Category: Blog

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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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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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By Marcy Marklay, LPCC, Adolescent Therapist,
Lindner Center of HOPE

Technology has changed the way people bully each other. Cyberbullying via text messages and use of social media, as well as the more traditional forms of bullying,can occur in childhood, adolescence and into adulthood, even in college and in the workplace. Bullying is far from uncommon and needs to be addressed.

Reasons For Bullying
Bullying can occur due to someone being different. Elevating one’s social status can be a common motivating factor for bullying. Some bullies are motivated by obtaining power and control of others through fear. Some groups can gang up on someone, or another group, because of different beliefs, for example, being bullied for being lesbian, gay, bisexual, or transgender (LGBT).

How It Appears
Bullying can be subtle or overt, occur once or be persistent and chronic in nature. Bullies can use rumors or gossip and berate a victim and turn others against them in a deliberate attempt to sabotage their reputation. Chronic bullying takes a greater toll on the bullied individual, and can lead to mental, emotional, physical and social harm.

Addressing Bullying
Best practices in addressing bullying will include providing education about bullying as well as providing treatment interventions to those individuals affected or targeted by bullying. Education needs to include what to look for or ways to identify bullying, why bullying is harmful and unacceptable, and how to go about reporting it. It is generally a bully’s goal to disempower the victim. Teaching assertiveness skills are not the only interested in touring method to teach the target of bullying. More recently, utilizing bystander intervention has become increasingly helpful in combating bullying because it addresses the problem from a systems or group perspective. Bystander intervention involves enlisting the help of others in the school or community to assist in addressing and reducing the problem behaviors, by using a social norming campaign to teach students about appropriate behaviors. By adopting a community responsibility standard, bullying can be reduced in an environment where it is not acceptable. The number of individuals willing to confront bullying , whether cyberbullying , assault, threats, verbal abuse, or offensive behavior that can be humiliating, intimidating or threatening can be reduced more significantly in this way.

It is important to thoroughly listen to the victim of bullying’s story without quickly jumping to conclusions, and to explore possible options, such as what a treatment professional can provide, a victim can do for themselves, what a school or the police can do to help the victim. Narrative therapy is helpful in letting the victim tell their story. It can help them look at what is in and out of their control. It can externalize the negative experience of being bullied from the victim. In some cases a threat assessment is indicated to assess for the potential escalation of violence by the bully and retaliation from the person being bullied. Suicide prevention is also a concern, as some who are bullied may become suicidal and need crisis intervention. Victims can experience a wide range of symptoms due to being bullied, which are not limited to anxiety, depression, somatic complaints, falling grades, family stress, isolation. Victims often blame themselves. It is critical to focus on finding a sense of safety, addressing mental health concerns, and connecting the victim to a support system. Work on self-esteem and coping skills is helpful, and working to restore lost confidence is a goal. Victims may suffer from depression, anxiety, panic attacks, PTSD, acute stress disorder and even suicide. The victim’s primary relationships may suffer as a result of the bullying.

Help for victims
Helping those who have been bullied includes exploring ways to heal, examining realistic solutions to the problems, and prioritizing health. Encourage self-care and social support. Provide psychoeducation. Assist victims with finding resources. Keep a focus on the present and near future; focusing too much on the past does not give the goal-directed and strengths based approach these individuals need. Role playing and practicing and rehearsing coping skills in a safe space can be empowering. There is immense power in the act of listening to a victim of bullying. Parents are important in supporting the young person and can also benefit from internet and online safety training, and social media training along with their children. Many parents fear the internet and require their children avoid technology, which may help in the short term, but is not a realistic long term solution, as the internet is used for homework, employment and socialization. Teaching internet and online safety skills to both youth and parents is most effective. Parents then can become good role models for youth in using technology, enhance communication and develop a greater bond; this can result in personal empowerment for both youth and their parents.

