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Child Mistreatment, Psychotropics, Sunshine Act, Dr. Peter Breggin

on Sunday, 17 February 2013. Posted in General

Child Mistreatment Certainly a Factor in Mental Illness, Meds Do Help, The Sunshine Act

Child Mistreatment, Psychotropics, Sunshine Act, Dr. Peter Breggin

I'm currently reading Toxic Psychiatry by Dr. Peter Breggin. Say what you want to say about him but one thing I can agree with him on is child mistreatment does play a major factor in why some develop mental illnesses. My humble opinion is there are genetic factors involved in mental illness as I've seen psychotropics help people diagnosed with various affective disorders. I think the key here is does the field of psychiatry really know what's going on? How a psychiatrist can only see a patient in the form of someone they throw meds at with little to no psychotherapy training is not very smart. Same goes with therapists and psychologists not factoring in psychotropics. Also, Dr. Breggin, I hope you take a holistic approach with patients and not just focus on talk therapy and why psychotropics are toxic.  

On a totally separate note, in reading more of Dr. Breggin's works, the thought crossed my mind that he must be very happy with the recent passage of the Physician Payments Sunshine Act which is a U.S. federal law stipulating that healthcare manufactures must aggregate and monitor total amount spent on individual healthcare professionals and organizations through payments, gifts, travel and other means to provide consumers with a transparent view into physician and industry interactions..       

Bipolar Disorder Medications

on Sunday, 03 February 2013.

Mood Stabilizer Sometimes with antipsychotics and antidepressants

Bipolar Disorder Medications

From the NIMH...

Mood stabilizers

People with bipolar disorder usually try mood stabilizers first. In general, people continue treatment with mood stabilizers for years. Lithium is a very effective mood stabilizer. It was the first mood stabilizer approved by the FDA in the 1970's for treating both manic and depressive episodes.

Anticonvulsant medications also are used as mood stabilizers. They were originally developed to treat seizures, but they were found to help control moods as well. One anticonvulsant commonly used as a mood stabilizer is valproic acid, also called divalproex sodium (Depakote). For some people, it may work better than lithium.6 Other anticonvulsants used as mood stabilizers are carbamazepine (Tegretol), lamotrigine (Lamictal) and oxcarbazepine (Trileptal).

Atypical antipsychotics

Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, antipsychotics are used along with other medications.

Antipsychotics used to treat people with bipolar disorder include:

  • Olanzapine (Zyprexa), which helps people with severe or psychotic depression, which often is accompanied by a break with reality, hallucinations, or delusions7
  • Aripiprazole (Abilify), which can be taken as a pill or as a shot
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)
  • Clozapine (Clorazil), which is often used for people who do not respond to lithium or anticonvulsants.8

Antidepressants

Antidepressants are sometimes used to treat symptoms of depression in bipolar disorder. Fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) are a few that are used. However, people with bipolar disorder should not take an antidepressant on its own. Doing so can cause the person to rapidly switch from depression to mania, which can be dangerous.9 To prevent this problem, doctors give patients a mood stabilizer or an antipsychotic along with an antidepressant.

Research on whether antidepressants help people with bipolar depression is mixed. An NIMH-funded study found that antidepressants were no more effective than a placebo to help treat depression in people with bipolar disorder. The people were taking mood stabilizers along with the antidepressants. You can find out more about this study, called STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder), here.10

What are the side effects?

Treatments for bipolar disorder have improved over the last 10 years. But everyone responds differently to medications. If you have any side effects, tell your doctor right away. He or she may change the dose or prescribe a different medication.

Different medications for treating bipolar disorder may cause different side effects. Some medications used for treating bipolar disorder have been linked to unique and serious symptoms, which are described below.

Lithium can cause several side effects, and some of them may become serious. They include:

  • Loss of coordination
  • Excessive thirst
  • Frequent urination
  • Blackouts
  • Seizures
  • Slurred speech
  • Fast, slow, irregular, or pounding heartbeat
  • Hallucinations (seeing things or hearing voices that do not exist)
  • Changes in vision
  • Itching, rash
  • Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs.

If a person with bipolar disorder is being treated with lithium, he or she should visit the doctor regularly to check the levels of lithium in the blood, and make sure the kidneys and the thyroid are working normally.

Some possible side effects linked with valproic acid/divalproex sodium include:

  • Changes in weight
  • Nausea
  • Stomach pain
  • Vomiting
  • Anorexia
  • Loss of appetite.

Valproic acid may cause damage to the liver or pancreas, so people taking it should see their doctors regularly.

