Dr. D’s Blog

Thank you for visiting me at Dr. D’s Blog. Here I will be responding to your most frequently asked questions and comments. I am unable to answer individually e-mailed questions. All submissions mailed are the property of Mindsupport, LLC and can edited for length and clarity.

I hope my blog will be a forum for my readers to address their ideas and concerns about a wide range of issues related to mental health issues.

Dr. D’s Blog does not render medical advice. Readers should make their treatment decisions based upon the advice of their own physicians. This information is to be used as a reference only and should not replace or be considered a substitute for the advice rendered by your health provider. You should discuss any conflicts with your own physician and should rely on the advice of your physician.

Please sign up for my blog using the field above to make sure you are the first to know about my latest posting, which will occur periodically. As a psychiatrist, I am on the front lines of mental health issues.

I am back on my blog! My personal home computer was infected with a “malicious virus” which took control of its operating system. During this period, having access to other computers did not allow for the same creative experience. The reality of being so vulnerable to the internet was eye opening. During my weeks “off line,” my usual rituals of blog writing and internet surfing in my home office were brought to an abrupt halt. It seemed ironic that I had just penned an Op-Ed article about my opposition to the electronic health record due to its unresolved problems which include security breaches. Express Scripts, the mail order company, just revealed that it has been blackmailed for their millions of patient records. If Fortune 500 companies with dedicated technology departments have ongoing security issues, what does that mean for the average physician’s office?

I am a psychiatrist. In my world, there is no difference between having your blood pressure values online and having documentation of your innermost secrets. Recorded high blood pressure readings can create potential damage by barring you from reasonably priced health, long term, and disability insurance. One “send” button intercepted from a doctor’s office by viral spyware can place your personal information in a danger zone. I was made painfully aware that the latest antivirus software in limited in its abilities. Hackers create viral codes for the “thrill of it” on a daily basis.

Meanwhile, President Bush has created a legislative agenda which would require all medical records to be electronic as of 2014. This will require all patients to be plugged into a computer data base. The technology titans of Y2K have successfully lobbied Congress and convinced them that electronic records will make the health system more efficient. Huge profits in medical health records are on the horizon for that industry. However, we have not solved the problem of identity theft on the internet.

I have no answers to the problem of security for your health records. My recent infection with a “malicious virus” reminded me of the complexity of the privacy issue. Everyone knows that security breaches increase with files being sent and downloaded to third parties via cyberspace. Unbeknown to most, the Express Scripts extortion letter of October 2008 has the names, birth dates, social security numbers, and prescription information of 75 patients. The company is being blackmailed to either pay the money or have their files with millions of items of patient information revealed. The electronic health record is more complicated than just cost saving and having easy access to your medical information online. Get informed!

Related links

http://www.privacyrights.org/ar/ChronDataBreaches.html
www.usa.gov/contact/Elected.shtml

My recent experience of crossing the George Washington Bridge into New York City was a gentle reminder of potential turmoil in daily life for my patients. My thousands of psychiatric interviews were crystallized in the ninety minutes it took me to negotiate what is usually a ten minute ride. Life happens! My arrival in NYC did not allow for the Yankees playing their last game in the old stadium located two exits off of that bridge. Traffic was backed up for miles and here I was, trapped under the hot sun, on the upper level, concerned about a scheduled appointment. My fellow commuters were also impatient with the sudden highway transformation to a bumper car city.

Being a psychiatrist, I wondered how my patients with active illness would respond in this environment. Unchecked illness can easily facilitate mood swings and bouts of anger. Life is unpredictable. Who would have considered the consequences of the Yankee game? It became apparent to me that while being trapped on this bridge, an episode of road rage could easily be triggered in a patient with active illness. The outcome could be a disaster.

This event underscored the importance of tight control of mood states. Life events can trigger out of control emotions. Someone who does not have sensitivities can readily keep unpleasant and unpredictable events in check. Clearly, that bridge experience was frustrating for me. In someone with active symptoms of illness, that bridge had the potential to trigger a permanent nightmare with legal consequences.

The George Washington Bridge experience reinforces my patient philosophy of understanding your symptoms and triggers. If you are on psychiatric medications, you have to comprehend how they interact with the wide range of life stressors. A personal assessment of the range of symptom control with treatment is vital. The limits of medication treatment require an appreciation of what else might be needed for mood management. In the car, you may need to use a variety of stress management techniques. These may include deep breathing for relaxation, books on tape, calming music, and soothing aromatherapy scents. You may also need to employ therapy coping thoughts you have identified for use in anger management.