Source
Cyberbullying: What Counselors Need to Know by Dr. Sheri Bauman; published in 2011

 

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Amanda Porter, MSN, APRN, PMHNP-BC

Psychiatric Nurse Practitioner, Lindner Center of HOPE Board-Certified in Internal Medicine, Psychiatry/Mental Health, and Addictions

 

The question of “What causes mental health disorders?” is the eternal question on the field of psychiatry. The most widely accepted theory as to the cause of depression thus far has been the neurotransmitter theory; however even with correct diagnosis and appropriate treatment “between 40% and 70% do no respond to treatment, or only partially, while roughly half of patients who do achieve full remission following txt for severe depressed mood relapse within 2 years even when continuing on antidepressants.” (Greenblatt & Brogan, 2016; Keitner & Mansfield, 2012). Even when we place patients on medications meant to boost their neurotransmitters, often remission of mood disorder symptoms is elusive. Therefore, it behooves us as clinicians to seek out complementary and integrative methods (CIM) for treating for mood disorders that can augment or sometimes replace traditional medical treatments.

One method of CIM includes Mindfulness and Meditation. Broadly, this is described as cultivation of awareness, relaxation, focused attention and stillness. This is a methodology pioneered by Jon Kabat-Zinn. Release of serotonin, GABA, dopamine and melatonin occurs during meditation (Newberg, 2010). Since 2009, roughly 10 studies have examined the efficacy of mindfulness practices with patients who were unresponsive to antidepressant therapy. Three-quarters of these studies showed statistically significant reduction in Ham-D scores (Jain, 2015). Mindfulness has been suggested to have the ability modulate the immune system itself as demonstrated in HIV-infected adults who show increased in circulation of CD4+ T lymphocyte counts (Cresswell, 2009).

Another method of CIM includes Spirituality/Prayer. Many of my patients experience depression surrounding some pretty heady questions such as “What is my purpose in life? What was I created for? What happens after I die?” Becoming involved in a faith community, and engaging in spiritual practices associated with that community increase a sense of belonging and self-worth in a person, which leads to overall improved mental health. “In a systematic review of 850 studies of religion and mental health, religion was associated with greater overall well-being in 79% of these studies, lower suicidality in 84%, lower depression 66% and lower anxiety in 51%.” (Koenig, 2001).  Also, it’s postulated that while a sense of well-being and purpose provides greater benefit in preventing depression, a positive relationship with God provides greater benefit after onset of depression.

Another method of CIM includes Yoga and Movement therapies. Yoga and other movement therapies such as Tai Chi or Qi Gong have been found to be helpful for depression, ADHD, anxiety and chronic pain and are especially helpful in vulnerable populations such as pregnancy, adolescents or the elderly. When combined with meditation, this is an incredibly effective therapy, and the beauty of Yoga practice is that even 15 minutes a day can be helpful, so it’s not time-consuming. Yoga practitioners downregulate their HPA axis and modulate their cortisol levels (Sieverdes, et al 2014). Yoga and Tai Chi also have excellent indication for sleep duration with less arousal time. The mechanisms that are involved in the effects of yoga on stress response include the following: positive affect, self-compassion, and inhibition of the posterior hypothalamus and salivary cortisol (Riley, 2015).

Another method of CIM includes Exercise. With depression, often the patient becomes isolated, withdrawn, with poor motivation. This leads to increase in sedentary behaviors. Therefore, it’s important to increase activity in the form of exercise. The higher the dose, the lower the risk of relapse rates in patients with MDD, with 10 days being sufficient to begin seeing an improvement in mood (Knubben, et al, 2007). Exercise increases rate of neurogenesis, production of BDNF, increases serotonin by increasing tryptophan, increases norepinephrine, increases phenylethylamine, decreased cortisol, increase endorphins, and increases dopamine (Greenblatt & Brogan, 2016). It’s hypothesized that exercise helps the brain deal more efficiently with stress by enhancing the body’s ability to respond to stress, and coordinating the sympathetic nervous system response (McWilliams, 2001).