Valproic acid may affect young girls and women in unique ways. Sometimes, valproic acid may increase testosterone (a male hormone) levels in teenage girls and lead to a condition called polycystic ovarian syndrome (PCOS).11,12 PCOS is a disease that can affect fertility and make the menstrual cycle become irregular, but symptoms tend to go away after valproic acid is stopped.13 It also may cause birth defects in women who are pregnant.

Lamotrigine can cause a rare but serious skin rash that needs to be treated in a hospital. In some cases, this rash can cause permanent disability or be life-threatening.

In addition, valproic acid, lamotrigine, carbamazepine, oxcarbazepine and other anticonvulsant medications (listed in the chart at the end of this document) have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional.

Other medications for bipolar disorder may also be linked with rare but serious side effects. Always talk with the doctor or pharmacist about any potential side effects before taking the medication.

For information on side effects of antipsychotics, see the section on medications for treating schizophrenia.

For information on side effects and FDA warnings of antidepressants, see the section onmedications for treating depression.

How should medications for bipolar disorder be taken?

Medications should be taken as directed by a doctor. Sometimes a person's treatment plan needs to be changed. When changes in medicine are needed, the doctor will guide the change. A person should never stop taking a medication without asking a doctor for help.

There is no cure for bipolar disorder, but treatment works for many people. Treatment works best when it is continuous, rather than on and off. However, mood changes can happen even when there are no breaks in treatment. Patients should be open with their doctors about treatment. Talking about how treatment is working can help it be more effective.

It may be helpful for people or their family members to keep a daily chart of mood symptoms, treatments, sleep patterns, and life events. This chart can help patients and doctors track the illness. Doctors can use the chart to treat the illness most effectively.

Because medications for bipolar disorder can have serious side effects, it is important for anyone taking them to see the doctor regularly to check for possibly dangerous changes in the body.

Stand Up For Mental Health!

on Friday, 01 February 2013.

end mental health stigma today. Don't tolerate it in your life!

Stand Up For Mental Health!

It's Time to Stand Up!!!

There are some 46 Million American women, men and children with mental health disorders. Many are still in hiding because of stigma and shame. It's time for this to end. Those 46 million people need you. If you have a website, blog, or social profile, please join us. Isn't it time you stood up for mental health? Join the campaign now: http://www.healthyplace.com/stigma/stand-up-for-mental-health/stand-up-for-mental-health-campaign/

Quiz on Suicide

on Wednesday, 30 January 2013.

Which of the following statements about suicide is false?

Quiz on Suicide

A. Community surveys suggest that approximately 5% of adults have made a serious suicide attempt. B. Mental health conditions most strongly associated with fatal and nonfatal suicide attempts include depression, bipolar disorder, PTSD, and alcohol and/or drug abuse. C. Occasional reactivity to negative emotional stimuli that occurs at least once per week as a reaction to depression. D. Men with a substance use disorder are more likely to die of suicide than are women with a substance abuse disorder. E. Older men with substance use disorders are at greater risk for death by suicide than are younger persons.

Significantly reduced activity in the inferior frontal gyrus

on Tuesday, 29 January 2013. Posted in General

Can this help determine children and young people at risk of bipolar disorder?

Significantly reduced activity in the inferior frontal gyrus

In a news release from the University of New South Wales, author Philip B. Mitchell, M.D. said, “Our results show that bipolar disorder may be linked to a dysfunction in emotional regulation and this is something we will continue to explore. And we now have an extremely promising method of identifying children and young people at risk of bipolar disorder. We expect that early identification will significantly improve outcomes for people that go on to develop bipolar disorder, and possibly even prevent onset in some people.”

Schizophrenia

on Saturday, 26 January 2013.

bStable provides symptom monitoring for patients diagnosed with schizophrenia but what is the prevalance of Schizophrenia?

Schizophrenia

According to the NIMH:

Schizophrenia

  • Approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year, have schizophrenia.
  • Schizophrenia affects men and women with equal frequency.
  • Schizophrenia often first appears in men in their late teens or early twenties. In contrast, women are generally affected in their twenties or early thirties.

Anxiety

on Saturday, 26 January 2013.

bStable Enables Symptom Monitoring for Patients Diagnosed with Anxiety Disorders but How Many People Suffer From Anxiety Disorders?

Anxiety

From the NIMH:

Anxiety Disorders

Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and specific phobia).

  • Approximately 40 million American adults ages 18 and older, or about 18.1 percent of people in this age group in a given year, have an anxiety disorder.
  • Anxiety disorders frequently co-occur with depressive disorders or substance abuse
  • Most people with one anxiety disorder also have another anxiety disorder. Nearly three-quarters of those with an anxiety disorder will have their first episode by age 21.5

Panic Disorder

  • Approximately 6 million American adults ages 18 and older, or about 2.7 percent of people in this age group in a given year, have panic disorder.
  • Panic disorder typically develops in early adulthood (median age of onset is 24), but the age of onset extends throughout adulthood.
  • About one in three people with panic disorder develops agoraphobia, a condition in which the individual becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack.