Sharing my experience is my gentle reminder about the impact of life stress on mental illness. If you are easily angered, how are you going to keep your symptoms in check in light of unpredictable life events?

Related Links

National Alliance on Mental Illness
www.nami.org

National Mental Health Association
www.nmha.org

Marijuana use among teenagers is a frequent topic of discussion with my baby boomer parents. Many recall their weed burning days as an innocent “rite of passage.” Frequently, parents who smoked pot in their hey day will minimize their children’s use as innocent and self-limited experimentation. Reports of finding marijuana plants in the closet, or a clandestine storage of pipes and other paraphernalia, tickles their memories. In addition, baby boomer parents’ familiarity with marijuana use provides an opportunity in which to finally understand their kids’ behavior versus being lost in the black hole of their technology.

When my patient discloses their kid’s marijuana use, my public service announcement is instantly triggered. I remind them that in 2008, marijuana is part of the diversified portfolio of the highly successful billion dollar illegal drug industry. The goal is to get their satisfied customers to buy all available illicit drug products. Many of my baby boomer patients are unaware of the CNN headline: “Marijuana Potency Reaches a 30 Year High in 2007” which appeared June 12, 2008. The report from the Mississippi Potency Monitoring Project, which tracts the psychoactive ingredient in marijuana (THC), announced that the level had reached 9.6 percent. This percentage represents a doubling of marijuana potency from under 4 percent in 1983.

What does this mean? I remind my patients that there are risk factors for mood disorders in their family. According to the report, marijuana use by their children increases the risk of triggering the child’s genetics by 40 percent. In psychiatry, we have known for years that marijuana use can be a form of self-medication. My patients smoke pot because it alters their mood state. Marijuana’s ability to increase symptoms of paranoia and to decrease motivation is also wel-lknown. Despite knowledge in the mental health community of its difficulties, marijuana is still viewed as an innocent recreational activity without problems.

The increased potency of the drug, especially when used by those with a genetic risk for mood disorders, has the potential for a catastrophic disaster. In my opinion, marijuana use, especially by those with genetic vulnerabilities for mood disorders, is a land mine waiting to explode. It is important for those who have risk factors for mental illness, or those who have a current illness, to carefully consider their choices. This blog is my public service announcement to you, your family, friends, and acquaintances.

Related Links:

www.nmha.org

Like many Americans, my eyes were captivated by the splendor and color of the Olympic Games’ opening night ceremonies. The design complexities viewed by the naked eye, and developed by merging man’s imagination with technology, are spectacular. Our technological advancements are wonderful, but in the process, we have devalued our own brainpower. As a psychiatrist, I can see parallels in my practice. A positive response with psychiatric medications is only one step along the road to wellness. My patients will also have to use their mental abilities to negotiate their roads to recovery.

What do I mean by such words? If the patient responds to the medication agents with symptom reduction, the challenging next step is evaluating triggers. In other words, which are the events, who are the people, and what are the modes of thinking that are present when symptoms relapse? These events may be situations involving conflict. Some individuals avoid conflict at all cost. If the conflict situation involves the family, whom they cannot avoid, these encounters often cause the return of their illness. Unfortunately, the ability to achieve this level of self-awareness requires a period of symptom change. Patients have to experience the absence or reduction of symptoms in order to recognize the events that trigger their return or increase.

It is easier to state that the medication is not working, rather than spend time to reflect on events. The medication is not an antidote for all of life’s stressful situations. Medication alone will not guarantee emotional wellness. All chronic illness management requires personal time and attention. If you have heart disease, your cardiologist will recommend lifestyle changes in order to achieve an optimum prognosis. The doctor will suggest looking at your life stressors and working on their resolution. It is well-known that stress triggers destructive hormones which are implicated in increasing heart rate and blood pressure. Cardiac rehabilitation recommendations will also include exercise and dietary changes. Almost all chronic medical illnesses will have a positive response to behavioral lifestyle changes.

Surprising to many, the brain is also an organ. Once it responds to medication for symptom reduction, additional attention is required. An optimum prognosis requires an understanding of symptom triggers. That can then allow for the development of coping mechanisms. Stress management techniques are highly beneficial. Generating physical activity programs and regular routines is also important. Many of my patients have poor diets. The brain needs protein, carbohydrates, and fats for good health. I have heard many patients complain of energy deficiencies, but their main meal of the day is dinner. They go throughout the day without breakfast or they drink soda and eat only snacks. Wellness, whether physical or emotional, requires work.

