Category: Disorders

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Peter White, M.A., LPCC, Lindner Center of HOPE, Addictions Counselor

Many loved ones of people with substance use disorders are often discouraged by the severity and duration of distress initiated and endured by their loved ones. In a related manner, many professionals working with people with substance use disorders become disillusioned and discouraged by the extent of problems, and a lack of progress in treatment. It seems that experiencing burnout, or feeling just plain burnt, are two common emotional consequences of committing time and energy in trying to help people with substance use disorders. I would argue that one of the most important things we can do, being the people who care, is revisit our understanding of the fundamentals of substance use disorders, and reorient our recovery approach in a manner that aligns with these fundamentals.

Substance use disorders are chronic, behavioral disease conditions that if not addressed will progress into increasingly diseased states up to critical illness and death.  They do not have a cure.

It is easy to be initially discouraged by this reality, until we consider an additional reality – substance use disorders are imminently recoverable. That is to say, at any time a person with a substance use disorder can make the changes that stop the progression of his or her disease process, ( a major accomplishment in itself,) and begin the process of establishing and consolidating a healthy and rewarding recovery. The bad news is that there is no cure. The good news is that once we accept this, we are then free to focus on the ever present possibility of sobriety, health and growth taking root as our loved one’s lifestyle.

Our real challenge is to remain continually present, authentic and hopeful as we develop interventions and support over the course of a disease and recovery process that will often endure for decades. Think about that. If we appreciate the nature of a chronic condition, then we acknowledge that the process of growth, as well as the potential threat to growth, is never over. In a way, I would say that the experience of burnout isn’t logical, because people with terrible conditions can and do get better all the time. It is the maintenance of this very realistic hope for the advancement of recovery in the face of the loss and distress of alcohol and drug use that is the most effective way to help our loved ones, as well as to prevent burnout for ourselves.

I once asked clients during a group to state what their definition of recovery was. I noticed that their answers really focused on the establishment and expansion of behaviors that were in line with their values much more than they were focused on the cessation of drug use  -“Dealing with responsibilities, ”Complete change of focus, ”Knowing I can change and grow,” Doing my best- healthy, clean, sober, ”Becoming self-reliant.” It was a very reassuring moment for me as a helping professional in that the clients were not searching for a tabulation of “clean” days vs. “using” days. What they were really focused on was a direction that would incorporate every part of their lives away from risk, disease and loss, and towards the pride and enjoyment of health and growth that I think all people desire.

Let me end on a note where we do acknowledge that substance use disorders are often very destructive. If you are a loved one or a professional who is becoming overwhelmed or burdened too long by the losses you’ve encountered, lets acknowledge that disengagement and the establishment of boundaries are often the healthiest option for all involved. Disengagement does not need to be related to the rejection of people or the abandonment of hope for recovery. It is most often a very appreciable need for self-care in the face of risk and loss. Just as we help those with substance use disorders by decreasing our focus on the multiplicity and duration of problems, let’s help ourselves by not focusing on all the problems that we find we can’t deal with. Instead let’s focus ourselves on our limits relative to all the help we have or might offer, and remind ourselves that our own growth is imminently available, and that we should honor any rest we need until we able to make ourselves available for help once more.

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November is Family Caregivers Month.

A growing number of Americans are taking roles as caregivers for loved ones suffering with a variety of illnesses and disabilities. At least 60 million have a caregiving role – most caregivers are middle-aged adults.

Caregivers can be anyone doing a broad range of tasks for loved ones who are unable to perform everyday duties like picking up groceries, getting dressed in the morning, or driving to medical appointments. These caregivers are often unpaid and untrained.

