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

WHY SHOULD I GET NARCAN™ TRAINING?

April 4th, 2016

Narcan™ (naloxone) is an opiate antidote that saves lives! And, you should know how to use it because someday someone in your family just may need it.
Overdoses from painkillers and heroin, both opioids, are alarmingly on the rise in the United States. Opioids include heroin and prescription pain pills like morphine, codeine, oxycodone, methadone and Vicodin. When a person is overdosing on an opioid, breathing can slow down or stop, and it can be very hard to wake them from this state.

Who is at risk for overdose? Your grandmother who just had a knee replacement, your aunt who is dealing with chronic back pain, your teenage son or daughter who first takes painkillers while recovering from a sports injury. The list can go on and on. Sadly, painkillers are prescribed at alarming rates, and long-term use leads to addiction. These painkillers are often the gateway drug for heroin.

On Tuesday, President Obama announced a series of initiatives aimed at curbing America’s opioid addiction epidemic. The steps he outlined would make it easier to obtain medication-based treatment, expand Medicaid coverage and increase the availability of a drug that saves people from overdoses.

Narcan is a drug that can save people from overdosing. It can be delivered in the nostrils with the use of a mucosal atomization device (MAD) or intramuscularly with a syringe. Narcan is a non-patient specific prescription that is distributed through an authorized agency, such as a local health department, and given to individuals who have been trained in opioid overdose recognition and response consistent with that agencies registration with their state.

What does Narcan do? Simply, Narcan knocks the opioids out of the opiate receptors in the brain. Tom Ferraro, professor of biomedical sciences at Cooper Medical School of Rowan University in Camden, N.J. told Newsworks in an online article published in 2014 that it essentially “blocks the ability of opioids to do what they do at the molecular level.”
Ferrero went on in the article to explain, “The proteins in your brain have special receptors that, when unlocked, release certain biochemical reactions. Think of opioids, like heroin, as being special keys, says Ferraro. When they get in your brain, they seek out those receptors, ‘latch on’ and unlock the lock. When the drug opens and closes that lock repeatedly, it ‘triggers a cascade of biochemistry inside that particular cell.’” He says, “this is the basic mechanism of being high. The heroin repeatedly unlocks the lock, releasing euphoria, pain relief and addiction from that cell.”

Narcan, on the other hand, cannot be used to get a person high, and if given to an individual who has not taken opioids, it will not have any effect on them. For more information on Narcan visit FDA.gov

LINKS
Obama Pushes For More Treatment for Opioid Addiction
CVS to Sell Heroin OD Reversal Drug Narcan in More Pharmacies
The overdose ‘antidote’: how Narcan works

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.

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

YOU’VE GOT IT ALL WRONG!

January 26th, 2016

“Most American parents are completely confused and going utterly in the wrong direction,” Dr. Leonard Sax

A new book out this month by family physician, psychologist, and author, Leonard Sax says that parents have this parenting thing all wrong! “The Collapse of Parenting: How We Hurt our Kids when We Treat Them Like Grown-Ups” looks at the major shift that has occurred over the past 30 years in American culture: the transfer of authority from parents to children.

Like Sax, I too, have been in practice for many years. I agree with Sax that we have become an obsessively child-focused society; the children today are running the show!

Sax talks about how parents ask their children to let the doctor look in their (the child’s) throat. The parent then offers to reward the child afterward if they “open up” and let the doctor look in their throat to see if they’re sick!

Another interesting parenting trend, check-out “Spoiled Rotten” in the July issue of Boston Magazine where parents are paying their kids for scoring goals and grades. The rationale behind the thinking of the parents is fascinating. It is also wrong!

Parents today give their children unwarranted praise, try to be their child’s best friend, and give them whatever they ask for. The ability for parents to see clearly when it comes to their children has gotten skewed. Families go into debt trying to give their kids things they shouldn’t. Does Johnny need the most expensive sneakers? Does Emily need an upgrade to her IPhone that is working perfectly fine? Should children receive a trophy just because they were on the team?

Children are used by parents to fill parental needs and thus have their self-realization derailed. Worst of all, this parental indulgence sends the message to kids that they are the center of everyone else’s universe. As a result, some kids grow up without a sense of limits and with a high degree of entitlement and a lack of compassion and with little empathy.

Parents need to assume the responsibility for the fact that today’s kids lack a sense of limits, humility and a decent respect for authority. Kids believe that the end justifies the means, and that process means nothing. Society models and exploits this behavior on television and Internet programs targeting children and teens. It is the parents and society that are allowing this to happen and they need to make changes. Kids didn’t get this way all on their own.

LINKS
The Collapse of Parenting
Spoiled Rotten

PHYSICIAN BURNOUT

January 15th, 2016

“The number of U.S. physicians who say they are suffering “burnout” has jumped to more than half of doctors as the practice of medicine becomes more complicated and millions more Americans gain health coverage under the Affordable Care Act.” FORBES, 12/23/15

A disturbing trend is facing the medical community as we kick-off 2016. A recent report by the MAYO Clinic says, “doctor’s work life balancing is worsening”. The new study says the percentage of physicians who say they are suffering burnout rose to 54% in 2014 from 45% in 2011.

The report doesn’t specifically address the Affordable Care Act as the problem, but it does attribute the situation to more people getting healthcare and more paperwork involved with the new healthcare regulations. Where we were seeing a doctor shortage before the Affordable Care Act, this is only going to make that situation worse.

I wrote in October about the shortage of psychiatrists and how the profession was experimenting with telepsychiatry. Long before there was a national shortage of psychiatrists, there was a dire shortage of psychiatrists in rural areas of the country. That trend led the profession to experiment with new ways to treat patients. Hence online sessions with patients. But that has raised its concerns particularly with HIPAA, which requires the protection and confidential handling of protected health information.

