By Peter White, M.A., LPCC, LICDC, Lindner Center of HOPE Outpatient Therapist

The problem during Bipolar Mood Disorders is a pattern of swings of the essential elements of mood between the two poles, like the North Pole and South Pole, of Mania and Depression. These swings are not moodiness, which are swings of mood throughout a day. A Bipolar swing is a distinct period of at least one week when the full spectrum of mood elements exhibits depressive and/or manic elements.

Although thought of as a subjective experience, mood deeply influences three areas. First is metabolism – sleep, appetite, libido and energy levels. Second, mood influences both motivation as well as the ability to experience pleasure and/or a sense of accomplishment. Thirdly, mood deeply influences interpretations within thoughts from positive to neutral to negative.

So, we can think of this first spectrum of mood disorder along an axis of depression to neutral to manic. Therefore, a depressed mood will depress metabolism. A person will have difficulty with sleep through either excessive or inadequate or disrupted sleep, loss of appetite or excessive eating despite disrupted appetite, loss of libido as well as loss of energy. Depression will hinder motivation making it difficult to experience the drive to initiate activities as well as hinder pleasure or the reward of activity. This is a very difficult cycle when it is hard to get active in the day compounded by not finding any pleasure or reward in the day’s activities. Lastly, depression will darken the flow of thoughts adding many themes of hopelessness, helplessness, worthlessness and guilt into our thought process.

Conversely, mania will elevate the same essentials. It will increase energy levels often in the face of declining sleep hours. It will increase libido, increase excessive and/or absence of appetite. It will increase motivation often leading to excessive engagement of plans or activities and will create a compounding loop of all activity feeling especially pleasurable or rewarding. Again, conversely is will paint thinking with elevated judgements of specialness, invulnerability, and inevitable positive outcomes.

The second spectrum of mood disorders, like most other behavioral health problems, is along the spectrum of severity – mild to moderate to severe. If you combine this spectrum of severity along with the first spectrum of depressive to manic, we see how varied and individualized any person’s experience with Bipolar Mood disorders can be.  Most people can relate to some degree of depression during periods of their life with perhaps a few weeks or month of low energy, noticing that they are not getting the same rewards in their regular activity as well as perhaps noticing they are thinking unusually negatively about themselves and their outlook on life. We might call this a mild, brief depressive episode. But the reality is that depression is one of the most disruptive and costly of all health conditions as recognized by the World Health Organization. This mean that depression is often moderate or severe to very severe and can disrupt functioning on every level for weeks to months if not years. A severe depression can make it difficult to get out or bed for days on end both from collapsed energy and motivation. It can destroy the pleasure and rewards of living so that all activity feels like a painful chore at best. Finally, it can turn thoughts dangerously dark with so much hopelessness, helplessness and worthless that suicidal thinking emerges nearly with a sense of relief.

Again conversely, though experienced less often by most people, Manic Episodes can present with mild, moderate, severe and very severe intensity. During a sever episode, a person with manic symptoms is often sleeping little but maintaining very high levels of energy. They are often talking very quickly and sometimes laughing excessively and outside the context of humorous things. Given the very high levels of motivation and the reinforcement of pleasure in all activities, they often initiate an excessive number of activities – starting multiple projects with little awareness of the ability to balance or complete them. They frequently initiate conversations or relationship in an open or disinhibited style very unusual for to their character. With elevated thought patterns, they might believe they have a unique or special purpose, and they are convinced that all their activities will be successful and rewarding. Give the excessive energy, motivation, pleasure and elevated sense of self and success, people in manic states will often engage in behavior patterns much riskier than typical – spending money well beyond their mean, unusually disinhibited sexual decision, reckless driving, shop lifting.

I hope it’s useful to review the way mood symptoms fluctuate along these two spectrums, because like all health care conditions, we are best off when we accurately identify what these behaviors are – symptoms. Mood symptoms are not moral challenges, personality traits or unconsciously desired behaviors. Mood symptoms are symptoms, and fortunately, there are many very effective treatments for all symptoms along both spectrums. Please know if you or a loved one or a client is experiencing any degree of Bipolar mood problems, there will be many ways to help and cope, and experience the satisfaction of effectively treating a behavioral health care condition.

 

Danielle Johnson, MD, FAPA
Lindner Center of HOPE/Chief Medical Officer
University of Cincinnati College of Medicine Adjunct Assistant Professor of Psychiatry

Medications are undoubtedly an important tool in the treatment of mental illnesses. Expert application of psychopharmacology is a game changer in improving symptoms of mental illness and helping individuals achieve a manageable baseline. Complex co-morbidities and severe mental illness make prescribing even more complex.

Psychiatric medications can stabilize symptoms and prevent relapse. They work by affecting neurotransmitters in the brain. Serotonin is involved in mood, appetite, sensory perception, and pain pathways. Norepinephrine is part of the fight-or-flight response and regulates blood pressure and calmness. Dopamine produces feelings of pleasure when released by the brain reward system.

One in ten Americans takes an antidepressant, including almost one in four women in their 40s and 50s. Women are twice as likely to develop depression as men.

Selective Serotonin Reuptake Inhibitors (SSRIs) Side Effects

Selective serotonin reuptake inhibitors (SSRIs) increase levels of serotonin. Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro) treat depression, anxiety disorders, premenstrual dysphoric disorder, eating disorders, and hot flashes. Potential side effects include jitteriness, nausea, diarrhea, insomnia, sedation, headaches, weight gain, and sexual dysfunction.

Zoloft Side Effects in Women

Zoloft, also known by its generic name sertraline, is an antidepressant medication that can cause a range of side effects in women. Some of the common side effects of Zoloft include nausea, diarrhea, headache, dizziness, dry mouth, drowsiness, and difficulty sleeping. Women may also experience sexual side effects such as decreased libido, difficulty reaching orgasm, and erectile dysfunction. In some cases, Zoloft may cause weight gain or weight loss, and it can also affect blood pressure and heart rate. Rare but serious side effects of Zoloft in women may include seizures, serotonin syndrome, and suicidal thoughts or behavior.

Prozac Side Effects in Women

Prozac, also known by its generic name fluoxetine, is an antidepressant medication that can cause a range of side effects in women. Some of the common side effects of Prozac include nausea, diarrhea, headache, dizziness, dry mouth, drowsiness, and difficulty sleeping. Women may also experience sexual side effects such as decreased libido and difficulty reaching orgasm. Prozac may also cause weight gain or weight loss, and it can affect blood pressure and heart rate. Rare but serious side effects of Prozac in women may include serotonin syndrome, suicidal thoughts or behavior, and seizures.

Lexapro Side Effects in Women

Lexapro, also known by its generic name escitalopram, is an antidepressant medication that can cause a range of side effects in women. Some of the common side effects of Lexapro include nausea, diarrhea, headache, dizziness, dry mouth, drowsiness, and difficulty sleeping. Women may also experience sexual side effects such as decreased libido and difficulty reaching orgasm. Lexapro may also cause weight gain or weight loss, and it can affect blood pressure and heart rate. Rare but serious side effects of Lexapro in women may include serotonin syndrome, suicidal thoughts or behavior, and seizures.

Serotonin-norepinephrine Reuptake Inhibitors (SNRIs) Side Effects

Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase levels of serotonin and norepinephrine. Venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq) are used to treat depression, anxiety disorders, diabetic neuropathy, chronic pain, and fibromyalgia. Potential side effects include nausea, dry mouth, sweating, headache, decreased appetite, insomnia, increased blood pressure, and sexual dysfunction.

