Definition
There are several categories of feeding disorders in infancy and early childhood, which is defined as a failure to eat adequately. Persistent eating of dirt or other nonnutritive substances may be diagnosed as pica. Repeated regurgitation and re-chewing of food may be diagnosed as rumination disorder.
Symptoms
Poor weight gain or an actual weight loss
Constipation
Excessive crying
Irritability
Apathy
Criteria for feeding disorder of infancy and early childhood include:
Lack of adequate eating with significant weight loss or failure to gain weight, lasting one month or longer
Behavior is not attributable to a gastrointestinal or other medical condition
Behavior is not better explained by lack of available food or another mental disorder
Onset is before age 6
Criteria for pica include:
Dirt or other nonnutritive substances are eaten for a month or longer
Behavior is not developmentally appropriate
Behavior is not acceptable within the child's culture
If behavior exists within sole context of a mental disorder such as mental retardation, a pervasive developmental disorder or schizophrenia, it warrants independent treatment.
Criteria for rumination disorder include:
After a period of normal eating, food is repeatedly regurgitated and re-chewed for a month or longer
Behavior is not attributable to a gastrointestinal or other medical condition
Behavior does not occur only during anorexia nervosa or bulimia
If behavior exists within sole context of a mental disorder such as mental retardation, or a pervasive developmental disorder, it warrants independent treatment.
Causes
Feeding disorders are diagnosed when the infant or young child does not eat adequately and the problem is not the result of a medical condition (such as a cleft palate) or a mental condition (such as any disorder that causes mental retardation). The cause of such disorders, while currently unknown, often results from a variety of factors such as poverty, parental misinformation and dysfunctional child-caregiver interactions.
Treatment
Depending on the severity of the condition, the number of calories and amount of fluid taken by the infant will be increased, any vitamin or mineral deficiencies will be corrected, and underlying physical illnesses or psychosocial problems will be uncovered and corrected. A short period of hospitalization is oftentimes required to accomplish these goals.
There is no quick cure for the majority of infants and children with a feeding disorder. Rather, a multidisciplinary approach is required with pediatricians, dieticians, social workers, outreach nurses, behavior specialists and parents collaborating to improve the child's well-being and nutritional status.
Treatment of pica and rumination disorder includes a variety of approaches such as psychotherapy for the parents and behavioral therapies for the child. One possibly effective tool is mild aversion therapy followed by positive reinforcement.
Sources:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders
National Institutes of Health - National Library of Medicine
8/26/2008
Are Antipsychotics Killing Elderly Patients?
Antipsychotics were long considered the most dangerous medications used in psychiatry. Then their reputation got worse.
It is new evidence that antipsychotics can cause harm and even death in demented (most often elderly) patients that has led to articles like the one in this week’s Science Times about overprescribing. The problem appears to include older medicines, like Haldol and Thorazine, as well as newer ones, like Risperdal, Seroquel, and Zyprexa.
In Great Britain, the drugs’ standing is yet worse. In the Guardian, a commentary by a geriatric psychiatrist from Liverpool carried the headline “The scandal of dementia drugs must be addressed” and the subhead “Overprescribing antipsychotic drugs to people with dementia is a symptom of our neglect.” A Member of Parliament, Paul Burstow (pictured above), called the prescribing abusive and proposed that the doctors responsible be prosecuted. The Health Minister has promised an investigation.
All right, the British can go overboard when it comes to expressing disapproval of psychotherapeutic medication. Sometimes it seems that they don’t like behavioral treatments much better. It’s as if mental health care undermines the national character — the stiff upper lip should suffice. But even our own Food and Drug Administration has put a black box warning on antipsychotics, first on the new versions and now, last week, on the older ones.
Antipsychotics, starting with Thorazine in 1952, were the first of the new psychotherapeutic medications — and the first medications tested in placebo-controlled trials. The drugs turned out to be helpful in the treatment of schizophrenia, though the side effects, including late-appearing neurological syndromes, were horrific. By 1955, there were reports that antipsychotics were useful in what was called senile dementia, and by the 1980s it seemed solidly established that, as an overview paper put it, “antipsychotic medication has a definite but limited therapeutic role in the treatment of behavioral disturbances in nursing home patients with dementia.”
Doctors hated to use antipsychotics, but the diseases they treated were heartbreaking, too. In the 1990s, a new generation of antipsychotics seemed to promise similar efficacy with fewer neurological side effects. Then it emerged that the new drugs led to obesity and diabetes — and that the pharmaceutical houses had been suppressing relevant evidence. Still, as recently as five years ago, family doctors were being encouraged to use antipsychotics in the elderly.
The unexpected news about excess deaths began to break in 2003 when a placebo-controlled study that was summarized as favorable (it showed that low-dose Risperdal diminished agitation associated with dementia) found higher, but not statistically significant, rates of cardiovascular death in patients given the active drug. In 2005, a summary study found a “small, increased risk for death” in demented patients given the newer antipsychotics. The difference, drug versus placebo, was one-and-a-half times, 3.5% compared to 2.3%, over ten to 12 weeks of use. Doctors’ worry was that over a longer periods, the change in risk might be greater. The cause of the excess deaths was unknown, but in the elderly, the medications can cause delirium which, also for unknown reasons, is associated with increased mortality.
The risk-of-death finding was later extended to older antipsychotic medications. So far, it does not seem that the problem applies to the use of the medication in its more traditional use, the treatment of schizophrenia. There, for all their (very substantial) flaws, the medications can be life-altering and life-saving.
Ironically, the mortality risk in the elderly was discovered only because drug companies had undertaken new trials, in the effort to get an FDA “indication” for the use of antipsychotics in treating dementia. The finding did not emerge until quite extensive research had been undertaken; the whole story makes the case for follow-up studies on widely used medications. In truth, even now we do not know what the risks and benefits are, in demented patients, for very short-term and very long-term use of antipsychotics, both of which are common.
Parallel to the change in understanding of risk came discouraging evidence about the drugs' ability to help demented patients. A controversial 2006 study in the New England Journal of Medicine concluded that “adverse effects offset advantages in efficacy” of the new antipsychotic drugs in patients with Alzheimer’s disease. Only 32% of the patients did well on Zyprexa, and 21% improved on a placebo. Presumably the placebo response was due not to expectancy on the part of the demented patients but to the enhanced care that they received when participating in a drug trial. As I have suggested elsewhere, “clinical management” can be a powerful tool for good.
Despite the suggestion from the British parliament that geriatricians be disciplined for using antipsychotics, the consensus in the field, reflected in the Times piece, remains that (as the older research literature suggests) with careful management, the medications can occasionally be of use in the elderly. But the risk of death seems real. In this population, the drugs are almost certainly overprescribed. And in approaching dementia, everyone is in agreement that a thorough diagnostic workup looking for discrete causes should come first, along with behavioral approaches that reorient patients and add variety to their days.
It is new evidence that antipsychotics can cause harm and even death in demented (most often elderly) patients that has led to articles like the one in this week’s Science Times about overprescribing. The problem appears to include older medicines, like Haldol and Thorazine, as well as newer ones, like Risperdal, Seroquel, and Zyprexa.
In Great Britain, the drugs’ standing is yet worse. In the Guardian, a commentary by a geriatric psychiatrist from Liverpool carried the headline “The scandal of dementia drugs must be addressed” and the subhead “Overprescribing antipsychotic drugs to people with dementia is a symptom of our neglect.” A Member of Parliament, Paul Burstow (pictured above), called the prescribing abusive and proposed that the doctors responsible be prosecuted. The Health Minister has promised an investigation.
All right, the British can go overboard when it comes to expressing disapproval of psychotherapeutic medication. Sometimes it seems that they don’t like behavioral treatments much better. It’s as if mental health care undermines the national character — the stiff upper lip should suffice. But even our own Food and Drug Administration has put a black box warning on antipsychotics, first on the new versions and now, last week, on the older ones.
Antipsychotics, starting with Thorazine in 1952, were the first of the new psychotherapeutic medications — and the first medications tested in placebo-controlled trials. The drugs turned out to be helpful in the treatment of schizophrenia, though the side effects, including late-appearing neurological syndromes, were horrific. By 1955, there were reports that antipsychotics were useful in what was called senile dementia, and by the 1980s it seemed solidly established that, as an overview paper put it, “antipsychotic medication has a definite but limited therapeutic role in the treatment of behavioral disturbances in nursing home patients with dementia.”
Doctors hated to use antipsychotics, but the diseases they treated were heartbreaking, too. In the 1990s, a new generation of antipsychotics seemed to promise similar efficacy with fewer neurological side effects. Then it emerged that the new drugs led to obesity and diabetes — and that the pharmaceutical houses had been suppressing relevant evidence. Still, as recently as five years ago, family doctors were being encouraged to use antipsychotics in the elderly.
The unexpected news about excess deaths began to break in 2003 when a placebo-controlled study that was summarized as favorable (it showed that low-dose Risperdal diminished agitation associated with dementia) found higher, but not statistically significant, rates of cardiovascular death in patients given the active drug. In 2005, a summary study found a “small, increased risk for death” in demented patients given the newer antipsychotics. The difference, drug versus placebo, was one-and-a-half times, 3.5% compared to 2.3%, over ten to 12 weeks of use. Doctors’ worry was that over a longer periods, the change in risk might be greater. The cause of the excess deaths was unknown, but in the elderly, the medications can cause delirium which, also for unknown reasons, is associated with increased mortality.
The risk-of-death finding was later extended to older antipsychotic medications. So far, it does not seem that the problem applies to the use of the medication in its more traditional use, the treatment of schizophrenia. There, for all their (very substantial) flaws, the medications can be life-altering and life-saving.
Ironically, the mortality risk in the elderly was discovered only because drug companies had undertaken new trials, in the effort to get an FDA “indication” for the use of antipsychotics in treating dementia. The finding did not emerge until quite extensive research had been undertaken; the whole story makes the case for follow-up studies on widely used medications. In truth, even now we do not know what the risks and benefits are, in demented patients, for very short-term and very long-term use of antipsychotics, both of which are common.
Parallel to the change in understanding of risk came discouraging evidence about the drugs' ability to help demented patients. A controversial 2006 study in the New England Journal of Medicine concluded that “adverse effects offset advantages in efficacy” of the new antipsychotic drugs in patients with Alzheimer’s disease. Only 32% of the patients did well on Zyprexa, and 21% improved on a placebo. Presumably the placebo response was due not to expectancy on the part of the demented patients but to the enhanced care that they received when participating in a drug trial. As I have suggested elsewhere, “clinical management” can be a powerful tool for good.
Despite the suggestion from the British parliament that geriatricians be disciplined for using antipsychotics, the consensus in the field, reflected in the Times piece, remains that (as the older research literature suggests) with careful management, the medications can occasionally be of use in the elderly. But the risk of death seems real. In this population, the drugs are almost certainly overprescribed. And in approaching dementia, everyone is in agreement that a thorough diagnostic workup looking for discrete causes should come first, along with behavioral approaches that reorient patients and add variety to their days.
When crime rates go down, recidivism rates go up
What should be the goal of the prison system in society? Should prisons aim to reduce crime rates? Or should they aim to rehabilitate their inmates so that they will not return to prison upon release and instead become productive members of society? As it turns out, we cannot achieve both goals simultaneously.
I was listening to a BBC Radio 4 program one morning, where two so-called “experts” were discussing increasing imprisonment in the UK and its effect on crime rates. One expert was saying that imprisonment and tougher sentences work, because the crime rates have gone down in recent years. The other expert was saying that imprisonment and tougher sentences have not worked, because, while the crime rates have indeed gone down, recidivism (the proportion of released prisoners who commit another crime and go back to prison) has gone up in recent years.
Both experts are mistaken. First, crime rates have gone down since the early 1990s in all the major western nations of the world which have experienced post-World War II baby boom. Crime rates increased in the 1970s in all of these nations as the baby boomers became young adults. As I explain in a previous post, crime is largely a young men’s game (largely, but not entirely, as I explain shortly). Crime rates in most societies at any given time are a very strong function of the proportion of young males in the society; the higher the proportion of young men in the population, the higher the crime rates. It makes perfect sense, because young men are the ones who are committing the crimes.
While politicians and policymakers everywhere, such as Rudolf Giuliani as Mayor of New York City, took inappropriate credit for the falling crime rates during the 1990s, the decreased crime rates had very little (if anything) to do with greater imprisonment rates, tougher law enforcement, or anything the politicians implemented. Crime rates went down in the 1990s simply because the baby boomers “aged out.” They became too old (and, as I explain in another post, too married) to commit crimes. Some criminologists indeed predicted the fall of crime rates in the 1990s before it happened.
Second, recidivism always goes up as a necessary consequence of falling crime rates. As the developmental psychologist Terrie E. Moffitt explains in her classic 1993 article in Psychological Review, there are roughly two types of criminals: adolescence limited and life-course persistent. The adolescence limiteds comprise the vast majority of criminals at any given time, and this is the type of criminals that I discuss in my previous series on criminals. They become increasingly delinquent, violent, and criminal in their late adolescence and early adulthood, then begin to desist from crime in late adulthood into their middle ages, as they get married, settle down, and switch to more conventional ways of life. The life-course persistents, on the other hand, are commonly known as “career criminals.” As the name implies, they do not age out of their criminality, and continue to commit crimes throughout most of their lives. This excellent figure from Moffitt’s 1993 article elucidates her argument.
While many men follow the life trajectories of the adolescence limiteds, the life-course persistents (career criminals) are a genetically distinct type. The late great behavior geneticist Linda Mealey estimated that sociopaths, who are prone to commit crimes because they are incapable of feeling remorse or empathize with others’ pain, comprise about 3-4% of the male population and less than 1% of the female population. The sociopaths nonetheless account for about 20% of the US prison population, and between 33% and 80% of chronic criminal offenders, many of whom are Moffitt’s life-course persistents.
The sociopaths are genetically distinct from the rest of the population, and their prevalence does not vary by social factors, such as the population age structure. As the proportion of adolescence limiteds decreases among the criminals due to the changing population age structure (because there are relatively fewer young men), the proportion of life-course persistents among them must necessarily rise. Since it is the life-course persistents (career criminals) who are most likely to experience recidivism, by returning to prison again and again, there must exist a necessary inverse relationship between crime rates (which are largely set by the number of adolescence limiteds) and the recidivism rates (which are largely set by the number of life-course persistents). So regardless of how tough the law enforcement or how effective the prison system, the lower the crime rates, the higher the recidivism rates in any society at any time. You can have one or the other, but not both at the same time.
One important implication of Moffitt’s groundbreaking work is that all attempts to “rehabilitate” criminals in prisons are doomed to failure. Adolescence limiteds will age out of crime when they are sufficiently old and married anyway, whether they go to prison or not. Life-course persistents will continue to commit crime their entire lives because they are genetically inclined to do so, whether they go to prison or not.
Media: Happily Ever After
Media: Happily Ever After
Fictional tales that surround a "just world" may influence belief in the fairness of the real world.
No one roots for the jocks in Revenge of the Nerds. If the bespectacled set, downtrodden by the brawny lettermen, didn't rise up to secure glory (and girls), it would be a terrible movie. Research suggests that not only are we drawn to stories of people getting their just desserts, but fictions following this satisfying arc may increase our faith in the fairness of real life.
Psychologists call this innate karmic sense "belief in a just world." Previous studies have shown that fiction persuades: Protagonists' attitudes about, say, seat belt use rub off on readers. But "if you could demonstrate that belief in a just world—which is part of a larger socialization process—is a media effect, that would be a bigger surprise," says Markus Appel of the University of Linz in Austria.
