Category: Mental Health

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Integrative mental health (IMH) combines conventional biological psychiatry and psychological interventions with traditional and complementary alternative medicine (CAM) to provide holistic patient-centered care. Using non-hierarchical interdisciplinary teamwork, the patient and practitioner are able to explore psychological paradigms involving biological, cultural and spiritual dimensions of health and illness. Kindness, avoidance of harm and informed consent are core ethical principles of practice. As well as addressing immediate mental health problems, the patient is encouraged to become actively involved in their own prevention of mental illness and maintenance of mental health.

Mental health is a key determinant of wellness, and has been shown to be strongly influenced by lifestyle factors such as chronic stress, sedentary life style, poor nutrition, obesity, substance abuse, and social isolation. Use of complementary alternative medicine in mental health conditions has been driven by the high cost of conventional care, and the growing list of medication safety concerns reported by the FDA, but due caution must be used with all Interested in touring therapies, conventional or complementary.

The fundamental goal of an integrative approach to mental health is to find the most appropriate treatments (conventional and complementary) that safely and effectively address the symptoms
of the individual, while taking into account personal preferences, cultural beliefs and financial constraints, an approach endorsed by the American Psychiatric Association.

Integrative mental health is an evolving, whole-systems approach to wellness of mind, body, and spirit. It considers that symptoms are associated with multiple causes and that multiple approaches to assessment and treatment may be necessary so that each individual may attain an optimal state of health and well-being. Therefore, the integrative mental health professional is knowledgeable about complementary and alternative medicine and trained in the art of collaboration so that they can discuss patient care with medical doctors, as well. The goal is to understand as much as possible about the whole person and to be aware of what treatments are occurring simultaneously. Approximately half of the individuals diagnosed with mood or anxiety disorders are using a combination of therapies and conventional strategies to alleviate symptoms. For this reason, it is important for health care professionals to ask the right questions and to collaborate in seeking answers when treating individuals who come seeking help.

Today, these individuals may first seek counsel from a medical doctor, a psychotherapist, a chiropractor, an acupuncturist. Therefore, it is important that patients disclose all of their treatments to all of their health care professionals. Mental health professionals trained in integrative approaches frequently serve as the historians of each patient’s care, especially since they are the ones who spend the most time with each patient during the course of treatment.

Recent years have witnessed growing openness to nonconventional therapies among conventionally trained clinicians and researchers. At the same time people who utilize Western biomedicine as currently practiced are turning increasingly to integrating non-conventional therapies for the treatment of both medical and mental health problems. Approximately 72 million U.S. adults used a non-conventional treatment in representing about one in three adults. If prayer is included in this analysis almost two thirds of adults use non-conventional therapies. Anyone diagnosed with a psychiatric disorder is significantly more likely to use nonconventional therapies compared to the general population.

Integrative health care is based on the philosophy that health is influenced by a variety of interrelated factors such as life choices, environment, genetic makeup, intimate relationships, and the
meaning and purpose in life. As a model it is collaborative and multidisciplinary. It is open to and recognizes the importance of conventional medicine, complementary and alternative medicine, mental health care, and mind-body approaches (such as meditation, yoga, hypnotherapy, Reiki, and therapeutic massage). There is a respect for each individual’s journey and for the stories that make up the history of their lives. There is a belief that these individual journeys influence the biology that manifests in illness or in health. Integrative health care supports all of the important
aspects of life, including creativity, cultural expression and the celebration of community. To have “health” means that the whole person is in balance – physically, emotionally, psychologically, and spiritually. Is health really health without mental health?

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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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Charles F. Brady, PhD, ABPP, Lindner Center of HOPE, Clinical Director of Outpatient Services and Staff Psychologist, OCD/CBT Psychotherapist, Associate Professor, University of Cincinnati’s Department of Psychiatry

In today’s culture the terms “obsessive” and “compulsive” have been adopted to refer to excessively repetitive thoughts and hard to resist behaviors.  In clinical situations this overly broad definition leads to substantial confusion when discussing obsessive compulsive disorder (OCD) and substance use disorders (SUDS).  Individuals who report they are always thinking about using addictive substances and “cannot stop” acting on their urges to use, are often erroneously referred to as obsessing about using or compulsively using.  Most often, someone who is struggling with a SUD does not have OCD and vice versa. However, both research and clinical practice reveal that these two conditions co-occur frequently.  Mancebo et al, 2009 documented that in their sample of OCD treatment seeking patients, twenty- seven percent were found to have SUDS.  To address the inevitable chicken and egg question, they delved further to uncover that seventy percent of the patients with co-occurring OCD and SUDS reported that their OCD symptoms preceded the onset of their SUD by at least one year.   They also found that in their sample, the participants who reported childhood onset of OCD symptoms were at higher risk for subsequently developing a SUD.  In this article, the similarities and differences between OCD and SUDS will be explained and the pertinent issues regarding the approach to treatment when a person suffers from both OCD and a SUD will be detailed.