Tricyclic Antidepressants Side Effects

Tricyclic antidepressants (TCAs) also increase serotonin and norepinephrine. Amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), nortriptyline (Pamelor), doxepin (Sinequan), trimipramine (Surmontil), protriptyline (Vivactil), and imipramine (Tofranil) are used to treat depression, anxiety disorders, chronic pain, irritable bowel syndrome, migraines, and insomnia. Possible side effects include sedation, forgetfulness, dry mouth, dry skin, constipation, blurred vision, difficulty urinating, dizziness, weight gain, sexual dysfunction, increased seizure risk, and cardiac complications.

Other Antidepressants Side Effects

Wellbutrin Side Effects in Women

Bupropion (Wellbutrin) increases levels of dopamine and norepinephrine. It treats depression, seasonal affective disorder, ADHD, and can be used for smoking cessation. It can also augment other antidepressants. Potential side effects include anxiety, dry mouth, insomnia, and tremor. It can lower the seizure threshold. There are minimal to no sexual side effects or weight gain.

Trazodone (Desyrel, Oleptro) affects serotonin and mirtazapine (Remeron) affects serotonin and norepinephrine. They are both used for depression and sleep. Mirtazapine has minimal sexual side effects.

Monoamine oxidase inhibitors (MAOIs) increase serotonin, norepinephrine, and dopamine. Isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate), and moclobemide are associated with more serious side effects than other antidepressants. There are dietary restrictions and numerous drug interactions. MAOIs are often used after other antidepressant classes have been tried. Other antidepressants need to be discontinued for a period of time prior to starting an MAOI.

Newer antidepressants include Viibryd (vilazodone) which affects serotonin, Fetzima (levomilnacipran) which affects serotonin and norepinephrine, and Brintellix (vortioxetine) which affects serotonin. Brintellix and Viibryd have mechanisms of action that make them unique from SSRIs. Viibryd is less likely to cause sexual side effects.

Excess serotonin can accumulate when antidepressants are used with other medications that effect serotonin (other antidepressants, triptans for migraines, certain muscle relaxers, certain pain medications, certain antinausea medications, dextromethorphan, St. John’s Wort, tryptophan, stimulants, LSD, cocaine, ecstasy, etc.) Symptoms of serotonin syndrome include anxiety, agitation, restlessness, easy startling, delirium, increased heart rate, increased blood pressure, increased temperature, profuse sweating, shivering, vomiting, diarrhea, tremor, and muscle rigidity or twitching. Life threatening symptoms include high fever, seizures, irregular heartbeat, and unconsciousness.

Estrogen Levels With Antidepressants in Females

Varying estrogen levels during the menstrual cycle, pregnancy, postpartum, perimenopause, and menopause raise issues with antidepressants and depression that are unique to women. Estrogen increases serotonin, so a decrease in estrogen at certain times in a woman’s reproductive life cycle can reduce serotonin levels and lead to symptoms of depression. Hormonal contraception and hormone replacement therapy can reduce or increase depressive symptoms; an increase in symptoms may be more likely in women who already had major depressive disorder. During pregnancy, antidepressants have a potential risk to the developing baby but there are also risks of untreated depression on the baby’s development. With breastfeeding, some antidepressants pass minimally into breast milk and may not affect the baby. The benefits of breastfeeding may outweigh the risks of taking these medications.   Antidepressant sexual side effects in women are vaginal dryness, decreased genital sensations, decreased libido, and difficulty achieving orgasm. Women should communicate with their psychiatrist and/or OB/GYN to discuss the risks and benefits of medication use vs. untreated illness during pregnancy and breastfeeding; the use of hormonal treatments to regulate symptoms associated with menses and menopause; and the treatment of sexual dysfunction caused by antidepressants.

It has been observed that some antidepressants can affect estrogen levels in women. For instance, selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) have been shown to decrease estrogen levels in women. On the other hand, other antidepressants such as venlafaxine (Effexor) and duloxetine (Cymbalta) have been shown to increase estrogen levels. The exact mechanisms behind these effects are not fully understood, but it is thought to be related to the interactions between the medication and the hypothalamic-pituitary-gonadal (HPG) axis, which is responsible for regulating estrogen production. It is important for women to discuss any potential effects of antidepressants on estrogen levels with their healthcare provider, especially if they have a history of hormonal imbalances or are taking hormonal therapies.

It is important for women to discuss any potential side effects with their healthcare provider before starting any depression medication.

Lindner Center of HOPE’s Approach

Lindner Center of HOPE’s residential services employ full-time psychiatrists with expertise in psychopharmacology. These prescribing physicians are designated members of each residential client’s treatment team. Medication management within Lindner Center of HOPE’s residential programs is also supported by 24/7 psychiatry and nursing staff, onsite pharmacy and an innovative Research Institute.

In some cases, patients over the course of treatment for mental illnesses accumulate many prescriptions. In cases like this, Lindner Center of HOPE’s residential units can offer a safe environment for medication assessment and adjustment. While the client participates in appropriate evaluation and treatment, their psychiatrist can also work with them on reaching rational polypharmacy — in other words, medication optimization.

For patients with more severe, treatment-resistant mental illness, Lindner Center’s psychiatrists can implement the most complicated, and often hard to use, treatments, in a safe environment, while under their observation.

If medication adjustments result in decompensation on the residential units, a patient can be temporarily stepped up to an acute inpatient unit on the same campus.

 

 

 

 

 

 

 

 

Sidney Hays, MSW, LISW, DARTT, Outpatient Therapist, Lindner Center of HOPE

“Trauma” has been a buzzword in recent years. Accompanying it has been discourse around what counts as trauma. From the extreme of exaggerating minor inconveniences as trauma to the opposite end of the spectrum which attempts to gatekeep this term, reserving it for life threatening events only.

These extremes create confusion around not only the definition of the term and related concepts, but unnecessarily polarizes an already sensitive topic. As people debate the validity of traumas, it often reinforces the harmful self-judgements adopted by those who have experienced trauma. This reinforcement is often what keeps people stuck in self-blame and blocks actual healing.

It is common for those who have experienced trauma to blame themselves. This occurs for many reasons. One of the most obvious reasons lies in cultural messaging related to victim blaming, exaggerated self-reliance, and toxic positivity. The messaging of victim blaming often sounds like: What were you wearing? Were you drunk? Why didn’t you leave? Why didn’t you fight back? Why were you there in the first place? Are you really going to talk about your mom like that? Rather than holding those who caused the damage accountable, the responsibility gets shifted to the person who experienced it. This causes significant shame, often keeping people stuck in trauma responses and unhelpful patterns.

The worlds of toxic positivity and “just do it” often dismiss the significance of trauma, which impedes the ability to process and heal from trauma. It can sound something like: But you have so much to be grateful for. Your parents weren’t that bad. Other people have it much worse. Just count your blessings. Just decide to change and make it happen. You just need to (insert unhelpful platitude here). These responses encourage us to ignore the impacts of our trauma, which leads to trauma being stored in the body.

Another explanation of the self-blame that often accompanies trauma is that it gives the person who experienced it a false sense of control. If it was my fault, that means I should have just done better. If it was my fault, I can control the situation. If it was my fault, I can make sure it never happens again. Our brains are often much more comfortable with the notion that we messed up than the reality that other people and many events are outside our control.

