Daily Healthy: psychiatrist

How Psychotherapy Changes the Brain

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By <a href="http://www.psychiatry.org/mental-health/healthy-minds-blog-contributors" target="_blank">Serina Deen, MDMPH</a><o:p></o:p> 
 
 
 
When I first see patients for evaluation, they often tell me that they’ve debated starting a “biological” treatment such as medication, versus a “psychological” treatment such as psychotherapy. I’m happy to report that as brain imaging technology advances, we’re finding that this distinction may be obsolete.  <o:p></o:p> 
 
 
 
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Psychotherapy is also “biological” in that it can lead to real functional and structural changes in the brain.   In fact, sometimes <a href="http://www.psychiatry.org/File%20Library/Mental%20IIlness/Lets%20Talk%20Facts/APA_Psycotherapy.pdf" target="_blank">psychotherapy </a>and <a href="http://apahealthyminds.blogspot.com/2011/01/six-tips-for-talking-to-your-doctor.html" target="_blank">medication </a>produce surprisingly similar changes in the brain.  We still have a lot to learn about the topic, but below are some examples of what researchers have been finding so far.<o:p></o:p></div>
 
Functional Changes in the Brain:<o:p></o:p> 
 
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisEmTMLfCdT4Vlws_S4zzD_DZMXoQasORIMPkNr9_AAZYC16pulHHwZa4jpsQNym3xQa3OrnQCf-4ulTtpnf-Fj9qhDljjpq41XkVv3PwdWVE2WuneH9ceuzl0iAN3JZ-X31uarvGAS8oU/s1600/Deen+pic+1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="How Psychotherapy Changes the Brain" border="0" height="130" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisEmTMLfCdT4Vlws_S4zzD_DZMXoQasORIMPkNr9_AAZYC16pulHHwZa4jpsQNym3xQa3OrnQCf-4ulTtpnf-Fj9qhDljjpq41XkVv3PwdWVE2WuneH9ceuzl0iAN3JZ-X31uarvGAS8oU/s1600/Deen+pic+1.jpg" title="How Psychotherapy Changes the Brain" width="200" /></a>In one study, researchers at UCLA found that people who suffered from depression had abnormally high activity in an area of the brain called the prefrontal cortex.  Those who got better after they were treated with a type of therapy called interpersonal therapy (IPT) showed a decrease in activity in the prefrontal cortex after treatment.  In other words, IPT seemed to “normalize” brain activity in this hyperactive region. 
 
 
 
Another study looked at people who have <a href="http://www.psychiatry.org/obsessive-compulsive-disorder" target="_blank">obsessive compulsive disorder</a> (OCD), who tend to have an overactive area of the brain called the caudate nucleus.  Treatment with a type of therapy called cognitive behavior therapy (CBT) was associated with a decrease in the hyperactivity of the caudate nucleus, and the effect was most evident in people who had a good response to CBT.  In other words, the better the therapy seemed to work, the more the brain activity changed. 
 
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Changes in Brain Volume:</div>
 
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People with chronic fatigue syndrome (CFS) suffer from debilitating fatigue.  People with CFS tend to have a decrease in a type of brain tissue called grey matter in the prefrontal cortex of the brain.  Researchers in the Netherlands gave people with CFS 16 sessions of CBT, and found significant increases in gray matter volume in the prefrontal cortex.  This seems to suggest that the CFS patients were able to “recover” some gray matter volume after CBT.</div>
 
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Similarities and Differences to Medications</div>
 
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<a href="http://www.psychiatry.org/File%20Library/Mental%20IIlness/Lets%20Talk%20Facts/APA_Psycotherapy.pdf" target="_blank">Psychotherapy </a>sometimes seems to work in similar ways as <a href="http://apahealthyminds.blogspot.com/2011/01/six-tips-for-talking-to-your-doctor.html" target="_blank">medications</a>, and other times appears to have different mechanisms of action.</div>
 
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In the study mentioned previously about people with <a href="http://www.psychiatry.org/mental-health/depression" target="_blank">depression,</a> both IPT and the antidepressant paroxetine (Paxil) showed a decrease in prefrontal cortex activity.  And with OCD patients, both CBT and the antidepressant fluoxetine (Prozac) produced similar decreases in activity in the caudate nucleus.  </div>
 
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However in a different study, the antidepressant Venlafaxine (Effexor) produced changes in different parts of the brain than IPT in depressed patients.  This shows that there is variability in how different treatments work in the brain.</div>
 
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How Psychotherapy Produces Brain Change</div>
 
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We now know that the brain keeps changing, even after we become adults.  Learning leads to the production of new proteins, which in turn can change connectivity in our brains in a process called neuroplasticity.   Indeed, researchers in Germany showed that certain neurochemicals involved in neuroplasticity increased in depressed patients who got better after a course of interpersonal therapy.  </div>
 
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Picking a Treatment that Works Best for You Even though we know that both <a href="http://apahealthyminds.blogspot.com/2011/01/six-tips-for-talking-to-your-doctor.html" target="_blank">medication</a> and <a href="http://www.psychiatry.org/File%20Library/Mental%20IIlness/Lets%20Talk%20Facts/APA_Psycotherapy.pdf" target="_blank">psychotherapy</a> can change our brain, we still have a long way to go in learning exactly how that happens and when to use what treatment. Given a specific mental illness, sometimes medications work best, sometimes psychotherapies are the best option, and sometimes it’s a combination of the two. In addition, there are different types of psychotherapies that work for different illnesses, just as there are many different types of medications.  If you’re considering seeking help for mental illness, it would be helpful to talk with a trained professional about what would work best for you.  <o:p></o:p> Read tips on what to expect during your <a href="http://apahealthyminds.blogspot.com/2013/03/what-to-expect-for-your-first-visit_21.html" target="_blank">first visit with a psychiatrist</a>   </div>
 