Another method of CIM includes appropriate Nutrition. There is an ongoing discussion about the gut-brain connection and the impact that our nutritional choices have on our mental health. The typical Western Diet consist of high fructose foods or beverages, transaturated fats, with large amounts of carbohydrates in the form of bread products. Sugar and gluten are both incredibly inflammatory, and alter the microbiome of the gut. Factors like alcohol, antibiotic use, NSAIDS, cytokine production, and psychological stress increase also intestinal permeability (Greenblatt and Brogan, 2016). So our dietary choices do have great impact on our mental health. Gluten attacks an enzyme involved in the production of GABA (Kramer & Bressnan, 2016). Patients with schizophrenia and autism are at higher risk for intolerance to gluten, and respond very positively to gluten-free and casein-free diets. Higher dietary fiber content was associated with lower odds of depression; increased consumption of vegetables and nonjuice fruit was associated with lower odds for depression; added sugars, but not total sugars or total carbohydrates, to be strongly associated with depression incidence (Gangswisch, 2015). It’s important to remember that sugar is not the enemy here, but excess sugar is. As with most things in life, balance is key.

Further methods of CIM used to treat mood disorders include: Creative Arts including painting, drawing, music, dance, and writing/narrative medicine; Nature therapy; Pet therapy; Water therapy/Floating; Life coaching/Financial planning; Massage therapy; Acupuncture; Micronutrient therapy; Essential oils; Light therapy; Media fasts; Psychotherapy; and TMS/ECT.

At Lindner Center of HOPE, an Integrative Mental Health consult service incorporates the above treatment modalities, aimed at addressing mental health disorders as holistically as possible. The goal is to strive for recovery with the whole person in mind.

 

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

May is Maternal Mental Health Awareness Month.  One in five women will develop a maternal mental health disorder.  They are also referred to as perinatal mood and anxiety disorders (PMADs) to emphasize that women experience more than postpartum depression during pregnancy and after birth.  Women who have symptoms of PMADs might not seek help because of guilt, shame, or embarrassment for feeling something different than the expected norms of motherhood.  Awareness and education are important to reduce stigma so mothers and babies get the help they need.

PMADs can occur during pregnancy or up to one year after giving birth. The most common PMAD is the “baby blues”, affecting up to 80% of new mothers.  Symptoms include sudden mood swings, loneliness, sadness, crying spells, loss of appetite, problems sleeping, irritability, restlessness, and anxiety.  These symptoms are a normal adjustment to changes in hormones and resolve without treatment in two to three weeks.

About 10% of women experience depression during pregnancy and about 15% during the first year postpartum.  Feeling sad, hopeless, helpless, or worthless; fatigue, difficulty sleeping or sleeping too much, appetite changes, difficulty concentrating, crying, loss of interest or pleasure; lack of interest in, difficulty bonding with, or excessive anxiety about the baby; feelings of being a bad mother, and fear of harming the baby or self are symptoms of peripartum depression.  Risk factors include poverty, being a teen mother, advanced maternal age; personal or family history of depression, anxiety, or postpartum depression; premenstrual dysphoric disorder, inadequate support, financial stress, relationship stress; complications in pregnancy, birth or breastfeeding; a history of abuse or trauma, a major recent life event, birth of multiples, babies in neonatal intensive care, infertility treatments, thyroid imbalance, and diabetes.

Anxiety can occur alone, or with depression, in 10% of new mothers.  Symptoms include constant worry, racing thoughts, inability to sit still, changes in sleep or appetite, feeling that something bad is going to happen; and physical symptoms like dizziness, hot flashes, and nausea.  Some mothers may also have panic attacks with shortness of breath, chest pain, dizziness, a feeling of losing control, and numbness and tingling.  Risk factors are a personal or family history of anxiety, previous perinatal depression or anxiety, and thyroid imbalance.

Post-traumatic stress disorder (PTSD) can occur in up to 6% of mothers following a traumatic childbirth.  Possible traumas are prolapsed cord, unplanned C-section, use of vacuum extractor or forceps to deliver the baby, baby going to NICU; and feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery.  Women who have experienced a previous sexual trauma are also at a higher risk for developing postpartum PTSD.  Intrusive re-experiencing of the traumatic event, flashbacks or nightmares; avoidance of stimuli associated with the event; increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response); anxiety and panic attacks, and feeling a sense of unreality and detachment are symptoms of PTSD.

