Anxiety Disorders

MILWAUKEE – A stepped-care approach to youth with functional abdominal pain disorders may be effective in targeting those with comorbid anxiety, according to ongoing research.

A study of 79 pediatric patients with a functional abdominal pain disorder (FAPD) and co-occurring anxiety found that those who received cognitive behavioral therapy (CBT) that included a component to address anxiety had less functional disability and anxiety than those who received treatment as usual. Pain scores also dropped, though the difference was not statistically significant.

The patients, aged 9-14 years and mostly white and female, were randomized to treatment allocation. Functional disability scores were significantly lower post-treatment for those who received the stepped therapy compared with the treatment as usual group (P less than .05, Cohen’s D = .49). This indicates a moderate effect size, said Natoshia Cunningham, PhD, speaking at the scientific meeting of the American Pain Society.

Mean scores on an anxiety rating scale also dropped below the threshold for clinical anxiety for those receiving the stepped therapy; on average, the treatment as usual group still scored above the clinical anxiety threshold after treatment (P for difference = .05).

The study, part of ongoing research, tests a hybrid online intervention, dubbed Aim to Decrease Anxiety and Pain Treatment, or ADAPT. The ADAPT program includes some common elements of CBT for anxiety that were not previously included in the pediatric pain CBT in use for the FAPD patients, she said.


The hybrid program began with two in-person sessions, each lasting one hour. These were followed by up to four web-based sessions. Patients viewed videos, read some material online, and complete activities with follow-up assessments. The web-based component was structured so that providers can see how patients fare on assessments – and even see which activities had been opened or completed. This, said Dr. Cunningham, allowed the treating provider to tailor what’s addressed in the associated weekly phone checks that accompany the online content.

Parents were also given practical, evidence-based advice to help manage their child’s FAPD. These include encouraging children to be independent in pain management, stopping “status checks,” encouraging normal school and social activities, and avoiding special privileges when pain interferes with activities.

Overall, up to 40% of pediatric functional abdominal pain patients may not respond to CBT, the most efficacious treatment known, said Dr. Cunningham, a pediatric psychologist at the University of Cincinnati. Her research indicates that comorbid anxiety may predict poor response, and that addressing anxiety improves pain and disability in this complex, common disorder.

With a brief psychosocial screening that identifies patients with anxiety, Dr. Cunningham and her colleagues can implement the targeted, partially web-based therapy strategy that tackles anxiety along with CBT for functional abdominal pain.

“Anxiety is common and related to poor outcomes,” noted Dr. Cunningham, She added that overall, half or more of individuals with chronic pain also have anxiety. Among children with FAPD, “Clinical anxiety predicts disability and poor treatment response.”

The first step, she said, was identifying the patients with FAPD who had anxiety, including those with subclinical anxiety.

At intake, children coming to the Cincinnati Children’s Hospital’s gastroenterology clinic complete anxiety screening via the Screen for Child Anxiety Related Emotional Disorders (SCARED) (Depress Anxiety. 2000;12[2]:85-91). Disability and pain are assessed by the Functional Disability Inventory and the Numeric Rating Scale (J Pediatr Psychol. 1991 Feb;16[1]:39-58).

In earlier research, Dr. Cunningham and her collaborators found a significant association between anxiety and both higher pain levels and more disability. And, clinically significant anxiety was more likely among the FAPD patients with persistent disability after six months of treatment.

A surprising finding from the screenings, said Dr. Cunningham, is that youth endorsed more anxiety symptoms in self-assessment than their parents observed. “Children are often their own best informants of their internalizing symptoms,” she said. “Not only do their parents not notice it, it may not be obvious to their providers, either.”

Since many children with FAPD have anxiety, the next question was “How do we better enhance their treatments?” she continued. To answer that question, she took one step back: “How do these youth respond to our current best practice?”

Looking at Cincinnati Children’s patients with FAPD who did – or did not – have anxiety, Dr. Cunningham found that “those who have clinical levels of anxiety don’t respond as well to CBT.” Pain-directed therapy alone, she said, “is insufficient to treat these patients.”

Together with brief screening, stepped therapy delivered via ADAPT offers promise to boost the efficacy of FAPD treatment, perhaps even in a primary care setting, said Dr. Cunningham. She and her collaborators are continuing to study comorbid anxiety and pain in youth; current work is using functional magnetic resonance imaging to examine cognitive and affective changes in patients receiving the ADAPT intervention.

The study was funded by the American Pain Society Sharon S. Keller Chronic Pain Research Grant, Cincinnati Children’s Hospital, and the National Institutes of Health. Dr. Cunningham reported no relevant conflicts of interest.

koakes@mdedge.com

SOURCE: Cunningham N. et al. APS 2019.

MILWAUKEE – A stepped-care approach to youth with functional abdominal pain disorders may be effective in targeting those with comorbid anxiety, according to ongoing research.

A study of 79 pediatric patients with a functional abdominal pain disorder (FAPD) and co-occurring anxiety found that those who received cognitive behavioral therapy (CBT) that included a component to address anxiety had less functional disability and anxiety than those who received treatment as usual. Pain scores also dropped, though the difference was not statistically significant.

The patients, aged 9-14 years and mostly white and female, were randomized to treatment allocation. Functional disability scores were significantly lower post-treatment for those who received the stepped therapy compared with the treatment as usual group (P less than .05, Cohen’s D = .49). This indicates a moderate effect size, said Natoshia Cunningham, PhD, speaking at the scientific meeting of the American Pain Society.

Mean scores on an anxiety rating scale also dropped below the threshold for clinical anxiety for those receiving the stepped therapy; on average, the treatment as usual group still scored above the clinical anxiety threshold after treatment (P for difference = .05).

The study, part of ongoing research, tests a hybrid online intervention, dubbed Aim to Decrease Anxiety and Pain Treatment, or ADAPT. The ADAPT program includes some common elements of CBT for anxiety that were not previously included in the pediatric pain CBT in use for the FAPD patients, she said.


The hybrid program began with two in-person sessions, each lasting one hour. These were followed by up to four web-based sessions. Patients viewed videos, read some material online, and complete activities with follow-up assessments. The web-based component was structured so that providers can see how patients fare on assessments – and even see which activities had been opened or completed. This, said Dr. Cunningham, allowed the treating provider to tailor what’s addressed in the associated weekly phone checks that accompany the online content.

Parents were also given practical, evidence-based advice to help manage their child’s FAPD. These include encouraging children to be independent in pain management, stopping “status checks,” encouraging normal school and social activities, and avoiding special privileges when pain interferes with activities.

Overall, up to 40% of pediatric functional abdominal pain patients may not respond to CBT, the most efficacious treatment known, said Dr. Cunningham, a pediatric psychologist at the University of Cincinnati. Her research indicates that comorbid anxiety may predict poor response, and that addressing anxiety improves pain and disability in this complex, common disorder.

With a brief psychosocial screening that identifies patients with anxiety, Dr. Cunningham and her colleagues can implement the targeted, partially web-based therapy strategy that tackles anxiety along with CBT for functional abdominal pain.

“Anxiety is common and related to poor outcomes,” noted Dr. Cunningham, She added that overall, half or more of individuals with chronic pain also have anxiety. Among children with FAPD, “Clinical anxiety predicts disability and poor treatment response.”

The first step, she said, was identifying the patients with FAPD who had anxiety, including those with subclinical anxiety.

At intake, children coming to the Cincinnati Children’s Hospital’s gastroenterology clinic complete anxiety screening via the Screen for Child Anxiety Related Emotional Disorders (SCARED) (Depress Anxiety. 2000;12[2]:85-91). Disability and pain are assessed by the Functional Disability Inventory and the Numeric Rating Scale (J Pediatr Psychol. 1991 Feb;16[1]:39-58).

In earlier research, Dr. Cunningham and her collaborators found a significant association between anxiety and both higher pain levels and more disability. And, clinically significant anxiety was more likely among the FAPD patients with persistent disability after six months of treatment.

A surprising finding from the screenings, said Dr. Cunningham, is that youth endorsed more anxiety symptoms in self-assessment than their parents observed. “Children are often their own best informants of their internalizing symptoms,” she said. “Not only do their parents not notice it, it may not be obvious to their providers, either.”

Since many children with FAPD have anxiety, the next question was “How do we better enhance their treatments?” she continued. To answer that question, she took one step back: “How do these youth respond to our current best practice?”

Looking at Cincinnati Children’s patients with FAPD who did – or did not – have anxiety, Dr. Cunningham found that “those who have clinical levels of anxiety don’t respond as well to CBT.” Pain-directed therapy alone, she said, “is insufficient to treat these patients.”

Together with brief screening, stepped therapy delivered via ADAPT offers promise to boost the efficacy of FAPD treatment, perhaps even in a primary care setting, said Dr. Cunningham. She and her collaborators are continuing to study comorbid anxiety and pain in youth; current work is using functional magnetic resonance imaging to examine cognitive and affective changes in patients receiving the ADAPT intervention.

The study was funded by the American Pain Society Sharon S. Keller Chronic Pain Research Grant, Cincinnati Children’s Hospital, and the National Institutes of Health. Dr. Cunningham reported no relevant conflicts of interest.

koakes@mdedge.com

SOURCE: Cunningham N. et al. APS 2019.

MILWAUKEE – A stepped-care approach to youth with functional abdominal pain disorders may be effective in targeting those with comorbid anxiety, according to ongoing research.

A study of 79 pediatric patients with a functional abdominal pain disorder (FAPD) and co-occurring anxiety found that those who received cognitive behavioral therapy (CBT) that included a component to address anxiety had less functional disability and anxiety than those who received treatment as usual. Pain scores also dropped, though the difference was not statistically significant.

The patients, aged 9-14 years and mostly white and female, were randomized to treatment allocation. Functional disability scores were significantly lower post-treatment for those who received the stepped therapy compared with the treatment as usual group (P less than .05, Cohen’s D = .49). This indicates a moderate effect size, said Natoshia Cunningham, PhD, speaking at the scientific meeting of the American Pain Society.

Mean scores on an anxiety rating scale also dropped below the threshold for clinical anxiety for those receiving the stepped therapy; on average, the treatment as usual group still scored above the clinical anxiety threshold after treatment (P for difference = .05).

The study, part of ongoing research, tests a hybrid online intervention, dubbed Aim to Decrease Anxiety and Pain Treatment, or ADAPT. The ADAPT program includes some common elements of CBT for anxiety that were not previously included in the pediatric pain CBT in use for the FAPD patients, she said.


The hybrid program began with two in-person sessions, each lasting one hour. These were followed by up to four web-based sessions. Patients viewed videos, read some material online, and complete activities with follow-up assessments. The web-based component was structured so that providers can see how patients fare on assessments – and even see which activities had been opened or completed. This, said Dr. Cunningham, allowed the treating provider to tailor what’s addressed in the associated weekly phone checks that accompany the online content.

Parents were also given practical, evidence-based advice to help manage their child’s FAPD. These include encouraging children to be independent in pain management, stopping “status checks,” encouraging normal school and social activities, and avoiding special privileges when pain interferes with activities.

Overall, up to 40% of pediatric functional abdominal pain patients may not respond to CBT, the most efficacious treatment known, said Dr. Cunningham, a pediatric psychologist at the University of Cincinnati. Her research indicates that comorbid anxiety may predict poor response, and that addressing anxiety improves pain and disability in this complex, common disorder.

With a brief psychosocial screening that identifies patients with anxiety, Dr. Cunningham and her colleagues can implement the targeted, partially web-based therapy strategy that tackles anxiety along with CBT for functional abdominal pain.

“Anxiety is common and related to poor outcomes,” noted Dr. Cunningham, She added that overall, half or more of individuals with chronic pain also have anxiety. Among children with FAPD, “Clinical anxiety predicts disability and poor treatment response.”

The first step, she said, was identifying the patients with FAPD who had anxiety, including those with subclinical anxiety.

At intake, children coming to the Cincinnati Children’s Hospital’s gastroenterology clinic complete anxiety screening via the Screen for Child Anxiety Related Emotional Disorders (SCARED) (Depress Anxiety. 2000;12[2]:85-91). Disability and pain are assessed by the Functional Disability Inventory and the Numeric Rating Scale (J Pediatr Psychol. 1991 Feb;16[1]:39-58).

In earlier research, Dr. Cunningham and her collaborators found a significant association between anxiety and both higher pain levels and more disability. And, clinically significant anxiety was more likely among the FAPD patients with persistent disability after six months of treatment.

A surprising finding from the screenings, said Dr. Cunningham, is that youth endorsed more anxiety symptoms in self-assessment than their parents observed. “Children are often their own best informants of their internalizing symptoms,” she said. “Not only do their parents not notice it, it may not be obvious to their providers, either.”

Since many children with FAPD have anxiety, the next question was “How do we better enhance their treatments?” she continued. To answer that question, she took one step back: “How do these youth respond to our current best practice?”

Looking at Cincinnati Children’s patients with FAPD who did – or did not – have anxiety, Dr. Cunningham found that “those who have clinical levels of anxiety don’t respond as well to CBT.” Pain-directed therapy alone, she said, “is insufficient to treat these patients.”

Together with brief screening, stepped therapy delivered via ADAPT offers promise to boost the efficacy of FAPD treatment, perhaps even in a primary care setting, said Dr. Cunningham. She and her collaborators are continuing to study comorbid anxiety and pain in youth; current work is using functional magnetic resonance imaging to examine cognitive and affective changes in patients receiving the ADAPT intervention.

The study was funded by the American Pain Society Sharon S. Keller Chronic Pain Research Grant, Cincinnati Children’s Hospital, and the National Institutes of Health. Dr. Cunningham reported no relevant conflicts of interest.

koakes@mdedge.com

SOURCE: Cunningham N. et al. APS 2019.

A study from researchers at Washington University in St. Louis and Aarhus University in Denmark charts the relationship of payment based on work done and employee mental health. According to phys.org, an aggregator of science, research, and technology news, performance-based pay is in place in 70% of U.S. companies. This means that employee income is based on a combination of bonuses, commission, profit sharing, and individual/team incentives, rather than guaranteed salaries. For some employees, performance-based pay can prove lucrative. But for others, such systems can lead to poor mental health.

The study, published in the Academy of Management Discoveries, charted the use of prescription medications for anxiety and depression by nearly 319,000 employees at about 1,300 companies in Denmark (2019 Feb 26. doi: 10.5465/amd.2018.0007). Those in lower-paid positions and older employees were most vulnerable.

“Basically, older workers seem to be driving all of this effect,” said coauthor Lamar Pierce, PhD, professor of organization and strategy, and associate dean at Washington University. “One, it’s harder for them to move, so they have less labor mobility. And, two, they have less flexibility: Learning new roles, adapting to change, they have more fully formed preferences at this point.”

A gender link also was evident; women were more likely to leave companies that adopted a pay-for-performance system. “Our study expands existing work by showing that the mental health costs of performance-based pay can be severe enough to necessitate pharmaceutical treatment,” the authors wrote.

Once a firm switched to the pay-for-performance system, the number of employees using anxiety and depression medications, which included Xanax and Zoloft, increased by 5.7%. The actual number of affected employees is almost certainly much higher, according to Dr. Pierce. Projecting the data to the United States, Dr. Pierce and his coauthor, Michael S. Dahl, PhD, estimated that 100,000 Americans could be affected.

“These types of mental health problems are incredibly costly to both the individual and firm. If this is reflective of a broader increase in stress and depression in employees, the costs are very high,” added Dr. Pierce. The study highlights the broader health and wellness implications of the companies’ compensation policies, he said. phys.org.

©rasslava/thinkstockphotos.com

More and more people in the United States with severe mental illness and addictions reportedly are homeless, particularly in the Pacific Northwest and on the West Coast. Legislation aimed at addressing that problem is under discussion by Washington state lawmakers and appears to have broad support. The bill, which would authorize creation of a teaching hospital with 150 beds for people with mental illness, garnered unanimous support in the state’s House of Representatives and now has passed a Senate committee.

“The need for mental health care across our state has outgrown our facilities and our supply of trained health care professionals,” said State Sen. Annette Cleveland, chair of the Senate Health & Long Term Care Committee. “This important facility will address those needs head-on by expanding our physical capacity, enlarging our skilled workforce and increasing access through the use of telehealth services. The establishment of this dedicated behavioral health facility at the University of Washington would be the first of its kind in the nation.”

Jürgen Unützer, MD, MPH told KOMO News that the facility would be accredited and modern. “We would have a facility that’s from 2021 that’s state of the art, that’s approved, that’s a safe, welcoming environment where people would take their family members and say ‘this is a place that can give me some hope,’ ” said Dr. Unützer, who chairs the department of psychiatry and behavioral services at the University of Washington, Seattle.