By giving so much for others, it is easy to neglect self-care and caregivers often suffer burnout that leads to higher rates of mental illness like depression and anxiety. Exhaustion and fatigue can lead to more serious health issues. Recent studies show 40-70 percent of caregivers have clinically significant symptoms of depression and anxiety due to chronic stress associated with providing care

Some self-care strategies can include:

  • Eating right, exercising and getting enough sleep (7-8 hours) is always important
  • Make a self-care calendar and share that plan with someone else
  • Don’t base your identity on your care for others. Caring is acting, not being
  • Be mindful: Recognize how an activity reenergizes you and fully participate in it
  • Keep a victory journal
  • For more tips, view:  http://www.fox19.com/video/2018/11/16/national-caregivers-month/

The Lindner Center of HOPE has some of the nation’s leading physicians experienced in depression treatment and self-care. If caregivers are experiencing symptoms of depression or anxiety, they can schedule an evaluation at the Lindner Center of HOPE Rapid Access Service, which is an outpatient service for patients 18 and older, open Tuesday and Thursday afternoons from 12:30 pm to 4 pm. This service enables patients in need to have a scheduled appointment, within days of the call. The appointment includes a thorough outpatient assessment with a psychiatrist and social worker, a care plan, recommendations with referrals and a written after-visit summary. Call 513-536-0639 to schedule.

 

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Chris Tuell Ed.D., LPCC-S, LICDC-CS
Clinical Director of Addiction Services Lindner Center of HOPE
Assistant Professor, Department of Psychiatry & Behavioral Neuroscience University of Cincinnati College of Medicine

In 1987, Francine Shapiro went for a walk. While on her walk, Francine was contemplating some very upsetting personal events that were occurring in her life at the time. But as she began to focus on this upsetting information, she noticed that her eyes began to flicker from side to side. More importantly, she noticed that the once upsetting information was no longer as upsetting. Shapiro felt that she had stumbled on some aspect of how the mind processes information. Eye Movement Desensitization and Reprocessing, better known as EMDR, was born.

For the past 30 years EMDR has become one of the most effective therapeutic approaches in the treatment of trauma. EMDR is not only approved by the American Psychiatric and Psychological Associations, but also by the United States Department of Defense and the Veterans Administration, as an effective therapy in the treatment of post traumatic stress disorder (PTSD). Dr. Shapiro believes that one of the major theories behind EMDR is the bilateral stimulation of both hemispheres of the brain. When we sleep at night, our brain continues to process information. This occurs during rapid eye movement sleep or better known as REM sleep.

The brain processes the events of the day, keeping what is important (e.g. family, work, school, friends), and purging what is unimportant (e.g., What I had for dinner last Tuesday). How many times have we have been faced with a tough decision and resorted to, “I’ll just sleep on it,” only to awake the next morning with a better idea of what to do? But when a traumatic event occurs, the processing of this information becomes disrupted. The brain becomes unable to process and clear the event or information, resulting in the trauma experience continuing to occur as if it is happening all over again. In this playing-out, the right hemisphere of the brain, the part of our brain that experiences emotions such as fear and anxiety, continues to be activated by the unresolved trauma. The patient experiences this activation through intrusive thoughts, flashbacks, and disturbing dreams, the basic elements of PTSD.

EMDR involves the bilateral stimulation of both hemispheres of the brain while targeting the upsetting aspects of the trauma. In therapy, the therapist recreates what happens naturally during REM sleep, with the movement of the eyes as they follow the therapist’s hand, stimulating both hemispheres of the brain. Over the years, additional bilateral stimulation methods have been found to be effective (i.e., tactile, audio). This targeting involves, not only activating the image of the event, but also identifying the negative thoughts, emotions and sensations experienced by the patient from the trauma. During the reprocessing of the trauma experience, the logical, rational part of the brain, the left hemisphere, is integrated with the right emotional hemisphere. This results in the patient having a more adaptive response to the trauma. The patient may still have memory of the event, but the emotional aspects of fear and anxiety have dissipated. During EMDR, the left hemisphere of the brain, the rational, logical part, is integrated with the emotional right hemisphere of the brain, resulting in the patient feeling and knowing that, “The trauma is no longer happening to me now; The trauma is in the past; I am safe now.”

EMDR is not a wonder cure nor is it a quick fix. EMDR involves hard work by the patient and it takes a good amount of clinical skills in order to implement. This is not about touching the person’s forehead and he or she is better. The patient and therapist have to be responsible and work at this process, but it does appear to go much more rapidly than traditional types of therapy. If a trauma can occur within a few moments, why do we automatically accept that it has to take years to undo it?