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"Let's Talk Facts" brochure on <a href="http://www.psychiatry.org/File%20Library/Mental%20IIlness/Lets%20Talk%20Facts/APA_Psycotherapy.pdf" target="_blank">Psychotherapy</a></div>
 
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<a href="http://www.nimh.nih.gov/about/director/2014/brain-awareness.shtml?utm_source=govdelivery&utm_medium=email&utm_campaign=govdelivery" target="_blank">Brain Awareness blog</a> post from NIMH Director Tom Insel, MD </div>
 
 
 
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APA Releases <a href="http://apahealthyminds.blogspot.com/2013/11/apa-releases-list-of-five-uses-of.html">List of Five Uses of Psychiatric Medication</a> to Question<o:p></o:p></div>
 
 
 
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Six tips for talking to your doctor about <a href="http://apahealthyminds.blogspot.com/2011/01/six-tips-for-talking-to-your-doctor.html">medication</a><o:p></o:p></div>
 
 
 
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For more information about <a href="http://www.apa.org/helpcenter/understanding-psychotherapy.aspx">psychotherapy</a><o:p></o:p></div>
 
 
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By Serina Deen, MDMPH When I first see patients for evaluation, they often tell me that they’ve debated starting a “biological” treatme...

Need a New Year’s Resolution? Try Exercise! Alzheimer’s Disease Prevention

4:51 AM Meme Art Studio 0 Comment

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By Ahmed Raza Khan, MD, MPH <o:p></o:p> 
 
Follow<a href="https://twitter.com/AhmedRazaKhanMD">@AhmedRazaKhanMD</a><o:p></o:p> 
 
Child and Adolescent Psychiatry Physician at Stanford University School of Medicine <o:p></o:p> 
 
 
 
Most people know that exercise is beneficial for cardiac health and is prescribed by physicians for the prevention and alleviation of various medical complications. But what if I told you exercise can also significantly benefit your mental health in more ways than one? Let’s take a look at some of the ways exercise can improve mental health and how to incorporate this into your new year’s resolution list! 
 
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Exercise and Depression Prevention:More than 350 million people in the world suffer from <a href="http://www.psychiatry.org/depression">depression</a> and it is the leading cause of disability worldwide.  Exercise has often been considered as a supplemental tool in treating depression, but recent evidence points to exercise playing a role in the prevention of future depressive episodes. These recent findings show that even low levels of physical activity (e.g., walking less than 150 minutes a week) can prevent future depression. There has been significant research in the last few years that links cardiovascular health’s role in the origin of depression. This would certainly be a plausible explanation for why exercise may prevent depression. <o:p></o:p> 
 
 
 
Alzheimer’s Disease Prevention:<a href="http://www.psychiatry.org/mental-health/key-topics/alzheimers-disease">Alzheimer’s disease</a> is a chronic, degenerative disease of the brain that affects over 25 million people in the world. This illness leads to a progressive mental decline, steering its victims to dependence on caregivers and, eventually, death. Amyloid plaques are abnormal clusters of protein fragments that are found in the brains of patients with Alzheimer’s disease and are thought to play a major role in its progression. Recent studies have found that people who exercised at or above the levels recommended by the American Heart Association had significantly lower numbers of amyloid plaques than those who exercised less. This was the case for even those who carried the APOE-e4 gene variant, which is an established risk factor for Alzheimer’s disease. When people with the APOE-e4 gene variant were compared, those with higher levels of exercise had lower levels of amyloid plaques.<o:p></o:p> 
 
 
 
Improving Cognitive Functioning:Exercise has been shown to increase cognitive functioning in rats. As rats get older, their memory tends to diminish and this appears to be due to a drop of nerve synapses in the hippocampus, the memory center of the brain. But after 12 weeks of voluntary running, both memory and hippocampus nerve synapses were restored in these rats. <o:p></o:p> 
 
 
 
Consistency in Exercise:Recent neuroscientific studies have shown that the cognitive benefit of exercise may have a window of time. In fact, rats that improved their cognitive functioning by exercise, had this improvement dissipate in 3-6 weeks of inactivity. This is similar to what is seen with muscle mass or heart rate when exercise is withdrawn. This evidence intimates that exercise is beneficial for the brain and should be performed consistently.<o:p></o:p> 
 
 
 
The <a href="http://www.heart.org/HEARTORG/">American Heart Association</a> is a great resource for planning the amount and type of exercise one needs. They recommend at least 30 minutes of moderate-intensity aerobic activity at least 5 days a week for a total of 150 minutes or at least 25 minutes of vigorous aerobic activity 3 days a week for a total of 75 minutes. An easy target to remember: 30 minutes a day, 5 days a week. <o:p></o:p> 
 
 
 
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Need a New Year’s Resolution? Try Exercise! Alzheimer’s Disease Prevention

Alzheimer's Disease depression exercise psychiatrist psychiatrist training psychotherapy Need a New Year’s Resolution? Try Exercise! Alzheimer’s Disease Prevention

By Ahmed Raza Khan, MD, MPH Follow @AhmedRazaKhanMD Child and Adolescent Psychiatry Physician at Stanford University School of Medicine...

Spreading Hope!

