Marks Psychiatry

Individuals with an disorder such as bipolar disorder can behave in ways that make them question whether their actions are part of their personality or part of their illness.  For example, two common symptoms with bipolar disorder are hypersexuality and hyperreligiousity.  However, defining what is “hyper” is not always an easy task.  It can be very difficult to tease out what is the person’s personality and what is being driven by the disinhibition that you can see with a manic episode.  It is often during a euthymic period (neither manic nor depressed) that a person can do some introspection and get a sense of who they are.  It can be sobering for some to realize their free spiritedness, high sex drive, etc. may have been their illness.  They are then left to figure out who they really are.

In a similar way, chronic irritability that may seem a part of someone’s personality could be persistent depression that once treated significantly improves.  In these cases, a person may feel relief to know they are capable of feeling happy or having a good outlook on life.

Popularity: 32%

We in psychiatry have always said it took 3-4 weeks for an antidepressant to show a clinical effect.  Those who showed improvement in the first 2 weeks were thought to be having a placebo effect.  In the past 2 years, there have studies that have shown that patients can have a “real” response to antidpressants as early as 1 week after starting the medication.

When Lexapro became available in 2002, pharmaceutical reps said it was supposed to show effect in the first week.  At that time, that was the first antidepressant that made that claim.  I find the literature still unclear about what is an expected response time.  This is probably because there are other factors such as lack of support, ongoing stressors, variability in how drugs are metabolized that affect response time.

Also, another source of confusion may be in how we define “working”.  A clinical response is not the same as a full recovery, so a person may experience some lifting of their depressed mood in the first week, but still have considerable irritability, insomnia, anxiety, etc. for several more weeks.  Bottom line, I think the current literature supports early responses in the first week as being real and possible, but we still need to give the medications 4-6 weeks at a therapeutic dose to show a full response.

Popularity: 21%

Sometimes it’s difficult for bipolar patients to tell when they are in a depressed mode or if they have simply lost their manic high.  For many, mania can be a very destructive phase, but for some, mania or hypomania (milder form of mania) can feel very good and be a very productive time.  Sometimes this loss of the elation can make patients not want to take their mood stabilizer.  Some will say they experience the non-manic period as being flat or as if they are living a generic version of themselves.  They may then conclude they are “depressed” when in fact, they may not be depressed, they are just experiencing the middle ground.

Some patients may swing between cycles so often that they may not know how to recognize the middle ground.  This is why it is important for patients with bipolar disorder to stay in regular contact with their health care provider so they can have someone keeping an eye out for their mood states.  It’s not always as easy to recognize the beginning of a manic state as it is to recognize depression.  A person who is hypomanic may appear happy, upbeat and busy.  On the surface, that doesn’t seem so bad.  But it is usually the people close to them that recognize the more destructive behaviors such as functioning on little sleep, making impulsive decisions, etc.   So, although the hypomanic state may seem desireable and some even try to prolong the state (by avoiding medication), mania can spiral out of control.  Therefore it is important to keep a careful watch and welcome periods of non-mania and middle ground.

Popularity: 21%

The short answer is yes. Anabolic Androgenic Steroids are the steroids used by those wanting to increase muscle mass usually in the context of sporting competitions. We hear about athletes being penalized after they are caught testing positive for these substances. This topic has gained much attention recently with former professional wrestler, Chris Benoit who killed himself as well as his wife and son in Fayetteville, Ga. He was found to have anabolic steroids in his home.

The term “Roid Rage” has been around for a while and even used as a defense in some cases where someone claimed to have harmed someone under the influence of anabolic steroid use. Non-anabolic steroids such as prednisone are commonly prescribed for many inflammatory conditions or other conditions such as asthma.  However, they can have mental health consequences such as psychosis, depression and mania. Androgenic anabolic steroids are testosterone-based and in addition to psychosis, depression and mania, can also cause increased aggression. Some athletes who use these performance enhancing drugs, will notice changes such as being more easily angered or irritable. Some athletic activities that involve contact, can be a natural outlet for the increased aggression.

Some criticize the wrestling community for lending itself to athletes abusing these drugs unchecked. As an activity that is a mix of sports and entertainment, the participants are not monitored in the same way as professional athletes.

Perhaps this recent death of a wrestling heavy weight and the deaths of several other wrestlers will bring more attention to the issue of anabolic androgenic steroid use.

Popularity: 19%

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?”

Popularity: 20%

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.

Popularity: 22%

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.

Popularity: 19%

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.

Popularity: 21%