Dr. Henry Paul, MD

Psychiatrist, Author and Educator

DEPRESSION & ANXIETY – WHO INVITED YOU TO THANKSGIVING?

November 25th, 2015

Thanksgiving has always been a day for families to get together and be thankful. It is also the official opening to the holiday season, and with that comes a lot of anxiety, stress, and yes for many, depression.

For many, the holiday season is an emotional roller-coaster. It can be a very fun and joyous time for many, but for others it is stressful and lonely. As we enjoy our holidays, let’s keep in mind those that may find this holiday season a difficult time. Those who are grieving, dealing with divorce or struggling with addiction. Those who have lost their job and are stressed about making ends meet. Those who have loved ones serving overseas and those who are dealing with illness. And those who are anxious and scared as America deals with the possibility of another terrorist attack on the homeland.

Some thoughts for making this holiday season easier:

Volunteer at a homeless shelter, hospital, hospice or even the ASPCA. Volunteering is a great way to establish new friendships and to make a difference for something you believe in.
Relax and have realistic goals and expectations.
Take some time and get out for a walk or a drive. It is amazing what a little fresh air and sunlight can do.
Watch what you eat. It’s easy with all the pies and goodies to eat too much of the wrong things.
Stick to your daily routine. If that means exercising in the morning – than do it. If it means eating a healthy diet – stick to it.
Reach out to a support group either online or locally. It helps to talk with others who are dealing with similar feelings.
Stick to your budget. One of the biggest holiday stressors is worrying about finances.
Make sure to get sleep. Your body needs a good night’s sleep.
Do less and enjoy more! We tend to go overboard with our planning for the holidays and our expectations can be unrealistic. Make a plan and share it with your family and friends.

This year in particular, many people will be wondering how to even muster up some holiday spirit when the world is in such chaos. Well, remember the real meaning of the holidays. It is a time to be thankful, to pray for peace, to give, and to reach out to those in need.
Happy Thanksgiving!

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

AUTISM SPECTRUM DISORDER NUMBERS RISING

November 23rd, 2015

Exactly one year ago I did a blog on this topic. At that time, I agreed with Amy Daniels, the assistant director for public health research at Autism Speaks, a New York City-based advocacy group, when she said in a CBS News interview that a significant part of the increase in autism has resulted from changes in diagnosis and reporting and not due to an actual increase in frequency of the disorder.

Daniels was speaking about results of a Danish study that last year attributed the rise in cases of children diagnosed with autism to the redefinition of what autism is and how it is reported. I agreed then, and I agree now that the “big jump” in the numbers of children diagnosed is due to more inclusive diagnostic criteria, and that leads to an increase in numbers.

Now, again a year later, we have a new study from the CDC that is reporting a “big jump in the number of children with autism.” The CDC’s National Center for Health Statistics is reporting that about one in 45 children between the ages of 3 and 17 have autism. The previous report by the CDC was one in 68 children. The CDC’s reasoning for the significant increase in numbers is due to the way they presented the questions in the National Survey of Children’s Health. The surveys from 2011 to 2013 reported that 1.25% of children had some level of autism. In 2014, the number jumped to 2.24% – a significant increase. The reason for the increase? The CDC is attributing it to survey techniques and how the questions were worded to parents.

In a report filed on the NBC News (11/13, Fox) website Benjamin Zablotsky, an epidemiologist at the National Center for Health Statistics who helped lead the study said, “One in 45 is what we think is the most accurate parental report of autism to date. I think within this report we found that the way that we ask the parents about autism spectrum disorder can have an impact on the way the parents respond to the question.” Thus, the children have not changed just how we make a diagnosis. This, of course, begs the questions about over diagnosis by over inclusion.

What other research is showing is that autism is simply being recognized and diagnosed more often and that children who were classified with something broad like pervasive developmental disorder are being reclassified to the more specific autism.

Regardless of where we stand on the academics of this debate if you suspect that your child has an autism spectrum disorder (ASD), you should schedule your child to see a child psychiatrist for proper diagnosis. If your child has an ASD, there are medications for some of the behavioral issues and alternative therapies that can help as well.

With an ASD diagnosis, parents will also have to reach out to the school district to have the proper classifications and education plan implemented. In some cases, depending on the severity of the diagnosis, a child may have to attend a specialized program/school outside of the public school system. The school, along with a child’s pediatrician and psychiatrist will be instrumental in designing and implementing the proper program.

On my blog, “I think my child might be on the spectrum” you will find more information on the ASD and the symptoms to look for.

LINKS:
Dr. Henry Paul — Autism – What is really behind the rising numbers?
AP — Latest US estimate suggests 1 in 45 children have autism
USA Today — Study Finds more than 2% of children have autism
Los Angeles Times — 1 in 45: New autism statistic suggests children with condition may have been undercounted

DISCLAIMER
The information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

THRIVE NYC PREPARES TO ROLL-OUT IN CITY TROUBLED WITH MENTAL HEALTH ISSUES

November 20th, 2015

Next month New York City is preparing to roll-out ThriveNYC, a new mental health initiative that Mayor Bill de Blasio says will help to prevent and treat mental health disorders among the city’s 8.4 million residents.