So Appel asked Germans and Austrians how often they watched various types of TV shows. He found that those who view more fiction believe more strongly in cosmic justice. He also found that the biggest TV watchers overall endorsed "mean-world" beliefs, fearing, say, walking alone in the dark. (Beliefs in fairness and meanness are uncorrelated.) Fans of tabloid shows had especially dire outlooks.
Choosing what to watch based on preexisting beliefs could explain Appel's findings, but he suspects his data reflect a two-way interaction where our viewing habits also guide our beliefs. Just don't go expecting your school mathletes to beat the meatheads on field day. —Matthew Hutson
Influential Fiction
Invented tales in Books, TV, and cinema are a force for social change.
1852
Harriet Beecher Stowe publishes Uncle Tom's Cabin, stoking the abolitionist movement and catalyzing the Civil War.
1977
The Fonz gets a library card on Happy Days and declares, "Reading is cool." Library card applications shoot up 500%.
2007
J.K. Rowling brings Dumbledore out of the closet and calls her novels "a prolonged argument for tolerance."
By: Matthew Hutson
Fictional tales that surround a "just world" may influence belief in the fairness of the real world.
No one roots for the jocks in Revenge of the Nerds. If the bespectacled set, downtrodden by the brawny lettermen, didn't rise up to secure glory (and girls), it would be a terrible movie. Research suggests that not only are we drawn to stories of people getting their just desserts, but fictions following this satisfying arc may increase our faith in the fairness of real life.
Psychologists call this innate karmic sense "belief in a just world." Previous studies have shown that fiction persuades: Protagonists' attitudes about, say, seat belt use rub off on readers. But "if you could demonstrate that belief in a just world—which is part of a larger socialization process—is a media effect, that would be a bigger surprise," says Markus Appel of the University of Linz in Austria.
So Appel asked Germans and Austrians how often they watched various types of TV shows. He found that those who view more fiction believe more strongly in cosmic justice. He also found that the biggest TV watchers overall endorsed "mean-world" beliefs, fearing, say, walking alone in the dark. (Beliefs in fairness and meanness are uncorrelated.) Fans of tabloid shows had especially dire outlooks.
Choosing what to watch based on preexisting beliefs could explain Appel's findings, but he suspects his data reflect a two-way interaction where our viewing habits also guide our beliefs. Just don't go expecting your school mathletes to beat the meatheads on field day. —Matthew Hutson
Influential Fiction
Invented tales in Books, TV, and cinema are a force for social change.
1852
Harriet Beecher Stowe publishes Uncle Tom's Cabin, stoking the abolitionist movement and catalyzing the Civil War.
1977
The Fonz gets a library card on Happy Days and declares, "Reading is cool." Library card applications shoot up 500%.
2007
J.K. Rowling brings Dumbledore out of the closet and calls her novels "a prolonged argument for tolerance."
By: Matthew Hutson
8/25/2008
Physical Frailty May Be Linked To Alzheimer's Disease
Physical frailty, which is common in older persons, may be related to Alzheimer's disease pathology, according to a study published in the August 12, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology.
For the study, researchers examined the brains of 165 people who had been participants in a larger community study of chronic diseases of aging. While participants were alive, physical frailty measurements were taken yearly including grip strength, time to walk eight feet, body composition and tiredness. After death, the brains of these participants were checked for the plaques and tangles that are signs of Alzheimer's disease pathology.
Of the participants in the study, 36 percent of the group had dementia, or showed signs of memory loss. "Interestingly, Alzheimer's disease pathology was associated with physical frailty in older persons both with and without dementia," said study author Aron S. Buchman, MD, with Rush University Alzheimer's Disease Center in Chicago and member of the American Academy of Neurology.
"The level of frailty was approximately two times higher in a person with a high level of AD pathology compared with a person with a low level of AD pathology," said Buchman. The results remained the same regardless of whether a person had a history of other diseases and regardless of their level of physical activity.
A previous study of the same group of participants while they were alive suggested that older people who are physically frail with no cognitive impairment appear to be at higher risk of developing Alzheimer's disease as compared to those who were less frail. "Together both of these studies suggest that frailty can be an early indicator of Alzheimer's disease pathology and may appear before memory loss."
"These findings raise the possibility that Alzheimer's disease may contribute to frailty or that frailty and Alzheimer's disease share a common cause. We theorize that the accumulation of these plaques and tangles in the brain could affect the areas of the brain responsible for motor skills and simple movements years before the development of dementia," Buchman said.
Studies show that about seven percent of people over age 65 are considered frail; that number jumps to 45 percent after age 85.
The study was supported by the National Institute on Aging, the Illinois Department of Public Health and the Robert C. Borwell Endowment Fund.
For the study, researchers examined the brains of 165 people who had been participants in a larger community study of chronic diseases of aging. While participants were alive, physical frailty measurements were taken yearly including grip strength, time to walk eight feet, body composition and tiredness. After death, the brains of these participants were checked for the plaques and tangles that are signs of Alzheimer's disease pathology.
Of the participants in the study, 36 percent of the group had dementia, or showed signs of memory loss. "Interestingly, Alzheimer's disease pathology was associated with physical frailty in older persons both with and without dementia," said study author Aron S. Buchman, MD, with Rush University Alzheimer's Disease Center in Chicago and member of the American Academy of Neurology.
"The level of frailty was approximately two times higher in a person with a high level of AD pathology compared with a person with a low level of AD pathology," said Buchman. The results remained the same regardless of whether a person had a history of other diseases and regardless of their level of physical activity.
A previous study of the same group of participants while they were alive suggested that older people who are physically frail with no cognitive impairment appear to be at higher risk of developing Alzheimer's disease as compared to those who were less frail. "Together both of these studies suggest that frailty can be an early indicator of Alzheimer's disease pathology and may appear before memory loss."
"These findings raise the possibility that Alzheimer's disease may contribute to frailty or that frailty and Alzheimer's disease share a common cause. We theorize that the accumulation of these plaques and tangles in the brain could affect the areas of the brain responsible for motor skills and simple movements years before the development of dementia," Buchman said.
Studies show that about seven percent of people over age 65 are considered frail; that number jumps to 45 percent after age 85.
The study was supported by the National Institute on Aging, the Illinois Department of Public Health and the Robert C. Borwell Endowment Fund.
Study Examines Testing Model To Predict And Diagnose New Cases Of Dementia
A preliminary report published in the August 20 issue of JAMA suggests that within-person variability on neuropsychological testing may be associated with development of dementia in older adults
"Developing strategies to improve the prediction and diagnoses of dementia has paramount therapeutic and public health implications," the authors write. "When neuropsychological tests are used for diagnostic purposes, an individual's level of performance on specific tests is measured against healthy normative samples to determine cognitive impairment. However, this approach does not take into account intra-individual variability in cognitive function." Intra-individual variability is inconsistency in cognitive performance within a person.
Roee Holtzer, Ph.D., and colleagues from the Albert Einstein College of Medicine, Yeshiva University, New York, evaluated 897 individuals, age 70 or older, who are part of The Einstein Aging Study, a longitudinal study of aging and dementia in Bronx County, New York. Participants had follow-up visits every 12 to 18 months, at which they underwent detailed neurological and neuropsychological evaluations. The researchers included tests for verbal IQ, attention/executive function, and memory. The study focused on whether within-person across-neuropsychological test variability predicts future dementia.
"Of the 897 participants, there were 61 cases of incident dementia (6.8 percent) … identified during the follow-up period (mean [average] 3.3 years)," the authors report. "On the basis of the consensus clinical diagnostic procedures, 47 participants developed incident dementia of the Alzheimer type and 18 participants developed incident vascular dementia. During the study, 128 individuals died, as expected for the age of this cohort. Of these, 18 had developed incident dementia."
"In summary, within-person across-neuropsychological test variability was associated with development of dementia independently of performance of the neuropsychological tests. This finding needs to be replicated in different populations before it is applied in a clinical setting," the authors conclude.
http://www.sciencedaily.com/releases/2008/08/080819170429.htm
"Developing strategies to improve the prediction and diagnoses of dementia has paramount therapeutic and public health implications," the authors write. "When neuropsychological tests are used for diagnostic purposes, an individual's level of performance on specific tests is measured against healthy normative samples to determine cognitive impairment. However, this approach does not take into account intra-individual variability in cognitive function." Intra-individual variability is inconsistency in cognitive performance within a person.
Roee Holtzer, Ph.D., and colleagues from the Albert Einstein College of Medicine, Yeshiva University, New York, evaluated 897 individuals, age 70 or older, who are part of The Einstein Aging Study, a longitudinal study of aging and dementia in Bronx County, New York. Participants had follow-up visits every 12 to 18 months, at which they underwent detailed neurological and neuropsychological evaluations. The researchers included tests for verbal IQ, attention/executive function, and memory. The study focused on whether within-person across-neuropsychological test variability predicts future dementia.
"Of the 897 participants, there were 61 cases of incident dementia (6.8 percent) … identified during the follow-up period (mean [average] 3.3 years)," the authors report. "On the basis of the consensus clinical diagnostic procedures, 47 participants developed incident dementia of the Alzheimer type and 18 participants developed incident vascular dementia. During the study, 128 individuals died, as expected for the age of this cohort. Of these, 18 had developed incident dementia."
"In summary, within-person across-neuropsychological test variability was associated with development of dementia independently of performance of the neuropsychological tests. This finding needs to be replicated in different populations before it is applied in a clinical setting," the authors conclude.
http://www.sciencedaily.com/releases/2008/08/080819170429.htm
Adolescent Depression
Adolescent depression is a disorder occurring during the teenage years marked by persistent sadness, discouragement, loss of self-worth, and loss of interest in usual activities.
Causes
Depression can be a temporary response to many situations and stresses. In adolescents, depressed mood is common because of the normal maturation process, the stress associated with it, the influence of sex hormones, and independence conflicts with parents.
It may also be a reaction to a disturbing event, such as the death of a friend or relative, a breakup with a boyfriend or girlfriend, or failure at school. Adolescents who have low self-esteem, are highly self-critical, and who feel little sense of control over negative events are particularly at risk to become depressed when they experience stressful events.
True depression in teens is often difficult to diagnose because normal adolescent behavior is marked by both up and down moods. These moods may alternate over a period of hours or days.
Persistent depressed mood, faltering school performance, failing relations with family and friends, substance abuse, and other negative behaviors may indicate a serious depressive episode. These symptoms may be easy to recognize, but depression in adolescents often starts very differently than these classic symptoms.
Excessive sleeping, change in eating habits, even criminal behavior (like shoplifting) may be signs of depression. Another common symptom of adolescent depression is an obsession with death, which may take the form either of suicidal thoughts or of fears about death and dying.
Adolescent girls are twice as likely as boys to experience depression.
Risk factors include:
Stressful life events, particularly loss of a parent to death or divorce
Child abuse - both physical and sexual
Unstable caregiving, poor social skills
Chronic illness
Family history of depression
Depression is also associated with eating disorders, particularly bulimia.
Back to TopSymptoms
Depressed or irritable mood
Temper (agitation)
Loss of interest in activities
Reduced pleasure in daily activities
Appetite changes (usually a loss of appetite but sometimes an increase)
Weight change (unintentional weight loss or unintentional weight gain)
Persistent difficulty falling asleep or staying asleep (insomnia)
Excessive daytime sleepiness
Fatigue
Difficulty concentrating
Fifficulty making decisions
Episodes of memory loss
Preoccupation with self
Feelings of worthlessness, sadness, or self-hatred
Excessive or inappropriate feelings of guilt
Acting-out behavior (missing curfews, unusual defiance)
Thoughts about suicide or obsessive fears or worries about death
Plans to commit suicide or actual suicide attempt
Excessively irresponsible behavior pattern
If these symptoms persist for at least 2 weeks and cause significant distress or difficulty functioning, treatment should be sought.
Back to TopSigns and Tests
The doctor will perform a physical examination and order blood tests to rule out medical causes for the symptoms.
The doctor will evaluate the teen for signs of substance abuse. Heavy drinking, frequent marijuana (pot) smoking, and other drug use can be caused by or occur because of depression.
A psychiatric evaluation will also be done to document the teen's history of sadness, irritability, and loss of interest and pleasure in normal activities. The doctor will look for signs of potentially co-existing psychiatric disorders such as anxiety, mania, or schizophrenia. A careful assessement of the teenager will help determine suicidal/homicidal risks -- that is, if the teen is a danger to him or herself or others.
Information from family members or school personnel can often help identify depression in teenagers.
Back to TopTreatment
Treatment options for adolescents with depression are similar to those for used to treat depression in adults. Treatments may include psychotherapy and antidepressant medications.
MEDICATION
The first medication considered is usually a type of antidepressant called a selective serotonin reuptake inhibitors (SSRI). Prozac is most often the first choice. NOTE: SSRI's carry a warning that they may increase the risk of suicidal thoughts and actions in children and adolescents. Teens and families should be alert for sudden changes or increased suicidal thoughts. Talk to your doctor about the benefits and risks of such medicine.
Not all antidepressants are approved for use in children and teens. For example, tricyclics are not approved for use in teens.
THERAPY
Family therapy may be helpful if family conflict is contributing to the depression. Support from family or teachers to help with school problems may also be needed. Occasionally, hospitalization in a psychiatric unit may be required for individuals with severe depression, or if they are at risk of suicide.
Because of the behavior problems that often co-exist with adolescent depression, many parents are tempted to send their child to a "boot camp", "wilderness program", or "emotional growth school."
These programs often use non-medical staff, confrontational therapies, and harsh punishments. There is no scientific evidence to support such programs. In fact, there is a growing body of research which suggests that they can actually harm sensitive teens with depression.
Depressed teens who act out may also become involved with the criminal justice system. Parents are often advised not to intervene, but to "let them experience consequences."
Unfortunately, this can also harm teens through exposure to more deviant peers and reduction in educational opportunities. A better solution is to get the best possible legal advice and search for treatment on your own, which gives parents more control over techniques used and options.
Though a large percentage of teens in the criminal justice system have mental disorders like depression, few juvenile prisons, "boot camps" or other "alternative to prison" programs provide adequate treatment.
Back to TopExpectations (prognosis)
Depressive episodes usually respond to treatment, and early and comprehensive treatment of depression in adolescence may prevent further episodes. However, about half of seriously depressed teens are likely to have continued problems with depression as adults.
Back to TopComplications
Teenage suicide is associated with depression as well as many other factors. Depression frequently interferes with school performance and interpersonal relationships. Teens with depression often have other psychiatric problems, such as anxiety disorders.
Depression is also commonly associated with violence and reckless behavior. Drug, alcohol, and tobacco abuse frequently coexist with depression. Adolescents with additional psychiatric problems usually require longer and more intensive treatment.
Back to TopCalling Your Health Care Provider
Call your health care provider if one or more warning signs of potential suicide are present.
Be alert to the following signs:
Withdrawal, with urge to be alone, isolation
Moodiness
Personality change
Threat of suicide
Giving most cherished possessions to others
NEVER IGNORE A SUICIDE THREAT OR ATTEMPT!
Back to TopPrevention
Periods of depressed mood are common in most adolescents. However, supportive interpersonal relationships and healthy coping skills can help prevent such periods from leading to more severe depressive symptoms. Open communication with your teen can help identify depression earlier.