The legislation, H.B. 1593, is part of efforts by Gov. Jay Inslee to tackle mental health issues in the state. The state’s aging mental health infrastructure has been losing federal funding, and patient safety issues have been identified at state-run mental health hospitals. KOMO News.

The New York Police Department recently reported a near-doubling of 911 calls by people the city refers to as “emotionally disturbed persons” over the past decade. Encounters between police and people in need reportedly have resulted in the deaths of 14 people over the last 3 years.

“There is a serious problem in New York City in the manner in which the NYPD interacts with mentally ill people,” said attorney Sanford Rubenstein, who is representing seven families whose family members with mental illness have been shot by police since 2016. “The training of police officers with regard to that interaction is limited and the number of patrol officers who have been trained is small. That is unacceptable.”

The problem was recognized years ago, and a plan was put in place by the city to provide mental health training to every police officer. Flash ahead 4 years and less than one-third of the police force has received any mental health training – just 11,970 of the 36,753 uniformed police officers. What’s more, teams of mental health workers and police that were formed 3 years ago to help intervene in responses to emotionally disturbed people have not been brought into the loop of the 911 system. The result has been 911 responses by officers not trained to deal with such situations and without the support of those who could help. The number of 911 calls related to emotionally disturbed people rose from just over 91,000 in 2009 to nearly 180,000 in 2018, averaging almost 500 every day. The calls are disproportionately from predominantly black and Hispanic precincts.

A 2014 announcement of “diversion centers,” where people with emotional disturbances could be brought by police instead of ferrying them to hospitals or jail, has failed to materialize. “[The problem] is overwhelming in the neighborhoods that I represent,” said Bronx council member Ritchie J. Torres. “Whether it be Tremont or Fordham – you can feel it and see it on the ground. ... You see chemically addicted, mentally ill people, who either are languishing on the street or being cycled in and out of the criminal justice system. And I’m wondering to myself, there has to be a better approach. This is insane.” New York Magazine.

Iowa Gov. Kim Reynolds has signed a comprehensive bill that, among other things, aims to make sweeping changes in the state’s mental health system. The new law also requires suicide prevention training for school personnel in the state. “This legislation was pushed over the finish line by individuals and families who knew firsthand the importance of having a robust mental health system,” Gov. Reynolds said. Critics contend that the legislation does not go far enough in several respects, including specifying where funding will come from and ensuring full access to care. Meanwhile, the governor announced plans to sign an executive order “establishing a platform to begin developing a children’s mental health system.” Des Moines Register.

Emergency room staff at AdventHealth hospitals in Orlando and neighboring Kissimmee, Fla., will begin assessing the mental health of patients as part of a pilot project with the University of Central Florida, according to reporting by 90.7 WMFE, a National Public Radio affiliate in central Florida. “How do we start providing that preventive care like we would with a typical chest pain patient? The same type of health care probably doesn’t apply to those patients with that mental health disorder,” said Robert Geissler, director of emergency services at AdventHealth Kissimmee. “And that’s why we’re trying to change the landscape with this particular project.” Similar programs in Michigan and Tennessee have helped curb suicides and lowered costs associated with mental health–related emergency care. As part of the AdventHealth program in Florida, emergency room staff will ask patients about feelings of hopelessness or despair as part of routine assessments. Patients deemed at high risk of suicide will be paired with counselors for the next 3 months, with daily calls and possibly house visits. Other mental health care resources in the community will be enlisted. 90.7 WMFE.
 

A study from researchers at Washington University in St. Louis and Aarhus University in Denmark charts the relationship of payment based on work done and employee mental health. According to phys.org, an aggregator of science, research, and technology news, performance-based pay is in place in 70% of U.S. companies. This means that employee income is based on a combination of bonuses, commission, profit sharing, and individual/team incentives, rather than guaranteed salaries. For some employees, performance-based pay can prove lucrative. But for others, such systems can lead to poor mental health.

The study, published in the Academy of Management Discoveries, charted the use of prescription medications for anxiety and depression by nearly 319,000 employees at about 1,300 companies in Denmark (2019 Feb 26. doi: 10.5465/amd.2018.0007). Those in lower-paid positions and older employees were most vulnerable.

“Basically, older workers seem to be driving all of this effect,” said coauthor Lamar Pierce, PhD, professor of organization and strategy, and associate dean at Washington University. “One, it’s harder for them to move, so they have less labor mobility. And, two, they have less flexibility: Learning new roles, adapting to change, they have more fully formed preferences at this point.”

A gender link also was evident; women were more likely to leave companies that adopted a pay-for-performance system. “Our study expands existing work by showing that the mental health costs of performance-based pay can be severe enough to necessitate pharmaceutical treatment,” the authors wrote.

Once a firm switched to the pay-for-performance system, the number of employees using anxiety and depression medications, which included Xanax and Zoloft, increased by 5.7%. The actual number of affected employees is almost certainly much higher, according to Dr. Pierce. Projecting the data to the United States, Dr. Pierce and his coauthor, Michael S. Dahl, PhD, estimated that 100,000 Americans could be affected.

“These types of mental health problems are incredibly costly to both the individual and firm. If this is reflective of a broader increase in stress and depression in employees, the costs are very high,” added Dr. Pierce. The study highlights the broader health and wellness implications of the companies’ compensation policies, he said. phys.org.

©rasslava/thinkstockphotos.com

More and more people in the United States with severe mental illness and addictions reportedly are homeless, particularly in the Pacific Northwest and on the West Coast. Legislation aimed at addressing that problem is under discussion by Washington state lawmakers and appears to have broad support. The bill, which would authorize creation of a teaching hospital with 150 beds for people with mental illness, garnered unanimous support in the state’s House of Representatives and now has passed a Senate committee.

“The need for mental health care across our state has outgrown our facilities and our supply of trained health care professionals,” said State Sen. Annette Cleveland, chair of the Senate Health & Long Term Care Committee. “This important facility will address those needs head-on by expanding our physical capacity, enlarging our skilled workforce and increasing access through the use of telehealth services. The establishment of this dedicated behavioral health facility at the University of Washington would be the first of its kind in the nation.”

Jürgen Unützer, MD, MPH told KOMO News that the facility would be accredited and modern. “We would have a facility that’s from 2021 that’s state of the art, that’s approved, that’s a safe, welcoming environment where people would take their family members and say ‘this is a place that can give me some hope,’ ” said Dr. Unützer, who chairs the department of psychiatry and behavioral services at the University of Washington, Seattle.

The legislation, H.B. 1593, is part of efforts by Gov. Jay Inslee to tackle mental health issues in the state. The state’s aging mental health infrastructure has been losing federal funding, and patient safety issues have been identified at state-run mental health hospitals. KOMO News.

The New York Police Department recently reported a near-doubling of 911 calls by people the city refers to as “emotionally disturbed persons” over the past decade. Encounters between police and people in need reportedly have resulted in the deaths of 14 people over the last 3 years.

“There is a serious problem in New York City in the manner in which the NYPD interacts with mentally ill people,” said attorney Sanford Rubenstein, who is representing seven families whose family members with mental illness have been shot by police since 2016. “The training of police officers with regard to that interaction is limited and the number of patrol officers who have been trained is small. That is unacceptable.”

The problem was recognized years ago, and a plan was put in place by the city to provide mental health training to every police officer. Flash ahead 4 years and less than one-third of the police force has received any mental health training – just 11,970 of the 36,753 uniformed police officers. What’s more, teams of mental health workers and police that were formed 3 years ago to help intervene in responses to emotionally disturbed people have not been brought into the loop of the 911 system. The result has been 911 responses by officers not trained to deal with such situations and without the support of those who could help. The number of 911 calls related to emotionally disturbed people rose from just over 91,000 in 2009 to nearly 180,000 in 2018, averaging almost 500 every day. The calls are disproportionately from predominantly black and Hispanic precincts.

A 2014 announcement of “diversion centers,” where people with emotional disturbances could be brought by police instead of ferrying them to hospitals or jail, has failed to materialize. “[The problem] is overwhelming in the neighborhoods that I represent,” said Bronx council member Ritchie J. Torres. “Whether it be Tremont or Fordham – you can feel it and see it on the ground. ... You see chemically addicted, mentally ill people, who either are languishing on the street or being cycled in and out of the criminal justice system. And I’m wondering to myself, there has to be a better approach. This is insane.” New York Magazine.

Iowa Gov. Kim Reynolds has signed a comprehensive bill that, among other things, aims to make sweeping changes in the state’s mental health system. The new law also requires suicide prevention training for school personnel in the state. “This legislation was pushed over the finish line by individuals and families who knew firsthand the importance of having a robust mental health system,” Gov. Reynolds said. Critics contend that the legislation does not go far enough in several respects, including specifying where funding will come from and ensuring full access to care. Meanwhile, the governor announced plans to sign an executive order “establishing a platform to begin developing a children’s mental health system.” Des Moines Register.

Emergency room staff at AdventHealth hospitals in Orlando and neighboring Kissimmee, Fla., will begin assessing the mental health of patients as part of a pilot project with the University of Central Florida, according to reporting by 90.7 WMFE, a National Public Radio affiliate in central Florida. “How do we start providing that preventive care like we would with a typical chest pain patient? The same type of health care probably doesn’t apply to those patients with that mental health disorder,” said Robert Geissler, director of emergency services at AdventHealth Kissimmee. “And that’s why we’re trying to change the landscape with this particular project.” Similar programs in Michigan and Tennessee have helped curb suicides and lowered costs associated with mental health–related emergency care. As part of the AdventHealth program in Florida, emergency room staff will ask patients about feelings of hopelessness or despair as part of routine assessments. Patients deemed at high risk of suicide will be paired with counselors for the next 3 months, with daily calls and possibly house visits. Other mental health care resources in the community will be enlisted. 90.7 WMFE.
 

A study from researchers at Washington University in St. Louis and Aarhus University in Denmark charts the relationship of payment based on work done and employee mental health. According to phys.org, an aggregator of science, research, and technology news, performance-based pay is in place in 70% of U.S. companies. This means that employee income is based on a combination of bonuses, commission, profit sharing, and individual/team incentives, rather than guaranteed salaries. For some employees, performance-based pay can prove lucrative. But for others, such systems can lead to poor mental health.

The study, published in the Academy of Management Discoveries, charted the use of prescription medications for anxiety and depression by nearly 319,000 employees at about 1,300 companies in Denmark (2019 Feb 26. doi: 10.5465/amd.2018.0007). Those in lower-paid positions and older employees were most vulnerable.

“Basically, older workers seem to be driving all of this effect,” said coauthor Lamar Pierce, PhD, professor of organization and strategy, and associate dean at Washington University. “One, it’s harder for them to move, so they have less labor mobility. And, two, they have less flexibility: Learning new roles, adapting to change, they have more fully formed preferences at this point.”

A gender link also was evident; women were more likely to leave companies that adopted a pay-for-performance system. “Our study expands existing work by showing that the mental health costs of performance-based pay can be severe enough to necessitate pharmaceutical treatment,” the authors wrote.

Once a firm switched to the pay-for-performance system, the number of employees using anxiety and depression medications, which included Xanax and Zoloft, increased by 5.7%. The actual number of affected employees is almost certainly much higher, according to Dr. Pierce. Projecting the data to the United States, Dr. Pierce and his coauthor, Michael S. Dahl, PhD, estimated that 100,000 Americans could be affected.

“These types of mental health problems are incredibly costly to both the individual and firm. If this is reflective of a broader increase in stress and depression in employees, the costs are very high,” added Dr. Pierce. The study highlights the broader health and wellness implications of the companies’ compensation policies, he said. phys.org.

©rasslava/thinkstockphotos.com

More and more people in the United States with severe mental illness and addictions reportedly are homeless, particularly in the Pacific Northwest and on the West Coast. Legislation aimed at addressing that problem is under discussion by Washington state lawmakers and appears to have broad support. The bill, which would authorize creation of a teaching hospital with 150 beds for people with mental illness, garnered unanimous support in the state’s House of Representatives and now has passed a Senate committee.

“The need for mental health care across our state has outgrown our facilities and our supply of trained health care professionals,” said State Sen. Annette Cleveland, chair of the Senate Health & Long Term Care Committee. “This important facility will address those needs head-on by expanding our physical capacity, enlarging our skilled workforce and increasing access through the use of telehealth services. The establishment of this dedicated behavioral health facility at the University of Washington would be the first of its kind in the nation.”

Jürgen Unützer, MD, MPH told KOMO News that the facility would be accredited and modern. “We would have a facility that’s from 2021 that’s state of the art, that’s approved, that’s a safe, welcoming environment where people would take their family members and say ‘this is a place that can give me some hope,’ ” said Dr. Unützer, who chairs the department of psychiatry and behavioral services at the University of Washington, Seattle.

The legislation, H.B. 1593, is part of efforts by Gov. Jay Inslee to tackle mental health issues in the state. The state’s aging mental health infrastructure has been losing federal funding, and patient safety issues have been identified at state-run mental health hospitals. KOMO News.

The New York Police Department recently reported a near-doubling of 911 calls by people the city refers to as “emotionally disturbed persons” over the past decade. Encounters between police and people in need reportedly have resulted in the deaths of 14 people over the last 3 years.

“There is a serious problem in New York City in the manner in which the NYPD interacts with mentally ill people,” said attorney Sanford Rubenstein, who is representing seven families whose family members with mental illness have been shot by police since 2016. “The training of police officers with regard to that interaction is limited and the number of patrol officers who have been trained is small. That is unacceptable.”

The problem was recognized years ago, and a plan was put in place by the city to provide mental health training to every police officer. Flash ahead 4 years and less than one-third of the police force has received any mental health training – just 11,970 of the 36,753 uniformed police officers. What’s more, teams of mental health workers and police that were formed 3 years ago to help intervene in responses to emotionally disturbed people have not been brought into the loop of the 911 system. The result has been 911 responses by officers not trained to deal with such situations and without the support of those who could help. The number of 911 calls related to emotionally disturbed people rose from just over 91,000 in 2009 to nearly 180,000 in 2018, averaging almost 500 every day. The calls are disproportionately from predominantly black and Hispanic precincts.

A 2014 announcement of “diversion centers,” where people with emotional disturbances could be brought by police instead of ferrying them to hospitals or jail, has failed to materialize. “[The problem] is overwhelming in the neighborhoods that I represent,” said Bronx council member Ritchie J. Torres. “Whether it be Tremont or Fordham – you can feel it and see it on the ground. ... You see chemically addicted, mentally ill people, who either are languishing on the street or being cycled in and out of the criminal justice system. And I’m wondering to myself, there has to be a better approach. This is insane.” New York Magazine.

Iowa Gov. Kim Reynolds has signed a comprehensive bill that, among other things, aims to make sweeping changes in the state’s mental health system. The new law also requires suicide prevention training for school personnel in the state. “This legislation was pushed over the finish line by individuals and families who knew firsthand the importance of having a robust mental health system,” Gov. Reynolds said. Critics contend that the legislation does not go far enough in several respects, including specifying where funding will come from and ensuring full access to care. Meanwhile, the governor announced plans to sign an executive order “establishing a platform to begin developing a children’s mental health system.” Des Moines Register.

Emergency room staff at AdventHealth hospitals in Orlando and neighboring Kissimmee, Fla., will begin assessing the mental health of patients as part of a pilot project with the University of Central Florida, according to reporting by 90.7 WMFE, a National Public Radio affiliate in central Florida. “How do we start providing that preventive care like we would with a typical chest pain patient? The same type of health care probably doesn’t apply to those patients with that mental health disorder,” said Robert Geissler, director of emergency services at AdventHealth Kissimmee. “And that’s why we’re trying to change the landscape with this particular project.” Similar programs in Michigan and Tennessee have helped curb suicides and lowered costs associated with mental health–related emergency care. As part of the AdventHealth program in Florida, emergency room staff will ask patients about feelings of hopelessness or despair as part of routine assessments. Patients deemed at high risk of suicide will be paired with counselors for the next 3 months, with daily calls and possibly house visits. Other mental health care resources in the community will be enlisted. 90.7 WMFE.
 

Depression, suicidal thoughts, and mental distress appear to be on the rise among American teenagers and young adults, and a new study points to their use of social media as a cause. According to the study’s lead author, Jean M. Twenge, PhD, the findings might be evident of a generational shift in mental illness. The study looked at data from more than 200,000 adolescents aged 12-17 and nearly 400,000 young adults aged 18 and over from 2005 to 2017. During that time, reported symptoms consistent with major depression increased by 52% among the teens and 63% among the young adults. Girls were especially at risk, with one in five teenage girls having experienced major depression in 2017. In addition, by 2017, nearly three-quarters of young adults had experienced feelings of hopelessness about their lives. Meanwhile, the rate of suicide rose during that study period. Dr. Twenge said a major factor contributing to those trends is the plugged-in lifestyle of many teens and young adults. “Spending time on social media tends not to be in real time,” said Dr. Twenge, a psychologist at San Diego State University. “You’re not having a real-time conversation with someone – usually you’re not seeing their face, and you can’t give them a hug; it’s just not as emotionally fulfilling as seeing someone in person,” she said in an interview with National Public Radio. The uncertain times are likely another influence, according to Robert Crosnoe, PhD, a sociologist and adolescent health researcher from the University of Texas at Austin. “I think we are living in a time of great uncertainty, where people are unsure about the future of the country but also their own futures,” he said. “And that is anxiety provoking for anybody, but it’s especially true for young people whose whole future is ahead of them.” NPR.