According to a report released earlier this month by the city’s Department of Mental Hygiene, at least one in five adults in NYC suffer from depression, substance abuse, suicidal thoughts or other psychological disorders. This report says that nearly 20 percent of New Yorker’s suffer each year with a mental health disorder and that, “at any given time over half a million adult New Yorkers are estimated to have depression, yet less than 40% report receiving care for it.”

The official website of the City of New York lists these sobering statistics from the report:

At least one in five adult New Yorkers is likely to experience a mental health disorder in any given year.
8% of NYC public high school students report attempting suicide.
Consequences of substance misuse are among the leading causes of premature death in every neighborhood in New York City. Each year, 1,800 deaths and upwards of 70,000 emergency room visits among adults aged 18 to 64 can be attributed to alcohol use.
73,000 New York City public high school students report feeling sad or hopeless each month.
Approximately 8% of adult New Yorkers experience symptoms of depression each year.
Major depressive disorder is the single greatest source of disability in NYC. At any given time over half a million adult New Yorkers are estimated to have depression, yet less than 40% report receiving care for it.
There are $14 billion in estimated annual productivity losses in New York City tied to depression and substance misuse.
Unintentional drug overdose deaths outnumber both homicide and motor vehicle fatalities.
The stigma of mental illness has been found to have serious negative effects on hope and an individual’s sense of self-esteem. Stigma also increases the severity of psychiatric symptoms and decreases treatment adherence.

Kudos to the Mayor and his team for recognizing this problem and doing something about it. Providing services is not going to be so easy in a city the size of New York City. With funding cutbacks to mental health agencies, reorganization and mergers of major hospitals, a shortage of beds and practitioners, and a lack of substance abuse preventative and rehab programs mental health officials face quite a conundrum. Other challenges include overcoming the stigma of mental illness, cultural issues, “income inequality,” and homelessness. I will be watching closely as this program rolls-out. I applaud the Mayor for tackling this!

Links:
Reuters
The New York Daily News
Crain’s New York Business

TERRORISM CREATS ANXIETY FOR US ALL

November 18th, 2015

The terrorist attacks on Friday night in Paris have raised the anxiety of people around the world. The news that a terrorist organization is targeting innocent civilians is unsettling. The television and the Internet are aflood with pictures of the attacks, stories from survivors and projections about the next target. As anxiety levels rise, parents must remember to set a good example. Anxiety is quite contagious and children model behaviors, they especially take their cues from their parents. Parents must act rationally and provide an atmosphere of protection and safety. Children, teens, and tweens, not to mention college students live in a world where school shootings have become the norm and terrorist groups like ISIS are daily news. After the Paris attacks, young people are seeing on television, reading on the Internet and hearing at home and in school about terrorist attacks that could happen in their city near their home.

As a nation, we need to make sure that our young people are a priority as we deal with the threats from both international and domestic terrorists. The images seen on TV or online do make terrorist attacks and school shootings seem close by. It’s scary. The reality is that your chances of being in an attack are very, very small. But, that doesn’t seem to matter much when you see the pain, fear and anxiety constantly going on around you.

Here are some strategies for dealing with the fears and anxiety created by such attacks:

Limit the time you and your children watch the news. Is it necessary to have the news channel on all day?
Reassure and provide your kids the space to talk about their fears and anxiety. Kids should not be afraid to share their fears.
Get out and do your normal routine. Getting back into a daily routine is comforting. Sometimes the mundane things in daily life are a great distraction.
Visit with friends and try to avoid too much conversation about the attacks. If you need to talk about the attacks, try to make sure that your children are not in ear-shot. Talking may help parents deal with their anxiety but it can heighten anxiety in kids.
Join others in participating in candlelight vigils, religious ceremonies, memorial services, or other events.
Get support if you or your children need it. If your feelings make it impossible for you to function and do normal stuff, like go to school, it’s time to get help. Children can turn to a parent, teacher, religious leader, or guidance counselor. Adults should reach out to medical professionals, religious leaders, and online support groups.

Sadly, these attacks don’t look like they are going to stop any time soon, so let’s remember to keep our anger and hatred in check and promote peace.

How to Talk to Your Kids About the Attacks in Paris
Helping Children Cope after a Traumatic Event
Helping Children Cope with Frightening News
How to talk to your kids about the terror attacks in Paris

SUICIDE IS A GROWING EPIDEMIC IN AMERICA

November 13th, 2015

I wrote several blogs earlier this year about the suicide epidemic among teens in this country. In March, New York City School Chancellor Carmen Farina said that ten students in the New York City public school system had taken their own lives over a seven week period creating a “suicide epidemic” in our schools.

We now are dealing with a similar epidemic among active duty service members and veterans in this country. The Military Times reported in October that “suicides among active-duty service members rose by 20 percent in the second quarter of this year to 71, according to a new report released Wednesday by the Defense Department.”

Earlier this week, Roll Call reported that Sen. Joe Donnelly (D-IN),”called for action to address the issue of military suicide.” The Senator “noted that the annual defense authorization bill includes a ‘care package’ related to veterans’ mental health issues, which involves certifying practitioners who are veteran-friendly, providing training on suicide risk recognition and establishing an online registry of certified practitioners that veterans can access.”

