May 30, 200811:42 am
posted by Aric Thorpe, MHR

Depression in stroke victims

Depression often occurs after individuals suffer from a stroke. Approximately 37% of stroke victims deal with resulting depression. However, a recent study published in the Journal of the American Medical Association found that problem-solving therapy or escitalopram within one year of stroke reduces the risk of depression. The following is an excerpt of an article from Medpage Today that reviews the study:

To investigate methods of preventing post-stroke depression, they conducted a multi-site randomized controlled trial among 176 nondepressed patients (mean age 62) within three months of an acute stroke (ischemic or hemorrhagic). Patients were enrolled from July 9, 2003, to Oct. 1, 2007.

The 12-month trial included three groups: a double-blind placebo-controlled comparison of escitalopram (n=59) with placebo (n=58) and a nonblinded problem-solving therapy group (n=59).

Escitalopram, a selective serotonin reuptake inhibitor similar to citalopram (Celexa), was chosen, the researchers said, because of empirical evidence that it might be more effective with a faster onset of action than citalopram and would be better tolerated over a 12-month period.

The drug was given at 10 mg/d in the morning for patients younger than 65 and five mg/day for those 65 or older.

,In the problem-solving therapy, patients selected a problem and then went through steps to arrive at a course of action. The intervention consisted of six treatment sessions over the first 12 weeks and six reinforcement sessions beginning at four months.

Click here to read the rest of this article from Medpage Today

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May 27, 20087:28 am
posted by Aric Thorpe, MHR

Jordan Burnham: On a mission of hope

A recent congressional briefing found Jordan Burnham co-presenting with Actor Joe Pantoliano, Actress Marcia Gay Harden, and Minnesota Rep. Jim Ramstad. The purpose of the Capital Hill presentation was to promote brain equality, that mental illness would be treated with no more stigma than cancer or diabetes, for example. Jordan relayed an amazing story of survival and hope during the meeting. For those of you that don’t know, after struggling with depression Jordan attempted suicide on Sept. 28, 2007 by jumping from his parent’s ninth floor apartment. In the aftermath of this event, Jordan has joined the ranks of those trying to end the stigma associated with mental illness. During his presentation at the congressional gathering, Jordan asserted that young people need to “replace their feelings… of embarrassment, shame and defeat” with feelings of acceptance. He went on to explain that young people need to be able to come out and discuss suicidal feelings without stigma or feelings of societal shame.

Actor Joe Pantoliano, who after struggling with depression for years founded the non-profit “No Kidding, Me Too!,” whose aim is to eliminate stigma surrounding mental illness, spoke of Jordan Burnham saying, “He’s got an incredible story… I don’t think kids want to hear from old people. He’s representative of this message for his generation.” After his presentation, Jordan was invited by the heads of various national mental health organizations to speak. The director of the federal Center for Mental Health Services, Kathryn Power, said that Jordan is an articulate speaker and that she would be in touch. “I think this is his calling,” Jordan’s mother commented.

Click here to view a video from CBS that discusses Jordan’s efforts

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May 23, 200810:05 am
posted by Aric Thorpe, MHR

Lack of Motivation in Psychosis

According to a recent small study published in BMC Psychiatry, deficits in motivation may not be accounted for entirely by institutionalization or long-term treatment in patients with schizophrenia and other forms of psychosis. According to Graham Murray, M.D., Ph.D., these deficits are present at the first episode of psychosis. Dr. Murray’s team measured “reinforcement-related speeding,” response time in relationship to the chance for reward, in patients with a first episode of psychosis; only four out of eighteen of these patients improved their response time to increase their chances for reward. Conversely, 17 out of 19 from a control group improved their response time to gain reward. The researchers believe that abnormalities in the brain’s reward center account for motivation deficits in psychosis. According to Dr. Murray, “Patients with psychosis already have motivational deficits the first time they present to health services… understanding the brain basis of these problems will ultimately help in developing new treatments.” The following is an excerpt of an article from Medpage Today that reviews the study:

It has been proposed that there are abnormalities in the brain’s reward system and in the processing of incentive motivation in psychosis, and that dopamine dysfunction may be responsible, but this has not been well evaluated clinically, the researchers said.