Psychologically, the difference between a person struggling with OCD and a person with a SUD lies in what fuels the behavioral urge.   For the person with a SUD, the behavior is positively reinforced. By this we mean that the mind anticipates pleasure from completing the action (i.e., using a substance).  For the OCD sufferer, negative reinforcement describes the mechanism of striving to reduce distress as the key for driving the behavioral urge behind the compulsion.   An additional difference is that thinking about substance use initiates a pleasure experience, whereas the intrusive thought the person with OCD experiences initiates a distress response (e.g., What if I touch a door knob and die?).  There are occasions in which the person with a SUD will express that they use their addictive substance even though they do not want to.  Typically, such an individual continues to experience pleasure and pleasurable anticipation of the use of the substance, but over time they develop an aversion to the negative consequences that use of the substance has brought into their life (e.g., loss of job, legal problems., relationship damage, shame, etc…  ).

Biologically, it appears that the orbitofrontal cortex (OFC) plays an important role for both SUDS and OCD.  The OFC is a part of the brain that helps to reign in emotional reactions.  For individuals with OCD, the OFC tends to be over activated, even in neutral situations. For individuals with SUDs, the OFC becomes over active in the presence of triggers. For instance, when a person with an alcohol addiction hears or sees a beer can being opened.  When the OFC is over activated, the individual experiences an intense drive to act and is overwhelmed by their desire to act.   This is why sufferers of both SUDS and OCD struggle to resist their urges to perform a compulsion or to engage in their addictive behavior.

For the individual with OCD and a SUD, the relationship between the two may vary.  Some individuals develop addictions as an attempt to soothe and self-medicate the distress caused by their OCD. Yet others may find that their use of addictive substances follows OCD-like rules.  For example, the person who must drink 7 ounces of alcohol per night due to the obsession that if they do not, something bad may happen to a loved one.  If the use of the substance is nested within a compulsion, exposure and response prevention (ERP)targeting the compulsion may need to be started.

At times if the addiction greatly interferes with treatment for the OCD symptoms then treatment must include aggressive treatment of the SUDS early in the treatment process. There are several ways in which substance abuse disorders, if untreated can impede effective treatment of OCD. First, many substances, including barbiturates, alcohol and benzodiazepines that are involved in SUDs are depressants.  They either cause or exacerbate depressed mood. If a person’s mood is depressed, the motivation and drive necessary to engage in ERP treatment for their OCD symptoms may be severely impacted.  Also, the essential component of successful ERP treatment involves learning. The person with OCD learns that the obsessive thoughts they experienced are not as dangerous or as intolerable as they previously believed.  This learning allows them to free themselves from compulsions and helps them resist relapse. Many individuals develop SUDS in an attempt to self-medicate and soothe the distress caused by their OCD by using drugs like alcohol, benzodiazepines (e.g., valium, Xanax, Ativan,  etc…), and marijuana. Unfortunately, these substances impede learning. The patients who are unable or unwilling to reduce or cease their abuse or dependency of these substances while they engage in ERP are going to have a more difficult time accomplishing the learning needed for recovery from their OCD symptoms.

When treating a patient with a co-occurring SUD and OCD, the clinician also must consider how willing and motivated is the person to tackle both the addictive behaviors and the OCD behaviors.  It is not uncommon for a person with a co-occurring SUD and OCD to be more hesitant and resistant to let go of their addictive behaviors as they derive some pleasure from them, yet they may be very motivated to rid themselves of their time consuming compulsions and the anxiety triggered by their obsessions.  In such instances, the clinician may need to start where the motivation allows, but continue to educate and explore with the patient about how the addiction may impede their OCD recovery and how it also may be negatively impacting their health and well-being.

In conclusion, for clinicians who treat individuals with OCD or SUDs, it is of primary importance to assess for symptoms of both disorders.  The person who presents with complaints of a SUD, may be ashamed of the absurdity of their obsessions and compulsions and may not volunteer them.  Likewise, the person with OCD may also feel hesitant to report their use of substances.  When the clinician discovers that a person may have co-occurring OCD and SUDS, the patient will benefit most from a thoughtfully and collaboratively developed treatment plan to address both conditions.

