality as well.
Forget malnourishment, meth mouth, depression and anxiety, sexually transmitted diseases, cardiac risks and devastation to one’s life. Amphetamine-Induced Psychosis is a significant byproduct of tweeking. The more speed you do, the more likely you are to lose your mind.
Anecdotally, most of us who work with psychiatric crises can attest that psychotic manifestations following meth use are commonplace. There is an academic problem of teasing out the cases of psychosis where amphetamines are the primary instigator rather than a pre-existing mental illness. The reality, though, is that even if the patient has a history of, say, schizophrenia, their meth use can and will elicit a full-blown psychotic episode.
I’m reminded of a long-ago friend who began experimenting with methamphetamine. Despite all our warnings and protests, he continued using and eventually lost all control. A rising star in the executive suites of entertainment, he lost his job, his reputation, and ultimately his ability to make money. I remember walking into the bedroom of his Hollywood Hills home, its darkness preserved by layers of aluminum foil blocking the bright midday sun, only to find him sitting in a corner talking to voices that existed only in his head. After calling to him several times, he finally recognized my presence.
The last time he was seen, he was homeless and found sleeping in the gazebo of a friend’s backyard. When he was awakened, he expressed paranoid delusions in panicky chatter: The CIA had been following him, listening to his thoughts and he might have to cut his ear off because that’s where their listening device had been implanted. Then, once inside the house, he vanished through a bathroom window, never to be seen again.
Although my friend may have appeared to have been well-enough adjusted and functioning before methamphetamine, I dont’ know that he really was, any more than I believe the thousands of other meth addicts were, either. I say this because I don’t believe you can sever one’s mental health from their addictive propensities. If the drug is not filling some void, I don’t believe there would be as many folks addicted to substances. If one keeps using in spite of the consequences, such as my friend, that indicates to me the expression of a very powerful need. In my friend’s case, I believe meth served as a fast-acting and sexy antidote for his depresson. In patients I have seen, nearly all of them who use meth regard it as an elixir for depression, ADHD, fatigue, and the emptiness of the Borderline Personality. Of course, the drug only leaves them wanting more and feeling worse than when they started, but it provides a fast, euphoric kick-start without having to see a doctor. Yet.
A friend of mine is fond of the saying, “Man doesn’t take the drugs; the drugs take the man.” But they really take so much more: the addict’s family, friends, career, home, personality, body, and sanity. If you have children or work with them, please take a few minutes and visit the Partnership for a Drug-Free America’s Meth Resource Center.
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Friday, September 26, 2008

Police Have it Tough


According to a new study from the University of Buffalo, the stresses of police work increase officers’ risks for high blood pressure, insomnia, increased levels of destructive stress hormones, heart problems, post-traumatic stress disorder (PTSD) and suicide. Based on data from over 400 officers, the study specifically reported that officers over age 40 had a higher 10-year risk of a coronary event compared to average national standards. Seventy-two percent of female officers and 43 percent of male officers had elevated cholesterol levels. As a whole, police officers as a group had higher-than-average pulse rates and diastolic blood pressure.
You can read more on this at ScienceDaily.com.Sphere: Related Content
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Monday, September 22, 2008

Self-Hatred Bodes Ill for Gay Men


“Homonegativity,” or gay self-loathing, predicts a dim future for gay and bisexual men held captve by it, University of Minnesota researchers reported today.
In a study published in the Journal of Homosexuality, researchers surveyed 422 gay and bisexal men in the Midwest at an HIV prevention conference. The surveys gathered data on the men’s attitudes toward affectional and sexual orientation as well as a set of physical and mental health variables. As one might expect, the higher degree of “homonegativity,” the more frequent depression, isolation and poor sexual health occurred.
I say “as one might expect” because it is well-known that secrecy and shame serve as mental prisons where, in their dark, dank interiors, substance abuse, unprotected sex and lies proliferate. Oddly enough, just before reading this story today, I had been discussing the startling death of a colleague’s friend. Otherwise healthy and highly functioning, this young man fell ill on a Wednesday and died two days later. Something about a perforated bowel from an undisclosed anal sex practice, my friend recalled. Of course, this young man was deeply in the closet about his homosexuality and wouldn’t dream of telling any physician he willingly allowed some foreign object to penetrate his rectum. Ultimately, his secrecy, born of his internalized homophobia, killed him.
How many lives have we lost because of the shame and stigma tarnishing otherwise naturally-occurring variations of human sexual and affectional variations?
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Friday, September 5, 2008

Weekly Psych News Roundup

Three Cheers for this Doctor
Dr. Raj Sherman, parliamentary assistant to Canadian Health Minister Ron Liepert, spoke publicly and boldly about his own suicide attempt at 16 years of age. He told his story as he announced that the government will invest $50 million over the next three years into children's mental health services. Read it online at the Edmonton Journal.Sphere: Related Content
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Tuesday, September 2, 2008

Updates on Yolanda's Law & Suzy's Law

Now that I've returned from hiatus, I want to give you the latest developments on two stories I'd covered on this blog during the summer months.