Counseling may help teens deal with periods of low mood. Cognitive behavioral therapy, which teaches depressed people ways of fighting negative thoughts and recognizing them as symptoms, not the truth about their world, is the most effective non-medication treatment for depression. Ensure that counsellors or psychologists sought are trained in this method.
For adolescents with a strong family history of depression, or with multiple risk factors, episodes of depression may not be preventable. For these teens, early identification and prompt and comprehensive treatment of depression may prevent or postpone further episodes.
Back to TopReferences
MacKenzie DL, Gover AR, Armstrong GS, Mitchell O. A National Study Comparing the Environments of Boot Camps With Traditional Facilities for Juvenile Offenders. Washington, DC. National Institute of Justice, US Dept. of Justice; 2001.
Borque B, Han M, Hill S. A National Survey of Aftercare Provisions for Boot Camp Graduates. Washington, DC. National Institute of Justice, US Dept. of Justice; 1996.
Bottcher J, Isorena T. First-year evaluation of the California Youth Authority Boot Camp. In: D MacKenzie, E Herbert, eds. Correctional Boot Camps: A Tough Intermediate Sanction. Washington, DC: National Institute of Justice, US Dept of Justice; 1995.
MacKenzie D, Souryal C. Multi-site Evaluation of Shock Incarceration. Washington, DC: National Institute of Justice, US Dept of Justice; 1994.
Peters M, Thomas D, Zamberlan C. Boot Camps for Juvenile Offenders Program Summary. Washington, DC: Office of Juvenile Justice and Delinquency Prevention, US Dept of Justice; 1997.
http://www.sciencedaily.com/releases/2008/07/080728193235.htm
Researchers have discovered that our society can influence the way we recognise other people's faces.
Because face recognition is effortlessly achieved by people from all different cultures it was considered to be a basic mechanism universal among humans. However, by using analyses inspired by novel brain imaging technology, researchers at the University of Glasgow have discovered that cultural differences cause us to look at faces differently.
Lead researcher Dr Roberto Caldara said: "In a series of eye-movement studies, we showed that social experience has an impact on how people look at faces. Specifically we noticed a striking difference in eye movements in Westerners and East Asian observers. We found that Westerners tend to look at specific features on an individual's face such as the eyes and mouth whereas East Asian observers tend to focus on the nose or the centre of the face which allows a more general view of all the features. One possible cause of this could be that direct or excessive eye contact may be considered rude in East Asian cultures."
The results of the study, funded by the Economic and Social Research Council and the Medical Research Council, provide novel insights into why non verbal communication between people from different cultures is sometimes problematic, in an age where globalisation has dramatically increased interdependence, integration and interaction among people and corporations from all over the world. Western societies are generally more individualistic, whereas East Asian societies are collectivistic; Westerners appear to think and perceive focally and Easterners globally.
Dr Caldara continued: "By disproving the long-held assumption that face processing is universally achieved we have highlighted that the external environment, including the society in which we develop, is very influential in basic human mechanisms and caution should be taken when generalising findings to the entire human population."
Lead researcher Dr Roberto Caldara said: "In a series of eye-movement studies, we showed that social experience has an impact on how people look at faces. Specifically we noticed a striking difference in eye movements in Westerners and East Asian observers. We found that Westerners tend to look at specific features on an individual's face such as the eyes and mouth whereas East Asian observers tend to focus on the nose or the centre of the face which allows a more general view of all the features. One possible cause of this could be that direct or excessive eye contact may be considered rude in East Asian cultures."
The results of the study, funded by the Economic and Social Research Council and the Medical Research Council, provide novel insights into why non verbal communication between people from different cultures is sometimes problematic, in an age where globalisation has dramatically increased interdependence, integration and interaction among people and corporations from all over the world. Western societies are generally more individualistic, whereas East Asian societies are collectivistic; Westerners appear to think and perceive focally and Easterners globally.
Dr Caldara continued: "By disproving the long-held assumption that face processing is universally achieved we have highlighted that the external environment, including the society in which we develop, is very influential in basic human mechanisms and caution should be taken when generalising findings to the entire human population."
‘There has been a rise in focus on the body aesthetic and that’s affecting men as well as girls,’ she said. There has undoubtedly been some influence
A recent study reveals that university undergraduate women who actively participate in sports and exercise-related activities tend to have higher rates of attitudes and behaviors related to eating disorders compared to those who do not regularly exercise.
The researchers concluded that women who have higher anxiety about their sport or exercise-related performance were even more likely to experience eating disorder symptoms and body dissatisfaction. This study is one of the first to document that women who participate in high levels of athletic competition and have sports anxiety are more likely to experience eating disorder symptoms.
The study was conducted with 274 female undergraduates from a large southeastern university. It examined whether differences in eating disorder symptoms exist between women who are varsity athletes (exercised an average of two hours per day), club athletes (practiced their sport an average of four times per week), independent exercisers (people who exercised on their own at least three times per week) and non-exercisers (people who exercise 0-2 times per week on average).
All participants completed the Eating Disorders Inventory, a self-report measuring eating related behaviors and attitudes; the Rosenberg Self Esteem Scale, a measurement tool used to evaluate self-esteem; and the Physical Activity and Sport Anxiety Scale, a questionnaire used to assess social fear and avoidance of physical activity or athletic situations.
This study has long-term significance in that the data suggest that coaches and athletic departments of competitive athletes should be on the look-out for sports-related anxiety as these athletes may be at higher risk for eating disorder symptoms in comparison to women who are less anxious about their performance and those who are not involved in competitive athletics.
"As women's participation in athletics increases, so too does the need for awareness of the link between eating disorders and sports participation among women. Coaches and athletic departments should consider consulting with clinicians to implement prevention and monitoring programs for the female athletes and independent exercisers at their universities," said Jill Holm-Denoma of the University of Denver, lead author of the study.
This study is published in International Journal of Eating Disorders.
http://www.sciencedaily.com/releases/2008/07/080728193235.htm
The researchers concluded that women who have higher anxiety about their sport or exercise-related performance were even more likely to experience eating disorder symptoms and body dissatisfaction. This study is one of the first to document that women who participate in high levels of athletic competition and have sports anxiety are more likely to experience eating disorder symptoms.
The study was conducted with 274 female undergraduates from a large southeastern university. It examined whether differences in eating disorder symptoms exist between women who are varsity athletes (exercised an average of two hours per day), club athletes (practiced their sport an average of four times per week), independent exercisers (people who exercised on their own at least three times per week) and non-exercisers (people who exercise 0-2 times per week on average).
All participants completed the Eating Disorders Inventory, a self-report measuring eating related behaviors and attitudes; the Rosenberg Self Esteem Scale, a measurement tool used to evaluate self-esteem; and the Physical Activity and Sport Anxiety Scale, a questionnaire used to assess social fear and avoidance of physical activity or athletic situations.
This study has long-term significance in that the data suggest that coaches and athletic departments of competitive athletes should be on the look-out for sports-related anxiety as these athletes may be at higher risk for eating disorder symptoms in comparison to women who are less anxious about their performance and those who are not involved in competitive athletics.
"As women's participation in athletics increases, so too does the need for awareness of the link between eating disorders and sports participation among women. Coaches and athletic departments should consider consulting with clinicians to implement prevention and monitoring programs for the female athletes and independent exercisers at their universities," said Jill Holm-Denoma of the University of Denver, lead author of the study.
This study is published in International Journal of Eating Disorders.
http://www.sciencedaily.com/releases/2008/07/080728193235.htm
Now men fall prey to anorexia as they seek a body like Beckham
It is a complaint usually associated with teenage girls but the number of men being treated for the eating disorder anorexia has gone up by 67 per cent in the past five years.
The increase is being blamed partly on the rising popularity of lifestyle magazines for men featuring pictures of trim sportsmen such as David Beckham.
Official figures for England show that 137 men suffering the most severe cases of anorexia saw specialists in the past year – up from 82 during 2001/02. Experts say the figure is just the tip of the iceberg as it reflects only those whose treatment is so vital that it could save their lives.
They say calls from men to eating disorder helplines increased tenfold after former Deputy Prime Minister John Prescott revealed his battle with bulimia. And they claim male anorexia has become an ‘unrecognised spiralling epidemic’ as men as well as women are bombarded with images of the ideal body.
The figures were released by the Department of Health in response to questions from the Conservatives.
They reveal that specialist appointments in hospitals for anorexia have risen by 32 per cent to 1,700. The number of children under 14 being seen rose by 26 per cent from 202 in 2001/02 to 255 during the past year.
Some areas were worse affected than others. In Durham the number of anorexics being seen in hospitals has rocketed by 360 per cent, in South-East London the figure has risen by 246 per cent and in Yorkshire by 139 per cent.
Susan Ringwood, chief executive of eating disorder charity Beat, said the rise in male anorexia masked a much bigger problem because men traditionally are less likely to seek help. But, since Mr Prescott spoke out, phone calls to its helpline from men had increased almost ten times.
‘There has been a rise in focus on the body aesthetic and that’s affecting men as well as girls,’ she said. There has undoubtedly been some influence from the rise in male magazines.
‘Clinics are now seeing many more men, as well as children as young as eight. We know children are more likely to develop an eating disorder during puberty, and puberty is starting on average five years earlier than it did 50 years ago.’
Consultant psychiatrist Frances Connan, lead clinician for the Vincent Square eating-disorder clinic, part of Central and North-West London NHS Foundation Trust, said it was ‘doubly humiliating’ for men to come forward because mental health and anorexia were seen as ‘girls’ problems’. But she said men were now succumbing to the same idealistic stereotypes as women.
Anorexics seeking clinical help are seen by psychologists or psychiatrists in a hospital trust. Children are referred to an adolescent mental health team.
Some need medical advice on nutrition and may need clinical help to put on weight. In some cases that can mean having a feeding tube or drip inserted.
But many hospitals do not have eating disorder specialists and some patients are forced to travel hundreds of miles to seek help.
Shadow Health Minister Anne Milton said the figures were shocking.
‘At one end of the scale we have some frightening statistics on obesity and at the other we have young people suffering from this tragic illness,’ she said.
‘This is yet another example of the Government dropping the ball on child and adolescent mental health.’
A Healthcare Commission inquiry last month found that many trusts were failing mental health patients. It revealed that many vulnerable patients were being allowed to escape and found wards to be understaffed and overcrowded.
A Department of Health spokesman said: ‘We take the issue of eating disorders, especially among young people, very seriously.’
The increase is being blamed partly on the rising popularity of lifestyle magazines for men featuring pictures of trim sportsmen such as David Beckham.
Official figures for England show that 137 men suffering the most severe cases of anorexia saw specialists in the past year – up from 82 during 2001/02. Experts say the figure is just the tip of the iceberg as it reflects only those whose treatment is so vital that it could save their lives.
They say calls from men to eating disorder helplines increased tenfold after former Deputy Prime Minister John Prescott revealed his battle with bulimia. And they claim male anorexia has become an ‘unrecognised spiralling epidemic’ as men as well as women are bombarded with images of the ideal body.
The figures were released by the Department of Health in response to questions from the Conservatives.
They reveal that specialist appointments in hospitals for anorexia have risen by 32 per cent to 1,700. The number of children under 14 being seen rose by 26 per cent from 202 in 2001/02 to 255 during the past year.
Some areas were worse affected than others. In Durham the number of anorexics being seen in hospitals has rocketed by 360 per cent, in South-East London the figure has risen by 246 per cent and in Yorkshire by 139 per cent.
Susan Ringwood, chief executive of eating disorder charity Beat, said the rise in male anorexia masked a much bigger problem because men traditionally are less likely to seek help. But, since Mr Prescott spoke out, phone calls to its helpline from men had increased almost ten times.
‘There has been a rise in focus on the body aesthetic and that’s affecting men as well as girls,’ she said. There has undoubtedly been some influence from the rise in male magazines.
‘Clinics are now seeing many more men, as well as children as young as eight. We know children are more likely to develop an eating disorder during puberty, and puberty is starting on average five years earlier than it did 50 years ago.’
Consultant psychiatrist Frances Connan, lead clinician for the Vincent Square eating-disorder clinic, part of Central and North-West London NHS Foundation Trust, said it was ‘doubly humiliating’ for men to come forward because mental health and anorexia were seen as ‘girls’ problems’. But she said men were now succumbing to the same idealistic stereotypes as women.
Anorexics seeking clinical help are seen by psychologists or psychiatrists in a hospital trust. Children are referred to an adolescent mental health team.
Some need medical advice on nutrition and may need clinical help to put on weight. In some cases that can mean having a feeding tube or drip inserted.
But many hospitals do not have eating disorder specialists and some patients are forced to travel hundreds of miles to seek help.
Shadow Health Minister Anne Milton said the figures were shocking.
‘At one end of the scale we have some frightening statistics on obesity and at the other we have young people suffering from this tragic illness,’ she said.
‘This is yet another example of the Government dropping the ball on child and adolescent mental health.’
A Healthcare Commission inquiry last month found that many trusts were failing mental health patients. It revealed that many vulnerable patients were being allowed to escape and found wards to be understaffed and overcrowded.
A Department of Health spokesman said: ‘We take the issue of eating disorders, especially among young people, very seriously.’
Eating disorder risk high in young active women
NEW YORK (Reuters Health) - Young female athletes or those with high levels of physical activity seem to be more vulnerable to eating disorders than their less athletic peers, a study suggests.
Researchers found that among 274 female undergraduates, those who were regularly active -- whether through sports or by exercising on their own -- were more likely to be dissatisfied with their bodies, strive to remain thin or have symptoms of bulimia.
At greatest risk were students who competed in varsity athletics and had a high level of anxiety over their performance, the researchers report in the International Journal of Eating Disorders.
Past studies have shown that female athletes tend to have a higher risk of eating disorders than their non-athletic counterparts, though the risk seems to vary according to the sport. Not surprisingly, sports that place a high value on thinness -- such as gymnastics, figure skating or distance running -- have been particularly linked to body-image concerns and unhealthy weight-control habits.
Similarly, excessive levels of exercise can be a symptom of an eating disorder, or a signal that someone is at risk of developing one.
These latest findings suggest that "sports anxiety" may contribute to eating disorder risk in athletes, according to the researchers, led by Dr. Jill M. Holm-Denoma of the University of Vermont in Burlington.
Among athletes in their study, those who scored high on a standard measure of sports anxiety also had the highest rates of body dissatisfaction and bulimia symptoms.
"As women's participation in athletics increases, so too does the need for awareness of the link between eating disorders and sports participation among women," Holm-Denoma said in a journal statement.
"Coaches and athletic departments should consider consulting with clinicians to implement prevention and monitoring programs for the female athletes and independent exercisers at their universities," she added.
It's not clear whether sports and physical activity actually cause young women to become dissatisfied with their bodies.
"On one hand," the researchers write, "women may develop eating disorder symptoms as a result of participating in athletic events and experiencing the associated pressures of competition."
"Alternatively," they add, "women who are at a high risk for developing eating disorders may elect to become involved in athletics, perhaps in an effort to manage their weight."
Future studies should try to weed out the reasons that sports, sports anxiety and eating disorder symptoms are all linked, the researchers conclude.
SOURCE: International Journal of Eating Disorders, August 2008.
http://www.reutershealth.com/archive/2008/08/12/eline/links/20080812elin003.html
Researchers found that among 274 female undergraduates, those who were regularly active -- whether through sports or by exercising on their own -- were more likely to be dissatisfied with their bodies, strive to remain thin or have symptoms of bulimia.
