Dr. Henry Paul, MD

Psychiatrist, Author and Educator

ALARMING JUMP IN SUICIDE RATES

April 26th, 2016

I was surprised by the latest CDC report out this week that showed suicide rates in the United States were at their highest level in three decades. The report released on Friday said that suicides have increased in the US to a rate of 13 per 100,000 people, the highest since 1986. The increase is particularly pronounced among middle-age white people who now account for a third of all US suicides.

According to the CDC study, more than 14,000 middle-aged white people killed themselves in 2014, and the overall suicide rate rose by 24% from 1999 to 2014. Among white men ages 45 to 64, the rate increased 43% and increased 63% for women in the same age-range. The study did not venture to say what the causes might be for the increase, but I think we can surmise that mental health, substance abuse and difficult economic times have contributed.

The study also showed a jump in the suicides amongst girls between the ages of 10 to 14. From 1999 to 2015 the number tripled from 50 to 150. This number is still very low but the fact that it tripled is a concern.

The study did show a decline for two groups; black men and seniors over age 75.

Robert D Putnam, a professor of public policy at Harvard, told the New York Times, “This is part of the larger emerging pattern of evidence of the links between poverty, hopelessness and health.”

The New York Times also reported that since they ran their story last week, they had gotten an overwhelming response. If you need to speak with someone for yourself or a friend or loved one you can call:

National Suicide Prevention Hotline: No matter what problems you are dealing with they want to help you find a reason to keep living. By calling 1-800-273-TALK (8255) you’ll be connected to a skilled, trained counselor at a crisis center in your area, anytime 24/7. This is a confidential, free call.

Crisis Text Line: They serve anyone, in any type of crisis, providing access to free, 24/7 support and information via the medium people already use and trust: text. According to their website this is how it works:

Text 741-741 from anywhere in the USA, anytime, about any type of crisis.
A live, trained Crisis Counselor receives the text and responds quickly.
The volunteer Crisis Counselor will help you move from a hot moment to a cool moment
As always, if this is an emergency and someone is in crisis you should call 911.

LINKS
U.S. Suicide Rate Jumps to 30 Year High NY Times, April 2016
Crisistextline.org
National Suicide Prevention Hotline
Suicide is a Growing Epidemic in America Dr. Henry Paul Blog, November 2015

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.

WHY SHOULD I CARE ABOUT A DRUG ADDICT?

April 15th, 2016

Addiction is similar to other diseases, such as heart disease. Both disrupt the normal, healthy functioning of the underlying organ, have serious harmful consequences, are preventable, treatable, and if left untreated, can last a lifetime. Source: From the laboratories of Drs. N. Volkow and H. Schelbert.

Last week I posted a blog about Narcan™ (naloxone), an opiate antidote that saves lives! It was brought to my attention this week that a local community coalition spreading the word about opiate and heroin addiction was offering a free Narcan training, and I was surprised by some of the online conversation about it.

Some of the comments were about “letting the addicts die” because they (the addict) had made a choice to use drugs. Others were debating whether-or-not addiction is a disease. What these comments tell me is that there is a lot of confusion out there amongst adults about opiate addiction (including heroin, which is an opiate). So, I thought I would dry to address some of the confusion here.

First, drug addiction is a disease that develops over time as a result of the initially voluntary behavior of using drugs. While the full causes are not known drug addiction does take on a life of its own. Addiction ends up affecting a host of functions of a person’s body and mind.

In June of 2015, TIME magazine had a cover story, “Why America Can’t Kick Its Painkiller Problem.” The story makes the case that these addictions no longer start in the dark alleys with drug dealers, but rather start in doctors’ offices with everyday people seeking relief for their pain. These painkillers, known as opioids, are used to treat everything from migraine headaches to back pain, to sports injuries, to severe pelvic pain to chronic Lyme disease.