Earlier in the summer I had written about Yolanda's Law in Massachusetts. At the time, the legislation was just about to come up for a vote. You may recall that the law provides training for teachers, guidance counselors and nurses to better identify students with mental health issues and, consequently, help them receive the treatment they need. It was named after 16-year-old Yolanda Torres who suffered from bipolar disorder and ultimately committed suicide. I'm happy to report that last Thursday, August 21, Massachusetts Governor Deval Patrick signed Yolanda's Law into reality.

Back on July 22, I had written about Mike and Mary Gonzalez going to Washington, DC to beef up support for Suzy's Law. This controversial piece of legislation would create penalties for any individual who provides information via the Internet detailing how one can commit suicide and encouraging them to do so. Five years ago, Mike and Mary's 19-year-old daughter Suzy committed suicide with the encouragement and detailed planning provided by individuals on a pro-suicide website. Although the Gonzalezes state that Suzy's Law will not violate freedom of speech, critics continue to argue that such legislation perches our nation on a slippery slope of censorship. Now, as I return from hiatus, Suzy's Law has seven Congressional sponsors.Sphere: Related Content
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Monday, September 1, 2008

September 1: Back to Work

After being hiatus for most of August, I'm back and we have a lot of 5150 news to cover. Elections, mental health law developments, and new public policies are just the beginning.
Happy Labor Day and I'll see you here daily!
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Mental Health Takes Front Seat In Elections

This may be the year Psyche takes center stage in politics, both domestically and internationally. Two storms have been brewing in the last few days, one over John McCain's mental state and the other over Pakistani presidential candidate Asif Ali Zardari's mental fitness to be in the nuclear chain of command.

John McCain & the Palin Factor
John McCain may have just conceded the election with his choice of Sarah Palin as his VP hopeful. For him, though, the real tragedy is his cluelessness.
Of all the pundits and bloggers feeding on his choice, Erik Ose nailed it squarely last week asking, Is John McCain Mentally Fit To Be President? McCain’s selection of running mate was just an icebreaker. We do have to question the judgment of a man who, wanting to woo one-time Hillary supporters, would pick an unknown, ultra-right wing woman with barely any experience in public service and whose only correlation to Clinton is chromosomal. Not to mention that Palin, who McCain only met casually once in February, is under investigation, Troopergate, for abuse of power in her home state of Alaska. Then there was the matter of her phone-in to the Bob and Mark Show on Alaska radio in January of this year. Palin sat back and laughed heartily as one host calls her political rival a "cancer" (she was a cancer survivor) and a "bitch." Play the video below to hear for yourself. The collective weight of all this means McCain's choice just doesn’t make much sense.



Ose then details McCain’s known problems with memory and occasional states of confusion. He uses Ronald Reagan’s frequently foggy-minded states as a reference point and wonders whether McCain may be displaying the onset of Alzheimer’s Disease.
This becomes all-too-disturbing when Professor John Banzhaf of George Washington University estimates that Sarah Palin has as much as a 40% chance of becoming president in a McCain administration.

An ordinary McDonald's franchisee wouldn't hire a manager who makes such poor personnel decisions. Should we trust a man with similarly poor judgment to be commander-in-chief?



Zardari's Record of Mental Illness

Benazir Bhutto's widower, Asif Ali Zardari, is running for president of Pakistan and has been expected to win. What may become a fatal bump in his road to victory are medical records which have been released documenting an extensive psychiatric history. Newsweek's issue dated September 8, 2008 contains an excellent accounting of this story.

Among the records are documentation of his depressive episodes, anxiety and suicidal thoughts. Why is this a matter of concern for the US? Rep. Pete Hoekstra, the ranking Republican on the House Intelligence Committee, told Newsweek, " 'Typically, [the U.S.] wouldn't want that kind of person' involved in a nuclear chain of command."
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Monday, August 18, 2008

California's Mental Health Services Act: Who Is Being Served


In the cash-strapped state of California, things aren't quite so golden these days. We like to govern by initiative, meaning all sorts of programs and laws are born without making much sense in the larger reality. So it was with Proposition 63 in 2004, the so-called Mental Health Services Act.


Well-intentioned but fundamentally flawed, the law imposed an additional levy on taxable incomes of $1 million or more. Out here in the land of swimming pools and movie stars, that can add up to a sizable chunk of change. So far, the Act has generated a handsome $3.2 billion for the state's coffers. Problem is, only $726 million has been distributed. What gives? Apparently not those administering the money.


