Providing Insights for Better Mental Health

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Stress Sucks but You Can Fight Back

on Saturday, 15 June 2013. Posted in General

How it kicks you in the ass and how you can boot it back

Stress Sucks but You Can Fight Back

Getting an In-Depth Look at Depression

on Saturday, 15 June 2013. Posted in General

The mental health screening site Help Yourself Help Others provides this infographic showing that 17-20 million Americans develop depression each year. Common symptons and an explanation of the different forms of depression are listed below

Getting an In-Depth Look at Depression

Awesome Bipolar Disorder Infographic!!

on Friday, 14 June 2013. Posted in General

Created by Deyanara Riddix of Nursingschoolhub.com - thanks!

Awesome Bipolar Disorder Infographic!!

What a great way to summarize bipolar disorder.

Great job Deyanara - all the way from West Bengal, India!

http://www.nursingschoolhub.com

http://www.nursingschoolhub.com/bipolar

 

6 Keys To Building Resilience

on Wednesday, 12 June 2013. Posted in General

Resilience key to dealing with depression or bipolar disorder

6 Keys To Building Resilience

Tactics for building resiliance include:

1. Learn how to regulate your emotions

2. Adopt a positive but realistic outlook

3. Become physically fit

4. Accept challenges

5. Maintain a close and supportive social network

6. Observe and imitate resilient role models

Mood & Food

on Monday, 27 May 2013.

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

Mood & Food

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

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

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

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

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

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

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

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

bStable in NAMI North Carolina 2013 Spring Clippings Newsletter

on Saturday, 25 May 2013. Posted in General

McGraw Systems Proud to Support NAMI

bStable in NAMI North Carolina 2013 Spring Clippings Newsletter

bStable Presented to Alzheimer's Association!!

on Thursday, 09 May 2013. Posted in General

bStable Presented to the Western North Carolina Alzheimer's Association Chapter's Caregiver Education Forum

bStable Presented to Alzheimer's Association!!

Parents With Bipolar Disorder - WAKE UP!

on Saturday, 27 April 2013. Posted in General

IF THERE IS ONE TOPIC AROUND BIPOLAR DISORDER THAT PISSES ME OFF MORE THAN ANYTHING, IT IS THIS!

Parents With Bipolar Disorder - WAKE UP!

PARENTS WHO SHOVE THEIR HEAD IN THE SAND AND NEVER ADMIT THEY ARE SICK AND SPEND THEIR LIFE TALKING ABOUT HOW THEIR CHILD IS SICK INSTEAD OF TAKING RESPONSIBILITY FOR THEIR OWN ILLNESS NEED TO BE PUT AWAY.

LOOK AT THE FACTS IN THIS ARTICLE. BIPOLAR DISORDER HAS A STRONG GENETIC FACTOR. ADD ABUSE ONTOP OF THAT FROM A PARENT THAT WON'T ADMIT THEY HAVE BIPOLAR DISORDER AND PHYSICALLY AND EMOTIONALLY ABUSES A CHILD ON A DAILY BASIS - THAT IS SICK.

 

Psychiatric Times. CHILD AND ADOLESCENT PSYCHIATRY

Offspring of Parents With Bipolar Disorder

By Karen Dineen Wagner, MD, PhD | February 8, 2010

Dr Wagner is the Marie B. Gale Centennial Professor and vice chair of the department of psychiatry and behavioral sciences and director of child and adolescent psychiatry at the University of Texas Medical Branch at Galveston.

It is generally held that the offspring of parents with bipolar disorder (BD) are at risk for BD. The degree of risk is an important question for both clinicians and parents. A

recent study of bipolar offspring by Birmaher and colleagues1 sheds light on this issue.

These authors compared the lifetime prevalence of bipolar and other psychiatric disorders in children whose parents had–or did not have–BD. The study involved 233 parents with BD and their 388 offspring and a control group of 143 parents without BD and their 251 offspring.

Parents with BD were recruited from outpatient clinics and advertisements for participation in the study. On the basis of diagnostic interviews, 158 parents had bipolar I disorder and 75 had bipolar II disorder. The majority (80%) of the parents interviewed were female. The mean age of parents with BD was 40 years. Sixty-four percent of parents reported that the onset of their mood disorder occurred before they

were 20 years old. Parents with BD were less likely to be married at the time of intake and had a slightly lower socioeconomic status than parents without BD.

The offspring of parents with BD did not have to be symptomatic to participate in the study. The mean age of these children was 12 years; 49% were female; and 88% were white. Fewer than half (42%) were living with both biological parents.