More than 20,000 practitioners have been trained to use EMDR since its discovery. The use of EMDR has been found to be beneficial in other areas of mental health besides, PTSD. Areas such as panic disorders, anxiety disorders, grief, pain, stress, addiction, and abuse, have shown to be responsive to this unique therapy. One aspect of EMDR that I have found to be valuable is the fact that it is unnecessary for me, as the clinician, to know all the details and specifics of a patient’s trauma in order for EMDR to be helpful. Many individuals who have experienced trauma stay clear of therapy for fear of reliving the memories and feelings. The EMDR protocol allows for such traumatic episodes to be addressed and reprocessed without describing the details of the trauma. As a practitioner, I have found EMDR to be a valuable therapeutic tool in assisting patients in moving past one’s past.

For more information about EMDR: https://www.emdria.org

 

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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

Depression is on the rise in American teens and young adults. Adolescent girls, in particular, seem to be the most vulnerable youth, according to recent research published online in the Journal of Pediatrics.  Data collected between 2005 and 2014, analyzed by the Johns Hopkins University School of Public Health, concluded that “the 12 month prevalence of major depressive episodes in adolescents increased from 8.7% in 2005 to 11.3% by 2014”.  This number rose from 4.5% to 5.7% in boys and 13.1% to 17.3% in girls. The reasons for this increase remain under discussion. However, cyber bullying has been hypothesized as one trigger, particularly for girls.

How does a parent know when and where to seek help? How can parents support their child or adolescent suffering from depression? Here are some general guidelines for getting started.

  1. Observe your child’s behavior for idiosyncrasies or changes. Children with depression may demonstrate low mood, irritability, anger, fear or anxiety, mood swings, disruptive or risk-taking behavior, disobedience/defiance/ illegal behavior, isolation, lack of self-care/hygiene, decreased interest in previously enjoyable activities, decreased energy, increased or decreased sleep, increased or decreased appetite, and changes in friendships or family relationships. Some children turn to drugs or alcohol. Others turn to the internet for support or socialization. School performance may deteriorate, or attendance may decrease due to physical complaints or blatant truancy. Some children engage in self-harming behaviors or talk of death and dying.
  2. Engage your child in daily conversation or other one- on -one activity to open lines of communication.  Gently ask questions about your child’s change in mood, daily life and issues or how he or she is getting along with others. Find novel ways, if necessary, for your child to communicate his or her feelings. This may include sharing a journal that you pass back and forth or quantifying your child’s mood with a “mood scale” (0= severe depression and suicidal thinking versus 5 = happy mood/doing well) or even sharing “emojis” reflecting how the child is feeling that day. If your child expresses suicidal thoughts, such as not wanting to live or wishing he or she were dead, talks about ending his or her life, or engages in writing suicide notes – please take them directly to the local emergency room for further psychiatric evaluation.
  3. Talk to your pediatrician or family doctor about your child’s mood or changes in behavior. Consult with your child’s teachers or school counselor. Talk to your minister, priest, or rabbi. Arrange timely assistance for your child, perhaps through your Employee Assistance Program or through your health insurance. These professionals can assist you in finding a qualified mental health professional to provide evaluation and counseling.
  4. Monitor and limit phone, computer and electronics time. Know with whom your child is communicating. Watch internet history, cellphone texting, and social media communications. Kids looking for support often look in the wrong places and meet the wrong people while there.
  5. Encourage a healthy and consistent sleep schedule.  Children and teens need about 8-10 hours of sleep per night. A regular pre-sleep routine that does not include electronics and enhances relaxation along with a scheduled bedtime and wake-up time are all tenets of a healthy sleep habit.
  6. Encourage healthy eating habits. Limit sodas, caffeine, sugar- laden foods and snacks. If your child is not eating regular meals or portions, encourage smaller, more frequent meals of healthy foods throughout the day. Observe aberrant behaviors at meals, such as restricting caloric intake, leaving the table immediately after eating to go to the restroom and diverting food by hiding it or throwing it away. Observe striking weight loss, excessive exercising, or obsessive concerns with body image that may indicate concern for an eating disorder.
  7. Be consistent and firm with limit setting. Some parents feel badly for their child with depression and feel they should relax limits or house rules to decrease perceived stress on the child with depression. They fear being too strict or harsh. Maintain the same or even slightly more stringent rules with your child to maintain structure and avoid singling out the child with depression. Treat all children in the family equally. Be aware of your child’s whereabouts and safety at all times.
  8. Safety- proof your home. Lock up all medications, even over- the -counter medications, and seemingly harmless remedies. Secure anything in the home that could be used as a weapon, particularly firearms. Remove firearms from the home entirely. Secure alcohol or remove it from the home entirely.
  9. Ensure that you are taking care of your own well-being and mental health. Depression can run in families. If you, as the parent, are struggling with your own mental health, it will be difficult to remain objective and supportive toward your child, who is also struggling. It may also make identifying your child’s depression more difficult or impossible. Resist the urge to tell your child that you know how they must feel or that you were once depressed or are currently depressed. Avoid trying to give advice or sharing how you have battled your own depression.