As eloquently pointed out in Prop 63 consultant Rose King's opinion piece last Monday in the Sacramento Bee, the state's Department of Mental Health issued 67 pages of requirements in 2005 for the first applications. Their strategy was to share the wealth with new and innovative programs while telling the old timers to take a hike. Apparently to some bureaucrats up in Sacramento, the death rattles emitted by our suffocating mental health system are little more than passing wheezes. Never mind there are hundreds and thousands unserved and underserved by exisiting services or that the traditional safety nets are full of gaping holes or that we have lost many psychiatric hospitals to financial woes.


Proof once again that if bureaucracy gets involved in healthcare, it's bound to mess it up.
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Saturday, August 9, 2008

Weekly News Roundup

If We Took a Holiday
UK residents regard their vacation as vital to their mental health, according to a new study. Of course, it's published by Just the Flight, an online travel agent.

Execs Need Help, Too
UC San Diego has created the Executive Mental Health Program which encourages executives, who are feeling the economic pinch in terms of pressure to perform, to take care of themselves as well as their bottom line. Read more about it in the San Diego Business Journal Online.

Suicide Prevention Tips
All too often we hear the words, "I never knew so-and-so was depressed. He just killed himself out of the blue." In fact, most people who suicide leave a trail of clues. They key is knowing what to look for. Here's a helpful piece from the Capital Flyer at Andrews Air Force Base in Maryland.Sphere: Related Content
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Friday, August 8, 2008

Anthrax Suspect Took Secrets and Demons to the Grave

At first blush, news that federal investigators had fingered a respected Army scientist post-mortem as the culprit behind the cryptic 2001 Anthrax scare seemed, well, flimsy. Now some of the facts of this rather bizarre case are surfacing and the accusations seem more justified.


Puzzling and even disturbing is the fact that scientist Bruce Ivins was apparently a troubled soul plagued by dual demons of depression and paranoia yet continued his work as a bioweapons specialist. He struck without warning, without overt provocation. How many others are lurking in our military laboratories, toiling feverishly on their concoctions and twisted plans, known to be possessed by similar demons, but operating without impediment?


Much to his credit, though, Ivins seemed to be more messenger than rogue domestic terrorist. His point seemed to be to scare us out of our complacency. "Look at what the terrorists can do!" he was exclaiming. He hinted that he knew something we didn't. Perhaps, but we'll likely never know. He took his secrets to the grave when he kiled himself a few weeks ago.


What, if anything, could have been done differently? Could Ivins have been stopped before the end to his Anthrax terror spree? Could he have been better protected from his own illness?Sphere: Related Content
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Tuesday, August 5, 2008

Your Economic State of Mind

The Atlanta Journal-Constitution today published an editorial that captures what must really be the overarching mental health story of the year: What toll has our faltering economy taken on the American psyche?

Mention is made in the piece of a woman who killed herself after her home went into foreclosure. Surely she is neither the first nor the last. While our leaders focus on bail-outs and shake-outs, perhaps it is time that states and local governments pay attention to what is surely a growing mental health crisis.Sphere: Related Content
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Monday, August 4, 2008

The Right to Bear Arms & Mental Illness


No matter where you may stand on the right to own firearms in America, there is no denying that the background checks to purchase them need closer inspection.


Josh Horwitz' piece today on the Huffington Post eloquently articulated this. The deficiencies of the background verification system exposed in the aftermath of the shootings at Virginia Tech and Northern Illinois University have produced little more than lip service to reform. As it stands, an individual with a severe mental illness, with a propensity to violence, can legally purchase a firearm in most areas of the country. By the time President Bush signed the NICS Improvement Act of 2007, which was supposed to improve the screening process, the National Rifle Association had successfully secured new gun-owning rights of the mentally ill. Amazing, isn't it.

I have worked off and on over the last few years with a young man who idolizes Seung-Hui Cho and his Virginia Tech massacre. He has threatened repeatedly to commit a similar act at a local school, which is how he found his way to me. He has shown up at my office, tattered copy of The Satanic Bible in hand, to discuss his latest theories on being the Evil One and how much libidinously-satisfying damage he can really do. Oh, yes, the police are well aware of this young man, but little can be done until something happens.

While we try to contain him, and thousands like him in our midst, it is likely only a matter of time before his hands are covered with blood. And ours, too.
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Saturday, August 2, 2008

Weekly Psych News Roundup

Mentally Ill Murders Decline in the UK
A new study pubished by BBC News this week found that murders committed by mentally ill perpetrators has fallen by two-third in the last 30 years...

Psychiatric Issues Clog Massachusetts Courts
The Wicked Local reports the Commonwealth's district courts were packed with mental health and substance abuse cases in 2008, to the tune of some 9,000, not including criminal cases with psych issues...