The rate of bipolar spectrum disorder in the offspring of parents with BD was 10.6% versus 0.8% in the offspring of control parents. The rate of bipolar I disorder was 2.1%; bipolar II disorder, 1.3%; and bipolar not otherwise specified (NOS), 7.2%. The rate of BD increased substantially–to 29%–when both parents had BD.

Overall, the offspring of parents with BD were at significantly greater risk (52%) for any Axis I disorder than those in the control group (29%).

The majority (76%) of these offspring experienced childhood-onset bipolar disorder before age 12 years. Bipolar NOS was the most common first episode of illness. Rates of comorbidity in these youths were high: 51% had anxiety disorder, 53% had disruptive behavior disorder, and 39% had attention-deficit/hyperactivity disorder (ADHD).

http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1490412

1

Psychiatric Times. Vol. No. February 8, 2010Psychiatric Times. Vol. No. February 8, 2010

The authors concluded that there is a 14-fold increase in the rate of bipolar spectrum disorder in youths who have a biological parent with BD. If both parents have BD, then the offspring are 3 times more likely to have BD.

The mean age of youths in this study was 12 years. Prevalence rates may therefore be an underestimate because some children with depression may become bipolar in adolescence. It is recommended that clinicians who treat adults with BD inquire about the functioning of their children to provide appropriate early intervention.

Posttraumatic stress disorder and substance abuse

In a family study of BD in youths, Steinbuchel and colleagues2 investigated the relationships among adolescent BD, posttraumatic stress disorder (PTSD), and substance use disorder (SUD). Because adults with BD who were severely abused as children are at high risk for SUD, these investigators sought to determine whether there is a similar association in adolescents.

A total of 105 adolescent offspring of parents with BD and a control group of 98 youths without mood disorders participated in this study. The diagnosis of BD was based on structured psychiatric interviews. SUDs included any alcohol(Drug information on alcohol) or drug abuse or dependence.

Rates of PTSD were significantly higher in adolescents with BD than in the control group. Sixteen percent of youths with BD had full or subthreshold PTSD compared with 3% in the control group. These youths had experienced trauma in the form of physical abuse, sexual abuse, witnessing of death, or family violence. Rates of SUDs were higher among youths with BD than in those in the control group (32% vs 4%, respectively). Alcohol was the most frequently used substance (86%) followed by marijuana (71%) and tobacco (29%).

What was the temporal order of these disorders? In half of the cases, BD preceded PTSD. In the other half of cases, PTSD was diagnosed before BD. For those youths in whom SUD developed, the majority had BD followed by PTSD and then SUD.

This study confirms an association between PTSD in adolescents with BD and subsequent development of SUD. Rates of SUD were higher in those youths who met full criteria for PTSD than for those with subthreshold symptoms. The findings reveal that BD increases the risk for PTSD, which in turn increases the risk for SUDs. The investigators suggest that treatment of adolescents with BD may prevent trauma related to the development of PTSD and subsequent SUD. It is recommended that clinicians who treat adolescents with BD evaluate for the presence of PTSD and SUD.

References

1. Birmaher B, Axelson D, Monk K, et al. Lifetime psychiatric disorders in school-aged offspring of parents with bipolar disorder: the Pittsburgh Bipolar Offspring study. Arch Gen Psychiatry. 2009;66:287-296.

2. Steinbuchel PH, Wilens TE, Adamson JJ, Sgambati S. Posttraumatic stress disorder and substance use disorder in adolescent bipolar disorder. Bipolar Disord. 2009;11:198-204.

 

 

Overdiagnosis: Examine the Assumptions, Anticipate New Bipolar Criteria

on Saturday, 20 April 2013. Posted in General

Bipolar Disorder

Overdiagnosis: Examine the Assumptions, Anticipate New Bipolar Criteria
By James Phelps, MD | March 13, 2013
 
Dr Phelps is Director of the Mood Disorders Program at Samaritan Mental Health in Corvallis, Ore. His Web site gathers no information on visitors and produces no income for him or others. He is the author of Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder (New York: McGraw-Hill; 2006), from which he receives royalties. He stopped taking honoraria from pharmaceutical companies in 2008.
 
Overdiagnosis of bipolar disorder is an increasing concern, particularly since the widely cited study by Zimmerman and colleagues.1 Findings from that study indicate that there is a problem with overdiagnosis (positive predictive value of only 43%) as well as with the much less publicized parallel finding of 30% underdiagnosis (sensitivity of 70%).

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

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

Consider the implicit assumptions.

