Archive for August 12th, 2019
By Rick Nauert PhD
Associate News Editor Last updated: 9 Aug 2019 ~ 2 min read
Emerging research suggests that for some individuals, online symptom self-management plus clinician telecare is the best strategy for treating anxiety, depression and pain.
As a background, it is well documented that pain is the most common physical symptom for which adults seek medical attention in the United States. Moreover, anxiety and depression are the most common mental health issues for which adults visit a doctor. We also now understand that medications, especially opioids for pain, may not be the only or best therapy.
In the new study, Regenstrief Institute research scientist Kurt Kroenke, M.D., a pioneer in the treatment of patient symptoms, discovered online symptom self-management or online symptom self-management plus clinician telecare can be effective solutions for individuals with anxiety, depression and pain.
“Pain, anxiety and depression can produce a vicious cycle in which the presence of one symptom, if untreated, may negatively affect the response to treatment of the other two symptoms,†said Dr. Kroenke.
“So treating not just pain, but pain and mood symptoms simultaneously is quite important, as is doing it how, when and where the patient is most receptive.â€
In the study, published in the Journal of General Internal Medicine, Dr. Kroenke and colleagues discovered that online symptom self-management works to decrease pain, anxiety and depression symptoms. They also found that online symptom self-management works even better when coupled with clinician telecare.
Prior studies have found a benefit to adding telecare to usual care in the doctor’s office. The researchers have now shown that the intermediate (and less costly) mechanism of online pain and mood self-management is effective and, for some, even more effective when coupled with live phone follow-up with a nurse.
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By Helen Nieves
Last updated: 16 Apr 2015 ~ 3 min read
What is Anxiety and Panic Attacks?
Anxiety is a part of life and normal to experience at some point or another. It’s a normal reaction to stress and can be beneficial in some situations. When you have an anxiety disorder, the anxiety becomes excessive where you have difficulty controlling it and interferes with daily life. The anxiety remains with you for months and can lead to phobias and fears which impact your life. Anxiety continues even after the stressor is gone. It is a fear that is accompanied by feelings of impending doom.
Common signs of anxiety are diarrhea, irritability, restlessness, headaches, sweating, upset stomach, muscle tension, anger, rapid heartbeat, and unable to concentrate, just to name a few. There are several anxiety disorders such as Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive Compulsive disorder, post-traumatic stress disorder, social phobia, and agoraphobia. Anxiety disorder is very common in the United States. Most of my clients who come to see me suffer from an anxiety related disorder.
A panic attack brings on sudden attacks of fear with no reason. It triggers physical reactions with no real danger or threat. It can happen with no warning and at any time. Symptoms usually peak within 10 minutes. A person usually fears that they will have another panic attack and often avoid situations where they may occur. Agoraphobias may develop because the person may be afraid to leave their home because nowhere seems safe. Symptoms of panic attacks include feelings of impending doom, fear of losing control, trembling, hyperventilation, chest pain, headaches, tightness in your throat, trouble swallowing, hot flashes and sweating, just to name a few.
There are many types of treatment for anxiety and panic attacks. Finding the right professional to help you cope with these disorders is important. There are many medications a doctor can prescribe to you to help manage with the symptoms. There are also natural supplements, relaxation training, cognitive behavioral therapy, exposure therapy, group therapy, and support groups which can help reduce the symptoms. Lifestyle changes such as stress management, exercising, removing stimulants and sugar from your diet, changing your perspective to situations, and changing your attitude from controlling things or the need to please others can also be of help to manage with anxiety or panic attacks.
Providing Support:
If you or someone you know takes care of a person who has panic or anxiety attacks, I would advise you to know as much as you can about the disorder. Ask the person with this disorder to share with you their thoughts and their feelings about the disorder during an attack and when they feel calm. The following is a list of tips that may be helpful in supporting a loved one or friend who suffers from these disorders:
- Listen: You should just listen and do not try to solve the attack. You cannot fix it or take the attack away.
- Support: Learn how to support your loved one or friend when they have an attack. Find out from them what will help and what they need you to do during an attack.
- Organize activities: Let the person organize activities that you can do together. If they set their own parameters, they may be more willing to try them.
- Compromise: Be open to adjustments that can help in making an outing successful and comfortable. Make adjustments for other similar activities that make the person uncomfortable such as taking stairs instead of an elevator.
- Respect: Never belittle or downplay the attack. This is a real disorder. Do not dismiss their attack or try to solve their problem though realization.
- Understand: When a person is going through an attack, rationality and listening is not what they are concentrating on. You have to understand that you cannot make the experience go away by trying to rationalize the situation to them.
