Marks Psychiatry

Stuttering affects 1% of children before puberty and decreases to 0.8% in adolescence (source Diagnostic and Statistical Manual of Mental Disorders).  It can be very debilitating for some leading to years of shame and embarrassment.  In 98% of cases the onset of stuttering is before age 10 and research estimates are less specific about recovery estimating 20-80% recover by age 16.  Currently the treatments for stuttering involve behavioral interventions such as speech therapy or a stuttering device.

Until now, there has not been a specific cause that could be attributed to stuttering.  Eun Chang PhD presented new information at the 2007 Annual meeting for the Society for Neuroscience showing that children who stutter have a specific lesion (abnormality) in an area of the brain that connects speech planning and comprehension.  This abnormality can be seen on MRI brain imaging.

I see this finding as very hopeful as it now gives us a focus of attention for developing new treatments for stuttering in lieu of speech therapy or a stuttering device.  As I previously mentioned, many cases of stuttering resolve, however for those that don’t, the consequences can be life-altering.  For example, some adults who continue to stutter can develop social phobia.  Perhaps more on this in a future post…

Popularity: 14%

Postpartum depression hurts mom and the entire family.  Some epidemiologic studies have revealed that postpartum depression can have the following negative consequences:

• increases the chance of alcohol and illicit drug use in teenaged mothers
• adversely affects temperament and cognitive development in the infant
• increase the negative interactions with their toddlers and preschoolers

There are other negative consequences that impact other close relationships, such as the relationship with a spouse/significant other or friends.

In addition to seeking treatment from a health provider, support groups can be an invaluable resource. 

Postpartum Support International has many resources including local support groups.

Another resource is Depression After Delivery which is more of an information resource.

Popularity: 25%

Our relationship with our parents, particularly the opposite sex parent, significantly influences how we choose our companions. It’s commonly said that women marry their fathers and men marry their mothers. There is a lot of truth to this.

When a person has a bad experience with their parent such as emotional absence or constant criticism, they can consciously say they do not want to be with someone who treats them the same way and set out to find the opposite person. However at an unconsciously level they can be attracted to those very same characteristics.

Why would this be? Why would someone purposely choose to be with someone whose behavior they loath?

Well, first of all it’s not purposeful; it’s beyond the person’s awareness. Let use an example. This person is fictitious, yet similar to many people I have seen.

Sam has been engaged to Sally for a year. They have put the wedding on hold because of continual problems, most recently the knowledge that Sam has been unfaithful. Sam has been seeing Rachel on the side for the past 9 months. Sam says he loves Sally and had no intention of getting involved with Rachel but “it just happened.” In fact, he said he was about to break it off with Rachel just before Sally found out.

Sam said he finds Rachel exciting, but describes her as a superficial “gold digger.” She also criticizes him and he frequently has to “put her in her place.” On the other hand, Sally is kind, self-reliant, attentive and frequently praises him.

Months pass and Sam is still involved with Rachel – despite his frustration with her and despite his not wanting to lose Sally.

As for family background, Sam describes his relationship with his father as somewhat distant as his father traveled frequently with his job. He describes his mother as controlling, critical and pretentious. He said “she uses people to get what she wants, even her own children.”

Can you see the similarities? Rachel is mom; however Sam would have never thought he’d want a woman like his mother. He recognized that Rachel behaved in similar ways, but couldn’t understand why he was so attracted to her despite the irritating things she did.

What was wrong with Sally? Nothing. Sam could never find a negative thing to say about Sally – except their relationship lacked the excitement that he had with Rachel.

This isn’t the answer for everyone, but for Sam, he was attracted to Rachel because despite her objectionable behavior, this is what he was used to. Rachel’s behavior was familiar to him. Sally’s was not. So although he hated her criticism and superficiality, it’s what he knows best as he experienced it from his first female love.

Sometimes we can repeat relationship dynamics, particularly ones that were injurious as an attempt to now conquer and overcome the injury as an adult. In Sam’s case, as a child he could not control how his mother treated him and was not able to stand up for himself. Instead, as children do, he endured the pain and continued to strive for mom’s love. In contrast, with Rachel he is able to fight back and “put her in her place.” There’s a certain gratification he gets from mastering this dynamic.

It turns out, Sam has had several Rachel’s in his past. Sally has been the first of her kind. It’s going to be difficult for Sam to get out of this cycle because his attraction to the familiar makes it hard for him to be attracted to women like Sally. Sam admits he finds Sally boring. With help, Sam learned to let go of his need to undo his earlier insults by repeating the relationships so he could focus his energy and attention on embracing the right person for him and enjoying the unfamiliar.

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Postpartum depression is defined as depression that develops within the first four weeks after childbirth and occurs in about 10% of women. Postpartum depression statistics have shown the following risk factors:

• a history of a mood disorder
• unwanted pregnancy
• unemployment of the mother
• lack of breast-feeding
• the mother as head of the household (source: Journal of Clinical Psychiatry)

Regarding other postpartum depression statistics, women who have had depression in the past have a 24% chance of developing postpartum depression. Depression during pregnancy increases the chances of developing postpartum depression to 35%.

Depression that develops for the first time during pregnancy is more likely to become bipolar disorder later on. Likewise, postpartum psychosis is usually a manisfestation of preexisting bipolar disorder.

Postpartum psychosis occurs infrequently in about 0.1-0.2% of women.

Popularity: 26%

I saw an advertisement in one of the psychiatry news journals with the capture line “Broken Promises.”  It was an advertisement for ADHD (attention deficit hyperactivity disorder) medication.  The ad went on to state “Adults with ADHD were nearly 2x more likely to have been divorced.”  That got my attention.  Of course, I wanted to know where they got the information. 

It was based on an article published in the Journal of Clinical Psychiatry in 2006 entitled “Functional Impairments in Adults with Self-reports of Diagnosed ADHD: A Controlled Study of 1001 Adults in the Community.”

Functional impairment is what we use to determine the significance of one’s symptoms and the need for medical intervention.  With any disorder, an individual can have some symptoms - but how much of a problem is it causing?  There are many adults with attentional problems who compensate by the job they choose or by putting in extra hours, creating To Do lists, etc.  Then there are those who have functional impairments such as threat of losing a job because they can’t keep up or serious relationship problems.  These individuals are the ones who often seek medical help for their problems.

This study surveyed 500 men and women who said they were diagnosed with ADHD and 500 who had not been diagnosed with ADHD.  The results were as follows - Adults with ADHD were found to have the following:

• less likely to have graduated high school or have a college degree
• less likely to be employed
• more likely to have been arrested - by a factor of 2
• more likely to have been divorced - by a factor of 2
• less likely to be satisfied with their family, social and professional lives

Notice the greatest differences when compared to the control group was the greater chance of divorce and arrests.  Not sure what this means clinically, but it’s an interesting finding none the less.  Keep in mind all studies have flaws and results have to be interpreted cautiously.  The drug advertiser didn’t mention the arrest statistic, probably because it would be considered too inflamatory and defeat the purpose of marketing their product.

Nonetheless, these results do emphasize the significance of Adult ADHD and how it can seriously impact one’s life.

Popularity: 17%