Author: pricilagran

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By Nicole Mori, RN, MSN, APRN-BC, Research Advanced Practice Nurse

The use of dietary supplements or vitamins for the treatment of depressive symptoms is increasingly common among patients. Factors driving this trend include unsatisfactory response with standard treatments, adverse drug events, skepticism about psychiatric medications and the perception of dietary supplements as “natural” and safe.

Although evidence increasingly supports the relationship between quality of diet and mood, more research is needed to clarify the role of dietary supplements in the management of depression. Consumers often take supplements based on inconclusive data from small, methodologically-flawed studies. Unlike FDA-approved drugs, supplements do not have to demonstrate unequivocal evidence for efficacy or safety. Adulteration, contamination, variations in potency, and product instability are not uncommon. When treating depressed patients, it is important to ask about use of dietary supplements and to be ready to offer guidance regarding the evidence for potential benefits, possible risks and drug-supplement interactions. The following are commonly-used supplements with a potential effect on depressive symptoms.

Omega 3 polyunsaturated fatty acids: Eicosapentanoic acid (EPA) and Docosahexaenoic acid (DHA)

Omega 3 fatty acids are long chain lipids found in oily fish. High dietary intake has been associated with low rates of depression. Omega 3 fatty acids enhance neurotransmission, neurogenesis and reduce inflammation. There is support for supplementation in Major depression with several meta-analyses showing efficacy. There is some evidence for efficacy of omega 3 fatty acids for bipolar depression. Over the counter products vary greatly in composition and EPA/DHA ratio. Evidence supports the use of EPA-dominant formulations. Adverse events and drug interactions are uncommon, but risk for excessive bleeding must be considered. Dose 1-2g of EPA/day.

Folic acid and Methylfolate

Involved in dopamine, serotonin and norepinephrine synthesis. Folate deficiency has been associated with increased risk for depression. Evidence supports adjunctive use of methylfolate with antidepressants for the reduction of Major depression symptoms. An FDA approved formulation of l-methylfolate available by prescription has shown efficacy at the 15mg/d dose level. Evidence for the efficacy of folic acid and Depression is mixed and there is no evidence supporting the use of either folate or methylfolate in Bipolar depression. Methylfolate is usually well-tolerated, although there are concerns about use masking B12 deficiency and historical concerns about cancer. Routine folate supplementation >1g/d is not recommended. l-methylfolate dosage is 7.5-30mg/day, maximum 1g/day (folate).

S-adenosylmethionine (SAMe)

An endogenous aminoacid involved in neurotransmitter synthesis. Decreased serum and CSF levels are associated with depression. A few studies support efficacy for supplementation in Major depression but more research is needed.  There is no data to support use of SAMe in bipolar depression. Adverse events include nausea and anxiety. May interact with serotonergic antidepressants and increase risk for manic and hypomanic episodes in Bipolar disorder. Dose 200-800 twice/day.

Vitamin D

Low serum concentrations have been associated with depression. Vitamin D acts as a receptor ligand in the prefrontal cortex and hypothalamus. Some evidence supports supplementation for reducing symptoms in clinically-depressed patients but further research is needed. Evidence does not support supplementation as a therapy for bipolar depression.  Caution regarding risk for hypercalcemia and toxicity with excessive intake. Dosing varies.

N-acetylcysteine (NAC)

Available as a nutritional supplement and as prescription medication for treating acetaminophen overdose. NAC has antioxidant and anti-inflammatory properties and modulates the glutamate pathway.  Some evidence for reduction in bipolar depression symptoms. Not effective in Major depression. Gastrointestinal upset may occur. Dosing 1-1.5g twice/day.

St. John’s Wort

A perennial herb containing active compound hypericin, which inhibits reuptake of dopamine, norepinephrine and serotonin. Some support for short-term efficacy in depressive symptoms, but more long term and safety data is needed. Significant risk for drug interactions due to interaction with serotonergic drugs (serotonin syndrome) and interference in the metabolism of hundreds of drugs by induction of Cytochrome P450 enzymes make this an undesirable adjunctive option. Dosing varies due to variability in potency.

