Thursday, March 25, 2010

When the treatment didn’t work.

By R. Scott Benson, M.D.

Once I realized how depressed his mother was I understood why the treatment for her son’s behavior problems had not worked. And there was nothing new about this scenario.

A study of the treatments for ADHD found that for most children the treatments were very effective – improvements in academic performance, peer and family relationship, and self-image. But in the group of children who did not get better, when the treatment didn’t work, there were high rates of depression in mothers.

The impact of depression on parents and parenting was the focus of a study from the National Research Council and the Institute of Medicine. Their report, Depression in Parents, Parenting, and Children, is available on-line. 7.5 million parents are affected with depression each year but fewer than a third receive any treatment. In addition to the stigma of seeking treatment there are practical barriers to care that need to be addressed. The children who are affected are treated in separate health care settings by professionals who are not prepared to look at the whole family. Many families face financial barriers to care since many health plans are not designed for the coordinated care these families need.

The family in my practice was struggling with their second grader and his behavior problems at school. The parents done all of the right things. They had been working with his teachers since kindergarten. They had tried a variety of behavior plans at home. There was no improvement, and his grades were falling in spite of good ability. Their pediatrician confirmed his attention problems and reluctantly they agreed to a trial of medicine.

There was not much improvement even with a higher dose. And there were unpleasant side effects with a second medicine. So she recommended a psychiatric evaluation.

The behaviors were typical of ADHD. But his mother gave a clue to the problem as she teared up, talking about the stress she was under with his problems and guilty feelings about not having enough time for her husband and other children. At a separate interview she described typical symptoms of depression. She had been in treatment during college but stopped treatment when she was first pregnant. I was able to make a referral to a colleague and as her mood improved her interaction with her children improved. And the smiley faces began appearing in the daily planner.



Friday, March 19, 2010

Suicide Prevention – What You Should Know

suicidepreventionlifeline.org

By Jeffrey Borenstein, M.D.

More Americans die as a result of suicide than from homicide. What can you do to minimize the risk of suicide for your family and friends? I was recently interviewed by US News and World Report on this important topic.

The vast majority of people who die by suicide have depression, chemical dependency or another underlying psychiatric condition – all of which are treatable. My advice to people is not to suffer in silence, but to seek treatment.

And, if your loved one appears depressed, encourage him or her to get professional help. If someone expresses thoughts about hurting themselves, take this seriously. If a person has chest pain, you take them to an ER to be evaluated by a physician. If a person has suicidal thoughts – they should also receive a careful evaluation and treatment.

Over the years, I have had the opportunity to treat people who attempted suicide but fortunately were not successful. These people have an important perspective in common: with treatment, once their depression lifted or once they began to recover from chemical dependency, they were thankful to be alive and happy that their suicide attempt was unsuccessful. The key point is that with help, there’s hope. And with help we can prevent the tragedy of a suicide.

If You or Someone You Know Is in Crisis and Needs Immediate Help
  • Call your physician’s office.
  • Call 911 for emergency services.
  • Go to the nearest hospital emergency room.
  • Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
  • Ask a family member or friend to help you make these calls or take you to the hospital.







Tuesday, March 16, 2010

Introducing NAMI’s Hearts and Minds Wellness Initiative!

By Felicia K. Wong, M.D.

Thank you Dr. Blanco for your post on the beneficial aspects of support groups and sharing NAMI’s online support groups as a resource. Today, I’d like to share a fantastic new health education program recently launched by the National Alliance on Mental Illness (NAMI) to promote sound “mind and body” health practices among individuals who live with mental illness.

Wellness is an ongoing process of learning how to make choices and changes in your life that can enhance your physical and emotional well-being. “Wellness is everyone’s concern,” said NAMI Executive Director Mike Fitzpatrick. “But it is especially urgent for people living with serious mental illness.” People living with serious mental illness such as major depression, bipolar disorder and schizophrenia live on average 25 years less than other Americans.

“Many kinds of risk factors contribute to health challenges for people with mental illnesses,” said NAMI Medical Director Ken Duckworth, M.D. “Many are preventable or reversible.” The “Hearts and Minds” initiative focuses on risk factors including high blood pressure, high cholesterol, smoking and obesity for major illnesses such as heart disease, cancer and diabetes. The program provides useful information and resources to help those with mental illness improve their diet, exercise more, and stop smoking.

“Persons with mental illnesses deserve to live a full and healthy life,” said Steven A. Schroeder, M.D., director of the Smoking Cessation Leadership Center. “At present, far too many compromise that opportunity because they smoke cigarettes, are overweight and don’t get sufficient exercise.”

Here is a video introducing “Hearts and Minds” that provides helpful suggestions for how to attain wellness.

