Sunday, November 4, 2007

Post-Disaster Children and Immigrants: Do They Face Similar Treatment in Mental Health World?

This week as I explored the blogosphere, I discovered two posts that led me to believe that children and immigrants face the same abandonment and lack of mental health treatment following a disaster such as a devastating wildfire or a destructive hurricane. In a recent post, William Meek, a doctoral candidate in counseling psychology, from the World of Psychology blog, explored how mental health services for children in the post-Katrina region are not meeting standards. Apparently children who suffer from post-traumatic stress disorder and anxiety are able to continue living their lives; however they are not receiving much help to ease the stress and anxiety issues that still linger from the disaster. In another post written by Seth Wessler, at the RaceWire, the Colorlines Blog, he mentions how a report by the New York Times shows incidents of undocumented immigrants being turned away from or arrested at evacuation shelters and detained by the Border Patrol as they tried to get back to their homes in parts of California following the wildfires. My comments to both of these blogs can be found by following the post links above and can also be seen below.

Comment to William Meek’s “Post-Katrina Mental Health Services”:
I think the study exploring the wane of mental health services in Katrina kids is a wake up call to the mental health care community. Just because media coverage of victims has subsided does not mean that mental health services available to the victims can subside as well. I think you make a good point in your post by saying that “it is troubling to think that a generation of children will have lingering psychological problems due to the disaster.” But the lingering problems are not entirely inevitable. With proper mental health services, the children will be able to overcome their traumatic experiences. That is why it is important to keep funding mental health services in the affected regions. This led me to wonder whether FEMA is still awarding grants to fund mental health care treatment. Most likely it is not, especially not as much as it did in August 2006 with its $34 million dollar contribution. With continued funding, programs can be created to train new psychologist to assist those in who are feeling burnt out. These psychologists should also be trained in multicultural psychology in order to appropriately deal with the barriers to treatment, such as the social stigma of mental illness, cultural mistrust, and availability issues.

Comment to Seth Wessler’s “Immigrants and the Fires”:
I do not think it is fair how immigrants are being turned away from evacuation shelters and being deported, yet they are expected to assist with the reconstruction efforts after the California wildfires. If they are being refused the basic support services, such as evacuation shelters, what guarantees that they are going to receive the mental health care needed to deal with post-disaster trauma? The fires can definitely be seen as a wide spread disaster that has affected many and those affected may be at high-risk for experiencing stress and trauma. Some people are able to recover from the trauma, however others have more difficulty. According to the National Institute of Mental Health, these people who have trouble recovering from the trauma are people who are faced with ongoing stress or who lack social support. Immigrants fit this description perfectly. Most of these illegal immigrants already face the stress of being deported as well as acculturation stress, however, now they face the stress of losing their jobs and being arrested due to the fires that have forced them to seek help from authorities. I like how you bring up the fact in your post that the Mexican Consulate and other service organizations “have stepped up to provide support, aiding in search efforts for workers in hard to access areas and supplying financial assistance.” This is really important because it will help ease some of the stress that immigrants face as they recover from the fire disasters. However, mental health care services should definitely be provided to these immigrants especially if they are going to be expected to aid in the reconstruction. We owe them that at least.

Monday, October 29, 2007

Major Stress in America: Studies Examine the Effects

Many people see stress as a natural part of life. However, extreme levels of it can prove to be quite dangerous. According to a survey recently released by the American Psychological Association (APA), one-third of Americans are living with extreme stress. The report published by the APA explains how the survey explored various issues, such as appropriate and excessive levels; circumstances, situations and life events that cause stress; activities, resources and behaviors people use to deal with it; and the personal costs of stress. This ongoing concern with stress and its physical symptoms has led many researchers to examine how mechanisms in the brain control the ability to adapt to it. It is important that researchers continue to study the effects of stress in order to develop new ways to promote resilience to psychological stress. This will prove beneficial to individuals whose stress contributes to the development of other mental disorders, such as anxiety and depression.