Obsessive-compulsive disorder (OCD) can occur in 3% to 5% of new mothers.  Obsessions are persistent, repetitive thoughts or mental images, often related to the baby. Obsessions can be so bizarre or disturbing that they can be mistaken as psychosis.  Compulsions are repetitive acts performed to reduce obsessions.   Mothers are distressed by the obsessions which can lead to a fear of being left alone with the baby or hypervigilance in protecting the baby.  Mothers with postpartum OCD know that their thoughts are out of the ordinary and are unlikely to ever act on them.

Postpartum psychosis is the most severe of the PMADs.  It is often associated with an episode of bipolar disorder. It is rare, occurring in 1 to 2 per 1000 women.  The onset is abrupt, within 48 to 72 hours and up to two weeks after delivery. This is a psychiatric emergency, requiring immediate treatment.  Mothers may experience hallucinations (hearing voices or seeing things) and/or delusions (believing things that aren’t true.)  If psychosis occurs as part of a bipolar manic episode, there might be additional symptoms such as irritability, hyperactivity, decreased need for or inability to sleep, paranoia and suspiciousness, rapid mood swings, difficulty communicating, and confusion or memory loss. Risk factors are a personal or family history of bipolar disorder or a psychotic disorder.  Most women with postpartum psychosis do not have violent delusions but there is an up to 5% rate of infanticide or suicide due to acting on delusions or having irrational judgement.

PMADs are the most common complication of pregnancy and childbirth.  They are treatable with psychotherapy and/or medication and early intervention provides relief for the mother and ensures the baby’s wellbeing.

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Amanda Porter, MSN, APRN, PMHNP-BC

Psychiatric Nurse Practitioner, Lindner Center of HOPE Board-Certified in Internal Medicine, Psychiatry/Mental Health, and Addictions

 

Depression is a serious and costly health problem facing our country. Depression is the most common form of mental illness, and is a leading cause of disability, and affects more than a quarter of the US population (CDC, 2017). To date the most prevalent theory as to the etiology of depression is the neurotransmitter theory, however not everyone responds to medications which boost neurotransmitters. Only about half of patients respond to antidepressants, and those who do respond will likely experience relapse of depression within two years (Greenblatt and Brogan, 2016). Thus, we need to consider other influences which might be causing depression.

The field of Integrative Mental Health considers other reasons for depression, such as an altered microbiome, chronic inflammation, hormones, mitochondrial dysfunction, dietary sensitivities, genetic mutations, and the role of neurogenesis.

Integrative Mental Health focuses on the whole person in order to promote recovery as holistically as possible from a mental health diagnosis. Integrative Medicine is synonymous with functional medicine and complementary and alternative medicine. Integrative Mental Health Medicine is an area of medicine that is evolving through the work of its pioneer, Dr. Andrew Weil.

It’s important to understand that integrative therapies are not necessarily a replacement for mental health medications. Rather, integrative therapies can supplement your current mental health treatment plan, or at times reduce the quantity of medications a person takes.

At the Lindner Center of HOPE Integrative Mental Health programming includes genotyping that enables the detection of the MTHFR genetic mutation, and treat accordingly. Micronutrient, thyroid, and metabolic testing is also offered with appropriate recommendations on diet and lifestyle changes. As Hippocrates famously said, “Let food be thy medicine.” Through the UC Center of Integrative Health and Wellness, treatment modalities such as massage, yoga, and acupuncture are available.

After an initial consult with an Integrative Mental Health practitioner, an Integrative Mental Health treatment plan will be developed. The treatment plan is also based off the patient’s individual mental health needs. This treatment plan incorporates lifestyle changes such as diet and exercise, nutrient therapy consisting of beneficial dietary supplements, and also considerations for services such as acupuncture, massage therapy, mindfulness, meditation, and hypnosis. The program appeals to patients who are seeking to treat their mental health diagnosis with as few prescription medications as possible. Integrative Mental Health consultations and follow-up visits are covered under many insurance plans.