Peerayot/Thinkstock.com

Alexandra Valoras was a high school student who earned straight As and participated in extracurricular school activities like robotics and pastimes like snowboarding. On the outside, her future looked bright. But inside, Alexandra lived in a world of despair. Her journals revealed profound self-loathing and sadness. She repeatedly expressed a desire to end her own life, reported Jim Axelrod of CBS News. Alexandra is far from alone. The suicide rate for American teens her age is at a 40-year high. One reason is the pressure for perfection, with failure being viewed as catastrophic. “I don’t want this notebook to end, I love it more than myself (?) I need a place where there is no need for me to be perfect,” Alexandra wrote in one entry. “We have a culture that makes kids think that if they’re not perfect, they’re less than good,” said Scott White, a counselor at Alexandra’s high school. Not every person can reach them.” On March 18, 2018, Alexandra wrote her last entry. “What I will miss by dying tonight. The possibility of anything getting better.” She then tidied up her room, walked to an overpass, and jumped. She was 17 years old. Her parents, Dean and Alysia Valoras, shared their daughter’s journals with the hope of helping others. “The hurt, the sadness is evolving,” Mr. Valoras said in the report. “And now there is this thing called living, so that I am a good father, a good husband, a good person.” CBS Sunday Morning.

For college students, accessing mental health services can be a challenge – especially when cost is an issue. In an effort to address that problem Loyola University in New Orleans recently opened a clinic for low-income students in need of psychiatric services. The clinic, opened in February, hopes to serve about 50 patients each week and is open to students and community members. “I’m really stoked about working with this demographic. It’s a population that doesn’t make a lot of money. So you can go to this clinic, pay a small co-pay, and not have to rely on having health insurance,” said Sarah Zoghbi of the New Orleans Musicians’ Clinic & Assistance Foundation, one of the organizations providing support to the clinic. The clinic aims to address the gap in mental health services for the underinsured and uninsured in the area. And it’s sorely needed. Louisiana ranks 38th among the states for lower rates of access to care and higher prevalence of mental illness, according to the 2019 Mental Health America report. About 599,000 adults in Louisiana, about 17% of the population, have a mental illness. “It is our sincere hope to fill a gap in the community by providing high-quality services for those in need,” said the clinic’s director John Dewell, PhD. “No one will be turned away for lack of funds.” The Times-Picayune.

More and more video games are “tackling mental health issues,” Laura Parker wrote in the New York Times. “Mental health is becoming a more central narrative in our culture with efforts to normalize mental health challenges,” according to Eve Crevoshay, of Take This, a group that seeks to destigmatize mental illness within the video game industry. “With that trend comes response from creative industries, including games.” One of the games that Ms. Parker mentioned, called Sea of Solitude, is expected to publish this year. Another, called Celeste, examines depression and anxiety through a protagonist who tries to avoid obstacles. And yet another, called Hellblade, focuses on a warrior who deals with psychosis. Raffael Boccamazzo, PsyD, a psychotherapist who works as clinical director for Take This, said video games can be more effective at helping people bounce back “from negative moods than passive forms of media like TV or movies.” Take This provides resources, guidelines, and training about mental health on its website. The New York Times.

General offers of help to families in crisis are fine but might not get acted upon. It is better to offer something specific, and “the more specific, the better,” wrote Andrea Paterson in the Washington Post. “Not ‘Can I bring dinner sometime?’ Instead, something like, ‘I’d like to come over on Thursday and bring turkey chili.’ Ms. Paterson wrote that she came to that conclusion after her husband was diagnosed with stage 4 metastatic lung cancer in 2013. His death 4½ years later plunged Ms. Paterson and her sons “into crisis,” she wrote. Her tight network of friends and neighbors helped her cope, she said, and their concrete offers of help kept the family going. Such offers need not be earth shattering or monumental, she said. One of her “all-time favorites” was delightfully simple: “ ‘I’m having a cup of tea, watching Audrey learn to roller skate in the driveway. Come join me.’ Needless to say, I joined her.” Ms. Paterson shared several other specifics that might help families in crisis, such as getting a friend to set up a support network of helpers who can pick up prescriptions, meet repairmen, and so on. “Remember that what you offer doesn’t need to be expensive or extravagant,” Ms. Paterson wrote. “ ‘Tomorrow night we are watching the Super Bowl: Join us for tacos and ice cream.’ After all, no one can be in a crisis 24/7.” The Washington Post.

Depression, suicidal thoughts, and mental distress appear to be on the rise among American teenagers and young adults, and a new study points to their use of social media as a cause. According to the study’s lead author, Jean M. Twenge, PhD, the findings might be evident of a generational shift in mental illness. The study looked at data from more than 200,000 adolescents aged 12-17 and nearly 400,000 young adults aged 18 and over from 2005 to 2017. During that time, reported symptoms consistent with major depression increased by 52% among the teens and 63% among the young adults. Girls were especially at risk, with one in five teenage girls having experienced major depression in 2017. In addition, by 2017, nearly three-quarters of young adults had experienced feelings of hopelessness about their lives. Meanwhile, the rate of suicide rose during that study period. Dr. Twenge said a major factor contributing to those trends is the plugged-in lifestyle of many teens and young adults. “Spending time on social media tends not to be in real time,” said Dr. Twenge, a psychologist at San Diego State University. “You’re not having a real-time conversation with someone – usually you’re not seeing their face, and you can’t give them a hug; it’s just not as emotionally fulfilling as seeing someone in person,” she said in an interview with National Public Radio. The uncertain times are likely another influence, according to Robert Crosnoe, PhD, a sociologist and adolescent health researcher from the University of Texas at Austin. “I think we are living in a time of great uncertainty, where people are unsure about the future of the country but also their own futures,” he said. “And that is anxiety provoking for anybody, but it’s especially true for young people whose whole future is ahead of them.” NPR.

Peerayot/Thinkstock.com

Alexandra Valoras was a high school student who earned straight As and participated in extracurricular school activities like robotics and pastimes like snowboarding. On the outside, her future looked bright. But inside, Alexandra lived in a world of despair. Her journals revealed profound self-loathing and sadness. She repeatedly expressed a desire to end her own life, reported Jim Axelrod of CBS News. Alexandra is far from alone. The suicide rate for American teens her age is at a 40-year high. One reason is the pressure for perfection, with failure being viewed as catastrophic. “I don’t want this notebook to end, I love it more than myself (?) I need a place where there is no need for me to be perfect,” Alexandra wrote in one entry. “We have a culture that makes kids think that if they’re not perfect, they’re less than good,” said Scott White, a counselor at Alexandra’s high school. Not every person can reach them.” On March 18, 2018, Alexandra wrote her last entry. “What I will miss by dying tonight. The possibility of anything getting better.” She then tidied up her room, walked to an overpass, and jumped. She was 17 years old. Her parents, Dean and Alysia Valoras, shared their daughter’s journals with the hope of helping others. “The hurt, the sadness is evolving,” Mr. Valoras said in the report. “And now there is this thing called living, so that I am a good father, a good husband, a good person.” CBS Sunday Morning.

For college students, accessing mental health services can be a challenge – especially when cost is an issue. In an effort to address that problem Loyola University in New Orleans recently opened a clinic for low-income students in need of psychiatric services. The clinic, opened in February, hopes to serve about 50 patients each week and is open to students and community members. “I’m really stoked about working with this demographic. It’s a population that doesn’t make a lot of money. So you can go to this clinic, pay a small co-pay, and not have to rely on having health insurance,” said Sarah Zoghbi of the New Orleans Musicians’ Clinic & Assistance Foundation, one of the organizations providing support to the clinic. The clinic aims to address the gap in mental health services for the underinsured and uninsured in the area. And it’s sorely needed. Louisiana ranks 38th among the states for lower rates of access to care and higher prevalence of mental illness, according to the 2019 Mental Health America report. About 599,000 adults in Louisiana, about 17% of the population, have a mental illness. “It is our sincere hope to fill a gap in the community by providing high-quality services for those in need,” said the clinic’s director John Dewell, PhD. “No one will be turned away for lack of funds.” The Times-Picayune.

More and more video games are “tackling mental health issues,” Laura Parker wrote in the New York Times. “Mental health is becoming a more central narrative in our culture with efforts to normalize mental health challenges,” according to Eve Crevoshay, of Take This, a group that seeks to destigmatize mental illness within the video game industry. “With that trend comes response from creative industries, including games.” One of the games that Ms. Parker mentioned, called Sea of Solitude, is expected to publish this year. Another, called Celeste, examines depression and anxiety through a protagonist who tries to avoid obstacles. And yet another, called Hellblade, focuses on a warrior who deals with psychosis. Raffael Boccamazzo, PsyD, a psychotherapist who works as clinical director for Take This, said video games can be more effective at helping people bounce back “from negative moods than passive forms of media like TV or movies.” Take This provides resources, guidelines, and training about mental health on its website. The New York Times.

General offers of help to families in crisis are fine but might not get acted upon. It is better to offer something specific, and “the more specific, the better,” wrote Andrea Paterson in the Washington Post. “Not ‘Can I bring dinner sometime?’ Instead, something like, ‘I’d like to come over on Thursday and bring turkey chili.’ Ms. Paterson wrote that she came to that conclusion after her husband was diagnosed with stage 4 metastatic lung cancer in 2013. His death 4½ years later plunged Ms. Paterson and her sons “into crisis,” she wrote. Her tight network of friends and neighbors helped her cope, she said, and their concrete offers of help kept the family going. Such offers need not be earth shattering or monumental, she said. One of her “all-time favorites” was delightfully simple: “ ‘I’m having a cup of tea, watching Audrey learn to roller skate in the driveway. Come join me.’ Needless to say, I joined her.” Ms. Paterson shared several other specifics that might help families in crisis, such as getting a friend to set up a support network of helpers who can pick up prescriptions, meet repairmen, and so on. “Remember that what you offer doesn’t need to be expensive or extravagant,” Ms. Paterson wrote. “ ‘Tomorrow night we are watching the Super Bowl: Join us for tacos and ice cream.’ After all, no one can be in a crisis 24/7.” The Washington Post.

Depression, suicidal thoughts, and mental distress appear to be on the rise among American teenagers and young adults, and a new study points to their use of social media as a cause. According to the study’s lead author, Jean M. Twenge, PhD, the findings might be evident of a generational shift in mental illness. The study looked at data from more than 200,000 adolescents aged 12-17 and nearly 400,000 young adults aged 18 and over from 2005 to 2017. During that time, reported symptoms consistent with major depression increased by 52% among the teens and 63% among the young adults. Girls were especially at risk, with one in five teenage girls having experienced major depression in 2017. In addition, by 2017, nearly three-quarters of young adults had experienced feelings of hopelessness about their lives. Meanwhile, the rate of suicide rose during that study period. Dr. Twenge said a major factor contributing to those trends is the plugged-in lifestyle of many teens and young adults. “Spending time on social media tends not to be in real time,” said Dr. Twenge, a psychologist at San Diego State University. “You’re not having a real-time conversation with someone – usually you’re not seeing their face, and you can’t give them a hug; it’s just not as emotionally fulfilling as seeing someone in person,” she said in an interview with National Public Radio. The uncertain times are likely another influence, according to Robert Crosnoe, PhD, a sociologist and adolescent health researcher from the University of Texas at Austin. “I think we are living in a time of great uncertainty, where people are unsure about the future of the country but also their own futures,” he said. “And that is anxiety provoking for anybody, but it’s especially true for young people whose whole future is ahead of them.” NPR.

Peerayot/Thinkstock.com

Alexandra Valoras was a high school student who earned straight As and participated in extracurricular school activities like robotics and pastimes like snowboarding. On the outside, her future looked bright. But inside, Alexandra lived in a world of despair. Her journals revealed profound self-loathing and sadness. She repeatedly expressed a desire to end her own life, reported Jim Axelrod of CBS News. Alexandra is far from alone. The suicide rate for American teens her age is at a 40-year high. One reason is the pressure for perfection, with failure being viewed as catastrophic. “I don’t want this notebook to end, I love it more than myself (?) I need a place where there is no need for me to be perfect,” Alexandra wrote in one entry. “We have a culture that makes kids think that if they’re not perfect, they’re less than good,” said Scott White, a counselor at Alexandra’s high school. Not every person can reach them.” On March 18, 2018, Alexandra wrote her last entry. “What I will miss by dying tonight. The possibility of anything getting better.” She then tidied up her room, walked to an overpass, and jumped. She was 17 years old. Her parents, Dean and Alysia Valoras, shared their daughter’s journals with the hope of helping others. “The hurt, the sadness is evolving,” Mr. Valoras said in the report. “And now there is this thing called living, so that I am a good father, a good husband, a good person.” CBS Sunday Morning.

For college students, accessing mental health services can be a challenge – especially when cost is an issue. In an effort to address that problem Loyola University in New Orleans recently opened a clinic for low-income students in need of psychiatric services. The clinic, opened in February, hopes to serve about 50 patients each week and is open to students and community members. “I’m really stoked about working with this demographic. It’s a population that doesn’t make a lot of money. So you can go to this clinic, pay a small co-pay, and not have to rely on having health insurance,” said Sarah Zoghbi of the New Orleans Musicians’ Clinic & Assistance Foundation, one of the organizations providing support to the clinic. The clinic aims to address the gap in mental health services for the underinsured and uninsured in the area. And it’s sorely needed. Louisiana ranks 38th among the states for lower rates of access to care and higher prevalence of mental illness, according to the 2019 Mental Health America report. About 599,000 adults in Louisiana, about 17% of the population, have a mental illness. “It is our sincere hope to fill a gap in the community by providing high-quality services for those in need,” said the clinic’s director John Dewell, PhD. “No one will be turned away for lack of funds.” The Times-Picayune.

More and more video games are “tackling mental health issues,” Laura Parker wrote in the New York Times. “Mental health is becoming a more central narrative in our culture with efforts to normalize mental health challenges,” according to Eve Crevoshay, of Take This, a group that seeks to destigmatize mental illness within the video game industry. “With that trend comes response from creative industries, including games.” One of the games that Ms. Parker mentioned, called Sea of Solitude, is expected to publish this year. Another, called Celeste, examines depression and anxiety through a protagonist who tries to avoid obstacles. And yet another, called Hellblade, focuses on a warrior who deals with psychosis. Raffael Boccamazzo, PsyD, a psychotherapist who works as clinical director for Take This, said video games can be more effective at helping people bounce back “from negative moods than passive forms of media like TV or movies.” Take This provides resources, guidelines, and training about mental health on its website. The New York Times.

General offers of help to families in crisis are fine but might not get acted upon. It is better to offer something specific, and “the more specific, the better,” wrote Andrea Paterson in the Washington Post. “Not ‘Can I bring dinner sometime?’ Instead, something like, ‘I’d like to come over on Thursday and bring turkey chili.’ Ms. Paterson wrote that she came to that conclusion after her husband was diagnosed with stage 4 metastatic lung cancer in 2013. His death 4½ years later plunged Ms. Paterson and her sons “into crisis,” she wrote. Her tight network of friends and neighbors helped her cope, she said, and their concrete offers of help kept the family going. Such offers need not be earth shattering or monumental, she said. One of her “all-time favorites” was delightfully simple: “ ‘I’m having a cup of tea, watching Audrey learn to roller skate in the driveway. Come join me.’ Needless to say, I joined her.” Ms. Paterson shared several other specifics that might help families in crisis, such as getting a friend to set up a support network of helpers who can pick up prescriptions, meet repairmen, and so on. “Remember that what you offer doesn’t need to be expensive or extravagant,” Ms. Paterson wrote. “ ‘Tomorrow night we are watching the Super Bowl: Join us for tacos and ice cream.’ After all, no one can be in a crisis 24/7.” The Washington Post.

Hoarding symptoms are frequently present in patients with obsessive-compulsive disorder (OCD), and significant differences can be found between them and patients with OCD and no hoarding symptoms, a study of 407 patients shows.

The study also identified links to autism spectrum disorder (ASD) among patients with OCD/hoarding symptoms. “The most relevant outcome of this study was the association between persons with OCD/hoarding and the increased severity of autism symptoms,” wrote Yentl E. Boerema of the Amsterdam Public Health Research Institute, and associates. The study was published in the Journal of Affective Disorders.