Probiotics

Alterations in intestinal flora have been implicated in mood disorders, although the mechanism is unclear. Probiotic supplements are thought to impart a health benefit by optimizing intestinal flora and are used to manage gastrointestinal symptoms. Animal studies show blunting in inflammatory response and improvement in mood symptoms with supplementation, but few clinical trials yielded positive results. Products on the market vary in terms of bacterial strain content, stability and bioavailability. Adverse events are rare, except for opportunistic infection immunocompromised individuals. Dosing varies.

There isn’t a one size fits all or best supplement for depression. There are some benefits to adding in supplements for depression symptoms and in other areas more research is needed. Be sure to work with a medical professional and consider the potential benefits, possible risks and any drug-supplement interactions for medications you may already be taking.

If you are seeking help for your depressive symptoms, contact us at the Lindner Center of HOPE. There is HOPE.

 

References

Sarris J, Murphy J, Mischoulon D, et al. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. Am J Psychiatry. 2016;173(6):575-87. Nahas, R., & Sheikh, O. (2011).

Complementary and alternative medicine for the treatment of major depressive disorder. Canadian Family Physician, 57(6), 659–663.

Sarris J. Clinical use of nutraceuticals in the adjunctive treatment of depression in mood disorders. Australas Psychiatry. 2017;:1039856216689533.

Rakofsky JJ, Dunlop BW. Review of nutritional supplements for the treatment of bipolar depression. Depress Anxiety. 2014;31(5):379-90.

 

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Touchdown for HOPE Scheduled for Sunday, February 4, 2018

Mason, OH –The ninth annual Touchdown for HOPE Super Bowl Sunday event will take place Sunday, February 4, 2018, starting with tailgating at 5:30 p.m. and with Super Bowl kick-off at 6:30 p.m., at the Great American Ballpark Champions Club.

Proceeds from Touchdown for HOPE will be used to support Lindner Center of HOPE’s cutting edge research, in addition to providing funding for acquiring new technology for mental health treatment.

The Research Institute at Lindner Center of HOPE has been instrumental in advancing the field of mental health treatment, funds from the event will help support continued efforts. Likewise, technology has the opportunity to advance patient care and improve access, funds from the event will be used to support these initiatives.

Touchdown for HOPE is a classy and fun Super Bowl party with big screen televisions, plush seating, and signature Cincinnati food favorites and other upscale tailgate-style treats. All taking place in a sports fan’s dream location –overlooking the baseball field.  Tickets are $125 per guest, but a young professional’s ticket, for those 35 and under, is priced at $75. Tickets purchased on or before January 15, will receive a discount. Reservations include free parking in Central Riverfront Garage and food and beverages.

Anthony and Dede Muňoz are Honorary Chairs, while Mike Glen is Touchdown Team Captain.

Event details:

Location: Great American Ballpark, Champions Club, 100 Joe Nuxhall Way.

Date: February 4, 2018; 5:30p.m., 6:30 p.m. kick-off

Tickets: $125; $75 young professional’s ticket (Pre-Season prices on or before January 15 are $100 per person and $65 per young professional)

Register on-line at https://lindnercenterofhope.org/donate/touchdown or call 513-536-0328.

A generous list of sponsors makes this event possible. Sponsorship opportunities are still available.

 

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, 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 and adolescents, outpatient services for substance

abuse through HOPE Center North location and co-occurring disorders for adults and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

(l-r) Marjorie Hulgrave, Albert Hulgrave, Frances Lindner and Craig Lindner attended Touchdown for HOPE.

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Free Community Education Series Offered the Third Wednesday of Every Other Month

The first session of a new, free education series to help community members increase awareness of mental health, substance use disorders, treatment and strategies for coping is February 21, 2018. Chris Tuell, EdD, LPCC-CS, LICDC-CS, Clinical Director of Addiction Services, Lindner Center of HOPE, will present The Addicted Brain and the Relationship with Mental Illness.

Lindner Center of HOPE with the support of Manor House in Mason, Ohio is once again offering a Free Community Education Series to increase awareness of mental health issues and substance use. The series offers expert discussion of Mental Health, Substance Use Disorders, Treatment and Strategies for Coping for community members seeking information.

The series is held at Manor House, 7440 Mason-Montgomery Rd., Mason at 6 p.m. the third Wednesday of every other month.

Register by calling Pricila Gran at 513-536-0318. Learn more by visiting lindnercenterofhope.org/education.

