Dr. Henry Paul, MD

Psychiatrist, Author and Educator

SHOULD I TALK ABOUT MY DEPRESSION AT WORK?

November 21st, 2014

Many people with depression or another mental disorder are overwhelmed enough just dealing with their diagnosis and their focus on getting better, so it is no wonder that they do not want the added stress of having to tell family, friends, co-workers and bosses about their mental health.

Last Friday, a New York Times article, Deciding Whether to Disclose Mental Disorders to the Boss analyzed the decision that Patrick Ross, a deputy director of communications for the U.S. Patent and Trademark Office, made when he decided to tell his boss he had bi-polar disorder.

There is no right or wrong answer about telling your boss or others that you have a mental disorder, but if suddenly you are unreliable, your work drops off, and you no longer are the team player you used to be, then your boss will notice.

At work, you have two options: tell your boss and hope s/he will understand or do not saying anything and hope it goes unnoticed (if it isn’t too severe).

In the NY Times article, Sarah von Schrader, a senior research associate at Cornell University’s Employment and Disability Institute, said, “In one recent study of 600 people with disabilities, roughly half involving mental health, about a quarter of the respondents said they received negative responses to revealing their problems — such as not being promoted, being treated differently or being bullied.”

For Ross, who recently published a book on the subject, “Committed: A Memoir of the Artist’s Road,” he said that telling his boss was more difficult than he had expected. Since he told his boss, Ross says the support from his boss has been positive and even helpful. Ross still wonders how telling might affect his overall career, though, since his job is a political appointment. Only time will tell.

The World Health Organization predicts that by 2020, mental illness will be the second leading cause of disability worldwide, after heart disease. Right now major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a new study funded by the National Institute of Mental Health, and the direct cost of depression to the United States in terms of lost time at work is estimated at 172 million days yearly.

I want to see a national dialog about mental health that helps employers to understand the importance of having an employee who is both physically and mentally well. Sadly, it is still a reality in America in 2014 that people with mental illness are somehow labeled or looked upon differently. I am proud to say that we are making strides in this country to change stereotypes like these. I only wish it could happen faster. Putting mental-health problems on an equal footing with physical illnesses will only help more people make the disclosure. In the end, all will benefit. An employee at the top of his/her game is much more productive!

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.

CDC SAYS 1 IN 68 CHILDREN IS ON THE AUTISM SPECTRUM – SO WHAT DOES THAT REALLY MEAN?

March 28th, 2014

This morning, almost every news outlet ran a story about the latest CDC study stating one in 68 children has Autism. Lenny Bernstein reported today in The Washington Post “To Your Health” section that “ The number of U.S. children with autism has surged to one in 68, the Centers for Disease Control and Prevention reported Thursday, a 30 percent increase since the agency estimated just two years ago that one child in 88 suffered from the disorder.

The new estimate, based on a review of records in 2010 for eight year olds in 11 states, also showed a marked increase in the number of children with higher IQs who fall somewhere on the autism spectrum, and a broad range of results depending on where a child lives. Only one child in 175 was diagnosed with autism in Alabama, while one in 45 was found to have the disorder in New Jersey.”

What does all this mean to parents? First, if you suspect that your child may be on the spectrum [read my earlier blog this week on the signs of Autism] then you need to have your child seen by a professional who will make a diagnosis. You will also need to speak with the CSE (Committee on Special Education) at your child’s school to discuss testing. The testing will identify what support services the school will be able to offer your child through an Independent Education Plan, known as the IEP.

As frightening as this diagnosis may be for parents there are children on the autism spectrum that are able to lead productive lives. Many celebrated people have been diagnosed or are suspected of being on the autism spectrum. The best thing you can do is to learn about autism and be sure your child receives all the services available in your area.

The Signs of Autism — I Think My Child Might Be on The Spectrum

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.

I THINK MY CHILD MIGHT BE ON THE SPECTRUM

March 24th, 2014

“I’m terrified, Doctor, Philip is almost two and he still hasn’t said a word. Could he be Autistic?”

Autism, today, is one of the most talked about, and feared, diagnoses for parents. Autism and Autism spectrum disorder (ASD) are both general terms for a group of complex disorders of brain development that affect each person in different ways, and can range from very mild to severe. Generally symptoms start before the age of three years old and last a lifetime. There are three types ASD’s; Autistic Disorder, Asperger Syndrome, and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS; also called “atypical autism”). All three are characterized by varying degrees of difficulty with social interaction, verbal and nonverbal communication and repetitive behaviors. These symptoms include:

Impaired social relatedness
Lack of social reciprocity
Decreased peer relationships
Sharing deficits
Delayed or lack of language
Odd/repetitive speech
Poor conversational skills
Rigidity
An obsessive need for sameness
Rituals
Motor mannerisms
Preoccupations with parts of objects or narrow interests

As with so many other psychiatric syndromes, we don’t know exactly what causes autism, but we do know that it is not caused — as had once widely been thought — by cold, inattentive, negligent or unloving parents. Autism seems to be a disorder connected with dysfunction in the central nervous system. While no clear lesion or specific neurotransmitter has been isolated as the cause, we know that genetics plays a role.

As for treating with medication, antipsychotic drugs have only proven helpful in a narrow range of symptoms including irritability, tantrums, some of the motor issues, the occasional high anxiety of these children (sometimes to the point of psychosis), and repetitive behaviors. Unfortunately, there is little pharmacological help for the core of Autism, which is impaired communication and decreased relatedness.

WHEN ARE SLEEP MEDICATIONS NECESSARY FOR CHILDREN?