To conduct the study, the investigators used cross-sectional baseline data from the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. Participants in the NOCDA sample were aged 18-79 years with current or remitted DSM-IV-TR criteria for OCD. Hoarding symptoms were determined via the adapted version of the Yale-Brown Obsessive Compulsive Scale. A total of 58 patients were found to have both OCD/hoarding symptoms, compared with 349 who did not, the investigators reported.

OCD/hoarding was associated with earlier age of onset (P less than .05) and more severe OCD symptoms (P less than .001), as well as higher scores on all OCD subtypes. It was associated with living without a partner (P less than .05), being less conscientious (P less than .05), and severity of autism symptoms (P less than .001). The investigators speculated that ASD factors might “be responsible for hoarding behavior, including (a) having intense or focused interests, which can lead to collecting of items, and/or (b) having a lack of seeking shared enjoyment, interests, and activity with other people.”

Meanwhile, the investigators found that coexisting OCD/hoarding was not associated with childhood trauma, posttraumatic stress disorder or attention-deficit/hyperactivity disorder – inattentive type or hyperactive type.

“Clinical implications of our findings are to have the treatment follow a more intensive and structured course (i.e., avoid surprises),” having more attention for affective education, and making more use of visual illustrations, the investigators said. “Taken together, this knowledge provides a better understanding of persons with OCD/hoarding and has the potential to improve treatment.”

The study authors reported no conflicts of interest.

lfranki@mdedge.com

Hoarding symptoms are frequently present in patients with obsessive-compulsive disorder (OCD), and significant differences can be found between them and patients with OCD and no hoarding symptoms, a study of 407 patients shows.

The study also identified links to autism spectrum disorder (ASD) among patients with OCD/hoarding symptoms. “The most relevant outcome of this study was the association between persons with OCD/hoarding and the increased severity of autism symptoms,” wrote Yentl E. Boerema of the Amsterdam Public Health Research Institute, and associates. The study was published in the Journal of Affective Disorders.

To conduct the study, the investigators used cross-sectional baseline data from the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. Participants in the NOCDA sample were aged 18-79 years with current or remitted DSM-IV-TR criteria for OCD. Hoarding symptoms were determined via the adapted version of the Yale-Brown Obsessive Compulsive Scale. A total of 58 patients were found to have both OCD/hoarding symptoms, compared with 349 who did not, the investigators reported.

OCD/hoarding was associated with earlier age of onset (P less than .05) and more severe OCD symptoms (P less than .001), as well as higher scores on all OCD subtypes. It was associated with living without a partner (P less than .05), being less conscientious (P less than .05), and severity of autism symptoms (P less than .001). The investigators speculated that ASD factors might “be responsible for hoarding behavior, including (a) having intense or focused interests, which can lead to collecting of items, and/or (b) having a lack of seeking shared enjoyment, interests, and activity with other people.”

Meanwhile, the investigators found that coexisting OCD/hoarding was not associated with childhood trauma, posttraumatic stress disorder or attention-deficit/hyperactivity disorder – inattentive type or hyperactive type.

“Clinical implications of our findings are to have the treatment follow a more intensive and structured course (i.e., avoid surprises),” having more attention for affective education, and making more use of visual illustrations, the investigators said. “Taken together, this knowledge provides a better understanding of persons with OCD/hoarding and has the potential to improve treatment.”

The study authors reported no conflicts of interest.

lfranki@mdedge.com

Hoarding symptoms are frequently present in patients with obsessive-compulsive disorder (OCD), and significant differences can be found between them and patients with OCD and no hoarding symptoms, a study of 407 patients shows.

The study also identified links to autism spectrum disorder (ASD) among patients with OCD/hoarding symptoms. “The most relevant outcome of this study was the association between persons with OCD/hoarding and the increased severity of autism symptoms,” wrote Yentl E. Boerema of the Amsterdam Public Health Research Institute, and associates. The study was published in the Journal of Affective Disorders.

To conduct the study, the investigators used cross-sectional baseline data from the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. Participants in the NOCDA sample were aged 18-79 years with current or remitted DSM-IV-TR criteria for OCD. Hoarding symptoms were determined via the adapted version of the Yale-Brown Obsessive Compulsive Scale. A total of 58 patients were found to have both OCD/hoarding symptoms, compared with 349 who did not, the investigators reported.

OCD/hoarding was associated with earlier age of onset (P less than .05) and more severe OCD symptoms (P less than .001), as well as higher scores on all OCD subtypes. It was associated with living without a partner (P less than .05), being less conscientious (P less than .05), and severity of autism symptoms (P less than .001). The investigators speculated that ASD factors might “be responsible for hoarding behavior, including (a) having intense or focused interests, which can lead to collecting of items, and/or (b) having a lack of seeking shared enjoyment, interests, and activity with other people.”

Meanwhile, the investigators found that coexisting OCD/hoarding was not associated with childhood trauma, posttraumatic stress disorder or attention-deficit/hyperactivity disorder – inattentive type or hyperactive type.

“Clinical implications of our findings are to have the treatment follow a more intensive and structured course (i.e., avoid surprises),” having more attention for affective education, and making more use of visual illustrations, the investigators said. “Taken together, this knowledge provides a better understanding of persons with OCD/hoarding and has the potential to improve treatment.”

The study authors reported no conflicts of interest.

lfranki@mdedge.com

Wavebreakmedia/iStock/Getty Images

The stigma tied to mental illness can be particularly difficult to overcome for people of Latin American descent, writes Concepción de León in El Espace, a column in the New York Times focused on news and culture relevant to Latinx communities. Sometimes those seeking help run into familiar mantras. “Let me know if any of these sound familiar: 'Boys don’t cry. We don’t air family business. You have to be strong. Turn to God.' These refrains (all of which I’ve heard at least once...) are just some of the responses that people dealing with mental health challenges in Latino communities have come to know well,” Ms. de León wrote. The unequal access to mental health services and health insurance that is a reality for some Latinos compounds the problem. The result is that mental illness can go untreated. Indeed, according to Ms. de León, Latinos, who are just as likely to suffer from a mental illness as non-Hispanic whites, are half as likely to seek treatment. Adriana Alejandre, a Latina who is a licensed marriage and family therapist in Los Angeles, is seeking to change that statistic. Through her podcast, Latinx Therapy, she seeks to spread the word that seeking therapy for mental illness is a positive step. There’s a long way to go, partly because Latino communities tend to value the group over the individual. “The downfall is that people suffer in silence,” said Ms. Alejandre. Therapy is important for some Latinos, according to Ms. Alejandre, because of intergenerational trauma that “allows the cycle to continue – whether it’s trauma, whether it’s depression, anxiety, domestic violence.” Ms. de León said one strategy she used for more than 1 year while she was in therapy was to set boundaries by not sharing what she was doing with family members. “It is tough when family sees you as ungrateful for healthy behaviors like boundary setting,” Ms. Alejandre said. “But the system will not change if someone does not initiate the change.” The New York Times.

Some state governments are seeking to make mental health services more available. The proposed budget of democratic Gov. Tony Evers of Wisconsin aims to allocate $22 million in mental health funding to school districts in the state to pay for social workers, psychologists, counselors, and nurses. The money would come on top of the $3 million designated by his predecessor and continues the efforts in Wisconsin to give children with mental health problems more access to needed help. The proposed budget also would add $7 million to a state program that works with local health agencies with the goal of providing mental health services for students and would allocate about $2.5 million annually for school staff training. The news is welcome to school districts across Wisconsin. “Schools are struggling to meet all of those [mental health] needs. I think there is an understanding that this is really something we need to be addressing,” said Joanne Juhnke, policy director at Wisconsin Family Ties, which helps families with children who have mental health challenges. Post Crescent, part of the USA Today network.

In Pennsylvania, the state Supreme Court is set to rule on whether those who provide mental health treatment to people addicted to illicit drugs can be free from prosecution. Right now, they are not. As reported in the Legal Intelligence, the case concerns two physicians at a drug addiction treatment facility who treated a man with an opioid addiction. In July 2018, a three-judge Superior Court panel upheld that physicians should not have liability protections under the Mental Health Procedures Act (MHPA). The ruling reversed a lower court decision. The Superior Court judges sympathized with the view that treatment of mental illness in drug treatment facilities be given more legal leeway. Whether that leeway remains in place depends on the Supreme Court. If judges decide no, physicians who recognize signs of mental illness in patients being treated for drug addiction would treat the illness at the risk of subsequent liability. The case has again raised the issue of whether alcoholism and drug dependency should be considered mental illnesses. “We don’t believe it was the intended purpose of the MPHA to include drug addiction. Our concern is we don’t want hospitals or rehab facilities just having patients be seen by psychiatrists in order to invoke the MHPA,” said Patrick Mintzer, the lawyer who will argue the cases before the court. A counter view came from Jack Panella, one of the three Superior Court judges. In his decision, he wrote: “In light of current scientific research, as well as the recent addition of ‘addiction disorders’ to the American Psychiatric Association’s Diagnostic and Statistical Manual–5, we suggest that the Department of Human Services revise this definition.” The Legal Intelligence.

An op-ed in the Des Moines Register applauds republican Gov. Kim Reynolds for introducing two bills that are aimed at expanding mental health services to children and family in Iowa. “After decades of discussion and growing public support, these two bills take a huge step toward establishing a children’s mental health system,” wrote guest columnists Erin Drinnin of the United Way of Central Iowa and Kim Scorza of Seasons Center for Behavioral Health. The two also serve as cochairs of the Coalition to Advance Mental Health in Iowa for Kids (CAMHI4Kids), which includes more than 50 organizations. “Just like building a house requires a sturdy foundation, these bills are an important first step toward creating a structure for children’s mental well-being. In particular, CAMHI4Kids appreciates that these bills establish a voice and a seat for children and families at a regional level, using a system that is already in place,” wrote Ms. Drinnin and Ms. Scorza. The legislation would spell out the core services that would be available regardless of location in Iowa. The services would be geared toward children, rather than adults, reflecting the different mental health needs of children. “These important steps would finally sew together a patchwork of care that families currently must navigate with little direction. If a child is hurt on the playground, a caregiver knows to follow a clear path of care to help that child recover. But for a caregiver who is concerned about a child’s mental health, they often don’t know where to turn for help and must seek out services that might not exist in their community,” wrote Ms. Drinnin and Ms. Scorza. In Iowa, 80,000 children have a diagnosed serious emotional disturbance. About half of children aged 14 years and older with mental illness drop out of high school, and 70% of youth in Iowa’s juvenile justice system have a mental illness. “We are proud that Iowa is working together in a bipartisan way to ensure that our kids have the best start for future success,” wrote Ms. Drinnin and Ms. Scorza. Des Moines Register.

Bill Reilly is the peer support program manager for Bert Nash Community Mental Health Center in Douglas County, Kan. His mental health troubles began in childhood and led to stints in alcohol rehabilitation and mental hospitals, and he tried to end his life several times. But Mr. Reilly now offers his experience to those in trouble. “Those [experiences] can be viewed as a negative until you turn that conversation around and ask, ‘How can this be helpful to another person?’ And to me, that’s where the urgency comes into the work that we’re doing because a clinical relationship is one thing, but a peer support relationship is something different.” He was speaking in support of an initiative that seeks to train and place peer support people in hospital emergency departments in Kansas. The initiative is being spearheaded by Bob Tryanski, Douglas County director of behavioral health projects. “In addition to giving folks the opportunity to have the work experience in an environment where we need peer support, we would wrap around those peers with training, professional development, with coaching and support in an ongoing way,” Mr. Tryanski said, “so that they could become real, robust, huge resources, not just to the emergency department but in our community.” If approved, hiring and training of peers would begin in April, with the goal of having six people in place in emergency rooms by the summer and hiring an additional six people by year end. LJWorld.com.

Wavebreakmedia/iStock/Getty Images

The stigma tied to mental illness can be particularly difficult to overcome for people of Latin American descent, writes Concepción de León in El Espace, a column in the New York Times focused on news and culture relevant to Latinx communities. Sometimes those seeking help run into familiar mantras. “Let me know if any of these sound familiar: 'Boys don’t cry. We don’t air family business. You have to be strong. Turn to God.' These refrains (all of which I’ve heard at least once...) are just some of the responses that people dealing with mental health challenges in Latino communities have come to know well,” Ms. de León wrote. The unequal access to mental health services and health insurance that is a reality for some Latinos compounds the problem. The result is that mental illness can go untreated. Indeed, according to Ms. de León, Latinos, who are just as likely to suffer from a mental illness as non-Hispanic whites, are half as likely to seek treatment. Adriana Alejandre, a Latina who is a licensed marriage and family therapist in Los Angeles, is seeking to change that statistic. Through her podcast, Latinx Therapy, she seeks to spread the word that seeking therapy for mental illness is a positive step. There’s a long way to go, partly because Latino communities tend to value the group over the individual. “The downfall is that people suffer in silence,” said Ms. Alejandre. Therapy is important for some Latinos, according to Ms. Alejandre, because of intergenerational trauma that “allows the cycle to continue – whether it’s trauma, whether it’s depression, anxiety, domestic violence.” Ms. de León said one strategy she used for more than 1 year while she was in therapy was to set boundaries by not sharing what she was doing with family members. “It is tough when family sees you as ungrateful for healthy behaviors like boundary setting,” Ms. Alejandre said. “But the system will not change if someone does not initiate the change.” The New York Times.

Some state governments are seeking to make mental health services more available. The proposed budget of democratic Gov. Tony Evers of Wisconsin aims to allocate $22 million in mental health funding to school districts in the state to pay for social workers, psychologists, counselors, and nurses. The money would come on top of the $3 million designated by his predecessor and continues the efforts in Wisconsin to give children with mental health problems more access to needed help. The proposed budget also would add $7 million to a state program that works with local health agencies with the goal of providing mental health services for students and would allocate about $2.5 million annually for school staff training. The news is welcome to school districts across Wisconsin. “Schools are struggling to meet all of those [mental health] needs. I think there is an understanding that this is really something we need to be addressing,” said Joanne Juhnke, policy director at Wisconsin Family Ties, which helps families with children who have mental health challenges. Post Crescent, part of the USA Today network.

In Pennsylvania, the state Supreme Court is set to rule on whether those who provide mental health treatment to people addicted to illicit drugs can be free from prosecution. Right now, they are not. As reported in the Legal Intelligence, the case concerns two physicians at a drug addiction treatment facility who treated a man with an opioid addiction. In July 2018, a three-judge Superior Court panel upheld that physicians should not have liability protections under the Mental Health Procedures Act (MHPA). The ruling reversed a lower court decision. The Superior Court judges sympathized with the view that treatment of mental illness in drug treatment facilities be given more legal leeway. Whether that leeway remains in place depends on the Supreme Court. If judges decide no, physicians who recognize signs of mental illness in patients being treated for drug addiction would treat the illness at the risk of subsequent liability. The case has again raised the issue of whether alcoholism and drug dependency should be considered mental illnesses. “We don’t believe it was the intended purpose of the MPHA to include drug addiction. Our concern is we don’t want hospitals or rehab facilities just having patients be seen by psychiatrists in order to invoke the MHPA,” said Patrick Mintzer, the lawyer who will argue the cases before the court. A counter view came from Jack Panella, one of the three Superior Court judges. In his decision, he wrote: “In light of current scientific research, as well as the recent addition of ‘addiction disorders’ to the American Psychiatric Association’s Diagnostic and Statistical Manual–5, we suggest that the Department of Human Services revise this definition.” The Legal Intelligence.

An op-ed in the Des Moines Register applauds republican Gov. Kim Reynolds for introducing two bills that are aimed at expanding mental health services to children and family in Iowa. “After decades of discussion and growing public support, these two bills take a huge step toward establishing a children’s mental health system,” wrote guest columnists Erin Drinnin of the United Way of Central Iowa and Kim Scorza of Seasons Center for Behavioral Health. The two also serve as cochairs of the Coalition to Advance Mental Health in Iowa for Kids (CAMHI4Kids), which includes more than 50 organizations. “Just like building a house requires a sturdy foundation, these bills are an important first step toward creating a structure for children’s mental well-being. In particular, CAMHI4Kids appreciates that these bills establish a voice and a seat for children and families at a regional level, using a system that is already in place,” wrote Ms. Drinnin and Ms. Scorza. The legislation would spell out the core services that would be available regardless of location in Iowa. The services would be geared toward children, rather than adults, reflecting the different mental health needs of children. “These important steps would finally sew together a patchwork of care that families currently must navigate with little direction. If a child is hurt on the playground, a caregiver knows to follow a clear path of care to help that child recover. But for a caregiver who is concerned about a child’s mental health, they often don’t know where to turn for help and must seek out services that might not exist in their community,” wrote Ms. Drinnin and Ms. Scorza. In Iowa, 80,000 children have a diagnosed serious emotional disturbance. About half of children aged 14 years and older with mental illness drop out of high school, and 70% of youth in Iowa’s juvenile justice system have a mental illness. “We are proud that Iowa is working together in a bipartisan way to ensure that our kids have the best start for future success,” wrote Ms. Drinnin and Ms. Scorza. Des Moines Register.