The Sadder Sex?
Fox News cited a study that found women may start off happier in life than men, but after 48, the happiness roles reverse...

Popal was Insane
This week, Omeed Aziz Popal, the man who went on a hit and run rampage in San Francisco in 2006, was found legally insane. See the full story at NBC...Sphere: Related Content
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Friday, August 1, 2008

A Gene of Interest for Schizophrenia Researchers


Researchers at Cardiff University in Wales, home of 2007 Nobel Prize winner for medicine Sir Martin Evans, etched a new place in history, this time for their genetic exploration of schizophrenia.

The team looked at genes that occur commonly in individuals with schizophrenia than those without it. What popped out them was one gene in particular, ZNF804A , which seems to work by turning other genes on and off. Now science will have to discover exactly which ones ZNF804A is fooling with. Their findings were published in the journal Nature Genetics on the evening of July 30th.

“The main message from this study is hope that the modern weapons of biomedical science will ultimately defeat the secrets of the disease," said Professor Michael O’Donovan of the Cardiff's School of Medicine, who led the study.

Many predict that the very core of psychiatry will change in the next few decades as the genetic secrets of mental illness are unraveled. The genetic treatment of devastating illnesses like schizophrenia will indeed be a godsend.
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Thursday, July 31, 2008

California Takes A Stand for Teen Suicide Prevention


In the ongoing and long-overdue flurry of activity around mental health services for our young people, Gov. Arnold Schwarzenegger here in California this week signed a bill for teen suicide prevention.
Known as the Jason Flatt Act, named after a 16-year-old who successfully suicided, the law allows school districts in California to use a handful of dollars from their Professional Development Block Grants for suicide prevention training of teachers.
This sort of legislation makes for decent ink for both the Governor and the California Teachers Association, which supported the bill. But the reality is the Jason Flatt Act falls very flat. Schools can't use the funds until 2014. When that day comes, they can provide faculty with a paltry two hours of training.
This hardly seems like an urgent response to a very real crisis. The bill itself points out that suicide is the third-leading cause of death for American youth 15 to 24, fourth for kids 10 to 14 and second for college-aged young people.
With tragic numbers like those, it's almost embarrassing that this is the best our Golden State can do.
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Tuesday, July 29, 2008

Yolanda Gets Her Own Law in Massachusetts


Last January, a 16-year-old girl suffering with bipolar disorder named Yolanda Torres committed suicide. She wasn't one of the handful of lucky children in Massachusetts to get the mental health care she needed. Like the rest of the nation, the Massachusetts system of care for children is abominable. A 2006 report found that 102,000 of the state's 146,000 children needing mental health services actually got any help.

This week, the state's House of Representatives may vote on Yolanda's Law which will dramatically increase services to Massachusetts children. Among the changes are its increase in screenings by pediatricians, day cares and preschools. The bill will also provide addiional assistance to schools for mental health services and even increase options available to those with managed care insurance.

The only opposition? The psychotics at the Church of Scientology. I guess if the kids can make it to the mothership, they'll be okay. But more on them in a later post. Keep up the good work Massachusetts!
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Monday, July 28, 2008

Veterans Suicide Hotline: 55,000 Served

As if there was ever any question that military service can take a profound psychological toll on those who serve our country, these statistics released by CBS News today offered a sobering reminder.

The Department of Veterans Affairs suicide hot line has logged some 55,469 calls in the first six months of 2008. At the beginning of the year, about 21,000 people had used the service. CBS also obtained data showing where the calls originated. Texas came in first place with 2102 calls, followed by California with 2088 calls, then Florida with 1250 calls, and in fourth place Massachusetts with 1051 calls.

Of the total calls, 22,044 identified themselves as vets. About 2966 identified themselves as family or friends of veterans.

Whether or not we agree with the military actions taken by the United States, the men and women serving our country deserve every bit of support we can possibly give them.
PHOTO: SERGEI KRASSII
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Saturday, July 26, 2008

Weekly Psych News Roundup

Puffing for Calm
The Alexza Pharmaceuticals inhaler to treat acute agitation in psychiatric patients is entering its Phase III clinical trial...

"Mad Pride" Sweeps the Nation
It had to happen, sooner or later. "Mad Pride" is a burgeoning movement among folks with mental illness, at least according to the Providence Journal...

Vets & Mental Illness
The VA isn't paying close enough attention to vets with mental illness some say and they point to one Navy man's suicide as a case in point. Meanwhile, the VA is rolling out suicide hotline ads in DC...

George Michael Has Faith in Music
The pop star is emerging victorious after a bout with grief and depression. He credits music as helping him get through...Sphere: Related Content
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Friday, July 25, 2008

Deadly Consequences of Negligence


A Double Tragedy Unfolds in Florida
On the evening of July 21, chronic psychiatric patient Mark Rohlman was brought in twice to Fort Walton Beach Medical Center for emergency psychiatric evaluations. Both times, he escaped. How, exactly, no one’s telling just yet, but the story ended tragically for Mark and Sheriff’s Deputy Anthony Forgione.