Like with most debates and continuums, the surrounding discourse usually harms those who live a life of less privilege. Expanding our understanding of trauma and its impacts creates space for healing and growth.

The problem with many definitions of trauma lies in the focus of the definition. Most center around the event that occurred. However, this focus is incorrect and shortsighted. The most important factor in defining trauma is actually related to how a person experiences a moment, event, or series of events. Because of this, what is experienced as trauma will vary between person to person and moment to moment, which impacts how the body physiologically responds to a perceived threat.

Dr. Peter Levine, the developer of Somatic Experiencing, states that “trauma lives in the body, not the event.” When our nervous system perceives something as a threat, it reacts in kind, regardless of whether or not there is an objective threat. Most of us have heard of the fight (yelling, hitting, approaching), flight (running away from, avoiding), and freeze (immobilization, dissociation, disconnection) responses to a threat without fully understanding how these reactions come to be… These are states of our autonomic nervous system, which controls the automatic functions of the body (blood pressure, heart rate, breathing, digestion, hormones, immune response). This means that these reactions are unconscious, automatic, and the result of our nervous system attempting to protect us from a perceived threat.

When our brains perceive something as a threat, our nervous system does not always choose the most effective response. Our responses are informed by a lifetime’s cycles of threat and response. Because of this, the response of our autonomic nervous system is often the one we’ve used most in the past, or the response we wish we could have used then but didn’t have access or ability to use. This can explain many confusing patterns in our lives, such as a person who experienced emotional neglect as a child might struggle to share their emotions and needs even with a partner in a safe, healthy relationship down the line. These patterns require intentional work to mend to get our nervous system on board with responding in ways that may be more effective, or better in line with our values. In order to do this, we need adequate resources to increase our capacity to tolerate threats and distress.

Many factors impact our ability to cope with perceived threats such as: resources, support, physical health, and the level to which our needs are met. When these factors are well resourced, we have increased capacity to tolerate threat and distress. However, the inverse is also true. When lacking in any of these areas, our capacity drops.

Linda Thai brilliantly defines trauma as, “too sudden, too little, or too much of something for too long or not long enough without adequate time, space, permission, protection, or resources.” This inclusive definition accounts for the many nuances of the human experience, including generational trauma, and trauma resulting from racism, sexism, homophobia, fat phobia, colonization, and other various systems of oppression. Mindfulness of these nuances creates space for the full spectrum of human suffering to be seen, processed, and healed.

When we create this kind of space, increase access to resources, validate, and protect one another, we can be agents of healing in a world severely lacking at.

“If you want to improve the world, start by making people feel safer.”

-Dr. Stephen Porges

Heather Melena, APRN, PMHNP-BC,

Psychiatric Nurse Practitioner, Lindner Center of HOPE

 

 

 

 

 

Living with a chronic illness can be difficult to manage not only physically but also emotionally and mentally as well. The challenges that can come with chronic illness include learning to cope with the symptoms of that diagnosis, figuring out ways to alleviate your symptoms, doctor’s appointments and strain to financial responsibilities and interpersonal relationships. On top of trying to figure out new ways to handle everything that comes with chronic illness, the emotional and mental strain can feel overwhelming and paralyzing.  Psychological distress has been shown to increase with chronic disease and its accompanying treatment protocols as well as the many other areas affected in one’s life. It has also been well documented that continued stress and/or distress can lead to poor health outcomes and mental illness (Sheth et al, 2023). Thus, finding ways to find acceptance, cope with the feelings of powerlessness, and learning to live within the limitations caused by one’s chronic illness is imperative to finding relief from the mental and emotional turmoil brought on by physiological changes of illness.

Seeking help from a mental health provider (with or without the use of medications), engaging in individual and group therapy, attending support groups are all ways to tackle the mental and emotional aspects of chronic illness. Studies have shown that engaging in acceptance and commitment therapy as well as learning mindfulness techniques can reduce pain intensity, depression, and anxiety with increased self-management and physical wellbeing for those living with chronic health conditions (Wallace-Boyd et al, 2023). Learning strategies such as active coping skills, planning, positive reframing, and emotional support will all be of value to learning to live with the changes experienced by persistent illness. In practice, discussion is had about learning how to live within these new limitations, being patient and kind to oneself, setting realistic expectations, and acknowledging that the way you feel physically may change from day to day- which can be extremely beneficial for someone experiencing chronic illness. Powerlessness is a tough emotional and mental barrier when struggling day to day, where much uncertainty feels uncomfortable. By practicing acceptance and self-love, we can learn to live in the present and move away from dwelling on what our bodies were once capable of or fearing what the future may hold.

The American Psychological Association (2023) defines self-efficacy as an individual’s belief in his or her capacity to engage in behaviors to achieve personal goals. This is reflected in the confidence one has to exert control over their own motivation, behavior, and social environment. Studies have shown that greater self-efficacy can increase one’s control (or belief of) over health outcomes (Sheth et al, 2023).  By learning more positive coping mechanisms and increasing self-efficacy, one can gain confidence in their ability to self-manage their illness and improve their quality of life.

While it may be a difficult task, especially for those that struggle with chronic health problems, engaging in physical activity three to five days a week can be extremely beneficial. There has been endless research on the benefits of physical activity including higher quality of life, lower mortality, reduction of pain, and improved mental health. It has been shown that physical activity can positively impact the overall relationship between inflammation and mental health symptoms, thus reducing inflammation will likely improve depression and anxiety symptoms (Sheth et al, 2023). Physical activity can also improve energy, mental clarity, cognitive ability, and reduce stress and anxiety. It has been shown to improve mood, sleep, and circulation (Sheth et al, 2023).. With that being said, be patient with yourself and listen to your body- if physical activity isn’t what your body needs- rest or try low-intensity activities such as yoga or swimming.

Self-care is something we hear about all the time now- but what does that look like in practice? Self-care is the action or behaviors we incorporate into our daily lives that help not only our physical health but overall mental wellness. Incorporating self-care into our daily lives will not only improve our mood, reduce the toll stress can have on our bodies (ie inflammation, fatigue, sadness), but improve our outlook on the constantly changing physical symptoms of chronic illness. Self-care should be personalized to your needs. In practice we often discuss what someone’s “life worth living” looks like and how to achieve this. Incorporating daily self-care is a step towards learning to live within the new limitation set by illness and reframing our thought processes to think more positively which will enable us to continue moving forward despite our body’s shortcomings. Self-care includes:

  • Seeking out professional help: Whether a therapist, mental health provider, nutritionist, personal trainer- all of which can help you navigate treating the many facets of chronic illness, including depression, anxiety, and stress.
  • Finding support: Joining a group of people or talking with others who suffer with similar conditions can be cathartic, oftentimes lowering distress levels, and offering ways to coping with the diagnosis.
  • Stress Reduction: Identifying sources of stress, finding ways to cut stress out of your life, and ways to better manage stress.
  • Physical activity
  • Eating well:  looking for ways to add foods to your diet that will be beneficial in reducing inflammation, improving immune function, and overall wellbeing. Learning moderation in the foods we eat rather than trying “crash” diets. When we eat foods aimed at healing our bodies, we find that our mood and mental health can improve.
  • Sleep: Adequate and restorative sleep is so important for everyone. Our bodies are in a reparative phase while sleeping- which is needed to heal! Try incorporating good sleep hygiene practices including going to bed around the same time each night, avoiding screens prior to sleep, meditation before bed.
  • Hobbies: Find things that make you feel fulfilled, and make you feel joy/bring joy to your life- whether they are the same hobbies or activities prior to your diagnosis- it is important to do things that make you feel good!

