Dr. Henry Paul, MD

Psychiatrist, Author and Educator

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

November 20th, 2015

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

46628740_sAccording to a report released earlier this month by the city’s Department of Mental Hygiene, at least one in five adults in NYC suffer from depression, substance abuse, suicidal thoughts or other psychological disorders. This report says that nearly 20 percent of New Yorker’s suffer each year with a mental health disorder and that, “at any given time over half a million adult New Yorkers are estimated to have depression, yet less than 40% report receiving care for it.”

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

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

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

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

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.

VICTIMS OF CHILDHOOD BULLYING & THE IMPACT ON THEM AS ADULTS

August 24th, 2015

42851807_sI have counseled plenty of children over the years who have been the victims of childhood bullying. Now, a new study says that childhood bullying has effects that last long into adulthood. I came across an article this week in MedicalNewsToday.com that says, “Research is now attempting to understand why victims of childhood bullying are at risk of poorer outcomes in adulthood, not only for psychological health, but also physical health, cognitive functioning and quality of life.”

Bullying comes in many forms, but intimidation, teasing and the threat of violence are often involved. The article in MedicalNewsToday.com references studies by the US Department of Health & Human Services (DHHS) that said that the most common types of bullying are verbal and social:

  • Name calling – 44.2% of cases
  • Teasing – 43.3%
  • Spreading rumors or lies – 36.3%
  • Pushing or shoving – 32.4%
  • Hitting, slapping or kicking – 29.2%
  • Leaving out – 28.5%
  • Threatening – 27.4%
  • Stealing belongings – 27.3%
  • Sexual comments or gestures – 23.7%
  • Email or blogging – 9.9%

In children, it has been shown that persistent bullying can lead to depression and anxiety. These disorders are often why parents finally call me. The bullying itself may go away with intervention from parents and school administrators, but the scars are deep and can last a lifetime.

In a study in the UK in 2014, “researchers found, at age 50, participants who had been bullied when they were children were more likely to be in poorer physical and psychological health and have worse cognitive functioning than people who had not been bullied.”

The study also said that “Victims of bullying were also found to be more likely to be unemployed, earn less and have lower educational levels than people who had not been bullied. They were also less likely to be in a relationship or have good social support. People who had been bullied were more likely to report lower quality of life and life satisfaction than their peers who had not been bullied.”

In working with children of bullying, I find that many of these kids suffer from severe anxiety with features of post-traumatic stress disorder (PTSD), depression and often, suicidal ideation. These children may find that they will need to seek counseling for an extended period to learn to handle their anxiety and depression. Psychotherapy is the treatment of choice and, in some cases, medication is necessary. These children also may find that they will need to seek counseling throughout their life to learn to handle their anxiety and depression. For many, lifestyle changes and talking about their childhood experiences with bullying will help. Sadly in some cases medication will be necessary. The sooner a child begins to deal with their bullying the better the outcome.

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.

WHAT IS THIS THING CALLED DEPRESSION ANYWAY?

November 18th, 2014

Depression is a scary word to hear, especially from a doctor who is diagnosing you! It is important to remember, when you are diagnosed with depression that you are not alone. Depression affects about 25 million Americans each year. That is about 5-8 percent of adults in the United States. What is startling is that only a fraction of these people receive any treatment.

Depression is a mental disorder. But depressive symptoms present themselves within other mental disorders such as: bipolar disorder, posttraumatic stress disorder PTSD, panic/anxiety disorder, obsessive compulsive disorder (OCD), schizophrenia and borderline personality disorder.

Depression can happen a few times in a lifetime, present with several episodes over a year or have ongoing symptoms that get better and worse. When someone comes in and receives a diagnosis of major depression, it is unknown whether this depression (not associated with mania or hypomania) is a plain unipolar depression or one that is part of bipolar disorder. Bipolar disorder is characterized by episodes of depression and mania/hypomania (like mania but less severe). This is very important because the depression that is part of bipolar disorder, called bipolar depression, is treated differently than simple unipolar depression.

When you first visit your psychiatrist make sure that you can provide a complete history of your mental health. This includes the drugs and treatments you have had over the years, as well as all your symptoms.

Depression symptoms, as listed by the National Alliance on Mental Illness NAMI, include:

  • Changes in sleep. Some people experience difficulty in falling asleep, waking up during the night or awakening earlier than desired. Other people sleep excessively or much longer than they used to.
  • Changes in appetite. Weight gain or weight loss demonstrates changes in eating habits and appetite during episodes of depression.
  • Poor concentration. The inability to concentrate and/or make decisions is a serious aspect of depression. During severe depression, some people find following the thread of a simple newspaper article to be extremely difficult, or making major decisions often impossible.
  • Loss of energy. The loss of energy and fatigue often affects people living with depression. Mental speed and activity are usually reduced, as is the ability to perform normal daily routines.
  • Lack of interest. During depression, people feel sad and lose interest in usual activities.
  • Low self-esteem. During periods of depression, people dwell on memories of losses or failures and feel excessive guilt and helplessness.
  • Hopelessness or guilt. The symptoms of depression often produce a strong feeling of hopelessness, or a belief that nothing will ever improve. These feelings can lead to thoughts of suicide.
  • Movement changes. People may literally look “slowed down” or overly activated and agitated.