Practice listening attentively and reassuring your child that you will get them whatever help is needed for them to feel better and return to a healthy, happy life. Be sure to get help for yourself, such as therapy or medication or both. This will assist you in being the best possible support for your child and family.

Identifying child and adolescent depression and dealing with it can be overwhelming. The key is to reach out for assistance and allow others to provide their support and expertise, so that a team approach can be utilized to its fullest. Organizations such as the American Academy of Child and Adolescent Psychiatry, National Alliance on Mental Illness (NAMI) and the American Psychiatric Association are all excellent sources of information and support.

References:
Mojtabai R, Olfson M, Han B. National trends in the prevalence and treatment of depression in adolescents and young girls. Pediatrics. 2016; doi: 10. 1542/peds.2016-1878.
Glowinski AL, D’Amelio G. Depression is a deadly growing threat to our youth: time to rally. Pediatrics. 2016; doi:10.1542/peds.2016-2869.
American Academy of Child and Adolescent Psychiatry. Your Adolescent. 1999. 301-304.

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BY: Elizabeth Wassenaar, MS, MD, Lindner Center of HOPE, Staff Psychiatrist and Medical Director of Williams House

 

Life can be overwhelming and we all would like to take a day off every once in a while. Likely, as helping professionals, we don’t take mental health days as often as we could actually benefit from them.  This is one of the reasons why, when a child or adolescent refuses to go to school, we may be initially sympathetic.  Maybe a day or two off will help, we may think.  In too many cases, however, we see that a day or two off turns into something much more problematic as parents and professionals struggle to get a school avoider back to school.  Homework piles up, grades start to fall, and friends wonder what has happened to their classmate.  Parents try many different tactics to try to get their child back to school; bribing, negotiating, punishing, or even carrying a child through the school door.

Children want to not go to school for many reasonable causes: kids can be cruel; learning can be difficult; anxiety about performance can be overwhelming; health concerns can require special privileges that feel too identifying; and getting up early in the morning is harder for some more than others. Furthermore, mental illness can make school attendance difficult for many additional reasons.  There are good reasons to keep children home from school – physical illnesses can be contagious, some stages of mental illness are better treated with mental rest, and in some cases of bullying the safest way to deal with an unsafe situation is to remove the child.

Nevertheless, school refusal is avoidance, and anxiety loves avoidance. Nothing is more reinforcing that one cannot handle something than not doing it.  So, after one has checked on physical health and for other explanations, how can professionals support parents to keep their children in school or break the cycle of school avoidance and school refusal?

  1. Help parents identify the behaviors of avoidance and link that to anxiety.

Avoidance is a coping mechanism for dealing with anxiety, which can become maladaptive when avoidance becomes the only options. Avoidance can look a lot of different ways –tantrums, tearfulness, vague physical symptoms, negotiation (more on that later), chaos, and so on.  Parents may not be able to recognize all of the forms avoidance can take. Helping them objectify avoidance will help them strategize on how to deal with it.

  1. We have to truly believe that avoiding school will not make it better.

It can be tempting to collude with anxiety that the precipitant needs to be avoided for all the reasons laid out in this article and we need to be internally convinced that anxiety is not correctly assessing the situation. As difficult as school can be, school occupies a unique place in a child’s life.  It is the place of work, play, and love.  Learning and playing are the main jobs of childhood.  Playing looks both like playing at recess and like experimenting in relationships with both friendship and love. Identity is formed and reformed through our work, play, and love.  When a child is not in school for an extended length of time, they are abrupting their opportunity for this developmental process to proceed.

