Marks Psychiatry

Dr. Ravi Dhingra and colleagues out of Harvard recently analyzed data from the Framingham Heart Study and found that people who drank at least one 12 ounce soda each day had a 44% increased risk of developing metabolic syndrome. The soda could be regular or diet and caffeinated or decaf. This suggests that it’s not just caloric intake that results in the metabolic syndrome.

What is metabolic syndrome and why is it relevant to psychiatry? In simple terms, Metabolic syndrome is seen as a precursor (condition that comes first) to developing type II diabetes. Mood stabilizing agents used in psychiatry such as Zyprexa, Geodon, Abilify, Seroquel and Risperdal all increase an individual’s risk of developing metabolic syndrome. These drugs can be very important in treating people with bipolar disorder and schizophrenia. We sometimes use it for other purposes such as difficult to treat depression. Many people will take Seroquel for sleep. But we now have to carefully monitor patients taking these drugs for the development of metabolic syndrome and weigh the risks/benefits of prescribing these medications.

Metabolic syndrome is defined by having three or more factors:

1. Waist circumference greater than 35 inches for women and 40 inches for men;
2. Fasting blood sugar of 100 mg/dL or taking insulin;
3. Blood pressure of 135/75 mm/Hg or taking blood pressure medication;
4. Serum triglyceride levels of 150 mg/dL;
5. HDL cholesterol less than 50 mg/dL for women and 40 mg/dL for men.

Why is the soda consumption important? I thought it is significant that even diet sodas are linked to metabolic syndrome. Often people think they are protected from weight gain issues if they consume caffeine free, diet drinks and will consume them in large quantities. This is important information for anyone maintaining healthy eating habits. But those taking any of the mood stabilizing agents mentioned above, it is especially important to be cautious about soda consumption so as not to multiply one’s risk of developing metabolic syndrome.

Popularity: 94%

Clinically, health care providers consider heavy drinking to be more than 2 drinks a day totaling 14 or more drinks per week. But what is a drink? In general one drink is one 5oz glass of wine 1oz of liquor or 12oz of beer. Heavy alcohol use can have serious health consequences.

Let’s look at Larry

Larry comes to see me because he has been depressed and wants to take medication. As usual, I get new patient bloodwork and see that Larry has elevated liver enzymes indicating liver inflammation. When I see this, I usually think alcohol or overuse of Tylenol products.

When I first saw Larry he told me he drank 1-2 glasses of wine with dinner. With further questioning, he admits that he consistently drinks 2 glasses of wine each night. When I ask for details, he tells me his “glass” is a 10oz beverage glass that his wife calls his chalice.

So Larry was really having the equivalent of 4 drinks a night. Larry did not want to switch to a smaller glass as he felt the use of his special glass was part of his evening ritual. He reluctantly cut back to one glass that he filled to the lip, then he slurped down to a level that allowed him to pick it up without spilling. Clearly Larry is trying to maximize his one glass, but at least it’s one.

Larry was also concerned about a chronic cough he’d had for months and was afraid it was cancer. I suggested he see his internist for a medical work up.

Months later…
Larry’s liver enzymes return to normal. His chronic cough turned out to be a combination of gastric reflux and allergies. He was told to reduce his alcohol intake to help with the reflux. He cut back by filling the chalice to ¾ full and skipping a night here and there. After several weeks his cough nearly diminished.

Larry does not refer to a specific person, but real situations I have seen many times. He illustrates how people can unknowingly consume heavy quantities of alcohol putting themselves at risk to develop medical problems.

Popularity: 36%

A survey out of the University of Chicago conducted by Dr. Stacy Lindau found that one third of individuals aged 64-75 are having sex at least once a week. This survey was administered to 3005 older people who were divided into 3 groups of roughly one thousand each. The three age groups were 57-64, 65-74 and 74-85.

In the younger group (57-65) 40% of the men and 34% of the men reported having sex once a week or more. But a very interesting finding was seen in the oldest group (75-85). In this group, 23% of the men and 24% of the women reported having sex at least once a week. This percentage was similar to what they saw in a different survey of 18-59 year olds. Imagine that. Some of the oldest seniors reported having sex as frequently as some 18 year olds! Go Seniors.

Of course sexual problems were common, usually related to physical problems. They discovered only 48% of the men and 34% of the women with sexual problems had ever discussed their sexual problem with their doctor.

I think the common perception is that the elderly are not at all sexually active so many physicians may not think to ask their elderly patients about their sex lives. If nothing else, this study shows that the elderly are not to be forgotten in this area. And as 50 becomes the new 30, sexual activity in older adults will continue to be real entity.

Popularity: 37%

I saw a flyer advertising Life Coaching at a local medical center. The flyer said that Life Coaching promoted change and you could expect the your life to be changed by adding “zest” to your life, look at things from a different perspective, create action plans and be more creative.

I read that and thought, those are pretty big promises how could anyone pass that up?

I often feel as though I am doing life coaching with patients who do not have serious mental disorders but are simply seeing me for life issues. It has taken me a while to depart from my more rigid, psychoanalytic stance that I learned in my residency training to a stance that allows me to give more direct, practical feedback (as opposed to deep, psychoanalytic interpretations).

But I’m still doing therapy. I’m listening to patients discuss their issues and helping them recognize blind spots, form a different perspective, suggest other alternatives they may not have thought of, etc. As a therapist, I have to remain neutral, that is, I’m not giving advice based on what I would do if I were in the situation. That’s one of the differences between professional feedback and advice from a friend or colleague.

I can’t imagine having anything useful to say to people (that was not my own personal opinion) if I were not a trained therapist. So I’m still a little baffled at how the trained life coaches achieve the results listed earlier without some experience/knowledge of psychology.

Some people may not need psychological interpretations but may benefit from having a person who gives you their undivided attention and is supportive. But be cautious in whom you choose to work with especially if you plan to share your innermost thoughts with them as the life coaching industry is not regulated in the same way as therapists. In this type of work, maintaining professional boundaries becomes of utmost importance.

Popularity: 24%