Author: pricilagran

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La gratitud de un inmigrante.

Cuando pregunté por la fecha limite para entregar esta mi segunda columna me informaron tambien que saldría publicada justo antes del dia de acción de gracias (Thanksgiving) Entonces, me parecio casi obligatorio dedicar este espacio a la gratitud, y su impacto en la salud mental.

A kilómetros de distancia de nuestro lugar de origen, los inmigrantes somos también un poco huérfanos. Migrar es también una tipo de orfandad.  Y es solo atravesando ese miedo que acompaña la falta de referentes familiares al llegar a un país distinto que podemos entonces reconstruirnos y reinventarnos como ese huerfano con desesperación que busca un nuevo hogar. Hay quienes mueren (literamente) en el intento, otros que toman la decisión de ni siquiera intentarlo, y aquellos que deciden apostarlo todo en esa nueva tierra dejando atrás su historia. Es un viaje titánico imposible de transitar en solitario. Todos podemos nombrar a un familiar, un amigo, un trabajo, un colega, un vecino que nos tendio la mano o nos facilito el hilo a la hora de tejer nuestro nuevo nido. Por eso digo que no conozco a nadie mas agradecido en la vida que a un inmigrante. Y cuando escribo pienso en mi abuelo italiano que hasta el nombre se cambio para parecer mas venezolano.

No pretendo ni espero que todos nos comportemos con ese animo “rosadamente” positivo a diario, sobretodo considerando los dolores y las cicatrices que acompañan a la orfandad. Independientemente de cual haya sido la manera o la circunstancia en la que se emigró, cada uno de nosotros lleva consigo un duelo y una melancolia que nos es única e incomparable y que tiende a hacernos mas sensibles y conscientes de lo que nos falta o de lo que hemos perdido, haciendo difícil el poder conectarnos con todo aquello que vamos reinventado en nosotros mismos y a nuestro alrededor. Mi reflexión va por el lado de compartir lo que me va pareciendo son los dos elementos claves para vivir en gratitud. Primero, la posibilidad de conservar “pequeñas expectativas”, sin que eso signifique renunciar a nuestras ambiciones  y segundo, la habilidad para vivir en el presente.  Se refiere a vivir sin dar nada por sentado. Como un aprendiz o principiante que se asombra ante cualquier vestigio de progreso en la tarea que ejecuta y que no se atormenta por aquello que debe para el dia siguiente o la semana próxima. Es poder disfrutar de un dia cálido y soleado sin atormentarse porque mañana será frio y lluvioso. Es disfrutar de la visita de un familiar o de un amigo sin contar los días para la despedida.

Muchos estudios científicos afirman que vivir en gratitud es una estrategia robusta para combatir la depresion y la ansiedad. Se trata de prestar atención a cosas que podrían pasar por insignificantes o inútiles. No hace falta hacer una lista de mercado (a menos que para usted si tenga sentido). Basta con detenerse aunque sea una vez al dia a saborear un olor, un sabor, un gesto o una sonrisa inesperada como inesperado ha sido mi propio camino para llegar a ustedes.

 

Margot Brandi, MD

Medical Director, Sibcy House

Staff Psychiatrist

Lindner Center of HOPE

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Angela Couch, RN, MSN, PMHNP-BC
Lindner Center of HOPE, Pyschiatric Nurse Practitioner

Making decisions about which medication to prescribe is a complicated process.  Janicak, et al (2006, p. 1) described the complexity of the issue fairly well,

“…while improved therapies to ease a patient’s suffering are constantly emerging, the practitioner is required to continually assimilate new information about recent advances, including novel agents targeted to affect specific components of various neurotransmitter systems, combination strategies, alternative uses of existing agents, and the specialized requirements of a growing number of identified diagnostic subgroups.”

The clinician must first have identified a valid diagnosis, and determine whether treatment with medication is indicated.  In some cases, psychotherapy alone may be an adequate treatment; whereas pharmacotherapy is less frequently an adequate treatment all by itself and is often paired with psychotherapy.  Diagnosis will somewhat narrow the field of choices, and comorbid mental health conditions must be considered as well. If the patient has more than one mental illness, it is wonderful when there is a class of medication which may be able to treat all the symptoms in one drug, but often that is not the case.  Treatment of mood disorders is often prioritized, particularly if a bipolar spectrum illness is present. For instance, though antidepressants are generally a first line treatment for anxiety related disorders, giving an antidepressant to a patient with a bipolar spectrum illness can be quite destabilizing. In that case, the mood disorder should be addressed with mood stabilizing medication prior to consideration of antidepressant use.