Thursday, March 11, 2010

Getting Support from Support Groups

By Roberto Blanco, M.D.

This last fall a colleague and I developed and co-led a support group for Young Adults, aged 18 to 25, who had survived cancer. As we collected feedback at the end of the group, here are some of the comments that we heard:

“I never knew that anybody else experienced this and felt this way too.”

“It’s so nice to finally know that someone else can understand what I’ve been through.”

This group experience helped to diminish the isolation their cancer experiences had caused these patients to feel. Many of them had been diagnosed with cancer as children or adolescents and it would have been virtually impossible for their peers to understand. Many had been cancer-free for many years and still had found few people that could relate. While we also discussed issues of autonomy, independence, self-esteem, dating, fertility, wellness, and survivorship, this connection through shared experience was the main benefit of the group for these patients.

Like my group of Young Adult Cancer Survivors, there are many groups for a multitude of illnesses, diseases, and situations. Goals of these groups vary and can include providing support and education, encouraging abstinence from problematic behaviors, restoring previous functioning, teaching coping skills, providing new defenses or techniques for managing difficult situations, decreasing social isolation, and helping people achieve common goals. Some groups recruit members once and only last for a set period of time whereas others are more open-ended and members can come and go as they please.

The attraction of group therapy is the opportunity for personal growth through learning from peers. Some people feel that support groups are less intimidating than individual therapy because they may not like to talk for fifty minutes or may prefer to have less of the focus on them. They can sit and gain valuable knowledge or skills while letting the more vocal members of the group talk. Others feel that sharing their story in front of others who understand is cathartic and relieves burdens.

However, face-to-face group therapy is not for everyone. Those people who are deathly afraid of speaking in front of people but still want to learn from peers might prefer online support groups and communities. While some of the interpersonal benefits of in-person groups may be lost, valuable knowledge and support can still be gained behind the protective screen of a computer.

Support groups can be found by contacting your local chapter of NAMI. Also, many large academic medical centers have a list of support groups within each medical specialty. Most centers that offer mental health services usually also offer support groups as part of their array of services. Even colleges and universities often have support groups for students attempting to finish dissertations or who are struggling with independence issues.

For those looking for support groups online, NAMI has online support communities as well.   Other support groups can be found at Supportgroups.com, WebMD  and The Wellness Community.

Friday, March 5, 2010

Let’s Pay Attention: Some Facts on ADHD

By Gariane Phillips Gunter, M.D.

What is ADHD?

There is a lot of talk in the media, schools and community about ADHD, but what exactly is it? ADHD which stands for Attention-Deficit/Hyperactivity Disorder is one of the most common mental disorders affecting children. ADHD is a brain condition that is often first identified in school-aged children when it causes a disruption in the classroom or problems with school work. An estimated 3 to 7 percent of school –aged children have symptoms of ADHD.


What are the Symptoms?

Many of the symptoms of ADHD such as high activity levels, difficulty remaining still for long periods of time and limited attention spans are common in young children in general. However, the difference in children with ADHD is that their hyperactivity and inattention are noticeably greater than expected for their age and interfere with functioning in more than one environment i.e. at school, at home or with friends.

A child with ADHD may:

*squirm and fidget

*daydream a lot

*have difficulty following instructions

*appear not to listen when spoken to

*not be able to stay seated

*talk too much or interrupt

*be easily distracted

What Causes ADHD?

The specific causes of ADHD are not yet determined however there is evidence that genetics do play a part. Other factors that may contribute include being born prematurely, brain injury, and the mother smoking, using alcohol or having extreme stress during the pregnancy.

What is the Treatment?

The most effective treatment for ADHD is the combination of behavioral therapy as well as medication if needed.

What can Parents do to Help?

Children with ADHD perform much better with structure, established routines and clear expectations. It can be helpful to:

• Maintain routines

• Make sure instructions are understood-use simple words to describe

• Focus on your child when talking to them

• Maintain communication with the child’s teacher

• Model calm behavior

• Focus on effort and reward good behavior

What are the Consequences if Left Untreated?

Sadly, if left untreated, children with ADHD are at greater risk for potentially serious consequences including school failure and dropout, social difficulties, family problems, alcohol and drug abuse and depression. These problems or the consequences of them can persist into adulthood, including relationship and employment problems.

Does my Child have ADHD?

Simply having the above symptoms does not mean that a child has ADHD as these symptoms can be normal childhood behavior or could be due to another disorder. Symptoms differ from child to child and there is no lab test for ADHD.

Diagnosis involves gathering information from parents, teachers, and others often filling out checklists and a medical evaluation to rule out medical problems. If you feel that your child is at risk, talk to your doctor about your concerns.