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

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

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

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

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

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

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

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

Risks of overdiagnosis

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

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

Effects of Pharmacokinetic and Pharmacodynamic Changes in the Elderly

on Saturday, 20 April 2013. Posted in General

PK & PD Changes

Effects of Pharmacokinetic and Pharmacodynamic Changes in the Elderly

This interesting article explains and demonstrates the need for monitoring and altering psychotropic medications and dosages in older patients.

http://www.psychiatrictimes.com/display/article/10168/2123794?pageNumber=1

Resources on dementia for health care providers and caregivers

on Saturday, 20 April 2013. Posted in General

Some great resources to supplement the use of bStable for dementia monitoring

Resources on dementia for health care providers and caregivers

Books

Mace NL, Rabins PV. The 36-Hour Day: A Family Guide to Caring for Persons With Alzheimer’s Disease, Related Dementia Illness, and Memory Loss in Later Life.Baltimore: Johns Hopkins University Press; 1999

Mayo Clinic Guide to Alzheimer’s Disease: The Essential Resource for Treatment, Coping, and Caregiving. MayoClinic.com bookstore; 2006.

Rabins PV, Lyketsos CG, Steele CD. Practical Dementia Care. New York: Oxford University Press; 1999.

Warner M, Warner E, Warner ML. The Complete Guide to Alzheimer’s-Proofing Your Home. West Lafayette, IN: Purdue University Press; 2000.

Radin L, Radin G. What If It’s Not Alzheimer’s? A Caregiver’s Guide to Dementia. Amherst, NY: Prometheus Books; 2008.


Web Sites – Disease-Related

NINDS—Dementia: Hope Through Research http://www.ninds.nih.gov/disorders/dementias/detail_dementia.htm

AlzGene—Database of genetic association studies on Alzheimer disease http://www.alzgene.org

National Mental Health Association—Multi-Infarct Dementia http://www1.nmha.org/infoctr/factsheets/102.cfm

NINDS—Multi-Infarct Dementia http://www.ninds.nih.gov/disorders/multi_infarct_dementia/multi_infarct_dementia.htm

NINDS—Dementia With Lewy Bodies http://www.ninds.nih.gov/disorders/dementiawithlewybodies/dementiawithlewybodies.htm

NINDS—Frontotemporal Dementia http://www.ninds.nih.gov/disorders/picks/picks.htm

NINDS—Parkinson’s Disease http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm

NINDS—Huntington Disease http://www.ninds.nih.gov/disorders/huntington/huntington.htm

NIH Senior Health—Parkinson’s Disease http://nihseniorhealth.gov/parkinsonsdisease/toc.html


Web Sites – Practice Guidelines

American Psychiatric Association—Practice Guideline for the Treatment of Patient’s With Alzheimer’s Disease and Other Dementias http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007

American Association for Geriatric Psychiatry—Position Statements http://www.aagponline.org/prof/positions.asp

AMA—Physician’s Guide to Assessing and Counseling Older Adult Drivers http://www.ama-assn.org/ama/pub/category/10791.html

American Academy of Neurology—Guideline Summary for Clinicians – Detection, Diagnosis, and Management of Dementia http://www.aan.com/professionals/practice/pdfs/dementia_guideline.pdf

American Academy of Neurology—Dementia Encounter Kit http://www.aan.com/go/practice/quality/dementia

American Geriatrics Society—Clinical Practice Guidelines – Dementia http://www.americangeriatrics.org/products/positionpapers/aan_dementia.shtml


Web Sites – Associations

Alzheimer’s Association http://www.alz.org

Lewy Body Dementia Association http://www.lbda.org

The Association for Frontotemporal Dementias http://www.ftd-picks.org

American Parkinson Disease Association http://www.apdaparkinson.org

Huntington’s Disease Society of America http://www.hdsa.org


Web Sites – Family and Caregiver Support

NIH Senior Health—Caring for Someone With Alzheimer’s http://nihseniorhealth.gov/alzheimerscare/toc.html

Alzheimer’s Disease Education and Referral Center http://www.nia.nih.gov/Alzheimers

Family Caregiver Alliance http://www.caregiver.org

Eldercare http://www.eldercare.gov

MedicAlert and Safe Return http://www.alz.org/we_can_help_medicalert_safereturn.asp


NINDS, National Institute of Neurological Disorders and Stroke.

7. American Psychiatric Association, Work Group on Alzheimer’s Disease and Other Dementias. Practice Guideline for the Treatment of Patients With Alzheimer’s Disease and Other Dementias. 2nd ed. Washington, DC: American Psychiatric Association; 2007. http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007. Accessed December 25, 2009.

Weight Loss Is Possible & Serious Mental Illness

on Saturday, 20 April 2013.

Losing weight is hard enough!