There are potential risks and benefits to any medication, and the clinician much consider these and discuss them with the patient. Special populations require special considerations. Treating pregnant patients, children or adolescents, the elderly, or those with certain medical conditions, may pose additional risks; this may make many medications, which might otherwise be appropriate, be contraindicated due their side effects profile.  Sometimes, the potential side effects of a given medication may be beneficial to certain patients and their mental health or other comorbid symptoms, and this may help narrow the field of choices.  During treatment, the patient is continually reassessed to determine if they continue to benefit from the medication, and whether they are experiencing any side effects that should be closely monitored or may require a treatment modification.

Patients may have had prior positive or negative experiences on medications, and this can also help drive the decision making process. For instance, this may help a clinician to decide whether to try the same or very similar medication again, or to consider changing class of medication.  Sometimes, a close family member’s prior response to medication may be considered.

Pharmacogenetic testing is a recent advancement in pharmacotherapy.  There is a lack of consensus about the value of this genetic testing.  It would be misleading to state that the genetic testing results can indicate the medication to which a patient will respond favorably.  However, it can identify whether patients may metabolize various drugs that pass through the CYP P450 system in different ways, which may impact outcomes or suggest dose modification. Also, there a limited number of medications for which the FDA has specific labelling regarding recommendations for certain types of metabolizers. So it is possible that pharmacogenetic testing would be a consideration in the decision making process, but not a required one. It is not often covered well, if at all, by insurance, and the out of pocket portion can be cost prohibitive for some patients.

Practice guidelines can be very beneficial. For instance, the APA has been developing practice guidelines since 1991, and these cover a wide range of topics, which undergo periodic updates. The guidelines are formed by work groups of actively practicing psychiatrists who are selected based on their experience in various topic areas.  Recommendations are based on evidence that includes research studies and clinical consensus.

Last but not least, cost is a factor that unfortunately must be considered for many patients.  For those that have high deductible insurances, or no insurance, many drugs may be out of reach including those that may add an extra layer of medical monitoring such as frequent laboratory testing.

In summary, decision making regarding medication choice is complex process.

References:

APA Practice Guideline Development Process (n.d.) Retrieved from:  https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/APA_Guideline_Development_Process.pdf

Janicak, P.G., Davis, J. M, Preskorn, S.H., Ayd, F.J., Marder, S.R. & Pavuluri, M.N.  (2006). Principles and practice of psychopharmacotherapy (4th ed.).  Philadelphia, PA: Lippincott Williams & Wilkins.

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Lo que fui es lo que soy….

(“What I was is what I am”. An article addressing the challenges and consequences of immigration from a social and psychological perspective and how this process ends up shaping us in multiple and unexpected ways while trying to maintain and cultivate original roots.)

Soy venezolana. Soy psiquiatra y psicoanalista. Le debo a mi país la esencia de mi formación como professional y mi Corazon latino. Finalmente, luego de mucho esfuerzo  tengo una practica solida como psiquiatria y psicoterapeuta en Mason, Ohio. Volver a estudiar fue un requisito inevitable para poder recuperar un pedazo de mi identidad perdida que no cupo en mi maleta a la hora de emigrar y que alimentaba de forma negativa a la nostalgia que no he podido sacudirme desde que llegue a los Estados Unidos de America. Desde que empece a trabajar formalmente siempre había querido encontrar una manera que me acercara a la comunidad latina y desde donde pudiese compartir mis ideas y experiencias en relación a distintos temas relacionados a la salud mental. Es una deuda pendiente con mi raiz latina. Mi intención es abrir un espacio que considero indispensable para abordar la salud mental sin tapujos ni prejuicios hasta ahora muy ligados a la manera como nuestra cultura tiende a referirse a cualquiera que sea la enfermedad mental. Todos podemos hablar con comodidad y compartir nuestra experiencia y nuestro sufrimiento físico cualquiera que este sea pero cuando se trata de nuestro sufrimiento psíquico tendemos a esconderlo o a avergonzarnos y sin darnos cuenta terminamos aislándonos y de esta forma empeorando nuestra padecer.