After his escape from Fort Walton Beach Medical Center, Mark found his way to his deceased father's home where he barricaded himself with a gun. When sheriff's deputies arrived to take Mark back to the hospital, he fired on them. His bullets killed Okaloosa County Deputy Anthony Forgione, a 33-year-old deputy from Niceville. Mark then turned the gun on himself and pulled the trigger.

In these last few days after the tragic series of incidents, politicians and pundits alike have been hammering at Florida’s Baker Act. But do they have the right culprit in their crosshairs?

What is the Baker Act?
Like many other involuntary detention laws across the nation for psychiatric patients, the Baker Act allows that individuals unable to care for themselves or presenting imminent danger can be detained for psychiatric assessment. They are taken to a designated facility where, within 72 hours, they are evaluated. Afterwards, the individual can be released into the community, involuntarily committed to an inpatient psychiatric hospital, or mandated to accept outpatient treatment. Inpatient hospitalization under this law extends up to six months.

The law has multiple patient's rights safeguards built into it, but many are arguing these protections are simply creating a loophole through which potentially dangerous patients can escape.

The Community Outraged
Reporter Tom McLaughlin of the Northwest Florida Daily News wrote a blog post headlined, "In FWB, little is done to secure mental patients. " McLaughlin is one of a growing chorus of understandably outraged citizens suggesting that maybe restraints or seclusion are the best antidote to dangerous psych patients.

On the other extreme, probably laying the groundwork for her hospital's defense, is Fort Walton Beach Medical Center's risk management officer Evelyn Ross. She is quoted in McLaughlin's blog stating, “The Baker Act does give us the opportunity to evaluate the patient even if they don't want to be here, but it does not give us the opportunity to secure them here. You don't restrain people just because they've been Baker Acted." True, but you don't just let them walk off, either. And twice in one day, no less.

Adding his voice to the cacophony was Okaloosa County Sheriff Charlie Morris who said the tragedy "absolutely a wake-up call" to change the Baker Act.

For their part, officials at Fort Walton Beach Medical Center have been mum on the particulars of how Mr. Rohlman escaped. Probably a good idea.

Who's really at fault here?
Vilifying a mentally deranged man who killed one of our finest might make sense of an otherwise senseless crime. Calling for legislative reforms makes better politics and press than examining the mundane details of this incident.

The fact is Fort Walton Beach Medical Center has been notorious for insufficient management of psychiatric patients, put mildly. Really, it’s downright incompetence. As McLaughlin has pointed out, the hospital has placed 45 calls to the Sheriff's Department reporting elopements of Baker act patients since January 1, 2007. They have made 21 such calls this year alone. These are simply staggering statistics for any one hospital.

Any hospital is responsible for their patients and that often means guarding them with one-to-one attention. Could it be that these deaths were needless not because the law is weak but because the hospital bungled the case? That one staff member taking care of the patient could have saved two lives? Right now, it’s too disconcerting to think that way.

But, experience tells me that the real story here is what’s going on at Fort Walton Beach Medical Center, not in Tallahassee.
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Thursday, July 24, 2008

OCD Conference Coming Up Quick!

If you are a clinician who treats OCD and you haven't already registered for the Obsessive-Compulsive Foundation's 15th Annual Conference in Boston, time is running out. The cut-off for online registration is Monday, July 28. The conference runs August 1 – 3, 2008, at Renaissance Waterfront Hotel in Boston, MA.Sphere: Related Content
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Tuesday, July 22, 2008

Suzy's Law: Parents Turn Grief Into Action

You've read in this blog last week about Kendra's Law and Laura's Law. Today, I'm writing to raise awareness of a like-titled piece of legislation, Suzy's Law.

Photo by Georgios Wollbrecht
HR 940, as it's officially known, proscribes using interstate commerce to publish suicide promotionals, such as how to kill yourself quickly and effectively, how to write a powerful suicide note, how to get the material means for suicide and how to delay others finding out you're dead.

Who Was Suzy Gonzales?
A resident of Red Bluff, California, a quaint town in the far reaches of Northern California, Suzanne Gonzales was a bright and fun-loving 19-year-old girl with a stellar future ahead of her. She was a national Hispanic scholar finalist and had a full scholarship to Florida State University. To quote the Suzy's Law web site,
"She loved to set her own style and was not afraid to march to her own beat. She was known as the girl wearing glasses with no lenses and hand-painted colorful shoes, and riding a red scooter carrying the stuffed two-headed cat she made herself. She loved polka-dot dresses and ska music, and she was a joy and bright light to be around."
That bright light was about to be tragically extinguished. Suzy became depressed while attending Florida State. She tried to talk to her boyfriend about the increasing thoughts of suicide she experienced, but he told her she needed help.