Weight Loss Is Possible & Serious Mental Illness

A study published in the New England Journal of Medicine reports that a behavioral weight-loss program significantly reduced weight in overweight and obese adults with serious mental illness. Daumit and colleagues1 emphasized the importance of such an investigation, noting, “Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population.”
The study employed an intervention program that modified diet and activity tailored to persons with serious mental illness and concluded participants were able to lose weight. This is significant because medication adverse effects of weight gain and increased appetite, together with non-adherence found in some persons with schizophrenia, bipolar disorder, and other serious mental illnesses, are challenges clinicians and their patients often face.2

References 1. Daumit GL, Dickerson FB, Wang NY, et al. A behavioral  weight-loss intervention in persons with serious mental illness. N Engl J  Med. 2013 Mar 21. [Epub ahead of print] 2.  Lieberman JA, Stroup TS, McEvoy JP, et al. Clinical antipsychotic trials of  intervention effectiveness (CATIE). Effectiveness of antipsychotic drugs in  patients with chronic schizophrenia. N Engl J Med.. 2005;353:1209-1223.

For particulars on study design and research methods, please see the abstract at http://www.ncbi.nlm.nih.gov/pubmed/23517118.

Confidentiality and the Family: 5 Guidelines for Better Outcomes

on Saturday, 20 April 2013. Posted in General

We've always promoted bStable's use with loved ones, patients and providers to provide a 360 degree loop

Confidentiality and the Family: 5 Guidelines for Better Outcomes

By Michael Ascher, MD, Justine Wittenauer, MD, Alison Heru, MD, and Ellen Berman, MD |April 11, 2013

 
Dr Ascher is MD a fourth-year Resident in the department of psychiatry and behavioral sciences at Beth Israel Medical Center, New York. Dr Wittenauer is a third-year Resident in the department of psychiatry and behavioral sciences at Emory University, Atlanta, Ga. Dr Heru is Associate Professor in the department of psychiatry at the University of Colorado, Denver. Dr Berman is Clinical Professor in the department of psychiatry at the University of Pennsylvania in Philadelphia.
 

Families  are an underutilized resource in psychiatric practice. Given the current practice of brief hospitalizations,  families are expected to provide more illness monitoring and in-home care. When  family members are included and welcomed as members of the treatment team,  patient care improves and the psychiatrist’s job is easier. Reaching out to  the families of patients can help psychiatrists generate clearer diagnostic  formulations, develop more effective treatment, and plan for emergencies.

What  should psychiatrists do when patients don’t give permission to contact their  families?

Many  psychiatrists erroneously believe that the sharing of information with others,  without the patient’s explicit consent, is prohibited by the Health Insurance  Portability and Accountability Act (HIPAA). HIPPA violations may have serious  consequences, so it is important to have a clear understanding of what the  HIPPA 45 CFR 164.510(b) rule entails as well as its intended use.1  The following information is extracted from the website of the US Department of  Health and Human Services and provides  guidance for health care providers. Here are some guidelines:

(1)  Health care information may be shared with relevant individuals present when  the patient has given prior approval, or simply does not object1

(2)  Asking a friend to be in the interview room provides the implicit right to  disclose information in their presence

(3)  Clinicians also have the authority within the Privacy Act to share information  based on their professional judgment, believing that there would be no  objection to its discussion. For example, a clinician may share information  about medication with those providing transportation from the hospital

(4)  If the patient is not present but has requested an individual to gather  information for him or her, or is incapacitated by an emergency, a physician  may once again use best judgment in sharing information. This may include a  proxy picking up of medications from the pharmacy or receiving other protected  information

(5)  Physicians should be aware of state laws within their region of practice that  may affect the use of the Privacy Act within scenarios of emergency or safety  concern

Using  these guidelines, family members (or friends) who accompany the patient can be  invited into the interview and the benefits of their inclusion explained. Most  evidence-based family interventions are psychoeducational, where illness  symptoms and treatments are explained and feelings and beliefs about the illness  are explored. When patients understand the goal of family intervention is  psychoeducational, they are more likely to agree.

Family  involvement is often misunderstood as being a hindrance to individuation, when  in fact family-oriented interventions can improve patient functioning, agency,  and autonomy. This is often the case when young adults are forced, because of  illness, to return home to live with their parents. The use of shared  decision-making may help the patients frame their long-term goals in line with  the goals of the family.2

Psychiatrists  can help the patient prepare for the family meeting. With a clear agenda, the  patient will be less anxious and be more accepting of family members working  with them. Psychiatrists can proceed, using one of the most underutilized  evidence-based interventions in psychiatry—family psychoeducation.