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, 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 and adolescents, outpatient services for substance abuse through HOPE Center North location and co-occurring disorders for adults and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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Ranking Places Four Lindner Center Doctors at the Top Locally

The Frances and Craig Lindner Center of HOPE is pleased to announce the following doctors were ranked among the best doctors in the nation and among the top specialists in the Tri-State as indicated by The Best Doctors in America 2017-2018 database. As selected by their peers, 479 specialists from the Tristate were included in the listing published in Cincy Magazine’s December 2017/January 2018 issue:

Paul E. Keck, Jr., M.D., President-CEO, Lindner Center of HOPE, is a nationally renowned psychiatrist and researcher in Bipolar Disorder and psychopharmacology. He authored over 525 scientific papers in leading journals and was the 7th most cited scientist in the world published in the fields of psychiatry and psychology over the last decade.

Michael A. Keys, M.D., Dr. Keys is a regionally known and respected expert in Geriatric Psychiatry. He currently serves as a Senior Adult Psychiatrist (part-time) at the Lindner Center of HOPE. He is also a member of several national and international psychiatric associations and editorial boards.

Susan L. McElroy, M.D., A nationally recognized researcher and educator, Dr. McElroy is internationally known for her research in bipolar disorder, eating disorders, obesity, impulse control disorders and pharmacology. As Chief Research Officer for the Lindner Center of HOPE, she currently oversees multiple ongoing studies in bipolar disorder, major depression, binge eating disorder and obsessive compulsive disorder.

This is the seventh consecutive year these doctors were included in this database. All three physicians hold faculty appointments with the University of Cincinnati College of Medicine and are part of UC Physicians.

Joining the list for the second year is:

Brian P. Dowling, M.D., a highly regarded psychiatrist in the Cincinnati area, who focuses on maximizing time with his patients in order to truly understand their individual stories attempting to offer them hope and a sense of possibility. Dr. Dowling is the Director of Medical Education at Lindner Center of HOPE.

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, 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 and adolescents, outpatient services for substance abuse through HOPE Center North location and co-occurring disorders for adults and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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Two of the Largest Mental Health Donations Ever Received in North America Will Fund Clinical, Research, Capital and Education Initiatives

Mason, OH – Dec. 18, 2017 – Lindner Center of HOPE, a nonprofit comprehensive mental health center serving people from around the world, today received commitments totaling $75 million to enhance treatment for people with mental health disorders and reduce the stigma associated with mental illness.

Cincinnati business leaders and philanthropists Linda and Harry Fath have pledged a $50 million challenge gift, while Frances and Craig Lindner have made a $25 million commitment in response to this challenge. The gifts, to be given over their lifetimes, are the largest ever received by the Center, and two of the largest in North America made by individuals in the area of behavioral health.

The gifts underscore the Center and the Cincinnati region as national leaders in mental health care.  The need is critical as mental health disorders affect more people nationally than cancer, heart disease, and diabetes combined.1 However, research and access to treatment are severely underfunded in comparison.

“My family believes in the power of the Lindner Center of HOPE’s diagnostic and treatment programs to help people who have lost hope,” Mr. Fath said. “It is time to break the silence associated with mental health and recognize much more must be done to understand, treat, and care for people with mental illnesses.

“We would like to challenge the community to match our gifts,” Mr. Fath continued. “Our hope is that over time we will raise well in excess of the $75 million announced today. This would truly put the Center in a position to accomplish the original dream of establishing the nation’s leading comprehensive facility for mental health care.”

The Faths have devoted their time, talent, and resources to causes benefiting Greater Cincinnati and the world.  Mr. Fath, a lawyer and entrepreneur, is owner of Fath Properties, a real estate management firm.

“Frances and I were so moved by the incredible generosity of Linda and Harry Fath that we have decided to contribute an additional $25 million to the endowment fund,” said Mr. Lindner, who founded the Lindner Center of HOPE along with his wife, Frances.  “Our hope is that others will join us in the effort to help more people on the road to mental wellness through the Lindner Center of HOPE.”

Mr. Lindner, co-CEO and co-president, American Financial Group Inc., is the board chair of the Lindner Center of HOPE.  In the decade since its founding, the Center has served nearly 30,000 patients from around the world and earned “Top Performer on Key Quality Measures®” recognition from The Joint Commission.