Sources

Greenblatt, J. M. & Brogan, K. (2016). Integrative therapies for depression. Boca Raton, FL: CRC Press

Mental Health Basics. (2013). Retrieved from https://www.cdc.gov/mentalhealth/basics.htm

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Marcy Marklay, LPCC

Child/Adolescent/Young Adult Therapist, Lindner Center of HOPE

Adjunct Instructor, Dept of Psychiatry and Behavioral Neuroscience

University of Cincinnati- College of Medicine

 

Gender identity is a person’s inner sense of being male, female, neither or both. Gender nonconforming refers to those who have behaviors and interests that run counter to what is expected of a male or female. Gender dysphoria refers to an individual’s affective/cognitive discontent with gender assigned at birth; gender dysphoria refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.  Transgender people are often unhappy with aspects of their bodies that do not conform to the gender they feel they are on the inside. There is a conflict between gender identity and biological sex and expectations. Transgender refers to the individuals whose gender identity is in contrast to their biological sex from birth.  Gender dysphoria can occur in children, adolescents and adults. Sexual orientation is not the same as gender; it has to do with who we find attractive.

Transgender individuals face discrimination and report a staggering rate of attempted suicide. It is estimated that 41 percent of transgender individuals have attempted suicide. This is greater than 25 times the rate of attempted suicide of the general population.  It is estimated that 75 percent of transgender youth experience harassment; many experience physical assault and sexual violence.  Anxiety and depression can often be found in transgender individuals. The needs of this community range from basic—safety, shelter, food, protection against discrimination and violence, to dealing with family, school and dating relationships, to transitioning with hormones and or surgery, and coming out concerns. It is crucial to respect them and respect the preferred name and pronouns they identify as, not to assume the gender or pronouns they use. Transgender individuals may face a lack of support or even open hostility from their family and friends, churches and communities. This rejection fuels high levels of anxiety and depression and makes the coming out process very difficult for many transgender people. They often have higher rates of peer isolation and hopelessness.

Coming out is a process of telling others that one is transgender, or gay, lesbian, bisexual or questioning. Parents need to educate themselves and be open to understanding their transgender child. Parents may have strong reactions with feelings of loss, worry what others may think, concerns for harassment, physical harm, possible regret, too young, not believe the child is really transgender, etc. It is important to work with a trusted mental health professional. Parents have their own social, cultural and religious views that must be addressed. `It is important to keep the communication open so the transgender child or teen can understand it is a difficult transition for the parents as well. Transgender teens and their parents benefit from support groups, in person or in a safe online network.

Each student needs to be in a supportive school environment. School administrators, counselors and teachers can help implement zero tolerance policies on bullying so that all students, including transgender students, can feel safe in school. Schools can establish a GSA, or gay straight alliance organization for transgender and other LGBTQ youth. Schools can develop a harassment policy that is specific regarding gender and sexual orientation. There needs to be a number of “safe” adults or advocates within each school. Transgender youth face challenges in the school setting also with practical issues in use of restrooms, locker rooms, use of legal name versus preferred name and pronouns if the child has not had a legal name change, etc. Issues of safety and respect are primary. Parents may be advocating for their transgender child with the school. It is important for the transgender youth to work on self-advocacy as well.

To be an ally of transgender people, it is important to spread a positive message and combat prejudice, to respect their preferred name, pronouns, accept them without judgment, give them a safe space where they do not have to hide who they are, and work on empowering them and giving them hope for the future. There are resources for both parents and transgender teens. The Gay, Lesbian, and Straight Education Network (GLSEN) is the largest national education organization working to ensure safe schools for all students. Parents and Friends of Lesbians and Gays (PFLAG) is focused on promoting the health of LGBTQ and transgender people, their families and friends. The Trevor Project is a free and confidential 24/7 crisis and suicide prevention helpline for LGBTQ youth. Trevor Space is a free, monitored social media and peer networking site for LGBTQ youth ages 13-24.

Sources of information:

 DSM-5, Diagnostic and Statistical Manual of Mental Disorders, fifth edition, American Psychiatric Association.

The World Professional Association for Transgender Health, www.wpath.org

 The Transgender Child by Stephanie Brill and Rachel Pepper, Cleis Press, 2008.