Your doctor will ask you if you have mania/hypomania to determine if your depression is only depression or if it is bipolar disorder. NAMI also has a good fact sheet with the symptoms of mania. Symptoms of mania/hypomania can include:

  • Feeling overly happy for an extended period of time.
  • An abnormally increased level of irritability.
  • Overconfidence or an extremely inflated self-esteem.
  • Increased talkativeness.
  • Decreased amount of sleep.
  • Engaging in risky behavior, such as spending sprees and impulsive sex.
  • Racing thoughts, jumping quickly from one idea to another.
  • Easily distracted.
  • Feeling agitated or “jumpy.”

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.

AM I MISSING THE SYMPTOMS OF SEXUAL ABUSE WITH MY CHILD?

October 31st, 2014

For starters, I will tell you that sexual abuse is hard to diagnose in children while it is happening because fully 25 to 35 percent of victimized children show no symptoms of the abuse. However, two-thirds do develop symptoms, which may range from anxiety, dissociation, depression, sexualized behaviors, bedwetting or expressions of anger to a general decline in social, academic, and overall functioning.  Studies of children who have been sexually abused indicate that 60 to 70 percent develop a psychiatric disorder – most commonly PTSD (Post Traumatic Stress Disorder), but also various behavior, anxiety, depressive and dissociative disorders.

Dissociative disorders may include avoiding people, numbness, daydreaming, obsessive fantasizing, depersonalization (objectifying oneself to others), and such somatic complaints as fainting and feelings of physical helplessness.

PTSD from sexual abuse leads to high anxiety.  The victim often relives the experience in flashbacks and sometimes reenacts the trauma through sexual acting out.  These children often battle depression.  Sometimes this depression can become suicidal; the child’s core identity is so fundamentally disturbed that he or she feels hurt beyond repair.  Such children also become enraged and quick to act out with other people, whether adults or friends and classmates their age.

Children who are sexually abused may also act out sexually in highly inappropriate ways with other adults they meet. They often have confused ideas about sexuality, closeness and intimacy.

Not every child experiences these severe reactions; it depends on the nature of the abuse the temperament and age of the child.  However, clearly some very serious psychic consequences can develop from sexual abuse, and parents need to take seriously any indications that it may be occurring now or has occurred in the past.

If you as a parent suspect that your child has been sexually abused and your child has, in fact, disclosed this, you should listen and be understanding.  Reassure your child that he or she should not feel guilty and that they did the right thing by disclosing the abuse.  Children should not be blamed for being victims of sexual abuse even though we are anxious and often angry at the time of disclosure.  Parents have to offer protection.

Parents should report any suspicion of child abuse to Child Protective Services if it happens inside the family, or to the police or the district attorney’s office if it occurs outside the family.

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.

PTSD IS AFFECTING OUR CHILDREN, TOO!

May 28th, 2014

Post-Traumatic Stress Disorder, often referred to as PTSD is in the news a lot. Much of the time referring to the anxiety disorder that many of our troops have returned home with. This anxiety disorder occurs after a person is a victim of, or exposed to, or a witness to a traumatic event(s) in which there is the experience of perceived possibility of death and/or bodily injury, and during which there was great fear, helplessness, horror, mental disorganization, or agitation. This can be one event (major car accident) or a series such as repeated sexual or physical abuse, or in the case of the troops, the horrors of war. PTSD can occur rather soon after a trauma or actually appear many months later.

In children and teenagers, several of the behavioral problems they manifest can be due to traumatic anxiety they are experiencing. Events that can cause PTSD in young people include a friend’s suicide, death of a parent or other family member or close friend, serious illness, seeing violence in the area where they live or in the house, physical or sexual abuse or parental drug use. As a result of the event(s) there is:

  1. An ongoing re-experiencing of the event(s) through mental images, thoughts, or perceptions of it
  2. Repetitive play involving aspects of the trauma (violent play themes over and over) Repetitive nightmares
  3. Repetitive re-enactments of the event
  4. Dissociative flashbacks (during which the child feels as if he is re-experiencing the event and misperceives events)
  5. Severe anxiety and altered physiology (startle response) when exposed to cues reminiscent of the trauma Avoidance of anything which reminds one of the event
  6. Altered memory
  7. Feeling distant and estranged
  8. A narrowing of feeling experience
  9. An attitude which conveys a feeling of having a foreshortened future
  10. Sleep problems, irritability, worry, startle response, trouble concentrating, hyper-vigilence, excessive anger.

According to the United States Department of Veteran’s Affairs about 15% to 43% of girls and 14% to 43% of boys go through at least one trauma. Of those children and teens who have had a trauma, 3% to 15% of girls and 1% to 6% of boys develop PTSD. Rates of PTSD are higher for certain types of trauma survivors.

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.