Saturday, July 12, 2008

Weekly Psych News Roundup

Special thanks to my friend Paulo JĂșnior in Rio de Janeiro for allowing me to use his art!

Mental Health Parity Is Alive & Well, Maybe
Both houses of Congress came to an agreement on mental health parity this week, meaning that mental health benefits must be comparable to those for other illnesses or conditions. Read more at the Wall Street Journal Blog.

Autism Treatment Takes A Risky Turn
Under pressure from parents of autistic children, the National Institute of Mental Health director Dr. Thomas Insel gave the green light on investigation of the controversial chelation therapy. This is a treatment based on the hypothesis that autism is the result of mercury in vaccines. Here's more from US News.

Men Are The Biggest Flirts
In the July issue of the Journal of Personality and Social Psychology, new research indicates that men and women handle flirtation differently, among other things. Apparently men tended to look at their partner more negatively after meeting an attractive potential new mate while women tried to strengthen their current relationships. See the full report at Medical News Today.

How Can You Mend A Broken Heart?
It may be easier than you think. Dr. Laura Berman cites new research that people tend to overestimate the pain of a breakup and bounce back quicker than expected.

Is Online Therapy A Good Thing?
For social worker Michael Callans and his wife, it definitely is. And a profitable one at that. Very interesting story including research and opinions on the subject at Related Content

Friday, July 11, 2008

Without Warning: Epilepsy Drugs, Suicide and the FDA

Numbers are convenient stand-ins for flesh-and-blood humans, making cold clean symbols behind which to hide the carnage of wars, car crashes and, apparently, suicidal tendencies.

In January of this year, the FDA came forward with the news that after a review of some 199 studies, people taking any of 11 epilepsy drugs had around twice the rate of suicide as those taking placebos. The culprits included heavy-hitters like Lamictal and Lyrica. This, they said, warranted consideration of the dreaded black label warning.

Yesterday, the FDA said the suicide rate was morbid, but not enough for a death warrant on the drugs. See, slap a black label on those bottles and it's pretty much guaranteed those bottles will sit on pharmacy shelves collecting dust. Meanwhile the profits of ailing pharmaceutical companies will continue plunging southward into a sea of red ink.

I do wonder, out of a disdainful and morbid curiosity: Have any of these FDA decision-makers ever experienced a suicide in their family? Have any come home from work one day to find their teenaged son's brains splattered across their white walls after he cracked the gun safe combo in hopelessness and panic over girlfriend issues? Have any awakened to find their partner's side of the bed untouched all night, only to discover their limp and lifeless body hanging by rope from a rafter in the garage?

Had they experienced such horrors, I doubt they would find a doubled suicide rate an acceptable risk.
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Alzheimer's Hope, At Last

Anyone who has endured the emotional and psychological devastation wrought by Alzheimer's Disease can find some encourage ment in this week's research findings emanating from Australia. The scientific details being too complex for either me or this blog, here's the layperson's version: The ionophore clioquinol, a compound that transports metal ions across cell membranes and has been the subject of chemotherapy study, has been shown in mouse models to rapidly reverse Alzheimer's symptoms, within a few days of taking it orally. More research is needed, of course, but the investigations of synaptic metals' role in Alzheimer's are exciting and offer the first glimmer of serious hope in Alzheimer's treatment.
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Wednesday, July 9, 2008

NYC Health Department Gets Its Own MySpace

Here are some statistics to consider: According to the Pew Internet and American Life Project, 58% of kids between 12 and 17 years old have a profile on a social networking site, such as MySpace. Meanwhile, about 20% of teens have mental health and/or substance abuse problems with very few of them getting needed professional help. Faced with those numbers, it would seem to make sense that health outreach efforts to teens have a strong Internet presence.

It has always been a disappointment to me that our institutions move slower than molasses and miss opportunities to optimize their programs. But finally, one agency has taken a leap in the right direction.

The New York City Health Department now has its own MySpace, complete with a healthy roster of friends (albeit may fictional ones) at its debut this week. The Department anticipates their presence in the world of social networking will create a safe place for teens and tweens to seek help, take polls and play games. Visitors will also have the opportunity to send confidential messages to mental health counselors. Sounds great, but it's about 10 years too late.

Just as they're coming online, social networking has catapulted far beyond the promise of MySpace. Services like Twitter and the revolution in telepsychiatry continue to open up brave new frontiers. The point isn't technology for its own sake, of course; it's to help people and maybe save lives. Technology is endlessly revealing new and improved means to do just that.

So kudos and plaudits to the New York City Health Department; I wish others would be progressive as well. Now if we can just get bureaucracy to get in step with technology, we would realize a compunding of benefits.Sphere: Related Content

Monday, July 7, 2008

Case Study: Rashida Comes to the New World

Rashida is a 22-year-old female from Iran. She arrived in our emergency room, accompanied by family and friends. She sat forlornly in her hospital bed, quiet and guarded. Her family did most of the talking. From them I learned that Rashida had only been in the US for three days. She had just come as a political refugee, by way of Austria.

Since arriving in the US, Rashida has been increasingly agitated, paranoid and threatening. So much so that she had reportedly threatened to murder her family. Mind you, Rashida had been evaluated just the day before and was cleared psychiatrically by two different mental health professionals.

It seems she went home that evening, told the family she was going to kill them, and was caught in the middle of the night hovering over her sleeping mother with a butcher knife. Apparently such behavior was nothing new for Rashida, as her family told me of two separate assaults on her mother, both in Iran and in Austria. Today her mother was still sporting a black eye, and various bruises from Rashida's last attack. So they know she's capable of exacting violence on the family and at this point, they are scared and unable to sleep in their own home while she's there. While the family explained all of this, Rashida sat in her bed, staring vacantly at all of us. "Do you know why you're here," I asked.