The APA report states that stress is taking its toll on people, contributing to health problems, poor relationships and lost productivity at work. The survey reports that half of Americans claim that they are more stressed than they were five years ago. In an APA press release, Russ Newman, APA executive director for professional practice, had this to say: “We know that stress is a fact of life and some stress can have a positive impact, however, the high stress levels that many Americans report experiencing can have long-term health consequences, ranging from fatigue to obesity and heart disease.” Even though 28% of Americans claimed to be managing their stress extremely well by engaging in activities such as exercising, praying, and listening to music, an even higher percentage reported experiencing the physical symptoms of stress (see image to the right). Surveys such as the one conducted by the APA are important in exploring what causes individuals the most stress. This survey found that the majority of American’s stress arose from work (74%) and money (73%). By knowing what aspects of life cause the most stress, specific programs can be designed to reduce stress in those target areas.

This great concern with the effects of stress has served to inspire many researchers to explore stress' underlying properties. For example, in a new study published online by Cell found that there is a distinct mechanism in the brains of mice that cause them to be resistant to stress. During stressful situations, vulnerable mice had excessive rates of impulse-firing by cells that make the chemical messenger dopamine in the brain. Adaptive mice on the other hand, maintained normal rates of firing due to a boost in activity of channels that allow the mineral potassium to flow into cells. The vulnerable mice were also found to have more activity of a protein called BDNF; resistant mice did not have this increase in BDNF. One of the authors of the study, Eric J. Nestler (pictured to the left, in the center with the other authors of the study) notes, “The fact that we could increase these animals’ ability to adapt to stress by blocking BDNF and its signals means that it may be possible to develop compounds that improve resilience.” He goes on to say that this is a great opportunity to explore potential ways of increasing stress-resistance in people faced with situations that might otherwise result in other disorders, such as post-traumatic stress disorder.

Continuing research on stress is essential in developing new and effective methods of regulating stress. One study that came out in the October issue of General Psychiatry, examined how behavioral intervention helps boost the stress regulating hormone, cortisol, in children who were at high-risk for developing antisocial behavior. The behavioral intervention proved to be successful in teaching these high-risk children the appropriate social skills needed to adapt to stressful situations. Interventions such as this one are important because they lessen the stress people would otherwise be left to face. Another study even examined the way video games can be a success in combating the stress by training people to change their perceptions of social threats and boost their self-confidence.

Collectively, all these studies done on stress work to explain how the dynamic interaction between the environment and the brain determine how one adapts to stress in life. More research will eventually lead to new medicine and treatments that will promote resilience to psychological stress. As new methods for controlling stress surface, they will undoubtedly help individuals deal with the pressures they face in life, from the post-traumatic stress of war to the stress induced by paying mortgage bills.

Sunday, October 21, 2007

Labeling Human Traits: Is it Shyness or Social Anxiety Disorder?

In honor of World Mental Health Day, which took place on October 10th, I would like to address issues that have been stirring the mental health community for some time now. Rick Nauert, Senior News Editor for the Psych Central website recently wrote an article looking at how a book, titled Shyness: How Normal Behavior Became a Sickness, challenges the method by which human behaviors are classified as psychiatric disorders. In his book, the author, Christopher Lane, a Northwestern University professor, brings attention to how labeling human traits as disorders leaves the doors wide open for the pharmaceutical industry to intervene and prescribe medication to fix the presumed biological imbalances. Lane argues that recent changes made to the Diagnostic and Statistical Manual of Mental Disorders (DSM) have set the diagnostic bar too low and more people may be diagnosed as having social anxiety disorder when in fact they may just be suffering from normal shyness. Issues such as these definitely need to be taken into consideration during the upcoming revisions to the DSM, because further ambiguity in diagnostic criteria will surely lead to high rates of over-diagnosis and harmful treatments. By examining the treatment for social anxiety disorder, for example, we can see how medications may not always be an effective approach to treating the disorder.

With more and more shy people being diagnosed with social anxiety disorder it would seem apparent that the DSM-IV is in need of revisions. In a New York Times article, “Shy on Drugs”, Lane reveals that, troublingly, in the fundamental handbook of psychiatry “the diagnostic criteria for shyness are far from clear.” Since the team of people who will oversee the development of the newest edition of the DSM, version V, scheduled to be published in 2012, has already been announced, it will be up to these professionals to make sure that diagnostic criteria are made clearer when it comes to disorders like social anxiety. In regards to the new edition of the DSM, Lane states that “this time they should make sure to carefully distinguish normal—even healthy—shyness from social anxiety disorder.” By making the language in the next DSM more direct and precise, mental health care providers might avoid misdiagnosing patients as having a serious disorder when the individual is only exhibiting typical personality traits.