Here’s a little excerpt from the article that gives a pretty clear picture. “The longer patients stay on the drugs, which are chemically related to heroin and trigger a similar biological response, including euphoria, the higher the chances users will become addicted. When doctors, regulators and law-enforcement officials try to curb access, addicted patients buy the pills on the black market, where they are plentiful. And when those supplies run short, people who would never have dreamed of shooting up, like suburban moms and middle-class professionals, seek respite from the pain of withdrawal with the more potent method of dissolving and injecting the pills’ contents, or going straight to heroin.” (Massimo Calabresi, TIME)

This opiate epidemic is leading elected officials and the medical community to a point where we have to rethink pain management in this country. Law enforcement is on the treatment side. Yes, believe-it-or-not getting arrested leads to the beginning of treatment for many. What we need to do, and what was evident to me by reading some of the comments online, is that we have to put much more effort into awareness and prevention.

LINKS
Drugs, Brains, and Behavior: The Science of Addiction – this booklet explains scientific information about addiction that is easily understandable. Here is a link to a PDF you can download.

Why America Can’t Kick Its Painkiller Problem – You do need a TIME subscription to read this article.

How Science Has Revolutionized the Understanding of Drug Addiction

Easy to Read Drug Facts from the NIDA

BLACK BOX WARNING ON PAINKILLERS

March 25th, 2016

“They’re the most powerful painkillers ever invented, and their creating the worst addiction crisis America has ever seen.” TIME Magazine Cover June 2015

The US Food and Drug Administration this week announced that painkillers, such as OxyContin and Fentanyl, will now have to carry a “black box” warning stating the dangers of abuse, addiction, overdose and death.

It is called a black box warning because that is how it appears – in a black box. According to the FDA website, “it appears on a prescription drug’s label and is designed to call attention to serious or life-threatening risks.”

The FDA hopes that this warning will help to slow a growing epidemic in this country of opioid addiction that is leading to heroin addiction, overdose and death. In 2015, TIME magazine reported in their cover story that “9.4 million Americans take opioids for long-term pain and 2.1 million are estimated by the NIH (National Institutes of Health) to be hooked.”

The article went on to say that the crisis is a “tragic combination of good intentions, criminal deception and feckless oversight to turn America’s desire to relieve its pain into such widespread suffering.”

Here’s what the FDA told CNN about how this warning will work. “When a patient gets his or her prescription filled, the bottle should have a notification indicating there is a black-box warning for the drug. The consumer would need to go to the manufacturer’s website for details. In addition, pharmacists are encouraged to provide patients with a medication guide — consumer-friendly language explaining the risks of the drug. Under this new effort from the FDA, all instant-release drugs will need to have such a guide. It is up to the pharmacist to dispense this information, something the FDA encourages.”

The FDA ruling is a long-overdue step toward fighting America’s drug epidemic. I’m not sure it is realistic to assume that consumers will go to the manufacturers website for details, but I do think that pharmacists taking the time to go over the risks of painkillers will help. I have to agree with Senator Markey in what he told CNN, “It’s too little, too late.” We have a long way to go to turn this epidemic around and educating the public and doctors is key.

LINKS
Time Magazine Releases Cover Story on Pain Killers
Physicians for Responsible Opioid Prescribing
FDA now requires ‘black box’ warning on painkillers

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.

“SAD” MAY BE HEREDITARY

February 26th, 2016

It probably seems odd that I’m writing about seasonal depression when spring
is right around the corner. But in October, I did a blog about Seasonal Affective Disorder (SAD). The symptoms mimic those of depression, and the disorder is believed to be triggered by changes in daylight, making it more prevalent in the late fall heading into the winter months when the days get shorter. Well, now it seems there might be a gene that predisposes a person to SAD. The details were published today in the in the Proceedings of the National Academy of Sciences.

Because SAD almost always occurs during the winter months, researchers have believed the condition was triggered by light or rather the lack of light. It is believed that the changes in sunlight affect the circadian rhythms of people with SAD messing up their biological clocks. It is also believed that the increase in the production of melatonin, which is produced at higher levels in the dark could also be a cause.

The researchers in this new study analyzed a group of patients with SAD and also with another sleep disorder called Familial Advance Sleep-Phase syndrome. They identified a mutation in a gene called PER3 suggesting that this gene might both affect sleep and mood.