(Mended Hearts, 2023)

References

American Psychological Association (2023). Teaching tip sheet: Self-efficacy. https://www.apa.org/pi/aids/resources/education/self-efficacy

Ciotti, S. (2023). “I Get It, I’m Sick Too”: An Autoethnographic Study of One Researcher/Practitioner/Patient With Chronic Illness. Qualitative Health Research33(14), 1305–1321. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1177/10497323231201027

MedlinePlus (2022). Living with a chronic illness- dealing with feelings. National Library of Medicine. https://medlineplus.gov/copingwithchronicillness.html

MendedHearts(2023). Chronic illness and mental health blog. https://mendedhearts.org/chronic-illness-and-mental-health-9-tips-for-self-care/

Sheth, M. S., Castle, D. J., Wang, W., Lee, A., Jenkins, Z. M., & Hawke, L. D. (2023). Changes to coping and its relationship to improved wellbeing in the optimal health program for chronic disease. SSM Mental Health3. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1016/j.ssmmh.2023.100190

Wallace-Boyd, K., Boggiss, A. L., Ellett, S., Booth, R., Slykerman, R., & Serlachius, A. S. (2023). ACT2COPE: A pilot randomised trial of a brief online acceptance and commitment therapy intervention for people living with chronic health conditions during the COVID-19 pandemic. Cogent Psychology10(1). https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1080/23311908.2023.2208916

By Danielle Beltz, MSN, PMHNP-BC, Psychiatric Nurse Practitioner, Lindner Center of HOPE

Pregnancy and childbirth can be one of the most rewarding and fulfilling things a woman can do in her
lifetime but can hand in hand be one of most challenging and emotionally taxing times.
A female goes through not only physical changes throughout pregnancy but also hormonal, emotional,
and psychological changes. In addition, a pregnancy can bring stress and emotional hardship to their
interpersonal dynamics.

A lot of new moms experience postpartum “baby blues” after giving birth which differentiates from
postpartum depression. Symptoms usually include sadness, irritability, moodiness, crying spells, and
decreased concentration. Baby blues usually begin within 2 to 35 days after childbirth and can persist up
to 2 weeks. When these symptoms last longer than 2 weeks this is when the mother should consider talking
to a healthcare provider.

About one in seven women develop postpartum depression. It most commonly occurs 6 weeks after delivery but can begin prior to
delivery as well. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) a major depressive episode with the onset
of pregnancy or within 4 weeks of delivery is considered postpartum depression. Five of the nine symptoms must be present nearly every
day for at least two weeks and constitute a change from previous functioning to be diagnosed. Depression or loss of interest in addition
to the following symptoms must be present:

• Depressed mood (subjective or observed) most of the day
• Diminished interest or pleasure in all or most activities
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Feelings of worthlessness or guilt
• Loss of energy or fatigue
• Recurrent suicidal ideation, thoughts of death or attempts
• Diminished concentration or indecisiveness
• Change in weight or appetite (5% weight change over 1 month)

Fifty percent of postpartum major depressive episodes begin before
delivery so collectively these episodes are described as peripartum
episodes. Mothers with peripartum major depressive episodes commonly have severe anxiety and panic attacks.

The exact etiology of postpartum depression is unknown. Several factors have been reported to contribute to the development of
postpartum depression. The physical and hormonal fluctuations resulting from pregnancy influence postpartum women to develop
depression when stressful and emotional events coincide with childbirth. Some of these factors include the stress of motherhood, difficult
labor, poor financial and family support, and harmful health outcomes of childbirth. Lower socioeconomic demographic, personal or
family history of depression, anxiety, or postpartum depression, PMDD, complications in pregnancy and birth, and mothers who have
gone through infertility treatments have also all been suggested to be strong contributors.

Postpartum depression not only affects the mother’s health but also the relationship the mother has with her infant and that child’s
development. Studies have shown that children are at a greater probability of developing behavioral, cognitive, and interpersonal problems
whose mothers have postpartum depression. It can also lead to inability to breastfeed and marital conflict.

Postpartum psychosis is another severe kind of depression but is not the same thing as postpartum depression. Around 1 in 500 or 1 in
1,000 women has postpartum psychosis after delivering a baby. It commonly starts the first 2 weeks after giving birth. Women who are
also diagnosed with bipolar disorder or schizoaffective disorder are more prone to have postpartum psychosis than women who are not
diagnosed with other mental health conditions.

Postpartum psychosis is considered a psychiatric emergency with a capacity of suicide and infanticidal threat. Some symptoms include
delusions, hallucinations, unusual behavior, paranoia, and sleep disturbances. If postpartum psychosis is suspected help should be sought
immediately.

Psychotherapy and antidepressant medications are the first line treatments for postpartum depression. Psychotherapy is considered first
line for women with mild to moderate depression or if they have concerns of starting a medication while breastfeeding. For moderate to
severe depression therapy and antidepressant medications are recommended. The most common medication for postpartum depression is
an SSRI or selective serotonin reuptake inhibitor. Once an efficacious dose is reached, treatment should persist for 6-12 months to prevent
relapse of symptoms. Risk versus benefits of treated versus untreated depression while breastfeeding or pregnant should be discussed.
Transcranial Magnetic Stimulation (TMS) is an alternate therapy that can be used for women who have concerns about their child being
exposed to a medication. Although, the risk of taking an SSRI while breastfeeding is relatively low. ECT is another option for women with
severe postpartum depression who do not respond to traditional treatment. It can be particularly helpful with psychotic depression.

Zurzuvae (zuranolone) is the first oral medication approved by the FDA specifically for the treatment of postpartum depression in adults.
Until August 2023, treatment for PPD was only available as an IV (Brexanolone) and was only available at certified healthcare facilities.

People with depression especially new mothers and postpartum mothers may not identify or accept that they’re depressed. They also
may be unaware of the signs and symptoms of depression. If you are questioning whether a friend or family member has postpartum
depression or is developing signs of postpartum psychosis, assist them in pursuing medical treatment and recognize that help is accessible.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Commissioner, O. of the. (n.d.). FDA approves first oral treatment for postpartum depression. U.S. Food and Drug Administration. https://www.fda.
gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression#:~:text=Today%2C%20the%20U.S.%20Food%20
and,the%20later%20stages%20of%20pregnancy
Guo, L. , Zhang, J. , Mu, L. & Ye, Z. (2020). Preventing Postpartum Depression With Mindful Self-Compassion Intervention. The Journal of Nervous and
Mental Disease, 208 (2), 101-107. doi: 10.1097/NMD.0000000000001096.
Mayo Foundation for Medical Education and Research. (2023, April 14). “I’m happy to be a new mom. but why am I feeling
so sad?” Mayo Clinic. https://mcpress.mayoclinic.org/mental-health/im-happy-to-be-a-new-mom-but-why-am-i-feeling-sosad/?
mc_id=global&utm_source=webpage&utm_medium=l&utm_content=epsmentalhealth&utm_
campaign=mayoclinic&geo=global&placementsite=enterprise&invsrc=other&cauid=177193
Miller, L. J. (2002). Postpartum depression. JAMA : The Journal of the American Medical Association, 287(6), 762-765. https://doi.org/10.1001/jama.287.6.762
Mughal S, Azhar Y, Siddiqui W. Postpartum Depression. [Updated 2022 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519070/
Postpartum depression. March of Dimes. (n.d.). https://www.marchofdimes.org/find-support/topics/postpartum/postpartum-depression?gad_
source=1&gclid=EAIaIQobChMIqKLemfTfggMVq0VyCh3ouwGDEAAYBCAAEgKxjPD_BwE
Silverman, M. E., Reichenberg, A., Savitz, D. A., Cnattingius, S., Lichtenstein, P., Hultman, C. M., Larsson, H., & Sandin, S. (2017). The risk factors for postpartum
depression: A population-based study. Depression and Anxiety, 34(2), 178–187. https://doi-org.uc.idm.oclc.org/10.1002/da.22597
Stewart, D. E., & Vigod, S. (2016). Postpartum depression. The New England Journal of Medicine, 375(22), 2177-2186. https://doi.org/10.1056/NEJMcp1607649