At greatest risk were students who competed in varsity athletics and had a high level of anxiety over their performance, the researchers report in the International Journal of Eating Disorders.
Past studies have shown that female athletes tend to have a higher risk of eating disorders than their non-athletic counterparts, though the risk seems to vary according to the sport. Not surprisingly, sports that place a high value on thinness -- such as gymnastics, figure skating or distance running -- have been particularly linked to body-image concerns and unhealthy weight-control habits.
Similarly, excessive levels of exercise can be a symptom of an eating disorder, or a signal that someone is at risk of developing one.
These latest findings suggest that "sports anxiety" may contribute to eating disorder risk in athletes, according to the researchers, led by Dr. Jill M. Holm-Denoma of the University of Vermont in Burlington.
Among athletes in their study, those who scored high on a standard measure of sports anxiety also had the highest rates of body dissatisfaction and bulimia symptoms.
"As women's participation in athletics increases, so too does the need for awareness of the link between eating disorders and sports participation among women," Holm-Denoma said in a journal statement.
"Coaches and athletic departments should consider consulting with clinicians to implement prevention and monitoring programs for the female athletes and independent exercisers at their universities," she added.
It's not clear whether sports and physical activity actually cause young women to become dissatisfied with their bodies.
"On one hand," the researchers write, "women may develop eating disorder symptoms as a result of participating in athletic events and experiencing the associated pressures of competition."
"Alternatively," they add, "women who are at a high risk for developing eating disorders may elect to become involved in athletics, perhaps in an effort to manage their weight."
Future studies should try to weed out the reasons that sports, sports anxiety and eating disorder symptoms are all linked, the researchers conclude.
SOURCE: International Journal of Eating Disorders, August 2008.
http://www.reutershealth.com/archive/2008/08/12/eline/links/20080812elin003.html
Goal: Keep mentally ill out of prison
McClatchy-Tribune Information Services -- Unrestricted - August 24, 2008
Aug. 24--Eyes peered through the narrow window in the cell door.
"I'm getting out tomorrow," said the man, little more than a disembodied voice shouting over the screams of neighboring inmates at the Larned Correctional Mental Health Facility.
He didn't mean out of prison -- just out of the cell where he spends 23 hours a day. Officially known as "administrative segregation," inmates call isolation units such as these "the hole."
The 27-year-old has been in isolation since 2002 -- a confinement prison officials say is necessary for security but which research shows can worsen mental illness.
Increasingly, it's the mentally ill who end up behind bars. In Kansas and nationwide, prisons have become this country's largest mental health institutions.
Many inmates come out in worse shape than when they went in, experts say -- a greater threat to public safety and a drain on public resources.
For the first time, the county's mental health providers and law enforcement are coming together to steer the mentally ill away from locked cells and into treatment, combating a complicated problem that's been building for decades.
This week, Wichita police and Sedgwick County sheriff's deputies and jail detention officers will learn how to identify the mentally ill and provide alternatives to arresting them. The approach is based on a model that has succeeded in Memphis, Las Vegas and other cities.
In Kansas, nearly 9 in 10 inmates in state prisons -- 7,690 -- suffer from mental illnesses, according to the Department of Corrections.
"I'm not sure we ought to be the primary source of residential mental health services in the state," said Kansas Secretary of Corrections Roger Werholtz. "That's certainly not our mission."
In Sedgwick County, every convict coming out of prison and into the county's re-entry program needs mental health services, according to a report from the University of Kansas.
"It's like coming back from a war zone," said re-entry program director Sally Frey.
Prisons were meant to harbor criminals, not treat persistent mental illnesses or behavior disorders.
But nationally, the number of mentally ill inmates in state prisons has tripled in the past decade, according to the U.S. Bureau of Justice Statistics. In 1998, the bureau counted 179,200 mentally ill state prison inmates. By 2005, there were 705,600.
"It's not like they had a straight path to prison," said Richard Cagen, Kansas director for the National Alliance on Mental Illness. "They didn't have other resources.... And once you're in the criminal justice system, it's difficult to get out."
In prison, many mentally ill people find:
Shelter, where before they were homeless
The best medications for their illnesses, which insurance or social services won't pay for on the outside
Respite from drugs and alcohol they have abused to stop the pain inside their heads
But prison isn't the alternative mental health care that professionals imagined when state hospitals began closing in the 1960s in favor of community-based care.
The money for that treatment didn't materialize, Risdon Slate and Wesley Johnson write in their book "Criminalization of Mental Illness."
Instead, states paid to build more prisons.
Life on lockdown
Checkerboard tiles cover some units at the Larned prison, where Kansas sends inmates with the most serious mental and behavior problems.
But only bare concrete covers the floor in administrative segregation.
Inmates there spend 23 hours a day in an 8-by-13-foot cell. When officers open the door for the 24th hour, they often receive an unpleasant greeting.
"The inmates have thrown urine out there until they have soaked tile right up off the floor," said warden Karen Rohling. "We just could not get tile to stick to the floor there."
The 27-year-old inmate who thought he would be getting out of isolation the next day came to Larned from solitary lockdown at the El Dorado Correctional Facility.
"I've been working on my behavior and now they're going to let me back out into population," he said in a voice full of hope.
Larned wasn't intended to provide long-term care when it opened in 1992. But it does.
"Over time, because of changes at the state hospital and other places, we find we're keeping them longer and longer," Rohling said.
Inside the cells
Inmates in the hole can earn a television or radio for good behavior. For one hour a day, they are led in shackles outdoors, where they can walk in an 8-by-33 1/2 -foot chain-link area inmates call "the dog run."
"You can walk back and forth in your cell two or three hours a day," said Morris Whittaker, 46, an inmate who lived in isolation at El Dorado and Larned prisons. "All the time you're trying to keep your calm and cool so you can do better things."
John Hawley, 46, who has served 27 years on convictions of rape and aggravated sodomy, has been at Larned since 1992. He's haunted by the memory of his wife, who died in surgery.
"I blame myself for that," he said. "I wasn't there for her."
Hawley still sees and hears his wife as part of his psychosis.
He briefly went to Larned's mental health hospital, which inmates call "the hill," but came back to the prison after an inappropriate relationship with a staff member.
He's now a porter, cleaning the F3 unit. That's where inmates move to transition from the hole. In F3, inmates may leave their cells for two hours and are trying to reach a point where they can join the general population.
Elston Taylor, 29, hears voices and responds by slitting his wrists. Taylor went to prison in 2002 for burglary in Sedgwick County. He served time in Hutchinson and Lansing before Larned.
At Lansing, he said his behavior landed him in the so-called "crisis cell."
"They take you over to the clinic and put you in a strip cell where you just get your boxers, a mattress and a security blanket," Taylor said.
When sentences end
Most of these inmates will get out and move back into communities across Kansas -- some after years in isolation.
"You can conceivably make their mental illness worse by isolating them too much," said Werholtz, the secretary of corrections.
Larned's goal is to get inmates out of isolation within six months. But some come from other prisons having lived that way for years.
Such was the case for Larned inmate Whittaker, who earned parole in 1983, 2005 and 2006. He returned to prison each time for violating his parole, not for committing a new crime.
He said it's because he drinks too much. Most mentally ill prisoners have drug and alcohol addictions.
Rohling, the warden, has heard this scenario many times:
In Larned, an inmate gets the newest drugs for his mental illness. But outside they're not covered by Medicare or Medicaid.
"He may have little choice but to go off his medication," she said.
The meds available outside often fetch more money being sold on the street than a person receives for rent or food. Parole officers say the mentally ill who can't work typically live off $241 a month in state financial assistance.
For extra money, they sell their pills, turning to alcohol or illegal drugs, such as methamphetamine and ecstasy -- drugs that "do awful things to the mentally ill," Rohling said.
They return to prison and get treatment, "but we almost never get them back to the same level of functioning that they were on that first release," she said.
Werholtz added that the biggest challenge the prison system faces is what to do when sentences run out.
"We struggle with making sure that the men and women who are leaving our facility get a smooth transition and continuity of care, particularly medication maintenance, once they're released."
Out on the streets
Outside prison, former inmates face problems compounded by mental illness, said parole officer Dawn Shepler, who works with the mentally ill.
Few have family support, and most need a place to live, she said. But landlords hesitate to rent to ex-cons. Some people go from prison to a homeless shelter.
It takes 30 to 90 days to get financial assistance from the state. It can take up to two years to receive permanent federal disability, which they lose each time they go to prison.
When someone has a psychotic episode or other crisis, it's usually the police who respond.
"Sometimes, they take them to jail because they don't know where else to take them," Shepler said.
This week's training will teach officers alternatives.
The goal is to forge law enforcement and mental health providers into a crisis intervention team, a program supported by the National Alliance for the Mentally Ill.
Jason Scheck, director of crisis intervention for Comcare, the county's mental health agency, saw a similar program at work in Memphis.
"They will approach consumers (of mental health) not in an adversarial role, but in a way which says they want to help them get the treatment they need," Scheck said.
Memphis began its program in 1988 after police shot and killed a 27-year-old mentally ill man. The police now say the program helped eliminate the stigma officers had against the mentally ill and helped the mentally ill trust police.
The best part for taxpayers, Shepler said: It doesn't cost anything. The approach centers more on changing the way police do their job than on adding new resources.
But authors Slate and Johnson say such alternatives work only if there are adequate community programs in place.
As governments and private insurance cut reimbursement for mental health, for-profit hospitals closed their units, and others went out of business.
There used to be eight units in Wichita to identify people who need mental health care. Now there is one -- at Via Christi Regional Medical Center-St. Joseph Campus.
Lois Clendening, director of Via Christi Behavioral Health Good Shepherd Campus, said the St. Joseph center sees 500 people a month.
In the past two years, Congress has allocated $5 million a year for programs that divert the mentally ill away from jails and prisons. But the money is enough to pay for only about 11 percent of program requests.
In 2006, the County Commission funded the Sedgwick County Offender Assessment Program as an alternative for mentally ill people arrested for minor, nonviolent crimes. It will serve the new crisis intervention program.
Still isolated
The 27-year-old inmate who spoke so excitedly about getting out of isolation made those statements on April 17.
On June 26, he was still in the hole.
On Aug. 7, he returned to El Dorado, where he remained in that prison's isolation unit.
He's set to get out of prison in seven years.
By then, Sedgwick County hopes to have trained 20 percent of its law enforcement in crisis intervention.
"We know Band-Aids won't work," Shepler said. "We need better housing. We need more mental health beds. You can't solve this by building a bigger jail."
Reach Ron Sylvester at 316-268-6514 or rsylvester@wichitaeagle.com. To see more of The Wichita Eagle, or to subscribe to the newspaper, go to http://www.kansas.com. Copyright (c) 2008, The Wichita Eagle, Kan. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2008 The Wichita Eagle, Kan.
Aug. 24--Eyes peered through the narrow window in the cell door.
"I'm getting out tomorrow," said the man, little more than a disembodied voice shouting over the screams of neighboring inmates at the Larned Correctional Mental Health Facility.
He didn't mean out of prison -- just out of the cell where he spends 23 hours a day. Officially known as "administrative segregation," inmates call isolation units such as these "the hole."
The 27-year-old has been in isolation since 2002 -- a confinement prison officials say is necessary for security but which research shows can worsen mental illness.
Increasingly, it's the mentally ill who end up behind bars. In Kansas and nationwide, prisons have become this country's largest mental health institutions.
Many inmates come out in worse shape than when they went in, experts say -- a greater threat to public safety and a drain on public resources.
For the first time, the county's mental health providers and law enforcement are coming together to steer the mentally ill away from locked cells and into treatment, combating a complicated problem that's been building for decades.
This week, Wichita police and Sedgwick County sheriff's deputies and jail detention officers will learn how to identify the mentally ill and provide alternatives to arresting them. The approach is based on a model that has succeeded in Memphis, Las Vegas and other cities.
In Kansas, nearly 9 in 10 inmates in state prisons -- 7,690 -- suffer from mental illnesses, according to the Department of Corrections.
"I'm not sure we ought to be the primary source of residential mental health services in the state," said Kansas Secretary of Corrections Roger Werholtz. "That's certainly not our mission."
In Sedgwick County, every convict coming out of prison and into the county's re-entry program needs mental health services, according to a report from the University of Kansas.
"It's like coming back from a war zone," said re-entry program director Sally Frey.
Prisons were meant to harbor criminals, not treat persistent mental illnesses or behavior disorders.
But nationally, the number of mentally ill inmates in state prisons has tripled in the past decade, according to the U.S. Bureau of Justice Statistics. In 1998, the bureau counted 179,200 mentally ill state prison inmates. By 2005, there were 705,600.
"It's not like they had a straight path to prison," said Richard Cagen, Kansas director for the National Alliance on Mental Illness. "They didn't have other resources.... And once you're in the criminal justice system, it's difficult to get out."
In prison, many mentally ill people find:
Shelter, where before they were homeless
The best medications for their illnesses, which insurance or social services won't pay for on the outside
Respite from drugs and alcohol they have abused to stop the pain inside their heads
But prison isn't the alternative mental health care that professionals imagined when state hospitals began closing in the 1960s in favor of community-based care.
The money for that treatment didn't materialize, Risdon Slate and Wesley Johnson write in their book "Criminalization of Mental Illness."
Instead, states paid to build more prisons.
Life on lockdown
Checkerboard tiles cover some units at the Larned prison, where Kansas sends inmates with the most serious mental and behavior problems.
But only bare concrete covers the floor in administrative segregation.
Inmates there spend 23 hours a day in an 8-by-13-foot cell. When officers open the door for the 24th hour, they often receive an unpleasant greeting.
"The inmates have thrown urine out there until they have soaked tile right up off the floor," said warden Karen Rohling. "We just could not get tile to stick to the floor there."
The 27-year-old inmate who thought he would be getting out of isolation the next day came to Larned from solitary lockdown at the El Dorado Correctional Facility.
"I've been working on my behavior and now they're going to let me back out into population," he said in a voice full of hope.
Larned wasn't intended to provide long-term care when it opened in 1992. But it does.
"Over time, because of changes at the state hospital and other places, we find we're keeping them longer and longer," Rohling said.
Inside the cells
Inmates in the hole can earn a television or radio for good behavior. For one hour a day, they are led in shackles outdoors, where they can walk in an 8-by-33 1/2 -foot chain-link area inmates call "the dog run."
"You can walk back and forth in your cell two or three hours a day," said Morris Whittaker, 46, an inmate who lived in isolation at El Dorado and Larned prisons. "All the time you're trying to keep your calm and cool so you can do better things."
John Hawley, 46, who has served 27 years on convictions of rape and aggravated sodomy, has been at Larned since 1992. He's haunted by the memory of his wife, who died in surgery.
"I blame myself for that," he said. "I wasn't there for her."
Hawley still sees and hears his wife as part of his psychosis.
He briefly went to Larned's mental health hospital, which inmates call "the hill," but came back to the prison after an inappropriate relationship with a staff member.
He's now a porter, cleaning the F3 unit. That's where inmates move to transition from the hole. In F3, inmates may leave their cells for two hours and are trying to reach a point where they can join the general population.
Elston Taylor, 29, hears voices and responds by slitting his wrists. Taylor went to prison in 2002 for burglary in Sedgwick County. He served time in Hutchinson and Lansing before Larned.
At Lansing, he said his behavior landed him in the so-called "crisis cell."
