Marks Psychiatry

Are you someone’s knight in shinning armor rescuing damsels in distress?  This can be an exhilarating feeling for some men who are attracted to women who need their help.  It feels good to be needed and in general there is nothing wrong with wanting to help others.  However, the kind of help delivered by the knight, is typically one that which requires personal sacrifice of some sort.  It’s difficult to sustain this type of “help” and what can happen is overtime the knight  becomes worn down and the armor starts to disappear.  A partner who was attracted to you for your ability to rescue, may not be as pleased when she sees what’s underneath the armor.  Then what?   The knight is left to deal with the needy, flailing damsel unshielded, and the true dynamics of the relationship is revealed.

The flip side of this is that the damsel is led to believe you will always be there to take care of things and can feel disappointed or even misled when you step away from your role.  She’s not completely to blame, after all, this is how you marketed yourself to her.

People can fall into this pattern for different reasons, however one way to explore your own reason is to ask yourself “what do I have to offer someone?”  Is the answer to that financial security or other resources versus just you?  What makes you valuable?  Some people believe they don’t have much to offer someone so they compensate by doing things or giving things.
 
When considering the connectedness between yourself and someone else, I think one good question to answer would be “If she and I were the last two people left on the earth, could we be content with just each other?”

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This term has become a popular on the internet lately with the recent murder of Jessie Davis, the pregnant woman from Canton, OH who was found dead after a massive search.  Her boyfriend, Bobby Cutts is the prime suspect.  I saw an interview on a morning news program where an FBI profiler said men who murder pregnant women are psychopaths.  They discussed Mark Hackett who killed his pregnant wife Lauri in Salt Lake City, UT and Scott Peterson who murdered Lacey and their unborn son.

The profiler went on to say that these men are psychopaths because they only care about themselves and have little concern for the victims.  She went on further to explain that a common reason they kill is because when their significant other gets pregnant, it stirs up emotions that may make them realize they made a mistake and they need to erase their mistake.  So to get out their situation, they kill. 

The news program played an excerpt of an interview with Bobby Cutts (Jessie Davis’ accused killer) where he told a local newspaper that he “can’t sleep, can’t eat”.  The profiler used this as an example of how he, just like the other psychopaths only think about themselves.

Although I agree psychopaths have very little feeling for others, I thought it was a bit simplistic to use Cutt’s interview to show that he was only thinking of himself.  If his girlfriend is missing and he’s upset by it, what’s he supposed to say?  In fact, if he told reporters he was eating and sleeping fine and not that worried, he actually would look more like a psychopath.

Psychopathy is a term synonymous with sociopathy that describes a person’s attitude toward others.  Robert Hare, Phd. from Canada has studied psychopathy extensively and designed a checklist of characteristics used to diagnose psychopathy.  These characteristics include:
• glibness
• shallow emotions
• lack of remorse or empathy
• manipulation of others
• lying
• egocentricity
• low frustration tolerance
• few and shallow relationships
• parasitic lifestyle
• persistent violation of social norms

I used the picture of Hannibal Lecter because he is a good media example of how these individuals can be very charming and intelligent, but cold and cunning. For more information, you can read one of Dr. Hare’s many books – the one listed below “Snakes in Suits,” is one of several choices.

DISCLAIMER: The views expressed by this author do not neccessarily reflect my views. I reference this book as a source of more information (among many sources) for those interested in the subject as the author has extensive knowledge and experience working in this area.

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WalMart’s SEO Lee Scott has developed his own solution to healthcare reform with the arrival of RediClinic inside Walmart Store.  Now you can shop and have your bronchitis treated all in one trip 7 days a week.  The service is designed to reach the uninsured as their services are low cost.  For example, a visit for an active condition (as opposed to well-check or routine physical) is $59.  They will often have coupons on their Website for $10 off.  Labwork is also inexpensive.

Unfortunately, they do not provide mental health services and I guess I shouldn’t be surprised as mental health care is often seen as a non-standard part of health care.  Another reason for this is the clinic is staffed by nurse practitioners with doctors available for backup.  Nurse practitioners trained in general medicine usually have little exposure to psychiatry.  But I would have thought they would have some services available for uncomplicated mood disorders such as depression and anxiety since these disorders are often being treated by primary care physicians.

Perhaps they may expand their services to include mental health checks.  But for now, they have begun to offer some benefit in the mental health arena by including a number of psychiatric medications in their $4 prescription drug plan.  For those who don’t know about this, you can take your prescription for certain medications to Walmart and get a one month’s supply for $4.  Target has a similar plan.  Check out Walmart $4 Drugs or Target $4 Drugs for a complete list, however just a few of the andtidepressants included are generic Prozac, Paxil, Trazadone, Celexa and Elavil.

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I did a double take when I saw this tiny article about Breastfeeding and Post-Traumatic Stress Disorder (PTSD). Some investigators at Boston University studied a group of children whose average ages were 13. The 102 children were hospitalized at two different hospitals in Boston for traumatic injuries including burns, motor vehicle accidents, gunshot wounds and assaults. About half of all of the children had been breastfed as infants.

They tested the children for PTSD using the Child PTSD Reaction Index which is a PTSD assessment scale for children. The children who had been breastfed scored in the mild range for PTSD, whereas the children who had not been breastfed scored in the moderate range.

Currently we know that breastfeeding has a positive impact on mental health, but there isn’t much research data on the specifics of the benefits. This study gives us something specific, but we can’t consider these findings to be definite just yet given the small number of people in the study. Also a study like this would need to be replicated by others who get the same results. But, despite the shortcomings of these findings, it is positive result and could have tremendous implications in the role of breastfeeding on an individual’s future mental health.