12:50 AM Meme Art Studio 0 Comment

By Matt Goldenberg D.O. <o:p><span style="font-family: "Times New Roman","serif"; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">@docgoldenberg </o:p> “You treat a disease, you win, you lose. You treat a person, I guarantee you, you'll win, no matter what the outcome.” <o:p></o:p> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGAuBL1SprzxDOE6jkkG1n5lpnddYDCnow2P4Jmhh0WvdglAt7K0fztqvqHWmTcmrLFYSiE9TP9dtiYVDhR_Qc-RsMERORHontoEuZrMJO3PBZt_0nUdWMIvc9ewQ0mvQFzJPe9_7XQQrL/s1600/patch-adams-553248l.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGAuBL1SprzxDOE6jkkG1n5lpnddYDCnow2P4Jmhh0WvdglAt7K0fztqvqHWmTcmrLFYSiE9TP9dtiYVDhR_Qc-RsMERORHontoEuZrMJO3PBZt_0nUdWMIvc9ewQ0mvQFzJPe9_7XQQrL/s1600/patch-adams-553248l.jpg" width="133" /></a></div> <div class="MsoNormal" style="margin: 0in 0in 10pt;"> I whole-heartedly agree with that statement. However, I cannot take credit for those words. Those are the words of Robin Williams, or more specifically, the words of his character in Patch Adams. I want to discuss the disease called depression. I will start by first discussing the diagnosis and the signs and symptoms of depression. I will then follow up with my thoughts on the various treatment options for depression and the strategies I employ with my patients to improve their outcomes. None of my thoughts and suggestions should serve in place of a formal consultation with a mental healthcare provider. However, I hope shedding light on mental health diagnoses like depression will lift the veil and social stigma on these chronic diseases that impact so many people. Psychiatry has come a long way in the last decade. This is a time of continued discovery and increasing public awareness. The leaders of our professional organization, the <a href="http://www.psych.org/File%20Library/Advocacy%20and%20Newsroom/Presidents%20Messages/Summergrad-2014-AM-Opening-Speech.pdf" target="_blank">American Psychiatric Association (APA), have suggested that we as mental health professionals are under a microscope</a>. I agree that we are and I also strongly believe that we are up for the challenge. School shootings and celebrity suicides and overdoses have increasingly put a focus on mental health. Psychiatry has significantly improved the outcomes, treatment options and the prognosis of patients with mental illness. However, we still are unable to decrease the prevalence of the diseases we treat or prevent them. We know that the brain changes during an episode of depression and our treatments help it to return to normal (see the image below). Although we are getting closer, we still currently do not have widely accessible blood or imaging tests that can confirm our diagnosis or localize the area of disease.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjHTc9LL0rGLMe7XKQOE8onH6uIwnyX6cgVdFxYuMOOK1kosrLV8_KrIZMITeThL099IFIRdkdOdeJqk2Sbs7JghO9ow0WjeSCGtMJqHRlL5SHn0oZaHKcSi2ho1Li_6dMsMZi_SZLZFKY/s1600/Manbrainimgae.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="160" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjHTc9LL0rGLMe7XKQOE8onH6uIwnyX6cgVdFxYuMOOK1kosrLV8_KrIZMITeThL099IFIRdkdOdeJqk2Sbs7JghO9ow0WjeSCGtMJqHRlL5SHn0oZaHKcSi2ho1Li_6dMsMZi_SZLZFKY/s1600/Manbrainimgae.jpg" width="200" /></a></div> <div class="MsoNormal" style="margin: 0in 0in 10pt;"> I can say with certainty, however, we are able to accurately diagnose patients. We are able to identify medications, psychotherapies and other treatments that patients with a specific diagnosis or cluster of signs and symptoms often benefit from. There is strong evidence that our treatments decrease symptomatology and disability and improve quality of life, clinical outcomes and a patient’s prognosis. Psychiatrists are trained to view the patient as a “whole person”. Psychiatry is a field of medicine whose assessment by definition includes all of the biological, psychological and social aspects of a patient’s life. We listen for the psychological and social factors that can contribute to disease. Oftentimes, the “whole story” can be more telling than only focusing on specific symptoms of a given disease. There is a saying, throughout all fields of medicine, that “most patients have not read the textbook.” In other words, patients usually do not present exactly as the textbook says they should. Stress and psychological factors can mimic chest pain, shortness of breath, gastrointestinal problems and a whole host of other diseases. If we do not step back and get the whole story, we can miss the root cause or the exacerbating factors of many manageable diseases which are of the mind. Many of the diseases we treat, such as depression, are chronic illnesses which require lifelong treatment. Our treatments can improve a patient’s mental health and coping skills and decrease their symptomatology and substance use. We know through decades of research that these are modifiable risk factors for suicide. Therefore, Psychiatrists have the training and tools necessary to decrease a patient’s risk of attempting suicide. Our treatments have the potential to not only significantly improve the lives of our patients, but also the lives of their families and everyone who comes into contact with them. Anyone who tells you otherwise is misleading, misinformed or both.</div> <div class="MsoNormal" style="margin: 0in 0in 10pt;"> <span style="font-family: "Calibri","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> <span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">I hope this information and the blogs to follow will give you hope. Mental illness can include symptoms which can be devastating and complications which can be <a href="http://psychiatry.org/suicide" target="_blank">life-threatening</a>. However, it is important to state again, these are treatable diseases. If you or someone you know, would like to talk to someone, call your primary care doctor or your insurance company for a referral to a Psychiatrist. A true multi-disciplinary team also includes therapists, psychologists, nurses and social workers. You are never alone. You can call the national suicide helpline 24 hours a day, seven days a week (1-800-273-TALK (8255) or visit <a href="http://www.suicidepreventionlifeline.org/">www.suicidepreventionlifeline.org</a>). There are also local crisis lines likely available in your area and are an internet search away. If you are ever feeling unsafe, or fearing for the safety of a loved one, you can call 911 or go to the nearest emergency department.</div> It is time for everyone to understand that there is no shame in getting help for depression, much as there is no shame in getting help with diabetes or high cholesterol. Even if you have never suffered from depression, there is a lot you can learn. <div class="MsoNormal" style="margin: 0in 0in 10pt;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtFwzBHqAnEjwkZBsUAwCX-AeHgooaLfCwYGVJTaTLFY1jGr8SovFrHlaH083SEvR7Lwdjpcj-C-7URLPVGLz-iMW8ZaLkr-NFOcnzW-xK90YoP7ZtPsgqqt6keYsGc4psxnedLQPpzON9/s1600/Depressed_NotDepressed+brain+image.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtFwzBHqAnEjwkZBsUAwCX-AeHgooaLfCwYGVJTaTLFY1jGr8SovFrHlaH083SEvR7Lwdjpcj-C-7URLPVGLz-iMW8ZaLkr-NFOcnzW-xK90YoP7ZtPsgqqt6keYsGc4psxnedLQPpzON9/s1600/Depressed_NotDepressed+brain+image.jpg" width="200" /></a></div> Together we can raise awareness and spread truth and hope. I know that if we spread knowledge, and ignore the misinformation, we will overcome the complacency and ignorance that is so pervasive today. That is how we can best honor those we have lost. That is how we can best prevent the next death from mental illness and addiction. <o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 10pt;"> </div> <a class="twitter-share-button" data-count="horizontal" data-related="APAPsychiatric" data-via="APAHealthyMinds" href="http://twitter.com/share">Tweet</a><script src="http://platform.twitter.com/widgets.js" type="text/javascript"> </script>