"They take you over to the clinic and put you in a strip cell where you just get your boxers, a mattress and a security blanket," Taylor said.
When sentences end
Most of these inmates will get out and move back into communities across Kansas -- some after years in isolation.
"You can conceivably make their mental illness worse by isolating them too much," said Werholtz, the secretary of corrections.
Larned's goal is to get inmates out of isolation within six months. But some come from other prisons having lived that way for years.
Such was the case for Larned inmate Whittaker, who earned parole in 1983, 2005 and 2006. He returned to prison each time for violating his parole, not for committing a new crime.
He said it's because he drinks too much. Most mentally ill prisoners have drug and alcohol addictions.
Rohling, the warden, has heard this scenario many times:
In Larned, an inmate gets the newest drugs for his mental illness. But outside they're not covered by Medicare or Medicaid.
"He may have little choice but to go off his medication," she said.
The meds available outside often fetch more money being sold on the street than a person receives for rent or food. Parole officers say the mentally ill who can't work typically live off $241 a month in state financial assistance.
For extra money, they sell their pills, turning to alcohol or illegal drugs, such as methamphetamine and ecstasy -- drugs that "do awful things to the mentally ill," Rohling said.
They return to prison and get treatment, "but we almost never get them back to the same level of functioning that they were on that first release," she said.
Werholtz added that the biggest challenge the prison system faces is what to do when sentences run out.
"We struggle with making sure that the men and women who are leaving our facility get a smooth transition and continuity of care, particularly medication maintenance, once they're released."
Out on the streets
Outside prison, former inmates face problems compounded by mental illness, said parole officer Dawn Shepler, who works with the mentally ill.
Few have family support, and most need a place to live, she said. But landlords hesitate to rent to ex-cons. Some people go from prison to a homeless shelter.
It takes 30 to 90 days to get financial assistance from the state. It can take up to two years to receive permanent federal disability, which they lose each time they go to prison.
When someone has a psychotic episode or other crisis, it's usually the police who respond.
"Sometimes, they take them to jail because they don't know where else to take them," Shepler said.
This week's training will teach officers alternatives.
The goal is to forge law enforcement and mental health providers into a crisis intervention team, a program supported by the National Alliance for the Mentally Ill.
Jason Scheck, director of crisis intervention for Comcare, the county's mental health agency, saw a similar program at work in Memphis.
"They will approach consumers (of mental health) not in an adversarial role, but in a way which says they want to help them get the treatment they need," Scheck said.
Memphis began its program in 1988 after police shot and killed a 27-year-old mentally ill man. The police now say the program helped eliminate the stigma officers had against the mentally ill and helped the mentally ill trust police.
The best part for taxpayers, Shepler said: It doesn't cost anything. The approach centers more on changing the way police do their job than on adding new resources.
But authors Slate and Johnson say such alternatives work only if there are adequate community programs in place.
As governments and private insurance cut reimbursement for mental health, for-profit hospitals closed their units, and others went out of business.
There used to be eight units in Wichita to identify people who need mental health care. Now there is one -- at Via Christi Regional Medical Center-St. Joseph Campus.
Lois Clendening, director of Via Christi Behavioral Health Good Shepherd Campus, said the St. Joseph center sees 500 people a month.
In the past two years, Congress has allocated $5 million a year for programs that divert the mentally ill away from jails and prisons. But the money is enough to pay for only about 11 percent of program requests.
In 2006, the County Commission funded the Sedgwick County Offender Assessment Program as an alternative for mentally ill people arrested for minor, nonviolent crimes. It will serve the new crisis intervention program.
Still isolated
The 27-year-old inmate who spoke so excitedly about getting out of isolation made those statements on April 17.
On June 26, he was still in the hole.
On Aug. 7, he returned to El Dorado, where he remained in that prison's isolation unit.
He's set to get out of prison in seven years.
By then, Sedgwick County hopes to have trained 20 percent of its law enforcement in crisis intervention.
"We know Band-Aids won't work," Shepler said. "We need better housing. We need more mental health beds. You can't solve this by building a bigger jail."
Reach Ron Sylvester at 316-268-6514 or rsylvester@wichitaeagle.com. To see more of The Wichita Eagle, or to subscribe to the newspaper, go to http://www.kansas.com. Copyright (c) 2008, The Wichita Eagle, Kan. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2008 The Wichita Eagle, Kan.
Children of mentally ill parents need support
Deutsche Presse-Agentur (dpa) - August 24, 2008
Stuttgart (dpa) - The offspring of mentally ill parents are at a higher risk of becoming psychologically disturbed than their peers, according to mental health experts in Germany.
In addition to genetic factors, the chance of developing a mental illness increases depending on the psycho-social stress a child is exposed to.
These children are also likely to experience poverty, discrimination and lack of people to relate to, according to Christa Schaff of the Stuttgart-based Professional Association of Child and Teenager Psychiatry, Psychosomatics, and Psychotherapy.
Schaff says it's important that affected children receive emotional and psychological support as soon as possible.
The basis for that support is the effective treatment of their parents.
It's also important that the illness is openly dealt with within the family structure because children often blame themselves for their parents' psychological problems, Schaff explains.
In many cases, children do not have the courage or opportunity to talk to someone about mental issues in the family.
Psychotherapy or discussion groups for the offspring of mentally ill parents often provide a good opportunity to get to grips with the situation.
The chance of a child becoming mentally ill depends on the type of illness and the degree to which their parents are affected.
The age at which their father or mother becomes ill also plays a role.
"If one of the parents suffers from depression, their child is four times more likely to suffer from a mental illness at a young age or as a teenager," says Schaff.
Preventative measures can greatly reduce the risk of that happening.
Copyright 2008 dpa Deutsche Presse-Agentur GmbH
Stuttgart (dpa) - The offspring of mentally ill parents are at a higher risk of becoming psychologically disturbed than their peers, according to mental health experts in Germany.
In addition to genetic factors, the chance of developing a mental illness increases depending on the psycho-social stress a child is exposed to.
These children are also likely to experience poverty, discrimination and lack of people to relate to, according to Christa Schaff of the Stuttgart-based Professional Association of Child and Teenager Psychiatry, Psychosomatics, and Psychotherapy.
Schaff says it's important that affected children receive emotional and psychological support as soon as possible.
The basis for that support is the effective treatment of their parents.
It's also important that the illness is openly dealt with within the family structure because children often blame themselves for their parents' psychological problems, Schaff explains.
In many cases, children do not have the courage or opportunity to talk to someone about mental issues in the family.
Psychotherapy or discussion groups for the offspring of mentally ill parents often provide a good opportunity to get to grips with the situation.
The chance of a child becoming mentally ill depends on the type of illness and the degree to which their parents are affected.
The age at which their father or mother becomes ill also plays a role.
"If one of the parents suffers from depression, their child is four times more likely to suffer from a mental illness at a young age or as a teenager," says Schaff.
Preventative measures can greatly reduce the risk of that happening.
Copyright 2008 dpa Deutsche Presse-Agentur GmbH
Restraining of mentally ill foster kids questioned
McClatchy-Tribune Information Services -- Unrestricted - August 25, 2008
Aug. 25--Last month, a 16-year-old Broward County girl was brought into Circuit Judge John A. Frusciante's courtroom for a hearing. She was handcuffed, her legs shackled with cloth restraints, with two armed deputies leading her by the arm.
Her offense? She's never been charged with one. A mentally ill foster child who was neglected by her mother and wound up in a psychiatric center, the teen was being restrained to keep her from running away, her attorney said.
The girl, who is not being identified to protect her privacy, is among scores of foster children in locked psychiatric centers in Florida recovering from abuse and neglect.
Now, the practice of restraining mentally ill foster children in court is prompting questions in both Broward and Miami-Dade counties.
In Fort Lauderdale, Walter Honaman, the 16-year-old's lawyer and an advocate for foster kids, is working with Frusciante and court officials to develop a voluntary policy to discourage deputies from handcuffing mentally ill foster kids who come to court.
And in Miami, a nurse practitioner who worked briefly as a director of patient care at Jackson Memorial Hospital's mental health center filed complaints with state regulators seeking to end the practice of restraining children who leave JMH's residential treatment center, or RTC.
"We bring these kids into the courtroom in handcuffs with armed deputies," said Honaman, who works for Legal Aid Service of Broward County. 'That's nuts. We don't maintain these kids' dignity, and we send the message that they are being punished. They are being treated like criminals. These are kids that need serious help."
Administrators at Jackson have defended the use of "walking restraints" when children from their treatment center leave the facility, arguing many kids run away, which can endanger them.
The treatment center "uses walking restraints for safety and prevention of elopement when clients are sent to an urgent medical appointment or court hearings that they can't miss early in their admission," Helga Mayrgundter, a program director for one of JMH's children's psychiatric units, wrote in an April e-mail.
Lorraine N. Nelson, a JMH spokeswoman, said the children's psychiatric unit uses walking restraints on less than 1 percent of its patients when they are being transported outside the facility, and follows all regulatory agency guidelines.
"The fabric restraints are only used when a patient is determined to be a flight risk and are removed immediately after a patient has returned safely to the facility," Nelson said. "A board-certified psychiatrist with extensive experience in childhood trauma and behavioral management must write an order for the use of restraints."
Jackson's use of foot restraints came under scrutiny beginning in April, when a new nurse administrator questioned the practice. The nurse, Lisa Burton, later filed complaints, including one to the Miami-Dade County Commission on Ethics and Public Trust.
The ethics commission "conducted a thorough investigation of the allegations and ultimately dismissed the complaint," said JMH's Nelson. The commission findings, "speak for themselves," she said.
In an April em-ail with other JMH administrators, risk manager Tish Batchelder wondered whether halting the restraints would lead to more escapes, thus "putting patients in danger." But she also acknowledged: "I hate the idea that we do it."
Real leg shackles -- the metal kind -- routinely have been used for delinquent children who appear in court, though several public defender offices mounted a statewide campaign two years ago to end the practice. In most counties, shackling continues, said Miami-Dade Public Defender-elect Carlos Martinez, but The Florida Bar is lobbying for a new rule requiring hearings before restraints can be used.
Some judges say there is even less justification for restraining mentally ill foster kids who have not been accused of delinquency.
"It's a horrible stigma," said Miami-Dade Circuit Judge Cindy Lederman, who heads Miami's juvenile courts. "These kids already have mental health problems. I would imagine this would exacerbate them. . . . These are not bad children, and they have not done anything wrong. They are just ill."
Frusciante said he has been asking questions of treatment center and courthouse staff members who bring children to court in restraints. Among them: Do we have to do this?
"It was very disturbing," said Frusciante, who oversees child welfare cases in Broward. He said he wasn't disturbed enough to outright ban the practice at the courthouse, but he is working with Honaman to find ways to limit the use of restraints.
Most treatment centers elsewhere in the state have abandoned the use of restraints, according to internal JHM e-mails obtained by The Miami Herald.
"We do not use them here when we transport children," said Robyn Baskin, a children's program director at Personal Enrichment Through Mental Health Services in Pinellas County. If a child is too great a risk, Baskin said, travel will be postponed or additional staff is provided to ensure safety. To see more of The Miami Herald or to subscribe to the newspaper, go to http://www.herald.com. Copyright (c) 2008, The Miami Herald Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2008 The Miami Herald
Aug. 25--Last month, a 16-year-old Broward County girl was brought into Circuit Judge John A. Frusciante's courtroom for a hearing. She was handcuffed, her legs shackled with cloth restraints, with two armed deputies leading her by the arm.
Her offense? She's never been charged with one. A mentally ill foster child who was neglected by her mother and wound up in a psychiatric center, the teen was being restrained to keep her from running away, her attorney said.
The girl, who is not being identified to protect her privacy, is among scores of foster children in locked psychiatric centers in Florida recovering from abuse and neglect.
Now, the practice of restraining mentally ill foster children in court is prompting questions in both Broward and Miami-Dade counties.
In Fort Lauderdale, Walter Honaman, the 16-year-old's lawyer and an advocate for foster kids, is working with Frusciante and court officials to develop a voluntary policy to discourage deputies from handcuffing mentally ill foster kids who come to court.
And in Miami, a nurse practitioner who worked briefly as a director of patient care at Jackson Memorial Hospital's mental health center filed complaints with state regulators seeking to end the practice of restraining children who leave JMH's residential treatment center, or RTC.
"We bring these kids into the courtroom in handcuffs with armed deputies," said Honaman, who works for Legal Aid Service of Broward County. 'That's nuts. We don't maintain these kids' dignity, and we send the message that they are being punished. They are being treated like criminals. These are kids that need serious help."
Administrators at Jackson have defended the use of "walking restraints" when children from their treatment center leave the facility, arguing many kids run away, which can endanger them.
The treatment center "uses walking restraints for safety and prevention of elopement when clients are sent to an urgent medical appointment or court hearings that they can't miss early in their admission," Helga Mayrgundter, a program director for one of JMH's children's psychiatric units, wrote in an April e-mail.
Lorraine N. Nelson, a JMH spokeswoman, said the children's psychiatric unit uses walking restraints on less than 1 percent of its patients when they are being transported outside the facility, and follows all regulatory agency guidelines.
"The fabric restraints are only used when a patient is determined to be a flight risk and are removed immediately after a patient has returned safely to the facility," Nelson said. "A board-certified psychiatrist with extensive experience in childhood trauma and behavioral management must write an order for the use of restraints."
Jackson's use of foot restraints came under scrutiny beginning in April, when a new nurse administrator questioned the practice. The nurse, Lisa Burton, later filed complaints, including one to the Miami-Dade County Commission on Ethics and Public Trust.
The ethics commission "conducted a thorough investigation of the allegations and ultimately dismissed the complaint," said JMH's Nelson. The commission findings, "speak for themselves," she said.
In an April em-ail with other JMH administrators, risk manager Tish Batchelder wondered whether halting the restraints would lead to more escapes, thus "putting patients in danger." But she also acknowledged: "I hate the idea that we do it."
Real leg shackles -- the metal kind -- routinely have been used for delinquent children who appear in court, though several public defender offices mounted a statewide campaign two years ago to end the practice. In most counties, shackling continues, said Miami-Dade Public Defender-elect Carlos Martinez, but The Florida Bar is lobbying for a new rule requiring hearings before restraints can be used.
Some judges say there is even less justification for restraining mentally ill foster kids who have not been accused of delinquency.
"It's a horrible stigma," said Miami-Dade Circuit Judge Cindy Lederman, who heads Miami's juvenile courts. "These kids already have mental health problems. I would imagine this would exacerbate them. . . . These are not bad children, and they have not done anything wrong. They are just ill."
Frusciante said he has been asking questions of treatment center and courthouse staff members who bring children to court in restraints. Among them: Do we have to do this?
"It was very disturbing," said Frusciante, who oversees child welfare cases in Broward. He said he wasn't disturbed enough to outright ban the practice at the courthouse, but he is working with Honaman to find ways to limit the use of restraints.
Most treatment centers elsewhere in the state have abandoned the use of restraints, according to internal JHM e-mails obtained by The Miami Herald.