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By Margarita Tartakovsky, M.S.
Last updated: 25 Nov 2018
~ 4 min read
For something so common, anxiety is still massively misunderstood. There are myths and misconceptions about everything from what anxiety disorders look and feel like to what actually helps to treat these illnesses and navigate anxiety. Which is why we asked several anxiety experts to clear things up. Below, you’ll find their illuminating insights.
Living with an anxiety disorder can be exceptionally difficult.
Many people minimize and trivialize anxiety disorders. For instance, how often have you said or heard someone say “I’m sooo OCD about my desk!†or “I’m really OCD about using hand sanitizer�
Such comments not only misconstrue OCD (cleanliness is just one way that OCD manifests), but they also leave sufferers feeling misunderstood and alone, said Janina Scarlet, Ph.D, a clinical psychologist and author of the book Superhero Therapy: Mindfulness Skills to Help Teens and Young Adults Deal with Anxiety, Depression and Trauma.
OCD—and other anxiety disorders—can be debilitating and devastating illnesses.
“Individuals with OCD suffer on a daily basis, some completing hours of rituals, while others are paralyzed by intrusive thoughts,†said Scarlet. People with other anxiety disorders also experience “a tremendous amount of distress†day to day. For some of Scarlet’s clients, it can take hours to get out of bed, while others are unable to leave the house (or another space “they deem to be safeâ€).
“Someone with illness anxiety disorder may [believe] they have a life-threatening illness…. [People with] GAD (generalized anxiety disorder), or OCD may have recurrent intrusive thoughts about their biggest fears coming true. It is similar to experiencing one’s worst nightmare on loop in someone’s mind.â€
Some people with social anxiety are so afraid of rejection or humiliation that making eye contact, waiting in line or saying “hello†triggers overwhelming anxiety or panic attacks, she said.
And what makes all of this worse is criticism from others, and comments like “just try to get over it,†Scarlet added.
Anxiety can be successfully treated in a timely fashion.
Even though anxiety disorders are difficult, they’re one of the most treatable disorders. Yet only a third of people seek treatment, said Kevin Chapman, Ph.D, a psychologist who specializes in evidence-based treatment for anxiety and related disorders in adults and adolescents at his private practice in Louisville, K.Y. That’s because “Most individuals with anxiety disorders manage their anxiety through avoidance behaviors.â€
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By John D. Moore, PhD
Last updated: 19 Mar 2018 ~ 2 min read
You have anxiety and have probably been living with it your entire life. I completely understand. That’s because I’ve struggled with this condition ever since I can remember.
Here are 10 small things you can do each day to help stay calm. You may think a few of these are silly. That’s OK. Try them anyway. What do you have to lose?
1. When you wake up in the morning and your mind starts rattling off a “to-do†list, take a deep breath. Focus your awareness on the moment. Using your five senses, identify what’s going on around you. This can help soften obsessiveness, and remove the sense of dread you might be feeling.
2. Find some quick humor by visiting a funny meme page on Facebook or checking out a comic strip from a newspaper. There are even apps you can download to get your funny on. The idea is to laugh and get out of your head.
3. Practice gratitude by finding something to be grateful for. It could be a friendship, your health or simply having an extra can of soup in the cupboard. This will help to focus your mind on the positive instead of the negative.
4. Do one task at a time. Don’t allow yourself to play the game of multi-tasking. Not only will it make your anxiety worse, research tells us most of us aren’t good at it.
5. Lean into your anxiety by doing something productive. This could be scrubbing out the sink or mopping the floor. Trying to pretend you aren’t feeling anxious only makes things worse. Do something constructive with that energy that benefits you in the long run.
6. Carry apples with you. The hard truth about living with anxiety is nervous eating. In many cases, this means reaching for whatever is in front of us (even when it’s unhealthy). If you are going to snack, why not consume something healthy? Apples are great because they give your mouth something crunchy to munch on while delivering fiber and vitamin C to your body.
7. Put money in your piggy bank each day. This can help you feel like you are doing something about financial stress; a common source of anxiety. It could be $1.00 or $10.00. The amount doesn’t matter. What does matter is the peace of mind you will gain by knowing you are saving.
8. Move your body. This could be something simple, such as a walk around the block or doing some quick jumping jacks. You don’t have to start a gym routine (although that doesn’t hurt). By becoming more physically active, you give all that energy you are carrying a place to discharge.