The Olympics was my gentle reminder that humans can still achieve seemingly impossible feats when the brain is focused. Many patients can achieve another level of wellness if their relationship with medication changes. A chronic illness responds best to the use of many tools in the toolbox, not just implementing one and then forgetting about it.

Many assume that mental illness is a rare problem. I was tickled when CNN announced that antidepressant treatment was the number one prescription in this country. The news came from the research findings of the Centers for Disease Control (CDC) in Atlanta, Georgia. It is the job of the CDC to track health care costs for planning, research, and other projects.

The bottom line is that medication treatment for depression surpasses medications for diabetes, heart disease, cholesterol problems, and arthritis. I read an editorial page which stated that two-thirds of the antidepressant medications in the world are prescribed to Americans. So what does that mean in my psychiatric world?

It is a myth that mental illness is rare. This may be because the stigma of mental illness remains. In addition, there is a perception that “this problem” does not occur in my family, much less to me. Nonetheless, behind the closed doors of the health professional, emotional issues are the most common presenting problem.

We have to thank the pharmaceutical ads for both adding to the cost of health care as well as adding to health awareness. On a daily basis, a patient will request a prescription for the sleep quality, happiness, and mood stability seen with the actors on the drug commercials. The ads clearly make my job more challenging since they present unrealistic expectations. However, it has sensitized Americans to possible treatments for their hurtful depressive symptoms and mood swings. The ads serve as a visual attack on the stigma of mental illness. This is great!

Sadly, in my opinion, more than half of the individuals on antidepressants do not need them. Psychiatrists do not write the bulk of prescriptions for mood complaints. If you go to a primary health care provider and you are upset and tearful about life, you will often leave with prescriptions. What can be expected with a ten minute office visit?

Bottom line, mental illness is a very common, equal opportunity disease. It effects all ages, socioeconomic classes, genders, and race.

Related Links

www.webmd.com, www.nami.org

Acceptance

Patients question me on a daily basis as to why they are the ones with an emotional illness. The answer is easy, why not? Everyone has some thing about themselves that they are unhappy about. It would be wonderful is we could discover the technique required to remove human illness. Until that time, the question becomes how do we best live with chronic and debilitating illnesses.

How do you accept events that are out of your control? My initial evaluation with patients documents symptoms of depression, uncontrolled anger/rage, mood swings, alcoholism and dysfunction in their family. Unfortunately, it takes a long time for many to recognize and accept their diagnosis. I have heard from patients years after our initial encounters to they inform me I was correct in my initial assessment. They could not hear me at that time. Meanwhile, they lost jobs and friends due to their untreated illness.

I realize that acceptance is very complicated. Many patients recognize and then quickly reject their symptoms because they are reminders of the behaviors of their dysfunctional parents and siblings. Others are aware of the stigma associated with emotional illness and immediately reject any possibility of such illness. Many seek advice but are really not ready to acknowledge the findings. The road to acceptance of illness is often tortuous and rocky.

We have made progress. In the 21st century, a diagnosis of depression or anxiety can be more easily accepted, but bipolar disorder and other illnesses still require a good deal of patient education. Direct consumer marketing about products from the pharmaceutcal companies has educated many about potential symptoms of mental illness. We still need more faces of treated individuals to “come out” and share their experiences.

I believe that acceptance of the illness starts the healing process. In other words, in order to address a problem, you have to acknowledge that it is an issue. In order to fix something, you have to figure out there is something to fix. Hopefully, in this 21st century, as more patients share their acknowledgement of illness with others, patients will be empowered by taking ownership. Much to the surprise of many, mental illness in America is not a rare condition.

Related Links

www.mayoclinic.com/health, www.nami.org

It seems obvious to me, as a psychiatrist, that insurance benefits should include all illnesses. Nonetheless, it is interesting to note the conflicting opinion that insurance “parity” will raise the cost of health care. It is true that in America there is a tremendous amount of confusion when differentiating between sadness and clinical depression. Sadness is a temporary emotional state that can be quickly remedied with distraction. Talking to a friend, shopping, and eating good dinners are activities that quickly elevate the mood of a sad individual.

Meanwhile, clinical depression travels with you and is not quickly relieved with a good time. Patients with active symptoms of depression often isolate themselves from others and have behaviors that are out of their control. Spontaneous crying for no apparent reason, concentration and focus challenges, appetite disturbance, and a short frustration tolerance are a few symptoms of illness that cannot be readily controlled by a depressed individual. In the midst of these unwanted symptoms, the person may be preoccupied with self-destructive thoughts or behaviors.