Así que entre mis resoluciones de ano nuevo estuvo darle inicio a esta columna y como seguramente les ha pasado a ustedes tambien con sus propias resoluciones me ha costado arrancar y con mucha suerte estarán ustedes leyéndome antes de que el ano termine…. Es decir casi con un ano de retraso en mi calendario de ilusiones.

He decidido titular mi columna “Lo que fui es lo que soy”. Es el nombre de una de mis canciones preferidas y recoje lo que a mi manera de ver es una utopia porque no es posible negar los efectos del tiempo, el espacio y la distancia en la identidad de todo emigrante pero a la vez es tambien un ancla que me permite estar atenta a la necesidad de preservar y cultivar mi identidad Latina.

No hay duda que al pisar otro pais con el proposito de emigrar se produce una division, una ruptura entre lo que dejamos atras y lo que empezamos a construir. Sin duda las redes sociales, las llamadas telefonicas, el facetime o el whatsapp sirven de cuerda que intenta mantener cierta continuidad entre estos dos mundos. Eso contando con que el internet y las telefonicas esten de nuestro lado, cosa que no es lo usual en paises como el mio.  Es una cuerda que a veces se siente floja o muy tensa dependiendo el dia y el interlocutor y caminar en ella da mucho susto por no decir vertigo y es entonces cuando empezamos a evitarla o a caminar en puntillas para que no se rompa. Nos comunicamos menos con los que quedaron del otro lado, o decimos menos omitiendo asuntos importantes por aquello de no preocupar al otro y asi sin darnos cuentas vamos perdiendo gente querida muchas veces ignorando por que.

Hace poco lei que “la emigracion distorsiona las leyes de la fisica. Es todo alucinante y un poco incomprensible”. “ Todo el que emprende el largo y azaroso viaje de la migración —que te cambia como persona, que siempre te somete a toda clase de sorpresas, que te arroja a orillas inesperadas— se convertirá en otra persona más rápida e imprevisiblemente de lo que espera y de lo que hubiera pasado en lugar de origen. Todos cambiamos, queramos o no, a medida que vivimos, pero ese cambio se dispara si nos mudamos de ciudad o de país o de continente. Así que irse implica siempre, en cualquier contexto, que te harás otra persona más pronto que tarde, y por tanto irás dejando de tener cosas en común con quienes te rodeaban en tu mundo anterior.”

Esta columna es mi intento por mantener esa cuerda firme a sabiendas de que las consencuencias de la migracion son muchas, y algunas irreversibles.  No me queda otra que hacer el intento. Tratar de dibujar en este espacio maneras de navegar entre estos dos mundos y revisar sus consecuencias en lo psicologico. En mi proxima columna explorare el tema de el duelo como proceso inevitable en toda migracion.

Margot Brandi, MD
Medical Director, Sibcy House
Staff Psychiatrist

 

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By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry

 

Innovations in Mental Health Treatment

By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry
The past year has brought exciting innovations in treatment options for people with attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD.) The U.S. Food and Drug Administration (FDA) approved the marketing of two devices which offer non-medication alternatives for the treatment of OCD and ADHD.  In August 2018, the Brainsway Deep TMS (Transcranial Magnetic Stimulation) system was approved for the treatment of OCD.  Deep TMS uses specially designed magnets to stimulate specific larger volume areas of the brain beneath the surface of the skull.  It is a non-invasive treatment that involves five 20-minute sessions per week for six weeks while sitting in a chair wearing a helmet with a sensation of tapping during the treatment.  Patients can continue medication and psychotherapy while receiving deep TMS.  According to the National Institute of Mental Health (NIMH), the lifetime prevalence of OCD among U.S. adults is 2.3% and 50% of these have had serious impairment.  Having another treatment option will bring hope to many people with severe OCD.

In April 2019, the Monarch eTNS (external trigeminal nerve stimulation) system was approved for the treatment of pediatric ADHD as monotherapy in children ages 7 through 12 years old who are not currently taking prescription ADHD medications. The Monarch eTNS System is intended to be used at home under the supervision of a caregiver when the child is sleep. The cell-phone sized device generates a low-level electrical pulse that feels like a tingling sensation and connects via a wire to a small patch that adheres to a patient’s forehead, just above the eyebrows. The system delivers electrical stimulation to the branches of the trigeminal nerve, which sends therapeutic signals to the parts of the brain thought to be involved in ADHD. The NIMH reports that the prevalence of ADHD is increasing, and severe ADHD is being diagnosed at an earlier age. This can be a treatment alternative for parents who prefer to avoid medications at an early age. Clinical response is expected in four weeks.