References 1. US  Department of Health and Human Services. Does the HIPAA Privacy Rule permit a  doctor to discuss a patient’s health status, treatment, or payment arrangements  with the patient’s family and friends? http://www.hhs.gov/hipaafaq/notice/488.html. Accessed  April 8, 2013. 2. Swindell JS,  McGuire AL, Halpern SD. Beneficent persuasion: pechniques and ethical  guidelines to improve patients’ decisions. Ann Fam Med. 2010;8:260–264.

Study: Dementia tops cancer, heart disease in cost

on Saturday, 20 April 2013. Posted in General

bStable for Alzheimer's To Be Released Soon!

Study: Dementia tops cancer, heart disease in cost

We have decided to release a version of bStable for Alzheimer's. Our new webpage for the bStable Alzheimer's offering will be available off our homepage soon!! 

From the AP on Fox News:

The biggest cost of Alzheimer's and other types of dementia isn't drugs or  other medical treatments, but the care that's needed just to get mentally  impaired people through daily life, the nonprofit RAND Corp.'s study found.

It also gives what experts say is the most reliable estimate for how many  Americans have dementia - around 4.1 million. That's less than the widely cited  5.2 million estimate from the Alzheimer's Association, which comes from a study  that included people with less severe impairment.

"The bottom line here is the same: Dementia is among the most costly diseases  to society, and we need to address this if we're going to come to terms with the  cost to the Medicare and Medicaid system," said Matthew Baumgart, senior  director of public policy at the Alzheimer's Association.

Dementia's direct costs, from medicines to nursing homes, are $109 billion a  year in 2010 dollars, the new RAND report found. That compares to $102 billion  for heart disease and $77 billion for cancer. Informal care by family members  and others pushes dementia's total even higher, depending on how that care and  lost wages are valued.

"The informal care costs are substantially higher for dementia than for  cancer or heart conditions," said Michael Hurd, a RAND economist who led the  study. It was sponsored by the government's National Institute on Aging and will  be published in Thursday's New England Journal of Medicine.

Alzheimer's is the most common form of dementia and the sixth leading cause  of death in the United States. Dementia also can result from a stroke or other  diseases. It is rapidly growing in prevalence as the population ages. Current  treatments only temporarily ease symptoms and don't slow the disease. Patients  live four to eight years on average after an Alzheimer's diagnosis, but some  live 20 years. By age 80, about 75 percent of people with Alzheimer's will be in  a nursing home compared with only 4 percent of the general population, the  Alzheimer's group says.

"Most people have understood the enormous toll in terms of human suffering  and cost," but the new comparisons to heart disease and cancer may surprise  some, said Dr. Richard Hodes, director of the Institute on Aging.

"Alzheimer's disease has a burden that exceeds many of these other  illnesses," especially because of how long people live with it and need care, he  said.

For the new study, researchers started with about 11,000 people in a  long-running government health survey of a nationally representative sample of  the population. They gave 856 of these people extensive tests to determine how  many had dementia, and projected that to the larger group to determine a  prevalence rate - nearly 15 percent of people over age 70.

Using Medicare and other records, they tallied the cost of purchased care -  nursing homes, medicines, other treatments - including out-of-pocket expenses  for dementia in 2010. Next, they subtracted spending for other health conditions  such as high blood pressure, diabetes or depression so they could isolate the  true cost of dementia alone.

"This is an important difference" from other studies that could not determine  how much health care cost was attributable just to dementia, said Dr. Kenneth  Langa, a University of Michigan researcher who helped lead the work.

Even with that adjustment, dementia topped heart disease and cancer in cost,  according to data on spending for those conditions from the federal Agency for  Healthcare Research and Quality.

Finally, researchers factored in unpaid care using two different ways to  estimate its value - foregone wages for caregivers and what the care would have  cost if bought from a provider such as a home health aide. That gave a total  annual cost of $41,000 to $56,000 per year for each dementia case, depending on  which valuation method was used.

"They did a very careful job," and the new estimate that dementia affects  about 4.1 million Americans seems the most solidly based than any before, Hodes  said. The government doesn't have an official estimate but more recently has  been saying "up to 5 million" cases, he said.

The most worrisome part of the report is the trend it portends, with an aging  population and fewer younger people "able to take on the informal caregiving  role," Hodes said. "The best hope to change this apparent future is to find a  way to intervene" and prevent Alzheimer's or change its course once it develops,  he said.

Read more:  http://www.foxnews.com/health/2013/04/04/study-dementia-tops-cancer-heart-disease-in-cost/#ixzz2QxmmUuJH

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

on Sunday, 24 February 2013.

McGraw Systems Proud To Support This Important Event

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

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

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

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

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

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