Bill Reilly is the peer support program manager for Bert Nash Community Mental Health Center in Douglas County, Kan. His mental health troubles began in childhood and led to stints in alcohol rehabilitation and mental hospitals, and he tried to end his life several times. But Mr. Reilly now offers his experience to those in trouble. “Those [experiences] can be viewed as a negative until you turn that conversation around and ask, ‘How can this be helpful to another person?’ And to me, that’s where the urgency comes into the work that we’re doing because a clinical relationship is one thing, but a peer support relationship is something different.” He was speaking in support of an initiative that seeks to train and place peer support people in hospital emergency departments in Kansas. The initiative is being spearheaded by Bob Tryanski, Douglas County director of behavioral health projects. “In addition to giving folks the opportunity to have the work experience in an environment where we need peer support, we would wrap around those peers with training, professional development, with coaching and support in an ongoing way,” Mr. Tryanski said, “so that they could become real, robust, huge resources, not just to the emergency department but in our community.” If approved, hiring and training of peers would begin in April, with the goal of having six people in place in emergency rooms by the summer and hiring an additional six people by year end. LJWorld.com.

Wavebreakmedia/iStock/Getty Images

The stigma tied to mental illness can be particularly difficult to overcome for people of Latin American descent, writes Concepción de León in El Espace, a column in the New York Times focused on news and culture relevant to Latinx communities. Sometimes those seeking help run into familiar mantras. “Let me know if any of these sound familiar: 'Boys don’t cry. We don’t air family business. You have to be strong. Turn to God.' These refrains (all of which I’ve heard at least once...) are just some of the responses that people dealing with mental health challenges in Latino communities have come to know well,” Ms. de León wrote. The unequal access to mental health services and health insurance that is a reality for some Latinos compounds the problem. The result is that mental illness can go untreated. Indeed, according to Ms. de León, Latinos, who are just as likely to suffer from a mental illness as non-Hispanic whites, are half as likely to seek treatment. Adriana Alejandre, a Latina who is a licensed marriage and family therapist in Los Angeles, is seeking to change that statistic. Through her podcast, Latinx Therapy, she seeks to spread the word that seeking therapy for mental illness is a positive step. There’s a long way to go, partly because Latino communities tend to value the group over the individual. “The downfall is that people suffer in silence,” said Ms. Alejandre. Therapy is important for some Latinos, according to Ms. Alejandre, because of intergenerational trauma that “allows the cycle to continue – whether it’s trauma, whether it’s depression, anxiety, domestic violence.” Ms. de León said one strategy she used for more than 1 year while she was in therapy was to set boundaries by not sharing what she was doing with family members. “It is tough when family sees you as ungrateful for healthy behaviors like boundary setting,” Ms. Alejandre said. “But the system will not change if someone does not initiate the change.” The New York Times.

Some state governments are seeking to make mental health services more available. The proposed budget of democratic Gov. Tony Evers of Wisconsin aims to allocate $22 million in mental health funding to school districts in the state to pay for social workers, psychologists, counselors, and nurses. The money would come on top of the $3 million designated by his predecessor and continues the efforts in Wisconsin to give children with mental health problems more access to needed help. The proposed budget also would add $7 million to a state program that works with local health agencies with the goal of providing mental health services for students and would allocate about $2.5 million annually for school staff training. The news is welcome to school districts across Wisconsin. “Schools are struggling to meet all of those [mental health] needs. I think there is an understanding that this is really something we need to be addressing,” said Joanne Juhnke, policy director at Wisconsin Family Ties, which helps families with children who have mental health challenges. Post Crescent, part of the USA Today network.

In Pennsylvania, the state Supreme Court is set to rule on whether those who provide mental health treatment to people addicted to illicit drugs can be free from prosecution. Right now, they are not. As reported in the Legal Intelligence, the case concerns two physicians at a drug addiction treatment facility who treated a man with an opioid addiction. In July 2018, a three-judge Superior Court panel upheld that physicians should not have liability protections under the Mental Health Procedures Act (MHPA). The ruling reversed a lower court decision. The Superior Court judges sympathized with the view that treatment of mental illness in drug treatment facilities be given more legal leeway. Whether that leeway remains in place depends on the Supreme Court. If judges decide no, physicians who recognize signs of mental illness in patients being treated for drug addiction would treat the illness at the risk of subsequent liability. The case has again raised the issue of whether alcoholism and drug dependency should be considered mental illnesses. “We don’t believe it was the intended purpose of the MPHA to include drug addiction. Our concern is we don’t want hospitals or rehab facilities just having patients be seen by psychiatrists in order to invoke the MHPA,” said Patrick Mintzer, the lawyer who will argue the cases before the court. A counter view came from Jack Panella, one of the three Superior Court judges. In his decision, he wrote: “In light of current scientific research, as well as the recent addition of ‘addiction disorders’ to the American Psychiatric Association’s Diagnostic and Statistical Manual–5, we suggest that the Department of Human Services revise this definition.” The Legal Intelligence.

An op-ed in the Des Moines Register applauds republican Gov. Kim Reynolds for introducing two bills that are aimed at expanding mental health services to children and family in Iowa. “After decades of discussion and growing public support, these two bills take a huge step toward establishing a children’s mental health system,” wrote guest columnists Erin Drinnin of the United Way of Central Iowa and Kim Scorza of Seasons Center for Behavioral Health. The two also serve as cochairs of the Coalition to Advance Mental Health in Iowa for Kids (CAMHI4Kids), which includes more than 50 organizations. “Just like building a house requires a sturdy foundation, these bills are an important first step toward creating a structure for children’s mental well-being. In particular, CAMHI4Kids appreciates that these bills establish a voice and a seat for children and families at a regional level, using a system that is already in place,” wrote Ms. Drinnin and Ms. Scorza. The legislation would spell out the core services that would be available regardless of location in Iowa. The services would be geared toward children, rather than adults, reflecting the different mental health needs of children. “These important steps would finally sew together a patchwork of care that families currently must navigate with little direction. If a child is hurt on the playground, a caregiver knows to follow a clear path of care to help that child recover. But for a caregiver who is concerned about a child’s mental health, they often don’t know where to turn for help and must seek out services that might not exist in their community,” wrote Ms. Drinnin and Ms. Scorza. In Iowa, 80,000 children have a diagnosed serious emotional disturbance. About half of children aged 14 years and older with mental illness drop out of high school, and 70% of youth in Iowa’s juvenile justice system have a mental illness. “We are proud that Iowa is working together in a bipartisan way to ensure that our kids have the best start for future success,” wrote Ms. Drinnin and Ms. Scorza. Des Moines Register.

Bill Reilly is the peer support program manager for Bert Nash Community Mental Health Center in Douglas County, Kan. His mental health troubles began in childhood and led to stints in alcohol rehabilitation and mental hospitals, and he tried to end his life several times. But Mr. Reilly now offers his experience to those in trouble. “Those [experiences] can be viewed as a negative until you turn that conversation around and ask, ‘How can this be helpful to another person?’ And to me, that’s where the urgency comes into the work that we’re doing because a clinical relationship is one thing, but a peer support relationship is something different.” He was speaking in support of an initiative that seeks to train and place peer support people in hospital emergency departments in Kansas. The initiative is being spearheaded by Bob Tryanski, Douglas County director of behavioral health projects. “In addition to giving folks the opportunity to have the work experience in an environment where we need peer support, we would wrap around those peers with training, professional development, with coaching and support in an ongoing way,” Mr. Tryanski said, “so that they could become real, robust, huge resources, not just to the emergency department but in our community.” If approved, hiring and training of peers would begin in April, with the goal of having six people in place in emergency rooms by the summer and hiring an additional six people by year end. LJWorld.com.

It used to be difficult to conceive of writing about climate change in light of the illnesses we psychiatrists treat. But talking about climate change has become unavoidable. Sometimes, it seems that things weigh heavy on my heart, and I have to write about them – especially when it is serious.

David Alan Pollack, MD, has been talking about climate change for some years now, and while I understood his concern, I had yet to see the psychological effects up close and personal. After all, I live in Chicago, and we are surrounded by concrete and asphalt.

Thankfully, I also travel, and I get a chance to get into nature. While in Hawaii at the American College of Psychiatrists annual meeting in February, I went snorkeling in Hanauma Bay. I saw coral and fish. The problem is I have a very vivid memories of snorkeling in that exact same nature preserve, which also was a Marine Life Conservation District in 1972 while I was attending the American Psychiatric Association annual meeting.

The contrast between the two experiences leaves me with a glum, sad, disappointed, heart-broken feeling because it was an intimate and personal experience with climate change. In 1972, I saw every type of coral imaginable: brain coral, club finger coral, elk coral, great star coral, pillar coral, staghorn coral, table coral, and tube coral. If I remember correctly, there were corky sea fingers and sea fans, but not sea turtles. In 1972, I saw bigeyefish, damselfish, doctorfish, filefish, goatfish, gobies, hogfish, lemon butterflyfish, lizardfish, parrottfish, porcupinefish, pufferfish, queen angelfish, rock beauties, sergeant majors, soldierfish, spot-tail spot-tail butterflyfish, Spanish hogfish, squirrelfish, tangs, trunkfish, or any bluehead or yellowhead wrasses.

In 2019, I saw two pieces of coral less that 9 inches in diameter and not a single sea urchin. There were maybe three types of tropical fish that I was unfamiliar with seeing. The difference between what I saw in 1972 and what I saw in 2019 was like the difference between the rain forest in Puerto Rico and the dunes of the Sahara Desert.

Sure, I have heard David talk about the mental health effects of climate change on stress, anxiety, and depression, and I have always thought that he was right. But to see climate change up close and personal is a sobering experience. Lately, I have found myself apologizing to children I know. I apologize to them for being part of the system and process that is destroying the planet – and leaving them with a hot mess.

At this point, it seems to me that we cannot just try to save the planet by being better stewards of our garbage and pointing out measurable indicators of climate change. We need to actively rather than passively try to save the planet. Of course, the question is who will pay for the active efforts to depollute Earth. From what I saw for myself in Hanauma Bay, I don’t think we have much time. So I am hoping that more people will take the issue of climate change seriously.

Dr. Bell is a staff psychiatrist at Jackson Park Hospital’s Medical/Surgical-Psychiatry Inpatient Unit in Chicago, clinical psychiatrist emeritus in the department of psychiatry at the University of Illinois at Chicago, former president/CEO of Community Mental Health Council, and former director of the Institute for Juvenile Research (birthplace of child psychiatry), also in Chicago. Check out Dr. Bell’s new book, “Fetal Alcohol Exposure in the African-American Community,” at https://thirdworldpressfoundation.org/product/pre-order-fetal-alcohol-exposure-in-the-african-american-community/.
 

It used to be difficult to conceive of writing about climate change in light of the illnesses we psychiatrists treat. But talking about climate change has become unavoidable. Sometimes, it seems that things weigh heavy on my heart, and I have to write about them – especially when it is serious.

David Alan Pollack, MD, has been talking about climate change for some years now, and while I understood his concern, I had yet to see the psychological effects up close and personal. After all, I live in Chicago, and we are surrounded by concrete and asphalt.

Thankfully, I also travel, and I get a chance to get into nature. While in Hawaii at the American College of Psychiatrists annual meeting in February, I went snorkeling in Hanauma Bay. I saw coral and fish. The problem is I have a very vivid memories of snorkeling in that exact same nature preserve, which also was a Marine Life Conservation District in 1972 while I was attending the American Psychiatric Association annual meeting.

The contrast between the two experiences leaves me with a glum, sad, disappointed, heart-broken feeling because it was an intimate and personal experience with climate change. In 1972, I saw every type of coral imaginable: brain coral, club finger coral, elk coral, great star coral, pillar coral, staghorn coral, table coral, and tube coral. If I remember correctly, there were corky sea fingers and sea fans, but not sea turtles. In 1972, I saw bigeyefish, damselfish, doctorfish, filefish, goatfish, gobies, hogfish, lemon butterflyfish, lizardfish, parrottfish, porcupinefish, pufferfish, queen angelfish, rock beauties, sergeant majors, soldierfish, spot-tail spot-tail butterflyfish, Spanish hogfish, squirrelfish, tangs, trunkfish, or any bluehead or yellowhead wrasses.

In 2019, I saw two pieces of coral less that 9 inches in diameter and not a single sea urchin. There were maybe three types of tropical fish that I was unfamiliar with seeing. The difference between what I saw in 1972 and what I saw in 2019 was like the difference between the rain forest in Puerto Rico and the dunes of the Sahara Desert.

Sure, I have heard David talk about the mental health effects of climate change on stress, anxiety, and depression, and I have always thought that he was right. But to see climate change up close and personal is a sobering experience. Lately, I have found myself apologizing to children I know. I apologize to them for being part of the system and process that is destroying the planet – and leaving them with a hot mess.

At this point, it seems to me that we cannot just try to save the planet by being better stewards of our garbage and pointing out measurable indicators of climate change. We need to actively rather than passively try to save the planet. Of course, the question is who will pay for the active efforts to depollute Earth. From what I saw for myself in Hanauma Bay, I don’t think we have much time. So I am hoping that more people will take the issue of climate change seriously.

Dr. Bell is a staff psychiatrist at Jackson Park Hospital’s Medical/Surgical-Psychiatry Inpatient Unit in Chicago, clinical psychiatrist emeritus in the department of psychiatry at the University of Illinois at Chicago, former president/CEO of Community Mental Health Council, and former director of the Institute for Juvenile Research (birthplace of child psychiatry), also in Chicago. Check out Dr. Bell’s new book, “Fetal Alcohol Exposure in the African-American Community,” at https://thirdworldpressfoundation.org/product/pre-order-fetal-alcohol-exposure-in-the-african-american-community/.
 

It used to be difficult to conceive of writing about climate change in light of the illnesses we psychiatrists treat. But talking about climate change has become unavoidable. Sometimes, it seems that things weigh heavy on my heart, and I have to write about them – especially when it is serious.

David Alan Pollack, MD, has been talking about climate change for some years now, and while I understood his concern, I had yet to see the psychological effects up close and personal. After all, I live in Chicago, and we are surrounded by concrete and asphalt.

Thankfully, I also travel, and I get a chance to get into nature. While in Hawaii at the American College of Psychiatrists annual meeting in February, I went snorkeling in Hanauma Bay. I saw coral and fish. The problem is I have a very vivid memories of snorkeling in that exact same nature preserve, which also was a Marine Life Conservation District in 1972 while I was attending the American Psychiatric Association annual meeting.

The contrast between the two experiences leaves me with a glum, sad, disappointed, heart-broken feeling because it was an intimate and personal experience with climate change. In 1972, I saw every type of coral imaginable: brain coral, club finger coral, elk coral, great star coral, pillar coral, staghorn coral, table coral, and tube coral. If I remember correctly, there were corky sea fingers and sea fans, but not sea turtles. In 1972, I saw bigeyefish, damselfish, doctorfish, filefish, goatfish, gobies, hogfish, lemon butterflyfish, lizardfish, parrottfish, porcupinefish, pufferfish, queen angelfish, rock beauties, sergeant majors, soldierfish, spot-tail spot-tail butterflyfish, Spanish hogfish, squirrelfish, tangs, trunkfish, or any bluehead or yellowhead wrasses.

In 2019, I saw two pieces of coral less that 9 inches in diameter and not a single sea urchin. There were maybe three types of tropical fish that I was unfamiliar with seeing. The difference between what I saw in 1972 and what I saw in 2019 was like the difference between the rain forest in Puerto Rico and the dunes of the Sahara Desert.

Sure, I have heard David talk about the mental health effects of climate change on stress, anxiety, and depression, and I have always thought that he was right. But to see climate change up close and personal is a sobering experience. Lately, I have found myself apologizing to children I know. I apologize to them for being part of the system and process that is destroying the planet – and leaving them with a hot mess.

At this point, it seems to me that we cannot just try to save the planet by being better stewards of our garbage and pointing out measurable indicators of climate change. We need to actively rather than passively try to save the planet. Of course, the question is who will pay for the active efforts to depollute Earth. From what I saw for myself in Hanauma Bay, I don’t think we have much time. So I am hoping that more people will take the issue of climate change seriously.