Now, the trend we have seen in the psychiatric profession is bleeding over to the entire medical profession as a whole. In March 2015, The Washington Post reported by 2025 the doctor shortage in the United States could be as high as 90,000.

In a statement to Reuters News Service, lead author Dr. Tait Shanafelt, of the Mayo Clinic in Rochester, Minnesota said, “Things are unfortunately getting worse for physicians.”

“Of the 6,880 doctors who responded to the 2014 survey, about 47 percent reported high emotional exhaustion, about 35 percent felt depersonalized or saw less value in their work and about 16 percent felt a low level of personal accomplishment,” Reuters reported on the study.

What is scary about the shortage is that it will create a critical need for specialists to treat an aging population that will increasingly live with chronic disease. According to The Washington Post, the report by the Association of American Medical Colleges says, “the greatest shortfall, on a percentage basis, will be in the demand for surgeons — especially those who treat diseases more common to older people, such as cancer.”

“An increasingly older, sicker population, as well as people living longer with chronic diseases, such as cancer, is the reason for the increased demand,” Darrell G. Kirch, the AAMC’s president and chief executive, told reporters during a telephone news briefing.

So what does this mean for the future of medicine? It will create longer wait times to get appointments, and most likely you will be traveling farther to see a specialist. More patients will be seeing physician assistants, too. For psychiatry, as well as many other medical professions there will be an increased use of concierge medicine, and you will have to get used to telemedicine for diagnosing and treatment.

LINKS
The Doctor Can See You Now – On Your Computer!
U.S. faces 90,000 doctor shortage by 2025, medical school association warns
The Complexities of Physician Supply and Demand: Projections from 2013 to 2025

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

PSYCHIATRIC DRUGS FOR BABIES – REALLY?

December 14th, 2015

Is it possible that psychiatric medications tested on adults and meant to treat adult psychiatric disorders are now being used to treat psychiatric disorders in children younger than two years old? So it seems according to The New York Times story last week. “Still in a Crib, Yet Being Given Antipsychotics” by Alan Schwarz.

According to the NYT story, “Cases like that of Andrew Rios, in which children age 2 or younger are prescribed psychiatric medications to address alarmingly violent or withdrawn behavior, are rising rapidly, data shows. Many doctors worry that these drugs, designed for adults and only warily accepted for certain school-age youngsters, are being used to treat children still in cribs despite no published research into their effectiveness and potential health risks for children so young.”

Using drugs “off-label” for treating all kinds of conditions from cancer to ADHD has become so common that almost every drug at some point is prescribed off-label. Off-label means the medication is being used in a manner not specified in the FDA’s approved packaging label or insert. Off-label prescribing isn’t necessarily bad. It can be beneficial.

In child and adolescent psychiatry, the majority of the drug prescribing is done off-label. Few medications are approved for young people, but making these valuable medications unavailable because drug companies have not tested them for all conditions and populations would cause a lot of prolonged suffering and even deaths. This is the case for hundreds of drugs, not just psychotropic medications. Studies have been coming out showing the helpfulness of psychotropic medication in young people, and hopefully, science and research will continue to catch up with clinical reality.

One problem with children under two receiving these medications is that one cannot get the feedback that you get treating older children and adults. Babies have very limited language skills and cannot participate in guiding treatment decisions. Additionally, the effects of these medications on the development of the young body of a baby are not known, and I think it is rational to worry about the high possible vulnerability of infant tissues.

As much as I believe in using drugs off-label I believe that babies should not be given psychotropic medication. Further tests are needed, and behavioral modifications should be tried first.

LINKS
Still in a Crib, Yet Being Given Antipsychotics

CHILD ABUSE, STRESS AND THE HOLIDAYS!

December 8th, 2015

The holidays for many are a joyous time of year. They are also a very stressful time. The increased stress put on families this time of year often leads to more cases of child abuse or neglect. Sad but true!

Statistics shows that the holidays are often the busiest time of year for agencies working with children and families dealing with abuse and neglect. The stress of dealing with holiday travel, planning, relationships, expenses and the likes leaves parents feeling angry and short on patience, and that can lead to abuse. The economic and personal stresses that can wear on a family over the course of a year are increased by the extra demands that the holidays place on their time, money and energy. Additionally, the increase in alcohol consumption during the holidays can lead to parents losing their tempers.

What makes this whole situation worse is the unrealistic expectations that both children and parents place on the “perfect” holiday. Having to chase down that one gift the kids just have to have is exhausting! So here are some things that families can do to minimize the risk of abuse.

Have a budget for the holidays. Nothing creates more stress than over-spending.
Sit down with you children and discuss the plans for the holidays and temper expectations on gifts and time. A big cause of holiday stress is having too much to do in a short period. Create a schedule so that everyone knows what to expect and can plan accordingly. Teens especially should be involved in the scheduling as they will want to include opportunities to spend time with their friends over the holiday break.
Having kids home from school when you have to work is stressful. Work out a plan sooner rather than later to make sure that kids are covered. Spouses maybe can split coverage so not as to miss too much time at work.
Limit your travel during this time. The holidays are a busy time to travel in general. If you have to travel leave enough time to get to your destination and expect delays. Go into your trip with a heavy dose of patience because you’re going to need it.
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 and drink. It’s easy with all the pies, goodies and alcohol to over-do-it during the holidays.
Stick to your daily routine. If that means exercising in the morning – then 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.
Make sure to get sleep. Your body needs a good night’s sleep.

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!