Dr. Henry Paul, MD

Psychiatrist, Author and Educator

“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?

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.

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

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.

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

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

ANGRY KIDS! WHAT’S A PARENT TO DO?

August 18th, 2015

Angry children are difficult for parents to deal with, and yet many parents don’t contact a specialist for help until a child’s problems are pretty well entrenched. Why? Because despite the fact most of us approach the major challenge of being a parent with no on-the-job training, we tend to consider ourselves experts. Who knows our children better than we do, after all? Also, because we have the notion that the difficult job of raising a child is supposed to come naturally, many of us think that seeking help is a weakness or shortcoming. Another reason is just simply that many of us wait until we feel our backs are against the wall before taking what we think of as drastic measures.

I have dealt with many angry children over the past 30 years, and I have counseled their parents on how to deal with their child’s anger. Uncovering the pain behind a child’s anger may not be easy but my job as a child psychiatrist is to help you and your child to pinpoint the cause of the anger.

With school having started for many children already and many others heading back in the next couple of weeks parents may begin to see even more outbursts of anger followed by that dreaded call from the school. Shortly after the school year begins, a teacher calls to tell you that your son is behaving badly and doing poorly on his work or your daughter is obnoxious and creating trouble when she gets together with her friends.

Anger manifests itself in many different ways. For a seven-year-old it is a panic attack before school every day and with a teenager it is excessive moodiness. What seemed to just be a normal part of your child’s personality has now taken on pathological proportions; your son was always shy, but now he has no social contacts whatsoever; your worrier, who has always been concerned with details and planning, seems suddenly terrified to touch anything in the house; your child who has always been somewhat of a troublemaker at school is now in trouble with the law and is a substance abuser. This is scary stuff!

So what’s a parent to do? Calling your pediatrician or a child psychiatrist is a good place to start – and the sooner, the better. As much as I wish it were otherwise — a problem caught early is more easily solved, and the pain and damage involved is decidedly less — I’m afraid that is simply human nature.

PROM – A RIGHT OF PASSAGE

May 22nd, 2015

This is the weekend for many high school proms across the country. Teenagers are eagerly awaiting this “adult” night out with friends. The dress is bought, the tux is rented, tickets are bought and the perfect flowers are ordered. But, the unspoken about prom night is what I’m concerned about. Parents need to talk to their kids about staying safe. They need to know what their child’s plans are for prom. Who is driving, where they are going, and what they are doing after the prom.

All too often, parties are a part of prom night. With them come drinking and drugs, particularly marijuana, and inexperienced drivers. Make sure they understand the dangers of distracted, drugged and drunk driving. A sobering reminder to parents – teenagers, cars, texting, alcohol and drugs are a deadly mix. Here are some things to keep in mind and to discuss with your children about prom night.

First, remember teenagers never set-out to hurt their friends when they drive high or drunk, no one does. But the tragic truth is that drugged driving does kill!
Substance abuse is on the rise in the United States, particularly, amongst teens and young adults in their 20’s.
Statistically, teens think that driving drunk is much worse than driving high. Make sure they understand that “drugged” driving is as bad as drunk driving. Both are illegal, and both can be deadly.
Talk to your kids about driving high. Smoking pot is not a “rite of passage” for teenagers. The stakes are much too high!
While you’re at it – remind your teenagers that almost 6,000 people die each year due to distracted driving, according to the National Highway Traffic Safety Administration. Make sure they know – no texting and driving.
Educate yourself about the other dangers that are out there for teens. MOLLY, synthetic heroin, powdered caffeine, powdered alcohol (a powdered form of alcohol called Palcohol is now approved for sale in the United States), “skittle bowls” and Raves.
Remember, to enjoy prom night and all that comes with it for you and your child. Be sure your teen knows that they can call you no matter what! Most important – keep the lines of communication open. Happy (and safe) prom to all!

Disclaimer
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.

WEIGHT GAIN IN KIDS TAKING PSYCHOTROPIC MEDICATIONS

May 20th, 2015

What to do about weight gain in kids on psychotropic medications seems to be one of the leading concerns of parents. Some antipsychotic medications and antidepressants cause weight gain.

First, I want to make clear that these medications in many instances are very helpful in treating children with mental health disorders. Weight gain does not occur in all young people who take them. In some cases, the medications are life-saving. As a parent, you have to weigh the benefits. Usually, the benefits outweigh the risks of side effects including weight gain.

Having treated thousands of children in my career, I know that gaining weight itself comes with its problems — self-esteem, social acceptance, and of course one’s physical health.

If your child has been prescribed a medication that is known to cause weight gain, here are some things you can do. The first is to consult with your pediatrician to establish what a healthy weight is for your child. Keep track of your child’s weight. If weight is being gained, then a common sense cutback in calorie consumption is necessary. Work with your child to create a healthy lifestyle of eating and exercise and try to limit calorie content of foods as much as possible. It has been my experience that high fat and sugar snacks are often the culprits for kids on medications. Help your child to cut down noshing, and only nosh on low-calorie foods and decrease overall intake of calories.
The best thing to do is to work with children to teach them better eating habits. Encourage them to be hands-on in the decisions about what they eat. Have them help you in the kitchen. Take them food shopping. More importantly, be an example. If you are eating junk food, of course, they will want it too. Make outings more about doing things rather than about going out to eat or going for ice cream.

In the end, when your child is on antidepressant or antipsychotic medications weight should be watched. There is no magic here and no magic mechanism. As parents, we have to watch what we and what our children eat. Parents need to set a good example and help their children make good choices.

YOUNG CHILDREN AND GENDER IDENTITY (GENDER DSYPHORIA)

May 12th, 2015

“People who have gender dysphoria feel strongly that they are not the gender they physically appear to be.