It is also important to note that the drug industry has taken advantage of these high recurring disorders. The makers of Paxil, for example, came out in the late 1990s saying that it could treat social anxiety as well. Let us keep in mind that this drug was originally used to treat depression. Lane stresses the fact that “after being prescribed Paxil or Zoloft for their shyness and public-speaking anxiety, a disturbingly large number of children, studies found, began to contemplate suicide and to suffer a host of other chronic side effects.” In October 2004, the Food and Drug Administration placed a black box warning on all antidepressant medications. Dr. Lester M. Crawford, Acting FDA Commissioner, said that these actions “represent the FDA’s conclusions about the increased risk of suicidal thoughts and the necessary actions for physicians prescribing these antidepressant drugs and for the children and adolescents taking them.” The prescription of these dangerous drugs is undoubtedly unacceptable, especially if they are being used to treat symptoms that do not actually constitute a real disorder.

The fact that a more than 1.4 billion antidepressant prescriptions are being issued to children per year goes to show that too many in the United States are now opting for what seem to be quick fixes and not considering alternative treatments. Mental health care providers should discourage the use of medications when it comes to treating conditions such as social anxiety disorder because studies have shown that there are other available options. For instance, one study published in the Journal of Child Psychology and Psychiatry examined the efficacy of a school-based, cognitive-behavioral intervention on adolescents with social anxiety disorder. The study found that emphasizing exposure and rehearsal of social skills during the intervention was highly efficacious. It also proved that effective interventions can be transported to nonclinical settings like schools. Non-medication treatments such as this one are a safer option, especially for those individuals whose diagnosis may be on the borderline of normal shyness and social anxiety disorder.

According to the Social Phobia/Social Anxiety Association approximately 7% of the population suffers from social anxiety disorder. Therefore, it is important that the above mentioned and unclear diagnostic criteria issues be resolved soon because many people may be suffering more from a misdiagnosis than from an actual disorder. This issue of diagnostic uncertainty does not only pertain to social anxiety but to other disorders as well. I believe that the release of the new DSM will help ease the number of black box warning prescriptions being issued because it will make diagnostic criteria more precise. But as the mental health community awaits the release it is important that we keep other forms of treatments in mind.

Monday, October 8, 2007

Technological Treatments: Can Computer Programs Cure Phobias?

In a world connected by technology it is no surprise that people suffering from phobias are now turning to computers to cure them of their fears. MSNBC recently published an article explaining that in Britain, general practitioners are issuing passwords allowing their patients to access computer programs that mimic sessions with psychiatric counselors. The computerized cognitive behavior therapy program mainly works to teach patients new ways to think or react in order to alter their fearful behavior and emotions. Many believe that these programs are a great innovation because patients in Britain often struggle to get appointments with their therapists. Although it sounds like this new technology is capable of helping many, it may not be suited for everyone and could possibly fall short in providing adequate treatment to all patients.

The computer therapy does offer many advantages to patients suffering from phobias. In one of the programs called FearFighter, patients are taught to recognize the signs that trigger their panic attacks in order to prevent future attacks and they are also taught how to deal with their fears. People living with phobias are not the only ones encouraged to use FearFighter. Individuals with obsessive compulsive disorder, post traumatic stress disorder, depression and sleep disorder are all urged to use the program as well. Another clinically proven computer program, Beating the Blues, is also being recommended to combat anxiety and depression.

Both the National Institute for Health and Clinical Excellence (NICE) and the Department of Health in the United Kingdom have previously published reviews that offer guidance to using computerized cognitive behavior therapy programs. These reviews proved that the computerized programs were not recommended to treat such a wide range of disorders. For example, when it came to obsessive compulsive disorder, NICE was unable to recommend any computerized program for treatment. When it came to depression, Beating the Blues was only recommended for mild and moderate depression, and not severe depression. Therefore, not everyone will be able to benefit from these computerized programs. Furthermore, recommending a computerized cognitive behavior therapy program to a depressed patient may not be so beneficial because they may actually need to be prescribed medication and only a certified practitioner can do that. Depressed patients may in fact benefit more from interacting with a therapist than from interacting with a computer screen because an interpersonal relationship is formed. The therapists can also be more beneficial in letting their patient know that social support is seen to be essential in dealing with emotional pain.

