Category: Mental Illness

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

 

Innovations in Mental Health Treatment

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

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

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

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

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

http://www.monarch-etns.com/ 

https://www.zulresso.com/ 

https://www.spravato.com/

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By Anna I. Guerdjikova, PhD, MSW, LSW

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

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

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

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

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

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

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

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

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

120 Tools and Tricks to Protect Your Kids Online

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

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

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

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

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

* Running in Place

* Holding breath

* Head shaking (side to side)

* Spinning in a chair

* Mirror staring

* All over muscle tensing

* Straw breathing

* Over breathing

* Head between legs

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

 

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

 

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

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

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

 

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 Innovations in Mental Health Treatment

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

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

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

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

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

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

http://www.monarch-etns.com/ 

https://www.zulresso.com/ 

https://www.spravato.com/

 

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Trevor Steinhauser’s struggle with mental illness began at an early age, but thanks to receiving early help and support for his symptoms, Trevor is feeling better and is now four years sober.

Trevor and Tracy Cummings, MD, Medical Director of Inpatient and Partial Hospital Program Services at Lindner Center of HOPE, spoke with Local 12’s Liz Bonis about mental illness warning signs to watch for in children, such as anxiety and panic attacks.

Trevor credits the Lindner Center of HOPE for helping him overcome his own issues with mental illness and substance abuse. By employing a team approach and giving him a voice in his own treatment, Trevor says the Center was the first to help him learn coping skills for lifelong problems, such as depression and anxiety.

According to Dr. Cummings, behaviors that lead to addiction often present in a person’s youth.

“The reality is that, in any given year, one in five of us are experiencing mental illness. About half of those cases started before age 14, so a lot of people have been having symptoms for a long time. They’ve just figured out ways to either adapt to those or not talk about those,” Dr. Cummings said.

Lindner Center of HOPE has a comprehensive program that treats both substance abuse and co-occurring mental health disorders. Learn more about our Intensive Outpatient program here.

 

 

Watch the full story from Trevor and Dr. Cummings’ sit down with Liz Bonis interview on local12.com

 

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Jennifer L. Farley, PsyD
Lindner Center of HOPE, Staff Psychologist

When horrible things happen, things that we didn’t want or expect, they can have a significant – and sometimes devastating – effect on our lives. This is especially the case when the horrible event was perceived as a risk to our life or the life of someone we care about. A traumatic event can be shocking, scary, and/or dangerous. It can affect the way we perceive our environment, it can lead us to do things we would not normally do, and it can affect the quality of our relationships. Hence, a trauma can negatively impact many aspects of our well-being.

When someone experiences a trauma, the effects of it can depend on a variety of factors such as the age when the trauma occurred, the duration of which the the trauma occurred, and the intensity of the negative effects of the trauma. These factors do not mean, for example, that one who experienced a one-time traumatic event “should” have a better mental health outcome than someone who experienced a repeated trauma; rather, it is helpful to understand the nature of the trauma and how individuals can be affected.

When a traumatic experience occurs, the limbic system in the brain is activated and initiates the “fight, flight, or freeze” response to protect the person from harm. Interested in touring Sometimes these responses are so strong that a person may do something they would not have imagined was possible. Imagine being able to move something very heavy to protect a child from harm’s way or to run fast away from danger. Other responses can lead one to experience “shock” to where one cannot process their environment in a way to elicit any response. During this “fight, flight, or freeze” response, the individual is not focused on problem-solving or rational thought process, which are functions elicited by the frontal lobe of the brain (the “executive” center, if you will). Instead, the person is focused on survival and protection.

Feeling afraid is natural during and after a traumatic experience. Also,most people recover from initial symptoms they may have after a trauma. However, there are some people who may experience anxiety long after the traumatic experience, even when they are no longer in danger. Some of these individuals may develop symptoms associated with Post Traumatic Stress Disorder (PTSD). People may experience flashbacks that triggers them to feeling the same intensity of fear they had during the trauma. People may develop a strong mistrust of others.

They may also develop feelings of guilt, as if they were responsible for the traumatic event. Some people may avoid certain places or things associated with the trauma. Nightmares may be common. People may also develop very unhealthy ways to cope with their symptoms of PTSD, for example, by “numbing” their feelings with alcohol and/or drugs or with self-harm behaviors. It is estimated that 7 or 8 out of every 100 people will experience PTSD at some point in their lives. When a traumatic event is experienced in a child, the negative effects upon that child’s social and emotional development can be even more profound. The attachment that child has to his or her loved ones can be severely impacted. They struggle to form healthy relationships with others. Their academic performances can be hindered, especially if they become focused on their worries instead of their school work.

For these reasons, seeking psychological treatment as soon after a traumatic is experienced is highly recommended. Psychotherapy can help a person become more empowered over their fears through cognitive and behavioral strategies. Medication also can be indicated for people with PTSD, especially to help regulate sleep, reduce anxiety, and minimize depression. The goal for treatment would be to help the individual function better in several ways (e.g., socially, emotionally, and behaviorally) and to reduce the long-term impact that a trauma might have.