D.O. depression Matt Goldenberg mental illness psychiatrist Robin Williams treatment Spreading Hope!

By Matt Goldenberg D.O. @docgoldenberg “You treat a disease, you win, you lose. You treat a person, I guarantee you, you'll win, no mat...

How does your primary care doctor coordinate with your psychiatrist?

9:32 PM Meme Art Studio 0 Comment

By Pierre Gingerich-Boberg, Medical Student<o:p></o:p> Reviewed by Claudia Reardon, MD<o:p></o:p> I’m stuck in behaviors that are making me unhealthy.  My smoking makes my asthma worse, and I don’t want to end up with emphysema like my dad.  I smoke when I’m anxious, and my finances, my teenager, my boss, and my increasing weight all make me anxious.  Now to top it off, my chronic headaches are getting worse.  My problems are physical, but I know they’re also mental.  But the idea of seeing a psychiatrist makes me even more anxious!  What should I do?<o:p></o:p> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5ZWkNPuSeKsEwK3FmrvIY0Rfq95F7IacuJkVf2zV8fSp4t84kQoifBEe66Vc_Ivjbrd3DGyAkW43qig9LTOYb6-rk0QrySgfTHLfl_mG6EwfxTBkJJyK4ye0SGx_XB4OCDx-EWwkRxBwh/s1600/IC+graphic+part+1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="118" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5ZWkNPuSeKsEwK3FmrvIY0Rfq95F7IacuJkVf2zV8fSp4t84kQoifBEe66Vc_Ivjbrd3DGyAkW43qig9LTOYb6-rk0QrySgfTHLfl_mG6EwfxTBkJJyK4ye0SGx_XB4OCDx-EWwkRxBwh/s1600/IC+graphic+part+1.jpg" width="200" /></a>Patients need primary care doctors who can comprehensively address the varied aspects of their physical and mental health. Health systems are starting to recognize that multi-disciplinary teams (sometimes called patient-centered medical homes) can be an effective way to provide <a href="http://www.psychiatry.org/practice/professional-interests/integrated-care">integrated care. </a> How might this look for our example patient?<o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> First, it’s worth noting that traditional <a href="http://integrationacademy.ahrq.gov/lexicon">primary care</a> doctors already spend a lot of effort helping patients with a wide spectrum of behavior issues.  We saw this for our example patient.  Her anxiety is an example of a classic mental health problem—others might be depression, panic attacks, and addictions. Primary care docs refer some of these patients to psychiatrists, but primary care docs are treating the majority directly.  Our patient’s headaches are likely a functional ailment. Like irritable bowel syndrome and general aches and pains, headaches are real problems that often defy simple solutions.  Standard treatments focus on limiting symptoms while helping patients cope with the stressors and psychological distress that often contribute.  Finally, our patient faces problems with health-related behaviors including tobacco use, diet, and stress management.  These and other common behaviors are hugely important for the development of chronic diseases.  <o:p></o:p></div> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuXw0Z1_O4xNQqCWAK4j2aFkrXXoyr_8n8_2M51rwpH67urSpaVedtIwNDpGEVwJfgOENOTZnaf2-nXuGlieZslyPpS1NYU9tgxacue5a3HGrWhgPMjg3WwFIEgafQhz6IPDN8gt11EUrw/s1600/IC+graphic+part+5.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuXw0Z1_O4xNQqCWAK4j2aFkrXXoyr_8n8_2M51rwpH67urSpaVedtIwNDpGEVwJfgOENOTZnaf2-nXuGlieZslyPpS1NYU9tgxacue5a3HGrWhgPMjg3WwFIEgafQhz6IPDN8gt11EUrw/s1600/IC+graphic+part+5.jpg" width="320" /></a>Our patient’s picture might seem complex, but primary care doctors face such complexity (and more) every day! Frankly, patients often are dealing with too much for their doctors to address optimally in a 15-20 minute time slot. One approach is to triage—to ask what’s treatable and doable, and what can wait until the next appointment. The limited time available for counseling tends to push primary care doctors toward relying on treatment with psych meds. A second approach is to refer the patient to a psychiatrist.  But psychiatrists in many communities are spread too thin, so patients often wait weeks or months for an appointment. Then there’s stigma--our example patient’s anxiety around psychiatric care is actually pretty typical.  This helps push up no-show rates for first visits with a psychiatrist to 30 or 40%.  It’s no wonder that careful studies show that only a fraction of the mental health problems in our communities are ever diagnosed, and fewer still are adequately treated.<o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> A third option returns us to the <a href="http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Guide-to-Health-Homes-Design-and-Implementation.html">medical home</a> concept.  At the VA and increasingly in federally qualified health centers (FQHCs), mental health services are being brought into the primary care setting.  Here, <a href="http://www.hipxchange.org/Access">behavioral health consultants</a> (BHCs) share space with primary care doctors.  These are generally psychologists or social workers, that is, non-physicians. BHCs’ schedules are intentionally left mostly open, so that they’re available to see patients immediately after a non-threatening ‘warm handoff’ from the primary care doc.  The BHC can offer expert counseling for the patient, and advise the primary care provider on diagnosis and treatment.  BHCs arrange for a small subset of their patients to get a subsequent visit with a psychiatrist (a specialist physician), who is also in-house.   All the BHC patients get systematic evaluation and follow-up by phone or with visits to make sure their needs don’t fall through the cracks.<o:p></o:p></div> <iframe allowfullscreen="" frameborder="0" height="160" src="//www.youtube.com/embed/Z8Kx0GxSle0?list=PLf3_-c0tpWquEz-UdYwSWBTBIJwwKfARC" width="280"></iframe> When a behavioral health consultation system is in place, problems of waiting times, missed appointments, and incomplete records are eliminated for most behavioral health visits.  Primary care docs have more time to focus on medical issues, while getting the expert consultation they need to optimize behavioral health care for their patients. Finally, because most behavioral issues can be addressed efficiently by BHCs, specialty psychiatrists are not so swamped, and waiting times can be greatly shortened for the small group of patients needing psychiatric care beyond what can be managed in the primary care setting. <a class="twitter-share-button" data-count="horizontal" data-related="APAPsychiatric" data-via="APAHealthyMinds" href="http://twitter.com/share">Tweet</a><script src="http://platform.twitter.com/widgets.js" type="text/javascript"> </script>