So the investigators recruited 18 patients (mean age 23, nine males) who had symptoms of psychosis for the first time and 19 healthy controls (mean age 25, nine males) to complete the Cued Reinforcement Reaction Time Task, which measures motivationally driven behavior.

Eleven of the 18 psychosis patients were taking atypical antipsychotics, including olanzapine (Zyprexa) (three), risperidone (Risperdal) (two), quetiapine (Seroquel) (two), clozapine (Clozaril) (one), aripiprazole (Abilify) (two), and amisulpride (one).

A year after the evaluation, nine patients were diagnosed by a psychiatrist with schizophrenia, two with schizoaffective disorder, five with bipolar disorder, one with delusional disorder, and one with a psychosis not otherwise specified.

On the task, all participants were asked to choose which of a simple set of three shapes did not belong in 96 trials, with varying likelihood of reward indicated by three different colors as the test progressed. Previous studies in healthy participants have shown increased reaction times associated with a higher likelihood of reward, the researchers said.

Click here to read the rest of this article from Medpage Today

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May 22, 20087:30 am
posted by Aric Thorpe, MHR

Domestic violence against men grossly under-reported

A recent study published in the American Journal of Preventative Medicine showed that domestic violence against men is grossly under-reported and may have implications on mental health. According to the study, a retrospective cohort, of the 420 men involved 28.8% had been victims of emotional or physical violence during their adult lives. In a similar study this number was at 44% among women. Additionally, men who were over the age of 55 and had suffered domestic violence had generally lower mental health scores, showing greater signs of depression; men that were under the age of 55 reported more difficulty functioning socially. According to the researchers conducting the study, “…the findings suggest that the failure of healthcare personnel to ask about and acknowledge men’s experiences may be shortsighted.” The following is an excerpt of an article from Medpage Today that reviews the study:

“Asking men about [intimate partner violence] may open a conversational space about violence — perhaps bi-directional in nature — that may be occurring in their relationships,” they said.

Future research, the researchers said, is needed to determine effectiveness of various interventions.

Dr. Reid said that this study should not overshadow the effects of violence against women.

“This study doesn’t downplay or mitigate the experience that women have with domestic violence. It’s common for women, and health consequences — including death — can be devastating,” he said. “But violence appears to go in many directions, directed against children, against women, and, in some cases, men.”

The researchers conducted a telephone survey of 420 adult men (mean age 53.8, 86.1% white) who were insured by Group Health for at least three years.

They were asked about past episodes of intimate partner violence using the Behavioral Risk Factor Surveillance Survey.

Health was assessed using the Short Form-36 version 2, the Center for Epidemiological Studies Depression Scale, and the National Institute of Mental Health Presence of Symptoms Survey.

A total of 18.4% of the participants reported being a victim of childhood physical or sexual violence and 14.5% had witnessed intimate partner violence.

Overall, 4.6% of the participants had been violenced in the past year by an intimate partner and 10.4% had been a victim of violence in the past five years.

Click here to read the rest of this article from Medpage Today

Pastoral Action Point: Recognizing an individual as being in a scenario that doesn’t fit the societal mold is difficult. However, the numbers are clear; 28.8% of men in this study had suffered domestic violence. The difficulty in recognizing domestic violence suffered by men is that societal expectations create seemingly impenetrable walls for pride to escape. It is tremendously difficult for one to share about domestic violence or reach out for help when collective beliefs dictate that men are rarely if ever victims of it. Therefore, fostering open communication and trust among congregants and staff is essential. In situations were violence is suspected… “ask.” It would also be well worthwhile to incorporate stats inclusive of male victims in domestic violence prevention talks that your church presents or hosts.