  1. Negotiation is another way of avoiding and is a dangerous game.

Many of my patients have used a variety of negotiating tactics with their parent: “Let me go in later and then I’ll go, I promise” or “Let me catch up on my work today and I’ll go in tomorrow”. Small avoidances add up to large avoidance and are not moving towards your goal.  Reverse the negotiation and set up conditions that will allow an out as long one starts the day at school.  Often, once anxiety has lost its argument that one cannot handle going to school, staying in school through the day is easier to manage.

  1. Encourage parents to work with the school

Parents and school are on the same side of this concern – both parties want the child to be successful in school. For parents, this may be the first time dealing with school refusal, but it is most certainly not the first time the school has dealt with school refusal.  Most schools have a variety of plans to help keep a child in school.  Have parents reach out to the school and let them know what is going on.

  1. Set small goals that lead to the victory

The ultimate goal of full school participation is an overwhelming prospect. Depending on how severe the school refusal is, reintroducing school can be an extended process of gradually introducing larger and larger challenges.  Perhaps, on the first day, one can only walk through the school doors.  Maybe a student will be able to be in the school building, but not in classes.  Parents can engage trusted friends to provide motivation and encouragement through social interaction and distraction while at school.

  1. School has many different forms

Many families choose alternative school arrangements including home schooling, virtual schooling, and others, for a variety of reasons and this article is not meant to convict choices that do not have a child in a classroom every day. There are many viable options for school that provide an environment that promote healthy development.  When a family is making a decision to change the way school is delivered, help them examine what factors are involved in their decision.  If they are making the decision from a place of believing that the anxiety that drives school avoidance cannot be defeated then, help them with all the ways described above.

School is a venerable and sometimes dreaded rite of passage. A great deal rides on academic and social success in school which increases anxiety and can lead to school refusal.  As a team, parents, professionals, and schools can help keep children and adolescents in school and accomplishing their goals.

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On October 28, 2015, Dr. Elizabeth Wassenaar, Lindner Center of HOPE Psychiatrist and Williams House Medical Director, joined Lon Woodbury on the Woodbury Report radio show.  Their discussion focused on outlining the benefits of a residential assessment for mental health concerns in adolescents.

Click here to listen.

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Susan L. McElroy, MD

Lindner Center of HOPE, Chief Research OfficerUniversity of Cincinnati College of Medicine, Professor of Psychiatry and Neuroscience

Intermittent Explosive Disorder (IED) is a common and serious disorder that is often unrecognized and untreated. People with IED are periodically unable to restrain impulses that result in verbal and physical aggression. The aggressive behaviors are unplanned, out of proportion to provocation, and cause distress and psychosocial impairment, including interpersonal difficulties, divorce, school suspension, job loss, and financial and legal problems.

The violent behaviors of IED, often called explosive outbursts or rage attacks, are often preceded by aggressive or violent impulses, described as “the need to attack,” ‘the need to defend oneself,” “the need to strike out,” “seeing red,” or “an adrenaline rush.” These impulses are associated with tension, anger, increased physiological arousal, and increased energy. The explosive outbursts are brief, lasting 10 to 30 minutes, and usually followed by feelings of depression, remorse, guilt, and fatigue.

Once thought to be rare, we now know that IED is very common. Research has shown that the lifetime prevalence of IED in the general population is 1 to 7 percent. The average age of onset is 14 to 18 years among adults, and 13 among adolescents. IED is most common males and younger people. Of note, people with IED often have other psychiatric disorders, like depression, bipolar disorder, alcohol or drug abuse, and anxiety.

The cause of IED is unknown but biological, psychological, and social factor are thought to be involved. Importantly, IED runs in families suggesting that genetic factor are involved. Research also suggests that abnormalities in serotonin function in the central nervous system plays a role in IED.

IED is usually treated with medications and/or cognitive behavioral therapy (CBT). Medications that may be helpful include serotonin reuptake inhibitor s (like fluoxetine), anti-epilepsy medications (like carbamazepine ), or mood-stabilizers like lithium. When treating IED, it is crucial that other psychiatric conditions are identified and properly managed.

