Month: June 2011

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 Is it a Problematic Concept?

Mason, Ohio – June 15, 2011 – At the Annual American Psychiatric Association (APA) meeting held May 14-18, Dr. Susan L. McElroy, Chief Research Officer at Lindner Center of HOPE presented research evidence supporting the broadening of the concept of Bipolar Disorder. Colleagues Dr. Mari Maj, from Italy and Dr. Stephen Strakowski, Professor and Chair at University of Cincinnati Department of Psychiatry & Behavioral Health argued that the diagnostic criteria should not be broadened.

Susan L. McElroy, MDDr. McElroy argued that Bipolar Disorder diagnostic criteria needs to be broadened to account for the broad range of mixed states- for instance when manic and depressive symptoms co-occur and for subthreshold hypomania- hypomanic symptoms that are shorter than 4 days.

Over the last decade a number of experts in the field have encouraged expanding the diagnosis to include mood changes that are much different than the traditional classic definition-which includes episodes of major depression that last at least two weeks and periods of mania or hypomania that last at least seven or four days respectively. At the APA Conference, Ellen Frank, PhD from Pittsburgh, Pa reviewed the risks and benefits of expanding the diagnostic criteria including misdiagnosis, exposure to inappropriate medications and their side effects. On the plus side, expanding the spectrum could mean an increase in diagnosis which could potentially mean that more people who need help will receive it.

On the other side of the debate are questions concerning emergency rooms and clinics seeing many patients who say they have bipolar disorder and who are then being prescribed a large number of psychiatric drugs for vague and unclear indications.
In our next issue of The Source, Dr. McElroy will provide a definition of bipolar spectrum and will explain one of the major differences of opinion around the diagnosis. Her perspective is that widening the Bipolar Spectrum will offer more accurate diagnosis and more appropriate treatment of those with true bipolar disease.

What do you think? Join us on LinkedIn to share your thoughts and hear from your colleagues and patient advocates on this APA topic. Will the broadening of Bipolar Spectrum lead to the over diagnosis of bipolar disorder or to more accurate diagnosis and more effective treatments? How will this affect individuals with milder symptoms and those without the illness to ineffective medications with harmful side effects? Has research helped delineate the importance of DSM IV expansion? We hope to hear from you.

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Everyone experiences some level of worry or anxiety from time to time. But when that worry or anxiousness becomes overwhelming or subsists for long periods of time, there may be a deeper issue at hand.

In a given year, anxiety disorders affect roughly 18 percent of Americans over the age of 18, according to the National Institute of Mental Health (NIMH). Following are descriptions of some of the more prominent anxiety disorders:

Panic Disorder: A panic attack is a brief period of intense uneasiness, fear or distress. The duration of these attacks can range anywhere from minutes to a few hours. While the cause is not completely clear, it is thought that the tendency toward panic attacks could be genetic or linked to a traumatic occurrence in an individual’s life. Those suffering from panic disorders display an inability to properly process stressful situations and therefore react to them with a heightened sense of fear and apprehensiveness.

Obsessive-Compulsive Disorder (OCD): Those suffering with OCD are bombarded with persistent thoughts and fears usually focusing on one area. They develop repetitive behaviors in an attempt to “control” the things causing their fears, and end up becoming obsessed with their rituals.

Post-Traumatic Stress Disorder (PTSD): PTSD is the result of a terrifying or traumatic event in one’s life where they will re-experience the event and react with intense fear, anger, anxiety or even numbness. These episodes are usually brought about by exposure to a situation, thought or image reminding them of the original experience.

A combination of psychotherapy, behavior modification and medications are used for OCD treatment, PTSD treatment and the treatment of most other anxiety disorders. Mental health professionals continue to gain a better understanding of anxiety-related disorders, which has resulted in more effective methods of therapy.

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C. Stephen Edwards, Director, Adolescent Psychiatry, Lindner Center of HOPE

Teen depression is a serious problem in the United States.  One in eight teens is likely to experience depression.  Teen depression is much more than just bad moods, growing pains or even feeling down.  Depression will impact every aspect of a teenager’s life.  It can lead to problems at school and at home, drug abuse, self-loathing, and even suicide or homicide.  As a caregiver, it is vital for you to understand the warning signs of teen depression.

Here is a quick guide to the behavioral changes of which you should be aware:

  • Sadness or Hopelessness
  • Irritability, Anger or Hostility
  • Frequent Crying
  • Loss of Interest in Favorite Activities
  • Changes in Sleeping or Eating Patterns
  • Restlessness or Agitation
  • Feelings of Worthlessness or Guilt
  • Fatigue or Lack of Energy
  • Difficulty Concentrating
  • Thoughts of Death or Suicide

When evaluating your teen or a teenager you love, consider how long these symptoms have been present, how severe the symptoms are and how much the teen’s behavior changed.

Do not assume your teen will show the same depression symptoms as an adult, as this mental illness will present itself in very different ways depending upon the age of the sufferer.  Teens are more likely to show irritability or anger instead of sadness, and may become grumpy or easily frustrated.  Teen depression can also manifest with unexplained aches and pains.   Be aware of any headaches or stomachaches that are not able to be attributed to a physical ailment.  Depressed teens will show an extreme sensitivity to criticism.  They have feelings of worthlessness, which makes them more vulnerable to criticism, rejection and failure.

If you know a teen who is exhibiting these symptoms, you can help them find treatment.  Start by talking with the teen.  Express your concerns in a comforting, non-judgmental way.  Talk about specific behaviors and why those behaviors are concerning to you.  Visit a doctor and have your teen screened for depression.  This screening will include a physical exam and blood test to rule out any medical reasons that the teen may be experiencing symptoms of depression.

If there are no physical reasons for the symptoms, ask the doctor to refer you to a specialist.  Make sure you get the teen’s input.  Your teen is an important part of this decision.  He or she needs to feel comfortable with the specialist and the treatment setting or it will not help the recovery process.  It is imperative to find someone with whom your teen can connect.  Don’t be afraid to explore a variety of treatment options – from one-on-one therapy or group therapy to medication – until you find what works best.

Never be afraid to talk with your teen about depression!  In many cases, families are unaware of the symptoms of depression and they can easily miss the subtle signs.  Many parents and caregivers can mistakenly assume their teen will show the same symptoms as an adult.  Instead, learn the unique signs and symptoms of teen depression – it could mean the difference between life and death!

 

C. Stephen Edwards, Director, Adolescent Psychiatry, Lindner Center of Hope is the author of this article on mental health clinics, teen depression and mood disorders.  Dr. Edwards is board certified in general psychiatry, child and adolescent psychiatry and board eligible in pediatrics. As Director, Adolescent Psychiatry at Lindner Center of HOPE he oversees the adolescent inpatient and outpatient programs. He specializes in Attention Deficit Hyperactivity Disorder (ADHD), Post Traumatic Stress Disorder (PTSD) and abuse prevention. The Lindner Center of Hope offers a level of service to patients, families and referring physicians not typically found in health care today.  The unique infrastructure provides access to cutting edge treatments years before they become widely available.