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May 21, 20087:26 am
posted by Aric Thorpe, MHR

Surviving suicide

Cases of suicide are often shrouded in secrecy because of the stigma connected with the act. However, this was not the case with Rob Chandler, a Windsor resident whose son took his own life. Following his son’s death Chandler found composure in a network of friends and in the faith community. This eventually led to Chandler becoming an Anglican deacon to minister to other families that had been affected by suicide. Chandler recalls that one of the greatest pieces of advice he was given was from a local minister who suggested that he not keep the means of his son’s death a secret. According to Chandler, “We said he sadly ended his life in the obituary. There is this stigma attached to suicide; person after person told us we were brave to do that. It was one of the best things we did for ourselves.”

The rate of suicides in Windsor has dropped from 55 in 1996 to 19 in 2006, according to Alive! Canada, a nonprofit organization. The organization recently held a workshop for faith leaders to support suicide awareness. According to Carol Mueller, organizer of the event, “We saw this workshop as a way to… bring together the social work and faith communities to work on suicide prevention and heightening awareness of the issues surrounding it.”

The following is an excerpt of an article from The Windsor Star that discusses suicide and the response of faith groups and the mental health community in Windsor, Canada:

When Rob Chandler’s son committed suicide in 2000, neighbors, friends, family and colleagues all came bearing the same thing: food.

And when it came time for the funeral even more food descended upon the Chandler household.

“On the day our world collapsed people brought food,” Chandler recalled at a workshop on suicide awareness for faith-based leaders held in Windsor Thursday.

“Spiritually oriented people always seem to bring food when there is a death and we ended up with about three months worth the day of Jeremy’s funeral,” said Chandler, whose experience coping his son’s suicide prompted him to become an Anglican deacon in 2003, to minister to others devastated by a family member’s suicide.

His son Jeremy was 38, married, had a new baby girl, and was a successful manager at a crane company — he seemed to have it all.

But, he had always suffered from low self-esteem and most likely depression, said Chandler.

Seven months before his death Jeremy and his family had left all their family and friends in Windsor for work in Kitchener.

Jeremy hanged himself at work on a Friday. Chandler calls that day “Black Friday.”

Click here to read the rest of this article from the Windsor Star

Click here for information on depression

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May 20, 20087:21 am
posted by Aric Thorpe, MHR

A merry heart doeth good like a medicine

According to Madan Kataria, M.D., laugher may be good for you when it comes to blood pressure. During an American Society of Hypertension meeting Dr. Kataria relayed that he conducted a observational study involving 200 healthy call-center employees in India. The employees were subjected to 20-minute laughter sessions, which were associated with significant reductions in blood pressure. Laughter that qualified as beneficial was not just simple giggling but lengthy belly laughs. The following is an excerpt of an article from Medpage Today that discusses Dr. Kataria’s study:

In the study, half the volunteers participated in seven 20-minute “laugh groups” over three weeks, and the other half were randomized to a wait list and served as controls.

Mean baseline systolic pressure was 128 mm Hg in the laugh-yoga group versus 126 mm Hg in the controls. Baseline diastolic pressures were 82 mm Hg in both groups. Stress was assessed at baseline and after the intervention by cortisol level, as well as by the Positive and Negative Stress Scale and the Perceived Stress Scale.

After the treatment, mean systolic pressure decreased by about 7 mm Hg in the laugh group versus no change in the control group (P<0.01) and diastolic pressure decreased by 3 mm Hg versus no change in the control group (P<0.05), Dr. Kataria said.

Laughter, he said, was an antidote to stress and “these IT workers, although healthy, have very stressful jobs.” He noted that laughter was also associated with a significant reduction in cortisol levels (P<0.001).

At the same time, participants in the laugh group had an 18% improvement in positive emotions and a 28% reduction in negative emotions (P<0.001 for both) and a significant reduction in perceived stress scale score (P<0.01).

Click here to read the rest of this article from Medpage Today

Accompanying scripture: Proverbs 17:22- “A merry heart doeth good like a medicine: but a broken spirit drieth the bones.”