The Lindner Center of HOPE will honor the Faths’ extraordinary generosity by naming:

  • The Chief Research Officer, Director of the Research Institute position: The Linda and Harry Fath Professor of Psychiatry
  • Both of its inpatient units as:
    • The Linda and Harry Fath Young Adult Inpatient Unit
    • The Linda and Harry Fath Adult Inpatient Unit
  • The endowment fund as: The Linda and Harry Fath Endowment

Commitments to Support Clinical, Capital and Public Education Programs

“One in five American adults experiences a mental illness.2 It is the leading public health issue in our community and our nation,” said Paul E. Keck, Jr., MD, president and CEO of the Lindner Center of HOPE.  “The Faths’ and Lindners’ generosity will kick-start our ability to enhance our staff, develop new treatment programs, and expand our research efforts to break new ground in mental health treatment.”

The funding will support the development and expansion of new clinical programs to provide treatment for conditions including depression, schizophrenia, bipolar, substance use, and eating disorders.  It will help fund research, professional education, and capital improvements at the Center.

A portion of the gifts will be earmarked to provide patient financial assistance and public outreach to reduce stigma.  According to Dr. Keck, significant challenges still exist to fight the stigma associated with mental illness, including in the level of reimbursement provided by the federal government and private insurance carriers.

A National Center of Excellence

The Lindner Center of HOPE is a charter member of the National Network of Depression Centers. Its Research Institute is a lead contributor in groundbreaking programs, such as the Mayo Clinic’s Individualized Medicine Biobank for Bipolar Disorder, which is studying the connection between gene types and medicines that treat disease.

“Through these lead gifts, the Faths and Lindners are inspiring everyone with a passion to improve mental health care to join them in supporting Lindner Center of HOPE,” said Dr. Keck. “This is not a conclusion but a beginning.  Together, we can ensure that people have access to life-changing care now and into the future.”

 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 and adolescents, 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.

#  #  #

1     Scientific American, July 14, 2017. https://blogs.scientificamerican.com/observations/mental-illness-is-far-more-common-than-we-knew/

2     National Association on Mental Illness https://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf

          

 

 

Click here to view video of announcement.

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At a reception on October 25, Paul Houser, MD, Lindner Center of HOPE, Medical Director of the Harold C. Schott Foundation Eating Disorders Program, was recognized as a 2017 Honoree among Rising Star Medical Leaders. The honor was presented by Venue Magazine and John D. Dovich & Associates, LLC at Mad Tree Brewery with guest speaker Kristen Schlotman, Executive Director of Film Cincinnati

.

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Free Community Education Series Addresses Substance Use Disorders, Behavioral Addictions, Treatment and Strategies for Coping

The tenth and final session of this free series to help increase understanding of addictions is November 15, 2017. William Jason Thompson, LISW-S, LICDC-CS, Lindner Center of HOPE, therapist, will present Information on Identifying and Treating Adolescent Substance Use Disorders.

Lindner Center of HOPE with the support of Manor House in Mason, Ohio has offered a Free Community Education Series in 2017 on topics related to addiction. The series offered expert discussion of Substance Use Disorders, Behavioral Addictions, Treatment and Strategies for Coping for community members seeking information.

The series is held at Manor House, 7440 Mason-Montgomery Rd., Mason at 6 p.m.

Register by calling Pricila Gran at 513-536-0318. Learn more by visiting lindnercenterofhope.org/education.

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, 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 and adolescents, outpatient services for substance abuse through HOPE Center North location and co-occurring disorders for adults and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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By Anna I. Guerdjikova, PhD, LISW, CCRC

Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program

University of Cincinnati, Department of Psychiatry, Research Assistant Professor

We spend about one third of our lives sleeping, yet more than one third of Americans do not get enough sleep. Adults, ages 18-60, are recommended to get between seven to nine hours of sleep each night. The need for sleep varies in children and teenagers, with 13-17 years olds needing eight to ten hours per night for optimal wellness. Getting adequate sleep each night is mandatory for maintaining one’s overall mental and physical health and insufficient sleep is associated with a number of chronic diseases and conditions including diabetes, cardiovascular disease, decreased sex drive, obesity, depression and even increased thoughts of suicide and death. While its exact biological purpose remains unclear, sleep is found to be crucial for proper nerve cell communication and possibly plays a housekeeping role in removing toxins that build up in the brain when awake.