So Suzy turned to the Internet and found multiple resources encouraging her to kill herself and providing her with the know-how to get the job done. They taught her how to pose as a jeweler to buy potassium cyanide. They gave her instructions on how to send time-delayed emails that would go out after her death. They taught her how to lie to her psychiatrist so she wouldn't get hospitalized. On and on it went.

Finally, on March 23, 2003, Suzy checked into a Florida motel and ingested a lethal dose of potassium cyanide.

Parents Turn Grief Into Action
Mike and Mary Gonzales were devastated by their daughter's suicide, but decided to take action. Suzy's Law was initially introduced in February 2007 by Rep. Wally Herger.

Under the Suzanne Gonzales Suicide Prevention Act of 2007, an individual who uses the Internet or other interstate commerce to teach a suicidal person how to commit suicide or provides them the resources to do it would be guilty of a crime punishable by fines and up to five years in prison. If the recipient actuall suicides, the penalty goes from five years to life in prison.

The bill was referred to the Judiciary Committee's subcommittee on Crime, Terrorism and Homeland Security. It has been in limbo ever since.

So Mike and Mary are going to Washington, DC, this week to bring Suzy's Law out into the daylight for support and, hopefully, action. If you want to get involved, you can read the full text of the law, urge your Congressperson to co-sponsor the bill, and tell your friends.

Here's wishing you the best, Mike and Mary!
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Monday, July 21, 2008

Frank Calloway Keeps On Keepin On

Happy Birthday, Frank Calloway, belated though it is. Frank's birthday was July 2 and he turned a spritely 112, though I never would have known it until reading this AP Feature written by Kate Brumback. This was no how-did-you-live-so-long article, but rather a refreshing tale of surviving schizophrenia.

Born July 2, 1896, in Alabama, Frank entered the mental health system in 1952, diagnosed with schizophrenia. He has lived in that system ever since. Today, he is showing signs of dementia and is spending his days in a nursing home.

All of that aside, Frank is known for his artwork. He creates vivd murals that recall his Alabama youth, glimpses into a world gone by.

As he recounts in the story, Frank was taught early on about drawing and he's been an avid artist ever since. According to staff at the nursing home, Frank is quite happy to just spend his time quietly absorbed in his artwork.

Frank Calloway


This October, the American Visionary Art Museum in Baltimore, MD, will feature 18 of Frank's murals in an exhibit titled, "The Mariage of Art, Science and Philosophy."

Frank had been giving away his artwork or selling it at times for $50. But the nursing home staff has put a stop to that after an appraiser told them Frank's work could be worth thousands. The money will go into a trust so Frank doesn't lose his Medicaid benefits.

Keep on keepin' on, Frank!
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Sunday, July 20, 2008

The Personality Tattoo


Dr. William Cardasis at the Michigan Center for Forensic Psychiatry offered some alarming research findings last week: Tattoos may predict Antisocial Personality Disorder. I have to admit, when I first read this at the LA Times, I thought it must be a joke. But, alas, 'twas not.

Apparently the good doctor and his colleagues studied 36 male inpatients at a maximum-security state psychiatric facility and looked for a correlation between sporting a tattoo and having Antisocial Personality Disorder. In other words, do men with tattoos tend to be psychopaths?

As one might expect, the investigators' question was answered with a resounding yes. Fully 73% of the men with tattoos also had an antisocial diagnosis compared to only a 29% of those without. There is no indication what percentage of these 36 men were sociopaths.

What fails the laugh test in this research are the obvious skews in the pitifully small sample. Well-researched literature pegs sociopaths at about 28% of the prison population, an exponentially higher percentage than among the rest of the population. The fact that they examined men in a prison psychiatry ward only loads the data more. I'm going to guess that a huge number of prisoners have tattoos. I don't know of any data, but anecdotally, people who work in the system estimate from 75% to 90% of inmate have tattoos.

So then, this study makes the leap that of 36 inmates, 10 (28%) have antisocial personality disorder. Within those 10, 7 have tattoos and 3 don't.

What to make of all this? According to Cardasis, we can predict "whether adolescents with tattoos are more likely to have conduct disorder than those without, and what the effect the meaning and subject content of the tattoo has."

With the prevalence of tattoos in our society in general, can we infer much meaning into them anyway? Using tattoos as a predictor of violence is about as meaningful as listening to hip-hop as a barometer of psychopathy.Sphere: Related Content
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Saturday, July 19, 2008

Weekly Psych News Roundup

Being A Good Sport Can Mean Having A Good Life
Many parents can tell you of the life-changing influence sports have had on their kids during difficult times. Martin Jones, a University of Alberta research scientist, told the Edmonton Journal the myriad ways sports teach kids life skills.