For example, a person who has a penis and all other physical traits of a male might feel instead that he is actually a female. That person would have an intense desire to have a female body and to be accepted by others as a female. Or, someone with the physical characteristics of a female would feel her true identity is male.

Feeling that your body does not reflect your true gender can cause severe distress, anxiety, and depression. “Dysphoria” is a feeling of dissatisfaction, anxiety, and restlessness. With gender dysphoria, the discomfort with your male or female body can be so intense that it can interfere with the way you function in normal life, for instance at school or work or during social activities.” (WEDMD, 2015)

Gender dysphoria is another term for Gender Identity Disorder. Whether-or-not young children who express transgender issues can really be believed is a hotly debated issue right now. Is this ever just a phase? How do you respond when your toddler daughter’s first sentence is that she’s a boy and she says it over-and-over, day-after-day? What do you do when your three-year-old son insists on wearing nail polish like mommy, and a dress to pre-school?

How young is too young to know? In March 2015, a Medscape study looked at the usual patterns for development of gender identity. According to the study, “Several studies by Milton Diamond of the University of Hawaii indicate that gender development reaches a critical point during childhood, after which it becomes extremely difficult to modify in most individuals. While there may be a number of children who do not clearly fit into a neat binary model of gender in which the polar extremes of behavior are reserved for those with clear sex and gender congruence, it is increasingly clear that gender identity is at the very least an intrinsic characteristic that emerges during early development.”

For parents, dealing with a child’s gender identity issues can be overwhelming. It also brings on a flood of questions. What causes it? What treatment will help? What should parents do or not do?

The first thing is not to panic. Love your child. Talk with your child’s pediatrician and seek out a child psychiatrist, if necessary. Many very young children express gender dysphoria and turn out not to be transgender when older. Thus, it is considered risky to support any permanent changes (name, gender reassignment surgery,etc.) until a child is older. Also, with gender identity there are usually underlying conditions, known as co-morbidities, which need to be addressed. These co-morbidities include such things as depression, anxiety and suicidal tendencies. Remember, that supportive parenting practices are key to strengthening a child’s self-esteem. Listen, learn and keep the communication open. Those are the first steps!

UNDERSTANDING TRANSGENDER CHILDREN

May 8th, 2015

Children and teenagers are grappling with a very grown-up issue that suddenly has everyone talking because of the Bruce Jenner interview last month. What is it? Gender Identity! It is when a person’s gender identity does not correspond to that person’s biological sex assigned at birth. It is when the body says one thing and the mind clearly says another.

CBS News did a story in 2014 that I recommend you watch. Born this way: Stories of young transgender children looks at what it is like to be young and transgender in America. It begins interviewing 12 year-old Zoey, who says she always knew she was a girl even though she was born a boy. She told interviewer Rita Braver, “I would be like, ‘No, I’m not a boy. I’m a girl. You know, like, I like the color pink, I scream like a girl. I act like a girl. I breathe like a girl. I’m not a boy.””

Zoey’s mom tells about her fear after Zoey told her she was a girl, and how she finally accepted Zoey’s decision to live as an openly-transgender girl. But, make no mistake it wasn’t easy. Although, Zoey tells Braver she was supported by many friends and family, she still endured cruel treatment.

Thirteen year-old Venice, tells Braver how he is taking testosterone because he was born a girl but always felt like a boy. His mom and brother were supportive from the start, but his father struggled with Venice’s decision. His father actually went so far as to hire a therapist to convince Venice to remain a girl. Both parents, even though they were separated, joined a support group for parents of transgender children.

For the parents of six year-old Mati, it started when she was two. Mati, born a boy, wanted to be a girl. Her parents decided that her happiness was most important and so they supported her transition. Many people have criticized their choice. They tell Braver why they feel it was right.

All of these children and their families should be applauded for doing the interview with CBS and Braver. It is their voice that will help others. Click here to watch the interview.

NOT GUILTY BY REASON OF INSANITY

April 30th, 2015

In criminal trials, the insanity defense is the claim that the defendant is not responsible for his or her actions during a mental health episode (psychiatric illness or mental handicap).

The defense for mass murderer James Holmes claims the defendant was not guilty by reason of insanity in the Colorado movie theater massacre. Twelve people were killed, and 70 people injured in the 2013 shooting that stunned a nation. If the jury convicts Holmes, it would then also have to decide whether he should be executed or be sentenced to life without parole.

There are four different legal defenses for insanity. Cornell University Law School defines them quite nicely here. Depending on which defense is used the punishment could vary.

The accurate prediction of violence is a difficult area in psychiatry, so being able to predict that Holmes would do something like this is very difficult. What can we learn from Holmes? In many of these shootings, often the perpetrators are shot, or they kill themselves; not leaving the opportunity to learn what triggered them to be so violent. In this instance, crazy as it may be, we have the opportunity to observe, listen and learn from Holmes. We can learn what he was thinking and how he acted and develop possible preventive measures.

In the meantime, as this trial unfolds I want to remind parents that this can bring up a lot of scary feelings for children all again. Children will no doubt be privy to hearing the details of this shooting all again as it is discussed in the news; creating discussions that adults will have that children may overhear. I recommend that first you make sure your response is developmentally appropriate. How you discuss the trial and the shooting with a teenager is very different from how you would discuss it with a younger child. Based on their age limit the exposure to the news. Young children do not need to see it at all. Teenagers may ask questions and it may bring up some of the fears that the shooting initially triggered in 2012. Talk with your teenager about how rare it is for this to happen and emphasize safety. With young children don’t overwhelm them with details. Reassure them that they are safe. Lastly, don’t create anxiety. If you become anxious, then your children will, too.

Disclaimer 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.