"We do not use them here when we transport children," said Robyn Baskin, a children's program director at Personal Enrichment Through Mental Health Services in Pinellas County. If a child is too great a risk, Baskin said, travel will be postponed or additional staff is provided to ensure safety. To see more of The Miami Herald or to subscribe to the newspaper, go to http://www.herald.com. Copyright (c) 2008, The Miami Herald Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2008 The Miami Herald
Survey says: Back-to-school need not be back-to-stress
TORONTO, Aug. 25, 2008 (Canada NewsWire via COMTEX) -- Desjardins Financial Security's National Health is Cool Survey shows
parents are stressed by overloaded academic and family calendars
With only one weekend left in the summer holidays, parents are likely sharing their kids' anxiety leading up to the new school year. Desjardins Financial Security's 2008 Health is Cool survey results show that parents experience added stress due to the social pressures of providing as much hands-on parenting as possible.
The majority of survey respondents with children said that they were generally enjoying good mental and physical health, financial security and an overall reduction in stress compared to the previous year. Despite this good news, many agreed that they do feel social pressure to raise exceptional kids (93.3 per cent). For some, this means doing as much possible so their children are the best among other children of the same age (84.8 per cent), to the extent that most suggested that parents do "too much" (81 per cent).
Overloaded family calendars are key stress triggers
This is particularly true of the majority of full-time working parents who agreed that their family calendars were overloaded. They also noted that meeting their children's needs was a key stress trigger, second only to money concerns. Other stressors included family and work issues, and taking care of one's health.
"It's natural for parents to make sacrifices to ensure that their kids get the very best," said Michele Nowski, director of disability income claims and disability management at Desjardins Financial Security. "But it becomes a problem when these sacrifices are detrimental to one's health. What tends to happen is that parents will put themselves last. This increases their stress and the likelihood that they will eventually become sick."
"The majority of all respondents, 83 per cent, said that they have gone to work sick or exhausted," Michele Nowski explained. "In this case, parents did so to avoid having their work pile up and ensure that they would have enough time for their kids. But this sometimes leads to serious illness and longer periods of time away from family and work."
Stop trying so hard-your kids are fine!
Dr. Steven Stein from the Psychology Foundation of Canada agreed that these results are not surprising. "Parents want to provide their kids with an enriched childhood full of opportunities and experiences. But let's remember that school/life balance is just as important as work/life balance. Sometimes, the basic lessons of life taught at home are just as enriching, if not more so."
So this year, mom and dad, take it easy. Think about your needs for a change and remember-your kids will be successful so long as you are happy and healthy, too!
About the Survey
SOM Surveys, Opinion Polls and Marketing conducted the survey on behalf of Desjardins Financial Security between February 7 and March 10, 2008. In total, 1,594 interviews were conducted with a representative sample of Canadian adults. The sampling plan provides proportional estimates with a maximum margin of error of plus or minus 2.6 per cent at a 95 per cent confidence level (19 times out of 20). The data was statistically weighted to accurately reflect the composition of Canadians by region, gender and age based on Statistics Canada's 2006 Census information.
About Desjardins Financial Security
Desjardins Financial Security, a subsidiary of Desjardins Group, the largest integrated cooperative financial group in Canada, specializes in providing life insurance, health insurance and retirement savings products and services to individuals and groups. Every day, over five million Canadians rely on Desjardins Financial Security to ensure their financial security. The company employs over 3,900 people and administers more than $22 billion in assets from offices in several cities across the country, including Vancouver, Calgary, Winnipeg, Toronto, Ottawa, Montréal, Québec, Lévis, Halifax and St. John's. For more information, visit our website at www.desjardinsfinancialsecurity.com
SOURCE: DESJARDINS FINANCIAL SECURITY
CONTACT: Sarah Twomey, Communications Advisor, (416) 926-2700 extension 2015, Toll free:
1-877-906-5551, extension 2015, sarah.twomey@dfs.ca; Virtual newsroom:
http://www.desjardinsfinancialsecurity.com/press
Copyright (C) 2008 CNW Group. All rights reserved.
KEYWORD: Quebec INDUSTRY KEYWORD: FIN SUBJECT CODE: SVY
(C) 2008 Canada NewsWire. All Rights Reserved
parents are stressed by overloaded academic and family calendars
With only one weekend left in the summer holidays, parents are likely sharing their kids' anxiety leading up to the new school year. Desjardins Financial Security's 2008 Health is Cool survey results show that parents experience added stress due to the social pressures of providing as much hands-on parenting as possible.
The majority of survey respondents with children said that they were generally enjoying good mental and physical health, financial security and an overall reduction in stress compared to the previous year. Despite this good news, many agreed that they do feel social pressure to raise exceptional kids (93.3 per cent). For some, this means doing as much possible so their children are the best among other children of the same age (84.8 per cent), to the extent that most suggested that parents do "too much" (81 per cent).
Overloaded family calendars are key stress triggers
This is particularly true of the majority of full-time working parents who agreed that their family calendars were overloaded. They also noted that meeting their children's needs was a key stress trigger, second only to money concerns. Other stressors included family and work issues, and taking care of one's health.
"It's natural for parents to make sacrifices to ensure that their kids get the very best," said Michele Nowski, director of disability income claims and disability management at Desjardins Financial Security. "But it becomes a problem when these sacrifices are detrimental to one's health. What tends to happen is that parents will put themselves last. This increases their stress and the likelihood that they will eventually become sick."
"The majority of all respondents, 83 per cent, said that they have gone to work sick or exhausted," Michele Nowski explained. "In this case, parents did so to avoid having their work pile up and ensure that they would have enough time for their kids. But this sometimes leads to serious illness and longer periods of time away from family and work."
Stop trying so hard-your kids are fine!
Dr. Steven Stein from the Psychology Foundation of Canada agreed that these results are not surprising. "Parents want to provide their kids with an enriched childhood full of opportunities and experiences. But let's remember that school/life balance is just as important as work/life balance. Sometimes, the basic lessons of life taught at home are just as enriching, if not more so."
So this year, mom and dad, take it easy. Think about your needs for a change and remember-your kids will be successful so long as you are happy and healthy, too!
About the Survey
SOM Surveys, Opinion Polls and Marketing conducted the survey on behalf of Desjardins Financial Security between February 7 and March 10, 2008. In total, 1,594 interviews were conducted with a representative sample of Canadian adults. The sampling plan provides proportional estimates with a maximum margin of error of plus or minus 2.6 per cent at a 95 per cent confidence level (19 times out of 20). The data was statistically weighted to accurately reflect the composition of Canadians by region, gender and age based on Statistics Canada's 2006 Census information.
About Desjardins Financial Security
Desjardins Financial Security, a subsidiary of Desjardins Group, the largest integrated cooperative financial group in Canada, specializes in providing life insurance, health insurance and retirement savings products and services to individuals and groups. Every day, over five million Canadians rely on Desjardins Financial Security to ensure their financial security. The company employs over 3,900 people and administers more than $22 billion in assets from offices in several cities across the country, including Vancouver, Calgary, Winnipeg, Toronto, Ottawa, Montréal, Québec, Lévis, Halifax and St. John's. For more information, visit our website at www.desjardinsfinancialsecurity.com
SOURCE: DESJARDINS FINANCIAL SECURITY
CONTACT: Sarah Twomey, Communications Advisor, (416) 926-2700 extension 2015, Toll free:
1-877-906-5551, extension 2015, sarah.twomey@dfs.ca; Virtual newsroom:
http://www.desjardinsfinancialsecurity.com/press
Copyright (C) 2008 CNW Group. All rights reserved.
KEYWORD: Quebec INDUSTRY KEYWORD: FIN SUBJECT CODE: SVY
(C) 2008 Canada NewsWire. All Rights Reserved
8/19/2008
Increased Burden Of Rare Genetic Variations Found In Schizophrenia
Increased Burden Of Rare Genetic Variations Found In Schizophrenia
People with schizophrenia bear an "increased burden" of rare deletions and duplications of genetic material, genome-wide, say researchers supported in part by the National Institute of Mental Health (NIMH), a component of the National Institutes of Health (NIH). "Although many of us have these changes in our genetic material, they are about 15 percent more frequent in people with schizophrenia," explained Pamela Sklar, M.D., Ph.D., of Harvard University and the Stanley Center for Psychiatric Research. "We also discovered two large areas of chromosomal deletions that confer a great deal of risk for schizophrenia and confirm involvement of a third previously reported area." Sklar and colleagues in the International Schizophrenia Consortium team, representing 11 research institutes worldwide, report on the largest study of its kind to date, online July 30, 2008, in the journal . "By implicating two previously unknown sites, this study triples the number of genomic areas definitely linked to schizophrenia," said NIMH Director R Thomas Insel, M.D. "It also confirms in a large sample that unraveling the secrets of rare structural genetic variation may hold promise for improved diagnosis, treatment and prevention of such neuro-developmental disorders." Although recent smaller studies had identified such structural genetic glitches in schizophrenia, this genome-wide association study is the first large enough to detect weak signals that might otherwise be drowned out amid a din of statistical noise. Genetic factors are thought to account for 73 to 90 percent of schizophrenia, but most of these have so far eluded detection. In search of rare illness-linked genetic variations, Sklar and colleagues scanned the genomes of 3,391 schizophrenia cases and 3,181 controls in a European sample. The cases showed a subtle, but statistically significant increased number of such variations, which were found in 13.1 percent of cases and 10.4 percent of controls. Variations affected 1.41-fold more genes in people with schizophrenia, who also had a 1.45-fold higher prevalence of the rarest glitches - those that occurred only once. The large sample also allowed the researchers to pinpoint previously undiscovered chromosomal locations associated with schizophrenia. An area on Chromosome 15 harbored deletions in 9 cases and no controls, while an area on Chromosome 1 had deletions in 10 cases and only one control. "This tells us that variations in both of these areas are very potent risk factors for schizophrenia," said Sklar. The researchers also confirmed in 13 cases a previously-reported association between schizophrenia and a deletion on chromosome 22 known to cause velo-cardio-facial syndrome. Other suspect sites identified were on Chromosomes 12 and 16 and in genes relevant to neural development and growth. Exactly how the subtly increased number of structural variations in schizophrenia might translate into illness remains to be discovered, say the researchers. The same sites of deletions on Chromosomes 1 and 15 reported by Sklar and colleagues, as well as an additional area on Chromosome 15, are also implicated in schizophrenia by another large study published online the same day in Nature by another international group of researchers supported in part by NIMH. ----------------------------Article adapted by Medical News Today from original press release.---------------------------- The International Schizophrenia Consortium is composed of researchers at: Cardiff University, Karolinska Institute/University of North Carolina at Chapel Hill, Trinity College Dublin, University College London, University of Aberdeen, University of Edinburgh, Queensland Institute of Medical Research, University of Southern California, Massachusetts General Hospital, Stanley Center for Psychiatric Research and Broad Institute of MIT and Harvard. References: The International Schizophrenia Consortium. Rare chromosomal deletions and duplications increase risk of schizophrenia. Nature. 2008 Jul 30, online. Stefansson h, et al. Large recurrent microdeletions associated with schizophrenia. Nature. 2008 Jul 30, online. The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website, http://www.nimh.nih.gov/. The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov/. Source: Jules Asher NIH/National Institute of Mental Health
People with schizophrenia bear an "increased burden" of rare deletions and duplications of genetic material, genome-wide, say researchers supported in part by the National Institute of Mental Health (NIMH), a component of the National Institutes of Health (NIH). "Although many of us have these changes in our genetic material, they are about 15 percent more frequent in people with schizophrenia," explained Pamela Sklar, M.D., Ph.D., of Harvard University and the Stanley Center for Psychiatric Research. "We also discovered two large areas of chromosomal deletions that confer a great deal of risk for schizophrenia and confirm involvement of a third previously reported area." Sklar and colleagues in the International Schizophrenia Consortium team, representing 11 research institutes worldwide, report on the largest study of its kind to date, online July 30, 2008, in the journal . "By implicating two previously unknown sites, this study triples the number of genomic areas definitely linked to schizophrenia," said NIMH Director R Thomas Insel, M.D. "It also confirms in a large sample that unraveling the secrets of rare structural genetic variation may hold promise for improved diagnosis, treatment and prevention of such neuro-developmental disorders." Although recent smaller studies had identified such structural genetic glitches in schizophrenia, this genome-wide association study is the first large enough to detect weak signals that might otherwise be drowned out amid a din of statistical noise. Genetic factors are thought to account for 73 to 90 percent of schizophrenia, but most of these have so far eluded detection. In search of rare illness-linked genetic variations, Sklar and colleagues scanned the genomes of 3,391 schizophrenia cases and 3,181 controls in a European sample. The cases showed a subtle, but statistically significant increased number of such variations, which were found in 13.1 percent of cases and 10.4 percent of controls. Variations affected 1.41-fold more genes in people with schizophrenia, who also had a 1.45-fold higher prevalence of the rarest glitches - those that occurred only once. The large sample also allowed the researchers to pinpoint previously undiscovered chromosomal locations associated with schizophrenia. An area on Chromosome 15 harbored deletions in 9 cases and no controls, while an area on Chromosome 1 had deletions in 10 cases and only one control. "This tells us that variations in both of these areas are very potent risk factors for schizophrenia," said Sklar. The researchers also confirmed in 13 cases a previously-reported association between schizophrenia and a deletion on chromosome 22 known to cause velo-cardio-facial syndrome. Other suspect sites identified were on Chromosomes 12 and 16 and in genes relevant to neural development and growth. Exactly how the subtly increased number of structural variations in schizophrenia might translate into illness remains to be discovered, say the researchers. The same sites of deletions on Chromosomes 1 and 15 reported by Sklar and colleagues, as well as an additional area on Chromosome 15, are also implicated in schizophrenia by another large study published online the same day in Nature by another international group of researchers supported in part by NIMH. ----------------------------Article adapted by Medical News Today from original press release.---------------------------- The International Schizophrenia Consortium is composed of researchers at: Cardiff University, Karolinska Institute/University of North Carolina at Chapel Hill, Trinity College Dublin, University College London, University of Aberdeen, University of Edinburgh, Queensland Institute of Medical Research, University of Southern California, Massachusetts General Hospital, Stanley Center for Psychiatric Research and Broad Institute of MIT and Harvard. References: The International Schizophrenia Consortium. Rare chromosomal deletions and duplications increase risk of schizophrenia. Nature. 2008 Jul 30, online. Stefansson h, et al. Large recurrent microdeletions associated with schizophrenia. Nature. 2008 Jul 30, online. The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website, http://www.nimh.nih.gov/. The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov/. Source: Jules Asher NIH/National Institute of Mental Health
Psychotic Symptoms Relieved With Estrogen Treatment