How does your primary care doctor coordinate with your psychiatrist?

behavioral health consultants integrated care mental health primary care psychiatrist How does your primary care doctor coordinate with your psychiatrist?

By Pierre Gingerich-Boberg, Medical Student Reviewed by Claudia Reardon, MD I’m stuck in behaviors that are making me unhealthy. My smokin...

Depression & Cancer

2:53 AM Meme Art Studio 0 Comment

By <a href="http://www.psychiatry.org/mental-health/healthy-minds-blog-contributors" target="_blank">Brad Zehring, DO</a> <a href="https://twitter.com/DrZehringDO" style="font-family: Cambria;" target="_blank">@DrZehringDO</a> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> </div> “Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul”  - Jim Valvano<o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> But, what happens when it does? <o:p></o:p></div> <a href="http://www.psychiatry.org/mental-health/depression">Depression</a> is a multifactorial disorder that requires acknowledgement of the biological, psychological, and social aspects of a person’s life. Professionals in the mental health community describe this as the biopsychosocial model. It provides an understanding of the factors influencing a person’s mental and physical state of being. <o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg94t7Ua5eER2Z3skRMzXF19p7wFEkDz-UpHwsTdELnSRl7-giBZsnySmucvkO6nuqZsItn7IFVVOW0As1ao1DkJaGjVM2cns4i5IqL35nMfipxYVOzMNZMixLSEjsQELiMYu6F3pwBbSRF/s1600/DSM5+icon.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg94t7Ua5eER2Z3skRMzXF19p7wFEkDz-UpHwsTdELnSRl7-giBZsnySmucvkO6nuqZsItn7IFVVOW0As1ao1DkJaGjVM2cns4i5IqL35nMfipxYVOzMNZMixLSEjsQELiMYu6F3pwBbSRF/s1600/DSM5+icon.jpg" /></a>When mental health professionals talk about depression they often do so in regards to Major Depressive Disorder (MDD). According to DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), 5 out of 9 criteria are needed to diagnose MDD. It requires a depressed mood or anhedonia (lack of enjoying what was previously enjoyed) for greater than 2 weeks including: disturbances in sleep, guilty/hopeless/worthless feelings, poor concentration, low energy, changes in appetite (weight loss or weight gain), psychomotor agitation or retardation, and suicidal ideation.</div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> </div> Depression affects your entire body. But, the physical aspects of depression are often overlooked. It is common for people with depression to experience weight changes, digestive problems, headaches, back pain, muscle and joint pain, and disruptions in sleep cycle. Many symptoms that are present in cancer.<o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> Depression has been linked with many health problems, including cancer. Cancer is a heavy word. The enormity of the word brings many images to the forefront of our imagination: radiation, chemotherapy, losing hair, sickness, weakness, and death - among others. There is so much symptom overlap between cancer and depression it can be hard to recognize the etiology of the symptoms.<o:p></o:p></div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYuxUyxMjq2ILDAVmQ937pPKH7PqOnXuJx20Oq9GyzTKn-z9hc6vRNEiFh3mXfGzt6tCXfYQTRRxnETWDdQfRcQn5Z1fuEYgnRwqA9Izq6Oum0fTFMQWy_zIBL0GwhLw3QMc0cJ8ArYGJ0/s1600/doctor+prescribing+feature.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="93" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYuxUyxMjq2ILDAVmQ937pPKH7PqOnXuJx20Oq9GyzTKn-z9hc6vRNEiFh3mXfGzt6tCXfYQTRRxnETWDdQfRcQn5Z1fuEYgnRwqA9Izq6Oum0fTFMQWy_zIBL0GwhLw3QMc0cJ8ArYGJ0/s1600/doctor+prescribing+feature.jpg" width="200" /></a></div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> It is important that health care professionals, family members, and other <a href="http://www.psychiatry.org/mental-health/key-topics/caregivers">caretakers</a> are vigilant with a person’s mental well being after they are diagnosed with cancer. Even if a person has never experienced depression previously, their risk of depression is increased when they find out they have cancer. Research shows that the incidence of depression increases proportionately with the cancer’s progression. It is believed those with depression have increased likelihood of depression because of increased immune response (cytokines) within the body. <o:p></o:p></div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> It is important not to assume that someone with cancer has an appropriate depressed mood due to his or her circumstances.  This is why it is important to screen for depression in those diagnosed with cancer. Screening for depression can help “tease out” symptoms related to depression and symptoms related to the cancer. Treating depression in patients with cancer can help them focus on their treatment and have the motivation to do everything needed to possibly achieve remission. Proper treatment gives them the ability to focus on their future. Cancer alone is enough, but when combined with untreated depression the results can be deadly. <o:p></o:p></div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhM4aKjNHHq7bqpZARc45SW8-H1gdqbUxWe-DkDZHeOqnphyXF2UMPi6BYvgEX5GPhRl3tj2Ri1bnl6KNzqE7PBT1amCWlKu71fSRB8DyfiDEao19D9ZrrLje4O6s7ojRav_uKSZx9CrW-5/s1600/Depression%23C-KS76864-getty.