In 2014, Donnelly’s bill known as the Jacob Sexton Military Suicide Prevention Act passed. It provided for annual mental health assessments for veterans. The Sexton Act is named after Indiana National Guardsman Jacob Sexton, who took his own life while home on a 15-day leave from Afghanistan.

Through his efforts Donnelly helped pass additional legislation relating to mental health care for service members and their families. Assessing suicide in the National Guard and the reserves and assessing suicide among military families were two key provisions. He also pushed to remove limits on mental health services. I have included a link below to read all of the provisions.

Suicide is a growing problem in this country. It doesn’t discriminate. Know the warning signs. Here is a link to Real Warriors, Real Battles with a list of warning signs. Below is a link to my blog with the warning signs for teens. Make sure to seek out professional advice if you think that a loved one is contemplating suicide.

Links:

Jacob Sexton Act & Provisions

The Warning Signs of Suicide

DON’T BE SAD!

November 10th, 2015

Seasonal affective disorder (SAD) is a type of depression that affects more than 14 million Americans, and it is related to changes in the seasons. Up until now the gold standard of treatment for SAD has been light therapy. That was up until a new study funded by the National Institute of Mental Health started pointing to cognitive-behavioral therapy as a better treatment.

Published online Friday in the American Journal of Psychiatry, a publication of the American Psychiatric Association, the study followed patients for several years noting the difference between cognitive-behavioral therapy and light therapy treatment. What researchers noticed was that those treated with cognitive behavioral therapy had higher remission rates with less recurrence than those treated with light therapy. These discrepancies were recorded during the second year of the study.

The standard treatment for SAD includes light therapy, psychotherapy and medications. Many people go undiagnosed and struggle through the winter months feeling like they just have to tough it out. That’s not true. If you have symptoms of SAD, you should make an appointment with your doctor and discuss the treatments.

So what are the symptoms of SAD? Most people first experience symptoms in the fall that continue through the winter months. Sometimes referred to as “winter depression” SAD has a variety of symptoms including moodiness, fatigue, low energy level and irritability. The physical symptoms can include weight gain, oversleeping, a change in appetite and arms and legs feeling heavy. Because SAD is a subtype of major depression it can have some of those symptoms too, including feeling hopeless or worthless, loss of interest in things that were once enjoyed, problems focusing, and even thoughts of death or suicide.

Know the symptoms of SAD and if you think you, a loved one or a friend might have it, seek out medical advice. The goal for treating SAD is to keep your mood and motivation steady throughout the year.

Outcomes One and Two Winters Following Cognitive-Behavioral Therapy or Light Therapy for Seasonal Affective Disorder
Talk Therapy Better Than Light Treatment For Seasonal Affective Disorder

EXCESSIVE TEXTING IS A REAL PROBLEM WITH TEENS

November 4th, 2015

Ask any parent who is raising teens today what it’s like to try to speak to your kids when they have a cell phone. At the dinner table, in the car, watching a movie, shopping, at work or just walking – their heads are down and their fingers are tapping away. Teens today are always on their phones. Try being around a teen who misplaces their phone and chaos breaks out until it’s found. Cell phones today are almost as important to teens as food (and some teens might even say their phone is more important)!

With this type of cell phone obsession, how are parents ever supposed to trust their teens not to text and drive? No matter how much parents talk to their teens about the dangers of texting behind the wheel, the temptation is still too great. Excessive texting is rampant and no doubt here to stay.

According to the CDC, each day in the United States, more than nine people are killed, and more than 1,153 people are injured in crashes that are reported to involve a distracted driver.

A distracted driver is a person who takes their eyes off the road, hands off the steering wheel or mind off of driving. Activities that cause distractions include using a cell phone, texting, eating, using in-vehicle navigation systems, and using audio devices.

The National Highway Transportation and Safety Administration (NHTSA) ran a campaign in October that emphasized the five most dangerous and deadly behaviors for teen drivers. One of those five was using a cell phone or texting while driving.

The NHTSA says on their website that “texting or dialing while driving is more than just risky – it’s deadly. In 2013, among drivers 15 to 19 years old involved in fatal crashes, 11 percent were reported as distracted at the time of the crash. This age group has the highest percentage of drivers distracted by phone use.”

Parents are facing an uphill battle trying to convince their teen of the dangers of texting and driving. Online Schools reported in 2012 that 52% of young-adult drivers said it was easy to text and drive while 34% of teens said they have texted while behind the wheel.

I would be remiss to say that teens are the only ones partaking in this risky behavior of texting and driving. Parents are doing it too! It’s a classic case of do as I say, not as I do. When it comes to highway safety, the parent is the role model. Unfortunately, from the studies that I’ve read most teens believe that adults, including their parents, are texting and driving. So if parents want to have an impact on their teens safety behind the wheel – parents must first practice what they preach. That’s always the best place to start!

Links:
‘5 to Drive’ campaign
Driving While Intexticated
Teen drivers are texting, just like their parents Washington Post, 2012