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By Chris Tuell, Ed.D., LPCC-S, LICDC-CS

Lindner Center of HOPE Clinical Director of Addiction Services

 

In April of 1975, the Viet Nam War came to an end. During this 10 years of military strife, 58,220 U.S. soldiers lost their lives.  However, the end of the war also brought another difficult issue to light.  A never before scene was about to appear on the horizon.  Estimates indicated that approximately 20% or 1 out of 5 American soldiers returning from Southeast Asia were addicted to heroin.  Experts believed that once these soldiers returned home, our country would be faced with a heroin pandemic.  How would we manage such an issue?  It never happened.

Today, our knowledge of the neurology of the addicted brain has grown by leaps and bounds. We have gained a better understanding of the disease of addiction and how this new awareness clearly indicates that it is not an issue of character, nor is it a moral failing or a lack of will power.  Addiction is the result of the brain’s reward system being hijacked by outside substances (alcohol and drugs) and various behaviors (gambling, pornography, gaming, Internet).  This hijacking tricks the brain in believing that the drug or behavior has more importance than it really does.  Because of this pairing with certain neurochemicals, the brain believes this drug and/or behavior (like food) become necessary for survival.  Each of us knows that we don’t need alcohol, drugs, or gambling to survive. That’s true.  But, the brain thinks we do.  This survival drives the urges and cravings for the patient to use substances.  We know that patients who suffer from addiction, will engage in negative behaviors.  These individuals unfortunately will lie, cheat and steal in the midst of their addiction.  But equally important is the understanding that bad acts do not necessarily mean bad actors.  If each of us would be without water for three days or without food for three weeks, every one of us would lie, cheat and steal to survive.  This is what’s happening within addiction.

So why did the heroin epidemic of the 1970s not occur? Our new knowledge of the workings of the brain has also demonstrated that when substances are introduced, it impacts the very area of the brain where we develop meaningful, connected relationships. When mental illness issues surface, such as depression, anxiety, and trauma, the drug brings about relief.  It is this relationship that allows a sense of meaningful connection, even though that connection is unhealthy and problematic.  As one patient shared, using heroin was like “getting a hug from your grandmother on Thanksgiving morning.”  This experience becomes meaningful for the drug-addicted individual.  The drug’s influence on the brain creates a sense of connection causing a disconnect with truly meaningful relationships.  For the patient, the drug relationship becomes “on par” with other important relationships (i.e., spouse, children, parents, relatives, friends).  Unfortunately, sometimes the drug becomes number one.  For the Viet Nam soldier who was addicted, connection was re-established with loved ones, family and friends, and were able to reconnect within his or her community.  The heroin addiction ceased.  When an individual suffers with mental illness, the depression, anxiety, trauma, disconnects them from others resulting in a vulnerability to substance use and a hijacking of the brain’s reward system.

This phenomenon also occurred within the laboratory. In the early 20th century, research-involving rats found that when a rat was placed within a small cage and given the choice of two forms of water (pure water or water laced with heroin or cocaine) the rat would prefer the water laced with drugs.  The rat continued to use the drug laced water, eventually developing addiction, overdosing and dying.  Experiments like these shaped our view of addiction for many years.

However, a series of new research looked at the same experiment, but this time expanding the cage. In fact, the researchers created a “rat park.”  The cage was bigger with various levels and tunnels along with the addition of other rats.  The same two samples of water were provided.  Rats in this study preferred the pure water to the water laced with drugs.  No instances of overdose were recorded.

Mental illness interferes with our ability to connect with ourselves, others, and the world in which we live.   This isolation and disconnect creates the perfect storm for addiction.  Nearly 80% of individuals with a substance use disorder also have a mental illness. How many of us who have never experienced mental illness lose site of the importance of a meaningful connected relationships in our lives?   Perhaps the opposite of addiction is not sobriety.  Perhaps the opposite of addiction is connection.

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

The second session of a free education series to help community members increase awareness of mental health, substance use disorders, treatment and strategies for coping is April 18, 2018. Stacey Spencer, EdD, Lindner Center of HOPE staff psychologist, will present ADHD Through the Lifespan.

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

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

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