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhM4aKjNHHq7bqpZARc45SW8-H1gdqbUxWe-DkDZHeOqnphyXF2UMPi6BYvgEX5GPhRl3tj2Ri1bnl6KNzqE7PBT1amCWlKu71fSRB8DyfiDEao19D9ZrrLje4O6s7ojRav_uKSZx9CrW-5/s1600/Depression%23C-KS76864-getty.jpg" /></a>After recognizing depression in someone with cancer, there are ways to treat depression in parallel with cancer treatment. There are two forms of treatment. One involves medication and the other involves psychotherapy, or talk therapy. The typical medications for depression are antidepressants like Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRI). These medications have been around for a long time and are generally well tolerated. They take anywhere from 2-6 weeks for clinical efficacy. These medications should be monitored with cancer treatment, as there can be drug interactions and side effects that may not be present in someone taking these medications without cancer. In addition to medications, psychotherapy can be effective. More specifically, Cognitive Behavioral Therapy (CBT) can help people change their negative thoughts about cancer and their future. For the most efficacious treatment a combination of both should be implemented. <o:p></o:p></div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> Cancer is a serious illness and a well-developed multi-disciplinary approach is necessary to best treat the patient. Cancer can cause a lot of different disturbances in physical and mental health. It is important to have health professionals, like <a href="http://www.psychiatry.org/mental-health/more-topics/what-is-a-psychiatrist">psychiatrists</a> and psychologists, part of the treatment team to ensure proper treatment of the whole patient. <o:p></o:p></div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> </div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> </div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> </div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> </div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> </div> <a class="twitter-share-button" data-count="horizontal" data-related="APAPsychiatric" data-via="APAHealthyMinds" href="http://twitter.com/share">Tweet</a><script src="http://platform.twitter.com/widgets.js" type="text/javascript"> </script>

cancer depression DSM-5 mental health psychiatrist treatment Depression & Cancer

By Brad Zehring, DO @DrZehringDO “Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and...

# 1 URBAN PSYCHOSIS

12:32 AM Meme Art Studio 0 Comment

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Limited tickets are available to two free events over July at Manchester Metropolitan University. If there’s a good chance that you can’t make the events, please don’t book tickets only to cancel at the last minute. Both these events are extremely popular. 
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<a href="http://www.holdengallery.mmu.ac.uk/2014/urbanpsychosis/"><img border="0" height="143" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOFiqMl55oZ1YTvia87pxs7i-01xKfGulfhHAq06PDfTQLFj6mgmYzHAXDq1nE7pCVCm3sQQFgBatxGEIILOFt57_XASEBAla-dcGdEAYHrDH-AufjN5f2UknBHHHf2neSoFS9W-nIDno/s1600/urbanpsychosis4.jpg" width="200" /></a></div>
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URBAN PSYCHOSIS will run from 14.07.14 - 22.08.14 at the <a href="http://www.holdengallery.mmu.ac.uk/2014/urbanpsychosis/">Holden Gallery</a> with work by John Baldessari – Matthew Buckingham – Sophie Calle – Marc Camille Chaimowicz – Moyra Davey – Luke Fowler – Gillian Wearing – Catherine Yass     </div>
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<a href="https://www.eventbrite.ca/e/urban-psychosis-an-evening-with-will-self-tickets-12074363747"><img border="0" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi19u2jKOqBOQUdiY5vOBh-eGWoCOWAy2ojoLEmOSMRCMLLcPclkqysMwiU-UKafhNQjMAfBhcekvCMqqwmblCE18mssL8YSKLKw4p-cR_Bl8geHsAnLLPm4_Za2S7oh1WTipKJpwLDMYc/s1600/Will-Self-008.jpg" width="320" /></a></div>
 The modern city has frequently been identified through its intensity - a busy and bustling environment of potentially creative and productive activity. For the spectator, this intensity can also tip over into a state in which reality is temporarily obscured. It is this finely balanced state which the exhibition explores, the condition of urban psychosis is presented as a recurring theme, a shadow which continues to haunt the city. We'll have more details of the exhibition itself next week. On the evening of 25th July, we are thrilled to be hosting <a href="https://www.blogger.com/goog_603365784">An Evening with Will Self</a><a href="https://www.eventbrite.ca/e/urban-psychosis-an-evening-with-will-self-tickets-12074363747" style="font-size: medium;">.</a> Find out more about the exhibition by clicking on the logo above. For more information and to reserve tickets for the <a href="https://www.eventbrite.ca/e/urban-psychosis-an-evening-with-will-self-tickets-12074363747">Will Self</a> event, click on his image above. 
 