Dr. Bell is a staff psychiatrist at Jackson Park Hospital’s Medical/Surgical-Psychiatry Inpatient Unit in Chicago, clinical psychiatrist emeritus in the department of psychiatry at the University of Illinois at Chicago, former president/CEO of Community Mental Health Council, and former director of the Institute for Juvenile Research (birthplace of child psychiatry), also in Chicago. Check out Dr. Bell’s new book, “Fetal Alcohol Exposure in the African-American Community,” at https://thirdworldpressfoundation.org/product/pre-order-fetal-alcohol-exposure-in-the-african-american-community/.
 

SAN FRANCISCO – Less than 4% of people who undergo drug-allergy testing are positive and need to avoid the drug in the future, but many patients who undergo drug-allergy testing and have a negative result cling to their allergic status and struggle with letting go.

Mitchel L. Zoler/MDedge News

New findings suggest that preexisting anxiety or depression plays a role in some people who refuse to believe a negative drug-allergy result, which suggests that these people may need a more tailored intervention to drug-allergy testing and its aftermath, including some type of behavioral intervention.

“Underlying anxiety and depression may reduce the effectiveness of negative drug-allergy evaluation and functional delabeling,” Christine Rukasin, MD, said while presenting a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “In the future, tailored drug-allergy evaluation, behavioral interventions, targeted follow-up communication, and patient education appear necessary to improve the sustained effectiveness of a negative drug-allergy and functional delabeling,” said Dr. Rukasin, an allergy immunology physician at Vanderbilt University in Nashville, Tenn.

The results showed that some people who undergo drug allergy testing “have a high anxiety state and don’t feel comfortable regardless of their test result,” she said in an interview. “This is not where one size fits all. We usually perform a single, oral drug challenge and then pronounce the person free of allergy if the result was negative. We need to better anticipate how effective a drug evaluation will be for someone; will they believe the result?” Individual patients, especially those with diagnosed anxiety or depression, may need multiple challenge tests, both oral and skin, before they believe a negative result, and they may also need referral to a behavioral health specialist, she said.

Dr. Rukasin and her associates ran their study with 100 people who underwent assessment at the Vanderbilt drug-allergy clinic and completed a set of questionnaires. The range of suspected drug allergies included 40% with a suspected reaction to penicillin, 22% to a sulfa-containing drug, 17% to a cephalosporin, 8% to another antibiotic, 7% to an NSAID, and the remainder to other drugs. The 100 participants included 57 people without diagnosed anxiety or depression, 31 diagnosed with anxiety, and 33 diagnosed with depression; some patients had diagnoses for both anxiety and depression.

The questionnaire results from before and after drug-allergy testing showed an apparent association between anxiety, depression, and a decreased willingness to believe the results of a negative drug-allergy test. For example, when posed with the prospect of finding out they were not allergic to the tested drug, 24% of the people with anxiety and 20% of those with depression said that they still would not take the medication if it were prescribed to them, compared with 7% of those without anxiety or depression who gave this response.

Many patients who come to the drug-allergy clinic are scared and worried. “We want to dig deeper, to better help these patients,” Dr. Rukasin said. This is the first reported study to evaluate anxiety in the setting of drug-allergy testing. Further insight into ways to improve the effectiveness of drug-allergy testing hopefully will come from additional analysis of the findings.

Dr. Rukasin had no relevant financial disclosures.

mzoler@mdedge.com

SOURCE: Rukasin C et al. J Allergy Clin Immunol. 2019 Feb;143(2):AB428.

SAN FRANCISCO – Less than 4% of people who undergo drug-allergy testing are positive and need to avoid the drug in the future, but many patients who undergo drug-allergy testing and have a negative result cling to their allergic status and struggle with letting go.

Mitchel L. Zoler/MDedge News

New findings suggest that preexisting anxiety or depression plays a role in some people who refuse to believe a negative drug-allergy result, which suggests that these people may need a more tailored intervention to drug-allergy testing and its aftermath, including some type of behavioral intervention.

“Underlying anxiety and depression may reduce the effectiveness of negative drug-allergy evaluation and functional delabeling,” Christine Rukasin, MD, said while presenting a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “In the future, tailored drug-allergy evaluation, behavioral interventions, targeted follow-up communication, and patient education appear necessary to improve the sustained effectiveness of a negative drug-allergy and functional delabeling,” said Dr. Rukasin, an allergy immunology physician at Vanderbilt University in Nashville, Tenn.

The results showed that some people who undergo drug allergy testing “have a high anxiety state and don’t feel comfortable regardless of their test result,” she said in an interview. “This is not where one size fits all. We usually perform a single, oral drug challenge and then pronounce the person free of allergy if the result was negative. We need to better anticipate how effective a drug evaluation will be for someone; will they believe the result?” Individual patients, especially those with diagnosed anxiety or depression, may need multiple challenge tests, both oral and skin, before they believe a negative result, and they may also need referral to a behavioral health specialist, she said.

Dr. Rukasin and her associates ran their study with 100 people who underwent assessment at the Vanderbilt drug-allergy clinic and completed a set of questionnaires. The range of suspected drug allergies included 40% with a suspected reaction to penicillin, 22% to a sulfa-containing drug, 17% to a cephalosporin, 8% to another antibiotic, 7% to an NSAID, and the remainder to other drugs. The 100 participants included 57 people without diagnosed anxiety or depression, 31 diagnosed with anxiety, and 33 diagnosed with depression; some patients had diagnoses for both anxiety and depression.

The questionnaire results from before and after drug-allergy testing showed an apparent association between anxiety, depression, and a decreased willingness to believe the results of a negative drug-allergy test. For example, when posed with the prospect of finding out they were not allergic to the tested drug, 24% of the people with anxiety and 20% of those with depression said that they still would not take the medication if it were prescribed to them, compared with 7% of those without anxiety or depression who gave this response.

Many patients who come to the drug-allergy clinic are scared and worried. “We want to dig deeper, to better help these patients,” Dr. Rukasin said. This is the first reported study to evaluate anxiety in the setting of drug-allergy testing. Further insight into ways to improve the effectiveness of drug-allergy testing hopefully will come from additional analysis of the findings.

Dr. Rukasin had no relevant financial disclosures.

mzoler@mdedge.com

SOURCE: Rukasin C et al. J Allergy Clin Immunol. 2019 Feb;143(2):AB428.

SAN FRANCISCO – Less than 4% of people who undergo drug-allergy testing are positive and need to avoid the drug in the future, but many patients who undergo drug-allergy testing and have a negative result cling to their allergic status and struggle with letting go.

Mitchel L. Zoler/MDedge News

New findings suggest that preexisting anxiety or depression plays a role in some people who refuse to believe a negative drug-allergy result, which suggests that these people may need a more tailored intervention to drug-allergy testing and its aftermath, including some type of behavioral intervention.

“Underlying anxiety and depression may reduce the effectiveness of negative drug-allergy evaluation and functional delabeling,” Christine Rukasin, MD, said while presenting a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “In the future, tailored drug-allergy evaluation, behavioral interventions, targeted follow-up communication, and patient education appear necessary to improve the sustained effectiveness of a negative drug-allergy and functional delabeling,” said Dr. Rukasin, an allergy immunology physician at Vanderbilt University in Nashville, Tenn.

The results showed that some people who undergo drug allergy testing “have a high anxiety state and don’t feel comfortable regardless of their test result,” she said in an interview. “This is not where one size fits all. We usually perform a single, oral drug challenge and then pronounce the person free of allergy if the result was negative. We need to better anticipate how effective a drug evaluation will be for someone; will they believe the result?” Individual patients, especially those with diagnosed anxiety or depression, may need multiple challenge tests, both oral and skin, before they believe a negative result, and they may also need referral to a behavioral health specialist, she said.

Dr. Rukasin and her associates ran their study with 100 people who underwent assessment at the Vanderbilt drug-allergy clinic and completed a set of questionnaires. The range of suspected drug allergies included 40% with a suspected reaction to penicillin, 22% to a sulfa-containing drug, 17% to a cephalosporin, 8% to another antibiotic, 7% to an NSAID, and the remainder to other drugs. The 100 participants included 57 people without diagnosed anxiety or depression, 31 diagnosed with anxiety, and 33 diagnosed with depression; some patients had diagnoses for both anxiety and depression.

The questionnaire results from before and after drug-allergy testing showed an apparent association between anxiety, depression, and a decreased willingness to believe the results of a negative drug-allergy test. For example, when posed with the prospect of finding out they were not allergic to the tested drug, 24% of the people with anxiety and 20% of those with depression said that they still would not take the medication if it were prescribed to them, compared with 7% of those without anxiety or depression who gave this response.

Many patients who come to the drug-allergy clinic are scared and worried. “We want to dig deeper, to better help these patients,” Dr. Rukasin said. This is the first reported study to evaluate anxiety in the setting of drug-allergy testing. Further insight into ways to improve the effectiveness of drug-allergy testing hopefully will come from additional analysis of the findings.

Dr. Rukasin had no relevant financial disclosures.

mzoler@mdedge.com

SOURCE: Rukasin C et al. J Allergy Clin Immunol. 2019 Feb;143(2):AB428.

Police officers often are criticized for the way they respond to people with serious mental illness. What happens when officers find themselves struggling with mental disorders? A police department in Florida is addressing this issue by hiring a licensed clinical psychologist and making her available to officers on a 24/7 basis, an ABC-TV affiliate reported. “The goal is they come in, they work on what they need to; we get them right, we get them good so that they can go back out and do what they need to do – and then they check in as needed,” Brandy Benson, PsyD, said in the report. The meetings take place in her office and not the police station, which allows officers to maintain confidentiality. Each officer is allotted a set number of free sessions for each issue that is fueling their distress. Issues can range from depression to anxiety to marital problems. The aim is prevention – not reaction to whatever has happened. Getting at the root cause can prevent spillover on the job, which in turn, can prove disastrous for officers, the people they serve, and their families. “It’s okay to go through those emotions, but you don’t want to tie those emotions up because sooner or later it’s going to pop and we want to make sure we address that issue before it goes ‘pop,’ ” said St. Petersburg Police Chief Anthony Holloway. WFTS-TV, Tampa Bay, Fla.

Antonprado/iStock.com

Two women have embarked on their self-described “joy tour” to raise awareness about suicide prevention. Shontice McKenzie and Cedrica Mitchell are on the road with the intention of visiting every state, according to an article on thefix.com, a website that focuses on addiction and recovery. The tour is the brainchild of Ms. McKenzie and is funded by her nonprofit H.U.M.A.N.I.T.Y. 360. During their month-long extended stops in Virginia, North Carolina, South Carolina, Georgia, Florida, and a just-completed stay in Alabama, the women are speaking and providing positive outlets to those in turmoil and contemplating suicide, thefix reported, based on a post on al.com. The choice of Alabama as one of the first stops on the planned nationwide tour was deliberate. The suicide rate in the state has been higher than the national average for nearly 3 decades – 16.2/100,000, compared with 13.9/100,000 nationally. Suicide is the second-leading cause of death of those aged 10-14 years in Alabama. Ms. McKenzie and Ms. Mitchell want to see the stigma surrounding mental illness removed. “We have met so many families who are still in denial about a family member who completed the act of suicide because they don’t want the backlash from the public,” Ms. McKenzie said. “They should have received more support around the topic. Then we can prevent suicides. That’s what the Joy Tour is about.” The end of each state visit includes what the two call a “joy jam” – a free event where people can eat, get information on mental health resources in their area, and learn how to incorporate mental health care into their everyday lives. The tour is slated to wrap up in 2023 in Hawaii. Thefix.com.

An editorial in the Winston-Salem (N.C.) Journal has backed a recently introduced bill in the state legislature that would open the door for mental health screenings for public school students. “This legislation is a worthwhile step in tackling the problem of school shootings as well as other problems that can arise among our children. It should work well in conjunction with other efforts, such as increased school security and gun-law reform,” the paper’s editorial board wrote. The bill would trigger a study by the North Carolina Department of Health and Human Services to come up with a screening system that would identify school children at risk of harming themselves or others. The idea is that all students would be screened initially. “We have nothing that determines if a child has a mental health concern ... to the point they could be contemplating harming themselves or others,” said state Rep. John Torbett, the bill’s main sponsor. “This bill would bring smart people together for determining the appropriate criteria.” One of the bill’s cosponsors, Rep. Debra Forsyth, said school counselors tell her that most of their time is spent dealing with students with emotional and mental issues. “When we were studying the impact of [math and reading standards] a few years back, many parents complained about emotional stress in very young children, so issues can obviously arise at an early age,” Ms. Forsyth said in the article. “Our children are facing pressures from all sides – increased testing, peer pressure, and economic difficulties. They’re not receiving the best resources we could provide. It’s about time they received a helping hand.” Winston-Salem Journal.

A mental health facility has opened in southeast Fresno, Calif., that seeks to provide a bridge for people experiencing a mental health crisis and need a place to live, according to a report by ABC affiliate KFSN. The $5 million, 12,000-square-foot, 16-bed facility is an alternative to hospitalization, said Gerardo Puga-Cervantes, an administrator at the facility. “A facility like this creates a stepping-stone that’s closer to the ones before and after, so when a person is making that pathway toward recovery, it’s not a Grand Canyon they have to leap to get that recovery. It’s really a clear pathway,” said Fresno County Behavioral Health Director Dawan Utecht. The facility, called the Fresno Crisis Residential Treatment Center, will provide psychiatric support to residents and will aim to serve hundreds of people each year. To get into the center, patients must be referred by the county’s behavioral health department. Next, the department hopes to provide residential housing for those who leave the facility. ABC30 Action News/KFSN-TV.

val_shep/Thinkstock

A former dairy farm reincarnated as a school called Green Chimneys in Putnam County, N.Y., is helping children with special needs find solace, the New York Times reported. Aside from usual pigs and goats, the farm’s denizens include more exotic critters, such as camels, an emu, peacocks, miniature horses and donkeys, owls, falcons, and a condor. “Green Chimneys’ approach focuses on an awareness of how trauma impacts human and animal lives, that a healing setting can benefit both, and that there is a broader parallel between human, animal, environmental, and societal well-being,” according to the school’s website. The article describes the experience of 8-year-old Xander DeLeon, who was diagnosed with attention-deficit/hyperactivity disorder and dyslexia, and experienced rages and absences while attending a charter school in Manhattan. Now he is pulling down As and Bs. “The school staff tell him that he won’t be able to work on the farm if he doesn’t continue to do well in school,” said Leslie DeLeon, Xander’s mother. The philosophy is that caring for animals can be a means to confidence and social skills for emotionally challenged children. The day and residential facility now has two campuses in Brewster and Carmel, N.Y., more than 240 students, and about the same number of animals. “There has been a lot of research on pets at home and how healthy it is in the past 10 years,” said Steven Klee, PhD, director of clinical and medical services at Green Chimneys. Yet, as he first became aware of the use of animal intervention for special-needs children, even he was skeptical. “When you have traditional training as a psychologist, you never think about doing anything outside of the office,” Dr. Klee said. But Dr. Klee was converted. “Animals in a sense are purer, more consistent, more accepting. You are kind to the animals; they show their appreciation.” New York Times.

Police officers often are criticized for the way they respond to people with serious mental illness. What happens when officers find themselves struggling with mental disorders? A police department in Florida is addressing this issue by hiring a licensed clinical psychologist and making her available to officers on a 24/7 basis, an ABC-TV affiliate reported. “The goal is they come in, they work on what they need to; we get them right, we get them good so that they can go back out and do what they need to do – and then they check in as needed,” Brandy Benson, PsyD, said in the report. The meetings take place in her office and not the police station, which allows officers to maintain confidentiality. Each officer is allotted a set number of free sessions for each issue that is fueling their distress. Issues can range from depression to anxiety to marital problems. The aim is prevention – not reaction to whatever has happened. Getting at the root cause can prevent spillover on the job, which in turn, can prove disastrous for officers, the people they serve, and their families. “It’s okay to go through those emotions, but you don’t want to tie those emotions up because sooner or later it’s going to pop and we want to make sure we address that issue before it goes ‘pop,’ ” said St. Petersburg Police Chief Anthony Holloway. WFTS-TV, Tampa Bay, Fla.

Antonprado/iStock.com

Two women have embarked on their self-described “joy tour” to raise awareness about suicide prevention. Shontice McKenzie and Cedrica Mitchell are on the road with the intention of visiting every state, according to an article on thefix.com, a website that focuses on addiction and recovery. The tour is the brainchild of Ms. McKenzie and is funded by her nonprofit H.U.M.A.N.I.T.Y. 360. During their month-long extended stops in Virginia, North Carolina, South Carolina, Georgia, Florida, and a just-completed stay in Alabama, the women are speaking and providing positive outlets to those in turmoil and contemplating suicide, thefix reported, based on a post on al.com. The choice of Alabama as one of the first stops on the planned nationwide tour was deliberate. The suicide rate in the state has been higher than the national average for nearly 3 decades – 16.2/100,000, compared with 13.9/100,000 nationally. Suicide is the second-leading cause of death of those aged 10-14 years in Alabama. Ms. McKenzie and Ms. Mitchell want to see the stigma surrounding mental illness removed. “We have met so many families who are still in denial about a family member who completed the act of suicide because they don’t want the backlash from the public,” Ms. McKenzie said. “They should have received more support around the topic. Then we can prevent suicides. That’s what the Joy Tour is about.” The end of each state visit includes what the two call a “joy jam” – a free event where people can eat, get information on mental health resources in their area, and learn how to incorporate mental health care into their everyday lives. The tour is slated to wrap up in 2023 in Hawaii. Thefix.com.