The estrogen estradiol, in combination with antipsychotic medications, appears to improve treatment for women with schizophrenia, according to an article releasedon August 4, 2008 in Archives of General Psychiatry, one of the JAMA/Archives journals. Previously, mental illness has been studied in conjunction with many different hormones, especially estrogen in women. However, the use of estrogen as a therapy for these diseases has only gained focus recently. According to the authors, "Epidemiologic observations of sex differences in the onset and course of schizophrenia prompted exploration of estrogen's role in schizophrenia." Estradiol is the member of the estrogen family best represented in the human body. While it is usually associated with female secondary sex characteristics, both males and females maintain levels of estradiol. To explore this association, Jayashri Kulkarni, M.B.B.S., M.P.M., F.R.A.N.Z.C.P., Ph.D., of The Alfred and Monash University and The Alfred Hospital, Melbourne, Australia, and colleagues performed a randomized, double blind study in women of child-bearing age with schizophrenia. A total 102 women were randomly assigned to one of two groups, receiving the following in combination with their regular medication regimens: 100 micrograms of estradiol via a skin patch, or a placebo skin patch. The patients were evaluated for psychotic symptoms, including hallucinations and delusions, using a standard scale. After examination, it was found that in combination with the regular the estradiol group showed improvement in their psychotic symptoms in comparison to the group taking the placebo. However, there was also a decline in the displayed positive symptoms, representing a loss or distortion of normal functions. In light of this, the two groups had similar rates of negative symptoms, which might occur when normal functions are diminished. The authors suggest some potential mechanistic explanations for this relationship: "Estrogen's neuroprotective and psychoprotective actions may be mediated by a variety of routes, ranging from rapid actions, including antioxidant effects and enhancement of cerebral blood flow and cerebral glucose utilization, to slower, genomic mechanisms, which may include permanent modification of neural circuits." They continue, focusing on the negative symptoms experienced by the women. "The lack of effect for negative symptoms is consistent with literature reporting that negative symptoms are less responsive to treatment than other symptoms of schizophrenia. It is possible that longer-term treatment is required for negative symptoms to respond to treatment. Alternatively, brain regions implicated in negative symptoms may be less responsive to gonadal hormone effects." The authors note that this therapy might be especially effective for women affected by schizophrenia who undergo hormonal changes, which seem to cause deterioration of their conditions. Examples of events that could cause this are childbirth and menopause. The authors conclude: "Estrogen treatment is a promising new area for future treatment of schizophrenia and potentially for other severe mental illnesses." Estrogen in Severe Mental Illness: A Potential New Treatment ApproachJayashri Kulkarni; Anthony de Castella; Paul B. Fitzgerald; Caroline T. Gurvich; Michael Bailey; Cali Bartholomeusz; Henry BurgerArch Gen Psychiatry. 2008;65(8):955-960.Click Here For Journal Written by Anna Sophia McKenney
View drug information on Estradiol.Copyright: Medical News Today Not to be reproduced without permission of Medical News Today
View drug information on Estradiol.Copyright: Medical News Today Not to be reproduced without permission of Medical News Today
Canadian Psychiatrists Press For Equal Treatment Of Mental Illness And Petition Fellow Physicians To Fight Discrimination Towards Mentally Ill Persons
Canadian Psychiatrists Press For Equal Treatment Of Mental Illness And Petition Fellow Physicians To Fight Discrimination Towards Mentally Ill Persons
Historically the care for patients with psychiatric illnesses has been loaded with prejudice and discrimination, the Canadian Psychiatric Association (CPA) told delegates at today's Canadian Medical Association (CMA) meeting. CPA also commends the CMA for putting a spotlight on mental health issues today at its annual meeting of Canadian physicians. "In our presentation to colleagues, we pointed out that despite medicine's ability to treat and diagnose psychiatric illness as effectively and accurately as it can diagnose and treat most chronic conditions in internal medicine, far too many people don't get access to care," said Dr. Patrick White, CPA president and meeting delegate. "We must commit to ensuring that such discrimination is no longer tolerated. This includes advocating for parity of resources for care. Resources devoted to treating psychiatric illnesses should be similar to that committed to physical illnesses with equivalent levels of disability," he added. "We asked our colleagues to work together as physicians to transform patient care for mental illnesses beginning by fighting stigma within our own profession and physician organizations. We also asked that they advocate for parity of resources for mental health research and the full range of services needed to treat mental illness. We are encouraged by the support shown by our colleagues in passing a number of motions for collaborative action." This year's annual CMA survey of Canadians on the state of health care reinforces many studies that show that Canadians' personal experience with mental illness is very prevalent and that they think mental health care is underfunded. "Today's announcement of additional funding for the Mental Health Commission of Canada is an encouraging sign that we are on the right track toward transforming mental health care in Canada," added Dr. White. Dr. Donald Milliken represented the CPA on a mental health panel at the CMA annual meeting alongside Michael Kirby Chair of the Mental Health Commission and Austen Mardon, a patient living with schizophrenia. The Canadian Psychiatric Association is the national voice for Canada's 4,100 psychiatrists and more than 600 psychiatric residents. Founded in 1951, the CPA is dedicated to promoting an environment that fosters excellence in the provision of clinical care, education and research. Canadian Psychiatric Association
Historically the care for patients with psychiatric illnesses has been loaded with prejudice and discrimination, the Canadian Psychiatric Association (CPA) told delegates at today's Canadian Medical Association (CMA) meeting. CPA also commends the CMA for putting a spotlight on mental health issues today at its annual meeting of Canadian physicians. "In our presentation to colleagues, we pointed out that despite medicine's ability to treat and diagnose psychiatric illness as effectively and accurately as it can diagnose and treat most chronic conditions in internal medicine, far too many people don't get access to care," said Dr. Patrick White, CPA president and meeting delegate. "We must commit to ensuring that such discrimination is no longer tolerated. This includes advocating for parity of resources for care. Resources devoted to treating psychiatric illnesses should be similar to that committed to physical illnesses with equivalent levels of disability," he added. "We asked our colleagues to work together as physicians to transform patient care for mental illnesses beginning by fighting stigma within our own profession and physician organizations. We also asked that they advocate for parity of resources for mental health research and the full range of services needed to treat mental illness. We are encouraged by the support shown by our colleagues in passing a number of motions for collaborative action." This year's annual CMA survey of Canadians on the state of health care reinforces many studies that show that Canadians' personal experience with mental illness is very prevalent and that they think mental health care is underfunded. "Today's announcement of additional funding for the Mental Health Commission of Canada is an encouraging sign that we are on the right track toward transforming mental health care in Canada," added Dr. White. Dr. Donald Milliken represented the CPA on a mental health panel at the CMA annual meeting alongside Michael Kirby Chair of the Mental Health Commission and Austen Mardon, a patient living with schizophrenia. The Canadian Psychiatric Association is the national voice for Canada's 4,100 psychiatrists and more than 600 psychiatric residents. Founded in 1951, the CPA is dedicated to promoting an environment that fosters excellence in the provision of clinical care, education and research. Canadian Psychiatric Association
Stress and Anxiety
Stress can come from any situation or thought that makes you feel frustrated, angry, or anxious. What is stressful to one person is not necessarily stressful to another.
Anxiety is a feeling of apprehension or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel.
Alternative Names
Anxiety; Feeling uptight; Stress; Tension; Jitters; Apprehension
Considerations
Stress is a normal part of life. In small quantities, stress is good -- it can motivate you and help you be more productive. However, too much stress, or a strong response to stress, is harmful. It can set you up for general poor health as well as specific physical or psychological illnesses like infection, heart disease, or depression. Persistent and unrelenting stress often leads to anxiety and unhealthy behaviors like overeating and abuse of alcohol or drugs.
Emotional states like grief or depression and health conditions like an overactive thyroid, low blood sugar, or heart attack can also cause stress.
Anxiety is often accompanied by physical symptoms, including:
Twitching or trembling
Muscle tension, headaches
Sweating
Dry mouth, difficulty swallowing
Abdominal pain (may be the only symptom of stress, especially in a child)
Sometimes other symptoms accompany anxiety:
Dizziness
Rapid or irregular heart rate
Rapid breathing
Diarrhea or frequent need to urinate
Fatigue
Irritability, including loss of your temper
Sleeping difficulties and nightmares
Decreased concentration
Sexual problems
Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety. They include generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, and social phobia.
Causes »
Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug. Such drugs include caffeine, alcohol, nicotine, cold remedies, decongestants, bronchodilators for asthma, tricyclic antidepressants, cocaine, amphetamines, diet pills, ADHD medications, and thyroid medications.
A poor diet -- for example, low levels of vitamin B12 -- can also contribute to stress or anxiety. Performance anxiety is related to specific situations, like taking a test or making a presentation in public. Posttraumatic stress disorder (PTSD) develops after a traumatic event like war, physical or sexual assault, or a natural disaster. People with generalized anxiety disorder experience almost constant worry or anxiety about many things on more than half of all days for 6 months. Panic disorder or panic attacks involve sudden and unexplained fear, rapid breathing, and increased heartbeat.
In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may be the cause of anxiety. The symptoms are caused by an overproduction of hormones responsible for the feelings of anxiety.In-Depth Causes »
Home Care
The most effective solution is to find and address the source of your stress or anxiety. Unfortunately, this is not always possible. A first step is to take an inventory of what you think might be making you "stress out":
What do you worry about most?
Is something constantly on your mind?
Does anything in particular make you sad or depressed?
Keep a diary of the experiences and thoughts that seem to be related to your anxiety. Are your thoughts adding to your anxiety in these situations?
Then, find someone you trust (friend, family member, neighbor, clergy) who will listen to you. Often, just talking to a friend or loved one is all that is needed to relieve anxiety. Most communities also have support groups and hotlines that can help. Social workers, psychologists, and other mental health professionals may be needed for therapy and medication.
Also, find healthy ways to cope with stress. For example:
Eat a well-balanced, healthy diet. Don't overeat.
Get enough sleep.
Exercise regularly.
Limit caffeine and alcohol.
Don't use nicotine, cocaine, or other recreational drugs.
Learn and practice relaxation techniques like guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation. Try biofeedback, using a certified professional to get you started.
Take breaks from work. Make sure to balance fun activities with your responsibilities. Spend time with people you enjoy.
Find self-help books at your local library or bookstore.
When to Contact a Medical Professional
Your doctor can help you determine if your anxiety would be best evaluated and treated by a mental health care professional.
Call 911 if:
You have crushing chest pain, especially with shortness of breath, dizziness, or sweating. A heart attack can cause feelings of anxiety.
You have thoughts of suicide.
You have dizziness, rapid breathing, or racing heartbeat for the first time or it is worse than usual.
Call your health care provider if:
You are unable to work or function properly at home because of anxiety.
You do not know the source or cause of your anxiety.
You have a sudden feeling of panic.
You have an uncontrollable fear -- for example, of getting infected and sick if you are out, or a fear of heights.
You repeat an action over and over again, like constantly washing your hands.
You have an intolerance to heat, weight loss despite a good appetite, lump or swelling in the front of your neck, or protruding eyes. Your thyroid may be overactive.
Your anxiety is elicited by the memory of a traumatic event.
You have tried self care for several weeks without success or you feel that your anxiety will not resolve without professional help.
Ask your pharmacist or health care provider if any prescription or over-the-counter drugs you are taking can cause anxiety as a side effect. Do not stop taking any prescribed medicines without your provider's instructions.
What to Expect at Your Office Visit
Your doctor will take a medical history and perform a physical examination, paying close attention to your pulse, blood pressure, and respiratory rate.
To help better understand your anxiety, stress, or tension, your doctor may ask the following:
When did your feelings of stress, tension, or anxiety begin? Do you attribute the feelings to anything in particular like an event in your life or a circumstance that scares you?
Do you have physical symptoms along with your feelings of anxiety? What are they?
Does anything make your anxiety better?
Does anything make your anxiety worse?
What medications are you taking?
Diagnostic tests may include blood tests (CBC, thyroid function tests) as well as an electrocardiogram (ECG).
If the anxiety is not accompanied by any worrisome physical signs and symptoms, a referral to a mental health care professional may be recommended for appropriate treatment.
Psychotherapy such as cognitive-behavioral therapy (CBT) has been shown to significantly decrease anxiety. In some cases, medications such as benzodiazepines or antidepressants may be appropriat
References »
Muller JE, Kohn L, Stein DJ. Anxiety and medical disorders. Curr Psychiatry Rep. 2005 Aug;7(4):245-51.
White KS, Farrell AD. Anxiety and Psychosocial Stress as Predictors of Headache and Abdominal Pain in Urban Early Adolescents. J Pediatr Psychol. 2005.
Lubit R, Rovine D, Defrancisci L, Eth S. Impact of trauma on children. J Psychiatr Pract. 2003; 9(2): 128-138.
Anxiety is a feeling of apprehension or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel.
Alternative Names
Anxiety; Feeling uptight; Stress; Tension; Jitters; Apprehension
Considerations
Stress is a normal part of life. In small quantities, stress is good -- it can motivate you and help you be more productive. However, too much stress, or a strong response to stress, is harmful. It can set you up for general poor health as well as specific physical or psychological illnesses like infection, heart disease, or depression. Persistent and unrelenting stress often leads to anxiety and unhealthy behaviors like overeating and abuse of alcohol or drugs.
Emotional states like grief or depression and health conditions like an overactive thyroid, low blood sugar, or heart attack can also cause stress.
Anxiety is often accompanied by physical symptoms, including:
Twitching or trembling
Muscle tension, headaches
Sweating
Dry mouth, difficulty swallowing
Abdominal pain (may be the only symptom of stress, especially in a child)
Sometimes other symptoms accompany anxiety:
Dizziness
Rapid or irregular heart rate
Rapid breathing
Diarrhea or frequent need to urinate
Fatigue
Irritability, including loss of your temper
Sleeping difficulties and nightmares
Decreased concentration
Sexual problems
Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety. They include generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, and social phobia.
Causes »
Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug. Such drugs include caffeine, alcohol, nicotine, cold remedies, decongestants, bronchodilators for asthma, tricyclic antidepressants, cocaine, amphetamines, diet pills, ADHD medications, and thyroid medications.
A poor diet -- for example, low levels of vitamin B12 -- can also contribute to stress or anxiety. Performance anxiety is related to specific situations, like taking a test or making a presentation in public. Posttraumatic stress disorder (PTSD) develops after a traumatic event like war, physical or sexual assault, or a natural disaster. People with generalized anxiety disorder experience almost constant worry or anxiety about many things on more than half of all days for 6 months. Panic disorder or panic attacks involve sudden and unexplained fear, rapid breathing, and increased heartbeat.
In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may be the cause of anxiety. The symptoms are caused by an overproduction of hormones responsible for the feelings of anxiety.In-Depth Causes »
Home Care
The most effective solution is to find and address the source of your stress or anxiety. Unfortunately, this is not always possible. A first step is to take an inventory of what you think might be making you "stress out":
What do you worry about most?
Is something constantly on your mind?
Does anything in particular make you sad or depressed?
Keep a diary of the experiences and thoughts that seem to be related to your anxiety. Are your thoughts adding to your anxiety in these situations?
Then, find someone you trust (friend, family member, neighbor, clergy) who will listen to you. Often, just talking to a friend or loved one is all that is needed to relieve anxiety. Most communities also have support groups and hotlines that can help. Social workers, psychologists, and other mental health professionals may be needed for therapy and medication.
Also, find healthy ways to cope with stress. For example:
Eat a well-balanced, healthy diet. Don't overeat.
Get enough sleep.
Exercise regularly.
Limit caffeine and alcohol.
Don't use nicotine, cocaine, or other recreational drugs.
Learn and practice relaxation techniques like guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation. Try biofeedback, using a certified professional to get you started.
Take breaks from work. Make sure to balance fun activities with your responsibilities. Spend time with people you enjoy.
Find self-help books at your local library or bookstore.
When to Contact a Medical Professional
Your doctor can help you determine if your anxiety would be best evaluated and treated by a mental health care professional.
Call 911 if:
You have crushing chest pain, especially with shortness of breath, dizziness, or sweating. A heart attack can cause feelings of anxiety.
You have thoughts of suicide.
You have dizziness, rapid breathing, or racing heartbeat for the first time or it is worse than usual.
Call your health care provider if:
You are unable to work or function properly at home because of anxiety.
You do not know the source or cause of your anxiety.
You have a sudden feeling of panic.
You have an uncontrollable fear -- for example, of getting infected and sick if you are out, or a fear of heights.
You repeat an action over and over again, like constantly washing your hands.