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ADVANCED NOTICE...Very soon we’ll be announcing details of the Urban Psychosis Symposium which includes Professors Richard Bentall, Peter Kinderman and John Read who will consider the psychology and treatment of psychiatric experiences. Richard Bentall has edited and written several books, most notably Madness Explained, which was winner of the British Psychological Society Book Award in 2004. I am thrilled that this event will be happening and we’ll announce the date next week. Biggest thanks to Dr Kat Taylor for making this happen. 
 
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<a href="https://www.eventbrite.co.uk/e/i-am-we-are-s-y-m-p-o-s-i-u-m-tickets-12028793445"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA5pmYS9XLxvIXR0vYw3RwJjbKGJjWpsZxdWARuufkSl_zQGp6XKosAeHW7Z91ppgjnDjlSSuE9l_kbpkgeZ3SCWzY1C6P7hYuBHvqW4Zcx1jIjEB_NHPW7jKgxY-ge5RThekGidCYaWM/s1600/man-with-the-golden-arm-end-title.jpg" width="320" /></a></div>
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I AM - WE ARE s y m p o s i u m +</div>
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I AM: Memoirs of Addiction Recovery </div>
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The 2 year European project led by Portraits of Recovery; an Oldham/Manchester based, visual arts charity has been developed in partnership with Arts for Health, at Manchester Metropolitan University, Gruppo Incontro and F.E.D.E.R.S.E.R.D - Italy, and the Turkish Green Crescent Society, Kütahya branch. Working with international artists: Ali Zaidi, founding Co Director of Moti Roti – UK, Cristina Nuñez of the Self Portrait Experience – Italy and Selda Asal, founding Director of the Apartment Project – Turkey, it’s all about looking at how the arts and culture can support people in recovery from substance misuse to develop new life-opportunities through self-portraiture.</div>
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The symposium on the 17th July will share some of the artistic outputs, learning and responses from people taking part in the project. We will share an emergent Recoverist Manifesto that seeks to place individuals in recovery and others affected by addiction at the heart of proactive advocacy for cultural change in the way substance misuse is publicly perceived. We are thankful to everyone who has supported this project.</div>
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 This free symposium with input from all three partner countries will also share the voices of participants and artists involved in the project. The day will feature the opening of the exhibition, I AM: Memoirs of Addiction Recovery in the Link Gallery at MMU to which delegates are invited between 4:00 and 6:00pm. We will confirm reserved symposium places a week before the event. Click on the arm above to find out more and apply for a ticket. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF7LMdTdMYTmFYPIduJ6rhv4S6VOcIP3QZ4_mQM6hw9FCcis6Cfnox99E8m7BcZTFD5p6NGHUK1CT40qb9-vDyIgimph6e6jTPKBMSeQQ7-2gl6J8RuTMjQniTOyh7UgefF_95WrgYm14/s1600/tracey-emin-my-bed.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="211" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF7LMdTdMYTmFYPIduJ6rhv4S6VOcIP3QZ4_mQM6hw9FCcis6Cfnox99E8m7BcZTFD5p6NGHUK1CT40qb9-vDyIgimph6e6jTPKBMSeQQ7-2gl6J8RuTMjQniTOyh7UgefF_95WrgYm14/s1600/tracey-emin-my-bed.jpg" width="320" /></a></div>
 Who's your Svengali? 
So, Tracey Emin’s <a href="http://www.christies.com/presscenter/pdf/2014/RELEASE_TRACEY_EMINS_MY_BED.pdf">My Bed</a> is up for auction this week with a guide price of £1.2 million and of course, there’s histrionics in the tabloids. Putting her personality-politics aside for a moment, it would be easy to lay into (no pun intended) this work as easy, lazy, contemporary nonsense. It’s not art surely? But I beg to differ on this one. </div>
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Whilst people will obsess with the cult of Emin and the bed’s sale-tag, everyone’s favourite performance artist, Marina Abramović is posing and preening with the needy gallery going masses, all desperate for some existential fix. Abramović is concerned with ‘nothingness’ and ‘more and more of less and less’ apparently. Visitors to the <a href="http://www.serpentinegalleries.org/exhibitions-events/marina-abramovic-512-hours">Serpentine,</a> where she’s going for her Guinness world record on Svengali-Art, ‘will both literally and metaphorically leave their baggage behind in order to enter the exhibition: bags, jackets, electronic equipment, watches and cameras may not accompany them.’ Poor visitors - it’ll be a big strain and probably frustrate most of them, not being able to get their communion with art, all posted up on youtube. Still, they can take comfort in the fact that ‘the public will become the performing body, participating in the delivery of an unprecedented moment in the history of performance art.’ Like an on-trend, quick-hit mindfulness exercise for busy and important people. </div>
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<a href="https://www.youtube.com/watch?v=QtxlCsVKkvY"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEig28W6TMwN4ayY6Nq7qF-RB0vYLglBcBJGY_JoeYLeOLJwyj0t_U52w5I5ZouPdOBb5IAXo77MwMuC_MXE_Nfmbvai5w7nkiaoSPlLNxLJyK60Lw4uyCITTtRPWCIlREDDFcu3zYSzOZM/s1600/Svengali+(64).jpg" width="320" /></a></div>
 I was in TATE Britain at the very moment in October 1999 when a couple of students started jumping up and down on <a href="https://www.youtube.com/watch?v=hOxPYrdLD8Y">My Bed</a>. It might have been a <a href="http://www.stuckism.com/stuckistmanifesto.html">Stuckist</a> attack, or spontaneous whimsy, but it made me smile. I love a bit of art terrorism; Banksy sticking up his own masterpieces and fake labels on the real McCoy, or <a href="http://www.robertmontgomery.org/robertmontgomery.org/43.html">Robert Montgomery</a> pasting up anti-consumerist poems on the marketeers very own bill-boards.  </div>
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<a href="http://www.robertmontgomery.org/robertmontgomery.org/43.html"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYXGrgxO6dsIdEU74WvnSMJOBIt-SzAdWJ0LAWqum3ZaKdGivg3I2GVvL4hKPJ2WQCHVm46OkZmZLDwW3hetndZdnUHbIFJlEMGseJI5Fs5HYZ22UHv0uf0XY9KQpAQ1VFVPSFTNnc-GM/s1600/shapeimage_2.jpg" width="320" /></a></div>
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Whilst the Serpentine remind us that, ‘Abramović is a pioneer of performance as an art form, using her own body as subject and object, she has pushed the physical and mental limits of her being,’ if it weren’t for her sometimes dubious political comments, I’m more inclined to the honesty of Emin and her bed. I’ve facilitated many public workshops with people outside the vapid world of the cultural elite and often use images of the bed as part of serious and passionate discussion with people who have really experienced the ‘limits’ of physical and mental being. And no, this isn’t instrumentalism - it’s engaging with contemporary art at the deepest level.</div>
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Go on Stuckists, Banksy, Clandestine Insurgent Rebel Clown Army or free-wheeling anarchists - how will you subvert this existential free-for-all?  
 