Obsessive-Compulsive Disorder (OCD)

  • Approximately 2.2 million American adults age 18 and older, or about 1.0 percent of people in this age group in a given year, have OCD.
  • The first symptoms of OCD often begin during childhood or adolescence, however, the median age of onset is 19.

Post-Traumatic Stress Disorder (PTSD)

  • Approximately 7.7 million American adults age 18 and older, or about 3.5 percent of people in this age group in a given year, have PTSD.
  • PTSD can develop at any age, including childhood, but research shows that the median age of onset is 23 years.
  • About 19 percent of Vietnam veterans experienced PTSD at some point after the war. The disorder also frequently occurs after violent personal assaults such as rape, mugging, or domestic violence; terrorism; natural or human-caused disasters; and accidents.

Generalized Anxiety Disorder (GAD)

  • Approximately 6.8 million American adults, or about 3.1 percent of people age 18 and over, have GAD in a given year.
  • GAD can begin across the life cycle, though the median age of onset is 31 years old.

Social Phobia

  • Approximately 15 million American adults age 18 and over, or about 6.8 percent of people in this age group in a given year, have social phobia.
  • Social phobia begins in childhood or adolescence, typically around 13 years of age.

Agoraphobia

Agoraphobia involves intense fear and anxiety of any place or situation where escape might be difficult, leading to avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area.

  • Approximately 1.8 million American adults age 18 and over, or about 0.8 percent of people in this age group in a given year, have agoraphobia without a history of panic disorder.
  • The median age of onset of agoraphobia is 20 years of age.

Specific Phobia

Specific phobia involves marked and persistent fear and avoidance of a specific object or situation.

  • Approximately 19.2 million American adults age 18 and over, or about 8.7 percent of people in this age group in a given year, have some type of specific phobia.
  • Specific phobia typically begins in childhood; the median age of onset is seven years.

Stress

on Saturday, 26 January 2013. Posted in General

Patients are told to reduce stress but is that practical?

Stress

From Healthline.com:

"Several studies have estimated that as many as 60% of people with bipolar disorder have an anxiety disorder. One study in 2004 showed that ore than 30% of bipolar disorder patients experience panic attacks".

bStable allows patients to identify triggers (stressful life events that are likely to spark episodes of mania or depression). Examples could be: deaths, anniversaries, traumas, etc. These can be recorded and communicated with your clinician or therapist.

Issues abound in out lives: work, school, money, time, health, kids and relationships: friends, family, etc. are the biggest stressors that we face. We can't eliminate stress and anxiety from our lives but can change how we deal with stress and anxiety.

Self monitoring using bStable is key but used in combination with CBT - Cognitive Behavioral Therapy - a great psychotherapeutic approach to address anxiety - has been said to be a very effective combo as reported by our bStable users. I'm also hearing a lot these days about IPSRT - Interpersonal and Social Rhythm Therapy that can help manage stressful life events. 

Depression Prevalence

on Saturday, 26 January 2013.

That's a lot of people!

Depression Prevalence

According to WebMD:

The CDC says that about 9% of Americans report they are depressed at least occasionally, and 3.4% suffer from major depression.

The 9% are people who reported to surveyors that they felt depressed to some degree in the two weeks prior to being questioned. That includes the 3.4% of adults who meet the CDC’s criteria for major depression.

The analysis, part of the CDC’s Morbidity and Mortality Weekly Report(MMWR) for Oct. 1, was based on a survey of 235,067 people aged 18 and older in 45 states, Washington, D.C., Puerto Rico, and the Virgin Islands.

According to the MMWR, estimates for current depression in states and territories in 2006-2008 ranged from a low of 4.8% in North Dakota to 14.8% in Mississippi. People in Kentucky, New Jersey, North Carolina, Pennsylvania, and South Dakota did not participate in either the 2006 or the 2008 survey.

From wiki.answers.com:

340 million people in the world suffer from depression and rising

1 in 4 women will suffer from depression

1 in 10 men will suffer from depression (this statistic is not absolutely correct because more women are apt to see their doctor for depression than men do.)

Depression strikes all races, rich and poor.