Software Developer Dies In Fall
Steven Thomas, the 36-year-old founder of Webroot Software, died of injuries sustained in a fall from Pali, a cliff 1,000 feet in the air above Honolulu. It wasn't explicitly declared a suicide, but Thomas did suffer from bipolar disorder. His wife told UPI.com that he had been depressed about the wars in Iraq and Afghanistan and thought both the government and space aliens were after him.Sphere: Related Content
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Friday, July 18, 2008

The Mentally Ill Sentenced to Misery by Our Indifference


Anyone who has worked in the mental health system can recite a litany of patients who spin through its revolving doors over and over. They become familiar faces and stories, some loved, some disdained.

This subset of patients return again and again for a variety of reasons, but the most common one is noncompliance with medications. This happens often times because of money and access, other times because of flat-out refusal.

Misfortune often laughs at our weakest, and some of these people end up floating face-down in a river after successfully suiciding, or mumbling in the hallways of a state mental hospital where they are psychologically buffed-up to competently stand trial for some bloody violence. The rest? Well, they walk among us.

As I've written in posts past, the mental health system in America is bleeding to death. The causes are most certainly legion, but the hemmorhage can be stemmed by creating law and infrastructure to get the most seriously mentally ill treated. How to do this?

Assisted Outpatient Treatment (AOT)
There's a prima facie impression that only a relative handful of us give a damn about mental health. After all, last week Congress had to pass a law just to push mental health benefits up to par with other medical treatments. Psychiatrists are the lowest paid medical specialists in the nation. Psychiatric programs are often relegated to the farthest corners of medical centers. Mental health staff are often among the lowest compensated employees. Indeed, it can feel like a service begrudgingly given.

Realistically, mental health's black sheep status is more a matter of evasion than indifference, of exasperation than antipathy, although there is a mix of all those. Sometimes they coalesce to create a perfect storm.

Kendra Webdale
On a rainy Sunday afternoon in January 1999, 32-year-old Kendra Webdale was waiting on a Manhattan subway platform. A young man named Andrew Goldstein approached her and asked for the time. Just as the subway train screeched towards them, Goldstein plunged Kendra down to a gruesome death on the tracks.

Andrew Goldstein was one of those caught in the revolving door of mental health. His life had started full of promise as he possessed an exceptional, perhaps beautiful, mind. It was a promise broken, though, when he had first psychotic break as a college freshman.

Diagnosed a paranoid schizophrenic, Andrew went through multiple psychiatric hospitalizations and, in spite of the fact he had assaulted thirteen strangers without provocation-all of them women-and had expressed fears he would act on his violent impulses towards even more women, he was released, again and again.

As you might expect, Andrew had not been compliant with his medications, mostly because of debilitating side effects, and was continually released before he was truly stable.

In the aftermath of this horrific episode, New York passed an Assisted Outpatient Treatment law for the mentally ill and named it Kendra's Law.

Not long afterwards, another tragic incident would underscore the failures of the mental health system, this time 3,000 miles away in California.

Laura Wilcox
On break from Haverford College in 2001, nineteen-year-old Laura Wilcox was working for a few days at a Nevada County mental health clinic. A 41-year-old client named Scott Harlan Thorpe showed up for his appointment on January 10. But to the horror of all around him, he pulled out a gun and opened fire, killing two clinic employees. Laura was one of them. Scott then drove to a restaurant and shot its 24-year-old manager.

As with Andrew, Scott had not been compliant with his treatment, including medications. By the time he went on his shooting spree, he had descended into a delusory hell where he was being tormented and stalked by the FBI. His family stood by, helplessly watching his unraveling, unable to do anything to compel him into treatment.

Like Kendra, Laura did not die in vain, either. Lawmakers California would enact their own AOT law, largely based on Kendra's, and call it Laura's Law.

What It Is
Under AOT, patients with severe and persistent mental illness can be court-ordered into outpatient treatment, rather than leaving it up to them. If the patient fails to show up for treatment, peace officers or field clinicians can bring them to an emergency room. The patient is evaluated for a possible 72-hour involuntary hospitalization (a 5150 in California). For a complete detail of these otherwise complex laws, please visit The Treatment Advocacy Center.

It is money that is the decisive difference between the New York and California AOT structures. New York has a well-organized and funded program. California's until recently had been all talk and no action, a legislative mandate without the cash to implement it. Happily, that is changing as Los Angeles and Nevada counties are now using Mental Health Services Act monies to initiate AOT programs.

Meanwhile, the investment has paid off handsomely for New York, both in societal costs and the toll of human suffering. To wit: A 59% reduction in repeat hospitalizations, a 75% reduction in incarcerations, a 57% reduction in homelessness, and a 53% increase in medication compliance. If that's not enough, the Office of Mental Health's web site features even more impressive data.