By relying solely on the computerized CBT, patients suffering from phobias may also be missing out on other successful treatments that occur specifically in therapists’ offices, such as systematic desensitization and exposure therapy. In systematic desensitization the patient is taught various relaxation skills and together with the therapist they develop a hierarchy of anxiety-provoking situations. Someone who is afraid of spiders, for example, might start off by looking at a picture of a spider (see image above) and they then go on to apply these relaxation techniques to this fear inducing situation. However, these are techniques that work better if conducted with the supervision of a therapist. In exposure therapy, the therapist helps the patient overcome their phobia by exposing them to the stimuli that actually frightens them. Sometimes exposure therapy might involve reliving a traumatic event in a controlled, therapeutic environment. Exposure therapy has helped many trauma victims overcome PTSD and this just goes to show how interaction with therapists may prove to be better than interactions with computers.

Computerized CBT programs undeniably work well to help individuals deal with their phobias and depression. In Britain, a few thousand people are estimated to have already been treated with the programs. However, CBT should not in any way be used to replace real therapy conducted with a therapist because patients may miss out on other valuable components of therapy.

Monday, October 1, 2007

The Gap of Happiness: Exploring Whether Men are Happier than Women

Abraham Lincoln once said, “Most folks are about as happy as they make up their minds to be.” Helen Keller believed “happiness is not attained through self-gratification but through fidelity to a worthy purpose.” And according to George Burns “happiness is having a large, loving, caring, close-knit family in another city.” These are just a few examples of the many ways in which individuals have come to define the concept of happiness. If, however, people view happiness in distinct ways, how can researchers come to accurately measure it? The New York Times recently published an interesting article that examines studies conducted on gender and happiness levels. The article, written by David Leonhardt, looks at two unpublished studies that have concluded that men are slightly happier than women. The first study, by Betsy Stevenson and Justin Wolfers, proposes that the decrease in women’s happiness may be due to life improvements they have acquired since the 1970s. Noted in the second study, by Alan Krueger, is the gradual downward trend in the proportion of time men spend on unpleasant activities. Although the findings of these two new studies could help us to better understand the subjective well-being of individuals, the concept of happiness will continue being a stochastic phenomenon, one incapable of being accurately and consistently measured over time.

To begin with, it seems that both studies did an excellent job exploring possible cultural reasons as to why women may at times be less happy than men. One study emphasized the fact that women have obtained access to many more opportunities that were not available to them before, while the other examines the activities that men might find pleasant to partake in but women fail to enjoy. These are important factors to examine because happiness does change from situation to situation. Nevertheless, how one feels at the moment and how one feels on average over time may primarily be a matter of chance and not a matter of statistical significance. This is in fact what one study from the University of Minnesota concluded back in 1996. Therefore, it can be argued that more men may have reported feeling happier than women by chance. John M. Grohol, CEO and publisher of Psych Central, was able to do his own analysis on the raw data from the Stevenson and Wolfer study and asserted that women are becoming more “pretty happy” and less “very happy.” He also found that the “not happy” category remained unchanged (see image to right). In his blog, Grohol assures readers that he is not sure he would read that much into the data, certainly not as much as the authors did.

If we were to look at the findings of these studies from the Biopsychosocial Model perspective, we would note that change in individual’s happiness may be caused by many factors. This model works to explain human behavior by taking into consideration biological, cognitive-affective, social interpersonal, social institutional and cultural factors. Thus, simply stating that because women have faced more life improvements they are less happy is not sufficient evidence. Culture alone has a strong impact on our happiness. Jeremy Dean, a freelance writer and creator of PsyBlog, considers the power of culture and argues that the New York Times article “is not only claiming to describe a happiness gap between the sexes, it is also creating it.” Mental health issues related to women such as depression, postpartum depression and eating disorders may also be at fault for lower levels of happiness.