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By Traci Pedersen
Associate News Editor
Last updated: 8 Aug 2018
~ 2 min read
Although individuals with autism spectrum disorder (ASD) appear to have a higher number of mutations in oncogenes (genes with the potential to cause cancer), they actually have lower rates of cancer, according to a new study at the University of Iowa.
The multidisciplinary team analyzed gene databases of patients with autism and found that autistic patients have significantly higher rates of DNA variation in oncogenes compared to a control group.
The researchers then followed up this finding with an analysis of electronic medical records (EMR) and discovered that patients with a diagnosis of autism are also much less likely to have a co-occurring diagnosis of cancer.
“It’s a very provocative result that makes sense on one level and is extremely perplexing on another,†says Benjamin Darbro, M.D., Ph.D., assistant professor of medical genetics in the Stead Family Department of Pediatrics at the UI Carver College of Medicine.
The researchers compared 1,837 patients with autism spectrum disorder to 9,336 patients with any other diagnosis, and determined what proportion of each group of patients carried a cancer diagnosis. They found that for children and adults with ASD there appeared to be a protective effect against cancer.
Specifically, 1.3 percent of patients with ASD also had a diagnosis of cancer compared to 3.9 percent of the control patients. This protective effect was strongest for the youngest group of patients and decreased with age.
For ASD children under 14 years of age, the odds of having cancer were reduced by 94 percent compared to individuals in the same age range without autism. Both males and females with ASD demonstrated the protective effect.
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By Rick Nauert PhD
Associate News Editor
Last updated: 8 Aug 2018
~ 1 min read
The recent “coming out†by Scottish singer Susan Boyle, who found she has high-functioning autism, also known as Asperger syndrome, improves awareness and shows that those with autism spectrum disorders can lead a full life — albeit one with unique challenges.
Now, researchers at Karolinska Institutet have announced a new screening tool to facilitate the diagnosis of autism in adults.
Autism spectrum disorders (ASDs) can cause major problems in communicating and interacting with other people, and can lead to compulsive routines and interests.
In adults, distinguishing ASD from other psychiatric conditions can be difficult, as their symptoms often overlap or are similar to those in schizophrenia, attention-deficit hyperactivity disorder (ADHD) or severe personality disorders.
Screening methods used today for making a correct diagnosis can sometimes be time-consuming and require considerable expertise.
Research specialists at the institute’s Department of Clinical Neuroscience have, under the leadership of Associate Professor Susanne Bejerot, M.D., Ph.D., refined and simplified an existing American test, RAADS-R (Ritvo Autism and Asperger Diagnostic Scale-Revised).
The new test is a questionnaire with 14 self-screening questions and is known as the RAADS-14 Screen.
The scale includes three sub-scales that measure mentalization difficulties, social anxiety and sensory oversensitivity — all common symptoms in autism.
The answers are categorized on the basis of whether the symptoms appeared in childhood or developed later in life.
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By Gwendolyn Kansen
Last updated: 15 Sep 2016
~ 2 min read
It still pisses me off that the DSM5 got rid of Asperger’s. Not only is Asperger’s it’s own thing (repetitive behaviors & special interests you guys!) but there’s different levels of it. There are so many genes that go into autism that it might even be split into several different disorders someday. Here’s a totally unscientific set of types based on aspies I’ve known:
Impulsive (aka Party Crasher)
These aspies are run by their ids. They’re the most high-energy and the most likely to blurt out rude shit. Most prone to repetitive behaviors. Also more likely to show their feelings than other types. Prone to addictions from Internet browsing to heroin. They usually have more social awareness than they’re given credit for. They can even be charismatic for short periods of time, which makes sense because they’re generally the most social. But they’re the hardest aspies to spend extended periods of time with. They used to let their inner monologue run wild when they were younger, driving people away. They may or may not have learned better. Most have developed some pride in their inadvertent “tell it like it is†attitude, which is appreciated by certain people. Misdiagnoses include ADHD, bipolar disorder, & borderline.
Methodical (aka Patrick Bateman)
These aspies study the social world long and hard. They’re generally pretty touchy, having very specific ideas about what’s good and what isn’t. The most outwardly adept of the bunch, they can hold jobs and sustain friendships longer than other types. High IQs. High intensity. Repetitive behaviors. Wry conversationalists. Like to control their environment. Their sperg finally shows when you notice the studied aspect of their interactions. Plus their obsessive special interests, which they’re among the most likely to have. May be misdiagnosed with OCD or a personality disorder. I think these aspies are mostly men.