Insomnia is a sleep disorder that can make it hard to fall or to stay asleep, or causes early awakenings and inability to get back to sleep. Insomnia is common (6-10% of population struggles regularly with at least a few insomnia symptoms) but it remains under recognized and under treated. According to recently published guidelines from the American Academy of Sleep Medicine (1), psychological and behavioral interventions are effective and recommended in the treatment of chronic primary and comorbid (secondary) insomnia and should be utilized as an initial inter­vention when appropriate and when conditions permit. Cognitive behavioral therapy for insomnia (CBT-I), for example, is a structured program and an effective, non-medication treatment for chronic sleep problems. CBT-I teaches identification of thoughts and behaviors that cause or worsen sleep problems and encourages habits that promote healthy sleep. Some basic techniques used in CBT-I reinforce good sleep hygiene that can be easily implemented if one struggles with poor sleep are described below:

  • “Yes” to fixed bedtime and an awakening time through the week- establishing a consistent sleep routine and allowing for no more than 30min variation, including on weekends, will reteach the body to “get used” to falling asleep at a certain time.
  • “Yes” to sleep rituals -from relaxing stretches or breathing exercises, reading something light, meditating, or taking a hot bath to sitting calmly with a cup of caffeine-free tea, pre-sleep rituals can vary, but are needed to break the connection between all the intensive daily activities and bedtime. The sleep rituals might be equally important for enhancing healthy sleeping in both children and adults.
  • “Yes” to using a sleep diary. Tracking amount and quality of sleep can be a very helpful tool in establishing realistic goals and following progress when working on improving sleep.
  • “Yes” to comfortable bedding, moderate room temperature, limited excess noise and a well ventilated room.
  • “No” to naps: avoiding activities/ taking naps because of tiredness or poor sleep the previous night perpetuates the insomnia issues. If a nap is needed, limiting it to no longer than 30 minutes, before 3pm, is recommended.
  • “No” to caffeine 4-6 hours before bedtime, including caffeinated beverages like tea, many sodas and chocolate. Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime.
  • “No” to exercise before bed. Regular exercise no less than 3h before bedtime promotes better sleep, but exercising shortly before going to bed can increase insomnia issues.
  • “No” to clock-watching and no electronics in the bedroom. Using a cell phone at night can increase depression and lower self-esteem, especially in teenagers.

On note, various smart phone apps that promote sleep hygiene via calming music (ex. Pzizz app), enhance circadian rhythm regulation (ex. Sleep Cycle app), teach meditation (ex. Long deep breathing” app), help with tracking sleep and can be used as a sleep diary (Sleep diary pro app) or even deliver mobile CBT-I support (ex. CBT-i Coach App.) can be helpful in insomnia management.

It takes up to one month before the body will naturally respond to some of the behavioral changes consistent with healthy sleep, thus patience and persistence while “relearning” sound sleep related habits are the key factors in psychological management of insomnia. Occasional restlessness at night can be normal, however if you have tried and failed to improve your sleep using some of the above mentioned strategies, you may like to consider professional help. Besides psychological interventions, an armamentarium of medications approved for insomnia is available and timely diagnosis and proper management of insomnia can significantly improve everyday wellness. Overall quality of life and life satisfaction should not be postponed, especially if symptoms are affecting daily functioning.

 

  1. http://www.aasmnet.org/Resources/ClinicalGuidelines/040515.pdf

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FOR IMMEDIATE RELEASE                                                                                                                                     

CONTACT:
Jennifer Pierson
Lindner Center of HOPE
(513) 536 -0316
[email protected]

Session of Free Series to Explore Red Flags in Identifying Addictions

Free Community Education Series to Address Substance Use Disorders, Behavioral Addictions, Treatment and Strategies for Coping

August The seventh session of this free series to help increase understanding of addictions is August 16, 2017. Anna Guerdjikova, PhD, LISW, CCRC, Lindner Center of HOPE, Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program, will present on Red Flags in Addiction Identification.

Lindner Center of HOPE with the support of Manor House in Mason, Ohio is offering a Free Community Education Series in 2017 on topics related to addiction. The series will offer expert discussion of Substance Use Disorders, Behavioral Addictions, Treatment and Strategies for Coping for community members seeking information.