The mechanism of action of most antidepressants involve the neurotransmitters serotonin, norepinephrine, and dopamine. In March 2019, two antidepressants with novel mechanisms
of action were approved. Zulresso (brexanolone) was the first drug specifically approved for postpartum depression. Postpartum depression affects about 15% of women. Zulresso modulates the neurotransmitter GABA. It is administered as a 60-hour intravenous infusion in a registered healthcare facility. Symptom improvement was seen at the end of the infusion and at the end of 30-day follow-up. There has never been a medication that treats the symptoms of postpartum depression so rapidly, so this can significantly improve the quality
of life for the mother, infant, and her support system.

Spravato (esketamine) nasal spray was approved for treatment-resistant depression in conjunction with an oral antidepressant. Patients must have tried at least two antidepressant treatments at adequate doses for an adequate duration in the current depressive episode before trying Spravato. The spray must be administered in a certified medical office where the patient can be monitored. Spravato is taken twice a week for four weeks then once a week for a month, then once a week or once every two weeks. It is an antagonist of the NMDA receptor, a type of glutamate receptor. Approximately 30% of people with MDD are considered to have treatment-resistant symptoms and have the potential to benefit from esketamine.

For more information about these treatment options: https://www.brainsway.com/treatments/obsessive-compulsive-disorder 

http://www.monarch-etns.com/ 

https://www.zulresso.com/ 

https://www.spravato.com/

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By Jen Milau, APRN, PMHNP-BC
Lindner Center of HOPE,
Psychiatric Mental-Health Nurse Practitioner

 There’s no denying it: the advent of social media has changed the way we connect with one another. In some ways, these programs have offered an opportunity to locate and reconnect with lost friends or family members – a phenomenon that was not even fathomable until recent decades. However, this near-immediate accessibility of information, coupled with the rapid growth of social media sources, has not been accompanied by a “user guide” or an algorithm for appropriate and healthy incorporation into our daily lives. Instead, the technology has been thrust upon us as a society, and we have been left with the task of “figuring it out as we go.” In the field of psychiatry and mental health, we are seeing the repercussions of this in a number of unexpected ways, and those who have been hit the hardest are among our most vulnerable – children, adolescents, and young adults.

As a clinician working primarily with this population, I have been struck by the stark and abrupt increase in suicidality and mental health concerns within the last five years. According to the Centers for Disease Control, in 2017, suicide stood as a leading cause of death for individuals aged 10-34, second only to accidental injury. Just this year, the American Psychiatric Association (APA) published data Continued from page 1 which cites that “more U.S. adolescents and young adults in the late 2010s (vs. the mid-2000s) experienced serious psychological distress, major depression, and suicidal thoughts, and more attempted suicide and took their own lives… These trends are weak or nonexistent among adults 26 years old and over, suggesting a generational shift in mood disorders and suicide-related outcomes rather than an overall increase across all ages.” The specific data presented within this report reflect a 40-122% increase (depending on specific age range) in suicidality and psychological/mood disturbances among individuals age 12-25. So the question stands: why have young people been so disproportionately affected?

The answer to this is complex, and certainly not yet fully understood. It is important to first consider what we know: Adolescence is a period of significant neurochemical and biological transformation. With these physiological changes comes the development of a sense of identity – a process fueled by social interactions, sexual exploration, experimentation with interests, exposure to information, and individual expression. These facets of development have not changed by any means. Rather, the way in which today’s youth is exposed to these experiences has shifted from primarily organic, physical, human interactions to online exchanges through a variety of social media and communication apps available with a simple tap of a finger. Since this happens behind a screen, kids are not faced with the immediate implications of their words or actions, as they do not witness the non-verbal cues accompanying a person’s response, and do not experience the inevitable feeling of anxiety that goes along with confrontation or conflict in a real-time situation. They have the opportunity to carefully calculate their responses over time, or blatantly ignore a person with whom they do not want to interact, rather than being placed into a situation that requires problem-solving and relational abilities in the immediate moment. This has led to a generation of individuals who have largely avoided natural social responses; in turn, we are seeing a serious rise in the prevalence of social anxiety and kids who are devoid of many vital interpersonal skills.