Finally, the assertion made by the Stevenson and Wolfer study declaring that the decreased happiness in women is ubiquitous across the old and young, employed and unemployed, married and divorced, seems to be a jump to conclusions. This would undoubtedly challenge the studies that have come out in previous years stating that recently divorced women feel liberated and happier. And although the study claims to be ubiquitous, it also states that the phenomenon does not occur across racial groups. For example, African American women have become happier just as much as African American men have. The study also points out that women’s subjective well-being “may be driven simply by a change in how [they] answer the question, i.e. a measurement, rather, than a hedonic trend.” These speculations, therefore, do not support the claim that women are in fact less happy than men.

Ubiquitous or not, happiness continues to be a complicated state of being to measure. Many factors influence it and the way happiness is experienced varies from individual to individual. Although studies such as the one conducted by Krueger or Stevenson and Wolfer provide some insight as to how gender differences in society explain happiness levels, their findings fail to provide external validity. Typically at the end of psychology articles, the authors of the study present ideas for possible future research that may offer more validity to their claims. In this case, however, given the complexity of the measuring happiness between genders I believe that further research might not contribute much to what is already known.

Monday, September 24, 2007

Adverse Drug Events Increase: Do the Benefits Outweigh the Risks?

Imagine someone being prescribed a drug that was approved by the FDA and their doctor. They would hope that the drug would alleviate their illness in some form or fashion. However, contrary to what we may expect, certain prescription drugs may cause adverse events, such as hospitalization or even death. What is worse is that warning of these adverse events may not even be included with the prescription. One study recently concluded that there has been an increase in the number of reported deaths and injuries associated with drug therapy. As I researched this topic more I discovered two quite insightful blogs challenging the key findings of this study. The first post I examined was from Furious Seasons, written by Philip Dawdy, a skeptical journalist suffering from bipolar disorder. This post lays the blame on the FDA, doctors and the media for not doing anything to bring more light to the issue of adverse drug events. The second post comes from a blog titled Clinical Psychology and Psychiatry: a Closer Look. Here, the author, “an academic with a respectable amount of clinical experience,” explores how clinical trials do a poor job of reporting drug safety outcomes. My comments to both these blogs, which can be found below and by following the links above, mainly focus on how some people may negatively react as a result of this increase in reported adverse drug events.

“Worse Than Vioxx: Zyprexa, Risperdal, Clozaril, And Paxil Killed Thousands of Americans” comment:
I agree with a lot of what you had to say on this topic. The media should really step it up and bring more light to such issues on reported adverse events. This, in turn, would increase public awareness. However, I could not help but wonder if more media coverage on these drug related deaths would ultimately lead patients to experience feelings of betrayal and mistrust toward their health care providers. In other words, patients being handed prescriptions will no longer trust the doctors issuing them. This might even cause them to avoid seeking treatment for their illness or deny drug therapy altogether. It hurt me most to hear that “Risperdal, a drug associated with over 1,000 deaths, is used in children--and the FDA approved its use”. How can drugs such as this one (see image above), used to treat schizophrenia, continue to be prescribed? It might be true that this drug has helped many. But, the FDA has to ask itself the pressing question: do the benefits outweigh the serious risks. I believe that risks such as death and disability outweigh the benefits. More research needs to be conducted on these drugs, in order to properly label all the side effects and to determine whether it is best to simply take the drugs off the market as was the case with Vioxx.

“The Drug Safety Blindfold” comment:
When I first read this study, one of the things that immediately caught my attention was the limitation that states that the submission of an adverse event does not establish causality. An adverse drug event could be reported by anyone who felt that there was a relationship between their drug and their adverse event. Right away this signaled to me that more research is needed to be sure that these adverse events are in fact being caused by the prescription drugs. I quickly visited the FDA MedWatch website and noticed how easy it was to submit a report. The reporting system should be altered, so that opinions from second sources such as health care providers can confirm suspected relationship with the drug. I agreed with Furious Seasons’ post that the media and the FDA need to further inform the public about the serious risks their prescription drugs may elicit, but I also feel that it is essential that more research be conducted first. Bringing too much attention to these pre-mature findings could lead many people to feel trepidation when taking their drugs or may lead them to report more and more serious injuries that may not even be related to the drug effects.

