Relationship With Patient Can Determine Treatment Success

Aaron Levin

 

An understanding of the patient’s values and the place of medication in a wider therapeutic program in which medication is one tool for recovery should inform a psychiatrist’s judgment.

Abstract Teaser

Medications may help psychiatric patients get better, but “getting better” is a “profoundly value-laden term,” said Ronald Diamond, M.D., a professor of psychiatry in the School of Medicine and Public Health at the University of Wisconsin.

“ ‘Better’ means different things to different people,” said Diamond at APA’s Institute on Psychiatric Services in New York in October.

“You and the patient might disagree not on what is happening but on its value,” he said. “It could be subjective improvement for the patient, better functioning, symptom improvement, reduced distress, or simply not getting worse.”

Medications are a tool for recovery and can make nonpharmacological treatments more effective, possibly by making the brain less sensitive to stimuli, he said.

“Medications are never a goal of treatment; rather, they can help patients reach their own goals,” he said. “Ambivalence about medications is normal, but people will take them if they feel they will help them and won’t if they don’t.”

All medications have potential risks as well as benefits, so side effects are best seen from the patient’s point of view. To read more, click here.

Research redefines 'recovery' in bipolar disorder

Researchers have developed the first accurate tool for measuring bipolar recovery which takes into account the personal experiences of people living with the disorder.
The Lancaster University-led research team worked with people with bipolar disorder and clinicians to develop the 36 item bipolar recovery questionnaire (BRQ) to reflect changing attitudes to what counts as ‘recovery’ in a severe mental illness such as bipolar.

The questionnaire, which was then tested by 60 people with bipolar, focusses on personal definitions of recovery rather than symptom reduction and relapse prevention. It is the first self-report tool specifically designed to capture the subjective experience of recovery in individuals with bipolar disorder.

In tests it has proved to be a reliable tool, higher BRQ recovery scores were associated with lower depression and mania scores as well as higher wellbeing, better functioning, better mental health quality of life and personal growth.
The results of the study are published this month in the Journal of Affective Disorders.

Professor Steven Jones of Lancaster University’s Spectrum Centre - a bipolar research centre dedicated to research which can improve the day to day lives of people living with this condition - - led the work.

He said: “The importance of personal recovery, rather than recovery as defined by an expert, in mental health is increasing widely recognised.

“But until now there has been no measure available to assess recovery experiences in individuals with a diagnosis of bipolar disorder.

“For some people recovery means getting back into the gym for the first time in five years, for others it is rebuilding successful relationships with family or getting back into paid work.

Click here to read more.

Psychiatrists approve vast changes to diagnosis manual

11:40PM EST December 2. 2012 - Asperger's is out, but binge eating and hoarding are in as official mental disorders in the latest version of the diagnostic bible published by the American Psychiatric Association, following a weekend vote by its board.

The Diagnostic and Statistical Manual of Mental Disorders — whose latest edition is nicknamed DSM-5 — is often called the "bible" because it's used to identify and classify mental disorders.

The vote gives only a hint of the massive changes that will be unveiled in detail in May when the guide is published. The last full revision was in 1994, with minor changes approved in 2000.

The revisions have been considered for more than a decade. Among the changes are:

Eliminating the mild form of autism known as Asperger's syndrome per se and including it as part of the autism spectrum disorder. To read more, click here.

Treatment Issues for Bipolar Disorder in Women

By HeidiAnne Duerr, MPH, Contributing Editor | November 9, 2012

 

Treating women with bipolar disorder (BD) requires some special considerations, explained Laura Miller, MD, during her presentation at the 2012 US Psychiatric & Mental Health Congress in San Diego. Miller reviewed treatment issues across the lifespan of women—from puberty and menstruation to sexuality to issues in menopause—and shared practical tips and clinical consideration with attendees.
Issues Associated With Menstruation
Miller, professor at Harvard Medical School and Director of the Women's Mental Health Divisionin the Department of Psychiatry at Brigham and Women's Hospital, said the hormonal changes associated with the menstrual cycle and menopause can complicate treatment and disease course. For instance, in a retrospective study of 2524 women, 65.1% of women with bipolar type I and 70.5% with bipolar type II reported increased premenstrual mood symptoms. Only 33.7% of women without BD reported increased mood symptoms.¹ She added that there are a number of well-documented cases showing a clear exacerbation of mood symptoms associated with the menstrual cycle. To read more, click here.

The benefits of gratitude

By Mary MacVean, Los Angeles Times

November 17, 2012

Before we eat Thanksgiving dinner at my house, along with saying grace, each of the 20 or so people at the table takes a turn lighting a candle and expressing gratitude. The appreciation can be lighthearted — for mashed potatoes or a day off from school. Or the thankfulness may be accompanied by a heavy heart — for the memories of a loved one recently passed.
As it happens, this expression is not an empty exercise. And if we developed the discipline to be consciously grateful on a regular basis, year-round, research shows we'd be happier and suffer less depression and stress. We'd sleep better and be better able to face our problems.

There's evidence that gratitude is uniquely important to well-being. Long embraced by religion as a "manifestation of virtue," it's one of the few things that "can measurably change people's lives," says Robert Emmons, a UC Davis professor who has been studying gratitude since 1998 and is the author of the book "Thanks! How the New Science of Gratitude Can Make You Happier."

"Gratitude implies humility — a recognition that we could not be who we are or where we are in life without the contributions of others," Emmons writes. Click here to read more.

What Do Bullying and Youth Substance Use Have in Common? More Than You Might Think.

Written By: Frances M. Harding, Director, Center for Substance Abuse Prevention

October is Bullying Prevention Month and National Substance Abuse Prevention Month, a busy and important time for prevention efforts.  On the surface, bullying and youth substance use may seem like separate problems.  However, from research, we know that youth who use substances are at risk for other problem behaviors during their teen years.  In fact, new findings suggest that middle and high school students who bully their peers are more likely to use alcohol, cigarettes, and marijuana.
Bullying and substance use among children and teenagers have shared risk and protective factors.  Effective prevention efforts minimize these risk factors and maximize protective factors in a child’s life.  If a problem has already surfaced, learn to recognize the warning signs of bullying and being bullied, underage alcohol use, and drug use to intervene before the problem becomes worse.
But let’s rewind: how do you know which risk and protective factors to focus on?  Read on!

Hormone Use in Menopause Lowers Depression, Anxiety

By Traci Pedersen Associate News Editor
Reviewed by John M. Grohol, Psy.D. on October 6, 2012

 

According to a new study, low doses of estrogen pills, such as Premarin, can significantly improve levels of stress and depression that often show up during menopause.

In younger women, the drug has no negative effect on memory or the ability to think clearly, which can be a side effect for women over 65 who take hormones.

Nearly all previous hormone replacement therapy studies have involved older women, researchers said.

“While we saw there was a wealth of data, a lot of it might not be applicable to young women,” said Mitch Harman, director of the nonprofit Kronos Longevity Research Institute.

Researcher and physician JoAnn Manson said it is important to pay attention to the concerns of women who just recently reached menopause. Click here to read more.