Sluggish (aka Stealth)
The low-energy type. They have the most sensory problems, but those sensory sensitivities can also bring them plenty of joy. They might have a better sense of smell, taste, and touch than most people. They get overwhelmed the most easily and it takes them the longest to recharge after any possible exertion. They generally don’t talk much. They have trouble articulating their thoughts to words. They have trouble with employment too. But to make up for all that they often have the most situational awareness of all types. They might even be street smart. That astuteness takes them ten times more energy than it takes everyone else, which is one reason they’re so tired. They might be misdiagnosed with ADD, hearing problems, schizophrenia, or a less intelligent form of autism.
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By Traci Pedersen
Associate News Editor Last updated: 11 Aug 2019 ~ 1 min read
Depression symptoms in cognitively healthy older adults together with brain amyloid — protein deposits which are a biological marker of Alzheimer’s disease (AD) — could trigger changes in memory and thinking over time, according to a new study published in the journal JAMA Network Open.
“Our research found that even modest levels of brain amyloid deposition can impact the relationship between depression symptoms and cognitive abilities,†said Jennifer Gatchel, M.D., Ph.D., of the Massachusetts General Hospital (MGH) Division of Geriatric Psychiatry, and lead author of the study.
“This raises the possibility that depression symptoms could be targets in clinical trials aimed at delaying the progression of Alzheimer’s disease. Further research is needed in this areaâ€
Increasingly, Alzheimer’s research has focused on the preclinical stage, when people have biological evidence of AD but no or minimal obvious symptoms, and when interventions might have the potential to prevent future decline of older adults.
Although previous studies have shown a link between depression and cognitive deficits in older adults, the new study is among the first to reveal that this association is influenced by the presence of cortical amyloid in unimpaired older adults, even when depression symptoms are mild to moderate.
Data were collected by researchers over a seven-year period from 276 community-dwelling older adults, all participants in the landmark Harvard Aging Brain Study (HABS).
They discovered a significant link between worsening depression symptoms and declining cognition over two to seven years that was influenced by AD pathology, as measured by PET imaging of brain amyloid.
Mark Moran Published Online:30 Jul 2019https://doi.org/10.1176/appi.pn.2019.8a5
In the absence of increased resources for college mental health, a university psychiatrist urges parents to advocate for their college-aged students, to recognize when they are having problems that require attention, and to urge them to seek treatment.
Adam is 19 years old and studies night and day—sometimes going without sleep—because he is worried about his grades and losing his financial aid. Jennifer is 21 and expects to graduate with student loan debt in excess of $50,000. Michelle, an 18-year-old freshman, has over 750 Facebook friends and more than 1,000 Instagram followers, but she has no one with whom she feels comfortable confiding in.
These are the faces of the American college students who are presenting in growing numbers to college mental health services—depressed, lonely, anxious, and financially and academically stressed.
Certainly, that doesn’t characterize all or even most college students; and college continues to be, for millions of young people, a unique period of independence, growth, and expansion of one’s horizons. But recent research and anecdotal accounts from psychiatrists in college health centers indicate that mental illness is on the rise among America’s college students.
“There has been a dramatic increase in mental health problems among college students,†Marcia Morris, M.D., a member of the APA Caucus on College Mental Health, told Psychiatric News. She is the associate program director of Student Health Care Psychiatry at the University of Florida (UF) Counseling and Wellness Center in Gainesville, Fla. “One of the biggest stressors is for students who are in college and on their own financially. Their parents may be unable to provide any financial help, and so the students are under enormous pressure to do well or risk losing their scholarship or financial aid. These are the students I see who can have the most serious problems. They don’t have financial backup and have to perform in school.â€
Morris is also an associate professor in the UF Department of Psychiatry and co-chair of the College Mental Health Task Force of the National Network of Depression Centers.
Morris and two Department of Psychiatry colleagues—Michael Shapiro, M.D., and Andres Pumariega, M.D.—compared UF enrollment data with the number of psychiatric hospitalizations among students presenting at the UF Student Health Care Center. They found that between 2013 and 2017, enrollment rose by just 11.5%, while hospitalizations nearly tripled—from 17 in 2013 to 49 in 2017 (see chart).
They published their findings as supplemental material accompanying a letter published in the June issue of Psychiatric Services. The three UF psychiatrists were responding to a report in the January issue of Psychiatric Services that found that among U.S. college students, the rate of treatment for a mental disorder increased from 19% in 2007 to 34% in 2017, while the percentage of students with lifetime diagnoses of mental conditions increased from 22% to 36%.
That study, by Sarah Ketchen Lipson, Ph.D., Ed.M., of Boston University School of Public Health, and colleagues also reported a decrease in mental health stigma among college students and speculated that diminishing stigma may be contributing to the rise in service utilization.