An editorial in the Winston-Salem (N.C.) Journal has backed a recently introduced bill in the state legislature that would open the door for mental health screenings for public school students. “This legislation is a worthwhile step in tackling the problem of school shootings as well as other problems that can arise among our children. It should work well in conjunction with other efforts, such as increased school security and gun-law reform,” the paper’s editorial board wrote. The bill would trigger a study by the North Carolina Department of Health and Human Services to come up with a screening system that would identify school children at risk of harming themselves or others. The idea is that all students would be screened initially. “We have nothing that determines if a child has a mental health concern ... to the point they could be contemplating harming themselves or others,” said state Rep. John Torbett, the bill’s main sponsor. “This bill would bring smart people together for determining the appropriate criteria.” One of the bill’s cosponsors, Rep. Debra Forsyth, said school counselors tell her that most of their time is spent dealing with students with emotional and mental issues. “When we were studying the impact of [math and reading standards] a few years back, many parents complained about emotional stress in very young children, so issues can obviously arise at an early age,” Ms. Forsyth said in the article. “Our children are facing pressures from all sides – increased testing, peer pressure, and economic difficulties. They’re not receiving the best resources we could provide. It’s about time they received a helping hand.” Winston-Salem Journal.

A mental health facility has opened in southeast Fresno, Calif., that seeks to provide a bridge for people experiencing a mental health crisis and need a place to live, according to a report by ABC affiliate KFSN. The $5 million, 12,000-square-foot, 16-bed facility is an alternative to hospitalization, said Gerardo Puga-Cervantes, an administrator at the facility. “A facility like this creates a stepping-stone that’s closer to the ones before and after, so when a person is making that pathway toward recovery, it’s not a Grand Canyon they have to leap to get that recovery. It’s really a clear pathway,” said Fresno County Behavioral Health Director Dawan Utecht. The facility, called the Fresno Crisis Residential Treatment Center, will provide psychiatric support to residents and will aim to serve hundreds of people each year. To get into the center, patients must be referred by the county’s behavioral health department. Next, the department hopes to provide residential housing for those who leave the facility. ABC30 Action News/KFSN-TV.

val_shep/Thinkstock

A former dairy farm reincarnated as a school called Green Chimneys in Putnam County, N.Y., is helping children with special needs find solace, the New York Times reported. Aside from usual pigs and goats, the farm’s denizens include more exotic critters, such as camels, an emu, peacocks, miniature horses and donkeys, owls, falcons, and a condor. “Green Chimneys’ approach focuses on an awareness of how trauma impacts human and animal lives, that a healing setting can benefit both, and that there is a broader parallel between human, animal, environmental, and societal well-being,” according to the school’s website. The article describes the experience of 8-year-old Xander DeLeon, who was diagnosed with attention-deficit/hyperactivity disorder and dyslexia, and experienced rages and absences while attending a charter school in Manhattan. Now he is pulling down As and Bs. “The school staff tell him that he won’t be able to work on the farm if he doesn’t continue to do well in school,” said Leslie DeLeon, Xander’s mother. The philosophy is that caring for animals can be a means to confidence and social skills for emotionally challenged children. The day and residential facility now has two campuses in Brewster and Carmel, N.Y., more than 240 students, and about the same number of animals. “There has been a lot of research on pets at home and how healthy it is in the past 10 years,” said Steven Klee, PhD, director of clinical and medical services at Green Chimneys. Yet, as he first became aware of the use of animal intervention for special-needs children, even he was skeptical. “When you have traditional training as a psychologist, you never think about doing anything outside of the office,” Dr. Klee said. But Dr. Klee was converted. “Animals in a sense are purer, more consistent, more accepting. You are kind to the animals; they show their appreciation.” New York Times.

Police officers often are criticized for the way they respond to people with serious mental illness. What happens when officers find themselves struggling with mental disorders? A police department in Florida is addressing this issue by hiring a licensed clinical psychologist and making her available to officers on a 24/7 basis, an ABC-TV affiliate reported. “The goal is they come in, they work on what they need to; we get them right, we get them good so that they can go back out and do what they need to do – and then they check in as needed,” Brandy Benson, PsyD, said in the report. The meetings take place in her office and not the police station, which allows officers to maintain confidentiality. Each officer is allotted a set number of free sessions for each issue that is fueling their distress. Issues can range from depression to anxiety to marital problems. The aim is prevention – not reaction to whatever has happened. Getting at the root cause can prevent spillover on the job, which in turn, can prove disastrous for officers, the people they serve, and their families. “It’s okay to go through those emotions, but you don’t want to tie those emotions up because sooner or later it’s going to pop and we want to make sure we address that issue before it goes ‘pop,’ ” said St. Petersburg Police Chief Anthony Holloway. WFTS-TV, Tampa Bay, Fla.

Antonprado/iStock.com

Two women have embarked on their self-described “joy tour” to raise awareness about suicide prevention. Shontice McKenzie and Cedrica Mitchell are on the road with the intention of visiting every state, according to an article on thefix.com, a website that focuses on addiction and recovery. The tour is the brainchild of Ms. McKenzie and is funded by her nonprofit H.U.M.A.N.I.T.Y. 360. During their month-long extended stops in Virginia, North Carolina, South Carolina, Georgia, Florida, and a just-completed stay in Alabama, the women are speaking and providing positive outlets to those in turmoil and contemplating suicide, thefix reported, based on a post on al.com. The choice of Alabama as one of the first stops on the planned nationwide tour was deliberate. The suicide rate in the state has been higher than the national average for nearly 3 decades – 16.2/100,000, compared with 13.9/100,000 nationally. Suicide is the second-leading cause of death of those aged 10-14 years in Alabama. Ms. McKenzie and Ms. Mitchell want to see the stigma surrounding mental illness removed. “We have met so many families who are still in denial about a family member who completed the act of suicide because they don’t want the backlash from the public,” Ms. McKenzie said. “They should have received more support around the topic. Then we can prevent suicides. That’s what the Joy Tour is about.” The end of each state visit includes what the two call a “joy jam” – a free event where people can eat, get information on mental health resources in their area, and learn how to incorporate mental health care into their everyday lives. The tour is slated to wrap up in 2023 in Hawaii. Thefix.com.

An editorial in the Winston-Salem (N.C.) Journal has backed a recently introduced bill in the state legislature that would open the door for mental health screenings for public school students. “This legislation is a worthwhile step in tackling the problem of school shootings as well as other problems that can arise among our children. It should work well in conjunction with other efforts, such as increased school security and gun-law reform,” the paper’s editorial board wrote. The bill would trigger a study by the North Carolina Department of Health and Human Services to come up with a screening system that would identify school children at risk of harming themselves or others. The idea is that all students would be screened initially. “We have nothing that determines if a child has a mental health concern ... to the point they could be contemplating harming themselves or others,” said state Rep. John Torbett, the bill’s main sponsor. “This bill would bring smart people together for determining the appropriate criteria.” One of the bill’s cosponsors, Rep. Debra Forsyth, said school counselors tell her that most of their time is spent dealing with students with emotional and mental issues. “When we were studying the impact of [math and reading standards] a few years back, many parents complained about emotional stress in very young children, so issues can obviously arise at an early age,” Ms. Forsyth said in the article. “Our children are facing pressures from all sides – increased testing, peer pressure, and economic difficulties. They’re not receiving the best resources we could provide. It’s about time they received a helping hand.” Winston-Salem Journal.

A mental health facility has opened in southeast Fresno, Calif., that seeks to provide a bridge for people experiencing a mental health crisis and need a place to live, according to a report by ABC affiliate KFSN. The $5 million, 12,000-square-foot, 16-bed facility is an alternative to hospitalization, said Gerardo Puga-Cervantes, an administrator at the facility. “A facility like this creates a stepping-stone that’s closer to the ones before and after, so when a person is making that pathway toward recovery, it’s not a Grand Canyon they have to leap to get that recovery. It’s really a clear pathway,” said Fresno County Behavioral Health Director Dawan Utecht. The facility, called the Fresno Crisis Residential Treatment Center, will provide psychiatric support to residents and will aim to serve hundreds of people each year. To get into the center, patients must be referred by the county’s behavioral health department. Next, the department hopes to provide residential housing for those who leave the facility. ABC30 Action News/KFSN-TV.

val_shep/Thinkstock

A former dairy farm reincarnated as a school called Green Chimneys in Putnam County, N.Y., is helping children with special needs find solace, the New York Times reported. Aside from usual pigs and goats, the farm’s denizens include more exotic critters, such as camels, an emu, peacocks, miniature horses and donkeys, owls, falcons, and a condor. “Green Chimneys’ approach focuses on an awareness of how trauma impacts human and animal lives, that a healing setting can benefit both, and that there is a broader parallel between human, animal, environmental, and societal well-being,” according to the school’s website. The article describes the experience of 8-year-old Xander DeLeon, who was diagnosed with attention-deficit/hyperactivity disorder and dyslexia, and experienced rages and absences while attending a charter school in Manhattan. Now he is pulling down As and Bs. “The school staff tell him that he won’t be able to work on the farm if he doesn’t continue to do well in school,” said Leslie DeLeon, Xander’s mother. The philosophy is that caring for animals can be a means to confidence and social skills for emotionally challenged children. The day and residential facility now has two campuses in Brewster and Carmel, N.Y., more than 240 students, and about the same number of animals. “There has been a lot of research on pets at home and how healthy it is in the past 10 years,” said Steven Klee, PhD, director of clinical and medical services at Green Chimneys. Yet, as he first became aware of the use of animal intervention for special-needs children, even he was skeptical. “When you have traditional training as a psychologist, you never think about doing anything outside of the office,” Dr. Klee said. But Dr. Klee was converted. “Animals in a sense are purer, more consistent, more accepting. You are kind to the animals; they show their appreciation.” New York Times.

Benzodiazepines are one of the most commonly prescribed medication classes worldwide.¹ Patients prescribed benzodiazepines who have no history of abuse or misuse may want to reduce or discontinue using these agents for various reasons, including adverse effects or wanting to reduce the number of medications they take. In this article, we offer strategies for creating an individualized taper plan, and describe additional nonpharmacologic interventions to help ensure that the taper is successful.

Formulating a taper plan

There is no gold-standard algorithm for tapering benzodiazepines.^1,2 Even with a carefully designed plan, tapering can be challenging because approximately one-third of patients will experience difficulties such as withdrawal symptoms.¹ Prior to creating a plan, carefully assess the patient’s history, including the type of benzodiazepine prescribed (short- or long-acting); the dose, dosing frequency, and duration of use; comorbid medical and psychiatric conditions; any previous experience with withdrawal symptoms; and psychosocial factors (eg, lifestyle and personality). Consider whether the patient can be safely tapered in an outpatient setting or will require hospitalization. Tapering designed to take place over several weeks or months tends to be more successful; however, patient-specific circumstances play a role in determining the duration of the taper.^1,2

For the greatest chance of success, a benzodiazepine should not be reduced faster than 25% of the total daily dose per week.¹ Consider which of the following pharmacologic approaches to benzodiazepine tapering might work best for your patient:

• Reduce the daily dose by one-eighth to one-tenth every 1 to 2 weeks over a 2- to 12-month period for patients with a physiological dependence.¹
• Reduce the benzodiazepine dose by 10% to 25% every 2 weeks over a 4- to 8-week period.²
• Some guidelines have suggested converting the prescribed benzodiazepine to an equivalent dose of diazepam because of its long half-life, and then reducing the diazepam dose by one-eighth every 2 weeks.³

There is uncertainty in the medical literature about using a long-acting benzodiazepine to taper off a short-acting benzodiazepine, although this practice is generally clinically accepted.^1,2 Similarly, there is no definitive evidence that supports using adjuvant medications to facilitate tapering.^1,2

Nonpharmacologic interventions

Patients are more likely to have a successful taper if nonpharmacologic interventions are part of a comprehensive treatment plan.¹

To help your patients through the challenges of a benzodiazepine taper:

• Validate their concerns, reassure them that you will support them throughout the taper, and provide information on additional resources for support.
• Provide education about the process of tapering and symptoms of withdrawal.
• Recommend therapies, such as cognitive-behavioral therapy or motivational interventions, that develop or enhance coping skills.
• Enlist the help of the patient’s family and friends for support and encouragement.

Despite some clinicians’ trepidation, 70% to 90% of patients can be successfully tapered off benzodiazepines by using an individualized approach that includes tailored tapering and nonpharmacologic interventions that provide benefits that persist after the patient completes the taper.¹

Benzodiazepines are one of the most commonly prescribed medication classes worldwide.¹ Patients prescribed benzodiazepines who have no history of abuse or misuse may want to reduce or discontinue using these agents for various reasons, including adverse effects or wanting to reduce the number of medications they take. In this article, we offer strategies for creating an individualized taper plan, and describe additional nonpharmacologic interventions to help ensure that the taper is successful.

Formulating a taper plan

There is no gold-standard algorithm for tapering benzodiazepines.^1,2 Even with a carefully designed plan, tapering can be challenging because approximately one-third of patients will experience difficulties such as withdrawal symptoms.¹ Prior to creating a plan, carefully assess the patient’s history, including the type of benzodiazepine prescribed (short- or long-acting); the dose, dosing frequency, and duration of use; comorbid medical and psychiatric conditions; any previous experience with withdrawal symptoms; and psychosocial factors (eg, lifestyle and personality). Consider whether the patient can be safely tapered in an outpatient setting or will require hospitalization. Tapering designed to take place over several weeks or months tends to be more successful; however, patient-specific circumstances play a role in determining the duration of the taper.^1,2

For the greatest chance of success, a benzodiazepine should not be reduced faster than 25% of the total daily dose per week.¹ Consider which of the following pharmacologic approaches to benzodiazepine tapering might work best for your patient:

• Reduce the daily dose by one-eighth to one-tenth every 1 to 2 weeks over a 2- to 12-month period for patients with a physiological dependence.¹
• Reduce the benzodiazepine dose by 10% to 25% every 2 weeks over a 4- to 8-week period.²
• Some guidelines have suggested converting the prescribed benzodiazepine to an equivalent dose of diazepam because of its long half-life, and then reducing the diazepam dose by one-eighth every 2 weeks.³

There is uncertainty in the medical literature about using a long-acting benzodiazepine to taper off a short-acting benzodiazepine, although this practice is generally clinically accepted.^1,2 Similarly, there is no definitive evidence that supports using adjuvant medications to facilitate tapering.^1,2

Nonpharmacologic interventions

Patients are more likely to have a successful taper if nonpharmacologic interventions are part of a comprehensive treatment plan.¹

To help your patients through the challenges of a benzodiazepine taper:

• Validate their concerns, reassure them that you will support them throughout the taper, and provide information on additional resources for support.
• Provide education about the process of tapering and symptoms of withdrawal.
• Recommend therapies, such as cognitive-behavioral therapy or motivational interventions, that develop or enhance coping skills.
• Enlist the help of the patient’s family and friends for support and encouragement.

Despite some clinicians’ trepidation, 70% to 90% of patients can be successfully tapered off benzodiazepines by using an individualized approach that includes tailored tapering and nonpharmacologic interventions that provide benefits that persist after the patient completes the taper.¹

Benzodiazepines are one of the most commonly prescribed medication classes worldwide.¹ Patients prescribed benzodiazepines who have no history of abuse or misuse may want to reduce or discontinue using these agents for various reasons, including adverse effects or wanting to reduce the number of medications they take. In this article, we offer strategies for creating an individualized taper plan, and describe additional nonpharmacologic interventions to help ensure that the taper is successful.

