Naked Medicine

By Robert Lamberts, M.D.

When I get discouraged about the state of the healthcare system, I but need to look in one place to see that things could be worse: the mental health system. While there remains hope that there will somehow be reform and things will get better in the arena in which I work, it is very difficult for me to see anything getting better for the Psychiatrists.

One of my staff recently had a family member have a fairly major “breakdown.” I was caring for this person, mainly due to the fact that there are not close to being enough psychiatrists available to help. I have found that as a primary care doctor, I have had to become an “amateur psychiatrist” (as I call it) and diagnose and treat people whenever possible. Some of this is due to the stigma of people going to psychiatrists, but most of it is simply due to their unavailability. This was the case with this family member, and I did my best to address the needs medically, and even offered the best counselling I could.

Yet things went from bad to worse, and she ended up needing hospitalization, as she started having paranoid ideation and was very worrisome to the family that she might harm herself or her husband. I thought she simply had to go to the teaching hospital ER and they would either admit (voluntary) or commit (involuntary) her to the psych ward. I found out that the only place where an involuntary admission can occur is the state psych hospital. This was not the case when I started practice, but due to the total lack of fianancial viability of a locked psych unit, all of the others have closed down.

Of all of the places I have worked, the scariest one for me personally was at a state psychiatric hospital. This was not only scary due to the significant pathology in the patients (the worst of the worst), but the total lack of hope in that setting. There were not the financial resources available to really help those who needed to be helped, so they all were basically held there at the state hospital. It was the most helpless set of people I have ever seen.

I am sure my picture was somewhat jaded by my dislike of the clinical rotation, but it still paints a pessimistic picture of the reality of psychiatric care. These are the most needy patients, and the ones least likely to seek out care for themselves. If there is an area of healthcare that needs to be nationalized, it is psychiatric care. These people often cannot help themselves, and lack the resources to do so even if they could. I have no idea what a national psychiatric healthcare system would look like (I fear to think of it, honestly), but I don’t see many ways that things could get worse than the current system.

To all you psychiatrists out there, you have my deepest respect.

By Tom Pauken II

“A Personal Perspective of Manic Depression: This reporter gives a first-hand account about the bipolar disorder” reprinted with permission from Mr. Tom Pauken II.

Bipolar disorder, commonly known as manic depression, affects 0.3 percent to 3.7 percent of the world’s population. Fifty percent of them seriously considered or attempted suicide. Forty-five percent of Americans with bipolar disorder believe this sickness made a high negative impact on their lives. Seventy percent of those same respondents assume the public doesn’t understand their condition.

These statistics were compiled by a Global Survey for World Mental Health Day 2005 (Oct. 10) also posted on the upliftprogram.com Web site. Are these statistics important? Do you know somebody afflicted with manic depression? Well, I consider these statistics important because I suffer from this ailment.

I make this revelation not to grab attention for myself. I’m more passionate writing about geo-political issues of the East Asia-Pacific region. I shun diaries and anticipate never using first person voice in future articles.

Nevertheless, I feel an obligation to my readers. I want those suffering from mental illness to feel inspired during their moments of darkness because I might be manic depressive but I’ve taken great strides to overcome my difficulties. Read the rest of this entry »

Dr. Jane Chin: What are the biggest misconceptions or “myths” people have about self-injury?

Dr. Deborah Serani: I’d have to say that the biggest misconception about self-injury is that most people think that those who cut or self-injure are suicidal. Though any behavior that puts a person in harm’s way requires clinical evaluation, the basic reason individuals cut or self-harm comes from the wish “to control” or to “numb away feelings.”

Dr. Chin: Why is cutting or self injury such a difficult subject for people to talk about?

Dr. Serani: There is a lot of shame associated with this behavior. Seeing the scars or scabs serves as reminder to the person that they cannot find a better way to move through pent up feelings. They feel like they have failed or are flawed in some way, which exacerbates there negative feelings even more. Read the rest of this entry »

By Zack Lynch

From this month’s Neurotech Insights investment newsletter focused on the depression market:

While drugs to treat depression have proven effective for millions of individuals there exist a significant number of patients who do not respond to antidepressants. Treatment resistant depression, or refractory depression, is a condition that affects an estimated 4 million people in the U.S. and 11 million worldwide. Until recently, there were no options for these individuals beyond treatment with electroconvulsive therapy (ECT), which commonly induces memory loss among other issues. Today, several neurodevice approaches for the treatment of refractory depression are emerging including Vagus Nerve Stimulation (VNS), Deep Brain Stimulation (DBS) and repetitive Transcranial Magnetic Stimulation (rTMS).

The first neurodevice to be approved by the FDA for depression was Cyberonics’ VNS Therapy system. On July 15, 2005, the FDA approved Cyberonics’ VNS Therapy as a long-term adjunctive treatment for patients 18 years of age or older with chronic or recurrent treatment-resistant depression in a major depressive episode that have not responded to at least four adequate antidepressant treatments. Chronic treatment-resistant depression is defined as being in the current depressive episode for more than two years. Recurrent treatment-resistant depression is defined as having a history of multiple prior episodes of depression. The approved indication for use includes patients with unipolar or bipolar depression in a major depressive episode. Read the rest of this entry »

Journal of Child and Adolescent Psychopharmacology is a peer-reviewed journal published by Mary Ann Liebert, Inc. The February/April issue (Volume 16, 2006) explored the controversial topic of using selective serotonin reuptake inhibitors, or SSRIs to treat depression in children and teens.

Peer Review: Peer review of a scientific publication is considered a rigorous process that makes a published scientific study a credible source of information. A panel of the researcher’s “peers” assess the submitted publication for scientific merit and objectivity.

This topic has been controversial because of the debate around safety and effectiveness of this class of drugs for what is considered a vulnerable population. Based on the potential impact of this controversy, the publisher has made this double issue free for viewing.

View: http://www.liebertonline.com/toc/cap/16/1-2

The association between treating teens and children with SSRI drugs and an increased risk of suicide has made this a highly public controversy – including a past episode of Law & Order on television.

This journal is clearly aimed for healthcare professionals, researchers, and industry consultants. The publisher of the journal is a privately held media company that also publishes other magazines in biomedical research and biotechnology.

If readers are particularly interested in a specific article, I will be happy to help decipher it for you.