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May 19, 20087:20 am
posted by Aric Thorpe, MHR

Bipolar disorder is often misdiagnosed

According to a recent study published in the Journal of Clinical Psychiatry, bipolar disorder is often misdiagnosed. In many the disorder has gone unrecognized; however, according to Mark Zimmerman, M.D., of Brown University, a gross amount are diagnosed who do not have the condition. According to the study, out of 145 psychiatric outpatients who had been previously diagnosed with bipolar disorder 56.6% were judged as not having the disorder after undergoing a Structured Clinical Interview per the DSM-IV. Additionally, out of 555 other patients that had not been diagnosed with bipolar, 27 actually had the condition. The following is an excerpt of an article from Medpage Today that attempts to shed light on why bipolar disorder is so often misdiagnosed:

Dr. Zimmerman blamed the overdiagnosis of bipolar disorder on drug companies and others seeking to reduce under-diagnosis, which he said was also a real problem.

“I think there has been a marketing campaign and it has had an impact,” Dr. Zimmerman said.

Noting the frequency with which patients ask if they are bipolar, he added, “I’ve never had a patient come into my office and ask, ‘Do I have borderline personality disorder?’”

The study was part of a larger investigation in which 2,500 patients presenting at an outpatient psychiatric clinic filled out questionnaires. For the most recent 700 patients, the questionnaire asked whether the patient had previously received a diagnosis of bipolar disorder.

Dr. Zimmerman acknowledged that the reliance on self-reports, without review of clinical records, was a limitation of the study.

All patients were subsequently evaluated with the Structured Clinical Interview for DSM-IV and other validated instruments.

The evaluation confirmed the diagnosis of bipolar disorder in only 63 of the 145 patients reporting a previous bipolar diagnosis.

The investigators examined family histories of those who did not have a bipolar diagnosis. They found no differences in the prevalence of bipolar disorder in first-degree relatives between those never diagnosed with the condition and those whose initial diagnosis was overturned in the structured interview.

Click here to read the rest of this article from Medpage Today

Click here for more information on bipolar disorder

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May 16, 20087:30 am
posted by Aric Thorpe, MHR

South Carolina veterans join the “old man’s crack club”

According to Diana Thorne, M.D., who treats addictions at the William Jennings Bryan Dorn VA Medical Center in Columbia, S.C., from 2000 to 2007 the number of veterans she has treated for crack cocaine addiction has dramatically increased, a population she refers to as “the old man’s crack club.” According to Dr. Thorne, “ninety percent of the patients that we see are alcoholics.” She went on to remark that until recently the second drug of choice has been marijuana at 70 to 80% consumption in the population she treats. However, it now seems that crack cocaine is the new second drug of choice with between 70 to 75% reporting use of the drug. Another surprising fact is that 14.5% of her patients did not try crack cocaine until after they were 50 years old. Dr. Thorne’s treatment population is based in a largely rural area of South Carolina and is composed of veterans of Vietnam, Korea, and World War II. The following is an excerpt of an article from Medpage Today that reviews Dr. Thorne’s findings:

The difference between South Carolina and other places where crack is a problem, she said, is that the state remains largely rural, so that her patients are not hanging around the mean streets, but are out in the countryside.

“They pay $20 for a couple of rocks and go off and smoke it under the trees,” she said.

Dr. Thorne said the ritual surrounding the drug — buying it and preparing to smoke it — is also part of the high for her patients.

Surprisingly, 17 of her patients — or 14.5% — tried crack cocaine for the first time after the age of 50, Dr. Thorne said.

An analysis of medical records showed that 44.4% of the 117 crack addicts had pain disorders, 70.9% had vascular disease, and 40.2% had hepatitis C, she reported.

Also, 59.5% had posttraumatic stress disorder, 34.2% had affective disorders, and 15.2% had psychotic disorders.

One of the study’s strengths is that it “sheds light on a group of cocaine users outside the presumed norm,” according to Petros Levounis, M.D., director of the Addiction Institute of New York at St. Luke’s-Roosevelt Hospital Center.