You can click below to read more of the details of the study. This team of researchers actively believes that there is a gene connection. Dr. Louis Ptáček, also a professor of neurology at the UCSF School of Medicine, said to MNT, “This is the first human mutation directly linked to seasonal affective disorder, and the first clear sign of a mechanism that could link sleep to mood disorders.”
This is an exciting time in research because the more we understand what causes these disorders, the better treatment options we can offer to patients.

LINKS
Seasonal affective disorder: first human gene mutation discovered
Don’t Be Sad
Does seasonal affective disorder actually exist?

DABBING – WHY PARENTS NEED TO WORRY!

February 8th, 2016

I came across this article yesterday on dabbing. I hadn’t heard of it before, so I was curious. Dabbing is a new method of smoking pot that gets you the quickest, long-lasting high with just one inhale. That’s right – one drag from a pipe or vaping pen can give the effect of smoking many joints.

On the website, Parents Opposed to Pot (POPPOT), they say that “Dabbing is to marijuana as crack is to cocaine.” They go on to say that the addiction from dabbing can be immediate, and once you do it “is nearly impossible to get unhooked.”

So how are “Dabs” made? According to the POPPOT website, “Dabbers take a tiny bit of butane hash oil, BHO – hardened or buttery, and quickly light it up in a small compartment.” The site explains how the THC is extracted from the plant using butane gas and some type of glass tube. THC is what causes a high. By extracting the THC into an oil (hash oil is known for giving a quick and lasting high) or buttery wax that hardens, you can then break it into tiny pieces that give a high that will last all day.

In states like Colorado where pot is legal, parents are fearful that legalization of the drug is why it is now showing up in middle school. We don’t have studies to confirm this, but I think the parents are right to assume this.

NJ.com reported in an article in September 2015, “According to a 2014 study by the National Institute on Drug Abuse, cigarette smoking by teens is down, but marijuana use has held its own and nearly 45% of the over 41,000 teens polled for the study reported that they’d smoked pot by the time they reached 12th grade, with an alarming number beginning as early as eighth grade.”

Angelo Valente, Executive Director of the Millburn-based Partnership for a Drug-Free New Jersey told NJ.com, “Kids are starting with pot younger and younger and middle school is a pivotal age for experimentation with pot, alcohol, and tobacco, especially when middle and high schools are located on the same campus.”

What I can say to parents is to know what dabbing is, know the signs and symptoms of drug use to watch for with your kids, and seek advice from a professional when you have concerns. Why should parents worry? Dabbing is new, it’s dangerous, it’s highly addictive, and it can result in injury and death.

LINKS
Kids exposed to marijuana at a younger age, experts say — NJ.com
What is “Dabbing” and Why Parents Need to Worry

LOOK THROUGH MY LENS

February 1st, 2016

I made a great video discovery on YouTube this week. I found this 14-minute video that explained autism. Most impressive was that this video was done, start to finish, by a 16-year-old high school student who wanted to let her peers know what it was like to have autism. No she doesn’t have autism, nor does anyone in her family. But, after she met her friend Jaime with cerebral palsy, she realized that we all need a better understanding of what it is like to live with a physical disability or learning difficulties. With her single YouTube video, she has helped thousands of teens understand a complex disorder.

Alex Jackman told Choices Magazine that it all began when out of curiosity she joined a girl for lunch at summer camp. Jaime was in a wheelchair and often ate by herself. Alex and Jaime became good friends. Alex tells Choices how that might not have happened had she not approached Jaime and sat down with her for lunch.

Jackman says that through her volunteer work at a local autism organization she was inspired to create the video, specifically targeted at teens, to help them better understand the developmental disorder. She told Choices, “I wanted to make something simple that put you in someone with autism’s shoes.”

After a year of interviewing kids she had met through her volunteering, interviewing experts on Autism, and writing, filming and editing – Jackman posted “A Teens Guide to Autism.” And, guess what? It took off. The video has been seen around the world and has won several awards! Kudos to Jackman for making a difference!