 

by Dawn Anderson, LPCCS

Humans are a very resilient species. We have overcome generations of burdens to accomplish family unity, and yet this effort renews with new barriers and challenges each year. A vital component of a thriving family unit is the ability to co-regulate. Co-regulation describes the process in which a parent can identify their child’s need for help, recognize their own emotional reaction, and then help themselves cope to share that gift with their child.

Just like the airplane metaphor- you must put on your own oxygen mask before you can help others. As a parent, we are bombarded with requests for our time, resources, and attention. We have a certain amount of emotional energy in the day, and this is a renewable resource! Taking the time to take care of your own emotional health allows you to be more responsive in the ways we’d like to show up with our children. Another huge burden on parents is the one we place there ourselves- guilt. We fret about the choices to be made, the amount we’re able to give our children, and the perpetual feeling we aren’t enough. The reality is we all bring different types and amounts of skills and talents to the table.

Some of us have different capacities for stress, and that doesn’t make us good or bad. Sometimes it’s helpful to think of your stress tolerance as a cup- is yours a 12 oz picnic cup? A 2 oz bathroom water cup? An Olympic swimming pool? Whatever the size, we must take ownership of knowing where we are throughout the day, and how we are showing up in interactions with our children. We also need to be intentional about emptying said cup proactively throughout the day, so it doesn’t overflow. Overflow here is where we see the unintentional screaming at our precious ones, storming off, or being unable to play with them after our long day.

Lastly in explanation, its valuable to consider the way language impacts our thoughts, feelings, and behavior. In common language, we say things about children such as “they’re a mess,” “they’re not listening to me,” “they’re being a brat.” In all humans, we have a system in our brain that takes in information and decides if it’s safe or not, and then sends it to either the thinking part or the survival part of our brain. What our brains decide as safe depends on the person. Some of us have different themes that activate the threat systems in our own bodies, and with careful observation, you might be able to pin these down for your loved ones. If this feels difficult, a licensed clinical therapist can help.

Once the “threat center” of your brain decides something isn’t safe, we have survival reactions: our heart rate picks up, heavy breathing, we feel shaky, and/or we have a hard time thinking clearly due to the process where your brain diverts power from the thinking brain to the survival brain. That said, that’s part of why it’s hard to talk to someone who doesn’t feel safe. It’s hard for them to hear you, and hard for them to express how they feel in words. If we use compassionate language, it removes blame from the driver seat. Try “they look like they need help” or “they are having some big feelings” You and your child are a team, and teams are stronger when they work from the operating point that we win when we work together with our strengths.

That said, here are some helpful tips to regulate with your child:

  1. When you identify that your child needs help, first check in with yourself on what you need to be best able to respond to them. Its valuable to practice the breathing skills when you don’t need them, so you can use them in the moment when you do. Trying to only use them in a moment of crisis is like expecting yourself to learn to swim in the choppy ocean.
  2. Get on their level. Kneel, squat, or sit down if necessary. Looking up at someone activates the “threat” center of our brain and makes it harder to calm down.
  3. Use a low, consistent tone. If I want someone to hear me, I need to be quieter, not louder. Especially if they are yelling. Keep your messages concise and direct, such as “I want to hear you, and it’s easier when you’re at a level 2” or “Let’s take a deep breath together then we can put your toy back together.”
  4. Take a full, deep breath in your nose and exhale slowly out your mouth. Imagine feeling like you’re smelling something super pleasant and trying to cool off hot cocoa with the exhale. Even if they are not in the place to participate because they’re too dysregulated, their body will unconsciously mirror yours.
  5. If you’re not able to offer your child 1:1 proximity, or their bodies are not safe for you (i.e. hitting) consider regulating in the room by counting items together. Redirection is a powerful tool for the right moment. Again, a licensed therapist can help you catch these windows of opportunity.
  6. If appropriate, leave the room and regulate yourself before returning. Use your words to announce the intention “I need two minutes to regulate myself and I will be back to work on this with you.” Stepping away from the situation is a tool that can give teenage parents the break we need to not ground our child for the next 100 years when we’re both stuck in an argument.
  7. With any strategy, it’s important to come back together and process Use the compliment sandwich: Identify one thing that went well, offer constructive feedback, and close with another positive thing you noticed or future oriented reconnection point. “I’m proud of you for breathing with me. Next time, do you think it would help if we used the feelings chart? I’m glad I have you.”

Learn what residential treatment facility is like and when is residential treatment necessary.

What is Residential Treatment?

A loved one is experiencing mental health problems – or perhaps you are dealing with mental illness yourself.  As you look into treatment options – outpatient, inpatient, etc., one option that may be recommended is a residential treatment center.

Residential treatment is a specialized form of inpatient care. It typically includes 24-hour supervision and monitoring within a non-hospital setting, often aimed at providing an intensive therapeutic environment for clients with mental health and/or substance use issues. This type of care provides an extended stay with personalized, clinically informed interventions and services that can often be more beneficial than traditional outpatient care.

Additionally, residential treatment programs can offer a variety of activities designed for both the physical and emotional health of clients, ranging from recreational activities to individual and group therapies. Residential treatment is highly individualized to meet each person’s specific needs, helping them build life skills as they work on their emotional stability and overall well-being.

What is a Residential Treatment Center?

A residential treatment center provides intensive, comprehensive assessment and care for individuals dealing with complex mental health and/or addiction issues.

But is this type of program right for you or your family member? After all, any type of treatment approach isn’t right for everyone.  Consider the following information before you make a decision about whether residential treatment is the best choice.

Who Is the Best Candidate for Residential Treatment?

While a variety of individuals can benefit from the structured and supportive environment of a residential treatment center, some of the best candidates are those who:

  • Have complex diagnostic or treatment issues;
  • Need a more structured environment or do not have a natural environment ideal for supporting their treatment;
  • Have not responded sufficiently to previous treatments;
  • May have a higher risk of decompensation. (While stable, they may need a greater degree of watchful oversight to address potential suicidal risk, “acting out” behaviors, etc.).

When is Residential Treatment Center Necessary?

Residential treatment centers can be an important lifeline for those struggling with mental or emotional health issues and are in need of additional support for wellness. These establishments, providing short-term 24-hour care and a safe environment, often benefit those at risk of self-harm or suicide as well as those with severe emotional trauma that can’t be handled without a structured program.

It is often recommended to individuals when more traditional treatments such as therapy or medication have not been successful. A residential treatment center can also act as a bridge to prevent the person from having to go into a higher level of care such as hospitalization or long-term into the institution if their mental health condition worsens.