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<a href="http://www.serpentinegalleries.org/exhibitions-events/marina-abramovic-512-hours"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihwUCbqG5fg6FrYyjULSfqMqFhIlIHbV7_d7Ntaty1AAj0SMVg-Xk4yVdeA8liH0QeJe-c3v3tqAs8OAtPpn7a1TIaROV8ZFw87Ody0yPA_cUXXf6a5i2EAVUF7mmUDCPja6VKsBoU-bU/s1600/1.+Photograph+by+Marco+Anelli+2014.jpg" width="200" /></a></div>
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                            The artist has a migraine</div>
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BBC Children in Need Small Grants Programme </h3>
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The next deadline for applications to the BBC Children in Need Small Grants programme is the 1st September 2014. Through the Small Grants programme, funding up to £10,000 is available for projects that combat disadvantage and improve children and young people's lives. In particular, grants are available for projects that help children and young people experiencing:</div>
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Illness, distress, abuse or neglect</div>
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Any kind of disability</div>
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Behavioural or psychological difficulties</div>
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And / or living in situations of deprivation.</div>
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Read more at:<a href="http://www.bbc.co.uk/programmes/articles/4fJVTzz5QmQx5rx0S4NVg0Q/small-grants">http://www.bbc.co.uk/programmes/articles/4fJVTzz5QmQx5rx0S4NVg0Q/small-grants</a></div>
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People's Postcode Trust Small Grants Programme </h3>
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(Scotland, Wales and South of England excl. London & Greater London)</div>
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The People's Postcode Trust has announced that its small grants programme has will re-open for applications on the 7th July 2014. Through its small grants programme, the Trust offers grants of between £500 and £20,000 to small organisations and community groups for projects lasting up to 1 year (for organisations in Wales 6 months) in the areas of:</div>
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<li>Poverty Prevention</li>
<li>Advancement of Health</li>
<li>Community Development</li>
<li>Public Sports</li>
<li>Human Rights</li>
<li>Environmental Protection.</li>
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<a href="http://www.postcodetrust.org.uk/">www.postcodetrust.org.uk</a></div>
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Artists in Residence Grants </h3>
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The Levehulme Trust is offering grants of up to £15,000 to UK universities and museums to foster a new creative collaboration with an artist (visual artists, creative writers, musicians, poets) working in a discipline outside the institution's usual curriculum. Artists may not apply directly - all applications must be made by the host institution. There must be a distinct contrast between the artist and host department's expertise (for example, a poet being hosted by a physics department, a composer by a geography department). The residency must be a newly constituted collaboration between artist and hosts. The grants provide a stipend of up to £12,500 for the artist and consumable costs, such as artist's materials, of up to £2500. A typical residency would be for ten months based on the artist being present at the host institution for two days per week. The deadline for applications is 16th September 2014. Read more at</div>
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<a href="http://www.leverhulme.ac.uk/funding/AIR/AIR.cfm">www.leverhulme.ac.uk/funding/AIR/AIRc.fm</a></div>
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