References:

Mancebo et al.,  J Anxiety Disord. 2009 May; 23(4): 429–435

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FOR IMMEDIATE RELEASE                                                                                                                                     

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

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

March session to explore Stress and Family Functioning

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

The series will be held at Manor House, 7440 Mason-Montgomery Rd., Mason the third Wednesday of the month at 6 p.m. starting January 18, 2017 for one year (though sessions will not be offered in May 2017 or December 2017. On May 7, 2017 Lindner Center of HOPE will offer their second Education Day, a ½ day workshop about mental illness and addiction.)

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

The third session is March 15, 2017. Michael K. O’Hearn, MSW, LISW-S, Clinical Director of the Lindner Center of HOPE’s Stress Related Disorders program and staff provider, will present Stress and Family Functioning.

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic and short-term residential services for adults and adolescents, outpatient services for substance abuse through HOPE Center North location and co-occurring disorders for adults and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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summerBy: Jennifer Farley Psy.D.

If you’re on social media, you may have chuckled at recent posts depicting the difference between teachers and students at the beginning versus the end of the school year – with all of them involving anticipation for summer’s reign to begin. Summer is The Quintessential Break for our kids and their educators, and it should be – it’s good for kids to have a nice break from the structure of school to be able to enjoy the opportunities that a no-school summer offers.

That being said, if you ask most kids what they are especially excited about for summer, “Sleeping in,” tends to be a common answer, especially for teenagers. (It is also the response that elicits the most sighs and eye rolls from their parents.)  Most parents are happy to have their kids experience a more relaxed schedule in the summers.  This is especially the case for parents of children who struggle with any number of cognitive or learning challenges that make the school year much more difficult and tiresome.  Yet, as with many things in life, it’s important to maintain a healthy balance, in this case, with having enough structure without being overscheduled..  What many parents may not realize is that after the first 3 or 4 weeks of summer, kids who experience the most radical shift between the structure of their school schedule to a completely unstructured summer often complain most of boredom.  I’ve heard quite a few of these children and adolescents say that they wish they could go back to school well before the start of the next school year.

There are many families who struggle with the idea of being “too scheduled” in the summertime. Setting aside the concept of being “overscheduled” for a second, there is actually quite a bit of value to having structure and routine to our days.  Having a routine helps us plan and prepare for what comes next.  Without this, we risk not being able to have some predictability and readiness to our days. Without some predictability, we risk feeling more chaotic and disorganized.  And leading a disorganized, unplanned lifestyle brings the risk of becoming more anxious and/or depressed.  Children as young as 2 can experience comfort knowing that after a good afternoon nap they’ll be able to play again.  Four-year olds ask their parents at bedtime what they’ll be doing the next day.  Even as adults, we benefit from knowing what is coming so that we can plan ahead for it.

Have you ever noticed a difference between how you (or others) function during the week compared to the weekends? Most of us who work or send our children off to school during the week have what is called “external structure.”  We know what time we have to wake up, what sequence of tasks we need to do before we leave, and we know what time we have to leave the house to get to school and/or work on time.  When at work, we know what is expected of us and what our responsibilities are. At the end of the work day, we leave with thoughts in mind of what comes next for what is planned that evening. There is much more inherent structure built into those days.  In contrast, weekends offer the opportunity for us to guide our own tasks (providing there are no athletic games or meetings or birthday parties to take our children to).  People who struggle with initiating tasks or motivating themselves to get tasks done all too often hit Sunday evening with a somber feeling that they did not accomplish most (if any) of what they intended. It can leave adults with a sense that they wasted their time, because they have nothing to show for their weekend. This same experience can be felt among children in the summer.

Think about what “boredom” looks like for kids: they may sleep in bed late, they may sprawl on the couch with no intellectually-stimulating activity, and they look “lazy” to parents by showing no initiation for any physically-active tasks. Now, picture what “sadness” or “loneliness” or any other negative feeling “looks like” for kids.  They can be quite similar to what kids experience when they are bored. Too much boredom leads to emotional discomfort, and this can lead one to lack creativity, to feel unproductive, and to experience poor confidence. These experiences can then lead one to feel more irritable, down, restless, and even anxious.