If you believe that you or someone you know might need residential treatment assistance, contact your healthcare provider who is best suited to assess the current level of care needed and guide you through this process.

What is Residential Treatment Like?

For an individual who meets one or more of the above criteria, a residential treatment center can provide many benefits, such as the following:

  • A supportive environment. The community and therapeutic milieu provided in a residential treatment environment can be treatment approach themselves. Many individuals with mental illness do not live in a naturally supportive environment and may easily become socially isolated or frustrated after an acute treatment episode.  Others lack the life skills necessary to function productively, and the therapeutic environment of a residential program provides a safe place to learn and practice them. It helps foster more responsible behavior, greater self-esteem, and positive relationships.
  • A greater degree of structure.  Residential treatment centers provide structured and stabilizing routines throughout the entire day.  These can be beneficial to individuals with impulsivity, compliance issues, medical problems, or high-risk behaviors.
  • More intensive, longer-term care. If a behavioral health problem is particularly severe or complex, outpatient treatment is not sufficiently intensive, and inpatient treatment is not long enough to help patients develop new coping and social skills. Ten- or 28-day programs are an increasingly popular option in many residential treatment centers today.
  • More extensive diagnostic assessment process and tools.   An estimated 85% of individuals with addiction are also dealing with a mental illness. Additionally, individuals with one type of mental disorder may also have other mental health issues.  Proper assessment and diagnosis is important to guide the best treatment plan possible.  Residential treatment programs typically provide more extensive assessment, often using sophisticated tools and technologies such as psychological tests, brain scans, and even genetic testing. Find out more about psychological assessments here.
  • Broader range of treatments. A residential treatment center typically offers a broader “menu” of services than other settings. Once assessment is completed, residential program offer a robust selection of therapies, from traditional psychotherapy to recreational therapy. The fact that the environment is more structured and supervised makes some treatments, such as medication adjustments, more feasible. The logistics of obtaining therapeutic assessment and high-tech treatments are also easier when services are provided literally under one roof. Finally, this environment is also ideal for implementing detailed protocols for specific disorders, such as obsessive-compulsive, substance abuse, and eating disorders.

There are many benefits to residential treatment. One way to remember the overall benefits is to think of the “4-S” approach to treatment: Supportive, Structured, Safe, and Sophisticated.

Alternative Options to Residential Treatment

Residential treatment is not appropriate for everyone.  Patients with short-term or milder disorders may benefit sufficiently from outpatient treatment, while individuals with critically acute problems or significant suicidal risk may need inpatient care.

But for many individuals, the “happy medium” provided by an effective residential treatment center offers the best head start on regaining a productive and enjoyable life. For more information about residential mental health and addiction treatment, view our in-depth guide.

There is HOPE. For more information, call 1-888-537-4229.

 

 

 

 

 

 

 

 

 

 

By: Laurie Little, PsyD
Chief Patient Experience Officer and Staff Psychologist,
Lindner Center of HOPE

In recent years, there has been a growing interest in exploring alternative and innovative treatments for mental illness. Among these novel approaches, ketamine has emerged as a promising treatment for various mental health disorders. Traditionally known as an anesthetic and pain-relieving medication, ketamine has shown potential in treating mental health disorders such as depression and anxiety.

History of Ketamine

Ketamine was originally discovered by chemist Calvin Stevens in 1962 for Parke Davis Company and was Food & Drug Administration (FDA)- approved for medical use as an analgesic and anesthetic in 1970.  It is considered a “Dissociative Anesthetic” with different dosages leading to differing effects. Lower dosages can lead to a psychedelic experience and higher dosages can lead to complete dissociation or analgesia. When using Ketamine as an analgesic, researchers noticed an intriguing off-label effect: a rapid and pronounced improvement in mood and depressive symptoms in some patients. This discovery sparked interest in exploring ketamine’s potential as a novel treatment for mental health disorders.

To curb its illicit and recreational use, the United States categorized Ketamine as a Schedule III federally controlled substance in 1999, however research into its mental health benefits continued to flourish. In 2019, the FDA approved the first ketamine derived therapy, called Esketamine, as a therapy for treatment-resistant depression.

Ketamine and Depression

Ketamine’s antidepressant effects are unique compared to traditional antidepressant medications, which typically take several weeks to produce noticeable results. Ketamine often provides immediate relief to patients who are suffering. Ketamine promotes the release of Glutamate, an essential neurotransmitter that is related to cognition, memory and mood.  Traditional antidepressants often affect neurotransmitters such as Serotonin and Dopamine and take longer to notice an improvement in symptoms.

A recently published large, systematic review of published journal articles on Ketamine treatment found “support for robust, rapid and transient antidepressant and anti-suicidal effects of ketamine. Evidence for other indications is less robust but suggests similarly positive and short-lived effects. “ The findings suggest that ketamine facilitates rapid improvements in symptoms among patients with major depressive disorder (MDD), bipolar disorder and suicidality, lasting up to 7-14 days after treatment. In some cases, effects last up to four weeks, depending on the number of ketamine sessions and the underlying mental health conditions.

There is also preliminary but growing evidence base supporting the efficacy of ketamine therapy for substance use disorders, anxiety disorders (generalized, social, OCD, PTSD)  and eating disorders.  However, just like its antidepressant effects, ketamine’s reductions in anxiety are also short-lived, and symptom recurrence is common after several weeks.

Patients who receive adjunctive psychotherapy appear to achieve the most long-lasting benefit compared with ketamine administration alone.

Ketamine Assisted Psychotherapy

Research shows that Ketamine is most beneficial when it is combined with psychotherapy. There is no current standard for how therapy and Ketamine should be combined. Some practitioners combine lower doses of Ketamine and engage in therapy during the treatment. Other practitioners use higher doses of Ketamine and have the patient engage in therapy either the following day or later in the week. Since patients notice an immediate improvement in their mood, they are more able to benefit from therapy and are more open and receptive to thinking about their current circumstances in a new, helpful way.

The Benefits and Challenges of Ketamine Treatment

The most notable benefit of ketamine treatment is its rapid and profound antidepressant effect. Unlike traditional medications, ketamine can provide relief within hours. This immediate response is particularly crucial for patients in crisis, who are suicidal or those struggling with treatment-resistant mental health conditions.

Moreover, ketamine treatment may benefit individuals who cannot tolerate or have not responded well to other standard treatments. Unfortunately, a significant percentage of patients do not find relief from standard therapies and it is important to have multiple treatment options available.

However, ketamine treatment does come with its challenges and risks. One major obstacle is the lack of long-term data on the safety and efficacy of ketamine as a mental health treatment. While research has shown short-term benefits, the question of how long the benefits last requires additional investigation.

Due to its powerful impact, Ketamine is also often misused. Research is still needed on the abuse potential of Ketamine. Interestingly, there is some evidence to suggest that Ketamine itself can be effective in the treatment of other substance use disorders such as alcohol and heroin. There is still much more to be learned.

Lastly, ketamine treatment is often not covered by insurance for mental health conditions, making it financially inaccessible for many patients. The cost of treatment, coupled with the need for repeated administrations to maintain benefits, raises concerns about equitable access to this innovative therapy.

Ketamine treatment represents a groundbreaking shift in the approach to mental health treatment. Its rapid and transformative effects on depression, anxiety and other mental health conditions have sparked hope for those who have exhausted conventional therapies. While ketamine shows immense promise, ongoing research is needed to fully understand its long-term safety and efficacy.