Additionally, within the world of social media, we are offered the opportunity to customize our “online identities” to mirror whichever characteristics we choose to share with others. Due to our human need for acceptance and attention, this usually results in the meticulous formation of an “ideal self” – one which typically is not reflective of our inherently flawed (and beautifully unique) personalities and instead represents a false utopian identity used to highlight those traits of ourselves and our lives that we feel may be most desirable to others. As this practice becomes typical of an entire society, we begin to unconsciously accept these “pseudo-selves” as reality, leading to the habit of comparing our actual lives to those that are portrayed on the internet. This can result in significant issues with self-esteem, increased self-doubt, shame, body image concerns, and social isolation – problems which, for an individual predisposed to mental illness, could trigger a major mood episode or exacerbation of anxiety symptoms.

Further, the immediate accessibility of information to which we have become accustomed has unfortunately led to an expectation for instant feedback and gratification that is simply not applicable to most real-life scenarios. Studies suggest that the neurochemical response to “likes” on a post or picture actually mirror that which is experienced with illicit drug use or other behavioral addictions. This, then, leads to further desire to obtain more likes, and the consequent sense of disappointment and desperation when posts do not receive the attention that we were expecting.

When we view these ideas in the context of an adolescent who is developmentally tasked with the goal of exploring and forming a sense of self while also battling the physical and emotional implications of rapid growth and hormone changes, this becomes extraordinarily problematic. Many patients that I see describe feelings of worthlessness and hopelessness due to their perception that they are not as “successful” as others they see online. For a child who has endured trauma, the ability to form harmful connections with ill-intentioned adults is too readily accessible, leading to exploitation and further exacerbation of trauma-related symptoms. Children with attention issues are experiencing insomnia due to being constantly stimulated by their devices into the nights, resulting in reduced academic performance and mood dysregulation. And most importantly – families are not connecting in the ways that are imperative for fostering well-adjusted and cognitively flexible young adults.

This being said – there is certainly hope for change moving forward. As we adapt to the presence of technology within our lives, we are learning more and more about the importance of moderation in regards to screen time and devices. As a clinician, I preach to my patients and their parents about the risks of social media and unlimited time with technology and encourage open conversations regarding limits and expectations for its use. I challenge parents to model what it looks like to balance screen time and “real” time, and recommend the implementation of rules for all members of the family, not just children or adolescents. By increasing the number of organic experiences and social interactions that our children have, we are preparing them to be able to adjust to the unexpected, unpredictable twists and turns.

 

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By Anna I. Guerdjikova, PhD, MSW, LSW

“Mens sana in corpore sano” is a Latin saying from the Satires of Juvenal (ad c.60–c.130) , literally translating to ‘a healthy mind in a healthy body’ and widely used nowadays to describe the concept of wellness – the need for both physical and mental wellbeing to be present for a person to be healthy. When raising children, paying attention to both aspects of health is indeed critical to ensure their bodies and minds grow and develop to the best of their potential. The mnemonic below (BE SAFE) can help with remembering the key concepts of how to parent healthy children.

B– Build sense of belonging. Ensure that your child socializes with an appropriate peer group, that they participate in activities suitable for their age and that they learn to develop nontoxic friendships. Spending time with relatives and family friends fosters sense of security and belonging and teaches children how to nurture meaningful relationships.

E– Educate and encourage. Encourage children to develop age appropriate competencies, both social and academic. Be their role model in teaching them respect, acceptance of diversity, responsibility, accountability and kindness. Reinforce positive behaviors and decision making, encourage them to help others by setting an example (like volunteering as a family).

S– Enough sleep is absolutely critical for wellness (9-13h/ night for ages 3-12; 8-10h/ night for teenagers).1 More than 70% of children in a contemporary family get less sleep than recommended, thus improving sleep hygiene for everyone in the household can significantly boost family wellness. Help them establish and keep a regulated schedule (even on weekends and during vacations) by setting an example and discussing the benefits of good sleeping habits.

A –According to the U.S. Department of Health and Human Services guideline issued in 2018, children 6 to 17 years of age can “achieve substantial health benefits by doing moderate-and vigorous-intensity physical activity for periods of time that add up to 60 minutes or more each day”.2 Unstructured play in the park, biking, walking, and sports, both recreational and competitive, they all count.