LINKS
The Autism Activist

KEEPING THE MIND OF COLLEGE ATHLETES HEALTHY

January 21st, 2016

The National Collegiate Athletic Association released last week new guidelines on dealing with the mental health of college athletes, an issue that remains a top concern for the association’s chief medical officer, Brian Hainline.

“Concussions may be the elephant in the room, but mental health is really, I think, going to be a game changer for the NCAA,” he said. “My hope is that mental health is going to become as accessible to every student-athlete as an ankle sprain, and the NCAA is going to take a leadership role in telling the rest of the United States of America how to move away from the pathetic way it handles mental health. And it is pathetic.”

Hainline spoke on Thursday at the NCAA’s annual meeting where he emphasized the importance of mental health. Earlier this month, the NCAA’s Sports Science Institute released a new set of guidelines directing institutions on how to manage the mental health issues surrounding college athletics. Behavior on and off the field are all part of the overall well-being of an athlete.

The new guidelines outline four best practices for the mental health care for college athletes and 24 different mental health agencies weighed in and helped to create the strategies.

The guidelines suggest that colleges implement procedures and clear action plans for dealing with mental health issues including a push for annual mental health screenings for athletes, evaluation of athletes by licensed practitioners and education that will help athletes to recognize symptoms of mental health disorders. The guidelines also address substance abuse and aggressive and risky behaviors that according to a study by the American College Health Association’s National College Health Assessment, says that athletes demonstrate more aggressive behavior and risky behavior than non-athletes.
I think the study and the new guidelines are a vital step in the right direction.

LINKS
Mental Health of College Athletes

BURIED PORNOGRAPHY? BIZARRE TWIST IN SEXUAL ASSAULT CASES

January 18th, 2016

“This is the third lawsuit filed by Ponvert in recent months against prestigious Connecticut boarding schools. Ponvert has filed two similar lawsuits against the Indian Mountain School, also located in Lakeville, alleging similar instances of sexual assault and rape of young schoolboys by faculty members dating back to the 1980s.” Hartford Courant

Since 2014, three lawsuits have been filed against Connecticut private schools; two at Indian Mountain and one at the prestigious Hotchkiss School, both in Lakeville, CT. Last week one of the cases took a bizarre turn when a judge ordered a dig on the school grounds to look for buried pornography. The Hartford Courant is reporting that a “federal judge has agreed to allow attorneys suing the Indian Mountain School in Salisbury over alleged student sex abuse to dig for evidence of child pornography claimed to be buried on school grounds.”

In the case of Indian Mountain School, former students told the Republican-American newspaper that the school failed to secure their safety from “sexual predators who had unfettered access to the school because they were teachers and even administrators.”

A Federal report in 2014 said, “The failure of U.S. schools to protect students from sexual abuse by school personnel is a story of district cover-ups, lack of training, incomplete teacher background checks and little guidance from the U.S. Department of Education.”

Many of the victims of sexual abuse are left to deal with a lifetime of anxiety, nightmares, panic, terror and other psychological issues. They struggle with sexual orientation and have trouble establishing healthy relationships. So how does this happen and why does it take so long, in many cases, for victims to come forward?

I think that a combination of denial by society and the authorities combined with devious sociopathic traits of the predators make it very hard to track these individuals. Plus, the very liberal court system that is very busy protecting predators in the name of fair and non-discriminatory treatment plus the charm and leadership roles and charisma of the perpetrators. But now there is a coming out of the victims broadly publicized which gives courage to the victim to tell what happened. Let’s hope in the end justice is served.

LINKS
Former Student Sues Hotchkiss School Over Alleged Sexual Abuse
Judge Allows Dig In Search Of Child Porn Buried At Private Connecticut School
Private school faces third suit
Federal Agencies Can Better Support State Efforts to Prevent and Respond to Sexual Abuse by School Personnel

20,000 GUN SUICIDES EVERY YEAR

December 24th, 2015

In a letter posted on the Brady Center & Campaign to Prevent Gun Violence, President Dan Gross said, “There are 20,000 gun suicides in the United States every year, more than 50 every single day. That’s more than half of all suicides and two-thirds of all gun deaths. These tragedies rarely make the news, or prompt action from our lawmakers, but they add up to a national tragedy of staggering proportions.”