Monday, September 17, 2007

Labeled and Misunderstood: A Look at the Increase of Bipolar Disorder in Youth

The Children and Adolescent Bipolar Foundation (CABF) is calling it a national wake-up call. But could an issue related to bipolar disorder really demand the attention of the nation? A study that was published at the beginning of the month by the Archives of General Psychiatry stated that there has been a dramatic increase in the number of children and adolescents being diagnosed with bipolar disorder. The disorder, also known as manic-depressive illness, may include symptoms like extreme mood changes, irritability, poor sleep, risky behavior and distractibility. Speculation among various news sources is rampant regarding the cause of the increase. However, in a Columbia University Medical Center press release, Dr. Mark Olfson, one of the doctors involved in the study, stated that “these trends likely reflect a recent tendency to over diagnose bipolar disorder in young people, a correction of historical under recognition, or a combination of both trends.” Undoubtedly, more research needs to be conducted in order to be sure that bipolar disorder is being diagnosed accurately because dismissing this issue of diagnostic uncertainty would only end up negatively affecting the youth of tomorrow.

Susan Resko, M.M., Executive Director of CABF, agrees that more research is imperative. She claims that today “children are being diagnosed and treated when they were previously dismissed as 'bad seeds' or the product of poor parenting." The truth is that over diagnoses leads us to wonder if doctors are misdiagnosing a lot of children and clumping them under labels. Bipolar disorder shares a great deal of resemblance with other illnesses such as schizophrenia and ADHD. During a lecture given by Dr. Terence Ketter, Chief of the Bipolar Disorders Clinic at the Stanford University School of Medicine, the similarities and differences between schizophrenia and bipolar disorder were the focus topic. For example, the two disorders share abnormalities in some of the same neurotransmitter systems. ADHD and bipolar disorder are also said to share many characteristics such as impulsivity, inattention, and hyperactivity. The study itself confirms that “symptomatic overlap between ADHD and pediatric bipolar disorder may be an important source of diagnostic uncertainty.” Considered like a bible to professionals who diagnose psychiatric disorders, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) works against misdiagnoses. Unfortunately, not everyone will perfectly fit under the categories listed. Dr. Ketter suggests that we now consider a more dimensional approach to diagnosis, one aimed at treating the common symptoms and pathophysiology.

There is, however, light at the end of the tunnel. New research in genetics and brain development provide optimism for more accurately diagnosing bipolar in the future. According to the Lundbeck Institute genetic linkage studies have shown that specific regions on certain chromosomes may be associated with a family history of bipolar disorder. As seen to the image on the right, the orange areas on chromosomes 4, 12, 16, 21, and X are believed to be linked to bipolar disorder. If researchers continue to discover these genetic linkages, doctors in the future will be able to diagnose the disorder more accurately and early. Children and adolescents would benefit greatly from early diagnoses because they would be able to get the treatment they deserve. Scientists studying the brain from the University of California at Los Angeles and The National Institute of Mental Health (NIMH) also have produced groundbreaking research on the brain development of bipolar youth. A recent article published on NIMH’s website shows a time lapse of composite MRA brain scans belonging to youth, ages 7-22, as they develop symptoms of mania and depression. The video shows a complicated pattern of gray matter gain in the left hemisphere and gray matter loss in the right hemisphere and mid-front part of the brain. Scientist Nitin Gogtay, M.D. states that their findings should put an end to speculation that onset schizophrenia and bipolar disorder stem from the same underlying illness. Continued research in both genetics and brain development should help establish a clearer distinction between disorders that resemble bipolar disorder.

Based on the study, we could expect to see the number of youths being diagnosed with bipolar disorder to continue rising; it probably has risen more since 2003. However, the numbers should eventually plateau or increase less over longer periods of time. A continued increase would definitely be a red flag signaling over diagnoses. Thanks to researchers though, who are continuing to seek answers on distinguishing the genetic and mental cause of bipolar disorder, new measures will surely emerge leading to better diagnosis of the disorder in children and adolescents.
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