F –Appropriate food choices with up to 5 servings of fruits and veggies per day and at least a few family meals a week. Frequent family meals increase the odds of child positive social skills and engagement in school, and decrease the likelihood of child problematic social behaviors3; they also have protective effect on the mental health of adolescents, particularly for depressive symptoms in girls. 4

E -Limit use of electronics. In 2016, the American Pediatric Association issued recommendations regarding screen time use and while they vary by age group, the overarching idea with older children is to “balance media use with other healthy behaviors”. 5 For children younger than 18 months the use of screen media other than video-chatting, should be altogether avoided.

Raising healthy children is hard. Raising healthy children when the parent struggles with mental illness can be particularly challenging; it is of paramount importance for them to seek professional help, but to also solicit support for daily logistics from friends and family. The old African proverb “It takes a village to raise a child” is especially relevant when one or more members of the family are suffering with mental illness, thus actively requesting help, practicing self-care and knowing one’s limitations can improve the wellness of the entire family.

  1. https://edubirdie.com/articles/american-academy-of-pediatrics-announces-new-recommendations-for-childrens-media-use/
  2. J Fam Psychol. 2014 Aug;28(4):577-82. doi: 10.1037/fam0000014. Frequency of family meals and 6-11-year-old children’s social behaviors.Lora KR, Sisson SB, DeGrace BW, Morris AS
  3. J Nutr Educ Behav. 2017 Jan;49(1):67-72.e1. doi: 10.1016/j.jneb.2016.09.002. Family Meals and Adolescent Emotional Well-Being: Findings From a National Study. Utter J1, Denny S, Peiris-John R, Moselen E, Dyson B, Clark T.

120 Tools and Tricks to Protect Your Kids Online

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Lindner Center of HOPE continues to lead fight against mental illness

Celebrates 11th anniversary with groundbreaking fundraising event

Mental illness is our country’s #1 health problem. This was recognized more than a decade ago by philanthropists and mental health pioneers Craig and Frances Lindner when they founded the Lindner Center of HOPE in August 2008.

Fast forward to today — Lindner Center of HOPE clinician-scientists have helped more than 40,000 patients from around the world, published more than 825 scientific articles, and was instrumental in bringing six new drugs to market for depression, bipolar disorder and eating disorders to improve clinical outcomes and safety.

Lindner Center of HOPE marks anniversary with fundraiser

To recognize these accomplishments, the Center marked its 11th anniversary by hosting a groundbreaking fundraiser using the Beatles mantra “Come Together” to benefit the Lindner Center of HOPE’s fight against mental illness.

“This event is a rare opportunity to bring together people across the region in support of one issue — mental health” said Craig Lindner. “By ensuring our community leaders are aware of the reality of the  mental health crisis, with both its human and local impact, we can come together to make Cincinnati the success story for fighting mental illness.”

Nearly 600 guests attended the fundraiser, raising more than $3.8 million for the Center. The evening included a live performance by Rain: A Tribute to the Beatles, fireworks and a presentation of the Mental Health Advocacy Award to Linda and Harry Fath, local philanthropists who in December 2017 made an unprecedented pledge to the Center to fight mental illness.

“Mental illness is our nation’s number one health problem: two and a half times more Americans suffer from mental illness than cancer, heart disease, and diabetes combined,” remarked Paul E. Keck Jr., MD, president and CEO of Lindner Center of HOPE at the event. “Mental health is a lifelong journey but the beauty of what we do is that we can help most people get well. We can change the path they’re on. As our name says, we can give them hope, the hope that they may not find anywhere else.”

 Leading the fight against mental illness
The donations and pledges have begun to open doors to new mental health advancements and to add mental health professionals to improve access and making Cincinnati a hub for mental healthcare.  Learn more about the Center’s offerings at LindnerCenterofHope.org.

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 Lindner Center of HOPE Announces Promotions

Talented Staff Members Grow in Leadership Roles.