Read more: http://wiki.answers.com/Q/How_many_people_in_the_world_suffer_from_depression#ixzz2J6DEV02m

Lithium, Lithium, Lithium, Lithium, Lithium, Lithium

on Saturday, 26 January 2013. Posted in General

Uh, Let's Stop and Think First People

Lithium, Lithium, Lithium, Lithium, Lithium, Lithium

I presented bStable as part of a session on computerized life management systems for the management of bipolar depression at the International Review of Bipolar Disorders May 8th, 2009 in Lisbon, Portugal with Dr. Andreas Erfurth, from the Department of General Medical Psychiatry, University of Vienna. 

At the conference I was AMAZED at how many researchers were totally fixated on lithium research! All I heard was them chirping like birds: "lithium, lithium, lithium, lithium, lithium". Then: "gold standard, gold standard, gold standard, gold standard".

Wow. I've talked with A LOT of people with bipolar disorder and FEW TO NONE are on Lithium. It can make:

your hands shake uncontrollably, make you very thirsty, want to pee a lot, diarrhea, throw up, pack on the pounds, mess with your memory, impair your concentration, make you drowsy, make your muscles feel weak, HAIR LOSS, make you look like a teenager with ACNE and FAT due to decreased thyroid function.

Sound fun?

The researchers should read this article:

http://www.sciencedaily.com/releases/2012/09/120921092502.htm

and stop the knee-jerk reaction "oh, you have bipolar disorder, let me put you on lithium" and start to THINK first and realize every patient is different. Thoughts??

Neanderthal Psychologists & Therapists

on Saturday, 26 January 2013. Posted in General

Get a Computer or Die!

So this article from Psychiatric Times:

http://www.psychiatrictimes.com/display/article/10168/2118508

got me very upset. It is from Dr. Geller who is a Professor of Psychiatry at the University of Massachusetts Medical School and Facility Medical Director, Worcester Recovery Center and Hospital in Worcester, Mass. 

He obviously is in the Stone Ages!! Wake up dude! Basically to summarize the article... he thinks if you put a computer in a therapist's office, everyone in the world will have a patient's mental health records. What??? Comments??? 

Computer-Based Therapists

on Saturday, 26 January 2013. Posted in General

I can see him/her, I just can't smell him/her!

Computer-Based Therapists

If you go to liveperson.com, you can find hundreds of psychologists and therapists just waiting to provide Internet-based psychotherapy. People are working more and more from home and using their computers, Internet connections and phones to stay connected so why not do the same for psychotherapy? Anyone had experience with this? Do you miss your therapist's couch? Do you miss looking at your patients in "real life" and not via a computer monitor? Maybe as part of the web conference, the patients and psychologist/therapist/psychologist could have live, interactive bStable sessions to view how the patient has done since the last visit via the symptom monitoring the patient has recorded. Sounds like a convenient, efficient and practical way of doing things. Anyone had experience with this type of approach?

Omega-3 Supplements

on Friday, 25 January 2013. Posted in General

bStable + Psychotropics, Exercise, Meditation and Eating Well + Fish Oil?

Omega-3 Supplements

Many bStable customers are either newly diagnosed, trying to stay "stable" or are having major problems with their psychotropic medication regimen and want to reset and establish a baseline to measure their progress towards wellness. Most of those who I talk with going through those various stages trying to regain and keep control of their life are experimenting with fish oil.

Lots of the bStable customers I have spoken with that have raved about using omega 3 fatty acid supplements have taken: Omax3, Nordic Naturals and OmegaVia.

 

A debate that is ongoing is do they help with mood disorders (seems they do) and if so, are the higher end brands worth the extra cost and if so, which ones are best. Thoughts? 

Overmedicating Patients

on Tuesday, 22 January 2013. Posted in General

Clinicians are sometimes flying blind

Overmedicating Patients

I once met a girl diagnosed with Bipolar Disorder I at an Annual DBSA event who was on 21 different medications! Yes, 21 medications! Obviously, the patient had multiple comorbid conditions and a lot of the patients I run into have several medications in their constantly changing "psychotropic cocktail". But 21?? I've seen psychiatrists fall into a deadly trap of chasing symptoms with psychotropics. Have you? Without constant and transparent visibility into how the patient is doing with a particular regimen, this trap is very easy to fall into. Thoughts?

What's the Purpose of a Cognitive Behavior Treatment Program Without Self Tracking?

on Tuesday, 22 January 2013. Posted in General

Therapists are not providing patients the tools they need to be successful with CBT

What's the Purpose of a Cognitive Behavior Treatment Program Without Self Tracking?

There are some great books out there on the subject of managing bipolar disorder using CBT (i.e. Michael Otto's book: Managing Bipolar Disorder - A Cognitive-Behavioral Approach) but as the famous quote from Peter Drucker states: "if you can't measure it, you can't manage it!" so why are thousands of therapists out there not giving the tools to their patients to track their thought patterns and measure progress towards goals?? 

 

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