People may experience a traumatic event, but the symptoms associated with experiencing the trauma can be overcome.

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Several suicides among local high school students has the Cincinnati community mourning these losses and searching for answers. WCPO’s Tanya O’Rourke spoke with Lindner Center of HOPE Medical Director of Inpatient and Partial Hospital Program Services Dr. Tracy Cummings about what families need to know about suicide prevention for themselves and their children.

According to Dr. Cummings, suicide has become more prevalent in recent years. “It’s striking actually – up to almost 30% increase since 1999.” This may be a conservative estimate due to stigma discouraging people from self-reporting suicide attempts.

Cummings cites risk factors that correlate with suicide attempts, including a family history of suicide, previous attempts, or a recent loss among close relatives or friends. Dr. Cummings also refers to a “contagion effect,” where one suicide within a community may trigger additional attempts by people who are suffering.

Social media use can also affect teens. Suggestions are offered on how parents can approach their kids on the topic of self-harm. Parents should not worry about “implanting” thoughts into their children’s minds by asking them directly about suicide. Rather, it is imperative that parents start a direct conversation with their children.

 

 

 

Watch both parts of Dr. Cummings’ two-segment interview on WCPO’s YouTube Page

Part 1

 

Part 2

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Services, resources and research unmatched in Midwest

Mental illness is a condition that affects one in five Americans[i]. While more celebrities are revealing their own struggles, and research has led to new understanding and treatments, mental illness remains shrouded in stigma. Many barriers prevent access to treatment as well, including cost.

Communities across the country are stepping up to confront these challenges. Cincinnati is increasingly being recognized as one of the leaders.

When Frances and Craig Lindner founded Lindner Center of HOPE, their dream was to build the nation’s leading mental healthcare facility. That was in 2008.

Today, Lindner Center of HOPE is a nonprofit renowned regionally and nationally for the depth and breadth of services offered in one location. Mental health researchers around the world look to Lindner Center’s research team for the latest findings in the field.

How did the Lindner Center of HOPE earn its distinguished reputation? And what does this mean for tri-state residents and families looking for help with mental illness?

Lindner Center of HOPE is a Leading-Edge Care Center

It starts by staying on top of emerging trends in mental healthcare. The Lindner Center has launched programs to meet needs for current issues like Internet and gaming addiction[ii] and substance abuse detoxification[iii], while continuing to treat a comprehensive list of mental disorders.

Having the right people and partnerships in place is also vital. Since 1996, Lindner Center president and CEO Paul E. Keck, MD, has been among the world’s top 10 most cited scientists in the field of psychiatry and psychology. Susan L. McElroy, MD, chief research officer, was the eighth most cited in the same period.

In the decade since the Lindner Center of HOPE opened its doors, it has cared for more than 37,000 patients from all 50 states and 10 countries. Its multidisciplinary, team approach provides continuous personalized care for each individual.

Local Collaboration Leads to Better Treatment

Partnerships between the Lindner Center, UC Health and Cincinnati Children’s Hospital mean each of these world-class healthcare providers connect seamlessly to give local patients access to the latest treatments available, and a broad array of specialized medical services.

Together with the University of Cincinnati, the Lindner Center was among the initial members that established a national network of mental health centers similar to those established for cancer and cardiac care. A founder of the National Network of Depression Centers, Lindner Center has conducted more than 100 studies with renowned health research organizations like Mayo Clinic and Cincinnati Children’s. This work has brought new, effective treatments first to members of the local community who have lost hope for a better life.

This level of collaboration between world-leading institutions, and the breadth of services offered at Lindner Center is unmatched in the Midwest and among the best nationally.

As one patient’s parents said, “Without the Center, it’s doubtful (our son) would be alive today and certainly not the productive young man he is now.”

Continuing the Fight

We have never had better evidenced-based treatment and achievable recovery for psychiatric disorders than we do now. Yet, the scale of the problem is growing.

Americans are now 2.5 times[iv] more likely to suffer from a major psychiatric disorder in their lifetime than cancer, heart disease and diabetes combined. Fewer than half of the people who need care receive help, often due to stigmas associated with the disease. Insurance reimbursement for mental healthcare in Cincinnati is among the lowest in the U.S.

The Lindner Center of HOPE is uniquely positioned to fight this crisis. In addition to new and ongoing programs, community leaders Linda and Harry Fath, and Frances and Craig Lindner, pledged $75 million[v] to the Center to further enhance treatment and reduce stigma.

As a non-profit, the Lindner Center depends on financial support to meet the high demand for essential services. Philanthropic gifts have enabled the Center’s clinicians to enhance thousands of lives, while expanding our community education and critical research programs.

There is no better time than now to help others who are suffering. A recent combined $75 million donation from Cincinnati humanitarians Linda and Harry Fath and Frances and Craig Lindner is the foundation of the Center’s Challenge Of Hope campaign, with the goal of raising an additional $50 million.