You have an intolerance to heat, weight loss despite a good appetite, lump or swelling in the front of your neck, or protruding eyes. Your thyroid may be overactive.
Your anxiety is elicited by the memory of a traumatic event.
You have tried self care for several weeks without success or you feel that your anxiety will not resolve without professional help.
Ask your pharmacist or health care provider if any prescription or over-the-counter drugs you are taking can cause anxiety as a side effect. Do not stop taking any prescribed medicines without your provider's instructions.
What to Expect at Your Office Visit
Your doctor will take a medical history and perform a physical examination, paying close attention to your pulse, blood pressure, and respiratory rate.
To help better understand your anxiety, stress, or tension, your doctor may ask the following:
When did your feelings of stress, tension, or anxiety begin? Do you attribute the feelings to anything in particular like an event in your life or a circumstance that scares you?
Do you have physical symptoms along with your feelings of anxiety? What are they?
Does anything make your anxiety better?
Does anything make your anxiety worse?
What medications are you taking?
Diagnostic tests may include blood tests (CBC, thyroid function tests) as well as an electrocardiogram (ECG).
If the anxiety is not accompanied by any worrisome physical signs and symptoms, a referral to a mental health care professional may be recommended for appropriate treatment.
Psychotherapy such as cognitive-behavioral therapy (CBT) has been shown to significantly decrease anxiety. In some cases, medications such as benzodiazepines or antidepressants may be appropriat
References »
Muller JE, Kohn L, Stein DJ. Anxiety and medical disorders. Curr Psychiatry Rep. 2005 Aug;7(4):245-51.
White KS, Farrell AD. Anxiety and Psychosocial Stress as Predictors of Headache and Abdominal Pain in Urban Early Adolescents. J Pediatr Psychol. 2005.
Lubit R, Rovine D, Defrancisci L, Eth S. Impact of trauma on children. J Psychiatr Pract. 2003; 9(2): 128-138.
Biracial Asian Americans And Mental Health
A new study of Chinese-Caucasian, Filipino-Caucasian, Japanese-Caucasian and Vietnamese-Caucasian individuals concludes that biracial Asian Americans are twice as likely as monoracial Asian Americans to be diagnosed with a psychological disorder.
The study by researchers at the Asian American Center on Disparities Research at the University of California, Davis, will be reported in a 10 a.m. (EDT) poster session, "Clinical, Counseling, and Consulting," on Sunday, Aug. 17, at the annual meeting of the American Psychological Association in Boston.
"Up to 2.4 percent of the U.S. population self-identifies as mixed race, and most of these individuals describe themselves as biracial," said Nolan Zane, a professor of psychology and Asian American studies at UC Davis. "We cannot underestimate the importance of understanding the social, psychological and experiential differences that may increase the likelihood of psychological disorders among this fast-growing segment of the population."
Zane and his co-investigator, UC Davis psychology graduate student Lauren Berger, found that 34 percent of biracial individuals in a national survey had been diagnosed with a psychological disorder, such as anxiety, depression or substance abuse, versus 17 percent of monoracial individuals. The higher rate held up even after the researchers controlled for differences between the groups in age, gender and life stress, among other factors.
The study included information from 125 biracial Asian Americans from across the U.S., including 55 Filipino-Caucasians, 33 Chinese-Caucasians, 23 Japanese-Caucasians and 14 Vietnamese-Caucasians.
The information was obtained from the 2002-2003 National Latino and Asian American Study, the largest nationally representative survey ever conducted of Asian Americans. Funded by the National Institute of Mental Health, the landmark survey involved in-person interviews with more than 2,000 Asian Americans nationwide. The survey yielded a wealth of raw data for researchers to analyze for insights into Asian American mental health.
Zane and Berger did not look at the mental health of non-Asian Americans.
Future research should investigate the factors that explain the higher rate of diagnosed psychological disorders among biracial Asian Americans, Zane said. Possibilities include influences of ethnic identification and experiences of ethnic discrimination.
The study by researchers at the Asian American Center on Disparities Research at the University of California, Davis, will be reported in a 10 a.m. (EDT) poster session, "Clinical, Counseling, and Consulting," on Sunday, Aug. 17, at the annual meeting of the American Psychological Association in Boston.
"Up to 2.4 percent of the U.S. population self-identifies as mixed race, and most of these individuals describe themselves as biracial," said Nolan Zane, a professor of psychology and Asian American studies at UC Davis. "We cannot underestimate the importance of understanding the social, psychological and experiential differences that may increase the likelihood of psychological disorders among this fast-growing segment of the population."
Zane and his co-investigator, UC Davis psychology graduate student Lauren Berger, found that 34 percent of biracial individuals in a national survey had been diagnosed with a psychological disorder, such as anxiety, depression or substance abuse, versus 17 percent of monoracial individuals. The higher rate held up even after the researchers controlled for differences between the groups in age, gender and life stress, among other factors.
The study included information from 125 biracial Asian Americans from across the U.S., including 55 Filipino-Caucasians, 33 Chinese-Caucasians, 23 Japanese-Caucasians and 14 Vietnamese-Caucasians.
The information was obtained from the 2002-2003 National Latino and Asian American Study, the largest nationally representative survey ever conducted of Asian Americans. Funded by the National Institute of Mental Health, the landmark survey involved in-person interviews with more than 2,000 Asian Americans nationwide. The survey yielded a wealth of raw data for researchers to analyze for insights into Asian American mental health.
Zane and Berger did not look at the mental health of non-Asian Americans.
Future research should investigate the factors that explain the higher rate of diagnosed psychological disorders among biracial Asian Americans, Zane said. Possibilities include influences of ethnic identification and experiences of ethnic discrimination.
ADULTS EASILY FOOLED BY CHILDREN'S FALSE DENIALS
Adults are easily fooled when a child denies that an actual event took place, but do somewhat better at detecting when a child makes up information about something that never happened, according to new research from the University of California, Davis. The research, which has important implications for forensic child sexual abuse evaluations, was presented Sunday at the annual meeting of the American Psychology Association in Boston.
"The large number of children coming into contact with the legal system -- mostly as a result of abuse cases -- has motivated intense scientific effort to understand children's true and false reports," said UC Davis psychology professor and study author Gail S. Goodman. "The seriousness of abuse charges and the frequency with which children's testimony provides central prosecutorial evidence makes children's eyewitness memory abilities important considerations. Arguably even more important, however, are adults' abilities to evaluate children's reports."
In an effort to determine if adults can discern children's true reports from false ones, Goodman and her co-investigators asked more than 100 adults to view videotapes of 3- and 5-year-olds being interviewed about "true" and "false" events. For true events, the children either accurately confirmed that the event had occurred or inaccurately denied that it had happened. For "false" events -- ones that the children had not experienced -- they either truthfully denied having experienced them or falsely reported that they had occurred.
Afterward, the adults were asked to evaluate each child's veracity.
The adults were relatively good at detecting accounts of events that never happened. But the adults were apt to mistakenly believe children's denials of actual events.
"The findings suggest that adults are better at detecting false reports than they are at detecting false denials," Goodman said. "While accurately detecting false reports protects innocent people from false allegations, the failure to detect false denials could mean that adults fail to protect children who falsely deny actual victimization."
Goodman's co-authors include Donna Shestowsky, acting professor of law at UC Davis, and doctoral students Stephanie Block, Jennifer Schaaf and Daisy Segovia.
Goodman was among the first researchers to undertake academic study of children's eyewitness accounts. She is the author of three books and more than 170 scientific articles in the field; some have been cited in U.S. Supreme Court decisions. She is the 2008 recipient of the American Psychological Association's Urie Bronfenbrenner Award for Lifetime Contributions to Developmental Psychology.
(C)1999-2008 AScribe News
"The large number of children coming into contact with the legal system -- mostly as a result of abuse cases -- has motivated intense scientific effort to understand children's true and false reports," said UC Davis psychology professor and study author Gail S. Goodman. "The seriousness of abuse charges and the frequency with which children's testimony provides central prosecutorial evidence makes children's eyewitness memory abilities important considerations. Arguably even more important, however, are adults' abilities to evaluate children's reports."
In an effort to determine if adults can discern children's true reports from false ones, Goodman and her co-investigators asked more than 100 adults to view videotapes of 3- and 5-year-olds being interviewed about "true" and "false" events. For true events, the children either accurately confirmed that the event had occurred or inaccurately denied that it had happened. For "false" events -- ones that the children had not experienced -- they either truthfully denied having experienced them or falsely reported that they had occurred.
Afterward, the adults were asked to evaluate each child's veracity.
The adults were relatively good at detecting accounts of events that never happened. But the adults were apt to mistakenly believe children's denials of actual events.
"The findings suggest that adults are better at detecting false reports than they are at detecting false denials," Goodman said. "While accurately detecting false reports protects innocent people from false allegations, the failure to detect false denials could mean that adults fail to protect children who falsely deny actual victimization."
Goodman's co-authors include Donna Shestowsky, acting professor of law at UC Davis, and doctoral students Stephanie Block, Jennifer Schaaf and Daisy Segovia.
Goodman was among the first researchers to undertake academic study of children's eyewitness accounts. She is the author of three books and more than 170 scientific articles in the field; some have been cited in U.S. Supreme Court decisions. She is the 2008 recipient of the American Psychological Association's Urie Bronfenbrenner Award for Lifetime Contributions to Developmental Psychology.
(C)1999-2008 AScribe News
Empty Nest Syndrome
Definition
Empty Nest Syndrome refers to feelings of depression, sadness, and/or grief experienced by parents and caregivers after children come of age and leave their childhood homes. This may occur when children go to college or get married. Women are more likely than men to be affected; often, when the nest is emptying, mothers are going through other significant life events as well, such as menopause or caring for elderly parents.
More mothers work these days and therefore feel less emptiness when their children leave home. Also, an increasing number of adult children between 25 and 34 are now living at home. Psychologist Allan Scheinberg notes that these "boomerang kids" want the "limited responsibility of childhood and the privileges of adulthood." Children may also return home due to economics, divorce, extended education, drug or alcohol problems or temporary transitions.
Symptoms
Feelings of sadness are normal at this time. It is also normal to spend time in the absent child's bedroom to feel closer to him or her.
If you are experiencing empty nest syndrome, monitor your reactions and their duration. If you are feeling that your useful life has ended, or if you are crying excessively or are so sad that you don't want to see friends or go to work, you should consider seeking professional help.
Causes
As noted earlier, when a woman is at the stage in life when her kids are leaving, she may also be going through other major changes, like dealing with menopause or coping with increasingly dependent elderly parents.
Recent research suggests that the quality of the parent-child relationship may have important consequences for both at this time. Parents gain the greatest psychological benefit from the transition to an empty nest when they have developed and maintain good relations with their children. Extreme hostility, conflict, or detachment in parent-child relations may reduce intergenerational support when it is most needed by youth during early adulthood and by parents facing the disabilities of old age.
At one time, it was commonly thought that women were particularly vulnerable to depression when their children left home, experiencing a profound loss of purpose and identity. However, studies show no increase in depressive illness among women at this stage of life.
Treatment
When a child's departure unleashes overwhelming sadness, treatment is definitely needed. Discuss your feelings with your general practitioner as soon as possible. You may need antidepressants, and you almost certainly could use some counseling to get your feelings into perspective.
Meanwhile, look to your friends for support and be kind to yourself. There are practical things to help you feel better. For instance:
Buy some pay-as-you-go mobile phone vouchers or prepaid calling cards for your son or daughter so that keeping in contact is financially viable.
Try to schedule a weekly chat on the phone.
Send your child brief e-mails of what's happening at home.
Make care packages for your child with anything from groceries to a set of towels for her new apartment. Try not to overdo it in the beginning, and don't attach any strings to the gifts.
Time and energy that you directed toward your child can now be spent on different areas of your life. This might be an opportune time to explore or return to hobbies, leisure activities or career pursuits.
This also marks a time to adjust to your new role in your child's life as well as changes in your identity as a parent. Your relationship with your child may become more peerlike, and you will have to get used to giving your children more privacy.
Many suggest preparing for an empty nest while your children are still living with you. Develop friendships, hobbies, career, and educational opportunities. Make plans with the family while everyone is still under the same roof, so you don't regret lost opportunities: Plan family vacations, enjoy long talks, take time off from work. And make specific plans for the extra money, time, and space that will become available when children are no longer dependent on you and living at home.
Source: Diagnostic and Statistical Manual of Mental Disorders
Empty Nest Syndrome refers to feelings of depression, sadness, and/or grief experienced by parents and caregivers after children come of age and leave their childhood homes. This may occur when children go to college or get married. Women are more likely than men to be affected; often, when the nest is emptying, mothers are going through other significant life events as well, such as menopause or caring for elderly parents.
More mothers work these days and therefore feel less emptiness when their children leave home. Also, an increasing number of adult children between 25 and 34 are now living at home. Psychologist Allan Scheinberg notes that these "boomerang kids" want the "limited responsibility of childhood and the privileges of adulthood." Children may also return home due to economics, divorce, extended education, drug or alcohol problems or temporary transitions.
Symptoms
Feelings of sadness are normal at this time. It is also normal to spend time in the absent child's bedroom to feel closer to him or her.
If you are experiencing empty nest syndrome, monitor your reactions and their duration. If you are feeling that your useful life has ended, or if you are crying excessively or are so sad that you don't want to see friends or go to work, you should consider seeking professional help.
Causes
As noted earlier, when a woman is at the stage in life when her kids are leaving, she may also be going through other major changes, like dealing with menopause or coping with increasingly dependent elderly parents.
Recent research suggests that the quality of the parent-child relationship may have important consequences for both at this time. Parents gain the greatest psychological benefit from the transition to an empty nest when they have developed and maintain good relations with their children. Extreme hostility, conflict, or detachment in parent-child relations may reduce intergenerational support when it is most needed by youth during early adulthood and by parents facing the disabilities of old age.
At one time, it was commonly thought that women were particularly vulnerable to depression when their children left home, experiencing a profound loss of purpose and identity. However, studies show no increase in depressive illness among women at this stage of life.
Treatment
When a child's departure unleashes overwhelming sadness, treatment is definitely needed. Discuss your feelings with your general practitioner as soon as possible. You may need antidepressants, and you almost certainly could use some counseling to get your feelings into perspective.
Meanwhile, look to your friends for support and be kind to yourself. There are practical things to help you feel better. For instance:
Buy some pay-as-you-go mobile phone vouchers or prepaid calling cards for your son or daughter so that keeping in contact is financially viable.
Try to schedule a weekly chat on the phone.
Send your child brief e-mails of what's happening at home.
Make care packages for your child with anything from groceries to a set of towels for her new apartment. Try not to overdo it in the beginning, and don't attach any strings to the gifts.
Time and energy that you directed toward your child can now be spent on different areas of your life. This might be an opportune time to explore or return to hobbies, leisure activities or career pursuits.
This also marks a time to adjust to your new role in your child's life as well as changes in your identity as a parent. Your relationship with your child may become more peerlike, and you will have to get used to giving your children more privacy.
Many suggest preparing for an empty nest while your children are still living with you. Develop friendships, hobbies, career, and educational opportunities. Make plans with the family while everyone is still under the same roof, so you don't regret lost opportunities: Plan family vacations, enjoy long talks, take time off from work. And make specific plans for the extra money, time, and space that will become available when children are no longer dependent on you and living at home.
Source: Diagnostic and Statistical Manual of Mental Disorders
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