As the field of mental health continues to evolve, ketamine treatment has the potential to offer a lifeline to those who struggle with treatment-resistant conditions. It is crucial for the medical community, researchers, clinicians, policymakers, and insurers to collaborate in ensuring equitable access to this promising therapy.

References

Banoff, MD, Young, JR, Dunn, T and Szabo, T. (2020). Efficacy and safety of ketamine in the management of anxiety and anxiety spectrum disorders: A review of the literature. CNS spectrums, 25(3), 331-342.

Berman, R. M., Cappiello, A., Anand, A., Oren, D. A., Heninger,

  1. R., Charney, D. S., & Krystal, J. H. (2000). Antidepressant effects of ketamine in depressed patients. Biological Psychiatry, 47(4), 351-354.

Feder, A., Rutter, S. B., Schiller, D., & Charney, D. S. (2020). The emergence of ketamine as a novel treatment for posttraumatic stress disorder. Advances in Pharmacology, 89, 261-286.

Krupitsky, E. M., & Grinenko, A. Y. (1997). Ketamine psychedelic therapy (KPT): A review of the results of ten years of research. Journal of Psychoactive Drugs, 29(2), 165-183.

Mia, M. (2021) Glutamate: The Master Neurotransmitter and Its Implications in Chronic Stress and Mood Disorders. Front Hum Neurosci. 15: 722323.

Murrough JW, Iosifescu DV, Chang LC, Al Jurdi RK, Green CE, Perez AM, Iqbal S, Pillemer S, Foulkes A, Shah A, Charney DS, Mathew SJ. (2013). Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry. 2013 Oct;170(10):1134-42. doi: 10.1176/appi.ajp.2013.13030392. PMID: 23982301; PMCID: PMC3992936.

Chadi G. Abdallah and Lynnette A. Averil

Ragnhildstveit, A., Roscoe, J., Bass, L., Averill, C., Abdallah, C. and Averillhe, L.. (2023). Potential of Ketamine for Posttraumatic Stress Disorder: A Review of Clinical Evidence. Ther Adv Psychopharmacol, Vol. 13: 1–22, DOI: 10.1177/.

Reznikov L. R., Fadel J. R., Reagan L. P. (2011). “Glutamate-mediated neuroplasticity deficits in mood disorders,” in Neuroplasticity, eds Costa e Silva J. A., Macher J. P., Olié J. P. (Tarporley: Springer; ), 13–26. 10.1007/978-1-908517-18-0_2

Walsh, Z., Mollaahmetoglu, O., Rootman, J., Golsof, S., Keeler, J., Marsh, B., Nutt, D., and Morgan, C. (2022). Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review. BJPsych Open (2022) 8, e19, 1–12. doi: 10.1192/bjo.2021.1061

Witt K, Potts J, Hubers A, et al. Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials. Australian & New Zealand Journal of Psychiatry. 2020;54(1):29-45. doi:10.1177/0004867419883341

Wolfson, P., & Hartelius, G. (Eds.). (2016). The ketamine papers: Science, therapy, and transformation. Multidisciplinary Association for Psychedelic Studies.

Zarate, C. A., Singh, J. B., Carlson, P. J., Brutsche, N. E., Ameli, R.,

Luckenbaugh, D. A., … & Manji, H. K. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives of General Psychiatry, 63(8), 856-864.

People often wonder what “psychological evaluation” is, what it is used for, and how it can help.

This blog post is written by Jennifer L. Farley, PsyD, Lindner Center of HOPE, Staff Psychologist. We’ll dive into the varying answers to those questions, learn more about referral questions, testing settings and why psychological evaluation is important.

What is psychological assessment?

Psychological assessment is the process of evaluating an individual’s mental health and behavioral functioning through the use of standardized tests, observations, and other methods. It is typically conducted by a mental health professional, such as a psychologist or psychiatric nurse practitioner, and is used to diagnose mental health conditions, determine appropriate treatment options, and measure progress in treatment.

Most broadly, psychological evaluation involves an objective manner in which one’s “psychological functioning” is assessed. An “objective” way of testing involves comparing one’s responses to standardized measures (in which every respondent is given the same measure or responds to tests that are administered in the same way) to normative group (usually based on the person’s age) to see how well they are functioning compared to their age peers. (Think of the standardized testing that students complete in school or with college preparatory examinations such as the ACT or SAT.) “Psychological functioning” is also a broad label, since many different abilities are assumed within this. More specifically, when people refer to “psychological functioning,” it helps to understand if they are referring to intellectual abilities and some other cognitive skills (such as attention), emotional functioning, and/or personality characteristics.

Types of psychological evaluation and what is included in testing?

There are different types of evaluations that can be pursued, depending on the purpose of the testing.

Psychoeducational evaluation

First, a psychoeducational evaluation is one in which the patient typically undergoes testing for a learning-based disorder. Often, this testing centers around intellectual testing and academic achievement measures (such as tasks involving math, reading, and written language). Comparisons are then made between one’s intellectual abilities and his or her academic skills; if there is a large discrepancy between one’s intellectual skills and academic skills in any particular area (in which the academic ability is significantly lower than what would be expected for the patient’s intellectual abilities), this helps form the basis of diagnosing a specific learning disorder.

Psychoeducational evaluations are often performed within schools when there is a concern about a child having a cognitive or learning-based disorder that is interfering with their learning. These types of evaluations are also often done “privately,” meaning that individuals pursue these evaluations in a clinical (i.e., not academic) setting with a licensed psychologist. Often, other measures (such as classroom observations or parent and teacher questionnaires of observations of behaviors or emotional functioning) may be included in these types of evaluations. Though school psychologists cannot diagnose specific disorders (such as Attention Deficit/Hyperactivity Disorder), what matters most is that regardless of the testing setting, the findings help guide interventions and/or accommodations that can be implemented into a 504 Plan or into a more formal, Individualized Education Plan (IEP).

Emotional and/or personality functioning evaluation

Some may seek evaluations to help understand a patient’s emotional and/or personality functioning, especially because the testing helps learn about the individual in a more comprehensive way in a shorter amount of time (instead of over several therapy sessions). Results from these measures can help with recommendations for mental health treatment, such as with use of medications and/or for therapy (such as which strategies can be most helpful to teach the patient). Findings can also help guide other referrals, such as to other specialists (such as a psychiatrist or a neurologist). Depending on the age of the patient, these measures may include questionnaires that are only completed by the patient themselves (this is particularly the case among adult patients).

Assessments in children

When assessing a child, parents often complete questionnaires that ask about what they observe (behaviorally and emotionally) in their child. When the patient is an adolescent, it is more common that a combination of emotional and personality questionnaires are included that involve the adolescent responding to self-report measures and the parent(s) or primary caregiver(s) responding to their own measures involving observations of the child. Parent or caregiver responses are particularly helpful (and often necessary) when assessing children and adolescents, as most children and many adolescents lack enough insight or awareness into their difficulties, and often parents are the ones to observe problems or concerns first. These evaluations are conducted in clinical settings such as outpatient practices and sometimes inpatient hospitals in which obtaining such information is necessary to guide a clinician’s diagnostic impressions and treatment recommendations.