MASON, Ohio – Lindner Center of HOPE, a leading provider of mental health care, is pleased to announce the promotions of the following individuals who are poised to continue to lead the organization into the future:

Paul Crosby, MD has accepted the position of Chief Operating Officer and will also take on the new role of Chief Clinical Officer. Dr. Crosby joined the Lindner Center of HOPE as a staff psychiatrist, as the Center opened to patients in 2008.In 2016, he was promoted to the role of Chief Medical Officer, in which he demonstrated great leadership. He will continue to support many service areas at Lindner Center of HOPE with responsibility for overall organizational growth and success.
Danielle Johnson, MD, FAPA has accepted the position of Chief Medical Officer. Dr. Johnson has been on the medical staff at Lindner Center of HOPE since 2008. In recent years, she has served as the Chief of Adult Psychiatry.
Mikaela Delyons, DNP, MSN, RN has accepted the position of Director, Residential Services, maintaining oversight of residential admissions. Her most recent role at Lindner Center of HOPE was Manager of Lindner Center of HOPE’s Access and Referral Center.
Marie Rueve, MD, has agreed to serve as Chief of Adult Psychiatry. Dr. Rueve joined Lindner Center of HOPE in 2017 as Medical Director of Sibcy House, an adult residential diagnostic and intensive treatment unit.
Margot Brandi, MD, has agreed to serve as Medical Director of Sibcy House. She joined Lindner Center of HOPE in 2017 as a staff psychiatrist and attending physician on the residential units.
Laura Yard, MD, has agreed to serve as Medical Director of Addiction Services at HOPE Center North. A recent addition to the medical staff, she has enthusiastically accepted more leadership responsibility.

Jan Marhefka, MSN, RN, has agreed to serve as Director of Nursing-Inpatient/ARC/Welcome Center.

 

 

Rick Webb has agreed to serve as Director of Plant Operations and Maintenance.

 

 

 

 

Marty Stephenson has agreed to serve as Program Director, HOPE Center North.
Tracy Cummings, MD has agreed to serve as Chief of Child and Adolescent Psychiatry.

 

About the Lindner Center of HOPE

Lindner Center of HOPE in Mason is a comprehensive mental health center providing patient-centered, scientifically advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic and short-term residential services for adults, outpatient services for substance abuse through HOPE Center North location and co-occurring disorders for adults and research. The Center is enhanced by its partnerships with UC Health and Cincinnati Children’s Hospital Medical Center as their clinicians are ranked among the best providers locally, nationally and internationally. Learn more at LindnerCenterofHope.org.

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By Nicole Bosse, PsyD
Lindner Center of HOPE, Staff Psychologist

What is panic disorder? Panic disorder consists of recurrent unexpected panic attacks, specifically a spike of intense anxiety
or discomfort that reaches a peak in minutes that is followed by four or more of the following symptoms: racing heart/palpitations, sweating, trembling/shaking, shortness of breath, feelings of choking, chest pain or discomfort, nausea, dizziness, chills or heat sensations, numbness or tingling in the hands or feet, derealization, fear of losing control or going crazy, and fear of dying. This has to occur in combination with fear and worry about having additional attacks, and a significant change in behavior related to the attacks, such as avoiding situations or activities that might bring on panic.

When treating panic disorder, it is treated mostly from a cognitive behavioral approach. The cognitive piece targets the person’s misappraisals about the panic. Individuals with panic disorder tend to overestimate the likelihood of panic occurrence, underestimate one’s ability to cope with panic, and exaggerate the negative consequences of panic attacks.

By helping the individual to identify the misappraisals and working on challenging them, individuals are less fused with their thoughts and can start to think differently about things rather than buy into their thoughts as facts.

The behavioral piece of the approach involves exposure therapy, specifically exposure to what situations they avoid, but also interoceptive exposures. Interoceptive exposures involve gradually exposing oneself to the physical sensations of the panic attack that are feared. Working with a therapist to identify the exposures that rank from low to high is important. Once this is identified, the patient and therapist work from the least distressing to the most distressing. The following are some examples of possible interoceptive exposures:

* Running in Place

* Holding breath

* Head shaking (side to side)

* Spinning in a chair

* Mirror staring

* All over muscle tensing

* Straw breathing

* Over breathing

* Head between legs

The therapist and the individual work to complete just one of these exposures, five times during the day for about 30-60 seconds. This is done repeatedly every day until the person habituates to that sensation before moving on to the next exercise.

 

Another exposure idea that is sometimes used is pretending to actually have a panic attack in a public area. This strategy is brought in when the person’s fear centers around the social consequences of having a panic attack, such as not wanting others to crowd around them or being embarrassed. For example, I have suggested that individual’s go to a store and practice sitting down somewhere to pretend they are dizzy or cannot catch their breath. This is a great strategy for teaching the person that what they typically fear in that situation is not as bad as they make it out in their mind. It actually usually ends up being pretty uneventful.