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Dr. Joris C. Verster at University of Utrecht in the Netherlands conducted a study and discovered that Ritalin significantly improved the driving skills of patients with Attention Deficit Hyperactivity Disorder (ADHD). They used a pool of 18 people ages 21-30 and compared their driving skills on and off of their medication. Off medication, they were able to maintain a steady speed, but they weaved more. The weaving was even more pronounced during the latter part of their trip.

This finding was not surprising because ADHD causes problems with sustained attention, or sticking to a task for a sustained period. The driving test in this study took 1 hour so the patients off their medication had more trouble staying focused on the road and not being distracted by things on the side of the road.

I’m not sure how the weaving (also called standard deviation from lateral position in the study) was measured. That is, are we talking weaving like a driver under the influence, or minor deviations from the center of the lane? I doubt that skipping medication means automatic driving into oncoming traffic, but these findings do illustrate the importance of knowing one’s limitations if you have ADHD.

I’m frequently asked if someone will have to remain on medication for ADHD forever. I tell some people that usually over time the impact of attention problems lessen in adulthood. Many people have attendtion deficit problems, but learn to adapt by staying away from activities or responsibilities that stress their attention capacity. So in this example of driving, rather than concluding that a person with ADHD is a dangerous driver off medication, one could say that the same person should not be considered the anchor driver for a long road trip.

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A study lead by Dr. Karen H. Seal of University of California, San Francisco found that 25% of the 100,000 veterans returning from Iraq and Afghanistan as of November 2005 were diagnosed with a mental disorder. This study was published in the Archives of Internal Medicine (2007:167 pp 476-82). The most common diagnosis was Post-Traumatic Stress Disorder (PTSD) which accounted for more than half of the veterans.

Of the roughly 25,000 vets diagnosed with a mental disorder, 44% had one diagnosis, 29% had two and 27% had three or more. Younger veterans ages 18-24 were found to be at higher risk of being diagnosed with a mental disorder. It was suggested this group was at higher risk because they were likely to be of lower rank and have more combat exposure.

These are disturbing statistics. Unfortunately the publication of research is often way behind real time as you can see with this article that was published in March 2007 and includes veterans returning home as of November 2005. Who knows what that number has grown to today, 18 months later? It is especially concerning that there are thousands with three or more mental disorders.

It is not uncommon for someone to have more than one diagnosis, as some disorders can beget others. PTSD and depression would be a good example. PTSD is an anxiety disorder that alone does not produce depressive symptoms. But individuals can subsequently develop depression or have had pre-existing depression and thus end up with two separate diagnoses if they later develop an anxiety disorder such as PTSD.

The study concluded by emphasizing the need for early screening and intervention to prevent these veterans from developing chronic mental illnesses, especially the younger population of veterans.

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The FDA issued a warning about buying medication online. The agency tested several medications including Ambien, Xanax, Lexapro and Ativan and determined they were contaminated with the drug Haldol. Haldol is an antipsychotic medication that can cause a number of side effects, but most notably muscle stiffness or other movement disorders.

In fact, the FDA statement noted instances of people who received emergency care for symptoms such as muscle stiffness and trouble breathing after taking the medication they bought online.

If you have purchased medication online, you can compare your pills to photos provided by the FDA at their site FDA Drug Warning Photos. According to the FDA, the packages were postmarked from Greece, but they still have been unable to determine their origin.

In March, the FDA recalled a dietary supplement that could be purchased over the internet because it was found to contain Cialis - the medication to help with erectile dysfunction.

What the take away message? Be very cautios when purchasing medications online. Most legitimate operations will require a prescription and have a pharmacist available for questions. Visit the FDA Buying Guide for more information.

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In April 2007, The US Supreme Court overturned the death sentences of three Texas men convicted of murder. Their sentences were thrown out by a 5-4 decision because it was the court’s opinion that the juries were not able to consider relevant information about their mental histories that could have been used to lessen their sentences.

One of the cases was Brewer vs. Quarterman (05-11287) see Brewer V Quarterman for details about the case. In short, in 1990 Brent Brewer stabbed a man to death during the course of a robbery in Amarillo, TX. He was found guilty of the murder, but during the sentencing phase wanted the jury to consider his history of being physically abused as a child and of him having a substance abuse problem.

The jury was not allowed to use this information to determine the severity of his sentence, but the prosecutor used the information to suggest that Mr. Brewer was a risk of future dangerousness. The court ruled that the prior judges were in error by not letting the jury consider this information as mitigating evidence (evidence that could lighten his sentence). As a result, Mr. Brewer was sentenced to death.

This ruling could affect the approximately 40 Texas inmates awaiting execution.

As a forensic psychiatrist, I’ve performed evaluations on inmates in similar situations, usually for the purpose of determining whether or not they have a mental illness that could have affected their behavior or made them unable to understand that what they were doing was wrong. Sometimes if the defendant’s legal team did not think the mental problem rose to the level of making them no longer responsible for their actions, they may still have a psychiatrist evaluate the extent of their problems so that a jury can consider this during the sentencing phase.

Juries have a high calling. They essentially exact justice by deciding people’s fate. As a psychiatrist, I’m asked specific questions about whether or not a mental disorder exists and what affect it has on the defendant’s behavior. Although this takes skill, I still consider the difficult decisions to lie with the jurors. What do you think of someone who has abused drugs who says have mercy on me for killing someone? Or, do you think someone who has been abused as a child should have a lighter sentence if they kill someone? These are hard questions that involve moral reasoning as opposed to purely clinical or legal reasoning.

In the case of Mr. Brewer, the trial judge relieved the jury of having to answer the questions I just posed by not allowing the information to be heard. The Supreme Court said this was an error and he now can either be retried by Texas or have his sentence converted to life.

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