March 14th, 2014

Recent studies show a striking rise in the prescription of sleeping pills for children by pediatricians and child psychiatrists. These doctors worry about the effects of disrupted sleep on children and mostly prescribe for this reason. This is alarming to me and many others in the field. Medications have side effects, and some could even lead to a habit forming situation. In general, I rarely prescribe a sleeping agent for children and teens. The few times that I do consider it necessary is when:

• The situation continues moderately to severely despite all other remedies.

• It is caused by another medication, which is necessary.

• It is part of a mental disorder, and the treatment does not affect the insomnia.

Most sleeping problems pass. As I mentioned in my earlier blogs, you need to try sleep hygiene techniques first. They almost always work! Other things that work include parent counseling and various behavioral interventions. Oh, and remember that too much technology, over-scheduling, and caffeine could all play a part. I can’t stress enough that medication should always be the last resort.

OTHER SLEEP DISORDERS IN CHILDREN AND TEENS – NIGHT TERROR DISORDER

March 11th, 2014

In my last couple of blogs, I have been discussing a group of sleep disorders in children called Parasomnias. I have addressed two of the four parasomnias in children; nightmares and sleepwalking. Today I will discuss night terror.

Night terror disorder is quite frightening for parents or to anyone who witnesses it. Typically the child bolts upright from sleep with eyes wide open (although often not able to recognize family members), appears frightened often to the point of panic, and is screaming, confused, and inconsolable. The heart rate is elevated; there is shortness of breath, and he might be sweating, as well. There is what appears to be acute terrifying distress. The child usually cannot be awakened. The episode usually occurs in the first third of the night, and he falls right back to sleep. There is amnesia for the event the next morning.

Although this is a dramatic event, it is not particularly serious in the long term. It occurs rarely and usually disappears by teenage years. Some hypothesized causes are fatigue, new environments, fever, obstructive sleep apnea, and stress of some sort. As with nightmares the way to handle this is to be reassuring and comforting and for you not to panic. Practicing good sleep hygiene is a parent’s best bet. If these night terror attacks become frequent and/or disrupt family life, the use of benzodiazepines for a short amount of time has been found helpful. Some parents have reported that 1-5 hydoxytryptophan, which is sold over the counter and metabolized to become serotonin in the body, has allayed these terror attacks.

Our next blog is bedwetting and it will conclude this short blog series on parasomnias.

SLEEP DISORDERS IN CHILDREN AND TEENS – SLEEPWALKING

March 6th, 2014

In the last blog, we discussed nightmares. Now, we are going to look at sleepwalking. This parasomnia is characterized by a child getting up and walking around. Eyes are open, but responsiveness is either absent or inappropriate. Walking around can vary from quiet walking to agitated running. There is usually a glassy dazed stare. Sometimes the child can go to the bathroom or engage in other activities. Rarely there is violence. There is amnesia for the event. After the episode, the child can be found sleeping somewhere in the house.

There appears to be a genetic contribution to causation. Additionally, sleep deprivation, a chaotic environment, stress, some sleeping pills, and antipsychotic drugs, stimulants, or antihistamines might cause these episodes. It is also associated with PTSD, panic disorder and possibly dissociative identity disorder. Some medical conditions including gastroesophageal reflux, fever, asthma, and obstructive sleep apnea are present.

As in other parasomnias, treatment becomes necessary if there is resultant family disturbance or increased frequency. Since children can hurt themselves by accidents such as falling down stairs or getting outside the house, safety measures have to be taken such as trying to make the first floor of a house the sleeping location, locking doors and windows, clearing obstructions, putting heavy drapes over glass windows, and possibly setting an alarm which will sound if the child gets out of bed. Treatment consists of clearing up any associated medical conditions and rarely the use of medication including the short term benzodiapine Klonopin or Trazadone.

OTHER SLEEP DISORDERS IN CHILDREN AND TEENS — NIGHTMARES

March 5th, 2014

Sandy has been scaring us. She seems to wake up screaming, terrified, and agitated. She bolts up. After a few minutes she goes back to sleep. It not only scares us but she doesn’t even remember the whole thing the next morning.

There is a group of sleep disorders called Parasomnias. These syndromes present as unusual behaviors or movements that occur during sleep. They occur mostly in children and are rarely serious. They usually are gone by adolescence and the most effective interventions are parent education and counseling. Medication is rarely needed for most cases. They are rarely associated with major mental disorders. The most common ones encountered in practice are Nightmares, Night Terrors, Sleepwalking, and Bedwetting.

I will discuss all four in my next few blogs, but we’ll start with nightmares today. Nightmares or bad dreams are quite common in young people. These are dreams in which the child experiences himself in danger, vulnerable, frightened, and helpless. There is great distress, sometimes even panic and horror. Common themes often involve being chased, drowning, and other frightening losses of control. These dreams usually happen in the second part of the night, and the child often wakes up scared and remembers the dream content.

The child is often quite anxious, possibly believing that the dream was reality. He has a fast heart rate and might be perspiring, as well. Children usually need soothing and reassurance. Sometimes from the content of the nightmare the parent will be able to figure out what might be causing a passing stress or anxiety and might be able to help. Of course, there might be causes for repetitive nightmares such as chronic stress/anxiety. Some physiological causes might be the administration of certain antidepressants or stimulant medication for ADHD and post-traumatic stress disorder. If nightmares have become disruptive to the point of interfering with functioning then treatment to decrease stress, a fitness program, relaxation therapy, yoga, and even meditation have all been reported to help. In the most severe cases, such as those following a severe stressor, medication has been used with success and includes the antidepressants Trazadone or Serzone, some mood stabilizer, and possibly a Benzodiazepine anti-anxiety drug for the short term (a week or so).