Click here to read the rest of this article from Medpage Today

Pastoral Action Point: One of the interesting items about this demographic is that crack cocaine use is seen in a group that would not normally be thought of as utilizing this drug, especially in the case of veterans over the age of fifty. Addictions in seemly traditional populations are not just isolated to veteran over the age of fifty in S.C.. The fact is that more often than one would assume “people” in general engage in problematic activities despite their Sunday best. I for one believe that this is why faith-based support groups surrounding addiction and other hang-ups are currently in droves in churches across the U.S..

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May 15, 20087:27 am
posted by Aric Thorpe, MHR

A story of recovery

Stories of recovery are powerful because they lend hope to those that may be in similar situations and are displays of God’s grace and love. Vera Crowl is one woman who had a seemingly promising future as a college graduate hopeful during the 1970’s. However, due to a series of ill-advised choices, she dropped out of school and began a struggle with a thirty-year addiction, which eventually led to a five-year period of homelessness. However, Vera found hope in the way of treatment, a new network of supportive friends, and through the church community. Now Vera’s life is completely different. Among her many accomplishments, the now married Vera Crowl has graduated with a bachelor’s degree in psychology from the University of Dayton. Vera relayed the joy of her graduation saying, “A lot of my professors were there and they came down out of the stands when I came down to the front… It was like this little commotion. There was so much love and they were so proud of me.” The following is an excerpt of an article from Palladium that discusses her transformation:

Vera graduated from high school with plans to study theater and music in college.

She enrolled at Southeast Missouri State College in 1971, which later attained university status while she was enrolled there.

“Nothing worked out,” Vera said. “I drank and drugged my way through college the first time. I thought it was fun, and it was just ruining everything. And I was letting it.”

Her first exposure to alcohol was actually years earlier while she was still in high school. It was then she first got drunk, although at the time she didn’t understand the consequences.

“My mother knew it when I came in,” Vera said. “And she walked up to me the next morning in the kitchen and very quietly said, ‘You don’t ever need to drink like that again.’

“I knew she was right because I felt horrible. I had a hideous hangover. I was 16, so that just felt like I was dying. But by the time I drank again, it was just fun with friends and I didn’t think about any of that.”

Instead, she carried on at college and earned 70-plus college credits before dropping out.

“In college the first time it was just a big party,” she said. “I didn’t have any trouble with the law, except I was probably carrying around illegal substances most of the time.

“I had pretty much no external consequences. The consequences were happening, but they were happening inside me and I didn’t realize it.”

Click here to read the rest of this article

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May 14, 200812:19 pm
posted by Aric Thorpe, MHR

PTSD responsive to exposure therapy

Information emerging from early results of an ongoing randomized trail show promise for exposure therapy in conjunction with virtual reality technology in veterans suffering from PTSD. According to Barbara Rotbaum, Ph.D. of Emory, the therapy appears to be responsible for substantial decreases in PTSD symptom scores. The study, which has now collected data from 22 patients and expects a total enrollment of 150 patients, found that the intensity of startle response in participants reduced by 75% after six months of treatment. The following is an excerpt of an article from Medpage Today that reviews the study:

Mean scores for the 22 patients on the Clinician Administered PTSD Scale were 83 at baseline. Among 14 patients who had completed three months in the study, mean scores declined to 60.

Two Iraq veterans who have completed a full year in the study had scores of 21, Dr. Rothbaum said.

Intensity of startle responses after six months of treatment declined 75% from baseline, she added.

All patients so far appear to have benefited to some degree from the therapy.

The drug assignments are double-blind, Dr. Rothbaum said. The blinding remains in place, so the preliminary signs of efficacy are likely due to the virtual reality therapy, she said.

The virtual reality therapy uses a head-mounted visual display, headphones, and even odor generators to recreate the traumas causing patients’ PTSD.

Dr. Rothbaum said the system can simulate urban foot patrols and Humvees traveling along a desert highway.

She showed a video clip indicating that the animated graphics are nearly as realistic as recent video games.

Click here to read the rest of this article from Medpage Today

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