Your donation will help make unprecedented strides in removing barriers for people taking needed steps toward mental wellness.

To share your gift of HOPE today, please go to: LindnerCenterofHope.org/donate

About the Lindner Center of HOPE

Lindner Center of HOPE, located in Mason, OH, is a comprehensive mental health center providing patient-centered, scientifically advanced care for individuals suffering with mental illness. Learn more at LindnerCenterofHope.org.

# #  #

[i] National Alliance on Mental Illness. Mental Health by the Numbers. https://www.nami.org/learn-more/mental-health-by-the-numbers

[ii] Borter G. (2019, Jan. 27). The digital drug: Internet addiction spawns U.S. treatment programs. https://www.reuters.com/article/us-usa-internet-addiction-feature/the-digital-drug-internet-addiction-spawns-u-s-treatment-programs-idUSKCN1PL0AG

[iii] Lindner Center of HOPE. 10-Day Substance Use Disorder Detox and Evaluation. https://lindnercenterofhope.org/residential-treatment-programs/detox/

[iv] Reuben, A. (2017, July 14). Mental Illness Is Far More Common Than We Knew. https://blogs.scientificamerican.com/observations/mental-illness-is-far-more-common-than-we-knew/

[v] Lindner Center of HOPE. (2017, Dec. 18). Lindner Center of HOPE Receives Commitments Totaling $75 Million from Community Leaders Linda and Harry Fath, and Frances and S. Craig Lindner. https://lindnercenterofhope.org/news/lindner-center-of-hope-receives-commitments-totaling-75-million-from-community-leaders-linda-and-harry-fath-and-frances-and-s-craig-lindner/

 

 

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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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Angela Couch, RN, MSN, PMHNP-BC
Psychiatric Nurse Practitioner
Lindner Center of HOPE
University of Cincinnati College of Medicine

 

Suspected side effects are one of the most frequent barriers to medication compliance.Therapists are likely meeting with
the patient more frequently than the prescriber, and in some cases, may have better rapport with that patient. Sometimes the patient is more likely to open up to their therapist about problems with their meds, rather than the prescriber, particularly if they are afraid of disappointing the prescriber. Therefore, this puts therapists in an important position to be able to intervene in a constructive way.Symptoms that occur after the start of a medication may or may not relate to the medication. Several possibilities should be considered before attribution of symptoms is determined (Goldberg and Ernst, 2012). The natural course of illness may be responsible for symptoms; often symptoms of mental disorders may overlap with potential side effects of medications. Discontinuation symptoms may present upon stopping the previous drug, and may complicate the picture. Discontinuation symptoms may also occur when a patient’s compliance is spotty. Interactions between multiple drugs may be responsible
for an effect, versus an independent effect of a single medication. Medical comorbidities, substance use and compliance issues may also be implicated. Timing of onset of symptoms in relation to when the medication trial started is also important to evaluate. It requires careful assessment on the part of the prescribing clinician to determine whether an adverse effect is occurring, and what, if any, change to make.Many side effects may be adequately managed by simple changes to the regimen. A dose decrease may result in reduced negative effects but still maintain efficacy of treatment.Interested in touring Changing the schedule of administration can have significant impacts on side effects.

For instance, moving the dose from morning to evening or vice versa, or moving the dose in relation to meals could both
be helpful. Changing the schedule in relation to when another medication is given might be helpful.

Other medication side effects may require more complicated changes. These may include stopping the medication, changing to another medication, or adding a medication that may counteract the negative effects while allowing the patient to make use of the positive benefits. Much discussion may need to occur in cases in which many previous medication trials have been unsuccessful, or resulted in other more bothersome side effects. In those cases, the benefits of the drug may outweigh the level of discomfort from the side effects.

How can you as the therapist help?

Do:
Ask your patient about compliance with each medication at each appointment. Poor compliance can often cause, or
be caused by, side effects.

Encourage your patient to talk to his/her prescriber if they have questions or concerns about their medications.

Remind your patient that most medications take several weeks of regular administration before they start exerting positive effects, and that dose changes MAY be required, so it is important to continue taking the medication even
if he/she is not seeing results, and communicate with his/her prescriber before making changes.

Contact your patient’s prescriber directly at any time if you have specific concerns or questions about the patient’s medication regimen, or you have a specific suggestion regarding the medication regimen.

Do Not:
Suggest to your patient that you believe they are on the wrong medication or make specific suggestions regarding medication changes directly to the patient. This can cast doubt on the prescriber’s ability and possibly impede their therapeutic relationship. Suggest to your patient that other patients have had bad experiences with a particular
medication. Instruct your patient to change the dosing of the medication.

In summary, patients benefit from good collaboration between prescribers and therapists, and the therapist can have a positive impact on a patient’s chance of success on medication. Reference: Goldberg, J.F., & Ernst, C.L. (2012) Managing the side effects of psychotropic medications. Arlington, VA: American Psychiatric Publishing.

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