Our society is a quick fix culture and it is assumed that all negative states of mind should be quickly eliminated. In this environment, anti-depressant medications have become the most frequent medical treatment prescribed in the United States. This CNN heading, of July 7, 2007, surprised many since anti-depressant medications now outnumber treatments for cardiovascular diseases including high cholesterol, diabetes, arthritis, and other common illnesses. Unfortunately, this fact may reflect a very brief visit with a health professional where a prescription is quickly rendered.

I agree with those that suggest in this time of limited resources that a bout of sadness should not be treated in the same light as a bout of severe clinical depression. Our problem is both a lack of resources and enough highly trained experts able to make the correct diagnosis in our quick fix society, in which anyone with a brief training course can assume the role of a psychiatrist.

Related Links

www.nimh.nih.gov,www.nami.org

Blog – Spas for tweens

Getting dressed, watching a morning talk show, a segment on Spas for Tweens mesmerized me. Exclusive spa owners shared that twenty percent of their gross receivables came from preadolescent girls. Bikini waxes for six year olds, eyebrow prunings for ten year olds, seaweed facials for twelve year olds are all growing markets. Being a psychiatrist, not too much takes me by surprise. Nonetheless, being a mother of a twelve year old, I felt sad for these girls and their mothers.

In America, a youthful image is everything. Unfortunately, young girls are the victims in this dialogue. Early on, they are given powerful messages that their natural bodies are defective. They are told that waxes, creams, potions, and spa treatments will enhance and make them beautiful. It is one thing to play grown up by dressing up. Cute images of little girls trying on high heel shoes are universal. An occasional girlie day of manicures and pedicures, in other works mani-pedi, can be fun. It is another message, however, for a six year old to have her eyebrows waxed or a bikini wax of her groin.

One mother interviewed cited that her daughter noticed that Miley Cyrus of Hannah Montana fame had her eyebrows tweezed when she came on the scene. Subsequently, her tween daughter wanted to do the same. This mother felt it was never too soon to start personal grooming in a girl. I agree that basic rituals of teeth brushing, body cleansing and moisturizing, and underwear changing should be instilled early. Yet it seemed a bit much to remove facial hair and change skin texture before reaching your double-digit birthday.

Today, conferences on Eating Disorders highlight the importance of disease prevention. It is well-known that mothers with poor body image and abnormal food relationships have an increased risk of their daughters having the same issues. It becomes important for mothers to really take heed of their personal issues and the messages they send their daughters. This segment on teen spas on television was a gentle reminder that mental health professionals have a lot of work to do. So here is my blog on the subject; consider yourself informed.

Related Links

www.webmd.com, www.nimh.nih.gov/healthinformation/childmenu.cfm

I was really surprised by the availability of home testing for Bipolar Disorder. I felt again that individuals with mental illness are being exploited. Being a biology undergraduate major, I learned early in my career how the environment could influence chromosomal expression of genetic material. Since my Cornell days, those basic rules have been repeatedly supported in research studies and in my patient care. It is a fact, for example, that not all individuals who experience trauma will develop posttraumatic stress disorder. There is individualized protective genetic chromosome material that can prevent the expression of illness. Ones’ temperament is also a factor. Genetics is not easy to figure out.

So now we have a bipolar test on the market that has not been tested by the FDA. There is no scientific data about false positives, the accuracy of the test or its applications. So if you spend the $399 and buy the test, what does that mean for you? Most importantly, if you have a positive test result, what does that say about your mind? Does it mean that you have Bipolar Disorder? Do you go to your primary care physician and ask for a prescription of lithium? Do you quit your job and divorce your spouse because you have this incurable illness? Do you surrender your driver’s license and security clearance for your job? Do you now test your children when they have behavioral problems? Does this mean that all moody teenagers should be tested for Bipolar illness?

CNN recently informed the world that antidepressant medication is the most common medical treatment in America. I guess mood-stabilizing agents for Bipolar Disorder are the next wave of medicines. The combination of a test for mood swings and availability of medications should make Bipolar Disorder a household disease in America.

Perhaps the benefit of the test will be that it may successfully combat the stigma associated with mental illness. If all individuals with mood swings have positive tests, persons with designated mental illness will then be the majority population.

Related Links

www.nami.org, www.mayoclinic.com/health