The series is held at Manor House, 7440 Mason-Montgomery Rd., Mason the third Wednesday of the month at 6 p.m. through November 15, 2017.

Register by calling Pricila Gran at 513-536-0318. Learn more by visiting lindnercenterofhope.org/education.

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, 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 and adolescents, outpatient services for substance abuse through HOPE Center North location and co-occurring disorders for adults and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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By Jennifer L. Shoenfelt, MD
Board Certified Child, Adolescent, and Adult Psychiatrist, Lindner Center of HOPE
Assistant Professor, University of Cincinnati, College of Medicine, Department of Psychiatry and Behavioral Neuroscience
Assistant Professor, Wright State University, Boonshoft School of Medicine, Department of Psychiatry

There are several levels of psychiatric care for children and adolescents. These are separated by the acuity of the clinical scenario, past care, and the goals of treatment. The least restrictive type of care is the outpatient setting.  Higher levels of care include intensive outpatient, partial hospitalization, inpatient hospitalization, and residential treatment centers. Residential care exists in different settings or types of environments. Residential care is often considered when a child has “failed” other less restrictive interventions, such as having repeated inpatient stays in a short span of time. Residential care is also considered when the adolescent‘s family feels unable to assure the teen’s safety or the safety of other family members in any other environment. The following outlines advantages to pursuing or choosing residential treatment options.

  1. Residential treatment programs are longer in duration than most other levels of care. These programs range from 10-14 days for a diagnostic program to 3 months or longer for long term therapeutic interventions. In residential settings, the patient is away from home, living at the facility. Often, this means that the adolescent is a significant distance away from their family. They are removed from their daily stressors and the environment that is likely contributing to their current mental, physical and behavioral state.
  2. Residential treatment affords diagnostic clarification which includes in-depth testing, observational analysis, formalized testing, concentrated, in –depth, historical information gathering, and observation of family dynamics and social interaction. Professionals in multiple areas of expertise interact with the patient and then collectively formulate a differential diagnosis over time. Most programs are staffed with physicians, psychologists, social workers, teachers, chemical dependency counselors, nurses, family therapists, dieticians, and other specialty area professionals.
  3. Residential programs offer a vast array of therapies and approaches that are not commonly available in other treatment programs. Utilizing a combination of therapies or approaches may be what the adolescent needs to achieve success they could not find in other limited programming. For instance, a partial hospitalization program may be able to offer, dialectical behavioral therapy, group therapy, and recreational therapy among their regimen of daily activities. However, a residential program may be able to combine this with family systems therapy, cognitive behavioral therapy, acceptance and commitment therapy, eye movement desensitization and reprocessing, yoga, equine therapy, holistic approaches, martial arts, community service, academic planning and testing, etc. Of course, these do not come without a significant price.
  4. Residential programming allows the adolescent time to practice and strengthen skills they are learning. Many programs are based on the adolescent achieving certain levels of competency and progressing step-wise through a customized program that encourages improved self-esteem, acknowledgement of accomplishments, recognition of effort and gentle re-integration to their family dynamic.
  5. Educational planning if often another advantage to residential treatment. Adolescents can undergo detailed educational and neuropsychological testing. While in treatment, a plan can be devised and implemented to address any deficits or challenges the teen is facing. The educational team can make recommendations for placement and interventions for post discharge.
  6. Residential treatment comes in many different settings. There are programs focused on wilderness, arts, education, addictions and many others. While the teen is being treated in these novel environments, family members at home can be focusing on improving the home setting and engaging in their own specific therapies to prepare for re-integration of the child. This break for the family has its own healing effect and enables other family members to focus on their issues and concerns while their family member is away. Likewise, the adolescent may find new interests and strengths to build upon after discharge.
  7. Although residential treatment is costly and sometimes not covered by commercial insurance, in the long-term it can be cost effective by saving the family from multiple hospitalizations, partial hospitalization or expensive intensive outpatient care.
  8. Lastly, residential treatment is often more successful in addressing or treating co-occurring disorders. The comprehensive nature of residential and the duration of treatment allow the team to focus on all aspects of the clinical picture and to thoroughly attack each facet of the adolescent’s needs.

Overall, there are many advantages to residential care, though it is often the least used avenue in adolescent psychiatry. The drawbacks of cost and availability often preclude the neediest of adolescents from obtaining the comprehensive treatment benefits that could help them most.