"Because I want to go to university," she replied. It seems the family had told her that in order to go to school in the US, she would have to go to the hospital for blood tests. They said that was the only way they could get her into the hospital.

"Have you threatened to hurt any of your family?" I asked.

"No, no. I would never ever do anything like that to my family."

"Did you threaten to kill them yesterday? Or today?"

"Of course not!"

By now, Rashida had gotten out of her bed and, as we spoke, she inched closer and closer to the door. Two security officers moved towards her. Rashida panicked. She suddenly lunged for the door, pushing her body weight as hard as she could against all of us. More staff rushed over, subduing her in a way that we are trained to do, but which is never comfortable. It is especially disconcerting to this day, when it is a female you’re subduing. Restraints were applied at her wrists and ankles. Rashida screamed, surely cursing us in her native tongue.

Between screams, she spat at us. She tried to bite us. She writhed on the bed, using all her might to squirm her way out of the restraints. Her nurse rushed in to the rescue armed with a syringe filled of psychotropic medications. Rashida would be getting a potent cocktail of Haldol, Ativan, and Cogentin in her right butt cheek. This scenario played out for about 15 minutes, getting the attention of nearly every patient and staff in the emergency room.

I promptly wrote my 5150 and advised her that, at least for the next 72 hours, she would be staying with us.

When everyone's adrenaline had declined, I had an opportunity to meet with Rashida's family. Over the course of the next few days, I would learn a great deal about Rashida and how her life had come to this. It seems that Rashida had been a local celebrity singer in Tehran. Then one day, about a year and a half ago, Rashida's parents decided they would be immigrating to the US. Rashida, they said, must go. After all, she was single and had no commitments, to her father's way of thinking, that might keep her in Tehran.

Not only was she feeling it imprisoned by the 3000-year-old ways of her family, Rashida was harboring yet another secret. While she was still in Iran, she had been hospitalized in one of the country's archaic asylums. A brutish doctor largely dismissed her while a fat, filthy orderly raped her. Repeatedly. And beat her. With sticks. Her terror of even setting foot into a hospital now seemed a rational response to the hell she had endured. Even murderous rage makes sense when faced with such a horrifying possibility. When we look closely, all behavior makes sense, doesn’t it?

What bubbled to the surface was less a story about a young woman’s mental illness than a culturally-imposed female ethic, if you will, enforced by the consequence of being labeled crazy. And if that doesn’t work, you will be beaten into submission.

The extension of this misogynistic system is the enmeshed family. In Middle Eastern cultures boys and girls are a treasured and controlled part of the family, often until marriage. But we boys have it easier; we’re expected to get our lives together, to branch out, to separate, at least to a degree. But girls, well their lives are to be centered on the nuclear family of origin, until a new nuclear arrangement is found by them or for them. In other words, woman has no life beyond her family.

Not so for Rashida. She had gotten a taste of life beyond and she refused to go back. When her efforts seemed to be paying off, she was shunned, dispossessed, sabotaged and spiraled downward into a deep sadness. Nothing that serving a few months in the mental hospital wouldn’t cure, and put her back in her rightful place.

Throughout her treatment, Rashida improved rapidly and with a new joy found not so much because of her lessening depression, but because of her newfound freedom. Strangers that we were, we had given her deep comfort in telling her that no, it’s okay to grow up, to be separate, to be free. She had finally arrived at the New World. Welcome.
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Sunday, July 6, 2008

Having My Baby: Mental Health, Abortion & Barack Obama

Presidential candidate Barack Obama disfigured his speech a few days ago, stating he opposed the mental health exception for late-term abortions. According to The Swamp, yesterday Obama clarified his position inflight between campaign appearances.

At issue is the legal precendent that provides for late-term abortions (i.e., after about 22 weeks into pregnancy) when the mother is in "mental distress." Obama had initially stated he opposed such abortions, alarming many supporters.

This is symptomatic of a much broader and far more politically delicate crisis: persistently, severely mentally ill women getting pregnant. Almost anyone working with this population can recount their tales of women who are, say, schizophrenic, noncompliant with treatment, prostitute themselves, and use every sort of street drug imaginable. When they get pregnant, often multiple times, a crisis of conscience ensues.

On the one hand, these mothers typically continue smoking cigarettes and crack, drinking alcohol, and tricking with johns throughout their pregnancy. Their babies are born crack-addicted, HIV-positive, or with any number of other complications. Often the odds of a decent life are already stacked against these newborns. Why not, some would say, encourage an abortion when these sorts of risks are apparent early on?

On the other hand, even among the most mentally ill mothers, the primal link between her and her child is enormous. These women often refuse abortion, even when they know they are injuring the fetus. They insist on having their baby and keeping it although they cannot even adequately provide for themselves. More often than not, these children land into the state's custody, shuffling through the foster home system ill and angry. But this is not universally true. There are a few children born in these circumstances who, through some higher intervention, survive and even thrive. Who, then, are we to play God because of risk factors and possibilities?

No clear right or wrong course exists in this space. The inability of the state to confine or mandate treatment of these severely mentally ill and drug-addicted mothers, though, would seem to me a good place to start.

Many thanks to photographer Bill Davenport in Nova Scotia for the image, "Life 7 to 12 Weeks"!
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Hiring Mental Health Consumers

For an uplifting story about the service mental health consumers can provide to business, please see the Summer issue of the Mental Health News, a publication based in Pennsylvania. Kudos to you!Sphere: Related Content
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