Formulating a taper plan

There is no gold-standard algorithm for tapering benzodiazepines.^1,2 Even with a carefully designed plan, tapering can be challenging because approximately one-third of patients will experience difficulties such as withdrawal symptoms.¹ Prior to creating a plan, carefully assess the patient’s history, including the type of benzodiazepine prescribed (short- or long-acting); the dose, dosing frequency, and duration of use; comorbid medical and psychiatric conditions; any previous experience with withdrawal symptoms; and psychosocial factors (eg, lifestyle and personality). Consider whether the patient can be safely tapered in an outpatient setting or will require hospitalization. Tapering designed to take place over several weeks or months tends to be more successful; however, patient-specific circumstances play a role in determining the duration of the taper.^1,2

For the greatest chance of success, a benzodiazepine should not be reduced faster than 25% of the total daily dose per week.¹ Consider which of the following pharmacologic approaches to benzodiazepine tapering might work best for your patient:

• Reduce the daily dose by one-eighth to one-tenth every 1 to 2 weeks over a 2- to 12-month period for patients with a physiological dependence.¹
• Reduce the benzodiazepine dose by 10% to 25% every 2 weeks over a 4- to 8-week period.²
• Some guidelines have suggested converting the prescribed benzodiazepine to an equivalent dose of diazepam because of its long half-life, and then reducing the diazepam dose by one-eighth every 2 weeks.³

There is uncertainty in the medical literature about using a long-acting benzodiazepine to taper off a short-acting benzodiazepine, although this practice is generally clinically accepted.^1,2 Similarly, there is no definitive evidence that supports using adjuvant medications to facilitate tapering.^1,2

Nonpharmacologic interventions

Patients are more likely to have a successful taper if nonpharmacologic interventions are part of a comprehensive treatment plan.¹

To help your patients through the challenges of a benzodiazepine taper:

• Validate their concerns, reassure them that you will support them throughout the taper, and provide information on additional resources for support.
• Provide education about the process of tapering and symptoms of withdrawal.
• Recommend therapies, such as cognitive-behavioral therapy or motivational interventions, that develop or enhance coping skills.
• Enlist the help of the patient’s family and friends for support and encouragement.

Despite some clinicians’ trepidation, 70% to 90% of patients can be successfully tapered off benzodiazepines by using an individualized approach that includes tailored tapering and nonpharmacologic interventions that provide benefits that persist after the patient completes the taper.¹

LAS VEGAS – The way Robert Hudak, MD, sees it, the terms excessive anxiety and anxiety disorders are not interchangeable – and do not mean the same thing.

“People with anxiety disorders have excessive anxiety, but not everyone with excessive anxiety has a psychiatric disorder,” he said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “Any anxiety above baseline can be normal. It’s not necessarily pathological. I think that’s an important point that’s easy to overlook when we’re in clinical practice, and it affects how we approach our patients.”

Anxiety can present in a variety of ways in different individuals. Panic attacks are often the primary chief complaint, and it’s common to hear complaints from family that the person is routinely seeking reassurance. In addition, tics and twitches are not unusual in people with anxiety disorder. “Some of that is brought out by anxiety itself,” said Dr. Hudak, who is a psychiatrist at the University of Pittsburgh. Sleep disturbances or other somatic complaints also are common. “They complain of racing thoughts, increased energy, and depression,” he added. “When someone complains about depression, don’t assume they have a mood disorder. The reason people with anxiety disorders complain about depression is that it really feels awful. Anxiety is incredibly dysphoric.” Physical complaints include shortness of breath, GI distress, dizziness, vague somatic complaints, and skin or gum lesions.

He went on to note that individuals with excessive anxiety virtually never lose consciousness. “The exception is blood/injection/injury phobia,” he said. “That’s the only case in which anxiety will cause loss of consciousness. It happens in virtually no other setting. Ondine’s curse while falling asleep is another symptom that only occurs with anxiety. It’s a sensation that you have to remember to breathe, and breathing is no longer automatic. There are medical conditions that cause Ondine’s curse. However, the patient who complains of Ondine’s curse as they’re falling asleep is pathognomonic for anxiety.”

Dr. Hudak said panic attacks, a discrete period of fear or discomfort, rarely last more than 30 minutes.

“I view panic attacks in three flavors,” he said. “Some people have the cardiovascular flavor with shortness of breath and heart palpitations. Some have what I call the neurological flavor, where the predominant symptoms seem to be dizziness and tingling. Other people have GI flavor, with gut pain, nausea, and diarrhea. Panic attacks are not a psychiatric disorder. It’s a qualifier for any psychiatric disorder.”

Social anxiety disorder, meanwhile, presents as two completely distinct and separate illnesses that have nothing in common with each other.

“The performance subtype of social anxiety really presents like a simple phobia,” Dr. Hudak said. “The treatment for that is really behavioral therapy and cognitive-behavioral therapy, and rarely the use of medications. The generalized type presents with intrusive, [obsessive-compulsive disorder]–like thoughts. Affected individuals describe themselves as ‘paranoid’ or feeling that they are being scrutinized. The categorical versus dimensional diagnosis is being debated.” Individuals with generalized anxiety disorder, on the other hand, have excessive and pervasive worry and anxiety present more days than not for a 6-month period. “The individual finds it difficult to control the worry,” he said. Somatic symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and insomnia. Different studies show the prevalence rate between 3% and 8%, affecting more women than men.

The medical work-up for excessive anxiety should consist of history and physical exam, complete blood count, the Chem-7 metabolic test, thyroid-stimulating hormone, and EKG if indicated. Both medications and behavioral therapy are used in the treatment of anxiety disorders. Many patients require both in order to achieve maximum treatment response. “Often, people with less severe illnesses can be managed with therapy alone,” Dr. Hudak said.

“In more severe cases, medications can help reduce symptoms to the point where therapy is easier to perform. The bottom line here is that at no time should you treat someone with an anxiety disorder with medications alone. Behavioral therapy is at least as effective as medications, and perhaps more so.”

Many trials of anxiety medications are of short duration and therefore lack evidence of long-term improvement, he said. Commonly used scales often include nonspecific items such as arousal score that can be reduced by sedating medications without improving the actual disorder. If someone has excessive anxiety that is not part of a primary anxiety disorder, Dr. Hudak typically prescribes benzodiazepines. “If someone is anxious because a loved one died, or if they’re nervous about their wedding day, or about taking a board exam, benzos can be used,” he said. “For someone who has an anxiety disorder, I virtually never use benzodiazepines. I generally use medications in the antidepressant category. I probably initiate fewer than five benzodiazepine prescriptions per year for anxiety disorder. There is also data to suggest that using benzodiazepines in patients with anxiety disorder may make cognitive-behavioral therapy more difficult.”

According to Dr. Hudak, selective serotonin reuptake inhibitors seem to have the largest evidence base in panic disorder and are first-line pharmacotherapy for both panic disorder and generalized anxiety disorder, while tricyclic antidepressants (TCAs) usually are considered a second-line therapy. “There is good data behind MAO inhibitors, and there is increasingly good data behind [selective norepinephrine reuptake inhibitors],” he said. “If someone has failed a trial of SSRIs, you may consider trying an SNRI before a TCA. However, I would try multiple SSRIs before ruling out that class of medications. I have had people fail five SSRIs and respond dramatically to the sixth SSRI.”

Dr. Hudak disclosed that he receives royalties from the Cambridge University Press.

dbrunk@mdedge.com

LAS VEGAS – The way Robert Hudak, MD, sees it, the terms excessive anxiety and anxiety disorders are not interchangeable – and do not mean the same thing.

“People with anxiety disorders have excessive anxiety, but not everyone with excessive anxiety has a psychiatric disorder,” he said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “Any anxiety above baseline can be normal. It’s not necessarily pathological. I think that’s an important point that’s easy to overlook when we’re in clinical practice, and it affects how we approach our patients.”

Anxiety can present in a variety of ways in different individuals. Panic attacks are often the primary chief complaint, and it’s common to hear complaints from family that the person is routinely seeking reassurance. In addition, tics and twitches are not unusual in people with anxiety disorder. “Some of that is brought out by anxiety itself,” said Dr. Hudak, who is a psychiatrist at the University of Pittsburgh. Sleep disturbances or other somatic complaints also are common. “They complain of racing thoughts, increased energy, and depression,” he added. “When someone complains about depression, don’t assume they have a mood disorder. The reason people with anxiety disorders complain about depression is that it really feels awful. Anxiety is incredibly dysphoric.” Physical complaints include shortness of breath, GI distress, dizziness, vague somatic complaints, and skin or gum lesions.

He went on to note that individuals with excessive anxiety virtually never lose consciousness. “The exception is blood/injection/injury phobia,” he said. “That’s the only case in which anxiety will cause loss of consciousness. It happens in virtually no other setting. Ondine’s curse while falling asleep is another symptom that only occurs with anxiety. It’s a sensation that you have to remember to breathe, and breathing is no longer automatic. There are medical conditions that cause Ondine’s curse. However, the patient who complains of Ondine’s curse as they’re falling asleep is pathognomonic for anxiety.”

Dr. Hudak said panic attacks, a discrete period of fear or discomfort, rarely last more than 30 minutes.

“I view panic attacks in three flavors,” he said. “Some people have the cardiovascular flavor with shortness of breath and heart palpitations. Some have what I call the neurological flavor, where the predominant symptoms seem to be dizziness and tingling. Other people have GI flavor, with gut pain, nausea, and diarrhea. Panic attacks are not a psychiatric disorder. It’s a qualifier for any psychiatric disorder.”

Social anxiety disorder, meanwhile, presents as two completely distinct and separate illnesses that have nothing in common with each other.

“The performance subtype of social anxiety really presents like a simple phobia,” Dr. Hudak said. “The treatment for that is really behavioral therapy and cognitive-behavioral therapy, and rarely the use of medications. The generalized type presents with intrusive, [obsessive-compulsive disorder]–like thoughts. Affected individuals describe themselves as ‘paranoid’ or feeling that they are being scrutinized. The categorical versus dimensional diagnosis is being debated.” Individuals with generalized anxiety disorder, on the other hand, have excessive and pervasive worry and anxiety present more days than not for a 6-month period. “The individual finds it difficult to control the worry,” he said. Somatic symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and insomnia. Different studies show the prevalence rate between 3% and 8%, affecting more women than men.

The medical work-up for excessive anxiety should consist of history and physical exam, complete blood count, the Chem-7 metabolic test, thyroid-stimulating hormone, and EKG if indicated. Both medications and behavioral therapy are used in the treatment of anxiety disorders. Many patients require both in order to achieve maximum treatment response. “Often, people with less severe illnesses can be managed with therapy alone,” Dr. Hudak said.

“In more severe cases, medications can help reduce symptoms to the point where therapy is easier to perform. The bottom line here is that at no time should you treat someone with an anxiety disorder with medications alone. Behavioral therapy is at least as effective as medications, and perhaps more so.”

Many trials of anxiety medications are of short duration and therefore lack evidence of long-term improvement, he said. Commonly used scales often include nonspecific items such as arousal score that can be reduced by sedating medications without improving the actual disorder. If someone has excessive anxiety that is not part of a primary anxiety disorder, Dr. Hudak typically prescribes benzodiazepines. “If someone is anxious because a loved one died, or if they’re nervous about their wedding day, or about taking a board exam, benzos can be used,” he said. “For someone who has an anxiety disorder, I virtually never use benzodiazepines. I generally use medications in the antidepressant category. I probably initiate fewer than five benzodiazepine prescriptions per year for anxiety disorder. There is also data to suggest that using benzodiazepines in patients with anxiety disorder may make cognitive-behavioral therapy more difficult.”

According to Dr. Hudak, selective serotonin reuptake inhibitors seem to have the largest evidence base in panic disorder and are first-line pharmacotherapy for both panic disorder and generalized anxiety disorder, while tricyclic antidepressants (TCAs) usually are considered a second-line therapy. “There is good data behind MAO inhibitors, and there is increasingly good data behind [selective norepinephrine reuptake inhibitors],” he said. “If someone has failed a trial of SSRIs, you may consider trying an SNRI before a TCA. However, I would try multiple SSRIs before ruling out that class of medications. I have had people fail five SSRIs and respond dramatically to the sixth SSRI.”

Dr. Hudak disclosed that he receives royalties from the Cambridge University Press.

dbrunk@mdedge.com

LAS VEGAS – The way Robert Hudak, MD, sees it, the terms excessive anxiety and anxiety disorders are not interchangeable – and do not mean the same thing.

“People with anxiety disorders have excessive anxiety, but not everyone with excessive anxiety has a psychiatric disorder,” he said at an annual psychopharmacology update held by the Nevada Psychiatric Association. “Any anxiety above baseline can be normal. It’s not necessarily pathological. I think that’s an important point that’s easy to overlook when we’re in clinical practice, and it affects how we approach our patients.”

Anxiety can present in a variety of ways in different individuals. Panic attacks are often the primary chief complaint, and it’s common to hear complaints from family that the person is routinely seeking reassurance. In addition, tics and twitches are not unusual in people with anxiety disorder. “Some of that is brought out by anxiety itself,” said Dr. Hudak, who is a psychiatrist at the University of Pittsburgh. Sleep disturbances or other somatic complaints also are common. “They complain of racing thoughts, increased energy, and depression,” he added. “When someone complains about depression, don’t assume they have a mood disorder. The reason people with anxiety disorders complain about depression is that it really feels awful. Anxiety is incredibly dysphoric.” Physical complaints include shortness of breath, GI distress, dizziness, vague somatic complaints, and skin or gum lesions.

He went on to note that individuals with excessive anxiety virtually never lose consciousness. “The exception is blood/injection/injury phobia,” he said. “That’s the only case in which anxiety will cause loss of consciousness. It happens in virtually no other setting. Ondine’s curse while falling asleep is another symptom that only occurs with anxiety. It’s a sensation that you have to remember to breathe, and breathing is no longer automatic. There are medical conditions that cause Ondine’s curse. However, the patient who complains of Ondine’s curse as they’re falling asleep is pathognomonic for anxiety.”

Dr. Hudak said panic attacks, a discrete period of fear or discomfort, rarely last more than 30 minutes.

“I view panic attacks in three flavors,” he said. “Some people have the cardiovascular flavor with shortness of breath and heart palpitations. Some have what I call the neurological flavor, where the predominant symptoms seem to be dizziness and tingling. Other people have GI flavor, with gut pain, nausea, and diarrhea. Panic attacks are not a psychiatric disorder. It’s a qualifier for any psychiatric disorder.”

Social anxiety disorder, meanwhile, presents as two completely distinct and separate illnesses that have nothing in common with each other.

“The performance subtype of social anxiety really presents like a simple phobia,” Dr. Hudak said. “The treatment for that is really behavioral therapy and cognitive-behavioral therapy, and rarely the use of medications. The generalized type presents with intrusive, [obsessive-compulsive disorder]–like thoughts. Affected individuals describe themselves as ‘paranoid’ or feeling that they are being scrutinized. The categorical versus dimensional diagnosis is being debated.” Individuals with generalized anxiety disorder, on the other hand, have excessive and pervasive worry and anxiety present more days than not for a 6-month period. “The individual finds it difficult to control the worry,” he said. Somatic symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and insomnia. Different studies show the prevalence rate between 3% and 8%, affecting more women than men.

The medical work-up for excessive anxiety should consist of history and physical exam, complete blood count, the Chem-7 metabolic test, thyroid-stimulating hormone, and EKG if indicated. Both medications and behavioral therapy are used in the treatment of anxiety disorders. Many patients require both in order to achieve maximum treatment response. “Often, people with less severe illnesses can be managed with therapy alone,” Dr. Hudak said.

“In more severe cases, medications can help reduce symptoms to the point where therapy is easier to perform. The bottom line here is that at no time should you treat someone with an anxiety disorder with medications alone. Behavioral therapy is at least as effective as medications, and perhaps more so.”

Many trials of anxiety medications are of short duration and therefore lack evidence of long-term improvement, he said. Commonly used scales often include nonspecific items such as arousal score that can be reduced by sedating medications without improving the actual disorder. If someone has excessive anxiety that is not part of a primary anxiety disorder, Dr. Hudak typically prescribes benzodiazepines. “If someone is anxious because a loved one died, or if they’re nervous about their wedding day, or about taking a board exam, benzos can be used,” he said. “For someone who has an anxiety disorder, I virtually never use benzodiazepines. I generally use medications in the antidepressant category. I probably initiate fewer than five benzodiazepine prescriptions per year for anxiety disorder. There is also data to suggest that using benzodiazepines in patients with anxiety disorder may make cognitive-behavioral therapy more difficult.”

According to Dr. Hudak, selective serotonin reuptake inhibitors seem to have the largest evidence base in panic disorder and are first-line pharmacotherapy for both panic disorder and generalized anxiety disorder, while tricyclic antidepressants (TCAs) usually are considered a second-line therapy. “There is good data behind MAO inhibitors, and there is increasingly good data behind [selective norepinephrine reuptake inhibitors],” he said. “If someone has failed a trial of SSRIs, you may consider trying an SNRI before a TCA. However, I would try multiple SSRIs before ruling out that class of medications. I have had people fail five SSRIs and respond dramatically to the sixth SSRI.”

Dr. Hudak disclosed that he receives royalties from the Cambridge University Press.

dbrunk@mdedge.com