It is healthy to have some semblance of plans and structure during the summer. A family vacation offers the excitement and anticipation of a journey to look forward to. For the day-to-day routine, many parents send their kids to day camps (especially working parents), while some send their kids to a sleep-away camp for a week or two. Some families hire a nanny or a babysitter to watch their children and to take them places.  Some families have a parent who can stay at home with their children.  In any of these instances, what is healthiest is when there is a routine by which kids wake up at a certain time and engage in a morning routine.  Structure can be in the form of whatever activity is intended that day, such as swimming in the neighborhood pool, going to a movie, or having a play date with friends.  What helps is that there is something to plan for that day. Adolescents who are taking care of themselves function even better when given structure in the form of expectations – if even to complete a designated chore first before enjoying whatever leisure activity the child hopes to do. Often times, parents get more compliance from kids who agree to complete a chore first before being allowed to engage in a fun activity, such as with their friends. Ending the day with a sense of accomplishment or satisfaction of having engaged in an activity leads one to feel more rested, physically and emotionally.

Being “overscheduled” can lead to stress on the entire family, and it does not allow for any rest time. It is good for children and adolescents to enjoy the feeling that comes with “lounging around” – especially since so many miss out on that opportunity during the school year when managing responsibilities associated with academics and extracurricular activities.   Being overscheduled also can dampen one’s creativity and ideas for how to spend down time.

The key is balance: allow for a mix of planned activities with some unscheduled leisure time by which children and adolescents can choose what they would like to do. Many children may balk at the idea of having any expectations upon them, but the structure and predictability they gain from it offers many more psychological and social benefits than having no plans at all.

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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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For more than two decades, Screening for Mental Health has developed programs to educate, raise awareness, and screen individuals for common behavioral and mental health disorders and suicide.The vision is a world where mental health is viewed and treated with the same gravity as physical health, and the public’s participation in National Depression Screening Day helps make that vision a reality.

National Depression Screening Day, held annually on the Thursday of the first full week in October, is an education and screening event conducted by hospitals, clinics, colleges, and community groups nationwide. Much like the medical community screens for diabetes and high blood pressure, the goal is to offer large-scale mood disorder screenings for the public. The program provides free, anonymous screenings for depression, generalized anxiety disorder, bipolar disorder and posttraumatic stress disorder, as well as referral to treatment resources if warranted.

This year, October 8th, will mark 25 years of this revolutionary event.

Please participate in this milestone National Depression Screening Day and help spread the word to increase awareness of mental health. Take a screening now at http://screening.mentalhealthscreening.org/#/lindner-center-of-hope and encourage your family, friends and colleagues to do the same.

Facts About Depression

General

  • Up to 80 percent of those treated for depression show an improvement in their symptoms generally within four to six weeks of beginning treatment. (NIH)

Global

  • According to the World Health Organization, depression is projected to become the second leading contributor to the global burden of disease by 2020
  • Depression is a common mental disorder. Globally, more than 350 million people of all ages suffer from depression. (WHO)

United States

  • One in five 18 to 25 year olds experienced a mental illness in the past year
  • An Estimated 1 in 10 U.S. Adults Report Depression (CDC)
  • Major depressive disorder is the leading cause of disability in the U.S. for ages 15-44. (World Health Organization, 2004)

Physical & Mental Health Connection

  • One-third of individuals with a chronic illness experience symptoms of depression
  • People with depression are 4 times as likely to develop a heart attack than those without the illness.
  • Many conditions may coexist with depression. Depression may increase the risk for another illness, and dealing with an illness may lead to depression. In fact, according to the NIMH, depression affects:
  • More than 40 percent of those with post-traumatic stress disorder
    • 25 percent of those who have cancer
    • 27 percent of those with substance abuse problems
    • 50 percent of those with Parkinson’s disease
    • 50 to 75 percent of those who have an eating disorder
    • 33 percent of those who’ve had a heart attack
  • Depression is a prevalent and increasingly recognized risk factor for both the development of and the outcome from coronary artery disease (CAD). (National Institute of Health)

Signs and Symptoms

Depression is a treatable mental health disorder that causes persistent sadness and loss of interest. Some of the most common signs and symptoms include:

  • Changes in sleep and appetite
  • Poor Concentration
  • Loss of energy
  • Loss of interest in usual activities
  • Low self-esteem
  • Hopelessness or guilt
  • Recurring thoughts of death or suicide

For a complete list visit: NAMI.org

Bipolar disorder, also known as manic depression, is a treatable illness defined by extreme changes in mood, thought, energy and behavior. These changes are categorized into manic (high) and depressive (low) episodes, ranging from bursts of energy to deep despair. Some of the most common symptoms include:

Mania Symptoms

  • Heightened mood, exaggerated optimism and self-confidence
  • Excessive irritability, aggressive behavior
  • Decreased need for sleep without experiencing fatigue
  • Racing speech, racing thoughts, flight of ideas
  • Impulsiveness, poor judgment, easily distracted
  • Reckless behavior

Depressive Symptoms

  • Changes in sleep and appetite
  • Poor Concentration
  • Loss of energy
  • Loss of interest in usual activities
  • Low self-esteem
  • Hopelessness or guilt
  • Recurring thoughts of death or suicide

For a complete list visit: dbsalliance.org

Generalized anxiety disorder (GAD) is an anxiety disorder that involves chronic worrying, nervousness, and tension. Some of the most common symptoms include:

  • Feeling like your anxiety is uncontrollable; there is nothing you can do to stop the worrying
  • A pervasive feeling of apprehension or dread
  • Inability to relax, enjoy quiet time, or be by yourself
  • Difficulty concentrating or focusing on things
  • Avoiding situations that make you anxious
  • Feeling tense; having muscle tightness or body aches
  • Having trouble falling asleep or staying asleep because your mind won’t quit
  • Feeling edgy, restless, or jumpy

For a complete list visit: helpguide.org

Posttraumatic Stress Disorder (PTSD) is a mental health condition that’s triggered by witnessing or experiencing a traumatic event. Some common symptoms include:

  • Intrusive, upsetting memories of the event
  • Flashbacks (acting or feeling like the event is happening again)
  • Nightmares (either of the event or of other frightening things)
  • Avoiding activities, places, thoughts, or feelings that remind you of the trauma
  • Feeling detached from others and emotionally numb
  • Difficulty falling or staying asleep
  • Irritability or outbursts of anger
  • Hypervigilance (on constant “red alert”)

For a complete list visit: helpguide.org

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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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By Scott Bullock, MSW, LISW-S

Lindner Center of HOPE, Clinical Director and Family Therapist Child/Adolescent Services, Harold C. Schott Foundation Eating Disorders Program Clinical Consultant, Cincinnati Children’s Hospital and Medical Center at The Lindner Center of HOPE University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, Adjunct Instructor

Despite numerous recent advances in the field of brain research, our understanding of the principles that guide the development and operation of the brain and its complex functioning remains elusive. This is particularly true when attempting to understand a multi-faceted illness as anorexia nervosa (AN), however having a comprehensive grasp on the neurobiology on AN brain is mandatory for successful treatment. Thus, with the narrative below, we will be providing some fundamental assumptions about the neurobiology of AN brain, as researched extensively by Dr.W.Kaye.

In AN all body organs, including the brain suffer from malnutrition. Malnutrition affects all parts of the brain and especially the anterior insula. This region acts as the “brain switchboard” assuring that all parts of the brain adequately communicate with each other. The anterior insula plays a key role in the brain’s ability to recognize and process the connection between emotions and cognition and when affected in AN patient, presents with typical symptoms of altered taste, abnormal response to pleasurable foods and body distortions. The neurotransmitters dysregulations in AN are very complex and involve many systems, circuits and brain regions. To date, most research has focused on serotonin function and dopamine/reward systems function that are found to be compromised in AN as briefly outlined below.

Serotonin

Brain imaging studies suggest alterations of 5-HT1A and 5-HT2A receptors and the 5-HT transporterin AN. Dysfunctions of these circuits may affect mood and impulse control as well as the motivating and pleasurable aspects of food consumption leading to a dysphoric mood. In an attempt to reduce their dysphoric mood, the patients engage in dieting and exercise which results in malnourishment of the brain leading to the lowering of tryptophan and steroid hormone metabolism. This then reduces serotonin levels at these critical sites, further increasing dysphoric mood thus perpetuating starvation.This becomes a cyclical action as the patient tries to control their dysphoric mood while driving themselves deeper into the illness.

Dopamine and Reward System

Dopamine system dysfunction might contribute to altered reward and affect, decision-making and executive control, and decreased food ingestion in patients with AN. Dysregulation in this circuit might contribute to patients with AN not being able to correctly act on immediately important tasks but rather focusing on planning and remote consequences.

In conclusion, this is just a glimpse of the complex function of the Anorexic brain. Genetics, puberty, stress, trauma, cultural and social expectations as well as the temperament of the individual also play important roles in the development of AN in adolescents.

 

Ref: Kaye, Walter H., Fudge, Julie L., and Paulus, Martin. New Insights into symptoms and neurocircuit function of Anorexia Nervosa. Nature Reviews/ Neuroscience. 10, 573-587 (2009)