In their response, Morris, Shapiro, and Pumariega suggested that increases in the prevalence and severity of mental illness are more likely the culprits. They asserted that research data on mental health stigma among young people are mixed and that rates of stigma differ dramatically by geographic region.
In comments to Psychiatric News, Shapiro said, “Our data tell me that it’s not just more college kids asking for help; it’s more young people with mental illness going to college. What concerns me is that if we believe there is less stigma when there really is not and we don’t recognize the increasing severity of mental illness among our college students, then we are not going to deal with the real problem: How do we support more mentally ill college students?â€
Shapiro, a child and adolescent psychiatrist, is not affiliated with the UF Counseling and Wellness Center but is affiliated with the university and sees a number of college students in his practice in the community.
“I have several patients who have become young adults that I have tried to follow since starting college,†he said. “Reading the article by Lipson and colleagues, I was not surprised to know that more college students were seeking mental health treatment. I continue to see kids who go to college because very often they are very reluctant to initiate treatment with a new professional at their school, but they still struggle with mental illness and the need for treatment.â€
Meera Menon, M.D., co-chair of the APA Caucus on College Mental Health, said that as the acuity of the mental health needs of college students increases, so does the need for psychiatrists practicing within this field. The Caucus supports college psychiatrists in entering this field and is currently creating a mentorship program for medical students, residents, fellows, and early career psychiatrists to connect with more experienced college psychiatrists (see box).
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https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2019.8a5
Among the many services the National Autistic Society offers for autistic people, the Moving Forward with Cashback for Communities programme in Scotland. It helps young autistic people who have been disadvantaged by unemployment, lack of education or training. It offers coaching, work experience opportunities, and support to apply for jobs and prepare for interviews. We caught up with Amy, a prospective college student and young autistic person on the programme, to have a chat about the project.
What were you doing before Moving Forward with CashBack for Communities?
I was supposed to go to college for a childcare course – a subject I wasn’t passionate about but felt I had to do. I had quite a bad experience at school and it put me in a dark place, having just left school I felt like I was going to be doing something else I hated. It really impacted my mental health.
How did you find out about the programme?
My mum works at a Glasgow café where one of the National Autistic Society groups meet. So, when I was getting diagnosed, my mum went over and introduced herself so that I would have support after my diagnosis and when I left school. I first met with Billy who told me about the project and encouraged me to join so I could start working towards finding something I actually wanted to do.
Most people do a work placement on the programme, but you did a college course. How did you find that and what are your plans now?
The programme helped me get onto an eye enhancements course, which involved learning how to deal with eyebrows and eyelashes, doing things like tinting and shaping. I really enjoyed it and found out that I was actually really good at it! I ended up getting 100% in my assessments, even the theory work. I now have a place on a full-time course to study make-up and beauty in August and I’m looking to get a part-time job while I study.
Some people on the programme get support from a mentor, but you were supported one-to-one by staff. How did you find this?
I’m really happy working with the staff. They’ve all continued to help me and have given me some of the best advice I could have ever asked for.
They’ve given me the confidence I needed to go and do what I wanted and have pretty much changed my life for the better.
What have you learned from the preparation for employment in terms of moving on after college?
I’ve learned how to communicate with a potential employer, received tips on how to behave during an interview, and actually have the confidence to apply for jobs in the first place. I now can update and change my CV accordingly to suit different jobs I apply for. Before I wasn’t confident with any of that!
What was the biggest benefit of doing the scheme?
The biggest benefit has been the big improvements with my mental health. I also have this new-found confidence I didn’t know I could ever have!
Tell us about the recent fundraising gig you organised…
I really wanted to say a huge thank you to the National Autistic Society for the help they have given me. My boyfriend is a musician and he had done charity gigs before, so we discussed doing that for the charity.
We got it organised and found the perfect venue which was the Ice Box Arts and Music Centre. They staff were so kind and helpful, and they had pretty much all the equipment we needed for the acts which made it easier to organise. The acts we had on were all unique and different in their own ways and helped us to almost sell out which was a first for the venue!
Not only did we do the charity gig, but Rock N Roll Tattoo also hosted a walk-in day. All the tattoos were done by apprentices, who had also designed them. The designs were all ideas relating to the autism spectrum and every penny went to the National Autistic Society!
In total we raised £1,500 from the charity gig and the tattoo walk-in day. And there’s hopefully more events and fundraising to come!
Gig goers enjoying the music at Amy’s fundraising event
Find out more about this employment service