Neuropsychological evaluation

Another type of psychological assessment is a neuropsychological evaluation that helps measure more detailed aspects of cognitive functioning, such as executive functioning abilities (i.e., one’s ability to plan, organize, and inhibit cognitive, emotional, and behavioral responses), attention, learning, memory, and even motor coordination and/or strength. Individuals who specialize in these types of assessments are required to have completed more thorough post-doctoral training. Often times, referrals may come from physicians or therapists who are concerned about a patient’s functioning in these areas, whether it be related to a neurological condition (such as a seizure disorder, a head injury, or dementia) or to a psychiatric disorder (in which it is common for mood states or anxiety to negatively affect one’s cognitive functioning). Neuropsychological assessments are most often conducted in medical-based settings. Yet, they can also be conducted when a more comprehensive evaluation is sought after (such as in psychiatric residential settings). When this is the case, a neuropsychological assessment battery can capture one’s functioning more globally with measures of intelligence, academic achievement, neurocognitive abilities, and personality and emotional functioning.

Why is psychological testing important?

There are several reasons why psychological testing is important:

  • Psychological assessment is important because it can help identify mental health conditions and other issues that may be impacting an individual’s thoughts, feelings, and behaviors.
  • It can provide a more complete understanding of an individual’s strengths and weaknesses, which can be useful in making decisions about treatment and support.
  • Psychological assessment can help diagnose conditions such as depression, anxiety, bipolar disorder, and attention deficit hyperactivity disorder (ADHD), among others.
  • It can also be used to assess an individual’s cognitive abilities, such as memory, problem-solving skills, and intellectual functioning.
  • Psychological assessment can help identify the underlying causes of an individual’s symptoms and provide a basis for developing a treatment plan that is tailored to their needs.
  • It can also be used to monitor an individual’s progress in treatment and make any necessary adjustments.
  • Psychological assessment can help individuals and their families better understand the nature of their struggles and the options available for addressing them.

A final consideration for any kind of psychological assessment is this: while testing is often sought after to diagnose a condition or to understand one’s possible difficulties in any area of functioning, it is also important to learn what someone’s strengths are. Everyone has strengths and weaknesses relative to their own abilities; it is helpful to inform individuals from testing of what their strengths are and how to use these to compensate for any documented weaknesses they may have. Information helps empower people to develop and grow, and results obtained from psychological assessment can help people be more informed as to how to proceed with utilizing their cognitive and/or emotional strengths to help improve their mental health overall.

There is HOPE. For help, call 1-888-537-4229.

If you or a loved one is suffering from mental illness or addiction, contact us for information on our residential treatment programs for mental health in adults.

Read more about Lindner Center of HOPE’s assessment programs.

What is Panic Disorder?

Panic Disorder is an anxiety disorder that occurs when someone experiences recurrent, spontaneous, unexpected, and untriggered panic attacks. This leads to preoccupation with and fear of experiencing another attack. Panic attacks occur when there is an intense physical surge of symptoms that quickly reach their peak, usually in a few minutes. A panic attack can be felt very differently from one person to another. A combination of the following symptoms is typically experienced during a panic attack:

  • Heart palpitations, pounding heart, or accelerated heart rate
  • Sweating/perspiration
  • Trembling or shaking
  • Sensations of shortness of breath or feeling smothered
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizziness, unsteadiness, light-headedness, or faintness
  • Chills or feeling over-heated
  • Numbness or tingling sensations
  • Feelings of depersonalization (unreality)
  • Feelings of derealization (being detached from oneself)
  • Fear of losing control or “going crazy”
  • Fear of death or dying
  • Sense of impending doom or danger

At least one of these panic attacks is followed by one month or more of persistent concern or worry about having another attack and/or a significant change in behavioral pattern (typically avoidance of certain places or situations).

Panic attacks can be viewed as a “false alarm” related to a fight-or-flight response to a mis-perceived threat. Fight-or-flight is a natural human reaction that prepares us to defend ourselves or flee the situation. When someone becomes hyperaware of their body’s sensations, they may interpret a sensation as a threat when there’s not one.

Panic disorder affects 2-3% of Americans and is affects women roughly twice as frequently as it affects men. The onset of Panic Disorder typically occurs in adulthood, but can also affect children and teens.

What is Agoraphobia?

Agoraphobia occurs when someone persistently avoids situations in which they might become embarrassed or have difficulty escaping. This is often the result of fear of having a panic attack in public. This can manifest in fear of using public transportation (such as planes, buses, trains), being in open spaces (such as parking lots, malls, or stadiums), being in enclosed spaces (such as elevators, stores, or cars), being in crowds or standing in line, or even being outside the home alone.

Panic Disorder can be present with or without Agoraphobia, but these disorders commonly present together. When they occur together, Agoraphobia usually develops following an adverse experience, such as having a panic attack in one of these places/situations in which the person feels trapped, embarrassed, or fearful. Over time, avoidance of these situations and places reinforces one’s fear, leading to further avoidance.

How are Panic Disorder and Agoraphobia treated?

People with Panic Disorder often present to emergency departments or their physician’s office due to their uncomfortable physical sensations (often fearing that they are suffering from a heart attack). While it is important to rule out any physical cause for these symptoms, repeated trips to the ER and doctor visits can also reinforce the symptoms. Instead, it is important to receive appropriate mental health treatment for Panic Disorder and Agoraphobia.

Treatment for Panic Disorder and Agoraphobia typically includes of a combination of medication and psychotherapy. Medications commonly used to treat Panic Disorder and Agoraphobia include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), beta blockers, and benzodiazepines. SSRIs and SNRIs are a category of antidepressants that are also useful in treating anxiety disorders such as Panic Disorder and Agoraphobia. Beta blockers can be used to help control some of the physical symptoms of panic attacks such as a rapid heart rate. Benzodiazepines are useful to provide temporary relief of acute anxiety symptoms. These medications can be very helpful, but they should be used with caution due to their potential for dependence. Benzodiazepines can also interfere with the ability to habituate or learn that situations are safe. Only your health care provider should determine whether these medications are appropriate for use and you should not discontinue any medications without consulting with your provider.

Cognitive-Behavioral Therapy (CBT) is an evidence-based type of psychotherapy that is helpful in treating Panic Disorder and Agoraphobia. This therapy helps people to change their behavior and their way of thinking. Various CBT techniques are useful in treatment of these anxiety disorders. Interoceptive exposures involve purposely provoking uncomfortable physical sensations (heart pounding, shortness of breath, dizziness) to desensitize oneself to them. This should be done with the guidance of a trained mental health professional to ensure that it is done correctly. Similarly, gradually limiting avoidance of circumstances and places (such as driving or going into stores) that are typically avoided allows someone to become comfortable and gain confidence in these situations. Breathing and relaxation exercises can help to lower someone’s overall level of anxiety to prevent them from having a panic attack. And finally challenging faulty beliefs, such shifting from thinking “I’m in danger” to “my body is telling me that I’m in danger, but I’m actually safe” can be helpful in lowering related anxiety. Other helpful interventions include biofeedback and mindfulness. Additional lifestyle changes such as reducing one’s intake of caffeine, sugar, nicotine, regular exercise and sleep, and limiting checking vital signs can be helpful in lowering anxiety.

If you believe that you or someone you know is suffering from Panic Disorder and/or Agoraphobia, it is important to seek the help of a mental health provider. These disorders can become debilitating without proper treatment but can become manageable if properly treated.

by Jennifer B. Wilcox, PsyD
Staff Psychologist, Lindner Center of HOPE