Patient's Rights
A subtext, perhaps, to the lack of political and financial will to enforce Laura's Law in California is simple complacency. It has been 36 years since the well-meaning but fundamentally flawed Lanterman-Petris Short Act effectively tied everyone's hands. Compulsory treatment for even the most seriously mentally ill was sacrificed in the name of patient's rights. Hence, a floridly psychotic patient who believes he's the King of Macaroni on a Moon that's made of cheese is considered legally competent to refuse antipsychotic medications. Mind you, I'm not suggesting that we violate or disregard constitutional rights in any way, but to allow severely ill patients to dictate their own treatment appears ludicrous at first blush, and then downright ridiculous in practice.

If you're a patient who has chronic paranoid schizophrenia, 20 or more psychiatric hospitalizations over the last two years, and a pesky penchant for dope on which you spend your entire monthly government check, do we as a society not have a vested interest, if not moral obligation, to force you into treatment? Or, perhaps we just really don't care if you end up dead at 35 behind some Skid Row trash dumpster. One less loser to worry about, right?

Final Thoughts: Rights Can Be Wrongs
The irony is that patient's rights can also be their undoing. Folks with severe mental illness carousel through mental hospital doors because they can't function in monitored settings. They take easy escapes like alcohol and drugs that lead to hard falls such as homelessness and incarceration. They are essentially children and adolescents in adult bodies. They need us to structure their lives, to support them, to help them make decisions, and to give them a time-out when they are spinning out of control.

Continuing with a business-as-usual approach is, in fact, the greatest violation of a mentally ill person's rights we can commit. The AOT laws are a welcome first step for our patients' recovery.

This post was updated on 12/11/2008.

Many thanks to Kristina M. Ragosta, J.D., Legislative & Policy Counsel at the Treatment Advocacy Center for her assistance.

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Thursday, July 17, 2008

An Ovation for Medivation


More good news on the Alzheimer's treatment front today. New research released today and being published in The Lancet demonstrates a significant improvement in people with Alzheimer's taking the drug Dimebon. Patients showed a substantial reduction in Alzheimer's symptoms after 6 months on Dimebon, and even more improvements at 12 months. Dimebon maker Medivation said they hope to have the drug to market in the US in 2010. The drug is also being investigated as a treatment for Huntington's Disease. If you or a loved are affected by Alzheimer's and are interested in enrolling in clinical drug trials, please visit The Connection Study today.Sphere: Related Content
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Tuesday, July 15, 2008

Managed Care: Who Pays?

One of the questions I am most frequently asked in my private practice is whether I accept insurance reimbursement. I have always been happy to provide clients with statements so they may seek reimbursement from their health insurance provider.

However I am part of a rapidly growing cadre of mental health professionals who do not accept health insurance. Following are issues I would urge you to carefully consider prior to seeking managed care coverage for your mental health services.

Is My Personal Information Private? If your managed care provider is paying for your treatment, they will review the details of your therapy sessions. In order for them to authorize a handful of sessions, I must provide them with an extensive list of information. If I don’t have it, I am expected to get it.

The information required is extensive: Has the client ever been in therapy before? If so, what was the precipitating event? Why did they terminate the previous therapy? What is the precipitating event now? Do they use alcohol or drugs, illicit or otherwise? Have they ever been medically treated for their psychological issues? What is their marital status? What is their family dynamic? In short, every conceivable detail of your private life is up for discussion between their case manager and me. This information then becomes part of the documentation which follows you throughout life. Should you apply for health insurance elsewhere, you will have the “mentally ill” stigma following you.

Who’s in Charge? As the old saying goes, “He who pays the piper picks the tune.” If a managed care company is footing the bill for your therapy, neither you nor I are really in control. Rather, a case manager, who is given financial incentive (bonuses, raises, promotions) to deny care, has the power to determine when you are ready to cease therapy. This is, of course, why they call it managed care in the first place.

Their focus is “symptom reduction” and once that has been achieved, there is simply no point from their perspective to continue. This is not to say that “symptom reduction” isn’t a worthwhile goal, but it isn’t the penultimate goal of therapy, either. This leads to the third issue of managed care therapy.

Whatever Happened to Happy? To reduce the power of therapy to “symptom reduction” is to undermine it all together. Psychotherapy in its various forms throughout the ages has been the key to personal liberation and fulfillment. Managed care isn’t particularly concerned with the quality of life or whether you’re happy and peaceful; they just want you to be able to have fewer “symptoms.”

These are three of the serious concerns about allowing managed care to manage your therapy. I urge you to consider them carefully.

PHOTO: STEVE WOODS, ESSEX, UK. THANKS, STEVE!
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