No medication, however, is approved by the United States Food and Drug Administration for the treatment of IED.   Hence, Azevan Pharmaceuticals is sponsoring a study to see if a novel medication is efficacious for IED in adults. This medication affects vasopressin, a hormone in the brain thought to play an important role in regulating aggressive behavior. This medication has been shown to reduce aggressive behavior in animals. The Research Institute at the Lindner Center of HOPE will be participating in this study which is scheduled to begin in late August. The Research Institute will be recruiting volunteers with IED to participate at that time. If an individual has questions about the study and might be interested in participating, they can call 513-536-0710 for further information.

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Millions of individuals live each day in fear – not of an actual physical threat, but imaginary dangers, remembered trauma, inanimate objects, or something as simple as walking outside their front door.

The most common psychiatric illnesses today are anxiety disorders.  Estimates place the number of affected Americans at up to 40 million. At least 18% of adults and 13% of children suffer from some type of anxiety disorder in a given year.

The Nature of Anxiety Disorders

We all experience brief moments of anxiety during stress.  In order to be considered an actual disorder, anxiety symptoms must be intense and frequent.

Mental health professionals recognize six different types of anxiety disorders:

  • Obsessive-compulsive disorder – continual disturbing thoughts and/or the need to perform ritualistic behaviors;
  • Generalized anxiety disorder – excessive, unrealistic worry or tension without apparent cause;
  • Post-traumatic stress disorder – frightening thoughts and memories after a traumatic event, often with emotional numbing;
  • Social anxiety disorder – overwhelming self-consciousness or phobia about being in social situations;
  • Panic disorder – sudden feelings of terror, often with incapacitating physical symptoms;
  • Specific phobias – intense fears of specific situations or objects.

Excessive fears or feelings of dread are common to all types of anxiety disorders.

Common Symptoms

While clusters of symptoms vary with the type of anxiety disorder, individuals with severe anxiety may experience:

  • Persistent feelings of panic, fear, or dread;
  • Obsessive thoughts;
  • Ritualistic, compulsive behaviors;
  • Flashbacks to traumatic experiences;
  • Feelings of losing control;
  • Frequent nightmares;
    • Intense fears in public situation;
    • Intense fears of certain objects or activities;
    • Physical symptoms such as shortness of breath, heart palpitations, nausea, muscle tension, dizziness, or dry mouth.

Causes and Risk Factors

Many factors may influence the development of an anxiety disorder.  They include genetic tendencies as well as such environmental factors as repeated exposure to stressful events or one major traumatic event. Even certain medications, including antihistamines, oral contraceptives, and insulin, have been found to trigger anxiety.  As with most mental illnesses, anxiety disorders appear to develop from an interaction of many medical, genetic, psychological, and environmental factors.

Anxiety disorders can affect anyone and often occur in conjunction with other physical and mental illnesses. Women are diagnosed with anxiety disorders more frequently than men.  No differences in prevalence have been noted across races or cultures.

Anxiety Treatment

Treatment of anxiety can greatly reduce or eliminate symptoms in most individuals.  Primary treatments for most anxiety disorders include medication and psychotherapy.  Treatment can usually be provided on an outpatient basis, although brief residential or inpatient treatment is sometimes needed, depending upon the individual’s unique needs.

Medications used to treat anxiety disorders include a variety of antidepressants and anti-anxiety drugs.

Cognitive-behavioral therapy is the preferred type of psychotherapy for severe anxiety.  Through therapy, patients learn to recognize unhealthy thought patterns and behaviors associated with their anxiety and to change both faulty thinking patterns and their reactions to “trigger” situations.

In addition to medication and psychotherapy, treatment may include relaxation therapy, changes in diet and lifestyle, and education on the illness for both patients and their families.

While anxiety disorders cannot be prevented, people can often reduce symptoms by limiting caffeine consumption, avoiding over-stimulating medications or supplements, and seeking immediate support or counseling after a traumatic experience.

Through proper treatment and symptom management, millions of individuals affected by anxiety disorders can lead fulfilling lives again.