The Brady Center released a study in September 2015 that examined the danger of having a gun in the home and its strong link to suicide. The study found that the impulsivity of many suicide attempts, and the fact that, even more than depression or substance abuse, the strongest predictor of how likely a person is to die from suicide is a gun in the home. According to the study, a gun in the home makes a suicide three times more likely.

I have written some blogs on gun violence mostly related to mass shootings. But, with all the debate that the mass shootings sparked, sadly the discussion never included guns and their role in suicide. I applaud the Brady Center for raising awareness about this important issue. Sadly, so many parents, spouses and others who choose to have a gun in their home do not realize how tragically that decision can impact their lives until it is too late.
Here are some key facts from the study:

The firearm suicide rate has increased more than 13 percent between 2007 and 2013
Suicide is the second leading cause of death among adolescents and young adults aged 10 to 24 years
85 to 91 percent of firearm suicide attempts are fatal, while drug overdose, is only fatal 2 percent of the time. This is a startling fact since the study points out that 92 percent of those who fail in a suicide attempt choose to embrace life and generally do not die by suicide.

The New York Times ran an editorial in September when the study was released. I liked what they said, “The suicide problem is enormously complicated without irresponsible access to guns. At a minimum, people who own guns should be required to keep them firmly under lock for the safety of society, let alone their own families.”

I agree that much more discussion and awareness needs to happen around the link between guns and suicide. The Brady Center is pushing for that happen. So check out the study, share the link and help the discussion to grow!

LINKS
The Truth About Suicide & Guns
Cayman’s Story
Full Report “The Truth About Suicide & Guns
The New York Times “The Quieter Gun Death”

CHEERLEADING: FEWER INJURIES BUT MORE SEVERE

December 17th, 2015

Interesting study out last week that says that cheerleading is a less dangerous sport for teens. The report does note that even though there are fewer accidents those that do happen tend to be more severe and more likely to result in concussions.

According to Reuters, “On average, cheerleading typically has less than one injury for every 1,000 minutes of participation time, meaning there’s no more than one accident every 17 hours, the study found.”

According to the report the only sports that are safer are track and field and swimming. The injury rates are obviously much higher for football and surprisingly high for girls’ soccer.

It is a very difficult decision that parents have to make when deciding whether or not to let their child participate in sports, particularly ones that are deemed dangerous. On one hand, children need to get exercise and it is good character building for young people to participate in team sports. On the other hand, when faced with the news about concussions and death it is not surprising that parents are fearful for their children’s safety when playing a sport like football. Look, even if you’re not a football fan, you can’t turn on the television without hearing something about the ongoing controversy over concussions and football.

The debate has been raging in this country for years now about the lack of exercise and the growing waistline of our young Americans. So how do parents decide where to draw the line? I think that you have to take into account that so many sports, like track and field, baseball, swimming and cheerleading are important because they get kids active, they build self-esteem and they teach comradery and teamwork.

I recommend that if parents have concerns that they discuss them with their pediatrician, the school and their children. Here are some alternatives to team sports that I recommend to help keep your child active.

Sports that are off the playing field such as skiing, swimming, Tae Kwon do, running, kick-boxing, resistance/weight training, etc. are very good for exercising. These days with extreme sports kids are finding where they “fit in” so take an interest in what they’re interested in and encourage them to pursue it.
Encourage exercise at the local gym. Suggest that they go with their friends. Encourage them to embrace exercise as a lifestyle change that they will have for a lifetime.
Outdoor sports such as kayaking, bike riding and hiking are also good alternatives. They can also be done in groups to encourage comradery.

Please send me your thoughts on exercise.

LINKS
Cheerleading Among the Safest Sports
Sitting Around Isn’t Good for Anyone’s Health