 

Exposures for the avoidance of situations is a little more specific for the person and their unique avoidances. Some common examples of avoidance that I have come across are the following: avoiding caffeine, avoiding intense exercise that increases their heart rate, avoiding being in a car, avoiding driving, avoiding going into stores, avoiding traveling far distances from one’s house, avoiding going places alone, avoiding going places without safety items (i.e., water, benzodiazepine, food, etc.), and avoiding places where the amount of time being there is uncertain (i.e., waiting in lines, sitting down at a restaurant, etc.)

Once the individual’s unique avoidances are identified, the therapist and individual work to create another hierarchy, ranking from low to high distress. For example, if someone avoids going certain distances from their house, some exposures could consist of walking down the street and gradually increasing the distance. A similar strategy could also be used for driving, gradually increasing the distance of driving from a person’s house. Similarly, for line waiting, the individual could practice waiting in lines and gradually increase the amount of time they wait in line, working up to actually waiting in the entire line and being uncertain of when it when it will end.

As you can see by the above described therapy, the main component is facing what the individual fears and letting the body learn that their anxiety will decrease without having to escape the situation. Panic disorder is a very treatable disorder, especially when engaging the correct therapy for it and when combined with the appropriate medication.

 

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 Innovations in Mental Health Treatment

By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry

The past year has brought exciting innovations in treatment options for people with attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD.) The U.S. Food and Drug Administration (FDA) approved the marketing of two devices which offer non-medication alternatives for the treatment of OCD and ADHD.  In August 2018, the Brainsway Deep TMS (Transcranial Magnetic Stimulation) system was approved for the treatment of OCD.  Deep TMS uses specially designed magnets to stimulate specific larger volume areas of the brain beneath the surface of the skull.  It is a non-invasive treatment that involves five 20-minute sessions per week for six weeks while sitting in a chair wearing a helmet with a sensation of tapping during the treatment.  Patients can continue medication and psychotherapy while receiving deep TMS.  According to the National Institute of Mental Health (NIMH), the lifetime prevalence of OCD among U.S. adults is 2.3% and 50% of these have had serious impairment.  Having another treatment option will bring hope to many people with severe OCD.

In April 2019, the Monarch eTNS (external trigeminal nerve stimulation) system was approved for the treatment of pediatric ADHD as monotherapy in children ages 7 through 12 years old who are not currently taking prescription ADHD medications. The Monarch eTNS System is intended to be used at home under the supervision of a caregiver when the child is sleep. The cell-phone sized device generates a low-level electrical pulse that feels like a tingling sensation and connects via a wire to a small patch that adheres to a patient’s forehead, just above the eyebrows. The system delivers electrical stimulation to the branches of the trigeminal nerve, which sends therapeutic signals to the parts of the brain thought to be involved in ADHD. The NIMH reports that the prevalence of ADHD is increasing, and severe ADHD is being diagnosed at an earlier age. This can be a treatment alternative for parents who prefer to avoid medications at an early age. Clinical response is expected in four weeks.

The mechanism of action of most antidepressants involve the neurotransmitters serotonin, norepinephrine, and dopamine. In March 2019, two antidepressants with novel mechanisms of action were approved. Zulresso (brexanolone) was the first drug specifically approved for postpartum depression. Postpartum depression affects about 15% of women. Zulresso modulates the neurotransmitter GABA. It is administered as a 60-hour intravenous infusion in a registered healthcare facility. Symptom improvement was seen at the end of the infusion and at the end of 30-day follow-up. There has never been a medication that treats the symptoms of postpartum depression so rapidly, so this can significantly improve the quality of life for the mother, infant, and her support system.

Spravato (esketamine) nasal spray was approved for treatment-resistant depression in conjunction with an oral antidepressant. Patients must have tried at least two antidepressant treatments at adequate doses for an adequate duration in the current depressive episode before trying Spravato. The spray must be administered in a certified medical office where the patient can be monitored. Spravato is taken twice a week for four weeks then once a week for a month, then once a week or once every two weeks. It is an antagonist of the NMDA receptor, a type of glutamate receptor. Approximately 30% of people with MDD are considered to have treatment-resistant symptoms and have the potential to benefit from esketamine.

For more information about these treatment options: https://www.brainsway.com/treatments/obsessive-compulsive-disorder 

http://www.monarch-etns.com/ 

https://www.zulresso.com/ 

https://www.spravato.com/